Is appendoscope a new option for the treatment of acute appendicitis?

Acute appendicitis is a common surgical emergency.It is commonly caused by obstruction of the appendiceal lumen due to fecaliths,tumors,or lymphoid hyperplasia.For over a century,appendectomy has been the primary treatment for acute appendicitis.Abraham Groves performed the first open appendectomy in 1883.In 1983,Kurt Semm completed the first laparoscopic appendectomy,heralding a new era in appendectomy.However,appendectomy is associated with certain complications and a rate of negative appendectomies.Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson’s disease,but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer,gallstones,and cardiovascular disease.With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic technology,Liu proposed the endoscopic retrograde appendicitis therapy.It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis.Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis.This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.

Therapeutic effect of San Bi Tang combined with glucosamine sulfate capsules in cold-dampness-type knee osteoarthritis

BACKGROUND Cold-dampness-type knee osteoarthritis is a common middle-aged and elderly disease,but its pathogenesis is not fully understood,and its clinical treatment has limitations.Glucosamine sulfate capsules are commonly used for treating arthritis,and San Bi Tang is a classic formula of traditional Chinese medicine(TCM)that has the effects of warming yang,dispelling dampness,relaxing muscles,and activating collaterals.This research hypothesized that the combination of modified San Bi Tang and glucosamine sulfate capsules could enhance the clinical efficacy of treating cold-dampness-type knee osteoarthritis through complementary effects.AIM To analyze the clinical efficacy of San Bi Tang combined with glucosamine sulfate capsules when treating cold-dampness-type knee osteoarthritis.METHODS A total of 110 patients with cold-dampness-type knee osteoarthritis were selected as research subjects and randomly divided into a control group and an experimental group of 55 cases each.The control group received only treatment with glucosamine sulfate capsules,while the experimental group received additional treatment with modified San Bi Tang for a duration of 5 wk.The patients’knee joint functions,liver and kidney function indicators,adverse reactions,and vital signs were evaluated and analyzed using SPSS 26.0 software.RESULTS Before treatment,the two groups’genders,ages,and scores were not significantly different,indicating comparability.Both groups’scores improved after treatment,which could indicate pain and knee joint function improvement,but the test group had better scores.The TCM-specific symptoms and the clinical efficacy of the treatment in the test group were higher.Before and after treatment,there were no abnormalities in the patients’liver and kidney function indicators.CONCLUSION The combination of modified San Bi Tang and glucosamine sulfate capsules is superior to treatment with sulfated glucosamine alone and has high safety.

Development and validation of a predictive model for acute-onchronic liver failure after transjugular intrahepatic portosystemic shunt

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a cause of acute-onchronic liver failure(ACLF).AIM To investigate the risk factors of ACLF within 1 year after TIPS in patients with cirrhosis and construct a prediction model.METHODS In total,379 patients with decompensated cirrhosis treated with TIPS at Nanjing Drum Tower Hospital from 2017 to 2020 were selected as the training cohort,and 123 patients from Nanfang Hospital were included in the external validation cohort.Univariate and multivariate logistic regression analyses were performed to identify independent predictors.The prediction model was established based on the Akaike information criterion.Internal and external validation were conducted to assess the performance of the model.RESULTS Age and total bilirubin(TBil)were independent risk factors for the incidence of ACLF within 1 year after TIPS.We developed a prediction model comprising age,TBil,and serum sodium,which demonstrated good discrimination and calibration in both the training cohort and the external validation cohort.CONCLUSION Age and TBil are independent risk factors for the incidence of ACLF within 1 year after TIPS in patients with decompensated cirrhosis.Our model showed satisfying predictive value.

链霉蛋白酶+西甲硅油对无痛胃镜检查效果的影响

目的探讨链霉蛋白酶+西甲硅油在无痛胃镜患者检查前不同时间口服及服用后体位不同对检查效果的影响。方法选择杭州市第一人民医院门诊及住院接受无痛胃镜检查的患者740例,随机分成链霉蛋白酶+西甲硅油组(n=300)、西甲硅油组(n=240)和对照组(盐酸利多卡因胶浆组,n=200)。观察并对比3组患者在无痛胃镜检查前5、10、15、20、25、30、45和60 min口服上述药物及服药后患者采取不同体位[坐位、立位(间断行走)和卧位(间断左右侧身)]的胃镜视野清晰度、丙泊酚使用剂量、胃镜操作时间、恶心呕吐发生率、癌前病变和早期胃癌检出率。结果链霉蛋白酶+西甲硅油组的胃镜视野清晰度、丙泊酚使用剂量、内镜操作时间和癌前病变及早期胃癌检出率明显优于西甲硅油组和对照组(P<0.01),而西甲硅油组又优于对照组(P<0.01);3组患者的恶心呕吐发生率比较,差异无统计学意义(P>0.05)。链霉蛋白酶+西甲硅油组在无痛胃镜检查前20和25 min口服链霉蛋白酶+西甲硅油后,胃镜视野清晰度更佳(P<0.05),但这两者间比较,差异无统计学意义(P>0.05)。链霉蛋白酶+西甲硅油组采取立位(间断行走)和卧位(间断左右侧身)的胃镜视野清晰度优于坐位,差异有统计学意义(χ^(2)_(1)=14.56,P1=0.000;χ^(2)_(2)=16.61,P2=0.000);采取立位(间断行走)和卧位(间断左右侧身)的胃镜视野清晰度比较,差异无统计学意义(χ^(2)_(3)=0.12,P3=0.733)。结论无痛胃镜检查前应用链霉蛋白酶+西甲硅油可有效提高胃镜视野清晰度、缩短内镜操作时间、减少丙泊酚使用剂量、提高癌前病变及早期胃癌检出率;胃镜前20和25 min服药及服药后采取立位(间断行走)及卧位(间断左右侧身)效果更佳。

超声内镜引导下对接技术治疗经内镜逆行胰胆管造影术失败的恶性梗阻性黄疸的疗效研究

目的探讨超声内镜引导下对接技术(EUS-RV)治疗经内镜逆行胰胆管造影术(ERCP)失败的恶性梗阻性黄疸的疗效。方法 12例恶性梗阻性黄疸患者在ERCP不成功后改为EUS-RV治疗。观察其操作成功率、术后1周及1个月肝功能指标恢复情况、并发症发生率、住院时间及患者生存期。结果 12例患者均通过超声内镜穿刺成功,经胃穿刺者8例,经十二指肠穿刺4例,成功率为100.00%;术后1周较术前、术后1个月较术后1周肝功能指标差异有统计学意义(P<0.05);并发出血1例,经保守治疗后改善,并发症发生率8.33%;所有患者住院时间为(20.68±5.76)d;平均生存期为224 d。结论 EUS-RV创伤小、疗效好,可作为ERCP失败的恶性梗阻性黄疸患者的替代治疗。

Consensus on the digestive endoscopic tunnel technique

With the digestive endoscopic tunnel technique(DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria(MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal(GI) tract.At present, the tunnel technique application range covers the following:(1)Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis;(2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and(3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment.The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism,and significance of DETT, prevention of infection and concepts of DETTassociated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract(indications and contraindications, procedures, pre-and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).

Risk factors for combined hepatocellular-cholangiocarcinoma:A hospital-based case-control study

AIM: To identify risk factors contributing to the development of combined hepatocellular-cholangiocarcinoma (CHC) in China.

Improved method increases sensitivity for circulating hepatocellular carcinoma cells

AIM:To improve an asialoglycoprotein receptor(ASGPR)-based enrichment method for detection of circulating tumor cells(CTCs)of hepatocellular carcinoma(HCC).METHODS:Peripheral blood samples were collected from healthy subjects,patients with HCC or various other cancers,and patients with hepatic lesions or hepatitis.CTCs were enriched from whole blood by extracting CD45-expressing leukocytes with monoclonal antibody coated-beads following density gradient centrifugation.The remaining cells were cytocentrifuged on polylysine-coated slides.Isolated cells were treated by triple immunofluorescence staining with CD45antibody and a combination of antibodies against ASGPR and carbamoyl phosphate synthetase 1(CPS1),used as liver-specific markers,and costained with DAPI.The cell slide was imaged and stained tumor cells that met preset criteria were counted.Recovery,sensitivity and specificity of the detection methods were determined and compared by spiking experiments with various types of cultured human tumor cell lines.Expression of ASGPR and CPS1 in cultured tumor cells and tumor tissue specimens was analyzed by flow cytometry and triple immunofluorescence staining,respectively.RESULTS:CD45 depletion of leukocytes resulted in a significantly greater recovery of multiple amounts of spiked HCC cells than the ASGPR+selection(P s<0.05).The expression rates of either ASGPR or CPS1were different in various liver cancer cell lines,ranging between 18%and 99%for ASGPR and between 9%and 98%for CPS1.In both human HCC tissues and liver cancer cell lines,there were a few HCC cells that did not stain positive for ASGPR or CPS1.The mixture of monoclonal antibodies against ASGPR and CPS1identified more HCC cells than either antibody alone.However,these antibodies did not detect any tumor cells in blood samples spiked with the human breastcancer cell line MCF-7 and the human renal cancer cell line A498.ASGPR+or/and CPS1+CTCs were detected in 29/32(91%)patients with HCC,but not in patients with any other kind of cancer or any of the other test subjects.Furthermore,the improved method detected a higher CTC count in all patients examined than did the previous method(P=0.001),and consistently achieved 12%-21%higher sensitivity of CTC detection in all seven HCC patients with more than 40 CTCs.CONCLUSION:Negative depletion enrichment combined with identification using a mixture of antibodies against ASGPR and CPS1 improves sensitivity and specificity for detecting circulating HCC cells.

Interventional endoscopic ultrasound for a symptomatic pseudocyst secondary to gastric heterotopic pancreas

Heterotopic pancreas(HP) is a relatively uncommon entity that is defined as pancreatic tissue without a true anatomical or vascular connection to the pancreas. HP does not cause symptoms in most cases but can occasionally produce various manifestations, including nausea, vomiting, abdominal pain, and even heterotopic pancreatitis. Here, we report an unusual case in which heterotopic pancreatitis complicated by the formation of a pseudocyst that caused gastric outlet obstruction was diagnosed based on serum hyperamylasemia and findings from endoscopic ultrasonography(EUS)-guided fine needle aspiration(EUS-FNA) cytology. EUS-guided single pigtail stent insertion was successfully performed for recurrent gastric outlet obstruction. The patient has remained healthy and symptom-free during 4 years of surveillance. In the context of the relevant literature, the described case is a rare case of HP complicated by a pseudocyst treated via EUS-FNA and stent insertion.

Centralized isolation of Helicobacter pylori from multiple centers and transport condition influences

AIM:To evaluate the efficacy of centralized culture and possible influencing factors.METHODS:From January 2010 to July 2012,66452 patients with suspected Helicobacter pylori(H.pylori) infection from 26 hospitals in Zhejiang and Jiangsu Provinces in China underwent gastrointestinal endoscopy.Gastric mucosal biopsies were taken from the antrum for culture.These biopsies were transported under natural environmental temperature to the central laboratory in Hangzhou city and divided into three groups based on their transport time:5,24 and 48 h.The culture results were reported after 72 h and the positive culture rates were analyzed by a χ2 test.An additional 5736 biopsies from H.pylori-positive patients(5646 rapid urease test-positive and 90 14C-urease breath test-positive) were also cultured for quality control in the central laboratory setting.RESULTS:The positive culture rate was 31.66%(21036/66452) for the patient samples and 71.72%(4114/5736) for the H.pylori-positive quality control specimens.In the 5 h transport group,the positiveculture rate was 30.99%(3865/12471),and 32.84%(14960/45553) in the 24 h transport group.In contrast,the positive culture rate declined significantly in the 48 h transport group(26.25%; P < 0.001).During transportation,the average natural temperature increased from 4.67 to 29.14℃,while the positive culture rate declined from 36.67%(1462/3987) to 24.12%(1799/7459).When the temperature exceeded 24℃,the positive culture rate decreased significantly,especially in the 48 h transport group(23.17%).CONCLUSION:Transportation of specimens within 24 h and below 24℃ is reasonable and acceptable for centralized culture of multicenter H.pylori samples.

可视穿刺经皮肾镜治疗肾盏憩室结石的临床研究

目的探讨可视穿刺经皮肾镜治疗肾盏憩室结石的安全性及临床价值。方法回顾性分析2016年3月-2019年3月采用可视穿刺针式肾镜治疗肾盏憩室结石的患者12例。其中,男7例,女5例;平均年龄(38.4±12.6)岁;憩室位于左肾7例,右肾5例,其中肾上盏憩室结石5例,肾中盏憩室结石3例,肾下盏憩室结石4例,憩室平均最大径(21.3±5.2)mm;结石平均最大径(18.3±4.2)mm。3例患者术前曾行体外冲击波碎石(ESWL)治疗,术中均“一针见石”建立经皮肾通道后碎石。结果12例患者均采用单通道,平均手术时间(54.4±23.3)min,术后住院时间(6.8±2.1)d。8例患者术后血红蛋白浓度下降,平均血红蛋白减少(9.8±4.3)g/L。12例患者均找到憩室管并扩张,1例患者术后出现发热,患者均未出现血气胸、肾周组织损伤等。术后第3天复查泌尿系平片,结石清除率达100.0%。10例患者术后4~10个月复查,8例患者憩室基本塌陷,2例憩室体积缩小达50.0%,憩室结石均无复发。结论使用可视穿刺经皮肾镜治疗肾盏憩室结石更加安全、有效,建立经皮肾通道具有成功率高、出血少、创伤小和患者术后恢复快等优点,值得临床进一步推广应用。

Preparation of Al2O3 nanowires on 7YSZ thermal barrier coatings against CMAS corrosion

The commonly-employed material for thermal barrier coatings(TBCs)is 7 wt.%Y2O3 ZrO2(7YSZ),generally deposited by electron beam-physical vapor deposition(EB-PVD).Due to the increasing demand for higher operating temperature in aero-derivative gas turbines,a lot of effort has been made to prevent the premature failure of columnar 7YSZ TBCs,which is induced by the microstructure degradation,sintering and spallation after the deposition of infiltrated siliceous mineral(consisting of calcium magnesium aluminum silicate(CaO MgO Al2O3 SiO2,i.e.,CMAS)).A new method called Al-modification for columnar 7YSZ TBCs against CMAS corrosion was present.The Al film was magnetron-sputtered on the surface of the columnar 7YSZ TBCs,followed by performing vacuum heat treatment of the Al-deposited TBCs.During the heat treatment,the molten Al reacted with ZrO2 to formα-Al2O3 overlay that effectively hindered CMAS infiltration.Moreover,the Al film could evaporate and re-nucleate,leading to the generation of Al2O3 nanowires,which further restrained the moving of molten CMAS.

Apoptosis of human colon carcinoma HT-29 cells induced by ceramide

AIM： To investigate the effect of exogenous ceramideinduced apoptosis on human colon carcinoma HT-29 cells. METHODS： Light microscope, transmission electron microscope and fluorescence microscope were used to observe the morphology change of apoptosis in HT-29 cells. Agarose gel electrophoresis was performed to detect the DNA fragment. Mitochondrial function was detected by MTT assay, mRNA expression of Bcl-2 family gene members was determined by reverse transcription polymerase chain reaction （RT-PCR） assay. RESULTS： After C2-ceramide treatment, typical characteristics of apoptosis, such as nuclear chromatin breakage, apoptotic body and DNA ladder, could be observed. After exposure to 50μmol/L C2-ceramide for 12 and 24 h, cell apoptosis was 64.1% and 81.3% respectively, which had a time-and dose-effect relationship. Mitochondrial function started to decrease from 6 h after exposure to ceramide. Meanwhile, ceramide up-regulated or down-regulated the mRNA expression of Bcl-2 family gene members. CONCLUSION： Ceramide induces apoptosis of human colon carcinoma HT-29 cells by affecting the expression of Bcl-2 family gene members and impacting the mitochondrial function.

Rare variant of pancreaticobiliary maljunction associated with pancreas divisum in a child diagnosed and treated by endoscopic retrograde cholangiopancreatography: A case report

BACKGROUND Pancreaticobiliary maljunction(PBM) is an uncommon congenital anomaly of the pancreatic and biliary ductal system, defined as a union of the pancreatic and biliary ducts located outside the duodenal wall. According to the Komi classification of PBM, the common bile duct(CBD) directly fuses with the ventral pancreatic duct in all types. Pancreas divisum(PD) occurs when the ventral and dorsal ducts of the embryonic pancreas fail to fuse during the second month of fetal development. The coexistence of PBM and PD is an infrequent condition.Here, we report an unusual variant of PBM associated with PD in a pediatric patient, in whom an anomalous communication existed between the CBD and dorsal pancreatic duct.CASE SUMMARY A boy aged 4 years and 2 mo was hospitalized for abdominal pain with nausea and jaundice for 5 d. Abdominal ultrasound showed cholecystitis with cholestasis in the gallbladder, dilated middle-upper CBD, and a strong echo in the lower CBD, indicating biliary stones. The diagnosis was extrahepatic biliary obstruction caused by biliary stones, which is an indication for endoscopic retrograde cholangiopancreatography(ERCP). ERCP was performed to remove biliary stones. During the ERCP, we found a rare communication between the CBD and dorsal pancreatic duct. After clearing the CBD with a balloon, an 8.5 Fr 4-cm pigtail plastic pancreatic stent was placed in the biliary duct through the major papilla. Six months later, his biliary stent was removed after he had no symptoms and normal laboratory tests. In the following 4-year period, the child grew up normally with no more attacks of abdominal pain.CONCLUSION We consider that ERCP is effective and safe in pediatric patients with PBM combined with PD, and can be the initial therapy to manage such cases,especially when it is combined with aberrant communication between the CBD and dorsal pancreatic duct.

Effects of 530 nm monochromatic light on basic fibroblast growth factor and transforming growth factor-β1 expression in Müller cells

AIMTo expose rat retinal M&#x000fc;ller cells to 530 nm monochromatic light and investigate the influence of varying light illumination times on basic fibroblast growth factor (bFGF) and transforming growth factor-&#x003b2;1 (TGF-&#x003b2;1) expression.METHODSThree groups of rat retinal M&#x000fc;ller cells cultured in vitro under a 530 nm monochromatic light were divided into 6, 12 and 24h experimental groups, while cells incubated under dark conditions served as the control group. The bFGF and TGF-&#x003b2;1 mRNA expression, protein levels and fluorescence intensity of the M&#x000fc;ller cells were analyzed.RESULTSThe bFGF mRNA expression and protein levels were significantly upregulated in M&#x000fc;ller cells in all three experimental groups compared with the control group (P&#x0003c;0.05), while that of TGF-&#x003b2;1 was downregulated (P&#x0003c;0.05). Also, bFGF expression was positively correlated, but TGF-&#x003b2;1 expression was negatively correlated with illumination time. The largest changes for both cytokines were seen in the 24h group. The changes in bFGF and TGF-&#x003b2;1 fluorescence intensity were highest in the 24h group, and significant differences were observed among the experimental groups (P&#x0003c;0.05).CONCLUSIONThe expressions of bFGF and TGF-&#x003b2;1 changed in a time-dependent manner in M&#x000fc;ller cells exposed to 530 nm monochromatic light with 250 lx illumination intensity. M&#x000fc;ller cells might play a role in the development of myopia by increasing bFGF expression or decreasing TGF-&#x003b2;1 expression. Changes in cytokine expression in retinal M&#x000fc;ller cells may affect monochromatic light-induced myopia.

Endoscopic submucosal tunnel dissection of upper gastrointestinal submucosal tumors: A comparative study of hook knife vs hybrid knife

AIM to compare the efficacy and safety of a hook knife(HO) with a hybrid knife(HK) during endoscopic submucosal tunnel dissection(EStD) procedure.METHODS Between August 2012 and December 2015, the ESt D procedure was performed for 83 upper GI submucosal lesions, which originated from the muscularis propria layer identified by upper endoscopy and endoscopic ultrasonography. Of these, 34 lesions were treated by a HO, whereas 49 lesions were treated by a HK. Data regarding age, gender, presenting symptoms, tumor location and size, procedure time, complications, en bloc resection rate and others were analyzed and compared between the two groups.RESULTS there were no significant differences in the age, gender, presenting symptoms and tumor location between the two groups. EStD was successfully completed in all the patients, and no case was converted to laparoscopy. the mean procedure time was significantly shorter in the HK group than in the HO group(41.3 ± 20.3 min vs 57.2 ± 28.0 min, p = 0.004). the mean frequency of device exchange was 1.4 ± 0.6 in the HK group and significantly less than 3.3 ± 0.6 in the HO group(p < 0.001). the differences in tumor size and histopathological diagnoses were not significant between the two groups(p = 0.813, p = 0.363, respectively). Both groups had an equal en bloc resection rate and complete resection rate. Additionally, the complication rate was similar between the two groups(p = 0.901). During the follow-up, no recurrence occurred in either group.CONCLUSION We demonstrate for the first time that HO and HK do not differ in efficacy or safety, but HK reduces the frequency of device exchange and procedure time.

Corneal epithelial thickness analysis of forme fruste keratoconus with optical coherence tomography

AIM:To explore the significance of corneal epithelial thickness analysis in diagnosing early keratoconus.METHODS:There were 26 clinical keratoconus,21 forme fruste keratoconus,40 high corneal astigmatism(ΔK)and 40 low ΔK eyes involved in the study.Fourierdomain optical coherence tomography was used to measure the corneal epithelial thickness of four groups.The morphological features of topographic map and the thickness of corneal epithelial thinnest point were analyzed.The distribution curve of corneal epithelial thickness at 45°,90°,and 135° axial directions that are through the pupil center was also analyzed.One-way ANOVA was performed to compare the data.RESULTS:The topographic map of forme fruste keratoconus corneal epithelial thickness was uniformity shape;crater shape existed only in clinical keratoconus group;and central island shape mainly existed in highΔK group.The thinnest point of corneal epithelial thickness of forme fruste keratoconus group was significantly lower than that of low ΔK group(P=0.022).The thickness of corneal epithelium in the forme fruste keratoconus at 90°was thinner than that in the low astigmatism group at -1,and -2 mm points(P_(-1mm)=0.015,P_(-2mm)=0.036).CONCLUSION:The analysis of the thinnest point in forme fruste keratoconus corneal epithelium appears earlier than corneal epithelial remodeling.The topographic map of corneal epithelium in high ΔK eyes appears in central island shape,and can be used for the differential diagnosis of early keratoconus.

Negative methylation status of Vimentin predicts improved prognosis in pancreatic carcinoma

AIM: To determine the existence of a potential relationship between the methylation state of the Vimentin gene and its prognostic value in pancreatic cancer.

Corrosion behavior of electrodeposited Ni with normal and bimodal grain size distribution

The corrosion behavior of electrodeposited Ni with normal and bimodal grain size distribution was investigated.The microstructure of samples was researched by SEM,EBSD,TEM and XRD.The corrosion behavior was studied by potentiodynamic tests and electrochemical impedance.Nanocrystalline Ni with(100)and(111)textures was prepared by an electrodeposition method.The Ni samples with different grain size distributions and twins were then obtained by heat treatment of nanocrystalline Ni at different temperatures.The effect of grain size on corrosion behavior of the sample depends on the ability of the environment to passivate.In the case where passive film forms on the sample surface,the corrosion resistance of the sample increases with decreasing grain size.Conversely,the corrosion resistance decreases with decreasing grain size when there is no passivation.The corrosion behavior of samples with bimodal grain size distribution obeys the rule of mixture.

ERCP处理Caroli’s病合并胆道感染:1例案例报告和文献综述

背景 Caroli’s病是一种临床少见的先天性肝内胆管囊性扩张性疾病,继发肝内胆管结石和反复发作的胆管炎是该病的主要合并症,严重者可导致脓毒血症而危及生命.既往多采用外科手术的治疗方式,但是在急性感染期施行外科手术的并发症发生率和死亡率均较高.病例概述 1例中年男性患者因"腹痛伴畏寒、发热11h"来院就诊.患者11年前在外院确诊Caroli’s病,期间患者反复出现胆道感染,约6-10 mo发作一次,经保守治疗后好转.此次入院后先给予药物保守治疗,但患者的血象、体温未见明显好转.在保守治疗无效的情况下,我们成功施行了经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)下胆管取石术,患者痊愈后出院.结论对于内科保守治疗无效的Caroli’s病合并胆道感染者,ERCP不失为一种安全、可行、有效的处理方法.