Background:Gastroesophageal reflux disease( GERD)that does not respond satisfactorily to standard proton pump inhibitor is defined as refractory gastroesophageal reflux disease( rGERD). Combined therapy is used to treat rGERD, however,the addition of baclofen is rarely studied. Aims:To investigate the efficacy of baclofen combined with esomeprazole and mosapride on rGERD. Methods:Seventy-two patients with rGERD from March 2013 to April 2014 at the First Hospital of Putian City were enrolled and randomly divided into group A and group B. Patients in group A were orally administrated with esomeprazole 20 mg bid + mosapride 5 mg tid + baclofen 5 mg tid. Patients in group B were treated with esomeprazole 20 mg bid + mosapride 5 mg tid. The treatment course was 8 weeks. The efficacy on symptoms, esophagitis under endoscopy and adverse effects were compared between the two groups. Results:After 8-week treatment, score of heartburn,regurgitation,retrosternal pain,dysphagia and overall symptom were significantly decreased in the two groups than before the treatment. The overall symptom alleviating rate was significantly higher in group A than in group B (90. 6% us. 70. 0%;χ2 =4. 585,P=0. 032). Esophagitis under endoscopy in the two groups was significantly improved, the effective rate was significantly higher in group A than in group B(93. 8% us. 75. 0%;χ2 =4. 500,P=0. 034). The main adverse effects of baclofen were somnolence,dizziness and fatigue,all the patients were well tolerated. Conclusions:Baclofen combined with esomeprazole and mosapride is an efficient option for rGERD.

Objective: To study the protective effects of tetrahydropalmatine (THP) against ischemia－reperfusion induced hippocamp lesion in rats. 　MethodS: A model of ischemia-reperfusion induced brain lesion was set up by ligation of common carotid arteria in rats, and the protective effects of THP was observed.　Results: It was found that, with administration of THP, the activities of superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and Na+, K+-ATPase as well as Ca2＋－ATPase were increased (P＜0.05, respectively), while malondialehyde (MDA) was decreased to 42.5% (P＜0.01) during brain ischemia－reperfusion.　Conclusion:The results suggested that THP can protect the rat against ischemia－reperfusion induced brain lesion.

Objective To observe the effects of soybean isoflavone in attenuating trans fatty acids-induced athero-sclerosis in rats .Methods The rats were randomly divided into normal diet group、trans fatty acids group、soybean isoflavone group and trans fatty acids +soybean isoflavone group .Research kit was used to test the amounts of TG , HDL,LDL and IL-6,TNF-αin rats'blood.Bovine aortic endothelial cells were cultured and divided into control group,trans fatty acids group and trans fatty acids group +soybean isoflavone group .Western blot was performed to test the NF-κB phosphorylation ,as well as to determine ICAM-1 and VCAM-1 protein contents in bovine aortic endo-thelial cells.Results Compared with normal diet group ,the amounts of TG,LDL,IL-6,TNF-αincreased evidently (P<0.05), whereas the amounts of HDL decreased evidently (P<0.05) in the rats'blood of trans fatty acids group . After the soybean isoflavone intervened ,the amounts of TG,LDL,IL-6,TNF-αall decreased (P<0.01), meanwhile the amounts of HDL increased significantly (P<0.01).Soybean isoflavone inhibited NF-κB phosphorylation induced by trans fatty acids ( P<0.01) .The high expression of ICAM-1 and VCAM-1 induced by trans fatty acids was de-creased by soybean isoflavone when comparing with those in the control group ( P<0.01 ) .Conclusions Soybean isoflavone has a role in attenuating trans fatty acids trans fatty acids-induced atherosclerosis in rats .

Objective:To assess the efficacy of trastuzumab combined with neoadjuvant chemotherapy in the treatment of human epidermal growth factor receptor-2 (Her-2)positive breast cancer patients,and to explore its influencing factors of prognosis of breast cancer.Methods:The clinical materials of 112 Her-2 positive breast cancer patients were collected and they were divided into combined treatment group (trastuzumab + neoadj uvant chemotherapy)and single chemotherapy group (without trastuzumab ). SPSS 1 9.0 software was employed to calculate and analyze their clinical characteristics.The survival rate and prognosis were analyzed by Kaplan-Meier method,Log-rank test, and Cox regression. Results:Among the 112 Her-2 positive breast cancer patients, 23 cases were treated with trastuzumab,89 cases were treated without trastuzumab.The disease-free survival (DFS)in combined treatment group and single chemotherapy group had significant difference (P=0.012).And there was no significant difference of overall survival (OS)between two groups (P=0.064).The HR negative group had 18 (32.7%)patients with 5-level of Miller and Payne (MP)classification which was higher than HR positive group (5/46,10.9%)(P=0.009).In univariate analysis,the tumor size,node status at diagnosis and node status after operation were the influencing factors of DFS in the Her-2 positive breast cancer patients;the tumor size,node status at diagnosis,MP classification and node status after operation were the influencing factors of OS in the Her-2 positive breast cancer patients.The result of multivariate analysis indicated that the tumor size, node status at diagnosis,and with or without radiotherapy were the independent influencing factors of DFS and OS in the Her-2 positive breast cancer patients. Conclusion:The breast lesions in the Her-2 positive breast cancer patients with negative HR are relieved after treated with trastuzumab combined with neoadjuvant chemotherapy. The combination of trastuzumab and neoadj uvant chemotherapy can significantly improve the DFS and has a positive influence in the prognosis of Her-2 positive breast cancer patients.

Objective To discuss the growth suppressing, apoptosing effect of new type tumor-supressor gene-p33ING1 in stomach cancer cell strain, and to explore new strategies and methods in tumor therapy. Methods The PCDNA3/p33ING1 nuclear expressing microsome was constructed, p33ING1 and wt-p53 were implanted to human stomach cancer cell both and to evaluate the effect of p33ING1 and p53 toward stomach cancer cell and synergism between them. Results The PCDNA3/p33ING1 nuclear expressing microsome was successfully constructed. The human stomach cancer cell strain SSCG-7901 under implantation of p33ING1 and wt-p53 showed a significant decrease in cell growth, the coupling time was delayed, DNA synthetic phase was shortened and G0/G1 phase prolonged. The cell collapse increased. Conclusions Despite of the tumor-inhibiting effect and biochemical activation of p33ING1, it also plays a role with p53 gene in controling growth of stomach cancer cell, inducing cell collapse and hampering cell proliferation cycle. P33ING1 and p53 are synergistic to each other.

Objective To investigate the indication,techniques,safety and efficacy of medical suture versus traditional suturein thoracoscopic surgery incision closure.Methods From October 2014 to January 2016,121 patients undergoing thoracoscopic surgery were divided into two groups according to the method of incision closure:53 cases of traditional suture group and 68 cases of medical suture hasp group.The time of closure,healing time,wound healing scores and patient's satisfaction were recorded and statistically analyzed.Results All patients were successfully operated without perioperative death.One patient underwent postoperative bleeding in the medical suture hasp group.The medical suture hasp was found to be reliable and easy to remove in secondary operation.The postoperative incision was changed to traditional suture.Two patients in each group had delayed healing.Two patients of medical suture hasp group were caused by incision bleeding,of whom one case switched to traditional suture,and one patient was treated with pressure bandage and healed.The wound closure time of the medical suture hasp group was significantly shorter than that of the traditional suture group:(110.0 ± 12.7) s vs.(305.0 ± 31.6) s,P ＜ 0.01.The wound healing scores of medical suture hasp group were higher than those of traditional suture group 2 weeks and 1 month after surgery (P ＜ 0.01).There was no significant difference in healing rate between two groups (P ＞ 0.05).The satisfaction scores of the patients in medical suture hasp group were higher than those in traditional suture group (P ＜ 0.01).Conclusions The use of medical suture hasp in the thoracoscopic surgical incision closure process is safe and reliable.It can accelerate the early repair of incision,and improve patient's satisfaction.

Objective:To analyze the clinical characteristics of patients suffering from acute ischemic stroke (AIS) complicated with obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods:Data of patients with AIS who visited the Second Affiliated Hospital of Soochow University from January 2015 to June 2020 and underwent polysomnography monitoring (PSG) in the sleep center were collected retrospectively. Patients were divided into OSAHS group and AIS only group. Demographic information of patients, general clinical data, hematological indicators of glucose and lipid metabolism and inflammatory markers, PSG parameters and neurological function scores were collected, including the National Institutes of Health Stroke Scale (NIHSS) on admission and the modified Rankin Scale (mRS) on discharge. We compared the differences between the two groups. In addition, OSAHS group were divided into good prognosis and poor prognosis subgroups according to mRS score. The differences between the two subgroups were compared.Results:A total of 112 AIS patients combined with OSAHS and 89 AIS only patients were included. The proportion of non-rapid eye movement stages 1+2 [(N1+N2) %], arousal index, the oxygen desaturation index (ODI), percentage of total sleep time with oxygen saturation<90% (TS90) in the OSAHS group were higher than those in the AIS only group, while N3%, lowest nocturnal oxygen saturation (LSaO 2) were lower (all P<0.05). There was no statistical difference in the distribution of cerebral apoplexy lesions (cortex, subcortical, brainstem, cerebellum) between the two groups, but the proportion of patients with multifocal cerebral apoplexy in the OSAHS group was higher ( P=0.032). There was no statistical difference in NIHSS score on admission between the two groups, but the neutrophil/lymphocyte ratio (NLR) score ( P=0.004) and mRS score on discharge ( P=0.010) of the OSAHS group were significantly higher than those in the AIS only group. There were 74 patients in the good prognosis group and 38 in the poor prognosis group. The analysis showed that the NIHSS and NLR scores of the poor prognosis group were higher than the good prognosis group, admission NIHSS score was a risk factor for poor prognosis, all P<0.01. Conclusions:AIS patients complicated with OSAHS are characterized by disordered sleep structure, more severe nocturnal hypoxia, higher risk of developing multiple lesions, poor neurological function recovery at discharge, and high inflammatory index of NLR. Among them, patients with poor prognosis have poorer sleep efficiency, and high admission NIHSS score is a risk factor for poor prognosis.

Objective To assess the choice between direct operation and followed- up observation for subclinical esophageal submucosal mass. Methods The clinical data of 133 patients with subclinical esophageal submucosal mass from February 1996 to October 2013 were retrospectively analyzed. The patients were divided into 2 groups according to the modes of intervention: direct operation group (82 cases) and followed-up group (51 cases). Their clinical data, imaging, endoscopy information, modes of intervention and final outcome were compared. Results All of the 133 patients were considered as esophageal leiomyoma. The age and body examination detection rate in direct operation group were significantly lower than those in followed-up group: (47.7 ± 13.1) years vs. (52.2 ± 10.1) years and 15.9% (13/82) vs. 37.3% (19/51), the tumor diameter, case history and incidence of chest and abdominal pain were significantly higher than those in followed-up group: (2.2 ± 1.4) cm vs. (1.7 ± 1.0) cm, 51 (44, 60) months vs. 47 (40, 55) months and 28.0% (23/82) vs. 9.8% (5/51), and there were statistical differences (P＜0.05 or ＜0.01). There was no operative mortality in direct operation group, and the incidence of mild surgical complication was 8.5% (7/82); the pathological result showed that esophageal leiomyoma and other benign diseases were in 70 cases, and malignant disease in 12 cases (12 cases of malignant diseases who missed diagnosis before operation were mostly caused by incomplete examination.). In followed-up group, the mean observation time was 35.5 (3 to 240) months, disease progression was in 23 cases (45.1%, 23/51), 3 cases developed new-onset symptoms, 20 cases increased in diameter, and the average doubling time was 856 (126 to 2 891) d. Twenty-seven patients eventually underwent surgery (52.9%, 27/51, post-observation intervention group), without perioperative death, and the incidence of surgical complication was 7.4% (2/27). The pathological result showed that esophageal leiomyoma and other benign diseases were in 23 cases, and malignant disease in 4 cases. Compared with direct operation group, post-observation intervention group had no delayed treatment due to the observation and did not increase the surgery risk and difficulty, and no malignant transformation occurred. Conclusions Subclinical esophageal submucosal mass could be followed up, but endoscopic ultrasonography, CT and gastrointestinal angiography must be performed and must be followed up closely.

Objective To investigate ultrahistopathological features of symmetrical acrokeratoderma.Methods Biopsy specimens were obtained from skin lesions and perilesional normalappearing skin of 6 patients with symmetrical acrokeratoderma,as well as from normal skin of 3 healthy volunteers.Then,these skin specimens were subjected to transmission electron microscopy (TEM).Results TEM showed obviously thickened stratum corneum,irregular morphology of keratinocytes and discontinuous cornified envelope.Aggregation and abnormal arrangement of keratin filaments occurred in all epidermal layers.Many vacuoles of different sizes were observed in the transitional zone between the stratum corneum and stratum granulosum.Hypogranulosis,abnormal shape and different sizes of keratohyalin granules,and reduction of membrane-coating granules were found in the stratum granulosum.Increased melanocytes with a large number of stage Ⅳ melanosomes in the cytoplasm were observed in the basal layers.Moreover,there was infiltration of a few lymphocytes in the superficial dermis.Perilesional normal-appearing skin tissues showed similar but milder ultrastructural changes.Conclusion Abnormal metabolism of keratins,epidermal differentiation complex proteins and lipids may exist in skin lesions of symmetrical acrokeratoderma,which may contribute to epidermal thickening and impairment of skin barrier function.

Objective To investigate the effect of the amputation order of pulmonary artery and pulmonary artery on pulmonary residual blood volume in total thoracoscopic lobectomy.Methods Sixtyeight patients who were scheduled to underwent total thoracoscopic lobectomy from June 2015 to April 2019 in Beijing Aerospace General Hospital were selected.The patients were divided into first amputation pulmonary artery group and first amputation pulmonary vein group by random envelope method with 34 cases in each group.Five cases in first amputation pulmonary artery group and 4 cases in first amputation pulmonary vein group were excluded because of the procedure modification or the fragmentation of the specimen during the course of operation.In the end,29 cases were enrolled in first amputation pulmonary artery group and 30 cases in first amputation pulmonary vein group.In first amputation pulmonary vein group,all arteries were ligated before interruption of the veins;and in first amputation pulmonary artery group had a reverse sequence.The perioperative period status were recorded,and the crude pulmonary quality,dry pulmonary quality,pulmonary residual blood volume and adjusted pulmonary residual blood ratio were measured or calculated.Results All 59 patients were operated successfully.No serious complications occurred,no perioperative death occurred,and no patients needed blood transfusion.There was no statistical difference in the incidence of minor complications between first amputation pulmonary artery group and first amputation pulmonary vein group:27.6％ (8/29) vs.33.3％ (10/30),P＞0.05.There were no statistical differences in operative time,transoperative bleeding volume,pulmonary residual blood volume,crude pulmonary quality,dry pulmonary quality,adjusted pulmonary residual blood ratio,hemoglobin difference before and after surgery,postoperative drainage time and postoperative hospitalization time between 2 groups (P＞0.05).Conclusions The amputation order of pulmonary artery and pulmonary vein sequence of vessel interruption during total thoracoscopic lobectomy has no effect on the pulmonary residual blood volume,can be reasonably selected according to the intraoperative situation.