Objective To evaluate the therapeutic effectiveness and safety of endoscopic submucosal dissection (ESD) with improved snare for colorectal polyps and submucosal tumors.Methods The clinical data such as clinical pathological characteristics, en bloc resection rate, curative resection rate, complications and follow-up results of 20 patients with colorectal polyps or submucosal tumors, who were treated by ESD, were retrospectively analyzed.Results 20 patients (total 24 lesions) with colorectal polyps or submucosal tumors were performed ESD operation successfully, in which 16 cases (total 20 lesions) were treated by ESD with improved snare (the trial group), 4 cases were treated by ESD with HOOK knife (the control group).The surgical success rate was 100.0% (24/24), the en blot resection rate was 100.0% (24/24). The mean polyps diameter in the trial group was (2.4 ± 0.9) cm (1.2~4.0 cm), while that in the control group was (2.2 ± 0.6) cm (1.5~3.0 cm). The mean procedure time in the trial group was (83.3 ± 23.9) min (45.0~120.0 min), while the control group was (66.2 ± 15.4) min (45.0~80.0 min), compared with the control group, the trial group need more times to complete the operation. The postoperative pathology as follows: 15 cases were adenoma (including 3 cases of adenoma with partial gland high-grade intraepithelial neoplasia), 1 case was hyperplastic polyp, 1 case was high-grade intraepithelial neoplasia, 2 cases were neuroendocrine tumor (total 4 lesions) 1 case was stromal tumor. Except for 1 case of stromal tumor from the muscularis propria was taken full thickness resection, no patient appeared complications such as hemorrhage, perforation, infection. No patient need intraoperative and postoperative surgical treatment.Conclusion Improved snare can be used to endoscopic submucosal dissection for large colorectal polyps and submucosal tumors safely and effectively, expanded the use and indications of snare in endoscopic resection, but need more times to completed the operation.

Objective:To explore the effect of multidisciplinary team (MDT) model on prognosis of patients with traumatic amputation.Methods:A retrospective case-control study was conducted to analyze the clinical data of 54 patients with traumatic amputation admitted to Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from July 2014 to June 2019. There were 41 males and 13 females, aged 39-72 years with an average age of 52.7 years. A total of 29 patients treated using MDT model intervention were served as observation group, and 25 patients treated using routine responsibility system holistic nursing as control group. The self rating anxiety scale (SAS) score, self rating depression scale (SDS) score and improved Barthel index were compared between the two groups on the day of admission and at 2 weeks, 4 weeks and 8 weeks after operation.Results:There was no significant difference in SAS, SDS and improved Barthel index between the two groups on the day of admission ( P>0.05). At 2 weeks, 4 weeks and 8 weeks after operation, the SAS score in observation group was respectively (52.5±7.6)points, (48.3±7.1)points and (41.3±6.1)points, lower than those in control group [(58.0±12.0)points, (54.4±10.7)points and (50.4±9.3)points]; the SDS scores in observation group was respectively (52.6±8.8)points, (47.9±7.6)points, (43.8±5.7)points, lower than those in control group [(58.4±12.4)points, (53.2±10.9)points, (49.5±8.7)points]; the Barthel index score in observation group was respectively (57.2±8.9)points, (80.7±7.7)points, (94.7±3.9)points, higher than those in control group [(50.4±11.4)points, (70.9±9.5)points, (85.6±6.8)points] (all P<0.05). Conclusion:For patients with traumatic amputation, MDT model is conducive to reducing anxiety and depression of patients, can improve the quality of life, and is worthy of clinical application.