AIM To determine short-and long-term outcomes of endoscopic submucosal dissection(ESD) using the stag beetle(SB) knife, a scissor-shaped device.METHODS Seventy consecutive patients with 96 early esophageal neoplasms, ...AIM To determine short-and long-term outcomes of endoscopic submucosal dissection(ESD) using the stag beetle(SB) knife, a scissor-shaped device.METHODS Seventy consecutive patients with 96 early esophageal neoplasms, who underwent ESD using a SB knife at Kure Medical Center and Chugoku Cancer Center, Japan, between April 2010 and August 2016, were retrospectively evaluated. Clinicopathological characteristics of lesions and procedural adverse events were assessed. Therapeutic success was evaluated on the basis of en bloc, histologically complete, and curative or non-curative resection rates. Overall and tumor-specific survival, local or distant recurrence, and 3-and 5-year cumulative overall metachronous cancer rates were also assessed.RESULTS Eligible patients had dysplasia/intraepithelial neoplasia(22%) or early cancers(squamous cell carcinoma, 78%). The median procedural time was 60 min and on average, the lesions measured 24 mm in diameter, yielding 33-mm tissue defects. The en bloc resection rate was 100%, with 95% and 81% of dissections deemed histologically complete and curative, respectively. All procedures were completed without accidental incisions/perforations or delayed bleeding. During follow-up(mean, 35 ± 23 mo), no local recurrences or metastases were observed. The 3-and 5-year survival rates were 83% and 70%, respectively, with corresponding rates of 85% and 75% for curative resections and 74% and 49% for noncurative resections. The 3-and 5-year cumulative rates of metachronous cancer in the patients with curative resections were 14% and 26%, respectively.CONCLUSION ESD procedures using the SB knife are feasible, safe, and effective for treating early esophageal neoplasms, yielding favorable short-and long-term outcomes.展开更多
AIM:To describe the prevalence,diagnosis,treatment,and outcomes of end stage liver disease(ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage(UGIH).METHODS:This observational s...AIM:To describe the prevalence,diagnosis,treatment,and outcomes of end stage liver disease(ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage(UGIH).METHODS:This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011.RESULTS:A total of 1249 patients were registered for severe UGIH in the data basis,461(36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen(75%) subjects required posterior nasal packing and 2(10%) embolization in addition to correction of coagulopathy. Five(25%) patients died in the hospital,12(60%) received orthotopic liver transplantation(OLT),and 3(15%) were discharged without OLT. The mortality rate was 63% in patients without OLT.CONCLUSION:Severe epistaxis in patients with ESLD is(1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH;and(2) associated with a high mortality rate in patients not receiving OLT.展开更多
目的观察重组人白细胞介素-2(rhuIL-2)联合弓形虫可溶性速殖子抗原(STAg)滴鼻免疫小鼠诱导的免疫应答,探讨rhuIL-2的佐剂效应及适宜剂量。方法5～6周龄BALB/c小鼠60只,随机分为6组,每组10只。实验组以STAg20μg或分别加rhuIL-2250、500...目的观察重组人白细胞介素-2(rhuIL-2)联合弓形虫可溶性速殖子抗原(STAg)滴鼻免疫小鼠诱导的免疫应答,探讨rhuIL-2的佐剂效应及适宜剂量。方法5～6周龄BALB/c小鼠60只,随机分为6组,每组10只。实验组以STAg20μg或分别加rhuIL-2250、500、1000、2000 IU滴鼻免疫,抗原与佐剂溶于20μlPBS中,对照组以PBS滴鼻,免疫2次,间隔2周。末次免疫后30d,颈椎脱臼处死全部小鼠,ELISA法检测血清IgG和粪便sIgA水平;分离脾淋巴细胞、肠上皮内淋巴细胞(iIEL),并计数。结果与PBS组相比,各佐剂组血清IgG水平都有增高,其中STAg+500 IU IL-2组IgG水平增高最显著(P<0.01);STAg+500 IU IL-2组和STAg+1000 IU IL-2组粪便sIgA抗体水平显著高于PBS组和STAg组(P<0.05)。联合IL-2佐剂免疫小鼠脾淋巴细胞和产生了增殖性应答,其中STAg+500 IU IL-2组和STAg+1000 IU IL-2组脾淋巴细胞数显著高于PBS组和STAg组(P<0.05);TAg+500 IU IL-2组iIEL高于PBS组(P<0.05)。结论rhuIL-2作为佐剂联合STAg鼻内免疫小鼠可有效诱导粘膜免疫、系统的细胞免疫和体液免疫应答;500 IU IL-2为鼻内免疫小鼠的适宜剂量。展开更多
文摘AIM To determine short-and long-term outcomes of endoscopic submucosal dissection(ESD) using the stag beetle(SB) knife, a scissor-shaped device.METHODS Seventy consecutive patients with 96 early esophageal neoplasms, who underwent ESD using a SB knife at Kure Medical Center and Chugoku Cancer Center, Japan, between April 2010 and August 2016, were retrospectively evaluated. Clinicopathological characteristics of lesions and procedural adverse events were assessed. Therapeutic success was evaluated on the basis of en bloc, histologically complete, and curative or non-curative resection rates. Overall and tumor-specific survival, local or distant recurrence, and 3-and 5-year cumulative overall metachronous cancer rates were also assessed.RESULTS Eligible patients had dysplasia/intraepithelial neoplasia(22%) or early cancers(squamous cell carcinoma, 78%). The median procedural time was 60 min and on average, the lesions measured 24 mm in diameter, yielding 33-mm tissue defects. The en bloc resection rate was 100%, with 95% and 81% of dissections deemed histologically complete and curative, respectively. All procedures were completed without accidental incisions/perforations or delayed bleeding. During follow-up(mean, 35 ± 23 mo), no local recurrences or metastases were observed. The 3-and 5-year survival rates were 83% and 70%, respectively, with corresponding rates of 85% and 75% for curative resections and 74% and 49% for noncurative resections. The 3-and 5-year cumulative rates of metachronous cancer in the patients with curative resections were 14% and 26%, respectively.CONCLUSION ESD procedures using the SB knife are feasible, safe, and effective for treating early esophageal neoplasms, yielding favorable short-and long-term outcomes.
基金Supported by National Institutes of Health,No.41301Veteran Administration Clinical Merit Review Grant,to Dr Dennis M JensenPhilippe Foundation Grant,to Dr.Marine Camus
文摘AIM:To describe the prevalence,diagnosis,treatment,and outcomes of end stage liver disease(ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage(UGIH).METHODS:This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011.RESULTS:A total of 1249 patients were registered for severe UGIH in the data basis,461(36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen(75%) subjects required posterior nasal packing and 2(10%) embolization in addition to correction of coagulopathy. Five(25%) patients died in the hospital,12(60%) received orthotopic liver transplantation(OLT),and 3(15%) were discharged without OLT. The mortality rate was 63% in patients without OLT.CONCLUSION:Severe epistaxis in patients with ESLD is(1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH;and(2) associated with a high mortality rate in patients not receiving OLT.
文摘目的观察重组人白细胞介素-2(rhuIL-2)联合弓形虫可溶性速殖子抗原(STAg)滴鼻免疫小鼠诱导的免疫应答,探讨rhuIL-2的佐剂效应及适宜剂量。方法5～6周龄BALB/c小鼠60只,随机分为6组,每组10只。实验组以STAg20μg或分别加rhuIL-2250、500、1000、2000 IU滴鼻免疫,抗原与佐剂溶于20μlPBS中,对照组以PBS滴鼻,免疫2次,间隔2周。末次免疫后30d,颈椎脱臼处死全部小鼠,ELISA法检测血清IgG和粪便sIgA水平;分离脾淋巴细胞、肠上皮内淋巴细胞(iIEL),并计数。结果与PBS组相比,各佐剂组血清IgG水平都有增高,其中STAg+500 IU IL-2组IgG水平增高最显著(P<0.01);STAg+500 IU IL-2组和STAg+1000 IU IL-2组粪便sIgA抗体水平显著高于PBS组和STAg组(P<0.05)。联合IL-2佐剂免疫小鼠脾淋巴细胞和产生了增殖性应答,其中STAg+500 IU IL-2组和STAg+1000 IU IL-2组脾淋巴细胞数显著高于PBS组和STAg组(P<0.05);TAg+500 IU IL-2组iIEL高于PBS组(P<0.05)。结论rhuIL-2作为佐剂联合STAg鼻内免疫小鼠可有效诱导粘膜免疫、系统的细胞免疫和体液免疫应答;500 IU IL-2为鼻内免疫小鼠的适宜剂量。
