Microvascular structural changes in esophageal squamous cell carcinoma pathology according to intrapapillary capillary loop types under magnifying endoscopy

BACKGROUND The intrapapillary capillary loop(IPCL)characteristics,visualized using magnifying endoscopy,are commonly assessed for preoperative evaluation of the infiltration depth of esophageal squamous cell carcinoma(ESCC).Japan Esophageal Society(JES)classification is the most widely used classification.Microvascular structural changes are evaluated by magnifying endoscopy for the presence or absence of each morphological factor:tortuosity,dilatation,irregular caliber,and different shapes.However,the pathological characteristics of IPCLs have not been thoroughly investigated,especially the microvascular structures corresponding to the deepest parts of the lesions'infiltration.AIM To investigate differences in pathological microvascular structures of ESCC,which correspond to the deepest parts of the lesions'infiltration.METHODS Patients with ESCC and precancerous lesions diagnosed at Peking University Third Hospital were enrolled between January 2019 and April 2023.Patients first underwent magnified endoscopic examination,followed by endoscopic submucosal dissection or surgical treatment.Pathological images were scanned using a threedimensional slice scanner,and the pathological structural differences in different types,according to the JES classification,were analyzed using nonparametric tests and t-tests.RESULTS The 35 lesions were divided into four groups according to the JES classification:A,B1,B2,and B3.Statistical analyses revealed significant differences(aP<0.05)in the short and long calibers,area,location,and density between types A and B.Notably,there were no significant differences in these parameters between types B1 and B2 and between types B2 and B3(P>0.05).However,significant differences in the short calibers,long calibers,and area of IPCL were observed between types B1 and B3(aP<0.05);no significant differences were found in the density or location(P>0.05).CONCLUSION Pathological structures of IPCLs in the deepest infiltrating regions differ among various IPCL types classified by the JES classification under magnifying endoscopy,especially between the types A and B.

国际海事组织船舶能效提案及其影响综述

This paper presents a review of the different International Maritime Organization(IMO)initiatives to improve the ship energy efficiency of new and existing ships,which is considered one of the essential tasks to reduce Greenhouse Gas(GHG)in the maritime industry.First,the IMO effort and initiatives and the different indices suggested by the IMO are presented till the last version of the Marine Environment Protection Committee(MEPC),showing the effect of different technologies on reducing the level of indices and the suggested improvement of the terms of indices in the next years.Second,the short-and long-term strategies suggested by the IMO are presented,showing that the effect of indices will be noticed in the short term,while the new fuels will show a significant improvement in the long term.Finally,several examples of cooperation between the different organizations are presented,showing that transferring knowledge and experience will significantly impact the maritime industry and thus lead to the concept of green ships in the near future.This paper shows that the combination of different solutions,the cooperation between stakeholders and the sharing of the data and information are important to achieve the required goal.

Epidemiology of perforating peptic ulcer:A population-based retrospective study over 40 years

BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades,but the incidence of reported peptic ulcer complications has not decreased.Perforating peptic ulcer(PPU)is a severe form of the disease.AIM To assess trends in the incidence,presentation,and outcome of PPU over a period of 40 years.METHODS This was a single-centre,retrospective,cohort study of all patients admitted to Levanger Hospital,Norway,with PPU from 1978 to 2017.The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases(ICD),revision 8,ICD-9,and ICD-10 codes for perforated gastric and duodenal ulcers.We reviewed the medical records of the patients to retrieve data.Vital statistics were available for all patients.The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable,and sex,age,and calendar year from 1978 to 2017 as covariates.Relative survival analysis was performed to compare long-term survival over the four decades.RESULTS Two hundred and nine patients were evaluated,including 113(54%)men.Fortysix(22%)patients were older than 80 years.Median age increased from the first to the last decade(from 63 to 72 years).The incidence rate increased with increasing age,but we measured a decline in recent decades for both sexes.A significant increase in the use of acetylsalicylic acid,from 5%(2/38)to 18%(8/45),was observed during the study period.Comorbidity increased significantly over the 40 years of the study,with 22%(10/45)of the patients having an American Society of Anaesthesiologists(ASA)score 4-5 in the last decade,compared to 5%(2/38)in the first decade.Thirty-nine percent(81/209)of the patients had one or more postoperative complications.Both 100-day mortality and long-term survival were associated with ASA score,without significant variations between the decades.CONCLUSION Declining incidence rates occurred in recent years,but the patients were older and had more comorbidity.The ASA score was associated with both short-term mortality and long-term survival.

Study of preoperative diagnostic modalities in Chinese patients with superficial esophageal squamous cell carcinoma

BACKGROUND Endoscopic ultrasonography(EUS)and magnifying endoscopy(ME)reliably determine indications for endoscopic resection in patients with superficial esophageal squamous cell carcinoma(SESCC).ME is widely accepted for predicting the invasion depth of superficial esophageal cancer with satisfying accuracy.However,the addition of EUS is controversial.AIM To evaluate the diagnostic efficiency of ME vs EUS for invasion depth prediction and investigate the influencing factors in patients with SESCC to determine the best diagnostic model in China.METHODS We retrospectively analyzed patients with suspected SESCC who completed both ME and EUS and then underwent endoscopic or surgical resection at Sun Yat-Sen University Cancer Center between January 2018 and December 2021.We evaluated and compared the diagnostic efficiency of EUS and ME according to histological results,and investigated the influencing factors.RESULTS We included 152 lesions from 144 patients in this study.The diagnostic accuracies of ME and EUS in differentiating invasion depth were not significantly different(73.0%and 66.4%,P=0.24);both demonstrated moderate consistency with the pathological results(ME:kappa=0.58,95%confidence interval[CI]:0.48-0.68,P<0.01;EUS:kappa=0.46,95%CI:0.34-0.57,P<0.01).ME was significantly more accurate in the diagnosis of high-grade intraepithelial(HGIN)or carcinoma in situ(odds ratio[OR]=3.62,95%CI:1.43-9.16,P=0.007)subgroups.Using a miniature probe rather than conventional EUS can improve the accuracy of lesion depth determination(82.3%vs 49.3%,P<0.01).Less than a quarter of circumferential occupation and application of a miniature probe were independent risk factors for the accuracy of tumor invasion depth as assessed by EUS(<1/4 circumferential occupation:OR=3.07,95%CI:1.04-9.10;application of a miniature probe:OR=5.28,95%CI:2.41-11.59,P<0.01).Of the 41 lesions(41/152,27.0%)that were misdiagnosed by ME,24 were corrected by EUS(24/41,58.5%).CONCLUSION Preoperative diagnosis of SESCC should be conducted endoscopically using white light and magnification.In China,EUS can be added after obtaining patient consent.Use of a highfrequency miniature probe or miniature probe combined with conventional EUS is preferable.

Human Brucellosis Mimicking Axial Spondyloarthritis: a Challenge for Rheumatologists when Applying the 2009 ASAS Criteria

Although the development of the 2009 Sp A classification criteria by Assessment of Spondylo Arthritis international Society（ASAS） represents an important step towards a better definition of the early disease stage particularly in axial spondyloarthritis（ax Sp A）, the specificity of the criteria has been criticized these days. As the commonest zoonotic infection worldwide, human brucellosis can mimic a large number of diseases, including Sp A. This study was performed to determine the frequency of rheumatologic manifestations in patients with brucellosis and the chance of misdiagnosing them as having ax Sp A in central China. The results showed that clinical manifestations of ax Sp A could be observed in brucellosis. Over half of patients had back pain, and one fifth of the patients with back pain were less than 45 years old at onset and had the symptom for more than 3 months. Two young males were falsely classified as suffering from ax Sp A according to the ASAS criteria, and one with MRI proved sacroiliitis was once given Etanercept for treatment. Therefore, differential diagnosis including human brucellosis should always be kept in mind when applying the ASAS criteria, even in traditionally non-endemic areas.

Effect of Kuanxiong Aerosol(宽胸气雾剂)on Patients with Angina Pectoris:A Non-inferiority Multi-center Randomized Controlled Trial

Objective： To evaluate the effect and safety of Kuanxiong Aerosol （宽胸气雾剂, KA） on patients with angina pectoris. Methods： Block randomization was performed to randomly allocate 750 patients into KA （376 cases） and control groups （374 cases）. During an angina attack, the KA group received 3 consecutive sublingual sprays of KA （0.6 mL per spray）. The control group received 1 sublingual nitroglycerin tablet （NT, 0.5 rag/tablet）. Log-rank tests and Kaplan-Meier estimations were used to estimate the angina remission rates at 6 time-points after treatment （1,2, 3, 4, 5, and 〉5 min）. Logistic regression analysis was performed to observe the factors influencing the rate of effective angina remission, and the remission rates and incidences of adverse reactions were compared for different Canadian Cardiovascular Society （CCS） classes of angina. Results： The 5-min remission rates in the KA and control groups were not significantly different （94.41% vs. 90.64%, P〉0.05）. The angina CCS class significantly influenced the rate of remission （95% confidence interval = 0.483-0.740, P〈0.01）. In the CCS subgroup analysis, the 3- and 5-min remission rates for KA and NT were similar in the CCS I and IV subgroups （P〉0.05）, while they were significantly better for KA in the CCS Ⅱ and Ⅲ subgroups （P〈0.05 or P〈0.01）. Furthermore, the inciden0ce of adverse reactions was significantly lower in the KA group than in the control group for the CCS Ⅱ and Ⅲ subgroups （9.29% vs. 26.22%, 10.13% vs. 20.88%, P〈0.05 or P〈0.01）. Conclusions： KA is not inferior to NT in the remission of angina. Furthermore, in CCS Ⅱ and Ⅲ patients, KA is superior to NT, with a lower incidence of adverse reactions. （Registration No. ChiCTR- IPR-15007204）