���Ե�����Ⱦ������ָ�ϣ�2018��������

??A review of Tokyo Guidelines 2018 for the management of acute biliary infections HU Feng-lin??SHANG Dong??ZHANG Hao-xiang??et al. Department of Abdominal Emergency Surgery??the First Affiliated Hospital of Dalian Medical University; Treatment Center of Traditional Chinese Medicine and Western Medicine for Pancreaticobiliary Diseases??Dalian 116000??China
Corresponding author??SHANG Dong??E-mail??tougao1971@163.com
Abstract The Tokyo Guidelines??published in 2007??is the first worldwide guideline to addressing acute cholangitis and acute cholecystitis and was revised in 2013. In line with the results of the epidemiological study of acute biliary tract infection in Japan-China Taiwan multicenter large sale from 2011 to 2013??the guideline was updated again in 2017 and published Tokyo Guidelines 2018. Tokyo Guidelines 2018 is divided into 10 parts. It covers the background of the guidelines??diagnosis of acute cholangitis and acute cholecystitis??grading of severity??use of antibiotics??choice of biliary drainage technique??laparoscopic cholecystectomy safety steps??treatment processes and so on. At the same time??for the convenience of clinical management??it developed a management bundle supporting with video and mobile software client. The Tokyo Guideline 2018 summarizes the guiding principles of clinical diagnosis and treatment of acute cholangitis more comprehensively??and reflects the current status and progress in the treatment of acute cholangitis and cholecystitis.     

������֧�ܳ�����ǰӦ�÷���ǿ��Աȸ߷ֱ�Ź���߿����������ֵ�о�

??Evaluation of the value of non-enhanced multi-contrast high-resolution magnetic resonance plaque imaging before carotid stenting ZHAO Ge-fei, FU Wei-guo, TANG Xiao, et al. Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032??China
Corresponding author??GUO Da-qiao??E-mail??guo.daqiao@zs-hospital.sh.cn
Abstract Objective To analyze the application value of non-enhanced multi-contrast high-resolution magnetic resonance imaging in preoperative evaluation of CAS. Methods The clinical medical records of patients with carotid stenosis treated at Zhongshan Hospital,Fudan University from January 2017 to March 2018 were analyzed retrospectively.The relationship between carotid plaque characteristics and cerebral infarction lesions after CAS were confirmed by univariate and multivariate logistic regression analysis. Results A total of 181 CAS patients were enrolled in the study. Among them??63 ??34.8%?? had asymptomatic new DWI lesions and 2 ??1.1%?? had symptomatic cerebral infarction. Logistic regression analysis showed carotid plaque hemorrhage ??IPH?? [subacute phase IPH vs. no IPH??OR??9.393??95% confidence interval ??4.431??19.911??] was an independent risk factor for predicting asymptomatic DWI lesions after CAS. Conclusion Preoperative application of non-enhanced multi-contrast high-resolution magnetic resonance imaging to evaluate plaque components can detect plaque instability and has important potential value for indication of CAS.     

�����Ի�����ǰ����������Ч����

??Therapeutic effect analysis of preoperative biliary drainage for obstructive jaundice CAO Feng, LI Fei. Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Corresponding author : LI Fei??E-mail??xw_lifei@yahoo.com.cn
Abstract Objective To determine the benefits and harms of preoperative biliary drainage (PBD) for obstructive jaundice. Methods Cochrane systematic evaluation was used to search data between 1966 and 2010 through Cochrane libraries of clinical comparative trials, PubMed, Embase, Cancer Lit and the Chinese BioMedical Literature on disc. The quality of literatures was independently evaluated and cross-checked by two evaluators. The indicators for assessment included overall mortality, overall morbidity and postoperative morbidity. The results were analyzed with RevMan 4.2 software. Results Eight articles were involved in the Meta analysis with total 728 patients. No statistical differences were found in the overall mortality??OR 1.08??95%CI 0.68-1.73, P=0.74??, overall morbidity??OR 1.72??95%CI 0.86-3.45, P=0.13?? and postoperative morbidity??OR 0.6??95%CI 0.35-1.03, P=0.06?? between the groups. Conclusion The potential benefits of PBD in terms of postoperative rates of death and complications do not outweigh the disadvantage of the drainage procedure and should be performed cautiously now.