Objective To study the relation of esophageal motility and acid reflux between gastroesophageal reflux disease (GERD) patients with and without esophageal injury.Methods A total of 25 patients who met the GERD diagnosis criteria were conducted esophageal-gastric-duodenal endoscopy examination and followed with high-resolution esophageal manometry.The changes of esophageal pH postprandial were also detected.The differences of esophageal motility and acid reflux time between GERD patients with and without esophageal injury were compared.Patients were divided into non-acid reflux group and acid reflux group according to DeMeester score.The changes of esophageal motility indexes of these two groups were compared.Wilcoxon test and t test were used for statistical analysis.Results There was no significant difference in baseline value of lower esophageal sphincter (LES) pressure,remained LES pressure,speed of the esophageal peristalsis,the time of esophageal pH＜4 and DeMeester score between groups with and without esophageal injury (all P＞0.05).But esophageal contraction amplitude of group with esophageal injury was lower than that of group without esophageal injury (31.9 mm Hg vs 64.2 mm Hg,1 mm Hg=0.133 kPa,Z=-2.37,P=0.02).There was no significant difference in baseline value of LES pressure,remained LES pressure,speed of the esophageal peristalsis between acid reflux group and non acid reflux group (all P＞0.05).But the esophageal contraction amplitude of acid reflux group was lower than that of non acid reflux group (36.4 mm Hg vs 71.8 mm Hg,Z=-2.25,P=0.02).Conclusions There was no significant correlation between the LES pressure and esophageal acid reflux with esophageal injury in GERD patients.Esophageal peristalic contraction may be associated with esophageal injury and acid reflux.

Objective To compare the the effect of PCI on short term (3 months) left ventricular diastolic function in the old patients with acute myocardial infarction (AMI) (≥ 65 years old). Methods 40 old AMI patients were divided into PCI group and non-operation group (pure medicine treatment group). The changes of left ventricular diastolic function were observed 3 months after operation which were compared with that before treatment so to define the effect of PCI. The major indexes were LA, LV, LVEF, E/A, and S/D. Results LA and LV in PCI group were not significandy changes but they were increased in non-operation group (P < 0.05). Although the left ventricular diastolic function in both group was continually impaird,it was better in PCI group than in non-operation greup(P <0.05). Conclusion PCI can prolong the progress of left heart remodeling and the excerbation of left ventricular diastolic function in old AMI patients.

Objective: To observe curative effect of radiofrequency catheter ablation (RFCA) and changes of cardiac function and left atrial diameter after operation in patients with atrial fibrillation (AF). Methods: A total of 28 AF patients with obvious clinical symptoms and without effective for drug therapy received RFCA in our hospital, their data were retrospectively analyzed. They received RFCA under guidance of three dimensional electro-anatomic mapping (EAM) system. Changes of cardiac function and left atrial diameter were evaluated by echocardiography and curative effect was evaluated by ambulary blood pressure monitoring before, three and six months after operation. Results: Pulmonary vein isolation rate was 100% in all patients. No severe complication occurred during or after operation. After six-month follow-up, 27 cases（96.4%）did not recur AF among the 28 patients; Compared with before operation, there were significant decrease in left atrial diameter [(37.3±4.8) mm vs. (33.6±4.5) mm] and significant increase in left ventricular ejection fraction [(59.8±8.7) % vs. (64.2±6.8) %] by echocardiography, P<0.05 both. Conclusion: Radiofrequency catheter ablation is safe and effective in treatment of atrial fibrillation, and there are significant improvements in cardiac function and left atrial diameter.

ObjectiveTo evaluate the accuracy of EUS,EUS-guided fine needle aspiration ( EUSFNA) and targeted biopsy in the diagnosis of wall-thickened gastric lesions with negative malignant results ofendoscopic biopsies.MethodsA retrospective study was carried out in 57 patients who were found with thickened gastric wall of negative malignant endoscopic biopsies and underwent EUS from January 2008 to December 2010 in our hospital.Compared the EUS findings with the surgical results and follow-up status.The diagnostic yield of EUS was characterized by the disappearance of the layers or the changes of thickness of gastric wall,the characteristics of echo imaging,and the results of EUS-FNA or EUS targeted biopsy were recorded to evaluate the value of EUS.ResultsOf 57 cases,gastric cancer was confirmed in 19,lymphoma in 10,dysplasia in 1,Menetrier's disease in 1 and inflammatory changes in 26.EUS could clearly demonstrate the changes of gastric wall including the thickness and the changes of layers,with the accuracy rate of 73.07％ ( 14/19 ) on gastric cancer.EUS diagnosed gastric cancer in 26 cases,in which 14 (53.8％) were confirmed by pathology.Gastric lymphoma was suspected by EUS in 20 cases,in which 10 (50.0％ ) were proved.EUS-FNA was conducted in 19 cases,with positive result in 9 (accuracy rate 50％ ).EUS-guided targeted deep biopsy or piece-meal biopsy were performed in 10 cases,with 8 malignant results.ConclusionEUS with/without EUS-FNA is not a golden standard for the diagnosis of gastric lesions in thickened gastric wall,yet it still has some significance.

Objective:To evaluate the effect of prophylactic irradiation of internal mammary lymph nodes in patients with breast cancer in this Meta-analysis.Methods:CNKI, Wanfang Medical network, CBM, PubMed, EMBASE and Web of Science were searched by computer. The controlled clinical studies comparing whether or not internal mammary lymph node irradiation as an intervention were included and the quality of the included literature was evaluated according to Newcastle-Ottawa Scale (NOS). RevMan 5.3 software and Stata 14 software were used for Meta-analysis.Results:A total of 11 original articles were included, and 13 181 patients were included for Meta-analysis. There was no statistically significant difference in the overall survival (OS) between patients with and without internal mammary lymph node irradiation ( P=0.490). The subgroup analysis using the date of treatment and the degree of risk in the enrolled population as criteria showed that 5-year OS was significantly increased after internal mammary area irradiation in high-risk stage Ⅱ-Ⅲ patients (N+ , T 3-T 4 stage) with the date of treatment of after 2000( P=0.003, 0.006). Compared with patients without internal mammary area irradiation, internal mammary irradiation significantly increased the 5-year disease-free survival (DFS)( P<0.001). Conclusion:Under the modern radiotherapy technology, internal mammary lymph node irradiation improves the DFS of patients, and may bring OS benefits to high-risk stage Ⅱ-Ⅲ breast cancer patients (N+ , T 3-T 4 stage).

Objective:To investigate drug resistance gene in Mycoplasma pneumoniae(MP) and the distribution of 13 respiratory pathogens in bronchoalveolar lavage fluid(BALF) of children with Mycoplasma pneumoniae pneumonia(MPP).Methods:A total of 100 BALF of children with MPP in Peking University Third Hospital and Peking University First Hospital from January 2018 to January 2019 were collected.Fluorogenic quantitative PCR was used to detect nucleic acid and it′s drug resistance gene of MP and multiple PCR method was adopted to detect influenza A virus, influenza A virus-H 1N 1, influenza A virus-H 3N 2, influenza B, human parainfluenza virus, adenovirus, human bocavirus, human rhinovirus, Chlamydia pneumoniae, human metapneumovirus, MP, human coronavirus, and respi-ratory syncytial virus gene, and the results were compared by using Chi square test. Results:In 100 BALF samples, MP and drug resistance gene were detected by fluorogenic quantitative PCR.Totally, 83 cases (83.00%) were MP positive and 78 cases (93.98%) were drug resistant.All of them had the point mutations A2063G in V region of 23S rRNA domain.A total of 13 kinds of respiratory pathogens were detected by multiplex PCR method, and 89 cases (89.00%) were positive.Totally, 79 cases (79.00%) were MP positive, of which 74 cases (74.00%) detected only MP, and 5 cases (5.00%) detected MP combined with other pathogens.Other pathogens were detected in 10 cases (10.00%). The virus detection rate of 0-4 years old group was higher than that of >4-6 years old group ( P=0.042) and >6 years old group ( P=0.002), and the differences were statistically significant. Conclusions:MP can be detected in most BALF samples of MPP children, the drug resistance phenomenon is serious, and the main point mutation is A2063G.There were other respiratory pathogens and 2 or 3 pathogens were detected in a small number of BALF samples.