Objective To determine the prevalence of gastroesophageal reflux disease (GERD) in patients with idiopathic pulmonary interstitial fibrosis (IPIF). Methods From December 2006 to January 2008, 24 consecutive patients with IPIF admitted to Beijing Chaoyang Hospital underwent 24-hour esophageal pH monitoring and esophageal manometry. Meanwhile, 23 patients with diffuse parenchymal lung disease (DPLD) (excluding IPIF) admired to the hospital in the same period served as a control group. Comparison of the prevalence of pathologic esophageal acid exposure GERD symptoms, and ineffective esophageal motility (IEM) between the two groups was made. In this study, nocturnal acid exposure is defined as acid reflux episodes occurring from 10pro to 6am. Results (1) 16 out of the 24 (66. 7%) patients with IPIF were demonstrated to have pathologic esophageal acid exposure; the prevalence of GERD in IPIF patients was significantly higher than that in other DPLD patients, whose prevalence was 26. 1% (P<0.05); (2) 87.5% patients with IPIF and GERD (GERD-IPIF) had nocturnal acid exposure episodes; (3) only 37.5% of the GERD-IPIF patients was found to have typical GERD symptoms such as heartburn and regurgitation; (4) The prevalence of IEM was similar in IPIF and other DPLD patients, being 42.9% and 39. 1% respectively (P >0. 05). Conclusions IPIF patients have higher prevalence of GERD and most of them usually do not show typical reflux symptoms. It is hereby suggested that IPIF patients should be screened with pH monitoring for GERD.

[Objective] To purify and characterize a novel factor X activator,Fve-1 from Daboia russelli siamensis (Myanmar) venom.[ Methods]F V e-1 was purified by ion-exchange chromatography and gel filtration.The hemostatic activity of F V e-1 was determined based on chromogenic substrates.The fibrinogen-clotting activity of F V e-1 was also determined.Thermal stability, pH stability,enzyme activity,and inhibition of F V e- 1 were determined by its remaining procoagulant activity.N-treminal sequence was determined by the method of automated Edman degradation.[ Results ]F V e-1 was achieved by chromatography with a molecular weight of 13,808 and an isoelectric point of 4.6. The hemostatic activity of 0.5 mg Fve-1 was equal to that of 1.5625 u thrombin or that of 54.93 ng RVV X. F V e-1 primarily activated F X, but did not affect on prothrombin and fibrinogen. The suitable pH and temperature range of F V e-1 was 6.5-7.5 and 25-60 ℃,respectively.The activity of F V e-1 was enhanced by Ca2+ and inhibited by EDTA and DTT.The N-terminal sequence of F V e-1 was NH2-N-L-Y-Q-F-G-E-M-I-N.[Conclusion] F V e-1 is a factor X-activating enzyme,which could activate FX to FX a,but have minimal effect on prothrombin and fibrinogen.

Objective To investigate the relationships between level of serum ferritin(SF)/blood lipid and the degree of coronary artery stenosis in elderly patients with acute coronary syndrome(ACS),and evaluate the value of SF in the diagnosis of coronary heart disease. Methods ①One hundred and twenty-five elderly patients with ACS(65 males,60 females)underwent coronary angiography examination,and the total cholesterol(TC), triglycerides(TG),high-density lipoprotein(HDL-C),low density lipoprotein(LDL-C)and SF were determined;according to the results of coronary angiography,the degree of coronary artery stenosis was obtained by using the Gensini score and the degrees of severity of stenosis were divided into three groups:light(42 cases),medium (45 cases)and severe(38 cases). The differences in levels of SF and blood lipids among the three groups were observed,and the relationships between the level of SF/blood lipids and various degrees of coronary artery stenoses were analyzed.②The elderly patients with ACS were divided into two groups,male and female,to compare the SF numerical value and Gensini score between the two groups. ③The SF numerical value and Gensini score of 65 senile male cases with ACS were compared to those of 60 middle aged male cases with the same disease. Results ①Variance analysis showed that SF,TC,LDL-C distribution had significant differences among light,medium and severe groups〔SF(μg/L):147.287±73.838,162.313±94.882,290.421±194.501;TC(mmol/L):4.423±0.900,4.998±0.740, 5.032±1.009;LDL-C(mmol/L):3.150±0.799,3.439±0.839,3.902±1.053,all P<0.01〕,while TG,HDL-C distribution among these groups had no such statistically significant differences(all P>0.05);in elderly patients with ACS,SF was positively correlated with Gensini score(r=0.355,P=0.000),while there was no correlation between Gensini score and any one of the following lipids:TC,TG,LDL-C,HDL-C(r=0.090,-0.170,0.256,-0.060,P=0.532,0.092,0.089,0.537).②The comparisons of SF value and Gensini score between senile male and senile female patients with ACS showed no significant differences(all P>0.05).③The comparisons of SF value and Gensini score between senile and middle aged male patients with ACS also showed no significant differences(all P>0.05). Conclusion The occurrence of ACS has certain correlation with SF and lipids,the degree of severity in coronary artery lesion is associated with SF,and there are no differences in age and sex in relation to the value of SF in the diagnosis of ACS.

Objective To explore the effect of atorvastatin application on serum ferritin(SF)levels in elderly male patients with acute coronary syndrome(ACS)and its clinical significance. Methods 120 elderly male patients treated in Department of Cardiology in Cangzhou People's Hospital were randomly divided into treatment group and control group(60 cases in each group). All the patients in the two groups took the standard treatment of coronary heart disease,and the patients in treatment group were additionally given atorvastatin 20 mg orally,once-daily for 1 month. After 1 month of treatment,the changes in SF and lipid levels before and after treatment were determined. Results The total cholesterol(TC),low density lipoprotein(LDL)and SF levels of the two groups after treatment were significantly decreased compared with those before treatment. After treatment,triacylglycerol (TG)was decreased,and high-density lipoprotein(HDL)was increased significantly in treatment group,while in the control group,after treatment TG was increased and HDL was decreased. Compared between treatment and control groups after treatment,the differences in SF,TC,TG,HDL and LDL levels were statistically significant〔SF(μg/L):174.33±99.87 vs. 255.66±100.34,TC(mmol/L):4.23±0.60 vs. 5.15±0.56,TG(mmol/L):1.98±0.64 vs. 2.00±1.03,HDL(mmol/L):1.13±0.14 vs. 1.09±0.22,LDL(mmol/L):2.45±0.33 vs. 3.35±0.50,P<0.05 or P<0.01〕. Conclusion In elderly male hospitalized patients with ACS,the level of SF is significantly higher than normal,after atorvastatin specification treatment,the blood fat and SF levels are significantly lower,thus the SF inducing myocardial damage may be reduced and the risk of recurrence of acute coronary events can be decreased.

ObjectiveTo investigate the safety and efficacy of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in the treatment of cirrhotic patients with gastric varices and gastric-renal shunt （GRS）. MethodsThe patients who attended Beijing Ditan Hospital， Capital Medical University， due to liver cirrhosis and gastric varices from February to June 2023 were enrolled， and all patients were confirmed to have GRS and received endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips. The primary evaluation index was alleviation or disappearance of varicose veins after surgery， and the secondary evaluation indices were surgical completion and complications. ResultsA total of 11 patients were enrolled in this study， among whom there were 7 male patients and 4 female patients， with a median age of 55 years. Of all patients， 1 had Child class A liver function， 7 had Child class B liver function， and 3 had Child class C liver function. The maximum （median） diameter of the shunt was 8 mm， and the minimum （median） diameter of the shunt was 4 mm. The median blood flow velocity of the target vessel was 11 cm/s before treatment and 5 cm/s after occlusion with metal clips. The median amount of tissue adhesive injected was 2 mL， and the amount of lauromacrogol used was 1 mL. Disappearance of blood flow signals was observed in all patients after surgery （100%）， and the success rate of surgery was 100%. No patient experienced rebleeding after follow-up for 6 weeks. Gastroscopy at 1 month after surgery showed that gastric varices were eradicated or almost disappeared in 9 patients and were alleviated in 2 patients. ConclusionEndoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips is a feasible， safe， and effective treatment method for cirrhotic patients with gastric varices and GRS.

Objective: To systematically review the barriers and facilitators affecting the implementation of clinical pathways for the clinical pathways. Methods: PubMed, Embase, CNKI, CBM, Wanfang, Cvip databases were searched to collect articles about clinical pathways implementation barriers and facilitators from inception to January 4th, 2019. The tool of confidence in the evidence from reviews of qualitative research(CERQual)was used to grade the confidence of each study. Results: A total of 43 articles from 12 countries were included.There were 8 main categories and 31 subcategories of the barriers about clinical pathways, including content of the clinical pathways, negative outcomes of clinical pathways, physicians knowledge, physicians attitude, resource availability, implementation of activities, patients factors and social factors. The first three barriers of high confidence were lacking of time, capital, equipment, staff and other resources(15 articles, 34.9%), increasing workload(14 articles, 32.6%), unrecognizing pathways(12 articles, 27.9%). There were 6 main categories and 28 subcategories of the facilitators about clinical pathways, including pathways content related, physician related, resource factor and implementation activity. The first three facilitators of high confidence were communication, education and training(25 articles, 58.1%), supporting from managers and colleagues(21 articles, 48.8%)and establishing a clinical pathway facilitation committee(17 articles, 39.5%). Conclusions The successful implementation of clinical pathways connects with its development process, aftereffect evaluation and feedback. It will be implemented effectively only by the completely and environmentally acceptable pathways design, adequate resources, effective organizational activities, continuous audit, evaluation and feedback and physicians active cooperation.

Objective To analyze the rebleeding rate in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) after endoscopic treatment of esophagogastric variceal bleeding and then assessed the risk factors of the rebleeding in the patients. Methods This study retrospectively recruited 169 hepatitis B-associated HCC patients complicated with PVTT and esophagogastric variceal bleeding treated by endoscopy in Department of Gastroenterology, Beijing Ditan Hospital from September 2008 to December 2016. Among them, 47 patients had PVTT Ⅱ, 67 patients had PVTT Ⅲ, and 55 patients had PVTT Ⅳ. Their clinicopathological and follow-up data were retrieved from the medical records and statistically analyzed. Continuous data were compared among groups using ANOVA or Kruskal-Wallis H test. Categorial data were compared among groups using Chi-square test or corrected Fisher test. The Kaplan-Meier curves and Log-rank test were performed to analyze the rebleeding rate and cumulative survival rates after treatment. The univariate multivariate Cox regression analyses were used to identify the risk factors affecting the rebleeding of patients. Results Compared with PVTT Ⅱ and Ⅲ, PVTT Ⅳ patients had a higher serum level of the direct bilirubin ( Z =6.153, P =0.046). The endoscopy treatment successfully blocked esophagogastric variceal bleeding in all patients. There was no significant difference in the rebleeding rates within six months and a year after the treatment (all P > 0.05). It was also no statistically significant difference in cumulative survival rates in six months and l-, 2-, and 3-year after the treatment in PVTT Ⅱ, Ⅲ, and Ⅳ patients (all P > 0.05). Cox multivariate regression analysis showed that hepatic encephalopathy ( HR =3.643, 95% CI : 2.099-6.325, P < 0.001), γ-glutamyltransferase ( HR =1.002, 95% CI : 1.000-1.005, P =0.029), AFP ( HR =1.000, 95% CI : 1.000-1.000, P =0.002) and numbers of tumor lesions ( HR =1.647, 95% CI : 1.011-2.684, P =0.045) were all independent risk factors for 1-year rebleeding in these PVTT patients with esophagogastric variceal bleeding after endoscopic treatment. Conclusion Endoscopic hemostasis is a feasible treatment option for HCC patients with PVTT and esophagogastric variceal bleeding. However, there was no significant difference in the rebleeding and cumulative survival rates in these patients. Furthermore, hepatic encephalopathy, γ-glutamyltransferase, AFP and numbers of tumor lesions were all independent risk factors for 1-year rebleeding in these patients.

Objective To investigate the rebleeding rate after endoscopic selective variceal devascularization (ESVD) and the predictive factors for rebleeding in patients with hepatitis B cirrhosis and esophageal variceal bleeding (EVB). Methods The patients with hepatitis B cirrhosis and EVB who attended Beijing Ditan Hospital, Capital Medical University, from October 2010 to December 2019 and underwent ESVD for the first time were enrolled, and a total of 442 patients were screened out based on inclusion and exclusion criteria. Routine clinical indices, laboratory markers, imaging findings, and endoscopic findings were compared between patients, and the patients were followed up to observe rebleeding. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to describe rebleeding and survival status, and a Cox regression analysis was used to determine the independent risk factors for variceal rebleeding. Results The 1-, 2-, 3-, 4-, and 5-year cumulative rebleeding rates after first ESVD treatment were 25.11%, 33.94%, 39.82%, 42.08%, and 45.02%, respectively. The univariate analysis showed that age, systolic pressure, duration of antiviral therapy ≥1 year, ascites, white blood cell count, neutrophil, and direct bilirubin were associated with rebleeding (all P < 0.05), and the multivariate analysis showed that duration of antiviral therapy ≥1 year (hazard ratio [ HR ]=0.504, 95% confidence interval [ CI ]: 0.357-0.711, P < 0.001) and ascites ( HR =1.424, 95% CI : 1.184-1.714, P < 0.001) were independent influencing factors for variceal rebleeding. Conclusion ESVD has a low rebleeding rate in the treatment of hepatitis B cirrhosis with EVB, and presence of ascites and a short duration of antiviral therapy are independent risk factors for rebleeding after treatment.

Background Exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) during pregnancy might affect thyroid-related hormone levels in pregnant women. However, most previous studies focused on the effects of PFAS containing 8-10 carbon atoms, and few studies have estimated the associations between PFAS with longer carbon chain and thyroid-related hormone levels. Objective To examine the associations between PFAS exposure and thyroid-related hormones in pregnant women. Methods The present study was based on the Jiashan Birth Cohort from September 2016 to April 2018. We analyzed 13 PFAS in maternal blood samples (n=781) by high-performance liquid chromatography-tandem mass spectrometry, as well as total triiodothyronine (T3), total thyroxine (T4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TG-Ab), and thyroid peroxidase antibody (TPOAb) by electrochemiluminescence immunoassay. PFAS were divided into three groups:low concentration, medium concentration and high concentration according to the tertile of their concentrations. We estimated the associations between PFAS concentrations and thyroid-related hormones in pregnant women by multiple linear regression. Results In the multiple linear regression models, a change in perfluorododecanoic acid (PFDoA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L⁻¹ change in T3, −0.15 (95%CI: −0.28, −0.02) pmol·L⁻¹ change in FT3, and −3.02 (95%CI: −5.66, −0.39) pmol·L⁻¹ change in FT4, respectively. A change in perfluorotridecanoic acid (PFTrDA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L⁻¹ change in T3. Compared with the low concentration group, the concentration of T4 in the medium concentration group of perfluorohexane sulfonate (PFHxS) increased by 6.10 (95%CI: 0.44, 11.75) nmol·L⁻¹. No statistically significant associations were found between PFAS and TSH concentration. The negative associations of PFAS with thyroid-related hormones were more pronounced in pregnant women with positive TG-Ab and/or TPOAb. Conclusion Exposure to PFAS during pregnancy may affect thyroid-related hormone homeostasis in pregnant women, and the effect is stronger in TG-Ab and/or TPOAb-positive pregnant women.