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Objective@#To evaluate esophageal motility and anti-reflux barrier function in patients with different phenotypes of heartburn and negative endoscopic findings based on the Rome Ⅳ criteria.@*Methods@#From March 2011 to November 2018, 136 patients with heartburn and negative endoscopic findings were retrospectively analyzed. The patients underwent high-resolution manometry (HRM), 24-hour pH monitoring and proton pump inhibitor (PPI) test and according to the Rome Ⅳ criteria and new diagnostic procedures, they were divided into non-erosive reflux disease (NERD) group, reflux hypersensitivity (RH) group, functional heartburn (FH) group and unclassified group. During the same period, 20 healthy volunteers were selected as healthy control group. The changes of esophageal motility and HRM were analyzed among different groups. Statistical analysis was performed using one-way analysis of variance, Kruskal-Wallis H test and chi-square test.@*Results@#According to Rome Ⅳ criteria, 35 patients were enrolled into the NERD group, 43 patients were enrolled into the RH group, 48 patients were included in the FH group, and 10 patients were enrolled into unclassified group. There were no significant differences between the NERD group, the RH group, the FH group, the unclassified group and healthy control group in the length of the lower esophageal sphincter (LES), end lower esophageal sphincter resting pressure (LESP), mean LESP, 4-second-integrated relaxation pressure (4 s-IRP), distal latency (DL) , upper esophageal sphincter residual pressure (UES-RP), upper esophageal sphincter relaxation time to nadir, upper esophageal sphincter (UES) recovery time and esophagogastric junction contractile integral (EGJ-CI, all P>0.05). The distal contractile integral (DCI) of NERD group and unclassified group were both lower than that of healthy control group (919.7 mmHg·s·cm (411.7, 1 417.9) mmHg·s·cm (1 mmHg=0.133 kPa), 535.6 mmHg·s·cm (321.4, 1 513.4) mmHg·s·cm vs. 1 322.1 mmHg·s·cm (841.6, 1 918.5) mmHg·s·cm), and the differences were statistically significant (Z=-2.62 and -2.20, P=0.01 and 0.03). The upper esophageal sphincter pressure (UESP) of the unclassified group was lower than that of the healthy control group(57.0 mmHg (31.3, 77.8) mmHg vs. 70.4 mmHg (49.4, 97.8) mmHg), and the difference was statistically significant (Z=-2.64, P=0.02). There was significant difference in esophagogastric junction (EGJ) subtypes between the NERD group, the RH group, the FH group and the unclassified group (χ2=10.85, P=0.02); the proportion of type Ⅲ patients was highest in unclassified group, followed by NERD group, which were both higher than those of RH group and FH group. There was no significant difference in the proportion of esophageal motility subtypes between NERD group, RH group, FH group and unclassified group (P>0.05).@*Conclusions@#Patients with different phenotypes of heartburn and negative endoscopy finding should be classified by efficient diagnostic procedure according to the Rome Ⅳ criteria combined with HRM, 24-hour pH monitoring and PPI test. The unclassified patients need further evaluation, especially for those with effective PPI test and negative pH monitoring. However, the evaluation of anti-reflux barrier function by the HRM parameters in patients with heartburn and negative endoscopic findings has certain limitations.
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Objective@#To analyze the pregnancy outcomes of fetal tetralogy of Fallot and to explore its prenatal diagnosis and treatment procedures.@*Methods@#The clinical data of 63 cases of fetal tetralogy of Fallot (62 cases were singleton and 1 case was one of twin) were collected retrospectively from November, 2013 to November, 2017 in Beijing Obstetrics and Gynecology Hospital.@*Results@#(1) Totally, 63 cases out of 46 352 pregnancies were diagnosed fetal tetralogy of Fallot by fetal ultrasonic cardiogram with about 0.136%(63/46 352) occurrence rate, and the mean gestational age was (23±3) weeks. And 50 cases (79%, 50/63) terminated pregnancy by induced labour. (2) Totally, 57 cases (90%,57/63) accepted genetic diagnosis.Eight cases (13%, 8/63) existed chromosome abnormality including 21-trimosy in 6 cases, 18-trisomy in 1 case and 22q11.2 microdeletion syndrome in 1 case; and these 8 cases were determined before 28 gestational weeks. (3) And 13 cases (21%, 13/63) of no fetal genetic abnormality selected to continue pregnancy. Twelve cases underwent full term delivery (5 cases were cesarean section delivery and 7 cases were vaginal delivery). Twelve newborns underwent surgical radical operation on heart malformation and got recovery. One case underwent preterm cesarean section at 35 gestational weeks for one of twin, and the newborn with tetralogy of Fallot was dead. The other the newborns survived and were followed up for tetralogy of Fallot surgery from 1 month to 3 years old after birth and recovered.@*Conclusions@#Fetal tetralogy of Fallot mainly is diagnosed by ultrasonic cardiogram in the second trimester. The gestational age of diagnosis may be as early as 15 gestational weeks. Fetal tetralogy of Fallot with no genetic abnormality could underwent radical heart malformation operation after birth. It is necessary to undergo genetic testing on fetal tetralogy of Fallot and prenatal multidisciplinary counseling as well.
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Objective To analyze the pregnancy outcomes of fetal tetralogy of Fallot and to explore its prenatal diagnosis and treatment procedures. Methods The clinical data of 63 cases of fetal tetralogy of Fallot (62 cases were singleton and 1 case was one of twin) were collected retrospectively from November, 2013 to November, 2017 in Beijing Obstetrics and Gynecology Hospital. Results (1) Totally, 63 cases out of 46 352 pregnancies were diagnosed fetal tetralogy of Fallot by fetal ultrasonic cardiogram with about 0.136%(63/46 352) occurrence rate, and the mean gestational age was (23±3) weeks. And 50 cases (79%, 50/63) terminated pregnancy by induced labour. (2) Totally, 57 cases (90%,57/63) accepted genetic diagnosis.Eight cases (13%, 8/63) existed chromosome abnormality including 21-trimosy in 6 cases, 18-trisomy in 1 case and 22q11.2 microdeletion syndrome in 1 case; and these 8 cases were determined before 28 gestational weeks. (3) And 13 cases (21%, 13/63) of no fetal genetic abnormality selected to continue pregnancy. Twelve cases underwent full term delivery (5 cases were cesarean section delivery and 7 cases were vaginal delivery). Twelve newborns underwent surgical radical operation on heart malformation and got recovery. One case underwent preterm cesarean section at 35 gestational weeks for one of twin, and the newborn with tetralogy of Fallot was dead. The other the newborns survived and were followed up for tetralogy of Fallot surgery from 1 month to 3 years old after birth and recovered.Conclusions Fetal tetralogy of Fallot mainly is diagnosed by ultrasonic cardiogram in the second trimester. The gestational age of diagnosis may be as early as 15 gestational weeks. Fetal tetralogy of Fallot with no genetic abnormality could underwent radical heart malformation operation after birth. It is necessary to undergo genetic testing on fetal tetralogy of Fallot and prenatal multidisciplinary counseling as well.
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Objective To evaluate esophageal motility and anti-reflux barrier function in patients with different phenotypes of heartburn and negative endoscopic findings based on the Rome Ⅳ criteria.Methods From March 2011 to November 2018,136 patients with heartburn and negative endoscopic findings were retrospectively analyzed.The patients underwent high-resolution manometry (HRM),24-hour pH monitoring and proton pump inhibitor (PPI) test and according to the Rome Ⅳ criteria and new diagnostic procedures,they were divided into non-erosive reflux disease (NERD) group,reflux hypersensitivity (RH) group,functional heartburn (FH) group and unclassified group.During the same period,20 healthy volunteers were selected as healthy control group.The changes of esophageal motility and HRM were analyzed among different groups.Statistical analysis was performed using one-way analysis of variance,Kruskal-Wallis H test and chi-square test.Results According to Rome Ⅳ criteria,35 patients were enrolled into the NERD group,43 patients were enrolled into the RH group,48 patients were included in the FH group,and 10 patients were enrolled into unclassified group.There were no significant differences between the NERD group,the RH group,the FH group,the unclassified group and healthy control group in the length of the lower esophageal sphincter (LES),end lower esophageal sphincter resting pressure (LESP),mean LESP,4-second-integrated relaxation pressure (4 s-IRP),distal latency (DL),upper esophageal sphincter residual pressure (UES-RP),upper esophageal sphincter relaxation time to nadir,upper esophageal sphincter (UES) recovery time and esophagogastric junction contractile integral (EGJ-CI,all P ＞0.05).The distal contractile integral (DCI) of NERD group and unclassified group were both lower than that of healthy control group (919.7 mmHg · s · cm (411.7,1 417.9) mmHg· s · cm (1 mmHg =0.133 kPa),535.6 mmHg · s · cm (321.4,1 513.4) mmHg · s · cm vs.1 322.1 mmHg · s · cm (841.6,1 918.5) mmHg · s · cm),and the differences were statistically significant (Z =-2.62 and-2.20,P =0.01 and 0.03).The upper esophageal sphincter pressure (UESP) of the unclassified group was lower than that of the healthy control group (57.0 mmHg (31.3,77.8) mmHg vs.70.4 mmHg (49.4,97.8) mmHg),and the difference was statistically significant (Z =-2.64,P =0.02).There was significant difference in esophagogastric junction (EGJ) subtypes between the NERD group,the RH group,the FH group and the unclassified group (x2 =10.85,P =0.02);the proportion of type Ⅲ patients was highest in unclassified group,followed by NERD group,which were both higher than those of RH group and FH group.There was no significant difference in the proportion of esophageal motility subtypes between NERD group,RH group,FH group and unclassified group (P ＞ 0.05).Conclusions Patients with different phenotypes of heartburn and negative endoscopy finding should be classified by efficient diagnostic procedure according to the Rome Ⅳ criteria combined with HRM,24-hour pH monitoring and PPI test.The unclassified patients need further evaluation,especially for those with effective PPI test and negative pH monitoring.However,the evaluation of anti-reflux barrier function by the HRM parameters in patients with heartburn and negative endoscopic findings has certain limitations.
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Objective:To report two cases of esophageal granular cell tumor treated by endoscopic submucosal dissection,and to improve the clinical awareness of the disease.Methods:The results of endoscope and ultrasonography endoscope of 2 cases were retrospectively analyzed.A preliminary diagnosis of the 2 cases was esophageal submucosal protruded lesion.The patients underwent endoscopic submucosal dissection and the tumors were removed completely.Firstly,the lesion border was marked and then hyaluronic acid was injected into submucosa to uplift the lesion sufficiently.Secondly,the mucosa was circumferentially incised along the marked points,and then the lesion was dissected along the submucosal layer gradually to the whole.Finally,necessary hemostatic was undertaken and the wound was clipped with titanium.Results:The pathological results after operation represented that the cells were polygonal or fusiform,rich in cytoplasm and had a dichromatic granular substance,and the nuclei were small.The immunohistochemical results showed S-100 (+),NSE (+) / (-),CK (-),SMA (-),CD117 (-),desmin (-) and proved that 2 cases of tumors were esophageal granular cell tumor.Two patients recovered smoothly after operation.They underwent endoscopic examination 16 months after operation,and no local recurrence or metastasis was founded.Conclusion:Endoscopic submucosal dissection is a safe and effective treatment of esophageal granular cell tumor,and the postoperative prognosis is good.
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Objective:To report two cases of esophageal granular cell tumor treated by endoscopic submucosal dissection,and to improve the clinical awareness of the disease.Methods:The results of endoscope and ultrasonography endoscope of 2 cases were retrospectively analyzed.A preliminary diagnosis of the 2 cases was esophageal submucosal protruded lesion.The patients underwent endoscopic submucosal dissection and the tumors were removed completely.Firstly,the lesion border was marked and then hyaluronic acid was injected into submucosa to uplift the lesion sufficiently.Secondly,the mucosa was circumferentially incised along the marked points,and then the lesion was dissected along the submucosal layer gradually to the whole.Finally,necessary hemostatic was undertaken and the wound was clipped with titanium.Results:The pathological results after operation represented that the cells were polygonal or fusiform,rich in cytoplasm and had a dichromatic granular substance,and the nuclei were small.The immunohistochemical results showed S-100 (+),NSE (+) / (-),CK (-),SMA (-),CD117 (-),desmin (-) and proved that 2 cases of tumors were esophageal granular cell tumor.Two patients recovered smoothly after operation.They underwent endoscopic examination 16 months after operation,and no local recurrence or metastasis was founded.Conclusion:Endoscopic submucosal dissection is a safe and effective treatment of esophageal granular cell tumor,and the postoperative prognosis is good.
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Objective To observe the effects of LPS and PMA on proliferation of human len epithelial( HLE )cells and expression of epidermal growth factor receptor(EGFR) in HLE cells.Methods The expressions of EGFR protein of HLE cells from felus,adult lens age-related cataract and cultured HLE cells were detected by immunohistochemical staining.The expression of EGFR mRNA was detected by RT-PCR.The effects of LPS (0.5,1.0,2.0 mg?L-1 ) and PMA(25,50,100 nmol?L-1 )on proliferation of HLE cells were detected by MTT colorimetry method,and the EGFR mRNA expression in HLE cells was determined by RT-PCR. Results The expressions of EGFR protein and mRNA were positive in HLE cells from felus,adult lens age-related cataract and cultured HLE cells.The proliferation rates of HLE cells treated with 0.5,1.0,2.0 mg?L-1 LPS were (3.21?0.42)%,(12.25?1.34)% and (36.67?3.65)%,respectively.The proliferation rate of HLE cells in 2.0 mg?L-1 LPS group was higher than those in 0.5 and 1.0 mg?L-1 LPS groups(F=7.709,P0.05).PMA(25,50,100 nmol?L-1 )could not effect the expression of EGFR mRNA in HLE cells .Conclusion Inflammation stimulant factor such as LPS can promote the proliferation of HLE cells by increasing the expression of EGFR and result in occurrence of posterior capsular opacifition(PCO).
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The heptadecatungstodiphosphate substituted by L a(Ⅲ) with the formula α2-K7P2W17O61(La.OH2 ) (P2W 17La) was prepared by vacant refilling method. The anion of single substitu ted Dawson-type tungstophosphate salt was doped into the polypyrrole (PPY) film on a glassy carbon electrode (GC) by electrochemical method to prepare the chem ically modified electrode (P2W17La/PPY/GC). It maintains not only t he electrochemical activity and electrocatalytic property of P2W17L a, but also has good stability and sensitivity. In 0.50 mol/L HCl solution, th e first cathodic peak of P2W17La doping in polypyrrole film can cat alyze well the electroreduction of nitrite. The catalytic current was proporti onal to the concentration of nitrite between 6.0×10-5 and 1.0×10-2 mol/L.