Objective:To investigate the clinical manifestations and prognosis of severe coronal virus disease 2019(COVID-19)pneumonia combined with coronary artery disease(CAD)in the elderly.Methods:A total of 351 old patients(&ge;60 years)with severe COVID-19 pneumonia combined with CAD admitted to Tongji Hospital of Wuhan from February 2020 to March 2020 were enrolled in this retrospective study.The patients were divided into CAD group(n=52)and non-CAD group(n=299). The clinical data, the changes of blood tests and cardiovascular complications were observed.Results:Compared with non-CAD group, CAD group showed a longer time of stay in hospital[(12.3±2.6)d and(9.3±2.1)d, t=3.24, P=0.002], and higher incidence of cardiovascular complications, such as myocardial infarction(7.7% and 0.0%, χ2=21.6, P<0.001), heart failure(15.4% and 0.3%, χ2=34.7, P<0.001), arrhythmia(50.0% and 12.4%, χ2=24.45, P<0.001)and all-cause mortality(15.4% and 4.3%, χ2=7.94, P=0.005). The serum levels of interleukin-2 receptor, interleukin 6, CK-MB, cTnI, NT-proBNP, D-dimer and fibrinogen were higher in CAD group than in non-CAD group.The oxygenation index was significantly lower and the blood lactic acid level was higher in CAD group than in non-CAD group. Conclusions:The aged patients with severe COVID-19 pneumonia combined with CAD show obvious inflammatory reaction, high incidence of cardiovascular complications and high mortality.

Objective To investigate the clinical,endoscopic and pathological features of gastritis cystica profunda (GCP).Methods A total of 40 patients with GCP confirmed by pathology who received endoscopic or surgical treatment at Renji Hospital,School of Medicine,Shanghai Jiaotong University from May 2013 to May 2018,were included in the retrospective analysis.The clinical data such as population composition,clinical manifestations,endoscopic findings and pathological results were summarized and analyzed.Results Among the 40 patients were predominantly males (75.0％,30/40),and the mean age of onset was 61.2 years.The most common sites were cardia (32.5％,13/40) and gastric antrum (30.0％,12/40).The clinical symptoms of the patients were atypical and it was difficult to diagnose GCP with routine endoscopy examination.The endoscopic findings were mostly type 0-Ⅱ (50.0％,20/40).GCP with neoplastic lesions accounted for 55％ (22/40).Unconditional logistic regression analysis showed that male (P =0.013,OR =31.093,95％ CI:2.079-464.976) and Helicobacter pylori infection (P =0.041,OR =10.225,95％ CI:1.096-95.411) were risk factors for GCP with neoplastic lesions.Conclusion GCP commonly occurs in middle-aged and elderly men,and varies in different manifestations under white light endoscopy.GCP is not a benign lesion,but can also coexist with neoplastic lesions,which are mostly differentiated intramucosal cancer.

Objective:To investigate the relationship of polymorphism of leptin receptor gene Gln223Arg with asthma and metabolic syndrome.Methods: Collected 120 asthma patients,92 metabolic syndrome patients,54 asthma combined metabolic syndrome patients and 81 normal controls.According to the severity,the asthma patients were divided into mild-medium group and severe group.The serum leptin level was measured by ELISA,the genotypes of leptin receptor were analyzed by the method of polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP),and statistcs of each subject′s MBI,blood pressure,lung function and fasting blood glucose were collected.Results: ①There were significant differences in genotype and allele frequency in leptin receptor gene Gln223Arg between the metabolic syndrome group,asthma combined metabolic syndrome group and normal control group(P<0.05).②The allele frequency and genotype in leptin receptor gene Gln223Arg were significant different between the severe asthma group and normal control group(P<0.05).③The serum leptin level,BMI and systolic blood pressure of AA+AG genotype group were significiant higher than GG genotype group(P<0.05),while the value of FEV1% and FEV1/FVC of lung function were lower than GG genotype group(P<0.05).Conclusion: Leptin receptor gene Gln223Arg polymorphism is correlated with asthma and metabolic syndrome,and by causing leptin resistance,the A allele might be the genetic factor that contribute to individual susceptibility for asthma and metabolic syndrome.

Objective To investigate the clinical characteristics and prognosis in the patients with type 2 diabetes mellitus and invasive pulmonary aspergillosis(IPA) for better management of the disease .Methods Clinical data of 9 cases of type 2 diabetes associated with IPA treated in Qingdao Municipal Hospital from January 2008 to December 2013 were analyzed retrospectively . Results The diagnosis of IPA was proven in 5 and probable in 4 of the 9 patients .The main clinical manifestations were fever , cough and expectoration .The findings of CT scan mainly showed pulmonary nodules along the bronchovascular bundle and cavity signs .Bronchoscopy showed congestion ,edema ,and erosion of bronchial mucosa covered with yellow‐white or brown pus ,partially or completely blocking the lumen .Antifungal treatment was effective for 4 patients .The other five patients died . Conclusions Type 2 diabetes mellitus is a risk factor for developing invasive pulmonary aspergillosis .Early diagnosis and proper treatment are critical for improved prognosis .

Adult ; Aged ; Aspergillosis ; epidemiology ; Female ; Humans ; Lung Diseases, Fungal ; epidemiology ; Male ; Middle Aged

ObjectiveTo investigate the long-term (＞1 year) rebleeding rate after capsule endoscopy (CE)-guided intervention in patients with obscure gastrointestinal bleeding (OGIB) and to identify the risk factors of rebleeding.MethodsA total of 307 consecutive patients who underwent CE for OGIB in our hospital from June 2002 to October 2010 were enrolled.Follow-up data were obtained by reviewing medical records,CE database and contacting the patients or their relatives by telephone.We evaluated the rebleeding rates and analyzed risk factors predictive of rebleeding by means of COX ratio hazard model.ResultsThe medium follow-up was 52 months (range13-112 months).Significant lesions were found in 202 patients (65.8％).The overall rebleeding rate after interventional therapy induced by CE findings was 28.0％ (86/307).CE positive patients had higher rebleeding rate than CE negative patients (37.6％ vs 9.5％,log-rank test,P=0.000),while specific therapy could prevent rebleeding,compared with nonspecific therapy (32.9％ vs 23.0％,P=0.042).95.3％ (82/86) rebleeding occurred within 24 months after CE.Multivariate analysis performed by using COX proportional hazards model showed that age over 50 years,CE positive findings,lowest hemoglobin (Hb) level 3 months before CE ≤7 g/dl,receiving nonspecific therapy after CE,hypertension,administration of anticoagulants,antiplatelet medicine or NSAIDs after CE were six risk factors associated with rebleeding.Conclusion Clinicians should be aware of these risk factors for OGIB rebleeding,which can reduce the occurrence of rebleeding and improve OGIB patients' prognosis.Those high risk OGIB patients should be followed up for at least 24 months after CE.

Objective To study the efficacy and safety of implantation of a modified temporary self-expanding metallic stent for cardia achalasia.Methods A total of 30 patients diagnosed as having cardia achalasia were randomly divided into 2 groups,group A (traditional stents) and group B (modified stents)(n =15 in each group).Two days after stent implantation at the cardia by endoscopy,stents were withdrawn with endoscope guided by X-ray.LES Pressure,X-ray images ( including the diameter of the most dilated part of esophageal and the most narrow part of cardia) and the symptoms of dysphagia were compared before and half year after the treatment.The width changes of the most narrow stenting part on the point of stenting and 2 days after removal were compared.The side effects and complications during the treatment were recorded.Results All thirty stents were successfully implanted and removed.Stent dislocation occured in 2 cases in group A,but none in group B.Dysphagia had significant improvement after the treatment in both groups ( P ＜ 0.05 ),but the recurrence rate of group A ( 26.7％ ) was significantly higher than group B (6.67％ ) in 6 months ( P ＜ 0.05 ).LES pressure and X-ray images of both groups significantly improved after treatment ( P ＜ 0.001 ),and those of group B were superior to group A ( P ＜ 0.05 ).There was no difference in adverse reaction between the two groups.No perforation occured in any group.Conclusion Self-expanding metallic stents is safe for patients with cardia achalasia,with implantation convenience,symptomatic improvement,low recurrence,and few complications or dislocation.

ObjectiveTo investigate the correlation between any two of Capsule Endoscopy ScroringIndex (Lewis score),simplified Crohn Disease Activity Index (CDAI) and C-reactive protein (CRP) in small bowel Crohn disease (CD).MethodsA total of 58 consecutive patients with known small bowel CD were enrolled. We evaluated disease activity with Lewis score and simplified CDAI. Correlations among CRP,simplified CDAI and Lewis score were calculated with Spearman's rank order correlation coefficient.The optimal CRP cut-off value was calculated using the ROC curve.ResultsThe Lewis score showed inactive,mild and moderate-severe patients were 13,21 and 24,respectively.CRP of moderate-severe group was significantly higher than that in mild and inactive groups ( P ＜ 0.05 ).The optimal CRP cut-off value that differentiated patients with moderate to severe disease from the others was 13.50 mg/L with sensitivity of 87.5％ and specificity of 82.4％.The area under the ROC curve to analyze the cut-off was 0.849.Lewis score was moderately correlated with CRP (r =0.58,P ＜ 0.01 ),and weakly correlated with the simplified CDAI (r =0.40,P ＜ 0.01 ).ConclusionSerum CRP and the simplified CDAI cannot replace Lewis score for capsule endoscopy in the assessment of disease activity in small bowel CD.However,CRP may be considered as an inflammatory marker for evaluating the moderate to severe capsule endoscopic activity.

Objective To study the long-term effect of argon plasma coagulation (APC) combined with proton pump inhibitor (PPI) on Barrett esophagus (BE). Methods A total of 36 patients, histologically proven as having BE from 2004 to 2007, were enrolled to underwent a therapy of APC plus PPI. The patients were re-examined on endoscopy at 1, 6 and 12 months after first APC and once a year thereafter.Results A total of 48 APC sessions were given to 36 patients with a mean number at 1. 33 per patient. The effective rate of reversal of BE was 100%. The follow-up was accomplished for all patients in 14-51 months with a median of 36months. The total recurrence rate (RR) of BE reached 16. 7% (6/36). The 1-year and 2-year RRs were 2. 8% (1/36) and 11.1% (4/36), respectively. The logistic regression analysis suggested that 2-year and total RRs were related to APC sessions ( P ＜ 0. 01 ). Conclusion The therapy of APC combined with PPI for BE is safe and of long-term effects.

Objective To investigate diagnostic value of colon capsule endoscopy (CCE) for mucosal lesions of patients with active ulcerative colitis. Methods A total of 19 consecutive patients, including 12 males and 7 females, were enrolled from July 2009 to June 2010, with a mean age at 44. 16 + 14.64.Dominant symptoms were hematochezia, diarrhea and abdominal pain, consistent with the criteria of ulcerative colitis. All cases were scored into 3 grades according to severity of mucosal lesions. Using conventionalcolonoscopic findings as golden standard, the consistence of mucosal classification of CCE was calculated with kappa- and P-value. Meanwhile, related data such as the rate of completion, colonic cleanliness and adverse reactions were also collected and analyzed. Results CCE revealed that mild, moderate and severe cases were 2, 8 and 9, respectively, while the 3 types shown by conventional colonoscopy were 3, 8 and 8,respectively. Kappa-value was 0. 826 and P-value was less than 0. 001, which indicated good consistence. In addition, the completion rate of CCE and excellent/fine rate of the colonic cleanliness were 100% (19/19)and 79% ( 15/19), respectively. There were no adverse reactions recorded. Conclusion With high diag-nostic consistency to conventional colonoscopy in classification of mucosa severity, CCE precisely reveals the mucosal lesions of ulcerative colitis and becomes a potential alternative to partially replace conventional colonoscopy, especially in surveillance.