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.

Based on the teaching advantages of "Internet +", we integrated the ATDE(asking, thinking, doing, evaluation) teaching model to explore the online teaching mode of neurology during the COVID-19 epidemic, and chose the ischemic cerebrovascular disease as a representative case of specific neurological diseases. The practical ATDE teaching in the teaching of neurology was elaborated by introducing, inspiring doubt, setting suspense, and raising questions, and leading students gradually to think deeply. Finally, the innovation and thinking of the online teaching of neurology brought by "Internet +ATDE" teaching model are discussed.

OBJECTIVE: To establish the in vivo traceable acute myeloid leukemia mice model with Luciferase-Expressing KG1a Cells. METHODS: KG1a cells with stable luciferase gene expression (called as KG1a-Luc cells) were constructed by lentivirus transfection, then sifted out by puromycin. Eighteen male NOD-SCID-IL2rg RESULTS: KG1a cells expressing luciferase stably were successfully obtained. The tumor luminescence wildly spread at day 17 captured by in vivo imaging. The KG1a-Luc tumor cells could be detected in the peripheral blood of the mice, with the average percentage of (16.27±6.66)%. The morphology and pathology result showed that KG1a-Luc cells infiltrate was detected in bone marrow, spleens and livers. The survival time of the KG1a-Luc mice was notably shorter as compared with those in the control group, the median survival time was 30.5 days (95%CI: 0.008-0.260). CONCLUSION The acute myeloid leukemia NOD-SCID-IL2rg
Animals ; Disease Models, Animal ; Interleukin Receptor Common gamma Subunit ; Leukemia, Myeloid, Acute ; Luciferases/genetics* ; Male ; Mice ; Mice, Inbred NOD ; Mice, SCID

OBJECTIVE: To investigate the association between homocysteine and renal function as well as possible influencing factors in inpatient population. METHODS: From January 2014 to December 2015, a total of 27,025 hospitalized people who were admitted to the First Hospital of Peking University and were tested for plasma homocysteine were enrolled. Multiple linear regression model was performed to determine the relationship between homocysteine and eGFR. RESULTS: After excluding patients with cardiovascular disease and patients taking antihypertensive drugs, 6681 inpatient participants were included for analysis. After adjusting for age, blood pressure and other related factors, we found that eGFR decreased significantly(β=-0.53, SE=0.02, P<0.001) with the increase of homocysteine. Furthermore, the gender, age and renal functional state, had significant influence the relationship between homocysteine and eGFR. In women, those younger than 60 years old and renal impairment(eGFR<90 mL/[min·1.73 m~2]) population, the correlation was more significant. CONCLUSION: The association between homocysteine and eGFR is significant in inpatient population.

OBJECTIVE: To investigate the clinical value of pancreaticogastrostomy(PG) in the treatment ofpancreatojejunostomy stricture(PJS) after pancreaticoduodenectomy(PD).METHODS: The clinical data of 3 patients withPJS who failed the endoscopic treatment underwent PG followed by resection of pancreatojejunostomy(PJ) from May2010 to December 2017 in Department of General Surgery,Xinhua Hospital,Shanghai Jiaotong University School ofMedicine were analyzed retrospectively. After the pancreatointestinal anastomosis was explored and resected, thedigestive tract of the remnant pancreas was reconstructed by using the single-layer bundle pancreaticogastric mucosaanastomosis. The intraoperative and postoperative conditions were observed.RESULTS: The median time of presentationwas 72,37 and 21 months. Three cases of operation were completed successfully. The operation time was 137, 210, 120 min,and blood loss was 210, 350, 180 m L. No pancreatic fistula,surgical bleeding and other serve complicationoccurred postoperatively. All the 3 patients experienced resolution of symptoms without recurrent acute pancreatitis afterPG during the follow-up of 23, 58 and 15 months.CONCLUSION: PG especially duct-to-mucosa PG followed byresection of PJ could be used in the PJS patients who failed the endoscopic treatment.

Objective: To investigate the value of early postoperative monitoring of serum albumin in the prediction of surgical site infection (SSI) in colorectal cancer surgery. Methods: A total of 169 patients undergoing colorectal cancer surgery between December 2012 and January 2016 were collected for this study. Patients was divided into SSI group and no SSI group according to whether SSI occurred after surgery. We continuously collected venous blood three days after surgery. Serum albumin, C-reactive protein level, Procalcitonin and White blood-cell were performed to evaluate the relationship between albumin changes and postoperative SSI. Results: There were 40 cases (23. 7％) of SSI, and the average time for clinical diagnosis of SSI was 3. 2 days after surgery. ALB decreased, and PCT, CRP, and WBC levels increased in the SSI group on the second postoperative day. The decrease in albumin concentration (A ALB2) was significantly higher on the second postoperative day than in the SSI group (P ＜ 0. 001). Receiver-operating characteristics (ROC) curve analysis showed that △ ALB2 had significant value in predicting the occurrence of SSI (area under the curve = 0. 864, sensitivity 97. 5％, specificity 70. 5％), and the optimal cutoff was 15. 5％. Multiple regression analysis showed that A ALB2 ＞15. 5％ was an independent predictor of SSI (OR=2. 10, 95％CI=1. 52-2. 90, P ＜ 0. 001). Conclusions: The dynamic change of serum albumin is valuable to predict the occurrence of SSI after colorectal cancer surgery.

Objective: To evaluate the difference of plasma myeloperoxidase (MPO) level in different types of acute coronary syndrome (ACS) patients, and the value of baseline MPO level in predicting short-term and long-term outcomes in patients with ACS. Methods: The study cohort was derived from "the 12th Five-Year" National Science and Technology Support Program Project "Study on Comprehensive Intervention and Prognosis of Acute Coronary Syndrome" . We enrolled all hospitalized ACS patients who were enrolled in "the 12th Five-Year" cohort from January 1, 2011 to December 31, 2013. A total of 630 patients from 20 centers were enrolled. According to the diagnosis, the patients were divided into two groups: ST-segment elevation myocardial infarction (STEMI) group and non-ST-elevation acute coronary syndrome (NSTE-ACS) group. Plasma levels of MPO were measured by ELISA method. Cardiovascular events in the hospital were recorded. All patients were followed-up by telephone, follow-up ended December 31, 2015. The occurrence of major adverse cardiovascular events (MACE, defined as cardiac death, recurrent myocardial infarction, unscheduled coronary revascularization procedure and stroke) and all-cause death were recorded. Logistic regression analysis and Cox regression analysis were used to evaluate the predictive value of baseline MPO levels obtained during hospitalization and the long-term outcomes of ACS patients. Results: A total of 597 ACS patients were enrolled in final analysis. Level of plasma MPO in STEMI patients was significantly higher than that of NSTE-ACS patients (34.02(19.31, 67.87) μg/L vs. 27.25(16.69, 52.92) μg/L, P=0.028) . MPO was not related to the in-hospital cardiovascular events (OR=0.797, 95%CI 0.366-1.737, P=0.569). Follow up was completed in 476 patients, median follow-up time was 796 (32, 1 816) days. There were 23 all-cause deaths and 51 MACE. Plasma MPO level was not an independent predictor for all-cause death (HR=1.434, 95%CI 0.502-4.100, P=0.501) and MACE (HR=1.271, 95%CI 0.662-2.442, P=0.471). Conclusion In hospitalized ACS patients, level of plasma MPO was significantly higher in STEMI patients than in NSTE-ACS patients, but MPO could not predict the short-term or long-term outcomes in patients with ACS.

More and more disputes have happened to confront us continuously since the separation of Japanese(wild) honeysuckle flower in Chinese Pharmacopoeia in 2005. The state pharmacopeia committee decided to separate Japanese(wild) honeysuckle flower into two species for japanese(wild) honeysuckle flower, but didn't define their the convincing reasons still did not provide to us as a result that two medicines are not described the differences in natural properties, efficiency and indication, usage and dosage, as well as not given a resolving methodand specific solution. It was known for us that in the history of traditional Chinese medicine（TCM）, the phenomenenphenomena of the "one drug from multi-species" and "one species for multi-drug" are very ordinary thingswere ubiquitous. Whether separation of the drug species are separated shall be decided to by clinical efficiency. Through Chinese pharmacopoeia (2015 edition) issue of Chinese Pharmacopoeia the 2015 issue of the Chinese Pharmacopoeia, we still cannot find a scientific solution for the dispute of for Japanese (wild) honeysuckle flower, perhaps because of insufficient reorganization of TCM clinical medication regularities, such as "treatment of different diseases with same drug", " treatment of the same disease with different drugs" and "treatment of the same syndrome with multi-prescriptions", and "one prescription treating multiple syndromes"; lack of in-depth analysis for multi-component TCM compounds and autonomisation of "supermolecular template" for organs and meridians; less attention to the advance of efficacy and safety evaluation technologies for multi-component TCM compounds; impacts from the medication mode of "one ingredient-one composition-one effect"; as well as insufficient research methods for bioequivalent evaluation in preclinic and clinic studies . The dispute for species combination or separation for Japanese(wild) honeysuckle flower was apparently caused by regional economy, drug biological equivalent of efficacy and safety, but arising from clinical principles for systematical syndrome treatment with TCM, or concepts in the treatment of diseases with TCM or western medicines. This paper focused on current studies on Japanese(wild) honeysuckle flower in the combination with TCM clinical medication regularities, such as "treatment of different diseases with same drug", "treatment of the same disease with different drugs" and "treatment of the same syndrome with multi-prescriptions", and "one prescription treating multiple syndromes", expounded the specific pharmacological regularity of "heterogeneous equivalence" of Japanese (wild) honeysuckle flower, and put forward methods for studying bioequivalence of Japanese(wild) honeysuckle flower, in order to solve the combination and separation of Japanese(wild) honeysuckle flower and lay a foundation for promoting the development of Chinese herbal medicine industry.

BACKGROUNDKnee osteoarthritis (KOA) is a chronic joint disease that manifests as knee pain as well as different degrees of lower limb swelling, stiffness, and movement disorders. The therapeutic goal is to alleviate or eliminate pain, correct deformities, improve or restore joint functions, and improve the quality of life. This study aimed to evaluate the efficacy and safety of Zhuanggu joint capsules combined with celecoxib and the benefit of treatment with Zhuanggu alone for KOA.

METHODSThis multi-center, randomized, double-blind, double-dummy, parallel controlled trial, started from December 2011 to May 2014, was carried out in 6 cities, including Beijing, Shanghai, Chongqing, Changchun, Chengdu, and Nanjing. A total of 432 patients with KOA were divided into three groups (144 cases in each group). The groups were treated, respectively, with Zhuanggu joint capsules combined with celecoxib capsule simulants, Zhuanggu joint capsules combined with celecoxib capsules, and celecoxib capsules combined with Zhuanggu joint capsule simulants for 4 weeks consecutively. The improvement of Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and the decreased rates in each dimension of WOMAC were evaluated before and after the treatment. Intergroup and intragroup comparisons of quantitative indices were performed. Statistically significant differences were evaluated with pairwise comparisons using Chi-square test (or Fisher's exact test) and an inspection level of α = 0.0167.

RESULTSFour weeks after treatment, the total efficacies of Zhuanggu group, combination group, and celecoxib group were 65%, 80%, and 64%, respectively, with statistically significant differences among the three groups (P = 0.005). Intergroup pairwise comparisons showed that the total efficacy of the combination group was significantly higher than that of the Zhuanggu (P = 0.005) and celecoxib (P = 0.003) groups. The difference between the latter two groups was not statistically significant (P > 0.0167). Four weeks after discontinuation, the efficacies of the three groups were 78%, 95%, and 65%, respectively, with statistically significant differences (P < 0.0001). Intergroup pairwise comparisons revealed that the efficacy of the combination group was significantly better than that of the Zhuanggu and the celecoxib groups (P < 0.0001). The difference between the latter two groups was not statistically significant (P > 0.0167). The incidences of adverse events in Zhuanggu group, combination group, and celecoxib group were 8.5%, 8.5%, and 11.1%, respectively, with insignificant differences (P > 0.05).

CONCLUSIONSZhuanggu joint capsules alone or combined with celecoxib showed clinical efficacy in the treatment of KOA. The safety of Zhuanggu joint capsules alone or combined with celecoxib was acceptable.

TRIAL REGISTRATIONChinese Clinical Trial Registry, ChiCTR-IPR-15007267; http://www.medresman.org/uc/project/projectedit.aspx?proj=1364.

Adult ; Aged ; Celecoxib ; administration & dosage ; adverse effects ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; drug therapy

Objective To discuss the effects of community diabetes specialist nurse training practice from the perspective of knowledge management, in order to provide some references for personnel training mode of the community nurses. Methods We established community diabetes specialist nurse training practices, screened 80 community nurses to participate in training, and implemented the training practices. The training objects were surveyed with the diabetes knowledge and performed duties questionnaires before and after the training. Diabetes knowledge level and the degree of willingness to perform duties were as evaluation indexes, SPSS 18. 0 software was used for analyzing and processing the date, and studying training effects from the perspective of knowledge management. Results Diabetes knowledge test accuracy of community nurses were 37. 0%, 68. 4% before and after the training (Z=7. 36, P<0. 01);willingness to perform their duties showed that options of very willing were 52. 5%(42/80), and options of willing were 46. 2%(37/80), and only one person said reluctantly willing. Conclusions The training practice can guarantee quality of nursing knowledge resources which were imported community health service centers, promote effectively spread, flow and use of knowledge resources in the community health service centers, then to promote knowledge utilization value.