改良内镜下黏膜结扎剥离术治疗胃固有肌层肿瘤临床价值分析

目的 探讨改良的内镜下结扎剥离术(ESD-L)对胃固有肌层小肿瘤的治疗价值.方法 对经超声胃镜检查证实来源于胃固有肌层、直径≤12 mm的黏膜下肿瘤(SMT) 60例,先行应用常规ESD术剥离至固有肌层深部后,继而对瘤体及其底部固有肌层充分结扎,结扎后继续剥离直至完整剥离瘤体.随访观察治疗效果.结果 60例病变全部完整切除,10例出现穿孔,行全层切除后金属止血夹封闭创面,未转外科手术,无其他并发症发生.60例均获得病理诊断,随访期内未见复发病例.结论 应用剥离后结扎再剥离的改良ESD-L术治疗来源于固有肌层的SMT既能达到完全剥离,减少病灶残留的治疗目的,又能降低因实施全层切除而导致胃壁穿孔的风险.     

消化道全层缺损内镜下闭合方式的研究进展

随着内镜技术的发展,内镜全层切除术（endoscopic full⁃thickness resection,EFR）已成为黏膜下肿瘤的首选治疗方式。相较于外科腹腔镜手术,EFR可经人体自然孔道完整切除肿瘤,具有安全性高、创伤小、术后住院时间短、恢复速度快等优点,目前已广泛应用于多数黏膜下肿瘤的切除。为完整剥离病变,EFR术中多会造成消化道管壁的全层缺损,现阶段主要使用的闭合夹有金属夹、尼龙圈联合金属夹、内镜吻合夹（over⁃the⁃scope clip,OTSC）等,具体方式的选择主要根据术中创面情况及缺损大小综合判断。对现有的常用消化道全层缺损闭合方式进行总结,评估其安全性及可靠性,为临床应用提供参考。     

食管隆起病灶EMR术后创面出血内镜治疗33例

目的:探讨食管隆起病灶内镜下黏膜切除术(EMR)术后创面出血内镜不同止血方法,并分析疗效.方法:33例食管隆起病灶行EMR术合并创面出血,其中直接使用金属肽夹止血8例,余下25例首先采用内镜下喷洒药物止血,成功10例,继续出血的15例中7例采用黏膜注射止血,8例采用内镜下热凝止血,仍然有3例无效采用金属钛夹止血,术后6 wk复查内镜,观察创面愈合情况.结果:8例直接使用金属肽夹止血均成功,25例采用喷洒药物止血成功10例;15例止血无效,对其中7例采用注射药物止血,成功6例;8例采用热凝止血成功6例,剩余3例止血仍然无效加用钛夹止血均成功.术后6 wk内镜复查,创面愈合良好.结论:对于食管隆起病灶EMR术后创面出血,内镜止血方法多样,操作简单、安全、效果好,值得推广.     

内镜切除技术在胃固有肌层肿瘤中的临床应用

目的:观察内镜黏膜下层剥离术(endoscopic submucosal dissection,ESD)为基础的内镜下切除术在胃固有肌层肿瘤治疗中的安全性及有效性.方法:收集江苏省苏北人民医院2013-01/2015-01接受内镜治疗的胃固有肌层肿瘤患者资料,总结并分析其手术并发症、临床病理及术后随访资料.结果:42例患者,20例接受ESD,15例接受内镜黏膜下肿瘤挖除(endoscopic submucosal excavation,ESE),7例接受内镜下胃壁全层切除术(endoscopic full-thickness resection,EFR)治疗.其中1例因较大穿孔、2例腔内外生长实施腹腔镜修补及辅助全层切除,1例出现出血,开腹止血修补,成功率90.48%.术后迟发性出血2例,通过保守治疗恢复,无迟发性穿孔.EFR组实施胃壁全层切除,主动穿孔,并在内镜下完全缝合胃壁缺损.42例患者术后均接受6-28 mo的随访,无局部复发及远处转移病例.结论:以ESD为基础的内镜切除技术治疗胃固有肌层肿瘤是一种有效的治疗手段,部分呈腔内外生长的瘤体完整切除需要腹腔镜帮助.     

老年人胃食管黏膜病变内镜黏膜下剥离术的安全性探讨

目的 探讨60岁以上老年人胃食管黏膜病变内镜黏膜下剥离术(ESD)治疗的安全性.方法 经胃镜检查发现胃食管扁平隆起性病变的老年患者36例,病理活检及内镜超声检查证实为异型增生14例,早期癌9例,平滑肌瘤13例.在清醒状态下,应用改良的针状钩刀、IT刀及电凝电切技术剥离病灶,应用去甲肾上腺素冰生理盐水、氩气刀、金属夹等处理创面.术后4周复查胃镜评价创面愈合及病灶残留情况.结果 36例中,ESD完整切除病灶29例(80.6%),借助圈套器切除7例(19.4%).术中穿孔3例(8.3%),经金属夹闭合、胃管引流、禁食、抑酸和抗感染等治疗,5～7d恢复;术后2h出现呕血1例(2.8%),经内镜下金属夹止血.结论 对老年胃食管黏膜病变患者行ESD治疗是安全有效的.     

老年人胃食管黏膜病变内镜黏膜下剥离术的安全性探讨

目的 探讨60岁以上老年人胃食管黏膜病变内镜黏膜下剥离术(ESD)治疗的安全性.方法 经胃镜检查发现胃食管扁平隆起性病变的老年患者36例,病理活检及内镜超声检查证实为异型增生14例,早期癌9例,平滑肌瘤13例.在清醒状态下,应用改良的针状钩刀、IT刀及电凝电切技术剥离病灶,应用去甲肾上腺素冰生理盐水、氩气刀、金属夹等处理创面.术后4周复查胃镜评价创面愈合及病灶残留情况.结果 36例中,ESD完整切除病灶29例(80.6%),借助圈套器切除7例(19.4%).术中穿孔3例(8.3%),经金属夹闭合、胃管引流、禁食、抑酸和抗感染等治疗,5～7d恢复;术后2h出现呕血1例(2.8%),经内镜下金属夹止血.结论 对老年胃食管黏膜病变患者行ESD治疗是安全有效的.     

不同部位上消化道黏膜下肿瘤临床特征及治疗方法

目的:探讨上消化道不同部位黏膜下肿瘤的临床特征及治疗方法.方法:收集159例上消化道不同部位黏膜下肿瘤患者,行内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)切除病灶,切除后病灶均送病理,比较不同部位性别及年龄组成比,病灶最大直径,手术时间及并发症发生率,所有患者2 mo及6 mo后复查胃镜.结果:159例患者中,病灶位于食道28例,贲门12例,胃底44例,胃体48例(其中2例为残胃),胃窦22例,十二指肠5例.病灶完全切除155例(155/159,97.5%),术中病灶行整块切除154例(154/159,96.9%),食道者16例以隧道法切除,胃底者16例行全层切除.病灶位于食道者,隧道法及普通ESD术手术时间相比差异无统计学意义.病灶位于胃底者,普通ESD术及全层切除法手术时间相比差异无统计学意义.术后病理主要包括平滑肌瘤、间质瘤及异位胰腺.本研究中共发生术中穿孔19例,后均行全层切除术,成功闭合创面;所有术中出血均以电凝止血钳及钛夹成功止血,术后迟发性出血发生2例,均经急诊内镜下钛夹成功止血.所有患者术后2 mo及6 mo复查胃镜,所有患者创面愈合良好,未见复发.结论:上消化道黏膜下肿瘤根据其不同生长部位,有其不同临床及病理特征,可采用不同ESD手术方式.     

内镜全层切除术后单钳道内镜对吻缝合技术的临床应用（含视频）

回顾性分析2017年2月—2019年5月在郑州大学第一附属医院因消化道黏膜下肿瘤（直径≥1 cm）行内镜全层切除术,并采用单钳道内镜对吻缝合法闭合消化道全层缺损的62例患者临床资料,评价内镜全层切除术后单钳道内镜对吻缝合技术闭合创面的临床应用价值。结果显示：所有术后创面成功闭合（100%）,未发生术后吻合口漏及其他严重...     

EFR治疗胃固有肌层肿物25例

目的探讨内镜全层切除术(EFR)治疗源于固有肌层的胃黏膜下肿物(SMT)的疗效和安全性。方法 25例于2011年1月至2013年9月于我院接受EFR治疗的胃SMT患者纳入研究,肿瘤经EUS和增强CT检查诊断为来源于固有肌层。对其治疗结果、并发症发生情况、近期随访结果等进行回顾性分析。结果 25例均完整切除病灶,病灶长径1.0~5.5 cm,黏膜切开至黏膜切口完整缝合时间为60~180 min,使用止血夹5~30枚,住院天数3~9 d,医疗费用8 000~20 000元。术后病理诊断间质瘤22例,平滑肌瘤2例,神经鞘瘤1例,切缘均为阴性。术后无出血,1例出现腹膜炎。出院后3个月内镜复查未见病变残留、复发。结论 EFR治疗来源于固有肌层的胃SMT安全、有效,可成为胃SMT的治疗选择。     

消化道黏膜下肿物内镜下切除及其并发症防治

目的探讨消化道黏膜下肿物(gastrointestinal submucosal tumor,SMT)的内镜下切除方法及其并发症的防治。方法对382例SMT采用内镜黏膜下挖除术(ESE)、胃镜与腹腔镜双镜联合、内镜黏膜下隧道肿瘤切除术(STER)以及内镜全层切除术(EFTR)进行肿物切除。结果 ESE切除332例,胃镜与腹腔镜双镜联合切除36例(其中20例为腹腔镜为主内镜辅助腹腔镜治疗,16例为瘤体较大,与浆膜层分界不清,单独内镜下挖除瘤体困难,术中转外科腹腔镜与胃镜双镜联合治疗),STER切除10例,EFTR切除4例。术中穿孔24例,其中内镜下瘤体剥离后发生胃壁穿孔转外科腹腔镜下缝合穿孔7例、内镜下尼龙绳荷包缝合9例、内镜下钛夹缝合6例、内镜下OTSC金属夹闭合器达到严密缝合2例。术后发生迟发性出血1例。术后感染1例。无死亡病例发生。结论 ESE、胃镜与腹腔镜双镜联合、STER以及EFTR是目前切除SMT微创、有效、安全、可行的方法。穿孔是其主要并发症,大多数穿孔可在内镜下达到严密缝合。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.