Esophageal manometry and 24 hour pH monitoring were performed in elderly control group,non elderly control group,elderly and non elderly gastroesophageal reflux disease (GERD) patients with or without sliding hiatal hernia(HH).Elderly patients with GERD and HH showed a lower LESP compared with elderly GERD patients without HH and elderly controls.Non elderly patients with GERD and HH also showed a lower LESP compared with non elderly controls.Elderly GERD patients with HH showed a lower pressure of contraction at the distal esophagus compared with elderly GERD patients without HH.Extent of reflux had no difference between elderly GERD patients with and without HH.The results suggested that HH affect esophageal antireflux function and peristalsis of the distal esophagus in elderly and non elderly GERD patients,especially in elderly GERD patients,but it could not significantly increase esophageal acid exposure in elderly GERD patients.

0 05). The results suggested that early diagnosis and treament were important factors to improve survival rate and prolong life expectancy for elderly patients with mutiple primary malignant tumors. Cardiac and cerebral vascular accidents, respiratary faliure, and gastrointestinal bleeding were common causes of death in elderly without eancer.

Objective To elucidate the clinical characteristics of multiple primary malignant neoplasms(MPMNs) in elderly patients,and the relationship between MPMNs and its prognosis.Methods The data of 155 patients,including 114 males and 5 females,who were hospitalized to the authors' department during 1974 to 2007 and were diagnosed as MPMNs were retrospectively analyzed.Among them there were 119 patients with MPMNs in digestive system,accounting for 76.77%.The analyses for the characteristics of MPMNs included the sites of neoplasms,the age of onset,length of interval,pathologic types and survival time.Results The median age of onset of the first,second and third tumor were 71,77 and 78.5 years old,respectively.In the digestive system the earliest tumor occurred in stomach(40.4%),and then large intestine(34.5%),esophagus(10.5%) and liver(8.7%) sequentially.Most of them were adenocarcinoma.When the whole body was concerned,the neoplasms occurred earliest in the digestive system,and then the respiratory system,urinary system,male reproductive system and hematological system in sequence.Adenocarcinoma was the primary carcinoma in the digestive system.There were 26 synchronous multiple primary cancers(SMPC) and 93 metachronous multiple primary cancers(MMPC) in the 119 cases,and the intervals in MMPC were 156 totally.Conclusion Multiple primary cancers in the gastrointestinal tract occur commonly.The predilection sites of MPMNs in elderly patients are stomach and large intestine,and most of the neoplasms are adenocarcinoma.The prognosis of MMPC is better than SMPC.The longer the intervals between the first tumor and the second one,the better the prognosis of the patients will be.

Objective To assess clinical results between proximal-first sequential anastomosis technique (POPCAB) and conventional technique off-pump coronary artery bypass grafting(COPCAB) in 72 patients over 65 years old.Methods Between Jan 2008 and Oct 2012,72 patients with multiple vessel coronary artery disease underwent off-pump coronary artery bypass grofting.They were divided into two groups,POPCAB and COPCAB groups.Preoperative and postoperative variables of two groups were compared.Results There were no significant difference in sex,age,history of acute myocardium infarction,hypertension,diabetes and number of bypass grafts between two groups.The ICU stay time in POPCAB group was less than in COPCAB group(P ＜0.05).There were lower creatine kinase MB and cardiac trop I after operation in POPCAB group compared with COPCAB group(P ＜ 0.05).Conclusion The results confirm that promixal-first sequential anastomosis technique remains a valuable option of surgical myocardial revascularization,and may optimize the outcome in the aged.

Objective To investigate the safety of laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively.Methods Forty patients who received laparoscopic common bile duct exploration and lithotomy at the Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from January 2011 to June 2013 were prospectively analyzed.All the patients were randomly divided into 2 groups according to the random number table.Twenty patients in the experimental group did not received drainage tube placement,and the other 20 patients in the control group had subhepatic drainage after operation.The operation time,duration of hospital stay and incidence of postoperative complications were compared between the 2 groups.Patients received computed tomography and B sonography at postoperative month 1 and 3,and then patients were reexamined every 6 months till postoperative year 3.The follow-up was ended on July 31,2013.The measurement data and the count data were analyzed using the independent sample t test and the Fisher exact probability,respectively.Results Patients in the 2 groups were cured after the operation.The operation time and duration of hospital stay were (117 ± 11) minutes and (5.6 ± 0.6) days in the experimental group,and (108 ± 12)minutes and (7.9 ± 0.7)days in the control group,with significant difference between the 2 groups (t =2.453,-ll.388,P ＜ 0.05).No complications including bile leakage,residual stones,obstructive jaundice,abdominal bleeding and subphrenic infection were detected after the operation.Thirty-one patients were followed up for 1 month to 2 years,no bile duct stone recurrence or biliary stricture were detected during the follow-up.Conclusion Laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively is safe and feasible.

Objective To determine if using a soft-tipped guidewire to cannulate the common bile duct may ameliorate development of PEP(post-ERCP pancreatitis)and facilitate cannulation of the CBD(common bile duct).Methods A total of 78 patients treated treateed in our hospital underwent ERCP through conventional direct cannulation(52 diagnostic ERCPs,26 therapeutics ERCPs)from 1998 to 2001 were randomly selected as group A while 112 patients underwent ERCP through guide wire-directed cannulation(21 diagnostic ERCPs,91 therapeutics ERCPs)from 2007 to 2008 as group B.Then we retrospectively studied and compared the following parameters between the two groups:1)Success rate of biliary access;2)visualization rate of pancreatic duct;3)the level of serum amylase,severity of abdominal pain and the rate of PEP.Meanwhile,the correlation between grading of pancreatic duct visualization and PEP was analyzed.Results The success rate of biliary access of the guidewire group(106/112 cases)was significantly greater than the conventional group(33/78 cases)(94.64%vs.42.30%,P<0.01).In group A,about61.53%(16/26)of the 26 cases could not continue the next therapeutics ERCP because of unsucceasful carmulation. The visualization rate of pancreatic duct of group A and B were 58.97%(46/78 cases)and 8.04%(9/112 cases)(P<0.01) respectively.On occurrence rate of PEP,group A(17/78 cases)was significantly higher than group B(4/112 cases)(21.79% vs.3.57%,P<0.01),and severe pancreatitis occurred in 3 patients in conventional group.However,there was no severe pancreatitis in the guide wire group.There were no significant differences (P>0.05) in terms of the rate of hyperamylasemia between the two groups.The significant correlation was found between the grading of pancreatic duct visualization and the occurrence of PEP.Condusion Guidewire-directed selective access to the bile duct lowers likdihood of PEP by facilitating cannulation and lowering the visualization rate of pancreatic duct.The occurrence of PEP could be predicted by the grading of pancreatic duct visualization,which is a very important but not the unique factor leading to PEP.

Objective To investigate the short- and long-term complications after endoscopic Oddi's sphincterotomy (EST) upon endoscopic retrograde cholangiopancreatography (ERCP) procedure and determine whether the size of EST correlates to the occurrence of EST complications.Methods 95 cases receiving EST in the process of ERCP in our hospital were studied and followed up. The patients were divided into large, moderate and small incision groups according to the size of EST and the states of short-term and long-term EST complications were statistically analyzed.Results The incidence of short-term complications of EST was 18. 94% (18/95). They included bleeding in the process of ERCP in 11 cases, delayed bleeding in 3, acute pancreatitis in 1, acute cholangitis in 2 and duodenal perforation in 1. All these patients but 1 with duodenal perforation were discharged after undergoing symptomatic treatments. Eleven out of the 95 patients had long-term complications (11.57 % ). These included biliary system infection in 5 cases, recurrent calculus of bile duct in 3, papilla stricture in 1 and chronic relapsing pancreatitis in 2. All 11 patients recovered after therapeutic ERCP again or symptomatic drug treatments. There was no significant difference in incidence of short-term (χ2 =2.433, P=0.296) or long-term complications (χ2 = 1.151, P=0.562) among the 3 groups. Furthermore, there was no statistical correlation between the incision size of Oddi and complications including operative bleeding (P=0.109), short-term complications (P=0.124) and longterm complications(P=0.402). Conclusion There are many short-term and long-term complications after EST, but there is no correlation between the complications and the incision size of Oddi. The occurring rate of complications might be reduced through accurate direction of papilla incision, avoidance from injury of blood vessel, keeping bile drainage unobstructed and protection of the function of Oddi sphincter as far as possible in the process of ERCP.

Objective:To investigate the safety and efficacy of transcatheter genicular artery embolization (GAE) for moderate to severe knee osteoarthritis (KOA).Methods:This prospective study included 13 patients (17 knees) with KOA who were treated with GAE from October 2020 to March 2021. The Kellgren-Lawrence (K-L) grade was 2-3 for 11 knees, and 4 for 6 knees. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the Whole-Organ Magnetic Resonance Imaging Score (WORMS) assessments were performed for all the subjects before operation. The success rate, clinical efficacy and complications were recorded after operation. Clinical outcomes were evaluated at 1 day, 1week and 1, 3, 6 months after the operation.Results:The success rate of GAE in 17 cases was 100%, and the success rate of target artery superselection was 98.4%(63/64). The baseline WOMAC pain score was 11(10, 13) and total score was 44(38, 58) for 17 knees. Post-operation follow-up WOMAC pain score were 4(3, 7), 2(1, 5), 2(1, 6) and 4(2, 6) at 1 day, 1 week, 1 month, and 3 months. Post-operation follow-up WOMAC total score were 22 (15, 34),20 (12, 24),17 (12, 26) and 20 (12, 31) at 1 day, 1 week, 1 month, and 3 months. There were 16 knees with 6 month follow-up assessment, with the WOMAC pain score of 2.5(2, 5), and the total score of 15(12, 26). Significant difference was found in the WOMAC pain score between baseline and the 1 day, 1 week, 1, 3 and 6 months follow up ( Z=-3.631, -3.623, -3.622, -3.622, -3.532, all P<0.001); also, the total score was statistically significant different between the baseline and the 1 day, 1 week, 1, 3 and 6 months follow up ( Z=-3.639, -3.634, -3.646, -3.527, -3.532, all P<0.001). At 3 months follow-up, there was 1 knee recognized clinical failure. Post-operative adverse reaction in this group included skin ecchymosis in femoral artery puncture area ( n=3), knee joint stiffness and pain within 1 week ( n=4),and clanging joints during postoperative activities ( n=6). Conclusion:GAE is a feasible and safe procedure with obvious short-term curative effect, which can alleviate pain symptoms and improve restricted movement in patients with KOA.

Carotenoids are a class of terpenes of commercial interest and exert important biological functions. Engineering morphological and biosynthetic aspects of Escherichia coli cell membrane could improve its storage capacity for β-carotene. However, how the synthesis of phosphatidylethanolamine, the major component of the cell membrane, was not discussed in detail. In this work, the synthesis of phosphatidylethanolamine was divided into three modules to discuss their synergetic effect, by expressing in different combinations. Overexpressing the upstream module 1 in CAR016 caused a 30.5% increase of β-carotene specific production (from 10.1 mg/g to 13.7 mg/g DCW); combined overexpressing module 1 and module 2 in CAR016 led to a 122% increase of β-carotene specific production (from 10.5 mg/g to 22.3 mg/g DCW). The optimal expression combination of the phosphatidylethanolamine synthetic pathway was obtained, which further increased the content of the cell membrane for β-carotene storage, and improved its production. The membrane engineering strategy opens up a new direction for engineering microbial producers for a large spectrum of hydrophobic molecules.

BACKGROUND/OBJECTIVES: There has been an increased interest in determining calcium magnesium, sodium, and potassium's distinct effects on hypertension over the past decade, yet they simultaneously regulate blood pressure. We aimed at examining the association of dietary calcium, magnesium, sodium, and potassium independently and jointly with hypertension using National Health and Nutrition Examination Survey data from 2007 to 2014.MATERIALS/METHODS: The associations were examined on a large cross-sectional study involving 16684 US adults aged>20 years, using multivariate analyses with logistical models. RESULTS: Sodium and calcium quartiles assessed alone were not associated with hypertension. Potassium was negatively associated with hypertension in the highest quartile, 0.64 (95% confidence interval [CI], 0.48–0.87). When jointly assessed using the high and low cut-off points, low sodium and corresponding high calcium, magnesium, and potassium intake somewhat reduced the odds of hypertension 0.39 (95% CI, 0.20–0.76). The sodiumto-potassium ratio was positively associated with hypertension in the highest quartile1.50 (95% CI, 1.11–2.02). When potassium was adjusted for sodium intake and sodium-topotassium ratio assessed among women, increased odds of hypertension were reported in the highest quartile as 2.02 (95% CI, 1.18–3.34) and 1.69 (95% CI, 1.12–2.57), respectively. The association of combined minerals on hypertension using dietary goals established that men meeting the reference intakes for calcium and exceeding for magnesium had reduced odds of hypertension 0.51 (95% CI, 0.30–0.89). Women exceeding the recommendations for both calcium and magnesium had the lower reduced odds of 0.30 (95% CI, 0.10–0.69). CONCLUSIONS Our results suggest that the studied minerals' association on hypertension is stronger when jointly assessed, mostly after gender stratification. As compared to men, women increased their risk of hypertension even with a low sodium intake. Women would also reasonably reduce their risk of developing hypertension by increasing calcium and magnesium intake. In comparison, men would somewhat be protected from developing hypertension with calcium intake meeting the dietary goals and magnesium exceeding the nutritional goals.