Objective: To investigate the significance of doctor -patient communication courses to medical staff.Methods:Using self-made questionnaire and self -evaluation of anxiety scale (SAS), selection in our u-niversity study of 200 cases of medical personnel , in accordance with the doctor -patient communication before and after the course is divided into classes before and after teaching group , respectively on two groups before and after learning the medical staff on the SAS scores and questionnaire survey .Results:Compared with group before teach-ing, teaching group after medical staff thought through the study of doctor -patient communication course , is con-ducive to cultivating communication consciousness , improve doctor -patient communication skills as well as pre-venting the doctor-patient contradiction (P<0.05).After teaching group SAS score (34.50 ±6.88), signifi-cantly lower than the teaching group SAS score (45.51 ±6.97), difference was statistically significant (t =15 .622 ,P<0 .01 ) .Conclusion:Doctor-patient communication courses are effective way to improve the ability to communicate , to alleviate the anxiety of the medical staff at the same time also has a certain value .

Objective To observe the therapeutic effects of electrical stimulation of pelvic floor muscles on urinary incontinence (UI) in patients with incomplete spinal cord injury (ISCI). Methods Seven patients (5 males and 2 females; average age: 32.5 years; average duration after injury: 7.5 months) with ISCI were treated with ESPFM applied on rectum (for male) or vagina (for female) for 30～45 min,once a day, 5 days a week for (2～3) months. The rate of success on stopping using catheters and the frequency and amount of urination were observed during treatment. Results Catheters were taken out successfully from all patients 2～3 weeks after treatment. Five out of the 7 patients had more self-control of urination than incontinence after 8 weeks of treatment though there was no significant difference in the amount of the urination. Conclusion ESPFM might improve the function of urinary bladder in patients with incomplete spinal cord injury.

Objective To assess the application value of pancreatic stent placement for endoscopic resection of duodenal major papilla adenoma.Methods A total of 67 cases of duodenal major papilla adenoma that were confirmed by biopsy and underwent endoscopic papillectomy from August 2007 to July 2016 in endoscopy center of Drum Tower Hospital of Nanjing were analyzed retrospectively.There were 50 patients treated with pancreatic stent placement and 17 patients without as the control group.The general information, efficacy and complications of two groups were collected at the same time.Results There were no significant differences in gender(P=0.070), age(P=0.151) or tumor size(P=0.136) between pancreatic stent placement group and the control group.There were no statistical differences in en bloc resection rates or complete resection rates between the two groups.And there were no significant differences in short-term complications of bleeding(P=0.428), pancreatitis(P=0.982), cholangitis(P=1.000), perforation(P=1.000)or long-term complications of distal common pancreatic duct stricture between the two groups.Conclusion Pancreatic stent should not be routinely placed in endoscopic papillectomy, and should be considered for specific cases.

Objective To investigate the efficacy of pancreatic duct stent in preventing post-ERCP pancreatitis (PEP) of difficult bile duct cannulation.Methods A total of 120 patients who underwent difficult bile duct cannulation during routine ERCP were randomized to receive pancreatic duct stent placement (S group) or not (NS group),and the incidence of PEP,hyperamylasemia and scores of abdominal pain were analyzed.Results There were 15 cases of hyperamylasemia and 5 cases of PEP occurred in S group,but no severe PEP was observed.The score of abdominal pain was (3.82 ± 1.48) in S group.There were 18cases of hyperamylasemia and 14 cases of PEP occurred,including 2 severe PEP in NS group.The score of abdominal pain was (7.48 ± 1.93) in NS group.There was no significant difference in the incidence of hyperamylasemia between the two groups (P ＞ 0.05).The incidence of PEP,severe PEP and the scores of abdominal pain were lower in the S group (P ＜ 0.05).Conclusion Placement of pancreatic duct stent can reduce the PEP rate of difficult bile duct cannulation and relieve the abdominal pain.

The clinical features of Lophomonas blattarum infection in 26 patients with bacterial pneumonia were analyzed.Common manifestation included fever,cough and breathlessness.Computed tomography(CT)showed interstitial change and alveolar exudation.The parasites were found in sputum smear and from the bronchoalveolar lavage fluid(BALF).Metronidazole was effectively used to cure the pulmonary infection of L.blattarum.

Objective To investigate the risk factors of post-ERCP pancreatitis( PEP). Methods Data of 4,234 patients who underwent ERCP in Nanjing Drum Tower Hospital were retrospectively analysed. Information of patients and operations,including age,gender,operation history,major disease history,labora-tory examination before operation,abdominal ultrasound,CT,MRCP,detailed ERCP operation process,com-plications and treatment were carefully recorded. Then Chi-square test was used for univariate analysis,and stepwise multivariate Logistic regression for variate analysis. Linear correlations between risk factors were de-tected. Results There were totally 226 PEPs,with 5. 3% incidence rate. Univariate analysis showed that the female(χ2 =9. 715,P=0. 002),young( <60 years)(χ2 =6. 108,P=0. 013),chronic pancreatitis(χ2 =14. 703,P=0. 001),initial ERCP(χ2 =14. 899,P=0. 000),hypertension(χ2 =4. 489,P=0. 034),nor-mal bilirubin levels before operation(χ2 =19. 159,P =0. 000 ),difficult cannulation(χ2 =45. 824,P =0. 000),pancreatic guide wire(χ2 =30. 223,P=0. 000),papillary pre cut(χ2 =45. 928,P=0. 000),pan-creatography(χ2 =20. 170,P=0. 000)may be risk factors for PEP. Non conditional Logistic regression analy-sis showed that female(OR=1. 449,P=0. 011),initial ERCP(OR=1. 745,P=0. 003),normal bilirubin levels before operation(OR=1. 917,P=0. 000),difficult cannulation(OR=3. 317,P=0. 000)and pancre-atography(OR=1. 823,P=0. 004)were independent risk factors for PEP. Linear correlation analysis sugges-ted that pancreatic duct guide wire and papillary precut were related to the difficult cannulation,and the corre-lation coefficients were -0. 788 and -0. 699. Conclusion Female,young(<60 years),chronic pancreati-tis,initial ERCP,hypertension,normal bilirubin levels,difficult cannulation,pancreatic duct guide wire,pa-pillary precut,pancreatography may induce PEP. Female,normal bilirubin levels before operation,initial ER-CP,difficult cannulation and pancreatography are independent risk factors for PEP,while pancreatic duct guide wire,papillary precut are not,as they were linear correlated to difficult cannulation.

Objective To assess feasibility and advantages of the improved endoscopic resection of duodenal major papillary.Methods A total of 56 cases were collected in Drum Tower Hospital from October 2007 to December 2012, which were diagnosed as duodenal major papillary adenoma or carcinoma in situ, where tumor didn't extend to the biliary or pancreatic duct by the endoscopic ultrasonography, intraductal ultrasonography or histology of biopsy specimens.The diameters of these adenoma ranged from 0.3 cm to 5.0 cm.Twenty-four lesions were resected by routine endoscopic method and 32 lesions were removed by modified endoscopic method.All patients underwent ERCP and biliary and/or pancreatic stents were placed.Results En bloc resection rate was significantly higher in modified group(87.5％ ,28/32) than that in routine group (60.9％, 14/23, P ＜ 0.05).There were no significant differences in complete resection rates (93.8％ ,30/32 VS 87.0％, 20/23;P ＞0.05), or in the amount and difficulty of pancreaticobiliary stenting(P ＞ 0.05)between modified group and routine group.Short-term complication occurrence in modified group was lower than that of the routine group(15.6％ ,5/32 VS 41.6％, 10/24, P ＜ 0.05), but long-term complication occurrence showed no significant difference.There was no significant difference in recurrence rate between two groups[7.1％ (2/28) VS 15.0％ (3/20) ,P ＞0.05].Conclusion Endoscopic resection of duodenal major papillary adenoma with a modified method shows more therapeutic effect.

Objective:To evaluate the application value of small IT knife pre-cut in assistance to duodenal papillary cannulation compared with conventional guidewire cannulation.Methods:A retrospective analysis was performed on the data of 90 patients with choledocholithiasis including 52 patients with small IT knife pre-cut assisted intubation (small IT knife group) and 38 patients with conventional guidewire intubation (conventional group) in endoscopic retrograde cholangiopancreatography (ERCP) from May 2016 to July 2019 in the digestive endoscopy center of Nanjing Drum Tower Hospital. The basic data, curative effect and complications of the two groups were collected and compared.Results:There was statistically significant difference in gender composition between the small IT knife group and the conventional group ( χ2=5.679, P=0.017), but no significant difference in other baseline data between the two groups (all P>0.05). The median intubation time of the small IT knife group was significantly shorter than that of the conventional group (141.5 s VS 270.0 s, Z=1 268.0, P=0.022). There were no significant differences in the success rate of intubation [98.1% (51/52) VS 94.7% (36/38), χ2=0.760, P=0.571], the incidence of intraoperative bleeding [15.4% (8/52) VS 7.9% (3/38), χ2=1.148, P=0.345], postoperative pancreatitis [5.8% (3/52) VS 7.9% (3/38), χ2=0.159, P=0.694], and postoperative cholangitis [1.9% (1/52) VS 5.3% (2/38), χ2=0.760, P=0.571] between the two groups. No perforation occurred in the two groups. After stratifying according to the operator′s proficiency, the median intubation time was significantly different between the small IT knife expert group and the conventional expert group (116.0 s VS 258.0 s, Z=276.0, P=0.038), while there was no significant difference in the intubation time among other groups (all P>0.05). Conclusion:The small IT knife is safe and effective to pre-cut and assist intubation in ERCP, and it may shorten the intubation time.

Objective To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for children with pancreaticobiliary diseases. Methods Data of children under 14 years old who have underwent ERCP in Nanjing Drum Tower Hospital between September 2007 and August 2016 were reviewed for completion, complications and therapeutic methods. Results A total of 41 children underwent 68 ERCP, including 6(8. 8%) diagnostic and 62(91. 2%) therapeutic procedures. All procedures were performed under deep sedation. Cannulation failed in only 1 child with anomalous junction of pancreaticobiliary duct. The procedure success rate was 98. 5%( 67/68 ) . There were 8 adverse events, including 7 mild post?ERCP pancreatitis and 1 fever. Incidence of adverse event was 11. 8%( 8/68) . There was no such severe adverse event as bleeding, perforation, death, or other anesthesia related adverse event. Thirty?two children ( 78. 0%) had follow?up, ranging from 2 month to 6 years. Children followed lived well with no long?term adverse event. Conclusion ERCP is an effective and safe procedure for the diagnosis and treatment of pancreaticobiliary diseases in children.

Objective To investigate the efficacy and safety of endoscopic ultrasound-guided biliary drainage ( EUS-BD ) on obstructive jaundice patients who had failed in the endoscopic retrograde cholangiography ( ERC ) . Methods Seventeen obstructive jaundice patients who underwent EUS-BD at Nanjing Drum Tower Hospital from October 2015 to July 2017 were enrolled in the study. The types of biliary drainage, technical success rate, clinical efficacy, post-procedure adverse events, and follow-up were analyzed. Results EUS-BD was successfully performed in 16 out of 17 patients, with technical success rate of 94. 1％. Operation pathway included 12 EUS-guided hepaticogastrostomy, 2 EUS-guided antegrade stenting, 1 EUS-guided rendezvous, and 1 EUS-guided choledochoduodenostomy. All the 16 patients′bilirubin decreased at different levels after operation, and the clinical success rate was 94. 1％ (16/17). Post-operation complications included 5 cases of cholangitis, 2 of bile leakage, and 1 of pneumoperitoneum and duodenal perforation. The patients were followed up for 14-390 days after procedures. Two patients died of underlying disease one month after operation. Jaundice in another 2 patients worsened during follow-up and were improved after replacement of previous stent. Conclusion EUS-BD has a relatively high technical success rate, and can be considered as an alternative choice for patients with obstructive jaundice after failure of ERC. Operation pathway should be decided according to patient′s condition.