INTRODUCTION

Acute cholangitis is a clinical entity caused by bacterial infection of the biliary system, most commonly secondary to partial or complete obstruction of the bile duct or hepatic ducts. The diagnosis is established by the characteristic clinical symptoms and signs of infection, abnormal laboratory studies suggestive of infection and biliary obstruction, and abnormal imaging studies suggestive of biliary obstruction[1]. The main importance of this condition is that it is a very treatable condition if treated appropriately, but the mortality can be high if there is delay in treatment. There are other varieties of cholangitis, which include primary biliary cholangitis, primary sclerosing cholangitis, IgG4-related autoimmune cholangitis and recurrent pyogenic cholangitis or Oriental cholangiohepatitis[2]. We will be exclusively discussing here acute bacterial cholangitis,also called ascending cholangitis. The term ascending cholangitis comes from the migration of bacteria from the duodenum into the common bile duct. But, rarely,translocation of bacteria from the portal vein into the bile duct can also occur.

ETIOLOGY

The biliary obstruction is most commonly caused by choledocholithiasis. Other causes of obstruction include benign or malignant stricture of the bile duct or hepatic ducts, pancreatic cancer, ampullary adenoma or cancer, porta hepatis tumor or metastasis, biliary stent obstruction (due to microbial biofilm formation, biliary sludge deposition and duodenal reflux of food content),primary sclerosing cholangitis, amyloid deposition in the biliary system[3], Mirizzi syndrome (gallstone impacted in cystic duct or neck of the gall bladder causing compression on common bile duct or common hepatic duct), Lemmel’s syndrome (peri-ampullary diverticulum causing distal biliary obstruction), round worm (Ascaris lumbricoides) or tapeworm (Taenia saginata) infestation of the bile duct[4], acquired immunodeficiency syndrome(commonly known as AIDS) cholangiopathy and strictured bilioenteric anastomoses[5]. Choledochocele and narrow-caliber bile duct are other risk factors for acute cholangitis. Recently, there was an outbreak of cholangitis due to carbapenem-resistant Enterobacteriaceae (CRE) as a result of exposure to contaminated duodenoscope[6]. Post-endoscopic retrograde cholangiopancreatography (ERCP) acute cholangitis can occur in 0.5% to 2.4% cases (Figure 1)[7]. As cholelithiasis is the most important risk factor,the same risk factors may play important roles in the development of acute cholangitis, particularly high fat(triglyceride) intake, sedentary life styles, obesity and rapid weight loss. Heavy alcohol consumption may lead to cirrhosis of the liver, which is a risk factor for gallstone formation.

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EPIDEMIOLOGY

The prevalence of cholelithiasis varies in different ethnicities. Gallstones are found in 10% to 15% of the white population in the United States. It is much more prevalent in native Americans (60%-70%) and Hispanics but less common in Asians and African Americans[8]. Many patients get admitted to the hospital with gallstone disease and 6% to 9% of them are diagnosed with acute cholangitis[9]. Males and females are equally affected. The average age of patients presenting with acute cholangitis is 50 to 60 years. Less than 200000 cases of cholangitis occur per year in the United States.

PATHOPHYSIOLOGY

Biliary obstruction is an important factor in the pathogenesis of cholangitis. When bile flow occurs,presence of bacteria in the bile is not that significant because bacterial concentration does not increase and the intraductal pressure does not increase. Normally,there are different defensive mechanisms to prevent cholangitis. The bile salts have bacteriostatic activity and the biliary epithelium secretes IgA and mucous which probably act as anti-adherent factors. Kupffer cells on the biliary epithelium and the tight junction between the cholangiocytes prevent translocation of bacteria from the hepatobiliary system into the portal venous system. Normal bile flow flushes out any bacteria into the duodenum.

The sphincter of Oddi also prevents any migration of bacteria from the duodenum into the biliary system.In case of biliary obstruction, bile becomes stagnant in the biliary system, the intraductal pressure increases,the tight junction between cholangiocytes widen,Kupffer cells malfunction and the production of IgA is decreased[10]. “Choledochal pressure” plays an important role in the pathogenesis of acute cholangitis.The normal biliary ductal pressure is 7 to 14 cm of water(H2O). When the intraductal pressure exceeds 25 cm of H2O, cholangiovenous and cholangiolymphatic reflux can occur, leading to bacteremia and endotoxinemia[11].Besides this, systemic release of inflammatory mediators like tumor necrosis factor (TNF), soluble TNF receptors, interleukin (IL)-1, IL-6 and IL-10 leads to profound hemodynamic compromise.

The most frequently found pathogens isolated in acute cholangitis are coliform organisms[12,13]. These include Escherechia coli (25%-50%), Klebsiella species(15%-20%), Enterococcus species (10%-20%)and Enterobacter species (5%-10%). Sometimes,anaerobic bacteria like Bacteroids fragilis and Clostridium perfringens can also cause acute cholangitis,particularly in patients with previous biliary surgery and in the elderly population[14]. Parasitic infestation of the biliary system by the liver flukes Clonorchis sinensis, Opisthorchis viverrini and Opisthorchis felineus and the roundworm Ascaris lumbricoides may lead to cholangitis[15].

伏牛山区中河南片区粮食秸秆资源可获得量。根据对小范围农业生物质进行现场测量和评定，并结合所走访农民得出，伏牛山区一些农作物的谷草比为：玉米为1∶1.2、小麦为1∶1.3。国家发改委在《生物质能开发利用管理文件和技术规定》上发布了“常见农作物秸秆草谷比”。因此，参考该文件，且综合考虑伏牛山区各县的实际，以粮食1∶1.3的谷草比参数来进行粮食秸秆资源的估算。

CLINICAL PRESENTATION

The presentation depends on the severity of cholangitis. Classically, patients present with high fever persisting for more than 24 h, abdominal pain and jaundice (Charcot’s triad or hepatic fever). The right upper quadrant abdominal pain is generally mild. When the cholangitis becomes more severe,patients become hypotensive and confused (Reynold’s pentad). Charcot’s triad has low sensitivity (26.4%) and high specificity (95.9%). Although the presence of Charcot’s triad is suggestive of acute cholangitis, it is not diagnostic. Charcot’s triad is present in 26.4% to 72% of patients with acute cholangitis[16].

（4）他自吃人在他眼前那等花丽胡哨，乔龙画虎的，两面刀哄他，就是千好万好了。（明·兰陵笑笑生《金瓶梅词话》第20回）

式中，k为频率维参数，l为调频维参数，为Chirp信号初始频率，l0为调频率，N为采样点数，WN=exp(-j2π/N)。该MDCFT算法对采样点数无质数限制，且信号参数不要求为整数，极大扩展了其应用范围。

To improve the sensitivity of Charcot’s triad, TG07 diagnostic criteria for acute cholangitis was made at the International Consensus Meeting held in Tokyo in 2006.TG07 criteria included: A: Clinical: (1) history of biliary disease; (2) fever and/or chills; (3) jaundice; and (4)abdominal pain (RUQ or epigastric); B: Lab data: (5)evidence of inflammatory response; (6) abnormal liver function tests; C: Imaging findings: (7) biliary dilatation or evidence of an etiology (stone, stricture, stent, etc.).Suspected diagnosis: 2 or more items in A. Definite diagnosis: (1) Charcot’s triad (2 + 3 + 4); and (2) two or more items in A plus both items in B plus item C.

13 Jain MK, Jain R. Acute bacterial cholangitis. Curr Treat Options Gastroenterol 2006; 9: 113-121 [PMID: 16539872 DOI: 10.1007/s11938-006-0030-7]

The sensitivity and specificity of diagnosing acute cholangitis in TG07 were 82.6% and 79.8%respectively. In 2012, TG13, a new Tokyo guideline for the diagnosis of acute cholangitis was published[17].The criteria included: (1) Systemic inflammation: A-1:Fever (body temperature ＞ 38 °C and/or shaking chills;A-2: Lab data: Evidence of inflammatory response –white blood cell (WBC) count ＜ 4000/cmm or ＞ 10000/cmm, C-reactive protein (CRP) - ≥ 1 mg/dL; and (2)Cholestasis: B-1: Jaundice-total bilirubin ≥ 2 mg/dL;B-2: Lab data: Abnormal liver function tests. Alkaline phosphatase (IU) ＞ 1.5 × upper limit of normal;Gamma-glutamyl transpeptidase (IU) ＞ 1.5 × upper limit of normal; Aspartate aminotransferase (IU) ＞1.5 × upper limit of normal; Alanine aminotransferase(IU) ＞ 1.5 × upper limit of normal. Imaging: C-1:Biliary dilatation; C-2: Evidence of etiology on imaging(stricture, stone stent, etc.).

Suspected diagnosis: One item in A + one item in either B or C. Definite diagnosis: One item in A, one item in B and one item in C. The sensitivity of diagnosing acute cholangitis improved to 91.8% but the specificity remained similar (77.7%) in TG13. The false positive rate of diagnosing acute cholecystitis also decreased to 5.9%in TG13 in comparison to Charcot’s triad (11.9%) and TG07 (15.5%).

Physical examination may show high temperature,tachycardia, hypotension, jaundice, right upper quadrant or epigastric tenderness and altered mental status.

Severity of acute cholangitis: two clinical factors determine the severity of acute cholangitis: (1) response to initial medical treatment; and (2) organ dysfunction[1].

12 van den Hazel SJ, Speelman P, Tytgat GN, Dankert J, van Leeuwen DJ. Role of antibiotics in the treatment and prevention of acute and recurrent cholangitis. Clin Infect Dis 1994; 19: 279-286[PMID: 7986900 DOI: 10.1093/clinids/19.2.279]

Grade Ⅱ is moderate acute cholangitis. Patients do not have any organ dysfunction and do not respond to the initial antibiotic treatment. Any two of the five conditions should be present: (1) leukocytosis (WBC＞ 12000/cmm) or leukopenia (WBC ＜ 4000/cmm);(2) high temperature (≥ 39 °C); (3) elderly (age ＞ 75 years); (4) hyperbilirubinemia (total bilirubin ≥ 5 mg/dL); and (5) hypoalbuminemia (＜ 0.7 × lower limit of normal).

Grade Ⅲ is severe acute cholangitis. Patients do not respond to initial medical treatment and have organ dysfunction in at least one of the following organs/systems: (1) cardiovascular system: hypotension requiring dopamine infusion ≥ 5 μg/kg per minute,or any dose of norepinephrine; (2) nervous system:disturbance of consciousness; (3) respiratory system:PaO2/FiO2 ratio ＜ 300; (4) renal system: oliguria, serum creatinine ＞ 2 mg/dL; (5) hepatic system: plateletinternational normalized ratio (INR) ＞ 1.5; and (6)hematological system: platelet count ＜ 100000/cmm.

Sometimes we make the diagnosis of acute suppurative cholangitis (ASC) when we notice pus extruding from the ampulla of Vater during ERCP(Figures 1 and 2). ASC does not always mean severe acute cholangitis. Sometimes, patients with severe acute cholangitis do not have pus in the bile duct,and sometimes patients with ASC are not that sick[18].Severe acute cholangitis or toxic cholangitis is present in 5% of all cases of cholangitis[19].

Differential diagnoses of acute cholangitis[20]: (1)acute cholecystitis; (2) cirrhosis of liver; (3) acute hepatitis; (4) liver abscess; (5) septic shock due to any cause; (6) right sided diverticulitis; and (7) righted sided pyelonephritis.

Recurrent acute cholangitis can occur when pigment stone is formed in the intrahepatic ducts leading to stricture formation, mainly in the lateral segment of the left lobe or posterior segment of the right lobe[21]. This condition is also called oriental cholangiohepatitis as it occurs almost exclusively in the natives of Southeast Asia. The exact mechanism is not known but related to malnutrition, ascariasis (Ascaris Lumbricoides)and clonorchiasis (Clonorchis sinensis). Transient portal bacteremia allows entrance of bacteria (E. coli,Klebsiella, Pseudomona, Proteus, anaerobes) into the biliary system, initiating a vicious cycle of infection and stone formation[22]. This condition may cause cholangiocarcinoma in 5% of cases.

INVESTIGATIONS

Lab tests should include complete blood count, erythrocyte sedimentation rate or CRP, complete metabolic profile including renal and hepatic function, prothrombin time and INR. Blood culture should be done as early as possible. TG13 guideline also recommends collection of bile sample during the drainage procedure. Bile culture can be positive in 59% to 93% of acute cholangitis cases.

Imaging studies may include ultrasound of the abdomen, regular or helical computed tomography (CT),magnetic resonance cholangiopancreaticography (MRCP)and endoscopic ultrasound (EUS). CT without contrast is more sensitive than abdominal ultrasound in detecting common bile duct stones[23]. Among these, MRCP (82.2%accuracy in detecting choledocholithiasis) and EUS(96.9% accuracy in detecting choledocholithiasis) are the most sensitive imaging modalities, which can detect the level and cause of biliary obstruction[24]. Transabdominal ultrasound is able to detect choledocholithiasis in 30% of cases, and CT in 42% of cases. Although MRCP is being increasingly used in the setting of acute cholangitis, its sensitivity in detecting less than 6 mm stone is low[11].

MANAGEMENT

Patients with cholangitis should be managed at the hospital, as this is considered as an emergent condition.Patients should be resuscitated first. As cholangitis is due to infection and obstruction of the biliary system,we have to treat both aspects. Intravenous fluid and antibiotics should be started as soon as possible.Fresh frozen plasma or vitamin K may be required for correction of coagulopathy. The choice of antibiotics depends on multiple factors, including the patient’s renal function, hepatic function, drug allergies, comorbidities,hospital-acquired (multiple or resistant organisms like Pseudomonas, CRE, vancomycin-resistant enterococcus or methicillin-resistant Staphylococcus aureus) or community-acquired infection (single agent like E. coli,Klebsiella, or Enterococcus), and also on the severity of cholangitis. The empiric antibiotics should cover both Gram-negative and anaerobic organisms. The initial choice should be piperacillin-tazobactam, ticarcillinclavulanate, ceftriaxone plus metronidazole or ampicillinsulbactam. If the patient is sensitive to penicillin,ciprofloxacin plus metronidazole, carbapenems or gentamicin plus metronidazole are good choices[25]. The antibiotics should be further evaluated and adjusted according to the blood culture results. Blood culture is positive in 21% to 71% of cases of acute cholangitis[26].The dose of the antibiotics should be adjusted according to renal and hepatic functions. Ideally, the antibiotics should be continued for 7 to 10 d[12].

Because of high biliary intraductal pressure, biliary secretion of antibiotics is impaired. So, biliary drainage is the next step. It can be best done by therapeutic ERCP. Depending on the etiology of biliary obstruction,intervention should be done. For example, in case of choledocholithiasis, sphincterotomy and stone extraction (Figures 3-5) should be done with or without transpapillary biliary stent placement. Sometimes,there is an increased risk of bleeding from biliary sphincterotomy if the patient is coagulopathic or on anti-platelet agents. In those cases, biliary stent can be placed temporarily without sphincterotomy. In case of biliary stricture, transpapillary biliary stent placement should give adequate drainage. If there is blockage of the existing stent due to growth of bacterial biofilm and formation of bile sludge, the old stent should be removed and replaced with a new one[27].

Other modalities of biliary drainage include endoscopic nasobiliary drainage (ENBD) by nasobiliary catheter (Figure 6), percutaneous transhepatic biliary drainage (PTBD), EUS-guided drainage and open surgical drainage (T-tube drainage after laparotomy).

In clinical practice, ENBD is done much less frequently, as compared to biliary stent placement.ENBD has the advantages that repeat cholangiogram could be done when the location of biliary stricture is not known, thick pus or purulent bile can be drained more effectively, washing can be done if the tube is clogged,biliary aspirate can be cultured and no additional sphincterotomy is required. The disadvantages are that it is uncomfortable to the patient and a confused patient may pull it out[28].

6 Epstein L, Hunter JC, Arwady MA, Tsai V, Stein L, Gribogiannis M, Frias M, Guh AY, Laufer AS, Black S, Pacilli M, Moulton-Meissner H, Rasheed JK, Avillan JJ, Kitchel B, Limbago BM,MacCannell D, Lonsway D, Noble-Wang J, Conway J, Conover C,Vernon M, Kallen AJ. New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014; 312: 1447-1455 [PMID: 25291580 DOI: 10.1001/jama.2014.12720]

EUS-guided biliary drainage can be performed when ERCP is unsuccessful due to various reasons like ampullary obstruction, gastric outlet obstruction or surgically altered anatomy (Roux-en-Y surgery,gastric bypass, etc.), and intrahepatic bile ducts are not dilated[30]. Urgent EUS-guided choledochoduodenostomy with placement of a covered metallic stent is an option in the setting of acute cholangitis[31], mainly in tertiary care centers.

Surgical drainage is reserved when other modalities of biliary drainage are contra-indicated or fail. It is done rarely now-a-days because of high morbidity and mortality of 20%to 60%[32]. To avoid prolonged surgery, choledochotomy with T-tube drainage without choledocholithotomy is recommended[33]. Laparoscopic choledochotomy with stone extraction can be done in case of failed endoscopic extraction of common bile duct stone[34].

In patients with surgically altered anatomy like Roux-en-Y anastomosis or hepaticojejunostomy, balloon enteroscope-assisted ERCP with biliary drainage is done with variable success rate, of 40% to 95%[35].

Timing of biliary drainage: In grade Ⅰ or mild acute cholangitis: Biliary drainage should be done in 24 h to 48 h. In grade Ⅱ or moderate acute cholangitis(i.e., patient has not responded to antibiotics in first 24 h): Early biliary drainage, and in grade Ⅲor severe acute cholangitis: Urgent biliary drainage should be done. Following endoscopic management of acute cholangitis, laparoscopic cholecystectomy is recommended in patients with gallstone disease[36].The various techniques of performing laparoscopic cholecystectomy safely have been described over the last few decades[37-39].

Management of recurrent pyogenic cholangitis(Oriental cholangiohepatitis) requires a multidisciplinary team (endoscopist, interventional radiologist and surgeon). Initial treatment includes administration of intravenous fluid and antibiotics, endoscopic treatment with stricture dilation, stone extraction and stent placement for biliary drainage or percutaneous biliary drainage in case of failed ERCP. Segmental hepatic resection should be considered in case of localized disease[40]. Orthotopic liver transplantation has also been reported in case of diffuse disease and end-stage liver disease due to recurrent acute cholangitis[41,42].

北平协和医院，1921年9月8日-1922年2月16日，1922年7月11日-1923年9月8日，1926年7月1日-1927年2月28日。

PROGNOSIS

The prognosis depends on the timing of biliary drainage,administration of antibiotics and comorbidities of the patient. Early biliary drainage leads to rapid clinical improvement. But, if biliary drainage is delayed,patients can deteriorate quickly and die. The overall mortality acute cholangitis is less than 10% after biliary drainage[43]. In the pre-ERCP era, severe acute cholangitis was associated with a mortality of more than 50%[44]. Emergency surgery for severe acute cholangitis also carries a high mortality, of about 30%[45].

Poor prognostic factors in the setting of acute cholangitis include old age, high fever, leukocytosis,hyperbilirubinemia and hypoalbuminemia[11]. Patients with comorbidities like cirrhosis, malignancy, liver abscess and coagulopathy also carry poor prognosis.

Patients with high pre-biliary drainage serum creatinine is also associated with higher mortality[46]. A recent study also suggested that serum IL-7 level of less than 6.0 and serum procalcitonin level of more than 0.5 was associated with higher mortality[47].

REFERENCES

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当油箱增加的长度ΔL设为0.1 m、0.2 m时，油箱的体积对应增加了100 L、200 L。系统最终达到平衡后的油箱温度分别为97.3 ℃，94.7 ℃，如图8所示。由此可得增加油箱体积的散热效果比增加肋板更有效，但是只增加油箱体积也无法将油液温度降低到80 ℃。

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PTBD is generally done in case of failed ERCP or if the patient has multiple comorbidities and is not a good candidate for ERCP. There is no need for intravenous sedation or anesthesia for PTBD. The disadvantages include patient’s discomfort, increased length of hospital stay, risks of biliary peritonitis, intraperitoneal hemorrhage and sepsis[29]. It is contraindicated in patients with ascites, coagulopathies and intrahepatic biliary obstructions.

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Grade Ⅰ is mild acute cholangitis. Patients do not have any organ dysfunction and do not meet the criteria of moderate acute cholangitis. They respond to the initial antibiotic treatment.

精进电动是全球领先的新能源汽车电机和动力系统提供商，技术路线覆盖纯电动、插电混合动力、混合动力等，能为客户提供全面的汽车电动系统解决方案。精进电动是行业内少数能全面涵盖新能源汽车最重要应用的动力系统及其核心零部件制造商，拥有丰富的产品组合，包括电机、电控、控制软件、新能源汽车专用变速器、减速器总成等。精进电动产品凭借出众的品质和技术优势赢得了全球客户的信赖。

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财务共享能够让各部门之间在第一时间分享消息，做到对企业财务情况的了解。因此在在财务管理工作中必须积极落实好该项任务，对共享工作有一个全面的了解。对此，不仅要在企业内部做好共享，及时的传递消息，让财务管理负责人做好企业的资金调度。还要与上下游供应商之间做到必要信息的共享，统筹安排财务规划，强化财务链整体结构。

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摘 要：中职教育是我国教育的重要组成部分，是培养技术人才的基地，中职教育的教学质量决定了学生的就业能力。中职物理是中职学校普遍开设的一门文化基础课，是一门理论性和实践性都很强的理性思维科学，对于学生的理论知识、实践能力、创新能力有着很好的促进作用。在物理课程的教学过程中，如何激发学生的学习积极性和主动性、培养学生浓厚的物理学习兴趣？离不开教师的教育教学智慧。

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25 Qureshi WA. Approach to the patient who has suspected acute bacterial cholangitis. Gastroenterol Clin North Am 2006; 35:409-423 [PMID: 16880073 DOI: 10.1016/j.gtc.2006.05.005]

24 de Lédinghen V, Lecesne R, Raymond JM, Gense V, Amouretti M,Drouillard J, Couzigou P, Silvain C. Diagnosis of choledocholithiasis:EUS or magnetic resonance cholangiography? A prospective controlled study. Gastrointest Endosc 1999; 49: 26-31 [DOI:10.1016/S0016-5107(99)70441-4]

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社区里面的大妈们至少短期内还习惯不了在网上买理财产品。而这类社区的中老年人往往具有很强的理财产品购买需求。他们将成为社区银行的潜在客户群体。余额宝能提供适合这一草根投资者的产品、用户体验和较高的安全性，社区服务点开展线下的理财产品销售大有可为。

30 Karaliotas C, Sgourakis G, Goumas C, Papaioannou N, Lilis C, Leandros E. Laparoscopic common bile duct exploration after failed endoscopic stone extraction. Surg Endosc 2008; 22:1826-1831 [PMID: 18071799 DOI: 10.1007/s00464-007-9708-8]

提升人才的培养质量 团队的工作方式主要强调团队协作，只有这样才能够有效实现全面合作，取得事半功倍的效果。这种工作方式能够在很大程度上提升高职院校的教学质量，更重要的是可以通过相互沟通、整合等方式，实现教师相互之间的取其精华、去其糟粕，实现技术、经验上的交流和互补。实现技术、经验共享，从而才可以使团队迎接更大的挑战。因此，高职学校的教学方式理应与时俱进，不要单纯依靠个人的力量，只有团队协作，共同进步和发展，才能最终实现共同目标[1]。

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比湿场叠加风场（700 hPa），6月4日08：00，伴随西南气流，阿拉善右旗上空比湿在4～5 g/kg，且有明显辐合区，水汽在不断堆积。一直维持到6月5日20：00，比湿都在6 g/kg，水汽条件好，对降水有利。

34 Tsuyuguchi T, Takada T, Kawarada Y, Nimura Y, Wada K, Nagino M, Mayumi T, Yoshida M, Miura F, Tanaka A, Yamashita Y, Hirota M, Hirata K, Yasuda H, Kimura Y, Strasberg S, Pitt H, Büchler MW, Neuhaus H, Belghiti J, de Santibanes E, Fan ST, Liau KH,Sachakul V. Techniques of biliary drainage for acute cholangitis:Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14: 35-45[PMID: 17252295 DOI: 10.1007/s00534-006-1154-9]

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笔者在高一第一学期首先对学生进行各种摸底考查，目的是了解学生对初中英语的掌握程度，看是否有该会未会、该记未记的东西，以便有的放矢地进行“填平补齐”的教学工作。在考查中发现有些学生对音素和读音规则掌握得不好，语音、语调有待改进，词汇也遗忘了许多，语法仍比较模糊。

39 Hori T, Oike F, Furuyama H, Machimoto T, Kadokawa Y, Hata T, Kato S, Yasukawa D, Aisu Y, Sasaki M, Kimura Y, Takamatsu Y, Naito M, Nakauchi M, Tanaka T, Gunji D, Nakamura K, Sato K, Mizuno M, Iida T, Yagi S, Uemoto S, Yoshimura T. Protocol for laparoscopic cholecystectomy: Is it rocket science? World J Gastroenterol 2016; 22: 10287-10303 [PMID: 28058010 DOI:10.3748/wjg.v22.i47.10287]

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47 Suwa Y, Matsuyama R, Goto K, Kadokura T, Sato M, Mori R,Kumamoto T, Taguri M, Miyasho T, Endo I. IL-7 and procalcitonin are useful biomarkers in the comprehensive evaluation of the severity of acute cholangitis. J Hepatobiliary Pancreat Sci 2017;24: 81-88 [PMID: 28002647 DOI: 10.1002/jhbp.420]