Objective To explore the feasibility, safety and the efficacy of peroral endoscopic myotomy (POEM) for pediatric patients with achalasia.Methods A total of 21 patients (mean age 2 years, range 11 months-7 years) with AC were enrolled and underwent POEM from January 2012 to December 2014.Procedure-related complications, reflux esophagitis were observed.Eckardt score and the pressure of the lower esophageal sphincter (LES) were analysed.Results All patients underwent POEM successfully.No serious POEM-related complications were observed.During a mean follow-up period of 20.4 months (range 9-36 months), mean Eckardt score decreased from 8.1 to 0.8 after treatment (P ＜ 0.01).Mean LES treatment also decreased from 30.2 mmHg to 11.5 mmHg after the operation (1 mmHg =0.133 kPa, P ＜ 0.01).Reflux esophagitis developed in four patients (19.0％ ,4/21).Conclusion POEM is safe and effective treatment for pediatric patients with achalasia.

BACKGROUND: Multiple sclerosis(MS) is a chronic autoimmune disease induced by the interaction between genetic and environmental factors. Its pathogen and the mechanism of the relapse and remission m the course of the disease are still unknown. Most of the MS research centers are looking for the pathogenic polypeptide epitope in proteolipid protein(PLP), myelin sheath basic protein (MBP) and oligodendrocyte glycoprotein (MOG) OBJECTIVE: To compare the proliferation of T cell lines(TCL) in MS induced by myelin sheath and delipidated myelin sheath towards 11 components of myelin sheath to mainly search the possible pathogenic polypeptide epitope in PLP, and investigate the possible effects of abnormal dcgrease in myelin sheath.DESIGN: A case-controlled trial.SETTING: Department of neurology in a hospital of a university.PARTICIPANTS: Mononuclear cells(MNC) of 16 MS cases(clinical relapsing-remitting type, patients did not receive any immunosuppresant for at least 3 months when their peripheral blood samples were taken) and 12 HLA-DR15 healthy volunteers were furnished by Dr. Trotter JL of MS Research Center of Washington University from the cell database.INTERVENTIONS: MS-TCL and normal TCL were induced twice by stimulation with myelin sheath and delipidated myelin sheath in vitro by cell culture in vitro. TCL proliferation was tested by 11 antigens including PLP,MBP, M87-106, P30-49, P40-60, P89-106, P95-117, P117-137,P139-151, P178-191, and P185-206.MAIN OUTCOME MEASURES: Difference of scintillation counting in every minute of every well, and the stimulative index of each well were calculated, and the mean wells with positive proliferation of TCL towards each antigen were confirmed as well.RESULTS: The general specific proliferation towards myelin sheath antigens was bigger in MS group than control group 5.49 ±5.31 to 3.10 ± 3. 17, and delipidated myelin sheath-induced TCL was bigger than myelin sheath-induced one 5. 49 ± 5.31 to 3.41 ± 4. 83 . Delipidated myelin sheath significantly changed the immune responses of MS group,especially the changes of responses towards P30-49, P40-60, P89-106,P117-137, P139-161, and P185-206 were significant compared with that the control group only responded to two polypeptides, which indicated that the antigen epitope of MBP, PLP, M87-106, P95-117, P40-60, and P185-206 might have significance in the triggering of MS autoimmune responses.CONCLUSION: TCL induced by MS myelin sheath has different proliferation towards antigen components of myelin sheath from control group. Delipidated myelin sheath significantly increases TCL proliferation in MS group, which suggests that if MS patients developed abnormal degrease in myelin sheath, TCL would produce autoimmune response towards self-myelin sheath, MBP, PLP and its polypeptide segments all can trigger MS or aggravate the state of the illness. Our finding supports the hypothesis of MS autoimmune pathogenic mechanism.

Objective To investigate the health-related quality of life (HRQOL), demographic characteristics, and health behaviors of the Chinese elderly to find out high-risk population and behaviors. Methods Data was collected from a cross-sectional survey performed in Jiangsu, Anhui, Gansu,Qinghai, Fujian, Beijing, Jilin, Jiangxi, and Henan province. MOS SF-36 was used for HRQOL assessment, t test was used for HRQOL comparison between the elderly and the general population. Multiple stepwise linear regression analysis was used to evaluate the affecting factors. Results The HRQOL among the Chinese elderly were PF ( Physical Functioning) 79 ± 21, RP ( Role-Physical ) 68 ± 40, BP ( Bodily Pain) 72 ± 23, GH ( General Health) 57±22, VT ( Vitality ) 69 ± 20, SF ( Social Functioning) 79 ± 23, RE ( Role-Emotional ) 72 ±40, M H ( Mental Health)76 ± 18, which were lower than Sichuan Norm on 7 dimensions ( P ＜ 0. 05 ; except on M H dimension) and lower than Hangzhou Norm on 5 dimensions (P ＜ 0. 05 ;except on GH, VT, and MHdimensions). The important affecting factors included physical exercise, education level, medical history of chronic disease, age, race, marriage, body mass index ( BMI ), sleeping habits, and gender. Conclusions Compared with the general population, the HRQOL in the elderly might be lower. The health policy and community heahhcare services should focus on the elderly individuals with insufficient exercise, lower education level, chronic disease history, and ethnic minority, or widows. Health education should encourage them to improve physical exercise and sleeping behavior.

Objective To study the effects of localized thermochemotherapy on cellular proliferation and the expression of PCNA and IGF-I protein of C6 gliomas in rat, and explore the possibility of developing new therapeutic method of gliomas. Methods C6 glioma cells were injectcd subcutaneously to rats. The rats were randomly assigned to 4 groups,and treatment were initiated on day 22 after tumor inoculation. Prior to treatment, the subcutaneous gliomas were examined to verify tumor size, which were ranged 1.5 to 2.0 cm. Then localized thermochemotherapy, hyperthermia and chemotherapy were given, respectively. The size and weight of subcutaneous tumors were measured. PCNA and IGF-I protein expression were detected by the technique of S-P immunohistochemistry. Glioma cells proliferation was detected by HE staining method and electron-microscopic observation. Results Compared with the control group, the tumor size of rats in the hyperthermia and chemotherapy as well as thermochemotherapy groups was decreased,the tumor weight was also decreased significantly (2.95g vs 1.95g vs 1.86g vs 1.09g, P

Objective To explore changes of expression of pro-and anti-inflammatory cytokines in the hippocam-pus of Aβ1-42-induced Alzheimer’s disease (AD) rat model. Methods Twenty-four SD rats were divided into control group, PBS group (PBS was injected into CA1 area of hippocampus) and AD model group (Aβ1-42 was injected into CA1 area of hip-pocampus). The escape latency was evaluated by Morris water maze in three groups. Nissl staining was used to detect the le-sions of hippocampal CA1 neurons. Levels of amyloid precursor protein (APP) and protein phosphatase 2A (PP2A) in hippo-campus were measured by Western blot analysis. Real-time PCR was employed to examine the expressions of pro-inflamma-tory cytokines, including interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), and the mRNA expressions of anti-inflammatory cytokines, including IL-4, IL-10 and transforming growth factor-β(TGF-β). Re-sults Rats subjected to Aβ1-42 injection in bilateral hippocampus led to a ability reduction of learning and memory, a loss of neurons in hippocampus and an increase in the expression of APP, and a decrease in PP2A expression in the hippocampus. In AD hippocampus, The mRNA expressions of the pro-inflammatory mediator, IL-1β, TNF-αand IFN-γ, were significant-ly up-regulated, but the expressions of the anti-inflammatory cytokines, IL-4, IL-10 and TGF-β, were markedly down-reg-ulated in AD group compared with those of control and PBS groups. Conclusion The pro-inflammatory/anti-inflammatory imbalance induced neuro-inflammation in AD rats, which was involved in pathogenesis of AD.

Objective To investigate the influencing factors related to the complications of esophageal foreign body in children. Methods Data of 150 children with esophageal foreign bodies admitted to Xi'an Children' s Hospital from January 2012 to June 2015 were included in the retrospective analysis. Related clinical variables ( gender, age, location, time, size, sharpness, quality, and severity of complications) were statistically analyzed. Results Spearman correlation analysis showed that the age of children was negatively correlated with esophageal foreign body complications (r=-0. 187, P=0. 022), incarceration time ( r=0. 456, P<0. 001) , sharpness ( r=0. 384, P<0. 001) and quality ( r=0. 234, P=0. 004) was positively correlated with the incidence of complications. Non?conditional Logistic regression analysis for polytomous ordinal response showed that incarceration longer than 8 h yielded complication risks 9. 507 times as much as that less than 8 h ( 95%CI:2. 982?30. 309) . Obtuse or sharp foreign body yielded risk 142. 751 times as smooth foreign body did (95%CI:13. 736?1483. 562). Conclusion Incidence and severity of complications of esophageal foreign body in children are closely related to the age of the children, incarceration time and the degree of sharpness. For patients of less than 1 year old, incarceration for more than 8 hours, with an obtuse or sharp foreign body, early diagnosis and treatment is essential.

Objective To study the effects of localized thermochemotherapy on angiogenesis and the expression of VEGF protein of C6 gliomas in rats,and explore the mechanisms of angiogenesis inhibition by localized thermochemotherapy. Methods Following the establishment of animal models, 40 rats harboring the C6 gliomas were randomly allocated to 4 groups,the rats in the fore 3 groups were treated by localized thermochemotherapy, hyperthermia and chemotherapy, respectively, the remaining group served as control. The expression of VEGF and FⅧ RA protein were detected by S P immunohistochemistry. The vascular structure in rat's glioma was observed by immunohistochemistry and electron microscopy technique. Results As compared with the control group, the expression of VEGF protein was decreased in the hyperthermia and chemotherapy groups,as well as in the thermochemotherapy group.The expression of VEGF was positively correlated with the microvessel density in the tumor ( r =0.9798, P

Objective To observe the effect of Qi-strengthening and blood-activating Chinese patent medicine Qigui Ershen Granules on the carotid intima-media thickness(IMT ) , atheromatous plaque scores, serum fibroblast growth factor 23 (FGF23) and Klotho protein levels, and oxidation- and inflammation-associated indicators in carotid atherosclerosis patients. Methods Fifty-two carotid atherosclerosis patients were randomized into Chinese medicine group and western medicine group, 26 cases in each group. Chinese medicine group was treated with Qigui Ershen Granules orally, and western medicine group was treated with Atorvastatin Calcium Tablets orally. The mediation for the two groups lasted for 24 continuous weeks. Carotid ultrasonography was performed before and after treatment for the examination of carotid IMT and plaque Crouse scores. Double antibody sandwich enzyme-linked immunosorbent assay(ELISA) was applied for the detection of serum Klotho, FGF23, interleukin 1(IL-1) and tumor necrosis factorα(TNF-α) levels, and radio-immuno-precitation method was used for the assay of serum reactive oxygen species (ROS), malondialdehyde (MDA) and superoxide dismutase (SOD) levels. The clinical efficacy of the two groups was evaluated by the scores of Qi deficiency syndrome and blood stasis syndrome before and after treatment. Results (1) In western medicine group, 5 cases dropped out and were excluded, and a total of 21 cases completed the trial; in Chinese medicine group, 3 cases dropped out and were excluded, and a total of 23 cases completed the trial.(2) After treatment for 24 continuous weeks, IMT and Crouse scores of the plaque in the two groups were obviously reduced(P < 0.01 compared with those before treatment) , but the differences of IMT and the scores between the two groups were insignificant after treatment(P > 0.05). (3) Serum Klotho protein level was increased while FGF23 was decreased in Chinese medicine group after treatment (P < 0.01 compared with those before treatment); no obvious changes of serum Klotho protein and FGF23 levels were found in western medicine group before and after treatment(P > 0.05). The effects of Chinese medicine on increasing Klotho protein level and decreasing FGF23 level were superior to those of western medicine (P<0.01). (4) After treatment, serum IL-1, TNF-α, ROS and MDA levels were decreased and serum SOD level was increased in the two groups (P < 0.01 compared with those before treatment). The differences of the above indexes were insignificant between the two groups after treatment(P > 0.05).(5) The scores of Qi deficiency syndrome and blood stasis syndrome in Chinese medicine were decreased after treatment (P < 0.01), but showed no significant changes in western medicine group (P > 0.05). Chinese medicine group had better effect on improving the scores of Qi deficiency syndrome and blood stasis syndrome than western medicine group(P < 0.01).(6) After treatment, the total effective rate for improving Qi deficiency syndrome and blood stasis syndrome in Chinese medicine group was 82.61%, 78.26%, and that in western medicine group was 28.57%, 14.28%respectively, the difference being significant (P<0.01). Conclusion Qi-strengthening and blood-activating Qigui Ershen Granules have certain effects on counteracting atherosclerosis, inflammatory aging and oxidation.

Objective:To investigate the effect of IL-7 on differentiation of thymic T lymphocytes and dendritic cells' differentiation in vitro.Methods:Thymic lobes were apspectically removed from 15-day-old or 16-day-old mouse fetueses and were cultured by the way of fetal thymus organ cultures (FTOC) in vitro.Lobes were cultured in the dishes with or without Interleukin-7(IL-7),then collected the cultured cells respectively.The expression of CD4,CD8,CD11c,B220,Ia,and CD11b was detected by flow cytometry,and the morphology was observed under the ligt microscope.The proliferation of these cells was determined by cell counting.The cultured cells were used as stimulators for allogeneic T cells,whose proliferation were detected later by MTT method.Results:The result of cell counting indicated that the total amount of the thymocytes was decresed obviously after being cultured with IL-7,while the proportion of CD4~+ CD8~+ thymocytes decreased,the proportion of CD4~- CD8~-,and CD4~- CD8~+ thymocytes increased,and no much difference in the amount of CD4~+ CD8~- thymocytes was found.In addition,the amount of B lymphocytes,natural killer cells,and dendritic cells increased in different degree.Conclusion:IL-7 participates in differentiation and development of thymic T lymphocytes and dendritic cells.

Objective To investigate the effect of simvastatin on heme oxygenase (HO) -1expression and ventricular remodeling in rats with non-ischemic heart failure. Methods Seventy eight male Wistar rats were randomized into three groups: normal control group (n = 18), model group and simvastatin group (n= 60). Male Wistar rats in model and simvastatin group were given adrimycin(ADR) in an accumulated dose of 15 mg/kg for two weeks (2.5 mg /kg, peritoneal injection, three times per week), and 8 rats were dead. The survival rats (n= 52) were then randomly divided into two groups: model group (n=26) and simvastatin group (n=26), and 6 rats were dead in model group, while 7 dead in simvastatin group at the end of the study. Then rats in simvastatin treatment group(n=19)were given simvastatin 20 mg·kg-1·d-1 by gavage for four weeks,and rats in model group (n=20) and in control group (n=18) were treated with 5% glucose by gavage.At the forth week, another 9 rats were selected into the study and given ADR with an accumulated dose of 15 mg/kg for two weeks. The hemodynamics, mRNA expression of HO-1 in myocardium, left ventricular function as well as hydroxyproline were measured at the end of the sixth week. Results At the sixth week, compared with control group, systolic (+) and diastolic (-) function of the left ventricule (±LVdp/dtmax) of rats in model group and simvastatin group were reduced significantly, and the reduction amplitudes of + LVdp/dtmax and -LVdp/dtmax were 28.2%, 11.9% and 33.0%,27.9%,4, respectively (F = 4.899,3. 890, all P<0.01). The + LVdp/dtmax of rats in simvastatin group was higher than that in model group (F= 2.461, P<0.05). The content of myocardium hydroxyproline was elevated from the end of the second week [(485.0±52.9)g/kg vs. (364.0±41.6)g/kg,F=0.441 ,P<0.01]. At the end of the sixth week, the content of myocardium hydroxyproline of model group elevated continuously [(572.9±75.4) g/kg vs. (485.0±52.9)g/kg, F=0.654,P<0.05], but not for simvastatin group [(475.9±86.5) g/kg vs. (485.0±52.9)g/kg, P>0.05]. The mRNA expression of HO-1 in myocardium 'in model group was higher than that in control group [(0.6217±0.1229) vs. (0.2475±0.1053), F = 0.128, P < 0.01]. The mRNA expression of myocardium HO-1 was increased further by simvastatin treatment [(0.7860±0.1133) vs. (0.6217±0.1229),F=3.622,P<0.05]. Conclusions Compared with control group, the myocardial HO-1expression of heart failure rats is increased. Simvastatin treatment enhances the myocardium HO-1 expression further and alleviates myocardial injury and the degree of heart failure.