Digestive endoscopic diagnosis and treatment technology in the development of ethical issues are :the expansion of endoscopic treatment indications , violation of patient choice;Health care costs increase , the pa-tient cannot enjoy medical equality;Staff is uneven , the patient can′t enjoy the fair medical treatment;Paternalistic doctor-patient relationship , ignore the patient′s autonomy and so on .Puts forward some Suggestions to solve these problems:people-oriented , fully respect patients option;Standard medical behavior , advocates the equal medical treatment;Standardized training for everyone to enjoy fair medical treatment;Build the good doctor -patient rela-tionship , respect the autonomy of patients .

Objective To investigate the relationship between the expression ofα1-antichymot-rypsin (α1-ACT)in plasma and postoperative cognitive dysfunction(POCD).Methods The cognitive function of 64 patients undergoing operation under general anesthesia was evaluated by a battery of cognitive assessment instruments(BCAI)and the levels ofα1-ACT were measured at the time 1 d pre-operatively and 7 d and 3 months postoperatively.The patients were randomly divided into two groups:30 patients in ulinastatin group (group U)were injected with 10 000 U/kg ulinastatin,which was dissolved in 100 ml saline,within 20 min at the time of 30 minutes before induction;while control group (group C)were injected with the same volume saline.Results There was no significant differ-ence between the expression of α1-antichymotrypsin in patients with POCD and in control patients at the time before operation.Compared with control patients,the levels of α1-ACT in patients with POCD at the time of 7 d and 3 months postoperation were significantly higher (P <0.05).The levels of α1-ACT at 7 d postoperation were significantly higher than that preoperatively in both groups (P <0.05).The incidence of POCD in group U were significantly lower than that in group C,at the time of 7 d and 3 months after surgery (P <0.05).Conclusion POCD is associated with high expression of plasma α1-ACT.

Objective: Endoscopic measurement mainly depends on visual estimation or open biopsy forceps,which have been proved lacking in accuracy due to the image barrel distortion caused by wide-angle lens in endoscope.This study aimed to validate a new concept of "virtual internal standard" proposed by ourselves and develop a new method for endoscopic measurement based on the concept.Methods: We photographed planar grid graphs printed with standard calibrations with an electronic endoscope at different object distances,obtained the information on the virtual internal standard from each photo at the corresponding object distance,and analyzed the digital characteristics of the barrel distortion photos,including the size of the visual field,the image compression ratio,and the credible area for measurement with the virtual internal standard.Based on the analyses,the method of endoscopic measurement by the virtual internal standard was established and experiments both in vivo and in vitro were conducted.Results: The ratio of the object distance to the visual field was 1 ∶ 2 when the former was between 10 mm and 40 mm.Calculation of the compression ratio showed that the credible area of measurement in the central area was 10 mm at the object distance of 10-15 mm,20 mm at 20-30 mm,and 30 mm at 30-50 mm.The credible area of measurement on various planes accounted for 2/5 to 3/5 of the total image width.There was a tendency of double-curve change in the arrangement of pixel values of the central grids on different planes.The differences between the pixel values per centimeter became slight at the object distance of 35-50 mm.Conclusion: Endoscopic measurement by the virtual internal standard is a objective,accurate,simple and practical method.

Objective To explore the early-term efficacy of porous titanium trabecular metal acetabular (TTM) compo-nents produced by E-beam technology in total hip arthroplasty(THA). Methods From May 2012 to JUN 2013, nineteen primary THA patients (20 hips) were devided into observation group of porous TTM acetabular prosthesis produced by E-beam technology and control group of Pinnacle acetabular prosthesis. TTM group had nine patients (10 hips), including 7 males and 2 females, with the mean age of 61.0 years. Pinnacle group had ten patients (10 hips), including 6 males and 4 females, with the mean age of 58.6 years. The patients were followed up at the 6,12,24 weeks after operation. X-rays were taken at the follow-ups. Acetabular compo-nent stability and osseointegration were assessed through radiograph. Harris scores system,SF-36 Heath Survey Questionnaire and WOMAC Osteoarthritis index were recorded before and after operation to evaluate clinical effects of surgery. Results In TTM group, the Harris score improved from 48.2 ± 5.5 preoperatively to 89.5 ± 4.0 postoperatively, SF-36 scores from 329.1 ± 86.7 to 763.8 ± 15.1, and WOMAC index from 18.8 ± 11.0 to 1.3 ± 0.9. No cases suffered aseptic loosening and migration. After 24 weeks, There was no significant difference regarding Harris scores system,SF-36 Heath Survey Questionnaire and WOMAC Os-teoarthritis index between two groups. In TTM group, two hips had a radiolucent line postoperatively, which occurred in 2 and 3 zone. The lines were disappeared 24 weeks later. Conclusion In THA, the initial stability of TTM produced by E-beam tech-nology was fine, which can facilitate bone ingrowth in early stage. However, the long-term follow-up effect still needs to be con-firmed.

Objective To prolong the working time of the crew under a high temperature and high humidity environment in armored vehicles , improve work efficiency , and to prevent excessive heat load from doing any harm to the human body . Methods The man-machine environment was analyzed , the corresponding environment and the conditions aboard were further quantitatively studied , and man-machine-environment interactions were analyzed .Also,a questionnaire survey was conducted at the same time .Results and Conclusion The thermal equilibrium and thermal comfort calculation program were compiled and validated through the questionnaire survey in order to provide support for environment assessment and protection design .

BACKGROUND/AIMS: This animal study aimed to define the underlying cellular mechanisms of intestinal barrier dysfunction. METHODS: Rats were fed 4% with dextran sodium sulfate (DSS) to induce experimental colitis. We analyzed the sugars in 24-hour urine output by high pressure liquid chromatography. The expression of claudins, mannan-binding lectin (MBL), and MBL-associated serine proteases 2 (MASP-2) were detected in the colonic mucosa by immunohistochemistry; and apoptotic cells in the colonic epithelium were detected by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling method assay. RESULTS: The lactulose and sucralose excretion levels in the urine of rats with DSS-induced colitis were significantly higher than those in the control rats. Mannitol excretion was lower and lactulose/mannitol ratios and sucralose/mannitol ratios were significantly increased compared with those in the control group (p<0.05). Compared with the controls, the expression of sealing claudins (claudin 3, claudin 5, and claudin 8) was significantly decreased, but that of claudin 1 was increased. The expression of pore-forming claudin 2 was upregulated and claudin 7 was downregulated in DSS-induced colitis. The epithelial apoptotic ratio was 2.8%+/-1.2% in controls and was significantly increased to 7.2%+/-1.2% in DSS-induced colitis. The expression of MBL and MASP-2 in the intestinal mucosa showed intense staining in controls, whereas there was weak staining in the rats with colitis. CONCLUSIONS: There was increased intestinal permeability in DSS-induced colitis. Changes in the expression and distribution of claudins, increased epithelial apoptosis, and the MASP-2-induced immune response impaired the intestinal epithelium and contributed to high intestinal permeability.
Animals ; Apoptosis/*physiology ; Claudins/*metabolism ; Colitis/chemically induced/immunology/*physiopathology ; Colon/immunology/physiopathology ; Dextran Sulfate ; Intestinal Mucosa/*physiopathology ; Lactulose/metabolism ; Mannitol/metabolism ; Mannose-Binding Lectin/*immunology ; Permeability ; Rats ; Rats, Sprague-Dawley ; Sucrose/analogs & derivatives/metabolism ; Up-Regulation

Objective To analyze the clinical characteristics of the elderly acute pulmonary embolism(APE) patients with normal blood pressure and right ventricular dysfunction(RVD).Methods A total of 133 elderly APE patients with normal blood pressure and RVD were retrospectively analyzed.According to whether or not to merge RVD,patients were divided into the RVD group(n=42)and the non-RVD group(n=91).The incidence of clinical symptoms and signs,the incidence of pulmonary embolism,clinical indicators after thrombolytic therapy,and the incidence of bleeding were compared and analyzed between RVD and non-RVD groups.Results The incidences of syncope(33.3％ or 14/42 vs.7.8％ 7/91),P2 accentuation(45.2％ or 19/42 vs.25.3％ or 23/91),tachycardia(40.5％ or 17/42 vs.20.9％ or 19/91),cyanosis(26.2％ or 11/42 vs.8.8％ or 8/91)and jugular vein filling(11.9％ or 5/42 vs.1.1％ or 1/91)had significant differences between RVD and non-RVD groups(x2 =4.928,4.644,5.410,4.971 and 4.163,all P＜0.05).The incidence of proximal pulmonary embolism was higher in RVD group than in non-RVD group[25(59.5％)vs.8(8.8％),x2 =13.636,P＜0.01],and the incidence of lobar artery embolism was higher in RVD group than in non-RVD group[32 (76.2％)vs.47(51.6％),x2 =9.530,P＜0.01].Thirteen RVD patients received low-molecular-weight heparin anticoagulation combined with thrombolytic therapy,and 29 RVD patients took low-molecular-weight heparin anticoagulant therapy.The pulmonary artery systolic pressure(PASP) and tricuspid regurgitation pressure levels were higher in the thrombolytic therapy group than in the anticoagulant therapy group(t =2.894,2.518 and 1.957,P =0.004,0.015 and 0.026).The incidence of bleeding was higher in the thrombolytic therapy group than in the anticoagulant therapy group (23.1％ vs.10.3 ％,x2 =3.498,P =0.015).Conclusions The right ventricular dysfunction should be confirmed in APE patients with embolism involving proximal pulmonary artery or(and)presenting clinical symptoms or signs such as syncope and tachycardia.The anticoagulation therapy is effective and safe for elderly patients with normal blood pressure and right heart dysfunction without risks for further deterioration.

OBJECTIVETo investigate the effects of Qili Qiangxin capsules on the amino-terminal pro-brain natriuretic peptide (NT-proBNP) level and cardiac function in patients with silicosis.

METHODSHospitalized silicosis patients with heart failure were divided into treatment group (41 cases) and control group (30 cases) according to their own will. Both groups received comprehensive symptomatic treatment; in addition, the treatment group received Qili Qiangxin capsules. The treatment lasted 6 months. The observed items included NT-proBNP level, 6-minute walk test, ultrasonic cardiogram, and NYHA classification before and after treatment.

RESULTSAccording to NYHA classification, the response rate was 29.27%in the treatment group and 10.00%in the control group; there was a significant difference between the two groups (P < 0.05). The average walk distance in the treatment group was increased from 150.96±73.12 m before treatment to 169.32±77.04 m after treatment, and the improvement was statistically significant (P < 0.05). The average NT-proBNP level in the treatment group was reduced from 1154.44 ± 480.79 ng/L before treatment to 494.49 ± 342.61 ng/L after treatment, and the reduction was statistically significant (P < 0.01). Left ventricular ejection fraction was significantly improved in the treatment group (P < 0.05).

CONCLUSIONQili Qiangxin capsules in addition to comprehensive symptomatic treatment can significantly reduce NT-proBNP level and improve cardiac function in silicosis patients, and thereby improve patients' quality of life.

Capsules ; Drugs, Chinese Herbal ; pharmacology ; Echocardiography ; Heart Failure ; physiopathology ; Humans ; Natriuretic Peptide, Brain ; drug effects ; metabolism ; Peptide Fragments ; drug effects ; metabolism ; Quality of Life ; Silicosis ; drug therapy ; physiopathology

Objective:To explore the peripheral blood levels changes of soluble glycosylation end product receptor (sRAGE), endotoxin and Toll-like receptor (TLR) in patients with severe acute pancreatitis (SAP) complicated with peritoneal cavity infection, and clarify the relationship between indexes and pathogenetic condition.Methods:The clinical data of 105 patients with SAP in Shanghai Pudong New Area People′s Hospital from January 2017 to December 2020 were retrospectively analyzed. Among them, 28 cases had peritoneal cavity infection (infection group), and 77 cases had peritoneal cavity infection symptoms but undiagnosed (non-infection group). The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) at admission was recorded. When patients had the suspected symptoms and signs of peritoneal cavity infection, the serum levels of sRAGE, endotoxin, TLR4 and TLR9 were detected by enzyme-linked immunosorbent assay. The correlation between serum levels of sRAGE, endotoxin, TLR-4, TLR-9 and APACHE Ⅱ was analyzed by Pearson analysis; the risk factors of peritoneal cavity infection in SAP patients were analyzed by multivariate Logistic regression; the receiver operating characteristic (ROC) curve was drawn, and the diagnostic efficacy of serum sRAGE, endotoxin, TLR-4 and TLR-9 in peritoneal cavity infection were evaluated in patients with SAP; the Kaplan-Meier survival curve was drawn, and the comparison used log-rank test.Results:The serum sRAGE, endotoxin, TLR-4 and TLR-9 in infection group were significantly higher than those in non-infection group: (822.16 ± 104.51) ng/L vs. (728.09 ± 96.47) ng/L, (62.59 ± 20.11) ng/L vs. (41.62 ± 13.64) ng/L, (45.17 ± 8.54) μg/L vs. (37.34 ± 6.22) μg/L, (26.35 ± 6.73) μg/L vs. (20.02 ± 5.49) μg/L, and there were statistical differences ( P<0.01). Pearson correlation analysis result showed that the serum sRAGE, endotoxin, TLR-4 and TLR-9 were positively correlated with APACHE Ⅱ in patients with SAP ( r = 0.632, 0.556, 0.521 and 0.631; P<0.05). Multivariate Logistic regression analysis result showed that the combined organ function damage, shock, hypoxemia and serum sRAGE, endotoxin, TLR-4 and TLR-9 were independent risk factors of peritoneal cavity infection in patients with SAP ( P<0.05). ROC curve analysis result showed that the area under the curve for the serum sRAGE, endotoxin, TLR-4 and TLR-9 combined diagnosis of peritoneal cavity infection in patients with SAP was the largest, which was 0.910 (95% CI 0.838 to 0.957, P<0.01), with a sensitivity of 82.14% and a specificity of 87.01%. According to the ROC curve cut-off value of serum sRAGE, endotoxin, TLR-4 and TLR-9 (764.58 ng/L, 58.01 ng/L, 40.24 μg/L and 22.61 μg/L), the 28 patients with SAP complicated with peritoneal cavity infection were divided into high levels patients (21, 14, 23 and 22 cases) and low levels patients (7, 14, 5 and 6 cases); Kaplan-Meier survival curve analysis result showed that the 28-day survival rates in patients with high levels of sRAGE, endotoxin, TLR-4 and TLR-9 were significantly lower than those in patients with low levels (61.90% vs. 71.43%, 50.00% vs. 78.57%, 60.87% vs. 80.00% and 59.09% vs. 83.33%), and there were statistical differences ( P<0.05). Conclusions:The serum sRAGE, endotoxin, TLR-4 and TLR-9 have a high combined diagnostic value in SAP complicated with peritoneal cavity infection, and they are all related to the severity of the disease and have a significant impact on survival.

Objective: To analyze the effect of a comprehensive intervention on the accuracy of children s body size perception, so as to provide a theoretical basis for child body size perception improvement. Methods: The participants were selected from a cluster randomized controlled trial (September 2018 to June 2019). A total of 1 287 children in 24 primary schools (clusters) equally distributed among three regions (Beijing, Changzhi and Urumqi) were selected, which included 12 intervention schools (648 students) and 12 control schools (639 students). The accuracy of body size perception was measured by Ma figural stimuli. A linear mixed model was employed to analyze the effect of the comprehensive intervention on the accuracy of children s body size perception. Results: At baseline, the accuracy rate of body size perception among children in the intervention group and the control group was 56.6% and 51.5%, respectively. The underestimation rate was 42.0% and 47.7%, and the overestimation rate was 1.4% and 0.8%. After the intervention, compared with the control group, the inaccuracy rate ( OR=0.50, 95%CI=0.37-0.68, P <0.01) and the underestimation rate in the intervention group decreased ( OR=0.37, 95%CI=0.26-0.54, P <0.01). There was no significant difference in the overestimation rate between the two groups( P =0.51). The results of the stratified analysis showed that the intervention could improve the accuracy of children s body size perception, regardless of their gender, nutritional status, region, or whether or not they were only child( P >0.05). Conclusion The inaccuracy rate of children s body size perception, which mainly involved underestimation was high. A comprehensive intervention can effectively reduce body size underestimation and improve the accuracy of children s body size perception.