Effect of pancreatic extracorporeal shock wave lithotripsy on chronic pancreatitis stones / 中华外科杂志

Objective: To analyze the therapeutic effect and safety of pancreatic extracorporeal shock wave lithotripsy(P-ESWL) for patients with chronic pancreatitis complicated by stones of the pancreatic duct and to investigate the influencing factors. Methods: A retrospective analysis was performed on clinical data from 81 patients with chronic pancreatitis complicated by pancreatic duct calculus treated with P-ESWL in the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi 'an Jiaotong University from July 2019 to May 2022. There were 55 males(67.9%) and 26 females(32.1%). The age was (47±15)years (range: 17 to 77 years). The maximum diameter(M(IQR)) of the stone was 11.64(7.60) mm, and the CT value of the stone was 869 (571) HU. There were 32 patients (39.5%) with a single pancreatic duct stone and 49 patients(60.5%) with multiple pancreatic duct stones. The effectiveness, remission rate of abdominal pain, and complications of P-ESWL were evaluated. Student's t test, Mann Whitney U test, χ2 test, or Fisher's exact test was used to compare the characteristics between the effective and ineffective groups of lithotripsy. The factors influencing the effect of lithotripsy were analyzed by univariate and multivariate logistic regression analysis. Results: Eighty-one patients with chronic pancreatitis were treated with P-ESWL 144 times, with an average of 1.78 (95%CI:1.60 to 1.96) times per person. Among them, 38 patients(46.9%) were treated with endoscopy. There were 64 cases(79.0%) with effective removal of pancreatic duct calculi and 17 cases(21.0%) with ineffective removal. Of the 61 patients with chronic pancreatitis accompanied by abdominal pain, 52 cases(85.2%) had pain relief after lithotripsy. After lithotripsy treatment, 45 patients(55.6%) developed skin ecchymosis, 23 patients(28.4%) had sinus bradycardia, 3 patients(3.7%) had acute pancreatitis, 1 patient(1.2%) had a stone lesion, and 1 patient(1.2%) had a hepatic hematoma. Univariate and multivariate logistic regression analysis showed that the factors affecting the efficacy of lithotripsy included the age of patient(OR=0.92, 95%CI: 0.86 to 0.97), the maximum diameter of the stone(OR=1.12,95%CI:1.02 to 1.24) and the CT value of the stone(OR=1.44, 95%CI: 1.17 to 1.86). Conclusions: P-ESWL is effective in the treatment of patients with chronic pancreatitis complicated by calculi of the main pancreatic duct.Factors affecting the efficacy of lithotripsy include patient's age, maximum stone diameter, and CT value of calculi.

Reaction mechanisms of flavins and flavoproteins from an electronic-structure perspective / Mecanismos de reação de flavinas e flavoproteínas por uma perspectiva de estrutura eletrônica

Proteins equipped with flavin adenine dinucleotides (FAD) or flavin mononucleotides (FMN) are named flavoproteins and constitute about 1% of all existing proteins. They catalyze redox, acid-base and photochemical reactions in a variety of biochemical phenomena that goes from energy metabolism to DNA repair and light sensing. The versatility observed in flavoproteins is ultimately a balance of flavin intrinsic properties modulated by a protein environment. This thesis aims to investigate how flavoproteins work by systematic evaluating flavin properties and reactivity. In particular, the mechanism of fumarate reduction by the flavoenzyme fumarate reductase Fcc3 was determined. Electronic-structure calculations were used for this task based on rigorous calibration with experimental data and error assessment. Flavin properties at chemical accuracy were obtained with single reference coupled-cluster CCSD(T) calculations at the complete basis set limit. Density functional theory was demonstrated an excellent alternative with lower computational costs and slightly less accuracy. Flavin protonation and tautomerism were shown to be important modulators of flavin properties and reactivity, with the possibility of various tautomers existing at neutral pH. Regarding flavin redox properties, an analysis based on multiconfigurational wave function weights was proposed for categorizing flavin redox reactions as hydride or hydrogen-atom transfers. This analysis is an upgrade over traditional partial charges methods and can be applied not only to flavin reactions but to any protoncoupled electron transfer. In the investigation of the enzymatic mechanism of fumarate reduction, the reaction was determined as a nucleophilic addition by hydride transfer with carbanion formation. Fumarate reductase employs electrostatic catalysis in contrast to previous proposals of substrate straining and general-acid catalysis. Also, hydride transfer was shown to be vibronically adiabatic with low tunneling contribution. These findings give new insights into the mechanisms of fumarate reductases and provide a framework for future computational studies of flavoproteins in general. The analyses and benchmark studies presented can be used to build better models of properties and reactivity of flavins and flavoproteins

Proteínas equipadas com dinucleotídeos de flavina-adenina (FAD) e mononucleotídeos de flavina (FMN) são chamadas flavoproteínas e constituem cerca de 1% de todas as proteínas existentes. Elas catalisam reações redox, ácido-base e fotoquímicas numa variedade de fenômenos bioquímicos que vão desde o metabolismo energético até reparo de DNA e captação de luz. A versatilidade observada em flavoproteínas é em última instância um balanço das propriedades intrínsecas de flavinas moduladas por um ambiente proteico. Esta tese busca investigar como flavoproteínas funcionam através de avaliações sistemáticas de propriedades e reatividade de flavinas. Em particular, o mecanismo de redução de fumarato pela flavoenzima fumarato redutase Fcc3 foi determinado. Cálculos de estrutura eletrônica foram usados para esta tarefa com base em rigorosa calibração com dados experimentais e avaliação de erros. As propriedades de flavinas foram determinadas com acurácia química com cálculos monoconfiguracionais de coupled-cluster CCSD(T) no limite de conjunto base completo. A teoria do funcional da densidade mostrou-se uma alternativa excelente com menor custo computacional e um pouco menos de acurácia. Protonação e tautomerismo de flavinas mostraram-se moduladores importantes de suas propriedades e reatividade, com a possibilidade de vários tautômeros existirem em pH neutro. Em relação às propriedades redox de flavinas, uma análise baseada nos pesos de funções de onda multiconfiguracionais foi proposta para categorizar as reações redox de flavinas como transferências de hidreto ou hidrogênio. Esta análise é uma melhoria em relação aos métodos tradicionais de cargas parciais e pode ser aplicada não apenas para reações de flavinas mas para qualquer transferência de próton acoplada a elétrons. Na investigação do mecanismo enzimático de redução de fumarato, a reação foi designada como uma adição nucleofílica por transferência de hidreto e formação de carbânion. A fumarato redutase usa catálise eletrostática diferentemente de prospostas anteriores envolvendo distorção do substrato e catálise ácida geral. Além disso, a transferência de hidreto mostrou-se vibronicamente adiabática com pouca contribuição de tunelamento. Estas descobertas abrem novas perspectivas sobre os mecanismos de fumarato redutases e fornecem uma base para estudos computacionais futuros sobre flavoproteínas em geral. As análises e estudos comparativos apresentados podem ser usados para construir melhores modelos para propriedades e reatividade de flavinas e flavoproteínas

Factores etiológicos de abscesos periodontales: Una patología emergente. Informe de tres casos / Etiological factors of periodontal abscesses: an emerging pathology. A three-case report

Introducción: La presencia de abscesos periodontales es la tercera emergencia dental más frecuente (6%-14%). Objetivo: Reportar información sobre diferentes factores etiológicos de absceso periodontal en tres pacientes. Descripción de casos: Primer caso, mujer de 52 años quien acudió a consulta por sangrado espontáneo, al examen clínico se evidenció sangrado al sondaje (SS), presencia de bolsas periodontales (BP) y cálculos (C); como tratamiento se realizó raspado y alisado radicular (RAR), complementado con detoxificación con tetraciclina y tratamiento farmacológico posoperatorio. Segundo caso, hombre de 27 años quien acudió a consulta por agrandamiento de encía, se observó (SS), y (BP); se retiró la lesión y se realizó (RAR). Tercer caso, hombre de 21 años quien acudió a consulta de control, al examen clínico se evidenció presencia de cálculos en órganos dentarios y bolsas periodontales en órganos dentarios 16-17; se utilizó (RAR) complementado con detoxificación con tetraciclina y tratamiento farmacológico posoperatorio. Conclusión: La etiología del absceso periodontal en el primer y último caso se basó en la falta de profundidad durante el raspado y alisado radicular, y en el segundo estuvo relacionado a impactación de alimentos. El identificar la etiología permite determinar diagnóstico, pronóstico y tratamiento ideal.

Introduction: Periodontal abscesses are the third most frequent dental emergency (6%-14%). Objective: To describe different etiological factors of periodontal abscesses in three patients. Case description: The first case was a 52-year-old woman who sought treatment due to spontaneous bleeding. During the examination, she revealed bleeding on probing (BP), presence of periodontal pockets (PP), and calculi (C). Scaling and root planning (SRP) was performed as treatment, which was complemented with detoxification with tetracycline and postoperative pharmacological treatment. The second case was a 27-year-old man who came to the clinic due to gum enlargement and showed BP and PP. The lesion was treated and SRP was performed. Finally, the third patient was a 21-year-old male who sought a follow-up consultation. The clinical examination showed the presence of dental calculi and periodontal pockets in teeth 16 and 17. SRP complemented with detoxification with tetracycline and postoperative pharmacology were used as treatments. Conclusion: The etiology of the periodontal abscesses in the first and third cases was based on the lack of depth during root scaling and planning. The cause in the second case was effects of food. Identifying this etiology is useful to achieve proper diagnosis, prognosis and treatment of periodontal abscesses.

Síndrome de Mirizzi tipo V: Manejo laparoscópico / Mirizzi syndrome type V: laparoscopic management

Resumen Introducción: El Síndrome de Mirizzi es una complicación infrecuente de la enfermedad litiásica biliar, con una incidencia menor al 1% en países desarrollados, puede desarrollarse en cinco variantes, siendo menos frecuente la variante tipo V. La literatura actual discrepa sobre el manejo de esta condición, afirmando que la cirugía laparoscópica no es segura como procedimiento estándar. Caso Clínico: Se presenta el caso de Síndrome de Mirizzi en un hombre de 80 años, que es remitido al departamento de urgencias por sospecha de sepsis de origen abdominal, con estudio ecográfico de colelitiasis, neumobilia y dilatación de las vías biliares. Se realizó Colangiopancreatografía retrógrada endoscópica con imposibilidad técnica para la movilización y extracción de los cálculos por gran tamaño, recurriéndose a exploración a través de técnica laparoscópica, obteniéndose resultados satisfactorios. Conclusión: Para tratar el Síndrome de Mirizzi, es necesario considerar las características del paciente y la experiencia del cirujano ya que ambos factores influyen directamente en la modalidad del tratamiento, sus complicaciones y tasas de éxito. En el presente caso, la experiencia del autor principal en el manejo de procedimientos mínimamente invasivos y la consideración de reducir el riesgo de complicaciones como infecciones en un paciente frágil, fueron los factores que influyeron para la decisión de intervención laparoscópica.

Abstract Introduction: Mirizzi's syndrome is an infrequent complication of biliary lithiasic disease, with an incidence of less than 1% in developed countries, being even less frequent the type V variant. Current literature disagrees on the management of this condition, stating that laparoscopic surgery is not safe as a standard procedure. Clinical Case: We present the case of Mirizzi's Syndrome in an 80-year-old man, which is referred to the emergency department for suspicion of sepsis of abdominal origin, with ultrasound study of cholelithiasis, pneumoobilia and dilation of the bile ducts. Retrograde endoscopic cholangiopancreatography was performed with technical impossibility for the mobilization and extraction of large-size stones, resorting to exploration through laparoscopic technique, obtaining satisfactory results. Conclusion: It is necessary to emphasize that the type of Mirizzi syndrome, the patient's characteristics and the surgeon's experience directly influence the treatment modality, its complications and/or success rates. In the present case, the experience of the main author in the management of minimally invasive procedures and the consideration of reducing the risk of complications such as infections in a fragile patient, were the factors that influenced the decision for laparoscopic intervention.

Reporte de Caso Clínico: Migración de cálculo dificultoso / Case Report: Migration of Large Gallstone

INTRODUCCIÓN: La coledocolitiasis es una patología con alta tasa de migración al duodeno de cálculos pequeños. No obstante, la migración asintomática de cálculos mayores a 1 cm (macrolitiasis) es atípica. A continuación, presentamos un caso de migración de un macrocálculo ubicado en colédoco medio. CASO CLÍNICO: Presentamos el caso de un hombre de 27 años que consulta por epigastralgia postprandial de 4 meses de evolución. La ecografía abdominal mostró barro biliar y un macro-cálculo en colédoco, con Colangio-RM se confirmó diagnóstico. Se decidió realizar una colecistectomía laparoscópica, con colangiografía intraoperatoria (CIO). EVOLUCIÓN: Durante la colecistectomía laparoscópica, no se evidenció cálculos en la colangiografía intraoperatoria, ante la discordancia entre las imágenes preoperatorias la CIO, se realizó instrumentación transcística con canastilla de Dormia, sin extracción de cálculos. El paciente evolucionó favorablemente, sin complicaciones dadas por la migración del macro-cálculo. Se realizó CRM posquirúrgica, sin evidencia de imágenes endoluminales en la vía biliar. CONCLUSIÓN: La patología biliar es dinámica, pudiendo presentar migración litiásica, aún en macro cálculos o cálculos de difícil manejo. Si bien la ecografÍa y la CRM tienen alta sensibilidad para su diagnóstico; la CIO es fundamental para hacer diagnóstico y tratamiento de la patología litiásica resolviéndola en un solo tiempo operatorio evitando procedimientos múltiples.(au)

BACKGROUND: Common bile duct lithiasis is a pathology with a high rate of migration of small stones to the duodenum. However, asymptomatic migration of stones larger than 1cm (macrolithiasis) is atypical. We present a case of migration of a macrocalculus located in the middle of the common bile duct. CASE REPORTS: We present the case of a 27-years-old man, who consulted for postprandial epigastric pain, that started 4 months ago. Abdominal ultrasound showed biliary sludge and common bile duct macrocalculus, with Cholangio-MRI the diagnosis was confirmed. A laparoscopic cholecystectomy with intraoperative cholangiography was performed. EVOLUTION: During the laparoscopic cholecystectomy, no stones were evidenced in the intraoperative cholangiograpy. Due to the disagreement between the preoperative IOC images, transcystic instrumentation with a Dormia basket was performed, without stone extraction. The patient had a favorably evolution, without complications due to the stone migration. Postoperative MRC was performed, without evidence of endoluminal images in the bile duct. CONCLUSIONS: Biliary pathology is dynamic, with the possibility of gallstone migration, even for large gallstones and complicated cases. Although ultrasound and MRI have high sensitivy for diagnosis; IOC is essential to diagnose and treat lithiasic pathology, resolving it in a single operating time, avoiding multiple procedures.

Composition and histopathological features of prostatic calculi in patients with benign prostatic hyperplasia / 中华男科学杂志

Objective@#To analyze the composition of prostatic calculus in patients with BPH and explore its pathogenic factors and histopathological characteristics.@*METHODS@#Strictly following the inclusion and exclusion criteria, we included in this retrospective study 580 cases of bipolar transurethral plasma kinetic prostatectomy (TUPKP) performed in our hospital from May 2015 to May 2019, analyzed the histopathological and calculus-composition features of the patients with BPH complicated by prostatic calculi (the BPH+PC group) and the histopathological data of those with BPH only (the BPH group). We compared the related factors between the two groups of patients and performed uni- and multivariate logistic regression analyses of the data on those in the BPH+PC group.@*RESULTS@#The incidence rate of chronic inflammation was significantly higher in the BPH+PC than in the BPH group (83.1% vs 61.1%, P 0.05). Logistic regression analyses showed that prostatic calculus was significantly correlated with chronic inflammation of the prostate, the patient's age and IPSS (P 0.05).@*CONCLUSIONS@#Prostatic calculus has a high incidence in BPH patients and varies widely in composition, chiefly consisting of calcium oxalate and carbonate apatite. The major factors contributing to prostatic calculi include chronic inflammation of the prostate (primarily the severe type), age and BPH. Prostate calculi may aggravate lower urinary tract symptoms, especially urinary storage symptoms, in patients with BPH, but not significantly affect the PSA level.？.

Estudio de las propiedades moleculares y reactivas del antibiótico Ciprofloxacina a nivel de teoría de funcional de densidad DFT B3LYP/6- 31G* / Study of the molecular and reactive properties of the antibiotic Ciprofloxacin at the level of functional density theory DFT B3LYP / 6-31G*

INTRODUCCIÓN: se realizó un estudio teórico computacional de la ciprofloxacina calculando detalladamente las propiedades moleculares del mismo. Se caracterizó este antibiótico, presentado valores de longitudes de enlace y ángulos, así como de propiedades químicas de interés en estudios QSAR, de energías y de reactividad, obtenidos por métodos mecano cuánticos utilizando la teoría funcional de densidad DFT B3LYP/6-31G*. OBJETIVO: determinar las propiedades moleculares, de QSAR y de reactividad de la Ciprofloxacina usando el método teórico de cálculo denominado: Teoría del Funcional de la Densidad (DFT) MÉTODO: la estructura de la ciprofloxacina fue trazada usando la interfaz de SPARTAN; esta fue sometida a cálculos de optimización geométrica inicialmente de Mecánica Molecular para obtener la estructura más estable, posteriormente todas las estructuras fueron analizadas utilizando la teoría de Hartree-Fock para obtener valores más confiables de energía y geometría. Posteriormente sobre estas estructuras se aplica la Teoría de Funcional de Densidad DFT usándose la base 6-31G*. Con esta estructura se realizaron cálculos de energía en conjunto con un análisis de población natural (NPA) para la molécula neutra e ionizada (positiva y negativa) para determinar los centros nucleofílicos, electrofílicos y radicalarios, y obtener posteriormente los descriptores de la reactividad local y las funciones de Fukui nucleofílica y electrofílica. RESULTADOS: Los valores experimentales de longitud de enlace para los enlaces C=C aromático del fenilo de 1.400 Å, respecto a longitudes de enlace C(10q)-C(5)=1.401 Å y C(8)- C(9q)=1.406 Å mostraron diferencias de 0.001 y 0.006. El enlace característico con el flúor F-C aromático reportado de 1.363Å, respecto al calculado en este estudio de 1.353Å muestra una diferencia de 0.01 del valor experimental. La longitud de enlace N1 de la quinolina y el C9 del ciclopropil reportado con 1.465Å y el calculado 1.450Å muestra una diferencia de 0.015. La longitud de enlace experimental C=O aromático de 1.230Å respecto al encontrado O(3)-C(4) de 1.227Å, muestra una diferencia de 0.003. Finalmente, en el anillo piperazina la longitud experimental C-N reportado de 1.465 Å, la calculada 1.463 Å diferencia de 0.002 De acuerdo con los datos calculados y reportados experimentalmente, se puede concluir que existe una buena correlación en los valores de las longitudes de enlace a nivel DFT B3LYP/6-31G*. Los ángulos entre átomos de carbono del sistema aromático encontrados en la ciprofloxacina oscilan entre 120.02° a 122.27°, en relación al valor teórico de este tipo de átomos de carbono con hibridación sp2 cuentan con un ángulo de 120°. En cuanto a la reactividad química, los índices descriptores de reactividad química global y local, el orbital HOMO es el dador y el orbital LUMO el aceptor. Un band-gap de 4.65 ev indica claramente que la molécula es muy estable. CONCLUSIÓN: se establecieron valores de las propiedades moleculares y así como de propiedades químicas de interés en estudios de estructura actividad QSAR, de energías y de reactividad del antibiótico ciprofloxacina.

INTRODUCTION: a theoretical computational study of ciprofloxacin was performed, calculating in detail the molecular properties of it. This antibiotic was characterized, presenting values of link lengths and angles as well as chemical properties of interest in QSAR, energy and reactivity studies, obtained by quantum mechanic methods using the Functional Density Theory DFT B3LYP / 6-31G *. OBJECTIVE: to determine the molecular, QSAR and reactivity properties of Ciprofloxacin using the theoretical calculation method called: Density Functional Theory (DFT). METHOD: the structure of ciprofloxacin was mapped using the SPARTAN interface; This was initially subjected to calculations of geometric optimization of Molecular Mechanics to obtain the most stable structure, later all the structures were analyzed using the Hartree-Fock theory to obtain more reliable values of energy and geometry. Subsequently on these structures the DFT Density Functional Theory is applied using the 6-31G * base. With this structure, energy calculations were performed in conjunction with a natural population analysis (NPA) for the neutral and ionized molecule (positive and negative) to determine the nucleophilic, electrophilic and radical centers, and subsequently obtain the descriptors of the local reactivity and the nucleophilic and electrophilic Fukui functions. RESULTS: The experimental values of bond length for the aromatic C = C bonds of the phenyl of 1,400 Å, with respect to link lengths C (10q) -C (5) = 1,401 Å and C (8) -C (9q) = 1,406 Å showed differences of 0.001 and 0.006. The characteristic link with the reported aromatic F-C fluorine of 1,363Å, compared to that calculated in this study of 1,353Å shows a difference of 0.01 of the experimental value. The linkage length N1 of the quinoline and the C9 of the cyclopropyl reported with 1,465Å and the calculated 1,450Å shows a difference of 0.015. The experimental aromatic C = O link length of 1,230Å with respect to the found O (3) -C (4) of 1,227Å, shows a difference of 0.003. Finally, in the piperazine ring, the reported CN experimental length of 1,465 Å, the calculated 1,463 Å difference of 0.002 According to the data calculated and reported experimentally, it can be concluded that there is a good correlation in the values of the link lengths at the DFT level B3LYP / 6-31G *. The angles between carbon atoms of the aromatic system found in ciprofloxacin range from 120.02 ° to 122.27 °, in relation to the theoretical value of this type of carbon atoms with sp2 hybridization have an angle of 120 °. Regarding chemical reactivity, the indexes describing global and local chemical reactivity [2], the HOMO orbital is the donor and the LUMO orbital is the acceptor. A band-gap of 4.65 ev clearly indicates that the molecule is very stable. The chemical potential obtained for the neutral ciprofloxacin of (-3,715ev) indicates that the electronic density of the system can vary spontaneously, since it has a negative value. The hardness gave the value of 2,325ev, indicates that ciprofloxacin will have little tendency to give or receive electrons, that is, the hardness has been associated with the stability of the chemical system. CONCLUSION: molecular and chemical properties values of interest were established in QSAR activity structure studies, energies and reactivity of the antibiotic ciprofloxacin.

Litiasis renal en paciente con enfermedad de crohn: reporte de caso / Renal lithiasis in patient with crohn's disease: case report

Caso de litiasis renal por oxalato de calcio asociado a enfermedad de Crohn de reciente debut en paciente masculino 43 años proveniente del Canton las Piñas, Provincia El Oro en Ecuador, sin antecedentes patológicos en relación a su enfermedad. En enero 2020 acude a consulta particular con dolor en fosa iliaca derecha, fiebre, fatiga, hiporexia, pérdida de peso, tenesmo y diarrea. Gastroenterólogo observó colon derecho con úlceras, áreas de mucosa infiltrada, y el estudio anatomopatológico identifica ulceraciones en subserosa, abscesos, infiltrado inflamatorio mixto, granulomas epitelioides con células gigantes multinucleadas. Previo consentimiento se realiza ecosonografía, detectándose un cálculo renal derecho de 5 mm de tamaño y otro de 4 mm en el izquierdo. El análisis de orina reporta aciduria, cristales oxalato de calcio y la radiografía simple demostró sombra de los cálculos. El estudio metabólico la 1,25 dihidroxivitamina D y la hormona paratiroidea resultó negativo. La evolución fue favorable y continua en control periódico que de ameritar se ordenaría tomografía helicoidal sin contraste o urograma excretorio.

We present a case of kidney stones due to calcium oxalate stones associated with Crohn's disease of recent debut in a 43-year-old male patient from the Piñas canton-El Oro Province-Ecuador with no personal and family pathological history in relation to his disease and that in January 2020 he went to a private medical consultation for presenting colic-type abdominal pain located in the right iliac fossa, fever, fatigue, hyporexia, weight loss, tenesmus and sometimes diarrhea. The gastroenterologist observed: right colon with ulcers and infiltrated mucosa areas; samples are taken for histopathological study. Anatomopathology It was identified ulcerations in subserosa, abscesses, mixed inflammatory infiltrate, epithelioid granulomas with multinucleated giant cells diagnosed with Crohn's disease. With the patient's consent, an echo-sonographic study was made, detecting a right kidney stone 5 mm in size and 4 mm in the left. Urinalysis showed aciduria, calcium oxalate crystals, and plain abdominal radiography showed shadow of the stones. In the metabolic study the 1,25 dihydroxyvitamin D and parathyroid hormone was negative. The evolution was favorable and he continuous in periodic control that, if it's required, would be ordered a helical computed tomography without contrast or excretory urogram.

Investigation of chemical profile of bile acids and determination of them in cultured Bovis Calculus with UPLC-QDA / 中国中药杂志

In this study, 10 batches of samples of cultured Bovis Calculus(cow-bezoar) were determined for the investigation of chemical profile of bile acids with the UPLC-QDA method established. The results showed that nine common bile acids, cholic acid(CA), deoxycholic acid(DCA), chenodeoxycholic acid(CDCA), taurocholic acid(TCA), taurodeoxycholic acid(TDCA), taurochenodeoxycholic acid(TCDCA), glycocholic acid(GCA), glycodeoxycholic acid(GDCA) and glycochenodeoxycholic acid(GCDCA), were founded in samples and 7 bile acids were quantified except GDCA and GCDCA. In these samples, unconjugated bile acids, the major type of bile acids, accounted for more than 97% of all types of bile acids. As for unconjugated bile acids, CA was the most major bile acid in cultured cow-bezoar and it was about twice as much as DCA. The relative low-cost method established in the current study is accurate, rapid and sensitive, which is suitable for the studies of other drugs from animal bile.

Intervencionismo endoscópico en la pancreatitis crónica / Endoscopic Intervention in Chronic Pancreatitis

Resumen La pancreatitis crónica es un trastorno irreversible y progresivo del páncreas caracterizado por inflamación, fibrosis y cicatrización. Las funciones exocrinas y endocrinas se pierden, lo que a menudo conduce al dolor crónico. La etiología es multifactorial, aunque el alcoholismo es el factor de riesgo más importante en los adultos. Si se sospecha pancreatitis crónica, la tomografía computarizada con contraste es la mejor modalidad de diagnóstico por imágenes. Aunque los narcóticos y los antidepresivos proporcionan el mayor alivio del dolor, más de la mitad de los pacientes eventualmente requiere una intervención por endoscopia o cirugía. La colangiopancreatografía retrógrada endoscópica es una alternativa eficaz para una variedad de terapias en el tratamiento de enfermedades benignas y malignas del páncreas. En los últimos 50 años, la endoterapia ha evolucionado hasta convertirse en la terapia de primera línea en la mayoría de las enfermedades inflamatorias agudas y crónicas del páncreas. A medida que avanza este campo, es importante que los gastroenterólogos mantengan un conocimiento adecuado de la indicación del procedimiento, mantengan el volumen de procedimiento suficiente para manejar la endoterapia pancreática compleja y comprendan enfoques alternativos a las enfermedades pancreáticas, incluidos el tratamiento médico, la terapia guiada por ecografía endoscópica, el manejo de las estenosis sintomáticas y cálculos, las intervenciones sobre el plexo celíaco y el drenaje de los pseudoquistes pancreáticos.

Abstract Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis and scarring. Exocrine and endocrine functions are lost often leading to chronic pain. Its etiology is multifactorial, although alcoholism is the most important risk factor in adults. If chronic pancreatitis is suspected, computed tomography with contrast is the best imaging modality. Although narcotics and antidepressants provide the greatest pain relief, more than half of all patients eventually require intervention by endoscopy or surgery. Endoscopic retrograde cholangiopancreatography (ERCP) is an effective alternative for a variety of therapies for treating benign and malignant diseases of the pancreas. In the last 50 years, endoscopic treatment has evolved to become the first-line therapy for most acute and chronic inflammatory diseases of the pancreas. As this field progresses, it has become important for gastroenterologists to keep their knowledge of indications for this procedure up-to-date and to perform a sufficient volume of procedures to allow them to manage complex pancreatic endoscopic therapy. Keeping up-to-date should include an understanding of alternative approaches to pancreatic diseases including medical treatment, therapy guided by endoscopic ultrasound, management of symptomatic stenoses and stones, interventions on the celiac plexus, and drainage of pancreatic pseudocysts.

Utilidad de la colangiopancreatoscopia directa en el manejo del cálculo pancreático, a propósito de un caso (con video) / Usefulness of Direct Cholangiopancreatoscopy for Management of Pancreatic Calculi: Case Study (with video)

Resumen Se presenta el caso de un paciente con pancreatitis crónica y hallazgo de lesión quística en el ducto pancreático principal, a quien se le realizó colangioscopia directa tipo Spyglass y se encontró un gran cálculo impactado a nivel de la cabeza del páncreas, condicionando una formación pseudoquística. Se realizó litotricia láser y se logró la extracción en su totalidad, con lo cual se logró la remisión sintomática.

Abstract We present the case of a patient with chronic pancreatitis. After finding a cystic lesion in the main pancreatic duct, the patient underwent direct cholangioscopy using the SpyGlass DS System. A large impacted calculus and pseudocyst formation was found in the head of the pancreas. Laser lithotripsy was used to extract the entire calculus and symptomatic remission was achieved.

Baicalein Treatment Promotes Osteoblast Proliferation and Osteogenic Differentiation through Activation of Immediate Early Response 3 / 치위생과학회지

BACKGROUND: The primary aims of periodontal disease treatment is to remove dental plaque and calculus, the main causes of tooth loss, and restore periodontal tissue destroyed by inflammation. Periodontal disease treatment should also help maintain the alveolar bone, alleviate inflammation, and promote periodontal ligament cell proliferation, which is essential for tissue regeneration. Conventional antibiotics and anti-inflammatories have adverse side effects, especially during long-term use, so there is a need for adjunct treatment agents derived from natural products. The purpose of this study was to investigate whether the herbal flavone baicalein has the osteogenic activity under inflammatory conditions, and assess the involvement of osteoblast immediate early response 3 (IER3) expression.METHODS: Human osteoblastic MG-63 cells were cultured with the pro-inflammatory cytokines tumor necrosis factor α and interleukin 1β in the presence and absence of baicalein. Proliferation was assessed using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay, and expression of IER3 mRNA was assessed using real-time polymerase chain reaction. The expression of IER3 protein levels and activation of associated signal transduction pathways were assessed using western blotting.RESULTS: Baicalein increased IER3 mRNA and protein expression synergistically. In addition, baicalein reversed the suppression of cell proliferation, and the downregulation of osteogenic transcription factor runt-related transcription factor 2 and osterix induced by pro-inflammatory cytokines. Baicalein also upregulated the phosphorylation of c-Jun N-terminal kinase (JNK) and extracellular signal-regulated kinase (ERK 1/2). The upregulation of IER3 by pro-inflammatory cytokines was blocked by pretreatment with inhibitors of AKT, p38, JNK, and ERK 1/2.CONCLUSION: Baicalein mitigates the deleterious responses of osteoblasts to pro-inflammatory cytokines. Further, IER3 enhanced the effect of baicalein via activation of AKT, p38, JNK, and ERK pathways.

Technical feasibility of da Vinci SP single-port robotic cholecystectomy: a case report

The da Vinci surgical system released its new pure single-port platform, the da Vinci SP, offering improvements and refinements for established robotic single-site procedures. Herein, we present the first case of robotic single-site cholecystectomy using the da Vinci SP system (RSPC) demonstrating its safety and technical feasibility. A 59-year-old female with chronic calculus cholecystitis was admitted for elective RSPC. Docking time took 6 minutes. The patient underwent successful RSPC with a total operation time of 89 minutes. There was no significant intraoperative event. The patient had unremarkable postoperative course. Multijoint instruments, simple docking process, and third-arm functionality are among the RSPC's advantages. Absence of the port for an assistant surgeon can be a hindrance in performing more complicated surgeries. The present case suggests that RSPC is safe and feasible. The promising features and potential application of da Vinci SP in hepatobiliary and pancreas surgery need further study.

A prospective clinical of lithium disilicate pressed zirconia and monolithic zirconia in posterior implant-supported prostheses: A 24-month follow-up / 대한치과보철학회지

PURPOSE: The purpose of this study was to compare the clinical outcomes of lithium disilicate ceramic pressed zirconia prostheses and monolithic zirconia prostheses and to investigate the complications after two years of follow-up in posterior edentulous site. MATERIALS AND METHODS: A total 17 patients (male: 12, female: 5) were treated with 60 posterior fixed implant-supported prostheses (LP. lithium disilicate ceramic pressed zirconia prostheses: n = 30, MZ. monolithic zirconia prostheses: n = 30). After 24-month, clinical examination of Implant survival rate, marginal bone resorption, probing depth, plaque index, bleeding index, calculus and complications were evaluated. RESULTS: There were no failed implants and all implants were normal in function without mobility. Marginal bone resorption was lower in LP group than MZ group at 12-month (P < .05), and 12-month probing depth and calculus deposit in LP group were significantly higher than MZ group (P < .05). Most common complications in MZ were marginal bone resorptions more than 1.5.mm and 2 chipping occurred in LP group. CONCLUSION: Within the limitations of the present study, lithium disilicate ceramic pressed zirconia is considered as a predictable treatment option as much as monolithic zirconia in posterior fixed implant-supported prostheses.

Management Algorithm of Pancreatic Calculi / 대한췌담도학회지

Pancreatic calculi associated with chronic pancreatitis lead to severe abdominal pain, which significantly reduces the quality of life of patients. Pancreatic calculi, especially those that obstruct the main pancreatic duct and cause abdominal pain, are considered to be treated. First, if pancreatic calculi are located in the head or body and the size is less than 5 mm, endoscopic removal can be attempted. If the size is greater than 5 mm, extracorporeal shockwave lithotripsy may be performed first, and subsequent endoscopic removal may be considered depending on the results. If such treatment fails, pancreatoscopic lithotripsy or surgery should be considered. Pancreatic duct stenting may be used as a bridge therapy during this process.

Vitamin C inhibits crystallization of struvite from artificial urine in the presence of Pseudomonas aeruginosa

ABSTRACT Background: Formation of struvite stones is associated with urinary tract infection by urease-producing bacteria. Biogenic crystal growth in natural and synthetic materials is regulated by the action of inhibitors, ranging from small ions, molecules to large macromolecules. Materials and Methods: We report the dynamics of in vitro crystallization of struvite in presence of vitamin C in synthetic urine using single diffusion gel growth technique. Sodium metasilicate gel of specific gravity 1.05 and the aqueous solution of ammonium dihydrogen phosphate were used as the medium for growing the struvite crystals. The crystallization process was induced by a urease positive struvite stone associated Pseudomonas aeruginosa to mimic the infection leading to stone formation. The grown crystals were characterized by ATR-FTIR and powder XRD. The surface morphology was analysed through FE-SEM for comparison between treatments. Results: We observed decrease in number, dimension, and growth rate of struvite crystals with the increasing concentrations of vitamin C. Crystals displayed well-defined faces and dendritic morphology of struvite in both control and biogenic systems. Conclusion: The results strongly suggest that, vitamin C can modulate the formation of struvite crystals in the presence of uropathogenic bacteria.

Periodontal health status of adolescents aged 15 years in Jinju city / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to evaluate the periodontal status of adolescents aged 15 years in Jinju city. METHODS: The study subjects were 506 adolescents aged 15 years in Jinju city. We investigated the prevalence and severity of periodontal disease using the Community Periodontal Index (CPI) recommended by the WHO. Data on the frequency of daily tooth-brushing were collected through self-reported questionnaires. The information obtained on both the periodontal health status and frequency of daily toothbrushing of adolescents in Jinju city was compared with the data from the 6th Korea National Health and Nutrition Examination Survey 2013-2015 (KNHANES-VI). The software utilized in the analysis was SPSS version 23. Statistical significance was set at P < 0.05. RESULTS: The rate of healthy periodontal status in Jinju city was lower compared to KNHANES-VI (57.7% versus 63.7%). The rate of gingival bleeding in Jinju city and KNHANES-VI was 11.3% and 10.8%, respectively. The rate of calculus in Jinju city and KNHANES-VI was 31.0% and 25.6%, respectively. The rates of gingival bleeding and calculus were not significantly different between Jinju city and KNHANES-VI. The healthy periodontal segments in Jinju city were more than those in KNHANES-VI (5.43 versus 5.25). The bleeding periodontal segments in Jinju city were less than those in KNHANES-VI (0.25 versus 0.45). However, the periodontal segments with calculus in Jinju city were not significantly different from those of KNHANES-VI (0.31 versus 0.30). The frequency of daily tooth-brushing in Jinju city was more than that in KNHANES-VI (2.67 versus 2.47). CONCLUSIONS: These findings suggest that appropriate oral health education should be widely conducted to promote periodontal health in adolescents.

Nefrolitotomía percutánea ambulatoria: serie de casos y revisión de la literatura / Percutaneous Nephrolithotomy Ambulatory: Case Series and Literature Review

La nefrolitotomía percutánea (PCNL), es un procedimiento mínimamente invasivo, considerado como el tratamiento de elección para el manejo de los cálculos renales de gran tamaño o de formación compleja. Esa técnica fue introducida en la urología desde hace más de 30 años. Inicialmente fue Goodwin en 1955 quien realizó el primer abordaje percutáneo en un riñón.1 Posteriormente en 1976 Fernstórm y Johansson, efectuaron la primera extracción de un cálculo renal por vía percutánea2; permitiendo así el inicio y desarrollo de una nueva técnica mínimamente invasiva para el manejo de la litiasis renal. Aquella técnica, si bien presenta menor morbilidad que la cirugía abierta, no es un procedimiento libre de complicaciones, por lo cual se han realizado una seria de modificaciones de la técnica inicial.

Percutaneous nephrolithotomy (PCNL) is a procedure minimally invasive, considered to be the treatment of choice for the handling of large kidney stones size or complex formation. This technique was introduced into urology over 30 years ago. Initially it was Goodwin in 1955 who made the first percutaneous approach in a kidney.1 Subsequently in 1976 Fernstórm and Johansson, carried out the first extraction of the a percutaneous renal stone2; thus allowing the initiation and development of a new technique minimally invasive for the management of renal lithiasis. This technique, although it presents less morbidity than the open surgery, it is not a procedure free of complications, for which a series of tests have been carried out. modifications to the initial technique

Experiencia en el manejo de litiasis renal y ureteral con ureteroscopio flexible y láser holmium en un hospital público de Bogotá: estudio retrospectivo / Experience in the management of renal and ureteral calculi with holmium laser and flexible ureteroscope in a public hospital in Bogotá: A retrospective study

Objetivos Discutir y evaluar la tasa libre de cálculos y las complicaciones de la ureterolitotomía endoscópica flexible con láser holmium en el manejo de cálculos ureterales y renales basada en la experiencia de un hospital público de iii nivel en Bogotá. Material and Métodos Estudio retrospectivo en una muestra poblacional en pacientes con litiasis renal y ureteral, tratados con ureteroscopio flexible y láser holmium, evaluándose la tasa libre de cálculos, complicaciones postoperatorias y otros parámetros. El seguimiento se realizó con radiografía de abdomen y urotac al mes del postoperatorio, la tasa libre de cálculos se definió como ausencia de cálculos residuales < 4 mm en la imagen control. Resultados Se realizaron 44 procedimientos en 43 pacientes con edad promedio de 45 años, tiempo quirúrgico promedio 91,2 min, la tasa libre de cálculos fue del 84% (37/44) en un solo evento quirúrgico; solo un paciente requirió una segunda intervención con posterior tasa libre de cálculos del 100%. La tasa libre de cálculos ureterales fue del 92% (24/26), cáliz superior 100% (2/2), cáliz medio 100%(1/1), cáliz inferior 78% (7/9) y calicial múltiple 50% (3/6). El porcentaje de complicaciones fue del 6,8%. Conclusiones La ureterolitotomía endoscópica flexible con láser es un procedimiento efectivo y seguro en el manejo de litiasis renal y ureteral con baja incidencia de complicaciones. Observamos que en la mayoría de los pacientes con fragmentos residuales significativos estos se encontraban en cáliz inferior o se trataba de cálculos en múltiples cálices, explicándose por el difícil acceso al cáliz inferior y la carga litiásica.

Objective To discuss and review the stone free rate and complications of using flexible ureteroscopy and holmium laser lithotripsy for treating patients with kidney and ureteral stones, based on the experience in a level III public hospital in Bogotá. Materials and Methods A retrospective review was conducted on patients with renal and ureteral stones treated with flexible ureteroscopy and holmium laser, by analysing the stone-free rate and postoperative complications. X-rays or computed tomography was performed at 30 days post-operation to assess the effects of surgery, and the stone-free rate was defined as absence of residual stones < 4 mm on follow-up imaging. Results A total of 44 procedures were performed on 43 patients with a mean age of 45 years. The mean operating time was 91.2 minutes, and the stone-free rate in a single surgical event was 84% (37/44). Only one patient required a second intervention, with a subsequent stone-free rate of 100%. The ureteral stone-free rate was 92% (24/26), with upper calyx 100% (2/2), middle calyx 100% (1/1), 78% lower calyx (7/9), and multiple calyceal 50% (3/6). The complication rate was 6.8%. Conclusions Flexible ureteroscopy and holmium laser lithotripsy is an effective and safe procedure in the management of renal and ureteral stones, with a low incidence of postoperative complications. It was noted that most patients with significant residual fragments, they were in lower calyx or had multiple stones. This was explained by the difficult access to the lower calyx and stone burden.