Objective To determine the diagnostic accuracy of alarm features in predicting upper gastro intestinal malignancy in patients who received gastroscopy examination.Methods A retrospective analysis of patients who underwent gastroscopy from Oct 2014 to Oct 2015 was conducted.Biopsy or surgical pathological findings served as the golden standard.The main outcome measure was the diagnostic accuracy of alarm features.Results Among 921 gastrointestinal outpatients,39 patients (4.2％) with malignancy were detected,including 13 (33.3％) with esophageal cancer,24 (61.5％) with gastric cancer and 2(5.1％) with duodenal ampulla cancer.36 patients (92.3％) were found with advanced cancer.In 137patients who had alarm features,21 (15.3％) were found to have malignancy and all were advanced.The sensitivity,specificity,positive predictive value and negative predictive value of alarm features were 53.8％(21/39),86.8％ (766/882),15.3％ (21/137) and 97.7％ (766/784),respectively.Conclusions Alarm features have a definite but limited value in predicting upper gastrointestinal malignancy.Noninvasive screening methods for Chinese patients are still needed to reduce unnecessary endoscopy workload.

Objective To investigate the basic status of healthcare-associated infection(HAI)in a hospital,and provide evidence for strengthening HAI management.Methods A cross-sectional study was conducted to investi-gate the prevalence rates of HAI in all hospitalized patients at 0 ∶00 -24∶00 of May 7,2014.Results A total of 2 262 patients were supposed to be investigated,while 2 253 (99.60%)patients were actually investigated,586 of whom (26.01%)came from pulmonary hospital(specialized in tuberculosis)affiliated to the general hospital.53 patients devel-oped 58 times of HAI,prevalence rate and case prevalence rate was 2.35% and 2.57% respectively;1 073 patients devel-oped 1 265 times of community-acquired infection (CAI),prevalence rate and case prevalence rate was 47.63% and 56.15% respectively.Rates of HAI and CAI were high in intensive care unit(ICU,21.28%)and pulmonary hospital (99.49%)respectively;the main infection site was lower respiratory tract,which accounting for 46.55%(n =27)and 69.72%(n=882)respectively.The major pathogens causing HAI were gram-negative bacteria(n = 19),and the major pathogens causing CAI were Mycobacteria(n=141)and fungi (n=89).The rate of antimicrobial usage and etiological ex-amination was 34.80%(n=784 )and 81.48%(n=550 )respectively.Conclusion In order to prevent cross infection of tuberculosis and reduce the incidence of HAI,lower respiratory tract and ICU should be one of the key infection sites and departments of HAI surveillance,treatment and management of patients with tuberculosis should be stand-ardized,professional precaution of health care workers should be enhanced.

IgG4-related disease (IgG4-RD) has been proved to be associated with malignancy.The incidence and risk factors of malignancy development in IgG4-RD were not clear.Nine IgG4-RD patients with malignancies and 27 IgG4-RD control cases were analyzed for risk factors and clinical features.The incidence of malignancy in IgG4-RD was 3.3％,higher than age-controlled general population.Smoking history was significantly more common in patients with malignancies than in the control group (9/9 vs 16/27,P ＜ 0.05).A total of 6/9 malignancies occurred within the first year after the diagnosis of IgG4-RD.Colorectal,biliary and thyroid cancers were the leading types.Smoking history is a risk factor for IgG4-RD associated malignancy.Careful vigilance to monitor malignancy needs to be paid during follow-up.

Objective To evaluate the performance of split-dosed polyethylene(PEG) for colonoscopy preparation.Methods Split-dose means that 1-3 L of PEG is taken in the afternoon or evening before examination and the remains in the next morning.And single-dose refers to all PEG is taken in the evening before ex-amination.A meta-analysis was conducted to compare bowel preparation quality,adenoma detection rate and patients' acceptance between groups.Results Ten randomized controlled trials were included into this study with 3 222 participants(1 481 in split-dose group and 1 741 in single-dose group).Split-dose group had higher rate of satisfactory bowel preparation(OR=3.37,95％CI:2.37-4.79),and so did the subgroup of 2～ 3 L PEG (OR =3.88,95％ CI:2.39-6.29).Split-dose group did not improve adenoma detection rate significantly (OR =0.94,95％ CI:0.71-1.24),but reported less adverse events such as nausea (OR =0.56,95％ CI:0.42-0.74)and vomiting(OR=0.51,95％CI:0.30-0.88).Conclusion Split-dosed PEG provides better colon cleansing with higher patient compliance,but does not improve detection rate of adenoma.

Objective To analyze the polymorphism of histidine rich protein 2(HRP II)gene in Plasmodium falciparum (Pfhrp2)from falciparum malaria patients in Yunnan Province,so as to lay the foundation for studying the defection of antigen genes of Plasmodium. Methods The filter paper blood samples and related information of falciparum malaria cases reported were obtained in Yunnan Province from August 2012 to September 2015. Under the guidance of the specific primers,the exon2 regions in Pfhrp2 gene in P. falciparum from DNA samples were amplified by PCR,and the PCR products were sequenced. The sequences of exon2 region in Pfhrp2 gene were blasted by comparing with the reference sequences AY816237,AY816240,and AY816301. Next,the polymorphism of the sequence in exon2 region of Pfhrp2 gene was analyzed by MEGA 5.04 software. The conserved sites and genetic distances between sequences were calculated by using the software as well,and the clustering tree was drawn according to the genetic distances between the amino acid sequences. Results A total of 218 bloods samples from the falciparum malaria cases in 15 prefectures of Yunnan Province were collected,and the sources of infection included Yun?nan,Africa and Myanmar. The PCR results showed that the exon2 regions in Pfhrp2 genes of 155 samples were positive by am?plification and their products were sequenced successfully. The sequence analysis showed that the length range of the amino acid residues of exon2 region in Pfhrp2 gene was from 115 aa to 298 aa,the average length was 239.7 aa. There was no statistically significance among the means of the amino acid residues of the isolates from Africa( 239.9 aa),Myanmar(239.5 aa)and Yun?nan(241.6 aa)(F=0.025,P>0.05). All the 155 amino acid sequences ended with type 12 repeat,98.1%(152/155)of them started with type 1 repeat and 1.9%(3/155)of them started with type 2. Type 2 presented most frequently repeat in all the se?quences and the average repeat times were 12.9. The homologous locus of the DNA sequences in exon2 regions of the 155 Pfhrp2 genes was 894 bp,among which the conservative sites accounted for 20.6%(186/894),and the variable sites for 78.2%(699/894). The genetic distances between the sequences of Africa isolates ranged from 0 to 0.741,and those of the Myanmar and Yun?nan isolates were 0-0.948 and 0-0.750,respectively. The cluster analysis showed that all the 155 sequences clustered into 3 cat?egories on genetic distances between amino acid sequences according to the size of the amino acid sequence length. At the same level,the sequences had approximate lengths and amino acid repeat types. Conclusion The sequence of exon2 region in Pfhrp2 gene of P. falciparum from falciparum malaria cases in Yunnan Province is highly polymorphic,the P. falciparum iso?lates are clustered mainly according to the size of the amino acid sequence of exon2 region in Pfhrp2 gene.

Objective:To explore the preoperative diagnostic value of endoscopic ultrasonography (EUS) for intraductal papillary mucinous neoplasms (IPMN).Methods:Data of 62 patients with IPMN confirmed by pathology who underwent EUS before surgery from 2008 to 2018 in Peking Union Medical College Hospital were analyzed. Characteristics that could distinguish low-grade dysplasia (LGD), high-grade dysplasia (HGD) and invasive carcinoma (IC) were explored. A scoring system based on EUS findings was established to determine the preoperative pathology of IPMN by using logistic model.Results:Of the 62 patients, 15 (24.2%) were diagnosed as having LGD, 20 (32.3%) HGD and 27 (43.5%) IC. Univariate analysis showed that the size of mural nodules and width of main pancreatic duct (MPD) were predictive factors for IPMN pathology. The possibility of higher pathological grading would increase 8% for every 1 mm increment in mural nodules. Multivariate analysis showed that only mural nodules≥5 mm ( OR=7.31, 95% CI : 2.49-21.40, P<0.001) was an independent risk factor to distinguish LGD, HGD and IC. Mural nodules≥5 mm, main pancreatic duct (MPD)≥10 mm and mural nodules <5 mm were assigned 2 points, 1 point and 1 point, respectively. The sensitivity, specificity, and area under receiver operator characteristic curve (AUC) of the EUS scoring system to distinguish benign and malignant IPMN were 0.830, 0.867, and 0.867, respectively. Conclusion:Preoperative EUS helps to distinguish LGD, HGD and IC. The size of mural nodules and the width of MPD are vital risk factors to distinguish benign and malignant IPMN.

Objective Mesenteric panniculitis is an idiopathic , uncommon disease involving the adipose tissue of mesentery .The etiology , diagnosis and treatment are still unnoticed .We thus reported a case series to improve the understanding of this rare disorder .Methods We retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation , diagnosis, treatment and prognosis.Results We found a male predominance (M∶F 3∶1) with the median age of 58 years old at diagnosis.The most common symptom was abdominal pain (9/12), followed by abdominal distension (3/12) and weight loss (3/12).Physical examination was unremarkable in the majority of patients (8/12).C reactive protein (9/12) and erythrocyte sedimentation rate (10/12) were normal in majority of patients.CT findings were of much diagnostic value .All patients had small intestinal mesentery involvement and multi-nodular appearance with increased fat density .Pseudo-capsule sign ( 8/12 ) and fat halo sign (6/12) were common.Pathological diagnosis was obtained in 4 cases showing fat tissue inflammation with local necrosis and fibrosis .Six cases all received prednisone , 2 with combined cyclophosphamide , 1 with azathioprine, 1 with tripterygium wilfordii .Short-term clinical response was achieved in all cases , but two patients relapsed .Conclusions Mesenteric panniculitis occurs predominantly in middle-aged and elderly . Abdominal pain is the leading symptom .Inflammatory markers are often normal while computed tomography is the most important diagnostic tool .Surgery combined with cortical steroid and immunosuppressant agents is effective.

Objective To evaluate the bacteriostatic effect of recombinant human lactoferrin(rhLF) on Helicobacter(H .) py‐lori and its influence on CagA ,Ure and gastric mucosal IL‐8 .Methods The minimum inhibitory concentration(MIC)and the influ‐ence of different drug concentrations on the proliferation of H .pylori were detected .The effects of rhLF on the mRNA and protein expressions of CagA and Ure in H .pylori were detected by RT‐PCR and Western blot ,respectively .The animal study :Balb/c mice were adopted and assigned randomly into four groups ,including the standard triple+rhLF(group A) ,rhLF(group B) ,standard tri‐ple(group C) and normal saline(group D) .The histopathological HE staining was used to observe the gastric inflammation and ELISA was used to detect the IL‐8 level of gastric tissue in each group .Results MIC was 0 .5 mg/mL ,moreover rhLF inhibited the bacterial growth and proliferation with a concentration‐dependent manner .rhLF could reduce the expression of H .pylori major viru‐lence factor CagA ,mRNA and protein of Ure .Comparing the group A with the group B ,C and D ,the gastric mucosal inflammation score and the IL‐8 levels of gastric tissue homogenates had statistically significant differences(P<0 .05) .Conclusion rhLF inhibits the growth and proliferation of H .pylori ,moreover inhibit the expression of major virulence factor CagA in H .pylori ,mRNA and protein of Ure in different degrees ,weakens its pathogenicity ,meanwhile reduces the IL‐8 level in mice gastric mucosa ,and allevi‐ates H .pylori related gastric mucosal inflammatory response .

Objective To differentiate colorectal sessile serrated adenoma(SSA)and large hyperplastic polyp(HP)with white light endoscopy and narrow band imaging. Methods Retrospective analysis was performed on the clinical data of 953 patients who underwent endoscopic screening for colorectal cancer at digestive endoscopy center of Peking Union Medical College Hospital from January 2015 to December 2015.Endoscopic features were compared with white light endoscopy and narrow band imaging between SSA and large HP in location, size, Paris classification, surface mucus, NICE classification and varicose microvascular vessel(VMV). Results A total of 28(2.9%)SSAs and 25(2.6%)HPs of diameter not less than 0.5 cm were detected in the total of 953 patients.Statistically significant difference was found in right hemi-colon, diameter not less than 1.0 cm and VMV in two groups(P<0.05). The sensitivities of the above three markers for SSA were 89.3%, 67.9% and 46.4% respectively. The specificities were 64.0%,76.0% and 84.0% respectively. Diagnostic accuracies were 77.4%,71.7% and 64.2% respectively. And the sensitivity, specificity and accuracy of three markers combined(at least two markers)were 75.0%, 88.0% and 81.1%, respectively. Conclusion SSA and large HP could be differentiated with a systemic consideration of lesion location, size, and surface of microvessels by using white light endoscopy and image-enhanced technique.

Objective: To explore the relationship between nutritional status and puberty onset in boys, and to provide a reference for promoting the development of physical and mental health of boys. Methods: A total of 2 724 boys aged 7 to 12 years from grade 2 to 6 were recruited from Xiamen city by cluster sampling method in 2017. The nutritional status was assessed by physical examination, pubertal developmental status was evaluated by rating scales of Tanner and Prader orchidometer, and puberty timing was determined by the P25 age of puberty onset. The association between nutritional status and puberty onset was estimated by logistic regression model. Results: Pubertal onset was found in 29.0% of the boys and the incidence of early pubertal timing was 2.9%. The prevalence of puberty onset in wasting, normal weight, overweight and obesity boys was 19.6%, 28.7%, 34.4% and 31.5%, respectively. The age of puberty onset was significantly earlier in obese boys (F=3.23, P<0.05). The results of Logistic regression analysis showed that with the increase of BMI, the possibility of puberty onset and risk of early pubertal timing increased. After adjusting for confounding factors, the odds of puberty onset in boys with wasting decreased by 64.0% (OR=0.36, 95%CI=0.22-0.60), the possibility of puberty onset and risk of early pubertal timing in boys with obesity increased by 78.3% (OR=1.78, 95%CI=1.14-2.79) and 192.9% (OR=2.93, 95%CI=1.46-5.86), respectively. These relationships were more pronounced in boys of households with lower economic level (P<0.05). Conclusion BMI was positively correlated with puberty onset in boys, the odds of puberty onset and risk of early pubertal timing were significantly increased in obese boys, especially in those with low household economic level.