ABSTRACT
As a glucocorticoid drug with wide clinical application， triamcinolone acetonide can be administered by multiple routes， such as eye， nose， joint cavity， and skin， for the treatment of various local diseases such as arthritis， macular edema， rhinitis， and urticaria. As a drug with extremely low solubility in water， the dose form of triamcinolone acetonide is closely correlated with administration route and site. The dosage form of triamcinolone acetonide administered via injection（including joint cavity injection， vitreous injection， suprachoroidal injection， intramuscular injection） is mainly suspension， and the representative drugs include Kenalog-40®， Zilretta®， Triesence®， Xipere®， etc.； the dosage forms of nasal mucosal administration are mostly sprays， and the representative drug is Nasacort®； the dosage forms of oral mucosal administration are mostly patches， ointments and creams， and the representative drug is Oracort®； the dosage forms for transdermal administration are mostly ointments， creams and lotions， and the representative drugs include Trianex®， Teva-Triacomb®， etc. At present， the research on dosage forms of triamcinolone acetonide by various administration routes mainly focuses on the construction of delivery carriers， the addition of cosolvents or the use of new delivery tools.
ABSTRACT
@#Objective To prepare recombinant F protein vaccine of respiratory syncytial virus(RSV) and evaluate its immunization effect.Methods Two RSV vaccines based on RSV F protein were prepared:one was a mucosal vaccine with bacterial like particle(BLP)as adjuvant and the other was an injectable vaccine with aluminium hydroxide as adjuvant.Forty female BALB/c mice were randomly divided into four groups:BLP-F,BLP control,AL-F and AL control group,with 10mice in each group.BLP-F and BLP control group were inoculated intranasally,and AL-F and AL control group were inoculated subcutaneously.The mice were immunized once each at day 0,14 and 28,respectively.Two weeks after the last immunization,the titers of serum IgG antibody and IgA antibody in nasal lotion were detected by ELISA,and the titers of neutralizing antibody were detected by plaque test.Results Both vaccines induced high levels of serum binding antibodies and neutralizing antibodies,and the induction capacity of injected vaccine was stronger than that of mucosal vaccine.The injected vaccine induced the increase of IgG in serum,which was about 10 times higher than the mucosal immune response,but could not induce the increase of IgA.However,the mucosal vaccine induced the high level of mucosal IgA,but the serum IgG antibody was relatively low.Conclusion Both vaccines based on RSV F protein are promising candidates,and each vaccine has its own advantages.Follow-up studies will evaluate the feasibility of these two vaccines as immunogens using a combination immunization approach to simultaneously enhance systemic and mucosal immune responses against RSV.
ABSTRACT
@#Adjuvant is the key factor for many new vaccines to play a protective role. The addition of adjuvant can not only reduce the amount of antigen,but also increase the immunogenicity of its antigen,and stimulate the strong immune response of body. Chitosan,as the product of natural polysaccharide chitin removing part of acetyl group,has the characteristics of adhesion,permeability,biocompatibility and so on,and has been widely studied and applied as a vaccine adjuvant. As a novel adjuvant,it can not only help to induce cellular and humoral immunity,but also activate mucosal immunity. This review discussed the recent progress of chitosan and quaternized chitosan as vaccine adjuvants and the related mechanism.
ABSTRACT
Objective@#To investigate the clinical effects of sinus elevation surgery and implant restorationdue to insufficient bone massafter tooth extraction in patients with odontogenic maxillary sinusitis (OMS) and to provide a reference for use in clinical practice.@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Forty-five teeth were extracted from patients with OMS in the maxillary posterior area (the study group). Sinus elevation and implantation were performed due to insufficient bone height in the implant area 6-8 months after tooth extraction in the study group. Forty-eight teeth were extracted from patients without "OMS" in the maxillary posterior area (the control group), and sinus elevation and implantation were performed due to insufficient bone height in the implant area 6-8 months after tooth extraction inthe control group. In the study group, 13 cases of discontinuous maxillary sinus floor bone and residual alveolar bone height of the maxillary sinus floor less than 4 mm were addressed with lateral wall sinus elevation, and the other 32 cases were addressed with crest-approach sinus elevation. In the control group, 8 cases of residual alveolar bone height less than 4 mm in the maxillary sinus floor were addressed with lateral wall sinus,and the other 40 cases were addressed with crest approach sinus elevation. Restorations were placed 6 to 8 months after surgery. The patients were followed up 21 days, 3 months, and 8 months after implantation and every 6 months after the placement of the restorations. The sinus bone gain (SBG), apical bone height (ABL) and marginal bone loss (MBL) were statistically analyzed 24 months after the restoration.@*Results@#The average preoperative mucosal thickness in the 45 patients in the study group was (1.556 ± 0.693) mm, which was significantly larger than that in the control group (1.229 ± 0.425) mm (P<0.001). There were no perforations in either group. Twenty-four months after restoration, there was no significant difference in the SBG, ABH or MBL between the two groups (P>0.05).@*Conclusion@#After the extraction of teeth from patients with OMS, the inflammation of the maxillary sinus decreased, and the bone height and density in the edentulous area were restored to a certain degree. The effects of sinus floor lifting surgery and implant restoration do not differ between patients with and without OMS.
ABSTRACT
Objective@#To evaluate the stability and aesthetic effect of a xenogeneic collagen matrix (mucograft) on achieving an adequate keratinized mucosa width (KMW) around implants and to provide a reference basis for the clinical application of xenogeneic collagen matrix materials.@*Methods@#The hospital ethics committee approved the study protocol, and the patients provided informed consent. Twenty patients with a KMW<2 mm at the buccal implant site who were treated in Binzhou Medical University Affiliated Yantai Stomatological Hospital from July 2020 to September 2022 were included, and a total of 36 implants were included. The mean age of the patients was (52.0±10.4) years, of which 18 were females and 2 were males. They were divided into a free gingival graft group (FGG, control group) and a xenogeneic collagen matrix group (test group) according to different graft materials. The incremental effect of the KMW on the buccal side of the implant and the mucosal shrinkage rate was measured at 1 month and 3 months after the operation. The mucosal scar index (MSI) was evaluated after the operation.@*Results@#At 3 months postoperatively, the KMW was (3.67 ± 1.06) mm in the control group and (2.96 ± 0.98) mm in the test group, and the difference was statistically significant (t = 2.076, P<0.05). The KMW shrinkage rate was (33.34 ± 16.30) % in the test group and (22.05 ± 15.47) % in the control group at 1 month postoperatively and (51.95 ± 12.60) % in the test group and (37.44 ± 16.30) % in the control group at 3 months postoperatively, with statistically significant differences between the two groups at the same time points (P<0.05). Three months after surgery, the test group showed significantly better outcomes than the control group in terms of the five scar indicators (scar width, scar convexity, scar color, scar trace, and overall appearance), and the difference was statistically significant (P<0.05).@*Conclusion@#Xenogeneic collagen matrix can increase the peri-implant KMW and achieve a more natural and coordinated soft tissue aesthetic effect but with a higher shrinkage rate.
ABSTRACT
El síndrome de Laugier-Hunziker (SLH) es un trastorno de hiperpigmentación macular benigno adquirido que se caracteriza por la presencia de máculas hiperpigmentadas policrómicas, de superficie plana, con morfología lenticular oval, de márgenes definidos; parte importante de éste es el desarrollo de melanoniquia longitudinal. Su principal diagnóstico diferencial es el síndrome de Peutz-Jeghers, ya que este último tiende a desarrollar neoplasias malignas en el tracto digestivo. Es importante que el estomatólogo conozca el SLH, con la finalidad de poder diagnosticarlo y diferenciarlo de otras entidades, particularmente de aquellas de carácter maligno (AU)
Laugier-Hunziker syndrome (LHS) is an acquired benign macular hyperpigmentation disorder, characterized by the presence of polychromic hyperpigmented macules, with a smooth surface, with oval lenticular morphology, with defined margins; An important part of this is the development of longitudinal melanonychia. Its main differential diagnosis is Peutz-Jeghers syndrome, since it tends to develop malignant neoplasms in the digestive tract. It is important that the Stomatologist knows the LHS, in order to be able to diagnose it and differentiate it from other entities, even those of a malignant nature (AU)
Subject(s)
Humans , Female , Middle Aged , Pigmentation Disorders , Hyperpigmentation , Diagnosis, Differential , Mexico , Mouth Mucosa/injuriesABSTRACT
ABSTRACT Purpose: The purpose of this study was to evaluate the long-term outcomes of patients with trichiasis treated with a modified interlamellar oral mucosa graft surgery technique using fibrin glue. Methods: A prospective study was conducted at the Oculoplastic Department of Ouro Verde Hospital Complex. Patients with recurrent trichiasis without entropion who did not respond to conventional therapy, underwent intermarginal lamellar splitting of the eyelid and oral mucous graft insertion with fibrin glue replacing sutures. They were then evaluated at 1-day, 1-week, 1-month, 6-month, and 4-year follow-ups. Graft adherence, symptom resolution, esthetic satisfaction, overall patient satisfaction, and trichiasis recurrence were assessed at 6-month and 4-year follow-ups. Results: Fifteen patients (a total of 19 eyes) were included, of whom 10 (66.7%) were female and 5 (33.3%) were male. The mean age was 75.4 ± 10.5 years (range, 54-98 years). Acquired trichiasis was the main cause. Of the patients with acquired trichiasis, 12 (86.7%) had chronic blepharitis, 2 (13.3%) had an undetermined cause, and one (6.7%) had trachomatous trichiasis. Most cases involved only one eyelid segment (89.4%) and =5 lashes (84.2%; minor trichiasis). No adverse reactions from the fibrin glue were reported and no sutures were required after graft placement. At 6 months, no graft failures occurred, 17 eyes of 13 patients (89.4%) showed good graft adherence, 2 eyes of 2 patients (10.5%) showed partial graft adherence, and 2 eyes of 1 patient (10.5%) had trichiasis recurrence. At 4-year follow-up, no graft failure occurred, 3 patients (3 eyes) were lost to follow-up, and 2 eyes of 2 patients (14.2%) had trichiasis recurrence. The 4-year cumulative success rate was 78.9%. Conclusions: The modified interlamellar surgery with fibrin glue showed a good long-term success rate. This technique reduces surgical time, facilitates smaller graft insertion, and therefore, should be considered for recalcitrant minor trichiasis without entropion.>
RESUMO Objetivo: O objetivo deste estudo foi avaliar os resultados a longo prazo da técnica cirúrgica modificada de enxerto interlamelar de mucosa oral usando cola de fibrina para o tratamento de triquíase. Métodos: Um estudo prospectivo foi realizado no Departamento de Óculo-plástica do Complexo Hospital Ouro Verde. Pacientes com triquíase recorrente sem entrópio, que não responderam à terapia convencional, foram submetidos à cirurgia com separação intermarginal das lamelas das pálpebras e inserção de enxerto de mucosa oral usando cola de fibrina, substituindo a sutura. Pacientes foram avaliados 1 dia, 7 dias, 1 mês, 6 meses e 4 anos após a cirurgia. A aderência do enxerto, resolução dos sintomas, satisfação estética, satisfação geral do paciente e recorrência de triquíase foram avaliados aos 6 meses e aos 4 anos. Resultados: Quinze pacientes (total de 19 olhos) foram incluídos, dos quais 10 (66.7%) eram do sexo feminino e 5 (33.3%) do sexo masculino. A média de idade foi 75.4 ± 10.5 anos (intervalo 54-98 anos). Triquíase adquirida foi a principal causa, da qual 12 pacientes apresentaram blefarite crônica (86.7%), 2 pacientes com causa indeterminada (13.3%) e 1 paciente com triquíase tracomatosa (6.7%). A maioria dos casos envolveu apenas um segmento da pálpebra (89.4%) e com =5 cílios (84.2%; triquíase menor). Nenhuma reação adversa foi reportada com o uso da cola de fibrina e nenhum caso necessitou de sutura após inserção do enxerto. Aos 6 meses, não houve nenhuma falha de enxerto, 17 olhos de 13 pacientes (89.4%) apresentaram boa aderência de enxerto, 2 olhos de 2 pacientes (10.5%) mostraram aderência parcial do enxerto e 2 olhos de 1 paciente (10.5%) apresentaram recorrência da triquíase. Aos 4 anos, não houve nenhuma falha de enxerto, 3 olhos de 3 pacientes tiveram perda de seguimento e 2 olhos de 2 pacientes (14.2%) apresentaram recorrência da triquíase. A taxa de sucesso acumulativa após 4 anos foi de 78.9%. Conclusão: A cirurgia modificada de enxerto interlamelar de mucosa oral usando cola de fibrina mostrou uma boa taxa de sucesso a longo prazo. Esta técnica reduz o tempo cirúrgico, facilita a inserção de enxertos menores e, portanto, deve ser considerada em triquíase menor sem entrópio resistente ao tratamento convencional.
Subject(s)
Humans , Female , Male , Middle Aged , Aged , Aged, 80 and over , Fibrin Tissue Adhesive , Mouth Mucosa , Fibrin Tissue Adhesive/therapeutic use , Prospective StudiesABSTRACT
Objective:To investigate clinical characteristics and factors influencing the prognosis of patients with mucosal melanoma.Methods:The clinical data of 49 patients with mucosal melanoma in Fujian Cancer Hospital from March 2012 to March 2022 were retrospectively analyzed, and their clinical characteristics and prognostic influencing factors were observed. Kaplan‐Meier method was used for survival analysis and Cox proportional risk model was used to analyze the prognostic influencing factors.Results:Female accounted for 61.2% (30/49) of all 49 patients with mucosal melanoma and the median age was 56 years (42-79 years). The most frequent primary tumor sites occurred in head and neck (42.9%, 21/49), followed by the reproductive system (32.7%, 16/49). At the time of initial diagnosis, 81.6% (40/49) of patients had no distant metastasis and 79.6% (39/49) of patients had normal levels of peripheral blood lactate dehydrogenase. The median overall survival time of 49 patients with mucosal melanoma was 39.5 months (95% CI 23.1-55.9 months). The median overall survival time of patients without distant metastasis at the time of initial diagnosis was significantly longer than that of patients with distant metastasis [46.5 months (95% CI 31.6-61.4 months) vs. 19.2 months (95% CI 0-42.2 months, P = 0.025]. There were no statistically significant differences in median overall survival time of patients with different gender, age at the time of initial diagnosis, primary tumor site, and the level of lactate dehydrogenase in peripheral blood at the time of initial diagnosis (all P > 0.05). The presence of distant metastasis at the time of initial diagnosis was an independent risk factor for the prognosis of patients with mucosal melanoma ( HR = 0.379, 95% CI 0.157-0.918, P = 0.032). Conclusions:Mucosal melanoma is more common in female. The most frequent primary tumor sites occur in head and neck. At the time of initial diagnosis, most patients have non‐distant metastasis and the normal level of peripheral blood lactate dehydrogenase. At the time of initial diagnosis, whether there is distant metastasis is an independent influencing factor for the prognosis of patients with mucosal melanoma.
ABSTRACT
Objective:To explore the differences of fecal calprotectin (FC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) between colon and small intestinal Crohn′s disease, and their predictive values for disease activity and mucosal healing in patients with small intestinal Crohn′s disease.Methods:From January 2017 to January 2023, 64 patients with Crohn′s disease who underwent capsule endoscopy in the First Affiliated Hospital of Zhejiang Chinese Medical University were enrolled, among them 28 patients had only small intestinal lesions (small intestine group) and 36 patients had lesions involving both small intestine and colon or only colon involvement (ileocolon group). The FC, CRP, and ESR levels of the two groups were detected and compared 15 days before capsule endoscopy examination. Wilcoxon rank-sum test was used for statistical analysis. Receiver operating characteristic curve analysis was used to evaluate the predictive value of FC, CRP, and ESR for disease activity and mucosal healing in patients with small intestinal Crohn′s disease.Results:The FC, CRP, and ESR levels of the small intestine group during the active phase of the disease were 1 689.00 μg/g (727.75 μg/g, 1 800.00 μg/g), 5.67 mg/L (1.00 mg/L, 17.01 mg/L), and 4.50 mm/1 h (2.00 mm/1 h, 11.00 mm/1 h), respectively; while FC, CRP, and ESR levels during the mucosal healing phase were 112.00 μg/g (46.50 μg/g, 130.50 μg/g), 1.00 mg/L (1.00 mg/L, 1.62 mg/L), and 2.00 mm/1 h (2.00 mm/1 h, 5.50 mm/1 h), respectively. The FC, CRP, and ESR levels of the ileocolon group during the active phase of the disease were 1 800.00 μg/g (895.50 μg/g, 1 800.00 μg/g), 4.94 mg/L (3.10 mg/L, 14.80 mg/L), and 10.00 mm/1 h (2.00 mm/1 h, 27.75 mm/1 h), respectively, while FC, CRP, and ESR levels during the mucosal healing phase were 66.00 μg/g (32.50 μg/g, 97.50 μg/g), 1.00 mg/L (1.00 mg/L, 1.55 mg/L), and 2.00 mm/1 h (2.00 mm/1 h, 4.50 mm/1 h), respectively. There were no statistically significant differences in FC, CRP, and ESR between the small intestine group and the ileocolon group during the active phase of the disease and mucosal healing phase (all P> 0.05). In the small intestine group, the levels of FC and CRP of patients during the active phase of the disease were 1 173.00 μg/g (312.00 μg/g, 1 800.00 μg/g) and 2.10 mg/1 L (1.00 mg/L, 16.00 mg/L), which were both higher than those of patients during the mucosal healing phase (112.00 μg/g (46.50 μg/g, 130.50 μg/g) and 1.00 mg/L (1.00 mg/L, 1.62 mg/L)), and the differences were statistically significant ( Z=-4.35 and-2.67, P<0.001 and =0.008). In the small intestine group, the level of ESR of patients during the active phase of the disease was 4.00 mm/1 h (2.00 mm/1 h, 16.00 mm/1 h), and there was no significant difference compared with that of patients during the mucosal healing phase (2.00 mm/1 h (2.00 mm/1 h, 5.50 mm/1 h)) ( P>0.05). When the cut-off level of FC was 188.50 μg/g, the sensitivity, specificity, and area under the curve for predicting disease activity in patients with small intestinal Crohn′s disease was 93.3%, 100.0%, and 0.964, respectively. When the cut-off value of CRP was 3.12 mg/L, the sensitivity, specificity, and area under the curve for predicting disease activity in patients with small intestinal Crohn′s disease was 46.7%, 92.3%, and 0.744, respectively. When the cut-off level of ESR was 10.00 mm/1 h, the sensitivity, specificity, and area under the curve for predicting disease activity in patients with small intestinal Crohn′s disease was 33.3%, 100.0%, and 0.654, respectively. There were no statistically significant differences in the area under the curve between the combinations of FC and CRP, FC and ESR, FC, CRP and ESR, and FC alone for predicting disease activity in patients with small intestinal Crohn′s disease (0.964, 0.959, and 0.959 vs. 0.964, all P> 0.05). There was a statistically significant difference in the area under the curve between the combination of CRP and ESR and FC alone in predicting disease activity in patients with small intestinal Crohn′s disease (0.708 vs. 0.964, Z=-2.57, P=0.010). Conclusions:There are no statistically significant differences in FC, CRP, and ESR between colon and small intestinal Crohn′s disease. FC has a high predictive value for disease activity and mucosal healing in patients with small intestinal Crohn′s disease and has certain clinical application value.
ABSTRACT
Objective:To compare the histopathological features and treatment efficacy of different methods for metachronous early gastric cancer (MEGC) in the remnant stomach.Methods:A total of 66 patients [38 endoscopic submucosal dissection (ESD) and 28 gastrectomy] with MEGC in the remnant stomach from January 2014 to December 2020 in Drum Tower Hospital were divided into the ESD group and the gastrectomy group. The baseline characteristics, histopathological features, treatment efficacy, and cost differences of the two groups were analyzed.Results:The MEGC in the remnant stomach mostly occurred in elderly male patients, with the mean age of 69.7±8.5 years. The mean interval of the occurrence of MEGC in the remnant stomach was 6 years. As for the tumor location, the gastric body (31.6%) was the main location in the ESD group and gastric cardia (53.6%) in the gastrectomy group with significant difference ( χ2=11.07, P=0.026). The mean operation time, hospital stay, postoperative fasting time, and total treatment cost were 80.0 min, 6.0 d, 1.5 d, ￥19 436 in the ESD group and 215.0 min, 19.0 d, 6.5 d, and ￥68 665 in the gastrectomy group, respectively, with significant differences between the two groups ( P<0.05). The overall survival rate during follow-up was 76.3% in the ESD group and 71.4% in the gastrectomy group with no significant difference between the two groups ( χ2=0.736, P=0.778). In terms of postoperative complications, the incidences of bleeding and infection were 7.9% and 5.3% in the ESD group, and those of obstruction and infection were both 14.3% in the gastrectomy group. There was significant difference in the incidences of postoperative obstruction between the two groups ( P<0.05). Conclusion:ESD is safe and effective for MEGC in the remnant stomach and is better than gastrectomy in terms of the treatment cost and operation time, but the long-term efficacy still needs to be validated by large-scale prospective studies.
ABSTRACT
Objective:To evaluate the efficiency and safety of modified endoscopic anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease (rGERD) with moderate hiatus hernia.Methods:A total of 30 patients with rGERD with moderate hiatus hernia (3-5 cm) diagnosed at the Department of Gastroenterology of Northern Jiangsu People's Hospital from June 2017 to June 2020 were randomly divided into 2/3 circumferential mucosal resection group ( n=15) and 3/4 circumferential mucosal resection group ( n=15) using random number table method, and received modified ARMS of the corresponding mucosal resection range. The GERD symptoms, esophagitis under endoscopy, 24 h pH results, and lower esophageal sphincter (LES) resting pressure were compared before and after the procedure. The therapeutic effect and complications of the two groups were analyzed. Results:In 2/3 resection group, the GERD questionnaire scores (9.53±0.36 VS 11.93±0.57, t=6.874, P<0.001), acid exposure time (19.81%±1.72% VS 31.45%±2.78%, t=8.020, P<0.001) and the DeMeester score based on 24 h esophageal pH monitoring (40.98±4.55 VS 55.33±5.65, t=6.408, P<0.001) at 6 months after the treatment showed a significant reduction compared with those before. In 3/4 resection group, the GERD questionnaire scores (9.0±0.57 VS 12.47±0.68, t=8.650, P<0.001), acid exposure time (20.07%±2.19% VS 29.96%±3.00%, t=7.444, P<0.001) and the DeMeester score (33.67±3.47 VS 51.17±6.03, t=4.973, P<0.001) at 6 months after the treatment were lower than those before. There was no significant difference in the GERD questionnaire scores ( t=0.790, P=0.436), acid exposure time ( t=0.093, P=0.926) or the DeMeester score ( t=1.278, P=0.212) between the two groups at 6 months after treatment. In the two groups, there was no significant difference in the ratio of esophagitis grade C and D (10/15 VS 5/15, χ2=3.894, P=0.063; 8/15 VS 4/15, χ2=2.778, P=0.125) or LES resting pressure [3.29 (2.66,8.29) mmHg VS 3.98 (3.67,9.43) mmHg, P=0.334;5.78 (1.9,8.46) mmHg VS 5.88 (3.28,8.99) mmHg, P=0.125] before and after the treatment. No postoperative delayed bleeding or perforation was observed. The incidence of postoperative esophageal stenosis of 2/3 resection group was lower than that of the other group (1/15 VS 6/15, χ2=4.658, P=0.021). Conclusion:Modified ARMS is effective for controlling reflux symptoms and esophageal acid exposure in rGRED patients with moderate hiatus hernia (3-5 cm), but cannot significantly increase the postoperative resting pressure of LES. Compared with 3/4 circumferential mucosal resection, 2/3 circumferential mucosal resection can reduce the incidence of postoperative esophageal stenosis.
ABSTRACT
Objective:To construct an artificial intelligence-assisted diagnosis system to recognize the characteristics of Helicobacter pylori ( HP) infection under endoscopy, and evaluate its performance in real clinical cases. Methods:A total of 1 033 cases who underwent 13C-urea breath test and gastroscopy in the Digestive Endoscopy Center of Renmin Hospital of Wuhan University from January 2020 to March 2021 were collected retrospectively. Patients with positive results of 13C-urea breath test (which were defined as HP infertion) were assigned to the case group ( n=485), and those with negative results to the control group ( n=548). Gastroscopic images of various mucosal features indicating HP positive and negative, as well as the gastroscopic images of HP positive and negative cases were randomly assigned to the training set, validation set and test set with at 8∶1∶1. An artificial intelligence-assisted diagnosis system for identifying HP infection was developed based on convolutional neural network (CNN) and long short-term memory network (LSTM). In the system, CNN can identify and extract mucosal features of endoscopic images of each patient, generate feature vectors, and then LSTM receives feature vectors to comprehensively judge HP infection status. The diagnostic performance of the system was evaluated by sensitivity, specificity, accuracy and area under receiver operating characteristic curve (AUC). Results:The diagnostic accuracy of this system for nodularity, atrophy, intestinal metaplasia, xanthoma, diffuse redness + spotty redness, mucosal swelling + enlarged fold + sticky mucus and HP negative features was 87.5% (14/16), 74.1% (83/112), 90.0% (45/50), 88.0% (22/25), 63.3% (38/60), 80.1% (238/297) and 85.7% (36 /42), respectively. The sensitivity, specificity, accuracy and AUC of the system for predicting HP infection was 89.6% (43/48), 61.8% (34/55), 74.8% (77/103), and 0.757, respectively. The diagnostic accuracy of the system was equivalent to that of endoscopist in diagnosing HP infection under white light (74.8% VS 72.1%, χ2=0.246, P=0.620). Conclusion:The system developed in this study shows noteworthy ability in evaluating HP status, and can be used to assist endoscopists to diagnose HP infection.
ABSTRACT
Mucosal-associated invariant T (MAIT) cells are highly conserved immune cells that could participate in innate and adaptive immune responses after being activated by major histocompatibility complex class 1-related molecule (MR1) pathway or cytokine pathway. At present, it has been confirmed that a large number of MAIT cells exist in human peripheral blood and specific tissues, and play an important role in infectious diseases. This review focused on the role of MAIT cells in immune responses to different pathogens. Additionally, the therapeutic methods and challenges of targeting MAIT cells in infectious diseases were also discussed.
ABSTRACT
Ureteral calculi after lingual mucosal ureteral reconstruction are rare. In this paper, we reported a case of a male patient who had undergone robotic-assisted laparoscopic lingual mucosal right ureteroplasty. Calculi were found in the right reconstructed ureteral segment 4 months after surgery. Then the patient underwent transurethral ureteroscopic holmium laser lithotripsy combined with a stone retrieval basket, and postoperative urological CT showed no residual calculi in the right ureter. No recurrence of right ureteral calculi or complications were observed during 20 months of follow-up.
ABSTRACT
Objective:To summarize and analyze the current application status of oral mucosal graft (OMG) technique in the repair of ureteral strictures in China, and clarify the feasibility, safety and effectiveness of this technique.Methods:The 175 patients who underwent repair of ureteral stricture using oral mucosal patches from June 2015 to February 2022 were etrospectively analyzed in 14 medical centers in China, including 49 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 32 cases in Affiliated Seventh Medical Center of PLA General Hospital, 3 cases in The Second Hospital of Anhui Medical University, 6 cases in The First Affiliated Hospital of Zhengzhou University, 56 cases in Peking University First Hospital, 3 cases in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 cases in Shanghai Sixth People' s Hospital, 4 cases in General Hospital of Estern Theater Command, 4 cases in Lanzhou University Second Hospital, 2 cases in Guizhou Province People 's Hospital, 2 cases in Peking University People' s Hospital, 5 cases in Jinzhou First People's Hospital, 5 cases in The First Affiliated Hospital of Wannan Medical College, 1 case in Shandong Provincial Hospital. In this study, 127 patients (72.6%) used lingual mucosal patches, 32(18.3%) labial mucosa, and 16(9.1%) buccal mucosa. The surgical approach for OMG ureteral reconstruction was mainly minimally invasive, with robot-assisted laparoscopy in 84 patients (48.0%), traditional laparoscopic surgery in 87 patients (49.7%), and open surgery in only 4 patients (2.3%). There were 133 males and 42 females with an average age of (35.0±17.2) years. The mean body mass index (BMI) and stenosis length were (23.1±4.1) kg/m 2 and (4.7±1.8) cm, respectively. The stricture was located in the left ureter in 116 patients, right ureter in 58 case and bilateral ureter in 1 case. The most common causes of ureteral stricture were endoscopic surgery in 88(50.3%)patients, congenital stricture in 55(31.4%)patients, failed ureteroplasty in 29(16.6%)patients, history of extracorporeal shock wave lithotripsy in 13(7.4%)patients, radiotherapy history in 3(1.7%)patients and other causes in 6(3.4%)patients. Strictures were mainly located in the upper ureter, accounting for 61.7% (108/175 cases), followed by 36.0% (63/175) at the ureteropelvic junction and 2.3%(4/175)in the middle ureter. According to the surgical methods, the patients were divided into robot-assisted laparoscopic surgery group ( n=84), traditional laparoscopic surgery group ( n=87)and open surgery group ( n=4). Subgroup analysis of patients in robot-assisted laparoscopic and traditional laparoscopic surgery groups was performed. There were no significant difference in preoperative data between the two groups except for age (32.0±18.3) years vs.(37.0±15.9)years, P=0.040], BMI[(22.5±4.3)kg/m 2 vs. (23.7±3.6)kg/m 2, P=0.028], and etiology of stenosis [endoscopic injury, 34(40.5%) vs. 53(60.9%), P=0.012]. Preoperative hydronephrosis and stricture length were assessed by CTU and ureterography. Ureterography 7-9 weeks after surgery showed patency of the reconstructed segment, or no recurrence of hydronephrosis was judged as success. Evaluate the operation method, operation time, success rate, length of OMG in repairing ureteral stricture between laparoscopic and robot-assisted groups. Results:The overall success rate of oral mucosal graft repair surgery reached 97.7%(171/175). The success rate of ureteral reconstruction in the two groups were 96.4%(81/84)and 98.9%(86/87), respectively ( P=0.351), and the difference was not statistically significant. There was no significant difference for operation time, intraoperative blood loss, and mean oral mucosal length between the robotic and laparoscopic groups[(244.7±85.8) min and (222.7±83.5)min ( P=0.116), (58.9±38.6) ml and (68.4±45.5) ml ( P=0.217), (5.0±2.0) cm and (4.6±1.5) cm ( P=0.350)], respectively.Postoperative complications were reported in 23 (13.1%) patients, such as fever, urinary leakage, lymphatic leakage, infection, but only 2 (1.4%) cases patients had complications of Clavien-Dindo score ≥ Ⅲ. The two patients developed urinary stricture after surgery with failed conservative treatment, and no urinary stricture occurred following endoscopic treatment.The short-term (three months after surgery)incidence of complications in the site where the oral mucosa was taken, such as difficulty in opening mouth, pain, and swelling, was 12.0% (21/175), and there was no significant difference for oral complications between patients harvesting different length of mucosal graft. Conclusions:Ureteroplasty with oral mucosal graft is a safe, feasible and reliable technique for ureteral reconstruction. At present, minimally invasive technology is the main surgical approach for ureteroplasty, and there is no significant difference in operation time and success rate between robotic surgery and laparoscopic surgery.
ABSTRACT
Objective:To investigate the clinicopathologic features and molecular genetics characteristics of sinonasal tract mucosal malignant melanomas(STMMMs)in elderly patients.Methods:The clinicopathological features, immunohistochemical features and BRAF, C-KIT, NRAS mutations of STMMM in ten elderly patients were retrospectively analyzed.Results:Among the 10 patients, 5 were female and 5 were male.The patients were aged 65-81 years, with an average age of(72.5 ± 8.5)years.The lesions in 7 cases were located in the nasal cavity and paranasal sinuses, and in the other 3 cases were located in the nasopharynx.The morphologies of tumor cells under microscope was complex and diverse, showing plasma cell-like, rhabdomyoblast-like, small cell-like, epithelial-like, and spindle cell-like morphologies.Immunohistochemically, HMB-45 and S-100 were generally positive in 10 cases, and the positive rate of Melan A was 70.0%.The genes detection data showed no mutations in BRAF or NRAS genes in all the 10 cases, while C-KIT exon 11 c. 1666_1667insA mutation was found in one case, and the remaining 9 cases were wild-type for C-KIT.All the 10 cases were followed up for 4~50 months.Three cases survived so far.Conclusions:STMMM in elderly patients are rare and easy to be misdiagnosed.Immunohistochemistry and genetic testing provide guidance for accurate diagnosis and targeted therapy.
ABSTRACT
Objective:To study the features of adenomyomatous hyperplasia (AH) of the Vaterian system (common bile duct and ampulla of Vater) to help in the diagnosis and management of this disease.Methods:A retrospective analysis on the data of 17 patients who had a postoperative pathological diagnosis of AH of the Vaterian system treated from January 2005 to December 2021 at the First Medical Center of the PLA General Hospital was carried out with 12 males and 5 females, aged (58.4±11.3) years. The clinical presentations, treatment and postoperative pathology of these patients were analyzed. Patients with dysplasia of the tubular mucosal epithelium in the non-cancerous area around the AH under microscopy were included in the AH with dysplasia group ( n=8), and those without dysplasia were included in the control group ( n=9). The clinical characteristics of the two groups were compared. Results:The main clinical symptoms were abdominal pain in 8 patients, jaundice in 7 patients and fever in 2 patients. Preoperative imaging showed 10 cases of occupying lesions and 6 cases of abnormally dilated intrahepatic and extrahepatic bile ducts without obvious lesions or stones or biliary tract injury stenosis. Sixteen patients underwent radical pancreaticoduodenectomy, and 1 patient underwent extrahepatic biliary resection combined with choledochojejunostomy for bile duct obstruction due to biliary stones, 3 patients had combined malignant tumors, 1 patient had a carcinoma of AH origin at the ampulla of Vater, and the other 2 patients had neoplastic lesions in the mucosal epithelium adjacent to the AH (cholangiocarcinoma and ampullary carcinoma, respectively). There were no significant differences in age, gender, bile duct stones, cholangitis, combined carcinoma and liver function indexes between the two groups of patients with AH of the Vaterian system (all P>0.05). Conclusion:Adenomyomatous hyperplasia of the Vaterian system was difficult to distinguish preoperatively from malignant tumors basing on its clinical presentations or imaging findings. Such patients are recommended to be treated surgically.
ABSTRACT
Objective:To explore the effect of cold-strap endoscopic mucosal resection (CS-EMR) in patients with colorectal polyps.Methods:A prospective randomized clinical trial was conducted to 320 selected patients with colorectal polyps diagnosed by Shenzhen Luohu District People′s Hospital from May 2019 to June 2021. The patients were randomly divided into CS-EMR group and HS-EMR group with 160 cases each, using a random number table generated by Excel 2007. The main parameters for statistical analysis contain the process indicators of the two groups of surgical methods, the complete polypectomy rate of patients after surgery, the degree of postoperative pain and the recovery of gastrointestinal function, and the differences in surgical complications.Results:The polypectomy time of CS-EMR group was shorter than that of HS-EMR group: (4.11 ± 1.20) min vs. (4.42 ± 0.98) min, with a statistically significant difference ( P<0.05). The score of visual analogue pain scale (VAS) in CS-EMR group was lower than that in HS-EMR group at 4 and 12 hours after operation: (3.11 ± 0.78) scores vs. (3.48 ± 0.80) scores, (3.38 ± 0.80) scores vs. (3.61 ± 0.92) scores, with a statistically significant difference ( P<0.05). The first anal exhaust time and first defecation time in CS-EMR group were lower than those in HS-EMR group: (27.83 ± 5.01) h vs. (29.66 ± 4.84) h, (43.73 ± 7.80) h vs. (47.28 ± 8.14) h, with a statistically significant difference ( P<0.05). The complications in CS-EMR group were significantly lower than those in HS-EMR group: 5.63% (9/160) vs. 12.50% (20/160), with a statistically significant difference ( P<0.05). Conclusions:The effect of CS-EMR in the treatment of colorectal polyps is not different from that of HS-EMR, but the former has the advantages of short resection time, rapid recovery of gastrointestinal function after operation, light pain and less complications.
ABSTRACT
Objective:To compare the effect of different methods of sputum aspiration in children with bronchopneumonia and explore the appropriate sputum aspiration methods for children with bronchopneumonia.Methods:This study was a randomized controlled trial. The convenience sampling method was used to select 165 children with bronchopneumonia treated in the Third Affiliated Hospital of Zhengzhou University from October 8, 2020 to September 30, 2021 as the research objects. They were divided into group A, group B and group C by random number table method, with 55 cases in each group. Group A used sputum aspirating tube to aspirate sputum through mouth and nose, group B used olive head to aspirate sputum through nose, and group C used both sputum aspirating tube to aspirate sputum through mouth and olive head through nose. The sputum aspirating effect, respiratory mucosal injury rate and satisfaction degree of children′s parents were compared among the three groups.Results:Finally, there were 53 cases in group A, 54 cases in group B and 53 cases in group C. The total effective rate of sputum aspiration was 96.21%(584/607) in group C, which was higher than that in group A 94.32% (581/616) and in group B 74.12% (464/626), the difference was statistically significant ( χ2=194.62, P<0.01), pairwise comparison among the three groups showed statistical difference ( χ2=95.95, 11.32, 132.16, all P<0.017). The respiratory mucosal injury rate was 1.12% (7/626) in group B, which was lower than that in group C 3.13% (19/607) and in group A 10.39% (64/616), the difference was statistically significant ( χ2=63.53, P<0.01), pairwise comparison among the three groups showed statistical difference ( χ2=49.52, 25.47, 6.04, all P<0.017). The satisfaction degree of children′s parents in group C was 98.11% (52/53), which was higher than that in group B 90.74% (49/54) and in group A 81.13% (43/53), the difference was statistically significant ( χ2=8.54, P<0.05). There was no statistically significant difference in the satisfaction degree of children′s parents between group A and group B, and between group B and group C( P>0.017). There was statistically significant difference in the satisfaction degree of children′s parents between group A and group C ( χ2=8.22, P<0.017). Conclusions:The combination of oral suction tube and nasal suction with olive head can improve the sputum aspirating effect of children with bronchopneumonia and the satisfaction degree of their parents, with a low rate of respiratory mucosal injury and high safety, which is worthy of clinical reference.
ABSTRACT
Objective: To investigate the effects of combined exposure to black carbon and lead on the expression of cell adhesion molecules and their regulating microRNAs (miRNAs) in the rat choroid plexus epithelial Z310 cells. Methods: i) Z310 cells were randomly divided into control group, black carbon exposure group, lead exposure group and combined exposure group. The lead exposure group and black carbon exposure group were treated with 10 μmol/L lead acetate and 10 mg/L black carbon, respectively, and the combined exposure group was treated with both in the above doses. After 12.0 hours, the expressions of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and mucosal vascular addressin cell adhesion molecule-1 (MAdCAM-1) in Z310 cells was detected by Western blotting. The expression of miR-326, miR-328-3p and miR-542-3p which regulated ICAM-1 was detected by real-time fluorescent quantitative polymerase chain reaction. ii) Z310 cells or Z310 cells transfected with miRNA-326 mimic were randomly divided into control group, miRNA-326 transfection control group, combined exposure group and miRNA-326 transfection combined exposure group. Cells in the two control groups were not treated. The two combined exposure groups were treated with 10 mg/L black carbon and 10 μmol/L lead acetate for 12.0 hours. The expression of ICAM-1 was detected by Western blotting. Results: i) The relative expression of ICAM-1, VCAM-1 and MAdCAM-1 in the cells of black carbon exposure group and ICAM-1 in the lead exposure group was higher than those in the control group (all P<0.05). The relative expression of ICAM-1 and MAdCAM-1 in the combined exposure group was higher than those in the other three groups (all P<0.05). The relative expression of VCAM-1 in cells of combined exposure group was higher than those in the control group and lead exposed group (all P<0.05). The relative expression of miR-326 in cells of the lead exposure group and black carbon exposure group was lower than those in the control group (all P<0.05). The relative expression of miR-326 in the combined exposure group was lower than that in the other three groups (all P<0.05). There was no significant difference between miR-328-3p and miR-542-3p in the four groups (all P>0.05). ii) The relative expression of ICAM-1 in cells of the miR-326 transfection control group cells was lower than that in the control group (P<0.05), while in the cells in the combined exposure and miRNA-326 transfection combined exposure group, it was higher than that in the control and miRNA-326 transfection control groups (all P<0.05), and lower in the miRNA-326 transfection combined exposure group than in the combined exposure group (P<0.05). Conclusion: Black carbon or lead exposure can upregulate the expression of ICAM-1, VCAM-1 and MAdCAM-1 in Z310 cells. Black carbon and lead combined exposure lead to a synergistic effect on upregulation of ICAM-1 and MAdCAM-1 expression, particularly ICAM-1. The combined exposure of black carbon and lead may upregulate the expression of ICAM-1 by downregulating the expression of miR-326.