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Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.
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Objective:To investigate the risk factors that affected pathological diagnosis upgrading after resection of colorectal adenoma.Methods:From January 2017 to December 2022, a total of 1 059 patients who underwent adenoma resection after pathologically diagnosed as adenoma by endoscopic forceps biopsy(EFB)were included in General Hospital of Ningxia Medical University. The patients were divided into the pathologically no difference group (1 003 cases) and the pathologically upgraded group (56 cases) based on the comparison of pathological diagnosis of EFB specimens and the specimens after adenoma resection. Clinical information and endoscopic characteristics of the adenoma were compared between the 2 groups. The clinical information included smoking history, family history of colorectal cancer, and the endoscopic characteristics included maximum diameter, morphological characteristics, surface depression, erosion or ulceration, and surface color of adenoma. Chi-square test and Fisher′s exact test were used for statistical analysis. Multivariate logistic regression model was used to analyze the risk factors for pathological diagnosis upgrading after adenoma resection.Results:The proportions of patients with smoking history, family history of colorectal cancer, concomitant hypertension, and coronary heart disease in the pathologically upgraded group were higher than those in the pathologically no difference group (46.43%, 26/56 vs.26.12%, 262/1 003; 8.93%, 5/56 vs.0.70%, 7/1 003; 46.43%, 26/56 vs.30.11%, 302/1 003; 21.43%, 12/56 vs.9.27%, 93/1 003), and the differences were statistically significant( χ2=11.05, Fisher′s exact test, χ2=6.61 and 8.78; all P<0.05). There were statistically significant differences between the pathologically no difference group and pathologically upgraded group in the maximum diameter (929 cases (92.62%) and 23 cases (41.07%) of < 20 mm, and 74 cases (7.38%) and 33 cases (58.93%) of ≥20 mm, respectively), morphological characteristics (220 cases (21.93%) and 28 cases (50.00%) with pedicle, and 783 cases (78.07%) and 28 cases (50.00%) without pedicle, respectively), surface color (347 cases (34.60%) and 3 cases (5.36%) of near normal mucosa, 613 cases (61.12%) and 50 cases (89.29%) of red surface color, and 43 cases (4.29%) and 3 cases (5.36%) of white surface color, respectively), erosion or ulceration (78 cases (7.78%) and 36 cases (64.29%) had erosion or ulceration, and 925 cases (92.22%) and 20 cases (35.71%) had no erosion or ulceration, respectively), and surface depression (6 cases (0.60%) and 8 cases (14.29%) of depression, and 997 cases (99.40%) and 48 cases (85.71%) of non depression, respectively) ( χ2=155.18, 23.30, 20.58 and 176.31, Fisher′s exact test; all P<0.001). The result of multivariate logistic regression analysis showed that surface depression ( OR=25.198, 95% confidence interval (95% CI) 5.812 to 109.246, P<0.001), erosion or ulceration( OR=9.913, 95% CI 4.652 to 21.124, P<0.001), red surface color ( OR=4.276, 95% CI 1.053 to 17.363, P=0.042), white surface color ( OR=8.803, 95% CI 1.398 to 55.435, P=0.021), maximum diameter≥20 mm ( OR=4.689, 95% CI 2.265 to 9.706, P<0.001), family history of colorectal cancer ( OR=8.764, 95% CI 1.418 to 54.162, P=0.019) and smoking history ( OR=2.713, 95% CI 1.376 to 5.349, P=0.004) were independent risk factors for pathological diagnosis upgrading after adenoma resection. Conclusion:Surface depression, maximum diameter ≥20 mm, erosion or ulceration, white or red surface color, family history of colorectal cancer and smoking history may enhance the heterogeneity of adenomas, interfere with the accuracy of EFB pathology, and lead to an upgrade of pathological diagnosis after adenoma resection.
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Objective:To investigate the safety and feasibility of the CHESS endoscpic ruler (CHESS ruler), and the consistency between the measured values and the interpretation values by endoscopic physician experience.Methods:From January 2021 to January 2022, a total of 105 liver cirrhosis patients with portal hypertension were prospectively enrolled from General Hospital, Xixia Branch Hospital, Ningnan Hospital of People′s Hospital of Ningxia Hui Autonomous Region (29 cases), and the First People′s Hospital of Yinchuan (25 cases), General Hospital of Ningxia Medical University (18 cases), Wuzhong People′s Hospital (10 cases), the Fifth People′s Hospital of Ningxia Hui Autonomous Region (10 cases), Shizuishan Second People′s Hospital (6 cases), Yinchuan Second People′s Hospital (5 cases), and Zhongwei People′s Hospital (2 cases) 8 hospitals. The clinical characteristics of all the patients, including gender, age, nationality, etiolog of liver cirrhosis, and Child-Pugh classification of liver function were recorded. A big gastroesophageal varices was defined as diameter of varices ≥5 mm. Endoscopist (associated chief physician) performed gastroscopy according to the routine gastroscopy procedures, and the diameter of the biggest esophageal varices was measured by experience and images were collected, and then objective measurement was with the CHESS ruler and images were collected. The diameter of esophageal varices of 10 randomly selected patients (random number table method) was determined by 6 endoscopists (attending physician or associated chief physician) with experience or measured by CHESS ruler. Kappa test was used to test the consistency in the diameter of esophageal varices between measured values by CHESS ruler and the interpretation values by endoscopic physician experience.Results:Among 105 liver cirrhosis patients with portal hypertension, male 65 cases and female 40 cases, aged (54.8±12.2) years old, Han nationality 82 cases, Hui nationality 21 cases and Mongolian nationality 2 cases. The etiology of liver cirrhosis included chronic hepatitis B (79 cases), alcoholic liver disease (7 cases), autoimmune hepatitis (7 cases), chronic hepatitis C (2 cases), and other etiology (10 cases). Liver function of 32 cases was Child-Pugh A, Child-Pugh B 57 cases, and Child-Pugh C 16 cases. All 105 liver cirrhosis patients with cirrhotic portal hypertension were successfully measured the diameter of gastroesophageal varices by CHESS ruler, and the success rate of application of CHESS ruler was 100.0% (105/105). The procedure time from the CHESS ruler into the body to the exit of the body after measurement was (3.50±2.55) min. No complications happened in all the patients during measurement. Among 105 liver cirrhosis patients with cirrhotic portal hypertension, 96 cases (91.4%) were recognized as big gastroesophageal varices by the endoscopists. Totally 93 cases (88.6%) were considered as big gastroesophageal varices by CHESS ruler. Eight cases were recognized as big gastroesophageal varices by the endoscopist, however not by the CHESS ruler; 5 cases were recognized as big gastroesophageal varices by the CHESS ruler, but not by the endoscopists; 4 cases were not recognized as big gastroesophageal varices both by the endoscopists and CHESS ruler; 88 cases were recognized as big gastroesophageal varices both by the endoscopists and CHESS ruler. The missed diagnostic rate of big gastroesophageal varices by the endoscopists experience was 5.4% (5/93), and the Kappa value of consistency coefficient between the measurement by the CHESS ruler and the interpretation by endoscopists experience was 0.31 (95% confidence interval 0.03 to 0.60). The overall Kappa value of consistency coefficient by 6 endoscopists measured by CHESS ruler in big gastroesophageal varices diagnosis was 0.77 (95% confidence interval 0.61 to 0.93).Conclusion:As an objective measurement tool, CHESS ruler can make up for the deficiency of subjective judgment by endoscopists, accurately measure the diameter of gastroesophageal varices, and is highly feasible and safe.
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Background Silicosis is caused by long-term inhalation of large amounts of free silica (SiO2) particles, and exploring its mechanism can provide new directions for the treatment of silicosis fibrosis. Objective To investigate the expression and role of fatty acid binding protein 5 (FABP5) in a silica-induced silicosis model. Methods In combination with the results of single-cell transcriptome sequencing, the expression pattern of FABP5 in mouse alveolar epithelial cells was explored by bioinformatic analysis, and the distribution pattern of fabp5 was detected by spatial transcriptomics. An in vivo model of silicosis was established by intratracheal injection with SiO2 into mice and four groups were set up: normal saline (NS) 7 d group, NS 56 d group, SiO2 7 d group, and SiO2 56 d group. An in vitro model of silicosis was established in SiO2-treated mouse lung epithelial cell line (MLE-12). At the whole animal level, the marker of epithelial cells (E-Cad) and the protein level of FABP5 were detected by tissue immunofluorescence assay; in vitro, the changes of fabp5 mRNA expression and protein level in MLE-12. Results The results of single-cell transcriptome sequencing and spatial transcriptome sequencing showed that the mRNA expression of fabp5 was upregulated in type II alveolar epithelial cells in the focal area of silicosis in mice, accompanied by elevated tissue immunofluorescent protein levels, and there was co-localization of E-CAD. Meanwhile, SiO2 stimulation induced a 1.58-fold increase in fabp5 mRNA expression and a 2-fold increase in protein levels in MLE-12 cells, with significant differences (P<0.05). Conclusion The protein level of FABP5 is increased in alveolar epithelial cells in a pulmonary fibrosis model, suggesting that FABP5 may be involved in the pathological process of epithelial cells in pulmonary fibrosis.
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Objective:To investigate the diagnostic value of independent and combined subtests of the psychometric hepatic encephalopathy score (PHES) in mild hepatic encephalopathy(MHE) of patients with liver cirrhosis, so as to optimize the PHES.Methods:This was a prospective, multicenter and real-world study which was sponsored by the National Clinical Research Center of Infectious Diseases and the Portal Hypertension Consortium. Twenty-six hospitals from 13 provinces, autonomous regions and municipalities countrywide participated in this study, induding Tianjin Third Central Hospital, the Fourth People′s Hospital of Qinghai Province, the Second Affiliated Hospital of Baotou Medical College, the Third People′s Hospital of Taiyuan, the Fifth Medical Center of PLA General Hospital and so on. From October 2021 to February 2022, outpatients and hospitalized patients with liver cirrhosis and no obvious hepatic encephalopathy were consecutively enrolled. All patients received 5 PHES subjects in the same order: number connection test(NCT)-A, NCT-B, digit symbol test(DST), line tracing test(LTT) and serial dotting test(SDT), and the scores were calculated. The total score of PHES <-4 was taken as the cut-off value for diagnosing MHE. Compare the differences in each subtest between MHE group and non-MHE group. Receiver operating characteristic curve(ROC) and area under the curve(AUC) was performed to assess the diagnostic value of independent and combined subtests in MHE. Mann-Whitney U test and DeLong test were used for statistical analysis. Results:A total of 581 patients with liver cirrhosis were enrolled, 457 were diagnosed as MHE, and the incidence of MHE was 78.7%. The results of NCT-A, NCT-B, SDT, LTT, DST of MHE group were 60.00 s(47.01 s, 88.00 s), 90.45 s(69.32 s, 125.35 s), 74.00 s(57.65 s, 96.60 s), 74.72(60.00, 98.61) and 27.00(20.00, 36.00), respectively. Compared those of non-MHE group(34.00 s(29.15 s, 44.48 s), 50.00 s(40.98 s, 60.77 s), 50.00 s(41.07 s, 63.03 s), 46.23(38.55, 59.42) and 42.00(34.00, 50.75)), the differences were statistically significant( Z=12.37, 12.98, 9.83, 11.56, 10.66; all P<0.001). The AUC(95% confidence interval(95% CI)) of subtests of PHES NCT-B, NCT-A, LTT, DST and SDT alone in MHE diagnosis were 0.880(0.849 to 0.910), 0.862(0.828 to 0.896), 0.838(0.799 to 0.877), 0.812(0.772 to 0.851) and 0.788(0.743 to 0.832), respectively. The combination of 2 PHES subtests significantly increased the diagnostic efficacy. Among them the diagnostic efficacy of the combination of NCT-B and LTT was the best, the AUC(95% CI) was 0.924(0.902 to 0.947), the specificity was 91.9% and the sensitivity was 79.2%, which was better than a single PHES subtest (NCT-A, NCT-B, SDT, LTT and DST) and the combination of NCT-A and DST(AUC was 0.879, 95% CI0.847 to 0.910) which was recommended by guidelines on the management of hepatic encephalopathy in cirrhosis, the differences were statistically significant ( Z=3.78, 3.83, 5.57, 5.51, 5.38, 2.93; all P<0.01). Furthermore, compared between the combination of NCT-B and LTT and the combination of 3 subests of PHES, only the diagnostic efficacy of combination of NCT-B, LTT and SDT (AUC was 0.936, 95% CI 0.916 to 0.956) was better than that of the combination of NCT-B and LTT, the difference was statistically significant( Z=2.32, P=0.020). Conclusion:Based on the diagnostic efficacy and clinical feasibility of PHES subtests and their combinations, the combination of NCT-B and LTT is recommended for the diagnosis of MHE.
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@#Silicosis, one of the most serious occupational diseases in the world, is a complex pathological process with multi-cell involvement and multi-factor regulation, and its pathogenesis has not been fully elucidated.Protein phosphatase 2A (PP2A) regulates tumor signaling pathways, cell development and cell cycle.The regulatory subunit B of PP2A binds to the core enzyme, resulting in tissue expression specificity and substrate specificity of the PP2A holoenzyme complex.Protein phosphatase 2A regulatory subunit B"α (PPP2R3A) is a subunit of PP2A regulatory subunit B", which is a regulator of cell proliferation.However, the role of PPP2R3A in pulmonary fibrosis is still unclear.In this study, the pulmonary fibrosis model was established by endotracheal infusion of silica (SiO2, 250 mg/kg).Human pulmonary fibroblast-adult cells (HFP-a) were stimulated with 5 ng/mL TGF-β1 to construct fibro-related cell models.The transcription level of Ppp2r3a was detected by qRT-PCR assay.Immunofluorescence and Western blot experiments were performed to detect protein levels.Cell viability was detected by CCK-8 assay.The cell migration ability was detected by scratch test.Experimental results showed that silica nodules and collagen deposition were obvious in the SiO2 group, and the expression of PPP2R3A in lung fibroblasts increased, which could affect cell viability and migration ability, and may promote the progression of pulmonary fibrosis by regulating the expression of p53 signaling pathways.This study provides a new idea for the prevention and treatment of pulmonary fibrosis.
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OBJECTIVE@#To analyze the association of integrinα5 (ITGA5) with grading of liver cancer and the overall patient survival and investigate the effects of integrin α5 (ITGA5) silencing on the proliferation, invasion and migration abilities of human liver cancer Bel-7404 cells.@*METHODS@#UALCAN was used to analyze the expression of ITGA5 in liver cancer tissues and normal tissues, and expression in different grades of liver cancer tissues. GEPIA was used to analyze the relationship between ITGA5 expression and the survival of liver cancer patients through.The ITGA5 shRNA lentiviral vector was used to infect Bel-7404 cells to establish a cell line with stable ITGA5 silencing verified by Western blotting. Plate clone formation assay and Transwell assay were used to detect the proliferation, invasion and migration of Bel-7404 cells. The correlation between ITGA5 and PI3K in liver cancer tissues and control tissues was analyzed using Oncomine cancer specimen database.@*RESULTS@#The expression of ITGA5 was significantly higher in liver cancer than in normal tissues ( < 0.05). The expression of ITGA5 was significantly lower in grade 1 than in grade 2 liver cancer, and also lower in grade 2 than in grade 3 liver cancer ( < 0.05). The patients with high ITGA5 expression had a significantly lower overall survival rate than those with low ITGA5 expression ( < 0.05). Plate clone formation assay showed that the clone formation rate was significantly lowered in Bel-7404 cells with ITGA5 silencing compared with the blank and negative control cells ( < 0.05). ITGA5 silencing significantly attenuated the migration of Bel-7404 cells as shown by Transwell assay ( < 0.05). ITGA5 and PI3K were both highly expressed and showed a positive correlation in liver cancer tissues ( < 0.05).@*CONCLUSIONS@#ITGA5 is closely related to the progression of liver cancer and the patients' prognosis. ITGA5 silencing inhibits the proliferation, invasion and migration of liver cancer cells. ITGA5 promotes the liver cancer growth and metastasis possibly by regulating the PI3K signaling pathway.
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Humans , Cell Line, Tumor , Cell Movement , Cell Proliferation , Gene Expression Regulation, Neoplastic , Integrin alpha5 , Liver Neoplasms , Neoplasm Invasiveness , Phosphatidylinositol 3-KinasesABSTRACT
Objective To evaluate the clinical efficacy of domestic sulfasalazine (SASP) combined with probiotics on the treatment of inflammatory bowel disease (IBD).Methods According to the search of Chinese periodical full-text database,PubMed and other Chinese databases as well as English databases,the cases of IBD treated with SASP combined with probiotics or metronidazole in China were collected and screened for randomized controlled trials (RCT).The results between combined group and control group were compared using odds ratio (OR) and 95％ Confidence Interval (CI) indicates.The evaluation indicator was the remission rate.According to the inclusion and exclusion criteria,the literature was selected,and data was extracted.Quality assessment of the included methodologies was performed,and RevMan 5.3 software was used for meta-analysis.Results 26 studies including a total of 2 403 patients were adopted in the present study.Among them,13 studies suggested that the remission rate of IBD in SASP combined with probiotics group was significantly improved compared with that in the SASP group alone (x2 =10.29,df =12,I2 =0％,P ＜0.05,the effect model OR =3.70,95％ CI as 2.62-5.21),demonstrating that the combined treatment was superior to monotherapy in IBD.10 studies suggested that the remission rate of ulcerative colitis (UC) in SASP combined with probiotics group was significantly improved compared with that in the SASP group alone (x2 =2.59,df =9,I2 =0％,P ＜ 0.05,the effect model OR =3.84,95％ CI as 2.52 -5.86),demonstrating that the combined treatment was superior in UC.The other 3 studies showed that the remission rate of UC with infection in SASP combined with probiotics group was significantly improved compared with that in SASP combined with metronidazole group (x2 =0.07,df =2,I2 =0％,P ＜ 0.05,the effect model x2 =4.77,95％ CI as 2.27-10.02),demonstrating that treatment of SASP combined with probiotics was superior in UC with infection.Conclusions SASP combined with probiotics can improve the effective response rate in the treatment of IBD.
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Objective To explore the risk factors for early rebleeding in patients with peptic ulcer bleeding (PUB) .Methods From June 2006 to May 2017 ,a total of 1210 hospitalized patients with PUB from The General Hospital of Ningxia Medical University were enrolled . Totally 1040 patients with bleeding stopped after the treatment were taken as the control group . And 170 patients with early rebleeding were as the rebleeding group .The clinical data of the patients in two groups were analyzed . Chi-square test ,t-test and multivariate factors analysis were performed for statistical analysis . Results Between control group and rebleeding group ,there were statistical significances in gender ,age ,place of residence , hematemesis , shock , volume of blood transfusion , anticoagulant use , combined diseases , hemoglobin level ,albumin level ,urea nitrogen ,neutrophil ratio ,platelet count ,ulcer location ,maximum ulcer diameter ,Forrest classification and endoscopic treatment (all P< 0 .05) .The rate of endoscopic hemostasis of rebleeding group (92 .56％ ,112/121) was lower than that of control group (98 .70％ ,228/231) , and the difference was statistically significant (χ2=13 .609 ,P=0 .001) .The result of multivariate logistic regression analysis showed that Forrest classification (odds ratio (OR)= 7 .735 , P< 0 .01) ,hemoglobin (OR=7 .332 ,P=0 .040) ,shock (OR=5 .245 , P<0 .01) and ulcer size (OR=2 .360 , P=0 .029) were independent risk factors for rebleeding in patients with PUB .The effect of Forrest classification better than hemoglobin ,hemoglobin better than shock and shock better than ulcer size in assessing the risk of rebleeding .Conclusions Forrest classification ,hemoglobin ,shock ,ulcer size are the risk factors for rebleeding in patients with PUB .Endoscopic hemostasis can reduce the risk of rebleeding .
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Objective To construct an Lentiviral expression vector of pLVX‐IRES‐ZsGreen1‐MIA2 targeting to MIA2 and in‐vestigate its effect on the expression of MIA2 and growth of HCC cell line HepG2 in vitro ,observe MIA2 changes and the influence on apotheosis ,thus to provide preliminary experimental fundament for successive researching on the role of MIA2 in the pathogene‐sis of HCC .Methods The sequence of pLVX‐IRES‐ZsGreen1‐MIA2 was designed and synthesized .The pLVX‐IRES‐ZsGreen1‐MIA2 Lentiviral expression vector was constructed and then transiently transfected into HepG2 HCC cells in vitro .The proportion of pLVX‐IRES‐ZsGreen1‐MIA2 positive cells was observed under the fluorescence microscope .Then ,the expression level of MIA2 was detected by real time PCR .Moreover ,the proliferation of HepG2 cells was observed by MTT assay and colony formation as‐say .Finally ,the migration of HepG2 cells in vitro was also determined by Scratch assay .Results pLVX‐IRES‐ZsGreen1‐MIA2 Lentiviral expression vector was successfully constructed .Compared with control group (NC) ,the expression level of MIA2 was significantly decreased in transfected groups(P<0 .05);MTT assay showed that the proliferation of HepG2 cells was dramatically reduced in pIRES2‐ZsGreen1‐MIA2transfected groups(P< 0 .05);furthermore ,the number of both colony forming and migrating cells were also remarkably reduced in transfected groups(P<0 .05) .Conclusion The pIRES2‐ZsGreen1‐MIA2 can significantly re‐duce the expression level of MIA2 and inhibit the proliferation and migration of the HepG2 HCC cells in vitro .
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Objective To analyze the risk factors of mortality in hospitalized patients with peptic ulcer bleeding (PUB).Methods From January 2003 to December 2012,1 210 patients with PUB were collected.Among them,1 170 patients were cured (cured group) and 40 patients died (dead group).The general information and clinical data of patients were collected,which included gender,age,smoking history,non-steroidal anti-inflammatory drugs intake,haematemesis,shock,blood infusion and rebleeding.The information of patients combined with other diseases was also collected.The lab findings and gastroendoscopy findings were also collected,including hemoglobin,platelets,serum albumin,blood urea nitrogen,serum creatinine levels,coagulation,location of ulcer and Forrest classification.Chi-square test was performed for comparison between groups of count data.The t-test was used for comparison between groups of measurement data and normally distributed,and Mann-Whitney rank sum test was used for non-normal distribution.The risk factors of mortality of patients with PUB were analyzed by univariate and multivariate Logistic regression analysis.Results The rates of age over 65,combined with other diseases,shock,rebleeding,abnormal coagulation,Forrest classification above Ⅱ b,medicine spraying to stop bleeding under gastroendoscope,gastroendoscopic hemostasis with titanium clip and operation of dead group (57.5％,23/40; 27.5％,11/40; 25.0％,10/40; 42.5％,17/40; 25.0％,10/40; 35.0％,14/40; 15.0％,6/40; 12.5％,5/40 and 17.5％,7/40) were all higher than those of cured group (25.0％,293/1 170; 7.4％,86/1 170; 12.5％,146/1 170; 13.1％,153/1 170; 5.1％,60/1 170; 20.9％,244/1 170; 4.8％,56/1 170; 4.1％,48/1 170 and 6.5％,76/1 170).The differences were statistically significant (x2 =21.117,18.651,5.400,27.728,9.203,4.613,6.332,4.661 and 5.710,all P＜0.05).The serum albumin level of dead group ((28.71±7.13) g/L) was lower than that of cured group ((32.82±7.55) g/L) and the difference was statistically significant (t=2.215,P＜0.05).Between the groups,there were no significant differences in gender distribution,rate of patients smoking,rate of patients taking non-steroidal anti-inflammatory drugs,rate of patients with haematemesis,volume of blood infusion,location of ulcer,dosage of proton pump inhibitor (PPI),average hemoglobin level,blood urea nitrogen level,serum creatinine and platelet count (all P＞0.01).Age over 65,combined with other diseases and rebleeding were the independent risk factors of mortality of patients with PUB during hospitalization (OR=4.821,12.959 and9.627,all P＜0.01).Conclusion Age over 65,combined with other diseases and rebleeding are the independent risk factors of mortality of patients with PUB during hospitalization.
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Objective To compare differential diagnostic value of narrow-band imaging (NBI) magnifying endoscopy and magnifying chromoendoscopy.Methods A total of 92 lesions from 75 patients were examined with conventional colonoscopy,NBI magnifying endoscopy and magnifying chromoendoscopy to evaluate pit patterns and vascular morphology patterns.Endoscopic findings were compared with the pathological results.Results The detection rate of conventional endoscopy,NBI magnifying endoscopy and magnifying chromoendoscopy were 94.6％ (87/92),97.8％ (90/92) and 100.0％ (92/92),respectively.NBI magnifying endoscopy was superior to the magnifying chromoendoscopy (P =0.000) in the the lesion contour and microvessels pattern detection,but there was no difference in the pit patterns detected with the two techniques (P =0.394).Consistency,sensitivity,and specificity of NBI magnifying endoscopy in diagnosis of colorectal neoplastic lesions were 91.3％ (84/92),83.9％ (26/31),95.1％ (58/61),respectively,while these variables of magnifying chromoendoscopy were 89.1％ (82/92),80.6％ (25/31),93.4％(57/61),which were not statistically significant (P ＞ 0.05).Conclusion Differential diagnostic value of NBI magnifying endoscopy and magnifying chromoendoscopy for colorectal neoplastic and non-neoplastic lesions was similar,but NBI magnifying endoscopy displays the lesion contours and microvessels clearlier,and is easy to manipulate.
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Objective To analyze the risk factors of esophageal and gastric variceal bleeding (EGVB) in patients with cirrhosis.Methods A retrospective study was conducted in 638 hospitalized patients with cirrhosis from 2002 to 2009,who were divided into study group as having EGVB (n =286) and control group as not having EGVB (n =352).Differences between 2 groups were analyzed with univariate analysis and multivariate logistic regression.Results Child-pugh classification,serum albumin,prothrombin time,portal vein diameter and spleen thickness were significantly different between 2 groups (P ＜ 0.05).Univariate analysis showed that serum albumin(OR =0.944,P =0.000),prothrombin time (OR =1.067,P =0.007),portal vein diameter (OR =3.423,P =0.007) and spleen thickness (OR =1.276,P =0.007) were correlated with EGVB.Multivariate logistic regression analysis showed that serum albumin (OR =0.936,P =0.000),portal vein diameter (OR =4.098,P =0.013) and spleen thickness (OR =1.275,P =0.000) were independent risk factors for EGVB in patients with cirrhosis.Conclusion Low serum albumin level,increased portal vein diameter and spleen thickness are the risk factors for EGVB in patients with cirrhosis,which can be important predictors.To some extent,increasing serum albumin might reduce the risk of EGVB.