Gastroesophageal reflux disease( GERD)is caused by dysfunction of lower esophageal sphincter( LES), which allows the contents of stomach and duodenum to reflux into esophagus. Currently,medical and surgical therapies are the main treatment for GERD,but patients need to take life-long acid suppression and the surgical treatment has the risks of potential side effects. Endolumenal therapy as a minimally invasive approach to GERD can safely and effectively relieve the symptoms of GERD,especially Stretta radiofrequency procedure,transoral noninvasive fundoplication( TIF ) and LinX reflux management system. This article reviewed the advances in study on endolumenal therapy for GERD.

Objective To investigate the effective mechanism of Jiawei Maxing Shigan Tang(JMST, Modified Decoction of Ephedra,Apricot Kernel,Gypsum and Licorice)in treatment of acute exacerbated chronic obstructive pulmonary disease(AECOPD).Methods Wistar rats(n =40)were randomly divided into blank control group,model group,JMST group and clarithromycin group.The blank control group was given normal feeding, and model group, JMST group and clarithromycin group were given airway instillation of lipopolysaccharide(LPS)and smudging for establishing AECOPD model.The model group was given normal saline,JMST group,JMST(8.7 g/kg)and clarithromycin group,clarithromycin suspension(50 mg/kg)continuously for 30 d.The lung function was measured on the 31std.The lung tissue was collected to making pathological sections for observing goblet cells after AB -PAS staining.The expressions of mucoprotein 5AC(MUC5AC)and neutrophil elastase(NE)were detected by using immunohistochemistry technique.Results Compared with blank control group, the ratio of 0.3-second forced expiratory volume to forced vital capacity(FEV0.3/FVC)decreased significantly, and number of goblet cells and expressions of MUC 5AC and NE increased significantly in model group,JMST group and clarithromycin group.Compared with model group, FEV0.3/FVC increased significantly,and number of goblet cells and expressions of MUC 5AC and NE decreased significantly in JMST group.The comparison in FEV0.3/FVC,number of goblet cells and expressions of MUC 5AC and NE had no statistical difference between JMST group and clarithromycin group.Conclusion Jiawei Maxing Shigan Tang can significantly promote FEV0.3/FVC, inhibit proliferation of goblet cells, down-regulate expressions of MUC5AC and NE and relieve airway mucus hypersecretion in AECOPD rats, which may be its one of therapeutic mechanisms in treatment of AECOPD.

Objective To explore the effect of Qingjin Huatan Decoction on forkhead box P3 (Foxp3) and retinoid-related orphan nuclear receptor γt (RORγt)in the lung tissue of airway mucus hypersecre-tion rat model with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods Altogether 40 male Wistar rats,SPF grade,were randomly divided into normal group,model group, Qingjin Huatan Decoction group and clarithromycin group.AECOPD rat model was induced by intratra-cheal instillation of lipopolysaccharide (LPS)with passive smoking.From the first day of the experiment, rats of model group were intragastrically administered saline,and those of Qingjin Huatan Decoction group and clarithromycin group took corresponding medicines at dose of 8.4 g/kg and dose of 50 mg/kg for consecutive 30 days.On day 31,all rats were sacrificed.The thin sections of the rats’resected lungs were made,the expressions of mucin 5AC (Muc5AC),neutrophil elastase (NE),Foxp3 and RORγt in lung tissue were detected by using immunohistochemical method,and the protein expressions of Foxp3 and RORγt were measured by using Western blot.Results Compared with the normal group,Foxp3 protein expression in model group had no significant difference (P >0.05),but expression of RORγt, Muc5AC and NE increased significantly with Foxp3 /RORγt decreased significantly (P <0.01 ).Com-pared with model group,Foxp3 expression in Qingjin Huatan Decoction group had no significant differ-ence (P >0.05),but expression of RORγt,Muc5AC and NE decreased significantly with Foxp3 /RORγt increased significantly (P <0.01 or P <0.05 ).Compared with clarithromycin group,Muc5AC de-creased significantly in Qingjin Huatan Decoction group (P <0.05).Conclusion The potential mecha-nism of Qingjin Huatan Decoction against AECOPD mucus hypersecretion was to downregulate RORγt protein expression in lung tissue and to upregulate Foxp3 /RORγt.

Objective To summarize the application experiences and curative efficacies of single lung transplantation assisted by extracorporeal circulation with coated lung ,centrifugal pump and coated pipe .Methods Retrospective analysis was conducted for clinical data of 6 adult patients with respiratory insufficiency undergoing single lung transplantation .The changes of hemodynamics and oxygenation before and after adjuvant treatment were observed ,the effects of adjuvant evaluated and the experiences of application summarized .Results The hemodynamic parameters post-assistance significantly improved as compared with that pre-assistance and pulmonary arterial pressure dropped from (56 ± 15 ) to (45 ± 13 ) mmHg with statistically significant differences . Arterial blood gas parameters significantly improved .PO2 spiked from (47 ± 12) to (68 ± 9) mmHg and PCO2 declined from (65 ± 14) to (55 ± 12)mmHg .And there were statistically significant differences .All patients were discharged successfully .Conclusions The simple extracorporeal membrane oxygenation system of coated lung , centrifugal pump and coated pipe during routine extracorporeal circulation may guarantee the operative safety of single lung transplantation and provide a new therapeutic option .

【Objective】 To compare the perioperative blood loss between interlaminar and transforaminal approaches by percutaneous endoscopic discectomy in order to provide more reference for guiding the proper choice of surgical methods clinically. 【Methods】 We retrospectively analyzed the clinical data of 160 patients who underwent percutaneous endoscopic lumbar discectomy from June 2019 to November 2020， with 80 patients in interlaminar approach group and 80 in transforaminal approach group. The blood loss was calculated according to Gross formula. 【Results】 The perioperative total blood loss （mL）， hidden blood loss （mL） and hemoglobin loss （g/L） were significantly lower in interlaminar approach group than in transforaminal approach group （119.73±179.26 vs. 158.6±190.65， 109.73±179.53 vs. 148.78±190.19， 3.76±8.12 vs. 4.31±7.62） （P<0.05）. However， there was no significant difference in visible blood loss between the two groups. 【Conclusion】 The perioperative hidden blood loss accounts for a large proportion in percutaneous endoscopic lumbar discectomy. In addition， the interlaminar approach causes less blood loss than the transforaminal approach.