Objective To evaluate the safety and efficacy of carbon dioxide (CO2) used as an alternative to air in the gastric endoscopic submucosal dissection (ESD). Methods 80 cases underwent ESD treatment were randomly as-signed to two groups, 40 cases in CO2 group and 40 in air group. Arterial blood CO2 partial pressure was measured preoperative, intraoperative and postoperative respectively. Visual analog scale (VAS) was used to record patients the degree of abdominal pain and distention at 1 h, 6 h and 24 h after operation in each group. The incidence of com-plications were evaluated. Regular follow up were scheduled in all the patients. Results There was no significant dif-ference in degree of abdominal pain score and the CO2 partial pressure between the two groups. The abdominal dis-tension scores of CO2 group were significant lower than air group at 1 h, 6 h after the ESD procedure. There were no statistically significant difference in the incidence rate of complications. Conclusion The utilization of CO2 in gas in-sufflation during gastric ESD is safe. CO2 insufflation can significant reduce the postoperative abdominal distension and improve the quality of postoperative recovery.

Objective:To observe any effect of high-intensity exercise on cardiac remodeling and nitroso-redox imbalance in rats modeling type 1 diabetes so as to provide a theoretical basis and targets for prescribing rehabilitation exercise for patients with diabetic cardiomyopathy.Methods:Forty-five 8-week-old healthy, male Sprague-Dawley rats were randomly divided into a normal control group (NC) of 10, a diabetic control group (DMC) and a diabetic exercise group (DME). Type 1 diabetes was induced in the DMC and DME groups by injecting streptozotocin. The NC and DMC group rats were then fed quietly in their cages, while the DME group rats performed high-intensity treadmill exercise 5 times a week for 4 weeks. Forty-eight hours after the last training, cardiac structure and function were detected by echocardiography, and fasting blood glucose was measured by the glucose oxidase method. Cardiomyocyte cross-sectional area (CSA) and interstitial collagen volume fraction (CVF) were observed. Myocardial tetrahydrobiopterin (BH4) content was determined chromatographically, and myocardial p47 phox and p67 phox protein, endothelial nitric oxide synthase (eNOS), and eNOS dimer and monomer protein levels were detected using western blotting. Results:Compared with the NC group, the average blood glucose, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), myocardial CSA and CVF, and p47 phox and p67 phox protein expression had all increased significantly, but the eNOS dimer/monomer ratio and BH4 content had decreased significantly in the DMC group. In the DME group the average blood glucose, LVEDD, LVESD, myocardial CSA and CVF were significantly lower than in the DMC group, while there was no significant difference between the two groups in p47 phox or p67 phox protein expression, the eNOS dimer/monomer ratio or BH4 content. Conclusion:Short-term, high-intensity exercise can inhibit cardiac remodeling in rats with diabetic cardiomyopathy, but it does not relieve the nitro-redox imbalance.

Background and objective hTe development of image technology has led to increasing detection of pulmonary small nodules year by year, but the determination of their nature before operation is diffcult. hTis clinical study aimed to investigate the necessity and feasibility of surgical resection of pulmonary small nodules through a minimally invasive approach and the operational manner of non-small cell lung cancer (NSCLC). Methods hTe clinical data of 129 cases with pulmonary small nodule of 10 mm or less in diameter were retrospectively analyzed in our hospital from December 2013 to November 2016. hTin-section computed tomography (CT) was performed on all cases with 129 pulmonary small nodules. CT-guided hook-wire precise localization was performed on 21 cases. Lobectomy, wedge resection, and segmentectomy with lymph node dissection might be performed in patients according to physical condition. Results Results of the pathological examination of 37 solid pulmonary nodules (SPNs) revealed 3 primary squamous cell lung cancers, 3 invasive adenocarcino-mas (IAs), 2 metastatic cancers, 2 small cell lung cancers (SCLCs), 16 hamartomas, and 12 nonspeciifc chronic inlfammations. hTe results of pathological examination of 49 mixed ground glass opacities revealed 19 IAs, 6 micro invasive adenocarcinomas (MIAs), 4 adenocarcinomas in situ (AIS), 1 atypical adenomatous hyperplasia (AAH), 1 SCLC, and 18 nonspeciifc chronic in-lfammations. hTe results of pathological examination of 43 pure ground glass opacities revealed 19 AIS, 6 MIAs, 6 IA, 6 AAHs, and 6 nonspeciifc chronic inlfammations. Wedge resection under video-assisted thoracoscopic surgery (VATS) was performed in patients with 52 benign pulmonary small nodules. Lobectomy and systematic lymph node dissection under VATS were performed in 33 patients with NSCLC. Segmentectomy with selective lymph node dissection, wedge resection, and selective lymph node dissection under VATS were performed in six patients with NSCLC. Two patients received secondary lobectomy and systematic lymph node dissection under VATS because of intraoperative frozen pathologic error that happened in six cases. Two cases of N2 lymph node metastasis were found in patients with SPN of IA. Conclusion Positive surgical treatment should be taken on patients with persistent pulmonary small nodules, especially ground glass opacity, because they have a high rate of malignant lesions. During the perioperative period, surgeons should fully inform the patients and family members that error exist in frozen pathologic results to avoid medical disputes.

Glucose monitoring is an important part of medical care in diabetes mellitus, which not only helps assess glycemic control and treatment safety, but also assists with treatment adjustment. With the development of continuous glucose monitoring (CGM), the use of CGM has increased rapidly. With the wealth of glucose data produced by CGM, new metrics are greatly needed to optimally evaluate glucose status and guide the treatment. One of the parameters that CGM provides, time in range (TIR), has been recognized as a key metric by the international consensus. Before the adoption of TIR in clinical practice, several issues including the minimum length of CGM use, the setting of the target range, and individualized TIR goals are summarized. Additionally, we discussed the mounting evidence supporting the association between TIR and diabetes-related outcomes. As a novel glucose metric, it is of interest to compare TIR with other conventional glucose markers such as glycated hemoglobin A1c. It is anticipated that the use of TIR may provide further information on the quality of glucose control and lead to improved diabetes management.