Objective To investigate the safety and efficacy of combined confluence microdissection or balloon dilatation followed by laparoscopic transcystic common bile duct exploration (LTCBDE) in day surgery laparoscopic cholecystectomy. Methods The clinical data of 203 patients with day surgery laparoscopic cholecystectomy combined with LTCBDE from June 2021 to June 2024 in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. They were divided into an observation group (59 cases, including 42 cases of confluent microdissection and 17 cases of balloon dilatation) and a conventional group (144 cases) according to the surgical technique used. Baseline characteristics, intraoperative exploration results, operation time, postoperative recovery and complications were compared between the two groups. Results The history of preoperative cholangitis or pancreatitis (P<0.001) was more common in the observation group. And total bilirubin level was significantly higher in the observation group than in the conventional group (P=0.035). The observation group had a longer operative time (P=0.014) and higher hospitalization costs (P=0.001), but there was no difference in intraoperative bleeding and postoperative discharge time. There were no serious postoperative complications in either group. Conclusions Under the premise of strict patient screening, day surgery LTCBDE combined with confluence microdissection or balloon dilatation can effectively solve the problem of difficult choledochoscopic access, with high safety and thoroughness of exploration. Both techniques provide a feasible minimally observation solution for day surgery biliary exploration.

Objective To compare the ability of single-phase,dual-phase,and triphasic models in forecasting postoperative pancreatic fistula(POPF)after pancreaticoduodenectomy(PD)using radiomics based on triphasic enhanced CT.Methods A total of 181 patients who underwent multi-phase enhanced CT prior to PD were retrospectively selected,and the collection phase included non-contrast,arterial phase(AP),and equilibrium phase(EP).3D Slicer software was utilized to segment the region of interest(ROI)for the postoperative pancreatic remnant on each phase.Radiomics feature extraction was performed using R software,followed by feature selection through least absolute shrinkage and selection operator(LASSO)regression with five-fold cross-validation to prevent model overfitting.The effective features selected were combined in a weighted linear manner to obtain a Radiomics score(Radscore).The patients were divided into training set and test set in a 7︰3 ratio.Logistic regression was employed to construct seven POPF prediction models(three single-phase,three dual-phase,and one triphasic models)based on different phase combinations.The diagnostic performance of the models was evaluated using the area under the curve(AUC)of receiver operating characteristic(ROC)curve,accuracy(ACC),sensitivity(SEN),and specificity(SPE).The DeLong test was applied to compare the differences in AUC among different models.Results After LASSO regression,24 effective features associated with POPF were selected from different phases.In the test set,the triphasic model exhibited the highest AUC and ACC(AUC=0.76,ACC=0.808).The calibration curve demonstrated the strongest agreement between the estimated probabilities and observed probabilities for the triphasic model.The decision curve analysis(DCA)curve indicated that the triphasic model had the largest threshold range with a higher net benefit.Conclusion Compared with single-phase and dual-phase models,the triphasic model based on enhanced CT provides better prediction of POPF after PD,aiding clinical decision-making and improve prognosis.

Objective To compare the ability of single-phase,dual-phase,and triphasic models in forecasting postoperative pancreatic fistula(POPF)after pancreaticoduodenectomy(PD)using radiomics based on triphasic enhanced CT.Methods A total of 181 patients who underwent multi-phase enhanced CT prior to PD were retrospectively selected,and the collection phase included non-contrast,arterial phase(AP),and equilibrium phase(EP).3D Slicer software was utilized to segment the region of interest(ROI)for the postoperative pancreatic remnant on each phase.Radiomics feature extraction was performed using R software,followed by feature selection through least absolute shrinkage and selection operator(LASSO)regression with five-fold cross-validation to prevent model overfitting.The effective features selected were combined in a weighted linear manner to obtain a Radiomics score(Radscore).The patients were divided into training set and test set in a 7︰3 ratio.Logistic regression was employed to construct seven POPF prediction models(three single-phase,three dual-phase,and one triphasic models)based on different phase combinations.The diagnostic performance of the models was evaluated using the area under the curve(AUC)of receiver operating characteristic(ROC)curve,accuracy(ACC),sensitivity(SEN),and specificity(SPE).The DeLong test was applied to compare the differences in AUC among different models.Results After LASSO regression,24 effective features associated with POPF were selected from different phases.In the test set,the triphasic model exhibited the highest AUC and ACC(AUC=0.76,ACC=0.808).The calibration curve demonstrated the strongest agreement between the estimated probabilities and observed probabilities for the triphasic model.The decision curve analysis(DCA)curve indicated that the triphasic model had the largest threshold range with a higher net benefit.Conclusion Compared with single-phase and dual-phase models,the triphasic model based on enhanced CT provides better prediction of POPF after PD,aiding clinical decision-making and improve prognosis.

Objective:To analyze the current situation of pregnant women′s health promotion behavior in early pregnancy, and to explore the multiple mediating effects of self-efficacy and sense of coherence in family function and health promotion behavior.Methods:The convenience sampling method selected 208 early pregnant women who visited the obstetric clinic of the Affiliated Hospital of Qingdao University from August to December 2020 as the research object was used. The electronic questionnaires including self-made general information questionnaire, Family APGAR Questionnaire, General Self-Efficacy Scale (GSES), Sense of Coherence Scale (SOC-13), and the Health-Promoting Lifestyle ProfileⅡ (HPLP-Ⅱ) were provided to women.Results:The total score of health promotion behaviors for early pregnancy was (139.58 ± 17.27) points with a good level. The influencing factors such as exercise habits and medical payment methods had statistical significance in the effects of health-promoting behaviors in the first trimester of pregnancy ( t=4.68, -3.55, both P<0.05). Structural equation model revealed that the total effect value of family function on health-promoting behaviors was 2.654, the direct effect value was 1.729 and the indirect effect value was 0.925. Meanwhile, the mediating effects of self-efficacy, the sense of coherence and self-efficacy upon the sense of coherence accounted for 15.9%, 15.2% and 3.8% of the indirect effect respectively. Conclusions:Family function of pregnant women in early pregnancy can not only affect health promotion behavior through self-efficacy and sense of coherence, but also indirectly affect sense of coherence through self-efficacy, so as to affect health promotion behavior. Maternal related health workers can construct targeted intervention measures from the perspective of self-efficacy and sense of coherence to maintain and improve the health promotion behavior of pregnant women in the early stage of pregnancy.

Abstract In China, road traffic injury has been the 2nd leading cause of death for minors aging from 1 to 14 years old, has become an urgent public health problem in China. This paper introduces the current situation of children s road traffic accident injuries. Based on Haddon s model, the influencing factors of children s road traffic safety are summarized into two aspects:individual and environmental levels. Also it puts forward targeted strategies for children road safety, including improving the relevant laws and regulations system, releasing commercial insurance into children CRS evaluation criteria, improving the safety awareness level of parents, strengthening the campus traffic safety education and optimizing the road safety protection facilities, all of which could contribute to protect child safety, thus providing reference for China to improve the road traffic safety education for children.