To explore the application value of endoscopic ultrasound fine-needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment ofpatients with pancreatic cancer combined with obstructive jaundice.

Objective:To investigate the effects of emodin on proliferation, adhesion, migration, c-kit mRNA and protein expression of human epidermal melanocytes.Methods:Human epidermal melanocytes cultured in vitro were treated with different concentrations of emodin, a blank control group (containing medium + human epidermal melanocytes) and an experimental group (containing medium + human epidermal melanocytes + different concentrations of emodin) were set up. Cell proliferation was measured by CCK-8 method, cell adhesion was measured by microplate assay, cell migration was measured by Transwell membrane assay, and c-kit mRNA expression was measured by reverse transcription-polymerase polymerase chain reaction; Western blot was used to detect the expression of c-kit protein.Results:Compared with the blank control group, emodin decreased the proliferation, adhesion and migration of human epidermal melanocytes, the difference was statistically significant ( F=391.48, P<0.0001; F=10.93, P=0.003; F=7.75, P=0.009). Compared with the blank control group, emodin in the experimental group had a bidirectional effect on the expression of c-kit mRNA and protein. High concentration of emodin inhibited the expression of c-kit mRNA and protein, and the expression of c-kit mRNA and protein was significantly increased by Emodin ( F=11.491, P=0.003; F=2155.11, P<0.001). Conclusions:Emodin inhibits the proliferation, adhesion and migration of human epidermal melanocytes, high concentration of emodin inhibits the expression of c-kit mRNA and protein, and low concentration of emodin promotes the expression of c-kit mRNA and protein, and the results provide a basis for the clinical application of emodin in pigmented dermatosis.

In order to improve the management level of medicine list of medical institutions in China ，and help medical institutions build a medicine list of medical institutions with reasonable drug use structure ，standardized adjustment procedures ， convenient operation and application and scientific evaluation methods ，so as to meet the needs of clinical rational drug use to the greatest extent ，with the support of the Pharmaceutical Care Professional Committee of the Chinese Pharmaceutical Association ， China-Japan Friendship Hospital and the First Affiliated Hospital of University of Science and Technology of China （Anhui Provincial Hospital ）jointly initiate and complete Guideline for the Evaluation of Medicine List in Chinese Medical Institutions jointly with a number of medical institutions. In strict accordance with the methodological requirements of World Health Organization standard guidelines ，based on the Delphi method ，the guideline formulation working group has constructed the quality evaluation index system and quantitative scoring table of medicine list management in medical institutions from the 5 dimensions of organization and management ，structure，adjustment，application and e valuation of the list. It is used to help medical institutions evaluate the quality of their medicine list management ，so asto play a positive role in the fine management of medicine list in medical institutions.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematopoietic stem cell disease. Gastrointestinal involvement is rarely seen in PNH. This study aims to analyze the clinical features in PNH patients complicated with ischemic bowel disease. Clinical date of 6 patients were collected at Peking Union Medical College Hospital from January 2010 to December 2020. The clinical manifestations, laboratory tests,imaging, endoscopic,and histopathological features and treatment were analyzed.Five in 6 patients were men, with a median age of 31 years old at onset. Most of disease course were recurrent episodes of chronic disease, with abdominal pain (5/6) and gastrointestinal bleeding (5/6). Laboratory examinations showed pancytopenia, reticulocytosis, elevated serum lactate dehydrogenase, high D-dimer and C-reactive protein levels in all patients. Multiple segments of small intestine were the most commonly involved and colon was also affected. Abdominal CT scan showed thickening and roughness or exudation of the intestinal wall (6/6), increased mesenteric density or “comb sign”(4/6), and cholestasis or gallbladder stones (5/6). Endoscopic manifestations included irregular shallow ulcers in the annular cavity (5/6), swelling mucosa with well-defined margins (6/6). Pathological biopsy revealed chronic inflammation of mucosa. The efficacy of steroids combined with anticoagulant therapy was better than that of steroids alone. Ischemic bowel disease in PNH patients is different from typical ischemic enteritis. Young patients, involvement of intestine with multiple segments are common characteristics. The anticoagulant is an essential agent for these patients.

Objective:To evaluate the development and application of gastrointestinal endoscopy technology in Beijing-Tianjin-Hebei (BTH) region from 2016 to 2020, and the impact of the corona virus disease 2019 (COVID-19) epidemic on gastrointestinal endoscopy screening and lesion detection rate of medical institutions.Methods:Data of gastroscopy and colonoscopy cases from 26 cooperative institutions in BTH Region Gastrointestinal Endoscopy Medical Association from January 2016 to December 2020 were collected by questionnaire. The number of gastrointestinal endoscopy, the detection of main lesions (including upper gastrointestinal malignant tumors, early gastric cancer and colon cancer), and the number of endoscopic treatment were retrospectively analyzed by year.Results:From 2016 to 2019, the number of gastroscopy and colonoscopy showed a yearly increasing trend with an annual growth rate of over 10%. Compared with 2019, the number of gastroscopy and colonoscopy decreased by 10.86% and 8.29%, respectively, in 2020 due to the impact of the epidemic. The annual detection rates of upper gastrointestinal malignant tumors, early gastric cancer and colon cancer were on a rise, from 7.22%, 1.49% and 8.98% in 2016 to 9.87%, 2.71% and 12.04% in 2020, respectively. The number of gastroscopic mucosal resection, submucosal dissection and colonoscopic endoscopic submucosal dissection increased yearly, from 2 132, 300 and 217 cases in 2016 to 5 466, 872 and 560 cases in 2020, respectively.Conclusion:The Medical Association has promoted the expansion of endoscopic screening and the application of endoscopic treatment techniques, resulting in a continuous increase in the endoscopy detection rate and early cancer diagnosis rate in the BTH region. The sharp decrease of gastrointestinal endoscopy procedures and the increase in the lesion detection rate in 2020 reflect the impact of epidemic COVID-19 on detection of gastrointestinal cancers.

Objective:To preliminarily understand the living habits, medication taking and treatment status including the therapeutic regimen, compliance and short-term efficacy of patients with chronic atrophic gastritis and erosion in Beijing area.Methods:From April to September in 2019 at Peking Union Medical College Hospital, Peking University Third Hospital and Peking University Shougang Hospital, the outpatients with chronic atrophic gastritis and erosion diagnosed with endoscopy within two weeks before visiting were prospectively included in this non-interventional observation study. Chi square test was used for statistical analysis.Results:A total of 277 patients with chronic atrophic gastritis and erosion had complete follow-up data, of which male patients accounted for 49.8% (138/277). The common initial symptoms of patients with chronic atrophic gastritis and erosion included acid reflux, abdominal distension, epigastric pain and postprandial distension, which accounted for 60.3% (167/277), 59.6% (165/277) , 58.8% (163/277) and 52.3% (145/277), respectively. For treatment, 36.8% (102/277) of the patients only received lifestyle instruction without medication. Among the patients with medication treatment, the short-term efficacy of gastric mucosal protectants+ proton pump inhibitor+ gastro-kinetic agent for abnominal distension, postprandial distention, acid reflux and nausea was highest as compared with other therapeutic regimen, and the differences were statistically significant ( χ2=25.18, 19.49, 13.75, 8.84, all P<0.05). Conclusions:Chronic gastritis with erosion may be caused by a combination of multiple factors, and the symptoms of which lack specific. If necessary, gastroscopy may help the diagnosis. Individualized treatment strategies based on the symptoms of patients is needed for treatment.

Objective This study sought to assess the value of the diaphragmatic thickening frac-tion ( DTF) , diaphragmatic-rapid shallow breathing index ( D-RSBI) and diaphragm thickening-rapid shal-low breathing index ( DT-RSBI) in predicting the outcomes of ventilator weaning. Methods A total of 59 patients receiving mechanical ventilation with indications for ventilator withdrawal were included in this stud-y. One hour within the spontaneous breath test ( SBT) began,diaphragmatic displacement ( DD) and DTF were measured with bedside ultrasonography to instead the tidal volume ( VT) in conventional rapid shallow breathing index ( RSBT) to calculate D-RSBI and DT-RSBI. Patients were divided into success group and failure group according to the weaning results. Multivariate logistic regression analysis was used to find inde-pendent risk factors of weaning failure and receiver operating characteristic ( ROC) curve was used to evalu-ate the efficacy of predicting the outcome of weaning. Results The multivariate logistic regression analysis showed that DTF was an independent factor affecting the success or failure after the correction of other fac-tors (P<0. 05), the threshold value is 35％, area under roc curve (AUC) 0. 972. Conclusions The DTF can be effectively used to predict the result of weaning from mechanical ventilation, the value of D-RS-BI and DT-RSBI in SBT needs to be confirmed by more research.

This study reported two women with extreme obesity who underwent metabolic surgery due to their mutations in leptin receptor (LEPR).Genomic DNA was extracted from the anticoagulant blood samples of the two patients and their parents.A panel of genes related to metabolic diseases or whole exon sequencing was screened and the results were confirmed by Sanger sequencing.This is the first time that these three mutations in LEPR were reported.Two patients complained insatiety and early-onset obesity since childhood at clinics.Patient 1 was a 39-year-old woman with height 150 cm,weight 130 kg,and BMI 57.8 kg/m2.Serum leptin level was 156.4 μg/L.A homozygous mutation of c.2317G＞T was found in exon 15 of LEPR gene in patient 1,which was descended from her father and mother respectively.Patient 2 was a 37-year-old woman with height 158 cm,weight 167 kg,and BMI 67 kg/m2.Serum leptin level was 193.4 μg/L.Genetic analysis showed compound heterozygous mutations of c.1482delT and c.1892C ＞ A.Her father showed heterozygous c.1482delT mutation,and her mother carried heterozygous c.1892C ＞ A mutation.Two patients all underwent metabolic surgery with body weight reduction of about 22 kg and 40 kg respectively after first six months.However,the follow-up studies showed that the body weight of patient 1 rebounded to pre-surgery level in two years and patient 2 did not further lose weight in the following six months.

OBJECTIVE: To investigate the association of the polymorphism of angiotensin-converting enzyme (ACE) gene and pregnancy-induced hypertension (PIH) in Chinese Women. METHODS: We systematically searched CNKI, Wanfang database, VIP and PubMed from database construction to March 2012 to collect case-control studies. Stata 11.0 was used for meta analysis after evaluating the quality of studies and collecting the data. The association was assessed by odds ratio (OR) with 95% confidence intervals (CIs). Publication bias was analyzed by Begg's funnel plot and Egger's regression test. RESULTS: We identified 11 case-control studies on association between ACE gene polymorphism and PIH, which included 806 PIH patients and 900 controls. Overall, significant association was found between ACE gene polymorphism and PIH risk [for D vs I: OR=2.73, 95% CI (1.64, 4.24), P<0.001; for DD+DI vs II: OR=3.11, 95% CI (1.98, 4.90), P<0.001; for DD vs II: OR=5.00, 95% CI (2.30,10.88), P<0.001; for DI vs II: OR=1.97, 95% CI(1.53, 2.53), P<0.001]. CONCLUSION Chinese women with D allele gene deletion have a higher risk of suffering pregnancy induced hypertension syndrome.
Adult ; Alleles ; Female ; Genetic Predisposition to Disease ; Humans ; Hypertension, Pregnancy-Induced ; genetics ; INDEL Mutation ; Peptidyl-Dipeptidase A ; genetics ; Polymorphism, Genetic ; Pregnancy ; Randomized Controlled Trials as Topic ; Risk Factors

ObjectiveTo evaluate the application of immunochemical fecal occult blood test for colorectal cancer screening in a gastroenterology clinic. MethodsTotal 512 outpatients received immunochemical fecal occult blood tests and colonoscopy for screening of colorectal cancer from January 2009 to October 2010 in Gastroenterology Clinic of Peking Union Hospital.The application of occult blood test was retrospectively evaluated using colonoscopy and pathological examination as the gold standard. Results Among 512 patients,203 were found positive for immunochemical fecal occult blood. According to the colonoscopy and histological study,115 patients had polyps,9 with high-grade dysplasia and 21 with colorectal cancer.The sensitivity,specificity,positive likelihood ratio and negative likelihood ratio of fecal occult blood to detect colorectal adenomatous polyps was 42.8％,60.9％,1.09 and 0.93,respectively.And those for detection of colorectal cancer and high-grade dysplasia were 76.6％,62.5％,2.05 and 0.37,respectively.ConclusionsImmunochemical fecal occult blood test was useful in the screening for colorectal tumors among gastroenterology clinic patients.More large-scale prospective studies are needed to establish a screening model for colorectal tumors.