ABSTRACT
Objective:To summarize the thoracic and abdominal CT presentations after endoscopic full-thickness resection (EFR) and to analyze its significance in the evaluation and management of postoperative complications.Methods:Data of 82 patients who underwent gastrointestinal EFR at the Endoscopy Center of Zhongshan Hospital, Fudan University and received a chest and/or abdominal CT within 1 week from September 2016 to September 2021 were collected retrospectively. The patients were divided into the intervention group ( n=38) and the control group ( n=44) according to the presence or absence of special postoperative interventions or prolonged hospital stays. The differences in the incidence of abnormal CT presentations between the two groups were analyzed. Risk factors for abnormal CT presentation were explored by multifactorial analysis. Results:Among the 82 patients, the main CT presentations were pneumoperitoneum in 51 patients (62.2%), abdominal and pelvic effusion in 30 patients (36.6%), pneumothorax in 5 (6.1%), pleural effusion in 43 (52.4%), and pulmonary inflammation in 16 (19.5%). The incidence of pelvic and abdominal effusions ( W=637.48, P=0.031) and pleural effusions ( W=622.06, P=0.031) in CT was higher in the intervention group than that in the control group. Age was an independent risk factor for air-related complications after EFR (>60 years old VS ≤60 years old: OR=0.17, 95% CI: 0.05-0.56, P=0.002). Conclusion:CT presentations of pelvic and abdominal effusion and pleural effusion after EFR is of great significance in suggesting complications, while patients with other CT presentations often do not require special intervention or prolonged hospital stay. Postoperative CT in elderly patients is less likely to detect air-related complications.
ABSTRACT
Background/Aims@#Previous studies reveal that immune-mediated neuroinflammation plays a key role in the etiology of esophageal achalasia. However, the understanding of leucocyte phenotype and proportion is limited. This study aim to evaluate the phenotypes of leukocytes and peripheral blood mononuclear cells transcriptomes in esophageal achalasia. @*Methods@#We performed high-dimensional flow cytometry to identified subsets of peripheral leukocytes, and further validated in lower esophageal sphincter histologically. RNA sequencing was applied to investigate the transcriptional changes in peripheral blood mononuclear cells of patients with achalasia. Cell-type Identification by Estimating Relative Subsets of RNA Transcripts (CIBERSORT) was used for estimating the immune cell types. A differential gene expression analysis was performed and the differential expressed genes were subjected to gene ontology, Kyoto Encyclopedia of Genes and Genomes network, protein-protein interaction network construction. @*Results@#An imbalance between innate and adaptive immune cells occurred in achalasia. Specifically, neutrophils and CD8+ T cells increased both in peripheral blood and lower esophageal sphincter in achalasia. Eosinophils decreased in peripheral blood but massively infiltrated in lower esophageal sphincter. CIBERSORT analysis of peripheral blood mononuclear cells RNA sequencing displayed an increased prevalence of CD8+ T cells. 170 dysregulated genes were identified in achalasia, which were enriched in immune cells migration, immune response, etc. Proton pump inhibitor analysis revealed the intersections and gained 7 hub genes in achalasia, which were IL-6, Toll-like receptor 2, IL-1β, tumor necrosis factor, complement C3, and complement C1q A chain. @*Conclusion@#Patients with achalasia exhibited an imbalance of systematic innate and adaptive immunity, which may play an important role in the development of achalasia.
ABSTRACT
Objective To analyze the differences in the incidence of malignant tumors among urban and rural residents in Shenyang from 2013 to 2018. Methods From 2013 to 2018, the incidence data of malignant tumors of residents with household registration from national cancer surveillance sites in Shenyang urban area and rural Kangping and Faku counties were extracted. Crude incidence rate, age-standardized rate (standardized rate by Chinese population, standardized rate by world population), age specific incidence rate, cumulative incidence rate (0-74 years old), and truncated incidence rate (35-64 years old) were respectively calculated. SPSS23.0 software was used to carry out chi square test for the incidence of disease in urban and rural areas and in different age groups. Joinpoint 3.5.3 software was used to analyze the incidence trend in urban and rural areas. Results From 2013 to 2018, the age-standardized rate of cancer incidence by Chinese population（2000）and the cumulative rate of 0-74 years old in urban residents of Shenyang City were 199.85/105 and 22.21%, respectively, which were higher than those in rural residents, 172.84/105 and 19.85%, respectively. The incidence rate of cancer in males and females in urban area was higher than that in rural areas (χ2=262.47，χ2=103.83, P<0.05). The incidence rates in urban males and females and in rural females all showed an increasing trend in the past 6 years (APC=3.06%, APC=4.03%，APC=3.28% , P<0.05). The top five malignant tumors of urban males were lung cancer, colorectal cancer, liver cancer, gastric cancer and bladder cancer, while the top five malignant tumors of rural males were lung cancer, esophageal cancer, liver cancer, gastric cancer and colorectal cancer, respectively. The top five malignant tumors of urban women were breast cancer, lung cancer, colorectal cancer, thyroid cancer and cervical cancer, while the malignant tumors of rural women were lung cancer, breast cancer, colorectal cancer, cervical cancer and liver cancer, respectively. Conclusion From 2013 to 2018, the incidence of malignant tumor in urban residents in Shenyang is higher than that in rural areas. The incidence rates of urban males and females and rural females have showed an upward trend year by year in the past 6 years. There is a large difference in the order of tumor incidence between urban and rural men and women.