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Objective:To explore the feasibility of 400 mL Sprite Zero ? in gastric preparation for magnetically controlled capsule endoscopy (MCE) . Methods:A randomized controlled trial at the Department of Gastroenterology of Changhai Hospital, Naval Medical University from December 16th, 2019 to January 15th, 2020 was conducted. The patients and healthy volunteers who intended to receive MCE were randomly divided into the Sprite Zero ? (S) group and the water (W) group at 1∶1. For subjects in the W group, 800 mL water was taken 10 minutes before swallowing the capsule. And for subjects in the S group, 400 mL Sprite Zero ? was taken. The primary endpoint was gastric filling score and the secondary endpoint included the fullness score, gastric transit time (GTT), small bowel transit time (SBTT), completion rate (CR) for small bowel examination and the diagnostic yield. Results:A total of 102 subjects were enrolled, 52 subjects in the S group and 50 subjects in the W group. The median score of gastric filling was 4 at 0-5 min, >5-10 min and >10-15 min after taking the capsule in both groups, with less median liquid consumption in the S group than the W group (500 mL VS 950 mL, P<0.001). The S group showed lower median fullness score (7.0 scores VS 7.5 scores, P=0.030) and higher proportion of patients with GTT less than 30 minutes [69.57% (16/52) VS 27.59% (8/29), P=0.030] compared with the W group. The CR of small bowel examination in the S group was 100.00%, higher than that of the W group (89.66%, P=0.245). Conclusion:Compared with 800 mL water, 400 mL Sprite Zero ? can fully fill the stomach with more comfort. It has the potential to accelerate gastric emptying and improve the CR of small bowel examination, which is feasible for the gastric preparation.
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Objective:To investigate the relationship between pancreatic fibrotic marker transforming growth factor-β(TGF-β) and platelet derived growth factor-BB(PDGF-BB) and serum glycated hemoglobin (HbA1c) levels in patients with type 3c diabetes mellitus secondary to chronic pancreatitis(CP-T3cDM).Methods:The clinical data of 39 patients with CP-T3cDM admitted to the Department of Gastroenterology of the First Affiliated Hospital of Naval Medical University between February 2018 and August 2020 were collected, and the patients' age, gender, body mass index, duration of chronic pancreatitis and diabetes mellitus, smoking history, alcohol consumption history, serum HbA1c level at admission, degree of pancreatic atrophy, morphology of the main pancreatic duct, and treatment of diabetes mellitus were recorded. Serum TGF-β and PDGF-BB were detected by ELISA. Patients were divided into high and low level group according to the median TGF-β and PDGF-BB levels, respectively. Clinical characteristics of patients were compared between the TGF-β and PDGF-BB high and low level group. The correlation between TGF-β, PDGF-BB and HbA1c was analyzed by Spearman's correlation analysis.Results:A total of 39 CP-T3cDM patients were included; 35 were male and 4 were female. The age of first onset of chronic pancreatitis was (42±14) years old, and the duration of diabetes mellitus was 24(4, 36) months. The serum HbA1c level was (7.8±1.6)%, and the serum TGF-β and PDGF-BB levels were 20.5(10.5, 43.1) and 647.5(276.9, 1349.2)pg/ml, respectively. The serum HbA1c levels of patients in the high-level group of serum TGF-β and PDGF-BB were significantly higher than those in the corresponding low-level group [8.6%(7.4%, 9.9%) vs 6.7%(6.2%, 7.8%) and 8.6%(7.4%, 9.6%) vs 6.7%(6.1%, 7.8%), respectively] , and the difference was statistically different (both P value <0.01), while none of other indicators showed statistically significant differences between both groups. The correlation analysis showed that the levels of TGF-β and PDGF-BB were significantly positively correlated with HbA1c level ( r=0.45, 0.53, both P value <0.01). Conclusions:Increased pancreatic fibrosis in patients with CP-T3cDM was an important factor contributing to elevated blood glucose level. Patients with higher serum pancreatic fibrotic factors exhibited a significant increase in HbA1c level.
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Objective:Based on the previous animal experiments, to preliminarily explore the safety and efficacy of self-developed new smartphone-controlled vibrating capsule (VC) in the treatment of patients with functional constipation (FC).Methods:At the Outpatient Department of Gastroenterology, Changhai Hospital, Naval Medical University, 24 patients with FC were prospectively enrolled. The trial process included basic period for ≥two weeks, treatment period for six weeks, and follow-up visits ≥six (once every two weeks). During treatment period, the patients were assigned into sham capsule group, VC at low frequency mode group and VC at high frequency mode group and the patients swallowed 12 corresponding capsules. The safety of VC treatment was evaluated based on the observation the occurrence of adverse events (AE) in patients of three groups, which included abdominal pain, abdominal distention, capsule retention and abnormal laboratory indicators. The efficacy of VC treatment was assessed by comparison of the patients of three groups in mean complete spontaneous bowel movements (CSBM) per week, mean spontaneous bowel movements (SBM) per week, capsule discharge time, patient assessment of constipation quatity of life questionnaire (PAC-QOL), patient assessment of constipation symptom questionnaire (PAC-SYM). Chi-square test, least significant difference- t test, Kruskal-Wallis test, Wilcoxon rank sum test and Fisher exact test were used for statistical analysis. Results:Two patients were lost in follow up. In the end, seven, eight and seven patients were enrolled in sham capsule group, VC at low frequency mode group and VC at high frequency mode group. AE occurred in three patients. At the sixth week of treatment, the difference between average CSBM in one week and baseline of sham capsule group, VC at low frequency mode group and VC at high frequency mode group was 0.0 (0.0, 2.0), 2.0 (1.0, 2.8) and 1.0 (0.0, 5.0), respectively; and the difference between average SBM in one week and baseline of sham capsule group, VC at low frequency mode group and VC at high frequency mode group was -1.0 (2.0, 2.0), 1.0 (-0.8, 2.0) and 1.0 (0.0, 4.0), respectively. During the six weeks of treatment period, the difference between mean CSBM per week and baseline of three, seven and five patients of sham capsule group, VC at low frequency mode group and VC at high frequency mode group was more than one, and the difference between SBM per week and baseline of two, five and five patients was more than one. At the sixth week of treatment, capsule discharge time of VC at low frequency mode group and VC at high frequency mode group was shorter than that of sham capsule group ((65.7±9.3) and (59.1±3.4) h vs. (96.7±10.0) h), and during the whole treatment period capsule discharge time of VC at low frequency mode group and VC at high frequency mode group was shorter than that of sham capsule group ((63.6±8.6) and (59.8±6.6) h vs. (100.5±13.1) h), and the differences were statistically significant ( t=3.119, 3.584, 2.832 and 3.036, all P<0.05). The PAC-SYM score of patients of sham capsule group, VC at low frequency mode group and VC at high frequency mode group during the period of treatment was 14.3±2.0, 9.9±2.3 and 7.0±2.0, respectively, there were no statistically significant differences among the three groups ( P>0.05). The PAC-QOL score of patients of sham capsule group, VC at low frequency mode group and VC at high frequency mode group during the period of treatment was 31.3±4.4, 24.0±3.8 and 13.9±4.1, respectively, and the PAC-QOL score of VC at high frequency mode group was lower than that of sham capsule group, and the difference was statistically significant ( t=2.808, P=0.012), however, there was no statistically significant difference in the PAC-QOL score between VC at low frequency mode group and sham capsule group, and between VC at high frequency mode group and VC at low frequency mode group (both P>0.05). Conclusions:VC can be safely used in patients with FC, which can promote defecation and relieve the symptoms of constipation. However, there is no significant difference in the therapeutic effect of capsules with different vibration frequencies.
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Programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) are involved in the regulation of immune checkpoints and are closely related to the occurrence and development of tumors. In thyroid cancer, an increase in PD-L1 expression and an increase in PD-1 positive T cells may be predictive of higher invasiveness and a greater risk of recurrence. Anti-PD-1/PD-L1 therapy has had significant effects in many tumors, but the efficacy in thyroid cancer is still relatively limited, which also requires finding biomarkers those can better predict the efficacy. Further understanding of the mechanism of PD-1/PD-L1, the current research status in thyroid cancer, and biomarkers related to its efficacy may provide new treatment methods and ideas for patients with thyroid cancer.
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Objective To analyze the optimal timing of endoscopic stone extraction combined with extracorporeal shock wave lithotripsy (ESWL) in the treatment of chronic pancreatitis (CP) with pancreatic stones. Methods Data regarding 170 pancreatic stone patients receiving ESWL and endoscopic stone extraction at Shanghai Changhai Hospital from February 2014 to February 2015 were retrospectively analyzed. Based on the the prior history of endoscopic treatment,patients were divided into group A and B,and then sub-divided into three groups according to the timing of endoscopic intervention after ESWL including <12 h,12~36 h and >36 h subgroup. The success of pancreatic ductal cannulation, clearance of stone in the main pancreatic duct, and ERCP-related complications were evaluated. Results Among all the enrolled 170 patients,107 previously received ERCP(group A) while the others didn't(group B). The overall success rate of cannulation and clearance rate of stones at different times showed no significant difference. The success rate and clearance rate in group A in <12 h,12~36 h and >36 h subgroup were 91.7%,95.2%,78.0%,and 91.7%,95.2%,80.0%,and no significant difference existed. In group B, the success rate and clearance rate in <12 h, 12~36 h and >36 h subgroup were 66.7%, 71.4%, 96.3%, and 60.0%, 76.2%, 92.6%, and the differences were statistically different. The success rate and clearance rate of >36 h subgroup in group B were obviously higher than that in <12 hours (P=0.025) and 12~36 h subgroup (P=0.04). The timing of endoscopic stone extraction did not influence ERCP-related complications. Conclusions Early endoscopic stone extraction after ESWL can be considered in patients with pancreatic stones who previously underwent ERCP. Delayed endoscopic stone extraction after ESWL is recommended in patients without prior ERCP,which can help promote the therapeutic efficacy.
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Objective To investigate the application value of magnetic-controlled capsule endoscopy (MCE) for gastric diseases in physical examination of asymptomatic population.Methods Data of 211 asymptomatic individuals who received MCE examinations from July 2015 to December 2016 in Changhai Hospital were collected and rctrospectively analyzed.The tolerance and safety of MCE were studied by analyzing the detection rate for the focal lesions and the rate of endoscopy transfer.Results Among 211 patients,the detection rate of the gastric focal lesions was 9.5％ (20/211).The detection rate in male was higher than that in female (P＜0.05).All patients completed MCE examination successfully and no adverse event was reported.Conclusion MCE,a non-invasive endoscopic modality,is safe and better tolerated than conventional endoscopy,and can be used as a promising approach to screening the gastric diseases in asymptomatic population due to high detection rate of these diseases.
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Objective To analysis the clinical features of dorsal pancreas agenesis ( DPA) and the associated diabetes, pancreatitis and other congenital organ malformations.Methods Chinese databases of Sinomed, CQVIP and CNKI using the term of short pancreas, pancreas agenesis, bulbar pancreas and dorsal pancreas, and English databases of PubMed using the term of dorsal pancreas agenesis, short pancreas and pancreas hypoplasia were searched.The clinical manifestation, pancreatic head characteristics and associations with diabetes, pancreatitis and other congenital organ malformations were analyzed.Results Six related publications from Chinese databases were searched and 21 patients were included with 2 cases excluded.Sixty-one publications from English database were searched and 71 patients were included.Thus, a total of 91 patients with DPA were analyzed.Abdominal pain was the most common manifestation, which was reported by 61.5% of the patients. 15.3% patients were identified during regular physical examination. Other manifestations including jaundice, fatigue, abdominal discomfort and diabetes were rare.After removing cases with insufficient information, 39 patients (61.9%) carried abnormal pancreatic head.Prevalence of diabetes or impaired glucose tolerance was 56.7% and the percentage of insulin-dependent diabetes in patients with abnormal glycaemia was 47.3%(n=18).20 patients (26.7%) were associated with pancreatitis, including 15 patients (75.0%) with acute pancreatitis, 1 patient (5.0%) with recurrent pancreatitis, and 4 patients (20.0%) with chronic pancreatitis. Thirty-three patients ( 36.2%) suffered other congenital organ malformations, including 21 patients (63.6%) with splenic malformation, 8 patients (24.2%) with heart malformation, and 17 patients (51.5%) with multi-organs malformations like gastrointestinal malformation, azygos vein and inferior cava vena fusion, duodenal and biliary atresia and renal absence.Conclusions The main diagnostic criteria of DPA was the absence of dorsal pancreatic duct.Diabetes was the most common complication followed by pancreatitis.