Objective To investigate the value of three-dimension (3D) ultrasound in identification of benign or malignant gastric ulceration. Methods A total of 88 patients with gastric ulcer were collected in Tianjin Nankai Hospital from March 2014 to May 2015, including 36 malignant cases and 52 benign cases confirmed by pathological results. Results of 2D ultrasound, 3D ultrasound and gastroscope diagnosis were compared, and the diagnostic values of the three methods were evaluated by the gold standard of pathologic results. Receiver operating characteristic (ROC) curves were plotted for the main measurement indicators (ulcer surface width, ulcer surface depth and thickness of stomach wall) of 3D ultrasound. The best cut-off value was determined. Results The positive rate of malignant gastric ulcer diagnosed by 3D ultrasound was significantly higher than that of 2D ultrasound (P=0.002), but there was no significant difference between 3D ultrasound and gastroscope detection (P=0.453). The diagnostic sensitivities of malignant gastric ulcer were 86.11%, 58.33%and 91.67%for 3D ultrasound, 2D ultrasound and gastroscope detection respectively. The diagnostic specificities were 100%, 100%and 96.15% respectively. The areas under the ROC curves measured by 3D ultrasound were 0.750, 0.940 and 0.977 for ulcer surface width, ulcer surface depth and thickness of stomach wall. And the best cut-off values of the three indicators were 16.55 mm, 8.05 mm and 9.90 mm. Conclusion The 3D ultrasound can show the form and structure of gastric ulcer more clearly and intuitively, which is valuable for the differential diagnosis of benign gastric ulcer and malignant gastric ulcer, and may be used for screening malignant gastric ulcer.

Objective To evaluate the feasibility,safety and efficacy of ESD for precancerous lesions and early cancer of remnant stomach after partial gastrectomy.Methods ESD was performed in 11 cases of high grade intraepithelial neoplasia/early cancer of remnant stomach.The short-term and long-term indices including time of procedure,complication,En Bloc resection rate,R0resection rate,local recurrence rate as well as lymph node metastasis were recorded and analysed.Results ESD was completed in all patients with only one case of delayed massive bleeding which was controlled by endoscopy successfully.Average procedure time,En Bloc resection rate,R0 resection rate were 85.5 minutes,100％ and 90％,respectively.No local recurrence or lymph node metastasis was detected during post-ESD surveillance (15 ～ 51 months).Conclusion High grade intraepithelial neoplasia and early cancer of remnant stomach after partial gastrectomy might be indication for ESD because of its safety and definite effect.Additionally,careful management of the fibre tissue is the key to procedure success.

Objective To study the effect of pioglitazone on the differentiation and function of rat osteoclast-like cells (OLC), and to probe the relationship between activated PPARγ2 and osteoclasts. Methods On day 1 of OLC formation from nonadherent bone marrow ceils (BMC) obtained from rats induced by M-CSF and receptor activator of NF-кB ligand (RANKL), 1, 5 and 10μmol/L pioglitazone hydrochloride was added. RT- PCR was performed to determine the mRNA expressions of PPARγ2 and receptor activator of NF-кB (RANK) on day 3, 5 and 7 during incubation, the number of tartrate-resistant acid phosphatase (TRAP)-positive cells,the number of bone resorption pits and the ratio of its area on dentin slice were counted, the activity of TRAP and the mean fluorescence intensity of integrin β3 (CD61) of OLC were also measured. Results (1) The effect on the differentiation of OLC: The addition of pioglitazone at the start of the culture period induced a dose-dependent decrease in TRAP-positive OLC and the activity of TRAP (P < 0.01 or P < 0.05) ; the mRNA expression of PPARγ2 was up-regulated by 5 and 10 μmol/L pioglitazone in the early stage of incubation and attenuated with thematuration of OLC on the contrary, however, the expression of RANK was down-regulated by 5 and 10 μmol/L piolitazone in every stage of incubation (P < 0.05 or P < 0.01), combined with decrease in TRAP-positive OLC from day 3 by 10 μmol/L pioglitazone. (2) The effect on the function of OLC: the number of bone resorption pits and the ratio of its area on dentin slice were decreased in groups of 5 and 10 μmol/L pioglitazone (P < 0.01 orP < 0.05), no obvious change was noted in the group with 1 μmol/L pioglitazone compared with the control group; the mean fluorescence intensity of CD61 were down-regulated in groups of 5 and 10 μmol/L pioglitazone (P < 0.05 or P <0.01). Conclusion Activation of PPARγ2 pathway by pioglitazone could partially inhibit differentiation and function of OLC derived from rat BMC.

The intestinal is the main and most important part of human flora settlement.The factors affecting the composition and diversity of intestinal flora in early life mainly include gestational age, delivery mode, feeding mode, antibiotic exposure, etc.The occurrence of neonatal late-onset sepsis(LOS)is associated with intestinal flora imbalance.The use of probiotics to regulate intestinal flora can reduce the incidence and mortality of LOS, which is helpful for treatment and prevention of LOS.

Objective:To analyze the potential risk factors of periventricular-intraventricular hemorrhage(PIVH)in premature infants.Methods:A retrospective study was conducted on clinical data of 279 premature infants admitted to the Affiliated Hospital of Guizhou Medical University From January 1, 2019 to December 31, 2019, who completed cranial ultrasound during hospitalization.According to the cranial ultrasound with or without PIVH, the cases were divided into PIVH group and non-PIVH group.The premature infants with PIVH were divided into severe PIVH(grade Ⅲ and Ⅳ)group and mild PIVH(grade Ⅰand Ⅱ)group according to the PIVH grades.A total of 25 factors, which may influnce PIVH, were analyzed by univariate analysis, and then multivariate Logistic stepwise regression analysis(stepwise backwards method)was performed to determine the major risk factors.Results:(1)A total of 279 premature infants were included in the study, 133 of them in PIVH group, and 146 of them in non-PIVH group.Univariate analysis showed that there were statistically significant differences in 14 factors between two groups, including full treatment of antenatal steroid, gestation age, birth weight, neonatal asphyxia, hypothermia, early onset sepsis, metabolic acidosis, hypernatremia, anemia, respiratory distress syndrome, noninvasive ventilation, invasive ventilation, invasive ventilation within 72 hours after birth, and lumbar puncture within 72 hours after birth( P<0.05). Multivariate analysis showed that gestational age( OR=0.709, 95% CI 0.602-0.835), and full treatment of antenatal steroid( OR=0.354, 95% CI 0.189-0.664) were protective factors for PIVH in premature infants, while neonatal asphyxia( OR=2.425, 95% CI 1.171-5.023), hypothermia( OR=2.097, 95% CI 1.088~4.041), early onset sepsis( OR=12.898, 95% CI 1.433-115.264), metabolic acidosis( OR=2.493, 95% CI 1.398-4.442), invasive ventilation within 72 hours after birth( OR=5.408, 95% CI 1.156-25.297), lumbar puncture within 72 hours after birth ( OR=5.035, 95% CI 1.269-19.993) were independent risk factors for PIVH in premature infants( P<0.05). (2) Among 133 cases of premature PIVH, 20 cases were severe PIVH and 13 cases were mild PIVH.Univariate analysis showed that there were statistically significant differences in 5 factors between two groups, including antenatal magnesium sulfate, gestation age, early onset sepsis, abnormal coagulation, and lumbar puncture within 72 hours after birth.Multivariate analysis showed that early onset sepsis( OR=4.392, 95% CI 1.343-14.367) and abnormal coagulation( OR=3.502, 95% CI 1.234-9.867) were independent risk factors for severe PIVH in premature infants( P<0.05). Conclusion:Gestational age is negatively correlated with the occurrence of PIVH in premature infants, and completion of more than a course of treatment for antenatal dexamethasone is an independent protective factor of PIVH in premature infants.Neonatal asphyxia, metabolic acidosis, hypothermia(<35 ℃), early onset sepsis, invasive ventilation within 72 hours after birth, and lumbar puncture within 72 hours after birth are independent risk factors for PIVH in premature infants.Abnormal coagulation and early onset sepsis are independent risk factors for severe PIVH in premature infants.

Objective     To investigate short-term outcomes of robot-assisted Heller-Dor myotomy (RAHM-Dor) for achalasia of cardia and our learning curve experience. Methods     The clinical data and recent follow-up results of 42 patients who received RAHM-Dor from November 2015 to January 2020 in the Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University were retrospectively analyzed, including 20 males and 22 females with a mean age of 40.8±18.4 years. Results    Dysphagia was the most common symptom, followed by heartburn and regurgitation. The mean operation time was 122.8±23.9 min. The mean blood loss was 47.5±32.7 mL. Two patients suffered mucosal injury, and successfully repaired by suturing during surgery. There was no esophageal fistula, conversion to an open operation or perioperative death in this series. The median length of hospital stay was 8 (6, 9) d. In all patients, the Stooler and Eckardt scores of postoperative 1, 6 and 12 months decreased compared to those of pre-operation (P<0.001). Conclusion     RAHM-Dor is a safe and feasible avenue for the treatment of achalasia of cardia, and can achieve a satisfying short-term results. The learning curve shows a transition to the standard stage from the learning stage after 16-18 operations.