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Meng K, Zhang DY, Chen DX, Liu WJ, Fang KX, Chen S, Wu L, Li MY. Large common bile duct stones in high-risk elderly patients: Immediate endoscopic stone removal or elective stone removal? A single-center retrospective study. BMC Gastroenterol 2023; 23:344. [PMID: 37798726 PMCID: PMC10552253 DOI: 10.1186/s12876-023-02976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE For high-risk elderly patients with chronic diseases, endoscopic stone removal for large common bile duct stones is associated with a high risk of adverse events and incomplete stone removal. The aim of this study was to investigate whether the treatment strategy of short-term biliary plastic stent placement followed by elective endoscopic stone removal is more effective and safer than immediate endoscopic stone removal. METHODS The data of 262 high-risk elderly patients who received endoscopic retrograde cholangiopancreatography (ERCP) for large common bile duct (CBD) stones from 2017 to 2022 were retrospectively analyzed. The patients were divided into group A (immediate stone removal) and group B (stent drainage + elective stone removal). The baseline data of the 2 groups were matched 1:1 by propensity score matching. The stone clearance rate, ERCP procedure time, total hospital stay, and procedure-related adverse events were compared between the matched groups. In group B, stone size before and after stent placement, hospital stay, procedure time and adverse events of two ERCPs were compared. RESULTS A total of 57 pairs of patients were successfully matched between the 2 groups. The stone clearance rate in group B was higher than that in group A (89.5% vs. 75.3, P = 0.049). The total hospital stay in group B was longer than that in group A (11.86 ± 3.912 d vs. 19.14 ± 3.176 d, P<0.001). The total adverse event rate in group A was higher than that in group B (29.8% vs. 12.3%, P = 0.005). The incidence of cholangitis/cholecystitis after ERCP was significantly higher in group A than in group B (7.0% vs. 0.9% P = 0.029). There was no significant difference in the incidence of post-ERCP pancreatitis, bleeding, pneumonia, and cardio-cerebrovascular events between the 2 groups. There were no perforation cases in either group. After plastic biliary stent placement in group B, the stone size was significantly smaller than before stent placement (1.59 ± 0.544 cm vs. 1.95 ± 0.543 cm, P < 0.001), and there was no significant difference in the total adverse event incidence between the two ERCP procedures (18.8% vs. 10.9%, P = 0.214). CONCLUSION For high-risk elderly patients with large CBD stones, the treatment strategy involving temporary placement of plastic stent and elective endoscopic stone removal is safer and more effective than immediate stone removal.
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Affiliation(s)
- Ke Meng
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Fuxing Road, #28, Haidian District, Beijing, 100853, China
| | - Da-Ya Zhang
- Graduate School, Hainan Medical University, Haikou, 571199, China
| | - De-Xin Chen
- Graduate School of PLA general hospital, Beijing, 100853, China
| | - Wen-Jing Liu
- Graduate School of PLA general hospital, Beijing, 100853, China
| | - Kai-Xuan Fang
- Graduate School of PLA general hospital, Beijing, 100853, China
| | - Shengxin Chen
- Graduate School of PLA general hospital, Beijing, 100853, China
| | - Lang Wu
- Graduate School of PLA general hospital, Beijing, 100853, China
| | - Ming-Yang Li
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Fuxing Road, #28, Haidian District, Beijing, 100853, China.
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Fang WW, Liu CC, Zhang HW, Xu H, Zhou S, Fang KX, Peng YL, Zhao WS. Selection of Differential Isolates of Magnaporthe oryzae for Postulation of Blast Resistance Genes. Phytopathology 2018; 108:878-884. [PMID: 29384446 DOI: 10.1094/phyto-09-17-0333-r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A set of differential isolates of Magnaporthe oryzae is needed for the postulation of blast resistance genes in numerous rice varieties and breeding materials. In this study, the pathotypes of 1,377 M. oryzae isolates from different regions of China were determined by inoculating detached rice leaves of 24 monogenic lines. Among them, 25 isolates were selected as differential isolates based on the following characteristics: they had distinct responses on the monogenic lines, contained the minimum number of avirulence genes, were stable in pathogenicity and conidiation during consecutive culture, were consistent colony growth rate, and, together, could differentiate combinations of the 24 major blast resistance genes. Seedlings of rice cultivars were inoculated with this differential set of isolates to postulate whether they contain 1 or more than 1 of the 24 blast resistance genes. The results were consistent with those from polymerase chain reaction analysis of target resistance genes. Establishment of a standard set of differential isolates will facilitate breeding for blast resistance and improved management of rice blast disease.
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Affiliation(s)
- W W Fang
- First, second, third, fifth, sixth, seventh, and eighth authors: State Key Laboratory of Agrobiotechnology and MOA Key Lab of Pest Monitoring and Green Management, China Agricultural University, Beijing 100193, China; and fourth author: Institute of Plant Protection, Liaoning Academy of Agricultural Sciences, Shenyang 110161, China
| | - C C Liu
- First, second, third, fifth, sixth, seventh, and eighth authors: State Key Laboratory of Agrobiotechnology and MOA Key Lab of Pest Monitoring and Green Management, China Agricultural University, Beijing 100193, China; and fourth author: Institute of Plant Protection, Liaoning Academy of Agricultural Sciences, Shenyang 110161, China
| | - H W Zhang
- First, second, third, fifth, sixth, seventh, and eighth authors: State Key Laboratory of Agrobiotechnology and MOA Key Lab of Pest Monitoring and Green Management, China Agricultural University, Beijing 100193, China; and fourth author: Institute of Plant Protection, Liaoning Academy of Agricultural Sciences, Shenyang 110161, China
| | - H Xu
- First, second, third, fifth, sixth, seventh, and eighth authors: State Key Laboratory of Agrobiotechnology and MOA Key Lab of Pest Monitoring and Green Management, China Agricultural University, Beijing 100193, China; and fourth author: Institute of Plant Protection, Liaoning Academy of Agricultural Sciences, Shenyang 110161, China
| | - S Zhou
- First, second, third, fifth, sixth, seventh, and eighth authors: State Key Laboratory of Agrobiotechnology and MOA Key Lab of Pest Monitoring and Green Management, China Agricultural University, Beijing 100193, China; and fourth author: Institute of Plant Protection, Liaoning Academy of Agricultural Sciences, Shenyang 110161, China
| | - K X Fang
- First, second, third, fifth, sixth, seventh, and eighth authors: State Key Laboratory of Agrobiotechnology and MOA Key Lab of Pest Monitoring and Green Management, China Agricultural University, Beijing 100193, China; and fourth author: Institute of Plant Protection, Liaoning Academy of Agricultural Sciences, Shenyang 110161, China
| | - Y L Peng
- First, second, third, fifth, sixth, seventh, and eighth authors: State Key Laboratory of Agrobiotechnology and MOA Key Lab of Pest Monitoring and Green Management, China Agricultural University, Beijing 100193, China; and fourth author: Institute of Plant Protection, Liaoning Academy of Agricultural Sciences, Shenyang 110161, China
| | - W S Zhao
- First, second, third, fifth, sixth, seventh, and eighth authors: State Key Laboratory of Agrobiotechnology and MOA Key Lab of Pest Monitoring and Green Management, China Agricultural University, Beijing 100193, China; and fourth author: Institute of Plant Protection, Liaoning Academy of Agricultural Sciences, Shenyang 110161, China
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