This article reviews the use of endoscopic retrograde cholangiopancreatography(ERCP)in elderly patients.ERCP is widely used in elderly patients with pancreaticobiliary diseases, with a high success rate.It is mainly used for the diagnosis and treatment of biliary calculi, benign and malignant biliary strictures, acute pancreatitis, chronic pancreatitis, and pancreatic tumors and other disease.ERCP plays an important role in accurate diagnosis and treatment, such as the removal of biliary calculi and the placement of stents for biliary obstruction.The perioperative management of ERCP in elderly patients includes preoperative assessment(medical history, nutrition, comorbidities, medication, psychology, etc.), intraoperative considerations(cannulation, stone removal, stent placement, etc.)and postoperative diet and nutrition management.Common complications include anesthesia-related risks and cardiopulmonary complications, postoperative pancreatitis, bleeding, perforation, and infection, which require corresponding measures need to be taken for prevention and treatment.ERCP plays an important role in the diagnosis and treatment of elderly patients, but faces many challenges.Comprehensive perioperative management can reduce risks.With the development of technology, its application prospects are broad, and it is expected to improve the treatment effect and quality of life of elderly patients.

Objective To conduct a comparative study on the biomechanical performance of using sutures for repairing inferior pole patellar fractures.Methods Compared to the normal patellar structure(Group A),four repair methods,namely,'Krackow'suture(Group B),"Kessler"fixation(Group C),'8-figure'mesh method(Group D),and modified suture bridge(Group E)were adopted.The static stiffness and dynamic stability of inferior pole patellar fractures fixed by each repair method were measured at 30°,60°,and 90° knee flexion.Results The stiffness at all flexion angles in Group E was closer to that in Group A,compared to other repair groups,followed by Group B,then Group D,and finally Group C.After the first cycle,at 30° knee flexion,Group C showed the greatest displacement,while Groups B and E had slightly larger displacements than the Group A,and the displacement of Group D was smaller than that of Group A.At 60° and 90° knee flexion,the displacement in all repair groups was smaller than that of Group A.After 200 cycles in the subsequent three cycles,displacement changes in all repair groups were smaller than those in Group A.Conclusions All repair methods were effective.In terms of biomechanical fixation performance,the modified suture bridge was superior to the'Krackow'suture and'8-figure'mesh,with Kessler fixation being the least effective.However,factors such as the injury severity,incision location,and surgical time should be comprehensively considered in actual clinical use,and it is recommended that the repair method should be selected in the following order:E,B,D,and C.

Objective To conduct a comparative study on the biomechanical performance of using sutures for repairing inferior pole patellar fractures.Methods Compared to the normal patellar structure(Group A),four repair methods,namely,'Krackow'suture(Group B),"Kessler"fixation(Group C),'8-figure'mesh method(Group D),and modified suture bridge(Group E)were adopted.The static stiffness and dynamic stability of inferior pole patellar fractures fixed by each repair method were measured at 30°,60°,and 90° knee flexion.Results The stiffness at all flexion angles in Group E was closer to that in Group A,compared to other repair groups,followed by Group B,then Group D,and finally Group C.After the first cycle,at 30° knee flexion,Group C showed the greatest displacement,while Groups B and E had slightly larger displacements than the Group A,and the displacement of Group D was smaller than that of Group A.At 60° and 90° knee flexion,the displacement in all repair groups was smaller than that of Group A.After 200 cycles in the subsequent three cycles,displacement changes in all repair groups were smaller than those in Group A.Conclusions All repair methods were effective.In terms of biomechanical fixation performance,the modified suture bridge was superior to the'Krackow'suture and'8-figure'mesh,with Kessler fixation being the least effective.However,factors such as the injury severity,incision location,and surgical time should be comprehensively considered in actual clinical use,and it is recommended that the repair method should be selected in the following order:E,B,D,and C.

This article reviews the use of endoscopic retrograde cholangiopancreatography(ERCP)in elderly patients.ERCP is widely used in elderly patients with pancreaticobiliary diseases, with a high success rate.It is mainly used for the diagnosis and treatment of biliary calculi, benign and malignant biliary strictures, acute pancreatitis, chronic pancreatitis, and pancreatic tumors and other disease.ERCP plays an important role in accurate diagnosis and treatment, such as the removal of biliary calculi and the placement of stents for biliary obstruction.The perioperative management of ERCP in elderly patients includes preoperative assessment(medical history, nutrition, comorbidities, medication, psychology, etc.), intraoperative considerations(cannulation, stone removal, stent placement, etc.)and postoperative diet and nutrition management.Common complications include anesthesia-related risks and cardiopulmonary complications, postoperative pancreatitis, bleeding, perforation, and infection, which require corresponding measures need to be taken for prevention and treatment.ERCP plays an important role in the diagnosis and treatment of elderly patients, but faces many challenges.Comprehensive perioperative management can reduce risks.With the development of technology, its application prospects are broad, and it is expected to improve the treatment effect and quality of life of elderly patients.

Background Electroplating technology is widely used in the mechanical manufacturing industry. Electroplating workers may be exposed to occupational hazards such as chromium, zinc, cyanides, and sulfuric acid. With the continuous improvement of protective conditions, occupational hazards have been effectively controlled, but there is less focus on the potential acute occupational poisoning that may occur during the electroplating process. Objective To identify causes of an acute chromium poisoning accident occurred during the cleaning process of electroplating tank in a hardware processing plant, and to formulate relevant prevention and control measures to avoid similar poisoning accidents. Methods Occupational history, medical history, and treatment process of the poisoned worker were inquired in detail, his inpatient medical records were consulted , and his blood samples were tested. Occupational health investigation and testing were carried out at the scene of the poisoning accident. Results The air concentration of peak exposure (CPE) and permissible concentration-time weighted average (CTWA) of chromium and its compounds in the workplace were 0.49 mg·m⁻³ and 0.31 mg·m⁻³ respectively. The results of auxiliary test were Serum chromium 4175.85 μg·L⁻¹, serum creatinine 1370.2 μmol·L⁻¹, urea 42.28 mmol·L⁻¹, and urine osmotic pressure 248 mosm·L⁻¹. The final diagnosis was occupational acute severe toxic nephropathy (chromium and its compounds) and occupational chemical skin moderate burn (chromic acid, sulfuric acid). The prescribed treatment included right lower limb expansion skin grafting, hemodialysis and symptomatic support. The patient’s condition was stable and gradually improved after the treatment. Conclusion The main causes of the poisoning accident include weak awareness of the employer of occupational disease prevention and control; failures in fulfilling legal obligations of occupational disease prevention and control, implementing effective occupational disease prevention measures, and providing proper occupational health and safety training and effective personal protective equipment. In order to protect the health of workers, the relevant government departments and employers should attach great importance to the prevention and control of occupational diseases, such as strengthening training and education, increasing the intensity of occupational health supervision, and urging employers to implement occupational disease prevention measures in accordance with the law.

Objective:To analyze and summarize the clinical manifestations, pathological characteristics, treatment, and outcomes of primary malignant melanoma of the esophagus(PMME)in elderly Chinese patients.Methods:A case study of an elderly patient with PMME was conducted at the Department of Gastroenterology in the China-Japan Friendship Hospital.Additionally, literature and case data on elderly PMME cases reported in China up to July 2023 were gathered and analyzed to summarize the epidemiological characteristics, endoscopic manifestations, clinical presentations, diagnosis, treatment, and prognosis of the disease.Results:A comprehensive review of the literature up to July 2023 documented a total of 114 cases of elderly patients with PMME in China, which also included cases from our hospital.Among these cases, there were 68 male patients(59.6%)and 46 female patients(40.4%), ranging in age from 60 to 81 years, with a median age of 65 years.The predominant clinical manifestations observed were dysphagia and choking while eating, followed by chest pain and retrosternal burning sensation.The majority of the lesions were found in the middle and lower segments of the esophagus, predominantly protruding into the lumen, with only 2 cases(1.8%)displaying esophageal mucosal pigmentation.Immunohistochemical analysis revealed that HMB45 was positive in 74 cases(64.9%)and negative in 3 cases(2.6%), while S-100 was positive in 66 cases(57.9%)and negative in 2 cases(1.8%), although data for some patients were not available.Lymph node or distant metastases were present in 45 cases(39.5%), while 38 patients(33.3%)had tumors confined to the esophagus without metastases.Of the 114 patients, 61(53.5%)had a follow-up period ranging from 0.3 to 39 months, with a median follow-up time of 6.75 months.Among the patients who survived during the follow-up period, there were 30 cases(26.3%), with a follow-up time of 1 to 39 months and a median follow-up time of 7.5 months.For the deceased patients, the time from consultation to death ranged from 0.3 to 31 months.Conclusions:Elderly individuals with PMME in China typically present with a gradual onset, nonspecific symptoms, frequent metastasis upon diagnosis, aggressive behavior, and unfavorable outcomes.

Objective:To assess the feasibility and effectiveness of transnasal ultra-thin gastrointestinal endoscope-guided ileus tube insertion for the treatment of adhesive intestinal obstruction in the elderly.Methods:Randomized controlled trial, a total of 81 elderly patients with adhesive intestinal obstruction were enrolled, with 46 receiving transnasal ultra-thin gastroscope-assisted tube placement(observation group)and 35 receiving conventional transoral gastroscope-assisted tube placement(control group). Tube insertion was carried out.Data on the time needed for tube placement, incidents of oral or nasal bleeding, rates of successful tube placement, physical signs of symptom relief and imaging signs of symptom relief were recorded and compared between the two groups.Results:The symptom remission rate within 3 d was 93.5%(43/46)in the observation group and 88.6%(31/35)in the control group, and the rate for imaging signs of symptom remission was 82.6%(38/46)in the observation group and 74.3%(26/35)in the control group.The differences in symptom remission and imaging signs of symptom remission within 3 d were not statistically significant between the two groups( χ2=0.144, 0.830, all P>0.05). In the observation group, the time needed for tube placement was(15.4±4.2)min, which was significantly shorter than that in the control group(21.3±3.1)min( t=6.984, P<0.01). The rate of successful tube placement was 100% in both groups.In terms of adverse reactions, the observation group had 1 patient with nasal bleeding, 2 with nausea and vomiting, and 1 with a sore throat, with an overall adverse reaction rate of 8.7%(4/46), while the control group had no patient with bleeding, 18 with nausea and vomiting, and 4 with a sore throat, with an overall adverse reaction rate of 62.9%(22/35). There was no statistically significant difference in nasal bleeding(Fisher's exact probability P=0.568)or a sore throat( χ2=1.559, P=0.212), but the differences in the incidence of nausea and vomiting as well as the incidence of total adverse reactions were statistically significant( χ2=23.694, 26.752, both P<0.01)between the two groups. Conclusions:Transnasal ultra-thin gastroscope-assisted tube placement can reduce discomfort such as nausea and vomiting during tube placement, the time needed for the procedure is short with a high success rate, and therefore has very good clinical value, especially for elderly patients.

Objective:To assess the efficacy of immunosuppressor on treatment of Henoch-Sch?nlein purpura nephritis(HSPN).Methods:Literatures were searched in PubMed, Cochrane library, Web of Science, Wanfang database, CNKI and CBM database from inception to January 2021.The studies that investigated the effect of immunosuppressor on HSPN outcomes were included.Article screening, data extraction and quality assessment were accomplished by two investigators independently, and statistical analyses were performed by STATA 14.Results:Ten studies were included with 443 cases, of which, 245 cases were in the experimental group while 198 cases were in the control group.The Meta-analysis showed that the experimental group had higher complete remission rate( OR=1.95, 95% CI 1.19-3.22, P=0.009), total remission rate ( OR=2.92, 95% CI 1.74-4.88, P<0.001), proteinuria decreasing level ( SMD=0.35, 95% CI 0.09-0.61, P=0.008), the increasing level of serum albumin ( SMD=1.27, 95% CI 0.43-2.11, P=0.003) and the increasing level of estimated glomerular filtration rate ( SMD=0.48, 95% CI 0.21-0.76, P=0.001), lower relapse rate ( OR=0.19, 95% CI 0.05-0.72, P=0.015) as well as death rate ( OR=0.19, 95% CI 0.04-0.78, P=0.021)than those of the control group. Conclusion:The immunosuppressor could enhance complete remission rate, total remission rate, proteinuria decreasing level, the increasing level of serum albumin and the increasing level of estimated glomerular filtration rate, reduce relapse rate and death rate of HSPN patients.

Objective:To evaluate the frailty status, and to explore its related factors among the community-dwelling elderly people in Beijing, so as to provide scientific basis for taking corresponding measures to delay the frail process of the elderly.Methods:From November 2015 to January 2016, a cross-sectional study was performed among elderly adults of Longtan Community in Dongcheng District, Beijing.Persons aged 60 years and over were selected using a stratified cluster sampling method, and the geriatric frailty-related information was collected through face-to-face household interview.The frailty index(FI)was used to evaluate the frailty status.Multivariate linear regression analysis was used to explore influencing factors on FI value among the elderly.Results:Of the 1 557 interviewees, the median(quartile)value of FI was 0.09(0.08); and women had a higher FI median value than men[0.10(0.08) vs.0.08(0.07)]( Z=5.376, P=0.000). The FI value increased with age( H=329.698, P=0.000). In addition, multivariate linear regression analysis showed that female, older age, disability, being hospitalized in the previous year, being hospitalized during the past 3 years, being unsatisfied to living conditions had relatively higher FI value than the control group( β=0.082, 0.236, 0.336, 0.065, 0.089, 0.193, all P<0.05); and people with high education level, family harmony, a large number of friends who gave support and help, more frequency of participating in organization activities, regular physical examination, and routine exercise had lower FI value than the control group( β=-0.049, -0.052, -0.089, -0.047, -0.045, -0.219, all P<0.05). For FI value, physiological disability was the greatest influencing factor, followed by ageing and not often physical exercise. Conclusions:Similar to foreign studies, the FI method is an effective method to evaluate the frailty status and characteristics among older adults, and is also applicable for the elderly in China.Frailty in elderly people is related not also to intrinsic factors, such as physiology and disease, but also to interventionable factor, such as society, psychology and behavior.Therefore, comprehensive measures should be adopted to delay the process of frailty among the elderly.

Objective:To evaluate the treatment effect of hemoperfusion(HP) on Henoch-Sch?nlein purpura(HSP) outcomes.Methods:PubMed, Cochrane library, Web of science, Wanfang database, CNKI and CBM database were searched from inception to February 2020.Literatures of randomized controlled trials(RCTs) that investigated the effect of HP on HSP outcomes were included.Articles screening, data extraction and quality assessment were accomplished by two investigators independently, and statistical analyses were performed by RevMan 5.3.Results:Thirteen RCTs were included with 803 cases, of which, 397 cases were in the HP group while 406 cases were in the control group.The Meta-analysis revealed the HP group had less disappearing time of hematuresis or albuminuria[ MD=-2.77, 95% CI(-3.18, -2.36), P<0.001], relieving time of abdominal pain[ MD=-1.70, 95% CI(-2.17, -1.23), P<0.001], disappearing time of hematochezia[ MD=-1.54, 95% CI(-1.68, -1.40), P<0.001], and the length of hospital stay[ MD=-3.23, 95% CI(-3.60, -2.87), P<0.001] than the control group. Conclusion:The HP could shorten disappearing time of hematuresis or albuminuria, relieving time of abdominal pain, disappearing time of hematochezia, and the length of hospital stay of HSP.