Objective
To compare the esophageal dynamic changes before and after laparoscopic Nissen fundoplication (LNF) in patients with gastroesophageal reflux disease (GERD) by high resolution manometry (HRM) and to explore the anti-reflux mechanism of the procedure.
Methods
A total of 73 consecutive hospitalized patients with GERD were included. A series of preoperative evaluations including HRM were performed within 1 weeks before LNF. After the GERD symptoms were significantly relieved and dysphagia and other complications disappeared, the HRM was rechecked. The 9 esophageal motility parameters of the HRM before and after operation were compared and analyzed, and further analysis was made on whether or not there were hiatus hernia before the operation.
Results
The average length of esophagus was prolonged by (0.43±1.72) cm after operation, and the length of intra-abdominal and lower esophageal sphincter was prolonged by (1.20±0.94) cm. Postoperative resting pressure of the lower esophageal sphincter increased by an average of (5.99±7.79) mmHg and the integrated relaxation pressure increased by (3.41±5.43) mmHg. The distal contractile integral increased by an average of (157.26±596.01) mmHg•s•cm, the distal latency increased by an average of (0.93±2.30) s, the above 6 motility parameters compared with preoperative had significant difference (P=0.04, <0.01, <0.01, <0.01, 0.03, <0.01). There were no significant differences in the length of the lower esophageal sphincter, the pressure of the upper esophageal sphincter and the contractile front velocity after operation (P=0.83, 0.43, 0.73). The length of the esophagus, the length of the lower esophageal sphincter, and the distal contractile integral were significantly improved in the patients with hiatal hernia comparing with those without hiatal hernia (P<0.01, <0.01, <0.01).
Conclusion
The effective anti-reflux effect is mainly achieved by prolonging the length of the intraperitoneal esophageal, enhancing the lower esophageal sphincter pressure and enhancing the esophageal clearance function by LNF. Patients with esophageal hiatal hernia had better esophageal motility improvement than those without esophageal hiatal hernia.
Key words:
Laparoscopic Nissen fundoplication; High resolution manometry; Gastroesophageal reflux disease; Hiatal hernia; Esophageal motility
Abstract Aims Following myocardial infarction (MI), the heart repairs itself via a fibrotic repair response. The degree of fibrosis is determined by the balance between deposition of extracellular matrix (ECM) by activated fibroblasts and breakdown of nascent scar tissue by proteases that are secreted predominantly by inflammatory cells. Excessive proteolytic activity and matrix turnover has been observed in human heart failure, and protease inhibitors in the injured heart regulate matrix breakdown. Serine protease inhibitors (Serpins) represent the largest and the most functionally diverse family of evolutionary conserved protease inhibitors, and levels of the specific Serpin, SerpinA3, have been strongly associated with clinical outcomes in human MI as well as non-ischaemic cardiomyopathies. Yet, the role of Serpins in regulating cardiac remodelling is poorly understood. The aim of this study was to understand the role of Serpins in regulating scar formation after MI. Methods and results Using a SerpinA3n conditional knockout mice model, we observed the robust expression of Serpins in the infarcted murine heart and demonstrate that genetic deletion of SerpinA3n (mouse homologue of SerpinA3) leads to increased activity of substrate proteases, poorly compacted matrix, and significantly worse post-infarct cardiac function. Single-cell transcriptomics complemented with histology in SerpinA3n-deficient animals demonstrated increased inflammation, adverse myocyte hypertrophy, and expression of pro-hypertrophic genes. Proteomic analysis of scar tissue demonstrated decreased cross-linking of ECM peptides consistent with increased proteolysis in SerpinA3n-deficient animals. Conclusion Our study demonstrates a hitherto unappreciated causal role of Serpins in regulating matrix function and post-infarct cardiac remodelling.
Importance Longitudinal tau positron emission tomography (PET) is a relevant outcome in clinical trials evaluating disease-modifying therapies in Alzheimer disease (AD). A key unanswered question is whether the use of participant-specific (individualized) regions of interest (ROIs) is superior to conventional approaches where the same ROI (group-level) is used for each participant. Objective To compare group- and participant-level ROIs in participants at different stages of the AD clinical continuum in terms of annual percentage change in tau-PET standardized uptake value ratio (SUVR) and sample size requirements. Design, Setting, and Participants This was a longitudinal cohort study with consecutive participant enrollment between September 18, 2017, and November 15, 2021. Included in the analysis were participants with mild cognitive impairment and AD dementia from the prospective and longitudinal Swedish Biomarkers For Identifying Neurodegenerative Disorders Early and Reliably 2 (BioFINDER-2) study; in addition, a validation sample (the AVID 05e, Expedition-3, Alzheimer’s Disease Neuroimaging Initiative [ADNI], and BioFINDER-1 study cohorts) was also included. Exposures Tau PET (BioFINDER-2, [ 18 F]RO948; validation sample, [ 18 F]flortaucipir), 7 group-level (5 data-driven stages, meta-temporal, whole brain), and 5 individualized ROIs. Main Outcomes and Measures Annual percentage change in tau-PET SUVR across ROIs. Sample size requirements in simulated clinical trials using tau PET as an outcome were also calculated. Results A total of 215 participants (mean [SD] age, 71.4 (7.5) years; 111 male [51.6%]) from the BioFINDER-2 study were included in this analysis: 97 amyloid-β (Aβ)–positive cognitively unimpaired (CU) individuals, 77 with Aβ-positive mild cognitive impairment (MCI), and 41 with AD dementia. In the validation sample were 137 Aβ-positive CU participants, 144 with Aβ-positive MCI, and 125 with AD dementia. Mean (SD) follow-up time was 1.8 (0.3) years. Using group-level ROIs, the largest annual percentage increase in tau-PET SUVR in Aβ-positive CU individuals was seen in a composite ROI combining the entorhinal cortex, hippocampus, and amygdala (4.29%; 95% CI, 3.42%-5.16%). In individuals with Aβ-positive MCI, the greatest change was seen in the temporal cortical regions (5.82%; 95% CI, 4.67%-6.97%), whereas in those with AD dementia, the greatest change was seen in the parietal regions (5.22%; 95% CI, 3.95%-6.49%). Significantly higher estimates of annual percentage change were found using several of the participant-specific ROIs. Importantly, the simplest participant-specific approach, where change in tau PET was calculated in an ROI that best matched the participant’s data-driven disease stage, performed best in all 3 subgroups. For the power analysis, sample size reductions for the participant-specific ROIs ranged from 15.94% (95% CI, 8.14%-23.74%) to 72.10% (95% CI, 67.10%-77.20%) compared with the best-performing group-level ROIs. Findings were replicated using [ 18 F]flortaucipir. Conclusions and Relevance Finding suggest that certain individualized ROIs carry an advantage over group-level ROIs for assessing longitudinal tau changes and increase the power to detect treatment effects in AD clinical trials using longitudinal tau PET as an outcome.
The objective of this study is to examine the risk factors associated with apnea in hospitalized patients diagnosed with bronchiolitis and to develop a nomogram prediction model for the early identification of patients who are at risk of developing apnea.
Objective To study the diagnostic value of pleural effusion combined with serum adenosine deaminase (ADA), carcinoe mbryonic antigen (CEA) in testing malignant pleural exudates. Methods Diagnostic kit for carcinoe mbryonic antigen (CEA) measured by ELISA and ADA was examined using continuous monitored enzymatic method among 119 cases of pleural exudates patients. Results The positive rates of TB-Ab-IgG in pleural effusion and in serum of 87 cases were 62.0% and 70.1% respectively. The ADA activity of tuberculous and malignant exudates were, respectively, (59.58±29.85)U/L and (15.31±7.36)U/L(P0.01). If the cut-off point of ADA was larger than 40 U/L in tuberculous diagnosis, its sensitivity was 79.3% and its specificity was 86.4%. If the cutoff value of P-ADA/S-ADA was larger than 1 in tuberculous diagnosis, its sensitivity was 97.7% and the specificity was 95.5%. Conclusion The test of ADA and CEA of pleural exudates is of great value in differentiating benign from malignant exudates.
The formation of the tomb form system and the stone animals before the tombs in the Han Dynasty are influenced by the funeral customs as well as foreign cultures.Because of the differences of geographical position,inheritance,and the relevant backgrounds,the stone carvings in different places show different features.The progressive perfection of the funeral customs and the establishment of tomb form system and stone carvings before the tombs in the Han Dynasty set up an outline for tomb form system and stone carvings before the tombs in China.
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