BACKGROUND: Endoscopic sphincterotomy (EST) is widely used to treat common bile duct stones (CBDS); however, long-term studies have revealed the increasing incidence of recurrent CBDS after EST. Loss of sphincter of Oddi function after EST was the main cause of recurrent CBDS. Reparation of the sphincter of Oddi is therefore crucial. This study aims to investigate the effectiveness and safety of endoclip papilloplasty (ECPP) for repairing the sphincter of Oddi and elucidate its mechanism. METHODS: Eight healthy Bama minipigs were randomly divided into the EST group and the ECPP group at a 1:1 ratio, and bile samples were collected before endoscopy and 6 months later. All minipigs underwent transabdominal biliary ultrasonography for the diagnosis of cholelithiasis 6 months after endoscopy. The biliary microbiota composition and alpha and beta diversity were analyzed by 16S ribosomal RNA gene sequencing. Differential metabolites were analyzed by bile acid metabolomics to explore the predictive indicators of cholelithiasis. RESULTS: Three minipigs were diagnosed with cholelithiasis in the EST group, while none in the ECPP group showed cholelithiasis. The biliary Firmicutes/Bacteroidota (F/B) ratio was increased after EST and decreased after ECPP. The Chao1 and observed species index significantly decreased 6 months after EST ( P  = 0.017 and 0.018, respectively); however, the biliary α-diversity was similar before and 6 months after ECPP. The β-diversity significantly differed in the EST group before and 6 months after EST, as well as in the ECPP group before and 6 months after ECPP (analysis of similarities [ANOSIM]: R  = 0.917, P  = 0.040; R  = 0.740, P  = 0.035; respectively). Glycolithocholic acid (GLCA) and taurolithocholic acid (TLCA) accumulated in bile 6 months after EST. CONCLUSIONS ECPP has less impact on the biliary microenvironment than EST and prevents duodenobiliary reflux by repairing the sphincter of Oddi. The bile levels of GLCA and TLCA may be used to predict the risk of cholelithiasis.
Animals ; Swine, Miniature ; Swine ; Cholelithiasis/prevention & control* ; Sphincterotomy, Endoscopic/methods* ; Sphincter of Oddi/surgery* ; Female ; Male

Objective To understand the current status and influencing factors of patient perception for humanistic care in China hospitals,and to provide a basis for developing nursing humanistic care measures and improving the quality of nursing humanistic care services.Methods A total of 30,099 outpatients and inpatients from 107 hospitals in 30 provinces(autonomous regions and municipalities)from July to August 2022 as survey subjects.A general information questionnaire and the Relational Caring Questionnaire-Patient Form were used for a cross-sectional survey,and a single-factor analysis was used to analyze the influencing factors of patient relationship care.Results Finally,29 108 valid questionnaires were collected,and the effective questionnaire recovery rate was 96.7％.The patient evaluation of relationship care was(65.72±8.61)points.Single-factor analysis showed that gender,age,marital status,children's situation,education level,occupation,place of residence,average family income,medical insurance type,visiting department,and location of the visiting hospital,and whether or not surgery were influencing factors of patient relationship care(P＜0.05).Conclusion The evaluation score of caregiver-patient relationship care among Chinese hospital patients is above average,but there is still room for improvement in western and rural regions,seriously ill and outpatient patients,low-income and low-medical insurance reimbursement populations,and non-surgical patients.Medical institutions at all levels should optimize and improve nursing humanistic care services based on influencing factors,and further enhance patients'perception of nursing humanistic care.

Objective:To explore the turnover intention of dental outpatient nurses, and analyze its influencing factors.Methods:From August to September 2021, multi-stage sampling was used to select nurses from 20 stomatology hospitals in 7 geographical regions of North China, East China, South China, Central China, Southwest, Northeast, and Northwest China. The survey was conducted using the General Information Questionnaire, Turnover Intention Scale, Nursing Work Environment Scale, Psychological Capital Scale for Nurses, and Work Engagement Scale.Results:A total of 1 513 questionnaires were collected, including 1 135 valid questionnaires, with a valid rate of 75.02% (1 135/1 513). The total score of turnover intention among 1 135 dental outpatient nurses was (2.22±0.56). Pearson correlation analysis showed a negative correlation between nursing work environment, psychological capital, work engagement, and turnover intention ( r=-0.421, -0.340, -0.446; P<0.01). The structural equation model showed that the nursing work environment had a direct negative effect on the turnover intention of dental outpatient nurses (β=-0.401, P<0.01) and had an indirect negative effect on turnover intention through work engagement (β=-0.106, P<0.01), with a mediating effect of 20.91%. Psychological capital had an indirect negative effect on the turnover intention of dental outpatient nurses through work engagement (β=-0.271, P<0.01), with a mediating effect of 52.83%. Conclusions:The turnover intention of dental outpatient nurses is at a high level. Managers can reduce the turnover intention of dental clinic nurses by improving the nursing work environment, developing psychological capital, and increasing work engagement.

Objective:To summarize the research on oral health education for pregnant women.Methods:The literature was described and analyzed using a scoping review method. Seven databases, such as PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and WanFang Data, were electronically searched, and the search period was from database establishment to October 30, 2023.Results:A total of 43 articles were included. The implementers of health education were mainly dental professionals and prenatal healthcare personnel. The theoretical basis included the health belief model, planned behavior theory, social cognitive model and so on. The methods involved traditional teaching or lectures, family-centered, internet-based, and motivational interviews. The contents contained many aspects of oral health for pregnant women. The evaluation indicators mainly covered oral health knowledge, attitude and practice, and self-efficacy, oral health beliefs, oral health status, the incidence of oral diseases, adverse pregnancy outcomes of pregnant and postpartum women, and childhood caries incidence.Conclusions:We should establish a cooperation team of the Department of Stomatology and Obstetrics and Gynecology, incorporate oral health for pregnant women into prenatal care projects, fully utilize the platform of pregnant women's schools, explore the optimal theoretical basis for oral health education, and improve the content of oral health education for pregnant women.

Objective:To explore the high-risk factors of endometrial cancer (EC) and provide clinical basis for early screening, diagnosis and treatment of EC.Methods:From January 2017 to December 2022, patients admitted to Shanxi Provincial Maternal and Child Health Hospital for hysteroscopic surgery or diagnostic curettage due to abnormal uterine bleeding, postmenopausal vaginal bleeding and other related symptoms were selected as the research objects. After histopathological examination, they were diagnosed with no atypical endometrial hyperplasia (EH), atypical endometrial hyperplasia (AEH), and EC as the research subjects. The general data of patients′ records, vaginal ultrasound, cervical liquid-based cytology test (LCT), carbohydrate antigen 125 (CA125) and pelvic magnetic resonance imaging were collected, and a case-control study was conducted and the risk factors of AEH and EC were explored using univariate and multivariate logistic regression analysis.Results:This study included a total of 420 cases, including 215 in the EH group, 69 in the AEH group, and 136 in the EC group. Through the comparison of various indicators among the three groups and the results of univariate factor logistic regression analysis, age, menopause, previous delivery history, hypertension, diabetes, color ultrasound showed endometrial thickening (>10 mm), uneven endometrial echo, abnormal echo mass in the uterine cavity, endometrial blood flow signals, cervical LCT examination showed that atypical glandular cells were related to the occurrence of EC, with a statistically significant difference (all P<0.05). The results of multivariate logistic regression analysis showed that age>48 years ( OR=3.65, 95% CI: 2.06-6.45), menopause ( OR=3.19, 95% CI: 1.46-6.98), uneven endometrial echo ( OR=4.08, 95% CI: 2.26-7.36), and intrauterine blood flow signal ( OR=2.91, 95% CI: 1.52-5.58), cervical LCT suggests that atypical glandular cells ( OR=4.25, 95% CI: 1.38-13.11) were independent risk factors for EC and precancerous lesions (all P<0.05). Conclusions:For patients with clinical symptoms such as abnormal uterine bleeding or postmenopausal bleeding, timely and focused screening based on whether they have EC risk factors is an economic, safe, and effective method for early detection and treatment of EC.

Stroke has become the leading cause of disability and death in China. At present, intravenous thrombolysis is one of the most effective treatment for acute ischemic stroke, but not all patients can benefit from intravenous thrombolysis. In recent years, the exploration of predictive models for the outcomes after intravenous thrombolysis in patients with acute ischemic stroke has attracted increasing attention. This article systematically reviews the scoring models for predicting the functional outcome, death and symptomatic intracranial hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke, with the aim of screening the scoring system suitable for clinical application and providing reference for the clinical diagnosis, evaluation and treatment of acute ischemic stroke.

Objective:To explore the status quo of physician-nurse collaboration among nurses in Dental Clinics in China, and analyze its influencing factors.Methods:From June to July 2020, 1 374 outpatient nurses from 18 ClassⅢ Grade A dental hospitals in 18 provinces, cities and autonomous regions were selected from 7 administrative regions of China with the convenient sampling as research objects. The nurses were investigated with the General Information Questionnaire and Nurse-Physician Collaboration Scale. Multiple linear regression analysis was used to explore the influencing factors of physician-nurse collaboration of nurses in Dental Clinics. A total of 1 374 questionnaires were distributed, and 1 321 valid questionnaires were recovered, with a valid recovery rate of 96.1% (1 321/1 374) .Results:Among 1 321 nurses in Dental Clinics, the total score of the Nurse-Physician Collaboration Scale was (84.20±13.27) . The dimension score of sharing of patient information was (33.20±4.77) , and the dimension score of joint participation in the cure/care decision making process was (38.88±7.80) . Multiple linear regression analysis showed that education background, professional title and participation in the four-hand collaboration were the influencing factors of the physician-nurse collaboration of the nurses in Dental Clinics ( P<0.05) . Conclusions:The physician-nurse collaboration among nurses in Dental Clinics is in good condition, but the joint participation of doctors and nurses in oral cure or care decision-making still needs to be improved. Hospital managers should actively carry out continuing education, strengthen the four-hand operation training and professional connotation training, improve the professional identity of nurses in Dental Clinics and the physician-nurse collaboration, so as to provide comprehensive nursing services for patients.

Objective:To build a sensitive quality index system of dental clinic nursing.Methods:Based on the Donabedian "structure-process-results" three-dimensional quality model, the indicators at all levels of the sensitive quality index system of dental clinic nursing was preliminarily constructed through literature review. The Delphi method was used to develop a system of sensitive quality indicators for dental outpatient care through two rounds of correspondence with 15 experts from the fields of dental care management, oral health care, quality of care management, and health policy.Results:The effective response rates of the two rounds of expert inquiry questionnaires were 100% (15/15), and the average authority coefficient of the experts was 0.93. The Kendall's harmony coefficients of the overall indicators were 0.115 and 0.141, respectively ( P<0.05). A sensitive quality indicator system for dental clinic nursing was finally determined, including 3 primary indicators, 7 secondary indicators and 19 tertiary indicators. Conclusions:The sensitive quality indicator system for dental clinic nursing constructed in this research is scientific and reliable. After verification through future research, it can serve as a basis for improving the quality of dental clinic nursing.

Objective:To investigate the status quo of nursing cognition of caregivers of patients with end-stage renal disease based on cognitive adaptation theory and explore its influencing factors.Methods:The convenient sampling method was adopted to select 150 caregivers of patients with end-stage renal disease admitted to Affiliated Hospital of Jining Medical University from June 2018 to June 2020 as the research objects. Guided by cognitive adaptation theory, a questionnaire was designed to investigate the caregivers' cognitive level of end-stage renal disease care. According to the survey results, caregivers were divided into the high cognition group and the low cognition group. Univariate analysis and Logistic regression analysis were used to analyze the influencing factors of cognitive level of caregivers.Results:There were 150 caregivers in this group, 60 of whom had high nursing cognition, accounting for 40%. There were statistically significant differences between the high cognition group and the low cognition group in knowledge training, life meaning score, internal control scale score and benefit discovery score ( P<0.05) . Logistic regression analysis showed that knowledge training, meaning of life, internal sources of control and the discovery of benefits were the influencing factors for the nursing cognition level of patients with end-stage renal disease ( P<0.05) . Conclusions:The nursing cognition level of caregivers of patients with end-stage renal disease is affected by whether they participate in knowledge training, sense of life meaning, internal control psychological control source and benefit discovery.

Objective:To evaluate the efficacy and safety of enteral extended biliary stenting for biliary stricture.Methods:A multicenter retrospective cohort study was conducted on data of 550 patients with obstructive jaundice due to extrahepatic bile duct stricture between February 2006 and April 2020. Patients were assigned to conventional group (undergoing conventional biliary stent placement) and extended group (undergoing enteral extended biliary stent placement). Propensity score was used to match the basic data of patients of the two groups. Then the stent patency time, bilirubin difference before and after 1 week operation, incidence of complications and hospital stay were compared between the two groups.Results:Among the 550 patients, clinical data of 20 cases were missing and 35 failed to be followed up. Finally, 326 patients were enrolled to the study after propensity score matching with 163 cases in each group. The patency time of extended group was 111.0 (82.0, 192.0) days, which was longer than that of conventional group with patency time of 93.0 (70.0, 141.8) days ( Z=3.260, P=0.001). Total bilirubin difference value of pre-operation and post-operation was less in extended group [51.2 (26.0, 114.7) μmol/L VS 46.0 (13.9, 81.1) μmol/L, Z=2.095, P=0.036]. The rate of early adverse events [4.3% (7/163) VS 3.7% (6/163), P=0.079] and median in-patient days (10.0 days VS 10.0 days, P=0.379) were similar in the two groups. Conclusion:Enteral extended biliary stent is effective and safe for treatment of biliary stricture, which can prolong the patency time without increasing postoperative complications and hospital stay.