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Objective To investigate the effect of targeting vascular endothelial growth factor (VEGF) by microRNA-126 (miR-126) on neuronal damage in neonatal rats with hypoxic-ischemic encephalopathy (HIE). Methods Newborn 7 days old SD male rats were randomly divided into four group, sham operation group (group A), HIE group (group B), HIE+negative control group (group C), and HIE+miR-126 overexpression group (group D), eighteen in each group. After modeling, neurological deficit score and brain water content were measured. HE staining was used to observe the pathological changes of CAI area in hippocampus of brain in each group. Real-time PCR was used to detect the expression of miR-126 and VEGF. Immunohistochemistry was used to detect the expression of VEGF in CAI area in hippocampus of brain. Double luciferase target experiment was used to verify the targeting relationship between miR-126 and VEGF gene. Flow cytometry was used to detect neuron apoptosis in hippocampus. Western blotting was used to detect the expression of cleaved-Caspase-3 protein in brain tissue of rats in each group. Results There was no neurobehavioral damage in group A, the neurobehavioral score was 0, and the brain tissue was not damaged; the neurobehavioral scores in group B and group C were (2. 50±0. 55) and (2. 33±0. 82) respectively, and the brain tissue damage was obvious; the neurobehavioral score in group D was ( 1. 50 ±0. 55), and the damage of brain tissue was improved. Compared with the group A, the neurobehavioral score (P<0. 05) and brain water content of group B and group C increased significantly (P<0. 05); Compared with the group B, the neurobehavioral score (P<0. 05) and brain water content of group D (P<0. 05) decreased. Compared with the group A, the expression level of miR-126, VEGF mRNA and protein, neuron apoptosis rate and cleaved-Caspase-3 in brain tissue of group B and group C were all significantly lower (P<0. 05). Compared with the group B, the expression level of miR-126, VEGF mRNA and protein, neuron apoptosis rate and cleaved-Caspase-3 in hippocampus of group D were all significantly higher (P<0. 05). The result of luciferase reporter gene experiment showed that miR-126 and VEGF could be targetly binded. Conclusion Overexpression of miR-126 can reduce neuronal apoptosis in hippocampus of brain and improve the development of HIE. The mechanism may be related to the targeted inhibition of VEGF gene expression by miR-126.
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<p><b>OBJECTIVE</b>To identify the factors that affect the safety and efficacy of peroral endoscopic myotomy (POEM) for treatment of achalasia.</p><p><b>METHODS</b>Data of consecutive patients undergoing POEM for confirmed achalasia between December, 2010 and December, 2015 were collected, including the procedure time, approach of tunnel entry incision, approach of myotomy, complications and follow-up data.</p><p><b>RESULTS</b>Among the total of 439 patients enrolled, the overall complication rate was 28.7% (126/439). Treatment success (Eckardt score≤3) was achieved in 94.5% of 364 patients followed up for a median of 6 months (1-48 months), and the mean score was reduced significantly from 6.7∓1.5 before treatment to 1.2∓1.1 after the treatment (P<0.05). Logistic regression revealed that the year when POEM was performed and the approach of entry incision were two significant factors contributing to complications: with the year 2015 as the reference, the odds ratio (OR) was 9.454 (95% CI: 2.499-35.76) for the years before 2011, 2.177 (95% CI: 0.794-5.974) for 2012, 3.975 (95% CI: 1.904-8.298) for 2013, and 1.079 (95% CI: 0.601-1.940) for 2014; with the longitudinal entry incision as the reference, the OR was 0.369 (95% CI: 0.165-0.824) for inverted T entry incision and 0.456 (95% CI: 0.242-0.859) for transverse entry incision. The approach of myotomy was the significantly associated with symptomatic relapse: with full-thickness myotomy combined with indwelling an anti-reflux belt as the reference, the OR was 0.363 (95% CI: 0.059-2.250) for gradual full-thickness myotomy, 2.137 (95% CI: 0.440-10.378) for circular muscle myotomy, and 4.385 (95% CI: 0.820-23.438) for circular muscle myotomy in combination with balloon shaping; the recurrence rate was 0 with a full-thickness myotomy.</p><p><b>CONCLUSION</b>The complication rates of POEM appears to decrease over time, and an inverted T entry incision is the best choice for controlling the complications. Gradual full-thickness myotomy is an excellent approach for treatment of achalasia in terms of the relapse rate, procedure time and the incidence of reflux esophagitis.</p>
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Humans , Endoscopy , Esophageal Achalasia , General Surgery , Esophagitis, Peptic , General Surgery , Gastroesophageal Reflux , Muscles , General Surgery , Recurrence , Treatment OutcomeABSTRACT
<p><b>BACKGROUND</b>Magnifying narrow-band imaging has enabled observation of the mucosal and vascular patterns of gastrointestinal lesions. This study investigated the potential value of magnifying endoscopy with narrow-band imaging for the classification of gastric intraepithelial neoplasia.</p><p><b>METHODS</b>Seventy-six patients with gastric intraepithelial neoplasia (82 lesions) at People's Liberation Army General Hospital from December 2009 to November 2010 were analyzed. All patients underwent magnifying endoscopy with narrow-band imaging, and their lesions were differentiated into probable low-grade intraepithelial neoplasia or possible high-grade intraepithelial neoplasia on the basis of the imaging features. Pathologic proof was subsequently obtained by endoscopic submucosal dissection in every case. The validity of magnifying endoscopy with narrow-band imaging was calculated, considering histopathology to be the gold standard.</p><p><b>RESULTS</b>Magnifying endoscopy with narrow-band imaging showed 22 low-grade intraepithelial neoplastic lesions and 60 high-grade intraepithelial neoplastic lesions. Of the 22 low-grade intraepithelial neoplastic lesions, 16 showed the same results on both imaging and pathology. Of the 60 high-grade intraepithelial neoplastic lesions, 53 showed the same results on both imaging and pathology. Thus, the sensitivity of magnifying endoscopy with narrow-band imaging for high-grade intraepithelial neoplasia was 89.83%, which was higher than that for low-grade intraepithelial neoplasia (69.57%). However, the specificity for high-grade intraepithelial neoplasia (69.57%) was lower than that for low-grade intraepithelial neoplasia (89.83%). The overall accuracy of magnifying endoscopy with narrow-band imaging was 84.15%.</p><p><b>CONCLUSIONS</b>Magnifying endoscopy with narrow-band imaging can distinguish between gastric low- and high-grade intraepithelial neoplasia. It may be a convenient and effective method for the classification of gastric intraepithelial neoplasia.</p>