Endoscopic retrograde cholangiopancreatography (ERCP) is the most challenging technique of gastrointestinal endoscopy. Patients are most likely to benefit from this mini invasive treatment, meanwhile they bear high risk of complications, which might be life-threatening. Standard operation, standardized training, quality control and whole-process management of perioperative period are critical factors for ERCP training, and should be popularized in medical centers, where ERCP are performed. This paper has illustrated the whole-process management of perioperative period for ERCP, including preoperative preparation, decision-making during operation, postoperative management, as well as prevention and treatment of complications. By performing whole-process management of ERCP, patient can benefit more from ERCP operation, and which will serve more patients.

Objective To explore the influence of telephone follow-up on home rehabilitation for patients with schizophrenia. Methods 200 patients with schizophrenia were assigned into experimental group and control group with 100 cases in each group. During their hospitalization,all patients were given conventional treating and nursing and were treated with atypical antipsychotic drugs. After getting a clinical recovery and discharge, the experimental group received telephone follow-up for 2 years while the control group received outpatient service follow-up. Results There was significant difference in scores of Positive and Negative Syndrome Scale (PANSS) in both groups with time (F=85.943, P=0.000). There was a significant interaction effect between intervention and time (F=6.458, P=0.000) and there was also a significant difference (F=26.012, P=0.000) between both groups on the scores of PANSS. At the end of the 6th, 12th, 18th and 24th month after discharge, the PANSS scores were significantly less in the experimental group than in the control group (P<0.05). The accumulative total relapse rate and frequency were significantly lower in the experimental group than in the control group anytime after discharge (P<0.05).Conclusion The telephone follow-up can significantly improve the effect of home rehabilitation for the patients with schizophrenia. It is beneficial for the patients to control disease and reduce the relapse.

0 05),but the difference was significant after administration of Cisapride two weeks and four weeks later(7 00?3 12,4 20?2 39 vs 4 90?2 45,2 10?1 19,P0 05),but the difference was statistically significant with Cisapride administrated(r=0 47,P

Objective To observe the bacterioflora of bile and it' s drugs sensitivity in patients with bile duct diseases to serve as a guidance in medication. Methods Bile of 156 cases of patients with biliary disease was collected and cultured respectively during endoscopic retrograde cholangiopancreatography (ER-CP) by deep cannulation and sucking out bile through the catheter. Forty eight blood samples among them were cultured simultaneously. Ten kinds of drug papers were used to investigate the bacterial sensitivity. The data were analysed statistically- Results Bacteria positive rate of these 156 bile samples was 62. 8% , including Gram - negative bacteria (81.6% ) and Gram - positive bacteria (18. 4% ). These bacteria consist of Pseudomonas aeruginosa (35. 1% ) , Escherichia coli(22. 8% ) , Streptococcus faecalis (16.7%) ,Entero bacilliaerogenes(7. 9% ) ,Klebsiella(7. 0% ) , Citrobacter(6. 1% ) ,Acinetobacler lwqffi(2. 6% ) and Staphylo-coccus aureus( 1. 7% ). The bacteria positive rate was only 4. 2% in the 48 blood samples. Drug sensitive rates of bacteria against 10 kinds of drugs were changed in recent years. The result indicated that the sensitive rates of bacteria were significantly higher in ciprofloxacin, fortum, cefoperazone, sulbactam + cefoperazone and cilastatin than those in ampicillin,azlocillin, cefazolin sodium, eefuroxime(P

Objective To summarize the clinical experience of the diagnosis and treatment for 23 cases with malignant peritoneal mesothelioma.Methods The clinical data of 23 cases of malignant peritoneal mesothelioma was analysed retrospectively.Results All of the 23 cases were finally diagnosed with pathology.The pertinacious abdominal pain and distension, bloody ascites,multiple abdominal masses were clinical manifestation chiefly.The examination of B type ultrasonography and CT displaied the obvious irregular thickening of peritoneum and mesenterium, multiple nodes in abdomen and pelvic masses.Conclusions The vigilance to the disease ought to be aroused when possesing the above-mentioned clinical manifestation. The diagnosis chiefly depends on the peritoneal biopsy with abdominal cavity puncture,peritoneoscopy and exploratory.

Objective To determine the effect of therapeutic ERCP(endoscopic retrograde cholan-giopancreatography) on endoscopic drainage of pancreatic pseudocysts and patency of main pancreatic duct after dilation or placement of stent. Methods Eight patients with pancreatic pseudocyst were selected after abdominal ultrasonography and computed tomography. All patients have had be operated two times because of acute pancreatitis and /or cholangitis, and were hard to receive further operation. These patients underwent endoscopic transpapillary drainage by main pancreatic duct dilation or placement of stents after ERCP, and were follow up by abdominal ultrasonography and / or computed tomography 6 months after drainage. The stent would be pulled out after the complete disappearance of the cyst. Results Diagnostic ERCP revealed that cysts communicated with main pancreatic duct in 3 cases and obstructive jaundice was present in 1 case. All patients were managed by transpapillary main pancreatic duct dilation (3 cases) and placement of stents (5 cases). Both forms of endoscopic drainage were effective in treating pancreatic pseudocyst and in 7 cases the cysts were completely disappeared within 4 months, while the rest one required surgery as the cyst merely decreased in size. Only 2 cases the levels of amylase in serum and urine were higher than normal but no severe complications occurred. Conclusion Endoscopic transpapillary drainage through main pancreatic duct dilation or placement of stents is quietly an effective, painless and safe mode in treating pancreatic pseudo-cyst. This method may be an ideal choice for the treatment of pancreatic pseudocysts in experts.

Objective Objective To analysis the clinical curative effect on elderly patients with choledocholithiasis by endoscopic retro-grade cholangiopancreatography ( ERCP) and endoscopic sphincterotomy ( EST) and discuss its clinical significance. Methods 256 patients with choledocholithiasis were collected for diagnosis and treatment by ERCP. The stone characteristics was mastered by ERCP and the pa-tients were treated with EST. Results Patients with choledocholithiasis were successful in 249 cases (97. 27%) for ERCP intubation and 239 cases (93. 36%) for stone remove. After EST,the stones were removed successfully at one time in 199 cases (83. 26%),2 times in 40 cases (16. 74%). 7 patients (2. 73%) with multiple diverticulum and papillary position poor by intubation failure were changed over to op-eration treatment. After ERCP,patients were performed endoscopic nasobiliary drainage (ENBD) 64. 44% (154/239). Pull out the drain-age tube of 90. 91% (140/154) of the patients after stones disappeared which was proved by angiography for 3~5 days. 14 cases (9. 09%) were performed second times to remove the stones due to the presence of residual stones. Postoperative complications occured in 15 cases (6. 02%) including 9 cases of acute pancreatitis and 6 cases of infection of biliary tract, and they were cured after 1 week of corresponding treatment. Transient increase of serum amylase occurred in 39 cases, and all of them recoveried after 3 days without special treatment. Con-clusion The results showed that ERCP ( or EST) were well tolerated by elderly patients with choledocholithiasis,and they were of obvious curative effect and quick recovery,which is worthy of promotion and application.

Objective To investigate risk factors decreasing cannulation success rate of trainees receiving hands-on ERCP training and to improve thelevel of ERCP training.Methods Clinical data of 1 193 ERCP cases involved in training in Xijing Hospital of Digestive Disease from December 2012 to December 2014 were retrospectively analyzed.Multivariate logistic regression analysis was performed to investigate the risk factors influencing cannulation success rate of trainees.Results There were 1 165 and 28 patients undergoing common biliary duct (CBD) cannulation and pancreatic duct(PD) cannulation respectively.The success rate of CBD cannulation by trainees was 58.5％(681/1 165)and the overall success rate was 97.9％(1 140/1 165).PD cannulation success rate by trainees was 39.3％ (11/28) and the overall success rate was 89.3％ (25/28).The overall complication incidence was 8.0％ (96/1 193)and the incidence of post-ERCP pancreatitis was 4.4％(53/1 193).Multivariate logistic regression analysis showed that the selective cannulation by trainees was more likely to fail in patients with malignant biliary stricture(OR =0.44,95％CI:0.28-0.67,P＜0.01),benign or undetermined biliary stricture(OR =0.32,95％ CI:0.17-0.60,P＜ 0.01),suspected sphincter of Oddi dysfunction(SOD) (OR =0.28,95％ CI:0.16-0.47,P＜ 0.01),coexisting hypertension (OR =0.65,95 ％ CI:0.44-0.96,P＜0.05),RDW ≥ 48 fL (OR =0.69,95％ CI:0.51-0.92,P＜ 0.05),PLT＜ 100 × 109/L (OR=1.68,95％CI:1.05-2.71,P＜0.05).Conclusion Biliary stricture,suspected sphincter of Oddi dysfunction,coexisting hypertension,abnormal RDW and PLT were independent risk factors influencing cannulation success rate by trainees during hands-on ERCP training.

Objective To analyze the safety and tolerability of endoscopic retrograde cholangiopancreatography ( ERCP) for elderly pa-tients in diagnose and therapy. Methods From Jan. 2010 to Dec. 2013, 1 560 patients were collected in our hospital for diagnosis and treatment, 1 116 cases were 60~69 years old, and the other 444 cases were over 70 years old. Retrospective data including clinical and bio-chemical characteristics, ERCP diagnosis and complications were analyzed. Results Using Logistic regression, the potential factors of com-plex multivariable were analyzed, and there was no statistical difference between the two groups (P=0. 039). The successful intubation, in-tubation difficulties and failed intubation in the examination and the treatment were of significantly difference between the two groups (P<0. 05). There were no significant difference between the two groups in common bile duct stones of bile duct obstruction and clinical di-agnosis (P>0. 05), but the ERCP diagnosis, postoperative complications and complications of acute pancreatitis were of certain difference (P<0. 05). Patients over 70 years old were of better tolerance, but their bile duct stones was about two times than that in patients of 60~69 years old (P=0. 004). Conclusion The results show that ERCP for elderly patients in diagnose and therapy is safe and well tolerated, and there were relatively less complications in patients over 70 years old.

Objective To explore the influence of dose rate reference control level on the design of accelerator shielding.Methods According to the standards of GBZ 126-2011,GBZ/T 201.1-2007 and GBZ/T 201.2-2011,two different shielding calculation methods,based on the dose rate reference control level and week dose control level,were used to calculate and compare the thickness of accelerator room shielding.Results Under the same condition of maximum weekly workload,the obtained results were different when the calculated dose rate reference control value was larger than dose rate reference control level (2.5 μSv/h).The maximum difference of shielding thickness reached 64 cm.Meanwhile,considering dose rate reference control level,the different accelerator rates could lead to different radiation shielding thickness.Conclusions The dose rate at reference point must be first calculated before calculating shielding thickness.The calculation should be made on the premise that dose rate reference control level is met.