Association between cardiometabolic diseases and quality of life and the mediation effect of perceived stress / 中华心血管病杂志

Objective: To explore the association between cardiometabolic diseases (CMD) and quality of life, the association between CMD and perceived stress, and the mediation effect of perceived stress on the association between CMD and quality of life, and to provide evidence for the prevention and treatment of CMD and the improvement of quality of life in these patients. Methods: This is a cross-sectional study. Data were collected by the employees' physical examination of a company in Xi'an in 2021. Multiple linear regression models were used to analyze the association between the status of CMD (divided into three categories: no CMD, presence of one kind of CMD, and with≥2 kinds of CMD (≥2 kinds of CMD were defined as cardiometabolic multimorbidity (CMM)), quality of life, and perceived stress. Mediation analysis with a multi-categorical independent variable was conducted to determine the mediation effect of perceived stress on the association between CMD and quality of life. Results: Among all 4 272 participants, 1 457 (34.1%) participants had one kind of CMD and 677 (15.8%) participants had CMM. The average scores for quality of life and perceived stress were (57.5±15.7) and (16.9±7.9), respectively. Compared with participants without CMD, after adjusting for demographic and lifestyle factors, no statistically significant associations were observed between one kind of CMD and perceived stress or quality of life (both P>0.05). Perceived stress did not mediate the association between one kind of CMD and quality of life. However, participants with CMM had lower quality of life and higher perceived stress than participants without CMD. The relative total effect coefficient c (95%CI) and the relative direct effect coefficient c' (95%CI) between CMM and quality of life were -3.71 (-5.04--2.37) and -2.52 (-3.81--1.24) (both P<0.05), respectively. The relative indirect effect coefficient a2b (95%CI) of perceived stress on the association between CMM and quality of life was -1.18 (-1.62--0.77) (P<0.05). The mediation effect size was 31.8%. Conclusions: CMM is negatively associated with quality of life and positively associated with perceived stress. Perceived stress partially mediates the association between CMM and quality of life. Our results suggest that, in addition to preventing and treating CMM actively, efforts should be taken to relieve the perceived stress of people with CMM to improve their quality of life.

Influencing factors of negative conversion time of nucleic acid detection in 228 patients infected with Omicron variant of SARS-CoV-2 in Shanghai / 中国热带医学

@#Abstract: Objective To analyze and compare the effects of different clinical characteristics on the negative conversion time of nucleic acid detection after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection, and to provide a scientific basis for the isolation and treatment of coronavirus disease 2019 (COVID-19). Methods　The epidemiological and clinical data of 228 mild SARS-CoV-2 Omicron variant infected patients diagnosed in Shanghai were retrospectively collected from April 27, 2022 to June 8, 2022 in Wujiaochang designated Hospital, Yangpu District, Shanghai. The negative conversion time of nucleic acid detection was used as the outcome variable, and the patients were divided into A (≤18 days) and B (>18 days). Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of the negative conversion time of nucleic acid detection. Results　The mean nucleic acid conversion time of 228 patients was (18.7±12.1) d, with the median time of 18 (2-46) d. Among them, 120 patients in group A had an average nucleic acid conversion time of (13.2±2.0) d, and 108 cases in group B had an average nucleic acid conversion time of (20.8±1.3) d. Univariate analysis showed that there were no statistically significant differences in the effects of hypertension, coronary heart disease, diabetes, hypokalemia, malignant tumors, neuropsychiatric diseases, chronic digestive diseases on the negative nucleic acid conversion time (P>0.05); however, there were significant differences in the effects of combined cerebrovascular disease, leukopenia, chronic respiratory system diseases and vaccination on the negative nucleic acid conversion time (P<0.05). Further multivariate logistic regression analysis revealed that the combination of chronic respiratory diseases and non-vaccination were significant risk factors for prolongation of negative nucleic acid conversion time (P<0.05). Conclusions The results of this study show that gender, age and whether hypertension, coronary heart disease, diabetes mellitus, hypokalemia, malignant tumor, neuropsychiatric disease and chronic digestive disease have no significant effect on the nucleic acid conversion time, whereas chronic respiratory disease and no vaccination are significantly correlated with the prolongation of nucleic acid conversion time in SARS-CoV-2 Omicron-infected patients.

Clinical features of COVID-19 Omicron variant cases in makeshift hospital of National Exhibition and Convention Center (Shanghai) / 中国热带医学

@#Objective To summarize and analyze the epidemiological and clinical characteristics of COVID-19 Omicron variant cases in makeshift hospital, and the influence of age, sex and vaccination status on the disease duration, so as to provide reference for the prevention and control of the COVID-19 epidemic. Methods The epidemiological and clinical characteristics of COVID-19 cases admitted to makeshift hospital of National Convention and Exhibition Center (Shanghai) from April 9 to May 31, 2022 were retrospectively described and analyzed, and further cohort analysis was conducted to determine the influence of age, sex and vaccination status on the disease duration of COVID-19 cases in the author's branch hospital. Results Among the 174 466 COVID-19 cases in makeshift hospital, most of them were male, accounting for 59.38%. The infected cases were mainly young and middle-aged people aged 18-59 years old, accounting for 83.50%, followed by 12.30% of the elderly group over 60 years old; the average hospital stay was 7.40 days; the proportion of patients with fever was less than 27.79%; 15.37% (26 817/174 466) of the patients complicated with underlying diseases, and the top three were hypertension, diabetes and coronary heart disease. The proportion of people who received COVID-19 vaccine accounted for 79.56% (13 799/17 956), of which the highest proportion of three doses was 44.09%. The disease duration of 17 956 COVID-19 cases in the author's branch of makeshift hospital was 10.18 (7.34, 13.05) days. The disease duration in the elderly group was the longest with 11.34 (8.35, 14.37) days, followed by 11.17 (9.07, 14.33) days in the preschool group, 10.37 (8.14, 13.34)· days in the middle-aged group, 10.07 (7.37, 12.37) days in the school-age group, and 9.34 (7.05, 12.16) days in the young group. There was significant difference in the overall distribution of disease duration among the five groups (H=550.479 P<0.01). The disease duration in each age group basically showed a V-shaped distribution. The disease duration was 10.27 (7.34, 12.57) days in males and 10.10 (7.25, 13.09) days in females, and there was no significant difference (Z=-1.505 P>0.05). The disease duration of vaccinated patients was 10.24 (7.35, 13.05) days, and that of unvaccinated patients was 9.47 (7.09, 12.47) days. There was significant difference between the two groups (Z=-4.338 P<0.01). Conclusions COVID-19 Omicron variant cases have a high proportion of males, mainly young and middle-aged, and the proportion of fever patients is less than 30%. The disease duration is significantly lower than that of the original strain in Wuhan, and shows "V" distribution with each age group. Sex had no effect on the disease duration. COVID-19 vaccination did not have a clinical effect on the disease duration.

Correlation between stomach disharmony and daily diets among students of Chinese medicine colleges and universities in China / 中国基层医药

Objective:To analyze the correlation between gastric disharmony and daily eating behaviors in college students, and to provide intervention measures for improving gastric disharmony among college students.Methods:From April 10 to 30, 2021, 3 825 college students from five Chinese medicine colleges and universities in China were selected for this study using the multi-level sampling method. The information regarding college student's general situation, daily eating behavior, and stomach disharmony was collected by questionnaire.Results:A total of 3 700 valid questionnaires were collected, with an effective response rate of 96.73%. The average age was (20.0 ± 3.0) years, and 66.41% of college students included in this study were female. Students with different characteristics had different gastric disharmonies and eating behaviors, and gastric disharmony was correlated with eating behavior. Multivariate analysis results showed that snacking ( OR = 1.11, 95% CI: 1.02-1.21), partial eclipse ( OR = 1.12, 95% CI: 1.00-1.26), picky eaters ( OR = 1.23, 95% CI: 1.08-1.41), and supper ( OR = 1.19, 95% CI: 1.04-1.36) were positively correlated with gastric disharmony. Eating regular meals ( OR = 0.86, 95% CI: 0.79-0.94) and 80% fullness ( OR = 0.89, 95% CI: 0.81-0.98) were negatively correlated with gastric disharmony. Conclusion:Poor eating behaviors may be an important factor leading to gastric disharmony.

Correlation between unhealthy dietary behaviors and traditional Chinese medicine constitution among students from colleges and universities of traditional Chinese medicine / 中国基层医药

Objective:To investigate the correlation between unhealthy dietary behaviors and traditional Chinese medicine constitution among students from colleges and universities of traditional Chinese medicine.Methods:College students from Shandong University of Traditional Chinese Medicine, Anhui University of Chinese Medicine, Henan University of Chinese Medicine, Shaanxi University of Chinese Medicine and Gansu University of Chinese Medicine were collected during April 10-30, 2021 and grouped taking classes as units. Research subjects were obtained by multistage sampling. Their dietary behaviors, traditional Chinese medicine constitution and demographic characteristics were surveyed using questionnaires. Statistical analysis was performed using SPSS23.0 software.Results:A total of 3825 college students were investigated and 3 700 valid questionnaires (96.7%) were collected. Peaceful constitution was detected in 7.9% of included college students. There was significant difference in peaceful constitution among studies of different sexes and different body types ( P < 0.05). There were significant differences in attention to diet, physical exercise and body weight control, out-of-control diet, excessive eating and drinking, denying body shape, and dissatisfaction with body shape between patients with peaceful and unbalanced constitutions. Multivariate analysis showed that attention to diet ( OR = 1.38, 95% CI: 1.14-1.68), physical exercise and body weight control ( OR = 1.19, 95% CI: 1.03-1.39), dissatisfaction with body shape ( OR = 1.26, 95% CI: 1.10-1.45) were conducive to the development of peaceful constitution. Conclusion:Students from colleges and universities of traditional Chinese medicine have a low proportion of developing peaceful constitution. Dietary behaviors may be an important factor that affects the development of peaceful constitution.

Application of oral fluid in SARS-CoV-2 nucleic acid and antibody detection / 中华预防医学杂志

This study aimed to explore the application value of new biological specimen oral fluid in SARS-CoV-2 nucleic acid and antibody detection. Oral fluid and paired respiratory and blood specimens from 7 confirmed cases of two COVID-19 cluster epidemic were collected in Beijing from October to November 2021. SARS-CoV-2 virus and IgG antibody were detected by real time PCR kits and serum antibody detection reagents, and SARS-CoV-2 IgG antibody in oral fluids was detected by a new established method of magnetic particle chemiluminescence. The results showed that the nucleic acid amplification test of SARS-CoV-2 on nasopharyngeal swabs, throat swabs and oral fluid specimens from 3 confirmed cases of COVID-19 was positive, among which the Ct value for ORF1a/b and N gene of oral fluid samples in 2 cases was close to that of throat swab, and the Ct value of oral fluid sample for 1 case was higher than that of throat swab. The complete genome sequence of one oral fluid specimen was obtained, which belonged to the VOC/Delta variant strain. The SARS-CoV-2 IgG antibodies of the paired oral fluid and serum were all positive, and the S/CO values of oral fluid were all lower than those of serum. The series of oral fluid results showed that SARS-CoV-2 IgG antibody level increased from 11 to 32 days after the onset of the disease.

Risk factors of hypotension after ligation of patent ductus arteriosus in very/extremely low birth weight infants / 中国新生儿科杂志

Objective:To study the risk factors of hypotension after ligation of patent ductus arteriosus (PDA) in very/extremely low birth weight infants (VLBWI/ELBWI).Method:From March 2016 to January 2021, preterm infants with birth weight <1 500 g receiving bedside PDA ligation in the neonatal intensive care unit (NICU) of our hospital were enrolled in the study. According to the occurrence of hypotension within 72 hours after ligation, the infants were assigned into non-hypotension group and hypotension group. The general status and perioperative conditions of the two groups were analyzed. Multivariate Logistic regression was used to analyze the risk factors of hypotension.Result:A total of 44 cases were enrolled, including 33 in non-hypotension group and 11 in hypotension group. Univariate analysis showed that hypotension group had significantly more cases with body weight <1 100 g during surgery and receiving preoperative high frequency oscillatory ventilation (HFOV) than non-hypotension group ( P<0.05). Multivariate Logistic regression analysis showed that weight <1 100 g during surgery ( OR=12.045, 95% CI 1.351~107.394, P=0.026) and receiving preoperative HFOV ( OR=27.832, 95% CI 1.363~568.292, P=0.031)were independent risk factors of hypotension. Conclusion:Hypotension is one of the common complications of PDA ligation in VLBWI/ELBWI. The infant's body weight during ligation and receiving preoperative HFOV are independent risk factors of hypotension.

Analysis of the incidence and risk factors of adhesive intestinal obstruction after colon cancer resection / 国际外科学杂志

Objective:To investigate the incidence of adhesive intestinal obstruction after resection of colon cancer and analyze its risk factors.Methods:Three hundred and sixty-three colon cancer patients who underwent colon cancer resection in Affiliated Hospital of Weifang Medical University from March 2016 to September 2019 were selected as the research objects, including 189 male and 174 female, aged from 45 to 75 years old, with the average of (62.36±10.69) years. Postoperative outpatient follow-up for 6 months to record the incidence of adhesive intestinal obstruction in patients after colon cancer resection. According to the occurrence of adhesive intestinal obstruction, they were divided into occurrence group and non-occurring group. The general data, laboratory data and pathological data of the two groups of patients were compared. Logistic regression was used to analyze the risk factors of adhesive intestinal obstruction after colon cancer resection.Results:As of the last follow-up time on March 23, 2020, a total of 13 patients were lost to follow-up due to different reasons. A total of 350 patients completed the follow-up, and 350 patients were finally included. The incidence of adhesive intestinal obstruction after colon cancer resection was 22.29% (78/350), these 78 patients were defined as the occurrence group, and the other 272 patients without adhesive intestinal obstruction were regarded as the non-occurrence group. There were statistically significant differences in age, comorbid diabetes, surgical methods, operation time, tumor differentiation, and lymphatic metastasis between the occurrence group and the non-occurring group ( χ2=275.397, P<0.001; χ2=52.574, P<0.001; χ2=137.931, P<0.001; χ2=48.419, P<0.001; χ2=2.099, P=0.036; χ2=36.073, P<0.001); multivariate logistic regression analysis showed that age>60 years old ( OR=41.113), complicated with diabetes ( OR=0.055), open surgery ( OR=21.913), long operation time ( OR=25.069), high degree of tumor differentiation ( OR=0.109), lymphatic metastasis ( OR=0.068) are the adhesive bowel after colon cancer resection Risk factors for obstruction. Conclusions:The incidence of bowel function after colon cancer resection was 22.29%. Age, operation method, operation time, comorbidities, tumor differentiation degree, and lymphatic metastasis are the influencing factors of adhesive intestinal obstruction after colon cancer resection, and should be treated in the treatment process. Focus on preventing the occurrence of adhesive intestinal obstruction after colon cancer resection.

Congenital Fibrinogen Deficiency Caused by Novel FGG Gene Mutation / 中国实验血液学杂志

OBJECTIVE@#To detect and analyze coagulation related indexes and genotypes of a patient with congenital fibrinogen deficiency and his family members, and to investigate the possible molecular pathogenesis.@*METHODS@#Four peripheral blood samples (proband and 3 family members) were collected and the prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fg), D-Dimer and eight coagulation factor indicators were detected. All exons and flanking sequences of the FGA, FGB, and FGG genes encoding the three peptide chains of fibrinogen were sequenced and analyzed by bioinformatics.@*RESULTS@#Among the eight coagulation factors of the proband and the elder sister, F Ⅴ and F Ⅷ were slightly higher, TT was significantly prolonged, and Fg was significantly reduced. Sequencing results showed that c.901C>T heterozygous mutation existed in the FGG gene. Bioinformatics analysis showed that the mutation changed the original protein structure and reduced the number of hydrogen bonds.@*CONCLUSION@#The fibrinogen gamma chain c.901C>T heterozygous mutation is the main cause of congenital fibrinogen deficiency in this family. This mutation is reported for the first time at home and abroad.

Application of the Children Neuropsychological and Behavioral Scale-Revision 2016 in young children with autism spectrum disorder / 中国当代儿科杂志

OBJECTIVE@#To compare the assessment results of the Children Neuropsychological and Behavioral Scale-Revision 2016 (CNBS-R2016) between young children with autism spectrum disorder (ASD) and global developmental delay (GDD, without ASD) and to explore whether CNBS-R2016 could be helpful to early identification of ASD.@*METHODS@#A total of 260 ASD and 371 GDD children aged 18-30 months were enrolled to finish the assessment of CNBS-R2016. The development quotients (DQs) of the five domains of CNBS-R2016 including gross motor, fine motor, adaptability, language and social behavior were compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate the value of the autism-predicted domain in identifying ASD and GDD.@*RESULTS@#The DQs of all the five domains in the ASD group were lower than those in the GDD group (P<0.05). The language DQ and total DQ of the ASD group had a negative correlation with the score of the autism-predicted domain (r=-0.566, -0.552 respectively, P<0.01). When the cut-off value of the autism-predicted domain was 10.5, the largest area under the ROC curve was 0.835, and the sensitivity and specificity for the diagnosis of ASD were 0.750 and 0.798 respectively.@*CONCLUSIONS@#The development of ASD children aged 18-30 months is worse than that of GDD children. CNBS-R2016 may be helpful to distinguish ASD from children with developmental delay.

A multicenter survey of antibiotic use in very and extremely low birth weight infants in Hunan Province / 中国当代儿科杂志

OBJECTIVE@#To investigate the current status of antibiotic use for very and extremely low birth weight (VLBW/ELBW) infants in neonatal intensive care units (NICUs) of Hunan Province.@*METHODS@#The use of antibiotics was investigated in multiple level 3 NICUs of Hunan Province for VLBW and ELBW infants born between January, 2017 and December, 2017.@*RESULTS@#The clinical data of 1 442 VLBW/ELBW infants were collected from 24 NICUs in 2017. The median antibiotic use duration was 17 days (range: 0-86 days), accounting for 53.0% of the total length of hospital stay. The highest duration of antibiotic use was up to 91.4% of the total length of hospital stay, with the lowest at 14.6%. In 16 out of 24 NICUs, the antibiotic use duration was accounted for more than 50.0% of the hospitalization days. There were 113 cases with positive bacterial culture grown in blood or cerebrospinal fluid, making the positive rate of overall bacterial culture as 7.84%. The positive rate of bacterial culture in different NICUs was significantly different from 0% to 14.9%. The common isolated bacterial pathogens Klebsiella pneumoniae was 29 cases (25.7%); Escherichia coli 12 cases (10.6%); Staphylococcus aureus 3 cases (2.7%). The most commonly used antibiotics were third-generation of cephalosporins, accounting for 41.00% of the total antibiotics, followed by penicillins, accounting for 32.10%, and followed by carbapenems, accounting for 13.15%. The proportion of antibiotic use time was negatively correlated with birth weight Z-score and the change in weight Z-score between birth and hospital discharge (r=-0.095, -0.151 respectively, P<0.01), positively correlated with death/withdrawal of care (r=0.196, P<0.01).@*CONCLUSIONS@#Antibiotics used for VLBW/ELBW infants in NICUs of Hunan Province are obviously prolonged in many NICUs. The proportion of routine use of third-generation of cephalosporins and carbapenems antibiotics is high among the NICUs.

Acute Toxicity of Shizaotang in Rats / 中国实验方剂学杂志

Objective:To study the acute toxicity of Shizaotang in rats, in order to provide reference for clinical drug safety and subsequent toxicological efficacy experiments. Method:Totally 40 SPF SD rats were randomly divided into control group and Shizaotang group, with 20 rats in each group (10 males and 10 females). By the maximum dose method, the Shizaotang group was given the maximum concentration of Shizaotang suspension 0.3 g·mL-1 for 2 consecutive times in the maximum dosage volume within 24 h, and the control group was given normal saline. The toxicity (death, poisoning symptoms) and its severity and recovery of the rats were observed within 14 days, and the changes in body weight and feeding before and after administration were recorded. After 14 days, the rats were put to death, and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea nitrogen (BUN), creatinine (SCr), and interleukin-2 (IL-2), tumor necrosis factor-alpha (TNF-α) and nuclear factor-κB (NF-κB) levels were measured, each tissue was weighed, and organ coefficients were calculated. Hematoxylin-eosin (HE) staining was used to observe the pathological changes of various organs, and evaluate the acute toxicity. Result:No animal death, obvious poisoning symptom, and visible organ abnormality were observed. Compared with the control group, there was no significant change in body weight and food consumption in the drug-administered group. There was no significant difference in the organ coefficients of rats. Serum ALT, AST, BUN, SCr, IL-2, TNF-α, and NF-κB did not change significantly, and no abnormality was observed in pathological sections of each tissue. Conclusion:The maximum oral dosage of Shizaotang in rats is 12 g·kg-1, which is 480 times of daily dosage for adults, with a good safety. This suggests that Shizaotang has a certain safety range.

Cardiotoxicity in Zebrafish Embryos of Euphorbiae Pekinensis Radix Before and After Processing with Vinegar / 中国实验方剂学杂志

Objective:Taking zebrafish embryos as research model, to investigate the toxic effect of different polar fractions of Euphorbiae Pekinensis Radix before and after processing with vinegar on heart. Method:Zebrafish embryos with normal development at 12 h after fertilization were treated with petroleum ether, dichloromethane and ethyl acetate extracts of Euphorbiae Pekinensis Radix before and after processing with vinegar for observation of cardiac development and function at 72 h. Result:Various polar fractions of Euphorbiae Pekinensis Radix before and after processing with vinegar had the cardiotoxicity on zebrafish embryos in a dose-dependent manner. In addition, the cardiotoxicity of different polar fractions was followed by petroleum ether, dichloromethane and ethyl acetate. The cardiotoxicity was mainly manifested as slow cardiac development, pericardial edema, decrease of heart rate and apoptosis of cardiac cells. Compared with the corresponding polar fraction of raw products, the cardiotoxicity of the same polar fraction of vinegar-processed products with similar doses decreased. Conclusion:Euphorbiae Pekinensis Radix has cardiotoxicity to zebrafish embryos and the cardiotoxicity is reduced after processing with vinegar, which can provide some experimental basis for further elucidation of the detoxication mechanism of Euphorbiae Pekinensis Radix processed with vinegar.

Effects of Euphorbiae Pekinensis Radix before and after processing with vinegar on liver and gastrointestinal toxicity of zebrafish embryos / 中国中药杂志

To study the effects of different fraction of Euphorbiae Pekinensis Radix before and after processing with vinegar on liver and gastrointestinal toxicity of zebrafish embryos,the zebrafish embryos after fertilized 12 h(12 hpf) were exposed to different concentrations of solution until 96 h(96 hpf),for observation of the toxicity response of the liver and gastrointestinal of individual zebrafish embryos. The results showed that toxicity increased in a dose-dependent manner. The liver and gastrointestinal toxicity of the zebrafish embryos in various polar fractions of Euphorbiae Pekinensis Radix before and after processing with vinegar was mainly manifested as slow liver development,smaller liver area,edema of yolk sac,delayed absorption,slowing of gastrointestinal motility,abnormal function of gastrointestinal goblet cell secretion. In addition,the toxicity of different polarity was followed by petroleum ether,dichloromethane,ethyl acetate. The above results indicated that the toxicity was reduced after processing with vinegar,and the fractions of petroleum ether and methylene chloride were the main sites responsible for liver and gastrointestinal toxicity.

Comparison of intraductal ultrasonography characteristics between cholangiocarcinoma and benign bile duct stricture / 中华消化内镜杂志

Objective To conclude the intraductal ultrasonography ( IDUS ) characteristics of cholangiocarcinoma and improve endoscopic diagnosis for cholangiocarcinoma by comparing manifestations of IDUS between cholangiocarcinoma and benign bile duct stricture. Methods A total of 52 patients undergoing endoscopic retrograde cholangiopancreatography ( ERCP ) and IDUS with definite diagnosis of cholangiocarcinoma from January 2012 to January 2017 were included in this retrospective study, and 59 patients undergoing ERCP and IDUS during the same period with definite diagnosis of benign bile duct stricture were included as control. Clinical data, indices of laboratory tests, and manifestations of IDUS ( including length of stricture, echo feature, thickness of bile duct, symmetry, and integrity of outer membrane of bile duct wall) were collected and compared between the two groups. Results The clinical manifestations and results of laboratory examination showed no significant differences between the two groups. Intraductal brushing cytology and forceps biopsy showed 28. 9％ and 40. 0％ malignant evidence respectively. IDUS showed thicker bile duct in the cholangiocarcinoma group (6. 8±4. 0 mm VS 4. 1±2. 3 mm, P<0. 01). Proportion of hypoechoic and nonsymmetrical thickened bile duct was higher in the cholangiocarcinoma group( 78. 8％ VS 44. 1％, 92. 3％ VS 50. 8％, respectively, all P<0. 01 ) . Outer membrane of bile duct destruction occurred in 8 cases ( 15. 4％) in the cholangiocarcinoma group, whereas none was seen in the control group. Conclusion Hypoecho and nonsymmetrical thickness on IDUS may be indicators of cholangiocarcinoma, and destruction of bile duct outer membrane is highly suggestive of cholangiocarcinoma.

Clinical characteristics of colonoscopic perforation and risk factors for complications after operational therapy / 中华消化内镜杂志

Objective@#To study clinical characteristics and treatment after colonscopic perforation, and to determine risk factors for postoperative complications.@*Methods@#Cases diagnosed as colonoscopic perforation within 7 days after colonoscopy in Peking Union Medical College Hospital between January 2010 and January 2017 were reviewed. Data regarding demography (age, sex), clinical information (comorbidities, medication history of glucocorticoid, length of hospital stay), colonoscopy (whether endoscopic therapy or anesthesia was performed, intestinal cleanliness), perforation (region, diagnosing time) and operation (laparotomy or laparoscopic operation, procedure, post-operational complications) were collected. Single factor analysis and Spearman correlation analysis were employed to determine the risk factors of postoperative complications.@*Results@#A total of 14 colonoscopic perforation cases were identified and included in this study, and the overall perforation rate was 0.03%. Most perforations occurred in rectum (2 cases) and sigmoid colon (8 cases). Twelve perforation patients received operational treatment, of who 6 developed postoperative complications, including 3 cases of incision infection, 2 cases of peritoneal infection, 1 case of catheter-related infection and 1 case of pulmonary embolism. Spearman correlation analysis showed that preoperative medication of glucocorticoid and non-rectosigmoid perforation were positively related to postoperative complications (both correlation coefficients were 0.707, P=0.01), while perforation diagnosed immediately and satisfying intestinal cleanliness were negatively related to it (both correlation coefficients were -0.667, P<0.05).@*Conclusion@#Perforations are rare but severe complications of colonoscopy, and surgical interventions are necessary in most cases. Postoperative complications were significantly related to perforation sites, preoperative medication of glucocorticoid, perforation diagnosis time and intestinal cleanliness.

A retrospective study of endoscopic treatment on early gastric cancer in a single center for 10 years / 中华消化内镜杂志

Objective To evaluate the efficacy, safety and risk factors of endoscopic treatment for patients with early gastric cancer. Methods A retrospective study was conducted in a single center and data was collected from 186 early gastric cancers in 168 pathologically confirmed patients who received endoscopic treatment in Peking Union Medical College Hospital from January 2006 to December 2015. The cases were divided into different groups according to indications of endoscopic treatment. The curative resection rate and complication rate were analyzed. Post-resection outcomes were evaluated by long-term surveillance. Results The curative resection rate was 86. 9%( 73/84) in the group with absolute indications, 61. 7%(50/81)in the group with expanded indications, and 33. 3%(7/21) in the group beyond indications (P＜0. 01). Multivariate analysis revealed that the significant independent predictors for curative resection included lower third location of stomach, no ulceration,≤2 cm at diameter, no adhesion, and well-differentiation in histopathology. In the expanded indications group, discordance of differentiation type and deeper invasion mainly resulted in non-curative resection in en bloc lesions. The rate of bleeding and perforation was 4. 8%( 9/186) and 3. 8%( 7/186), respectively. The perforation rate was significantly lower in the lesions located in the lower third of stomach, without adhesion or performed by en bloc resection. During a median follow-up period of 22. 3 months, 154 patients were followed successfully. The incidence of synchronous and metachronous gastric cancers in curative resected lesions was 7. 5%( 8/106) and 0. 9%(1/106), respectively. Conclusion Endoscopic resection is an optimal treatment with high curative resection rate for early gastric cancer patients with absolute indications. Patients with expanded indications should take precise preoperative evaluation to avoid higher risk of non-curative resection endoscopically. Close follow-up is necessary for synchronous and metachronous gastric cancers after endoscopic resection.

Comparison analysis of conventional criteria versus Rosemont criteria for diagnosis of chronic pancreatitis by endoscopic ultrasonography / 中华消化内镜杂志

Objective To compare the Rosemont criteria with conventional criteria for diagnosis of patients with chronic pancreatitis(CP)by endoscopic ultrasonography(EUS). Methods The data of patients with CP confirmed in Peking Union Medical College Hospital from January 2001 to September 2011 were retrospectively analyzed. Pancreatic parenchymal and ductal features were evaluated by conventional criteria and Rosemont criteria using EUS,respectively. The diagnostic value of the two kinds of criteria were compared. Results Among the 45 CP patients with mean age of 48.8 years, 34 were male, and 11 were female. Nineteen cases were in clinical phase 1, 8 in clinical phase 2, and 18 in clinical phase 3. The diagnostic yield of conventional criteria with at least 3 imaging features was higher than that of Rosemont criteria(51.1% VS 31.1%, P=0.004), but there was no significant difference between conventional criteria with at least 5 imaging features and Rosemont criteria(26.7% VS 31.1%,P>0.05).In CP patients of clinical phase 1,the diagnostic yield of conventional criteria with at least 3 imaging features was higher than that of Rosemont criteria(47.4% VS 21.1%, P=0.033), but there was no significant difference in phase 2 and 3. Conclusion Conventional criteria shows higher diagnostic yield than Rosemont criteria. It will be more valuable to apply conventional criteria with at least 3 imaging features of EUS in early suggestive chronic pancreatitis.

Efficacy of 308-nm excimer laser versus high-intensity ultraviolet radiation for the treatment of active localized vitiligo / 中华皮肤科杂志

Objective To investigate the efficacy and safety of 308-nm excimer laser compared to high-intensity ultraviolet radiation for the treatment of active localized vitiligo,and to observe changes in skin lesions before and after the treatment by confocal laser scanning microscopy.Methods Sixty patients with 203 skin lesions of active localized vitiligo and were enrolled into this study,and the vitiligo disease activity (VIDA) score of these patients ranged from 2 to 3.We selected more than 3 skin lesions from a same anatomical site of each patient,one of lesions served as a control and the other skin lesions (≥ 2) were randomly treated with 308-nm excimer laser (laser group) or high-intensity ultraviolet radiation (ultraviolet group).The treatment was conducted twice a week for 25 sessions,and a 3-month follow-up was performed.Results A total of 48 patients with 169 skin lesions completed the trial.The marked response rate was significantly higher in the laser group [66.15％ (43/65)] than in the ultraviolet group [44.64％ (25/56),x2 =8.28,P ＜ 0.01].The patients with a VIDA score of 2 showed a significantly higher marked response rate [67.69％(44/65)] compared with those with a VIDA score of 3 [44.64％(25/56),x2 =6.80,P ＜ 0.01].During the 3-month follow-up,no relapse was observed.Confocal laser scanning microscopy showed that the number of inflammatory cells increased at the dermal-epidermal junction of the intra-and extra-marginal lesional skin.After treatment,the number of inflammatory cells markedly decreased and returned to normal level in lesions.Conclusion Both 308-nm excimer laser and high-intensity ultraviolet radiation are effective in the treatment of active localized vitiligo,but the 308-nm excimer laser shows a more rapid onset of action and a better therapeutic effect.

The colonoscopic characteristics of colorectal endometriosis: a single-centered retrospective study / 中华内科杂志

Objective To reinforce the awareness of colorectal endometriosis (EM) in colonoscopy examination.Methods Patients diagnosed as colorectal EM at Peking Union Medical College Hospital between February 2002 and February 2017 were enrolled in this study.The clinical characteristics and endoscopic features of EM lesions were summarized and compared between pathologically positive group and negative group.Results A total of 34 cases were included with average age of (38.3± 8.9) years old.All EM lesions located within rectum and sigmoid colon.The endoscopic lesions manifested as protrusion in 21 cases (61.8％) and protrusion-depression in 13 cases (38.2％),local stenosis in 8 cases (23.5％);erosive surface in 33 cases (97.1％) with local spontaneous hemorrhage in 4 cases (11.8％);nodal surface in 23 cases (67.6％),and lymphangiectasis base in 9 cases (26.4％).Endoscopic biopsy specimens were obtained in all cases with average 3 (2,4) pieces.Positive results were found only in 4 patients (11.8％) with 3 endometriosis and one (endometrial) adenosarcoma.Compared with negative group,spontaneous hemorrhage was more frequent in positive group (2/4 vs.2/30,P=0.013).Mean biopsy sample number was significantly larger in positive group (5 vs.3,P=0.004).Conclusions Colorectal endometriosis is mostly located within rectosigmoid region.Endoscopic features mainly include protrusion or protrusion-depression lesions with erosive and nodular surface,or local stenosis.Spontaneous hemorrhage under colonoscopy yields higher positive rate for biopsy,thus increasing biopsy sample numbers may improve pathology results.