Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: A propensity scorematched analysis

BACKGROUND During emergency endoscopic retrograde cholangiopancreatography(ERCP),the safety and feasibility of performing one-stage endoscopic treatment for patients with acute cholangitis(AC)due to choledocholithiasis are unclear.AIM To investigate the safety and feasibility of one-stage endoscopic treatment for moderate to severe AC.METHODS We enrolled all patients diagnosed with moderate to severe cholangitis due to common bile duct stones from January 2019 to July 2023.The outcomes were compared in this study between patients who underwent ERCP within 24 h and those who underwent ERCP 24 h later,employing a propensity score(PS)frame-work.Our primary outcomes were intensive care unit(ICU)admission rates,ICU length of stay,and duration of antibiotic use.RESULTS In total,we included 254 patients and categorized them into two groups based on the time elapsed between admission and intervention:The urgent group(≤24 h,n=102)and the elective group(>24 h,n=152).Ninety-three pairs of patients with similar characteristics were selected by PS matching.The urgent ERCP group had more ICU admissions(34.4%vs 21.5%,P=0.05),shorter ICU stays(3 d vs 9 d,P<0.001),fewer antibiotic use(6 d vs 9 d,P<0.001),and shorter hospital stays(9 d vs 18.5 d,P<0.001).There were no significant differences observed in adverse events,in-hospital mortality,recurrent cholangitis occurrence,30-d readmission rate or 30-d mortality.CONCLUSION Urgent one-stage ERCP provides the advantages of a shorter ICU stay,a shorter duration of antibiotic use,and a shorter hospital stay.

Hydroxychloroquine-azithromycin,doubase C,and QTc prolongation in congolese patients with COVID-19:Myth or reality?

BACKGROUND QTc interval prolongation with an increased risk of torsade de pointes(Tsd)has been described in coronavirus disease 2019(COVID-19)patients treated with hydroxychloroquine(HCQ)and azithromycin(AZI)in Western countries.In the DR Congo,few studies have evaluated the safety of this association or proposed new molecules.AIM To determine the incidence of QTc prolongation and Tsd in COVID-19 patients treated with HCQ-AZIs vs doubase C(new molecule).METHODS In present randomized clinical trial,we have included patients with mild or moderate COVID-19 treated with either HCQ-AZI or doubase C.Electrocardiogram(ECG)changes on day 14 of randomization were determined based on pretreatment tracing.Prolonged QTc was defined as≥500 ms on day 14 or an increase of≥80 ms compared to pretreatment tracing.Patients with cardiac disease,those undergoing other treatments likely to prolong QTc,and those with disturbed ECG tracings were excluded from the study.RESULTS The study included 258 patients(mean age 41±15 years;52%men;3.4%diabetics,11.1%hypertensive).Mild and moderate COVID-19 were found in 93.5%and 6.5%of patients,respectively.At baseline,all patients had normal sinus rhythm,a mean heart rate 78±13/min,mean PR space 170±28 ms,mean QRS 76±13 ms,and mean QTc 405±30 ms.No complaints suggesting cardiac involvement were reported during or after treatment.Only four patients(1.5%)experienced QTc interval prolongation beyond 500 ms.Similarly,only five patients(1.9%)had an increase in the QTc interval of more than 80 ms.QTc prolongation was more significant in younger patients,those with high viral load at baseline,and those receiving HCQ-AZI(P<0.05).None of the patients developed Tsd.CONCLUSION QTc prolongation without Tsd was observed at a lower frequency in patients treated with HCQ-AZI vs doubase C.The absence of comorbidities and concurrent use of other products that are likely to cause arrhythmia may explain our results.

Security Assurance for One-stage Resection of Left Colon Cancer with Acute Obstruction—Thorough and Prompt Enteral Decompression without Contamination

Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.

超对称Bullough-Dodd模型的prolongation分析

在扭曲仿射代数 A(2 )2 上建立了超对称的 Bullough-Dodd模型 .Prolongation方法的研究表明 ,该模型承认一个 Lax pair,从 Lax意义上证明该模型可积 .另外 ,当该超对称模型的所有费米量为零时 ,该系统就定义了一个新奇的由单标量玻色场指数相互作用构成的可积模型 .这个发现还打破了长久以来的一种认识 :只有 sinh-Gordon和标准Bullough-Dodd模型是 Liouville模型 .

Prolongation Structure of Semi-discrete Nonlinear Evolution Equations

Based on noncommutative differential calculus, we present a theory of prolongation structure for semidiscrete non/inear evolution equations. As an illustrative example, a semi-discrete model of the non/inear SchrSdinger equation is discussed in terms of this theory and the corresponding Lax pairs are also given.

QT prolongation is associated with increased mortality in end stage liver disease

AIM To determine the prevalence of QT prolongation in a large series of end stage liver disease(ESLD) patients and its association to clinical variables and mortality.METHODS The QT interval was measured and corrected for heart rate for each patient,with a prolonged QT cutoff defined as QT > 450 ms for males and QT > 470 ms for females.Multiple clinical variables were evaluated including sex,age,serum sodium,international normalized ratio,creatinine,total bilirubin,beta-blocker use,Model for EndStage Liver Disease(MELD),MELD-Na,and etiology of liver disease. RESULTS Among 406 ESLD patients analyzed,207(51.0%) had QT prolongation. The only clinical variable associated with QT prolongation was male gender(OR = 3.04,95%CI:2.01-4.60,P < 0.001). During the study period,187patients(46.1%) died. QT prolongation was a significant independent predictor of mortality(OR = 1.69,95%CI:1.03-2.77,P = 0.039). In addition,mortality was also associated with viral etiology of ESLD,elevated MELD score and its components(P < 0.05 for all). No significant reversibility in the QT interval was seen after liver transplantation. CONCLUSION QT prolongation was commonly encountered in an ESLD population,especially in males,and served as a strong independent marker for increased mortality in ESLD patients.

Prolongation structure for nonlinear integrable couplings of a KdV soliton hierarchy

In this paper, a new nonlinear integrable coupling system of the soliton hierarchy is presented. Prom the Lax pairs, the coupled KdV equations are constructed successfully. Based on the prolongation method of Wahlquist and Estabrook, we study the prolongation structure of the nonlinear integrable couplings of the KdV equation.

Covariant Prolongation Structure of Konno-Asai-Kakuhata Equation

Based upon the covariant prolongation structures theory, we construct the sl（2, R）×R（p） prolongation structure for Konno-Asai-Kakuhata equation. By taking two and one-dimensional prolongation spaces, we obtain the inverse scattering equations given by Konno et al. and the corresponding Riccati equation. The Baecklund transformations are also presented.

THE PROLONGATION STRUCTURES AND NONLOCAL SYMMETRIES FOR MODIFIED BOUSSINESQ SYSTEM

The Wahlquist-Estabrook （WE） prolongation structures of modified Boussi-nesq （MB） system are studied from the coverings point of view. The realizations and classifications of one-dimensional coverings of this system are obtained completely. More-over the sufficient and necessary conditions for a vector field to be a nonlocal symmetry of this system are also demonstrated in the WE prolongation structures.

Prolongation structure of the variable coefficient KdV equation

The prolongation structure methodologies of Wahlquist-Estabrook [Wahlquist H D and Estabrook F B 1975 J. Math. Phys. 16 1] for nonlinear differential equations are applied to a variable-coefficient KdV equation. Based on the obtained prolongation structure, a Lie algebra with five parameters is constructed. Under certain conditions, a Lie algebra representation and three kinds of Lax pairs for the variable coefficient KdV equation are derived.

Antipsychotic Medication and Risk of QTc Prolongation: Focus on Multiple Medication and Role of Cytochrome P450 Isoforms

Objective: To identify the effects of antipsychotics on QTc prolongation in light of age, gender, antipsychotic combination pattern, antipsychotic doses and cytochrome P450 (CYP) mediation, using large database describing the antipsychotic treatment of patients with schizophrenia in Japan. Methods: Using database of 4176 patients with schizophrenia discharged between April 2004 and March 2005 and receiving outpatient treatment from 526 psychiatric hospitals in Japan. Of the patients, 1437 were included for the analysis. These patients were classified into three groups according to the antipsychotic CPZ-equivalent doses that they received (low, 1 - 299 mg;middle, 300 - 999 mg;and high, ≥1000 mg). QTc intervals ≥ 440 msec were considered prolonged. We reviewed all the package inserts of the antipsychotics used from the website of Pharmaceuticals and Medical Devices Agency. Results: The mean QTc interval of the total patient group was 410.4 ± 23.3 msec. The females had significantly higher QTc values than the males (414.5 ± 24.0 vs. 406.8 ± 22.2 msec, respectively;p 0.05). Logistic regression analysis revealed that female gender (odds ratio [OR] = 1.83;95% CI: 1.28 - 2.56), CYP3A4-metabolized drugs (OR 1.56;95% CI: 1.05 - 2.30) were associated with an increased risk of QTc prolongation. Conclusion: The co-prescription of CYP3A4-mediated antipsychotic drugs should be carefully considered in females due to potential risk of QTc prolongation. Further studies of the cardiovascular safety of antipsychotics are warranted in patients receiving multiple medications.

The Prolongation Structures for the System of the Reaction-Diffusion Type

Equations of the reaction-diffusion type are very well known and have been extensively studied in many research areas. In this paper, the prolongation structures for the system of the reaction-diffusion type are investigated from theory of coverings. The realizations and the classifications of the one-dimensional coverings of the system are researched. And the corresponding conservation law of the one-dimensional Abelian coverings is concluded, which is closely connected with the symmetry of the system by Noether theorem.

Use of Human Embryonic Stem Cell-Derived Cardiomyocyte Clusters to Assess Potential for Chronic Treatment with Compounds to Cause QT Prolongation

Drug-induced QT prolongation is a serious clinical issue in developing novel drug candidates and marketing drugs. A major cause of QT prolongation is direct inhibition of human ether-à-go-go-related gene (hERG) channels. Reduction in repolarization-related channel expression levels on plasma membranes is another mechanism that induces QT prolongation. Recently, we established a system for assessing the risk of QT prolongation by using human embryonic stem cell-derived cardiomyocyte clusters (hES-CMCs) in which the field potential duration (FPD) or corrected FPD (FPDc) was measured as an indicator of drug-induced QT interval prolongation. Here, we examined whether this system was able to detect FPDc prolongation caused by pentamidine or probucol, both of which can induce QT prolongation after long-term treatment. hES-CMCs were treated with pentamidine or probucol, and the FPDc of the same clusters was measured 10 min, 4 h, and 24 h after the start of treatment. Concentration-dependent FPDc prolongation was observed at 24 h, but not at 10 min, with pentamidine or probucol treatment. These results suggest that the hES-CMC-based assessment system can be used to detect both acute (at 10 min) and delayed (at 24 h) QT prolongation risk on the same platform by simple alteration of the extended culture period.

Covariant Prolongation Structure, Conservation Laws and Soliton Solutions of the Gross-Pitaevskii Equation in the Bose-Einstein Condensate

In this paper, we investigate the Gross-Pitaevskii (GP) equation which describes the propagation of an electron plasma wave packet with a large wavelength and small amplitude in a medium with a parabolic density and constant interactional damping by the Covariant Prolongation Structure Theory. As a result, we obtain general forms of Lax-Pair representations. In addition, some hidden structural symmetries that govern the dynamics of the GP equation such as SL(2,R), SL(2,C), Virasoro algebra, SU(1,1) and SU(2) are unearthed. Using the Riccati form of the linear eigenvalue problem, infinite number of conservation laws of the GP equation is explicitly constructed and the exact analytical soliton solutions are obtained by employing the simple and straightforward Hirota’s bilinear method.

A Rare Long Term Survival Case of Complete Pentalogy of Cantrell in Adult after One-Staged Surgery

Pentalogy of Cantrell is a rare congenital abnormality.Even with high-quality medical care and staged corrective surgeries in professional hospitals,the mortality rate is still very high and long-term prognosis is poor.Survival is largely determined by the complexity and severity of cardiac abnormalities,the efficiency of abdominal wall closure and postoperative complications.A 24-year-old male patient with complete pentalogy of Cantrell was diagnosed.One-stage surgical repair of all abnormalities were completed.The patient recovered well and had been follow-up for 7 years.He has a good cosmetic outcome,with no signs of cardiac dysfunction.No complications were noted.

One-stage revision arthroplasty in a patient with ochronotic arthropathy accompanied by joint infection:A case report

BACKGROUND Ochronotic arthropathy(OcA)is a rare disease,which is caused by the accumulation of homogentisic acid in the joint.Patients with OcA have obvious joint pain and the disease progresses rapidly,eventually resulting in disability.Arthroplasty is an efficacious treatment in patients with OcA.However,when OcA patients have joint infection,is joint replacement an option?In the present report,we performed total knee arthroplasty in a patient with OcA and knee infection under the guidance of one-stage revision theory.CASE SUMMARY A 64-year-old male was referred to our hospital due to severe left knee pain with limited mobility for 2 years.On physical examination,the patient was found to have dark brown pigmentation of the sclera and auricle.Laboratory test results showed elevations in C-reactive protein level(65.79 mg/L)and erythrocyte sedimentation rate(90.00 mm/h).The patient underwent debridement of the left knee joint,during which the cartilage surface of the knee joint was found to be black-brown in color.Bacterial culture of synovial fluid revealed Achromobacter xylosoxidans.We then carried out arthroplasty under the guidance of the theory of one-stage revision.After surgery,the patient’s left knee joint pain disappeared and function recovered without joint infection.CONCLUSION OcA accompanied by joint infection is rare.One-stage revision arthroplasty may be a treatment option for this disease.

Effect of natural prolongation with geological features on maritime delimitation

The United Nations Convention on the Law of the Sea entitled the coastal States to naturally extend the continental shelf, which has caused more drastic disputes of maritime delimitation. This paper devotes to clarifying the significant concept of natural prolongation through an effect method combing the legal principles and technical analysis. Firstly, the classic samples with respect of the development of geological features are traced. Based on these samples, the classification with a model is proposed in order to affirm the concept＇s significance under certain geomorphologic situations. Lastly, scientific analysis is used to present two potential prolongation situations and emphasize that all the technical analysis on maritime delimitation should be complied with international law and protect the common interest of all the mankind.

Covariant Prolongation Structure of Coupled Inhomogeneous Nonlinear Schrodinger Equation

We investigate the coupled inhomogeneous nonlinear Schrodinger equation by the covariant prolongationstructure theory, and obtain its Lax's representation. Moreover, we present the corresponding Riccati equations, Backlundtransformation, and one-soliton solution.

Should we use similar perioperative protocols in patients undergoing unilateral and bilateral one-stage total knee arthroplasty?

BACKGROUND Bilateral one-stage total knee arthroplasty(BTKA)is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy.However,postoperative pain and disablement during convalescence from BTKA,and procedure-related complications have been concerning issues for patients and surgeons.Although some studies reported that BTKA in selected patients is as safe as the staged procedure,well-defined guidelines for patient screening,and perioperative care and monitoring to avoid procedure-related complications are still controversial.AIM To compare the perioperative outcomes including perioperative blood loss(PBL),cardiac biomarkers,pain intensity,functional recovery,and complications between unilateral total knee arthroplasty(UTKA)and BTKA performed with a similar perioperative protocol.METHODS We conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols.The exclusion criteria of this study included patients with an American Society of Anesthesiologists score>3,and known cardiopulmonary comorbidity or high-sensitivity Troponin-T(hs-TnT)>14 ng/L.Outcome measures included visual analogue scale(VAS)score of postoperative pain,morphine consumption,range of knee motion,straight leg raise(SLR),length of stay(LOS),and serum hemoglobin(Hb)and hs-TnT monitored during hospitalization.RESULTS Of 210 UTKA and 137 BTKA patients,those in the BTKA group were younger and more predominately female.The PBL of the UTKA vs BTKA group was 646.45±272.26 mL vs 1012.40±391.95 mL(P<0.01),and blood transfusion rates were 10.48%and 40.88%(P<0.01),respectively.Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA,whereas preoperative Hb was only a determinant in UTKA patients.The BTKA group had significantly higher VAS scores than the UTKA group at 48,72,and 96 h after surgery,and also had a significantly lower degree of SLR at 72 h.The BTKA group also had a significantly longer LOS than the UTKA group.Of the patients who had undergone the procedure,5.71%of the UTKA patients and 12.41%of the BTKA patients(P=0.04)had hs-TnT>14 ng/L during the first 72 h postoperatively.However,there was no difference in other outcome measures and complications.CONCLUSION Following similar perioperative management,the blood transfusion rate in BTKA is 4-fold that required in UTKA.Also,BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA.Hence,BTKA patients may require more extensive perioperative management for blood loss and pain,even if having no higher risk of complications than UTKA.

One-Stage Bilateral Total Hip Arthroplasty for Hemophilic Spontaneous Ankylotic Hip: A Case Report

Total hip arthroplastys (THAs) for hemophilic spontaneous ankylotic hips are rare. We performed one-stage bilateral THA for hemophilic patient and I would like to report the results of the case. A 61-year-old male had been diagnosed with mild hemophilia A as a neonate. He had severe pain in both hips and moderate pain in both knees. His hips were ankylotic and had no mobility. Uncemented simultaneous bilateral THAs were performed under general anesthesia. This case suggests that one-stage THA can be a good option for hemophilic hips, provided that sufficient substitution therapy is used.