Influencing factors on the detection rate of colorectal polyps in colonoscopy using repeated examination / 中华消化内镜杂志

Objective@#To study influencing factors on the detection rate of colorectal polyps by repeated examination in colonoscopy.@*Methods@#A total of 900 patients in the digestive endoscopy center of the People′s Hospital of Xinjiang Uygur Autonomous Region received colonoscopy, 300 patients were randomly selected for a second examination and they were selected for three times examination from August 2016 to March 2017. Objective factors for colonoscopy were strictly controlled during the examination, such as endoscopists′ experience, endoscopic operating method, cleansing degree of the intestine and withdrawal time. The characteristics of polyps were recorded, including number, location, shape, size and pathological types of polyps. The characteristics of polyps were compared between the same patient, and between the first-examination group, the second-examination group and the third-examination group. Logistic regression was used to analyze the independent influencing factors of missed diagnosis.@*Results@#A relatively high rate of missed diagnosis could occur in multiple polyps, ascending colon polyps, transverse colon polyps, sigmoid polyps, stepless polyps and small polyps (<5 mm) (All P<0.05), and the pathological type was irrelevant to missed diagnosis (P>0.05). Logistic regression analysis showed that the number, location, shape and size of colorectal polyps were all independent factors influencing the detection rate(all P<0.05). The detection rate of polyps in the two times colonoscopy group was higher than that of the one time colonoscopy group, but there was no statistical difference between the second observation and the third observation (P>0.05).@*Conclusion@#The number, location, shape and size of colorectal polyps are all independent factors influencing the detection rate. The detection rate of polyps may be improved by using the second colonoscopy.

Correlation of GerdQ Score with Severity of Reflux Esophagitis / 胃肠病学

Background:Gastroesophageal reflux disease questionnaire(GerdQ)is a potentially useful tool for diagnosis of gastroesophageal reflux disease(GERD). Reflux esophagitis(RE)is a clinical type of GERD characterized by endoscopic mucosal injury of esophagus. Aims:To study the correlation of GerdQ score with severity of RE. Methods:Patients with typical reflux-related symptoms and meeting the inclusion criteria were recruited consecutively from Department of Gastroenterology,the People's Hospital of Xinjiang Uygur Autonomous Region during Aug. 2014 to Dec. 2015. All patients recruited were asked to complete the GerdQ scoring scale,meanwhile,the demographic information was collected and an upper gastrointestinal endoscopy was performed. The severity of RE was graded endoscopically by Los Angeles classification system. Results:A total of 1 554 patients were enrolled in this study,664 with RE(RE group)and 890 without RE(control group). The proportion of males in RE group was significantly higher than those in control group (50.9% vs. 37.1%,P<0.05). The prevalence of RE was significantly higher in Uygur than in Han and other ethnics (48.5% vs. 40.5% and 39.3%,P all <0.05). The proportions of patients with RE rose up with the increase of GerdQ score in a cut-off range from 0-14(0%,19.7%,50.1% and 51.7% for 0-2,3-7,8-11 and 11-14,respectively). The mean GerdQ score was significantly higher in RE group than in control group(9.95 ± 2.76 vs. 9.09 ± 3.33,P<0.05), and GerdQ score was positively correlated with severity of RE(r=0.243,P<0.05). When stratified by nationality,the correlation of GerdQ score with severity of RE was unchanged. Conclusions:GerdQ is a useful complementary tool for the diagnosis of RE. A cut-off value of 8 might predict the presence of RE and the GerdQ score might reflect the disease severity.

Impact of plasma homocysteinemia on contrast-induced nephropathy after percutaneous coronary intervention in patients with coronary syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the impact of plasma homocysteinemia(Hcy) on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients.</p><p><b>METHODS</b>Consecutive 684 ACS patients undergoing first PCI in our department between January 2013 and December 2014 were prospectively enrolled.Patients were divided into 2 groups according to the pre-procedural plasma Hcy level: high-Hcy group (Hcy≥10 μmol/L, n=404) and control group (Hcy<10 μmol/L, n=280). The CIN was defined as serum creatinine ≥ 44.2 μmol/L or 25% increase compared to baseline within 48-72 h after PCI.The baseline clinical data and the ratio of CIN were compared between the 2 groups.Multivariate logistic regression analysis was used to define the independent risk factors for CIN.</p><p><b>RESULTS</b>CIN occurred in 133(19.4%) out of 684 enrolled patients, and the incidence of CIN was significantly higher in high Hcy group than in the control group (22.0%(89/404)vs. 15.7%(44/280), P=0.040). After adjusting the confounding factors, including age, acute myocardial infarction, co-morbidities(hypertension, diabetes mellitus, and old myocardial infarction), laboratory examination (level of cystatin C and uric acid), glomerular filtration rate, left ventricular ejection fraction, angiographic and procedural characteristics (3 diseased vessels, multiple stent implantation), treatment at admission (spironolactone, digoxin), multivariate logistic regression analysis showed that high Hcy was independently associated with the development of CIN (OR=1.70, 95%CI 1.60-2.64, P=0.021).</p><p><b>CONCLUSION</b>Elevated Hcy prior PCI is an independent risk factor of CIN in ACS patients undergoing first PCI.</p>

Effectiveness and safety of the side-branch balloon pre-imbedding technique on coronary bifurcation lesions in elderly patients / 中华老年医学杂志

Objective To study the effectiveness and safety of the side-branch (SB) balloon preimbedding technique on coronary bifurcation lesions (CBLs) in elderly patients.Methods A retrospective analysis was conducted on 111 elderly patients with CBLs in our hospital from January 2011 to January 2013,of whom 59 patients received SB balloon pre-imbedding and 52 patients received SB wire protection.The immediate blood flow of the side-branch after treatment,the performance of the stent,and major adverse cardiovascular events (MACE) during hospitalization,6 and 12 months after treatment,and coronary angiography 6 months after treatment were compared between the two groups.Results There were no statistical differences between the two groups in clinical characteristics,lesion distribution,length and diameter of MB or SB,bifurcation angle,length and number of main branch(MB) stenting,or MACE during hospitalization and 6 months after treatment (each P＞0.05).There was no statistical difference in immediate postoperative angiography between patients with thrombolysis in myocardial infarction (TIMI) grade 3,coronary stenosis more than 25％ in the MB (P＞0.05).The percentages of patients with coronary stenosis more than 50 ％ in SB and patients who needed SB stenting were lower in the balloon pre-imbedding group than in the wire protectiongroup[8.5％ (5/59) vs.23.1％ (12/52),42.4％ (25/59) vs.61.5％ (32/52),each P＜0.05].After 6 months of treatment,there was no statistical difference in coronary angiography in TIMI grade 3 of MB and coronary stenosis more than 25％ in MB between the two groups (P＞0.05)Also,the percentage of patients with TIMI grade 3 in SB was higher in the balloon pre-imbedding group than in the wire protection group (37/41 vs.24/34,P＜0.05);the percentage of patients with coronary stenosis more than 50％ in SB was lower in the balloon pre-imbedding group than in the wire protection group (3/41 vs.8/34,P＜0.05);and the degree of stenosis,the late lumen loss and the incidence of stem restenosis in SB were lower in the balloon pre-imbedding group than in the wire protection group (P＜0.01).The incidence of MACE 12 months after PCI was lower in the balloon pre-imbedding group than in the wire protection group (7/59 vs.14/52,P＜0.05).The pre-balloon imbedding group had a lower cost than the wire protection group,but with no statistical significance [(55 113±968) RMB vs.(61 023±1 311) RMB,P＞0.05].Conclusions SB balloon preimbedding is safe for the treatment of CBLs in elderly patients,and its effectiveness in both short-and long-term is better than that of wire protection.

Relationship between hyperhomocysteine and long-term outcome of coronary artery disease patients after drug-eluting stent implantation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the relationship between hyperhomocysteinemia (H-Hcy) and long-term outcome of coronary artery disease (CAD) patients after drug-eluting stent (DES) implantation in a single centre.</p><p><b>METHODS</b>A total of 1 408 consecutive patients implanted with DES in our department between March 2011 and January 2013 were enrolled in this prospective study. Patients were stratified into H-Hcy (Hcy≥10 µmol/L, n=798, 56.7%) and non-H-Hcy group (Hcy<10 µmol/L, n=610, 43.3%). The clinical characteristics, coronary artery lesions, SYNTAX score and 1-year major adverse cardiac and cerebrovascular events (MACCE) were compared between the two groups.</p><p><b>RESULTS</b>Compared with non-H-Hcy group, coronary artery stenosis was severer as shown by higher diseased arteries (2.11±0.87 vs. 1.91±0.82, P<0.001), higher incidence of three diseased arteries (39.7% vs. 29.5%, P<0.001) and higher SYNTAX score (36.99±29.66 vs. 27.39±22.70, P=0.001) in H-Hcy group. The 1-year incidence of MACCE was also higher in H-Hcy group compared with non-H-Hcy group(18.4% vs. 8.9%, P<0.001). Multivariate Cox analysis showed that diabetes mellitus (OR=1.530, 95%CI 1.142-2.050, P=0.004), age (OR=1.065, 95%CI 1.038-1.093; P<0.001), and Hcy (OR=1.019, 95%CI 1.005-1.033, P=0.009) are the independent predictors for 1-year MACCE.</p><p><b>CONCLUSION</b>High Hcy level is correlated with the severity of coronary artery stenosis, and serves as an independent predictor of MACCE after stenting in CAD patients.</p>