Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones

BACKGROUND A clinical pathway(CP)is a standardized approach for disease management.However,big data-based evidence is rarely involved in CP for related common bile duct(CBD)stones,let alone outcome comparisons before and after CP implementation.AIM To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography(ERCP).METHODS This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017.The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care(non-pathway group,n=467)and CP care(pathway group,n=2196).RESULTS At baseline,the main differences observed between the two groups were the percentage of patients with multiple stones(P<0.001)and incidence of cholangitis complication(P<0.05).The percentage of antibiotic use and complications in the CP group were significantly less than those in the nonpathway group[adjusted odds ratio(OR)=0.72,95%confidence interval(CI):0.55-0.93,P=0.012,adjusted OR=0.44,95%CI:0.33-0.59,P<0.001,respectively].Patients spent lower costs on hospitalization,operation,nursing,medication,and medical consumable materials(P<0.001 for all),and even experienced shorter length of hospital stay(LOHS)(P<0.001)after the CP implementation.No significant differences in clinical outcomes,readmission rate,or secondary surgery rate were presented between the patients in the non-pathway and CP groups.CONCLUSION Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS,hospital costs,antibiotic use,and complication rate.

Evaluation of an ischemic model in ischemia prone and general Mongolian gerbils by neurological symptom, injury,and sex difference

Background: In the previous study, we established an ischemia-prone gerbil population(IG), which was selectively bred to increase the incidence of unilateral carotid arterial occlusion(UCO)-induced ischemia in Mongolian gerbils. However, if the characteristics of ischemia model in IG are the same as those in general gerbils(GG), and if the neurological symptoms are associated with the neurological insults in IG is still unclear.Methods: In the present study, we evaluated the UCO model in IG by analyzing neurological symptoms, neurological injury in the hippocampal CA1 region and compared with GG.Results: The data showed that the ratios of neurological symptom scores ≥ 2 in the IG and GG groups were 65.0% vs 30.0%, respectively, and were significantly different(P <.01).The neuronal damage following a UCO ischemic insult in the IG group was more severe compared to the GG group. There was a high correlation between the neurological insults' scale and the neurological symptom score in the IG and GG groups(r =.979 and.943 in the IG and GG groups, respectively). In animals with mild neurological symptom scores(2 and 3), the neuronal insults were significantly different between female and male gerbils in both IG and GG.Conclusion: Our findings suggest that IG population would likely be more advantageous to establish an ischemic model.

Circulating anti-Müllerian hormone as predictor of ovarian response to gonadotrophins in women with polycystic ovary syndrome

Objective To investigate the impact of high circulating anti-Müllerian hormone（AMH）on the outcome of ovulation induction using human menopausal gonadotropin（hM G）in women with polycystic ovary syndrome（PCOS）.Methods This prospective study included 63 anovulatory women with PCOS who underwent hM G ovarian stimulation. Serum AMH concentrations were compared between responders and non-responders. The receiver-operating characteristic（ROC）curve was used to evaluate the prognostic value of circulating AMH.Results hM G responders had a significantly lower serum AMH concentration compared with non-responders（8.43±2.18 μg/L vs 11.05±2.85 μg/L, P〈0.001）. In multivariate Logistic regression analysis, AMH was an independent predictor of ovulation induction by hM G in PCOS patients. ROC curve analysis showed AMH was a useful predictor of ovulation induction by hM G in PCOS patients, having 91.7% specificity and 66.7% sensitivity when the threshold AMH concentration was 10.12 μg/L.Conclusion Serum AMH can be used as an effective parameter to predict ovarian response to hM G treatment in PCOS patients.