Elderly patients with biliary and pancreatic diseases are often complicated by other underlying diseases and have poor cardiopulmonary function,and most of them cannot tolerate general anesthesia.The patients aged above 80 years who have undergone bile duct exploration have high mortality rate and incidence rate of complications.Endoscopic retrograde cholangiopancreatography (ERCP) is applicable to elderly patients with biliary and pancreatic diseases.This article elaborates on the features of perioperative treatment and technical operation of ERCP in elderly patients.

OBJECTIVE:To study the change in grain size and in vitro dissolution ratio of Atractylodes macrocephala after ultramicronization. METHODS: The particle size before and after ultramicronization was analyzed using particle size analyzer. The content of the sample was determined by HPLC using atractylenolide Ⅲ and atractylenolide Ⅰ as indexes to reflect the dissolution ratio. RESULTS: After ultramicronization, the particle size of the sample became thinner obviously, about 30% that of the common fine powder, and the content increased by 27% as compared with the common fine powder. CONCLUSION: The ultramicronization can significantly decrease the particle size, increase specific surface area and contribute to the dissolution of atractylenolide Ⅲ and atractylenolide I from Atractylodes macrocephala.

OBJECTIVE To prepare pneumolysin(Pn)by genetic engineering and thereby establish the basis for the study of vaccines against otitis media. METHODS A pair of primers including two restriction sites was designed based on the pneumolysin gene sequence reported by Walker in 1987. The pneumolysin gene was PCR-amplified from pneumococcal DNA. The resulting fragment, digested by restriction enzymes, was ligated into the vector PET-28a and then transformed into host cell E.coli JM109(DE3). RESULTS The sequence of the inserted pneumolysin gene was confirmed by DNA sequencing. CONCLUSION The pneumolysin gene was successfully cloned into the host cell.

96% and with the same bio-activity as unlabeled Huwen toxin-1; Radioactivity detected in epidural space was 38% of injected radioacti vity at 10 min after epidural injection, which demonstrated successful administr ation into epidural space; The maximum serum concentration after epidural or iv administration of [ 125 I]labeled Huwentoxin-1 were determined to be (0 70?0 04) MBq?L -1 and (4 98?0 58) MBq?L -1 , respectively, a t the maximum serum concentration times of 30 min and 2 min. Terminal T 1/2 after epidural or iv administration were (10 36?0 27) h or (11 03?1 16) h, respectively. Cls was (1 29?0 07) L?h -1 ?kg -1 or (1 25? 0 23) L?h -1 ?kg -1 , respectively. Bioavailability after epidural a dministration was(95?5)%. CONCLUSION Concentration-time cur ves of [ 125 I] labeled Huwentoxin-1 after two routes were different. The degradation profiles after epidural and iv injection supported the using of HWTX-1 as analgesic by epidural administration.

Based on integrate circuit (IC) technology, an eight-channel gold electrodes (GEs) array was developed. The immunosensor array is prepared by co-immobilizing thionine and Hepatitis B (HB) antibody on the gold electrodes through covalently binding them to GEs with a cysteamine/glutaraldehyde linkage. Hepatitis B surface antigen (HBsAg) was detected qualitatively and quantitatively by the peak current decrease percentage of the thionine. HBsAg positive/negative standard serum was well defined by the array. 8-channel synchronous detection for HBsAg was noted to be of good accuracy and reliability. The results of its clinical application were in good agreement with the results from ELISA.
Biosensing Techniques ; instrumentation ; Electric Impedance ; Electrochemistry ; instrumentation ; methods ; Electrodes ; Hepatitis B Antibodies ; immunology ; Hepatitis B Surface Antigens ; analysis ; immunology ; Humans ; Immunoassay ; instrumentation ; methods

Background:With the progress and widely application of endoscopic techniques,the prevalence rate of periampullary diverticulum (PAD)is increasing in recent years. However,the results of studies investigating the correlation of PAD and its types with common bile duct (CBD)stone are different. Aims:To investigate the influence of PAD and its types on CBD stone. Methods:A total of 1524 consecutive inpatients who underwent diagnostic and therapeutic ERCP for pancreatobiliary diseases from Jan. 2014 to Dec. 2016 at the General Hospital of Xinjiang Military Region of Chinese PLA were enrolled and divided into two groups according to the presence or absence of PAD. Patients in PAD group were further classified into 3 subgroups by the papilla's location with respect to the diverticulum. Their clinical data were collected and retrospectively analyzed. Results:The proportion of elderly patients (≥60 years old)in PAD group was 82. 2% (310 /377),which was significantly higher than that in non-PAD group [60. 8% (697 / 1147),P < 0. 05]. The prevalences of CBD stone,gallstone associated with CBD stone,post-cholecystectomy and recurrent CBD stone were higher and the size of CBD stone was larger in PAD group than in non-PAD group (P all < 0. 05). Furthermore,stratified analysis revealed that the CBD stone was more prevalent and the size of stone was larger in type Ⅱ PAD than in type Ⅰ and type Ⅲ PAD (P <0. 05), while recurrent CBD stone was more frequent in type Ⅰ and type Ⅱ PAD than in type Ⅲ PAD (P < 0. 05). Multivariate analysis indicated that the elderly and PAD were the risk factors for recurrence of CBD stone,and cholecystectomy was a protective factor. Conclusions:The elderly is predisposed to PAD. PAD and its types are associated with the development and recurrence of CBD stone. CBD stone is more prevalent in patients with PAD especially type Ⅱ PAD. The size of stone is larger and the post ERCP recurrence rate is high in type Ⅱ PAD.

Objective To investigate the clinical effect of angioplasty for symptomatic intracranial atherosclerotic stenosis. Methods Eighty-two patients with symptomatic intracranial atherosclerotic stenosis whom underwent angioplasty after the failure of standard medical therapy were enrolled from Nan-jing Stroke Registry Program from September 2010 to June 2013.Nine of them underwent routine balloon angioplasty alone and 73 underwent intracranial stenting.The median time from onset to surgery was 24.5 days.The occurrence of endpoint events (any stroke ≤30 d after procedure,death and ischemic stroke >30 d in guilty vessels or original stenosis had restenosis and needed to be treated again)was assessed. The incidence of restenosis was followed up with imaging (CTA or DSA). Results (1)In the 82 patients, the success rate of operation was 92.7%(n=72 ),and 78 (95.1%)received follow-up,4 were lost to follow-up.The median follow-up time was 22.5 months (range 9 to 29 months ).Ten patients had an endpoint event,7 of them were ischemic stroke,1 was cerebral hemorrhage,and two were severe asymptomatic restenosis who underwent stenting again.The endpoint events of 3 patients occurred at day 30 after procedure (at ≤24 h after procedure).Kaplan-Meier curves showed that the incidences of cumulative endpoint events at 1,6,12,and 24 months were 3.7%,8.6%,11%,and 13%,respectively.(2)60 patients (73.2%)received imaging examination (11 CTA and 49 DSA ).Restenosis occurred in 17 patients (28.3%),among them the incidence of symptomatic restenosis was 5%(n =3 ),and asymptomatic restenosis was 23.3%(n=14). Conclusion After a comprehensive assessment and a rigorous screening, the safety is high and the mid- and long-term efficacy are satisfactory in patients with symptomatic intracranial arterial stenosis who are treated with angioplasty when their medical treatment is invalid.

Objective: To understand pneumonia mortality in children aged 0-14 years in China in recent 15 years, and to provide reference for child pneumonia prevention and treatment. Methods: Based on the death data from China Statistical Yearbook 2005-2019, pneumonia mortality in urban and rural children aged 0-14 was extracted and the standardized mortality was calculated, and the trend of mortality was fitted by Joinpoint regression model. Results: The crude mortality rate of child pneumonia in urban and rural areas showed an increasing trend, while the standardized mortality rate showed a fluctuating downward trend. Joinpoint regression showed that the mortality rate of pneumonia in urban and rural children showed a monotonous downward trend, and there was no turning point. The overall APC of pneumonia mortality of urban children was -3.4, that of boys and girls were both -3.5. Trend for annual changes in urban areas were found significant among total sample and boys (both P <0.05). The overall APC of pneumonia mortality in rural children was -7.8, that of boys and girls were -7.1 and -7.8, respectively. Trend for annual changes in rural areas were found significant among total sample and boys(both P <0.05). There was no significant differences in the trend of mortality between urban and rural groups. Conclusion During 2005 to 2019, child pneumonia mortality in urban and rural areas in China shows a downward trend, which is relatively balanced in urban and rural areas. Further strengthened pediatric pneumonia treatment and management are expected to reduce the pneumonia mortality.

Objective: To understand the incidence and mortality of drowning and secular trend among children aged 0-14 from 1990 to 2019 in China, so as to provide reference for drowning intervention among children in China. Methods: Based on data of drowning incidence and death in 0-14 years old children in China in 1990-2019 years Global Burden of Disease (GBD 2019) database, the standardized rate was calculated by the world standard population, and the trend of incidence rate and mortality rate was fitted by Joinpoint regression model respectively. Results: From 1990 to 2019, the overall incidence of drowning among children aged 0-14 years in China decreased from 37.17/100 000 to 12.54/100 000, a relative decrease of 66.26%; the standardized incidence rate decreased from 21.78/100 000 to 14.98/100 000, a relative decrease of 31.22%. The incidence rate and standardized incidence rate of drowning in children showed an increasing after decreasing trend, with decreasing mortality and standardized mortality rate. Joinpoint regression showed that the incidence rate of standardized AAPC for child drowning was -1.3, -2.5 for males and 0 for females. The overall standardized mortality rate of drowning was -3.9, male was -3.6, female was about -4.5 , the trend changes were statistically significant ( P <0.05). The incidence rate and mortality rate of male were higher than that of female, and there was significant difference between male and female groups ( P <0.05). Conclusion Significant progress has been made in child drowning prevention and control, with substantial decreasing in the incidence rate of child drowning. However, considering recent slight increase in drowning incidence, effective measures should be developmed including risk factors, vulnerable population to further control the incidence and mortality of child drowning.

Objective:To explore the marking method for magnetically controlled capsule gastroscopy (MCCG) pictures with artificial intelligence (AI), so as to improve the work efficiency of endoscopist and to reduce the blind area of AI image reading.Methods:According to the consensus of MCCG, 24 parts of stomach in 14 775 pictures of MCCG from 35 subjects in Shenzhen Zifu Medical Technology Co., Ltd received MCCG from March to August, 2020 were marked by ten gastroenterologists and one developer of MCCG with medical background, the marking shape included rectangles and polygons. Among the ten gastroenterologists, three were senior endoscopist (the total number of gastroenteroscopy operations over 80 000, chief physician or associate chief physician), four were medium seniority endoscopist (the total number of gastroenteroscopy operations between 10 000 and 80 000, associate chief physician), and three were junior endoscopist (the total number of gastroenteroscopy operations less than 10 000, attending physician). The pictures of the same subject were pre-marked by two selected senior endoscopists with blind method, and the standard of marking with most appropriate coincidence rate was determined. The qualified marked pictures were automatically learn with AI deep learning method, and the learning results were fed back. Chi square test was used for statistical analysis.Results:According to the pre-marked results, the standard of coincidence rate for rectangular marking area was set as 50.0% and that for polygon marking area was 70.0%. The first correction for qualified rate was 39.0% (5 762/14 775). A total of 9 013 pictures were corrected. After repeated training and correction for one to five times, all pictures were qualified marked. The marking qualified rate of senior endoscopist partners was higher than that of partners of different qualifications (48.7%, 1 200/2 466 vs. 19.0%, 825/4 337), and the difference was statistically significant ( χ2=659.20, P<0.001). There was no statistically significant difference in the marking qualified rate between the senior endoscopist partners and partners of senior endoscopist and capsule developer (48.7%, 1 200/2 466 vs. 49.6%, 1 496/3 019; P>0.05). Conclusions:Establishment of AI marking method for MCCG can provide technical support for AI non-blind area reading, and AI non-blind area monitoring during the operation of MCCG.