Objective To investigate the effect of Helicobacter pylori (Hp) plantation in Barrett's esophagus (BE) columnar epithelium on esophageal adenocarcinoma (EA) in the elderly.Methods 109 patients with reflux esophagitis (RE),51 patients with Barrett's esophagus and 16 patients with esophagus adenocarcinoma were diagnosed by endoscopy and pathological biopsy.The 4-quadrant biopsies in esophagus lesions were respectively taken from each patients.1 were tested by silver staining and urease test for rapid detection of Hp,and the other were stained by HE staining for pathological analysis,AB /PSA staining and immunohistochemistry for gene expressions of cyclooxygenase-2 (COX-2) and B cell lymphoma / leukemia-2 (Bcl-2).Results Hp colonization in RE group,BE group and EA group were 0％,44.4％ and 42.1％ respectively.The expression levels of COX-2 in abnormal squamous epithelium in RE group,BE group and EA group were 46.7％,100％ and 100％ respectively.The expression of COX-2 was higher in BE and EA groups than in RE group (x2=126.21,both P＜0.05).Moreover,a gradually increase in COX-2 expression was observed in abnormal esophageal squamous epithelium from RE to BE to EA.COX-2 expression was significantly increased in mucosa in BE and EA patients with Hp plantation and in lower esophageal carcinoma in EA patients with Hp plantation and without Hp plantation.Bcl-2 expression in esophageal squamous epithelium was 40.2％,85％ and 100％ in RE,BE and EA groups respectively.The expression of Bcl-2 was higher in BE and EA groups than in RE group (x2 =125.25,P＜0.05).Bcl-2 expression was increased in mucosa BE patients with Hp plantation.Conclusions Hp plantation in BE esophageal columnar epithelium can increase the expression of COX-2,and induce its downstream Bcl-2 expression,inhibit cell apoptosis,and might lead to EA.

AlM: To compare the clinical effects of two different surgical ways on congenital cataract.
METHODS: We selected 52 children ( 84 eyes ) with congenital cataract surgery between December 2009 and December 2012 in our hospital. They were divided into two groups based on the surgical way: A group were treated by phacoemulsification + posterior curvilinear capsulorhexis, B group were treated by phacoemulsification+posterior curvilinear capsulorhexis+anterior vitrectomy. The follow-up was 6-12mo, and postoperative corrected visual acuity and complications were observed.
RESULTS: Postoperative visual acuity of two groups were increased ( P< 0. 05 ). Preoperative visual acuity between two groups had no significant difference ( P>0. 05 ) , while postoperative visual acuity between two groups had significant difference (P<0. 05), group B was better than group A. Complications had no significant difference between two groups except posterior capsule opacification (PCO) (P<0. 05). The incidence rate of PCO in group B (12%) was far lower than group A (53%).
CONCLUSlON: Compare with phacoemulsification +posterior curvilinear capsulorhexis, the way combined with anterior vitrectomy can improve the postoperative visual acuity and decrease the incidence rate of PCO.

Objective To observe the effects of enteral nutrition on the glucose and fat metabolism in elderly patients with metabolic symdrome (MS) and nonalcoholic fatty liver disease (NAFLD).Methods The 109 patients with MS and NAFLD were randomized into enteral nutrition(EN)(n=55)and total parenteral nutrition(TPN) (n=54) group.The EN patients received aggressive enteral nutrition therapy,the TPN patinets got the treatment of total parenteral nutrition.The body mass index (BMI),liver function,blood glucose,blood liquid and hepatic ultrasonography were observed in two groups.Results After treatment of 2 monthes,the values of BMI,TG and LDL-C were decreased,2 hBG,HbA1c,ALT,AST and BIL were significant improved in enteral nutrition group in comparison with pretherapy (P＜0.05),while not significantly different in total parenteral nutrition group(P＞0.05).There were 55.6 ％ (10/18) patients changing from middle fatty liver mild fatty liver in enteral nutrition group,while only 46.2％ (6/13) in TPN group (P＞0.05).Conclusions EN support is superior to TPN in improving the glucose and fat metabolism in elderly patients with MS and NAFLD.

Objective To investigate the clinical manifestations,pathological features hy endoscopy and possible risk factors of ischemic colitis (IC).Methods A retrospective analysis was made upon 89 hospitalized patients diagnosed as IC.Logistic regression analysis was performed to determine morbidity risk factors.Results The majority of patients with IC in our study group had histories of hypertension,heart disease,hyperlipidemia,diabetes,etc.The common features included abdominal pain (80.9％,72/89),hematochezia (76.4％,68/89),etc.Colonic mucosal lesions presented regional distribution under colonoscope (80％,72/89),with manifestations of petechial hemorrhages,edema,segmental erosion,pleomorphism ulcerations,visible lesion edge and sharply defined segment of involvement,even be characterized by lumens stricture (13.5％,12/89).Histopathological examination revealed mucosa edema,necrosis,hemorrhage and formation of ulceration,inflammatory cell infiltration,and submucous hemorrhage,etc.Laboratory examination showed that white blood cells,neutrophils,serum fibrin,D-Dimer,serum TC,TG and serum apolipoprotein B were higher than normal.Colonic mueosal roughness,thumbmark symptoms,etc,and even bowel limited spasm,stricture or curtailment were visible in 47 patients underwent barium enema.Colonic wall thickening was visible in 29 patients underwent mesentericography,however,strictured or closed blood vessels were not found logistic regression analysis showed that hypertension,diabetes,higher TG,atrial fibrillation were strongly associated with onset of IC (all P values ＜ 0.05).Conclusions Since IC symptoms are not typical,it requires early colonoscopy to clarify diagnosis.Hypertension,diabetes,hyperlipidemia,and atrial fibrillation are risk factors for IC.

Objective To explore the effects of different ways of nutritional support on organ functional recovery and prognosis in the elderly with multiple organ dysfunction syndromes (MODS).Methods 85 patients with MODS were randomized into enteral nutrition(EN) group (n=43 cases)and total parenteral nutrition(TPN) as control group (n=42 cases).EN group received nutritional support by nasogastric feeding tube or percutaneous endoscopic gastrotomy (PEG)/ percutaneous endoscopic jejunostomy (PEJ),and TPN group got nutrition by central vein for at least 2 months of therapeutic course.Body mass index (BMI),hemoglobin (HB),functions of liver and kidney,electrolytes,blood glucose and lipid,serum albumin(ALB),transferring(TRF),prealbumin (PA),immunoglobulin(IgA,IgG,IgM),leukomonocyte (CD3+,CD4+,CD4+/CD8+) were compared between two groups before and after treatment.Results The levels of Hb,BMI,ALB,TRF and PA after treatment for 1 and 2 months significantly improved (t1EN =2.672,2.440,2.209,3.331,5.025,t1TpN=2.720,2.337,2.179,3.418,2.221 and tEN2nd maonh=2.279,3.021,2.337,3.005,5.779,tTPN2nd month=2.118,2.956,3.018,3.310,2.119,all P＜0.05) in two groups as compared with before treatment,and there was remarkable difference in the level of PA between EN group and TPN group(t=2.336,P＜0.05).Hyperlipemia at 1 and 2 months after treatment occurred in TPN group (t1TPN =3.609,t2TPN =3.114,P＜0.05).The levels of IgG (t1st month=2.664,t2nd month =2.983,P＜0.05) and IgA (t1st month =2.437,t2nd month =3.005,P＜0.05) were higher after treatment for 1 and 2 months than before treatment.The levels of CD3+,CD4+ and CD4+/CD8+ cells improved (t2nd month =2.399,3.478,2.579,3.995,P ＜ 0.05 ) and IgM (t2nd month =3.886,P＜0.05) increased after treatment for 2 months in EN group.In EN group,aspiration pneumonia appeared in 34 cases and the occurrence rate decreaed (x2 =51.12,P ＜ 0.05 ) after PEG/PEJ operation (only 5 cases).Reflux esophagitis reduced and alleviated 2 months after PEG/PEJ operation (x2=13.53,P＜ 0.05).ConclusionsTimely sufficient EN support may improve nutritional and immunological status in elderly patients with MODS.PEG/PEJ can reduce the occurrence of aspiration pneumonia and reflux esophagitis caused by the nasogastric feeding tube.

ObjectiveTo discuss the hematological adverse reactions of oral omeprazole administration with convention dosage and treatment course in aged patients.MethodsFour hundred and nine cases of reflux esophagitis by endoscopic diagnosis from Beijing Hospital during January 2000 to December 2010 were divided into three groups according to their ages: group A ( 168 cases) aged from 60 to 69 years,group B ( 152 cases) aged from 70 to 79 years and group C (89 cases) aged equal to or above 80 years.Each group of patients was randomly divided into three subgroups,A 1 ( 56 cases),B 1 ( 51 cases) and C 1 ( 30 cases ) were administered with oral omeprazole,20 mg,bid; A2 ( 56 cases ),B2 ( 51 cases ) and C2 ( 30 cases ) were administered with oral famotidine,20 mg,bid; A3 ( 56 cases),B3 ( 50 cases),C3 ( 29 cases ) and all above subgroups were administered with oral sucralfate,10 ml,tid.The treatment course lasted for one month.The clinical efficacy,WBC count,RBC count,the Hemoglobin level,platelet count,as well as the prothrombin time,thrombin time,activated partial thromboplastin time,fibrinogen,Plasma fibronectin and serum D-Dimer were tested and compared after 10-days and 30-days treatment.ResultsAfter the treatment,all the patients had alleviated symptoms,to varied extend,especially in subgroups treated with oral omeprazole and sucralfate.After 30 days' treatment,blood WBC counting in B1 subgroup declined to lower than normal values in two cases; PLT counting drops in 1 case; blood WBC dropped in 6 cases and PLT dropped in4 cases of the C1 subgroup;blood WBC counting dropped in 1 case and PLT dropped in 2 cases of the C2 subgroup.Hemoglutination did not show significant change in all groups (P ＞ 0.05 ).Conclusion The hematological adverse reactions of oral omeprasole in aged patients,under convention dosage and treatment course,occured with age increase,especially for blood WBC and platelet counting.

Objective To investigate the effect of Trimebutine maleate on reflux esophagitis in elderly patients.Methods A total of 160 elderly patients with typical esophageal reflux symptoms diagnosed as reflux esophagitis by gastroscope,with concomitant gastroesophageal disease confirmed by esophageal motility manometry and 24 h esophageal pH impedance monitoring acid reflux,were selected and retrospectively analyzed.All patients were treated with proton pump inhibitor(PPI) esomeprazole 20 mg tid,antecibum(AC)for 8 weeks,and randomly divided into four groups:group A (itopride hydrochloride 50 mg tid,AC),group B(citrate mosapride 5 mg tid,AC),group C (trimebutine maleate 200 mg tid,AC),group D(treated without prokinetic drugs).After 4 and 8 weeks of therapy,the symptom improvements were observed in the four groups.Endoscopy,esophageal motility manometry,24h esophageal pH impedance monitoring were performed in the 160 cases after 8 weeks of treatment.Results The total effective rate was 97.5％(39 cases),95.0％ (38 cases),92.5％(37 cases)and 77.5％(31 cases)in group A,B,C and D respectively after 8 weeks of treatment.Endoscopic examination showed that the cure rate was 70.0％ (28 cases),62.5％ (25cases),72.5％(29 cases),67.5％(27 cases),and the effective rate was 87.5％,(35 cases),92.5％(37 cases),87.5％(35 cases)and 87.5％(35 cases)in group A,B,C and D respectively after 8 weeks of treatment,without statistically significant differences in the cure rate and effective rate between the four groups.The results of esophageal motility manometry showed that the lower esophageal sphincter pressure(LESP),lower esophageal sphincter relaxation (LESR),lower esophageal peristaltic wave pressure(LEPP) and percentage of abnormal esophageal body contraction had significant difference before versus after treatment in group A and B,but not in control group.The improvements in the percentage of total time of pH＜4.0,the percentage of time of pH＜4 at standing position,the percentage of time of pH＜4 at supine position,supine reflux times,the times of supine reflux＞5 min,the longest reflux time(min)at supine position were more significant in group A,B and C than in group D.Compared with pre-treatment,the times of non-acid reflux were reduced significantly in group A,B and D(all P＜0.01),and there was a significant difference(P＜0.05)between the three (A,B,C)groups and group D(P＜0.05).There were significant differences in the times of reflux liquid and gas reflux between the group A,B and D(P＜0.05).The proximal reflux times were improved more significantly in group A,B and C after treatment than in control group(P＜0.05).Conclusions Prokinetic drugs combined with PPI therapy has better effect than single PPI application in improving the clinical symptoms and upper gastrointestinal motility in elderly patients with RE.Trimebutine maleate is safe and effective in the elderly,and has a similar effect on esophageal motility with mosapride citrate and itopride hydrochloride,which may be involved in selectively improving esophageal motility,lower esophageal sphincter pressure and gastric emptying function.

Objective To investigate the predictive value of trauma index on the prognosis in pa-tients with traumatic spinal cord injury.Methods Enrolled 168 cases of patients with traumatic spinal cord injury,the traumatic index score and the American Spinal Injury Association (ASIA)grade were as-sessed on admission,then followed up for 6 months,the Spearman correlation analysis was performed to a-nalysis the relationship between trauma index and ASIA grade,and Receiver operating curve (ROC)anal-ysis was used to evaluate the relationship between trauma index and prognosis.Results There was a sig-nificant negative correlation between trauma index score and ASIA grade(r =-0.68,P <0.01).A total of 157 cases (93.5%)completed follow-up,the trauma index score had a good predictive value on the traumatic death in these patients,it's sensitivity was 71.4%,specificity was 76.1%,the best cut-off point was 25 points(P <0.01 );Compared with the low score group (<25 points),the high group (≥25 points)showed a lower ASIA grade and higher mortality,the differences were statistically significant (P <0.01).Conclusion The trauma index score was related with the spinal cord injury,and it is a predictive factor of poor prognosis in patients with traumatic spinal cord injury.

Objectives To study a correlation between Helicobacter pylori Infection and reflux esophagitis in the elderly.Methods In a prospective study,180 cases of elderly patients with confirmed diagnosis of reflux esophagitis were consecutively recruited in our hospital from 2010-2016 years.180 reflux esophagitis patients were divided into three groups:non-HP infection group(group A,n=78),and 102 HP infection patients were subdivided into B1 group(n=51)with single-drug therapy and B2 group(n=51)with multiple drugs therapy.The groups A and B1 were treated with only esomeprazole 20 mg/bid for 8 weeks.The group B2 was treated with esomeprazole 20 mg/bid for 8 weeks,colloidal bismuth 200 mg/bid for 2 weeks plus two kinds of antibiotics(taking any 2 of the following 3:Amoxicillin 1 000 mg/bid,Clarithromycin 500 mg/bid and tinidazole 500 mg/bid)for 2 weeks.Gastroscope and cognate biopsy,helicobacter pylori detection,and 24 h esophagus pH monitoring was performed before and after the therapy.Results Group A,B1 and B2 showed that the total effective rate of symptoms improvement were more than 95.0% in post-versus pre-treatment(P<0.05),the gastro scope evidence-based total effective rate of reflux esophagitis were 84.6%、80.4%、82.4%(66/78,41/51,42/51)after therapy(P<0.05),and 24 h esophagus pH was significantly improved(P<0.05)after therapy.But the differences in above indexes showed no statistical significance between three groups(P>0.05).After HP eradication therapy,HP negative rate was 90.2%(46/51)in multiple drugs group.Conclusions Reflux esophagitis in elderly patients with Helicobacter pylori infection can be treated with anti-HP drugs,but the treatment should include drugs inhibiting gastric acid,so as to effectively prevent the progress of reflux esophagitis.There is no clear correlation between irritation of esophagus by reflux contents and Helicobacter pylori infection.

Objective To study the influence of anti-Helicobacter pylori therapy on reflux esophagitis (RE) and Barrett's esophagus (BE). Methods Two hundred and sixty-two patients including 177 patients with RE and 85 patients with BE were divided into 2 groups: Group A,139 patients without Hp infection;Group B,123 patients with Hp infection, which was further divided into 2 groups (group B1 and group B2) randomly. The pa-tients in group A and B1 were treated with Losec 20 mg bid, domperidone 10 mg tid and colloidal bismuth pectin 100 mg tid for 8 weeks, group B2 were treated with 2 kinds of antibiotics which were chosen from 3 types of antibiot-ics including amoxicillin 500 mg bid, Clarithromycin 500 mg bid or tinidazole 500 mg bid for 2 weeks additional to the same treatment as group A and B1. Endoscopy, pathologic examination, 24 h esophagus pH value and bilirubin were measured before and after treatment. Results The overall rates of improvement on symptoms in the 3 groups were 95.0% (group A: 97.8% (136/139), group B1: 96.8% (60/62), group B2: 98.4% (60/61)), which was significantly different from that before treatment (P < 0.05). However, the overall effect rates were not significantly different among the 3 groups (P > 0.05). The overall effect rate based on endoscopy examination in the RE patients 92.9% (78/84),91.8% (45/49) and 88.6% (39/44) in group A,B1 and B2,respectively,and the differences were statistically significant among the 3 groups (P <0.05). The overall effect rates in the BE patients were about 35.0%,which showed non-significant effect compared to that before treatment (P >0.05). 24 hrs esophagus PH value and bilirubin were significantly improved in the 3 groups (P < 0.05), whereas the difference among the 3 groups were not significant (P > 0.05). Conclusions RE and BE patients with HP infection could be treated with anti-Helicobacter pylori therapy. However, systematic therapy of anti gastric acid, prokinetics and mucosa protector must be performed simultaneously. This might be effective in preventing the development of RE and BE in short term. The long term effect is still uncertain and large scale, long term clinical studies are needed.