Background:Capsule endoscopy has been demonstrated to be an effective diagnostic tool for small bowel diseases in a series of small sample researches. However,the results need to be verified by large sample studies. Aims:To investigate the diagnostic performance and safety of capsule endoscopy for small bowel diseases. Methods:Consecutive patients undergoing capsule endoscopy for suspected small bowel diseases from May 2008 to Apr. 2013 in Nanjing General Hospital of Nanjing Military Command of PLA were collected and analyzed retrospectively. Results:A total of 573 patients were enrolled,the overall success rate of the examination was 99. 13%(568 / 573)and the overall completion rate was 88. 38%(502 / 568). The mean time of capsule passing the pylorus was 43. 45 min,and that of passing the small bowel was 287. 21 min. The overall detection rate of small bowel lesions was 53. 52%(304 / 568)and the overall diagnostic rate was 51. 06%(290 / 568). Both the detection rate and diagnostic rate in patients with obscure gastrointestinal bleeding(OGIB) were significantly higher than those in patients with obscure abdominal pain and chronic diarrhea(64. 26% and 62. 46%vs. 41. 72% and 39. 07% ,and 32. 14% and 27. 38% ,P all < 0. 05). Small bowel lesions detected by capsule endoscopy included angiopathy(21. 38% ),ulceration(20. 72% ),neoplasms(14. 47% ),erosion(11. 84% ),and Crohn’s disease(11. 18%),etc. Capsule retention occurred in 2. 29%(13/568)of the patients,and one acute intestinal obstruction and 2 perforations were observed. Conclusions:Capsule endoscopy is a safe and effective diagnostic modality for small bowel diseases. OGIB is the most common indication for capsule endoscopy,and capsule endoscopy is also helpful for evaluation of established or suspected Crohn’s disease.

Fifty-six patients diagnosed as early stage lung cancer by spiral CT scan,underwent CTguided percutaneous transthoracic biopsy with a successful rate of 100%.Forty nice cases were confirmed pathologically including adenocarcinoma in 30 cases,squamous carcinoma in 14,alveolar cell carcinoma in 2 and small cell lung cancer in 3.Three cases were diagnosed as chronic inflammatory lesion,2 cases as tuberculosis and the diagnosis was not confirmed in 2 cases.The results suggest that CT-guided percutaneous transthoracic biopsy is an effective diagnostic measure for patients with stage Ⅰ-Ⅱ lung cancer.

Background:Abnormal immune response is involved in the pathogenesis of Crohn’s disease( CD),and T lymphocytes are the main players in the immune response. Aims:To investigate the relationship between peripheral blood CD3 + ,CD4 + and CD8 + T cells and inflammation-related markers in patients with CD. Methods:Proportions of peripheral blood CD3 + ,CD4 + and CD8 + T cells were measured by flow cytometry in 26 CD patients( including 14 patients in active stage and 12 in remission stage )and 8 healthy volunteers(control group),and their correlation with inflammation-related markers(including white blood cell count,platelet count,ESR,CRP,albumin and hemoglobin) were analyzed. Results:Proportions of CD3 + ,CD4 + and CD8 + T cells were significantly increased in patients with active CD than those with remission CD and controls( P ﹤ 0. 05),however,no significant differences were found between remission CD patients and controls(P ﹥ 0. 05). ESR and CRP in active CD patients were significantly higher than those in controls(P ﹤ 0. 05),while albumin and hemoglobin levels were significantly decreased(P ﹤ 0. 05);albumin in remission CD patients was significantly lower than that in controls(P ﹤ 0. 05). No significant differences in white blood cell count and platelet count were found between active,remission CD patients and controls(P ﹥ 0. 05). Proportions of CD3 + , CD4 + and CD8 + T cells were positively correlated with CRP,and negatively correlated with hemoglobin( P ﹤ 0. 05);CD3 + and CD4 + T cells were positively correlated with ESR(P ﹤ 0. 05). However,CD3 + ,CD4 + and CD8 + T cells were not correlated with white blood cell count,platelet count and albumin level( P ﹥ 0. 05). Conclusions:Proportions of peripheral blood CD3 + ,CD4 + and CD8 + T cells are increased with the increase of disease activity in CD,and are positively correlated with CRP,and negatively correlated with hemoglobin.

Objective To investigate the effects of ultrashortwave therapy associated with home-based rehabilitation on lung function and quality of life (QOL) in chronic obstructive pulmonary disease (COPD) patients. Methods Ninety patients with stable COPD were equally and randomly divided into a combination group (received uhrashortwave therapy combined with home-based rehabilitation and regular treatment), a rehabilitation group (received home-based rehabilitation and regular treatment), and a control group ( received regular treatment). Spirometry and diaphragm function were measured, and St George's respiratory questionnaire (SGRQ) was administered for QOL assessment at the beginning and after 6-month of treatment. Results FEVI% pred and FEV1% increased and average SGRQ scores decreased in the combination group and rehabilitation group. FEVI% pred and SGRQ scores improved most in combination group (all P < 0.05 ). FEV1% pred, FEV1 % and SGRQ scores in control group did not show any obvious change. Diaphragm function in all groups did not change significantly. Conclusions Ultra-shortwave therapy combined with home-based rehabilitation might have combinative effects in improving lung function and QOL of COPD patients.

We reported a case of cryptogenic organizing pneumonia ( COP) who was admitted to the hospital in July 2008 and reviewed the Chinese literature of COP from 2003 to 2008. The most common symptoms of COP are fever, cough and exertional dyspnea. The imaging characteristics of COP are similar to those of pneumonia, therefore is often misdiagnosed as pneumonia with a high misdiagnosis rate. Lung biopsy is the main method for pathological diagnosis; polypoid growth of granulation tissue was noted within respiratory bronchioles, small airways and alveolar spaces.

Objective Through observing the clinical effect and the changes of gastrointestinal hormones caused by the treatment of different moxibustion time of the superficial gastritis patients due to the spleen and stomach weakness,to investigate the regulation of the dose-effect relation and the adjustment function on gastrointestinal hormone of serum of patients caused by the warming and nourish effect with moxibustion.Methods Eighty-four superficial gastritis Patients due to the spleen and stomach weakness were divided into group 1(treated by warming moxibustion for twenty minutes)(n=28),group 2(treated by warming moxibustion for forty minutes)(n=28),and drug(n=28)groups.The changes of the content of the Prostaglandin E2(PGE2)、Somatostatin(SS)and Epidermal growth factor(EGF)were observed before and after treatment between 3 groups and the clinical effect in different time.Results ①All 3 groups were compared after treatment,their clinical effect had no significant difference(P＞0.05):②Compared with pre-treatment,the superficial gastritis symptom score had a very significant difference after the treatment(3.07±1.54)、(3.11±1.40)、(3.79±2.25)and during the 1 month follow-up(2.25±1.32)、(2.57±1.10)、(4.11±2.48),(P＜0.01);③After treatment,the content of the PGE2 of the serum was increased obviously,compared with pre-treatment.There was a significant difference in each group(33.751±1.267)pg/ml、(33.774±8.583)pg/ml、(32.583±8.259)pg/ml,(P＜0.05);After warming moxibustion for forty minutes,the content of the EGF of the serum was increased obviously,compared with pre-treatment,showing a significant difference(1.331±0.823)pg/ml,(P＜0.05).Conclusion ①All of the three treatment methods had significant curative effect,and the curative effect had no significant difference among these 3 groups.But the moxibustion groups were markedly higher than the drug group in long-term result;②The moxibustion had established adjustment function on gastrointestinal hormone of the superficial gastritis patients due to the spleen and stomach weakness,which suggested that the gastrointestinal hormone may participate in its onset and the process of pathology and physiology.

Objective To study clinical application of Bard automated disposable instrument for percutaneous transtheracic biopsy guided by CT in diagnosis of pulmonary lesions. Methods Percutaneons transthoracic biopsy was performed with CT-guided Bard automated disposable instrument for 95 patients with pulmonary lesions but without established diagnosis by clinical and imaging procedures in order to obtain pathological diagnosis. Results Tissue specimens were obtained from all the 95 patients by Bard automated disposable instrument for percutaneous transthoracis biopsy, with a hundred percent of success. After the procedure, 68 of 95 were pathologically diagnosed as lung cancer (including adenocarcinoma in 44,squamous carcinoma in 19, alveolar cell carcinoma in three and small cell carcinoma in two), 10 as chronic inflammatory lesions, eight as tuberculosis, two as inflammatory pseudotumor, one as metastatic cancer, two as fungal infection, and four without an established diagnosis, with an overall diagnosis rate of 95.8%.Pneumothorax occurred in eight and mild haemoptysis in six of 95 patients, respectively, by the procedure.Conclusion Percutaneons transthoracic biopsy with Bard automated disposable instrument is an effective diagnostic procedure for patients with pulmonary lesions but their diagnoses were not established by routine examinations.

Objective To analyze the clinical features and clinical significance of patients with inflammatory bowel disease (IBD) complicated by thrombosis.Methods From March 14th,2001 to February sixth 2017,at Nanjing General Hospital of Nanjing Military Command,27 IBD patients with thrombosis diagnosed by clinical symptoms,endoscopy,imaging and pathology were enrolled.During the same period,81 gender and age matched IBD patients without thrombosis were included in the control group.The basic data,information of IBD diagnosis and treatment and thrombotic events of patients were collected and analyzed.T-test and Chi-square test were performed for statistical analysis.Binary logistics regression was used for risk factors analysis.Results The mean age of diagnosis of IBD patients with thrombosis was (44.8 ± 15.8) years,which was higher than that of the IBD patients of control group ((36.0 ± 14.4) years),and the difference was statistically significant (t =2.69,P =0.008).Among 27 IBD patients with thrombosis,arterial thrombosis was 51.9％ (14/27),deep venous thrombosis of the lower extremity veins was 29.6％ (8/27),portal venous system involved was 11.1％ (3/27),pulmonary embolism was 3.7％ (1/27) and disseminated intravascular coagulation accounted for 7.4％ (2/27).Nine patients (33.3％,9/27) underwent surgery six months before the diagnosis of thrombosis.The results of binary logistic regression indicated that the age of diagnosis and vascular catheterization were independent risk factors for thrombosis in IBD patients (odds ratio (OR) =1.04,95％ confidence interval (CI) 1.01 to 1.07,P=0.01;0R=5.64,95％ CI 1.39 to 22.96,P=0.02).After medicine treatment or surgery,81.5％ (22/27) of the patients improved,9.1％ (2/22) were worse and 13.6％ (3/22) died.Conclusion Screening and prevention of thrombosis should be paid attention in IBD patients with a history of vascular catheterization,at active phase and older age when diagnosed.

Background and purpose:Along with the development of diagnosis and treatment technology, the disease free survival and overall survival of breast cancer have been extended. In order to improve the quality of life after mastectomy, more and more breast reconstructions were applied in breast cancer patients. We retrospectively reviewed 118 cases of free abdominal lfaps for breast reconstruction performed in Fudan University Shanghai Cancer Center. Clinical outcomes, reconstructive techniques and experiences are discussed. Methods:From November, 2006 to June, 2013, we used free abdominal lfaps to perform 118 cases of breast reconstruction on 117 female patients after mastectomy. We observed the surgery, complications and safety of this technic. Results:We performed 118 cases of lfaps based on deep inferior epigastric vessels. The average operation time was 7.72 h. The average time of ischemia was 78.74min. The average anastomosis time was 60.83min. The average number of perforators included in the lfap was 3. The internal thoracic vessels were preferred recipient vessels. Ten cases of vessel crisis occurred and 6 of them were venous thrombosis and 4 cases were venous kink. Seven of them were salvaged, and the other 3 failed, the success rate was 97.46%. Postoperative infection rate was 7.00%. Abdominal bulge occurred in 3.50%of patients. None of the patients developed abdominal hernia. The median interval between surgery and the ifrst cycle of adjuvant chemotherapy was 19 days. The median follow-up time was 12 months. One case of distant metastasis, but no local recurrence was observed. Conclusion: Although free abdominal flap breast reconstruction requires complicated microsurgical techniques, and the learning curve does exist, free abdominal lfap breast reconstruction has a high success rate with oncological safety and few complications.

Objective:We compared the clinical outcomes between β-blocker with angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) in patients with acute myocardial infarction (AMI) without left ventricular systolic dysfunction.Methods:A total of 750 patients who were diagnosed as AMI without left ventricular systolic dysfunction and successfully received percutaneous coronary intervention (PCI) in TEDA International Cardiovascular Hospital from October 2016 to September 2017 were collected retrospectively. We divided the patients into two groups: β-blocker + ACEI group (BB+ ACEI group, n=666) and β-blocker + ARB group (BB+ ARB group, n=84) according to discharge medications. The clinical datas were gathered and the end-point events were followed up. K-M curve was used to describe cumulative survival rate of the two groups. We used Cox regression analysis to compare the clinical outcomes of the two groups. Results:The occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) (8.3% vs 3.4%, HR=2.377, 95% CI: 1.006-5.616, P=0.048), all-cause death (3.6% vs 0.4%, HR=12.951, 95% CI: 1.947-86.159, P=0.008) and non-fatal myocardial infarction (3.6% vs 0.8%, HR=5.231, 95% CI: 1.193-22.934, P=0.028) in the BB+ ARB group was significantly higher than those in the BB+ ACEI group followed up for 13 months. However, there was no difference between the two groups in the incidence of stroke (1.2% vs 1.4%, HR=0.922, 95% CI: 0.117-7.276, P=0.516) and target vessel revascularization (3.6% vs 1.6%, HR=1.607, 95% CI: 0.384-6.729, P=0.516). The cumulative survival rate of BB+ ACEI group was higher than that of BB+ ARB group, with statistically significant difference ( P<0.05). Conclusions:Compared with β-blocker combined with ARB, β-blocker combined with ACEI are more beneficial to reduce the incidence of MACCE, all-cause death and non-fatal myocardial infarction in AMI patients without left ventricular systolic dysfunction after PCI.