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.

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 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.

Objective:To investigate the current status of multiple leadership styles of head nurses and affective domain ability of nurses, and to explore the influence of multiple leadership styles of head nurses on affective domain ability of clinical nurses.Methods:From June and August 2019, we selected 380 clinical nurses in the Second People's Hospital of Liaocheng with the method of cross-sectional survey and convenience sampling. All nurses were investigated with the General Information Questionnaire, Multifactor Leadership Questionnaire (MLQ) and Nurse Affective Domain Ability Scale. We analyzed the influence of multiple leadership styles of head nurses on affective domain ability of clinical nurses. In this study, a total of 380 questionnaires were distributed and 372 valid questionnaires were recovered with a valid recovery rate of 97.9%.Results:Among 372 clinical nurses, the total score of perceived MLQ of head nurses was (86.30±18.59) and the item average score was (2.70±0.58) ; the total score of the Nurse Affective Domain Ability Scale and the item average score were (97.67±13.35) and (3.91±0.53) respectively. Univariate analysis showed that there were statistical differences in the total score of Nurse Affective Domain Ability Scale among nurses with different nursing ages, professional titles and educational levels ( P<0.05) . Pearson correlation analysis indicated that the total score of MLQ of head nurses had a positive correlation with the total score of the Nurse Affective Domain Ability Scale of nurses with a statistical difference ( r=0.364, P<0.05) . Hierarchical regression analysis showed that nursing ages and transformative leadership style had a predictive effect on clinical nurses' affective domain ability. Conclusions:Head nurses adopt a transformative leadership style to enhance clinical nurses' affective domain ability, so that they devote themselves to nursing work with full enthusiasm and stabilize the development of the nursing talent team.

Objective To reduce the occurrence of recurrent choledocholithiasis caused by biliary sphincter dysfunction after extensive endoscopic sphincterotomy ( EST ) for large stone extraction, and to investigate the sphincter-preserving effects of duodenal papilla occlusion by SureClip from MicroTech. Methods Three patients with large biliary stones ( 1. 0-2. 5 cm in stone size, 1. 2-3. 0 cm in common bile duct diameter) and without ERCP history underwent EST ( larger than 1. 0 cm) in Peking University Third Hospital from March 2018 to May 2018. Biliary and pancreatic stents were placed after stone extraction, followed by duodenal papilla occlusion with SureClip from MicroTech. Pressures of biliary duct and Oddi sphincter were measured at pre-EST, immediately after EST, and when stents were removed 3 weeks after EST, respectively. Healing conditions of papilla and complications were documented. Five pigs underwent similar experiments without stone extraction. Results The pressure of Oddi sphincter was significantly reduced after EST, and recovered after papilla occlusion 3 weeks after operation both in pigs and human. All stones were completely removed in the 3 patients without any post-ERCP complications. The papilla was healed under endoscopic observation when stents were removed 3 weeks after papilla occlusion. In animal experiments, histology revealed completely muscularis propria disruption of post-EST papilla without occlusion. In contrast, the muscle layer of post-EST papilla with occlusion by SureClip from MicroTech appeared scar healing. Conclusion The duodenal papilla occlusion by SureClip from MicroTech after EST works as "papilla remolding", which accelerates healing of papilla, and retains the sphincter pressure and anti-reflux barrier function.

Computational Biology ; Factor VII ; Factor VII Deficiency ; Genetic Testing ; Humans ; Pedigree

Objective To investigate effect of FK506 binding protein 51 (FKBP51) on the c-JunN-terminal kinase (JNK) pathway in cerebral ischemia-reperfusion injury.Methods Transient global cerebral ischemia rat models were made by four-vessel method.Healthy male SD (Sprague Dawley) rats were randomly divided into:sham group,ischemia/reperfusion group (I/R group),FKBP51 antisense oligonucleotide group (FKBP51 ASODN group),FKBP51 missense oligonucleotide group (FKBP51 MSODN group),and solvent control group (TE group).The effect of FKBP51 ASODN on expression of FKBP51 protein and JNK was detected,and c-Jun phosphorylation was detected by Western blot.Results (1) FKBP51 protein expression in the FKBP51 ASODN group was reduced.The change of FKBP51 protein expression between the FKBP51 ASODN and sham groups was statistically significant (P ＜ 0.05).(2) The expression differences of total JNK protein between all the groups were not statistically significant (P ＞ 0.05).The expression of p-JNK in sham group was significantly less than the other groups (P ＜ 0.05).The expressions of p-JNK in I/R 3d,TE,and FKBP51 MSODN groups were higher relative to Sham group; however,the differences among those three groups were not statistically significant (P ＞ 0.05).The expression of p-JNK in FKBP51 ASODN group was significantly less than FKBP51 MSODN group (P ＜ 0.05).(3) The expression differences of total c-Jun protein among all groups were not statistically significant (P ＞ 0.05).The expression of p-c-Jun in sham group was significantly less than the other groups (P ＜ O.05).The expressions of p-c-Jun in I/R 6 h,TE,and FKBP51 MSODN groups were higher relative to the sham group; however,the differences among those three groups were not statistically significant (P ＞ 0.05).The expressions of p-c-Jun in FKBP51 ASODN group was significantly less than FKBP51 MSODN group (P ＜ 0.05).Conclusions FKBP51 might activate JNK signaling pathway in cerebral ischemia-reperfusion injury.

Objective To investigate the effects of the FKBP51 · PHLPP · AKT signal module on the phosphorylation of Akt and hippocampal neuronal injury after the cerebral ischemia / reperfusion induced neuronal death in rat hippocampus.Methods Transient(15 min)brain ischemia was induced by the four-vessel occlusion in Sprague-Dawley rats.6 rats were used in each group.The antisense oligodeoxynucletides(AS ODN)of PHLPP2 (PH domain and leucine rich repeat protein phosphatases) was used to suppress the assembly of FKBP51 · PHLPP · Akt signal module by intracerebroventricular infusion once per day for 3 days before ischemia.After 6 hours reperfusion,interactions of PHLPP2 and FKBP51 (FK506 binding protein 5) with Akt were detected by immunoprecipitation (IP) and the phosphorylation of Akt was detected by western blot (IB).After 5 days reperfusion,rats were perfusion-fixed with paraformaldehyde and Hematoxylin-Eosin staining was used to examine the survival number of CA1 pyramidal cells of hippocampus.Results Compared to PHLPP2 MS ODN group(1.24±0.24,1.68±0.11,0.58±0.01),PHLPP2 AS ODN suppressed the assembly of the FKBP51 · PHLPP · Akt signaling module(1.06±0.01,1.04±0.13),and increased the phosphorylation of Akt(0.76±0.02) (P＜0.05).Furthermore,compared to PHLPP2 MS ODN group (20.1±2.5),the number of surviving neurons significantly increased in PHLPP2 AS ODN group(88.3±2.7)(P＜0.05).Conclusion The increasing assembly of FKBP51 · PHLPP · Akt signal module can damage CA1 pyramidal cells of hippocampus by inhibiting the phosphorylation level of Akt.