Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) with scissors knife in difficult cases.Methods A total of 36 sessions of ESD in 34 patients were performed from May 2010 to May 2012 with application of new scissors knife.The complications and followup outcomes were recorded.Results All lesions were removed successfully with an en bloc resection rate at 91.7％.Delayed bleeding occurred in 2 patients (5.6％),and both of them were cured sucessfully with endoscopy.No perforation happened and the average hospitalization time was 5 days.Follow-up endoscopy performed 6 or 12 months after ESD in 6 patients revealed no recurrence or residual lesions.Other patients are under follow-up now.Conclusion The scissors knife is easy to manipulate,which can ensure the safety and efficiency of ESD.

Objective To investigate the clinical efficacy of biological dressing A covering bandage of Ⅲ° burn wounds given comprehensive treatment including dermabrasion.Methods For patients of non Ⅲ° ° burn wounds (deep Ⅱ ° and partial superficial Ⅲ ° wounds),28 cases in the treatment group,were given improved dermabrasion with tangential excision plus thin layer of skin graft from the body,the wounds were covered with biological dressing A bandage.21 patients in the control group were treated by traditional tangential excision,escharectomy and self-skin grafting.The clinical treatment effect was observed and compared between the two groups.Results The wounds were healed 2 ～ 3 weeks after surgery in treatment group,the cure rate of burns in patients with a total area of 40％ ～ 50％ TBSA was 99％,and after treatment the scar formation significantly reduced,self-donated skin significantly reduced,the hospital stay and postoperative recovery time of the patients were significantly shorter,patients were easier to accept.In the control group,the operation time was longer,the blood loss was more,the wounds had more scar healing wounds.The wound healing time of the treatment group was (14.8 ± 1.8) d,which was significantly shorter than (19.4 ± 3.0) d of the control group (P ＜ 0.05).Conclusion The improved grinding A scab plus biological dressings covering bandage has the advantages of simple operation,light damage,less complications,need less skin,to maximize retention of healthy tissue,wound healing speed up,healing scar lessened.

Objective To investigate the effect of repairing soft tissue defects in the middle and distal phalanx with the reverse dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery. Methods Twenty-five fingers with soft tissue defects in the middle and distal phalanx were repaired by the reverse dorsal metacarpal and digital fasciocutaneous flaps based on the dorsal cutaneous branches of the proper digital artery from June 2007 to June 2009. Their pivot points were located at the midpoint or distal segment of proximal phalanx. Results Among 25 flaps, 24 survived completely, but cuticular layer in the distal part of one flap was partially necrotic. Twenty flaps were followed up from 12 to 18 months after operation. All flaps were characterized by rich blood supply, cold-resistance, suitable thickness, soft texture and good colour, except that 6 flaps required a secondary operation because of their fat and clumsy pedicel. There was no adhesion of extensor tendon and contraction of interdigital web in the donor sites. Two-point discriminations of anastomosing cutaneous nerve ranged from 6 mm to 10 mm in 5 of the 20 flaps, and 8 mm to 14 mm in the other 15 flaps. Conclusion The dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery is an ideal option for repairing soft tissue defects of middle and distal phalanx because of its advantages of easy and secure dissection, reliable blood supply, longer arch of rotation, being closer to the raw surface of finger, less injury to the donor site, good appearance, avoidance of sacrificing major arteries ,and high probability of reconstructing flap sensation by anastomosing cutaneous nerve.

Objective To achieve the best chance and optimize the method of operation,the clinical outcomes of 76 cases with complete atrioventricular septal defect (CAVSD) were summarized.Methods According to the Rastelli classification,there were 57 cases of type A,6 type B,and 13 type C.The repaired procedures included the two-patch technique for atrioventricular septal defect (65 cases),direct closure of ventricular septal defect (7 cases),and the Glenn bidirection shunt (4 cases).Results Two patients died.Of them,one was concomitant with double outlet right ventricle (DORV) and total anomalous pulmonary venous connection (TAPVC),died of low cardiac output syndrome; another was complicated with severe pulmonary hypertension,and the death reason was hypoxaemia and respiratory function failure.The survived patients were followed up,and the follow-up period was varied from one to ten years,mitral valve regurgitation was found in 12 cases,3 were middle and 9 were mild.Conclusions In order to prevent deteriorated condition of these patients and improve the survival rate,CAVSD should be operated as soon as the diagnosis is certain,and the co-exist malformation also should be corrected.

Objective To evaluate the efficacy and safety of clip traction in endoscopic submucosal dissection (ESD) for heterotopic pancreas in stomach.Methods Data of 62 patients with pathologically confirmed heterotopic pancreas treated by ESD between May 2013 and February 2016 were retrospectively studied in Department of Gastroenterology of Xinqiao Hospital,whose lesions were single and origins were submucosal.Thirty-six cases underwent ESD with clip traction (clip group,n=36),and 26 cases underwent ESD without clip traction (non-clip group,n =26).The procedure time,visualization of the submucosal during dissection,complications and the result of follow-up were evaluated between the two groups.Results ESD was successful in all cases.The procedure time was significantly shorter in the clip group than in the non-clip group (19.35±10.34 min VS 27.02± 14.27 min,t'=2.333,P=0.023),and good visualization was obtained by applying clip traction.The rate of bleeding in the clip group was 55.6％ (20/36),and that in the non-clip group was 61.5％ (16/26).There was no significant difference between the two groups(x2 =0.222,P =0.638).Moreover,perforation did not occur in the clip group,but occurred in one patient in the non-clip group (3.8％,1/26).There was no significant difference between the two groups (P =0.419).All patients were followed up,there was no recurrence.Conclusion ESD is effective and safe for heterotopic pancreas in stomach.Clip traction can shorten the operation time and reduce complications of ESD.

Objective:To investigate the value of chest CT quantitative index in clinical classification and lung injury severity evaluation of COVID-19.Methods:The current study retrospectively analyzed the clinical and CT data of 438 patients with COVID-19 between January 2020 and March 2020 in Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology. The clinical types included common type ( n=146), severe type ( n=247) and critical type ( n=45). The chest CT indexes of all patients were quantitatively analyzed by artificial intelligence (AI) deep learning, including whole lung volume, CT lung opacification, ground glass opacification volume (GGO volume; CT value<-300 HU), solid opacification volume (SO volume; CT value ≥-300 HU) and the ratio of volume to the whole lung volume, the ratio of SO volume to GGO volume (SO volume/GGO volume). Kruskal-Wallis test was used to conduct statistical analysis of the differences in quantitative parameters among clinical types, and multiple ordered logistic regression was used to analyze the correlation between quantitative parameters and clinical types. Results:Among the 438 patients diagnosed with COVID-19, severe and critical patients were older ( P<0.05), and most of the critical patients were male ( P<0.05). The main clinical manifestations of all clinical types were fever, followed by cough, fatigue, chest tightness, dyspnea, gastrointestinal symptoms and so on. GGO volume was the main CT manifestation of all the three clinical subtypes. The whole-lung opacification volume, GGO volume, SO volume and their proportions in whole-lung volume significantly increased from common, severe to critical types (all P<0.05). SO volume/GGO volume increased with the severity of clinical type [common type 0.12 (0.03, 0.34), severe type 0.29 (0.11, 0.59), critical type 0.61 (0.39, 0.97)]. Multiple ordered logistic regression analysis showed that whole-lung opacification volume (OR=1.009), SO volume/GGO volume (OR=1.866), GGO volume (OR=1.008) and SO volume (OR=1.016) had a significant positive effect on the severity of clinical typing ( P<0.01). Conclusion:Quantitative indicators of chest CT based on deep learning algorithm (SO volume, GGO volume, SO volume/GGO volume) are closely related to the clinical severity of COVID-19.

Objective To explore the value of elastography score and strain rate ratio in the diagnosis of small breast malignant focus. Methods We retrospectively analyzed 22 patients with breast small malignant foci less than 10 mm. Ultrasound characteristics were summed up in breast small cancer. Results On elastogram, 2 patients scored 3, 14 scored 4 and 6 scored 5.The average strain rate ratio of all foci was 4.76, and there was correlation between it and elastography scores. Conclusion Ultrasonic elastography has important value in the diagnosis of breast small cancer.

Objective To analyze the reasons and treatment methods of high transprothetic pressure gradient after aortic valve replacement. Methods The clinical data of 45 patients with high transprothetic pressure gradient after aortic valve replacement were retrospectively analyzed. The patients were followed up for average 24.6 (12 - 40) months. The postoperative effective orifice area (EOA) of artificial valve was measured by transthoracic color Doppler ultrasound. Compared with published referred EOA of different artificial valve, there were 2 kinds results:measured EOA=referred EOA and measured EOA0.85 cm2/m2 and EOAI<0.85 cm2/m2. The reasons of high transprothetic pressure gradient were analyzed according to the above different standard. Results In the 45 patients with high transprothetic pressure gradient after aortic valve replacement, prosthesis-patient mismatch (PPM) was in 33 cases, and prosthetic dysfunction was in 10 cases, among whom 5 cases were because of thrombus (3 cases improved after increasing the dosage of warfarin, 2 cases underwent re-aortic valve replacement), 3 cases were because of severe bioprosthetic calcification (underwent re-aortic valve replacement), and 2 cases were because of prosthetic ring pannus and influenced movement of the leaflets (underwent re-aortic valve replacement). High flow in the left ventricular outflow tract occurred in 2 cases. The patients had no obvious discomfort, and did not receive special treatment. Four cases died, among whom 2 cases were because of severe PPM, and the other 2 cases were because of noncardiac. Conclusions Many reasons can result to the high transprothetic pressure gradient, and the PMM is the most common reason. Choosing the right treatment plan can improve the survival rate of patients.

OBJECTIVETo observe the effect of Pinggan Qianyang Recipe (PQR) on inhibiting angiotensin II (Ang II) induced proliferation and migration of vascular smooth muscle cells (VSMCs) and changes of DNA methylation.

METHODSVSMCs were cultured using tissue explant method, and PQR containing serum was prepared. Primarily cultured VSMCs were divided into four groups, the normal group, the model group, the folate group (folic acid intervention) , and the PQR group. The proliferation and migration of VSMCs was duplicated by Ang II. After 24-h Ang II induced culture, 40 microg/mL folic acid was added to the folate group for 48 h, while 5% PQR containing serum was added to the PQR group for 48 h. The cell growth curve of VSMCs was drawn by using Cell Counting Kit (CCK-8). The proliferative activity of VSMC was determined by MTT assay. The migration of VSMCs was measured by Millicell chamber. The general level of cytosine methylation in cell nucleus was detected via 5-mC antibodies immunofluorescence, and mRNA expression levels of DNA methyltransferase 1 (DNMT1) were measured by Real-time q-polymerase chain reaction (q-PCR).

RESULTSVSMCs were promoted by Ang II at 10(-6) mol/L for 24 h. Compared with the normal group, the proliferative activity and migration quantity of VSMCs obviously increased, and DNA methylation level obviously decreased (P < 0.05, P < 0.01). Compared with the model group, the cell growth, proliferative activity and migration quantity of VSMCs obviously decreased and the general DNA methylation level increased in the folate group and the PQR group (P < 0.05, P < 0.01). Compared with the normal group, the mRNA expression of DNMT1 decreased in the model group (P < 0.01). Compared with the model group, mRNA expression of DNMT1 in Ang II induced VSMCs was obviously enhanced in the folate group and the PQR group (P < 0.01).

CONCLUSIONSPQR could inhibit Ang II induced proliferation and migration of VSMCs, and cause high genomic DNA methylation level. Changes of DNA methylation might be associated with DNMT1 expression.

Angiotensin II ; pharmacology ; Cell Movement ; Cell Proliferation ; Cells, Cultured ; DNA (Cytosine-5-)-Methyltransferase 1 ; DNA (Cytosine-5-)-Methyltransferases ; metabolism ; DNA Methylation ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Muscle, Smooth, Vascular ; cytology ; Myocytes, Smooth Muscle ; cytology ; drug effects

AIM:To investigate the effect of β-elemene on reversing hepatocyte growth factor(HGF)-induced resistance to gefitinib in PC-9 cells, and to explore its possible mechanisms.METHODS: The gefitinib-resistant PC-9 cells induced by HGF were treated with β-elemene or/and gefitinib.The cell activity was measured by MTT assay.The effect of β-elemene on the invasion ability in HGF-induced resistance to gefitinib in PC-9 cells was detected by Transwell migration assay.The protein levels of p-Met, c-Met, p-AKT and AKT in PC-9 cells of each group were determined by Western blot.RESULTS:The results of MTT assay showed that the cell activity of PC-9 cells was significantly inhibited by β-elemene(P<0.05).IC50of β-elemene for PC-9 cells was 169.31 mg/L.IC50of gefitinib for PC-9 cells was 0.30 μmol/L.Exogenously adding recombinant HGF induced significantly resistance to gefitinib in PC -9 cells.Moreover, SU11274(an inhibitor of c-Met)significantly decreased the viability of the cells exposed to HGF and gefitinib(P <0.05).Combined treatment with β-elemene and gefitinib in the presence of HGF(50 μg/L)significantly decreased the viability of PC-9 cells as compared with the PC-9 cells treated with gefitinib alone in the presence of HGF(P<0.05),so did the result of the cell migration.The protein levels of p-Met and p-AKT were significantly up-regulated by HGF,while the protein levels of p-Met and p-AKT were markedly down-regulated in the cells treated with β-elemene and gefitinib com-pared with gefitinib alone in the presence of HGF.CONCLUSION: β-elemene reverses HGF-induced resistance to ge-fitinib in lung cancer PC-9 cells,likely due to the inhibition of HGF-induced activation of c-Met and its down streams sig-naling pathways(P<0.01).