Long-term outcomes of endoscopic papillary large-balloon dilation(12-15 mm)with or without limited sphincterotomy for removal of bile duct stones

Background:Limited endoscopic sphincterotomy with large balloon dilation(ES-LBD)and endoscopic papillary large-balloon dilation(EPLBD)have been proven safe and effective for removal of bile duct stones.However,the long-term outcomes are not clear.The aim of this study was to assess the long-term outcomes of EPLBD(12-15 mm)with or without limited sphincterotomy for removal of common bile duct(CBD)stones.Methods:Patients with EPLBD or ES-LBD referred for the removal of bile-duct stones between June 2008 and August 2020 were retrospectively reviewed.Complete stone clearance,endoscopic retrograde cholangiopancreatography(ERCP)-related adverse events,and late biliary complications during long-term follow-up were analyzed.Results:Basic patient characteristics were not significantly different between the groups that underwent EPLBD(n=168)and ES-LBD(n=57).EPLBD compared with ES-LBD resulted in similar outcomes in terms of overall successful stone removal(99.4%vs.100%,P=1.00)and ERCP-related adverse events(7.7%vs.5.3%,P=0.77).The mean duration of the follow-up were 113.6 months and 106.7 months for patients with EPLBD and ES-LBD,respectively(P=0.13).There was no significant difference between EPLBD and ES-LBD in the incidence of stone recurrence[20(11.9%)vs.9(15.8%);P=0.49].Multivariate analysis showed that a diameter of CBD≥15 mm(OR=3.001;95%CI:1.357-6.640;P=0.007)was an independent risk factor for stone recurrence.Conclusions:The application of a large balloon(12-15 mm)via EPLBD is an effective and safe alternative to ES-LBD for extraction of large CBD stones.Endoscopic sphincterotomy prior to EPLBD may be unnec-essary.A diameter of CBD≥15 mm is a risk factor of stone recurrence.

Prevalence of musculoskeletal symptoms among industrial employees in a modern industrial region in Beijing,China

Background:Growing industrialization of China exposes its labor population to the risk of musculoskeletal disorders(MSDs).This study aimed to investigate the prevalence and risk factors of MSDs in a modern industrial region of Beijing.Methods:A cross-sectional study included 1415 employees in six industrial companies was conducted between January 2018 and May 2018 in Fangshan district,Beijng,China.Nordic Musculoskeletal Questionnaire(NMQ)was used to collect the information about MSDs.Demographic factors,lifestyle factors,health and medical factors,and work-related factors were collected as independent variables.Descriptive statistics,the chi-squared(/2)test,and binary logistic regression analysis were used to analyze data.Results:Among 1415 participants,498 reported MSDs.The regions involved were the neck(25.16%),shoulders(17.17%),and upper back(13.29%).There was a significant statistical difference between frontline industrial workers and other staff in the prevalence of self-reported symptoms involving the shoulders(Х^2=4.33,P=0.037),wrists and hands(Х^2=8.90,P=0.003),and ankles and feet(Х^2=12.88,P<0.001).Increased age(P=0.005,OR=1.63;P=0.001,OR=2.33),a high or a low salary(P<0.001,OR=0.49;P<0.001,OR=0.30),night-shift(P=0.027,OR=1.46),two-week-history of illness and treatment(P=0.004,OR=5.60;P=0.013,OR=4.19),concurrent chronic diseases(P=0.001,OR=3.45;P=0.092,OR=7.81),limited access to health information(P=0.004,OR=0.49),and negative attitude towards seeking healthcare(P=0.010,OR=1.77;P=0.009,OR=2.75)were associated with MSDs in frontline workers.Female gender(P<0.001,OR=2.30),high education(P=0.001,OR=1.96),no exercises(P=0.027,OR=0.59),night-shift(P=0.017,OR=1.98),concurrent chronic diseases(P=0.002,OR=3.73;P=0.020,OR=13.42),limited access to health information(P=0.013,OR=0.53),far distance to medical institution(P=0.009,OR=1.83),and negative propensity(P=0.009,OR=1.94;P=0.014,OR=2.74)were associated with MSDs in other staffs.Conclusions:The prevalence of MSDs among industrial employees has changed.Frontline workers had different prevalence and risk factors for MSDs compared with other employees.Negative propensity to healthcare,limited ways to obtain health knowledge,and concomitant chronic diseases were associated with MSDs.Surprisingly,highly educated and high-income employees had a higher risk of MSDs.