Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis.

BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) constitutes a prevalent emergency within Gastroenterology, encompassing 80%-90% of all gastrointestinal hemorrhage incidents. This condition is distinguished by its abrupt onset, swift progression, and notably elevated mortality rate. AIM: To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis. METHODS: We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023, utilizing our medical record system. Data pertaining to general patient information, etiological factors, disease outcomes, and other relevant variables were meticulously collected and analyzed. RESULTS: Among the 532 patients diagnosed with ANVUGIB, the male-to-female ratio was 2.91:1, with a higher prevalence among males. Notably, 43.6% of patients presented with black stool as their primary complaint, while 27.4% had hematemesis as their initial symptom. Upon admission, 17% of patients exhibited both hematemesis and black stool, while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding. Urgent routine blood examinations at admission revealed that 75.8% of patients had anemia, with 63.4% experiencing moderate to severe anemia, and 1.5% having extremely severe anemia (hemoglobin < 30 g/L). With regard to etiology, 53.2% of patients experienced bleeding without a definitive trigger, 24.2% had a history of using gastric mucosa-irritating medications, 24.2% developed bleeding after alcohol consumption, 2.8% attributed it to improper diet, 1.7% to emotional excitement, and 2.3% to fatigue preceding the bleeding episode. Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals, while bleeding due to alcohol consumption showed the opposite trend. Additionally, diet-related bleeding was more common among the young age group compared to the middle-aged group. Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB (73.3%), followed by gastrointestinal malignancies (10.9%), acute gastric mucous lesions (9.8%), and androgenic upper gastrointestinal bleeding (1.5%) among inpatients with ANVUGIB. Of the 532 patients with gastrointestinal bleeding, 68 underwent endoscopic hemostasis, resulting in an endoscopic treatment rate of 12.8%, with a high immediate hemostasis success rate of 94.1%. CONCLUSION: ANVUGIB patients exhibit diverse characteristics across different age groups, and endoscopic hemostatic treatments have demonstrated remarkable efficacy.

The association between perceived cause of glaucoma and illness perceptions.

Purpose: The perceived cause of disease is an important factor that has been linked with treatment outcomes but has not been fully assessed in primary open-angle glaucoma (POAG). This study assessed the accuracy of patients' perceived cause of POAG and identified associations between accuracy, illness perceptions, medication adherence, and quality of life (QoL). Methods: The Brief Illness Perception Questionnaire (BIPQ) was used to assess illness perceptions and asked patients to rank the three most important causes of their disease in order of importance. POAG risk factors recognized by the American Academy of Ophthalmology were used to code responses as accurate or inaccurate based on the following three methods: (1) coding any reported cause, regardless of rank, (2) coding only the first-ranked cause, and (3) coding and weighting all reported causes. Medication adherence was measured electronically. QoL was measured using the Glaucoma Quality of Life questionnaire. Mann-Whitney U test was used to detect differences in illness perceptions, medication adherence, and QoL between accuracy groups. Results: A total of 97 patients identified a cause of their POAG and were included in this analysis. A higher proportion of patients reported an accurate cause (86.6% using method 1, 78.4% using method 2, and 79.4% using method 3; all p < 0.001). Mean medication adherence was 86.0% ± 17.8 and was similar across accuracy groups (all p > 0.05). Using method 2 (p = 0.045) and method 3 (p = 0.028), patients who reported an accurate cause of their POAG believed that their illness would last for a longer time compared to patients who reported an inaccurate cause. Method 3 also revealed that patients who reported an accurate cause of their POAG had lower perceived understanding of their illness (p = 0.048) compared to patients who reported an inaccurate cause. There were no differences in QoL between accuracy groups (all p > 0.05). Conclusion: This study highlights the association between perceived cause of POAG and illness perceptions related to knowledge level and POAG duration. Future studies should assess associations between perceived cause of disease and other critical dimensions of illness perception.

The etiological diagnosis value of soft bronchoscopy in children with laryngeal stridor / 中国小儿急救医学

Objective:To evaluate the etiological diagnosis value of soft bronchoscopy in children with laryngeal stridor.Methods:The clinical data of 402 children with laryngeal stridor wheezing were retrospectively analyzed, which examined by soft bronchoscopy in Anhui Provincial Children′s Hospital from January 2016 to January 2019.Results:A total of 402 cases of laryngeal stridor were diagnosed by soft bronchoscopy, 317(78.8%) cases were diagnosed as congenital airway dysplasia, including 200(49.7%)cases of congenital laryngeal chondromalacia, which including 132 cases of single laryngeal chondromalacia and 68 cases with other respiratory tract dysplasia, and 117(29.1%) cases of respiratory dysplasia other than laryngeal chondromalacia; 46(11.5%) cases of laryngitis; 28(7.0%) cases of airway acquired stenosis and 11 (2.7%)cases of foreign body.Among 402 cases of children with laryngeal stridor who were diagnosed according to clinical feature, combined with chest X-ray, chest CT, CT angiography and color Doppler echocardiography as well as other imaging data, 335(83.3%) cases were congenital laryngeal chondromalacia, 16(4.0%) cases were other respiratory tract dysplasia (including six cases of subglottic and tracheal stenosis, five cases of laryngeal space occupying lesions, four cases of tracheobronchial malformation, and one case of subglottic hemangioma), 35 (8.7%)cases of laryngitis, acquired airway stenosis in 15 cases including 13 cases of congenital heart disease, one case of pulmonary artery sling, one case of mediastinal cyst, and one case of foreign body.Congenital laryngeal chondromalacia, other causes of respiratory dysplasia and foreign body detected by flexible bronchoscopy were not consistent with clinical examination( P<0.05). Conclusion:Congenital laryngeal chondromalacia is the main cause of laryngeal stridor, but it is often associated with other airway dysplasia.Soft bronchoscopy can provides etiological diagnosis for children with laryngeal stridor wheezing, especially in the diagnosis of respiratory tract dysplasia and airway foreign body.

Magnetic resonance imaging indicator of the causes of optic neuropathy in IgG4-related ophthalmic disease.

BACKGROUND: The following study investigates the involvement of optic neuropathy in IgG4-related ophthalmic diseases (IgG4-ROD) based on the magnetic resonance imaging (MRI) data, and different imaging features of IgG4-ROD related optic neuropathy related to other orbital diseases. METHODS: This retrospective study included 225 patients with IgG4-RD admitted at two ophthalmology centers between January 2014 and December 2017. Twenty-six patients had both pre-therapeutic orbital MRI and optic never injury. The causes of optic neuropathy were analyzed, and the special sign in MRI to diagnose IgG4-ROD was also evaluated. RESULTS: Twelve cases had inflammation of the optic nerve sheath, while 14 cases had compression due to extraocular muscles and pseudo tumor masses. Two cases had hypertrophic cranial pachymeningitis, while one case had hypophysis involving optic chiasma. CONCLUSION: The most common causes of optic nerve injury in IgG-4 ROD are inflammation of optic nerve sheath, compression of extraocular muscles, pseudo tumor mass and hypertrophic cranial pachymeningitis, and hypophysis involving optic chiasma.

Etiology and treatment strategies of anemia in myelodysplastic syndromes / 天津医药

@#Myelodysplastic syndrome (MDS) is a group of highly heterogeneous diseases. Anemia is the most common manifestation of MDS, which is also an important factor affecting the survival and quality of life in MDS patients. Different factors are involved in the pathogenesis of anemia of MDS, and for a particular patient, anemia maybe the results of multiple factors. In current review, we summarized the common reasons for MDS anemia including expansion of abnormal clone, immune regulation dysfunction, abnormal hematopoiesis concerning with 5q-, ineffective hematopoiesis and iron overload. Erythropoietin (EPO), immunosuppressive agent, iron chelators, immunomodulatory, transforming growth factor beta (TGF- β) pathway inhibitor, demethylation drugs and hematopoiesis stem cell transplantation may help to improve the anemia of different causes in MDS patients.

The Population Education Transition Curve: Education Gradients Across Population Exposure to New Health Risks.

The salutary effect of formal education on health-risk behaviors and mortality is extensively documented: ceteris paribus, greater educational attainment leads to healthier lives and longevity. Even though the epidemiological evidence has strongly indicated formal education as a leading "social vaccine," there is intermittent reporting of counter-education gradients for health-risk behavior and associated outcomes for certain populations during specific periods. How can education have both beneficial and harmful effects on health, and under which contexts do particular effects emerge? It is useful to conceptualize the influence of education as a process sensitive to the nature, timing of entry, and uniqueness of a new pleasurable and desirable lifestyle and/or product (such as smoking) with initially unclear health risks for populations. Developed herein is a hypothesis that the education gradient comprises multiple potent pathways (material, psychological, cognitive) by which health-risk behaviors are influenced, and that there can be circumstances under which pathways act in opposite directions or are differentially suppressed and enhanced. We propose the population education transition (PET) curve as a unifying functional form to predict shifting education gradients across the onset and course of a population's exposure to new health risks and their associated consequences. Then, we estimate PET curves for cases with prior epidemiological evidence of heterogeneous education gradients with health-risk behaviors related to mass-produced cigarettes in China and the United States; saturated fats, sugar, and processed food diets in Latin America; and HIV infection in sub-Saharan Africa. Each offers speculation on interactions between environmental factors during population exposure and education pathways to health-risk behaviors that could be responsible for the temporal dynamics of PET curves. Past epidemiological studies reporting either negative or positive education gradients may not represent contradictory findings as much as come from analyses unintentionally limited to just one part of the PET process. Last, the PET curve formulation offers richer nuances about educational pathways, macro-historical population dynamics, and the fundamental cause of disease paradigm.

Comparison of risk of death between older and non-older critical patients in ICU: a retrospective cohort study of consecutive 3 years / 中华危重病急救医学

Objective To investigate the risk of death between older and non-older critical patients in intensive care unit (ICU) in Shuyang People's Hospital.Methods A retrospective cohort study was conducted. The critical patients who aged 15 or above, and admitted to ICU of Shuyang People's Hospital from January 2014 to December 2016 were enrolled, and all the data was collected from theregistration and electronic medical records in the ICU. The prevalence and causes of death in ICU critical patients during the study period were observed. The patients were divided into elderly group (65 years and older) and non-elderly group (15-65 years), and logistic regression analysis was performed for the risk of death in the two groups.Results During the study period, 2707 critical patients in emergency were admitted to the ICU of Shuyang People's Hospital, and patients not satisfied the inclusion criteria were excluded. Finally, a total of 2466 patients were enrolled in the analysis with the male and female ratio of 1.6 : 1, an average age of (61.8±17.3) years, a median Glasgow coma scale (GCS) score of 6 (4, 8), and with a median ICU stay of 3 (1, 6) days. In 2466 critical patients, the most common cause of critical state was spontaneous intracerebral hemorrhage (25.5%) and traumatic brain injury (17.0%), with a fatality rate of 46.0% and 39.5% within first 7 days respectively. Compared with the non-elderly patients (n = 1415), the incidences of death of the elderly patients (n = 1051) due to traumatic brain injury, cerebral infarction, heart failure/cardiovascularcrisis, and respiratory critically ill were significantly increased (9.4% vs. 4.7%, 2.9% vs. 0.8%, 5.0% vs. 2.1%, 2.5% vs. 1.0%, respectively), while the incidence of death for pesticide/drug poisoning in the elderly group was significantly lower than that in the non-elderly group (0.2% vs. 1.2%, allP < 0.01). Stepwise logistic regression analysis showed that traumatic brain injury [hazard ratio (HR) = 1.878, 95% confidence interval (95%CI) = 1.233-2.864,P = 0.003), cerebral infarction (HR = 0.435, 95%CI = 0.229-0.826, P = 0.011), heart failure/cardiovascular crisis (HR = 0.399, 95%CI = 0.238-0.668,P = 0.000), and respiratory critically ill (HR = 0.239, 95%CI = 0.126-0.453,P= 0.000) in the older patients were significantly high risk factors of death as compared with those in non-older patients.Conclusions In the general ICU, the most common cause is spontaneous intracerebral hemorrhage and traumatic brain injury in critical patients with a high fatality rate. The risk of death in elderly patients with severe traumatic brain injury, cerebral infarction, heart failure/cardiovascular crisis, respiratory critically ill is higher than that of the non-elderly patients.

The investigation on clinical features of acute pancreatitis / 中国医师进修杂志

Objective To explore the causes and clinical features change of acute pancreatitis,to get early diagnosis of severe acute pancreatitis.Methods The clinical data of 1195 cases of patients with acute pancreatitis were retrospectively analyzed.Results Main causes of acute pancreatitis were still biliary disease 31.72％ (379/1195),engorgement 25.44％ (304/1195) and hyperlipidemia 16.82％ (201/1195).But the causes of severe acute pancreatitis had changed.Hyperlipidemia was 44.59％ (140/314),biliary disease accounted for 28.34％ (89/314),engorgement accounted for 17.52％ (55/314).The incidence of hyperlipidemia severe acute pancreatitis was 69.65％ (140/201),the incidence of biliary severe acute pancreatitis was 69.88％ (58/83).The incidence of severe acute pancreatitis on patients with body mass index (BMI) ≤25 kg/m2,BMI26-30 kg/m2,BMI≥31 kg/m2 were 5.41％ (17/314),24.84％ (78/314),69.75％ (219/314).There was significant difference (P ＜ 0.05).The incidence of severe acute pancreatitis on patients at age ≤54 years-old,55-69 years-old,≥70 years-old were 12.42％ (39/314),21.66％(68/314),65.92％ (207/314).There was significant difference (P ＜ 0.05).Conclusions In shanghai,the main causes of acute pancreatitis still is biliary disease and engorgement in the lastest ten years.The causes of severe acute pancreatitis have changed.Hyperlipidemia is main casuse; the second one is biliary disease.The incidence rate of severe acute pancreatitis as well as high BMI and elder age were very high and serious.Thus control of blood-lipid and weight should be strengthened.

The cause analysis of deep venous thrombosis in lower extremities / 中国综合临床

Objective To explore the causes of deep vein thrombosis in lower extremities (DVT). Meth-ods Retrospective analysis of 411 patients with DVT being treated in our hospital from 2004 to 2009. Results 301 (73.2%) cases were with definite causes and 110( 26.8%) cases without definite causes. 195 cases occurred follow-ing operations and 68 cases following wounds and fractures. 122 cases accompanied with medical conditions ,50 cases occurred following pregnancy or child birth,39 cases suffered from cancer, 19 cases suffered from infection of lower extremity or local lesion,67 cases had past history of DVT. Conclusions Suggest that surgery, wound and fractures, postpartum, cancer, chronic illness inducing long-term bed stay and past history of DVT might correlate with DVT.

The etiological distribution of 146 cases of chronic cough patients / 中国基层医药

Objective To analyze the causes of chronic cough. Results Totally 146 patients with chronic cough were diaguosed according to the diagnostic routine based on the guideline on diagnosis and treatment of chronic cough established by Chinese Medical Association, which included medical history, medical examination, X-ray or CT of paranasal sinus or chest, lung function, gastroscope, sputum cytology classification. The final diagnosis was made based on clinical manifestation examination findings and a positive response to therapy. Conclusion The cause of chronic cough was defined in 93.2% of the patients, and multiple causes: Cough variant asthma (n = 45,30.3%), postnasal drip syndrome,PNDs (n = 27, 18.5%), gastroesophageal reflux cough(n = 21,14.4%), post infection cough(n = 16,10.9%), ensinophilic bronchitis(n = 13, 8.9%), drug induced cough(n = 10,6.8%), unidentified cough(n = 10,6.8%). Conclusion Complex etiology of chronic cough,be specific therapeutic effect,and its clear cause is the key to treatment.

Analysis and Differentiation on Chronic Nephritis / 浙江中医药大学学报

You ought to differentiate the cause, location, nature and trend of disease, for chronic nephritis. The causes inducing or worsening the disease can be exopathy, as well as internal injury, pathological substance and drug pathogenic factors; while the deficiency of Qi blood Yin Yang of organs is often the internal basis of the disease. The location mainly concerns lung, spleen, liver and kidney, esp. kidney. The nature is deficient root and excessive superficiality; its general trend mostly appears Qi deficiency-both deficiency of Qi and Yin(blood)- both deficiency of Yin and Yang, a discipline of gradual development, and wind, wetness, heat, stasis, sputum and toxin worsen the development of the disease.

Re-analysis of disease location, pathogenesis and treatment of ischemic stroke / 中华中医药杂志

Based on fundamental theory, literatures of TCM and clinical practice, we have found that there are some errors in the theory of stroke. We put forward several views on it: Firstly, the key reason of stroke is the hidden pathogenic factor which is phlegm and stasis, but not wind and fire. Secondly, the production of wind is due to the liver-blood injury caused by phlegm and stasis; the production of f ire is due to whether the liver-blood injury caused by phlegm and stasis or the f ire stagnated by phlegm and stasis in pericardium. Thirdly, the disease location of stroke is in the level of spirit, not in channels and collaterals. Liver soul injury leads to paralysis and aphemia. Lung soul injury leads to numbness. Kidney will injury leads to sensory aphasia. Pericardium invaded by phlegm and stasis, mind disorder will exists. Fourthly, spirit injury is a def icient syndrome, and supplementing blood and qi is the key of treatment, and expelling phlegm and stasis, balancing yin and yang are also needed. The main treatment principles of liver soul injury, lung soul injury, kidney will injury and pericardium injury are tonifying blood, cultivating qi, replenishing essence and nourishing both qi and blood respectively.

Major causes of diabetes in ancient literatures / 中华中医药杂志

In this article,the author analyzes the major causes of diabetes at large.They can be divided into deficiency of yin,weakness of five zang organs,improper diet,intemperance in sexual life,metal stimulation,emotional stress,attack by six climate exopathogens,disoperation by toxin and pathogen,over-taken powder,transformation into dryness and damage to fluids and so on.This article offers some valuable clinical bases for the study of this kind of disease.

Thought Characteristics of Clinical Syndrome Differentiation of Yu Changrong / 中华中医药杂志

To explore the characteristics of thought of clinical syndrome differentiation and promote the curative effects in TCM.When treating the patients,doctors must attach great importance to the activities of qi.Only the functional activity of qi theory is studied with the combination of the holistic concept can the curative effects be improved.Perpetual motion theory can not work well without the guidance of holism and visceral theory.The theory of "treatments are determined by the variations of symptoms" which bases itself on the precondition that pathology changes in advance,constitutes one of the treatment methods under the guidance of perpetual motion theory.The word `root' in the theory of "treatment aiming at the root cause of disease" mainly refers to pathogenesis,nature and location of disease,and disease should be analyzed with pathological changes of human body to seek out the root cause of the disease.To accumulate and explore into the treatment by differentiation of syndromes will be conducive to the treatment of the patients who spend long time to cure.The essence of prescription lies in its differentiation in treatment.With the Zhongjing's spirit of prescriptions in mind,though not prescribing in the name of Zhongjing,we can call this kind of prescription is Zhongjing style.Medicine is valued in its quality and character,and also in its wise use under the guidance of TCM theories.

Hepatolenticular Degeneration Is Disease Due to Toxin-pathogen Invading Collaterals / 中华中医药杂志

Hepatolenticular degeneration,namely Wilson's disease,an autosomal recessive disorder of copper metabolism.The author of this article gave a definition to toxin-pathogen,discussed the basic concept of collaterals disease briefly.And pointed out that hepatolenticular degeneration is a disease due to toxin-pathogen invading collaterals,which was caused by disorder of copper metabolism.This can result in toxin stagnating in collaterals and stagnation of blood stasis in collaterals in the initial stage,and collaterals injured at last.To improve QI-blood circulation and regulate the function of zang fu is important in order to accelerate elimination of toxin and prevent copper from stagnating. Specific therapy vary according to different clinical symptoms,such as promoting blood circulation for removing obstruction in collaterals and clearing toxin, clearing heat-fire and clearing toxin and dispersing stagnated liver-qi for promoting bile flow et al.