Objective:To investigate the efficacy and safety of modified endoscopic submucosal multi-tunnel dissection (ESMTD) for superficial circumferential esophageal cancer with an axial length of more than 8 cm.Methods:Data of 79 patients with superficial circumferential esophageal cancer with lesion length of more than 8 cm who were treated in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021 were retrospectively analyzed. Patients were divided into modified ESMTD group (32 cases) and surgery group (47 cases) according to the treatment. The en bloc resection rate, complete resection rate, operation time, hospitalization time, medical expenses, incidence of procedure-related complications of the two groups were compared.Results:The en bloc resection rate in the modified ESMTD group and the surgery group were both 100.0% ( χ2=0.000, P=1.000), and the complete resection rate were 96.9% (31/32) and 97.9% (46/47) ( χ2=0.000, P=1.000), respectively. The operation time in the modified ESMTD group was shorter than that in the surgery group (150.5±17.2 min VS 185.8±15.2 min, t=9.527, P<0.001). The incidence of delayed bleeding [3.1% (1/32) VS 10.6% (5/47), χ2=0.648, P=0.421] and delayed perforation [3.1% (1/32) VS 4.3% (2/47), χ2=0.000, P=1.000] in the two groups were not statistically different. Postoperative C-reactive protein (64.3±6.9 mg/L VS 89.2±7.4 mg/L, t=15.634, P<0.001) and neutrophil levels [(10.1±1.4)×10 9/L VS (13.1±1.2)×10 9/L, t=15.083, P<0.001] were lower in the modified ESMTD group than those in the surgery group. The hospital stay of the modified ESMTD group was shorter than that of the other group (9.2±1.2 d VS 11.5±1.2 d, t=8.363, P<0.001), and the medical expense was less than that of the surgery group (32±3 thousand yuan VS 59±6 thousand yuan, t=26.384, P<0.001). Conclusion:Compared with traditional surgery, modified ESMTD for the treatment of superficial circumferential esophageal cancer with an axial length >8 cm has definite curative effect, safety, short hospital stay, and low medical costs, and can preserve the integrity of the esophagus and improve the quality of life of patients. It has good clinical application value.

To investigate the effect of long-term indwelling gastric tube on the prevention and treatment of esophageal stenosis after endoscopic submucosal dissection (ESD) for esophageal circumferential superficial cancer, data of patients with esophageal circumferential superficial cancer who underwent ESD in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021 were retrospectively analyzed. There were 15 patients with gastric tube placement (GTP) after ESD (the GTP group ), and 23 patients without GTP (the non-GTP group). The general information, lesion location, pathological stage, postoperative complications, degree of esophageal stenosis (water intake), pain conditions, number of hospitalizations and medical expenses were compared between the two groups. The results showed that there was no significant difference in age, gender, lesion location or postoperative pathological stage between the two groups ( P>0.05). Compared with the non-GTP group, the rate of water intake in the GTP group was significantly higher (11/15 VS 6/23, P<0.05), the frequency of pain was less in the GTP group (7.3±3.1 times VS 10.7±3.6 times, t=3.00, P<0.05), and the number of hospitalizations and the medical expenses after ESD to before and after stent placement were significantly lower in the GTP group than those in the non-GTP group ( P<0.05). There were no significant differences in the incidence of delayed bleeding and perforation, or time of the first stenosis after ESD between the two groups ( P>0.05). The results of the study initially showed that long-term indwelling gastric tube after ESD can reduce the degree of esophageal stenosis with good safety for esophageal circumferential superficial lesions.

Objective: To identify the etiology and source of infection in a diarrhea outbreak in Yunnan in May 2017 and to provide the evidence for formulating prevention and control measures. Methods: Epidemiological investigation was carried out on the epidemic situation of diarrhea in the village of Lvchun County in Yunnan Province, the field sampling, laboratory testing and data analysis were also performed. Results: Among the 44 patients, 11 of the 13 samples were positive for rotavirus nucleic acid in group A, and the positive rate was 84.62%. The survey showed that the water supply pipe was damaged and polluted by human and livestock manure and domestic sewage. The trend of the damaged water pipe was basically the same as the case distribution, and the rainfall was significantly related to the number of the disease. Conclusions This event was an outbreak of diarrhea caused by group A rotavirus. The direct pollution of drinking water caused by rainfall may be the risk factor of this outbreak. The health management of rural drinking water should be strengthened and the health knowledge and education of preventing intestinal infectious diseases should be promoted.