Objective To evaluate the value of percutaneous endoscopic gastrostomy (PEG) in the treatment of amyotrophic lateral sclerosis (ALS) patients with dysphagia. Method Sixty-five ALS patients underwent PEG from April 2005 to July 2010 were analysed retrospectively. Results All the 65 patients underwent PEG,and 2 patients failed because of dyspnea. Totally 63 patients were intubated successfully,the successful rate was 96.9%(63/65). The operation time was 8-17 min. Two patients had local infection.After 3 months, the body mass index was increased from (18.3 ± 1.0) kg/m2 to (19.7 ± 1.2) kg/m2(t = 15.8,P ＜ 0.01), without peritonitis, migration of the gastrostomy tube and other complications. Conclusions PEG is a safe method with a low complication for ALS patients to get enteral nutrition. Dyspnea is the main reason of failure.

Objective To evaluate the therapeutic effect and safety of forward-viewing,doublechannel endoscope in the process of ERCP in patients with bile duct diseases after Billroth-Ⅱ gastroenterostomy.Methods ERCP was applied to 46 patients with bile duct diseases using forward-viewing,doublechannel endoscope.All patients had the history of Billroth-Ⅱ gastroenterostomy.The success rate of selective cannulation,complication rate and the outcome of all the patients were recorded.Results The procedure succeeded in 38 patients with a success rate of 82.6％,and failed in 8.Of all the failing cases,the afferent loop couldn't be accessed in 6,failure in biliary cannulation in 2.Of 38 successful cases,bile duct stones were successfully removed in 31,metal stents placed for malignant bile duct obstruction in 4,and endoscopic balloon dilation for benign common bile duct stricture in 3.All patients recovered without complications of perforation,delayed bleeding or pancreatitis.Conclusion For patients with history of Billroth-Ⅱgastroenterostomy,ERCP with forward-viewing,double-channel endoscope yields to a higher success rate and lower complication rate.

Objective To investigate the characteristics of etiology,efficacy of endoscopic management for recurrent idiopathic pancreatitis (RIP).MethodsThe clinical data of 58 cases of RIP diagnosed in our hospital from April 2005 to April 2011 were retrospectively analyzed.All the patients underwent endoscopic retrograde cholangiopancreatography (ERCP),and patients with suspected sphincter of Oddi dysfunction received manometry.According to the clinical and ERCP manifestations,the etiologies of RIP were determined and individualized endoscopic treatment was applied.The patients were followed-up postoperatively about the improvement of abdominal pain and recurrence of RIP.ResuItsFifty-eight patients (29 males,29 females) were suffered from acute pancreatitis from 3 to more than 10 times.The etiologies were as follows:29 cases of biliary microlithiasis,19 case of sphincter of Oddi dysfunction ( 16 cases of pancreatic type,3 cases of mixed type),4 cases of anomalous arrangement of the pancreaticobiliary duct,and 6 cases of normal manifestations at ERCP.Biliary sphincterotomy alone was performed in 33 patients,while both biliary and pancreatic sphincterotomy was performed in 8 patients,and pancreatic sphincterotomy alone was performed in 17 patients,after sphincterotomy,pancreatic stent insertion was performed in 24 patients.The follow-up data was obtained from 41 out of 58 patients,the follow-up period ranged from 3 ～ 67 months ( average 33 months).During this period,9(22.0％ ) patients suffered from RIP,and the treatment efficiency was 78％.ConclusionsBiliary microlithiasis and sphincter of Oddi dysfunction are the main causes of RIP.Drink could induce RIP.ERCP has definite treatment efficacy for RIP.

Objective This study was designed to assess whether Bushen Tongluo Fang(BSTLF),a Chinese materia medica formula,can ameliorate the hypercoagulable state in rats with membranous glomerulonephritis(MGN)induced by cationized bovine serum albumin(C-BSA)in order to gain an insight into the mechanisms responsible for its therapeutic effect.Methods Seventy-two male Sprague-Dawley rats were randomly separated into six groups:the normal control group,the MGN model group,the prednisone-plus-aspirin treatment group,and the low-,moderate-,and high-dose groups of BSTLF.The model of MGN was induced by sc(preimmunization)and iv injections of C-BSA in the latter five groups.After the development of MGN model,the decoctions of BSTLF and the prednisone-plus-aspirin solution were ig administered to the treatment groups respectively twice daily for four weeks.The rats in the model group received their drinking water as vehicle controls.Urinary albumin excretion for 24 h was measured using a rat albumin ELISA kit.The platelet aggregation was analyzed by turbidimetry.The plasma level of fibri-nogen(Fib)was determined by the von Clauss assay.Radioimmunoassay was used to examine thromboxane B2(TXB2)and 6-keto-prostaglandin F1?(6-keto-PGF1?)of the renal cortex.Results Urinary albumin excretion for 24 h,maximal platelet aggregation,plasma Fib level,and TXB2 production of renal cortex in the MGN model group were significantly higher than those in the normal control group,respectively.Compared with the MGN model group,these four measurements were decreased significantly in BSTLF-treated groups.The 6-keto-PGF1? production of renal cortex in the MGN model group was subnormal but no statistically significant differences were observed between the model group and BSTLF groups.Conclusion The results of this study suggest that the administration of BSTLF could attenuate platelet aggregability,lower plasma level of Fib and reduce thromboxane A2 production by renal cortex in the rats with MGN,so that their hypercoagulable state is corrected at least partly and glomerular microthroimbosis is prevented in several ways.These effects may contribute considerably to the mechanisms of BSTLF efficacy for chronic nephritis.

Objective To find the relationship between mutation of gamma 2 subunit of the gamma-aminobatyric acid type A receptor(GABRG2) and generalized epilepsy with febrile seizure plus(GEFS+).Methods Probands of 10 families with GEFS+ were selected,the GABRG2 gene were sequenced.Results We found a single nucleotide polymorphism site,and did not find the reported mutations.Conclusion GABRG2 mutation is not common in Hans of northern China.

Objective To investigate the effects of genistein(GEN) on the expression of collagen I and transforming growth factor-?1(TGF-?1 ) of osteoblast.Method The secondary generation of skull osteoblast of newborn SD rat was incubated with GEN.The cells were divided into six groups:control group,different dose of GEN(10-8,10-7,10-6,10-5mol/L,respectively) groups and E2 group( 10-10mol/L).MTT(OD),the contents of cell protein,the activity of alkaline phosphatase(ALP),the expression of collagen I and the content of TGF-?1 were detected.Results After 48h and 72h,the MTT(OD) of all GEN group and E2 group were significantly higher than those in control group.The MTT(OD) of control group and 10-8,10-7,10-6mol/L GEN groups in 72h were significantly higher than those in 48 h.The protein of 10-5,10-6 mol/L GEN group and E2 group were significantly higher than those in control group.The ALP activity of all GEN groups and E2 group were significantly higher than those in control group.The level of above indices were correlated with the dose of GEN.The expression of collagen I and the content of TGF-?1 in 10-7,10-6,10-5mol/L GEN group and E2 groups were higher than those in control group.They werecorrelated with the dose of GEN and TGF-?1.Conclusion GEN could stimulate proliferation and differentiation of osteoblast,and enhance the expression of collagen I and content of TGF?-1.Compared with E2,,there were similar effects with the higher dosage of GEN.

Objective To explore the endoscopic managements for biliary and pancreatic diseases in patients with the history of complex gastrointestinal surgery.Methods Data of four patients who underwent balloon-assisted enteroscopy after complex digestive surgeries (2 patients underwent Roux-en-Y reconstruction,2 others Whipple reconstruction) were retrospectively collected.One patient with bilio-intestinal anastomosis was explored by double-balloon enteroscope (DBE),and balloon-assisted enteroscopy combined with ERCP was used for other 3 patients.Results Therapeutic ERCP was successfully performed on one patient,and the diagnosis of 3 others were confirmed.No operation-related complications such as bleeding or perforation was observed.Conclusion Balloon-assisted enteroscopy combined with ERCP is an important diagnostic and therapeutic method for biliary and pancreatic diseases in the patients after complex gastrointestinal surgery.

Objective To evaluate the feasibility of diagnostic and therapeutic peroral direct cholan-gioscopy (PDCS)using an ultra-slim upper endoscopy assisted by a snare.Methods Between November 2014 and January 2015,8 patients underwent PDCS with assistance of an ultra-slim endoscopy.After endo-scopic papillary balloon dilation,the duodenoscopy was withdrew,an ultra-slim endoscopy was inserted di-rectly into the biliary tract assisted by a snare,and biopsy or laser lithotripsy was performed.The snare was closed tightly in the bent portion of the scope,and the snare was pulled while scope shaft had to become the form of U loop by counterclockwise rotation,in order to advance the scope into common bile duct.Results PDCS succeeded in all eight cases,one common hepatic duct adenoma was diagnosed by biopsy,and con-firmed by surgery;one benign biliary stricture was diagnosed by PDCS;laser lithotripsy was successfully per-formed in 4 patients with large CBD stones;bile duct clearance was verified by PDCS in two patients who was suspected of residual CBD stones.No perforation,bleeding or post-operative pancreatitis was found.Con-clusion PDCS using an ultra-slim gastroscopy assisted by a snare is a safe,simple and practical procedure in the diagnosis and treatment of biliary tract diseases.

Objective To compare the medical economics and safety of colonic metallic stent implantation as a bridge to elective resection with traditional emergency resection.Methods Data of colonic cancer obstruction cases in emergency room from 2008 to 2013 were retrospectively analyzed and divided into stent group(colonic stent as a bridge to surgery) and control group(emergency surgery).Main parameters between the two groups were compared,including surgery-associated mortality and morbidity,colostomy rate and re-anastomosis rate,ICU admitted rate,average days and costs in hospital,and colonic stent insertion associated clinical success rate and mortality.Results Ten and 11 patients were included in stent group and control group respectively.Surgery associated morbidity and colostomy rates were both 0 in stent group,and 18.2％ and 100.0％ in control group.Days of hospitalization and costs were 23 days and 67 742 Yuan in stent group,and 49 days and 92 553 Yuan in control group.The surgery associated mortality rates both were 0 in the two groups.ICU admitted rates were 20％ and 18％ respectively.Conclusion Colonic stenting as a bridge to surgery has a high clinical success rate and has a lower morbidity and colostomy rate,shorter hospitalization days,less cost compared with traditional emergency surgery.This strategy for colonic cancer obstruction is of safety and great health economic value.