nal surface coil,and it can be a promising method to diagnose interphalangeal joints lesions.

Objective:To apply endoscopic ultrasound (EUS) elastography to the evaluation of EUS-guided fine needle injection (EUS-FNI) for insulinoma.Methods:Clinical data of 21 patients with insulinoma who were treated with EUS-FNI at the digestive endoscopy center of the First Affiliated Hospital of Guangxi Medical University from April 2016 to March 2021 were collected. Some patients underwent EUS real-time elastography before and after the treatment. The minimum blood glucose, synchronous insulin, synchronous C peptide, elastic imaging color pattern, elastic score, a-elasticity, elastic imaging strain rate before and after the treatment were analyzed.Results:Among the 21 cases with 24 lesions, there were 5 males and 16 females. There were totally 39 times of injection, where 8 cases underwent single injection, and 13 cases repeated injection. After the operation, patients' symptoms improved, the minimum blood glucose increased in different degree [2.59 (1.95, 3.82) mmol/L VS 1.50 (1.00, 2.00) mmol/L, Z=-4.278, P<0.001], the level of synchronous insulin [96.69 (44.80, 249.30) pmol/L VS 159.10 (100.30, 373.70) pmol/L, Z=-1.445, P=0.148] and C peptide [3.56 (2.98, 8.05) ng/mL VS 6.16 (3.74, 11.47) ng/mL, Z=-1.825, P=0.068] decreased, but no statistical difference compared with those before the operation. Sixteen cases underwent preoperative endoscopic elastography, with elastic score of 2.00 (2.00, 3.00), and 15 cases underwent postoperative elastography with elastic score of 5.00 (5.00, 5.00). Preoperative a-elasticity was recorded in 15 cases with value of 0.16 (0.08, 0.30), and postoperative a-elasticity was recorded in 12 cases with value of 0.07 (0.05, 0.18). The preoperative strain rate were recorded in 14 cases with 2.28 (1.67, 4.38), and postoperative strain rate were recorded in 12 cases with 5.16 (2.08, 8.17). Compared with those before the operation, the postoperative elastic score increased ( Z=-4.694, P<0.001), the a-elasticity decreased ( Z=-2.099, P=0.036), and the difference in strain ratio was not statistically significant ( Z=-1.492, P=0.136). Meanwhile, the lesions of insulinoma became harder, the elastic imaging mode changed from green to blue. There were no complications such as abdominal pain, fever, or pancreatitis during and after the operation. Conclusion:EUS-FNI is safe and effective for the treatment of insulinoma. Endoscopic elastography, as a new means to evaluate the efficacy of the operation, can be used to evaluate lesion ablation and guide injection therapy.

Purpose: The incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased in recent years, and the optimal surgical strategy for AEG remains highly controversial. We aimed to evaluate the safety and efficacy of proximal gastrectomy with double-tract reconstruction (PG-DT) for the treatment of patients with AEG. Materials and Methods: We retrospectively analyzed patients with Siewert type II/III AEG between January 2013 and July 2018. Clinicopathological characteristics, survival, surgical outcomes, quality of life (QOL), and nutritional status were compared between the PG-DT and total gastrectomy with Roux-en-Y anastomosis (TG-RY) groups. Results: After propensity score matching, 33 patients in each group were analyzed. There were no statistical differences between the 2 groups in terms of disease-free survival and overall survival. The surgical option was not an independent prognostic factor based on the multivariate analysis. In addition, no differences were found in terms of surgical complications. There were no significant differences in QOL assessed by the Visick grade, Gastrointestinal Symptom Rating Scale, or endoscopic findings. Furthermore, the long-term nutritional advantage of the PG-DT group was significantly greater than that of the TG-RY group. Conclusions PG-DT is a safe and effective procedure for patients with local Siewert type II/III AEG, regardless of the TNM stage.

Objective    To explore the feasibility and clinical value of free-of-puncture positioning in three-dimension-guided anatomical segmentectomy for ground-glass nodule (GGN) compared with percutaneous positioning. Methods    Clinical data of 268 enrolled patients undergoing anatomical pulmonary segmentectomy from October 2018 to June 2019 were retrospectively collected, including 75 males and 193 females with an average age of 56.55±12.10 years. The patients were divided into two groups, including a percutaneous positioning group (n=89) and a free-of-puncture positioning group (n=179). Perioperative data of the two groups were compared. Results    The average CT scan times of the percutaneous positioning group was 3.01±0.98 times, and the numerical rating scale (NRS) score of puncture pain was 3.98±1.61 points. Pulmonary compression pneumothorax (≥30%) occurred in 7 (7.87%) patients and intercostal vascular hemorrhage occurred in 8 (8.99%) patients after puncture. Lung nodules were successfully found and removed in both groups. There was no statistically significant difference between the two groups in the location of nodules (P=0.466), operation time (151.83±39.23 min vs. 154.35±33.19 min, P=0.585), margin width (2.07±0.35 cm vs. 1.98±0.28 cm, P=0.750), or the number of excised subsegments (2.83±1.13 vs. 2.73±1.16, P=0.530). Conclusion    Anatomical segmentectomy with three-dimensional navigation avoids the adverse consequences of puncture, which has the same clinical efficacy and meets the requirements of oncology compared with percutaneous positioning. The free-of-puncture positioning method can be used for GGN located in the central region of pulmonary segment/subsegment or adjacent to   intersegment veins instead of percutaneous positioning.