Risk factors for recurrence of common bile duct stones after surgical treatment and effect of ursodeoxycholic acid intervention

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an accurate diagnostic method for choledocholithiasis and treatment option for stone removal.Additionally,ursodeoxycholic acid(UDCA)can dissolve cholesterol stones and prevent their development and reappearance by lowering the cholesterol concen-tration in bile.Despite these treatment options,there are still patients who experience stone recurrence.The clinical data of 100 patients with choledochal stones who were hospitalized at the Yixing People’s Hospital and underwent ERCP for successful stone extraction between June 2020 and December 2022 were retrospectively collected.According to the post-ERCP treatment plan,100 patients were classified into UDCA(n=47)and control(n=53)groups.We aimed to assess the clinical efficacy and rate of relapse in the two patient populations.We then collected information(basic demographic data,clinical characteristics,and serum biochemical indicators)and determined the factors contributing to relapse using logistic regression analysis.Our secondary goal was to determine the effects of UDCA on liver function after ERCP.Compared to the control group,the UDCA group demonstrated a higher clinical effectiveness rate of 92.45%vs 78.72%(P<0.05).No significant differences were observed in liver function indices,including total bilirubin,direct bilirubin,gamma-glutamyl transpeptidase,alanine aminotransferase,alkaline phosphatase,and aspartate aminotransferase,between the two groups before treatment.After treatment,all liver function indices were significantly reduced.Comparing the control vs UDCA groups,the UDCA group exhibited significantly lower levels of all indices(55.39±6.53 vs 77.31±8.52,32.10±4.62 vs 45.39±5.69,142.32±14.21 vs 189.63±16.87,112.52±14.25 vs 149.36±15.36,122.61±16.00 vs 171.33±22.09,96.98±10.44 vs 121.35±11.57,respectively,all P<0.05).The stone recurrence rate was lower in the UDCA group(13.21%)in contrast with the control group(44.68%).Periampullary diverticula(OR:6.00,95%CI:1.69-21.30),maximum stone diameter(OR:1.69,95%CI:1.01-2.85),stone quantity>3(OR:4.23,95%CI:1.17-15.26),and positive bile culture(OR:7.61,95%CI:2.07-27.91)were independent factors that influenced the relapse of common bile duct stones after ERCP(P<0.05).Furthermore,postoperative UDCA was identified as a preventive factor(OR:0.07;95%CI:0.08-0.09).CONCLUSION The intervention effect of UDCA after ERCP for common bile duct stones is adequate,providing new research directions and references for the prevention and treatment of stone recurrence.

Beneficial effects of a novel shark-skin collagen dressing for the promotion of seawater immersion wound healing

Background: Wounded personnel who work at sea often encounter a plethora of difficulties. The most important of these difficulties is seawater immersion. Common medical dressings have little effect when the affected area is immersed in seawater, and only rarely dressings have been reported for the treatment of seawater-immersed wounds. The objective of this study is to develop a new dressing which should be suitable to prevent the wound from seawater immersion and to promote the wound healing.Methods: Shark skin collagen(SSC) was purified via ethanol de-sugaring and de-pigmentation and adjusted for p H. A shark skin collagen sponge(SSCS) was prepared by freeze-drying. SSCS was attached to an anti-seawater immersion polyurethane(PU) film(SSCS+PU) to compose a new dressing. The biochemical properties of SSC and physicochemical properties of SSCS were assessed by standard methods. The effects of SSCS and SSCS+PU on the healing of seawaterimmersed wounds were studied using a seawater immersion rat model. For the detection of SSCS effects on seawaterimmersed wounds, 12 SD rats, with four wounds created in each rat, were divided into four groups: the 3 rd day group, 5 th day group, 7 th day group and 12 th day group. In each group, six wounds were treated with SSCS, three wounds treated with chitosan served as the positive control, and three wounds treated with gauze served as the negative control. For the detection of the SSCS+PU effects on seawater-immersed wounds, 36 SD rats were divided into three groups: the gauze(GZ)+PU group, chitosan(CS)+PU group and SSCS+PU group, with 12 rats in each group, and two wounds in each rat. The wound sizes were measured to calculate the healing rate, and histomorphology and the immunohistochemistry of the CD31 and TGF-β expression levels in the wounded tissues were measured by standard methods.Results: The results of Ultraviolet-visible(UV-vis) spectrum, Fourier-transform infrared(FTIR) spectrum, circular dichroism(CD) spectra, sodium dodecyl sulfate polyacrylamide gel electrophoresis(SDS-PAGE), and amino acid composition analyses of SSC demonstrated that SSC is type I collagen. SSCS had a homogeneous porous structure of approximately 200μm, porosity rate of 83.57%±2.64%, water vapor transmission ratio(WVTR) of 4500 g/m2, tensile strength of 1.79±0.41 N/mm, and elongation at break of 4.52%±0.01%. SSCS had significant beneficial effects on seawater-immersed wound healing. On the 3 rd day, the healing rates in the GZ negative control, CS positive control and SSCS rats were 13.94%±5.50%, 29.40%±1.10% and 47.24%±8.40%, respectively. SSCS also enhanced TGF-in the initial stage of the healing period. The SSCS+PU dressing effectively protected woundsβ and CD31 expression from seawater immersion for at least 4 h, and accelerated re-epithelialization, vascularization and granulation formation of seawater-immersed wounds in the earlier stages of wound healing, and as well as significantly promoted wound healing. The SSCS+PU dressing also enhanced expression of TGF-n and gauze dressings.β and CD31. The effects of SSCS and SSCS+PU were superior to those of both the chitosaConclusion: SSCS has significant positive effects on the promotion of seawater-immersed wound healing, and a SSCS+PU dressing effectively prevents seawater immersion, and significantly promotes seawater-immersed wound healing.