Рентгенохирургия ятрогенного повреждения желчных протоков после лапароскопической холецистэктомии (опыт одного центра)

IM OF STUDY To show the possibilities of antegrade X-ray surgical techniques in the treatment of iatrogenic bile duct injuries after videolaparoscopic cholecystectomy.MATERIAL AND METHODS The study included 24 patients with “minor” and 20 patients with “major” (according to Strasberg) iatrogenic injuries of the extrahepatic biliary tract. Antegrade endobiliary intervention was performed in 26 patients, including the “bridge-procedure” variant preceding the reconstructive surgery. Endobiliary drains were maintained during the reconstructive surgery and in the early postoperative period to control the viability of the anastomosis.When a stricture of the biliodigestive anastomosis (BDA) was detected, balloon dilatation of the anastomotic area was performed. In the subgroup of “minor” injuries, external drainage of the subhepatic biloma in 18 people were supplemented with endoscopic papillotomy in 12 cases.RESULTS In all patients with “minor” injuries of the biliary tree, X-ray surgical techniques were effective. In 11 patients with “major” bile duct injuries, cholangiostomy drainage was gradually transformed into external-internal drainage. In 2 trauma cases of classes D and E temporary antegrade stenting of the duct injury area with a coated self-expanding endobiliary stent was performed. The follow-up period after removal of the antegrade frame drainage ranged from 8 months to 14 years. There were no stricture or failure of BDA.CONCLUSION Short-term external biliary drainage, including the use of rendezvous techniques, may be suffi cient to eliminate the failure of the cystic duct stump. Cholangiostomy drainage, temporary endobiliary stent allow preparing the patient for reconstructive intervention. Drainage marking of the damaged area facilitates the verifi cation of tubular structures in the reconstruction area. Preservation of drainage after reconstructive intervention is the prevention of failure of the biliodigestive anastomosis in the early postoperative period, the development of its stricture in the long term.ЦЕЛЬ Показать возможности антеградных рентгенхирургических методик в лечении ятрогенных по­вреждений желчных протоков после видеолапароскопической холецистэктомии.МАТЕРИАЛ И МЕТОДЫ В исследование включены 24 пациента с «малыми» и 20 пациентов с «большими» (по Strasberg) ятрогенными повреждениями внепеченочных желчных путей. Антеградное эндобилиарное вмешательство было выполнено 26 пациентам, в том числе в варианте “bridge-procedure”, предшествовавшем реконструктивной операции. Эндобилиарные дренажи сохранялись во время рекон­структивной операции и в раннем послеоперационном периоде для контроля состоятельности анастомоза. При выявлении стриктуры билиодигестивного анастомоза (БДА) выполняли баллонную дилатацию зоны анастомоза. В подгруппе «малых» повреждений наружное дренирование подпеченочной биломы у 18 человек было дополнено эндоскопической папиллотомией в 12 наблюдениях.РЕЗУЛЬТАТЫ У всех пациентов с «малыми» повреждениями желчного дерева рентгенохирургические методики оказались эффективными. У 11 пациентов с «большими» повреждениями желчных протоков холангиостомический дренаж этапно был трансформирован в наружно-внутренний. В 2 наблюдениях при травме классы D и Е использовали временное антеградное стентирование зоны повреждения протоков покрытым саморасширяющимся эндобилиарным стентом. Сроки наблюдения после удаления антеградного каркасного дренажа составили от 8 месяцев до 14 лет. Стриктуры и несостоятельности БДА отмечено не было.ЗАКЛЮЧЕНИЕ Кратковременное наружное билиарное дренирование, в том числе с применением «рандеву методик», может оказаться достаточным для устранения несостоятельности культи пузырного протока. Холангиостомический дренаж, временный эндобилиарный стент позволяют подготовить пациента к реконструктивному вмешательству. Дренажная маркировка зоны повреждения облегчает верификацию трубчатых структур в области реконструкции. Сохранение дренажа после реконструктивного вмешательства является профилактикой несостоятельности билиодигестивного анастомоза в раннем послеоперационном периоде, развития его стриктуры в отдаленные сроки

Vertical-external-cavity surface-emitting lasers and quantum dot lasers

The use of cavity to manipulate photon emission of quantum dots (QDs) has been opening unprecedented opportunities for realizing quantum functional nanophotonic devices and also quantum information devices. In particular, in the field of semiconductor lasers, QDs were introduced as a superior alternative to quantum wells to suppress the temperature dependence of the threshold current in vertical-external-cavity surface-emitting lasers (VECSELs). In this work, a review of properties and development of semiconductor VECSEL devices and QD laser devices is given. Based on the features of VECSEL devices, the main emphasis is put on the recent development of technological approach on semiconductor QD VECSELs. Then, from the viewpoint of both single QD nanolaser and cavity quantum electrodynamics (QED), a single-QD-cavity system resulting from the strong coupling of QD cavity is presented. A difference of this review from the other existing works on semiconductor VECSEL devices is that we will cover both the fundamental aspects and technological approaches of QD VECSEL devices. And lastly, the presented review here has provided a deep insight into useful guideline for the development of QD VECSEL technology and future quantum functional nanophotonic devices and monolithic photonic integrated circuits (MPhICs).Comment: 21 pages, 4 figures. arXiv admin note: text overlap with arXiv:0904.369

Searches for the light invisible axion-like particle in K+→π+π0aK^{+}\to\pi^{+}\pi^{0}a decay

A high statistics data sample of the $K^{+}$ decays is recorded by the OKA collaboration. A missing mass analysis is performed to search for a light invisible pseudoscalar axion-like particle (ALP) $a$ in the decay $K^{+} \to \pi^{+} \pi^{0} a$. No signal is observed, the upper limits for the branching ratio of the decay are calculated. The $90\%$ confidence level upper limit is changing from $2.5\cdot10^{-6}$ to $2\cdot10^{-7}$ for the ALP mass from 0 to 200 MeV/$c^{2}$, except for the region of $\pi^{0}$ mass, where the upper limit is $4.4\cdot10^{-6}$.Comment: 6 pages, 6 figure

Observation of K+→π+π0π0γK^{+} \to \pi^{+}\pi^{0}\pi^{0}\gamma decay

The $K^{+} \to \pi^{+}\pi^{0}\pi^{0}\gamma$ decay is observed by the OKA collaboration. The branching ratio is measured to be $(4.1 \pm 0.9(stat) \pm 0.4(syst))\times 10^{-6}$. The branching ratio and $\gamma$ energy spectrum are consistent with ChPT prediction.Comment: arXiv admin note: text overlap with arXiv:2310.1642

Constraints on the χ_(c1) versus χ_(c2) polarizations in proton-proton collisions at √s = 8 TeV

The polarizations of promptly produced χ_(c1) and χ_(c2) mesons are studied using data collected by the CMS experiment at the LHC, in proton-proton collisions at √s=8  TeV. The χ_c states are reconstructed via their radiative decays χ_c → J/ψγ, with the photons being measured through conversions to e⁺e⁻, which allows the two states to be well resolved. The polarizations are measured in the helicity frame, through the analysis of the χ_(c2) to χ_(c1) yield ratio as a function of the polar or azimuthal angle of the positive muon emitted in the J/ψ → μ⁺μ⁻ decay, in three bins of J/ψ transverse momentum. While no differences are seen between the two states in terms of azimuthal decay angle distributions, they are observed to have significantly different polar anisotropies. The measurement favors a scenario where at least one of the two states is strongly polarized along the helicity quantization axis, in agreement with nonrelativistic quantum chromodynamics predictions. This is the first measurement of significantly polarized quarkonia produced at high transverse momentum