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Leading by cytotoxicity against HepG2 cells, bioactivity-guided fractionation of the EtOAc fraction from
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Objective To compare the diagnostic accuracy of white light endoscopy ( WLE ) and magnifying endoscopy combined with narrow-band imaging ( ME-NBI) for intestinal-type gastric adenoma in benign lesions. Methods Data of patients with suspected early gastric neoplastic lesions diagnosed with WLE were collected from Shanghai Renji Hospital from January 2016 to December 2017. Patients with suspected early gastric neoplastic lesions by WLE were examined with WLE, ME-NBI and targeted biopsy again within 2 weeks. The results of WLE, ME-NBI and biopsy were recorded. Using pathological diagnosis as the golden standard, diagnostic efficacy of WLE and ME-NBI for intestinal-type gastric adenoma and other non-adenoma lesions was evaluated. Results A total of 232 patients ( 232 lesions) were included, i. e. , 124 intestinal-type gastric adenoma and 108 other non-adenoma lesions such as atrophy, ulcers, hyperplasia, low-grade intraepithelial neoplasia, etc. . The sensitivity, negative predictive value and accuracy of ME-NBI in intestinal-type gastric adenoma were higher than those of WLE ( 92. 7％ VS 71. 8％, 91. 6％ VS 73. 7％, 91. 8％ VS 80. 6％, all P <0. 01 ) . The specificity was consistent ( both 90. 7％) . There was no significant difference in the positive predictive value between WLE and ME-NBI ( 92. 0％ VS 89. 9％, P>0. 05 ) . Conclusion Diagnostic efficacy of ME-NBI in intestinal-type gastric adenoma from other non-adenoma lesions is significantly higher than that of WLE.
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Objective To study the diagnostic value of Japan narrow band imaging expert team ( JNET) classification for differentiating pathological type of colorectal lesions. Methods A total of 418 colorectal lesions were retrospectively diagnosed by magnifying endoscopy with narrow band imaging ( ME-NBI) using JNET classification by two inexperienced doctors after a short time of training in JNET classification. Then lesions were diagnosed with Sano classification by the two doctors. Diagnostic results were compared with histologic findings as a golden standard. Results The sensitivity, specificity, and accuracy of JNET classification and Sano classification for neoplastic lesion differentiation were 98. 2％ VS 98. 5％, 77. 8％ VS 66. 7％, and 96. 9％ VS 96. 4％, respectively ( all P>0. 05 ) . These indicators for diagnosing cancerous lesions, including high grade intraepithelial neoplasia, intramucosal carcinoma and submucosal carcinoma, were 66. 7％ VS 80. 2％ ( P=0. 023) , 87. 6％ VS 79. 5％ ( P=0. 006) , and 82. 1％ VS 79. 7％( P=0. 379 ) , respectively, and those for predicting submucosal deep invasive cancers were 34. 8％ VS 39. 1％, 100. 0％ VS 99. 0％, and 96. 4％ VS 96. 3％, respectively ( all P>0. 05) . The diagnostic accuracy of JNET classification for differentiating neoplastic lesions were 95. 2％ in those with diameter <10 mm, 97. 0％ in 10～<20 mm, and 97. 8％ in ≥20 mm (P=0. 483), this finding were 95. 2％, 85. 1％ and 72. 1％ for cancer, respectively ( P<0. 0001 ) , and 100％, 96. 3％, and 94. 4％ for submucosal deep invasive cancer, respectively (P=0. 026). Shape and location of colorectal lesions showed no significant effect on the diagnostic efficacy of JNET classification. Conclusion JNET classification is valuable for doctors without experience of ME-NBI in diagnosing colorectal lesions and the efficiency is slightly superior to Sano classification. However, the accuracy of diagnosis for cancer with diameter ≥20 mm need to be improved.
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Objective@#To study the risk factors of recurrent and metachronous cancer of early gastric cancer (EGC) after endoscopic resection.@*Methods@#A retrospectively study was performed on the data of 309 patients (318 lesions) who underwent endoscopic mucosal resection or endoscopic submucosal dissection and were pathologically confirmed as EGC (including high-grade intraepithelial neoplasia) in the digestive endoscopy center of Shanghai Renji Hospital from October 2008 to December 2016. The risk factors of recurrent and metachronous cancer were analyzed using univariate and multivariate Cox regression analysis.@*Results@#The follow-up time ranged from 6 to 80 months, with median time of 26.6 months. Thirteen patients (4.2%, 13/309) had recurrence, and 8 (2.6%, 8/309) occurred metachronous cancer, and the total incidence rate of recurrent and metachronous cancer was 6.8% (21/309). The multivariate regression analysis showed that non-curative resection (P<0.01, HR=5.73, 95%CI: 1.75-18.74) was the independent risk factor of recurrence, and moderate to severe mucosa atrophy around the lesions before resection (P=0.04, HR=4.87, 95%CI: 1.10-21.50) was the independent risk factor of metachronous cancer of differentiated EGC after endoscopic resection.@*Conclusion@#Recurrent and metachronous cancer of EGC after endoscopic resection are rare but cannot be ignored. Patients with non-curative resection should be alert to postoperative recurrence, and differentiated EGC patients with moderate to severe mucosa atrophy around the lesions before resection should pay more attention to metachronous cancer.
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Objective To assess the potential risk factors of canceration for intestinal?type gastric adenoma. Methods A retrospective study were performed on the data of 142 intestinal?type gastric adenoma patients who underwent endoscopic resection and was confirmed by postoperative histopathology at Digestive Endoscopy Centre, Shanghai Renji Hospital from May 2012 to December 2016. Potential risk factors for canceration of intestinal?type gastric adenoma were analyzed using univariate and multivariate Logistic analysis. Results A total of 142 intestinal?type gastric adenomas from 142 patients were collected in the study,comprised of 124 noncancerous lesions(low grade intraepithelial neoplasia)and 18 cancerous lesions (high grade intraepithelial neoplasia or carcinoma). Age 65 and older(P=0.03, OR=3.37, 95%CI:1.10?10.29),size equal or greater than 2 cm(P= 0.04, OR= 3.93, 95%CI: 1.07?14.49), and Helicobacter Pylori infection(P=0.04,OR=3.60,95%CI:1.07?12.14)were significantly associated with canceration in the univariate Logistic regression analysis. In the multivariate regression analysis,age 65 and older(P=0.03,OR=4.36,95%CI:1.17?16.24),size equal or greater than 2 cm(P=0.02,OR=5.79, 95%CI:1.28?26.12),and Helicobacter Pylori infection(P=0.03,OR=3.89,95%CI:1.15?13.59)were independent risk factors of canceration. Conclusion Intestinal?type gastric adenoma has varying degrees of intraepithelial neoplasia. Patient who is 65 years or older, or with Helicobacter Pylori infection, and lesion diameter of more than 2 cm are the potential risk factors of carceration.
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Objective To estimate dry weight (DW) and prevent dialysis-related hypotension and hypertension with the on-line monitoring of relative blood volume (RBV) and other judgments.Methods One hundred and eight maintenance hemodialysis patients were assigned to three groups according to their blood pressure:normal blood pressure group (A group,n=43),hypotension group (B group,n=35) and hypertension group (C group,n=35).The level of hemoglobin,serum albumin,dialysis adequacy were determined.Systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,ultrafiltration volume,relative blood volume changes and the corresponding clinical symptoms were monitored during hemodialysis in all patients.Each of the patients was continuously monitored of the indicators above for 10-12 times.At the observing period,the inferior vena cava diameter (IVCD),brain natriuretic peptide (BNP) and cardiothoracic ratio(CTR) were measured.Then according to the monitoring results,appropriate clinical interventions were given under on-line blood volume monitoring guidance.Results (1)The shape of RBV curve in group A showed doubleexponential curve early,then down to the final linear decling ended during hemodialysis.(2)The RBV curve in group B was stable in the former two hours,then rapidly linear declined.RBV changes were significantly higher in group B than group A (P ＜ 0.05),but when changes in RBV were plotted against ultrafiltration volume,there was no significant difference in the two groups.The level of RBV reduction at which symptomatic hypotension occurred showed considerable inter-individual variability (P ＜ 0.05,coefficient of variation=0.28).(3)The RBV curve in group C slowly linear declined.At the end of dialysis,RBV changes were significantly lower in group C than group A (P ＜ 0.05).(4)The IVCD values in three groups of patients before dialysis were greater than normal,significantly decreased after the dialysis (P ＜ 0.05),but that in group B and group C were still greater than that in group A (P ＜ 0.05).The BNP values were significantly greater in three groups before and after dialysis (P ＜ 0.05),but after dialysis,the values decreased significantly than that before dialysis (P ＜ 0.05).(5)After appropriate clinical intervention were given under on-line blood volume monitoring in hemodialysis,the patients of group B controlled weight gain,and even cut dry weight,the RBV change significantly decreased at the end of dialysis and significantly reduced the incidence of hypotension events (P ＜ 0.05); When the patients of group C cut dry weight,increased ultrafiltration,the RBV change increased,the mean arterial pressure decreased significantly than before (P＜ 0.05).Conclusions (1)Hemodialysis patients with symptomatic hypotension show larger RBV decline rate in the forth hour and lager total RBV changes,which provides important information for forecasting the symptomatic hypotension in hemodialysis.(2)IVCD and CTR have certain significance to the adjustment of dry weight,but the BNP has guiding significance to volume change.(3)On-line monitoring of RBV can effectively guide the adjustment of dry weight,reduction of symptomatic hypotension occruence,and controlling of refractory hypertension in hemodialysis.
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Objective To investigate the prevalence and risk factors of chronic kidney disease (CKD) in middle-aged and older adult population in Shanghai Pudong New District.Methods Two thousand residents aged 45 years and above were randomly selected for questionnaire survey and health check-up in Shanghai Pudong New District from July 2006 to October 2010.The laboratory examinations were also performed including the urine routine,urinary protein to creatinine ratio,serum creatinine,blood glucose and lipids.The glomerular filtration rate (eGFR) was estimated by simplified Chinese MDRD (modification of Diet in Renal Disease) equation.SPSS 13.0 statistical software was used for statistical analysis.Results Among 1905 residents who completed survey and examinations,the adjusted prevalence of albuminuria was 12.0％ (95％ CI:0.105-0.135) and of eGFR less than 60 ml · min-1 · 1.73 m-2 was 1.9％ (95 ％ CI: 0.172-0.213).The prevalence of CKD was 12.6％ (95 ％ CI: 0.112-0.142).Logistic regression analysis revealed that age (OR =1.043),hypertension (OR =2.272),diabetes mellitus (OR =1.233)and hyperuricemia (OR =1.003)were independently associated with CKD.Conclusions The prevalence of CKD in adult residents (≥45 years) from Shanghai Pudong New District is high.It is necessary to carry out early screening and to intervene risk factors of CKD in middle-aged and older residents.