Plasma levels of homocysteine (Hcy),folic acid (FA) and Vitamin B12 (VB12) were measured in 120 patients of colon adenomatous polyps and 40 healthy subjects.Plasma Hcy levels in colon adenomatous polyps patients were significantly higher than those in controls[(14.24 ± 0.52) μmol/L vs.(10.93 ± 0.81) μmol/L,P =0.0014)],while plasma FA levels in polyps patients were lower than those in controls [(6.26 ± 0.27) μg/L vs.(10.74 ± 0.85) μg/L,P ＜ 0.0001].There was no difference in plasma VB12 levels between two groups(P =0.7100).The plasma Hcy levels in patients with multiple colon polyps were higher than those with single colon polyps (P =0.0092),while the plasma FA levels demonstrated contrary results (P =0.0047).With the pathological type progression,the plasma Hcy levels were gradually raised,and FA levels gradually decreased.Plasma levels of FA,Hcy and VB12 were not correlated with the location and distribution of polyps.These results suggest that plasma FA and Hcy levels may be related to disease progress in patients with colon adenomatous polyps.

Objective To evaluate the feasibility and safety of direct peroral cholangioscopy (DPCS) by freehand intubation using routine straight-view endoscope for diagnosis and therapy of biliary diseases.Methods Patients with unexplained choledochal stenosis and choledocholithiasis underwent standard ERCP.Native papilla was dilated using endoscopic papillary large balloon dilation (EPLBD)according to the size of papilla and the diameter of common bile duct.DPCS was performed using routine straight-view endoscope,and biopsy or laser lithotripsy was performed according to imaging of DPCS.General data of patients,procedure of ERCP,diagnosis of DPCS,and complications were recorded.Serum amylase after 2 hours and 24 hours,total bilirubin,direct bilirubin,leukocyte count,neutrophilic granulocyte percentage,and C-reactive protein were measured.Results A total of 15 patients underwent DPCS,including 5 cases of huge common bile duct stones and 10 cases of common bile duct stricture.The diameter of common bile duct ranged from 1.5 cm to 2.5 cm.Single EPLBD was required in 3 cases,endoscopic sphincteropapillotomy and EPLBD was required in 12 cases to facilitate DPCS.DPCS was successfully completed in 14 cases,including 11 cases in distal common bile duct,3 cases in proximal common bile duct.Among the 14 cases,4 cases used ordinary gastroscope,and 10 cases used ultrathin gastroscope.Laser lithotripsy was successfully completed in 4 choledocholithiasis patients.DPCS was successfully completed in 9 patients of common bile duct stenosis.The reasons of stenosis included 5 calculi,2 normal,1 scar and 2 adenoma.There were 1 case of cholangitis and 4 cases of hyperamylasemia after operation.No procedure related death occurred.Conclusion Freehand DPCS using ordinary gastroscope or ultrathin gastroscope is feasible and safe,and may be clinically useful for diagnosis and therapy of unexplained choledocholithiasis and common bile duct stenosis.

Objective To study the effects of cyclooxygenase( COX)?2 selective inhibitors on post?endoscopic retrograde cholangiopancreatography ( ERCP ) pancreatitis ( PEP ) and hyperamylasemia for common bile duct stones. Methods A total of 128 patients with normal serum amylase underwent ERCP from June 2014 to February 2015 in our hospital and were given corresponding drugs to prevent PEP.The pa?tients were divided randomly into four groups:combination group( n=33) , celecoxib group( n=34) , nitro?glycerin group(n=32) and control group(n=29). The serum amylase(AMS), C?reactive protein(CRP) and direct bilirubin( Dbil) after ERCP were measured. Abdominal pain was observed, and the incidence of PEP and post?ERCP hyperamylasemia were recorded. Results The incidence of PEP in combination group, celecoxib group were lower than those in nitroglycerin group and the control group ( 3?03%, 2?94% VS 15?63%, 17?24%),but the difference was not statistically significant(P=0?078).The incidence of post?ERCP hyperamylasemia in combination group and celecoxib group were lower than that in the control group ( 3?03%,5?88% VS 31?03%) with statistically significant difference( P=0?003, P=0?010) . There was no significant difference between nitroglycerin group ( 25%) and control group. The abdominal pain grades of combination group and celecoxib group were lower than those in nitroglycerin group and control group with significant difference(P<0?05). Celecoxib may reduce CRP after ERCP(P=0?001) and nitroglycerin may reduce Dbil after ERCP(P=0?016). Conclusion Celecoxib may reduce the incidence of hyperamylasemia and can help to reduce the abdominal pain and inflammatory reactions after ERCP . Nitroglycerin can help to reduce the Dbil after ERCP .

Objective To investigate the correlation and differences of serum calcium ( Ca) and intact parathyroid hormone ( i-PTH) in patients with hyperlipidemic or biliogenic acute pancreatitis ( AP) .Methods From Jan 2012 to Jan 2014 , total 80 AP patients admitted to Bejing Chaoyang Hospital were enrolled . According to the etiology , AP patients were divided into 2 groups, hyperlipidemic acute pancreatitis ( HLAP) group and biliogenic acute pancreatitis (BAP) group.Blood routine, function of liver and kidney , blood lipids, Ca, and i-PTH were measured .Differences between Ca and i-PTH in HLAP group and BAP group were analyzed, and found the correlation with disease severity of AP .Results 80 AP patients included 43 HLAP and 37 BAP patients, 55 mild acute pancreatitis(MAP) and 25 moderately severe acute pancreatitis (MSAP) patients.HLAP group had 34 male and 9 female patients, average age was 37 years, 31 MAP and 12 MSAP patients.BAP group had 17 male and 20 female patients, average age was 58 years, 24 MAP and 13 MSAP patients.proportion of males was significantly higher in HLAP group than BAP group .on the contrary, average age was significantly lower (P<0.01 and <0.01, respectively).No significantly difference was found in MAP/MSAP ration.Level of serum Ca in HLAP group was significantly decreased than BAP group (1.92 ± 0.24 mmol/L vs 2.14 ±1.99 mmol/L, P<0.05).No significantly difference was found in i-PTH between two groups.Level of serum Ca in MAP and MSAP subgroup in HLAP group were 1.98 ±0.20 mmol/L and 1.76 ± 0.27 mmol/L.Accordingly, Level of serum Ca were 2.23 ±0.15 mmol/L and 1.98 ±0.19 mmol/L in BAP group. i-PTH in MAP and MSAP subgroup in HLAP group were 43.41 ±18.40 ng/L and 56.07 ±33.61 ng/L.Accordingly, i-PTH was 39.22 ±17.19 mmol/L and 52.73 ±29.42 mmol/L in BAP group.Compared to MAP, Ca in MSAP group was significantly decreased in HLAP and BAP group ( P<0.01 and <00.5, respectively).In HLAP group, Ca was a negative correlation with low density lipoprotein cholesterol (LDLC-) and triglycerides(TG) (P<0.05 and <0.01, respectively).In BAP group, Ca was a negative correlation with i-PTH(P<0.05).Conclusions Serum Ca is decreased with severity of HLAP and BAP .Decreased Ca has correlation with increased LDL-C, TG in HLAP and increased i-PTH in BAP.

Objective To study the relationship between fibrinolysis,anticoagulation system indexes and serum albumin (ALB) in patients with liver cirrhosis.Methods One hundred and thirty-seven patients with liver cirrhosis were enrolled.Serum ALB,D-dimer (D-D),tissue plasminogen activator (t-PA),plasminogen activator inhibitor-1 (PAI-1),protein C (PC),protein S (PS) and antithrombin-Ⅲ (AT-Ⅲ) levels were measured.Results D-D level was increased with deterioration of liver function.D-D levels were (0.38 ± 0.24),(0.58 ± 0.43) and (0.90 ± 0.55) mg/L in Child-Pugh class A,B and C,respectively.PC,PS and AT-Ⅲ levels were decreased with deterioration of liver function.PC levels were (3.29 ± 1.04),(2.50 ± 1.27) and (2.29 ± 1.05)mg/L in Child-Pugh class A,B and C,respectively.PS levels were (20.74 ± 5.91),(17.97 ± 5.26) and (17.79 ± 5.12) mg/L,respectively.AT-Ⅲ levels were (104.62 ± 8.59)％,(101.76 ± 10.08)％ and (92.91 ± 10.48)％,respectively.D-D showed negative correlation with ALB (r =-0.402,P ＜ 0.01).On the contrary,PC,PS and AT-Ⅲ levels showed positive correlation with ALB (r =0.266,0.286 and 0.405,P ＜0.01).Conclusions Fibrinolysis and anticoagulation system indexes are changed with deterioration of liver function and are related with ALB directly.The indexes may be a helpful tool to evaluate the liver function in patients with liver cirrhosis.

Objective To investigate the coagulation and anticoagulation changes in liver cirrhosis(LC)patients with and without portal vein thrombosis(PVT).Methods Patients with LC during 2006 to 2007 in our hospital were reviewed and twenty cases of LC with PVT were included in the study.Forty cases of LC without PVT were chosen as controls.PVT was confirmed by dynamic abdominal computed tomography.Using an analyzer and following manufacturer instructions,we determined PT,APTT,Fib,Antithrombin Ⅲ and Protein S.SPSS software was used for statistic analysis.Results In PVT group,the average level of PS and AT-Ⅲ were(18.68?3.14)mg/L and(94.65?7.96)%,significantly lower than(20.44?3.04)mg/L and(100.26?9.27)% in controls.No difference was found between patients with or without PVT in PT、APTT、Fib.PT and APTT were progressively prolonged from A to B and then to C.Fib and AT-Ⅲ were progressively decreased from A to B and then to C.Low levels of PS was found in LC patients.Conclusion The changes of coagulation and anticoagulation in patients with LC dearly exist.The average level of PS and AT-Ⅲ in PVT group is significantly lower than controls.PS and AT-Ⅲ may play a pathogenetic role in the development of PVT.

Objective To detect the characteristics of NE patients with GERD.Methods All the 36 NE patients were divided into two groups:GERD group(11 patients)and non-GERD group(25 patients).Their clinical features and manometric findings were compaired.Results There were significant differences between the two groups in the parameters of 24 h pH monitoring and LES relaxation rate(P0.05).The difference of DeMeester score had statistical significance.Conclusion To properly diagnose the NE patients with reflux,we should consider not only clinical characteristics but also the result of 24 h pH monitoring and esophageal manometry.

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.

Objective To investigate the changes of anticardiolipin antibody(ACA) and protein C(PC) in cirrhotic patients with or without portal vein thrombosis(PVT). Methods During Jan. 2006 to Dec. 2007, 60 cirrhotic patients with (n=20) or without (n=40) PVT were analyzed. The concentrations of prothrombin time (PT), activited patial thromboplastin time (APTT), fibrogen, ACA and protein C (PC) were determined. Results The positive rate of ACA was 35% (7/20) in PVT group and 10% (4/40) in control group (P=0.045). The average level of ACA-IgG was significantly higher in PVT group [(10.15±5.31)U/ml] than that in control group [(6.70±3.75) U/ml]. The concentration of PC was significantly lower in PVT group [(2.47±0.62) mg/L] than that in control group [(2.93±0.88)mg/L]. No difference was found in APTT, levels of fibrogen and ACA-IgM between two groups. PT and APTT were progressively prolonged and fibrogen and PC were decreasing with the severity of Child-Pugh, respectively. The levels of ACA-IgG and ACA-IgM were increasing with the severity of Child-Pugh. Conclusions The coagulation and anticoagulation system is abnormal in patients with PVT who has higer ACA-IgG level and lower PC level. It is indicated that the ACA and PC may play an important role in formation of PVT.

Objective To investigate the relationship between thrombomodulin(TM), fibrinolytic system changes and the score of the model for end-stage liver disease(MELD)in liver cirrhosis patients.Methods Eighty-five liver cirrhosis patients admitted from January 2008 to December 2009 were included in this study. TM, D-dimer, tissue plasminogen activator(t-PA), plasminogen activator inhibitor -1(PAI-1),serum creatinine, serum total bilirubin and international normalized ratio(INR)on all patients were measured and then the score of the MELD was calculated. Results The score of the MELD was 1-29(11.35 ± 6.02)scores. The score of the MELD ≤ 9 scores was 40 cases(47.1%), 10- 19 scores was 32 cases (37.6%),20-29 scores was 13 cases(15.3%).TM and D-dimer were progressively increased with MELD score. There was significant difference among the three groups(P＜0.01). The levels of TM and D-dimer had positive correlation with the score of the MELD(r = 0.706,0.425,P ＜ 0.01). Conclusions The levels of TM and D-dimer have positive correlation with the score of the MELD in liver cirrhosis patients. These indices can help predicting the degree of liver function disorder and prognosis.