Duodenum-preserving pancreatic head resection， also known as Beger surgery， has a high incidence rate of bile duct injury after surgery， while the treatment modality for bile duct injury depends on the severity of the injury， and endoscopic therapy is often challenging in case of severe bile duct injury. Recently a patient with biliary fistula after Beger surgery was admitted to Affiliated Hangzhou First People’s Hospital， Westlake University， and successful diagnosis and treatment were achieved through oral choledochoscopy-assisted percutaneous-endoscopic rendezvous technique.

Objective:To comprehensively understand the disease burden of liver cirrhosis and other chronic liver diseases caused by alcohol use in China from 1990 to 2019, as well as to predict the trends in disease burden from 2020 to 2030.Methods:The analysis utilized data from the Global Burden of Disease study in 2019 (GBD2019). Key indicators such as incidence rate, mortality rate, disability-adjusted life years (DALY), years of life lost due to premature mortality, and years lived with disability were selected to describe the disease burden of alcohol-related liver cirrhosis and other chronic liver diseases in China from 1990 to 2019. The estimated annual percentage change (EAPC) was used to depict the temporal trends in disease burden. Furthermore, a Bayesian age-period-cohort (BAPC) model was constructed using R software to predict the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of alcohol-related liver cirrhosis and other chronic liver diseases in China from 2020 to 2030.Results:From 1990 to 2019, the incidence of alcohol-related liver cirrhosis and other chronic liver diseases in China showed an upward trend, with an EAPC of 0.31% (95% CI: 0.10%-0.52%). However, the DALY declined, with an EAPC of -2.81% (95% CI: -2.92% - -2.70%). The ASMR showed a downward trend, with an EAPC of -2.55% (95% CI: -2.66% - -2.45%). The highest incidence of cirrhosis of liver caused by alcohol and other chronic liver diseases was reported in the age group of 35-49 years, while the ASMR increased gradually with age, with a significant rise after the age of 30. The age-standardized DALY rate peaked between the ages of 55 and 64. The disease burden indicators for males were consistently higher than those for females during the same period. According to the predictions of the BAPC model, from 2020 to 2030, the ASIR for cirrhosis of liver caused by alcohol and other chronic liver diseases in the entire population of China was projected to increase from 3.45/100 000 in 2020 to 3.78/100 000 in 2030, a growth of 9.57%. Conversely, the ASMR was expected to decrease from 1.45/100 000 in 2020 to 1.24/100 000 in 2030, a reduction of 14.48%. Conclusions:The disease burden of cirrhosis of liver caused by alcohol and other chronic liver diseases remained serious in China, especially in men and the middle-aged to elderly population. There is a pressing need to prioritize attention and resources towards these groups. Despite the projected decrease in ASMR, the ASIR continued to rise and is expected to persist in its upward trend until 2030.

Objective To evaluate the safety and efficacy of CT-guided percutaneous transhepatic gallbladder drainage(PTGBD)in treatment of high-risk acute cholecystitis(AC)patients.Methods CT-guided PTGBD was performed in 29 patients with high-risk AC.The therapeutic results were evaluated by comparing the preoperation and postoperation clinical manifestations and laboratory results.Results The implantation of PTGBD catheter was successfully accomplished with single procedure in all patients.Complica-tions occurred in 2 cases,including abdominal pain in 1 case and a small amount of gallbladder bleeding in 1 case,and the incidence of complications was 6.9%.Compared with preoperation,the pain number rating scale(NRS)score,temperature(T),white blood cell count(WBC),C-reactive protein(CRP),total bilirubin(TBIL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were significantly decreased 3 days after PTGBD(P<0.001).Except for 1 case of choledocholithiasis with continuous abdominal pain after PTGBD,the postoperation symptoms of the other patients were significantly relieved.Followed up for 3 months,2 cases of calculous AC recurred after PTGBD,and the recurrence rate of cholecystitis was 25.0%.Conclusion For high-risk AC,the CT-guided PTGBD is a safe and effective treatment method,and it can remarkably relieve the clinical symptoms.Patients with calculous AC have higher risk of recurrence and might benefit from definitive cholecystectomy.

BACKGROUND:Intervertebral disc degeneration is clinically considered to be the main cause of low back pain,but due to the unclear pathogenesis of intervertebral disc degeneration,there is still a lack of effective means to delay the progression of the disease.Single-cell RNA sequencing technology can amplify and sequence mRNA at the single-cell level,reveal the gene expression intensity of a single cell,discover different cell subsets in tissues according to the heterogeneity of cells,study the pathogenesis of intervertebral disc degeneration at the molecular level,and provide a new theoretical basis for its early diagnosis and treatment. OBJECTIVE:To introduce the basic principles of single-cell RNA sequencing technology and review the research progress of single-cell RNA sequencing technology in intervertebral disc degeneration in recent years. METHODS:A computer was used to search PubMed,Web of Science,CNKI and WanFang databases for the literature published from 2012 to 2022.Key words were"single-cell RNA sequencing,intervertebral disc degeneration,sequencing Technology"in Chinese and English.Duplicate,poor-quality and irrelevant articles were excluded;a total of 70 articles were eventually included. RESULTS AND CONCLUSION:(1)We identified new cell subsets such as homeostatic chondrocytes,hypertrophy chondrocyte-like nucleus pulposus cells and fibrous nucleus pulposus cells,identified the marker genes and transcription factors of these cell subsets,and described the functions,differentiation paths and cell fate of these cell subsets during the development and progression of intervertebral disc degeneration,and proposed the concept of progenitor nucleus pulposus cells.A cell subpopulation with progenitor nucleus pulposus cells properties was identified and its effectiveness in treating intervertebral disc degeneration was verified in mice.(2)Fibro chondrocyte-like annulus fibrosus cells and annulus fibrosus stem cells with both cartilage and fiber properties were identified,and a new type of composite hydrogel was prepared by combining fibrous cartilage inducers silk fibroin and hyaluronic acid in vitro.Experiments in mice demonstrated that this hydrogel could repair both annulus fibrosus tissue and cartilage matrix,and was remarkably effective in the treatment of intervertebral disc degeneration.(3)Regulatory chondrocytes were found in endplate cartilage.Two distinct fates in the progression of intervertebral disc degeneration were analyzed and the differential genes in the two fates were identified.Intercellular communication analysis indicated that regulatory chondrocytes interact with endothelial cells to promote angiogenesis.(4)Immune cells such as macrophages,T cells,myeloid progenitor cells and neutrophils were identified in the degenerated intervertebral disc tissues,demonstrating the existence of immune response during intervertebral disc degeneration.It was found that apolipoprotein induced the polarization of macrophages M1 and M2 subtypes,and this polarization process affected the activity of progenitor nucleus pulposus cells by amplifying the inflammatory response through the MIF signaling pathway.

ObjectiveTo observe the efficacy and safety of Uyghur medicine Yangxin Dawayimixike Honey Paste （养心达瓦依米西克蜜膏， YDMHP） in the treatment of stable angina pectoris （SAP） of qi stagnation and blood stasis syndrome. MethodsA randomized ， double-blind， positive-controlled，multi-center clinical trial was conducted， in which 370 patients with SAP of qi stagnation and blood stasis syndrome were randomly divided into treatment group（279 cases）and control group（91cases）at a ratio of 3∶1. The treatment group was orally administered with YDMHP， 3 g each time， and placebo of Xuefu Zhuyu Capsule （血府逐瘀胶囊）， 2.4 g each time， while the control group was treated with Xuefu Zhuyu Capsule， 2.4 g each time， and placebo of YDMHP， 3 g each time， both twice a day for a course of 12 weeks. The primary outcome was the effect of angina pectoris symptom. The secondary outcomes include single angina symptom scores such as number of attacks， duration of attacks， pain intensity and usae of nitroglycerin scores， the total angina symptom score before and after the treatment， the usage of nitroglycerin， the exercise duration in treadmill exercise test （TET） and the Duck treadmill score among patients，the scores of Seattle Angina Questionnaire （SAQ） on five dimensions including physical limitations， anginal stability， anginal frequency， treatment satisfaction， and disease perception， and efficacy of TCM syndrome and of each single TCM symptom after treatment. The safety were evaluated by examine blood routine， urine routine， liver and kidney function， fasting blood sugar， electrocardiogram， adverse events. ResultsThe total effective rate of angina symptom in the treatment group was 71.69% （200/279）， significantly higher than 51.64% （47/91） in the control group （P＜0.01）. The curative and markedly effective rate of TCM syndrome in the treatment group was 53.05% （148/279）， which was significantly higher than 25.27% （23/91） in the control group （P＜0.01）. After treatment， scores of the number as well as duration of angina attacks and pain severity， the total score of angina symptoms， and the usage of nitroglycerin significantly decreased in both groups， and more changes were seen in the treatment group than in the control group； the scores of physical limitations， anginal stability， anginal frequency， treatment satisfaction， and disease perception in both groups significantly increased， and more improvement were shown in the experimental group regarding the anginal stability， anginal frequency and treatment satisfaction （P＜0.05 or P＜0.01）. The effects of chest pain， chest tightness， palpitation， shortness of breath and fatigue in experimental group were significantly higher than those in control group （P＜0.05 or P＜0.01）. There was no significant difference in the exercise duration of treadmill test and Duke score among patients between the two groups either before or after treatment （P＞0.05）. Adverse events occurred in 66 cases （23.66%） of the experimental group and 16 cases （17.58%） of the control group， with no statistical significance between the two groups （P＞0.05）. ConclusionThe Uyghur medicine YDMHP can effectively improve symptoms of angina pectoris， reduce the number， duration， and intensity of attacks， decrease the dosage of nitrogly-cerin and improve the individual TCM symptoms and has good safety in the treatment of SAP patients of qi stagnation and blood stasis.

OBJECTIVE To provide the basis for commodity grade classification and quality evaluation of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao by studying the correlation between the microscopic quantification of transsection tissue of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao and the content of quality markers. METHODS The microscopical quantitative parameters of 7 tissues in the cross section of 13 batches of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao were measured, and the chemical components of 7 quality markers were measured by HPLC. For 7 tissues microquantitative parameters and 7 quality markers of 13 batches of Astragalus membranaceus (Fisch.)Bge.var.mongholicus(Bge.)Hsiao and 8 results of addition and division calculation(hereinafter referred to as “calculation results”), SPSS 26.0 software was used for Spearman correlation analysis and cluster analysis, Graphpad Prism 8.0 was used for multiple linear regression of significant correlation variables, and SIMCA 14.1 was used for principal component analysis. RESULTS There were many pairs of significant correlation between wood ray number, xylem width, cork layer width, phloem width/xylem width and the quality markers and their calculation results. The tissue morphology of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao transverse section could describe the content of quality markers. Two principal components were extracted by principal component analysis, and the six variables that contributed significantly to the principal components were calycosin-7-glucoside, ononin, phloem width/xyloside width, astragaloside IV, Astragaloside I and Astragaloside II. Thirteen batches of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao were divided into two categories, and the results were consistent with cluster analysis. CONCLUSION Based on the correlation between the microscopic quantification of cross-section tissue and the content of quality markers, this study indirectly represents the content of quality markers with the microscopic quantitative parameters of Astragalus membranaceus(Fisch.)Bge. var. mongholicus(Bge.) Hsiao cross-section tissue, which provides a new scientific basis for the comprehensive basis of commodity grade classification of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao medicinal materials, and has reference value for the formation of modern evaluation model of Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao medicinal materials quality.

Objective:To compare iodine nutritional status of different populations consuming iodized salt and non-iodized salt in iodine adequate areas, and to provide a basis for formulating iodine supplementation strategies.Methods:In October 2021, Luyi County in Henan Province was selected as an iodine adequate area consuming iodized salt, while Ningling County was selected as an iodine adequate area consuming non-iodized salt. Stratified by water iodine (50 - 59, 60 - 69, 70 - 79, 80 - 89, 90 - 100 μg/L), one village was selected from each layer. One hundred children aged 8 - 10, one hundred adults, and 20 pregnant women were selected from each village to collect their urine and salt samples for testing salt and urinary iodine, and their thyroid gland was measured by ultrasound.Results:A total of 600 salt samples in Luyi County were collected, with the coverage rate of iodized salt (99.8%, 599/600) and the consuming rate of qualified iodized salt (95.5%, 573/600). A total of 1 008 salt samples in Ningling County were collected, with the rate of non-iodized salt (93.8%, 946/1 008). The median urinary iodine of children in Luyi County ( n = 240) was higher than that in Ningling County ( n = 468, 305.0 vs 232.0 μg/L, Z = - 8.10, P < 0.001). There was no statistically significant difference in median urinary iodine between pregnant women in Luyi County ( n = 120) and Ningling County ( n = 53, 240.0 vs 236.0 μg/L, Z = - 1.02, P = 0.306). The median urinary iodine of adults in Luyi County ( n = 238) was higher than that in Ningling County ( n = 486, 289.0 vs 178.5 μg/L, Z = - 11.14, P < 0.001). Children's urinary iodine ( r s = 0.21, P = 0.001) in Luyi County and adults' urinary iodine ( r s = 0.17, P < 0001) in Ningling County were positively correlated with water iodine. There was no statistically significant difference in the incidence of thyroid enlargement in children between Luyi County (0.8%, 2/240) and Ningling County (0.4%, 2/468, χ 2 = 0.80, P = 0.586), but the incidence of thyroid nodules in children in Luyi County (11.2%, 27/240) was higher than that in Ningling County (1.7%, 8/468, χ 2 = 27.36, P < 0.001). The incidence of thyroid nodules in pregnant women in Luyi County (23.3%, 28/120) was lower than that in Ningling County (46.5%, 33/71, χ 2 = 10.99, P = 0.001). There was no statistically significant difference in the incidence of adult thyroid nodules between Luyi County and Ningling County (χ 2 = 0.86, P = 0.354), with a ratio of 29.6% (71/240) to 32.9% (160/486). Conclusions:Providing population with non-iodized salt in iodine adequate areas, the overall iodine nutrition is at an appropriate level. However, children consuming iodized salt in iodine adequate areas have high level of iodine nutrition, and it is necessary to consider supplying non-iodized salt or reducing the concentration of iodized salt. Pregnant women in iodine adequate area should maintain the current policy of supplying iodized salt unchanged.

Objective:To compare the safety and efficacy of two-person and three-person operation of endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y anastomosis.Methods:A total of 31 cases of bile duct stones where endoscopic access was successful and papilla was detected after Roux-en-Y anastomosis in Hangzhou First People's Hospital from January 2021 to September 2022 were recruited. Based on the retrospective study, 17 patients with the two-person operation (an operator and an assistant completed selective intubation) were included in group A from January to December 2021, and 14 patients with the three-person operation (an operator and two assistants completed the selective intubation) from January to September 2022 were included in group B. The success rate, the time of intubation, and complication incidence of the two groups were compared.Results:The intubation success rate of all enrolled patients was 90.32% (28/31). There was no significant difference in the intubation success rate between group A and group B [82.35% (14/17) VS 100.00% (14/14), P=0.232]. The intubation time in group B was significantly less than that of group A (42.89±6.57 min VS 61.02±9.23 min) with significant difference ( t=5.77, P<0.001). The incidence of postoperative complication of ERCP in all enrolled patients was 16.13% (5/31). There was no significant difference in the postoperative complication incidence between group A and group B [17.65% (3/17) VS 14.29% (2/14), P=1.000]. Conclusion:For patients undergoing ERCP after Roux-en-Y anastomosis, the two methods were not statistically different in terms of the intubation success rate and the incidence of procedure-related complications. But three-person operation shows clear advantage in terms of operation time.

BACKGROUND/OBJECTIVES: The specific impact of different fruit and vegetable consumption categories on frailty is not completely understood. This study examined the relationships between the daily consumption of fruit and vegetables and frailty in a large general population. SUBJECTS/METHODS: This study used the data from the US National Health and Nutrition Examination Survey (2005–2020). Two intermittent 24-h dietary recalls were used to evaluate fruit and vegetable consumption. Frailty was assessed using the frailty index. Logistic regression, stratified analyses, and restricted cubic spline models were used to examine these associations. RESULTS: A higher daily intake of citrus, melons, and berries (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.65–0.92), other fruit (OR, 0.74; 95% CI, 0.62–0.88), intact fruit (OR, 0.71; 95% CI, 0.60–0.84), dark-green vegetables (OR, 0.71; 95% CI, 0.60–0.83), and total vegetables (OR, 0.80; 95% CI, 0.66–0.96), along with a lower fruit juice intake (OR, 0.81; 95% CI, 0.69–0.96), were associated with a reduced risk of frailty in adults aged 18 yrs and older.Further analysis showed that the daily consumption of citrus melons and berries, other fruit, intact fruit, fruit juice, and tomatoes and tomato products were inversely associated with frailty in adults under 60 yrs and females. Dark green vegetables were inversely correlated with frailty in individuals aged 40–60 yrs and over 60 yrs, regardless of sex. CONCLUSION The daily consumption of most types of fruit, dark green vegetables, and tomatoes and tomato products may reduce the risk of frailty in American adults, particularly for individuals under 60 yrs of age and females.