[Endoscopic hand-suturing combined with titanium clips for rectal defects closure after endoscopic submucosal dissection: a pilot study].

Objective: To explore the feasibility of endoscopic hand-suturing (EHS) for rectal defects closure after endoscopic submucosal dissection (ESD), and the clinical practicability of EHS combined with titanium clips. Methods: This is a prospective study performed by two experienced endoscopists from the Cancer Hospital, Chinese Academy of Medical Sciences who had received EHS training in sixporcine gastric ESD defects in vivo before the study. From December 2022 to February 2022, 20 patients with rectal mucosal lesions or submucosal diseases underwent ESD. Then EHS combined with titanium clips was adopted to close the rectal ESD defects. Specifically, we first sutured the defects as much as possible through EHS, then use titanium clips to fix the tail of the suture, and finally use additional titanium clips to close the residual parts of the defects that cannot be sutured. The main observational indicators were complete closure of the wound and delayed bleeding within one month after surgery. Results: In the 20 rectal cases, the size of defects ranged from 2.2 to 3.6 cm, with a median of 2.7 cm. All cases achieved complete closure without delayed bleeding, of which 12 (60.0%) were completely sutured with EHS and 8 (40.0%) required additional titanium clips to achieve complete closure after suturing. Conclusion: EHS technique is feasible and safe for rectum. EHS combined with titanium clips can also effectively close the rectal ESD defects, prevent postoperative delayed bleeding, and may be easier to be implemented in clinical practice.

[Effect and prognosis of new type of re-dilated stent in the treatment of pulmonary artery bifurcation stenosis].

the early and med-term follow-up results and technical points of new re-dilated stent in the treatment of pulmonary artery bifurcation opening stenosis, and explore its feasibility and advantages. From March 2019 to October 2020, 10 children [5 males, mean age (7±3) years], mean weight 18.75(13.35,23.05) kg with pulmonary artery bifurcation opening stenosis were treated with new re-dilated stents in the Central China Fuwai Hospital. Including 5 cases of tetralogy of Fallot, 4 cases of pulmonary atresia, 1 case of anomalous origin of coronary artery, all children were given new re-dilated stent implantation. Echocardiography, chest X-ray and electrocardiogram were performed 1 day, 3, 6, 12 months after intervention. Pulmonary artery CTA was performed after 6 or 12 months to evaluate the results, including restenosis, malposition and rupture. A total of 16 stents were implanted in 10 children, 5 cases had simultaneous stenosis of bifurcation openings of pulmonary arteries, and 1 stent was implanted in each of the left and right pulmonary artery openings. The pressure of right ventricular and gradient was significantly decreased immediately after intervention, from preoperative (38-80) mmHg(1 mmHg=0.133 kPa) to postoperative (0-22) mmHg, only one patient's pressure gradient is over 20 mmHg (22 mmHg), and all cases discharged successfully. Stent restenosis, malposition, fracture and other abnormalities were not observed in follow-up. Stents implantation for patients with pulmonary artery bifurcation opening stenosis is very more difficult. A good strategy can ensure that the intervention is safe and effective. It not only avoids the risk of repeated surgery, but also achieves good med-term follow-up results.

[Establishment and clinical validation of an artificial intelligence YOLOv51 model for the detection of precancerous lesions and superficial esophageal cancer in endoscopic procedure].

Objective: To construct the diagnostic model of superficial esophageal squamous cell carcinoma (ESCC) and precancerous lesions in endoscopic images based on the YOLOv5l model by using deep learning method of artificial intelligence to improve the diagnosis of early ESCC and precancerous lesions under endoscopy. Methods: 13, 009 endoscopic esophageal images of white light imaging (WLI), narrow band imaging (NBI) and lugol chromoendoscopy (LCE) were collected from June 2019 to July 2021 from 1, 126 patients at the Cancer Hospital, Chinese Academy of Medical Sciences, including low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia, ESCC limited to the mucosal layer, benign esophageal lesions and normal esophagus. By computerized random function method, the images were divided into a training set (11, 547 images from 1, 025 patients) and a validation set (1, 462 images from 101 patients). The YOLOv5l model was trained and constructed with the training set, and the model was validated with the validation set, while the validation set was diagnosed by two senior and two junior endoscopists, respectively, to compare the diagnostic results of YOLOv5l model and those of the endoscopists. Results: In the validation set, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the YOLOv5l model in diagnosing early ESCC and precancerous lesions in the WLI, NBI and LCE modes were 96.9%, 87.9%, 98.3%, 88.8%, 98.1%, and 98.6%, 89.3%, 99.5%, 94.4%, 98.2%, and 93.0%, 77.5%, 98.0%, 92.6%, 93.1%, respectively. The accuracy in the NBI model was higher than that in the WLI model (P<0.05) and lower than that in the LCE model (P<0.05). The diagnostic accuracies of YOLOv5l model in the WLI, NBI and LCE modes for the early ESCC and precancerous lesions were similar to those of the 2 senior endoscopists (96.9%, 98.8%, 94.3%, and 97.5%, 99.6%, 91.9%, respectively; P>0.05), but significantly higher than those of the 2 junior endoscopists (84.7%, 92.9%, 81.6% and 88.3%, 91.9%, 81.2%, respectively; P<0.05). Conclusion: The constructed YOLOv5l model has high accuracy in diagnosing early ESCC and precancerous lesions in endoscopic WLI, NBI and LCE modes, which can assist junior endoscopists to improve diagnosis and reduce missed diagnoses.

Association between interleukin-3 gene polymorphism and acute rejection after kidney transplantation.

BACKGROUND: Acute rejection (AR) after kidney transplantation resulting from alloimmune responses has a negative effect on graft survival. AR is mainly caused by T-cell immune responses activated by cytokines, including interleukin (IL)-2, -4, and -7. Many reports have shown that single nucleotide polymorphisms (SNPs) of these cytokines can affect the occurrence of AR. IL-3, which is secreted by activated T cells, can mediate AR. Our study sought to investigate the association between SNPs of the IL3 gene and the occurrence of an AR episode (ARE). METHODS: We analyzed 3 SNPs of IL3 (rs181781, rs2073506, and rs40401) among 330 renal recipients, 60 of whom had developed an ARE. SNPs of the IL3 gene, including 1 exonic SNP (rs40401) and 2 regulatory thought to be promoter SNPs (rs181781 and rs2073506). RESULTS: The genotypes of 60 ARE subjects and the 270 patients without AR demonstrated a significant relationship between genotype frequencies and the SNPs. The occurrence of an ARE was associated with rs181781 (P = .041, dominant model), rs2073506 (P = .009, codominant 1 model; P = .003, dominant model), and rs40401 (P = .014, recessive model). Among haplotypes, AAT showed a significant association with ARE. (P = .0033). CONCLUSION: Our results suggest that IL3 gene polymorphisms were associated with this event.

Superfine saengshik improves liver protecting effect compared with fine saengshik in an animal model.

This study was performed to compare the effect of liver protection of fine saengshik (FS) and superfine saengshik (SS) and uncooked and powdered grains and vegetables, produced by the different mill technique on the acute hepatotoxicity induced by CCl(4) in mouse. As the result of particle size distribution in number, particles included under 0.955 microm dia were 7.02% and 68.92% respectively. Hematological and serological examination showed that AST (P < 0.05) and ALT (P < 0.05) of SS + CCl(4) group decreased significantly compared with those of FS + CCl(4) group. On the examination of antioxidant effect, water extract of SS showed a higher superoxide dismutase (SOD)-like activity on the condition of the HX/XOD system than that of FS (P < 0.001). Also, the glutathione peroxidase (P < 0.01) and glutathione reductase (P < 0.05) activities in liver showed a significant difference between FS + CCl(4) and SS + CCl(4) groups. On the histological observation of liver, SS + CCl(4) group showed a mild reversible hepatocytic change and infiltration of inflammatory cells around the central veins, whereas FS + CCl(4) group showed severe agglutination necrosis by CCl(4) toxicity. These results suggest that superfine saengshik significantly improves liver protection effect compared with fine saengshik; its major mechanism is supposed to be the improved antioxidant effect of saengshik by reduced size of particles.

Effects of hexachlorobenzene on antioxidant status of liver and brain of common carp (Cyprinus carpio).

Hexachlorobenzene (HCB)-induced oxidative damages have been published in rats while the effects have not yet been reported in fishes. Juvenile common carps (Cyprinus carpio) were exposed to waterborne HCB from 2 to 200 microg l-1 for 5, 10 or 20 days. Liver and brain were analyzed for various parameters of oxidative stress. There were no significant changes of glutathione (GSH) content and superoxide dismutase (SOD) activity in liver after 5 or 10 days exposure, whereas obvious drops were observed at higher concentrations after 20 days exposure. Significant decreases of GSH content and SOD activity in brain were found during all the exposure days. In brain, HCB also significantly elevated the contents of reactive oxygen species (ROS), thiobarbituric acid- reactive substances (TBARS, as an indicator of lipid peroxidation products), glutathione disulfide (GSSG), and activities of nitric oxide synthase (NOS), glutathione peroxidase (GPx), and glutathione reductase (GR), and inhibited activities of acetylcholinesterase (AchE) and glutathione S-transferase (GST). The results clearly demonstrated that environmentally possible level of HCB could result in oxidative stress in fish and brain was a sensitive target organ of HCB toxicity.

Cloning and characterization of the UDP-sugar hydrolase gene (ushA) of Enterobacter aerogenes IFO 12010.

A bacterial alkaline phosphatase (BAP, the phoA gene product) is primarily responsible for the hydrolysis of the substrates 5-bromo-4-chloro-3-indolylphosphate-p-toluidine (XP) and p-nitrophenyl phosphate (pNPP). Using these substrates and an E. coli phoA mutant, we have cloned Enterobacter aerogenes genes conferring an XP(+) phenotype. Two types of clones were identified based on phenotypic tests and DNA sequences. One of them is a E. aerogenes phoA gene (XP(+), pNPP(+)) as expected; surprisingly the other one was found to be a ushA gene (XP(+), pNPP(-)), which encodes an UDP (uridine 5'-diphosphate)-sugar hydrolase. The E. aerogenes ushA gene shares high sequence identity with ushA of E. coli and the mutationally silent ushA0 gene of Salmonella typhimurium at both the nucleotide (over 79%) and amino acid (over 93%) levels. Expression of the E. aerogenes ushA gene in E. coli produced high level of UDP-sugar hydrolase, as confirmed by TLC (thin layer chromatography) analysis together with a presence of a strong band due to a XP hydrolysis on a polyacrylamide gel.

[Infection status of anisakid larvae in anchovies purchased from local fishery market near southern and eastern sea in Korea].

A survey was carried out on the larval anisakis in anchovies (Engrauris japonica) which were caught from April to June in 1993 at the southern and eastern sea in Korea. Anisakids in anchovies were morphological classified into Anisakis type I and II and Contracaecum type B and C, after fixation in 70% alcohol and clearing in lactophenol. A total of 171 larval anisakids were collected from 150 anchovies (6.9%) out of 2,180 examined. The infection rates showed no relation with length of the anchovies. The numbers of anisakids by organs of anchovies were 96 (56.1%) from the muscle, 65 (38.0%) from the omentum, 7 (4.1%) from the intestine, 2 (1.7%) from the stomach and 1 (0.6%) from the testis. Infection rates of anchovies with anisakids by localities were 5.1% at Taebyon, 8.0% at Sokcho and 9.2% at Chungmu. The larval anisakids in anchovies may infect humans who often eat raw anchovies.

[Infection status of larval anisakids in Astroconger myriaster collected from the Southern Sea near Pusan].

A study was presented on the anisakid larvae in Astroconger myriaster which were caught at the Southern Sea and saled at Pusan area. The nematodes were morphologically classified into Anisakis sp. and Contracaecum sp. after fixation in 70% ethanol and clearing in lactophenol. Total of 1,768 larval anisakids were collected from 259 (67.8% positive rate) out of 382 examined A. myriaster. Total 642 larvae of Anisakis sp. were obtained from 94 (24.6%) and 1,126 Contracaecum sp. were recovered from 165 (43.1%) fish. The average number of worms per infected fish was 4.6. The infection rate increased according to the length of fish, and all of the fish over 71 cm were found infected. The numbers (proportions) of recovered worms by the organs were 1,440 (80.5%) in the omentum, 166 (9.4%) in the intestine, 107 (6.0%) in the stomach, 32 (1.8%) in the skin, 18 (1.0%) in the muscle, 13 (0.7%) in the liver, and 2 (0.1%) in the head. The larvae in the muscle may infect the humans who are enjoying raw sliced meat of the fish.

[Clinical analysis of 140 patients with periampullary carcinoma].

From 1964 to 1984, 140 patients were treated by operation in our hospital with the diagnosis of periampullary carcinoma established by exploration or pathology. 86 patients were male and 54 were female. The age ranged from 29 to 73 years. 126 (90%) of them were over forty, pancreatoduodenectomy was performed in 60 patients. The resection rate was 42.9%. The operation mortality was 11.7%. Pancreatoduodenectomy gave a mean postoperative survival of 22 months. The longest survival was 13 years 10 months, palliative choledochoenterostomy or gastro-enterostomy was done in 66 patients with a mean survival of 5.2 months. 14 patients were given laparotomy only with a mean survival of 4 months. In this paper, the diagnosis of periampullary carcinoma, early postoperative complications of pancreatoduodenectomy and prognosis are discussed.

[Prostaglandin E (PGE) and gastric carcinoma].

Since 1984, an experimental and clinical study on the relation between PGE and gastric carcinoma has been performed by determining PGE content in the bioptic gastric mucosa and plasma. It is found the PGE content in the gastric mucosa and plasma is increased in all patients with gastric cancer, especially with signet ring cell carcinoma. It is higher in the regional lymph node metastasis than in the early cancer, extensive metastases and normal subjects. The PGE content in the plasma is reduced obviously 7-10 days after operation but is increased markedly in recurrent patients. There is no significant difference in extensive metastases, relapse free and normal subjects. The PGE content in the plasma is significantly higher in gastric carcinoma than in chronic atrophic gastritis, but no difference is present between chronic atrophic gastritis and normal subjects.