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Objective:To investigate the therapeutic efficacy and mechanisms of transcutaneous electrical acupoint stimulation (TEAS) in the treatment of postprandial distress syndrome (PDS) in functional dyspepsia (FD).Methods:A double-blinded, randomized, controlled study was conducted. At Sir Run Run Shaw Hospital, Medical School Zhejiang University 40 patients aged 18-70 years old who met the Rome Ⅳ diagnostic criteria of PDS were prospectively enrolled. After informed consent, the patients were randomly assigned to TEAS group or sham-TEAS group. The patients in the TEAS group received transcutaneous electrical acupoint stimulation at acupoints Zusanli and Neiguan, and those in the sham-TEAS group underwent stimulation at other mimic acupoints for four weeks. The symptoms, gastric accommodation (initial satiety volume (ISV) and maximum tolerable volume (MTV), time of half gastric emptying of solid food ( T1/2) and heart rate variability (high frequency, low frequency and ratio of low frequency to high frequency) were compared between the two groups before and after treatment. The expression levels of inflammatory cytokines in duodenal mucosa were also evaluated by polymerase chain reaction in PDS patients and 24 healthy volunteers. Independent sample t test, Mann-Whitney U test and chi square test were used for statistical analysis. Results:A total of 26 PDS patients were enrolled in the study, 13 cases each in the TEAS group and sham-TEAS group. Between the patients of the two groups, there were no statistically significant differences in gender, age, or score of 36-item short form health survey (SF-36), score of self-rating anxiety scale (SAS), score of self-rating depression scale (SDS), score of dyspeptic symptom severity index (DSSI), ISV, MTV, T1/2 or heart rate variability indexes (high frequency, low frequency and ratio of low frequency to high frequency) before treatment (all P>0.05). After treatment, the DSSI score of TEAS group was lower than that of sham-TEAS group (13.5±5.3 vs. 19.9±9.3), the values of ISV and MTV were both higher than those of sham-TEAS group ((180.0±44.6) mL vs. (121.9±61.0) mL, (480.4±200.7) mL vs. (338.5±108.8) mL), and the differences were all statistically significant ( t=2.18, 2.77 and 2.24, all P<0.05). After treatment there was no statistically significant difference in T1/2 between TEAS group and sham-TEAS group ( P>0.05). There was no statistically significant difference in T1/2 between before and after treatment in patients of TEAS group ( P>0.05). After treatment, the high frequency increased (5.3±1.2 vs. 4.0±0.9) and the ratio of low frequency to high frequency decreased (1.0±0.2 vs. 1.3±0.2), and the differences were statistically significant ( t=-3.31 and 3.73, both P<0.01). The expression levels of interleukin 6 (IL-6) mRNA in mucosa of duodenal bulb and descending duodenum of PDS patients were both higher than that of healthy control group (0.68, 0.11 to 6.74 vs. 0.03, 0.02 to 0.25; 6.46, 1.35 to 12.62 vs. 0.86, 0.32 to 2.90), and the differences were statistically significant ( Z=-2.24 and -2.03, P=0.02 and 0.04). After TEAS treatment for four weeks, the expression of IL-6 mRNA in duodenal bulb mucosa decreased compared with that before treatment in TEAS group (0.04, 0.01 to 0.06 vs. 0.23, 0.09 to 3.66) and the difference was statistically significant ( Z=-2.07, P=0.04). Conclusions:TEAS can improve the gastric accommodation and dyspeptic symptoms in PDS patients. The mechanism may be related with the vagal pathway mediating and regnlating the expression of inflammatory cytokine IL-6 in duodenal bulb mucosa.
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To investigate the clinical efficacy, feasibility and safety of new "three tubes" method in the treatment of spontaneous esophageal rupture. A total of 22 patients with spontaneous esophageal rupture were retrospectively analyzed. Through the new "three tubes" method of treatment, patients achieved leak cured with reduced hospital stay, less medical expenses and early resumption of oral diet. The new "three tubes" method for spontaneous esophageal rupture has the advantages of easy handling, minimal invasion, few complication and exact curative effect.
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Objective To investigate the risk factors of pathological upgrading in gastric mucosal lesions with low-grade intraepithelial neoplasia (LGIN) after endoscopic submucosal dissection (ESD).Methods From January 2010 to December 2016,the complete clinical data of 326 patients pathologically diagnosed with gastric LGIN lesions before ESD were retrospectively analyzed.Single factor analysis of variance and multiple factor Logistic regression analysis were performed to analyze the risk factors of pathological upgrading after ESD.Results A total of 326 patients with gastric LGIN lesions diagnosed by preoperative biopsy before ESD were enrolled.Among them the postoperative pathological diagnosis of 244 cases (74.85％) were still LGIN,while the postoperative pathological diagnosis of 82 cases (25.15 ％) were upgraded,of which 61 cases (18.71％) were upgraded to high-grade intraepithelial neoplasia and 21 (6.44％) were upgraded to gastric early cancer.The results of single and multiple factor analysis indicated that lesion size≥2.0 cm,deep depressed-type,surface erythema,lesion mucosa with ulceration and lesions with spontaneous bleeding were the risk factors of pathological diagnosis upgrading after ESD (F=5.37,6.44,4.56,7.56 and 7.78,respectively;all P＜0.01),odds ratio (OR) value and 95％ confidence interval (CI) were 4.086 (2.035 to 10.786),7.435 (2.845 to 19.862),3.205 (1.535 to 8.541),8.668 (3.365 to 21.457) and 7.056 (2.732 to 18.355).The age,gender and location of the lesion were not the risk factors.Conclusions Pathological upgrading is common in gastric lesions with LGIN after ESD.The lesions with high risk factors should be alerted and treated more actively.
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Objective To investigate the risk factors of pathological upgrading in gastric mucosal lesions with low-grade intraepithelial neoplasia (LGIN) after endoscopic submucosal dissection (ESD).Methods From January 2010 to December 2016,the complete clinical data of 326 patients pathologically diagnosed with gastric LGIN lesions before ESD were retrospectively analyzed.Single factor analysis of variance and multiple factor Logistic regression analysis were performed to analyze the risk factors of pathological upgrading after ESD.Results A total of 326 patients with gastric LGIN lesions diagnosed by preoperative biopsy before ESD were enrolled.Among them the postoperative pathological diagnosis of 244 cases (74.85％) were still LGIN,while the postoperative pathological diagnosis of 82 cases (25.15 ％) were upgraded,of which 61 cases (18.71％) were upgraded to high-grade intraepithelial neoplasia and 21 (6.44％) were upgraded to gastric early cancer.The results of single and multiple factor analysis indicated that lesion size≥2.0 cm,deep depressed-type,surface erythema,lesion mucosa with ulceration and lesions with spontaneous bleeding were the risk factors of pathological diagnosis upgrading after ESD (F=5.37,6.44,4.56,7.56 and 7.78,respectively;all P＜0.01),odds ratio (OR) value and 95％ confidence interval (CI) were 4.086 (2.035 to 10.786),7.435 (2.845 to 19.862),3.205 (1.535 to 8.541),8.668 (3.365 to 21.457) and 7.056 (2.732 to 18.355).The age,gender and location of the lesion were not the risk factors.Conclusions Pathological upgrading is common in gastric lesions with LGIN after ESD.The lesions with high risk factors should be alerted and treated more actively.
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Objective To evaluate the diagnostic superiority of endoscopic ultrasonography (EUS) in primary gastric lymphoma (PGL) and its value in follow-up.Methods From January 2012 to June 2015,38 patients with suspected PGL under regular gastroendoscopy,biopsy and surgery operation received EUS combined with targeted deep biopsy.T test and chi-square test were performed for statistical analysis.Results Among 50 patients suspected for PGL under regular gastroendoscopy,38 patients were confirmed pathologically.The sensitivity of EUS examination with targeted deep biopsy in PGL was 86.8％ (33/38),the specificity was 83.3％ (10/12) and accuracy was 86.0％ (43/50).The accuracy of EUS examination with deep biopsy was higher than that of regular gastroscopy,and the difference was statistically significant (86.0％ (43/50) vs 57.9％ (22/38),x2 =19.4,P＜0.05).The main endosonographic characteristics of PGL were partial or diffuse thickening of stomach wall presented with,even or uneven hypoechoic lesions and extramural enlarged lymph nodes.Compared with pathological stage after surgery,the accuracy of T and N stage of EUS was 8/8 and 7/8.The times to achieve complete remission of Helicobacter pylori (H.pylori) eradication group and H.pylori eradication group were (3.3±0.8) months and (4.6± 0.9) months,respectively,and the difference between the two groups was statistically significant (t =4.3,P＜0.05).Conclusions The detection rate of EUS combined with targeted deep biopsy is high,which could clearly indicate the depth and extent of lesion invasion and guide clinical stage and selection of therapy.EUS could effectively evaluate efficacy of PGL treatment.
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This study was to examine the influence of Naloxone on respiratory failure among patients with acute organophosphorus pesticide poisoning(AOPP). From June 1997 to May 2000, 106 AOPP-related respiratory failure patients were assigned to the control group. During June 2000 to September 2002, 83matched patients were assigned to the treatment group and obtained intravenous Naloxone injection. Duration of mechanical ventilation was recorded. In comparison to the treatment group, the control group showed prolonged mechanical ventilation[(342±123)h vs(235±89)h;t=6. 92, P＜0. 01], demonstrating that intravenous Naloxone injection may promote the reoccurrence of independence-breathing in AOPP-related respiratory failure patients.
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Objective To establish a rat model of chronic atrophic gastritis and investigate the factors inducing gastric atrophy. Methods According to the repeated orthogonal design of L 8(2 7), 60% alcohol and 20 mmol/L sodium deoxycholate (served as factor A), 0.05%～0.1% ammonia water (factor B) and 0.05% indomethacin (factor C) were given, alone or in combination, to rats in three experiments for 3 months, 6 months and 9 months, respectively. Then the rats were sacrificed and pathologic changes of the gastric mucosa were studied by gross appearence and microscopy. Results Typical appearance of CAG, which could maintain over one month, were found in all rats treated with factor A,B,C alone or in combination for 6 or 9 months. Conclusion 60% alcohol, 20 mmol/L sodium deoxycholate, 0.05%～0.1% ammonia water and 0.05% indomethacin given to SD rats for 6 months could establish animal model of CAG with a 100% successful rate.