Purpose To evaluate the correlation between neovascularization in femoral artery plaque and cerebral infarction by using contrast enhanced ultrasound,and to assess the predictive value of femoral artery plaque stability in cerebral infarction and its clinical significance.Materials and Methods Sixty-two patients with femoral artery hypoechoic plaques were retrospectively studied.The patients were divided into cerebral infarction group and control group,and all of them underwent two-dimensional ultrasound and contrast enhanced ultrasound.The parameters such as the maximum thickness,the stenosis rate of cross-sectional area,the enhanced intensity (EI),the area under the curve (AUC) and the grading of the neovascularization in the plaque were detected and compared.Results The EI and AUC of the cerebral infarction group were higher than those of the control group,the differences were statistically significant (P＜0.05).Many grade Ⅲ and Ⅳ neovascularizations were found in cerebral infarction group,while the grade Ⅰ and Ⅱ neovascularizations were mostly in the control group,the difference between the two groups was statistically significant (P＜0.05).There were no significant differences in the maximum thickness and stenosis rate of cross-sectional area between the two groups (P＞0.05).The neovascularization grade,EI and AUC in the plaque were positively correlated with cerebral infarction (r=0.331,0.416 and 0.410,P＜0.05).Conclusion ① The chara-cteristics of femoral artery hypoechoic plaques in patients with cerebral infarction are rich of neovascularization and instable by using contrast-enhanced ultrasonic imaging.② The neovascularization of femoral artery hypoechoic plaque has positive correlation with cerebral infarction,which may provide a new method for clinical prediction and prevention of intracranial atherosclerosis.

Objective To determine if using a soft-tipped guidewire to cannulate the common bile duct may ameliorate development of PEP(post-ERCP pancreatitis)and facilitate cannulation of the CBD(common bile duct).Methods A total of 78 patients treated treateed in our hospital underwent ERCP through conventional direct cannulation(52 diagnostic ERCPs,26 therapeutics ERCPs)from 1998 to 2001 were randomly selected as group A while 112 patients underwent ERCP through guide wire-directed cannulation(21 diagnostic ERCPs,91 therapeutics ERCPs)from 2007 to 2008 as group B.Then we retrospectively studied and compared the following parameters between the two groups:1)Success rate of biliary access;2)visualization rate of pancreatic duct;3)the level of serum amylase,severity of abdominal pain and the rate of PEP.Meanwhile,the correlation between grading of pancreatic duct visualization and PEP was analyzed.Results The success rate of biliary access of the guidewire group(106/112 cases)was significantly greater than the conventional group(33/78 cases)(94.64%vs.42.30%,P<0.01).In group A,about61.53%(16/26)of the 26 cases could not continue the next therapeutics ERCP because of unsucceasful carmulation. The visualization rate of pancreatic duct of group A and B were 58.97%(46/78 cases)and 8.04%(9/112 cases)(P<0.01) respectively.On occurrence rate of PEP,group A(17/78 cases)was significantly higher than group B(4/112 cases)(21.79% vs.3.57%,P<0.01),and severe pancreatitis occurred in 3 patients in conventional group.However,there was no severe pancreatitis in the guide wire group.There were no significant differences (P>0.05) in terms of the rate of hyperamylasemia between the two groups.The significant correlation was found between the grading of pancreatic duct visualization and the occurrence of PEP.Condusion Guidewire-directed selective access to the bile duct lowers likdihood of PEP by facilitating cannulation and lowering the visualization rate of pancreatic duct.The occurrence of PEP could be predicted by the grading of pancreatic duct visualization,which is a very important but not the unique factor leading to PEP.

Humans ; Diagnosis, Differential ; Constriction, Pathologic/diagnosis* ; Bile Duct Neoplasms/diagnosis* ; Endoscopy, Digestive System

Objective To explore correlation between ultrasonic characteristics of femoral artery atherosclerotic plaques and non-ST-elevation acute coronary syndrome (NSTE-ACS).Methods Seventy-two patients with coronary heart disease (CHD) coexisting carotid artery and femoral artery plaques were divided into NSTE-ACS group (n=42) and chronic ischemic syndrome (CIS) group (n=30).The enhanced intensity (EI),volume,shape and internal echo level (EL) of plaques were detected with contrast-enhanced ultrasonic imaging and three-dimensional ultrasound combined with ultrasonic greyscale intensity quantitative analysis,and all parameters were analyzed between the two groups.Results EI and the proportion of irregular artery plaques were higher,and EL was lower in NSTE-ACS group than those in CIS group (all P＜0.05).EI,EL and shape of carotid artery and femoral artery plaques were correlated with NSTE-ACS (all P＜0.05).EI and EL of femoral artery plaques were risk factors for NSTE-ACS (OR=1.222,1.177,P＜0.05).Areas under ROC curve of EI and EL of carotid artery plaques were 0.801 and 0.757 (both P＜0.001),and those of femoral artery plaques were 0.814 and 0.774,respectively (both P＜0.001).Conclusion Neovascularization,shape and internal echo are correlated with NSTE-ACS,and the correlation of femoral artery plaques with NSTE-ACS is more significant than that of carotid artery plaques.Detecting ultrasonic characteristics of femoral artery atherosclerotic plaque can provide references to early identify unstable plaque and screening high-risk patients with CHD.

Objective To investigate the current popularity of ERCP training in China.Methods A questionnaire-based survey was performed on a professional survey website.A total of 48 questions were designed,including personal information,training information,current status of ERCP performance and sug-gestions to ERCP training.The questionnaire was completed anonymously by physicians who fulfilled full-time ERCP training in any Chinese endoscopy center for at least 1 year before.Results A total of 464 phy-sicians,from all the regions of mainland China,among which 362 people completed all the questions.More than two thirds trainees thought that they had got fruitful training and 27.4% trainees had their ERCP vol-umes greatly increased and 64.3% trainees increased practice.According to related index,the physicians who were competent in routine ERCP performance were 84.5%,with outstanding operators of 12.2%.Con-clusion China has made great progress in the training program of ERCP technique in recent decades,but problems still remain such as various admission standard,insufficient training duration,incomprehensive program,as well as lack of evaluation and follow-up system.

Objective To assess the clinical value and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for duodenal lesions.Methods The data of 12 patients with duodenal space-occupying lesions underwent EMR or ESD from January 2010 to December 2015 in Chinese PLA General Hospital were retrospectively analysed.Results All patients received operation, including 9 male and 3 female with mean age of 50.0 years(33.0-62.0 years).There were 8 lesions in duodenal bulb and 4 in descending part.The mean diameter of the lesions was 1.2 cm (0.5-3.0 cm).Three lesions were originated from mucosa, of which 2 were high-grade intraepithelial neoplasia and 1 was villous/tubular adenoma.Nine lesions were located in submucosa, including 3 cases of neuroendocrine neoplasm, 1 case of stromal tumor, 1 liomyoma case, 1 lipoma case, 1 case of Brunner glands adenoma, 1 case of ectopic pancreas, and 1 inflammatory lesion.One patient had perforation with rate of 8.3%(1/12) and was recovered after conserved treatment.The bleeding was very little during operation.No infection or stenosis happened.The mean hospitalized time was 6.0 days (1.0-12.0 days) after operation.No recurrence was found during 23.8 months(3.0-73.0 months) of follow-up.Conclusion EMR and ESD are effective and safe for treatment of duodenal space-occupying lesions.

Purpose: The aim of this study was to evaluate the value of elastography in the differential diagnosis of benign versus malignant testicular lesions. Methods: The PubMed, Cochrane Library, and Embase databases were searched for relevant studies. The diagnostic accuracy of elastography was evaluated using pooled sensitivity, specificity, likelihood ratio, post-test probability, diagnostic odds ratio, and by summarizing the area under the hierarchical summary receiver operating characteristic (HSROC) curve. Results: Seven studies with 568 lesions were included. The pooled sensitivity and specificity were 87% (95% confidence interval [CI], 81% to 92%) and 81% (95% CI, 65% to 90%), respectively. The pooled estimates of the positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 4.48 (95% CI, 2.37 to 8.47), 0.16 (95% CI, 0.10 to 0.25), and 28.11 (95% CI, 11.39 to 69.36), respectively. The area under the HSROC curve was 90% (95% CI, 88% to 93%). Conclusion Elastography is useful for assessing the stiffness of testicular lesions and for differentiating benign from malignant lesions. Elastography can be an effective supplement to conventional ultrasonography.

OBJECTIVETo study the expression of tumorigenesis-related stem cell markers Lgr5 and CD44 in different pathological types of intestinal polyps and their clinical significance in predicting tumorigenesis.

METHODSA total of 145 cases of colorectal polyps, adenomas and cancer tissues were obtained by colonoscopy biopsy. Immunohistochemistry was employed to detect the expression of Lgr5 and CD44 to analyze their relationship with the occurrence and prognosis of colon and rectal cancer.

RESULTSThe expression of CD44 in colon cancer tissue was 95.65%, significantly higher than that in normal mucosa (5%), inflammatory hyperplastic polyps (22.58%), tubular adenomatous polyps (55.26%) and villous polyps (75.76%) (P<0.05). The expression of Lgr5 in colorectal cancer was up to 95.65% while negative in normal colorectal tissue and was 16.12% in inflammatory hyperplastic tissues (P<0.05). The expression rate of Lgr5 was 86.84% in tubular adenoma and 93.94% in villous polyps, both comparable with that in colon cancer (P>0.05). Correlation analysis indicated that the expression of CD44 and Lgr5 were positively correlated with the progression of intestinal polyp tumorigenesis (rs=0.69377, P<0.0001; rs=0.81637, P<0.0001).

CONCLUSIONLgr5 and CD44 are highly expressed in colorectal cancer tissues in close correlation with the clinical and pathological features. The expression profiles of Lgr5 and CD44 represent a distinct feature to differentiate colorectal cancer from normal intestinal mucosa. Lgr5 is more closely correlated with tumor progression of polyps than CD44. This means detecting of the expression of Lgr 5 together with CD44 is important and necessary in clinical diagnosis of patients with early stage colorectal diseases such as polyps and their canceration.

Adult ; Aged ; Colorectal Neoplasms ; metabolism ; pathology ; Female ; Humans ; Hyaluronan Receptors ; metabolism ; Intestinal Polyps ; metabolism ; pathology ; Male ; Middle Aged ; Prognosis ; Receptors, G-Protein-Coupled ; metabolism ; Young Adult

Objective:To explore the therapeutic effect of peroral endoscopic myotomy (POEM) for primary achalasia (AC) in patients aged over 60 years.Methods:Data of 146 patients aged ≥60 years (the elderly group) and 146 patients aged 18-59 years (the adult group) who received POEM from November 2010 to September 2019 at the Digestive Endoscopy Center of PLA General Hospital were retrospectively analyzed. Baseline data, surgery data, surgery-related complications and surgery-related efficacy were compared.Results:There was no significant difference in gender, Ling classification, HRM classification or previous treatment between the two groups ( P>0.05). All 292 patients successfully underwent POEM surgery. The clinical success (Eckardt score ≤3) rates in the elderly group and the adult group were 96.33% (105/109) and 96.77% (90/93), respectively with no significant difference between the two groups ( χ2=0.030， P>0.05). There was no significant difference in the length of myotomy between the two groups (7.09±2.49 cm VS 7.12±2.24 cm， t=0.472， P>0.05). Complications occurred in 26 cases (17.81%) in the elderly group and 21 cases (14.38%) in the adult group with no significant difference between the two groups ( χ2=0.634， P>0.05). There was no significant difference in the postoperative hospital stay (12.61±9.69 days VS 11.00±4.43 days, t=1.825, P>0.05) or the incidence of gastroesophageal reflux [43.33% (13/30) VS 51.52% (17/33), χ2=0.422, P>0.05] between the elderly group and the adult group. Conclusion:The efficacy of POEM for AC patients over 60 years old is equivalent to that of adult patients, and the incidence of complications is similar. POEM is safe and effective for AC patients over 60 years old.

Objective:To evaluate the efficacy and safety of endoscopic biliary drainage for biliary fistula.Methods:Data of consecutive 409 biliary fistula patients who were treated and diagnosed at the First Medical Center of Chinese PLA General Hospital from November 2002 to November 2022 were reviewed, and 53 patients who received endoscopic retrograde cholangiopancreatography (ERCP) drainage were finally included. General information, procedural conditions, clinical outcomes and adverse events were analyzed. The patients were categorized into two groups: the endoscopic retrograde biliary drainage (ERBD) group ( n=46) and the endoscopic nasobiliary drainage (ENBD) group ( n=7). Procedural characteristics, operation outcomes, and operation time were compared between the two groups. Results:There were 36 males and 17 females, with the age of 52.2±12.7 years, among whom 58.5% (31/53) were secondary to cholecystectomy. Clinical success was achieved in 83.0% (44/53) patients, with the operation time of 27.0 (13.5, 33.5) minutes and the treatment session of 1 (1, 2). The time to resolution was 89 (47, 161) days. The success rate of ERCP for low-grade biliary fistula was higher compared with that of high-grade biliary fistula [96.4% (27/28) VS 68.0% (17/25), χ2=7.57, P=0.006]. Bridging drainage achieved higher success rate compared with that of non-bridging drainage [91.7% (33/36) VS 64.7% (11/17), χ2=5.95, P=0.015], while different diameters of stents (≥10 Fr VS <10 Fr) achieved similar success rate [81.8% (27/33) VS 84.6% (11/13), χ2=0.05, P=0.822]. Adverse events occurred in 10 patients (18.9%), including 6 pancreatitis, 2 bleeding, 1 cholangitis and 1 death. Except for 1 death, 9 other adverse events were mild and managed with conservative treatment without interventions. There was no significant difference in clinical success rate [6/7 VS 82.6% (38/46), χ2=0.04, P=0.838] or the median operation time [28.0 min VS 23.0 min, Z=0.38, P=0.774] between ENBD group and ERBD group. Conclusion:Endoscopic biliary drainage is safe and effective for biliary fistula. ENBD and ERBD have comparable clinical efficacy. ERCP for low-grade biliary fistula may achieve a higher success rate, and bridging drainage may facilitate fistula resolution.