Polipectomia a frio: um procedimento seguro para remover pequenas lesões colorretais não pediculadas / Cold snare polypectomy: a safe procedure for removing small non-pedunculated colorectal lesions

ABSTRACT Background: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re­cognized as a risk factor for interval cancer. Objective: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. Methods: We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. Results: A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. Conclusion: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.

RESUMO Contexto: A polipectomia é uma importante opção terapêutica na prevenção do câncer colorretal (CCR). A ressecção incompleta do pólipo (RIP) é reconhecida como fator de risco para o câncer de intervalo. Objetivo: O principal objetivo foi avaliar o índice de ressecção completa da polipectomia a frio (PF) em pequenos pólipos não pediculados e, secundariamente, a recuperação do espécime e índice de complicações. Métodos: Avaliamos prospectivamente 479 pólipos <10 mm removidos por PF em 276 pacientes, por um endoscopista sem experiência com este método. Resultados: Foram ressecados em bloco 476 pólipos (99,4%). Tivemos margem negativa, considerada ressecção completa do pólipo (RCP), em 435 (90,8%) casos. Margem indefinida ou positiva (classificada como RIP) foi observada em 43 (9,0%) casos e em 1 (0,2%) caso, respectivamente, com um índice global de RIP de 9,2% (44/479). O índice de RIP foi de 12,5% na primeira metade dos casos e 5,9% na última metade (P=0,02). Dividindo em tercis, o índice de RIP foi de 15,0% no primeiro terço, 6,9% no segundo terço e 5,7% no terceiro quarto, P=0,01. Dividindo em quartis, o índice de RIP foi de 15,8% no primeiro quarto, enquanto o último quarto foi de 5,9%, P=0,03. O índice de RIP foi de 6,3% para lesões tipo 0-IIa e de 14,1% para lesões tipo 0-Is, P=0,01. O índice de RIP foi de 9,2% para lesões serrilhadas e adenomatosas. Houve falha na recuperação dos espécimes em 3,6% dos casos. Sangramento imediato (>30 s) ocorreu em um caso (0,2%), controlado com plasma de argônio. Sem sangramento tardio e perfuração. Conclusão: PF é uma técnica segura que apresenta bons resultados para a ressecção de pequenas lesões não pediculadas, com uma curta curva aprendizado.

Analysis of the effect of cold snare endoscopic mucosal resection in the treatment of colorectal polyps / 中国医师进修杂志

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.

Comparison study colonic polypectomy / Монголын Анагаах Ухаан

Introduction@#Colorectal cancer remains one of the critical healthcare challenges nowadays. There are a lot of studies done on colonic polypectomy around the world, and mostly diagnosis with dysplasia change, so we consider to chose to study this topic.@*Aim@#In this study, we aimed to compare the between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) of removing colon polyps. This method helped us to investigate which of the two methods is most prevalent for polypectomy.@*Materials and Method@#The research was carried out using a targeted sampling method from the cases where colonoscopy was performed between 2022 and 2023, based on the Center for Imaging Diagnostics and Pathology of Third General Hospital of Mongolia with a colon polyps less than 5mm in size should be removed using the cold snare method according to the recommendation, and polyps between 5-10 mm should be removed using the hot snare method. After polypectomy, we assessed deep mucosal lesions using the Sydney classification.@*Result@#The average age of the 81 cases included in the study was 57.9 years, and the male-female ratio was 1:1.2.149 cases (75.6%) of slightly elevated type 0-IIa according to the Paris classification, according to the morphological structure revealed by endoscopy, while 79 cases (75.6%) were tubular adenoma according to histological analysis. (38.9%), low grade dysplasia 52 (25.6%) and high grade dysplasia 3 (1.5%) cases are noteworthy. Average polyp was 5-9 mm. Most of polyps removed was left side of colon especially in sigmoid colon. Bleeding rate was higher in hot snare method 11.5%. (1/149, 0.7%, 5/52, 9.6%; P = 0.6). There was no recurrent rate and no perforation in our study. @*Conclusions@#In our study, average size of 5-9 mm were removed and slightly elevated (0-IIa), sessile (0-Is) type of polyps were commonly found in the sigmoid colon. There is a higher risk of bleeding due to mucosal damage in hot snare polypectomy. A combination of hot and cold methods is equally effective for resection of colon pollyps up to 1 cm in size.

Snare assisted manual small-incision cataract surgery: Single solution for any grade of cataract

Cataract surgery is constantly evolving with new techniques, machines, and procedures entering the lexicon. With the modernization, the cost of surgery is increasing with respect to the surgeon, patient, and the society. Early rehabilitation with modern minimal access techniques reduces the societal cost of intervention. Manual small-incision surgery is simple, safer, and cheaper when contrasted with the cost and steep learning curve of machine-driven surgeries. A nucleus of a normal size is 6 mm, which can be bisected; 3 mm longitudinal fragments can be removed through 3.5 to 4.5 mm incision, and a large nucleus of 9.0 mm can trisected and removed through 3.5 to 4.5 mm. The limbal tunnel incision is 3.5 mm, which is close to 2.8 mm phacoincision, so it gives all the advantages of modern phacosurgery. The search of an ideal technique for manual phaco-fragmentation leads us to this specially designed snare (designed by the first author AS) which can tackle any grade nucleus. The nucleus can be bisected or trisected with ease. The technique has been around for 2 decades. There is a small learning curve. The complications are few and can be minimized with practice and simulation. It is a safe, valid, repeatable, and generalizable surgical procedure.

Implante de un electrodo de estimulación ventricular izquierdo mediante doble canulación del seno coronario, técnica de snare y acceso retrógrado de la vena posterolateral / Implant of a left ventricular pacing electrode by double cannulation of the coronary sinus, snare technique and retrograde access of the posterolateral vein

Resumen El implante percutáneo de un electrodo de estimulación ventricular izquierdo a través del seno coronario para resincronización cardiaca siempre ha implicado un reto y más aún en pacientes con anatomía venosa coronaria compleja. Este caso demuestra cómo una técnica de doble canulación del seno coronario con uso de catéter multi-snare permite la colocación exitosa de un electrodo de estimulación ventricular izquierdo mediante acceso retrógrado a una vena posterolateral estenótica.

Abstract The percutaneous implantation of a left ventricular pacing electrode through the coronary sinus for cardiac resynchronization has always been a challenge, especially in patients with a complex coronary venous anatomy. This case shows how double cannulation of the coronary sinus using a multisnare catheter allows a left ventricular pacing electrode to be placed through retrograde access to a stenotic posterolateral vein, with a good clinical outcome.

Snare Guiding Technique in Bifurcated Endovascular Repair of Abdominal Aortic Aneurysm with Severely Tortuous Iliac Artery Access: A Case Report

@#Endovascular aneurysm repair (EVAR) has gained acceptance as a viable alternative to open surgical treatment for abdominal aortic aneurysm (AAA). We report the use of snare guiding wire in bifurcated EVAR case with severely tortuous femoral access. A 63-year-old man referred to the hospital from another facility with complaints of pulsating mass in right iliac and umbilical region for the last 2 years. He was then admitted to the cardiac catheterization lab for EVAR under general anaesthetic. Endovascular aneurysm repair (EVAR), also known as an endoprosthesis, is a stent-graft device-guided therapy for a AAA. This procedure is a safer choice for individuals who are elderly or have pulmonary, cardiac, or renal problems. Tortuous iliac arteries might obstruct device delivery during EVAR. The Snare Guiding Wire approach might be an alternate method for EVAR to treat AAA if conventional cannulation is difficult or impossible in individuals with highly tortuous iliac access.

A comparative study of cold snare and hot snare resection of colon polyps / Монголын Анагаах Ухаан

Introduction@#Colorectal cancer remains one of the critical healthcare challenges nowadays. Most patients’ disease, especially colorectal polyps develop via the adenoma carcinoma sequence; using colonoscopy with polypectomy reduces both mortality and incidence by removing precancerous adenomas, which are called polyps. In recent years, colorectal cancer tends to increase among Asian population. There are only limited studies that have been conducted in Mongolia regarding colorectal polypectomy and its complications. Both cold polypectomy and hot polypectomy are accepted methods. In this study, we aimed to compare the complications (bleeding, perforation) between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) of adenomas and hyperplastic polyps. After the procedure, repeated endoscopy was performed to compare the incomplete resection rate (IRR) and complete resection rate (CRR) of mucosal residual and presence of recurrency. This method helped us to investigate which of the two methods is most prevalent for polypectomy.@*Materials and Method@#The research was carried out using a targeted sampling method from the cases where colonoscopy was performed between 2020 and 2022, based on the Center for Imaging Diagnostics and Pathology of Third General Hospital of Mongolia with a colonoscopy with a high-performance Olympus EVIS EXERA III brand NBI from Japan. In this study, we selected only hyperplastic polyps and adenomas <10 mm in size. Polyps less than 5 mm in size should be removed using the cold snare method according to the recommendation, and polyps between 5-10 mm should be removed using the hot snare method. After polypectomy, we assessed deep mucosal lesions using the Sydney classification.@*Result @#According to the results of the study, in terms of age, the percentage of people having a polyp removed was relatively low among 15-39 year olds compared to the other age groups, while it was higher in those aged >65 years. In terms of body mass index, 75% of the total number of people who had a tumor removed were overweight, indicating that overweight or obese people are at higher risk of developing a colorectal polyps. In terms of gender, 63% of people who had a polyp removed were male, indicating a male predominance in polyp prevalence. The percentage of tumor questionnaires in the total study population was 0% or absent. Early detection of adenomas and hyperplastic polyps, which are precursors of tumor, is the main way to prevent the development of cancer. A slightly raised polyp was present in 53 or 79.1% of the polyps, while a broad-based polyp occurred in 13 or 19% of the polyps, indicating the predominance of the slightly raised polyp in the population. In terms of location, polyps occurred more often in the descending colon and the sigmoid colon, and complications (perforation, bleeding) related to the anatomical structure and location are more likely to occur in these parts of the colon. However, the likelihood of relapse is very low. The procedure time was 17.6 minutes on average, and in 14 cases, hemostatic clamps were placed to prevent the risk of bleeding, and in 5 cases, epinephrine was injected for hemostasis. Early detection of colorectal diseases (endoscopy), changes in the lifestyle of clients, and regular preventive examinations are the main factors to reduce the risk of cancer development, and early start of treatment as well as complete removal of adenoma, an antecedent to cancer, will have a significant impact on cancer prevention and mortality reduction.@*Conclusions@#</br>1. Left sided polyps were commonly diagnosed among study participants. </br>2. Correlation between the probability of recurrence and the anatomical location of the polyps was very low. </br>3. Our results suggest that HSP and CSP techniques can be effectively used for the complete removal of 4–10mm colorectal polyps. Moreover, there was no significant difference between CSP and HSP in terms of overall complications.

A clinical study of cold snare resection for large colorectal polyps / 中华消化内镜杂志

Objective:To investigate the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for the removal of colorectal polyps of 10-15 mm.Methods:A total of 173 polyps of 154 patients with at least one polyp of 10-15 mm were resected under colonoscopy from December 2019 to December 2020. Based on Paris classification, the polyps were divided into Ⅰsp, Ⅰs and Ⅱa. According to random number table, the polyps were randomly divided into CSP group ( n=85) and HSP group ( n=88). The polyp size, location, morphology, histological classification, complete resection rate, incidence of complications, resection time and the number of prophylactic clips were compared between the two groups. Results:There were no significant differences in age, sex, indication of colonoscopy or the success rate of intubation at the end of ileum between the two groups. The polyps of the two groups were comparable in size, position, morphology and histological classification. There were no significant differences in the complete resection rate of polyps, rates of intraoperative bleeding and postoperative bleeding or perforation between the CSP group and the HSP group. The operation time in CSP group was significantly shorter than that in HSP group (63.5 ±23.6 s VS 184.3 ±62.4 s, P<0.05). The number of prophylactic clips used in CSP group was significantly less than that in HSP group (0.8±0.5 VS 1.4±0.7, P<0.05). Conclusion:CSP shows similar complete resection rate and complication incidence, and requires shorter operation time and fewer prophylactic clips, compared with HSP, in the resection of colorectal sessile polyps of 10-15 mm.

Current status and research advances on the use of assisted traction technique in endoscopic full-thickness resection / 中华胃肠外科杂志

Endoscopic full-thickness resection (EFTR) allows completely resecting deep submucosal tumors (SMTs) in the gastrointestinal wall, which has a broad application prospect in clinic. However, its application and promotion are limited by complex surgical procedures and high surgical risk. Various auxiliary traction techniques are expected to reduce the operation difficulty and risk of EFTR and improve its operative success rate. To provide a reference for clinicians, we summarize various auxiliary traction techniques in EFTR in this article. The clip-with-line method is simple to operate and widely used, whereas its traction is limited and there is a risk of clip falling off. The snare traction method and the clip-snare traction method has advantage of large traction force, but its thrust is affected by the hardness of snare. The traction point of the grasping forceps traction method is flexible and easy to adjust. Nevertheless, it requires the use of a dual-channel upper endoscope, which is difficult to operate. The transparent cap traction method and the full-thickness resection device traction method takes a short time and is easy to promote, whereas the resectable lesion is limited, and the size of the lesion may affect the success rate. In contrast, the suture loop needle-T-tag tissue anchors assisted method has a large resection range, but the operation is complicated and the feasibility has not been verified. The robot-assisted method has flexible operation and excellent visualization, whereas it is expensive and difficult to operate. There is no report of the application of magnetic anchor technology in EFTR, but it may have good application prospects in the auxiliary traction of EFTR.

Cold snare polypectomy for colorectal adenoma: a retrospective cohort study / 中华消化内镜杂志

Objective:To explore the curative effect and safety of cold snare polypectomy for colorectal adenoma of less than 15 mm.Methods:Data of 464 colorectal adenoma from 315 patients who were treated with cold snare polypectomy (CSP) and cold endoscopic mucosal resection (cold EMR) in the Third People′s Hospital of Jingdezhen from January 2018 to December 2019 were collected. Patients were divided into group A(3-5 mm), B (6-9 mm), and C (10-15 mm) according to the size of adenoma. Enbloc resection rate, immediate bleeding during polypectomy, delayed postpolypectomy bleeding, cold snare defect protrusions(CSDPs)and postoperative recurrence were analyzed.Results:The overall enbloc resection rate was 99.4%(461/464), and 100.0%(248/248), 98.8%(170/172), 97.7%(43/44) respectively in group A, B, and C without significant difference( P =0.126, 95% CI: 0.097-0.157). The overall incidence of immediate bleeding during polypectomy was 1.1%(5/464), and 0.4%(1/248), 1.7%(3/172), 2.3%(1/44) respectively in group A, B, and C without significant difference( P = 0.267, 95% CI: 0.227-0.308), showing an upward trend in the immediate postpolypectomy bleeding incidence with the increase of diameter of the polyps. No delayed postpolypectomy bleeding occurred. The overall incidence of CSDPs was 20.5%(95/464), 16.4%(63/384) and 40.0%(32/80) in the group of CSP and cold EMR respectively with significant difference( P<0.001, 95% CI: 0-0.006), showing an upward trend in the incidence of CSDPs with the increase of the diameter. A total of 286 adenomas in 195 patients were followed up. The median follow-up time was 9.7 months. Three patients relapsed. Conclusion:CSP is safe and effective for colorectal adenoma ≤15 mm with low incidence of immediate bleeding during polypectomy and recurrence, and no delayed postprocedural bleeding.

Application of domestic snare in retrograde percutaneous coronary intervention for coronary chronic total occlusion lesions / 中国介入心脏病学杂志

Objective To evaluate the safety and efficiency of domestic snare applied during retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions.Methods A total of 27 patients who underwent retrograde PCI for CTO and used domestic snare during the procedure were enrolled in our study from March 2012 to November 2016.Clinical data, angiographic characteristics and PCI details were collected.Clinical data, characteristics of CTO lesion, effect of the domestic snare and snaring time were retrospectively analyzed.Special complications related to the domestic snare and major adverse cardiovascular events (MACE) were also documented.Results Domestic snare was used in all the procedures, which included facillitating the micro-catheter to pass through the CTO lesions in 6 patients and assisting the RG3/rotational guide-wire externalization in all the 27 patients.Mean snaring time was 3.5±5.4 minutes.Stents were successfully implanted in 26 patients except in 1 patient who failed to receive stent implantation for severe coronary calcification.No complications including coronary dissection, fracture of guide-wire and unreleased snare happened during the procedures and no MACE occurred during hospitalization.Conclusions Domestic snare facilitates retrograde micro-catheter crossing CTO lesions and retrograde guide-wire entering the guiding catheter and externalization.It is a simple, safe and efficient method.

Clinical evaluation of endoscopic submucosal dissection with improved snare for colorectal polyps and submucosal tumors / 中国内镜杂志

Objective To evaluate the therapeutic effectiveness and safety of endoscopic submucosal dissection (ESD) with improved snare for colorectal polyps and submucosal tumors.Methods The clinical data such as clinical pathological characteristics, en bloc resection rate, curative resection rate, complications and follow-up results of 20 patients with colorectal polyps or submucosal tumors, who were treated by ESD, were retrospectively analyzed.Results 20 patients (total 24 lesions) with colorectal polyps or submucosal tumors were performed ESD operation successfully, in which 16 cases (total 20 lesions) were treated by ESD with improved snare (the trial group), 4 cases were treated by ESD with HOOK knife (the control group).The surgical success rate was 100.0% (24/24), the en blot resection rate was 100.0% (24/24). The mean polyps diameter in the trial group was (2.4 ± 0.9) cm (1.2~4.0 cm), while that in the control group was (2.2 ± 0.6) cm (1.5~3.0 cm). The mean procedure time in the trial group was (83.3 ± 23.9) min (45.0~120.0 min), while the control group was (66.2 ± 15.4) min (45.0~80.0 min), compared with the control group, the trial group need more times to complete the operation. The postoperative pathology as follows: 15 cases were adenoma (including 3 cases of adenoma with partial gland high-grade intraepithelial neoplasia), 1 case was hyperplastic polyp, 1 case was high-grade intraepithelial neoplasia, 2 cases were neuroendocrine tumor (total 4 lesions) 1 case was stromal tumor. Except for 1 case of stromal tumor from the muscularis propria was taken full thickness resection, no patient appeared complications such as hemorrhage, perforation, infection. No patient need intraoperative and postoperative surgical treatment.Conclusion Improved snare can be used to endoscopic submucosal dissection for large colorectal polyps and submucosal tumors safely and effectively, expanded the use and indications of snare in endoscopic resection, but need more times to completed the operation.

Clinical application of high-frequency electric snare in treatment of airway neoplasm / 中国内镜杂志

Objective To investigate the clinical efficacy and safety of high-frequency electric snare for the treatment of main airway neoplasm through bronchoscopy. Methods The clinical datas of 18 patients from July 2013 to April 2016, who had main airway neoplasm and were treated with high-frequency electric snare through bronchoscopy, were retrospectively analyzed. Meanwhile, the interventional bronchoscopic techniques partly included argon plasma coagulation and cryoablation. After operarion, the relief of symptoms and complications were observed. Results After operarion, the clinical symptoms, shortness of breath, dyspnea index score and the degree of airway stenosis were improved significantly. No serious complications such as massive hemoptysis occurred in all patients. Conclusion High-frequency electric snare is an effective and safe approach for the treatment of main airway neoplasm.

Research of the expression and significance of syntaxin 8 in non-small cell lung cancer tissues / 天津医药

Objective To investigate the expression and significance of syntaxin 8 (STX8) in non-small cell lung cancer (NSCLC),and analyze the relationship between STX8 expression and clinicopathological features of NSCLC.Methods Seventy samples of NSCLC and 70 samples of pericancerous tissues were collected for immunohistochemistry staining,and another 10 samples of NSCLC and pericancerous tissues were used for RNA and protein extraction,qRT-PCR was performed to detect the expression of STX8 mRNA,and Western blot assay was adopted to detect the expression of STX8 protein.The relationship between STX8 expression and clinicopathological features of NSCLC was analyzed.Results Results of qRT-PCR showed that the expression of STX8 mRNA was significantly higher in NSCLC tissues than that in the pericancerous tissues (3.962 5±0.487 3 vs.0.538 2±0.097 5,t=21.797,P＜0.01).Immunohistochemistry results showed that the high expression rate of STX8 was significantly higher in NSCLC tissues than that in the pericancerous tissues [71.43％ (50/70) vs.38.57％ (27/70),x2=15.267,P＜0.01].Western blot results showed that the expression of STX8 protein was significantly higher in NSCLC tissues than that in the pericancerous tissues (2.496 1±0.362 5 vs.0.340 2±0.119 1,t=17.876,P＜0.01).The high expression rate of STX8 was significantly different in different histological types of NSCLC (P ＜0.05).The high expression rate of STX8 was higher in squamous cell carcinoma and adenocarcinoma than that in adenosquamous carcinoma,and the high expression rate of STX8 was not observed in large cell carcinoma.There were no significant differences in expressions of STX8 in NSCLC patients with different gender,ages,tumor diameters,TNM stages and with or without lymph node metastasis (P＞0.05).Conclusion A high expression of STX8 in NSCLC tissues may be correlated with the occurrence and development of NSCLC.

Sterile repositionable hemostasis clipping device in combination with high frequency electric snare in resection of colorectal polyps with wide and long peduncle / 中国内镜杂志

Objective To discuss the efficacy and safety of sterile repositionable hemostasis clipping device in combination with high frequency electric snare in polypectomy of colorectal polyps with wide and long peduncle. Methods From January 2014 to December 2015, 21 cases of colorectal polyps with wide and long peduncle (diameter greater than 2 cm) in endoscopic treatment under electronic colonoscopy. We used 1 ~ 2 hemostatic clips to clip colorectal polyps roots, then used electric resection with high frequency electric snare electric coagulation. Postoperative bleeding, perforation were observed follow-up. Results 24 polyps in 21 cases were removed one-time successfully. Stump errhysis in 1 case, hot biopsy forceps is given to deal with local wound followed by Olympus Clip HX-610-135L EZ titanium clip. There was no complication such as bleeding and perforation in 3 to 6 months after the operation. In the colonoscopy examination, recurrence of polyps were not found in the original polyp resection site. Conclusion Sterile repositionable hemostasis clipping device in combination with high frequency electric snare in polypectomy of colorectal polyps with wide and long peduncle is safe and effective, without bleeding or perforation.

Application of a simulator-based teaching method in training of bronchoscopic high-frequency electrocautery snare technique / 第二军医大学学报

Objective To explore the role of a comprehensive-teaching method based on a diagnosis-and-treatment simulator for bronchoscopic procedure in the training of high-frequency electrocautery using snare. Methods A prospective self-control study including 20 trainees from the Bronchoscopic Center of Changhai Hospital was designed to evaluate the training outcome of bronchoscopic high-frequency electrocautery snare technique. During the training course, theoretical knowledge teaching was followed by simulator-based practice under the guidance of respiratory endoscopic exports from Changhai Hospital. We recorded and analyzed the procedure accuracy and fluency, operation time, and target tissue excision rate of each trainee before and after the training project The appraisal of the training effect for each trainee in this study was conducted by questionnaire survey. Results All the 20 trainees successfully completed thewhole training project Compared with the data before the training, the procedure accuracy of excising the target tissue by snare after the training was significantly increased from 5. 73 ± 1.37 to 8.50 ± 0.81 (P<0.01); the fluency of operating snare was significantly improved from 5.20 ± 1.61 to 8.27 ± 1.00 (P<0. 01); the total operation time-consuming was significantly shortened from (214.9 ± 112. 6) s to (88.1 ± 18.2) s (P=0.01); and the target tissue excision rate was increased significantly from (60 0 ± 16.3)% to (76.0 ± 12.6)% (P=0. 05). The questionnaire survey showed that all the trainees benefited from the comprehensive simulator-based teaching method. The advantages of this teaching method included repeatability, high simulation degree, safety, operational stability and 1529 improved training efficiency. Conclusion The simulator-based comprehensive teaching method has a distinct teaching outcome in bronchoscopic electrocautery snare technique raining, and is worth promoting in bronchoscopic raining.

Endoscopic Instruments and Electrosurgical Unit for Colonoscopic Polypectomy

Colorectal polypectomy is an effective method for prevention of colorectal cancer. Many endoscopic instruments have been used for colorectal polypectomy, such as snares, forceps, endoscopic clips, a Coagrasper, retrieval net, injector, and electrosurgery generator unit (ESU). Understanding the characteristics of endoscopic instruments and their proper use according to morphology and size of the colorectal polyp will enable endoscopists to perform effective polypectomy. I reviewed the characteristics of endoscopic instruments for colorectal polypectomy and their appropriate use, as well as the basic principles and settings of the ESU.

Endoscopic Duodenal Snare Papillectomy Induced Complication: Prevention and Management / 대한소화기학회지

Tumors of the major duodenal papilla are being recognized more often because of the increased use of diagnostic upper endoscopy and ERCP. The standard of management for ampullary tumor is local surgical excision or pancreaticoduodenectomy, but these procedures are associated with significant mortality, as well as post-operative and long-term morbidity. Endoscopic snare papillectomy was introduced as an alternative to surgery, but post-procedure complications are serious drawback. The most serious complications are perforation, delayed bleeding and pancreatitis. Identification of high risk patients, early recognition of complications, and aggressive management abates frequency and severity. Prevention and management of endoscopic duodenal papillectomy-induced complications will be reviewed in this article.

Reduced expression of exocytotic proteins caused by anti-cholinesterase pesticides in Brachionus calyciflorus (Rotifera: Monogononta) / Redução da expressão de proteínas de exocitose causados por pesticidas anti-colinesterase em Brachionus calyciflorus (Rotifera: Monogononta)

AbstractThe organophosphate and carbamate pesticides methyl-parathion and carbaryl have a common action mechanism: they inhibit acetylcholinesterase enzyme by blocking the transmission of nerve impulses. However, they can alter the expression of exocytotic membrane proteins (SNARE), by modifying release of neurotransmitters and other substances. This study evaluated the adverse effects of the pesticides methyl-parathion and carbaryl on expression of SNARE proteins: Syntaxin-1, Syntaxin-4 and SNAP-23 in freshwater rotifer Brachionus calyciflorus. Protein expression of these three proteins was analyzed before and after exposure to these two pesticides by Western Blot. The expression of Syntaxin-1, Syntaxin-4 and SNAP-23 proteins in B. calyciflorussignificantly decreases with increasing concentration of either pesticides. This suggests that organophosphates and carbamates have adverse effects on expression of membrane proteins of exocytosis by altering the recognition, docking and fusion of presynaptic and vesicular membranes involved in exocytosis of neurotransmitters. Our results demonstrate that the neurotoxic effect of anticholinesterase pesticides influences the interaction of syntaxins and SNAP-25 and the proper assembly of the SNARE complex.

ResumoOs pesticidas organofosforados e carbamatos metil- paration e carbaril tem um mecanismo de ação comum: eles inibem a enzima acetilcolinesterase, bloqueando a transmissão dos impulsos nervosos. No entanto, eles podem alterar a expressão de proteínas de membrana de exocitose (SNARE), através da modificação da libertação de neurotransmissores e outras substâncias. Este estudo avaliou os efeitos adversos dos pesticidas metil- paration e carbaril sobre a expressão de proteínas SNARE: Sintaxina -1, Sintaxina-4 e SNAP-23 em rotíferos de água doce Brachionus calyciflorus. A expressão destas três proteínas foi analisada antes e depois da exposição a estes dois pesticidas por Western Blot. A expressão das proteínas Sintaxina-1, Sintaxina-4 e SNAP-23 em B. calyciflorus diminui significativamente com o aumento da concentração de ambos os pesticidas. Isto sugere que os organofosfatos e carbamatos têm efeitos adversos sobre a expressão de proteínas de membrana de exocitose, alterando o reconhecimento, de encaixe e fusão de membranas pré-sinápticas e vesiculares envolvidas na exocitose de neurotransmissores. Nossos resultados demonstram que o efeito neurotóxico de pesticidas anticolinesterásicos influencia a interação de sintaxinas e SNAP-25 e a montagem correta do complexo SNARE.

Insulin replacement restores the vesicular secretory apparatus in the diabetic rat lacrimal gland / Reposição de insulina restaura o mecanismo secretório da glândula lacrimal de ratos diabéticos

ABSTRACT Purpose: In the lacrimal gland (LG) acinar cells, signaling regulates the release of secretory vesicles through specific Rab and SNARE exocytotic proteins. In diabetes mellitus (DM), the LGs are dysfunctional. The aim of this work was to determine if secretory apparatus changes were associated with any effects on the secretory vesicles (SV) in diabetic rats as well as the expression levels of constituent Rab and members of the SNARE family, and if insulin supplementation reversed those changes. Methods: DM was induced in male Wistar rats with an intravenous dose of streptozotocin (60 mg/kg). One of the two diabetic groups was then treated every other day with insulin (1 IU). A third control group was injected with vehicle. After 10 weeks, Western blotting and RT-PCR were used to compared the Rab and SNARE secretory factor levels in the LGs. Transmission electron microscopy evaluated acinar cell SV density and integrity. Results: In the diabetes mellitus group, there were fewer and enlarged SV. The Rab 27b, Rab 3d, and syntaxin-1 protein expression declined in the rats with diabetes mellitus. Insulin treatment restored the SV density and the Rab 27b and syntaxin expression to their control protein levels, whereas the Vamp 2 mRNA expression increased above the control levels. Conclusions: Diabetes mellitus LG changes were associated with the declines in protein expression levels that were involved in supporting exocytosis and vesicular formation. They were partially reversed by insulin replacement therapy. These findings may help to improve therapeutic management of dry eye in diabetes mellitus. .

RESUMO Objetivo: Células acinares da glândula lacrimal (GL) sinalizam a regulação da liberação através de vesículas secretórias específicas Rab proteínas exocitóticas SNARE. No diabetes mellitus (DM), as glândulas lacrimais são disfuncionais. O objetivo deste trabalho foi determinar se em ratos diabéticos, alterações dos aparatos secretórios estão associados a efeitos sobre vesículas secretoras (VS) e sobre os níveis de expressão do constituinte Rab, bem como membros da família SNARE, e se a suplementação de insulina reverte as alterações. Métodos: DM foi induzido em ratos Wistar machos com uma dose intravenosa de estreptozotocina (60 mg/kg). Um dos dois grupos diabéticos foi então tratado a cada dois dias com insulina (1 UI). Um terceiro grupo controle foi injetado com o veículo. Após 10 semanas, western blot e RT-PCR comparou níveis de fatores secretórios de Rab e SNARE na glândula lacrimal. Microscopia eletrônica de transmissão (MET) avaliaram a densidade e integridade de VS de célula acinar. Resultados: No grupo diabetes mellitus , houve poucas e alargadas VS. Rab27b, Rab 3d e Sintaxina-1 diminuiu a expressão da proteína em ratos com Diabetes Mellitus. O tratamento com insulina restaurou a densidade das VS e expressão de Rab 27b e Sintaxina para seus níveis de proteína controle, enquanto a expressão de Vamp 2 RNAm aumentou em relação aos controles. Conclusões: Alterações na glândula lacrimal de diabetes mellitus estão associadas a reduções nos níveis de expressão de proteínas envolvidas no apoio a exocitose e formação vesicular. Eles são, em parte, revertida por terapia de reposição de insulina. Estes resultados podem ajudar a melhorar a conduta terapêutica do olho seco no diabetes mellitus. .