Perforation-free removal of gastric gastrointestinal stromal tumors: Endoscopic inversion and strangulation of muscle layer and resection (EISMR).

Endoscopic resection for GIST has become more widespread in recent years because it is less invasive than surgery. However, when endoscopic resection is performed, a full-layer resection of the gastric wall is often necessary, and extensive suturing is required if perforation occurs, which is a technically challenging procedure. Recently, we reported a new method called endoscopic inversion and strangulation of the muscle layer and resection (EISMR), which consists of endoscopically inverting the muscle layer into the gastric lumen and strangulating the muscle layer with a detachable snare, followed by resection. The study comprised five consecutive patients with gastric GIST ≤50 mm in diameter who underwent EISMR procedures. The main outcomes of the study were en bloc resection rate, R0 resection rate, procedure time, and complications. The results showed that all five patients successfully underwent complete resection without perforation, and the en bloc resection and R0 resection rates were 100%. The median procedure time was 93 min (range, 58-120 min), and there were no major complications. We concluded that EISMR would be a safe and effective technique for endoscopic resection of gastric GISTs and may be an alternative to surgery or endoscopic submucosal dissection.

Viral Infection in Esophageal, Gastric, and Colorectal Cancer.

The human gastrointestinal tract, which constitutes the digestive system, contains a large number of virus particles that maintain organizational homeostasis and health. Conversely, viral pathogens have also attracted attention for their involvement in the pathogenesis of certain cancers, including gastrointestinal cancers. To aid prevention and treatment of these cancers, the relevance of gastrointestinal viral factors as potential risk factors needs to be carefully investigated. This review summarizes and discusses the available literature on the relationship between the development of esophageal, gastric, and colorectal cancers and their corresponding viruses. This review reveals that research on the association between colorectal cancer and viruses, in particular, is still in its infancy compared to the association between HPV and esophageal cancer and between EBV and gastric cancer.

Gel Immersion Endoscopic Mucosal Resection (EMR) for Superficial Nonampullary Duodenal Epithelial Tumors May Reduce Procedure Time Compared with Underwater EMR (with Video).

Materials and Methods: This was a retrospective cohort study conducted in two municipal hospitals. We identified 24 patients with SNADETs of 3-18 mm in diameter who underwent UEMR or GIEMR. One lesion was excluded from the analysis because it was found to be in the stomach after surgery. The primary outcome was procedure time. Results: GIEMR significantly reduced the procedure time compared with UEMR (5 min vs. 10 min, P = 0.016). There was no significant difference between the UEMR and GIEMR groups for en bloc resection rate (93% vs. 100%, P = 1.0) and R0 resection rate (57% vs. 80%, P = 0.39). No serious complications were observed in either group. Conclusions: GIEMR of SNADET has the potential to reduce procedure time compared with UEMR and may be particularly effective in areas where immersion in water is difficult.

Diffuse Pancreatic Cancer Mimicking Autoimmune Pancreatitis.

The characteristic finding of sausage-shaped pancreas or capsule-like rim facilitates the diagnosis of autoimmune pancreatitis. We herein report a case of a 67-year-old man showing a sausage-shaped, enlarged pancreas with a capsule-like rim on computed tomography. Furthermore, endoscopic retrograde cholangiopancreatography demonstrated diffuse narrowing of the main pancreatic duct, in addition to stenosis of the lower bile duct. Finally, we were able to diagnose pancreatic cancer in this patient by an endoscopic ultrasound-guided fine-needle aspiration biopsy following peroral cholangioscopy and bile cytology. This report emphasizes the significance of pathological confirmation before starting treatment, even in cases with diffuse pancreatic enlargement.

The degradation of the inwardly rectifying potassium channel, Kir2.1, depends on the expression level: examination with fluorescent proteins.

The expression of ion channels is regulated by their synthesis as well as degradation, and some ion channels are degraded in an expression level-dependent way. Recently, new techniques of fluorescent proteins have been developed and seem to be useful to study protein degradation. To examine the regulation of the degradation of strongly inwardly rectifying potassium channel (Kir2.1) and the usefulness of the fluorescent proteins, we constructed Kir2.1 fusion proteins with SNAP tag and fluorescent timer (FT). The SNAP tag, which covalently binds to a specific membrane-permeable fluorescent dye, enables a pulse-chase experiment with fluorescence. When the SNAP-Kir2.1 proteins were expressed in 293T cells by low and high expression plasmids, the half-life of the fusion protein expressed by a high-expression plasmid was shorter (18.2±1.9 h) than that expressed by a low-expression plasmid (35.1+2.3h). The addition of Ba(2+), a selective blocker of Kir2.1, slowed the degradation, suggesting a current-dependency of degradation. Consistently, patch-clamp recording showed that cultivation in the presence of Ba(2+) increased the whole cell conductance of SNAP-Kir2.1. Since the fluorescence of FT changes gradually changes from green to red, the green/red ratio should allow us to monitor the changes in the degradation rate of FT-Kir2.1. Using this method, we confirmed the slower degradation by Ba(2+). The results suggest a homeostatic regulation of the degradation of Kir2.1 in the 293T cells, and the usefulness of fluorescence-based methods for examining the degradation of ion channels.

Model analysis in "8020" achievers using three-dimensional images.

The purpose of this study was to clarify the effect of aging on the dentition by quantifying the dimensions of the dental arches in elderly persons aged over 80 years with 20 or more remaining teeth (8020 achievers). The study included twenty 8020 achievers (10 males and 10 females, with an average age of 82.3 years and an average of 28.3 present teeth). Their dental casts were digitized with a 3-dimensional (3-D) laser scanner, reconstructed into 3-D images, and measured with IMAGEWARE. The anterior and posterior widths of the upper and lower coronal arches and their anterior and posterior lengths together with the anterior and posterior widths of the maxillary and mandibular basal arches and their anterior and posterior lengths were measured. An unpaired t-test was performed using statistical analysis software. Dental models of 31 people with normal occlusion (16 males and 15 females, with an average age of 23.3 years) were measured with digital calipers and compared with the measurements obtained from the 8020 achievers. Several common items with significant differences were observed in the mandibular measurements. Each comparison indicated a tendency toward a decrease in size in the 8020 group: Coronal Arch P-length (p<0.05 in Male group, p<0.01 in Female group), Basal Arch A-width (p<0.05 in Male group, p<0.001 in Female group), Basal Arch A-length (p<0.001 in both group), and Basal Arch P-length (p<0.001 in both group). From these results, 3-D dental model analysis in twenty 8020 achievers revealed narrowing of the mandibular intercanine width and shortening of the mandibular anterior and posterior lengths.

Mesio-distal tooth angulation in elderly with many remaining teeth observed by 3-D imaging.

Few studies have investigated the morphologic characteristics of teeth, dental arches and occlusion in elderly persons with many remaining teeth. The purpose of this study was to establish a method of measurement using 3-D imaging to investigate tooth angulation in the elderly from the orthodontic point of view. The dental casts of 20 elderly persons with many remaining teeth were digitized with a 3-D laser scanner (VMS-100F, UNISN INC., Osaka, Japan) to construct 3-D images. The mesio-distal angulation of each tooth was then measured with analytical software (SURFLACER, UNISN INC. and IMAGEWARE 12, UGS PLM Solutions, MO, USA). The occlusal plane formed by the incisal edge of the central incisor and distal buccal cusp tip of the first molar on either side was used as a reference plane for measurements. Mesio-distal tooth angulation (indicated in degrees) of maxillary teeth in this subjects averaged 1.26 for central incisors, 5.46 for lateral incisors, 7.84 for canines, 6.59 for first premolars, 5.78 for second premolars, 1.64 for first molars and -4.17 for second molars. Average values for mandibular teeth were 0.91 for central incisors, 2.35 for lateral incisors, 7.04 for canines, 8.76 for first premolars, 10.44 for second premolars, 7.33 for first molars and 12.67 for second molars. There was no statistical difference between the data in man and women except maxillary second molar (p<0.05). Mesial angulation in the mandibular arch showed a progressive increase from the anterior to the posterior. However, this tendency was not observed in the maxillary arch.

Tooth inclination in elderly with many remaining teeth observed by 3-D imaging.

Tooth inclination has been discussed many times in terms of esthetics and functionality, but reports related to aging are extremely rare. The purpose of this study was to evaluate tooth inclination in the elderly from the orthodontic point of view. The dental casts of twenty elderly persons with many remaining teeth were digitized with a 3-D laser scanner (VMS-100F,UNISN INC., Osaka, Japan) for reconstruction into 3-D images. Inclination of each tooth was then measured with an analytical software (SURFLACER, UNISN INC. and IMAGEWARE 12, UGS PLM Solutions, MO, USA). The occlusal plane formed by the incisal edge of the central incisor and distal buccal cusp tip of the first molar on either side was used as a reference plane to measure tooth inclination, and the complementary angle as tooth inclination was measured. The average tooth inclinations (degrees) of the maxillary teeth were 8.08 for central incisors, 8.10 for lateral incisors, 4.85 for canines, -6.68 for first premolars, -5.58 for second premolars, -5.15 for first molars, and -5.41 for second molars. The corresponding values for the mandibular teeth were 6.78 for central incisors, 4.87 for lateral incisors, -5.73 for canines, -13.74 for first premolars, -19.21 for second premolars, -23.76 for first molars, and -28.63 for second molars. There was no statistical difference between men and women, except for in the maxillary lateral incisors (p<0.05). Tooth inclination showed a progressive decrease from anterior to posterior. The decrease in the mandibular teeth was more regular than that of the maxillary teeth.

Occlusal force in people in their sixties attending college for elderly.

The "8020" goal of retaining 20 or more teeth after the age of 80 necessitates investigating oral health status in people below the age of 80. The purpose of this study was to determine similarities and differences between people in their sixties attending college and achievers of the 8020 goal. The results of oral examination and occlusal force measurement in 46 students enrolled at a college for the elderly in Chiba City with an average age of 66.9 years (22 men, 24 women) were compared with data from previous surveys of fifty-two 8020 achievers (28 men, 24 women). Occlusal force was measured and evaluated using Dental Prescale (Fuji Photo Film Co., Tokyo). The average number of present teeth was 25.8, and no subjects showed anterior crossbite, comparable with findings in 8020 achievers. Average occlusal force was 942.9 + or - 440.1 N (1,029.6 + or - 545.9 N for men, 863.4 + or - 305.1 N for women), not significantly different from that in 8020 achievers. The results of multiple regression analysis suggest that occlusal force is unaffected by aging if many teeth are present.