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25 October 2016, Volume 15 Issue 05 Previous Issue    Next Issue

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The clinical diagnosis of hemorrhagic portal hypertensive gastropathy (PHG) GU Leilei, ZHU Shiyan, XIN Xiaorong, XIE Ling, ZHOU Yufen, YU Xiaojun, WU Yunlin 2016, 15 (05):  459-463.  DOI: 10.16150/j.1671-2870.2016.05.005 Abstract ( 154 )   PDF (1072KB) ( 166 )   Objective: To investigate the clinical diagnosis of acute hemorrhagic portal hypertensive gastropathy (PHG) and to analyze the endoscopic appearance and therapeutic outcome in PHG patients. Methods: Clinical data, endoscopic results and outcome of 196 patients with upper gastrointestinal bleeding caused by portal hypertension in Ruijin Hospital North were collected and analyzed. Results: Sixty-seven patients with PHG were verified by endoscopy, which comprised 34.2% of total patients, including 49 patients with mild PHG (25.0%), 18 patients with severe PHG(9.2%); 5 patients (2.6%) with gastrointestinal bleeding were caused by severe PHG solely, which were verified by endoscopy, and 13 patients (6.6%) with bleeding were partially caused by severe PHG. All of the acute bleeding caused by severe PHG were stopped after therapy with vasoactive agents and endoscopic sclerotherapy. Conclusions: PHG is common in patients with portal hypertension. Mild PHG usually does not tend to cause bleeding, but its progression merits attention. The main endoscopic pattern of severe PHG is extensive cherry-red spots and diffuse hemorrhagic gastritis, which may lead to massive upper gastrointestinal bleeding. Treatment for reducing portal hypertension can effectively control bleeding caused by PHG. References | Related Articles | Metrics

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Impact of different endoscopic esophageal varices treatment on portal hypertensive gastropathy WU Wei, WANG Lifu, TAO Fenglai, XU Beili, YE Peijun, CHEN Shu, YUAN Yaozong 2016, 15 (05):  464-467.  DOI: 10.16150/j.1671-2870.2016.05.006 Abstract ( 137 )   PDF (479KB) ( 48 )   Objective: To analyze the impact of different endoscopic esophageal varices treatment on severity of portal hypertensive gastropathy(PHG). Methods: A total of 35 patients with endoscopic treatment of esophageal varices at Department of Gastroenterology, Shanghai Ruijin Hospital from January 2015 to March 2016 were enrolled. Either endoscopic injection sclerotherapy(EIS) or varices ligation(EVL) was performed, and the concomitant gastric varices, if present, was treated with tissue adhesive obturation(GVO). Additional endoscopic treatment was performed when necessary and patients were followed up for PHG evaluation. Results: Seventeen patients received EIS and 18 received EVL at the initial endoscopy. During follow-up, 16 and 13 patients of the above mentioned groups, respectively, remained in the same group, while the other 6 patients turned to receive a mixed therapy of EIS and EVL because of either technical failure, inadequate regression after EIS or residue varices not suitable for another EVL. Mean endoscopic follow-up was (8.6±4.0) months. Patients with severe, mild and absent of PHG were 0, 18, 17 at baseline and 3, 16, 16 at last follow-up, respectively (P>0.05). EVL and mixed therapy were seemed to be superior to EIS in both long-term hemostasis and PHG stability. The average Child-Pugh scores at baseline and last follow-up were (6.77±1.73) and (6.00±0.91), respectively, indicating that endoscopic treatment was beneficial to liver function improvement(P<0.01). Conclusions: Endoscopic treatment for esophageal varices would not have significant negative influence on PHG. References | Related Articles | Metrics

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The effect of endoscopic variceal ligation on portal hypertensive gastropathy in liver cirrhosis patients WANG Xiaoyu, XU Yan, WANG Libing, WU Yunlin, CHEN Ping, ZHANG Guohua 2016, 15 (05):  468-471.  DOI: 10.16150/j.1671-2870.2016.05.007 Abstract ( 128 )   PDF (935KB) ( 49 )   Objective: To investigates the effect of endoscopic variceal ligation (EVL) on portal hypertensive gastropathy (PHG) in liver cirrhosis patients. Methods: Sixty-three liver cirrhosis patients with PHG were divided into 2 groups: patients with EVL treatment (35 cases) and control groups without endoscopic therapy (28 cases). Eight weeks after therapy, endoscopy was performed to determine the aggravation of PHG. Results: Increased severity of PHG was seen in 26 cases (74.28%, 26/35) of treated group, while only 3 (10.71%) in the control group showed increase of severity (P<0.01). Conclusions: EVL of esophageal varices might be an important risk factor for the development and aggravation of PHG in liver cirrhosis patients. References | Related Articles | Metrics

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Application of high performance liquid chromatography (HPLC) in the screening of thalassemia in Shanghai WANG Yefei, WU Beiying, XIA Wenquan, HU Yiqun 2016, 15 (05):  472-476.  DOI: 10.16150/j.1671-2870.2016.05.008 Abstract ( 126 )   PDF (645KB) ( 54 )   Objective: To investigate the application of high performance liquid chromatography (HPLC) in the screening of thalassemia in Shanghai. Methods: The hemoglobin of 135 patients with suspected thalassemia were analyzed by using HPLC. Gene detection of thalassemia by GAP-PCR and reverse dot blot (RDB) were simultaneously performed. Results: Using gene detection as a gold standard, when HbA2>3.7% was taken as the cutoff value for diagnosis of β-thalassemia carriers by HPLC, the sensitivity and specificity were 100%, and 98.41%, and the positive predictive value and negative predictive value were 98.0% and 100%, respectively. If <1.7% was taken as the cutoff value of HbA2 for diagnosis of α-thalassemia （HbH disease） by HPLC, the indice above-mentioned were 100%, 100%, 100%, 100%, respectively. Out of 135 samples, there were 8 cases being detected a HbH peak. Conclusion: Results of HPLC detection are in excellent agreement with those of the gene detection in the diagnosis of β-thalassemia and HbH disease, while certain false negative rate may occur in the diagnosis of minor α-thalassemia or α-thalassemia trait. References | Related Articles | Metrics

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Identification and function analysis of risk pathways in subjects with a family history of type 2 diabetes WANG Wei, WU Liping, ZHAO Yongju, CAO Jiumei 2016, 15 (05):  477-481.  DOI: 10.16150/j.1671-2870.2016.05.009 Abstract ( 127 )   PDF (684KB) ( 68 )   Objective: To investigate the relationship between family history of type 2 diabetes (T2D) and insulin resistance. Bioinformatic approach was used to identify the risk pathways in subjects with a family history (FH) of T2D, and then functions of key driver genes were analyzed using gene expression profiles from Gene Expression Omnibus (GEO). Methods: Gene expression data set was retrieved using GSE 25462 at NCBI GEO. The data set contained 26 normoglycemic individuals with 1 or both parents having T2D (FH+) and 15 normoglycemic individuals with no one having diabetes in first-degree relatives(FH-). Insulin sensitivity was assessed by the Bergman minimal model from intravenous glucose tolerance test. Gene expression in quadriceps muscle biopsies was analyzed to identify the differentially expressed genes associated with insulin resistance. Gene set enrichment analysis and identification of risk pathways were used to explore the pathogenesis of T2D at molecular level. Results: Compared with FH- subjects, FH+ subjects were insulin resistant as demonstrated by a 41% reduction in insulin sensitivity(P<0.05). A total of 202 genes showed differential expression in our analysis. Five biological pathways of gene set enrichment in FH+ were identified, including hematopoiesis from multipotent stem cells, hematopoiesis from pluripotent stem cells, role of JAK1 and JAK3 in c-cytokine signaling, antiproliferative role of TOB in T cell signaling, and B cell development. Conclusions: Family history of T2D in normal subjects is associated with insulin resistance. Significantly enriched pathways identified by gene set enrichment analysis reveale that pathogenesis of T2D is associated with function of multipotent stem cells and immune status. References | Related Articles | Metrics

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Relevant factor analysis of cervical lymph nodes metastasis in papillary thyroid microcarcinoma KANG Huili, DONG Yijie, ZHAN Weiwei 2016, 15 (05):  482-486.  DOI: 10.16150/j.1671-2870.2016.05.010 Abstract ( 104 )   PDF (458KB) ( 45 )   Objective: To determine the relevant factors for cervical lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). Methods: A total of 826 patients with pathologically confirmed PTMC at Ruijin Hospital from December 2014 to January 2009 were enrolled. The following factors were assessed for their correlation with the occurrence of cervical LNM, including sex, age, multiple tumor focus, tumor size, bilateral tumor, coexistence of chronic lymphocytic thyroiditis and ultrasonography (US) features. Univariate and multivariate analyses were performed to identify the predicting factors of cervical LNM. Results: Two hundred and sixteen (26.15%) of the 826 patients had cervical LNM. Univariate and multivariate analyses revealed that the following factors were correlated independently with cervical LNM, including male (OR=1.600; P<0.001), ≤45 years of age (OR=2.020; P<0.001), tumor maximum diameter >5 mm (OR=2.371; P<0.001), microcalcification (OR=1.407; P=0.042). Coexistence of chronic lymphocytic thyroiditis (OR=0.492; P=0.016) was a protective factor for cervical lymph node metastasis. Multiple tumor focus, bilateral tumor and other US cha-racteristics were not significantly correlated with the occurrence of cervical LNM. Conclusions: Male, ≤45 years of age, tumor maximum diameter >5 mm and microcalcification are risk factors for the occurrence of cervical LNM in PTMC patient and prophylactic neck dissection should be considered. Coexistence of chronic lymphocytic thyroiditis could be considered as a protective factor for cervical LNM. References | Related Articles | Metrics

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Awareness, treatment and control of dyslipidemia in middle-aged and older population in Guiyang: A three-year follow-up study ZHANG Miao, ZHANG Ying, SHI Lixin, ZHANG Qiao, PENG Nianchun, HU Ying 2016, 15 (05):  487-491.  DOI: 10.16150/j.1671-2870.2016.05.011 Abstract ( 116 )   PDF (542KB) ( 44 )   Objective: To study the status of awareness, treatment, control of dyslipidemia in people aged40years, over in Guiyang. Methods: A total of6,872adults aged40years, over with dyslipidemia in Guiyang were recruited randomly in2011, 2014. Baseline, follow-up clinical, laboratory data were collected through questionnaire survey, physical examination, blood glucose, lipid tests. The status of awareness, treatment, control of dyslipidemia, relative factors were analyzed. Results: Three years of follow up showed that the awareness, treatment, control rates of dyslipidemia among middle-aged, older adults with dyslipidemia were29.9%, 6.4%, 17.2%, respectively, the successful control rates of HDL cholesterol, LDL cholesterol, total cholesterol, triglyceride were76.7%, 27.5%, 19.9%, 27.7%, respectively. Factors related to unsuccessful control included female, postprandial blood glucose, diastolic blood pressure, BMI. Conclusions: The awareness, treatment, successful control rates of dyslipidemia in middle-aged, over adults with dyslipidemia in Guiyang are low, should pay more attention References | Related Articles | Metrics

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New silent cerebral infarction in patients with hypertensive intracerebral hemorrhage: related risk factors and prognosis MU Jinjin, YANG Kang, FENG Yulan, FU Yi 2016, 15 (05):  492-497.  DOI: 10.16150/j.1671-2870.2016.05.012 Abstract ( 101 )   PDF (691KB) ( 106 )   Objective: To investigate the frequency and risk factors of new silent brain infarction (SBI) in patients with acute hypertensive intracerebral hemorrhage(ICH) and to analyze the association of new SBI with subsequent clinical cerebrovascular events and vascular related deaths. Methods: This prospective study was performed on 100 patients diagnosed as hypertensive ICH within 3 days after onset and MRI was performed on the fifth day after onset to detect new SBI and lesions of cerebral microbleeds(CMBs). Patients were regularly followed up one year for subsequent clinical cerebrovascular events and vascular related death. Results: Fourteen new SBI were observed in 11(11%) patients. Univariate analysis showed that baseline cerebral microbleeds (CMBs) and white matter leukoaraiosis were associated with new SBI. During 1 year of follow-up, 14 patients experienced clinical cerebrovascular events or vascular related deaths, including 9 cases of cerebral infarction, 1 case of recurrent cerebral hemorrhage and 4 cases of vascular related death. Cox proportional hazards models showed that age, atrial fibrillation and new SBI were independently associated with clinical cerebrovascular events or vascular related death. Conclusions: New SBI frequently occurs during the acute phase of ICH and is mainly associated with CMBs and white matter leukoaraiosis. The risk of subsequent clinical cerebrovascular events and vascular related death is increased in hypertensive ICH patients with new SBI. References | Related Articles | Metrics

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Analysis on relationship between polymorphism of chromosome region 9p21 and susceptibility of carotid plaque in acute non-cardioembolic cerebral infarction patients MAIMAITI Yiming, RE Xidan, CHEN Bo, ZHANG Xiang, MA Weiying, YANG Kang, FU Yi 2016, 15 (05):  498-502.  DOI: 10.16150/j.1671-2870.2016.05.013 Abstract ( 133 )   PDF (596KB) ( 29 )   Objective: To analyze the relationship between gene polymorphism of chromosome region 9p21 (rs10757274, rs7044859, rs4977574 and rs496892) and carotid plaque in acute non-cardioembolic cerebral infarction patients. Methods: The gene polymorphisms of site rs10757274, rs7044859, rs4977574 and rs496892 in chromosome region 9p21 were analyzed with polymerase chain reaction-ligase detection reaction (PCR-LDR) in 411 acute non-cardioembolic cerebral infarction patients (230 with carotid plaque while 181 without). Results: Compared with those without carotid plaque, an increased frequency in the G allele of rs4977574 was seen in patients with carotid plague group(52.6% vs 41.7%) (adjusted P=0.006), as well as the frequency in GG allele of rs4977574 genotype (26.5% vs 20.4%) (P=0.002). Strong linkage disequilibrium existed not only between rs10757274 and rs4977574, but also between rs7044859 and rs496892. Conclusions: Genetic polymorphism of rs4977574 on 9p21 is potentially associated with carotid plaque in patients with non-cardioembolic cerebral infarction in Xinjiang and Shanghai. References | Related Articles | Metrics

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Analysis of adverse reactions of blood transfusion and preventive measures JIN Yanping, ZHU Minhua, JIANG Ming 2016, 15 (05):  503-506.  DOI: 10.16150/j.1671-2870.2016.05.014 Abstract ( 214 )   PDF (465KB) ( 101 )   Objective: To analyze the etiology and characteristics of adverse reactions of blood transfusion, and to explore measures to reduce the adverse reactions. Methods: Data of adverse reactions of blood transfusion from 2011 to 2015 were retrospectively reviewed, and all the adverse reactions were statistically analyzed. Results: In the past five years, a total of 17 592 cases receiving blood transfusion and 58 cases suffered from adverse transfusion reactions, with an incidence of 0.33%. Most of them were caused by following blood products: single donor platelets (with an incidence of 1.02%); plasma products (with an incidence of 0.49%); suspended red blood cells (with an incidence of 0.18%). The incidences of adverse blood transfusion reactions caused by different blood components were significantly different ( χ2=26.1,P<0.01). Most of the adverse reactions of blood transfusion were anaphylactic reactions, and were mainly caused by blood plasma transfusion and single donor platelets transfusion,with a constituent ratio of 63.8%; constituent ratio of febrile reaction was 36.2%, commonly caused by transfusing suspended red blood cells. The overall incidence of blood transfusion reactions decreased year by year. Conclusions: For reducing the incidence of transfusion reaction and ensuring the safety of blood transfusion, the management of blood transfusion should be strengthened and the indications of blood transfusion should be held strictly, and reducing unnecessary blood transfusions, especially avoiding the transfusing of plasma with matched red blood cells. References | Related Articles | Metrics

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Changes and analysis of arterial pulse wave velocity, ankle-brachial index and carotid plaque in type 2 diabetes mellitus patients receiving intensive therapy LU Hanying, WANG Tairong, TENG Bin 2016, 15 (05):  507-512.  DOI: 10.16150/j.1671-2870.2016.05.015 Abstract ( 128 )   PDF (717KB) ( 28 )   Objective: To investigate the changes in arterial pulse wave velocity(PWV), ankle brachial index (ABI) and carotid plaque in type 2 diabetes mellitu patients receiving 2-year intensive therapy,and analyze their clinical significance and monitoring role on the prevention of large blood vessel lesions in type 2 diabetes mellitus patients. Methods: Two hundred and six patients with type 2 diabetes from January 2012 to December 2014 at Yuyuan Community Health Service Center, Huangpu District were enrolled. Patients were randomly divided into 2 groups: patients in group A received intensive therapy for 2 years , while patients in group B were given conventional therapy. Differences in blood glucose, blood lipid, PWV, ABI and carotid artery ultrasound indices between the two groups were compared after 24 months follow up. Results: Differences in systolic blood pressure,diastolic blood pressure,urinary protein,postprandial 2 hours blood glucose (2hPG), glycosylated hemoglobin (HbA1c),low density lipoprotein cholesterol (LDL-C), PWV were statistically significant between the two groups（P<0.05）. PWV was significantly lower in blood pressure controlled patients than in uncontrolled patients (P<0.05). In patients with course of diabetes <5 years, PWV in those with HbA1c controlled was significantly lower than those with HbA1c not controlled （P<0.05）. Conclusions: PWV, ABI and carotid artery plaque can objectively reflect the changes in structure and function of blood vessels for patients with type 2 diabetes mellitus, which has a guiding significance for prevention and delay of diabetic complication such as atherosclerosis. References | Related Articles | Metrics

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Warfarin anticoagulation in elderly patients with atrial fibrillation : evaluation by occurrence of adverse cardiovascular events HUANG Hongman, ZHA Shuangying, LIU Xinbing, BO Xiaosong, FENG Liuliu 2016, 15 (05):  513-516.  DOI: 10.16150/j.1671-2870.2016.05.016 Abstract ( 135 )   PDF (483KB) ( 69 )   Objective: To investigate the occurrence of adverse cardiovascular events in elderly patients with atrial fibrillation (AF) during anticoagulation with warfarin. Methods: One hundred and eight older patients (80 years or older) taking warfarin for AF were enrolled. According to the value of international normalized ratio (INR), patients were divided into 2 groups, low intensity warfarin group (INR between 1.40 and 1.80, n=52) and moderate intensity warfarin group (INR between 1.81 and 2.50, n=56), and effects and safety were compared. All patients were followed up for (1.8±1.2) years. The major end point events included the occurrence of ischemic stroke or systemic embolism;the secondary endpoint events included non-fatal myocardial infarction and all causes of death. The safety endpoint events included the occurrence of the mild, severe and fatal hemorrhage. Results: Embolism occurred in 3 patients (5.36%) in moderate intensity warfarin group and in 6 patients (11.54%) in low intensity warfarin group (all were cerebral stroke); the difference was statistically significant. Conjunctival and nasal hemorrhage occurred in 2 patients in low intensity warfarin group and in 3 patients in moderate intensity warfarin group; no severe hemorrhage was seen in all the patients. No significant difference in hemorrhagic rate was seen between the low intensity and moderate intensity warfarin groups (P>0.05). Conclusions: The INR ranged from 1.81-2.50 is safe for elderly patients with atrial fibrillation treated with warfarin for anticoagulation. References | Related Articles | Metrics

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Significance of HPV genotype detection in diagnosis of cervical lesion GU Zhengrong, WU Hong, WANG Ling 2016, 15 (05):  517-520.  DOI: 10.16150/j.1671-2870.2016.05.017 Abstract ( 147 )   PDF (631KB) ( 68 )   Objective: To investigate the infection of different genotypes of papillomavirus (HPV) and the relationship between high-risk HPV genotype and cervical lesion in females. Methods: HPV genotype detection was performed in 1 669 subjects. Colposcopy was conducted in positive cases after informed consent was obtained and biopsy was performed in suspected cases under colposcopy. Results: Five hundred and sixty-seven cases of the 1 669 subjects were HPV positive, with a positive rate of 33.97% (567/1 669). The five leading frequencies of HPV genotype were HPV-16 (9.05%), HPV-52 (7.85%), HPV-58 (6.29%), HPV-CP8304 (5.81%), HPV-53 (3.71%). Women ≤30 were at the peak of HPV infection when compared with other ages. Four hundred and fifty-four cases of 567 HPV positive subjects were infected with high-risk HPV genotype. The five leading frequencies of high-risk HPV infection with high grade squamous intraepithelial lesion (HSIL) in biopsy were HPV-16 (58 cases), HPV-52 (26 cases), HPV-58 (25 cases), HPV-18 (25 cases), HPV-31 (6 cases). Conclusions: The peak age for HPV infection is getting younger, and HPV genotype detection has significant value in the diagnosis of cervical lesion, especially HPV-16, HPV-52, HPV-58, HPV-18, HPV-31, they are closely associated with cervical cancer. References | Related Articles | Metrics

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Application of Multivane XD technique in liver T2-weighted imaging WANG Tao, FU Meng, XIAO Ruijie, DONG Haipeng, LI Ruokun, YAN Fuhua 2016, 15 (05):  521-524.  DOI: 10.16150/j.1671-2870.2016.05.018 Abstract ( 168 )   PDF (513KB) ( 64 )   Objective: To investigate the value of Multivane XD technique in liver T2-weighted imaging (T2WI). Methods: Fifty-six patients(29 men, 27 women; age ranged 25-84 years, average 54 years) underwent liver MR imaging including conventional T2WI and Multivane XD T2WI were analyzed. Sixteen patients had focal hepatic lesions (FHL). Qualitative analysis was performed by two abdominal radiologists. Overall image quality was scored 5-scales ranged from 1 to 5. Signal intensity of right lobe, left lobe and FHL, and background SD were measured. SNRright lobe, SNRleft lobe, CNRright lobe, CNRleft lobe and contrast between FHL and liver parenchyma were calculated and compared between Multivane XD T2WI and conventional T2WI. Results: Overall image quality score of Multivane XD T2WI was significantly higher than that of conventional T2WI [(4.70±0.50) vs (2.86±0.80), P=0.001]. SNRright lobe and SNRleft lobe were significantly higher than those of conventional T2WI [(189.84±112.39) vs(3.52±70.08), P<0.001; (218.82±136.24) vs (28.70±96.97), P<0.001]. There was no significant difference in CNRright lobe, CNRleft lobe and contrast [(4.30±51.86) vs (3.52±70.08), P=0.447; (24.68±82.61) vs (28.67±96.95), P=0.742; (2.94±1.43) vs (2.92±1.16), P=0.958] between Multivane XD T2WI and conventional T2WI. Conclusions: Multivane XD technique can reduce motion artifacts and improve the imaging quality of T2WI. References | Related Articles | Metrics