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Saudi Journal of Gastroenterology :... 2023Endoscopic submucosal dissection (ESD) of rectal tumors involving the dentate line (RT-DL) is challenging because of the anatomical features of the anal canal. This...
BACKGROUND
Endoscopic submucosal dissection (ESD) of rectal tumors involving the dentate line (RT-DL) is challenging because of the anatomical features of the anal canal. This study aimed to identify optimal techniques and sedation and to determine the clinical outcomes of ESD for RT-DL.
METHODS
We retrospectively collected medical records and endoscopic results of patients who underwent ESD for rectal tumors between January 2012 and April 2021. Patients were divided into RT-DL and rectal tumors not involving the dentate line (RT-NDL) groups, as per involvement of the dentate line. The treatment results and clinical outcomes of the two groups were evaluated and analyzed. Additionally, subgroup analysis was performed in the RT-DL group for the sedation method involved.
RESULTS
In total, 225 patients were enrolled and 22 were assigned to the RT-DL group. The complete resection rate (90.9% vs. 95.6%, P =0.336), delayed bleeding (13.6% vs. 5.9%, P =0.084), perforation (0% vs. 3.9%, P = 0.343), hospital stays (4.55 vs. 4.48 days, P = 0.869), and recurrence (0% vs. 0.5%) showed no significant group differences. However, in RT-DL group, the procedure time (78.32 vs. 51.10 min, P = 0.002) was longer and there was more perianal pain (22.7% vs. 0%, P = 0.001). The subgroup analysis revealed that deep sedation using propofol reduced perianal pain during the procedure (0/14 vs. 5/8, P = 0.002).
CONCLUSIONS
ESD of RT-DL is a safe and effective treatment despite the challenges of requiring a high level of technique and longer procedure time. In particular, ESD under deep sedation should be considered in patients with RT-DL to control perianal pain.
Topics: Humans; Endoscopic Mucosal Resection; Pain; Rectal Neoplasms; Retrospective Studies; Treatment Outcome; Deep Sedation
PubMed: 37282445
DOI: 10.4103/sjg.sjg_67_23 -
Journal of Pharmaceutical Analysis Jul 2023Nine major cell populations among 46,716 cells were identified in mouse intestinal ischemia‒reperfusion (II/R) injury by single-cell RNA sequencing. For enterocyte...
Nine major cell populations among 46,716 cells were identified in mouse intestinal ischemia‒reperfusion (II/R) injury by single-cell RNA sequencing. For enterocyte cells, 11 subclusters were found, in which enterocyte cluster 1 (EC1), enterocyte cluster 3 (EC3), and enterocyte cluster 8 (EC8) were newly discovered cells in ischemia 45 min/reperfusion 720 min (I 45 min/R 720 min) group. EC1 and EC3 played roles in digestion and absorption, and EC8 played a role in cell junctions. For TA cells, after ischemia 45 min/reperfusion 90 min (I 45 min/R 90 min), many TA cells at the stage of proliferation were identified. For Paneth cells, Paneth cluster 3 was observed in the resting state of normal jejunum. After I 45 min/R 90 min, three new subsets were found, in which Paneth cluster 1 had good antigen presentation activity. The main functions of goblet cells were to synthesize and secrete mucus, and a novel subcluster (goblet cluster 5) with highly proliferative ability was discovered in I 45 min/R 90 min group. As a major part of immune system, the changes in T cells with important roles were clarified. Notably, enterocyte cells secreted Guca2b to interact with Gucy2c receptor on the membranes of stem cells, TA cells, Paneth cells, and goblet cells to elicit intercellular communication. One marker known as glutathione S-transferase mu 3 (GSTM3) affected intestinal mucosal barrier function by adjusting mitogen-activated protein kinases (MAPK) signaling during II/R injury. The data on the heterogeneity of intestinal cells, cellular communication and the mechanism of GSTM3 provide a cellular basis for treating II/R injury.
PubMed: 37577387
DOI: 10.1016/j.jpha.2023.02.002 -
Medicine Sep 2023This study aimed to assess the effectiveness of Endoscopic Mucosal Resection (EMR) and Argon Plasma Coagulation (APC) as therapeutic approaches for intestinal polyps in...
This study aimed to assess the effectiveness of Endoscopic Mucosal Resection (EMR) and Argon Plasma Coagulation (APC) as therapeutic approaches for intestinal polyps in patients, and to examine the factors associated with postoperative bleeding. This study included 132 patients diagnosed with colorectal polyps (188 polyps) who underwent endoscopic surgery at our hospital between January 2022 and December 2022. Based on the surgical method employed, the patients were divided into 2 groups: EMR (68 cases, 97 polyps) and APC (64 cases, 91 polyps). Comparative analyses were conducted to assess the clinical efficacy, surgery-related indicators, and quality of life the 2 groups. Furthermore, an investigation was carried out to identify the factors associated with postoperative bleeding. The analysis revealed no statistically significant difference in the cure rate of flat and superficial raised polyps between the EMR group and the APC (P > .05). However, it was found that the EMR group exhibited a significantly higher cure rate for subpedunculated and raised-pedunculated polyps compared to the APC group (P < .05). The results of logistics analysis showed that patients with hypertension (OR = 2.876, 95% CI: 1.119-7.393), patients with diabetes (OR = 5.278, 95% CI: 1.388-20.064), patients with hyperlipidemia (OR = 2.594, 95% CI: 1.054-6.380), the polyps of right hemicolon (OR = 2.743, 95% CI: 1.003-7.504), rectal polyps (OR = 5.143, 95% CI: 1.728-7.504), pedunculated polyps (OR = 4.758, 95% CI: 1.322-17.129), adenomatous polyps (OR = 3.152, 95% CI: 1.018-9.757) were independent risk factors for postoperative bleeding in patients with colorectal polyps (P < .05). The findings suggest that for subpedunculated and pedunculated-raised polyps, EMR can be a suitable treatment approach. On the other hand, flat and superficial-raised polyps can be effectively managed with either EMR or APC. The presence of hypertension, diabetes, hyperlipidemia, polyps of the right hemicolon, rectal polyps, pedunculated polyps, and adenomatous polyps has been established as independent risk factors for postoperative bleeding in patients with colorectal polyps.
Topics: Humans; Colonic Polyps; Endoscopic Mucosal Resection; Quality of Life; Intestinal Polyps; Postoperative Hemorrhage; Hypertension; Adenomatous Polyps
PubMed: 37713827
DOI: 10.1097/MD.0000000000034941 -
Revista Espanola de Enfermedades... May 2024A 70-year-old male was admitted with severe haematochezia and lipothymia. His medical history was relevant for coronary artery disease and radiation proctopathy. During...
A 70-year-old male was admitted with severe haematochezia and lipothymia. His medical history was relevant for coronary artery disease and radiation proctopathy. During hospitalization, was hemodynamically stable with persistent haematochezia. Laboratory examination revealed continuous haemoglobin fall, despite erythrocyte reposition, with administration of 11 units since admission. Colonoscopy showed an 8mm fibrinous lesion with an adherent clot, at 40cm from the anal verge. During exploration, a heavy spurting haemorrhage developed, with haemostasis being achieved with 4 clips, followed by site tattoo. Considering the risk of severe bleeding relapse in a high-risk patient, the patient underwent emergent Hartmann type colectomy. Histopathology report revealed a vascular lesion with arterial and venous vessels, protruding through the submucosa, muscular and subserosa, with a focal mucosal erosion, without neoplastic disease, compatible with an arteriovenous malformation (AVM).
PubMed: 38767028
DOI: 10.17235/reed.2024.10419/2024 -
Zhongguo Dang Dai Er Ke Za Zhi =... Jan 2024To investigate the clinical characteristics, treatment, and prognosis of children with perianal fistulizing Crohn's disease (pfCD).
OBJECTIVES
To investigate the clinical characteristics, treatment, and prognosis of children with perianal fistulizing Crohn's disease (pfCD).
METHODS
A retrospective analysis was conducted on the children, aged 6-17 years, who were diagnosed with Crohn's disease (CD) from April 2015 to April 2023. According to the presence or absence of perianal fistulizing lesions, they were divided into two groups: pfCD (=60) and non-pfCD (=82). The two groups were compared in terms of clinical characteristics, treatment, and prognosis.
RESULTS
The incidence of pfCD was 42.3% (60/142). The proportion of males in the pfCD group was higher than that in the non-pfCD group. Compared with the non-pfCD group, the pfCD group had a significantly higher proportion of children with involvement of the colon and small intestine or those with upper gastrointestinal lesions (<0.05). Compared with the non-pfCD group, the pfCD group had a significantly higher rate of use of infliximab during both induction and maintenance treatment (<0.05). In the pfCD group, the children with complex anal fistula accounted for 62% (37/60), among whom the children receiving non-cutting suspended line drainage accounted for 62% (23/37), which was significantly higher than the proportion among the children with simple anal fistula patients (4%, 1/23) (<0.05). There were no significant differences between the two groups in mucosal healing rate and clinical remission rate at week 54 of treatment (>0.05). The pfCD group achieved a fistula healing rate of 57% (34/60) at week 54, and the children with simple anal fistula had a significantly higher rate than those with complex anal fistula (<0.05).
CONCLUSIONS
There is a high incidence rate of pfCD in children with CD, and among the children with pfCD, there is a high proportion of children with the use of biological agents. There is a high proportion of children receiving non-cutting suspended line drainage among the children with complex anal fistula. The occurrence of pfCD should be closely monitored during the follow-up in children with CD.
Topics: Child; Male; Humans; Crohn Disease; Retrospective Studies; Prognosis; Infliximab; Rectal Fistula
PubMed: 38269458
DOI: 10.7499/j.issn.1008-8830.2308119 -
Microorganisms Nov 2023Pouchitis is a common complication of restorative proctocolectomy and ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC), significantly affecting the...
BACKGROUND
Pouchitis is a common complication of restorative proctocolectomy and ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC), significantly affecting the postoperative quality of life. Paneth cells play an important role in the maintenance of gut homeostasis. This study aimed to investigate the role of Paneth cells in the pathogenesis of pouchitis.
METHOD
Endoscopic biopsies from the pouch body and terminal ileum of UC patients undergoing IPAA with or without pouchitis were obtained to analyze Paneth cell function. Acute pouchitis was induced with 5% dextran sulfate sodium (DSS) for seven consecutive days in a rat model of IPAA. The Paneth cell morphology was examined by immunofluorescence and electron microscopy. The effect of exogenous lysozyme supplementation on pouchitis was also investigated. The fecal microbiota profile after DSS and lysozyme treatment was determined by 16s rRNA ITS2 sequence analysis.
RESULT
Abnormal mucosal lysozyme expression was observed in patients with pouchitis. The rat model of pouchitis showed increased pouch inflammation, increased CD3+ and CD45+ T cell infiltration, and decreased tight junction proteins, including ZO-1 and Occludin. There is a significant deficiency of Paneth cell-derived lysozyme granules in the rat model of pouchitis. Supplementation with exogenous lysozyme significantly ameliorated pouchitis, lowering the levels of inflammatory cytokines such as TNF-α and IL-6 in the pouch tissue. 16s rRNA analysis revealed a higher Lachnospiraceae level after lysosome treatment.
CONCLUSIONS
Paneth cell dysfunction is prominent in patients and rat models of pouchitis and may be one of its causes. The decrease in Lachnospiraceae, a characteristic of dysbiosis in pouchitis, could be reserved by lysosome treatment. Lysozyme supplementation shows promise as a novel treatment strategy for pouchitis.
PubMed: 38137976
DOI: 10.3390/microorganisms11122832 -
Endoscopy International Open Aug 2023Complete closure of large defects after colorectal endoscopic submucosal dissection (ESD) can be problematic, especially in challenging areas or lesions larger than...
Complete closure of large defects after colorectal endoscopic submucosal dissection (ESD) can be problematic, especially in challenging areas or lesions larger than half the lumen circumference. We report a reopenable clip-over-the-line method for such defects and aim to investigate its feasibility through a case series. We retrospectively evaluated data from 30 consecutive patients who underwent ESD with defect closure using the reopenable clip-over-the-line method between October 2020 and September 2022. This method requires the first clip-with-line grasp of the oral side's defect edge and muscle layer. The next reopenable clip (with a line fed through a hole in the reopenable clip tooth) is placed on the opposing mucosal defect edge and muscle layer. This process is repeated until complete closure. The primary study outcome was the rate of complete mucosal defect closure. We also reported post-procedure bleeding or perforation. The median dimensions of the resected specimens were 45 mm (range, 35-70) by 39 mm (range, 29-60). Complete closure was achieved for all defects, including nine rectal defects, of which three bordered the anal verge. Of the 30 defects included in this study, nine were larger than half the lumen circumference. The median closure time was 25 minutes (range, 14-52), and the median clip number was 17 (range, 9-42). No post-procedure bleeding or perforation occurred. The reopenable clip-over-the-line method is a feasible technique for the complete closure of large colorectal defects after endoscopic submucosal dissection, regardless of location.
PubMed: 37564328
DOI: 10.1055/a-2095-0033 -
Analytical Cellular Pathology... 2024Allergic rhinitis (AR) is a common chronic respiratory disease that has become a global health problem. miRNAs play an important role in multiple immune and inflammatory...
BACKGROUND
Allergic rhinitis (AR) is a common chronic respiratory disease that has become a global health problem. miRNAs play an important role in multiple immune and inflammatory diseases, including AR. In this work, the mechanism by which miR-224-5p regulates AR in vivo and in vitro was examined.
METHODS
Human nasal epithelial cells (HNEpCs) were used to establish an AR cell model induced by Der P1, and C57BL/6 mice were used to establish an AR animal model induced by OVA (ovalbumin). RT-qPCR was used to determine the level of miR-224-5p; western blot analysis was used to determine GATA3; ELISA was used to determine the levels of OVA-specific IgE, IFN-, IL-4, IL-5, and IL-13; flow cytometry was used to determine the differentiation of Th1 and Th2 cells; and HE and PAS staining was used to observe the histopathological alterations in the mouse nasal mucosa and spleen.
RESULTS
miR-224-5p was downregulated in nasal mucosa from mice with AR and an AR cell model. Overexpressed miR-224-5p can improve AR development and attenuate AR symptoms by regulating GATA3-mediated Th1/Th2 responses.
CONCLUSION
miR-224-5p attenuates allergic reactions in mice with AR by regulating the Th1/Th2 response.
Topics: Mice; Humans; Animals; Cytokines; Mice, Inbred C57BL; Rhinitis, Allergic; Nasal Mucosa; MicroRNAs; Disease Models, Animal; Mice, Inbred BALB C; Ovalbumin
PubMed: 38455868
DOI: 10.1155/2024/5531970 -
Acta Dermato-venereologica Dec 2023is missing (Short communication).
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Topics: Humans; Drug Eruptions; Mucous Membrane; Nose
PubMed: 38053321
DOI: 10.2340/actadv.v103.18295 -
Travel Medicine and Infectious Disease 2023
Topics: Humans; Monkeypox virus; Mpox (monkeypox); Skin
PubMed: 37302775
DOI: 10.1016/j.tmaid.2023.102605