Analysis of correlative factors in peptic ulcer recurrence in the elderly / 中华消化杂志

Objective To analyze the correlative factors of peptic ulcer recurrence in the elderly. Methods From January to December 2009,169 elderly patients (≥ 60 years old)with peptic ulcer delected by edoscopy were enrolled,whose treatment and usage of medication were analyzed.Data of treatment and recurrence in 3-year follow-up were recorded.Mann-Whitney rank sum test and Logistic regression analysis were performed to analyze the correlated factors.Results The potential risk factors associated with recurrence of peptic ulcer in the elderly were screened and analyzed by single factor analysis,and ulcer size, ulcer location, concomitant usage of drugs, smoking and condition of Helicobacterpylori (H .pylori )infection at the end of follow-up were found to be correlated with recurrence of peptic ulcer in the elderly.After adjusting age and gender,the potential risk factors were analyzed by a Logistic stepwise regression model.Smoking (OR = 1 .788,P = 0.001 ),combined medication (OR=6.202,P =0.015 ),ulcer size (OR =2.697,P =0.032 )and condition of H .pylori infection at the end of follow-up (OR=43.784,P =0.007)were found to be correlated with recurrence of peptic ulcer in the elderly.Conclusion Smoking,combined medication,ulcer size and condition of H .pylori infection at the end of follow-up have an impact on peptic ulcer recurrence in the elderly.

Evaluation of life quality in patients with gastric remnant cancer / 中华消化杂志

Objective To investigate the health-related quality of life (HRQoL) and its influencing factors in patients with gastric remnant cancer (GRC).Methods A total of 130 patients received gastrectomy more than 10 years ago because of early gastric cancer.According to the gastric remnant canceration after the surgery,patients were divided into GRC group (80 cases) and gastric remnant group (50 cases).Both the patients of these two groups accepted questionnaires of cancer patients' quality of life questionnaire (QLQ) C30 and gastric cancer specific questionnaire QLQ-STO22,the HRQoL were evaluated.The comparison between two groups with normal distribution of data was aralyzed by t test.Wilcoxon rank sum test was applied for the comparison between two groups with non-normal distribution of data.Optimal scaling regression analysis was used for screening HRQoL related clinical influencing factors.Results All the research objectives finished the questionnaires survey.Compared with health control group,the scores of GRC group were lower,which included quality of life evaluation,physical function,role function,emotional function,cognitive function and social function,and the differences were statistically significant (t =-6.678,-7.111,-10.605,-5.748,-4.765 and-21.170,all P＜0.01).The scores of fatigue,pain,diarrhea,nausea and vomiting,loss of appetite,economic difficulties,dysphagia,abdominal pain,reflux symptoms,diet restricted,anxiety,physical appearance and hair loss were higher,and the differences were significant (t=6.925,4.218,4.728 and Z=-5.236,-7.890,-7.698,-10.058,-3.612,-6.914,-9.711,9.940,-7.987 and-4.966,all P＜0.01).Compared with gastric remnant group,the scores of GRC group were lower,which included quality of life evaluation,physical function,role function,emotional function,cognitive function and social function,and the differences were statistically significant (t=-5.861,-5.821,-7.077,-7.999,-2.808and-5.710,all P＜0.01).However the scores of fatigue,pain,diarrhea,nausea and vomiting,loss of appetite,economic difficulties,dysphagia,diet restricted,anxiety,physical appearance and hair loss were higher,and the differences were significant (t=9.363,6.842 and Z=-2.654,-6.256,-3.266,-4.132,-2.854,-7.996,-4.258 and-2.005,all P＜0.01).Compared with health control group,the score of social function of gastric remnant group was lower and the difference was significant (t =-9.820,P＜ 0.01); the scores of diarrhea,nausea and vomiting,economic difficulties,dysphagia,reflux symptoms,diet restricted,physical appearance and hair loss were higher,the differences were statistical significant (t=3.020 and Z=-1.981,-3.775,-6.505,-6.098,-8.032,-3.369 and-3.147,all P＜0.05) ; the symptom scores of fatigue and pain were lower,the differences were significant (t=-2.890 and-2.439,all P＜0.05).HRQoL of patients was positively correlated with education degree,marital status,family income and the disease course of gastric remnant.Conclusions HRQoL of GRC patients decreased to certain degree.Education degree,marital status,family income and the disease course of gastric remnant were the influential factors of HRQoL in GRC patients.

Exercise pharynx and genioglossus to treat obstructive sleep apnea and hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the method and effect of exercising larynx and genioglossus to treat obstructive sleep apnea hypopnea syndrome (OSAHS).@*METHOD@#Fifty-four patients who were diagnosed as OSAHS and exercised larynx and genioglossus were defined as treatment group. We took Epworth sleep scale, check patient's PSG, and took computer tomography (320CT) before treatment, 6 months and 12 months later. We made a record of AHI, LSaO2, BMI, the shortest sagittal diameter and transverse diameter. Compared with 30 patients who had taken UPPP surgery (control group 1) and the 21 patients without any treatment (control group 2) at the same time. SPSS 10.0 was used to analyze the data.@*RESULT@#According to Chinese OSAHS construction in 2009, 6 months and 12 months later, the effective rates of treatment group were 31.48% and 44.44%, among which the effective rates in mild and moderate patients of treatment group were 44.74% and 63.16%. Before treatment the mark of Epworth sleep scale was 7.67, 6 month and 12 month later the marks were 3.54 and 3.25. AHI were up to 15.45 after 6 months and 13. 60 after 12 months from 22. 84 at the beginning. LSaO2 were up to 81.18% after 6 months and 81.93% after 12 months from 74.05% at the beginning. The effective rate of control group 1 was 66.67%, and was much higher than the treatment group 6 months later (P 0.05). The effective rates of treatment group were much higher than control group 2 (P < 0.01). After 12 months, the sagittal wall compliance of retropalatal area was lower (P < 0.01). There was no significant change of BMI in every group.@*CONCLUSION@#Exercising larynx and genioglossus is one kind of non-invasive and effective method without payment to treat part of OSAHS patients, especially the patients who is old, without surgical condition, and especially mild and moderate OSAHS patient that do not want to take surgery and CPAP treatment. Besides, exercising larynx and genioglossus can be considered as remedial treatment of OSAHS to surgery and other therapy.

Studv on the role of renin angiotensin system in pathogenesis of nonalcoholic fatty liver disease / 中华消化杂志

Objective To investigate the role of renin angiotensin system (RAS) in pathogenesis of nonalcoholic fatty liver disease (NAFLD).Methods Twenty-four Wistar rats were evenly divided into control group and model group.The rats of control group were fed with normal diet,and model group were with high-fat diet.Rats were killed at the eighth week and serum liver function,blood lipid,glucose and insulin were tested.The liver tissues were stained with HE and Picro acid-Sirius red for pathological observation.The liver tissue concentration of angiotensin Ⅱ was determined by ELISA method and the expression of TGF-β1 in liver tissue was examined by immunohistochemistry.Results After eight weeks high fat feeding,weight,liver index,liver function,blood lipids and serum insulin of model group were significantly higher than those of control group (weight:(463.50±22.72) g vs.(404.29±10.32) g; liver index:(3.75±0.21) g vs.(2.66±0.15) g; ALT:(79.8±8.6) U/L vs.(58.8±11.6) U/L; AST:(200.01±51.72) U/L vs.(150.30±37.27) U/L; total cholesterol:(3.67±0.48) mmol/L vs.(1.50±0.23) mmol/L; triglycerides:(2.06±0.40) mmol/L vs.(0.71±0.34) mmol/L; insulin:(17.37±2.89) pmol/L vs.(11.08±2.12) pmol/L),and all the differences were statistically significant (P＜0.01).The histopathological results of model group indicated liver steatosis,inflammatory reaction in part of lobule and portal area and significant fibrosis in part of liver tissue.The liver tissue angiotonin Ⅱ concentration of model group [(32.80 ± 2.81)pg/ml] was higher than that of control group [(22.83 ± 1.75) pg/ml,t =9.559,P＜0.01].The immunohistochemistry results showed that the expression of TGF-β1 of model group was obviously higher than that of control group (Z=-2.540,P =0.011 ).Spearman correlation analysis revealed that the increasing degree of angiotensin Ⅱ concentration was positively correlated with liver steatosis scores (r=0.644,P=0.002) and the expression of TGF-β1 (r=0.470,P=0.037).Conclusion The concentration of angiotensin Ⅱ and TGF-β1 increased in the livers of model rats,which indicated that RAS may participate in the pathogenesis and progress of NAFLD.

Applying value of 13C-urea breath test in the diagnosis of Helicobacter pylori infection in gastric remnant / 中华消化杂志

Objective To investigate the diagnostic accuracy of 13C urea breath test (13C-UBT)in the diagnosis of Helicobacter pylori (Hp) infection in patients with gastric remnant.Methods A total of 94 gastric remnant patients (gastric remnant group) and 100 non-gastric remnant patients (control group) received 13C-UBT.According to the course of the disease,the gastric remnant group were divided into group 1 (29 cases,≤5 years),group 2 (33 cases,6 to 10 years) and group 3 (32cases,＞10 years).Before surgery,the diagnosis of Hp infection was according to 13C-UBT and gastric mucosa tissue staining.After surgery,the diagnosis was according to gastric mucosa tissue staining.The applying value of 13C-UBT in gastric remnant patients was evaluated.The consistency of results between 13C-UBT and gastric mucosa tissue staining were evaluated by the Kappa test.Results In gastric remnant group,the Hp infection rate after surgery (37.2％) was obviously lower than that before operation (79.8％;x2 =35.058,P＜0.01) and that of control group (77.0％).After surgery,the Hp infection rate of patients with Billroth Ⅱ gastrectomy (24.4％) was lower than that of patients with Billroth Ⅰ gastrectomy (47.2％ ; x2 =5.133,P=0.023).Before surgery,the Hp infection rate of gastric remnant subgroups were similar (P＞0.05).With the extension of the postoperative course,the Hp infection rate gradually decreased in gastric remnant subgroups (group 1:58.6％,group 2:36.4％,group 3:18.8％; x2=7.839,P=0.021).Setting the cut-off point at 2.0‰ in the gastric remnant group and 3.5‰ in the control group,the accuracy rate of diagnosis was the highest (92.6％ and 96.0％).There was good consistency between the results of 13C-UBT and gastric mucosa tissue staining (Kappa =0.84,P＜0.01).Conclusion With suitable operation and standard,13C-UBT may be a easy,safe and effective assay applied in the gastric remnant patients.