Objective To compare the clinical efficacy of modified multi-side hole nasobiliary drainage(MHND)via the percuta-neous transhepatic cholangiography(PTC)route with traditional percutaneous transhepatic cholangial drainage(PTCD)for palliative treatment of patients with advanced obstructive cholangiocarcinoma.Methods A retrospective analysis was conducted on the data from 66 patients with advanced cholangiocarcinoma who underwent biliary drainage.Results Both groups normalize temperature and alleviate symptoms of acute cholangitis within 24 h post-puncture.There was no statistically significant difference in laboratory indicators such as white blood cell(WBC),total bilirubin(TBiL),alanine transaminase(ALT),aspartic transaminase(AST)at 48 h post-operation,and in the incidence of bile leakage,biliary peritonitis,and cholangitis during the postoperative hospital stay(P>0.05).However,the incidence of postoperative electrolyte disorders,gastrointestinal symptoms,and the recurrence rate of gastrointestinal symptoms during the follow-up period were significantly higher in the PTCD group compared to the MHND group,while the recur-rence rate of biliary tract infections was slightly higher in the MHND group compared to the PTCD group.The differences between the two groups were statistically significant(P<0.05).Conclusion Modified MHND shows better clinical efficacy in the treatment of patients with advanced tumor jaundice.Compared with traditional PTCD,it not only effectively reduces jaundice and relieves acute cholangitis but also significantly reduces gastrointestinal symptoms during the postoperative period,thereby improving the quality of life for patients.However,it is noteworthy that it may also increase the risk of biliary tract infections.

Background and Aims:Complex choledocholithiasis often coexists with stenosis of the ampulla of Vater,which increases the difficulty and complexity of treatment.If only the stones in the bile duct are removed without addressing the ampullary stenosis,the disease is prone to recurrence.Previously,most treatments involved the use of endoscopic retrograde cholangiopancreatography(ERCP)to guide the wire for sphincterotomy and stone extraction,followed by laparoscopic cholecystectomy.However,ERCP has limitations in handling complex cases.In response,our team pioneered a new method of treating choledocholithiasis combined with stenosis of the ampulla of Vater via a transabdominal approach.This study was performed to investigate the feasibility and efficacy of this method,aiming to provide a new therapeutic option for clinical practice.Methods:A randomized controlled study was conducted with 120 patients treated at Chengdu Second People's Hospital from 2021 to 2023 for gallbladder stones and choledocholithiasis with stenosis of the ampulla of Vater.Patients were divided into an observation group and a control group,with 60 cases in each group.The observation group underwent laparoscopic cholecystectomy with choledochotomy for stone extraction,followed by retrograde guidance of duodenal papillary sphincterotomy through the opened bile duct,simultaneously treating gallbladder,bile duct stones,and stenosis of the ampulla of Vater.The control group underwent traditional ERCP approach for sphincterotomy,stone extraction,and laparoscopic cholecystectomy.Perioperative variables were collected for both groups and the surgical outcomes were compared.Results:Among the 120 patients,54 were male and 66 were female.There were no statistically significant differences between the two groups in terms of stone extraction success rate,intraoperative blood loss,postoperative 24-h total bilirubin,direct bilirubin,transaminases,white blood cell count,jaundice relief time,or incidence rates of bile leakage,retroperitoneal bleeding/infection,and severe pancreatitis(all P>0.05).The observation group had significantly shorter average operative time and postoperative hospital stay compared to the control group(98.67 min vs.110.8 min,P<0.05;3.81 d vs.5.61 d,P<0.05).Additionally,the observation group had a significantly lower incidence of postoperative hyperamylasemia and/or hyperlipasemia and mild pancreatitis(1.67%vs.25.00%,P<0.001;0 vs.10%,P=0.027).Conclusion:The novel transabdominal approach is superior to the ERCP approach in terms of reducing surgery time and hospitalization time,and it carries a lower risk of postoperative mild pancreatitis and hyperamylasemia and/or hyperlipasemia.The stone extraction success rate is comparable to that of ERCP,making it a viable alternative treatment option.

AIM:To investigate the effect of Clostridium butyricum on the intestinal barrier of mice with dex-tran sodium sulfate(DSS)-induced colitis,and to explore its mechanism related to the regulation of endogenous hydrogen sulfide enzymes.METHODS:Forty male C57BL/6J mice(ten per group)were randomly divided into control group,DSS-induced colitis group,and two groups with different doses(1×1010 CFU/L and 1×1011 CFU/L)of Clostridium butyri-cum.To establish the colitis model,mice were given distilled water containing 3.5%DSS.The mice in Clostridium butyri-cum groups received a 10 mL/kg Clostridium butyricum solution by gastric intubation once per day for 14 d.At the end of the experiment,the disease activity index(DAI)and colon length of the mice from each group were recorded.The colon tissue morphology was determined using HE staining,and qRT-PCR was used to measure the mRNA expression levels of two endogenous hydrogen sulfide enzymes,cystathionine β-synthase(CBS)and cystathionine γ-lyase(CSE),and the mu-cus marker LY6/PLAUR domain containing 8(Lypd8).The protein levels of CSE,CBS and macrophage migration inhibi-tory factor(MIF)in the colon were measured by Western blot.Finally,the expression of tight junction proteins,zonula occludens-1(ZO-1)and occludin,in the colon were evaluated by immunohistochemical staining.RESULTS:Compared with control group,the mice in DSS-induced colitis group had a significant increase in DAI and a decrease in colon length(P＜0.05).Furthermore,the DSS-induced colitis mice exhibited loss of colonic mucosal epithelium,disordered crypt ar-rangement,and extensive infiltration of inflammatory cells.Compared with DSS-induced colitis group,both DAI and co-lon shortening were significantly attenuated in the groups with different doses of Clostridium butyricum(P＜0.05).The mice in Clostridium butyricum groups also exhibited relatively intact colonic mucosal epithelial structure with reduced in-flammatory cell infiltration and reversed crypt disorder.The mRNA expression of CSE and CBS was significantly de-creased,and the mRNA expression of Lypd8 was significantly increased in the colon(P＜0.05).Western blot exhibited down-regulation in the protein expression of CSE,CBS and MIF,whereas immunohistochemical staining showed higher ex-pression of ZO-1 and occludin.CONCLUSION:Clostridium butyricum attenuated DSS-induced colitis in mice,mainly through down-regulating the expression of the endogenous hydrogen sulfide enzymes,CSE and CBS,to promote the intesti-nal mucus barrier and protect the integrity of the intestinal epithelium.

Enterotoxigenic Escherichia coli(ETEC)is the main cause of diarrhea in piglets,which seriously threatens the development of animal husbandry.In order to effectively prevent and con-trol piglet diarrhea,the neutralizing epitopes of the screened K88(FTDYEGASVELRKPDGGT-NK),K99(NVGNGSGGANIN),987P(LAAPAENNTSQAN),F41(VMAADWTEGQPGDII)and F18(PPNAQTYPLSSGDLK)ETEC adhesins were assembled to construct the multi-epitope fusion antigen(MEFA),whose immunogenicity was verified by in silico simulations and in vitro.The computer simulation results showed that MEFA has excellent physicochemical properties and reasonable prediction results of secondary and tertiary structures and exhibits strong interaction force when docking with toll-like receptor 3,and the kinetic simulation shows that it can be stably presented.In vitro validation results showed that anti-K88,K99,987P,F18 and F41 IgY could spe-cifically recognize MEFA proteins.After immunization of laying hens with MEFA,the titers of IgY antibodies against the five ETEC were higher than those of non-specific IgY.In addition,specific anti-MEFA IgY significantly inhibited the adhesion of K88,K99,987P,F41 and F18 ETEC strains to piglet intestinal IPEC-J2 cell lines.These results indicate that MEFA has strong immunogenicity and can be used as an ideal vaccine candidate for the prevention of K88,K99,987P,F41 and F18 ETEC infection,and provide reference and technical support for the development of multivalent broad-spectrum ETEC vaccine candidates.

Objective To compare the clinical efficacy of modified multi-side hole nasobiliary drainage(MHND)via the percuta-neous transhepatic cholangiography(PTC)route with traditional percutaneous transhepatic cholangial drainage(PTCD)for palliative treatment of patients with advanced obstructive cholangiocarcinoma.Methods A retrospective analysis was conducted on the data from 66 patients with advanced cholangiocarcinoma who underwent biliary drainage.Results Both groups normalize temperature and alleviate symptoms of acute cholangitis within 24 h post-puncture.There was no statistically significant difference in laboratory indicators such as white blood cell(WBC),total bilirubin(TBiL),alanine transaminase(ALT),aspartic transaminase(AST)at 48 h post-operation,and in the incidence of bile leakage,biliary peritonitis,and cholangitis during the postoperative hospital stay(P>0.05).However,the incidence of postoperative electrolyte disorders,gastrointestinal symptoms,and the recurrence rate of gastrointestinal symptoms during the follow-up period were significantly higher in the PTCD group compared to the MHND group,while the recur-rence rate of biliary tract infections was slightly higher in the MHND group compared to the PTCD group.The differences between the two groups were statistically significant(P<0.05).Conclusion Modified MHND shows better clinical efficacy in the treatment of patients with advanced tumor jaundice.Compared with traditional PTCD,it not only effectively reduces jaundice and relieves acute cholangitis but also significantly reduces gastrointestinal symptoms during the postoperative period,thereby improving the quality of life for patients.However,it is noteworthy that it may also increase the risk of biliary tract infections.

Background and Aims:Complex choledocholithiasis often coexists with stenosis of the ampulla of Vater,which increases the difficulty and complexity of treatment.If only the stones in the bile duct are removed without addressing the ampullary stenosis,the disease is prone to recurrence.Previously,most treatments involved the use of endoscopic retrograde cholangiopancreatography(ERCP)to guide the wire for sphincterotomy and stone extraction,followed by laparoscopic cholecystectomy.However,ERCP has limitations in handling complex cases.In response,our team pioneered a new method of treating choledocholithiasis combined with stenosis of the ampulla of Vater via a transabdominal approach.This study was performed to investigate the feasibility and efficacy of this method,aiming to provide a new therapeutic option for clinical practice.Methods:A randomized controlled study was conducted with 120 patients treated at Chengdu Second People's Hospital from 2021 to 2023 for gallbladder stones and choledocholithiasis with stenosis of the ampulla of Vater.Patients were divided into an observation group and a control group,with 60 cases in each group.The observation group underwent laparoscopic cholecystectomy with choledochotomy for stone extraction,followed by retrograde guidance of duodenal papillary sphincterotomy through the opened bile duct,simultaneously treating gallbladder,bile duct stones,and stenosis of the ampulla of Vater.The control group underwent traditional ERCP approach for sphincterotomy,stone extraction,and laparoscopic cholecystectomy.Perioperative variables were collected for both groups and the surgical outcomes were compared.Results:Among the 120 patients,54 were male and 66 were female.There were no statistically significant differences between the two groups in terms of stone extraction success rate,intraoperative blood loss,postoperative 24-h total bilirubin,direct bilirubin,transaminases,white blood cell count,jaundice relief time,or incidence rates of bile leakage,retroperitoneal bleeding/infection,and severe pancreatitis(all P>0.05).The observation group had significantly shorter average operative time and postoperative hospital stay compared to the control group(98.67 min vs.110.8 min,P<0.05;3.81 d vs.5.61 d,P<0.05).Additionally,the observation group had a significantly lower incidence of postoperative hyperamylasemia and/or hyperlipasemia and mild pancreatitis(1.67%vs.25.00%,P<0.001;0 vs.10%,P=0.027).Conclusion:The novel transabdominal approach is superior to the ERCP approach in terms of reducing surgery time and hospitalization time,and it carries a lower risk of postoperative mild pancreatitis and hyperamylasemia and/or hyperlipasemia.The stone extraction success rate is comparable to that of ERCP,making it a viable alternative treatment option.

AIM:To investigate the effect of Clostridium butyricum on the intestinal barrier of mice with dex-tran sodium sulfate(DSS)-induced colitis,and to explore its mechanism related to the regulation of endogenous hydrogen sulfide enzymes.METHODS:Forty male C57BL/6J mice(ten per group)were randomly divided into control group,DSS-induced colitis group,and two groups with different doses(1×1010 CFU/L and 1×1011 CFU/L)of Clostridium butyri-cum.To establish the colitis model,mice were given distilled water containing 3.5%DSS.The mice in Clostridium butyri-cum groups received a 10 mL/kg Clostridium butyricum solution by gastric intubation once per day for 14 d.At the end of the experiment,the disease activity index(DAI)and colon length of the mice from each group were recorded.The colon tissue morphology was determined using HE staining,and qRT-PCR was used to measure the mRNA expression levels of two endogenous hydrogen sulfide enzymes,cystathionine β-synthase(CBS)and cystathionine γ-lyase(CSE),and the mu-cus marker LY6/PLAUR domain containing 8(Lypd8).The protein levels of CSE,CBS and macrophage migration inhibi-tory factor(MIF)in the colon were measured by Western blot.Finally,the expression of tight junction proteins,zonula occludens-1(ZO-1)and occludin,in the colon were evaluated by immunohistochemical staining.RESULTS:Compared with control group,the mice in DSS-induced colitis group had a significant increase in DAI and a decrease in colon length(P＜0.05).Furthermore,the DSS-induced colitis mice exhibited loss of colonic mucosal epithelium,disordered crypt ar-rangement,and extensive infiltration of inflammatory cells.Compared with DSS-induced colitis group,both DAI and co-lon shortening were significantly attenuated in the groups with different doses of Clostridium butyricum(P＜0.05).The mice in Clostridium butyricum groups also exhibited relatively intact colonic mucosal epithelial structure with reduced in-flammatory cell infiltration and reversed crypt disorder.The mRNA expression of CSE and CBS was significantly de-creased,and the mRNA expression of Lypd8 was significantly increased in the colon(P＜0.05).Western blot exhibited down-regulation in the protein expression of CSE,CBS and MIF,whereas immunohistochemical staining showed higher ex-pression of ZO-1 and occludin.CONCLUSION:Clostridium butyricum attenuated DSS-induced colitis in mice,mainly through down-regulating the expression of the endogenous hydrogen sulfide enzymes,CSE and CBS,to promote the intesti-nal mucus barrier and protect the integrity of the intestinal epithelium.

Enterotoxigenic Escherichia coli(ETEC)is the main cause of diarrhea in piglets,which seriously threatens the development of animal husbandry.In order to effectively prevent and con-trol piglet diarrhea,the neutralizing epitopes of the screened K88(FTDYEGASVELRKPDGGT-NK),K99(NVGNGSGGANIN),987P(LAAPAENNTSQAN),F41(VMAADWTEGQPGDII)and F18(PPNAQTYPLSSGDLK)ETEC adhesins were assembled to construct the multi-epitope fusion antigen(MEFA),whose immunogenicity was verified by in silico simulations and in vitro.The computer simulation results showed that MEFA has excellent physicochemical properties and reasonable prediction results of secondary and tertiary structures and exhibits strong interaction force when docking with toll-like receptor 3,and the kinetic simulation shows that it can be stably presented.In vitro validation results showed that anti-K88,K99,987P,F18 and F41 IgY could spe-cifically recognize MEFA proteins.After immunization of laying hens with MEFA,the titers of IgY antibodies against the five ETEC were higher than those of non-specific IgY.In addition,specific anti-MEFA IgY significantly inhibited the adhesion of K88,K99,987P,F41 and F18 ETEC strains to piglet intestinal IPEC-J2 cell lines.These results indicate that MEFA has strong immunogenicity and can be used as an ideal vaccine candidate for the prevention of K88,K99,987P,F41 and F18 ETEC infection,and provide reference and technical support for the development of multivalent broad-spectrum ETEC vaccine candidates.

Objective:To explore the effects of health education using new media in nursing outside the hospital among colon cancer patients.Methods:From January 2016 to December 2018, this study selected 86 colon cancer patients at Nanyang Central Hospital as subjects by convenience sampling. A total of 43 patients between January 2016 to June 2017 were in control group, and 43 patients from July 2017 to December 2018 were in observation group. Control group carried out health education outside the hospital, while observation group implemented health education using new media outside the hospital for six months. The effects were compared with the knowledge need questionnaire for cancer patients, Champion Health Belief Model Scale (CHBMS) and the Strategies Used by People to Promote Health (SUPPH) .Results:Six months after discharge, the scores of knowledge need questionnaire of patients in observation group and control group were (41.24±7.64) and (51.94±9.62) respectively ( t=5.712, P<0.01) ; the score of CHBMS of patients in observation group and control group were (118.10±31.53) and (92.20±28.23) respectively ( t=4.013, P<0.01) ; and the score of SUPPH of patients in observation group and control group were (98.37±17.17) and (80.45±17.45) respectively ( t=4.800, P<0.01) ; the differences were all statistical. Conclusions:The application of health education using new media in nursing outside the hospital among colon cancer patients can improve patients' health knowledge need, rebuild the health belief and increase self-management efficacy.

Objective? To explore the effects of health education under the concept of health quotient on self-management ability and medication compliance among ulcerative colitis patients. Methods? From December 2015 to December 2017, we selected 140 ulcerative colitis patients at Nanyang City Center Hospital of the Affiliated Hospital of Zhengzhou University as subjects by convenience sampling. All of the patients were divided into observation group and control group with the method of random number table, 70 cases in each group. Control group adopted routine health education, while observation group carried out health education under the concept of health quotient which implemented health education using five dimensions of health quotient concept as start points. The intervention effects of patients of two groups, self-management ability and medication compliance, were compared with the Adult Health Self-Management Skill Rating Scale (AHSMSRS) and Morisky Medication Adherence Scale before (on admission) and after (reexamining three months after discharge) intervention. Results? Before intervention, there were no statistical differences in the dimension scores of AHSMSRS of patients between two groups (P＞ 0.05). After intervention, the scores of AHSMSRS both groups all increased compared with those before intervention;the scores of diet management, sport management, responses to the diseases, resource usage, self-efficacy and environment self-management and the total score of AHSMSRS in observation group after intervention were higher than those in control group with statistical differences (P＜0.05). After intervention, the fine rate of medication compliance of observation group was 95.71% statistically higher than that (85.71%) of control group (P＜0.05). Conclusions? Health education under the concept of health quotient can improve self-management ability and medication compliance among ulcerative colitis patients which is worthy of being spread in clinical application.