Endoscopic mucosal resection with double band ligation versus endoscopic submucosal dissection for small rectal neuroendocrine tumors

BACKGROUND Endoscopic resection remains an effective method for the treatment of small rectal neuroendocrine tumors(NETs)(≤10 mm).Moreover,endoscopic mucosal resection(EMR)with double band ligation(EMR-dB),a simplified modification of EMR with band ligation,is an alternative strategy to remove small rectal NETs.AIM To evaluate the feasibility and safety of EMR-dB for the treatment of small rectal NETs(≤10 mm).METHODS A total of 50 patients with small rectal NETs,without regional lymph node enlargement or distant metastasis confirmed by endoscopic ultrasound,computerized tomography scan,or magnetic resonance imaging,were enrolled in the study from March 2021 to June 2022.These patients were randomly assigned into the EMR-dB(n=25)group or endoscopic submucosal dissection(ESD)group(n=25).The characteristics of the patients and tumors,procedure time,devices cost,complete resection rate,complications,and recurrence outcomes were analyzed.RESULTS There were 25 patients(13 males,12 females;age range 28-68 years old)in the EMR-dB group,and the ESD group contained 25 patients(15 males,10 females;age range 25-70 years old).Both groups had similar lesion sizes(EMR-dB 4.53±1.02 mm,ESD 5.140±1.74 mm;P=0.141)and resected lesion sizes(1.32±0.52 cm vs 1.58±0.84 cm;P=0.269).Furthermore,the histological complete resection and en bloc resection rates were achieved in all patients(100%for each).In addition,there was no significant difference in the complication rate between the two groups.However,the procedure time was significantly shorter and the devices cost was significantly lower in the EMRdB group.Besides,there was no recurrence in both groups during the follow-up period.CONCLUSION The procedure time of EMR-dB was shorter compared with ESD,and both approaches showed a similar curative effect.Taken together,EMR-dB was a feasible and safe option for the treatment of small rectal NETs.

Berberine prevents stress-induced gut inflammation and visceral hypersensitivity and reduces intestinal motility in rats

BACKGROUND Irritable bowel syndrome (IBS) is a common chronic non-organic disease of the digestive system. Berberine (BBR) has been used to treat patients with IBS, but the underlying therapeutic mechanism is little understood. We believe that BBR achieves its therapeutic effect on IBS by preventing stress intestinal inflammation and visceral hypersensitivity and reducing bowel motility. AIM To test the hypothesis that BBR achieves its therapeutic effect on IBS by preventing subclinical inflammation of the intestinal mucosa and reducing visceral hypersensitivity and intestinal motility. METHODS IBS was induced in rats via water avoidance stress (WAS). qRT-PCR and histological analyses were used to evaluate the levels of cytokines and mucosal inflammation, respectively. Modified ELISA and qRT-PCR were used to evaluate the nuclear factor kappa-B (NF-κB) signal transduction pathway. Colorectal distention test, gastrointestinal transit measurement, Western blot, and qRT-PCR were used to analyze visceral sensitivity, intestinal motility, the expression of Ckit (marker of Cajal mesenchymal cells), and the expression of brain derived neurotrophic factor (BDNF) and its receptor TrkB.RESULTS WAS led to mucosal inflammation, visceral hyperalgesia, and high intestinal motility. Oral administration of BBR inhibited the NF-κB signal transduction pathway, reduced the expression of pro-inflammatory cytokines [interleukin (IL)- 1β, IL-6, interferon-γ, and tumor necrosis factor-α], promoted the expression of anti-inflammatory cytokines (IL-10 and transforming growth factor-β), and improved the terminal ileum tissue inflammation. BBR inhibited the expression of BDNF, TrkB, and C-kit in IBS rats, leading to the reduction of intestinal motility and visceral hypersensitivity. The therapeutic effect of BBR at a high dose (100 mg/kg) was superior to than that of the low-dose (25 mg/kg) group. CONCLUSION BBR reduces intestinal mucosal inflammation by inhibiting the intestinal NF-κB signal pathway in the IBS rats. BBR reduces the expression of BDNF, its receptor TrkB, and C-kit. BBR also reduces intestinal motility and visceral sensitivity to achieve its therapeutic effect on IBS.

Diagnosis of follicular lymphoma by laparoscopy: A case report

BACKGROUND Over the past years, only few cases of follicular lymphoma diagnosed by laparoscopy have been reported in the world. Since follicular lymphoma related ascites often causes occult disease and lacks specific clinical manifestations, it is often difficult to identify the cause by routine laboratory tests and imaging methods. Diagnostic experience is not sufficient and more cases need to be accumulated for further analysis.CASE SUMMARY Ascites due to unknown reasons often causes problems for clinical diagnosis and treatment. In this paper, we report one case with ascites in whom the reason causing ascites was not identified through routine examination. Laparoscopic examination of the celiac lesions and histological examination of the lesions were performed and the final diagnosis was peritoneal follicular lymphoma.CONCLUSION Laparoscopic abdominal examination is of great significance for the definite diagnosis of ascites due to an unknown reason.

Overlooked risk for needle tract seeding following endoscopic ultrasound-guided minimally invasive tissue acquisition

Endoscopic ultrasound-guided minimally invasive tissue acquisition can be performed by two approaches as follows: Endoscopic ultrasound-guided fineneedle aspiration(EUS-FNA) and endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB). These have been evolved into leading approaches and widely used for the histological diagnosis of tumors in the gastrointestinal tract and adjacent organs. However, the role of EUS-FNA and EUS-FNB in disease diagnosis and evaluation remains controversial. Although the incidence of surgery-associated complications remains low, the consequences of needle tract seeding can be serious or even life-threatening. Recently, increasing case reports of needle tract seeding are emerging, especially caused by EUS-FNA. This complication needs serious consideration. In the present work, we integrated these case reports and the related literature, and summarized the relevant cases and technical characteristics of needle tract seeding caused by EUS-FNA and EUSFNB. Collectively, our findings provided valuable insights into the prevention and reduction of such serious complication.

Oral higher dose prednisolone to prevent stenosis after endoscopic submucosal dissection for early esophageal cancer

BACKGROUND Esophageal stenosis is one of the main complications of endoscopic submucosal dissection(ESD)for the treatment of large-area superficial esophageal squamous cell carcinoma and precancerous lesions(≥3/4 of the lumen).Oral prednisone is useful to prevent esophageal stenosis,but the curative effect remains controversial.AIM To share our experience of the precautions against esophageal stenosis after ESD to remove large superficial esophageal lesions.METHODS Between June 2019 and March 2022,we enrolled patients with large superficial esophageal squamous cell carcinoma and high-grade intraepithelial neoplasia experienced who underwent ESD.Prednisone(50 mg/d)was administered orally on the second morning after ESD for 1 mo,and tapered gradually(5 mg/wk)for 13 wk.RESULTS In total,14 patients met the inclusion criteria.All patients received ESD without operation-related bleeding or perforation.There were 11 patients with≥3/4 and<7/8 of lumen mucosal defects and 1 patient with≥7/8 of lumen mucosal defect and 2 patients with the entire circumferential mucosal defects due to ESD.The longitudinal extension of the esophageal mucosal defect was<50 mm in 3 patients and≥50 mm in 11 patients.The esophageal stenosis rate after ESD was 0%(0/14).One patient developed esophageal candida infection on the 30th d after ESD,and completely recovered after 7 d of administration of oral fluconazole 100 mg/d.No other adverse events of oral steroids were found.CONCLUSION Oral prednisone(50 mg/d)and prolonged prednisone usage time may effectively prevent esophageal stricture after ESD without increasing the incidence of glucocorticoid-related adverse events.However,further investigation of larger samples is required to warrant feasibility and safety.

Effect and safety of mark-guided vs standard peroral endoscopic myotomy: A retrospective case control study

BACKGROUND Peroral endoscopic myotomy(POEM)is a promising therapeutic modality for esophageal achalasia worldwide.However,clinical failure and adverse events of POEM have still been concerned.AIM To compare the efficacy and safety of a novel mark-guided POEM with standard POEM.METHODS A total of 133 patients with esophageal achalasia who underwent POEM from May 2013 to May 2019 were enrolled in this retrospective study.Of the 133 patients,there were 64 patients in the mark-guided POEM group and 69 patients in the standard POEM group.The clinical success,procedural duration and adverse events were compared between the two groups at 3 mo,12 mo and 24 mo postoperatively.RESULTS Characteristic baseline was similar in the mark-guided POEM group and standard POEM group.The clinical success was comparable between the two groups,ranging from 92%to 98%,at 3 mo,12 mo and 24 mo postoperatively(all P>0.5).Eckart score,Gastroesophageal Reflux Disease Questionnaire score and SF-36 score were not different between the two groups after treatment(all P>0.05).No severe adverse events occurred in the two groups.However,markguided POEM required shorter procedural duration,and less use of proton pump inhibitors and lower incidence of reflux symptoms than the standard POEM(all P<0.001).CONCLUSION Mark-guided POEM and standard POEM were both effective and safe for the treatment of esophageal achalasia.However,the mark-guided POEM was characterized by shorter procedural duration,less use of proton pump inhibitors and lower incidence of reflux symptoms.

Quality Evaluation of Astragali Radix based on DPPH Radical Scavenging Activity and Chemical Analysis

Objective To assess the quality of Astragali Radix from different areas based on the biological evaluation and chemical analysis. Methods The bioassay method of 1,1- diphenyl-2-picryl-hydrazyl （DPPH） radical scavenging activity for Astragali Radix was established. The parameters of DPPH assay including sample extraction time, reaction time, repeatability, and stability were detected. Furthermore, a method of HPLC-MS was developed to simultaneously determine calycosin-7-O-glucoside, ononin, formononetin, and astragaloside IV in Astragali Radix samples. And the total flavonoids and total saponins were detected by spectrophotometry. The relationship between DPPH evaluation and chemical analysis was studied by Pearson correlation analysis. Results Twelve batches of Astragali Radix from different origins showed a wide range of DPPH radical scavenging activities （ICso = 1.395-9.894 tJg/mL）. Based on DPPH assay, Sample ]0 derived from Inner Mongolia Autonomous Region （ICso = 1.395 iJg/mL） showed the best quality of all samples. Chemical analysis showed that different compounds selected as indices would cause different results for quality evaluation. Pearson correlation analysis revealed that the contents of total flavonoids （P = 0.032）, calycosin-7-giucoside （P = 0.035）, and astragaloside IV （P = 0.010） were positively correlated with DPPH radical scavenging activity. Conclusion Except for chemical analysis, DPPH radical scavenging activity can be used as a good alternative to assess and control the quality of Astragal/Radix.

Soil microbiomes divergently respond to heavy metals and polycyclic aromatic hydrocarbons in contaminated industrial sites

Contaminated sites from electronic waste(e-waste)dismantling and coking plants feature high concentrations of heavy metals(HMs)and/or polycyclic aromatic hydrocarbons(PAHs)in soil.Mixed contamination(HMsþPAHs)hinders land reclamation and affects the microbial diversity and function of soil microbiomes.In this study,we analyzed HM and PAH contamination from an e-waste dismantling plant and a coking plant and evaluated the influences of HM and PAH contamination on soil microbiomes.It was noticed that HMs and PAHs were found in all sites,although the major contaminants of the e-waste dismantling plant site were HMs(such as Cu at 5,947.58±433.44 mg kg^(-1),Zn at 4,961.38±436.51 mg kg^(-1),and Mn at 2,379.07±227.46 mg kg^(-1)),and the major contaminants of the coking plant site were PAHs(such as fluorene at 11,740.06±620.1 mg kg^(-1),acenaphthylene at 211.69±7.04 mg kg^(-1),and pyrene at 183.14±18.89 mg kg^(-1)).The microbiomes(diversity and abundance)of all sites were determined via high-throughput sequencing of 16S rRNA genes,and redundancy analysis was conducted to investigate the relations between soil microbiomes and contaminants.The results showed that the microbiomes of the contaminated sites divergently responded to HMs and PAHs.The abundances of the bacterial genera Sulfuritalea,Pseudomonas,and Sphingobium were positively related to PAHs,while the abundances of the bacterial genera Bryobacter,Nitrospira,and Steroidobacter were positively related to HMs.This study promotes an understanding of how soil microbiomes respond to single and mixed contamination with HMs and PAHs.