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Objective:To develop a robotic digestive endoscope system (RDES) and to evaluate its feasibility, safety and control performance by experiments.Methods:The RDES was designed based on the master-slave control system, which consisted of 3 parts: the integrated endoscope, including a knob and button robotic control system integrated with a gastroscope; the robotic mechanical arm system, including the base and arm, as well as the endoscopic advance-retreat control device (force-feedback function was designed) and the endoscopic axial rotation control device; the control console, including a master manipulator and an image monitor. The operator sit far away from the endoscope and controlled the master manipulator to bend the end of the endoscope and to control advance, retract and rotation of the endoscope. The air supply, water supply, suction, figure fixing and motion scaling switching was realized by pressing buttons on the master manipulator. In the endoscopy experiments performed on live pigs, 5 physicians each were in the beginner and advanced groups. Each operator operated RDES and traditional endoscope (2 weeks interval) to perform porcine gastroscopy 6 times, comparing the examination time. In the experiment of endoscopic circle drawing on the inner wall of the simulated stomach model, each operator in the two groups operated RDES 1∶1 motion scaling, 5∶1 motion scaling and ordinary endoscope to complete endoscopic circle drawing 6 times, comparing the completion time, accuracy (i.e. trajectory deviation) and workload.Results:RDES was operated normally with good force feedback function. All porcine in vivo gastroscopies were successful, without mucosal injury, bleeding or perforation. In beginner and advanced groups, the examination time of both RDES and ordinary endoscopy tended to decrease as the number of operations increased, but the decrease in time was greater for operating RDES than for operating ordinary endoscope (beginner group P=0.033; advanced group P=0.023). In the beginner group, the operators operating RDES with 1∶1 motion scaling or 5∶1 motion scaling to complete endoscopic circle drawing had shorter completion time [1.68 (1.40, 2.17) min, 1.73 (1.47, 2.37) min VS 4.13 (2.27, 5.16) min, H=32.506, P<0.001], better trajectory deviation (0.50±0.11 mm, 0.46±0.11 mm VS 0.82±0.26 mm, F=38.999, P<0.001], and less workload [42.00 (30.00, 50.33) points, 43.33 (35.33, 54.00) points VS 52.67 (48.67, 63.33) points, H=20.056, P<0.001] than operating ordinary endoscope. In the advanced group, the operators operating RDES with 1∶1 or 5∶1 motion scaling to complete endoscopic circle drawing had longer completion time than operating ordinary endoscope [1.72 (1.37, 2.53) min, 1.57 (1.25, 2.58) min VS 1.15 (0.86, 1.58) min, H=13.233, P=0.001], but trajectory deviation [0.47 (0.13, 0.57) mm, 0.44 (0.39, 0.58) mm VS 0.52 (0.42, 0.59) mm, H=3.202, P=0.202] and workload (44.62±21.77 points, 41.24±12.57 points VS 44.71±17.92 points, F=0.369, P=0.693) were not different from those of the ordinary endoscope. Conclusion:The RDES enables remote control, greatly reducing the endoscopists' workload. Additionally, it gives full play to the cooperative motion function of the large and small endoscopic knobs, making the control more flexible. Finally, it increases motion scaling switching function to make the control of endoscope more flexible and more accurate. It is also easy for beginners to learn and master, and can shorten the training period. So it can provide the possibility of remote endoscopic control and fully automated robotic endoscope.
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Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.
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AIM: To explore the predictive value of red blood cell distribution width (RDW) in early poor neurologic improvement after intravenous thrombolysis in acute ischemic stroke (AIS). METHODS: A total of 102 patients with acute ischemic stroke who received intravenous thromblysis with alteplase within 4.5 hours of onset were analyzed retrospectively. RDW level was measured before thrombolysis. According to the percentage change in NIHSS at 24 hours, the patients were divided into two groups: good neurological improvement (≥ 30%) group (n=53) and poor neurological improvement (<30%) group (n=49). The univariate and multivariate Logistic regression analysis were used to investigate whether RDW level is an independent factor affecting patients' neurological improvement. The receiver operating characteristic (ROC) curve was used to analyze the cut-off value of RDW to predict poor early neurological improvement after thrombolysis. RESULTS: Compared with the good neurological improvement group, higher proportion of atrial fibrillation (24.5% vs. 9.4%, P= 0.042), diabetes mellitus (57.1% vs. 30.2%, P= 0.006), hemorrhagic transformation (10.2% vs. 0%, P=0.023) in the poor neurological improvement group. The level of RDW in poor neurological improvement group was significantly higher than that in good neurological improved group(14.09±0.77) vs. (13.31±0.63), P=0.000. Logistic regression analysis showed that elevated RDW (OR=4.614, 95%CI: 2.263-9.408, P=0.000) and history of diabetes mellitus (OR=2.606, 95%CI: 1.034-6.573, P=0.042) were independently associated with early poor neurological improvement. The ROC curve analysis showed that the optimal cut-off value of RDW to predict poor early neurological improvement after thrombolysis was 13.56% (AUC=0.782, 95%CI: 0.690-0.874; sensitivity 76%; specificity 74%). CONCLUSION: Elevated RDW is of a certain value in predicting the poor early neurological improvement of AIS patients after thrombolysis.
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Background: Hemangioma is a vasogenic benign tumor commonly seen in the head and neck. However, it is rare in gastrointestinal tract and can cause symptoms such as gastrointestinal bleeding and abdominal pain, and it also can be life-threatening in severe cases. Aims: To analyze the clinical characteristics, treatment, and prognosis of gastrointestinal hemangioma, and to provide appropriate therapy for the diagnosis and treatment of gastrointestinal hemangioma. Methods: The patients with gastrointestinal hemangioma from August 2011 to October 2021 at the First Affiliated Hospital of Zhengzhou University were collected, and the clinical data, examination results, treatment and prognosis were analyzed retrospectively. Results: A total of 51 patients with gastrointestinal hemangioma were included, the ratio of male to female was 1.43:1, and the average age was (46.2±19.2) years old. Single gastrointestinal hemangioma was found in 45 patients (88.24%), and 18 lesions (35.29%) were in the esophagus, followed by the stomach (15.69%), small intestine (15.69%), colon (11.76%), and rectum (9.80%). The majority of patients were asymptomatic (50.98%), while 15 patients (29.41%) were presented by gastrointestinal bleeding. Thirty-two patients (62.75%) underwent endoscopic treatment, including 25 patients underwent endoscopic mucosal resection (EMR), 6 patients underwent endoscopic submucosal dissection (ESD), and 1 patient underwent endoscopic ligation. Nineteen patients (37.25%) underwent surgical surgery, including 5 patients underwent transrectal lesion resection, 1 patient underwent small intestinal lesion resection and 13 patients underwent resection of digestive tract. All patients recovered well after surgery. The average follow-up period was (61±32) months. One patient relapsed 1 year after surgery, 4 patients died of other diseases, and the remaining patients did not occur tumor recurrence, and 5 patients were lost to follow-up. Conclusions: Gastrointestinal hemangioma is rare and has no specific clinical symptoms. Endoscopy is important for its diagnosis, and endoscopic therapy is safe and effective for patients with indications.
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Objective:To evaluate endoscopic retrograde appendicitis therapy in treatment of children with acute uncomplicated appendicitis.Methods:Sixty children patients were admitted at the Affiliated Hospital of Zhengzhou University from Oct 2019 to Jun 2021 and were divided into ERAT group ( n=30) and LA group ( n=30). Results:All operations were successfully performed . ERAT children started oral feeding earlier [(6.8±2.0) h vs. (12.3±2.0) h, t=-10.636, P<0.001], postoperative hospital stay was shorter [(3.2±1.3) d vs. (5.0±1.3) d, t=-5.360, P<0.001]. After 14 months follow up, the recurrence rate in the ERAT group was 6%. The complication rate of LA was 10%. Conclusion:ERAT is a safe and effective therapy in treating children with acute uncomplicated appendicitis with low,acceptable recurrence rate.
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Clinical data of 62 patients with gastrointestinal submucosal tumors (diameter ≥1 cm) who were treated with kissing suture by single-channel endoscope after endoscopic full-thickness resection (EFR) in the First Affiliated Hospital of Zhengzhou University from February 2017 to May 2019 were analyzed retrospectively to evaluate the clinical value of kissing suture technique by single-channel endoscope in defect closure after EFR. All the post-EFR defects were successfully closed (100%). No postoperative anastomotic leakage or other serious complications occurred. The mean maximum diameter of lesions was 3 cm (ranged 1-7 cm), and 13 (21%) of them were greater than or equal to 5 cm.The mean number of clips used was 25.7 (ranged 7-78). The mean procedure time was 168 min (ranged 44-300 min), and the mean suture time was 63 min (ranged 13-211 min). The mean postoperative hospital stay was 7 days (ranged 4-12 days). Endoscopic reexamination 3-6 months after operation showed that all wounds healed well. Kissing suture method by single-channel endoscope is a safe, effective, easy and feasible for closing gastrointestinal defect after EFR.
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Objective:To compare the clinical efficacy of endoscopic resection and laparoscopic surgery in the treatment of gastric gastrointestinal stromal tumor (GIST) with a maximum diameter of 2 to 5 cm, and to analyze the influence of factors such as tumor surface, growth pattern and lesion origin on the choice of resection method, so as to provide a safer and more effective treatment for patients with gastric GIST.Methods:From January 2012 to November 2019, at the First Affiliated Hospital of Zhengzhou University, the clinical data of 301 patients with gastric GIST who underwent endoscopic resection (137 cases in the endoscopic resection group) or laparoscopic surgery (164 cases in the laparoscopic surgery group) were retrospectively analyzed, including age, gender, whether there was depression on the tumor surface (the local subsidence depth of the mucosa on the tumor surface was >5 mm), whether the tumor surface was irregular (non-hemispherical or non-elliptical tumor surface), whether there was combined ulcer, location, shape, origin of the lesion, growth pattern (intralumina growth or combined intraluminal and extraluminal growth), risk classification (very low risk, low risk, medium risk, high risk), whether the tumor was en bloc resection, operation time, whether bleeding or not, fasting time, indwelling time of gastric tube, time of hospitalization, time of postoperative hospital stay, postoperative complications and follow-up. Independent sample t test, chi-square test or Fisher′s exact test and Wilcoxon rank sum test were used for statistical analysis. Results:Among the 137 patients with gastric GIST in the endoscopic resection group, 85 cases (62.0%) underwent endoscopic submucosal dissection, 9 cases (6.6%) underwent endoscopic submucosal excavation, 42 cases (30.7%) underwent endoscopic full-thickness resection, and 1 case (0.7%) underwent submucosal tunnel endoscopic resection. There were no significant differences in gender, age, lesion location, tumor size, and risk classification between the endoscopic resection group and the laparoscopic surgery group (all P>0.05). The tumor surface was depressed, with ulcer or irregular in 1, 49, 26, and 2 cases of patients with gastric GIST of very low risk, low risk, medium risk and high risk, respectively. There was statistically significant difference in the proportion of depression, irregularity and ulcer on the tumor surface at different risk levels ( Z=-2.55, P=0.011). The complete tumor resection rate of the endoscopic resection group was lower than that of the laparoscopic surgery group (86.1%, 118/137 vs. 100.0%, 164/164), and the difference was statistically significant ( χ2=24.28, P<0.001). However the operation time, fasting time, the indwelling time of gastric tube, time of hospitalization, and the time of postoperative hospital stay of the endoscopic resection group were shorter than those of the laparoscopic surgery group, and the total hospitalization cost was lower than that of the laparoscopic surgery group (90.0 min (62.5 min, 150.0 min) vs. 119.5 min, (80.0 min, 154.2 min); 3 d (3 d, 4 d) vs. 5 d (4 d, 7 d); 3 d (2 d, 4 d) vs. 4 d (2 d, 6 d); 11 d (10 d, 14 d) vs. 16 d (12 d, 20 d); 7 d (6 d, 9 d) vs. 9 d (7 d, 11 d); (38 211.6±10 221.0) yuan vs. (59 926.1±17 786.1) yuan), and the differences were statistically significant ( Z=-2.46, -7.12, -4.44, -6.89 and -5.92, t=-13.24; all P<0.05). The incidence of postoperative abdominal pain and other severe postoperative complications (including shock, respiratory failure, pulmonary embolism, gastroparesis, etc.) of the endoscopic resection group were all lower than those of the laparoscopic surgery group (16.8%, 23/137 vs. 27.4%, 45/164; 0.7%, 1/137 vs. 4.9%, 8/164), and the differences were statistically significant ( χ2=4.84, Fisher′s exact test, P=0.028 and 0.043). There were no significant differences in the incidence of intraoperative bleeding, postoperative bleeding, fever and perforation between the two groups (all P>0.05). The incidence of operation-related complications of lesions with intraluminal growth and originating from muscularis propria in the endoscopic resection group were lower than those of the laparoscopic surgery group (19.5%, 25/128 vs. 32.6%, 45/138; 12.6%, 12/95 vs. 31.4%, 37/118), and the differences were statistically significant ( χ2=5.86 and 10.42, P=0.016 and 0.001). There was no significant difference in the postoperative tumor recurrent rate between the endoscopic resection group and the laparoscopic surgery group (0, 0/137 vs. 2.4%, 4/164; Fisher’s exact test, P=0.129). Conclusions:Endoscopic treatment is safe and effective for gastric GIST with a maximum diameter of 2 to 5 cm, which is superior to laparoscopic surgery. However, laparoscopic surgery is recommended for tumor with depressed, ulcerative, or irregular surface and combined intraluminal and extraluminal growth.
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From June 2017 to September 2019, 5 patients who were diagnosed as having benign severe pyloric stenosis underwent fully covered stent placement using a new stenting method at the First Affiliated Hospital of Zhengzhou University. Five patients were performed successfully without serious complications. Postoperative barium meal radiograph revealed that the stents were in good location and the acontrast agent passed smoothly. The liquid diet was commenced 1-3 days after surgery. No vomiting, abdominal pain and diarrhea occurred. During the follow-up, all the patients had improved weight and nutritional status. Four patients underwent stent removal 3-4 months postoperatively. One patient was found that the stent had migrated to stomach 3 months after discharge. After removing the stent, balloon dilation and mucosal resection was performed for the mild pyloric stenosis. All 5 patients had an additional follow-up of 3 months, and no symptoms and restenosis occured. These preliminary results showed that the new stenting method of fully covered stent placement is feasible, safe and effective in the treatment of benign pyloric stenosis.
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Objective:To study the safety and effectiveness of endoscopic full-thickness resection(EFR) in the treatment of large gastric stromal tumors with diameter of 5-7 cm.Methods:Data of 36 patients with large gastric stromal tumors (5-7 cm) who received EFR or surgery (including laparoscopic and open surgery) in the First Affiliated Hospital of Zhengzhou University and confirmed by postoperative histopathology from January 2017 to October 2018 were retrospectively analyzed. Patients were divided into endoscopic group (9 cases) and surgical group (27 cases) according to different resection methods. The perioperative indicators and the total incidence of complications in the two groups were compared.Results:In terms of perioperative indicators, the median operation time of the endoscopic group was significantly longer than that of the surgical group (4.0 hours VS 2.0 hours, P<0.01), and the postoperative fasting time (4.55±0.88 days VS 6.22±2.24 days, t=-2.15, P=0.03) and hospital stay (6.88±1.26 days VS 10.03±2.90 days, t=-3.13, P<0.01) were significantly shorter than those of the surgical group. The median visual analogue scores (VAS) of abdominal pain of the endoscopic group on the first postoperative day (3 VS 6, P<0.01)and the third postoperative day (1 VS 3, P<0.01) were significantly lower than those of the surgical group. The hospitalization cost was significantly less than that of the surgical group (55±14.7 thousand yuan VS 73±24.3 thousand yuan, t=-2.11, P=0.04). In term of the total incidence of complications, the endoscopic group was 11.1% (1/9), which was higher than that of the surgical group [7.4% (2/27)], but there was no statistically significant difference( P=1.00). Conclusion:EFR is safe and effective in the treatment of large gastric stromal tumors (5-7 cm), and has the advantages of less invasiveness, rapid postoperative recovery, and lower hospitalization cost. But how to shorten the operation time is an urgent problem to be solved.
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Data of 55 cases of gastric neuroendocrine neoplasms (G-NENS) with diameter ≤12 mm in the First Affiliated Hospital of Zhengzhou University from August 2014 to August 2019 were retrospectively analyzed. According to the methods of endoscopic resection, the patients were divided into two groups: the endoscopic mucosal resection with a cap (EMR-C) group (35 cases) and the endoscopic submucosal dissection (ESD) group (20 cases). The results showed that the success rates of operation, the whole resection rates and the complete resection rates were all 100.0% in the two groups. Compared with the ESD group, the EMR-C group had a shorter median operation time (12.00 min VS 28.35 min, P<0.001), less mean hospitalization costs (21 165.19 yuan VS 28 400.35 yuan, P=0.004), and a similar overall incidence of complications [2.86% (1/35) VS 0, P=1.000]. By March 2020, the recurrence rate of EMR-C group and ESD group were 28.6% (10/35) and 15.0% (3/20), respectively, without significant difference ( P=0.418). It is suggested that for G-NENS with diameter ≤12 mm, without muscular invasion, lymph node metastasis or distant metastasis, EMR-C and ESD are both safe and effective, but EMR-C has more advantages in terms of operation time and hospitalization costs.
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Objective:To investigate the risk factors of esophageal stenosis after endoscopic submucosal dissection (ESD) of early esophageal cancer and precancerous lesions, and to construct and assess a predictive model for esophageal stenosis.Methods:Data of 421 patients with early esophageal cancer or precancerous lesions who underwent ESD and were confirmed by pathology in the First Affiliated Hospital of Zhengzhou University between January 2015 and April 2020 were retrospectively analyzed.Eighty-nine cases developed postoperative esophageal stenosis (stenosis group) and 332 cases did not (non-stenosis group). Risk factors of esophageal stenosis were investigated by univariate and multivariate logistic regression analysis. Independent risk factors were used as predictors to construct a nomogram model by using the lasso algorithm.The accuracy of the model was evaluated by the consistency index (C-index) and the calibration curve. Bootstrap was applied to internal verification to avoid over-fitting of the model.Results:Univariate analysis showed that postoperative pathology, depth of infiltration, median long and short diameters of the specimen, circumferential resection range, and muscularis propria injury were related to postoperative esophageal stenosis( P<0.05). Further multivariate logistic regression analysis showed that the resection range≥1/2 of the circumference (VS <1/2 circumference: P<0.01, OR=48.453, 95% CI: 11.288-207.983), muscularis propria injury( P<0.01, OR=4.671, 95% CI: 2.283-9.557)and longitudinal length≥50 mm (VS <50 mm: P=0.008, OR=2.741, 95% CI: 1.299-5.785) were independent risk factors for esophageal stenosis after ESD. The nomogram model was constructed through the lasso algorithm by taking the longitudinal length, circumferential resection range, and muscularis propria injury as the predictive factors. The C-index of the nomogram was 0.934 (95% CI: 0.909-0.959)and was 0.931 after 100 times of Bootstrap internal sampling, which meant the prediction probability of the model in the calibration curve was in good agreement with the actual observation probability. Conclusion:Circumferential resection range ≥1/2, muscularis propria injury, and longitudinal length≥50 mm are independent risk factors for post-ESD esophageal stenosis. The nomogram model constructed by the above three indicators as predictors shows an ideal prediction effect on esophageal stenosis after ESD for early esophageal cancer and precancerous lesions, which is helpful to establish a standard plan for early intervention in patients at high risk of stenosis after ESD.
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Aiming at the low efficiency and low quality detection level of the manual infusion set, a gas detection system for infusion set based on STM32 single-chip microcomputer was designed. The detection system includes hardware system design and software system design. The hardware system is based on the STM32F103 single-chip microcomputer. It mainly designs the gas pressure sensor acquisition circuit and the multi-way solenoid valve control circuit. The software system uses a C ++ real-time operating system to ensure system monitoring's real-time performance and validity. Test data is transmitted to the upper computer and displayed via USB serial communication. The experiment proves that the infusion set gas detection system can perform gas detection on the infusion set. The system has the characteristics of stability and high accuracy. The relative error of the experimental measurement is within ±5%, and the detection efficiency is better than manual detection.
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Computadores , Diseño de Equipo , Microcomputadores , Programas InformáticosRESUMEN
Objective:To compare the clinical efficacy of anti-reflux mucosectomy (ARMS) and endoscopic cardial constriction ligation (ECCL) on treatment of gastroesophageal reflux disease.Methods:A retrospective study was conducted on the data of 48 consecutive patients with gastroesophageal reflux disease, who underwent ARMS or ECCL at the First Affiliated Hospital of Zhengzhou University from December 2015 to August 2018. Twenty cases were in the ARMS group and 28 cases in the ECCL group. The short-term and long-term efficacies were compared between the two groups.Results:The success rate of operation was 100.0% in the both groups. The operation time of the ECCL group was significantly shorter than that of the ARMS group (8.43±1.59 min VS 34.05±12.35 min, t=-9.227, P<0.001). After 2 months follow-up, the symptom improvement rate of the ECCL group and the ARMS group was 89.3% (25/28) and 60.0% (12/20), respectively ( χ2=4.128, P=0.042). The GERD Q score of the ECCL group was significantly lower than that of the ARMS group (6.24 ±1.22 VS 7.35±1.79, t=-2.400, P=0.023). One year after operation, there were no significant differences in the symptom improvement rate, GERD Q score, DeMeester score and the time percentage of pH<4 between the two groups ( P>0.05). Conclusion:The long-term clinical effect of ARMS and ECCL is similar, but the short-term clinical effect of ECCL is superior to ARMS.
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Objective To assess the efficacy and safety of the endoscopic anti-reflux mucosectomy for gastroesophageal reflux disease. Methods Data of 18 patients with gastroesophageal reflux disease who underwent endoscopic anti-reflux mucosectomy at the First Affiliated Hospital of ZhengZhou University from December 2015 to July 2018 were retrospectively studied. The therapeutic effects ( improvement of heartburn and reflux symptoms, 24 h esophageal pH monitoring) and complications were analyzed. Results Anti-reflux mucosectomy was performed successfully in all patients with successful rate of 100％. ESD was performed in 8 cases and EMR in 10 cases. 24 h esophageal pH monitoring results showed that the Demeester score, the time percentage of pH < 4, total reflux events and reflux times of pH < 4 with time longer than 5 minutes after treatment were significantly lower than those before treatment (20. 16±9. 12 VS 74. 16±20. 03, (2. 70±0. 88)％ VS (6. 42±1. 37)％, 43. 78±19. 68 VS 156. 56±41. 22, 2. 89±1. 68 VS 9. 89±2. 95, all P<0. 05) . No bleeding, perforation or infection was observed after the procedure. During a follow-up period of 3-34 months, symptom relief rate was 89％ (16/18). A tightened cardiac was noted in 18 cases and recovery of mucosal damage was found in 16 patients. Conclusion Anti-reflux mucosectomy is safe, effective and easy to operate for gastroesophageal reflux disease.
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Objective@#To assess the efficacy and safety of the endoscopic anti-reflux mucosectomy for gastroesophageal reflux disease.@*Methods@#Data of 18 patients with gastroesophageal reflux disease who underwent endoscopic anti-reflux mucosectomy at the First Affiliated Hospital of ZhengZhou University from December 2015 to July 2018 were retrospectively studied. The therapeutic effects (improvement of heartburn and reflux symptoms, 24 h esophageal pH monitoring) and complications were analyzed.@*Results@#Anti-reflux mucosectomy was performed successfully in all patients with successful rate of 100%. ESD was performed in 8 cases and EMR in 10 cases.24 h esophageal pH monitoring results showed that the Demeester score, the time percentage of pH < 4, total reflux events and reflux times of pH < 4 with time longer than 5 minutes after treatment were significantly lower than those before treatment (20.16±9.12 VS 74.16±20.03, (2.70±0.88)% VS (6.42±1.37)%, 43.78±19.68 VS 156.56±41.22, 2.89±1.68 VS 9.89±2.95, all P<0.05). No bleeding, perforation or infection was observed after the procedure. During a follow-up period of 3-34 months, symptom relief rate was 89% (16/18). A tightened cardiac was noted in 18 cases and recovery of mucosal damage was found in 16 patients.@*Conclusion@#Anti-reflux mucosectomy is safe, effective and easy to operate for gastroesophageal reflux disease.
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Objective To compare the difference between modified peroral endoscopic myotomy (Liu?POEM) and conventional POEM for achalasia. Methods Thirty achalasia patients treated with Liu?POEM and 30 with conventional POEM were enrolled. A retrospective study was performed to compare the conventional POEM and Liu?POEM procedures by evaluating total operation time, postoperative complications and symptoms( Eckardt score) . Results The average total operation time of Liu?POEM was 27?13 ±11?42 min and the average myotomy time was 13?20±5?09 min. There was no pneumomediastinum, subcutaneous emphysema or fever. The average total operation time of conventional POEM was 51?22 ± 25?63 min. The average myotomy time was 11?18±7?61 min. There were three cases(10%) of subcutaneous emphysema but recovered after two days without any special treatment. One patient who underwent conventional POEM had fever( the highest temperature was 37?6℃) and his temperature subsided to normal after physical cooling in one day. Postoperative Eckardt scores of patients were all less than 3. After postoperative follow?up of 3 to 12 months, no complications occurred in any patient. Conclusion Liu?POEM is a modified approach to treat achalasia, advantageous over conventional POEM in more simplified operation procedure, shorter operation time and less invasiveness.
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Objective To explore the influence of arsenous acid on hepatic and colonic cancer cell lines BEL-7402 and HT-29 .The effect of bortezomib combined with chemotherapeutic medicine and the optimal combination plan of them were also investigated .Methods We detected cell proliferation by MTT to get the inhi-bition rate of two cell lines and further to determine IC 50 ( inhibitory concentration50%) of 5-Fu,oxaliplatin or arsenous acid;preincubated cancer cells for 2 h、4 h or 8 h by bortezomib .Chemotheraputic medicine were com-bined respectively .The cell proliferation and apoptosis were analysed by MTT ,TUNEL and Annexin V -PI.Re-sult s The 24 h inhibition rate of arsenous acid to BEL -7402 and HT-29 was:0.59 ±0.09、0.71 ±0.12 re-spectively;the IC50 of 5 -Fu,Oxaliplatin or arsenous acid to BEL -7402 was:5.33 ±0.07 mg/L,28.73 ± 0.72 mg/L,25.93 ±4.05 mg/L, while to HT -29 was:7.33 ±1.13 mg/L、53.94 ±1.23 mg/L,21.93 ± 2.05 mg/L.Both inhibition rate and apoptosis rate were enhanced when chemotheraputic medicine was combined with bortezomib .Co nclusion Arsenous acid can inhibit the growth of cancer cells obviously;the susceptibility of each chemotherapy medicine can be strengthened significantly when it is combined with bortezomib ,P<0.05.
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We changed the form of literature reading from simple reading and translation to comprehensive lecture,analysis,discussion and exchange under the guidance of teachers in order to promote postgraduates' capability of learning professional English and to enhance their overall quality.The new form not only improves students' English proficiency but also enhances their overall quality,such as literature quality,teaching ability,competitive consciousness,psychological quality,etc.At the same time,it is also beneficial for teachers.
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Objective To evaluate the safety of endoscopic ligation of gastric and colic full-thickness wall with nylon loops.Methods Endoscopic ligation of full gastric and colic wall with detachable nylon loops, assisted by laparotomy, were performed in 4 dogs.Ligation healing was assessed on 3, 7, 10and 17 days after the procedure.Results All animals recovered after the procedure, without any clinical signs of infection or hemorrhage.Postoperative examination did not reveal gastric or colonic perforation, or local abscess.Loop ligature showed ulcer-like lesion.Histopathology revealed muscularis propria disruption, granulation tissue bridging the site of ligation and formation of scar tissue.Regenerative mucosa coyered the surface of the ligature completely 17 days after the operation.Conclusion Endoscopic ligation of gastric and colic full-thickness wall with detachable nylon loops is safe.Its application can be extended to other fields.