Resection and Cryotherapy Combined with Amniotic Membrane Transplantation for the Treatment of Vernal Keratoconjunctivitis with Giant Papillae

To evaluate the efficacy and safety of resection and cryotherapy combined with amniotic membrane transplantation （AMT） for the treatment of vernal keratoconjunctivitis （VKC） with giant papillae （GP）. Eight patients （16 eyes involved） with VKC, characterized by GP on the upper tarsal conjunctiva, underwent resection and cryotherapy in combination with AMT. The follow-up lasted for 3-22 months. The results showed that corneal shield ulcers and superficial punctuate keratitis healed during the first week after surgery and did not recur. Fourteen eyes （87.5 %） were symptom-free l month after surgery, and no GE ectropion, trichiasis and other complications were noted, but the blood vessels of upper tarsal conjunctiva could not be clearly seen and a little conjunctival scar was observed. Recurrence of GP was observed in 2 eyes （12.5 %）, with the area being less and irritation milder as compared with those before the operation. Among the two eyes, one eye was treated by cyclosporine eyedrops with improvement, but the other eye showed no improvement after the treatment, and underwent a second surgery with a cotton patch soaked in fluorouracil applied onto the supratarsal area after resection and cryotherapy. Four months after the treatment the patient presented no symptoms and GP did not recur. It is concluded that the resection and cryotherapy combined with AMT is an effective and safe treatment for VKC with GP.

Ablation of NTPDase2+ cells inhibits the formation of filiform papillae in tongue tip

Background: Lingual epithelia in the tongue tip are among the most rapidly regenerating tissues, but the mechanism of cell genesis in this tissue is still unknown. Previous study has suggested the existence of multiple stem cell pools in lingual epithelia and papillae. Like K14+ and Sox2+ cells, NTPDase2+ cells have characteristics of stem cells.Methods: We employed a system using doxycycline to conditionally ablate NTPDase2+ cells in lingual epithelia and papillae by regulated expression of the diphtheria toxin A(DTA) gene. Transgenic lines, which expressed the rtTA gene in NTPDase2+ cells, were produced by pronuclear injection of zygotes from C57 BL/6 mice using the BAC clone RP23-47 P18. The NTPDase2-rtTA transgenic mice were crossed with the TetO-DTA transgenic animals. The double transgenic mice were treated with doxycycline. Doxycycline(Dox) was diluted in 5% sucrose in water to a final concentration of 0.3-0.5 mg/mL and supplied as drinking water.Results: After 15 days of Dox induction, the expression of NTPDase2, Sox2 and K14 was ablated from lingual epithelia. DTA expression in NTPDase2+cells did not inhibit the turnover of GNAT3+ or PLCb2+ cells in taste buds,nor the expression of S100 b beneath lingual epithelia and papillae. After35 days ablation of NTPDase2+ cells, the basic structure of lingual epithelia and papillae remained intact. However, the ratio of cell to total tissue area was decreased in lingual epithelia and circumvallate(CV) papillae. DTA expression also inhibited the regeneration of filiform papillae on the dorsal surface of the tongue tip.Conclusions: These studies provide important insights into the understanding of dynamic equilibrium among the multiple stem cell populations present in the lingual epithelia and papillae.

Papillae alterations around single-implant restorations in the anterior maxillae:thick versus thin mucosa

To evaluate the papilla alterations around single-implant restorations in the anterior maxillae after crown attachment and to study the influence of soft tissue thickness on the papilla fill alteration. According to the inclusion criteria, 32 patients subjected to implant-supported single-tooth restorations in anterior maxillae were included. The patients were assigned to two groups according to the mucosal thickness： （i） group 1, 1.5 mm≤mucosal thickness≤3 mm; and （ii） group 2, 3 mm〈mucosal thickness≤4.5 mm. Assessments of interproximal papillae at the time of crown placement （baseline） and at 6-month postloading （follow-up） were made by two prosthodontists using papilla fill index （PFI）. The mean mucosal thickness was （2.49±0.31） mm （group 1） and （3.81±0.31） mm （group 2） for the two groups respectively. A significant difference in PFI between the groups was detected at the baseline （P〈O.O01）. PFI improvements over time occurred after 6-month follow-up irrespective of the groups. When compared to group 1, the likelihood to obtain papilla fill was significantly higher for group 2 with an odds ratio of 6.05 （P〈O.O01）. The interproximal papilla level around single-implant restorations could improve significantly over time after 6-month restoration according to PFI assessment. The thicker mucosa before implant placement implied a more favorable esthetic outcome in papilla alteration.

Needle knife fstulotomy in flat and diverticular papillae:Is it time for redemption?

Background: European Society of Gastrointestinal Endoscopy( ESGE) recommends needle-knife fstulotomy(NKF) as the preferred precut technique in cases when standard cannulation techniques fail. Despite scarce scientifc evidence, flat and diverticular papillae are thought not to be ideal for NKF, as they are associated with poor outcomes. The present study aimed to determine the outcomes of the use of NKF in relation to flat and intradiverticular papillae. Methods: This prospective multicenter study enrolled consecutive patients, evidencing na?ve flat(group A, n = 49) or diverticular papilla(group B, n = 28), who underwent NKF after failure of standard cannulation techniques. Diverticular morphology was subdivided into intradiverticular(group B1, n = 14) and diverticular border papillae(group B2, n = 14), using a previously validated endoscopic classifcation of the major papilla. The success of biliary cannulation at initial endoscopic retrograde cholangiopancreatography(ERCP), overall biliary cannulation, overall cannulation time, and the rate of adverse events were assessed in the study. Results: The initial cannulation rates were 93.9%, 64.3% and 71.4% for group A, B1, and B2, respectively( P = 0.005);overall cannulation rates after a second ERCP were 98.0%, 92.9% and 85.7%, respectively( P = 0.134). Adverse events occurred in 11.7% of patients, with post-ERCP pancreatitis(PEP) being the most common adverse event(10.4%). Although there was a trend towards a higher incidence of PEP in flat papillae, univariate and multivariate analyses did not show any signifcant relationship between pancreatitis and trainee involvement, papillary morphology, nor overall cannulation time. Conclusions: Although flat papillae are associated with high success rates of biliary cannulation using NKF, the rate of PEP is not negligible. NKF is feasible in diverticular papillae, but it is associated with a modest success rate in the initial ERCP.

Hair growth-promotion effects and antioxidant activity of the banana flower extract HappyAngel^(■):double-blind, placebo-controlled trial

Banana flowers contain various bioactive components, including several antioxidants with anti-inflammatory effects. However, it is unclear whether they can reduce and prevent hair loss. This study examines the effect of banana flower extracts on preventing hair loss and strengthening hair roots. The banana flower extract(HappyAngel^(■))was used to treat human hair follicle dermal papilla cells(HFDPCs)and the expression of reactive oxygen species(ROS), dihydrotestosterone(DHT), and hair-related genes(SRD5A1, SRD5A2, AR, and KROX20)were monitored. Fifty subjects were divided into a placebo group and a banana flower group. The experimental group consumed banana flower extract daily for twelve weeks and then underwent hair testing, hair-related genes analysis, collection of hair loss, and questionnaires. The results showed that the banana flower extract significantly increased hair cell growth and decreased the expression of ROS, DHT, and hair follicle growth inhibition-related SRD5A1, SRD5A2, and AR genes, and significantly increased the expression of hair growth-related KROX20 gene in HFDPCs. Consuming banana flower extract for twelve weeks increased the hair root diameter and reduced hair loss and scalp redness compared to the placebo group. Thus, banana flower extract(HappyAngel^(■))can stimulate hair growth and inhibit the activation of hair loss genes.

Flavonoids in safflower extract reduce cisplatin-induced damage to human follicle dermal papilla cells by inhibiting DNA damage and Rad17/Chk1/Cdc25C signaling

Background:Cisplatin is a chemotherapeutic agent commonly used clinically for the treatment of various human cancers.Patients often reduce the use of cisplatin due to its side effects,which in turn affects its treatment.This study explored the mechanism of action of safflower extract as an adjuvant traditional Chinese medicine for chemotherapy.Methods:Primary human follicle dermal papilla cells(HFDPCs)were used as target cells for cisplatininduced damage to hair cells.Western blotting was used to investigate the molecular targets of cisplatin and safflower extract in causing HFDPCs damage.Cell survival and cell cycle were analyzed by mitochondrial staining reagent WST-1 and propidium iodide.Results:Cisplatin could reduce the viability of HFDPCs without causing cell death.Cisplatin increased the level of phospho-Rad17 in HFDPCs and activated the Chk1/Cdc25C signaling to reduce the expression of Cdc2 protein,thereby arresting the cells in the G2/M phase.The combination of safflower extract and the flavonoids could effectively inhibit the signal transduction of Rad17/Chk1/Cdc25 in cisplatin-treated cells and reduce the cell population in the G2/M phase.Finally,we also confirmed that safflower extract could effectively inhibit the damage to HFDPCs caused by cisplatin,mainly at the level of reducing the DNA damage caused by cisplatin.Conclusions:Safflower extract can be used as an adjuvant Chinese medicine for chemotherapy to reduce the damage caused by chemotherapy to normal hair follicle cells.

Morphological adaptation of sheep's rumen epithelium to high-grain diet entails alteration in the expression of genes involved in cell cycle regulation, cell proliferation and apoptosis

Background: The objectives of this study were to characterize changes in the relative m RNA expression of candidate genes and proteins involved in cell cycle regulation, cell proliferation and apoptosis in the ruminal epithelium(RE) of sheep during high-grain(HG) diet adaptation.Results: Twenty sheep were assigned to four groups with five animals each. These animals were assigned to different periods of HG diet(containing 40% forage and 60% concentrate mix) feeding. The HG groups received an HG diet for7(G7, n = 5), 14(G14, n = 5) and 28 d(G28, n = 5), respectively. In contrast, the control group(CON, n = 5) was fed the forage-based diet for 28 d. The results showed that HG feeding linearly decreased(P < 0.001) the ruminal p H, and increased the concentrations of ruminal total volatile fatty acid(linear, P = 0.001), butyrate(linear, P < 0.001), valerate(quadratic P = 0.029) and the level of IGF-1(quadratic, P = 0.043) in plasma. The length(quadratic, P = 0.004), width(cubic, P = 0.015) and surface of the ruminal papillae(linear, P = 0.003) were all enlarged after 14 d of HG diet feeding.HG feeding cubically increased the number of cell layers forming the stratum corneum(SC, P < 0.001) and the thickness of the SC(P < 0.001) and stratum basale(P < 0.001). The proportion of basal layer cells in the RE decreased(linear, P < 0.001) in the G0/G1-phase, but it increased linearly(P = 0.006) in the S-phase and cubically(P = 0.004) in the G2/M-phases. The proportion of apoptosis cells in G7, G14 and G28 was reduced compared to the CON(quadratic, P <0.001). HG diet feeding linearly decreased the m RNA expression of Cyclin E1(P = 0.021) and CDK-2(P = 0.001) and(P = 0.027) the protein expression of Cyclin E1. Feeding an HG diet linearly increased the m RNA expression of genes IGFBP-2(P = 0.034) and IGFBP 5(P < 0.009), while linearly decreasing(P < 0.001) the IGFBP 3 expression. The expression of cell apoptosis gene Caspase 8 decreased(quadratic, P = 0.012), while Bad m RNA expression tended to decrease(cubic, P = 0.053) after HG feeding.Conclusions: These results demonstrated sequential changes in rumen papillae size, cell cycle regulation and the genes involved in proliferation and apoptosis as time elapsed in feeding a high-grain diet to sheep.

Unexpected anomaly of the common bile duct and pancreatic duct

Variations in the bile duct and pancreatic duct opening are related to the process of rotation and recanalization during embryologic development. Complete nonunion of distal common bile duct and pancreatic duct gives rise to double papillae of Vater. The separation of the drainage of the main pancreatic duct and bile duct can be appreciated by careful assessment at the time of endoscopic retrograde cholangiopancreatograpy. The cranial orifice is a bile duct opening, whereas the caudal orifice is a pancreatic duct opening. The separate orifice finding can be confirmed by cholangiogram and pancreatogram with no communication between the two orifices. Endoscopists should be aware of this rare variant because late recognition can result in unnecessary manipulation and contrast injections of the main pancreatic duct and biliary cannulation failure.

Application of extracellular vesicles from mesenchymal stem cells promotes hair growth by regulating human dermal cells and follicles

BACKGROUND Dermal papillae(DP)and outer root sheath(ORS)cells play important roles in hair growth and regeneration by regulating the activity of hair follicle(HF)cells.AIM To investigate the effects of human mesenchymal stem cell-derived extracellular vesicles(hMSC-EVs)on DP and ORS cells as well as HFs.EVs are known to regulate various cellular functions.However,the effects of hMSC-EVs on hair growth,particularly on human-derived HF cells(DP and ORS cells),and the possible mechanisms underlying these effects are unknown.METHODS hMSC-EVs were isolated and characterized using transmission electron microscopy,nanoparticle tracking analysis,western blotting,and flow cytometry.The activation of DP and ORS cells was analyzed using cellular proliferation,migration,western blotting,and real-time polymerase chain reaction.HF growth was evaluated ex vivo using human HFs.RESULTS Wnt3a is present in a class of hMSC-EVs and associated with the EV membrane.hMSC-EVs promote the proliferation of DP and ORS cells.Moreover,they translocateβ-catenin into the nucleus of DP cells by increasing the expression ofβ-catenin target transcription factors(Axin2,EP2 and LEF1)in DP cells.Treatment with hMSC-EVs also promoted the migration of ORS cells and enhanced the expression of keratin(K)differentiation markers(K6,K16,K17,and K75)in ORS cells.Furthermore,treatment with hMSC-EVs increases hair shaft elongation in cultured human HFs.CONCLUSION These findings suggest that hMSC-EVs are potential candidates for further preclinical and clinical studies on hair loss treatment.

Relationship between Lingual Papilla Surface Roughness and Oral Condition in Elderly Individuals

Objectives: Recently, an increasing number of elderly patients have complained of tongue pain and fissured tongue, while atrophy of the lingual papillae with low nutrition has also become a commonly encountered condition. The viewpoint that lingual papilla atrophy reflects systemic and pathological conditions, such as diabetes and in the circulatory system abnormalities, is supported by many clinicians. The present study was conducted to clarify the relationship of degree of atrophy of tongue papillae with oral symptoms, with an aim to evaluate the usefulness of clinical diagnostic criteria for tongue papillae atrophy. Subjects and Methods: The subjects were asked to protrude the tongue forward. The tongue was held at rest and impressions were taken of the tongue dorsum 15 mm posterior to the apex of the tongue. Surface impressions were measured using a Surfcoder SE300 and the obtained values were used to define surface roughness (Ra). Multivariate analyses of the relationships between the Ra measurements and the living environment, subjective symptoms of oral health, and survey results of measurements were performed to examine factors associated with Ra. The tongue was photographed with a digital camera, then RGB color value of four random points 15 mm from the tongue apex was determined. Using those findings, redness was calculated. Results and Conclusions: One hundred and six subjects with a mean age of 79.5 ± 9.2 years were analyzed. In the smooth group, there was more redness in the tongue dorsum as compared to the rough group. Total and Sagittal Ra values of subjects with dysphagia were lower than those without dysphagia, suggesting that the degree of oral mucosal atrophy is related to subjective symptoms of dysphagia. Subjects with high water intake had higher Coronal Ra values, which was considered to be related to the edematous state of the lingual papillae.

Hypertrophic Anal Papillotomy by Transparent Cap-Assisted Endoscopic Hot Snare Resection

Background/Aim: Conventional treatment for hypertrophic anal papillae (HAP) has effectiveness and safety concerns. This study aimed to investigate the feasibility, safety, and efficacy of transparent cap-assisted endoscopic hot snare resection for the treatment of HAP. Methods: Endoscopic and clinical data of patients treated with transparent cap-assisted endoscopic hot snare resection for HAP at the Department of Gastroenterology, First Affiliated Hospital of Yangtze University from June 2019 to June 2021, were collected and retrospectively analyzed. Results: A total of 56 patients with HAP were treated with transparent cap-assisted endoscopic hot snare resection, including 53 patients (94.6%) with single hypertrophic anal papillae and 3 patients (5.4%) with multiple HAP;51 patients (83.6%) with basal diameter <5 mm and 10 patients (16.4%) with basal diameter ≥5 mm. The procedures that were performed together with transparent cap-assisted endoscopic hot snare resection for HAP treatment included total colon examination in 56 cases (100%), endoscopic polypectomy in 20 cases (35.7%), endoscopic sclerotherapy for hemorrhoids in 29 cases (51.8%), and endoscopic rubber band ligation for hemorrhoids in 11 cases (19.6%). No patient experienced bleeding during or after HAP with transparent cap-assisted endoscopic hot snare resection. Pain level was evaluated by the visual analog score (VAS) method. 52 patients (92.9%) did not have pain and 4 patients (7.1%) had mild pain 3 days after surgery. At a postoperative follow-up of 2 to 18 months, patient satisfaction with transparent cap-assisted endoscopic hot snare resection for HAP treatment was 100% (56/56). Conclusion: Transparent cap-assisted endoscopic hot snare resection is safe and effective for treating HAP.

Endoscopic papillectomy: Data of a prospective observational study

AIM:To investigate the clinical value of endoscopic papillectomy indicated by feasibility and safety of the procedure in various diseases of the papilla in a representative number of patients in a setting of daily clinical and endoscopic practice and care by means of a systematic prospective observational study. METHODS:Through a defined time period, all consecutive patients with tumor-like lesions of the papilla, who were considered for papillectomy, were enrolled in this systematic bicenter prospective observational study, and subdivided into 4 groups according to endoscopic and endoscopic ultrasonography (EUS) findings as well as histopathological diagnosis:adenoma; carcinoma/ neuroendocrine tumor (NET)/lymphoma; papilla into which catheter can not be introduced; adenomyomatosis, respectively. Treatment results and outcome were characterized by R0 resection, complication, recurrence rates and tumor-free survival.RESULTS:Over a 7-year period, 58 patients underwent endoscopic papillectomy. Main symptoms prompting to diagnostic measures were unclear abdominal pain in 50% and cholestasis with and without pain in 44%. Overall, 54/58 patients [inclusion rate, 93.1%; sex ratio, males/females = 25/29 (1:1.16); mean age, 65 (range, 22-88) years] were enrolled in the study. Prior to papillectomy, EUS was performed in 79.6% (n = 43/54). Group 1 (adenoma, n = 24/54; 44.4%):91.6% (n = 22/24) with R0 resection; tumor-free survival after a mean of 18.5 mo, 86.4% (n = 19/22); recurrence, 13.6% (n = 3/22); minor complications, 12.5% (n = 3/24). Group 2 (carcinoma/NET/lymphoma, n = 18/54; 33.3%):75.0% (n = 10/18) with R0 resection; tumor-free survival after a mean of 18.5 (range, 1-84) mo, 88.9% (n = 8/9); recurrence, 11.1% (n = 1/9). Group 3 (adenomyomatosis, n = 4/54; 7.4%). Group 4 (primarily no introducible catheter into the papilla, n = 8; 14.8%). The overall complication rate was 18.5% (n = 10/54; 1 subject with 2 complications):Bleeding, n = 3; pancreatitis, n = 7; perforation, n = 1 (intervention-related mortality, 0%). In summary, EUS is a sufficient diagnostic tool to preoperatively clarify diseases of the papilla including suspicious tumor stage in conjunction with postinterventional histopathological investigation of a specimen. Endoscopic papillectomy with curative intention is a feasible and safe approach to treat adenomas of the papilla. In high-risk patients with carcinoma of the papilla with no hints of deep infiltrating tumor growth, endoscopic papillectomy can be considered a reasonable treatment option with low risk and an approximately 80% probability of no recurrence if an R0 resection can be achieved. In patients with jaundice and in case the catheter can not be introduced into the papilla, papillectomy may help to get access to the bile duct. CONCLUSION:Endoscopic papillectomy is a challenging interventional approach but a suitable patientand local finding-adapted diagnostic and therapeutic tool with adequate risk-benefit ratio in experienced hands.

Epidermal stem cells and skin tissue engineering in hair follicle regeneration

The reconstitution of a fully organized and functional hair follicle from dissociated cells propagated under defined tissue culture conditions is a challenge stillpending in tissue engineering. The loss of hair follicles caused by injuries or pathologies such as alopecia not only affects the patients' psychological well-being, but also endangers certain inherent functions of the skin. It is then of great interest to find different strategies aiming to regenerate or neogenerate the hair follicle under conditions proper of an adult individual. Based upon current knowledge on the epithelial and dermal cells and their interactions during the embryonic hair generation and adult hair cycling, many researchers have tried to obtain mature hair follicles using different strategies and approaches depending on the causes of hair loss. This review summarizes current advances in the different experimental strategies to regenerate or neogenerate hair follicles, with emphasis on those involving neogenesis of hair follicles in adult individuals using isolated cells and tissue engineering. Most of these experiments were performed using rodent cells, particularly from embryonic or newborn origin. However, no successful strategy to generate human hair follicles from adult cells has yet been reported. This review identifies several issues that should be considered to achieve this objective. Perhaps the most important challenge is to provide threedimensional culture conditions mimicking the structure of living tissue. Improving culture conditions that allow the expansion of specific cells while protecting their inductive properties, as well as methods for selecting populations of epithelial stem cells, should give us the necessary tools to overcome the difficulties that constrain human hair follicle neogenesis. An analysis of patent trends shows that the number of patent applications aimed at hair follicle regeneration and neogenesis has been increasing during the last decade. This field is attractive not only to academic researchers but also to the companies that own almost half of the patents in this field.

ampullary 腺瘤的诊断和管理: 内视镜检查法的膨胀角色

Ampullary adenoma is a pre-cancerous lesion arising from the duodenal papilla that is often asymptomatic.It is important to distinguish whether the adenoma is sporadic or arises in the setting of familial adenomatous polyposis as this has important implications with respect to management and surveillance.Multiple modalities are available for staging of these lesions to help guide the most appropriate therapy.Those that are used most commonly include computed tomography,endoscopic ultrasound,and endoscopic retrograde cholangiopancreatography.In recent years,endoscopy has become the primary modality for therapeutic management of the majority of ampullary adenomas.Surgery remains the standard curative procedure for confirmed or suspected adenocarcinoma.This review will provide the framework for the diagnosis and management of ampullary adenomas from the perspective of the practicing gastroenterologist.

Endoscopic approach through the minor papilla for the management of pancreatic diseases

AIM:To clarify the efficacy and safety of an endoscopic approach through the minor papilla for the management of pancreatic diseases.METHODS:This study included 44 endoscopic retrograde cholangiopancreatography(ERCP) procedures performed in 34 patients using a minor papilla approach between April 2007 and March 2012.We retrospectively evaluated the clinical profiles of the patients,the endoscopic interventions,short-term outcomes,and complications.RESULTS:Of 44 ERCPs,26 were diagnostic ERCP,and 18 were therapeutic ERCP.The most common cause of difficult access to the main pancreatic duct through the major papilla was pancreas divisum followed by distortion of Wirsung's duct.The overall success rate of minor papilla cannulation was 80%(35/44),which was significantly improved by wire-guided cannulation(P = 0.04).Endoscopic minor papillotomy(EMP) was performed in 17 of 34 patients(50%) using a needle-knife(13/17) or a pull-type papillotome(4/17).EMP with pancreatic stent placement,which was the main therapeutic option for patients with chronic pancreatitis,recurrent acute pancreatitis,and pancreatic pseudocyst,resulted in short-term clinical improvement in 83% of patients.Mild post-ERCP pancreatitis occurred as an early complication in 2 cases(4.5%).CONCLUSION:The endoscopic minor papilla approach is technically feasible,safe,and effective when the procedure is performed in a high-volume referral center by experienced endoscopists.

Endoscopic pancreaticobiliary drainage with overlength stents to prevent delayed perforation after endoscopic papillectomy:A pilot study

BACKGROUND Endoscopic papillectomy(EP)is rapidly replacing traditional surgical resection and is a less invasive procedure for the treatment of duodenal papillary tumors in selected patients.With the expansion of indications,concerns regarding EP include not only technical difficulties,but also the risk of complications,especially delayed duodenal perforation.Delayed perforation after EP is a rare but fatal complication.Exposure of the artificial ulcer to bile and pancreatic juice is considered to be one of the causes of delayed perforation after EP.Draining bile and pancreatic juice away from the wound may help to prevent delayed perforation.AIM To evaluate the feasibility and safety of placing overlength biliary and pancreatic stents after EP.METHODS This is a single-center,retrospective study.Five patients with exposure or injury of the muscularis propria after EP were included.A 7-Fr overlength biliary stent and a 7-Fr overlength pancreatic stent,modified by an endoscopic nasobiliary drainage tube,were placed in the common bile duct and pancreatic duct,respectively,and the bile and pancreatic juice were drained to the proximal jejunum.RESULTS EP and overlength stents placement were technically feasible in all five patients(63±12 years),with an average operative time of 63.0±5.6 min.Of the five lesions(median size 20 mm,range 15-35 mm),four achieved en bloc excision and curative resection.The final histopathological diagnoses of the endoscopic specimen were one tubular adenoma with high-grade dysplasia(HGD),one tubulovillous adenoma with low-grade dysplasia,one hamartomatous polyp with HGD,one poorly differentiated adenocarcinoma and one atypical juvenile polyposis with tubulovillous adenoma,HGD and field cancerization invading the muscularis mucosae and submucosa.There were no stent-related complications,but one papillectomy-related complication(mild acute pancreatitis)occurred without any episodes of bleeding,perforation,cholangitis or late-onset duct stenosis.CONCLUSION For patients with exposure or injury of the muscularis propria after EP,the placement of overlength biliary and pancreatic stents is a feasible and useful technique to prevent delayed perforation.

各种牙种植体软组织增量技术临床效果的系统评价

目的:评价各种软组织增量技术在牙种植体周软硬组织稳定度等方面随访半年以上的临床效果。方法:计算机检索MEDLINE(Pub-Med)和Cochrane Library(1980-2013),手动检索部分重要英文期刊(2000-2013),并辅以文章追溯,建立该系统评价的纳入标准。由两位研究者主要进行文献筛选、数据提取和质量评价,并对合格文献进行综合描述或Meta分析。结果:初步筛选出文献325篇,纳入26篇。仅唇侧结缔组织移植恢复龈乳头外形、结缔组织移植恢复或保持KMW和腭侧带蒂瓣实现初期创口封闭的相关研究中测量方法和测量指标统一。对此三组数据分析的结果显示,该三种方法均有利软硬组织稳定。结论:现有各种手术方法均能不同程度扩增或维持软/硬组织水平。但是,由于手术方法、测量方法、测量指标不统一,同时受到纳入数量、研究质量的限制,本研究论证强度有待提高,其结果有待大量规范随机对照研究予以论证。讨论:纳入文献以手术目的分组,有利于各技术的比较,便于医生根据问题选择方案。然而,同一技术高质量文献极少,且测量方法多样,测量指标不全面,不利于统计。统一规范的软组织研究方法和测量标准是需要尽快解决的问题。

Endoscopic treatment for pancreatic diseases:Needle-knife-guided cannulation via the minor papilla

AIM: To determine the efficacy and safety of meticulous cannulation by needle-knife.METHODS: Three needle-knife procedures were used to facilitate cannulation in cases when standard cannulation techniques failed. A total of 104 cannulationsvia the minor papilla attempted in 74 patients at our center between January 2008 and June 2014 were retrospectively reviewed.RESULTS: Standard methods were successful in79 cannulations. Of the 25 cannulations that could not be performed by standard methods, 19 were performed by needle-knife, while 17(89.5%) were successful. Needle-knife use improved the success rate of cannulation [76.0%, 79/104 vs 92.3%,(79 +17)/104; P = 0.001]. When the 6 cases not appropriate for needle-knife cannulation were excluded, the success rate was improved further(80.6%, 79/98 vs98.0%, 96/98; P = 0.000). There were no significant differences in the rates of post-endoscopic retrograde cholangiopancreatography adverse events between the group using standard methods alone and the group using needle-knife after failure of standard methods(4.7% vs 10.5%, P = 0.301).CONCLUSION: The needle-knife procedure may be an alternative method for improving the success rate of cannulation via the minor papilla, particularly when standard cannulation has failed.

Simultaneous liver mucinous cystic and intraductal papillary mucinous neoplasms of the bile duct:A case report

Cystic hepatic neoplasms are rare tumors,and are classified into two separate entities:mucinous cystic neoplasms(MCNs)and intraductal papillary mucinous neoplasms of the bile duct(IPMN-B).We report the case of a 56-year-old woman who presented with abdominal pain and jaundice due to the presence of a large hepatic multilocular cystic tumor associated with an intraductal tumor.Partial hepatectomy with resection of extrahepatic bile ducts demonstrated an intrahepatic MCN and an intraductal IPMN-B.This is the first report of the simultaneous occurrence of these two histologically distinct entities in the liver.