To investigate the effect of long-term indwelling gastric tube on the prevention and treatment of esophageal stenosis after endoscopic submucosal dissection (ESD) for esophageal circumferential superficial cancer, data of patients with esophageal circumferential superficial cancer who underwent ESD in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021 were retrospectively analyzed. There were 15 patients with gastric tube placement (GTP) after ESD (the GTP group ), and 23 patients without GTP (the non-GTP group). The general information, lesion location, pathological stage, postoperative complications, degree of esophageal stenosis (water intake), pain conditions, number of hospitalizations and medical expenses were compared between the two groups. The results showed that there was no significant difference in age, gender, lesion location or postoperative pathological stage between the two groups ( P>0.05). Compared with the non-GTP group, the rate of water intake in the GTP group was significantly higher (11/15 VS 6/23, P<0.05), the frequency of pain was less in the GTP group (7.3±3.1 times VS 10.7±3.6 times, t=3.00, P<0.05), and the number of hospitalizations and the medical expenses after ESD to before and after stent placement were significantly lower in the GTP group than those in the non-GTP group ( P<0.05). There were no significant differences in the incidence of delayed bleeding and perforation, or time of the first stenosis after ESD between the two groups ( P>0.05). The results of the study initially showed that long-term indwelling gastric tube after ESD can reduce the degree of esophageal stenosis with good safety for esophageal circumferential superficial lesions.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

ObjectiveChemical components in ethanol extract of Cyclocarya paliurus dried leaves were analyzed by ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry （UHPLC-Q-TOF/MS）. MethodAn Agilent Poroshell 120 EC-C₁₈ column （3.0 mm×100 mm， 2.7 μm） was used with 0.1% formic acid aqueous solution （A）-acetonitrile （B） as the mobile phase for gradient elution （0-26 min，2%-18%B； 26-60 min， 18%-72%B； 60-70 min， 72%-100%B； 70-71 min， 100%-2%B； 71-72 min， 2%B）， and the flow rate of 0.4 mL·min^-1 and injection volume of 3 μL. The electrospray ionization （ESI） was used in positive and negative modes， and detection range was m/z 50-1 100. The collected data were processed by Agilent MassHunter workstation. According to the retention time and MS information of each compound， combined with existing literature and MS database information， the compounds were identified and analyzed for the fragmentation rule. ResultA total of 52， 55 components were identified in the positive and negative ion modes， respectively. Among them， 14 flavonoids， 3 triterpenoids， 15 organic acids and 20 other compounds were identified under positive ion mode， while 18 flavonoids， 9 triterpenoids， 18 organic acids and 10 other compounds were identified under the negative ion mode. By summarizing the positive and negative ion modes and removing the common compounds， 87 compounds were identified， including 22 flavonoids， 27 organic acids， 11 triterpenoids and 27 other compounds. ConclusionUHPLC-Q-TOF/MS can be used to quickly analyze the chemical constituents in C. paliurus dried leaves. 1-Kestose and 18β-glycyrrhetinic acid and other components related to hypoglycemic activity of this herb are identified for the first time， which can provide reference for clarifying the pharmacodynamic substance basis of C. paliurus dried leaves.

Objective: To investigate the maternal and neonatal outcomes of fetal meconium peritonitis (FMP) cases with different ultrasonic manifestations. Methods: The clinical data of 31 pregnant women with FMP diagnosed by prenatal ultrasound and confirmed by postnatal imaging examination in Guangzhou Women and Children's Medical Center from January 2011 to December 2018 were analyzed retrospectively. According to the last prenatal ultrasonographic findings, the 31 cases were classified into the following grades: grade 0 (three cases), grade 1 (20 cases, grade 1A: nine cases, grade 1B: three cases, grade 1C: eight cases), grade 2 (seven cases) and grade 3 (one case). All neonates were also divided into two groups: the operation group (19 cases) and conservative treatment group (12 cases) based on whether or not underwent surgery. Statistical methods were independent sample t-test and Chi-square test. Results: (1) The gestational ages at the first diagnosis of FMP and birth of the operation group were both lower than those of the conservative treatment group [(29.9±4.5) vs (38.2±1.0) weeks, t=-6.202; (36.2±2.7) vs (38.2± 1.0) weeks, t=-2.426; both P<0.05]. (2) The operation rates in cases of grade 0, 1, 2 and 3 groups were 0/3, 55%(11/20), 7/7 and 1/1, respectively (χ²=10.136, P=0.017). However, the operation rates in grade 1A, 1B and 1C groups were 7/9, 1/3 and 3/8, respectively (χ²=3.446, P=0.179). Conclusions The rate of operation of FMP newborn was related to the gestational age of the first prenatal ultrasound diagnosis of FMP and the ultrasonic grade. The different grades of prenatal ultrasound in FMP cases can provide important information for guiding perinatal treatment.

Objective:To implement quality control in whole life cycle for infant incubator, and ensure it working in safe and efficient situation.Methods:The parameter detection cases of infant incubator was analyzed and researched according to relative standards and requirements of technique for medical equipment.Results:The detection data and frequent failures of clinical cases revealed that there were parameter deviation existing in infant incubators. These deviations should be adjusted in time according to relative standards and requirements of technique for medical equipment.Conclusion:The quality control of whole life cycle for infant incubator is the necessary condition for ensuring medical quality and safety of patients. To pay attention to the quality control before and after application and after maintenance of the infant medical incubator, in order to ensure the medical equipment can achieve to meet the performance requirement of treatment and provide safe and efficient quality service for patients.

Objective To investigate the correlation between anxiety, depression and quality of life in patients undergoing in vitro fertilization and embryo transfer. Methods The psychological status of patients undergoing in vitro fertilization and embryo transfer in Nanjing General Hospital of Nanjing Military Command from November 2016 to March 2017 was investigated with the method of purposive sampling. Results The survey released a total of 300 questionnaires with effective recovery of 280, the effective recovery rate was 93.33%. The score of anxiety scale was (55.16 ± 3.92) points, the score of depression scale was (55.62 ± 8.45) points. Nearly 87%(244/280) patients showed anxiety symptom, and 48%(134/280) patients showed depression symptom. The score of quality of life was (62.55±12.09) points, and the anxiety and depression were negatively correlated with the quality of life (r=-0.581,-0.544). Multivariate regression analysis showed that factors affecting the fertility quality of life scores including anxiety, depression, age, educational level, family income, infertility years, type of infertility, previous receiving assisted reproductive history. Conclusions The patients with in vitro fertilization and embryo transfer show different degrees of anxiety and depression, and is correlated with quality of life. Medical staff should pay more attention to the psychological status of patients, adopt targeted interventions to improve anxiety and depression status of patients, help patients to actively take effective coping style to improve the quality of life of patients, improve the clinical pregnancy rate.

Objective To evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) guided with endoscopic ultrasonography (EUS) for rectal neuroendocrine neoplasms(NENs).Methods A retrospective analysis was performed on 58 patients with rectal ENEs who underwent ESD from January 2011 to December 2015 in JiangSu Province Hospital.Manifestations of EUS, clinicopathological characteristics, proliferation activity grade, complete resection rate, complications and follow-up results of lesion were studied.Results Those treated by ESD included 58 patients with 64 lesions of rectal NENs.EUS results showed that 3 lesions originated from mucosa, 3 from muscularis mucosa and 58 from submucosa.A total of 34 lesions located within 5 cm from anus, 26 in 6-10 cm from anus and 4 more than 10 cm from anus.All 64 lesions were successfully treated by ESD.The mean maximum diameter of the lesions was 0.8 cm(0.2-3.5 cm), and the mean procedure time was 31 min(10-60 min).The complete resection rate was 93.8% (60/64).There were 4 patients with positive basal surgical margin, and two of them underwent additional surgery and two others were treated with argon plasma coagulation after rejecting surgery and ESD.Histological examination determined that 59 lesions were pathologic grade 1(G1) and 5 were pathologic grade 2(G2).Delayed bleeding occurred in 4 cases after ESD,which was managed by medicine in 1 case and endoscopic treatment in 3 cases.No perforation occurred after ESD.During a mean follow-up period of 22.9 months(3-48 months), no lymph node metastasis or distant metastasis was observed.Conclusion EUS is able to distinguish the origin of rectal NENs and aid determining the range and depth of ESD.ESD appears to be a safe, feasible and effective procedure for providing accurate histopathologica1 evaluations as well as curative treatments for rectal NENs limited to submucosa.

Objective To investigate the status of social participation of young and middle-age peritoneal dialysis patients and analyze its influencing factors. Methods Descriptive study was used to investigate the general information and social participation of 113 cases of young and middle-age patients with peritoneal dialysis, and we analyzed the influencing factors of social participation using ordinal Logistic regression analysis. Results In the 113 cases of young and middle-age patients with peritoneal dialysis, 97. 3%of patients could take care of themselves. Rating of social participation showed that 63. 7% of patients were in grade three, that was, to take care of themselves, and to carry out at least one of the social participation; the unemployed people accounted for 76. 1%. The status of social participation was related to age, marriage, education, social support, self efficacy and other factors. Conclusions The unemployed rate of young and middle-age peritoneal dialysis patients is high. To pay attention to the peritoneal dialysis population at work age, and improve the social participation of young and middle-age patients with peritoneal dialysis, the matter needs the joint efforts of medical personnel and social forces.

Objective To investigate the correlations between social support and self efficacy of young and middle-aged patients with peritoneal dialysis. Method The status of social support and self-efficacy of 97 young and middle-aged patients undergoing peritoneal dialysis were investigated and the correlation were analyzed. Results The score on social was (28.0 ± 6.4), lower than the norm (P < 0.01). The score on self-efficacy was (2.38 ± 0.62). The level of confidence was lower in 28 cases (28.9%), high in 58 cases (59.8%), very high in 11 cases (11.3%). The self-efficacy was positively correlated with social support, subjective support and support utilization (all P<0.05). Conclusions The levels of social support and self-efficacy are lower than the norm in young and middle-aged patients undergoing peritoneal dialysis. The self-efficacy is positively correlated with social support including subjective support and support utilization, which indicates that improved social support is effective for the improvement of self-efficacy by providing patients with family and social support.

Objective To analyse the sensitivity ,specificity and coincidence rate of genechip method in the detection of resistance to antibacterial agents in Mycobacterium tuberculosis(MTB) ,in order to provide a convenient ,accurate and rapid method for detec‐ting antibacterial resistance in MTB .Methods The DNA sequencing was taken as gold standard ,and antibacterial resistance of the strains of MTB isolated from sputum specimens of 250 cases of patients with tuberculosis from August to December 2014 were de‐tected by using the genechip method and proportion method for susceptibility testing at the same time .Efficacies of the two methods in detecting MTB resistance to rifarnpin and isoniazid were compared .Results The MTB resistance rate to rifarnpin detected by u‐sing the genechip method and proportion method for susceptibility testing was 3 .0% and 3 .5% respectively ;that to isoniazid was 6 .7% and 8 .2% respectively .For detecting M TB resistance to rifarnpin and isoniazid ,the DNA sequencing was taken as gold standard ,the sensitivity ,specificity and coincidence rate of genechip method was higher than those of proportion method for suscep‐tibility testing ,and the test time of genechip method was shorter than that of proportion method for susceptibility testing ,there were statistically significant differences(P<0 .05) .Conclusion Using the genechip method to detecting MTB resistance to rifampin and isoniazid has high sensitivity ,specificity and coincidence rate ,which could replace the proportion method for susceptibility tes‐ting and become an effective method .