Gastroesophageal reflux disease(GERD)is a commonly seen digestive disease. So far,there is no golden standard for the diagnosis of GERD. The main diagnosis methods used in clinical practice include gastroscopy,24 h esophageal pH monitoring and proton pump inhibitor test,however,these methods are either invasive or complex in procedure and with low diagnostic accuracy rate. Gastroesophageal reflux disease questionnaire(GerdQ)possesses multiple advantages such as simple,non-invasive and easily acceptable. This article reviewed the use of GerdQ in diagnosis of GERD.

[Objective]To compare the effects of continuous femoral nerve block(CFNB) and epidural analgesia(CEA) on rehabilitation after total knee arthroplasty(TKA) surgery. [Methods]Fifty patients undergoing unilateral TKA surgery were randomly divided into group CFNB(n=25) and group CEA(n=25).All patients were received unilateral spinal anesthesia with 0.5% dicaine and given analgesia with 0.2 % ropivacaine with 1ug/ml sufentanil.VAS pain scores during rest and continuous passive movement(CPM) at each time point was recorded.Other parameter such as the angle of initiative flections,blood loss at 6 h post operation,the concentration of serum hemoglobin at 24 h,48 h and side effect were recorded.[Results]The VAS pain scores during test had no significant difference between two groups.The VAS scores of CPM at 24 h and 48 h in group CFNB were obvious lower(3.68?0.93 and 3.93?0.78) than those in group CEA.The initiative flections were similar at 12 and 24 hours after operation.The concentration of hemoglobin at 6 h after operation was lower than that before operation.After reinfusion it was increased but did not reach the level before operation.The incidence of side effects was not noted in both groups.[Conclusion]After TKA surgery,the continuous femoral nerve block can provide better pain relief.No adverse impact on rehabilitation movement of operated legs or blood loss and has less side effect.Therefore,it should be considered an alternative analgesia method after TKA.

Objective To investigate the risk factors of dual anti-platelet treatment in upper gastrointestinal hemor-rhage after percutaneous coronary intervention (PCI). Methods Clinical data of 2004 PCI patients with dual anti-platelet treatment were collected,including gender,age,body mass index (BMI),history of drug therapy, history of digestive disease, history of smoking and drinking,history of hypertension,history of diabetes,history of cerebrovascular disease and history of combined treatment with a proton pump inhibitor (PPI). The different characteristics of gastrointestinal bleeding were com-pared. The risk factors of upper gastrointestinal bleeding were analyzed. Results The risk factors for PCI patients with up-per gastrointestinal bleeding were age>65 years of old, history of smoking, history of hypertension,abnormal platelet count, creatinine and hemoglobin. The combined treatment with a proton pump inhibitor was a protective factor associated with gas-trointestinal bleeding. Conclusion We should pay attention to the upper gastrointestinal bleeding induced by dual anti-platelet treatment, and take appropriate measures to reduce the incidence of gastrointestinal bleeding in PCI patients.

Objective: To explore the pathogenesis of phlegm-blood stasis syndrome in mice model of coronary heart disease based on PPAR gamma pathway. Methods: Healthy SPF C57BL/6J mice were used in the control group and the sham operation group, and ApoE-/-mice were used in the blood stasis group, phlegm turbid group and phlegm-blood stasis group. The phlegm turbid group and the phlegm-blood stasis group were fed with high-fat diet for 12 weeks, and the other groups were fed with normal feed for 12 weeks. At the end of the 8th week, the left anterior descending coronary artery was ligated in the blood stasis group and the phlegm-blood stasis group. The sham operation group was not ligated. The levels of IL-6, ET, Ang II and PPARγ in serum were measured by enzyme linked immunosorbent assay, the levels of PPARγ, ABCA1 and CD36 protein in liver tissue were detected by Western blotting, and the levels of CD40, MMP-9 and NF-κB protein in aorta were detected by immunohistochemistry. Results: Compared with sham operation group, there was no significant change in serum IL-6, the content of serum ET in the group of phlegm and blood stasis was increased significantly (P < 0.01), the content of Ang II in blood stasis group was increased significantly (P < 0.05), the content of serum Ang II in phlegm turbid group and phlegm-blood stasis group was increased significantly (P < 0.01), and the content of PPARγ was decreased. In liver tissue, the expression levels of PPARγ and ABCA1 protein in blood stasis group, phlegm turbid group and phlegm-blood stasis group were decreased significantly (P < 0.01), the expression of CD36 protein was increased. CD40, MMP-9 and NF-κB levels in aorta tissue were increased significantly (P < 0.01). Conclusion: The phlegm-blood stasis syndrome of coronary heart disease can cause more serious atherosclerotic plaque in the course of its onset. Its mechanism may be through activating PPARγ pathway.

Objective To observe the clinical curative effect of Xintong decoction in treating unstable angina pectoris(UAP) and impact on serum matrix metalloproteinase 2(MMP-2) of patients with syndrome of phlegm and blood stasis,qi stagnation and obstruction of heart meridian,and probes into its intervention mechanism on UAP.Method Patients were randomly divided into treatment group(30 cases,treated with Xiaotong decoction + routine western medicine) and control group(30 cases,treated with routine western medicine).The course was four weeks.The clinical curative effect was observed and serum MMP-2 before and after treatment was detected.Results TCM syndrome score,angina pectoris,nitroglycerin discontinue rate,serum concentration of MMP-2 in the treatment group were significantly better than the control group.Conclusion Xintong decoction has good curative effect in treating UAP.It can reduce the serum level of MMP-2 of patients with UAP,so as to slowing the progress of plaque and stabilizing plaques.

AIM: To compare the efficacy and safety between quetiapine and clozapine. METHODS: There were 85 patients with first on-set schizophrenia in this study,43 patients treated with quetiapine 425? 56 mg?d -1 and 42 patients treated with clozapine 350? 73 mg?d -1 . The study lasted for 8 wk. The Positive and Negative Symptom Scale (PANSS) and Treatment Emergent Symptom Scale (TESS) were used to evaluate therapeutic and side effects. RESULTS: The PANSS scores in both groups decreased significantly after treatment with those two drugs(P

Objective To investigate the factors related to choice of community health service centers (CHSCs) in standardized training general practitioners (GPs) in Shanghai.Methods Totally 152 GPs,(including those of Traditional Chinese Medicine) who completed the residency training in 2013 and signed employment contract with community in Shanghai were surveyed with a self-designed questionnaire.Results Among all the participants,113 (74.3％) attached the greatest importance to the salary level when choosing CHSC,58 (38.2％) expected annual salary more than 120 000 Yuan during the first 3 years.GPs tended to work in the city center(40.1％) or CHSCs near to their home(38.2％),mainly because of the job commuting (59.9％).Considering career development,the CHSCs with high level comprehensive service (51.3％) and with large population (5.0％) were more attractive.GPs paid more attention to the national demonstration community (57.2％) and CHSCs with member ofShanghai outstanding young physician training program(51.7％).In this survey,household register was the main influencing factor for choosing CHSCs,Shanghai natives paid more attention to the location of the community than those not Shanghai natives (61.8％ vs.34.2％),more inclined to CHSCs that close to their house (55.3％ vs.21.1％),non-Shanghai natives preferred authorized strength (51.3％ vs.28.9％).GPs of Western medicine expected higher salary than GPs of TCM (x2 =13.648,P ＜ 0.05),Males expected higher salary than females (x2 =7.799,P ＜ 0.05),Conclusions GPs pay the most attention on salaries and tend to work in the city central area,prefer CHSC with high level comprehensive service and large served population.The main factor influencing GPs to chose CHSCs is the household register,the category of Gps and gender.

Objective To assess the value of procalcitonin (PCT) levels compared to C-reactive protein (CRP) levels and blood white cell count in early detection of sepsis following percutaneous nephrolithotomy.Methods This prospective observational study included 91 patients,including 59 male patients and 32 female patients,undergoing percutaneous nephrolithotomy between April 2014 and October 2015.Their mean age was (54 ± 15)years old,ranging 15 to 88 years old.The average size of stone was (20.9 7.0) am.Those patients were classified into two groups,based on whether the postoperative sepsis existed.In this group,51 cases were concluded in the sepsis group and 40 in the non-sepsis group.A statistically significant difference between patients with and without sepsis was found in the hydronephrosis (44 vs.25,P =0.009),urine white cell count [(402 ± 970) / μ1 vs.(70 ± 171) / μ1,P ＜ 0.01],positive urine culture(36 vs.20,P ＜ 0.05),positive pelvic urine culture (22 vs.5,P =0.001).There was not any significant difference in sex,age,size of calculi and blood culture between patients with and without sepsis (P ＞ 0.05).Blood white blood cell count,CRP,and PCT were measured in patients with an acute onset of sepsis.Diagnostic accuracy of PCT values was analyzed by the receiver operating characteristics (ROC) curve.Results A statistically significant difference between patients with and without sepsis was found in the PCT [(7.43 ± 10.15)μg/L vs.(0.14 ± 0.10)μg/L,P ＜ 0.01] and blood white cell count [(14.18 ± 6.47) × 109/L vs.(11.22±4.22) × 109/L,P ＜0.05].There was not any significant difference in CRP [(64.93 ± 68.60) mg/ml vs.(70.76 ± 53.36) mg/ml,P ＞ 0.05] between patients with and without sepsis.ROC curve analysis showed that blood white cell count and PCT concentrations had similar predictive values for the development of sepsis (area under the curve,0.78 and 0.90,respectively) with the best cut-off values of blood white cell count for 12 × 109/L (sensitivity 50％,specify 88％) and 0.5 μg/L (sensitivity 64％,specify 100％)for PCT.54 cases were performed blood culture,which showed positive in 12 cases and negative in 42 cases.The significant difference of PCT level could be noticed in two groups [(16.99 ± 11.64) μg/ L vs.(3.77 ± 7.23) μg/ L,P ＜ 0.05)].No significant difference was found in CRP,Blood white cells count among those groups (P ＜ 0.05).ROC curve analysis showed that PCT concentrations had predictive values for the positive blood culture (area under the curve,0.80) with the best cut-off values of 8 μg/L (sensitivity 71％,specify 88％) for PCT.Conclusions PCT was a useful marker for the diagnosis of the sepsis after percutaneous nephrolithotomy as compared with WBC and CRP.

Objective To compare the effects of flexible ureterorenoscope holmium laser for treatment of different sizes lower pole caliceal stones. Methods 140 patients with lower pole caliceal stones from August 2011 to April 2015 were enrolled, 40 patients were divided into observation group which the largest stone diameter > 2.0 cm, 100 patients were divided into control group which the largest stone diameter ≤ 2.0 cm. All these patients received flexible ureterorenoscope holmium laser treatment. Then we observe and compare the prognosis. Results The postop﹣erative 3 d and 1 month of gravel success rates were 97.5 % and 80.0 % in observation group, while the control group were 98.0% and 95.0%. The postoperative 1 month of gravel success rates in observation group was signifi﹣cantly lower than that in control group (P< 0.05). The operative time and postoperative hospital stay in observation group were significantly higher than control group (P<0.05). The postoperative 1 month complications of lung infec﹣tion, hematuria, urinary extravasation and so on in observation group were significantly higher than that in control group (P<0.05). The postoperative 3 d creatinine contents in observation group were significantly higher than preop﹣erative (P< 0.05), and significantly higher than that in control group (P< 0.05). The creatinine contents compared between the two groups at other time points were not statistically significant (P> 0.05). Conclusion Compared with small lower pole caliceal stones, the success rate of flexible ureterorenoscope holmium laser treatment of large lower pole caliceal stones is declined, the patients also have some trauma, and the renal function is also fluctuate, postop﹣erative disease is relatively higher that clinically to be carefully chosen.