Objective:To investigate the effect of paper towel combined with 360° horizontal turning over method on the field of vision, operation time and detection of small lesions before gastroscopy, so as to improve the detection rate of early gastrointestinal cancer.Methods:The outpatients and inpatients who voluntarily accepted gastroscopy in the First Affiliated Hospital of Shandong First Medical University from May to October 2020 were enrolled. A prospective randomized controlled study was used. They were divided into the experimental group (paper towel group combined with 360° horizontal turning over) and the control group (routine) according to the random number table. Finally, a total of 948 patients were included, including 487 cases in the experimental group and 461 cases in the control group. The visual field clarity, operation time, rinse times, detection of micro lesions and detection of early cancer of the two groups were compared.Results:The scores of gastric mucosa clarity (fundus, body, antrum and whole stomach) in experimental group were (1.61 ± 0.79), (1.18 ± 0.56), (1.01 ± 0.36), (3.20 ± 0.51) points, which were significantly lower than (2.56 ± 0.82), (2.01 ± 0.65), (1.98 ± 1.10), (5.05 ± 0.89) points in control group. The difference was statistically significant ( t values were 0.02-0.07, all P<0.05). The operation time of the experimental group was (5.91 ± 0.41) min, which was significantly shorter than (6.80 ± 0.72) min of the control group, and the difference was statistically significant ( t=-7.46, P<0.05). The number of flushing in the experimental group was 67 times, accounting for 13.8%, which was significantly lower than 144 times in the control group, accounting for 31.2%, and the difference was statistically significant ( χ2=54.78, P<0.05). The number of microlesions in the experimental group was 398 cases, which was higher than 245 cases in the control group. The difference was statistically significant ( χ2=8.43, P<0.05). For biopsy pathology, the detection of precancerous lesions or early carcinomas in the experimental group (56 cases) was significantly higher than that in the control group (24 cases), and the difference was statistically significant ( χ2=6.45, P<0.05). Conclusions:The application of paper towel combined with 360° horizontal turning over method before gastroscopy can significantly improve the clarity of gastroscope field of vision, shorten the operation time, increase the detection rate of small lesions, and effectively improve the detection rate of early gastrointestinal cancer, which is a simple and practical preoperative preparation method.

OBJECTIVE: To explore the genetic basis, clinical phenotype and pathogenesis for a child with mosaicism ring chromosome 4. METHODS: Clinical data of the child was collected. Peripheral blood chromosomal karyotype G banding analysis, chromosomal microarray analysis (CMA), fluorescence in situ hybridization (FISH) were carried out for the child, in addition with a review of the literature. RESULTS: The child was born full-term with low birth weight, facial dysmorphism, patent ductus arteriosus and ventricular septal defect. His karyotype was determined as mos46,XY,r(4)(p16.3q35.2)[259]/45,XY,-4[25]/47,XY,r(4)(p16.3q35.2), +r(4)(p16.3q35.2)[8]/46,XY,der(4)del(4)(p16.3)inv(4)(p16.3q31.1)[6]/46,XY,dic?r(4;4)(p16.3q35.2;p16.3q35.2)[4]/48,XY,r(4)(p16.3q35.2),+r(4)(p16.3q35.2)×2[3]/46,XY,r(4)(p1?q2?)[2]; CMA result was arr[GRCH37]4p16.3(68 345-2 981 614)×1; FISH result was 45,XY,-4[12]/45,XY,-4×2,+mar1.ish r1(4)(WHS-,D4Z1+)[1]/ 46,XY,-4,+mar1.ishr1(4)(WHS-,D4Z1+)[73]/46,XY,-4,+mar2.ishr2(4)(WHS-,D4Z1++)[1]/47,XY,-4,+mar1×2.ishr1(4) (WHS-, D4Z1+)×2[4]/46,XY,del(4)(p16.3).ish del(4)(p16.3)(WHS-,D4Z1+)[9]. CONCLUSION In this case, the ring chromosome 4 as a de novo variant has produced a number of cell lines during embryonic development and given rise to mosaicism. The clinical phenotype of ring chromosome 4 is variable. The instability of the ring chromosome itself, presence of mosaicism, chromosome breakpoint and range of deletion and/or duplication may all affect the ultimate phenotype.
Humans ; Pregnancy ; Female ; Ring Chromosomes ; In Situ Hybridization, Fluorescence ; Karyotyping ; Karyotype ; Mosaicism