Objective:To evaluate the efficacy and safety of balloon-assisted enteroscopy (BAE) in the follow-up treatment of small intestinal polyps in patients with Peutz-Jeghers syndrome (PJS).Methods:From February 2005 to September 2019, the clinical data of patients with PJS who visited Air Force Medical Center many times and underwent BAE for small intestinal polyps surveillance and treatment were collected. The number of follow-up treatment times under BAE, operation-related complications and conservative theragy or surgical treatment were observed. Spearman rank correlation analysis was used to analyze the correlation between follow-up treatment times under BAE and the number and maximum diameter of small intestinal polyps.Results:A total of 165 PJS patients were enrolled, including 98 males and 67 females, and the mean age of first visit was (22.5±9.4) years. A total of 664 BAE operations were performed in the 165 PJS patients. The number of BAE operations and the number of follow-up treatments for each patient were 4.0±1.8 and 2.8±1.1, respectively. There were 26, 52, 35, 28, 12, 4, 2, 2, 2 and 2 patients who underwent 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11 BAE operations, respectively. There were 165, 76, 30, 12, 4 and 4 patients who received 2, 3, 4, 5, 6 and 7 follow-up treatments, respectively. During the first to the fifth times of BAE follow-up treatment, the numbers of small bowel polyps resected under BAE of each patient were 7.0 (2.0, 11.0), 4.0 (2.0, 10.0), 3.0 (1.0, 8.5), 5.5 (1.8 , 10.3) and 3.0 (2.0, 6.8), respectively; and the maximum diameters of resected small intestinal polyps were 4.5 cm(3.0 cm, 6.0 cm), 3.0 cm(1.5 cm, 4.0 cm), 2.0 cm (1.5 cm, 3.0 cm), 3.0 cm(2.5 cm, 4.0 cm) and 2.5 cm(1.5 cm, 4.0) cm, respectively. The results of Spearman rank correlation analysis indicated that the number of follow-up treatment under BAE was negatively correlated with the number and maximum diameter of resected small intestinal polyps ( r s=-0.141, P=0.003; r s=-0.400, P<0.01). The total incidence of operation-related complications of small intestinal polyps resection under BAE was 3.2% (21/664), and 61.9%(13/21)of the complications were cured by conservative therapy. During the follow-up period, there were 26 cases of PJS complicated with intestinal intussusception, of which 20 cases (76.9%, 20/26) disappeared after BAE resection of small intestinal polyps. A total of 13 patients received surgery for intussusception (6 cases) or large polyps blocking the intestinal lumen (7cases). Conclusions:BAE is safe and effective in the follow-up treatment of small intestinal polyps in PJS. It can reduce the number and maximum diameter of small intestinal polyps, prevent and treat the complications related to small intestinal polyps, and effectively reduced surgical treatments.

BACKGROUND: Total knee arthroplasty is an important measure to save the function of knee joint, but the postoperative pain caused great pain to patients. On the background of multimodal analgesia, cocktail therapy and femoral nerve block are widely used in clinic, and the analgesic effect is exact; however, the analgesic effect and safety of the two methods used together are unknown, so more clinical evidence is needed. OBJECTIVE: To study the effect and safety of analgesic and functional recovery of cocktail therapy combined with femoral nerve block after total knee arthroplasty. METHODS: Totally 100 patients undergoing primary unilateral total knee arthroplasty were enrolled. One hundred patients were randomly divided into two groups (n=50 per group) according to the table of random numbers. Group A was given cocktail therapy combined with femoral nerve block; group B received the injection of same volume of normal saline surrounding the knee joint combined with femoral nerve block. The postoperative resting-state visual analogue scale score, knee joint range of motion, global pain scale, and incidences of adverse reactions were compared between groups. The time and frequency of analgesic drugs were recorded. RESULTS AND CONCLUSION: (1) The postoperative visual analogue scale score at rest in the group A was significantly lower than that in the group B at 24, 36 and 48 hours postoperatively (P < 0.05). The scores at 12 and 72 hours did not differ significantly between groups (P < 0.05). (2) The knee joint range of motion on postoperative 1 and 3 days in the group A was significantly higher than that in the group B (P < 0.05), and no significant difference was detected at 14 days, 1 and 3 months postoperatively (P < 0.05). (3) At 3 months after operation, there was no significant difference in the Global Pain Scale between the two groups (P < 0.05). (4) There was no significant difference in incidences of adverse reactions and additional analgesics between the two groups (P < 0.05). (5) In summary, cocktail therapy combined with femoral nerve block can relieve the early resting pain after total knee arthroplasty, and improve the activity of knee joint in the early stage, which is safe and effective.

Humans ; Liver Cirrhosis ; diagnosis

Objective:To investigate the efficacy of double balloon enteroscopy (DBE) in the treatment of bleeding from small intestinal vascular lesion and risk factors of bleeding recurrence .Methods:From April 2013 to May 2020, at Air Force Medical Center, the clinical data of 65 patients with confirmed or suspected bleeding from small intestinal vascular lesion were retrospectively analyzed. The patients were divided into DBE treatment group (patients of Yano classification 1a and 1b received argon plasma coagulation, and patients of Yano classification 2 and 3 accepted combination of titanium clip and submucosal injection of lauromacrogol sclerosing agent) and non-DBE treatment group (traditional treatments such as stopping anticoagulant or antiplatelet drugs, blood transfusion, and iron supplementation). The bleeding recurrence of patients with single small intestinal vascular lesion between DBE treatment group and non-DBE treatment group, and patients with single or mulitiple vascular lesion of DBE treatment group were compared. Univariate analysis was used to analyze the clinical data of patients with or without recurrent bleeding. Multivariate logistic regression model was used to analyze the independent risk factors and protective factors of recurrent bleeding in small intestinal vascular lesion. Independent sample t test, chi-square test and Fisher exact probability method were used for statistical analysis. Results:Forty-four (25 of single vascular lesion and 19 of multiple vascular lesion) patients were diagnosed with small intestinal vascular lesions and received DBE treatment (DBE treatment group). Twenty-one patients with single vascular lesion accepted traditional treatment (non-DBE treatment group). The recurrent rate of bleeding in patients with single vascular lesion of DBE treatment group was lower than that in patients with single vascular lesion of non-DBE treatment group and patients with multiple vascular lesion of DBE treatment group (24.0%, 6/25 vs. 71.4%, 15/21 and 12/19), and the differences were statistically significant ( χ2=10.348 and 6.848, P=0.001 and 0.009). The results of univariate analysis showed that the proportion of blood transfusion, hypertension, complicated with valvular heart disease and DBE treatment in patients with rebleeding or not rebleeding from small intestinal vascular lesion was different with statistically significant (69.7%(23/33) vs. 37.5%(12/32), 51.5%(17/33) vs. 18.8%(6/32), 42.4%(14/33) vs. 12.5%(4/32) and 54.5%(18/33) vs. 81.2%(26/32), χ2=6.777, 7.628, 7.265, and 5.298, all P<0.05). The results of multivariate logistic regression analysis indicated that blood transfusion during the course of disease (odds ratien ( OR)=3.736, 95% confidence interval ( CI) 1.082 to 12.898, P=0.037) and complication with valvular heart disease ( OR=4.916, 95% CI 1.107 to 21.829, P=0.036) were independent risk factors of bleeding recurrence in patients with small intestinal vascular lesions. DBE treatment was the protective factor of bleeding recurrence in patients with small intestinal vascular lesion ( OR=0.214, 95% CI 0.057 to 0.808, P=0.023). Conclusions:DBE is effective in the treatment of small intestinal vascular lesion bleeding, especially for single vascular lesion. Blood transfusion during disease course and complication with valvular heart disease are independent risk factors for bleeding recurrence in patients with small intestinal vascular lesion.

Objective To study the effects of γ-IFN on the expression of HLA-G mRNA in primary cultured astrocytoma cells. Methods Different concentrations of γ-IFN were added to primary cultured cells, and HLA-G mRNA were detected by RT-PCR. Results After γ-IFN treatment, HLA-G mRNA can not be determined from HLA-G originally negative astrocytoma cells. The expression of HLA-G are up - regulated in all original HLA-G positive astrocytoma cells in a dose-dependent manner. Conclusion γ-IFN can increase the ex-pression of HLA-G gene in the primary cultured astrocytoma cells which HLA - G are originally positive.

Objective To compare the clinical utility of alpha-fetoprotein (AFP) and des-gammacarboxyprothrombin (DCP) in diagnosing hepatocellular carcinoma (HCC) in patients with a hepatic mass.Methods From January 2015 to May 2015,141 patients were diagnosed to have a liver tumor after imaging examinations in the Hepatobiliary Surgical General Hospital of PLA,Beijing,China.Preoperative AFP and DCP were measured using commercial assay kits.The reference standard was either pathologic or clinical diagnosis of HCC.The performance of AFP and DCP in diagnosing HCC was determined using receiver operating characteristic curve analysis.Results Of 141 patients,98 were diagnosed to have HCC and 43 without.The levels of AFP were significantly higher in patients with HCC than those without [80.0(3.9-1 375.0) μg/L vs.2.1 (1.6-3.2) μg/L,Z =6.98,P ＜ 0.01].Similar results were observed in the levels of DCP [141.5 (24.0-978.0) AU/L vs.19.0 (14.0-25.5) AU/L,Z =5.18,P ＜ 0.01].Receiver operating curves (ROC) indicated the cut-off value with the best sensitivity and specificity was 3.6 μg/L for AFP and 35 AU/L for DCP.The difference in the area under ROC between AFP and DCP was not statistically significant (0.87 vs.0.78,Z =1.72,P =0.085).The sensitivity and specificity for detection of HCC in patients with a hepatic mass were 56.1％ and 95.4％ for AFP ＞ or =20 μg/L,69.4％ and 83.7％ for DCP ＞ or =40 AU/L,respectively.The level of AFP was associated with DCP in patients with HCC (x2 =9.12,P ＜ 0.01,r =0.292) and parallel testing of AFP and DCP gave an optimal sensitivity of 79.6％ with a specificity of 81.4％ in diagnosing HCC.Conclusions DCP is a useful biomarker and it gave an equal performance as AFP in diagnosing HCC in patients with a liver mass in this study.Parallel testing of AFP and DCP effectively increased the diagnostic sensitivity.Although the biomarkers only marginally improved the diagnostic results,it could be useful in diagnosing HCC in individuals who had atypical imaging results.

Objective:To evaluate the value of blood urea nitrogen (BUN)/creatinine (Cr) ratio for guiding the access route of double balloon enteroscopy (DBE) for small intestinal bleeding.Methods:The clinical information was collected from 105 patients who underwent DBE for suspected small intestinal bleeding at Air Force Medical Center from January 2015 to October 2019. Patients were divided into the elevated BUN/Cr group ( n=52) and the normal BUN/Cr group ( n=53), with a cut-off value of 81. Comparison was made for the detection rate of lesions between the oral route and anal route separately in the two groups using Chi-square test. Results:Among the 105 patients with suspected small intestinal bleeding, definite causes of bleeding were identified in 79 patients by DBE, and the overall lesion detection rate was 75.24% (79/105). In the elevated BUN/Cr group, the overall lesion detection rate was 76.92% (40/52), among which 79.49% (31/39) was through oral and 47.37% (9/19) through anal enteroscopy. In the normal BUN/Cr group, the overall lesion detection rate was 73.58% (39/53), and 63.64% (21/33) was transoral and 51.43% (18/35) transanal. The lesion detection rate of transoral enteroscopy in the elevated group was significantly higher than that in the normal group ( χ2=6.576, P=0.010). There was no significant difference in the lesion detection rate of transanal enteroscopy between the two groups ( χ2=2.230, P=0.135). Conclusion:For patients with active small intestinal bleeding (active bleeding within 48 hours), the BUN/Cr ratio higher than 81 may indicate that DBE should be performed firstly via oral route.

Background/Aims: Enteroenteric intussusception in Peutz-Jeghers syndrome (EI-PJS) is traditionally treated by surgery. However, enteroscopic treatment is a minimally invasive approach worth attempting. We aimed to develop a risk scoring system to facilitate decision-making in the treatment of EI-PJS. Methods: This was a single-center case-control study, including 80 patients diagnosed with PJS and coexisting intussusception between January 2015 and January 2021 in Air Force Medical Center. We performed logistic regression analysis to identify independent risk factors and allocated different points to each subcategory of risk factors; the total score of individuals ranged from 0 to 9 points. Then, we constructed a risk stratification system based on the possibility of requiring surgery: 0–3 points for “low-risk,” 4–6 points for “moderate-risk,” and 7–9 points for “high-risk.” Results: Sixty-one patients (76.25%) were successfully treated with enteroscopy. Sixteen patients (20.0%) failed enteroscopic treatment and subsequently underwent surgery, and three patients (3.75%) received surgery directly. Abdominal pain, the diameter of the responsible polyp, and the length of intussusception were independent risk factors for predicting the possibility of requiring surgery. According to the risk scoring system, the incidence rates of surgery were 4.44% in the low-risk tier, 30.43% in the moderate-risk tier, and 83.33% in the high-risk tier. From low- to high-risk tiers, the trend of increasing risk was significant (p<0.001). Conclusions We developed a risk scoring system based on abdominal pain, diameter of the responsible polyps, and length of intussusception. It can preoperatively stratify patients according to the risk of requiring surgery for EI-PJS to facilitate treatment decision-making.

OBJECTIVETo develop a reserved-phase HPLC method for the determination of praeruptorin A, praeruptorin B, qianhucoumarin E in roots of Peucedanum praeruptorum.

METHODAgilent TC-C18 column (4.6 mm x 250 mm, 5 microm) was used at 30 degrees C with the mobile phase of methanol-water (75:25). The flow rate was set at 0.8 mL x min(-1). The detection wavelength was 321 nm.

RESULTThe linear response ranged from 3.20-28.80 microg for +/- praeruptorin A (r = 0.9999, n = 5), 1.60-14.40 g for praeruptorin B (r = 0.9995, n = 5) and 1.64-14.76 g for qianhucoumarin E (r = 0.9994, n = 5), respectively. Recoveries were 98.92% with RSD 1.6% for praeruptorin A, 99.66% with RSD 1.5% for praeruptorin B and 99.72% with RSD 1.4% for qianhucoumarin E.

CONCLUSIONThe method is quick, simple and repeatable for determination of three coumarin constituents in root of P. praeruptorum.

Apiaceae ; chemistry ; Chromatography, High Pressure Liquid ; Coumarins ; analysis ; isolation & purification ; Linear Models ; Plant Roots ; chemistry ; Reproducibility of Results ; Time Factors

Objective To evaluate the clinical outcomes of partial lateral patellar facetectomy ( PLPF ) combined with lateral retinaculum release ( LRR ) for treatment of patellofemoral osteoarthritis ( PFOA ). Methods From June 2017 to March 2018, 30 PFOA patients underwent PLPF combined with LRR at Department of Orthopedics and Traumatology, Foshan Hospital of Traditional Chinese Medicine. They were 7 men and 23 women with an average age of 56.4 ± 9.7 years. Their patellar position, patellofemoral joint function, overall knee function, and quality of life were assessed by comparing preoperation and last follow-up in patellofemoral congruence angle ( PFCA ) , lateral patellofemoral angle ( LPFA ) , modified Kujala score, The Western Ontario and Mcmaster Universities Osteoarthritis Index ( WOMAC ) , and SF-12 quality of life scale. Results All the patients were followed up for an average of 7.6 ± 3.4 months ( from 4 to 13 months ). The PFCA was improved from preoperative 22.9°± 7.6°to 12.4°± 4.2°at the last follow-up, the LPFA from preoperative 3.2°± 3.7° to 12.9°± 6.0° at the last follow-up, the modified Kujala score from preoperative 17.1 ± 9.8 to 34.3 ± 5.7 at the last follow-up, the WOMAC from preoperative 14.1 ± 5.2 to 5.9 ± 1.7 at the last follow-up, the stiffness index from preoperative 5.5 ± 3.2 to 2.7 ± 1.2 at the last fol-low-up, daily functional index from preoperative 43.9 ± 9.0 to 25.2 ± 5.4 at the last follow-up, and the SF-12 scores from preoperative 31.3 ± 5.2 to 55.7 ± 6.0 at the last follow-up. All the above comparisons showed a significant difference ( P ＜0.05 ) . Conclusion PLPF combined with LRR is a minimally invasive, easy-to-master and effective knee joint preserving procedure for PFOA as it can significantly relieve joint pain and maximally keep patellar functions.