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Endoscopic identification of endoluminal esophageal landmarks for radial and longitudinal orientation and lesion location

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World Journal of Gastroenterology 2019年第4期25卷 498-508页

作者： Fabian Emura Rene Gomez-Esquivel Carlos Rodriguez-Reyes Petros Benias Javier Preciado Michael Wallace Luis Giraldo-Cadavid Division of Gastroenterology Universidad de La Sabana Advanced Gastrointestinal Endoscopy EmuraCenter LatinoAmerica Emura Foundation for the Promotion of Cancer Research Unidad de Endoscopia Digestiva Clínica Pediátrica Colsanitas Division of Digestive Diseases and Nutrition Morsani College of Medicine University of South Florida Division of Gastroenterology North Shore-Long Island Jewish Medical Center Unidad de Exploraciones Digestivas Clinica Universitaria Colombia Department of Gastroenterology and Hepatology Mayo Clinic Department of Internal Medicine. Universidad de La Sabana Division of Interventional Pulmonology Fundacion Neumologica Colombiana

AIM To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion *** Distance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination. A sub-study was also performed using white light followed by endoscopic ultrasound(EUS) in 25 consecutive patients to confirm the *** scope orientation throughout the exam was maintained at the natural axis,where the left esophageal quadrant corresponds to the area between 6 and 9 o'clock. When an anatomical landmark was identified, it was recorded with a photograph and its quadrant orientation and distance from the incisors were determined. The reference points to obtain the distances and radial orientation were as follows: the midpoint of the left main bronchus and the most intense pulsatile zone of the left atrium. With the video processor system set to moderate insufflation, measurements were obtained at the end of the patients' air *** The left main bronchus and left atrium esophageal landmarks were identified using white light in 99% and 100% of subjects at a mean distance of 25.8 cm(SD2.3), and 31.4 cm(SD 2.4) from the incisors, respectively. The left main bronchus landmark was found to be a tubular, concave, non-pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. The left atrium landmark was identified as a round, convex, pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. Both landmarks were identified using white light on the anterior esophageal quadrant. In the substudy, the left main bronchus was identified in 24(92%) patients at 25.4 cm(SD2.1) and 26.7 cm(SD 1.9) from the incisors, by white light and EUS, *** left atrium was recognized in all patients at 30.5 cm(SD 1.9), and 31.6 cm(SD2.3) from the incisors, by b

关键词： Esophagus Natural landmark Radial orientation Longitudinal orientation Four-quadrants Left main bronchus Left atrium

Beneficial Applications and Deleterious Effects of Near-Infrared from Biological and Medical Perspectives

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Optics and Photonics Journal 2013年第4期3卷 31-39页

作者： Yohei Tanaka Lisa Gale clinica Tanaka Plastic Reconstructive Surgery and Anti-Aging Center Matsumoto Japan

Over half of solar energy consists of near-infrared and a wide range of preventative mechanisms have been evolutionarily maintained in organisms to protect against effects of near-infrared. However, the biological effects of near-infrared have not been investigated in detail. Despite the essential requirement of a water-filter to imitate solar near-infrared filtered by atmospheric water, previous studies used near-infrared resources without a water-filter or a cooling system. With these methods, near-infrared energy is primarily absorbed in the superficial tissues, thus these approaches are unable to sufficiently evaluate the biological effects of solar near-infrared that reaches human tissue. We have elucidated that near-infrared (1100 - 1800 nm together with a water-filter that excludes wavelengths 1400 - 1500 nm) non-thermally affects the skin into the deeper tissues. The biological effects of near-infrared have both beneficial applications and deleterious effects. Near-infrared induces collagen and elastin stimulation, which achieves skin rejuvenation and skin tightening, and induces long-lasting vasodilation that may prevent vasospasm and be beneficial for ischemic disorders. Near-infrared also relaxes and weakens dystonic and hypertrophic muscles to reduce wrinkles and myalgia. Nearinfrared is an essential tool in cancer detection and imaging, and induces drastic non-thermal DNA damage of mitotic cells, which may be beneficial for treating cancer. Activation of stem cells by near-infrared may be useful in regenerative medicine. However, continuous near-infrared exposure induces photoaging and potentially photocarcinogenesis. Humans have protective mechanisms against near-infrared on multiple levels, including perspiration, blisters, vasodilation, hair, skin, adipose tissue, and cotton or wool clothing. Further protection should be considered, as biological effects of near-infrared are significant, and standard sunscreens and glasses cannot sufficiently block n

关键词： Biological Effects Near-Infrared Non-Thermal Water-Filter

Replication of interleukin 23 receptor and autophagy-related 16-like 1 association in adult-and pediatric-onset inflammatory bowel disease in Italy

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World Journal of Gastroenterology 2008年第29期14卷 4643-4651页

作者： Anna Latiano Orazio Palmieri Maria Rosa Valvano Renata D'Incà Salvatore Cucchiara Gabriele Riegler Anna Maria Staiano Sandro Ardizzone Salvatore Accomando Gian Luigi de Angelis Giuseppe Corritore Fabrizio Bossa Vito Annese U.U. O.O. di Gastroenterologia ed Endoscopia Ospedale IRCCS-CSSSan Giovanni Rotondo (Fg) 71013 Italy Cattedra di Gastroenterologia Università di PadovaPadova 35122 Italy clinica Pediatrica Università "La Sapienza" Roma 00185 Italy Cattedra di Gastroenterologia Università di NapoliNapoli 80131 Italy clinica Pediatrica Università di Napoli Napoli 80131 Italy Unità di Gastroenterologia Ospedale "Sacco" Milano 20157 Italy clinica Pediatrica Università di Palermo Palermo 90128 Italy clinica Pediatrica Università di Parma Parma 43100 Italy

AIM: To investigate gene variants in a large Italian inflammatory bowel disease (IBD) cohort, and to analyze the correlation of sub-phenotypes (including age at diagnosis) and epistatic interaction with other IBD genes. METHODS: Total of 763 patients with Crohn's disease (CD, 189 diagnosed at age < 19 years), 843 with ulcerative colitis (UC, 179 diagnosed <19 years), 749 healthy controls, and 546 healthy parents (273 trios) were included in the study. The rs2241880 [autophagy-related 16-like 1 (ATG16L1)], rs11209026 and rs7517847 [interleukin 23 receptor (IL23R)], rs2066844, rs2066845, rs2066847 (CARD15), rs1050152 (OCTN1), and rs2631367 (OCTN2) gene variants were genotyped. RESULTS: The frequency of G allele of ATG16L1 SNP (Ala197Thr) was increased in patients with CD compared with controls (59% vs 54% respectively) (OR = 1.25, CI = 1.08-1.45, P = 0.003), but not in UC (55%). The frequency of A and G (minor) alleles of Arg381Gln, rs11209026 and rs7517847 variants of IL23R were reduced significantly in CD (4%, OR = 0.62, CI = 0.45-0.87, P = 0.005; 28%, OR = 0.64, CI = 0.55-0.75, P < 0.01), compared with controls (6% and 38%, respectively). The A allele (but not G) was also reduced signifi cantly in UC (4%, OR = 0.69, CI = 0.5-0.94, P = 0.019). No association was demonstrated with sub-phenotypes and interaction with CARD15 , and OCTN1/2 genes, although both gene variants were associated with pediatric-onset disease. CONCLUSION: The present study confirms the association of IL23R polymorphisms with IBD, and ATG16L1 with CD, in both adult- and pediatric-onset subsets in our study population.

关键词： Inflammatory bowel disease Crohn'sdisease Ulcerative colitis Genetic predisposition Autophagy-related 16-like 1 Interleukin 23 receptor Genome-wide association study Pediatric inflammatorybowel disease

Adjuvant Therapy on Cancer of the Lower Rectum. Evaluation of the Effects of Preoperative Radiotherapy on the Prognosis of Patients with Cancer of the Lower Rectum

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Journal of Cancer Therapy 2012年第6期3卷 912-919页

作者： Jose Alfredo Reis Neto Jose Alfredo Reis Junior Odorino Kagohara Joaquim Simoes Neto Sergio OBanci Luciane HOliveira Surgery Catholic University of CampinasCampinasBrazil Surgery Clinica Reis NetoCatholic University CampinasCampinasBrazil Coloproctology Clinica Reis NetoCatholic University CampinasCampinasBrazil.

Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 to 55% seems immutable in several published series. The main cause for those results is the high incidence of recurrence, either local or widespread. Local recurrence is directly related to the number of undifferentiated cells and to the grade of wall invasion. Widespread recurrence depends specifically on the lymphatic and vascular spreading. So any kind of treatment that would diminish the number of undifferentiated cells and the size or the tumor wall penetration would certainly decrease the local recurrence rate, lengthening the interval free from cancer and, perhaps, modifying the long term survival rate. Between 1978 and 2009, a total of 538 patients with adenocarcinoma of the lower rectum (from the pectinate line to 10 cm above) were treated by preoperative radiotherapy. Methodology: The same protocol was used in all the patients – 400 cGy, 200 cGy/day, during 4 consecutive weeks (anterior and posterior pelvic fields) by means of a Linear Megavoltage Accelerator (25 MeV). Surgery was performed 2 months after completion of the radiotherapy. Results: Statistical analysis of the whole group showed that preoperative radiotherapy does decrease frequency of undifferentiated cells. Moreover, the incidence of local recurrence diminished after irradiation by 3.4%. Preoperative radiotherapy reduces tumor volume (ERUS) and wall invasion, as well as the mortality rate due to local recurrence (2.4%) and alters long-term survival rate (80.1%). Conclusion: Preoperative radiotherapy is really effective in reducing the number of undifferentiated cells and in diminishing the tumor volume and the carcinomatous infiltration of the rectal wall.

关键词： Rectal Cancer Cancer of the Lower Rectum Irradiation Preoperative Radiotherapy Local Recurrence Mortality Survival

Local Excision of Early Rectal Cancer by Transanal Endoscopic Microsurgery (TEM): The 23-Year Experience of a Single Centre

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Journal of Cancer Therapy 2015年第11期6卷 1000-1007页

作者： Mario Guerrieri Monica Ortenzi Maria Michela Cappelletti Trombettoni Indrit Kubolli Roberto Ghiselli clinica Chirurgica Università Politecnica delle Marche Ospedali Riuniti Ancona Italy

Aim: Transanal endoscopic microsurgery (TEM) is an effective, minimally invasive alternative approach to traditional surgery. This study reviews the characteristics of a series of patients affected by early rectal cancer and discusses the results of this treatment. Methods: From 1992 to 2014, 187 patients with rectal cancer staged as pT1 by preoperative endorectal ultrasound, computerized tomography and/or magnetic resonance imaging were treated by TEM at our institution. We analysed age, gender, size of lesion, distance from the anal verge, histological grading and stage. Furthermore we considered operative time, intra and post-operative complications and hospital stay. Patients were also enrolled in a tight follow-up for recurrence and survival. Results: There were no intraoperative complications or conversions to other procedures. There were minor complications (partial suture dehiscence, stool incontinence, rectal haemorrhage) in 24 patients (12.8%) and a major complication (perianal phlegmon) in one (1.5%). Two (5%) of the 40 patients with pT3 disease before neoadjuvant therapy experienced a local recurrence and one (2.5%) died for metastasis. Conclusion: TEM is a safe technique characterized by low morbidity and mortality and excellent oncological outcomes. These advantages, coupled with its ability to be applied to a strikingly high proportion of rectal tumours, suggest that it should be considered as the gold standard approach to early rectal cancer in accurately selected patients.

关键词： Transanal Endoscopic Microsurgery Rectal Cancer

Minimal volume vitrification of epididymal spermatozoa results in successful in vitro fertilization and embryo development in mice

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Asian Journal of Andrology 2017年第1期19卷 107-112页

作者： Fabrizzio Horta Hamida Alzobi Sutthipat Jitanantawittaya Sally Catt Penny Chen Mulyoto Pangestu Peter Temple-Smith Education Program in Reproduction and Development Department Obstetrics and Gynaecology Monash University Clayton VlC 3168 Australia Department of Obstetrics and Gynaecology Unit of Reproductive Medicine Clinica Las Condes Lo Fentecilla 441 Las Condes Santiago Region Metropolitana 7550000 Chile.

This study compared three cryopreservation protocols on sperm functions, IVF outcomes, and embryo development. Epididymal spermatozoa cryopreserved using slow-cooling （18% w/v raffinose, RS-C） were compared with spermatozoa vitrified using 0.25 M sucrose （SV） or 18% w/v raffinose （RV）. The motility, vitality, and DNA damage （TUNEL assay） of fresh control （FC） spermatozoa were compared with post-thawed or warmed RS-C, RV, and SV samples. Mouse oocytes （n = 267） were randomly assigned into three groups for insemination： RV （n = 102）, RS-C （n = 86）, and FC （n = 79）. The number and the proportion of two-cell embryos and blastocysts from each treatment were assessed. Sperm motility （P 〈 0.01） and vitality （P 〈 0.05） were significantly reduced after vitrification compared with slow-cooled spermatozoa. However, DNA fragmentation was significantly reduced in spermatozoa vitrified using sucrose （15 - 1.8% [SV] vs 26 - 2.8% [RV] and 27 - 1.2% [RS-C]; P 〈 0.01）. Although the number of two-cell embryos produced by RS-C, RV, and FC spermatozoa was not significantly different, the number of blastocysts produced from two-cell embryos using RV spermatozoa was significantly higher than FC spermatozoa （P = 0.0053）. This simple, small volume vitrification protocol and standard insemination method allows successful embryo production from small numbers of epididymal spermatozoa and may be applied clinically to circumvent the need for ICSI, which has the disadvantage of bypassing sperm selection.

关键词： cryopreservation epididymal sperm in vitro fertilization/intracytoplasmic sperm injection reproductive techniques sperm DNA damage vitrification

Early renal failure as a cardiovascular disease:Focus on lipoprotein(a) and prothrombotic state

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World Journal of Nephrology 2015年第3期4卷 374-378页

作者： Cristiana Catena Gian Luca Colussi Francesca Nait Francesca Pezzutto Flavia Martinis Leonardo A Sechi clinica Medica Department of Experimental and Clinical Medical SciencesUniversity of Udine

Patients with renal failure are at increased risk of cardiovascular events even at the earliest stages of disease. In addition to many classic cardiovascular risk factors, many conditions that are commonly identified as emerging risk factors might contribute to occurrence of cardiovascular disease. Changes in circulating levels of many of these emerging risk factors have been demonstrated in patients with early stages of renal failure caused by different types of renal disease and have been associated with detection of cardiovascular complications. However, for most of these factors evidence of benefts of correction on cardiovascular outcome is missing. In this article, we comment on the role of lipoprotein（a） and prothrombotic factors as potential contributors to cardiovascular events in patients with early renal failure.

关键词： Early renal failure Cardiovascular disease Risk factors Lipoprotein(a) Prothrombotic state

Tailored therapy in patients treated with fluoropyrimidines: focus on the role of dihydropyrimidine dehydrogenase

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Cancer Drug Resistance 2019年第3期2卷 787-802页

作者： Filippo Merloni Nicoletta Ranallo Laura Scortichini Riccardo Giampieri Rossana Berardi Scuola di Specializzazione in Oncologia Universita Politecnica delle MarcheAncona 60121Italy clinica Oncologica UniversitàPolitecnica delle MarcheAOU Ospedali RiunitiAncona 60126Italy

Fluoropyrimidines are widely used in the treatment of solid tumors, mainly gastrointestinal, head and neck and breast cancer. Dihydropyrimidine dehydrogenase (DPD) is the rate-limiting enzyme for catabolism of 5-FU and it is encoded by DPYD gene. To date, many known polymorphisms cause DPD deficiency and subsequent increase of 5-FU toxicity. In addition, reduced inactivation of 5-FU could lead to increased 5-FU intracellular concentration and augmented efficacy of this drugs. Therefore DPD expression, particularly intratumoral, has been investigated as predictive and prognostic marker in 5-FU treated patients. There also seems to be a tendency to support the correlation between DPD expression and response/survival in patients treated with fluoropyrimidine even if definitive conclusions cannot be drawn considering that some studies are conflicting. Therefore, the debate on intratumoral DPD expression as a potential predictor and prognostic marker in patients treated with fluoropyrimidines is still open. Four DPD-polymorphisms are the most relevant for their frequency in population and clinical relevance. Many studies demonstrate that treating a carrier of one of these polymorphisms with a full dose of fluoropyrimidine can expose patient to a severe, even life-threatening, toxicity. Severe toxicity is reduced if this kind of patients received a dose-adjustment after being genotyped. CPIC (clinical Pharmacogenetics Implementation Consortium) is an International Consortium creating guidelines for facilitating use of pharmacogenetic tests for patient care and helps clinicians ensuring a safer drug delivery to the patient. Using predictive DPD deficiency tests in patients receiving 5FU-based chemotherapy, in particular for colorectal cancer, has proven to be a cost-effective strategy.

关键词： 5-fluorouracil fluoropyrimidines chemotherapy dihydropyrimidine dehydrogenase dihydropyrimidine dehydrogenase DPYD CPIC polymorphisms

Cholangiocyte anion exchange and biliary bicarbonate excretion

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World Journal of Gastroenterology 2006年第22期12卷 3496-3511页

作者： Jesús M Banales Jesús Prieto Juan F Medina Laboratory of Molecular Genetics Division of Gene Therapy and Hepatology University of Navarra School of MedicineClinica Universitaria and CIMAPamplonaSpain

Primary canalicular bile undergoes a process of fluidization and alkalinization along the biliary tract that is influenced by several factors including hormones, innervation/neuropeptides, and biliary constituents. The excretion of bicarbonate at both the canaliculi and the bile ducts is an important contributor to the generation of the so-called bile-salt independent flow. Bicarbonate is secreted from hepatocytes and cholangiocytes through parallel mechanisms which involve chloride efflux through activation of Cl- channels, and further bicarbonate secretion via AE2/SLC4A2-mediated Cl-/HCO3- exchange. Glucagon and secretin are two relevant hormones which seem to act very similarly in their target cells （hepatocytes for the former and cholangiocytes for the latter）. These hormones interact with their specific G protein-coupled receptors, causing increases in intracellular levels of cAMP and activation of cAMP-dependent Cl- and HCO3- secretory mechanisms. Both hepatocytes and cholangiocytes appear to have cAMP-responsive intracellular vesicles in which AE2/SLC4A2 colocalizes with cell specific Cl- channels （CFTR in cholangiocytes and not yet determined in hepatocytes） and aquaporins （AQP8 in hepatocytes and AQP1 in cholangiocytes）, cAMP-induced coordinated trafficking of these vesicles to either canalicular or cholangiocyte lumenal membranes and further exocytosis results in increased osmotic forces and passive movement of water with net bicarbonate-rich hydrocholeresis.

关键词： AE2 anion exchanger Bile salt-independent flow Biliary bicarbonate excretion Regulation of intracellular pH Hydroionic fluxes in cholangiocytes