Clinical guideline on magnetically controlled capsule gastroscopy (2021 edition).

With the development and generalization of endoscopic technology and screening, clinical application of magnetically controlled capsule gastroscopy (MCCG) has been increasing. In recent years, various types of MCCG are used globally. Therefore, establishing relevant guidelines on MCCG is of great significance. The current guidelines containing 23 statements were established based on clinical evidence and expert opinions, mainly focus on aspects including definition and diagnostic accuracy, application population, technical optimization, inspection process, and quality control of MCCG. The level of evidence and strength of recommendations were evaluated. The guidelines are expected to guide the standardized application and scientific innovation of MCCG for the reference of clinicians.

Features of capsule endoscopy in COVID-19 patients with a six-month follow-up: A prospective observational study.

Recently, the coronavirus disease 2019 (COVID-19) has caused a global pandemic. Several studies indicate that the digestive system can also be affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, patients with digestive symptoms should have a capsule endoscopy (CE). COVID-19 patients with gastrointestinal (GI) symptoms who underwent CE were recruited from March 2020 to April 2020. We collected patients' data and performed a prospective follow-up study for 6 months. All 11 COVID-19 cases with GI symptoms who underwent CE presented gastritis. Eight cases (72.7%) had intestinal mucosa inflammation. Among them, two cases showed intestinal ulcers or erosions. Moreover, two cases displayed colonic mucositis. One case was lost during follow-up. At 3-6 months after hospital discharge, five patients underwent CE again, presenting gastrointestinal lesions. Five of the 10 cases had GI symptoms, such as abdominal pain, diarrhea, constipation, and others. Among these five cases, the GI symptoms of three patients disappeared at the last follow-up and two patients still presented diarrhea symptoms. Overall, we observed damaged digestive tract mucosa that could be caused by SARS-CoV-2. Moreover, after discharge, some patients still presented intestinal lesions and GI symptoms.

Accuracy of Magnetically Controlled Capsule Endoscopy, Compared With Conventional Gastroscopy, in Detection of Gastric Diseases.

BACKGROUND & AIMS: Diseases of the stomach, including gastric cancer and peptic ulcer, are the most common digestive diseases. It is impossible to visualize the entire stomach with the passive capsule currently used in practice because of the large size of the gastric cavity. A magnetically controlled capsule endoscopy (MCE) system has been designed to explore the stomach. We performed a prospective study to compare the accuracy of detection of gastric focal lesions by MCE vs conventional gastroscopy (the standard method). METHODS: We performed a multicenter blinded study comparing MCE with conventional gastroscopy in 350 patients (mean age, 46.6 y), with upper abdominal complaints scheduled to undergo gastroscopy at a tertiary center in China from August 2014 through December 2014. All patients underwent MCE, followed by conventional gastroscopy 2 hours later, without sedation. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of detection of gastric focal lesions by MCE, using gastroscopy as the standard. RESULTS: MCE detected gastric focal lesions in the whole stomach with 90.4% sensitivity (95% confidence interval [CI], 84.7%-96.1%), 94.7% specificity (95% CI, 91.9%-97.5%), a positive predictive value of 87.9% (95% CI, 81.7%-94.0%), a negative predictive value of 95.9% (95% CI, 93.4%-98.4%), and 93.4% accuracy (95% CI, 90.83%-96.02%). MCE detected focal lesions in the upper stomach (cardia, fundus, and body) with 90.2% sensitivity (95% CI, 82.0%-98.4%) and 96.7% specificity (95% CI, 94.4%-98.9%). MCE detected focal lesions in the lower stomach (angulus, antrum, and pylorus) with 90.6% sensitivity (95% CI, 82.7%-98.4%) and 97.9% specificity (95% CI, 96.1%-99.7%). MCE detected 1 advanced gastric carcinoma, 2 malignant lymphomas, and 1 early stage gastric tumor. MCE did not miss any lesions of significance (including tumors or large ulcers). Among the 350 patients, 5 reported 9 adverse events (1.4%) and 335 preferred MCE over gastroscopy (95.7%). CONCLUSIONS: MCE detects focal lesions in the upper and lower stomach with comparable accuracy with conventional gastroscopy. MCE is preferred by almost all patients, compared with gastroscopy, and can be used to screen gastric diseases without sedation. Clinicaltrials.gov number: NCT02219529.

Segmental Duodenectomy in Surgical Therapy of Tumor of the Third and Fourth Portions of Duodenum.

BACKGROUND/AIMS: To analyze our experience of segmental duodenectomy for tumors located at the third and fourth portion of the duodenum and attempt to explore the security and feasibility of this surgical procedure. METHODOLOGY: A retrospective cohort study of five patients who underwent segmental duodenectomy in our hospital, medical records were analyzed in this study. RESULTS: The initial symptoms in five patients are not specific. Five were surgically treated by segmental resection. All patients without postoperative anastomotic leakage, the gastroparesis and anastomotic stenosis each appeared in a case and all recovered after supportive care. Pathological examination showed: 3 cases of stromal tumor, 1 :ases of lymphangioma, diffuse large B-cell lymphoma. Postoperative gastrointestinal bleeding does not appear in the lymphangioma,two cases of high risk group of stromal tumor patients received targeting therapy with Imatinib Mesylate for 2 years after resection, the patient with lymphoma administer postoperative adjuvant chemotherapy. All patients are still alive and the lymphoma patient developed postoperative local recurrence after approximately six months. CONCLUSIONS: Segmental duodenectomy is a reliable and curative option for most duodenal benign tumor and stromal tumor located at the third and fourth portion. It is also applicable to some malignant tumor.

Activation of BK(Ca) channels in zoledronic acid-induced apoptosis of MDA-MB-231 breast cancer cells.

BACKGROUND: Zoledronic acid, one of the most potent nitrogen-containing biphosphonates, has been demonstrated to have direct anti-tumor and anti-metastatic properties in breast cancer in vitro and in vivo. In particular, tumor-cell apoptosis has been recognized to play an important role in the treatment of metastatic breast cancer with zoledronic acid. However, the precise mechanisms remain less clear. In the present study, we investigated the specific role of large conductance Ca(2+)-activated potassium (BK(Ca)) channel in zoledronic acid-induced apoptosis of estrogen receptor (ER)-negative MDA-MB-231 breast cancer cells. METHODOLOGY/PRINCIPAL FINDINGS: The action of zoledronic acid on BK(Ca) channel was investigated by whole-cell and cell-attached patch clamp techniques. Cell apoptosis was assessed with immunocytochemistry, analysis of fragmented DNA by agarose gel electrophoresis, and flow cytometry assays. Cell proliferation was investigated by MTT test and immunocytochemistry. In addition, such findings were further confirmed with human embryonic kidney 293 (HEK293) cells which were transfected with functional BK(Ca) α-subunit (hSloα). Our results clearly indicated that zoledronic acid directly increased the activities of BK(Ca) channels, and then activation of BK(Ca) channel by zoledronic acid contributed to induce apoptosis in MDA-MB-231 cells. The possible mechanisms were associated with the elevated level of intracellular Ca(2+) and a concomitant depolarization of mitochondrial membrane potential (Δψm) in MDA-MB-231 cells. CONCLUSIONS: Activation of BK(Ca) channel was here shown to be a novel molecular pathway involved in zoledronic acid-induced apoptosis of MDA-MB-231 cells in vitro.

[Necessity of No.13 lymph node dissection in advanced gastric carcinoma].

OBJECTIVE: To investigate the feasibility and necessity of No.13 lymph node dissection for advanced gastric carcinoma. METHODS: Clinical data of 144 cases who were diagnosed as TNMII-III stage gastric carcinoma were collected from January 2007 to December 2009 in the Department of General Surgery at the First Affiliated Hospital of Nanchang University. Seventy-two cases who received D2 radical gastrectomy plus No.13 lymph node dissection were selected as the study group, and they were matched 1:1 to 72 cases who received D2 Radical gastrectomy (the control group) for TNMII-III stage gastric carcinoma. The differences in the intraoperative and postoperative parameters and survival time were compared, and the factors associated with No.13 lymph node metastasis were analyzed. RESULTS: There were no significant differences between the two groups in operative time [(2.8 ± 0.4) h vs. (2.7 ± 0.4) h], blood loss [(191.9 ± 81.5) ml vs. (186.0 ± 81.7) ml], the incidence of postoperative complications (18.1% vs. 15.3%), length of hospital stay [(12.3 ± 4.2) d vs. (11.9 ± 3.2) d] and 3-year survival rate (63% vs. 57%) (all P>0.05). In the study group, there were 15 patients (20.8%) with positive No.13 lymph nodes, and the 3-year survival rate was 13%, significantly lower compared to those with negative No.13 lymph node (73%, n=57) (P<0.05). Multivariate analysis showed that N stage (P<0.01) and histological type (P<0.05) were independently associated with No.13 lymph node metastasis. CONCLUSION: No.13 lymph node dissection for TNMII-III stage gastric cancer is feasible and necessary.

[Association of the jejunal mucosal structure and the tolerance of early postoperative enteral nutrition in gastric carcinoma patients at different ages].

OBJECTIVE: To explore the association of the changes of the jejunal mucosal structure and the tolerance of early postoperative enteral nutrition in gastric cancer patients at different ages. METHODS: Thirty patients of gastric carcinoma undergone total gastrectomy were enrolled in this study, including 16 cases over 65 years old and 14 cases under 40 years old. The specimens of jejunal mucosa were taken during operation and were observed by light and electronic microscopes. The height and width of the jejunal villus and the thickness of the jejunal mucosa were measured. All the patients received enteral nutrition from the second postoperative day to discharge. The complications related to enteral nutrition, such as abdominal pain, abdominal distention, and diarrhea, were observed. RESULTS: The height of the jejunal villus was longer in young age group than that of old age group. The width of the jejunal villus was shorter in young age group than that of old age group. The thickness of the jejunal mucosa was thinner in old age group than that of young age group. The changes of ultrastructure of the jejunal mucosal epithelial cell in old age group showed that microvilli are rare and disorder, mitochondrial cristaes were broken and dissolved. The young age group was normal in the ultrastructure. The complications related to enteral nutrition were more frequent in old age group than those in young age group, especially in abdominal distention and diarrhea (P<0.01). CONCLUSION: The atrophy of jejunal mucosa in old age patients with gastric carcinoma lead to decrease the tolerance and increase the complications of the postoperative enteral nutrition.

[Clinical analysis of prognostic factors for patients with gastrointestinal stromal tumors].

OBJECTIVE: To investigate the prognostic factors for patients with gastrointestinal stromal tumors (GIST). METHODS: From 2000 to 2003, clinical data of 41 cases with GIST were reviewed retrospectively. The clinicopathologic diagnosis was determined by immunochemistry. The relationships of the prognosis with mitotic counts, tumor size and location,range of tumor resection were analyzed. RESULTS: The patients with GIST had pathological section of high expression in CD117, CD34 and vimentin (92.7%, 82.9%, 78%, respectively). Patients with tumor location in intestine, tumor size > 5 cm,mitotic counts > 5/50HPF, incomplete resection had poorer outcome, compared with those with tumor location in stomach and colon,tumor size < or = 5 cm,mitotic counts < or = 5/50HPF and complete resection (all P< 0.05). CONCLUSION: Complete gross resection can improve prognosis for patients with GIST. Tumors with mitotic counts > or = 5/50HPF, tumor size more than 5 cm and tumor location in intestine are poor prognostic factors.

[Treatment of benign bone tumor in extremities of children by subperiosteal free fibula graft].

OBJECTIVE: To investigate the way to reconstruct bone scaffold after removal of giant benign bone tumor in extremities of children. METHODS: From June 1995 to October 2000, 6 cases of benign bone tumor were treated, aged 6-14 years. Of 6 cases, there were 4 cases of fibrous hyperplasia of bone, 1 case of aneurysmal bone cyst and 1 case of bone cyst; these tumors were located in humerus (2 cases), in radius (1 case), in femur (2 cases) and in tibia (1 case), respectively. All patients were given excision of subperiosteal affected bone fragment, autograft of subperiosteal free fibula(4-14 cm in length) and continuous suture of in situ periosteum; only in 2 cases, humerus was fixed with single Kirschner wire and external fixation of plaster. RESULTS: After followed up 18-78 months, all patients achieved bony union without tumor relapse. Fibula defect was repaired, and the function of ankle joint returned normal. CONCLUSION: Autograft of subperiosteal free fibula is an optimal method to reconstruct bone scaffold after excision of giant benign bone tumor in extremities of children.

[Application of decalcified dental matrix in bone reparation].

OBJECTIVE: To investigate the effect of decalicified dental matrix (DDM) on healing of traumatic fracture and its side-effect. METHODS: From June 1997 to December 1998, 42 patients with closed traumatic long bone fracture (36 males and 6 females, aged from 18 to 57 years with an average of 32 years) were divided into two groups randomly; open reduction and internal fixation were carried out in all patients, but the DDM was used only in experimental group. After operation, the body temperature, ALT, and bone union time were observed and recorded. RESULTS: Following-up 1 to 3 years, the bone union time of experimental group was significantly shorter than that of control group (P < 0.01), there was no significant difference in the temperature and ALT changes between two groups(P > 0.05). No infection occurred. CONCLUSION: DDM can promote the growth of bony callus and enhance the healing of fracture. There is no side-effect.

[Effects of simulated weightlessness on pressure-volume relationships of femoral vein of New Zealand Rabbits].

Objective. To observe the changes of pressure-volume relationships of rabbit femoral veins and their structural changes caused by simulated weightlessness. Method. Head-Down Tilt (HDT) -20 degrees rabbit model was used to simulate weightlessness. Twenty four healthy male New Zealand Rabbits were randomly divided into 21 d HDT group,10 d HDT group and control group, (8 in each group). Pressure-volume (P-V) relationship of rabbits femoral veins was measured and the microstructure of the veins was observed. Result. The femoral vein P-V relationship curves of HDT groups showed a larger volume change ratio than that of control group. This change was that 21 d HDT group was even more obvious than that of HDT-10 d group. B1 and B2 in quadratic equations of 21 d HDT group were significantly higher than the values of both 10 d HDT group and control group during expansion (inflow) and collapse (outflow) (P<0.01). The result of histological examination showed that the contents and structure of femoral vein wall of HDT-rabbits changed significantly. Endothelial cells of femoral vein became short and columnar or cubic, some of which fell off. Smooth muscle layer became thinner. Conclusion. Femoral venous compliance increased after weightlessness-simulation and the femoral venous compliance in 21 d-HDT rabbits increased more obviously than that in 10 d-HDT rabbits. The structure of femoral vein wall had changed obviously.