Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.

Objective:To understand the illness experience of patients with autologous liver transplantation and to lay the foundation for the formulation of targeted nursing measures.Methods:The objective sampling method was used to select the patients with autologous liver transplantation who were hospitalized in the hepatochydatid area of the First Affiliated Hospital of Xinjiang Medical University from September 2022 to March 2023 as the research objects. Based on the social ecosystem theory, the interview outline was formulated and semi-structured interview was conducted. After interviewing 15 people, the data was saturated. Colaizzi ′s 7-step phenomenological data analysis method was used to sort out and analyze the data. Results:There were three themes in body and mind experience of autologous liver transplantation patients: microsystem including changes in body function and mental state, meso-system including social adjustment and social dysfunction, macro system including limited access to care and lack of information support.Conclusions:The quality of life for patients improves after autologous liver transplantation compared to before surgery, but there are still issues within the social ecosystem. Medical staff should develop targeted nursing measures based on each patient ′s illness experience, improve their physical and mental functions and maintain stability in their social ecosystem.

Objective:To investigate the correlation between platelet distribution width(PDW)and cerebral microbleeds(CMB)in the middle-aged and elderly population.Methods:A total of 2 839 subjects who underwent cranial magnetic resonance imaging(MRI)examination at Lishui Hospital of Zhejiang University from May 2016 to December were enrolled in this cross-sectional study.According to MRI results, subjects were divided into the CMB group(n=525)and the non-CMB group(n=2 314). Clinical data and PDW levels were compared between the two groups.CMB-related factors were analyzed by using a logistic regression equation.A receiver operating characteristics(ROC)curve was drawn to analyze the value of PDW levels in predicting the incidence of CMB.Results:The percentage of males, the proportion of smokers, the number of subjects with diabetes and serum creatinine levels were higher in the CMB group than in the non-CMB group[(55.05%(289/525) vs.45.12%(1 044/2 314), 42.67%(224/525) vs.34.67%(802/2 314), 12.76%(67/525) vs.9.51%(220/2 314), (68.91±21.38)μmol/L vs.(66.45±15.40)μmol/L, all P<0.05]. PDW levels were higher in the CMB group than in the non-CMB group(15.52±2.49)% vs.(14.67±2.90)%, χ2=93.75, P<0.05). Multivariate logistic regression analysis showed that the PDW level was an independent risk factor for CMB in the middle-aged and elderly population( OR=1.13, P<0.05). The area under the ROC curve(AUC)of PDW in predicting the incidence of CMB was 0.582, and with 15.95% as the optimal threshold value, the sensitivity and specificity were 75.0% and 41.8%.Patients were divided into the high PDW sub-group(n=1 691)and the low PDW sub-group(n=1 083)based on the PDW cutoff at 15.95%.The number of CMB and the incidence of CMB were higher in the high PDW group than in the low PDW group(0.75 vs.0.48, 23.3% or 394/1 691 vs.12.1% or 131/1 083, χ2=30.37 and 51.28, P<0.05). Conclusions:PDW levels are high in middle-aged and elderly patients with CMB, and elevated PDW levels are an independent risk factor for CMB.

Objective: This article summarizes and analyzes the rule of main acupoints selection in the treatment of epilepsy. Methods: The acupuncture domestic literatures about the treatment for epilepsy from CNKI, Wanfang, Vip and SinoMed Chinese databases from 1981 to 2017. To set up a database of selection points of epilepsy, we collected data of acupoints for epilepsy treatment and then did descriptive analysis and cluster analysis to the data with Excel 2007, SPSS 20.0. Results: A total of 80 acupoint prescriptions were recorded. The points of DU Meridian, BL Meridian, EX, ST Meridian and RN Meridian, were used more frequently than others.Acupoints with higher frequency of use were Dazhui, Baihui, Yaoqi, Fenglong, Xinshu. Cluster analysis divided the high frequency acupoints into 4 groups. The specific points used more were Fenglong, Xinshu and Jiuwei. Conclusions To grasp the law of acupuncture and moximoxition in the treatment of epilepsy can help to improve the clinical effect. The results can be used as reference for clinical application.

BACKGROUND:Recovery of motor and sensory function from peripheral nerve injury is relatively slow and incomplete. It is a difficult problem for orthopedic surgeons that mainly leads to the decline in the quality of life in patients.
OBJECTIVE: To conclude the methods and corresponding outcomes in peripheral nerve regeneration by analyzing the new treatment means for peripheral nerve injury.
METHODS:PubMed, Wanfang, CNKI databases were retrieved for relevant articles using key words of “nerve injury, regeneration”, and then retrieval data were sorted and analyzed.
RESULTS AND CONCLUSION:In recent years, in-depth studies on peripheral nerve repair have been made in the folowing aspects: surgical mode, drug, cytokine, gene transfer and biomaterials as wel as traditional Chinese medicine. If the detect size is four times longer than the diameter of nerves, the nerve regeneration chamber can achieve good outcomes. The methods of restoring nerve continuity folowing nerve injury are developed from surgical anastomosis to photochemohistological method, thermal laser welding, plastic repair and other emerging technologies. Studies have found that plasminogen activator, nerve growth factor, neurotrophic factor, recombinant erythropoietin, human tissue kalikrein, B vitamins and their derivatives, herbal preparations, immunosuppressive agents al can promote nerve regeneration.

BACKGROUND:Studies have shown that craniocerebral injury can promote the repair of sciatic nerve injury in rats, but its precise mechanism remains unclear.
OBJECTIVE:To further explore the action mechanism of craniocerebral injury on the repair of sciatic nerve injury using morphology and histology.
METHODS:Sixty specific-pathogen-free healthy male Sprague-Dawley rats were randomly divided into two groups. Rats with craniocerebral injury and sciatic nerve injury were considered as the experimental group. Rats with simple sciatic nerve injury were considered as the control group. Classical Feeney method was used in models of craniocerebral injury and SunderlandV sciatic nerve injury. At 8 and 12 weeks after modeling, sciatic nerve index was detected. Masson staining and NF200 immunofluorescence staining were used to observethe nerve regeneration atthe anstomotic site. Transmission electron microscope was used to observe the number of regenerative axons.
RESULTS AND CONCLUSION:At 8 and 12 weeks after modeling, compared with the control group, gait and sciatic nerve index recovered better in the experimental group. In the experimental group, Masson staining showed fewer nerve membrane colagen fibers, and the axon arranged neatly.NF200 immunohistochemistry showed that in the experimental group, the density of regenerated nerves was high, and nerveswere regularly distributed. Transmission electron microscopy showed that in the experimental group, regenerative axons were regularly arranged, colagen scar was less, and myelin layer arranged regularly. Results suggested that the craniocerebral injury in rats may promote the repair of peripheral nerve injury by reducing scar colagen in nerve endings.

Objective To explore the related risk factors of cerebrovascular disease induced cerebral microbleeds and its nursing strategies. Methods A total of 393 patients with acute cerebrovascular disease who were admitted to our hospital from January 2012 to January 2014 were selected. 146 patients who were hospitalized due to non-central ner-vous system disease at the period of time were selected as control group. Baseline data of patients were recorded, and regular MRI T2-weighted imaging were given to all patients. Incidence rate of cerebral microbleeds for patients with different types of cerebrovascular diseases was analyzed. Results Among 393 patients with acute cerebrovascular dis-ease, 206 patients were cerebral microbleeds. Incidence rate was different for different diseases. Incidence rate of hy-pertension was 47.20%, cerebral infarction was 45.98%, diabetes was 44.00%, atrial fibrillation was 50.00%, cerebral hemorrhage was 84.00%, TIA was 25.00%, and leukoencephalopathy was 63.24%. The incidence rate in the control group was 13.70%, except for TIA, the differences between the control group and other groups were statistically signifi-cant (P<0.05). Cerebral microbleeds were taken as dependent variables, and other risk factors were taken as independent variables. Leukoencephalopathy, hypertension, high cholesterol, asymptomatic lacuna cerebral infarction, cerebral bleeding and cerebral infarction were risk factors for cerebral microbleeds, in which low density lipoprotein was a pro-tective factor. 206 patients with cerebral microbleeds were given nursing care. 20 patients recovered and discharged, 129 patients got better, 40 patients were not recovered, 7 patients were transferred to other hospitals, and 10 patients died. The hospitalization time was 1 to 33 days, with an average of (15.3±2.3) days. Conclusion Incidence rate of cere-bral microbleeds for patients with cerebral infarction, cerebral bleeding and leukoencephalopathy is relatively high, and low density lipoprotein is the protective factors for cerebral microbleeds. Hypertension, asymptomatic lacuna cerebral infarction, cerebral bleeding, cerebral infarction, high cholesterol and leukoencephalopathy are risk factors for cerebral microbleeds. Scientific and proper nursing care for patients with cerebral microbleeds is able to significantly improve patients' recovery rate, which is worthy of further clinical promotion and application.

Objective:To analyze the characteristics of health financing at the provincial level according to the total health expenditure since China health system reform began in 2009 and provide evidence for improving health fi-nancing policy. Methods:20 provinces were chosen and vertical and horizontal Comparative approach was used to an-alyze the data. Results:Total health expenditure increased for all regions, of which the biggest rate was Anhui prov-ince, about 82. 97%, while the largest increasing for government health care expenditure was Ningxia province, a-bout 108 . 71%. In 2012 , the provinces with social health expenditure share of total above 40% were allocated in the east region, and the number of provinces with out-of pocket payment share of total above 40% reduces to 5. Conclu-sion:Total health expenditure grew in all regions, but there were differences in the degree that this spending matched the economic level;The financing structure was optimized, but the characteristic of regional financing was different. Some provinces were under huge pressure to reduce out-of pocket payments. Suggestions: Under the premise of im-proving the funding level, financing structure adjustment must be focused, and public funding should play a bigger role and out-of pocket payments should be reduced.

Objective To investigate CT findings of concealed rupture of intestine following abdominal trauma.Methods CT findings of 11 cases with concealed rupture of intestine following abdominal trauma proved by surgery were identified retrospectively.Results The main special signs included:(1)Free air in 4 cases,mainly around injured small bowel or under the diaphragnl,or in the retroperhoneal space or and in the lump.(2)High density hematoma between the intestines or in the bowel wall(4 cases).(3)Bowel wall injury sign,demonstrated as low density of the injured intestinal wall,anenuated locally but relatively enhanced in neiighbor wall on enhanced CT.(4)Lump around the injured bowel wall with obvious ring.shaped enhancement(4 cases).Other signs included:(1)Free fluid in the abdominal cavity or between the intestines with blurred borders.(2)Bowel obstruction.Conclusion CT is valuable in diagnosing concealed rupture of intestine following abdominal trauma.