Objective To compare the effect of endoscopic retrograde cholangiopancreatography sphincterot-omy plus laparoscopic cholecystectomy(ERCP/S +LC)and laparoscopic common bile duct exploration(LCBDE)in the treatment of cholecystolithiasis patients with concurrent choledocholith.Methods Retrospective analysis was made of information of 280 cholecystolithiasis patients with concurrent choledocholith,who were randomly divided into group A (n =60)and group B (n =220).group A was arranged with LCBDE and group B was treated ERCP/S +LC. The operation time,hospital stay after operation,hospitalization fee,size of common bile duct calculi,stone clearance rate and the incidence of postoperative complications were compared.Results The operation time,hospital stay after operation,hospitalization fee,size of the common bile duct calculi,stone clearance rate and the incidence of postopera-tive complications of group A &B were (95.58 ±22.66)m vs.(87.46 ±40.25)m,(15.18 ±5.46)d vs.(14.32 ± 4.21)d,(2.45 ±0.32)ten thousand yuan vs.(2.89 ±0.64)ten thousand yuan,(1.12 ±0.34)cm vs.(1.39 ± 0.38)cm,96.6% vs.91% and 1.6% vs.3.2%.There was no significant difference in calculus clearance rate between the two treatments(χ2 =1.44,P >0.05 ).Patients in LCBDE group spent slightly less on hospitalization expenses than patients in ERCP/S +LC group,but there was no significant difference shown(t =0.923,P >0.05). Patients in ERCP/S +LC group had suffered a relatively high incidence of complications than patients in LCBDE group,and significant difference was found(χ2 =4.17,P <0.05).Conclusion Both LCBDE and ERCP/S +LC are effective minimally invasive therapies for concurrent cholecystolithiasis and choledocholith,and should be clinically applied in accordance with their specific characteristics.

Objective: To investigate the prevalence of nutritional risk,malnutrition and application of nutritional support in department of digestive trad in our hospital in Ningbo.Methods: The information of 205 patients were collected in our hospital.Nutrition status was assessed according to Nutrition Risk Screening(NRS) published by ESPEN in 2002.Results: A total of 205 patients were enrolled,and 189 patients(92.2%)underwent NRS 2002.Prevalence of malnutrition was 20.0% and nutritional risk was 32.7%.Totally 18 patients(8.8%) receiving nutritional support had a NRS2002≥3.The PN∶EN ratio was 2.6 ∶1. Conclusion: A large proportion of inpatients were at nutritional risk or malnutrition in our hospital.The application of PN and EN is inappropriate in inpatients.Evidence-based guidelines are required to improve this situation.

Parkinson's disease was primarily considered to be a movement disorder affecting only the extrapyramidal system. Although the non-motor symptoms such as neuropsychiatric symptoms, dysautonomia, sleep disturbances and olfactory dysfunction, etc., were also common, they were often misdiagnosed or neglected. This paper would review the manifestation, relevant factors, pathogenesis and treatment of non-motor symptoms of Parkinson's disease.

Objective To observe the effect of Isoket on standard dobutamine stress echocardiography(DSE).Methods Thirty-seven patients were divided into three groups according to the results of quantitative coronary angiography(QCA):the control group(CON) including 12 patiens,the coronary artery disease group 1(CAD1) including 15 patients,and the coronary artery disease group 2(CAD2) including 10 patients.Among the three group,the DSE+Isoket was done in CAD2,while the standard DSE was done in the other two groups.The improvement of segments of left ventricular after percutaneous transluminal intervention(PCI) was looked as the standard evaluating DSE.Results Isoket could increase heart rate and decrease systolic blood pressure,but could hardly affect diastolic blood pressure.The rate of biphysic response was 62.5% in group CAD1,and the sensitivity of detecting viable myocardium was 61%,while the specificity was 76%.In group CAD2,the rate of biaphysic response was 72.2% ,and the sensitivity of detecting viable myocardium was 82%,while the specificity was 88%.The rate detecting viable myocardium and sensitivity was improved significantly in group CAD2.Conclusions DSE combined with Isoket was beneficial for detecting viable myocardium.

Objective To investigate the status of patient safety culture cognition and safety nursing behavior among nurses and examine the influence of patient safety culture cognition on safety nursing behavior of nurses using structural equation model. Methods A total of 350 clinical nurses were recruited in a hospital in Dalian with multi-stage sampling method. Patient Safety Culture Assessing Scale, Safety Behavior Scale were delivered to the investigation object. Results The mean score of the patients safety culture was 4.09±0.47, which was above average;the total score of nurses′safety nursing behavior was 4.74 ± 0.31, which was at high level; the causality model of patient safety culture cognition and the safety nursing behavior was accepted (path coefficient=0.35,P<0.01). Conclusions Nurses′ patient safety culture cognition has a significant impact on safety nursing behavior. Hospital should cultivate the awareness of the patient safety culture, so as to promote the safety nursing behavior.

Objective To investigate the optimal operative time interval from the combined application of endoscopic sphincteropapillotomy ( EST) and endoscopic nasobiliary drainage ( ENBD) to laparoscopic cholecystecto-my ( LC) in the treatment of concurrent cholecystolithiasis and choledocholith.Methods Retrospective analysis was made in the 180 patients who had received sequential treatment of concurrent cholecystolithiasis and choledocholith with the combined application of EFS+ENBD+LC.Patients in group A received LC 3 days after EST +ENBD;patients in group B received LC 7 days after EST +ENBD;patients in group C received LC 30 days after EST +ENBD.Comparative analysis was made in the duration of LC,the intraoperative blood loss,the number of conversion to laparotomy and the total hospital expenses among patients in the three groups.Results Operation time in group A,B and C was separately (34.70 ±2.24)min,(51.00 ±2.31)min and (34.43 ±2.51)min.Patients in group B suffered significantly-extended surgical duration ( F=6.15,P<0.01);Intraoperative blood loss in the three groups was separately (28.86 ±3.35)mL,(50.43 ±3.90)mL,(28.57 ±3.40)mL.Significant increase was observed in group B(F=7.23,P<0.01).There were 1,6 and 1 patients who underwent conversion to laparotomy in the three groups. Slight increase was found in group B(χ2 =6.54,P<0.05).Total hospitalization expenses was separately (10 093.29 ± 496.05)yuan,(10 845.86 ±744.27)yuan and (15 250.57 ±1 006.67)yuan.Patients in group C had incurred a significant increase(F=6.62,P<0.01).Statistical difference was equally found.Conclusion 3 days after EST+ENBD is the optimal operative time for LC.

Objective:To deeply study and explore the cognitive and barrier factors of clinical nurses' nutrition management in patients with pressure injury (PI), and provide evidence for developing quantifiable standardized management model and strengthening individualized nutrition management.Methods:A semi-structured in-depth interview was conducted with 11 nurses. The NVivo10.0 software and Colaizzi's 7-step analysis of phenomenological data were used to analyze interview data.Results:The study summarized four themes that hindered nutrition management: subjective judgment bias; education training lags behind and radiates one-sided; lack of policy and configuration; conflict between workload, roles and perceptions.Conclusions:There are many obstacles to the implementation of nutrition management in patients with PI. An objective, feasible and standardized nutrition management plan should be established, support should be provided by policy, configuration and information system, and relevant knowledge training and multi-team cooperation should be strengthened to improve patient life.

Therapeutic hypothermia has been shown to improve neurological outcomes after global ischaemia/hypoxia in patients who have had cardiac arrest. Therapeutic hypothermia is one of the most extensively studied and influential therapeutic strategies of acute ischemic stroke. Previous studies of therapeutic hypothermia mainly focused on whole-body cooling. However, delayed induction and systemic complications have limited the clinical application of whole-body cooling. As a selective cerebral hypothermia, the selective intra-arterial brain hypothermia treatment has the characteristics of rapid and even induction of hypothermia, and less affecting the core body temperature. Therefore, it has become a promising treatment modality. This article reviews the application of selective intra-arterial brain hypothermia in acute ischemic stroke and its advantages and limitations in order to provide reference for further experimental studies and future clinical trials.

Objective To investigate the effect of curcumin on the expression of heat shock protein 70 (HSP70) in the hippocampus and spatial learning ability in APPswe/PS1△9 transgenic mice,and provide a new theoretical basis for the treatment of Alzheimer' s disease (AD).Methods Mice were divided into wild-type (WT) group,APP/PS1 transgenic group,curcumin-treated group,quercetin combined with curcumin-treated group.The 5-month-old mice in curcumin-treated group received 150 mg · kg-1 · d-1 curcumin by intraperitoneal injection for four consecutive weeks.In addition to curcumin,the mice in quercetin combined with curcumin-treated group also received quercetin 50 mg· kg-1 · d-1 intraperitoneally for four consecutive weeks.The expression of HSP70 in the hippocampus of APP/PS1 mice was detected by Western blot.Learning and memory ability of APP/ PS1 mice were measured by Morris water maze test.The latency of finding the platforms and the number of crossing the platforms were observed.Results The results of Western blot analyses showed that the expression of HSP70 in the hippocampus of APP/PS1 transgenic mice decreased significantly compared with that of WT mice (OD:APPswe/PS1△9:0.31±0.14;WT:1.14±0.51;P＜0.01).The expression of HSP70 in curcumin-treated group significantly increased compared with that of APP/PS1 transgenic group (OD:0.91±0.20 in curcumin-treated group;P＜0.05).The results of water maze test showed that compared with WT group,in APP/PS1 group,the latency of finding the platforms was significantly longer (APPswe/PS 1 △9:(82.3 ± 6.8) s;WT:(19.5±4.4) s),and the number of crossing tbe platforms were significantly decreased (APPswe/PS1 △9:(2.7± 1.1);WT:(5.2± 2.1)).In curcumin-treated group,the latency of finding the platform ((47.7±7.6) s) was significantly shorter and the number of crossing platform ((4.5±1.9) s) was more than those in APP/ PS1 group.However,in quercetin combined with curcumin-treated group,the latency of finding the platform was significantly longer ((69.7±9.1) s) and the number of crossing platform (3.2±1.6) was decreased compared with those in curcumin-treated group.Conclusion Curcumin can promote the expression of HSP70 in the hippocampus of APP/PS1 transgenic mice,thus improve spatial learning ability of APP/PS1 transgenic mice.These results provide evidences that curcumin may have potential therapeutic value for the treatment of AD.

OBJECTIVE:To evaluate the economic effectiveness in different pharmacotherapeutic schemes for Hp infection in children.METHODS:To analyze four therapeutic schemes for Hp infection in children with cost - effectiveness analysis.RESULTS: The cost- effectiveness ratios of four therapeutic schemes were 14.92,8.85,8.37 and 8.58 respectively. CONCLUSIONS: scheme C(clarithromycin + bismuth potassium citrate + metronidazole)is the best one.