Objective To investigate the clinical characteristics of the patients with portal hypertension secondary to primary myelofibrosis (PH-PMF). Methods The clinical data of patients with PH-PMF retrieved from Peking University Third Hospital were collected and analyzed. Results A total of 6 from illness onset to definite diagnosis was 24 months. The symptoms related to portal hypertension included bloating, abdominal mass, hematemesis and melena. The signs related to portal hypertension included splenomegaly ( moderate or severe in all patients), hepatomegaly ( mild or moderate in most of patients),shifting dullness positive and varices in abdominal wall. Only a small portion of patients had jaundice, liver palms and spider angioma. The indexes related to liver functions were normal or only mild abnormal in most cases. The average diameters of portal vein and splenic vein were ( 16. 0 ±3.2) mm and ( 11.0 ±3.4) mm,respectively. Thrombosis of portal vein or splenic vein was found in 2 cases. Liver biopsy revealed extramedullary hemopoiesis in one patient. In addition to medicine therapy related to portal hypertension in 5 patients with PH-PMF, 1 patient received splenectomy and another received endoscopic variceal ligation.Conclusions The patients with PH-PMF were clinically rare and easy to be misdiagnosed. The main keys to differentiate PH-PMF from cirrhosis included marked splenomegaly, mild or moderate hepatomegaly, good liver functions, lack of liver palms or spider angioma and extramedullary hemopoiesis showed in liver biopsy samples.

Objective To improve the ingestion protocol of esophageal capsule endoscopy in right lateral supine (RLS) position. Methods A total of 53 patients were randomized into RLS group and improvement group. The time of passing the esophagus, visual range and clarity of esophagus and z-line, and comfort of the procedure were compared between the two groups. Results The time of capsule passing the esophagus in improvement group was significantly longer than that in RLS group [ 202 (20-480) s vs.63 (8-210) s, P ＜ 0. 001 ) ]. The range of visualization in esophagus (2. 69 ± 0. 21 ) and Z-line (2. 54 ±0. 22) in improvement group was significantly larger than that in RLS group (2. 55 ± 0. 23 and 2. 40 ± 0. 24,respectively, P =0. 019 and P =0. 037, respectively). No significant difference was detected in clarity of esophagus or Z-line between 2 groups (P ＞0. 05). Two patients (7.7%) in RLS group had transient cough due to frequent water drinking, while no cough was observed in improvement group. Conclusion Compared with the ingestion protocol of esophageal capsule endoscopy in right lateral supine position, the improved ingestion protocol shows larger range of visualization, better safety and the same definition.

Objective To evaluate the efficacy and safety of common therapy and individualized treatment in newly diagnosed patients with Helicobacter pylori (H.pylori) infection.Methods From March 2008 to February 2010,September 2013 to April 2014,January to October 2015,a total of 1 440 patients with H.pylori infection who received eradication therapy and with complete clinical data were retrospectively enrolled.Each was 350 cases in individualized treatment group,clarithromycin and bismuth containing quadruple therapy group and concomitant therapy group.A total of 100 cases were in standard triple therapy group,90 cases in sequential therapy group,and 200 cases in levofloxacin and bismuth-containing quadruple therapy group.The eradication rate of H.pylori,incidence of adverse events and compliance rate were compared in the six groups.Chi square test was performed for statistical analysis.Results The results of intention-to-treat analysis indicated that there was no statistically significant difference in H.pylori eradication rates among six groups (x2 =0.985,P=0.323).However,the results of modified intention-to-treat analysis showed that H.pylori eradication rate of individualized treatment group was the highest (92.5％ (282/305) and 93.3％ (278/298)),second was levofloxacin and bismuth-containing quadruple therapy group (90.3％ (167/185) and 91.6％ (164/179)),and the differences were statistically significant (x2 =11.285 and 13.981,both P＜0.01).There was statistically significant difference in indcidence of adverse events among the six groups (x2 =5.692,P=0.018),the incidence of adverse events in levofloxacin and bimuth-containing quadruple therapy group was lowest (16.2 ％ (30/185)),and second was individualized treatment group (21.0％ (64/305)).There was statistically significant difference in compliance rates among the six groups (x2 =4.712,P=0.023),the compliance rates of standard triple therapy group and sequential therapy group were highest (100％ (100/100) and 100％ (90/90)),and second was individualized treatment group (97.7％ (298/305)).Conclusions Both the levofloxacin and bimuth-containing quadruple therapy group and individualized treatment group can effectively eradicate H.pylori infection.The former may be safe and effective to patients unable to receive individualized therapy.

Objective To evaluate the middle and long term effects of the two-stage procedures of drilling for hydroxyapatite orbital implant and inserting a motility peg, and to investigate the pathogenesis and treatment of the various complications during the procedure. Methods This retospective study included 68 patients who had underwent the drilling of the hydroxyapatite and motility peg placement for over 3 years. Mean age at operation was 30.7 years (range from 17～60 years). All patients were placed plastic peg. Information recorded included pre-and post-operative facial appearance, motility of the artificial eye, conjunctival sac discharge and other complications. Results No secondary infection occured in 36～72 months of follow up. All patients felt that there had been an improvement in the motility of their artificial eye. And their cosmetic appearance was acceptable. The most frequent complication encountered was discharge from conjunctiva sac, which occurred in 31 patients. Extrusion of the motility peg was found in 6 patients. 5 patients had exuberant granulation in conjunctiva sac. Conclusion Drilling of the hydroxyapatite implant improves both the appearance and the motility of the artificial eye. Complications are minor and can be easily prevented and treated. The vascularization of HA sphere with good motility should be drilled at relatively larger conjunctival sac in the patients who can cooperate under local anesthesia.

Objective To evaluate the application of the polymethyl methacrylate (PMMA) artificial eye in acquired ophthalmostewesis. Methods We summarized the experience in the application of PMMA in prosthesis for 8 years. 1155 patients were involved in the artificial eye custom-made program. The artificial eye was individually prepared based on the patient's condition and characters of the healthy eye.Results PMMA artificial eye associated with hydroxyl apatite implantation gave good cosmetic results with good motility, and there was no rejective reaction. The artificial eye was almost same to the real one in color and transparency. Conclusion It is suggested that PMMA is one of the best materials for manufacture of artificial eye at present.

Objective To summarize the clinical features, diagnosis and treatment of Ménétrier disease in China. Methods A systematic review of Ménétrier disease in China was performed. Four electronic databases were searched from 1993 to 2008 including CNKI and Wanfang seeking studies about pathologically performed Ménétrier disease. Results Data of 95 patients with Ménétrier disease from 62 studies was included. There were 74 males and 21 females. The mean age of onset in adults was (47.4± 5.3) years . The process of the disease was longer in male individuals that in female individals (47.5 months vs. 13.7 months, P<0.05). The main symptoms included abdominal pain (76.8%), weight loss (42.1%), anorexia (40.0%) and edema of lower extremities (36.8%), etc.Hypoproteinemia was accounted for 71.6 % and most of the patients had hypochlorhydria. The typical giant hyperplastic gastric fold was found in 88.4 % of the patients under endoscopy. The diffuse type was in predominance and mainly involved the greater curve of the stomach (55.3 %). Whereas 5.3 patients were accompanied with gastric cancer. The misdiagnostic rate of the disease was 31. 6%,which accounted for 50% in surgically treated patients. Conclusions In China, the Ménétrier disease is predominant in middle-aged males, and the process is longer in males than in females. Misdiagnosis is related to existence of weight loss and hypoproteinemia. Most of the patients with Ménétrier disease have a good prognosis even the disease process is long.

Objective To evaluate the clinical effect of the procedure that involves drilling and inserting a motility peg at the time of hydroxyapatite orbital implant.Methods 89 patients who needed hydroxyapatite orbital implant were divided into groups A and B.The patients in group A were drilled and inserted a motility titanium peg when hydroxyapatite implantation.The patients in group B were drilled and inserted a motility titanium peg 6 months after hydroxyapatite implantation.Data were recorded.including the rate of postoperative pain and conjunctive edema,postoperative facial appearance,motility of the artifieial eye,the rate of hydroxyapatite exposure,excursion and extrusion of titanium peg and other complications.Results The mobility of the prosthesis was 44.97%in group A,and 45.34%in group B.There was no difference in appearance and the motility of their artificial eye between the two groups.The rate of excursion of titanium peg was 4.2% in group A and 7.3%in group B and no statistical difference was found between the two groups.There were no prosthesis exposure,extrusion of titanium peg,secondary infeetion and other complication in one-year follow-up.There were no difference in the rate of postoperative pain and eonjunctive edema in first operative stage.The postoperative reaction in group A was lighter than that in group B in secondary operanve stage.Conclusion The hydroxyapatite orbital implant primary procedure drilling is simple,safe,convenient and effective.It is worth to recommend that procedure that involves drilling and inserting a motility peg at the time of hydroxyapatite orbitaI primary implant.

Objective To compare eradication rates,safety and compliance of minocycline quadruple and tailored therapies in patients retreated for Helicobacter pylori (H.pylori) infection.Methods Between January 2014 and June 2014,135 patients with dyspepsia (18-70 years) and H.pylori infection after at least one previous eradication treatment at a tertiary hospital were randomly assigned to a 10-day treatment with minocycline quadruple therapy versus tailored triple regimen of PPI,amoxicillin and a third antibiotic.In the group of tailored therapy,medications were adjusted based on clarithromycin sensitivity and cytochrome P450 isoenzyme 2C19 genotype.Eradication status was assessed 4-12 weeks after treatment.Results Although H.pylori eradication rates were higher in the minocycline therapy group than that in the tailored therapy group in intention-to-treat [84.1％ (95％ CI 75.0％-93.2％) vs 75.8％ (95％ CI 65.1％-86.5％),P =0.245] and per-protocol [88.3％ (95％ CI 80.3％-96.3％) vs 79.7％ (95％CI 69.7％-89.7％),P =0.197] analyses,the differences between the two groups were not statistically significant.The incidence of adverse effects and compliance between the two groups were also comparable.Conclusions The tailored therapy in this study had a poor eradication efficacy in the retreated patients with H.pylori infection.Minocycline quadruple therapy achieved a relatively satisfactory eradication efficacy and may be an alternative choice for the retreatment of H.pylori infection.Clinical trial registration Chinese Clinical Trial Registry,ChiCTR-TRC-13003975.

Objective To identify and analyze the homology of Ochrobactrum isolated from clinical blood samples of children.Methods The 26 strains of Ochrobactrum anthropi were identified by Vitek 2 Compact and test strips of API 20 NE bacterial identification system.The biochemical phenotypes were identified by manual tests.The 16S rRNA and recA gene were amplified by PCR and sequenced.The drug sensitivity tests of Ochrobactrum anthropi were performed by Vitek 2 Compact and matched GN13 card.The homology was analyzed by pulsed field gel electrophoresis.Results Based on the identification of the instruments and the manual tests for biochemical phenotype,all the 26 experimental strains were Ochrobactrum anthropi.The results of sequencing for 16S rRNA and recA gene amplification products showed 25 strains were Pseudochrobactrum saccharolyticum and the other 1 was O.grignonensein.Drug sensitivity analysis showed that the all the 26 strains were resistant to aztreonam,but the sensitive rates to quinolones,aminoglycosides,trimethoprim sulfamethoxazole,four generation of cephalosporins and the antibiotics compound of piperacillin/tazobactam were all more than 80％.Pulsed field gel electrophoresis analysis showed that the 25 strains were highly homologous with differences of only 1 to 3 bands in fingerprint profiles.Conclusion Based on the biochemical phenotype and the sequencing of 16S rRNA and recA gene,the Ochrobactrum-like bacteria could be identified to the level of species.The highly homologous strains of Pseudochrobactrum saccharolyticum may be sourced from a clustered infection.

Objective To analyze the CYP2C19 genetic polymorphisms in patients suffering from gastric diseases in Beijing and Shandong, and to evaluate the possibility of using the same gastric biopsy samples for the isolation of Helicobacter pylori ( H.pylori) strains.Methods A total of 1649 gastric biopsy samples positive for rapid urease test ( RUT) were collected from patients with gastric diseases in Beijing and Shandong.Each sample was grinded and equally divided into two parts for the isolation of H.pylori strains and the analysis of CYP2C19 genetic polymorphisms, respectively.H.pylori strains were isolated from the samples and identified with catalase and urease.CYP2C19*2 and CYP2C19*3 specific primers were used for the PCR amplification of DNA extracts.The PCR products were analyzed by electrophoresis and nucleo-tide sequencing.The metabolic types of CYP2C19 were analyzed based on the results of nucleotide sequen-cing.Results Altogether 1415 (85.81%) H.pylori strains were isolated successfully from the 1649 gastric biopsy samples.The products of CYP2C19 specific PCR for all DNA extracts showed clear bands in electro-phoresis and were further confirmed with sequencing analysis.Statistical analysis revealed that there were no statistical differences with the percentages of CYP2C19 metabolic types between Beijing and Shandong, nor between males and females (P>0.05).Conclusion It showed the possibility of using the same gastric bi-opsy samples for the isolation of H.pylori strains and the analysis of CYP2C19 genetic polymorphisms.No significant differences with the percentages of CYP2C19 metabolic types were found between patients from Beijing and Shandong.