ObjectiveTo investigate the incidence rate of post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） in patients with difficult common bile duct intubation undergoing pancreatic duct stenting during surgery， as well as the effect of pancreatic duct stenting in the prevention and treatment of PEP， and to provide a basis for clinical treatment. MethodsA retrospective analysis was performed for the clinical data of 186 patients with biliary tract disease who underwent initial ERCP and had difficult common bile duct intubation in The First Affiliated Hospital of Zhengzhou University from January 2016 to December 2024， and according to the condition of pancreatic duct stenting， the patients were divided into control group with 73 patients （without pancreatic duct stenting）， 5Fr-5 cm stent group with 67 patients， and 7Fr-5 cm stent group with 46 patients. The three groups were compared in terms of baseline data， intraoperative procedures， and postoperative outcomes. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups； the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between multiple groups， and the Dunn method was used for further comparison between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The Logistic regression analysis was used to investigate the influencing factors for PEP in patients with difficult intubation during ERCP. ResultsThe overall incidence rate of PEP was 12.37% （23/186）. Compared with the 5Fr-5 cm stent group and the 7Fr-5 cm stent group， the control group had a significantly higher incidence rate of PEP， a significantly higher score of postoperative abdominal pain， and a significantly longer length of postoperative hospital stay （all P0.01）， and 55.56% of the patients in the control group had moderate-to-severe PEP. The univariate Logistic regression analysis showed that intradiverticular papilla， double guide wire intubation， needle knife precut， the application of basket and balloon for removal of common bile duct stones， intraoperative biopsy， pancreatic duct stenting， intubation time≤10 minutes， frequency of intubation≤5 times， preoperative CRP≤5 mg/L were influencing factors for PEP （all P0.05）， and the multivariate Logistic regression analysis showed that intraoperative pancreatic duct stenting， needle knife precut， and intraoperative biopsy were independent influencing factors for the onset of PEP （all P0.05）. ConclusionPancreatic duct stenting during ERCP can effectively reduce the risk of PEP in patients with difficult intubation， while needle knife precut and intraoperative biopsy can increase the risk of PEP in patients with difficult intubation.

Objective To systematically review the efficacy of anti-inflammatory drugs in the treatment of diabetic nephropathy(DN).Methods Databases including PubMed,The Cochrane Library,EMbase,Web of Science,Scopus,Ovid,ProQuest,CBM,CNKI,WanFang Data,VIP and Duxiu data were electronically searched to collect randomized controlled trials(RCTs)of anti-inflammatory drugs for DN from inception to April 5,2022.Two reviewers independently screened the literature,extracted data,and assessed the risk of bias of the included studies.RevMan 5.4 software were then used to perform Meta-analysis.Results A total of 29 literature and 26 RCTs involving 4 095 patients were included.The results of Meta-analysis showed that compared with conventional treatment,conventional treatment combined with anti-inflammatory drugs could effectively reduce urinary albumin to creatinine ratio[SMD=-0.17,95％CI(-0.31,-0.03),P=0.02],urinary albumin excretion rate[SMD=-0.37,95％CI(-0.56,-0.18),P=0.000 1],urinary protein excretion rate[SMD=-0.97,95％CI(-1.29,-0.64),P=0.000 01],and glycosylated hemoglobin[SMD=-0.17,95％CI(-0.27,-0.08),P=0.000 4],while there was no significant difference in reducing serum creatinine[SMD=-0.04,95％CI(-0.19,0.1),P=0.57],urea nitrogen[MD=-0.23,95％CI(-0.50,0.04),P=0.09]and fasting blood glucose[SMD=-0.15,95％CI(-0.32,0.02),P=0.08].There was no statistically significant difference in changing glomerular filtration rate(GFR)[SMD=-0.04,95％CI(-0.15,0.07),P=0.47]with multiple drugs,except for a few drugs.Conclusion Conventional treatment combined with anti-inflammatory drugs can better improve the level of proteinuria in patients with DN,but the improvement of renal function is not obvious.Due to the limitations of the number of included studies and the duration of treatment,the above conclusion needs to be verified by more high-quality studies.

In order to isolate Mycoplasma hyopneumoniae(Mhp)and select virulent strains with high growth titer from the isolates to acclimate at high temperature to obtain attenuated strains.Forty lung and trachea tissues were aseptically collected from pigs suspected of Mhp in several farms in Nanyang City.A total of 6 strains of Mhp were isolated through pathogen isolation,colony observation,PCR identification and sequencing.For each isolate,round colonies with neat edges,dewdrop like particles and ridges in the center were observed on solid medium.PCR could amplify the target gene bands of each isolated P36.After sequencing,the amplified products were compared with the gene sequences of ATCC 25934 reference strain(J strain)P36 registered in NCBI,and the homology was more than 99％.The growth titer of TH-1 strain measured by CCU experiment could reach 1011 CCU/mL,which showed a high growth titer.TH-1 strain was selected for continu-ous passage at high temperature(40 ℃)in vitro to obtain different passages(P50,P1 00,P1 50).TH-1 P150 still had a higher growth titer(1010 CCU/mL)at 40 ℃ growth temperature.TH-1 P1,P50,P100 and P150 were injected into the trachea to infect 25-day-old weaned piglets,and the re-sults of virulence evaluation showed that 4 pigs(4/5)in the P1 infection group had typical"meat or shrimp meat"lesions,and serious monocyte and lymphocyte infiltration were found in the lung HE pathological sections,and the cilia were clutter-tangled,shortened and exfoliated.P150 infec-tion group did not show typical Mhp characteristic lesions,lung HE and tracheal scan sections did not show microscopic pathological changes,indicating that TH-1 was a virulent strain,but its viru-lence was continuously decreased after continuous in vitro passage,and TH-1 P150 was a low-viru-lence strain.TH-1 P150 strain,as a attenuated vaccine strain,has good immunogenicity,and the av-erage reduction rate of pneumonia disease after immune challenge was 83.3％.In conclusion,a low-virulence strain with high growth titer(TH-1 P150)was obtained by continuous passage at high temperature in vitro for the first time,and its immunogenicity was good,which laid the foundation for further research and development of Mhp attenuated vaccine.

Objective To systematically review qualitative studies on the experience of virtual reality(VR)rehabilitation in stroke patients,so as to provide references for the clinical practice of stroke rehabilitation.Methods The relevant qualitative studies in PubMed,Web of Science,Scopus,Embase,Cochrane Library,CINAHL,CNKI,WanFang Data,SinoMed and VIP Database were retrieved.The retrieval time was from the establishment of the database to April 2023.The quality of included studies was evaluated according to JBI Critical Appraisal Tool(2020)for qualitative studies.Meta-synthesis was used to integrate results.Finally,the quality of evidence was evaluated by the Confidence in the Qualitative Evidence(ConQual)approach.Results A total of 14 studies were included to extract 45 research results,and 3 synthesized findings were grouped from 10 categories according to their similarities,including the perceived benefits of VR rehabilitation;the perceived barriers of VR rehabilitation;the expectations and needs for VR rehabilitation in stroke patients.The ConQual score showed a moderate quality of the synthesized findings.Conclusion Stroke patients are positive about VR rehabilitation.But in the future,we should pay attention to optimizing the VR rehabilitation support system for stroke,improving the feedback mechanism of VR rehabilitation technology,innovating VR multi-functional rehabilitation form,promoting VR rehabilitation extend to the community and home,providing a reference for the application of VR rehabilitation in stroke patients.

Objective:To explore the effect of esketamine on inflammatory cytokines and myocardial injury markers in children undergoing living-donor liver transplantation (LT).Methods:Considering the inclusion criteria, 50 children with biliary atresia were selected for living donor LT. They were equally randomized into two groups of control (C) and esketamine (E) (25 cases each). Esketamine 0.5 mg/kg was administered to group E during induction and continued at a dose of 0.5 mg·kg –1·h -1 after an induction of anesthesia. Group C provided the same dose of 0.9% sodium chloride injection during induction and then continued to pumping until the end of the procedure. Basic profiles of two groups were recorded. Hemodynamic parameters, such as heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP), were monitored at 5 min of anesthesia induction (T 0), 30 min of anhepatic phase (T 1), immediately after repercussion (T 2), 30 min of neohepatic phase (T 3) and end of surgery (T 4) in both groups. Central venous blood samples were collected at T 0, T 1, T 3 and T 4. Serum levels of cardiac troponin I (cTnI), creatine kinase isoenzyme-MB (CK-MB) ,tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) were measured. The incidence of adverse cardiac events, postoperative mechanical ventilation time, ICU stay and hospitalization length were compared. Results:As compared with T 0, mean arterial pressure (MAP) at T 2 declined markedly in group E [(48.6±12.7) mmHg (1 mmHg=0.133 kPa) vs (55.6±10.7) mmHg, P<0.001] and C [(39.3±8.0) mmHg vs (53.2±9.4) mmHg, P<0.001 ] ;As compared with T 0, the TNF-α and IL-6 spiked at T 3 in group C [169.0 (207.1) ng/L vs 43.8 (26.4) ng/L, (132.63±51.75) ng/L vs (51.79±17.83) ng/L, P<0.001] and E [78.5 (138.8) ng/L vs 43.8 (26.4) ng/L, (87.44±32.17) ng/L vs (51.79±17.83) ng/L, P<0.001 ] ; In group C, the concentration of myocardial injury markers CK-MB and cTnI rose at T 3/T 4 compared with T 0[T 3 vs T 0: 5.7 (5.4) μg/L vs 4.0 (3.5) μg/L, 0.09 (0.08) μg/L vs 0.02 (0.02) μg/L; T 4 vs T 0: 5.3 (5.0) μg/L vs 4.0 (3.5) μg/L, 0.07 (0.08) μg/L vs 0.02 (0.02) μg/L, P<0.001 ]. In group E, the levels of CK-MB and cTnI were higher at T 3/T 4 than those at T 0[T 3 vs T 0: 7.0 (5.0) μg/L vs 4.6 (2.1) μg/L, 0.06 (0.09) μg/L vs 0.03 (0.04) μg/L; T 4 vs T 0: 5.4 (4.9) μg/L vs 4.6 (2.1) μg/L, 0.03 (0.06) μg/L vs 0.03 (0.04) μg/L; P<0.001]. Compared with group C, the MAP of E rose at T 1/T 2/T 3 [(58.8±10.3) mmHg vs (53.3±8.6) mmHg, P=0.048; (48.6±12.7) mmHg vs (39.3± 8.0) mmHg, P=0.003; (55.8±7.4) mmHg vs (51.5±7.3) mmHg, P=0.044]. Compared with group C, TNF-α and IL-6 decreased in E at T 3/T 4[T 3: 78.5 (138.8) ng/L vs 169.0 (207.1) ng/L, P=0.010; (87.44±32.17) ng/L vs (132.63±51.75) ng/L, P=0.017. T 4: 62.3 (118.3) ng/L vs 141.3 (129.2) ng/L, P=0.001; (74.34±26.38) ng/L vs (100.59±30.40) ng/L, P=0.002]. Compared with group C, cTnI decreased in E at T 3/T 4[0.06 (0.09) μg/L vs 0.09 (0.08) μg/L, P=0.014; 0.03 (0.06) μg/L vs 0.07 (0.08) μg/L, P=0.003]. Compared with group C, the mechanical ventilation time in group E decreased [195 (120) min vs 315 (239) min, P<0.001]. Compared with group C, the incidence of severe hypotension [16%(4/25) vs 48% (12/25), P=0.015 ], bradycardia [12% (3/25) vs 36 % (9/25), P=0.047 ], myocardial ischemia [4 % (1 /25) vs 24 % (6/25), P=0.042 ] and premature ventricular contractions [0 vs 4 %(1/25), P=0.312 ] decreased in group E. Conclusion:Intraoperative dosing of esketamine may suppress inflammatory reactions and alleviate perioperative myocardial injury in children undergoing living-donor LT.

Objective:To summarize the experience of brain death determination under veno-arterial extracorporeal membrane oxygenation (VA-ECMO) assisted circulatory support, especially apnea test (AT) precautions, and to provide references for brain death determination in this scenario.Methods:In 78 patients who had VA-ECMO at Organ Transplant Center, Zhengzhou People's Hospital from October 2019 to December 2023, 8 organ donors had brain death determination under VA-ECMO assisted circulatory support. Baseline data, clinical data, and VA-ECMO data during AT trial were collected from these 8 patients to summarize the process of brain death determination.Results:Six of the 8 donors met the criteria of brain death; 10 EEG, 12 evoked potentials and 15 ATs were performed. Complications in ATs, including hypotension, decreased oxygenation and arrhythmia, were alleviated after timely improved VA-ECMO flow and applied cardiotonic and pressor drugs.Conclusion:AT is key for successful brain death determination in organ donors under VA-ECMO assisted circulatory support; therefore, complications should be closely monitored and managed.

Objective:To compare the accuracy of dynamic navigation system,fully-guided and Pilot-drill guided implant surgery in anterior dental aesthetic area.Methods:45 patients underwent single tooth implantation in anterior dental aesthetic area were random-ly divided into 3 groups(n=15).Dynamic navigation system imlanting(A),3D printing fully-guided template with ASTRA EV assis-ted orthopedic implantation(B)and Pilot-drill guided implantation(C)were respectively used for the patients in group A,B and C.The deviation between the preoperative design and actual results were measured by CBCT and/or 3D reconstruction with navigation de-sign software or 3SHAPE software.SPSS 25.0 software package was used and(x)±s was used for descriptive analysis,results were pair-wise compared among the 3 groups using ANOVA.Results:Data were normally distributed and the variance of the data was homoge-neous.In group A,the distance deviation of implant top center was(0.571±0.196)mm,the horizontal deviation was(0.405±0.222)mm,the distance deviation of implant apical center was(0.449±0.267)mm,the vertical deviation was(0.312±0.223)mm,the de-viation of the connection angle between the two centers was 2.257°±0.989°.In group B,those were(0.520±0.242)mm,(0.219±0.201)mm,(0.643±0.284)mm,(0.464±0.292)mm and 1.272°±0.951° respectively.In group C those were(1.179±0.365)mm,(0.667±0.276)mm,(1.518±0.566)mm,(0.967±0.444)mm and 2.568°±0.632°.The deviation of all the measurments of group A and B was lower than those of group C(P＜0.05).The deviation of the connection angle between the 2 centers of group B was less than that of group A(P＜0.05),but no statistical significance(P＞0.05)was found in other 4 measured items.Conslusion:The accuracy of the dynamic navigation system and the fully-guided implantation is significantly higher than that of the Pilot-drill guided implantation,but is not statistically significant between dynamic navigation and the fully-guided system.

Objective:To investigate the iodine nutrition levels of children aged 8 - 10 and pregnant women in iodine deficient areas and iodine adequate areas of Inner Mongolia Autonomous Region (Inner Mongolia for short), and to provide scientific basis for prevention and treatment of iodine deficiency disorders.Methods:From March to July 2022, iodine nutrition analysis was conducted in iodine deficient areas and iodine adequate areas of 104 banners (counties, cities and districts) in 12 league cities in Inner Mongolia. Each monitoring banner (county, city and district) was divided into five sampling areas by east, west, south, north, and center, with one Sumu (township, street) selected from each area. One primary school was selected from each Sumu (township, street), and 40 non-boarding students aged 8 - 10 were selected from each primary school. One third of the students underwent thyroid ultrasound examination. Twenty pregnant women were selected from each of the 5 Sumus (townships, streets) in each monitoring banner (county, city and district). Household salt samples and random urine samples of children and pregnant women were collected to detect salt iodine and urinary iodine levels.Results:In 2022, the median thyroid volume of children aged 8 - 10 in iodine deficient areas and iodine adequate areas of Inner Mongolia was 2.44 ml, and the goiter rate was 1.89% (123/6 496). There were statistically significant differences in thyroid volume and goiter rate between different league cities ( H = 1 229.05, χ 2 = 34.13, P < 0.001). The coverage rate of iodized salt in 12 league cities was 98.51% (30 628/31 090), the consumption rate of qualified iodized salt was 94.42% (29 355/31 090), and the median salt iodine was 22.80 mg/kg. The median urinary iodine of children ( n = 20 968) was 195.00 μg/L, among which the median urinary iodine in 7 league cities was at the appropriate level of iodine nutrition (100 - 199 μg/L), and the median urinary iodine in 5 league cities was at the level of iodine nutrition exceeding the appropriate level (200 - 299 μg/L). The median urinary iodine of pregnant women ( n = 10 122) was 168.00 μg/L, among which, except for Bayannur (149.18 μg/L), the median urinary iodine in other 11 league cities was at the appropriate level of iodine nutrition (150 - 249 μg/L). Conclusions:The overall iodine nutrition of children and pregnant women in Inner Mongolia is at an appropriate level, but some pregnant women still face the risk of iodine deficiency. In the future, the focus of iodine deficiency disorders prevention and control should be on iodine nutrition monitoring for special needs populations.

ObjectiveTo investigate the therapeutic effect and mechanism of coptisine on chronic atrophic gastritis （CAG） in rats based on the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway. MethodA CAG rat model was induced by multiple factors， including sodium salicylate， N-methyl-N′-nitro-N-nitrosoguanidine （MNNG）， and irregular feeding. The successfully modeled rats were randomly divided into the model group， folic acid group， and high- and low-dose coptisine groups. The high- and low-dose coptisine groups were given coptisine （50， 10 mg·kg^-1， respectively）， and the folic acid group was given folic acid at 2 mg·kg^-1 for 60 days. The pathological changes were detected by hematoxylin-eosin （HE） staining. The ultrastructure of gastric mucosal cells was observed by electron microscopy. Serum pepsinogen Ⅰ （PGⅠ）， pepsinogen Ⅱ （PGⅡ）， and PGⅠ/PGⅡ ratio （PGR） were detected by immunoturbidimetry. Serum gastrin-17 （G-17） level was detected by radioimmunoassay. The content of interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） in serum of rats was detected by enzyme-linked immunosorbent assay （ELSIA）. Western blot analysis was used to detect the expression levels of TGF-β₁， PI3K， phosphorylated-Akt （p-Akt）， mTOR， and phosphatase and tensin homolog deleted on chromosome 10 （PTEN） in gastric mucosa. The mRNA levels of TGF-β₁， PI3K， Akt， mTOR， PTEN， microtubule-associated protein light chain 3Ⅱ （LC3Ⅱ）， and Beclin-1 were detected by real-time quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the normal group， the model group showed atrophy and reduced number of intrinsic glands in the gastric mucosal tissues， as well as inflammatory cell infiltration. The ultrastructure of gastric mucosal cells in the model group displayed nuclear condensation， reduced and swollen mitochondria， and abnormal structure. The serum levels of G-17， PGⅠ， PGR， and the protein and mRNA levels of PTEN in gastric tissues were significantly lower in the model group （P<0.01）， while serum levels of IL-6， IL-1β， TNF-α， and the protein and mRNA levels of TGF-β₁， PI3K， Akt， and mTOR in gastric tissues were significantly higher （P<0.01）. Compared with the model group， various drug intervention groups showed different degrees of improvement in pathological damage and gastric mucosal cell ultrastructure， significantly increased serum levels of G-17， PGⅠ， and PGR （P<0.05，P<0.01）， and significantly decreased levels of IL-6， IL-1β， and TNF-α （P<0.05，P<0.01）. The high-dose coptisine group significantly downregulated the protein and mRNA levels of TGF-β₁， PI3K， Akt， and mTOR （P<0.05，P<0.01）. ConclusionBerberine has a therapeutic effect on CAG in rats， possibly exerting a protective effect on gastric mucosa by inhibiting inflammation and blocking the PI3K/Akt/mTOR signaling pathway.

BACKGROUND:Compared with traditional two-dimensional culture,three-dimensional microtissue culture can show greater advantages.However,more favorable cultivation methods in three-dimensional culture still need to be further explored. OBJECTIVE:To evaluate the cell behavior of microtissue and its ability to promote cartilage formation under two three-dimensional culture methods. METHODS:Cartilage-derived microcarriers were prepared by chemical decellularization and tissue crushing.DNA quantification and nuclear staining were used to verify the success of decellularization,and histological staining was used to observe the matrix retention before and after decellularization.The microcarriers were characterized by scanning electron microscopy and CCK-8 assay.Cartilage-derived microtissues were constructed by combining cartilage-derived microcarriers with human adipose mesenchymal stem cells through three-dimensional static culture and three-dimensional dynamic culture methods.The cell viability and chondrogenic ability of the two groups of microtissues were detected by scanning electron microscopy,live and dead staining,and RT-qPCR. RESULTS AND CONCLUSION:(1)Cartilage-derived microcarriers were successfully prepared.Compared with before decellularization,the DNA content significantly decreased after decellularization(P<0.001).Scanning electron microscope observation showed that the surface of the microcarrier was surrounded by collagen,maintaining the characteristics of the natural extracellular matrix of cartilage cells.CCK-8 assay indicated that microcarriers had no cytotoxicity and could promote cell proliferation.(2)Scanning electron microscopy and live and dead staining results showed that compared with the three-dimensional static group,the three-dimensional dynamic group had a more extended morphology of microtissue cells,and extensive connections between cells and cells,between cells and matrix,and between matrix.(3)The results of RT-qPCR showed that the expressions of SOX9,proteoglycan,and type Ⅱ collagen in microtissues of both groups were increased at 7 or 14 days.The relative expression levels of each gene in the three-dimensional dynamic group were significantly higher than those in the three-dimensional static group at 14 days(P<0.05).At 21 days,the three-dimensional static group had significantly higher gene expression compared with the three-diomensional dynamic group(P<0.001).(4)The results showed that compared with three-dimensional static culture microtissue,three-dimensional dynamic culture microtissue could achieve higher expression of chondrogen-related genes in a shorter time,showing better cell viability and chondrogenic ability.