[Changes in platelet related parameters in obese patients after sleeve gastrectomy].

To compare changes in platelet related parameters in obese patients before and after sleeve gastrectomy (SG), we retrospectively analyzed the clinical data of 31 obese patients who underwent SG in Peking Union Medical College Hospital from December 2012 to September 2020. Results showed that compared with those before surgery, platelet count (PLT) decreased significantly at 2-12 weeks of follow-up (P=0.009), while platelet distribution width (PDW), mean platelet volume (MPV), and large platelet ratio (P-LCR) increased significantly at the same periods of follow-up after operation (P<0.001). However, the levels of PDW, MPV, and P-LCR began to decrease at 16-55 weeks when compared with those at 2-12 weeks of follow-up (P<0.01). PLT was positively correlated with white blood cells and neutrophils at 2-12 weeks of follow-up and positively correlated with high sensitivity C-reactive protein at 16-55 weeks of follow-up after operation (P<0.05).

[The development of malnutrition assessment criteria and the analysis of current problems].

It is well known that parenteral and enteral nutrition support is helpful to improve clinical outcomes in patients with malnutrition or nutritional risk, and surgical nutrition has been used in China for 40 years. However, there is still insufficient awareness of malnutrition among clinical workers. There were different opinions from many experts after the publications of the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus of malnutrition assessment 2015 and ESPEN guidelines on definitions and terminology of clinical nutrition 2017. Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition has also been published in 2018. Though it is lack of clinical validation, it is a big step forward. In order to achieve better prevention and treatment of malnutrition in clinical work, this present paper analyzes and compares the core contents of malnutrition assessment (diagnosis) in recent years, proposes current practical strategy for Chinese clinical workers, emphasizes that GLIM criteria cannot replace the three steps named "screening-assessment-intervention" .

Gastric Stump Cancer Following Gastrectomy After Renal Transplantation: A Case Report.

A patient who had previously undergone a gastrectomy due to gastric ulcer perforation was admitted to our hospital. He presented with epigastric pain and poor oral intake accompanied with gastrointestinal bleeding, and was diagnosed with gastric stump cancer. He had a history of renal transplantation and was administered immunosuppressive agents. To alleviate the obstructive symptom and cure the gastrointestinal bleeding, the patient underwent surgical resection of the malignant tumor, with stable kidney function during the perioperative period. To the best of our knowledge, this is the first case reported in the English literature concerning gastric stump cancer that developed after renal transplantation. We speculate that the long-term use of immunosuppressants concomitant with gastrointestinal disorders after gastric surgery was an important causative factor in its etiology. We also investigated the possible treatment for it.

[Retrospective analysis of the discharge outcome of external ventricular drainage and conservative treatment in patients with severe intraventricular hemorrhage].

Objective: To investigate the discharge outcome of external ventricular drainage(EVD) and conservative treatment in patients with severe intraventricular hemorrhage (SeIVH). Methods: From January 2011 to December 2016, patients with SeIVH admitted to the General Hospital of the PLA Rocket Force and the Army General Hospital received EVD treatment and were classified as the treatment group. According to intraventricular hemorrhage volume and age, patients received conservative treatment were pair matched and classified as control group. Then we compared the clinical outcome of moderate disability or less degree of discharge (mRS ≤3) and death incidence (mRS 6) between two groups. Results: A total of 361 patients with IVH were treated during these six years. Among them, 75 cases were chosen as treatment group. Another 75 cases were pair matched as control group from 286 cases. At the time of admission, the ventricular hemorrhage volume of two groups were (55.8±22.7) ml and (53.7±23.3) ml (P=0.569) respectively. Cerebral hemorrhage volume were (23.6±5.3) ml and (24.0±5.4) ml (P=0.631). And the median Glasgow coma score (GCS) were 4[IQR(3, 7)] and 5[IQR(4, 7)](P=0.131). At the discharge time, there were 16% (12/75) patients scored mRS≤3 in treatment group, while 2.7% (2/75) in control group (P<0.005). The absolute risk reduction (ARR) was 13.3%, and the number needed to treat (NNT) was 7.5. The mortality rate of treatment group was 13.3% (10/75), much lower than that of the control group 41.1% (31/75, P<0.001). ARR was 27.8% and NNT was 3.6. Conclusion: Although the prognosis of SeIVH was poor, compared with conservative treatment, EVD treatment significantly improved the outcome of these patients. Randomized controlled trials are needed to validate the efficacy of EVD.

Influence of sodium chloride treatment and polysaccharides as debittering agent on the physicochemical properties, antioxidant capacity and sensory characteristics of bitter gourd (Momordica charantia) juice.

The effects of sodium chloride (NaCl) (3.5%) solution and polysaccharides, such as carboxymethyl cellulose (CMC) (0.1, 0.3 and 0.5%) and gum arabic (5, 10 and 15%), on the physicochemical properties, antioxidant capacity and sensory characteristics of bitter gourd juice were investigated. An increase in the concentration of CMC and gum arabic significantly was observed to increase the lightness (L value) and the viscosity (mPas) of bitter gourd juice at all levels. Increased concentrations of gum arabic significantly increased the total soluble solids. The bitter gourd fruit treated with NaCl solution produced the highest lightness (L value) and scavenging activity of free radical 2,2-diphenyl-1-picrylhydrazyl of bitter gourd juice. Increased concentration of gum arabic up to 15% significantly increased the total phenolic content. The addition of 5% gum arabic effectively reduced the bitterness of the bitter gourd juice. Viscosity of the juice resulted in negative correlation for bitterness.

Treatment strategy for early gastric cancer.

Gastric cancer ranks the second leading cause of cancer-specific mortality worldwide. With a poor prognosis, 5-year survival rate of gastric cancer is less than 20%-25% in the USA, Europe, and China [1]. However, early gastric cancer(EGC) offers an excellent (over 90%) chance of cure based on surgical resection [2]. As the increasing detection of EGC, more treatment options have been developed both curatively and minimally invasively to maintain a good quality of life(QOL). One of the advanced therapeutic techniques is endoscopic dissection. Improvements in surgical treatment include minimizing lymph node dissection, reconstruction methods, laparoscopy-assisted surgery, and sentinel node navigation surgery(SNNS) [3]. With technological advances, even Natural Orifice Transluminal Endoscopy Surgery (NOTES) and robotic surgery are expected to represent the next revolution [4]. However, there still remains much dispute among these treatments, which arouses further clinical trials to verify. Update of the treatments, controversial indications, prognosis and current strategies for EGC are discussed in this review.

Comparison of antiepileptic drugs on cognitive function in newly diagnosed epileptic children: a psychometric and neurophysiological study.

Using a randomized parallel group study design, we compared the cognit ive effects of carbamazepine (CBZ), phenobarbital (PB), and valproate (VPA) in children with epilepsy. Seventy-three children with newly diagnosed epilepsy were tested with the Wechsler Intelligence Scale for Children-Revised (WISC-R), Bender-Gestalt test, and auditory event-related potentials (P 300) before and 6 and 12 months after antiepileptic drug (AED) treatment. There were no significant differences in WISC-R IQs and Bender-Gestalt scores for children in any group at any of the three sessions. P 300 latencies were increased in the children receiving PB but not in children receiving CBZ and VPA. P 300 amplitudes were significantly reduced in treated children in all three groups, but amplitudes were not significantly different among the three groups. These findings suggest that PB may affect cognitive function of epileptic children and that the P 300 may be a sensitive additional procedure that can be used to assess the cognitive effect of AEDs.

Effects of bilirubin on visual evoked potentials in term infants.

UNLABELLED: To determine bilirubin-induced neurotoxicity, serial visual evoked potentials (VEPs) of 72 infants with neonatal hyperbilirubinaemia and 22 controls were evaluated and compared in four sessions for 8 weeks after birth. The levels of maximal serum bilirubin were found positively related to the wave latencies of first VEP. Within 8 weeks after birth, the wave latencies were significantly prolonged in infants in the severe and moderate groups than in the controls. The amplitudes of VEPs were apparently lower in severe and moderate groups than in the control group only in the 1st week after birth. At 1 year, 4 of the 18 infants in the severe group had poor motor skills and one had general hypotonia. CONCLUSION: These results suggest that bilirubin may affect the visual pathways, and that VEP is a useful adjunct to the neurological assessment of neonatal hyperbilirubinaemia.

X-linked recessive inheritance of dysgenesis of corpus callosum in a Chinese family.

This report describes a new syndrome of dysgenesis of corpus callosum with other anomalies, presenting as microcephaly, mental retardation, spasticity, and unusual facial appearance in 2 Chinese brothers and their maternal cousins. To date, there has not been any case reported in the Chinese population of this syndrome. All 4 patients in this report present with the same unusual face. Hydrocephalus and/or interhemispheric cyst were found among them. This syndrome is transmitted as an X-linked trait. The nosology is reviewed and discussed.

Heat probe thermocoagulation and pure alcohol injection in massive peptic ulcer haemorrhage: a prospective, randomised controlled trial.

We conducted a prospective randomised controlled trial of 137 patients with massive peptic ulcer haemorrhage over a period of 12 months to compare the haemostatic effects of endoscopic heat probe thermocoagulation and pure alcohol injection. Seventy eight patients (56.9%) were in shock at the time of randomisation to the trial. The age, sex, number of patients in shock, haemoglobin value at the time of entry to the trial, number of patients with severe medical illness, location of bleeders, and stigmata of recent haemorrhage were comparable among the heat probe, pure alcohol, and control groups. The initial haemostatic effect of the heat probe was better than that of the pure alcohol injection (44 of 45 v 31 of 46, p = 0.0004). The ultimate haemostasis achieved by the heat probe group (41 of 45) was better than that of the pure alcohol group (31 of 46, p = 0.012) and of controls (24 of 46, p = 0.0001). The duration of hospital stay was shorter for patients in the heat probe group than for the control group (6.2 days v 13.8 days, p less than 0.05). The incidence of emergency surgery was less for the heat probe than the control group (three of 45 v 12 of 46, p = 0.027). The mortality rate was less in the heat probe than in the control group (one of 45 v seven of 46, p = 0.031). We suggest that heat probe thermocoagulation should be the first treatment of choice for arrest of massive peptic ulcer haemorrhage.

Heat probe thermocoagulation as a substitute for surgical intervention to arrest massive peptic ulcer hemorrhage: an experience in 153 cases.

In a period of 2 years 7 months, we performed heat probe (HP) thermocoagulation in 153 cases of massive peptic ulcer hemorrhage. The male/female sex ratio was 125/28. The average age was 57.6 +/- 1.3 years (mean +/- SEM; range, 17 to 88). There were 69 cases (45.1%) of spurting hemorrhage, 50 cases (32.7%) of oozing hemorrhage, and 34 cases (22.2%) of nonbleeding visible vessels. Seventy-seven patients (50.3%) were in shock before therapy. After therapy we obtained initial success in 147 cases (96.1%). Rebleeding episodes occurred in 23 patients (15.6%) within 1 month after therapy. Nineteen patients received a second therapy, and treatment in 15 of these cases (78.9%) was ultimately successful. Finally, treatment in 142 cases (92.8%) was ultimately successful. The duration of hospitalization was 6.3 +/- 0.4 days (mean +/- SEM). After discharge all patients were followed at the outpatient department for at least 1 month. Sixty-seven patients were followed endoscopically for at least 2 to 3 months after therapy. Fifty-six patients (83.6%) had a healed scar at the previous bleeding site 2 months after therapy, and 62 patients (92.5%) had a healed scar 3 months after therapy. We conclude that HP thermocoagulation is an ideal and reliable modality of therapeutic endoscopy in arrest of massive peptic ulcer hemorrhage. HP thermocoagulation may become the first choice of therapy for massive peptic ulcer bleeding in the near future.

A controlled study of therapeutic endoscopy for peptic ulcer with non-bleeding visible vessel.

In a period of 14 months, a prospective, randomized, controlled trial was undertaken in 61 patients who had bled from peptic ulcers in which, at endoscopy, non-bleeding vessels were visible in the ulcer crater. The control group consisted of 31 patients in whom the procedure was limited to observation alone; in 30 patients the ulcer base was coagulated by means of a heat probe. There were no statistically significant differences between the two groups in the rate of rebleeding, the assurance of ultimate hemostasis, the volume of blood transfusion required, the duration of hospitalization, or eventual mortality. However, the need for emergency surgical intervention was less frequent in the heat probe group (2 of 30) than among the controls (9 of 31) (p = 0.0243). Moreover, in the treatment group, those patients of advanced age (greater than 60 years), in shock, requiring blood transfusion of greater than 500 ml, and in whom blood or coffee ground material was seen in the stomach, thermocoagulation achieved statistically more effective hemostasis than that observed in the control group. For these high-risk subsets of patients with non-bleeding visible vessels, we recommend heat probe coagulation rather than mere observation.

Therapeutic endoscopy for Dieulafoy's disease.

Dieulafoy's disease is an underdiagnosed cause of massive upper gastrointestinal bleeding. The mortality rate is extremely high and the diagnosis is usually made at autopsy. Operation has been deemed the treatment of choice for Dieulafoy's disease in the past decades. Here, however, we report successful therapeutic endoscopy in eight cases of Dieulafoy's disease in a period of 20 months. Six patients (75%) were in shock before therapy. Six received heat-probe thermocoagulation, one received pure alcohol (99.8%) injection and one received hypertonic glucose solution (50%) injection. No perforation or recurrent hemorrhage occurred in the following period of 11.2 +/- 3.4 months (SEM) in six patients. The other two died of unrelated illness. In the near future, therapeutic endoscopy may replace surgery in the management of Dieulafoy's disease.

A clinical evaluation of ultrasonography in the diagnosis of acute appendicitis.

Recently ultrasonography (US) has proven effective in the diagnosis of acute appendicitis. However, the impact of US on surgical decision-making in clinical practice remains unclear. From August 1986 to July 1987, 62 patients with clinical signs of acute appendicitis received US examinations after initial clinical evaluations. According to clinical pictures, they were classified into two groups: group I, clinically typical (Alvarado's score greater than or equal to 7) and group II, clinically dubious (Alvarado's score less than or equal to 6) cases. All group I patients (n = 34) had surgery. Group II patients (n = 28) received close in-hospital observation on an every 4-hour basis for less than 24 hours. However, surgery was performed if Alvarado's score increased up to or above 7 or surgical indications became evident during observation. The pathologic reports and operative findings were retrospectively correlated with the US diagnosis. For group I patients, clinical examination without knowledge of US findings was correct in 30 (88.9%) cases, 26 (86.7%) of which were detected by US. Four (50%) of eight patients with negative US findings had acute appendicitis. In group II, 12 of 15 patients who had surgery had acute appendicitis, and 10 (83.3%) were detected by US. Two (11%) of 18 patients with negative US findings were finally proved to have acute appendicitis. The average duration from initial clinical examination to surgical decision fpr patients with acute appendicitis was 6.8 hours. There were no false-positives in either group. For patients with typical clinical presentation, US is not superior to clinical examination, and surgery is recommended even if US findings are negative.(ABSTRACT TRUNCATED AT 250 WORDS)

[Predictive impact on malaria prevalence by hydraulic project of three gorges of the Yangtze River].

Malaria had a wide distribution and high prevalence throughout the Three Gorges region of the Yangtze River. After antimalarial program, its incidence rate was reduced to 2.2% in 1985, but sporadic cases still occurred in 34.7% of the townships and local outbreaks were not uncommon. Therefore, potential factors of malaria outbreak are still present. It is predicted that maximum risk of malaria outbreak will take place, during construction and after the completion of the reservoir, the breeding sites of Anopheles would be extended to irrigation network, low-lying of flooded land, and malaria prevalence might be increased.