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Objective To explore the influencing factors of the vaginal birth after cesarean section (VBAC), and establish a model for predicting the risk of trial of the trial of labor after cesarean section (TOLAC). Methods From January 2016 to December 2018, total 694 pregnant women who underwent TOLAC in Northwest Women's and Children's Hospital were retrospectively analyzed. Those cases were divided into two groups according to the mode of delivery: the VBAC group and the failed TOLAC group. At the same time, 700 cases in the elective repeat cesarean section (ERCS) group were randomly selected as control group. The influencing factors of VBAC were analyzed by univariate and multivariate logistic regression, and the pregnancy outcomes between the three groups were compared. Results (1) The VBAC rate was 76.1% (528/694) and 166 women underwent the failed TOLAC (23.9%, 166/694). (2) Univariate analysis found that, the pre-pregnancy body mass index (BMI) [(22.0±3.0),(23.3±2.7) kg/m2], the previous vaginal delivery history [10.4%(55/528),3.6%(6/166)], the cervical score (5.2±1.9,4.3±1.6) and the neonatal birth weight [(3 315 ± 468), (3 484 ± 274) g] of the VBAC group were significantly different from the failed TOLAC group (P<0.05). (3) The comparison of pregnancy outcomes: the neonatal birth weight was (3 315± 468) g, and the intrapartum hemorrhage volume was (255 ± 121) ml in the VBAC group, which were significantly lower than those in the failed TOLAC group [intrapartum hemorrhage (325 ± 173) ml] and the ERCS group [(3 572±344) g, (281±125) ml], there were statistically significant differences in the comparison among the three groups (all P<0.05). Two cases of bladder injury occurred during cesarean section in the TOLAC failure group (1.2%,2/166). The rates of the blood transfusion, puerperal infection, 5-minute Apgar score and neonatal ICU admission among the three groups were no statistically significantly different (all P>0.05). There was no maternal or perinatal death. (4) Multivariate logistic regression analysis showed that the delivery age of pregnant women ( OR=0.92, 95% CI : 0.87-0.98), pre-pregnancy BMI ( OR=0.92, 95% CI :0.86-0.98), vaginal delivery history ( OR=3.31, 95% CI : 1.35-8.01), cervical score ( OR=1.29, 95% CI :1.13-1.42) and the birth weight of the neonates <3 300 g ( OR=3.15, 95% CI : 2.02-4.90) were independent influencing factors for VBAC. The area under curve of the receiver operating characteristic curve was 0.74. Conclusions The influencing factors of VBAC are delivery age, pre-pregnancy BMI, vaginal delivery history, cervical score and neonatal birth weight <3 300 g. The adequate individualized management and assessment of the TOLAC may be helpful to improve the VBAC rate.
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Objective To investigate the effect of continuous renal replacement therapy (CRRT) combined with Rhubarb at early stage on inflammatory cytokine in the treatment of severe acute pancreatitis.Methods Fifty two patients with SAP were randomly divided into three groups,the conventional treatment group,the CRRT group,and the combined group.CRRT was inplemented in 48 h after the diagnosis of SAP.APACHE-Ⅱ score,mortality were compared before and after treatment.Double sandwich ELISA method was used to detect the levels of interleukin 22 (IL 22),IL-18 and tumor necrosis factor α(TNF-α).Results The clinical effect in combined group was better than other groups,and the mortality was lower than other groups,but the difference was not statisticaly different(P＞0.05).The levels of IL-22,TNF-α and IL-18 were not significantly different among three groups before treatment (P＞0.05).After treatment,the inflammatory factors decreased in all groups.The levels of IL-18,TNF-and IL-22 in CRRT group and combined group were significantly lower than those in control group (P＜0.05),and the combined group decresed most abviously(P＜0.05).There was no significant difference in APACHE Ⅱ score among the three groups before treatment (P＞0.05),while the APACHE-Ⅱ scores were significantly decreased after treatment,the difference was statistically significant (P＜0.05).After treatment,the APACHE-Ⅱ score of the combined group were significantly lower than the other two groups(P＜0.05).Conclusion The therapy of CRRT combined with Rhubarb at early period in SAP patients can better clean up inflammatory cytokines of IL-22,TNF-,IL-18,so that patients with SAP can get more clinical benefits.
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Background and purpose: Currently endoscopic ultrasonography is clinically accepted for preoperative staging of gastric cancers. Endoscopic raucosai resection (EMR) and endoscopic subraucosal dissection (ESD) have been widely applied in the treatment of early gastric cancer. We need to improve the accuracy of pre-operative staging of gastric cancers, especially of early gastric cancers. This paper was to investigate the clinical significance of high frequency endoscopic ultrasound mini probe (UMP) in the preoperative T-staging of gastric cancer. Methods: Both UMP and MSCT were performed in 63 patients with pathologically proven gastric cancer frora Oct. 2008 to Apr.2009, and the results of UMP and MSCT were compared with surgical pathologic findings. Results: The accuracy of UMP and MSCT in T staging was 82.26% (51/62) and 88.71% (55/62) respectively, and there was no statistical difference (P>0.05). The accuracy of UMP and MSCT for early gastric cancer was 100.00% and 88.89% respectively.The accuracy of UMP and MSCT for advanced gastric cancer was 79.25% and 88.68% respectively. Conclusion: UMP appears to have a substantial diagnostic value for early stage gastric cancer. It is the approach of choice for superficial lesions.
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Objective The aim of this study was to describe the FICE application on gastric mucosa characteristics including normal and pathological changes, with or without H.pylori infection, and its corre-lation with histopathoingical evidence. Methods A total of 32 patients with dyspepsia symptoms and 5 healthy controls were enrolled into study. Each one underwent esophngogastreduedenoscopy (EGD) examina-tion with FICE and magnified observation. The whole stomach was examined by 3 steps: including conven-tional endoscopy followed by magnifying and FICE observation of the gastric antrum and body as well as biop-sies. All the patients were asked to take the rapid urease test (RUT) 、13C -urea breath test (13C-UBT) . Gastric antrum and body were both sub-classified into following 3 patterns by FICE observation and high reso-lution magnifying endoscopy. The sensitivity, specificity of each FICE pattern of both gastric antrum and body were analysed for the assessment of H. pylori infection, and the consistency with the results of RUT and 13C-UBT. Furthermore, the histopathologic parameters including inflammation、activity、atrophy and intestinal metaplasia were also assessed, Results FICE patterns of gastric antrum and body of all 5 control subjects were type Ⅰ, corresponded to an H. pylori negative and non-atrephy gastric mueosa. In study group on gastric antrum, 14 cases of FICE type Ⅰ pattern were noted and only 1/14(7. 1%) corresponded to an H. pylori positive gastric mucosa. 13 cases of FICE type Ⅱ pattern were noted and 10/13 (76. 9%) corresponded to an H.pylori positive mucosa and 9/13(69. 2%) were positive for both gastric atrophy. 5 cases of FICE type Ⅲ pattern were noted and 5/5 (100%) corresponded to an H. pylori positive mucosa and 3/5 (60%) were positive for both gastric atrophy and intestinal metaplasia. There was statistical difference in prediction of H. pylori infection between type Ⅰ FICE pattern and type Ⅱ or type Ⅲ pattern on gastric antrum (P <0. 01). In study group on gastric body, 15 cases of FICE type Ⅰ pattern were noted and only 1/14(7. 1%) corre-sponded to an H. pylori positive gastric mucosa. 13 cases of FICE type Ⅱ pattern were noted and 11/13 (84. 6%) corresponded to an H. pylori positive mucosa. 4 cases of FICE type Ⅲ pattern were noted and 4/4 (100%) corresponded to an H.pylori positive mucosa. There was statistical difference in prediction of H. pylori infection between type Ⅰ FICE pattern and type Ⅱ or type Ⅲ pattern on gastric body (P < 0. 01). Conclusion FICE in combination with high resolution magnifying endoscopy is valuable for identifying the normal gastric mucosa, H.pylori infection and its associated gastritis, gastric atrophy as well as intestinal metaplasia.
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Objective To evaluate the accuracy and clinical application of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in diagnosis of occupying lesions in upper digestive tract and its pe-ripheral areas. Methods The data of 64 patients who underwent EUS-FNA for occupying lesions in upper di-gestive tract, between July 2006 and December 2007, were retrospectively analyzed. Results EUS-FNA was successfully performed on 62 patients, with a success rate of 96.88%. The overall diagnostic accuracy, sensi-tivity, specificity, positive predictive value and negative predictive value of EUS-FNA for occupying lesions in upper digestive tract and its peripheral areas were 88.71%, 86.54%, 100.00%, 100.00%, and 58.82%, respectively. There was no significant difference between the foei larger and smaller than 3cm (P > 0.05), re-garding the diagnostic accuracy and average puncture numbers. Diagnostic accuracy of those with real-time cy-tolngical evaluation was significantly higher than those without (P=0.029), and the puncture numbers were less (P=0.001). Among the total 99 punctures, the positive diagnostic accuracy of those with 5ml negative pressure suction was significantly higher than those of 10 ml (P = 0.044). Conclusion EUS-FNA is a safe and applicable approach to diagnosis of occupying lesions in upper digestive tract and its peripheral areas with higher diagnostic accuracy, sensitivity, specificity and positive predictive value. Moreover, the real-time cyto-logical evaluation and adequate negative pressure might facilitate the diagnosis accuracy.
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Objective To observe the safety and efficacy of oncolytic adenovirus (H101) implantation under EUS guidance combined with gemcitabine in patients of non-operative pancreatic cancer.Methods From May 2007 to December 2007,6 patients with non-operative pancreatic cancer were enrolled in the study.H101 were implanted into 3 sites of the tumor under EUS guidance.Gemcitabine Was siren systemicly on d2,d9 and d16 after implantation, and repeated 1 month later.Tumor size and perfusion were assessed by computed reconstruction and perfusion imaging.Changes of clinical indices,adverse effects and complications were also recorded.Results All patients completed the two periods of treatment as planned.Tumor size decreased in 5 cases(18.21%-38.65%),but without statistical difference (P=0.078).The area of liver metastasis Was found decreased in 1 ease.Perfusion imaging showed significant increase of mean transit time(P=0.049) and improvement in blood flow,blood volume and permeability surface at 2 weeks after the treatment. KPS increased in 2 patients and pain score decreased in 3 patients.Three patients died 2.5,2.5 and 3 months respectively after the procedure.while 3 other patients are still alive with the survival time of 3,5 and 10 months. Major adverse effects associated with H101 implantation were fever and flu-like symptoms.Mild acute pancreatitis occurred in 1 cage.Conclusion EUS guided oncolytic adenovirus implantation in advanced pancreatic cancer is feasible and safe.With the combination of gemcitabine,it is capable of shrinking the tumor size,destroying the angiogenesis of the tumor and improving the patients'living quality.
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Objective To explore the value of EUS in the diagnosis,differential diagnosis and follow-up of primary gastric lymphoma(PGL).Methods A total of 26 patients whose endoscopic findings were highly suspected for PGL were enrolled in this study.Initial endoscopic examination anti routine biopsy were performed in all patients.EUS were undergone in all cases and its guided large piecemeal biopsy was administered in selected patients.The results of EUS,routine biopsy and routine biopsy combined with a large piecemeal biopsy were compared.Results Compared with biopsy and histopathological results,EUS made the fight diagnosis in 23 cases with overall accuracy of 88.46%,which was significantly superior to routine endoscopy and biopsy(50.0%,P=0.006),but was slightly lower than that of routine biopsy combined with large piecemeal biopsy(88.5%vs.92.3%,P=1.000).EUS can accurately differentiate gastric malignancy from benign disease with accuracy of 100.0%(23/23).Meanwhile EUS accuracy of tumor invasion(T stage)was 100.0%(12/12)as well.Conclusion EUS is valuable in the diagnosis,differential diagnosis and follow-up of PGL.
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Objective To evaluate contrast-enhanced endoscopic uhrasonography(CE-EUS)in the differential diagnosis of pancreatic diseases.Methods Eighteen patients with suspected pancreatic neoplasms and chronic pancreatitis,which would be finally affirmed with EUS-FNA or histophathologic examinations,as well as five normal control subjects were enrolled and underwent CE-EUS by using ultrasonic contrast agent(sonovue,Bracco Co.,Italy).Characteristics of enhancement including form,echo and enhanced blood perfusion of the target areas were investigated in normal pancreas and various diseased ones.Results By CE-EUS,five cases of normal pancreatic parenchyma were presented as punctiform or claviform enhancement pattern with homogeneous distribution(type Ⅰ-Ⅱ);while two chronic pancreatitis cases were presented as claviform or plaquelike enhancement pattern with inhomogeneous distributition(type Ⅱ-Ⅲ).In addition,thirteen pancreatic carcinomas were presented as inhomogeneous punctiform or claviform enhancement(typeⅠ-Ⅱ)partially with border enhancement and with slow enter-in and fast wash-out phase.However,three benign insulinomas were presented as holo-plaquelike enhancement(type Ⅲ),and 2 with fast enter-in and fast washout phase.Besides,different enhancement intensity was identified in different diseases.Conclusion CEEUS,from which different enhancement pattern,phase and intensity would be shown in various pancreas,is a safe and feasible imaging modality in the differential diagnosis of pancreatic diseases.
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Objective To investigate the functional esophageal dismotility in patients with gastroesophageal reflux disease(GERD) by simultaneous high frequency intraluminal ultrasonography(HFIUS) and esophageal manometry,and evaluate the correlation between the peak pressure and the peak muscle thickness of the esophagus.Besides,to identify the potential efficacy and feasibility of the HFIUS for evaluating the functional gastrointestinal diseases(FGIDs).Methods Ten GERD patients and 5 healthy controls were enrolled into this study.High-frequency ultrasonic probe and esophageal manometry catheter were simultaneous administrated.The cross sectional image of esophageal motion was recorded by HFIUS and was analyzed by the contractility index (CI)of the longitudinal smooth muscle(LSM)and circular smooth muscle(CSM),the duration of the contraction (DC)and the maximum cross section area(CSA)during distension;In addition,esophageal peak pressure during wet-swaltow was measured by manometry.Results Tile contractility index of the LSM and CSM of esophagus at 5 cm,10 cm,1 5 cm and 20 em proximal to the LES was significantly lower in patients with GERD than that of controls(P＜0.05).The duration of the contraction was longer in patients with GERD.But there was no siginificant difference of the maximum CSA during distension between GERD patients and normal controls(P＞0.05).However,the simultaneous manometry only demonstrated nonspecific esophageal motility disorder on 6 of 10 GERD patients.And there was positive correlation between the peak pressure and the peak muscle thickness at all sites along the axis of the esophagus,revealed the pressure was increasing along with the thickening of the esophageal muscle layers(r=0.552-0.736).Conclusions Functional esophageal dismotility played an important role in the pathogenesis of GERD.Meanwhile,there was positive correlation between the esophageal pressure and the muscle layer thickness of the esophagus.HFIUS can detect the minor changes of the layer structure of the esophagus and is a potentially useful imaging modality for evaluating esophageal dismotility as well as FGIDs.
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Background and purpose:The radio-labeled glucose analogue F-18-fluoro-2-deoxyglucose(FDG) is the most widely used tracer in PET imaging,and its application in oncology has become one of the standard imaging modalities.But FDG uptake is not tumor specifi c.The aim of this paper was to study the endoscopic result with the patients of 18F-FDG accumulations in gastrointestinal tract after PET-CT examinations.Methods:Thirtythree patients with 18F-FDG accumulations in gastrointestinal tract were correlated with endoscopic and histopathologic results.Results:Of these,14 patients were harboring newly occurring cancers in gastrointestinal tract(esophagus cancer,2 patients;gastric cancer,5 patients;colorectal cancer,7 patients) .Eight patients were identified with precancerous lesions(adenoma,4 patients;hyperplastic polyp,1 patient;Barrett’s esophagus,1 patient;intestinal metaplasia of the gastric mucosa,2 patients) .Inflammatory lesions were detected in six patients(active colitis,5 patients;anastomotic leakage,1 patient) .In fi ve patients,PET/CT showed normal fi ndings in endoscopic examinations.The false positive rate of PET-CT was 33.33%(11/33) .Conclusion:Endoscopic result is important for patients of 18F-FDG accumulations in gastrointestinal patient.