Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations

A history of abdominal biliary tract surgery has been identified as a relative contraindication for laparoscopic common bile duct exploration (LCBDE), and there are very few reports about laparoscopic procedures in patients with a history of abdominal biliary tract surgery. We retrospectively reviewed the clinical outcomes of 227 consecutive patients with previous abdominal biliary tract operations at our institution between December 2013 and June 2019. A total of 110 consecutive patients underwent LCBDE, and 117 consecutive patients underwent open common bile duct exploration (OCBDE). Patient demographics and perioperative variables were compared between the two groups. The LCBDE group performed significantly better than the OCBDE group with respect to estimated blood loss [30 (5–700) vs. 50 (10–1800) ml; p = 0.041], remnant common bile duct (CBD) stones (17 vs. 28%; p = 0.050), postoperative hospital stay [7 (3–78) vs. 8.5 (4.5–74) days; p = 0.041], and time to oral intake [2.5 (1–7) vs. 3 (2–24) days; p = 0.015]. There were no significant differences in the operation time [170 (60–480) vs. 180 (41–330) minutes; p = 0.067]. A total of 19 patients (17%) in the LCBDE group were converted to open surgery. According to Clavien’s classification of complications, the LCBDE group had significantly fewer postoperative complications than the OCBDE group (40 vs. 57; p = 0.045). There was no mortality in either group. Multiple previous operations (≥ 2 times), a history of open surgery, and previous biliary tract surgery (including bile duct or gallbladder + bile duct other than cholecystectomy alone) were risk factors for postoperative adhesion (p = 0.000, p = 0.000, and p = 0.000, respectively). LCBDE is ultimately the least invasive, safest, and the most effective treatment option for patients with previous abdominal biliary tract operations and is especially suitable for those with a history of cholecystectomy, few previous operations (< 2 times), or a history of laparoscopic surgery.     

同期两镜或三镜下留置输尿管导管胆管引流207例

目的总结运用同期两镜或三镜术中留置输尿管导管胆管引流的治疗经验。方法从1992年10月-2014年8月,我们运用同期两镜或三镜术中留置输尿管导管胆管引流的手术方式,即腹腔镜术中经胆囊管残端输尿管导管胆管引流术（LUD）,对207例患者进行治疗。结果 181例胆管引流获得成功（87.4%）。输尿管导管插管失败12例（5.8%）,其中中转为鼻胆管引流7例,T管引流2例,放弃胆管引流3例。输尿管导管打折或堵塞导致无任何液体流出2例（1.0%）。输尿管导管早期滑脱导致胆汁性腹膜炎2例（1.0%）,再次腹腔镜下放置输尿管导管及腹腔引流管1例和放置T管及腹腔引流管1例而治愈。术后胆漏4例（1.9%）,经腹腔引流管引流自愈。乳头切开术后发生轻症胰腺炎3例（1.4%）。术后经输尿管导管胆管造影无残石,胆管切口一期缝合术后有轻度狭窄影像2例未处理,乳头区狭窄影像1例未处理。无其他严重并发症,无死亡。结论只要选择合适的病例,同期两镜或三镜术中留置输尿管导管胆管引流是可行、有效和安全的。     

腹腔镜下经腹顺行推进法T管双导管捆绑支撑引流术45例

目的探讨在腹腔镜胆总管切开胆管镜探查取石术中采用腹腔镜下经腹顺行推进法T管双导管(T形管＋2根裁剪后的鼻胆管导管)捆绑支撑引流术(LCTBS)联合治疗胆囊结石、胆总管结石、合并的十二指肠乳头部梗阻或狭窄的应用体会。 方法回顾性分析2001年4月至2018年6月期间符合入选标准的45例患者的临床资料。 结果本组45例患者行胆囊切除术、行胆总管切开胆管镜取石术,必要时行冲击波碎石术。预先行逐级导管乳头扩张术、后行T形管＋双导管支撑引流术86.7% (39/45),行逐级导管联合球囊导管乳头扩张术、T形管＋双导管支撑引流术4.4% (2/45),行乳头扩张术失败而改为内镜乳头切开术、T形管＋双导管支撑引流术6.7% (3/45),双导管支撑引流放置失败而改为T管引流术2.2% (1/45)。无残余结石。胆漏1例(2.2%)。经T管瘘道拔除双导管支撑引流管无失败病例。术后无肠穿孔和胆管穿孔,无大出血,无重症胰腺炎,无非计划再次手术病例,无死亡病例。手术并发症发生率为2.2%(1/45)。 结论从本文有限病例进行初步研究发现,只要病例选择合适,LCTBS治疗胆囊结石、胆总管结石、合并十二指肠乳头部梗阻或狭窄是可行、有效和安全的。     

L2‐L∞ filtering for a class of stochastic nonlinear systems with aperiodic sampling

This work investigates the problem of L₂‐L_∞ filtering for a class of stochastic nonlinear systems with nonuniform sampling. The sampled‐data filter developed in this paper is an impulsive differential system whose states change abruptly at every sampling instant. The resulting filtering error system is modeled as a stochastic nonlinear impulsive differential system. The goal is to propose a method for designing a target filter that ensures the stochastic asymptotic stability of the filtering error system and guarantees a prescribed L₂‐L_∞ performance. Based on a time‐varying Lyapunov functional, by virtue of a convex combination technique, a design method to achieve such a filter is formulated in the form of solving a set of linear matrix inequalities. The effectiveness of the proposed filtering strategy is shown via a numerical example of a stochastic Chua's circuit system.     

腹腔镜胃癌根治术

应用电钩沿横结肠与大网膜附着处分离大网膜分别至结肠脾曲及结肠肝区。用超声刀沿胰腺被膜分离,至胰腺上缘显露近脾门处的脾动静脉主干向脾门解剖,清扫第10、11组淋巴结;显露胃网膜左血管根部并离断,向上离断部分胃短血管后,裸化胃大弯,清扫第4组淋巴结。沿胰腺下缘胰后间隙解剖,显露肠系膜上静脉,清扫14v组淋巴结,于胃网膜右静脉汇入胃结肠静脉干处夹闭,显露胃网膜右动脉根部并夹闭,清扫第6组淋巴结。沿胰腺上缘打开胃胰皱襞进入胰后间隙解剖肝总动脉及腹腔动脉干,游离并显露胃左动、静脉,脾动脉及部分肝总动脉,根部切断胃左动、静脉,清扫7、8、9组淋巴结。显露肝总动脉,清扫第8a组淋巴结,显露肝固有动脉,显露胃右动脉根部,夹闭切断胃右动脉,清扫第5、12组淋巴结。沿小网膜与胃小弯前壁附着处切除小网膜,裸化胃壁,清扫第3、5组淋巴结。     

无髓牙冠内漂白方法的对比研究

目的探讨无髓牙内漂白技术中2种细节操作方法对漂白效果影响。方法选择口腔中前牙和双尖牙区至少2颗变色无髓牙的患者40例,对2颗牙分别采用方法Ⅰ(标准根管治疗后,用光固化玻璃离子封闭根管口,用常温下浸有30%过氧化氢的棉球封闭在髓腔内,3d复诊1次,共封药3次后进行充填治疗)和方法Ⅱ(标准根管预备后,根充前用加热到36℃的30%过氧化氢反复冲洗髓腔,然后做常规根充和充填治疗)治疗。2组均采用同种复合树脂严密充填,1 a后用相同方法观察美观效果和强度效果。结果方法Ⅱ美观效果与强度效果均明显优于方法Ⅰ(P<0.05)。结论漂白变色的无髓牙最好方法是即刻高效的热漂白方法。     

康胃方对新生大鼠HP感染的根除及胃黏膜保护作用

目的 :HP悉尼菌株灌胃复制感染动物模型 ,观察康胃方对HP的根除及胃黏膜细胞保护作用。方法 :SD新生大鼠随机分为正常对照组、病理模型组、三联治疗组及康胃方组 ,除正常对照组外 ,每日经口接种 10 9CFU mlHP菌液 0 1ml,共 3次。 8周后进行UBT ,随即接受相应的治疗 ,共 4周。疗后第 4周 ,测定胃黏膜RO、NO、iNOS、MnSOD及NPSH的含量或活性。结果 :HP感染动物 ,UBT与胃黏膜所含RO、NO、iNOS和MnSOD明显升高 ,NPSH显著下降 (P <0 0 1)。康胃方治疗后 ,UBT降低 ,其他指标明显改善 (P <0 0 1)。结论 :康胃方对新生大鼠感染HP有明显的根除作用 ,并对胃黏膜有一定的细胞保护作用。     

A solid-phase approach to DDB derivatives

Since the discovery of 2,2'-dimethoxycarbonyl-4,4-dimethoxy-5,6,5',6'-biomethylenedioxy-biphenyl (DDB) as a potent anti-HBV agent, we have studied the structure-activity relationships of 4,4'-dimethoxy-5,6,5',6'-dimethenedioxy-2-alkyloxycarbonyl-2'-(4-substituted benzyl piperazin-1-yl)carbonyl-biphenyl as anti-HBV agents. Therefore, it is rational to extend this study to the 3,3'-disustituted-4,4'-dimethoxy-5,6,5',6'-dimethenedioxy-2-alkyloxycarbonyl-2'-Serine derivatives. Thus, in an attempt to develop an efficient method for the preparation of a large number of DDB derivatives, the reaction between a DDB acid chloride and serine derivatives on solid support was studied. The structure of resulted compounds was confirmed by LC-MS and (1)H NMR analysis. Compounds 2a, 2d, 2f, 2j showed in vitro anti-HBV activity without significant toxicity up to 100 microM.     

Tissue transglutaminase during mouse central nervous system development: lack of alternative RNA processing and implications for its role(s) in murine models of neurotrauma and neurodegeneration

Tissue transglutaminase (tTG) is a member of a multigene family principally involved in catalyzing the formation of protein cross-links. Unlike other members of the transglutaminase family, tTG is multifunctional since it also serves as a guanosine triphosphate (GTP) binding protein (Galpha(h)) and participates in cell adhesion. Different isoforms of tTG can be produced by proteolysis or alternative splicing. We find that tTG mRNA is expressed at low levels in the mouse CNS relative to other tissues, and at lower levels in the CNS of mouse in comparison to that of human or rat. tTG mRNA levels are higher in the heart compared to the CNS, for example, and much higher in the liver. Within the CNS, tTG message is lowest in the adult cerebellum and thalamus and highest in the frontal cortex and striatum. In the hippocampus, tTG expression is highest during embryonic development and falls off dramatically after 1 week of life. We did not find alternative splicing of the mouse tTG. At the protein level, the predominant isoform is approximately 62 kDa. In summary, tTG, an important factor in neuronal survival, is expressed at low levels in the mouse CNS and, unlike rat and human tTG, does not appear to be regulated by alternative splicing. These findings have implications for analyses of rodent tTG expression in human neurodegenerative and neurotrauma models where alternative processing may be an attractive pathogenetic mechanism. They further impact on drug discovery paradigms, where modulation of activity may have therapeutic value.     

The expression of EGFR family ligands in breast carcinomas

Expression of EGF, HB-EGF, TGF-alpha, HRG-alpha, HRG-beta1, and HRG-beta3 in 100 frozen breast carcinoma materials was immunohistochemically studied. Among these tumors, 67% were positive for EGF, 53% for HB-EGF, 57% for TGF-alpha, 60% for HRG-alpha, 53% for HRG-beta1, and 63% for HRG-beta3 in the neoplastic epithelial cells. No significant associations between expression of the growth factors and clinicopathological features like tumor size, histologic grade, node status, ploidy, ER status, and c-erbB-4 expression were observed, with the exceptions that significant relations were present between EGF expression and tumor size (p = 0.01) and between HRG-beta3 expression and node status (p = 0.02). The expressions of these growth factors showed no association with cancer-specific survival by the Kaplan Meier analysis.