体位管理在内镜下胃肿瘤全层切除术中的影响

目的分析术中体位管理对胃黏膜下巨大肿瘤患者在内镜下全层切除术(EFTR)中的影响。方法回顾性分析2017年12月-2019年7月在该院消化内科被诊断为胃黏膜下巨大肿瘤(肿瘤直径≥2.0 cm)并接受EFTR的患者。术中调整患者体位以避免肿瘤被胃腔内液体淹没,并分析患者的术中体位与肿瘤位置的关系以及对EFTR术后效果的影响。结果共37例患者纳入研究,术中体位包括:左侧卧位、仰卧位、俯卧位和右侧卧位。根据肿瘤的位置,采取对应的术中体位使肿瘤处于高位,术中视野暴露良好,镜下止血、缝合以及其他操作不受胃腔内液体的影响。所有患者均成功实施EFTR,未见大出血、肿瘤掉入腹腔、显性腹膜炎征象。结论EFTR治疗胃黏膜下巨大肿瘤时,使肿瘤处于高位的术中体位管理应受到重视。通过术前CT确认肿瘤位置或内镜下注水后观察手术视野,均可为患者体位的选择提供依据。该体位管理简单易行,不增加医疗费用,具有降低内镜下操作难度、增加手术安全性和缩短手术时间的优势。

Could gastrointestinal tumor-initiating cells originate from cell-cell fusion in vivo?

Tumor-initiating cells(TICs)or cancer stem cells are believed to be responsible for gastrointestinal tumor initiation,progression,metastasis,and drug resistance.It is hypothesized that gastrointestinal TICs(giTICs)might originate from cell-cell fusion.Here,we systemically evaluate the evidence that supports or opposes the hypothesis of giTIC generation from cell-cell fusion both in vitro and in vivo.We review giTICs that are capable of initiating tumors in vivo with 5000 or fewer in vivo fused cells.Under this restriction,there is currently little evidence demonstrating that giTICs originate from cell-cell fusion in vivo.However,there are many reports showing that tumor generation in vitro occurs with more than 5000 fused cells.In addition,the mechanisms of giTIC generation via cell-cell fusion are poorly understood,and thus,we propose its potential mechanisms of action.We suggest that future research should focus on giTIC origination from cell-cell fusion in vivo,isolation or enrichment of giTICs that have tumor-initiating capabilities with 5000 or less in vivo fused cells,and further clarification of the underlying mechanisms.Our review of the current advances in our understanding of giTIC origination from cell-cell fusion may have significant implications for the understanding of carcinogenesis and future cancer therapeutic strategies targeting giTICs.

Chronic Intracerebroventricular Infusion of Metformin Inhibits Salt-Sensitive Hypertension via Attenuation of Oxidative Stress and Neurohormonal Excitation in Rat Paraventricular Nucleus

Metformin(MET), an antidiabetic agent, also has antioxidative effects in metabolic-related hypertension.This study was designed to determine whether MET has anti-hypertensive effects in salt-sensitive hypertensive rats by inhibiting oxidative stress in the hypothalamic paraventricular nucleus(PVN). Salt-sensitive rats received a highsalt(HS) diet to induce hypertension, or a normal-salt(NS)diet as control. At the same time, they received intracerebroventricular(ICV) infusion of MET or vehicle for 6 weeks. We found that HS rats had higher oxidative stress levels and mean arterial pressure(MAP) than NS rats. ICV infusion of MET attenuated MAP and reduced plasma norepinephrine levels in HS rats. It also decreased reactive oxygen species and the expression of subunits of NAD(P)H oxidase, improved the superoxide dismutase activity,reduced components of the renin-angiotensin system, and altered neurotransmitters in the PVN. Our findings suggest that central MET administration lowers MAP in saltsensitive hypertension via attenuating oxidative stress,inhibiting the renin-angiotensin system, and restoring the balance between excitatory and inhibitory neurotransmitters in the PVN.