Two ent-kauranoids were isolated from the ethanol extraction of rhizomes of Canna generalis (Cannaceae), and were purified by various technologies, including silica gel and high performance liquid chromatography, and their structures were determined by modern spectroscopy techniques as (5R,8S,9S,10R,13R)-2-oxo-ent-kaur-15-en-17-oic acid (1) and (4R,5S,8S,9S,10S,13R)-19-hydroxy-ent-kaur-15-en-17-oic acid (2). Compound 1 is a new ent-kauranoid, and compound 2 is obtained from rhizomes of Canna generalis for the first time.

Objective To study the risk factors of skin lesion (keratosis and abnormal skin pigmentation) of population exposed to arsenic via drinking water in Inner Mongolia.Methods A cluster sampling method was used to select 902 cases from Linhe district,Hanghou and Wuyuan county in Inner Mongolia and physical examination was done.They were interviewed for information by questionnaire.The sample of fingernails and drinking water were collected.Water arsenic (As) was analyzed by inductively coupled plasma mass spectrometry (ICPMS); fingernail As and Se content were analyzed by instrumental neutron activation analysis(INAA).Data were analyzed by univariate and multivariate non-conditional Logistic regression.Results Single factor analysis showed that risk factors of keratosis were age,pesticide,arsenic in nails,smoking,years of smoking,drinking of alcohol,arsenic content in drinking water,fluorosis and duration of drinking arsenic-containing water,while occupation,nail selenium content and vitamin were protective factors.There were 10 risk factors for pigment abnormalities,which were age,pesticide,arsenic in nails,smoking,years of smoking,numbers of cigarette smoked daily,drinking of alcohol,fluorosis,the arsenic content in drinking water and duration of drinking arseniccontaining water,while sex,occupation and nails with selenium were protective factors.The multivariate factor analysis showed that the risk factors of keratosis were age,pesticide and arsenic content in drinking water(OR =1.387,1.583,1.321,all P ＜ 0.05),while occupation and vitamin were protective factors(OR =0.307,0.260,all P ＜ 0.05).The risk factors of abnormal skin pigmentation were age,pesticide,arsenic in nails,fluorosis and arsenic content in drinking water(OR =1.724,2.636,2.741,3.699,1.863,all P ＜ 0.05),while sex was protective factor(OR =0.255,P ＜ 0.01 ).Conclusions Many factors have influence on endemic arsenism and a composite measure should be implemented to prevent it such as excluding arsenic from drinking water,health education,and a reasonably intake of nutrients.

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.

ObjectiveTo investigate the diagnostic value of transgastic peritoneoscopy for ascites of unknown aetiology.MethodsTransgastric peritoneoscopy was performed on 7 patients with ascites of unknown aetiology.Diagnosis and complications were both recorded.ResultsDiagnosis of all the 7 patients were confirmed after transgastric peritoneoscopy,among whom 6 ( 85.7％ ) were found to have tuberculosis peritonitis,and 1 ( 14.3％ ) with liver disease.All patients recovered after the operation.No intraoperative or postoperative complications occurred.ConclusionTransgastric peritoneoscopy is a valuable diagnostic method for ascites of unknown aetiology.

ObjectiveTo evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of laterally spreading tumors (LST).MethodsESD was applied to remove 32 colorectal LSTs larger than 2 cm.The characteristics of the tumors and clinical results including en bloc resection rate,procedure time,complication and recttrrence rates were retrospectively evaluated.Results The lesions ranged from 2.5 cm to 8.0 cm,with a mean diameter of 4.1 ± 2.1 cm.En bloc resection wasachieved in 29 patients (90.6％ ) with a mean operation time of 75.7 ±66.0 min.Immediate arerial bleeding occurred in 5 ( 15.6％ ) cases but was stopped successfully by clips or coagulations.Late bleeding occurred in 2 ( 6.2％ ) and perforations in 3 (9.4％ ),which were closed successfully by clips without surgery.Pathological diagnosis revealed low-grade intraepithelial dysplasia in 19 (59.4％ ),high-grade intraepithelial dysplasia in 6 ( 18.8％ ),and carcinomas in 7 (21.9％).The lesions were restricted in mucosal layer in 25 (78.1％ ),infiltrating into sm1 layer in 5 ( 15.6％ ) and sm2 layer in 2 (6.2％ ),and the later 2 were referred to surgery.Twenty patients were followed up for 3-12 months,and no local recurrence was found..ConclusionESD was an effective and safe therapy for colorectal LST larger than 2 cm.

Objective To compare the diagnostic value of magnifying chromoendoscopy with probebased confocal laser endomicroscopy (pCLE) for differentiation of neoplastic from non-neoplastic colorectal polyps. Methods A total of 16 consecutive patients, who were diagnosed as having polyps with endoscopy between December 2009 and January 2010 at Nanfang Hospital, were included in this study. The pit pattern of the polyp was first determined with magnifying chromoendoscopy in all patients. Then, confocal images of the polyps were recorded and subsequently analyzed offline. Using pathological diagnosis as golden standard,the sensitivity and specificity of the two methods were compared. Results A total of 26 polyps from 16 patients were found. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of magnifying chromoendoscopy was 94. 1%, 77.8%, 88. 8%, 87. 5% and 88.4%, respectively,while those of pCLE were 100. 0%, 88. 8%, 94. 4% ,100. 0% and 96. 1%, respectively. There was no significant difference between pCLE and magnifying chromoendoscopy. Conclusion In differentiation between neoplastic and non-neoplastic colorectal lesions, pCLE shows higher sensitivity and specificity than does magnifying chromoendoscopy, although without significant difference. pCLE can be used as a new real time method to determine the property of colorectal polyps.

ObjectiveTo detect the changes of gastroesophageal reflux disease (GERD) with high resolution endoscopy,and to explore its diagnostic value for nonerosive reflux disease (NERD). Methods From April 2007 to January 2008, consecutive out-patients visiting the Department of Gastroenterology due to continuous or recurrent symptoms of acid reflux, heartburn, cardiac-like chest pain for at least three months and volunteer healthy controls were recruited to the study. The subjects were classified into the normal group ( n =48 ), the NERD group ( n =70), the erosive esophagitis (EE) group ( n =70), and the Barrett esophagus (BE) group ( n =48). All subjects underwent endoscopy, and the shape of Z-lines, the shape of mucosal pits, mucosa roughness above Z-line and the shape of mucosal blood vessels were observed. The NERD changes were analyzed with optimal scale. ResultsZ-line shape of NERD group showed a significant difference from that of EE and BE groups ( P ＜ 0. 01 ), which was not different from that of normal controls ( P ＞0. 01 ). The shape of mucosal pits of NERD group was different from that of EE and BE (P ＜0. 01 ), which also was not different from that of control (P＞0. 01 ). Roughness of the mucosa above Z-line of NERD group was different from other 3 groups (P ＜0. 05). And the shape of mucosal blood vessels of NERD was different from the control (P＜0. 05), but was not from two others. Features of NERD relative images were thin,straight and spiral blood vessels, bar-like pits, plat mucosa, round, smooth and wide tooth-like Z-line and mucosa of white particle hypertrophy. ConclusionHigh resolution endoscopic features of most NERD patients are cloudy, white and rough mucosal surface, with white particular hypertrophy, spiral vascular dilation, extending to Z-line. These features can be indicators of NERD.

Objective To evaluate the effectiveness of single balloon enteroscopy (SBE) in diagno-sing of suspected lesions in small intestine. Methods Data of 23 patients with suspected small intestinal disease, who underwent SBE (Olympus) between February 2009 and August 2009, were retrospectively studied. A total of 34 procedures were performed in 23 patients. The indications for the examination were suspected obscure gastrointestinal bleeding (n = 9), abdominal pain (n = 7), suspected intestinal tumor re-vealed by capsule endoscopy (n = 4), and Crohn disease (n = 3). Results The average preparation time of SBE was less than 5 minutes. The mean procedure time was 61±25 minutes and 67±28 minutes for the oral and anal routes, respectively. Examination of whole length of small intestine was achieved in 6 patients. The diagnostic rate of small-intestinal lesions was 60. 9%, and no severe complications including perforation occurred. Conclusion SBE is safe and easy to prepare and perform, which can be a useful diagnostic and therapeutic tool for suspected small bowel disease.

Objective To investigate the miss rate of adenoma with colonoscopy and assess the features and risk factors for missed diagnosis.Methods Patients with colorectal adenoma received a second colonoscopy within 120 days after adenoma was detected and removed on the initial colonoscopy.The findings of two colonoscopies were reviewed and analyzed.The features of adenoma (including size, location, shape, number and pathology) , clinical characteristics of patients (including age, sex, reasons of colonoscopy, history of diverticular disease, history of abdominal or pelvic surgery and colonoscopy with sedation) and endoscopists were recorded.Miss rate and features of different types of missed adenoma were analyzed.We also assessed the effects of adenoma features, patients' characteristics and endoscopists on missed diagnosis of adenoma.Results Adenoma missed diagnosis was found in 271 patients out of 809 recruited subjects (33% ).A total of 425 adenomas were missed out of 2134 (20% ) adenomas detected by repeated colonoscopy.A large diameter was associated with a decrease in the miss rate for adenoma (P < 0.01).Conversely , sessile or flat shape (P < 0.01) , locations at sigmoid, hepatic flexure, cecum and ascending colonic ( P < 0.05) were significantly associated with a higher miss rate of adenoma, as was the number of adenomas (P <0.01).A higher adenoma missed diagnosis rate was observed in beginner colonoscopists, as compared with experienced ones (P < 0.01).Conclusion A marked miss rate of adenoma exists on colonoscopy, which is significantly associated with the size, shape, location and number of adenomas and endoscopists.

Objective To study the influence of arsenic exposure on menstruation.Methods A cluster sampling method was applied to select the subjects of women aged 10 to 65 from Linhe,Hangjinhouqi and Wuyuan counties in Inner Mongolia in 2004.Drinking water samples were collected to detect arsenic levels,and menstrual related situation was surveyed.The subjects were divided into four groups according to drinking water arsenic concentration:control(≤0.01 mg/L),low(＞ 0.01-0.10 mg/L),moderate(＞ 0.10-0.20 mg/L) and high(＞ 0.20mag/L).Results A total of 602 women were surveyed.There were 83 subjects exposed to arsenic before menarche and their menarche age was (14.37 ± 1.54) years old.There were 90 people exposed to arsenic before menopause and the menopause age was (48.13-0.41) years old.The age of menarche and menopause were positively related to the years of arsenic exposure,and correlation coefficients were 0.268 and 0.278 (all P ＜ 0.05).Compared to control group(14.0％,16/112),menstrual abnormality rate decreased in low(12.1％,21/173) and high dose groups(10.2％,19/186),while increased in the moderate dose group(18.2％,16/88),but the differences were not statistically significant(x2 =3.664,P ＞ 0.05).Conclusions Long-term arsenic exposure delays the menarche and menopause age,suggesting that arsenic has certain endocrine disruption or estrogen-like effects.