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@#Esophageal cancer is an aggressive malignancy with high morbidity and poor prognosis. Symptoms of early esophageal cancer are insidious and difficult to detect, while advanced esophageal obstruction, lesion infiltration and metastasis seriously affect patients’ quality of life. Early detection and treatment can help to increase the survival chance of patients. Recently, artificial intelligence (AI) has shown remarkable success in diagnosis of esophageal cancer, highlighting the great potential of new AI-assisted diagnostic modalities. This paper aims to review recent progress of AI in the diagnosis of esophageal cancer and to prospect its clinical application.
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Objective:To investigate phobia of acute myocardial infarction(AMI)patients after percutaneous coronary intervention(PCI), analyze its latent profile and explore the influencing factors in different categories.Methods:Three hundreds and thirty-five AMI patients who received PCI in Emergency Department ofthe First Affiliated Hospital of Naval Medical University from January 2021 to June 2022 were selected by convenient sampling method and prospective research as the survey objects. The basic situation questionnaire, cardiophobia scale (TSK-SV Heart), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Connor Davidson Psychoelasticity Scale (CD-RISC) and Posttraumatic Stress Disorder Checklist (PCL) were selected to investigate them, and the linear growth model was selected to analyze the latent profile of postoperative phobia in AMI patients.Results:The score of post-operative phobia in AMI patients was (44.47 ± 7.25) points, and the latent profile analysis showed that AMI patients were classified into psychological type (156 cases, 46.57%), physiological type (164 cases, 48.96%) and severe type (15 cases, 4.47%). The severe phobia type was selected as the reference group, and multiple logistic regression analysis showed that compared with the severe phobia type, age, resilience, posttraumatic stress disorder (PTSD) and no or mild anxiety were significant influencing factors for phobia after PCI in patients with psychophobia type AMI ( P<0.05), while age and resilience were significant influencing factors for phobia after PCI in patients with physiological phobia type AMI ( P<0.05). Conclusions:Through latent profile analysis, there are three types of phobia in AMI patients after PCI: psychophobia, physiological phobia and severe phobia. Postoperative phobia is affected by psychological resilience, PTSD, age, chronic disease and depression. Therefore, targeted intervention should be carried out for AMI patients based on different characteristics of phobia after PCI to enhance their enthusiasm for rehabilitation.
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ObjectiveTo compare the nocturnal erectile function between SRPE patients and normal people. MethodsFrom July 1st， 2019 to December 15th， 2022， a clinical comparative study was conducted on 29 SRPE patients （experimental group） and 58 volunteers （control group） who visited our urology department. The Rigiscan System was used to monitor sleep monitoring time， the number of nocturnal erections and the rigidity， duration and circumference growth of the penis when the erection reached 60%～79% and 80%～100%， respectively. The patients and volunteers were asked to make written records when they woke up， and then the total number of awakenings and the number of awakenings when the penis erection reached 60% and 80% were compared between the two groups. ResultsAge was eliminated by matching. There was no statistically significant difference in sleep monitoring time， rigidity， circumference growth and duration of the penis when the erection reached 60%～79% and 80%～100%. between the two groups. In terms of sleep， there was a statistically significant difference in the total number of awakenings between the two groups［3（2 ~ 4）vs 0（0 ~ 0），P<0.01］ .And the same was true for the number of awakenings when the penis erection exceeded 60%～79% ［1（0 ~ 1）vs 0（0 ~ 0），P<0.01］and 80%～100% ［2（1 ~ 3）vs 0（0 ~ 0），P<0.01］. ConclusionRigiscan monitoring showed that there was no difference between SRPE patients and normal male in nocturnal penile erection function. Painful awakening usually occurs when the penis erection reaches 60%～79% or 80%～100%， which reveals that SRPE may be caused by abnormal sensation of nocturnal erections or pain sensitivity in some of these patients.
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Objective:To explore the efficacy of the combination of radiofrequency ablation(RFA) and endoscopic metal stent in the treatment of patients with unresectable cholangiocarcinoma.Methods:From January 3, 2012 to June 30, 2019, at the Department of Endoscopic of the Third Affiliated Hospital of Naval Medical University, the clinical data of 44 patients with unresectable cholangiocarcinoma who were treated by the combination of RFA and endoscopic metal stent were retrospectively collected, which included age, gender, location of cholangiocarcinoma(hilar cholangiocarcinoma and distal cholangiocarcinoma), etc. Postoperative evaluation was conducted based on the follow-up, including clinical success rate, postoperative complication rate, time of stent patency and overall survival time (OS). The Kaplan-Meier method and log-rank test were used to analyze the difference of OS between patients with hilar cholangiocarcinoma and distal cholangiocarcinoma. Mann-Whitney U test was used for statistical analysis. Results:The age of the 44 patients with cholangiocarcinoma was (70.3±11.6) years old, with 20 males (45.5%). There were 22 patients (50.0%) with hilar cholangiocarcinoma and 22 patients (50.0%) with distal cholangiocarcinoma. The clinical success rate of 44 patients was 93.2%(41/44). A total of 5 patients(11.4%) had postoperative complications, which were all improved by appropriate treatment. The median time of follow-up of the 44 patient was 9.2 months(ranged from 3.1 to 57.6 months), the median time of stent patency was 7.0 months (ranged from 5.8 to 8.2 months). Thirty-two patients (72.7%) died during the follow-up, and the median OS was 10.9 months(ranged from 9.0 to 12.8 months). The median OS of patients with hilar cholangiocarcinoma was 7.8 months(ranged from 4.6 to 11.0 months) and that of patients with distal cholangiocarcinoma was 12.5 months(ranged from 5.7 to 19.4 months), and there was no statistically significant difference( P>0.05). Conclusion:RFA combined with endoscopic metal stent is safe and effective in the treatment of patients with unresectable cholangiocarcinoma.
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Objective:To investigate the influence of liver drainage volume on overall survival time in patients with unresectable malignant hilar bile duct obstruction.Methods:Data of 633 patients with unresectable malignant hilar bile duct obstruction (BismuthⅡ-Ⅳ) who underwent endoscopic stent drainage in 3 endoscopy centers from January 2002 to May 2019 were retrospectively analyzed. Main observation indicators included clinical success rate, stent patency, overall survival, the effective liver drainage volume, and complication incidence.Results:The clinical success rates of patients with liver drainage volume <30%, 30%-50%, and >50% were 56.8% (25/44), 77.3% (201/260) and 84.2% (277/329) respectively. The incidences of early cholangitis were 31.8% (14/44), 18.8% (49/260) and 16.1% (53/329). The median stent patency time was 4.5 (95% CI: 1.8-7.2) months, 5.6 (95% CI: 5.0-6.2) months and 6.6 (95% CI: 5.2-8.0) months. The overall survival time was 2.4 (95% CI: 1.8-3.0) months, 4.0 (95% CI: 3.4-4.6) months and 4.9 (95% CI:4.4-5.4) months, respectively. The clinical success rate ( χ 2=8.28, P=0.012), median stent patency period ( χ 2=18.87, P=0.015) and overall survival time ( χ 2=6.93, P=0.024) of 30%-50% liver drainage volume group were significantly higher than those of <30% group. Further multivariate cox regression analysis showed that the disease type (hepatocellular carcinoma VS hilar cholangiocarcinoma: HR=1.50, 95% CI:1.18-1.91, P=0.001; gallbladder carcinoma VS hilar cholangiocarcinoma: HR=1.45, 95% CI:1.14-1.85, P=0.002; metastatic cholangiocarcinoma VS hilar cholangiocarcinoma: HR=1.48, 95% CI:1.08-2.04, P=0.015), bilirubin level >200 μmol/L ( HR=1.35, 95% CI:1.14-1.60, P<0.001),metal stents ( HR=0.67, 95% CI:0.56-0.79, P<0.001), liver drainage volume (volume 30%-50% VS <30%: HR=0.64, 95% CI: 0.45-0.90, P=0.010; volume>50% VS <30%: HR=0.58, 95% CI:0.41-0.81, P=0.002) and anti-tumor therapy ( HR=0.51, 95% CI:0.42-0.61, P<0.001) were independent predictors for overall survival time of patients with unresectable malignant hilar bile duct obstruction. Conclusion:When endoscopic stent drainage is performed for patients with unresectable malignant hilar bile duct obstruction, at least 30% liver volume is required for better overall survival. In addition, the use of metal stent drainage and anti-tumor therapy may increase survival benefits.
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Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.
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Objective:To investigate the application value of different metal stents place-ment position in endoscopic drainage of malignant hilar bile duct obstruction.Methods:The retro-spective cohort study was conducted. The clinicopathological data of 300 patients with malignant hilar bile duct obstruction who were admitted to 3 medical centers, including 216 patients in the Third Affiliated Hospital of Naval Medical University, 48 patients in the Xijing Hospital of Air Force Medical University, 36 patients in the First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, from January 2012 to January 2019 were collected. There were 164 males and 136 females, aged (67±12)years. All patients were determined to be unresectable by multidisciplinary consultation and underwent endoscopic retrograde cholangiopancreatography. Observation indicators: (1) clinicopathological features of patients; (2) follow-up; (3) analysis of influencing factors for patency time of metal biliary stents and overall survival time of patients. Follow-up was conducted using outpatient examination and telephone interview to detect patency of metal biliary stents and survival of patients up to July 2019 or death of patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used to conduct survival analysis. COX regression model was used for univariate and multivariate analyses. Factors with P<0.1 in univariate analysis were included in multivariate analysis. Results:(1) Clinicopathological features of patients. Of the 300 patients, 163 cases underwent endoscopic drainage with at least one metal biliary stent' distal portion crossing the duodenal main papilla (hereinafter referred to as crossing papilla), and 137 cases underwent endoscopic drainage with no metal biliary stent' distal portion crossing the duodenal main papilla (hereinafter referred to as no crossing papilla). Age, disease type (hilar cholangiocarcinoma, hepatocellular carcinoma, intrahepatic cholangio-carcinoma, gallbladder carcinoma, metastatic cholangiocarcinoma), metal biliary stents type (unilateral metal biliary stent, bilateral metal biliary stents) of patients with crossing papilla were (68±13)years, 95, 8, 11, 31, 18, 63, 100, respectively. The above indicators of patients with no crossing papilla were (64±12)years, 63, 22, 20, 23, 9, 126, 11, respectively. There were significant differences in the above indicators between patients with crossing papilla and patients with no crossing papilla ( t=2.70, χ2=17.69, 90.79, P<0.05). (2) Follow-up. All the 300 patients were followed up for 5.4(3.1,9.3)months. The patency time of metal biliary stents was 9.0(8.2,9.8)months and 6.4(4.8,8.0)months of patients with crossing papilla and patients with no crossing papilla, showing a significant difference between them ( χ2=8.23, P<0.05). The overall survival time was 5.5(4.2,6.8)months and 5.5(4.3,6.8)months of patients with crossing papilla and patients with no crossing papilla, showing no significant difference between them ( χ2=0.28, P>0.05). (3) Analysis of influencing factors for patency time of metal biliary stents and overall survival time of patients. Results of univariate analysis showed that type of metal biliary stents and the placement position of metal biliary stents were related factors affecting the patency time of metal biliary stents [ hazard ratio( HR)=0.44, 0.60, 95% confidence intervals as 0.30?0.64, 0.42?0.85, P<0.05]. Results of multi-variate analysis showed that bilateral metal biliary stents was an independent protective factor for the patency time of metal biliary stents ( HR=0.46, 95% confidence interval as 0.29?0.72, P<0.05). Results of univariate analysis showed that disease type (intrahepatic cholangiocarcinoma versus hilar cholangiocarcinoma), preoperative serum total bilirubin, type of metal biliary stents, anti-tumor therapy were related factors affecting the overall survival time of patients ( HR=1.05, 1.43, 0.72, 0.61, 95% confidence intervals as 0.70?1.57, 1.12?1.83, 0.55?0.92, 0.47?0.81, P<0.05). Results of multi-variate analysis showed that age >60 years, disease type as hepatocellular carcinoma, preoperative serum total bilirubin >200 μmol/L were independent risk factors for the overall survival time of patients ( HR=1.35, 1.98, 1.46, 95% confidence intervals as 1.02?1.79, 1.40?2.80, 1.13?1.89, P<0.05), and bilateral metal biliary stents, anti-tumor therapy were independent protective factors for the overall survival time of patients ( HR=0.68, 0.60, 95% confidence intervals as 0.53?0.89, 0.45?0.80, P<0.05). Conclusions:Endoscopic drainage with or without metal biliary stents' distal portion crossing the duodenal main papilla is safe and feasible for patients with malignant hilar bile duct obstruction. Bilateral metal biliary stents is an independent protective factor for the patency time of metal biliary stents. Age >60 years, disease type as hepatocellular carcinoma, preoperative serum total bilirubin >200 μmol/L are independent risk factors for the overall survival time of patients, and bilateral metal biliary stents, anti-tumor therapy are independent protective factors for the overall survival time of patients.
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Objective:To evaluate the feasibility, efficacy, and safety of ultra-fine metal stents for malignant hilar biliary strictures (MHBS).Methods:Ultra-fine metal stents were simultaneously placed into the intrahepatic duct of 30 patients with unresectable malignant hilar biliary strictures of Bismuth type Ⅱ or higher (based on imaging or histological and/or cytological findings) by using the stent-by-stent mode from January 2014 to June 2021 at the Department of Gastroenterology, Eastern Hepatobiliary Surgical Hospital. The technical success rate, clinical efficacy and incidence of complications were observed.Results:The technical success rate was 100.0% (30/30), and the clinical success was achieved in 28 patients (93.3%) . The mean procedure time was 55.7±20.7 min and the placement time was 28.3±18.2 min. Early adverse events included mild acute pancreatitis ( n=2) and cholangitis ( n=5). The median stent patency and the median overall survival were 243 days (95% CI: 186.6-299.4 days) and 237 days (95% CI: 149.0- 325.0 days), respectively. The incidence of late cholangitis was 36.7% (11/30). Stent malfunction occurred in 14 of the 30 patients, and 5 of them received endoscopic reintervention. The technical success rate for the reintervention was 4/5 with the mean procedure time of 49.8±6.9 min. Conclusion:Malignant hilar biliary obstruction endoscopic palliation with ultra-fine metal stents using the stent-by-stent mode is safe, feasible and effective.
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To investigate the effectiveness and safety of diverticular peroral endoscopic myotomy (D-POEM) for mid-esophageal diverticulum. Data of consecutive patients in the prospective database with mid-esophageal diverticulum who received D-POEM in West China Hospital, Sichuan University between April 2014 to September 2019 were collected. The modified Eckardt scoring system for mid-esophageal diverticulum was used to evaluate the severity of diverticular symptoms. The effectiveness and safety of D-POEM were evaluated in terms of clinical success, technical success, complications and recurrence. A total of 7 patients with mid-esophageal diverticulum were included. Clinical and technical success was achieved in all patients with operation time of 16-70 minutes. No serious complications (2 cases with minor complications) or recurrence occurred. The follow-up time was 2-16 months. The median modified Eckardt score decreased from 3 points before operation to 0 points after operation. It is preliminarily believed that D-POEM ensures a complete septotomy between normal esophageal lumen and esophageal diverticulum. It is a safe and effective technique for mid-esophageal diverticulum. The modified Eckardt scoring system is suitable for symptom evaluation before and after treatment of mid-esophageal diverticulum.
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Objective:To explore the application value of transpancreatic precut sphincterotomy combined with pancreatic duct stent placement for difficult intubation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:A total of 169 patients with difficult papilla intubation who underwent ERCP treatment in the Third Affiliated Hospital of Naval Medical University from January 2017 to December 2019 were included. Double guide wire intubation was used in 137 cases and transpancreatic precut sphincterotomy combined with pancreatic duct stent placement was used in 32 cases. The success rate of intubation, intubation time and postoperative complications of the two groups were compared.Results:The success rates of intubation in the double guide wire group and the transpancreatic precut sphincterotomy combined with pancreatic duct stent placement group were 98.54% (135/137) and 100.00% (32/32) ( P>0.05); the mean intubation time of the two groups were 15.69±9.07 min and 17.06±5.79 min ( P>0.05); the incidence of postoperative complications were 25.55% (35/137) and 9.38% (3/32) ( P<0.05), among which incidences of pancreatitis were 5.8% (8/137) and 0 respectively. Conclusion:During difficult ERCP papilla intubation, the transpancreatic precut sphincterotomy combined with pancreatic duct stent placement can yield higher safety and a similar success rate compared with the double-guide wire technique, which is worthy of clinical application.
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Objective:To evaluate endoscopic ultrasonography (EUS) in the diagnosis and preoperative assessment of hilar cholangiocarcinoma.Methods:Data of consecutive patients with hilar biliary strictures who underwent EUS and were confirmed by postoperative pathology from April 2016 to December 2019 were collected in the retrospective study. The clinical information, EUS image characteristics and lymph nodes of patients were recorded and analyzed.Results:A total of 58 patients were finally included in our study. Hilar cholangiocarcinoma of EUS image was characterized by heterogeneous hypoechoic, non-rich blood supply masses and (or) asymmetric thickening of bile duct wall. Among the 58 cases, 45 cases (77.6%) were manifested as masses and 32 cases (55.2%) were presented as thickening of bile duct wall. Nineteen cases (32.8%) had both manifestations above. There were 10 cases of vascular invasion detected by EUS scanning, including 3 cases of portal vein invasion, 4 cases of hepatic artery invasion, 3 cases of invasion of both loci. Postoperative pathology confirmed 14 cases of vascular invasion, with the diagnostic coincidence rate of 71.4% (10/14). A total of 101 lymph nodes were found in 53 patients by EUS scanning. The malignant lymph nodes presented hypoechoic, round or oval shape, and homogeneous echo. Compared with benign lymph nodes, malignant lymph nodes had higher morphological score (11.41±0.6 VS 9.01 ± 0.15, P<0.001), but there was no significant difference in size (13.29±0.90 mm VS 11.87±0.56 mm, P=0.28). According to the malignancy criteria of EUS lymph nodes (morphological score≥12), the accuracy, the sensitivity, the specificity, the positive predictive value and the negative predictive value of EUS for malignant lymph nodes were 92.1%(93/101), 76.5% (13/17), 95.2% (80/84), 76.5% (13/17) and 95.2% (80/84) , respectively. Conclusion:EUS can show the whole extrahepatic bile duct and part of intrahepatic bile duct, which is helpful to determine the location of tumor in the diagnosis of hilar cholangiocarcinoma. Moreover, EUS is helpful to diagnose hilar cholangiocarcinoma, which is of guiding significance in operative decisions.
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Objective:To compare the efficacy of three approaches of parallel-style bilateral metal stenting in the management of unresectable malignant hilar biliary obstruction.Methods:Data of 118 patients with unresectable malignant hilar biliary obstruction (Bismuth type Ⅱ-Ⅳ) treated by endoscopic bilateral metal stenting in Oriental Hepatobiliary Surgery Hospital from January 2012 to February 2019 were retrospectively studied. According to the method of stent placement, patients were divided into three groups, both stents crossing the main duodenal papilla (long long-stent by stent, LL-SBS) group (53 cases), one stent crossing the papilla (long short-SBS, LS-SBS) group (53 cases) and no stent crossing the papilla (short short-SBS, SS-SBS) group (12 cases). The main outcomes, clinical success rate, stent patency, success rate of re-intervention of both intrahepatic systems and overall survival, were compared among the three groups.Results:There were no significant differences in clinical success rate [96.2% (51/53), 98.1% (52/53), and 91.7% (11/12)], median stent patency [9.2 (8.0-10.3) months, 11.6 (6.8-16.4) months, and 8.1 (3.7-12.5) months] or overall survival time [6.7 (4.6-8.8) months, 7.6 (5.7-9.4) months, and 7.1 (0.7-13.6) months] among the three groups (all P>0.05). The success rate of endoscopic re-intervention of both intrahepatic systems was 12/13, 0/10, and 1/5 in LL-SBS, LS-SBS and SS-SBS groups, respectively ( P<0.001). Conclusion:Parallel-style bilateral metal stenting is an effective endoscopic modality in the treatment of malignant hilar biliary obstruction, and LL-SBS may improve the success rate of endoscopic re-intervention to both intrahepatic systems.
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Objective:To investigate the feasibility and efficacy of endoscopic placement of transpapillary parallel-style bilateral metal stents for malignant hilar biliary stricture.Methods:A total of 55 patients with malignant hilar biliary stricture (Bismuth Ⅱ-Ⅳ) were treated with an improved endoscopic drainage technique (endoscopic transpapillary parallel-style bilateral metal stenting) from January 2012 to December 2018 in Shanghai Oriental Hepatobiliary Surgery Hospital. The technical success rate, clinical success rate, incidence of complications, success rate of endoscopic re-intervention, stent patency and overall survival were analyzed.Results:The technical success rate of endoscopic placement of bilateral metal stents was 96.4% (53/55), the clinical success rate was 96.2% (51/53), and the early complication incidence was 13.2% (7/53). The median stent patency was 9.2 months (95% CI: 8.0-10.3 months), the success rate of endoscopic re-intervention of bilateral biliary systems was 92.3% (12/13), and the median overall survival was 6.7 months (95% CI: 4.7-8.8 months). Conclusion:This modified technique of bilateral metal stent placement is safe and effective for malignant hilar biliary stricture that is unsuitable for surgery.
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Objective:To compare the efficacy of bilateral and unilateral metallic stenting in the treatment of unresectable malignant hilar biliary obstruction.Methods:From January 2012 to December 2018, a total of 300 patients with malignant hilar biliary obstruction (Bismuth type Ⅱ-Ⅳ) were treated with endoscopic metallic stenting in Oriental Hepatobiliary Surgery Hospital. Ninety-four patients with bilateral metallic stenting (bilateral metallic stent group) and 94 patients with unilateral metallic stenting (unilateral metallic stent group) were matched and analyzed by propensity score matching. The clinical success rate, the total number of interventions, the stent patency and overall survival time were compared between the two groups.Results:The clinical success rate in the bilateral metallic stent group was significantly higher than that of the unilateral metallic stent group [98.9% (93/94) VS 78.7% (74/94), χ2=19.352, P<0.001], and the mean number of intervention in the bilateral metallic stent group was significantly less than that of the unilateral metallic stent group (1.2±0.5 times VS 1.7±0.9 times, t=-4.345, P<0.001). The stent patency time in the bilateral metallic stent group was significantly longer than that of the other group [10.0 (8.0, 12.1) months VS 5.7 (5.2, 6.3) months, χ2=19.789, P<0.001]. The median survival time of patients in the bilateral group was numerically longer than that in the unilateral group, but did not reach statistical significance [7.6 (6.3, 8.9) months VS 4.6 (3.7, 5.7) months, χ2=3.628, P=0.057]. Conclusion:Endoscopic bilateral metallic stenting is superior to unilateral metallic stenting in the clinical management of malignant hilar biliary obstruction unsuitable for surgery.
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Objective:To evaluate the value of ultrasound-guided transperineal systematic prostate biopsy(SPB)and cognitive fusion multi-parameter magnetic resonance imaging(mpMRI) suspicious transperineal targeted biopsy(CFTB) in the prostate cancer with different serum prostate specific antigen(PSA) levels.Methods:A retrospective analyses were performed in 527 patients with suspected prostate cancer who underwent ultrasound-guided SPB from January 2018 to December 2019 in Shanghai Jiaotong University Affiliated 6th People′s Hospital. According to the PSA levels, they were divided into group A(PSA 4-10 μg/L) and group B(PSA>10 μg/L). All the patients underwent ultrasound-guided SPB, 376 patients with suspicious mpMRI had two additional targeted biopsies. The detection rates of ultrasound-guided SPB and CFTB in prostate cancer were tested by χ 2 test. Compared with pathological results, the sensitivity, specificity, accuracy of two methods were calculated and tested by χ 2 test, and a P<0.05 was defined as statistically significant difference. Results:Prostate cancer was detected in 319 of 527 patients(60.5%). One hundred and three cases of 198 patients in group A were diagnosed as prostate cancer, with an overall detection rate was 52.0%. Among them, ultrasound-guided SPB detected 72 cases of prostate cancer, the detection rate was 36.4%, sensitivity was 67.9%, specificity was 17.7%, accuracy was 26.5%, the detection rate, sensitivity, specificity and accuracy of CFTB were 39.9%, 75.6%, 91.6% and 88.8%, respectively. In this group, there were no statistically significant differences in the detection rate and sensitivity of the two methods in the diagnosis of prostate cancer (χ 2=0.525, 0.005, both P>0.05), and the differences in specificity and accuracy were statistically significant (χ 2=108.340, 79.829, respectively, both P<0.05). Two hundred and sixteen cases of 329 patients in group B were diagnosed as prostate cancer, with an overall detection rate was 65.7%. Among them, 160 cases of perineal prostate cancer were detected by ultrasound-guided SPB, with the detection rate was 48.6%, sensitivity was 78.2%, specificity was 37.6% and accuracy was 49.5%. A total of 189 cases of prostate cancer detected by CFTB, the detection rate was 57.4%, the sensitivity was 89.3%, the specificity was 90.6%, and the accuracy was 90.2%. All the differences were statistically significant in group B(χ 2=5.131, 4.391, 61.339, 38.982, all P<0.05). Conclusions:When PSA is greater than 10 μg/L, CFTB has a higher diagnostic efficiency than SPB.When PSA is 4-10 μg/L, there are no significant differences between the two methods in the detection rate and sensitivity of prostate cancer.
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@#Esophageal diseases include esophageal malignant diseases and benign diseases, with a high incidence in our country. Along with the development of the endoscopic technique, many of them which required medical treatment or surgery in the past can now be cured by endoscopic surgery. This article is an overview of long-term follow-up of endoscopic surgery for the common esophageal disease, such as early squamous cell carcinoma, esophageal stricture, achalasia and submucosal tumor of the esophagus.
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Objective:To investigate the efficacy and adverse effects of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in preventing neutropenia in patients undergoing sequential adjuvant radiotherapy after postoperative chemotherapy for breast cancer.Methods:A total of 43 female patients with breast cancer from January 2017 to January 2019 in Shandong Cancer Hospital and Institute were analyzed prospectively. Twenty-one patients in the experimental group were given 6 mg of PEG-rhG-CSF subcutaneously 1-3 days before radiotherapy. In the control group, 22 patients were enrolled without PEG-rhG-CSF utilization. The lowest absolute neutrophil count (ANC), the number of days of radiotherapy interruption due to neutropenia, the number of recombinant human granulocyte colony-stimulating factor (rhG-CSF) used during radiotherapy and the occurrence of drug-induced skeletal muscle pain in the two groups were statistically analyzed.Results:No neutropenia fever was observed in the two groups during radiotherapy. In the experimental group, there was no case of grade Ⅲ neutropenia; while in the control group, there were 3 cases of grade Ⅲ neutropenia. The median value of the lowest ANC in the experimental group was 1.56×10 9/L, higher than that in the control group (1.37×10 9/L), with a statistically significant difference ( Z=-2.261, P=0.023). The median number of rhG-CSF used in the experimental group was 1, which was smaller than 2 in the control group, and the difference was statistically significant ( Z=-2.498, P=0.012). The median numbers of days of radiotherapy interruption due to neutropenia were 0 and 3 in the experimental group and the control group, with a statistically significant difference ( Z=-3.117, P=0.001). One case (4.8%) of drug-induced skeletal muscle pain was found in the experimental group and 5 cases (22.7%) in the control group, with no statistically significant difference ( χ2=1.586, P=0.208). Conclusion:PEG-rhG-CSF can effectively prevent neutropenia caused by radiotherapy after postoperative chemotherapy for patients with breast cancer, and can reduce the interruption of radiotherapy and the use of rhG-CSF during radiotherapy, which is helpful to the smooth process of radiotherapy.
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Objective To investigate the mechanism of mechano-chemical coregulation in chemokine-induced calcium response of Jurkat T cells under fluid shear stress (FSS). Methods By using parallel-plate flow chamber combined with fluorescence microscope, the calcium response of Jurkat T cells on CXCL12 was observed to extract the corresponding characteristic parameters under static or flow state, with or without extracellular Ca2+, respectively. Results Immobilized CXCL12 could induce firm adhesion of the circulating Jurkat T cells, and the arrested cells increased with the increase of CXCL12 concentration. Force could trigger the calcium response of Jurkat T cells and sharply raised the activation ratio from 4% up to 75% when the FSS increased from 0 to 20 mPa. Under 20 mPa FSS, extracellular Ca2+ could stimulate quickly the calcium response by shortening the delay time (about 23 s), and enhance calcium intensity by prolonging the climbing time (about 7 s) and half time (about 20 s). Conclusions The cooperation between FSS and extracellular Ca2+ would accelerate and enhance CXCL12-mediated-calcium response of Jurkat T cells, which indicated a fast mechanosensitive pathway through ‘extracellular calcium influx-intracellular calcium store release’. The research results would contribute to understanding the process of T cells activation and providing the clue for relevant pathological and drug research.
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@#Endoscopic resection and surgical resection are the two major therapeutic methods for early esophageal cancer. Endoscopic resection is safe and minimally invasive, but lymph node dissection can not be performed. Although surgery provides a rather thorough resection of the lesions and affected lymph nodes, surgical trauma brings certain negative impact on patients' long-term life quality. A comprehensive assessment of the patient's general condition, the risk of diseased lymph node metastasis, and the risk of the treatment itself is an important measure to optimize treatment decisions and formulate personalized treatment plans.
ABSTRACT
Objective:To develop an diagnostic equipment with artificial intelligence (AI) real-time assistance under endoscopy (endoscopic AI equipment) for the detection of gastrointestinal protruding lesions, and to evaluate its performance and safety.Methods:From January to December 2017, at Endoscopy Center of West China Hospital, Sichuan University, the endoscopic images of individuals who underwent routine gastroscopy and colonoscopy were collected. The model was established based on convolutional neural network and the endoscopic AI equipment was developed. From June to December 2019, a prospective, single center, blinded and parallel controlled study was conducted to compare the differences in evaluation of protruding lesions of the same patient under gastroscopy or colonoscopy between endoscopist and the endoscopic AI equipment and to evaluated the impact of lesion size (lesions <5 mm and ≥5 mm) on the detection of endoscopic AI equipment. The main outcome measure was the detection time difference in reporting the protruding lesion between endoscopic AI equipment and endoscopist; and the secondary indicator was the accuracy of endoscopic AI equipment in detecting the protruding lesion. Wilcoxon rank sum test and chi-square test were used for statistical analysis.Results:A total of 71 582 white light endoscopy images were used for endoscopic AI equipment training, which included 41 376 images of protruding lesions. The endoscopic AI equipment was successfully developed and obtained the registration certificate of medical devices of the People′s Republic of China (Sichuan Instrument Standard, 20202060049). The accuracy, sensitivity, and specificity of endoscopic AI equipment in detecting protruding lesions were 96.4%, 95.1% and 92.8%, respectively. The detection time of each protruding lesions under gastroscopy of endoscopic AI equipment was 1.524 seconds faster than that of endoscopist; but the detection time of each protruding lesions under colonoscopy was 0.070 seconds slower than that of endoscopist, and the differences were statistically significant ( Z=-5.505 and -4.394, both P<0.01). The detection time of each protruding lesions under gastroscopy or colonoscopy of endoscopic AI equipment was not inferior to that of endoscopist. The detection rate of protruding lesions under colonoscopy by endoscopic AI equipment was 89.9% (249/277) and the sensitivity was 89.9%; the detection rate of protruding lesions under colonoscopy was 87.0% (450/517) and the sensitivity was 86.9%. There were no statistically significant differences in the detection time difference, sensitivity and missed diagnostic rate between the lesions <5 mm and ≥5 mm detected by endoscopic AI equipment under gastroscopy (all P>0.05). The sensitivity of endoscopic AI equipment in detecting the lesions ≥5 mm under colonoscopy was higher than that of lesions <5 mm (96.8% vs. 84.9%), and the missed diagnostic rate was lower than that of lesions <5 mm (3.2%, 3/94 vs. 15.1%, 61/405), and the differences were statistically significant ( χ2=9.615 and 9.612, both P=0.002). No adverse events on patients and medical staffs occurred, and there were no cases of equipment electricity leakage, and abnormal work reported during the use of endoscopic AI equipment. Conclusions:The endoscopic AI equipment can report the protruding lesions simultaneously with endoscopists, and the accuracy is close to 90%, which is expected to be a practical assistant for endoscopists to avoid missed detection of protruding lesions.