In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Background::Prenatal and postnatal factors may have joint effects on cardiovascular health, and we aimed to assess the joint association of birth weight and ideal cardiovascular health metrics (ICVHMs) prospectively in adulthood with incident cardiovascular disease (CVD).Methods::In the UK Biobank, 227,833 participants with data on ICVHM components and birth weight and without CVD at baseline were included. The ICVHMs included smoking, body mass index, physical activity, diet information, total cholesterol, blood pressure, and hemoglobin A1c. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) in men and women.Results::Over a median follow-up period of 13.0 years (2,831,236 person-years), we documented 17,477 patients with incident CVD. Compared with participants with birth weights of 2.5-4.0 kg, the HRs (95% CIs) of CVD among those with low birth weights was 1.08 (1.00-1.16) in men and 1.23 (1.16-1.31) in women. The association between having a birth weight <2.5 kg and CVD risk in men was more prominent for those aged <50 years than for those of older age ( P for interaction = 0.026). Lower birth weight and non-ideal cardiovascular health metrics were jointly related to an increased risk of CVD. Participants with birth weights <2.5 kg and ICVHMs score 0-1 had the highest risk of incident CVD (HR [95% CI]: 3.93 [3.01-5.13] in men; 4.24 [3.33-5.40] in women). The joint effect (HR [95% CI]: 1.36 [1.17-1.58]) could be decomposed into 24.7% (95% CI: 15.0%-34.4%) for a lower birth weight, 64.7% (95% CI: 56.7%-72.6%) for a lower ICVHM score, and 10.6% (95% CI: 2.7%-18.6%) for their additive interaction in women. Conclusions::Birth weight and ICVHMs were jointly related to CVD risk. Attaining a normal birth weight and ideal ICVHMs may reduce the risk of CVD, and a simultaneous improvement of both prenatal and postnatal factors could further prevent additional cases in women.

China is one of the countries in the world with the highest rate of esophageal cancer. Early detection, accurate diagnosis, and treatment of esophageal cancer are critical for improving patients’ prognosis and survival. Machine learning technology has become widely used in cancer, which is benefited from the accumulation of medical images and advancement of artificial intelligence technology. Therefore, the learning model, image type, data type and application efficiency of current machine learning technology in esophageal cancer are summarized in this review. The major challenges are identified, and solutions are proposed in medical image machine learning for esophageal cancer. Machine learning's potential future directions in esophageal cancer diagnosis and treatment are discussed, with a focus on the possibility of establishing a link between medical images and molecular mechanisms. The general rules of machine learning application in the medical field are summarized and forecasted on this foundation. By drawing on the advanced achievements of machine learning in other cancers and focusing on interdisciplinary cooperation, esophageal cancer research will be effectively promoted.

To explore the clinical efficacy and possible mechanism of Tai Ji Quan for post-stroke depression (PSD), literature related to Tai Ji Quan and PSD were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full- text Database (Wanfang), Chongqing VIP Database (CQVIP), China Biology Medicine Disc (CBM), and PubMed, screened and then summarized. The results showed that Tai Ji Quan could effectively improve the depression and quality of life of stroke patients, and there were differences in the clinical efficacy among different training programs. Tai Ji Quan has the characteristics of "regulating mind", "regulating breath", and "regulating body". It may achieve the effect of "combined physique-spirit treatment" by improving social psychology, increasing the level of neurotrophin, regulating neuroendocrine, reducing inflammatory factors, and regulating neural circuits.

Objective:To investigate the influences of abnormal white matter micro-structures and stressful life events in relapse status of patients with major depressive disorder (MDD).Methods:A prospective sutdy was performed; 108 patients with MDD were chosen as study subjects in our hospital from May 2017 to June 2018. All subjects underwent MR imaging scanning, and were followed up for 2 years after treatment (once every 3 months). Their relapse status were assessed by 4 th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. The degrees of depression and existence and level of stressful life events in MDD patients were assessed by Hamilton Depression Rating Scale (HDRS) and Life Events Scale (LES). The differences of clinical data and white matter micro-structures between relapse and non-relapse patients were compared. Binary Logistic regression analysis was used to determine the independent influencing factors for MDD relapse. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of influencing factors in MDD relapse. The correlations of white matter fractional anisotropy (FA) values with follow-up HDRS scores and follow-up LES scores were analyzed by Pearson correlation analysis. Results:In the end, 92 patients were enrolled in the study, including 38 relapse patients and 54 non-relapse patients. As compared with those in the non-relapse group, patients in the relapse group showed younger onset age, higher incidence of disease onset, longer course of disease, higher LES scores (baseline), and higher HDRS and LES scores (follow-up), with significant differences ( P<0.05). FA values of the right superior longitudinal fasciculus and corpus callosum in the relapse patients were significantly decreased as compared with those in the non-relapse patients ( P<0.05). Binary Logistic regression analysis showed that FA values of the right superior longitudinal fasciculus ( OR=0.350, 95%CI: 0.168-0.728, P=0.005) and FA values of the corpus callosum ( OR=0.646, 95%CI: 0.438-0.951, P=0.027), and LES scores (follow-up) ( OR=1.483, 95%CI: 1.226-1.793, P=0.000) were independent influencing factors for relapse in MDD patients. ROC curve showed that the area under curve (AUC) of FA values of the right superior longitudinal fasciculus, FA values of the corpus callosum, and LES scores (follow-up) to predict MDD relapse were 0.655, 0.661 and 0.841, respectively. Correlation analysis showed that FA values of the superior right longitudinal fasciculus and FA values of the corpus callosum were significantly negatively correlated with HDRS scores (follow-up) ( r=-0.470, P=0.000; r=-0.398, P=0.004), and LES scores (follow-up) were significantly positively correlated with HDRS scores (follow-up) ( r=0.429, P=0.000). Conclusion:Abnormal white matter micro-structures and stressful life events are closely related to the relapse of MDD.

Objective To evaluate endoscopic pancreaticobiliary separation (EPBS) in patients with gallstone and occult pancreaticobiliary reflux (OPBR).Methods The clinical data of 47 cases with gallstone and OPBR from Oct 2013 to Oct 2016 was analyzed retrospectively.Results The mean gallbladder bile amylase (GBA) was (864 ± 575) U/L.40 cases have undergone the treatment of endoscopic retrograde cholangiopancreatography.26 cases were diagnosed as duodenal papillitis,16 cases as periampullary diverticula,14 cases as long nipple,5 cases as atrophic papilla,3 cases as ampulla stone and 2 cases as papillary tumor.9 were diagnosed as pancreaticobiliary maljunction in the 14 patients with long nipple.33 cases were performed with EPBS.GBA was tested in 16 cases,and the GBA of 15 cases returned to normal level.The difference of GBA was statistically significant [(1 161 ±764) U/L vs.(47 ± 17) U/L,(t =5.641,P ＜ 0.05)].Patients were followed up for 1 to 4 years,among 36 cases without cholecystectomy,there was no recurrence of cholecystolithiasis after EPBS in 27 cases,but 2 cases had recurrent gallstones in 9 cases without EPBS,and the difference of gallstone recurrence rate was statistically significant (x2 =21.340,P ＜ 0.05).Conclusions Pancreaticobiliary junction diseases is an important cause for gallstone formation and OPBR.EPBS can avoid pancreaticobiliary reflux and reduce the recurrence rate of gallstone after choledochoscopic lithotomy.

Objective: To study the impact of aging on pancreatic atrophy, fibrosis and exocrine hypofunction in patients with post-ERCP pancreatitis (PEP) and its severity. Methods: A retrospective study was conducted on 786 patients who underwent ERCP at the Affiliated Zhongshan Hospital of Dalian University from June 2011 to April 2018. Patients who were aged over 75 years were grouped into the elderly group while those aged less than 75 years were grouped into the younger group. The incidences and severity of post-ERCP pancreatitis in the two groups were analyzed. Results: In the elderly group, there were 308 patients. The average age was (81.8±4.8) years. In the younger group, there were 478 patients. The average age was (57.7±12.0) years. The average operation time for the elderly group was (52.5±14.1) minutes, and that for the younger group was (50.7±14.9) minutes. There were no significant differences in operation time and in the related factors between the two groups (P>0.05). There was no significant difference in the rates of hyperamylasemia between the two groups (29.9% vs 30.1%, P>0.05). The overall rate of PEP was 11.3% (89/786). In the elderly group, the rate of PEP was 6.5% (20/308), which was significantly lower than that in the younger group (χ²=11.765, P<0.05). The rates of mild, moderate and severe PEP in the elderly group was significantly lower than those in the younger group (all P<0.05). Hyperamylasemia and pancreatitis in the 2 groups were alleviated after conservative treatment. Conclusions Aging (≥75 years) resulted in pancreatic atrophy, fibrosis, exocrine hypofunction which had a protective effect on PEP.

Objective To investigate the effect of X-ray assisted nasal catheter extractor on nose biliary oronasal conversion. Methods A total of 892 patients,receiving endoscopic nasal biliary drainage in Affiliated Zhongshan Hospital of Dalian University from January 2014 to December 2015, were randomly divided into experiment group and control group. X-ray assisted nasal catheter extractor was used in the experiment group,and guide wire was used in the control group. The mean extracting number and operation time, the total success rate, one-time success rate, response to stimulation and the incidence of complications were compared between the two groups. Results There were 457 cases in the experiment group. The mean extracting number was 1.08±0.32,the mean operation time was 1.07±0.29 min,the total success rate was 100.00%(457/457)and one-time success rate was 93.65%(428/457). The stimulation degree score was 1.27±0.50 with 348 cases of mild response,96 cases of moderate response and 13 cases of severe response. The rate of adverse reaction was 15.54%(71/457)with 50 cases of nausea, 18 cases of vomiting and 3 cases of mucosal bleeding. There were 435 cases in control group. The mean extracting number was 1.68±0.61,the mean operation time was 1.75±0.53 min, the total success rate was 75.63%(329/435)and one-time success rate was 38.16%(166/435). The stimulation degree score was 1.59 ±0.62 with 210 cases of mild response,194 cases of moderate response and 31 cases of severe response. The rate of adverse reaction was 35.86%(156/435)with 87 cases of nausea,36 cases of vomiting,27 cases of mucosal bleeding,and 6 cases of nasal duct prolapsed for vomiting. There were significant differences in the mean extracting number, mean operation time, stimulation degree score and the adverse reaction rate between the two groups(all P<0.001). The total success rate and one-time success rate in the experiment group were higher than those in the control group(all P<0.001).Conclusion X-ray assisted nasal catheter extractor can improve the success rate of operation,shorten the operation time,reduce the stimulation degree and the rate of adverse reactions in nose biliary oronasal conversion.

The clinical data of 7 patients who underwent the treatment of gradual and persistent balloon dilatation (GPBD) by percutaneous transhepatic cholangiography (PTC)for traumatic biliary stricture in Zhongshan Hospital Affiliated to Dalian University were analyzed retrospectively.Balloon catheters were successfully implanted in 5 cases by PTC,and with the help of ERCP in 2 PTC failed cases.There was no bleeding,acute pancreatitis and other complications.Two balloon catheters were damaged and displaced,respectively.All the biliary strictures were relieved.No biliary sludge was attached on the surface of the balloon and in the bile duct.Bile duct mucosa had congestion edema and cellulose attachment.There was no biliary stricture recurrence in the follow-up of 5 to 27 months.This study showed GPBD by PTC was a simple,safe and effective method for treating traumatic biliary strictures.

Objective:To analyze the wall thickness of C-shaped canals in permanent mandibular second molars.Methods:40 ex-tracted permanent mandibular second molars with C-shaped root were collected from native Chinese and were scanned by micro-CT scan-ner.The specimens were reconstructed three-dimensionally by software Mimics 10.01.The roots were sliced from cemento-enamel junc-tion (CEJ)to apex with 1 mm intervals.The cross-sectional root canal configurations were classified into 5 types according to the Fan's Classification.The minimum buccal wall thickness (MBWT),minimum lingual wall thickness(MLWT)and their locations,as well as the wall thickness at the mesial and distal reference sites were detected.Two-way ANOVA and post hoc LSD-t tests were used to com-pare the mean thickness at 4 sides.Results:Among 370 cross-sections of 40 C-shaped roots,C1,C2 and C3 canals were observed on 126(34.1%),46 (12.4%)and 160 (43.2%)sections respectively.Except at the 10 mm level,the mean MLWT was always lower than MBWT;and the MLWT and MBWT were always lower than the wall thickness at the mesial and distal reference sites.The differ-ence was statistically significant (P <0.05)along the root length above the 12 mm level.The MBWT of the C2 and C3 canals was more likely located at the mesial region,and the MBWT of the C1 and the MLWT of C1,C2 and C3 was more frequently located at the center region.Conclusion:The lingual wall of C-shaped canal in mandibualr second molars was the thinnest zone among four sides,and care should be taken during root canal instrumentation and post space preparation to avoid perforation.