Primary esophageal mucosa‐associated lymphoid tissue lymphoma treated by endoscopic submucosal dissection

Primary esophageal mucosa‐associated lymphoid tissue (MALT) lymphoma is rare. There have been few reports about early primary esophageal MALT lymphoma being treated endoscopically. The clinical profile of primary esophageal MALT lymphoma is currently unclear, so it is important to accumulate more information about early esophageal MALT lymphoma. To achieve early detection of esophageal MALT lymphoma, we need more accurate knowledge and information about the macroscopic and morphological features of this tumor. Endoscopic resection is one of the most effective treatments. With respect to the lateral andvertical margins of the resected specimen, endoscopic submucosal dissection (ESD) may be superior to endoscopic mucosal resection for treating early esophageal MALT lymphoma. Here we report the macroscopic appearance of the tumor which is the first successful case of ESD for early esophageal MALT lymphoma.     

Endoscopic full-thickness resection using an over-the-scope device: A prospective study

BACKGROUND Endoscopic submucosal dissection to treat mucosal and submucosal lesions sometimes results in low rates of microscopically margin-negative(R0)resection.Endoscopic full-thickness resection(EFTR)has a high R0 resection rate and allows for the definitive diagnosis and treatment of selected mucosal and submucosal lesions that are not suitable for conventional resection techniques.AIM To evaluate the efficacy and safety of EFTR using an over-the-scope clip(OTSC).METHODS This prospective,single-center,non-randomized clinical trial was conducted at the endoscopy center of Shengjing Hospital of China Medical University.The study included patients aged 18-70 years who had gastric or colorectal submucosal tumors(SMTs)(≤20 mm in diameter)originating from the muscularis propria based on endoscopic ultrasound(EUS)and patients who had early-stage gastric or colorectal cancer(≤20 mm in diameter)based on EUS and computed tomography.All lesions were treated by EFTR combined with an OTSC for wound closure between November 2014 and October 2016.We analyzed patient demographics,lesion features,histopathological diagnoses,R0 resection(negative margins)status,adverse events,and follow-up results.RESULTS A total of 68 patients(17 men and 51 women)with an average age of 52.0±10.5 years(32-71 years)were enrolled in this study,which included 66 gastric or colorectal SMTs and 2 early-stage colorectal cancers.The mean tumor diameter was 12.6±4.3 mm.The EFTR procedure was successful in all cases.The mean EFTR procedure time was 39.6±38.0 min.The mean OTSC defect closure time was 5.0±3.8 min,and the success rate of closure for defects was 100%.Histologically complete resection(R0)was achieved in 67(98.5%)patients.Procedure-related adverse events were observed in 11(16.2%)patients.The average post-procedure length of follow-up was 48.2±15.7 mo.There was no recurrence during follow-up.CONCLUSION EFTR combined with an OTSC is an effective and safe technique for the removal of select subepithelial and epithelial lesions that are not amenable to conventional endoscopic resection techniques.     

钛夹标记联合CT图像后处理技术在早期胃癌腹腔镜术前定位中的应用

目的探讨钛夹标记联合CT图像后处理技术在早期胃癌腹腔镜术前定位中的应用。方法30例早期胃癌患者经消化道内窥镜检查发现病灶并常规活检后,于瘤体旁放置钛夹,术前12~24 h分别行腹部卧位X线摄影及腹部CT平扫,通过CT图像后处理技术及腹部X线摄影来了解钛夹的位置,以便术前确定病灶部位及范围,并与术中所见病灶位置进行比较,评判两种方法对早期胃癌腹腔镜手术的术前定位准确率,并通过CT对胃周围淋巴结转移进行初步评判。结果本组30例患者术前行钛夹标记联合CT图像后处理技术对胃癌的定位与手术结果符合率为100%(30/30),其定位准确率优于钛夹标记联合腹部X线摄影对胃癌的定位方法。所有患者均顺利完成腹腔镜手术。结论对于早期胃癌患者,利用钛夹标记联合CT图像后处理技术是术前准确可靠的病灶定位方法,亦可大体了解胃周围淋巴结的情况,对早期胃癌腹腔镜手术顺利完成有重要的临床意义。     

内镜下金属钛夹止血联合黏膜下注射肾上腺素治疗溃疡性上消化道出血的效果及对氧化应激指标的影响

目的探讨内镜下金属钛夹止血联合黏膜下注射肾上腺素治疗溃疡性上消化道出血(UGIB)的效果及对氧化应激指标的影响。方法将2016年5月至2020年5月住院治疗的86例溃疡性UGIB患者按随机抽签法分为对照组与观察组,每组43例。对照组于内镜下黏膜下注射肾上腺素,观察组在对照组基础上联合内镜下金属钛夹止血,比较两组的治疗效果。结果观察组的治疗总有效率高于对照组(P<0.05)。观察组的止血时间、大便潜血转阴时间、住院时间短于对照组(P<0.05)。治疗后,观察组的AOPP、MDA、血管升压素水平低于对照组(P<0.05)。观察组的不良反应总发生率低于对照组(P<0.05)。结论内镜下金属钛夹止血联合黏膜下注射肾上腺素治疗溃疡性UGIB可获得理想的止血效果,缩短止血时间,改善患者氧化应激指标,安全可靠。     

Alpha-linolenic acid and coronary heart disease

AIM: To summarize our present knowledge about vegetable omega-3 fatty acids. DATA SYNTHESIS: Alpha-linolenic acid (ALA) is one of the two essential fatty acids in humans. Epidemiological studies and dietary trials strongly suggest that this fatty acid is important in relation with the pathogenesis (and prevention) of coronary heart disease. Like other n-3 fatty acids from marine origin, it may prevent cardiac arrhythmias and sudden cardiac death. The optimal dietary intake of alpha-linolenic acid seems to be about 2 g per day or 0.6 to 1% of total energy intake. Obtaining an optimal ratio of the two essential fatty acids, linoleic and alpha-linolenic acids--ie a ratio of less than 4 to 1 in the diet--is a major issue. The main sources of alpha-linolenic acid for the European population should be canola oil (and canola-oil based margarine if available), nuts (English walnut), ground linseeds and green leafy vegetables such as purslane. CONCLUSIONS: Epidemiological studies and dietary trials in humans suggest that alpha-linolenic acid is a major cardio-protective nutrient.     

纠正低血糖生活食物卡夹在低血糖处置的效果观察

目的观察使用“纠正低血糖的生活食物卡夹”(已获国家实用新型专利,专利号ZL 201720756805.8)对发生低血糖的糖尿病患者的影响,指导患者在日常生活中选择标准的纠正低血糖的食物种类和量,及时纠正低血糖。方法选择2017年10月—12月住院的糖尿病患者90例,通过自制问卷,了解患者对低血糖反应的知识掌握情况,通过使用“纠正低血糖的生活食物卡夹”进行健康指导,观察使用卡夹后,患者在发生低血糖时对生活食物种类和量的选择正确率。结果通过该卡夹的使用及健康指导,糖尿病患者在发生低血糖时,能够准确、及时的选择生活中食物的种类和量,差异有统计学意义(P<0.001)。结论“纠正低血糖的生活食物卡夹”可作为临床护理教育工具使用,针对患者或家属,具有直观、具体、形象,实用性强的特点,能够更规范地帮助糖尿病患者在发生低血糖时,及时、准确地选择含糖食物和进食量,纠正低血糖,减少对机体的损害。另外还可作为日常健康保健资料推广使用,提高群众健康管理知识。     

Development of mitral stenosis after single mitraclip insertion for severe mitral regurgitation

We report the first case of mitral stenosis following Mitra‐Clip insertion in a patient with symptomatic NYHA IV heart failure, secondary to severe mitral regurgitation (MR). A 79‐year‐old female with a history of prior aortic valve replacement underwent percutaneous mitral valve (MV) repair. A single clip was advanced coaxially down onto the MV under TOE guidance, with the anterior and posterior leaflets clipped together between A2 and P2. TOE confirmed a significant reduction in MR (grade 4 to grade 1). Despite initial symptomatic relief, she represented 3 months later with similar symptoms. Repeat TOE confirmed a well positioned Mitra‐Clip with mild residual MR. However, the possibility of significant mitral stenosis was raised due to the presence of significant turbulence through the bi‐orifice valve, with a peak gradient of 25 mm Hg. In addition there was evidence of severe functional tricuspid valve (TV) regurgitation with elevated pulmonary artery pressures (PAP 90 mm Hg), confirmed on subsequent right heart catheterization. After repeated heart team discussions and a failure of optimal medical therapy, and despite a logistic EuroScore of 35.5, minimally invasive surgical replacement of the MV and simultaneous TV repair was undertaken via a right thoracotomy. Despite procedural success and initial good postoperative response, the patient died subsequently from a combination of hospital‐acquired pneumonia and significant gastrointestinal bleeding (post operative day 35). Mitra‐Clip is a promising novel approach to MV repair. The establishment of further clinical and echocardiographic based selection criteria will help identify the correct patients for this treatment. © 2013 Wiley Periodicals, Inc.