ObjectiveTo investigate the feasibility and safety of endoscopic retrograde cholangiopancreatography （ERCP） combined with oral cholangiopancreatography in the treatment of major duodenal papilla gallbladder polyps. MethodsA retrospective analysis was performed for the clinical data of eight patients with choledocholithiasis and gallbladder polyps who underwent ERCP and combined with oral cholangiopancreatography for major duodenal papilla cholecystectomy in Center of Digestive Endoscopy， Jilin People’s Hospital， from May 2022 to June 2024， and related data were collected， including the success rate of surgery， the technical success rate of gallbladder polyp removal， the superselective method of cystic duct， the time of operation， the time of gallbladder polyp removal， and surgical complications. ResultsBoth the success rate of surgery and the technical success rate of gallbladder polyp removal reached 100%， and of all eight patients， three patients used guide wire to enter the gallbladder under direct view， while five patients received oral cholangiopancreatography to directly enter the gallbladder. The time of operation was 51.88±12.34 minutes， and the time of gallbladder polyp removal was 23.13±10.94 minutes. The diameter of gallbladder polyp was 2‍ ‍—‍ ‍8 mm， and pathological examination showed inflammatory polyps in three patients， adenomatous polyps in one patient， and cholesterol polyps in four patients. There were no complications during or after surgery. The patients were followed up for 2‍ ‍—‍ ‍27 months after surgery， and no recurrence of gallbladder polyp was observed. ConclusionOral cholangiopancreatography is technically safe and feasible in endoscopic major duodenal papilla cholecystectomy.

Objective To evaluate the relationship between diabetic nephropathy(DN)and diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM)based on imaging and clinical testing data.Methods Totally 600 T2DM patients who visited the First People's Hospital of Ziyang from March 2021 to December 2022 were included.The fundus photography and fundus fluorescein angiography were performed on all these patients and their age,gender,T2DM duration,cardiovascular diseases,cerebrovascular disease,hypertension,smoking history,drinking history,body mass in-dex,systolic blood pressure,diastolic blood pressure and other clinical data were collected.The levels of fasting blood glu-cose(FPG),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipo-protein cholesterol(LDL-C),glycosylated hemoglobin(HbA1c),24 h urinary albumin(UAlb),urinary albumin to creati-nine ratio(ACR),serum creatinine(Scr)and blood urea nitrogen(BUN)were measured.Logistic regression was used to analyze the risk factors associated with DR.DR staging was performed according to fundus images,and the convolutional neural network(CNN)algorithm was used as an image analysis method to explore the correlation between DR and DN based on emission computed tomography(ECT)and clinical testing data.Results The average lesion area rates of DR and DN detected by the CNN in the non-DR,mild-non-proliferative DR(NPDR),moderate-NPDR,severe-NPDR and pro-liferative DR(PDR)groups were higher than those obtained by the traditional algorithm(TCM).As DR worsened,the Scr,BUN,24 h UAlb and ACR gradually increased.Besides,the incidence of DN in the non-DR,mild-NPDR,moderate-NPDR,severe-NPDR and PDR groups was 1.67％,8.83％,16.16％,22.16％and 30.83％,respectively.Logistic regression analysis showed that the duration of T2DM,smoking history,HbA1c,TC,TG,HDL-C,LDL-C,24 h UAlb,Scr,BUN,ACR and glomerular filtration rate(GFR)were independent risk factors for DR.Renal dynamic ECT analysis demonstrated that with the aggravation of DR,renal blood flow perfusion gradually decreased,resulting in diminished renal filtration.Conclusion The application of CCN in the early stage DR and DN image analysis of T2DM patients will improve the diag-nosis accuracy of DR and DN lesion area.The DN is worsening as the aggravation of DR.

Objective: To investigate the characteristics and trends of malaria cases in Lishui City, Zhejiang Province from 2012 to 2023, so as to provide a basis for improving malaria prevention and control measures. Methods: Case data of malaria in Lishui City from 2012 to 2023 were collected from the Parasitic Disease Control Information Management System of the National Information System for Disease Control and Prevention in China. The parasite species, source of infection, temporal distribution, population distribution, geographical distribution, and clinical diagnosis and treatment of the cases were descriptively analyzed. Results: A total of 169 malaria cases were reported in Lishui City from 2012 to 2023, and P. falciparum malaria was the main type, accounting for 79.88% (135 cases). The positive rate of Plasmodium detection was 3.30‰(169/51 212), the highest was 5.41‰ (18/3 327) in 2017, and the lowest was 0.38‰ (1/2 632) in 2021. Malaria cases were reported in every month from 2012 to 2023, with 91 cases (53.85%) reported from May to October. There were 168 imported cases, of which 163 (96.45%) originated from Africa. There were 127 male cases (75.15%), and the majority of cases were aged 20 to 49 years, with 138 cases accounting for 81.65%. The majority of the occupation was overseas labor export workers, with 164 cases accounting for 97.04%. A total of 161 cases (95.27%) were registered residents of Lishui City, and cases were reported from all nine counties (cities, districts), with Qingtian County and Liandu District having the higher numbers of 98 and 41 cases, respectively. The median interval from onset to hospital visit for malaria cases was 2.00 (interquartile range, 4.00) days, and the median interval from hospital visit to diagnosis was 0 (interquartile range, 1.00) day. The diagnostic rate of first-diagnosed malaria cases in municipal and county medical institutions was 95.90% (117/122) and 91.49% (43/47), respectively, with no statistical significance (P>0.05). Conclusions The P. falciparum malaria was the predominant type in Lishui City from 2012 to 2023, with the majority of cases being imported. Male overseas labor export personnel aged 20 to <50 were the key demographic.

Objective To explore the nutritional efficacy of compound protein powder formulations from different sources. Methods Three groups of compound protein powder formulations were obtained through scientific blending using soy protein, whey protein and yeast protein as raw materials. The effects of the compound protein powders on nitrogen metabolism, serum biochemical indicators, and pathological changes of liver tissue and epididymal fat in rats were evaluated. Results Compared with the control (casein), the net protein utilization, biological evaluation, and protein efficacy ratio of the compound protein powders in rats were significantly improved, and the changes in these indicators in the formula with the highest whey protein content were most significant among all three formulas. The compound protein powders effectively increased the levels of albumin and globulin, while decreased the content of total cholesterol, indicating beneficial effects on improving immunity and controlling lipid metabolism, with the formula group 2 being the most effective among all three groups. The pathological examination showed that the three groups of protein powder did not have adverse effects on liver tissue and epididymal fat. Conclusion The present study demonstrates that the compound protein powder formulation has nutritional value, which suggests a potential of the application of the compound protein powder formulation in the elderly, and people with special nutritional needs, such as sports people.

Objective:To standardize the naming of organ at risk (OAR) and target area during cervical cancer radiotherapy based on AAPM TG-263.Methods:After self-programming of Matlab software to implement the reading and resolution of radiotherapy structure files, the naming of each substructure was automatically output, recorded and restored. After naming all substructures, the structure names were classified by keywords. According to TG-263, a standard naming conversion table of OAR and target area was developed, and the classified structure names were standardized through procedures. Finally, the standardized named radiotherapy structure files were output and imported into the treatment planning system (TPS).Results:The radiation structure of 144 patients with cervical cancer was successfully transformed and displayed correctly in TPS. Before the transformation, the naming of OAR and target area lacked of uniform norms and standards, and the naming of the same structure significantly differed. After the transformation, 43 naming methods of OAR and 74 naming methods of the target area were unified into 20 and 8 naming methods, which were more convenient for staff understanding and communication.Conclusion:The standardization of cervical cancer radiotherapy structure naming can reduce the inconsistency of naming and provide reference for the standardized naming of pelvic tumors.

Objective:To evaluate the readiness for application of the Facilitating Client Centred Learning guideline among nurses in a general hospital and analyze its influencing factors. Methods:In December 2019, cluster sampling was used to select 138 nurses from 12 nursing units in a general hospital who intended to apply the guideline as research subjects. The Clinic Readiness of Evidence-Based Nursing Assessment (CREBNA) was used to evaluate the readiness of the guideline application, and the influencing factors were investigated and analyzed through the self-designed Influencing Factors Questionnaire. A total of 138 questionnaires were retrieved and 138 valid questionnaires were collected, with an effective rate of 100%.Results:Among 138 nurses, the score of CREBNA was (134.17±15.57) . The scores of the evidence subscale, organization environment subscale and promotion factor subscale were (51.35±6.22) , (39.85±5.00) and (42.97±5.88) respectively. Univariate analysis showed that the differences in the total score of CREBNA of nurses with different initial qualifications and whether they received evidence-based practice training were statistically significant ( P<0.05) . Multiple linear regression analysis showed that the influencing factors of nurses' readiness for evidence-based practice included the initial qualifications and whether they received evidence-based practice training with statistical differences ( P<0.05) . Conclusions:Nurses' readiness for evidence-based practice is affected by their initial qualifications and whether they have received evidence-based practice training. It is recommended that managers applying the guideline create an organizational environment that supports evidence-based practice, strengthen leadership in evidence-based practice, develop training programs suitable for different groups and various forms, and improve the knowledge, beliefs and skills of evidence-based practice for head nurses, guidance nurses and general nurses to lay a solid foundation for the smooth application of the guideline.

Objective To retrieve and evaluate the evidences for fall prevention in elderly inpatients, and to summary the best evidence. MethodsGuidelines, evidence summaries and systematic reviews related to fall prevention of elderly patients were retrieved in guideline websites and databases by computer from building database to 31st December 2018. Literatures' quality evaluation and evidence grading were carried out with the Chinese version of appraisal of guidelines for research and evaluationⅡ (AGREEⅡ), "2016 Joanna Briggs Institute quality assessment tool on validity evaluation of systematic reviews" and "2014 Joanna Briggs Institute quality level of evidence and grade of recommendation system". ResultsA total of 6 documents were included with 3 guidelines and 3 systematic reviews. Based on evaluation and results extracted, 14 items of the best evidences on fall prevention were summarized in two parts including assessment and prevention, and in 6 aspects involving the medication, facility, environment, functional training, informational support and multifactorial intervention. ConclusionsMedical staff should guide patients to take standardized fall preventive measures to guarantee the safety of patients based on evidence-based medicine.

Objective To probe into the status and correlation between elder abuse tendency and psychological resilience of family caregivers of the elderly with chronic diseases. Methods Totally 402 family caregivers of the elderly with chronic diseases were investigated by the Chinese version of Caregiver Abuse Screening and Conner-Davidson Resilience Scale. Then the results underwent statistical analysis. Results Nearly 63.68%(256/402) family caregivers had the risk of elder abuse tendency. The median of family caregivers′resilience score was 53, lower than normal population(Z=-10.106, P=0.000), and was significantly negatively correlated with elder abuse tendency(r=-0.480, P=0.000).And caregivers′ high level of resilience was a protective factors for elder abuse tendency. Conclusions Nurses should motivate the family caregivers of the elderly with chronic diseases to adapt successfully when faced stress which could be associated with resilience. Thus the psychological resilience would play a role of protective effect against elder abuse tendency, with the purpose of reducing the risk for abusing the elderly who suffered from chronic diseases.

Objective To probe into the status quo of maltreatment tendency among family caregivers of elderly patients with chronic diseases and its influence factors.Methods Totally 402 family caregivers of the elderly patients with chronic diseases were selected and surveyed by using the Chinese version of caregiver elder abuse assessment scale and the results underwent statistical analysis.Results 63.70％ of family caregivers in elderly patients with chronic diseases had the elder abuse risk tendency and its influence factors were involved with both aspects of family caregivers and the care recipients,including the gender,cultural level and self-care ability of daily living in the elderly patients with chronic diseases and the age,cultural level,care period and living together with elderly in caregivers.Conclusion The elder abuse problem in the patients with chronic diseases should be paid more attention to,which needs the collaboration of multidisciplinary team,various effective ways should be adopted to relieve the family caregivers' pressure for reducing the occurrenc of elder abuse risk.

To test the hypothesis that the first degree relatives of Chinese women with polycystic ovarian syndrome (PCOS) have higher risk of cardiovascular disease than those without PCOS.The metabolic phenotype and risks of cardiovascular disease were evaluated in 110 family members of 35 women with PCOS and 85 unrelated healthy control subjects without family history of diabetes and PCOS ( four age- and weight-matched subgroups ).The prevalence of impaired glucose tolerance was 51.4％ in mothers and 57.5％ in fathers with their daughters suffering from PCOS.The first degree relatives of PCOS women had significantly higher serum fasting insulin level,homeostasis model assessment for insulin resistance,insulin area under the curve,and lower insulin sensitivity index in all subgroups than the control subjects( P＜0.05 ).The control subjects had significantly elevated high molecular weight-adiponectin levels and decreased high sensitive-C reactive protein levels compared to the first degree relatives of PCOS women in all subgroups.Parents and brothers,but not sisters,of women with PCOS had significantly higher total cholesterol and low density lipoprotein-cholesterol ( P＜ 0.05 ),as well as triglyceride levels ( P＜ 0.05 ),compared with control subjects.The first degree relatives of PCOS women had features of insulin resistance and increased risk of cardiovascular disease.