Short-term clinical and echocardiographic outcomes of the novel domestic transcatheter edge-to-edge repair Neonova? system in patients with mitral regurgitation / 中华超声影像学杂志

Objective:To investigate short-term safety, efficacy and the learning curve of this self-developed novel transcatheter valve repair system (Neonova?) in patients with mitral regurgitation, and explore the role of perioperative echocardiography.Methods:Ten patients who visited the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from June 2021 to March 2022 and met the inclusive criteria were prospectively enrolled. All the patients were at high risk of surgery with moderate to severe or severe mitral regurgitation (MR). Clamps of Neonova? were implanted under guidance of transesophageal echocardiography and digital subtraction angiography. Clinical outcomes, echocardiography indexes and learning curves of this technique were evaluated immediately after intervention, 7 d, 1 month and 3 months post-intervention.Results:The technical success rate was 100% with MR relieved in all patients immediately after intervention. The device and procedural success rates were both 90.0% with 1 patient received surgical replacement at 37 days post-intervention while the others′ reduced to mild (8/9) and moderate (1/9) MR. New York Heart Association class and the Kansas City Cardiomyopathy Questionnaire improved significantly (all P<0.001). Mean mitral valve pressure gradient didn′t increase significantly after intervention when compared with that before intervention( P=0.324), and no mitral stenosis was observed. Left ventricular end-diastolic diameter decreased significantly ( P=0.008) during follow up.Procedure duration ranged from 60 to 300 (175.8±75.2)minutes. The simple linear regression model between procedure volume and duration showed that procedure duration decreased significantly with the increase of procedure volume ( F=15.857, P=0.004). Conclusions:Neonova? implantation can improve MR severity and clinical symptoms safely and effectively. Transthoracic echocardiography and transesophageal echocardiography are essential for perioperative management of transcatheter mitral valve repair.

Echocardiographic evaluation of the domestic D-Shant device for treatment of patients with chronic heart failure / 中华超声影像学杂志

Objective:To evaluate the efficacy of the domestic D-Shant device for the treatment of patients with chronic heart failure (CHF) using echocardiography.Methods:Twenty-four CHF patients who were treated with domestic D-Shant device in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2020 to December 2021 were enrolled in the study. Pulmonary capillary wedge pressure (PCWP)/ left atrial pressure (LAP), right atrial pressure (RAP), pulmonary artery pressure, interatrial septal gradient pressure, cardiac index and pulmonary/systemic blood flow ratio (Qp/Qs) were measured before and after implantation using right heart catheterization.Left atrial end-diastolic area index (LAEDAI), left atrial end-diastolic volume index (LAEDVI), left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), left ventricular ejection fraction (LVEF), right atrial end-diastolic diameter, right ventricular end-diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), right ventricular tractional area change (RVFAC), device shunt aperture, velocity and pressure, together with mitral and tricuspid regurgitation severity were measured using echocardiography before, and 1 month as well as 3 months after D-Shant device implantation. Clinical data were collected and analyzed including 6-minute walking test (6MWT), New York Heart Association (NYHA) classification and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Spearman correlation analysis was used to determine the relation between the changes in PCWP/LAP as well as echocardiographic parameters before and 3 months after implantation and NYHA classification. Binary Logistic regression analysis was performed to determine the predictive factors of NYHA classification improvement at 3-month follow-up after D-Shant device implantation.Results:①D-Shant devices were successfully implanted in all patients. ②Compared with preoperative values, invasive PCWP/LAP systolic, diastolic and mean pressures, transatrial septal gradient, and pulmonary systolic, diastolic and mean pressures decreased significantly after implantation(all P<0.001); Qp/Qs increased significantly after implantation( P<0.001). ③Compared with preoperative values, TAPSE, RVFAC and pulmonary artery flow velocity increased at 1 month after implantation(all P<0.05), whereas a significant reduction in mitral regurgitation grade, and an increase in LVEF and pulmonary artery flow velocity at 3 months after implantation(all P<0.05). Right atrial end-diastolic diameter, right ventricular end-diastolic diameter, LAEDAI, LAEDVI, LVEDVI, LVESVI, ratio of early to late diastolic peak velocities of mitral inflow(E/A), systolic peak velocity of mitral annulus at septal site(S′), ratio of early diastolic peak velocity of mitral inflow to diastolic peak velocity of mitral annulus(E/e′), pulmonary artery diameter, inferior vena cava diameter and degree of tricuspid regurgitation did not change among before, and 1 month as well as 3 months after implantation. There were no significant changes in the device shunt aperture, velocity and pressure between 1 month and 3 months after implantation(all P>0.05). ④The significant improvements in NYHA classification, KCCQ scores and 6MWT were observed at 1 and 3 months after implantation compared with preoperative values (all P<0.01). ⑤NYHA classification at 3 months after implantation was correlated with LVEF pre-post, PCWP/LAP pre-post, TAPSE pre-post and RVFAC pre-post ( rs=0.738, -0.730, 0.738, 0.723; all P<0.001). Logistic regression analysis showed that LVEF pre-post was an independent predictor for NYHA classification improvement at 3 months after implantation ( OR=0.687, 95% CI=0.475-0.992, P=0.045) . Conclusions:Domestic D-Shant device can effectively improve the cardiac function and clinical symptoms in patients with CHF. Echocardiography is a feasible and effective method to evaluate the benefits of domestic D-Shant device for the treatment of CHF.

Design of hospital consumables distribution and cost control system based on consignment mode / 医疗卫生装备

Objective To explore and improve the hospital consumables logistics distribution and cost control system based on consignment mode to solve the current problems in many hospitals for material management.Methods Improvement measures were taken from the aspects of network information system,inventory management,establishing organization architecture and post responsibility as well as introducing IOT technology.Results The system contributed to optimizing consumables management flow and saved hospital cost.Conclusion The hospital consumables logistics distribution and cost control system based on consignment mode is of great value for the management of hospital consumables.

Influencing factors of health seeking intention among patients with type 2 diabetes in Chongqing Chronic Disease Management System / 复旦学报（医学版）

Objective To investigate the health seeking intention and its influencing factors among patients with type 2 diabetes in Chongqing Chronic Disease Management System.Methods Multistage cluster random sampling was used to investigate basic information,diabetes-related treatment situation including first heal seeking and reasons for choosing medical institutions in the last year.Relative risk ratios (RRR) and its influencing factors were analyzed with the method of multi-nominal Logistic regression,as community as a reference.Results Over the past year,38.02％ of type 2 diabetes patients preferred to hospitals above the county level,36.78％ preferred to pharmacy or clinics,and 25.21％ preferred to community health service centers.Univariate analysis showed that different education levels,family income levels,health insurance and therapies were significantly different from health seeking intention.Multi-nominal Logistic regression results indicated that higher educational level (RRR =2.39,95％ CI:1.20-4.78),higher income level (RRR =3.37,95％CI:1.44 -7.88),applying to specific diseases medical insurance (RRR =3.32,95 ％CI:1.72-6.42),the use of insulin and oral hypoglycemic agents (RRR =5.02,95％CI:1.15-22.00) of respondents were more inclined to the hospitals above the county level,rather than community health services.Conclusions Health seeking intention of type 2 diabetes patients preferred to hospital above the county level in Chongqing.Type 2 diabetes was an important disease of non-infectious chronic diseases,while the patients preferred go to utilize hospitals rather than community services.

Influencing factors of diabetic patients applying for specific disease health insurance and its treatment cost / 浙江大学学报·医学版

OBJECTIVE@#To compare the treatment costs on type 2 diabetes between patients with and without specific diseases health insurance, and to identify the influencing factors related to specific diseases health insurance application.@*METHODS@#A structured questionnaire was used to investigate basic information, diabetes-related pharmacy, outpatient and inpatient treatment costs. SAS9.1 software was used for statistical analysis. The enumeration data was analyzed by using Chi-square test, and variables of statistical difference were bought into Logistic regression model through stepwise method. Continuous variables were represented by median(inter-quartile range)[M(Q)], and were analyzed by using Wilcoxon test.@*RESULTS@#Compared with patients without specific disease health insurance in outpatient group, patients with specific disease health insurance had higher annual per capita total cost [2160(3081) vs 1000(2100) yuan, P5 years (OR=2.04) were more likely to succeed in specific diseases health insurance application.@*CONCLUSION@#To reduce the financial burden of patients with type 2 diabetes, government should make huge efforts to promote specific disease health insurance policies, and encourage patients to apply for it. Meanwhile, medical insurance department and medical institutions should reinforce supervision and simplify the application process. To improve the availability of specific disease health insurance, the number and coverage of designated retail pharmacies should be increased. Besides, government should pay more attention to low-income patients and those with short duration diabetes, so as to enhance their ability to resist economic risks and reflect the fairness of specific disease health insurance.

Assessment of left ventricular volume and function in patients with left ventricular non-compaction by contrast-enhanced three-dimensional echocardiography / 中华超声影像学杂志

Objective To evaluate the value of echo‐contrast RT‐3DE for assessment of left ventricular volume and function in patients with left ventricular non‐compaction(LVNC) .Methods Twenty‐one patients of LVNC were involved and underwent non‐enhanced and contrast‐enhanced RT‐3DE to evaluate left ventricular end‐diastolic volume (LVEDV) ,left ventricular end‐systolic volume (LVESV) ,left ventricular ejection fraction (LVEF) .The endocardial border definition of LV was graded for each of the 16 LV segments as follows :0 = border invisible ,1 = border visualized only partially ,and 2 = complete visualization of the border .Three image‐quality groups (good ,fair ,and uninterpretable) were identified . Results ①Duringcontrast‐enhancedRT‐3DE,ascomparedwithnon‐enhancedRT‐3DE,thenumberof segments with complete visualization of the endocardial border increased significantly (55% vs 82% ,P <0.01) ,and the number of patients with a good‐quality echocardiogram increased significantly (33% vs 81% , P <0.01) .②Contrast‐enhanced RT‐3DE provided significantly larger values of LVEDV ( P < 0 0.1) and LVESV ( P < 0 0.1) as compared with non‐enhanced RT‐3DE ,the values of LVEF were not statistically different between the two techniques ( P =0.07) .③Intra‐and inter‐observer agreement for assessment of LV volumes and systolic function improved during contrast‐enhanced RT‐3DE ,as compared with non‐enhanced RT‐3DE .Conclusions Contrast‐enhanced RT‐3DE can increase the prevalence of good‐quality echocardiograms and significantly improve the reproducibility of LV volumes and function measurements .

Clinical curative effect analysis and predictors of prognosis in patients with temporal lobe epilepsy after anterior temporal lobectomy: results after five years / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Anterior temporal lobectomy (ATL) is the most common surgical treatment for temporal lobe epilepsy (TLE), although long-term prognosis is often less favorable than short-term outcomes. This study aimed to examine the outcomes of patients with TLE 5 years after undergoing ATL, and to seek possible predictors of prognosis.</p><p><b>METHODS</b>We examined the clinical records of 121 patients with TLE who underwent ATL in our institution between January 2005 and December 2008. The Engel seizure classification was used to divide patients into "seizure free" and "non-seizure free" groups. Univariate and multivariate Logistic regression analyses were used to identify potential prognostic indicators, including history, clinical features of seizures, and magnetic resonance imaging (MRI) and video-electroencephalography (EEG) findings.</p><p><b>RESULTS</b>The majority of patients were seizure free during the follow-up period: 71.9% 1 year after surgery; 71.6% after 2 years; 75.8% after 3 years; 78.8% after 4 years after surgery and 68.8% after 5 years. There were significant differences between seizure-free and non-seizure-free groups in terms of preoperative seizure duration, history of febrile seizures, type of seizure, and MRI and video-EEG findings (P < 0.05), but not in terms of sex, age at seizure onset, age at surgery, side of surgery, auras, family history of seizure, or history of traumatic brain injury, perinatal anoxia or intracranial infection history (P > 0.05). Multivariate Logistic regression analysis showed that a preoperative seizure duration <10 years, a history of febrile seizures, simple complex partial seizures, positive MRI findings, hippocampal sclerosis and unilateral localized video-EEG spikes predicted better outcome (P < 0.05).</p><p><b>CONCLUSIONS</b>ATL appears to be an effective means of treating TLE. Patients undergoing ATL for TLE require careful and comprehensive assessment to ensure optimal outcomes and to allow patients to make informed decisions about their treatment.</p>

Evaluation of structural and elastic changes of arteries in patients with chronic kidney disease by ultrasonography / 中华超声影像学杂志

Objective To evaluate the structural and elastic changes of the arteries of chronic kidney disease (CKD) patients before dialysis by echo-tracking technique.Methods Thirty-nine CKD patients were enrolled in the study before dialysis and subdivided into CKD stage 2-3 group (n =19) and CKD stage 4-5 group (n =20).Forty age matched healthy subjects were selected as the control group.The parameters of arterial structural and stiffness such as intima-media thickness (IMT),stiffness parameter (β),pressure strain elastic modulus(Ep),arterial compliance(AC),augmentation index(AI),carotid pulse wave velocity (PWVβ),carotid-femoral pulse-wave velocity (PWVcf),carotid diameter (D) were measured by echotracking technique and compared among groups.Stepwise multiple linear regression analysis was performed to identify the associated factors of arterial stiffness.Results Compared with healthy group,PWVcf and Dwere significantly increased in CKD stage 2-3 group (P ＜0.05,P ＜0.001),PWVβ significantly increased in CKD stage 4-5 group(P ＜0.05) ;when compared CKD4-5 group with CKD2-3 group,PWVcf and D were significantly increase in CKD stage 4-5 group(P ＜0.05,P ＜ 0.001).The results of stepwise multiple regression analysis demonstrated that the age and estimated glomerular filtration rate (eGFR) were independent impact factors of PWVcf.Conclusions Echo-tracking technique can assess the structural and stiffness changes of arteries in patients with CKD in the early stage and provide valuable information for clinical management.

Effect of esophageal mucosal acid exposure on visceral sensation of patients with non-erosive gastroesophageal reflux disease / 第三军医大学学报

Objective To investigate the effect of esophageal mucosal acid exposure on visceral sensation of patients with non-erosive gastroesophageal reflux disease (NERD) and to evaluate the role of visceral hypersensitivity in NERD pathogenesis. Methods We recruited 21 NERD patients and 10 normal healthy volunteers. Mechanical distentions stimulation and acid perfusion through esophagus were performed using the balloon-affixed and polyvinyl multilumen catheter. Esophageal visceral perception thresholds were examined before and after acid perfusion with esophageal balloon distention by means of a computer-controlled barostat. Results As compared with healthy subjects, NERD patients demonstrated significantly lower initial perception threshold and maximally tolerated pain threshold (P

Cerebral evoked potentials response to esophageal mucosal acid exposure and distention in patients with non-erosive gastro-oesophageal reflux disease / 中华消化杂志

Objective To investigate characteristics and alternation of cerebral evoked potentials (CEP) response to esophageal mucosal acid exposure and distention in patients with non-erosive gastro-oesoph- ageal reflux disease (NERD) and in healthy subjects,and to study the mechanism of visceral hypersensitivity in NERD.Methods Twenty-one NERD patients and 10 volunteers were recruited.Mechanical distention stimulation and acid perfusion of the esophagus were performed using the balloon-affixed and polyvinyl multi- lumen catheter.First,maximally tolerated pain thresholds of all subjects were recorded,then esophageal mechanical stimulation with a 75% of maximal tolerated intensity and a frequency of 0.2 Hz was performed altogether 64 times by means of a computer-controlled barostat.The alternation of esophageal CEP was recorded before and after acid perfusion with a multichannel international 10-20 system of electroencephalography. Experimental data was analyzed by student's t-test and one way analysis of variance.Results Esophageal mu- cosal distention may evoke recognizable and reproducible and multi-peak CEP.The latencies for N1,P1 and N2 in volunteers were (246?77),(388?84)and (502?78) ms,CEP morphology of NERD patients was charac- terized by randomly distributed patterns,and the latencies for N1 ,P1 and N2 were (192?46),(293?76) and (440?79)ms,significantly shorter for mechanical stimulation compared with those of control group respectively (all P value

Research on the relationship between functional changes of fibroblasts in local esophageal tissues and re-stenosis after stenting / 中华消化杂志

Objective Re stenosis is the common complication of stenting. This study was designed to investigate the functional changes of fibroblast in local re stenosis esophageal tissue after stenting and its relation to re stenosis. Methods Sixteen healthy adult dogs were divided into four groups. Esophageal stent was placed by means of “autogenous broad fascia transplantation and fixation”. At the end of 1,2,4 and 8 weeks,the dogs were killed, and the esophageal tissue with stent were taken out and analyzed by gross observation, light microscopy and electron microscopy. The expression of proliferation cell nuclear antigen (PCNA) and alpha smooth muscle actin (? SMA) in esophageal tissue at 1,2,4 and 8 weeks after stenting were studied by immunohistochemistry. The contents of hydroxyproline and gross amino acid(AA) in re stenosis tissue were measured by amino acid analysis. Results At week 1 and 2 the inflammatory reaction occurred evidently in stented esophagus, with granulation and fibrosis; in some places esophageal tissues began to proliferate towards the lumen. At week 1 some fibroblasts began to express PCNA and ? SMA, and at week 2 the expression augmented significantly. The content of hydroxyproline and AA was significantly higher in the esophageal tissues at 1 and 2 weeks after stenting than that in normal esophagus. At week 4 and 8 esophageal lumen became narrow conspicuously, with a lot of fibrotic tissue and few inflammatory cells. Only a few fibroblasts displayed the expression of PCNA instead of the expression of ? SMA at week 4. There was no expression of PCNA and ? SMA at week 8. The content of AA at week 4 increased significantly compared with that at week 2, and the level was similar between 4 and 8. Electron microscopy revealed that the fibroblasts were in the state of vigorous proliferation and secretion in esophageal tissue at week 2, and a lot of fibrotic tissue formed at week 8. Conclusions Re stenosis mainly expressed as granulation and fibrosis. At week 4 and 8 the fibrosis becomes stable gradually with the lessening of inflammatory reaction. Within 4 weeks of stenting fibroblast retains active proliferation and secretion, but after week 4 the function of fibroblasts gradually lessen or even lose.

Early complications of diagnostic and therapeutic ERCP and its treatment / 中华消化内镜杂志

Objective To investigate the occurrence of early complications of diagnostic and therapeutic ERCP and its treatment .Methods Occurrence,kind,treatment and outcome of early complications of diagnostic and therapeutic ERCP were respectively reviewed in 8 579 cases in our hospital between January 1977 and December 1999.Results 112 cases had early complications(1.31%).In diagnostic ERCP morbidity of early complications was 1.30%(95/7290) and it was 1.32%(17/1289)in therapeutic ERCP.Of them,acute pancreatitis occurred in 38 cases(0.44%),billiary infection 30 cases(0.35%),bleeding of digestive tract 26 cases(0.30%),drug reaction 8 cases(0.09%),stone and basket incarceration 5 cases(0.06)%,intestinal perforation 1 cases (0.01%) and retroperitoneal pneumatosis 1 cases(0.01%).Of them,106 patients were cured by conservative therapy.Operations were performed in 5 patients.1 patient died.Conclusion In diagnostic ERCP acute pancreatitis is the most common complication,which may be related to difficulty of cannulation,repeated developing and inappropriately injecting contrast medium. In therapeutic ERPC bleeding of digestive tract is the most common complication ,which is related to the procedure ,jaundice and diabetes.Most of complications can be cured by conservative therapy,but a minority needs operation.

Clinical studies of double stent drainage on biliary and pancreatic duct obstruction / 中华消化内镜杂志

Objective To study the technique of double stent drainage on biliary and pancreatic ducts obstruction,and to assess its clinical effectiveness.Methods Firstly,ERCP was done on all patients to investigate the locus and extent of the stricture or obstruction,in order to choice the stent with suitable diameter and length.Then the stents placed into biliary and pancreatic ducts though the guidewires those was inserted into the ducts already.After the operation,the level of serum amylase and clinical symptoms such as jaundice,abdominal pain and diarrhea were observed to assess the therapeutic effect.Results 14 patients diagnosed as biliary and pancreatic ducts stricture or obstruction were treated successfully with this method(5 patients suffered from ampulla cancer,4 carcinoma of head of pancreas,3 carcinoma of duodenum papilla,2 chronic inflammation of head of pancreas).Thirteen patients were placed with 14 plastic biliary stents in their biliary ducts(each was placed with one stent except one with 2 stents),and one patient was placed with metal stent.At the same time,14 pancreatic stents were placed into pancreatic ducts of these patients.The rate of jaundice extinction in 2 weeks,1 month and 3 months after the operation was 50 percent,71 percent and 93 percent respectively.The rate of abdominal pain remission in 2 weeks after operation was 75 percent.Among 7 diarrhea patients ,the clinical symptoms disappeared in 5 patients and were significantly improved in 2 patients one month after the operation.The obstruction and displacement of stents had not been observed in all patients within 3 months after the operation.The complications related to operation had not been observed in all patients within 3 months after the operation.Conclusions The therapy with double stent drainage in biliary and pancreatic duct stricture is safe and effective.It can relieve jaundice and abdominal pain,decrease biliary pressure and improve the exocrine dysfunction of pancreas.

Clinic application of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography in bile duct injury / 中华消化杂志

Objective To evaluate the role of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography(ERCP)in bile duct injury. Methods Thirty-one patients with bile duct injury from March 1999 to March 2004 were managed by ERCP. Patients with indications of endoscopic therapy were treated by endoscopic sphincterectomy(EST)and plastic stent drainage. Results Twenty-two of 31 patients with bile duct injury received endoscopic therapy . The patients included 3 cases of common bile duct transection or ligation, 13 cases of bile duct stricture, and 15 cases of bile leakage. Seven of 13 patiens with bile duct stricture received plastic stent therapy, followed for 8-20 months, 4 cases with satisfaction and 3 cases with poor outcome. Fifteen cases of bile leakage accepted EST and endoscopic nasalbiliary drainage(ENBD) , in the first time,13 cases resulted in healing of the leakage,2 cases were of no effect. Seven cases of bile duct stricture were treated with plastic stent, maintaining for 4-12 months. No procedure related complications. Conclclusions ERCP is helpful not only for diagnosing and localizing localizing bile duct injury, but also for treating it in most of patients with relatively good and safe results.

Risk factors for postoperative pancreatitis of diagnostic and therapeutic endoscopic retrograde cholangio- pancreatography / 中华消化杂志

Objective To investigate the influence of endoscopic retrograde cholangiography (ERC), endoscopic retrograde pancreatography (ERP), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic biliary stenting on postoperative pancreatitis. Methods 412 patients referred to ERCP were divide into 7 groups, there were both biliary and pancreatic ducts group (ERCP), biliary duct contrast filling group (ERC), pancreatic duct contrast filling group (ERP), ERCP plus biliary stenting group (stent), ERC plus stent, ERCP plus EST and stone extraction (SE) group, and ERC plus EST and SE group. And the differences of postoperative serum amylase in 4 hours and in 24 hours as well as clinical symptoms were compared among different groups. Results The incidence of postoperative hyperamylasaemia in 4 hours and 24 hours were 17.7% and 4.4% respectively. The incidence of postoperative acute pancreatitis was 3.9%, and ERP group had the highest incidence of postoperative acute pancreatitis among the 7 groups. Conclusions Repeated pancreatic duct contrast filling during ERCP manipulation is the main risk factor for postoperative pancreatitis, and therapeutic ERCP such as EST, stent and SE does not increase the incidence of postoperative pancreatitis.

Clinical characteristics of reflux esophagitis in Chinese population / 中华消化内镜杂志

Objective To investigate clinical characteristics of reflux esophagitis ( RE) in Chinese population according to the retrospective analysis of RE in the past 14 years. Methods 3851 cases of RE were diagnosised in our department according to the Los Angeles grading system, and the general status, clinical symptoms, endoscopic findings and values of esophageal manometry,24-hour esophageal pH and biliru-bin monitoring were assessed. Results RE accounted for 2. 95% of the total endoscopy numbers, but the present of RE during 2000 - 2004 y was significantly elevated to 4. 25%. The gender ratio (male: female) was 3.4-1. In the recent 4 years mean age of the patients with original RE was (53. 9 ?14. 5) years. Grade A and B RE comprised of 85. 8% and grade C and D only 14. 2%. The index values such as percent of time with pH 0. 14 and total reflux times were abnormal in RE group, and significant difference existed between the mild and severe RE (P

Application of pancreatic stents in chronic pancreatitis / 中华消化内镜杂志

Objective The clinical efficacy of pancreatic stent in treating chronic pancreatitis was summarized. Methods The stents were applied in 14 patients with chronic pancreatitis and ductal stricture manifested clinically and roentgenographically. Postoperative abdominal pain, changes in appetite, body weight and fat in stools were observed in follow－ ups. Results The stents, 5～ 10F in caliber, were successfully placed in all patients with first attempt. They were followed up for 210 days ( ranging 28～ 520 days ). The early (3 months ) results showed that the pain remitted in 13/14 (92.9％ ) and 11/13 (84.6％ ) of cases respectively. While abdominal pain persisted in 2 cases inspite of the stents. Along with pain remission the appetite and presence of fat in stools improved associated with increase in body weight. The stents drainage maintained for a median to 256 days (ranging 90～ 520 days) Transient hyperamylasemia occurred in 3 cases. Translocation and occlusion of the stent was found in 1 occasion each on the 98 and 520 day respectively. No other serious complication was detected. Conclusion It is assumed that pancreatic stent is effective to treat chronic pancreatitis with ductal stricture.

Aberrant methylation of CpG island in 5′promoter region of p16 gene and its role in diagnosis of pancreatic cancer / 第二军医大学学报

Objective:To investigate the aberrant methylation of CpG island in 5′promoter region of p16 gene in the pancreatic juice and its value in diagnosis of patients with pancreatic cancer.Methods:Pure pancreatic juice(PPJ)was collected from the pancreatic duct by a nasopancreatic tube put under endoscopic retrograde cholangiopancreatography(ERCP). Cytological examination was performed by H-E staining in pure pancreatic juice.Aberrant p16 methylation was detected using the methylation specific PCR(MSP)in the PPJ.Results:The sensitivity,specificity,positive predictive value,negative predictive value and accuracy cytological examination in diagnosis of pancreatic cancer were 40%,100%,100%,45.4% and 60.0%,respectively.The DNA sequences were successfully extracted from the PPJ of 30 patients with pancreatic diseases and were subjected to MSP.Seven(35%)of the 20 cases with pancreatic cancer showed aberrant methylation of p16 gene.No aberrant methylation was detected in the pancreatic juice samples of patients with chronic pancreatitis and mucinous cystoadenocarcinoma of pancreas.When cytological examination combined with p16 methylation detection,the sensitivity, specificity,positive predictive value,negative predictive value and accuracy for diagnosis of pancreatic cancer were 55%,100%, 100%,52.6% and 70%,respectively.Conclusion:Pancreatic juice collected by nasopancreatic drainage during ERCP can be used for molecular analysis.Detection of aberrant methylation of p16 gene in pancreatic juice combined with cytological examination is a better method for diagnosis of pancreatic cancer.

Endoscopic management of foreign bodies in upper gastrointestinal tract: a report of 802 cases / 解放军医学杂志

Objective To summarize the experiences in diagnosing and removing foreign bodies in the upper gastrointestinal tract. Methods Eight hundred and two cases were examined endoscopically for their ingested foreign bodies from 1978 to 2003. Endoscopy and various instruments for grasping the foreign bodies were used. Results Altogether there were 1 198 pieces of foreign bodies, 424 of which were impacted in the esophagus, 662 in the stomach, and 112 in the duodenum. One thousand one hundred and ninity-eight pieces of foreigen bodies were successfully removed from 780 patients without any complications. But removal of 31 pieces in 22 patients failed because the foreign bodies were impacted in the gastrointestinal tract. The success rate was 97.3%. Among all the foreign bodies taken out, the largest one was 20cm in length and 4.2cm in width. Conclusion Endoscopy could be used safely and effectively in patients with ingested foreign bodies.