AIM:To evaluate efficacy and safety of clip-and-snare method using pre-looping technique(CSM-PLT)for gastric endoscopic submucosal dissection(ESD).METHODS:In the CSM-PLT method,a clip attached to the lesion side was s...AIM:To evaluate efficacy and safety of clip-and-snare method using pre-looping technique(CSM-PLT)for gastric endoscopic submucosal dissection(ESD).METHODS:In the CSM-PLT method,a clip attached to the lesion side was strangulated with a snare,followed by application of an appropriate tension to the lesion independent of an endoscope.Twenty consecutive lesions were resected by ESD using CSM-PLT(CSM-PLT group)and compared with a control group,including20 lesions that were resected by conventional ESD.The control group was matched based on the size and location of the lesion,presence of pathologic fibrosis,and experience of endoscopists.Total procedure time of ESD,proportion of en bloc resection,and complications were analyzed.RESULTS:The total procedure time for the CSM-PLT group was significantly shorter than that for the control group(38.5 min vs 59.5 min,P=0.023);all lesions were resected en bloc by ESD.There was no significant difference in complications between the two groups.Moreover,there was no complication in the CSM-PLT group.In one large lesion(size:74 mm)that underwentextensive CSM-PLT during ESD,we used an additional CSM-PLT on another edge of the lesion after achieving submucosal resection to the maximum extent possible during initial CSM-PLT.In two lesions,the snare came off the lesion together with the clip after a sudden pull;nevertheless,ESD was successful in all lesions.CONCLUSION:CSM-PLT was an effective and safe method for gastric ESD.展开更多
目的分离体外培养的结核分枝杆菌分泌的膜囊泡，检测其形态和粒径分布，初步探索结核分枝杆菌膜囊泡对巨噬细胞中细胞因子释放的作用。方法采用结核分枝杆菌实验室标准菌株H37Rv，通过7H9培养基复苏、扩大培养标准株H37Rv至对数生长期...目的分离体外培养的结核分枝杆菌分泌的膜囊泡，检测其形态和粒径分布，初步探索结核分枝杆菌膜囊泡对巨噬细胞中细胞因子释放的作用。方法采用结核分枝杆菌实验室标准菌株H37Rv，通过7H9培养基复苏、扩大培养标准株H37Rv至对数生长期，菌体全部接种于苏通培养基中继续培养3周，离心取上清，超滤浓缩结合超速离心分离提取结核分枝杆菌H37Rv膜囊泡，通过透射电镜观察膜囊泡的大小、形态，采用纳米颗粒跟踪仪分析膜囊泡的粒径及分布。同时，设置不处理对照组、H37Rv感染组[按照感染复数（multiplicity of infection，MOI）=20：1]和H37Rv膜囊泡处理组（按照膜囊泡：细胞=100：1）处理佛波酯（50ng／ml）诱导贴壁的单核巨噬细胞（THP-1）4h，更换新鲜培养基后0h、4h、8h、24h收集细胞培养上清，采用Milliplex多细胞因子检测试剂盒检测细胞因子的释放情况，通过曼-惠特尼U（Mann-WhitneyU）检验对各时间点H37Rv膜囊泡处理组和不处理对照组之间肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、白细胞介素1β（IL-1β）、白细胞介素10（IL-10）释放量进行比较，以P〈0．05为差异有统计学意义。结果按照调整后的提取方法得到的提取物中可检测到H37Rv分泌的膜囊泡，平均粒径为137nm，主要分布在30～510nm之间，〈250nm的膜囊泡数量占总量的96．88％。4h、8h和24h的TNF-α、ID6和IL-1β释放量与不处理对照组[分别为348．19（333．99，360．47）pg／ml、412．38（406．67，418．79）pg／ml、324．44（316．11，331．14）pg／ml；3．01（2．81，3．02）pg／ml、5．40（5．26，5．83）pg／ml、13．22（11．80，13．77）pg／ml；118．92（113．97，122．47）pg／ml、132．33（125．87，137．62）pg／ml、169．31（167．75，172．49）pg／ml]相比，H37Rv膜囊泡处理组[分别为507．33（501．80，513．84）pg／ml、4483．00（4130．75，4522．50）pg／ml、8170．00（8058．25，8206．75）pg／ml；12．88（12．04，13．84）pg／ml、68．51（66．88，69．77）pg／ml、335．44（331．02，340．64）pg／ml；800．57（791．18，809．60）pg／ml、1559．00（1546．00，1566．00）pg／ml、4316．50（4094．75，4389．75）pg／ml]均明显增加，差异均有统计学意义（u值均〈0．001，P值均〈0．01）；但4h、8h和24h的ID-10释放量[不处理对照组分别为1．23（1．21，1．31）pg／ml、1.56（1．31，1．82）pg／ml、5．41（4．99，5．89）pg／ml；H37Rv膜囊泡处理组分别为4．56（4．49，4．82）pg／ml、1．43（1．28，1．89）pg／ml、1．56（1．48，1．68）pg／ml]差异均无统计学意义（U值分别为6．00、17.00、7．00，P值分别为0．065、0．898和0．087）。结论本研究建立了结核分枝杆菌膜囊泡分离提取的技术流程，可以得到纯度较好、形态完整、粒径正常的膜囊泡。同时，结核分枝杆菌膜囊泡可以诱发巨噬细胞中细胞因子TNF-α、IL-6和IL-1β的释放。展开更多
We report a case of an infant with Menkes' disease(MD) presented at the age of five months,with coffee ground vomiting,melaena with a significant drop of haemoglobin.Urgent endoscopic assessment revealed a friable...We report a case of an infant with Menkes' disease(MD) presented at the age of five months,with coffee ground vomiting,melaena with a significant drop of haemoglobin.Urgent endoscopic assessment revealed a friable bleeding trans-pyloric multi-lobulated sessile polyp.Due to further significant upper gastrointestinal bleeding,polypectomy occurred.Endoscopic mucosal resection was performed with a grasp-and-snare technique using a dual channel operating gastroscope.Haemostasis was achieved by application of argon plasma coagulation where required.No perforation occurred.Repeated debridement was required 6 wk after which the growth was excised completely with no further blood transfusion required after that procedure.Histological examination confirmed ulcerated and inflamed hyperplastic polyp.We discuss our endoscopic technique and discuss the reported gastrointestinal manifestation of MD in the literature.展开更多
文摘AIM:To evaluate efficacy and safety of clip-and-snare method using pre-looping technique(CSM-PLT)for gastric endoscopic submucosal dissection(ESD).METHODS:In the CSM-PLT method,a clip attached to the lesion side was strangulated with a snare,followed by application of an appropriate tension to the lesion independent of an endoscope.Twenty consecutive lesions were resected by ESD using CSM-PLT(CSM-PLT group)and compared with a control group,including20 lesions that were resected by conventional ESD.The control group was matched based on the size and location of the lesion,presence of pathologic fibrosis,and experience of endoscopists.Total procedure time of ESD,proportion of en bloc resection,and complications were analyzed.RESULTS:The total procedure time for the CSM-PLT group was significantly shorter than that for the control group(38.5 min vs 59.5 min,P=0.023);all lesions were resected en bloc by ESD.There was no significant difference in complications between the two groups.Moreover,there was no complication in the CSM-PLT group.In one large lesion(size:74 mm)that underwentextensive CSM-PLT during ESD,we used an additional CSM-PLT on another edge of the lesion after achieving submucosal resection to the maximum extent possible during initial CSM-PLT.In two lesions,the snare came off the lesion together with the clip after a sudden pull;nevertheless,ESD was successful in all lesions.CONCLUSION:CSM-PLT was an effective and safe method for gastric ESD.
文摘目的分离体外培养的结核分枝杆菌分泌的膜囊泡，检测其形态和粒径分布，初步探索结核分枝杆菌膜囊泡对巨噬细胞中细胞因子释放的作用。方法采用结核分枝杆菌实验室标准菌株H37Rv，通过7H9培养基复苏、扩大培养标准株H37Rv至对数生长期，菌体全部接种于苏通培养基中继续培养3周，离心取上清，超滤浓缩结合超速离心分离提取结核分枝杆菌H37Rv膜囊泡，通过透射电镜观察膜囊泡的大小、形态，采用纳米颗粒跟踪仪分析膜囊泡的粒径及分布。同时，设置不处理对照组、H37Rv感染组[按照感染复数（multiplicity of infection，MOI）=20：1]和H37Rv膜囊泡处理组（按照膜囊泡：细胞=100：1）处理佛波酯（50ng／ml）诱导贴壁的单核巨噬细胞（THP-1）4h，更换新鲜培养基后0h、4h、8h、24h收集细胞培养上清，采用Milliplex多细胞因子检测试剂盒检测细胞因子的释放情况，通过曼-惠特尼U（Mann-WhitneyU）检验对各时间点H37Rv膜囊泡处理组和不处理对照组之间肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、白细胞介素1β（IL-1β）、白细胞介素10（IL-10）释放量进行比较，以P〈0．05为差异有统计学意义。结果按照调整后的提取方法得到的提取物中可检测到H37Rv分泌的膜囊泡，平均粒径为137nm，主要分布在30～510nm之间，〈250nm的膜囊泡数量占总量的96．88％。4h、8h和24h的TNF-α、ID6和IL-1β释放量与不处理对照组[分别为348．19（333．99，360．47）pg／ml、412．38（406．67，418．79）pg／ml、324．44（316．11，331．14）pg／ml；3．01（2．81，3．02）pg／ml、5．40（5．26，5．83）pg／ml、13．22（11．80，13．77）pg／ml；118．92（113．97，122．47）pg／ml、132．33（125．87，137．62）pg／ml、169．31（167．75，172．49）pg／ml]相比，H37Rv膜囊泡处理组[分别为507．33（501．80，513．84）pg／ml、4483．00（4130．75，4522．50）pg／ml、8170．00（8058．25，8206．75）pg／ml；12．88（12．04，13．84）pg／ml、68．51（66．88，69．77）pg／ml、335．44（331．02，340．64）pg／ml；800．57（791．18，809．60）pg／ml、1559．00（1546．00，1566．00）pg／ml、4316．50（4094．75，4389．75）pg／ml]均明显增加，差异均有统计学意义（u值均〈0．001，P值均〈0．01）；但4h、8h和24h的ID-10释放量[不处理对照组分别为1．23（1．21，1．31）pg／ml、1.56（1．31，1．82）pg／ml、5．41（4．99，5．89）pg／ml；H37Rv膜囊泡处理组分别为4．56（4．49，4．82）pg／ml、1．43（1．28，1．89）pg／ml、1．56（1．48，1．68）pg／ml]差异均无统计学意义（U值分别为6．00、17.00、7．00，P值分别为0．065、0．898和0．087）。结论本研究建立了结核分枝杆菌膜囊泡分离提取的技术流程，可以得到纯度较好、形态完整、粒径正常的膜囊泡。同时，结核分枝杆菌膜囊泡可以诱发巨噬细胞中细胞因子TNF-α、IL-6和IL-1β的释放。
文摘We report a case of an infant with Menkes' disease(MD) presented at the age of five months,with coffee ground vomiting,melaena with a significant drop of haemoglobin.Urgent endoscopic assessment revealed a friable bleeding trans-pyloric multi-lobulated sessile polyp.Due to further significant upper gastrointestinal bleeding,polypectomy occurred.Endoscopic mucosal resection was performed with a grasp-and-snare technique using a dual channel operating gastroscope.Haemostasis was achieved by application of argon plasma coagulation where required.No perforation occurred.Repeated debridement was required 6 wk after which the growth was excised completely with no further blood transfusion required after that procedure.Histological examination confirmed ulcerated and inflamed hyperplastic polyp.We discuss our endoscopic technique and discuss the reported gastrointestinal manifestation of MD in the literature.
