Improvement of atropine on esophagogastric junction observation during sedative esophagogastroduodenoscopy.

BACKGROUND AND STUDY AIMS: Although sedation esophagogastroduodenoscopy (EGD) is now widely used, previous research has reported that sedation during EGD exhibits a negative effect on esophagogastric junction (EGJ) exposure. Atropine might improve EGJ exposure, as noted in clinical practice. The aim of this study was to examine whether sedation had a negative effect on EGJ observation in the Chinese population, and whether atropine had some ability to act as an antidote to this unexpected secondary effect of sedation. PATIENTS AND METHODS: In this cross-sectional study, subjects were divided into the following three groups according to the methods of EGD examination: the non-sedation group, the propofol-fentanyl combined sedation group and the combined sedation with atropine administration group. The EGJ observation was assessed by a key photograph taken with the endoscopic camera 1 cm from the EGJ, which was rated on the following four-degree scale: excellent (score = 4), good (score = 3), fair (score = 2) and poor (score = 1). RESULTS: The EGJ exposure was better in the sedation group administered atropine (score = 2.64±1.05) than in the sedation group (score = 1.99±1.08, P<0.05) but not as good as in the non-sedation group (score = 3.24±1.12, P<0.05). Reduced detection of EGJ diseases in the sedation group was also found, compared to the non-sedation group (P<0.05). Only the use of atropine (OR = 2.381, 95%CI: 1.297-4.371, P = 0.005) was independently associated with excellent observation of the EGJ during sedation EGD. CONCLUSIONS: Combined propofol-fentanyl sedation reduces the extent of exposure of the EGJ during EGD and reduces the detection of EGJ diseases. The application of atropine in the sedation endoscopy examination helped to achieve better EGJ observation, but still cannot achieve an equal extent of exposure compared to non-sedation EGD.

Serum Albumin and C-Reactive Protein/Albumin Ratio Are Useful Biomarkers of Crohn's Disease Activity.

BACKGROUND Serum albumin (ALB) may be low during acute inflammation, but it is also affected by nutritional status. Therefore, we hypothesized that ALB and the C-reactive protein/ALB ratio (CRP/ALB) may be associated with disease activity in patients with Crohn's disease (CD). MATERIAL AND METHODS Altogether, 100 patients with CD and 100 age- and sex-matched healthy volunteers were retrospectively enrolled in the current study. The patients with CD were subdivided into patients with active disease (Crohn's Disease Activity Index >150) and those in remission. ALB levels, CRP levels, and lipid profiles were measured. RESULTS ALB and CRP levels and the CRP/ALB ratio were the most useful for differentiating between active and nonactive CD. ALB levels (r=-0.50, P<0.01), CRP levels (r=0.39, P<0.01), and CRP/ALB ratio (r=0.42, P<0.01) all correlated with CD activity. These correlations were more prominent in males. Receiver Operating Characteristic (ROC) analysis indicated that the area under the curve (AUC) representing ALB (0.79) was higher than the AUC representing CRP (0.73) or CRP/ALB ratio (0.75; P>0.05). The AUCs corresponding to ALB level, CRP level, and CRP/ALB ratio were more prominent in males versus females (P<0.05). CRP level (14.55 mg/L), ALB level (34.35 g/L), and CRP/ALB ratio (0.69) had sensitivities of 67.7%, 72.6%, and 59.7%, and specificities of 73.7%, 78.9%, and 81.6%, respectively, for CD activity. CONCLUSIONS In the present retrospective study, we found that ALB level and CRP/ALB ratio were useful biomarkers for identifying CD activity, especially in males. These results suggest that, in addition to inflammation, assessment of patient nutritional status could also aid in identifying CD activity.

Polymorphisms in ERCC1 and XPF gene and response to chemotherapy and overall survival of non-small cell lung cancer.

We conducted a perspective study to assess the association between ERCC1 and XPF polymorphisms and response to chemotherapy and clinical outcome of NSCLC receiving chemotherapy. Between May 2009 and May 2011, a prospective study was conducted on 240 NSCLC cases. Genotypes of ERCC1 (rs11615, rs3212986 and rs2298881) and XPF (rs2276465 and rs6498486) were performed by Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP) assay. By conditional logistic regression analysis, patients carrying AA genotype of ERCC1 rs11615 showed more CR+PR to chemotherapy when compared with GG genotype, and the adjusted OR (95% CI) was 2.73 (1.21-6.18). By Cox regression analysis, AA genotype of ERCC1 rs11615 was associated with longer overall survival of NSCLC, and the adjusted HR (95% CI) was 0.38 (0.14-0.96). In conclusion, our study found that ERCC1 rs11615 polymorphism can influence the chemotherapy response and overall survival of NSCLC patients receiving cisplatin-based chemotherapy.

The value of the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio in predicting carotid atherosclerosis among Chinese individuals with metabolic syndrome: a cross-sectional study.

BACKGROUND: Metabolic syndrome (MetS) is associated with carotid intima-media thickness (CIMT), which is a good predictor of cardiovascular disease (CVD). However, among individuals with MetS, direct comparative data regarding the utility of the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio to diagnose carotid atherosclerosis are scarce, particularly in Chinese populations. We aimed to determine the relationship between the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio and carotid atherosclerosis among Chinese individuals with MetS. METHODS: We performed a retrospective study of 5822 Chinese participants who underwent a routine health screening examination. Lipid profiles, fasting glucose, fasting insulin, CRP, apoB, apoAΙ and CIMT were measured. RESULTS: We observed that among Chinese individuals with MetS, men (53.95±0.58 ys) developed carotid atherosclerosis at a younger age than women (58.47±1.17 ys) (P<0.001). Both the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio positively correlated with carotid atherosclerosis among Chinese individuals with MetS, particularly among women. Meanwhile, CIMT increased progressively across the quartiles of the non-HDL-C/HDL-C ratio (P for trend, <0.05). Receiver Operating Characteristic (ROC) analysis indicated that the AUC of the apoB/apoAΙ ratio (0.561) was higher than that of the non-HDL-C/HDL-C ratio (0.522) in men (P<0.05) and the AUC of the apoB/apoAΙ ratio (0.640) was lower than that of the non-HDL-C/HDL-C ratio (0.695) in women (P<0.05). Among Chinese individuals with MetS, the AUC of the non-HDL-C/HDL-C ratio was more prominent among women compared with men (P<0.05). CONCLUSION: Our findings indicate that among individuals with MetS, Chinese men develop carotid atherosclerosis at a much younger age than women. There were no significant differences between the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio for the prediction of carotid atherosclerosis among Chinese individuals with MetS. Among Chinese individuals with MetS, the utility of the non-HDL-C/HDL-C ratio was found to be greater among women than among men.

[The effect of ventricular fibrillation time and NYHA classification on defibrillation in intensive care unit patients].

OBJECTIVE: To investigate whether the sequence of defibrillation (DF) and cardiopulmonary resuscitation (CPR), duration of ventricular fibrillation (VF), and New York Heart Association (NYHA) classification would affect DF result in intensive care unit. METHODS: Ninety-three cases needing instantaneous DF were divided into three groups according to VF lasting time: <4 minute group (n=53), 4 - 8 minute group (n=24), >8 minute group (n=16), and each group was randomly divided into two sub-groups according to time sequence: the prior DF group or the prior CPR for five cycles followed by DF group (prior CPR group). The effect of VF time, the sequence of DF and CPR, and NYHA classification on success rate of DF were observed. RESULTS: With prolonging VF time, success rate of DF obviously lowered [success rate of DF for VF<4 minute, 4 - 8 minute, and >8 minute groups were 83.0% (44/53), 62.5% (15/24), and 25.0% (4/16), respectively, all P<0.01]. When VF time lasted less than 4 minutes, success rate of DF in the prior DF group was obviously higher than that in the prior CPR group [88.9% (24/27) vs. 76.9% (20/26), P<0.05]. When VF time lasted for 4 - 8 minutes, the prior DF group had slightly higher success rate of DF compared with the prior CPR group [66.7% (8/12) vs. 58.3% (7/12), P=0.09]. When VF time lasted longer than 8 minutes, the success rate of DF in the prior CPR group was obviously higher than that in the prior DF group [37.5% (3/8) vs. 12.5% (1/8), P<0.01]. The success rate of DF was lowered in higher NYHA classification [success rate of DF for NYHA classification I-IV was 96.4% (27/28), 80.0% (20/25), 47.8% (11/23), 29.4% (5/17), respectively, P<0.05 or P<0.01]. CONCLUSIONS: VF lasting time and NYHA classification are key factors to success rate of DF, and the choice of sequence of DF and CPR depends on the lasting time of VF. For cases with the high NYHA classification, we should make some judgement beforehand and prepare some preventive measures.

[Follow-up study on psychic and neuropathic delayed effects of acute organophosphorus pesticides poisoning].

OBJECTIVE: To study the delayed effect on neuropsychopathy and its related factors after acute organophosphorus pesticides poisoning (AOPP). METHODS: Two hundred and fifty-seven cases of AOPP in the observation period were chosen to follow-up 2 months later from the 4 county hospitals in Shandong Province where the incidence of organophosphorus pesticide poisoning is high. RESULTS: Nine cases of organophosphate induced delayed polyneuropathy (OPIDP) were found and the incidence rate was 3.5%. The occurrence of OPIDP were related to the need for emergent artificial respiration, and the degree of poisoning, and the kinds of organophosphorus pesticides (Ops). The positive rate of symptoms of peripheral nerves, central nerves and psychogeny except auditory and visual hallucination after poisoning was significantly higher than that before (P < 0.05). The patient's situation of health, economy and work became statistically worse (P < 0.05). CONCLUSION: We found some had delayed effects on neuropsychopathy after AOPP which could debase the patient's life quality. The control measure should be administered as early as possible.