Objective To investigate the clinical effects of peroral endoscopic myotomy (POEM) in the treatment of achalasia of cardia. Methods Clinical data of 27 cases who were diagnosed with achalasia of cardia recived POEM from May 2014 to March 2016 were collected retrospectively. The surgical results, before and after POEM, parameters measured by esophageal manometry and complications after POEM and during follow-up were analyzed. Results POEM were successful 100.0% in the 27 patients. There was 1 case of subcutaneous emphysema, 1 case of aeropleura symptoms were significantly improved in all patients who had successful POEM; parameters measured by esophageal manometry were also improved obviously (P < 0.05). Conclusion POEM has appreciable short-term effects in the treatment for achalasia of cardia, and it can be relieve dysphagia and other adverse symptoms in postoperation, but the long-term efficacy and complications need further follow-up observations.

Background and purpose:Previous studies have suggested Na+-Ca2+ exchanger isoform 1 (NCX1) as a key component of calcium homeostasis was involved in the tumorigenesis. However, the role of NCX1 and calcium signal in tumorigenesis of hepatocellular carcinoma (HCC) has not been explored. This study aimed to investigate the effect of NCX1 on cell proliferation and migration of HCC HepG2 cells in vitro and the possible mechanism.Methods:Both the real-time fluorescent quantitative polymerase chain reaction (RTFQ-PCR) and Western blot were applied to assess the expression of NCX1 mRNA and protein in normal hepatic cells (LO2), HCC cell line (HepG2), human normal hepatic tissues and hepatocellular carcinoma tissues. The change of intracellular calcium signal in LO2 and HepG2 cells via acti-vated NCX1 channel in the presence or absence of Na+ was examined by a confocal laser scanning microscope. The effects of NCX1 special inhibitor KB-R7943 on cell proliferation and migration of HepG2 cells were measured by MTT and cellscratch test.Results:Both mRNA and protein expression of NCX1 were higher in HCC tissues and cell line HepG2 than in the normal tissues and cell line LO2 (P<0.05). The activation of NCX1 channel induced a slight rise in cytoplasmic Ca2+concentration ([Ca2+]cyt) in normal cells, but caused a marked increase in cancer cells. And the NCX1 activation induced intracellular calcium increase was significantly reversed by NCX1 inhibitor KB-R7943 (P<0.05). Both NCX1-mediated proliferation and migration of HepG2 were also significantly attenuated by the KB-R7943 (P<0.05).Conclusion:NCX1 is up-regulated in HCC cells and tissues. The activation of NCX1 mediates intracellular calcium homeostasis. The inhibition of NCX1 activity can suppress the proliferation and migration of HepG2 cells. It is suggested that NCX1 may be involved in the development and progression of HCC.

Objective:To explore the efficacy and safety of endoscopic injection of polidocanol combined with low-dose tissue glue occlusion in the treatment of F3 esophageal varices in liver cirrhosis.Methods:Retrospective analysis was made on 42 patients with cirrhosis type F3 esophageal varices admitted to the Affiliated Hospital of Zunyi Medical University from January 2020 to June 2021. According to different treatment methods, they were divided into the observation group and the control group, with 21 cases in each group. The observation group received endoscopic injection of polidocanol combined with low-dose tissue glue occlusion, while the control group received endoscopic injection of polidocanol. The differences in the effectiveness (remission rate of varices) and safety (incidence of intraoperative bleeding and postoperative rebleeding, incidence of ectopic embolism, incidence of esophageal ulcer, incidence of esophageal perforation, incidence of esophageal stricture) of the two groups of patients were compared.Results:The total effective rate of relieving esophageal varices in the observation group was significantly better than that in the control group [95.2%(20/21) vs 61.9%(13/21), χ 2=6.929, P=0.008]. There were no cases of ectopic embolism in both groups; The intraoperative bleeding rate in the observation group was 4.8% (1/21), significantly lower than the 38.1% (8/21) in the control group (χ 2=6.929, P=0.008); There was no statistically significant difference in postoperative rebleeding rates between the two groups [33.3%(7/21) vs 23.8%(5/21), χ 2=0.467, P=0.495]; The incidence of esophageal ulcers in the observation group was higher than that in the control group [23.8%(5/21) vs 0, χ 2=5.676, P=0.017], mainly caused by glue discharge ulcers; There were no cases of esophageal perforation and esophageal stricture in both groups. Conclusions:Endoscopic injection of polidocanol combined with low-dose tissue glue occlusion for the treatment of F3 esophageal varices in liver cirrhosis is safe, can greatly reduce the occurrence of intraoperative bleeding, and has a better one-time variceal eradication effect.

Objective: To study the effects of estrogen on bicarbonate secretion of duodenal mucosal, and to observe estrogen receptor (ER) subtypes of estrogen. Methods: Sixteen 4-week-old male C57 mice were divided into control group and estrogen group, with eight mice in each group. The mice serum level of estrogen was detected by chemiluminescence. The expression of cystic fibrosis transmembrane conductance regulator (CFTR), solute carrier family 26 (SLC26) A3 and SLC26A6 in the duodenum tissues were determined by real-time polymerase chain reaction (RT-PCR). After SCBN cells treated with estrogen, ERα and ERβ blocking agent, and transfected with silenced ERα and ERβ for 24 and 48 hours, the expression levels of CFTR, SLC26A3 and SLC26A6 mRNA in cells were detected by RT-PCR. The effects of estrogen before and after silenced ERα and ERβ on bicarbonate secretion of SCBN cells were observed by high-speed ion imaging system. T test and rank sum test were used for statistical analysis. Results: Compared with that of control group, the serum estrogen level of estrogen group was significantly high ((4 874±942) pmol/L vs. (657±187) pmol/L, t=-11.579, P<0.01). The expression levels of CFTR, SLC26A3 and SLC26A6 mRNAs in duodenum tissues of estrogen group were higher than those of control group (0.856±0.302 vs. 0.452±0.246, 2.910±1.680 vs. 1.120±0.540, 1.272±0.667 vs. 0.319±0.114), and the differences were statistically significant (t=-2.317, -2.483 and -3.721, all P<0.05). Compared with those treated with estrogen for 24 and 48 hours, the levels of CFTR mRNA and SLC26A6 mRNA were lower after the ERβ blocking agent were added into estrogen for 24 and 48 hours (CFTR mRNA: 0.171±0.059 vs. 0.522±0.260 and 0.111±0.014 vs. 0.578±0.297; SLC26A6 mRNA: 0.486±0.289 vs. 1.118±0.571 and 0.492±0.231 vs. 1.551±0.605), and the differences were statistically significant (t_{CFTR mRNA}=2.974 and 2.655, t_{SLC26A6 mRNA}=2.393 and 3.272; all P<0.05). Compared with those of silenced ERα group, the levels of CFTR mRNA, SLC26A3 mRNA and SLC26A6 mRNA were higher after ERα silenced and then added estrogen for 24 and 48 hours (24 h: 5.073±2.270 vs. 1.185±0.494, 1.796±1.168 vs. 0.468±0.108 and 3.085±1.357 vs. 0.706±0.347; 48 h: 5.025±1.998 vs. 1.185±0.494, 1.557±0.653 vs. 0.468±0.108 and 3.290±1.750 vs. 0.706±0.347), and the differences were statistically significant (t_{24 h}=-4.122, -2.773 and -4.162, t_{48 h}=-4.604, -4.034 and -3.250; all P<0.05). Compared with that of silenced ERα group, the bicarbonate secretion increased after ERα silenced and then added estrogen for 24 and 48 hours (0.72±0.17 and 1.15±0.25 vs. 0.35±0.17), and pH also elevated, and the differences were statistically significant (t=-6.516 and -12.387, both P<0.01). Conclusion Estrogen mainly up-regulates the expression of bicarbonate transporter protein in duodenal mucosal epithelial cells through ERβ, and promotes the bicarbonate secretion of duodenal mucosa.

Erythropoietic protoporphyria(EPP)is an inherited metabolic disease caused by the deficiency in ferrochelatase(FECH)encoded by the FECH gene,and it is inherited in an autosomal recessive manner.EPP usually produces acute pain photosensitivity after exposure to sunlight in infancy or early childhood,and liver failure is the most serious associated complication.This article reported an adult female case of EPP complicated with thyrotoxicosis and liver dysfunction which is a rare condition.The patient's liver function improved after liver protection treatment,her thyroid function returned to normal,and her EPP symptoms improved significantly.Moreover,the c.286C＞T gene mutation may be the pathogenic locus of EPP.For patients with abnormal liver function,the possibility of EPP should be considered after the common causes are excluded,and FECH gene detection should be done to confirm the diagnosis in time.When EPP is associated with thyrotoxicosis and liver dysfunction,priority may be given to hepatoprotective therapy.