Objective To investigate the diagnosis and treatment of primary presacral tumor. Methods The clinical data of 18 patients with primary presacral tumor were retrospectively analyzed. Results Preoperative diagnosis of primary presacral tumor depended on digital rectal examination, endorectal ultrasound, CT, MRI, et al. The surgical approaches of 18 cases included posterior approach (14 cases) and abdominoperineal approach (4 cases). All tumors were completely resected. Postoperative complications were rectal injury (1 case) and wound infection (2 cases), which were cured by symptomatic treatment. Postoperative pathological results showed that 15 cases had benign lesions and 3 cases had malignant lesions. Sixteen patients were followed up from 0.5 to 5.0 years, with recurrence in 2 cases and death in 2 cases. Conclusions Primary presacral tumor should be treated with operation. Sufficient preoperative examination, personalized operative planning, subtle manipulation operative procedures with an experienced multidisciplinary team, are the important points in preventing or reducing recurrence. Endorectal ultrasound plays an important role in the diagnosis and treatment of primary presacral tumor.

Objective To analyze the correlative factors of peptic ulcer recurrence in the elderly. Methods From January to December 2009,169 elderly patients (≥ 60 years old)with peptic ulcer delected by edoscopy were enrolled,whose treatment and usage of medication were analyzed.Data of treatment and recurrence in 3-year follow-up were recorded.Mann-Whitney rank sum test and Logistic regression analysis were performed to analyze the correlated factors.Results The potential risk factors associated with recurrence of peptic ulcer in the elderly were screened and analyzed by single factor analysis,and ulcer size, ulcer location, concomitant usage of drugs, smoking and condition of Helicobacterpylori (H .pylori )infection at the end of follow-up were found to be correlated with recurrence of peptic ulcer in the elderly.After adjusting age and gender,the potential risk factors were analyzed by a Logistic stepwise regression model.Smoking (OR = 1 .788,P = 0.001 ),combined medication (OR=6.202,P =0.015 ),ulcer size (OR =2.697,P =0.032 )and condition of H .pylori infection at the end of follow-up (OR=43.784,P =0.007)were found to be correlated with recurrence of peptic ulcer in the elderly.Conclusion Smoking,combined medication,ulcer size and condition of H .pylori infection at the end of follow-up have an impact on peptic ulcer recurrence in the elderly.

Objective To evaluate the effect of colonoscopy with a transparent hood on the adenoma detection rate.Methods A prospective randomized controlled trial was performed.A total of 376 patients,who underwent colonoscopy for screening colorectal polyps,were randomly allocated to 2 groups:transparent hood group (TH group,n =190) and conventional colonoscopy group (CC group,n =186).Only one endoscopist performed all the colonoscopy examinations,recorded the withdrawal time,bowel preparation status,the number,shape,location,size of adenoma when withdrawing the endoscope.All the adenoma were removed under the colonoscopy.The pathological results were recorded,and the data and relative factors were analysed.Results A total of 317 adenomas were detected in 175 patients:172 adenomas in 99 patients of TH group,145 adenomas in 76 patients of CC group.Total ADR was 46.54％.ADR of TH group was 52.11％ and ADR of CC group was 40.86％ (P =0.029).A total of 40 adenomas were found behind the fold,32 in TH group and 8 in CC group(P ＜ 0.01).In cecum and transverse colon,there were more adenomas in TH group than in CC group.In cecum,there were 23 adenomas found in TH group,6 adenomas in CC group(P ＜0.05).In transverse colon,there were 46 adenomas in TH group,25 adenomas in CC group (P ＜ 0.05).In descending colon and rectum,there were more adenomas in CC group than in TH group.In descending colon,there were 16 adenomas TH group,and 30 adenomas in CC group.In rectum,there were 14 adenomas in TH group,24 adenomas in CC group(P ＜0.05).There was no significant difference in size or shape of adenomas found between two groups.Conclusion Colonoscopy with transparent hood for screening can increase the adenoma detection rate,especially the adenoma behind the fold.

Objective To explore the effect of age on clinical postoperative outcomes of elderly patients with colorectal cancer undergoing surgical treatment. Methods The clinical data of 1249 patients from January 1999 to December 2007 were analyzed retrospectively, and patients were divided into two groups according to age; the study group (≥75 years, n=312) and the control group (<75 years, n=937). Results (1) The average age was significantly higher in study group than in control group (t=33.09,P<0.05), and the rates of malnutrition risk, co-morbidity, tumor in right colon and local Iymphonodus metastasis were significantly higher in study group than in control group (x2=47.33, 130.75, 21.24 and 45.33, P<0.05). ( 2 ) The rates of preoperative surgical complications, bowel obstruction and emergency operation were significantly higher in study group than in control group (x2 =26.81, 34.14 and 10.72, P<0.05) . The rate of resection was significantly lower in study group than in control group (x2 =9.732, P<0.05). (3) The overall incidences of postoperative complications, general complications and mortality of perioperative period were significantly higher in study group than in control group (x2= 19.38, 20.75 and 10.11,P<0.05). (4) The two-year survival and five-year survival were significantly lower in study group than in control group (x2=11.91 and 27.17, P<0.05), but there were no significant differences in the cancer-specific two-year survival and five-year survival between the both groups. Conclusions Preoperative complications and co-morbidities, local tumor metastasis and postoperative nonsurgical complications adversely affect the postoperative outcomes for elderly patients with colorectal cancer.

Background:Colonoscopy is considered as a standard method for detecting various kinds of colorectal polyps. However,conventional colonoscopy( CC)still has the chance to miss some lesions. Literatures have already reported that transparent hood assisted colonoscopy( THAC)can improve the detection of colorectal polyps. However,the effect of black hood assisted colonoscopy( BHAC)on detection of colorectal polyps is still unclear. Aims:To evaluate the effect of BHAC on detection of colorectal polyps. Methods:A total of 1 076 patients underwent CC and BHAC from Sept. 2014 to April 2015 at Huadong Hospital Affiliated to Fudan University were enrolled in this prospective randomized controlled study. Baseline characteristics,cecal intubation time,withdrawal time,number of polyps,detection rate of polyps,location, size,morphology and pathological diagnosis of polyps between two groups were compared. Results:Compared with CC group,cecal intubation time was significantly shorter in BHAC group than in CC group[(6. 31 ± 3. 51)min vs.(7. 05 ± 4. 15)min,P=0. 002]. No significant differences in withdrawal time and rate of cecal intubation were found between two groups(P>0. 05). Detection rate of polyps was significantly higher in BHAC group than in CC group(65. 4% vs. 48. 7%,P=0. 004). No significant differences in size,morphology of polyps were found between two groups(P>0. 05). Conclusions:Compared with CC,BHAC could significantly improve the detection of colorectal polyps,and shorten cecal intubation time.

Objective To determine risk factors for the miss rate of colorectal adenomas during colonoscopy.Methods A total of 981 patients,diagnosed as having at least one polyp in colonoscopy,received a second colonoscopy in 6 months from November 2012 to March 2016.All polyps were removed in the second colonoscopy.Bio-information of patients such as sex,age,surveillance interval and features of polyps such as number,size,shape,location,pathology,withdrawal time,bowel preparation was retrospectively analyzed.Factors associated with the miss rates in these patients were analyzed with Chisquare and was also analyzed with Logistic regression model for multiple factors.Results A total of 981 patients were selected according to the inclusion and exclusion criteria,including 604 males and 377 females.Miss rates of males and females were 38.9％ (235/604) and 27.9％ (105/377) (P＜0.01)respectively.Age ranged from 25 to 87 years with mean age being 61.0±9.7 years.Miss rates of senior patients ＜65 and ≥65 years were 31.5％(195/619) and 40.1％(145/362) respectively (P＜0.01).A total of 1 728 adenomas were found in first colonoscopy.A total of 2 267 adenomas were found in the second colonoscopy.The adenoma miss rate was 23.8％ (539/2 267).The miss rate of adenoma whose size ≤ 5 mm was 42.5％ (311/732);and that of larger size of 6 to 9 mm was 17.8％ (194/1 090);that of even larger size,i.e.,≥10 mm,was 7.6％(34/445)(P＜0.01).Miss rates of Is,Isp,Ip,LST and Ⅱ adenomas in shape were 28.4％(489/1 720),9.3％(24/235),6.6％ (12/182),9.0％(6/67) 20.5％ (8/39) respectively (P＞0.05).Location with highest adenoma miss rate were descending colon,ascending colon and transverse colon,27.8％(64/230),25.5％(120/470),25.5％ (161/632) respectively.Miss rates of high and low risk adenoma were 44.8％ (277/618) and 17.4％ (63/363) (P＜0.01).The highest adenoma miss rate of all the pathology type was tubular adenoma.The adenoma miss rate was 26.9％ (449/1 671) (P＜0.01).Miss rates of good and poor bowel preparation were 30.2％ (271/897) and 82.1％ (69/84) (P＜0.01).Miss rates of adequate and inadequate withdrawal time were 24.3％ (174/717) and 62.9％ (166/264) (P＜0.01).Conclusion Male,old-age,diameter ≤ 5 mm,poor bowel preparation and inadequate withdrawal time,high risk adenoma are the risk factors for missed adenoma.But the shape and location of adenoma are not the risk factors.

renal dysfunction.Logisitic regression showed that cardiovascular disease and hypoalbuminemia were correlated with perioperative death rate significantly. Conclusions Improving the perioperative management is very important for lowering the perioperative mortality in elderly patients with digestive tract disease.

Objective To observe the effect of fastigial nucleus stimulation(FNS)on heart rate variability(HRV)of surgically induced myocardial infarction rats.Methods 100 Sprague-Dawley rats were randomly allocated in four groups,including sham-operation control group,rats with coronary arteries ligated but fastigial nucleus(FN)sham stimulated(AMI group),rats both coronary arteries ligated and FN stimulated(FNS group),and rats on which FN lesioned 5 d before,then coronary arteries ligated and FN stimulated(FNL group).HRV characteristics were determined 6 h,1 d,7 d and 21 d after the ligation,and mortality rates were observed after 21 d.Results FNS can improve the survival of myocardial infarction rats,and this may be due to the increased vagal tone and decreased sympathetic tone.Conclusion FNS may have cardio-protective effects on surgically induced myocardial infarction rats.

Objective To evaluate the value of near focus narrow-band imaging ( NF-NBI ) in differentiating hyperplastic polyp ( HP ) and sessile serrated adenomas/polyp ( SSA/P ) . Methods Data of 65 cases of pathologically confirmed HP or SSA/P with clear NF-NBI images in Huadong Hospital Affiliated to Fudan University from October 2017 to September 2018 were retrospectively analyzed. Three senior doctors observed the images of NF-NBI, including expanded crypt opening ( ECO ) and thick & branched vessel ( TBV) . The results were compared with pathological results in order to analyze differential diagnostic value of ECO and TBV for HP and SSA/P. Results Among 65 lesions, 44 were SSA/P and 21 were HP. The sensitivity, specificity, and accuracy of ECO, TBV, and ECO combined with TBV for differential diagnosis between HP and SSA/P were 80. 3％( 106/132 ) , 85. 7％( 54/63 ) and 82. 1％( 160/195 ); 38. 6％( 51/132) , 82. 5％( 52/63 ) , and 52. 8％( 103/195 ); and 84. 8％( 112/132 ) , 73. 0％( 46/63 ) , and 81. 0％(158/195), respectively. Conclusion ECO under NF-NBI has a high sensitivity for diagnosis of SSA/P . ECO combined with TBV is helpful for differential diagnosis between HP and SSA/P .

Objective To explore the experimental methods and conditions of 131I-labeled anti-epidermal growth factor receptor (EGFR) vⅢ preparation,and to evaluate the targeting distribution of 131I-Anti-EGFRvⅢ in malignant glioma-loading nude mice.Methods The 131I labeling on anti-EGFRvⅢ was performed by Iodogen method.The labeling rate was determined after separation and purification and paper chromatography was used for the determination of radioactive chemical purity.Twenty-eight U87-EGFRvⅢ malignant glioma-loading nude mice with glioma average diameter of 10-15 mm were chosen and randomly divided into group of 131I-Anti-EGFRvⅢ intravenous injection,group of Na131I intravenous injection,group of 131I-Anti-EGFRvⅢ intratumor injection and group of Na131I intratumor injection;7.5 MBq/0.1 mL labeled products with 131I-Anti-EGFRvⅢ or Na131I were injected in the veins or the tumors to observe the changes of the radioactivity distribution of malignant glioma-loading nude mice with SPECT imaging.Results The rate of 131I-labeled anti-EGFRvⅢ was (68.12±6.19)％,and the immediate rate of radiochemieal purity was (95.12±0.59)％,and (87.78 ±5.35)％ in room temperature and (85.12±3.58)％ in 37 ℃ serum placed for 24 h.SPECT scan showed that the tumor site had significantly stronger imaging than the thyroid gland with the labeled products either by intravenous or intratumor injection.Conclusions It is applicable to the 131I-labeled Anti-EGFRvⅢ with Iodogen method.131I-Anti-EGFRvⅢ has good radiation chemical purity and stability in vitro and in vivo,and could be combined with tumor tissue specificity.