Objective To investigate the local anatomical characteristics of the cyctic duct and the feasibility of bile duct exploration through the cystic duct for stone removal and primary suture.Methods From February to September 2023,100 cases of secondary choledocholithiasis(SCL)were treated with laparoscopic transcystic common bile duct exploration(LTCBDE).During the operation,6 indicators were measured,including the direction of the gallbladder duct joining the common bile duct,the inner diameter of the gallbladder duct,the length of the gallbladder duct incision,the length of the gallbladder duct parallel to the common bile duct,the distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum,and the diameter of the stone taken by the cholangioscopy.Results The direction of the gallbladder duct joining into the common bile duct:92 cases at 9-12 o'clock,of which 76 cases at 10 and 11 o'clock,accounting for 76%;1 case each at 1 and 2 o'clock,accounting for 2%;2 and 4 cases at7 and 8 o'clock respectively,accounting for6%.The inner diameter of the cystic duct ranged from 3 mm to13 mm,with a median of 5.0 mm.The length of the common bile duct opened:21 cases(21%)had the common bile duct cut open,with an incision of 1-5 mm and a median of 3.0 mm.The parallel length of gallbladder duct and common bile duct:there was a parallel length of 2-40 mm and a median of 10.0 mm in36 cases.The distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum was5-20 mm,with a median of 15.0 mm.Intraoperative choledochoscope was used in 90 cases to remove stones,with a total of 128 stones removed.The diameter of the stones ranged from 1.5 mm to 22.0 mm,with a median of 5.0 mm.All the100 cases of LTCBDE were successful.A total of 83 cases(83%)were followed up for 3 months after surgery.After discharge,their appetite returned to normal,and they resumed normal life and work.There were no symptoms of bile duct stones such as abdominal pain,jaundice,or fever,and their liver function was normal.B-ultrasound showed a diameter of 5-10 mm for the common bile duct,with a median of 7 mm,and no postoperative stenosis.Conclusions Exploring the common bile duct through the cystic duct is feasible,with no or minimal damage to the common bile duct and no damage to the Oddi sphincter.It is the best way and surgical technique for laparoscopic exploration and stone removal via choledochoscope in SCL.

Objective To explore the clinical efficacy of membrane anatomy in laparoscopic radical resection of rectal cancer.Methods A retrospective cohort study was conducted,involving 33 patients who underwent laparoscopic radical resection of rectal cancer guided by membrane anatomy(observation group)from April 2023 to April 2024,compared with 35 patients who underwent traditional total mesorectal excision(control group)from March 2022 to March 2023.Surgical indicators(duration of surgery,intraoperative blood loss,and number of lymph nodes dissected)and postoperative recovery were compared between the two groups.Results There was no statistically significant difference in the operation time between the two groups[(173.8±14.7)min in the observation group vs.(179.1±15.3)min in the control group,t=-1.437,P=0.156].There were also no statistically significant differences in the postoperative hospital stay[(9.4±1.4)d vs.(9.8±2.4)d,t=-0.859,P=0.394]and in the incidence of various complications[12.1%(4/33)vs.20.0%(7/35),χ2=0.778,P=0.378].The intraoperative blood loss in the observation group was significantly less than that in the control group[(34.6±10.8)ml vs.(81.0±14.3)ml,t=-15.156,P=0.000].The number of lymph nodes dissected in the observation group was significantly higher than that in the control group(19.8±1.3 vs.12.4±1.9,t=18.684,P=0.000).The time to first flatus after surgery in the observation group was shorter than that in the control group[(50.4±6.5)h vs.(55.2±8.9)h,t=-2.557,P=0.013].The postoperative drainage time in the observation group was shorter than that in the control group[(5.9±1.1)d vs.(6.5±1.0)d,t=-2.532,P=0.014].A total of 66 cases were followed up for 8-39 months,with a median time of 25 months.The observation group had no metastasis,local recurrence,or death,while the control group had 1 case of liver metastasis,1 case of local recurrence,and 1 case of death from other systemic diseases.Conclusions The application of membrane anatomy in laparoscopic radical resection of rectal cancer can ensure complete mesorectal excision,expand the surgical field of view,minimize intraoperative bleeding,and enhance the thoroughness of lymph node dissection,thereby improving surgical quality.However,it fails to shorten the operation time.

Objective To investigate the local anatomical characteristics of the cyctic duct and the feasibility of bile duct exploration through the cystic duct for stone removal and primary suture.Methods From February to September 2023,100 cases of secondary choledocholithiasis(SCL)were treated with laparoscopic transcystic common bile duct exploration(LTCBDE).During the operation,6 indicators were measured,including the direction of the gallbladder duct joining the common bile duct,the inner diameter of the gallbladder duct,the length of the gallbladder duct incision,the length of the gallbladder duct parallel to the common bile duct,the distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum,and the diameter of the stone taken by the cholangioscopy.Results The direction of the gallbladder duct joining into the common bile duct:92 cases at 9-12 o'clock,of which 76 cases at 10 and 11 o'clock,accounting for 76%;1 case each at 1 and 2 o'clock,accounting for 2%;2 and 4 cases at7 and 8 o'clock respectively,accounting for6%.The inner diameter of the cystic duct ranged from 3 mm to13 mm,with a median of 5.0 mm.The length of the common bile duct opened:21 cases(21%)had the common bile duct cut open,with an incision of 1-5 mm and a median of 3.0 mm.The parallel length of gallbladder duct and common bile duct:there was a parallel length of 2-40 mm and a median of 10.0 mm in36 cases.The distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum was5-20 mm,with a median of 15.0 mm.Intraoperative choledochoscope was used in 90 cases to remove stones,with a total of 128 stones removed.The diameter of the stones ranged from 1.5 mm to 22.0 mm,with a median of 5.0 mm.All the100 cases of LTCBDE were successful.A total of 83 cases(83%)were followed up for 3 months after surgery.After discharge,their appetite returned to normal,and they resumed normal life and work.There were no symptoms of bile duct stones such as abdominal pain,jaundice,or fever,and their liver function was normal.B-ultrasound showed a diameter of 5-10 mm for the common bile duct,with a median of 7 mm,and no postoperative stenosis.Conclusions Exploring the common bile duct through the cystic duct is feasible,with no or minimal damage to the common bile duct and no damage to the Oddi sphincter.It is the best way and surgical technique for laparoscopic exploration and stone removal via choledochoscope in SCL.

Objective To explore the clinical efficacy of membrane anatomy in laparoscopic radical resection of rectal cancer.Methods A retrospective cohort study was conducted,involving 33 patients who underwent laparoscopic radical resection of rectal cancer guided by membrane anatomy(observation group)from April 2023 to April 2024,compared with 35 patients who underwent traditional total mesorectal excision(control group)from March 2022 to March 2023.Surgical indicators(duration of surgery,intraoperative blood loss,and number of lymph nodes dissected)and postoperative recovery were compared between the two groups.Results There was no statistically significant difference in the operation time between the two groups[(173.8±14.7)min in the observation group vs.(179.1±15.3)min in the control group,t=-1.437,P=0.156].There were also no statistically significant differences in the postoperative hospital stay[(9.4±1.4)d vs.(9.8±2.4)d,t=-0.859,P=0.394]and in the incidence of various complications[12.1%(4/33)vs.20.0%(7/35),χ2=0.778,P=0.378].The intraoperative blood loss in the observation group was significantly less than that in the control group[(34.6±10.8)ml vs.(81.0±14.3)ml,t=-15.156,P=0.000].The number of lymph nodes dissected in the observation group was significantly higher than that in the control group(19.8±1.3 vs.12.4±1.9,t=18.684,P=0.000).The time to first flatus after surgery in the observation group was shorter than that in the control group[(50.4±6.5)h vs.(55.2±8.9)h,t=-2.557,P=0.013].The postoperative drainage time in the observation group was shorter than that in the control group[(5.9±1.1)d vs.(6.5±1.0)d,t=-2.532,P=0.014].A total of 66 cases were followed up for 8-39 months,with a median time of 25 months.The observation group had no metastasis,local recurrence,or death,while the control group had 1 case of liver metastasis,1 case of local recurrence,and 1 case of death from other systemic diseases.Conclusions The application of membrane anatomy in laparoscopic radical resection of rectal cancer can ensure complete mesorectal excision,expand the surgical field of view,minimize intraoperative bleeding,and enhance the thoroughness of lymph node dissection,thereby improving surgical quality.However,it fails to shorten the operation time.

Objective To summarize the experience of laparoscopic common bile duct exploration(LCBDE)by means of micro-incision of the cystic duct confluence.Methods From January 2020 to March 2023,267 cases of cholecystolithiasis complicated with choledocholithiasis were given LCBDE by means of micro-incision through the cystic duct confluence.An incision was made along the inferior wall of the cystic duct to the conjunctive part of the common bile duct,and the lateral wall of the common bile duct was cut for 3-5 mm longitudinally.The bile duct exploration and stone extraction were completed under choledochoscope.Primary suture was performed.An abdominal drainage tube was placed.Results The operations were completed in all the 267 cases and the common bile duct stones were thoroughly removed.The operation time was 45-128 min(mean,96.5±9.7 min),the postoperative drainage indwelling time was 3-13 d(mean,5.1±1.2 d),and the postoperative hospitalization time was 5-13 d(mean,6.8±1.1 d).Biliary leakage occurred in 4 cases and was cured after abdominal drainage for 9-11 d.Postoperative fever was noted in 1 1 cases and was treated with anti-inflammatory therapy for 1-3 d.Abdominal abscess developed in 2 cases and was cured by abdominal drainage.A total of 242 cases(90.6％)were followed up for 6-39 months(median,11 months),of which 66 cases were followed up for more than or equal to 36 months.Residual stones were found in 2 cases,stone recurrence was noted in 2 cases,and no choledochal stenosis was found.Conclusion Laparoscopic lithotomy with micro-incision of the cystic duct confluence has a good clinical effect in the treatment of choledocholithiasis.

Objective:To analyze the biological characteristics, phylogeny and the taxonomic status of strain 7712 (=CGMCC 1.17031=NBRC 113783=KCTC 15766) isolated from a clinical blood sample.Methods:Strain 7712 was identified by the cultural properties, cellular and colonial morphology, physiological and biochemical reactions, matrix-assisted laser desorption ionization time-of-flight mass spectrometry system, and genome correlation index analysis. The genomic phylogenetic tree was construct to analyze the taxonomic position. The virulence factors and resistance genes of strain 7712 and related strains were then compared by the online virulence factor database and online comprehensive antibiotic research database respectively.Results:Strain 7712 was urease negative, gram-negative nonfermenters, which was identified as Ochrobactrum anthropi by VITEK GN card. The 16S rRNA gene analysis showed that the strain was closely related to the members of genera Ochrobactrum and Brucella. The phylogenetic tree showed that strain 7712 was clustered together with Ochrobactrum teleogrylli LCB8 T and Ochrobactrum haematophilum CCUG 38531 T, along with genus Brucella and other Ochrobactrum species. The genome relatedness indexes analysis showed that the average nucleotide identity between strain 7712 and Ochrobactrum teleogrylli LCB8 T was 98.16%, which was higher than the threshold for prokaryotic species. Genetic prediction showed that strain 7712 carried several virulence-related genes and resistance-related genes, of which the existence of OCH gene might be responsible to the resistance to cephalosporin. Conclusions:A case of human infection caused by Ochrobactrum teleogrylli is identified, which would help promote the understanding of biodiversity of genus Ochrobactrum.

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*

Based on the investigation of wild medicinal plant resources in Dexing city, Jiangxi province, and the collected plant specimens, which were identified by taxonomy, two new record species of geographical distribution were found, which are Meehania zheminensis A. Takano, Pan Li & G.-H. Xia and Corydalis huangshanensis L.Q.Huang & H.S.Peng. The voucher specimens are kept in Dexing museum of traditional Chinese medicine. In this paper, the new distribution species were reported, which provides valuable information for further enriching and supplementing the species diversity of medicinal plant resources in Jiangxi province.
China ; Corydalis ; Humans ; Lamiaceae ; Medicine, Chinese Traditional ; Museums ; Plants, Medicinal

Objective:To verify and discuss the consistency and applicability of the semi empirical formula and Monte Carlo simulation method in the radiation shielding calculation for high energy synchrotron radiation source.Methods:The semi empirical formula and Monte Carlo simulation were used to calculate the ambient dose equivalent outside of the shielding.Results:The ratio of Jenkins semi empirical formula result to Monte Carlo simulation result was 111%-153%. The ratio of Sakano semi empirical formula result to Monte Carlo simulation result was 201%.Conclusions:For a single shielding material, the semi empirical formula can be simple and conservative to complete the shielding calculation for high-energy electron accelerator. For a variety of shielding materials, Monte Carlo simulation method should be used.

Objective:To compare MRI characteristics between hepatic benign nodules and hepatocellular carcinoma (HCC) associated with Budd-Chiari syndrome(BCS).Methods:A retrospective study was conducted on 130 consecutive patients with BCS who were treated at the Affiliated Hospital of Xuzhou Medical University from January 2011 to June 2018. There were 67 males and 63 females, age ranged from 18 to 78 years, with median age was 46 years. There were 45 patients with HCC and 85 patients with benign liver nodules. This study aimed to compare the clinical characteristics of BCS patients with HCC and benign nodules, and to compare the MRI features (distribution, capsule, plain scan signal, enhancement pattern) between HCC and benign nodules. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of each of the indicators in the diagnosis of hepatocellular carcinoma.Results:The age and alpha-fetoprotein levels of the BCS patients with benign nodules were significantly lower than the BCS patients with HCC, while the international standardized ratio was significantly higher than the BCS patients with HCC (all P<0.05). Of the 130 BCS patients, there were 337 benign and 78 hepatocellular carcinomas nodules. The diameter of benign nodules was significantly smaller than HCC, and the proportions of benign nodules with encapsulation, fat content, cystic necrosis and hemorrhage were significantly lower than HCC (all P<0.05). The proportions of benign nodules with T 1 weighted imaging high signal, T 2 weighted imaging (T 2WI) low or equal signal and diffusion-weighted imaging (DWI) equal signal were significantly higher than HCC (all P<0.05). The proportions of benign nodules with washout appearance, arterial phase hyperenhancement and washout appearance were significantly lower than HCC (all P<0.05). The areas under the ROC curve for the diagnosis of HCC by DWI high signal and T 2WI high signal were 0.936 and 0.927, respectively, with sensitivities of 96.2% and 92.3%, specificities of 91.0% and 90.1%, respectively. Conclusion:The MRI features of BCS patients with benign regenerative nodules were significantly different from those of BCS patients with HCC. The washout appearance had a low specificity for the diagnosis of HCC.