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Objective:To evaluate the efficacy and safety of endoscopic ultrasound (EUS)-guided coil embolization combined with endoscopic cyanoacrylate injection for gastric fundal varices with large spontaneous shunt.Methods:Data of 24 patients with gastric fundal varices with large spontaneous shunt (the smallest diameter was 5-15 mm) treated by EUS-guided coil embolization combined with endoscopic cyanoacrylate injection in Renmin Hospital of Wuhan University from December 2016 to December 2020 were retrospectively analyzed. The short-term efficacy (the rates of technical success, five-day rebleeding and six-week mortality) and long-term efficacy (the rates of one-year rebleeding, one-year mortality and three-year mortality) and safety (ectopic embolism) were evaluated.Results:The technical success rate was 91.7% (22/24), and the five-day rebleeding rate was 0 (0/22). Computed tomography angiography of portal vein reexamined 2 days after the treatment showed embolism of splenic vein in 1 patient (4.5%). The median follow-up time was 14.9 months (ranging 1.0-48.6 months) and 2 patients were lost during follow-up. The six-week mortality was 0 (0/20), and the one-year rebleeding rate was 35.0% (7/20). Among 12 patients who underwent endoscopy in the follow-up, 5 had aggravation of esophageal varices, and 5 had aggravation of portal hypertension gastropathy. The one-year and three-year mortalities were 5.0% (1/20) and 20.0% (4/20), respectively, neither of which was related to such events as bleeding or ectopic embolism.Conclusion:EUS-guided coil embolization combined with endoscopic cyanoacrylate injection for gastric fundal varices with large spontaneous shunt is effective and safe in short term, with a low rate of ectopic embolism. Long-term efficacy and safety need to be further confirmed.
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Endoscopic ultrasonography (EUS)is routinely performed before endoscopic submucosal dissection (ESD)for treatment of upper gastrointestinal stromal tumors.However,when a miniprobe sonography (12,15 and 20 MHz)was used,the size of tumor revealed by EUS was often inconsistent with what it actually was,which might increase the difficulty of ESD and the risk of perforation and massive bleeding.Aims:To investigate the value of standard probe (5 and 7.5 MHz)EUS in detecting the size of upper gastrointestinal stromal tumors before ESD.Methods:Clinical data of patients who were suspicious of esophageal and gastric stromal tumors by gastroscopy and EUS from Jan.2012 to Oct.2014 at the Renmin Hospital of Wuhan University were collected.Of them,195 cases treated by ESD were retrospectively analyzed.Results:Of 195 cases treated by ESD,37 cases diagnosed by standard probe EUS and 108 cases diagnosed by miniprobe EUS were confirmed as stromal tumors by pathology.Fourteen cases were failure for ESD and then transferred to surgical treatment,one was due to misjudgement of the origin of tumor by standard probe EUS and 9 were due to misjudgement of the size of tumor by miniprobe EUS.The misjudgement rate of standard probe EUS was lower than that of miniprobe EUS with an insignificant difference (2.7%vs.8.3%,P>0.05).In 9 cases misjudged by miniprobe EUS, the size of tumor presented by miniprobe EUS was significantly smaller than its real size [(1.22 ±0.51)cm vs.(3.97 ±1.06)cm,P<0.01].ESD was avoided or terminated in 3 cases because of the accurate estimation of tumor origin, structure and blood flow by standard probe EUS.Conclusions:For patients who are going to receive ESD for suspected upper gastrointestinal stromal tumors,it would be best to select standard probe EUS to detect the size,origin and blood flow of the tumor before ESD.It will decrease the risk and improve the success rate of ESD.
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Objective To explore the value of serum procalcitonin (PCT) for early evaluation of the severity in bacterial infection, and compare it with C-reactive protein(CRP), white blood cell(WBC) and temperature to understand their strengths and weaknesses. Methods A sample of 139 impatients with bacterial infection from July 2009 to June 2010 in our hospital were divided into four groups, including local bacterial infection group(Group A, n = 50), sepsis group(Group B, n = 51), severe sepsis group(Group C, n = 21) and septic shock group (Group D, n = 17) according to ACCP/SCCM consensus conference and the clinical manifestation. Twenty noninfectious patients during the same time were recruited as control(Group E, n = 20)PCT, CRP,WBC and temperature were evaluated in all patients before treatment and PCT were measured 5 days after treatment. Results During the early period of the bacterial infection, PCT was highest in Group D ([42.36±48.49] × 10-6 g/L),which was higher than that of (4.66 ±2.46) × 10-6 g/L in Group C,( 1.08 ± 0. 68) × 10 -6 g/L in Group B and (0. 09 ± 0. 05) × 10 -6 g/L in Group A(Ps ＜ 0. 05), PCT in the four infectious groups were all higher than the control group([0. 05 ± 0. 01 ] × 10-6 g/L)(Ps ＜ 0. 05). No significant difference in CRP between Group D and Group C, neither did between Group C and Group B (Ps ＞0. 05). No significant difference was found in WBC between Group D and Group C,neither did between Group D and Group B (Ps ＞ 0. 05). Temperature in Group D was not significantly different to Group C(P ＞ 0. 05). After 5 days' treatment, PCT decreased in the four infectious groups than before. Conclusion The level of PCT can be used to evaluate the severity of infection during the early period of bacterial infection, which is better than CRP,WBC and temperature. PCT decreases after effective treatment,which can help monitor the patients' condition.
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Objectives To investigate the etiological factors of gastric eosinophilic granuloma(GEG).Methods Clinical manifestations,histopathological features, diagnosis and treatment were analysed retrospectively.Reformed Giemsa staining was employed to detect the helicobacter pylori in 23 patients.Results There was a significant sex difference in patients with GEG. And the misdiagnosis was quite high before resection. Lymphoid follicles were found in 68 8% of the lesion tissues and helicobacter infection was detected in 69 6% of the patients. Increased eosinophils in peripheral blood was observed in 11 patients.Conclusions Helicobacter infection, estrogen and allergic reaction may be related to the development of GEG.
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AIM: To investigate the effects of berberine (Ber) on ion transport and hypersecretion induced by cholera toxin(ChT) in ileum and its mechanism. METHODS: Ussing Chamber technique was used to measure the potential difference(PD), short-circuit current(SCC), and the resistance(R) in isolated guinea-pig ileum. The effects of Ber on PD, SCC and R in glucose Tyrode solution or glucose-free Tyrode solution were examined. The secretory diarrhoea model was made by ChT to investigate the effects of ChT and ChT+Ber on PD, SCC and R. RESULTS: (1)The PD and SCC were decreased in glucose Tyrode solution by the Ber added in mocosal side or in serosal side in ileum of normal guinea-pig and which was with secretory diarrhoea ( P