Objective To investigate the relationship of body mass index with hiatal hernia (HH) and reflux esophagitis (RE).Methods Two hundreds and twenty seven gastroesophageal reflux disease (GERD) patients with typical acid regurgitation and heartburn were enrolled and categorized into three groups according to body mass index (BMI, kg/m2) as normal weight (18.5≤BMI ＜24), overweight (24≤BMI＜28), and obesity (BMI≥28).RE, non-erosive reflux disease (NERD) and HH were diagnosed by gastroscopy.All the patients underwent ambulatory 24-hour pH monitoring and the pathological acid reflux was considered when the DeMeester score≥15.Effects of BMI on RE and HH were estimated by using logistic regression analysis.Results The percentages of RE and HH were 30.0%(68/227) and 5.7%(13/227), respectively.76.9% (10/13) HH patients had RE. Proportions of RE and HH increased significantly with increasing BMI (P＜0.05), so was that of RE above grade B in three groups (6.4%, 16.9% and 31.6%,P=0.003).DeMeester scores of the three groups were 15.9, 19.8 and 36.9, respectively (P＜0.05).The average 24-hour intra-esophagus pH value of overweight group, was significantly lower than that of normal weight patients in the afternoon and midnight (P＜0.01).Multivariate analysis showed obesity was a risk factor for HH with OR 7.058 (95% CI: 1.294～38.488, P=0.024), male (OR: 2.537, 95% CI: 1.350～4.766, P=0.004), overweight (OR: 1.921, 95% CI: 1.005～3.670, P=0.048), obesity (OR: 3.305, 95% CI: 1.123～9.724, P=0.030) and HH (OR: 6.879, 95% CI: 1.695～27.913, P=0.007) were risk factors for RE.Conclusion BMI has a significant association with HH and RE, obesity is a common risk factor for both HH and RE, HH may induce the development of RE.

Objective To study the role of esophagogastric junction contractile index (EGJ-CI) in evaluating the function of anti-reflux barrier,and in differentiating patients with gastroesophageal reflux disease (GERD) from those with functional heartburn (FH).Methods A total of 115 patients presenting heartburn were enrolled in the study from January 2012 to June 2015.All subjects had completed Gerd-Q questionnaire and undergone gastroscopy,24-hour pH-impedance monitoring and esophageal high-resolution manometry.GERD patients were divided into as reflux esophagitis,acid-nonerosive reflux disease (NERD) and weakly acid-NERD groups.Patients with normal esophageal mucosa,normal acid exposure and negative proton pump inhibitor test were enrolled in FH group.EGJ-CI (mmHg · cm) as well as EGJ rest pressure and 4s integrated relaxation pressure (IRP 4s) were measured.Results Among the 115 patients,18 were reflux esophagitis [(49.0 ± 18.9) years,M ∶ F =10 ∶ 8],25 were acid-NERD [(48.7 ± 14.4) years,M∶F=13∶ 12],37 were weakly acid-NERD [(52.0 ±14.8) years,M∶F=15∶22] and 35 were FH [(53.6 ± 14.8),M∶ F =8∶27].No differences of Gerd-Q scores were noticed between the four groups.(1) Negative correlations were demonstrated between EGJ-CI and esophageal acid exposure time (r =-0.283,P =0.002),EGJ-CI and acid reflux events (r =-0.233,P =0.012),EGJ-CI and weakly acid reflux events (r =-0.213,P =0.022),EGJ-CI and non-acid reflux events (r =-0.200,P =0.032).(2)The value of EGJ-CI was significantly higher in FH patients than in the three subgroups of GERD(all P ＜ 0.01).EGJ rest pressure of FH group was higher than that of acid-NERD (P ＜ 0.01).IRP 4s in acid-NERD group was lower than that of FH and weakly acid-NERD (P ＜ 0.05).(3) The area under curve (AUC) of EGJ-CI was higher than that of EGJ-CIT,EGJ rest pressure or IRP 4s (0.686 vs 0.678,0.641 and 0.578).The cut-off value of EGJ-CI to differentiate GERD from FH was 9.74 mmHg · cm with sensitivity 82.86％ and specificity 51.52％.Conclusions The EGJ-CI values are negatively correlated with esophageal acid exposure time,weakly acid reflux events and non-acid reflux events.Thus it might be used as a metric to reflect the anti-reflux function of EGJ.According to the cut-off value of EGJ-CI 9.74 mmHg · cm,patients with GERD can be sensitively differentiated from patients with FH.

Objective To evaluate the value of the Heidelberg retina tomograph - Ⅱ in detection of primary chronic angle-closure glaucoma(CACG) in a Chinese population, and to investigate the difference of parameters detected by HRT-Ⅱ between normal subjects and CACG patients. To evaluate the sensitivity and specificity of optic disk detection using Moorfields regression analysis (MRA) and linear discriminant function(LDF) of the HRT-Ⅱ in differentiating normal from CACG eyes. Design Prospective, comparative case series. Participants 64 eyes of 32 normal subjects and 77 eyes of 51 patients with CACG were studied. The normal subjects were ageand refraction-matched with the glaucoma patients. Methods The interventions consisted of optic disk imaged by means of HRT-Ⅱ and visual field (VF) detected with Oculus Twinfield perimetry. The CACG patients then were divided into two groups according to the VF discriminant standard and mean defect (MD) of Oculus Twinfield perimetry, the group with the glaucomatous VF defect and the group without VF defect. The optic disk was described with 14 optic disk parameters. The optic disc parameters between the normal and the patients were compared. The optic disks were also classified as "normal/borderline/outside normal limits" on the basis of MRA. The results from MRA and from LDF provided in the HRT-Ⅱ were compared. Main Outcome Measures Optic disk parameters, MD of the VF, the VF discriminant standard, the sensitivity and specificity of HRT-Ⅱ examination. Results Between the normal and CACG patients, differences of the most of optic disk parameters were significant statistically (P

Bone Neoplasms ; Cartilage Diseases ; Humans ; Osteochondroma ; Soft Tissue Neoplasms

Objective To analyze geometrical uncertainties of the target and provide the margin enlarging from clinic target volume (CTV) to planning target volume (PTV) with HT.Methods Analysis set-up data of 220 cases include 97 cases of head and neck,45 cases of chest and 78 cases of abdomen and pelvic,calculating the systematic error (Σ) and the random error (σ) in the three-dimension and check whether the set-up data accord with the normal distribution or not,then acquire the values expand in the three directions based on formula 2.0Σ + 0.7σandμ ± 2.58σ.Results The systematic error (Σ) and random error (σ) of head and neck,the chest and abdomen and pelvic were (0.7-1.9 mm,1.1-1.4 mm),(0.8-4.2 mm,1.5-3.2 mm),(1.1-4.1 mm,1.8-4.1 mm),respectively,and the margin that expand in the direction of x,y,z were (5.2,6.5,7.7 mum),(7.5,16.2,10.3 mm),(7.6,17.1,15.7 mm),respectively.Conclusions The curative effect of this task need prove with a large sample during HT,but other should establish data of margin by yourself.

Objective To quantitatively investigate the image quality and dose calculation accuracy of megavoltage computed tomography (CT) in helical tomotherapy.Methods The megavoltage CT was used to scan the Cheese phantom,and the geometric accuracy of images,noise,image uniformity,spatial resolution,density-CT value conversion,and dose calculation accuracy were analyzed and compared with conventional kilovoltage CT.Results The geometric accuracy of megavoltage CT images was within 2 mm in three directions.The megavoltage CT was inferior to kilovoltage CT in terms of image noise,uniformity,and spatial resolution.The dose-volume histogram (DVH) in dose reconstruction based on CT images was well consistent with DVH in the kilovohage CT plan.Conclusions The megavoltage CT can obtain images with accurate geometric dimensions and has a low imaging dose and accurate dose calculation,which meets clinical requirements.

OBJECTIVE To investigate the effective treatment for secretory otitis media. METHODS 63 patients (78 ears)with secretory otitis media were randomly devided into two groups: The experimental group :Thirty-one patients (38 ears) were treated by eustachian tube insertion under nasal endoscope. Drugs were injected repeatedly through the pipe. The control group: 32 patients (40 ears) were treated by traditional method: the tympanic cavity pressure equalization tube. All patients were followed up for 6-9 months, the effectiveness was compared.RESULTS The experimental group: 16 ears (42.1 %) were cured, 18 ears (47.4 %) were straightened up, The total efficiency rate was 89.5 %. The control group: 8 ears (20.0 %) were cured, 21 ears (52.5 %) were straightened up, The total efficiency rate was 72.5 %. There were significant difference between the two groups after treatment (P

Objective To investigate the impact of injection current (IC), injection voltage (IV), and pulse forming network (PFN) on energy (depth ratio D20/D10) and profiles of helical tomotherapy, and to improve the quality control for the stability of beam characteristics.Methods The energy and profiles were measured by ion chamber and TomoDose at different values of IC, IV, and PFN, the relationship between the energy and various parameters was evaluated by Pearson correlation analysis, and the changes in profiles were evaluated by comparative analysis.Results The energy had no correlation with IV and PFN values (P>0.05), but had a strong correlation with IC value (P=0.007), which showed a downward trend with the increase in IC.For the profiles in the x direction:(1) in the main beam region (-200 to 200 mm), the shoulder area of the profiles increased regularly with the increase in IC.There were no significant changes for the profiles when the IV values ranged from 6.42 V to 6.54 V, and the shoulder area of the profiles reached the highest point with IV=6.60 V, then decreased with further increase in IV.The shoulder area of the profiles decreased regularly with the increase in PFN.(2) In the penumbral region (±200 mm outside), all the three parameters had no effect on the profiles.For the profiles in the y direction:(1) in the main beam region (-20 to 20 mm), the profiles showed an upward trend in the area with an off-axis distance less than 16 mm when IC values were 5.40 V and 5.46 V, and showed an upward trend in the area with an off-axis distance less than 16 mm.But on the whole, the shoulder area of the profiles increased with the increase in IC, and was not affected by IV and PFN.(2) In the penumbral region (±20 mm outside), the profiles decreased regularly with the increase in IV, and was not affected by IC and PFN.IC had the highest influence on the profiles in the main beam region, followed by PFN and IV.Only IV had impact on the profiles in the penumbral region.Conclusions When the energy needs to be adjusted, the IC value should be given a priority, and PFN should be taken as a supplementary factor.When the profile needs to be adjusted, the IC value should be given a priority, and IV should be used as an auxiliary factor in the main beam region.But in the penumbral region, adjustment of parameters is only related to the profiles in y direction, so the IV value should be adjusted.This study has a guiding role in the quality control of energy and profiles, which can reduce the blindness of quality control, thus saving the time.

Objective:To investigate the effects of Huang-Lian-Jie-Du-Decotion containing serum for the autophagy of RAM264.7 macrophages ,and to explore its possible anti-atherosclerosis mechanism .Methods:The SD rats were intervened with large , middle and small dose Huang-Lian-Jie-Du-Decotion to prepare containing drug serum .Cell proliferation was tested by MTT assay .The gene and protein expressions of Beclin 1, mTOR was assessed by fluorescent quantitative PCR and Western blot method .Results:Compared with the normal serum group ,Huang-Lian-Jie-Du-Decotion containing serum enhanced expression of the mRNA and protein level of Beclin1,and decreased the expression of mTOR and p-mTOR(P<0.05 or P<0.01).Conclusion:Huang-Lian-Jie-Du-Decotion containing serum could regulate the expressions of Beclin 1 and mTOR.These might be one of the mechanisms for preventing atheroscle-rosis.

Objective To evaluate the clinical significance of intercellular space diameters (ISD)of squamous epithelium by light microscopy (LM) in lower esophagus of erosive reflux esophagitis (ERD),non-erosive reflux disease ( NERD), Barrett esophagus (BE) and healthy controls. Methods A total of 21 ERD and 21 NERD patients with reflux symptoms and confirmed with 24-hour esophageal pH monitoring, 13 BE patients diagnosed by gastroscopy and biopsy, and 20 other healthy controls were enrolled in the study.Samples of ERD, NERD and control group were collected at 2 cm above dentate line, and made HE slides in the conventional way. Images for measurement of ICS were acquired with oil lens ( × 1000). ICS of squamous epithelium was quantitatively measured by computer-assisted morphometry. Ten cells were taken for each sample, 10 consecutive ISD for each cell, i.e. 100 ISD for each subject. Mean ISD was calculated.Results Mean ISDs by LM in control, BE, ERD, and NERD groups were 0. 59, 0. 99, 1.29 and 1.06 μm, respectively. The mean ISDs in BE, ERD, and NERD group were much greater than that in control (P＜0. 05). The mean, maximal and minimal ISDs of group ERD were greater than those of NERD and BE (P = 0. 000). However, the ISDs of NERD and BE are of no significant difference ( P ＞ 0. 05 ). The cut-off value of mean ISD for diagnosis of gastro-esophageal reflux disease (GERD) was 0. 85 μm. Diagnostic sensitivity and specificity for ERD, NERD and BE were 89. 1% and 100. 0%, with reference to clinical symptoms, endoscopy and ISDs above the cut-off value. Conclusion Larger ISDs in lower esophagus by using LM will be found in all subgroups of GERD, including ERD, NERD and BE. Increased ISDs may be one of the markers for diagnosis of ERD, NERD and BE.