Endoscopic removal of foreign bodies:A retrospective study in Japan

BACKGROUND The ingestion of foreign bodies(FBs)and food bolus impaction(FBI)in the digestive tract are commonly encountered clinical problems.Methods to handle such problems continue to evolve offering advantages,such as the avoidance of surgery,reduced cost,improved visualization,reduced morbidity,and high removal success rate.However,to date,no studies have evaluated the endoscopic management of FBs in Japan.AIM To elucidate level of safety and efficacy in the endoscopic management of FBs and FBI.METHODS A total of 215 procedures were performed at Keio University Hospital between November 2007 and August 2018.Data were collected from medical charts,and endoscopic details were collected from an endoscopic reporting system.Procedures performed with a flexible gastrointestinal endoscope were only taken into account.Patients who underwent a technique involving FB or FBI from the digestive tract were only included.Data on patient sex,patient age,outpatient,inpatient,FB type,FB location,procedure time,procedure type,removal device type,success,and technical complications were reviewed and analyzed retrospectively.RESULTS Among the 215 procedures,136(63.3%)were performed in old adults(≥60 years),180(83.7%)procedures were performed in outpatients.The most common type of FBs were press-through-pack(PTP)medications[72(33.5%)cases],FBI[47(21.9%)],Anisakis parasite(AP)[41(19.1%)cases].Most FBs were located in the esophagus[130(60.5%)cases]followed by the stomach[68(31.6%)cases].AP was commonly found in the stomach[39(57.4%)cases],and it was removed using biopsy forceps in 97.5%of the cases.The most common FBs according to anatomical location were PTP medications(40%)and dental prostheses(DP)(40%)in the laryngopharynx,PTP(48.5%)in the esophagus,AP(57.4%)in the stomach,DP(37.5%)in the small intestine and video capsule endoscopy device(75%)in the colon.A transparent cap with grasping forceps was the most commonly used device[82(38.1%)cases].The success rate of the procedure was 100%,and complication were observed in only one case(0.5%).CONCLUSION Endoscopic management of FBs and FBI in our Hospital is extremely safe and effective.

Hydrogen gas and preservation of intestinal stem cells in mesenteric ischemia and reperfusion

BACKGROUND Patients with mesenteric ischemia frequently suffer from bowel necrosis even after revascularization.Hydrogen gas has showed promising effects for ischemiareperfusion injury by reducing reactive oxygen species in various animal and clinical studies.We examined intestinal tissue injury by ischemia and reperfusion under continuous initiation of 3%hydrogen gas.AIM To clarify the treatment effects and target cells of hydrogen gas for mesenteric ischemia.METHODS Three rat groups underwent 60-min mesenteric artery occlusion(ischemia),60-min reperfusion following 60-min occlusion(reperfusion),or ischemiareperfusion with the same duration under continuous 3%hydrogen gas inhalation(hydrogen).The distal ileum was harvested.Immunofluorescence staining with caspase-3 and leucine-rich repeat-containing G-protein-coupled 5(LGR5),a specific marker of intestinal stem cell,was conducted to evaluate the injury location and cell types protected by hydrogen.mRNA expressions of LGR5,olfactomedin 4(OLFM4),hairy and enhancer of split 1,Jagged 2,and Neurogenic locus notch homolog protein 1 were measured by quantitative polymerase chain reaction.Tissue oxidative stress was analyzed with immunostaining for 8-hydroxy-2'-deoxyguanosine(8-OHdG).Systemic oxidative stress was evaluated by plasma 8-OHdG.RESULTS Ischemia damaged the epithelial layer at the tip of the villi,whereas reperfusion induced extensive apoptosis of the cells at the crypt base,which were identified as intestinal stem cells with double immunofluorescence stain.Hydrogen mitigated such apoptosis at the crypt base,and the LGR5 expression of the tissues was higher in the hydrogen group than in the reperfusion group.OLFM4 was also relatively higher in the hydrogen group,whereas other measured RNAs were comparable between the groups.8-OHdG concentration was high in the reperfusion group,which was reduced by hydrogen,particularly at the crypt base.Serum 8-OHdG concentrations were relatively higher in both reperfusion and hydrogen groups without significance.CONCLUSION This study demonstrated that hydrogen gas inhalation preserves intestinal stem cells and mitigates oxidative stress caused by mesenteric ischemia and reperfusion.

Dosimetric Comparison of Different Prescription Modes in Lung Stereotactic Body Radiation Therapy

The purpose of this study was to compare the dose-volume statistics of stereotactic body radiotherapy (SBRT) for lung cancer between planning target volume (PTV): D95 and gross tumor volume (GTV): D99 dose prescriptions using Monte Carlo (MC) calculation. Plans for 183 patients treated between October 2010 and April 2013 were generated based on four-dimensional (4D) computed tomography (CT) under free breathing. A uniform margin of 8 mm was added to the internal target volume (ITV) to generate PTV. A leaf margin of 2 mm was added to the PTV. The plans were calculated with two different dose prescription methods: 40 Gy to cover 95% of the PTV (PTV prescription) and 44 Gy to cover 99% of the GTV (GTV prescription). A 6-MV photon beam was used. A dose-volume histogram (DVH) analysis was performed for dose to the GTV using PTV and GTV dose prescriptions. For each treatment plan, we evaluated the minimum dose to 99% of the GTV (D99). The D99 of GTV was 44.5 ± 1.9 Gy and 44.0 ± 0.0 Gy for PTV and GTV prescriptions, respectively. The dose to the GTV had wide variations with PTV prescription. We recommend that GTV based dose prescription should be used to standardize dose to the tumor and to achieve highly conformal dose distributions in SBRT for lung cancer.

Evaluation and Commissioning of Commercial Monte Carlo Dose Algorithm for Air Cavity

The purpose of this study was to compare the Pencil Beam (PB) with Monte Carlo (MC) calculated dosimetric results using phantoms for air cavity region. Measurements in Tough water phantom with air gaps were used to verify the calculated dose. The plane-parallel ionization chamber was moved from 2 mm to 20 mm behind air gap. Calculations were performed for various air gaps (1.0, 2.0, 3.0 and 4.0 cm) and field sizes (4.2 × 4.2, 6.0 × 6.0 and 9.8 × 9.8 cm2). The lateral missing tissue measurement was performed using the radiochromic RT-QA film. Dose difference between PB and chamber measurement near an air gap was greater for smaller field size, larger air gap thickness, and shallower depth behind air gap. As the distance from the phantom edge became shorter, the dose differences of the PB calculation and film measurement became larger. MC calculations were found within 3% agreement to the measured dose distributions. Our results demonstrate an excellent agreement between ionization chamber and radiochromic RT-QA film measurements and MC calculations.

Length of hospital stay and mortality associated with burns from assault:a retrospective study with inverse probability weighting analysis

Background:Burns resulting from assaults account for considerable morbidity and mortality among patients with burn injuries around the world.However,it is still unclear whether unfavorable clinical outcomes are associated primarily with the severity of the injuries.To elucidate the direct relationship between burns resulting from assaults and mortality and/or length of hospital stays,we performed this study with the hypothesis that burns from assault would be independently associated with fewer hospital-free days than would burns from other causes,regardless of the severity of burn injuries.Methods:We conducted a retrospective cohort study,using a city-wide burn registry(1996–2017)accounting for 14 burn centers in Tokyo,Japan.Patients who arrived within 24 hours after injury were included,and those with self-inflicted burn injuries were excluded.Patients were divided into two groups according to mechanism of burns(assault vs.accident),and the number of hospitalfree days until day 30 after injury(a composite of in-hospital death and hospital length of stay)was compared between the groups.To estimate the probability that an injury would be classified as an assault,we calculated propensity scores,using multivariate logistic regression analyses adjusted for known outcome predictors.We also performed an inverse probability weighting(IPW)analysis to compare adjusted numbers of hospital-free days.Results:Of 7419 patients in the registry with burn injuries during the study period,5119 patients were included in this study.Of these,113(2.2%)were injured as a result of assault;they had significantly fewer hospital-free days than did those with burns caused by accident(18[27]vs.24[20]days;coefficient=−3.4[−5.5 to−1.3]days;p=0.001).IPW analyses similarly revealed the independent association between assault burn injury and fewer hospital-free days(adjusted coefficient=−0.6[−1.0 to−0.1]days;p=0.009).Conclusions:Burn from assault was independently associated with fewer hospital-free days,regardless of the severity of burn injuries.The pathophysiological mechanism underlying the relationship should be further studied in a prospective observational study.