Angiography ; Aortic Valve Stenosis ; Heart Valve Prosthesis ; Humans ; Tomography

Coronary Stenosis ; diagnostic imaging ; Fractional Flow Reserve, Myocardial ; Humans ; Tomography, X-Ray Computed ; methods

Objective To assess the role of the combination of Helicobacter pylori (H.polyri)antibody detection and serum pepsinogen (PG) examination (ABC method) in risk prediction of gastric cancer.Methods From July 2014 to July 2015,a total of 320 patients underwent gastroendoscopy examination because of stomach discomfort were enrolled.According to the results of serum H.polyri antibody test,PG Ⅰ and PG Ⅰ/PG Ⅱ ratio (PGR),patients were divided into four groups:group A was both H.polyri and PG negative,group B was H.polyri positive and PG negative,group C was both H.polyri and PG positive,group D was H.polyri negative and PG positive.The incidence rates of gastric cancer were compared among the groups.PG positive was defined as PG Ⅰ ≤70 μg/L and PGR≤3.0.And according to the results of gastroendoscopy examination and histopathology,the levels of gastrin 17,PG Ⅰ,PG Ⅱ and PGR of different atrophic regions with different pathological changes and atrophic degree were compared.Chi-square test and analysis of variance were performed for statistical analysis.Receiver operating characteristic(ROC) curve was used to calculate the optimal cut-off value of serum PG Ⅰ and PGR in gastric cancer diagnosis.Results Among the 320 patients,there were 159 patients in group A,124 patients in group B,23 patients in group C and 14 patients in group D,respectively.The incidence of gastric cancer in group A,group B,group C and group D were 0.63％ (1/159),4.03％ (5/124),13.04％ (3/23) and 3/14,respectively.The incidences of gastric cancer in group C and D were much higher than those in group A and B (x2 =11.700 and 21.900,both P＞0.01).Among the 320 patients,there were 179 cases in non-atrophic gastritis group,129 in atrophic gastritis group and 12 in gastric cancer group.The PG Ⅰ and PGR levels of gastric cancer group were (46.84 ± 24.07) μg/L and 3.21 ±1.45,which were lower than those of atrophic group ((100.09±48.15) μg/L and 9.78±7.32) and nonatrophic group ((103.97 ± 44.72) μg/L and 13.09 ± 9.05),and the differences were statistically significant (F=12.460 and 30.290,both P＜0.01).The PGR level of severe atrophy group was 5.62±3.00,which was significantly lower than those of moderate atrophy group (10.04 ± 6.08) and mild atrophy group (11.61±4.05).And the PGⅡ level of severe atrophy group was (18.85±10.54) μg/L,which was much higher than those of moderate atrophy group ((14.63 ± 11.19) μg/L) and mild atrophy group ((10.88 ± 7.41) μg/L),and t he differences were statistically significant (F=8.057,P＜ 0.01;F =3.374,P=0.021).The gastrin 17 level of antrum atrophy group was 2.16 pmol/L (1.12 pmol/L to 4.15 pmol/L),which was lower than those of gastric body atrophy group (4.49 pmol/L,1.88 pmol/L to 18.71 pmol/L) and whole gastric atrophy group (6.18 pmol/L,2.63 pmol/L to 17.82 pmol/L),and the differences were statistically significant (H=13.408,P＜0.01).The optimal cut-off values of PG Ⅰ and PGR for the diagnosis of gastric cancer were 66.7 μg/L and 4.45.Conclusions ABC stratification has certain value in gastric cancer screening in China,however,it still needs improvement.For patients with digestive symptoms,PG Ⅰ ≤ 66.7 μg/L and PGR ≤4.45 can be considered as high risk of gastric cancer and suggested to receive gastroendoscopy examination.

Objective To evaluate the efficacy of probiotics to treat irritable bowel syndrome (IBS).Methods Publications from database including PubMed,the Cochrane Library,Embase,CNKI,CBM and WanFang Data were searched up to August 31,2014.The randomized controlled trials (RCTs) on probiotics to treat IBS were eligible.The related articles were extracted and cross-checked independently by two reviewers.Methodological quality of trials was evaluated according to Cochrane Handbook 5.1.0 criteria.Meta-analysis was conducted using RevMan 5.2 software.Results A total of 17 RCTs involving 1 700 patients were included.Results of meta-analyses showed that compared with the placebo,probiotics was statistically better in improving the overall symptoms integral (SMD =-0.20,95％ CI-0.33--0.07,P =0.002),alleviating abdominal pain/discomfort (SMD =-0.19,95％ CI-0.29--0.09,P ＜ 0.001),relieving abdominal distention (SMD =-0.16,95％ CI-0.28--0.03,P =0.020),and defecation discomfort (SMD =-0.22,95％ CI-0.42--0.02,P =0.030).There was no statistical significance in the overall quality of life (SMD =-0.08,95％ CI-0.07-0.23,P =0.290) and adverse effect ratio (RR =1.08,95％CI0.79-1.49,P=0.630).Conclusion Probiotics have beneficial effects on IBS,which can improve the patients' symptoms and with less adverse reaction.Due to the bias,further large-scale,multicenter and high-quality RCTs are required to unify outcome indicators,further define sensitive strain,and standardize its usage,dosage and course of treatment.

Objective To investigate the risk factors of peripartum hysterectomy in placenta previa through retrospective study of 3 840 placenta previa cases. Methods The clinical data of 3 840 patients with placenta previa who delivered in West China Second University Hospital between Jan 2005 and June 2014 were analyzed retrospectively. The relationship of certain factors and peripartum hysterectomy was analyzed, including maternal age, residence place, parity, prior curettage, prior cesarean section, twin or multiple pregnancy, antenatal vaginal bleeding, type of placenta previa, suspected placenta accreta, antenatal level of hemoglobin and gestational age at delivery. Results The prevalence of placenta previa was 4.84% (3 840/79 304) in West China Second University Hospital during the study period, and the incidence of preipartum hysterectomy in patients with placenta previa was 2.76% (106/3 840). One-factor analysis demonstrated that residence place, parity, times of prior curettage, prior cesarean section, prenatal vaginal bleeding, anterior placenta, type of placenta previa, placenta accreta, antenatal anemia and gestational age at delivery were potential risk factors for peripartum hysterectomy (P<0.01). Variables with P<0.1 in one-factor analysis were introduced to multi-factor logistic regression analysis, which suggested that one prior cesarean section (OR=12.9,95%CI:6.3-26.3), two or more prior cesarean sections (OR=14.4, 95%CI:3.9-53.2), anterior placenta (OR=4.8, 95%CI:2.1-10.7), complete placenta previa (OR=5.9, 95%CI:1.8-42.5), placenta accreta (OR=11.2, 95%CI:6.8-18.6), antenatal hemoglobin<100 g/L (OR=1.7, 95%CI:1.0-2.8) and delivery before 34 gestational weeks (OR=3.2, 95%CI:1.6-6.3) were independent risk factors of peripartum hysterectomy in patients with placenta previa (P<0.05). Conclusions Prior cesarean section, anterior placenta, complete placenta previa, placenta accreta, antenatal anemia and delivery before 34 gestational weeks are high risk factors of peripartum hysterectomy in placenta previa patients. Perinatal care and risk evaluation before cesarean section are important to improve perinatal outcomes and reduce peripartum hysterectomy.

Objective To measure HPSE and VEGF-C expression in pancreatic cancer tissues and to observe the effect of small interfering RNA targeting heparanase gene on VEGF-C expression and malignant biological behavior of pancreatic cancer cell lines BxPC-3.Methods We measured the relative mRNA levels of HPSE and VEGF-C in 34 pancreatic ductal cell adenocarcinoma(PDAC) specimens by RT-qPCR.The recombinant plasmid GV230/HPSE was constructed.BxPC-3 was transiently transfected with GV230/HPSE and HPSE-siRNA.The expression levels of HPSE and VEGF-C were measured by performing florescent real-time quantitative PCR (RT-qPCR) and immunoblotting.The invasion and migration potential of treated BxPC-3 was evaluated by transwell invasion assay and Scratch-wound assay.Results Spearman rank correlation analysis indicated a positive correlation between HPSE and VEGF-C (r =0.812,P ＜0.01)in pancreatic cancer tissues.HPSE and VEGF-C overexpression was correlated with tumor differentiation,lymph node metastasis and TNM stage(all P ＜0.01).RT-qPCR and Western blot showed high expression of HPSE mRNA and VEGF-C mRNA in GV230/HPSE group than that in control group,compared to low expression of HPSE mRNA and VEGF-C mRNA in siRNA group (all P ＜ 0.01).Invasion chamber assay and Scratch-wound assay showed higher invasion in GV230/HPSE group than that in control group,while lower invasion in siRNA group (all P ＜ 0.01).Conclusions Joint detection of HPSE and VEGF-C may be of significance in predicting prognosis of patients with pancreatic cancer.HPSE regulates the expression of VEGF-C and facilitates invasion and migration of BxPC-3 in vitro.

Objective To explore the treatment effect of peripherally inserted central catheter (PICC) in parenteral nutrition of infants and observation and nursing of its complication.Methods Clinical data of 32 cases of infants who underwent parenteral nutrition through PICC were analyzed.The nursing experience and observation and handling of common nursing problems were summarized.Results 2 cases failed catheterization,the others succeeded,1 case through scalp,2 cases through axillary,27 cases through basilic vein.2 cases completed TPN treatment with a second try of PICC.The shortest indwelling time of PICC was 3 days,the longest was 34 days.Catheter blockage happened in 1 case,leakage in 1 case,and catheter-related infections in 1 case.Conclusions Difficulty exists in application of PICC in infants,but the complications were less.The tube can be retained for a long time,which conforms to higher intravenous nutrition requirement of infants,and this method possesses wide application perspective.

Objective To systematically evaluate whether eradication of Helicobacter pylori (H.pylori) is associated with the development of endoscopic gastroesophageal reflux disease (GERD) and reflux symptoms.Methods PubMed,CENTRAL,Embase,CNKI and Wanfang Database from April 1978 to April 2015 were retrieved to collect the randomized controlled trials (RCTs) comparing the incidence of reflux symptoms or reflux esophagitis in patients receiving H.pylori eradication treatment and those without treatment.The quality of trials was evaluated by the Cochrane Collaboration's tool for assessing risk of bias and Jadad scoring.A Meta-analysis was conducted by using RevMan 5.20 software.Results Twenty RCTs involving 6 575 cases were included.Meta-analysis showed that:(1) There was a positive link between H.pylori eradication and endoscopic reflux esophagitis.The diagnostic rate of endoscopic reflux esophagitis after H.pylori eradication therapy was higher than that of control group(7.25％ vs 4.20％;OR =1.62,95 ％ CI 1.20-2.19,P =0.002).Subgroup analysis found that Asian patients,40 to 50 years old,followup time more than 1 year,and peptic ulcer had higher incidence of endoscopic reflux esophagitis;(2) The incidence of reflux symptoms was not significantly different between H.pylori eradication group and control group (25.2％ vs 24.6％;OR =1.03,95％ CI 0.87-1.21,P =0.76).Further analysis indicated that reflux symptoms were not related to some relevant factors,such as races,age at diagnosis,follow-up time and underlying diseases.Conclusions The eradication of H.pylori is considered as one of risk factors for GERD,especially in Asian populations,long time follow-up,40 to 50 years old and patients with peptic ulcer.Meanwhile,the eradication of H.pylori does not suggest the correlation with reflux symptoms.H.pylori eradication therapy should be administrated according to patients' individual conditions.

Objective To evaluate the diagnostic significance of esophageal minimal change in gastroesophageal reflux disease (GERD) and explore its clinical characteristics.Methods From May to September in 2013,patients with minimal esophageal mucosa changes including esophageal mucosa rough,white secretin adhesion,erythema,edema,increased brittleness,blurring of the Z line or zigzag looking and blurring of paliform blood vessel,or patients with Los Angeles classification (LA) which were identified by endoscopy were enrolled.The subjects received gastroesophageal reflux disease questionnaire (GcrdQ) investigation and the related history were collected.The total score of GerdQ over eight was set as the criteria for GERD diagnosis.The R × C chi-square test was performed for statistical analysis.Results A total of 417 valid questionnaires were completed.Of which,202 cases were in minimal change group,176 were in LA A group and 36 were in LA-B group.The diagnostic rate of GERD in minimal change group was 20.3％ (41/202),which was lower than that of LA-A group (74.4％,131/176) and LA-B group (83.3 ％,30/36),and the differences were statistically significant (x2 =129.144,P＜0.01).The incidences of heartburn in minimal change group,LA A group and LA-B group were 25.7％ (52/202),62.5％ (110/176) and 86.1％ (31/36),respectively.The incidences of reflux were 29.7％ (60/202),67.6％ (119/176) and 75.0％ (27/36),respectively.The incidences of non cardiac chest pain were 5.4％ (11/202),22.2％ (39/176) and 22.2％(8/36),respectively.The incidences of heartburn,reflux and non cardiac chcst pain of minimal change group were all lower than those of LA A group and LA-B group,and the differences were statistically significant (x2 =75.775,64.120,24.016;all P＜0.01).The leading cause of endoscopy examination in minimal change group was abdominal discomfort,which accounted for 49.0％(99/202).The leading causes of endoscopy examination in LA A group and LA-B group were esophageal symptoms,which accounted for 52.8％ (93/176) and 61.1％ (22/36).Conclusions The diagnostic rate of GERD in patients of minimal change group is low and the clinical symptoms are not typical,which is insufficient for diagnosis of GERD and needed further investigation.

Appendiceal mucinous adenocarcinoma is a rare disease.The preoperative diagnosis is almostly impossible due to the lack of typical symptoms and inexperienced surgeons.One patient with appendiceal mucinous adenocarcinoma was diagnosed successfully at the 210th Hospital of Chinese PLA,who was misdiagnosed as with periappendiceal abscess by other hospitals.The result of intraoperative frozen pathological section confirmed appendiceal mucinous adenocarcinoma.And then the patient received extended resection and effective recovery.