Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by t...Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by the Food and Drug Administration for treatment of gastroparesis is metoclopramide, although other agents are frequently used off label. With this caveat, first-line treatments for gastroparesis include dietary modifications, antiemetics and promotility agents, although these therapies are limited by suboptimal efficacy and significant medication side effects. Treatment of patients that fail first-line treatments represents a significant therapeutic challenge. Recent advances in endoscopic techniques have led to the development of a promising novel endoscopic therapy for gastroparesis via endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy or per-oral endoscopic pyloromyotomy. The aim of this article is to review the technical aspects of the per-oral endoscopic myotomy procedure for the treatment of gastroparesis, provide an overview of the currently published literature, and outline potential next directions for the field.展开更多
Grain number per-panicle is one of the most important components for rice yield. Spikelets on the primary and secondary branches determine the grain number per-panicle in rice. In this study, we identified a natural m...Grain number per-panicle is one of the most important components for rice yield. Spikelets on the primary and secondary branches determine the grain number per-panicle in rice. In this study, we identified a natural mutant, gnp4, lack of lateral spikelet on the secondary branches in the field condition. In addition, the Gnp4 and Lax1-1 double mutant showed dramatically reduced secondary branches and spikelets in panicle at reproductive stage, and tillers at vegetative stage. By map-based cloning approach, and using four F2 segregating populations, the Gnp4 gene was finally mapped to a 10.7-kb region on the long arm of chromosome 4 in rice. In this region, only one gene was predicted, and genomic DNA sequencing of the 10.7-kb region showed no nucleotide differences between the mutant and wild type. Interestingly, we found that the methylation level of several cytosines in the promoter CpG islands region of the predicted gene in gnp4 were different from the wild type. Thus, we propose that the DNA methylation changes at these sites may induce to decrease expression level of Gnp4, consequently, resulting in phenotypic variation.展开更多
Background: Post-partum haemorrhage is the leading cause of maternal death throughout the world, and anaemia is one of its indirect causes. Anaemia during labour increases the risk of PPH and may lead to maternal mort...Background: Post-partum haemorrhage is the leading cause of maternal death throughout the world, and anaemia is one of its indirect causes. Anaemia during labour increases the risk of PPH and may lead to maternal mortality even after moderate PPH. Undiagnosed PPH and post-partum anaemia increases the risk of late maternal death in the community. The aim of this study was to assess the prevalence of anaemia on admission for labour, the occult early post-partum haemorrhage and the magnitude of post-partum anaemia in a low resource setting. Methods: This was a longitudinal study. We included pregnant women in labour. Haemoglobin concentration was measured on admission (H0), then 24 hours (H24) and 48 (H48) hours later. The post-partum blood loss was estimated by delta haemoglobin, using the criteria of M. Driessen et al. Results: We recruited 245 pregnant women. The mean age was 27.0 ± 6.0 years. The mean hemoglobin concentration was 11.7 ± 1.9 g/dl, the frequency of anaemia was 30.6% and was related to ethnicity (P = 0.042) gestational age (p < 0.001) marital status (p = 0.014) and the inter pregnancy time space (p = 0.001). Twenty-two-point two percent had post-partum haemorrhage among which 40% were undiagnosed. The mean blood loss was 375 ml and post-partum anaemia rate was 44.5%. Conclusion: Anaemia on admission was related to socio-demographic characteristics. The frequencies of anaemia during labour, missed PPH and undiagnosed post-partum anaemia were high. Haemoglobin concentration on admission for labour and after delivery, reliable method to assess PPH should be mandatory, to better identify per and post-partum anemia, and the management of PPH, in low income environments.展开更多
Per-oral endoscopic myotomy(POEM)represents a natural orifice endoscopic surgery(NOTES)approach to laparoscopy Heller myotomy(LHM).POEM is arguably the most successful clinical application of NOTES.The growth of POEM ...Per-oral endoscopic myotomy(POEM)represents a natural orifice endoscopic surgery(NOTES)approach to laparoscopy Heller myotomy(LHM).POEM is arguably the most successful clinical application of NOTES.The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM.Initial efficacy,safety and acid reflux data suggest at least equivalence of POEM to LHM,the previous gold standard for achalasia therapy.Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM.The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis.展开更多
文摘Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by the Food and Drug Administration for treatment of gastroparesis is metoclopramide, although other agents are frequently used off label. With this caveat, first-line treatments for gastroparesis include dietary modifications, antiemetics and promotility agents, although these therapies are limited by suboptimal efficacy and significant medication side effects. Treatment of patients that fail first-line treatments represents a significant therapeutic challenge. Recent advances in endoscopic techniques have led to the development of a promising novel endoscopic therapy for gastroparesis via endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy or per-oral endoscopic pyloromyotomy. The aim of this article is to review the technical aspects of the per-oral endoscopic myotomy procedure for the treatment of gastroparesis, provide an overview of the currently published literature, and outline potential next directions for the field.
基金funded by the Project of the 973 Program(2010CB125904)the 948 Program (2011-G2B)+1 种基金the National Natural Science Foundation of China(31171521)the National Key Technology R&D Program of China (2009BADA2B01)
文摘Grain number per-panicle is one of the most important components for rice yield. Spikelets on the primary and secondary branches determine the grain number per-panicle in rice. In this study, we identified a natural mutant, gnp4, lack of lateral spikelet on the secondary branches in the field condition. In addition, the Gnp4 and Lax1-1 double mutant showed dramatically reduced secondary branches and spikelets in panicle at reproductive stage, and tillers at vegetative stage. By map-based cloning approach, and using four F2 segregating populations, the Gnp4 gene was finally mapped to a 10.7-kb region on the long arm of chromosome 4 in rice. In this region, only one gene was predicted, and genomic DNA sequencing of the 10.7-kb region showed no nucleotide differences between the mutant and wild type. Interestingly, we found that the methylation level of several cytosines in the promoter CpG islands region of the predicted gene in gnp4 were different from the wild type. Thus, we propose that the DNA methylation changes at these sites may induce to decrease expression level of Gnp4, consequently, resulting in phenotypic variation.
文摘Background: Post-partum haemorrhage is the leading cause of maternal death throughout the world, and anaemia is one of its indirect causes. Anaemia during labour increases the risk of PPH and may lead to maternal mortality even after moderate PPH. Undiagnosed PPH and post-partum anaemia increases the risk of late maternal death in the community. The aim of this study was to assess the prevalence of anaemia on admission for labour, the occult early post-partum haemorrhage and the magnitude of post-partum anaemia in a low resource setting. Methods: This was a longitudinal study. We included pregnant women in labour. Haemoglobin concentration was measured on admission (H0), then 24 hours (H24) and 48 (H48) hours later. The post-partum blood loss was estimated by delta haemoglobin, using the criteria of M. Driessen et al. Results: We recruited 245 pregnant women. The mean age was 27.0 ± 6.0 years. The mean hemoglobin concentration was 11.7 ± 1.9 g/dl, the frequency of anaemia was 30.6% and was related to ethnicity (P = 0.042) gestational age (p < 0.001) marital status (p = 0.014) and the inter pregnancy time space (p = 0.001). Twenty-two-point two percent had post-partum haemorrhage among which 40% were undiagnosed. The mean blood loss was 375 ml and post-partum anaemia rate was 44.5%. Conclusion: Anaemia on admission was related to socio-demographic characteristics. The frequencies of anaemia during labour, missed PPH and undiagnosed post-partum anaemia were high. Haemoglobin concentration on admission for labour and after delivery, reliable method to assess PPH should be mandatory, to better identify per and post-partum anemia, and the management of PPH, in low income environments.
文摘Per-oral endoscopic myotomy(POEM)represents a natural orifice endoscopic surgery(NOTES)approach to laparoscopy Heller myotomy(LHM).POEM is arguably the most successful clinical application of NOTES.The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM.Initial efficacy,safety and acid reflux data suggest at least equivalence of POEM to LHM,the previous gold standard for achalasia therapy.Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM.The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis.
