Endoscopic management of difficult laterally spreading tumors in colorectum

Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult,including large(>20 mm)laterally spreading tumors(LSTs),has increased in the last decade.All LSTs should be assessed carefully,looking for suspicious areas of submucosal invasion(SMI),such as nodules or depressed areas,describing the morphology according to the Paris classification,the pit pattern,and vascular pattern.The simplest,most appropriate and safest endoscopic treatment with curative intent should be selected.For LST-granular homogeneous type,piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI.LST-nongranular pseudodepressed type has an increased risk of SMI,and en bloc resection should be mandatory.Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field,e.g.,for the resection of scar lesions,with no lifting,adjacent tattoo,incomplete resection attempts,lesions into a colonic diverticulum,in ileocecal valve and lesions with intra-appendicular involvement.Endoscopic full thickness resection is very useful for the treatment of difficult to resect lesions of less than 20 up to 25 mm.Among the indications,we highlight the treatment of polyps with suspected malignancy because the acquired tissue allows an exact histologic risk stratification to assign patients individually to the best treatment and avoid surgery for low-risk lesions.Endoscopic submucosal dissection is the only endoscopic procedure that allows completes en bloc resection regardless of the size of the lesion.It should therefore be indicated in the treatment of lesions with risk of SMI.

Virtual reality simulators for gastrointestinal endoscopy training

The use of simulators as educational tools for medical procedures is spreading rapidly and many efforts have been made for their implementation in gastrointestinal endoscopy training. Endoscopy simulation training has been suggested for ascertaining patient safety while positively influencing the trainees' learning curve. Virtual simulators are the most promising tool among all available types of simulators. These integrated modalities offer a human-like endoscopy experience by combining virtual images of the gastrointestinal tract and haptic realism with using a customized endoscope. From their first steps in the 1980s until today, research involving virtual endoscopic simulators can be divided in two categories: investigation of the impact of virtual simulator training in acquiring endoscopy skills and measuring competence. Emphasis should also be given to the financial impact of their implementation in endoscopy, including the cost of these state-of-theart simulators and the potential economic benefits from their usage. Advances in technology will contribute to the upgrade of existing models and the development of new ones; while further research should be carried out to discover new fields of application.

Endoscopic ultrasound guided fine needle tissue acquisition:Where we stand in 2013?

Since its introduction,endoscopic ultrasound(EUS)guided fine needle aspiration and fine needle biopsy have become an indispensable tool for the diagnosis of lesions within the gastrointestinal tract and surrounding organs.It has proved to be an effective diagnostic method with high accuracy and low complication rates.Several factors can influence the accuracy and the diagnostic yield of this procedure including experience of the endosonographer,availability of onsite cytopathology services,the method of cytopathology preparation,the location and physical characteristics of the lesion,sampling techniques and the type and size of the needle used.In this review we will outline the recent studies evaluating EUS-guided tissue acquisition and will provide practical recommendations to maximize tissue yield.

How to establish endoscopic submucosal dissection in Western countries

Endoscopic submucosal dissection(ESD) has been invented in Japan to provide resection for cure of early cancer in the gastrointestinal tract. Professional level of ESD requires excellent staging of early neoplasias with image enhanced endoscopy(IEE) to make correct indications for ESD,and high skills in endoscopic electrosurgical dissection. In Japan,endodiagnostic and endosurgical excellence spread through personal tutoring of skilled endoscopists by the inventors and experts in IEE and ESD. To translocate this expertise to other continents must overcome two fundamental obstacles:(1) inadequate expectations as to the complexity of IEE and ESD; and(2) lack of suitable lesions and master-mentors for ESD trainees. Leading endoscopic mucosal resection-proficient endoscopists must pioneer themselves through the long learning curve to proficient ESD experts. Major referral centers for ESD must arise in Western countries on comparable professional level as in Japan. In the second stage,the upcoming Western experts must commit themselves to teach skilled endoscopists from other referral centers,in order to spread ESD in Western countries. Respect for patients with early gastrointestinal cancer asks for best efforts to learn endoscopic categorization of early neoplasias and skills for ESD based on sustained cooperation with the masters in Japan. The strategy is discussed here.

Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images

AIM:To compare the diagnostic yield of heterotopic gastric mucosa(HGM)in the cervical esophagus with conventional imaging(CI)and narrow-band imaging(NBI).METHODS:A prospective study with a total of 760patients receiving a CI examination(mean age 51.6years;47.8%male)and 760 patients undergoing NBI examination(mean age 51.2 years;45.9%male).The size of HGM was classified as small(1-5 mm),medium(6-10 mm),or large(>1 cm).A standardized questionnaire was used to obtain demographic characteristics,social habits,and symptoms likely to be related to cervical esophageal HGM,including throat symptoms(globus sensation,hoarseness,sore throat,and cough)and upper esophageal symptoms(dysphagia and odynophagia)at least 3 mo in duration.The clinicopathological classification of cervical esophageal HGM was performed using the proposal by von Rahden et al.RESULTS:Cervical esophageal HGM was found in 36of 760(4.7%)and 63 of 760(8.3%)patients in the CI and NBI groups,respectively(P=0.007).The NBI mode discovered significantly more small-sized HGM than CI(55%vs 17%;P<0.0001).For the 99 patients with cervical esophageal HGM,biopsies were performed in 56 patients;37(66%)had fundic-type gastric mucosa,and 19 had antral-type mucosa.For the clinicopathological classification,77 patients(78%)were classified as HGMⅠ(asymptomatic carriers);21 as HGMⅡ(symptomatic without morphologic changes);and one as HGMⅢ(symptomatic with morphologic change).No intraepithelial neoplasia or adenocarcinoma was found.CONCLUSION:NBI endoscopy detects more cervical esophageal HGM than CI does.Fundic-type gastric mucosa constitutes the most common histology.One-fifth of patients have throat or dysphagic symptoms.

Transanal endoscopic surgery in rectal cancer

Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond(T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentageof infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present.

A study of RNA-editing in Populus trichocarpa nuclei revealed acquisition of RNA-editing on the endosymbiont-derived genes,and a preference for intracellular remodeling genes in adaptation to endosymbiosis

RNA-editing is a post-transcriptional modification that can diversify genome-encoded information by modifying individual RNA bases.In contrast to the well-studied RNA-editing in organelles,little is known about nuclear RNA-editing in higher plants.We performed a genome-wide study of RNA-editing in Populus trichocarpa nuclei using the RNA-seq data generated from the sequenced poplar genotype,‘Nisqually-1’.A total of 24,653 nuclear RNA-editing sites present in 8,603 transcripts were identified.Notably,RNA-editing in P.trichocarpa nuclei tended to occur on endosymbiont-derived genes.We then scrutinized RNA-editing in a cyanobacterial strain closely related to chloroplast.No RNA-editing sites were identified therein,implying that RNA-editing of these endosymbiont-derived genes was acquired after endosymbiosis.Gene ontology enrichment analysis of all the edited genes in P.trichocarpa nuclei demonstrated that nuclear RNA-editing was primarily focused on genes involved in intracellular remodeling processes,which suggests that RNA-editing plays contributing roles in organellar establishment during endosymbiosis.We built a coexpression network using all C-to-U edited genes and then decomposed it to obtain 18 clusters,six of which contained a conserved core motif,A/G-C-A/G.Such a short core motif not only attracted the RNA-editing machinery but also enabled large numbers of sites to be targeted though further study is necessary to verify this finding.

Practice of Endo-Urology in the Centre of Ivory Coast: Overview and Results

Background: Endoscopic exploration and treatment of urinary tract disorders, whether by retrograde, percutaneous or endoscopic approach, defines endo urology. Objective: To report the results of endo urology practice in Bouaké during the two practice sessions. Patients and Methods: Cross-sectional and descriptive study of patients followed up and had benefited from exploration and/or endoscopic surgery in Bouaké. Our study was carried out in a facility in Bouaké, for two years, from January 2021 to December 2022. The parameters of interest were clinical, diagnostic, endoscopic procedure and results. Results: During the study period, 157 patients underwent endoscopic exploration and/or intervention. The mean age was 58.9 years (range 28 - 90 years). Males predominated with 95.5% (n = 150). Acute urinary retention was the most frequent reason for consultation (55.41%). Benign prostatic hyperplasia (BPH) was the most frequent pathology at 22.92% (n = 36). Urethrocystoscopy was performed in 52 cases (33.12%), Transurethral resection of the prostate (TURP) in 36 cases (22.92%), Endoscopic resection of secondary cervical sclerosis in 23 cases (14.64%), Endoscopic internal urethrotomy (EUI) in 15 cases (9.55%) and Transurethral resection of the bladder (TURB) in 10 cases (6.36%). Post-operative management was straightforward in 93.63% of cases (n = 147). Operative times of between 21 and 35 minutes were more frequent in 55.41% of cases (n = 87). Urinary tract infections accounted for 3.8% (n = 6) of surgical morbidity. The germ responsible for the infections was essentially Escherichia coli (E. coli). The mean duration of post-operative urinary drainage was 5.5 days (range: 4 - 6 days) for patients who underwent TURP, TURB and endoscopic resection of secondary sclerosis of the bladder neck. The mean duration of drainage after endoscopic internal ureterotomy was 21.6 days (range 14 - 30 days). Of the 157 endoscopies performed, 154 patients (98.08%) had a favourable outcome, with adenomyofibroma of the prostate being the most common histological type (52.17%, n = 36). Mortality was 1.27% (n = 2) in our series. Conclusion: Endo urology should be the urologist’s first choice for both exploration and surgery, given the satisfactory results.

endo-button系统关节镜下重建膝关节交叉韧带的应用探讨

目的探讨利用endo—button系统配合可吸收界面螺钉固定自体或异体肌腱重建膝关节前、后交叉韧带的临床效果。方法关节镜下利用自体肌腱或异体胫前肌腱辅以endo—button系统治疗45例膝关节交叉韧带损伤患者。结果所有患者随访0．5—4．5年（平均2．4年），按lysholm膝关节功能评分与Tegner膝关节运动评分标准，术前前交叉韧带损伤患者平均为52．7分（lysholm）、2．6分（Tegner），术后为78．6分（lysholm）、5．7分（Tegner）；后交叉韧带损伤患者术前平均57．6分（lysholm），3．1分（Tegner），术后79．4分（lysholm），5．4分（Tegner）。结论自体半腱肌、股薄肌与同种异体胫前肌腱重建膝关节前、后交叉韧带强度好，植入后以endo—button系统固定牢靠，术后并发症少。

uPARAP、MMP_9、VEGF在鼻咽癌中的表达及其意义

目的探讨尿激酶型纤溶酶原激活剂相关蛋白(uPAR-associated protein,uPARAP)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP9)和血管内皮生长因子(vascular endothelial growth factor,VEGF)在鼻咽癌组织中的表达及其相关性。方法采用免疫组化SP技术检测58例鼻咽癌组织和30例慢性鼻咽炎组织中uPARAP、MMP9和VEGF蛋白的表达,分析其与鼻咽癌临床病理特征及预后的关系。结果鼻咽癌组织中uPARAP、MMP9和VEGF的阳性表达率分别为75.9%(44/58)、60.3%(35/58)和77.6%(45/58);与慢性鼻咽炎比较,uPARAP、MMP9和VEGF在鼻咽癌中的阳性表达显著增高(P<0.05)。结论uPARAP、MMP9和VEGF在鼻咽癌组织中协同表达对促进鼻咽癌的扩散转移可能起重要作用,联合检测这些指标有望成为判断鼻咽癌恶性程度和估计患者预后的重要生物学标志。

经腹腔镜子宫切除术

作者结合25例的腹腔镜子宫手术工作实践,重点介绍腹腔镜子宫切除术的手术技巧和常用的设备,并闸述腹腔镜全子宫切除的适应征。

旋转铰链膝关节置换术治疗严重畸形膝关节病变近期效果

目的探讨初次旋转铰链膝关节置换术治疗严重畸形的膝关节病变的近期疗效。方法采用Endo-Model旋转铰链假体行初次膝关节置换患者30例(30膝),比较手术前后X线片、KSS临床及功能评分、膝关节活动范围以及屈曲角度。结果患者手术时间平均(85.0±14.2)min。无一例发生感染、血栓、神经血管损伤等并发症。所有患者均获得随访,随访时间18～48个月,平均33个月。膝关节活动范围、屈曲角度、KSS临床和功能评分均大于术前(P<0.01)。术后膝关节胫股关节对线及髌股关节对线较术前改善,差异有统计学意义(P<0.01)。9例(30%)膝前痛患者髌骨轴位片显示髌骨有移位或倾斜。结论 Endo-Model旋转铰链膝关节假体早期效果满意,是手术治疗膝关节严重畸形病变的一个良好选择,但应重视髌股关节并发症的发生。

Interesting rendezvous location in a liver transplantation patient with anastomosis stricture

An endoscopic or radiologic percutaneous approach may be an initial minimally invasive method for treating biliary strictures after living donor liver transplantation; however, cannulation of biliary strictures is sometimes difficult due to the presence of a sharp or twisted angle within the stricture or a complete stricture. When an angulated or twisted biliary stricture interrupts passage of a guidewire over the stricture, it is difficult to replace the percutaneous biliary drainage catheter with inside stents by endoscopic retrograde cholangiopancreatography. The rendezvous technique can be used to overcome this difficulty. In addition to the classical rendezvous method, in cases with complete transection of the common bile duct a modified technique involving the insertion of a snare into the subhepatic space has been successfully performed. Herein, we report a modified rendezvous technique in the duodenal bulb as an extraordinary location for a patient with duct-to-duct anastomotic complete stricture after liver transplantation.

安道什猜想推广的全相等正奇数的问题(英文)

本文研究了安道什猜想推广问题并给出了它的全相等正奇数解的公式

电针对缺血再灌注大鼠海马区凋亡诱导因子及核酸内切酶G表达的影响

目的:观察电针对缺血再灌注大鼠海马区凋亡诱导因子(AIF)及核酸内切酶G(Endo G)表达的影响。方法:SPF级健康成年雄性大鼠随机分为模型组、假手术组、针刺1d组和针刺7d组,除假手术组外,其余各组大鼠建立缺血再灌注模型。造模成功后针刺组针刺大鼠水沟、内关穴,并使用电针仪刺激。针刺等处理完成后各组大鼠断头处死取材,运用TTC染色技术观察脑梗死体积百分比,运用western blot技术观察AIF和Endo G的蛋白表达。结果:缺血再灌注后,模型组、针刺1d组、针刺7d组大鼠脑组织内AIF及Endo G的表达均较假手术组明显升高(P<0.01);针刺1d组、针刺7d组大鼠脑组织内AIF和Endo G的表达较模型组明显降低(P<0.01),其中针刺7d组上述指标又明显低于针刺1d组(P<0.05)。结论 :电针能够有效降低脑梗死大鼠海马区AIF及Endo G蛋白的表达,且效果与治疗次数呈正相关。

1,3-环己二烯与丙烯反应exo和endo机理的理论研究

采用从头算方法在3-21G基组上研究了1,3-环己二烯与丙烯生成exo和endo产物的反应机理.该反应生成exo和endo产物各存在三条反应途径,其中两条为分步途径,一条为协同途径.经计算研究表明:1,3-环己二烯与丙烯生成exo和endo产物的有利途径为经过一个双自由基中间体的分步过程,由丙烯端位碳原子先进攻的分步过程最为容易.对应于该过程,生成exo和endo产物的反应速控步骤的位垒值分别为80.69kJ/mol和75.58kJ/mol.表明生成endo产物的反应比生成exo产物的反应略为有利.

1,3环己二烯与丙腈D-A反应机理研究

采用从头算方法在３－２１Ｇ基组上，对１，３环己二烯与丙腈ｄｉｅｌｓ－Ａｌｄｅｒ反应所有可能的反应通道进行了研究。该反应生成的ｅｘｏ和ｅｎｄｏ两种产物，它们各自存在两条分步途径和一条协同途径，共６条反应通道。计算研究表明，无论生成ｅｘｏ还是ｅｎｄｏ产物，最有利的途径为由丙腈的端位碳原子先进攻环上碳原子的分步过程。其生成两种产物的反应速控步骤的位垒分别为５０．１７和５０．６７ｋＪ／ｍｏｌ。表明ｅｘｏ和ｅｎｄｏ产物竟争生成。

基于Petri网的基因调控网络建模与分析

如何有效描述与分析复杂的基因调控网络(GRN)是生物学家研究基因表达调控机制的关键步骤.现有大部分方法在建模过程中忽略了生物中广泛存在的协同作用,模型预测结果与实际生物行为之间存在误差.基于混合函数Petri网(HFPN)理论提出了一种对基因调控网络进行定量分析的新方法.首先简要介绍GRN与HFPN的基础理论,然后为HFPN引入两类新元素:逻辑库所与逻辑变迁,描述基因调控网络的逻辑规则以及转录因子间的协同作用,最后构建海胆endo16基因调控网络的Petri网模型,并预测模型在不同位点发生突变时的基因表达水平变化.分析结果与文献实验数据相一致,验证了方法的正确性.