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In order to evaluate the efficacy of peroral endoscopic myotomy (POEM) for achalasia, data of 63 patients with achalasia who were treated with POEM in China-Japan Union Hospital of Jilin University from 2017 to 2021 were collected. Postoperative Eckardt score, high-resolution manometry and upper gastrointestinal radiography were compared with preoperative data. The mean age of the 63 patients was 49.0 years, and there were 31 famales. The preoperative Eckardt score was 9 (3), and the postoperative Eckardt score was 2 (2), with significant difference ( V=1 953, P<0.001). The lower esophageal sphincter pressure decreased significantly after operation compared with that before operation [9.90 (3.35) mmHg VS 26.80（13.85）mmHg， V=2 016, P<0.001]. Fifty-three patients (84.1%) had satisfactory curative effects. The incidence of adverse events was 3.2% (2/63). POEM is safe, effective and minimally invasive for the treatment of achalasia.
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Objective To study the effects of laser combined with alpha lipoic acid on hemodynamics and vascular endothelial growth factor(VEGF) in the central retinal artery of diabetic retinopathy.Methods From June 2014 to December 2016,84 patients with diabetic retinopathy (109 eyes) in the General Hospital of Zoucheng Yankuang were selected as the research objects,and they were randomly divided into observation group of 42 cases (56 eyes) and control group of 42 cases(53 eyes).The two groups were treated with laser at first.The observation group was treated with alpha lipoic acid after laser treatment for 4 weeks.The central retinal artery systolic peak velocity(PSV),end diastolic flow velocity (EDV) and resistance index (RI) were evaluated by color Doppler ultrasonography before and after the treatment.The serum VEGF was measured before and after treatment.Results The PSV,EDV and RI of central retinal artery of the control group before therapy were (5.72 ± 1.33) cm/s,(2.26 ±1.09) cm/s,(0.71 ± 0.08),respectively,which after treatment were (8.15 ± 1.72) cm/s,(3.88 ± 1.06) cm/s,(0.65 ±0.05),respectively.The PSV,EDV and RI of central retinal artery of the observation group before therapy were (5.70 ± 1.17) cm/s,(2.31 ± 1.12) cm/s,(0.70 ± 0.07),respectively,which after treatment (9.82 ±1.83) cm/s,(4.62 ± 1.01)cm/s,(0.53 ± 0.04),respectively.The blood PSV and EDV of central retinal artery of the two groups were increased significantly after treatment (t =2.368,4.016,2.886,3.924,all P ＜ 0.05),which of the observation group increased more significantly compared with those of the control group after treatment(t =2.628,2.776,all P ＜ 0.05).After the treatment,the RI of the central retinal artery flow decreased significantly (t =2.013,4.448,all P ＜ 0.05),which of the observation group decreased significantly after treatment compared with the control group after treatment(t =3.014,P ＜0.05).The serum VEGF before treatment in the control group was (409.5 ±28.6) ng/L,which after treatment was (261.3 t± 11.6)ng/L.The serum VEGF before treatment in the observation group was (397.5±27.1) ng/L,which after treatment was (192.5 ± 10.1) ng/L.After treatment,the serum VEGF levels of the two groups were significantly lower(t =3.162,5.334,all P ＜ 0.05),the serum VEGF of the observation group decreased more significantly compared with those of the control group after treatment(t =3.016,P ＜ 0.05).Conclusion Laser combined with lipoic acid can improve the central retinal artery hemodynamics and VEGF in diabetic retinopathy patients,which may be an important reason for improving the therapeutic effect.
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Objective To observe the effects of immune acupuncture and moxibustion on the infection in hospital and the outcome of re-habilitation after stroke. Methods From January, 2014 to January, 2016, 100 patients following acute stroke were randomly divided into ob-servation group (n=50) and control group (n=50). The control group accepted routine medications, rehabilitation and acupuncture, while the observation group accepted acupuncture and moxibustion on Guanyuan (RN4), Qihai (RN6) and Zusanli (ST36) in addition. The nosocomi-al infection rate was recorded 90 days after treatment, and the T lymphocyte subsets, scores of Fugl-Meyer Assessment (FMA) and modified Barthel index (MBI) were measured before and after treatment. Results The nosocomial infection rate was 20% in the observation group, less than 42% in the control group (χ2=5.657, P2.463, P2.225, P<0.05). Conclusion Immune acupuncture and moxibustion therapy can reduce the incidence of nosocomial infection, and promote the func-tion of the immune system and outcome in patients after acute stroke.
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Objective To investigate the clinical efficacy of combined acupuncture and medicine plus ultrashort wave diathermy in treating post-stroke complicated urinary tract infection.Methods One hundred and twenty patients with post-stroke complicated urinary tract infection were randomly allocated to groups A, B and C, 40 cases each. Group A received acupuncture, ultrashort wave diathermy and treatment with anti-infective drugs; group B, ultrashort wave diathermy and treatment with anti-infective drugs; group C, treatment with anti-infective drugs alone. The clinical therapeutic effects and the recurrence rates were compared between the three groups.Results The total efficacy rate was 92.5% in group A, 90.0% in group B and 72.5% in group C. There was a statistically significant difference in the total efficacy rate between group A or B and group C (P<0.05). The recurrence rate was 8.1% in group A, 27.8% in group B and 31.0% in group C. There was a statistically significant difference in the recurrence rate between group A and group B or C (P<0.05).Conclusion Combined use of acupuncture and medicine plus ultrashort wave diathermy is an effective way to treat post-stroke complicated urinary tract infection.
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@#Objective To investigate the bacterial distribution and antibiotic resistance situation of urinary tract infection (UTI) among the inpatients following stroke. Methods The clinical data of pathogens from UTI in the stroke patients in our hospital from March 2009 to March 2011 were collected and analyzed with WHONET software. Results Among 203 strains from UTI, the most common pathogens were Escherichia coli (35.5%), Enterococcus (27.1%), Klebsiella (8.9%) and Fungi (10.8%). The main Gram negative bacilli were found highly resistant to ampicillin, levofloxacin and cefotaxim. 38.9% of Escherichia coli and 44.4% of Klebsiella produced extended-spectrum β-lactamases (ESBLs) respectively. The rate of antibiotic resistance of Enterococcus was high to the most of antibiotics commonly used. The fungi were highly sensitive to the drugs. Conclusion Gram negative bacilli are the main pathogens of urinary tract infection in stroke inpatients. Drug resistant strains, especially those with severe multiple resistance, increase fast.
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Objective To observe whether appropriate intermittent exercise at the ischemic threshold can safely promote collateral circulation in an ischemic area of the myocardium through the increased expression of vascular endothelial growth factor(VEGF)and its receptor fetal liver kinase-1(Fik-1). Methods A balloon constrictor was surgically implanted in the first obtuse marginal coronary artery(OM1)of miniature pigs.The subjects were divided into 3 groups:a sham-operation group,a pure ischemia group,and an exercise training group.Subjects in the exercise training group performed individualized treadmill programs 30 min daily,5 d per week,for 8 weeks,including 2 two-minute episodes of exercise-induced ischemia.Two pre-exercise episodes of pure ischemia induced by brief OM1 occlusion were also conducted.Only pure ischemia was induced in the pure ischemia group,and the sham-operation group remained sedentary for the experimental period.Relative myocardial blood flow(RMBF)was measured using microspheres.VEGF and Flk-1 expression levels were measured by Western blotting and real time RT-PCR analyses.Cardiac troponin I(ctnI)levels were determined using an enzyme-linked immunosorbent assay(ELISA). Light and electron microscopy were employed to examine myocardia damage in the ischemic area.Results RMBFs in the exercise training group were significantly higher than those in the pure ischemia and sham-operation groups. RMBFs in the pure ischemia group were significantly higher than those in the sham-operation group.The expression of VEGF and Flk-1 proteins and mRNAs in the exercise training group were significantly higher than those in the pure ischemia and sham-operation groups,and the levels in the pure ischemia group were also significantly higher than those in the sham-operation group.After training,no myocardial damage and no ctnI increase was observed in the pure ischemia group.Microscopy revealed no obvious structural changes. Conclusion Intermittent exercise at the isehemia threshold intension can safely promote coronary collateral formation through upregulation of VEGF and Flk-1 expression in the ischemic myocardial area of a porcine model.