Objective:To analyze the differences in clinical and endoscopic ultrasonography (EUS) findings between diffuse and focal IgG4-related autoimmune pancreatitis (IgG4-AIP).Methods:Data of patients diagnosed as having IgG4-AIP who underwent EUS at Chinese PLA General Hospital from September 2011 to April 2022 were retrospectively collected. General clinical data, EUS features, and postoperative pathology were analyzed for characteristic differences.Results:A total of 40 patients were included in the study, 60.03±10.87 years old, a higher proportion of males (85.0%, 34/40). All patients underwent EUS, and 28 underwent EUS-guided fine-needle aspiration. Among the 40 patients, 29 (72.5%) had diffuse type and 11 (27.5%) had focal type. Abdominal pain [65.5% (19/29) VS 18.2% (2/11), χ2=5.393, P=0.020] and thickening of the bile duct wall [51.7% (15/29) VS 9.1% (1/11), χ2=4.394, P=0.036] were more common in the diffuse type, while main pancreatic duct dilation [45.5% (5/11) VS 10.3% (3/29), χ2=4.146, P=0.042] was more common in the focal type, with the lesion most commonly located in the pancreatic head (90.9%, 10/11). There was no significant difference in the presence of chronic pancreatitis parenchymal changes between the two groups [34.5% (10/29) VS 27.3% (3/11), χ2=0.003, P=0.955]. Conclusion:There are certain differences in abdominal pain and biliary and pancreatic duct lesions between diffuse and focal AIP. The high expression of chronic pancreatitis characteristics is not observed in either group, which provides clues for the classification of AIP in clinical practice.

Objective:To investigate the clinical effect of free anterolateral thigh perforator flap(ALTPF) in reconstruction of temporal scalp defect after blood circulation reconstruction surgery for moyamoya disease.Methods:From May 2020 to July 2022, 7 patients with scalp defect after revascularisation of moyamoya disease were treated in Department of Hand and Foot Microsurgery, Henan Provincial People’s Hospital (People’s Hospital of Zhengzhou University). The patients were 4 males and 3 females, aged 33-59 years old, at 43 years old in average. There were 5 defects in left tempus and 2 in right tempus. The sizes of scalp defect were 4.5 cm × 5.5 cm-7.5 cm × 9.5 cm. Debridement and VSD management were primarily performed. After wounds were stabilised, ultrasound location of perforator vessels of ALTPFs was performed. Having confirmed that the perforator vessels were suitable for the surgical requirements, flap transfers were then performed. The descending branch of the lateral femoral circumflex artery was end-to-side anastomosed with the superficial temporal artery, and the descending branch of the lateral femoral circumflex vein was end-to-end anastomosed with the superficial temporal vein. Postoperative follow-up was conducted through outpatient clinic visits, telephone and WeChat reviews. Appearance, texture of ALTPFs and the flap donor sites were observed in follow-ups. Comparisons of the changes of nervous system before and after surgery were made. Cognitive function of the patients was assessed with the Mini Mental State Examination (MMSE), together with the Activities of Daily Living (ADL) .Results:All 7 flaps survived. One flap had vascular compromise 6 hours after surgery, and was rectified after surgical intervention. All the patients were included in the postoperative follow-up for 7-33 (average 19) months. All flaps had good appearance with soft texture. There was no obvious difference in colour comparing with the skin around the recipient region. The donor sites healed well without hypertrophic scar. Examinations of nervous system of the patients were found the same as that before surgery. Using Manual Muscle Testing (MMT), the average limb muscle strength of the patients was 4 before surgery and 4 after surgery, without change; Using the Ashworth assessment scale, the average preoperative and postoperative limb muscle tension in this group of patients was 1, without change; The Berg balance scale was used to evaluate the patient's balance function, with an average score of 42 before surgery and 42 after surgery, without any changes; There was no change in limb sensation before and after surgery; Using the MMSE, the average preoperative score and postoperative score of this group of patients were 25 points, without any change. Using the modified Barthel index scoring standard, the average preoperative score for this group of patients was 75 points, and the average postoperative score was 79 points, and the ADL of the patient had improved to various levels.Conclusion:Reconstruction of scalp defect with free ALTPF after revascularisation of moyamoya disease has obvious advantages, such as it closes the wound quickly, prevents infection and achieves a good appearance. This surgical procedure can produce a good clinical effect.

OBJECTIVE To prepare Angelica•Cinnamomum（Angelica sinensis-Cinnamomum cassia ）self•microemulsion drug delivery system （AC•SMEDDS），and to optimize its formulation and characterize its preparation . METHODS Using Angelica• Cinnamomum mixed volatile oil as oil phase and model drug ，on the basis of selecting emulsifier and co -emulsifier and the optimization of their mass ratio range ，the formulation was optimized with central composite design •response surface methodology using the ratio of oil phase （Angelica•Cinnamomum mixed volatile oil ），mass ratio of emulsifier and co -emulsifier as factors ，the comprehensive score of volatile oil content ，particle size and emulsifying time as index . Morphology，particle size ，drug loading ， entrapped efficiency and stability of optimized AC•SMEDDS were characterized . RESULTS The optimum formulation of AC•SMEDDS contained the ratio of oil phase was 30%，and the mass ratio of emulsifier （EL•40）and co -emulsifier（ethanol）was 9∶1. Results of validation tests showed that the average particle size of AC•SMEDDS was （148.33±1.53）nm，and emulsifying time was （18.44±0.11）s. The comprehensive score was 0.68，relative deviation of which from the predicted value （0.70）was 2.86%. AC•SMEDDS prepared by optimal formulation was faint yellow ，uniform and transparent liquid ，and spherical particals with translucent edge were observed under transmission electron microscope . Calculated by ligustilide and cinnamaldehyde ，the drug loading was （7.58±0.03） and （4.17±0.01） mg/g，and entrapped efficiency was （93.25±0.01）% and （88.89±0.02）% ， respectively. No stratification or precipitation occurred after centrifugation at the speed of 10 000 r/min or placing within 7 （No.2019-0520） days at 4 and 25 ℃ . The contents of ligustilide and cinnamaldehyde were stable . Its particle size had no significant change after 50，100 and 200 times dilution by purified water . CONCLUTIONS AC•SMEDDS is prepared successfully and its formulation is optimized . The stability of the preparation is good .

Objective:To determine the safety and long-term efficacy of endoscopic ultrasonography-guided lauromacrogol ablation (EUS-LA) for treatment of pancreatic cystic neoplasms (PCNs) with a larger population.Methods:From April 2015 to April 2019, 255 patients suspected of PCNs were enrolled in the First Medical Center of Chinese PLA General Hospital in the study, and 57 patients underwent EUS-LA. The effectiveness of EUS-LA was determined based on imaging volume changes. The occurrence of complications was observed and recorded.Results:Among the 57 patients who underwent EUS-LA, 38 were female and 19 were male, with the mean age of 52.0±14.6 years. The cysts were located in the head/uncinate of the pancreas in 33 patients and in the body/tail of the pancreas in 24 patients. A total of 50 patients were followed up by imaging examinations. After treated by EUS-LA, the cyst median volume sharply reduced from 11 434.1 mm 3 to 639.4 mm 3 ( Z=-5.556, P<0.01), and the median diameter decreased from 32.0 mm to 12.0 mm ( Z=-6.161, P<0.01). Postoperative imaging showed a complete resolution in 24 patients (48.0%), partial resolution in 14 patients (28.0%), and persistent cyst in 12 patients (24.0%). The total number of ablation was 69, and there were 12 patients undergoing a second ablation. The adverse events rate was 4.3% (3/69). Among the 34 patients followed up for 12 months or more, complete resolution was observed in 18 patients (52.9%), partial resolution in 9 (26.5%), and persistent cyst in 7 (20.6%). Conclusion:EUS-LA is effective and safe for the treatment of PCNs. Its effectiveness is stable after more than 12 months′ follow-up.

Objective To explore the clinical safety of peroral endoscopic cardial constriction for gastro-esophageal reflux.Methods Clinical data of 47 patients with gastro-esophageal reflux who underwent peroral endoscopic cardial constriction in Chinese PLA General Hospital were retrospectively studied from August 2013 to August 2016.Results A total of 47 patients underwent peroral endoscopic cardial constriction successfully with no perforation or fever.Retrostemal vague pain and discomfort occurred in 7 cases,mild dysphagia occurred in 2 cases,and mild hemoptysis occurred in one patient the day after the operation.No special measures were taken and all 10 patients showed symptom remission in less than two days.As for the postoperative treatment,22 (46.8％) patients were given a liquid diet on the day of operation,39(82.9％) patients were given semi-or liquid diet on the first day after the operation,and two days later,43 (91.5％) resumed semi-or liquid diet.Only 9 cases were given antibiotics for prophylaxis for infection.Conclusion Peroral endoscopic cardial constriction is safe and effective for gastro-esophageal reflux.The hospitalizing time is short and postoperative recovery is quick.

OBJECTIVETo compare the safety and efficiency of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) for large esophageal superficial neoplasms.

METHODSA total of 235 consecutive patients undergoing endoscopic resection for esophageal neoplasms between October, 2010 and June, 2013 in our endoscopy center were analyzed retrospectively. According to the inclusion and exclusion criteria, 29 patients receiving ESTD or ESD for large esophageal superficial neoplasms were enrolled for data analysis.

RESULTSOf the 29 patients, 11 underwent ESTD and 18 received ESD. The dissection speed of ESTD was significantly higher than that of ESD (22.4∓5.2 mm(2)/min vs 12.2∓4.0 mm(2)/min, P<0.05). Despite a similar en bloc rate between the two groups (100% [11/11] vs 88.9% [16/18], P>0.05), the radical curative rate of ESTD was significantly greater than that of ESD (81.8% [9/11] vs 66.7% [12/18], P<0.05). No serious bleeding or perforation occurred in the patients except for 1 in ESD group with intraoperative bleeding, which was managed with hemostatic forceps. Eight patients had postoperative esophageal strictures in relation with circumferential extension and the longitudinal length (P<0.05).

CONCLUSIONESTD is a safe and effective alternative for large esophageal superficial neoplasms with a shortened operative time, a higher dissection speed and a higher radical curative rate in comparison with ESD, but postoperative esophageal strictures should be closely monitored especially for lesions more than 3/4 of the circumferential extension or exceeding 50 mm.

Aged ; Endoscopy ; Esophageal Neoplasms ; surgery ; Esophagus ; surgery ; Female ; Humans ; Male ; Middle Aged ; Mucous Membrane ; surgery ; Retrospective Studies

Objective To compare the safety and efficiency of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) for large esophageal superficial neoplasms. Methods A total of 235 consecutive patients undergoing endoscopic resection for esophageal neoplasms between October, 2010 and June, 2013 in our endoscopy center were analyzed retrospectively. According to the inclusion and exclusion criteria, 29 patients receiving ESTD or ESD for large esophageal superficial neoplasms were enrolled for data analysis. Results Of the 29 patients, 11 underwent ESTD and 18 received ESD. The dissection speed of ESTD was significantly higher than that of ESD (22.4±5.2 mm2/min vs 12.2±4.0 mm2/min, P<0.05). Despite a similar en bloc rate between the two groups (100%[11/11]vs 88.9%[16/18], P>0.05), the radical curative rate of ESTD was significantly greater than that of ESD (81.8%[9/11]vs 66.7%[12/18], P<0.05). No serious bleeding or perforation occurred in the patients except for 1 in ESD group with intraoperative bleeding, which was managed with hemostatic forceps. Eight patients had postoperative esophageal strictures in relation with circumferential extension and the longitudinal length (P<0.05). Conclusions ESTD is a safe and effective alternative for large esophageal superficial neoplasms with a shortened operative time, a higher dissection speed and a higher radical curative rate in comparison with ESD, but postoperative esophageal strictures should be closely monitored especially for lesions more than 3/4 of the circumferential extension or exceeding 50 mm.

Objective To compare the safety and efficiency of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) for large esophageal superficial neoplasms. Methods A total of 235 consecutive patients undergoing endoscopic resection for esophageal neoplasms between October, 2010 and June, 2013 in our endoscopy center were analyzed retrospectively. According to the inclusion and exclusion criteria, 29 patients receiving ESTD or ESD for large esophageal superficial neoplasms were enrolled for data analysis. Results Of the 29 patients, 11 underwent ESTD and 18 received ESD. The dissection speed of ESTD was significantly higher than that of ESD (22.4±5.2 mm2/min vs 12.2±4.0 mm2/min, P<0.05). Despite a similar en bloc rate between the two groups (100%[11/11]vs 88.9%[16/18], P>0.05), the radical curative rate of ESTD was significantly greater than that of ESD (81.8%[9/11]vs 66.7%[12/18], P<0.05). No serious bleeding or perforation occurred in the patients except for 1 in ESD group with intraoperative bleeding, which was managed with hemostatic forceps. Eight patients had postoperative esophageal strictures in relation with circumferential extension and the longitudinal length (P<0.05). Conclusions ESTD is a safe and effective alternative for large esophageal superficial neoplasms with a shortened operative time, a higher dissection speed and a higher radical curative rate in comparison with ESD, but postoperative esophageal strictures should be closely monitored especially for lesions more than 3/4 of the circumferential extension or exceeding 50 mm.

OBJECTIVETo compare the safety and efficiency of transverse-incision peroral endoscopic myotomy (POEM) with longitudinal-incision POEM.

METHODSPOEM, with a transverse or longitudinal entry incision, was performed in 53 consecutive patients with confirmed achalasia (AC) between December 2010 and September 2012. Data of those patients was collected including the time spent for different procedures and complications.

RESULTSAll the 53 patients underwent POEM successfully, among whom 41 patients had a transverse entry incision and 12 had a longitudinal incision. Treatment success (Eckardt score≤3) with a follow-up for 3-24 months (median 5 month) was achieved in 96.2% of the cases (mean score pre-treatment vs. post-treatment: 7.5 vs 0.6, P<0.001). The whole operation time of transverse-incision group was slightly shorter than that of longitudinal-incision group (65.0∓18.0 min vs 74.1∓18.2 min, P=0.142), but it took much less time in tunnel built-up and muscle dissection in the transverse-incision group (36.3∓9.0 min vs 45.4∓10.5 min; 10.2∓4.6 min vs 15.5∓5.5 min, P<0.05). In addition, patients in transverse incision group were much less likely to develop pneumatosis- related complications [9.8% (4/41) vs 41.7% (5/12), P<0.05). No serious complications occurred in these two groups such as pleural effusion, mediastinitis or digestive tract fistula.

CONCLUSIONSPOEM with a transverse entry incision can significantly decrease the operation time and reduce the incidence of pneumatosis-related complications while obviously relieving the symptoms.

Adolescent ; Adult ; Endoscopy ; Esophageal Achalasia ; surgery ; Female ; Humans ; Male ; Middle Aged ; Tendons ; surgery ; Treatment Outcome ; Young Adult

Objective To compare the safety and efficiency of transverse-incision peroral endoscopic myotomy (POEM) with longitudinal-incision POEM. Methods POEM, with a transverse or longitudinal entry incision, was performed in 53 consecutive patients with confirmed achalasia (AC) between December 2010 and September 2012. Data of those patients was collected including the time spent for different procedures and complications. Results All the 53 patients underwent POEM successfully, among whom 41 patients had a transverse entry incision and 12 had a longitudinal incision. Treatment success (Eckardt score≤3) with a follow-up for 3-24 months (median 5 month) was achieved in 96.2% of the cases (mean score pre-treatment vs. post-treatment: 7.5 vs 0.6, P<0.001). The whole operation time of transverse-incision group was slightly shorter than that of longitudinal-incision group (65.0±18.0 min vs 74.1±18.2 min, P=0.142), but it took much less time in tunnel built-up and muscle dissection in the transverse-incision group (36.3±9.0 min vs 45.4±10.5 min;10.2±4.6 min vs 15.5±5.5 min, P<0.05). In addition, patients in transverse incision group were much less likely to develop pneumatosis-related complications [9.8% (4/41) vs 41.7% (5/12), P<0.05). No serious complications occurred in these two groups such as pleural effusion, mediastinitis or digestive tract fistula. Conclusions POEM with a transverse entry incision can significantly decrease the operation time and reduce the incidence of pneumatosis-related complications while obviously relieving the symptoms.