There is still a lack of guidelines on biliary cannulation in recent years. The guidelines are an initiative of the World Endoscopy Organization （WEO） formulated by a panel of experts from Asia， Europe， and America. Through a systematic literature review and the application of the Grading of Recommendations Assessment， Development， and Evaluation methodology， the guidelines address clinical questions pertaining to four key domains， i.e.， prevention of post-ERCP pancreatitis （PEP）， bile duct cannulation techniques， sphincterotomy/papillary balloon dilation， and bile duct cannulation under special circumstances. Successful biliary cannulation and sphincterotomy are cornerstones of ERCP and are indispensable for almost all therapeutic and advanced diagnostic procedures； however， adverse events， especially PEP， may occur frequently and affect the prognosis of patients. A high success rate of bile duct cannulation and a low incidence rate of PEP are quality indicators for ERCP and should be the goal of all endoscopists. The guidelines aim to provide clinical practice recommendations applicable worldwide， regardless of resources and expertise. The guidelines cover the preoperative， intraoperative， and postoperative management of ERCP， including the measures to reduce the risk of PEP， the technique for an initial biliary cannulation attempt， options for cannulation in case of difficult biliary access， alternatives to ERCP in case of failure （under the guidance of percutaneous and endoscopic ultrasound）， and biliary access in altered anatomy （periampullary diverticulum and postsurgical anatomy） and in the presence of duodenal stenosis.

Objective:To investigate the epidemiological characteristics of herpangina (HA) and its correlation with the incidence of hand, foot and mouth disease (HFMD) in children aged ≤6 years in Yinzhou District of Ningbo from 2017 to 2022.Methods:Epidemiological characteristics of HA in children aged ≤6 years were analyzed based on the electronic medical record data and public health management data from 2017 to 2022 collected from the Health Information Platform of Yinzhou. The incidence of HFMD was calculated using the infectious disease reporting data from the public health management data. Autoregressive integrated moving average model and cross-correlation function were used to evaluate the correlation between the incidence of HA and HFMD.Results:From 2017 to 2022, a total of 25 385 cases of HA were detected in children aged ≤6 years in Yinzhou, the male-to-female ratio of the cases was 1.12∶1. The average annual incidence of HA was 4 986.67/100 000, with the highest incidence in 2018 (10 477.09/100 000) and the lowest incidence in 2020 (870.88/100 000). The incidence peak of HA was during June to July. The incidence of HA was higher in age group 1 year (7 950.45/100 000) than in other age groups. The incidences of HA in Yunlong, Jiangshan and Xiaying were higher, with the incidence of 8 764.31/100 000, 8 377.58/100 000 and 7 965.31/100 000, respectively. The correlation coefficients between the incidence of HA and HFMD at lag day 0, 7, 12 and 18 were 0.199, 0.139, 0.090 and 0.086, respectively (all P<0.05). Conclusions:From 2017 to 2022, the incidence of HA was high in children aged ≤6 years in Yinzhou with obvious seasonality and area difference. The incidence of HA was correlated with the incidence of HFMD and the incidence of HFMD had certain lags. The comprehensive prevention and control of HA and HFMD should be further strengthened by prioritizing HA surveillance and implementing integrated surveillance and management of HA and HFMD.

Objective To study the mechanical response of tibial prostheses and the distal tibial cancellous bone after implantation of radial and axial functionally graded materials(FGM)into the ankle joint.Methods Three FGM were used:titanium alloy-bioactive glass composite FGM(FGM-Ⅰ),titanium(Ti)alloy-ideal bone elastic composite FGM(FGM-Ⅱ),and Ti alloy-hydroxylapatite composite FGM(FGM-Ⅲ).A three-dimensional finite element model of total ankle arthroplasty(TAA)was established,and the simulation software ABAQUS was used for secondary development based on Fortra.By changing the volume fraction,the mechanical properties of the FGM tibial prosthesis can be adjusted both axially and radially.The stress distributions of the tibial prosthesis and cancellous bone after FGM axial and radial tibial component implantation in the standing position were analyzed.Results Compared with Ti alloy tibial prosthesis,three kinds of FGM could effectively reduce the stress concentration on the tibial prosthesis,and the overall effect of FGM-Ⅲ tibial prosthesis was better than that of FGM-Ⅰ and FGM-Ⅱ tibial prosthesis;the radial distribution of FGM could effectively reduce the maximum von Mises stress of the prosthesis.For the tibial cancellous bone,the three types of FGM radial tibial prostheses and FGM-Ⅲ axial tibial prostheses could effectively increase the distal stress,thus,relieving the stress shielding on the cancellous bone;the FGM-Ⅲ radial tibial prosthesis was the most effective in improving the stress level of the cancellous bone.Conclusions FGM-Ⅲ radial ankle prosthesis can effectively reduce the stress concentration phenomenon and the stress shielding effect on the prosthesis to prolong its life,with potential application prospects.

Objective To analyze the maternal health security policy in China from the perspective of policy tools,improve the policy system and improve the level of maternal fertility security.Methods Content analysis was used to encode and quantify 44 policy texts related to maternal health security at the national level.Results China's maternal health security policy focused on public health and medical fields.In the field of public health,environmental policy tools were the main tools,among which the demand-oriented policy tools of propaganda and guidance are the short board.The most commonly used policy tools in the medical field are supply-based and environmental-based policy tools;the medical insurance field was dominated by supply-oriented policy tools,but the overall number relatively small.Conclusion In the field of maternal health,we should focus on increasing the supply of medical insurance policies,strengthen the regulatory role of medical insurance in the fields of public health and medical care,and achieve joint development.

Objective:To analyze the clinical features, treatment, pathology and prognosis of retroperitoneal paraganglioma(PGL).Methods:Surgery adopted, pathology and follow-up data of patients with retroperitoneal PGL at the First Affiliated Hospital of Zhengzhou University from Jan 2015 to Jan 2022 were retrospectively analyzed.Results:Compared with non-functional PGL patients, those with functional PGL had higher systolic and diastolic blood pressure (180 mmHg vs. 140 mmHg, Z=-4.807, P<0.001;100 mmHg vs. 82 mmHg, Z=-4.495, P<0.001)at admission, and were more prone to hemodynamic instability during operation ( χ2=8.188, P=0.004). All 65 patients under wentresection,with partial excision and repair of inferior vena cava in 1 patient . Sixty-two patients out of 65 were followed up, and 4 patients died of disease progression. The overall 5-year survival rate was 92%. The prognosis of patients with G3 tumor and distant metastasis was poor , the difference was statistically significant ( χ2=4.259, P=0.039; χ2=13.061, P<0.001). Tumor diameter and tumor functional status were not related to the prognosis, and the difference was not statistically significant ( χ2=0.519, P=0.472; χ2=0.010 P=0.920). Conclusions:Retroperitoneal PGL is less common, and some may encroach abdominal large vessels. The prognosis is good after complete resection of the tumor. Distant metastasis and G3 tumors are associated with poor prognosis .

Heat stroke is the most serious type of heat-related diseases, and the induced multiple organ dysfunction syndrome (MODS) is an important cause of death for heat stroke patients. The cardiovascular system is one of the important targets of heat injury. Studies have reported that heat stress can lead to myocardial inhibition, abnormal heart conduction and blood flow redistribution, thus changing the hemodynamic state, leading to obvious abnormalities in electrocardiogram, echocardiography, myocardial injury biological markers and hemodynamic indicators of patients with heat stroke. In this article, the pathophysiological and histological changes and clinical manifestations of heatstroke-induced myocardial injury are reviewed, aiming to provide references for further understanding and research of myocardial damage caused by hyperthermia.

Heat stroke is the most serious type of heat-related diseases, and the induced multiple organ dysfunction syndrome (MODS) is an important cause of death for heat stroke patients. The cardiovascular system is one of the important targets of heat injury. Studies have reported that heat stress can lead to myocardial inhibition, abnormal heart conduction and blood flow redistribution, thus changing the hemodynamic state, leading to obvious abnormalities in electrocardiogram, echocardiography, myocardial injury biological markers and hemodynamic indicators of patients with heat stroke. In this article, the pathophysiological and histological changes and clinical manifestations of heatstroke-induced myocardial injury are reviewed, aiming to provide references for further understanding and research of myocardial damage caused by hyperthermia.
Biomarkers ; Heart Injuries ; Heart Rate ; Heat Stroke ; Humans ; Multiple Organ Failure

OBJECTIVE: To investigate the effect of estrogen on expression of the cysteine-rich secretory protein containing LCCL domain 2 (CRISPLD2) in myocardium of lipopolysaccharide (LPS)-induced mice model of sepsis. METHODS: Totally 12 female and 12 male Balb/c mice of specific pathogen-free (SPF) level with 7 weeks were served as objectives. The female and male mice were randomly divided into model groups and control groups, respectively, with 6 mice in each group. The model of sepsis was reproduced by intraperitoneal injection of 10% LPS (5 mg/kg), and the mice in control groups were injected with the same volume of normal saline. The general condition of mice during experiment was observed at 24 hours after injection. All the mice were sacrificed and the heart was harvested after collecting the whole blood. The concentration of estrogen in serum was determined by double antibody sandwich enzyme linked immunosorbent assay (ELISA). The myocardial tissue homogenate was prepared at the same time, and the total protein was extracted. The expression level of CRISPLD2 was determined by Western Blot. Pearson correlation analysis was used to analyze the bivariate correlation. RESULTS: All of the experimental mice survived at 24 hours after injection. The mice in the model groups showed disorder and gray signs of body hair, with diarrhea and decreased appetite. No significant abnormality was observed in the control groups. There was no significant difference in the body weight or concentration of estrogen in serum between model and control group of both female and male mice [body weight (g): 24.6±1.8 vs. 24.5±1.3 in male mice, 18.0±0.8 vs. 17.5±1.1 in female mice; estrogen (ng/L): 11.93±2.59 vs. 12.17±3.87 in male mice, 28.20±5.75 vs. 29.82±6.10 in female mice, all P > 0.05]. There was no statistical difference in the expression of CRISPLD2 in myocardium between male control mice and female control mice (gray value: 1.02±0.19 vs. 1.00±0.11, P > 0.05). No significant difference in the expression of CRISPLD2 in myocardium was found between female sepsis mice and female control mice (gray value: 1.05±0.13 vs. 1.00±0.11, P > 0.05). The expression of CRISPLD2 in myocardium of male sepsis mice was significantly lower than that of male control mice (gray value: 0.29±0.08 vs. 1.02±0.19, P < 0.01), and it was significantly lower than that of female sepsis mice (P < 0.01). It was shown by correlation analysis that the expression level of CRISPLD2 in myocardium of sepsis mice was significantly correlated with serum estrogen concentration [R² = 0.736, 95% confidence interval (95%CI) = 0.560-0.960, P < 0.001]. CONCLUSIONS In female mice with sepsis, the expression of CRISPLD2 is comparable to that of female healthy mice. It is suggested that estrogen can maintain the expression of CRISPLD2 in LPS-induced septic mice at the normal level.
Animals ; Cysteine ; Estrogens ; Female ; Lipopolysaccharides ; Male ; Mice ; Myocardium ; Sepsis

Sepsis is a common disease in intensive care units (ICU), and the resulted multi-organ dysfunction syndrome (MODS) is the main cause of death in patients with severe sepsis. The cardiovascular system is one of the most important target organ for sepsis. The severity of cardiac dysfunction is closely related to the clinical prognosis of patients with sepsis. Studies have reported that various cytokines are expressed during sepsis. They have influence on myocardial contractile function, mitochondrial function and self-regulation. Where after, it will induce cardiomyocyte apoptosis, which can lead to myocardial dysfunction. In this article, the pathogenesis of sepsis-induced myocardial dysfunction (SIMD) were reviewed to further clarify the pathogenesis of SIMD, and provide theoretical basis for subsequent research.

Objective To observe the clinical effect of single urokinase and urokinase pump combined with low-molecular-weight Heparin in the treatment of autogenous arteriovenous fistula thrombolysis,and the influence on inflammatory factors [interleukin (IL)-1,IL-6,tumor necrosis factor-α (TNF-α)] and CD62p.Methods 20 hemodialysis patients hospitalized in our hospital for the treatment of thrombosis in fistula were selected.They were randomly divided into group A (n =10) and group B (n =10).The group A was treated by urokinase infusion,and the group B was treated with urokinase pump combined with low-molecular heparin respectively.Results Compared with that before thrombolysis,the blood flow rate was increased significantly while the IL-1,TNF-oα and CD62p decreased significantly in the two groups after thrombolytic treatment,with statistically significant difference (P ＜ 0.05).Compared with the group A,the IL-1,IL-6 and CD62p in group B were decreased after thrombolytic therapy,with statistically significant difference (P ＜ 0.05).Conclusions Urokinase combined with low-molecular-weight heparin is better than single urokinase in the treatment of arteriovenous fistula thrombolysis,providing a theoretical basis for clinical fistula thrombolysis treatment.