Diagnostic yields of endoscopic ultrasound-guided fine-needle tissue acquisition according to the gastric location

The diagnostic accuracy of endoscopic ultrasound-guided fine-needle tissue acquisition (EUS-FNTA) according to the gastric location of subepithelial tumors (SETs) has not been well established. We aimed to evaluate the efficacy of EUS-FNTA for the diagnosis of gastric SETs according to tumor location.Thirty-three patients diagnosed with gastric SETs via EUS-FNTA from January 2016 to May 2018 were analyzed retrospectively. Patient demographics, diagnostic yields, and complications were evaluated.Nineteen patients (57.6%) were female, with a mean age of 57.7 years. Endoscopic ultrasound revealed a mean longitudinal diameter of 25.6 mm. The most common location of SETs was in the gastric body (n = 18, 54.5%), followed by cardia and fundus (n = 10, 30.3%), and antrum (n = 5, 15.2%). A 20-gauge biopsy needle was most frequently used (90.9%). The diagnostic yield was obtained in 23 patients (69.7%). The most common diagnosis was gastrointestinal stromal tumor (73.9%), followed by leiomyoma (17.4%). The diagnostic yield of SETs in gastric antrum (0/5, 0%) was significantly lower than that in the gastric body and cardia (23/28, 82.1%, P = .001). A case of immediate bleeding after EUS-FNTA occurred in 1 patient (3.0%) who recovered uneventfully. According to related literature, the overall diagnostic yield of SETs in gastric antrum was significantly lower than that in the gastric body, fundus, and cardia (29.7% vs 71.4%, P < .001, n = 191).EUS-FNTA is ineffective in the diagnosis of SETs in the gastric antrum. Although EUS-FNTA is an advanced diagnostic tool for gastric SETs, it is essential to develop more effective methods for the diagnosis of antral SETs.     

Efficacy of warming needle moxibustion in the treatment of ankylosing spondylitis: A protocol of a randomized controlled trial

Background:Ankylosing spondylitis is a recurrent autoimmune disease, which has a high disability rate and seriously affects patients’ daily life. Conventional treatment cannot effectively solve the clinical problems of patients, and long-term medication is accompanied by adverse reactions. The evidence shows that warming needle moxibustion has advantages in the treatment of ankylosing spondylitis, but there is still a lack of clinical studies on warm acupuncture alone and long-term follow-up.Methods:This is a prospective randomized controlled trial to study the efficacy and safety of needle warming through moxibustion in the treatment of ankylosing spondylitis. It was approved by the Ethics Committee of Clinical Research of our hospital. Patients were randomly assigned to an observation group or a control group. The patients were followed up for 6 months after 30 days of treatment. Observation indicators include; activity index, functional ability, Bath Ankylosing Spondylitis Metrology Index, inflammatory indicators, adverse reactions, and so on. Finally, SPASS 22.0 software is used for statistical analysis of the data.Discussion:This study will evaluate the clinical efficacy of warming needle moxibustion in the treatment of ankylosing spondylitis. The results of this study will provide a reference basis for the clinical use of warm needle moxibustion in the treatment of ankylosing spondylitis.Trial registration:OSF Registration number: DOI 10.17605/OSF.IO/GWPX3     

Updates in diagnosis and management of pancreatic cysts

Incidental pancreatic cysts are commonly encountered with some cysts having malignant potential. The most common pancreatic cystic neoplasms include serous cystadenoma, mucinous cystic neoplasm and intraductal papillary mucinous neoplasm. Risk stratifying pancreatic cysts is important in deciding whether patients may benefit from endoscopic ultrasound (EUS) or surgical resection. Surgery should be reserved for patients with malignant cysts or cysts at high risk for developing malignancy as suggested by various risk features including solid mass, nodule and dilated main pancreatic duct. EUS may supplement magnetic resonance imaging findings for cysts that remain indeterminate or have concerning features on imaging. Various cyst fluid markers including carcinoembryonic antigen, glucose, amylase, cytology, and DNA markers help distinguish mucinous from nonmucinous cysts. This review will guide the practicing gastroenterologist in how to evaluate incidental pancreatic cysts and when to consider referral for EUS or surgery. For presumed low risk cysts, surveillance strategies will be discussed. Managing pancreatic cysts requires an individualized approach that is directed by the various guidelines.     

Effectiveness and safety of warm needle acupuncture for sciatica: A protocol for systematic review and meta-analysis

Background:Sciatica is a syndrome characterized by sciatic nerve path and distribution area pain. Many kinds of literature reported the definite effect of warm needle acupuncture (WNA) on sciatica. However, there is no systematic review or meta-analysis on WNA for sciatica. Therefore, this study will design a protocol to comprehensively and systematically evaluate the effectiveness and safety of WNA on sciatica.Methods:The two researchers in this study will search the electronic database for randomized controlled trials, (RCTs) of WNA on sciatica, The databases we will search include PubMed, EMBASE, Cochrane Library, Web of Science, Chinese national knowledge infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and Chinese biomedical literature database (CBM). Review Manager 5.4 software and Cochrane risk bias tool will be us used for data analysis and to evaluate research quality. The main clinical indicators will include visual analogue scale (VAS) and Oswestry Disability Index (ODI).Results:This study will evaluate the efficacy and safety of WNA for sciatica.Conclusion:This study will provide a reliable scheme for objectively and comprehensively evaluating the efficacy and safety of WNA on sciatica.Trial registration number:INPLASY2020110074     

Acupoint catgut embedding therapy for functional constipation: A protocol for systematic review and meta-analysis

Background:This review will assess current evidence related to the effectiveness and safety of acupoint catgut embedding therapy for functional constipation (FC) and provide efficacy assessments for clinical applications.Methods:We will search the following databases for relevant trials: PubMed, EMBASE OVID, Cumulative Index of Nursing and Allied Health Literature, OVID MEDLINE, Web of Science, the Cochrane Central Register of Controlled Trials, Cochrane library, and Scopus. We will also search the following Chinese databases for trials published in the Chinese literature: China National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journals Database, Wan Fang Database, Chinese Biomedicine and other resources from inception to December 2020. Only randomized controlled trials comparing acupoint catgut embedding versus acupuncture or sham acupuncture or placebo or other therapies will be included. The outcomes involved mean spontaneous bowel movements, complete spontaneous bowel movements, the Bristol Stool Form Scale, the Cleveland Clinic Score, Patient Assessment of Constipation symptom and so on. The risk of bias assessment and quality of evidence for outcomes will be appraised using the Cochrane Risk of Bias Tool and the Grading of Recommendations, Assessment, Development and Evaluation guidelines. RevMan 5.3 software will be employed for the meta-analysis.Results:This work will compare and arrange the comparative efficacy of acupoint catgut embedding with different treatments for FC by summarizing the current evidences.Conclusion:The results of this meta-analysis may help doctors determine the best treatments for patients to manage FC.Ethics and dissemination:This is a protocol with no patient recruitment and personal information collection, approval by the ethics committee is not required.OSF Registration number:DOI 10.17605/OSF.IO/XTKE2.     

The study on the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of nerve root sciatica: A protocol for systematic review and meta-analysis of randomized controlled trials

Background:Nerve root sciatica (NRS) is a common orthopedic disease, which usually occurs between 20 and 40 years of age, and the incidence rate is increasing year by year and is being younger. The disease has no special effect of treatment, clinically generally taking the symptomatic treatment, such as taking short-term glucocorticoids, sedatives, analgesics, and so on. Long-term use of drugs will adversely affect the patient''s gastrointestinal tract, liver, and kidney function. The surgical treatment has a high risk of surgery, high cost, side effects, and other problems, so the choice of treatment method has always been a difficult problem in clinical and scientific research. The study shows that 90% of patients with sciatica can be cured by non-surgical treatment, so conservative therapy is often used in the treatment of sciatica, traditional Chinese medicine treatment methods in the treatment of NRS has been widely used, which has achieved good results, but there is no evidence of evidence-based medicine. Therefore, this study uses systematic evaluation to conduct the scientific evaluation of the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS, and provide evidence-based medical evidence support for the treatment of NRS.Methods:Using the computer to retrieve the PubMed, ScienceDirect, Web of Science, Embase, Cochrane Library, CNKI, VIP, WANFANG Database, and CBM. Using the subject words and terminology words to retrieve the Chinese-English database and retrieve a randomized controlled study on the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS, and the range of search time is January 1990 to January 2021. The searched literature is screened and evaluated by two researchers respectively according to the inclusion and exclusion criteria. If there is disagreement, discussing it with the third researcher to determine the final inclusion of the literature. Using the RevMan 5.3 software to conduct the meta-analysis.Results:This study will compare the effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS.Conclusion:The results of this study will be published in internationally influential academic journals to provide evidence-based medical evidence for the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding in the treatment of NRS.Ethics and dissemination:This study does not involve specific patients, and all research data comes from publicly available professional literature, so an ethics committee is not required to conduct an ethical review and approval of the study.OSF registration number:DOI 10.17605/OSF.IO/Q492E.     

超声引导下经皮肺胸膜穿刺自动活检

目的探讨超声引导下经皮肺、胸膜自动活检的组织学诊断准确性和并发症。方法回顾性总结分析９４例外周型肺占位和胸膜病变９８次Ｂ超引导下经皮穿刺自动活检的结果。病例包括肺癌３２例,胸膜间皮瘤２０例,转移性肺癌５例,肺或胸膜结核２７例,肺炎性病变１０例。使用带１８Ｇ内槽式穿刺针的自动活检装置,在Ｂ超引导下行病变穿刺活检,术后观察气胸、出血等并发症发生情况。结果９８次穿刺均一次取材成功,８７例做出了明确的组织学分型诊断,组织学确诊阳性率为９２．６％（８７／９４）,穿刺后并发症中气胸和出血各２例（占２．１％）,均无须手术处理而愈。结论Ｂ超引导下经皮肺、胸膜穿刺活检是一种安全可靠的确诊肺外周型占位和胸膜病变的方法。     

手动式及弹枪式经皮肺穿刺活检方法的对比研究

目的 比较螺旋CT引导下手动式及弹枪式两种经皮肺穿刺活检法在诊断准确率、并发症及操作流程等方面的差异.方法 对广东顺德第一人民医院呼吸科2006年6月至2010年5月住院、在CT引导下行经皮肺穿刺活检并经手术病理或临床随访结果证实的原因不明的肺部占位性病变患者97例,男61例,女36例;年龄19～87岁,平均(50±17)岁.采用抽取信封随机分组法将患者分为手动式活检法组(简称手动组)和弹枪式活检法组(简称弹枪组).手动组53例,男32例,女21例,平均(49±20)岁,采用手动式操作活检针进行经皮肺活检.弹枪组44例,男29例,女15例,平均(52±16)岁,采用传统弹枪式操作活检针进行经皮肺活检.所有病例均由同1名医师操作.两组均采用德国Optimed公司生产的Vitesee穿刺活检针,直径为18 G,弹枪组所使用的活检弹枪为德国Optimed公司生产的Vitesse活检枪.全部病例均排除相关禁忌证,在CT导管光栅条定位下,依据CT即时横断面影像设定穿刺点、穿刺角度及深度.原则上采用肿块病灶距胸壁最近点垂直进针.结果 手动组诊断准确率为91%(48/53),气胸发生率为11%(6/53),出血发生率为15%(8/53).弹枪组诊断准确率为75%(33/44),气胸发生率为30%(13/44),出血发生率为27%(12/44).结论 手动组诊断准确率明显高于弹枪组,气胸发生率相对减少,并且操作流程简单易掌握,值得临床推荐使用.

Abstract：

Objective To evaluate the difference in diagnostic accuracy and complication rate and operational procedures between manual and coaxial automated percutaneous lung biopsy under CT-guidance.Methods Ninety-seven patients [ aged from 19 -87 (50 ± 17 ) years ], with undiagnosed pulmonary lesions underwent CT-guided percutaneous lung biopsy from June 2006 to May 2010 in this hospital. The final diagnosis was confirmed by surgical pathology or clinical follow-up. Fifty-three patients (32 males and 21 females) underwent manual percutaneous lung biopsy, while 44 patients (29 males and 15 females) underwent percutaneous lung biopsy by using a coaxial automated biopsy device( biopsy gun). Biopsies were carried out by the same physician in all cases with the 18G vitesse needle made by optimed company in German. Biopsy guns made by the same company were used in coaxial automated biopsy group. The puncture point, angle and depth were set according to the CT images under the guidance by CT grating. Generally, the puncture was directed vertically towards the lesions closest to the chest wall. Results In the manual biopsy group, the diagnostic accuracy was 91% (48/53), the pneumothorax rate was 11% (6/53), and the hemorrhage rate was 15% (8/53), while in the coaxial automated biopsy group, they were 75% (33/44),30% (13/44)and 27% (12/44), respectively. Conclusion The diagnostic accuracy was higher while the pneumothorax rate was lower in the manual biopsy as compared to the coaxial automated biopsy group.     

纤维支气管镜检查对结节病诊断的临床价值

目的 评价经纤维支气管镜下不同取材对结节病诊断的价值.方法 回顾性分析50例经纤维支气管镜检查,采用肺内活检(包括经支气管黏膜活检和经纤维支气管镜肺活检)、经气管镜针吸活检(TBNA)和经气管镜超声引导针吸活检术(EBUS-TBNA)等方法获取标本,经病理学或细胞学检查确诊为结节病的患者,比较不同取材及联合取材检测结节...     

易筋经之出爪亮翅式对延长浅静脉留置针时间的效果观察

【】目的 延长静脉留置针使用时间,减轻患者的痛苦和医疗费用,得到安全、舒适的护理。方法 我们以留置浅静脉留置针并且肌力正常的患者为研究对象。对照组在留置期间实施常规护理。实验组在实施常规护理的基础上,指导患者输液完毕封管后习练出爪亮翅式。结果 实验组浅静脉留置针留置时间明显延长,并且浅静脉留置针并发症的发生率显著低于对照组。结论 出爪亮翅式可以降低浅静脉留置针并发症的发生率,延长置管时间。