Objective To explore the efficacy and safety of fluoroscopy-guided balloon dilation for esophageal strictures in patients with epidermolysis bullosa(EB).Methods The clinical data and follow-up results of EB patients,who received fluoroscopy-guided balloon dilation due to esophageal stricture at Shanghai Xinhua Hospital from May 2020 to May 2023,were retrospectively collected.The therapeutic efficacy and the prognosis of this treatment method were analyzed.Results A total of 17 EB patients received fluoroscopy-guided balloon dilation treatment due to dysphagia caused by esophageal stricture.Most esophageal strictures were single-site stenosis(13/17,76.5％)and it commonly occurred in the esophageal cervical segment(12/17,70.6％)and the upper thoracic segment(8/17,47.1％)of esophagus.Two patients developed esophageal bleeding after dilatation and no special treatment is required.No other post-treatment complications were observed.In most of the patients(15/17,88.2％)a long-term improvement of the dysphagia symptoms could be obtained after receiving a single balloon dilation treatment.By the last follow-up visit,most of the patients(15/17,88.2％)gained more weight when compared with their pre-treatment body weight,with an average increased weight of 2.97 kg.Conclusion Clinically,EB is a rare etiology that can cause an esophageal stricture.This esophageal stenosis is characterized by a single stenosis mostly located in the upper segment of the esophagus.Fluoroscopy-guided balloon dilation is an effective and safe treatment for this type of esophageal strictures.

Clinical data from 11 previously diagnosed and treated patients with hyperthyroidism(Graves′ disease) complicated by liver failure were collected. Among them, 4 cases were drug-induced liver injury leading to liver failure, 1 case had a history of schistosomal liver cirrhosis combined with hyperthyroidism, and 6 cases had hyperthyroidism-induced liver injury(HILI) leading to liver failure. During hospitalization, all patients received supportive therapy and symptomatic treatment with β-blockers. Nine patients were treated with glucocorticoids and artificial liver support therapy. Among the 11 patients, 2 died, 8 patients achieved normal thyroid and liver function within 1-12 months after treatment, and 1 patient with liver cirrhosis had stable liver function in the later stage. After improvement in liver function, 7 patients received isotope therapy, 1 patient underwent total thyroidectomy, and 1 patient received medication. These results indicate that the clinical characteristics differ for drug-induced liver injury and HILI-related liver failure. Early initiation of artificial liver support therapy, in addition to β-blockers and glucocorticoids, is important in alleviating thyroid toxicity and liver damage, thus creating an opportunity for subsequent radioactive iodine or surgical treatment.

Tinnitus and anxiety disorder are common clinical symptoms. Comorbidity between tinnitus and anxiety state is increasing year by year. The relationship between tinnitus and anxiety state has always been a hot topic, and this paper reviews the literature on the relationship between chronic subjective tinnitus and anxiety state in recent years.
Humans ; Tinnitus/diagnosis* ; Anxiety ; Anxiety Disorders/epidemiology* ; Comorbidity

Objective:To investigate the protective effect and mechanism of Icaritin Ⅱ (ICAⅡ) on bladder in radiation cystitis model.Methods:A total of 18 10-week-old male SD rats were selected from July 2021 to March 2022 and divided into control group, model group and treatment group by random number table method, with 6 cases in each group. Model group and treatment group were given a single dose of 20 Gy X-ray irradiation in the pelvic area. 24 h after irradiation, the treatment group was given ICAⅡ 4.5 mg/(kg·d) gavage, while the control group and model group were given the same volume of solvent (10% anhydrous ethanol, 20% isopropyl alcohol, 30% polyethylene glycol and 40% deionized water) gavage for 4 consecutive weeks. Drug eluting for 1 week. The bladder volume and leakage point pressure of the three groups of rats were measured by multi-conducting physiological apparatus, and the bladder function was evaluated. HE staining, Masson staining, ELISA, TUNEL staining and western blotting were performed on the bladder samples of the three groups of rats. The pathological changes (thickness of bladder mucosa, ratio of smooth muscle to collagen fiber), oxidative stress level (superoxide dismutase SOD, malondialdehyde), apoptosis rate, protein levels of inflammatory factors (IL-6, NF-kB) and anti-oxidative stress signaling pathway factors (Nrf2, HO-1) of the three groups of rats were compared.Results:After 4 weeks of modeling, in the model group, the bladder volume [(1.01±0.12)ml vs. (1.58±0.21)ml, P=0.001], the bladder leakage point pressure [(38.79±4.12) cmH 2O (1 cmH2O=0.098 kPa)vs.(60.59±3.81) cmH 2O, P=0.001], the ratio of smooth muscle of bladder wall to collagen fiber [1.78±0.17 vs.3.15±0.57, P=0.001], SOD[(6.31±0.73) U/mg vs.(14.67±1.04) U/mg, P=0.001] were lower than the control group, and the differences were statistically significant. In the model group, the thickness of bladder mucosa [(47.33±1.78)μm vs.(20.83±2.33)μm, =, P=0.001], malondialdehyde [(1.01±0.13) nmol/mg vs.(0.49±0.03) nmol/mg, P=0.001], IL-6 (0.87±0.11 vs. 0.33±0.10, P=0.001), NF-kB (0.71±0.14 vs. 0.29±0.07, P=0.001), apoptosis rate [(11.60±3.04)% vs. (3.91±1.40)%, P=0.007] was higher than the control group, and the differences were statistically significant. In the treatment group, the bladder volume [(1.27±0.13)ml, P=0.030], bladder leakage point pressure [(47.83±2.50)cmH 2O, P=0.004], smooth muscle to collagen fiber ratio (2.78±0.68, P=0.015), SOD[(10.48±0.85) U/mg, Compared with model group, bladder mucosa thickness [(31.94±3.20)μm, P=0.001], malondialdehyde [(0.64±0.09) nmol/mg, P=0.001], IL-6 (0.69±0.11, P=0.035), NF-kB (0.45±0.06, P=0.002) and apoptosis rate [(6.05±0.60)%, P=0.030] were lower than those in model group. The protein expression level of Nrf2 in model group (0.73±0.08 vs. 0.58±0.11, P=0.023) was higher than that in control group, but there was no significant difference in the protein expression level of downstream antioxidant factor HO-1 (0.50±0.14 vs. 0.35±0.06, P=0.060). Nrf2 protein expression level (0.88±0.03, P=0.027) and HO-1 expression level (0.68±0.07, P=0.026) in treatment group were higher than those in model group. Conclusion:ICAⅡ can reduce radiation cystitis injury, and its mechanism may be related to anti-oxidative stress and reducing inflammation.

Objective:To explore the metabolic outcomes of type 2 diabetes patients with different durations after 1 year treatment under the standardized metabolic disease management model.Methods:(1)From September 2017 to September 2018, 345 type 2 diabetes patients in the Standardized Metabolic Management Center(MMC) of Shanghai General Hospital were recruited and included in this research. They were divided into newly-diagnosed type 2 diabetes(duration≤1 year) and long-term groups(duration>1 year). The general characteristics, blood pressures, glycemic levels, lipids levels, control rates and comprehensive compliance rates(blood glucose, pressure and lipids all reached targets) were compared at baseline between 2 groups.(2)All patients underwent one year standardized management, and metabolic indicators mentioned above and control rates at the time were compared as well.Results:(1) At baseline, compared with long-term group, patients in newly-diagnosed type 2 diabetes group were younger ( P<0.01), and 2 h blood glucose level after glucose loading were higher [(15.20±5.26 vs 13.68±4.94) mmol/L, P<0.01]. (2) After one year standardized management, body weight, blood pressure, glucose and lipids metabolism in all patients were significantly improved. Compared with patients in long-term group, newly-diagnosed type 2 diabetes patients achieved better glycemic level [fasting blood glucose(6.27±1.56 vs 7.63±2.08) mmol/L, P<0.01; glycated hemoglobin(6.33±0.96 vs 7.23±1.37) %, P<0.01] , and had higher HOMA-β [(74.01±56.45 vs 40.17±37.07) %, P<0.01]. The glycemic control, blood pressure and blood lipids control rates in both groups increased significantly in one year. Comprehensive compliance rate of the whole patients increased from 5.80% to 24.06%. The metabolism indexes of the newly-diagnosed type 2 diabetes group were better than those of the long-term group[comprehensive compliance rate: (24.73% vs 17.18%, P=0.087, glycemic control rate(84.62% vs 53.37%, P<0.01)]. Conclusion:Standardized metabolic disease management promoted the overall improvement in blood glucose, blood pressure, and lipids levels in type 2 diabetes patients, especially in terms of blood glucose and those of the newly-diagnosed type 2 diabetes. In the future, we should focus on the early diagnosis and treatment of type 2 diabetes, actively promote the MMC model and stress the integrated management of blood glucose, blood pressure, and blood lipid levels. We should pay more attention to the long-term patients, to improve their awareness and treatment compliance.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Objective:To explore the correlation between body mass index(BMI)and coronary flow reserve(CFR)in patients with chest pain and no obstructive coronary artery disease(NOCA).Methods:This study was a single-center retrospective cross-sectional study. Sixty-six patients with chest pain and NOCA on coronary angiography who underwent PET/CT quantitative myocardial blood flow measurements at TEDA International Cardiovascular Hospital were retrospectively analyzed from August 2018 to October 2019. Pearson correlation analysis and linear regression analysis were used to explore the correlation between BMI and CFR. Patients were divided into 2 groups according to CFR: coronary microvascular dysfunction(CMD)group(CFR<2.5)and control group(CFR≥2.5). Logistic regression analysis was applied to analyze the association of BMI with CMD.Results:The proportions of female, obesity, and overweight plus obesity in CMD group were higher than those in control group( P<0.05). The levels of BMI and low density lipoprotein-cholesterol(LDL-C)were higher in CMD group compared with control group( P<0.05). Pearson correlation analysis showed that CFR was linearly correlated with BMI( r=-0.45, P<0.01), which still existed after adjusted by confounding factors using linear regression model( r=-0.371, P<0.01). Logistic regression analysis showed that BMI was dependently associated with CMD after adjusted by gender, age, hypertension, diabetic mellitus, and LDL-C. The OR value of CMD was 4.46(95% CI 1.47-13.55, P<0.01)with BMI increased by 5 kg/m 2. Conclusion:In patients with chest pain and NOCA, higher BMI is an independent risk factor of CMD.

Objective To investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. Methods Surgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People's Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. Results All 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (18.18%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.

Objective:To diagnose female coronary microvascular diseases (CMVD) without obstructive coronary artery disease through coronary flow reserve (CFR) measured with PET/CT imaging, and further analyze its related risk factors of quantitative parameters and clinical characteristics.Methods:From September 2017 to August 2019, a total of 75 female patients (age: 25-77 years) with clinically suspected CMVD from TEDA International Cardiovascular Hospital were retrospectively analyzed. All patients had negative results of coronary angiography (CAG) or coronary CT angiography (CCTA) and underwent 13N-NH 3·H 2O PET/CT dynamic quantitative imaging. Left ventricle (LV) coronary flow reserve (LV-CFR) value of 2.5 for critical value was divided into CMVD group and non-CMVD group. Clinical characteristics and quantitative parameters including rest LV-myocardial blood flow (MBF) and stress LV-MBF were respectively analyzed and compared between groups. Independent-sample t test, Mann-Whitney U test and Pearson correlation analysis were used to analyze the data. Results:Of 75 patients, 51 cases (68%) were diagnosed with CMVD and 24 cases (32%) with non-CMVD. Body mass index (BMI) of the CMVD group was higher than that of the non-CMVD group ((26.93±3.52) vs (23.83±3.42) kg/m 2, t=3.63, P=0.001), and LV-CFR was negatively correlated with BMI ( r=-0.341, P=0.003). The LV-CFR of the overweight group (BMI≥24 kg/m 2) was lower than that of non-overweight group (BMI<24 kg/m 2) (2.18±0.47 vs 2.54±0.55, t=-2.89, P=0.005). The rest LV-MBF in the CMVD group (0.74(0.65, 0.84) ml·min -1·g -1) was higher than that in the non-CMVD group (0.66(0.58, 0.75) ml·min -1·g -1; U=417.5, P=0.027), and the stress LV-MBF and LV-CFR was lower than that in the non-CMVD group ((1.53±0.35) vs (1.96±0.45) ml·min -1·g -1, 2.07(1.71, 2.34) vs 2.86(2.61, 2.95); t=-4.54, U=0, both P<0.001). In the hypertensive group, the CMVD sub-group had higher rest LV-MBF than the non-CMVD sub-group ((0.77±0.16) vs (0.65±0.13) ml·min -1·g -1; t=2.26, P<0.05), but lower stress LV-MBF ((1.49±0.34) vs (1.85±0.40) ml·min -1·g -1; t=-3.07, P<0.05) and LV-CFR(1.99(1.64, 2.23) vs 2.85(2.55, 2.95); U=0, P<0.05] than the non-CMVD sub-group. In the non-hypertensive group, stress LV-MBF and LV-CFR of the CMVD sub-group were lower than those of the non-CMVD sub-group (1.53(1.36, 1.97) vs 1.94(1.76, 2.16) ml·min -1·g -1, 2.35(1.94, 2.43) vs 2.87(2.65, 3.09); U values: 43.5 and 0, both P<0.05). LV-CFR of CMVD subgroup in hypertensive group was lower than that of CMVD subgroup in non-hypertensive group ( U=164.0, P=0.028). Conclusions:BMI is negatively correlated with LV-CFR in CMVD. The decrease of stress LV-MBF and the increase of rest LV-MBF in CMVD lead to the decrease of LV-CFR. Hypertension is one of the important influence factors for MBF and CFR.

Lymphocytic hypophysitis(LYH) is a rare autoimmune inflammatory disorder of the pituitary gland, usually affecting young women in late pregnancy or postpartum period. To enhance the knowledge of LYH, herein we reported a case of LYH in a female during postpartum who presented with pituitary crisis.