OBJECTIVE: To analyze the causes of the esophagogastric junction outlet obstruction (EGJOO) patients, to discuss the differences of the clinical manifestation and esophageal motility characteristics between the anatomic EGJOO (A-EGJOO) and functional EGJOO (F-EGJOO) subgroups, and to search the diagnostic values of the specific metrics for differentiating the subgroups of EGJOO patients. METHODS: For the current retrospective study, all the patients who underwent the esophageal high resonance manometry test were retrospectively analyzed from Jan 2012 to Oct 2018 in Peking University Third Hospital. The EGJOO patients were enrolled in the following research. The clinical characteristics, such as symptoms and causes of the patients were studied. Then the patients were divided into two subgroups as A-EGJOO subgroup and F-EGJOO subgroup. The clinical symptoms and the main manometry metrics were compared between these two subgroups. The significant different metrics between the two groups were selected to draw receiver operating characteristic (ROC) curves and the diagnostic values were analyzed in differentiating the A-EGJOO and F-EGJOO subgroups. RESULTS: The most common symptom of EGJOO was chest pain or chest discomfort (30.63%), then the dysphagia (29.73%), and acid regurgitation/heartburn (27.03%). Non-erosive reflux disease (36.04%) was the most popular cause for EGJOO, then the reflux esophagitis (17.12%). Besides the intra-EGJOO and extra-EGJOO lesions, the connective tissue disease (6.31%) and central nervous diseases (2.70%) were found to be the etiology of EGJOO. The causes of the rest 19 EGJOO were unknown. A-EGJOO patients presented significantly higher intra bolus pressure (IBP) than that of F-EGJOO [6.80 (5.20, 9.20) mmHg vs. 5.10 (3.10, 7.60) mmHg, P=0.016]. The area under curve of IBP was 0.637. When IBP≥5.15 mmHg, the sensitivity was 78.60% and specificity 50.70% to differentiate A- or F-EGJOO. CONCLUSION Chest pain or chest discomfort was the most common symptom in EGJOO patients. Besides the intraluminal structural disorders, the extra-luminal causes were found in EGJOO patients. A-EGJOO presented higher IBP than that of F-EGJOO patients. The cutoff value of IBP to differentiate A-EGJOO from EGJOO was 5.15 mmHg with sensitivity 78.06% and specificity 50.70%. However for the low area under curve, the diagnostic value of IBP was limited.
Deglutition Disorders ; Esophageal Motility Disorders/diagnosis* ; Esophagogastric Junction ; Humans ; Manometry ; Retrospective Studies

·AIM: To improve our understanding of retinoschisis at the macular area.·METHODS: From January 2003 to January 2005, the patients whose macular retinoschisis was confirmed by optical coherence tomography (OCT) were included in the study. Their data and other results were further analyzed.·RESULTS: During that period, macular retinoschisis was found in 116 eyes which fit the including criteria. Among these, 94 eyes were pathological myopia; 17 were X-linked congenital retinoschisis; and 5 had excavation of optic disk.By analyzing the OCT figures, it was found that retinoschisis could happen at many locations within retinal neural epithelium, including inner, middle and outer part. The retinoschisis caused by different reasons differs in OCT results.·CONCLUSION: Retinoschisis at the macular area was not rare at the clinic, and the retinoschisis may be located at different parts of the retina. OCT was useful in the diagnosis and follow-up of macular retinoschisis.

Objective:To assess the feasibility and accuracy of real-time three dimensional echocardiography(RT-3DE) in quantitative evaluation of left ventricular(LV) volume and ejection fraction(EF) in patients with ventricular aneurysm and myocardial infarction.Methods: Twenty-three patients with left ventricular aneurysm combined with myocardial infarction were examined by RT-3DE,two dimensional echocardiography Simpson's method,and M-mode Teichholz method separately.The following parameters: left ventricular end diastolic volume(LVEDV),end systolic volume(ESV),stroke volume(SV) and EF were obtained by each method and the results were compared with those obtained by left ventriculography(LVG).Results: The values of LVEDV,LVESV,SV,and EF determined by RT-3DE showed good correlations with those determined by LVG(r=0.92,0.90,0.88,and 0.91,respectively;P(0.05).) The values of LVEDV,LVESV,SV,and EF determined by Simpson's method also showed good correlations with those determined by LVG(r=0.85,0.87,0.86,0.91,respectively;P

Objective:To evaluate the effect of percutaneous coronary intervention(PCI) on mitral regurgitation(MR) in patients with acute myocardial infarction(AMI).Methods: A total of 213 AMI patients were divided into PCI group(n=87,(PCI +) medication) and medication group(n=126,medication) according to the treatments they received.Echocardiographic examination was conducted in patients during admission and 6 months follow-up.Color Doppler was used to determine the degree of MR.Echocardiogram indices included MR degree,left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVEDs),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),and left ventricular ejection fraction(LVEF).Results: The overall incidence of MR was 28.6% in 213 patients during admission.The MR incidence in patients with acute inferior myocardial infarction was higher than that in patients with other parts of infarction((34.5%) vs 22.3%,P0.05),while the incidence in medication group increased significantly than that during admission(43.7% vs 30.2%,P

Objective To explore the heterosexual intercourse characteristics and its influencing factors among MSM population. Methods Voluntary counseling/testing and questionnaire survey were carried out at the bathhouses where MSM usually assemble. Results Among 342 MSM surveyed,52. 05% were married. 76 people( 22. 22%) were completely homosexual,while 266 people(77. 78%)were bisexual. 24(31. 57%)MSM who answered″ totally gay″ in self-assessment of sex orientation were married,significantly lower than those answered bisexual(57. 89%)(p<0. 05). 197 of participants had sex with women ,and 123 MSM had sex with women during the last six months,49 MSM of which used condoms at each heterosexual activity. MSM who were married or bisexual were easy to have heterosexual intercourse. Among the MSM surveyed,the HIV and syphilis infection rates were 11. 40% and 16. 67% respectively. There was no significant difference between the use of condoms and infection( both p>0. 05). In the recent six months,there was no significant difference in the use of condoms between infected( 43. 34%)and non-infected persons( 43. 34%)( p >0. 05). Conclusion Among MSM population,the prevalence of heterosexual intercourse is high,while condom use rate is relatively low. It is necessary to strengthen the behavioral intervention and promote condom use.

Objective To study the influencing factors on the operation and nursing of 24-hour gastroesophageal pH monitoring to improve the completion rate and accuracy.Methods The patients who underwent 24-hour gastroesophageal pH monitoring by HYW-2 pH monitoring device were enrolled in the study from 1 January,2010 to 30 June,2012 in Peking University Third Hospital.The patient' s cooperation and feeling during the operation,whether or not the process of monitoring the electrodes position was all right,and whether or not the results met the needs of analysis were recorded and analyzed.Results Two hundreds and sixty-four patients received the examination,and 230 cases (87.1％) successfully finished the monitoring.The problems such as difficulty in electrode insertion,patient tolerance and the obstacle to contact the electrode were found in 34 patients.Conclusions The 24-hour gastroesophageal pH monitoring is affected by the degree of patients' tolerance,the electrode insertion and position,electrode contact barrier and so on.The detailed health education is beneficial to examination.

OBJECTIVESTo test the effect of rapamycin (RAPA) on hepatic tumor growth and metastasis in Sprague-Dawley (SD) rat model and explore the possible mechanism.

METHODSSD rat hepatocellular carcinoma (HCC) model with metastatic potential was induced by diethylnitrosamine (DEN) and N-nitrosomorpholine (NMOR). 120 SD rats were randomized into four groups 16 weeks after DEN and NMOR treatment, and received 4-week intraperitoneal injection of RAPA (1.5 or 4.5 mg x kg(-1) x d(-1)), CsA (25 mg x kg(-1) x d(-1)) or equal volume of 0.9% saline, respectively. Tumor growth and metastasis were checked after the 4-week treatment. Serum vascular endothelial growth factor (VEGF) was determined by enzyme-linked immunosorbent assay (ELISA). Antiangiogenetic effects were assessed by CD34 immunostaining. The levels of hypoxia-inducible factor 1 alpha (HIF-1 alpha) and VEGF proteins and mRNAs were detected by immunohistochemistry, western blot and reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTSThe mean liver weight (5.58% +/- 0.42% and 5.69% +/- 0.74%), the metastatic liver nodules (5.12 +/- 0.68 and 5.67 +/-1.12), the metastasis lung nodules (0.43 +/- 0.11 and 0.45 +/- 0.83), and the lung metastasis rate (17.2% and 14.8%) were lower in rats treated with RAPA 1.5 mg x kg(-1) x d(-1) or 4.5 mg x kg(-1) x d(-1) than those in rats treated with saline, which were 10.42% +/- 1.86%, 12.36 +/- 3.45, 1.81 +/- 0.3 and 50.0% respectively (P < 0.01 or P < 0.05). The intratumoral microvessel density (MVD), serum VEGF, and the levels of HIF-1 alpha and VEGF were lower in RAPA-treated rats than those in control rats. However, CsA-treated rats showed an opposite trend compared with the RAPA-treated rats.

CONCLUSIONRAPA can repress the expression of angiogenesis-promoting factors HIF-1 alpha and VEGF, and significantly inhibits the growth and metastasis of HCC.

Animals ; Carcinoma, Hepatocellular ; blood supply ; metabolism ; pathology ; Cyclosporine ; pharmacology ; therapeutic use ; Disease Models, Animal ; Hypoxia-Inducible Factor 1, alpha Subunit ; genetics ; metabolism ; Immunohistochemistry ; Immunosuppressive Agents ; pharmacology ; therapeutic use ; Liver Neoplasms, Experimental ; blood supply ; metabolism ; pathology ; Male ; Microvessels ; pathology ; Neoplasm Metastasis ; Neovascularization, Pathologic ; RNA, Messenger ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Sirolimus ; pharmacology ; therapeutic use ; Vascular Endothelial Growth Factors ; genetics ; metabolism

Introduction:The 2010 targets of the China Hepatitis B Prevention Programme were a prevalence of hepatitis B surface antigen (HBsAg) less than 1.0% for children less than five years old and less than 6.0% for the total population. This survey assessed the prevalence of Hepatitis B infection in Lianyungang, Jiangsu province, China in 2009–2010.Methods:Multistage sampling was used with 2372 subjects among 17 selected villages. Blood specimen collection and testing by enzyme-linked immunosorbnet assay (ELISA) were completed using the following markers for hepatitis infection: HBsAg and antibody to HBsAg (anti-HBs); hepatitis B e antigen (HBeAg) and antibody to HBeAg (anti-HBe); and hepatitis B core antibody (total anti-HBc). The data were analysed with Epi Info, version 3.3.2.Results:The prevalence of HBsAg was 2.4% (95% Confidence Interval [CI]: 1.8–3.0; Adjusted Prevalence [AP] 2.9%); anti-HBs prevalence was 51.1% (95% CI: 49.1–53.1; AP 49.2%) and total anti-HBc prevalence was 41.7% (95% CI: 39.8–43.7; AP 45.5%). The prevalence of HBsAg and total anti-HBc positivity increased from young to older age groups, yet the prevalence of anti-HBs positivity decreased from young to older age groups (P< 0.001 for all). There was no difference in the prevalences of HBsAg and anti-HBs among females and males (P= 0.108 and 0.089), but females had a higher prevalence than males for total anti-HBc positivity (P< 0.001). Discussion: This survey showed that in 2010 the prevalence of HBsAg among children aged less than five years was lower than the national target of 1.0% and that the prevalence of HBsAg for the total population was lower than the national target of 6.0%.

OBJECTIVETo investigate the clinicopathological features and surgical treatment of pulmonary sclerosing hemangioma (PSH).

METHODSClinic data of PSH patients admitted by surgical resection from January 1985 to December 2010 was analyzed retrospectively. One hundred and sixty-five patients were enrolled in the study. There were 27 male and 138 female patients with a mean age of (48 ± 13) years. Seventy-nine patients were asymptomatic at the time of diagnosis. Eighty-nine tumors arose in the right lung (27 in right upper lobe, 24 in right middle lobe, 34 in right lower lobe, 2 in right upper lobe with invasion of right middle lobe, 1 in right middle lobe with invasion of right lower lobe, and 1 case with multiple lobe lesions), 75 in the left (33 in left upper lobe, 42 in left lower lobe), and 1 in the bilateral. There were huge mass lesions in 2 cases, endobronchial lesions in 2 cases, and multiple lesions in 6 cases. The mean size of the lesion was (2.6 ± 0.9) cm (ranging from 0.9 to 10.0 cm). Forty-eight cases (29.1%) were misdiagnosed as malignancies preoperatively, and 41 cases (24.8%) were misdiagnosed intraoperatively.

RESULTSResections were performed by means of video-assisted thoracoscopy (n = 53) and thoracotomy (n = 112). Surgical resection included pulmonary wedge excision in 61 patients, lobectomy in 89 patients, right bilobectomy in 5 patients, anatomic segmentectomy in 2 patient, enucleation in 6 patients, and synchronous bilateral pulmonary wedge resection in 1 patient. Operative mortality and morbidity occurred in 0 and 2 (4.3%) patients, respectively. Mean follow-up was 34.7 months (ranging from 6 to 62 months). There was no local recurrence or death from PSH.

CONCLUSIONSPSH is a rare benign lung tumor. It is difficult to make accurate diagnosis preoperatively, and sometimes even intraoperative frozen sections can't differentiate it from malignant tumors. Surgical resection is usually indicated for definite diagnosis and treatment. Partial resection is a sufficient treatment in view of uncommon tumor recurrence. Thoracoscopic surgery is recommended for PSH.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pneumonectomy ; Pulmonary Sclerosing Hemangioma ; diagnosis ; surgery ; Retrospective Studies ; Young Adult

BACKGROUNDThe association between vulnerability of plaque assessed with intravascular ultrasound (IVUS) and plasma levels of fibrinolytic biomarkers was determined in patients with acute coronary syndrome (ACS). However, few data are available on the relationship between the levels of tissue type plasminogen activator (t-PA) and virtual histological intravascular ultrasound (VH-IVUS) signs of plaque instability.

METHODSEighty-nine patients with ACS were enrolled in the study. Blood was collected to measure t-PA levels by liquid phase bead flow cytometry. Eighty-nine nonbifurcate lesions (identified by coronary angiography and ECG) were investigated using IVUS before catheterization. IVUS radiofrequency data obtained with a 20 MHz catheter were analyzed with IVUS virtual histological software. The areas of plaque and media were calculated and lesions were classified into two groups: VH-IVUS derived thin cap fibroatheroma (VH-TCFA) and non-VH-TCFA plaque.

RESULTSPlasma t-PA level in the patients with TCFA was significantly lower than that with non-TCFA ((1489+/-715) pg/ml vs (2163+/-1004) pg/ml). Decreased plasma levels of t-PA were associated with plaque vulnerability. Plasma levels of t-PA correlated negatively with plaque plus media and necrotic core in plaque in patients with ACS.

CONCLUSIONSt-PA is an independent risk factor and a powerful predictor of vulnerable plaques. Decreased levels of t-PA may reflect instability of atherosclerotic plaques and might therefore serve as noninvasive determinants of those at high risk for consequent adverse events.

Acute Coronary Syndrome ; blood ; pathology ; Aged ; Coronary Artery Disease ; pathology ; Coronary Vessels ; pathology ; Female ; Humans ; Male ; Middle Aged ; Tissue Plasminogen Activator ; blood ; Ultrasonography, Interventional