Epidemiology and exposure management of rabies in Shanxi Province， 2011‒2022 / 上海预防医学

ObjectiveTo analyze the epidemiological features and influencing factors of rabies in Shanxi Province，and to provide evidence to further promote the elimination of rabies in Shanxi Province. MethodsThe incidence data of rabies in Shanxi from 2011 to 2022 were collected and subjected to descriptive analysis. ResultsFrom 2011 to 2022， a total of 348 rabies cases were reported in Shanxi Province， with an average annual incidence of 0.080 3/105. The incidence of rabies showed a downward trend overall. The highest incidence was in August. The cases were mainly farmers， mostly males， and most cases were reported between 50 and 69 years old. The data of cases showed that dogs were the main animals attacking human （93.96%）. The incubation period of most cases was 1‒3 months （37.37%）.The main exposure site was hand（51.33%）. Only 2.66% cases with grade Ⅲ exposure were injected with passive immune agents. ConclusionThe incidence of rabies in Shanxi Province continues to decrease， but there are still loopholes in prevention and control measures. It is necessary to strengthen the management and immunization of dogs，health education， and standardized procedures after exposure to maintain the achievements in the prevention and control of rabies.

The effect of feeding methods on fecal metabolites of infants delivered by cesarean section based on non-targeted metabolomics / 中华实用儿科临床杂志

Objective:To explore the effect of breast feeding versus mixed feeding on fecal metabolites of infants delivered by cesarean section.Methods:This was a cross-sectional study.Fecal samples were collected from 23 healthy 1-month-old infants delivered by cesarean section from autumn 2021 and winter 2022 in two maternal and infant care facilities in the North and South of Xi′an city.The samples were divided into the breast feeding group (11 cases) and mixed feeding group (12 cases). Fecal metabolites were analyzed by the non-targeted metabolomic approach and gas chromatography-mass spectrometry coupling, and differentially expressed fecal metabolites between groups were screened using the non-parametric Mann- Whitney U test.Metabolic pathways enriched in them were further analyzed. Results:A total of 155 metabolites were characterized, including 57 sugars and sugar derivatives, 34 fatty acids, 25 organic acids, 22 amino acids, 8 esters, 4 nucleosides, 3 vitamins and 2 other substances.The relative contents of the differentially expressed fecal metabolites were measured, and it was found that some types of sugars and sugar derivatives were highly expressed in the fecal samples of breast feeding group, while amino acids, organic acids and fatty acids were highly expressed in those of the mixed feeding group.A total of 28 metabolic pathways enriched in differentially expressed fecal metabolites were obtained.Among them, alanine, aspartic acid and glutamic acid metabolism, valine, leucine and isoleucine metabolism, arginine metabolism and the tricarboxylic acid (TCA) cycle influenced infant health.Conclusions:Feeding methods have an effect on the fecal metabolites in infants delivered by cesarean section born infants, and mixed feeding may speed up the process of TCA cycle and amino acid metabolism in the intestine of infants delivered by cesarean section to a certain extent.

Lung protective effect of driving pressure-guided lung protective ventilation strategy combined with pressure-controlled ventilation in elderly patients undergoing thoracoscopic radical resection of lung cancer / 肿瘤研究与临床

Objective:To investigate the lung protective effect of driving pressure-guided lung protective ventilation strategy (LPVS) combined with pressure-controlled ventilation (PCV) in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods:One hundred elderly patients scheduled for thoracoscopic radical resection of lung cancer from April 2021 to April 2022 in the Second Hospital of Shanxi Medical University were selected. Patients were aged 60-80 years old and American Society of Anesthesiologists (ASA) classification Ⅰ-Ⅱ. All patients were divided into 4 groups by using the random number table method, with 25 cases in each group. Group A received volume-controlled ventilation (VCV) + 5 cm H 2O (1 cm H 2O = 0.098 kPa) PEEP, group B received PCV+5 cm H 2O PEEP, group C received VCV+driving pressure-guided individualized PEEP, and group D received PCV+driving pressure-guided individualized PEEP. The arterial oxygen partial pressure (PaO 2) was recorded before one-lung ventilation (OLV) (T 0), 30 min after OLV (T 1) and 60 min after OLV (T 2). The serum concentrations of neutrophil elastase (NE) in radial artery blood samples of patients were measured at T 0 and 10 min after the end of OLV (T 3). The occurrence of postoperative pulmonary complications (PPC) within 5 d after surgery was recorded. Results:The PaO 2 of group A and B at T 1 [(135±50), (146±51) mmHg (1 mmHg = 0.133 kPa)] and T 2 [(137±46), (143±47) mmHg] were lower than those of group C and group D at T 1 [(168±27), (190±30) mmHg] and T 2 [(180±30), (183±24) mmHg] (all P < 0.05). The incidence of PPC within 5 d after surgery in group A was higher than that in group D [36% (9/25) vs. 4% (1/25)] ( P = 0.005). The concentration of NE at T 3 in group A [(202.8±9.7) ng/ml] was lower than that in group B, C and D [(182.5±12.0), (180.0±10.3), (160.6±13.0) ng/ml] ( P < 0.05). Conclusions:During OLV, driving pressure-guided LPVS combined with PCV can not only improve oxygenation, but also show obvious advantages in reducing inflammatory response. It is a safe and effective intraoperative ventilation strategy for elderly patients undergoing thoracoscopic radical resection of lung cancer.

OCTN2 gene polymorphisms affect the chemotherapeutic sensitivity of oxaliplatin in colorectal cancer / 中国临床药理学与治疗学

AIM: To explore the effect of OCTN2 gene polymorphism on the expression and function of OCTN2, as well as the sensitivity of SW480 cells to oxaliplatin. METHODS: Four mutations of OCTN2 (F17L, E317K, S467C and P478L) transfected cell lines were constructed. Real-time RT-PCR and Western blot were used to detect the levels of OCTN2 mRNA and protein. The content of oxaliplatin was detected by HPLC. MTS assay was used to detect cell viability. RESULTS: The expression level of all mutant OCTN2 mRNA and protein was not significantly different from that of wild-type OCTN2. Oxaliplatin uptake experiments showed that there was no significant difference in V

Study on the relationship between pre-pregnancy vitamin D level and pregnancy outcome in unexplained recurrent spontaneous abortion / 中国医师杂志

Objective:To investigate the pre-pregnancy vitamin D level and pregnancy outcome in patients with unexplained recurrent spontaneous abortion (URSA).Methods:A prospective study was performed in 4 534 patients with URSA from May 2017 to April 2019 at Shanghai First Maternity and Infant Health Hospital Affiliated to Tongji University. The serum Vitamin D levels was obtained before pregnancy. Pregnancy complications and newborns outcomes were recorded after pregnancy.Results:The serum vitamin D level of patients with URSA before pregnancy was (42.22±16.27)nmol/L, and the proportions of vitamin D deficiency, insufficiency and sufficiency were 72.3%, 24.0 %, and 3.7%, respectively. The Vitamin D level was positively correlated with age ( P<0.05); The age of vitamin D<50 nmol/L group was lower than that of vitamin D≥50 nmol/L group ( P<0.05); patients with vitamin D<50 nmol/L had higher proportion of spontaneous abortions ≥3 times than those with the vitamin D≥50 nmol/L ( P<0.05); The level of vitamin D was negatively correlated with the ratio of CD3 + CD4 + T cells in peripheral blood ( P<0.05); In multivariate logistic regression analysis, the final model adjusted for age, abortion frequency and season. The risk of pregnancy failure was increased in vitamin D <50 nmol/L group [30.6%(76/248) vs 17.9%(12/67), χ 2=3.67, P=0.02], OR=2.02(95% CI: 1.02-3.9); In the group of vitamin D<50 nmol/L before pregnancy, the risk of newborns entering NICU was increased, OR=3.16(95% CI: 1.15-8.65). Conclusions:Vitamin D deficiency is prevalent in URSA patients before pregnancy, which correlates with the times of previous spontaneous abortions and recurrent pregnancy failure. Vitamin D deficiency before pregnancy is one of the high-risk factors for URSA.

Application of endoscopic ultrasonography guided reverse dissection for refractory benign esophageal stricture / 中华消化内镜杂志

Objective:To study the effect and safety of endoscopic ultrasonography guided reverse dissection for refractory benign esophageal stricture.Methods:Seventeen patients with refractory benign esophageal stricture were selected for endoscopic ultrasonography guided reverse dissection in Shunde Hospital, Southern Medical University from January 2016 to December 2019. The clinical data including operation success rate, complications and clinical efficacy were analyzed.Results:All 17 patients were successfully treated with endoscopic ultrasonography guided reverse dissection. The operating time was 38.82±24.27 minutes. No serious complications such as major bleeding, perforation, and infection were found during and after the operation. The follow-up time ranged from 3 to 44 months. Four patients had symptoms of dysphagia again at 3, 12, 18, and 26 months after operation, and re-examination of gastroscopy revealed recurrent esophageal stenosis. The rest of the patients did not re-stenosis until the last time of follow-up.Conclusion:Endoscopic ultrasonography guided reverse dissection is a safe and effective treatment for refractory benign esophageal stricture.

Reasons and endoscopic management for proximally migrated pancreatic stents / 中华消化内镜杂志

Objective:To explore the reasons of the proximal migration of pancreatic stents and the endoscopic management.Methods:From April 2007 to January 2015, of all 967 patients with biliopancreatic diseases implanted with pancreatic duct plastic stents at the First Affiliated Hospital of Nanchang University, proximal migration occurred in 10 cases. Migrated rates and endoscopic retrieval methods of pancreatic straight stents and single pigtail stents were compared.Results:Pancreatic straight stents showed a higher migration rate than those single pigtail ones [3.23% (7/217) VS 0.40% (3/750)]. For 3 migrated single pigtail pancreatic stents: 2 were directly removed with biopsy forceps. Another failed in retrieval, and the same stent then was implanted. There was no discomfort after the operation. For 7 migrated pancreatic straight stents: 2 were pulled out of duodenum papilla incision under wire-guided balloon and basket. Five others were pulled out of papilla under wire-guided balloon, and then the stents were removed by a snare.Conclusion:Pancreatic straight stents are more likely to migrate compared with single pigtail stents. Migrated pancreatic straight stents can be removed with wire-guided balloon or basket and snare, while migrated single pigtail stents can be directly retrieved with biopsy forceps.

The validity and reliability of the Chinese version of Connor Davidson Resilience Scale in schizophrenia / 中国实用护理杂志

Objective:To test the factor structure and psychometric properties of the Chinese version of the Connor Davidson Resilience Scale (CD-RISC) in schizophrenia patients. In order to provide resilience scale for schizophrenia patients in China.Methods:A convenient sampling method was used to select 503 inpatients with schizophrenia in Chifeng Anding hospital from December 2017 to December 2018. The Chinese version of CD-RISC was used to conduct a questionnaire survey. Data processing was performed using SPSS 23.0 statistical software and AMOS 24.0 software.Results:The item analysis showed that the Chinese version of CD-RISC could discriminate the high-score group from the low-score group ( P<0.01). Pearson correlation analysis and principal component analysis showed that the correlation between item 3 and the total amount was poor, and it was considered to be deleted. A total of 6 common factors were extracted from the revised exploratory factor analysis of the CD-RISC, and the cumulative variance contribution rate was 50.79%. The Cronbach α coefficient was 0.882, and the test-retest reliability was 0.912 after two weeks. Confirmatory factor analysis fitted index: χ2/ df was 1.057, RMSEA was 0.015, GFI was 0.926, CFI was 0.989, and IFI was 0.989. Conclusions:The revision 24-item CD-RISC has good psychometric properties, it could be used to assess resilience in Chinese patients with schizophrenia.

Value of three-dimensional multi-slice spiral computed tomography imaging in the diagnosis and activity evaluation of Crohn's disease / 中国医师杂志

Objective@#To evaluate the diagnostic value of three-dimensional multi-slice spiral computed tomography (CT) imaging in Crohn's disease(CD) of small intestine and its active and remission stages.@*Methods@#The clinical and CT data of 34 patients with Crohn's disease confirmed by digestive endoscopy were retrospectively analyzed. According to whether the lesions were active, the patients were divided into active group (25 cases) and remission group (9 cases). The difference of CT signs between the two groups was compared. Chi square test was used to evaluate the diagnostic efficiency of CT three-dimensional imaging for polyps and their activity evaluation of Crohn's disease.@*Results@#The incidences of intestinal wall stratification, moderate enhancement, severe enhancement, ulcer, cellulitis, lymph node enlargement and wood comb sign in active group were higher than those in remission group (χ2=20.193, 9.018, 4.986, 3.947, 9.551, 4.986, 6.766, 4.986 respectively, P<0.05). The incidence of intestinal wall monolayer thickening, non-enhancement, mild enhancement and abdominal abscess in remission group was higher than that in active group, with significant difference (χ2=15.092, 13.768, 25.336, 16.996, P<0.05). while there were no significant difference between the two groups in the incidence of pneumoperitoneum, intestinal stenosis and enlargement (P>0.05).@*Conclusions@#Spiral CT three-dimensional reconstruction imaging can show the intestinal wall thickening, intestinal lesions and parenteral complications of Crohn's disease comprehensively, carefully and intuitively, and play an important role in guiding clinical treatment by evaluating the active and remission stages of CD.

Estimates of influenza-associated excess mortality by three regression models in Shanxi Province during 2013-2017 / 中华预防医学杂志

Objective@#Using three models too estimate excess mortality associated with influenza of Shanxi Province during 2013-2017.@*Methods@#Mortality data and influenza surveillance data of 11 cities of Shanxi Province from the 2013-2014 through 2016-2017 were used to estimate influenza-associated all cause deaths, circulatory and respiratory deaths and respiratory deaths. Three models were used: (i) Serfling regression, (ii)Poisson regression, (iii)General line model.@*Results@#The total reported death cases of all cause were 157 733, annual death cases of all cause were 39 433, among these cases, male cases 93 831 (59.50%), cases above 65 years old 123 931 (78.57%). Annual influenza-associated excess mortality, for all causes, circulatory and respiratory deaths, respiratory deaths were 8.62 deaths per 100 000, 6.33 deaths per 100 000 and 0.68 deaths per 100 000 estimated by Serfling model, respectively; and 21.30 deaths per 100 000, 16.89 deaths per 100 000 and 2.14 deaths per 100 000 estimated by General line model, respectively; and 21.76 deaths per 100 000, 17.03 deaths per 100 000 and 2.05 deaths per 100 000, estimated by Poisson model, respectively. Influenza-related excess mortality was higher in people over 75 years old; influenza-associated excess mortalityfor all causes, circulatory and respiratory deaths, respiratory deaths were 259.67 deaths per 100 000, 229.90 deaths per 100 000 and 32.63 deaths per 100 000, estimated by GLM model, respectively; and 269.49 deaths per 100 000, 233.69 deaths per 100 000 and 31.27 deaths per 100 000, estimated by Poisson model,respectively.@*Conclusion@#Excess mortality associated with influenza mainly caused by A (H3N2), Influenza caused the most associated death amongold people.

Value of three-dimensional multi-slice spiral computed tomography imaging in the diagnosis and activity evaluation of Crohn's disease / 中国医师杂志

Objective To evaluate the diagnostic value of three-dimensional multi-slice spiral computed tomography (CT) imaging in Crohn's disease(CD) of small intestine and its active and remission stages.Methods The clinical and CT data of 34 patients with Crohn's disease confirmed by digestive endoscopy were retrospectively analyzed.According to whether the lesions were active,the patients were divided into active group (25 cases) and remission group (9 cases).The difference of CT signs between the two groups was compared.Chi square test was used to evaluate the diagnostic efficiency of CT three-dimensional imaging for polyps and their activity evaluation of Crohn's disease.Results The incidences of intestinal wall stratification,moderate enhancement,severe enhancement,ulcer,cellulitis,lymph node enlargement and wood comb sign in active group were higher than those in remission group (x2 =20.193,9.018,4.986,3.947,9.551,4.986,6.766,4.986 respectively,P ＜ 0.05).The incidence of intestinal wall monolayer thickening,non-enhancement,mild enhancement and abdominal abscess in remission group was higher than that in active group,with significant difference (x2 =15.092,13.768,25.336,16.996,P ＜0.05).while there were no significant difference between the two groups in the incidence of pneumoperitoneum,intestinal stenosis and enlargement (P ＞ 0.05).Conclusions Spiral CT three-dimensional reconstruction imaging can show the intestinal wall thickening,intestinal lesions and parenteral complications of Crohn's disease comprehensively,carefully and intuitively,and play an important role in guiding clinical treatment by evaluating the active and remission stages of CD.

Safety analysis of endoscopic retrograde cholangio-pancreatography under general anesthesia in 14 724 patients / 中华消化杂志

Objective To evaluate the safety of anesthesia endoscopic retrograde cholangio pancreatography (ERCP) under general anesthesia.Methods From January 1st,2008 to June 30th,2016,patients underwent ERCP under general anesthesia were enrolled as anesthesia group and from January 1st,2005 to December 31st,2007,patients accepted ERCP without anesthesia were enrolled as control group.Chi-square test was performed to analyze disease composition,conditions during operation,success rate of operation and complications in these two groups.Results A total of 14 724 patients with ERCP under general anesthesia and 2 102 patients received ERCP without anesthesia were enrolled.In 14 724 patients with ERCP under general anesthesia,1 799 cases had malignant biliary and pancreatic diseases and 12 925 cases with biliary and pancreatic diseases.During the operation,transient hypoxemia occurred in 441 cases (3.00％) and relieved by increasing oxygen flow,lower anesthetic dose or lifting lower jaw.The success rate of ERCP in the anesthesia group (98.41 ％,14 490/14 724) was higher than that in the control group (97.34％,2 046/2 102),and the difference was statistically significant (x2 =11.500,P=0.001).The incidence rate of post-ERCP pancreatitis in the anesthesia group was 2.35％ (346/14 724),which was lower than that in the control group (3.85％,81/2 102),and the difference was statistically significant (x2 =16.813,P＜0.01).Conclusion ERCP under general anesthesia is safe,which could increase the success rate of operation and reduce the incidence rate of post-ERCP pancreatitis.

Endoscopic submucosal dissection and gastrectomy for early gastric cancer: a Meta-Analysis / 中国内镜杂志

Objective To compare the difference of the effects and safety of endoscopic submucosal dissection (ESD) and surgery for early gastric cancer. Methods We searched the Pubmed, CBM, Embase, Cochrane Library, CNKI, CQVIP and WanFang data from January 1990 to June 2016 studies comparing endoscopic resection with gastrectomy for treatment of early gastric cancer. We selected the eligible studies according the including and excluding criteria. The quality of the included studies was assess using the Newcastle-Ottawa Scale (NOS), then using Revman 5.3 to make the Meta analysis. Result The meta-analysis enrolled 12 studies with 4331 patients, all of the studies were retrospectively analyzed. The result of the meta-analysis showed that there were no significant difference regarding the recurrence rate [(22/2586, 0.85%) vs (6/1134, 0.53%), P = 0.370] and five-year survival rate [(852/909, 93.72%) vs (707/746, 94.77%), P = 0.340] between endoscopic resection and gastrectomy. Gastrectomy was associated with higher en bloc resection rate, which were 100.00% and 92.23% respectively. However, gastrectomy was also related to longer operative time (SMD = -3.04, 95%CI: -3.64 ~ -2.45, P = 0.000) and hospital stay (SMD = -2.53, 95%CI: -3.73 ~ -1.32, P = 0.000). The postoperative complication was also higher than endoscopic, which were (45/816, 5.50%) vs (101/686, 14.72%) respectively. Conclusion There were no significant difference regarding recurrence rate and five-year survival rate between endoscopic and gastrectomy. While the en bloc resection rate was lower than gastrectomy, endoscopic offers a shorter hospital stay, shorter operative time with minimal invasive and fewer operating and postoperative complications than gastrectomy. Endoscopic should be recommended as a standard treatment for early gastric cancer with indications.

Risk evaluation of endoscopic retrograde cholangiopancreatography for elder patients / 中华消化内镜杂志

Objective To evaluate the safety of endoscopic retrograde cholangiopancreatography (ERCP) for elder patients (age more than or equal to 80 years).Methods Data of 464 patients (age ≥ 80 years) who underwent ERCP procedures from June 2008 to June 2014 in the First Affiliated Hospital of Nanchang University were compared with those of patients less than or equal to 60 years old,randomly chosen at 1∶4,for comorbidity,feature of disease distribution,intraoperative situation and postoperative complications of ERCP.Results The comorbidity rates of coronary heart disease,hypertension,chronic pulmonary disease and type 2 diabetes in observation group were significantly higher than those in the control group(P＜0.05),but there was no significant difference between two groups regarding to the comorbidity rate of arrhythmia(P =0.111).The main feature of disease distribution in two groups was choledocholithiasis,but the rate of malignant tumor in observation group was higher than that in the control group(P＜0.05).The success rate of ERCP showed no significant difference in two groups (98.92％ VS 99.35％,P=0.358).There was no significant difference between the two groups in the complication rates of acute pancreatitis (4.96％ VS 3.18％,P =0.064),infection (0.43％ VS 0.54％,P =1.000) and hemorrhage (1.08％ VS 0.59％,P=0.259).However the rate of perforation in observation group was lower than that in the control group (0.43％ VS 0.05％,P =0.043).Conclusion ERCP is safe and effective for elder patients.

A meta-analysis of diffusion tensor imaging for diagnosis of early radiation-induced brain injury / 中华放射肿瘤学杂志

Objective To analyze the diagnostic value of diffusion tensor imaging (DTI) for early radiation-induced brain injury.Methods We searched CNKI and PubMed and included articles according to the PRISMA statement.FA value, λ||, and λ丄 were pooled, and Forest plot generation, cumulative analysis, sensitivity analysis, and regression analysis were performed.We also used the funnel plot to analyze publication bias.Results A total 11 studies were included for meta-analysis.The results of FA value heterogeneity test were as follows:P=0.000, I2=93.6% in China;P=0.004, I2=82.2% in other countries and regions;P=0.000, I2=91.5% in all regions.The regression analysis of time-dose dependence and study design showed significant and non-significant associations, respectively, with the heterogeneity of these studies (adjusted P=0.026, P=0.005;adjusted P=0.859, P=0.908).The results of λ||and λ丄 heterogeneity tests were as follows:P=0.908, I2=0.0%;P=0.100, I2=56.6%.There was a sign of publication bias by Egger's test (coefficient:-6.26, 95%CI:-9.31 to-3.20, P=0.001) and Begg's test (P=0.004).Conclusions DTI-derived metrics are sensitive and reliable in the diagnosis of early radiation-induced brain injury.

Evaluation of the value of resting state BOLD-fMRI in radiation-induced brain injury after nasopharyngeal carcinoma radiotherapy / 实用放射学杂志

Objective To analyze the value of resting state BOLD-fMRI in the early diagnosis of brain injury after nasopharyngeal carcinoma radiotherapy.Methods Four groups of nasopharyngeal carcinoma patients,including before radiotherapy group (G0),0-3 months after radiotherapy group (G1), 3-6 months after radiotherapy group (G2) and 6-9 months after radiotherapy group (G3),were underwent a resting state BOLD-fMRI scan, and Matlab software DPARSF tool was used to analyze and postprocess the data based on G1-G0,G2-G0,G3-G0,G2-G1,G3-G2 and G3-G1.Results Compared with the G0 group,the activity of bilateral hippocampus and temporal lobes was decreased in G1 and G2 groups,and the decreased degree in G2 group was smaller than that in G1 group.Compared with G1 group,brain metabolic activity increased in G2 and G3 group,but did not return to the initial level before radiotherapy.Conclusion Abnormal changes of resting state BOLD-fMRI have an important clinical significance in early diagnosis of radiation-induced brain injury after nasopharyngeal carcinoma radiotherapy.

Research progress of functional magnetic resonance imaging in radiation-induced brain injury after head and neck carcinoma radiotherapy / 中华放射肿瘤学杂志

Radiation?induced brain injury is a common adverse reaction to radiotherapy for head and neck carcinoma, and may develop into radiation?induced brain necrosis in some patients. The disease has a substantial impact on the quality of life and 5?year survival in patients. Early diagnosis and prevention are important for the clinical treatment of radiation?induced brain injury. On the other hand, recurrence and pseudoprogression as complications of malignant tumor radiotherapy are also key problems for clinical diagnosis and identification of radiation?induced brain injury. Magnetic resonance imaging ( MRI) , especially functional MRI, provides an important approach for basic and clinical studies of radiation?induced brain injury.

Risk factors for ERCP-related complications:a review of 1 951 cases / 中华消化内镜杂志

Objective To investigate the risk factors for post-ERCP complications. Methods Data of the patients who underwent ERCP in the First Affiliated Hospital of Nanchang University from 1 January 2011 to 31 December 2013 were retrospectively analyzed. Post-ERCP complications were analyzed by univariate and multivariate analyses. Results A total of 277 patients out of 1 951 developed complications, 101(5.18%)pancreatitis, 54(2.77%)hyperamylasemia(not including pancreatitis), 134(6.87%) biliary infection,8(0.41%)hemorrhage,1(0.05%)obstruction and 1(0.05%)perforation.Multivariate analyses showed cholangiocarcinoma(P=0.002,OR=2.39, 95% CI:1.38-4.14), long operation time(>60 min)(P=0.020,OR=3.77,95%CI:1.23-11.53)and endoscopic sphincterotomy(EST)(P=0.008, OR=2.56,95% CI:1.28-5.14)and entrance of guidewire to pancreatic duct(P=0.012,OR=1.43, 95%CI:1.08-1.87)were independent risk factors for PEP. Cholangiocarcinoma(P<0.01, OR=2.93, 95%CI:1.88-4.56),multiple times of ERCP during the period of hospitalization(P<0.01, OR=2.53, 95%CI:1.63-3.93)were independent risk factors for post-cholangitis. However, EST(P=0.03, OR=0.65,95%CI:0.44-0.97)and antibiotics prophylaxis after ERCP(P=0.03, OR=0.64, 95% CI:0.39-0.95)were protective factors for post-cholangitis. ConclusionCholangiocarcinoma, endoscopic sphincterotomy, long operation time(> 60 min)and entrance of guidewire to pancreatic duct were independent risk factors for PEP. Cholangiocarcinoma and multiple ERCP during the period of hospitalization are independent risk factors for post-cholangitis.EST and antibiotics prophylaxis after ERCP might reduce the occurrence of cholangitis.

Value of antibiotic prophylaxis after endoscopic retrograde cholangio-pancreatography / 中华消化杂志

Objective To investigate the effects of antibiotic prophylaxis on post-operation complications after endoscopic retrograde cholangio-pancreatography (ERCP).Methods From January 1st,2011 to December 31st,2013,1 951 patients undergoing ERCP were enrolled and divided into postoperative antibiotic prophylaxis group (antibiotics group,630 cases) and postoperative non-antibiotic treatment group (non-antibiotics group,1 321 cases).Complications after ERCP were compared between the two groups.Chi square test,single factor analysis and multiple factor analysis were performed for statistical analysis.Results Among the 1 951 patients,277 patients had postoperative complications:101 patients (5.18％) with post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP),54 patients (2.77％) with hyperamylasemia,134 patients (6.87％) with biliary infection,eight patients (0.41％) with hemorrhage,one patient (0.05％) with intestinal obstruction and one patient (0.05％) with perforation.The incidence of postoperative biliary infection of antibiotics group was 4.44％ (28/630),which was lower than that of non-antibiotics group (8.02％,106/1 321),and the difference was statistically significant (x2 =8.546,P =0.030).The incidences of PEP of antibiotics group and nonantibiotics group were 4.92％ (31/630) and 5.30％ (70/1 321),respectively.The incidences of postoperative hyperamylasemia of antibiotics group and non-antibiotics group were 3.02％oo (19/630) and 2.65％ (35/1 321),respectively.The incidences of upper gastrointestinal hemorrhage were 3.02％ (19/630) and 2.65％ (35/1 321),respectively.The incidences of intestinal obstruction were 0 (0/630) and 0.08％ (1/1 321),respectively,while the incidences of perforation post-operation were 0.16％ (1/630) and 0 (0/1 321),respectively,and the differences were not statistically significant (all P＞0.05).Cholangiocarcinoma (odd ratios (OR)=2.93,95％ confidence interval (CI) 1.88 to 4.56,P＜0.01) and repeated ERCP during hospitalization (OR=2.53,95 ％ CI 1.63 to 3.93,P＜0.01) were the independent risk factors of cholangitis after operation.However,endoscopic sphincterotomy (OR=0.65,95 ％ CI 0.44 to 0.97,P =0.030) and antibiotics prophylaxis (OR =0.64,95％ CI 0.39 to 0.95,P =0.030) were the protective factors.Conclusions Antibiotic prophylaxis after ERCP can reduce the occurrence of postoperative cholangitis.Paitents with cholangiocarcinoma,repeated ERCP procedures during hospitalization or without endoscopic sphincterotomy should be recommended for antibiotic prophylaxis.

Current status of diagnosis and treatment of IgG4-related sclerosing cholangitis / 临床肝胆病杂志

In recent years, many reports on the diagnosis and treatment of IgG4-related sclerosing cholangitis have been published in China and foreign countries, but due to the small number of cases, there are few large-scale controlled clinical trials. Therefore, this article reviews the literature on the diagnosis and treatment of IgG4-related sclerosing cholangitis and points out that the diagnosis of IgG4-related sclerosing cholangitis needs complete clinical data and comprehensive pathological examinations, and its treatment relies on glucocorticoids and immunosuppressants.