ABSTRACT
Objective:To investigate the relationship between the cardia morphology under magnetically controlled capsule gastroscopy and the clinical characteristics of subjects.Methods:A total of 216 subjects with gastrointestinal symptoms or receiving physical examination who underwent magnetically controlled capsule gastroscopy at the Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University from August 2022 to November 2022 were enrolled. All subjects took gastroesophageal reflux disease questionnaire (Gerd-Q) survey. Clinical data of subjects were collected, and images of cardia morphology under magnetically controlled capsule gastroscopy were recorded. The subjects were divided into 4 groups according to differrent cardia morphology based on the degree of relaxation. The clinical characteristics of each group were compared, and the influencing factors for cardia morphology were analyzed.Results:In non-swallowing state, 116 subjects showed good continuous closure of the cardia in plum shape (group A), 33 subjects radial closure of cardia (group B), 46 subjects slightly relaxed linear cardia (group C) and 21 subjects relaxed and continuous opening of cardia in the shape of cave (group D). The ages of subjects in group A, B, C and D were 35.00 (31.00, 42.00) years, 53.00 (37.50, 60.50) years, 61.50 (41.50, 68.25) years and 52.00 (39.00, 70.00) years, respectively, with significant differences ( H=44.348, P<0.001). The Gerd-Q scores of subjects in group A, B, C and D were 1.50 (1.00, 2.00), 3.00 (2.00, 6.50), 8.00 (5.75, 9.00) and 8.00 (7.50, 9.00), respectively, with significant differences ( H=90.788, P<0.001). The body mass index (BMI) of subjects in group A, B, C and D were 22.66 (19.53, 24.70) kg/m 2, 23.44 (21.41, 27.05) kg/m 2, 23.77 (21.19, 26.93) kg/m 2 and 23.73 (19.63,24.79) kg/m 2, respectively, with significant differences ( H=8.114, P=0.044). The degree of cardia relaxation was positively correlated with the age ( rs=0.456, P<0.001), Gerd-Q score ( rs=0.648, P<0.001) and BMI ( rs=0.146, P=0.032) of subjects. Conclusion:The magnetically controlled capsule gastroscopy provides good visualisation of cardia morphology in non-swallowing state. There is a positive correlation between the degree of cardia relaxation under magnetically controlled capsule gastroscopy in non-swallowing state and the subjects' age, Gerd-Q score, and BMI.
ABSTRACT
To evaluate the clinical effects and pathological characteristics of gastric tumors of fundic gland type treated with endoscopic submucosal dissection (ESD), data of 7 patients who treated by ESD and whose postoperative pathology indicated gastric adenocarcinoma of fundic gland type or gastric oxyntic gland adenoma in Endoscopic Center of Beijing Chao-Yang Hospital of Capital Medical University from August 2018 to June 2022 were collected. The clinical characteristics, surgical complications, preoperative and postoperative pathological data and follow-up data were evaluated. The lesions of the 7 patients were all located at gastric fundus, and were treated by ESD successfully. No bleeding, perforation or other complications occurred during and after the operation. Postoperative pathology showed that tumor cells originated from deep mucosa with an invasive growth pattern. Most of tumor surfaces were covered with normal concave epithelium. Tumors infiltrated into submucosa in 4 patients, and submucosa infiltration depth was more than 500 μm (550 μm) in 1 patient. Immunohistochemistry showed that MUC-6 was diffusely positive, indicating that the tumor originated from the main cell source. The expressions of MUC-2, MUC-5AC, CDX-2, CD10, and CgA were negative in all cases. With the mean follow-up time of 21 months, the ulcer healed well after the operation, with no recurrence. Gastric tumors of fundic gland type have relatively unique biological characteristics, and ESD is the preferred treatment. In addition, the histological characteristics can be used to differentiate from other gastric tumors by immunohistochemistry.
ABSTRACT
Objective:To evaluate the efficacy and safety of SPOT (GI Supply, USA), a new carbon-based permanent marker approved by the Food and Drug Administration (FDA), in the endoscopic marking for gastrointestinal lesions.Methods:A total of 115 patients with gastrointestinal lesions who underwent endoscopic treatment or surgery in Beijing Friendship Hospital or Beijing Chao-Yang Hospital from April 2019 to November 2019 were enrolled in the study. SPOT was used to mark the lesions, and marking points were found during endoscopic treatment or surgery to calculate the effective marking rate by single-group target value method. Adverse events after marking were recorded, and the changes of blood routine test, liver and kidney functions before and after marking were compared.Results:The effective rate of endoscopic marking with SPOT was 99.13% (114/115). The longest marking time was 57 days. There was no puncture of intestinal wall or injection into abdominal cavity during the marking process. One patient developed mild fever after marking. The incidence of adverse events was 23.48% (27/115), which were all unrelated to the test equipment. There was no significant difference in blood routine tests or liver and kidney functions before and after marking ( P>0.05). Conclusion:SPOT produced by GI Supply can effectively mark gastrointestinal lesions without serious adverse events, which meets the requirements of clinical use.
ABSTRACT
Objective:To investigate the characteristics of endoscopic ultrasonography for rectal neuroendocrine neoplasms (R-NENs) of different origin and its influence on the diagnosis and treatment.Methods:A retrospective cross-sectional study was conducted to analyze 56 cases of R-NENs diagnosed by miniprobe endoscopic ultrasonography (MEUS) and/or pathology in the Endoscopy Center of Beijing Chaoyang Hospital, Capital Medical University from January 2016 to July 2021. The endoscopic ultrasonography characteristics, pathological features, surgical selection and the follow-up of R-NENs originating from deep mucosa and submucosa were compared.Results:Among the 56 patients, 49 were diagnosed as R-NENs.The diagnostic sensitivity, positive predictive value and diagnostic accuracy of MEUS for R-NENs were 93.88% (46/49), 86.79% (46/53) and 82.14% (46/56), respectively. R-NENs were mainly manifested by medium hypoechoic with MEUS [95.92% (47/49)]. Three R-NENs originated from submucosa were missed diagnosis, with 1 case presenting hypoechoic and 2 cases presenting hyperechoic. There were no significant differences in the tumor diameter, echo intensity under endoscopic ultrasonography, echo uniformity and pathological grade composition between deep mucosal origin and submucosal origin R-NENS (all P>0.05), but there was significant differences in the distance from tumor to anus ( χ2=5.011, P=0.025). The proportion of the distance from tumor to anus ≤5 cm of submucosal origin lesions was significantly higher than that of deep mucosal origin [43.75% (14/32) VS 17.65% (3/17)]. Endoscopic submucosal dissection [67.5% (27/40)] and transanal endoscopic microsurgery [25.0% (10/40)] were the major treatment method, but there were no significant differences in endoscopic ultrasonography manifestations and pathological grading of R-NENs between these two surgical procedures. Conclusion:There is no significant difference in endoscopic ultrasonography manifestations and pathological grade of R-NENs between deep mucosal origin and submucosal origin, suggesting that the prognosis is similar between the two types. It is no significant influence of endoscopic ultrasonography manifestations of R-NENs at different levels of origin.
ABSTRACT
Objective:To investigate the clinical application value of magnetically controlled capsule endoscopy (MCCE) for risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin.Methods:Clinical data of elderly patients taking enteric-coated aspirin and undergoing MCCE from January 2018 to December 2020 in Beijing Chaoyang and Beijing Anzhen Hospital, Capital Medical University were analyzed. Patients were divided into low-risk group (scores ≤ 3) and moderate/high risk group (scores >3) to study the risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin.Results:A total of 66 patients (aged 60-81 years, 45 males and 21 females) were enrolled and 17 patients developed bleeding. The indicators of low-risk ( n=51) and moderate/high risk groups ( n=15) were as follows: the incidences of upper gastrointestinal bleeding were 17.6% and 53.3%( P<0.001), gastric ulcer 5.9% and 26.7% ( P<0.001), median gastric Lanza score 2.0 and 2.0( P=0.621), duodenal ulcer 2.0% and 18.8% ( P<0.001), median duodenal mucosal injury score 1.0 and 1.0( P=0.936), respectively. Receiver operator characteristic curve showed that the area under the curve of risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin by MCCE was 0.855. Conclusion:Risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin can be used to predict the risk of upper gastrointestinal bleeding, but the scoring rules need to be further improved. Moderate and high-risk patients should undergo MCCE to monitor aspirin related upper gastrointestinal mucosal injury.
ABSTRACT
Objective:To investigate the clinical efficacy, safety and tolerance of different enteral nutritional therapy in the treatment of moderately severe acute pancreatitis (MSAP).Methods:From January 2018 to January 2019, 65 patients with MSAP who were hospitalized in Beijing Chao-Yang Hospital, Capital Medical University were prospectively enrolled. According to random number table, the patients were divided into the nasogastric tube enteral nutrition (NGEN) group (35 cases) and the nasojejunal tube enteral nutrition (NJEN) group (30 cases). All the patients received enteral nutrition solution through continuously pumping at a constant speed for 24 h. The two groups were compared in the relief time of abdominal pain, time from admission to receiving enteral nutrition treatment, time to resume oral feeding, computed tomography severity index (CTSI) score 1 week after enteral nutrition, nutrition status, infection parameters, hospitalization time, hospitalization expenses and complications. Independent sample t test and rank sum test of two independent samples were used for statistical analysis. Results:There were no significant differences in age, gender, body mass index (BMI), CTSI score and Ranson score at admission, relief time of abdominal pain, time from admission to receiving enteral nutrition treatment, time to resume oral feeding, CTSI score one week after enteral nutrition or hospitalization time between NGEN group and NJEN group (all P>0.05), and there was no death in both groups. The cost of hospitalization, catheterization time, cost of catheterization of NGEN group were all lower than those of NJEN group ((40.0±10.0) thousand yuan vs. (40.4±9.0) thousand yuan; 2.00 min (1.50 min, 2.50 min) vs. 11.50 min (9.50 min, 12.75 min); 135.42 yuan (135.42 yuan, 135.42 yuan) vs. 1 313.30 yuan (1231.20 yuan, 1 823.72 yuan)), and the differences were statistically significant ( t=2.342, Z=6.737 and 7.687, all P<0.01). The albumin levels of MSAP patients of the NGEN group at admission and 1 week after enteral nutrition were both higher than those of NJEN group ((43.5±5.1) g/L vs. (41.0±4.0) g/L, (42.1±4.1) g/L vs. (39.5±4.4) g/L), and the differences were statistically significant ( t=2.135 and 2.486, P=0.04 and 0.02), however there was no statistically significant difference in the decrease of albumin level between the two groups ( P>0.05). There were no statistically significant differences in the incidence of nutrition-related complications (abdominal distension, diarrhea, gastric retention and lumen obstruction) or the incidence of severe complications (transient organ failure and pancreatic necrosis complicated with infection) between NGEN group and NJEN group (all P>0.05). Conclusions:The efficacy and safety of NGEN are equivalent to NJEN in MSAP. Moreover, it can reduce the medical expenses of patients, and it is convenient to carry out in primary hospitals because of its easy operation.
ABSTRACT
Objective:To investigate the differences of gene expression and signal transduction pathways in large conductance calcium-activated potassium channels(BKCa) gene knockout rats and analyze the role of BKCa gene in pancreas.Methods:Three adult female BKCa knockout SD rats (BKCa knockout group) were donated by Professor Wang Wei from Department of Pathology and Physiology of Basic Medical College of Capital Medical University, and three wild type adult femal SD rats were used as wide-type group. The whole pancreas was resected and RNA was extracted. RNA transcriptome sequencing (RNA-seq) technology was used for sequencing and DESeq2 differentiation analysis software was used for screening differentially expressed genes between two groups, and the gene ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment analysis were performed. The key genes were validated by RT-PCR.Results:18 258 genes were detected by sequencing in the 2 groups. There were statistically significant differences in the expression of 348 genes screened by DESeq2, 200 of which were highly expressed in the pancreas of BKCa knockout group, and 148 of which were low-expressed. 214 differentially expressed genes enrichments were found in GO database, including 25 involved in biological process, 18 in cell components and 14 molecular functions. All 348 differentially expressed genes were found in KEGG database, 15 of which were significantly enriched in PI3K/Akt signaling pathways. RT-PCR results showed that the expression of key genes Hsp90ab1, Hsp90aa1, Foxo3a and Col1a2 in the BKCa knockout group was significantly higher than that in wide type group ( P<0.0001), while Thbs1, Pik3r1 and Ppp genes were not significantly different. Conclusions:Differentially expressed genes and related important regulatory signaling pathways were screened out between BKCa knockout SD rats and wild-type SD rats at the transcriptional level, and PI3K/Akt pathway was found to be the most enriched, providing an important clue for predicting the function of BKCa in the pancreas.
ABSTRACT
Objective To compare the safety and effectiveness of endoscopic retrograde biliary drainage ( ERBD ) and endoscopic nasobiliary drainage ( ENBD ) in treatment of acute cholangitis. Methods A retrospective analysis was performed on data of 272 patients with acute cholangitis who underwent emergent endoscopic retrograde cholangiopancreatography ( ERCP ) in Beijing Chaoyang Hospital from January 2009 to June 2017. Patients were divided into ERBD group ( n=143) and ENBD group ( n=129) according to the drainage measures. In the ERBD group, there were 63 cases of gradeⅠ(mild) acute cholangitis, 51 of grade Ⅱ ( moderate) , and 29 of grade Ⅲ ( severe) , and the corresponding cases in the ENBD group were 54, 37 and 38, respectively. The rate of improvement of inflammation, ERCP-related complications and interventions to drainage were compared between the two groups in all patients and each grade. Results The rates of improvement of inflammation in the ERBD group and the ENBD group were 89. 5％ (128/143) and 94. 6％ (122/129), respectively, in overall patients (χ2=2. 399, P=0. 126), 93. 7％ (59/63) and 98. 1％ (53/54), respectively, in grade Ⅰ patients (χ2 =0. 548, P=0. 459), 90. 2％ (46/51) and 94. 6％ (35/37), respectively, in grade Ⅱ patients (χ2=0. 125, P=0. 724), and 79. 3％ (23/29) and 89. 5％ (34/38), respectively, in grade Ⅲ patients (χ2=0. 657, P=0. 418). The incidence of ERCP-related complications in the ERBD group and the ENBD group were 11. 9％ ( 17/143) and 7. 8％ ( 10/129) , respectively, in overall patients (χ2=1. 298, P=0. 225) , 9. 5％ ( 6/63) and 7. 4％( 4/54) , respectively, in grade Ⅰ patients (χ2=0. 006, P=0. 939) , 13. 7％ ( 7/51) and 8. 1％ ( 3/37) , respectively, in grade Ⅱ patients (χ2=0. 230, P=0. 632), and 13. 8％ (4/29) and 7. 9％ (3/38), respectively, in grade Ⅲ patients (χ2=0. 144, P=0. 705) . There were no significant differences in the rate of improvement of inflammation and ERCP-related complications between the two groups. The incidences of interventions to drainage in the ERBD group and the ENBD group were 10. 5％ ( 15/143 ) and 3. 1％(4/129), respectively, in overall patients (χ2=5. 699, P=0. 017), 6. 3％ (4/63) and 1. 9％ (1/54), respectively, in grade Ⅰ patients (χ2 = 0. 548, P = 0. 495 ) , 9. 8％ ( 5/51 ) and 5. 4％ ( 2/37 ) , respectively, in grade Ⅱ patients (χ2=0. 125, P=0. 724), and 20. 7％ (6/29) and 2. 6％ (1/38), respectively, in grade Ⅲ patients (χ2 = 3. 965, P= 0. 046 ) . There were significant differences in the incidence of interventions to drainage between the two groups in overall and gradeⅢpatents. Conclusion ERBD and ENBD are equally safe and effective in treatment of different grades of acute cholangitis, but ENBD can reduce the incidence of interventions to drainage.
ABSTRACT
Objective To evaluate the efficacy and safety of double guidewire technique in perforation of duodenal papilla caused by guide wire during endoscopic retrograde cholangiopancreatography ( ERCP ) intubation. Methods A retrospective analysis was performed on data of 57 patients whose duodenal papilla were perforated by guidewire in ERCP from January 2008 to September 2016. Among the 57 patients, 30 patients were cannulated with double guidewire technique ( double guidewire group ) and 27 patients were performed with traditional technique ( standard group ) for continue. The biliary intubation success rate, intubation time, and post-ERCP complication rate were compared between the two groups. Results The rate of successful intubation of the double guidewire group was significantly higher than that of the standard group[96. 7％ (29/30) VS 74. 1％ (20/27),χ2=5. 545, P=0. 019]. The intubation time of the double guidewire group was significantly shorter than that of the standard group (21. 8±7. 8 min VS 40. 7 ±8. 4 min, t=8. 076, P=0. 000). The double guidewire group had a similar incidence of post-ERCP complication compared to the standard group[ 13. 3％ ( 4/30) VS 11. 1％ ( 3/27) ,χ2=0. 292, P=0. 596] , and the complication in two groups was hyperamylasemia. Conclusion Double guidewire technique is safe and effective for difficult biliary cannulation because of perforation of duodenal papilla with a higher success rate and less time compared to classic technique.
ABSTRACT
Objective To evaluate the feasibility and safety of direct peroral cholangioscopy (DPCS) by freehand intubation using routine straight-view endoscope for diagnosis and therapy of biliary diseases.Methods Patients with unexplained choledochal stenosis and choledocholithiasis underwent standard ERCP.Native papilla was dilated using endoscopic papillary large balloon dilation (EPLBD)according to the size of papilla and the diameter of common bile duct.DPCS was performed using routine straight-view endoscope,and biopsy or laser lithotripsy was performed according to imaging of DPCS.General data of patients,procedure of ERCP,diagnosis of DPCS,and complications were recorded.Serum amylase after 2 hours and 24 hours,total bilirubin,direct bilirubin,leukocyte count,neutrophilic granulocyte percentage,and C-reactive protein were measured.Results A total of 15 patients underwent DPCS,including 5 cases of huge common bile duct stones and 10 cases of common bile duct stricture.The diameter of common bile duct ranged from 1.5 cm to 2.5 cm.Single EPLBD was required in 3 cases,endoscopic sphincteropapillotomy and EPLBD was required in 12 cases to facilitate DPCS.DPCS was successfully completed in 14 cases,including 11 cases in distal common bile duct,3 cases in proximal common bile duct.Among the 14 cases,4 cases used ordinary gastroscope,and 10 cases used ultrathin gastroscope.Laser lithotripsy was successfully completed in 4 choledocholithiasis patients.DPCS was successfully completed in 9 patients of common bile duct stenosis.The reasons of stenosis included 5 calculi,2 normal,1 scar and 2 adenoma.There were 1 case of cholangitis and 4 cases of hyperamylasemia after operation.No procedure related death occurred.Conclusion Freehand DPCS using ordinary gastroscope or ultrathin gastroscope is feasible and safe,and may be clinically useful for diagnosis and therapy of unexplained choledocholithiasis and common bile duct stenosis.
ABSTRACT
Objective To investigate the changes of C-reactive protein(CRP)and D-dimer in the patients with hyperlipidemic acute pancreatitis(HLAP)and biliogenic acute pancreatitis(BAP).Methods One hundred fifty-five inpatients with acute pancreati-tis in our hospital from Jan.2012 to Dec.2014 were divided into the HLAP group and BAP group by etiology.Also the patients were divided into mild acute pancreatitis(MAP)subgroup and moderately severe acute pancreatitis(MSAP)subgroup by disease se-verity.Blood routine,liver and kidney function,glucose(Glu),calcium,blood lipids,CRP and D-dimer were measured.Results Platelet,Glu and blood lipid indicators in the HLAP group were significantly higher than those in the BAP group.But alanine amin-otransferase(ALT),r-glutamyl transferase(GGT),alkaline phosphatase(ALP),total bilirubin(TBIL),direct bilirubin(DBIL),calci-um(Ca)and creatinine(Cr)in the HLAP group were significantly lower than those in the BAP group(P <0.05).CRP in the HLAP group was significantly higher than that in the BAP group with statistical difference(P <0.01).CRP had statistical difference be-tween the HLAP group and BAP group in the MAP and MSAP subgroups (P <0.01).CRP and D-dimer had statistical difference between in the MAP and MSAP subgroups of the HLAP group(P <0.05).Increased CRP and D-dimer in the HLAP group were the risk factors for MSAP occurrence(OR =1.121,3.716,P =0.025,0.001 ).In the BAP group,only increased D-dimer was the risk factor for MSAP occurrence(OR=2.717,P =0.002).Conclusion CRP and D-dimer in HLAP and BAP are increased with dis-ease severity aggravation,moreover CRP increase is more obvious in HLAP patients.
ABSTRACT
Objective To explore the four criteria,including bedside index for severity in acute pancreatitis(BISAP),Ranson score,modified CT severity index(MCTSI) and acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) in assessment of severity and prognosis of hyperlipidemic acute pancreatitis.Methods A total of 326 patients with hyperlipidemic acute pancreatitis were studied retrospectively from August 2006 to July 2015.The discrepancy of the four criteria in assessment of severity and prognosis of hyperlipidemic acute pancreatitis was compared with chi-square test and receiver operating characteristic curve.Results The incidences of moderately severe acute pancreatitis and severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥3,Ranson score ≥3,APACHE Ⅱ score≥8 and MCTSI score≥4 were significantly higher than BISAP score ＜ 3,Ranson score ＜ 3,APACHE Ⅱ score ＜ 8 and MCTSI ＜ 4 respectively (all P ＜ 0.05).As far as severity was concerned,the sensitivity and AUC of APACHE Ⅱ were 57％ and 0.814,which were higher than the other systems.The second most sensitive criterion was BISAP.In assessment of local complications,the sensitivity and AUC of MCTSI were 68％ and 0.791,which were higher than the other three.The most sensitive criterion to predict mortality was BISAP with sensitivity 89％ and AUC 0.867,which was followed by APACHE Ⅱ.Conclusions All four criteria can be used to determine the severity,local complications and mortality.Generally,BISAP is simple and easy to practice,and better than the other three.
ABSTRACT
Objective To study the effects of cyclooxygenase( COX)?2 selective inhibitors on post?endoscopic retrograde cholangiopancreatography ( ERCP ) pancreatitis ( PEP ) and hyperamylasemia for common bile duct stones. Methods A total of 128 patients with normal serum amylase underwent ERCP from June 2014 to February 2015 in our hospital and were given corresponding drugs to prevent PEP.The pa?tients were divided randomly into four groups:combination group( n=33) , celecoxib group( n=34) , nitro?glycerin group(n=32) and control group(n=29). The serum amylase(AMS), C?reactive protein(CRP) and direct bilirubin( Dbil) after ERCP were measured. Abdominal pain was observed, and the incidence of PEP and post?ERCP hyperamylasemia were recorded. Results The incidence of PEP in combination group, celecoxib group were lower than those in nitroglycerin group and the control group ( 3?03%, 2?94% VS 15?63%, 17?24%),but the difference was not statistically significant(P=0?078).The incidence of post?ERCP hyperamylasemia in combination group and celecoxib group were lower than that in the control group ( 3?03%,5?88% VS 31?03%) with statistically significant difference( P=0?003, P=0?010) . There was no significant difference between nitroglycerin group ( 25%) and control group. The abdominal pain grades of combination group and celecoxib group were lower than those in nitroglycerin group and control group with significant difference(P<0?05). Celecoxib may reduce CRP after ERCP(P=0?001) and nitroglycerin may reduce Dbil after ERCP(P=0?016). Conclusion Celecoxib may reduce the incidence of hyperamylasemia and can help to reduce the abdominal pain and inflammatory reactions after ERCP . Nitroglycerin can help to reduce the Dbil after ERCP .
ABSTRACT
Objective To investigate the relationship of thyroid hormone (TH), thyroid stimulating hormone (TSH) and blood calcium in hyperlipidemic acute pancreatitis (HLAP) patients. Methods Fifty patients with HLAP were selected, among whom 37 patients with mild acute pancreatitis (MAP) were enrolled into MAP group, and 13 patients with moderately severe acute pancreatitis (MSAP) were enrolled into MSAP group. The albumin, blood glucose, creatinine, blood lipids, blood calcium, free tri-iodothyronine (FT3), free thyroxine (FT4) and TSH levels were measured and analyzed. Results The blood calcium, FT3 and TSH levels in MAP group were significantly higher than those in MSAP group:(2.02 ± 0.26) mmol/L vs. (1.75 ± 0.27) mmol/L, (1.88 ± 0.46) ng/L vs. (1.52 ± 0.35) ng/L and (0.28 ± 0.20) mU/L vs. (0.17 ± 0.12) mU/L, but the blood glucose and triglycerides (TG) levels were significantly lower than those in MSAP group: (13.36 ± 5.83) mmol/L vs. (19.99 ± 7.97) mmol/L and (24.01±12.46) mmol/L vs. (34.76 ± 20.39) mmol/L, and there were statistical differences (P0.05). The correlation analysis result showed: in patients with HLAP, TSH and albumin had a positive correlation with blood calcium (r=0.344 and 0.372, P=0.014 and 0.008), LDL-C and TG had negative correlation with blood calcium (r=-0.315 and-0.444, P=0.026 and 0.001), and other indexes had no correlation with blood calcium (P>0.05). Conclusions Blood calcium, FT3 and TSH levels are decreased with severity of HLAP. Decreased blood calcium may be one of reasons for decreased TSH in HLAP patients.
ABSTRACT
Objective To investigate the correlation and differences of serum calcium ( Ca) and intact parathyroid hormone ( i-PTH) in patients with hyperlipidemic or biliogenic acute pancreatitis ( AP) .Methods From Jan 2012 to Jan 2014 , total 80 AP patients admitted to Bejing Chaoyang Hospital were enrolled . According to the etiology , AP patients were divided into 2 groups, hyperlipidemic acute pancreatitis ( HLAP) group and biliogenic acute pancreatitis (BAP) group.Blood routine, function of liver and kidney , blood lipids, Ca, and i-PTH were measured .Differences between Ca and i-PTH in HLAP group and BAP group were analyzed, and found the correlation with disease severity of AP .Results 80 AP patients included 43 HLAP and 37 BAP patients, 55 mild acute pancreatitis(MAP) and 25 moderately severe acute pancreatitis (MSAP) patients.HLAP group had 34 male and 9 female patients, average age was 37 years, 31 MAP and 12 MSAP patients.BAP group had 17 male and 20 female patients, average age was 58 years, 24 MAP and 13 MSAP patients.proportion of males was significantly higher in HLAP group than BAP group .on the contrary, average age was significantly lower (P<0.01 and <0.01, respectively).No significantly difference was found in MAP/MSAP ration.Level of serum Ca in HLAP group was significantly decreased than BAP group (1.92 ± 0.24 mmol/L vs 2.14 ±1.99 mmol/L, P<0.05).No significantly difference was found in i-PTH between two groups.Level of serum Ca in MAP and MSAP subgroup in HLAP group were 1.98 ±0.20 mmol/L and 1.76 ± 0.27 mmol/L.Accordingly, Level of serum Ca were 2.23 ±0.15 mmol/L and 1.98 ±0.19 mmol/L in BAP group. i-PTH in MAP and MSAP subgroup in HLAP group were 43.41 ±18.40 ng/L and 56.07 ±33.61 ng/L.Accordingly, i-PTH was 39.22 ±17.19 mmol/L and 52.73 ±29.42 mmol/L in BAP group.Compared to MAP, Ca in MSAP group was significantly decreased in HLAP and BAP group ( P<0.01 and <00.5, respectively).In HLAP group, Ca was a negative correlation with low density lipoprotein cholesterol (LDLC-) and triglycerides(TG) (P<0.05 and <0.01, respectively).In BAP group, Ca was a negative correlation with i-PTH(P<0.05).Conclusions Serum Ca is decreased with severity of HLAP and BAP .Decreased Ca has correlation with increased LDL-C, TG in HLAP and increased i-PTH in BAP.
ABSTRACT
Objective To study the relationship between fibrinolysis,anticoagulation system indexes and serum albumin (ALB) in patients with liver cirrhosis.Methods One hundred and thirty-seven patients with liver cirrhosis were enrolled.Serum ALB,D-dimer (D-D),tissue plasminogen activator (t-PA),plasminogen activator inhibitor-1 (PAI-1),protein C (PC),protein S (PS) and antithrombin-Ⅲ (AT-Ⅲ) levels were measured.Results D-D level was increased with deterioration of liver function.D-D levels were (0.38 ± 0.24),(0.58 ± 0.43) and (0.90 ± 0.55) mg/L in Child-Pugh class A,B and C,respectively.PC,PS and AT-Ⅲ levels were decreased with deterioration of liver function.PC levels were (3.29 ± 1.04),(2.50 ± 1.27) and (2.29 ± 1.05)mg/L in Child-Pugh class A,B and C,respectively.PS levels were (20.74 ± 5.91),(17.97 ± 5.26) and (17.79 ± 5.12) mg/L,respectively.AT-Ⅲ levels were (104.62 ± 8.59)％,(101.76 ± 10.08)％ and (92.91 ± 10.48)％,respectively.D-D showed negative correlation with ALB (r =-0.402,P ＜ 0.01).On the contrary,PC,PS and AT-Ⅲ levels showed positive correlation with ALB (r =0.266,0.286 and 0.405,P ＜0.01).Conclusions Fibrinolysis and anticoagulation system indexes are changed with deterioration of liver function and are related with ALB directly.The indexes may be a helpful tool to evaluate the liver function in patients with liver cirrhosis.
ABSTRACT
Objective To explore the diagnostic value of alcohol fixation and liquid-based cytology method for malignant stricture of common bile duct and to study the interval time between sampling and fixation for procedure of alcohol fixation.Methods Data of 82 patients were retrospectively studied,who were suspected of having malignant stricture of common bile duct underwent brushing through endoscopic retrograde cholangiopancreatography (ERCP),and were confirmed by follow-up for 2 years or pathology after surgery from October 2008 to June 2013.These patients were randomly divided into alcohol fixation group (n =30),liquid-based cytology group (n =28) and conventional cytology group (n =24).The positive diagnostic rates of brush cytology in each group were compared.The alcohol fixation group were randomly divided into 2-minute group and 5-minute group according to the interval time between sampling and fixation.Positive diagnostic rates were also compared.Results The positive rates were 73.33％ (alcohol fixation group,22/30),75.00％ (liquid-based cytology group,21/28) and 20.83％ (conventional cytology group,5/24),respectively.The positive rate of conventional cytology group was obviously lower than alcohol fixation group (x2 =21.525,P=0.000) and liquid-based cytology group (x2 =22.208,P =0.000) with statistical significance.But the positive rate of alcohol fixation group was similar to the liquid-based cytology group (x2 =0.683,P =0.898).In alcohol fixation group,the positive rate of 2-min group (88.24％,15/17) was significantly higher than the 5-min group (53.85％,7/13) with statistical significance (x2 =4.535,P =0.033).Conclusion Compared with conventional fixation,alcohol fixation and liquid-based cytology can improve positive diagnostic rate of brushing during ERCP.The alcohol fixation is more simple in procedure and low in cost than liquid-based cytology.The interval time between sampling and fixation should be reduced to no more than 2 minutes.
ABSTRACT
Objective To evaluate curative effects of treatment of malignant biliary and gastric outlet-duodenal obstruction with endoscopically placed self-expandable metal stents.Methods A retrospective analysis was performed in 17 patients who underwent enteral stenting after placement of the biliary stent.The success rate of insertion,the effective palliation of biliary and duodenal obstruction,the rate of complication,recurrent stent obstruction and the median patency were observed.Results In 17 patients,biliary stenting were all performed for obstructive jaundice and then enteral stents were inserted.The levels of tatal billirubin [from (263.4 ± 62.5) μmol/L to (157.6 ± 25.1) μmol/L],direct billirubin [from (1233.2 ±66.5) μmol/L to (130.9 ± 27.7) μmol/L] and alkaline phosphatase [from (233.2 ± 66.5) IU/L to (130.9 ±27.7)IU/L] decreased significantly (P ＜0.01),and the gastric outlet score increased significandy [from (0.9 ± 1.1) points to (2.1 ±0.7) points] (P ＜0.01).No serious complication in all patients.Lifetime of patients ranged from 70 days to 332 days,and the median survival time was 192 day.Conclusion Combined biliary and enteral stenting is an effective method for palliation of malignant biliary and gastric outlet-duodenal obstruction.
ABSTRACT
Plasma levels of homocysteine (Hcy),folic acid (FA) and Vitamin B12 (VB12) were measured in 120 patients of colon adenomatous polyps and 40 healthy subjects.Plasma Hcy levels in colon adenomatous polyps patients were significantly higher than those in controls[(14.24 ± 0.52) μmol/L vs.(10.93 ± 0.81) μmol/L,P =0.0014)],while plasma FA levels in polyps patients were lower than those in controls [(6.26 ± 0.27) μg/L vs.(10.74 ± 0.85) μg/L,P ＜ 0.0001].There was no difference in plasma VB12 levels between two groups(P =0.7100).The plasma Hcy levels in patients with multiple colon polyps were higher than those with single colon polyps (P =0.0092),while the plasma FA levels demonstrated contrary results (P =0.0047).With the pathological type progression,the plasma Hcy levels were gradually raised,and FA levels gradually decreased.Plasma levels of FA,Hcy and VB12 were not correlated with the location and distribution of polyps.These results suggest that plasma FA and Hcy levels may be related to disease progress in patients with colon adenomatous polyps.
ABSTRACT
Objective To investigate the factors affecting health-related quality of life (HRQOL) in patients with chronic liver disease (CLD).Methods HRQOL was measured with SF-36v2 Chinese version.All patients with CLD diagnosed between December 2009 and May 2011 in Liver Research Center,Beijing Friendship Hospital and Digestive Department,Beijing Chaoyang Hospital were enrolled in this study.Patients with CLD were divided into 4 groups according to their Child-Turcotte-Pugh scores:no cirrhosis,Child's classes A,B,and C.Demographic and clinical data were collected in each group.Results A total of 392 patients with CLD and 91 healthy controls were included.HRQOL in patients with CLD was lower than that in healthy controls.Physical component score (PCS) in healthy controls was 54.6 ± 5.5,and in CLD was 47.8 ± 8.8 (t =9.343,P ＜ 0.01).Mental component score (MCS) in healthy controls was 56.4 ± 8.1,and in CLD was 51.7 ± 7.4 (t =5.302,P ＜ 0.01).Increasing severity of CLD from no cirrhosis to advanced cirrhosis was associated with a decrease on HRQOL,PCS scores were 53.1 ± 5.9,48.7 ± 6.6,42.4 ± 7.1 and 37.2 ± 8.9 (F =93.353,P ＜ 0.01) ; MCS scores were 53.2 ± 4.8,52.7 ±6.5,51.8 ±7.5,and 46.8 ± 7.5 (F =11.325,P ＜0.01),for no patients with cirrhosis,Child's classes A,B and C respectively.Stepwise linear regression analysis showed that severity of disease,age,present ascites,present varices,and prothrombin time had significant effects on physical health area (F =100.893,P ＜ 0.010).Severity of disease,female gender,present varices,total bilirubin,prothrombin time and hemoglobin had significant effects on mental health area (F =19.237,P ＜ 0.010).Conclusions Patients with CLD have reduced HRQOL.Increasing severity of CLD is associated with a decreasing HRQOL.Old age,female gender,advanced stage of CLD,present ascites,hyperbilirubinemia and prolonging prothrombin time are risk factors for reducing HRQOL.