Comparative study of the risk prediction model of early postoperative frailty in elderly enterostomy patients based on machine learning methods.

Objective: Based on machine learning method, four types of early postoperative frailty risk prediction model of enterostomy patients were constructed to compare the performance of each model and provide the basis for preventing early postoperative frailty of elderly patients with enterostomy. Methods: The prospective convenience sampling method was conducted and 362 early postoperative enterostomy patients were selected in three hospitals from July 2020 to November 2023 in Shanghai, four different prediction models of Support Vector Machine (SVM), Bayes, XG Boost, and Logistic regression were used and compared the test effects of the four models (MCC, F1, AUC, and Brier index) to judge the classification performance of the four models in the data of this study. Results: A total of 21 variables were included in this study, and the predictors mainly covered demographic information, stoma-related information, quality of life, anxiety and depression, and frailty. The validated models on the test set are XGBoost, Logistic regression, SVM prediction model, and Bayes on the MCC and F1 scores; on the AUC, XGBoost, Logistic regression, Bayes, and SVM prediction model; on the Brier scores, Bayes, Logistic regression, and XGBoost. Conclusion: XGBoost based on machine learning method is better than SVM prediction model, Logistic regression model and Bayes in sensitivity and accuracy. Quality of life in the early postoperative period can help guide clinical patients to identify patients at high risk of frailty and reduce the incidence of early postoperative frailty in elderly patients with enterostomy.

The effect of telemedicine on stoma-related complications in adults with enterostomy: A systematic review and meta-analysis.

To assess the effect of telemedicine on stoma-related complications in adults with enterostomy, we conducted a meta-analysis to evaluate the effects of the telemedicine group compared to the usual group. Literature searches were performed in PubMed, Embase, Web of Science, The Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang and VIP databases from their inception up to October 2023. Two authors independently screened and extracted data from the included and excluded literature according to predetermined criteria. Data collected were subjected to meta-analysis using Review Manager 5.3 software. The final analysis included a total of 22 articles, encompassing 2237 patients (telemedicine group: 1125 patients, usual group: 1112 patients). The meta-analysis results demonstrated that, compared to the usual group, the telemedicine group significantly reduced the overall occurrence of stoma-related complications, with an odds ratio (OR) of 0.22 (95% CI = 0.15-0.32, p < 0.00001). Furthermore, it resulted in a decrease in stoma complications (OR = 0.27, 95% CI = 0.15-0.47, p < 0.00001) and peristomal complications (OR = 0.25, 95% CI = 0.19-0.34, p < 0.00001). Therefore, the existing evidence suggests that the application of telemedicine can reduce the incidence of stoma and peristomal complications, making it a valuable clinical recommendation.

Evaluation of the correlation between sleep quality and work engagement among nurses in Shanghai during the post-epidemic era.

AIM: To examine the status quo and influencing factors of sleep quality and work engagement of nurses participating in COVID-19 during the post-epidemic era and to study the relationship between them. DESIGN: We conducted a cross-sectional survey and correlational and predictive logic to determine the association between sleep quality and work engagement among nurses in Shanghai during the post-epidemic era. METHODS: This design involved 1060 frontline nurses in Shanghai. The Pittsburgh Sleep Quality Index questionnaire and the Utrecht Work Engagement Scale-9 scales were used for data collection. RESULTS: This study found that the sleep quality of frontline nurses was impaired and the nurses with poor sleep accounted for 48.20% during the post-epidemic era. The work engagement of frontline nurses was at the medium level. Factors affecting nurses' sleep quality were the number of nurse night shifts, family support and nurse health. The factors affecting the nurse work engagement were monthly income, profession title, family support and self-health status. There was a positive correlation between nurses' sleep quality and work engagement.

Use of TIME in treating a hard-to-heal localised scleroderma wound.

OBJECTIVE: Localised scleroderma is a rare disease and the wound is difficult to heal because of tissue fibrosis. We present the case of a patient with localised scleroderma treated using the TIME (tissue, infection or inflammation, moisture and edge of wound) clinical decision support tool (CDST) for wound management. This includes: assessment, bringing, control, decision and evaluation (the ABCDE approach). The patient was fully evaluated and multidisciplinary teams were involved in wound treatment. Complications of wound healing were controlled and treated, and the wound was continuously assessed until it healed. CONCLUSION: This method of wound management provides a sound theory for the evaluation and management of hard-to-heal wounds and is worthy of clinical application.

Advancements in medical and surgical treatments of Takayasu arteritis-induced renal arteritis: a systematic review / 中华医学杂志(英文版)

BACKGROUND@#Takayasu arteritis-induced renal arteritis (TARA), commonly seen in Takayasu arteritis (TA), has become one of the main causes of poor prognosis and early mortality in patients with TA. TARA progressing into Takayasu arteritis-induced renal artery stenosis (TARAS), could lead to severe complications including malignant hypertension, cardiac-cerebral vascular disease, and ischemic nephropathy. Since there existed no guidelines on treatments, this study aimed to review the comprehensive treatments for TARA.@*METHODS@#We searched systematically in databases including PubMed, Ovid-Medline, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and SinoMed, from inception to May 2018. Literature selection, data extraction, and statistical analysis were performed.@*RESULTS@#Eighty-two literatures were recruited focusing on medical treatments (n = 34) and surgical treatments (n = 48). We found that combined medical treatments of glucocorticoids and conventional synthetic disease-modifying anti-rheumatic drugs could reach high rates of remission in patients with TARA, and biological disease-modifying anti-rheumatic drugs were preferred for refractory patients. After remission induction, surgical treatment could help reconstruct renal artery and recover renal function partly. Percutaneous transluminal angioplasty was the first choice for patients with TARAS, while open surgery showed a good long-term survival.@*CONCLUSIONS@#Patients with TARA should benefit both from medical treatments and from surgical treatments comprehensively and sequentially. Multidisciplinary team coordination is recommended especially in patients with severe complications.

Mori Cortex extract ameliorates nonalcoholic fatty liver disease (NAFLD) and insulin resistance in high-fat-diet/streptozotocin-induced type 2 diabetes in rats / 中国天然药物

Nonalcoholic fatty liver disease (NAFLD) and type 2 Diabetes Mellitus (T2DM) are highly prevalent diseases and are closely associated, with NAFLD being present in the majority of T2DM patients. In Asian traditional medicine, Mori Cortex is widely used for the treatment of diabetes and hyperlipidemia. However, whether it has a therapeutic effect on T2DM associated with NAFLD is still unknown. The present study showed that the oral treatment with Mori Cortex extract (MCE; 10 g·kg·d) lowered the blood lipid levels and reversed insulin resistance (IR) in high fat-diet/streptozotocin-induced type 2 diabetes in rats. The expression levels of sterol receptor element-binding protein-1c (SREBP-1c) and carbohydrate-responsive element binding protein (ChREBP), which are involved in steatosis in NAFLD rats, were measured in the liver samples. MCE decreased the protein and mRNA expression levels of SREBP-1c and ChREBP. In conclusion, down-regulation of SREBP-1c and ChREBP might contribute to the protective effect of MCE on hepatic injury and IR in the rats with T2DM associated with NAFLD.

Mori Cortex extract ameliorates nonalcoholic fatty liver disease (NAFLD) and insulin resistance in high-fat-diet/streptozotocin-induced type 2 diabetes in rats / 中国天然药物

Nonalcoholic fatty liver disease (NAFLD) and type 2 Diabetes Mellitus (T2DM) are highly prevalent diseases and are closely associated, with NAFLD being present in the majority of T2DM patients. In Asian traditional medicine, Mori Cortex is widely used for the treatment of diabetes and hyperlipidemia. However, whether it has a therapeutic effect on T2DM associated with NAFLD is still unknown. The present study showed that the oral treatment with Mori Cortex extract (MCE; 10 g·kg·d) lowered the blood lipid levels and reversed insulin resistance (IR) in high fat-diet/streptozotocin-induced type 2 diabetes in rats. The expression levels of sterol receptor element-binding protein-1c (SREBP-1c) and carbohydrate-responsive element binding protein (ChREBP), which are involved in steatosis in NAFLD rats, were measured in the liver samples. MCE decreased the protein and mRNA expression levels of SREBP-1c and ChREBP. In conclusion, down-regulation of SREBP-1c and ChREBP might contribute to the protective effect of MCE on hepatic injury and IR in the rats with T2DM associated with NAFLD.

Clinical significance of expression of eIF-4E and p-4EBP-1 protein in the gastric carcinoma / 临床与实验病理学杂志

Purpose To study the expression of eIF-4E and p-4EBP-1 and its clinical significance in the gastric carcinoma.Methods Expression of eIF-4E and p-4EBP-1 was detected in tissue array including 168 cases of gastric carcinoma and 52 cases of peri-cancer tissues by immunohistochemical SP method.Results The positive expression of eIF-4E and p-4EBP-1 in the gastric carcinoma was significantly higher than that of peri-cancer tissues (P =0.001,P =0.000).There was significantly higher expression of eIF-4E and p-4EBP-1 with lymph node metastases than without lymph node metastases in the gastric carcinoma (P =0.025,P =0.001).Also,there was significantly higher expression of eIF-4E and p-4EBP-1 with clinical stages Ⅲ + Ⅳ than that of stages Ⅰ + Ⅱ (P =0.001,P=0.049).In addition,there was a significantly positive correlation between the expression of eIF-4E and p-4EBP-1 in the gastric carcinoma (r =0.432,P ＜ 0.01).The overall survival rates for patients with negative expression of eIF-4E protein was higher than that with positive expression (P =0.012).Conclusion The abnormal co-expression of eIF-4E and p-4EBP-1 may be related to the tumorgenesis,development,metastasis and invasion of gastric carcinoma,and eIF-4E and p-4EBP-1 may act as the new molecular targets for the therapy and diagnosis of gastric carcinoma.

Role of mulberry resources in prevention and treatment of type 2 diabetes / 中草药

Mulberry resources including Mori Folium, Mori Fructus, Mori Ramulus, and Mori Cortex are used in clinic of traditional Chinese medicine, and have important functional effects on type 2 diabetes. In order to better explore diabetic drugs and take better advantage of mulberry resources, we review the chemical constituents and pharmacological effects of mulberry including hypoglycemic, hypolipidemic, anti-inflammatory, and anti-oxidant activities.

Narrow band imaging versus iodine staining for margin determination of early esophageal cancer during endoscopic submucosal dissection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the clinical value of narrow band imaging (NBI) and iodine staining for margin determination of early esophageal cancer during endoscopic submucosal dissection (ESD).</p><p><b>METHODS</b>Clinical data of 87 patients with early esophageal cancers undergoing endoscopic submucosal dissection (ESD) were analyzed retrospectively. Patients were assigned to NBI group and iodine staining group according to the staining method before ESD operation. Clinicopathological features, esophageal spasm ratio, operation time, en bloc resection rate, complications, local recurrence, and distant metastases were compared between the two groups.</p><p><b>RESULTS</b>There were 37 patients in NBI group while 50 patients in iodine staining group. Location and size of the lesions between two groups were not significantly different. The ratio of moderate-severe esophageal spasm in NBI group was significantly lower as compared to iodine staining group [10.8%(4/37) vs. 32.0%(16/50), P<0.05]. The average operation time in NBI group was significantly shorter than that in iodine staining group [(42.2±19.5) min vs. (53.3±30.9) min, P<0.05). All the tumors were resected in an en bloc fashion and the R0 resection rate was 100%. Perforations in 2 patients and delayed bleeding in 1 patient were successfully treated by endoscopic methods. Esophageal strictures occurred in 3 patients of NBI group and 4 patients of iodine staining group, who were treated by endoscopic dilation and retrievable stents. During mean 13.2 months (range 4 to 20 months) follow-up periods, local recurrence occurred in 2 patients of NBI group and 2 patients of iodine staining group. These patients received ESD or other surgery.</p><p><b>CONCLUSION</b>Compared with iodine staining, using NBI for margin determination of early esophageal cancer during ESD is more convenient and fast because of distinctly lower degree of esophageal spasm.</p>

Association between single nucleotide polymorphisms of BARD 1 gene and susceptibility of early-onset breast cancer in Uygur women in Xinjiang / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the association between single nucleotide polymorphisms (SNPs) of BARD1 gene and susceptibility of early-onset breast cancer in Uygur women in Xinjiang.</p><p><b>METHODS</b>A case-control study was designed to explore the genotypes of Pro24Ser (C/T), Arg378Ser (G/C) and Val507Met (G/A) of BARD1 gene, detected by PCR-restriction fragment length polymorphism (PCR-RFLP) assay, in 144 early-onset breast cancer cases of Uygur women (≤ 40 years) and 136 cancer-free controls matched by age and ethnicity. The association between SNPs of BARD1 gene and risk of early-onset breast cancer in Uygur women was analyzed by unconditional logistic regression model.</p><p><b>RESULTS</b>Early age at menarche, late age at first pregnancy, and positive family history of cancer may be important risk factors of early-onset breast cancer in Uygur women in Xinjiang. The frequencies of genotypes of Pro24Ser (C/T), Arg378Ser (G/C) and Val507Met (G/A) of BARD1 gene showed significant differences between the cancer cases and cancer-free controls (P < 0.05). Compared with wild-type genotype Pro24Ser CC, it showed a lower incidence of early-onset breast cancer in Uygur women with variant genotypes of Pro24Ser TT (OR = 0.117, 95%CI = 0.058 - 0.236), and dominance-genotype CT+TT (OR = 0.279, 95%CI = 0.157 - 0.494), or Arg378Ser CC (OR = 0.348, 95%CI = 0.145 - 0.834) and Val507Met AA(OR = 0.359, 95%CI = 0.167 - 0.774). Furthermore, SNPS in three polymorphisms would have synergistic effects on the risk of breast cancer. In addition, the SNP-SNP interactions of dominance-genotypes (CT+TT, GC+CC and GA+AA) showed a 52.1% lower incidence of early-onset breast cancer in Uygur women (OR = 0.479, 95%CI = 0.230 - 0.995). Stratified analysis indicated that the protective effect of carrying T variant genotype (CT/TT) in Pro24Ser and carrying C variant genotype (GC/CC) in Arg378Ser were more evident in subjects with early age at menarche and negative family history of cancer. With an older menarche age, the protective effect was weaker.</p><p><b>CONCLUSIONS</b>SNPs of Pro24Ser(C/T), Arg378Ser (G/C) and Val507Met (G/A) of BARD1 gene are associated with significantly decreased risk of early-onset breast cancer in Uygur women in Xinjiang. Early age at menarche and negative family history of cancer can enhance the protective effect of mutant allele.</p>

Endoscopic treatment of duodenal Brunner adenoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of endoscopic treatment for duodenal Brunner adenoma.</p><p><b>METHODS</b>Twenty-nine cases of duodenal Brunner adenoma were diagnosed by pathology between November 2006 and May 2010 in the Endoscopy Center of Zhongshan Hospital. The clinical data were retrospectively analyzed.</p><p><b>RESULTS</b>In 29 cases, there were 13 males and 16 females. The median age was 55(29-72) years. The mean adenoma diameter was (1.7 ± 0.1) cm, among which 17 adenomas ranged from 0.5 to 1.0 cm, 6 ranged from 1.0 to 2.0 cm, and 6 greater than 2.0 cm. Nine cases were treated by polypectomy, 12 by endoscopic mucosal resection (EMR), and 8 by endoscopic submucosal dissection(ESD). En-bloc resection rate was 100%. Intraoperative bleeding was seen in one case (200 ml), managed by nonsurgical method, including electrocoagulation, metal clips and nylon rope. Perforation occurred in 1 case during the procedure and was managed by metal clips. Delayed bleeding occurred in 1 case in the second day and was managed endoscopically. During a median follow-up of 13 (range, 2-39) months, the quality of life was satisfactory in this cohort, and no patients developed long-term complications. There was one recurrence within 1 year after the procedure and a second ESD was performed.</p><p><b>CONCLUSION</b>Endoscopic treatment is technically feasible and may be considered as the procedure of choice for duodenal Brunner adenoma.</p>

Therapeutic value of endoscopic submucosal dissection for gastrointestinal stromal tumor in the esophagogastric junction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) for gastrointestinal stromal tumor(GIST) in the esophagogastric junction(EGJ).</p><p><b>METHODS</b>Twenty patients with pathologically confirmed GIST in the EGJ were screened from all the patients undergoing ESD between November 2007 and June 2011. The clinicopathological and postoperative follow up data were analyzed.</p><p><b>RESULTS</b>There were 11 males and 9 females with the age ranging from 29 to 67 years(mean, 54.1 years). The maximum diameter of the lesions ranged from 8 to 20 mm(mean,14.8 mm). Fifteen patients underwent endoscopic submucosal excavation, 4 patients underwent endoscopic full-thickness resection, and 1 patient underwent submucosal tunneling endoscopic resection. The operative time ranged from 15 to 90 min(mean, 47.8 minutes). The estimated blood loss was 5 to 200 ml. The en bloc resection rate was 100%. Perforations occurred in 4 patients, pneumoperitoneum in 3 patients, cardia mucosal tear in 1 patient. All the complications were successfully managed with endoscopic intervention and conservative therapy. The post-operative follow up ranged from 3 to 36 months(mean, 13.2 months). No local recurrence or distant metastasis occurred.</p><p><b>CONCLUSION</b>ESD is a safe and effective procedure for GIST in the EGJ.</p>

Complete closure of gastric wall defect after endoscopic full-thick resection with metal clips and endoloop snare / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the value of the metal clips and endoloop snare for gastric wall defect after endoscopic full-thick resection(EFR).</p><p><b>METHODS</b>All the patients who underwent complete closure of gastric wall defect after endoscopic full-thick resection with metal clips and endoloop snare in the Endoscopy Center of Zhongshan hospital from March 2011 to October 2011 were retrospectively studied. The feasibility, safety, and efficacy were evaluated.</p><p><b>RESULTS</b>Fourteen patients were included in this study. The median age was 49(32-63) years. Lesions located in the gastric body in 5 cases, the gastric fundus in 8 cases, and the gastric antrum and body junction in 1 case. The were diameter was 0.6-3.0 cm. Complete closure rate was 100% using this technique. The median repair time was 12(8-20) min. No patients were converted to surgery or laparoscopic surgery. Four patients complained of abdomen pain with elevated body temperature, and ultrasonography showed minor peritoneal fluid in 2 cases, which were drained. These four cases were asked to maintain semi-reclining position and were put on fasting, continuous gastrointestinal decompression, and received antibiotics. They were discharged after 1-3 days. All the patients were followed up with a median time of 3(1-8) months. Nylon and clips residual were removed endoscopically and the wound healing was satisfactory.</p><p><b>CONCLUSION</b>Metal clips and endoloop snare is safe and effective for the closure of gastric wall defect after EFR.</p>

Selection and evaluation of endoscopic resection for submucosal tumors of the esophagogastric junction originating from muscularis propria / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application and indication of endoscopic dissection technique for submucosal tumors (SMTs) of the esophagogastric junction (EGJ) originating from the muscularis propria.</p><p><b>METHODS</b>A total of 143 SMTs of the EGJ were treated by endoscopic resection in the Endoscopy Center of Zhongshan Hospital Affiliated to Fudan University between March 2007 and June 2011. The clinical and histopathologic feature, surgical approach, en bloc resection rate, complications, and postoperative follow up were evaluated.</p><p><b>RESULTS</b>There were 74 males and 69 females with a mean age of 49.1 years old. The en bloc resection rate was 94.4%(135/143). There were 126 patients who underwent endoscopic submucosal excavation in an en bloc fashion. Six patients underwent endoscopic full-thickness resection without laparoscopic assistance. Three patients underwent submucosal tunneling endoscopic resection. The other 8 SMTs were partially resected for histological evaluation and the residual tumors were further treated with nylon snare ligation. The mean lesion size was 17.6 mm. The mean procedure time was 45.1 minutes and the mean intraoperative bleeding was 50.0 ml. Perforations occurred in 6 patients and metal clips were used to close the defect. One patient with Mallory-Weiss syndrome was successfully treated with conservative treatment. Pathological examination showed that the lesions were leiomyoma (n=121), gastrointestinal stromal tumor (n=20), granulosa cell tumor (n=1), and intermuscular lipoma (n=1). No local recurrence and distant metastasis were noted during the follow-up (range, 3-48 months).</p><p><b>CONCLUSION</b>Endoscopic resection technique is safe and effective, and should be selected for each patient individually.</p>

Endoscopic sclerotherapy of gastric varices by tissue adhesives / 中华胃肠外科杂志

The diagnosis and treatment of gastric varices is a clinically concerned issue. With the development of endoscopic technology. The success rate of controlling bleeding from gastric and esophageal varices has been improved a lot. It is efficacious and safe to treat gastric and esophageal varices by endoscopic injection of tissue adhesives and to prevent re-bleeding. There is few acute and long-term complications of this modality. It has been the first line treatment for gastric varices.

Clinical value of different magnifying chromoendoscopy methods in screening gastric precancerous lesions and early cancers / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To prospectively evaluate the clinical value of different magnifying chromoendoscopy(MCE) methods in screening gastric precancerous lesions and early cancers.</p><p><b>METHODS</b>Between March 2010 and October 2011, among all the patients aged over 40 who received esophagogastroduodenoscopy at Zhongshan hospital, Fudan University, suspicious lesion was detected in 699 patients, who were randomly assigned to three groups: epinephrine dye(n=240), indigo carmine dye(n=246), and acetic acid-indigo carmine mixture dye(n=213). Diagnosis was made according to surface patterns and microvessels of the lesion. Pathological diagnosis was used as the gold standard. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement(Kappa) test. McNemar Paired chi-square test was used to compare the concordance of three MCE methods, regular white light, magnification alone, and NBI magnifier before and after MCE.</p><p><b>RESULTS</b>Pathological examination showed inflammatory lesions in 415 patients, intestinal metaplasia in 190, low grade intra-epithelial neoplasia in 17, and high grade intra-epithelial neoplasia or early cancer in 77. The percentage of patients with consistent endoscopic and pathological diagnosis was 77.1%(185/240) for epinephrine dye, 80.5%(198/246) for indigo carmine dye, and 81.2%(173/213) for acetic acid-indigo carmine mixture dye. Kappa values were 0.579, 0.502, and 0.667 respectively(all P<0.01). For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 84.0%, 83.3%, and 92.9%, respectively, and the specificities were 98.6%, 97.3%, and 98.4%. All the three chromoendoscopy methods improved the diagnostic accuracy for precancerous lesions compared with conventional gastroscopic observation with white light(all P<0.01). Indigo carmine and acid-indigo carmine mixture dye improved the diagnostic accuracy of magnification alone(both P<0.05). There was no significant difference in diagnostic accuracy between each MCE method and magnifying NBI observation(all P>0.05).</p><p><b>CONCLUSION</b>NBI magnification and all the three MCE methods may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.</p>

Use of endoscopic tissue adhesive injection for gastric varices / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term efficacy and safety of endoscopic tissue adhesive(N-octyl-α-cyanoacrylate) injection for the treatment of gastric varices.</p><p><b>METHODS</b>A retrospective study was performed to review the clinical and follow up data of 169 patients with gastric variceal who received tissue adhesive injection at the Fudan University Affiliated Zhongshan Hospital between April 2004 and December 2011.</p><p><b>RESULTS</b>There were 128 males and 41 females with a mean age of 56.8(37-85) years old. One hundred and thirty-one patients received one injection, 38 received two injections or more with a mean of 1.12 per patient. Volume of injection ranged from 1 to 3 ml(mean, 1.7 ml). Eighty-three patients received adhesive injection alone, 231 received injection combined with ligation, 50 received combined sclerotic agent injection. All the patients had follow up ranging from 1 to 78 months(mean, 3.4 months). The treatment outcome was satisfactory in 130 patients(76.9%), good in 36(21.3%), and ineffective in 3(1.8%). The rate of ectopic embolization was 3.0%, and the rate of early re-bleeding was 1.2%. Postoperatively there were no septic complications or esophageal stricture. There were no deaths within 2 weeks.</p><p><b>CONCLUSION</b>Injection of tissue adhesive under endoscopic guidance for treatment of gastric varices is convenient, safe and effective.</p>

Prognostic significance of serial determinations of lactate dehydrogenase in follow-up for patients with myelodysplastic syndrome / 中国实验血液学杂志

This study was aimed to dynamically observe the expression level of lactate dehydrogenase (LDH) in MDS patients and to explore the significance of LDH level for prognostic judgement of MDS patients. The expression level of LDH in 163 confirmedly diagnosed patients from 2001 to 2009 years in our hospital, the changes of LDH level in follow-up patients and relation of the LDH changes to prognosis, survival time and MDS progression, as well as the relation of LDH level to blood cell count, ratio and karyotype of blast cells in bone marrow were analyzed retrospectively. The results showed that the median LDH level in 163 MDS patients at diagnosis was 214 U/L (range 102 - 865 U/L), the median survival time of patients with increased LDH (> 240 U/L) was 25.6 months which was significantly shorter than that of patients with normal LDH level (56.8 months)(p < 0.05). When MDS patients were classified according to IPSS, the increased LDH level in MDS patients was observed in high risk and intermediate II groups (337.20 ± 298.00 U/L and 234.07 ± 216.00 U/L, respectively) which was significantly higher than that in low risk group (154.94 ± 46.08 U/L) (p < 0.05). The LDH level in patients with MDS progression was obviously enhanced while LDH level in patients without progression was not enhanced, mainly maintained in stable level as compared with LDH level at diagnosis and before progression (p < 0.005). By multivariate analysis, the increase of LDH level was found to be an independent prognostic factor. It is concluded that the LDH level may be used as indicator for judging prognosis of MDS patients, which is helpful to early recognition of MDS progression and risk stratification of disease, as well as selection of rational therapy.

Impact of serum epidermal growth factor on progressive psoriasis vulgaris and regulation of Chinese herbal medicine for cleaving heat, cooling blood, and detoxicating on it / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the impact of serum epidermal growth factor (EGF) on progressive psoriasis vulgaris and the regulatory effect of Chinese herbal medicine on it.</p><p><b>METHODS</b>Serum level of EGF was measured in 31 patients with progressive psoriasis vulgaris (the tested group) and 17 healthy subjects (the control group) by ELISA. The changes in EGF level and condition of illness were observed before and after patients orally administered Chinese composite recipe for clearing heat, cooling blood and removing toxic substances for 10 weeks, and the severity of illness was assessed by psoriasis area and severity index (PASI) as well.</p><p><b>RESULTS</b>Serum level of EGF in patients was 175.35 +/- 179.86 ng/L before treatment, markedly higher than that in healthy subjects (72.05 +/- 63.01 ng/L), showing significant difference between them (t = - 2.888, P = 0.006); it reduced to 121.67 +/- 94.74 ng/L after treatment, significantly different to that before treatment (t = 2.155, P = 0.04), but still higher than that in the control (t = - 2.146, P = 0.037). Average PASI was 9.65 +/- 5.82 before treatment and 5.74 +/- 4.69 after treatment, displaying a significant reduction (t = 7.740, P < 0.01). Linear regression analysis showed no apparent correlation between serum EGF level and PASI (r = 0.030, P = 0.872; r = 0.050, P = 0.793).</p><p><b>CONCLUSION</b>Serum level of EGF might be an important factor related to the progress of psoriasis. Chinese herbal medicine for clearing heat, cooling blood and removing toxic substances can lessen the severity of psoriasis, its action in reducing serum EGF is possibly one of the mechanisms for these kinds of herbs in treating psoriasis.</p>