Value of biliopancreatic-duct-imaging-system-assisted endoscopic retrograde appendicitis therapy for children with acute appendicitis (with video) / 中华消化内镜杂志

Objective:To investigate the diagnostic and therapeutic value of one-time biliopancreatic-duct-imaging-system (eyeMax)-assisted endoscopic retrograde appendicitis therapy (ERAT) for children.Methods:A total of 11 children who were diagnosed as having uncomplicated acute appendicitis by imaging in Xi′an Children′s Hospital from August to November 2022 were enrolled. All patients received subscope-assisted ERAT. Subscope was intubated into the appendix cavity to observe the mucosa directly. Appendicitis was treated through cleansing, fecalith extraction, stent drainage. The clinical manifestations under subscope were recorded, as well as the treatment success rate, intubation success rate, the effective rate, complication incidence during and after the operation.Results:The age of 11 children was 7.93±2.67 years old. Appendix intubation was successful in all patients. Congestion and swelling of the mucosa in appendiceal orifice and appendix cavity were seen under the subscope in 11 children. There were 6 cases with appendiceal fecaliths, 8 cases with pus and 6 cases with luminal distortion or stenosis. Perforation was observed in 1 case during the operation and no other complication occurred. All patients were treated under subscope, including flushing appendiceal cavity (11 cases), fecalith extraction with extraction basket (3 cases), and appendiceal drainage with stenting (2 cases). The symptoms and signs were relieved after the operation, and the effective rate within 48 hours was 10/11. There were no procedure-related complications or recurrence during postoperative follow-up for 1 week to 4 months.Conclusion:Acute appendicitis could be diagnosed by observing the appendix cavity directly under one-time biliopancreatic-duct-imaging-system-assisted ERAT, and also could be treated with the system, where appendix could be preserved and radiation damage could be avoided with safety and effectiveness.

The influence of serum triggering receptor expressed on myeloid cells 1 level on prognosis in elderly patients with sepsis and acute respiratory distress syndrome / 中华老年医学杂志

Objective:To study the influence of serum triggering receptor expressed on myeloid cells 1(TREM-1)level on prognosis in elderly patients with sepsis and acute respiratory distress syndrome(ARDS).Methods:A total of 100 elderly patients with sepsis were selected as the research objects.All the patients with sepsis were divided into sepsis ARDS group and sepsis non-ARDS group.General data and TREM-1 level were compared between the two groups.The patients with sepsis ARDS were divided into death group and survival group according to the survival status during the 28-day follow-up.TREM-1 level, acute physiology and chronic health evaluation(APACHE)Ⅱ score and SOFA score were compared between the two groups.The correlation between serum TREM-1 level and procalcitonin(PCT), APACHE Ⅱ score and SOFA score was analyzed.The survival rate of high TREM-1 level group and low TREM-1 level group was compared.Results:The age, white blood cell(WBC), PCT, APACHE Ⅱ score, SOFA score and TREM-1 level of sepsis ARDS patients were significantly higher than those of non-ARDS patients( t=2.722, 6.088, 11.55, 6.889, 4.661, 6.122, all P<0.05). The incidence of sepsis ARDS patients with chronic obstructive pulmonary disease was significantly higher than that of non-ARDS patients( χ2=7.895, P<0.05). Serum TREM-1 level, APACHE Ⅱ score and SOFA score of ARDS patients in death group were significantly higher than those in survival group( t=3.293, 6.173, 4.255, all P<0.05). Serum TREM-1 level was positively correlated with PCT, APACHE Ⅱ score and SOFA score( t=0.553, 0.602, 0.636, P<0.001). The Kaplan-Meier survival curve showed that the survival rate of high TREM-1 level group was significantly lower than that of low TREM-1 level group( χ2=3.999, P=0.036). Cox regression analysis showed that TREM-1 level was a risk factor for the prognosis of ARDS patients with sepsis( HR=1.893, 95% CI: 1.049-3.414). Conclusions:Serum TREM-1 level is significantly increased in elderly patients with sepsis ARDS, which is closely related to the prognosis and can be used as a potential prognostic biomarker.

Clinical value of capsule endoscopy for intestinal diseases in children / 中华消化内镜杂志

Objective:To evaluate the safety and effectiveness of capsule endoscopy for the diagnosis of intestinal diseases in children.Methods:Clinical data of 113 pediatric patients who received capsule endoscopy in Xi'an Children's Hospital from October 2018 to September 2020 were retrospectively analyzed. The completion rate, passage time of stomach and small intestine, lesion detection rate, adverse reactions and complications of capsule endoscopy were analyzed.Results:Among 113 pediatric patients, 78 (69.03%) were male and 35 (30.97%) were female. The age was (99.8±44.7) months (9-195 months), and 31 (27.43%) were under 7 years old. The minimum weight was 9 kg and the minimum height was 70 cm. Eighty-seven pediatric patients (76.99%) swallowed capsules orally (the oral group) with the minimum age of 4 years and 3 months. Capsules were implanted in 26 pediatric patients (23.01%) under gastroscopy (the gastroscopic group), with the maximum age of 9 years and 2 months. Unexplained abdominal pain (47.79%) and unexplained gastrointestinal bleeding (31.89%) were common in the pediatric patients. The completion rate of capsule endoscopy was 97.35% (110/113), and the detection rate of lesions in small intestine was 31.81% (35/110). The passage time of small intestine in the gastroscopic group was significantly longer than that of the oral group (461.04±129.27 min VS 288.23±107.84 min, t=5.646, P<0.01). There was no significant difference in the passage time of stomach or small intestine among different genders, different ages or different endoscopic examination results ( P>0.05). The positive results of capsule were not correlated with the method of ingestion ( P=0.401, OR=2.562, 95% CI:0.284-23.077), gender ( P=0.154, OR=2.352, 95% CI:0.726-7.616), age ( P=0.949, OR=1.007, 95% CI:0.816-1.242), examination reason ( P=0.246) or small intestine passage time ( P=0.219, OR=1.003, 95% CI:0.998-1.008). No complications such as capsule retention occurred in any pediatric patient. Conclusion:Capsule endoscopy in children is noninvasive, rapid and simple, which can improve the diagnostic rate of small intestinal diseases in children, and can be further promoted in pediatric patients.

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.

Body composition and sarcopenia in patients with stable chronic obstructive pulmonary disease (COPD) and its influencing factors / 中华全科医师杂志

Objective:To investigate the body composition and sarcopenia in patients with stable chronic obstructive pulmonary disease (COPD) and to analyze the influencing factors.Methods:A total of 220 patients with stable COPD were enrolled in the study from China-Japan Friendship Hospital during July 2018 to December 2019; 220 age and sex-matched healthy subjects (control group 1) and 220 healthy young adults aged 20-40 years (control group 2) were enrolled from the community. The body composition was measured by bioelectrical impedance method. The demographic characteristics, disease conditions, living background and other related factors were collected by questionnaire. T test or one-way ANOVA were used for comparison between groups, and non parametric test was used for non normal distribution data.Results:Compared with the control group 1 and control group 2, the body fat rate ( Z=-10.037, t=-8.411), the fat free mass index ( Z=-8.165, t=-7.856), and appendicular skeletal muscle index (ASMI) ( t=-7.158, t=-11.989) were significantly lower in stable COPD patients ( P<0.05). Among 220 patients with stable COPD, 51 (23.2%) were diagnosed as sarcopenia; the prevalence of sarcopenia was 18.3% (24/131) in men and 30.3% (27/89) in women (χ2=4.297, P=0.038). The decreased ASMI and grip strength in COPD patients with sarcopenia were significantly associated with age≥75 (χ2= 15.746, F= 14.048), female sex ( Z=5.805, t=2.672), low income ( Z=-4.291, t=-4.789), Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade Ⅳ (χ2=22.644, F=3.905), Modified British Medical Research Council (mMRC) Dyspnea Scale grade 4 (χ2=12.475, F=4.369), not receiving systematic health education ( Z=-4.239, Z=-2.474), no exercise (χ2=14.786, F=3.402), insufficient nutrition intake (χ2=40.531, F=10.529). The range of 6-min walking distance was (110-268) m, that was even shorter for patients with mMRC dyspnea scale grade 4 ( F=3.468, P<0.05). Conclusion:The impairment of body composition is common in COPD patients, which will further affect the body function. It is suggested that the routine evaluation of COPD should include the measurement of body composition.

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.

Hospital diagnosis and surgery master data management practice / 中华医院管理杂志

Facing the problems of inconsistent standards and lack of standardized management procedures in the management of hospital diagnosis and surgical operation master data, the hospital redefined the metadata and data model by analyzing the data characteristics and the requirements of different application scenarios, cleaned and transformed the existing data to form a standardized unified standard for distribution, and established a complete data lifecycle management process.Finally, the consistency, integrity and controllability of diagnosis and operation data in each system could be realized, and the management level of diagnosis and operation master data could be effectively improved.

Choroidal thickness in severe congenital ptosis with amblyopia / 中华实验眼科杂志

Objective:To measure the choroidal thickness (CT) in the macular area of patients with amblyopia in severe congenital ptosis and to compare the thickness with that of severe congenital ptosis without amblyopia.Methods:A cross-sectional study was performed.Total of 83 eyes of 60 severe congenital ptosis patients were enrolled from January to October in the year 2019 in the Shanxi Eye Hospital, including 29 patients 37 eyes with amblyopia and 36 patients 46 eyes without amblyopia.Thirty-seven eyes of 37 normal people were included in the control group.All subjects underwent mydriatic optometry and the spherical equivalent (SE) was calculated.IOL-Master was used to measure the axial length (AL), and EDI-OCT was used to measure the CT in the macular area.The CT was measured at 13 points: directly beneath the fovea (SFCT) and at 1 mm, 2 mm and 3 mm intervals to the nasal, temporal, superior and inferior to the fovea.The points of CT measurements were named according to their positions and distances relative to the fovea, and represented by SFCT, N1, N2, N3, T1, T2, T3, S1, S2, S3, I1, I2, I3 respectively.The SE, absolute astigmatism degree, AL and CT at each point were compared among the groups.The corrected AL covariance analysis was used to compare the CT at different measurement points among the groups.Spearman rank correlation analysis was used to evaluate the correlation between CT and AL or SE, and unitary linear regression analysis was used to evaluate the influence of age on AL in each group.This study was approved by the Ethics Committee of Shanxi Eye Hospital.All the subjects signed informed consent.Results:Compared with the non-amblyopia group and control group, the SE and absolute astigmatism value was larger, and the AL was shorter in the amblyopia group (all at P<0.05). The mean SFCT was (388.85±54.85), (301.48±56.68), and (287.08±61.88)μm in the amblyopia group, non-amblyopia group, and control group, respectively.Except for I3, the CT values of the rest parts in the amblyopia group were greater than those in the non-amblyopia group and the control group (all at P<0.05). Except for S3 and I3, the CT values of the rest parts in the amblyopia group were greater than those in the non-amblyopia group and the control group after adjusting the AL ( P<0.05). In all the three groups, the CT value was high in the subfovea and was thin in the nasal side.The SFCT was negatively correlated with AL (amblyopia group: rs=-0.340, P=0.045; non-amblyopia group: rs=-0.340, P=0.020; control group: rs=-0.463, P<0.001) and positively correlated with SE (amblyopia group: rs=0.350, P=0.039; non-amblyopia group: rs=0.412, P=0.004; control group: rs=0.450, P=0.005) in each group.Age was the influencing factor of AL in the non-amblyopia group and the control group ( β=0.243, 0.225; both at P<0.001). Conclusions:In comparison with severe congenital ptosis without amblyopia, the SE and absolute astigmatism degree are larger, the AL is shorter, and the CT values at most areas are higher in the severe congenital ptosis with amblyopia.CT value may be associated with the development of amblyopia in severe congenital ptosis.

Exploration on the Construction of Intensive Care Clinical Information Management System / 中国医疗器械杂志

OBJECTIVE@#This study introduces the feasibility study experience of intensive care clinical information management system in order to provide reference for the construction of intensive care clinical information management system in other hospitals.@*METHODS@#Four kinds of mainstream intensive care clinical information management system software were used to evaluate the implementation effect of each software such as equipment integration, information integration and application function module, so as to explore the construction scheme of intensive care clinical information management system.@*RESULTS@#The optimized construction scheme and comprehensive feasibility study report of intensive care clinical information management system were formed, which provided an objective basis for the final scheme design, demonstration, procurement and decision-making of the hospital.@*CONCLUSIONS@#The trial and feasibility study of intensive care clinical information management system contribute to optimize the construction scheme.

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.

Autophagy plays a role in genistein inhibiting proliferation of cervical cancer cells / 医学研究生学报

Objective For Genistein has been reported to inhibit many tumors ,we investigate the role of autophagy in the proliferation inhibition to Hela cells by Genistein and the machanism of autophagy plays in this process.Methods Human cervical cancer Hela cells were divided into control group,Genistein group and 3-MA+Genistein group,the control group were cultured in RPMI 1640 medium supplemented with 10% fetal bovine serum(FBS),Genistein group were cultured in various concentrations Genistein(25,50,100μmol/L),3-MA+Genistein group were treated with 5mmol/L 3-MA for 1h before cultured in 100μmol/L Genistein.The proliferation inhibitory rate of Hela cells was detected by MTT method.The ultrastructure changes of Hela cells was observed under transmission electronic microscope(TEM).The levels of autophagy-associated protein P62 and Beclin-1 were detected by Western blotting analysis.The expressions of autophagy-associated proteins LC3A/B in Hela cells were determined by fluorescent staining to analyse the autophagy induced by Genistein in Hela cells.Results Compared with control group ,the proliferation inhibitory rate of Hela cells was 20.9%±1.3%,33.5%±1.6% and 46.5%±3.2% when cultured in 25,50,100μmol/L Genistein(P<0.01).After treated with various concentrations Genistein for 48h, we observed a dose-dependent increase in the expression of Beclin-1 and decrease of P62.Confocal laser scanning microscopy confirmed the fluorescent density of LC3A/B expression in Hela cells treated with 100μmol/L Genistein increased significantly as compared with control group.TEM showed there are many vacuoles and double-membrane autophagosomes which involved cytoplasmic components in Hela cells treated with 100μmol/L Genistein.The proliferation inhibitory rate of Hela cells of Genistein group is decreased as compared with those in 3-MA+Genistein group[(46.5±3.2)% vs (58.2±2.2)%,P<0.01].Conclusion Genistein could inhibit Hela cells proliferation and induce autophagy.

Influencing factors for complications of esophageal foreign bodies in children / 中华消化内镜杂志

Objective To investigate the influencing factors related to the complications of esophageal foreign body in children. Methods Data of 150 children with esophageal foreign bodies admitted to Xi'an Children' s Hospital from January 2012 to June 2015 were included in the retrospective analysis. Related clinical variables ( gender, age, location, time, size, sharpness, quality, and severity of complications) were statistically analyzed. Results Spearman correlation analysis showed that the age of children was negatively correlated with esophageal foreign body complications (r=-0. 187, P=0. 022), incarceration time ( r=0. 456, P<0. 001) , sharpness ( r=0. 384, P<0. 001) and quality ( r=0. 234, P=0. 004) was positively correlated with the incidence of complications. Non?conditional Logistic regression analysis for polytomous ordinal response showed that incarceration longer than 8 h yielded complication risks 9. 507 times as much as that less than 8 h ( 95%CI:2. 982?30. 309) . Obtuse or sharp foreign body yielded risk 142. 751 times as smooth foreign body did (95%CI:13. 736?1483. 562). Conclusion Incidence and severity of complications of esophageal foreign body in children are closely related to the age of the children, incarceration time and the degree of sharpness. For patients of less than 1 year old, incarceration for more than 8 hours, with an obtuse or sharp foreign body, early diagnosis and treatment is essential.

Long-term effect of peroral endoscopic myotomy on achalasia in pediatric patients / 中华消化内镜杂志

Objective To explore the feasibility, safety and the efficacy of peroral endoscopic myotomy (POEM) for pediatric patients with achalasia.Methods A total of 21 patients (mean age 2 years, range 11 months-7 years) with AC were enrolled and underwent POEM from January 2012 to December 2014.Procedure-related complications, reflux esophagitis were observed.Eckardt score and the pressure of the lower esophageal sphincter (LES) were analysed.Results All patients underwent POEM successfully.No serious POEM-related complications were observed.During a mean follow-up period of 20.4 months (range 9-36 months), mean Eckardt score decreased from 8.1 to 0.8 after treatment (P ＜ 0.01).Mean LES treatment also decreased from 30.2 mmHg to 11.5 mmHg after the operation (1 mmHg =0.133 kPa, P ＜ 0.01).Reflux esophagitis developed in four patients (19.0％ ,4/21).Conclusion POEM is safe and effective treatment for pediatric patients with achalasia.

Roles of NF-κB signaling pathway in regulatory network of pancreatic cancer metastasis / 国际外科学杂志

Pancreatic cancer is one of the most malignant tumors with a high mortality rate attributed to its widespread metastasis.A number of cellular signal transduction pathways involved in multiple genes play an important role in regulating this complex metastatic cascade of pancreatic cancer.NF-kappa B is one of the crucial signaling pathways.Studies has indicated that NF-kappa B could modulate a series of biological events relevant to tumor progress by controlling multiple targeted genes expression,such as cell proliferation,anti-apoptosis,angiogenesis,epithelial-mesenchymal transition,inflammation,stress response,etc.Furthermore,it can also up-regulate Hedgehog and MMPs signaling pathways.To help us better understand the potential mechanism and identify more sensitive tumor markers and selective targets,this review will underline the significant roles of NF-kappa B signaling pathway in regulatory network of pancreatic cancer metastasis.