[Summary] As the gradual deepening understanding of gastroesophageal reflux disease ( GERD ) , more extraesophageal symptoms are noted .The concept and therapeutic strategy for GERD has also undergone a quiet revolution over recent years .The application of proton pump inhibitor ( PPI) has been a landmark of medical treatment for GERD , and the invention of laparoscopic fundoplication and endoscopic radiofrequency energy delivery to the lower esophageal sphincter are marking a new era of comprehensive therapy for GERD .Good short and long term outcomes have been obtained since endoscopic radiofrequency energy delivery to the lower esophageal sphincter was applied on typical symptoms of GERD .Furthermore, the technique has also been successfully used in treating extraesophageal symptoms induced by proximal reflux in China .With more simple and less invasive features compared with anti-reflux surgery, the radiofrequency procedure has broad application prospects .

Objective To explore the surgical methods in the treatment of carotid aneurysms. Methods A retros-pective analysis was made on the operations and results in 21 cases with 24 carotid aneurysms. Of the 24 carotid aneurysms, 18 were true and 6 false aneurysms. Nineteen cases underwent various operations including emergency operation in 3 cases. Carotid shunting device was used in 3 cases during operation. Results 2 cases were re-operated because of the recurrence of aneurysm,and 17 cases had satisfactory outcome without complications.None died in this series in perioperative period. Conclusions For carotid aneurysms,the first choice of treatment is syrgery.Surgical treatment is relatively safe and effective.

Objective To assess the efficacy and safety of lanthanum carbonate in treatment of hyperphosphatemia in end-stage renal disease (ESRD).Methods Randomized controlled trails of lanthanum carbonate in treatment of hyperphosphatemia in ESRD patients were searched in the database of MEDLINE,Cochrane Central Register of Controlled Trials,EMBASE,CNKI,Wanfang database.Data extracted from the literatures were analyzed with the Cochrane Collaboration's RevMan 5.1 software.Results Lanthanum carbonate group was similar with calcium carbonate group in treating hyperphosphatemia[RR =1.00,95 ％ CI (0.92-1.09),P =0.97],and more effective than placebo [RR=4.69,95％ CI (2.63-8.39),P＜ 0.01] (intervention dose≤ 1500 mg) and [RR =18.92,95％ CI (7.42-48.22),P ＜ 0.01] (intervention dose ＞ 1500 mg).In comparison with calcium carbonate group,the incidence of hypercalcinemia of lanthanum carbonate group was lower [RR =0.06,95 ％ CI (0.01-0.72),P =0.03],while the incidence of nausea [RR =1.80,95 ％ CI(0.70-4.64),P =0.22],vomiting [RR =3.94,95％ CI (0.45-34.38),P=0.22] and constipation [RR=0.82,95％ CI (0.49-1.37),P=0.45] were similar.The incidence of nausea and vomiting of lanthanum carbonate group were similar with placebo,with lower incidence of constipation [RR =0.19,95 ％ CI (0.06-0.59),P ＜ 0.01].Conclusions The efficacy of lanthanum carbonate in treating hyperphosphatemia is similar with calcium carbonate.The incidence of hypercalcinemia of lanthanum carbonate is lower than that of calcium carbonate,and the incidence of gastrointestinal adverse effect such as nausea,vomiting and constipation are similar with calcium carbonate.

ObjectiveTo explore the clinical significance of arterial portography in the diagnosis an d management of prehepatic type portal hypertension(PHPHT). Met hodsBetween 2000 to 2002, all the 11 patients with PHPHT were dia gnosed by angiography and B type ultrasounography. Different operations were par formed including mesocaval shunt in 5 patients,portal-vena cava shunt in 1, splenorenal shunt in 2,and portoazygos venous disconection in 1. Two patien ts were not operated. Results Nine cases undergoing surgical operations had satisfactory outcome. Conclusions PHPHT can be correctly diagnosed by indirect portal venography which is important for the choice of operation.

Objective To evaluate the effectiveness and complications of laparoscopic repair for hiatal hernia.Methods The clinical data of 992 patients with hiatal hernia undergoing laparoscopic repair from Jan 2008 to June 2014 were collected and analyzed.Postoperative symptom scores,postoperative complications,recurrence rate and satisfaction were evaluated.Results 858 cases were followed up,including type Ⅰ HH accounting for 79.8％,type Ⅱ for 1.3％,type Ⅲ for 17.1％,type Ⅳ for 1.8％ respectively.HH repaired with mesh in 520 cases.The overall improvement rate was 96.2％.Postoperative symptom scores significantly decreased.Recurrence of anatomy and symptoms were 31 and 15 cases respectively.Short-term and long-term of postoperative complications were 35.8％ and 5.6％ respectively.Excellent,fair and poor result were achieved in 91.8％,4.3％,3.9％ of postoperatively follow-up cases,respectively.Conclusion The laparoscopic approach for repair of hiatal hernias is of minimally invasive,lower recurrence rate,less complications and high satisfaction.

Objective:To investigate the effect of 12(S)-HETE on the p27~(kip1) expression in mesangial cells and glomeruli.Methods:Mesangial cells were exposed to 12(S)-HETE.12(S)-HETE was infused to rats by osmotic mini-pump.Total protein content measurement for cell hypertrophy,RT-PCR for mRNA expression and Western blot for protein expression were performed respectively.Results:12(S)-HETE stimulation induced mesangial cell hypertrophy and p27~(kip1) protein expression,but not p27~(kip1) mRNA expression.Furthermore,p27~(kip1) mRNA and protein expression in the glomeruli were significantly increased by 12(S)-HETE stimulation using osmotic mini-pump.Conclusion:12(S)-HETE plays an important role in the pathogenesis of glomerular cell hypertrophy and senescence through upregulation of p27~(kip1) expression.

Objective To investigate the effect of 12-lipoxygenase(12-LO) on the p27Kip1 expression in diabetic glomeruli. Methods Mesangial cells were exposed to 12-LO product 12 (S)-HETE (10-7 mmol/L) with or without p38 MAPK (p38) inhibitor (SB203580, 1 μmol/L) for 24 hours. Rats fed with high fat diet received low dose streptozotoein (ST-Z, 35 mg/kg, IP injection) to develop type 2 diabetes and were divided into 2 groups: low dose STZ, low dose STZ+12-LO inhibitor cinnamyl-3,4-dihydroxy-α-cynanocinnamate (CDC, 8 mg/kg) treatment. Rats fed with regular chow were divided into two groups: controls, CDC treatment. The rats received injection of CDC or vehicle subcutaneously in the hind leg. CDC or vehicle injection was performed three times weekly on alternate days. All the rats were sacrificed after 4 weeks, Wild type and 12-LO knockout C57BL/6 mice were divided into 4 groups: wild type control, 12-LO knockout, STZ-induced wild type type 1 diabetes and STZ-induced 12-LO knockout type 1 diabetes. All the mice were sacrificed after 16 weeks. Urine, blood, kidney cortical tissue and isolated glomeruli by sieving method were collected at the end of study respectively. Western blot and immunohistochemistry for target protein were performed respectively. Results Inhibition of p38 activation could significantly reduce p27Kip1 expression induced by 12 (S)-HETE in mesangial cells (P<0.01). Increased glomerular volume, microalbuminuria, elevated glomeluli p38 activation, p27Kip1 expresssion in type 2 diabetic glomeruli was decreased after CDC treatment (P<0.01). Compared with wild type diabetic mice, glomerular p38 activation, p27Kip1 exprcsssion and extracellular matrix accumulation in the 12-LO knockout diabetic mice were significantly decreased (P <0.01, respectively). Conclusions 12-LO induces p27kipl expression via p38 pathway in diabetic glomeruli.

Objective To explore the safety and feasibility of calf arterial stent angioplasty to treat severe lower limb ischemia. Methods Clinical data of 13 patients in our hospital during recent 3 years were retrospectively analysed and all these patients were followed up after discharge.Of these patients there were 10 males and 3 females; mean age was (73 ±7) years; mean disease course was (8 ±4) months.Severe claudication was reported in 5 patients,rest pain in 4 patients,toe ulcer in 2 patients,gangrene in 2 patients.Stent was placed in the tibioperoneal trunk artery in 5 patients ; in the proximal part of peroneal artery in 3 patients; in the tibioperoneal trunk and proximal peroneal artery in 2 patients; in the anterior tibial artery in 2 patients; in the posterior tibial artery in one patient.Simultaneous endovascular treatment of femoral/popliteal arterial disease was done in 11 patients. Results All the procedures were successful and the treated arteries kept patent on discharge of patients.Claudication distance increased to be above 500 meter in 5 patients; rest pain relieved in 4 patients ; toes ulcer reduced in 2 patients,feet gangrene kept dry till discharge in 2 patients.Postoperative ABI increased in all patients.Patients were followed-up of mean (6.9 ± 2.2) months.One patient with previous toe gangrene underwent amputation due to recurrent pain while the stent in anterior tibial artery kept patent after 6 months discharge.In the other patient gangrene toe had fallen off and the wound healed.Two patients with toe ulcer had a total recovery and patients with previous rest pain had no recurrent symptoms. Conclusions Below knee arterial stent angioplasty is a safe and effective method in the treatment of severe lower limb ischemia.

Objective To investigate the effect and safety of autologons bone margow-mononuclear cell (BM-MNC)transplantation after the bone marrow stimulation in patients with thromboangiitis obliterans (TAO).Methods The bone marrows of 12 patients were stimulated by an injection of the recombinant human granuloeyte-macmphage colony-stimulatory factor(GCSF)for 3-5 days.150-200 ml bone marrow was drown from the iliac spine and the autologous BM-MNC were obtained in each patients.Fifteen lower limbs of 12 patients received implantation of the autologous BM-MNC by an intramuscular iniecdon.A series of subjective indexes(including improvement of pain and cold sensation)and objeetive indexes [including increase of ankle braehial index(ABI),transcutaneons oxygen pressure(TcPO2)and improvement of foot skin ulcer] were used to evaluate the effects.Results The outcomes were evaluated after 2 months of transplantation.The pain-relief rate and the cold feeling improvement rate were 86.7%(13/15)and 93.3%(14/15)respectively.The ABI were 0.38 ±0.05 vs.0.61 ±0.14(P<0.05)before transplantation and 2 months after transplantation respectively.increased in 66.7%(10/15)limbs.The TcPO2 of the ischemic legs increased from(27.47±2.85)mm Hg to(43.53 ±8.38)mm Hg(t=-7.03,P<0.05)after the transplantation,and the improvement rate of TcPO2 was 93.3%(14/15).Skin ulcers in improved in 8/9 limbs.Twelve patients were followed up for all average period of 10 months.The patients'symptoms improved in 80.0%(12/15)limbs,as to the objective index the ABI was0.57±0.13,TcPO2 was(42.07 ±7.81)mm Hg,which improved significandy compared to before treatment(t=-5.33,-7.80,Ps<0.05).skin ulcer healing rate was 66.7%(6/9).The ischemic symptoms in 2 patients were not relieved.There WBS no mortality and high level amputation in all subjects.The complications,such as proliferative retinopathy,malitpmnt tumor,myocardial infarction,stroke or hemangioma were not found in any patients.Conclusion In patients with TAO,intramuscular transplantation of autologous BM-MNC after the bone marrow stimulation has advantages of less bone marrow aspiration,more mononuclear cell content and relatively high safety.It may be a new and effective method to alleviate symptoms and accelerate the healing of skin ulcer.

Objective To evaluate surgical treatment of lower limb ischemia due to combination of thromboangiitis obliterans (TAO) and arteriosclerosis obliterans (ASO). Methods Clinical data of six patients suffering from lower limb ischemia due to TAO and ASO were retrospectively analyzed. All patients had a history of smoking, and complained of rest pain. Three patients had foot ulcer and one had toe gangrene. Two patients reeeived aortie artery endartereetomy combined with FIFE graft bypass to deep femoral artery and below knee popliteal artery plus saphenous vein graft bypass to tibial artery. One patient received aortic thrombectomy and endarterectomy plus aortofemoral and femoropopliteal PTFE graft bypass. One patient with a history of left graft thrombosis after aorto-bifemoral arterial bypass using PTFE graft before admission underwent left PTFE graft thrombectomy via left groin and left deep femoral artery endarterectomy followed by femoropopliteal arterial bypass. One patient received left common iliac artery endarterectomy plus left profound femoral PTFE graft-left anterior tibial arterial bypass using in situ great saphenous vein graft. One patient received right to left femorofemoral arterial bypass using PTFE graft to left posterior tibial artety bypass using reversed great saphenous vein graft. Results One patient receiving aortoiliac thrombectomy and endarterectomy with aortofemoropopliteotibial arterial bypass suffered from graft thrombosis several hours after operation and emergency thrombectomy with distal posterior tibial arteriovenous fistulization was performed. The rest pain disappeared in 5 patients and partially relieved in one. All the grafts were patent on discharge. The foot ulcer reduced in 3 patients. All the 6 patients were followed up with a mean of 6. 5 months. 3 foot ulcers healed. One patient eventually received below knee amputation due to foot gangrene three months later. Conclusion Although it is difficult to treat combined limb ischemia of TAO and ASO, satisfactory results could be achieved when proper surgical procedure is adopted.