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In order to evaluate the efficacy and safety of submucosal tunneling endoscopic resection (STER) for the treatment of multiple submucosal tumors (SMT) in the upper gastrointestinal tract, data of 24 cases with upper gastrointestinal SMT (including 56 SMT lesions) treated at Taizhou Municipal Hospital and Shanghai East Hospital from January 2016 to June 2021 were collected for retrospective observation. The treatment effect, occurrence of major adverse events and follow-up results were analyzed. The results showed that 19 cases (79.2%) underwent tumor resection through one tunnel, and 5 cases (20.8%) underwent tumor resection through two tunnels. The length of the tunnel was 3-12 cm, with an average of 6.2 cm. The surgical time ranged from 19 to 130 minutes, with an average of 55.6 minutes. The overall resection rate was 89.29% (50/56). The hospitalization time was 2-7 days, with an average of 3.5 days. Major adverse events occurred in 2 cases (8.3%), all of which were mucosal injuries, and were cured with titanium clips and self expanding metal sealing stents. During a follow-up period of 6-64 months, with an average of 32.0 months, there was no residual tumor, tumor implantation tunnel, local recurrence, distant metastasis or death. To sum up, STER is safe and feasible for the treatment of multiple SMT in the upper gastrointestinal tract. The main resection method is single tunnel, and double tunnel is required for multiple SMT far apart.
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In recent years, studies have found that mitochondrial transfer between leukemic cells and different types of cells in their bone marrow microenvironment, especially mesenchymal stem cells, plays a key role in the occurrence, development and drug resistance of hematological malignant tumors. This paper mainly introduces the role and latest research progress of mitochondrial transfer in acute and chronic myeloid leukemia, acute lymphoblastic leukemia and multiple myeloma, and briefly describes the mechanism of drug resistance caused by mitochondrial transfer in leukemic cells during chemotherapy. The aim is to provide a new idea and theoretical basis for using intercellular mitochondrial transfer as a potential therapeutic target.
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Humans , Bone Marrow , Hematologic Neoplasms/metabolism , Mesenchymal Stem Cells , Mitochondria , Multiple Myeloma/metabolism , Tumor MicroenvironmentABSTRACT
Objective:To evaluate the safety and efficacy of combination of submucosal tunneling endoscopic septum division (STESD) and peroral endoscopic myotomy (POEM) for the treatment of esophageal epiphrenic diverticulum with esophagogastric junction (EGJ) outflow tract disorder.Methods:From October 2017 to August 2021, 6 patients with esophageal epiphrenic diverticulum complicated with EGJ outflow tract disorder receiving combination of STESD and POEM in the Endoscopic Center of the First Affiliated Hospital of Nanjing Medical University were enrolled. The clinical characteristics of the patients were retrospectively analyzed, which included the ratio of male to female, age, course of disease, length of diverticula, location, whether with multiple diverticula, type of EGJ outflow tract disorders, whether the endoscopic technique was successful (the completion of all steps under endoscopy, including tunnel establishment and diverticulum cristae, lower esophageal sphincter and cardia muscularis propria incision); operation time, changes in the severity of clinical symptoms before and after operation (including weight loss, dysphagia, retrosternal pain, and reflux assessed using the Eckardt score), intraoperative and postoperative complications, and follow-up, including whether achieved clinical success (complete or nearly complete improvement of dysphagia, vomiting after eating, retrosternal pain, regurgitation, weight loss, no need for repeat endoscopic intervention during follow-up) and adverse events. Descriptive methods were used for statistical analysis.Results:The male to female ratio of the 6 patients was 3 to 3, the median age was 69.2 years old, and the median disease course was 92.3 months. The median length of the diverticula was 47.5 mm. Diverticulum was located in the right wall of esophagus in 4 cases and in the left wall of esophagus in 2 cases, of which 1 patient was multiple diverticulum of esophagus. Achalasia was found in 5 cases, and EGJ outflow obstruction was found in 1 case. All the 6 patients successfully completed combination of STESD and POEM, and all achieved successful edoscopic technique. The operation time (range) was 55 min (40 to 70 min). Clinical symptom Eckardt score (range) before and after operation was 9.0 (7.0 to 11.0) and 1.3 (1.0 to 2.0), respectively. After operation the clinical symptom improved compared with that before operation. There were no delayed bleeding, perforation, infection, subcutaneous emphysema and other complications and severe adverse events. Six patients were all cured and discharged. Follow-up period was 1 to 50 months. The symptoms of dysphagia, vomiting after eating, retrosternal pain, regurgitation and weight loss were all significantly improved compared with those before operation. There were no severe adverse events and all achieved clinical success.Conclusions:Combination of STESD and POEM is safe and effective in the treatment of esophageal epiphrenic diverticulum with EGJ outflow tract disorder, and has good short-term and long-term effects.
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Objective To explore the mechanism of human umbilical cord mesenchymal stem cell (HUC-MSC) alleviating ischemia-reperfusion injury (IRI) of liver cells through mitochondrial transfer. Methods Normal human liver cell line L02 was divided into the blank control group, oxygen-glucose deprivation (OGD) group, experimental control group, and L02 and HUC-MSC co-culture group (L02+HUC-MSC group). L02+HUC-MSC group was further divided into 10:1 co-culture subgroup (group A), 4:1 co-culture subgroup (group B), 2:1 co-culture subgroup (group C), 1:1co-culture subgroup (group D) and 1:2 co-culture subgroup (group E) according to different co-culture ratio of L02 and HUC-MSC. The apoptosis rate and relative reactive oxygen species (ROS) level of L02 cells were detected by flow cytometry. The MitoTracker positive rate of L02 cells was detected by flow cytometry. The mitochondrial transfer from HUC-MSC to L02 cells was observed by laser confocal microscope. Results The apoptosis rate and relative ROS level of L02 cells in the OGD group were significantly higher than those in the blank control group (both P < 0.05). Compared with the OGD group, the apoptosis rates of L02 cells in group B, C, D and E were significantly decreased (all P < 0.05), and the relative ROS level of L02 cells in group E was significantly declined (P < 0.05). The MitoTracker positive rate of L02 cells did not significantly differ between group A and experimental control group (P>0.05), whereas the MitoTracker positive rates of L02 cells in group B, C, D and E were significantly higher than that in the experimental control group in a concentration-dependent manner (all P < 0.05). Under the laser confocal microscope, mitochondrial transfer fromHUC-MSC to L02 cells could be observed through tunneling nanotube (TNT). Conclusions HUC-MSC may alleviate cell apoptosis and reduce ROS level of liver cells after IRI via direct mitochondrial transfer between cells.
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@#AIM:To evaluate the effect of two incision-making methods on operation and postoperative effect in manual small incision cataract surgery(MSICS)for patients with hard nucleus aged cataract and evaluate the advantages and disadvantages of two incision methods.<p>METHODS: A retrospective analysis of 56 patients with senile cataract with hard nucleus from February 2017 to February 2019 in our hospital was made, which was divided into two groups according to the different surgical methods. group A(31 eyes)with long incision(about 7-8mm), long tunnel(central 5mm length 3.5-4mm, internal incision of both sides extending about 1-1.5mm to the back of the side, making the front end of the incision trapezoid), thick scleral flap(about 2/3 film thickness). group B(25 eyes)with short incision(about 5.5mm), short tunnel(long 3mm, regular flush of internal incision, linear), and regular thickness scleral flap(about 1/2 film thickness). The best corrected visual acuity recovery of 1d, 1wk, 1mo and 3mo after operation, central corneal thickness after 1d, 1wk operation and corneal astigmatism degree, corneal endothelial cell loss degree after 3mo operation were compared.<p>RESULTS: The best corrected visual acuity(greater than or equal to 0.5)for 1d, 1wk, 1mo and 3mo after operation in the two groups(77%, 90%,94% and 94% in the A group and 32%, 72%, 88% and 88% in the B group)was statistically significant \〖<i>β</i>=-1.338, Exp<i>(β)</i>=0.262, <i>P</i><0.05\〗. The central corneal thickness of the two groups had time difference and interaction effect before and after operation(<i>P</i><0.05), and there was no difference between the two groups(<i>P</i>>0.05). There was a statistically significant difference in corneal endothelial cell density(2159.84±245.20/mm2 in the group A and 2019.68±203.97/mm2 in the group B)between the two groups after 3mo of operation(<i>t</i>=2.289, <i>P</i><0.05). There was no significant difference in corneal astigmatism between the two groups(group A 1.57±0.74D and group B 1.39±0.71D)after 3mo of operation(<i>t</i>=0.930,<i>P</i>>0.05).<p>CONCLUSION: MSICS with long incision, long tunnel, thick scleral flap and trapezoidal internal incision has less damage, quicker recovery and better effect on patients with hard nucleus aged cataract than short incision, short tunnel and linear internal incision.
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With the development of instruments and the innovation of techniques, gastrointestinal endoscopy is expanding the scope and scale in its application. As an important component of endoscopic therapeutic techniques, the development of endoscopic resection techniques is undoubtedly remarkable. The representative techniques including endoscopic submucosal dissection, submucosal tunneling endoscopic resection and natural orifice transluminal endoscopic surgery have made endoscopic resectable scope gradually extend from the initial intramucosal to the submucosal, and even extraserosal lesions. This article reviews the state of the art and advances of main endoscopic resection techniques.
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With the development of instruments and the innovation of techniques, gastrointestinal endoscopy is expanding the scope and scale in its application. As an important component of endoscopic therapeutic techniques, the development of endoscopic resection techniques is undoubtedly remarkable. The representative techniques including endoscopic submucosal dissection, submucosal tunneling endoscopic resection and natural orifice transluminal endoscopic surgery have made endoscopic resectable scope gradually extend from the initial intramucosal to the submucosal, and even extraserosal lesions. This article reviews the state of the art and advances of main endoscopic resection techniques.
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Objective@#To evaluate the short-term outcomes and safety of submucosal tunneling endoscopic resection (STER) for submucosal tumors (SMT) originating from muscularis propria (MP) layer at esophagogastric junction.@*Methods@#The clinical data of 31 patients with SMT originating from MP layer at esophagogastric junction underwent STER were collected and retrospectively analyzed.@*Results@#The success rate of STER of the thirty-one patients was 100%. The mean tumor size was (2.5±1.3) cm and the average operative time was (95.9±56.7) min. Perforation occurred in 3 patients and was successfully clipped by endo-clips during operation. One patient developed delayed bleeding and the bleeding was stopped by endoscopic hemostasis. Twenty-nine leiomyomas and two stromal tumors (GIST) were finally pathologically diagnosed. No local recurrence and distant metastasis were noted during the mean 15.4 months follow-up of 20 cases. According to the lesion size, 31 patients who received STER were divided into two groups. The operation time of maximum diameter ≥3.5 cm group was (134.0±70.6) min, significantly longer than (80.3±42.6) min of maximum diameter <3.5 cm group (P=0.014). However, the en bloc removal rate, postoperative hospital stay and the complication incidence between the two groups had no obvious differences (P>0.05). Univariate analysis showed that the piecemeal removal group had longer tumor diameter, higher incidence of irregular tumor morphology, and longer operative time than the en bloc removal group (all P<0.05). Stepwise logistic regression analysis showed that irregular shape was a risk factor for failure of en bloc removal (OR=18.000, 95% CI: 1.885~171.88, P=0.012).@*Conclusion@#As a new method of minimally invasive treatment, STER technology appears to be a safe and effective option for patients with SMT originating from MP layer at esophagogastric junction.
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Resumen Introducción: La recesión gingival puede estar relacionada con la enfermedad periodontal o condiciones mucogingivales ocasionando hipersensibilidad, caries radicular y problemas estéticos. La combinación de la técnica en túnel y el injerto de tejido conectivo subepitelial puede considerarse una opción para el tratamiento de recesiones gingivales múltiples. Presentación del caso: Paciente de sexo femenino de 38 años de edad, al interrogatorio refiere tener hipersensibilidad dentaria en los dientes superiores (13, 14, 22, 23, 24) que presentan recesión gingival. A la valoración periodontal se observan recesiones gingivales clase I y III de Miller en cuadrante I y II, el diagnóstico periodontal es periodonto sano. Para realizar la cobertura radicular se planea combinar la colocación de injerto de tejido conectivo subepitelial con técnica en túnel, siendo un procedimiento adecuado cuando las papilas interdentales son amplias, además de ser una técnica de alta predictibilidad para lograr la cobertura radicular. En este caso, se decidió iniciar por el segundo cuadrante, ya que eran los sitios con mayor hipersensibilidad dentaria y un mes después realizar el tratamiento en el primer cuadrante. Conclusiones: La técnica que se aplicó permitió eliminar la hipersensibilidad dentaria en un 100% considerando como única desventaja el doble sitio quirúrgico del sitio donador. Es importante mencionar que además de lograr mejoría en la hipersensibilidad dentaria, se mejoraron las condiciones estéticas.
Abstract Introduction: Gingival recession can be associated to periodontal disease or muco-gingival conditions causing hypersensitivity, root caries and esthetic problems. A combination of the tunneling technique with sub-epithelial connective tissue graft can be considered an option for multiple gingival recession treatment. Case presentation: A 38 year old female patient who informed of suffering hypersensitivity in upper teeth (13, 14, 22, 23, 24), exhibiting gingival recession. Periodontal evaluation revealed Miller class I and III gingival recessions in quadrants I and II. Periodontal diagnosis was healthy periodontium. In order to achieve root coverage, placement of sub-epithelial connective tissue graft with tunneling was planned. This represents a suitable procedure in cases when interdental papillae are wide, moreover, it constitutes a high predictability technique in order to achieve root coverage. In the present case, it was decided to initiate treatment on the second quadrant since it lodged sites with greater dental hypersensitivity, to be followed a month later by treatment on the first quadrant. Conclusions: This applied technique allowed for 100% elimination of tooth hypersensitivity, only considering a disadvantage the double surgical site of the donor site. It is important to mention that, in addition to achieving improvement in tooth hypersensitivity, esthetic appearance was improved.
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Objective To investigate the clinical efficacy and application value of submucosal tunneling endoscopic resection(STER)for upper gastrointestinal submucosal tumors(SMTs). Methods A retrospective analysis was performed on the endoscopic and clinical data of 44 cases with SMTs who received STER from January 2015 to June 2016 in Chinese PLA General Hospital. Results The rate of complete resection was 88.6%(39/44). The operating time was 60.1±30.6 min. The hospitalization time was 10.1± 3.3 days. The rate of complications was 6.8%(3/44). The diagnosis of SMTs by pathology and endoscopic ultrasonography(EUS),the size of SMTs measured by EUS and ruler after STER,and the growing direction judged by EUS and CT were consistent. Conclusion STER for SMTs has a higher complete resection rate, shorter operating time and hospitalization time, and fewer complications. EUS combined with CT is an effective method for preoperative evaluation.
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BACKGROUND: In this research article, we evaluate the use of sub-periosteal tunneling (tunnel technique) combined with alloplastic in situ hardening biphasic calcium phosphate (BCP, a compound of β-tricalcium phosphate and hydroxyapatite) bone graft for lateral augmentation of a deficient alveolar ridge. METHODS: A total of 9 patients with deficient mandibular alveolar ridges were included in the present pilot study. Ten lateral ridge augmentation were carried out using the sub-periosteal tunneling technique, including a bilateral procedure in one patient. The increase in ridge width was assessed using CBCT evaluation of the ridge preoperatively and at 4 months postoperatively. Histological assessment of the quality of bone formation was also carried out with bone cores obtained at the implant placement re-entry in one patient. RESULTS: The mean bucco-lingual ridge width increased in average from 4.17 ± 0.99 mm to 8.56 ± 1.93 mm after lateral bone augmentation with easy-graft CRYSTAL using the tunneling technique. The gain in ridge width was statistically highly significant (p = 0.0019). Histomorphometric assessment of two bone cores obtained at the time of implant placement from one patient revealed 27.6% new bone and an overall mineralized fraction of 72.3% in the grafted area 4 months after the bone grafting was carried out. CONCLUSIONS: Within the limits of this pilot study, it can be concluded that sub-periosteal tunneling technique using in situ hardening biphasic calcium phosphate is a valuable option for lateral ridge augmentation to allow implant placement in deficient alveolar ridges. Further prospective randomized clinical trials will be necessary to assess its performance in comparison to conventional ridge augmentation procedures.
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Humans , Alveolar Process , Alveolar Ridge Augmentation , Bone Transplantation , Calcium , Miners , Osteogenesis , Pilot Projects , Prospective Studies , TransplantsABSTRACT
Objective To investigate the optimal indication of submucosal tunneling endoscopic resection(STER)in patients with esophageal submucosal tumor(SMT). Methods Clinical data of 67 patients with esophageal SMT from May 2013 to August 2014 were summarized in the Digestive Endoscopy Center of Shanghai Changhai Hospital, and relationships between lesion features and success rate or complications of STER were analyzed. Results Of all 67 cases, 60 cases(89.6%)located in the middle and low segment of the esophagus,64 cases(95.6%)were endo-luminal growth. The maximum diameter of lesions were ranged from 1 to 6 cm with mean length of(2.34±1.13)cm. The length of tunnel incision was 1-2 cm with mean length of(1.19±0.37)cm,and the length of submucosal tunnel was 2-7 cm with mean length of(4.09±1.26)cm. The mucosal injury rate and muscularis propria injury rate was 7.5%(5/67) and 4.5%(3/67), respectively. The number of hemostatic clips for tunnel incision closure was 2-17 with mean number of 8.79 ± 3.39. No delayed hemorrhage or severe adverse events occurred in any of the 67 patients following STER. The success rate of STER was 100%. The en bloc resection rate was 91.0% (61/67),while the en bloc removal rate was 83.6%(56/67). When the maximum diameter of lesions was more than 3 cm,the operation time increased significantly,while the en bloc resection or removal rates were declined. Conclusion STER is safe and effective for esophageal SMT, especially for lesions located in the middle and low segment esophagus with less than 3 cm maximum diameter.
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Objective To evaluate the efficacy and safety of endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) for gastroesophageal junction (GEJ)submucosal tumors (SMTs) originating from the muscularis propria(MP) layer.Methods Clinical data of sixty-one patients with GEJ SMTs originating from the MP layer who were treated with ESE(ESE group,n=39) or STER(STER group,n=22) between January 2013 and December 2015 in Changhai Hospital were retrospectively analyzed.Outcomes and complications in the two groups were compared.Results Single lesion in 61 patients were all resected by therapeutic endoscopy successfully.Operation time in the STER group was shorter than that of the ESE group(47.27±20.89 min VS 66.56±40.07 min,P＜0.05).There was no significant difference in number of hemostatic clips between the two groups[7.10±5.57 VS 8.00± 1.88,P＞0.05].Hospitalization time of STER group was shorter than that of the ESE group [3.0(1.25) d VS 4.0 (1.00) d,P＜0.05].One patient developed delayed hemorrhage in ESE group,while no other complications occurred in either group.The wound healed in both groups under gastroscopy,and no residual or recurrent tumors were detected during the follow-up period.Conclusion Both STER and ESE can be used for GEJ SMTs originating from the MP layer,but STER is more safe and efficient.
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Objective To investigate the preoperative identification of esophageal submucosal tumor by endoscope. Methods 40 patients of esophageal submucosal tumors with lesions range from 1.0 to 2.0 cm from March 2012 to August 2016 were randomly divided into A, B groups. Patients in group A underwent submucosal tunneling endoscopic resection (STER) 3.0 cm from the lesions, while patients in group B first underwent submucosal injection of saline to mark the lesions, then perform STER in the same way. Then record the time of checking. Results The average time of group A was (420.0 ± 25.0) s, the average time of B group was (300.0 ± 25.0) s, there was statistical differences between the two groups. Conclusion Preoperative identification of the lesions before STER holds more advantages.
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Objective To estimate the safety and efficacy of submucosal tunneling endoscopic resection (STER) on treatment of large esophageal submucosal tumors (SMTs) originating from muscularis propria layer.Methods The data of patients with large esophageal SMTs (diameter ≥ 3.5 cm) undergone STER (n=17) or endoscopic submucosal dissection (ESD,n =15) at the Endoscopy Center of Tianjin Medical University General Hospital from December 2009 to March 2016 were retrospective analyzed.The therapeutic effects,hospitalization times,post-operation expenses,and occurrence of complications were evaluated and compared between the two groups.Results All the endoscopic treatments of the 32 patients were successfully completed.The operating time of the STER group was significantly longer than that of the ESD group (t =2.595,P =0.015).There was no statistical difference on the en bloc resection rate,complete resection rate and complication rate between STER group and ESD group (P＞0.05).The mean post-operative hospital stay of the STER group was significantly less than that of the ESD group (3.8± 1.0days VS 6.7±1.8 days,t=5.644,P=0.000).The mean hospital cost of the STER group was significantly less than that of the ESD group (22 456.1±5 232.0 yuan VS 27 392.5±5 747.9 yuan,t =2.543,P =0.016).The wound healing rates at 1 month after operation in the STER group was significantly higher than that of the ESD group [94.1％ (16/17) VS 20.0％ (3/15),P=0.000].No recurrence and metastasis occurred in the STER group and ESD group during the 41.2±20.6 months follow-up.Conclusion STER is a safe and effective technique for treating large esophageal SMTs originating from the muscularis propria layer,with earlier wound healing,shorter hospital stay and lower cost compared with those of the traditional method of ESD.
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O recobrimento radicular é indicado por razões estéticas, para reduzir a hipersensibilidade de raiz e para criar ou aumentar tecido queratinizado. Várias técnicas cirúrgicas têm sido descritas, com a decisão dependendo de parâmetros clínicos anatômicos e técnicos. A principal meta terapêutica é alcançar uma cobertura completa da raiz com um resultado estético satisfatório. Uma abordagem previsível para o recobrimento radicular é a técnica de tunelização associada ao enxerto de tecido conjuntivo subepitelial, matriz dérmica acelular (MDA) ou outros biomateriais. Neste relato de caso com controle clínico de seis anos foi realizada a recuperação do tecido gengival perdido na região do dente 13, com o uso de uma técnica minimamente invasiva: a técnica de túnel associado ao enxerto de tecido conjuntivo subepitelial. Esta associação resultou em um importante ganho de inserção e, além do recobrimento radicular, foram melhoradas a hipersensibilidade e a estética na região.
The root coverage is indicated for aesthetic reasons, to reduce root hypersensitivity and to create or to increase keratinized tissue. Several surgical techniques have been described, with the decision depending on anatomical clinical and technical parameters. The main therapeutic goal is to achieve full coverage of the root with a satisfactory cosmetic result. A predictable approach to root coverage is a tunneling technique associated with subpeithelial connective tissue graft, acellular dermal matrix (ADM) or other biomaterials. In this case report with a 6-year clinical follow-up, the gingival tissue lost at the tooth 13 region was recovered using a minimally invasive technique (tunneling + subepithelial connective tissue graft). This association contributed to a signifi cant attachment level recovery and, besides root coverage, hypersensitivity and esthetics were improved in the operated site.
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Male , Connective Tissue/transplantation , Free Tissue Flaps , Gingival Recession/therapy , Tissue Transplantation/methodsABSTRACT
Tunneling nanotubes (TNT) is a newly discovered connection mode between animal cells, and its formation is of great importance in physiological and pathological processes of animals and humans. The forming conditions and the promoting mechanism of TNT are not fully understood yet. It has been known that the state of cells (such as inflammatory conditions and stress reaction), molecular level (Fas ligand, cell adhesion molecules and the ligand interactions, M-Sec/TNFaip2/B94 and lipid molecules), and pathogenic infection are important for the formation of TNT. In this paper we reviewed the promoting mechanisms for TNT formation.
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Reciprocal exchange of morphogenetic proteins between epithelial and mesenchymal cells in a stem/progenitor cell niche results in formation of a nephron. To maintain diffusion of morphogenetic proteins, it is assumed that a close contact exists between involved cells. However, recent publications underline that both types of stem/progenitor cells are separated by a striking interface. To explore this microarchitecture in detail, neonatal rabbit kidneys were fixed in traditional glutaraldehyde (GA) solution for transmission electron microscopy. For contrast enhancing specimens were fixed in GA solution including cupromeronic blue, ruthenium red or tannic acid. To record same perspectives, embedded blocks of parenchyma were cut in exactly orientated vertical and transverse planes to lining collecting ducts. Electron microscopy of specimens fixed by traditional GA solution illustrates a spatial separation of stem/progenitor cells and an unobstrusively looking interface. In contrast, advanced fixation of specimens in GA solution including cupromeronic blue, ruthenium red and tannic acid unmasks earlier not visible extracellular matrix. In addition, projections of mesenchymal cells covered by matrix cross the interface to contact epithelial cells. Surprisingly, the end of a mesenchymal cell projection does not dangle but is enclosed in a fitting sleeve and connected via tunneling nanotubes with the plasma membrane of an epithelial cell. Regarding this complex ensemble the question is to what extent illustrated cell-cell connections and extracellular matrix are involved in communication and transmission of morphogenetic proteins during induction of a nephron.
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Cell Membrane , Diffusion , Epithelial Cells , Extracellular Matrix , Glutaral , Kidney , Microscopy, Electron , Microscopy, Electron, Transmission , Nanotubes , Nephrons , Ruthenium Red , Strikes, Employee , TanninsABSTRACT
While endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal tumors, it is rarely used for subepithelial tumors (SETs) originating from the muscularis propria of the esophagus and gastric cardia because of the risk of perforation and problems with inadequate space and field of view during procedures. Submucosal tunneling endoscopic resection (STER) is a new therapeutic method for treating SETs in specific locations in the esophagus and stomach. This technique is highly skill-dependent, using a mucosal flap that covers a deeper part of the gut wall, but is safe and minimally invasive compared with conventional endoscopic approaches such as ESD in SETs originating from the muscularis propria.We report a patient who underwent STER to remove a SET located at the gastric cardia. The patient recovered without any complications. We believe that our case shows the efficacy and safety of the STER technique for patients with a SET originating from the muscularis propria.
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Humans , Male , Middle Aged , Cardia/pathology , Endosonography , Gastric Mucosa/pathology , Gastroscopy , Leiomyoma/diagnosis , Stomach Neoplasms/diagnosisABSTRACT
Gingival recession related to periodontal disease or developmental problems can result in root sensitivity, root caries, and esthetically unacceptable root exposures. In the past, multiple surgical procedures have been proposed to obtain root coverage on exposed buccal root surfaces. There has been great interest in the treatment of gingival recession defects, especially with subepithelial connective‑tissue grafting (SCTG). Recent advances have focused on SCTG by the tunnel technique. This article highlights the esthetic results obtained by adopting a modification of the tunnel technique using a single vertical incision along with autologous SCTG in the management of multiple adjacent Miller Class‑II gingival recessions. A single vertical incision was used along with tunnel preparation for the facile placement of SCTG into the prepared tunnel. After 6 months of follow‑up, the clinical condition was stable with satisfactory root coverage outcome. An excellent esthetical outcome was achieved and the patient was satisfied with the result.