Significance of esophagogastric junction outflow obstruction in gastroesophageal reflux disease / 中华消化杂志

Objective:To explore features and clinical significance of motility characteristics, related clinical symptoms, 24-hour esophageal impedance-pH monitoring in patients with gastroesophageal reflux disease (GERD) complicated with esophagogastric junction outflow obstruction (EGJOO).Methods:From August 2014 to August 2019, a total of 512 GERD patients visited Zhuhai People′s Hospital were enrolled. All patients were divided into EGJOO group (85 cases) and non-EGJOO group (427 cases) according to the presence or absence of EGJOO. The patients were also divided into non-erosive reflux disease (NERD) group (393 cases) and reflux esophagitis (RE) group (119 cases) based on the endoscopic findings. The esophageal high resolution manometry (HRM) motility characterisrics, clinical symptoms, results of 24-hour esophageal impedance-pH monitoring of each group were analyzed. Fisher exact probability method, Wilcoxon rank sum test for comparison among groups and McNemar test for comparison of paired data were used for statistical analysis.Results:The lower esophageal sphincter (LES) resting pressure, integrated relaxation pressure (IRP), distal contractile integral (DCI), intrabolus pressure (IBP) and maximum IBP of EGJOO group were all higher than those of non-EGJOO group (30.70 mmHg, 22.50 mmHg to 40.75 mmHg (1 mmHg=0.133 kPa) vs. 19.90 mmHg, 14.50 mmHg to 26.20 mmHg; 17.80 mmHg, 16.20 mmHg to 22.85 mmHg vs. 7.80 mmHg, 5.20 mmHg to 10.20 mmHg; 1 282.80 mmHg·s·cm, 654.55 mmHg·s·cm to 2 563.20 mmHg·s·cm vs. 818.90 mmHg·s·cm, 495.10 mmHg·s·cm to 1 365.10 mmHg·s·cm; 7.00 mmHg, 4.40 mmHg to 11.65 mmHg vs. 3.60 mmHg, 1.10 mmHg to 5.80 mmHg; 14.90 mmHg, 11.50 mmHg to 18.80 mmHg vs. 10.40 mmHg, 8.10 mmHg to 13.10 mmHg, respectively), and the differences were statistically significant ( Z=-7.82, -14.57, -4.25, -7.16, and -6.27, all P<0.01). The LES resting pressure of NRED group was higher than that of RE group (21.70 mmHg, 15.65 mmHg to 29.40 mmHg vs. 19.40 mmHg, 13.60 mmHg to 25.10 mmHg), and the difference was statistically significant ( Z=-2.47, P=0.014). The DeMeeste score, episodes of long time (more than five minutes) acid reflux, the longest duration of reflux and the percentage of time pH<4 of EGJOO group were all higher than those of non-EGJOO group (6.60 points, 2.70 points to 11.20 points vs. 3.25 points, 1.30 points to 9.18 points; 1.00 times, 0.00 times to 1.00 times vs. 0.00 times, 0.00 times to 0.00 times; 6.50 s, 2.00 s to 15.00 s vs. 1.00 s, 0.00 s to 5.00 s; 1.70%, 0.30% to 2.30% vs. 0.30%, 0.00% to 1.63%, respectively), and the differences were statistically significant ( Z=-2.04, -2.94, -3.98 and -2.42, all P<0.05). Before treatment, the percentage of dysphagia of EGJOO group was higher than that of non-EGJOO group (9.4%, 8/85 vs. 2.1%, 9/427), and the difference was statistically significant (Fisher exact test, P=0.01). The percentage of heartburn, belching, abdominal pain, abdominal distention and chest pain of EGJOO group and non-EGJOO group after treatment were all significantly lower than those before treatment (EGJOO group: 11.8%, 10/85 vs. 34.1%, 29/85; 34.1%, 29/85 vs. 51.8%, 44/85; 4.7%, 4/85 vs. 20.0%, 17/85; 3.5%, 3/85 vs. 22.4%, 19/85; 4.7%, 4/85 vs. 21.2%, 18/85. Non-EGJOO group: 14.8%, 63/427 vs. 33.0%, 141/427; 36.8%, 157/427 vs. 51.5%, 220/427; 5.4%, 23/427 vs. 26.5%, 113/427; 6.6%, 28/427 vs. 21.1%, 90/427; 2.8%, 12/427 vs. 18.3%, 78/427), and the differences were statistically significant (all McNemar test, all P<0.05). Conclusions:In EGJOO patients with LES dysfunction, the symptoms are more severe, acid reflux is more obvious, and the efficacy of conventional prokinetic therapy is poor. The occurrence of esophageal erosion is not only due to acid reflux and acid exposure time, but also to esophageal motility disorder and local mucosal barrier function.

Research advance in gastric neuroendocrine tumors / 中南大学学报(医学版)

Gastric neuroendocrine tumors are rarely seen in the gastric tumors, because there are few case reports and the clinical diagnosis rate is low. There is no consensus treatment method in the world. However, with the benefit of esophagogastrodenoscopy and widespread use of proton pump inhibitors, the diagnostic rate of gastric neuroendocrine tumors is on the increase, which gives us an updated understanding for the pathogenesis and pathophysiology of the disease. By studying its pathogenesis, scholars have found that hypergastrinemia caused by various causes is closely related to its occurrence. Gastric neuroendocrine tumors are classified into different types or pathological grades depending on the state of progression of the disease and the unique clinical manifestations. Clinically used diagnostic methods include gastroscopy, medical imageology, nuclear medicine, gastrin, CgA, etc. There are also differences in treatments depending on the clinical classification. If the disease progresses rapidly and the grade is high, surgical resection of the lesion plus postoperative adjuvant chemotherapy should be actively performed. Other better treatments are still being explored.

Progress in study on the treatment of gastric cancer with docetaxel / 中南大学学报(医学版)

Gastric cancer is one of the most common malignant gastrointestinal tumors.Docetaxel alone or combination with other drugs can attenuate the progress of disease,prolong the overall response rate and the median overall survival rate in advanced gastric cancer.However,the incidence of toxicities is high.Moreover,there is no uniform standard for dosage and course for docetaxel treatment.Currently,its efficacy is not definite.

Research progress in epidemiology, diagnosis and treatment for pancreatic cancer / 中南大学学报(医学版)

Pancreatic cancer is a highly lethal disease in gastrointestinal malignant tumors.The mortality of pancreatic cancer closely parallels its incidence.Most patients with pancreatic cancer remain asymptomatic until the disease reaches an advanced stage.There is no program for screening patients at high risk of pancreatic cancer.Although CT,MRI,positron emission tomography,endoscopic ultrasonography,and endoscopic ultrasonography-guided fine-needle aspiration offer high diagnostic ability for pancreatic cancer,it cannot be found at the early stage easily.Surgical resection is regarded as the only potentially curative treatment and adjuvant chemotherapy is given after surgery.This article reviews epidemiology,risk factors,diagnosis and treatment for pancreatic cancer by summarizing relevant literature.

A study on the expressions of IL-17A and IL-17RA in different degrees of malignant glioma / 天津医药

Objective To explore the expressions of interleukin (IL)-17A and its receptor IL-17RA in different degrees of malignant gliomas. Methods Fifty patients with glioma were collected in this study. Accordance to the World Health Organization Classification System, patients were classified by malignancy grade, including gradeⅠ(n=12), gradeⅡ(n=18), gradeⅢ(n=13) and gradeⅣ(n=7). The glioma tissue and peripheral blood samples of patients were obtained for detecting the expression levels of IL-17A and IL-17RA mRNA by using immunohistochemistry, quantitative real-time PCR. Western blot assay was used to detect expressions of IL- 17A and IL- 17RA in both the macroscopic (immunohistochemistry) and molecular levels (mRNA and protein). Results Immunohistochemical staining showed that the expression levels of IL-17A and its receptor IL-17RA increased with the increase of the malignant degree of gliomas. The mRNA levels of IL-17A and IL-17RA receptors in peripheral blood were up-regulated with the increasing malignancy grade of glioma (F=8.96, P<0.05;F=10.34, P<0.05). The mRNA levels of IL-17A and IL-17RA in glioma tissues were up-regulated with the increasing malignancy grade of glioma (F=11.21, P<0.05;F=14.11, P<0.05). The protein levels of IL-17A and IL-17RA in peripheral blood and glioma tissues were also up-regulated with the increasing malignancy grade of glioma (in peripheral blood:F=9.90, P<0.05;F=11.80, P<0.05;and in gliomas tissues:F=8.15, P<0.05;F=14.46, P<0.05). Conclusion The expressions of IL-17A and IL-17RA receptor are positively correlated with malignancy grade of glioma. These results provide some reference for clinical diagnosis of malignant gliomas.

Analyses of the characteristics of esophageal motility in patients with pharyngeal paraesthesia who visit the Department of gastroenterology / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the influence of the local sensory abnormality in throat while the change of motility in the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), as well as the change of esophageal body in pharyngeal paraesthesia.</p><p><b>METHODS</b>From January 2014 to January 2015 there were sixty-four patients who had pharyngeal susceptible syndrome (PSS) but without confirmed organic disease were enrolled as the PSS group, forty healthy volunteers as the control group. High resolution manometry (HRM) was utilized to distinguish esophageal motility patterns of PSS, including the muscular tension of LES and UES, the integrity, adaptability, amplitude, speed and duration of esophageal peristalsis at 10 swallows.</p><p><b>RESULTS</b>The resting LES and UES pressures and the distal contractile integral (DCI) of esophagus in PSS group were lower than that in control group (P < 0.05). The esophageal peristalsis was decelerated and shortened in duration, and amplitude of contraction notably lower in PSS group compared with its counterpart (P < 0.05). The integrity of esophageal peristalsis was impaired in PSS with remarkable changes in motility patterns, involving ratio of major and minor interrupts, and synchronous contraction rate (P < 0.05). As for the time course from relaxation to the lowest pressure point of UES and time for restoration, no definite difference was noticed between the two groups (P > 0.05). The average peak pressure was similar in two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Muscle tension around the UES has no obvious change when pharyngeal paraesthesia occurred, but the reduction of esophageal motor function, clearance ability, anti-reflux gastroesophageal junction, causing the abnormal reflux which hurt the pharyngeal surface mucosa maybe one of the most important reasons leading to pharyngeal paresthesia.</p>

Advances in Study on Eosinophilic Esophagitis / 胃肠病学

Eosinophilic esophagitis(EoE)is a chronic autoimmune inflammatory disease characterized by accumulation of eosinophils in all layers of esophagus and lacking typical clinical manifestations. The pathogenesis has not yet been clarified. Diagnosis is mainly by combined judgment,including clinical manifestation,endoscopy and histopathology. Treatment includes food,drug and surgical therapy. This article reviewed the advances in study on EoE.

Dynamic lumbar pedicle fixation in repair of lumbar degenerative disease:K-Rod elastic rod, universal elastic rod and Dynesys system / 中国组织工程研究

BACKGROUND:Discectomy and pedicle fixation fusion are golden standard to repair lumbar degenerative disease, but the treatment would induce other complications such as degeneration of adjacent segments or severer pre-existing spinal degeneration. For the problem of lumbar fusion and fixation, lumbar elastic fixation has recently been a hot focus. ＜br> OBJECTIVE:To evaluate the short-term effectiveness of dynamic lumbar pedicle fixation in repair of lumbar spinal stenosis and lumbar disc herniation. ＜br> METHODS:From December 2010 to December 2012, 62 cases of lumbar spinal stenosis and lumbar disc herniation treated with lumbar dynamic system were included. The involved segments included:5 cases at L 3/4 , 20 cases at L 4/5 , 20 cases at L 5 S 1 , 6 cases at double segment L 3/4 and L 4/5, 8 cases at double segment L 4/5 , L 5 S 1 , 3 cases at L 3/4 and L 5 S 1 . There were 34 males and 28 females with an average age of 50.8 years (range 32 to 72 years). According to different fixation systems, they were assigned to three groups:general dynamic lumbar fixation system in 17 cases, K-Rod posterior dynamic stabilization system in 28 cases, and Dynesys system in 17 cases. The fol ow-up time was from 24 to 48 months. Evaluation indexes included visual analogue scale, Oswestry disability index, imaging analysis and excellent and good rate of curative effects. ＜br> RESULTS AND CONCLUSION:Compared with before treatment, visual analogue scale score and Oswestry disability index were significantly improved at 6 months after treatment and final fol ow-up (P＜0.01). No apparent changes were detected in the length of inserted segments and adjacent segments before treatment and during final fol ow-up. There were no significant differences in the excellent and good rate in each group after treatment (P>0.05). These data indicated that the lumbar dynamic system was an effective option for lumbar disc herniation and spinal stenosis. Although there are some differences in the structure of three kinds of flexible fixation, no obvious difference in early therapeutic effects was detected. Long-term effects deserve further investigations.

Investigation of public awareness of stroke in Yangquan residents / 中华全科医师杂志

Objective We conducted a survey on the awareness rate of stroke in Yangquan residents and analyzed factors affecting awareness to provide basic information for Yangquan residents to prevent and treat stroke in Shanxi.MethodsA questionnaire regarding awareness and basic knowledge of stroke was used in this study and applied to Yangquan residents.A cluster stratified sample of 7983 residents were questionnaired by cross-sectional method.Results7921 returned copies were valid.The awareness rate of stroke in 7921 selected Yangquan residents was 30.14％ (2387/7921). Upon the occurrence of stroke,the awareness rates of the way to see a doctor,the right department to look for medical care and test manners to diagnose the illness as stroke were relatively high in these investigated people,which were 74.03％ (5864/7921),78.17％ (6192/7921) and 84.04％ (6657/7921),respectively.However,the number of people who knew characteristic symptoms and complications of stoke,risk factors that cause stroke and how to treat stroke was 2021 (25.51％),841 ( 10.62％ ),and 902 ( 11.39％ ),respectively,which was relatively low. After multivariate analysis,the awareness rate of stroke in Yangquan residents was positively correlated with an education degree.ConclusionsYangquan residents know little about stroke.Therefore,it is necessary to increase the level of their knowledge regarding stroke by extended propaganda and encourage them to live a healthy life to be able to treat stoke in time and to reduce the possibility of stroke occurring.

Analysis on Incidence and Related Factors of Anemia in Cancer Patients Caused by 7 Kinds of Chemotherapy Regimes / 中国药房

OBJECTIVE:To study the situation of anemia in newly diagnosed ovarian cancer and breast cancer patients treated with 7 kinds of chemotherapy regimes. METHODS:110 cases of newly diagnosed ovarian cancer and breast cancer from May 2008 to Feb. 2009 in People’s Hospital of Peking University were analyzed retrospectively. The level of hemoglobin in patients treated with different chemotherapy regimes were evaluated and analyzed with SPSS software. RESULTS:Of total 110 patients, class Ⅰ anemia occurred 194 times and class Ⅱ anemia occurred 55 times. High incidence of anemia appeared in chemotherapy regimes with platinum as base. Low incidence of anemia occurred in TA chemotherapy regime. The older patient is,the more easily anemia occurred. CONCLUSION:The incidence of anemia after chemotherapy is related to type of cancer,chemotherapy regime, chemotherapy cycle and patient’s age.