Achalasia: The Current Clinical Dilemma and Possible Pathogenesis

Achalasia is a primary esophageal motility disorder manifested by dysphagia and chest pain that impair patients’ quality of life, and it also leads to chronic esophageal inflammation by food retention and increases the risk of esophageal cancer. Although achalasia has long been reported, the epidemiology, diagnosis and treatment of achalasia are not fully understood. The current clinical dilemma of achalasia is mainly due to its unclear pathogenesis. In this paper, epidemiology, diagnosis treatment, as well as possible pathogenesis of achalasia will be reviewed and summarized. The proposed hypothesis on the pathogenesis of achalasia is that genetically susceptible populations potentially have a higher risk of infection with viruses, triggering autoimmune and inflammation responses to inhibitory neurons in lower esophageal sphincter.

Effect of early bundle therapy on prognosis of patients with sepsis and septic shock / 中华急诊医学杂志

Objective To observe the effect of early bundle therapy on prognosis of patients with sepsis/septic shock and analyze the risk factors for death.Methods A retrospective cohort study was conducted to select patients with sepsis/septic shock at the Second Soochow University Hospital betweenJanuary 1,2016,and December 31,2016.Data pertaining to demographic variables,compliance rate of bundle therapy,and incidence of organ failure were collected.Patients were categorized into the nonsurvivor or survivor groups based on 28-day mortality.Logistic regression analysis was used to identify risk factors for 28-day mortality.Results Totally 118 sepsis/septic shock patients were included in the analysis;28-day mortality was 32.2％.Compared to the survivor group,patients in the non-survivor group were more likely to have chronic heart dysfunction and cerebrovascular disease,lower lactate clearance,lower 6-h compliance rate of bundle therapy and higher incidence of failure of one or ＞2 organs.Age,leukocyte,blood urea nitrogen,creatinine,brain natriuretic peptide,sequential organ failure score and acute physiological and chronic health scores Ⅱ on admission,and lactate after bundle therapy were higher than that of the survivor group.Logistical regression analysis showed that age ≥ 75 years [odds ratio (OR)1.012],6-h lactate clearance ＜30％ (OR=1.122),chronic heart failure (OR=1.741),failure of ＞2 organs (OR=1.769),and 6-h compliance rate of bundle therapy (OR=1.958) were independent risk factors for 28-day mortality.Conclusions Patients with sepsis/septic shock need early diagnosis and resuscitation to improve the compliance rate of bundle therapy and reduce the mortality.

The significance of different predictive equations for resting energy expenditure in patients receiving invasive mechanical ventilation / 中华内科杂志

To calculate resting energy expenditure (REE) in patients receiving invasive mechanical ventilation and compare different predictive equations with indirect calorimetry(IC).A total of 60 patients in intensive care unit(ICU) were enrolled. Measure calculating daily REE in the first week included IC, Harris-Benedict formula, Penn State formula and Swinamer formula. Daily REE did not exhibit significant difference in the first week of mechanical ventilation by IC (all P>0.05).All patients' REE values by IC were higher than those by Harris-Benedict formula (all P<0.01). By Penn State formula, REE in day l, 2, and 5 were comparable (all P>0.05) with those by IC, whereas the consistency between the two methods was poor. Similarly, daily REE by Swinamer formula calculation in the first week did not show significant difference (all P>0.05), with acceptable consistency as IC. Resting energy expenditure in patients receiving invasive mechanical ventilation dose not significantly change during the first week. Swinamer formula is more accurate than other equations when IC is considered as the standard method.