Objective:To evaluate the clinical efficacy and prognosis of mechanical lithotripsy, laser lithotripsy under direct peroral cholangioscopy, and their combination in the treatment of difficult common bile duct (CBD) stones.Methods:Clinical data of 345 patients with difficult CBD stones treated at the Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Shandong University, between January 2020 and December 2024 were retrospectively analyzed, including 176 males and 169 females, aged (71.2±14.2) years. Patients were categorized into three groups based on the lithotripsy technique used: mechanical lithotripsy group ( n=275), laser lithotripsy group under direct peroral cholangioscopy ( n=34), and combined lithotripsy group ( n=35). Operative time, hospitalization costs, stone clearance rate, and postoperative complications were recorded. Follow-ups were conducted through outpatient visits and telephone reviews to monitor stone recurrence. Propensity score matching (PSM) at a 1: 3 nearest-neighbor ratio with a caliper of 0.02 was performed, using lithotripsy method as the dependent variable, and age, sex, stone size, and bile duct diameter as independent variables, resulting in well-balanced mechanical and laser lithotripsy groups. Kaplan-Meier survival analysis was used to assess recurrence-free survival, with comparisons performed using the log-rank test. Results:Before PSM, there were significant differences in age, sex, stone length, and bile duct diameter between the groups (all P<0.05). After PSM, 40 patients were included in the mechanical lithotripsy group, 34 in the laser group, and 35 in the combined group, with no significant differences in baseline or preoperative clinical characteristics (all P>0.05). The combined group had a significantly longer operative time compared to the mechanical group [71.0 (66.0, 92.0) min vs. 50.5 (40.4, 56.5) min, Z=-5.02, P<0.001] and the laser group [71.0 (66.0, 92.0) min vs. 53.0 (26.5, 73.5) min, Z=-2.61, P=0.001]. The laser group also had a longer operative time than the mechanical group [53.0 (26.5, 73.5) min vs. 50.5 (40.4, 56.5) min, Z=-2.27, P=0.023]. Hospitalization costs were significantly higher in the combined group compared to the mechanical group [43 000(33 000, 50 000) yuan vs. 30 000(26 000, 37 000) yuan; Z=-3.43, P<0.001]. The single-session stone clearance rates were 80.0% (32/40) for the mechanical group, 85.3% (29/34) for the laser group, and 62.9% (22/35) for the combined group. Postoperative complication rates were 20.0% (8/40), 11.7% (4/34), and 11.4% (4/35), respectively, with no statistically significant differences among the three groups (all P>0.05). There were also no significant differences in cumulative recurrence-free survival among the groups ( χ2=0.06, P=0.970). Conclusions:For endoscopic management of difficult CBD stones, combined lithotripsy is associated with longer operative time and higher hospitalization costs compared to mechanical and laser lithotripsy alone. Laser lithotripsy also requires more operative time than mechanical lithotripsy. However, the three lithotripsy strategies show no significant differences in postoperative complications or cumulative recurrence-free survival.

Innate lymphoid cells are an important part of innate mucosal immunity and participate in immune response by secreting effector cytokines and regulating the functions of other immune cells.They are similar to T helper cells in transcription factors and secretory cytokines,but they also have some unique functions.Different innate lymphocyte subsets play different roles in chronic obstructive pulmonary disease(COPD)according to their respective characteristics.Compared with adaptive lymphocyte,innate lymphocyte is relatively less in lymphoid tissue,accounting for only a small part of lung immune cells,but these lymphocyte cells play a crucial role in the development and progression of COPD.In this paper,the role of innate lymphoid cells in COPD and the related research progress were reviewed.

Objective To evaluate and compare the long-term efficacy of endoscopic radiofrequency ablation(RFA)and photodynamic therapy(PDT)combined with biliary stenting for the treatment of unresectable extrahepatic cholangiocarcinoma.Methods Clinical data of patients with cholangiocarcinoma who received endoscopic RFA or PDT treatment from February 2018 to February 2023 were retrospectively collected.The patients were divided into RFA group(n=30,received endoscopic RFA combined with biliary stent placement)and PDT group(n=20,received PDT combined with biliary stent placement).The frequency of treatment,stent patency time,overall survival time and adverse events incidence were counted.The factors affecting the survival time of patients were analyzed.Results The overall survival time was 14.0(95%CI:11.8～16.2)months in RFA group and 18.0(95%CI:15.4～20.6)months in PDT group,the median patency time of stent was 4.0(95%CI:2.7～5.3)months in RFA group and 3.5(95%CI:2.3～4.7)months in PDT group,the differences were not statistically significant(P>0.05).Multivariate Cox regression analysis showed that the H＾R of patients with≥2 endoscopic RFA or PDT treatments was 2.417,which was a protective factor affecting overall survival(P=0.018),while the H＾R of TNM stage Ⅲ to Ⅳ was 0.300,which was a risk factor affecting the overall survival period(P=0.002).No significant difference was found in clinical success rate(both 100.00%)and adverse events incidence between the two groups[28.13%(9/32)vs.23.81%(5/21)],the difference was not statistically significant(P>0.05).Conclusion The long-term efficacy of endoscopic RFA or PDT combined with biliary stenting in the treatment of unresectable extrahepatic cholangiocarcinoma is comparable,while the sequential treatment of endoscopic RFA or PDT≥2 times can effectively prolong the overall survival of patients.

Objective To explore the relationship between the risk of falls and the prolonged hospital stay in elderly patients with acute pancreatitis and to provide evidences for the decision-making of nursing and patient management.Methods A total of 232 elderly patients with acute pancreatitis admitted to our hospital from October 2021 to May 2024 were included as the study objects.General information questionnaire and revised Morse fall scale(MFS)were used for investigation.The patients were divided into a prolonged group and a non-prolonged group according to the length of hospital stay.Logistic regression was used to identify the factors that influenced the prolonged hospital stay.The effect of a risk of falls on prolonged hospital stay was analysed by Logistic regression with controlled variables.Results A total of 229 patients completed the study.The average hospital stay of the 229 patients was(9.8±5.5)days,with a median of 9 days(interquartile range:6,12 days).A total of 53 patients(23.14%)had a prolonged hospital stay.The average score of the risk of falls was(5.9±3.0),with a median score of 6(interquartile range:4,8).Multivariate Logistic regression analysis showed that the factors influencing the prolonged hospital stay were diabetes(OR=3.005,95%CI=1.380-6.542),nutritional risk(OR=2.393,95%CI=1.220-4.695),risk of falls(OR=1.233,95%CI=1.098-1.385)(all P<0.05).Further logistic regression analysis was conducted using multiple models and controlled variables,including gender,age,body mass index,history of smoking,history of alcohol consumption,hypertension,diabetes,education,lifestyle,primary disease,time from morbidity to admission,payment method for medical care,and nutritional risk.The results showed that the risk of falls was associated with prolonged hospital stay even after the adjustment of variables(OR=1.278,95%CI=1.126-1.451,P<0.001).Restricted cubic spline(RCS)curve analysis demonstrated that there was a nonlinear relationship between the risk of falls and the prolonged hospital stay(Pfor overall<0.001,Pfor nonlinear<0.05).Threshold effect analysis indicated that while the score of risk of falls was≥8,then per additional increase in the score was associated with a 2.3-fold of increase in the risk of prolonged hospital stay(OR=2.300,95%CI=1.454-3.637,P<0.001).Conclusion The risk of falls,in conjunction with diabetes and a nutritional risk,affects the prolonged hospital stay in elderly patients with acute pancreatitis.The risk of falls also affect independently on a prolonged hospital stay.When the score of risk of falls is≥8,the risk of prolonged hospital stay increases with the increment of the fall risk score.

Objective:To investigate the clinical efficacy of artificial humeral head replacement versus locking plate internal fixation in the treatment of comminuted proximal humeral fractures in older adult patients. Methods:A total of 30 older adult patients with proximal humeral comminuted fractures, admitted to Beifang Hospital, Huainan Xinhua Medical Group from January 2022 to December 2024, were included in this study. A prospective randomized controlled study design was used. The patients were divided into an observation group and a control group using a random number table method, with 15 patients in each group. The observation group underwent artificial humeral head replacement surgery, while the control group received internal fixation with a proximal humeral locking plate. Clinical treatment outcomes, shoulder joint function recovery, and complications were observed and compared between the two groups.Results:The intraoperative blood loss in the observation group was less than that in the control group [(182.24 ± 24.36) mL vs. (245.17 ± 46.08) mL]. The surgery duration [(71.84 ± 7.52) minutes vs. (93.67 ± 12.50) minutes] and hospital stay [(11.37 ± 1.89) days vs. (13.52 ± 2.67) days] were also significantly shorter in the observation group compared with the control group ( t = 4.68, 5.80, 2.55, all P < 0.05). The range of motion in the shoulder joint was greater in the observation group compared with the control group [forward elevation: (94.47 ± 7.66) ° vs. (86.14 ± 5.15) °, external rotation: (61.35 ± 6.57) ° vs. (52.40 ± 4.82) °, and internal rotation: (74.35 ± 4.80) ° vs. (62.76 ± 3.59) °]. The total Constant-Murley score was higher in the observation group [(92.91 ± 10.58) vs. (76.29 ± 7.48)], and the rate of excellent recovery of shoulder function was also higher in the observation group [73.33% (11/15) vs. 53.33% (8/15)] compared with the control group. The incidence of complications was lower in the observation group [6.66% (1/15) vs. 33.33% (5/15)] compared with the control group. All differences were statistically significant ( t = 3.50, 4.25, 7.49, 4.97, χ2 = 4.12, 5.12, all P < 0.05). Conclusions:For older adult patients with severe osteoporosis or irreparable proximal humeral comminuted fractures, artificial humeral head replacement yields more favorable outcomes compared with locking plate internal fixation, resulting in a better recovery of shoulder joint function.

Objective To investigate the effect and mechanism of remimazolam on circulatory function in septic shock rats.Methods Seventy-two SPF grade rats were randomly divided into the control group,the model group,the dexamethasone group,the low and high dose remimazolam groups and the high-dose remimazolam+Nrf2 inhibitor(ML385)group,with 12 rats in each group.The septic shock rat model was established by intravenous infusion of 10 mg/kg lipopolysaccharide(LPS).After 6 hours of modeling,the mean arterial pressure(MAP)and heart rate(HR)of rats were measured.Enzyme linked immunosorbent assay(ELISA)method was applied to measure serum levels of lactic acid(Lac),tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6,nitric oxide(NO),and endothelin-1(ET-1).Hematoxylin-eosin(HE)staining was applied to observe morphological changes in vascular tissue.TUNEL staining was applied to observe the apoptosis of vascular endothelial cells.DHE fluorescent probe was used to detect the level of ROS in vascular tissue.The colorimetric method was applied to detect the contents of MDA and the activity of SOD in vascular tissue.Western blot assay was applied to detect the protein expression of nuclear factor E2-related factor 2(Nrf2)and glutathione peroxidase 4(GPX4)in vascular tissue.Results Compared with the control group,MAP,SOD activity in vascular tissue,Nrf2 and GPX4 protein levels were lower in the model group,while HR,serum Lac,NO,ET-1,TNF-α,IL-1β,IL-6 levels,endothelial cell apoptosis rate,ROS level in vascular tissue and MDA content were higher(P＜0.05).Compared with the model group,MAP,SOD activity in vascular tissue,Nrf2 and GPX4 protein levels were higher in the dexamethasone group and in the low and high dose remimazolam groups,while HR,serum Lac,NO,ET-1,TNF-α,IL-1β,IL-6 levels,endothelial cell apoptosis rate,ROS level in vascular tissue and MDA content were lower(P＜0.05).Nrf2 inhibitor ML385 greatly reduced the protective effect of remimazolam on septic shock rats(P＜0.05).Conclusion Remimazolam may improve circulatory function in septic shock rats by activating the Nrf2/GPX4 pathway,inhibiting inflammatory response and oxidative stress,reducing endothelial cell damage.

Objective To evaluate and compare the long-term efficacy of endoscopic radiofrequency ablation(RFA)and photodynamic therapy(PDT)combined with biliary stenting for the treatment of unresectable extrahepatic cholangiocarcinoma.Methods Clinical data of patients with cholangiocarcinoma who received endoscopic RFA or PDT treatment from February 2018 to February 2023 were retrospectively collected.The patients were divided into RFA group(n=30,received endoscopic RFA combined with biliary stent placement)and PDT group(n=20,received PDT combined with biliary stent placement).The frequency of treatment,stent patency time,overall survival time and adverse events incidence were counted.The factors affecting the survival time of patients were analyzed.Results The overall survival time was 14.0(95%CI:11.8～16.2)months in RFA group and 18.0(95%CI:15.4～20.6)months in PDT group,the median patency time of stent was 4.0(95%CI:2.7～5.3)months in RFA group and 3.5(95%CI:2.3～4.7)months in PDT group,the differences were not statistically significant(P>0.05).Multivariate Cox regression analysis showed that the H＾R of patients with≥2 endoscopic RFA or PDT treatments was 2.417,which was a protective factor affecting overall survival(P=0.018),while the H＾R of TNM stage Ⅲ to Ⅳ was 0.300,which was a risk factor affecting the overall survival period(P=0.002).No significant difference was found in clinical success rate(both 100.00%)and adverse events incidence between the two groups[28.13%(9/32)vs.23.81%(5/21)],the difference was not statistically significant(P>0.05).Conclusion The long-term efficacy of endoscopic RFA or PDT combined with biliary stenting in the treatment of unresectable extrahepatic cholangiocarcinoma is comparable,while the sequential treatment of endoscopic RFA or PDT≥2 times can effectively prolong the overall survival of patients.

Objective To investigate the effect and mechanism of remimazolam on circulatory function in septic shock rats.Methods Seventy-two SPF grade rats were randomly divided into the control group,the model group,the dexamethasone group,the low and high dose remimazolam groups and the high-dose remimazolam+Nrf2 inhibitor(ML385)group,with 12 rats in each group.The septic shock rat model was established by intravenous infusion of 10 mg/kg lipopolysaccharide(LPS).After 6 hours of modeling,the mean arterial pressure(MAP)and heart rate(HR)of rats were measured.Enzyme linked immunosorbent assay(ELISA)method was applied to measure serum levels of lactic acid(Lac),tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6,nitric oxide(NO),and endothelin-1(ET-1).Hematoxylin-eosin(HE)staining was applied to observe morphological changes in vascular tissue.TUNEL staining was applied to observe the apoptosis of vascular endothelial cells.DHE fluorescent probe was used to detect the level of ROS in vascular tissue.The colorimetric method was applied to detect the contents of MDA and the activity of SOD in vascular tissue.Western blot assay was applied to detect the protein expression of nuclear factor E2-related factor 2(Nrf2)and glutathione peroxidase 4(GPX4)in vascular tissue.Results Compared with the control group,MAP,SOD activity in vascular tissue,Nrf2 and GPX4 protein levels were lower in the model group,while HR,serum Lac,NO,ET-1,TNF-α,IL-1β,IL-6 levels,endothelial cell apoptosis rate,ROS level in vascular tissue and MDA content were higher(P＜0.05).Compared with the model group,MAP,SOD activity in vascular tissue,Nrf2 and GPX4 protein levels were higher in the dexamethasone group and in the low and high dose remimazolam groups,while HR,serum Lac,NO,ET-1,TNF-α,IL-1β,IL-6 levels,endothelial cell apoptosis rate,ROS level in vascular tissue and MDA content were lower(P＜0.05).Nrf2 inhibitor ML385 greatly reduced the protective effect of remimazolam on septic shock rats(P＜0.05).Conclusion Remimazolam may improve circulatory function in septic shock rats by activating the Nrf2/GPX4 pathway,inhibiting inflammatory response and oxidative stress,reducing endothelial cell damage.

Objective To explore the relationship between the risk of falls and the prolonged hospital stay in elderly patients with acute pancreatitis and to provide evidences for the decision-making of nursing and patient management.Methods A total of 232 elderly patients with acute pancreatitis admitted to our hospital from October 2021 to May 2024 were included as the study objects.General information questionnaire and revised Morse fall scale(MFS)were used for investigation.The patients were divided into a prolonged group and a non-prolonged group according to the length of hospital stay.Logistic regression was used to identify the factors that influenced the prolonged hospital stay.The effect of a risk of falls on prolonged hospital stay was analysed by Logistic regression with controlled variables.Results A total of 229 patients completed the study.The average hospital stay of the 229 patients was(9.8±5.5)days,with a median of 9 days(interquartile range:6,12 days).A total of 53 patients(23.14%)had a prolonged hospital stay.The average score of the risk of falls was(5.9±3.0),with a median score of 6(interquartile range:4,8).Multivariate Logistic regression analysis showed that the factors influencing the prolonged hospital stay were diabetes(OR=3.005,95%CI=1.380-6.542),nutritional risk(OR=2.393,95%CI=1.220-4.695),risk of falls(OR=1.233,95%CI=1.098-1.385)(all P<0.05).Further logistic regression analysis was conducted using multiple models and controlled variables,including gender,age,body mass index,history of smoking,history of alcohol consumption,hypertension,diabetes,education,lifestyle,primary disease,time from morbidity to admission,payment method for medical care,and nutritional risk.The results showed that the risk of falls was associated with prolonged hospital stay even after the adjustment of variables(OR=1.278,95%CI=1.126-1.451,P<0.001).Restricted cubic spline(RCS)curve analysis demonstrated that there was a nonlinear relationship between the risk of falls and the prolonged hospital stay(Pfor overall<0.001,Pfor nonlinear<0.05).Threshold effect analysis indicated that while the score of risk of falls was≥8,then per additional increase in the score was associated with a 2.3-fold of increase in the risk of prolonged hospital stay(OR=2.300,95%CI=1.454-3.637,P<0.001).Conclusion The risk of falls,in conjunction with diabetes and a nutritional risk,affects the prolonged hospital stay in elderly patients with acute pancreatitis.The risk of falls also affect independently on a prolonged hospital stay.When the score of risk of falls is≥8,the risk of prolonged hospital stay increases with the increment of the fall risk score.

Objective:To evaluate the clinical efficacy and prognosis of mechanical lithotripsy, laser lithotripsy under direct peroral cholangioscopy, and their combination in the treatment of difficult common bile duct (CBD) stones.Methods:Clinical data of 345 patients with difficult CBD stones treated at the Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Shandong University, between January 2020 and December 2024 were retrospectively analyzed, including 176 males and 169 females, aged (71.2±14.2) years. Patients were categorized into three groups based on the lithotripsy technique used: mechanical lithotripsy group ( n=275), laser lithotripsy group under direct peroral cholangioscopy ( n=34), and combined lithotripsy group ( n=35). Operative time, hospitalization costs, stone clearance rate, and postoperative complications were recorded. Follow-ups were conducted through outpatient visits and telephone reviews to monitor stone recurrence. Propensity score matching (PSM) at a 1: 3 nearest-neighbor ratio with a caliper of 0.02 was performed, using lithotripsy method as the dependent variable, and age, sex, stone size, and bile duct diameter as independent variables, resulting in well-balanced mechanical and laser lithotripsy groups. Kaplan-Meier survival analysis was used to assess recurrence-free survival, with comparisons performed using the log-rank test. Results:Before PSM, there were significant differences in age, sex, stone length, and bile duct diameter between the groups (all P<0.05). After PSM, 40 patients were included in the mechanical lithotripsy group, 34 in the laser group, and 35 in the combined group, with no significant differences in baseline or preoperative clinical characteristics (all P>0.05). The combined group had a significantly longer operative time compared to the mechanical group [71.0 (66.0, 92.0) min vs. 50.5 (40.4, 56.5) min, Z=-5.02, P<0.001] and the laser group [71.0 (66.0, 92.0) min vs. 53.0 (26.5, 73.5) min, Z=-2.61, P=0.001]. The laser group also had a longer operative time than the mechanical group [53.0 (26.5, 73.5) min vs. 50.5 (40.4, 56.5) min, Z=-2.27, P=0.023]. Hospitalization costs were significantly higher in the combined group compared to the mechanical group [43 000(33 000, 50 000) yuan vs. 30 000(26 000, 37 000) yuan; Z=-3.43, P<0.001]. The single-session stone clearance rates were 80.0% (32/40) for the mechanical group, 85.3% (29/34) for the laser group, and 62.9% (22/35) for the combined group. Postoperative complication rates were 20.0% (8/40), 11.7% (4/34), and 11.4% (4/35), respectively, with no statistically significant differences among the three groups (all P>0.05). There were also no significant differences in cumulative recurrence-free survival among the groups ( χ2=0.06, P=0.970). Conclusions:For endoscopic management of difficult CBD stones, combined lithotripsy is associated with longer operative time and higher hospitalization costs compared to mechanical and laser lithotripsy alone. Laser lithotripsy also requires more operative time than mechanical lithotripsy. However, the three lithotripsy strategies show no significant differences in postoperative complications or cumulative recurrence-free survival.