Outcomes of laparoscopic bile duct exploration for choledocholithiasis with small common bile duct

BACKGROUND Laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct(CBD)exploration(LCBDE)is one of the main treatments for choledocholithiasis with CBD diameter of larger than 10 mm.However,for patients with small CBD(CBD diameter≤8 mm),endoscopic sphincterotomy remains the preferred treatment at present,but it also has some drawbacks associated with a series of complications,such as pancreatitis,hemorrhage,cholangitis,and duodenal perforation.To date,few studies have been reported that support the feasibility and safety of LCBDE for choledocholithiasis with small CBD.AIM To investigate the feasibility and safety of LCBDE for choledocholithiasis with small CBD.METHODS A total of 257 patients without acute cholangitis who underwent LC+LCBDE for cholecystolithiasis from January 2013 to December 2018 in one institution were reviewed.The clinical data were retrospectively collected and analyzed.According to whether the diameter of CBD was larger than 8 mm,257 patients were divided into large CBD group(n=146)and small CBD group(n=111).Propensity score matching(1:1)was performed to adjust for clinical differences.The demographics,intraoperative data,short-term outcomes,and long-term follow-up outcomes for the patients were recorded and compared.RESULTS In total,257 patients who underwent successful LC+LCBDE were enrolled in the study,146 had large CBD and 111 had small CBD.The median follow-up period was 39(14-86)mo.For small CBD patients,the median CBD diameter was 0.6 cm(0.2-2.0 cm),the mean operating time was 107.2±28.3 min,and the postoperative bile leak rate,rate of residual CBD stones(CBDS),CBDS recurrence rate,and CBD stenosis rate were 5.41%(6/111),3.60%(4/111),1.80%(2/111),and 0%(0/111),respectively;the mean postoperative hospital stay was 7.4±3.6 d.For large CBD patients,the median common bile duct diameter was 1.0 cm(0.3-3.0 cm),the mean operating time was 115.7±32.0 min,and the postoperative bile leak rate,rate of residual CBDS,CBDS recurrence rate,and CBD stenosis rate were 5.41%(9/146),1.37%(2/146),6.85%(10/146),and 0%(0/146),respectively;the mean postoperative hospital stay was 7.7±2.7 d.After propensity score matching,184 patients remained,and all preoperative covariates except diameter of CBD stones were balanced.Postoperative bile leak occurred in 11 patients overall(5.98%),and no difference was found between the small CBD group(4.35%,4/92)and the large CBD group(7.61%,7/92).The incidence of CBDS recurrence did not differ significantly between the small CBD group(2.17%,2/92)and the large CBD group(6.52%,6/92).CONCLUSION LC+LCBDE is safe and feasible for choledocholithiasis patients with small CBD and did not increase the postoperative bile leak rate compared with choledocholithiasis patients with large CBD.

Article History Investigation and analysis of the quality of life of centenarians in Chongming area of Shanghai

Objective:To investigate the status quo and influencing factors of the quality of life of the elderly aged≥100 years old in Chongming area of Shanghai,and provide a basis for the construction of a world-class ecological island in Chongming area and promote the cause of healthy aging.Methods:A cross-sectional survey was conducted to screen 71 elderly people who were 100 years old and reached the age of 100.The interview was conducted with a face-to-face questionnaire survey.Results:The SF-36 health questionnaire of the centenarians in Chongming area scored and in the physiological functions,physiological functions,physical pain,general health status,energy,social function,emotional function and mental health is(36.35±13.45),(36.62±38.69),(62.56±21.57),(47.04±6.06),(67.23±18.76),(71.83±25.85),(60.09±45.29),(78.70±22.20).The total physical health assessment and mental health assessment scores are(181.577±50.271)and(277.855±81.636).Univariate statistics show that different genders,education levels,marital status,economic sources,urban or rural areas,insurance categories,chronic diseases,number of children,old-age patterns,preferred forms of residence,interval between child care,and whether children are in the same city Factors such as≥2 in the family,long-term diet,diet,eating habits,drinking habits,tea drinking habits,physical examination,lack of sleep 4h,nap habits and other factors in the different dimensions of the SF-36 scale,the difference is statistically significant(P<0.05);multivariate stepwise regression showed that the relevant influencing factors were pension mode,dietary preference,location(urban/rural),chronic disease,preferred lifestyle,lack of sleep 4 h,education level,marital status(P<0.05).Conclusion:The centenarians in Chongming area have a medium quality of life rating and a high overall mental health assessment.The centenarians in Chongming have a good psychological state.The life behavior pattern of the centenarians is worth learning.It is recommended to implement the family mutual aid public service project to alleviate the problem of loneliness of the elderly.It is recommended to strengthen the chronic disease health management for the elderly,encourage regular medical examinations,and promote the improvement of the old-age care.

Complete mitochondrial DNA sequence analysis in two southern Chinese pedigrees with Leber hereditary optic neuropathy revealed secondary mutations along with the primary mutation

AIM: To investigate mitochondrial factors associated with Leber hereditary optic neuropathy (LHON) through complete sequencing and analysis of the mitochondrial genome of Chinese patients with this disease. METHODS: Two unrelated southern Chinese families with LHON and 10 matched healthy controls were recruited, and their entire mitochondrial DNA (mtDNA) was amplified and sequenced with the universal M13 primer. Then DNA sequence analysis and variation identification were performed by DNAssist and Chromas 2 software and compared with authoritative databases such as Mitomap. RESULTS: Mutational analysis of mtDNA in these two Chinese pedigrees revealed one common LHON-associated mutation, G11778A (Arg -> His), in the MT-ND4 gene. In addition, there were two secondary mutations in Pedigree 1: C34971 (Ala -> Val), and C3571T (Leu -> Phe) in the MT-ND1 gene, which have not been reported; and two secondary mutations occurred in Pedigree 2: A10398G (Thr -> Ala) in the MT-ND3 gene, and T14502C (Ile -> Val) in the MT-ND6 gene. Three polymorphisms, A73G, G94A and A263G in the mtDNA control region, were also found. CONCLUSION: Our study confirmed that the known MT-ND4* G11778A mutation is the most significant cause of LHON. The C3497T and C3571T mutations in Pedigree 1 were also both at hot-spots of MT-ND1; they may affect the respiratory chain in coordination with the primary mutation G11778A. In Pedigree 2, the two secondary mutations A10398G of MT-ND3 and T14502C of MT-ND6 may influence mitochondrial respiratory complex I, leading to the mitochondrial respiratory chain dysfunction which results in optic atrophy together with G11778A. Therefore, not only the common primary LHON mutation is responsible for the visual atrophy, but other secondary mtDNA mutations should also be considered when giving genetic counseling.

Brusatol:A potential anti-tumor quassinoid from Brucea javanica

Brusatol,a triterpene lactone compound mainly from Brucea javanica,sensitizes a broad spectrum of cancer cells.It is known as a specific inhibitor of nuclear factor-erythroid 2-related factor 2(Nrf2)pathway.In this review,we provide a comprehensive overview on the antitumor effect and molecular mechanisms of brusatol in vitro and in vivo.This review also covers pharmacokinetics studies,modification of dosages forms of brusatol.Increasing evidences have validated the value of brusatol as a chemotherapeutic agent in cancers,which may contribute to drug development and clinical application.

Low-temperature synthesis of SiC nanowires with Ni catalyst

SiC nano wires were fabricated on the silicon substrate dipped with a layer of Ni catalyst at 900 ℃ by gas pressure annealing processing. The morphologies and crystal structures were determined by scanning electron microscopy(SEM), transmission electron microscopy(TEM)and X-ray diffraction(XRD). The results show that the assynthesized nanowires are β-SiC single crystalline with diameter range of 50-100 nm, and length of tens of micron by directly annealing at 900 ℃. The SiC nano wires grow along the [111] direction with highly uniform morphology. And the possible growth mechanism of SiC nano wires is proposed.The present work provides an efficient strategy for the production of high-quality SiC nano wires.

Quassinoids from the Root Barks of Ailanthus altissima:Isolation,Configurational Assignment,and Cytotoxic Activities

Main observation and conclusion Quassinoids,a class of highly oxygenated triterpenes,have been isolated as bitter principles from the plants of Simaroubaceae family.Five new quassinoids,chouchunlactone A-E(1-5),and two known ones were identified from the root barks of Ailanthus altissima Swingle(Simaroubaceae).The chemical structures of the new compounds were deduced by spectroscopic data analyses,NMR calculations and DP4+probability analysis.The absolute configurations were defined by comparison of their experimental and calculated electronic circular dichroism(ECD)spectra data,and compounds 1-2 were further confirmed by single-crystal X-ray diffraction.Biologically,compound 5 showed potencies equivalent to sorafenib(IC50 value,9.70μmol·L–1)against HepG2 cells.The Hoechst 33342 staining,JC-1 fluorescent dye and Annexin V/PI analysis studies demonstrated that 5 can induce apoptosis and attenuate mitochondrial membrane potential(MMP)in HepG2 cells.

Isolation of chemical compositions as dietary antioxidant supplements and neuroprotectants from Chaga mushroom (Inonotus obliquus)

Excessive free radicals can cause oxidative stress (OS),which lead to neurodegenerative diseases (ND) are harmful to the human body.Therefore,it is necessary to explore dietary antioxidants and neuroprotectants from nutrient foods.Chaga mushroom (Inonotus obliquus ) has been used as an important functional food in many countries for centuries.This present study was carried out to discover active compounds from I.obliquus and investigate the in vitro antioxidant activity and neuroprotective activity.Sixteen natural products including two new isocoumarins (1 –2 ),a new 8-O -4′-neolignan (3 ),a new cyclic diarylheptanoid (4 ),and twelve known compounds (5 –16 ) were separated from I.obliquus .Their structures were elucidated by extensive spectroscopic analyses of high resolution electrospray mass spectrometry (HRESIMS),ultra violet (UV),and nuclear magnetic resonance (NMR).Among them,compounds 1 and 2 revealed remarkable antioxidant activities through the comprehensive analysis of DPPH,ABTS,and ferric reducing antioxidant power (FRAP) methods.Meanwhile,compound 1 demonstrated significant neuroprotective activity by increasing SH-SY5Y cells viability and preventing mitochondrial damage.Apart from that,electronic analyses were performed using the highest occupied molecular orbital (HOMO),and the lowest unoccupied molecular orbital (LUMO) to analyze compound 1 .These results indicated that compound 1 had a significant implication for the search of natural raw material to prevent OS and nerve damage in the field of functional foods,and the isocoumarin fragment as well as an oxygenated cis double-bond might be the active sites to play prominent parts in antioxidant and neuroprotective activities of compound 1 .