Objective:To investigate the safety and efficacy of laparoscopic fundoplication in the treatment of gastroesophageal reflux related cough (GERC).Methods:Clinical data of 138 GERC patients undergoing laparoscopic fundoplication at our center from Jan 2013 to Dec 2017 were analyzed and patients were followed up until Dec 2022.Results:A total of 138 patients underwent surgery successfully.The median follow-up time was 51 (7-130) months.There were no mortality,nor major complications. In 138 GERC patients, GERC was cured in 85 patients,the cure rate of fundoplication was 61.6%, and altogether 112 patients reported effective, the effective rate was 81.2%. Multivariate regression analysis showed that normal esophageal peristalsis was independent predictors of good efficacy of fundoplication[ OR=3.810(1.373,10.573), P=0.01]. Conclusions:Laparoscopic fundoplication has long term efficacy for refractory GERC. Esophageal motility is an important dynamic characteristic that affects the postoperative efficacy of GERC.

Objective:To investigate the safety and efficacy of laparoscopic fundoplication in the treatment of gastroesophageal reflux related cough (GERC).Methods:Clinical data of 138 GERC patients undergoing laparoscopic fundoplication at our center from Jan 2013 to Dec 2017 were analyzed and patients were followed up until Dec 2022.Results:A total of 138 patients underwent surgery successfully.The median follow-up time was 51 (7-130) months.There were no mortality,nor major complications. In 138 GERC patients, GERC was cured in 85 patients,the cure rate of fundoplication was 61.6%, and altogether 112 patients reported effective, the effective rate was 81.2%. Multivariate regression analysis showed that normal esophageal peristalsis was independent predictors of good efficacy of fundoplication[ OR=3.810(1.373,10.573), P=0.01]. Conclusions:Laparoscopic fundoplication has long term efficacy for refractory GERC. Esophageal motility is an important dynamic characteristic that affects the postoperative efficacy of GERC.

Objective:To analyze the etiology of biliary fungal infection and risk factors of case fatality.Methods:Clinical and laboratory data of 91 biliary fungal infection patients admitted in Li Huili Hospital of Ningbo Medical Center from January 2013 to June 2019 were retrospectively reviewed, including 14 patients (16.4%) with fungal infection and 77 patients (84.6%) with fungal and bacterial mixed infection. There were 79 survivors and 12 deaths, the risk factors of fatality were analyzed by binary Logistic regression analysis.Results:The fungal strain Candida albicans was detected in 61 cases, Candida glabrata in 19 cases and Candida tropicalis in 6 cases. Drug sensitivity test showed that the fungal strains were highly sensitivity to amphotericin B and 5-fluorouracil [100.0%(91/91),97.8%(89/91)]. In 77 mixed infection cases Gram-negative bacteria was the more common (34 cases,44.2%). The average age of patients was 70.7 years old. Benign diseases were found in 66 cases (72.5%) and 61(67.0%)of them were cholelithiasis. Patients with a history of repeated biliary operation were more likely to have mixed infection of biliary fungi and bacteria (χ 2= 4.56, P=0.03). The mean albumin level in the fatal group was significantly lower than that in the survival group [(28.1±5.2)g/L vs. (33.3±5.3)g/L; t=2.77, P=0.01]. The median length of hospital stay in the survival group was significantly shorter than that in the fatal group [12.0(9.0, 18.0)d vs. 29.5 (13.0, 42.7)d; Z=-2.37, P=0.02]. Multiple logistic regression analysis showed that the history of repeated biliary operation ( OR=4.46, 95% CI: 1.06—4.97) and mixed infection of fungi with bacteria ( OR=10.20, 95% CI: 1.48—70.27) were the risk factors of case fatality. Conclusion:Candida albicans is the main fungus in biliary fugal infection which is often complicated with bacterial infection. Repeated biliary operations and mixed infection of fungi with bacteria are the risk factors of death in patients with biliary infection.