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Objective: To evaluate the safety and efficacy of domestically produced magnetic sphincter augmentation (MSA) for gastroesophageal reflux disease. Method: This study is a prospective cohort study. Patients with typical heartburn and reflux symptoms (at least partial response to proton pump inhibitors), abnormal esophageal acid exposure and normal esophageal peristalsis were included, prospectively in the Department of Gastroesophageal Surgery, Rocket Force Characteristic Medical Center from June 2019 to September 2022. Patients with hiatal hernia >2 cm and severe esophagitis were excluded. The MSA was wrapped around the distal esophagus after esophageal hiatus repair by laparoscopy. A postoperative questionnaire survey was conducted to assess the relief of symptom, complications, the discontinuation rate of proton pump inhibitor, and surgical satisfaction. Gastroscopy, high-resolution esophageal pressure measurement, and pH value impedance monitoring were also reviewed. The pre- and postoperative rates were compared using the McNeinar χ2 test. Result: Currently, 23 patients with gastroesophageal reflux disease were enrolled and underwent MSA surgery. There were 20 males and 3 females, aged (M (IQR)) 48 (14) years (range: 25 to 64 years). All cases were successfully implanted with MSA. Subjective indicators were followed for 17 (18) months (range: 14 to 53 months), while objective indicators were followed for 17 (1) months (range: 12 to 23 months). The postoperative gastrointestinal and extraesophageal symptom scores showed a significant decrease compared to preoperative levels as follows: the degree of subjective relief of overall digestive symptoms was 90 (20)% (range:0~100%), the degree of subjective relief of overall respiratory symptoms was 100(10)% (range: 10%~100%), the overall satisfaction rate was 83% (19/23), the proton pump inhibitor discontinuation rate was 70% (16/23). The proportion of esophagitis has decreased from 44% (10/23) to 9% (2/23) (κ=0.169, P=0.039), The Hill grade of gastroesophageal valve morphology improved from 1 case of grade â , 5 cases of grade â ¡, 10 cases of grade â ¢, and 7 cases of grade â ¢ preoperative to 22, 1, 0, and 0 cases postoperative. The proportion of lower esophageal sphincter pressure below normal has decreased from 70% (16/23) to 35% (8/23) (κ=0.170, P=0.012). There were 21 patients who restored normal esophageal acid exposure. Eleven patients had mild long-term dysphagia, but it didn't affect their daily life. No postoperative device migration, erosion, or secondary surgical removal occurred. Conclusions: Laparoscopic implantation of the MSA device was safe and well tolerated. It can effectively control the symptoms of gastroesophageal reflux disease, reduce medication, restore normal cardia morphology and function, and esophageal acid exposure. The main postoperative complication was dysphagia, but it was relatively mild.
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Refluxo Gastroesofágico , Humanos , Refluxo Gastroesofágico/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Estudos Prospectivos , Resultado do Tratamento , Laparoscopia/métodos , Inibidores da Bomba de Prótons/uso terapêutico , Manometria , Esfíncter Esofágico Inferior/cirurgia , Hérnia Hiatal/cirurgiaRESUMO
Objective: To explore the clinical characteristics, diagnosis, treatment, and follow-up of multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 Omicron variant infection. Methods: A retrospective analysis was conducted on clinical data of 11 children with MIS-C, who were admitted to the Department of Pediatrics of Peking University First Hospital from December 2022 to January 2023. Clinical characteristics, treatment, and follow-up of MIS-C were summarized in this study. Results: The 11 cases contained 7 boys and 4 girls, with an age of 4.4 (2.0, 5.5) years on admission. All the patients had fever, with a duration of 7(5, 9) days. Other clinical manifestations included rash in 7 cases, conjunctival hyperemia in 5 cases, red lips and raspberry tongue in 3 cases, lymphadenopathy in 3 cases, and swollen fingers and toes in 2 cases. There were 8 cases of digestive symptoms, 8 cases of respiratory symptoms, and 3 cases of nervous system symptoms. Eight patients had multi-system injuries, and one of them had shock presentation. All 11 patients were infected with SARS-CoV-2 Omicron BF.7 variant. The laboratory examination results showed that all cases had elevated inflammatory indicators, abnormal coagulation function and myocardial damage. Six patients had elevated white blood cell counts, 5 cases had liver function abnormalities, 3 cases had kidney function abnormalities, and 8 cases had coronary artery involvement. All 11 patients received anti-infection treatment, of which 3 cases received only 2 g/kg intravenous immunoglobulin (IVIG), while the remaining 8 cases received a combination of IVIG and 2 mg/(kg·d) methylprednisolone. Among the 8 cases with coronary artery disease, 6 cases received low molecular weight heparin anticoagulation therapy. All patients were followed up in 2 weeks after being discharged, and their inflammatory markers had returned to normal by that time. The 8 cases with coronary artery disease and 3 cases with pneumonia showed significant improvement or back to normal at the 4-week follow-up. All patients had no new complications or comorbidities during follow-up of more than 3 months. Conclusions: MIS-C may present with Kawasaki disease-like symptoms, with or without gastrointestinal, neurological, or respiratory symptoms. Elevated inflammatory markers, abnormal coagulation function, and cardiac injury contribute to the diagnosis of MIS-C. IVIG and methylprednisolone were the primary treatments for MIS-C, and a favorable short-term prognosis was observed during a follow-up period of more than 3 months.
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COVID-19 , Doenças do Tecido Conjuntivo , Doença da Artéria Coronariana , Masculino , Feminino , Humanos , Criança , SARS-CoV-2 , Imunoglobulinas Intravenosas/uso terapêutico , Estudos Retrospectivos , COVID-19/complicações , Metilprednisolona/uso terapêutico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológicoRESUMO
Because of the half-filled t_{2g}-electron configuration, the BO_{6} octahedral distortion in a 3d^{3} perovskite system is usually very limited. In this Letter, a perovskitelike oxide Hg_{0.75}Pb_{0.25}MnO_{3} (HPMO) with a 3d^{3} Mn^{4+} state was synthesized by using high pressure and high temperature methods. This compound exhibits an unusually large octahedral distortion enhanced by approximately 2 orders of magnitude compared with that observed in other 3d^{3} perovskite systems like RCr^{3+}O_{3} (R=rare earth). Essentially different from centrosymmetric HgMnO_{3} and PbMnO_{3}, the A-site doped HPMO presents a polar crystal structure with the space group Ama2 and a substantial spontaneous electric polarization (26.5 µC/cm^{2} in theory) arising from the off-center displacements of A- and B-site ions. More interestingly, a prominent net photocurrent and switchable photovoltaic effect with a sustainable photoresponse were observed in the current polycrystalline HPMO. This Letter provides an exceptional d^{3} material system which shows unusually large octahedral distortion and displacement-type ferroelectricity violating the "d^{0}-ness" rule.
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Objective: To investigate the effect of a novel laparoscopic W-H fundoplication in the treatment of proton pump inhibitor (PPI) dependent gastroesophageal reflux disease (GERD). Methods: The clinical data of PPI dependent GERD patients who underwent laparoscopic W-H fundoplication in PLA Rocket Force Characteristic Medical Center from October 1st, 2018 to April 30th, 2019 were analyzed retrospectively. The GERD symptom score, subjective symptom relief, PPI withdrawal, efficacy satisfaction and postoperative complications were followed up and analyzed by a questionnaire. Results: A total of 80 GERD patients were included in this study, and 49 were male and 31 were female, with a median age of 58 years. Among all patients, 85% (68/80) are with esophagitis and 77.5% (62/80) with hiatal hernia. The operation time was 67 (52, 73) minutes, without intraoperative complications and conversion to laparotomy. The postoperative follow-up period was 16 (14, 18) months. The postoperative GERD symptom scores were significantly lower than those before surgery, with an statistical difference (all P<0.05). The subjective remission degree of the overall digestive and respiratory symptoms were 100 (90, 100)% and 100 (80, 100)%, respectively. During the follow-up period, the PPI discontinuation rate was 83% (69/80), and the satisfactory rate was 93% (75/80). Postoperative complications included dysphagia, flatulence, increased exhaust and diarrhea, and the incidence was 61% (49/80), 8% (6/80), 5% (4/80) and 4% (3/80), respectively, and 16% (13/80) of the patients had prolonged occasional mild dysphagia. There was no death, symptomatic recurrence or reoperation. Conclusions: The novel W-H fundoplication has a good medium-term efficacy, with significant GERD symptom control rate and PPI discontinuation rate. The postoperative dysphagia is common, but it is self-limiting and does not affect the satisfaction of the surgical effect.
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Refluxo Gastroesofágico , Laparoscopia , Feminino , Fundoplicatura , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: MicroRNA-329-3p (miR-329-3p) has been shown to be involved in tumor development. But its role in hepatocellular carcinoma has not been explored. Our study aims to explore the effect and mechanism of miR-329-3p on hepatocellular carcinoma development. PATIENTS AND METHODS: Hepatocellular carcinoma tissues and paired paracancerous specimens from 31 hepatocellular carcinoma patients undergoing surgery were collected. Quantitative real-time polymerase chain reaction and Western blot were employed to measure genes expression at mRNA and protein level. CCK-8 and transwell assays were performed to evaluate hepatocellular carcinoma cells proliferation and migration. Dual-Luciferase reporter gene assay was designed to validate the target gene of miR-329-3p. RESULTS: Our study showed miR-329-3p expression was significantly lower in hepatocellular carcinoma tissue. MiR-329-3p mimic inhibits proliferation and migration of HepG2 cells. By using Dual-Luciferase reporter gene assay, we proved that miR-329-3p inhibited HepG2 cell proliferation and migration by targeting USP22 directly. By up- and downregulation of USP22 expression, we also proved that USP22 can activate the Wnt/ß-Catenin pathway, which in turn affected the proliferation and migration of HepG2 cells. CONCLUSIONS: We demonstrated that miR-329-3p can inhibit HepG2 cell proliferation and migration by inhibiting USP22-Wnt/ß-Catenin pathway. Our study provides novel insights into the aetiology and potential treatment of hepatocellular carcinoma.
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Carcinoma Hepatocelular/metabolismo , Neoplasias Hepáticas/metabolismo , MicroRNAs/metabolismo , Ubiquitina Tiolesterase/metabolismo , beta Catenina/metabolismo , Carcinoma Hepatocelular/patologia , Movimento Celular , Proliferação de Células , Humanos , Neoplasias Hepáticas/patologia , MicroRNAs/genética , Células Tumorais Cultivadas , Ubiquitina Tiolesterase/genética , Via de Sinalização WntRESUMO
Objective: To investigate the application of severity classification according to the protocol on the Diagnosis and Treatment of coronavirus disease 2019(COVID-19)by the National Health Commission of China, pneumonia severity index(PSI) and CURB-65ãin risk stratification and prognostic assessment of COVID-19. Methods: Clinical data of 234 in-hospital patients with COVID-19 were collected and retrospectively reviewed in Wuhan Tongji Hospital. Patients were divided into 3 groups (common, severe, and critical type) at admission according to the sixth version of the protocol issued by the National Health Commission of China on Diagnosis and Treatment of COVID-19. At the same time, the severity of pneumonia was calculated by PSI and CURB-65, and the patients were stratified into 3 risk groups, namely mild, moderate, and severe groups. The hospital mortality rate was evaluated in each group. Sensitivity, specificity, positive predictive values, negative predictive values, and the area under the receiver operating characteristic(ROC) curve(AUC) for predicting hospital mortality in each rule were assessed. Results: According to the severity classification of Chinese protocol, the proportion of patients with common type, severe type, and the critical type was 15.8%, 75.6%, and 8.5%, respectively. No in-hospital death occurred in the common type. As for PSI and CURB-65, greater proportions of patients were classified as low risk(79.1% and 75.6%, respectively), while smaller proportions of patients were classified as moderate and high risk(16.2%, 15.0%; 4.7%, 9.4%, respectively). In-hospital death occurred in low and moderate risk patients identified by these 2 scoring systems. The mortality of the critical group of the Chinese protocol was 65%, and the sensitivity and specificity of predicting in-hospital mortality were 36.4% and 97.0%, respectively. The mortality in the high risk group of PSI and CURB-65 was 100% and 77.3%. The risk class V of PSI and CURB-65 score 3-5 had high specificity(100% and 97.4%, respectively)but low sensitivity(33.3% and 51.5%, respectively)in predicting in-hospital mortality. The AUC of the Chinese protocol severity classification, PSI, and CURB-65 was 0.735, 0.951, and 0.912. The optimal cut-off point of PSI was risk class â £, and the sensitivity and specificity for predicting mortality were 90.9% and 90.5%. The optimal cut-off point of CURB-65 was score 2, and the corresponding sensitivity and specificity were 84.8% and 85.6%. Conclusions: PSI and CURB-65 can be used for risk stratification and prognostic assessment in patients with COVID-19.
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Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Índice de Gravidade de Doença , Betacoronavirus , COVID-19 , China/epidemiologia , Infecções por Coronavirus/mortalidade , Humanos , Pandemias , Pneumonia Viral/mortalidade , Prognóstico , Estudos Retrospectivos , Medição de Risco , SARS-CoV-2 , Sensibilidade e EspecificidadeRESUMO
Severe and critical coronavirus pneumonia 2019 (COVID-19) often occurs in elder patients with multiple comorbidities, and severe hypoxemia events constitute a key factor for the deterioration of some cases. The critical type of COVID-19 could progress into acute respiratory distress syndrome and multi-organ dysfunction, which are the major causes of death. Early non-invasive ventilation (NIV) treatment of possible pathophysiological abnormalities is helpful to improve prognosis. Close monitoring of oxygenation, reducing patients' oxygen consumption, active psychological intervention, and rapid handling of severe hypoxemia events are the key factors for successful NIV treatment. In addition, active adjuvant therapies such as correcting coagulation dysfunction, providing proper nutritional support, accurate volume control, and safe individualized blood glucose monitoring are of great significance.
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Infecções por Coronavirus , Pandemias , Pneumonia Viral , Pneumonia , Idoso , Betacoronavirus/isolamento & purificação , Glicemia/análise , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Estado Terminal , Humanos , Oxigênio/administração & dosagem , Pneumonia/etiologia , Pneumonia/terapia , Pneumonia Viral/complicações , Pneumonia Viral/terapia , SARS-CoV-2RESUMO
Objective: To analyze the relationship between the severity of esophageal acid reflux and esophageal motility, esophageal mucosal injury and morphological anatomy of gastroesophageal junction (GEJ) in patients with gastroesophageal reflux disease (GERD). Methods: The clinicaldata of GERD patients who underwent 24 h pH-impedance monitoring, gastroscopy and high-resolution manometry (HRM) from January 2016 to January 2019 in the Gastroesophageal Surgery Department of PLA Rocket Force Characteristic Medical Center were retrospectively analyzed. The patients were divided into non-pathological acid reflux group, mild pathological acid reflux group and moderate to severe pathological acid reflux group according to the DeMeester score. The gender and age of each group were matched, with 60 cases in each group. Statistical analysiswas performed to analyze thedifferences in upper esophageal sphincter pressure, lower esophageal sphincter pressure (LES), LES length, length of ventral LES, percentage of ineffective swallowing, esophagitis, Hill grade of GEJ, and hiatus hernia (HH) in each group. The comparison and correlation analysis are also carried out between the groups. Results: The male-female ratio was 33/27, and the age was (57±13) years in each group. Non-parametric analysis showed that the LES pressure and the length of the ventral LES decreased with the severity of acid reflux, and there was a statistical difference (P= 0.033, P=0.015). The detection rate of HH by HRM increased significantly (χ(2)=0.001) as well. Esophagitis score increased with the severity of acid reflux and there was statistical difference (P<0.001).The detection rate of esophagitis increased significantly (χ(2)<0.001) as well. Hill grading score of GEJ increased with the severity of acid reflux, and there was statistical difference (P<0.001).The detection rate of HH by endoscopy increased significantly (χ(2)<0.001) as well. The correlation between DeMeester score and LES pressure, length of ventral LES, percentage of ineffective swallowing, esophagitis score, and Hill grade score were statistically significant (P<0.05). Conclusions: The esophageal low motility (such as low LES pressure) and anatomical abnormalities (abdominal esophageal shortening, GEJ flabbiness, and even HH formation) of the GEJ regionare significantly associated with the severity of acid reflux. These factors may be important causes of increased acid reflux. In addition, the aggravation of acid reflux can also increase the incidence and severity of esophagitis.
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Transtornos da Motilidade Esofágica , Esofagite Péptica , Refluxo Gastroesofágico , Hérnia Hiatal , Adulto , Idoso , Feminino , Azia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: The study was designed to investigate the JAK2/STAT3 signaling pathway in pancreatitis and its association with inflammation and cell death to provide a potential treatment method for pancreatitis. MATERIALS AND METHODS: The rat pancreatic acinar AR42J cells were used for the study, and they were transfected with JAK2 and STAT3 siRNAs to mimic knockdown condition. Cerulein was used to treat AR42J cells. Western blot and ELISA were employed to detect the expression of related proteins. Flow cytometry was done to analysis the necrosis of AR42J cells. RESULTS: In this study, we found that cell death and the secretion of IL-6 and TGF-ß1 were significantly increased, and the JAK2/STAT3 signaling pathway was activated in cerulein-induced AP. To determine the role of JAK2 and STAT3, JAK2 siRNA and STAT3 siRNA were used to block JAK2 and STAT3, respectively. The levels of IL-6 and TGF-ß1 levels in the medium were lower in JAK2 siRNA and STAT3 siRNA-treated cells compared with controls. Flow cytometry analysis showed that the level of cell death, expression of cleaved caspase-3, and the release of LDH were decreased following JAK2 siRNA and STAT3 siRNA treatment. CONCLUSIONS: These findings point to a novel role for the JAK2/STAT3 signaling pathway in the progression of cerulein-induced AP.
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Ceruletídeo/farmacologia , Inflamação/tratamento farmacológico , Janus Quinase 2/metabolismo , Fator de Transcrição STAT3/metabolismo , Animais , Morte Celular/efeitos dos fármacos , Células Cultivadas , Citocinas/biossíntese , Inflamação/metabolismo , Inflamação/patologia , Janus Quinase 2/antagonistas & inibidores , RNA Interferente Pequeno/farmacologia , Ratos , Fator de Transcrição STAT3/antagonistas & inibidores , Transdução de Sinais/efeitos dos fármacosRESUMO
Objective: To analyze esophageal motility dysfunction in gastroesophageal reflux disease (GERD) with different severity of esophagitis, and the relationship between the esophageal motility dysfunction and the severity of esophagitis. Methods: GERD patients simultaneously undergone endoscopy and high-resolution manometry were divided into four groups: Non-esophagitis (Non-erosive gastroesophageal reflux disease, NERD) group, mild esophagitis group, moderate esophagitis group and severe esophagitis group. The gender and age were matched for each group, and every group consisted of 80 cases. Nonparametric test was used to analyze the differences in HRM parameters, such as upper esophageal sphincter (UES) pressure, lower esophageal sphincter (LES) pressure, LES length, LES-CD (crural diaphragm) separation distance, and the percentage of failed peristalsis of the four groups, and the differences between each two of the groups were also analyzed. Results: Nonparametric test showed that the LES pressure and length decreased with the severity of esophagitis, and there were statistical differences (P<0.001, P=0.030). The failed peristalsis percentage increased with the severity of esophagitis and the difference was statistically significant (P<0.001). The LES-CD separation distance was increased with the severity of esophagitis and had statistically significance (P<0.001). When comparing the differences between each two of the groups, there were significant differences (P<0.001, P=0.012, P<0.001, P<0.001) between NERD group and severe esophagitis group in the HRM parameters of the lower esophageal sphincter pressure, the LES length, the LES-CD separation distance, and the percentage of ineffective swallowing in the NERD and severe esophagitis group. The detection rate of HH was significantly increased from NERD to severe esophagitis, the detection rate of HH was 6.3% to 82.5% in gastoracopy and 16.3% to 45.0% in HRM, and the diagnostic consistency was fair (Kappa Value: 0.31). Conclusions: Hypo-dynamic state of esophageal and HH are the main motility characteristics of erosive gastroesophageal reflux disease, Esophageal motility abnormalities increase in parallel with the severity of GERD from NERD to severe esophagitis, these motility disorders may also play important roles in causing esophagitis.
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Transtornos da Motilidade Esofágica , Refluxo Gastroesofágico/fisiopatologia , Manometria , Esofagite Péptica , Feminino , Humanos , Masculino , CintilografiaRESUMO
OBJECTIVE: To develop a aided mechanical appliance for rapid reconstruction of three-dimensional(3D)relationship of dentition model after scanning and evaluation of its accuracy. METHODS: The appliance was designed by forward engineering software and fabricated by a high precision computer numerical control(CNC)system. It contained upper and lower body, magnetic pedestal and three pillars. Nine 3 mm diameter hemispheres were distributed equally on the axial surface of each pedestal. Faro Edge 1.8m was used to directly obtain center of each hemisphere(contact method), defined as known center. A pair of die-stone standard dentition model were fixed in intercuspal position and then fixed on the magnetic pedestals with low expansion ratio plaster. Activity 880 dental scanner was used to scan casts after the plaster was completely set. In Geomagic 2012, the centers of each hemisphere were fitted and defined as scanning centers. Scanning centers were aligned to known centers by reference point system to finish the 3D reconstruction of the intercuspal occlusion for the dentition casts. An observation coordinate system was interactively established. The straight-line distances in the X(coronal), Y(saggital), and Z(vertical)between the remaining 6 pairs of center points derived from contact method and fitting method were measured respectively and analyzed using a paired t-test. RESULTS: The differences of the straight-line distances of the remaining 6 pairs of center points between the two methods were X:(-0.05±0.10)mm, Y:(0.02±0.06)mm, and Z:(0.01 ± 0.05)mm. The results of paired t-test showed no significant differences(P>0.05). CONCLUSIONS: The mechanical appliance can help to reconstruct 3D jaw relation by scanning single upper and lower dentition model with usual commercial available dental cast scanning system.
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Oclusão Dentária , Dentição , Processamento de Imagem Assistida por Computador , Modelos Dentários , Software , HumanosRESUMO
OBJECTIVE: To investigate the safety and effectiveness of laparoscopic reoperation for patients with gastroesophageal reflux disease (GERD) recurred form previous anti-reflux surgery. METHODS: Totally 19 patients received laparoscopic reoperation for symptomatic and anatomic recurred GERD in Department of Gastroesophageal Reflux Disease, Rocket Force General Hospital from January 2008 to September 2015 were retrospectively analyzed. There were 12 male and 7 female patients. The average reoperation age was (48±14) years, the average duration of reoperation from original ones was (43±38) months. The patients underwent preoperative barium, endoscopy, manometry and 24-hour pH studies. Laparoscopic hiatal hernia repair plus fundoplication was carried out for reoperation. Gastroesophageal reflux related symptoms (reflux, heartburn, chest pain, chough, wheezing, chest tightness and globus sensation) before and after surgery were compared by a questionnaire. The patients' medication consumption, complications and satisfaction of the reoperation were investigated as well. The repeated measures analysis of variance was used for statistical comparison of data preoperatively and postoperatively. RESULTS: No major complication and death occurred. Six cases (32%) had complications such as diarrhea, increased passing wind, flatulence, dysphagia and abdominal pain. The GERD related symptom score of reflux, heartburn, chest pain, chough, wheezing, chest tightness and globus sensation all significantly decreased (F: 25.0 to 56.7; P: 0.000 to 0.001) after the reoperation, with 68% good outcome of all the patients. After a follow-up of (33±22) months after reoperation, 1 case had partial recurrence at the 3(rd) month after reoperation. For all the patients, 12 cases felt very satisfied or satisfied with the reoperation. CONCLUSION: Laparoscopic reoperation is generally effective with acceptable morbidity rates for patients with esophageal and extraesophageal symptoms recurred form previous hiatal repair and (or) fundoplication.
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Refluxo Gastroesofágico , Transtornos de Deglutição , Feminino , Fundoplicatura , Humanos , Laparoscopia , Masculino , Manometria , Pessoa de Meia-Idade , Recidiva , Reoperação , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
STUDY DESIGN: This is a survey-based study. OBJECTIVE: To investigate the practice of spinal cord injury (SCI) core data collection by Chinese physicians to measure the extent and accuracy of routine collection of elements contained in the International Spinal Cord Injury Core Data Set (ISCICDS). SETTING: This study was conducted in a workshop in Peking University, China. METHODS: During an SCI workshop, a survey questionnaire was administered to 48 physicians from 20 provinces of China. The questions were developed on the basis of the data elements within the ISCICDS including the following issues: date of birth, injury, acute admission and inpatient discharge, total hospitalized days, gender, injury etiology, vertebral injury, associated injury, spinal surgery, ventilatory assistance and place of discharge. In addition, data collection practice on neurologic examinations including date, neurological level, injury severity and frequency of examination were involved. RESULTS: The self-reported practice of data collection regarding date of birth, acute admission and inpatient discharge, gender, vertebral injury, associated injury, spinal surgery and frequency of neurological examination are consistent with the information in the ISCICDS among the majority (⩾76%) of physicians. However, only gender, vertebral injury, associated injury and spinal surgery are completely consistent. The consistency percentages of other data elements ranged from 39.5 to 66.8%. CONCLUSION: Apart from four data elements, which were collected consistently with the intention in the ISCICDS, the collection of other core data elements need to be documented according to the guidelines included in the ISCICDS to ensure consistency of practice among Chinese physicians and to support worldwide comparison of SCI data.Suggestion:Only four data elements are collected in complete accordance with the ISCICDS by Chinese physicians. ISCICDS guidelines for the remaining elements need to be more rigorously adhered to in order to promote consistency and comparability of data.
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Coleta de Dados/métodos , Traumatismos da Medula Espinal , China , Humanos , Internacionalidade , Médicos , Autorrelato , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/terapiaRESUMO
AIM: The aim of the present study was to prospectively evaluate the Stretta radiofrequency (RF) treatment for gastroesophageal reflux disease (GERD) -related respiratory symptoms over a 5-years follow-up period. METHODS: A total of 132 patients underwent the Stretta procedure between April 2007 and February 2009; 122 of the patients (92.4%) completed the 5-year follow-up. Symptom scores and PPI usage were evaluated at baseline, 6 months, 1 year, 3 years and 5 years after treatment. RESULTS: A total of 122 patients (age, 51.7 ± 13.0 years, M:F, 52: 70) were followed up for 5 years and their outcomes were analyzed. At 5 years after treatment, the symptom scores were significantly reduced (heartburn score, from 5.67 ± 1.52 to 2.41 ± 1.13; regurgitation score, from 5.43 ± 1.66 to 2.27 ± 1.33; chest pain score, from 4.45 ± 1.47 to 2.40 ± 0.88; cough score, from 6.62 ± 1.73 to 3.14 ± 1.43; and asthma score, from 6.83 ± 1.46 to 3.26 ± 1.53, P<0.001). Moreover, 56.6% of the patients were completely off PPIs. CONCLUSION: Stretta RF significantly improves the symptoms and reduces PPI usage at 5 years. Therefore, it is a viable, effective, and minimally invasive endoluminal procedure for patients with GERD-related respiratory symptoms.
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Ablação por Cateter/métodos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/cirurgia , Qualidade de Vida , Adulto , Idoso , Antiulcerosos/uso terapêutico , Asma/etiologia , China/epidemiologia , Tosse/etiologia , Feminino , Seguimentos , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Inibidores da Bomba de Prótons/uso terapêutico , Resultado do TratamentoRESUMO
STUDY DESIGN: Descriptive comparison analysis. OBJECTIVE: To evaluate whether five training cases of International Spinal Cord Injury Core Data Set (ISCICDS) are appropriate for testing the facts within the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and could thus be used for testing its training effectiveness. METHODS: The authors reviewed the five training cases from the ISCICDS and determined the sensory level (SL), motor level (ML) and American Spinal Injury Association Impairment Scale (AIS) for the training cases. The key points from the training cases were compared with our interpretation of the key aspects of the ISNCSCI. RESULTS: For determining SL, three principles of ML, sacral sparing, complete injury, classification of AIS A, B, C and D, determining motor incomplete status through sparing of motor function more than three levels below the ML, there are corresponding case scenarios in ISCICDS. However, no case scenario shows classification of AIS E and the use of voluntary anal sphincter contraction for determination of motor incomplete status. Neurological level of injury could be deduced from the SL and ML. Finally, none of the cases include information about zone of partial preservation, sensory score or motor score. CONCLUSION: Majority of the facts related to SL, ML and AIS are included in the five training cases of ISCICDS. Thus, using these training cases, it is feasible to test the above facts within the ISNCSCI. It is suggested that the missing fact should be included in an update of the training cases.
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Neurologia/normas , Traumatismos da Medula Espinal/classificação , Adulto , Canal Anal , Bases de Dados Factuais , Estudos de Viabilidade , Humanos , Movimento/fisiologia , Exame Neurológico/normas , Padrões de Referência , Sensação/fisiologia , Traumatismos da Medula Espinal/diagnósticoRESUMO
AIM: Laparoscopic Nissen fundoplication (LNF) and Stretta radiofrequency (RF) are used as main alternative strategies to manage medication-refractory GERD. This study was therefore prospectively evaluated outcomes of patients with refractory GERD 5 years after LNF or Stretta RF. METHODS: A total of 215 consecutive patients with refractory GERD underwent LNF (N.=102) and Stretta RF (N.=113) in our department between 2007 and 2008. They were followed-up for 5 years, during which the outcome measures including symptom scores of regurgitation, heartburn, chest pain, belching, hiccup, cough and asthma as well as the proton pump inhibitor (PPI) use and complications. RESULTS: Of the 215 patients, 179 patients following LNF (N.=87) or Stretta RF (N.=92) completed the designated 5-year follow-up and were included in the final analysis. At the end of 5-year follow-up, the post-treatment scores were statistically lower as compared with the pre-treatment scores in both groups, while the symptom improvements after Stretta were significantly lower than that after LNF (p < 0.05). Besides, 81 (91%) patients achieved complete PPI therapy independence after LNF, comparing with 47 (51.1%) after Stretta RF (P<0.05). No significant differences in post-treatment complications were observed except for the abdominal distention. CONCLUSION: Even though laparoscopic Nissen fundoplication and Stretta RF are capable of controlling GERD symptoms effectively and safely in selected patients, LNF could improve more in symptoms and PPI elimination.
Assuntos
Ablação por Cateter , Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Laparoscopia , Adulto , Ablação por Cateter/métodos , Feminino , Seguimentos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
AIM: Chronic cough is the most common extra-esophageal manifestation of gastroesophageal reflux disease (GERD). This study aimed to retrospectively analyze outcomes in patients with GERD-related cough following laparoscopic Nissen fundoplication (LNF) and Stretta radiofrequency (RF) respectively. METHODS: Medical charts of 83 patients with GERD-related cough that underwent LNF or Stretta RF between 2007 and 2012 were retrieved. Symptom scores (heartburn, regurgitation and cough) and proton pump inhibitors (PPIs) usages were evaluated. RESULTS: A total of 83 patients with GERD-related cough underwent LNF (N.=35) and Stretta RF (N.=48), and were followed up 36.78 ± 16.12 months (range 13-55 months). During the follow-up, the post-treatment scores were statistically lower as compared with the pre-treatment scores in both groups, while the cough improvement after Stretta was significantly lower than that after LNF (P<0.001). Besides, 27 (77.1%) patients achieved complete PPI therapy independence after LNF, comparing with 27 (65.1%) after Stretta (P<0.05). No significant differences in post-treatment complications were observed except for the abdominal distention. CONCLUSION: Even though laparoscopic Nissen fundoplication and Stretta are capable of controlling GERD-related cough effectively and safely in selected patients, laparoscopic Nissen fundoplication could improve more in symptoms and PPI elimination.
Assuntos
Ablação por Cateter/métodos , Tosse/cirurgia , Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Laparoscopia , Adulto , Idoso , Doença Crônica , Tosse/etiologia , Esfíncter Esofágico Inferior , Feminino , Seguimentos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Epidemiologic studies have shown a strong association between gastroesophageal reflux (GER) and asthma, especially in children. Diagnosing GER can be difficult in some patients when GER presents solely with asthma. The aim of this study was to explore the relationship between GER and asthma with animal model. Sixty rats were randomly divided into six equal groups, GER group, GER-associated-asthma group, allergic asthma group, and their control groups. The cytokine levels and concentration of inflammatory cells in bronchoalveolar lavage (BAL) were determined. The BAL of the rats with allergic asthma contained higher concentration of Interleukin-5 (IL-5) and more eosinophils than those of rats with GER-associated-asthma. This demonstrates that assaying the concentrations of IL-5 and inflammatory cells in BAL may be an effective method of distinguishing GER-associated asthma from allergic asthma.
Assuntos
Asma/imunologia , Líquido da Lavagem Broncoalveolar/imunologia , Refluxo Gastroesofágico/imunologia , Interleucina-4/imunologia , Interleucina-5/imunologia , Interleucina-6/imunologia , Pepsina A/imunologia , Substância P/imunologia , Animais , Asma/etiologia , Líquido da Lavagem Broncoalveolar/citologia , Modelos Animais de Doenças , Eosinófilos/citologia , Eosinófilos/imunologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Linfócitos/citologia , Linfócitos/imunologia , Macrófagos/citologia , Macrófagos/imunologia , Neutrófilos/citologia , Neutrófilos/imunologia , Ratos , Ratos Sprague-DawleyRESUMO
Phase-contrast X-ray diffraction imaging and high-angular-resolution diffraction combined with phase-contrast radiographic imaging were employed to characterize defects and perfection of a uniformly grown tetragonal lysozyme crystal in the symmetric Laue case. The full-width at half-maximum (FWHM) of a 4 4 0 rocking curve measured from the original crystal was approximately 16.7 arcsec and imperfections including line defects, inclusions and other microdefects were observed in the diffraction images of the crystal. The observed line defects carry distinct dislocation features running approximately along the <1 1 0> growth front and have been found to originate mostly in a central growth area and occasionally in outer growth regions. Inclusions of impurities or formations of foreign particles in the central growth region are resolved in the images with high sensitivity to defects. Slow dehydration led to the broadening of a fairly symmetric 4 4 0 rocking curve by a factor of approximately 2.6, which was primarily attributed to the dehydration-induced microscopic effects that are clearly shown in X-ray diffraction images. The details of the observed defects and the significant change in the revealed microstructures with drying provide insight into the nature of imperfections, nucleation and growth, and the properties of protein crystals.