Clinical efficacy of laparoscopic cholecystectomy plus cholangioscopy for the treatment of cholecystolithiasis combined with choledocholithiasis.

BACKGROUND: Currently, endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy (LC) is the main treatment for cholecystolithiasis combined with choledocholithiasis. However, the treatment is unsatisfactory, and the development of better therapies is needed. AIM: To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis. METHODS: Patients (n = 243) with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University (910th Hospital of Joint Logistic Support Force) between January 2019 and December 2023 were included in the study; 111 patients (control group) underwent ERCP + LC and 132 patients (observation group) underwent LC + laparoscopic common bile duct exploration (LCBDE). Surgical success rates, residual stone rates, complications (pancreatitis, hyperamylasemia, biliary tract infection, and bile leakage), surgical indicators [intraoperative blood loss (IBL) and operation time (OT)], recovery indices (postoperative exhaust/defecation time and hospital stay), and serum inflammatory markers [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were compared. RESULTS: No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups. However, the complication rate, IBL, OT, postoperative exhaust/defecation time, and hospital stays were significantly reduced in the observation group compared with the control group. Furthermore, CRP, TNF-α, and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group. CONCLUSION: These results indicate that LC + LCBDE is safer than ERCP + LC for the treatment of cholecystolithiasis combined with choledocholithiasis. The surgical risks and postoperative complications were lower in the observation group compared with the control group. Thus, patients may recover quickly with less inflammation after LCBDE.

Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery: A Randomized Clinical Trial.

Importance: Epidural anesthesia is a primary choice for cesarean delivery, but supplemental analgesics are often required to relieve pain during uterine traction. Objective: To investigate the sedative and analgesic effects of intravenous esketamine administered before childbirth via cesarean delivery with the patient under epidural anesthesia. Design, Setting, and Participants: This multicenter, double-blind randomized clinical trial assessed 903 women 18 years or older who had full-term single pregnancy and were scheduled for elective cesarean delivery with epidural anesthesia in 5 medical centers in China from September 18, 2021, to September 20, 2022. Intervention: Patients were randomized to receive intravenous injection of 0.25 mg/kg of esketamine or placebo before incision. Main Outcomes and Measures: The coprimary outcomes included scores on the numeric rating scale of pain (an 11-point scale, with 0 indicating no pain and 10 indicating the worst pain; a difference of ≥1.65 points was clinically meaningful) and Ramsay Sedation Scale (a 6-point scale, with 1 indicating restlessness and 6 indicating deep sleep without response; a difference of ≥2 points was clinically meaningful) immediately after fetal delivery. Secondary outcomes included neonatal Apgar score assessed at 1 and 5 minutes after birth. Results: A total of 600 women (mean [SD] age, 30.7 [4.3] years) were enrolled and randomized; all were included in the intention-to-treat analysis. Immediately after fetal delivery, the score on the numeric rating scale of pain was lower with esketamine (median [IQR], 0 [0-1]) than with placebo (median [IQR], 0 [0-2]; median difference, 0; 95% CI, 0-0; P = .001), but the difference was not clinically important. The Ramsay Sedation Scale scores were higher (sedation deeper) with esketamine (median [IQR], 4 [3-4]) than with placebo (median [IQR], 2 [2-2]; median difference, 2; 95% CI, 2-2; P < .001). The neonatal Apgar scores did not differ between the 2 groups at 1 minute (median difference, 0; 95% CI, 0-0; P = .98) and at 5 minutes (median difference, 0; 95% CI, 0-0; P = .27). Transient neurologic or mental symptoms were more common in patients given esketamine (97.7% [293 of 300]) than in those given placebo (4.7% [14 of 300]; P < .001). Conclusions and Relevance: For women undergoing cesarean delivery under epidural anesthesia, a subanesthetic dose of esketamine administered before incision produced transient analgesia and sedation but did not induce significant neonatal depression. Mental symptoms and nystagmus were common but transient. Indications and the optimal dose of esketamine in this patient population need further clarification, but study should be limited to those who require supplemental analgesia. Trial Registration: ClinicalTrials.gov Identifier: NCT04548973.

Iridescent Colloidal Crystals Composed of SiO2 Porous Hollow Sphere for SERS Application.

In recent years, the application of low-refractive-index materials in the optical field has attracted considerable attention due to it high transmittance and high optical sensitivity. In this study, we synthesized SiO2 porous hollow spheres (SPHS) with an ultralow refractive index (n = 1.05) by using a templating method. Their refractive indices could be easily controlled from 1.05 to 1.08 by tuning the thickness of shell. In addition, a droplet coatings method is proposed for SPHS colloidal crystal (CC) by controlling the temperature and humidity. The SPHS CCs displayed distinct structural colors when the incident angle was adjusted and demonstrated high angular resolution. Moreover, the iridescent color changes could be observed with the naked eye. For surface-enhanced Raman scattering application, more analyte could be absorbed by the porous shells, and metal nanoparticles were coated on the SPHSs surface to increase the hot spot density for improving the SERS intensity.

[Characteristics and molecular mapping of a novel chlorophyll-deficient yellow-leaf mutant in rice].

A yellow-leaf mutant (yl11) with chlorophyll-deficient in rice (Oryza sativa L.) was selected from the progeny of a japonica rice variety "Jiahua 1" treated with 60Co γ-radiation. In comparison with the wild-type parent, "Jiahua 1", the mutant had yellow-leaves at whole growth stages and displayed significantly decreased in chlorophyll content and net photosynthetic rate. Underdeveloped chloroplast and alterations of the major agronomic traits, such as plant-heights, were also observed in the mutant. Genetic analysis confirmed that the yellow-leaf mutant trait was controlled by a single recessive nuclear gene (yl11). Using SSR and In/Del molecular markers and 920 F2 and F3 plants from the cross of yl11 with the indica variety Peiai 64S, the yl11 was mapped between the molecular markers MM2199 and InDel21039 with a physical distance of 110 kb on the long arm of chromosome 11, in which no known functional genes for chlorophyll synthesis or chloroplast development in rice has been found. These findings will provide a foundation for the cloning and functional analysis of this gene in the future.

[A study on the differences of emotion and depression between patients as doctor/nurse and others occupation with severe acute respiratory syndrome].

OBJECTIVE: To study the emotional and depressive differences between severe acute respiratory syndrome (SARS) patients whose occupations were doctor/nurse and others. METHODS: During the three months when SARS was explosive in 2003, 524 questionnaires were collected from Xuanwu Hospital, You'an Hospital, Xiaotangshan Hospital, Renmin Hospital and Ditan Hospital in Beijing. There were 109 questionnaires finished by patients as doctors/nurses themselves. For a background matching, 109 questionnaires were also finished by the others. RESULTS: From 218 questionnaires, we found that the score on emotional condition (46.6204 +/- 8.4408 vs. 41.6789 +/- 8.612 95, P < 0.001) of SARS patients whose jobs were doctor/nurse was higher than the other groups on while the score of SARS patients whose jobs were doctor/nurse was lower than the other groups (37.7615 +/- 9.026 61 vs. 41.2844 +/- 9.655 25, P = 0.006) regarding depressive condition. The scores of emotional and depressive condition were all correlated with the factor as "I can not master my future". CONCLUSION: Doctors/nurses having SARS had less emotional and depressive conditions than the others, which might due to the difference in medical knowledge, working condition and the route of infection, suggesting that psychological intervention in the post-SARS period called for attention.