Psychometric Evaluation of the Union Physio-Psycho-Social Assessment Questionnaire / 中国医学科学院学报

Objective To validate the Union Physio-Psycho-Social Assessment Questionnaire(UPPSAQ-70)and test its validity and reliability.Methods From April,2013 to July,2018,patients were asked to finish the computer evaluation of UPPSAQ-70 and Symptom Checklist 90(SCL-90)in Peking Union Medical College Hospital(PUMCH).Confirmatory factor analysis(CFA)was conducted on the SPSS 17.0,and the number of fixed factors was 8 factors and 3 factors.Amos 23.0 was used to verify the original 8-factor model,8-factor revision model,3-factor model,3-factor revision model,and single-factor model.Each factor of SCL-90 was used as the calibration standard to calculate the correlation coefficient between factors.The retest reliability was tested by the outpatients in PUMCH in July,2018.Results Exploratory factor analysis indicated that the 8-factor revised model included:depression,anxiety and fatigue,sleep,physical discomfort,sexual function,happiness and satisfaction,hypochondria,and social anxiety.The 3 factors revised model included that:psychological,physiological and social dimension.Confirmatory factor analysis indicated that the 8-factor modified model was superior to the 3-factor model and the single-factor model: =10 410.4,=1862,RMSEA=0.07,CFI=0.753,and NFI=0.715.With SCL-90 as the standard criteria,except the low correlation coefficient between emotional scale and depression(=0.600)and anxiety(=0.520),the correlation coefficients of other symptoms were below 0.5.The chronbach's between each factor and total score of UPPSAQ-70 was between 0.823 and 0.904,and the Chronbach's coefficient of the whole scale was between 0.954 and 0.956 after each item was deleted.The retest reliability of the scale of 32 participants Chronbach's was 0.847.Each item of the scale measured between one week was significantly correlated(<0.05). Conclusion UPPSAQ-70 is a good scale for evaluating overall health status and is especially feasible in general hospitals.

Clinical application of high resolution manometry for examining esophageal function in neonates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To examine the esophageal function of neonates by high resolution manometry (HRM), and to provide preliminary data for research on the esophageal function of neonates.</p><p><b>METHODS</b>Esophageal HRM was performed on neonates using a solid-state pressure measurement system with 36 circumference sensors arranged at intervals of 0.75 cm, and ManoView software was used to analyze esophageal peristalsis pattern.</p><p><b>RESULTS</b>Esophageal HRM was performed successfully in 11 neonates, and 126 occurrences of complete esophageal peristalsis were recorded. Complete esophageal peristalsis with pressure increase was recorded in some neonates but most neonates showed a different esophageal peristalsis pattern compared with adults. Some neonates had no relaxation of the upper esophageal sphincter (UES) when pharyngeal muscles contracted in swallowing, some neonates had multiple swallowing without esophageal peristalsis and some neonates had relatively low pressure of esophageal peristalsis. Full-term infants could have relatively low UES pressure and esophageal sphincter (LES) pressure but some preterm infants showed relatively high UES pressure and LES pressure. Longitudinal contraction of the whole esophagus and elevation of LES after swallowing were recorded in some neonates.</p><p><b>CONCLUSIONS</b>Esophageal HRM is safe and tolerable for neonates. HRM shows that esophageal peristalsis after swallowing may not occur or may be incomplete in neonates. The esophageal function of neonates has not yet been developed completely, with large individual differences in esophageal peristalsis. Large sample data are needed for further analysis and research on the esophageal function of neonates.</p>

Effects of enteral and parenteral nutrition on gastroenteric hormones and gastric motility after subtotal gastrectomy / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motility and gastroenteric hormones after subtotal gastrectomy.</p><p><b>METHODS</b>Forty-one patients underwent gastrectomy were randomly divided into EN group (n = 20) and PN group (n = 21). From the first postoperative day to the seventh day, patients received either EN (EN group) or PN (PN group) with isocaloric (84.9 kJ x kg(-1) x d(-1)) and isonitrogenous (0.11 g x kg(-1) x d(-1)) intake. Serum gastrin (GAS), plasma motilin (MTL), and plasma cholecystokinin (CCK) were measured on preoperative day, the first and seventh postoperative day. Electrogastrography (EGG) was measured on preoperative day and the seventh postoperative day.</p><p><b>RESULTS</b>Compared with preoperation, blood GAS, MTL, and CCK levels of 41 patients decreased significantly on the first day after subtotal gastrectomy (P < 0.001), but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained (P < 0. 001). On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group (P < 0.05). There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoperatively.</p><p><b>CONCLUSIONS</b>The levels of gastroenteritic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.</p>

Changes of serum gastrin, plasma motilin, and gastric motility in gastric cancer patients after subtotal gastrectomy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the change of the serum gastrin (GAS) and plasma motilin (MTL) levels as well as the gastric motility in gastric cancer patients after subtotal gastrectomy.</p><p><b>METHODS</b>We used radioimmunoassay method to detect the levels of serum GAS and plasma MTL in 39 healthy volunteers (control group) and 39 gastric cancer patients before and after gastrectomy (gastric cancer group). Electrogastrography (EGG) was measured at the same time points.</p><p><b>RESULTS</b>The levels of serum GAS and plasma MTL in gastric cancer group before operation were significantly higher than those in control group (P = 0.000), and the levels of serum GAS and plasma MTL in gastric cancer stage II patients were also significantly higher than those in stage III patients (P <0.05). The levels of serum GAS and plasma MTL in gastric cancer group significantly decreased on the first post-operative day (P = 0.000), but returned to the pre-operative levels on the seventh post-operative day. The incidence of the abnormity of gastric motility in gastric cancer group on the seventh post-operative day was significantly higher than the pre-operation incidence (89.7% vs. 43.6%; chi2 = 18.692, P <0.01).</p><p><b>CONCLUSIONS</b>The levels of serum GAS and plasma MTL transiently decreased in gastric cancer patients. Subtotal gastrectomy could affect the gastric motility in gastric cancer patients.</p>

The effects of enteral nutrition vs parenteral nutrition on gastric motility and gastroenteric hormones after subtotal gastrectomy: a perspective randomized compared clinical trial / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motility and gastroenteric hormones after subtotal gastrectomy. Try to find the possible prognosticating marks for the postoperative gastroparesis.</p><p><b>METHODS</b>Forty-one patients after gastrectomy were randomly divided into EN group (n = 20) and PN group (n = 21). From the first day after operation (POD + 1) to the seventh day (POD + 7), patients received either EN (EN group) or PN (PN group) with isocaloric and isonitrogenous intake. Serum gastrin (GAS), plasma motilin (MTL) and plasma cholecystokinin (CCK) were measured on preoperative day, POD + 1 and POD + 7. Electrogastrography (EGG) was measured on preoperative day, and POD + 7.</p><p><b>RESULTS</b>On the seventh day after gastrectomy, plasma MTL and CCK levels in EN group are higher than those in PN group. There is no difference in GAS between two groups. EGG in EN group is better than that in PN group postoperatively.</p><p><b>CONCLUSIONS</b>The level of gastroenteric hormones and the gastric motility are decreased significantly after subtotal gastrectomy. In contrast with PN, EN could accelerate the recovery of some gastroenteric hormones and the gastric motility after subtotal gastrectomy. GAS, MTL, CCK and EGG are not accurate enough as the marks for prognosticating the postoperative gastroparesis.</p>

Effects of two test-meals on transient lower esophageal sphincter relaxation in patients with gastroesophageal reflux disease and mechanism of gastroesophageal reflux / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the effects of standard meal and fat meal distending the fundus on transient lower esophageal sphincter relaxation (TLESR) and esophageal motility and to explore the mechanism of gastroesophageal reflux (GER) in patients with gastroesophageal reflux disease (GERD).</p><p><b>METHODS</b>Eight patients with GERD (3 male, 5 female; median age: 43.5 ys) were enrolled in the study. All received 2 times of esophageal manometry and pH monitoring simultaneously for 30 min during fasting and 2 h after two different test-meals, including standard meal (SM) and fat meal (FM) on separate day at least 1 week apart.</p><p><b>RESULTS</b>The frequency of TLESR significantly increased after 2 test-meals (P < 0.05). There were no significant difference in the frequency and duration of TLESR between SM group and FM group 1 h after meal (P > 0.05). However, the frequency of TLESR in FM group 2 h after meal was more than that in SM group and during fasting (P < 0.05). Lower esophageal sphincter pressure (LESP) significantly decreased in FM group than in SM group (P < 0.05). The contractive amplitude of post lower esophageal sphincter relaxation and the contractive amplitude of the distal esophagus had no difference after FM and SM. Acid reflux episodes and duration of pH < 4 were larger after FM than after SM (P < 0.05). A total of 50.2% of GER occurred during decreased LESP and 37.8% during TLESR after FM, while 61.7% of GER occurred during TLESR after SM.</p><p><b>CONCLUSIONS</b>Both the SM and FM can increase the frequency of TLESR in patients with GERD. Decreased LESP and increased frequency of TLESR after FM are the major mechanism of GER, while reflux after SM may attribute to the increased frequency of TLESR.</p>

Roles of diaphragmatic crural barrier and esophageal body clearance in patients with gastroesophageal reflux disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>Aim of this study was to investigate functions of lower esophageal sphincter (LES) barrier and esophageal clearance in fasting and postprandial stages in gastroesophageal reflux disease (GERD).</p><p><b>METHODS</b>Eight patients with confirmed GERD and 8 healthy subjects (HS) were observed in the study. The esophageal pH and manometry were recorded simultaneously for 1 h during fasting and 2 h after a meal (1,675 kJ) using pneumohydrolic capillary perfusion system.</p><p><b>RESULTS</b>(1) The esophageal pH monitoring showed that median of percentage of pH < 4 at postprandial in HS and patients with GERD was 0.45% and 11.2%, respectively (P < 0.05). (2) Pressure of lower esophageal sphincter (LESP) significantly decreased after a test meal in GERD (P < 0.001) and in HS (P < 0.001). (3) The amplitude of post-LES relaxation related to swallow (post-LESRA) in GERD was much lower than in HS either during fasting or postprandial stage (P < 0.05). (4) The tension of crural diaphragm at resting (Dia-A0) in GERD was lower than in HS during fasting and postprandial stage(P < 0.05). (5) The tension of crural diaphragm at deep inspiration (dia-AM) in GERD and HS increased 3 or 4 times at pressure at gastroesophageal junction (GEJ). (6) The peristaltic amplitude of the distal esophagus in GERD were much lower than that in HS in both pre- and postprandial periods.</p><p><b>CONCLUSIONS</b>(1) Impaired clearance of Post-LESRA and esophageal body, function of diaphragmatic crural play an important role in development of GERD. (2) The tension of crural diaphragm at deep inspiration can increase the pressure at GEJ.</p>