Objective To explore the relationship between acid pocket and acid reflux in gastroesophageal reflux disease (GERD).Methods From March 2011 to January 2012,29 patients with GERD were enrolled and nine healthy individuals were set as control.All objects of this study accepted esophageal manometry test,acid pocket test,test of the occurrence time of acid pocket and ambulatory 24 hours pH monitoring.The t-test was performed for comparison between two groups.The relationship between the incidence of GERD and acid pocket was analyzed by Logistic regression analysis.Pearson correlation analysis was used for correlation analysis.Results The percentage of acid pocket in GERD group and control group was 58.6％ (17/29) and 5/9,respectively,and the difference was not statistically significantly (P＞0.05).The duration time of acid pocket was (56.3±44.7) minutes in GERD group which was longer than that of control group ((16.0±8.2) minutes) and the difference was statistically significant (t=1.970,P＜0.01).There was no statistical significance in the average pH value of acid pocket between GERD group with acid pocket (2.8 ± 1.3) and that of control group with acid pocket (1.9±0.5,P＞0.05).The duration time of acid pocket was correlated with the longest reflux time in GERD group with acid pocket (r=0.550,P＜0.01).The peak velocity of esophageal motility in GERD group ((3.3±0.6) cm/s) was lower than that of control group ((5.0±4.1) cm/s) and the difference was statistically significant (t=-1.354,P＜0.05).The peak velocity of esophageal motility in GERD group with acid pocket ((3.2±0.6) cm/s) was lower than that of control group with acid pocket ((7.2± 6.3) cm/s) and the difference was statistically significant (t=-2.693,P＜0.05).Conclusions The duration time of acid pocket in GERD is correlated with the time of acid reflux.Esophageal dysmotility may be related with the pathogenesis of GERD and the occurrence of acid pocket.

Objective To investigate the function of acid pocket in reflux esophagitis. Methods The 15 healthy controls and 24 reflux esophagitis patients were identified by reflux disease questionnaire (RDQ) and gastric endoscopy. The location of subjects' lower esophageal sphincter (LES) was determined by 4 channel esophageal manometry system. Then a single-channel pH electrode was positioned 1 cm below the distal border of the LES to monitor fasting pH for half an hour. After a standard meal, the pH was continuously measured for two hours. Then the electrode was moved to 5 cm above the proximal border of the LES to monitor the dynamic pH for 24 h.Results Acid pocket was found in 16 cases of reflux esophagitis patients(66.67%) and 10 cases of healthy individuals (10/15). Acid pocket occurred earlier in reflux esophagitis group than healthy controls [11.00(4.25-17.00) min vs 30.00(15.50-54.25) min, P＜0.05], and the average pH value was lower [1.84(1.59-2. 19) vs 2.32 (1.96-2.71), P＜0.05]. There was no statistic difference in mean pH value of gastroesophageal junction and the duration of acid pocket before the meal.Conclusion There is abnormal acid reflux in reflux esophagitis patients, and acid pocket with earlier occurrence and lower pH value may relevant to esophageal mucosal impairment.

Objective To evaluate the consistency of the test results detected by multiple automated hematology analyzers .Meth-ods The EP9-A2 guideline of NCCLS ,Passing-Bablok regression analysis and t test were adopted to compare the detection results of hemoglobin(HGB) ,hematocrit (HCT) ,red blood cell count(RBC) ,white blood cell count (WBC) and platelet(PLT) in 115 samples from patients by 5 automated haematology analyzers of the Sysmex XE-2100 ,the Sysmex XT-1800i ,the Sysmex XS-1000i , the Mindray BC-5300 and ABX pentra80 .The Sysmex XE-2100 was used as the reference instrument .Results In the detection of all the compared items including HGB ,HCT ,RBC ,WBC and PLT ,these automated hematology analyzers exhibited very good cor-relation(r>0 .97) ,whereas the individual parameters in 3 automated hematology analyzers appeared the proportional systematic differences and /or constant systematic differences ,including HCT in the sysmex XT-1800i ,HCT and RBC in the sysmex XS-1000i and RBC in the ABX pentra 80 .Conclusion The Passing-Bablok regression analysis combined with t test may identify the system-atic differences of the comparative results of 2 automated haematology analyzers ,the consistency of the comparative results of the automated hematology analyzers can not be evaluated by the simple correlation coefficient .

Objective To develop an assay of PCR-produet direct sequencing to detect hepatitis B virus (HBV) YMDD mutation, and compare the results gained by the sequencing and traditional real-time fluorescent PCR assays. Methods Serum samples were collected from 103 patients with chronic hepatitis B. HBV DNA were extracted from sers. YMDD mutation was detected by a commercial real-time PCR assay. Meanwhile, HBV reverse transcriptase-encoding gene was amplified by a nested PCR assay. The PCR products were directly subjected to sequencing at two directions, and the sequencing results were analyzed by NTI program. Using Kappa test, comparison was made between the results of rtM204-site mutations obtained by the direct sequencing and YMDD mutations by the real-time fluorescent PCR. Results The direct sequencing assay proved to be highly effective with bread range of detection in viral load from 500 to 1010copies/ml. And it may simultaneously avoid inhibitory effect caused by high viral load. The coincidence rates between two assays were 100% for YIDD, 97. 1% for YVDD, 76. 2% for YIDD/YVDD coexistence (Kappa = 0. 853, P < 0. 01). Conclusions The direct sequencing assay for HBV drug-resistant mutation detection is highly sensitive with broad dynamic range. It has high coincidence rate with real-time fluorescent PCR assay with advantage of detecting YMDD, YIDD and YVDD mutations simultaneously.

In view of the challenges and opportunities presented in the new century and after rational deliberations on five occasions, the completely new model of "hi tech+humanistic solicitude=the green hospital" was put forward and the overall framework of "one line of thought", "two cornerstones", and "three goals" was carefully formulated. In the meantime, all staff members of the hospital were called on to be involved in the "six major activities". As a result, great changes have taken place in the appearance and development of the hospital. It has been proved through practice that "the green hospital" is a successful model conforming to the trends of the times.

In this study, the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated. From March to August, 2009, 17618 women, from Wufeng area of Hubei province, China, were recruited to screen breast diseases by using breast infrared diagnostic apparatus. Other diagnostic methods, such as B-mode ultrasound, X-ray mammography, needle biopsy and pathological examination were, if necessary, used to further confirm the diagnosis. The screening showed that 5990 of 17618 cases (34.00%) had breast diseases, 5843 (33.16%) had mammary gland hyperplasia, 48 (0.27%) had breast fibroadenoma, 11 (0.06%) had breast carcinoma, and 88 (0.50%) had other breast diseases. The peak morbidity of breast cancer was found in the women aged 50-60 ages. The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8, 0.157%) in comparison with that in the subjects younger than 50 years old (n=3, 0.024%) (u=2.327, P<0.05). It was shown that the occurrence of breast diseases was concentrated in women aged 20-40 years, while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40. Compared with the patients elder than or equal to 40 years old (n=3289, 27.46%), the morbidity rate of breast diseases was significantly increased in women less than 40 years old (2648 cases, 47.18%; P<0.001). However, there was no significant difference in the morbidity of breast diseases between the age group of 20-29 years and that of 30-39 years (P=0.453), and both of them were high. There was no significant association between the morbidity of breast diseases and cervical cancer. Since the morbidity of breast diseases was higher among young women, more attention should be paid to the screening of breast diseases among young women for early diagnosis.

Objective:To investigate the safety of minimally invasive liver resection for resectable hepatocellular carcinoma (HCC) complicated with portal hypertension.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 807 patients with resectable HCC who underwent minimally invasive liver resection in 8 medical centers, including Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine et al, from June 2011 to November 2022 were collected. There were 670 males and 137 females, aged 58(50,66)years. Of the 807 patients, 173 cases with portal hypertension were divided into the portal hypertension group, and 634 cases without portal hypertension were divided into the non-portal hypertension group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and post-operative situations; (3) subgroup analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.001. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was constructed using the non-parameter rank sun test. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 807 patients, 268 cases were successfully matched, including 134 cases in the portal hypertension group and 134 cases in the non-portal hypertension group. The elimination of the tumor diameter and robot-assisted surgery confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. The occlusion time of porta hepatis, cases with intraoperative blood transfusion, cases with postoperative complication, cases with complication >Ⅱ grade of Clavien-Dindo classification, cases of Clavien-Dindo classification as Ⅰ grade, Ⅱ grade, Ⅲ grade, Ⅳ grade, cases with liver related complication were 27.0(15.0,43.0)minutes, 33, 55, 15, 13, 29, 14, 1, 37 in the portal hypertension group, versus 35.0(22.0,60.0)minutes, 17, 25, 5, 14, 9, 4, 1, 13 in the non-portal hypertension group, showing significant differences in the above indicators between the two groups ( Z=-2.15, χ2=6.30, 16.39, 4.38, 20.72, 14.16, P<0.05). (3) Subgroup analysis. Results of subgroups analysis showed that in cases with major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 243.5(174.6,296.3)minutes, 200.0(150.0,600.0)mL, 7.5(6.0,13.0)days in the portal hypertension group, versus 270.0(180.0,314.5)minutes, 200.0 (75.0,450.0)mL, 7.0(5.5,10.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.54, -1.73, -0.92, P>0.05). In cases with non-major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 8.0(5.0,10.0)days in the portal hypertension group, versus 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.5,9.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-1.39, -0.10, 1.05, P>0.05). In cases with anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 210.0(150.0,285.0)minutes, 150.0(50.0,200.0)mL, 8.0(6.0,9.3)days in the portal hypertension group, versus 225.5(146.3,306.8)minutes, 100.0(50.0,250.0)mL, 7.0(6.0,9.0)days in the non-portal hypertension group, showing no significant difference in the above indica-tors between the two groups ( Z=-0.75, -0.26, -0.91, P>0.05). In cases with non-anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 173.5(120.0,231.5)minutes, 175.0(50.0,300.0)mL, 7.0(5.0,11.0)days in the portal hyper-tension group, versus 186.0(123.0,262.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.0,9.5)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.97, -1.12, -0.98, P>0.05). Conclusion:Minimally invasive liver resection or even major liver resection is safe and feasible for screened HCC patients complicated with portal hyper-tension, but attention should be paid to the prevention and treatment of postoperative complications.

A semi-supervised learning method based on multi-scale consistency and regional reliability perception is proposed to combine unlabeled data with a small amount of labeled data to achieve high-performance lung tumor segmentation tasks.A multi-scale consistency mean teacher framework is used to construct a multi-scale consistency loss and constrain the outputs in the mean teacher network to be consistent across multiple scales,so that the model learns richer consistency knowledge.In addition,a regional reliability perception scheme is adopted to make the knowledge exchange between consistency learning more efficient,enabling the model to learn more valid and reliable knowledge from unlabeled data.The evaluation on the lung tumor dataset in the Medical Segmentation Decathlon shows superior performance of the proposed method over current state-of-the-art semi-supervised learning methods,validating its effectiveness.

In this study,the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated.From March to August,2009,17618 women,from Wufeng area of Hubei province,China,were recruited to screen breast diseases by using breast infrared diagnostic apparatus.Other diagnostic methods,such as B-mode ultrasound,X-ray mammography,needle biopsy and pathological examination were,if necessary,used to further confirm the diagnosis.The screening showed that 5990 of 17618 cases (34.00％) had breast diseases,5843 (33.16％) had mammary gland hyperplasia,48 (0.27％) had breast fibroadenoma,ll (0.06％) had breast carcinoma,and 88 (0.50％) had other breast diseases.The peak morbidity of breast cancer was found in the women aged 50-0 ages.The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8,0.157％) in comparison with that in the subjects younger than 50 years old (n=3,0.024％) (u=2.327,P＜0.05).It was shown that the occurrence of breast diseases was concentrated in women aged 20-40 years,while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40.Compared with the patients elder than or equal to 40 years old (n=3289,27.46％),the morbidity rate of breast diseases was significantly increased in women less than 40 years old (2648 cases,47.18％; P＜0.001).However,there was no significant difference in the morbidity of breast diseases between the age group of 20-29 years and that of 30-39 years (P=0.453),and both of them were high.There was no significant association between the morbidity of breast diseases and cervical cancer.Since the morbidity of breast diseases was higher among young women,more attention should be paid to the screening of breast diseases among young women for early diagnosis.

An airway segmentation method based on coordinate information and multi-scale parallel network is proposed to solve the problem of insufficient accuracy of airway model in surgical navigation.Airway features at different scales are learned separately by a parallel network to address the feature conflict arising from airways of different sizes.Then,a coordinate guided up-sampling module is designed to utilize coordinate information from shallow features for guiding reconstruction of deeper features,thus restricting the spatial location of the target and improving the model accuracy.Finally,a channel guided multi-scale feature aggregation module is constructed to capture semantic details across multiple scales and investigate channel relationships between features at different scales.The proposed method and other models are trained and tested on two public datasets,namely LIDC-IDRI and EXACT'09.Experimental results show that the proposed method achieves an average Dice coefficient of 93.20%which is 2.61%higher than 3D U-Net,a false positive rate of only 0.012%,a tree length detection rate of 88.59%,and a branch detection rate of 97.42%,demonstrating that the method can be applied to lung disease diagnosis or navigation bronchoscopy.