Objective To investigate the correlation between capsule endoscopy Crohn′s disease activity index (CECDAI ) , capsule endoscopy Lewis score , simplified Crohn′s disease activity index (sCDAI) ,C reactive protein (CRP) ,erythrocyte sedimentation rate (ESR) and Crohn′s disease (CD) activity .Methods From April 2009 to April 2014 , 120 patients having received capsule endoscopy examination and diagnosed as CD were collected . The data of CRP and ESR were analyzed . The CD severity was scored by CECDAI ,Lewis score and sCDAI .Spearman correlation was performed to analyze the correlation between CECDAI ,Lewis score ,sCDAI ,CRP and ESR .Results Among all the patients , CECDAI had a good correlation with Lewis score (r=0 .645 , P< 0 .01) and also was correlated with sCDAI (r=0 .190 , P< 0 .05) ,CRP and ESR (r= 0 .315 and 0 .393 ,both P< 0 .01) .However ,the Lewis score was not correlated with sCDAI ,CRP and ESR (r=0 .052 ,0 .041 and 0 .021 ,all P>0 .05) . sCDAI had a good correlation with CRP and ESR (r=0 .438 and 0 .429 ,both P<0 .01) .Among patients whose capsule endoscope failed to pass through the whole small intestinal ,the CECDAI had no significant correlation with sCDAI ,CRP and ESR (r=0 .126 ,0 .181 and 0 .269 ,all P>0 .05) .Conclusions Lewis score ,sCDAI ,CRP and ESR can reflect disease activity of CD patients in a certain degree .CECDAI is the most suitable index in evaluating the disease activity of CD patients .Therefore ,it is necessary to attach importance to capsule endoscopy examination .

Objective To explore the molecular basis of the characteristics of the serum auto-fluorescent spectrum in patients with ovarian cancer and the changes that might be induced by surgery. Methods Using fluorospectrophotometer and 300nm excitation light,the serum auto-fluorescent spectrum of 84 patients with ovarian cancer before and after the surgery and 30 healthy people were detected. Meanwhile, the serum tumor signs (CEA, CA199 and CA125), hemoglobin and plasma albumin level of all patients with ovarian cancer were detected. Their correlation with the fluorescence spectral characteristic parameters were analyzed. Results Compared with healthy people, the serum auto-fluorescent spectrum in patients with ovarian cancer exhibited purple-shifted position of λ2 peak and red shift in λ4 peak,had higher peak extent inλ1, λ2, λ4 and λ6 peak, and larger peak area of λ1, λ2, λ3, λ4 and λ6. Compared with those in ovarian cancer patients before surgery, the serum auto-fluorescent spectrum in these patients after operation had red shifts in λ1, λ2 and λ3 peak, lower peak extent in λ1, λ2, λ3 and λ4, and smaller peak area in λ1, λ2, λ3,λ4 and λ6 peak. In ovarian cancer patients, the serum level of CEA was positively correlated with the λ2 peak extent and the peak area of λ2 and λ3, while the serum level of CA125 was positively correlated with the peak extent of λ1-λ4 and λ6 and the peak area of λ1-λ3. The serum level of CA199 was negatively correlated with the λ2 position and positively correlated with the peak extent of λ1-λ6 and the peak area ofλ1-λ3 and λ6 in patents with ovarian cancer. Besides, the serum albumin was positively correlated with theλ2 peak position and negatively with the peak extent of λ1-λ6 and the λ1-λ3 peak area, while the level of hemoglobin was positively correlated with λ1 peak position. Conclusions The elevated serum tumor markers and lower albumin (plasma) level lead to the changes of the serum autofluorescence spectra characteristic parametersin in patients with ovarian cancer.These changes can be modestly corrected by surgery.

Objective To study the clincial effectiveness and safety of endoscopic sphincteropapillotomy combined with balloon dilation for decompensated cirrhosis accompanied with choledocholithiasis.Methods Data of 79 cases of decompensated cirrhosis patients with choledocholithiasis who underwent limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD,the ESBD group) and 42 cases who underwent endoscopic papillary balloon dilation(EPBD,the EPBD group)were retrospectively analysed and compared for complete stone clearance rate,one-time stone clearance rate and complications.Results The rate of complete stone clearance and one-time stone clearance were 94.9％ (75/79) and 77.2％ (61/79)in ESBD group,and those were 88.1％ (37/42) and 59.5％ (25/42) in EPBD group respectively.The rate of complete stone clearance was a little higher in ESBD group than that in EPBD group.In ESBD group,ERCP-related bleeding occurred in 3 patients (3.8％),post-ERCP hyperamylasemia in 3 (3.8％)and post-ERCP pancreatitis in 2 (2.5％) ; while in EPBD group,post-ERCP hyperamylasemia occurred in 8 patients(19.0％),post-ERCP pancreatitis in 6(14.3％) and ERCP-related bleeding did not occur.There were no significant difference in ERCP-related bleeding between ESBD group and EPBD group (P =0.551).However,the rates of post-ERCP pancreatitis and hyperamylasemia in ESBD group were significantly lower than those in EPBD group(P ＜ 0.05).Conclusion ESBD is a safe and effective procedure for choledocholithiasis accompanied by decompensated cirrhosis,with several advantages over EPBD in terms of higher one-time stone clearance rate,reduced risk of post-ERCP pancreatitis and hyperamylasemia,and without noticeable increase in the risk of bleeding related to ERCP.

Objective To explore the mechanism ofHuanshuai Oral Liquid in the process of hypoxia-microvascular waste-renal interstitial fibrosis in mice with atherosclerosis renal artery stenosis.Methods The atherosclerosis renal artery stenosis model was established on Apoe-/- mice by high fat feed and uninephrectomy. After 2 weeks of renal ablation, model mice were randomly divided into TCM group (Huanshuai Oral Liquid) and model group. C57BL/6J mice were taken as the blank group. The mice of TCM group receivedHuanshuai Oral Liquid 0.01 mL/(g?d) for gavage, while the blank group and the model group received normal saline 0.01 mL/(g?d) for gavage. Renal function, atherosclerosis and renal interstitial fibrosis were assessed in the 12th week after taking medicine via immunohistochemical method to detect the expressions of the collagen typeⅣ, alpha smooth muscle actin (α-SMA) andⅧ factor related antigen (vWF), and via RT-PCR to detect the expressions of HIF-1α and TGF-β.ResultsCompared with the blank group, the model group suffered severe renal artery stenosis and renal fibrosis, and the expressions of HIF-1α, TGF-β, collagen typeⅣ andα-SMA significantly increased (P<0.05), while the expression of vWF decreased (P<0.05). Compared with the model group, the expressions of HIF-1α, TGF-β, collagen typeⅣ andα-SMA group, the expressions of HIF-1α, TGF-β, collagen typeⅣ andα-SMA significantly decreased in the TCM group (P<0.05), while the expression of vWF significantly increased (P<0.05).ConclusionHuanshuai Oral Liquid could significantly improve the renal function and the renal tubular-interstitial fibrosis. The mechanism might be associated with regulating the expressions of HIF-1α and TGF-β.

Objective To evaluate the effects of multi-functional self-help lower extremity training band on elderly patients after hip fracture surgery. Methods A total of 120 elderly patients after hip fracture surgery were randomly divided into two groups experimental group (n=60) and control group (n=60). The patients of two groups were treated with routine care, but patients of experimental group also received functional exercise using multi-functional self-help lower extremity training. The compliance of functional exercise were compared between two groups, and the effects of postoperative rehabilitation exercise were evaluated. Results The exercise effects of knee joint and hip joint in experimental group were significantly better than those in control group (χ2 =14. 90,13. 89;P<0. 05). The patients′compliance of functional exercise in the experimental group was significantly higher than that in the control group (P<0. 01). Conclusions The using of multi-functional self-help lower extremity training band can improve the compliance of functional exercise and the effects of rehabilitation on elderly patients after hip fracture surgery, and can promote the progress of rehabilitation.

Objective To assess the predictive value for survival of BioCliM index in liver cirrhosis caused esophageal and gastric varices bleeding(EGVB)treated by endoscopic variceal ligation(EVL),endoscopic injection sclerotherapy(EIS)and endoscopic tissue adhesives(ETA).Methods From December 2006 to December 2011, the clinical data of 166 hospitalized patients with first occurrence of EGVB caused by liver cirrhosis and received endoscopic therapies were retrospectively analyzed.The scores of model for end-stage liver disease(MELD),model for end-stage liver disease-Na(MELD-Na),BioCliM index and Child-Turcotte-Pugh(CTP)were calculated. Receiver operating characteristic(ROC)curve and area under the curve(AUC)were applied to assess the accuracy of the four models in one-year and two-year prognosis evaluation,and to obtain the best critical value,and the mortality rates were compared among groups.Chi-square test,t test and rank-sum test were performed for statistical analysis.Results Among 166 patients,the levels of creatinine,bilirubin,albumin,sodium,international normalized ratio and prothrombin time were(0.10 ± 0.06)mmol/L,(0.02 ± 0.01)mmol/L,(30.13 ± 5.06)g/L, (139.13 ± 4.27)mmol/L,1.50 ± 0.32 and(17.83 ± 2.88)s,respectively.During the one-year and two-year follow-up,there were 14 patients and 23 patients dead,respectively.During the one-year and two-year follow-up, the incidences of portal thrombosis of death group were lower than those of survival group(10/14 vs 93.4%,142/152;73.9%,17/23 vs 94.4%,135/143);and the differences were statistically significant(χ2=8.029 and 10.774, both P<0.01).During the one-year and two-year follow-up,BioCliM indexes of death group were 0.12(-0.82, 1.44)and -0.81(-0.87,0.92),respectively,which were both higher than those of survival group(-0.84,-0.94 to -0.73;and -0.84,-0.94 to -0.72),and the differences were statistically significant(Z= -3.074 and -2.260,both P<0.05).During the one-year follow-up,the AUC values of MELD,MELD-Na,BioCliM index and CTP score were 0.698,0.691,0.749 and 0.723,respectively.During the two-year follow-up,the AUC values of MELD,MELD-Na,BioCliM index and CTP score were 0.587,0.582,0.647 and 0.633,respectively. But there was no statistically significant difference in AUC between BioCliM index and MELD,MELD-Na,and CTP score in one-year and two-year follow-up for prognosis evaluation(Z=0.509,0.566,0.271,0.687,0.731 and 0.162,respectively;all P>0.05).The best critical value of BioCliM index was -0.234.Followed up for one year and two years,the mortality rates of patients with BioCliM index over -0.230 were higher than that of patients with BioCliM index less than -0.234(31.0%,9/29 vs 3.6%,5/137;34.5%,10/29 vs 9.5%,13/137);and the differences were statistically significant(χ2=23.242 and 12.526,both P<0.01).Conclusions BioCliM index has a high accuracy in one-year and two-year mortality rate evaluation in liver cirrhosis patients with EGVB and received endoscopical therapies.We should pay attention to the prognosis evaluation before the endoscopical therapy.

Objective:To explore the risk factors of intensive care unit-acquired weakness (ICU-AW), and to establishment and verify its risk prediction model.Methods:A modeling group of 231 patients who met the inclusion criteria and were admitted to the intensive care unit (ICU) of the First Hospital of Jiaxing from July 2019 to June 2020 was collected by convenience sampling method. According to whether they developed ICU-AW, they were divided into ICU-AW group (55 cases) and non ICU-AW group (176 cases). The clinical data were collected concerning patients' individual information, disease-related factors, treatment-related factors and laboratory indicators, and the differences of the above indexes between two groups were compared. Logistic regression was used to analyze the ICU-AW risk factors and a risk prediction model was constructed. Calculate the area under ROC curve (AUC) to test the prediction effect of the model. At the same time, 60 patients who admitted to ICU from July to October 2020 and met the standards were collected to verify the model.Results:Compared with non ICU-AW group, there were more males in ICU-AW group [61.8% (34/55) vs. 44.3% (78/176), P < 0.05], with higher levels of systemic inflammatory response syndrome (SIRS), sepsis, immobilization and the use of neuromuscular blockers [SIRS: 30.9% (17/55) vs. 3.4% (6/176), sepsis: 12.7% (7/55) vs. 2.3% (4/176), immobilization: 72.7% (40/55) vs. 39.2% (69/176), the use of neuromuscular blockers: 50.9% (28/55) vs. 14.2% (25/176), all P < 0.05], and acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, blood lactic acid level and duration of mechanical ventilation, length of hospital stay were all increased [APACHEⅡ score: 18 (15, 24) vs. 12 (8, 17), blood lactic acid (mmol/L): 2 (1, 2) vs. 1 (1, 2), duration of mechanical ventilation (days): 7 (4, 12) vs. 2 (2, 5), length of hospital stay (days): 10 (6, 16) vs. 5 (3, 9), all P < 0.05]. SIRS, APACHEⅡ score, duration of mechanical ventilation and blood lactic acid were included to construct a risk prediction model [odds ratio ( OR) values were 4.835, 1.083, 1.210, 1.790, P values were 0.018, 0.013, 0.015, 0.013]. The model equation was P = exp [-5.207+(1.576×SIRS)+(0.079×APACHEⅡ)+(0.191×duration of mechanical ventilation)+(0.582×blood lactic acid)]. Internal verification: Calibration diagram showed the calibration curve above the ideal curve, AUC = 0.888, 95% confidence interval (95% CI) was 0.839-0.938; when the cut-off value was 0.166, the sensitivity was 89.1%, the specificity was 75.6%, and the maximum index was 0.649. External verification: Calibration diagram showed that the calibration curve was above the ideal curve, and the plotted AUC = 0.853, 95% CI was 0.753-0.953. When the cut-off value of the corresponding predictive risk value was 0.367, the sensitivity was 68.8%, the specificity was 86.4%, and the maximum approximate index was 0.552. Conclusion:The risk prediction model of ICU-AW constructed in this study has good consistency and prediction efficiency, which can provide reference for medical personnel to identify high-risk groups of ICU-AW patients in the early stage and provide targeted interventions in advance.

Objective:To investigate the prevalence of the decline of intrinsic capacity(IC)and to explore the effect of intrinsic capacity decline on falls and hospital readmission during 1 year follow-up.Methods:A total of 311 elderly patients treated in Geriatrics Department of Zhejiang Hospital were enrolled.General information and intrinsic ability data, including cognitive(simple mental state inventory), motor(Tinetti-Balance Scale and 4 m test), vitality(grip strength and mini-nutrition assessment table), perception(self-rated vision or hearing impairment), and psychosocial(Geriatric depression scale), were collected at admission.Falls and hospital readmission within 1 year after discharge were followed up.Multivariate Logistic regression analysis was used to investigate the relationship of baseline intrinsic ability at admission with falls and hospital readmission during 1-year follow-up.Results:Of 311 elderly hospitalized patients, 282(90.7%)had intrinsic capacity decline.During 1 year follow-up, 38 elderly patients(12.2%)had falls and 69 elderly patients(22.2%)were hospital readmitted.After adjusting for confounding factors such as age, gender, education level, comorbidities, multiple medications, fear of falling, and assistive tool use and so on, Logistic regression analysis showed that decreased balance ability was a risk factor for falls within 1 year in elderly patients( OR=3.515, 95% CI: 1.089-11.346, P=0.036), and slow walking speed was a risk factor for one-year hospital readmission( OR=2.426, 95% CI: 1.181-4.983, P=0.016). Conclusions:Decreased motor capacity is closely associated with falls and hospital readmission within 1 year in older patients.Great attention should be paid to the assessment and intervention of motor ability in elderly patients.

Objective To investigate the correlation between the frailty and nutritional status of the elderly hospitalized patients.Methods A total of 244 hospitalized patients were enrolled in this investigation. By using comprehensive geriatric assessment (CGA),patients answered these questions together with experts (questionnaire assessment by professional instructions). Researchers input the result into computer at same time. Results Compared with normal patients,frailty patients were older (P<0.001),and had lower ability to take care of themselves (P<0.001),in other words,they had more demands from their families and carers in terms of medical care (P<0.01). In addition, frailty patients had higher risks of having depressive symptom (P=0.016),cognitive impairment (P<0.001), living function disability (P<0.001),as well as malnutrition (P<0.001). Regression analysis result showed a negative correlation between frailty and nutrition (P=0.005).Conclusions Malnutrition is closely related to frailty,and malnutrition patients and patients with risks of malnutrition were easily to acquire frailty.

Objective To investigate the detection rate of motoric cognitive risk syndrome (MCR)and explore the possible risk factors.Methods A total of 429 elderly patients from geriatric department of Zhejiang Hospital from October 2014 to September 2018 were recruited in the crosssectional study.General information and functional assessment including fall history,self-reported visual impairment and hearing impairment,depressive symptom,cognitive function and gait speed were collected.Patients with MCR were screened out according to the MCR diagnostic criteria.Multiple logistic regression analysis was used to analyze the associated risk factors.Results Seventeen patients(4.0％)met the MCR diagnostic criteria.The proportions of obesity,polypharmacy,cerebral vascular diseases,self-reported hearing impairment,depressive symptoms and slow gait were higher in MCR patients than in non-MCR patients(P＜0.05).Compared with non-MCR patients,MCR patients had lower mini mental state examination (MMSE) scores (P ＜ 0.01).After adjusting for associated confounding factors,multiple logistic regression analysis showed obesity (OR =3.74,95 ％ CI:1.14-12.23,P ＜ 0.05) and depressive symptoms (OR =5.79,95％ CI:1.76-19.06,P ＜ 0.01) were risk factors for MCR.Conclusions MCR is not uncommon in elderly patients.Obesity and depressive symptoms are closely associated with an increased risk of MCR.