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Objective:To explore the value of quantitative parameters of enhanced MRI in predicting the establishment of inferior vena cava collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus.Methods:Sixty-seven patients with renal cell carcinoma and inferior vena cava tumor thrombus who underwent radical resection and inferior vena cava venography in First Medical Center, PLA General Hospital from May 2006 to January 2021 were included retrospectively. According to the results of inferior vena cava venography, the patients were divided into two groups: the well-established collateral circulation group ( n=41) and the poor-established collateral circulation group ( n=26). Quantitative parameters were measured on preoperative enhanced MRI images, including tumor size, the maximum diameter of bilateral lumbar veins, the length of tumor thrombus, and the long and short diameters of tumor thrombus. Student′s t test or Mann-Whitney U test was used for comparison between the two groups. The independent risk factors related to the establishment of collateral circulation were obtained by binary logistic regression analysis and the model was established. The receiver operating characteristic curve was employed to evaluate MRI quantitative parameters and the logistic model, and the area under the curve (AUC) was compared by the DeLong test. Results:Between the well-established collateral circulation group and the poor-established collateral circulation group, the maximum diameter of the right lumbar vein, the maximum diameter of the left lumbar vein, the length of the tumor thrombus, the long diameter of the tumor thrombus, and the short diameter of the tumor thrombus were different significantly ( P<0.05). There was no significant difference in the tumor size between the two groups ( t=0.30, P=0.766). The AUC of the maximum diameters of the right lumbar veins and left lumbar veins, length of tumor thrombus, long and short diameters of tumor thrombus in predicting the collateral circulation were 0.917 (95%CI 0.824-0.971), 0.869 (95%CI 0.764-0.939), 0.756 (95%CI 0.636-0.853), 0.886 (95%CI 0.785-0.951), and 0.906 (95%CI 0.809-0.963). The AUC of the maximum diameter of the right lumbar vein and the short diameter of the tumor thrombus were larger than those of the length of the tumor thrombus, and the differences were statistically significant ( Z=2.25, 2.04, P=0.025, 0.041), but the AUC between other parameters had no significant difference ( P>0.05). The maximum diameter of the right lumbar vein (OR 24.210, 95%CI 2.845-205.998), the maximum diameter of the left lumbar vein (OR 20.973, 95%CI 2.359-186.490), and the length of the tumor thrombus (OR 23.006, 95%CI 2.952-179.309) were independent risk factors for predicting the establishment of inferior vena cava collateral circulation. The AUC of logistic model was 0.969 (95%CI 0.931-1.000). Conclusion:Quantitative parameters of tumor thrombus and lumbar vein based on enhanced MRI have a good ability in predicting the establishment of inferior vena cava collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus. The maximum diameter of bilateral lumbar veins and the length of the tumor thrombus were independent risk factors for inferior vena cava collateral circulation.
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Objective:To evaluate the test-retest reliability of MRI criteria in the 2019 Bosniak classification of cystic renal masses (CRMs) and to analyze the impact of lesions′ property, size and readers′ experience on the test-retest reliability.Methods:From January 2009 to June 2019, 207 patients with 207 CRMs were included in this retrospective study. All of them underwent renal MRI and surgical-pathologic examination. According to Bosniak classification, version 2019, all CRMs were independently classified twice by eight radiologists with different levels of experience. All radiologists were blinded to the pathology of the lesions. By using intraclass correlation coefficient (ICC), test-retest reliability was evaluated for all CRMs and for subgroups with different pathological properties (benign and malignant) and different sizes (≤40 mm and>40 mm). The test-retest reliability of 4 senior readers (≥10 years of experience) and 4 junior readers (<10 years of experience) were evaluated respectively. The comparison of ICC was performed using Z test. Results:The 207 CRMs included 111 benign lesions (83 benign cysts, 28 benign tumors) and 96 malignant tumors. There were 87 lesions with maximum diameter ≤40 mm and 120 with maximum diameter>40 mm. The test-retest reliability (ICC) of each reader for all lesions was 0.776-0.888, the overall ICC was 0.848 (95%CI 0.821-0.872). The ICCs of senior and junior readers were 0.853 (95%CI 0.824-0.880) and 0.843 (95%CI 0.811-0.871) respectively, without significant difference between the two groups ( Z=0.85, P=0.374). The ICC of all readers was 0.827 for benign lesions and 0.654 for malignant lesions, showing significant difference ( Z=2.80, P=0.005). The ICC was 0.770 for lesions ≤40 mm and 0.876 for lesions>40 mm, which was significantly different ( Z=-2.36, P=0.018). For CRM subgroups with different pathological properties and different sizes, there was no significant difference in test-retest reliability between senior and junior readers (all P>0.05). Conclusion:The test-retest reliability of MRI criteria in the 2019 Bosniak classification of CRMs is excellent and unaffected by readers′ experience. The reliabilities are not consistent among CRMs of different pathological properties and different sizes, but all reached the level of good and above.
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Objective:To evaluate the safety and efficacy of combination of submucosal tunneling endoscopic septum division (STESD) and peroral endoscopic myotomy (POEM) for the treatment of esophageal epiphrenic diverticulum with esophagogastric junction (EGJ) outflow tract disorder.Methods:From October 2017 to August 2021, 6 patients with esophageal epiphrenic diverticulum complicated with EGJ outflow tract disorder receiving combination of STESD and POEM in the Endoscopic Center of the First Affiliated Hospital of Nanjing Medical University were enrolled. The clinical characteristics of the patients were retrospectively analyzed, which included the ratio of male to female, age, course of disease, length of diverticula, location, whether with multiple diverticula, type of EGJ outflow tract disorders, whether the endoscopic technique was successful (the completion of all steps under endoscopy, including tunnel establishment and diverticulum cristae, lower esophageal sphincter and cardia muscularis propria incision); operation time, changes in the severity of clinical symptoms before and after operation (including weight loss, dysphagia, retrosternal pain, and reflux assessed using the Eckardt score), intraoperative and postoperative complications, and follow-up, including whether achieved clinical success (complete or nearly complete improvement of dysphagia, vomiting after eating, retrosternal pain, regurgitation, weight loss, no need for repeat endoscopic intervention during follow-up) and adverse events. Descriptive methods were used for statistical analysis.Results:The male to female ratio of the 6 patients was 3 to 3, the median age was 69.2 years old, and the median disease course was 92.3 months. The median length of the diverticula was 47.5 mm. Diverticulum was located in the right wall of esophagus in 4 cases and in the left wall of esophagus in 2 cases, of which 1 patient was multiple diverticulum of esophagus. Achalasia was found in 5 cases, and EGJ outflow obstruction was found in 1 case. All the 6 patients successfully completed combination of STESD and POEM, and all achieved successful edoscopic technique. The operation time (range) was 55 min (40 to 70 min). Clinical symptom Eckardt score (range) before and after operation was 9.0 (7.0 to 11.0) and 1.3 (1.0 to 2.0), respectively. After operation the clinical symptom improved compared with that before operation. There were no delayed bleeding, perforation, infection, subcutaneous emphysema and other complications and severe adverse events. Six patients were all cured and discharged. Follow-up period was 1 to 50 months. The symptoms of dysphagia, vomiting after eating, retrosternal pain, regurgitation and weight loss were all significantly improved compared with those before operation. There were no severe adverse events and all achieved clinical success.Conclusions:Combination of STESD and POEM is safe and effective in the treatment of esophageal epiphrenic diverticulum with EGJ outflow tract disorder, and has good short-term and long-term effects.
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Background/Aims@#Esophageal mean nocturnal baseline impedance (MNBI) levels and post-reflux swallow-induced peristaltic wave (PSPW) index could increase the diagnostic value of 24-hour multichannel intraluminal impedance and pH monitoring in patients with gastroesophageal reflux disease. This study aims to compare the MNBI and PSPW index in patients with no evidence of erosive reflux disease. @*Methods@#Impedance-pH monitoring tracings from 70 patients, 50 with non-erosive reflux disease (NERD) and 20 with functional heartburn (FH), were reviewed. According to proton pump inhibitors (PPI) treatment response, NERD patients were divided into NERD/PPI responders and NERD/PPI nonresponders. MNBI, PSPW index, and intercellular spaces were measured and compared among each group. @*Results@#MNBI values and PSPW index were lower in NERD patients than in FH (P < 0.01 and P < 0.05, respectively). MNBI positively correlated with PSPW index (r = 0.525, P < 0.001). NERD/PPI responders had lower MNBI values and PSPW index compared to NERD/PPI nonresponders (both P < 0.01). MNBI and PSPW index distinguished NERD from FH patients with an area under the curve of 0.914 and 0.677, respectively. Wider intercellular space could be identified in patients with NERD (P < 0.01). @*Conclusion@#MNBI and PSPW index may differentiate NERD from FH patients and relate to PPI treatment efficacy in patients with NERD.
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Background/Aims@#Some inflammatory bowel disease (IBD) patients in remission suffer from irritable bowel syndrome (IBS)-like symptoms (IBD-IBS). The pathogenesis has not yet been elucidated. The study aim is to evaluate relationships among quality of life (QOL), psychological status, and visceral sensitivity, and explore the formation mechanism of IBD-IBS. @*Methods@#Forty-seven patients with Crohn’s disease in remission, 24 ulcerative colitis in remission, 26 IBS, and 20 healthy controls were included in the study. The abdominal pain, QOL, anxiety, and depression were evaluated through questionnaires. Visceral sensitivity was measured by rectal balloon distension. The serum levels of 5-hydroxytryptamine (5-HT) and nerve growth factor (NGF) were measured by enzyme-linked immunosorbent assay. The expressions of tryptase, 5-HT, NGF, and related receptors in colonic tissues were detected by immunohistochemistry and western blot. @*Results@#Prevalence of IBS-like symptoms in Crohn’s disease and ulcerative colitis patients in clinical remission was 29.8% and 50.0%, respectively. The QOL was lower, the anxiety/depression scores were higher in IBD-IBS patients than those without IBS-like symptoms. Additionally, patients with IBD-IBS existed visceral hypersensitivity. Besides, abdominal pain was associated with poor QOL, visceral hypersensitivity, anxiety, and depression in IBD-IBS patients. The number of mast cells (MCs) and expressions of 5-HT, NGF, and related receptors were higher in IBD-IBS patients than those with no such symptoms. The serum levels of 5-HT and NGF positively correlated with abdominal pain and visceral hypersensitivity. @*Conclusion@#IBD-IBS patients may have low QOL and psychological abnormalities, as wells as visceral hypersensitivity which may be related to increased 5-HT and NGF levels released from activated mast cells.
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Background/Aims@#Esophageal mean nocturnal baseline impedance (MNBI) levels and post-reflux swallow-induced peristaltic wave (PSPW) index could increase the diagnostic value of 24-hour multichannel intraluminal impedance and pH monitoring in patients with gastroesophageal reflux disease. This study aims to compare the MNBI and PSPW index in patients with no evidence of erosive reflux disease. @*Methods@#Impedance-pH monitoring tracings from 70 patients, 50 with non-erosive reflux disease (NERD) and 20 with functional heartburn (FH), were reviewed. According to proton pump inhibitors (PPI) treatment response, NERD patients were divided into NERD/PPI responders and NERD/PPI nonresponders. MNBI, PSPW index, and intercellular spaces were measured and compared among each group. @*Results@#MNBI values and PSPW index were lower in NERD patients than in FH (P < 0.01 and P < 0.05, respectively). MNBI positively correlated with PSPW index (r = 0.525, P < 0.001). NERD/PPI responders had lower MNBI values and PSPW index compared to NERD/PPI nonresponders (both P < 0.01). MNBI and PSPW index distinguished NERD from FH patients with an area under the curve of 0.914 and 0.677, respectively. Wider intercellular space could be identified in patients with NERD (P < 0.01). @*Conclusion@#MNBI and PSPW index may differentiate NERD from FH patients and relate to PPI treatment efficacy in patients with NERD.
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Background/Aims@#Some inflammatory bowel disease (IBD) patients in remission suffer from irritable bowel syndrome (IBS)-like symptoms (IBD-IBS). The pathogenesis has not yet been elucidated. The study aim is to evaluate relationships among quality of life (QOL), psychological status, and visceral sensitivity, and explore the formation mechanism of IBD-IBS. @*Methods@#Forty-seven patients with Crohn’s disease in remission, 24 ulcerative colitis in remission, 26 IBS, and 20 healthy controls were included in the study. The abdominal pain, QOL, anxiety, and depression were evaluated through questionnaires. Visceral sensitivity was measured by rectal balloon distension. The serum levels of 5-hydroxytryptamine (5-HT) and nerve growth factor (NGF) were measured by enzyme-linked immunosorbent assay. The expressions of tryptase, 5-HT, NGF, and related receptors in colonic tissues were detected by immunohistochemistry and western blot. @*Results@#Prevalence of IBS-like symptoms in Crohn’s disease and ulcerative colitis patients in clinical remission was 29.8% and 50.0%, respectively. The QOL was lower, the anxiety/depression scores were higher in IBD-IBS patients than those without IBS-like symptoms. Additionally, patients with IBD-IBS existed visceral hypersensitivity. Besides, abdominal pain was associated with poor QOL, visceral hypersensitivity, anxiety, and depression in IBD-IBS patients. The number of mast cells (MCs) and expressions of 5-HT, NGF, and related receptors were higher in IBD-IBS patients than those with no such symptoms. The serum levels of 5-HT and NGF positively correlated with abdominal pain and visceral hypersensitivity. @*Conclusion@#IBD-IBS patients may have low QOL and psychological abnormalities, as wells as visceral hypersensitivity which may be related to increased 5-HT and NGF levels released from activated mast cells.
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Objective:To evaluate the role of esophagogastric junction contractile index (EGJ-CI) in distinguishing patients with refractory gastroesophageal reflux disease (RGERD) from functional heartburn (FH).Methods:From March 2014 to January 2018, 82 patients with proton pump inhibitor (PPI) refractory heartburn and/or regurgitation, who visited the Outpatient Department of Gastroenterology at The First Affiliated Hospital with Nanjing Medical University were enrolled, among them 50 patients with RGERD (RGERD group) and 32 patients with FH (FH group). EGJ-CI of RGERD group and FH group were compared. The sensitivity and specificity of EGJ-CI to distinguish RGERD from FH patients. The correlation between EGJ-CI and high resolution esophageal manometry parameters, baseline impedance level and 24 h impedance-pH monitoring parameters were analyzed. Mann-Whitney U test, receiver operator characteristic curve analysis and Spearman correlation analysis were used for statistical analysis. Results:The EGJ-CI of RGERD group was lower than that of FH group (25.8 mmHg·cm (14.1 mmHg·cm, 35.9 mmHg·cm)(1 mmHg=0.133 kPa) vs. 39.2 mmHg·cm (23.0 mmHg·cm, 60.8 mmHg·cm)), and the difference was statistically significant ( Z=-2.833, P=0.005). When the cut-off value of EGJ-CI was 35.8 mmHg·cm, the sensitivity and specificity to distinguish RGERD from FH were 76.0% and 62.5%, respectively; area under the curve was 0.69 (95% CI 0.57 to 0.81). EGJ-CI was positively correlated with lower sphincter resting pressure, integrated relaxation pressure, distal contractile integral, distal esophageal pressure, and mean nocturnal baseline impedance ( r=0.812, 0.631, 0.451, 0.490 and 0.401, all P<0.01). EGJ-CI was negatively correlated with DeMeester score, acid exposure time, total reflux episodes, acid reflux episodes, long reflux episodes and longest reflux time ( r=-0.363, -0.372, -0.346, -0.318, -0.300 and -0.291, all P<0.01). Conclusions:EGJ-CI can help to distinguish patients with FH from RGERD.
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Background/Aims@#It is known that post-reflux swallow-induced peristaltic wave (PSPW) index represents the chemical clearance of the esophagus. However, few studies have explored why some reflux episodes could induce PSPW while others in the same patient could not. The purpose of this study is to investigate the characteristics of reflux episodes which could elicit PSPW. @*Methods@#In this study, 269 reflux episodes were detected, of which 90 with a PSPW and 179 without a PSPW. Comparisons were made between the characteristics of reflux episodes with a PSPW and without a PSPW. The characteristics were including nadir pH, pH drop, proximal extent (cm, sec), ascending velocity (cm/sec), volume clearance time, acid clearance time, percentage acidic (%), 15 to 60-minute acid burden (seconds), and 15- to 60-minute volume burden (seconds). The characteristics between the 2 groups were compared through performing Wilcoxon signed rank test. @*Results@#Reflux episodes followed by a PSPW were significantly associated with a higher proximal extent than those without a PSPW. After the reflux episodes, higher volume clearance time and larger volume burden were more likely to trigger a PSPW. However, there were no significant differences between the 2 groups in nadir pH, pH drop, ascending velocity, acid clearance time, percentage acidic, or acid burden. @*Conclusions@#The role of acid seems to be less important in a reflux episode inducing a PSPW. Proximal reflux episodes are more likely to induce a PSPW. The depression of volume clearance may also be an important factor in eliciting a PSPW.
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Objective To conduct a systematic review on the experience of patients with inflammatory bowel disease (IBD) during self-management.Methods Five English (PubMed,Embase,Science Direct,Web of Science,PsycINFO) and four Chinese (CBM,WANFANG,CNKI,VIP) databases were chosen to retrieve literatures on selfmanagement experience of patients with inflammatory bowel disease from inception to March 31st,2017.The JBI Critical Appraisal Tool for qualitative studies in Australia was used to evaluate the quality of studies.Integrating method was applied to integrate the results.Results Totally 35 findings were extracted from 6 qualified studies,7 new categories were generated and finally 3 synthesized results were obtained:l Medical management:in order to maintain remission,diversified methods were used by IBD patients,such as adjusting behaviors and accumulating disease knowledge;2 Emotion management:positive attitude towards life was achieved via dealing with stress and negative emotions caused by IBD;3 Role management:cognitive and behavioral adjustment were taken to adapt the role of IBD patients and maintain the daily role before having IBD.Conclusion Many aspects were involved in self-management of IBD,and emotional management was often overlooked.Guidance and supports should be given by nurses targeting weak links of self-management,in order to improve disease management as well as quality of life for IBD patients.
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Objective To investigate the correlation between the subjective well-being,optimism and coping mode of patients with inflammatory bowel disease(IBD). Methods A total of 159 IBD patients were surveyed and analyzed by the general information questionnaire, General Well-Being Schedule, Revised The Life Orientation Test, and Simplified Coping Style Questionnaire. Results The subjective well-being scores of IBD patients were (75.04 ± 14.32). And the Pearson analysis showed that subjective well-being scores were positively correlated with optimism scores and positive coping scores(r=0.408, P＜0.01; r=0.429, P＜0.01). Negative coping was negatively correlated with subjective well-being scores(r=-0.174, P＜0.05). Optimism had a direct positive predictive effect on subjective well-being with a path coefficient of 0.22, and coping mode was an intermediary variable of optimism and subjective well-being. Conclusion The subjective well-being of patients with IBD needs to be further improved, which is both related to optimism and coping mode. Coping mode takes effects as a mediator in optimism and subjective well-being.
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Objective To examine the effects of two different cold compress modes (continuous cold compress and intermittent cold compress) on the pain and swelling among patients receiving extraction of impacted tooth of mandibular. Methods From January 2016 to August 2016, 64 cases of adult patients with impacted mandibular impacted wisdom teeth and 24 h in the outpatient department of Oral and Maxillofacial Surgery of Affiliated Stomatological Hospital of Fujian Medical University were selected. They were randomly assigned to the control group and the experimental group (32 cases in each group) by random digital table. The participants in the control group received the usual care plus intermittent cold compress. The participants in the experimental group received the usual care plus continuous cold compress. And the treatment was continued for 24 hours. Outcomes including pain and skin temperature were measured in the intervention cycle, and the swelling was measured at baseline, 6 hour, 12 hours,18 hours, and 24 hours after the intervention. All the participants were asked to have further consultation at 7th days after the operation. Results At 6 hour, 12 hours,18 hours, and 24 hours, the pain of the experimental group was lower than the control group ,and there was significant difference (F=63.665-290.872, P<0.05 ). At 12 hours,18 hours, and 24 hours after the intervention ,number of the swelling grades (0-I-Ⅱ-III) in the control group was 16, 14, 2, 0 cases, 11, 13, 8, 0 cases, 11, 12, 8, 1 cases,number of the swelling grades (0-I-Ⅱ-III) in the experimental group was 27, 5, 0, 0 cases, 26, 6, 0, 0 cases, 26, 6, 0, 0 cases, and there was significant difference (Z=-2.968,-4.017,-4.052, P<0.05). A positive correlation between swelling grade and time (M2=45.22, P<0.05). At 6 hour, 12 hours,18 hours, and 24 hours , the skin temperature of the experimental group was lower than the control group, and there was significant difference (F=1 735.106-23 993.33, P<0.05). Conclusions This study showed that the continuous cold compress was more effective in reducing the pain and swelling among the patients receiving extraction of impacted tooth of mandibular. Compared with the intermittent cold compress, it suggested that continuous cold compress can be integrated into usual care to reduce the pain and swelling among the patients receiving extraction of impacted tooth of mandibular.
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<p><b>OBJECTIVE</b>To explore the effect of transcutaneous electrical nerve stimulation(TENS) for symptoms,life quality and sleep quality in patients with gastroesophageal reflux disease(GERD).</p><p><b>METHODS</b>A total of 46 GERD patients were randomly assigned into an observation group and a control group,23 cases in each one. The conventional medication and nursing were applied in the two groups. TENS was used at Neiguan(PC 6) and Zusanli(ST 36) in the observation group for 4 weeks,20 min a time,twice a day. The indexes were compared between the two groups before and after treatment,including reflux disease questionnaire,the MOS 36-item short-form,Pittsburgh sleep quality index(PSQI).</p><p><b>RESULTS</b>Except the factor score of gengral health in the control group, the symptoms,life quality and sleep quality were superior to those before treatment in the two group (all<0.01). The symptom and PSQI scores in the observation group were lower than those in the control group(<0.01,<0.05). The scores of general health, life vitality and mental health in the observation group were more apparently improved than those in the control group (all<0.05).</p><p><b>CONCLUSIONS</b>TENS at Neiguan(PC 6) and Zusanli(ST 36) can improve the clinical symptoms,life quality and sleep quality of GERD based on the conventional treatment.</p>
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Objective To explore the relationship between health?related quality of life and resili?ence of patients with inflammatory bowel disease( IBD) ,and provide a new entry point to improve the quality of life. Methods The general information questionnaire,the Chinese version of inflammatory bowel disease questionnaire ( IBDQ) and the Chinese version of Connor?Davidson mental resilience scale ( CD?RISC) were used to investigate 102 patients with IBD. Results The average scores of IBDQ and CD?RISC of IBD pa?tients were (157.6±31.7) and (62.5±15.0). Except for the correlation between the score of optimistic di?mension and the social function dimension,the total score and the scores of other dimensions of IBDQ were significantly correlated with the total score and the scores of dimensions of CD?RISC( r=0.200?0.490, P<0.05). Multiple regression analysis showed that tenacity,residence,moderate and severe disease severity,and disease duration with more than 10 years could significantly predict the level of health?related quality of life (β=0.319,0.268,-0.218,-0.373,-0.260, P<0.05) . Conclusion The health?related quality of life of IBD patients has a strong relationship with resilience. Health care workers can help improve health?related quality of life of the patients through fostering resilience.
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BACKGROUND/AIMS: Little data exists about esophageal body dysmotility and reflux patterns in refractory gastroesophageal reflux disease (RGERD) patients off therapy. We aimed to evaluate effects of esophageal body dysmotility on reflux parameters in RGERD patients by combining impedance-pH monitoring and high-resolution manometry (HRM). METHODS: We retrospectively reviewed the impedance-pH data and HRM metrics in patients with refractory gastroesophageal reflux symptoms. Impedance-pH monitoring and manometric data were compared between 2 groups: ineffective esophageal motility (IEM) and normal motility. RESULTS: Forty-eight patients (30 males, mean age 54.5 years) were included (16 erosive esophagitis, 24 non-erosive reflux disease, and 8 functional heartburn), amongst which 24 subjects showed IEM, and others had normal motility. Number of patients who had a large break in the IEM group was significantly higher than that of normal motility patients. IEM group had more patients with weakly acid reflux and long term acid reflux than the normal group (P = 0.008, P = 0.004, respectively). There was no statistical difference in baseine impedance levels from z4 to z6 between the 2 groups (2911 ± 1160 Ω vs 3604 ± 1232 Ω, 2766 ± 1254 Ω vs 3752 ± 1439 Ω, 2349 ± 1131 Ω vs 3038 ± 1254 Ω, all P > 0.05). Acid exposure time, numbers of long term acid reflux and weakly acid reflux showed strong negative correlation with esophageal body motility and/or lower esophageal sphincter function. CONCLUSIONS: IEM was associated more with acid exposure, abnormal weakly acid reflux, and long term acid reflux in RGERD patients. These data suggested the role of esophageal body dysmotility in the pathophysiological mechanisms of RGERD patients.
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Humans , Male , Electric Impedance , Esophageal Motility Disorders , Esophageal Sphincter, Lower , Esophagitis , Gastroesophageal Reflux , Manometry , Retrospective StudiesABSTRACT
Bleeding and swelling is one of the first kinds of complications or main symptoms after tooth extraction. With the development of high quality oral treatment, the doctors and nurses of oral and maxillofacial alveolar surgery pay more and more attention to maximize reduce the postoperative tooth extraction reaction, improve patient comfort. Cold compress can effectively reduce postoperative bleeding and pain, so it has been widely used in clinical application. The mechanism of bleeding and swelling after tooth extraction and the application principle, method, material selection of cold compress are reviewed in this paper, in order to provide reference for the colleague.
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Objective To explore the mechanisms of individual, social and environmental factors influencing physical activity and the relationships among the factors in patients with type 2 diabetes. Methods A survey was conducted from January to July 2015 among 225 patients with type 2 diabetes using convenience sampling. The questionnaire included 9- item Patient Health Questionnaire, the International Physical Activity Questionnaire,Perceived Social Support Scale, Chinese Walkable Environment Scale, Bandura′s Exercise Self- efficacy Scale. Results The effective questionnaire recovery rate was 98.7%(222/225). Exercise self- efficacy was a mediator of factors influencing physical activity. Exercise self- efficacy and physical activity were positively correlated (β=0.24, P<0.05). Walkable environment only affected physical activity indirectly medicated by exercise self- efficacy (β=-0.26, P<0.05). Perceived social support directly associated with physical activity (β=0.14, P<0.05). Depression not only affected physical activity directly (β=-0.28, P<0.05), but also associated with physical activity indirectly medicated by exercise self-efficacy (β=-0.32, P<0.05). Conclusions Interventions should be taken to increase the perceived social support, improve depression and walkable environment, especially to enhance exercise self- efficacy, so as to improve the physical activity level of patients with type 2 diabetes.
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Objective To compare the effects of biofeedback (BF) training on clinical symptoms , psychological status and quality of life in different subtypes of patients with functional defecation disorders (FDD) .Methods According to Rome Ⅲ criteria ,50 FDD patients were divided into non coordinated defecation (F3a) and the lack of promoting defecation (F3b) two subtypes .The patients of these two subtypes received BF training three times every week ,five to ten times each course ,two to three times training at home were required during and after treatment .The changes ,of clinical symptoms scores ,self‐rating anxiety scale (SAS) ,self‐rating depressive scale (SDS) and the patient assessment of constipation quality of life question naire (PAC‐QOL ) were compared between before and after BF training in the patients of two subtypes .The difference between two subtypes were also analyzed as well .Paired t‐test or Wilcoxon signed‐rank test was performed for comparison between before and after treatment ,and group t‐test or Wilcoxon rank sum test was for comparison between groups .Results Among 50 FDD patients , there were 13 cases of F3a type and 37 cases of F3b type .After BF training ,the clinical symptoms scores of two subtypes patients were both lower than those before BF training (5 .62 ± 3 .91 vs 8 .77 ± 3 .59 , 5 .89 ± 3 .67 vs 9 .35 ± 3 .22 ,t = 3 .264 and 6 .272 ,both P 0 .05) .After BF training ,the SAS scores of two subtypes patients were both lower than those before BF training (30 .85 ± 6 .67 vs 42 .46 ± 8 .37 ,30 .65 ± 7 .51 vs 38 .59 ± 8 .38 , t= 4 .536 and 6 .402 ,both P 0 .05) .After BF training ,the PAC‐QOL scores of two subtypes [0 .54 (0 .15 ,0 .88) 、0 .98 (0 .51 ,1 .34)] were both lower than those before BF training [2 .08(1 .18 ,2 .34) 、1 .86(1 .34 ,2 .29)] ,Z= - 2 .903 、- 4 .825 ,both P 0 .05) .Conclusions BF training is both effective on two subtypes of FDD ,which can improve clinical symptoms ,psychological status and quality of life ,and with There is no difference in efficacy between the two subtypes .
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Objective To investigate the correlation between the clinical symptoms of patients with achalasia of cardia (AC) and high-resolution manometry (HRM) parameters.Methods The clinical data of 30 AC patients were retrospectively analyzed.The severe degree of symptoms was evaluated by Eckardt score questionnaires,and motility of esophagus was assessed by HRM parameters.According to Chicago classification,patients were divided into three types.Mann-Whitney U test was performed for non normal distribution quantitative data comparison.Spearman correlation was used to analyze the correlation between AC symptoms and the HRM parameters.Results The reflux symptom of type Ⅱ patients was more severe than that of type Ⅰ patients (2.50(1.00) vs 1.00(1.50),U=56.000,P＜0.05).The integrated relaxation pressure (IRP) was moderately correlated with total Eckardt score of all AC patients,the frequency of reflux and the degree of body weight loss (r=0.528,0.441 and 0.662,all P＜0.05),furthermore IRP was strongly correlated with the degree in weight loss in type Ⅰ AC patients (r =0.703,P＜ 0.05).Lower esophageal sphincter resting pressure was weakly correlated with the degree of weight loss in all AC patients (r=0.398,P＜0.05).Conclusions The degree of severity of symptoms may be different in different types of AC patients.HRM parameters,especially IRP,might play a role in the assessment of severity of AC symptoms.
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Objective To analyze the status and influencing factors of physical activity in patients with diabetes.Methods A survey was conducted in patients with diabetes from one hospital in Tianjin city using the International Physical Activity Questionnaire, Exercise Self-efficacy Scale, 9-item Patient Health Questionnaire,Perceived Social Support Scale, Chinese Walkable Environment Scale, Visual Analogue Scale.The cumulative logits model was used to explore the influencing factors of physical activity in diabetic patients.Results The average of sitting time for diabetic patients was 6.1 hours per day.41.2％ of patients with diabetes were at high level of physical activity ,42.7％ were at moderate level of physical activity, and 16.1％ were at low level of physical activity.The cumulative logits model showed that perceived social support (β=0.029, OR=1.03, P=0.039,95％ CI=0.001-0.057) ,exercise self-efficacy (β=0.014, OR=1.01, P=0.001,95％ CI=0.005-0.023),and beautiful neighborhood surroundings(β=-0.366, OR=0.69, P=0.008,95％ CI=-0.635--0.096) were protective factors of physical activity, and depression(β=-0.093, OR=0.91, P=0.020,95％ CI=-0.172--0.015) was a risk factor of physical activity.Conclusion The physical activity status of diabetic patients are not ideal.Measures should be taken to improve the exercise self-efficacy, perceived social support and environment of surroundings, to reduce the symptoms of depression, so as to promote regular physical activities in patients with diabetes mellitus.