Objective Explore the differences in effectiveness and safety between endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early esophageal cancer (EEC).Methods Papers published from January 1990 to December 2012 in Medline,Embase,Cochrane library,Wanfang,VIP and CNKI were searched in English and Chinese respectively to identify the studies comparing ESD with EMR for EEC.Meta-analysis for each outcome of the included studies that were identified by the inclusion criteria and the exclusion criteria was conducted using software Revman 5.1.Outcome measures consisted of three effectiveness-relevant measures (rates of en bloc resection,curative resection,local recurrence) and four safety-relevant measures (bleeding,perforation,stenosis and operation time).Results A total of 8 non-randomized retrospective cohort studies (five full-text and three abstracts) were included.Meta-analysis showed significantly higher rates of en bloc resection [98.36％ (360/366) vs.41.79％ (252/603),P ＜ 0.01],curative resection [90.81％ (168/185) vs.50.65 ％ (194/383),P ＜ 0.01] and perforation [4.51％ (21/466) vs.1.25％ (8/640),P =0.03] in ESD group compared with EMR group,and the rate of local recurrence was significantly lower in ESD group [0.55％ (2/366) vs.13.76％ (83/603),P ＜0.01].There were no significant differences in the rates of bleeding [0.21％ (1/466) vs.0.63％(4/640),P =0.41] or stenosis [10.48％ (39/372) vs.10.15％ (41/404),P =0.89].Conclusion Compared with EMR,ESD showed obvious advantages of effectiveness and resemble risks for endoscopic resection of EEC,therefore ESD should be the first choice for endoscopic treatment of EEC.

Objective To investigate the alternation of right ventricular volume and systolic function in patients with severe pulmonary regurgitation under percutaneous pulmonary valve implantation(PPVI) by real-time three-dimensional echocardiography(RT-3DE).Methods Ten patients with severe pulmonary regurgitation were enrolled.The 2D echocardiography images and real-time 3D full volume images on apical four-chamber view on a Philips IE33 system were acquired before PPVI and at 3 days,1 month,3months and 6 months after PPVI.Right ventricular end diastolic volume (EDV),end systolic volume(ESV),stroke volume (SV),ejection fraction(EF),fractional area change(FAC),tricuspid annular plane systolic excursion (TAPSE),right ventricular longitudinal strain-free wall(RVLSf) and right ventricular longitudinal strainseptum(RVLSs) were analysed using off-line TomTec software,the differences among the five groups were compared,and correlation analysis was made between the CMR and RT-3DE measurements.Results The level of pulmonary regurgitation had decreased or disappeared after PPVI.Compared with the preoperation,EDV,ESV at 3 days,1 month,3months and 6 months after operation had decreased significantly.EF,FAC,TAPSE,RVLS had increased significantly(all P ＜0.05).There were close correlation in EDV,ESV,EF between RT-3DE and CMR(pre-operation r =0.811,0.817,0.807,post-operation r =0.735,0.834,0.800,all P ＜0.055).Conclusions RV volume notably decreases while RV systolic function remarkably improves.The RT-3DE is a helpful technology in the evaluation of right ventricular volume and systolic function in patients after PPVI.

OBJECTIVESTo increase the diagnosis and treatment of ectopic ACTH syndrome.

METHODSThe data of 12 ectopic ACTH syndrome patients treated from 1985 to 1999 were retrospectively analyzed.

RESULTSTwelve patients were diagnosed as having ACTH syndrome by endocrinary test and primary tumors were ascertained by imaging examination. Follow-up from 7 months to 8 years showed 3 out of 5 patients with radical resection of primary tumor died. One patient with bilateral adrenorectomy was still alive. All patients received only chemotherapy except one died.

CONCLUSIONSPatients with Cushing's syndrome should be evaluated by endocrine test and followed up by imaging screen examination. The key points to increase treatment effect include early detection, localization and resection of primary tumors.

ACTH Syndrome, Ectopic ; Adrenocorticotropic Hormone ; Cushing Syndrome ; Humans

Objective: To investigate the effects of apolipoprotein E deficiency (Apo E^-/-) on plasma and lipoprotein distribution of sphingosine-1-phosphate (S1P) in mice. Methods: Five male or female Apo E^-/- or wild type (WT) mice were fed with chow diet and sacrificed at 32-week-age and plasma was collected. The constituents of lipoprotein(very low density lipoprotein (VLDL), low density lipoprotein (LDL), high density lipoprotein (HDL)) were separated by ultracentrifuge. The protein concentration of constituents was detected by BCA protein quantitative kit, and the S1P concentration in plasma and various lipoprotein constituents was detected by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Western blot was used to determine the plasma, liver, and kidney protein expression of apolipoprotein M(Apo M), which is considered as specific ligand of S1P.The S1P concentration in plasma and various constituents of lipoprotein in the Apo E^-/- mice was compared to respective WT mice. Results: (1)Plasma S1P content was significantly higher in the Apo E^-/- groups than that of WT groups (male: (535.7±78.5)nmol/L vs. (263.3±22.0)nmol/L; female: (601.1±64.0)nmol/L vs. (279.0±33.9)nmol/L; all P<0.01). (2) Compared with WT mice, S1P content in non-HDL(LDL+ VLDL) was significantly higher in Apo E^-/- mice (male: (504.9±52.8)nmol/L vs. (28.7±9.0)nmol/L; female: (427.7±27.4) vs. (27.8±4.7)nmol/L; after standardization of protein concentration, male: (385.0±41.2)pmol/mg protein vs. (71.4±6.6)pmol/mg protein; female: (330.2±22.0)pmol/mg protein vs. (67.2±12.1)pmol/mg protein; all P<0.01). (3) The expression of Apo M in plasma, liver and kidney was significantly higher in Apo E^-/- groups than that of WT groups(all P<0.05). Conclusion The deficiency of Apo E could lead to upregulated S1P expression in the non-HDL, the underlying mechanism might be the increased transfer of HDL into the non-HDL by Apo M-S1P.

OBJECTIVETo understand the Escherichia coli O157:H7 carrier rate of host animals and the toxic gene of the strains in different areas in Jiangsu province.

METHODSSurveillance spots were set up in different areas, to collect feces of pigs, chickens, sheep, cattle to culture for O157:H7 with immunomagnetic separation as well as detection of toxic gene of the strain with MPCR were both carried out.

RESULTSOne hundred and seventy strains of O157:H7 were separated from 1 767 feces of different animals in six spots, with a overall positive rate 9.62%. The positive rates of cattle and sheep were 19.05% and 12.01% respectively. Among 85 strains SLT1, SLT2, eaeA and hly toxic genes were detected. In which, 56.47% of the strains were positive curturely while 79.17% of them carried SLT2, eaeA and hly gene simultaneously.

CONCLUSIONThe positive rate of O157:H7 in animals and the positive rates of strains were correlated to the incidence of the area. The highest rates were seen in areas where there had been O157:H7 epidemic, followed by the areas where there were only scattered cases identified while the lowest was in areas with no patients. Data indicated that it was important to enforce the surveillance of O157:H7 in animals to better predict and control of the disease.

Animals ; Cattle ; microbiology ; Chickens ; microbiology ; China ; Escherichia coli O157 ; isolation & purification ; Rabbits ; microbiology ; Sheep ; microbiology ; Swine ; microbiology ; Time Factors

Objective To evaluate the role of transthoracic echocardiography ( T T E ) and transesophageal echocardiography( T EE) in the process of transapical mitral valve repair using a novel edge‐to‐edge device( ValveClamp) and this device′s efficacy and safety in a preliminary clinical trial . Methods Six patients with moderate to severe or severe degenerative mitral regurgitation ( DM R) confirmed by T T E and T EE were enrolled . T T E was performed pre and post procedure as well as 30 days post procedures . Related cardiac structure and hemodynamic parameters ,including mitral regurgitation area ( MRA‐max ) , vena contracta width ( VCW ) ,mitral valve effective orifice area ( M VEOA ) ,left ventricular end diastolic diameter ( LVEDD ) , left ventricular end systolic diameter ( LVESD ) , left ventricular ejection fraction ( LVEF) ,max and mean mitral valve pressure gradient ( M VPG‐max and M VPG‐mean) were recorded and evaluated in a central core laboratory . Results All the procedures were successfully performed .M RA‐max , VCW and M VEOA decreased significantly post procedures ( all P ＜ 0 .000 ) , and they remained no significant changes within 30 days post procedures ( all P ＞ 0 .05 ) . M eanwhile ,M VPG‐max and M VPG‐mean slightly increased ( all P ＜0 .01 ) and left atrial anterior‐posterior dimension attenuated 30 days post procedures( P ＜0 .05) ,but all M VPG‐mean were lower than 5 mm Hg ( 1 mm Hg＝0 .133 kPa) . T here were no significant changes in other hemodynamic parameters ( all P ＞ 0 .05) . Conclusions T ransapical mitral valve repair using ValveClamp can be performed safely and a significant reduction in mitral regurgitation can be achieved in patients with DM R . T EE and T T E facilitate the patient selection for ValveClamp procedures as well as perioperative navigation and assessment .

Hypertonic dehydration is prevalent in the elderly, increases the risk of adverse events, reduces quality of life, and increases hospitalization and mortality.Current methods of diagnosing dehydration, such as physical signs, urine tests, urea nitrogen/creatinine, bioelectrical impedance and saliva, are not suitable for the diagnosis of dehydration in the elderly.There is no gold standard for the diagnosis of hypertonic dehydration in the elderly.The European Society for Clinical Nutrition and Metabolism(ESPEN)recommends the direct measurement of plasma/serum osmotic pressure or using an osmotic pressure formula[osmolarity(mmol/L)=1.86 ×(Na + + K + )+ 1.15×glucose+ urea+ 14](all measured in mmol/L)for the diagnosis of hypertonic dehydration.

Tricuspid regurgitation (TR) interventions are under rapid development. The K-Clip? system is the first domestic transcatheter tricuspid annuloplasty system with unique clamping procedure to achieve annular reduction.Intraoperative echocardiographic monitoring procedures for transcatheter tricuspid annuloplasty have not been reported yet in China. Thus, this review aimed to propose the standard two-dimensional and three-dimensional transesophageal echocardiographic workplanes and procedures to guide and monitor the implantation of K-Clip system based on our experience in Zhongshan Hospital, Fudan University to provide a reference point for the intraoperative echocardiographic monitoring of future transcatheter tricuspid annuloplasty devices in China.

Transcatheter tricuspid valve intervention is the new frontier of interventional cardiology. The LuX-Valve is a radial force-independent orthotopic tricuspid valve replacement device developed in China. The LuX-Valve Plus transcatheter tricuspid valve replacement (TTVR) system is changed from the trans-atrial to the transjugular approach, which further reduces trauma and pulmonary complications compared with the first generation LuX-Valve. The first-in-human study has been completed at Zhongshan Hospital, Fudan University and an exploratory multicentre clinical study is underway. Echocardiography plays an important role in pre-TTVR screening, intraoperative guidance and postoperative evaluation and follow-up, especially two-dimensional transoesophageal echocardiography (2D-TEE) and three-dimensional transoesophageal echocardiography (3D-TEE). However, there is a lack of appropriate intraoperative guidance and assessment protocols. In this study, we briefly described the protocols and imaging considerations for intraoperative 2D-TEE and 3D-TEE to ensure the successful implantation of TTVR.

Objective    To investigate the relationship between the expression of programmed cell death ligand-1 (PD-L1) and the maximal standardized uptake value (SUVmax) in 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the correlation of clinical factors between SUVmax values and PD-L1. Methods    The clinical data of 84 patients with invasive lung adenocarcinoma diagnosed pathologically in West China Hospital, Sichuan University from August 2016 to November 2018 were analyzed retrospectively, including 38 males and 46 females, aged 60 (32-85) years. The tumor was acinar-predominant in 37 patients, papillary in 20, lepidic in 19, solid in 5 and micropapillary in 3. Multivariate analysis of the relationship between SUVmax value and other clinicopathological features was performed by linear regression. Logistic regression analysis was used to analyze the relationship between PD-L1 protein expression and other pathological features. Results    The SUVmax of the PD-L1 expression group was significantly higher than that of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group (P=0.002) and intermediate-grade histologic subtype (P=0.016). The SUVmax cut-off value of PD-L1 expression in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype was 5.34 (AUC: 0.732, P=0.002) and 5.34 (AUC: 0.720, P=0.017), respectively. Multivariate analysis showed that pleura involvement, vascular tumor thrombus and the increase of tumor diameter could cause the increase of the SUVmax value, while the SUVmax value decreased in the moderately differentiated tumor compared with the poorly differentiated tumor. The SUVmax cut-off value between low-grade histologic subtype and intermediate-grade histologic subtype, intermediate-grade histologic subtype and high-grade histologic subtypes was 1.54 (AUC: 0.854, P<0.001) and 5.79 (AUC: 0.889, P<0.001), respectively. Multivariate analysis of PD-L1 expression showed pleura involvement (P=0.021, OR=0.022, 95%CI 0.001 to 0.558) and moderate differentiation (opposite to poor differentiation) (P=0.004, OR=0.053, 95%CI 0.007 to 0.042) decreased the expression of PD-L1. Conclusion    The SUVmax of the PD-L1 expression group is significantly higher than that of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype. The level of SUVmax and the expression of PD-L1 in invasive lung adenocarcinoma are related to many clinical factors.