ABSTRACT
Objective:To investigate the clinical value of endoscopic ultrasound elastography versus contrast-enhanced computed tomography in the risk stratification of gastrointestinal stromal tumors (GISTs). Methods:Clinical and imaging data were obtained from 77 patients who were confirmed to have GISTs and underwent endoscopic or surgical treatment at Wenzhou Central Hospital between May 2019 and April 2021. Endoscopic ultrasound elastography based on a five-point scoring system and hypotonic gastrointestinal contrast-enhanced computed tomography were performed for preoperative risk stratification of GISTs. The two techniques were compared in terms of the accuracy of preoperative risk stratification of GISTs. The imaging features of the two techniques were summarized.Results:According to the postoperative pathological results, 13 patients were at high risk, 13 patients were at medium risk, 35 patients were at low risk, and 16 patients were at extremely low risk. These patients were divided into two groups according to postoperative pathological results: a low-risk group (low risk + extremely low risk) and a medium- and high-risk group (high + medium risk). In the low-risk group ( n = 51), 42 patients were identified by endoscopic ultrasound elastography to have low-risk GISTs and were recommended to receive endoscopic treatment, while the rest 9 patients were identified to have medium-risk GISTs. Contrast-enhanced computed tomography findings revealed that 30 patients had low-risk GISTs and were recommended to receive endoscopic treatment, and 21 patients had medium-risk GISTs. In the medium- and high-risk group ( n = 26), 4 patients were identified by endoscopic ultrasound elastography to have low-risk GISTs, and 22 patients had medium- or high-risk GISTs. Contrast-enhanced computed tomography findings revealed that 9 patients were identified to have low-risk GISTs, and 17 patients had medium- or high-risk GISTs. Endoscopic ultrasound elastography yielded an overall diagnostic accuracy of 83.11% (64/77), while contrast-enhanced computed tomography had an overall diagnostic accuracy of 61.04% (47/77). Endoscopic ultrasound elastography outperformed contrast-enhanced computed tomography in accurate risk stratification of GISTs ( χ2 = 4.66, P < 0.05). In terms of predicting high-risk GISTs, endoscopic ultrasound elastography had a sensitivity of 84.62% and a specificity of 82.35%, both were higher than those of contrast-enhanced computed tomography (sensitivity: 65.38%; specificity: 58.82%), but the differences in sensitivity and specificity between the two techniques were not significant (sensitivity: Fisher's exact test P = 0.590, specificity: χ2 = 0.93, P > 0.05). Conclusion:Endoscopic ultrasound elastography appears to have a better overall diagnostic accuracy in the risk stratification of GISTs compared with contrast-enhanced computed tomography. The combined use of these two techniques may offer a better comprehensive understanding of the perilesional structure and organ involvements and distant metastasis than a single technique, thereby providing a reliable reference for the choice of treatment for GISTs.
ABSTRACT
Objective:To investigate the efficacy of Modified Banxia Xiexin Decoction on patients with functional dyspepsia (FD) and its impact on gastric function.Methods:From June 2021 to December 2022, at the Department of Gastroenterology, Wenzhou Central Hospital, a total of 56 patients with FD who met the diagnostic criteria of Rome Ⅳ were prospectively enrolled. The patients were treated with Modified Banxia Xiexin Decoction for 4 weeks. The clinical efficacy was evaluated by the upper gastrointestinal symptom severity index score. The gastric function was assessed by standard gastric loading test of liquid nutrient meal and standard gastric emptying test of solid meal. The total scores of dyspeptic symptoms, the maximal satiety threshold of proximal stomach, the initial satiety threshold of proximal stomach and 5-hour solid gastric emptying rate were compared before and after the treatment. During the treatment and in 4-week follow-up after treatment, the adverse events (such as nausea, diarrhea, dizziness and rash) were observed. Wilcoxon rank sum test and paired sample t-test were used for statistical analysis. Results:After the treatment, 14 FD patients were cured, 22 patients showed significant improvement, 12 patients had response, and 8 patients showed no improvement. The total efficacy rate was 85.71%(48/56). The total score of dyspepsia symptoms after the treatment was lower than that before treatment (3.00(1.00, 4.00) vs. 13.00(8.00, 18.00)), and the difference was statistically significant ( Z=-7.96, P<0.001). After the treatment, the maximal satiety threshold of proximal stomach and 5-hour solid gastric emptying rate were both higher than those before treatment ( (897.45±98.82) mL vs. (588.46±60.26) mL, (87.59±12.74)% vs. (36.59±15.95)%), and the differences were statistically significant ( t=19.98 and 18.70, both P<0.001). The initial satiety threshold of proximal stomach before and after treatment was compared((131.84±52.91) mL vs. (130.0±47.61) mL), and the difference was not statistically significant( P>0.05). No adverse events related to this study were observed during treatment period and in the 4-week follow-up. Conclusions:The Modified Banxia Xiexin Decoction can improve proximal gastric compliance and gastric emptying function in patients with FD. Additionally, it can alleviate dyspeptic symptoms and have good clinical efficacy and high safety.
ABSTRACT
Objective To evaluate the efficacy and safety of prostatic arterial embolization (PAE) and transurethral resection of prostate (TURP) in treatment of benign prostatic hyperplasia (BPH).Methods Totally 40 patients with BPH from Jan 2016 to Oct 2016 were selected.All patients were divided into PAE (n=20) and TURP (n=20) group by random number table method.The curative effect indexes (international prostate symptom score [IPSS],quality of life score [QOL],prostate volume [PV],postvoid residual [PVR],maximum urinary flow rate [Qmax] and prostate-specific antigen [PSA]),the complications and side effects,as well as the incidence of sexual dysfunction were analyzed and compared between the two groups.Results No statistical difference of IPSS,QOL,PV,PVR,Qmax nor PSA was found between the two groups before operation (all P＞0.05).IPSS,QOL,PV,PVR and PSA were significantly lower than those before operation 3,6 and 12 months after operation (all P＜0.05),while Qmax was obviously higher than that before operation (P＜0.05).Three months after operation,the curative effect indexes were statistically different between the two groups (all P＜0.05),while no statistical difference was found 6 and 12 months after operation (P＞0.05).The incidence of postoperative complications in TURP group was higher than that in PAE group (x2 =4.329,P=0.037).There was no statistical difference in the incidence of sexual dysfunction between the two groups (x2=2.105,P=0.147).Conclusion PAE and TURP can significantly alleviate clinical symptoms of patients with BPH.Three months after operation,the efficacy of TURP is better than PAE,but PAE is more minimally invasive and has fewer complications.
ABSTRACT
Objective To evaluate the effect of oral mesalazine combined with metronidazole enema in the treatment of patients with ulcerative colitis and the impact on interferon-γ (IFN-γ),interleukin-4 (IL-4),interleukin-8 (IL-8).Methods A total of 80 patients with ulcerative colitis were selected and randomly divided into control group and observation group,40 cases in each group.The control group was treated with oral mesalazine.The observation group was treated with oral mesalazine and metronidazole retention enema.4 weeks as a course of treatment,the patients were treated for 2 courses.The clinical efficacy,disease activity index(DAI) score before and after treatment,as well as peripheral blood erythrocyte sedimentation rate (ESR),levels of IFN-γ,IL-4,IL-8 changes was compared between the two groups.Results The total effective rate was 90.00％ in the control group,which was significantly higher than 75.00％ in the control group,the difference was statistically significant (x2 =23.52,P ＜ 0.05).Before treatment,there were no significant changes in diarrhea,colonic mucosal inflammation,bloody stool and DAI scores (t =0.32,0.08,0.03,0.05,all P ＞ 0.05).After treatment,there were significant decline in each integral of the two groups,the integral of the observation group declined more than those in the control group,the differences were statistically significant(t =15.35,5.8,11.25,14.12,all P ＜0.05).Before treatment,there were no significant changes in ESR,IL-4,IL-8,IFN-γ of peripheral blood in the two groups (t =0.60,-0.95,0.03,-0.06,all P ＞ 0.05).After treatment,ESR,IL-8,IFN-γ of peripheral blood declined in the two groups,IL-4 was increased,and the changes were more significantly in the control group than those in the control group(t =10.02,4.70,10.23,22.82,all P ＜ 0.05).Conclusion Oral mesalazine enema combined with metronidazole enema has significant clinical effect in patients with ulcerative colitis,it is better than treating with oral mesalazine only,and can effectively improve the clinical symptoms and possibly plays a role by regulating IL-8,IFN-γ,IL-4,and it deserves further clinical application.
ABSTRACT
Objective To investigate the condition of defecation function,psychological health and quality of life about patients who underwent low rectal cancer anus preservation operation.Methods We randomly selected 40 cases from patients who went to do rectal cancer anus preservation operation as observation group,who received e-valuation with bowel habit questionnaire (the result using Zhong-fa Xu anal function evaluation method which widely used for subjective evaluation),SF-36 scoring systems at 2 weeks before surgery,postoperative 3 months,6 months, 1 year,and the anorectal manometry postoperative 3 months,6 months,1 year.The normal controls were 40 healthy people without anus-rectal disease and disordered defecation,investigated and detected at the same time point.Results Compared with the control group,the ARP,MSP,RAIA,MTV of the observation group significantly decreased(P 0.05).Compared with the control group,in the preoperation,the results of anal function evaluation method and SF-36 scoring systems had no significant differences.Based on the Zhong-fa Xu anal function evaluation,we could draw the following conclusions:anal function was impaired obviously in postoperative 3 months (fine rate was 62.5%,χ2 =16.08,P 0.05),but the scores of PF and RF dimension were lower than those of the healthy con-trols:postoperative PF dimension[3 months:(80.12 ±15.12),6 months:(82.19 ±17.01),and 1 year:(83.13 ± 17.12),compared with the control group,t =4.5,3.1,2.5 respectively],postoperative RP dimension [3 months:(58.29 ±40.15),6 months:(59.48 ±41.07),1 year:(60.17 ±42.15),compared with the control group,t =4.1, 2.9,2.7 respectively];there were statistically significant differences (P <0.05).Conclusion For patients who underwent low rectal cancer anus preservation operation,postoperative anal function and life quality were affected,and is significant in a short period of time,part of the quality of life for long-term survival in patients decreased obviously, and it is necessary to assess sufficiently preoperation,do defecation function exercise or biological feedback therapy postoperation.
ABSTRACT
Objective To investigate the expressions of PTEN and MDM2 in bladder transitional cell carcinoma (BTCC) and their clinical significance.Methods The expressions of PTEN and MDM2 were detected by tissue immunohistochemistry test (SP method) in BTCC (n =80) and normal bladder tissues (n =20).The relationship between PTEN and MDM2 as well as their correlations with clinical pathological features were analyzed.Results The positive rate of PTEN in different pathological grading (G1,G2,G3)and clinical staging [superficial (Tis ～ T1),infiltration (T2 ～ T4)] was (86.20％,74.07％,37.50％ ;80.00％,46.67％),respectively,with a significant difference (x2 =15.004,P ＜ 0.01 ; x2 =9.497,P ＜0.01).The positive rate of MDM2 in different pathological grading(G1,G2,G3) and clinical staging [superficial (Tis ～ T1),infiltration (T2 ～ T4)] was (82.75％,55.55％,37.50％ ; 70.00％,43.35％),respectively,with a significant differcnce(x2 =11.543,P ＜ 0.01 ; x2 =5.556,P ＜ 0.05).The expression of PTEN was negatively correlated with that of MDM2 in BTCC (r =-0.611,P ＜ 0.05).Conclusions Expressions of PTEN and MDM2 might be involved in the BTCC pathogenesis.The combined detection of PTEN and MDM2 might be of great value in the prediction of tumor behavior and prognosis.