Objective Analysis of the teaching effect of the micro-classroom in the experimental teaching of diagnostics.Methods In the 50 classes of undergraduate clinical specialty of 2014 level of guangdong medical mniversity,2 classes were selected as the control group (n=67) by random number table method,2 classes were selected as the experience group (n=65).Theoretical knowledge and clinical skills were calculated.Recognition of two groups of students on two kinds of teaching methods.The data of two groups were compared using t-test and chi-square test.Results The results of the theoretical knowledge and clinical skills of the experimental group were significantly higher than the control group (P< 0.05).There was a significant difference between the two groups (P< 0.05),which was found to be able to deepen the understanding of theoretical knowledge,to improve the ability of clinical skills operation,to cultivate clinical thinking and to mobilize the enthusiasm of independent learning.Conclusions Micro classroom teaching can significantly improve the quality of experimental training of diagnoses.

Transanal endoscopic microsurgery(TEM) is a safe and effective procedure for the treatment of local tumors, especially for the rectal villous adenoma (pT0), polyps with severe dysplasia and in situ carcinoma(pTis). It can also be applied as salvage surgery for incidental carcinoma after colonoscopy as well as in cases of giant villous adenoma. With the introduction of screening colonoscopy, more early polyps will be detected. We should be able to customize our treatment accordingly. On one hand, we want to prevent overkill and on the other hand to avoid under-treatment. This article is aimed to review the development of TEM and discuss its various indications.
Carcinoma in Situ ; Colonoscopy ; Humans ; Polyps ; Rectal Neoplasms ; Transanal Endoscopic Microsurgery

Objective To explore the function of colonic mucosal barrier of patients with colonic slow transit constipation (STC).Methods From June 2008 to June 2012,a total of 136 patients with STC were enrolled.Among them,course of disease of 55 cases was between one and six years,of 43 cases was between six and 10 years,and of 38 cases was over 10 years.The colonic transit time of 66 cases was between three and five days,of 42 cases was between five and seven days,and of 28 cases was over seven days.Altogether,35 cases received subtotal resection of the colon.At same time,individuals who received partial resection of the colon because of single polypus were set as control group.Fasting blood and urine samples of all subjects were collected.The colonic specimens of STC patients who received surgery and control group were harvested.The urinary lactulose and mannitol ratio (L/M) was detected by high performance liquid chromatography (HPLC).The level of blood Dlactic acid (D-LAC) was tested by enzymatic spectrophotometric.The level of blood diamine oxidase (DAO) was determined by speetrophotometry.The level of endotoxin (ET) was detected by azo chromogenic substrate limulus test.The colonic epithelial cells membrane resistance (TER) and paracellular mannitol permeability (PMP) were measured with Ussing perfusion chamber.t-test was performed for comparison between groups.Results Urinary L/M of STC group and control group was 0.16±0.03 and 0.10±0.02,respectively.The level of blood D-LAC was (1.81±0.19) and (1.04±0.13) mmol/L.The level of blood DAO was (17.07±1.81) and (9.78±1.14) U/L.The level of blood ET was (64.20±6.85) and (51.30±5.90) EU/L.The TER of colonic epithelia cell was (61.23±7.76) and (75.87±9.65) Ω/cm2.The PMP of colonic epithelia cell was (3.17±0.35) ％ and (2.14 ±0.22)％.All the differences were statistically significant (t =3.185,3.378,3.863,3.201,3.125 and 3.543,all P＜0.05).Among patients with disease course between one and six years,six to 10 years and over 10 years,colonic transit time of STC between three and five days,five to seven days and over seven days,urinary L/M,blood D-LAC level and blood DAO level increased along with the disease course and colonic transit time and the differences were statistical significantly compared with control group (urinary L/M:t=1.993,2.311,2.356,2.204,2.347 and 3.673; blood D-LAC level:t=2.023,2.886,4.124,1.999,2.998 and 3.465; blood DAO level:t=1.994,2.995,4.423,2.203,3.673 and 5.211; all P＜0.05).Compared with control group,there were significant differences in blood ET level of course of STC between six and 10 years,over 10 years,colonic transit time of STC between five and seven days and over seven days (t=2.121,4.245,3.241 and 4.657,all P＜0.05).Conclusion The permeability of colonic mucosal barrier increased and which was more significant in longer colonic transit time and long course of disease.

Objective To investigate the regulation of insulin VGLUT2 gene expression in pancreatic β cells and its exactly mechanism.Methods The rat pancreatic β cell line RIN-5F was treated by different insulin concentrations and different siRNA.The changes of VGLUT2 mRNA and protein expression levels were detected by adopting real-time qPCR and Western blot.Results In-sulin with a concentration of 100,200 nmol/L significantly inhibited the expressions of VGLUT2 mRNA and protein in RIN-5RF cells(P<0.05),moreover the inhibiting effect was most significant at 100 nmol/L.After 100 nmol/L insulin treatment,the expres-sions of VGLUT2 mRNA and protein at 12,18,24 h were significantly inhibited compared with that at 0 h(P<0.05).Compared with the Blank group,Lip2000 group and Control-siRNA group,after interfering RIN-5F by using IR-siRNA,IRS1-siRNA and IRS2-siRNA,the inhibition situation of VGLUT2 mRNA and protein expressions by 100 nmol/L insulin in each group was signifi-cantly recovered(P<0.05).Conclusion Insulin at low concentration could inhibit VGLUT 2 gene expression in rat pancreatic β cell line RIN-5F.

OBJECTIVETo detect the expression of collagen and elastin fibers in the rectum of patients with obstructive defecation syndrome (ODS), and to explore the possible role of these fibers in the pathogenesis of ODS.

METHODSThe rectum specimens of 20 patients with ODS were collected. These patients had undergone stapled transanal rectal resection (STARR) surgery in our hospital since 2012. Full-thickness rectal specimens were stained with Masson and EVG staining to show collagen and elastin fibers. As the control, rectum specimens of 20 patients with severe prolapsed hemorrhoids also undergoing STARR surgery in our hospital during the same period were collected.

RESULTSMasson staining showed that the structure of collagen fibers in submucosa was slender, area decreased [(13.88±7.02)% vs. (30.98±3.46)%, P<0.01], and the expression level was significantly lower in ODS group compared with control group. EVG staining also showed that collagen fiber area of ODS patients was reduced compared with control group [(17.18±7.24)% vs. (27.04±9.65)%, P<0.01]. Meanwhile EVG staining revealed that elastic fibers were fragmented in ODS group and the expression level was lower compared with control group [(1.20±1.39)% vs. (1.47±1.06)%], whereas the difference was not statistically significant(P>0.05).

CONCLUSIONThe expression level of collagen fibers in patients with ODS is significantly reduced, which may play an important role in the pathogenesis of ODS.

OBJECTIVETo explore the safety and efficacy of Shaobei injection in the management of I(-II( degree rectal prolapse.

METHODSA total of 80 patients eligible for the inclusion criteria were divided into 2 groups: 40 patients in the treatment group (treated with Shaobei injection) and 40 cases in the control group (treated with Xiaozhiling) respectively. The short-term efficacy was identified by the length of rectal prolapse and the depth of rectocele demonstrated by the defecography while the long-term efficacy was evaluated by the length of rectal prolapse. In addition, the safety was assessed by the occurrence of postoperative complications.

RESULTSThe variation of the lengths of rectal prolapse and the depth of rectocele demonstrated by the defecography at the sixth month follow up in the two groups did not reach significant difference (P>0.05). After 2 year follow up, 37 patients (92.5%) in the treatment group and 35 cases(87.5%) in the control group was cured. Therefore, there was no significant difference in the long term efficacy between the two groups (P>0.05). The adverse events in the therapy group(10%) was less than that in the control group (45%)(P<0.01).

CONCLUSIONSShaobei injection in the management of I(-II( degree rectal prolapse has a similar efficacy of short-term and long-term higher safety compared to Xiaozhiling injection.

Objective To investigate the clinical value and surgical methods of pancreaticoduodenectomy (PD) combined with portal vein (PV)/superior mesenteric vein (SMV) resection and reconstruction in the treatment of pancreatic cancer with PV/SMV invaded by tumor.Methods The clinical data of 21 patients of pancreatic cancer with PV/SMV invaded by tumor (group A) and 62 patients of pancreatic head cancer without PV/SMV invaded by tumor (group B) in the same period were collected and analyzed retrospectively from Jan 2014 to Apr 2017.There were no distinct invasion of celiac artery (CA),hepatic common artery (HCA) and superior mesenteric artery (SMA) in two groups of pancreatic cancer patients.The patients of group A underwent PD combined with PV/SMV resection and reconstruction,and the patients of group B were only treated with PD surgery.The complication rate and overall survival time after PD was compared between the 21 patients of pancreatic cancer with PV/SMV invaded by tumor and the 62 patients of pancreatichead cancer without PV/SMV invaded by tumor.'Results The average overall survival time of 21 patients of pancreatic cancer with PV/SMV invaded by tumor (group A) was 19.2 months,specifically with 1-year survival rate of 57.1％ (12/21),2-year survival rate of 28.6％ (6/21),and 3-year survival rate of 14.3％ (3/21).Meanwhile,the average overall survival time of group B was 19.4 months,specifically with 1-year survival rate of 58.1％ (36/62),2-year survival rate of 30.6％ (19/62),and 3-year survival rate of 14.5％ (9/62).The results indicated that no differences for overall survival time of patients treated with PD including 1,2,3-year survival rate between two groups were found (P ＞ 0.05).Conclusions For pancreatic cancer accompanied by PV/SMV invasion without invasion of SMA,CA and HCA,PD combined with PV/SMV resection and reconstruction are safe and feasible surgical procedures.The surgical reconstruction method was determined according to the location and length of the invaded vessels,and also there were no significant differences on the complication rate and overall survival time after PD between the pancreatic cancer patients with invasion of PV/SMV and the pancreatic head cancer patients without invasion of PV/SMV.

Objective:To discuss the treatment methods for old pelvic fractures and urethral injuries in young girls.Methods:We retrospectively analyzed the clinical data of 10 girls, mean age of(8.5±4.3)years with old pelvic fractures and urethral injuries treated with different surgical methods in our hospital from April 2015 to April 2023. 7 cases were complicated with urethrovaginal fistula, 1 case was complicated with vesicovaginal fistula; 5 patients had distal urethral atresia or stenosis; 5 cases complicated with vaginal stenosis or partial atresia. One case underwent repair of urethrovaginal fistula via transpertoineal approach, two cases underwent urethral anastomosis (end to end anastomosis) via transpubic approach, one case underwent repair of urethrovaginal fistula and bladder neck urethral anastomosis via transpubic approach, four cases underwent urethroplasty repair of urethrovaginal fistula and bladder neck reconstruction surgery, one underwent urethroplasty and bladder neck reconstruction surgery via transpubic approach, one underwent augmented enterocystoplasty and continent urinary diversion by using the appendix. Observe the urination condition after operation (Urinary incontinence is defined as the use of more than 1 piece of urine pad per day, good urination is defined as the use of ≤ 1 piece of urine pad per day, and dysuria is defined as the complaint of laborious urination, and the maximum urine flow rate is less than 10 ml/s).Results:All surgeries were successfully completed without complications such as wound infection or tissue necrosis.The postoperative follow-up time was (52.0±26.2) months. 2 cases achieved good continence and no dysuria.Postoperative complications occurred in 7 cases, of which 2 cases had dysuria due to urethral stricture and improved after urethral dilatation; 5 cases of urethrovaginal fistula recurred, of which 3 cases had undergone rerepair surgery, and 2 of them achieved good urinary control without dysuria. One case with enterocystoplasty and contiunent urinary diversion recovered well after surgery.Conclusions:The management of old pelvic fractures and urethral injuries in girls is complicated, with a high rate of postoperative complications. It is necessary to choose appropriate treatment methods based on age, severity of the lesion, and urethral and vaginal conditions.

Objective:To explore whether the specific synaptic vesicle glycoprotein 2A (SV2A) targeted imaging agent ( R)-4-(3-fluoro-5-(fluoro- 18F)phenyl)-1-((3-methylpyridin-4-yl)methyl)pyrrolidin-2-one ( 18F-SDM-8) can be used to detect epileptic foci. Methods:Twenty male Sprague-Dawley (SD) rats (8-9 weeks) were injected with 1.2 μl of kainic acid (16 rats in the epilepsy group) or saline (4 rats in the control group) into the right hippocampus. 18F-SDM-8 and 18F-FDG mircoPET/CT imaging were respectively performed at 1-2 d (acute phase), 6-7 d (incubation period) and 45-60 d (chronic phase) after the seizure. Asymmetric index (AI) was used to evaluate the epileptic foci identify ability of 18F-SDM-8. Paired t test, Mann-Whitney U test and Pearson correlation analysis were used to analyze data. Results:In the three periods of 18F-SDM-8 imaging, the differences of AI of hippocampus between the epilepsy group and control group were statistically significant ( z values: from -2.64 to 2.67, all P<0.05). Both imaging agents had asymmetric uptake in the epilepsy group (right was lower than left), and the decrease in the medial right temporal lobe was the most significant. The pathological staining results were consistent with the imaging results. In the chronic phase of the epilepsy group, the differences of 18F-SDM-8 SUV mean (right versus left) in each brain area of interest were statistically significant ( t value: from -33.40 to -5.60, all P<0.05). The asymmetric uptake of the two imaging agents in the hippocampus had a better correlation ( r=0.97, P=0.001), and the AI of 18F-SDM-8 ((34.2±8.4)%) in this area was 1.4 times higher than that of 18F-FDG ((24.6±4.7)%). Conclusions:18F-SDM-8 PET is a promising method to test the level of SV2A. It can reflect the changes of SV2A in the rat epilepsy model induced by intrahippocampal injection of kainic acid, and improve the sensitivity of molecular imaging for epileptic foci.

Objective:To investigate the value of 68Ga-1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid- D-Phe1-Tyr3-Thr8-octreotide (DOTATATE) combined with 18F-FDG total-body PET/CT imaging in the diagnosis and heterogeneity assessment of primary foci of neuroendocrine neoplasms (NEN). Methods:Clinical, imaging and pathological data of 39 patients with pathological diagnosis (30 NEN and 9 non-NEN, 18 males and 21 females, age (54.0±11.4) years) who underwent 1/10 activity 18F-FDG and 1/2 activity 68Ga-DOTATATE total-body PET/CT combined imaging in Zhongshan Hospital, Fudan University from August 2020 to March 2023 were retrospectively analyzed. The NEN primary foci were classified as neuroendocrine tumor (NET) G1, G2, G3, and neuroendocrine carcinoma (NEC). Diagnostic efficacy of combined dual-low activity dual-tracer imaging for NEN primary foci and its value for evaluating tumor heterogeneity were analyzed. Results:The sensitivities, specificities, and accuracies of 68Ga-DOTATATE alone and in combination with 18F-FDG total-body PET/CT for the diagnosis of NEN primary foci were 81.2%(26/32), 7/9, 80.5%(33/41) and 90.6%(29/32), 7/9, 87.8%(36/41), respectively. Ten NET G1 and seven NET G2 lesions showed 68Ga-DOTATATE uptake and no 18F-FDG uptake; two NET G2 lesions showed no 68Ga-DOTATATE uptake but 18F-FDG uptake; and two NET G1 and six NET G2 lesions showed both 68Ga-DOTATATE and 18F-FDG uptake. The radiation doses of 68Ga-DOTATATE, 18F-FDG and a single examination of CT were (1.59±0.50), 0.49(0.44, 0.58) and 11.46(10.53, 12.85) mSv, respectively. Conclusion:Combining total-body PET/CT imaging with dual tracers can effectively diagnose NEN primary foci and assess inter-tumor heterogeneity.