Objective To investigate the efficacy and safety of self-help inflatable balloon in the treatment of refractory benign upper digestive tract stricture.Methods From November 2022 to February 2024,10 patients with refractory benign upper digestive tract stricture underwent self-help inflatable balloon were retrospectively analyzed.Preoperative treatment,intraoperative and postoperative complications,dysphagia score before and after surgery,wearing time of external self-help inflatable balloon,and the clinical efficacy were evaluated.Results All the 10 patients received self-help inflatable balloon treatment.No complications such as bleeding and perforation occurred in all patients during the wearing of the balloon.The placement time of the balloon was 60～180 d,and the average wearing time was 104.9 d.Before surgery,nine cases had a stricture segment length less than 2 cm,and one case had a stricture segment length of 6 cm.The dysphagia score before surgery was(3.60±0.52),and the dysphagia score after removal of the self-help inflatable balloon was(0.60±0.52),and there was statistical significance in preoperative and postoperative comparison(P＜0.05).The dysphagia score 3 months after removal of the external self-help inflatable balloon was(0.70±0.48),there was no significant difference in dysphagia score between the day after surgery and 3 months after surgery(P＞0.05).The diameter of the stricture before and after operation was(5.09±2.02)mm and(10.35±0.73)mm respectively,and the difference was statistically significant(P＜0.05).Sore throat,wing of nose pain and balloon displacement were the most common adverse events,with 30.0％(3/10),50.0％(5/10)and 70.0％(7/10),respectively.Conclusion It is safe,effective and feasible to treat refractory benign upper digestive tract stricture with self-help inflatable balloon in vitro.It is worthy for clinical application.

Objective To investigate the efficacy and safety of self-help inflatable balloon in the treatment of refractory benign upper digestive tract stricture.Methods From November 2022 to February 2024,10 patients with refractory benign upper digestive tract stricture underwent self-help inflatable balloon were retrospectively analyzed.Preoperative treatment,intraoperative and postoperative complications,dysphagia score before and after surgery,wearing time of external self-help inflatable balloon,and the clinical efficacy were evaluated.Results All the 10 patients received self-help inflatable balloon treatment.No complications such as bleeding and perforation occurred in all patients during the wearing of the balloon.The placement time of the balloon was 60～180 d,and the average wearing time was 104.9 d.Before surgery,nine cases had a stricture segment length less than 2 cm,and one case had a stricture segment length of 6 cm.The dysphagia score before surgery was(3.60±0.52),and the dysphagia score after removal of the self-help inflatable balloon was(0.60±0.52),and there was statistical significance in preoperative and postoperative comparison(P＜0.05).The dysphagia score 3 months after removal of the external self-help inflatable balloon was(0.70±0.48),there was no significant difference in dysphagia score between the day after surgery and 3 months after surgery(P＞0.05).The diameter of the stricture before and after operation was(5.09±2.02)mm and(10.35±0.73)mm respectively,and the difference was statistically significant(P＜0.05).Sore throat,wing of nose pain and balloon displacement were the most common adverse events,with 30.0％(3/10),50.0％(5/10)and 70.0％(7/10),respectively.Conclusion It is safe,effective and feasible to treat refractory benign upper digestive tract stricture with self-help inflatable balloon in vitro.It is worthy for clinical application.

Objective:To investigate the incidence and prothrombotic risk factors of postoperative venous thromboembolism(VTE) in Cushing′s disease and to further develop an assessment model to identify those at high risk of postoperative VTE events.Methods:A retrospective study was performed in 82 patients who were admitted to Huashan Hospital, Fudan University during January 2019 and January 2020 and diagnosed with Cushing′s disease. These patients underwent the evaluation about their clinical, hormonal, and coagulation parameters, as well as ultrasonography and pulmonary angio-CT when necessary. The least absolute shrinkage and selection operator(LASSO) regression analysis was used to screen independent risk factors, and a nomogram model for postsurgical VTE risk assessment in Cushing′s disease was initially established, and Bootstrap method was used for internal verification. Finally, the predictive model was evaluated for calibration and clinical applicability in the study cohort.Results:Nineteen patients(23.17%) developed VTE events, with 14 cases occurring after endoscopic transsphenoidal surgery. Compared to patients without VTE, those in the VTE group were older( P<0.001), had longer postoperative bed rest, higher rates of current infection, higher HbA 1C levels, and more severe glucose tolerance impairment(all P<0.05). Through LASSO regression analysis, two independent risk factors for postoperative VTE were identified: Age and current infection. Then a VTE risk assessment nomogram model was established to predict the patients at high risk of VTE. In the nomogram model for VTE risk assessment, the area under the receiver operating characteristic curve was 0.868(95% CI 0.787-0.949), with the calibration curve closely aligning with the ideal diagonal line and the clinical decision curve exceeding the two extreme curves. Conclusions:Advanced perioperative assessment needs to be taken to screen those with high VTE risks in patients diagnosed with Cushing′s disease. Additionally, during the perioperative period, patients with Cushing′s disease should undergo mandatory physical activity or prophylactic anticoagulant therapy.

Objective To investigate the efficacy and safety of endoscopic dilatation in treatment of esophageal stenosis after esophageal varices sclerotherapy.Methods Clinical data of 17 patients with esophageal stenosis after sclerotherapy for esophageal varices from January 2014 to December 2023 were retrospectively analyzed,and they were divided into balloon expansion group and bougie expansion group.The remission rate and recurrence rate of esophageal stenosis after endoscopic dilation were analyzed,as well as the incidence of intraoperative complications such as intraoperative bleeding,perforation,infection and chest pain.Results 50 endoscopic dilation treatments were performed in 17 patients.The stenosis remission rate after the first dilation was 76.47％,and the recurrence rate was 53.85％.The total number of dilation required for complete remission of esophageal stenosis ranged from 1 to 15 times,and the median required dilation was 2 times,and 35.29％ (6/17)only needed 1 dilation to complete remission.Intraoperative laceration bleeding occurred in 4.00％ (2/50) requiring endoscopic hemostasis.Fever occurred in 6.00％ (3/50),chest pain occurred in 2.00％ (1/50),and no other complications such as perforation and mediastinal infection occurred.The relief rate of balloon dilatation was higher than that of bougiate dilatation,and the difference was statistically significant (P<0.05).There were no significant differences in recurrence rate and complication rate between the two groups (P>0.05).Conclusion Endoscopic dilatation is generally safe and effective in the treatment of esophageal stenosis after sclerotherapy for esophageal varices,and balloon dilatation is superior to bougiate dilatation in the relief of stenosis.

Objective To investigate the efficacy and safety of endoscopic dilatation in treatment of esophageal stenosis after esophageal varices sclerotherapy.Methods Clinical data of 17 patients with esophageal stenosis after sclerotherapy for esophageal varices from January 2014 to December 2023 were retrospectively analyzed,and they were divided into balloon expansion group and bougie expansion group.The remission rate and recurrence rate of esophageal stenosis after endoscopic dilation were analyzed,as well as the incidence of intraoperative complications such as intraoperative bleeding,perforation,infection and chest pain.Results 50 endoscopic dilation treatments were performed in 17 patients.The stenosis remission rate after the first dilation was 76.47％,and the recurrence rate was 53.85％.The total number of dilation required for complete remission of esophageal stenosis ranged from 1 to 15 times,and the median required dilation was 2 times,and 35.29％ (6/17)only needed 1 dilation to complete remission.Intraoperative laceration bleeding occurred in 4.00％ (2/50) requiring endoscopic hemostasis.Fever occurred in 6.00％ (3/50),chest pain occurred in 2.00％ (1/50),and no other complications such as perforation and mediastinal infection occurred.The relief rate of balloon dilatation was higher than that of bougiate dilatation,and the difference was statistically significant (P<0.05).There were no significant differences in recurrence rate and complication rate between the two groups (P>0.05).Conclusion Endoscopic dilatation is generally safe and effective in the treatment of esophageal stenosis after sclerotherapy for esophageal varices,and balloon dilatation is superior to bougiate dilatation in the relief of stenosis.

Apoptosis ; Autophagy ; Ferroptosis ; Iron/metabolism* ; Sequestosome-1 Protein/metabolism* ; Ubiquitin-Specific Proteases/metabolism*

Objective To investigate the changes of metamorphopsia between before and after surgery in the patients with idiopathic epiretinal membrane and its influence factors.Methods A series cases observitional study included 39 eyes of 39 patients with idiopathic epiretinal membrane.Follow-up was carried out at 1 week before surgery and 3,6 months after surgery respectively.M-chart was used to quantify the severity of metamorphopsia (M-score).EDTRS visual chart was used to quantify best corrected visual acuity (BCVA) (converted to LogMAR).Central subfield thickness (CST),central foveal volumn (CV),cube average thickness (CAT),central foveal thichness (CFT),ganglion cell layer (GCL) thickness,inner nuclear layer (INL) thickness,outer nuclear layer (ONL) and outer plexiform layer (OPL) thickness,the integrity of external limiting membrane,ellipsoid zone and interdigitation zone were analyzed by using spectral domain-optical coherence tomography (OCT).This study protocol was approved by Ethic Committee of Beijing Tongren Hospital (No.TRECKY-012).Written informed consent was obtained from each subject before surgery.Results Mean M-score was significantly decreased from 0.8 (0.3,1.1) before surgery to 0.5 (0.2,0.8) at 3 months after surgery,with a significant difference between the two time points (Z=-2.013,P=0.044).Mean M-score was 0.6(0.2,0.8) at 6 months after surgery,which was not significantly different in comparison with before surgery and 3 months after surgery (Z =-1.873,P =0.061;Z =-0.288,P =0.773).Compared with before surgery,the horizontal M-score was significantly decreased 3 months and 6 months after surgery (Z =-2.329,P =0.020;Z =-2.858,P =0.004).No significant difference was found in vertical M-score among before surgery and 3,6 months after surgery (all at P＞0.05).The BCVA was improved from 0.40 (0.30,0.66) before surgery to 0.20 (0.06,0.42) 3 months after surgery and declined to 0.30 (0.10,0.52) at 6 months after surgery,and significant differences were obtained between 3 months after surgery and before surgery or 6 months after surgery (Z =-4.087,P＜0.001;Z =-2.235,P =0.025).Compared with before surgery,the BCVA in cataract combined with vitrectomy operative group was significantly improved in 3 months and 6 months after surgery (Z=-2.613,P=0.009;Z=-2.466,P=0.014) and the BCVA in only vitrectomy group was significantly improved at 3 months after surgery but decreased 6 months after surgery,showing significant differences between 3 months after surgery and before surgery or 6 months after surgery (Z =-3.104,P =0.002;Z =-3.464,P =0.001).Preoperative M-score was positively correlated with preoperative BCVA,preoperative CST or preoperative CFT (rs =0.384,P =0.016;rs =0.585,P＜0.001;rs =0.601,P＜0.001).No correlation was found between BCVA with GCL,INL or ONL + OPL thickness.Horizontal M-score was positively correlated with CST,postoperative CV and postoperative CAT (rs=0.322,P=0.045;rs=0.340,P=0.034;rs =0.336,P=0.036),and no correlation was found between horizontal M-score and BCVA,CFT,GCL thickness,INL thickness,ONL+OPL thickness in 6 months after surgery.The vertical M-score and mean M-score were not correlated with OCT parameters in 6 months after surgery.The mean M-score was positively correlated with preoperative mean M-score,preoperative CST,preoperative CV,preoperative CAT in 6 months after surgery (rs =0.589,P＜0.001;rs =0.330,P =0.040;rs =0.404,P =0.011;rs =0.410,P =0.009).In addition,and no significant correlation between mean M-score and preoperative BCVA,CFT,GCL thickness,INL thickness,ONL+OPL thickness.Multivariate stepwise linear regression showed that preoperative M-score was a predictor of postoperative M-values (adjusted R2 =0.211,P =0.002).Conclusions Most metamorphopsia can be alleviated after idiopathic epiretinal membrane surgery.The residue metamorphopsia after surgery probably is correlated with preoperative metamorphopsia and CFT.

Objective To evaluate the relationship of retinal sensitivity (MS) with vision-related quality of life in patients with idiopathic macular hole (IMH).Methods A prospective cohort study was performed in this study.Thirty-one monocular IMH patients were enrolled in Beijing Tongren Hospital from May to September of 2017.Vision-related quality of life (VR-QoL) was analyzed in 31 patients with National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) (Chinese version),and MS in the affected eye and the fellow eye in these patients was detected by Microperimeter-3.MS and best corrected visual acuity (BCVA) between the affected eye and the fellow eye were compared.The correlations among BCVA,age,MS,minimum macular hole diameter,composite scores and subscales score were evatuateds.This study protocol was approved by Ethic Committee of Beijing Tongren Hospital.This study complied with Declaration of Helsinki.Results There were significant correlations between composite scores and MS in the affected eye and the fellow eye (affected eye:ρ=0.484,P=0.006;fellow eye:ρ=0.387,P =0.031).Significante correlations were shown in near activities (affected eye:ρ =-0.353,P =0.048;fellow eye:ρ =0.352,P =0.048) and distance activities (affected eye:ρ =0.496,P =0.004;fellow eye:ρ =0.415,P =0.015).No obvious correlations were shown between VR-QoL and BCVA or minimum hole diameter.The correlation between composite scores and the MS in the affected eye was the most strong.Conclusions MS can reflect the retinal function in patients of IMH more widely.The correlations VR-QoL and MS is correlated in the affected eye and fellow eye in patients of monocular IMH,however,patient's VR-QoL dependes more on the affected eye.IMH can violate the patient's near and distance activities.

Objective To research the relationship between high temperature and population death in cardio-cerebrovascular diseases in Shijiazhuang.Methods The time series of maximum daily temperature and daily death number of cardio-cerebrovascular diseases were described,and the relationship between daily maximum temperature and daily mortality of cardio-cerebrovascular diseases in summer was analyzed.The impact of daily highest temperature in summer from 2009 to 2011 on daily death of cardio-cerebrovascular diseases was analyzed.Results In summer,the highest temperature which could reach to 41.7℃ emerged mostly in July and August,and when the highest temperaiure was higher than 34℃,cardio-cerebrovascular diseases death increased obviously as the temperature increasing.The relative humidity was more than 70％ in most time of the year round.The excessive death in hot days accounted for 10.9％ in which the old people occupied the majority.Conclusion The extreme high temperature may obviously increase the cardio-cerebrovascular death in Shijiazhuang.

Objective To compare the efficacy, toxicity and later period complications of Cf-252 neutron intracavitary brachytherapy(IBT) combined with external-beam radiotherapy (EBRT) with those of EBRT alone in patients with esophageal carcinoma. Methods Eighty-six patients were randomized into 252Cf neutron IBT and EBRT group (intracavitary group: 43 patients) and EBRT alone group (external group:43 patients). The external group was treated with three-dimensional conformal radiotherapy(3DCRT) or conventional radiotherapy of 70 Gy in 7.0 weeks using Elekta Precise medical linear accelerator. The EBRT in intraeavitary group was as same as external group, except the total dose was decreased to 60 Gy in 6.5 weeks. For IBT, the applicator with special water bursa was settled to the esophageal lesion through the mouth. The dose calculation point was 10 mm far away from the source and 1-2 em cranial-caudally from the tumor margin. 252Cf braehytherapy was delivered 3-4 fractions at 4 Gy per fraction per week. In intracavitary group, EBRT was begun on the second day of IBT. EBRT and IBT were not given on the same day. Results After the treatment,the esophageal stricture was relieved earlier in intracavitary group than external group.Six patients in intracavitary group who had drinking obstruction symptom could eat liquid food after esophageal balloon dilation, one fraction of 252 Cf neutron IBT and 5-6 days of EBRT, and could eat semiliquid food two weeks after. In the third month, the complete response rate, partial response rate and no response rate were 33%, 67% and 0% in i ntracavitary group and 19% ,76% and 5% in external group, respectively. The overall response rates of the two groups were 100% and 95% ( χ2 = 4.32, P ＜ 0.05 ). The 1 -year local control rates were 84% and 70% (χ2 =4.57 ,P ＜0.05). The 1-year survival rates were 81% and 61% (χ2 =4.17,P ＜0.05 ). The rates of acute esophageal toxicity was 61% and 51% ( χ2 = 1.75,P ＞ 0.05 ). The acute radiation esophagitis was slightly higher in "BZ ]intracavitary group than that in external group, but the difference was insignificant. The late esophageal-cardiac stricture had no significant difference between the two groups. Conclusions 252 Cf-252 neutron IBT plus EBRT, without increasing the toxicity,are better than EBRT alone.