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Objective:To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) after pancreaticoduodenectomy and endoscopic selection strategies.Methods:Clinical data of 34 patients treated with ERCP after pancreaticoduodenectomy at the Endoscopic Center of the First Affiliated Hospital of Air Force Medical University from January 2013 to December 2021 were retrospectively analyzed. The success rates of endoscopic insertion, diagnosis, treatment and ERCP, and the incidence of adverse events were analyzed.Results:Fifty ERCP treatments were performed in 34 patients. The success rates of endoscopic insertion, diagnosis, treatment, and ERCP after pancreaticoduodenectomy were 92.0% (46/50), 93.5% (43/46), 88.4% (38/43) and 76.0% (38/50), respectively. The success rates of ERCP assisted with colonoscope and balloon-assisted enterosocpe were 76.0% (19/25) and 75.0% (18/24), respectively. There were 3 adverse events, including 1 case of anastomotic mucosa tear during surgery, 1 case of cardiopulmonary arrest and 1 case of postoperative cholangitis.Conclusion:ERCP is effective and safe after pancreaticoduodenectomy in general. ERCP assisted with colonoscope and balloon-assisted colonoscope shows similar success rate after pancreaticoduodenectomy.
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Objective:To investigate the outcome and prognostic factors associated with endoscopic retrograde cholangiopancreatography (ERCP) in patients with primary sclerosing cholangitis (PSC).Methods:PSC patients admitted to Xijing Hospital from May 2009 to May 2020 were included. Data of demographics, clinical symptoms, laboratory and imaging tests, and ERCP consultations were collected to explore the population characteristics and clinical efficacy of ERCP treatment, and to follow up disease progression, transplant-free survival, and overall survival .Results:A total of 74 patients with PSC were included in this study, with a median age of 53 years, 54.1% (40/74) male. Patients combined with bile duct dominant stenosis, inflammatory bowel disease (IBD), and another autoimmune liver disease were 32.4% (24/74), 18.9% (14/74), and 17.6% (13/74), respectively, and those undergoing ERCP were 36.5% (27/74). Logistic regression analysis showed that high total bilirubin ( OR=12.33, 95% CI: 1.24-122.63, P=0.032) and bile duct dominant stenosis ( OR=24.67, 95% CI: 3.40-178.88, P=0.002) were independent high-risk factors for ERCP consultation. The operation and clinical success rates of ERCP were both 96.3% (26/27). As of the last follow-up, the proportions of patients progressing to cirrhosis, bile duct cancer, liver transplantation and death were 9.5% (7/74), 4.1% (3/74), 5.4% (4/74) and 18.9% (14/74), respectively. The five-year survival rate of the follow-up patients ( n=54) was 83.3%. The differences in transplant-free survival ( P=0.933) and overall survival ( P=0.608) between ERCP patients and non-ERCP patients were not statistically significant. Transplant-free survival of those who were companied with pruritus ( HR=5.30, 95% CI: 1.50-18.90, P=0.010) was shorter. Conclusion:PSC patients have higher proportion of IBD and less autoimmune liver disease. Higher proportion of patients with higher total bilirubin or bile duct dominant stenosis receive ERCP. While the short-term efficacy of ERCP is satisfactory, the long-term prognosis is still suboptimal. Patients with pruritus have a shorter transplant-free survival.
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Objective To analysis the necessity,feasibility and route of introducing Harvard Ethics Tool Kit into China.Methods Translated and edited The Ethics Tool Kit of Multi-Regional Clinical Trials (MRCT) Center of Harvard.Analyze the necessity and feasibility of introducing Ethical Tool Kit into China from the perspective of researchers and ethics committees.Explore the ways to introduce ethical toolkits into China from clinical trials and clinical research projects.Results Harvard MRCT Center developed Ethical Tool Kit in 2014 and proposed incorporating ethical principles into clinical research protocols.The Ethics Tool Kit includes 11 essential elements:addressing relevant question,choice of control and standard of care,choice of study design,choice of subject population,potential benefits and risks,informed consent,community engagement,return of research results and incidental findings,post-trial access,payment for participation,study related injury.The Ethics Tool Kit is helpful not only for researcher to develop their protocols,but also for ethical committees to conduct efficient review.From the perspective of researchers and ethics committees,it is necessary and feasible to introduce ethical toolkits into China now.From the ways of introduction,the clinical trial is proposed to be led by the government and the medical association,and the clinical research project is proposed to be explored by the institutions.Conclusions The Harvard Ethical Tool Kit has great practical value for researchers writing protocols and ethics committee reviewing protocols.It is recommended that introducing ethics tool kits to China for improving the overall quality of clinical research.
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Objective@#To investigate the history, risk factors for prognosis of malignant biliary stricture (MBS) patients receiving conservative therapy after endoscopic retrograde cholangiopancreatography(ERCP) and to set up a predictive model for overall survival (OS).@*Methods@#MBS patients who underwent ERCP and conservative therapy in Xijing Hospital and PLA No.451 Hospital from January 2009 to December 2013 were enrolled to the present study. Predictive factors associated with OS were identified in the training cohort by stepwise multivariate Cox regression analysis. A predictive model was then developed and externally validated in the validation cohort.@*Results@#Between January 2009 and December 2013, 152 and 149 patients were eligible to the training and validation cohort respectively. In the training cohort, tumors were mainly originated from bile duct (33.6%), pancreas (23.5%) or ampulla (20.4%). 76.3% (116/152) patients died during the observation period. The median OS for the training population was 5.0 months (3.9-6.2 months). CA19-9≥1 000 U/mL, non-ampulla tumor, metastasis, pre-ERCP total bilirubin≥7 mg/dL and hilar stricture were identified as independent predictive factors of poor OS (all P<0.05). Based on these factors, the COMTH predictive model was developed. The median OS of patients with COMTH>8 in the training and validation cohorts were both 3.0 months, which were significantly shorter than those with COMTH≤8 (10.0 and 6.9 months in the training and validation cohorts respectively, both P<0.001).@*Conclusion@#The prognosis of MBS patients undergoing ERCP is poor. The survival chance of patients with COMTH>8 is even more dismal.
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Endoscopic retrograde cholangiopancreatography(ERCP)is a well-established advanced endoscopic technique for the diagnosis and treatment of pancreatobiliary diseases. New advances have been made in the treatment concept and techniques of ERCP in recent years. This article elaborates on the recent advances in ERCP,including the application of pancreatic duct stent,non-steroidal anti-inflammatory drugs,and aggressive hydration to prevent postoperative pancreatitis,covered metal stent for the treatment of benign bile duct stenosis,in-traluminal radiofrequency ablation for malignant bile duct stenosis,extracorporeal shockwave lithotripsy and covered metal stent for the treat-ment of chronic pancreatitis,peroral choledochoscopy for qualitative diagnosis of bile duct stenosis and huge refractory stones,definition of difficult intubation,timing of pre-cut technique,and ERCP after gastrointestinal reconstruction.
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Objective To analyze the risk factors of post-ERCP pancreatitis (PEP) and to evaluate the relationship between cannulation time and PEP.Methods The data of cannulation time in 1 625 patients who underwent ERCP from 2010 to 2012 were retrospectively studied.The risk factors associated with PEP were analyzed by univariate and multivariate Logistic regression analysis.The effect of different cannulation time on PEP was evaluated.Results The incidence of overall PEP was 4.6％ (75/1 625) including 4.1％ (67/1 625)of mild and 0.5％ (8/1 625)of moderate-to-severe.Univariate analysis revealed that diabetes mellitus (P =0.02),choledocholithiasis (P =0.02),malignant biliary stenosis (P =0.007),duodenal stenosis (P =0.029),precut (P＜0.01),cannulation time ≥ 8 min (P＜0.01),blood platelet count ≥ 180× 109/L(P =0.089),alkaline phosphatase ≥ 120 U/L (P =0.083) and total bilirubin ≥ 17.1 μmol/L (P =0.094)were associated with PEP.Multivariate analysis revealed that precut (OR=1.93,95％CI:1.10-3.39,P=0.022),cannulation time ≥8 min (OR =3.50,95％CI:2.00-6.13,P＜0.01) and duodenum stenosis (OR=2.92,95％CI:1.08-7.86,P=0.034) were independent risk factors of PEP.Within 30 min of cannulation,longer cannulation time was accompanied with higher PEP rate.Conclusion The cannulation time is an independent risk factor of PEP.Overall PEP is increased when cannulation time is more than 8 min.
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The hospital spirit is not only the spiritual support and vital source for staff, but also the concentrat-ed expression of ideology and faith, value orientation, moral trait, psychology tendencies, culture stereotypes, the unified will and code of conduct for all kinds of personnel.The party organizations are the best helmsmen to culti-vate and carry forward the hospital spirit, which reveals distinctive and profound medical ethical principles and norms.In this paper, taking X hospital as an example, we describe the core function of the party committee′s lead-ership and results in the process of breeding, inheritance and innovation of hospital spirit and reflect ethically so as to provide good references for the current hospital spirit cultivation and promotion.
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Objective To analyze the safety and tolerability of endoscopic retrograde cholangiopancreatography ( ERCP) for elderly pa-tients in diagnose and therapy. Methods From Jan. 2010 to Dec. 2013, 1 560 patients were collected in our hospital for diagnosis and treatment, 1 116 cases were 60~69 years old, and the other 444 cases were over 70 years old. Retrospective data including clinical and bio-chemical characteristics, ERCP diagnosis and complications were analyzed. Results Using Logistic regression, the potential factors of com-plex multivariable were analyzed, and there was no statistical difference between the two groups (P=0. 039). The successful intubation, in-tubation difficulties and failed intubation in the examination and the treatment were of significantly difference between the two groups (P0. 05), but the ERCP diagnosis, postoperative complications and complications of acute pancreatitis were of certain difference (P<0. 05). Patients over 70 years old were of better tolerance, but their bile duct stones was about two times than that in patients of 60~69 years old (P=0. 004). Conclusion The results show that ERCP for elderly patients in diagnose and therapy is safe and well tolerated, and there were relatively less complications in patients over 70 years old.
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Grassroots organizations of the party function as the center to advocate voluntary services.The hospital volunteer service campaign is considered part of the party's work at the grassroots level and as an indicator of its branch appraisal.volunteer ambassadors are employed to serve as role model for volunteer services.Party branch guides volunteer service teams to carry out voluntary services.And students,retiree party members actively participate in the campaigr.Outstanding ones are awarded and the management is improved.All these measures enable these organizations to play a spearhead role,encouraging volunteers and party members to promote each other,promoting healthy development of the campaign,and making volunteer services sustainable.
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The authors introduced,against the backdrop of the new round of accreditation,organization and practice of the hospital.In accordance with the five management elements of planning,organization,leadership,coordination and control,and the level management theory,the hospital divided,based on a top-down design and step-by-step implementation,the process into four stages of mobilization and deployment,study and training,self-assessment and rectification,supervised self-assessment and constant improvement.These efforts aim at exploring the key points and methodology of hospital accreditation,proposing such key points as the combination of the accreditation with building a long-term mechanism,that of theory with practice,that leadership with full staff involvement,that of top-down design with step-by-step implementation,that of training and rectification,that of self-assessment and supervision,and that of system management with implementation of provisions.This way the hospital accreditation may upgrade the hospital as a whole.
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ObjectiveTo study the effects of health education on quality of life in patients with osteoporotic fracture.MethodsFrom March 2006 to July 2011,240 patients with osteoporotic fracture admitted into our hospital were randomly divided into the intervention group (130 cases)and the control group( 110 cases).The control group only received routine nursing.The intervention group was applied with health education intervention based upon routine nursing.Bone mineral density were measured with dual energy X ray absorptiometry (DXA,DMS)in L2-4,neck of femur and total hip.MMSE.NIHSS,HAMD,FMA,Barthel index (BI)and WHOQOL-BREF were adopted for effect evaluation before and after three years of follow-up.ResultsAfter 3 years of follow-up,NIHSS and HAMD scores in the intervention group were lower than the control group,MMSE,FMA and BI scores were higher than those in the control group,physical,psychological,social and environmental scores in the intervention group were higher than those in the control group.ConclusionsHealth education for patients with osteopomtic fracture is conducive to patients′ rehabilitation and improvement of quality of life.
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Objective To investigate the efficacy and complications of therapeutic ERCP for patients over 80 years. Methods Data of 80 patients aging over 80 years, who tnderwent therapeutic ERCP from August 2007 to August 2009 were retrospectively studied. The etiology, complications and therapeutic effects were evaluated. Results A total of 51 patients (63. 8% ) were accompanied by cardiovascular diseases, and 43 patients were diagnosed as having malignant bile duct stricture (53. 8% ). The overail therapeutic efficacy was 96. 3%. The incidence of post-operative complications was 12. 5% (10/80). Occurrence of complications in patients with malignant tumors ( 18. 6% ) was significantly higher than that in patients with bile duct stones (5.6% ,P ＜0. 05). Incidence of complications in those with cardiopulmonary diseases was similar with that in patients without (11.8% vs. 13.8%,P＞0.05). Conclusion Age more than 80should not be considered as contraindication of ERCP. Therapeutic ERCP is effective in senior patients. Patients with advanced ages shows a relatively high incidence of complication after ERCP, which may not be related to other accompanying diseases.
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Objective To explore the status, characteristics and factors in relation to occupational stress for medical staffs in tertiary general hospitals. Methods A total of 2460 medical staff were sampled in five tertiary general hospitals in Beijing, with their occupational stress levels evaluated with the Occupational Stress Inventory. Results The top ten stressors as found ranked as heavy duty, high risk exposure, high workload, low wages, setbacks in the health care management system, insufficient staffing, excessively frequent inspections and examinations, strained doctor-patient relationship, price inflation, frequent overtime, and pressure from continuous learning. Occupational stress is seen as moderate and above by 95.2% of the surveyed. Differences in age, gender, marital status, professional title, education, work experience, as well as those of different organizations, departments, professions, and duty were found to be statistically significant in regard of professional stress. Conclusions Stress management should be in place targeting demographic and stress characteristics. Effective measures are recommended to alleviate the pressure on medical staff, in order to maintain their physical and mental health, hence improving their work efficiency and organizational cohesion.
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Objective To probe into the social support, coping styles, and mental health status of medical staff in a tertiary hospital in Beijing, for identifying potential mental problems. Methods Such means as the Social Support Rating Sheet (SSRS), Simple Coping Style Questionnaire (SCSQ), Symptom Checklist (SCL-90), and demographic characteristics questionnaire were called into play, to study 2460 medical staff in five tertiary hospitals in Beijing. Results Differences were identified among medical staff of different demographic characteristics, in terms of positive coping style and support dimensions. Analysis of the survey data indicates that the total SCL scores, total symptom problem index, positive symptom pain level, total average score of the factors, are positively related to passive coping style, as P<0. 01; and are negatively related to subjective/objective support, support utilization, and total support scores, as P<0. 01. Conclusions Hospital administration is expected to implement focused intervention to such medical staff as those under 40 years old, women, widows or divorcees, those with education lower than university degree, those with junior academic title or lower, those without titles, those in emergency departments and emergency intensive care units, doctors and nurses, frequent night-shift workers, those of excessively low self evaluation, and medical staff with chronic diseases. The purpose of this practice is to alleviate their mental stress.
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Objective: To investigate the biological significance of CerbB-2 expression in nasopharyn-geal carcinoma. Methods: The expression of CerbB-2 was detected in 90 nasopharyngeal carcinoma tissues and 22 nasopharyngitis tissues by SP immunohistochemical method. The relationship between CerbB-2 ex-pression and clinicopathological characteristics of nasopharyngeal carcinoma was investigated. Results: The positive expression rate of CerbB-2 protein was 65.56% in nasopharyngeal carcinoma tissues, and 31.82% in nasopharyngitis tissues, with a significant difference (P<0.05). The ratio of expression was 81.0% in patients of N_2 and N_3 lymth node stage, significantly different from that in patients of N_0 and N_1 lymph node stage (52.1%, P<0.05). The expression of CerbB-2 gene was not correlated with age, gender, clinical stage, T stage and distant metastasis of nasopharyngeal carcinoma (P>0.05). Conclusion: There is a high expression of CerbB-2 in nasopharyngeal carcinoma tissues, which might be an important event in the pathogenesis and progression of nasopharyngeal carcinoma.
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<p><b>BACKGROUND</b>To evaluate the efficacy and toxicity of the combination of gemcitabine and carboplatin in the treatment of patients with advanced non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Forty-one patients with locally advanced (stage IIIB) or metastatic (stage IV) NSCLC were enrolled into the study. The patients received gemcitabine 1 000 mg/m² on days l, 8 and 15, and carboplatin AUC 5 on day 1, with 28 days as a cycle. Each patient received at least two cycles.</p><p><b>RESULTS</b>Of the 41 patients, 2 cases got complete response, 18 got partial response, 15 had stable disease, and 6 had progressive disease, with an overall response rate of 48.8%. The response rate was 55.6% (10/18) in the initial patients, and 43.5% (10/23) in the retreated patients (P > 0.05). The median survival duration was 11.8 months. The 1-year survival rate was 49%. There were 29 patients whose KPS score increased. The main toxicities were leukopenia (incidence of 34.1% for grade III+IV) and thrombocytopenia (incidence of 29.3% for grade III+IV).</p><p><b>CONCLUSIONS</b>The combination of gemcitabine and carboplatin is a feasible, well-tolerated and active scheme in either first-line or second-line treatment of advanced NSCLC.</p>
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<p><b>BACKGROUND</b>To explore the significance of lung biopsy through CT-guided percutaneous paracentesis in the diagnosis of space-occupying lesions of the lung.</p><p><b>METHODS</b>Thirty-five patients with space occupying lesions of the lung underwent lung biopsy through CT-guided percutaneous paracentesis and DLTRA-CUT 16G, 18G or 20G soft-tissue-cutting biopsy needles and PICKER IQ computerized tomograph were used.</p><p><b>RESULTS</b>Of the 35 patients, 26 were confirmed by pathological examination to suffer from primary malignant tumor, 1 from metastatic carcinoma, 3 from tuberculosis and 3 from inflammatory pseudotumor. No definite diagnosis was made in two patients. The diagnostic rate was 94.3%. After operation, minor pneumothorax occurred in 5 cases and traces of blood in sputum in 2 cases, however, they didn't need any treatment.</p><p><b>CONCLUSIONS</b>Lung biopsy through CT-guided percutaneous paracentesis is a safe and practical technique and may be widely used in hospitals if conditions permit.</p>