Objective To identify the possible risk factors for esophageal delayed bleeding after endoscopic submucosal dissection ( ESD ) of early esophageal carcinoma and precancerous lesions. Methods Data of 281 patients with early esophageal carcinoma and precancerous lesions treated by ESD were reviewed. Risk factors for esophageal delayed bleeding were investigated by univariate analysis and logistic multivariable regression analysis. Results Esophageal delayed bleeding occurred in 22 patients ( 7. 83%) . Univariate analysis showed there was significant difference between delayed bleeding group and non?delayed bleeding group in regard of age ( P=0. 046 ) , lesion size ( P=0. 013 ) , and lesion infiltration depth( P<0. 001 ) . Together with three factors above, the intraoperative bleeding ( P=0. 068 ) was also analyzed by Logistic multivariable regression analysis which showed only infiltration depth was the independent risk factor of early esophageal carcinoma and precancerous lesions treated by ESD( P=0. 002, OR=6. 88,95%CI:1. 07?39. 28) . Conclusion Patients older than 60 years and diameters more than 3 cm might be prone to delayed bleeding, but the direct factor is infiltration depth. The deeper lesions infiltrate, the delayed bleeding is more likely to occur.

Observe under endoscope the effect s of raising effective rate on the treatment of duodenal bulbar ulcers by the addition of epidermal growth factor. The control group , 1 08 cases , was randomized from 234 cases of active duodenal bulbar ulcer. Oral omeprazole , 20 mg , in the murning , and amoxil , 0. 5g , t. i. d. were administered for 4 weeks. The treatment group , 1 26 cases , in addition to the above mentioned 2 drugs , epidermal growth factor , 20 ml ( 40?g) , was added orally each morning for 4 weeks , followed by en- doscopy. The therapeutic effect of treatment group was better than that of the control with very significant difference. The effective rate of control group was 84 . 26% , and that of the treatment group , 96. 03% , X~2 = 9. 82 ,P

ObjectiveTo evaluate the Fuji intelligent chromo endoscopy (FICE) in the diagnosis of Barrett esophagus (BE).MethodsFrom September 2010 to March 2011,a total of 180 patients with suspected reflux esophagitis were examined successively by FICE,magnifying FICE,acetic dyeing endoscopy and magnifying acetic dyeing endoscopy.The diagnosis was made out under the observation of lesion extensions,superficial mucosa contrast ratio,pit patterns and capillary forms of BE.The endoscopic diagnosis was made and compared with the pathologic diagnosis,and the consistency of the diagnosis was evaluated by Kappa value.ResultsBE was confirmed in 35 patients ( 19.4％ ) pathologically.The consistency rates of diagnosis under FICE and acetic dyeing endoscopy were 81.7％ and 72.8％ ( P ＜ 0.05 ).The consistency rates of diagnosis under magnifying FICE and magnifying acetic dyeing endoscopy were 97.8％ and 85.6％,respectively (P ＜ 0.05).FICE magnifying endoscopy revealed better mucosal structures of capillaries than magnifying acetic dyeing endoscopy did ( P ＜ 0.05 ),but there was no significant difference in revealing of duct openings (P ＞ 0.05).The specificity,sensitivity,positive predictive value,negative predictive value and Kappa value of FICE in diagnosis of BE were 82.1％,80.0％,51.9％,94.4％ and 0.52,respectively,which were 73.2％,71.4％,39.1％,91.4％ and 0.34 of acetic dyeing endoscopy,98.6％,94.3％,94.3％,98.6％ and 0.93 of magnifying FICE,and 88.3％,74.3％,60.5％,93.4％ and 0.58 for magnifying acetic dyeing endoscopy.ConclusionAs a neotypical endoscopic system,magnifying FICE could exhibit clearly the pit patterns and microvascular structures of esophagus mucosa,and it can capture the optimal images of Barrett's epithelium.FICE could improve the diagnosis of BE in vivo.

OBJECTIVE:To provide scientic basis for clinical use of hormone.METHODS:The influence of methylpred?nisolone injection(MP)on levels of serum potassium,sodium,calcium,blood sugar,blood pressure,blood lipid,and protein was observed.RESULTS:MP had the most obvious influence on serum calcium and protein,while it had the least influence on triglyceride.Along with the increases of dosage of drug and patient’s age,the changes of biochemical indices induced by MP w_ ere more obvious.The changes of serum sodium and blood pressure were greater in male patients under age40in comparison with those in females.Supplement of potassium,calcium and protein could postpone the influence of drug on serum calcium and protein but could not reduce the incidence rates.CONCLUSION:The use of hormone should adhere to individualized principle and adopt the minimum dosage with expected therapeutic efficacy to reduce the occurrence of adverse reactions.

Objective To investigate the inhibitory effect of silencing survivin gene with siRNA on the growth of gastric cancer cells and its mechanism,and provide evidence in treatment for gastric cancer.Methods DNA template coding survivinspecific siRNA was designed and synthesized.Two recombinant plasmids (pGCsilencerU6/GFP/survivin-siRNA-1 and-2) were constructed.The gastric carcinoma cel1 line SGC-7901 were divided into three groups: liposome-treated control group,empty plasmid-transfected control group and survivin-siRNA-1 transfected group.In order to observe the effect of survivin-siRNA,the expressions of survivin mRNA and protein were detected by RT-PCR and Western blotting,respectively.Methyl thiazolyl tetrazolium(MTT) assay was applied to determine the cell growth status.Apoptotic rates were evaluated by flow cytometry(FCM).Results The results of Western blotting and RT-PCR indicated that the inhibitory rates of protein and mRNA in pGCsilenerU6/GFP/survivin-siRNA-1 transfected group(78.25% and 88.75%) were higher than those in liposome-treated control group(5% and 2%) and empty plasmid-transfected control group(1% and 6%)(P

OBJECTIVE To find out the actual situations of antibiotics utilization in Respiratory Department of our hospital and provide feedback of improper applications to the clinic,so as to promote proper utilization of antibiotics.METHODS To take samples from clinical cases of 141 samples in Oct to Nov 2006 and fill the forms of the basic information and investigation items of General Hospital of Chinese People′s Armed Police Forces,the cases were finally sorted and summarized with Excel.RESULTS The antibiotics utilization ratio was 96.5%,their combination usage accounted for 70.2%,the etiology detection rate was 61.7%,the improper usage accounted for 34.8%.CONCLUSIONS The situation of antibiotics utilization in our hospital has changed a lot.Hospitals should define regulations and reinforce the management according to The Principle Guidelines of Antibiotics Utilization and actual situations.

Objective To evaluate the flexible spectral imaging color enhancement (FICE) system in the diagnosis of early esophageal carcinoma and precancerous lesions.Methods A total of 257 patients with suspicious esophageal lesions were examined successively by FICE,magnifying FICE,iodine dyeing endoscopy and magnifying iodine dyeing endoscopy.Findings were compared with the pathologic diagnosis.Results The positive rates of early esophageal carcinoma by FICE (92.6％,25/27) and iodine dyeing endoscopy (88.9％,24/27) were not significantly different (P =0.642),nor were those of magnifying FICE (96.3％,26/27) and magnifying iodine dyeing endoscopy (92.6％,25/27),(P =0.556).The magnifying FICE could reveal the IPCL of early esophageal carcinoma clearly.Early esophageal carcinoma and advanced neoplasia were mainly type Ⅳ + Ⅴ,low-level neoplasia and esophagitis were type Ⅱ + Ⅲ,and normal esophagus was type Ⅰ.However,the magnifying iodine dyeing endoscopy was not able to reveal IPCL.There was no adverse reaction in FICE,but the adverse reaction rate was 12.8％ (33/257) in iodine dyeing endoscopy.Conclusion Magnifying FICE can accurately determine the pathological types of early esophageal carcinoma,which is an effective complement to iodine dyeing endoscopy.

Objective To investigate the expression and clinicopathological features of matrix metalloproteinase 17 (MMP17) in gastric cancer.Methods The expressions of MMP17 at protein and mRNA level in 42 gastric carcinoma surgical specimens,42 endoscopic biopsy specimens of normal gastric tissue and 40 endoscopic biopsy specimens of atrophic gastritis were detected by immunohistoehemistry and reverse transcriptase-polymerase chain reaction (RT-PCR) respectively.Their relations with gastric clinicopathological features were analyzed.Chi square test,t-test and one-way ANOVA analysis were performed for comparing the differences between groups.Results There was no statistically significant difference(P＞0.05) in the expression rate of MMP17 between 42 specimens of normal gastric tissue(7.1％,3/42) and 40 specimens of atrophic gastritis (10.0％,4/40),however both were significantly lower than that of gastric carcinoma (73.8％,31/42,x2 =38.74,34.10,both P＜0.05).The expression quantity of MMP17 at mRNA level of 42 specimens of normal gastric tissue and 40 specimens of atrophic gastritis was 0.226 ± 0.032 and 0.254 ± 0.074 respectively,there was no significant difference(P＞0.05),however both were lower than that of gastric carcinoma (0.476±0.043,t=8.079 and 4.493,both P＜0.05).The expressions of MMP17 at protein and mRNA level were related to depths of invasion,lymph node metastasis and serous membrane involvement in gastric carcinoma patients (x2 =5.300,5.054,4.438,t =2.437,2.372,2.203,all P＜0.05),but not correlated with age,gender,lesion length,lesion site and histological grade (all P＞0.05).The positive rate of MMP17 expression in patients with survival time less than 2 years was significantly higher than that in patients with survival time over two years (x2 =12.71,P＜0.05).Conclusions In gastric carcinoma tissues,the expression of MMP17 increased along with the progression of gastric carcinoma.The detection of MMP17 may have some clinical reference value in determining the prognosis of gastric cancer patients.

Objective To evaluate the flexible spectral imaging color enhancement (FICE) system for determine the margin of early gastric cancer and precancerous lesions.Methods From February 2008 to October 2011,a total of 51 patients with early gastric cancer or high-grade intraepithelial neoplasm who received ESD were enrolled and randomly divided into experimental group to determine lesion margin by FICE (n =26) and control group to identify lesion margin by indigo carmine (n =25).Histological complete resection rate (the lateral and vertical margins were free of cancer),operation time,complications,post-ESD ulcer-healing rates and local recurrence were assessed.Results The histological complete resection rate,acute minor bleeding rate and post-ESD abdominal pain rate in experimental group were 2.3％ (24/26),88.5％ (23/26),15.4％ (4/26) and 73.1％ (19/26),which were not significantly different from those of control group,i.e.,92.0％ (23/25),84.0％ (21/25),12.0％ (3/25)and 72.0％ (18/25) (P＞0.05).The mean operation time of in experimental group was shorter than that of control group (P ＜ 0.05).No massive bleeding,delayed bleeding or perforation occurred in either group.Follow-up showed no local residue or recurrence.Conclusion FICE is safe and effective to determine the tumor demarcation of early gastric cancer and high-grade intraepithelial neoplasm,and needs less operation time.

Objective To observe the impact of diabetes and stress hyperglycemia on thrombolytic effect and short-term prognosis in patients with acute cerebral infarction. Methods A total of 127 patients with acute cerebral infarction (≤4. 5 h) who received thrombolytic therapy with alteplase at General Hospital of Beijing Military Command from January 2012 to August 2013 were enrolled retrospectively. They were divided into three groups:Diabetes group (n=35),stress hyperglycemia group (n=49),and normal glucose group (n=43) according to whether they had a history of diabetes,random glucose on admission, and oral glucose tolerance test at day 7. At 24 h after thrombolysis,the National Institute of Health Stroke Scale (NIHSS) scores,recanalization rate,and the modified Rankin Scale (mRS) scores at day 90 were compared between the 2 groups. Results Before thrombolysis,the NIHSS scores of the diabetic group, stress hyperglycemia group,and normal glucose group were 14. 2 ± 5. 1,12. 8 ± 5. 6,and 13. 0 ± 4. 6,respectively (P>0.05);at 24 h after thrombolysis,they were 14.7 ±6.0,11.9 ±4.9,and 8.0 ±2.9,respectively (P<0.05);compared with before thrombolysis,the NIHSS scores of the diabetes group and the stress hyperglycemia group had no significant change (P>0. 05);the NIHSS score of the normal glucose group was lower than before thrombolysis. There was significant difference (P <0. 05). After thrombolysis,the patients with good recanalization were 54. 3% (n=19),57. 1% (n=28),and 67. 4% (n=29),respectively in the three groups;the hemorrhagic conversion rate was 14. 3% (n=5),6. 1% (n=3),and 2. 3% (n=1),respectively. There were no significant differences. At day 90 after thrombolysis,the mRS scores in the 3 groups showed that the good prognosis rate of the normal glucose group was 72. 1% (n=31);it was significantly higher than 51. 0% (n=25) of the stress hyperglycemia group and 29. 6% (n=10) of the diabetes group. There were significant differences (P<0. 05,P<0. 01). There was also significant difference between the stress hyperglycemia group and the diabetes group. Conclusion Diabetes and stress hyperglycemia have varying degrees of adverse effects on the efficacy and prognosis of the thrombolytic therapy for acute cerebral infarction.