Objective:To compare the clinical efficacy of transendoscopic retrograde cholangiopancreatography (ERCP) lithotripsy with that of traditional surgical procedures in the treatment of pancreatic ductal stones.Methods:The clinical data of 47 patients with chronic pancreatitis combined with pancreatic duct stones hospitalized in Yueyang Hospital affiliated to Hunan Normal University and Third Xiangya Hospital of Central South University between November 2017 and November 2022 were retrospectively analyzed. All the patients were divided into ERCP group ( n=19), laparoscopic group ( n=10) and open abdominal group ( n=18) according to the mode of surgical treatment for pancreatic stone, and the general clinical characteristics, the surgical and postoperative recovery indicators, pain level grading, one-stage stone removal rate, complication rate and evaluation of pancreatic function were compared among the three groups. Results:The age, gender, body mass index, etiology, duration of disease, symptoms (abdominal pain, diarrhea), stone location, stone size, preoperative tumor markers (CEA, AFP, CA19-9) and serum inflammatory factor (CRP) level were not statistically significant among three groups. In ERCP group, the operation time (1.47±0.51) h, the time of the first postoperative intestinal ventilation (1.16±0.20) days, the time of drainage removal (8.68±3.30) days, the length of hospitalization (11.37±4.59) days and intraoperative blood loss (109.5±16.5) ml, the CRP on the first postoperative day (11.24±2.62) mg/L, and the treatment cost (35 238±10 663) were obviously shorter or lower than those of laparoscopic and open abdominal group; in the laparoscopic group, the time to first postoperative bowel ventilation (2.40±0.70) days, drainage removal time (12.10±5.36) days and intraoperative blood loss (195.0±83.2) ml, postoperative CRP on day one (14.52±3.62) mg/L, and the treatment cost (69 908±11 310) were greatly shorter or lower than those in open abdominal group; and all the differences were statistically significant (all P value <0.05). Those with moderate and severe pain in ERCP group (10.53%) were lower than those in laparoscopic group (70.00%) and open abdominal group (83.38%), and the difference was statistically significant (all P value <0.05). There was no statistically significant difference between ERCP group and laparoscopic and open abdominal group in terms of phase I stone removal rate, complication rate, and postoperative glycated haemoglobin level, but patients' weight loss (26.32%) and incidence of diarrhea (21.05%) were lower than those of laparoscopic and open abdominal group, and all the difference was statistically significant (all P value <0.05). Conclusions:ERCP lithotripsy is an effective, safe, minimally invasive and economical treatment for pancreatic duct stone and is suitable for most patients with pancreatic duct stone, but patients with embedded or complex pancreatic duct stones should be treated with laparoscopic or open abdominal surgery according to the actual situation.

Objective:To compare the effects of rosuvastatin and atorvastatin on coronary artery bypass grafting (CABG) on the incidence of acute kidney injury (AKI), and assess the independent risk factors of AKI.Methods:We retrospectively collected 550 patients aged 18 years or older who underwent CABG from May 2014 to May 2020. They were divided into the rosuvastatin group ( n=322), atorvastatin group ( n=125) and non statins group ( n=103) according to whether rosuvastatin or atorvastatin was routinely used before operation. Demographic data, clinical data before and after CABG and laboratory results were collected. Blood urea nitrogen (BUN), serum creatinine (Scr), creatinine clearance rate (Ccr) and incidence of postoperative AKI were compared among the three groups. Univariate analysis and binary logistic regression analysis were used to investigate the effect of statins on AKI in patients undergoing CABG. Results:Compared with preoperation, BUN showed no significant change ( P>0.05), while Scr was increased and Ccr was decreased significantly (both P<0.01); BUN in the rosuvastatin group was decreased significantly ( P<0.01), whereas Scr and Ccr had no significant change ( P>0.05); Scr in the atorvastatin group was increased significantly ( P<0.01), but there was no significant difference in BUN and Ccr ( P>0.05). BUN and Scr in the non statins group were increased significantly (both P<0.01), while Ccr was decreased significantly ( P<0.01). After operation, BUN and Scr in the rosuvastatin group and atorvastatin group were significantly lower than those in the non statins group (all P<0.01); Ccr was significantly higher than that in the non statins group ( P<0.01). BUN and Scr were not significantly different between the rosuvastatin and atorvastatin groups ( P>0.05), but Ccr was significantly higher than that in the atorvastatin group ( P< 0.05). There were significant differences in BUN, Scr and Ccr among the three groups ( χ2=48.925, 22.677 and 34.426, all P<0.01). The incidence of AKI among 550 patients was 15.1% (83/550), of which 9.6% (31/322) in the rosuvastatin group, 16.0% (20/125) in the atorvastatin group and 31.1% (32/103) in the non statins group. The incidence of AKI in the rosuvastatin and atorvastatin groups was significantly lower than that in the non statins group ( χ2=28.412, 7.282, P<0.01). Multivariate regression analysis showed that hypertension ( OR=3.555, 95% CI: 1.959-6.451, P<0.01), NHYAⅢ/Ⅳ ( OR=2.438, 95% CI: 1.187-5.008, P=0.015), and increased serum creatinine level ( OR=1.018, 95% CI: 1.003-1.032, P=0.016), and intraoperative cardiopulmonary bypass ( OR=2.936, 95% CI: 1.454-5.927, P=0.003) were independent risk factors for AKI after CABG, while preoperative conventional statin therapy ( OR=0.490, 95% CI: 0.247-0.974, P=0.042) and increased serum albumin level ( OR=0.920, 95% CI: 0.856-0.990, P=0.026) were protective factors for AKI after CABG. Conclusions:The incidence of AKI after CABG is common. Rosuvastatin or atorvastatin and increased preoperative serum albumin level can protect renal function and reduce the incidence of AKI, which are the protective factors of AKI after CABG. The hypertension, NHYAⅢ/Ⅳ, increased preoperative serum creatinine level and cardiopulmonary bypass are the independent risk factors of AKI after CABG.

Objective: To explore the application effect of mixed reality technology in the teaching of hepatobiliary surgery. Methods: A total of 120 professional postgraduates majored in surgery who had received the four-month standardized training of residents in hepatobiliary surgery department of the First Affiliated Hospital of Army Military Medical University and the First Affiliated Hospital of Chongqing Medical University during 2016-2018 were selected and were equally allocated into the control group and the research group via random number table method. Students in the control group were trained with traditional surgical teaching mode and in the research group were trained with three-dimensional visualization model which was constructed by mixed reality. Students in both groups received assessment and questionnaires at the end of training. Results: Scores of theoretical examination and surgical operation assessment of students in the research group were higher than those in the control group (P<0.05). The error rate for separating gallbladder artery and bile duct in the laparoscopic simulated system of students in the research group was significantly lower than that in the control group (P<0.05). Students-teacher satisfaction degree in the research group was higher than that in the control group (P<0.05). Conclusion Using mixed reality technology to construct a three-dimensional visualization model and to implement hepatobiliary surgery teaching enables the trainees to better master anatomical key points in the hepatobiliary system and the hepatobiliary surgical approach, with good feedback.

Objective Investigate the effect of gestational diabetes mellitus (GDM)on the neonatal metabolism and prognosis.Methods A total of 265 singleton pregnancy GDM patients were collected as the observation group,while 260 cases of healthy singleton pregnant women were chosen as the control group.Detected the levels of adiponectin,insulin,C-peptide,glycated hemoglobin and blood glucose,compared the prognosis of two groups.Results Compared with the control group,adiponcetin and blood glucose in 2 hours after birth in observation group were lower,insulin,C-peptide and glycated hemoglobin were higher,the number of cesarean section was more,the difference was statically significant (P＜0.05).The incidence of low birth weight infant,macrosomia,neonatal asphyxia,neonatal hypoglycemia,neonatal hyperbilirubinemia,neonatal pneumonia,fetal death and newborn teratogenesis in the observation group was higher than that in the control group,the difference was statically significant (P＜0.05).Conclusion GDM could cause metabolic disorder and affect fetal growth and development,leading to poor prognosis.

Objective To evaluate the effectiveness of anticoagulation management by physician-clinical pharmacist team for patients with valvular atrial fibrillation. Methods One hundred and seventy two patients with valvular atrial fibrillation received warfarin therapy for anticoagulation during hospitalization in Linyi People′s Hospital from January 2014 to December 2016, the patients continued to receive warfarin therapy for>6 months after discharge. The patients were randomly assigned in two groups:the anticoagulation management was given by physician-clinical pharmacist team in 87 cases (trial group), while the dosage of wargarin was adjusted in outpatient department by physicians alone in 85 cases (control group). The goal attainment rate of international normalized ratio (INR), the proportion of patients with a stable warfarin dose, knowledge of anticoagulants, belief of medication, medication compliance were compared between two groups. Results There were no significant differences in age, sex, body weight, smoking and drinking habits, valvular disease type, comorbidities; and the initial INR, knowledge of anticoagulants, belief of medication and medication compliance at admission between two groups (all P>0.05). The goal attainment rate of INR (52.17％vs. 41.02％,χ2=8.178, P=0.004), the proportion of patients with a stable dose of warfarin (74.71％ vs. 56.47％,χ2=6.349, P=0.012), the knowledge of anticoagulants (11.03 ± 2.25 vs. 10.08 ± 1.86, t=3.018, P=0.003), the belief of medication[(12.23 ± 2.07) vs. (11.67 ± 1.48), t=2.042, P=0.043], and the medication compliance[(7.36 ± 0.89) vs. (7.04 ± 1.10), t=2.1128, P=0.036] in the trial group were significantly higher than those in control group. Conclusion Anticoagulation management by physician - clinical pharmacist team can improve the management level of anticoagulation and the knowledge of anticoagulans, enhance the medication belief, improve the goal attainment rate of INR and the compliance rate of medication in patients with valvular atrial fibrillation.

Objective To investigate the prevention of acute kidney injury (AKI) by earlier application of rosuvastatin in patients after coronary artery bypass grafting (CABG).Methods A total of 200 patients with CABG were enrolled from May 2013 to April 2017.According to whether rosuvastatin were used routinely before operation or not,all patients were divided into the trial group (n =136) and the control group (n =64).Demographics,and clinical data were collected before and after CABG.The renal function markers including blood urea nitrogen (BUN),serum creatinine (sCr),endogenous creatinine clearance rate (GFR),emergence of AKI of two groups were documented and compared.Enumeration data were analyzed with x2 test,measurement data were analyzed with t test,and P ＜ 0.05 was considered to be significant.Results There were no differences in sCr (t =-1.156,P ＞ 0.05) but differences in BUN and eGFR (t =-2.915,3.690,respectively,P ＜ 0.05) before operation between two groups.After operation,the BUN was decreased (t =2.486,P ＜ 0.05) compared with that of pre-operation in the trial group,but there were no significant difference in sCr and eGFR (t =-1.877,-0.752,respectively,P ＞0.05).The BUN and sCr were increased (t =-3.792,-5.027,respectively,P ＜ 0.05) after operation compared with that of pre-operation in the control group,while the eGFR was decreased (t =5.540,P ＜0.05).Compared with the control group,BUN,sCr and the incidence of AKI were significantly decreased in the trial group (t/x2 =5.759,4.196,15.506,respectively,P ＜0.05),while the eGFR was increased (t =-6.215,P ＜ 0.05).Conclusions Earlier application of rosuvastatin before CABG can effectively protect renal function and reduce the incidence of AKI.

OBJECTIVE:To evaluate the effects of clinical pharmacists participating in clinical pathway management for chron-ic heart failure(CHF). METHODS:A total of 107 CHF adult inpatients in Linyi People's Hospital during Jan. 2014-Oct. 2015 were divided into control group(56 cases,3 withdrawal,53 in total)and trial group(58 cases,4 withdrawal,54 in total)accord-ing to random number table. Control group received routine clinical pathway management method of CHF;trial group received clin-ical pathway management with the participation of clinical pharmacists. Clinical efficacy,the utilization of heart failure drugs,eco-nomic indexes,medication compliance after discharge,re-hospitalization rate due to heart failure were compared between 2 groups. RESULTS:Total response rate of trial group was significantly higher than control group,with statistical significance(P<0.05). The utilization rate of ACEI/ARB,β-receptor blocker,target dose rate of ACEI/ARB in trial group were significantly higher than control group,with statistical significance(P<0.05);target dose rate of β-receptor blocker was higher than control group,without statistical significance(P>0.05). Hospitalization time,drug cost,total hospitalization cost and drug ratio of trial group were short-er or lower than control group,without statistical significance(P>0.05). One month after discharge,the proportion of medication compliance in trial group was significantly higher than control group,with statistical significance(P<0.05);re-hospitalization rate was lower than control group,without statistical significance(P>0.05). Three months after discharge,the proportion of medica-tion compliance in trial group was higher than control group,while re-hospitalization rate was lower than control group,with statis-tical significance(P<0.05). CONCIUSIONS:The participation of clinical pharmacists in clinical pathway management of CHF can significantly improve the utilization rate of recommended drugs by guideline,clinical efficacy and medication compliance,and reduce re-hospitalization rate.

Objective: To evaluate the effectiveness that gelatin lines the injured vasuclar wall to prevent from restenosis.Methods: The animal model of restenosis was established by balloon dilation in femoral artery,and 30% gelatin was lined on injured vascular wall in experimental group.The samples were collected at the 2nd week and 4th week after operation.The neointimal area(NEA),neointimal area/media area(NEA/MA)and cell apoptosis were observed by image analysis system and TUNEL technique. Results: The intima of the control group was thicker than that of the experimental group,and more cells appeared in the control group.Compared with the control group,the NEA was reduced significantly in the experimental group at the 2nd and 4th week (0.67?0.25cm 2 vs 1.02?0.41cm 2,and 1.18?0.36cm 2 vs 1.46?0.15cm 2).The NEA/MA ratio in the experimental group was lower than the control group at the 2nd and 4th week(0.35?0.05% vs 0.54?0.14%,and 0.62?0.25% vs 0.75?0.10%).The apoptosis rate of vascular smooth muscle in the experimental group was higher than the control group at the 2nd and 4th week(18.2?5.8% vs 13.6?2.4%,and 15.1?2.1% vs 13.0?1.5%).These diffences were all significant (P

ObjectiveTo explore the diagnosis and management of acute deep vein thrombosis(DVT) of lower extremity. Methods The clinical data of 96 patients with DVT were analysed retrospectively. ResultsThe diagnosis rate of DVT by vascular color ultrasounography was 97.8%, by MVC/SVO ratio combi ned with air plethysmagraphy was 97.2%, and by ECT was 100%. The MVO/SVC ratio, and diameter of calf and thigh in surgery group and in non surgery group showed significant difference in 7 days after operation (P