Objective To explore the effects of different ways of nutritional support on organ functional recovery and prognosis in the elderly with multiple organ dysfunction syndromes (MODS).Methods 85 patients with MODS were randomized into enteral nutrition(EN) group (n=43 cases)and total parenteral nutrition(TPN) as control group (n=42 cases).EN group received nutritional support by nasogastric feeding tube or percutaneous endoscopic gastrotomy (PEG)/ percutaneous endoscopic jejunostomy (PEJ),and TPN group got nutrition by central vein for at least 2 months of therapeutic course.Body mass index (BMI),hemoglobin (HB),functions of liver and kidney,electrolytes,blood glucose and lipid,serum albumin(ALB),transferring(TRF),prealbumin (PA),immunoglobulin(IgA,IgG,IgM),leukomonocyte (CD3+,CD4+,CD4+/CD8+) were compared between two groups before and after treatment.Results The levels of Hb,BMI,ALB,TRF and PA after treatment for 1 and 2 months significantly improved (t1EN =2.672,2.440,2.209,3.331,5.025,t1TpN=2.720,2.337,2.179,3.418,2.221 and tEN2nd maonh=2.279,3.021,2.337,3.005,5.779,tTPN2nd month=2.118,2.956,3.018,3.310,2.119,all P＜0.05) in two groups as compared with before treatment,and there was remarkable difference in the level of PA between EN group and TPN group(t=2.336,P＜0.05).Hyperlipemia at 1 and 2 months after treatment occurred in TPN group (t1TPN =3.609,t2TPN =3.114,P＜0.05).The levels of IgG (t1st month=2.664,t2nd month =2.983,P＜0.05) and IgA (t1st month =2.437,t2nd month =3.005,P＜0.05) were higher after treatment for 1 and 2 months than before treatment.The levels of CD3+,CD4+ and CD4+/CD8+ cells improved (t2nd month =2.399,3.478,2.579,3.995,P ＜ 0.05 ) and IgM (t2nd month =3.886,P＜0.05) increased after treatment for 2 months in EN group.In EN group,aspiration pneumonia appeared in 34 cases and the occurrence rate decreaed (x2 =51.12,P ＜ 0.05 ) after PEG/PEJ operation (only 5 cases).Reflux esophagitis reduced and alleviated 2 months after PEG/PEJ operation (x2=13.53,P＜ 0.05).ConclusionsTimely sufficient EN support may improve nutritional and immunological status in elderly patients with MODS.PEG/PEJ can reduce the occurrence of aspiration pneumonia and reflux esophagitis caused by the nasogastric feeding tube.

ObjectiveTo discuss the hematological adverse reactions of oral omeprazole administration with convention dosage and treatment course in aged patients.MethodsFour hundred and nine cases of reflux esophagitis by endoscopic diagnosis from Beijing Hospital during January 2000 to December 2010 were divided into three groups according to their ages: group A ( 168 cases) aged from 60 to 69 years,group B ( 152 cases) aged from 70 to 79 years and group C (89 cases) aged equal to or above 80 years.Each group of patients was randomly divided into three subgroups,A 1 ( 56 cases),B 1 ( 51 cases) and C 1 ( 30 cases ) were administered with oral omeprazole,20 mg,bid; A2 ( 56 cases ),B2 ( 51 cases ) and C2 ( 30 cases ) were administered with oral famotidine,20 mg,bid; A3 ( 56 cases),B3 ( 50 cases),C3 ( 29 cases ) and all above subgroups were administered with oral sucralfate,10 ml,tid.The treatment course lasted for one month.The clinical efficacy,WBC count,RBC count,the Hemoglobin level,platelet count,as well as the prothrombin time,thrombin time,activated partial thromboplastin time,fibrinogen,Plasma fibronectin and serum D-Dimer were tested and compared after 10-days and 30-days treatment.ResultsAfter the treatment,all the patients had alleviated symptoms,to varied extend,especially in subgroups treated with oral omeprazole and sucralfate.After 30 days' treatment,blood WBC counting in B1 subgroup declined to lower than normal values in two cases; PLT counting drops in 1 case; blood WBC dropped in 6 cases and PLT dropped in4 cases of the C1 subgroup;blood WBC counting dropped in 1 case and PLT dropped in 2 cases of the C2 subgroup.Hemoglutination did not show significant change in all groups (P ＞ 0.05 ).Conclusion The hematological adverse reactions of oral omeprasole in aged patients,under convention dosage and treatment course,occured with age increase,especially for blood WBC and platelet counting.

Objective To investigate the effect of Helicobacter pylori (Hp) plantation in Barrett's esophagus (BE) columnar epithelium on esophageal adenocarcinoma (EA) in the elderly.Methods 109 patients with reflux esophagitis (RE),51 patients with Barrett's esophagus and 16 patients with esophagus adenocarcinoma were diagnosed by endoscopy and pathological biopsy.The 4-quadrant biopsies in esophagus lesions were respectively taken from each patients.1 were tested by silver staining and urease test for rapid detection of Hp,and the other were stained by HE staining for pathological analysis,AB /PSA staining and immunohistochemistry for gene expressions of cyclooxygenase-2 (COX-2) and B cell lymphoma / leukemia-2 (Bcl-2).Results Hp colonization in RE group,BE group and EA group were 0％,44.4％ and 42.1％ respectively.The expression levels of COX-2 in abnormal squamous epithelium in RE group,BE group and EA group were 46.7％,100％ and 100％ respectively.The expression of COX-2 was higher in BE and EA groups than in RE group (x2=126.21,both P＜0.05).Moreover,a gradually increase in COX-2 expression was observed in abnormal esophageal squamous epithelium from RE to BE to EA.COX-2 expression was significantly increased in mucosa in BE and EA patients with Hp plantation and in lower esophageal carcinoma in EA patients with Hp plantation and without Hp plantation.Bcl-2 expression in esophageal squamous epithelium was 40.2％,85％ and 100％ in RE,BE and EA groups respectively.The expression of Bcl-2 was higher in BE and EA groups than in RE group (x2 =125.25,P＜0.05).Bcl-2 expression was increased in mucosa BE patients with Hp plantation.Conclusions Hp plantation in BE esophageal columnar epithelium can increase the expression of COX-2,and induce its downstream Bcl-2 expression,inhibit cell apoptosis,and might lead to EA.

Objective To analyze the clinical characteristics of gastric polyps in different histopathological types. Methods Based on histopathological difference, gastric polyps were categorized into fundic gland polyps, hyperplastic polyps, inflammatory polyps, adenomatous polyps, etc; Different types of polyps in the aspects of distribution, Helicobacter pylori (H. pylori) infection, the relationship between the proton pump inhibitors (PPI) and the occurrence of gastric polyps to provide guidance on treatment Results 365 cases of gastric polyps were diagnosed in 10 197 patients who underwent gastroscopy. The prevalence was 3. 6%. The histopathological type of the polyps were fundic gland polyps (61. 1%), hyperplastic polyps (23. 3%) , inflammatory polyps (12. 3%) , adenomatous polyps (2. 2%). 289 cases showed single polyps, which was the majoriry across all types of gastric polyps. Majority of the gastric polyps were located in gastric body and fundus, followed by gastric antrum and cardia Most of the fundic gland polyps were located in gastric body and fundus; Majority of the hyperplastic polyps and adenomatous polyps were located in gastric antrum; The main locations of inflammatory polyps were cardia and gastric body and fundus. A higher percent (51. 6%) of fundic gland polyps patients used PPI. The difference was statistically significant compared with the hyperplastic polyps(8. 2%)and inflammatory polyps group(8.9%) (x2 = 48. 31,27. 63 ,P <0. 01). The H. pylori infection rate of hyperplastic polyps and inflammatory polyps were 72.4% and 74.4% ,respectively, both of which were higher than that of fundic gland polyps(20. 2%)(x2 =46. 50,35. 04, P < 0. 01) . One year after the H. pylori eradication, the recurrence cases of hyperplastic polyps and inflammatory polyps were 1/41 and 0/19,respectively. Conclusions The main histopathological type of gastric polyps is fundic gland polyps followed by hyperplastic polyps. The main location of the gastric polyps is gastric body and fundus, followed by gastric antrum and cardia. The distribution of different types of gastric polyps has some characteristics. Long-time usage of PPI may increase the risk of fundic gland polyps. The occurrence of hyperplastic polyps and inflammatory polyps may be related to H. pylori infection. The H. pylori eradication helps preventing the recurrence of hyperplastic and inflammatory gastric polyps.

Objective To summarize the clinical and pathological data of gastric polyps under gastroscope,and to investigate the clinical characteristics of gastric polyps in elderly patients.Methods The 692 cases of gastric polyps diagnosed by gastroscopy and pathology were retrospectively analyzed.The elder group was defined as aged 60 years and over.The young group was defined as aged less than 60 years.The data were analyzed by SPSS software.Results The detected ratios of gastric polyps were 3.9% in the elder group and 2.9% in the young group (χ2 =15.792,P<0.01).The rates of gastric polyps found in fundus,gastric body and gastric antrum were 32.0%,41.3% and 19.8% respectively in the elder group.And the corresponding rates in the young group were 37.5%,45.8% and 11.1% respectively (χ2 = 2.277,1.404,10.289,P = 0.131,0.236,0.001).The pathological types of the gastric polyps were in the order of fundic gland (60.0%),hyperplastic (26.2%),inflammatory (11.3%),adenomatous (1.7%) and others (0.8%).The diagnostic rates of hyperplastic polyps in the elder group and the young group were 31.7% and 21.9% respectively;the corresponding rates of adenomatous polyps were 3.0% and 0.8% respectively (χ2 = 8.525,4.834,P=0.004,0.028).Conclusions The detected ratio of gastric polyps is higher in the elder group than in the young group.In both groups,the polyps in the fundus and the body are more prevalent,followed by those in the antrum.The diagnostic rate of polyps in the antrum is significantly higher in the elder group than in the young group.Although the main pathological type of the gastric polyps is fundic gland in both groups,the diagnostic rates of hyperplastic polyps and adenomatous polyps are both higher in the elder group,the risk of cancer is higher as well.Therefore,in the elderly,the gastric polyps are recommended to be cut off as soon as possible and followed up closely.

BACKGROUND:Proteoglycan, chondroitin sulfate and keratan sulfate, and hyaluronic acid are important substances in the maintenance of intervertebral discs of normal structure. They impact the physiological function of intervertebral disc.
OBJECTIVE:To observe the influence of Liuwei Dihuang Wan on proteoglycan in rabbit models of intervertebral disc degeneration, and to study the efficacy of Liuwei Dihuang Wan on prevention and treatment of intervertebral disc degeneration.
METHODS:80 New Zealand rabbits were randomly divided into Liuwei Dihuang Wan group, model group, sham surgery group and blank control group (n=20 per group). Animal models of intervertebral disc degeneration were established in the model and Liuwei Dihuang Wan groups. In the sham surgery group, surgery via the same approach to expose the lumbar spine was conducted fol owed by layer-by-layer suturing. In the Liuwei Dihuang Wan group, rabbits were given 10 mg/kg Liuwei Dihuang Wan by lavage, once a day. In the model group, sham surgery group and blank control group, rabbits were given an equal volume of physiological saline, once a day, by natural feeding. At 2, 4, 6 and 8 weeks, five rabbits from each group were sacrificed, and intervertebral disc specimens were taken to measure proteoglycan components in the intervertebral disc.
RESULTS AND CONCLUSION:With the extension of feeding time, Liuwei Dihuang Wan could increase sugar amino polysaccharide content, chondroitin sulfate/acid ratio of keratin, and hyaluronic acid content in the intervertebral disc degeneration model, and stabilized the proteoglycan content. Thus, it delayed the degeneration of the intervertebral disc to a certain extent.

Objective To investigate the clinical manifestations,pathological features hy endoscopy and possible risk factors of ischemic colitis (IC).Methods A retrospective analysis was made upon 89 hospitalized patients diagnosed as IC.Logistic regression analysis was performed to determine morbidity risk factors.Results The majority of patients with IC in our study group had histories of hypertension,heart disease,hyperlipidemia,diabetes,etc.The common features included abdominal pain (80.9％,72/89),hematochezia (76.4％,68/89),etc.Colonic mucosal lesions presented regional distribution under colonoscope (80％,72/89),with manifestations of petechial hemorrhages,edema,segmental erosion,pleomorphism ulcerations,visible lesion edge and sharply defined segment of involvement,even be characterized by lumens stricture (13.5％,12/89).Histopathological examination revealed mucosa edema,necrosis,hemorrhage and formation of ulceration,inflammatory cell infiltration,and submucous hemorrhage,etc.Laboratory examination showed that white blood cells,neutrophils,serum fibrin,D-Dimer,serum TC,TG and serum apolipoprotein B were higher than normal.Colonic mueosal roughness,thumbmark symptoms,etc,and even bowel limited spasm,stricture or curtailment were visible in 47 patients underwent barium enema.Colonic wall thickening was visible in 29 patients underwent mesentericography,however,strictured or closed blood vessels were not found logistic regression analysis showed that hypertension,diabetes,higher TG,atrial fibrillation were strongly associated with onset of IC (all P values ＜ 0.05).Conclusions Since IC symptoms are not typical,it requires early colonoscopy to clarify diagnosis.Hypertension,diabetes,hyperlipidemia,and atrial fibrillation are risk factors for IC.

Objective To observe the effects of enteral nutrition on the glucose and fat metabolism in elderly patients with metabolic symdrome (MS) and nonalcoholic fatty liver disease (NAFLD).Methods The 109 patients with MS and NAFLD were randomized into enteral nutrition(EN)(n=55)and total parenteral nutrition(TPN) (n=54) group.The EN patients received aggressive enteral nutrition therapy,the TPN patinets got the treatment of total parenteral nutrition.The body mass index (BMI),liver function,blood glucose,blood liquid and hepatic ultrasonography were observed in two groups.Results After treatment of 2 monthes,the values of BMI,TG and LDL-C were decreased,2 hBG,HbA1c,ALT,AST and BIL were significant improved in enteral nutrition group in comparison with pretherapy (P＜0.05),while not significantly different in total parenteral nutrition group(P＞0.05).There were 55.6 ％ (10/18) patients changing from middle fatty liver mild fatty liver in enteral nutrition group,while only 46.2％ (6/13) in TPN group (P＞0.05).Conclusions EN support is superior to TPN in improving the glucose and fat metabolism in elderly patients with MS and NAFLD.

Objective To study the influence of anti-Helicobacter pylori therapy on reflux esophagitis (RE) and Barrett's esophagus (BE). Methods Two hundred and sixty-two patients including 177 patients with RE and 85 patients with BE were divided into 2 groups: Group A,139 patients without Hp infection;Group B,123 patients with Hp infection, which was further divided into 2 groups (group B1 and group B2) randomly. The pa-tients in group A and B1 were treated with Losec 20 mg bid, domperidone 10 mg tid and colloidal bismuth pectin 100 mg tid for 8 weeks, group B2 were treated with 2 kinds of antibiotics which were chosen from 3 types of antibiot-ics including amoxicillin 500 mg bid, Clarithromycin 500 mg bid or tinidazole 500 mg bid for 2 weeks additional to the same treatment as group A and B1. Endoscopy, pathologic examination, 24 h esophagus pH value and bilirubin were measured before and after treatment. Results The overall rates of improvement on symptoms in the 3 groups were 95.0% (group A: 97.8% (136/139), group B1: 96.8% (60/62), group B2: 98.4% (60/61)), which was significantly different from that before treatment (P < 0.05). However, the overall effect rates were not significantly different among the 3 groups (P > 0.05). The overall effect rate based on endoscopy examination in the RE patients 92.9% (78/84),91.8% (45/49) and 88.6% (39/44) in group A,B1 and B2,respectively,and the differences were statistically significant among the 3 groups (P <0.05). The overall effect rates in the BE patients were about 35.0%,which showed non-significant effect compared to that before treatment (P >0.05). 24 hrs esophagus PH value and bilirubin were significantly improved in the 3 groups (P < 0.05), whereas the difference among the 3 groups were not significant (P > 0.05). Conclusions RE and BE patients with HP infection could be treated with anti-Helicobacter pylori therapy. However, systematic therapy of anti gastric acid, prokinetics and mucosa protector must be performed simultaneously. This might be effective in preventing the development of RE and BE in short term. The long term effect is still uncertain and large scale, long term clinical studies are needed.

Objective To investigate the relationship between the recurrence of Barrett esophagus (BE) and Helicobacter pylori (Hp) eradication therapy, according to endoscopic follow-up outcomes in the elderly patients with BE after endoscopic argon plasma coagulation (APC). Methods A total of 201 elderly patients were enrolled to be treated with APC, including 53 patients without Hp infection (control group) and 148 cases with Hp infection (infection group), then the infection group was randomly divided into two groups: infection group A (n=74) and infection group B (n=74). After APC, all patients were given acid suppression therapy with omeprazole infusion 40 mg twice daily for 7 days, then omeprazole capsules 20 mg twice a day orally, the overall time was 2months. The patients in infection group B received Hp eradication therapy with two of the following three kinds of antibiotics for 2 weeks: amoxicillin 500 mg twice a day, clarithromycin 500 mg twice a day and tinidazole 500 mg twice a day. All patients received reexamination of endoscopy and pathology, and underwent 24-hour esophageal pH test 1, 3, 6, 12 and 24 months after treatment.Results By APC treatment for an average of 2.4 times (1-3 times), 1 month after treatment, all BE epithelium disappeared and stratified squamous epithelium was repaired completely. Reflux esophagitis (RE) and BE in some cases were found in 3 groups 3 months after therapy. The relapse incidence of RE was significantly increased at 6 months after therapy [control group: 22.6%, infection group A:12.2o%and infection group B: 17. 6%, t = 2.21, 2.17 and 2.30,P＜0. 05]. At 12 months after therapy, the relapse incidence of BE was significantly increased [control group: 22.6%, infection group A: 18.9% and infection group B: 23.0%, t=2.11, 2.19 and 2.32, P＜0. 05]. All patients presented pathological gastro-esophageal reflux (DeMeester index＞14.72) before treatment. At 1 month after therapy, all patients returned to normal DeMeester index[control group: 14.5, infection group A: 15.2 and infection group B: 12.0, t=2.09, 2.22 and 2.15, P＜0. 05]. At 6 months after treatment, DeMeester index increased (t=2.29, 2.33 and 2.14, P＜0.05). But there were no significant differences among 3 groups (P＞0. 05). Conclusions The elderly BE patients with HP infection in gastric antrum can receive APC treatment plus Hp eradication treatment, but it has no significant effect on long-term prognosis for BE patients. APC treatment can completely remove BE epithelium, long-term acid suppression therapy may delay recurrence of BE.