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.

Background: Diabetes can complicate hypertension management by increasing the risk of cardiovascular disease (CVD) and all-cause mortality. Studies targeting diabetes detection in hypertensive individuals demonstrating an increased risk of diabetes are lacking.We aimed to assess the performance of hemoglobin A1c (HbA1c) and its cut-off point in detecting diabetes in the abovementioned population. Methods: Data from 4,096 community-dwellers with hypertension but without known diabetes were obtained from the Study on Evaluation of iNnovated Screening tools and determInation of optimal diagnostic cut-off points for type 2 diaBetes in Chinese muLti-Ethnic (SENSIBLE) study; these data were randomly split into exploration (70% of the sample) and internal validation (the remaining 30%) datasets. The optimal HbA1c cut-off point was derived from the exploration dataset and externally validated using another dataset from 2,431 hypertensive individuals. The oral glucose tolerance test was considered the goldstandard for confirming diabetes. Results: The areas under the ROC curves for HbA1c to detect diabetes were 0.842, 0.832, and 0.829 for the exploration, internal validation, and external validation datasets, respectively. An optimal HbA1c cut-off point of 5.8% (40 mmol/mol) yielded a sensitivity of 76.2% and a specificity of 74.5%. Individuals who were not diagnosed as having diabetes by HbA1c at 5.8% (40 mmol/mol) had a lower 10-year CVD risk score than those diagnosed as having diabetes (P = 0.01). HbA1c ≤ 5.1% (32 mmol/mol) and ≥ 6.4% (46 mmol/mol) could indicate the absence and presence of diabetes, respectively. Conclusions HbA1c could detect diabetes effectively in community-dwellers with hypertension.