Objective To investigate the efficacy of esomeprazole (Esomeprazole) and flupentixol and melitracen (Deanxit) in treatment of non-erosive gastroesophageal reflux disease (NERD) with depression and anxiety.Methods The diagnosis of NERD was based on the results of esorneprazole scale (reflux diagnostic ques- tionnaires,RDQ) and endoscopy,the degree and frequency of symptoms were graded and scored.Hamilton de- pression scale was used to evaluate depression and anxiety status.Sixty-three patients were randomly divided into group A (esomeprazole 20 mg qd),B (Deanxit 1 tab qd),C (esomeprazole 20 mg qd and Deanxit 1 tab qd) with each group 21 patients,and treated for four weeks.The efficacy was evaluated by the symptom scores.Results There were some effects of esomeprazole or Deanxit alone on the improvement of symptoms of NERD.Although the effect of Deanxit was not as good as esomeprazole,there was not difference for relieving heartburn and sub- sternal pain between two groups in time point of each week after treatment (P＞0.05).esomeprazole was better for relieving acid regurgitation than Deanxit (P＜0.01).Combined treatment of esomeprazole with Deanxit was better and faster for relieving the symptoms of NERD than esomeprazole or Deanxit alone (relieving rate 81% in group C,23.8% in group A and 14.3% in group B,P＜0.01).The total efficacy rate of group C (100%) was higher than that of group A (80.9%) or group B (61.9%,P＜0.01),but there were not difference of relieving rate and total efficacy rate between group A and B (P＞0.05).Conclusions There was better efficacy of com- bined treatment of esomeprazole and low-dose Deanxit in treating NERD with depression and anxiety.These re- sults suggest that depression and anxiety have some effects on the pathogenesis and progress of NERD.

Objective:Mutations in epidermal growth factor receptor (EGFR) can predict tumor response to tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC). However, not all cases of NSCLC with EGFR mutations can respond well;thus, discovering the heterogeneity of NSCLC at the molecular level is necessary. This study aimed to determine the discrepancy in EGFR mutations in primary tumors, N2 lymph nodes, and plasma samples. Methods:Primary tumors, N2 lymph nodes, and plasma samples obtained from 49 patients with stageⅢA-N2 NSCLC were analyzed for EGFR mutations in exons 19 and 21 by using mutant-enriched liquidchip technology. Results:In 49 patients, we detected 18 (36.7%) EGFR mutations in primary tumors, 11 (22.4%) mutations in N2 lymph nodes, and 2 (4.1%) mutations in plasma samples. Eleven (22.4%) cases showed discordance in EGFR mutations between primary tu-mors and N2 lymph nodes. In nine cases, EGFR mutations were detected only in primary tumors, whereas EGFR mutations were de-tected only in N2 lymph nodes in two cases. In addition, EGFR mutations were detected in the plasma samples of two patients, who al-so carry mutations in their primary tumors. Conclusion:A considerable proportion of NSCLC cases showed discrepancy in EGFR muta-tions between primary tumors and N2 lymph nodes. In addition, the detection rate of EGFR mutations was lower in plasma samples obtained from patients with stage IIIA-N2 NSCLC. All of the results indicated tumor heterogeneity at the molecular level during metas-tasis, and this heterogeneity may have implications during treatment with TKIs.

Objective To summarize the experience in the diagnosis and treatment of intraductal papillary mucinous neoplasms (IPMN) of the pancreas.Methods The clinical data of 16 cases of intraductal papillary mucinous neoplasms of the pancreas in the First Affiliated Hospital of China Medical University from January,2000 to October,2013 was retrospectively analyzed.Results There were 9 males and 7 females,age ranging from 37 to 61 years (average 49 years).The common complaint was epigastric pain.Ultrasonography and CT scan found solid lesions in all cases,main pancreatic duct dilatation was found in 10 cases.All the cases received surgical resection of the tumor.Pathology showed adenomas in 14 cases,borderline tumors in one,and adenocarcinoma in one.14 patients were followed-up ranging from 5 to 48 months,all were alive without recurrence and metastasis.Conclusions IPMT is a special type of pancreatic tumor.Surgical resection is the most effective treatment with excellent prognosis.

Objective To approach the evaluative effect of respiratory variation of superior vena cava peak flow velocity measured using transthoracic echocardiography (TTE) on fluid responsiveness in patients with mechanical ventilation.Methods A prospective cohort study was conducted.All mechanical ventilated critically ill patients whose fluid therapy was planned due to hypovolemia in Department of Critical Care Medicine of Beijing Tongren Hospital of Capital Medical University from April 2011 to April 2013 were enrolled.Volume expansion was performed with 500 mL Linger solution within 30 minutes.Patients were classified as responders if pulse pressure variation (PPV) increased ≥ 13％ before volume expansion.The respiratory variation in superior vena cava peak velocity was calculated as the difference between maximum and minimum values of velocity in peak A,peak S and peak D over a single respiratory circle,and their variations (ΔA,ΔS,ΔD) were also calculated.The receiver operating characteristic curve (ROC curve) was plotted to assess the evaluative effect of respiratory variation of superior vena cava peak velocity on fluid responsiveness.Results Twenty-seven patients were enrolled in this study.Volume expansion increased PPV ≥ 13％ happened in 14 patients (responders).The velocity of superior vena cava in peak A,peak S,peak D was significantly increased after volume expansion compared with that before volume expansion in responders [peak A (cm/s):34.6 ± 2.2 vs.31.3 ±2.1,t=-2.493,P=0.027; peak S (cm/s):39.1 ± 1.3 vs.35.3 ±2.1,t=-2.564,P=0.024; peak D (cm/s):28.1 ± 1.2 vs.23.3 ± 1.4,t=-4.995,P=0.000],but there was no significant difference in ΔA,ΔS and ΔD between before and after volume expansion.The ΔA,ΔS and ΔD were positively correlated with PPV (r＝0.040,P=0.854; r=0.350,P=0.074; r=0.749,P=0.000).The area under ROC curve (AUC) of peak S was 0.36 [95％ confidence interval (95％CI):0.11-0.52],but the AUC of ΔS was 0.68 (95％CI 0.47-0.89),the AUC of peak D was 0.41 (95％CI 0.19-0.63),but the AUC of ΔD was 0.95 (95％CI 0.86-1.00),so the aberration rate of superior vena cava in respiration was better than the flow rate in superior vena cava.When the cut-off value of ΔS was 20.7％ for predicting fluid responsiveness,the sensitivity was 78.6％ and the specificity was 61.5％.When the cut-off value of ΔD was 12.7％ for predicting fluid responsiveness,the sensitivity was 92.0％ and the specificity was 92.3％.Conclusion Respiratory variations in superior vena cava peak velocity measured by TTE could assess fluid responsiveness in patients with mechanical ventilation.

Objective To explore the diagnosis and treatment of bronchogenic cyst in the abdomen.Methods Clinical data of 7 cases with abdominal bronchogenic cyst in the First Affiliated Hospital of China Medical University from October 2001 to February 2016 were retrospectively analyzed.Results Of the 7 patients,5 were male and 2 were female aging from 36 to 50 years with a median age of 37 years.Two cases were complaining for upper abdominal pain,5 cases were asymptomatic.Ultrasonography revealed hypoechoic or anechoic mass.Color doppler flow imaging showed no blood flow.Contrast-enhanced CT scans showed no obvious enhancement in 6 out of 7 cases,all patients underwent cystectomy successfully.Cysts were of unilocular in 6 cases and multilocular in one.Bronchogenic cysts were diagnosed by pathology in all 7 cases.Six patients were followed up from 1 month to 6 years with no recurrence.Conclusions Abdominal bronchogenic cyst is benign and postoperative prognosis is very good.

Objective To compare the pre-and post-operative tumor target volume and to examine the consistency in physical dosimetric parameters of organs at risk (OAR) following 3D-printed coplanar template (3D-PCT)-assisted and CT-guided radioactive seed implantation.Methods The 3D-printed coplanar template was designed using a computer software, and the coordinate system was established where the center was used as the basis for setting the x axis and y axis.Crosses defining the center of treatment were drawn on the patient''s body and matched with the corresponding central point, x axis, and y axis of the coplanar template.3D-PCT-assisted and CT-guided radioactive seed implantation was performed based on the pre-operative plan, and the pre-operative, operative, and post-operative plans were designed to evaluate the target tumor volume and the normal dose received by the tissues.In addition, dosimetric parameters, including D90(minimum dose received by 90% of the gross target volume), V100, V150, V200(percentage of GTV that received 100%, 150%, and 200% of the prescribed dose, respectively), minimum peripheral dose (MPD), conformal index (CI), external index (EI), and homogeneity index (HI) in the pre-operative and post-operative plans were also assessed and compared using the Wilcoxon test. Results Fourteen patients treated in our institution from August to October, 2016 were included in this study. The median age of the patients was 61.5 years, and the median Karnofsky Performance Scale score was 80. A total of 14 lesions from the 14 patients were treated by seed implantation in the neck (n=4), chest (n=3), abdomen (n=5), and pelvis (n=2). Of the 14 patients that underwent implantation, 8 had previously received radiation therapy, and 6 had not received radiation therapy. Dosage optimization was performed for all patients during the operation. The median activity of the implanted seeds was 0.625 mCi (0.55-0.75 mCi,1 Ci=3.7×1010 Bq), and the preoperatively planned median number of needling and implanted seeds were 9(4-34) and 45.5(10-162), respectively. However, the actual median number of needling and implanted seeds were 9.5(4-34) and 45.5(10-162), respectively. Dosimetric analysis showed that there were no significant changes in tumor volume (P=0.135), D90(P=0.208), MPD (P=0.104), V100(P=0.542), V150(P=0.754), V200(P=0.583), CI (P=0.426), EI (P=0.326), and HI (P=0.952) after implantation. Conclusions 3D-PCT guidance and dosage optimization can result in good consistency between pre-and post-operative plans for radioactive seed implantation. 3D-PCT is a convenient and cheap technique suitable for large-scale clinical application.

OBJECTIVETo determine the content of notoginsenoside R1 and ginsenoside Rg1 in Rupixiao tablet by reverse-phase high performance liquid chromatography.

METHODA Kromacil C18 column was used with a mixture of acetonitrile and 0.05% phosphoric acid solution (20:80) as the mobile phase at a flow rate of 1.2 mL x min(-1) with the detection wavelength at 203 nm.

RESULTThe measurement proved to be linear over the range of 0.941-9.41 g for notoginsenoside R1 and 1.04-10.4 g for ginsenoside Rg1. The average recovery of this method was 97.3% and 97.9% respectively.

CONCLUSIONThe method was simple, reliable, and accurate and can be used for the quality control of this preparation.

Chromatography, High Pressure Liquid ; methods ; Drug Combinations ; Drugs, Chinese Herbal ; chemistry ; isolation & purification ; Ginsenosides ; analysis ; Panax ; chemistry ; Plants, Medicinal ; chemistry ; Quality Control ; Reproducibility of Results

Objective To investigate the relevance ratio of abnormal electrocardiogram (ECG) and describe the abnormal ECG index among the residents in Keshan disease (KD) area.To assess the KD illness severity and provide comparable quantitative indicators,provide the scientific basis for elimination of KD.Methods Non probability sampling method was used,and monitoring stations with the highest incidence of KD at the county level were selected in 2012.Clinical examination and 12 lead ECG was carried out.According to The KD Diagnosis Standard (WS/T 210-2011),eight common changes in ECG of KD were scored.According to age and sex group,check the abnormal rate of ECG detection of Keshan disease,while analysed the changes of abnormal ECG index score in latent KD patients and chronic KD patients.Abnormal ECG index to determine:If there was one change,the score was 1 and the abnormal ECG index was 1.And so on,the highest score was 8.Results Totally 61 831 residents were surveyed and 9 634 were found with abnormal ECG,and the relevance ratio of abnormal ECG was 15.58％;totally 3 862 residents had eight ECG changes of KD and the relevance ratio was 6.25％;totally 508 residents were diagnosed with KD and the relevance ratio was 0.82％.The relevance ratio of abnormal ECG among all age groups was statistically different (x2 =3 065.64,P ＜ 0.05).The relevance ratio of abnormal ECG in women was higher than that of men [3.91％ (2 419/61 831) vs 2.33％ (1 443/61 831),x2 =86.30,P＜ 0.05].Abnormal ECG index score was (1.06 ± 0.25) which was not statistically different between gender [men:(1.07 ± 0.27) vs women:(1.06 ± 0.24),t =1.41,P ＞ 0.05].The abnormal ECG index score in latent KD patients was lower than that of chronic KD patients [(1.09 ± 0.30) vs (1.60 ± 0.69),t =-4.87,P ＜ 0.05].In eight ECG changes,the most check out items were T wave and/or ST segment changes (2 816).Conclusions The relevance ratio of abnormal ECG in KD area is at a higher level.The abnormal ECG index can be used to assess the KD illness severity and provide comparable quantitative indicators,in order to provide a new train of thought for the evaluation of KD elimination.

Objective To investigated the efficacy and toxic effects of combined chemotherapy of vinorelbine plus cisplatin or carboplatin in patients aged ≥ 70 years and with non-small cell lung cancer (NSCLC).Methods One hundred patients with lung cancer aged ≥70 years were enrolled in the study.Fifty patients in chemotherapy group were assigned to receive vinorelbine 25 mg/m2 at the first day and the fifth day plus cisplatin 60-70 mg/m2 or carboplatin 250 mg/m2 at the second day.All treatments were repeated every 3 or 4 weeks.Another fifty patients aged ≥ 70 years were taken as control group, not receiving treatment.The primary endpoint was survival.Results Forty-five patients were evaluable for response and the partial remission rate was 35.6% (16/45).One year survival rate was 37.8% and median survival time was 9.75 months in chemotherapy group.The median survival time was 4.0 months for patients in control group.All 50 patients in chemotherapy group were evaluable for toxic side effects.WHO grade Ⅲ incidences of leucopoenia, neutropenia and anemia were 38.0%, 52.0% and 2.2%, respectively.Grade IV incidence of neutropenia was 35.5%.WHO grade Ⅲ incidences of fatigue, constipation and vomit were 22.0%, 8.0% and 14.8%,respectively.Five patients failed to complete the treatment due to side effects.Conclusions Combined chemotherapy of vinorelbine plus platinum drugs is effective and tolerated in patients aged over 70 years with advanced NSCLC.Even patients with stable clinical effects shows benefit of survival time.

Objective To evaluate the feasibility of assessing osteoarthritis (OA) in hip dysplasia using 3D delayed gadolinium-enhanced MRI of cartilage (dGEMRIC).Methods Thirty-five hips in 20 patients with radiographic evidence of hip dysplasia underwent 3D-dGEMRIC scanning.Clinical symptoms were assessed with the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) questionnaire.Radiographic measurement of lateral center-edge angle and T(o)nnis grading were performed on the X-rays.Hips of T(o)nnis grade 1were included in the group of hips with early OA,while the hips with no evidence of OA and without pain symptom were included in the group of hips with normal morphology.The 3D-dGEMRC scans were completed on a 1.5 T MR scanner.The data of 3D-dGEMRIC was reconstructed radically.The dGEMRIC indices were measured on six sites of periphery zones of hip cartilage on reconstructed images.The dGEMRIC indices among different groups were analyzed by non-parametric tests.The differences of dGEMRIC indices among six sites in the group of early OA or the group of normal morphology were analyzed by Wilcoxon test.Results The mean dGEMRIC indices of six sites were lower in group of T(o)nnis grade 1than in group of T(o)nnis grade 0 ( Z =- 2.149,P =0.032 ),and lower in group of T(o)nnis grade 2 than in group of T(o)nnis grade 1( Z =- 1.990,P =0.047 ).The dGEMRIC indices of the anterior site,anterosuperior site,superior-anterior site,and superior site were significantly different between the group of hips with early OA and the group of hips with normal morphology (Z =-2.333--2.041,all of the P values were lower than 0.05).In the group of hips with normal morphology,the dGEMRIC indices of superior-anterior site of hip were lower than superior site(P =0.028).In the group of hips with early OA,the dGEMRIC indices of superior-anterior site were lower than the other sites except for anterior-superior site ( Z =- 3.041- - 2.277,all of the P values were lower than 0.05 ).Conclusions 3 D-dGEMRIC might be a sensitive technique for detection of glycosaminoglycans alteration in early OA and staging of OA in hip dysplasia.Radial reconstruction could provide an accurate assessment of OA,and the results demonstrated that early cartilage alteration could be detected in the anterior to superior sites of hips,and the earliest cartilage alteration may occur in the superior-anterior site of hips.