Objective To explore the effect of achalasia with temporary metal internal stent dilation on esophageal motility.Methods Twenty nine patients with achalasia were undertaken temporary metal internal stent placement under X ray control (stents were of 20 25 mm in diameters). After stent dilation 3 7 days, the stents were removed by endoscopy. We measured the lower esophageal sphincter (LES) residual pressure and carried out 24h pH value monitor on the patients, and only LES pressure with relaxation rate for 12 healthy subjects (HS). Results LES residual pressure before stent dilation were markedly higher than that after stent dilation ( P 0.05).Conclusions Temporary metal internal stent dilation shows LES pressure and higher rate of GER for achalasia

Objective To investigate cervical spinal upper motor neuron (UMN) dysfunction in patients with frail arm syndrome (FAS) by physical examination,triple stimulation technique (TST) and pectoralis tendon reflex tests.Methods Sixty-seven FAS patients,coming from Peking University Third Hospital from June 2013 to June 2016,underwent physical examination and routine electrophysiological tests.The pyramid signs,the results of pectoralis tendon reflex and TST were collected to estimate the function of cervical spinal UMN.Results On the time of diagnosis,weakness of bilateral proximal upper limbs was found in 61 patients,while weakness of unilateral proximal upper limb was found in six patients.There were 25 patients with tendon hyperreflexia,20 patients with tendon hyporeflexia and 22 patients with tendon areflexia.All the patients were pectoral muscle tendon hyperreflexia except one.UMN score of cervical region was 2.0 ± 0.5.Lower motor neuron score of cervical region was 2.0 ± O.2.The amplitude ratio of TSTtest/TSTcontrol was 78.31％ ± 6.52％.The latency and amplitude of quantitative detection of pectoralis tendon reflex was (7.80 ± 1.22) ms and (1.23 ± 0.14) mV,respectively.In the follow-up study,the tendon reflexes and the UMN score declined,the amplitude ratio of TSTtest/TSTcontrol decreased,while the lower motor neuron score increased and the latency of quantitative detection of pectoralis tendon reflex remained almost unchanged.Conclusion The results showed that there was cervical spinal UMN dysfunction in patients with FAS,and the pyramid signs were often concealed by muscle atrophy with progression of the disease.

Objective To investigate the risk factors of chylous leakage after pancreatioduodenectomy so as to find effective measures to prevent this complication.Methods A retrospective analysis was conducted on 230 patients who underwent pancreatioduodenectomy at the First Affiliated Hospital of Zhejiang University from Jun.2012 to Jun.2014.Patients with chylous leakage were identified and a 1 ∶ 2 patients in the study and the control groups were selected.The parameters for matching included tumor volume,vascular invasion,and extent of lymph node dissection.A logistic analysis was performed to identify independent risk factors of chylous leakage.Results 15 (6.5％) patients developed chylous leakage after pancreatioduodenectomy.The average hospital stay after surgery of the study group was 20.8 days,compared to 13.5 days in the control-group (P =0.004).In the study group,chylous leakage rate increased in patients with 14th and 16th group of lymph nodes dissection (80％ vs 36.7％,P =0.006).Logistic analysis showed that 14th and 16th lymph nodes dissection was an independent risk factor of chylous leakage after pancreatioduodenectomy (P ＜ 0.05,OR =6.909,95％ CI 1.593 ～ 29.958).Conclusions Chylous leakage prolonged hospitalization after pancreatioduodenectomy.Dissection of the 14th and 16th lymph node groups was an independent risk factor of chylous leakage after pancreatioduodenectomy.Careful ligation of the gastrocolic vein near the lymphatic trunk and dissection of 14th and 16th group of lymph nodes were effective interventions to reduce postoperative chylous leakage.

Objective To determine the effect and safety of metallic stents in the treatment of acute malignant colorectal obstruction.Methods From May,2000 to June,2003, self-expanding metallic stents were implanted in 15 patients with acute left colonic obstruction caused by malignancies. The postoperative remission and complications were observed.Results Stents were implanted successfully in 12 cases(80.0%,12/15).Of the 12 cases,the obstruction were all disappeared within 24h. No death or colonic perforation happened in this series. Stent migration and anal pain developed each in one case after stent implantation. Elective radical resection was performed on 8 cases after bowel preparation and supportive therapy; and stents reserved permanently in other 4 cases. Conclusions The implantation of self-expanding metallic stents is a safe and effective method for the temporary remission or permanent treatment of acute left-colonic or rectal obstruction caused by malignancies,it can instead of colostomy.

AIM: To investigate the influence of Sini decoction (SND) on the proliferation and apoptosis of rabbit abdominal aorta smooth muscle cells after ballon injury and discuss the effect of vascular smooth muscle cell's (VSMCs) proliferation and apoptosis in post-percutaneous coronary intervention (PCI) restenosis (RS) and the feasibility of SND preventing post-PCI RS. METHODS: The animal model of rabbit abdominal aorta ballon injury was set up and the therapertic group was treated with SND. The shape of proliferative and apoptotic cell were investigated by electron microscope. Immunohistochemistry staining was performed using ?-actin,PCNA and Cyclin E monoclonal antibodies. In situ Cell Death Detection Kit was used to identify apoptotic cells. Abdomial aorta angiography was operated in the 84th day subgroup and the stenosis degree was evalued by quantitative angiographic analysis. RESULTS: As compared with the control group, the therapeutic group displayed a lower proliferative percentage and a higher apoptosic percentage (P

[Objective] To explore the safety and efficacy of submucosal injection of glycerol and fructose saline in bladder tumor endoscopic submucosal dissection (BT-ESD) with a 450 nm blue laser semiconductor treatment machine in the treatment of non-muscular invasive bladder cancer (NMIBC). [Methods] Clinical data of 20 patients with bladder tumor treated with submucosal injection of glycerol and fructose saline BT-ESD via a 450 nm blue laser semiconductor treatment machine at our hospital during Nov.2023 and Apr.2024 were retrospectively analyzed.The patients included 13 males and 7 females, aged (64.95±6.89) years, tumor diameter (1.02±0.24) cm, and preoperative hemoglobin (Hb) (130.55±4.36) g/L.The operation time, Hb the next day after operation, positive rate of tumor basal biopsy, postoperative bladder irrigation time, catheter indwelling time, postoperative hospital stay, complications and recurrence rate were recorded. [Results] All operations were successful, and 28 lesions were removed.The postoperative pathological results confirmed that all cases were NMIBC, and the basal mucosa biopsies were negative.The operation time was (9.40±3.14) min, postoperative Hb (130.15±4.59) g/L, bladder irrigation time (17.70±1.34) h, catheter indwelling time 1 day, and postoperative hospital stay 1 day.There were no complications such as obturator nerve reflex, bladder perforation.There were no need for blood transfusion, no conversion to open surgery, and no secondary bleeding after operation.No tumor recurrence was found during 6-month postoperative follow up. [Conclusion] Submucosal injection of glycerol and fructose saline BT-ESD with a 450 nm blue laser semiconductor treatment machine is a safe and effective method for the treatment of NMIBC.It has advantages of whole enucleation of bladder tumor, clear basal layer, small amount of bleeding, short operation time and few complications.It can be used as a day surgery and is worthy of clinical promotion.

Objective:To study the neurophysiological features of Kennedy disease (KD) and to figure out the function of the nervous system.Methods:Subjects were recruited from the outpatient and the ward of Peking University Third Hospital from November 2010 to November 2022. Sixty patients with KD (29 patients with KD alone, 31 KD cases with the complication of diabetes mellitus) and 60 patients with diabetic polyneuropathy (DPN) were included in this study. Electrophysiological tests were performed in all subjects, including electromyogram, nerve conduction study, somaosensory evoked potential (SEP), contact heat evoked potential (CHEP) and triple stimulation technique (TST). Student′s t-tests were conducted to compare differences intra or inter groups of nerve conduction velocity and action potential of nerve conduction study, latency and interphase of SEP, initial peak latency of CHEP and other parameters. Results:Compared with the normative value, the amplitude of the sensory nerve action potential (SNAP) declined by 30%-80% in KD patients [median nerve (0.7±0.4) μV, ulnar nerve (0.8±0.3) μV, sural nerve (1.8±0.1) μV], the amplitude of the median and ulnar nerves was lower than the sural nerves ( t=2.43, P=0.010; t=2.40, P=0.010). The conduction time of peripheral segments of SEP and CHEP was prolonged by 115%-130%, while that of the central segments was prolonged by 104%-115% in SEP. TST test/TST control declined by 40%-60% in 17 patients with KD. The amplitude of SNAP declined by 30%-50% in patients with DPN [median nerve (2.9±0.5) μV, ulnar nerve (2.6±0.6) μV, sural nerve (1.6±0.2) μV], the amplitude of the sural nerves was lower than the median and ulnar nerves ( t=2.52, P=0.006; t=2.47, P=0.007). The conduction time of peripheral segments of SEP and CHEP was prolonged by 75%-112%, while that of the central segments was normal in both SEP and CHEP in DPN patients. Compared with DPN patients, the upper limb SNAP amplitude was lower in KD patients with the complication of diabetes mellitus [median nerve (0.7±0.3) μV, t=3.18, P=0.001; ulnar nerve (0.8±0.4) μV, t=3.20, P=0.001]. Conclusions:Sensory nerve is involved in patients with KD, including the large fiber and the small one. The central segments was abnormal in the deep sensory pathway, and the pyramid tract may be involved besides the anterior horn cell.

Inflammation plays an important role in the development of acute lung injury (ALI). Severe pulmonary inflammation can cause acute respiratory distress syndrome (ARDS) or even death. Expression of proinflammatory interleukin-1β(IL-1β) and inducible nitric oxide synthase (iNOS) in the process of pulmonary inflammation will further exacerbate the severity of ALI. The purpose of this study was to explore the effect of Palrnatine (Pa) on lipopolysaccharide (LPS)-induced mouse ALI and its underlying mechanism. Pa, a natural product, has a wide range of pharmacological activities with the potential to protect against lung injury. Western blotting and quantitative real-time polymerase chain reaction (qRT-PCR) assays were performed to detect the expression and translation of inflammatory genes and proteins in vitro and in vivo. Immunoprecipitation was used to detect the degree of P65 translocation into the nucleus. We also used molecular modeling to further clarify the mechanism of action. The results showed that Pa pretreatment could significantly inhibit the expression and secretion of the inflammatory cytokine IL-1β, and significantly reduce the protein level of the proinflammatory protease iNOS, in both in vivo and in vitro models induced by LPS. Further mechanism studies showed that Pa could significantly inhibit the activation of the protein kinase B (Akt)/nuclear factor-κB (NF-κB) signaling pathway in the LPS-induced ALI mode and in LPS-induced RAW264.7 cells. Through molecular dynamics simulation, we observed that Pa was bound to the catalytic pocket of Akt and effectively inhibited the biological activity of Akt. These results indicated that Pa significantly relieves LPS-induced ALI by activating the Akt/NF-κB signaling pathway.

OBJECTIVE: To explore the association between rare HSPB1 variants and amyotrophic lateral sclerosis (ALS). METHODS: We performed next-generation sequencing for 166 Chinese ALS patients to screen for possible pathogenic rare variants of HSPB1. The control individuals were obtained from 1000 Genome Project and an in-house whole-exome sequencing database. The Sequence Kernel Association Test (SKAT) and the SKAT-optimal test (SKAT-O) were used to identify the association between rare HSPB1 variants and ALS. RESULTS: We identified 3 possible pathogenic rare variants of HSPB1 (all were missenses), including c.379C>T (p.R127W), c.446A>C (p.D149A) and c.451A>C (p.T151P). Compared with 1000 Genome Project, SKAT p=3.61×10 CONCLUSIONS Rare variants of HSPB1 are probably associated with the pathogenesis of ALS.
Amyotrophic Lateral Sclerosis/genetics* ; Asian Continental Ancestry Group ; Heat-Shock Proteins ; Heterozygote ; High-Throughput Nucleotide Sequencing ; Humans ; Molecular Chaperones ; Phenotype

In order to achieve the goal of integration, homogeneity, a net and a center of medical groups in Hainan province, Hainan province built an integrated management information platform of urban medical alliances and county medical communities based on projects such as the provincial three medical linkage information platform in February 2022. The overall architecture of the medical alliance and medical community platform was divided into system integration layer, data center layer, service layer and application layer. The service layer included four major systems: unified operation management platform, business center, performance evaluation management platform and comprehensive supervision subsystem, which was the core hub connecting the data center layer and application layer, and also was the unified operation and closed-loop management platform of the medical alliance and medical community. As of November 2022, the platform had covered 31 medical alliances or medical communities in 19 cities and counties of Hainan province, achieving information exchange, personnel interaction, resource sharing, business collaboration, and data integration among member units, narrowing the gap between urban and rural medical and health services, which had preliminarily achieved homogeneous management of the medical alliances and medical communities throughout the province, for a reference for the integrated management of medical alliances and medical communities within the regional scope of China.