In addition to acid reflux and heartburn, the clinical manifestations of gastroesophageal reflux disease (GERD) can also include a series of extrA-esophageal complications, among which the incidence of respiratory system related diseases is high. Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease characterized by fibrosis, inflammation and lung structure destruction. Long-term chronic microaspiration caused by gastroesophageal reflux plays an important role in the pathophysiological process of idiopathic pulmonary fibrosis. This article will review the relationship between gastroesophageal reflux disease and idiopathic pulmonary fibrosis, the role of acid suppression and anti-reflux therapy in the treatment of idiopathic pulmonary fibrosis.

Arteriovenous fistula (AVF) is the preferred vascular access for maintenance hemodialysis (MHD) in patients with end-stage renal disease (ESRD). The vascular selection and evaluation before AVF establishment, the maturity assessment after AVF establishment, the timely treatment of AVF mature disorders, and the timely monitoring, location, and treatment of complications during AVF use, are all crucial for the MHD treatment. Ultrasound has the advantages of convenience, non-invasiveness, safety, and economy in evaluating vascular anatomy and blood flow, and is helpful for selecting AVF vessels, assessing the maturity of AVF, discovering the AVF maturity disorders and their causes, detecting and locating postoperative complications, guiding the treatment of mature disorders and complications, improving the success rate of AVF establishment, and ensuring the proceeding of MHD. This article reviewed the current status and prospect of the clinical application of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in the AVF of MHD patients in recent years.

目的 通过检测胃癌患者血浆中长链非编码RNA(lncRNA)ENST00000568893.1 RNA序列不同片段水平,探究RNA片段化分析作为筛选胃癌诊断标志物的可行性.方法 依据lncRNAENST00000568893.1 RNA全长序列将其分为3个不同序列片段,分别设计对应各RNA片段的PCR扩增引物,采用qRT-PCR方法检测lncRNA ENST00000568893.1 RNA不同片段在健康者、胃癌前病变和早期胃癌患者血浆中的含量.结果 lncRNA ENST00000568893.1 RNA是以片段化形式存在于血浆中,其不同片段在同类型的血浆样本中含量不同,同一片段在不同类型的血浆中含量不同.结论 基于lncRNA ENST00000568893.1 RNA片段在胃癌患者血浆中存在异质性,提示血浆RNA片段异质性可用于筛选胃癌标志物分子,将为肿瘤标志物分子的发现提供新的思路.

Objective:To compare the clinicopathological characteristics of main and accessory lesions in patients with synchronous multiple esophageal lesions (SMEL, i. e. early esophageal cancer and intraepithelial neoplasia) and to explore their correlation.Methods:Data of 80 patients with SMEL treated by endoscopic resection in The First Medical Center of Chinese PLA General Hospital from November 2006 to September 2019 were retrospectively analyzed, and the clinicopathological characteristics as well. The lesions were divided into main and accessory lesions, and their correlation in macroscopic type, lesion location, pathological type and invasion depth in 70 patients with double SMEL were investigated.Results:The age of 80 patients with SMEL was 61.3±8.32 years, more common in males (83.8%, 67/80). Fifty-seven patients (71.2%) had a history of smoking and drinking, respectively. There was a positive correlation between the size of main and accessory lesions in the 70 patients with double SMEL ( r=0.464, P<0.001). The macroscopic type ( P=0.115), location ( P=0.340) and depth of invasion ( P=0.555) of the main and accessory lesions were not correlated, but the pathological type had high correlation ( P<0.001). The consistency rate was 50.0% (35/70). Conclusion:Most SMEL patients are elderly males with a history of smoking and drinking. When one lesion is found, there is high possibility of multiple lesions. Physicians should be aware of the correlation between main and accessory lesions to avoid missed diagnosis.

目的 通过临床大样本研究,进一步明确内镜下射频消融术(RFA)治疗胃低级别上皮内瘤变(LGIN)的有效性及安全性.方法 回顾性选择2014年10月至2019年12月经解放军总医院消化内镜中心术前筛查的175例患者证实为胃LGIN的255例病变纳入研究,并进行内镜下RFA,关注其围手术期并发症发生情况,术后采用Wong-Baker面部表情量表进行疼痛评分,并追踪其复查随访结果.结果 255例病变均成功完成内镜下RFA,术中无明显并发症发生;术后3个月、6个月、1年、2年、3年的治愈率分别为91.3％、90.8％、89.4％、88.2％、86.5％,术后腹痛为主要并发症.结论 内镜下RFA是治疗胃LGIN的一种安全有效、操作简便、可门诊治疗的新方法,具有良好的临床应用前景.

Objective To evaluate the safety and efficacy of endoscopic submucosal tunnel dissection for large early esophageal cancer.Methods A total of 68 patients with large early esophageal cancer accepted endoscopic submucosal dissection (ESD) or endoscopic submucosal tunnel dissection (ESTD) in our center from Jan.2018 to Aug.2019.Based on the operation strategy,45 patients underwent ESD and 23 patients underwent ESTD treatment.Hemorrhage,perforation,dissection speed,curative resection rate and relative clinical date of ESD and ESTD group were collected and analyzed.Results Delayed bleeding occurred in 1 patient (2.2％) of ESD group.There was no significant difference compared with 2 patients (8.7％) of ESTD group (P =0.545).Hemostatic forceps were used to manage bleeding successfully.No perforation was observed in ESD group and intraoperative perforation occurred in 1 patient of ESTD group.No significant difference was observed between two groups (P =0.730).The perforation was treated with fibrin sealant and tissue forceps.40 patients (88.9％) achieved curative resection and there was no significant difference compared with 21 patients (91.3％) of ESTD group (P =1.000).The dissection speed of ESTD was significantly quicker than that of ESD group (41.8 ± 17.3)mm2/min vs (33.2 ±13.4)mm2/min(P=0.027).Conclusions ESTD appeared to be comparable with ESD in terms of safety and effficacy for large esophageal cancer.Besides,ESTD could provide a quicker dissection speed.

目的 通过调查重症监护室(ICU)一起疑似泛耐药鲍氏不动杆菌(PDR-AB)感染暴发的情况,研究泛耐药鲍氏不动杆菌医院感染防控的集束化策略,指导医院感染防控措施实施.方法 通过分子流行病学分析与环境卫生学监测相结合的方法,对2018年2月-2018年4月ICU住院患者鲍氏不动杆菌分离与感染情况展开调查,对疑似污染的环境与物品进行微生物学采样、鉴定和药敏试验.患者和环境中PDR-AB克隆菌株采用脉冲场凝胶电泳(Pulsed Field Gel Electrophoresis,PFGE)技术进行同源性分析.结果 2018年3月ICU PDR-AB院内定植或感染患者7例,患者新发感染率10.14％;PDR-AB定植或感染患者的头部垫巾,病床床尾板、床栏,护士站台面及医务人员护理服和清洗消毒后的纤支镜中分离出PDR-AB存在;ICU患者与环境分离的27株PDR-AB耐药谱基本一致;PFGE结果显示患者、环境、纤支镜PDR-AB克隆菌株来自于同一亚型.结论 PDR-AB克隆菌株在患者、环境及纤支镜之间具有高度同源性的克隆传播,通过强化医务人员无菌观念,患者隔离,环境及医疗器械的严格清洁消毒,暴发流行情况得到有效控制.

Objective To investigate the clinical application of closed-circuit extracorporeal circuit for hemodialysis in hemodialysis combined with hemoperfusion. Methods Sixty patients with maintenance hemodialysis from January 2014 to December 2015 were enrolled in this study.Hemodi-alysis and blood perfusion were randomly divided into control group and experimental group (n=30). Each patient underwent 10 rounds of treatment. In the control group, the conventional single straight tube was used to connect hemodialyzer and blood perfusion device. In the experimental group,the closed dialysis hemodialysis cardiopulmonary bypass was used to connect hemodialyzer and blood perfusion device. Conduct pipeline pre-flushing,the end of the treatment of the operation time,coagulation of the pipeline,nozzle exposure, such as blood drip were analyzed. Results In the experimental group,the operation time of the pre-flushing of the pipeline,the end of treatment, the incidence of blood perfusion of the blood perfusion device and the dialyzer were obviously less than those in control group. The incidence of orifice exposure and blood dripping were significantly lower than that of the control group(P<0.05). Conclusion The closed double dialysis hemodialy-sis with extracorporeal circulation pipeline for hemodialysis combined with blood perfusion is superior to conventional pipeline,which is worth of clinical application.

Objective To evaluate the dynamic changes and clinical significance of coagulation,fibrinolytic markers and platelet parameters before and after chemotherapy in lung cancer patients.Methods The prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-dimer(D-D),protein C(PC),free protein S(FPS),plasminogen activator inhibitor-Ⅰ(PAI-Ⅰ),platelet total(PLT),plateletcrit(PCT),mean platelet volume(MPV) and platelet distribution width(PDW) were measured in sixty lung cancer patients before and after chemotherapy,with twenty healthy people as control.Results Compared with the control group,the mean value of FIB,D-D,PAI-Ⅰ,PLT,PCT and MPV were significantly increased(P0.05 or P0.01) in patients with lung cancer while the mean value of PC and FPS was decreased(P0.05).Compared with the pre-treatment patients,the mean value of PT,TT,APTT,FIB,D-D,PC,FPS,PLT,PCT and MPV was significantly decreased(P0.05 or P0.01) in post-treatment patients.However,the mean value of PAI-Ⅰ was increased(P0.01).There existed no relationship between the plasma level of coagulation,fibrinolytic markers,platelet parameters,sex,histological classification,TNM stages,and metastasis in lung cancer patients before or after chemotherapy(P0.05).Conclusion The state of hypercoagulability,secondary hyperfibrinolysis and low anticoagulation occur among patients with lung cancer.Chemotherapy may enhance blood coagulation functional disorders.