The long-term efficacy of transoral incisionless fundoplication with Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux disease.

BACKGROUND: To evaluate the long-term efficacy of transoral incisionless fundoplication (TIF) with Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux disease (GERD). METHODS: A total of 16 patients with proton pump inhibitor-dependent gastroesophageal reflux disease had undergone TIF by MUSE in Shanghai General Hospital （Shanghai, China）from March 2017 to December 2018. Patients were followed up at 6 months, and the GERD-health-related quality of life (GERD-HRQL) questionnaire score, the GERD questionnaire (GERD-Q) score, high-resolution esophageal manometry (HREM) and 24 h esophageal pH parameters, the Hill grade of the gastroesophageal flap valve (GEFV) and daily Proton pump inhibitor (PPI) consumption before and after procedure were compared. Patients also were followed up at 3 years and 5 years using a structured questionnaire via phone which evaluated symptoms of reflux, dose of PPI medication and side effects. RESULTS: Follow-up data were collected from 13 patients, ranging from 38 to 63 months, 53 months on average. 10/13 patients reported symptomatic improvement and daily PPI consumption was stopped or halved in 11/13. After procedure, the mean scores of GERD-HRQL and GERD-Q were significantly increased. The mean DeMeester score, the mean acid exposure time percentage and the mean number of acid reflux episodes were significantly lower. The mean rest pressure at lower esophageal sphincter (LES) had no significant difference. CONCLUSION: TIF by MUSE has significant efficacy in the treatment of PPI-dependent GERD, which can improve symptoms and life quality of patients, and reduce the acid exposure time for long-term. Chictr.org.cn. TRIAL REGISTRATION: ChiCTR2000034350.

[Clinical efficacy of Paroxetine combined with mid-frequency electrical pulse acupoint stimulation for premature ejaculation].

OBJECTIVE: To investigate the clinical value of Paroxetine combined with mid-frequency electrical pulse acupoint stimulation (EPAS) in the treatment of premature ejaculation (PE). METHODS: Totally 69 PE patients were equally assigned to receive oral Paroxetine 20 mg/d, mid-frequency EPAS, or oral Paroxetine 10 mg/d combined with mid-frequency EPAS (P + EPAS) , all for 8 weeks. We obtained the intravaginal ejaculation latency time (IELT) and Chinese Index of Premature Ejaculation (CIPE-5) scores of the patients before and after treatment, and compared adverse reactions among the three groups of patients. RESULTS: One patient of the Paroxetine group gave up treatment because of abdominal pain and nausea. Compared with the baseline, the patients in the Paroxetine, EPAS, and P + EPAS groups all showed markedly increased IELT ([0.92 ± 0.11] vs [4.07 ± 0.11] min, P < 0.01; [0.92 ± 0.12] VS [2.78 ± 0.17] min P < 0.05; [0.91 ± 0.09] vs [5.31 ± 0.13], P < 0.01) and decreased CIPE-5 scores (12.5 ± 3.0 vs 22.0 ± 2.1, P < 0.01; 12.8 ± 2.9 vs 19.5 ± 1.9, P > 0.05; 13.1 ± 2.8 vs 25.2 ± 2.1, P 0.01), with statistically significant differences between the P + EPAS group and the other two (P < 0.05). The total effectiveness rate was 95.7% in the P + EPAS group, remarkably higher than in the Paroxetine (72.7%, P < 0.05) and the EPAS group (47.8, P < 0.01). CONCLUSION: Oral Paroxetine combined with mid-frequency EPAS has a higher safety and efficacy than either Paroxetine or EPAS alone in the treatment of PE.

[Moxibustion therapy is superior to manual acupuncture in the treatment of perimenopausal insomnia: a randomized controlled trial].

OBJECTIVE: To compare the clinical effect of manual acupuncture and moxibustion therapies in the treatment of perimenopausal insomnia (PMI). METHODS: A total of 60 outpatients with PMI were randomly and equally divided into an acupuncture group (29 cases) and a moxibustion group (28 cases). Acupoints Zhongwan (CV12), Xiawan (CV10), Qihai (CV6) and Guanyuan (CV4) were employed in these two groups. For acupuncture group, filiform needles were inserted slowly into these acupoints and twirled mildly for a while, and then retained for 30 min. When moxibustion performed, the ignited moxa-cone was applied to the same 4 acupoints, with 7 cones for each acupoint. The treatment was conducted once daily for 10 consecutive days, suspended for 2 days, then another 10 days' treatment followed. The Pittsburgh Sleep Quality Index (PSQI) scale (7 items: subjective sleep quality, sleep latency, duration of sleep, habitual sleep efficiency, sleep disturbance, use of sleeping medications, and daytime dysfunction, 0－3 points per item, 0－21 points in total) was used to evaluate the patient's sleep quality. The clinical therapeutic effect was also assessed according to the sleep rate (＝sleep duration/total duration from spin-in to wake-up×100%). The contents of serum follicular stimulating hormone (FSH), estradiol (E2) and luteinizing hormone (LH) were detected using radioimmunoassay. RESULTS: After treatment, the total score of PSQI and the score of each item were all significantly reduced in the two groups relevant to their own pre-treatment (P<0.01). The scores of sleep latency, sleep disturbance and daytime dysfunction were comparable between the two groups (P>0.05), but the total score, and scores of sleep quality, sleep duration, sleep efficiency, and use of sleeping medication were significantly lower in the moxibustion group than in the acupuncture group (P<0.05). Of the 29 and 28 cases in the acupuncture and moxibustion groups, 6 (20.69%) and 11 (39.29%) were cured, 7 (24.14%) and 9 (32.14%) experienced marked improvement, 9(31.03%) and 5 (17.86%) were effective, and 7(24.14%) and 3 (10.71%) ineffective, with the total effective rate being 75.86% and 89.29%, respectively. The therapeutic effect of moxibustion was obviously superior to that of acupuncture treatment (P<0.05). After the treatment, the levels of serum FSH and LH were significantly decreased (P<0.01), and that of E2 was significantly increased in both groups (P<0.01). The levels of FSH and E2 in the moxibustion group were obviously improved than those of the acupuncture group (P<0.05). CONCLUSION: Both acupuncture and moxibustion can relieve the sleep quality of patients with PMI, which may be associated with their effect in regulating serum hormone levels. The therapeutic effect of moxibustion is superior to that of acupuncture.