Objective To investigate the clinic and endosoopic features of left-sided portal hypertension ( LSPH). Methods Eight patients with left-sided portal hypertension were analyzed retrospectively. Results The main manifestations of patients with LSPH were hematemesis, hematochezia, splenomegaly and hypersplenism. The patients have the features of pancreatic disease, but without the evidences of hepatic disease. Solitary gastric varices account for 62. 5% , both gastric and esophageal varices account for 37. 5% . The patients with features of LSPH often mislead to diagnose as blood diseases or portal hypertension resulted from hepatic cirrhosis. Conclusions Pancreatic diseases may lead to portal hypertension, solitary gastric varices were the important evidence of left-sided portal hypertension.

Objective To compare the effectiveness and adverse effects among three groups of patients with esophageal achalasia treated with small balloon dilation and/or intrasphincteric injection of botulinum toxin. Methods Forty-eight patients were divided randomly into three groups, A, B, and C, treated with small balloon dilation, intrasphincteric injection of botulinum toxin, and combination of these two respectively. At 1 week, 3 months and 1 year after treatment, the clinical scores, lower oesophageal sphincter-ic pressure, and lower oesophageal sphincteric relax rate in three groups were compared. Results At 1 week, 3 months and 1 year after treatment, the effective rates and gaps of pre - and post - treatment LESP and LESRR were higher in group B and C than those in group A. There were no differences between BT group and combination group at 1 week and 3 months, but in 1 year after treatment the effective rates and gaps of LESP and LESRR in combination group were higher than those in BT group. Complications never happened in all groups. Conclusion The combination of small balloon dilation and intrasphincteric injection of botulinum toxin was the effective procedure with the advantages of lasting longer time, less complications and milder chest pain.

[Abstract] Objective To evaluate the clinical and endoscopic manifestations of abdominal type allergic purpura in adult patients as the evidences in reaching early diagnosis. Methods The clinical and endoscopic manifestations of 32 patients with abdominal type allergic purpura were analyzed retrospectively. Re-SllltS All the patients complained of paroxysmal abdominal colic, 59. 4% patients complained of nausea and vomiting, 50% patients had hematochezia and haematemesis, the occult blood test was positive in all patients, and 25% patients had elevated level of amylase in the blood and urine. Purpura was found in 2-10 days after the presentation of abdominal pain. Endoscopy found hyperaemia, edema, bleeding spots, erosion and ulcer in gastroenterologic mucosa. Duodenal, ileum and caecum had more severe mucous lesions, but the esophageal mucosas in all patients were normal. The clinic and endoscopic misdiagnosis rates were 87.5% and 85.7% respectively. Glucocorticoids were the especially effective medicine in its treatment, while those agents for relieving spasm or antacids were ineffective. Conclusion Many scattered bleeding spots and snow flower-like ulcers on the gastrointestinal mucosa are the most important findings in adult abdominal type allergic purpura patients. Clinic manifestations of these patients are very severe abdominal colic in indefinite sites and merely with mild abdominal objective signs is the important characteristic feature.

Objective By analyzing the clinical symptoms, heart rate ( HR) , arterial oxygen saturation ( SaO2 ) and the number of white blood cells (WBC), we aimed to explore the implication of the above-mentioned indexes for early warning of high altitude pulmonary edema ( HAPE) .Methods Based on the Lake Louise Self-assessmeat Scoring System ( LLSS) and the scoring of respiratory symptoms, 628 subjects were divided into three groups: group A ( the healthy;score<3),group B(acute mountain sickness, AMS; score>3 and excluding HAPE),and group C (HAPE).Moreover, we analyzed the incidence of some clinical symptoms, HR and SaO2 , as well as the WBC number of some subjects in the three groups.Results The incidence of respiratory symptoms and WBC number were significantly increased in group C compared with group B(P<0.05).In addition,unlike group A and B, the mean HR in group C rose gradually in the first 3 days and was markedly increased at the third day(F=6.37,P<0.05).The mean SaO2in group C was remarkably lower than in group A and B in the first 3 days(F=8.21,F=8.77,F=9.58,P<0.01).Conclusion Those who enter high altitude for the first time with notable respiratory symptoms, WBC increase, HR maladaptation and decrease in SaO2 (>30%) have high risk of HAPE.It is of special importance to detect HAPE earlier at high altitude.

Objective To investigate the clinical features, diagnosis and treatment of heterotopic pancreas in gastrointestinal tract. Methods A total of 60 cases of heterotopic pancreas in gastrointestinal tract diagnosed through endoscopic ultrasonography and pathological examination were treated in our hospital in the recent 10 years. Their data were retrospectively analyzed. Results Among all the 60 patients, the lesions were located in duodenal bulb cavity in 3 cases, in duodenal descendent in 2 cases, in gastric angle in 3 cases,in the junction of gastric antrum and corpus ventriculi in 2 cases and in gastric antrum in 50 cases. All of the 60 patients were definitely diagnosed through endoscopy, endoscopic ultrasonography and pathological examination. 28 patients were treated by endoscopic high-frequency electronic resection, 2 patients were treated by endoscopic mucosal resection (EMR), 30 patients were treated by surgical operation; no operative complication was found, and satisfactory clinical effects had been observed in these patients. Conclusions Endoscopic ultrasonography has great value in the diagnosis and endoscopic therapy of heterotopic pancreas in gastrointestinal tract. It can provide the guide for the choice of treatment. Minimally invasive endoscopic treatment is safe and effective for heterotopic pancreas and has great clinical value.

ObjectiveTo explore the diagnostic value of Tei index of right ventricle and serum level of NT-proBNP in patients with high-altitude heart disease (HAHD).MethodsRight ventricle Tei index and serum NT-proBN level were calculated and tested in 32 local healthy volunteers and 34 cases of HAHD patients hospitalized in our hospital in Golmud city (2808 meters above sea level) from 2008 to 2010,and a correlation study was conducted thereafter.ResultsThe pulmonary arterial systolic pressure and right ventricle Tei index,elevated significantly in HAHD patients compared with the control group [(86.61 vs 9.72)mm Hg(1 mm Hg=0.133 kPa) and(0.90 vs 0.33)respectively,P＜0.05].Patients diagnosed as mild pulmonary hypertension without alteration in cardiac structure showed higher pulmonary arterial systolic pressure and the Tei index compared with the control group [( 57.1 vs 9.72 )mm Hg and (0.78 vs 0.33 ) respectively,P ＜ 0.05 ].In addition,the level of serum NT-proBNP was significantly higher in HAHD group than that of control group [( 1246.8 ± 512.6) ng/L and (98.6 ± 21.7 ) ng/L respectively,P ＜ O.05 ].ConclusionRight ventricle Tei index and serum NT-proBNP level are sensitive indicators for right ventricular function and thus of favorable clinical significance for the diagnosis of HAHD.

OBJECTIVETo evaluate the effect of endogenous nitric oxide (NO) on the ability of 5-fluourouracil (5-FU) to induce apoptosis in the liver carcinoma Bel7402 cell line, and to observe the anti-tumor mechanism and effective adjuvant of 5-FU.

METHODSCells were cultured under routine conditions with Dulbecco's modified Eagle's medium (DMEM) without L-Arginine (L-Arg). We observed the expression of inducible nitric oxide synthase (iNOS) and apoptosis of cells induced by 5-FU with L-Arg added to the medium. The production of nitric oxide was determined by the cell expression of iNOS detected by immunohistochemical staining, and by the concentrations of nitrite and nitrate in the supernatant.

RESULTS5-fluourouracil significantly increased the iNOS expression to 0.1687 +/- 0.01968 (P < 0.05, vs control group), and the concentration of nitric oxide to 213 +/- 30.2 micromol/L (P < 0.05, vs control group). The apoptotic cell rate increased significantly to 17.85 +/- 0.78%, while the necrotic cell rate decreased to 3 2.99 +/- 0.83% (P < 0.05,compared with the 5-FU group). N(omega)-nitro-L-Arginine methyl ester (L-NAME), the antagonist of L-Arg, can block the apoptotic effects of endogenous nitric oxide.

CONCLUSIONS5-FU had a synergistic effects with L-Arg by increasing the production of endogenous nitric oxide. Endogenous nitric oxide plays an important role in the process where 5-FU induces apoptosis in liver carcinoma cells. L-Arg may be a good adjuvant for chemotherapy with 5-FU.

Antimetabolites, Antineoplastic ; pharmacology ; Apoptosis ; drug effects ; Arginine ; pharmacology ; Fluorouracil ; pharmacology ; Humans ; Immunohistochemistry ; Liver Neoplasms ; pathology ; Nitric Oxide ; biosynthesis ; Nitric Oxide Synthase ; analysis ; Nitric Oxide Synthase Type II ; Tumor Cells, Cultured

Objective:To compare the clinical efficacy of percutaneous transhepatic choledochoscope lithotomy (PTCSL) with laparoscopic choledocholithotomy (LD) in treatment of choledocholithiasis.Methods:Data of 132 patients with choledocholithiasis treated at the First Affiliated Hospital of Guangzhou Medical University from July 2012 to December 2018 were retrospectively analyzed. There were 75 males and 57 females, with an average age of 62.7 years. For 76 patients underwent PTCSL (the PTCSL group) and 56 underwent LD (the LD group). The data of the patients the success rate of lithotomy, stone residual rate, operation time, postoperative complications and stone recurrence, chronic cholangitis, and acute cholangitis 1 month after operation were compared between the two groups.Results:The ratio of upper abdominal operation history and biliary tract infection in the PTCSL group was higher than that in the LD group, and the difference was statistically significant (both P<0.05). In the PTCSL group, the calculi were successfully removed in 64 patients in one treatment session, while residual calculi were removed through subsequent sinus choledochoscopy in 9 patients. In the remaining 3 patients, the residual calculi were removed with LD or laparotomy operations. Postoperative complications occurred in 14 patients (19.2%, 14/73). In the LD group, the calculi were successfully removed in one session in 46 patients while in 8 patients the residual calculi were removed by choledochoscopy (1 patient still had residual calculi after choledochoscopy). The remaining 2 patients underwent open surgery due to anatomical difficulties. Postoperative complications occurred in 11 patients (20.4%, 11/54). There were no significant differences between the two groups in the one-off stone removal rate, postoperative stone residual rate, final stone removal rate and postoperative complication rate (all P>0.05). The operation time of the PTCSL group was (156±60) min, which was significantly shorter than the LD group (203±59) min ( P<0.05). There was no significant difference between the two groups in the incidence of postoperative chronic cholangitis and recurrence rate of calculi (both P>0.05). The incidence of acute cholangitis in the PTSCL group was significantly higher than that in the LD group ( P<0.05). Conclusion:PTCSL was as safe and effective as LD, with fewer complications and faster recovery. It is especially suitable for patients with previous upper abdominal surgery, recurrence of calculi and repeated biliary tract infection.

Objective To investigate the curative effect on patients with choledocholithiasis by percutaneous transhepatic rigid choledochoscope lithotomy (PTCSL) vs endoscopic retrograde cholangiopancreatography (ERCP) plus EST.Methods From Jan 2010 to Dec 2015,92 cases of choledocholithiasis were treated by one-stage PTCSL (n =23) vs ERCP (n =69).The curative effects and postoperative complications in two groups were observed and analyzed.Results In PTCSL group,the complete stone clearance at one-time achieved in all 23 cases (100％).While in ERCP group stone clearance was achieved in 72.46％ cases at first attempt and the final clearance rate was 82.60％,leaving 12 cases with residual stones and among those 12 cases 5 cases were converted to surgical operation.The average intra-operative hemorrhage in two groups was (20.6 ± 4.6) ml vs (3.0 ± 0.3) ml,and the average hospital stay after operation was 6.8 d and 7 d respectively.The post-operative complications (30.43％) and stone recurrence (13.04％) were similar in the two groups.Conclusions PTCSL is safe,effective,and more suitable to patients with large stones and those with a history of biliary surgeries.

Objective: To analyze the correlation between refractive errors and physical development indicators among primary school students aged 6 to 9, so as to provide a scientific basis for the development of effective prevention and control measures. Methods: A stratified cluster random sampling method was used to recruit 2 833 elementary school students aged 6 to 9 from Guangdong Province for vision screening, ocular biometry, and physical examinations in Octorber, 2020. The Chi square test, t-test, and ANOVA were employed to compare myopia rates and indicator values across different groups. Multiple linear regression models were used to analyze the correlations between height, weight, and body mass index (BMI) with refractive development indicators. Results: The screening myopia rate among primary school students aged 6 to 9 was 16.7%, and the myopia rate increased with age ( χ 2= 51.58 , P <0.01). The height and weight of the myopic group [(126.96±7.41)cm, (26.59±6.45)kg] were higher than those of the non myopic group [(124.76±7.77)cm, (25.42±5.87)kg] ( t =5.84, 3.65, P <0.01). The mean values of spherical equivalent (SE), axial length (AL), anterior chamber depth (ACD), and AL/corneal curvature radius (CR) ratio for students aged 6 to 9 were (-0.17±1.04)D, (22.96±0.78)mm, (3.38±0.24)mm, and (2.95±0.08), respectively, with statistically significant differences across different age and myopia severity groups ( t =37.08, 119.20, 41.54, 133.60; 935.30, 184.10, 73.95, 498.50, P < 0.01). After adjusting for gender, age, and residence, the multiple linear regression model showed that height was positively correlated with AL and CR, weight was positively correlated with ACD, and BMI was positively correlated with AL and ACD ( β = 0.191 , 0.070, 0.035, 0.013, 0.007, P <0.05). When stratified by myopia status, results for the non-myopic group were similar to the overall results, whereas in the myopic group, the correlations between height, BMI, and AL were not statistically significant ( P > 0.05). Conclusions Among primary school students aged 6 to 9, height and BMI are positively correlated with AL in the non myopic group but no similar correlation is observed in the myopic group, indicating that factors other than physical development, such as environmental and behavioral factors, should be considered for their impact on refractive development.