Objective To evaluate the blue laser imaging (BLI) magnifying endoscopy combined with endoscopic submucosal dissection (ESD) in diagnosis and treatment of low grade intraepithelial neoplasia detected by normal endoscopic biopsy.Methods A total of 76 patients were diagnosed as having LGIN by preoperative biopsy.But 3 months later,BLI endoscopic re-examination showed that the lesions did not heal or even worsened.Patients who received ESD therapy were included in the retrospective study during January 2014 to January 2016 in Remin Hospital of Wuhan University.The efficacy and complications of ESD,and the consistence rate of diagnosis between general endoscopic biopsy,BLI magnifying endoscopy and pathologic diagnosis of total tumor after ESD were analyzed.Results The complete resection rate and curative rate of ESD were 100.0％ (76/76) and 97.4％ (74/76) respectively.The incidences of hemorrhage and perforation during the operation were 3.9％ (3/76) and 1.3％ (1/76),and there was no delayed bleeding or perforation.The consistence rates of diagnosis of common endoscopic biopsy and BLI were 55.3％ (42/76) and 92.1％ (70/76) respectively,with significant difference (x2 =51.987,P＜0.001).Conclusion Low-grade intraepithelial neoplasia of the upper digestive tract may be easily underestimated by ordinary endoscopy biopsy.For these underestimated low-grade intraepithelial neoplasia lesions,ESD can not only be used to confirm the diagnosis,but also give safe and effective treatment.The examination of BLI combined with magnifying endoscopy is recommended before ESD,because BLI endoscopy classification of the lesions has positive effects on ESD of upper gastrointestinal mucosa lesions.

Objective To evaluate the diagnostic value of blue laser imaging( BLI) combined with magnifying endoscopy for precancerous lesions and early gastric cancers. Methods From September 2015 to May 2016, a total of 249 gastric lesions detected with conventional white light endoscopy ( WLE) on the basis of the assessment of mucosal shape and color were enrolled in this study. The pathological results were used as golden standard,and diagnostic accuracy rates of precancerous lesions or early cancers by white light magnification alone,BLI?contrast magnification and BLI?bright magnifier were determined according to the VS criteria. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement ( Kappa ) test, and diagnostic value was compared with McNemar paired Chi?square test. Results Pathological examination showed chronic gastritis in 149 lesions, intestinal metaplasia in 67, low grade intra?epithelial neoplasia in 8, and high grade intra?epithelial neoplasia or early cancer in 25. The concordance rates of lesions were 76?7% for white light magnification alone, 85?1% for BLI?contrast magnification, and 86?7% for BLI?bright magnification. Kappa values were 0?571, 0?730, and 0?760 respectively. For the screening of high grade intra?epithelial neoplasia or early cancer, the diagnostic sensitivities were 72?0%, 92?0%, and 92?0%, respectively, the specificities were 95?5%, 98?2%, and 99?1%,the consistencies were 93?2%,97?6%,98?4%,and the Kappa values were 0?642,0?871,and 0?911. In contrast to white light magnification alone,the concordance between endoscopic diagnosis and pathological diagnosis of BLI?contrast magnification and BLI?bright magnification was significantly higher(P<0?05).And in the diagnosis of high?grade intraepithelial neoplasia or early gastric cancer,the concordance between endoscopic diagnosis and pathological diagnosis of BLI?contrast magnification and BLI?bright magnification was higher than that of white light magnification alone( P<0?05) . Conclusion BLI combined with magnifying endoscopy may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.

Objective To compare the outcomes of operative with non-operative treatment for thoracolumbar burst fracture without neurological deficit using Meta-analysis.Methods Electronic database were searched from inception to February 2014 by two independent reviewers,including Pubmed Medline,Excerpta Medica Database (Embase),Cochrane Central Register of Controlled Trials,Chinese Biology Medicine (CBM),Chinese Wanfang Database,and China National Knowledge Infrastructure (CNKI).Inclusion and exclusion criteria were applied to select the studies.Quality appraisal and data extraction were based on Cochrane Collaboration guidelines.Results Two randomized controlled trials (RCTs),which reported outcomes for 79 patients (41 with operative treatment and 38 with nonoperative treatment) at a follow-up of two years or more were included.Between-study heterogeneity was found to be significant,for one reported better results in surgery group concerning pain relief,function recovery and returning to work.However,opposite results were found in another trial.Meta-analysis showed surgery led to higher complication rates (RR =2.85,95％ CI 0.83-9.75),including subsequent surgery (RR =8.39,95％ CI 1.12-62.87).Conclusion Operative and nonoperative managements produce similar results with respect to pain relief,function regain,and returning to work when performed for thoracolumbar burst fractures without neurologic deficit,but operation is often associated with more complications.

Based on the description of styles and characteristics of fume hoods in modern laboratories, this paper analyzes the control strategies in fume hoods and ventilation systems and discusses the control and application of VAV as well as its advantages on safety, energy conservation and comfort.

Objective To evaluate the efficacy and safety of single forcep endoscopic purse-string suture closing the wound of cardia and gastric fundus after endoscopic full-thickness resection (EFTR) for patients with submucosal tumor (SMT).Methods The clinical data of 32 patients with wound in the cardia and gastric fundus after EFTR for SMT undergoing single forcep endoscopic purse-string suture in Endoscopy Center of Renmin Hospital of Wuhan University from January 2015 to January 2016 were collected.Completion of operation, postoperative complication and follow-up results of these patients were retrospectively analyzed.Results All of the patients successfully received EFTR and purse-string suture.The maximal diameter of tumors was 1-4 cm.The suture time was 10-15 min, and postoperative hospital stay was 5-10 d.Low fever and upper abdominal pain were found in 13 and 20 cases respectively, and all cases were alleviated or restored after conservative treatment.All patients underwent gastroscopy during follow-up of 1 month, and titanium clip and nylon rope were found on the wound surface in 29 cases (90.6%).Three months after operation, 28 patients underwent gastroscopy, and titanium clip but no nylon rope was detected in 15 cases (46.9%).Conclusion Single forcep endoscopic purse-string suture can effectively treat the postoperative wound in the cardia and gastric fundus of patients with submucosal tumors after EFTR.

ObjectiveTo constructe the quality-evaluation index system of clinical teaching of operating room. MethodsThe quality-evaluation indicator system was constructed using literature study and Delphi. Then the Precedence Chart and Analytic Hierarchy Process was adopted to ensure the index's weight. ResultsThe scale was formed by 5 items of level 1 and 21 items of level 2 of the index system. ConclusionThe index system has high reliability,which can be confirmed from experts' authority degree, their attentive involvement and the concentrating degree of the views. The Quality-Evaluation Index System ( QEIS ) is constructed which can be used to evaluate clinical teaching of operating room.

Proximal transparent cap of endoscope has an important effect in endoscopic diagnosis and treatment, including endoscopic submucosal tumor ligation, endoscopic mucosal resection, endoscopic removal of foreign body, endoscopic variceal ligation and sclerotherapy, endoscopic submucosal dissection, peroral endoscopic myotomy, endoscopic submucosal dissection through tunnel.This article reviewed the effect of different transparent caps in endoscopic diagnosis and treatment.

In cardiomyocytes,sodium-calcium exchanger(NCX) is regarded to play an important role in the regulation of intracellular Ca~(2+) concentration.During the cardiac ischemia/reperfusion or cardenolide intoxication,the inflow Ca~(2+) through NCX reverse mode induce calcium overload and arrhythmia.Recently,the benzyloxyphenyl derivatives have been developed as selective NCX inhibitors,which may have therapeutic potential as a new remedy for arrhythmias.

Data of 55 patients with duodenal mass lesions treated by endoscopic submucosal dissection (ESD) were retrospectively analyzed. Risk factors of delayed bleeding after ESD were explored by univariate analysis and multivariate unconditional logistic regression analysis. Duodenal delayed bleeding occurred in 5 patients (9.09%). No closure treatment under endoscopy( P=0.035) was significantly different between the delayed bleeding group and the non-delayed bleeding group. Multivariate non-conditional logistic regression showed no closure treatment under endoscopy was an independent risk factor for delayed bleeding after ESD in duodenal mass lesions ( P=0.029, OR=0.079, 95% CI: 0.008-0.776). Patients older than 60 years and who did not take endoscopic closure treatment have higher incidences of delayed bleeding after ESD. No closure treatment under endoscopy is directly related to postoperative delayed bleeding.

Objective To investigate rare etiological causes of giant gastric ulcers. Methods A retrospective investigation was made on 4986 endoscopically proved giant gastric ulcer in our hospital, from January 1976 to December 2000. The morphological features under endoscopy, pathology, diagnosis, treatment and prognosis were analyzed in 59 giant gastric ulcers with special causes. Results Thirty two cases of gastric eosinophilic granuloma,8 gastric carcinoid tumor,8 gastric schistosomiasis, 5 gastric Crohn's disease,4 gastric lymphoma and 2 gastric Behcet's disease were identified. Ten gastric eosinophilic granuloma,3 gastric carcinoid tumor,3 gastric schistosomiasis, 5 gastric Crohn's disease,3 gastric lymphoma , 1 gastric Behcet's disease were misdiagnosed at initial endoscopy.Conclusions Rare etiological causes of giant gastric ulcers could be divided into 3 categories: non-epithelium gastric tumor, gastric granulomatous disease and gastric vascular disease. Careful observation ulcer endoscopy, history inquiry, physical examination, comprehensive analysis and laboratory examination may provide useful information for the diagnosis. Biopsy may be falsely negative in some cases.