非溃疡性消化不良患者胆囊收缩功能的初步探讨

非溃疡性消化不良（ＮＵＤ）为临床常见的一组症候群，其发生的病理生理机制迄今尚未明了。我们在研究ＮＵＯ患者胃排空功能的基础上，利用超声波检查对其胆囊的收缩排空功能进行探讨。结果显示：３８例ＮＵＤ患者与３０例无症状对照者的空腹胆囊体积及餐后胆囊最大收缩指数无差异，不同的是两组的胆囊收缩速度不同。ＮＵＤ患者中胆囊收缩延缓及过速者较对照组明显增多，并与ＮＵＤ患者的早饱、恶心有一定关系。胃的排空延缓并不影响胆囊的收缩。这一结果为临床缓解ＮＵＤ患者的症状提供了新的线索。     

A review of treatment options for bile duct stones

Introduction: Approximately 10–15% of bile duct stones cannot be treated using conventional stone removal techniques. For difficult common bile duct stones (CBDS), various endoscopic techniques have been developed. This review covers technical tips and endoscopic treatments including Endoscopic retrograde cholangiopancreatography (ERCP), particularly under Endoscopic ultrasound (EUS) guidance.

Areas covered: Literatures about endoscopic treatment for bile duct stone were searched in Pub Med. As novel methods, EUS-guided approaches have also been reported, although long-term results and prospective evaluation are not yet sufficient. Large stones may need fragmentation prior to removal, to prevent stone impaction. To perform fragmentation, mechanical lithotripsy, extracorporeal shock wave lithotripsy or laser lithotripsy techniques are available.

Expert commentary: Despite the fact that most bile duct stones can be treated using endoscopic techniques, endoscopists should remind to be able to select the temporary biliary stenting or percutaneous transhepatic cholangiodrainage as an option.     

巨大膀胱尿酸性结石1例报告并文献复习

膀胱结石是临床常见病、多发病,但本例患者膀胱结石长到如此巨大且为纯尿酸性极为罕见,经治疗后好转出院.现将病例及巨大膀胱尿酸性结石的形成、特点、危害、防治总结如下,以提高临床医生的重视程度.     

Medium and long-term complications difference between laparoscopic transcystic common bile duct exploration versus endoscopic sphincterotomy against choledocholithiasis: A protocol for systematic review and meta-analysis

Background:Common bile duct stone (CBDS) is typically manifested with abdominal pain, chills, fever, and jaundice. Laparoscopic transcystic common bile duct exploration (LTCBDE) and endoscopic sphincterotomy (EST) are currently the main minimally invasive methods for the treatment of CBDS. However, there are few studies about the differences of medium and long-term complication after EST or LTCBDE. Therefore, we will conduct a meta-analysis and systematic review to systematically evaluate the difference of medium and long-term complications between EST and LTCBDE against CBDS.Methods:Randomized controlled trials of EST or LTCBDE against CBDS will be searched in several English and Chinese databases with the following vocabularies: “laparoscopic transcystic common bile duct exploration,” “endoscopic sphincterotomy,” “choledocholithiasis,” “common bile duct stone” until December, 2020. Two reviewers will independently conduct the literature extraction, risk of bias assessment, and statistical analysis.Results and Conclusions:The study will help to systematically evaluate the difference of medium and long-term complication between EST and LTCBDE against CBDS.OSF Registration number:DOI 10.17605/OSF.IO/5U7SA.     

经十二指肠镜括约肌切开胆总管结石的处理(附168例报告)

目的：采用各种方法处理不同大小的胆总管结石。方法：于1986年3月至1996年9月经内镜括约肌切开（EST）治疗胆总管结石168例，其中单颗结石63例，2颗结石56例，3颗以上结石49例，最多一例8颗结石，结石的直径为5～25mm不等。结果：165例（98．2％）切开成功，3例失败。161例（95．8％）结石排出，其中96例（59．6％）结石自然排入肠道，57例（35．4％）采用网篮或气囊取出结石，6例（3．7％）采用碎石网篮碎石后排出，2例（1．2％）经震波碎石后排出。术后出现胃肠道出血1例（0．6％），胰腺炎1例（0．6％），胆管炎3例（1．8％）。48例术后行胃肠钡餐检查，43例胆道内无钡剂返流，2例胆道内有积气，3例有钡剂返流入胆道，但无临床症状。结论：EST是目前治疗胆管结石的重要手段之一。     

Single‐incision laparoscopic cholecystectomy for gallbladder torsion: A case report and literature review

We present a case of preoperatively diagnosed gallbladder torsion (GT) that was successfully treated by single‐incision laparoscopic cholecystectomy. An 80‐year‐old woman presented with sudden pain and a palpable mass in the right upper quadrant. Contrast‐enhanced CT revealed ischemic changes, a swollen gallbladder with a V‐shaped distortion of the extrahepatic ducts, and the gallbladder in an abnormal anatomical position; clinical findings indicated GT. We performed single‐incision laparoscopic cholecystectomy and intraoperatively found that the floating gallbladder was twisted counterclockwise by 180° around the cystic duct. After an uneventful postoperative course, the patient was discharged on postoperative day 7. Laparoscopic cholecystectomy for a GT was first performed in 1994, and since then, 28 cases, including ours, have been treated laparoscopically. Laparoscopic cholecystectomy for GT could be the standard treatment for this condition, and single‐incision laparoscopic cholecystectomy may be a good surgical option for patients with GT because of its anatomical characteristics.     

The evaluation and management of urolithiasis in the ED: A review of the literature

Background

Urolithiasis is a common condition in the U.S. Patients frequently present to the emergency department (ED) for care, including analgesia and treatments to facilitate stone passage.

Per-oral pancreatoscopy-guided lithotripsy vs. extracorporeal shock wave lithotripsy for treating refractory main pancreatic duct stones in chronic pancreatitis: Protocol for an open-label multi-center randomized clinical trial

Backgrounds/ObjectivesPatients with chronic pancreatitis may develop pancreatic duct stones that can obstruct outflow leading to ductal hypertension and pain. Both endoscopic retrograde pancreatography (ERP) with per-oral pancreatoscopy (POP) and intraductal lithotripsy and extracorporeal shock wave lithotripsy (ESWL) are feasible options to attempt ductal stone clearance. This study aims to compare POP-guided lithotripsy with ESWL in the management of refractory symptomatic main pancreatic duct stones.MethodsThis is an open-label, multi-center, parallel, randomized clinical trial. Patients with chronic pancreatitis and main pancreatic duct stones ≥5 mm who fail standard ERP methods for stone removal will be eligible for this study. In total, 150 subjects will be randomized 1:1 to either ESWL or POP. A maximum of 4 sessions of either ESWL or POP will be allowed in each arm, with crossover permitted thereafter. The primary outcome is complete stone clearance and secondary outcomes include quality of life, pain scores, number of interventions, and daily opiate requirements.ConclusionsThis study aims to answer the question of which lithotripsy method is superior in removing refractory pancreatic duct stones while addressing the effects of lithotripsy on quality of life and pain in patients with chronic calcific pancreatitis (ClinicalTrials.gov NCT04115826).     

Expression of reg protein in rat regenerating islets and its co-localization with insulin in the Beta cell secretory granules

Summary Regenerating islets can be induced by the administration of poly(ADP-ribose) synthetase inhibitors to 90% depancreatized rats. In screening a regenerating isletderived cDNA library, we previously isolated a novel gene, reg (regenerating gene), which encodes a 165-amino acid protein with a 21-amino acid signal sequence. In the present study, we have examined the expression and localization of reg protein in the regenerating islets by immunocytochemical techniques using a monoclonal antibody against a recombinant rat reg protein of 144 amino acids without the signal sequence. Light microscopy examination showed strong immunoreactivity for reg protein in the regenerating islets of the rats at two weeks and two months after the 90% pancreatectomy, whereas reg protein was almost undetectable in normal rat islets or in the islets of the rats one year after the pancreatectomy. Almost all the reg protein-positive cells were stained for insulin. By applying the immunogold technique at the ultrastructural level, it was demonstrated that both reg protein and insulin occur in the central granular core of the regenerating Beta cell secretory granules. These results suggest that reg protein is synthesized in and secreted from the regenerating Beta cells and that its expression is closely associated with Beta-cell regeneration.