Early esophageal cancer is derived from mucosa and submucosa without lymph node metastasis. They are detected generally during endoscopy or physical examination without clinical symptoms. Main treatment of early esophageal cancer is endoscopic resection,and the 5-year survival rate is over 90% . Once symptoms occur,local lymph node metastasis is often present and the prognosis is poor with a markedly reduced 5-year survival rate. Thus it is vital to diagnose and treat esophageal cancer at an early stage. With the development of endoscopic techniques,especially the proficiency of endoscopic ultrasonography(EUS),the detection rate of early esophageal cancer has been increased greatly. EUS also plays an important role in the staging of early esophageal cancer. This article reviewed the application of EUS in diagnosis and treatment of early esophageal cancer.

Objective:To investigate the stability of flurbiprofen axetil lipid microspheres injection combined with 0. 9% sodium chloride injection or 5% dextrose injection, and provide theoretical basis for the clinical application. Methods:The content changes of flurbiprofen axetil in the mixture of flurbiprofen axetil lipid microspheres injection and 0. 9% sodium chloride injection or 5% dextrose injection were determined in 5 h at 25℃ away from light, and the changes in the appearance and particle size of flurbiprofen axetil lip-id microspheres were investigated. The changes in the appearance and particle size of flurbiprofen axetil lipid microspheres in the mix-ture of flurbiprofen axetil lipid microspheres injection and 0. 9% sodium chloride injection before and after freezing and thawing were also investigated. Results:The appearance, particle size and content had no significant changes in all mixtures in 5 h at 25 ℃ away from light. The appearance and particle size of flurbiprofen axetil lipid microspheres in the mixture before and after freezing and thawing had no significant changes as well. Conclusion:The mixture of flurbiprofen axetil lipid microspheres injection and 0. 9% sodium chlo-ride injection or 5% dextrose injection is stable in 5 h away from light.

BACKGROUND:Caspase plays a crucial role in the cellapoptosis, but the influence of different facial nerve injury on caspase 1, caspase 8, cyto-c protein expression and their correlation stil remain unclear.
OBJECTIVE:To construct facial nerve crush or distal transection injury models, observe the morphological changes of facial motoneurons, investigate death gene caspase 3, caspase 8, cyto-c expression, and analyze their correlation.
METHODS:Facial nerve crush or distal transection injury model was established in the right facial nerve of rats, while the left facial nerve served as normal controls. We observed the morphology and the death of facial motoneurons with toluidine blue staining and transmission electron microscope. Expressions of caspase 3, caspase 8 and cyto-c proteins were studied by immunohistochemistry analysis fol owing facial nerve injury.
RESULTS AND CONCLUSION:Both facial nerve distal transection and crush injury resulted in the death of facial motoneurons, and the death pattern was mainly apoptosis. Caspase 3, caspase 8 and cyto-c protein expressions were observed in the subnucleus of normal rat facial nucleus. cells of the distal transection group were stained more intensely than that of crush group. Expressions of these proteins began to increase at 3 days after the injuries. Caspase 3 and caspase 8 protein expression peaked at 14 days, whereas cyto-c protein expression peaked at 7 days after the injuries. Expressions of caspase 3, caspase 8 and cyto-c proteins were correlated with facial nerve injury type and injury time. Expressions of caspase 8 and cyto-c protein were correlated with expression of caspase 3 protein. The findings indicate that, caspase 8 and cyto-c contribute to activate caspase 3, and caspase cascade reaction plays an important role in the apoptosis of facial motoneurons.

Objective To identify the necessity to carry out optimization procedure in routine digital radiography (DR) by evaluating changes of patient radiation dose and image waste ratio before and after optimization.Methods Two hundred patients with near-standard body build were enrolled in the study.Half of them undertook routine examination,and the others undertook the examination with bestlyoptimized protocol.The dose-area product (DAP) and entrance surface dose (ESD) were recorded.The image waste ratios in 2 groups were calculated and the reasons for image waste were analyzed.The radiation dose and image waste ratio before and after optimization were compared.Results The ESD,DAP and image waste ratio in bestly-optimized radiography were significantly lower than those in non-optimized radiography (z =9.31,16.22,P＜0.05; x2 =36.5,P ＜ 0.05).Conclusion Using the bestlyoptimized digital radiography,the patient radiation dose and image waste ratio are effectively reduced.

Objective To investigate the infection status of A ngiostrongylus cantonensis in winkle from 9 cities in Guizhou Province.Methods The winkles were collected randomly from aquatic products wholesale market,agricultural market or restaurants in 9 cities (Guiyang,Zunyi,Tongren,Kaili,Anshun,Duyun,Xingyi,Bijie and Shuicheng) and classified in Guizhou Province,and the third-stage larvas of Angiostrongylus cantonensis were separated and detected with microscopy by tissue homogenization (Pomacea canaliculata was first checked with lung screening method,and then rechecked by tissue homogenization),and infection rate was calculated.Results Totally 2 177 winkles were tested,the overall infection rate of Angiostrongylus cantonensis was 1.5％ (32/2 177),among them,Pomacea canaliculata was 1 287,five was positive,and the infection rate was 0.4％; Achatinafulica was 240,positive 27,the infection rate was 11.3％; Bellamya lithophaga was 372 and all 278 Cipangopaludina chinensis was not positive.Conclusions There is a higher risk of infection with Angiostrongylus cantonensis if eating winkles.The third-stage larva in Pomacea canaliculata and Achatina fulica has been found in Guizhou Province.Market management,food-safety inspection of the winkles on sale,and public health education should be strengthened.

Objective　To investigate the current status and attrition among HIV-infected persons receiving antiretroviral therapy (ART), and to analyze factors affecting attrition in Hainan. Methods　In this study, HIV-infected patients who started ART treatment in Hainan Province from 2005 to 2022 were selected from the antiviral treatment submodule of China Disease Prevention and Control Information System.According to the inclusion and exclusion criteria,a total of 4 286 HIV-infected persons were receiving . A Cox proportional hazards regression model was used to analyze factors affecting attrition. Results　Among the 4 286 study subjects, 3 718 were males (86.7%), with a sex ratio of 6.55∶1. Unmarried individuals accounted for 58.4%, and the average age was (39.68±13.17) years. Transmission through homosexual contact accounted for 49.8%, and 84.3% were in WHO clinical stage I. Treatment regimens containing Efavirenz (EFV) accounted for 71.7%. During a follow-up of 19 677.44 person-years, the overall attrition rate was 0.80 per 100 person-years, with the first-year post-ART initiation attrition rate being 21.10 per 100 person-years. The results of Cox regression analysis showed that the time of treatment initiation in 2016-2022 (AHR=2.40, 95%CI: 1.40-4.10), and the last HIV viral load (VL) 20-<1 000 copies/mL (AHR=3.69, 95%CI: 2.08-6.54), the last HIV-1 VL≥1 000 copies/mL (AHR=15.98, 95%CI: 9.46-27.01), and no last HIV-1 VL test (AHR=92.90, 95%CI: 57.68-149.62), the time interval from diagnosis to treatment for 1-12 months (AHR=1.62, 95%CI: 1.12-2.36), and an interval longer than 12 months (AHR=1.68, 95%CI: 1.07-2.62) were the main factors that increased the risk of attrition. Treatment regimens containing Lopinavir/ritonavir (Lpv/r) (AHR=0.34, 95%CI:0.18-0.66) and treatment regimens containing integrase strand transfer inhibitors (INSTIs) (AHR=0.24, 95%CI: 0.09-0.58) were the factors that reduced the risk of attrition after antiretroviral therapy. Conclusions　The attrition of ART in HIV/AIDS patients in Hainan Province is related to a longer interval from diagnosis to treatment, treatment plan, and abnormal HIV viral load test results. Case-based measures should be taken to address factors influencing antiretroviral treatment attrition, while improving the timeliness of antiviral treatment and treatment management service quality to further improve the efficacy of antiviral treatment.

Objective To study the roles of abnormal expressions of Caspase-8 and protein kinase C(PKC)-β of cardiomyocytes in the development of the apoptosis of cardiomyocyte in diabetic rat. Methods Rats were divided into 4 groups:(1)normal control (NC, n=37),(2)rats given STZ injection and normal diet(STZ,n= 42), (3) rats fed with high fat and high sngar ( HFS, n= 37), (4)rats given STZ injection and high fat and high sugar diet (type 2 DM, n=64). Plasma glucose, insulin and lipids were detected. At the end of experiment, the animals were sacrificed, and their hearts were examined. Pathological changes were observed and the expressions of Caspase-8, PKC-β mRNA were determined by real time-PCR method; apoptosis was analyzed by flow cytometry. Results (1)The body weight was higher in HFS group than in other three groups, and progressively decreased in type 2 diabetes group. The glucose level was highest in diabetic group, and was similar between groups of HFS and NC. (2)The apoptosis showed tendency to ascend during course of disease in diabetes model group. (3)The expressions of Caspase-8 and PKC-β mRNA were significantly enhanced in diabetes model group than in normal control group, and had a tendency to ascend during the course of disease.(4)The myocardial cells of the diabetic rats were rarified and swelling, fibrosis was observed. (5)At the 16th week, the level of plasma glucose was correlated positively with the expressions of Caspase-8 and PKC-β mRNA. Conclusions The enhancement of expressions of Caspase-8 amd PKC-β may play iportat rols in the pathogenesis of diabetic cardiomyopathy,in which apoptosis of the cardiomyocytes increased.

Objective To study the dynamic changes of injury and apoptosis of liver induced by lipid metabolic disturbance in the rats with diabetes mellitus and their correlation with the expressions of sterol regulatory element binding protein-1c(SREBP-1c)and c-Jun N-terminal kinase(JNK).Methods Experimental animals were randomly divided into 4 groups:diabetesgroup(n=64)induced by high-carbohydrate and high-fat diet plus intra-peritoneal streptozeotocin(STZ)injection,normal control(n=37)fed regular diet and receiving citric buffer solution injection,STZ group(n=42)fed regular diet and receiving STZ injection,high gluaxeard fat group(n =37)receiving citric buffer solution injection.Body weight,liver weight,fasting plasma glucose(FPG),fasting insulin(FINS),triglyceride(TG),total cholesterole(TC),alanine transaminase(ALT),asparate transaminase(AST)were detected at various time intervals.The changes of liver histopathology and ultrastructure were observed by ES and Sudan Ⅲ stanings,transmission electrom microscope.The expressions of SREBP-1c and JNK mRNAs and proteins were determined by real time-PCR methods.Apoptosis was analyzed by flow cytometry.Results The diabetic rats showed much lower body weight(P＜0.05)and higher liver weight than controls,STZ group and high-carbohydrate and fat group(P＜0.05),while showed higher levels(P＜0.05)of serum FPG,FINS,TG,TC,ALT,AST.Diabetic rats exhibited fatty degeneration of liver cells accompanied by inflammatory infiltration and fibrosis.Organelle structures were more disturbed and apoptosis was more obviou along with longer course of disease.The expressions of SREBP-1c,JNK proteins and mRNA were significantly enhanced.The rats fed high-carbohydrate and fat diet also showed similar liver lesions and enhanced SREBP-1c,J NK proteins and mRNA expressions but not as severe as in diabetes group Conclusions Insulin resistance and high blood glucose may induce diabetic hepatopathy.The high expressions of JNK and SREBP-1c may play important roles in liver lipid metabolism disorders and cell apoptosis.

Objective To study the development of cardiomyopathy complicated with type 2 diabetes mellitus in the rats. Methods The 120 health male Sprague-Dawley rats, weighing 180-220 g, were divided into 4 groups: (1)STZ-modeled diabetes, fed with high-carbohydrate plus high-fat diet (n=40);(2)fed with regular diet (n=30);(3)and (4)SD rats with citrate buffer instead of STZ injection, fed with high-carbohydrate and high fat diet (n= 25);and fed with regular diet (n= 25); At the 4th, 8 th, 12 th and 16 th week after the intra-peritoneal injection of STZ solution or citrate buffer solution, rats from each group were scarified and examined. Results There were no significant differences in body mass and blood glucose among those groups after one week of feeding (P＞0. 05).After 4 weeks of feeding before injection, the body mass, fasting insulin (FINS) and insulin sensitive index (ISI) were obviously increased in diabetes group and high-carbohydrate plus high-fat control group as compared with STZ control group and normal control group (P＜ 0. 05). There were no significant differences between diabetes group and high-carbohydrate plus high-fat control group,between STZ control group and normal control group (P＞0. 05). After injection, the blood glucose,body mass, ventricular mass, TG and TC were higher in diabetes group and high-carbohydrate plus high-lipid control group than in STZ control group and normal control group (P＜0.05). The above parameters were much higher in diabetes group than in high-carbohydrate plus high-lipid control group, but there was no difference between STZ control group and normal control group (P＜0. 05).Pathological examination showed that the weight of the heart was significantly increased, the myocardial cells were hypertrophied accompanying degenerative changes and apoptosis, the interstitial collagen fibers were hyperplasia in the diabetic rats. The ultrastructures also presented severe damage.These changes indicated that cardiomyopathy was induced in the diabetes rats. Although similar changes were found in the rats fed with high-carbohydrate plus high-fat diet, they were much less significant than those in the diabetic rats. Conclusions Cardiomyopathy developes frequently in the rats with type 2 diabetes mellitus induced by feeding high-carbohydrate plus high-lipid diet and single intra-peritonial injection of 30 mg/kg STZ solution.

Objective To investigate the curative effect of bronchoalveolar lavage with fiberoptic bronchoscopy combined with vibration sputum drainage in the treatment of severe pneumonia patients undergoing mechanical ventilation (MV).Methods A prospective randomized controlled trial was conducted. 286 severe pneumonia patients undergoing MV admitted to intensive care unit (ICU) of Hunan People's Hospital from January 2014 to July 2016 were enrolled, and they were divided into control group and observation group according to random number table, with 143 patients in each group. Patients in both groups received sensitive antibiotics for anti-infection, etiological treatment, and calefacient and humidifying treatment. The patients in the control group received bronchoalveolar lavage with fiberoptic bronchoscopy, and those in the observation group received bronchoalveolar lavage combined with vibration sputum drainage. The parameters of respiratory function and inflammation before and after treatment, curative effect, and prognosis were compared between the two groups.Results ① There were no significant differences in respiratory function parameters between the two groups before treatment, 2 hours after treatment, the parameters were improved in both groups. Moreover, oxygenation index (PaO2/FiO2) in observation group was significantly higher than that of control group [mmHg (1 mmHg = 0.133 kPa): 379.1±20.2 vs. 351.8±24.7], and arterial partial pressure of carbon dioxide (PaCO2) and airway resistance (Raw) were significantly lower than those of the control group[PaCO2 (mmHg): 36.5±5.8 vs. 45.3±6.9, Raw (cmH2O, 1 cmH2O = 0.098 kPa): 12.9±0.6 vs. 13.1±0.8, allP < 0.01]. ② There were no significant differences in inflammation parameters between the two groups before treatment, 24 hours after intervention, which were significantly decreased in both groups. Moreover, white blood cell count (WBC), procalcitonin (PCT) and C-reactive protein (CRP) in the observation group were significantly lower than those of the control group [WBC (×109/L): 8.2±1.7 vs. 12.8±3.7, PCT (μg/L): 15.4±2.4 vs. 21.8±3.1, CRP (mg/L): 37.1±6.1 vs. 67.2±7.2, allP < 0.01]. ③ Compared with the control group, the treatment efficiency of observation group was improved [95.1% (136/143) vs. 87.4% (125/143)], the quantity of sputum excretion was increased (mL: 49.2±12.5 vs. 36.9±11.0), duration of MV and length of ICU stay were significantly shortened (days: 6.4±3.6 vs. 9.4±2.1, 8.6±5.7 vs. 12.4±4.6, bothP < 0.01), however, there was no significantly statistical difference in 28-day mortality between control group and observation group [2.8% (4/143) vs. 2.1% (3/143),P > 0.05].Conclusion Compared with bronchoalveolar lavage with fiberoptic bronchoscopy alone, the treatment of bronchoalveolar lavage combined with vibration sputum drainage is more effective in sputum excretion for severe pneumonia patients undergoing MV, which could improve the respiratory function, reduce infection, shorten the duration of MV and the length of ICU stay, and improve the recovery.