Safety and Effectiveness Analysis of Different Surgical Methods for Intrahepatic Bile Duct Stones.

BACKGROUND: Intrahepatic bile duct stones, a prevalent condition within hepato-biliary diseases, present a considerable challenge due to the high rates of recurrence, complications, and difficulty in treatment. Selecting an optimal surgical approach is vital for effective stone clearance and minimizing patient morbidity. While laparoscopic hepatectomy and percutaneous transhepatic choledochoscopy are established modalities, their comparative efficacy and safety profiles necessitate further investigation to inform clinical decision-making. OBJECTIVE: To explore the effectiveness and safety of different surgical methods for intrahepatic bile duct stones.  Methods: The clinical data of 65 patients with intrahepatic bile duct stones admitted to Nanchong Central Hospital, China, from January 2021 to January 2022 were retrospectively analyzed. According to the differences in surgical methods, patients undergoing laparoscopic hepatectomy were included in the laparoscopic group (n = 33), and patients undergoing percutaneous transhepatic choledochoscopy were included in the percutaneous transhepatic group (n = 32). The differences in perioperative indicators, inflammatory factors, postoperative complications, and one-year follow-up recurrence rates between the two groups were compared. RESULTS: Compared with percutaneous transhepatic group, laparoscopic group had significantly shorter operation time and hospitalization time (p < 0.05), and significantly higher blood loss (p < 0.05). After the operation, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in the laparoscopic and percutaneous transhepatic groups were significantly lower than those in the same group before the operation (p < 0.05). CRP, TNF-α, and IL-6 in the laparoscopic group were significantly lower than in the percutaneous transhepatic group (p < 0.05). There was no significant difference in the incidence of postoperative complications and the recurrence rate of one-year follow-up between the laparoscopic group and the percutaneous transhepatic puncture group (p > 0.05). CONCLUSION: Laparoscopic hepatectomy and percutaneous transhepatic choledochoscopy are both practical and safe, and the appropriate surgical scheme should be selected according to the patient's specific condition.

Dynamic Characteristics of Plasma in Ultrasonic-Assisted Narrow-Gap Laser Welding with Filler Wire.

Laser welding with filler wire was applied to Q345D in a narrow gap under ultrasonic assistance, and the dynamic characteristics of plasma were studied by high-speed imaging and spectral acquisition. The results showed that the plasma area decreased gradually with increasing distance between the ultrasonic loading position and welding seam. The electron density and temperature of the plasma with ultrasonic assistance were higher than those without ultrasound. The electron density was approximately 1016~1017 cm-3, and the plasma temperature was approximately 4000~6000 K. Ultrasonic assisted laser wire filling welding can bring about cavitation effect and significantly reduce the porosity problem.

Fault detection sensitivity analysis and optimization of the few-mode fiber link under a dynamic spatial mode crosstalk cumulative effect.

Due to the cumulative effect of dynamic spatial mode crosstalk, it is difficult to obtain the amplitude distribution of backscattering with high purity. Hence, the fault detection sensitivity (FDS) of the few-mode fiber (FMF) link is deteriorated, and the fault location accuracy is limited. This work investigates the characteristics and optimization method of FDS for the FMF link under the dynamic spatial mode crosstalk cumulative effect. We establish a mathematical model and analyze the influence of dynamic spatial mode crosstalk on the FDS of LP01, LP11a, and LP11b modes. The crosstalk mentioned above is caused by different splice misalignments and rotation angles during FMF fusion splicing. The results show that the dynamic spatial mode crosstalk has a great influence on the detection sensitivity of the high-order spatial mode. To solve this problem, the FDS optimization method is proposed based on high-order mode waveform reconstruction. The coupling efficiency matrix at the fusion splice point is estimated by the Rayleigh backscattering waveform of each mode, and the Rayleigh backscattering waveform of high-order spatial modes is reconstructed. The simulation experiment is carried out based on the above theoretical model. The results show that the proposed method can effectively eliminate the influence of the cascading dynamic crosstalk accumulation on the fault loss of the high-order spatial mode, and then optimize the FDS of the FMF link. This study offers new opportunities to develop FMF fault detection devices with high detection sensitivity performance.

Fault detection performance of a multi-mode transmission reflection analysis for a few-mode fiber link.

We propose a novel monitoring technique based on multi-mode transmission reflection analysis for a long-reach few-mode fiber (FMF) based mode division multiplexing system. By launching unmodulated continuous-wave optical light modes into the corresponding spatial modes of the FMF, the transmitted and reflected or backscattered optical powers can be measured and quantitatively analyzed to accurately characterize and locate the fault. The influences of the capture fraction, attenuation coefficient, and Rayleigh backscattering coefficient are discussed, and simulation results show that the proposed method can realize the fault location of the FMF link. Moreover, considering the influence of mode crosstalk on localization accuracy, it is clear that using the monitoring combination modes LP01 and LP21 gives a high precision of 3.58 m.

Analysis of characteristics of few-mode fiber fusion splicing under dynamic spatial modecrosstalk.

In this paper, an analytical model of the fusion splicing loss of few-mode fiber (FMF) under the condition of dynamic crosstalk is proposed. Under different dynamic spatial modal crosstalk caused by fusion mismatches and rotation angles, we analyze the variation trend of the fusion splicing loss characteristics of FMF with LP01,LP11a, and LP11b, respectively. Simulation results show that under the condition of axial misalignment introducing modal crosstalk, the splice loss of the LP11a and LP11b modes is higher than that of LP01. On the other hand, the modal crosstalk caused by rotation angles makes the fusion splice loss of LP01 present symmetrical distribution, and the loss of fusion splice of LP01 is maximum at 45°. When rotating from 0° to 90°, for LP11a and LP11b modes, the fusion loss of LP11a decreases gradually, while the loss of LP11b increases gradually. Both are in a symmetrical distribution. Meanwhile, we build an FMF fusion splice loss measurement system based on photon lanterns and FMF circulators. The experimental results show that it is consistent with the simulation results, and the experimental and simulation results confirm the feasibility of the fusion splice fault loss analysis modal under dynamic crosstalk conditions.

Quantum image processing algorithm using edge extraction based on Kirsch operator.

In this work, a quantum image processing algorithm is developed using the edge extraction method together with the Kirsch operator. In our approach, novel enhanced quantum representation (NEQR) is employed as the image representation model for processing quantum image, which generates results of edge extraction using the Kirsch operator. The proposed algorithm can perform real-time image processing with high accuracy. We carry out the design, analyses, and simulations of quantum circuits based on our approach, which shows that the image processing speed and acuracy are much better than the classical edge extraction algorithms.

Controlling Nutritional Status (CONUT) Score as a New Indicator of Prognosis in Patients With Hilar Cholangiocarcinoma Is Superior to NLR and PNI: A Single-Center Retrospective Study.

BACKGROUND: Currently, many nutritional indicators, including controlling nutritional status score (CONUT), can be used to assess a patient's nutritional status and have been reported as reliable predictors of multiple malignancies. However, the value of CONUT score in predicting postoperative outcomes in patients with hilar cholangiocarcinoma has not been explored. In this study, its predictive value will be discussed and compared with the known predictors the neutrophil lymphocyte ratio (NLR) and prognostic nutritional index (PNI). METHODS: Preoperative CONUT scores, PNI and NLR levels of 94 Hilar cholangiocarcinoma (HCCA) patients who underwent radical-intent resection of hepatobiliary surgery in our hospital from March 2010 to April 2019 were retrospectively collected and analyzed. They were grouped according to their optimal cutoff value and the prognostic effects of patients in each group were compared respectively. RESULTS: CONUThigh was more frequent in patients with Clavien-Dindo classification of ≥IIIa (P = 0.008) and Bile leakage presence (P = 0.011). Kaplan-Meier curves analyzing the relationship between CONUT, PNI, and NLR values and HCCA patient survival (including total survival (OS) and recurrence-free survival (RFS) showed significant differences between groups (P <0.001). Meanwhile, multi-factor analysis found that Degree of cure, PNI, NLR, and preoperative CONUT score were independent prognostic factors for OS and RFS. The predictive power of CONUT score was higher than that of NLR and PNI based on time-dependent receiver operating Characteristic (ROC) analysis and the net reclassification index (NRI) and integrated discriminatory index (IDI) values (P < 0.05). CONCLUSION: CONUT score may be of some clinical reference value in evaluating postoperative prognosis of HCCA patients.

Searching for differentially expressed proteins in spinal cord injury based on the proteomics analysis.

AIMS: We aimed to identify potential differentially expressed proteins that play roles in the spinal cord injury. MATERIALS AND METHODS: The mouse model of spinal cord injury was firstly built, followed by grip strength evaluation. Then, isobaric tags for relative and absolute quantization (iTRAQ) analysis was used to identify differentially expressed proteins at 1, 2, 3 and 8 weeks after spinal cord injury. Finally, analysis of spinal cord injury repair related differentially expressed proteins in the early and middle-late stage of injury was performed followed by the functional analysis. KEY FINDINGS: The result of grip strength evaluation showed that the motor function of the forelimbs of the mouse was significantly impaired after spinal cord injury. In the iTRAQ analysis, a total of 29 common differentially expressed proteins (such as Hbb-bs, Hba, S100a6, Ca1, Apoa4, Hspb1, Hist1h1c, Hist1h1e, Hbb-b1, Apoa1 and S100a10) were obtained at 1, 2, 3 and 8 weeks after spinal cord injury. A total of 70 and 180 common differentially expressed proteins were identified in the early and middle-late stage of injury, respectively. PPAR signaling pathway (involved Apoa1) and VEGF signaling pathway (involved Hspb1) were identified in the middle-late stage of spinal cord injury repair. SIGNIFICANCE: Identified differentially expressed proteins and related signaling pathways may be associated with spinal cord injury.

Diagnostic role of staging laparoscopy in a subset of biliary cancers: a meta-analysis.

BACKGROUND: Accurate preoperative radiological staging of biliary cancers remains difficult. Despite the improvement in imaging techniques, a number of patients with biliary cancers who undergo laparotomy are ultimately found to have unresectable diseases. The goals of staging laparoscopy (SL) are to rule out metastatic and locally advanced unresectable diseases and better define locally advanced unresectable diseases. This study evaluates the efficiency of SL in ruling out unresectable disease in a subset of biliary cancers. METHODS: Literature published between January 2000 and December 2015 on the use of SL for patients with biliary cancers was retrieved from five electronic databases. Summary estimates of sensitivity, specificity and diagnostic odds ratio were calculated. RESULTS: Eight studies were included in the meta-analysis. During the laparoscopy, unresectable disease was found in 316 of 1062 patients (29.8%), of whom 32.4% were patients with suspected hilar cholangiocarcinoma (HC) and 27.6% were patients with suspected gallbladder cancer (GBC). The sensitivities were 0.556 (95% confidence interval (CI): 0.495-0.616) for patients with HC and 0.642 (95% CI: 0.579-0.701) for patients with GBC. The pooled specificity for the SL was 100% (95% CI: 0.993-1.000) for all studies. CONCLUSIONS: This meta-analysis revealed that 32.4% of patients with HC and 27.6% of patients with GBC may avoid unnecessary laparotomy with the use of SL. It is worthwhile to perform SL combined with an intraoperative ultrasound in patients with suspected GBC or HC.

Nobiletin attenuates lipopolysaccharide/D­galactosamine­induced liver injury in mice by activating the Nrf2 antioxidant pathway and subsequently inhibiting NF­κB­mediated cytokine production.

Inflammation and oxidative stress serve an important role in the development of lipopolysaccharide/D-galactosamine (LPS/GalN)­induced acute liver injury. Nobiletin, which is found in high quantities in the peel of citrus fruits, is able to modulate immune responses, including inflammatory response and oxidative stress. The present study aimed to evaluate the protective effects of nobiletin on LPS/GalN­induced acute liver injury. Male C57BL/6 mice were intraperitoneally treated with nobiletin (50, 100 and 200 mg/kg) 2 h prior to LPS/GalN injection. Liver injury was observed in the LPS/GalN group, as demonstrated by increased levels of serum hepatic enzymes and hepatic inflammatory mediators, as well as by histopathological alterations. Treatment with nobiletin reduced serum alanine aminotransferase and aspartate aminotransferase levels, improved hepatic structure, and suppressed hepatic interleukin (IL)­1ß, IL­6 and tumor necrosis factor­α production 24 h after LPS/GalN exposure. Western blot analysis revealed that nobiletin treatment inhibited inducible nitric oxide synthase and cyclooxygenase­2 liver expression. In addition, nobiletin suppressed LPS/GalN­induced phosphorylation and degradation of inhibitor of nuclear factor (NF)­κB (IκB)α, as well as NF­κB p65 translocation into the nucleus. Nobiletin also upregulated the expression of nuclear NF­E2­related factor 2 (Nrf2) and cytoplasmic heme oxygenase­1. In conclusion, these results indicate that nobiletin serves a protective role in LPS/GalN­induced acute liver injury via activation of the Nrf2 antioxidant pathway and subsequent inhibition of NF­κB­mediated cytokine production. These findings support the potential for nobiletin as a therapeutic agent for the treatment of acute liver injury.

Aspirin regulates hepatocellular lipid metabolism by activating AMPK signaling pathway.

Aspirin has been reported to regulate lipid metabolism. However, the mechanism underlying the regulation is not clear. We presently investigated aspirin's promotion of AMP-activated protein kinase (AMPK) pathway activation in human hepatoma HepG2 cells by examining AMPK expression, the promotion of AMPK activation. Then we investigated the influence of aspirin-promoted AMPK signaling on fatty acid oxidation in HepG2 cells. The results demonstrated that aspirin treatment did not regulate the expression of AMPK and its downstream target, Acetyl-Coenzyme A Carboxylase (ACC), but activated the AMPK signaling pathway by promoting the phosphorylation of AMPK and ACC. And, interestingly, the promotion by aspirin is dependent of cellular esterase, which catalyzes aspirin to salicylate. Moreover, the activated AMPK signaling promoted the fatty acid oxidation, by promoting expression of Carnitine palmitoyltransferase I (CPT1) and Medium-Chain Acyl-CoA Dehydrogenase (MCAD) in both mRNA and protein levels. Thus, we confirmed in this study that aspirin promoted lipid oxidation by upregulating the AMPK signaling pathway.