Objective:To compare the treatment effect of endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy plus laparoscopic cholecystectomy (ERCP/EST+ LC) and laparoscopic cholecystectomy plus laparoscopic common bile duct exploration (LC+ LCBDE) for patients with choledocholithiasis combined with gallbladder stones.Methods:Clinical data of 172 patients with choledocholithiasis combined with gallbladder stones treated in Heze Municipal Hospital from March 2018 to March 2021 were retrospectilvely analyzed, including 78 males and 94 females, aged (66.88±9.72) years. According to surgical method, patients were divided into the ERCP/EST+ LC group ( n=86) and LC+ LCBDE group ( n=86). The initial clearance rate of choledochal stones, operation time, intraoperative blood loss and postoperative complications were compared between the groups. Results:The initial clearance rate of the choledochal stones of the ERCP/EST+ LC group is 76.5%(13/17), lower than 96.3%(26/27) of LC+ LCBDE group when the diameter of stones was over 1.2 cm ( χ2=4.07, P=0.044). When the number of choledochal stones were more than 3, the initial clearance rate of the ERCP/EST+ LC group is 78.9%(15/19), lower than that of the LC+ LCBDE group [96.7%(29/30), χ2=3.99, P=0.046]. The operation time of LC+ LCBDE group was longer than that of ERCP/EST+ LC group [(129.07±19.33)min vs. (101.86±27.48)min, t=7.51, P<0.001]. The median intraoperative blood loss of LC+ LCBDE group and ERCP/EST+ LC group was 25.0 (20.0, 30.0) ml and 13.0 (10.0, 15.0) ml, respectively ( Z=916.00, P<0.001). The age, gender, maximum diameter of stones, number of stones, preoperative common bile duct diameter, surgical success rate, postoperative hospital stay, total stone clearance rate, and complication rate were comparable between the groups (all P>0.05). Conclusion:Both LC+ LCBDE and ERCP/EST+ LC are safe and feasible for choledocholithiasis combined with cholecystolithiasis. When the maximum diameter of choledochal stones is ≥1.2 cm or the number of choledochal stones is ≥3, LC+ LCBDE should be favored. When patient is in poor general condition, ERCP/EST+ LC might be more feasible.

Objective:To compare the treatment effect of endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy plus laparoscopic cholecystectomy (ERCP/EST+ LC) and laparoscopic cholecystectomy plus laparoscopic common bile duct exploration (LC+ LCBDE) for patients with choledocholithiasis combined with gallbladder stones.Methods:Clinical data of 172 patients with choledocholithiasis combined with gallbladder stones treated in Heze Municipal Hospital from March 2018 to March 2021 were retrospectilvely analyzed, including 78 males and 94 females, aged (66.88±9.72) years. According to surgical method, patients were divided into the ERCP/EST+ LC group ( n=86) and LC+ LCBDE group ( n=86). The initial clearance rate of choledochal stones, operation time, intraoperative blood loss and postoperative complications were compared between the groups. Results:The initial clearance rate of the choledochal stones of the ERCP/EST+ LC group is 76.5%(13/17), lower than 96.3%(26/27) of LC+ LCBDE group when the diameter of stones was over 1.2 cm ( χ2=4.07, P=0.044). When the number of choledochal stones were more than 3, the initial clearance rate of the ERCP/EST+ LC group is 78.9%(15/19), lower than that of the LC+ LCBDE group [96.7%(29/30), χ2=3.99, P=0.046]. The operation time of LC+ LCBDE group was longer than that of ERCP/EST+ LC group [(129.07±19.33)min vs. (101.86±27.48)min, t=7.51, P<0.001]. The median intraoperative blood loss of LC+ LCBDE group and ERCP/EST+ LC group was 25.0 (20.0, 30.0) ml and 13.0 (10.0, 15.0) ml, respectively ( Z=916.00, P<0.001). The age, gender, maximum diameter of stones, number of stones, preoperative common bile duct diameter, surgical success rate, postoperative hospital stay, total stone clearance rate, and complication rate were comparable between the groups (all P>0.05). Conclusion:Both LC+ LCBDE and ERCP/EST+ LC are safe and feasible for choledocholithiasis combined with cholecystolithiasis. When the maximum diameter of choledochal stones is ≥1.2 cm or the number of choledochal stones is ≥3, LC+ LCBDE should be favored. When patient is in poor general condition, ERCP/EST+ LC might be more feasible.

Objective To investigate the relationship between X-ray injury cross-complementing protein 1 (XRCC1) gene polymorphism and prognosis in patients with triple-negative breast cancer (TNBC). Methods Patients with primary triple-negative breast cancer (TNBC) diagnosed in the Ninth People′s Hospital, Shanghai Jiaotong University School of Medicine from January 2013 to January 2015 were selected. Patients were selected for genotyping (XRCC1 gene Arg280His, Arg399Gln and Arg194Trp) and divided into survival group and death group according to the prognosis of patients. Logistic regression was used to analyze the relationship between XRCC1 genotype and prognosis. Results A total of 130 patients were enrolled in the study, with an average age of (50.4 ± 6.3) years. The mean follow-up time was (45 ± 13) months, including 62 patients with breast cancer-related deaths and 68 patients with survival. The patients in death group was older than those in the survival group [(52.6 ± 6.7) years vs. (48.3 ± 5.2) years, P < 0.01), and and the lymph node metastasis rate was higher [88.7%(55/62) vs.73.5%(50/68), P＝0.028]. The frequency of XRCC1 gene Arg399Gln genotype in the survival and death group was GG: 61.8% vs. 38.7%; GA: 32.4% vs. 41.5%; AA: 5.9% vs. 19.4%, P＝0.011.There were also statistical differences between the two groups in the frequency of allele, and the frequency of A allele was significantly higher in the death group than in the survival group (40.4% vs. 22.0%, P<0.01). For the additive model of the Arg399Gln polymorphism A allele, for each additional copy of the A allele, the risk was 1.443 times that before the increase (95% CI 1.174-1.793, P<0.01). After adjusting for age and lymph node metastasis, the A allele still significantly increased the risk of death ( OR＝1.533, 95% CI 1.254-1.903, P < 0.01). Conclusions The XRCC1 gene Arg399Gln polymorphism is associated with the prognosis of TNBC, and patients with the A allele have a poor prognosis.

Objective? To explore the effects of the flipped classroom based on micro-lecture in the standardized training for new nurses. Methods? A total of 65 new nurses in Shenzhen Hospital, Beijing University of Traditional Chinese Medicine who were recruited from July 2015 to July 2016 were selected and divided into observation group(n=32)and control group (n=33) by random number table method. The control group received the routine standard training, while the observation group received the flipped classroom based on micro-lecture in addition to the routine standard training. After training, the nurses' theoretical and clinical practise competence were analyzed and compared based on their performance in the Self-initiated Learning Ability Scale, Registered Nurses' Core Competence Assessment Scale and Satisfaction Questionnaire. Results? After training, the nurses in the observation group achieved higher score in theory (82.68±8.85), clinical practice(83.64±5.93), self-initiated learning(112.32±8.62), and nurses' core competence (162.23±17.96) than the control group with statistical significance (t=3.258, 6.679, 6.085, 3.808;P＜0.01). The satisfaction rate was 87.9% in the observation group and 65.6% in the control group with statistical significance (χ2=4.532,P=0.033). Conclusions? The application of the flipped classroom based on micro- lecture in the standardized training of new nurses can better improve the training efficacy, young nurses' comprehensive and core ability and their autonomous learning ability .