Associations between multiple metal exposure and fertility in women: A nested case-control study.

Metal pollution can cause a decline in female fertility, however, previous studies have focused more on the effect of a single metal on fertility. In this study, we evaluated the effect of metal mixtures on female fertility based on nested case-control samples. The plasma levels of 22 metal elements from 180 women were determined by an inductively coupled plasma mass spectrometer (ICP-MS). Minimum absolute contraction and selection operator (LASSO) penalty regression selected metals with the greatest influence on clinical outcome. Logistic regression was used to analyze the correlation between single metals and fertility while a Bayesian kernel function regression (BKMR) model was used to analyze the effect of mixed metals. Eight metals (Calcium (Ca), Chromium (Cr), Cobalt (Co), Copper (Cu), Zinc (Zn), Rubidium (Rb), Strontium (Sr) and Zirconium (Zr)) were selected by LASSO regression for subsequent analysis. After adjusting for covariates, the logistic model showed that Cu (Odds Ratio(OR):0.33, 95% CI: 0.13 - 0.84) and Co (OR:0.38, 95% CI: 0.15 -0.94) caused a significant reduction in fertility, and identified the protective effect of Zn (OR: 2.96, 95% CI:1.21 -7.50) on fertility. Trend tests showed that increased Cr, Cu, and Rb levels were associated with reduced fertility. The BKMR model showed that Cr, Co, Cu, and Rb had a nonlinear relationship with fertility decline when controlling for the concentrations of other metals and suggested that Cu and Cr might exert an influence on fertility. Analysis showed a negative correlation between Cu, Cr, Co, Rb, and fertility, and a positive correlation between Zn and fertility. Furthermore, we found evidence for the interaction between Cu and Cr. Our findings require further validation and may identify new mechanisms in the future.

Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors.

BACKGROUND: The management and nursing care of women's temperature during delivery is an important part of clinical obstetrics. We aimed to evaluate maternal intrapartum fever during epidural labour analgesia to provide evidence for the management and care of women in labour. METHODS: This study was conducted and reported according to the STROBE statement. Women in labour undergoing epidural labour analgesia in our hospital from 1 January 2021 to 31 August 2022 were retrospectively selected. The characteristics of women in labour with and without intrapartum fever were compared. Pearson correlation and logistic regression analysis were used to analyse the influencing factors of postpartum fever. RESULTS: A total of 196 women in labour were included, the incidence of maternal intrapartum fever in women in labour undergoing epidural analgesia was 27.5%. Pearson correlation analyses showed that BMI, oxytocin use, labour duration, number of vaginal examinations, time from rupture of the foetal membranes to the end of labour and duration of epidural analgesia were all correlated with the occurrence of intrapartum fever (all P < 0.05). Logistic regression analyses indicated that body mass index ≥28 kg/m2 (OR = 1.825), oxytocin use (OR = 2.082), labour duration ≥9.2 h (OR = 2.613), number of vaginal examinations ≥8 (OR = 2.044-3.115), the time from rupture of the foetal membranes to the end of labour ≥250 min (OR = 2.766) and duration of epidural analgesia ≥300 min (OR = 3.106) were risk factors for intrapartum fever in women in labour undergoing epidural analgesia (all P < 0.05). CONCLUSIONS: Maternal intrapartum fever in women in labour undergoing epidural analgesia is common and influenced by many factors. Nurses should take early preventive care measures according to these factors during epidural analgesia in labour.

[The neural basis underlying primary dysmenorrhea: evidence from neuroimaging and animal model studies].

Primary dysmenorrhea (PDM), cyclic menstrual pain in the absence of pelvic anomalies, is characterized by acute and chronic gynecological pain disorders in childbearing age women. PDM strongly affects the quality of life of patients and leads to economic losses. PDM generally do not receive radical treatment and often develop into other chronic pain disorders later in life. The clinical treatment status of PDM, the epidemiology of PDM and chronic pain comorbidities, and the abnormal physiological and psychological characteristics of patients with PDM suggest that PDM not only is related to the inflammation around the uterus, but also may be related to the abnormal pain processing and regulation function of patients' central system. Therefore, exploring the brain neural mechanism of PDM is indispensable and important to understand the pathological mechanism of PDM, and is also a hotspot of brain science research in recent years, which will bring new inspiration to explore the target of PDM intervention. Based on the progress of the neural mechanism of PDM, this paper systematically summarizes the evidence from neuroimaging and animal model studies.

Temporal variation of heavy metals in sewage sludge in typical cities in Gansu Province, northwest China.

To investigate the temporal behaviors of heavy metals in sewage sludge in typical cities of industrial, industrial-agricultural, agricultural, or energy focused. Samples were collected every 10 days for a period of 1 year in four types of cities of Lanzhou, Tianshui, Qingyang, and Zhangye. The average annual values for all four cities were Cd (1.59-3.16 mg/kg), Pb (41.9-55.1 mg/kg), Cr (63.8-92.0 mg/kg), Cu (75.7-92.6 mg/kg), Zn (498-612 mg/kg), and Ni (3.66-4.25 mg/kg). The highest values were observed in June for Cd, Cr, and Zn, at Lanzhou and Tianshui. At Qingyang and Zhangye, the Cd, Cr, and Zn contents were stable throughout the year. There was a similar monthly change among the four cities regarding the levels of Ni content, and it was far below the background value. The monthly fluctuations in Cd, Pb, Cr, and Zn are mainly due to street dust effect. For cities with a developed industry, the impact of street dust during the first rains of the year on sewage sludge's heavy metal content must be highlighted as being of particular importance.

CDC Like Kinase 2 plays an oncogenic role in colorectal cancer via modulating the Wnt/ß-catenin signaling.

Colorectal cancer (CRC) is a common malignant tumor with high morbidity and mortality, and significant heterogeneity among patients. In this study, we aimed to explore the role and mechanism of CLK2 in CRC, a kinase that phosphorylates SR proteins involved in splicing. Based on the analysis from The Cancer Genome Atlas (TCGA) dataset and tissue microarray, we found that CLK2 was upregulated in CRC tissues and associated with a higher tumor stage and poorer overall survival. Consistent with the bioinformatics analysis, the functional experiments validated that CLK2 acted as a tumor-promoting factor in CRC progression. CLK2 knockdown suppressed aggressive cell proliferation, migration, and invasion in vitro, as well as restrained tumor growth in vivo. In terms of mechanism, we found that the Wnt/ß-catenin signaling pathway was responsible for the CLK2-induced CRC progression, based on the results of pathway enrichment analysis and subsequent experimental validation. Thus, our study, for the first time, identified the role of CLK2 in CRC development and provided a compelling biomarker for targeted therapy in CRC treatment.

Comparison of Venous Thromboembolism Risks Between COVID-19 Pneumonia and Community-Acquired Pneumonia Patients.

OBJECTIVE: The objectives were to investigate and compare the risks and incidences of venous thromboembolism (VTE) between the 2 groups of patients with coronavirus disease 2019 (COVID-19) pneumonia and community-acquired pneumonia (CAP). Approach and Results: Medical records of 616 pneumonia patients who were admitted to the Yichang Central People's Hospital in Hubei, China, from January 1 to March 23, 2020, were retrospectively reviewed. The patients with COVID-19 pneumonia were treated in the dedicated COVID-19 units, and the patients with CAP were admitted to regular hospital campus. Risks of VTE were assessed using the Padua prediction score. All the patients received pharmaceutical or mechanical VTE prophylaxis. VTE was diagnosed using Duplex ultrasound or computed tomography pulmonary angiogram. Differences between COVID-19 and CAP groups were compared statistically. All statistical tests were 2 sided, and P<0.05 was considered as statistically significant. All data managements and analyses were performed by IBM SPSS, version 24, software (SPSS, Inc, Chicago, IL). Of the 616 patients, 256 had COVID-19 pneumonia and 360 patients had CAP. The overall rate of VTE was 2% in COVID-19 pneumonia group and 3.6% in CAP group, respectively (P=0.229). In these two groups, 15.6% of the COVID-19 pneumonia patients and 10% of the CAP patients were categorized as high risk for VTE (Padua score, >4), which were significantly different (P=0.036). In those high-risk patients, the incidence of VTE was 12.5% in COVID-19 pneumonia group and 16.7% in CAP group (P=0.606). Subgroup analysis of the critically ill patients showed that VTE rate was 6.7% in COVID-19 group versus 13% in CAP group (P=0.484). In-hospital mortality of COVID-19 and CAP was 6.3% and 3.9%, respectively (P=0.180). CONCLUSIONS: Our study suggested that COVID-19 pneumonia was associated with hypercoagulable state. However, the rate of VTE in COVID-19 pneumonia patients was not significantly higher than that in CAP patients.

Enhanced temperature effect of electrorheological fluid based on cross-linked poly(ionic liquid) particles: rheological and dielectric relaxation studies.

Recent research of using poly(ionic liquid) (PIL) particles as the dispersal phase has provided a new strategy to develop a high-performance anhydrous polyelectrolyte-based electrorheological (ER) fluid. However, the working temperature range of the ER fluid of PIL particles is still narrow due to an inherently low glass transfer temperature caused by the plasticization of polyatomic organic counter ions in PILs. In this paper, we develop a new ER system based on cross-linked PIL (C-PIL) particles and demonstrate that crosslinking with a suitable degree only slightly degrades the ER properties but significantly improves the working temperature range of the ER fluid of PIL particles. By using differential scanning calorimetry, rheology, and dielectric spectroscopy, we systematically study the ER properties of C-PILs and their temperature dependence at different crosslinking levels and understand the mechanism behind the improved temperature effect. The results indicate that crosslinking can effectively increase the glass transition temperature of PIL particles and enhance local ion-motion induced interfacial polarization by suppressing the thermally promoted long-range drift of mobile counter ions in the PIL matrix, and this results in the improved temperature effect of the ER fluid of C-PIL particles.

A novel ratiometric electrochemical aptasensor based on M-shaped functional DNA complexes for simultaneous detection of trace lead and mercury ions in series aquatic edible vegetables.

Simultaneous quantification of multiple heavy metal ions (HMIs) is essential due to enhanced toxicity induced by synergistic effects. The currently available detection methods suffer from drawbacks such as costly devices, poor anti-interference, and specificity. In this work, a ratiometric electrochemical aptasensor for simultaneous detection of trace lead (Pb2+) and mercury ions (Hg2+) was developed. Here, a metal-organic framework, UiO-66-CNTs, with inherent and stable electrochemical signal was used for loading complementary strands (CSs) and internal reference. Guanine-rich and thymine-rich oligonucleotides, labelled with carbon dots (CDs), acted as aptamers (Apts) and hybridized with CSs to form M-shaped DNA complexes. Pb2+ and Hg2+ could be recognized and captured by Apts to form Pb2+-G-quadruplex and T-Hg2+-T complexes, leading to the destruction of M-shaped DNA complexes and changes in CDs' signal. The current ratios, ICDs/IUiO-66-CNTs, were applied to quantify Pb2+ and Hg2+. Benefiting from the anti-interference ability of the ratiometric strategy and the specificity of Apts, the proposed method enabled detection Pb2+ and Hg2+ through simple instrumentation, with detection limits of 2.0 ng mL-1 and 0.5 ng mL-1. Moreover, it was applied to assess Pb2+ and Hg2+ contamination in series of aquatic edible vegetables. The experimental results were consistent with inductively coupled plasma-mass spectrometry (ICP-MS), demonstrating its potential in practical applications.

Electrorheological Effect of Suspensions of Polyaniline Nanoparticles with Different Morphologies.

Polyaniline (PANI) nanospheres, nanofibers, and nanoplates were prepared using the oxidative polymerization method. Scanning electron microscopy (SEM) was used to observe the three morphologies of PANI, and their structure was tested using infrared spectroscopy, X-ray diffraction, Raman spectroscopy, and X-ray photoelectron spectroscopy. The influence of particle morphology on the electrorheological (ER) effect was studied through rheological experiments and molecular dynamics (MD) simulation. The experimental and simulation results indicate that without applying an electric field, the nanofibers easily form a three-dimensional network structure in the suspension, resulting in yield stress. The three-dimensional network structure of the nanoplate suspension becomes weaker and the PANI nanosphere suspension lacks the ability to form a three-dimensional network structure. After applying an electric field, under the same condition, the yield stress and electric field-induced shear stress increment of PANI nanofibers are the highest, followed by nanoplates, and those of PANI nanospheres are the lowest. This indicates that the ER effect increases with the increase in particle morphology anisotropy. Through three-dimensional visual simulation analysis, it can be concluded that the enhanced ER effect associated with increased particle anisotropy can be attributed to improved stability in the ER chain structure.

[Ion chromatography for determination of ammonia sampled by silica gel in air of workplace].

OBJECTIVE: To establish an ion chromatography (IC) method for determination of ammonia in air of workplace. METHODS: Ammonia in workplace air was collected in silica gel tube, desorbed with 10 mmol/L methanesulfonic acid by ultrasonic for 10 min, determined by IC. RESULTS: The linearity range was 0.02-1.00 microg/ml. The linear equation was Y = 12041X-187 (r = 0.9997). The limit of quantification was 0.13 mg/m3 (the air volume was 1.5 L). Collection efficiency was 100%. Extraction efficiency was 99%. The relative standard deviation was 4.2%-6.3%. The penetration capacity was more than 264 microg. Sample could be stored for 14 days at least by ambient storage. CONCLUSION: This method is convenient, applicable and sensitive, suitable to determinate ammonia in air of workplace.

Electrorheological Fluids of GO/Graphene-Based Nanoplates.

Due to their unique anisotropic morphology and properties, graphene-based materials have received extensive attention in the field of smart materials. Recent studies show that graphene-based materials have potential application as a dispersed phase to develop high-performance electrorheological (ER) fluids, a kind of smart suspension whose viscosity and viscoelastic properties can be adjusted by external electric fields. However, pure graphene is not suitable for use as the dispersed phase of ER fluids due to the electric short circuit caused by its high electrical conductivity under electric fields. However, graphene oxide (GO) and graphene-based composites are suitable for use as the dispersed phase of ER fluids and show significantly enhanced property. In this review, we look critically at the latest developments of ER fluids based on GO and graphene-based composites, including their preparation, electrically tunable ER property, and dispersed stability. The mechanism behind enhanced ER property is discussed according to dielectric spectrum analysis. Finally, we also propose the remaining challenges and possible developments for the future outlook in this field.

A long waiting time from diagnosis to treatment decreases the survival of non-small cell lung cancer patients with stage IA1: A retrospective study.

Objective: The prognostic effect of delayed treatment on stage IA1 non-small cell lung cancer (NSCLC) patients is still unclear. This study aimed to explore the association between the waiting time before treatment and the prognosis in stage IA1 NSCLC patients. Methods: Eligible patients diagnosed with pathological stage IA1 NSCLC were included in this study. The clinical endpoints were overall survival (OS) and cancer-specific survival (CSS). The Kaplan-Meier method, the Log-rank test, univariable, and multivariable Cox regression analyses were used in this study. Propensity score matching was used to reduce the bias of data distribution. Results: There were eligible 957 patients in the study. The length of waiting time before treatment stratified the survival in patients [<3 months vs. ≥3-months, unadjusted hazard ratio (HR) = 0.481, P = 0.007; <2 months vs. ≥2-months, unadjusted HR = 0.564, P = 0.006; <1 month vs. ≥1-month, unadjusted HR = 0.537, P = 0.001]. The 5-year CSS rates were 95.0% and 77.0% in patients of waiting time within 3 months and over 3 months, respectively. After adjusting for other confounders, the waiting time was identified as an independent prognostic factor. Conclusions: A long waiting time before treatment may decrease the survival of stage IA1 NSCLC patients. We propose that the waiting time for those patients preferably is less than one month and should not exceed two months.

The Release of Indium Ion Derived from Epithelial Cells and Macrophages Solubilization Contribute to Pneumotoxicity Induced by Indium Oxide Nanoparticles.

Occupational exposure to indium oxide and indium containing particles has been associated with the development of severe lung diseases called "indium lung." According to the survey of occupational hygiene, indium oxide nanoparticles have been identified in the workplaces and the lungs of workers. To date, the potential mechanism of the pneumotoxicity has been poorly understood and no effective therapies are available against "indium lung." Our present study reported that the exposure of indium oxide nanoparticles damaged lung epithelial cells and alveolar macrophages and induced pulmonary alveolar proteinosis and inflammation in rats. In the 8-week post-exposure period, the indium oxide nanoparticles still mostly accumulated in the lungs and then persistently release indium ions in two months after exposure. In vitro, the epithelial cells show the greater potential for release of indium ions from indium oxide nanoparticles compared with the macrophages. EDTA-2Na, a metal chelating agent expected to remove the indium ions, was found to significantly reduced the cytotoxicity of indium oxide nanoparticles. Herein, the pneumotoxicity may be attributed to the slow and incremental release of indium ions from indium oxide nanoparticles primary dissolved by epithelial cells and macrophages, at least partially. The study may provide some insights to the pathogenicity mechanisms of "indium lung" and some clues against the health hazards of occupational inhaled indium oxide nanoparticles at the workplaces.

The Psychological Impact of the COVID-19 Pandemic on Teenagers in China.

PURPOSE: The 2019 COVID-19 pandemic poses a challenge to adolescent psychological health. The aim of this study was to survey junior high and high school students in China to better understand the psychological consequences, such as anxiety, depression, and stress, of the COVID-19 pandemic. METHODS: A cross-sectional online survey using structural questionnaires was conducted from April 7, 2020, to April 24, 2020. Demographic information and general information related to the pandemic were collected. Psychological consequences were assessed by the Impact of Event Scale-Revised and the Depression, Anxiety and Stress Scale. Influencing factors were assessed by the Brief Resilience Scale and Coping Style Questionnaire. RESULTS: Our sample comprised 493 junior high school students (male = 239, mean age = 13.93 years) and 532 high school students (male = 289, mean age = 17.08 years). Resilience and positive coping were protective factors for the occurrence of depressive, anxiety, and stress symptoms in junior high and high school students (p < .05). Positive coping was a protective factor for trauma-related distress in junior high school students (p < .05). Negative coping is a risk factor for depression, anxiety, stress symptoms, and trauma-related distress in junior high and high school students (p < .05). CONCLUSIONS: During the COVID-19 pandemic in China, more than one fifth of junior high and high school students' mental health was affected. Our findings suggested that resilience and positive coping lead to better psychological and mental health status among students. In contrast, negative coping is a risk factor for mental health.

Downregulation of UBC9 promotes apoptosis of activated human LX-2 hepatic stellate cells by suppressing the canonical NF-κB signaling pathway.

UBC9, the only known E2-conjugating enzyme involved in SUMOylation, is a key regulator in fibrosis. However, the roles of UBC9 in liver fibrosis remain unclear. Therefore, in this study, we investigated the roles of UBC9 in HSC apoptosis and liver fibrogenesis. Our results showed that the UBC9 levels in activated LX-2 cells, HepG2 and SMMC-7721 were increased compared with LO2, and the expression of UBC9 in activated LX-2 cells, HepG2 and SMMC-7721 were no significant differences. The expression of UBC9 was effectively down-regulated by the UBC9-shRNA plasmid, and this effect was accompanied by the attenuated expression of the myofibroblast markers smooth muscle actin (α-SMA) and Collagen I. Downregulation of UBC9 also promotes activated HSCs apoptosis by up-regulating cell apoptosis-related proteins. Further, knockdown of UBC9 in activated HSCs inhibited cell viability and caused cell cycle arrest in the G2 phase. Moreover, knockdown of UBC9 suppressed the activation of NF-κB signaling pathways. In conclusion, these results demonstrated that down-regulation of UBC9 expression induced activated LX-2 cell apoptosis and promoted cells to return to a quiescent state by inhibiting the NF-κB signaling pathway. These results provide novel mechanistic insights for the anti-fibrotic effect of UBC9.

Pyrolysis temperature influences ameliorating effects of biochars on acidic soil.

The biochars were prepared from straws of canola, corn, soybean, and peanut at different temperatures of 300, 500, and 700 °C by means of oxygen-limited pyrolysis.Amelioration effects of these biochars on an acidic Ultisol were investigated with incubation experiments, and application rate of biochars was 10 g/kg. The incorporation of these biochars induced the increase in soil pH, soil exchangeable base cations, base saturation, and cation exchange capacity and the decrease in soil exchangeable acidity and exchangeable Al. The ameliorating effects of biochars on acidic soil increased with increase in their pyrolysis temperature. The contribution of oxygen-containing functional groups on the biochars to their ameliorating effects on the acidic soil decreased with the rise in pyrolysis temperature, while the contribution from carbonates in the biochars changed oppositely. The incorporation of the biochars led to the decrease in soil reactive Al extracted by 0.5mol/L CuCl2, and the content of reactive Al was decreased with the increase in pyrolysis temperature of incorporated biochars. The biochars generated at 300 °C increased soil organically complexed Al due to ample quantity of oxygen-containing functional groups such as carboxylic and phenolic groups on the biochars, while the biochars generated at 500 and 700 °C accelerated the transformation of soil exchangeable Al to hydroxyl-Al polymers due to hydrolysis of Al at higher pH. Therefore, the crop straw-derived biochars can be used as amendments for acidic soils and the biochars generated at relatively high temperature have great ameliorating effects on the soils.

[Adsorption of methylene blue from water by the biochars generated from crop residues].

Biochars were prepared from straws of rice, peanut and soybean and rice hull using a low temperature pyrolysis method and adsorption of methylene blue by these biochars were investigated with batch and leaching experiments. Results indicated that biochars have high adsorption capacity for methylene blue and followed the order: rice straw char > soybean straw char > peanut straw char > rice hull char. This order is generally consistent with the amount of negative charge and specific surface area of these biochars. While methylene blue was mainly adsorbed specifically by the biochars, because the adsorption of methylene blue increased with the increase of ionic strength and the adsorption led to the shift of zeta potential of biochar particles to positive value direction. Langmuir equation fitted the adsorption isotherms well and can be used to describe the adsorption behaviors of methylene blue by the biochars. The maximum adsorption capacity of methylene blue predicted by langmuir equation was 196.1, 169.5, 129.9 and 89.3 mmol x kg(-1) for rice straw char, soybean straw char, peanut straw char and rice hull char, respectively. Leaching experiments show that rice hull char of 156 g can remove methylene blue from 30 L water containing 0.3 mmol x L(-1) of methylene blue completely and the cumulative amount of methylene blue absorbed by the biochar reaches 57.7 mmol x kg(-1). The biochars can be used as efficient adsorbents to remove methylene blue from waste water of dye.

The forms of alkalis in the biochar produced from crop residues at different temperatures.

The forms of alkalis of the biochars produced from the straws of canola, corn, soybean and peanut at different temperatures (300, 500 and 700°C) were studied by means of oxygen-limited pyrolysis. The alkalinity and pH of the biochars increased with increased pyrolysis temperature. The X-ray diffraction spectra and the content of carbonates of the biochars suggested that carbonates were the major alkaline components in the biochars generated at the high temperature; they were also responsible for the strong buffer plateau-regions on the acid-base titration curves at 500 and 700°C. The data of FTIR-PAS and zeta potentials indicated that the functional groups such as -COO(-) (-COOH) and -O(-) (-OH) contained by the biochars contributed greatly to the alkalinity of the biochar samples tested, especially for those generated at the lower temperature. These functional groups were also responsible for the negative charges of the biochars.

Adsorption of methyl violet from aqueous solutions by the biochars derived from crop residues.

The adsorption of methyl violet by the biochars from crop residues was investigated with batch and leaching experiments--adsorption capacity varied with their feedstock in the following order: canola straw char>peanut straw char>soybean straw char>rice hull char. This order was generally consistent with the amount of negative charge of the biochars. Zeta potentials and Fourier transform infrared photoacoustic spectroscopy, combined with adsorption isotherms and effect of ionic strength, indicated that adsorption of methyl violet on biochars involved electrostatic attraction, specific interaction between the dye and carboxylate and phenolic hydroxyl groups on the biochars, and surface precipitation. Leaching experiments showed that 156 g of rice hull char almost completely removed methyl violet from 18.2 L of water containing 1.0 mmol/L of methyl violet. The biochars had high removal efficiency for methyl violet and could be effective adsorbents for removal of methyl violet from wastewater.

Multidisciplinary team meeting before therapeutic ERCP: A prospective study with 1,909 cases.

OBJECTIVE: To determine the effect of multidisciplinary team meeting (MDTM) on the success rate and complications of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for hepato-pancreato-biliary diseases. METHODS: All patients undergoing their first therapeutic ERCP over a 21-month period of time in a tertiary care medical center were included. Generally, patients scheduled for ERCP on Friday, Saturday, Sunday, and Monday were subject to MDTM group, and those on Tuesday, Wednesday, and Thursday were allocated to the control group. For each MDTM case, an MDTM was held on the Tuesday prior to the scheduled ERCP. At the meeting, the cases were discussed by a team consisting of chief physicians, radiologists, endoscopists, anesthetists, and surgeons, and a decision was made on the schedule of ERCP. For control cases, a clinical team of one chief physician and two attending physicians made the decision. RESULTS: From April 2006 to December 2007, 912 and 997 ERCP procedures were allocated to the MDTM and control groups, respectively. There was no significant difference in the baseline characteristics and indications between the two groups. Although the success rates were not significantly different between MDTM and control groups (82.9% vs. 84.8%, P=0.321), MDTM was significantly associated with a decreased overall complication rate of (6.9% vs. 12.0%, p<0.001) and severe complication rate (0.4% vs. 2.5%, p=0.035). CONCLUSIONS: Pre-ERCP MDTM decreases the frequency and severity of ERCP-related complications, with similar success rate, compared to routine practice.