Factors associated with reduced insertion depth at double balloon enteroscopy: A retrospective,multivariate analysis

Background

Deep small bowel insertion during double balloon enteroscopy can be difficult to achieve.

Aims

To determine the factors influencing depth of insertion during double balloon enteroscopy.

Methods

History of abdomino-pelvic surgery, route of insertion, type of enteroscope, age, sedation or general anaesthesia used and gender were considered as potential influencing factors; procedures were categorised accordingly and maximal depth of insertion calculated.

Results

At multivariate analysis, maximal depth of insertion was significantly associated with history of abdominal-pelvic surgery (P < 0.001), rectal approach (P = 0.011), gender (P = 0.02) and use of the therapeutic enteroscope (P = 0.047). Mean maximal depth of insertion was 266 ± 12 cm, 255 ± 9 cm (P = 0.50), 197 ± 10 cm (P < 0.0001), 160 ± 12 cm (P < 0.01) and 103 ± 33 cm (P < 0.15) when 0, 1, 2, 3 and 4 influencing factors were present, respectively.

Conclusion

Maximal depth of insertion was significantly influenced by history of abdomino-pelvic surgery, insertion route, gender and type of enteroscope used.     

CD4−CD8− T-cells in primary Sjögren's syndrome: Association with the extent of glandular involvement

ObjectivesGrowing evidence suggests that IL-17-producing T cells, lacking both CD4 and CD8 molecules and defined as double negative (DN) cells, play a pivotal role in the pathogenesis of a number of systemic autoimmune disorders. We recently demonstrated that this T-cell subset is expanded in the peripheral blood (PB) of patients with primary Sjögren's syndrome (pSS), produces IL-17 and accumulates in minor salivary glands (MSGs). We aimed to investigate glandular and PB DN T cells in early pSS in order to verify a possible correlation with MSGs histological patterns and clinical parameters.MethodsPaired samples of PB mononuclear cells and MSGs from pSS patients were evaluated at the diagnosis by flow cytometry and immunofluorescence staining respectively. Histological analysis to identify histological scores, B/T cell segregation and the presence of germinal center (GC)-like structures was also performed.ResultsIn early stages of pSS, circulating DN T cells appear to be not yet expanded and inversely correlated with circulating CD4⁺Th17 cells. The number of infiltrating DN T cells were associated with extent of glandular involvement, presence of GC-like structures and dryness symptoms and were inversely correlated with circulating DN T cells.ConclusionsOur findings suggest that DN T cells are actively involved in the pathogenic mechanisms leading to glandular dysfunction and damage in pSS and may play a role in ectopic lymphoneogenesis development occurring during the disease.     

Długotrwała odpowiedź na leczenie azacytydyną pacjentki z ostrą białaczką szpikową z niekorzystnym profilem cytogenetycznym – prezentacja przypadku

Acute myeloid leukemia (AML) is the most common type of leukaemia found in adults and the number of disease cases increases with age. Despite the advances in the AML treatment, the results in patients over the age of 60 remain unsatisfactory.In this study we present the case of a 73-year-old female patient with an unfavourable cytogenetic profile, in whom we observe long-term response to azacitidine, after previous failures of classic polychemotherapy.In February 2010, a 70-year-old patient was admitted to the Department of Haematology USK in Bialystok on suspicion of AML. The patient was qualified for intensive chemotherapy regimen of daunorubicin (DNR) and cytarabine (Ara-C).Cytogenetic examination revealed the presence of double minutes – acentric fragments of extrachromosomal DNA, which is associated with resistance to standard chemotherapy. Induction chemotherapy was complicated by febrile neutropenia, pneumonia and episodes of atrial fibrillation. Due to the lack of remission and severe after-induction period, a brief reinduction chemotherapy with DNR and Ara-C was applied to obtain complete remission with incomplete regeneration (CRi).Due to the recurrence in October 2010, reinduction chemotherapy was given followed by two cycles of maintenance chemotherapy. After another relapse in February 2011 (23,6% blasts in the bone marrow), a chemotherapy regimen designed for refractory and relapsed leukaemia was given, without any effect. In April 2011, the patient began azacitidine treatment. By the end of March 2013, the patient received twenty-one treatment cycles. The twelfth cycle of chemotherapy was complicated by pulmonary embolism which was treated successfully. The complete blood count remains at normal values.Recent reports indicate a clear relationship processes such as epigenetic regulation of DNA methylation with leukaemogenesis. The use of hypomethylating drugs in AML is yielding promising results.     

Tropomyosin is required for cardiac morphogenesis,myofibril assembly,and formation of adherens junctions in the developing mouse embryo

BACKGROUND: We explored a function for tropomyosin (TM) in mammalian myofibril assembly and cardiac development by analyzing a deletion in the mouse TPM1 gene targeting αTM1, the major striated muscle TM isoform. RESULTS: Mice lacking αTM1 are embryonic lethal at E9.5 with enlarged, misshapen, and non‐beating hearts characterized by an abnormally thin myocardium and reduced trabeculae. αTM1‐deficient cardiomyocytes do not assemble striated myofibrils, instead displaying aberrant non‐striated F‐actin fibrils with α‐actinin puncta dispersed irregularly along their lengths. αTM1's binding partner, tropomodulin1 (Tmod1), is also disorganized, and both myomesin‐containing thick filaments as well as titin Z1Z2 fail to assemble in a striated pattern. Adherens junctions are reduced in size in αTM1‐deficient cardiomyocytes, α‐actinin/F‐actin adherens belts fail to assemble at apical cell–cell contacts, and cell contours are highly irregular, resulting in abnormal cell shapes and a highly folded cardiac surface. In addition, Tmod1‐deficient cardiomyocytes exhibit failure of α‐actinin/F‐actin adherens belt assembly. CONCLUSIONS: Absence of αTM1 resulting in unstable F‐actin may preclude sarcomere formation and/or lead to degeneration of partially assembled sarcomeres due to unregulated actomyosin interactions. Our data also identify a novel αTM1/Tmod1‐based pathway stabilizing F‐actin at cell–cell junctions, which may be required for maintenance of cell shapes during embryonic cardiac morphogenesis. Developmental Dynamics 243:800–817, 2014. © 2014 Wiley Periodicals, Inc.     

内镜下抗反流黏膜切除术和贲门缩窄术治疗胃食管反流病的临床疗效对比

目的 对比内镜下抗反流黏膜切除术（anti-reflux mucosectomy,ARMS）和贲门缩窄术（endoscopic cardial constriction ligation,ECCL）治疗胃食管反流病的临床疗效。方法 回顾性分析2015年12月—2018年8月在郑州大学第一附属医院行ARMS或ECCL治疗,并定期随访的48例胃食管反流病患者病例资料,其中20例行ARMS（ARMS组）,28例行ECCL（ECCL组）,比较两种术式短期及长期临床疗效。结果 两种术式的操作成功率均为100.0%,ECCL组手术时间明显短于ARMS组[（8.43±1.59）min比（34.05±12.35）min,t=－9.227,P＜0.001]。术后2个月随访,ECCL组和ARMS组症状改善有效率分别为89.3%（25/28）和60.0%（12/20）,差异有统计学意义（χ2=4.128,P=0.042）,ECCL组GERD Q评分低于ARMS组[（6.24±1.22）分比（7.35±1.79）分,t=-2.400,P＝0.023]。术后1年随访,两组症状改善有效率、GERD Q评分,以及DeMeester评分和pH＜4时间百分比差异均无统计学意义（P＞0.05）。结论 ARMS和ECCL治疗胃食管反流病的长期临床疗效相当,但ECCL短期疗效更具优势。     

不明原因消化道出血患者行双气囊小肠镜检查的时机选择

目的探讨不明原因消化道出血（OGIB）患者行双气囊小肠镜检查（DBE）的最佳时机。方法回顾性分析盛京医院2009年1月至2013年11月间接受DBE检查的OGIB患者的临床资料,按检查时机的不同分为急诊DBE组和非急诊DBE组,整理两组患者的临床特征、DBE检查结果、检查时间和并发症,并进行统计学分析及比较。结果78例OGIB患者接受DBE检查,发现病变48例,病变总检出率为61．54％。急诊DBE组病变检出率为77．14％（27／35）,明显高于非急诊DBE组的病变检出率48．83％（21／43）（P=0．019）。在检查时间方面,急诊DBE组明显短于非急诊组,差异有统计学意义（P=0．031）。结论对于OGIB患者,急诊DBE的检查时间更短,病变检出率更高。条件允许时,对OGIB患者应尽早行DBE检查。