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Proton pump inhibitor (PPI) is often used for the prevention and treatment of digestive system diseases, and the adverse outcomes caused by the use of PPI are increasingly concerned by scholars. This article elaborates on the association of the complications of liver cirrhosis, such as upper gastrointestinal bleeding, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatocellular carcinoma, and infection, and the change in gut microbiota with the use of PPI, and points out that in clinical practice, it is important to master the medication rules of PPI, understand the risk of complications caused by PPI, and actively improve the complications caused by medication.
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Liver cirrhosis is a pathological stage in which most chronic liver diseases progress to the advanced stages, and the main complications of liver cirrhosis include portal hypertension, gastroesophageal variceal bleeding, and liver cancer. Transient elastography (TE) uses acoustic waves to obtain liver stiffness measurement (LSM) noninvasively and is currently widely used in clinical practice. At present, various studies on LSM and liver cirrhosis and its complications suggest that TE has the ability to identify liver cirrhosis and its complications and can thus reduce unnecessary invasive procedures to a certain degree. This article summarizes and elaborates on the advances in the clinical application of TE in liver cirrhosis and its complications.
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Objective To investigate the expressions of CD28 and CD117 in patients with newly diagnosed multiple myeloma (MM) and their clinical significances. Methods The clinical data of 115 newly diagnosed MM patients in the First Affiliated Hospital of Zhengzhou University from May 2015 to December 2017 were retrospectively analyzed. The expressions of CD28 and CD117 were detected by using multiparameter flow cytometry. The relationship between the expressions of CD28 and CD117 and MM staging and clinical parameters was analyzed. The staging was performed according to the International Staging System (ISS). Results Among these 115 patients, there were 15 patients with CD117 positive and 30 patients with CD28 positive. Erythrocyte sedimentation rate (r ＝ -0.481, P ＝ 0.039), Cˉreactive protein level (r ＝ -0.314, P＝0.015), the proportion of plasma cells detected by bone marrow cytology (r＝-0.027, P＝0.001) were negatively correlated with CD117 positive expressions. CD28 positive expression was positively correlated with lactate dehydrogenase level (r ＝ 0.249, P ＝ 0.033) and ISS stage (r ＝ 0.319, P ＝ 0.017), while it was negatively correlated with hemoglobin level (r ＝ -0.372, P ＝ 0.026). CD28 positive was associated with light chain type, and nonˉsecretory type mostly occurred (P ＝ 0.016). The incidence of osteolytic lesions in CD28 positive group and CD117 positive group was high, but there was no statistical difference between CD28 positive group, CD117 positive group and CD28 negative group, CD117 negative group (P ＝ 0.052, P＝0.479). Conclusions The positive expression of CD117 in the early stage of MM patients is higher than that in the advanced stage, and the expression of CD28 positive in the advanced stage of MM patients is higher than that in the early stage. CD28 and CD117 can be used as indicators of prognosis stratification in the patients with newly diagnosed MM.
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Objective To investigate the diagnostic value of contrast-enhanced CT and MR diffusion-weighted imaging (DWI) in differentiating autoimmune pancreatitis (AIP) from pancreatic carcinoma (PC).Methods Twelve patients with AIP (AIP groups) and 15 patients with PC (PC groups) were included in this study.Contrast-enhanced CT and DWI were performed in all patients.The manifestations of the pancreatic lesions,pancreatic duct and bile duct were observed.The CT attenuation values and the apparent diffusion coefficient (ADC) values of the lesions were calculated.Frequencies of the CT manifestations,and the mean CT attenuation values,and the ADC values were compared between the two groups.Results Most of the AIP showed diffuse enlargement,sausage shape,peripancreatic capsule,penetrating sign of pancreatic duct and thickness of the bile duct.The frequencies of the findings mentioned above were significantly different between AIP and PC (P＜0.05).The CT attenuation values of the lesions,and the rate of lesions' CT attenuation values to livers' in 3 phases of contrast enhanced CT were significantly different between AIP and PC (P＜0.05).The ADC values of AIP were significantly lower than that of PC (P＜0.05).Conclusion The changes of morphology of pancreas,pancreatic and bile duct may facilitate in differentiating AIP from PC.Quantitative analysis of CT attenuation values and ADC values measured on MR images may be helpful in differentiating AIP from PC.
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Objective To investigate the clinical application of liquid pressurization under obstruction of healthy-side uterine horn with the tip of double lumen balloon catheter combined with guidewire recanalization in treating unilateral obstruction of fallopian tube.Methods Hysterosalpingography was performed in infertility patients.A total of 50 patients with unilateral obstruction of fallopian tube were selected.Attempt was made to use catheter tip to obstruct the healthy-side uterine horn,then liquid pressurization was carried out to reopen fallopian tube,and the relationship between the success of recanalization and uterine morphology was analyzed;further guidewire recanalization was employed when liquid pressurization method failed,and the recanalization rate was calculated.Results In 33 among the 50 patients,the distance from the uterine horn to the cervical internal orifice was shorter than the catheter length that was inserted into the uterus,besides,the width of the uterine horn was smaller than the catheter diameter,thus the uterine horn was tightly occluded by the catheter tip.Recanalization of the fallopian tube was obtained in 19 patients,and recanalization of the fallopian tube failed in 14 patients because the obstruction was very severe.In 17 among the 50 patients,the distance from the uterine horn to the cervical internal orifice was longer than the catheter length that was inserted into the uterus,besides,the width of the uterine horn was larger than the catheter diameter,thus the uterine horn could not be tightly occluded by the catheter tip,resulting failure of recanalization of fallopian tube.Further guidewire recanalization had to be carried out for the 33 patients whose recanalization of fallopian tube with liquid pressurization method failed,and recanalization of fallopian tube was achieved in 22 patients.Conclusion Liquid pressurization under obstruction of healthy-side uterine horn with the tip of double lumen balloon catheter can reopen the obstructed fallopian tube in some patients,and the success of recanalization is closely related to the uterine morphology.Additional use of guidewire recanalization technique can significantly improve the recanalization rate for unilateral fallopian tube obstruction.
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Objective To analyze the clinical features and prognosis of CD34-positive and CD34-negative adult patients with acute T-lymphoblastic leukemia (T-ALL),and to explore the value of CD34 expression for prognosis of patients with T-ALL.Methods 75 adult patients diagnosed with T-ALL from January 2012 to July 2015 in the Department of Hematology,the First Affiliated Hospital of Zhengzhou University,were analyzed retrospectively.According to the expression of CD34,the patients were divided into CD34-positive group and CD34-negative group,and then the clinical characteristics and prognosis of both groups were analyzed.Results In 75 patients,CD34-positive group had 24 (32.0 ％) patients and CD34-negative group had 51 (68.0 ％) patients.Between the two groups,there was no significant difference in these factors,such as sex,age,infiltration of liver,spleen and lymph nodes,thrombocytopenia,high white blood cell count,abnormal karyotype,complete remission within 4 weeks and central nervous system leukemia (CNSL).The proportions of patients with hemoglobin (Hb) ＜ 90 g/L and expression of myeloid lineage marker were higher in the CD34-positive group than those in the CD34-negative group (x2 =5.888,P=0.015;x2 =10.758,P =0.001,respectively).There were only 18 patients treated with hematopoietic stem cell transplantation (HSCT),57 patients were not.In patients without HSCT,the median survival time in the CD34-positive group and CD34-negative group was significant different (5 months vs.32 months,x2 =9.172,P =0.002).Conclusions CD34 expression in adult patients with T-ALL appears to be associated with Hb ＜ 90 g/L and the expression of myeloid lineage markers.For the patients without HSCT,CD34 is likely negatively related with the prognosis.
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Objective To explore the facilitative mechanism of the behavioral improvement resulting from gaming experience in internet gaming addicts. Methods Seventeen gaming addicts and twenty normal subjects were involved in the study, and their behavioral performance were evaluated by using the revised paradigm of event-related design. Results 1. Mean reaction times (RTs) under valid and invalid cue conditions were ( (614.27 ± 85.25)ms,(645.4±80.24)ms)and ((710.24 ± 131.42)ms,(765.53 ± 142. 53)ms) respectively. There were statistically significant differences of mean RTs within each group (P < 0. 05 ) and between the two groups (P < 0.01 ). 2. There were statistically significant differences of mean RTs on three cue levels between addiction group (online game picture(643.65 ±90.82) ms,neutral face picture(616. 73 ±82. 19)ms,neutral picture(629. 21 ± 78.20)ms) and control group(game picture (744. 54 ± 140. 42) ms, neutral face picture ( 727. 98 ± 142.26)ms, neutral picture(741. 13 ±138. 21)ms, P<0.05).3. There were statistically significant differences on trends of mean RTs on three cue levels of addiction group between valid cue condition ( online game picture (619. 02 ± 91.00) ms,neutral face picture (604.90 ±90. 71 )ms,neutral picture (618.87 ±77.85)ms) and invalid cue con-dition( online game picture ( 668. 28 ± 86. 27 ) ms, neutral face picture ( 628. 56 ± 73. 53 ) ms, neutral picture (639.54 ±79. 54) ms, P<0. 05). Conclusion Both exogenous and endogenous attention orientation are improved in internet gaming addicts. Enhancement of endogenous attention function resulting from gaming experience might be greater than that of exogenous attention.
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Objective To investigate the MSCT characteristics of peritoneal pseudomyxoma. Methods CT findings of peritoneal pseudomyxoma proved by surgery and pathology in 11 cases were retrospectively analyzed. Results On MSCT,the peritoneal pseud-omyxomas were irregular intraperitoneal cystic-solid masses, the CT attenuation was 18.5 ～ 27.6 HU, there were scallop-like, wavy and nodule-like indentations on the liver and/or spleen surface,large amount of mucinous ascites within abdominal, pelvic an-domentum cavity , thickening of peritoneum. On post-contrast administration , mild enhancement of peritoneum,cystic wall and omentum could be revealed. Conclusion MSCT examination has important value in diagnosis and differential diagnosis of peritoneal pseudomyxomas
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A new head and neck location frame for positron emission tomography (PET) and computed tomography (CT) cross-modality medical image fusion in radiotherapy was developed. The solid mark bars of N form in the old designed CT location frame were replaced by closed hollow pipes which could be filled with different developer solutions before CT or PET scan, respectively. Nine points of external marker used for registration and fusion were obtained in CT images and PET images, respectively. The locations of the two sets of nine points showed the method of registration to be effective and accurate in achieving the PET and CT image fusion. This method, based on its characteristics of simple structure and easy-to-use, can be of wide application in clinical setting.
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Humans , Head , Diagnostic Imaging , Image Interpretation, Computer-Assisted , Methods , Multimodal Imaging , Methods , Neck , Diagnostic Imaging , Positron-Emission Tomography , Methods , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Methods , Tomography, X-Ray Computed , MethodsABSTRACT
Objective To assess the value of enhanced MSCT scan for the Crohn's disease of small bowel.Methods Fourty-five patients of small bowel Crohn's disease who were proved by multi-methed were examined by two-phase enhanced scan with MSCT.The images were reformed in ADW 4.2 by MPR mainly.The CT values of the lesion segments in different phases were tested, with one way ANOVA in statistical analysis; the density difference between the lesion segments and normal segments in different phases were tested,the cases were divided according to 10 HU,and compared them with each other by X2 test.Results The average CT value of lesion segments was (39.3±3.7) HU in plain scan, (74.8 ± 13.8) HU in artery phase, (90.2 ± 12.3) HU in portal vein phase, there were sinigicant difference in them(F =258.87,P < 0.01).There were sinigicant difference in CT value of lesion segments between any phase and other two phases (P < 0.05).In 45 cases, there were 44 cases and one case that the difference of CT value were ≤±10 HU and > 10 HU respectively in plain scan, 6 cases and 39 cases in artery phase, 2 cases and 43 cases in portal vein phase, by X2 test, there were sinigicant difference betwwen plain scan and artery phase(X2 =32.49,P <0.01), and significant difference between plain scan and portal vein phase(X2 = 39.22,P <0.01), there were no significant difference between artery phase and portal vein phase (X2 = 1.10,P>0.05).After enhancement, the lesions can display clearly than plain scan, and the detectable rate was raised highly.Conclusion Two-phase enhancement scan can diagnosis the Crohn's disease of small bowel and evaluate it overall.
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Objective To observe curative effect and clinical outcome in 30 recipients undergoing allogcneic peripheral blood stem cell transplantation (PBSCT) combined with bone marrow transplantation (BMT). Methods 30 patients with a median age of 32.6 years underwent allo-HSCT, of which 11 patients with AML, 14 patients with ALL, and 5 patients with CML They all have a HLA-identical sibling. PBSCswere mobilized with G-CSF. Three hundreds milliliter bone marrow blood was transplanted to the patients on the day that the PBSC was transplanted. Amended Bu/Cy was used as the conditioning regimen. MTXcombined with CsA and MMF was used as GVHD prophylaxis. Results A median number of mononuclear cells of (5.13±2.6)x10~8/kg recipient's weight was collccted from peripheral blood, and (1.3±0.6)x10~8/kgrecipient' s weight from bone marrow blood. Engraftment of neutrophils and platelets was achieved at a median of (12.1±3.25) days and (14±5.33) clays respectively. Ⅰ - Ⅱ acute GVHD occurred in 40.0 % cases,Ⅲ - Ⅳ acute GVHD occurred in 3.3 % cases, and chronic GVHD developed in 43.3 % cases. Severe cGVHD developed in 3.3% cases. The 2 years disease free survival rate (DFS) by the day of transplantation was 72.0 %. Conclusion PBSCT combined with BMT was effective to cure leukemia. The results also suggested that PBSC recipients had an lower incidence of aGVHD and cGVHD as compared with previous reports.
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BACKGROUND:The prognosis of malignant hematologic diseases has improved greatly with the application of the hematopoietic stem cell transplantation. Peripheral blood stem cell transplantation (PBSCT) has been used as an alternative to bone marrow transplantation (BMT).OBJECTIVE:To observe curative effect and clinical outcome in 53 patients with hematological malignancy undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT) or autologous peripheral blood stem cell transplantation (auto-PBSCT).DESIGN:Randomized controlled study.SETTING:BMT Center, Hematology Department of the First Affiliated Hospital of Zhengzhou University.PARTICIPANTS:From July 2003 to May 2006, 53 patients (33 males and 20 females) with a median age of 37 years underwent PBSCT. Thirty-five patients received allo-PBSCT, including 13 of acute myelocytic leukemia (AML), 7 of acute lymphocytic leukemia (ALL), 10 of chronic myelocytic leukemia (CML), 2 of multiple myeloma (MM), and 3 of myelodysplastic syndrome (MDS). Eighteen patients underwent auto-PBSCT, including 7 AML, 6 ALL, 2 MM, and 3 non-Hodgkin lymphoma (NHL). Thirty-three donors (20 males and 13 females) with a median age of 35 age in the allo-PBSCT were HLA-identical siblings, 2 donors (5.7%) had one mismatch. Sixteen allografts were sex mismatched. Study was authorized by the Ethic committee of the hospital, and all patients had signed an inform consent.METHODS:① PBSC were mobilized with granulocyte colony-stimulating factor (G-CSF) or chemotherapy combined with G-CSF. A median of 6.2×106 CD34+ cells/kg was infused for allo-PBSCT and 3.0×106 CD34+ cells/kg was infused for auto-PBSCT. Amended BU/CY was used as conditioning regimen in allo-PBSCT and MAC was used in auto-PBSCT. Methotrexate (MTX) combined with cyclosporine A (CsA) and mycophenolate mofetil (MMF) was used as graft-versus-host disease (GVHD) prophylaxis. ALG was used in 1 patient with 1 locus mismatched in allo-PBSCT. ② Time to engraftment was calculated from the time of transplantation to neutrophil recovery ≥ 0.5×109 L-1 and platelet recovery ≥ 20×109 L-1, GVHD and relapse were observed until 1 year of follow-up.MAIN OUTCOME MEASURES:① Time to neutrophil and platelet recovery; ② GVHD occurrence after transplantation; ③ outcome of treatment.RESULTS:All the 53 patients were analyzed. ① Engraftment of neutrophils (> 0.5×109 L-1) and platelets (> 20×109 L-1) was achieved at a median of 13 days for neutrophils and 19 days for platelets in auto-PBSCT, and 12 days and 15 days respectively in allo-PBSCT. ② In allo-PBSCT, I-VI acute GVHD occurred in 31.4% cases, and chronic GVHD developed in 71.4% cases. ③ The relapse rate was 38.9% in auto-PBSCT, and 5.7% in allo-PBSCT. CONCLUSION:PBSCT can provide rapid hematopoietic reconstitution. It is an important method to cure the malignant hematologic diseases.
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Objective To discuss the advantages and disadvantages of the iodized oil,diatrizoate and non-ionic iohexol used as contrast media in performing hysterosalpingography and to evaluate the modified hysterosalpingography in clinical practice.Methods Patients who were scheduled to receive hysterosalpingography were randomly selected and divided into three conventional groups:iodized oil group,diatrizoate group and iohexol group,with 100 cases in each group.Another 100 cases(modified group) were examined with modified hysterosalpingographic technique by using iohexol as contrast medium.During the procedure and after the hysterosalpingography all the patients were carefully observed.The image quality,the fallopian tube patent rate,the incidence of abdominal pain,clinical safety,etc.were documented and the results were compared among groups.The advantages of modified hysterosalpingographic technique were analyzed.Results No significant difference in image quality and the fallopian tube patent rate existed among the three conventional groups.The occurrence of abdominal pain in iohexol group was significantly lower than that in both iodized oil group and diatrizoate group(?2 = 10.54,P
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The application of covered stent in vascular malformation such as aneurysm,pseudoneurysm(PSA) ,arteriovenous fistula(AVF) has outcome to an encouraging result.Recently,it has also been effectively used for PTA,TIPS,traumatic lesions of peripheral vessels,and pseudoneurysm of dialysis grafts,etc.But there still remain some issues on the restenosis and endothelialization after the performance with covered stent.This review will pay attention to them.
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50%) of the stent at 2 weeks follow-up,so did 3 cases at 12 weeks follow-up,and the total stenosis rate was 37.5% and 5 cases manifested full endothelialization(3 different locations of the sample all manifested full endothelialization) ,3 cased manifested partial endothelialization(at least 1 location of the sample didn't show full endothelialization) ,and the two terminal parts were easier to get endothelialization than the central part.Before and after the stent implantation,hepatic function of all cases didn't demonstrate any obvious changes.Conclusions Balloon-expandable covered stent can be implanted in canine hepatic artery successfully,with good apposition ability,full endothelialization,and no influence on hepatic function.
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Objective To evaluate the clinical application value of multislice spiral CT (MSCT) in diagnosis andclinical treatment of the chronic suppurative otitis media(CSOM). Methods Multislice spiral CT with direct axial plane and saggitalmultiplanar reformation(MPR) were performed in 61 cases including 76 ears.The results from those images were comparedwith that of operations. Results The sagittal MPR images preferably could delineate the anatomical details of the temporal bone and theadjacent relationship,and could display the tympanicand mastoid segment of the facial nerve,sigmoid sinus plate and the glomusjugular better.On the sagittal MPR images,the disruption of the ossicular chain and bony erosion in the tympanic cavity and antrum weredisplayed in 38 ears.The destruction of the facial nerve canal was severe in the type of cholesteatoma compared with the type of granuloma of chronic suppurative otitis media.The congenital abnormities were showed in 8 ears of the sigmoid sinus plate and 2 ears of the glomus jugular.Conclusion CT sagittal MPR images are of significant clinical value in showing the degree and location of destruction of the canal of facial nerve , and the relation between around structures in chronic suppurative otitis media.
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Objective To evaluate the value of DSA in the diagnosis of staging moyamoya disease (MMD).Methods DSA of 31 patients with MMD were reviewed retrospectively. Results The stenosis or occlusion with different extents of the supracranial internal carotid arteries and the collateral circulations were shown in DSA of the all patients. MMD lesions of 57 cerebral hemispheres shown in the DSA of 31 patients were diagnosed by staging according to the description of Suzuki: Stage Ⅰ in 4 cerebral hemispheres; Ⅱ,10;Ⅲ17;Ⅳ12;Ⅴ6 and Ⅵ,8. Conclusions DSA could show clearly the stenotic degree, occlusive site and collateral circulation of the MMD and simultaneously with the staging of the disease; and thus guiding the choice for early surgical teatment.