Objective To study the influence of continuous blood purification(CBP)on the intra-abdomi-nal pressure (IAP ) and the gastrointestinal dysfunction of intra -abdominal hypertension (IAH ).Methods 80 patients with IAH were selected and divided into observation group and control group(n=40)according to random number table method.The observation group was given 3d CBP therapy.The control group was given conventional treatment.The mean arterial pressure (MAP ),IAP and abdominal perfusion pressure (APP ) were detected.The number of gastrointestinal symptoms was observed,sequential organ failure score(SOFA score)was used to assess the organ function of the two groups before and after treatment.Results The MAP,IAP,APP,SOFA score of the two groups before treatment had no statistically significant differences(P>0.05).The MAP of the two groups after treat-ment[(88.46 ±8.93)mmHg vs.(87.76 ±8.04)mmHg]had no statistically significant difference(P>0.05).The IAP[(9.02 ±1.06)mmHg]and SOFA score[(1.32 ±0.45)]of the observation group after treatment were signifi-cantly lower,the APP [(85.34 ±7.59)mmHg]was obviously higher than before treatment and the control group [(19.54 ±4.23)mmHg,(5.24 ±2.05)points,(70.76 ±6.43)mmHg],the differences were statistically significant (t=3.575,2.855,3.274,3.563,3.114,3.782,all P<0.05).Before treatment,the number of the gastrointestinal symptoms of the two groups[(44.56 ±8.53)times vs.(45.32 ±8.21)times]had no statistically significant difference (P>0.05).The number of gastrointestinal symptoms of the observation group after treatment [(6.54 ±2.24)times] was obviously lower than before treatment and the control group [(15.45 ±4.43)times],the difference was statisti-cally significant(t =3.022,P<0.05 ).The 30 d and 60 d survival rates of the observation group were 87.5%(35/40)and 65%(26/40),which of the control group were 80.0%(32/40)and 55%(22/40),although which of the observation group were higher than the control group,but there were no statistically significant differences(P>0.05 ).Conclusion CBP could significantly reduce the IPA of the patients with IAH,raise the APP,improve gastro-intestinal perfusion,reduce gastrointestinal symptoms,has positive significance to improve the gastrointestinal dysfunction.

Objective To evaluate the safety and effectiveness of capsule endoscopy(CE) in a large cohort of the elderly patients with obscure gastrointestinal bleeding(OGIB). Methods The demographic, clinical and diagnostic data of all geriatric patients with obscure gastrointestinal bleeding who underwent CE between May 2002 and February 2007 were retrospectively analyzed. For comparison, non-geriatric patients with obscure gastrointestinal bleeding who underwent CE during the same period were selected as the control group. Results Ninety-seven geriatric patients [40men/57 women, mean age (70.84-6.8) yrs]and ninety-nine non-geriatric patients [61 men/38women, mean age (44. 4±10. 3) yrs)were retrospectively reviewed. Eighty-nine patients presented with overt OGIB while eight patients had occult OGIB in the geriatric group. The section in the nongeriatric group was ninety-one and eight respectively. No significance was seen in the gastric transit time, completion rate and delay rate between two groups. The small bowel transit time was significantly longer in the geriatric group than that in the non-geriatric group (P<0. 05). Sixty-two patients in the geriatric group obtained positive diagnosis and angiodysplasia was the most frequent lesion;while sixty-seven patients in the non-geriatric group obtained positive diagnosis and Crohn's disease was the most frequent lesion. No significance was seen in the positive diagnostic rate between two groups (P>0. 05). However, the constituent ratio of the positive diagnosis was significantly different between two groups (P<0. 01). Conclusions CE is a safe and effective procedure for geriatric patients with obscure gastrointestinal bleeding. Angioectasia accounts for the majority of positive findings in geriatric group.

objective To analyse the incidence of technical breakdown and clinical problem leading to the failure of capsule endoscopy examination and their influence on the diagnosis and to evaluate its feasibility and safety in special patient population.Methods A retrospective study of 300 consecutive patients referred to Renji Hospital for evaluation of suspected small bowel diseases between May 2002 and May 2006 was done.This included 300 consecutive patients.The median age of the patients was 51y (range,3～91Y).The young children group was defined as less than 10 years and the elderly group as more than 80 years.Technical problems were those related to the functioning of the equipment and clinical problems were those related to the patient.The incidence and the type of above-mentioned events and their influence on the diagnosis were analyzed.The safety and feasibility of the capsule endoscopy procedure were evaluated in the young children group,elderly group and patients with pacemakers,gastrectomy and Billroth Ⅱ gastrojejunostomy,intestinal diverticula,Crohn's disease and polyp of small intestine.Results A total of 300 patients were involved.The incidence of technical problems was 1.3%.including one case of failing in activating the capsule,one case of failing in loading the data and two cases of short life of battery.Failure of diagnosis was encountered in two cases.The incidence of clinical problems was 33.0%(99 cases)and they caused 35.4%(35 cases)failure of diagnosis in the 99 cases.Three patients in the young children group were unable to swallow the capsule and endoscope-guided overtube technique was used with success in all.In the elderly group.the incidence of capsule retaining in the oesophagus and stomach was as high as 23.0%.In two patients with pacemaker no interference between pacemaker and capsule was detected.In two patients with Billroth Ⅱ gastrojejunostomy uo capsule retention occurred.In 16 patients with diverticulum,capsule retention occurred in 1 case(6.0%).In 42 patients with Crohn's disease,capsule retention occurred in 5 cases.No acute gastrointestinal obstruction was found in the 42 patients with Crohn's disease and in 5 patients with polyp of small intestine.Conclusions With capsule endoscopy technical mistakes causing failure were very rare.The majority of the clinical problems were related to the inability capsule to reach the colon during the recording time.Capsule endoscopy provides a well-tolerated,safe and effective tool to investigate the gastrointestinal diseases.especially some small bowel diseases.

Objective To explore the mediating effects of rumination and its subtypes on the relationship between negative life events and depressive symptoms in treatment-naive depressed patients.Methods Sixty-two treatment-naive depressed patients completed the center for epidemiologic studies depression scale (CESD),rumination response scale (RRS),and life event scale (LES).Results ① The scores of CESD were positively correlated with total score of RRS,brooding score of RRS,and negative LES score (NLES) in depressed patients (r=0.66,P＜ 0.01;r =0.50,P＜ 0.01;r =0.51,P＜ 0.01).The total score of RRS and brooding score of RRS were positively correlated with NLES(r=0.45,P＜0.01;r=0.47,P＜0.01).② The total score of RRS played a mediating role between NLES and CESD (indirect effect=0.12,95％ CI =0.04 ～ 0.23).③The brooding of RRS played a mediating role between NLES and CESD (indirect effect =0.07,95％ CI=0.02～0.15).Conclusion The RRS and the brooding of RRS exert mediation effects on the relationship between NLES and CESD in patients with depression.

Objective To evaluate the effects of capsule endoscopy in the diagnosis and prognosis of small bowel tumors.Methods Three hundred and fifty-eight consecutive patients who underwent capsule endoscopy for suspected small bowel disease during May 2002 to Feb.2007 were examined.The final diagnosis was confirmed pathologically.Results Thirty-three(9.22%) out of 358 patients were identified as small bowel tumors[male 14/female 19,mean age(51?17)years].Of them,23(69.70%) patients had malignant tumors and ten(30.30%) had benign tumors.Obscure gastrointestinal bleeding were found in 26 cases,bleeding with abdominal pain in 2 cases,bleeding with diarrhea in 1 case,abdominal pain in 2 cases,abdominal pain with diarrhea in 1 case and vomiting in 1 case.All patients with benign tumors underwent surgery for their tumor.No further bleeding or abdominal pain after resection was found in all but one patient.Of the patients with malignant tumors,all expect two underwent surgery.Three patients accepted palliative surgery while eighteen patients received a curative resection.The locations of the tumor detected by capsule endoscopy were correlated well with the results of surgery.Conclusions Capsule endoscopy promises a higher diagnostic yield in small bowel tumors. h may improve the diagnosis of small bowel tumors and alter management thoroughly.