Could near focus endoscopy,narrow-band imaging,and acetic acid improve the visualization of microscopic features of stomach mucosa?

BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capillary network,and gastric pits.AIM To evaluate the effectiveness of a new one-dual(near)focus,NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional magnification.METHODS During 2021 and 2022,68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid(AA).The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric mucosa.At the time of the endoscopy,the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy(WLE),near focus(NF),NF-NBI,AA-NF,and AA-NF-NBI modes.RESULTS The WLE,NF and NF-NBI endoscopic modes for all patients(204 images)were classified in the same order into three groups.Two images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same order.According to all three observers who completed the work independently,NF magnification was significantly superior to WLE(P<0.01),and the NF-NBI mode was significantly superior to NF magnification(P<0.01).After applying AA,the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF(P<0.01).Interobserver kappa values for WLE were 0.609,0.704,and 0.598,respectively and were 0.600,0.721,and 0.637,respectively,for NF magnification.For the NF-NBI mode,the values were 0.378,0.471,and 0.553,respectively.For AA-NF,they were 0.453,0.603,and 0.480,respectively,and for AA-NF-NBI,they were 0.643,0.506,and 0.354,respectively.CONCLUSION When investigating gastric mucosa in microscopic detail,NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules,subepithelial capillary network,and gastric pits among the five endoscopic modalities investigated in this study.AA-NF-NBI was the most powerful endoscopic mode for analyzing crypt opening and intervening part.

Microanatomical study of the nutrient artery of the glossopharyngeal nerve root

BACKGROUND： Because the artery leading to the glossopharyngeal nerve is small and complex, insufficient blood supply can occur due to atherosclerosis, occlusion, or injury. This sometimes results in corresponding nerve degeneration, demyelination, and/or arachnoid adhesion. OBJECTIVE： To observe the nutrient artery origin of the glossopharyngeal nerve root in the medulla oblongata region, as well as the relationship between the artery and glossopharyngeal nerve root, to verify dependence of primary glossopharyngeal neuralgia, which is related to contact and compression of the nutrient artery of the glossopharyngeal nerve root. DESIGN, TIME AND SETTING： Repetitive measurement. The experiment was performed at Harbin Medical University and Daqing Oilfields General Hospital between November 2006 and April 2007. MATERIALS： Ten cadaver heads （seven male and three female） were supplied by the Department of Anatomy, Harbin Medical University. A total of 15 patients （nine male and six female）, aged 38-56, that suffered from glossopharyngeal neuralgia were treated at Daqing Oilfields General Hospital and were between 38-56 years old. All cadaver heads were strictly handled according to the Guideline for Medical Ethics Committee. The patients agreed to the criteria set for the study objects. METHODS： （1）The bilateral veins of the nutrient artery were dissected under a surgery microscope. A sliding caliper was used to measure the length of the glossopharyngeal nerve from the oblongata to the jugular foramen. The origin of the nutrient artery was noted, as well as the courser and diameter to explore the relationship between the glossopharyngeal nerve root and the vertebral artery, posterior inferior cerebellar artery, anterior inferior cerebellar artery, as well as the branching veins. （2） A total of 15 patients received glossopharyngeal neuralgia surgery. Contact or oppression of the glossopharyngeal nerve with the posterior inferior cerebellar artery, the anterior inferior cerebellar artery, vertebral artery, and its branches, were evaluated. MAIN OUTCOME MEASURES： The relationship and compression of the glossopharyngeal nerve with the posterior inferior cerebellar artery, anterior inferior cerebellar artery, vertebral artery, and its branches in cadaver sections and the living human body. RESULTS： （1） Cadaver dissection： the nutrient arteries of the glossopharyngeal nerve root originated from three or two branches of the posterior inferior cerebellar artery, anterior inferior cerebellar artery, and dorsolateral medullary artery. During the procedure, four sides of the glossopharyngeal nerve root received contact or compression from the posterior inferior cerebellar artery trunk or thick loop branch. The four sides represented 20% of the area, and the two sides that received glossopharyngeal nerve root contact or compression from the anterior inferior cerebellar artery represented up to 10%. （2） Human living body： during surgery, obvious contact or compression of the glossopharyngeal nerve with three or more branches of the nutrient arteries accounted for 53.3% of the area. CONCLUSION： The cause of a number of primary glossopharyngeal neuralgia is related to contact and pressure of the nutrient artery of the glossopharyngeal nerve root.