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Objective:To analyze the endoscopic characteristics of early gastric cancer and precancerous lesions after Helicobacter pylori ( H. pylori) eradication. Methods:From May 2019 to June 2022, at Shanghai Sixth People′s Hospital affiliated to Shanghai Jiaotong University School of Medicine, the medical data of patients diagnosed with differentiated early gastric cancer and precancerous lesions were collected. A total of 93 patients with early gastric cancer and precancerous lesions who had previous history of H. pylori infection and had undergone standardized eradication treatment were selected, and their endoscopic characteristics were retrospectively analyzed. Independent sample t-test, chi-square test, and Fisher′s exact test were used for statistical analysis. Results:Among 93 patients with early gastric cancer and precancerous lesions after H. pylori eradication, there were 56 males and 37 females, with an average age of (66.9±8.2) years old. The time after H. pylori eradication was 3.4 years (range 1.0 to 7.0 years). A total of 109 early gastric cancer and precancerous lesions were found, including 79 patients with single lesion and 14 patients with multiple lesions (30 lesions). There were 60 cases with 73 lesions in the early gastric cancer group and 33 cases with 36 lesions in the precancerous group. Among 93 patients, 89 cases (95.7%) were diagnosed with atrophy level above C-2 according to Kimura-Takemoto classification under endoscopy. The long diameter of 109 lesions was (1.38±0.70) cm and the short diameter was (1.04±0.53) cm. A total of 80 lesions (73.4%) were located in the lower 1/3 part of the stomach, and 53 lesions (48.6%) were located in the lesser curvature. A total of 106 lesions (97.2%) were superficial type (0-Ⅱ) under the endoscopy. The long diameter and short diameter in the early gastric cancer group after H. pylori eradication were both greater than those in the precancerous lesion group ((1.54±0.78) cm vs. (1.06±0.35) cm, (1.16±0.58) cm vs. (0.78±0.33) cm), and the differences were statistically significant ( t=3.53 and 3.73, both P<0.001). There was statistically significant difference in the morphological types between early gastric cancer group after H. pylori eradication and precancerous lesion group ( χ2=11.01, P=0.012). The main morphological type of early gastric cancer after H. pylori eradication was superficial depression type (0-Ⅱc), accounting for 45.2% (33/73), while the precancerous lesions were mainly superficial protruded and flat type, both accounting for 38.9% (14/36). Conclusions:After H. pylori eradication, the endoscopic atrophy range of early gastric cancer and precancerous lesions is mostly above C-2. And the lesions are mostly located in the middle and lower 1/3 part of the stomach, long diameter of lesions <20 mm. The main morphological type is superficial type, especially superficial depression type.
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Objective:To compare the effect and biotoxicity of tert-butyl acetate (TBA) and ethyl butyrate (EB) on stone dissolution in vitro.Methods:Ten gallstone samples from patients with multiple gallbladder stones were selected and the cholesterol content was analyzed by HPLC. Stone dissolution tests of TBA and EB were performed on cholesterol gallstone in vitro, and the weight of stone at each time point was recorded, meanwhile, methyl tert-butyl ether (MTBE) was used as the control. The inhibitory effects of MTBE, TBA and EB on proliferation of human normal liver cell line LO2 were analyzed by cell proliferation inhibition assay. Flow cytometry was used to analyze the effects of MTBE, TBA and EB on the early and late apoptosis of LO2 cells, and the changes of reactive oxygen species level in LO2 cells were also analyzed.Results:Of the 10 gallbladder gallstones, 6 were cholesterol gallstones and 4 were non-cholesterol gallstones. Stone dissolution experiment showed that the remaining stones of MTBE, TBA and EB groups were (47.83±3.84)%, (58.12±4.53)% and (75.75±4.61)% 30 minutes later. The remaining stones were (18.38±6.47)%, (33.82±6.22)% and (56.38±3.91)% 90 minutes later. MTBE had the best stone dissolution effect in vitro, the stone dissolution effect of TBA was slightly weaker than MTBE, and the stone dissolution effect of EB was relatively weak in all ( P<0.05). The cell proliferation inhibition experiment showed that the cell viability of the control group, MTBE group and TBA group were (100.00±4.46)%, (96.79±4.32)% and (93.72±3.51)%, respectively, and there were no significant differences among the three groups ( P>0.05). However, the cell viability of EB group (87.57±5.29)% was lower than the above three groups, and the differences were statistically significant ( P<0.001). The early apoptosis and late apoptosis of the control group were (1.67±0.15)% and (1.27±0.06)%, respectively. EB induced early apoptosis (15.90±0.53)% ( P<0.001) and late apoptosis (5.13±0.76)% ( P<0.05). However, MTBE and TBA had no significant effect on cell apoptosis ( P>0.05). Compared with control group, MTBE, TBA and EB all significantly inhibited the level of reactive oxygen species ( P<0.05), and the inhibitory effect of EB was the most obvious. Conclusions:TBA has good stone dissolution effect and biosafety for gallbladder cholesterol stones in vitro, while EB has relatively poor performance. TBA is a potential drug for gallstone dissolution.
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Objective:To analyze and compare the features of undifferentiated-typed early gastric cancer (UD-EGC) and gastric mucosa-associated lymphoid tissue(MALT) lymphoma under white light endoscopy (WLE) and magnifying endoscopy-narrow band imaging (ME-NBI).Methods:Data of patients with complete endoscopic images of WLE and ME-NBI in Shanghai General Hospital, Shanghai Jiao Tong University from March 2015 to July 2019 were retrospectively analyzed.Twenty-six UD-EGC patients and seven gastric MALT lymphoma patients in ⅠE1 stage were included, and the characteristics of the two diseases under WLE and ME-NBI were compared and summarized.Results:There were no significant differences in age, sex or infiltration depth of lesions between the two groups.Under WLE, UD-EGC was often manifested as a single lesion located in the lower part of the stomach, with unclear lesion boundaries. While MALT lymphoma lesions were mostly multifocal with clear boundaries, located in the middle of the stomach. Under ME-NBI, the microsurface pattern of UD-EGC showed dilation or disappearance of areas between the recesses, and the spiral microvascular pattern. However, the microsurface pattern of MALT lymphomas were characterized by " cross-road traffic sign" , " pebble sign" , and the presentation of residual glandular duct at the lesion was similar to that of Helicobacter pylori ( HP)-related gastritis. Furthermore, the microvascular pattern of MALT lymphomas often showed " tree like appearance (TLA)" . After HP eradication therapy, the morphology of microsurface pattern and microvascular pattern in the original lesion area gradually returned to normal. Conclusion:UD-EGC and gastric MALT lymphoma showed particular features in the number, site and boundary under WLE, and they showed significantly different microsurface pattern and microvascular pattern under ME-NBI. Differentiation of the two diseases will help reduce the risk of missed diagnosis and misdiagnosis.
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Background: The mouse model of high-fat diet-induced cholesterol gallstone is widely used in researches of pathogenesis, prevention and treatment of gallstones. Aims: To investigate the characteristics and hepatic transcriptomics of the mouse model of high-fat diet-induced cholesterol gallstone. Methods: Twenty male C57BL/6J mice were randomly allocated into chow diet (control) group and lithogenic diet (LD) group. After 8 weeks, the occurrence of gallstone was observed; the serum lipids and gallbladder bile lipids were detected; and the differentially expressed hepatic genes between the two groups were identified with Illumina NovaSeq sequencing systems. The enrichment analysis was mapped in GO and KEGG pathway databases. Real-time PCR was used to detect the expressions of genes related to bile acid synthesis in the liver. Results: The cholesterol gallstone formation rate was 100% in LD group, whereas no gallstone was observed in control group. Hepatomegaly and steatosis were obvious in mice of LD group. The serum levels of total cholesterol and triacylglycerol, as well as the cholesterol content and cholesterol saturation index of the gallbladder bile in LD group were significantly higher than those in control group (P<0.05). A total of 1 330 differentially expressed genes were identified by high-throughput sequencing and bioinformatics analysis. KEGG analysis showed that the differentially expressed genes were mainly enriched in lipid metabolism, bile secretion, and insulin secretion pathways. GO analysis showed that fatty acid metabolic process-related pathways were significantly enriched. Both hepatic transcriptomics analysis and real-time PCR showed that the expression levels of genes related to bile acid synthesis, including CYP7A1, CYP8B1 and CYP7B1 decreased significantly in the liver of LD group as compared with those of control group (P<0.05). Conclusions: The metabolism of cholesterol, bile acids and fatty acids is significantly disordered in mice with cholesterol gallstone. Transcriptomics analysis can screen out the differentially expressed genes that play roles in the formation of cholesterol gallstone, so as to provide references for studies focusing on these topics.
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Background:Cholangitis is common in patients with advanced cholangiocarcinoma after endoscopic metal biliary endoprothesis (EMBE). Aims:To explore the effect of EMBE combined with endoscopic nasobiliary drainage (ENBD)on preventing post-ERCP cholangitis in patients with cholangiocarcinoma. Methods: A total of 263 advanced cholangiocarcinoma patients underwent EMBE were enrolled and divided into EMBE group and EMBE plus ENBD group. Incidence of post-ERCP cholangitis,adverse event rate and hospital stay were evaluated between the two groups. Results:Compared with EMBE group,incidence of post-ERCP cholangitis (2. 3% vs. 10. 8%,P ＝0. 032 )and hospital stay [(4. 68 ± 1. 43)days vs. (5. 18 ± 1. 45 )days,P ＝0. 011 ]were significantly lower in EMBE plus ENBD group, especially in patients with hilar cholangiocarcinoma [incidence of post-ERCP cholangitis:3. 5% vs. 15. 0%,P＝0. 045;hospital stay:(5. 18 ± 1. 44)days vs. (5. 68 ± 1. 39)days,P＝0. 033]. C-reactive protein,white blood cell count, percentage of neutrophil after 3,24,72 hours were significantly decreased in EMBE plus ENBD group than in EMBE group (P＜0. 05). No significant difference in procedure-related adverse event was found between the two groups (P＞0. 05). Conclusions:The combination of EMBE with ENBD is safe and effective in preventing post-ERCP cholangitis,especially in patients with hilar cholangiocarcinoma.
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Background:As the endogenous inhibitor of interleukin(IL)-22,IL-22 binding protein(IL-22BP)inhibits the protective effect of IL-22. Expression and significance of IL-22BP in intestinal mucosa of patients with active inflammatory bowel disease(IBD)remain unclear. Aims:To investigate the expression and significance of IL-22BP in intestinal mucosa of patients with active IBD. Methods:A total of 25 Crohn's disease(CD)and 36 ulcerative colitis(UC)patients from Jan. 2017 to Jan. 2018 at Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine were enrolled, and 30 colonic polyp patients were served as controls. The disease activity of CD and UC was assessed. Expressions of IL-22BP mRNA and protein in intestinal mucosa were determined by real-time fluorescent quantitative PCR and immunohistochemistry,respectively. Correlation of IL-22BP protein expression with the disease activity of CD,UC was analyzed. Results:Compared with corresponding control group,expressions of IL-22BP mRNA in intestinal mucosa in CD and UC groups were significantly increased(CD:3.59 ± 0.83 vs. 1.08 ± 0.45,P<0.001;UC:2.19 ± 0.52 vs. 1.05 ± 0.34,P<0.001),and expressions of IL-22BP protein were also significantly increased(CD:6.12 ± 2.30 vs. 1.83 ± 1.86,P<0.001;UC:5.58 ± 2.27 vs. 2.23 ± 1.77,P<0.001). Expression of IL-22BP protein in intestinal mucosa was positively correlated with disease activity of CD(r =0. 649,P <0. 001)and UC(r =0. 732,P <0.001). Conclusions:Expressions of IL-22BP mRNA and protein are increased in intestinal mucosa of patients with active IBD, and the expression of IL-22BP protein is positively correlated with disease activity of IBD.
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Background:Dissolution therapy is used as an alternative to surgery in patients with gallbladder stone and contraindication for surgery.Finding medicines with optimal litholysis effect and low cytotoxicity is of great importance in clinical practice.Aims:To study the litholysis effect and biological safety of different ethers for gallbladder stones.Methods:Methyl tertiary-butyl ether (MTBE),ethyl tertiary-butyl ether (ETBE),ethylene glycol mono-tert-butyl ether (ETB),and di (ethylene glycol) tert-butyl ether (DETB),arranged by the order of relative molecular weight,were used to dissolve the gallbladder stones in vitro.Normal human liver cell line LO2 was treated with the above mentioned four ethers,and the cell viability was assessed by CCK-8 assay for analyzing the proliferative toxicity.Thirty Sprague-Dawley rats were administered intragastrically with the four ethers for 2 weeks,and then the serum biochemical indices and histopathology of liver,lung,kidney,stomach,duodenum and jejunum were examined.Results:The litholysis effect of MTBE was the most prominent (P ＜ 0.05);that of ETB and DETB were weaker than ETBE (P ＜ 0.05) but still had a substantial effect.CCK-8 assay showed that ETBE was the most toxic ether (P ＜ 0.05),and the proliferative toxicity of ETB and DETB was similar (P ＞ 0.05).Except for the slightly increased serum AST in MTBE,ETBE and ETB groups (P ＜ 0.05),the four ethers had no significant impact on serum biochemical indices and histopathology of multiple organs of the model rats.Conclusions:The increase of relative molecular weight of ether may reduce its litholysis effect,but meanwhile its biological safety is increased.
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Inflammatory bowel disease (IBD)is a chronic inflammatory disease of the digestive tract,including Crohn's disease (CD)and ulcerative colitis (UC). The cause and pathogenesis of IBD is not fully clear,and the disorder of immune function plays a key role in the pathogenesis of IBD. Th17 cells are CD4 + T cells that can specifically produce IL-17. Recent studies have demonstrated that Th17 cells play an important role in the abnormal immune response of IBD. This article reviewed the role of Th17 cells in the pathogenesis of IBD.
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Inflammatory bowel disease (IBD)is a chronic inflammatory disease of the digestive tract,including Crohn's disease (CD)and ulcerative colitis (UC). The cause and pathogenesis of IBD is not fully clear,and the disorder of immune function plays a key role in the pathogenesis of IBD. Th17 cells are CD4 + T cells that can specifically produce IL-17. Recent studies have demonstrated that Th17 cells play an important role in the abnormal immune response of IBD. This article reviewed the role of Th17 cells in the pathogenesis of IBD.
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Background: Early diagnosis and staging of liver fibrosis are important for the prognosis and evaluating the survival of patients.Aims: To systematically assess the diagnostic value of transient elastography (TE) for staging of liver fibrosis in patients with chronic liver disease.Methods: PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP from Jan.2001 to Dec.2015 were retrieved to collect the articles with staging of liver fibrosis in patients with chronic liver disease by TE.Data extraction was conducted.Article quality was evaluated by quality assessment of diagnostic accuracy studies 2 (QUADAS2).Meta-analysis was conducted by Stata 12.0 software.Results: Twenty articles involving 5 748 patients were included.Meta-analysis showed that the combined sensitivity,specificity and AUC of TE for diagnosing significant fibrosis (≥F2) were 0.78 (95％ CI: 0.73-0.82),0.85 (95％ CI: 0.80-0.88) and 0.88 (95％ CI: 0.85-0.91),respectively.The combined sensitivity,specificity and AUC for advanced fibrosis (≥F3) were 0.89 (95％ CI: 0.86-0.91),0.88 (95％ CI: 0.85-0.91) and 0.94 (95％ CI: 0.92-0.96),respectively.The combined sensitivity,specificity and AUC for cirrhosis (F4) were 0.91 (95％ CI: 0.86-0.95),0.89 (95％ CI: 0.87-0.92) and 0.95 (95％ CI: 0.93-0.97),respectively.Conclusions: TE technique has a good diagnostic value in assessing significant fibrosis,advanced fibrosis and cirrhosis in patients with chronic liver disease,especially for advanced fibrosis and cirrhosis.
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Objective To develop a new silicone coating iodine-125 (s-125I) radioactive stent, and to compare it with the traditional titanium coating iodine-125 (t-125I) radioactive stent.Methods Medical silicone solution was mixed with 125I solution, evenly applied to specific locations of stents to make the silicone-coated 125I stents.The total radioactivity of 125I solution was 24mCi, by which 20 silicone-coated 125I stents were made.A total of 20 traditional titanium stents of the same radioactivity were collected, and the utilization rate of the radionuclides of the two types of stents were compared.Results With the same amount of radioactivity, the s-125 I stent showed a higher utilization rate of nuclide [91.2％ (21 878/24 000) VS 50.1％ (12 031/24 000)] (P ＜ 0.05).Conclusion The s-125I stent has a high utilization rate of nuclide,which can save the cost and energy largely.However, the application of the s-125I stent still needs further research.
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ObjectiveTo establish a new model of biliary peffusion in vitro,and to explore the feasibility of comparative biliary studies with the model.MethodsA set of ten-text-area model of biliary peffusion was designed in vitro.Saline,glycerol and pig bile were put into this model.The outflow of the first tube was set at 8 drops/min,and these liquids were collected through the ten sample test areas and measured at 0.5 hour,1.0 hour,1.5 hours,2.0 hours,12.0 hours and 24.0 hours.Equality of liquid amount was evaluated from each sample test area.Rods containing delayed release EDTA of ten different levels were placed in the test areas.The liquid was collected and EDTA concentrations were evaluated from the ten tubes at 24.0 hours.EDTA concentrations of the same rod in the three liquids were compared.ResultsA(1) the same time point,the amounts of saline,glycerol,pig bile flowing through the ten sample test areas showed no significant difference (P ＞ 0.01 ) ; but EDTA concentrations of the same liquid at 24.0 hours were significantly different (P ＜ 0.01 ) ; and EDTA concentrations of the same rod in the three liquids were also obviously different ( P ＜ 0.01 ).ConclusionThe same liquid flow rates and the same experimental environment can be achieved.Different test results can be obtained from different test areas in different experiments.The test results of the same kind of sample change with the changes of experimental conditions,which simulates biliary duct.
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ObjectiveTo investigate the effect of vasostatin on the migration of pancreatic cancer endothelial cells.Methods Ad-vasostatin with different concentrations of vasostatin was used to transfect pancreatic cancer endothelial cells.Ad-LacZ transfection and PBS was used as control.The effect of vasostatin gene mediated by adenovirus on the migration of pancreatic cancer endothelial cells was measured by woundhealing assay,transwell migration assay,and tube formation assay.ResultsThe scratched lines in PBS group and Ad-LacZ group were almost healed 48 hours later,while the lines in Ad-vasostatin group were rarely healed.At the MOI of 1,2,5,the migration rate of Ad-Laz group was ( 84.7 ± 2.6) ％,(80.7 ± 1.7 ) ％ and (81.3±4.0)％,while the corresponding values were (77.7 ±2.1)％,(67.3 ±2.1)％ and (38.8 ±2.1 ) ％ in Ad-vasostatin group.Transwell migration assay indicated that the number of migrated cells in Advasostatin group was inhibited in a dose-dependant manner,at the MOI of 5,the migration became significantly decreased (F=180.88,P ＜0.05).At the MOI of 1,5,10,the number of tubes in Ad-LacZ group was 118±6,120±6 and 82±5,while the corresponding values were 65±4,21±4 and 4 ±1 in Ad-vasostatin group.The number of tubes of pancreatic cancer endothelial cells was inhibited by Ad-vasostatin in a dose-dependant manner,at the MOI of 10, it was difficult to form the tubes (F-300.85,P＜0.05). Conclusions The vasostatin gene mediated by adenovirus has a significant inhibitory effect on the migation of pancreatic cancer endothelial cells in vitro in a dose-dependent manner.
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Objective To evaluate the therapeutic effect of endoscopy for patients with anastomotic or nonanastomotic biliary strictures after liver transplantation.Methods Clinical and follow-up data of 56 patients,38 (67.9％) with anastomotic strictures (AS),and 18 (32.1％) with nonanastomotic strictures (NAS) after liver transplantation,who underwent endoscopic therapy were collected and analyzed.Results Compared to AS patients,NAS patients showed shorter time from liver transplantation to initial presentation (4.45 ± 1.47 vs.8.00 ±2.31 months,P =0.000),underwent more ERCP procedures (6.20 ±1.28 vs.4.11 ± 1.51,P =0.000) and received more stents (10.20 ±3.59 vs.7.53 ±2.12,P =0.001).Although the success rate was not statistically different,patients with NAS needed longer treatment duration and had higher recurrence rate (50.0％ vs.18.2％,P =0.033) as well as shorter duration from treatment to recurrence.Among patients with AS,the treatment failure group had longer stricture length (13.00 ±3.61 vs.6.63 ±2.09,P =0.000) than the success group and the patients who experienced recurrence had longer stricture length (10.48 ± 1.07 vs.5.86 ± 1.55,P =0.000) and narrower stricture diameter (1.52 ± 0.38 vs.1.94 ± 0.32,P =0.001).Among NAS patients,the multiple biliary strictures group had lower success rate and higher recurrence rate,but with no statistical significance (62.5％ vs.90.0％,P =0.275 and 66.7％ vs.37.5％,P =0.592,recpectively).Conclusion NAS patients have lower response to endoscopic treatment than AS patients.The length and diameter of biliary stricture in AS as well as the number of stricture in NAS may influent the effect of endoscopic treatment.
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Objective To explore the biological characteristics of pancreatic cancer vascular endothelial cells,including the aspects of morphology,species,genetics,vascular formation ability,and proliferation ability in vitro.Methods The human pancreatic cancer cells were inoculated in nude mice pancreas to get pancreatic cancer vascular endothlial cell.The pancreatic cancer vascular endothelial cells were cultured in vitro.The passage number and passage time were recorded.The morphological features under common microscopy of each passage were observed.The species origin and genetic characteristics of the pancreatic cancer vascular endothelial cells were detected by karyotype assay.The ability of angiogenesis of the pancreatic cancer vascular endothelial cells in vitro was determined by tube formation assay.The proliferation of the pancreatic cancer vascular endothelial cells in vitro was measured by MTT method.The data were analyzed by one way analysis of variance and paired difference test.Results Under appropriate culture condition, the pancreatic cancer endothelial cells were passaged every two to three days.Once confluence was attained,the cells were in monolayer growth and with cobblestone feature.The species type of the pancreatic cancer vascular endothelial cells was human type.A large number of polyploid cells, non-integer multiple chromosomes cells, nuclear chromosome loss, nuclear chromosome dislocation, and unanalyzable fragments were observed.The pancreatic cancer vascular endothelial cells could form a hollow tubular structure in vitro.After cultured for 48 and 72 hours,the absorbance of the pancreatic cancer vascular endothelial cells was 0.581 ± 0.014 and 1.082 ± 0.033 respectively,both were significantly higher than those of human umbilical vein vascular endothelial cells (0.379± 0.038,t=8.720,P=0.001;0.604±0.026,t=19.883,P＜0.01).Conclusions The species origin of pancreatic cancer vascular endothelial cells is same as human pancreatic cancer cells.The cells have typical morphological features and in vitro angiogenesis formation ability of vascular endothelial cells,whose genetic feature is instable and proliferation is active.
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Objective To evaluate the effect of small endoscopic sphincterotomy and endoscopic balloon dilatation in the treatment of common duct stones (CDS) in patients with atypical papillae (combined with diverticula; after surgical operation; combined with abnormal duodenal lumen with no definite cause).MethodsOne hundred and three patients with CDS and with atypical papillae treated from July 2007 to March 2010 were randomly divided into three groups.Thirty-four patients received endoscopic sphincterotomy (EST group),34 patients received endoscopic balloon dilatation (EBD group) and the remaining 35 patients received small endoscopic sphincterotomy and endoscopic balloon dilatation (EST+EBD group).The general state of the patients in the 3 groups showed no significant difference (P＞0.05).We tried to remove all CDS using baskets and/or balloons after the procedures on the papillae.In some patients the stones were crushed by using a basket mechanical lithotriptor (BML).In some patients with huge stones,we could only placed in a plastic stent because of the high risk of removing the stones in a single procedure.ResultsSuccessful endoscopic retrograde cholangiopancreatography (ERCP) was carried out in 96 patients.Patients in the EST+ EBD group had less complications,especially hemorrhage,when compared with the EST group (P＜0.05).Also,the EST+EBD group had a significantly higher success rate of complete stone removal (P＜0.05),decreased use of BML (P＜0.05) and decreased rate of acute pancreatitis when compared with the EBD group (P＜0.05).ConclusionsThe success rate of ERCP in managing patients with CDS with atypical papillae remained high.Small endoscopic sphincterotomy and endoscopic balloon dilatation had a higher success rate of removing stones at the first attempt and a decreased rate of complications.
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Objective To compare and analyze the kinetics changes of lower esophageal sphincter (LES) and esophageal body of achalasia after treated by simple dilation, dilation with botulinum toxin injection and stenting under endoscope. Methods The 99 clinical diagnosed achalasia cases were divide into simple dilation group, dilation with botulinum toxin injection group and stenting group, which were treated with simple dilation, dilation with botulinum toxin injection and stenting respectively. The resting pressure of LES, relaxing ratio, the percentage of concordant and discordant contraction of esophageal body and the contraction range at 10 cm above LES were tested. The variation of each indicator was compared and analyzed before and after the operation. Results Before treatment, the value of the resting pressure of LES, the percentage of discordant contraction,contracting amplitude of esophageal body was higher than normal, while the relaxing ratio of LES and percentage of concordant contraction of esophageal body was lower. There was no significant difference between 3 groups. One week after the treatment, there was no statistic difference in the variation of each indicator compared with pre-operation in 3 groutps. Six months after the treatment, theimprovement of LES resting pressure, relaxing rate and contracting amplitude of esophageal body in dilation with injection group and stenting group were better than those of dilation group (P was 0.041,0.006,0.037and 0. 029,0.004,0.033 respectively). However there was no statistic difference between dilation with injection group and stenting group. Twelve months after treatment, the improvement of LES resting pressure, relaxing ratio, the percentage of concordant contraction and contracting amplitude of esophageal body in stenting group were better than those of dilation group (P was 0.035,0.028, 0. 008, and 0. 007 respectively). However there was no statistic difference between dilation with injection group and simple dilation group. Conclusion Simple dilation, dilation with botulinum toxin injection and stenting are effective methods of achalasia treatment. The effect in near future is significant, while the long-term recurrence is in rising trend as time extension. The effect of stenting is better than the other two methods in the long-term.
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Objective To investigate the factors predicting endoscopic stone extraction complications during operation and 1 week within operation. Methods The clinical data of 136 patients with common duet stones during endoscopic procedures and 1 week within procedures were collected, and the impacts of the number, size of stones, and the first-attack versus recurrent-attack stone, with or without cholangeitis on the complications during operation and 1 week within operation were analyzed, and the effect of nasobiliary drainage was investigated. Results The success rate in single-stone group was high, the incidences of complications during endoscopy including sphincter hemorrhage, cardiac laceration, hyperamylasemia, acute pancreatitis were significantly lower than those in the multi-stones group ( P < 0. 05 ). The group of < 2 cm stone also had high success rate of stone extraction, the incidences of complications including sphincter hemorrhage, stone impaction, cardiac laceration, hyperamylasemia, acute pancreatitis were significantly lower than those in the ≥2 cm group. The first-attack group had low success rate of stone extraction, the incidences of complications including sphincter hemorrhage, stone impaction, hyperamylasemia, acute pancreatitis and biliary infection were significantly higher than those in the recurrent-attack group. The patients with cholangeitis had low success rate of stone extraction, the incidences of complications including sphincter hemorrhage, hypoxemia, hyperamylasemia, acute pancreatitis and biliary infection were significantly higher than those without cholangeitis. After nasobiliary drainage, the incidences of hyperamylasemia, acute pancreatitis and biliary infection significantly decreased while the incidence of sphincter hemorrhage significantly increased. Conclusions The number, size of stones, and the first-attack versus recurrent-attack stone, symptoms with orwithout cholangeitis could predict the complications of stone extraction;post-ERCP nssobiliary drainage could decrease the complications, but increase the possibility of sphincter hemorrhage.
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Objective Re stenosis is the common complication of stenting. This study was designed to investigate the functional changes of fibroblast in local re stenosis esophageal tissue after stenting and its relation to re stenosis. Methods Sixteen healthy adult dogs were divided into four groups. Esophageal stent was placed by means of “autogenous broad fascia transplantation and fixation”. At the end of 1,2,4 and 8 weeks,the dogs were killed, and the esophageal tissue with stent were taken out and analyzed by gross observation, light microscopy and electron microscopy. The expression of proliferation cell nuclear antigen (PCNA) and alpha smooth muscle actin (? SMA) in esophageal tissue at 1,2,4 and 8 weeks after stenting were studied by immunohistochemistry. The contents of hydroxyproline and gross amino acid(AA) in re stenosis tissue were measured by amino acid analysis. Results At week 1 and 2 the inflammatory reaction occurred evidently in stented esophagus, with granulation and fibrosis; in some places esophageal tissues began to proliferate towards the lumen. At week 1 some fibroblasts began to express PCNA and ? SMA, and at week 2 the expression augmented significantly. The content of hydroxyproline and AA was significantly higher in the esophageal tissues at 1 and 2 weeks after stenting than that in normal esophagus. At week 4 and 8 esophageal lumen became narrow conspicuously, with a lot of fibrotic tissue and few inflammatory cells. Only a few fibroblasts displayed the expression of PCNA instead of the expression of ? SMA at week 4. There was no expression of PCNA and ? SMA at week 8. The content of AA at week 4 increased significantly compared with that at week 2, and the level was similar between 4 and 8. Electron microscopy revealed that the fibroblasts were in the state of vigorous proliferation and secretion in esophageal tissue at week 2, and a lot of fibrotic tissue formed at week 8. Conclusions Re stenosis mainly expressed as granulation and fibrosis. At week 4 and 8 the fibrosis becomes stable gradually with the lessening of inflammatory reaction. Within 4 weeks of stenting fibroblast retains active proliferation and secretion, but after week 4 the function of fibroblasts gradually lessen or even lose.
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Objective To investigate the effect of antiulcer agents Omeprazole, Misoprostol and Talcid on the gastric mucosa lesion by analyzing the gastric mucosa cell apoptosis and proliferation and CX43 transcriptional expression. Methods Mucosa lesion were evaluated by UI, 32 mice were randomly divided in equal numble into Omprazole (O), Misoprostol (M), Talcid (T), Comparison (C). Apoptosis cells in gastric mucosa were quantitated by terminal deoxynucleatidyl transferase mediared dUTP nick and labelling (TUNEL) techniques, while the expression of PCNA proteins were detected by immunohistochemical staining, CX43 mRNA was detected by In situ hyberdization. at 2h after WRS. Results We found that in comparison with control group, the group of pretreatment with Omeprazole, Misoprostol and Talcid showed a significant reduction in damaged mucosa and epithelial cell apoptosis and increase in the expression of PCNA proteins, and the effect of Omeprazole and Misoprostol was better than Talcid. All three antiulcer agents increased CX43 mRNA expression, the effect of Misoprostol and Talcid was better than Omeprazole. Conclusions Omeprazole, Misoprostol and Talcid can attenuate the multiple gastric mucosa lesion induced by WRS. It may be the ultimate way to prevent and cure stress ulcer by exerting direct cytoprotective effect to improve the cell ability and inhibit stress injury.