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To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumor (RNET). Data of 71 patients (43 males and 28 females, aged 46.66±10.15 years) with histologically diagnosed RNET ≤15 mm in diameter who underwent ESD in Department One of Gastroenterology, Digestive Diseases Hospital, Heilongjiang Provincial Hospital from December 2012 to January 2021 were retrospectively analyzed. Epidemiological characteristics, endoscopic characteristics, the operation time, complications, pathology results, the consistency of endoscopic ultrasound (EUS) and pathology and prognosis were analyzed. Sixty-nine patients had single lesion and 2 patients had multiple lesions (two of each). Seventy lesions (70/73, 95.89%) were?located?in?the?middle-lower?rectal?segment, and 3 lesions (3/73, 4.11%) in the upper segment. The maximum diameter was 8.54±3.12 mm. The en bloc resection rate was 100%. No adverse event was observed. The R0 resection rate was 87.67% (64/73), with 8 had undetermined vertical resection margin and 1 had lymphovascular invasion. EUS showed no case involving the muscularis propria with pathologic coincidence rate of 100.0%. The follow-up period was 4.52±3.85 years (1-9 years). No local recurrence or distant metastasis was found. ESD is safe and effective in RNET ≤15 mm in diameter. For?tumors of G1 without metastasis in preoperative evaluation, close?follow-up?seems?to?be?a?feasible?option with lymphovascular invasion or undetermined margin after?ESD.
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Objective:To explore the prophylactic effect of clipping after endoscopic mucosal resection(EMR) of sessile colorectal polyps of diameter below 10 mm on delayed post-polypectomy bleeding (DPPB).Methods:Patients with sessile colorectal polyps of below 10 mm undergoing EMR from January 2017 to December 2019 in Digestive Disease Hospital, Heilongjiang Provincial Hospital were randomly divided into the clipping group (group A) and the non-clipping group (group B) by random number table, and DPPB rates of both groups were compared.Results:A total of 1 838 patients were included, 912 patients in group A and 926 patients in group B. The incidences of DPPB were 1.00% (9/912) and 1.10% (10/926) respectively, with no significant difference ( χ2=0.039, P>0.05). The proportion of bleeding polyps were 0.44%(9/2 029)and 0.49%(10/2 025) respectively, with no significant difference ( χ2=0.055, P>0.05). Polyp of 6-9 mm ( OR=11.032, 95% CI: 2.545-47.821, P<0.05) was the independent risk factor for delayed bleeding in small sessile colorectal polyps after EMR. Conclusion:Prophylactic clipping for sessile colorectal polyps below 10 mm after EMR may not significantly reduce the risk of DPPB.
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Objective To investigate the clinical efficacy of double locking mini-plates for fixation of the comminuted fracture of the first metacarpal base.Methods Twenty-four patients with the comminuted fracture of the first metacarpal base were treated by double locking mini-plates in our hospital from January 2013 to January 2016.They were 17 males and 7 females,from 27 to 65 years of age (average,33.5 years).By the Green classification,6 cases were type Ⅰ,13 cases type Ⅱ and 5 cases type Ⅲ.All the fractures were closed.The average time from injury to surgery was 2.3 days (from 8 hours to 7 days).After open reduction via the palmar-radial incision,the fracture was fixated with 2 mini-plates,one locking T-plate on the radial side and one straight locking plate on the dorsal side.Fracture healing time,pain and finger function were followed up postoperatively.Visual analogue scale (VAS) was used to evaluate the pain at 12 months and scoring for digital total range of motion to assess the function of the affected finger at the final follow-up.Results The 24 patients obtained follow-up for 8 to 28 months (average,18 months).All the Fractures healed after 9 to 12 weeks (average,10.5 weeks).The VAS scores at 12 months ranged from 0 to 3 (average,1.5).The function of the affected finger at the final follow-up was excellent in 20 cases and good in 4,giving an excellent to good rate of 100％.Two patients complained of pain after frequent motion of the finger.No complications like skin problems,dislocation of the first metacarpal base,implant failure,necrosis or irritation of the soft tissue were observed during follow-up.No angulation or rotational deformity occurred after fracture union.Conclusion Fixation with double locking mini-plates can effectively treat comminuted fractures of the first metacarpal base,because it can provide rigid stabilization which promotes early functional exercise of the finger,and prevents joint stiffness as well.
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ObjectiveTo explore the biological features of colorectal adenoma with chicken-skin mucosa ( CSM ) and its clinical significance.MethodsExpression of cell proliferation markers ( Ki-67 and COX-2) and apoptosis-related factors ( survivin and caspase-3) in normal colorectal mucosa,colorectal adenoma without CSM,colorectal adenoma with CSM and colorectal adenocarcinoma were detected by immunohistochemistry SP method and enzyme-linked immunosorbent assay (ELISA).ResultsImmunohistochemical results revealed a decreased trend in expressions of Ki-67 and COX-2 from colorectal adenocarcinoma through colorectal adenoma with and without CSM to normal colorectal mucosa,while the expressions of survivin and caspase-3 showed an increased trend.By ELISA,the expressions of Ki-67,COX-2,surviving and caspase-3 showed no significant difference (P ＞ 0.05 ) between colorectal adenoma with CSM and coloreetal adenocarcima,while these variables were significantly different (P ＜ 0.05) between coloreetal adenoma with and without CSM,so as well between normal colorectal mucosa and other 3 groups.ConclusionThe biological characteristics of colorectal adenoma with CSM are different from those without,showing an activated cell proliferation and inhibited cell apoptosis with increased carcinogenesis risk.
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Objective To evaluate the value of neck blood vessel colored doppler ultrasound (NBVCDU) and magnetic resonance angiography (MRA) to extracranial carotid artery stenosis in patients with transient ischemic attack (TIA).Methods After implementing NBVCDU and MRA examinations at the same time,45 TIA patients with at least one examination showing arteriostenosis in extracranial section were chosen to carry out cerebral digital subtraction angiography( DSA ),then the stenosis rate was calculated by American symptomatic carotid endarterectomy trial (NASCET) method.Results Regarding DSA as the gold standard,for 45 TIA patients that having 180 arteriostenosis in extracranial section, sensitivity,specificity,accuracy of NBVCDU examination was 93.51% ,95.15% ,94.44%, Kappa = 0.735; sensitivity,specificity,accuracy of MRA was 92.21% ,94.17% ,93.33% , Kappa =0.681; sensitivity,specificity,accuracy of NBVCDU combined with MPA was 97.40% ,99.03% ,98.33%, Kappa = 0.872.Conclusions The sensitivity and accuracy of arteriostenosis in extracranial section by NBVCDU examination is higher than that by MRA, and it is suitable in the crowd primary examination.NBVCDU combined with MRA has shown good consistence with DSA for diagnosing arteriostenosis in extracranial section,but can't replace DSA comlpetely.