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.

Objective To explore the value of multiple non-gaussian distribution models DWI in evaluating hepatic ischemia reperfusion injury (HIRI) model in rats.Methods Forty-two SD rats were divided into 7 groups by random numeric table method.Each group had 6 rats.The 7 groups were 6 h,12 h,1 d,3 d,7 d,14 d group after HIRI and control group,respectively.The experimental groups underwent right hepatic portal vein and hepatic artery ligation,and received reperfusion 3 h after operation.MRI scanning (T1WI,T2WI,single b-values DWI and 15 b-values DWI) was performed at 6 h,12 h,1 d,3 d,7 d and 14 d after reperfusion.The control group underwent sham operation and MRI scanning.According to monoexponential model,biexponential model,threxponential model,stretched-exponential model DWI and diffusion kurtosis imaging,many parametres were obtained and their dynamic changes at each time point were observed.The parameters included standard apparent diffusion coefficient (ADCs),pure diffusion coefficients (D),pseudodiffusion coefficients (D*),perfusion fraction (f),ultra-high apparent diffusion coefficient (ADCu),distributed diffusion coefficient (DDC),water diffusion heterogeneity index (or),mean diffusion coefficient (MD) and mean diffusion kurtosis (MK).One way ANOVA was used to compare the differences of parameters among different groups.Results MRI examination and pathological examination were successfully completed in all rats.The right hepatic lobe in the experimental groups appeared hypointense on T1WI and hyperintense on T2WI relative to control group from 6 h after operation.The infarcted liver lobe in the experimental groups became significantly smaller at 1 week after HIRI and almost disappeared at 2 weeks after HIRI.The findings of DWI at different b-values were consistent with those at T2WI.There were significant differences in parameters among 6 h,12 h,1 d,3 d,7 d,14 d groups after HIRI and control group (P＜0.05).There were significant differences among 12 h after HIRI,1 d after HIRI,3 d after HIRI and 6 h after HIRI,7 d after HIRI,14 d after HIRI,control group concerning ADCs values respectively (P＜0.05).There were significant differences among 6 h after HIRI,12 h after HIRI,1 d after HIRI,3 d after HIRI,7 d after HIRI and 14 d after HIRI,control group concerning D,D*,f,ADCu,α,DDC,MK values respectively (P＜0.05).In addition,there were significant differences among 1 d after HIRI,3 d after HIRI and 6 h after HIRI,12 h after HIRI,7 d after HIRI and 14 d after HIRI,control group concerning D values respectively (P＜0.05).There were significant differences among 6 h after HIRI,12 h after HIRI,1 d after HIRI,3 d after HIRI and 7 d after HIRI,14 d after HIRI,control group concerning f values respectively (P＜0.05).There were significant differences among 12 h after HIRI and 14 d after HIRI,control group concerning MD values respectively (P＜0.05).There were significant differences between 1 d after HIRI and 14 d after HIRI concerning MD values (P＜0.05).Conclusion Multiple non-gaussian distribution models DWI is superior to conventional DWI in evaluating HIRI model in rats.

Objective To explore the feasibility and the clinical effect of laparoscopic treatment of incomplete small intestinal obstruction.Methods Eighty-five patients with intestinal obstruction from January 2011 to January 2016 were analyzed retrospectively.Five cases caused by adhesion band were released by laparoscopic cut of the adhesion band.Seventy-five cases were caused by adhesion between intestine, abdominal wall, and pelvic cavity were given laparoscopic adhesion and angle separation.Laparoscopic exploration found appendicitis in 3 cases and a laparoscopic appendectomy was carried out.Two cases were given laparoscopic removal of foreign body inside the intestine.For patients with obvious abdominal distention, an indwelling ileus tube was placed in the intestine before the operation.Results All the laparoscopic surgeries were successfully performed except 2 patients required an additional small incision to perform partial enterectomy and intestinal anastomosis due to intensive local adhesion.No complications happened.Postoperative follow-ups for 3-60 months (mean, 35 months) found no recurrence.ConclusionsLaparoscopic treatment of small intestinal obstruction is feasible and minimally invasive, having advantages of small incision, rapid recovery and short hospitalization.It avoids the trauma caused by open operation.

Objective To observe the correlation of intrapulmonary TREM-1 with endoplasmic reticulum stress in mice with acute lung injury (ALI).Methods Balb/c mice were tracheally injected with lipopolysaccharide(LPS,5 mg/kg) to induce ALI.Real-time PCR and Western blot were used to detect the expressions of TREM-1,CHOP and GRP78.The correlation of TREM-1 with endoplasmic reticulum-related proteins was analyzed.LPS (100 ng/mL) was used to induce inflammation in mouse primary peritoneal macrophages,and expressions of TREM -1,CHOP and GRP78 mRNA were detected by real-time PCR.The effect of TREM-1 activation on the expressions of CHOP and GRP78 was observed in macrophages.Results The expressions of TREM-1,CHOP and GRP78 mRNA were increased in ALI mice.TREM-1 mRNA expression was positively correlated with CHOP and GRP78 mRNA expression.In vitro,LPS up-regulated the expressions of TREM-1,CHOP and GRP78,and TREM-1 was positively correlated with CHOP and GRP78.Activation of TREM-1 increased CHOP and GRP78 mRNA expressions.Conclusions TREM-1 is positively related to the endoplasmic reticulum stress.The activation of TREM-1 enhances endoplasmic reticulum in mouse macrophages.

Objective To discuss the specific role of association rules in the compatibility of herbs and the relationship between herbs and symptoms by analyzing ancient analogous prescriptions Zhizichi Decoction with SQL Server software.Methods The prescriptions which contain Gardenia and Semen Sojae Preparatum were searched in the database of “Ancient Prescriptions for Epidemic Disease”, and they were imported to software with the standardized data of their symptoms and ingredients, then the proper association rules were found. The laws between parameter setting and rule generation were searched through parameter adjustment.Results Many laws of the drug compatibility and relationship between herbs and symptoms were obtained effectively in data mining by adjusting the parameters:The support setting was good for finding common used drug compatibility, and the confidence was good for finding specific drug compatibility and relationship between herbs and symptoms;the item set which had high frequency, sometimes made the rule’s importance low.Conclusion The laws of compatibility of herbs and the relationship between herbs and symptoms for data mining of analogous prescriptions are discovered by analyzing the support, confidence and importance of the association-rules and the clinical magnificence between symptoms and herbs.