The associations of muscle size and density with handgrip strength and timed up and go test / 中华老年医学杂志

Objective:The aim of this study was to explore the associations of muscle size and density with handgrip strength(HGS)and the Timed Up and Go(TUG)test.Methods:Totally 301 participants living in the Xinjiekou community near Beijing Jishuitan Hospital were recruited for CT imaging of the hip and a 1-cm slice of the mid-thigh.The cross-sectional area and density of the gluteus maximus and the mid-thigh muscles were estimated by the Osirix viewer based on CT images.HGS and TUG were also performed in these subjects.Logistic regression analysis was used to evaluate the correlations of muscle density and size with TUG and grip strength.Results:In women, after adjustment for age and BMI, the density of the gluteus maximus was negatively correlated with TUG( P trend=0.0366), while the size of the gluteus maximus and the mid-thigh muscles was not correlated with TUG.In men, the density or size of these muscles was not correlated with TUG.After adjustment for age and BMI, the density of the gluteus maximus was positively correlated with grip strength( P trend=0.0334)and the size of the mid-thigh muscles was also positively correlated with grip strength( P trend=0.0155)in men, but they were not correlated with grip strength in women. Conclusions:There were sex differences in the relationship between muscle size or density and grip strength or timed up and go.The density of the gluteus maximus is associated with muscle strength and physical performance while the size of the mid-thigh muscles is correlated with muscle strength.

Anti-HBc levels in patients with different natural history of chronic HBV infection and cirrhosis and its clinical significance / 重庆医学

Objective To investigate the serum anti-HBc level in patients with different natural history of chronic hepatitis B virus (HBV) infection and cirrhosis,and its clinical value for distinguishing the natural history statue.Methods A total of 160 patients with chronic HBV infection from March 2015 to June 2016 were enrolled,and they were divided into immune tolerance group (n=43),HBeAg-positive chronic hepatitis B (CHB) group (n=37),inactive carrier group (n=39) and HBeAg-negative CHB group (n=41).A total of 44 patients with HBeAg-positive cirrhosis and 46 patients with HBeAg-negative cirrhosis were enrolled too.The general conditions data were collected,and HBsAg,HBeAg,anti-HBc,HBV DNA load and HBV genotype were detected.The associations between anti-HBc level and clinical parameters were analyzed,and the diagnostic value of anti-HBc for distinguishing different natural histories was analyzed.Results The anti-HBc levels in different natural history from high to low were as following: HBeAg-positive CHB group (4.22±0.68)log10 IU/mL,HBeAg-negative CHB group (3.89±0.88)log10 IU/mL,inactive carrier group (3.07±0.68)log10 IU/mL and immune tolerance group (2.88±0.82)log10 IU/mL.The anti-HBc levels in HBeAg-positive and HBeAg-negative cirrhosis patients were (3.04±0.82) and (3.15±0.86) log10 IU/mL,respectively.In HBeAg-positive CHB group,the anti-HBc was positively associated with ALT (r=0.353,P=0.032) and AST (r=0.421,P=0.009).In HBeAg-negative CHB group,the anti-HBc was positively associated with HBV DNA (r=0.343,P=0.028),ALT (r=0.458,P=0.003) and AST (r=0.495,P=0.001).The AUC of anti-HBc used to distinguish immune tolerance from HBeAg-positive CHB was 0.903,and the AUC used to distinguish inactive carrier from HBeAg-negative CHB was 0.833.Conclusion Anti-HBc levels in different natural history of chronic HBV infection are significantly different,and anti-HBc could be used to distinguish the natural history statue of chronic HBV infection with a higher diagnostic value than HBsAg.

Expression of heparanase in serum and tissues of patients with papillary thyroid carcinoma / 中华内分泌外科杂志

Objective To investigate the expression of heparanase (Hpa) in serum and tissue of patients with papillary thyroid carcinoma (PTC) and its clinical significance.Methods Immunohistochemical method (SP) and enzyme linked immunosorbent assay (ELISA) were used to detect the expression of Hpa protein in serum and tissues of 38 cases of PTC,37 cases of patients with benign thyroid nodules,and 30 normal controls.Results Expression of Hpa in PTC was higher than that of benign thyroid nodules (P＜0.01).Expression of Hpa in lymph node metastasis group was higher than that in group without lymph node metastasis (P＜0.05).Compared with the normal control group,the content of serum Hpa in patients with benign thyroid nodules had no significant difference (P＞0.05).Hpa content in serum of patients with PTC was higher than that of benign thyroid nodules group and the normal control group (P＜0.01).There was no statistically significant difference of the level of serum Hpa between groups with and without lymph node metastasis.Conclusions Detecting tissue and preoperative serum Hpa concentration is valuable for diagnosis of PTC.Hpa detection in tissues can be used to determine whether there was lymph node metastasis in PTC patients,while Hpa detection in preoperative serum can not judge whether there is lymph node metastasis.

Research Progress on Relationship Between Gastroesophageal Flap Valve and Gastroesophageal Reflux Disease / 中国微创外科杂志

[Summary] The mechanisms of gastroesophageal reflux disease ( GERD) include abnormal antireflux function and esophageal mucosa attacked by regurgitation .Gastroesophageal flap valve ( GEFV) located in the gastroesophageal junction is one mechanism of the antireflux barrier .An increased GEFV grade is associated with an increased incidence of erosive esophagitis and Barrett ’ s epithelium.With abnormal esophageal acid exposure and prevalence of a mechanically defective sphincter , patients usually have severe symptoms and lower efficiency of medication .Therefore , GEFV is valued in the diagnosis and treatment of GERD .This review summarized the relationship between GEFV and GERD .

Expression and clinical significance of Hpa and uPA in thyroid carcinoma / 中华内分泌外科杂志

Objective To study the relationship between heparanase( Hpa) , urokinase type plasminogen activator( uPA) expression and lymph node metastasis in thyroid carcinoma.Methods Immunohistochemieal SP method was used to analyze the expression of Hpa and uPA in 113 cases of thyroid carcinoma and 134 cases of be-nign thyroid nodules.The expression of Hpa and uPA in thyroid carcinoma and its clinical significance were ana-lyzed.Results The positive expression rate of Hpa and uPA in thyroid carcinoma and benign nodular thyroid tis-sue were 82.30%,16.42%and 89.38%, 11.19%.The positive expression rate of Hpa and uPA in carcinoma tissues with lymph metastasis and without metastasis were 93.94%,100% and 65.96%,74.47%.Expression of Hpa and uPA in thyroid carcinoma group was significantly higher than that of benign thyroid nodules group( P<0.001) .The rate of positive expression in lymph metastatic tissues were significantly higher than those in tissue without metastasis( P<0.001) .Hpa and uPA expression in thyroid carcinoma tissues was positively correlated( r=0.437, P=0.021).Conclusion The expression of Hpa and uPA is closely related with the occurrence and metastasis of thyroid carcinoma.

The application of preoperative angiography and intraoperative Doppler blood flow detection in the surgery of colonic interposition for esophageal / 中国医师进修杂志

Objective To investigate the effect of preoperative angiography and intraoperative Doppler blood flow detection in the surgery of colonic interposition for esophageal.Methods Thirty-seven patients who underwent the surgery of colonic interposition for esophageal were chosen,17 cases received colonic interposition for esophageal routine operation (routine group),and 20 cases received preoperative angiography of superior and inferior mesenteric arteries and intraoperative Doppler blood flow detection (improved group),the clinical efficacy was observed.Results Routine group occurred anastomotic leak in 4 cases on postoperative 6-15 d,operation time was (367.0 ± 53.3) min,and improved group occurred anastomotic leak in 1 case on postoperative 7 d,operation time was (302.0 ± 67.1) min,the operation time between two groups had significant difference (P ＜ 0.05).Conclusions The adoption of preoperative angiography and intraoperative Doppler blood flow detection can real-time directly display the vascular morphology of transplanted colon segment,observe the traveling direction and distribution of mesenteric arteries,provide accurate and rehable evaluation of blood vessel of transplanted colon,which can conduct to the optimum selection of transplanted colon and reduce the incidence of postoperative complications.

Surgical effect of dysphagia in patients with bulbar myasthenia gravis / 中华全科医师杂志

To retrospectively analyze the clinical data of 42 patients at our department with bulbar myasthenia gravis.They underwent video-assisted thoracoscopic extended thymectomy (VATET) from May 2003 to August 2010.Another 42 patients treated with medications alone were selected as controls.Compared with the control group (4.32 ± 0.23),postoperative dysphagia scores improved significantly in patients undergoing VATET(9.21 ±0.41).And so did the dysphagia assessment classification (P ＜0.05).Thus VATET could effectively and definitely relieve dysphagia in patients with bulbar myasthenia gravis.

Comparison of three kinds common methods in detection of hepatitis B / 中国医师进修杂志

ObjectiveTo investigate the clinical application value of enzyme-linked immunosorbent assay (ELISA) and time-resolved fluorescence analysis(TRFIA) and latex immune chromatography (GICA) in detecting hepatitis B serum markers.MethodsOne hundred and forty-five suspected patients of hepatitis B were detected serum markers of hepatitis B by ELISA,TRFIA and GICA method,and the results were compared and analyzed.ResultsWhen TRFIA method was as gold standard,the positive coincidence rate of ELISA and GICA method in HBsAg,HBeAb,HBcAb was 71％ (57/80),45％ (36/80),and in HBsAb,HBeAb,HBcAb was 33％( 1/3),0 (0/3),and there were significant differences between two methods (P＜0.05 ) ; the others were no significant differences (P ＞ 0.05 ).There was significant difference in the sensitivity of HBsAg between ELISA method and GICA method (P ＜ 0.05 ),but there was no significant difference in HBsAb,HBeAg,HBeAb,HBcAb(P ＞ 0.05 ).There was no significant difference in the specificity of HBsAg,HBsAb,HBsAg,HBeAb and HBcAb between ELISA method and GICA method (P ＞0.05).There was significant difference in HBsAg among three methods(P ＜0.05),but there was no significant difference between ELISA method and TRFIA method (P＞0.05),and there was significant difference between GICA method and TRFIA method (P＜0.05).There was no significant difference in HBsAb,HBeAg,HBeAb and HBcAb among three methods (P ＞ 0.05 ); there was significant difference in both HBsAb and HBeAb positive among three methods (P ＜ 0.05),and there was significant difference between ELISA method,GICA method and TRFIA method (P＜ 0.05).ConclusionTRFIA method has supreme measuring range,sensitivity and specificity supreme,but the price is higher;ELISA method is in the intermediate level of three methods and price is cheap,and it as well as TRFIA is suitable for the batch detection; GICA accuracy is low,but quick and simple,it is more suitable for the complement of the first two methods.

The clinical analysis of the synchronous multiple primary esophageal carcinoma / 中华胸心血管外科杂志

Objective To investigate the clinical characteristics,the diagnosis and therapy of synchronous multiple primary esophageal carcinoma.Methods Thirty-two cases of synchronous multiple primary esophageal carcinoma were collected from January 1980 to December 2010 and their clinic data were retrospectively analysised.Results In the whole group,there were totally 66 lesions in 30 cases of double primary lesion and 2 cases of three primary lesion.The length of the lesions were 1 cm to 6.5 cm,and there were 22 lesions in cervical esophagus,10 in upper thoracic esophagus,19 in midthoracic esophagus and 15 in lower thoracic esophagus.Within the 66 lesions,65 lesions were squamous cell carcinoma and 1 was adenocarcinoma.The mucosa between the lesions were normal,with a distance of 4 cm to 9.5 cm,average 7.1 cm.Thirty-two patients with synchronous multiple primary esophageal carcinoma received surgery.Among 32 cases,26 of them were given definite diagnosis before operation.Four of them had exploratory operation,one patient underwent palliative resection,27 patients underwent radical resection.Two cases of the pathologic results of esophageal stump showed carcinoma after operation.The complications occurred in 8 patients.Twenty-eight cases were followed up after operation,the 1,3 and 5-survival rate were 76.9％,43.3 and 14.8％,respectively.Conclusion General pre-operation examination can significant helpful for the definite diagnosis of synchronous multiple primary esophageal carcinoma and surgical treatment is better choice for this disease.

Mechanism of antireflux procedures in treating sliding hiatal hernia / 中华胸心血管外科杂志

Objective To investigate the mechanism of anireflux procedures in treating sliding hiatal hernia and the effectiveness of the method of cardia position by clock to evaluate the outcome of antireflux procedures. Methods From 1992 to 2008, 136 patients with sliding hiatal hernia underwent transabdominal antireflux surgery: 27 patients received Nissen procedure and 109 recieved floppy Nissen operation. Results There is no postoperative death. Within one month after operation, in the Nissen group, 2 patients developed severe dysphagia and 1 had regurgitation; in the floppy Nissen group, 9 patients had regurgitation, and 3 had dysphagia. During the over-2-year follow-up period, 2 patients developed severe dysphagia,1 had nausea and 2 had significant reflux in the Nissen group. While 3 patients recturred, 2 had dysphagia and 7 had significant reflux in the floppy Nissen group. The effective rates of the Nissen group and the floppy Nissen group were 81.5% and 88.1%, respectively. There was no significant difference in postoperative tests between two groups ( P ＞ 0.05 ). Tests of cardia position by o'clock showed that cardia positions of 80. 1% patients before surgery were located at sites between 10 and 11 o'clock and those of 91.7% after surgery being at 9 o' clock or less. Conclusions The Niseen and the floppy Nissen fundoplication can reach good long-term results in treatment of sliding hiatus hernia. Mechanism of these antireflux procedures include, by fundoplication, increasing esophageal sphincter pressure, prolonging the sphincter length, deepening His angle and prolonging abdominal esophagus, etc. Among them, the last one, descending the cardia position to 9 o'clock or less is vital to antireflux.The test of cardia position by o'clock is practically important to reach the successful result.

Colon interposition for esophageal benign stricture:58 cases experience / 中华胸心血管外科杂志

Objective To review the experience of colon interposition in the treatment of benign esophageal stricture.Methods 58 patients who had undergone colon interposition for esophageal replacements were studied retrospectively,including 53 patients with corrosive burn esophageal strictures,3 traumatic esophageal strictures and 2 congenital esophageal strictures.The interposition colon for all patients went through substemum paths.Results There was no postoperative death in the duration of hospital stay.14 cases developed postoperative complication including 2 total colon necrosis,7 anastomotic leak,2 anastomotic stricture and 3 recurrent laryngeal nerve injury.52 patients were followed-up(ranged 1 to 16 years),40 cases were extremely satisfied(1 grade),9 very satisfied(2 grade),2 satisfied(3 grade)and 1 unsatisfied(4 grade).Conclusion Colon interposition is an ideal procedure for esophageal benign stricture.

Utility of intraoperative laparoscopic ultrasonography in laparoscopic nephron-sparing surgery / 中华泌尿外科杂志

Objective To discuss the role of assistance of intraoperative uitrasonography in ret-roperitoneal laparoscopic nephron-sparing surgery for renal tumors. Methods The intraoperative laparoscopic ultrasonography was applied in retroperitoneal nephron-sparing surgery for 20 patients, of whom 11 were men and 9 were women. The average age was 53(range 33 to 73) years. There were 12 patients with renal cell carcinoma and the mean tumor size was 2.9(range 1.4 to 4.6)cm in diame-ter. All of them were staged as T1 N0 M0. Seven patients had angiomyolipoma and the mean tumor size was 4.5(range 1.8 to 8.0)cm in diameter and 1 patient had a 3.1 cm oncocytoma in diameter. The ul-trasonography was used to locate the tumor, observe the bloodstream and detect whether there were small satellite tumors. The surgical time, time of renal artery occlusion and operative effect were ob-served. Results Laparoscopic surgery was successful in all cases without conversion to open surger-y. Mean operative time was 115 (range 85 to 270) min, mean time of renal artery occlusion was 28 (range 22 to 50) min. During the mean followup of 16(range 4 to 30) months, no patients with renal cell carcinoma had local or port site recurrence or metastatic disease. Conclusion In retroperitoneal laparoscopic nephron-sparing surgery, the intraoperative uhrasonography is helpful to locate the tumor in the surgery, to estimate whether the renal artery is occluded completely and to excise the tumor pre-cisely.

Surgical management of the cervical esophageal carcinoma / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the surgical management and its result of the cervical esophageal cancer.METHODS Forty six patients with cervical esophageal carcinoma who received surgical treatment in our hospital were included in this retrospective study.The removed hypopharynx and cervical esophagus were repaired with laryngotracheal flap in 5 cases,free myocutaneous flap in 4 patients and free jejunum in 2 patients.The inversion stripping esophagectomy without thoracotomy were performed in 35 patients.RESULTS During the early postoperative period,complications included recurrent laryngeal nerve paralysis in 2 cases,anastomotic fistula in 3 cases,anastomotic stenosis in 5 cases,Long-term postoperative gastro-esophageal reflux occurred in 19 cases.The 5-year survival rate was 28.7%. CONCLUSION The surgical treatment for cervical esophageal carcinoma should be decided by the location of the tumor,the extent of the cancer involved and lymph node metastasis.

Value of instructions to outpatients in helping postgraduates of thoracic surgery promote their clinical abilities / 中华医学教育探索杂志

Education to medical postgraduates is relatively special. Their study and research work have something to do with their clinical practice. Based on their technical training for thoracic surgery,postgraduates were demanded to follow up and instruct their patients on postoperative recovery from surgery. In this way,these postgraduates were trained not only in clinical practice but also in other aspects,such as communication techniques,how to take care of patients,professional moral education. Instruction to outpatients is helpful to cultivate post-graduates and promote their abilities in self-thinking,self-acknowledging,initiative,creation,and so on. Instruction to outpatients is an important way to bring up excellent medical postgraduates.