Objective: To evaluate the importance of waist to hip ratio among all the possible risk factors in the development of NAFLD. Methods: The samples were selected from individuals receiving physical examination from the 14th of October to the 4th of November in 2004.The enrolling criteria were as follows:①BMI between 25-29.9.②ethanol consumption was less than 40 g per week.③markers of hepatitis virus were negative.④no diabetes mellitus.The diagnosis of fatty liver was based on sonographic evidence.According to the standards,81 cases were chosen,including 59 patients with NAFLD and 22 normal controls.Seven indices were recorded in fasting state: age,BMI,waist to hip ratio(WHR),serum cholesterol,serum lipid,serum glucose and insulin sensitivity index.Results: The fatty liver group,compared with the normal controls,was significantly marked with higher BMI(26.70 vs 26.15,(P=)0.026), WHR(0.90 vs 0.86,P=0.002),serum lipid(1.99 vs 1.42 P=0.001) and lower insulin sensitive index(0.025 vs 0.039,P=0.005).By binary logistic regression analysis,WHR and insulin sensitive index is significantly associated with the development of NAFLD,and the P value is 0.01 and 0.069 respectively. Conclusion: WHR is an independent factor in the development of NAFLD in patients with BMI matched and non-DM mild fatty individuals.

Objective To observe the influences of Yiqi-Humo recipe,A traditional Chinese prescription,on mucosa repair after endoscopic mucosal resction (EMR) and (or) endoscopic submucoal dissection (ESD).Methods 32 patients,who received EMR or ESD,were randomly recurited into a control group with 14 patients (omeprazole) and a experiment group with 18 patients (Yiqi-Humo recipe + omeprazole).Patients of both groups received treatment for a period of 4 weeks.Follow-up endoscopy was performed at 1 and 4 weeks after EMR or ESD,the index of symptom and mucosa signs were evaluated before and after the operation.Results At the 4 weeks after the procedure,the index of pain,pantothenic acid,anorexia,burning sensation in the experiment group [(0± 0.00)、(0± 0.00)、(2 ± 0.11)、(1 ± 0.06)] were lower than those in the control group [(12±0.86)、(6±0.43)、(15 ± 1.07)、(14± 1.00),P＜0.01].The index of hyperemia and edema of the experiment group [(3 ± 0.17)、(3 ± 0.17)] were less than those of the control group [(16± 1.14)、(15 ± 1.07),P＜ 0.01].Conclusion The prescription of Yiqi-Humo recipe promoted mucosa repair significantly after EMR or ESD.

Objective To observe the growth characters of upper gastrointectinal tract leiomyoma. Methods Using endoscopic ultrasonography to detect leiomyoma of upper gastrointestinal tract leiomyoma in 18 cases once every 6 months on follow-up , and to measure the longest diameter ( A mm) and calculate its growth rate per month. Results In this series,the majority of cases have the leiomyoma of longest diameter(A) 10～20mm. Their growth rates in A≤10mm, 10mm

Objective To observe the extent of injury in esophageal mucosa resulted from Argon plasma coagulation (APC). Methods The injuries from APC were observed in 55 sites of esophageal normal mucosa in 11 patients with esophageal cancer. APC powers in 45 W,60 W and 90 W were selected with exposure times of 1 sec and 3 sec respectively. The probe of APC was hold approximately at 30?and 2 mm from the mucosa. The histological changes of esophageal wall injured by APC were examined under light and electric microscopy. Results The injuries in 46 out of 55 sites were merely restricted in the mucosa or sub-mucosa,7 out of 55 extended into the muscularis propria.and 2 of 9 sites extended to the whole depth of e-sophageal wall. The depth of injury increased in relation with the elevating of APC power (P 0. 05). Conclusion APC is a safe way for treating esophageal diseases if its power is limited in an appropriate range.

Objective To study the diagnostic value of double-balloon endoscopy (DBE) and capsule endoscopy (CE) for small intestinal bleeding. Methods Overall detection rates of small intestinal bleeding with DBE, CE and the whole alimentary tract barium meal were compared. Positive rates of bleeding detection with DBE and CE were compared within the same patients. Influence of CE on one-procedure rate of DBE was analyzed. Results In 105 cases of small intestine bleeding, DBE detected 24 cases of Crohn's disease, 15 adenocarcinoma, 12 chronic nonspecific inflammation, 10 small intestinal ulcer of unknown reason, 8 entero-mesenchymoma, 8 polypus, 6 vascular deformation hemorrhage, 5 ancylostomiasis, 5 Mechel's diverticula ( including multiple diverticula), 3 lymphoma and 9 of no evident abnormalities. The positive detection rate of DBE is 91.4% (96/105). Disease detection rates of CE and whole alimentary tract barium meal were 75.0% (30/40) and 33.3% (25/75), respectively. The one-procedure rate of DBE is 90% (36/40) based on CE results, but it was only 69. 2% (45/65) according to clinic features and the whole alimentary tract barium meal. Conclusion The main causes of small intestinal bleeding are benign ulcers (including Crohn's disease) and tumor, as well as chronic inflammation. Polyps, vascular deformation, parasitosis, Mechel's diverticulum and lymphoma are the secondary causes.DBE is superior to CE in diagnosis of small intestine bleeding, but CE can increase the one-procedure rate of DBE.

Objective To investigate the regularity of TCM diagnoses and treatment of the endoscope for the early phrase of colorectal cancer. Methods A total of 114 patients diagnosed with colorectal cancer were treated with endoscopy and herbal nursingfrom January 2013 to March 2016. The syndromes, herbs and channel tropism were analyzed to explore the regularity of TCM diagnoses and treatment of the endoscope for the early phrase of colorectal cancer. Results The common syndromes were spleen and kidney deficiency, liver and kidney Yin deficiency, Qi deficiency and blood stasis. There were 18 categories Chinese medicine. The most commonly medicine showed the function of promoting blood circulation, removing blood stasis, regulating Qi. The drugs mostly belonged to the liver, spleen, stomach, kidney meridian. Conclusions Most patients were spleen deficiency and kidney deficiency, and the disease's nature focusd on Qi and bood, with the pathogenesis characteristics of deficiency-excess complication. So the basic treatment mainly tonify the spleen and kidney, regulate Qi, promote blood circulation, and clearing heat and dampness.

Objective To evaluate the efficacy of computed tomography ( CT ) and diffusion?weighted magnetic resonance imaging ( DWMRI ) in the diagnosis of regional lymph node metastasis in thoracic carcinoma, and to figure out the methods and thresholds for delineation of lymph nodes with higher reasonability and accuracy. Methods A total of 43 patients with thoracic carcinoma, including 35 patients with esophageal cancer and 8 patients with non?small cell lung cancer, were enrolled as subjects from 2012 to 2013. All patients received abdominal CT scan and DWMRI examination one week before surgery, and regional lymph node metastasis was diagnosed based on the images of CT scan or DWMRI. With the postoperative pathology as the gold standard, the diagnostic efficacy was evaluated and compared between the two methods. The two sets of obtained images were analyzed using the χ2?test. Results The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden’ s index of CT versus DWMRI in the diagnosis of regional lymph node metastasis were 57?1% vs. 60?0%, 96?3% vs. 98?9%, 93?8% vs. 96?5%, 50?0% vs. 77?8%, 97?2% vs. 97?4%, and 53?4% vs. 58?9%, respectively;the specificity, accuracy, and positive predictive value of DWMRI were significantly superior to those of CT ( P=0?005,0?038,0?022) . Twenty out of forty lymph nodes diagnosed by CT scan were false positive, and 15( 75%) of them could be corrected by DWMRI. Fifteen out of forty lymph nodes diagnosed by CT scan were false negative, and 3 ( 20%) of them could be recognized by DWMRI. In all 35 metastatic lymph nodes, 5 lymph nodes had no apparent swelling on images, and 13(43?3%) out of the other 30 lymph nodes had a short diameter less than 1?0 cm. Conclusions CT scan has apparent limitation in the diagnosis of regional lymph node metastasis. Many metastatic lymph nodes would be missed if a short diameter not less than 1? 0 cm is the only standard for target volume delineation . With superior specificity , accuracy , and positive predictive value to CT in the diagnosis of regional lymph node metastasis, DWMRI can effectively rule out non?cancerous intumescent lymph nodes and recognize some of small metastatic lymph nodes.

Objective To evaluate the efficacy of biliary tract prosthesis and pancreatic duct stents for advanced periampullary carcinoma. Methods A total of 36 patients were diagnosed as advanced periampullary carcinoma pathologically or clinically, with strictures both in pancreatic and biliary ducts confirmed by imaging. Teflon stents were firstly implanted through endoscopy to the narrowed pancreatic ducts, expansible metal prosthesis were then implanted to the biliary tract. If failed, the metal stents were given through percutaneous transhepatic biliary drainage (PTCD) pathway. Serum levels of liver enzymes, amylase and clinical manifestations were observed before and after operation. Results Teflon stents were successfully implanted into pancreatic ducts in all patients. Metal prostheses into bile ducts were endoscopically implanted in 29 cases, and via PTCD in 7, including 2 cases of Billroth Ⅱ gastrectomy. The levels of liver enzymes significantly decreased (P<0.01) after stents implacement. The levels of amylase (plasma and urine) and lipase increased in 15 cases, but they were corrected to normal levels after adequate treatments. Rates of abdominal pain relieving and diahhrea improvement were 82.4% (28/34) and 88.2% (15/17), respectively. Conclusion The combined implacement of biliary tract prosthesis and pancreatic duct stents is safe and effective in relieving malignant obstruction in periampullary carcinoma.

Objective To investigate the clinic effect of tunnel technique on endoscopic submucosal dissection(ESD)for massive colorectal laterally spreading tumor(LST). Methods A retrospective study was conducted on the data of patients with colorectal large area LST(the shortest diameter>4 cm) undergoing ESD by tunnel technique from January 2015 to June 2016 in Digestive Endoscopy Center of Jiangsu Province Hospital of Traditional Chinese Medicine. The size of resected specimens, operation time, complications, pathology results, the number of en bloc resection and curative resection were analyzed. Results A total of 14 cases were collected, including 7 males and 7 females. The longest diameters of resected specimens were from 4.0 to 7.0 cm with mean size of 5.18 ± 0.49 cm. The operation times were from 40 to 120 min with mean time of 63.57±12.95 min. Intraoperative perforation occurred in 2 cases but no delayed perforation and bleeding occurred. Postoperative pathology showed 1 patient with adenoma hyperplasia with crypt abscess,3 patients with low grade intraepithelial neoplasia,6 patients with high grade intraepithelial neophasia,1 patient with carcinoma in situ, 1 patient with carcinoma in M3, and 2 patients with carcinoma in SM1. The number of cases who received en bloc resection, complete resection, and curative resection were 13, 13, and 13, respectively. Conclusion ESD by tunnel technique is safe and effective in the treatment of colorectal large area LST,which is worth popularizing in clinics.

Objective To determine the efficacy of primary tumor of esophageal cancer,according to the result of magnetic resonance imaging before and after chemoradiotherapy of esophageal cancer,combined with clinical efficacy evaluation,and to verify the reliable evaluation of the short-term curative effect of magnetic resonance on esophageal cancer,combined with the original CT and esophagogram evaluation criteria.Methods From May 2010 to March 2014,totally 83 patients with esophageal carcinoma treated with 3D-CRT or IMRT were enrolled.The prescribed doses were ranged from 50-64 Gy with median dose of 60 Gy and 1.8-2.0 Gy per fraction,of which 34 of the patients received concurrent chemotherapy of FP or TP.All the patients performed the examinations of DWI,CT scan and esophagogram before and after radiotherapy.The treatment efficacy was evaluated by short-term therapeutic effect evaluation criterion of versions 1989 and 2013 and the hyperintense expression on DWI sequence.Results According to the short-term therapeutic effect evaluation criterion of versions 1989 and 2013 based on the examination of esophagogram and CT scan,45 patients achieved complete remission (CR) after treatment(54.2％) and 38 achieved partly remission(PR) (45.8％) version 1989,while 35 patients achieved CR (42.2％) and 48 achieved PR (57.8％) version vesion 2013.In the two differentcriterions,the local control rate and survival rate of the complete remission group in 1 to 5 years were better than those in the partial remission group.According to the examination of DWI,48 patients' hyperintense disappeared completely at the end of treatment (which was defined to CR),25 patients had a slightly hyperintense expression and 10 patients still had hyperintense expression on DWI sequence (which two defined to PR),the local control and survival rates of the former group were superior to the latter groups (x2 =6.125,11.652,P ＜0.05).The TE results evaluated by DWI and TE evaluation criterion of version 2013 were compared according to Kappa test,as a result,the Kappa coefficient 0.478.According to the examination of esophagogram,CT scan and DW1,25 patients achieved CR and 58 achieved PR in all exams,and the local control and survival rates of the former group were superior to the latter group (x2 =5.559,10.014,P ＜0.05).Conclusions The esophagogram and CT based TE evaluation criterion could well indicate local control status of esophageal cancer,and the examination of DWI could afford visualized and quantifying reference information about the TE of esophageal cancer.The expression of hyperintense at the end of treatment may indicate a high risk of recurrence and metastasis.The therapeutic effect evaluated by esophagogram,CT scan and DWI maybe more objective and more accurate.