Type I Mirizzi syndrome treated by electrohydraulic lithotripsy under the direct view of SpyGlass:A case report

BACKGROUND Mirizzi syndrome is an uncommon clinical complication for which the available treatment options mainly include open surgery,laparoscopic surgery,endoscopic retrograde cholangiopancreatography(ERCP),electrohydraulic lithotripsy,and laser lithotripsy.Here,a patient diagnosed with type I Mirizzi syndrome was treated with electrohydraulic lithotripsy under SpyGlass direct visualization,which may provide a reference to explore new treatments for Mirizzi syndrome.CASE SUMMARY This paper describes a middle-aged female patient with suspected choledocholithiasis who complained for over 1 mo of intermittent abdominal pain,dark yellow urine,jaundice,and was proposed to undergo ERCP lithotomy.Mirizzi syndrome was found during the operation and confirmed by SpyGlass.Electrohydraulic lithotripsy was performed under the direct vision of SpyGlass.After the lithotripsy,the stones were extracted using the stone extraction basket and balloon.After the operation,the patient developed transient hyperamylasemia.Through a series of symptomatic treatments(such as fasting,fluids and antiinflammation medications),the symptoms of the patient improved.Finally,laparoscopic cholecystectomy or open cholecystectomy was performed after a half-year post-operatively.CONCLUSION Direct visualization-guided laser or electrohydraulic lithotripsy with SpyGlass is feasible and minimally invasive for type I Mirizzi syndrome without apparent unsafe outcomes.

PNPLA3 rs738409 underlies treatment response in nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)has now become the leading cause of chronic liver disease with its growing incidence worldwide.Patatin-like phospholipase domain-containing protein 3(PNPLA3)rs738409 C>G reflects one of the critical genetic factors that confers high-risk to NAFLD.However,the role of PNPLA3 polymorphism in NAFLD treatment remains uncertain.Here,the present review reveals that NAFLD patients with G-allele at PNPLA3 rs738409(PNPLA3 148M variant)are sensitive to therapies of lifestyle modification,dipeptidyl peptidase-4 inhibitors,and bariatric surgery.They exhibit much significant reduction of liver fat content,in concurrence with weigh loss and abolished insulin resistance,as compared to those of C-allele carriers.In contrast,patients bearing PNPLA3 rs738409 C-allele(PNPLA3 148I variant),instead of G-allele,demonstrate greater beneficial effects by omega-3 poly-unsaturated fatty acids and statin intervention.Improved adipose tissue-liver interaction and decrease in intrahepatic triglyceride efflux may contribute to the PNPLA3 rs738409related diversities in therapeutic efficacy.Therefore,PNPLA3 rs738409 underlies the response to a variety of treatments,which warrants a personalized,precise medicine in NAFLD on the basis of genotype stratification.

Additive effects of warming and grazing on fine-root decomposition and loss of nutrients in an alpine meadow

Fine-root decomposition is a critical process regulating ecosystem carbon cycles and affecting nutrient cycling and soil fertility.However,whether interaction between warming and grazing affects fine-root decomposition is still under-researched in natural grasslands.A two-factorial experiment with asymmetric warming(i.e.daytime vs.nighttime and growing season vs.nongrowing season)and moderate grazing(i.e.about average 50%forage utilization rate)was conducted to explore whether warming and grazing affect fine-root decomposition and loss of nutrients during a 2-year decomposition period in an alpine meadow on the Tibetan Plateau.Both warming and grazing facilitated carbon cycling through increase in fine-root decomposition,and influenced element cycling which varies among elements.The effects of warming and grazing on fine-root decomposition and loss of nutrients were additive.Both warming and grazing significantly increased cumulative percentage mass loss and total organic carbon loss of fine roots during the 2-year experiment.Only warming with grazing treatment reduced percentage nitrogen loss,whereas warming,regardless of grazing,decreased percentage phosphorus loss.Warming and grazing alone increased percentage loss of potassium,sodium,calcium and magnesium compared with control.There were no interactions between warming and grazing on fine-root decomposition and loss of nutrients.There was greater temperature sensitivity of decreased phosphorus loss than that of decreased nitrogen loss.Different temperature sensitivities of percentage loss of nutrients from fine-root decomposition would alter ratios of the available nutrients in soils,and may further affect ecosystem structure and functions in future warming.