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Objective:To explore the effect of cold-strap endoscopic mucosal resection (CS-EMR) in patients with colorectal polyps.Methods:A prospective randomized clinical trial was conducted to 320 selected patients with colorectal polyps diagnosed by Shenzhen Luohu District People′s Hospital from May 2019 to June 2021. The patients were randomly divided into CS-EMR group and HS-EMR group with 160 cases each, using a random number table generated by Excel 2007. The main parameters for statistical analysis contain the process indicators of the two groups of surgical methods, the complete polypectomy rate of patients after surgery, the degree of postoperative pain and the recovery of gastrointestinal function, and the differences in surgical complications.Results:The polypectomy time of CS-EMR group was shorter than that of HS-EMR group: (4.11 ± 1.20) min vs. (4.42 ± 0.98) min, with a statistically significant difference ( P<0.05). The score of visual analogue pain scale (VAS) in CS-EMR group was lower than that in HS-EMR group at 4 and 12 hours after operation: (3.11 ± 0.78) scores vs. (3.48 ± 0.80) scores, (3.38 ± 0.80) scores vs. (3.61 ± 0.92) scores, with a statistically significant difference ( P<0.05). The first anal exhaust time and first defecation time in CS-EMR group were lower than those in HS-EMR group: (27.83 ± 5.01) h vs. (29.66 ± 4.84) h, (43.73 ± 7.80) h vs. (47.28 ± 8.14) h, with a statistically significant difference ( P<0.05). The complications in CS-EMR group were significantly lower than those in HS-EMR group: 5.63% (9/160) vs. 12.50% (20/160), with a statistically significant difference ( P<0.05). Conclusions:The effect of CS-EMR in the treatment of colorectal polyps is not different from that of HS-EMR, but the former has the advantages of short resection time, rapid recovery of gastrointestinal function after operation, light pain and less complications.
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Helicobacter pylori (HP) infection is one of the most prevalent chronic bacterial infections in the world, which is closely related to the development of gastrointestinal diseases, such as chronic gastritis, gastroduodenal ulcer and gastric cancer. Empirical treatment of HP infection may lead to antibiotic resistance, adverse reactions and poor compliance. The decreased HP eradication rate is related to antibiotic resistance, HP converting to coccoid form and admission of proton pump inhibitors (PPI). The implementation of precise therapy can effectively enhance the HP eradication rate, through antibiotics selecting based on detection of drug sensitivity phenotype and drug resistance genes, reducing adverse drug reactions, increasing patient compliance, and rationally administrating PPI, etc. This article reviews the research progress of precision therapy for HP infection to provide reference for clinicians.
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Objective To study the missed diagnosis of colorectal polyps during colonoscopy and its risk factors.Methods Data of 655 patients who underwent repeated co]onoscopy in 3 months (90 days) were analyzed in three endoscopy centers in Shenzhen.Miss rates of polyps and patients were calculated.Logistic regression analysis was used to identify the suspected risk factors associated with the miss rate including gender,age,symptoms of patient and number,shape,location of polyps.Results A total of 459 polyps(20.47％,459/2 242) in 224 patients(34.20％,204/655) were missed in overall 1 783 polyps within 655 patients.The patient miss rate increased with the polyp count increasing from 1 to 4,but with no significant differences.Polyp count of more than 5 was the independent risk factor for patient miss rate during colonoscopy(OR=4.98,P=0.00).Polyps in males were easier to be missed than those in females (OR =1.76,P =0.00).Size less than 5 mm was the independent risk factor for missed diagnosis during colonoscopy(OR=2.94,P=0.00).The flat type(Yamada Ⅰ,Ⅱ) was also the independent risk factor(OR=2.72,P=0.01;OR=3.23,P=0.00 respectively).Conclusion The miss rate of polyps is related to gender,basic polyp count,the size and shape of polyp.Male with multiple polyps and polyps with flat type and small size tend to be missed.
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Objective To explore the efficacy and safety of dexmedetomidine combined with propofol on double-balloon enteroscopy.Methods Forty cases of patients ASA Ⅰ-Ⅱ grade who underwent double-balloon enteroscopy were divided into dexmedetomidine combined with propofol group (combine group) and propofol group by random digits table with 20 cases each group.Combine group was given load 0.7 μg/kg (intravenous infusion for 10 min) before induction and 0.2 μg/ (kg·h) continuous infusion during the surgery.All the patients were used propofol by target concentration with 2.5-4.0 mg/L for target-controlled infusion heart rate (H R),mean arterial pressure (MAP),respiratory rate (RR),peripheral oxygen saturation (SpO2) were recorded before examination(T0),eye lash reflex time(T1),during the perform (T2),the end of check (T3),sedation score,induction time,recovery time,total propofol amount,rates of adverse reaction and satisfaition were recorded.Results The induction time,recovery time was no statistically significant difference between two groups (P ＞ 0.05).The RR,SpO2 was no statistically significant difference between two groups at different time points (P ＞0.05).The HR at T1,T2 in combine group was significantly lower than that at T0 and in propofol group same period[(65.8 ± 7.3),(68.6 ± 8.2) times/min vs.(84.6 ± 7.1) and (77.6 ± 7.2),(89.6 ± 8.4) times/min,P ＜ 0.05].The MAP at T1 in combine group was significantly higher than that at T0 and in propofol group same period [(88.9 ± 9.4) mm Hg (1 mm Hg =0.133 kPa) vs.(81.3 ± 4.5) and (73.5 ± 6.8) mm Hg,P ＜ 0.05],at T2 was significantly lower than that in propofol group [(80.6±6.6) mm Hgvs.(88.5 ±7.6) mm Hg,P＜0.05].Sedation score 1 score 18 cases,2 scores 2 cases in combine group; 1 score 3 cases,2 scores 17 cases in propofol group,the difference was statistically significant (P ＜ 0.05).Combine group apnea two cases,moving,choking three cases,propofol group were eight cases and seven cases,the difference was statistically significant (P ＜ 0.05).The total propofol amount in combine group was significantly lower than that in propofol group [(421 ± 76) mg vs.(638 ± 89) mg,P ＜ 0.05].Conclusion Dexmedetomidine composite target controlled infusion of propofol used for double-balloon enteroscopy can produce good narcotic analgesic which is safe and effective anesthesia.
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Objective To evaluate magnifying Fuji intelligent chromo endoscopy (FICE) in diagnosis of colorectal lesions,and to explore the correlation between pit pattern,expression of Angiopeietin-2 (Ang-2) and mierovessel density (MVD). Methods A total of 100 colorectal lesions with pit patterns ranging from type Ⅰ to type Ⅴ (20 cases in each type) determined by magnifying FICE were divided into group A (n = 40,type Ⅰ and Ⅲ ),group B (n = 40,type Ⅲ and Ⅳ ) and group C ( n = 20,type Ⅴ ). The resuits of FICE were compared with pathological findings. Expression of Ang-2 was examined by immunohistochemical streptavidin-perosidase method and MVD was calculated. The correlation between pit pattern,Ang2 expression and MVD was analyzed. Results The diagnostic sensitivity,specificity and consistent rates of magnifying FICE for non-neoplastic colorectal lesions were 88.0%,92. 5% and 90. 2%,respectively,and those for neoplastic lesions were 94. 8%,91.7% and 93. 2%,respectively,with an overall consistent rate for colorectal lesions at 92. 0%. The positive expression rate of Ang-2 and MVD were progressively increasing from group A,B to C. Conclusion Magnifying endoscopy with FICE is valuable to differentiate neoplastic colorectal lesions from non-neoplastic ones. The positive expression of Ang-2 and MVD are closely correlated with the pit patterns of colorectal lesions.
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AIM: To study the effects of norepinephrine preconditioning(NE-P) and ischemic preconditioning (IP)on apoptosis and Bcl-2, Bax expression in rat myocardial cells in myocardial ischemic reperfusion (I/R). METHODS: The model of rat ischemic-reperfusion was used to conduct NE-preconditioning. Apoptotic myocytes were detected with TUNEL. Bcl-2, Bax expression were detected with immunohistochemistry. RESULTS: The rate of apoptosis cells in I/R group was higher, the rate of apoptosis cells in NE-P group and IP was lower significantly than that in I/R group( P0.05). CONCLUSION: NE-P reduced myocyte apoptosis by I/R in rats; The expression of Bcl-2 ,Bax genes played an important role in myocardial apoptosis.