Objective:To evaluate high resolution esophageal manometry (HREM) in peroral endoscopic myotomy (POEM) for pediatric achalasia of cardia (AC).Methods:Data of 30 AC children who received POEM in Xi′an Children′s Hospital from January 2013 to September 2019 were reviewed. HREM was performed before and 6 months after POEM. Preoperative and postoperative lower esophageal sphincter pressure (LESP), 4-second integrated relaxation pressure (4sIRP), Eckardt scores and nutritional status were compared.Results:Children with AC aged between 4-14 years. Postoperative LESP was 5.50±1.13 mmHg (1 mmHg=0.133 kPa), which was significantly lower than that before operation (26.23±4.47 mmHg) with significant difference ( t=-24.623, P<0.001). Postoperative median 4sIRP was 5 mmHg, which was 20 mmHg lower than that before operation (25 mmHg) with significant difference ( Z=-4.786, P<0.001). Postoperative median Eckardt symptom score decreased significantly compared with that before (1 VS 8, Z=-4.796, P<0.001). Severe malnutrition of the AC children improved evidently to normal( Z=-5.166, P<0.001). Conclusion:POEM can significantly improve the characteristics of esophageal dynamics in children with AC, and HREM can be an important indicator for follow-up evaluation of POEM.

Objective To compare the imported (Diasorin,Italy) and domestic (Mindray,Shenzhen) chemiluminescent systems used in the measurement of plasma aldosterone and renin concentrations;To establish the reference interval of plasma aldosterone and renin concentrations in healthy adults.Methods With the assay instrument and its kits from Italy Diasorin as the reference system,the concentrations of plasma aldosterone and renin were measured by the two systems,in 143 healthy adults,72 patients with hypertension (16 patients with primary aldosteronism) and to establish the medical reference range (P2.5-P97.5) of them.Results The plasma aldosterone (r=0.914,P＜0.01) and renin(r=0.977,P＜0.01)concentrations detected by the two systems were positively correlated.Distribution of plasma aldosterone and renin was skewed in healthy adults.The reference interval was 30.8-344.6 pg/ml for aldosterone and 2.4-90.0 μIU/ml for renin by the imported chemiluminescent system.The reference interval was 29.4-473.3 pg/ml for aldosterone and 3.6-98.3 μIU/ml for renin by the domestic chemiluminescent detection system.Conclusion The two systems are closely correlated in measuring plasma aldosterone and renin concentrations.

Objective To observe the effects of electroacupuncture on intestinal flora and serum inflammatory factors in rabbit model with rheumatoid arthritis(RA);To explore the mechanism of its therapeutic effect on RA.Methods RA model rabbits were established by ovalbumin induction combined with Freund's complete adjuvant,and the rabbits after successful modeling were randomly divided into model group,probiotic group and electroacupuncture group,with 6 rabbits in each group.Another 6 rabbits were set as the normal group.The electroacupuncture group received electroacupuncture at the bilateral"Zusanli"and"Dubi"for 30 minutes,the probiotic group was given probiotic capsules solution(14.5 mg/kg)by gavage,once a day,for two consecutive weeks.The knee joint circumference and pain threshold of rabbits were measured,histopathological morphological changes of colonic tissue and synovial tissue ws observed by HE staining,16S rDNA sequencing was used to analyze structural changes of intestinal flora,the contents of TNF-α,IL-1β and IL-6 in serum were detected by ELISA.Results Compared with the normal group,the circumference of knee joint of rabbits in the model group increased significantly,the pain threshold was significantly decreased(P<0.01);the colonic mucosal damage was serious,the goblet cells were missing,a large number of inflammatory cells were infiltrate;the joint capsule synovial surface was rough,the synovial cell layer was hyperplasia and thickening,the synovial tissue inflammatory cell infiltration was obvious;the number and evenness of gut microbiota species decreased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes decreased(P<0.05,P<0.01),the relative abundance of Desulfobacteria increased(P<0.01),while the relative abundance of Campylobacter,Lawsonella,and Pseudomonas increased(P<0.01),while the relative abundance of Heshanomonas and Herbaspirillum decreased(P<0.01);the contents of serum TNF-α,IL-1β and IL-6 increased(P<0.01).Compared with the model group,the knee joint circumference of the probiotic group and the electroacupuncture group decreased,the pain threshold increased(P<0.01,P<0.05);the degree of intestinal mucosal damage was reduced,the goblet cells were basically arranged neatly,the inflammatory cell infiltration was reduced;synovial cells proliferation and thickening decreased,with a small amount of inflammatory cell infiltration;the number and evenness of gut microbiota species increased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes increased(P<0.05,P<0.01),the relative abundance of Desulfobacteria decreased(P<0.01),while the relative abundance of Campylobacter,Lawsonella and Pseudomonas decreased(P<0.01),the relative abundance of Heshanomonas and Herbaspirillum increased(P<0.05,P<0.01);the contents of serum TNF-α,IL-1β and IL-6 significantly decreased(P<0.01).Conclusion Electroacupuncture can significantly improve the symptoms of RA rabbits and reduce the inflammatory reaction in synovial tissue of joint,and the mechanism may be related to the regulation of intestinal flora structure.

Objective: To evaluate the consistency of different methods for detecting aldosterone concentration in blood and to establish a reference interval of serum aldosterone concentration by liquid chromatography-tandem mass spectrometry(LC-MS/MS). Methods: Concentrations of blood aldosterone were measured by LC-MS/MS, chemiluminescent assays (Diasorin, Domestic A and B systems) and radioimmunoassay (RIA) in 138 healthy adults, 67 patients with essential hypertension and 23 patients with primary aldosteronism. Results: Aldosterone concentrations measured by various methods were quiet different(P<0.01). Spearman correlation analysis showed that the correlation coefficient were 0.776(P<0.01) between CLIA (Diasorin) and LC-MS/MS, 0.805(P<0.01) between CLIA (Domestic A) and LC-MS/MS, 0.058(P>0.05) between CLIA(Domestic B) and LC-MS/MS, 0.338(P<0.01) as well as between RIA and LC-MS/MS. Bland-Altman analysis for the measurements showed poor consistency among methods for aldosterone concentrations. The reference interval was 15.2-222.2 pg/ml for serum aldosterone concentrations by LC-MS/MS. Conclusions There are significant differences of blood aldosterone concentrations determined by different methods. Clinically, a specified reference interval might be needed while using different methods.

OBJECTIVETo compare the differences in the clinical therapeutic effects on juvenile myopia between's stunt needling technique and traditional even needling technique.

METHODSA total of 166 cases of mild juvenile myopia (diopter <-3.00D) were randomized into an observation group ('s stunt needling technique) and a control group (traditional even needling technique), 83 cases in each one (166 affected eyes). Taiyang (EX-HN 5), Fengchi (GB 20), Cuanzhu (BL 2), Hegu (LI 4) and Guangming (GB 37) were used in the two groups. In the observation group, theneedling technique was adopted at Taiyang (EX-HN 5), theneedling technique at Fengchi (GB 20) andneedling technique at Cuanzhu (BL 2). The traditional needling technique was used at Hegu (LI 4) and Guangming (GB 37). In the control group, traditional even needling technique was applied at all the acupoints. The treatment was given once every day, continuously for 6 times as one course. There was 1 day at interval. After treatment for 4 courses, the changes in visual acuity, diopter and axial length were observed before and after treatment. The therapeutic effects were evaluated.

RESULTSAfter treatment, the visual acuity of the naked eyes, and diopter were remarkably improved in the patients of the two groups (all<0.05). The improvements in the observation group were better than those in the control group (both<0.05). The axial length did not change in the two groups (both>0.05). The total effective rate was 78.3% (130/166) in the observation group, which was better than 57.8% (96/166) in the control group (<0.05). .

CONCLUSION 's stunt needling technique effectively improves the vision, rectifies the refractive error and delays the progression of myopia. The therapeutic effects of it are better than traditional even needling technique.

OBJECTIVETo explore heat-reinforcing needling for the metabolite profiling changes in serum of rheumatoid arthritis (RA) rabbits with liquid chromatograph-mass spectrometer (LC-MS) technique, and to investigate its mechanisms.

METHODSForty clean purple blue rabbits were randomized into a normal group, a model group, a reinforcing-reducing needling (RRN) group, a twirling-reinforcing needling (TRN) group, and a heat-reinforcing needling (HRN) group, 8 cases in each group. RA rabbits with cold syndrome were made with ovalbumin and freezing except those in the normal group. No treatment was given in the normal and model groups. The corresponding manipulations for 7 days were applied at "Zusanli" (ST 36) in the three acupuncture groups, 30 min a time, once a day. After intervention the pain threshold and the local skin temperature of each group were observed. Fresh serum from heart was collected for metabonomics detection. Principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) were adopted. Several metabolites were screened by the variable importance in the projection values (VIP>1) andvalue (<0.05).

RESULTSThe pain threshold and the local skin temperature in the model group were lower than those in the normal group (both<0.05). The pain threshold and the local skin temperature in the three acupuncture groups were higher than those in the model group after intervention (all<0.05), which were better in the HRN group than those in the RRN and TRN groups (all<0.05). The serum metabolites of carnitine, LysoPC (14∶0), LysoPC (18∶3), LysoPE (0∶0/20∶5), LysoPE (0∶0/22∶1), decylic acid, stearic acid and lactic acid in the model group increased compared with those in the normal group, and other metabolites decreased, including leucine, valine, glutamine, pyroglutamic acid, α-ketoglutaric acid, succinic acid, fumaric acid, malic acid, galactose, mannose. Those metabolites were correlated fatty acid, amino acid, citric acid cycle, and glucose metabolism. The metabolites above-mentioned in the three acupuncture groups were regulated in various degrees (all<0.05). Lactic acid decreased and succinic acid, fumaric acid, malic acid, galactose, mannose increased more obviously in the HRN group than those in the RRN and TRN groups.

CONCLUSIONThe specificity of heat-reinforcing needling for RA presents the regulation for citric acid cycle and glucose metabolism.