Quality of ulcer healing (QUH) was applied to explore the mechanism of the recurrence of peptic ulcer. The relationship of QUH and epidermal growth factor, prostaglandins, heat shock proteins, immune function and Helico-bacter pylori was assayed. Mechanism of Chinese herbal medicine for the recurrence of peptic ulcer was presented as follows: improving blood circulation and barrier function of gastric mucosa, eliminating Helicobacter pylori and increas ing QUH.

Objective To explore the nursing measures in blue laser endoscopy. Methods Endoscopy was performed in 102 patients. The nursing was done including preoperative preparation, nurse's coordination for different mode of endoscpy, postoperative nursing and so on. Result The endoscopy for the 102 patients was successfully done,the time ranging between 10~25 min,averaged 13.85 min.No complications were found. Conclusion The nursing measures including careful preoperative preparation,intraoperative cooperation and postoperative nursing are key to the successful detection and diagnosis of diseases by blue laser endoscopy.

Objective:To analyze and predict the clinical efficacy of rigid choledochoscopic percutaneous transhepatic biliary fistulation (PTBF) lithotripsy for the treatment of hepatolithiasis.Methods:Databases including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang were searched for literatures from January 1, 1990 to March 1, 2022 on rigid choledochoscopic PTBF lithotripsy for hepatolithiasis studies. The primary outcomes including the final clearance rate, recurrence rate and overall postoperative complication rate, were analyzed by the random effects model in meta analysis and Bayesian network. The Markov Chain Monte Carlo was used for evaluation and prediction.Results:Fifteen articles were ultimately included, involving 1 296 patients, of which 1 008 patients were clearly shown to have complex intrahepatic bile duct stones in the literature [divided into two groups, the percutaneous transhepatic one-step biliary fistulation (PTOBF) stone removal group ( n=568) and the percutaneous transhepatic two-step biliary fistulation (PTTBF) stone removal group ( n=440)]. The results of Bayesian single-arm meta-analysis showed that the final clearance rate, recurrence rate and overall postoperative complication rate of PTOBF for hepatolithiasis were 84.19% (95% HPD: 79.08%-88.93%), 15.79% (95% HPD: 11.01%-21.07%) and 10.85% (95% HPD: 7.93%-14.21%). For complex hepatolithiasis, the final clearance rate, recurrence rate and overall postoperative complication rate of PTOBF were 82.58% (95% HPD: 75.46%-88.83%), 17.99% (95% HPD: 11.51%-25.45%), 10.34% (95% HPD: 6.42%-15.40%). For PTTBF, they were respectively 73.56% (95% HPD: 65.67%-80.30%), 29.48% (95% HPD: 23.13%-36.01%), 11.42% (95% HPD: 6.18%-17.67%). In comparison to PTTBF, the patients treated with PTOBF has a higher clearance rate ( OR=1.74, 95% CI: 1.17-2.60) and a lower recurrence rate ( OR=0.56, 95% CI: 0.37-0.84)but the overall complication rate did not improve ( OR=1.03, 95% CI: 0.66-1.62). Conclusions:Rigid choledochoscopic PTBF lithotripsy for hepatolithiasis is safe, effective and feasible. For complex hepatolithiasis, PTOBF has a higher clearance rate and a lower recurrence rate.

Objective:To predict the efficacy of biliary drainage stenting (BDS) versus primary duct closure (PDC) alone after laparoscopic common bile duct exploration (LCBDE)using Bayesian network Meta analysis.Methods:Databases including PubMed, MedLine, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang were searched for literatures from January.1st 1990 to January. 31st 2020 with the key words of ( "Choledocholithiasis" OR "common bile duct stone" OR "CBDS" OR "extrahepatic bile duct stone" ) AND ( "laparoscopic common bile duct exploration" OR "LCBDE" ) AND ( "primary duct closure" or "PDC" ) AND ( "T-tube drainage" or "TTD" or "T-tube" ) AND ( "biliary drainage stenting or BDS" ) AND ( "clinical trials" ),胆总管结石,腹腔镜胆总管探查, T管引流,一期缝合,胆道内支架引流. The randomized controlled trials (RCTs) about comparison of efficacy among BDS, PDC alone and T-tube drainage after LCBDE were received and included. BDS group included patients who underwent BDS after LCBDE, PDC group included patients who underwent PDC alone after LCBDE, and T-tube drainage group included patients who underwent T-tube drainage after LCBDE. The primary outcomes were the incidence of postoperative overall complications, bile leakage and residual stones. GeMTC software was used for Meta analysis in the Rstudio environment. This study was conducted using the random effects model in Bayesian network. The Markov Chain Monte Carlo was used for direct evaluation and indirect prediction. The Brooks-Gelman-Rubing graphing method, tracing method and density plotting were used to evaluate the model convergence. No closed loop formed between intervention measures, so there was no need to evaluate consistency. The matrix of rank probabilities in terms of the outcomes were also calculated.Results:(1) Document retrieval: a total of 12 available RCTs were enrolled. There were 982 patients, including 190 in the BDS group, 296 in the PDC group, and 496 in the T-tube drainage group. (2) Results of Bayesian network meta analysis. ① The BDS group and PDC group had lower overall complication rate than T-tube drainage group [ odds ratio ( OR)=0.21, 0.48, 95% confidence interval ( CI): 0.06-0.52, 0.24-0.87, P<0.05]. There was no significant difference in the indirectly predicted overall complication rate between the BDS group and PDC group ( OR=0.43, 95% CI: 0.12-1.30, P>0.05). ② The BDS group had lower incidence of postoperative bile leakage than T-tube drainage group ( OR=0.18, 95% CI: 0.02-0.86, P<0.05). There was no significant difference in the incidence of postoperative bile leakage between the PDC group and T-tube drainage group ( OR=0.70, 95% CI: 0.27-1.70, P>0.05). There was no significant difference in the indirectly predicted incidence of postoperative bile leakage between the BDS group and T-tube drainage group ( OR=0.25, 95% CI: 0.03-1.60, P>0.05). ③ T-tube drainage group had no significant difference in the incidence of postoperative residual stones compared with the BDS group and PDC group ( OR=0.58, 1.40, 95% CI: 0.13-2.40, 0.41-5.50, P>0.05). There was no significant difference in the indirectly predicted incidence of postoperative residual stones between the BDS group and PDC group ( OR=0.39, 95% CI: 0.05-2.70, P>0.05). (3) Ranking of the incidence of postoperative complication among the three groups: for the BDS group, PDC group, and T-tube drainage group, the probability of ranking the first in the incidence of overall complication was 0.08%, 0.98%, 98.94%, the probability of ranking the second was 6.57%, 92.38%, 1.05%, and the probability of ranking the third was 93.36%, 6.64%, 0.01%, respectively, showing the ranking list as T-tube drainage group >PDC group >BDS group in the incidence of overall complication. The probability of ranking the first in the incidence of postoperative bile leakage was 1.25%, 18.93%, 79.82% for the BDS group, PDC group, and T-tube drainage group, the probability of ranking the second was 6.11%, 74.01%, 19.88%, and the probability of ranking the third was 92.64%, 7.06%, 0.30%, respectively, showing the ranking list as T-tube drainage group >PDC group >BDS group in the incidence of postoperative bile leakage. The probability of ranking the first in the incidence of postoperative residual stones was 10.89%, 67.37%, 21.74% for the BDS group, PDC group, and T-tube drainage group, the probability of ranking the second was 16.09%, 21.09%, 62.82%, and the probability of ranking the third was 73.02%, 11.55%, 15.44%, respectively, showing the ranking list as PDC group >T-tube drainage group >BDS group in the incidence of postoperative residual stones. Conclusions:For patients with appropriate choledocholithiasis, BDS would be recommended first after LCBDE, which can reduce duct closure related complications. This study was registered at http: //www.crd.york.ac.uk/ero/, with the registration number of CRD42019137344.

AIM: To compare the efficacy of intravitreal injection of ranibizumab(IVR)and intravitreal injection of conbercept(IVC)in children with retinopathy of prematurity(ROP).METHODS: Retrospective study. A total of 1 100 eyes with ROP treated with intravitreal anti-VEGF at our hospital from January 2015 to June 2023 were included. According to the different therapeutic drugs, the children were divided into two groups: IVR group and IVC group. According to the degree of ROP, the patients were divided into three groups: aggressive ROP(A-ROP), Zone Ⅰ type 1 ROP and Zone Ⅱ type 1 ROP. The reactivation and retreatment between the two groups were compared after propensity score matching(PSM)analysis, and they were followed-up for at least 3 mo after surgery.RESULTS: In Zone Ⅱ type 1 ROP, there was a statistically significant difference in the rates of reactivation and retreatment between the IVR and IVC groups(P<0.05); however, in A-ROP and Zone I type 1 ROP, there were no statistically significant differences in the rates of reactivation and retreatment between the two groups(P>0.05). The risk of reactivation and retreatment of Zone I type 1 ROP was higher than the Zone II type 1 ROP. Furthermore, the use of drugs and corrected gestational age of first treatment were influencing factors of lesion recurrence and retreatment.CONCLUSION: There is a significant difference in the initial cure effect between the two drugs in Zone II type 1 ROP, with the reactivation and retreatment rates of the IVC group being much lower than those of the IVR group.

Background Essential and non-essential elements have an important impact on the development of the central nervous system during fetal development. Due to their less developed brain, preterm infants are more sensitive to element exposure, and are high-risk groups of neurodevelopmental abnormalities. However, it is not clear whether the effects of element exposure in utero on postpartum neurodevelopment are different between full-term infants and preterm infants. Objective To evaluate the effects of element exposure levels during pregnancy on neurodevelopment of children aged 6-24 months (of corrected age), and compare the effects between preterm and full-term children. Methods A prospective study design was adopted and this study was conducted based on the Maoming Birth Cohort Study (MBCS) in Maoming City, Guangdong Province. Twenty elements in cord blood of 197 preterm infants and 297 full-term infants were measured, including 11 essential trace elements [vanadium (V), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), selenium (Se), strontium (Sr), tin (Sn), and iron (Fe)], and 9 non-essential trace elements [aluminum (Al), arsenic (As), thallium (Tl), lead (Pb), uranium (U), cerium (Ce), antimony (Sb), cadmium (Cd), and yttrium (Y)]. The neurodevelopment of the children at 6, 12, and 24 months were evaluated by the Ages and Stages Questionnaires-the Third Edition (ASQ-3). A generalized estimating equation (GEE) model was adopted to evaluate the associations between elements and neurodevelopment in full-term and preterm children separately. Results The positive rates of 10 elements (Mn, Cu, Zn, Se, Sr, Fe, Sb, Tl, Pb, and As) in cord blood were greater than 80%. Among the preterm birth children, the results of GEE analysis showed that after adjusting for the covariates, for each increase of interquartile range (IQR) in ln-transformed concentration, As was associated with problems/delay in the communication and problem-solving sub-scales, with the adjusted odds ratios (OR) and 95% confidence intervals (CI) of 1.36 (1.03-1.80) and 1.55 (1.10-2.20), respectively; the adjusted OR (95%CI) of problems/delay in the fine motor and problem-solving sub-scales were 1.44 (1.00-2.07) and 1.76 (1.09-2.84) for Sb, respectively; the adjusted OR (95%CI) of problems/delay in the communication sub-scale was 1.37 (1.09-1.74) for Se. No statistically significant associations between umbilical cord blood element concentrations and neurodevelopment indicators were observed among full-term children. The results of stratified analysis by sex showed that the associations between umbilical cord blood element concentrations and neurodevelopment problems/delay were only significant among female preterm children. Conclusion Exposures to As, Se, and Sb during pregnancy may increase the risk of neurodevelopment problems/delay in preterm children aged 6-24 months, and female seem to be more vulnerable.