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Objective:To analyze the influence of micro-course guided by mind mapping on the examination results, critical thinking ability and learning efficiency of interns in internal medicine department of traditional Chinese medicine.Methods:A total of 86 interns rotated in the internal medicine department of traditional Chinese medicine from July 2018 to November 2019 were randomized into two groups, namely the control group ( n=43) and the research group ( n=43). The control group received traditional teaching, and the research group adopted micro-course guided by mind mapping to carry out teaching activities. SPSS 21.0 was used to conduct t test and chi-square test to compare the evaluation results of assessment, critical thinking ability, learning efficiency and comprehensive ability. Results:The scores of theory and skill practice in the research group were higher than those in the control group ( P<0.05). After intervention, the evaluation results of critical thinking ability in the two groups were better than before intervention ( P<0.05), and the evaluation results of critical thinking ability in the research group were better than those in the control group ( P<0.05). The total effective rate of the research group was significantly higher than that of the control group ( P<0.05). The evaluation results of comprehensive ability in the research group were significantly higher than those in the control group ( P<0.05). Conclusion:The application of micro-course guided by mind mapping in practice teaching of internal medicine department of traditional Chinese medicine has a positive impact on the cultivation of interns' critical thinking ability and comprehensive ability, with excellent examination results and high learning efficiency.
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Objective:To investigate the clinical value of magnifying endoscopy and high frequency endoscopic ultrasonography (HFUS) in the diagnosis and recurrence monitoring of gastric mucosa-associated lymphoid tissue lymphoma (GML).Methods:A total of 15 patients with newly diagnosed GML in the Jiangsu Province Hospital of Chinese Medicine from October 2016 to October 2019 were collected. The general data, clinical manifestations, Lugano staging, gastroscope performance, magnifying endoscopic performance, HFUS performance and helicobacter pylori infection were retrospectively analyzed. The efficacy and follow-up were also analyzed.Results:The most common symptom of 15 patients with GML was upper abdominal discomfort, followed by weight loss and anemia. The frequent site of GML was the middle 1/3 of the stomach (10 cases) and the most common type was diffuse (8 cases). The positive helicobacter pylori were detected in 9 cases. The positive tree-like appearance (TLA) was found in 13 cases under magnifying endoscopy; after the treatment, 2 cases had positive TLA. The unclear 1-3 layer structure of gastric wall in lesions was observed by using HFUS, accompanied with hypoechoic alteration. After the treatment, HFUS reexamination showed that the 1-5 layer structure of gastric wall disappeared in one patient, the pathological results confirmed that GML transformed into diffuse large B-cell lymphoma.Conclusion:Magnifying endoscopy combined with HFUS has an important application value in therapeutic efficacy evaluation and recurrence monitoring of GML; HFUS may has a certain clinical value in the progress assessment of GML.
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Objective To investigate the clinical utility of magnifying endoscopy combined with nar-row-band imaging( ME-NBI)and endoscopic ultrasonography( EUS)in predicting the depth of early eso-phageal cancer. Methods Sixty-eight patients with early esophageal cancer after gastroscopic and pathological diagnosis were enrolled in Jiangsu Provincal Hospital of Traditional Chinese Medicine from January 2017 to May 2018,ME-NBI and EUS were performed preoperatively to determine the depth of lesion infiltration respectively, the accuracies of the two methods were calculated by referring to the postoperative pathology,and the McNemar test and Kappa test were used for comparison. Results The lesion confined to shallow mucosa and submucosa superficial layer was confirmed in 57 patients by postoperative pathology,submucosa superficial below in 11 pa-tients. Compared with that of histology,the ability of assessment of the invasion depth was moderately consistent with ME-NBI(McNemar test P = 0. 508;Kappa = 0. 560,P < 0. 001),not with EUS(McNemar test P =0. 019;Kappa = 0. 266,P = 0. 015). The accuracy for assessing invasion depth of early esophageal cancer was 86. 8％(59 / 68)by ME-NBI,72. 1％(49 / 68)by EUS,respectively,with statistically significant difference (McNemar test P = 0. 015;Kappa = 0. 258,P = 0. 026). Conclusion ME-NBI and EUS can help to deter-mine the infiltration level of early esophageal cancer. The accuracy of ME-NBI is higher,which is of high value for the formulation of surgical plans for patients.
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Objective To investigate the regularity of TCM diagnoses and treatment of the endoscope for the early phrase of colorectal cancer. Methods A total of 114 patients diagnosed with colorectal cancer were treated with endoscopy and herbal nursingfrom January 2013 to March 2016. The syndromes, herbs and channel tropism were analyzed to explore the regularity of TCM diagnoses and treatment of the endoscope for the early phrase of colorectal cancer. Results The common syndromes were spleen and kidney deficiency, liver and kidney Yin deficiency, Qi deficiency and blood stasis. There were 18 categories Chinese medicine. The most commonly medicine showed the function of promoting blood circulation, removing blood stasis, regulating Qi. The drugs mostly belonged to the liver, spleen, stomach, kidney meridian. Conclusions Most patients were spleen deficiency and kidney deficiency, and the disease's nature focusd on Qi and bood, with the pathogenesis characteristics of deficiency-excess complication. So the basic treatment mainly tonify the spleen and kidney, regulate Qi, promote blood circulation, and clearing heat and dampness.
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Objective To investigate the clinic effect of tunnel technique on endoscopic submucosal dissection(ESD)for massive colorectal laterally spreading tumor(LST). Methods A retrospective study was conducted on the data of patients with colorectal large area LST(the shortest diameter>4 cm) undergoing ESD by tunnel technique from January 2015 to June 2016 in Digestive Endoscopy Center of Jiangsu Province Hospital of Traditional Chinese Medicine. The size of resected specimens, operation time, complications, pathology results, the number of en bloc resection and curative resection were analyzed. Results A total of 14 cases were collected, including 7 males and 7 females. The longest diameters of resected specimens were from 4.0 to 7.0 cm with mean size of 5.18 ± 0.49 cm. The operation times were from 40 to 120 min with mean time of 63.57±12.95 min. Intraoperative perforation occurred in 2 cases but no delayed perforation and bleeding occurred. Postoperative pathology showed 1 patient with adenoma hyperplasia with crypt abscess,3 patients with low grade intraepithelial neoplasia,6 patients with high grade intraepithelial neophasia,1 patient with carcinoma in situ, 1 patient with carcinoma in M3, and 2 patients with carcinoma in SM1. The number of cases who received en bloc resection, complete resection, and curative resection were 13, 13, and 13, respectively. Conclusion ESD by tunnel technique is safe and effective in the treatment of colorectal large area LST,which is worth popularizing in clinics.
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Objective To observe the influences of Yiqi-Humo recipe,A traditional Chinese prescription,on mucosa repair after endoscopic mucosal resction (EMR) and (or) endoscopic submucoal dissection (ESD).Methods 32 patients,who received EMR or ESD,were randomly recurited into a control group with 14 patients (omeprazole) and a experiment group with 18 patients (Yiqi-Humo recipe + omeprazole).Patients of both groups received treatment for a period of 4 weeks.Follow-up endoscopy was performed at 1 and 4 weeks after EMR or ESD,the index of symptom and mucosa signs were evaluated before and after the operation.Results At the 4 weeks after the procedure,the index of pain,pantothenic acid,anorexia,burning sensation in the experiment group [(0± 0.00)、(0± 0.00)、(2 ± 0.11)、(1 ± 0.06)] were lower than those in the control group [(12±0.86)、(6±0.43)、(15 ± 1.07)、(14± 1.00),P＜0.01].The index of hyperemia and edema of the experiment group [(3 ± 0.17)、(3 ± 0.17)] were less than those of the control group [(16± 1.14)、(15 ± 1.07),P＜ 0.01].Conclusion The prescription of Yiqi-Humo recipe promoted mucosa repair significantly after EMR or ESD.
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Objective To study the diagnostic value of double-balloon endoscopy (DBE) and capsule endoscopy (CE) for small intestinal bleeding. Methods Overall detection rates of small intestinal bleeding with DBE, CE and the whole alimentary tract barium meal were compared. Positive rates of bleeding detection with DBE and CE were compared within the same patients. Influence of CE on one-procedure rate of DBE was analyzed. Results In 105 cases of small intestine bleeding, DBE detected 24 cases of Crohn's disease, 15 adenocarcinoma, 12 chronic nonspecific inflammation, 10 small intestinal ulcer of unknown reason, 8 entero-mesenchymoma, 8 polypus, 6 vascular deformation hemorrhage, 5 ancylostomiasis, 5 Mechel's diverticula ( including multiple diverticula), 3 lymphoma and 9 of no evident abnormalities. The positive detection rate of DBE is 91.4% (96/105). Disease detection rates of CE and whole alimentary tract barium meal were 75.0% (30/40) and 33.3% (25/75), respectively. The one-procedure rate of DBE is 90% (36/40) based on CE results, but it was only 69. 2% (45/65) according to clinic features and the whole alimentary tract barium meal. Conclusion The main causes of small intestinal bleeding are benign ulcers (including Crohn's disease) and tumor, as well as chronic inflammation. Polyps, vascular deformation, parasitosis, Mechel's diverticulum and lymphoma are the secondary causes.DBE is superior to CE in diagnosis of small intestine bleeding, but CE can increase the one-procedure rate of DBE.
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Objective To evaluate the efficacy of biliary tract prosthesis and pancreatic duct stents for advanced periampullary carcinoma. Methods A total of 36 patients were diagnosed as advanced periampullary carcinoma pathologically or clinically, with strictures both in pancreatic and biliary ducts confirmed by imaging. Teflon stents were firstly implanted through endoscopy to the narrowed pancreatic ducts, expansible metal prosthesis were then implanted to the biliary tract. If failed, the metal stents were given through percutaneous transhepatic biliary drainage (PTCD) pathway. Serum levels of liver enzymes, amylase and clinical manifestations were observed before and after operation. Results Teflon stents were successfully implanted into pancreatic ducts in all patients. Metal prostheses into bile ducts were endoscopically implanted in 29 cases, and via PTCD in 7, including 2 cases of Billroth Ⅱ gastrectomy. The levels of liver enzymes significantly decreased (P<0.01) after stents implacement. The levels of amylase (plasma and urine) and lipase increased in 15 cases, but they were corrected to normal levels after adequate treatments. Rates of abdominal pain relieving and diahhrea improvement were 82.4% (28/34) and 88.2% (15/17), respectively. Conclusion The combined implacement of biliary tract prosthesis and pancreatic duct stents is safe and effective in relieving malignant obstruction in periampullary carcinoma.
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Objective: To evaluate the importance of waist to hip ratio among all the possible risk factors in the development of NAFLD. Methods: The samples were selected from individuals receiving physical examination from the 14th of October to the 4th of November in 2004.The enrolling criteria were as follows:①BMI between 25-29.9.②ethanol consumption was less than 40 g per week.③markers of hepatitis virus were negative.④no diabetes mellitus.The diagnosis of fatty liver was based on sonographic evidence.According to the standards,81 cases were chosen,including 59 patients with NAFLD and 22 normal controls.Seven indices were recorded in fasting state: age,BMI,waist to hip ratio(WHR),serum cholesterol,serum lipid,serum glucose and insulin sensitivity index.Results: The fatty liver group,compared with the normal controls,was significantly marked with higher BMI(26.70 vs 26.15,(P=)0.026), WHR(0.90 vs 0.86,P=0.002),serum lipid(1.99 vs 1.42 P=0.001) and lower insulin sensitive index(0.025 vs 0.039,P=0.005).By binary logistic regression analysis,WHR and insulin sensitive index is significantly associated with the development of NAFLD,and the P value is 0.01 and 0.069 respectively. Conclusion: WHR is an independent factor in the development of NAFLD in patients with BMI matched and non-DM mild fatty individuals.
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Objective To observe the extent of injury in esophageal mucosa resulted from Argon plasma coagulation (APC). Methods The injuries from APC were observed in 55 sites of esophageal normal mucosa in 11 patients with esophageal cancer. APC powers in 45 W,60 W and 90 W were selected with exposure times of 1 sec and 3 sec respectively. The probe of APC was hold approximately at 30?and 2 mm from the mucosa. The histological changes of esophageal wall injured by APC were examined under light and electric microscopy. Results The injuries in 46 out of 55 sites were merely restricted in the mucosa or sub-mucosa,7 out of 55 extended into the muscularis propria.and 2 of 9 sites extended to the whole depth of e-sophageal wall. The depth of injury increased in relation with the elevating of APC power (P 0. 05). Conclusion APC is a safe way for treating esophageal diseases if its power is limited in an appropriate range.
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Objective To observe the growth characters of upper gastrointectinal tract leiomyoma. Methods Using endoscopic ultrasonography to detect leiomyoma of upper gastrointestinal tract leiomyoma in 18 cases once every 6 months on follow-up , and to measure the longest diameter ( A mm) and calculate its growth rate per month. Results In this series,the majority of cases have the leiomyoma of longest diameter(A) 10～20mm. Their growth rates in A≤10mm, 10mm