Objective To assess the role of the combination of Helicobacter pylori (H.polyri)antibody detection and serum pepsinogen (PG) examination (ABC method) in risk prediction of gastric cancer.Methods From July 2014 to July 2015,a total of 320 patients underwent gastroendoscopy examination because of stomach discomfort were enrolled.According to the results of serum H.polyri antibody test,PG Ⅰ and PG Ⅰ/PG Ⅱ ratio (PGR),patients were divided into four groups:group A was both H.polyri and PG negative,group B was H.polyri positive and PG negative,group C was both H.polyri and PG positive,group D was H.polyri negative and PG positive.The incidence rates of gastric cancer were compared among the groups.PG positive was defined as PG Ⅰ ≤70 μg/L and PGR≤3.0.And according to the results of gastroendoscopy examination and histopathology,the levels of gastrin 17,PG Ⅰ,PG Ⅱ and PGR of different atrophic regions with different pathological changes and atrophic degree were compared.Chi-square test and analysis of variance were performed for statistical analysis.Receiver operating characteristic(ROC) curve was used to calculate the optimal cut-off value of serum PG Ⅰ and PGR in gastric cancer diagnosis.Results Among the 320 patients,there were 159 patients in group A,124 patients in group B,23 patients in group C and 14 patients in group D,respectively.The incidence of gastric cancer in group A,group B,group C and group D were 0.63％ (1/159),4.03％ (5/124),13.04％ (3/23) and 3/14,respectively.The incidences of gastric cancer in group C and D were much higher than those in group A and B (x2 =11.700 and 21.900,both P＞0.01).Among the 320 patients,there were 179 cases in non-atrophic gastritis group,129 in atrophic gastritis group and 12 in gastric cancer group.The PG Ⅰ and PGR levels of gastric cancer group were (46.84 ± 24.07) μg/L and 3.21 ±1.45,which were lower than those of atrophic group ((100.09±48.15) μg/L and 9.78±7.32) and nonatrophic group ((103.97 ± 44.72) μg/L and 13.09 ± 9.05),and the differences were statistically significant (F=12.460 and 30.290,both P＜0.01).The PGR level of severe atrophy group was 5.62±3.00,which was significantly lower than those of moderate atrophy group (10.04 ± 6.08) and mild atrophy group (11.61±4.05).And the PGⅡ level of severe atrophy group was (18.85±10.54) μg/L,which was much higher than those of moderate atrophy group ((14.63 ± 11.19) μg/L) and mild atrophy group ((10.88 ± 7.41) μg/L),and t he differences were statistically significant (F=8.057,P＜ 0.01;F =3.374,P=0.021).The gastrin 17 level of antrum atrophy group was 2.16 pmol/L (1.12 pmol/L to 4.15 pmol/L),which was lower than those of gastric body atrophy group (4.49 pmol/L,1.88 pmol/L to 18.71 pmol/L) and whole gastric atrophy group (6.18 pmol/L,2.63 pmol/L to 17.82 pmol/L),and the differences were statistically significant (H=13.408,P＜0.01).The optimal cut-off values of PG Ⅰ and PGR for the diagnosis of gastric cancer were 66.7 μg/L and 4.45.Conclusions ABC stratification has certain value in gastric cancer screening in China,however,it still needs improvement.For patients with digestive symptoms,PG Ⅰ ≤ 66.7 μg/L and PGR ≤4.45 can be considered as high risk of gastric cancer and suggested to receive gastroendoscopy examination.

ObjectiveTo investigate the effect on improving immune function by hemofiltration combined with hemoabsorption in septic patients with low human leukocyte antigen DR (HLA-DR) expression.Methods A prospective randomized controlled trial was conducted. Sixty sepsis patients aged over 18 years, with HLA-DR expression lower than 30% were enrolled, and they were randomly divided into experimental group and control group, n = 30 in each group. The patients were treated with standard operating procedure for sepsis, and hemofiltration combined with hemoabsorption were added in addition in the experimental group within 1-3 days. The continuous veno-venous hemofiltration (CVVH) mode was performed, with former dilution volume 4 L/h, and the hemofilter HF2000 was carried out with blood absorber HA-330H. The expression of HLA-DR in peripheral blood mononuclear cells was determined before the treatment and 3, 5, 7 days after treatment. Acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and 28-day survival rate were evaluated in both groups.Results The HLA-DR expression before treatment in experimental group and control group was both lower than 30%, and there was no statistical difference [(25.9±7.3)% vs. (26.4±6.7)%,P>0.05]. The HLA-DR expression at 3, 5, 7 days after treatment in experimental group was gradually increased, and it was significantly higher than that of the control group [3 days: (38.9±8.6)% vs. (29.3±7.1)%, 5 days: (42.7±9.2)%vs. (31.4±6.5)%, 7 days: (40.9±8.5)% vs. (29.4±6.7)%, allP< 0.05]. There was no significant difference in APACHEⅡ score before treatment between experimental group and control group (22.4±5.3 vs. 21.7±6.2,P>0.05). APACHEⅡ score at 3, 5, and 7 days after treatment was gradually decreased in experimental group, and it was obviously lower than that of the control group (3 days: 18.6±3.6 vs. 20.5±4.3, 5 days: 15.8±3.9 vs. 21.1±4.4, 7 days: 14.9±4.2 vs. 19.8±3.7, allP< 0.05). Compared with the control group, the duration of mechanical ventilation (days: 13.3±3.4 vs. 19.8±3.7,t = 6.432,P = 0.003) and length of ICU stay (days: 20.7±3.9 vs. 26.8±4.7,t = 5.452, P = 0.006) in experimental group were significantly shortened, and the 28-day survival rate was significantly elevated (83.3% vs. 73.3%,χ2 = 3.121,P = 0.016).Conclusion Hemofiltration combined with hemoabsorption can improve the expression of HLA-DR in sepsis patients with low expression of HLA-DR, and it can improve immune function and prognosis of sepsis patients in certain degree.

Colon cancer is the most common malignant tumor in the worldwide scale and it is one of the leading causes of cancer-related deaths.Finding accurate and informative cancer markers will provide significant insights in diagnosis and treatment strategy of colon cancer.Proteomic technology is an important tool in cancer research.In recent years,many studies have found a great of potential biomarkers of colon cancer.

Objective To investigate the clinical efficacy of combination therapy of ambroxol with vibration? expectoration machine on ventilator-associated pneumonia Methods A total of 96 patients from the Department of Critical Care Medicine were selected and randomly divided into 3 groups:control group,ambroxol group and ammonia ambroxol + vibration expectoration machine group (n=32,each).The ventilator-associated pneumonia (VAP) was randomly divided into three groups (n =32,each).All patients were treated with conventional therapy including anti-inflammatory,suction,airway humidification,nutritional support.On this basis,ambroxol group was given ambroxol 30 mg in 100 ml normal saline,intravenously dripped 3 times a day.On the basis of treatment in the ambroxol group,ammonia ambroxol + expectoration machine were given G5 vibration expectoration machine to expectorate sputum 2 times every other day.Results There were significant differences in acute physiology and chronic health evaluation (APACHE Ⅱ),PaO2/FiO2,respiratory rate (RR),heart rate (HR) before versus after the treatment of the three groups (F =5.736,9.432,6.361,5.862,respectively,all P＜0.05).After treatment in the three groups,APACHE Ⅱ,PaO2/FiO2,RR and HR showed statistically significant differences inter-group among three groups (F=4.674,8.665,7.351,6.562,respectively,all P＜0.05).Clinical effective rates of the three groups were 71.9％,84.4％,93.8％ respectively,and showed statistically significant differences inter-group among three groups (all P＜0.05).Conclusions Combination therapy of ambroxol and vibration expectoration machine shows significant effects on VAP,and it is better than ambroxol alone.

Objective To explore the influence of 8-week aerobic exercise in heart rate variability (HRV)in obese adolescents and to provide the evidence for formulating special exercise prescription.Methods Forty male obese adolescents (BMI≥25 kg·m-2 )were randomly divided into exercise group (n=20)and control group (n=20). The subjects in exercise group conducted a 8-week (five times/week,50-60 min)aerobic exercise while those in control group maintained their routine lifestyle. The body composition, hemodynamic parameters including heart rate(HR)and blood pressure and HRV parameters including total power (TP),normalized low frequency (LFn), normalized high frequency (HFn)and LFn/HFn ratio were measured before and after experiment.Results There were no significant differences of the indicators of the subjects between two groups before experiment (P>0.05). At the end of experiment,compared before experiment,the fat mass(FM),the percentage of body fat(BF%), the rest HR,SBP and DBP were decreased (P<0.05 or P<0.01);the TP and HFn were increased(P<0.01);the LFn and LFn/HFn ratio were reduced (P<0.01)in exercise group after experiment;but the indexes of the subjects in control group showed no significant changes (P>0.05).Compared control group,the FM,the BF%, the rest HR,SBP,DBP,LFn and LFn/HFn ratio were decreased while the TP and HFn were increased (P<0.01)in exercise group after experiment.Conclusion Aerobic exercise may effectively reduce the sympathetic activity and increase the vagal tone in the obese adolescents.

The objective of the study is to predict the spatial structure and B‐cell epitopes of Mycoplasma suis ORF5 pro‐tein .The secondary structure ,hydrophilicity ,flexible region ,antigenic index and surface probability were analyzed and predic‐ted by the Protean module in DNAStar software and B Cell Epitope Prediction Tools of IDEB ,then B‐cell epitopes were predic‐ted by aggregate analysis .Results showed that the secondary structure of Mycoplasma suis ORF5 protein was relatively regu‐lar ,in which the potential B cell antigenic epitopes were located at GGVDGGRD ,GMRLPEDSR ,and EGHPDLESAR .The methods of prediction of the secondary structure and B‐cell epitopes of Mycoplasma suis ORF5 protein may provide a new method for the study of M .suis immunogenicity ,and provides a new idea for the study on immunogenicity of pathogenic micro‐organisms .

Objective To analyze the association of postnatal weight gain proportion of very low birth weight (BW) preterm babies and the onset of severe retinopathy of prematurity,and investigate the optimal cut-off points and predictive ability of postnatal weight gain (WG) proportion for the onset of retinopathy of prematurity (ROP).Methods A retrospective cohort study.257 preterm infants underwent screening whose weight was less than 1500 g were enrolled in this study.Risk factors include BW,gestational age (GA),history of oxygen inhalation,need for blood transfusions,Apgar score in 1 to 10 minutes,embryo number,delivery mode,in vitro fertilization infants,and WG proportion within 6 weeks after birth and other systemic diseases were recorded.Their correlation with severe ROP is analyzed.Clinical outcomes were divided into severe ROP group (patients who suffered from ROP and required treatment) and mild and no ROP group (patients who suffered from ROP but do not require treatment and-patient without ROP).The severe ROP group included 18 patients and mild and no ROP group included 239 patients.Multiple logistic regression and receiver operating characteristic (ROC) curve were used to determine if the WG proportion was independently related to severe ROP development and if it was capable of predicting severe ROP.This study determines the predict value by comparing the area under the ROC curve (AUC) of independent risk factors.Results GA (t=-4.835,P＜0.001),BW(t=-5.192,P＜0.001),history of oxygen inhalation (x2=6.001,P=0.009),proportion of infants who had oxygen inhalation for more than 10 days(x2 =10.019,P=0.002),postnatal WG proportion at 1 week(t =-3.663,P＜ 0.001),postnatal WG proportion at 2 weeks(t=-3.425,P=0.001) had significant difference between two groups.Multiple logistic regression analysis revealed that GA (β =-0.858,P =0.008),BW (β =-0.005,P =0.010),postnatal WG proportion at 2 weeks (β=-8.745,P =0.035) were correlated to severe ROP significantly.And their area under the ROC were 0.836[95％ confidence interval (CI):0.752-0.920],0.826 (95％CI:0.947-0.903),0.744 (95％CI:0.598-0.891) respectively.The optimal cut-off points of GA,BW,and postnatal WG proportion at 2 weeks were 28.41 weeks,1241.96 g,12.80％ respectively.Conclusion Low WG proportion at 2 weeks of very low BW preterm babies is an important and independent risk factor for severe ROP and has certain predictive value of the onset of severe ROP.

Background Current researches of choroidal structure changes primarily focus on macular choroidal thickness in adolescents and children,but there are few studies on peripapillary choroidal thickness in children with enhanced depth imaging (EDI)-OCT.In addition,the reliability of manual measurements to peripapillary choroidal thickness is an important factor for the estimation of EDI-OCT.Objective This study was to determine the repeatability and reproducibility of manual measurements of peripapillary choroidal thickness in children by EDI-OCT.Methods A reliability evaluation of diagnosis test was performed.EDI-OCT technology was used to image the peripapillary choroidal thickness in 49 children aged 7-14 years in Eye Hospital of Wenzhou Medical University from February to March 2015 under the informed consent of their custodians.An annular scanning was carried out surrounding optical disc by the same ophthalmologist with Spectralis OCT,and the peripapillary choroidal thickness was manually measured at global,temporal,superotemporal,superonasal,nasal,inferonasal and inferotemporal zones.The intraclass and interclass repeatability and reducibility of measuring values from intraobserver,inter-observer and intra-session were evaluated with intraclass correlation coefficients (ICC),and BlandAltman agreement analysis was used to assess the consistency of repeated measurements.Results The average age in the subjects was (9.9 ± 1.3) years.No significant difference was found in the mean difference of reduplicative measured peripapillary choroidal thickness at each zone (all at P＞0.05).The ICCs of intra-observer,inter-observer and intra-session were 0.971-0.993,0.827-0.952 and 0.974-0.991,respectively,and the 95％ limit of agreement of global peripapillary choroidal thickness were-12.4-9.7 μm,-15.2-11.6 μm and-16.3-19.1 μm,respectively.Conclusions The repeatability,reproducibility and consistency are favorable in manually measured values of peripapillary choroidal thickness from EDI-OCT image.EDI-OCT appears a good application in the assessment of peripapillary choroidal thickness in children.

Objective To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) for achalasia.Methods A total of 40 achalasia patients who underwent POEM at our hospital were enrolled.The outcomes of Eckardt score,Barium contrast imaging,esophageal manometry as well as esophagogastroscopy were assessed before and at 6th day,1 month,3 months and 6 months after POEM respectively.Results All 40 patients successfully underwent POEM,with the mean operation time 57.2 ± 18.4 minutes.lntraoperative mediastinal and subcutaneous emphysema occurred on two patients.All patients had significant symptom relief after POEM (Eckardt score ≤ 3).The patients had a mean follow-up of 13.3 months.Two patients had symptom relapse,and treatment success rate (Eckardt score ≤3) was 90％ in 6-month follow up.According to high-resolution manometry (HRM),the resting lower esophageal sphincter (LES) pressures were 30.6 and 15.8 mmHg (P =0.001),and intergrated relaxation pressure(IRPs) were 28.1 and 12.2 mmHg (P =0.000) before and after POEM,respectively.The diameter of the esophageal lumen was 4.2 cm and 3.1 cm before and after POEM (P＜0.001).Conclusion POEM is safe and effective in a short term with less complications.Further follow-up studies are needed to evaluate long-term outcomes.

Objective To compare the respective diagnostic efficiency for breast cancer with ultrasound diffusion optical imaging (DOI),ultrasonic elastography (UE),contrast-enhanced ultrasound (CEUS),X-ray mammography(XRM),magnetic resonance imaging (MRI),and combinations of these imaging modalities.Methods Seventy-five breast lesions were collected.These lesions were confirmed by surgery and histopathology.All of breast lesions were examined ultrasound,mammography and enhancedMRI examinations before surgical excision.The specificity,sensitivity,positive predictive value and negative predictive value of each modality were compared.Results The sensitivities and the diagnostic negative predictive values for MRI + US + XRM (97.44％,96.15％),CEUS (92.31％,90.63％) and MRI (94.87 ％,92.86％) were significantly higher than those for XRM (74.36 ％,71.43 ％),respectively.The sensitivity for DOI + CEUS + UE was the same as one for CEUS,they were not significantly higher than those for UE and DOI (P ＞0.05),while they were significantly higher than that for XRM (P ＜0.05).The kappa values for DOI,UE,CEUS,USG(UE + DOI + CEUS),XRM,MRI and MRI + US + XRM were 0.678,0.624,0.732,0.705,0.439,0.677 and 0.676,respectively.Conclusions Different imaging modalities have themselves advantages to diagnose malignant or benign lesions.CEUS,MRI and combinations of these imaging modalities have highly important clinical values in breast disease diagnosis.