Meta-analysis of single-stage versus two-staged management for concomitant gallstones and common bile duct stones.

OBJECTIVE: The purpose of this article was to compare the effectiveness and safety of single-stage (laparoscopic cholecystectomy [LC] plus laparoscopic common bile duct exploration [LCBDE]) with two-stage (LC plus endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy [EST]) in management for concomitant gallstones and common bile duct (CBD) stones. MATERIALS AND METHODS: Systematic review and meta-analysis of randomised controlled trials (RCTs) comparing outcomes following single-stage with two-stage management for concomitant gallstones and CBD stones published from 1990 to 2017 in PubMed, Embase and the Science Citation Index. The primary outcomes were stone clearance from the CBD, post-operative morbidity and mortality. The secondary outcomes were retained stone, conversion to other procedures, length of hospital stay and total operating time. Pooled risk ratio (RR) or weighted mean differences (WMD) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or random effects model. RESULTS: Eleven RCTs studies were included in this analysis. These studies included a total of 1338 patients: 666 underwent LC + LCBDE and 672 underwent LC + ERCP/EST. The meta-analysis showed that no significant difference was noted between the two groups regarding CBD stone clearance (RR: 1.06; 95% CI: 0.99-1.14; P= 0.12), post-operative morbidity (RR: 1.03; 95% CI: 0.79-1.34; P= 0.81), mortality (RR: 0.30; 95% CI: 0.06-1.41; P= 0.13), retained stone (RR: 0.91; 95% CI: 0.57-1.47; P= 0.71), conversion to other procedures (RR: 0.80; 95% CI: 0.55-0.16; P= 0.23), length of hospital stay (WMD: 1.24, 95% CI: 3.57-1.09, P= 0.30), total operating time (WMD: 25.42, 95% CI: 22.38-73.22, P= 0.30). CONCLUSION: Single-stage is efficient and safe in the treatment of patients with concomitant gallstones and CBD stones while avoiding the second procedure. In selected patients, single-stage management for concomitant gallstones and CBD stones might be considered as the preferred approach. However, the findings have to be carefully interpreted due to the existence of heterogeneity, in addition, patient's condition, operator's experience also should be taken into account in making treatment decisions.

Dispec: a novel peptide scoring algorithm based on peptide matching discriminability.

Identifying peptides from the fragmentation spectra is a fundamental step in mass spectrometry (MS) data processing. The significance (discriminability) of every peak varies, providing additional information for potentially enhancing the identification sensitivity and the correct match rate. However this important information was not considered in previous algorithms. Here we presented a novel method based on Peptide Matching Discriminability (PMD), in which the PMD information of every peak reflects the discriminability of candidate peptides. In addition, we developed a novel peptide scoring algorithm Dispec based on PMD, by taking three aspects of discriminability into consideration: PMD, intensity discriminability and m/z error discriminability. Compared with Mascot and Sequest, Dispec identified remarkably more peptides from three experimental datasets with the same confidence at 1% PSM-level FDR. Dispec is also robust and versatile for various datasets obtained on different instruments. The concept of discriminability enhances the peptide identification and thus may contribute largely to the proteome studies. As an open-source program, Dispec is freely available at http://bioinformatics.jnu.edu.cn/software/dispec/.

Recurrent lithiasis after surgical treatment of elderly patients with choledocholithiasis.

BACKGROUND: The recurrence rates of choledocholithiasis depend on the type of the disease. This study was undertaken to examine recurrent lithiasis after surgical treatment of elderly patients with choledocholithiasis, especially with primary common bile duct stones, and thereby to determine the best treatment modality for choledocholithiasis in the elderly. METHODS: The recurrence rates of choledocholithiasis were calculated from the records of 193 outpatients who had been treated from January 1993 to January 2005 and monitored for periods ranging from 1 to 12 years (mean 6.7 years). The patients were divided into 3 groups: 81 who had undergone choledocholithotomy and T-tube drainage, 41 who had had choledochoduodenostomy, and 71 patients who had received choledochojejunostomy. RESULTS: Since the 41 choledochoduodenostomy cases had only one recurrence of choledocholithiasis, the recurrence rate was analyzed for the remaining 152 cases, which were divided into two groups: group A with recurrent lithiasis (13 cases), and group B without recurrence (139 cases). The recurrence was found in 7 patients after choledocholithotomy and T-tube drainage (7/81, 8.6%), and in 6 patients after choledochojejunostomy (6/71, 8.5%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/41, 2.4%, P<0.05). Moreover, stones recurred in 4 of the 11 patients with primary bile duct stones who underwent choledocholithotomy and T-tube drainage (4/11, 36.4%), and in 5 of the 34 patients who had choledochojejunostomy (5/34, 14.7%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/39, 2.6%, P<0.05). The diameter of the common bile duct was more dilated in group A (14.6+/-3.9 mm) than in group B (10.8+/-4.5 mm, P<0.05). Primary bile duct stones were found in 9 cases of group A (69.2%), and in 36 cases of group B (25.9%, P<0.01). CONCLUSION: Choledochoduodenostomy should be recommended for elderly patients with primary bile duct stones to prevent postoperative recurrent lithiasis.

Pre-ligation of afflicted hepatic inflow and outflow blood vessels of lesioned liver lobe during hepatectomy.

OBJECTIVE: To compare the merits of hepatectomy after pre-ligation of the hepatic inflow and outflow blood vessels of the lesioned liver lobe with those of Pringle's maneuver. METHODS: A total of 68 patients were divided into two groups A and B. In the group A (n=38), Pringle's maneuver was employed, whereas in the group B (n=30), hepatectomy after pre-ligation of the hepatic inflow and outflow blood vessels of the lesioned side of the liver was used. Peri-operative blood loss, postoperative bleeding and drainage, time of liver function recovery as well as incidence of postoperative complications were compared between the 2 groups. RESULTS: The mean perioperative blood loss, the mean amount of postoperative bleeding and drainage, the time of liver function recovery as well as incidence of postoperative complications were significantly higher in the group A than in the group B (P<0.01). CONCLUSION: Hepatectomy after pre-ligation of the hepatic inflow and outflow blood vessels of the lesioned side of the liver is superior to Pringle's maneuver.