Objective To investigate the clinical effect of simultaneous use of three endoscopes(laparoscope,choledochoscope,and duodenoscope)combined with holmium laser in the treatment of gallstones complicated with common bile duct stones.Methods A prospective randomized controlled study was carried out.A total of 80 patients with cholecystolithiasis combined with choledocholithiasis in our hospital from August 2022 to January 2024 were selected and divided into three-endoscope group(n=40)and two-endoscope group(n=40)according to random number table method.Patients in the three-endoscope group underwent laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)combined with holmium laser lithotripsy,primary closure of the common bile duct,endoscopic retrograde cholangiopancreatography(ERCP),and endoscopic nasobiliary drainage(ENBD),while the two-endoscope group underwent LC+LCBDE+T-tube drainage.The intraoperative bleeding volume,operation time,hospitalization time,hospitalization costs,and postoperative complications between the two groups were observed and analyzed.Results There was no significant difference in intraoperative bleeding volume between the two groups[(55.6±14.3)ml vs.(53.2±16.3)ml,t=0.703,P=0.484].The operation time of the three-endoscope group was significantly longer than that in the two-endoscope group[214.5(171.5,246.8)min vs.178.0(151.0,227.8)min,Z=-2.069,P=0.039].The length of hospital stay in the three-endoscope group was significantly shorter than that in the two-endoscope group[(13.2±3.3)d vs.(16.2±3.7)d,t=3.864,P=0.001].The hospitalization costs were significantly higher in the three-endoscope group than those in the two-endoscope group[39 316.0(32 338.5,43 421.0)yuan vs.33 717.0(30 873.3,37 813.3)yuan,Z=-3.272,P=0.001].There were no significant differences in the incidence of postoperative pancreatitis[2.5%(1/40)vs.2.5%(1/40),χ2=0.000,P=1.000],the incidence of bile leakage[7.5%(3/40)vs.2.5%(1/40),χ2=0.263,P=0.615],and residual stone rate[7.5%(3/40)vs.0.0%(0/40),P=0.241]between the two groups.Forty cases in the three-endoscope group were followed up for 2-20 months,with a median of 13 months.One case of stone recurrence occurred at 8 months after surgery.Forty patients in the two-endoscope group were followed up for 1-21 months,with a median of 15 months.There was 1 case of stone recurrence at 6 and 10 months postoperatively,respectively.There was no statistically significant difference in stone recurrence rate between the two groups[2.5%(1/40)vs.5.0%(2/40),χ2=0.000,P=1.000].Conclusions LC+LCBDE combined with holmium laser lithotripsy,primary closure of the common bile duct,ERCP,and ENBD in the treatment of cholecystolithiasis and choledocholithiasis can shorten the hospitalization time.The replacement of T-tube with nasobiliary duct protects the function of the Oddi sphincter,which is more in line with the concept of minimally invasive surgery and worthy of clinical application.

Objective To investigate the clinical effect of simultaneous use of three endoscopes(laparoscope,choledochoscope,and duodenoscope)combined with holmium laser in the treatment of gallstones complicated with common bile duct stones.Methods A prospective randomized controlled study was carried out.A total of 80 patients with cholecystolithiasis combined with choledocholithiasis in our hospital from August 2022 to January 2024 were selected and divided into three-endoscope group(n=40)and two-endoscope group(n=40)according to random number table method.Patients in the three-endoscope group underwent laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)combined with holmium laser lithotripsy,primary closure of the common bile duct,endoscopic retrograde cholangiopancreatography(ERCP),and endoscopic nasobiliary drainage(ENBD),while the two-endoscope group underwent LC+LCBDE+T-tube drainage.The intraoperative bleeding volume,operation time,hospitalization time,hospitalization costs,and postoperative complications between the two groups were observed and analyzed.Results There was no significant difference in intraoperative bleeding volume between the two groups[(55.6±14.3)ml vs.(53.2±16.3)ml,t=0.703,P=0.484].The operation time of the three-endoscope group was significantly longer than that in the two-endoscope group[214.5(171.5,246.8)min vs.178.0(151.0,227.8)min,Z=-2.069,P=0.039].The length of hospital stay in the three-endoscope group was significantly shorter than that in the two-endoscope group[(13.2±3.3)d vs.(16.2±3.7)d,t=3.864,P=0.001].The hospitalization costs were significantly higher in the three-endoscope group than those in the two-endoscope group[39 316.0(32 338.5,43 421.0)yuan vs.33 717.0(30 873.3,37 813.3)yuan,Z=-3.272,P=0.001].There were no significant differences in the incidence of postoperative pancreatitis[2.5%(1/40)vs.2.5%(1/40),χ2=0.000,P=1.000],the incidence of bile leakage[7.5%(3/40)vs.2.5%(1/40),χ2=0.263,P=0.615],and residual stone rate[7.5%(3/40)vs.0.0%(0/40),P=0.241]between the two groups.Forty cases in the three-endoscope group were followed up for 2-20 months,with a median of 13 months.One case of stone recurrence occurred at 8 months after surgery.Forty patients in the two-endoscope group were followed up for 1-21 months,with a median of 15 months.There was 1 case of stone recurrence at 6 and 10 months postoperatively,respectively.There was no statistically significant difference in stone recurrence rate between the two groups[2.5%(1/40)vs.5.0%(2/40),χ2=0.000,P=1.000].Conclusions LC+LCBDE combined with holmium laser lithotripsy,primary closure of the common bile duct,ERCP,and ENBD in the treatment of cholecystolithiasis and choledocholithiasis can shorten the hospitalization time.The replacement of T-tube with nasobiliary duct protects the function of the Oddi sphincter,which is more in line with the concept of minimally invasive surgery and worthy of clinical application.

Pyroptosis is a form of new programmed cell death which is dependent on Caspase-1 in recent years.When it' s stimulated by various dangerous signals from hepatic ischemia-reperfusion injury,the intracellular pattern recognition receptors are assembled into inflammasomes and Caspase-1 which was transformed into active form.Activated Caspase-1 promotes the maturation and secretion of pro-inflammatory cytokines IL-1β and IL-18,initiates the innate immunity rapidly and then induces severe inflammatory reaction.In addition,Caspase-1 can also cleave Gasdermin D and release its N-terminal domain triggering pyroptosis.Many studies showed that pyroptosis play a crucial role in hepatic ischemia-reperfusion injury.In this review,we discussed the activation mechanism and research progress of pyroptosis in hepatic ischemia-reperfusion injury.

Objective ToexploretheMRIperformanceofpapillarythyroidcarcinomawithhobnailfeatures(HPTC)andthedifferential diagnosisfromclassicpapillarythyroidcarcinoma(CPTC).Methods Dataof93patientswithconfirmedPTCandMRIexamination oneweekbeforesurgerywereretrospectivelycollected.Thedifferencesoftheage,sex,tumorsize,ADCvaluesand MRIfeaturesof HPTCandCPTCweredetermined.Results 10HPTCand78CPTCwereincludedinthisstudy.ThefrequencyofT2WIsignificantly highsignal,segmentationlinearlowsignal,lacesignandgyrus-likestructureofHPTCwassignificantlyhigherthanthatofCPTC (P=0.000).ComparedtoCPTC,HPTCshowedmoreirregularshape(P=0.005),largervolume(P=0.025),moremixedT2WI andDWIsignals(P=0.002,0.028,respectively),higherADCvalues(P=0.019),anddelayedmass-likeenhancement(P=0.041). Conclusion HPTClesionshavelargervolume,irregularshape,mixedT2WIsignals,mixedDWIsignalsandhigherADCvalues. Significantlyhighsignal,segmentationlinearlowsignal,lacesignandgyrus-likestructurearecommonlyobservedonT2WI.Delayed mass-likeenhancementpatternismorecommon.ThesecharacteristicscouldcontributetothediagnosisofHPTC.

Objective To investigate the value of multi-phase contrast enhanced MR in the diagnosis and differential diagnosis of thyroid nodules. Methods From September 2015 to January 2018,176 patients with 257 thyroid nodules(109 malignant and 148 benign)preoperatively evaluated by multi-phase contrast enhanced MR were included in the present study.The final diagnoses for all cases were proved by the final pathological reports in our hospital.The diagnostic value of multi-phase contrast enhanced MR in thyroid nodules was analyzed retrospectively. Results The outflow ring sign can be regarded as a specific sign of papillary thyroid carcinoma (χ2＝125.03,P＝0.000)and the diagnostic sensitivity,specificity,positive predictive value and negative predictive value were 66.06%,98.65%,97.30%and 79.78%,respectively.The obvious enhancement was more common in benign thyroid nodules (χ2＝33.45,P＝0.000)and it can be regarded as a specific sign of adenoma and adenomatoid nodule(χ2＝74.7 5 ,P＝0.000 ).Conclusion The multi-phase contrast enhanced MR has important clinical application value in the diagnosis and differential diagnosis of thyroid nodules.The outflow ring sign can be regarded as a specific sign of papillary thyroid carcinoma,and the obvious enhancement was an important feature of benign nodules,especially of adenoma and adenomatoid nodules.

Multi-source satellite remote sensing technology can be used to monitor the distribution and growth status of aquatic plant species on a large scale.In this paper,C,aoyou Lake was selected as the research area.Aquatic medicine material Euryaleferox Salisb was used as the research object.The spectral characteristics of plants in Euryaleferox Salisb growing area were analyzed by ASD portable spectrometer and the remote sensing image of Pléiades and GF-1.The spectral range of species was obtained.And the decision tree algorithm model was constructed,which were used to extract the information of Euryale ferox Salisb from remote sensing images.Through verification,the results showed that the accuracy of comprehensive classification was 83％.It was concluded that multi-source satellite remote sensing image and GIS spatial analysis technology can accurately reflect the area and distribution of aquatic medicine material Euryale ferox Salisb.