To analyze the clinical value and significance of partial pressure of end-tidal carbon dioxide(PETCO₂)monitoring during gastrointestinal endoscopic anesthesia.

A total of 200 patients who underwent gastroscopy and colonoscopy under general anesthesia in Department of Endoscopy of Shandong Qianfoshan Hospital from March 2020 to May 2020 were selected and randomly divided into experimental group(oxygen was inhaled via nasal catheter, and pulmonary ventilation was monitored by sidestream PETCO₂ monitoring device, n=100)and control group(only oxygen was inhaled via nasal catheter, n=100). Dezocine 1-3 mg and propofol 1.5-3 mg/kg were administrated 2 minutes before the lens was placed.After the eyelash reflex disappeared, and the mandible did not respond, the endoscope was inserted.After the lens was successfully placed, propofol was continuously pumped at 3-5 mg/kg/h until the end of the operation.The anesthesia effect and the incidence of complications were compared between the two groups.

There was no significant difference in age, gender, body mass index, ASA grade, anesthesia induction time and endoscopic examination time between the two groups(P>0.05). The incidence of hypoxemia, the frequency of mask pressurization, the rate of nausea and vomiting, the dosage of propofol and the recovery time in the experimental group were lower than those in the control group(P<0.05). The frequency of apnea, the incidence of jaw-lift and chest compressions to aid breathing in the experimental group were higher than those in the control group(P<0.05).

The monitoring of PETCO₂ can detect the status of lung ventilation, guide clinical intervention, reduce complications, shorten the recovery time, and improve the quality of gastrointestinal endoscopic anesthesia.

To evaluate the clinical value of ProGN and ProUGN in patients with Crohn disease(CD).

The plasma ProGN and ProUGN levels of Crohn disease patients and healthy controls were detected by enzyme-linked immunosorbent assay(ELISA), and the correlation between plasma levels and clinical disease activity and 24-hour stool frequency was analyzed.

Compared with the healthy controls, the plasma ProGN and ProUGN levels of CD patients were significantly lower(P<0.05). Subgroup analysis showed that the plasma ProGN level of patients in remission period and active period was significantly lower than that of healthy control group(P<0.001), while the level of patients in active period was lower than that of patients in remission period, but there was no statistical significance(P=0.121); the plasma ProUGN level of patients in remission period was significantly lower than that in healthy control group(P<0.001), and plasma level of patients in active period was lower than that in healthy control group, but there was no statistical significance(P=0.266), and plasma level of patients in remission period was significantly lower than that in active period(P=0.011). Pearson correlation analysis showed that plasma ProGN and ProUGN levels were negatively correlated with 24-hour stool frequency(r=-0.804, P<0.001; r=-0.767, P<0.001). There was a significant negative correlation between the plasma ProGN level and the Best Crohn disease activity index(r=-0.561, P<0.001), but there was no linear correlation between the plasma ProGN level and the Best Crohn disease activity index(r=-0.155, P=0.314).

The clinical activity and diarrhea may be the determinants for level of proGN in plasma.

To investigate risk factors associated with difficult endoscopic submucosal dissection(ESD)for superficial esophageal lesions(operating time≥90 min, non-curative resection, esophageal perforation).

The medical records of 452 patients with single esophageal lesion who received ESD at Department of Gastroenterology, Subei People′s Hospital of Jiangsu Province from July 2015 to June 2019 were retrospectively reviewed, including gender, age, lesion site, endoscopic gross morphology, lesion diameter, circumference, operative period, preoperative pathology, postoperative pathology, operating time and perforation complication.The factors associated with ESD operating time, non-curative resection and perforation were analyzed by univariate analysis.Statistically significant factors were then included in Logistic regression analysis to look for independent risk factors leading to difficulties in ESD surgery.

The mean age of the patients was(66.47±7.59)years, and the mean operating time was(72.7±32.9)min.A total of 212 cases of high-grade intraepithelial neoplasia and 240 cases of squamous cell carcinoma were diagnosed by postoperative pathology.The rate of curative resection was 83.1%(375/452). Complications of perforation occurred in 9 cases.The lesions gross morphology, length, circumference, location and experience of operator were risk factors of difficult ESD for superficial esophageal lesions by univariate analysis.Multivariate analysis showed that typeⅡa+ Ⅱc/Ⅱc was an independent risk factor for operating time≥90 min(OR=2.689, P=0.003), non-curative resection(OR=2.238, P=0.009)and perforation(OR=1.928, P=0.042). Lesion length(>2 cm)was an independent risk factor for operating time≥90 min(OR=5.917, P<0.001). Circumferential lesion size(1/3-2/3 esophageal circumference)was an independent risk factor for operating time≥90 min(OR=2.733, P=0.019), and≥2/3 circumference was an independent risk factor for operating time≥90 min(OR=26.502, P<0.001)and non-curative resection(OR=4.174, P<0.001). The lesion located in the upper esophagus(OR=2.609, P=0.016)and the operator′s experience(OR=1.897, P=0.045)were independent risk factors for operating time≥90 min.

TypeⅡa+ Ⅱc/Ⅱc lesions, the lesion length(>2 cm), circumferential lesion size(>1/3 esophageal circumference), the lesion located in the upper esophagus and the operator′s experience were independent risk factors for difficult esophageal ESD procedures.