腔内聚乙烯十二指肠-空肠导管对体重调节的作用:猪动物模型可行性研究

目的评估十二指肠-空肠导管(EndoluminalDuodeno-JejunalTube,EDJT)在活体猪实验动物模型中减缓体重增加的可行性,及其在中短期生存中的安全性。方法本项研究共用8只45kg重的Yorkshire猪,其中3只置入180cmEDJT,1只置入360cmEDJT,另4只猪作为对照组。切开十二指肠,将EDJT导管缝合固定在十二指肠近Vater壶腹起始处。结果评估全部猪的不适反应和体重,每日一次,共7周,未发现严重并发症发生。术后7周3组动物的平均体重变化百分率:对照组、180cm组和360cm组分别是22.5%,6%和-2.8%。EDJT组(180cm组、360cm组)体重增加明显减慢,与对照组相比,有统计学意义(P=0.05)。结论EDJT可以安全使用,无肠梗阻、肠套叠或胰腺炎等并发症发生。EDJT可明显减缓体重增加。

End-to-end and end-to-side neurorrhaphy between thick donor nerves and thin recipient nerves:an axon regeneration study in a rat model

During nerve reconstruction,nerves of different thicknesses are often sutured together using end-to-side neurorrhaphy and end-to-end neurorrhaphy techniques.In this study,the effect of the type of neurorrhaphy on the number and diameter of regenerated axon fibers was studied in a rat facial nerve repair model.An inflow-type end-to-side and end-to-end neurorrhaphy model with nerve stumps of different thicknesses（2：1 diameter ratio） was created in the facial nerve of 14 adult male Sprague-Dawley rats.After 6 and 12 weeks,nerve regeneration was evaluated in the rats using the following outcomes：total number of myelinated axons,average minor axis diameter of the myelinated axons in the central and peripheral sections,and axon regeneration rate.End-to-end neurorrhaphy resulted in a significantly greater number of regenerated myelinated axons and rate of regeneration after 6 weeks than end-to-side neurorrhaphy;however,no such differences were observed at 12 weeks.While the regenerated axons were thicker at 12 weeks than at 6 weeks,no significant differences in axon fiber thickness were detected between end-to-end and end-toside neurorrhaphy.Thus,end-to-end neurorrhaphy resulted in greater numbers of regenerated axons and increased axon regeneration rate during the early postoperative period.As rapid reinnervation is one of the most important factors influencing the restoration of target muscle function,we conclude that end-to-end neurorrhaphy is desirable when suturing thick nerves to thin nerves.

Japanese apricot improves symptoms of gastrointestinal dysmotility associated with gastroesophageal reflux disease

AIM: To investigate the effects of Japanese apricot(JA) consumption on gastroesophageal reflux disease(GERD)-related symptoms.METHODS: Participants included individuals living in Minabe-cho,a well-known JA-growing region,who received specific medical check-ups by the local community health service in 2010.GERD-related symptoms were examined in 1303 Japanese individuals using a validated questionnaire,the Frequency Scale for Symptoms of GERD(FSSG),which consists of 7 questions associated with acid reflux symptoms and 5 questions asking about gastrointestinal dysmotility symptoms.Each question was answered using a 4-point scale,with higher scores indicating more severe GERDrelated symptoms.Subjects were divided into two groups according to their intake of dried and pickled JA: daily intake(≥ 1 JA daily)(392 subjects) and none oroccasional intake(< 1 JA daily)(911 subjects).FSSG scores were compared between subjects who consumed JA daily and those who did not.Next,subjects were stratified by age,gender and Helicobacter pylori(H.pylori) status for subanalyses.RESULTS: Those who ate JA daily were significantly older than those who did not(60.6 ± 10.5 years vs 56.0 ± 11.0 years,P < 0.001).Total FSSG scores were significantly lower in subjects with daily JA intake than in those with none or only occasional intake(2.13 ± 3.14 vs 2.70 ± 3.82,P = 0.005).In particular,subjects who consumed JA daily showed significantly improved FSSG dysmotility scores compared with subjects who did not(1.05 ± 1.58 vs 1.46 ± 2.11,P < 0.001).In contrast,the FSSG reflux score did not differ between subjects with and without daily intake of JA(1.08 ± 1.90 vs 1.24 ± 2.11,P = 0.177).Subanalysis indicated that improvement in dysmotility by JA intake was specifically observed in non-elderly(1.24 ± 1.68 vs 1.62 ± 2.22,P = 0.005) and H.pylori-negative subjects(0.99 ± 1.58 vs 1.57 ± 2.06,P < 0.001).GERD patients(total FSSG score ≥ 8) were less frequently observed among subjects with daily intake of JA as compared to those without daily intake of JA(6.1% vs 9.7%,P = 0.040).CONCLUSION: Daily JA intake may improve digestive dysmotility symptoms,resulting in relief of GERD symptoms.The effect is more obvious in non-elderly and H.pylori-negative subjects.

A case of chronic pancreatitis in which endoscopic ultrasonography was effective in the diagnosis of a pseudoaneurysm

Endoscopic ultrasonography (EUS) was performed on a patient being treated for chronic pancreatitis because a submucosal tumor was observed in the stomach during gastrointestinal endoscopy. As internal pulsa- tile blood flow on Doppler was present, the diagnosis of an aneurysm was made. The pseudoaneurysm of the left gastric artery was embolized with histoacryl and lipiodol and the splenic artery was embolized with coils at the location of the pseudoaneurysm to prevent hemorrhage. Follow up EUS confirmed the cessation of blood flow from the pseudoaneurysm. Clinicians encountering a gastric submucosal tumor-like protrusion in a patient with chronic pancreatitis should use EUS to investigate the possibility of a pseudoaneurysm, which must be treated as quickly as possible once identified.

hepatocellular 癌的 Ultrasonogram 在 radiofrequency 脱离以后与结果被联系

AIM:To investigate the association between B-mode ultrasound classification of small hepatocellular carcinoma(HCC) and outcome after radiofrequency ablation(RFA).METHODS:Ninety-seven cases of HCC treated using RFA between April 2001 and March 2006 were reviewed.Ultrasound images were classified as follows:type 1,with halo(n=29);and type 2,without halo(n=68).Type 2 was further categorized into three subgroups:type 2a,homogenous hyperechoic(n=9);type 2b,hypoechoic with smooth margins(n=43);and type 2c(n=16),hypoechoic with irregular or unclear margins.Patients with type 2a HCC were excluded from analysis due to the small number of cases.RESULTS:Two year recurrence rates for type 2b,type 1 and type 2c were 26%,42% and 69%,respectively,with significant differences between type 2b and type 2c(P【0.01),and between type 1 and type 2c(P【0.05).Five year survival rates were 89%,43% and 65%,respectively.Survival was significantly longer for type 2b than for other types(type 1 vs type 2b,P【0.01;type 2b vs type 2c,P【0.05).On univariate analysis,factors contributing to recurrence were number of tumors,tumor stage,serum level of lens culinaris agglutinin-reactive alpha-fetoprotein and ultrasound classification(P【0.05).Factors contributing to survival were tumor stage and ultrasound classification(P【0.05).Multivariate analysis identified ultrasound classification as the only factor independently associated with both recurrence and survival(P【0.05).CONCLUSION:B-mode ultrasound classification of small HCC is a predictive factor for outcome after RFA.

在屏蔽胃的 mucosal 瘤形成的 Transnasal 和标准 transoral 内视镜检查法

AIM: To compare the diagnostic performances of transnasal and standard transoral esophagogastroduodenoscopy (EGD) in gastric cancer screening of asymptomatic healthy subjects. METHODS: Between January 2006 and March 2010, atotal of 3324 subjects underwent examination of the upper gastrointestinal tract by EGD for cancer screening, with 1382 subjects (41.6%) screened by transnasal EGD and the remaining 1942 subjects (58.4%) by standard transoral EGD. Clinical profiles of the screened subjects, detection rates of gastric neoplasia and histopathology of the detected neoplasias were compared between groups according to the stage of Helicobacter pylori (H. pylori )-related chronic gastritis. RESULTS: Clinical profiles of subjects did not differ significantly between the two EGD groups, except that there were significantly more men in the transnasal EGD group. During the study period, 55 cases of gastric mucosal neoplasias were detected. Of these, 23 cases were detected by transnasal EGD and 32 cases by standard transoral EGD. The detection rate for gastric mucosal neoplasia in the transnasal EGD group was thus 1.66%, compared to 1.65% in the standard transoral EGD group, with no significant difference between the two groups. Detection rates using the two endoscopies were likewise comparable, regardless of H. pylori infection. However, detection rates when screening subjects without extensive chronic atrophic gastritis (CAG) were significantly higher with standard transoral EGD (0.70%) than with transnasal EGD (0.12%, P 【 0.05). In particular, standard transoral EGD was far better for detecting neoplasia in subjects with H. pylorirelated non-atrophic gastritis, with a detection rate of 3.11% compared to 0.53% using transnasal EGD (P 【 0.05). In the screening of subjects with extensive CAG, no significant differences in detection of neoplasia were evident between the two endoscopies, although the mean size of detected cancers was significantly smaller and the percentage of early cancers was significantly higher with standard transoral EGD. CONCLUSION: These results strongly suggest that the diagnostic performance of transnasal endoscopy issuboptimal for cancer screening, particularly in subjects with H. pylori-related non-atrophic gastritis.

Diazepam during endoscopic submucosal dissection of gastric epithelial neoplasias

AIM:To investigate risk factors and adverse events related to high-dose diazepam administration during endoscopic submucosal dissection for gastric neoplasias.METHODS:Between February 2002 and December 2009,a total of 286 patients with gastric epithelial neoplasia underwent endoscopic submucosal dissection in our hospital.To achieve moderate sedation,5-7.5 mg of diazepam was administered intravenously by non-anesthesiologists.Intermittent additional administration of 2.5-5 mg diazepam was performed if uncontrollable body movement of the patient was observed.All patients were classified into groups based on the required diazepam dose:low-dose (≤ 17.5 mg,n=252) and high-dose (> 17.5 mg,n=79).RESULTS:Differences between the low-and highdose diazepam groups were observed in lifetime alcohol consumption (0.30 ± 0.48 vs 0.44 ± 0.52 tons,P=0.032),body weight (58.4 ± 10.3 vs 62.0 ± 9.9 kg,P=0.006),tumor size (15 ± 10 vs 23 ± 18 mm,P < 0.001),lesion location (P < 0.001) and the presence of ulcerative findings (14/238 vs 18/61,P < 0.001).Multivariate analysis identified all five variables as independently related to required diazepam dosage.In terms of adverse reactions to diazepam administration,paradoxical excitement was significantly more frequent in the high-dose diazepam group (P < 0.001).CONCLUSION:Intermittent administration of diazepam enabled safe completion of gastric endoscopic submucosal dissection except in patients who were alcohol abusers or obese,or who showed complicated lesions.

Assessment of gastroesophageal reflux disease by serodiagnosis of Helicobacter pylori-related chronic gastritis stage

AIM:To evaluate the association of Helicobacter pylori(H.pylori)-related chronic gastritis stage with upper gastro-intestinal symptoms and gastro-eso-phageal reflux disease(GERD).METHODS:Subjects underwent upper gastrointestinal endoscopy,a questionnaire using a frequency scale for symptoms of GERD(FSSG),and measurements of serum H.pylori-antibody and pepsinogen(PG)levels.They were classified into the following 4 groups in terms of H.pylori-related chronic gastritis stage:Group A(n = 219),H.pylori(-)PG(-);Group B(n = 310),H.pylori(+)PG(-);Group C(n = 279),H.pylori(+)PG(+);and Group D(n = 17),H.pylori(-)PG(+).RESULTS:Reflux esophagitis occurred in 30.6% of Group A,14.5% of Group B,6.8% of Group C,and 0% of Group D(P < 0.001).Scores for acid reflux sympto-ms decreased significantly with chro-nic gastritis stage(from Group A to D)(P < 0.05),while scores for dysmotility symptoms did no-t differ significantly.The prevalence of nonerosive reflux disease(NERD)did not differ amo-ng groups.However,in subjects with GERD,the prevalence of NERD tended to increase with chronic gastritis stage(P = 0.081).CONCLUSION:Acid reflux sympto-ms and the prevalen-ce of reflux esophagitis can be assessed by measuring both serum H.pylori-antibody and PG levels.

Steakhouse syndrome causing large esophageal ulcer and stenosis

A 66-year-old man developed dysphagia during dinner and was evaluated 2d later in our hospital because of persistent symptoms.Upper gastrointestinal endoscopy showed no impacted food,but advanced esophageal cancer was suspected based on the presence in the upper esophagus of a large irregular ulcerative lesion with a thick white coating and stenosis.Further imaging studies were performed to evaluate for metastases,revealing circumferential esophageal wall thickening and findings suggestive of lung and mediastinal lymph node metastases.However,dysphagia symptoms and the esophageal ulcer improved after hospital admission,and histopathological examination of the esophageal mucosa revealed only nonspecific inflammation.At the timeof symptom onset,the patient had been eating stewed beef tendon(Gyusuji nikomi in Japanese) without chewing well.Esophageal ulceration due to steakhouse syndrome was therefore diagnosed.The lung lesion was a primary lung cancer that was surgically resected.Although rare,steakhouse syndrome can cause large esophageal ulceration and stenosis,so care must be taken to distinguish this from esophageal cancer.

Usefulness of continuous suction mouthpiece during esophagogastroduodenoscopy: A single-center, prospective,randomized study

AIM: To develop a new continuous suction mouthpiece(CSM) and evaluate its usefulness for screening esophagogastroduodenoscopy(EGD).METHODS: A total of 196 patients who were scheduled to undergo screening EGD were assigned to one of two groups: a group using the CSM and a group using a conventional mouthpiece. Extent of salivary flow,frequency of saliva suction, number of choking episodesduring the examination, and incidence of aspiration pneumonia after the examination were evaluated and compared between the two groups. Adverse events during and after EGD were also examined. In addition, the oral cavity was meticulously examined after the EGD.RESULTS: The same number of patients was randomly allocated to each group. There were no significant differences between the two groups in sex, age,biopsy procedure, duration of procedure and depth of sedation. Aspiration pneumonia and other significant adverse events were not observed in either group. The grade of extent of salivary flow was significantly lower in patients with the CSM than in patients with the conventional mouthpiece(P < 0.001). Although there was no significant difference, less frequent suctioning and fewer choking episodes were observed in patients with the CSM than in patients with the conventional mouthpiece(P = 0.082 and P = 0.084, respectively). In addition, there were no patients in the CSM group who required saliva suctioning during the procedure.CONCLUSION: Use of the CSM during screening EGD can reduce the extent of salivary flow. The device is expected to reduce complications and contamination with saliva.