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Objective:To investigate the characteristics, process, and prognosis of esophageal stricture after circumferential endoscopic submucosal dissection (ESD), and to preliminarily analyze the prevention and treatment effects of simple dilation, stent placement, mucosal transplantation, and glucocorticoid (hereinafter referred to as hormone) application in esophageal stricture.Methods:From August 2017 to March 2022, at the First Affiliated Hospital of Zhengzhou University, the clinical and follow-up data of 55 patients who underwent circumferential ESD for early esophageal cancer and precancerous lesions were retrospectively analyzed. According to the prevention and treatment methods for esophageal stricture, the patients were divided into two groups: simple dilation group (23 cases) and combined dilation group (32 cases). The combined dilation group was divided into mucosal transplantation subgroup (9 cases), stent placement subgroup (14 cases), hormone application subgroup (7 cases), and bleomycin subgroup (2 cases, excluded from comparative analysis due to limited cases). Overall prognosis of patients was observed. Treatment efficacy, prognosis, and adverse events were compared among the simple dilation group, mucosal transplantation subgroup, stent placement subgroup, and hormone application subgroup. Independent samples t-test, chi-square test, and Fisher′s exact test were used for statistical analysis. Results:Among the 55 patients, the follow-up time was (894.1±417.7) days. Refractory esophageal stricture (total dilation times ≥ 5) occurred in 33 patients (60.0%). Fifty-two patients (94.5%) achieved clinical remission of the stricture. The total number of dilations was 5.8±4.0, and the average dysphagia-free period was (52.3±37.1) days. The dysphagia-free period of mucosal transplantation subgroup was longer than that of the simple dilation group, stent placement subgroup, and hormone application subgroup ((114.5±50.0) days vs. (40.9±20.0), (39.7±10.0), and (40.9±25.5) days, respectively), and the differences were statistically significant ( t=4.82, 3.77 and 3.14, P<0.001, =0.011, =0.009). There were no statistically significant differences between the simple dilation group and the mucosal transplantation subgroup, stent placement subgroup, and hormone application subgroup in the total number of dilations (6.8±4.8 vs. 3.0±2.5, 5.8±2.2, and 5.7±5.0), stricture remission rate (95.7%, 22/23 vs. 8/9, 13/14, and 7/7), and incidence of adverse events (17.4%, 4/23 vs. 5/9, 5/14, and 2/7; all P>0.05). Conclusions:Esophageal stricture formed after circumferential ESD shows the characteristics of recurrence and intractability. The over all number of dilations is high, and the average dysphagia-free period is short. Most patients can achieve clinical remission of the stricture after multiple times of endoscopic dilation treatment. However mucosal transplantation, stent placement, and hormone application cannot well intervene the natural process of esophageal stricture.
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Objectives To examine the association of the maternal high-fat (HF) diet with increased susceptibility to obe-sity and the development of metabolic diseases in their offspring, and observe difference in the effect of maternal vs. acquired high fat diet on metabolic state in their offspring. Methods A total of 15 SD female rats were divided into HF diet group (group H, n=9) and control diet group (group C, n=6). After fed on different diet for seven weeks, they were mated at the age of ten weeks and became pregnant. Their offspring were then divided to groups CH and HH fed HF diet and groups CC and HC fed control diet. At the age of 3 and 8 weeks, the metabolic markers and the liver pathohistological evidences of their offspring were obtained. Results The body weight, area under curve (AUC) of glucose tolerance, cholesterol and triglyceride were all higher in group H than those in group C (P0.05). At the age of 8 weeks, there was no difference in fasting glucose and insulin levels among the four offspring groups. The AUC and body weight were higher in group H than in group C (main effect of maternal diet, P=0.024, P=0.013). The AUCs were also higher in groups CH and HH than groups CC and HC respectively (main effect of acquired diet, P=0.041). The levels of total cholesterol, triglycerides and LDL at the age of 8 weeks were all higher in HH and CH groups than those in HC and CC groups (main effect of acquired diet, P=0.008, 0.007, 0.000, respectively). Their histological analysis at 8 weeks showed different degrees of fatty liver in HH, HC and CH groups, and normal liver in CC group. Conclusions Maternal HF diet may result in increased body weight, fatty liver and impaired glucose tolerance in their adult offspring, and thus increase the risk of developing metabolic diseases at their later age. .
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Objective To explore the impact of advanced glycation end-products ( AGEs) on matrix metalloproteinase 2 ( MMP-2) expression in cultivated INS-1 cells. Method INS-1 cells were cultivated and MMP-2 expression was analyzed. Glycated serum was prepared for incubating with INS-1 cell. Reactive oxygen species (ROS) was detected by flow cytometry. The intracelluar MMP-2 expression was analyzed by RT-PCR, realtime PCR and Western blot. The MMP-2 cDNA was expressed in cultivated INS-1 cells. Result The level of ROS treated with AGEs was significantly higher than that in the control( P<0.05 ) , and the levels of MMP-2 and its protein expressions turned out as well( P<0. 05). Conclusion The results suggest that MMP-2 was expressed in INS-1 cells. Increased MMP-2 expression in ?cells may be induced by AGEs, suggesting that MMP-2 might play an important role in oxidative stress-mediated islet injury.