RESUMO
Objective To assess the predictive value for survival of BioCliM index in liver cirrhosis caused esophageal and gastric varices bleeding(EGVB)treated by endoscopic variceal ligation(EVL),endoscopic injection sclerotherapy(EIS)and endoscopic tissue adhesives(ETA).Methods From December 2006 to December 2011, the clinical data of 166 hospitalized patients with first occurrence of EGVB caused by liver cirrhosis and received endoscopic therapies were retrospectively analyzed.The scores of model for end-stage liver disease(MELD),model for end-stage liver disease-Na(MELD-Na),BioCliM index and Child-Turcotte-Pugh(CTP)were calculated. Receiver operating characteristic(ROC)curve and area under the curve(AUC)were applied to assess the accuracy of the four models in one-year and two-year prognosis evaluation,and to obtain the best critical value,and the mortality rates were compared among groups.Chi-square test,t test and rank-sum test were performed for statistical analysis.Results Among 166 patients,the levels of creatinine,bilirubin,albumin,sodium,international normalized ratio and prothrombin time were(0.10 ± 0.06)mmol/L,(0.02 ± 0.01)mmol/L,(30.13 ± 5.06)g/L, (139.13 ± 4.27)mmol/L,1.50 ± 0.32 and(17.83 ± 2.88)s,respectively.During the one-year and two-year follow-up,there were 14 patients and 23 patients dead,respectively.During the one-year and two-year follow-up, the incidences of portal thrombosis of death group were lower than those of survival group(10/14 vs 93.4%,142/152;73.9%,17/23 vs 94.4%,135/143);and the differences were statistically significant(χ2=8.029 and 10.774, both P<0.01).During the one-year and two-year follow-up,BioCliM indexes of death group were 0.12(-0.82, 1.44)and -0.81(-0.87,0.92),respectively,which were both higher than those of survival group(-0.84,-0.94 to -0.73;and -0.84,-0.94 to -0.72),and the differences were statistically significant(Z= -3.074 and -2.260,both P<0.05).During the one-year follow-up,the AUC values of MELD,MELD-Na,BioCliM index and CTP score were 0.698,0.691,0.749 and 0.723,respectively.During the two-year follow-up,the AUC values of MELD,MELD-Na,BioCliM index and CTP score were 0.587,0.582,0.647 and 0.633,respectively. But there was no statistically significant difference in AUC between BioCliM index and MELD,MELD-Na,and CTP score in one-year and two-year follow-up for prognosis evaluation(Z=0.509,0.566,0.271,0.687,0.731 and 0.162,respectively;all P>0.05).The best critical value of BioCliM index was -0.234.Followed up for one year and two years,the mortality rates of patients with BioCliM index over -0.230 were higher than that of patients with BioCliM index less than -0.234(31.0%,9/29 vs 3.6%,5/137;34.5%,10/29 vs 9.5%,13/137);and the differences were statistically significant(χ2=23.242 and 12.526,both P<0.01).Conclusions BioCliM index has a high accuracy in one-year and two-year mortality rate evaluation in liver cirrhosis patients with EGVB and received endoscopical therapies.We should pay attention to the prognosis evaluation before the endoscopical therapy.
RESUMO
Objective To investigate the correlation between capsule endoscopy Crohn′s disease activity index (CECDAI ) , capsule endoscopy Lewis score , simplified Crohn′s disease activity index (sCDAI) ,C reactive protein (CRP) ,erythrocyte sedimentation rate (ESR) and Crohn′s disease (CD) activity .Methods From April 2009 to April 2014 , 120 patients having received capsule endoscopy examination and diagnosed as CD were collected . The data of CRP and ESR were analyzed . The CD severity was scored by CECDAI ,Lewis score and sCDAI .Spearman correlation was performed to analyze the correlation between CECDAI ,Lewis score ,sCDAI ,CRP and ESR .Results Among all the patients , CECDAI had a good correlation with Lewis score (r=0 .645 , P0 .05) . sCDAI had a good correlation with CRP and ESR (r=0 .438 and 0 .429 ,both P0 .05) .Conclusions Lewis score ,sCDAI ,CRP and ESR can reflect disease activity of CD patients in a certain degree .CECDAI is the most suitable index in evaluating the disease activity of CD patients .Therefore ,it is necessary to attach importance to capsule endoscopy examination .
RESUMO
Objective To analyze the features of cervical vertebra X-ray examination and transcranial Doppler (TCD) in children with cervical vertigo, and investigate the mechanism of the disease. Methods X-ray examination of cervical vertebra and TCD were performed on 80 children with cervical vertigo, and the features of the results were analyzed. Results The abnormal results of cervical X-ray examina-tion mainly showed atlantoaxial joint or/and C2, C3 vertebral joint disorders, some of which combined with cervical instability, cervical cur-vature straightened and even reverse curvature, cervical scoliosis. The abnormal results of TCD showed the blood flow velocity in single or multiple branch of artery increased mainly, some of which decreased or became asymmetrial. Conclusion The cervical vertigo in children may result from various kinds of disorders of the atlas, axis or/and C2, C3 vertebrae.
RESUMO
Objective To study the clincial effectiveness and safety of endoscopic sphincteropapillotomy combined with balloon dilation for decompensated cirrhosis accompanied with choledocholithiasis.Methods Data of 79 cases of decompensated cirrhosis patients with choledocholithiasis who underwent limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD,the ESBD group) and 42 cases who underwent endoscopic papillary balloon dilation(EPBD,the EPBD group)were retrospectively analysed and compared for complete stone clearance rate,one-time stone clearance rate and complications.Results The rate of complete stone clearance and one-time stone clearance were 94.9％ (75/79) and 77.2％ (61/79)in ESBD group,and those were 88.1％ (37/42) and 59.5％ (25/42) in EPBD group respectively.The rate of complete stone clearance was a little higher in ESBD group than that in EPBD group.In ESBD group,ERCP-related bleeding occurred in 3 patients (3.8％),post-ERCP hyperamylasemia in 3 (3.8％)and post-ERCP pancreatitis in 2 (2.5％) ; while in EPBD group,post-ERCP hyperamylasemia occurred in 8 patients(19.0％),post-ERCP pancreatitis in 6(14.3％) and ERCP-related bleeding did not occur.There were no significant difference in ERCP-related bleeding between ESBD group and EPBD group (P =0.551).However,the rates of post-ERCP pancreatitis and hyperamylasemia in ESBD group were significantly lower than those in EPBD group(P ＜ 0.05).Conclusion ESBD is a safe and effective procedure for choledocholithiasis accompanied by decompensated cirrhosis,with several advantages over EPBD in terms of higher one-time stone clearance rate,reduced risk of post-ERCP pancreatitis and hyperamylasemia,and without noticeable increase in the risk of bleeding related to ERCP.