Objective:To investigate the main causes of failed endoscopic retrograde cholangiopancreatography (ERCP) in children and the remedial treatment strategies.Methods:This retrospective cohort study analyzed the clinical data of 21 children who experienced failed ERCP at Beijing Children′s Hospital, Capital Medical University between January 2021 and December 2024. Data was collected included demographic information, clinical diagnoses, and ERCP outcomes. The annually trend in the ERCP failure rate was analyzed. Patients were categorized by etiology into the following groups: chronic pancreatitis, post-surgical status, pancreatic trauma, pancreas divisum, non-neoplastic pancreatic lesions, and ulcerative colitis. The relationship between etiologies and ERCP failure was analyzed by Fisher exact test.Results:A total of 175 ERCP procedures were included, of which 21 procedures failed (12.0%). The failure rate decreased annually from 2021 to 2024: 18.2% (4/22), 13.2% (5/38), 11.4% (5/44), and 9.9% (7/71), respectively. The etiological distribution among the 21 failed cases was as follows: chronic pancreatitis 28.6% (6/21), pancreatic duct stenosis following pancreatic trauma 23.8% (5/21), post-surgical status 14.3% (3/21), pancreas divisum 9.5% (2/21), acute pancreatitis 9.5% (2/21), non-neoplastic pancreatic lesions 9.5% (2/21), and pancreatic duct stenosis associated with ulcerative colitis 4.8% (1/21). Remedial treatments included surgical intervention (2 cases), ultrasound-guided percutaneous drainage (3 cases), and repeat ERCP (2 cases). For post-surgical and pancreatic trauma patients, failure was primarily due to bile duct stenosis, pancreatic duct stenosis, or pancreaticobiliary duct disruption. Active surgical interventions such as cholangiojejunostomy and pancreaticojejunostomy, and ultrasound-guided drainage following ERCP failure led to significant clinical improvement.Conclusions:A stratified management approach guided by etiology is essential following failed ERCP in children. Early and active remedial treatment, particularly surgical interventions, is recommended for post-surgical and pancreatic trauma cases.

ObjectiveTo investigate the present situation of input, output, outcome and impact of all registered community-based rehabilitation stations in Inner Mongolia in China, and analyze how the input predict the output, outcome and impact. MethodsFrom March 1st to April 30th, 2025, a questionnaire survey was conducted on all registered community-based rehabilitation stations in Inner Mongolia, covering four dimensions: input, output, outcome and impact. A total of 1 365 questionnaires were distributed. The input included four items: laws and policies, human resources, equipment and facilities, and rehabilitation information management. The output included two items: technical paths and benefits/effectiveness. The outcome included three items: coverage rates, rehabilitation interventions and functional results. The impact included two items: health and sustainability. Each item contained several questions, all of which were described in a positive way. Each question was scored from one to five. A lower score indicated that the situation of the community-based rehabilitation station was more in line with the content described in the question. Regression analysis was performed using the total score of each item of input dimension as independent variables, and the total scores of the output, outcome and impact dimensions as dependent variables. ResultsA total of 1 262 valid questionnaires were collected. The mean values of input, output, outcome and impact of community-based rehabilitation stations were 1.827 to 1.904, with coefficient of variation of 45.892% to 49.239%. The regression analysis showed that, rehabilitation information management, human resources, and laws and policies significantly predicted the output dimension (R² = 0.910, P < 0.001). Meanwhile, all four items in the input dimension predicted both the outcome (R² = 0.850, P < 0.001) and impact dimensions (R² = 0.833, P < 0.001). ConclusionInput, output, outcome and impact of the community-based rehabilitation stations in Inner Mongolia were generally in line with the content of the questions, although some imbalances were observed. Additionally, the input of community-based rehabilitation stations could significantly predict their output, outcome and impact.

Objective To preliminarily investigate the safety and efficacy of donor pancreas needle biopsy in simultaneous pancreas-kidney transplantation. Methods Clinical data of 7 cases undergoing donor pancreas biopsy were collected retrospectively. All cases underwent donor pancreas biopsy before or during simultaneous pancreas-kidney transplantation. Frozen section or paraffin sectioning techniques were used for tissue preparation, and hematoxylin-eosin and Masson staining were performed to histologically evaluate the donor pancreas. The quality of donor pancreas was comprehensively assessed by combining histological findings with the donor's clinical data. Postoperative follow-up data of 5 simultaneous pancreas-kidney transplant recipients were collected to summarize the safety of donor pancreas biopsy and the prognosis of transplant recipients. Results The 7 pancreas donors were aged 28 to 62 years, with a body mass index ranging from 20.76 to 27.68 kg/m². Liver ultrasound indicated fatty liver in 3 cases, while pancreatic ultrasound did not reveal any significant abnormalities. Among them, biopsy was performed on 2 donors after completion of pancreatic procurement and processing, and the frozen section histology showed moderate acute pancreatitis changes (edema of acinar cells, necrosis and inflammatory cell infiltration). Combined with a serum amylase level elevated more than 3 times the upper limit of normal value, these two donor pancreases were finally discarded. The remaining 5 cases underwent biopsy immediately after pancreatic vascular anastomosis during simultaneous pancreas-kidney transplantation, and histological evaluation was performed on paraffin-embedded sections. No biopsy-related complications (such as bleeding, pancreatic fistula, etc.) occurred after transplantation. One recipient died of severe infection 2 months after transplantation, while the other 4 recipients were followed up for more than 5 years, with well-functioning transplant kidneys and pancreases. Conclusions Donor pancreas biopsy is relatively safe, and the risk of biopsy-related complications after transplantation is controllable. Comprehensive assessment of donor pancreas quality by combining histological evaluation with the donor's clinical indicators is conducive to improving the accuracy of donor pancreas selection and organ utilization.

This article provides a systematic interpretation and review of the Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design. Developed based on the Grading of Recommendations Assessment, Development and Evaluation methodology, the guideline address five core themes: ICU layout, room design, infection control, infrastructure, and staff spaces, and put forward 17 evidence-based recommendations, including 5 good practice statements. This article briefly introduces the guideline development methods and evidence characteristics, and focuses on summarizing key recommendations, including high-visibility layouts, single-bed ward settings, natural lighting and noise reduction strategies, integrated infection prevention and control design, remote monitoring, and flexible capacity expansion capabilities. Furthermore, it delves into the applicability and localized implementation pathways within China's healthcare environment, analyzing limitations in terms of evidence quality, specialty applicability, and cost-effectiveness. Furthermore, by integrating the Chinese Guidelines for the Construction and Development of Critical Care Medicine (2025 Edition) and current domestic practices, the article proposes tiered and phased implementation recommendations. This article aims to provide domestic healthcare institutions with a scientific reference that balances international cutting-edge concepts with China's real-world conditions for the construction and renovation of ICUs, thereby promoting the development of intensive care environments centered on patient safety, healthcare worker well-being, and infection control.

AIM:To automatically identify and quantitatively assess myopia-related fundus structural changes by combining non-mydriatic color fundus photography with an artificial intelligence(AI)-powered quantitative fundus analysis system and to further analyze the correlations between these fundus parameters and spherical equivalent(SE), axial length(AL), and age, providing the objective basis for monitoring myopia progression and supporting the formulation of personalized myopia prevention and control strategies. METHODS:A cross-sectional study was conducted enrolling myopic patients aged 18-50 y who underwent myopia screening from March 2023 to December 2023. Patients were stratified into three groups based on SE: the -3.00 D

Objective:To investigate the main causes of failed endoscopic retrograde cholangiopancreatography (ERCP) in children and the remedial treatment strategies.Methods:This retrospective cohort study analyzed the clinical data of 21 children who experienced failed ERCP at Beijing Children′s Hospital, Capital Medical University between January 2021 and December 2024. Data was collected included demographic information, clinical diagnoses, and ERCP outcomes. The annually trend in the ERCP failure rate was analyzed. Patients were categorized by etiology into the following groups: chronic pancreatitis, post-surgical status, pancreatic trauma, pancreas divisum, non-neoplastic pancreatic lesions, and ulcerative colitis. The relationship between etiologies and ERCP failure was analyzed by Fisher exact test.Results:A total of 175 ERCP procedures were included, of which 21 procedures failed (12.0%). The failure rate decreased annually from 2021 to 2024: 18.2% (4/22), 13.2% (5/38), 11.4% (5/44), and 9.9% (7/71), respectively. The etiological distribution among the 21 failed cases was as follows: chronic pancreatitis 28.6% (6/21), pancreatic duct stenosis following pancreatic trauma 23.8% (5/21), post-surgical status 14.3% (3/21), pancreas divisum 9.5% (2/21), acute pancreatitis 9.5% (2/21), non-neoplastic pancreatic lesions 9.5% (2/21), and pancreatic duct stenosis associated with ulcerative colitis 4.8% (1/21). Remedial treatments included surgical intervention (2 cases), ultrasound-guided percutaneous drainage (3 cases), and repeat ERCP (2 cases). For post-surgical and pancreatic trauma patients, failure was primarily due to bile duct stenosis, pancreatic duct stenosis, or pancreaticobiliary duct disruption. Active surgical interventions such as cholangiojejunostomy and pancreaticojejunostomy, and ultrasound-guided drainage following ERCP failure led to significant clinical improvement.Conclusions:A stratified management approach guided by etiology is essential following failed ERCP in children. Early and active remedial treatment, particularly surgical interventions, is recommended for post-surgical and pancreatic trauma cases.

Objective To systematically evaluate the psychological characteristics of adolescent inflammatory bowel disease(IBD)patients during the transition period and provide evidence-based guidance for healthcare professionals in developing transition management strategies.Methods A systematic search was conducted across The Cochrane Library,PubMed,Web of Science,CINAHL,Embase,SinoMed,CNKI,Wanfang,and VIP databases for qualitative studies on adolescent IBD patients during transition,from database inception to May 2024.Eligible studies were critically appraised,and themes were synthesized using the meta-aggregation approach of meta-synthesis.Results Twelve studies were included,yielding 13 findings that were synthesized into five categories:self-development challenges,healthcare system transition barriers,family support conflicts,social adaptation difficulties,and lack of societal support systems.Conclusion Adolescents with IBD experience complex psychological challenges during transition,characterized by excessive psychological burdens,inadequate healthcare support,and insufficient societal recognition.Targeted interventions are needed to improve psychological outcomes during this critical phase.

Objective:Systematically review the release status and characteristics of policies related to cross-regional medical insurance settlement policies in China,providing reference for promoting the convenience of medical insurance settlement services and improving management efficiency.Methods:Using content analysis,a two-dimensional framework of"policy objectives-policy tools"was constructed.A total of 127 policy documents were coded and analyzed.Results:Demand-based tools were applied most frequently(43.6%),followed by environmental and supply-based tools.Policy objectives mainly focused on improving service convenience,supported by expanding coverage and ensuring regulatory security.Conclusions:China's cross-regional medical insurance settlement policies have improved service accessibility and strengthened institutional supervision while gradually expanding coverage.However,deficiencies remain in assessment refinement and emergency mechanisms.Greater interdepartmental coordination is needed to enhance regulatory linkage and ensure the safe operation of medical insurance funds.

Objective:To observe the clinical value of neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),C-reactive protein(CRP)to albumin(ALB)ratio(CAR)dynamic monitoring in the acute phase of Kawasaki disease(KD).Methods:This study was a single-center prospective study,146 in the acute phase of KD patients who were admitted to The Third Affiliated Hospital of Guangdong Medical University from June 2022 to September 2024 were selected as the study subjects(KD group).Hospitalized patients with fever ≥ 3 days received during the same period(fever control group,n=146)and healthy children underwent physical examination(healthy control group,n=146)were seleted.According to the differences in response to intravenous immunoglobulin treatment,KD patients were divided into two subgroups:immunoglobulin insensitive group(n=21)and immunoglobulin sensitive group(n=125).According to the presence or absence of coronary artery injury(CAL),KD patients were divided into two subgroups:non CAL group(n=97)and CAL group(n=49).According to alanine aminotransferase(ALT)expression level,KD patients were divided into two subgroups:non liver injury group(ALT value＜80 U/L,n=110)and liver injury group(ALT value ≥ 80 U/L,n=36).NLR,PLR,and CAR of KD group,fever control group,and healthy control group were compared.NLR,PLR,and CAR were compared at admission,before and 3 d after immunoglobulin infusion between the immunoglobulin sensitive group and immunoglobulin insensitive group,liver injury group and non liver injury group,CAL group and non CAL group.Receiver operating characteristic(ROC)curve was used to evaluate diagnostic efficacy.Result:NLR,PLR,and CAR of the KD group and fever control group were higher than those of the healthy control group,and the KD group were higher than those of the fever control group(P＜0.05).NLR,PLR,and CAR of the immunoglobulin insensitive group were higher than those of the immunoglobulin sensitive group at admission,before and 3 d after immunoglobulin infusion(P＜0.05).NLR,PLR,and CAR of the liver injury group were higher than those of non liver injury group at admission,before and 3 d after immunoglobulin infusion(P＜0.05).NLR,PLR,and CAR of the CAL group were higher than those of the non CAL group at admission,before and 3 days after immunoglobulin infusion(P＜0.05).When NLR,PLR,and CAR were used alone or in combination at admission,the area under curve(AUC)(95％CI)of ROC values were 0.798(0.715～0.869),0.802(0.717～0.871),0.833(0.752～0.896),and 0.935(0.873～0.973),respectively,among them,the combination had the highest diagnostic efficacy.Conclusion:NLR,PLR,and CAR are all abnormally elevated in KD patients,and which are associated with patient immunoglobulin sensitivity,liver injury and CAL.The combination detection of the above three indicators has better diagnostic efficacy for KD.

Objective To analyze the expression of ILT4 and CD147 in lung adenocarcinoma and their relationships with tumor immunoinfiltration and prognosis of patients.Methods The specimens of cancer tissues and adjacent tissues of 134 patients with lung adenocarcinoma who underwent surgical treatment at our hospital from January to December 2024 were collected,and a retrospective analysis was conducted on the clinical data of the patients.The protein and mRNA expression of ILT4 and CD147 in different tissues were detected by immunohistochemistry and qRT-PCR,respectively.The correlations of the expression of ILT4 and CD147 with the clinicopatho-logical characteristics of lung adenocarcinoma were analyzed.The expression of ILT4 and CD147 in pan-cancer tissues were retrieved based on the GEPIA2 database,and their relationships with the prognosis of lung adenocarcinoma were analyzed.The correlations of the expression of ILT4 and CD147 with the infiltration of 6 kinds of immune cells in lung adenocarcinoma samples were analyzed based on TIMER database.Results The protein positive rates and mRNA expression levels of ILT4 and CD147 in lung adenocarcinoma tissues were significantly higher than those in adjacent tissues(P<0.05).The analysis of GEPIA database showed that ILT4 and CD147 upregulated in various tumors,and the expression levels of ILT4 and CD147 in lung adenocarcinoma tissues were both higher than those in unpaired adjacent tissues.The expression of ILT4 protein was closely related to the TNM stage and lymph node metastasis of lung adenocarcinoma(P<0.05);the expression of CD147 protein was correlated with TNM stage,lymph node metastasis and degree of differentiation(P<0.05).The analysis of GEPIA database showed that the patients with high expression of ILT4 and CD147 had lower overall survival rates than those with low expression(Log-rank P=0.000 58,0.002 6).The analysis of the TIMER database showed that the expression of ILT4 was negatively correlated with the infiltration of macrophages,neutrophils and dendritic cells(P<0.05);the expression of CD147 was negatively correlated with the infiltration of B cells,CD4+T cells and dendritic cells(P<0.05).Conclusion ILT4 and CD147 are highly expressed in lung adenocarcinoma tissues,which are related to clinicopathological features,prognosis and immunoinfiltration of patients.They may be the potential markers for prognosis evaluation and immunotherapeutic targets of patients with lung adenocarcinoma.