Objective To investigate the characteristics of clinical course and outcome in elderly patients with nonvariceal upper gastrointestinal bleeding (NUGB) Methods The 206 hospitalized patients were devided into elderly group (≥60 yrs, 105 cases) and non elderly growp (

Objective To analyze the nutritional status of premature neonates first fed with extensively hydrolyzed protein formula.Methods From January 2013 to December 2014, 157 premature neonates hospitalized in Neonatal Intensive Care Unit of Shanghai Children's Medical Center who were first fed with extensively hydrolyzed protein formula were enrolled.Clinical data were recorded, including related diseases, birth weight and gestational age, nutrients intake, and growth charts.Two groups were divided according to the existence or absence of feeding intolerance, and three groups were divided based on birth weight (＜ 1 500 g, 1 500 ～ 2 500 g,and ≥2 500 g).Results A total of 60 (38.2％) premature infants had feeding intolerance.The lower the birth weight and gestational age, the higher the frequency of feeding intolerance, and the incidence of feeding intolerance in ＜ 1 500 g group was 71.1％.Compared with the feeding tolerance group, the feeding intolerance group had significantly smaller birth weight [(1 620 ±440) g vs.(1 980 ±421) g, P =0.000], gestatonal age [(31.3 ±2.6) weeks vs.(33.0 ±2.1) weeks, P =0.000], birth head circumference [(28.9 ±2.2) cm vs.(30.4±1.9) cm, P=0.000], and birth length [(41.1 ±3.9) cmvs.(43.2±3.4) cm, P=0.000],but significantly longer time before transfer formula [(26.4 ± 17.6) d vs.(7.9 ± 5.3) d, P =0.000] and time before reaching sufficient feeding [(21.5 ± 10.0) d vs.(13.8 ± 6.2) d, P =0.000].The time of first feeding [＜ 1 500 g group (6.1 ±5.1) d, 1 500 ～2 500 g group (3.8 ±2.5) d, ≥2 500 g group (3.3 ± 1.2) d,P =0.002], time before transfer formula [＜ 1 500 g group (28.7 ± 18.3) d, 1 500 ～ 2 500 g group (9.7 ± 8.1) d, ≥2 500 g group (7.0 ±3.8) d, P =0.000] and time before reaching sufficient feeding [＜ 1 500 g group (24.0±10.4) d, 1 500～2 500 g group (14.3±6.0) d, ≥2 500 g group (11.4±3.5) d, P=0.000] increased along with the decrease of birth weight.The proportions of infants receiving parenteral nutrition in the feeding intolerance group (93.3％) and ＜ 1 500 g group (97.8％) were higher, with more calorie intake from parenteral nutrition [＜ 1 500 g group (325.9 ± 59.4) kJ/ (kg · d), 1 500 ～ 2 500 g group (281.2±64.8) kJ/ (kg·d), ≥2 500 g group (269.9 ±43.9) kJ/ (kg·d),P=0.001] and longer duration [＜ 1 500 g group (27.1 ± 14.5) d, 1 500 ～2 500 g group (13.0 ±7.0) d, ≥2 500 g group (8.7 ± 3.4) d, P =0.000].In terms of growth indicators, the increase in head circumference was significantly higher in the feeding intolerance group than in the feeding tolerance group [(0.7 ± 0.6) cm/week vs.(0.6 ± 0.5) cm/week, P =0.045].The increases in body weight and head circumference in the ＜ 1 500 g group were significantly higher than in the other 2 birth weight groups [body weight: ＜ 1 500 g group (21.8 ± 9.5) g/d, 1500～2500ggroup(4.2±7.6) g/d, ≥2 500 g group (4.9 ±11.9) g/d,P=0.000;head circumference : ＜ 1 500 g group (0.8 ± 0.4) cm/week, 1 500 ～ 2 500 g group (0.5 ± 0.4) cm/week, ≥ 2 500 g group (0.6 ± 0.8) cm/week, P =0.005].After controlling the variable of feeding intolerance,weight gain was negatively associated with gestational age (r =-0.666, P =0.035), birth weight (r =-0.700, P =0.024), head circumference (r =-0.846, P =0.002), and the day of returning to birth weight (r =-0.697, P =0.025), while positively associated with head circumference gain (r =0.672, P =0.033).There were no relationship between weight gain and birth length, the day of first feeding, time before transfer formula, time before reaching sufficient feeding, parenteral nutrition calorie and duration, days of hospital stay and complications.Conclusions First fed with extensively hydrolyzed protein formula, the growth in feeding intolerant premature infants may be similar to the feeding tolerant ones, which is associated with parenteral nutrition support.Premature infants with lower gestational age, birth weight, and head circumference may be more suitable for extensively hydrolyzed protein formula feeding.

Objective To study on the results of magnifying endoscopy in gastric atrophy, intestinal metaplasia (IM) and dysplasia, and evaluate their feasibility and accuracy for the diagnosis of these lesions. Methods One hundred patients were examined by magnifying endoscopy, Fujinon EG485 ZH modal, and stained with 0. 5% methylene blue. After defining magnifying endoscopic patterns of gastric pits as types A, B, C, D, and E, the diagnostic classification and endoscopic criteria were developed for the diagnosis of atrophy, IM and dysplasia. The results of 417 histopathological biopsy specimens taken from the corresponding areas of gastric mucosa under magnifying endoscopy were regarded as gold standard. Results Sparse and thick gastric pits mainly appeared in gastric atrophy, IM mainly appeared in gastric mucosa of type C, type D, and type E with positive stain, dysplasia appeared as depressed, slightly raised, or flat mucosa accompanied by loss of clear pattern, fine pits or coarse and irregular microstructure. The sensitivity and specificity of magnifying endoscopies in the diagnosis of atrophy, IM and dysphasia were 95. 85% , 95. 09% ; 88. 30% , 90.83% ; and 91.52% , 94. 41% respectively, all were higher than those of routine endoscopy. Conclusion The diagnostic accuracy significantly increased as depending upon the morphological features of gastric atrophy , IM, or dysplasia under magnifying endoscopy.

To investigate the role of nitric oxide (NO) in hyperoxic lung injury, the 3-day-old preterm rats were randomly assigned to four groups: group I (hyperoxia group), group Ⅱ (hyperoxia+Nw-nitro-L-arginine methyl ester (L-NAME) group), group Ⅲ (air group), and group Ⅳ (air+L-NAME) group. Group Ⅰ and Ⅱ were exposed to ≥90 ％ O2 for 3 or 7 days. Group Ⅱ and Ⅳ received subcutaneous L-NAMEy on daily basis (20 mg/kg). After 3 day or 7 day exposure, the lung wet weight/dry weight ratio (W/D), total protein and malondialdehyde (MDA) in bronchoalveolar lavage fluid (BALF) and lung pathology were examined in all groups. NO content, expression of endothelial NOS (eNOS) and inducible NOS (iNOS) in lungs were measured in group Ⅰ and Ⅲ. Our results showed that after 3 day exposure, group Ⅰ appeared acute lung injury characterized by the increase of MDA content (P<0.01) and the presence of hyperaemia, red cell extravasation and inflammatory infiltration; after 7 day exposure, except MDA, total protein and W/D were also increased in comparison with group Ⅲ (P<0.01, 0.05), pathological changes were more severe than those after 3 day exposure. After 3 and 7 day exposure, total protein in group Ⅱ was significantly increased as compared with group Ⅰ (P<0.01 for both). The pulmonary acute inflammatory changes were more obvious in group Ⅱ than in group Ⅰ. Occasionally, mild hemorrhage was detected in the lungs of group Ⅳ. BALF protein content in group IV was higher than that in group Ⅲ after 7 day exposure (P<0.01). After 3 and 7 day exposure, NO content in BALF were all significantly elevated in group Ⅰ as compared with group Ⅲ (P<0.01 for all). In the lungs of group Ⅰ, strong immunostaining for iNOS was observed in airway and alveolar epithelia, inflammatory cells, which were stronger than those in group Ⅲ. Expression of iNOS in rats after 7 day hyperoxic exposure was stronger than that after 3 day exposure. Shortly after 7 day exposure, stronger immunostaining for eNOS in airway epithelia in group Ⅰ than that in group Ⅲ was seen. Our study suggested that treatment with L-NAME worsened acute hyperoxic lung injury in preterm rats and also had a deleterious effect on the rats exposed to air, indicating that endogenous nitric oxide may play a protective role in rats under both physiological and hyperoxic status. Hyperoxia can significantly upregulate the expression of iNOS and eNOS in inflammatory cells, epithelia in the lungs of preterm rats, promote NO generation, which suggests that endogenous NO may mediate the hyperoxic pulmonary damage. Over-stimulation of iNOS may contribute to the pathogenesis of hyperoxic lung injury. NO may have dual roles in pulmonary oxygen toxicity.

To investigate the role of nitric oxide (NO) in hyperoxic lung injury, the 3-day-old preterm rats were randomly assigned to four groups: group I (hyperoxia group), group Ⅱ (hyperoxia+Nw-nitro-L-arginine methyl ester (L-NAME) group), group Ⅲ (air group), and group Ⅳ (air+L-NAME) group. Group Ⅰ and Ⅱ were exposed to ≥90 ％ O2 for 3 or 7 days. Group Ⅱ and Ⅳ received subcutaneous L-NAMEy on daily basis (20 mg/kg). After 3 day or 7 day exposure, the lung wet weight/dry weight ratio (W/D), total protein and malondialdehyde (MDA) in bronchoalveolar lavage fluid (BALF) and lung pathology were examined in all groups. NO content, expression of endothelial NOS (eNOS) and inducible NOS (iNOS) in lungs were measured in group Ⅰ and Ⅲ. Our results showed that after 3 day exposure, group Ⅰ appeared acute lung injury characterized by the increase of MDA content (P<0.01) and the presence of hyperaemia, red cell extravasation and inflammatory infiltration; after 7 day exposure, except MDA, total protein and W/D were also increased in comparison with group Ⅲ (P<0.01, 0.05), pathological changes were more severe than those after 3 day exposure. After 3 and 7 day exposure, total protein in group Ⅱ was significantly increased as compared with group Ⅰ (P<0.01 for both). The pulmonary acute inflammatory changes were more obvious in group Ⅱ than in group Ⅰ. Occasionally, mild hemorrhage was detected in the lungs of group Ⅳ. BALF protein content in group IV was higher than that in group Ⅲ after 7 day exposure (P<0.01). After 3 and 7 day exposure, NO content in BALF were all significantly elevated in group Ⅰ as compared with group Ⅲ (P<0.01 for all). In the lungs of group Ⅰ, strong immunostaining for iNOS was observed in airway and alveolar epithelia, inflammatory cells, which were stronger than those in group Ⅲ. Expression of iNOS in rats after 7 day hyperoxic exposure was stronger than that after 3 day exposure. Shortly after 7 day exposure, stronger immunostaining for eNOS in airway epithelia in group Ⅰ than that in group Ⅲ was seen. Our study suggested that treatment with L-NAME worsened acute hyperoxic lung injury in preterm rats and also had a deleterious effect on the rats exposed to air, indicating that endogenous nitric oxide may play a protective role in rats under both physiological and hyperoxic status. Hyperoxia can significantly upregulate the expression of iNOS and eNOS in inflammatory cells, epithelia in the lungs of preterm rats, promote NO generation, which suggests that endogenous NO may mediate the hyperoxic pulmonary damage. Over-stimulation of iNOS may contribute to the pathogenesis of hyperoxic lung injury. NO may have dual roles in pulmonary oxygen toxicity.

Objective Mouse models of sepsis-induced myocardial injury by intraperitoneal injection of lipopolysaccharide (LPS) was established in order to provide a reliable method for the research of pathogenesis of sepsis-induced myocardial injury. Methods According to the method of random number table, a total of 150 male C57BL/6 mice were divided into five groups: NC group, sham group, and LPS 10, 12, 15 mg/kg groups, with 30 in each group. Septic myocardial injury was induced by intraperitoneal injection LPS in mice; sham group was injected with equal 0.9% saline; while there was no treatment in mice of NC group. Fifteen of the 30 mice in each group were used to observe the general status of mice before and after LPS or saline injection. Twenty-four hours after LPS or saline injection, the left ventricular function was assessed by echocardiography, serum level of cardiac troponin (cTnI) was determined by enzyme linked immunosorbent assays (ELISA), and the cardiac histomorphology and ultrastructure were observed; the other 15 mice were used to monitor the 7-day mortality after LPS or saline injection. Results The mice challenged to LPS displayed symptoms of sepsis, such as depression, ruffled fur, and diarrhea. Compared with NC group, left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS) were significantly decreased at 24 hours after LPS administration in LPS 10, 12, 15 mg/kg groups [LVEF: 0.459±0.044, 0.432±0.034, 0.348±0.064 vs. 0.588±0.019, LVFS: (22.36±2.60)%, (20.78±1.91)%, (16.27±3.31)% vs. (30.55±1.30)%, all P < 0.01], and cTnI levels were significantly increased (ng/L: 270.40±43.50, 281.14±41.79, 298.39±42.05 vs. 192.59±16.90, all P <0.01). Myocardium injury was observed in three LPS groups, myocardial fibrosis, interstitial edema, erythrocyte leakage and infiltrating inflammatory cells were observed under light-microscope; ultrastructural changes disorderly arranged in cardiac muscle fibers, mitochondrial swelling and even partly missing mitochondria cristae were found under transmission electron microscope (TEM), and the higher of the dose, the more sever of the damage. There was no significant difference between sham group and NC group. The 7-day mortality in LPS 10, 12, 15 mg/kg groups were 33.3%, 53.3% and 86.7%, respectively, while no death in the NC group and sham group. Conclusion For establishing the mouse model of sepsis-induced myocardial injury, intraperitoneal injection with 12 mg/kg LPS is a preferable choice in our research.

Objective To investigate the anesthetic effects and adverse effects of cypropofol and propofol combined with alfentanil,respectively,for gastroenteroscopy.Methods A total of 162 patients who underwent elective gastroenteroscopy at the Gastrointestinal Endoscopy Center of the First Hospital of Lanzhou University from January to February 2024 were enrolled,including 86 males and 76 females,at an age of 18～65 years old,with a BMI value of 18～30 kg/m2,and ASA grade ≤ Ⅱ.They were randomly divided into propofol group(Group P)and cypropofol group(Group C),with 81 cases in each group.All patients were sedated with 0.7 μg/kg alfentanil,and in 30 s later,2 mg/kg propofol and 0.4 mg/kg cypropofol was intravenously dripped into Group P and Group C,respectively.When the modified alertness/sedation score(MOAA/S)≤1,a gastroscope was started to insert.The related indicators,including total procedure time,successful cases of sedation,induction time and awakening time,heart rate,blood pressure,and pulse oximetry saturation were recorded,occurrence of adverse reactions such as hypotension,respiratory depression,injection pain,intraoperative body movement,nausea and vomiting were observed,and the satisfaction of endoscopists and of patients to anesthesia were recorded and compared between the 2 groups.Results There were no statistical differences in the success rate of sedation,induction time and awakening time between the 2 groups.The patients of the Group C had more stable intraoperative vital signs,statistically lower incidences of injection pain,respiratory depression and hypotension(P＜0.05),and increased satisfaction for anesthesia(P＜0.05)when compared with those in Group P.No obvious difference were observed in the satisfaction of endoscopist to anesthesia between the 2 groups.Conclusion In combination with small-dose alfentanil,0.4 mg/kg cypropofol shows similar sedation effect as 2 mg/kg propofol in gastroenteroscopy,with comparable induction and awakening time.Cypropofol has more advantages in stable intraoperative vital signs,less adverse effects such as low blood pressure,respiratory depression and injection pain,higher the patient satisfaction,which is worthy of clinical promotion.

Objective To explore the experience on using duodenoscope to treat hepatolithiasis through normal physiological ways.Methods ERCP,EST were used firstly,then removed calculus of the extrahepatic bile duct.Endoscopic papillary balloon dilatation was used if there was stenosis of bile duct.Removed calculus when it had been crushed in the hepatic duct.Injected decoction to dissolve calculus through endoscopic nasobiliary drainage,or inserted the endoscopic retrograde biliary drainage when the calculus was hard to removded.Results 101 cases of calculus in the extrahepatic bile duct were all removed.215 cases of hepatolithiasis were cleaned out at first time.9 cases were cured 1 week after dissolving calculus through endoscopic nasobiliary drainage.59 cases carried out ERBD,and 21 of them were cured 3 months later,37 patients were still in regular follow-up.33 cases with stenosis of bile duct were treated by endoscopic papillary balloon dilatation,19 of them were cured,the others were inserted with the endoscopic retrograde biliary drainage.19 cases of cholangitic abscess were cured by endoscopic nasobiliary drainage.Conclusion Using duodenoscope to treat hepatolithiasis through normal physiological ways is safe and effectic.

Objective To explore the experience of the double guide wires technology in the difficult ERCP examinations.Methods There were 776 difficult ERCP patients.701 cases with difficult cannulation of the bile duct had been inserted another guide wire into the upper left corner of the duodenal papilla after retained pancreatic guide wire.75 cases with difficult cannulation of the pancreatic duct had been inserted another guide wire into the right vertical direction of the duodenal papilla after retained a guide wire into the commom bile.Results 697cases(99.4%)with difficult cannulation of the bile duct were examined successfully at first time;74 cases(98.7%)with difficult cannulation of the pancreatic duct were examined successfully at first time.Conclusion Double guide wires technology is easy to use.The method of retaining a guide wire into the duct which was cannulated easily may increases the achievement ratio of cannulation into another duct.The check time was shortened significantly.

Objective:To investigate the clinical and genetic features, and treatment of X-linked hypophosphatemic rickets (XLH).Methods:In this retrospective study, we reviewed the medical records of 25 pediatric patients with XLH who were admitted to Department of Endocrinology Genetics and Metabolism,Beijing Children′s Hospital from January 2010 to January 2020. The clinical characteristics, PHEX gene variants, as well as clinical outcome of the patients were summarized. To analyze the correlation between genotype and phenotype, the patients were divided into different subgroups according to the location of the variants, including N-terminal-located vs. C-terminal-located variant, and Zn-binding domain exon 17 or 19 variant vs. non-exon 17 or 19 variant. The age at onset, height standard deviation score (HtSDS), intercondylar or intermalleolar distance, fasting serum phosphorus, and HtSDS and intercondylar or intermalleolar distance at the final follow-up were compared by rank sum test or t text. Results:Among the 25 children with XLH, 8 were boys and 17 were girls. The median age of onset was 1.2 (1.0, 1.8) years, and the median age of diagnosis was 2.5 (1.5, 4.3) years. The main clinical manifestations were abnormal gait and lower limb deformity. The HtSDS was -2.0(-3.2, -0.8), and the intercondylar or intermalleolar distance was 4.5 (3.0, 6.0) cm. The fasting serum phosphorus level was 0.8 (0.7, 0.9) mmol/L, while the serum alkaline phosphatase level was (721±41) U/L and the serum calcium level was (2.5±0.1) mmol/L. Three patients (12%) had parathyroid hormone levels above the upper limit of the normal range. Twenty-five patients (100%) showed radiographic changes of active rickets. Nephrocalcinosis was found in 2 cases (9%). Twenty-four different PHEX variations were detected in 25 patients, among whom 11 (44%) had not been reported previously. No hot spot variation was found. No statistical differences (all P>0.05) were identified in clinical features and outcomes either in comparing patients with N-terminal (21 cases) and C-terminal (4 cases) variants, or in comparing patients with variant located in exon 17 or 19 (4 cases) or not (21 cases). Twenty-four cases (96%) were treated regularly with phosphate supplements and active vitamin D. After 2.7 (1.6, 5.0) years of follow-up, clinical symptoms were relieved in 96% (24/25) of the patients. The HtSDS after treatment had no significant difference compared to that before treatment (-2.0(-3.2, -0.8) vs.-2.0(-2.8, -1.1), Z =-0.156, P>0.05), while the intercondylar or intermalleolar distance after treatment was significantly reduced compared to that before treatment (4.5(3.0, 6.0) vs. 1.5(0, 3.3) cm, Z =-3.043, P<0.05). Bone X-rays were reexamined in 17 cases after treatment, and radiographic signs of rickets were improved. Eighteen cases had secondary hyperparathyroidism and 7 cases had nephrocalcinosis. Conclusions:The main clinical manifestations of XLH are abnormal gait, lower limb deformity and short stature. A high proportion of novel variations of PHEX gene but no hot spot variation neither genotype-phenotype correlation are found. Regular treatment with phosphate supplements and active vitamin D can significantly improve the symptoms except for the height. However, the rate of adverse events including secondary hyperparathyroidism and nephrocalcinosis seems to be high.