ABSTRACT
Objective:To investigate the aspiration risk of preventive placement of nasal jejunum nutrition tube in advanced esophageal cancer patients receiving radiotherapy and the influencing factors.Methods:The clinical data of 220 patients with advanced esophageal cancer who received radiotherapy and preventive placement of nasal jejunum nutrition tube feeding from November 2020 to November 2021 in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. The level of aspiration risk was measured according to the standard swallowing function assessment scale (SSA). The questionnaire collected the following data: (1) the general data including gender, age, educational level, history of smoking, history of alcoholism, knowledge of aspiration; (2) the disease factors including tumor staging, tumor site, swallowing function, abdominal distention; (3) the nosocomial factors including history of esophageal cancer surgery, sedation and analgesia treatment, combination of chemotherapy or not, cumulative radiotherapy dose, grade of radiation esophagitis, the position, time and tube feeding method of enteral nutrition. The standard swallowing function of patients was measured and repeated saliva swallowing test (RSST) was used to screen the patients with the difficulty in the esophageal function swallowing. Multiple linear regression was used to analyze the factors affecting aspiration risk.Results:A total of 220 patients with advanced esophageal cancer were enrolled in the investigation. Finally, 70 patients (31.8%) had grade 0 aspiration risk, and SSA score was 19; 23 patients (10.5%) had grade I aspiration risk, and SSA score was (23.4±1.3); 103 patients (46.8%) had grade Ⅱ aspiration risk, and SSA score was (27.5±1.1); 24 patients (10.9%) had grade Ⅲ aspiration risk, and SSA score was (33.2±1.5); 136 patients (61.8%) in total had aspiration risk. There were 32.7% (72/220) patients knowing the knowledge of aspiration. Multifactor analysis showed that esophageal tumor site ( t = -2.869, P = 0.005), cumulative radiotherapy dose ( t = 5.558, P < 0.001), grade of radiation esophagitis ( t = 11.405, P < 0.001), the duration time of enteral nutrition ( t = 4.050, P < 0.001) were independent factors affecting the aspiration risk. Conclusions:The aspiration risk of preventive placement of nasal jejunum nutrition tube in advanced esophageal cancer patients receiving radiotherapy is high, which is related to esophageal tumor site, grade of radiation esophagitis, cumulative radiotherapy dose and the duration time of enteral nutrition.
ABSTRACT
Objective:To study the effect of related laboratory indexes such as glycosylated hemoglobin on the occurrence of complications in patients with type 2 diabetes mellitus, and to construct a nomogram model.Methods:The clinical data of 203 patients with 2 diabetes mellitus from May 2020 to April 2022 in Quzhou Hospital, Zhejiang Medical and Health Group were retrospectively analyzed. Among them, 64 patients had no diabetic complications (control group), and 139 patients had diabetic complications (complication group). The clinical data of the two groups were recorded, and the related influencing factors of complications in patients with type 2 diabetes were analyzed; receiver operating characteristic (ROC) curve was used to analyze the predicting value of significant indexes for the complications in patients with type 2 diabetes; multivariate Logistic regression analysis was used to analyze the independent risk factors of complications in patients with type 2 diabetes; R language software 4.0 "rms" package was used to construct the nomogram model for predicting the complications in patients with type 2 diabetes, the calibration curve was internally validated, and the decision curve was used to evaluate the predictive efficacy of the nomogram model.Results:The hypertension rate, hyperlipemia rate, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin in complication group were significantly higher in those in control group: 44.60% (62/139) vs. 20.31% (13/64), 48.92% (68/139) vs. 25.00% (16/64), (5.42 ± 0.68) years vs. (4.84 ± 0.51) years, (12.60 ± 2.80) mmol/L vs. (10.20 ± 1.90) mmol/L, (16.50 ± 3.10) mmol/L vs. (12.50 ± 2.90) mmol/L and (9.62 ± 1.33)% vs. (7.96 ± 0.85)%, and there were statistical differences ( P<0.01); there were no statistical differences in gender composition, age, body mass index, smoking rate, drinking rate, albumin and creatinine between the two groups ( P>0.05). ROC curve analysis result showed that the area under the curve of the course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin for predicting the complications in patients with type 2 diabetes were 0.725, 0.752, 0.830 and 0.861, respectively; the optimal cut-off values were 5 year, 11.8 mmol/L, 15.1 mmol/L and 9.23%. Multivariate Logistic regression analysis result showed that hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin were independent risk factors of complications in patients with type 2 diabetes ( OR = 1.563, 1.692, 1.451, 1.703, 1.506 and 1.805; 95% CI 1.268 to 1.689, 1.483 to 1.824, 1.215 to 1.620, 1.402 to 1.903, 1.303 to 1.801 and 1.697 to 1.926; P<0.05). The hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin were used as predictors to construct a nomogram model for predicting the complications in patients with type 2 diabetes. Internal validation result showed that the nomogram model predicted the complications with good concordance in patients with type 2 diabetes (C-index = 0.815, 95% CI 0.796 to 0.843); the nomogram model predicted the complications in patients with type 2 diabetes at a threshold >0.18, provided a net clinical benefit, and all had higher clinical net benefits than hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin. Conclusions:The nomogram model constructed based on hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin has better clinical value in predicting the complications in patients with type 2 diabetes.
ABSTRACT
【Objective】 To study the characteristics of voluntary apheresis platelet donors in Zhoushan Islands and its influence on the collection and supply of apheresis platelets. 【Methods】 From January 1, 2017 to December 31, 2021, 1038 eligible donors were selected out of 1151 apheresis candidates for demographic analysis, donation time analysis, blood routine test. We also investigated whether the current supply of apheresis platelet met the needs of clinical. The lapsed donors(with only one donation) were telephone interviewed to investigate the lapsing reasons. 【Results】 From 2017 to 2021, the median (M) ratio of platelet donors to the population in Zhoushan City was 0.454 ‰. And 90.18% (1038/1151) of the candidates completed donation, involving 2659 donations and 3205 U products. The per capita donation amount was (1.29±0.77) U per person, which basically met the blood demand in clinical of Zhoushan Islands. The 1038 platelet donors were 18 to 59 yeas old[M(QR) 34(16)], and 47.50% (493/1038) of them aged 31 to 45; the ratio of male to female blood donors was 2.0∶1; 70.61% (733/1038) had college education or above; ABO blood group profile was A>O>B>AB. There were several peak periods of donation during 2017~2021: the second and third quarters of 2017~2019 and the third quarter of 2020; none in 2021, as yeae 2021 was volatile. The donation proportion of the first quarter was the lowest throughout 2017~2021. In 2017 and 2018, the proportion of donors with one donation accounted for 79.79% (75/94) and 51.63% (95/184), respectively. From 2019 to 2021, the proportion of donors with twice or more donation accounted for 60.35% (137/227), 57.36% (187/326) and 53.13% (170/320) , respectively. During 5 years, 10.88% (113/1051) of the candidates failed to donate platelets, of whom 72.57% (82/113) were due to unqualified pre-donation testing. 【Conclusion】 The donation behaviors in Zhoushan have been affected by each above-mentioned demographic factors. The awareness of donation and donation services in Zhoushan have been improved as combing the special geographic condition and demographic characteristics together, and the donation units is elevating yearly which has met the clinical needs of the whole island.
ABSTRACT
Objective:To analyze the endoscopic and histological characteristics of Helicobacter pylori ( HP)-negative early gastric cancer (EGC) and high grade intraepithelial neoplasia (HGIN). Methods:Data of patients diagnosed as having EGC or HGIN confirmed by pathology at the Seventh Medical Center of Chinese People′s Liberation Army General Hospital from January 2013 to January 2020 were collected. Patients were included according to the diagnostic criteria of HP-negative gastric cancer, and their endoscopic features and histopathological characteristics were retrospectively analyzed. Results:Among 469 lesions of EGC/HGIN, HP-negative lesions accounted for 2.1% (10/469), which included 3 signet ring cell carcinomas, 3 fundic gland type carcinomas, 1 foveolar adenocarcinoma, 1 HGIN of the cardia, 1 familial adenomatous polyposis with gastric HGIN, and 1 Lynch syndrome with gastric HGIN. The 3 cases of signet ring cell carcinoma were all whitish flat/depressed lesions and commonly seen in the lower part of the stomach (2/3). Most of the 7 cases of differentiated EGC/HGIN were elevated type (5/7) and commonly seen in the upper and middle stomach (6/7). Conclusion:HP-negative EGCs are usually solitary lesions under gastroscopy. Undifferentiated type mostly appears whitish flat/depressed in the lower part of the stomach, while differentiated type appears elevated in the upper and middle part.
ABSTRACT
Objective:To propose a strategy for detecting early gastric cancer (EGC) under high-definition gastroscopy.Methods:Data of 469 lesions of EGC or high grade intraepithelial neoplasia (HGIN) confirmed by pathology detected at The Seventh Medical Center of Chinese People′s Liberation Army General Hospital from January 2013 to January 2020 were collected and gastroscopic images were re-interpreted. The Helicobacter pylori ( HP) infection status, lesion location in the area of atrophy or at the cardia, morphological type of lesions, lesions with/without clear or regular boundary, and lesion color were analyzed for morphological characteristics of EGC and HGIN under high-definition gastroscopy. Results:Among the 469 lesions of EGC or HGIN, HP-negative lesions accounted for 2.1% (10/469) and ulcerative lesions for 7.7% (36/469). Among non-ulcerative lesions of suspected HP infection ( n=423), there were 28 lesions in the cardia outside the atrophic area and 82.1% (23/28) were reddish under white light imaging. There were 29 non-cardiac lesions outside the atrophic area and 82.8% (24/29) were white or showed clear border under white light imaging. Inside the atrophic area, there were 73 elevated lesions, 95.9% (70/73) of which had clear border or irregular depression on the top. There were 293 flat/depressed lesions in the atrophic area, and 90.8% (266/293) had irregular border or were brown under narrow band imaging. Conclusion:According to the status of HP infection, the location and morphological category of lesions, above endoscopic features can be used as clues to detect EGC and HGIN.
ABSTRACT
Objective:To investigate the effect of flipped classroom in functional experiment teaching.Methods:A total of 86 medical students from 4 classes of Tongji University School of Medicine were selected as subjects. 44 students were randomly selected from 2 classes as experimental group using flipped classroom as teaching approach; 42 students were randomly selected from the other 2 classes as control group using traditional teaching method. The teaching effect was assessed by objective evaluation and subjective evaluation. SPSS 22.0 was used for data analysis. The t-test was used for objective evaluation, and the chi-square test was used for subjective evaluation.Results:There were significant differences in the scores of experimental reports [(45.00±2.63) vs. (41.05±3.62), t=5.766, P<0.01] and experimental operation [(48.27±2.31) vs. (44.79±3.04), t=5.962, P<0.01] between the experimental group and the control group. The statistical analysis of subjective evaluation showed that compared with the control group, the experimental group had a significantly higher number of students who selected "helpful" or "very helpful" in improving self-learning ability, innovation ability, understanding of theoretical knowledge, and communication ability ( P<0.05). Conclusion:The teaching method of flipped classroom applied in medical functional experiments can improve students' operation ability, self-learning ability, innovation ability, and communication ability and deepen their understanding of theoretical knowledge.
ABSTRACT
Objective@#Using data of health information system (HIS) of medical institutions to study the incidence and hospitalization of herpes zoster in three districts of Beijing.@*Methods@#According to the different level of economic development and geographical features in Beijing, 3 districts of Xicheng, Changping and Miyun were chosen and all 110 medical institutions of the first level and above in the 3 districts are included in the survey. All the outpatient and inpatient herpes zoster cases in 2015 were retrospectively reviewed by HIS system. After distinguishing the reduplicated cases, Using the first outpatient case as a molecule and the resident population as denominator to estimate the annual incidence rate, as well as the annual hospitalization rate was estimated based on primary diagnostic hospitalized cases as molecule and the resident population as denominator.@*Results@#A total of 32 313 primary visit outpatient cases were investigated, of which 18 360 cases (56.8%) were women and 20 923 cases (64.8%) were ≥50 years old. The overall estimated incidence of the 3 districts was 8.8‰ with an increase trends with age and reached to the highest in ≥80 years old (30.5/1 000). The incidence of Xicheng, Changping and Miyun districts are respectively 16.2‰, 4.0‰ and 5.7‰. A total of 701 primary visit inpatient cases were identified, of which 366 cases (52.2%) were women and 651 cases (92.9%) were ≥50 years old. The estimated annual hospitalization rate was 19.4/100 000, with the primary and secondary diagnostic hospitalization rate are respectively 5.9/100 000 (212 cases) and 13.5/100 000 (489 cases). The disease types of secondary diagnostic inpatient herpes zoster cases were as follows: cardiovascular disease (19.0%, 93 cases), stroke (14.5%, 71 cases), pneumonia/chronic obstructive pulmonary disease (14.1%, 69 cases), tumor (12.5%, 61 cases) and diabetes (5.7%, 28 cases).@*Conclusion@#Most of the herpes zoster cases in Beijing are over 50 years old, and the incidence of female is slightly higher than male. This disease should become a public health issue of great concern.
ABSTRACT
Objective To study the differences of endoscopic submucosal dissection ( ESD ) for colorectal tumors of different diameters. Methods Data of 210 cases which were treated with ESD for colorectal tumors at the Endoscopy Center, the Seventh Medical Center of PLA General Hospital from October 2012 to December 2015 were retrospectively analyzed. The lesions were divided into two groups according to different diameters (≥4. 0 cm group and <4. 0 cm group) for comparative analysis of related factors. Results The mean procedure time of ESD for 210 colorectal tumor cases was 50. 3±42. 7 min and the mean size of lesions was 7. 98 ± 10. 84 cm2 . En bloc resection rate was 91. 4％, R0 resection rate was 90. 5％, and the curative resection rate was 88. 6％. Perforation rate was 5. 2％ (11/210), and the late hemorrhage rate was 0. 5％ (1/210). Compared with lesions < 4. 0 cm, those ≥ 4. 0 cm required longer resection time (79. 63±53. 91 min VS 35. 28±24. 99 min, P<0. 001); and the lesions were mainly located in the rectum ( 61. 97％) . LSTs were mainly mixed granular/nongranular type ( 54. 93％);en bloc resection rate, complete resection rate and curative resection rate of the tumors≥4. 0 cm were all lower than those of tumors < 4. 0 cm. The difference in complete resection rate was statistically significant ( 85. 92％ VS 94. 24％;P=0. 041) . The perforation rate ( 7. 04％) was higher in≥4. 0 cm group, but the difference was not statistically significant. Conclusions ESD of colorectal tumors of diameters ≥ 4. 0 cm requires longer time with higher operation risk. Additionally, physicians should be more careful with non-rectal lesions.
ABSTRACT
Objective To investigate the effect of ultrasound-guided stellate ganglion block ( SGB) on perioperative inflammatory responses and postoperative recovery of gastrointestinal function in patients un-dergoing gastrointestinal surgery. Methods Fifty-five American Society of Anesthesiologists physical classⅠ-Ⅲpatients of both sexes, aged 18-64 yr, weighing 50-75 kg, undergoing elective gastrointestinal sur-gery, were divided into SGB group ( n=18) and control group ( C group, n=37) using a random number table method. Ultrasound-guided SGB was conducted with 0. 5％ ropivocaine 7 ml at the left C6 level in SGB group. The equal volume of normal saline was given under ultrasound guidance at the same site in C group. Peripheral venous blood samples were collected at 5 min before SGB and 2, 4 and 24 h after SGB for deter-mination of plasma tumor necrosis factor-α ( TNF-α) , interleukin ( IL)-1β and IL-6 concentrations by en-zyme-linked immunosorbent assay. The increased level of leukocyte count ( leukocyte count at 24 h after SGB-leukocyte count at 24 h before SGB) was recorded. The recovery time of bowel sounds and anal or sto-ma exhaust time were also recorded. Results Compared with C group, the concentrations of TNF-αat 2 h after SGB and IL-1βat 2, 4 and 24 h after SGB were significantly decreased, the increased level of leuko-cyte count was decreased, and the recovery time of bowel sounds and anal or stoma exhaust time were short-ened in SGB group ( P<0. 05) . Conclusion Ultrasound-guided SGB can reduce perioperative inflammato-ry responses and promote the recovery of postoperative gastrointestinal function in the patients undergoing gastrointestinal surgery.
ABSTRACT
Objective To explore the clinical significance of colonoscopy follow-up in Chinese Lynch syndrome mismatch repair (MMR) gene mutation carriers.Methods The results of colonoscopy follow-up was analyzed in 194 MMR gene mutation carriers of 50 Lynch syndrome families.The follow-up period was from April 2001 to November 2016.The detection rates of advanced adenomas and colorectal cancers,five-year survival rate and ten year survival rate were compared between 123 patients of regular follow-up group (colonoscopy interval less than two years) and 71 patients of irregular follow-up group (time colonoscopy interval more than two years).T test,chi-square test and Kaplan-Meier method were performed for statistically analysis.Results The incidence of colorectal cancer of irregular follow up group was significantly higher than that of regular follow-up group (57.7％,41/71 vs 22.8％,28/123);and the difference was statistically significant (x2 =24.00,P＜0.01).The average age at diagnosis for colorectal cancer in irregular follow up group was younger than that of regular follow up group ((45.3 ± 1.9) years vs (48.7±1.8) years);and the difference was statistically significant (t=4.10,P＜0.01).In regular follow-up group,28.6％ (8/28) advanced-stage colorectal cancer (TNM Ⅲ or Ⅳ) was found,while in irregular follow up group,73.2 ％ (30/41) advanced-stage colorectal cancer was found,and there was statistically significant difference in pathological stage between two groups (x2 =4.90,P =0.032).The five year and ten-year survival rates of regular follow-up group were 96.2 ％ and 85.1 ％,respectively,which were both higher than those of irregular follow-up group (46.3 ％ and 28.7 ％);and the differences were statistically significant (x2 =13.20 and 14.80,both P＜0.05).The incidence of advanced adenomas of irregular follow up group was significantly higher than that of regular follow-up group (49.3％,35/71 vs 18.7％,23/123);and the difference was statistically significant (x2 =20.10,P＜0.05).The detection rate of advanced adenomas of MMR gene mutation carriers was higher than those without MMR mutation gene (85.4％,35/41 vs 14.6％,6/41);and the difference was statistically significant (x2 =5.20,P＜ 0.05).Conclusion Regular colonoscopy surveillance may decrease the incidence and mortality of colorectal cancer in MMR mutation carriers of Lynch syndrome families,and increase five-year and tenyear survival rates.
ABSTRACT
It's an essential part of delivery management for obstetricians to estimate fetal weight accurately.Nowadays,the two-dimensional ultrasonography is a main method to estimate fetal weight,but the sonographic estimated fetal weight (SEFW) is not accurate enough.Therefore,assessing the influencing factors in the accuracy of SEFW,decreasing the error of SEFW,and promoting the accuracy of SEFW,are important aspects for delivery decisions.In this article,papers on factors affecting the SEFW accuracy were reviewed.Our study shows that formulae containing three to four parameters were more accurate than those of one parameter or two.Ethnics,regions,the time interval between ultrasonic examination and delivery,birth weight,fetal gender and seniority of sonographers are influencing factors on SEFW.However,whether fetal position,the volume of amniotic fluid,maternal body mass index,and maternal diabetes have influence on SEFW,are controversial.
ABSTRACT
Objective To evaluate the feasibility of developing hospital acquired pneumonia (HAP) risk warning model in critically ill patients based on genomic copy number polymorphisms (CNPs) of the genes encoding human neutrophil peptides 1-3 (DEFA1/DEFA3).Methods Seventy-seven HAP patients (group HAP) and 109 non-HAP patients of matched age and sex in intensive care unit (ICU) (group NHAP) were enrolled in the study.The genomic CNPs of DEFA1/DEFA3 was determined by realtime quantitative polymerase chain reaction after extracting DNA from peripheral blood samples.The source of patients,condition of endotracheal intubation within 24 h after admission to ICU,Acute Physiology Score,Acute Physiology and Chronic Health Evaluation Ⅱ score,Sequential Organ Failure Assessment score,mechanical ventilation time,length of hospital and ICU stay and outcomes were obtained.The predictive model was developed using logistic regression through combining DEFA1/DEFA3 copy numbers and clinical characteristics (Acute Physiology Score and source of emergency) within 24 h after admission to ICU.The receiver operating characteristic curve was used to evaluate the predictive efficacy of the model.Results The copy numbers of DEFA1/DEFA3 were significantly lower in HAP group than in NHAP group (P ＜0.05).The area under the receiver operating characteristic curve of the predictive model developed through combining the DEFA1/DEFA3 copy numbers with clinical characteristics was 0.789 (95％ CI 0.724-0.854) when the model was used for predicting HAP.Conclusion CNPs of DEFA1/DEFA3 can be used to develop the HAP risk warning model in critically ill patients.
ABSTRACT
Objective To observe the long-term efficacy and safety of topiramate in the treatment of symptomatic epilepsy in infants.Methods Fifty infants with symptomatic epilepsy were collected.The monotherapy was started with topiramate from April 2012 to April 2013,including 26 males and 24 females.The effective rate,retention rate and adverse effects after using the medication at 1 year,2 years,3 years,4 years were evaluated.Kaplan -Meier and Cox proportional hazards regression model were used to calculate the retention rate and analyze the risk factors for retention rate.Results From the beginning of using the medicine,the effective rate was 66.00％ at 1 year,61.90％ at 2 years,58.33％ at 3 years,and 53.33％ at 4 years,respectively.The rates of complete remission were 44.00％,42.86％,41.67％,36.67％ at 1 year,2 years,3 years,4 years,respectively.The main adverse effects of topiramate were drowsiness,hypodynamia,weight loss,anepithymia,vomit,diarrhea,hypohidrosis,slowly thinking active,attention disorders,etc.The retention rate was 84.00％ at 1 year,72.00％ at 2 years,60.00％ at 3 years,and 48.00％ at 4 years.The main causes of stopping medication were lower curative effect of topiramate monotherapy and side effects.Conclusion Topiramate in the treatment of infants with symptomatic epilepsy has good effect and safety,with higher retention rate in a long-term follow-up.The major factors that affect the retention rate are lower curative effect and adverse reactions.Slowly add quantity and low dose treatment can reduce adverse drug reactions,improve compliance and increase retention rate.
ABSTRACT
Objective To evaluate the efficacy of premedication of pronase and simethicone before upper gastrointestinal endoscopy. Methods A total of 4 690 patients undergoing upper gastrointestinal en?doscopy from January 2014 to November 2014 were recruited at gastrointestinal endoscopy center in Beijing Military General Hospital. All patients were randomized into 3 groups. The pronase plus simethicone group( n=1 602) took 40 ml mixed solution of pronase, sodium bicarbonate and simethicone orally 20 minutes before endoscopy. The simethicone group( n=1 548) took 40 ml simethicone orally 20 minutes before endoscopy. And the control group( n=1 540) took 10 ml lidocaine hydrochloride mucilage orally 5 minutes before endos?copy. The visibility during gastroscopy was observed. Results Each patient underwent gastroscopy, and no severe adverse event occurred during the procedure. The visibility of 82?3%( n=1 318) of the pronase plus simethicone group, 67?7%( n=1 048) of the simethicone group and 28?1% patients( n=432) of the control group respectively reached grade A or B. The visibility during gastroscopy in the pronase plus simethicone group was higher than that in the simethicone group(χ2=89?42, P=0?000) , while that in the simethicone group was higher than that of the control group(χ2=486?30, P=0?000). Conclusion Premedication of pronase and simethicone can improve the visibility during gastroscopy.
ABSTRACT
ObjectiveTo analyze the clinical characteristics of inflammatory bowel disease (IBD) in neonates.MethodsFrom July 2010 to July 2015, seven neonates were diagnosed with IBD in Affiliated BaYi Children's Hospital, Clinical Medical College in Chinese People's Liberation Army General Hospital, Southern Medical University. The data regarding these neonatal cases were analyzed and compared with 45 children with IBD from literature. Thet-test andChi-square test were used for statistical analysis of the data.ResultsSix cases had ulcerative colitis, and one case had Crohn's disease, both occurred 2-20 days after birth, and were characterized by diarrhea, no increase in body weight, anemia and intermittent higher hypersensitive C-reactive protein. Compared with IBD in children, abdominal pain and abdominal mass were rarer, while anemia was more common in neonatal IBD. All fecal cultures and blood cultures in the seven cases of neonatal IBD were negative. Abdominal X-ray revealed intestinal wall thickening in four cases. Multiple ulcers were observed from the cecum to the rectum by colonoscopy. Chronic intestinal mucosal inflammation associated with acute inflammation were found on pathological examination. Six infants received treatment with 5-aminosalicylic acid (combined with glucocorticoid in four cases), and one received glucocorticoid treatment only. One infant was started on infliximab treatment from two years old. One of these seven cases died one month after discharge due to refusal to continue treatment, and the disease was controlled in the other six cases. After treatment, one infant was lost to follow-up six months after discharge, two were cured at six and 12 months old without further treatment, and three improved and continued treatment.ConclusionsIn neonates with diarrhea, anemia and no increase in body weight, especially when antibiotic treatment is ineffective, colonoscopy should be performed to facilitate early diagnosis of IBD. Standard treatments result in good outcomes.
ABSTRACT
Objective To investigate therapeutic effect of endoscope?guided bougie dilatation on children with benign esophageal stricture. Methods Data of 71 patients with benign esophageal stricture were retrospective analyzed.Patients were divided into group A (reflux stricture),B (congenital esophageal atresia stricture) and C ( caustic injuries stricture) ,based on different causes. The expansion effectiveness and factors of the three groups were analyzed. Results A total of 885 expansions were performed on 71 patients with the total efficacy rate 94?37%( 67/71) . No statistic differences were shown in expansion effectiveness among the 3 groups; group C ( 14?9 times/case, P < 0?05 ) showed more expansion frequencies than group A (9?1 times/case,P<0?05)and group B(10?7 times/case, P<0?05),more complications than group A(1?22%VS 0,P<0?05) and group B(1?22% VS 0?31%,P<0?05). Conclusion Endoscope?guided bougie dilatation is safe and effective for childrens′ benign esophageal stricture. Caustic injuries, refractory benign esophageal stricture,need more expansions and may be accompanied with more complications.
ABSTRACT
Physiology experiment can effectively stimulate the enthusiasm of the students to explore the scientific truth by providing the opportunity to observe real physiological phenomena,analyze,discuss and solve practical problems.Lab-based learning (LBL) and theory teaching have complementary advantages,promoting each other and can maximize the use of teaching resources.During the process of physiological LBL,training of students' thinking ability by creating problem situation,inspiration and guidance,carrying out exploring experiments can develop students' intelligence,promote innovation,improve the teaching effect.
ABSTRACT
Objective To evaluate the accuracy of cerebrospinal fluid (CSF) amyloid beta 42 (Aβ-42) to tau level ratio (Aβ-42/tau) in predicting postoperative cognitive dysfunction (POCD) in elderly patients.Methods Eighty ASA physical status Ⅱ or Ⅲ patients of both sexes,aged 65-85 yr,undergoing elective total hip or knee replacement under combined spinal-epidural anesthesia,were enrolled in the study.Epidural catheter was placed at T3,4 interspace,and after a catheter was successfully placed into the subarachnoid space,CSF 2 ml was obtained to measure Aβ-42 and tau levels (units:pg/ml),and the ratio between them was calculated.Neuropsychological tests were performed at 1 day before surgery and 1 week after surgery.The Z score was used to identity POCD.The cut-off value for POCD and nonPOCD patients was determined by using ROC curve.Results Thirty-two patients were diagnosed with POCD,and the incidence was 40％.The Aβ-42/tau was 2.6±0.3 and 1.7±0.4 in non-POCD and POCD groups,respectively,and the ratio was significantly lower in POCD group than in non-POCD group.The sensitivity of CSF Aβ-42/tau in predicting POCD was 91.7％,the specificity was 81.2％,and Youden index was 0.7.ROC curves revealed that the cut-off value for POCD and non-POCD patients was 2.0.Conclusion CSF Aβ-42/tau can accurately predict the occurrence of POCD in elderly patients.
ABSTRACT
The application of micro-lectures in higher medical education is still in a stage of exploration.The au-thors applied the micro-lectures with the traditional teaching method in the teaching of physiology, and conducted a questionnaire survey about it.In this article, the authors summarized the developing process, the students’attitude and the video production of micro-lectures, and compared the micro-lecture with traditional teaching method and MOOCS.At last, they gave some suggestions about application of micro-lectures in higher medical college.
ABSTRACT
Objective To investigate the diagnostic value of endoscopic ultrasonography( EUS)for gastrointestinal submucosal tumors. Methods EUS was performed on 378 patients with submucosal tumor detected by endoscopy. The shape,number,origin,and property were recorded under endoscopic ultrasonogra-phy. The diagnostic consistent rate was calculated with pathology as the golden standard. Results Among 378 patients,there were 131 cases of gastrointestinal leiomyoma,mostly low echo( n=87 ),homogeneous echo (n=119),and originated from muscular layer of mucosa(n=92). There were 111 cases of gastrointestinal stromal tumor,mainly low echo(n=51),medium low echo(n=51),homogeneous echo(n=78),originated from muscularis propria(n=85). There were also 50 cases of carcinoid tumor,mainly low echo(n=36), originated from submucosa(n=27). Forty-five cases of lipoma were detected,also originated from submuco-sa,mainly hyperecho(n=40),homogeneous echo(n=41). Heterotopic pancreas(n=19),schwannoma (n=4),and granular cell tumor(n=4)were relatively rare. Overall diagnostic consistent rate of EUS in submucosal tumor was 78. 6%( 297/378 ),diagnostic consistent rate of the shape of the tumor was 91. 8%(347/378),diagnostic consistent rate of the number was 95. 5%(361/378),and the consistent rate of origin was 96. 8%(366/378). Conclusion All kinds of submucosal tumor have certain features under endoscopic ultrasonography. Endoscopic ultrasonography can display echo,size,origin of gastrointestinal submucosal tumors,as well as their relations with the wall layer in gastrointestinal tract. It plays an important role in the diagnosis,differential diagnosis and treatment options,but there are still some limitations.