Analysis of the Effect of Laparoscopic Versus Open Cholecystectomy in Patients with Cholelithiasis and the Effect on CRP and IL-1βLevels

Objective:To evaluate the therapeutic effect of laparoscopic cholecystectomy(LC)and open cholecystectomy(OC)on cholelithiasis.Methods:92 cases of cholelithiasis patients admitted to the hospital in the past 2 years were selected and grouped by random number table;the observation group was treated with LC;the reference group was treated with OC,and the inflammatory factor and other indexes were compared.Results:The total effective rate of the observation group was higher than that of the reference group,and the perioperative indexes were better than that of the reference group(P<0.05).Preoperatively,the C-reactive protein(CRP)and interleukin-1β(IL-1β)levels and immune function indexes of the two groups were compared,and no difference was seen(P>0.05).At 5 days postoperatively,the CRP and IL-1βlevels of the observation group were lower than those of the reference group,and the immune function indicators were higher than those of the reference group(P<0.05).The complication rate of the observation group was lower than that of the reference group(P<0.05).Conclusion:LC can increase the effective rate of cholelithiasis patients,improve their perioperative indexes,reduce the inflammatory response,protect patients’immune function,and ensure higher surgical safety.

Association of education with cholelithiasis and mediating effects of cardiometabolic factors:A Mendelian randomization study

BACKGROUND Education,cognition,and intelligence are associated with cholelithiasis occurrence,yet which one has a prominent effect on cholelithiasis and which cardiometabolic risk factors mediate the causal relationship remain unelucidated.AIM To explore the causal associations between education,cognition,and intelligence and cholelithiasis,and the cardiometabolic risk factors that mediate the associations.METHODS Applying genome-wide association study summary statistics of primarily European individuals,we utilized two-sample multivariable Mendelian randomization to estimate the independent effects of education,intelligence,and cognition on cholelithiasis and cholecystitis(FinnGen study,37041 and 11632 patients,respectively;n=486484 participants)and performed two-step Mendelian randomization to evaluate 21 potential mediators and their mediating effects on the relationships between each exposure and cholelithiasis.RESULTS Inverse variance weighted Mendelian randomization results from the FinnGen consortium showed that genetically higher education,cognition,or intelligence were not independently associated with cholelithiasis and cholecystitis;when adjusted for cholelithiasis,higher education still presented an inverse effect on cholecystitis[odds ratio:0.292(95%CI:0.171-0.501)],which could not be induced by cognition or intelligence.Five out of 21 cardiometabolic risk factors were perceived as mediators of the association between education and cholelithiasis,including body mass index(20.84%),body fat percentage(40.3%),waist circumference(44.4%),waist-to-hip ratio(32.9%),and time spent watching television(41.6%),while time spent watching television was also a mediator from cognition(20.4%)and intelligence to cholelithiasis(28.4%).All results were robust to sensitivity analyses.CONCLUSION Education,cognition,and intelligence all play crucial roles in the development of cholelithiasis,and several cardiometabolic mediators have been identified for prevention of cholelithiasis due to defects in each exposure.

Biliary complications associated with weight loss,cholelithiasis and choledocholithiasis

Biliary complications like cholelithiasis and choledocholithiasis are more common in bariatric surgery patients due to obesity and rapid weight loss.Patients with a body mass index>40 face an eightfold risk of developing cholelithiasis.Postbariatric surgery,especially after laparoscopic Roux-en-Y gastric bypass(LRYGB),30%of patients develop biliary disease due to rapid weight loss.The aim of this review is to analyze the main biliary complications that occur after bariatric surgery and its management.A review of the literature was conducted mainly from 2010 up to 2023 with regard to biliary complications associated with bariatric patients in SciELO,PubMed,and MEDLINE.Patients undergoing LRYGB have a higher incidence(14.5%)of symptomatic calculi post-surgery compared to those undergoing laparoscopic sleeve gastrectomy at 4.1%.Key biliary complications within 6 to 12 months post-surgery include:Cholelithiasis:36%;Biliary colic/dyskinesia:3.86%;Acute cholecystitis:0.98%-18.1%;Chronic cholecystitis:70.2%;Choledocholithiasis:0.2%-5.7%and Pancreatitis:0.46%-9.4%.Surgeons need to be aware of these complications and consider surgical treatments based on patient symptoms to enhance their quality of life.

Laparoscopic Surgery and Modified Xiaoyan Lidan Decoction:An Effective Combination for Treating Cholecystitis with Cholelithiasis

Objective:To assess the clinical effects of combining laparoscopic surgery with Modified Xiaoyan Lidan Decoction in patients diagnosed with cholecystitis and cholelithiasis.Methods:Following the guidelines of the double-blind method,86 cases of cholecystitis with cholelithiasis were randomly divided into two groups,each comprising 43 cases.Both groups underwent laparoscopic surgery,with the observation group additionally receiving Modified Xiaoyan Lidan Decoction.A comparative analysis was conducted on clinical treatment effectiveness,general observation indicators,Traditional Chinese Medicine(TCM)syndrome scores,and the occurrence of adverse reactions between the two groups.Results:The observation group demonstrated a significantly higher overall clinical treatment effectiveness compared to the control group(P<0.05).The clinical symptom improvement time and hospitalization time were shorter in the observation group,and the pain score and TCM syndrome score after treatment were lower than those in the control group(P<0.05).No statistically significant difference was observed in the total reaction values(P>0.05).Conclusion:The combined application of laparoscopic surgery and Modified Xiaoyan Lidan Decoction can enhance clinical treatment efficiency for patients with cholecystitis and cholelithiasis.It facilitates a quicker improvement in clinical symptoms without causing serious adverse reactions,suggesting its potential for widespread adoption.

改进YOLOv5su模型检测桃树缩叶病

为实现自然环境下桃树缩叶病的检测,该研究提出了一种基于YOLOv5su的桃树缩叶病识别改进模型DLLYOLOv5su。首先,针对桃树缩叶病目标特征变化较大的问题,在骨干网络最后一层C3模块中加入可变形自注意力模块(deformable attention,DA),使模型更加关注目标区域,降低背景对模型的影响,提高模型在复杂背景下的拟合能力。其次在SPPF(fast spatial pyramid pooling)模块中引入LSKA(large separable kernel attention)结构,大核卷积增大了模型的感受野,使模型能够关注更多信息。最后,提出了LAWD(lightweight adaptive weighted downsampling)模块,使用轻量化的下采样结构替换卷积模块,减少计算开销。在桃树缩叶病数据集上进行试验,结果显示,DLL-YOLOv5su模型权重大小为17.6 MB,检测速度为83帧/s。识别准确率P、召回率R和平均精度均值mAP_(50)分别达到了80.7%、73.1%和80.4%,相较于原始YOLOv5su分别提高了4.2、2.4和4.3个百分点。与YOLOv3-tiny、Faster R-CNN、YOLOv7和YOLOv8相比mAP_(50)分别高出了28.5、11.8、2.1和4.1个百分点。改进模型识别精度高,误检、漏检率低,检测速度满足实时检测的要求,可以为桃树缩叶病的实时监测和预警提供参考。

小麦SUS基因家族鉴定与生物信息学分析

【目的】对小麦蔗糖合成酶(sucrose synthase,SUS)基因家族进行鉴定和生物信息学分析,为探究小麦SUS(TaSUS)基因家族的作用机制提供理论参考。【方法】采用生物信息学方法在小麦全基因组上鉴定TaSUS基因家族成员,并对其系统进化关系、染色体位置、基因结构、保守结构域、启动子顺式作用元件和基因表达模式进行分析。【结果】在小麦基因组中共鉴定到分布于14条染色体上的24个TaSUS基因,可分为3个亚组。TaSUS基因含有多个外显子,但部分基因缺失非翻译区结构。TaSUS基因家族成员启动子区域包含45种顺式作用元件,涉及植物生长发育和逆境胁迫响应。大多数TaSUS基因在小麦穗中显著表达,在叶、茎和根中的相对表达量较低。【结论】研究结果有助于了解小麦SUS基因家族的进化,为后期小麦SUS基因家族的生物功能研究奠定理论基础。

Current management of concomitant cholelithiasis and common bile duct stones

The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one-or two-stage procedure.It basically includes either laparoscopic cholecystectomy(LC)with laparoscopic common bile duct(CBD)exploration(LCBDE)in the same operation or LC with preoperative,postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy(ERCP-ES)for stone clearance.The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC,preferably on the next day.In cases where preoperative ERCP-ES is not feasible,the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated.The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES.However,there is no consensus on the superiority of laparoendoscopic rendezvous.This is equivalent to a traditional two-stage procedure.Endoscopic papillary large balloon dilation reduces recurrence.LCBDE and intraoperative ERCP have similar good outcomes.The risk of recurrence after ERCP-ES is greater than that after LCBDE.Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones.The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage,but the transcystic approach must be used where possible.LCBDE is a safe and effective choice when performed by an experienced surgeon.However,the requirement of specific equipment and advanced training are drawbacks.The percutaneous approach is an alternative when ERCP fails.Surgical or endoscopic reintervention for retained stones may be needed.For asymptomatic CBD stones,ERCP clearance is the firstchoice method.Both one-stage and two-stage management are acceptable and can ensure improved quality of life.

Improvement of inflammatory response and gastrointestinal function in perioperative of cholelithiasis by Modified Xiao-Cheng-Qi decoction

BACKGROUND In the perioperative period of biliary surgery,various factors can induce the release of a large number of inflammatory factors,leading to an imbalance in proinflammatory and anti-inflammatory responses and resulting in gastrointestinal(GI)dysfunction.Enhanced Recovery After Surgery protocols in biliary surgery have been shown to reduce the stress response and accelerate postoperative recovery.It is crucial to reduce the inflammatory response and promote the recovery of GI function after biliary surgery,both of which are the basis and key for perioperative care and postoperative recovery.AIM To better understand the effects of Modified Xiao-Cheng-Qi decoction(MXD)on inflammatory response and GI function in the perioperative management of cholelithiasis and their correlation.METHODS This was a prospective randomized placebo-controlled trial,in which 162 patients who received biliary tract surgery were randomly assigned to three groups:MXD group,XD group,and placebo-control group.The observed parameters included frequency of bowel sounds,time of first flatus and defecation,time of diet,and amount of activity after surgery.The serum levels of C-reactive protein(CRP),interleukin(IL)-6,IL-10,serum amyloid A protein(SAA),and substance P were measured by the enzyme-linked immunosorbent assay.Then,the spearman correlation coefficient was used to analyze the relationship between the indicators of GI function and inflammation.RESULTS Compared to the placebo-control,improvements in GI function were observed in the MXD groups including reduced incidence of nausea,vomiting,and bloating;and earlier first exhaust time,first defecation time,and feeding time after surgery(P<0.05).On the 1st and 2nd d after surgery,IL-6,CRP and SAA levels in MXD group were lower than that in placebo control,but substance P level was higher,compared to the control(P<0.05).Functional diarrhea occurred in both MXD and XD groups without any other adverse effects,toxic reactions,and allergic reactions.Diarrhea was relieved after the discontinuation of the investigational remedies.Bowel sounds at 12 h after surgery,the occurring time of the first flatus,first defecation,postoperative liquid diet and semiliquid diet were significantly correlated with levels of IL-6,CRP,SAA and substance P on second day after surgery(P<0.05).CONCLUSION Treatment with MXD can relieve inflammatory response and improve GI function after surgery.Moreover,there are significant correlations between them.Furthermore,it does not cause serious adverse reactions.

温度对SUS410/BNi-2/Hastelloy X钎焊接头界面组织及力学性能的影响

目的针对汽封部件的高质量制造需求,系统研究了温度对SUS410/BNi-2/Hastelloy X钎焊接头微观组织及力学性能的影响。方法将以SUS410/BNi-2/Hastelloy X搭接结构装配的试样放入真空炉中在不同温度(1060~1140℃)下进行钎焊连接,利用SEM和EDS等手段分析钎料与母材之间的相互作用,测试接头的力学性能并分析接头断裂行为,研究温度对接头界面组织演化和力学性能的影响。结果钎缝主要由Ni(s,s)与Cr-B相组成,B元素扩散进入两侧母材,在晶界处聚集形成硼化物相。随着钎焊温度的升高,钎缝中富Cr的硼化物和浅灰色Ni(s,s)相消失,形成均匀的Ni(s,s)组织,两侧母材中B元素扩散深度增加。随着钎焊温度不断升高,钎焊接头的抗剪强度逐渐上升,上升到某一强度后,温度继续升高,但强度反而下降,断裂位置由钎缝中心先转移至Hastelloy X基体,随着温度继续升高,断裂位置又转移至SUS410扩散区。断裂形式由脆性断裂转变为韧性断裂。结论采用BNi-2黏带钎料实现了SUS410与Hastelloy X合金的可靠连接,接头典型界面组织为SUS410/扩散区((Fe,Cr)+(Fe,Cr)-B)/钎缝区(Ni(s,s)+Cr-B+β_(1)-phases)/扩散区(γ-phase+(Cr,Ni)-B+(Cr,Ni,Mo)-B)/Hastelloy X;钎焊接头的最大抗剪强度为235.6 MPa(1100℃)。

Pulsed current-assisted twelve-roll precision rolling deformation of SUS304 ultra-thin strips with exceptional mechanical properties

Innovative pulsed current-assisted multi-pass rolling tests were conducted on a 12-roll mill during the rolling deformation processing of SUS304 ultra-thin strips.The results show that in the first rolling pass,the rolling reduction rate of a conventionally rolled sample(at room temperature)is 33.8%,which can be increased to 41.5%by pulsed current-assisted rolling,enabling the formation of an ultra-thin strip with a size of 67.3μm in only one rolling pass.After three passes of pulsed current-assisted rolling,the thickness of the ultra-thin strip can be further reduced to 51.7μm.To clearly compare the effects of a pulsed current on the microstructure and mechanical response of the ultra-thin strip,ultra-thin strips with nearly the same thickness reduction were analyzed.It was found that pulsed current can reduce the degree of work-hardening of the rolled samples by promoting dislocation detachment,reducing the density of stacking faults,inhibiting martensitic phase transformation,and shortening the total length of grain boundaries.As a result,the ductility of ultra-thin strips can be effectively restored to approximately 16.3%while maintaining a high tensile strength of 1118 MPa.Therefore,pulsed current-assisted rolling deformation shows great potential for the formation of ultra-thin strips with a combination of high strength and ductility.

Research Progress of Ethnic Medicine in the Treatment of Cholelithiasis

In a broad sense, ethnic medicine includes Han traditional Chinese medicine, folk medicine and ethnic minority medicine;ethnic medicine in a narrow sense refers to ethnic minority medicine. It is a medicine developed by ethnic minorities in order to survive and reproduce and in the process of fighting diseases. Culture, based on its own language, life experience and cultural traditions, has its own understanding and theoretical system of disease naming, etiology and pathogenesis, treatment principles and treatment methods, which is a major feature of my country’s medical care. Among them, ethnic medicine has unique advantages and good clinical efficacy in the prevention and treatment of cholelithiasis. Therefore, this paper focuses on summarizing the characteristic theories and diagnosis and treatment experience of Tibetan medicine, Mongolian medicine, Miao medicine, Yao medicine, and Beijing medicine in ethnic medicine by sorting out and summarizing the relevant materials in this regard, so as to provide new ideas for improving the treatment of cholelithiasis and enriching clinical drug selection.

SU电器产品的差异化营销策略研究

文章围绕SU电器平台展开差异化营销策略优化探讨,通过深入分析SU电器平台的市场定位和发展现状,提出了针对性优化建议。SU电器应充分利用自身资源优势,通过提升产品品质和服务水平,加强品牌宣传和推广,探索多元化的渠道拓展方式,以形成规模效应,提升市场竞争力。同时,SU电器还应注重市场变化和消费者需求的变化,持续优化营销策略,实现可持续发展。

SUS321不锈钢表面Cr/CrN涂层的制备与抗氧化及耐腐蚀研究

采用磁控溅射技术,在SUS321不锈钢表面制备Cr/Cr N涂层,利用扫描电子显微镜(SEM)、X射线衍射仪(XRD)及分析天平等分别表征样品高温氧化及酸性盐雾腐蚀实验后的微结构及增重。结果表明,当磁控溅射气体分压比为P_(Ar)/P_(N_(2))=3∶1的涂层样品抗氧化性能及耐腐蚀性能最佳。在此基础上通过循环沉积制备了多层Cr/CrN涂层,6周期涂层样品在600℃氧化200 h后的单位面积增重为3.599 g/m^(2),表面氧化膜致密,没有出现剥落现象;6周期的涂层样品在酸性盐雾环境中能够保持480 h表面无变化,在放置500 h后边缘部位才开始出现轻微锈迹。固定磁控溅射气体分压比为P_(Ar)/P_(N_(2))=3∶1时,制备的6周期Cr/CrN多层膜涂层具有最佳的抗氧化及耐酸性盐雾腐蚀性能。

从小米SU7爆火看雷军十八般营销武艺

近日,小米汽车SU7重磅发布,根据小米汽车官方信息,4分钟内完成大定10000辆,27分钟实现50000辆,24小时达88898辆。小米汽车旗开得胜,它像鲶鱼一样,无形中搅动了新能源汽车市场。雷军的营销能力有目共睹,这一仗让他再创辉煌。小米汽车面世用到了18个经典营销原理,其具体做法对营销人员具有借鉴意义。

SuperPATH入路与MDAA入路在老年患者髋关节置换术中的应用价值

【目的】探讨改良直接前方入路(MDAA)与SuperPATH入路在老年患者髋关节置换术中的应用价值。【方法】选取2020年7月至2023年7月在河南省洛阳正骨医院(河南省骨科医院)行髋关节置换术的104例老年患者,根据治疗方法不同分为观察组(采用SuperPATH入路髋关节置换术,n=54)和对照组(采用MDAA入路髋关节置换术,n=50)。比较两组手术相关指标、Harris髋关节功能评分、患侧髋臼杯前倾角和外展角、疼痛程度评分、并发症发生率及白细胞介素-6(IL-6)、去甲肾上腺素(NE)、醛固酮(ALD)水平。【结果】观察组患者手术时间及术后首次下床活动时间均短于对照组(P<0.05),术中切口长度短于对照组(P<0.05)。术后1周、术后1个月,观察组髋关节功能评分高于对照组(P<0.05)。术后1个月,观察组患侧髋臼杯外展角小于对照组(P<0.05)。术后1周,观察组疼痛程度评分低于对照组(P<0.05)。术后24 h,两组IL-6、NE、ALD均升高,但观察组低于对照组(P<0.05)。两组股外侧皮神经损伤发生率比较,差异无统计学意义(P>0.05)。【结论】MDAA入路与SuperPATH入路应用于老年患者髋关节置换术中,可促进患者髋关节功能恢复,安全性均良好,但SuperPATH入路术式,可缩短术中切口长度,缩小术后患侧髋臼外展角,提升术后髋关节功能,减轻患者术后疼痛。

厚壁SUS321焊接工艺研究

SUS321是含有稳定化元素Ti的奥氏体型不锈钢,在锅炉和石化容器产品中有着广泛应用。厚壁SUS321在应用中较为少见,其埋弧焊焊接工艺的应用及厚壁条件下的试板成形需要经过验证,其各项性能也需得到保证。通过焊接工艺试验,对厚壁SUS321不锈钢试板进行工艺性检验,并对试板进行力学性能、微观组织等检验。最终证明用于厚壁SUS321国产埋弧焊焊丝工艺性良好,各项性能均满足使用要求。

SUS430LX冷弯裂纹缺陷分析与控制

冷弯开裂是一种材料加工性能类缺陷,针对SUS430LX冷弯开裂缺陷,采用扫描电镜和能谱分析检测了冷弯部位及基体析出相情况。从检测分析结果来看,析出相是引起冷弯开裂的主要原因。围绕断面不同位置析出相的特点,对影响析出相尺寸、数量及类型的主要因素进行了讨论,并提出优化方向。

Liver fat accumulation measured by high-speed T2-corrected multiecho magnetic resonance spectroscopy can predict risk of cholelithiasis

BACKGROUND Liver fat accumulation is associated with increased cholesterol synthesis and hypersecretion of biliary cholesterol,which may be related to the development of cholelithiasis.AIM To investigate whether liver fat accumulation measured by high-speed T2-corrected multi-echo magnetic resonance spectroscopy(MRS)is a risk factor for cholelithiasis.METHODS Forty patients with cholelithiasis and thirty-one healthy controls were retrospectively enrolled.The participants underwent high-speed T2-corrected multi-echo single-voxel MRS of the liver at a 3T MR scanner.The proton density fat fraction(PDFF)and R2 value were calculated.Serum parameters and waist circumference(WC)were recorded.Spearman’s correlation analysis was used to analyze the relationship between PDFF,R2,and WC values.Multivariate logistic regression analysis was carried out to determine the significant predictors of the risk of cholelithiasis.Receiver operating characteristic curve(ROC)analysis was used to evaluate the discriminative performance of significant predictors.RESULTS Patients with cholelithiasis had higher PDFF,R2,and WC values compared with healthy controls(5.8%±4.2%vs 3.3%±2.4%,P=0.001;50.4±24.8/s vs 38.3±8.8/s,P=0.034;85.3±9.0 cm vs 81.0±6.9 cm,P=0.030;respectively).Liver iron concentration extrapolated from R2 values was significantly higher in the cholelithiasis group(2.21±2.17 mg/g dry tissue vs 1.22±0.49 mg/g dry tissue,P=0.034)than in the healthy group.PDFF was positively correlated with WC(r=0.502,P<0.001)and R2(r=0.425,P<0.001).Multivariate logistic regression analysis showed that only PDFF was an independent risk factor for cholelithiasis(odds ratio=1.79,95%CI:1.22-2.62,P=0.003).ROC analysis showed that the area under the curve of PDFF was 0.723 for discriminating cholelithiasis from healthy controls,with a sensitivity of 55.0%and specificity of 83.9%when the cut-off value of PDFF was 4.4%.CONCLUSION PDFF derived from high speed T2-corrected multi-echo MRS can predict the risk of cholelithiasis.

日本SUS630不锈钢洁净度分析

本文对日本某钢厂模铸生产的两种传感器用SUS630不锈钢进行了洁净度分析。结果表明:SUS630不锈钢棒材中夹杂物类型主要为氧化物O-Al-Ca-Mg,少部分夹杂物为O-Al-Ca-Mg-S;SUS630不锈钢板材中夹杂物类型主要为氧化物O-Mg-Al-Si-Mn,少部分夹杂物为O-Mn-Al-Si-Ti、O-Mn-Si-Al-Ca;它们的夹杂物形貌均为球形或近球形。棒材、板材中夹杂物密度、平均等效直径、面积占比分别为:26/mm^(2)、3.1μm、0.024%,以及:29/mm^(2)、2.3μm、0.013%;棒材的夹杂物评级结果为细系B1.0、细系D1.0,板材的夹杂物评级结果为细系B0.5、细系D1.0,两材料的洁净度整体控制水平较高;此外,钢中还存在超细微Nb(C,N)夹杂物。

SUS441不锈钢/Al金属间化合物微叠层复合板的界面结构与力学性能

采用“表面预处理—交替层叠—热轧复合—热处理”的工艺流程制备了SUS441不锈钢/Al金属间化合物微叠层复合板。利用光学显微镜、X射线衍射仪、扫描电子显微镜等检测与表征方法研究了热处理温度对复合板界面形貌、微观组织、物相组成、维氏硬度、拉伸性能的影响。结果表明:复合板界面结合良好;热处理后,固–液反应界面氧化严重,易导致界面分层而开裂;固–固、固–半固、固–液热处理后,金属间化合物层由均匀层和两相层组成,均匀层的物相组成为Fe_(2)A_(15),两相层的物相组成为Fe_(4)Al_(13)和Al_(13)Cr_(2),且两相层具有韧性特征,固–半固反应所得到的复合板的综合力学性能最佳。