Indocyanine green fluorescence and three-dimensional imaging of right gastroepiploic artery in gastric tube cancer

A 79-year-old male was admitted to our hospital for the treatment of cancer of the gastric tube.Gastrointestinal examination revealed a T1 b Union for International Cancer Control(UICC) tumor at the pyloric region of the gastric tube.Laparotomy did not reveal infiltration intothe serosa,peritoneal dissemination,regional lymph node swelling,or distant metastasis.We performed a distal gastrectomy preserving the right gastroepiploic artery by referencing the preoperative three-dimensional computed tomoangiography.We also evaluated the blood flow of the right gastroepiploic artery and in the proximal gastric tube by using indocyanine green fluorescence imaging intra-operatively and then followed with a gastrojejunal anastomosis with Roux-en-Y reconstruction.The definitive diagnosis was moderately differentiated adenocarcinoma of the gastric tube,pT 1bN 0M0,pS tage IA(UICC).His postoperative course was uneventful.Three-dimensional computed tomographic imaging is effective for assessing the course of blood vessels and the relationship with the surrounding structures.Intraoperative evaluation of blood flow of the right gastroepiploic artery and of the gastric tube in the anastomotic portion is very valuable information and could contribute to a safe gastrointestinal reconstruction.

Combined thoracoscopic and endoscopic surgery for a large esophageal schwannoma

A 47-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy identified a submucosal tumor in the left wall of the esophagus that was diagnosed as a benign schwannoma on biopsy. Computed tomography revealed a tumor of length 60 mm in the thoracic esophagus, with its cranial edge at the level of the aortic arch. On endoscopy, a submucosal tunnel was created 40 mm proximal to the cranial edge of the tumor, and its oral end was dissected from the mucosal and muscular layers. This was followed by the resection of the entire tumor by left-sided thoracoscopy. The esophageal defect was closed in layer by continuous suture from the thoracic side. Endoscopic closure was achieved by using clips. No postoperative complications were observed. Oral diet was resumed from postoperative day 7 and the patient was discharged on postoperative day 9. This combined approach has not been described for similar tumors. Our experience demonstrated that large esophageal tumors can be safely excised with minimally invasive surgery by using a combination of thoracoscopy and endoscopy.

Use of water jet instruments in gastrointestinal endoscopy

In recent years, water jet instruments have been used in the field of gastrointestinal endoscopy, mainly in two clinical situations: Investigation and treatment under endoscopic view. Injecting water jet into the gastrointestinal lumen is helpful for maintaining a clear endoscopic view, washing away blood or mucous in the lumen or on the surface of the tip of the endoscope. This contributes to reducing time and discomfort of examination. Water jet technology is an alternative method for dissecting soft tissue; this method does not harm the small vessels or cause mechanical or thermal damage. However, its use in clinical settings has been limited to the transmucosal injection of water into the submucosal layer that elevates the mucosa to prepare for endoscopic mucosal resection or endoscopic submucosal dissection, instead of tissue dissection, which may occur because of the continuous water jet. A preclinical study has been conducted using a pulsed water jet system as an alternative method for submucosal dissection by reducing intraoperative water consumption and maintenance of dissection capability. This review introduces recent studies pertaining to using a water jet in gastrointestinal endoscopy and discusses future prospects.

CBP蛋白是转录因子GATA-2的辅激活因子

转录因子GATA家族含有6个成员，分别为GATA 1-6，本实验主要针对GATA-2与CREB结合蛋白（CBP）的关系进行了研究，GATA-2主要在造血祖细胞中表达，对维持这类细胞的非分化状态有重要作用，CBP是多种可调控的与DNA结合的转录因子的辅激活因子，其中包括转录因子GATA-1，目前尚未有报道表明CBP蛋白也是GATA-2的辅激活因子，本研究利用免疫沉淀技术和洗脱技术证明了小鼠的GATA-2能够与CBP结合，而且发生结合的位点分别位于CBP蛋白的CHI，CH3和CT4523个区域，以及GATA-2蛋白的N-finger，N-C-finger和C-finger3个区域，荧光素酶活性测定结果表明，CBP能够以剂量依赖的方式提高GATA-2转录激活的活性，有研究表明，虽然GATA-1主要在已分化的造血细胞中表达，但与GATA-2的表达在时间上仍有重叠，那么是何种机制决定着CBP蛋白与GATA-2选择性结合时维持造血细胞的非分化状态，而与GATA-1结合时诱导造血细胞的分化是一个值得探讨的问题，本文对此进行了讨论，

CREB-binding proteins (CBP) as a transcriptional coactivator of GATA-2

The GATA family consists of six members, GATA 1-6. In this study, we focused on GATA-2, which is expressed predominantly in hematopoietic progenitor cells and plays the key role in keeping these cells in the undifferentiated status. CREB-binding proteins (CBP) are essential transcriptional coacti- vators for a large number of regulated DNA-binding transcription factors, including GATA-1. But there have been no reports on whether CBP is still a co-activator of GATA-2. Here, we used the immunopre- cipitation and pull-down experiments to show that the GATA-2 and CBP were physically binding to- gether, and clarified the binding sites CH1, CH3 , CH452 and CT1430 in CBP and N-finger, C-finger and N-C-finger in GATA-2. Luciferase assay results in our experiment indicated that CBP could increase GATA-2 transcriptional activity in the dose-dependent manner. GATA-1 is mainly expressed in differen- tiated hematopoietic cells, but still has overlap expression with GATA-2. CBP is a coactivator of GATA-2 and GATA-1. The investigation on the mechanism that could decide whether CBP binds to GATA-2 to keep hematopoietic cells in the progenitor status or to GATA-1 to start differentiation will be a very in- teresting and very meaningful project in the near future.