Objective To evaluate diagnostic endoscopic submucosal dissection(D-ESD) for gastric intraepithelial neoplasia(GIN).Methods From January 2012 to May 2016,64 patients with biopsy-proven LGIN who accepted magnifying endoscopy combined with digitalchromoendoscopy(ME-DCE) and D-ESD in Gastrointestinal Endoscopy Center of Nanfang Hospital affiliated to Southern Medical University were retrospectively analyzed in this study.The consistency of ME-DCE prediction with D-ESD pathologic outcome was analyzed by using Kappa test.According to D-ESD pathologic outcome,the two groups were analyzed with independent t-test,chi-square test,or Fisher's exact probability test.Results Sixty-four patients with biopsyproven LGIN were enrolled;25 and 39 patients were predicted by ME-DCE as LGIN and HGIN/differentiated adenocarcinoma respectively;27 and 37 patients were diagnosed as LGIN and HGIN/differentiated adenocarcinoma by D-ESD respectively.ME-DCE prediction was well consistent with D-ESD pathologic outcome(k =0.676).According to pathologic outcome of D-ESD,no significant difference was observed in lesion size,biopsy amount,D-ESD sample size,complete resection rate,operation time period,complications,length of hospital stay,or in-hospital cost(P＞0.05).Conclusion ME-DCE can be proposed when the endoscopic biopsy indicates LGIN.And D-ESD should be performed for definitive diagnosis when the MEDCE indicates HGIN/differentiated adenocarcinoma.

Objective To evaluate the diagnostic value of the Eating Assessment Tool (EAT-10) in screening dysphagia by using 2 and 3 as cut-off value with systematic review. Methods A retrieval on the diagnostic value of EAT-10 in dysphagia was done all through PubMed, Embase, the Cochrane Library, CBM, CNKI, WANFANG and VIP databases (from January 2008 to November 2016)."Quality As-sessment of Diagnostic Accuracy Studies" (QUADAS) was used to appraise included papers. Meta-Disc1.4 software was used to analyze heterogeneity and the combined effect of the data. Results Three papers were included and 394 subjects were included in the review. By using 2 and 3 as the cut-off value of EAT-10, the value of the weighted sensitivity was 0.84 [95%CI (0.79, 0.88)] and 0.77 [95%CI(0.71, 0.82)], the specificity was 0.64[95%CI (0.55, 0.72)] and 0.74 [95%CI(0.66, 0.81)],and the area under the receiver-operating-characteris-tic-curve (AUC-ROC) was 0.8621 and 0.8343, which illustrated the diagnostic accuracy of EAT-10 on dysphagia at the medium level. Conclusion The diagnostic ability of EAT-10 is good, but the sensitivity and specificity are different by using 2 and 3 as the cut-off value. The subjects should consider the specific clinical situation to determine the best cut-off value.

BACKGROUND/AIMS: In recent years, endoscopic submucosal tunnel dissection (ESTD) has gained popularity worldwide. The aim of this study was to evaluate the safety and efficacy of ESTD in treating upper gastrointestinal submucosal tumors (SMTs) in a large-volume endoscopic center. METHODS: Patients with SMTs were enrolled in this study between January 2012 and January 2015. Demographic data, clinical data, and treatment outcome were collected and analyzed. RESULTS: Seventy SMTs originating from the muscularis propria (MP) layer were identified in 69 patients. All patients successfully underwent the ESTD procedure. The mean procedure time was 49.0±29.5 minutes, and the mean tumor size was 18.7±7.2 mm. Among all lesions, the majority (70.0%) were located in the esophagus, 12.9% in the cardia, and 17.1% in the stomach. Complete resection was achieved in 67 lesions (95.7%). Perforation occurred in three patients (4.3%), who were treated by endoclips. Pneumothorax occurred in two patients (2.9%) and was successfully managed by thoracic drainage. During a median follow-up of 18.1 months, patients were free of local recurrence or distant metastasis. CONCLUSIONS: Our results demonstrated the feasibility and safety of ESTD in treating upper gastrointestinal SMTs originating from the MP layer. Large-scale comparative studies with other treatment methods should be conducted in the future.
Cardia ; Drainage ; Esophagus ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Pneumothorax ; Recurrence ; Stomach ; Treatment Outcome

Objective To compare the clinical efficacy and safety of Hybrid knife versus triangular tip during peroral endoscopic myotomy(POEM) for patients with achalasia of cardia. Methods Data of patients with achalasia of cardia who received POEM in Nanfang Hospital, Southern Medical University from June 2012 to July 2014 were collected and divided into the Hybrid knife group ( using Hybrid knife) and triangular tip group ( using injection needle and triangular tip). Procedure-related parameters, symptom relief, and adverse events were compared between the two groups. Results A total of 57 patients were selected, including 25 patients in the Hybrid knife group and 32 in the triangular tip group. There were no significant differences on baseline characteristics between the two groups ( P＞0. 05). The mean procedure time was shorter in the Hybrid knife group than that in the triangular tip group (55. 3±17. 7 min VS 69. 5± 9. 4 min, P＝0. 038). The mean frequency of devices exchange was less in the Hybrid knife group than that in the triangular tip group (4. 5±1. 5 VS 10. 7±1. 7, P＝0. 000). No serious complications occurred during operation and periodical follow-up in both groups. At one-year follow-up, the treatment success rate was 92. 0%(23/25) in the Hybrid knife group and 96. 9%(31/32) in the triangular tip group (P＝0. 576). Conclusion Using Hybrid knife in POEM can shorten procedural time and achieve similar treatment success rate compared to triangular tip.

0bjective To synthesis evidence of self-efficacy-based interventions to improve self-management and health behaviour change in patients with diabetes. Methods PubMed, Cochrane, MEDLINE, CINAHL, EBSCO and Web of Science were searched from 1977 to August 2018. The primary outcomes were self-efficacy and self-care ability. Pooled effect sizes of standardised mean difference ( SMD ) were calculated if outcome measurements and the units were different, and if outcome measurements and the units were the same, such as measuring blood glucose by HbA1c, weighted mean difference ( WMD ) were used to calculate pooled effect sizes. Results Nine eligible randomised control trials (RCTs) including 1578 participants were identified. The results showed that interventions based on self-efficacy significantly improved patients′self-efficacy ( SMD=0.69, 95% CI :0.58 to 0.80, P＜0.05) and self-management ( SMD=0.93,95% CI : 0.74 to 1.12, P＜0.05), helped them control blood glucose ( WMD=-0.69, 95% CI :-0.85 to-0.52, P＜0.05), reduced hospitalisation and emergency times, and improved their quality of life ( SMD=0.52,95% CI : 0.32 to 0.72, P＜0.05). Conclusions Even though the results showed significant improvement in self-efficacy and self-management after interventions, the conclusion needs to be generalised with caution because of the quality of RCTs and high heterogeneity. Future trials could consider RCTs with high quality, appropriate sample size, specific component of diabetes management, and reliable and valid scales or objective measures as outcomes.

Objective To explore the status quo and influencing factors of caring efficacy of nursing undergraduate students so as to provide reference for improving their caring efficacy. Method A cross-sectional study was conducted. Totally 274 nursing undergraduate students from 10 general hospitals in Sichuan Province were surveyed by using general information questionnaire, professional model scale for nursing students, professional identity questionnaire for nursing students and caring efficacy scale. Results The average score of caring efficacy of undergraduate nursing students was (4.00 ±0.64), which was lower that of jurior nurse before training (4.55±0.34) and after training (4.98±0.27). The average score of career identity and professional model (3.63±0.68) were postively related with career effevtieness (all P＜0.001). The care from family, medical staffs, job-taking benefits and dimission risks, social comparison and self-reflection were the main factors influencing caring efficacy (P＜0.01), which explained 40.9％ of the varianceof caring efficacy among undergraduate nursing students. Conclusions Caring efficacy of the nursing students was above the middle level, but lower than that of clinical junior nurses. Their professional model and professional identity were positively correlated with caring efficacy. It is necessary to establish a good professional model, through example education, perfect career planning and improve the professional identity of nursing undergraduate students, so as to improve their caring efficacy of nursing students, and then improve the quality of nursing team reserves.

Objective:To systematically evaluate the application effect of somatosensory interactive games in patients with chronic obstructive pulmonary disease (COPD) in order to provide a basis for clinical application.Methods:Randomized controlled trials and quasi-experimental studies on the application of somatosensory interactive games in patients with COPD were retrieved from PubMed, Embase, Cochrane Library, CINAHL, Chinese Biomedical Literature Database, Wanfang, China Knowledge Network and VIP. The retrieval time limit is from the establishment of the database to October 2022. RevMan5.2 software was used for Meta analysis.Results:Ten articles involving 611 patients were included. The results of Meta-analysis showed that the somatosensory interactive game group was superior to the conventional training group in improving FEV 1/FVC% ( WMD=6.83, 95% CI 3.71-9.95, Z=4.29, P<0.01), 6-minute walking distance (6MWD) ( WMD=13.36, 95% CI 0.50-26.23, Z=2.04, P<0.05), Hospital Anxiety and Depression Scale ( WMD=-1.64, 95% CI -2.31--0.97, Z=4.78, P<0.01), COPD Assessment Test score ( WMD=-2.95, 95%CI -4.08--1.82, Z=5.13, P<0.01) in COPD patients. However, there was no significant difference in FEV1 % ( WMD=2.91, 95% CI -1.61-7.43, P=0.210) and dyspnea ( SMD=0.63,95% CI -0.24-1.49, P=0.150) between the two groups. Conclusions:Compared with conventional training, somatosensory interactive game training can effectively improve lung function and quality of life in patients with COPD, relieve anxiety and depression. Due to the limited quantity and quality of the included literature, the reliability of the conclusions still needs to be verified by more high-quality studies.

OBJECTIVES: The purpose of the study was to evaluate the effect of hydroxyapatite (HA)-based desensiti-zing agents and determine their influence on the bonding performance of mild universal adhesives. METHODS: Mid-coronal dentin samples were sectioned from human third molars and prepared for a dentin-sensitive model. According to desensitizing applications, they were randomly divided into four groups for the following treatments: no desensitizing treatment (control), Biorepair toothpaste (HA-based desensitizing toothpaste) treatment, Dontodent toothpaste (HA-based desensitizing toothpaste) treatment, and HA paste treatment. Dentin tubular occlusion and occluded area ratios were evaluated by scanning electron microscopy (SEM). Furthermore, All-Bond Universal, Single Bond Universal, and Clearfil Universal Bond were applied to the desensitized dentin in self-etch mode. The wettability and surface free energy (SFE) of desensitized dentin were evaluated by contact angle measurements. Bonded specimens were sectioned into beams and tested for micro-tensile bond strength to analyze the effect of desensitizing treatment on the bond strength to dentin of universal adhesives. RESULTS: SEM revealed that the dentin tubule was occluded by HA-based desensitizing agents, and the area ratios for the occluded dentin tubules were in the following order: HA group>Biorepair group>Dontodent group (P<0.05). Contact angle analysis demonstrated that HA-based desensitizing agents had no statistically significant influence on the wettability of the universal adhesives (P>0.05). The SFE of dentin significantly increased after treatment by HA-based desensitizing agents (P<0.05). The micro-tensile bond strength test showed that HA-based desensitizing toothpastes always decreased the μTBS values (P<0.05), whereas the HA paste group presented similar bond strength to the control group (P>0.05), irrespective of universal adhesive types. CONCLUSIONS HA-based desensitizing agents can occlude the exposed dentinal tubules on sensitive dentin. When mild and ultra-mild universal adhesives were used for subsequent resin restoration, the bond strength was reduced by HA-based desensitizing toothpastes, whereas the pure HA paste had no adverse effect on bond strength.
Humans ; Dental Cements/analysis* ; Dentin/chemistry* ; Durapatite/pharmacology* ; Tensile Strength ; Toothpastes

Objective:To analyze the diagnostic and prognostic value of routine bone marrow examination in patients with extranodal NK/T-cell lymphoma (ENKTCL) based on PET-CT staging.Methods:Clinical data of 186 patients who received bone marrow biopsy and bone marrow aspiration in Fujian Medical University Union Hospital from 2013 to 2021 were retrospectively analyzed. All patients were divided into bone marrow biopsy + bone marrow aspiration group ( n=186) and PET-CT + bone marrow biopsy group ( n=139). The sensitivity, specificity, positive and negative predictive values were compared between two groups. The data were analyzed and plotted. Survival analysis was performed using Kaplan-Meier method and log-rank test. Results:In the whole cohort, 45 patients were positive for bone marrow biopsy, and 30 of them were positive for bone marrow aspiration. A total of 141 patients who were negative for bone marrow biopsy also achieved negative results for bone marrow aspiration. A total of 139 patients completed PET-CT staging and bone marrow biopsy. And 30 patients were diagnosed with positive bone marrow by PET-CT, in which 22 of them were confirmed positive by bone marrow biopsy. Among 109 patients diagnosed with negative bone marrow by PET-CT, 5 of them were confirmed positive by bone marrow biopsy. All these cases were classified as stage Ⅳ due to distant metastases. PET-CT had a diagnostic sensitivity of 81.5%, a specificity of 92.9%, a positive predictive value of 73.3%, and a negative predictive value of 95.4%. Among early stage (Ⅰ-Ⅱ stage) patients diagnosed with PET-CT, all of them were negative for bone marrow biopsy (the negative predictive value was 100%). In stage Ⅳ patients ( n=55), the 1-year overall survival of patients with bone marrow involvement by bone marrow biopsy or PET-CT ( n=35) compared with their counterparts with the involvement of other organs ( n=20) was 28.7% vs.42.0% ( P=0.13), and 1-year progression free survival rates was 23.2% vs. 23.3% in ( P=0.94). Conclusions:Routine bone marrow biopsy does not change the original staging of patients with early stage ENKTCL based on PET-CT staging. Advanced stage patients with positive bone marrow biopsy tend to obtain worse prognosis, indicating that bone marrow biopsy still has certain value.