Objective To evaluate the characteristics and safety of capsule endoscopy for elderly patients.Methods The clinical data of 376 patients who underwent capsule endoscopy between May 2002 and September 2007 were retrospectively analyzed,and patients were divided into geriatric group(≥60 years old,n=134)and control group(

Objective To analyze the cost of capsule endoscopy in diagnosing small bowel bleeding and to compare it with traditional diagnostic methods.Methods The patients suspected with small bowel bleeding were divided into group A(n=58,collected during 1998 to 2005)diagnosed with traditional processes and group B (n=93,collected during 2002 to January 2005)diagnosed with capsule endoscopy.The diagnostic yield,specific treatments,examination costs and other accumulated costs of two groups was compared.The examination cost ratio and the integration cost ratio were evaluated.The sensitivity analysis was performed.Results The diagnostic yield of small bowel bleeding in group A and group B were 22.4%(13/58) and 86%(80/93),respectively.The total of examination costs were 133 750 RMB and 790 500 RMB,respectively.The examination costs in group B(RMB 9881.3/each) was slightly lower than group A(RMB 10 288.5/each).Furthermore,as the diagnostic yield of group B was significantly higher than group A(P=0.001).The specific treatments based on the results of the diagnosis was 37.4% higher in group B(49.5%) than group A(12.1%).That means the cost of repeat- ed consultations,emergencies room visit,examinations,supporting treatments and hospitalizations in group B were significantly decreased.After the adjustment,the cost in group B(RMB 9881/patient) was lower than group A(16 361.5 RMB in one month—97 424.0 over 5 years/patient).The total cost of each patient in group A was 6480.2—87 542.7 RMB more than group B,which represented 1.7—9.9 folds increase.Conclusions The patients who suspected with small bowel bleeding and had a negative results of gastroscopy and colonoscopy were recommended to have capsule endoscopy which yields early diagnosis and less cost.

Objective To evaluate the effects of capsule endoscopy in the diagnosis and prognosis of small bowel tumors.Methods Three hundred and fifty-eight consecutive patients who underwent capsule endoscopy for suspected small bowel disease during May 2002 to Feb.2007 were examined.The final diagnosis was confirmed pathologically.Results Thirty-three(9.22%) out of 358 patients were identified as small bowel tumors[male 14/female 19,mean age(51?17)years].Of them,23(69.70%) patients had malignant tumors and ten(30.30%) had benign tumors.Obscure gastrointestinal bleeding were found in 26 cases,bleeding with abdominal pain in 2 cases,bleeding with diarrhea in 1 case,abdominal pain in 2 cases,abdominal pain with diarrhea in 1 case and vomiting in 1 case.All patients with benign tumors underwent surgery for their tumor.No further bleeding or abdominal pain after resection was found in all but one patient.Of the patients with malignant tumors,all expect two underwent surgery.Three patients accepted palliative surgery while eighteen patients received a curative resection.The locations of the tumor detected by capsule endoscopy were correlated well with the results of surgery.Conclusions Capsule endoscopy promises a higher diagnostic yield in small bowel tumors. h may improve the diagnosis of small bowel tumors and alter management thoroughly.

Aged, 80 and over ; Heart Valve Prosthesis Implantation ; methods ; Humans ; Male ; Prosthesis Failure

Objective To investigate the characteristics of carotid atherosclerosis (CA) in patients with acute ischemic cerebrovascular disease (AICD) and explore the relation between metabolic syndrome (MS) and CA. Methods Color Dopple ultrasound was used to examine the carotid artery of 514 patients with AICD and 300 healthy subjects as control group. The intima-media thickness (IMT) of common carotid artery, carotid plaque index, the occurrence rate of CA and the prevalence of MS were compared between the 2 groups. Patients with AICD were divided into CA group and non-CA group according to the occurrence situation of CA; the prevalence of MS and the correlation between MS and single risk factor were analyzed. Results The prevalence of MS, IMT, carotid plaque index and the occurrence rate of CA in the AICD group were all significantly higher than those in the control group (P<0.05). The prevalence of MS, and the incidence of hypertension and high levels of triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) in the CA group were significantly increased than those in the non-CA group. After age, gender and smoking adjusted and further adjusted component risk factors of MS, the MS defined by CDS criteria was associated with a 1.81 to 3.96 fold high risk of the CA. The risk of CA in patients with MS accompanied with diabetes was 5.6 times higher than that in patients with MS alone. Conclusion The prevalence of MS and CA in patients with AICD was high. The MS was positively associated with the risk of CA and cooperated with its component risk factors or diabetes to further impact CA.

OBJECTIVE: To evaluate the relationship between serum levels of soluble Fas(sFas), soluble Fas li gand(sFasL), soluble IL-2 receptor(sIL-2R) and coronary heart disease (CHD). METHODS: With enzyme-linked immunosorbent assay (ELISA) tests, sFas, sFasL and sIL-2R were measured in the sera from 30 patients with CHD and 26 subjects without CHD as controls. RESTULTS: Mean level of sFas was significantly higher in patients with CHD than in controls [(1 583.41+/-174.46)ng/L compared with (1 374.55+/-142.42)ng/L, P<0.01]. Compared with the controls, the mean level of sIL-2R was significantly higher in patients with CHD [(944.50+/-395.59)ng/L compared with (652.45+/-163.36)ng/L P<0.01]. Moreover, in patients with CHD sFas and sIL-2R were positively correlated (r=0.418 P<0.05). Whereas no such difference was found between both groups in sFasL (P<0.05). CONCLUSION: High levels of serum sFas and sIL-2R were associated with CHD, and elevation of sFas may inhibit apoptosis in activated T cells, leading to coronary events.

OBJECTIVEBasis on the dynamic changes of the ventilation and arterial blood gas parameters to symptom-limited maximum cardiopulmonary exercise testing (CPET), we further investigate the effect of alkalized blood by drinking 5% NaHCO3 on ventilation during exercise.

METHODSAfter drinking 5% NaHCO3 75 ml (3.75 g) every 5 min, total dosage of 0.3 g/Kg, 5 volunteers repeated CPET. All CPET and ABG data changes were analyzed and calculated. At the same time, CPET and ABG parameters after alkalized blood were compared with those before alkalized blood (control) used paired t test.

RESULTSAfter alkalized blood, CPET response patterns of parameters of ventilation, gas exchange and arterial blood gas were very similar (P > 0.05). All minute ventilation, tidal volume, respiratory rate, oxygen uptake and carbon dioxide elimination were gradually increased from resting stage (P < 0.05-0.001), according to the increase of power loading. During CPET after alkalized blood, ABG parameters were compared with those of control: hemoglobin concentrations were lower, CaCO2 and pHa were increased at all stages (P < 0.05). The PaCO2 increased trend was clear, however only significantly at warm-up from 42 to 45 mmHg (P < 0.05). Compared with those of control, only the minute ventilation was decreased from 13 to 11 L/min at resting (P < 0.05).

CONCLUSIONEven with higher mean CaCO2, PaCO2 and pHa, lower Hba and [H+]a, the CPET response patterns of ventilatory parameters after alkalized blood were similar.

Blood Gas Analysis ; Carbon Dioxide ; Exercise Test ; Humans ; Oxygen ; Oxygen Consumption ; Respiration ; Respiratory Physiological Phenomena ; Tidal Volume

OBJECTIVEUnder the guidance of the holistic integrative physiology medicine, we reanalyzed the data during symptom-limited maximum cardiopulmonary exercise testing (CPET) in order to investigate control and regulatory mechanism of breathing.

METHODSThis study investigated 5 normal volunteers who accepted artery catheter, performed CPET room air. Continuous measured pulmonary ventilation parameters and per minute arterial blood gas (ABG) analysis sample parameters during exercise. All CPET and ABG data changes were standard analyzed and calculated.

RESULTSWith gradually increasing power, minute oxygen uptake(every breath oxygen uptake x respiratory rate = O2 paulse x heart rate) and minute ventilation (tidal volume x respiratory rate) showed nearly linear progressive increase during the CPET(compared with the rest stage, P < 0.05 - 0.001); Minute ventilation increased even more significant after the anaerobic threshold (AT) and respiratory compensation point. PaO2 was increased at recovery 2 minutes (P < 0.05); PaCO2 was decreased after anaerobic threshold 2 minutes (P < 0.05); [H+]a was increased from AT (P < 0.05), and rapidly raised at last 2 minutes, remained high at recovery. Lactate was increased rapidly from AT (compared with resting, P < 0.05); bicarbonate decreased rapidly from AT (compared with resting, P < 0.05) and it's changed direction was contrary to lactic acid.

CONCLUSIONIn order to overcome the resistance of the power during exercise, metabolic rate othe body increased, respiratory change depend upon the change metabolism, and the accumulation of acidic products exacerbated respiratory reactions at high intensity exercise.

Anaerobic Threshold ; Blood Gas Analysis ; Exercise Test ; Healthy Volunteers ; Heart Rate ; Humans ; Oxygen ; Oxygen Consumption ; Pulmonary Ventilation ; Respiration ; Respiratory Physiological Phenomena ; Tidal Volume

This study aimed to establish a method for the detection and identification of H7N9 avian influenza viruses based on the NA gene by pyrosequencing. According to the published NA gene sequences of the avian influenza A (H7N9) virus, a 15-nt deletion was found in the NA gene of H7N9 avian influenza viruses. The 15-nt deletion of the NA gene was targeted as the molecular marker for the rapid detection and identification of H7N9 avian influenza viruses by pyrosequencing. Three H7N9 avian influenza virus isolates underwent pyrosequencing using the same assay, and were proven to have the same 15-nt deletion. Pyrosequencing technology based on the NA gene molecular marker can be used to identify H7N9 avian influenza viruses.
Animals ; Base Sequence ; Birds ; Chickens ; High-Throughput Nucleotide Sequencing ; methods ; Influenza A Virus, H7N9 Subtype ; classification ; enzymology ; isolation & purification ; Influenza in Birds ; virology ; Molecular Sequence Data ; Neuraminidase ; genetics ; Phylogeny ; Poultry Diseases ; virology ; Viral Proteins ; genetics

BACKGROUNDIn obscure gastrointestinal (GI) bleeding, it is often difficult to detect the bleeding sites located in the small bowel with conventional radiological, scintigraphic or angiographic techniques. Push enteroscopy and capsule endoscopy are currently considered to be the most effective diagnostic procedures. The aim of this study was to compare the detection rates between capsule endoscopy and push enteroscopy.

METHODSFrom May 2002 through January 2003, we prospectively examined by capsule endoscopy 39 patients with suspected small bowel diseases, in particular GI bleeding of unknown origin in Renji Hospital. Among them, 32 complained of obscure recurrent GI bleeding. Between January 1993 and October 1996, we used push enteroscopy on 36 patients who suffered from unexplained GI bleeding. All patients had prior normal results on gastroscopy, colonoscopy, small bowel barium radiography, scintigraphy and/or angiography.

RESULTSM2A capsule endoscopy disclosed abnormal small bowel findings in 26 (82%) out of 32 patients. Twenty-one of them had significant pathological findings explaining their clinical disorders. Diagnostic yield was therefore 66% (21 of 32 patients). Definite bleeding sites diagnosed by capsule endoscopy in 21 patients included angiodysplasia (8), inflammatory small-bowel (5), small-bowel polyps (4), gastrointestinal stromal tumour (2), carcinoid tumour and lipoma (1), and hemorrhagic gastritis (1). Push enteroscopy detected the definite sources of bleeding in 9 (25%) of the 36 patients. Patients with definite bleeding sources included angiodysplasias (2), leiomyosarcoma (2), leiomyoma (1), lymphoma (1), Crohn's disease (1), small-bowel polyps (1) and adenocarcinoma of ampulla (1). Suspected bleeding sources were shown by push enteroscopy in two additional patients (6%), and in other five patients (16%) by capsule endoscopy.

CONCLUSIONSThe present study of patients with obscure GI bleeding showed that capsule endoscopy significantly superior to push enteroscopy in detecting GI bleeding (P < 0.001). Capsule endoscopy is safe and painless, and should become the initial diagnostic choice for patients with obscure GI bleeding.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Endoscopy, Gastrointestinal ; methods ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; Humans ; Male ; Middle Aged ; Prospective Studies