Objective To evaluate the safety and feasibility of primary endoscopic retrograde cholangiopancreatolithiasis(ERCP)plus laparoscopic cholecystectomy(LC)in patients with choledocholithiasis combined with cholecystolithiasis.Methods From January 2023 to August 2024,185 patients with common bile duct stones combined with gallbladder stones were treated at our hospital.Patients who underwent ERCP+LC during the same surgical period were assigned to Group A(94 patients),and those who underwent LC+ERCP in separate sessions during the same hospital stay were assigned to Group B(91 patients).The gender,age,total hospitalization costs,number and size of stones,whether a drainage tube was left in place,intraoperative blood loss,duration of anesthesia,time to postoperative bowel gas passage,length of hospital stay,incidence of postoperative cholangitis,incidence of postoperative pancreatitis(PEP),rate of residual stones in the bile ducts,and changes in preoperative and postoperative neutrophils,neutrophil percentage,total serum bilirubin,indirect serum bilirubin,alanine aminotransferase,aspartate aminotransferase,and γ-glutamyl transferase were recorded for both groups of patients.Results Compared to Group B[(9.7±2.0)d],the hospital stay duration for patients in Group A[(8.6±2.6)d]was significantly reduced(P＜0.05).The duration of anesthesia for patients in Group A[(2.5±0.8)h]was also significantly shorter than that for Group B[(3.7±0.5)h],with a statistically significant difference(P＜0.05).Similarly,the total hospitalization costs for patients in Group A[(23 969±7 421)yuan]were lower than those for Group B[(25 427±5 236)yuan],and this difference was statistically significant(P＜0.05).Conclusion The one-stage ERCP combined with LC treatment protocol for common bile duct stones with gallbladder stones is safe and feasible,with the potential advantages of reducing hospital stay,costs,and duration of anesthesia.

Objective To evaluate the safety and feasibility of primary endoscopic retrograde cholangiopancreatolithiasis(ERCP)plus laparoscopic cholecystectomy(LC)in patients with choledocholithiasis combined with cholecystolithiasis.Methods From January 2023 to August 2024,185 patients with common bile duct stones combined with gallbladder stones were treated at our hospital.Patients who underwent ERCP+LC during the same surgical period were assigned to Group A(94 patients),and those who underwent LC+ERCP in separate sessions during the same hospital stay were assigned to Group B(91 patients).The gender,age,total hospitalization costs,number and size of stones,whether a drainage tube was left in place,intraoperative blood loss,duration of anesthesia,time to postoperative bowel gas passage,length of hospital stay,incidence of postoperative cholangitis,incidence of postoperative pancreatitis(PEP),rate of residual stones in the bile ducts,and changes in preoperative and postoperative neutrophils,neutrophil percentage,total serum bilirubin,indirect serum bilirubin,alanine aminotransferase,aspartate aminotransferase,and γ-glutamyl transferase were recorded for both groups of patients.Results Compared to Group B[(9.7±2.0)d],the hospital stay duration for patients in Group A[(8.6±2.6)d]was significantly reduced(P＜0.05).The duration of anesthesia for patients in Group A[(2.5±0.8)h]was also significantly shorter than that for Group B[(3.7±0.5)h],with a statistically significant difference(P＜0.05).Similarly,the total hospitalization costs for patients in Group A[(23 969±7 421)yuan]were lower than those for Group B[(25 427±5 236)yuan],and this difference was statistically significant(P＜0.05).Conclusion The one-stage ERCP combined with LC treatment protocol for common bile duct stones with gallbladder stones is safe and feasible,with the potential advantages of reducing hospital stay,costs,and duration of anesthesia.

Objective To investigate the effects of simple topical anesthesia and intravenous general anesthesia on the occurrence of pancreatitis after ERCP.Methods 400 Patients who underwent ERCP due to pancreaticobiliary duct disease in our hospital from January 2021 to March 2023 were selected and divided into two groups:Simple topical anesthesia group and intravenous general anesthesia group,200 cases in each group.The levels of venous pancreatic amylase and abdominal symptoms and signs were recorded in the two groups before operation and 3 h and 24 h after operation.The observation results were hyperamylaseemia and postoperative pancreatitis at 3 h and 24 h after operation.Results The incidence of postoperative pancreatitis after ERCP was higher in the superficial anesthesia group than in the intravenous general anesthesia group(7.5％and 2.0％,respectively;P＜0.05),there was statistical significance;The level of serum pancreatic amylase(198±216)U/L in intravenous general anesthesia group was significantly lower than that in superficial anesthesia group(379±327)U/L at 3h after surgery(P＜0.05).The level of serum pancreatic amylase(129±98)U/L in intravenous general anesthesia group was lower than that in superficial anesthesia group(187±156)at 24h after surgery(P＜0.05).The incidence of hyperamylasemia was 15.5％(31/200 cases)in the 3h postoperative intravenous general anesthesia group,lower than that in the simple surface anesthesia group(34.5％)(69/200 cases),and 5.5％(11/200 cases)in the 24h postoperative intravenous general anesthesia group,lower than that in the simple surface anesthesia group(19.0％)(38/200 cases)(P＜0.05).Conclusion Compared with simple surface anesthesia,intravenous general anesthesia can reduce the level of serum amylase after ERCP,and can reduce the occurrence of pancreatitis after ERCP.

In recent years, with the rapid development of Chinese materia medica (CMM) industry, its clinical applications have become more and more widespread. While, adverse reactions of CMM have also become increasingly prominent. However, for adverse reactions of some CMM, the applications of conventional toxicology studies cannot draw definitive conclusions. These CMM, which were not defined as toxic drugs in traditional Chinese medicine (TCM) theories, have unknown potential toxicities and affect the safety in their clinical use. This paper reviewed recent advances in studies on potential toxicity of non-toxic CMM. It analyzed and summarized potential toxic compounds among them, and introduced application for metabolomics researches on potential toxicities in non-toxic CMM.

Objective To study the potential protective and toxic effects of Acanthopanax senticosus harms(AS)in rats. Methods Twenty male SD rats were divided into the AS-treated and control groups by random number table method. Each group comprised 10 rats. The rats in the AS-treated group were gavage-fed with AS extracts 31. 6 mg/ kg(equivalent to crude drug 0. 386 g/ kg in human)once daily for 20 days and the volume of the drug was 10 ml/ kg. The rats in the control group received an equal volume of saline once daily for 20 days. The urinary samples of 24 h from rats in the 2 groups which were gavage-fed for 1,5,10,15,and 20 days were collected respectively. Ultra-performance liquid chromatography-quadrupole time-of-flight-mass spectrometry was used to detect the ion intensities of metabolites from urinary samples. The ion intensities of urinary metabolites at different time points in the 2 groups were compared. The ion intensity of each metabolite was normalized with respect to the total ion intensities to generate a data matrix. The data matrix at different time points were processed by partial least-squares-discrimination analysis(PLS-DA)of EZinfo software. Characteristic metabolites were screened according to the PLS-DA score plot. Two sets of data matrix with relatively large distance were further processed by orthogonal partial least-squares-discrimination analysis(OPLS-DA)and the variable importance of project(VIP)scores were calculated. Characteristic metabolites induced by AS intervention were screened from variables with VIP > 1 and P < 0. 05 and their mass-charge ratios were detected and compared to the information in Human Metabolome Database(HMDB),and the corresponding metabolites were identified at last. The potential protective or toxic effects of AS in rats represented by these metabolites were analyzed through literature review. Results PLS-DA score plot showed that the urinary metabolic profiles at different time points in the 2 groups had good similarity within groups or time period and presented clustering phenomenon. The urinary metabolic profiles in rats in the 2 groups which were gavage-fed for 1,5,10,15,and 20 days partly overlapped. The urinary metabolic profiles in rats in the AS-treated group with 20 days of AS treatment were far from those in the control group. Two sets of data matrix with relatively large displacement were further processed and 6 potential intervention targets of AS with VIP > 1 and P < 0. 05 were screened and identified as 3-methylguanine,3-methylglutarylcarnitine,3-hydroxydodecanedioic acid, tiglylcarnitine, kynurenic acid,and 13-cis-retinoic acid by comparing with the information of HMDB. At the 20 d of AS-treated group, the expression of 3-methylguanine,kynurenic acid,and 3-hydroxydodecanedioic acid were up-regulated and the expression of tiglylcarnitine,3-hydroxydodecanedioic acid,and 13-cis-retinoic acid were down regulated. By reviewing the related literature,kynurenic acid,13-cis-retinoic acid,and 3-methylguanine may have potential protective effects in rats which were treated with AS and the other 3 metabolites may have potential toxicity. Conclusion The potential intervention effects of AS in rats had two sides,which may have protective effects,and may also have toxic effects.

Objective To study the potential protective and toxic effects of Acanthopanax senticosus harms(AS)in rats. Methods Twenty male SD rats were divided into the AS-treated and control groups by random number table method. Each group comprised 10 rats. The rats in the AS-treated group were gavage-fed with AS extracts 31. 6 mg/ kg(equivalent to crude drug 0. 386 g/ kg in human)once daily for 20 days and the volume of the drug was 10 ml/ kg. The rats in the control group received an equal volume of saline once daily for 20 days. The urinary samples of 24 h from rats in the 2 groups which were gavage-fed for 1,5,10,15,and 20 days were collected respectively. Ultra-performance liquid chromatography-quadrupole time-of-flight-mass spectrometry was used to detect the ion intensities of metabolites from urinary samples. The ion intensities of urinary metabolites at different time points in the 2 groups were compared. The ion intensity of each metabolite was normalized with respect to the total ion intensities to generate a data matrix. The data matrix at different time points were processed by partial least-squares-discrimination analysis(PLS-DA)of EZinfo software. Characteristic metabolites were screened according to the PLS-DA score plot. Two sets of data matrix with relatively large distance were further processed by orthogonal partial least-squares-discrimination analysis(OPLS-DA)and the variable importance of project(VIP)scores were calculated. Characteristic metabolites induced by AS intervention were screened from variables with VIP > 1 and P < 0. 05 and their mass-charge ratios were detected and compared to the information in Human Metabolome Database(HMDB),and the corresponding metabolites were identified at last. The potential protective or toxic effects of AS in rats represented by these metabolites were analyzed through literature review. Results PLS-DA score plot showed that the urinary metabolic profiles at different time points in the 2 groups had good similarity within groups or time period and presented clustering phenomenon. The urinary metabolic profiles in rats in the 2 groups which were gavage-fed for 1,5,10,15,and 20 days partly overlapped. The urinary metabolic profiles in rats in the AS-treated group with 20 days of AS treatment were far from those in the control group. Two sets of data matrix with relatively large displacement were further processed and 6 potential intervention targets of AS with VIP > 1 and P < 0. 05 were screened and identified as 3-methylguanine,3-methylglutarylcarnitine,3-hydroxydodecanedioic acid, tiglylcarnitine, kynurenic acid,and 13-cis-retinoic acid by comparing with the information of HMDB. At the 20 d of AS-treated group, the expression of 3-methylguanine,kynurenic acid,and 3-hydroxydodecanedioic acid were up-regulated and the expression of tiglylcarnitine,3-hydroxydodecanedioic acid,and 13-cis-retinoic acid were down regulated. By reviewing the related literature,kynurenic acid,13-cis-retinoic acid,and 3-methylguanine may have potential protective effects in rats which were treated with AS and the other 3 metabolites may have potential toxicity. Conclusion The potential intervention effects of AS in rats had two sides,which may have protective effects,and may also have toxic effects.

To investigate the serum level changes of tumor related factors in patients with mechanical trauma and with acute inflammation, and to inquire into the possible reason and its clinical significance, TSGF level was detected on day 1, 3 and 12 after trauma or inflammation in 60 patients with mechanical trauma (39 with mild trauma and 21 with severe trauma) and 37 patients with acute inflammation, while 40 healthy persons were selected as the normal control group. TSGF serum level was significantly higher in patients with trauma and with infectious inflammation than that in normal control group on day 1 and day 3( P 0 05).The results suggest that TSGF is related with the recovery of trauma and inflammatory response.