Objective To study the clinical features of spontaneous rupture of the right cardiac atrium. Methods Two cases of spontaneous rupture of right cardiac atrium were reported, and related literature was reviewed. Results Spontaneous rupture of the right cardiac atrium which was a rare disease, presented symptoms including stifling sensation in the chest, chest pain and symptoms of cardiac tamponade. The diagnosis should be differentiated with by ultrasonic examination and CT from cardiac infarction, cardiac rupture caused by external injury and dissecting aneurysm of aorta. Conclusion Spontaneous rupture of right cardiac atrium is rare disease, and an early diagnosis and prompt operation are necessary.

Objective To investigate the effects of peroral endoscopic myotomy (POEM) on esophageal dynamics in patients with achalasia (AC) and appraise the role of high resolution manometry (HRM)in assessment of POEM therapy.Methods From July 2011 to September 2012,20 patients with achalasia underwent POEM in the department of gastroenterology,Tianjin Medical University General Hospital.Preoperation esophageal dynamics of all the patients were evaluated by high resolution manometry (HRM) system and one month after POEM operation the test was repeated.Data of lower esophageal sphincter (LES)and esophageal body were analyzed,with 15 healthy volunteers as a contrast study.Results Mter POEM,the LES pressure (LESP) and 4-second integrated relaxation pressure (4sIRP) significantly decreased:LESP [pre-operation (24.5 ± 13.1) mm Hg vs.post-operation (8.5 ± 3.1) mm Hg,P ＜ 0.05] ; 4sIRP [pre-operation (20.7 ± 6.8) mm Hg vs.post-operation (5.0 ± 3.4) mm Hg,P ＜ 0.05].The LES relax rate (LESRR) significantly elevated [pre-operation (12.7 ± 9.8) ％ vs.post-operation (39.6 ± 18.1) ％,P ＜ 0.05].However,the esophageal aperistalsis remained after POEM.The total of 20 patiems were all type Ⅰ achalasia and responded well to POEM therapy.Post-operation data on the symptom scores markedly decreased and a significant correlation was found between the decreasing level of symptom scores and LESP,as well as the scores 4sIRP in the 20 patients (LESP:r =0.751,P ＜ 0.05 ; 4sIRP:r =0.500,P ＜ 0.05).Conclusion POEM can significantly improve esophageal dynamics in patients with achalasia and the treatment outcome is definite.HRM plays an important role in evaluation of POEM therapy on achalasia.

Objective To study the relationship between serum uric acid and insulin resistance in type 2 diabetic patients Methods A total of 728 middle-aged and elderly type 2 diabetic patients were recruited and the anthropometric,clinical and biochemical parameters and fasting serum C-peptide were measured and retrospectively studied.All patients were divided into groups based on the levels of uric acid and on metabolic syndrome diagnosis or not.Results Among a total of 728 patients,the proportion of hyperuricemia was 26.9％(196/728),and metabolic syndrome(MS)was 64.6％.The levels of body mass index(BMI),waist circumference(WC),systolic pressure (SBP),diastolic pressure (DBP),triglyceride (TG),fasting C-peptide,HOMA(C-Peptide) were significantly higher in hyperuricemia group than in normal uric acid group,while the level of HDL was lower in hyperuricemia group than in normal uric acid group.The proportion of MS was statistically higher in hyperuricemia group (81.6％)than in normal uric acid group (58.3％,P ＜ 0.05).Groups Ⅰ,Ⅱ,Ⅲ,Ⅳ-the four quartiles of serum uric acid from low-to high-level were correlated with MS component number of 2.1±1.0,3.1±1.1,3.3±1.2,3.7±0.8,separately,and with HOMA(CP)of 3.7± 0.8,3.7 ± 0.8,4.0 ± 0.6,4.1 ± 0.9,separately (all P ＜ 0.05).When all patients were divided into groups based on with or without MS,the level of uric acid in MS group was (377.3 ± 43.5)μumol/L,and the proportion of hyperuricemia was 34.0％ (160/470),and HOMA(CP)was 3.90±0.72,all were significantly higher than those of non-MS group[(318.2±47.9)μmol/L,14.0％ (36/258),3.64±0.67].The levels of serum uric acid in groups with 1-5 components of MS were(285.0±62.8)μmol/L,(335.7±62.7)μmol/L,(367.1±45.0) μmol/L,(377.9±40.2) μmol/L,(389.8±46.6)μmol/L,and HOMA(CP) was 3.6±0.6,3.7±0.7,3.9±0.8,3.9±0.7,4.3±0.7 separately(P＜0.05).Serum uric acid was positively correlated with age,WC,BMI,TG,SBP,fasting C-peptide,and HOMA (CP),while negatively correlated with glycosylated hemoglobin(HbA1C),high density lipoprotein cholesterol (HDL-C).Binary logistic regression showed that the OR value of MS was 1.033 with the increase of serum uric acid,and 95％CI:1.026-1.041,P＜0.05.Conclusions Serum uric acid is correlated with insulin resistance in middle-aged and elderly hospitalized patients with type 2 diabetes.Hyperuricemia might be a new risk factor for MS.

The impact of hypofunction of kidney on evaluating of islets β cell function in patients with type 2 diabetes was investigated. 635 type 2 diabetic patients with normal liver function were grouped using Cockcroft-Gault. Following the decrease in kidney function, blood C-peptide concentration was increased with decreased urinary exeretion of C-peptide(P<0. 05). It is proposed to pay an attention to renal function while evaluating islets β cell function in the patients.

Objective To explore the difference in short-term efficacy between peroral endoscopic myotomy (POEM) and pneumatic dilatation (PD) in achalasia patients.Methods A retrospective analysis was applied.From September 2010 to March 2015,patients with POEM or PD were enrolled and divided into POEM group (n=26) and PD group (n=40).High-resolution manometry (HRM) before and one month after treatment were compared between POEM group and PD group.Before and three months after treatment,Eckardt score and gastroesophageal reflux symptom was compared between groups (Eckardt score ≤ 3 as the standard for successful treatment).Wilcoxon signed rank test was performed for before and after treatment comparison in the same group.Mann-Whitney U test was used to compare between two groups and Fisher's exact test was used for rate comparison.Results The successful treatment rates at one and three month after POEM group were 92.3 ％ (24/26) and 96.2％ (25/26),respectively.The successful treatment rates at one and three month after PD were 87.5％ (35/40) and 75.0％ (30/40).At three month after treatment,the successful treatment rate of POEM group was higher than that of PD group (Fisher's exact test,P =0.02).At three months after treatment,the Eckardt score of POEM group was lower than that of PD group (1.35,0 to 4.00,vs2.73,0 to 6.00;U=-3.921,P＞0.01).By the end of three months after treatment,the rate of gastroesophageal reflux symptom of POEM group was higher than that of PD group (7/26,26.9 ％ vs 2/40,5.0％;Fisher's exact test,P=0.01).The postoperative 4 second integrated relaxation pressure (4s-IRP) and lower esophageal sphincter pressure (LESP) of POEM group were both lower than those of PD group (7.01 mmHg,3.48 to 10.40 mmHg vs 10.11 mmHg,5.75 to 12.91 mmHg,U=-4.541,P＜0.01;11.61 mmHg,4.21 to 14.64 mmHg vs 17.85 mmHg,8.39 to 24.57 mmHg,U=-6.142,P＜0.01).The analysis of achalasia subtypes indicated that the efficacy of POEM was better than that of PD both in type Ⅰ and type Ⅱ.Conclusion During short-term follow-up,the efficacy of POEM was better than that of PD in achalasia patients,however there was a higher incidence of post-operative gastroesophageal reflux after POEM.

Objective To analyze risk factors of nosocomial infections in cancer patients after undergoing radiotherapy. Methods A total of 1 000 tumor patients receiving radiotherapy were chosen as the study objects. The related factors of nosocomial infections were analyzed. Results Out of 1 000 tumor patients, there were 68 cases with nosocomial infections, accounting for 6. 8％, and the infections were mainly located in respiratory tract (29. 41％), and lungs (26. 47％). Age≥65, diabetes history, hospital stay≥30 d, Ⅲ to Ⅳ stages of TNM classification, simultaneous radiotherpy and chemotherapy, and invasive operation (PICC) were found to be risk factors of nosocomial infection (P ＜ 0. 05 or P ＜ 0. 01). Conclusion Risk factors of nosocomial infections are varied. Hence the prevention and control measures should be taken correspondingly to decrease the hospital infection rate.

Objective To analyze risk factors of nosocomial infections in cancer patients after undergoing radiotherapy. Methods A total of 1 000 tumor patients receiving radiotherapy were chosen as the study objects. The related factors of nosocomial infections were analyzed. Results Out of 1 000 tumor patients, there were 68 cases with nosocomial infections, accounting for 6. 8％, and the infections were mainly located in respiratory tract (29. 41％), and lungs (26. 47％). Age≥65, diabetes history, hospital stay≥30 d, Ⅲ to Ⅳ stages of TNM classification, simultaneous radiotherpy and chemotherapy, and invasive operation (PICC) were found to be risk factors of nosocomial infection (P ＜ 0. 05 or P ＜ 0. 01). Conclusion Risk factors of nosocomial infections are varied. Hence the prevention and control measures should be taken correspondingly to decrease the hospital infection rate.

Objective To explore the value of deep learning(DL)models semi-automatic training system for automatic optimization of clinical image quality control of transthoracic echocardiography(TTE).Methods Totally 1 250 TTE videos from 402 patients were retrospectively collected,including 490 apical four chamber(A4C),310 parasternal long axis view of left ventricle(PLAX)and 450 parasternal short axis view of great vessel(PSAXGv).The videos were divided into development set(245 A4C,155 PLAX,225 PSAXGV),semi-automated training set(98 A4C,62 PLAX,90 PSAXGV)and test set(147 A4C,93 PLAX,135 PSAXGV)at the ratio of 5:2:3.Based on development set and semi-automatic training set,DL model of quality control was semi-automatically iteratively optimized,and a semi-automatic training system was constructed,then the efficacy of DL models for recognizing TTE views and assessing imaging quality of TTE were verified in test set.Results After optimization,the overall accuracy,precision,recall,and F1 score of DL models for recognizing TTE views in test set improved from 97.33％,97.26％,97.26％and 97.26％to 99.73％,99.65％,99.77％and 99.71％,respectively,while the overall accuracy for assessing A4C,PLAX and PSAXGV TTE as standard views in test set improved from 89.12％,83.87％and 90.37％to 93.20％,90.32％and 93.33％,respectively.Conclusion The developed DL models semi-automatic training system could improve the efficiency of clinical imaging quality control of TTE and increase iteration speed.

OBJECTIVE To investigate ameliorative effects and mechanisms of two probiotics （Bacillus subtilis， Lactobacillus acidophilus） combined with Aurantii Fructus Immaturus （AFI） on functional dyspepsia （FD） in rats. METHODS Rats were randomly divided into blank group， model group， positive control group （domperidone group， 2.7 mg/kg）， AFI group （9 g/kg）， L. acidophilus group （5×107 cfu/kg）， B. subtilis group （5×107 cfu/kg）， L. acidophilus+ AFI group （L. acidophilus 5×107 cfu/kg+ AFI 9 g/kg）， and B. subtilis+AFI group （B. subtilis 5×107 cfu/kg+AFI 9 g/kg）， with 8 rats in each group. Except for the blank group， FD model was established by tail-clamping stimulation+hunger and satiety disorder+swimming exhaustion in other groups. After modeling， each group was given the corresponding drug/probiotic suspensions/physiological saline intragastrically， once a day， for 14 consecutive days. After the last medication， gastric emptying rate and the rate of propulsion of the small intestine in rats were measured； the levels of brain-gut peptide-related indicators [gastrin （GAS）， substance P （SP）， vasoactive intestinal peptide （VIP）， somatostatin （SS） and cholecystokinin （CCK）] in the serum of rats were measured. The pathological morphology of the gastric antrum tissue and duodenal tissue was observed. Cecal contents from the rats were collected for gut microbiota sequencing analysis. The protein expression levels of tyrosine kinase receptor c-Kit and stem cell factor （SCF） in the gastric antrum tissue， as well as Toll-like receptor 4 （TLR4）， myeloid differentiation factor 88 （MyD88）， and nuclear factor κB （NF-κB） in the duodenal tissue of the rats were detected. RESULTS Compared with the blank group， model group showed significantly lower gastric emptying rate， small intestinal propulsion rate， serum levels of GAS and SP， relative abundance of Firmicutes， Ace， Chao and Sobs indexes of the gut microbiota， and protein levels of SCF and c-Kit in gastric antrum （P＜0.05）， while serum levels of VIP， SS and CCK， relative abundance of Bacteroidetes， as well as protein expressions of TLR4， MyD88， and NF-κB， were significantly higher （P＜0.05）. The histological structure JZYC23S53） of the gastric antrum tissue appeared basically normal； however， abnormalities were observed in the duodenal structure， with a significant infiltration of inflammatory cells visible. Compared with the model group， all treatment groups significantly modulated most of the above indexes （P＜0.05）. The histological structure of the gastric antrum tissue was normal. Except for the B. subtilis group and the B. subtilis+AFI group， the pathological states of the duodenum in the remaining rats gradually recovered. Compared with each single drug group， most of above indexes in rats from each combination group showed further improvement （P＜0.05）. CONCLUSIONS The combination of AFI with two probiotics can improve gastrointestinal motility in FD rats， and the effect is superior to that of using the drugs alone. The specific underlying mechanisms may be related to the activation of the SCF/c-Kit signaling pathway and the inhibition of the TLR4/MyD88/NF-κB signaling pathway.