Objective To investigate the etiology, clinical features, diagnosis and treatment of regional portal hypertension (RPH).Methods The clinical data of 26 patients with RPH treated in Beijing Chaoyang Hospital Affiliated to Capital Medical University between January 2005 and June 2010 were analyzed with retrospective analysis.The first symptom, routine analysis of blood, liver function test, hepatitis B and C markers, tumor markers, abdominal ultrasound, abdominal enhanced CT, endoscopy findings of 26 patients and the results of abdominal CT angiography (CTA) of 16cases were analyzed.Results Pancreatic disease (18 cases) was the leading cause of RPH.The main clinical manifestations of splenomegaly in 26 cases, irregularly abdominal pain in 14 cases, and upper gastrointestinal bleeding in 10 cases.Isolated gastric varices were revealed by endoscopy in 25 cases,complicated with lower esophageal varices in 1 case.4 cases with endoscopic tissue glue injection in gastric variceal bleeding, splenectomy in 4 cases, 2 cases with splenectomy and pericardialdevascularization, 2 cases with splenectomy, pancreatic tail resection and spleno-renal shunt, 3 cases with splenic embolization treatment.Conclusions RPH often accompanied by pancreatic disease,manifested as splenomegaly, hypersplenism, but normal liver function, absence of liver cirrhosis.Isolated gastric varices is the characteristic features of RPH.RPH caused by benign diseases is curable.Splenectomy is more effective than simple endoscopic hemostasis in RPH associated with gastrointestinal bleeding.

ObjectiveTo investigate the characteristics of gastroesophageal reflux disease (GERD) with chronic cough by the results of combined multichannel intraluminal impedance and high-resolution manometry (MII-HRM) procedure and 24-hour muhichannel intraluminal impedance combined pH (MII pH) monitoring.Methods From March 2010 to November 2010,consecutive patients of GERD with chronic cough (more than 8 weeks) admitted to Beijing Chaoyang Hospital of Capital Medical University underwent 24-hour MII-pH monitoring and MII-HRM procedure with symptom association probability(SAP) over 95％.Data of lower esophageal sphincter (LES) pressure,LES relaxation,LES residual pressure,esophageal body peristalsis function and swallow bolus transit (liquid/viscous) was collected and the result of 24-hour MII-pH monitoring was analysed by the computer software containing reflux episode activity(acid/nonacid,upright/recumbent),proximal extent,acid exposure and mean acid/bolus clearance time.Seventeen patients of GERD with typical reflux symptom were selected as the control group.ResultsComparing with patients of GERD with typical reflux symptom,patients of GERD with chronic cough showeddecreased upper esophageal sphincter pressure (UESP) [( 122.55 ± 60.48 )mm Hg vs ( 86.37 ± 41.35 ) mm Hg,P ＜ 0.05,1 mm Hg =0.133 kPa ],higher percentage of abnormality peristalsis [(9.47 ± 15.63 ) ％ vs ( 22.16 ± 17.45 ) ％,P ＜ 0.05 ],degraded esophagus transmittability of liquid substance [( 88.82 ± 12.23) ％ vs ( 71.68 ± 23.06 ) ％,P ＜ 0.05 ],more reflux episode activity ( acid/nonacid ) in supine position and proximal reflux episode (nonacid) in supine position (P ＜ 0.05 )and longer mean bolus clearance time( P ＜ 0.05 ).Conclusion Decrease of the UESP,increase of the reflux episode activity (acid/nonacid) in supine position and proximal reflux episode (nonacid) in supine position,lengthened mean bolus clearance time in supine position and the degraded esophagus clearance ability may all correlated with the pathogenesy of GERD with chronic cough.

Objective To summarize the experience of nursing the patients with liver transplantation complicated with early portal vein thrombosis treated with post-embolectomic anticoagulation. Method The clinical data of 5 cases of liver transplantation-induced portal vein thrombosis treated with post-embolectomic anticoagulation was reviewed to summarize the curative effect , key points for disease conditions and anticoagulative nursing. Results The anticoagulative effect was not good in only one case. 4 other cases were recovered by embolectomy and postoperative anticoagulation therapy as well as related nursing measures. Conclusion The nursing measures such as close observation of the disease processing, early reasonable anticoagulation, accurate medication, prevention of patent complication are critical for preventing the recurrence of portal vein thrombosis after liver transplantation.

OBJECTIVETo observe the effects between acupuncture combined with rehabilitation and simple rehabilitation for shoulder pain after stroke, and to select the best plan of acupuncture manipulations at different stages by orthogonal design.

METHODSNinety patients were treated with comprehensive rehabilitation, and nine cases without acupuncture were arranged into a control group. Eighty-one patients of orthogonal design were applied by acupuncture with the same acupoints and course. The VAS score and its weighted value were regarded as the observation indices,and the effects between the acupuncture group and the control group were compared. The optimal plans of acupuncture manipulations of the early stage and the later stage were chosen after the first course treatment and the third course treatment separately. The acupuncture depth (factor A:A: shallow depth less than 25 mm, A(II): modest depth 25-40 mm, A(III): deep depth 40-50 mm), the acupuncture angle (factor B:B(I): perpendicular insertion, B(II): horizontal insertion, B(III): oblique insertion), needle manipulated frequency (factor C: C(I): zero time, C(II): one time, C(III): three times) and needle retained time(factor D:D(I):20 min, D(II): 30 min, D(III): 60 min) were studied. The differences among all factors and the diversity among major factors at different stages were analyzed.

RESULTS(1) Acupuncture combined with rehabilitation at the early and the later stage acquired better improvement than simple rehabilitation (all P < 0.01). (2) The optimal acupuncture manipulation plan at the early stage was A(III) B(III) C(I) D(I), which was deep acupuncture and oblique insertion for 20 min with zero-time manipulation; the optimal acupuncture manipulation plan at the later stage was A(III) B(III) C(III) D(I), which was deep acupuncture and oblique insertion for 20 min with three-time manipulation. (3) There was significance for acupuncture depth and angle at the early stage (both P < 0.01) and there was significance for insertion depth, acupuncture angle and manipulating frequency at the later stage (all P < 0.05). (4) At the early stage, the insertion depth was statistically significant between A(I) and A(II), A(I) and A(III), A(II) and A(III) (P < 0.05, P < 0.01), and the statistical significance was existed between B(I) and B(III) (P < 0.01). At the later stage, the insertion depth was statistically significant between A(I) and A(III), A(III) and A(II), A(I) and A(II) (P < 0.05, P < 0.01), and the statistical significance was existed between C(I) and C(III), C(II) and C(III) (P < 0.05).

CONCLUSIONAcupuncture combined with rehabilitation acquire apparent effect for shoulder pain after stroke. At the early stage,the optimal plan is deep and oblique insertion for 20 min with zero-time manipulation. At the later stage, the best plan is deep and oblique insertion for 20 min with 3-time manipulation.

Acupuncture Therapy ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Shoulder Pain ; etiology ; rehabilitation ; therapy ; Stroke ; complications ; Treatment Outcome

Objective To investigate the factors affecting health-related quality of life (HRQOL) in patients with chronic liver disease (CLD).Methods HRQOL was measured with SF-36v2 Chinese version.All patients with CLD diagnosed between December 2009 and May 2011 in Liver Research Center,Beijing Friendship Hospital and Digestive Department,Beijing Chaoyang Hospital were enrolled in this study.Patients with CLD were divided into 4 groups according to their Child-Turcotte-Pugh scores:no cirrhosis,Child's classes A,B,and C.Demographic and clinical data were collected in each group.Results A total of 392 patients with CLD and 91 healthy controls were included.HRQOL in patients with CLD was lower than that in healthy controls.Physical component score (PCS) in healthy controls was 54.6 ± 5.5,and in CLD was 47.8 ± 8.8 (t =9.343,P ＜ 0.01).Mental component score (MCS) in healthy controls was 56.4 ± 8.1,and in CLD was 51.7 ± 7.4 (t =5.302,P ＜ 0.01).Increasing severity of CLD from no cirrhosis to advanced cirrhosis was associated with a decrease on HRQOL,PCS scores were 53.1 ± 5.9,48.7 ± 6.6,42.4 ± 7.1 and 37.2 ± 8.9 (F =93.353,P ＜ 0.01) ; MCS scores were 53.2 ± 4.8,52.7 ±6.5,51.8 ±7.5,and 46.8 ± 7.5 (F =11.325,P ＜0.01),for no patients with cirrhosis,Child's classes A,B and C respectively.Stepwise linear regression analysis showed that severity of disease,age,present ascites,present varices,and prothrombin time had significant effects on physical health area (F =100.893,P ＜ 0.010).Severity of disease,female gender,present varices,total bilirubin,prothrombin time and hemoglobin had significant effects on mental health area (F =19.237,P ＜ 0.010).Conclusions Patients with CLD have reduced HRQOL.Increasing severity of CLD is associated with a decreasing HRQOL.Old age,female gender,advanced stage of CLD,present ascites,hyperbilirubinemia and prolonging prothrombin time are risk factors for reducing HRQOL.

Objective To evaluate the apparent diffusion coefficient (ADC) of parenehyma and necrosis in distinguishing among metastatic lymph nodes, lymphoma and tuberculous lymph nodes. Methods Thirty-six patients with cervical lymph nodes metastasis from the head and neck squamous cell carcinomas,19 patients with lymphoma and 23 patients with lymph nodes tuberculosis underwent diffusion-weighted imaging. The ADC values were measured and compared in parenchyma and necrosis of 177 lymph nodes confirmed by histopathology (n = 114) and clinical follow-up (n = 63). The means between two groups were compared by t-test, and one-way analysis of variance (one-way ANOVA) was used to analyze the data among three or more groups. Results The mean ADC values of parenchyma in metastatic nodes, lymphoma and tuberculous nodes were (0.93±0.16) × 10-3mm2/s, (0.64±0.13) × 10-3mm2/s and (1.01±0.11) ×10 -3 mm2/s respectively (F = 82.928, P < 0.01) ; the ADC values of necrosis in metastatic and tuberculous nodes were (2.02 ± 0. 36) × 10-3 mm2/s and (1.25 ± 0.15) × 10-3 mm2/s respectively (t = 12.045, P <0.01). An ADC value of parenchyma lower than or equal to 0.77 × 10 -3mm2/s was used as the threshold for lymphoma, with a sensitivity 83% and specificity of 89%. An ADC value of necrotic area greater than or equal to 1.60 × 103mm2/s was used as the threshold for metastatic nodes, with a sensitivity of 88% and specificity of 100%. Conclusion The ADC value of lymph nodes, especially for their internal necrotic areas, can help judge the nature of the cervical lymph nodes.

ObjectiveTo investigate the feasibitity of detecting S100A6 expression at mRNA level in endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) pancreatic ductal adenocarcinoma (PDA) specimens and its diagnostic value in PDA.MethodsA total of 18 PDA specimens and 22 normal pancreatic specimens were collected. RNA was extracted for reverse transcription.The expression of S100A6 gene was examined by real-time polymerase chain reaction.The cut-off value of S100A6 expression at mRNA level in PDA diagnosis was established through receiver operating characteristic (ROC) analysis. 28 patients with pancreatic head masses were selected for EUS-FNA examination,and the value of S100A6 mRNA expression level in PDA diagnosis was prospectively evaluated. The expression of S100A6 protein in PDA tissue was determined by immunohistochemistry staining.ResultsS100A6 mRNA expression in EUS-FNA and surgical PDA specimens (0.05023±0.10120,0.02083 ± 0.02848) was significantly higher than that of normal pancreatic tissues (0.00164±0.00202),both P＜0.01.The expression of S100A6 in 22 EUS-FNA PDA specimens was significantly higher than that of 6 pancreatic benign disease biopsy specimens (0.00193 ± 0.00278,P =0.0009). There was no significant difference in S100A6 expression between 6 pancreatic benign disease biopsy specimens and normal surgical pancreatic samples (P=0.6143).When S100A6 mRNA expression in EUS-FNA specimens over 0.00525 was taken as positive diagnostic value,the sensitivity,specificity and accuracy in prospective pancreatic cancer diagnosis were 90.01％,100 ％ and 92.85 ％,respectively.ConclusionThe high expression of S100A6 mRNA in EUS-FNA specimens of PDA has good preoperative diagnostic value.

Objective To analysis the effect of axial loading to ADC value, FA of lumbar intervetebral discs. Methods Forty five patients with low back pain (age range, 25 to 54 years) were evaluated with MR T2WI, MR T1WI and diffusion tensor imaging (DTI) of the lumbar spine. Following axial loading with 40% to 50% body weight for 10 minutes, a repeat DTI was performed. DTI were obtained by using an echo-planar imaging ( EPI ) sequence, TE 89 ms, TR 2500 ms, b value of 400 s/mm2,6 noncollinear diffusion directions. Scan time was approximately 4 min 10 s. An isotropic ADC map, FA map and bo map were calculated from DTI sequence. The mean ADC value, FA prior to and following axialloading were analyzed with t test and Rank Sum test. Results Forty five patients with 225 discs were evaluated and 223 discs were included in the study except for 2 calcified discs. The Pfirrmann grading results were as following: 100 Grade Ⅱ , 48 Grade Ⅲ, 59 Grade Ⅳ, and 16 Grade Ⅴ. No significant difference existed in the mean ADC value before [ ( 1666 ± 252 ) × 10-3 mm2/s ] and after [ ( 1662 ± 253 ) ×10 -3 mm2/s ] axial loading ( Z = - 1.363, P ＞ 0.05 ), but the mean FA [ ( 301 ± 104 ) × 10 -3, ( 316 ±112) × 10-3 ] value increased ( Z = - 2.794, P ＜ 0.05 ). The paired-samples t test show that the mean ADC value [ ( 1685 ± 190) × 10-3 mm2/s, ( 1624 ± 180) × 10-3mm2/s] of Grade Ⅲ discs decreased after axial loading, t=3.513, P＜0. 05, Grade Ⅲ, Ⅳdiscs mean FA value [(300±87) ×10-3, (326±87) ×10-3 for Grade Ⅲ and (348 ±67) × 10-3, (351 ± 71 ) × 10-3 for Grade Ⅳ ] increased, t = - 2. 210,- 2.006, P ＜ 0.05. No significant difference existed in Grade Ⅱ , Ⅳ and Ⅴ discs ADC value, all the P ＞0.05. No significant difference existed in Grade Ⅱ and Ⅴ discs FA value, both the P ＞ 0.05. Conclusions Short time axial loading mainly affect the mildly degenerated discs, the ADC value decreases and the disc diffusion ability decreases. No obvious change in ADC value or disc diffusion ability existed in the normal and severely degenerated discs.

BACKGROUND:Plastic as a durable,inexpensive,easy to manufacture organic synthetic polymer materials are widely used.At the same time,plastic resistance to high temperatures,acid and alkali resistance,corrosion-resistant properties make it difficult to degrade in nature,and ultimately forming a huge number of microplastic pollution threatening human health. OBJECTIVE:To investigate the effects of microplastic exposure on growth and development and hepatic lipid metabolism in mice. METHODS:Twenty C57BL/6J male mice were adaptively fed for one week,and then randomly divided into normal and microplastic groups(n=10 per group).Mice in the normal group were given a normal diet and water,for 4 weeks.Mice in the microplastic group were given a normal diet and free drinking of microplastic(polystyrene)water with a concentration of 1 000 μg/L,for 4 weeks.At 2 and 4 weeks of drinking,body mass and grip strength,blood lipids and liver and kidney function,ultrasonic morphology and pathological morphology of liver and lipid deposition were detected. RESULTS AND CONCLUSION:(1)With the extension of time,the body mass of mice in the two groups gradually increased,and the body mass of mice in the microplastic group was greater than that in the normal group after 2,4 weeks of drinking water(P<0.05).With the extension of time,the grip strength of mice in the normal group gradually increased,and the grip strength of mice in the microplastic group first decreased and then increased,and the grip strength of mice in the microplastic group was lower than that in the normal group after drinking water for 4 weeks(P<0.05).(2)Liver ultrasound examination showed that compared with the normal group,the ultrasonic echo signal of the liver in the microplastic group was enhanced after 2 and 4 weeks of drinking water.(3)Hematoxylin-eosin staining showed that the morphology of liver cells in the microplastic group did not change significantly after 2 and 4 weeks of drinking water,but inflammatory cell infiltration could be seen.Oil red O staining showed that obvious lipid deposition was observed in the liver of microplastic group after 2 and 4 weeks of drinking water.(4)Compared with the normal group,the levels of serum high density lipoprotein cholesterol,triacylglycerol,and aspartate aminotransferase in the microplastic group were decreased after 2 weeks of drinking water(P<0.05),and the serum triacylglycerol concentration was decreased after 4 weeks of drinking water(P<0.05).(5)These findings confirm that microplastics may cause weight gain,loss of physical strength,and abnormal hepatic lipid metabolism in mice.

Objective To summarize the experience in nursing patients with gut leak after liver transplantation. Methods Two patients with recurrent gut leakafter liver transplantation underwent surgical repair. The nursing measures included strict observation of postoperative disease, observation of drainage fluid and abdominal signs, early nutritional support, good psychological nursing and health education. Results Gut leak occurred in the two cases again after liver transplantation.One case was treated with repair again and the other with end-stage ileotomy and ileostomy. The patients were discharged after medication and nursing care. Conclusions The close postoperative observation of the disease, observation of drainage fluid and abdominal signs can prompt the discovery of intestinal re-perforation.The early nutritional support plays an important role in the rehabilitation of patients with gut leak after liver transplantation.Mental care and health education can enhance patient's confidence in treatment.