Evaluation of high resolution esophageal manometry in peroral endoscopic myotomy for pediatric achalasia of cardia / 中华消化内镜杂志

Objective:To evaluate high resolution esophageal manometry (HREM) in peroral endoscopic myotomy (POEM) for pediatric achalasia of cardia (AC).Methods:Data of 30 AC children who received POEM in Xi′an Children′s Hospital from January 2013 to September 2019 were reviewed. HREM was performed before and 6 months after POEM. Preoperative and postoperative lower esophageal sphincter pressure (LESP), 4-second integrated relaxation pressure (4sIRP), Eckardt scores and nutritional status were compared.Results:Children with AC aged between 4-14 years. Postoperative LESP was 5.50±1.13 mmHg (1 mmHg=0.133 kPa), which was significantly lower than that before operation (26.23±4.47 mmHg) with significant difference ( t=-24.623, P<0.001). Postoperative median 4sIRP was 5 mmHg, which was 20 mmHg lower than that before operation (25 mmHg) with significant difference ( Z=-4.786, P<0.001). Postoperative median Eckardt symptom score decreased significantly compared with that before (1 VS 8, Z=-4.796, P<0.001). Severe malnutrition of the AC children improved evidently to normal( Z=-5.166, P<0.001). Conclusion:POEM can significantly improve the characteristics of esophageal dynamics in children with AC, and HREM can be an important indicator for follow-up evaluation of POEM.

Regulation of glutathione S-transferase P1 on the radiosensitivity of mouse Lewis lung cancer cells / 中华放射肿瘤学杂志

Objective:To explore the regulatory effect of glutathione S-transferase P1(GSTP1) on the radiosensitivity of mouse Lewis lung cancer (LLC) cells.Methods:GSTP1-shRNA lentivirus and negative control lentivirus were used to respectively infect the LLC cells, and stable transgenic strains were selected. Real-time PCR and Western blot were conducted to quantitatively measure the expression levels of GSTP1 mRNA and protein in the LLC cells to verify the knockdown effect. The cell counting kit-8(CCK-8) assay was used to detect cell viability after irradiation. The colony formation assay was utilized to assess the cell proliferation ability after irradiation. Flow cytometry was performed to assess the level of cell apoptosis after irradiation. The tumor-bearing mice were established and irradiated to detect the changes in the tumor volume after irradiation. TUNEL staining was employed to detect the level of tumor apoptosis after irradiation. Immunofluorescence was used to detect the number of CD 4+ CD 8+ T cells in the tumor after irradiation. Results:Real-time PCR and Western blot showed that after shRNA lentivirus interference, the expression levels of GSTP1 mRNA and protein were significantly down-regulated. Down-regulation of GSTP1 reduced cell viability and proliferation, and increased the rate of cell apoptosis after irradiation. The tumor volume of the tumor-bearing mice after irradiation in the GSTP1 knockdown group was significantly smaller than that in the NC group, whereas the tumor apoptosis rate was significantly higher and the number of infiltrating CD 4+ CD 8+ T cells in the tumor was remarkably higher compared with those in the control group. Conclusion:Knockdown of GSTP1 can significantly increase the radiosensitivity of LLC cells and enhance the infiltration of lymphocytes in tumor tissues.

Comparative analysis of clinical characteristics between children and adults with eosinophilic gastroenteritis / 中华消化杂志

Objective:To explore the similarities and differences between children and adults with eosinophilic gastroenteritis (EGE), and to guide the diagnosis and treatment of EGE.Methods:From February 2013 to August 2018 at Xi′ an Children′ s Hospital, 18 children with EGE (child group) and from June 2008 to June 2018 at Xijing Hospital of Digestive Diseases, Air Force Medical University, 24 adults with EGE (adult group) were retrospectively selected as study subjects. The general data, clinical symptoms, laboratory examinations, imaging, endoscopy manifestations, pathological biopsy, treatment and prognosis of the two groups were analyzed. Chi-square test was used for statistical analysis. Results:The proportion of child group with allergic history was higher than that of adult group (9/18 vs. 20.8%, 5/24), the incidence of nausea and vomiting was higher than that of adult group (13/18 vs. 29.2%, 7/24), the incidence of diarrhea and weight loss were both lower than those of adult group (4/18 vs. 58.5%, 14/24; 3/18 vs. 54.2%, 13/24), and the proportion of patients with elevated peripheral blood eosinophil count was lower than that of adult group (4/18 vs. 58.3%, 14/24), and the differences were statistically significant ( χ2=3.938, 7.644, 5.477, 6.133 and 5.477, P=0.047, 0.006, 0.019, 0.013 and 0.029). The main endoscopic manifestations of the two groups were mucosal congestion and edema (13 cases of child group and 22 cases of adult group). Mucosal roughness (7 cases) and erosion (6 cases) were also common in child group, while mucosal erosion (18 cases, 75.0%) and ulcer (8 cases, 33.3%) were more common in adult group. There was a statistically significant difference in the incidence of mucosal erosion between the two groups ( χ2=7.292, P=0.007). The positive rates of biopsy in the terminal ileum, colorectum and duodenum of child group and adult group were both high (6/6, 14/15, 9/18 and 8/10, 12/15, 6/8, respectively). The response time of glucocorticoid treatment was 4.5 d (2.0 to 27.0 d) and 3.7 d (1.0 to 14.0 d) in child group (8 cases) and adult group (13 cases), respectively. There was no statistically significant difference in the recurrence rate after glucocorticoid treatment between the two groups (5/8 vs. 6/13, P > 0.05). Conclusions:The clinical characteristics of children and adults with EGE are different, which may provide references for clinicians to understand, diagnose and treat EGE.

Detection of retinal and optic disc neovascularization in patients with stage 4 diabetic retinopathy by multidirectional optical coherence tomography angiography / 中华眼底病杂志

Objective:To observe and analyze the detection rate of optical disc and retinal neovascularization in stage Ⅳ diabetic retinopathy by multidirectional OCT angiography (OCTA).Methods:A retrospective study. From September to October 2018, 50 eyes of 46 patients with diabetic retinopathy of stage Ⅳ diagnosed in Tangshan Ophthalmological Hospital were included in the study. Among them, there were 18 males (19 eyes) and 28 females (31 eyes). The age ranged from 31 to 78 years, with an average age of 56.64±10.64 years. All patients underwent medical optometry, mydriasis fundus examination and FFA examination. All patients met the diagnostic criteria of stage Ⅳ diabetic retinopathy. All patients underwent multidirectional OCTA examination on the same day after mydriasis fundus examination and FFA examination. Angiography 6 mm × 6 mm scanning mode was selected for OCTA examination. The retinal areas of macular area, optic disc, superior nasal disc, superior optic disc, superior macular area, superior temporal macular area, temporal macular area, inferior nasal disc, inferior optic disc, inferior macular area and inferior temporal macular area were scanned respectively. All images were taken by the same physician and read by two physicians independently. Cases with inconsistent opinions between the two physicians were not included in this study. The optical disc and retinal neovascularization in patients with stage Ⅳ diabetic retinopathy were observed on FFA and multidirectional OCTA images.Results:In 50 eyes, the positive number of screening optic disc neovascularization using FFA was 8 eyes, OCTA was 15 eyes (100%). In the 42 eyes without optic disc neovascularization detected by FFA, OCTA detected 7 eyes, all located on the optic disc surface. Four of the eyes were located in the optic cup, linear and branching, with an area of less than 1/4 optic disc. In 50 eyes, the positive number of screening retinal neovascularization using FFA was 50 eyes, the positive number of OCTA was 43 eyes. In 43 eyes with detected by OCTA, retinal neovascularization buds were detected in 3 eyes, but not in FFA. The retinal neovascularization not detected by OCTA was located in the mid-peripheral part of the retina, which is beyond the inspection range of multi-directional OCTA.Conclusion:The positive rate of optic disc neovascularization and retinal neovascularization in stage Ⅳ DR by multidirectional OCTA is 100.0% and 86.0%, respectively.

The correlation of neutrophil-lymphocyte ratio and platelet parameters with the prognosis of elderly patients with cerebral hemorrhage / 中华老年医学杂志

Objective:To investigate the correlation of peripheral blood neutrophil-lymphocyte ratio(NLR)and platelet parameters with the prognosis of elderly patients with cerebral hemorrhage.Methods:Clinical data of 80 patients with cerebral hemorrhage admitted to the neurosurgery department of our hospital from January 2017 to July 2019 were retrospectively analyzed.Based on modified Rankin scale scores, they were classified into the good prognosis group(n=49, with modified Rankin scale scores <3 points)and the poor prognosis group(n=31, with modified Rankin scale scores between 3-6 points). General demographic data and results on laboratory indexes including platelet(PLT), platelet distribution width(PDW), mean platelet volume(MPV), absolute lymphocyte count(ALC)and absolute neutrophil count(ANC)were compared between the two groups.Logistic regression analysis was performed to examine the effects of platelet parameters and NLR on the prognosis of elderly patients with cerebral hemorrhage.Results:NLR, PDW and MPV were higher and PLT was lower in the poor prognosis group than in the good prognosis group[(8.89±1.95) vs. (3.13±0.21), (16.75±4.32) % vs.(12.89±2.71) %, (14.82±3.52) % vs. (10.78±1.62) %, (0.37±0.20) % vs.(0.62±0.33) %, t=20.564, 4.918, 6.969 and 4.918, all P<0.001)]. Logistic regression analysis showed that increased levels of NLR, PDW and MPV and decreased levels of PLT were influencing factors for poor prognosis in elderly patients with cerebral hemorrhage( OR=2.759, 2.606, 1.756 and 0.095, all P<0.001). Conclusions:NLR, PDW, MPV and PLT are closely correlated with the prognosis of elderly patients with cerebral hemorrhage and may be used as indexes for prognosis evaluation in these patients.

Literature review on Ershiwuwei-Shanhu pill / 国际中医中药杂志

Objective To identify the scientific research status of Ershiwuwei-Shanhu pill among the literature review. Methods The literature were retrieved from CNKI, Wanfang and VIP databases (from databases built up to 2017), and quantitative analysis was carried out in the fields of time, journals and types of literature published. Results There were 58 literatures, including 33 clinical studies, 9 pharmacological studies, 14 pharmacological studies and 2 reviews. The literature published 39 kinds of journals, among which there were 81.0％ studies published in the journals holding the impact factors more and equal to 0.15 and 7 were core journals. Conclusions The results showed that the Ershiwuwei-Shanhu pill was in the developing period, mainly focused on clinical research, although there are some studies on pharmacology and pharmacy.The study of the ancient Tibetan medicine to the mature period there is still much space for development.

Evaluation of endoscopic radial incision for benign esophageal stenosis in children / 中华消化内镜杂志

Objective To evaluate the efficacy and safety of endoscopic radial incision ( ERI) for treatment of benign esophageal stenosis in children. Methods A retrospective analysis was performed on clinical data of 20 children with benign esophageal stenosis who underwent ERI from January 2013 to May 2018 in Xi′an Children′s Hospital. The procedure, improvement of clinical symptoms, and complications related to the operation were analyzed. Results All 20 patients were successfully treated with ERI, with median operation time of 10 min (5-25 min), and median number of narrow ring incision of 4 times (1-8 times) . No fever, poststernal pain, bleeding or perforation was found in any child after operation. The hospital stay was 4-7 days, with a median of 4. 5 days. The postoperative follow-up was 3-24 months, with an average of 7. 9 months. At one month after operation, the stenosis diameter of 20 cases was enlarged[ 1. 0 cm ( 0. 6-1. 5 cm) VS 0. 3 cm ( 0. 1-0. 5 cm) , t=11. 018, P<0. 001] , and dysphagia score was lower[ 0 ( 0-2) VS 2. 5 (2-4), Z=4. 027, P<0. 001] compared with that before. The median weight of 19 children increased by 2 kg ( 1-4 kg ) three months after operation. There was no significant correlation between improvement of dysphagia after ERI and sex, age, times of preoperative treatment and diameter of stenosis ( all P>0. 05) , but there was a negative correlation between improvement of dysphagia after ERI and the length of stenosis ( r=-0. 514, P=0. 020) . Conclusion ERI is safe and effective for treatment of benign esophageal stenosis in children, which can be recommended in clinic.

Establishment of quality standard for Tibetan medicineRuyi-Zhenbao pill / 国际中医中药杂志

Objective To establish a quality standard for Tibetan medicineRuyi-Zhenbao pill. Methods Thin-layer chromatography (TLC) was applied to identify 12 Tibetan medicinal materials, and High performance liquid chromatography (HPLC) was employed to determine the contents of gallic acid, dehydrodiisoeugenol, piperine, and cinnamaldehyde.Results The identified characteristics of TLC were distinct and the spots were clear. Linearity of gallic acid, dehydrodiisoeugenol, piperine, and cinnamaldehyde were in the range of 0.106-0.901μg, 0.033-0.281μg, 0.007-0.060μg, and 0.021-0.178μg, respectively. Average recovery was in the range of 98.47%-101.65% (RSD<3.0%).Conclusions The method of identification and content determination was good in terms of specificity, accuracy and repeatability, and can be used for quality control ofRuyi-Zhenbaopill.

Analysis on the Characteristics of Urinary Microalbumin/Creatinine Ratio in Central Obesity Hypertension and Its Correlation with Traditional Chinese Medicine Syndromes / 中国中医药信息杂志

Objective To explore the TCM syndrome distribution characteristics of central obesity hypertension patients; To analyze its correlation with urinary microalbumin/creatinine (MA/Cr) ratio; To provide some proof for an efficient way to control central obesity hypertension and prevent and cure its early renal injury with integrated TCM and Western medicine.Methods It was performed in a cross-sectional epidemiological study. The age, gender, height, weight, waist circumference, blood pressure, medical history and symptoms of 359 central obesity hypertension patients were collected in Shanghai. Then according to the four diagnostic methods, TCM syndromes were recorded. The urinary MA/Cr ratio, fasting blood glucose, fasting insulin and hs-CRP levels were detected.Results The urinary MA/Cr detectable rate in Shanghai among central obesity hypertension was 33.4% (120/359), men accounting for 56% and women 44%. Among central obesity hypertension patients, the HOMA-IR and hs-CRP level of urinary albumin group were significantly higher than those of normal group, with statistical significance (P<0.05). Among 359 central obesity hypertension patients, 140 people had phlegm-dampness syndrome, accounting for 39%, the largest part; 108 had liver-yang hyperactivity syndrome, accounting for 30%; 61 had yin-yang deficiency syndrome, accounting for 17%; 50 had yin-deficiency and yang-hyperactivity syndrome, accounting for 14%; the number of four TCM syndromes had statistical difference (P<0.05). Urinary MA/Cr ratio of the patients with phlegm-dampness syndrome was significantly higher than that of other three syndromes (P<0.05).Conclusion The incidence rate of early renal damage with central obesity hypertension patients is high in Shanghai area, and the early stage of renal damage is associated with insulin resistance and inflammatory reaction. Among central obesity hypertension, phlegm-dampness syndrome and liver-yang hyperactivity account for the majority, and patients with phlegm- dampness syndrome are more likely to have early kidney damage.

Discussion on necessity of introduction of qualitative research into clinical research of traditional Chinese medicine / 中西医结合学报

Currently, the model of the research evaluation system of traditional Chinese medicine (TCM) is set up through imitating that of western medicine. The application of quantitative research to TCM does promote the advance of modernization of TCM, which explore the part of TCM that can be measured in quantitative method. However, TCM has a background of profound philosophy and culture. The priority of TCM can not be expressed through quantitative research alone. On the contrary, qualitative research is more suitable to most research area of TCM. In TCM clinical research, the priority of TCM should be fully explored. It is very significant to set up the effectiveness evaluation system of TCM, especially by applying qualitative research to the diagnosis and the evaluation of treatment results and combining quantitative research.