Efferent loop syndrome is a very rare postgastrectomy syndrome that can occur following Billroth-Ⅱor Rouxen-Y reconstruction.The most common loop syndrome after gastric surgery is afferent loop syndrome;however,effer...Efferent loop syndrome is a very rare postgastrectomy syndrome that can occur following Billroth-Ⅱor Rouxen-Y reconstruction.The most common loop syndrome after gastric surgery is afferent loop syndrome;however,efferent loop syndrome has been reported in rare cases.Here,we report a case of efferent loop obstruction that occurred after postoperative adhesiolysis of a small-bowel obstruction.The patient had undergone a partial gastrectomy with BillrothⅡanastomosis and gastric ulcer perforation 30 years prior.The efferent loop obstruction was successfully resolved by the insertion of a double pigtail stent.To the best of our knowledge,this is the first case in the literature describing the treatment of efferent loop obstruction.展开更多
The epididymis is divided into caput, corpus and cauda regions, organized into intraregional segments separated by connective tissue septa （CTS）. In the adult rat and mouse these segments are highly differentiated. ...The epididymis is divided into caput, corpus and cauda regions, organized into intraregional segments separated by connective tissue septa （CTS）. In the adult rat and mouse these segments are highly differentiated. Regulation of these segments is by endocrine, lumicrine and paracrine factors, the relative importance of which remains under investigation. Here, the ability of the CTS to limit signaling in the interstitial compartment is reviewed as is the effect of 15 days of unilateral efferent duct ligation （EDL） on ipsilateral segmental transcriptional profiles. Inter-segmental microperifusions of epidermal growth factor （EGF）, vascular endothelial growth factor （VEGFA） and fibroblast growth factor 2 （FGF2） increased phosphorylation of mitogen activated protein kinase （MAPK） in segments 1 and 2 of the rat epididymis and the effects of all factors were limited by the CTS separating the segments. Microan＇ay analysis of segmental gene expression determined the effect of 15 days of unilateral EDL on the transcriptome-wide gene expression of rat segments 1-4. Over 11 000 genes were expressed in each of the four segments and over 2 000 transcripts in segment 1 responded to deprivation of testicular lumicrine factors. Segments 1 and 2 of control tissues were the most transcriptionally different and EDL had its greatest effects there. In the absence of lumicrine factors, all four segments regressed to a transcriptionally undifferentiated state, consistent with the less differentiated histology. Deprivation of lumicrine factors could stimulate an individual gene＇s expression in some segments yet suppress it in others. Such results reveal a higher complexity of the regulation of rat epididymal segments than that is generally appreciated. （Asian J Androl 2007 July; 9： 565-573）展开更多
A phytobezoar is one of the intraluminal causes of gastric outlet obstruction,especially in patients with previous gastric surgery and/or gastric motility disorders.Before the proton pump inhibitor era,vagotomy,pyloro...A phytobezoar is one of the intraluminal causes of gastric outlet obstruction,especially in patients with previous gastric surgery and/or gastric motility disorders.Before the proton pump inhibitor era,vagotomy,pyloroplasty,gastrectomy and gastrojejunostomy were commonly performed procedures in peptic ulcer patients.One of the sequelae of gastrojejunostomy is phytobezoar formation.However,a bezoar causing gastric outlet obstruction is rare even with giant gastric bezoars.We report a rare case of gastric outlet obstruction due to a phytobezoar obstructing the efferent limb of the gastrojejunostomy site.This phytobezoar which consisted of a whole piece of okra(lady finger vegetable) was successfully removed by endoscopic snare.To the best of our knowledge,this is the first case of okra bezoar-related gastrojejunostomy efferent limb obstruction reported in the literature.展开更多
The accessory olfactory bulb(AOB), located at the posterior dorsal aspect of the main olfactory bulb(MOB), is the first brain relay of the accessory olfactory system(AOS), which can parallelly detect and process volat...The accessory olfactory bulb(AOB), located at the posterior dorsal aspect of the main olfactory bulb(MOB), is the first brain relay of the accessory olfactory system(AOS), which can parallelly detect and process volatile and nonvolatile social chemosignals and mediate different sexual and social behaviors with the main olfactory system(MOS). However, due to its anatomical location and absence of specific markers, there is a lack of research on the internal and external neural circuits of the AOB. This issue was addressed by singlecolor labeling and fluorescent double labeling using retrograde rAAVs injected into the bed nucleus of the stria terminalis(BST), anterior cortical amygdalar area(ACo), medial amygdaloid nucleus(MeA), and posteromedial cortical amygdaloid area(PMCo) in mice. We demonstrated the effectiveness of this AOB projection neuron labeling method and showed that the mitral cells of the AOB exhibited efferent projection dispersion characteristics similar to those of the MOB. Moreover, there were significant differences in the number of neurons projected to different brain regions, which indicated that each mitral cell in the AOB could project to a different number of neurons in different cortices. These results provide a circuitry basis to help understand the mechanism by which pheromone information is encoded and decoded in the AOS.展开更多
The innervation of cholinergic efferent fibers in the vestibular endorgans of the rat was investigated using a modified preembedding immunostaining technique of immunoelectron microscopy. A monoclonal antibody to chol...The innervation of cholinergic efferent fibers in the vestibular endorgans of the rat was investigated using a modified preembedding immunostaining technique of immunoelectron microscopy. A monoclonal antibody to choline acetyltransferase (ChAT) was used as a marker of cholinergic fibers. It was found that there were four types of cholinergic innervation in the vestibular endorgans of the rat: (1) cholinergic nerve endings formed axo-dendritic synapses with afferent chalice surrounding the type I sensory hair cells; (2) cholinergic nerve endings formed axo-somatic synapses with type Ⅱ hair cells; (3) cholinergic fibers synapse with afferent nerve fibers and (4) a synaptic contact developed between cholinergic nerve endings. The results demonstrated that a multiform innervation of the cholinergic efferents exists in the rat vestibular periphery.展开更多
Background:The activation of the medial olivocochlear reflex reduces the cochlear gain,which is manifested perceptually as decreased auditory sensitivity.However,it has remained unclear whether the extent of this supp...Background:The activation of the medial olivocochlear reflex reduces the cochlear gain,which is manifested perceptually as decreased auditory sensitivity.However,it has remained unclear whether the extent of this suppression varies according to the cochlear region involved.Here we aims to assess the magnitude of contralateral efferent suppression across human cochlea,at low levels,and its impact on hearing sensitivity.Methods:Assuming that acoustic stimulation activates the contralateral medial olivocochlear reflex,we evaluated the magnitude of the suppressive effect as a function of frequency in 17 subjects with normal hearing.Absolute thresholds were measured for bursts tones of various durations(10,100,and 500 ms)and frequencies(250,500,1000,4000,and 8000 Hz)in the presence or absence of contralateral white noise at 60 d B SPL.Results:We found that contralateral noise raised the absolute threshold for the burst tones evaluated.The effect was greater at lower than higher frequencies(3.85 d B at 250 Hz vs.2.22 d B at 8000 Hz).Conclusions:Our findings suggest that in humans,the magnitude of this suppression varies according to the cochlear region stimulated,with a greater effect towards the apex(lower frequencies)than the base(higher frequencies)of the cochlea.展开更多
Objective:Contralateral suppression of oto acoustic emission (OAE) is referred as activation of efferent system. Previous literature mentioned about the importance of contra-lateral suppression of OAEs as a tool to as...Objective:Contralateral suppression of oto acoustic emission (OAE) is referred as activation of efferent system. Previous literature mentioned about the importance of contra-lateral suppression of OAEs as a tool to assess efferent system in different groups of popula-tion. There is dearth of literature to explore the efferent system function in experienced musicians exposed to rock music using TEOAEs and DPOAEs. Methods:Two groups of participant (14 rock musicians and 14 non-musicians) in the age range of 18e25 years were involved in the study. Contralateral suppression of TEOAEs and DPOAEs were measured using ILO (Version 6) in both groups. Results: Descriptive statistics showed higher suppression of TEOAEs and DPOAEs in rock-musicians at most of the frequencies in comparison to non-musicians. For DPOAE measures, Mann Whitney U test results revealed significantly greater DPOAE suppression only at 1 kHz and 3 kHz in rock-musicians compared to non-musicians. For within group comparison, Kruskal Wallis test results revealed there were significant difference observed across most of the fre-quencies i.e. at 1 kHz, 3 kHz and 6 kHz. For TEOAE measures, Mann Whitney U test results re-vealed that only at 2 kHz, TEOAE suppression in rock-musician was significantly greater compared to non-musicians. Similarly, Kuskal Wallis test results revealed that within group there were no significant differences observed for most of the frequencies except 2 kHz. Conclusions:Based on the above finding, present study concludes that rock musicians are hav-ing better efferent system compared to non-musicians. No suppression effect at few fre-quencies probably indicates more vulnerability at those frequencies. Contralateral suppression of DPOAE shows more significant finding in comparison to contralateral suppression of TEOAEs in present study.展开更多
It has been revealed in recent years that contralateral acoustic stimulation can affect cochlear active mechanisms through activating medial olivocochlear system (MOC) of the cochlear efferent nerve fibers. The MOC is...It has been revealed in recent years that contralateral acoustic stimulation can affect cochlear active mechanisms through activating medial olivocochlear system (MOC) of the cochlear efferent nerve fibers. The MOC is therefore postulated to exert protective effects on outer hair cells (OHCs) under intense sound condition. In this study the effects of 4 kHz intense tone exposure on distortion product otoacoustic emissions (DPOAEs) in guinea pigs with and without contralateral white noise stimulation were observed so that to investigate the protective effects of MOC on OHCs. The results showed that DPOAEs obviously deceased after the intense tone exposure in all animals, while both the amplitude reduction and the affected frequency range of DPOAEs were smaller in animals with simultaneously delivered contralateral white noise during the tone exposure than that in animals without colltralateral acoustic stimulation. The above results may suggest some protective nature of the contralateral sound stimulating effects which might be mediated through the activity of MOC. These perhaps can serve as the evidence that the protective mechanism against intense sound operates in the outer hair cells which are strongly innervated by MOC展开更多
AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroe...AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroenterostomy with Braun anastomosis(n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic ret-rograde cholangiopancreatography(ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triplelumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the "open-channel" guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.RESULTS: For the patients with Billroth Ⅱ gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients(85%) and there was therapeutic success in 16 patients(80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth Ⅱ gastroenterostomy, there was failure in accessing the papilla in 15 patients(13.8%). ERCP was unsuccessful because of tumor infiltration(6 patients), a long afferent loop(9 patients), and cannulation failure(4 patients). The papilla was successfully accessed in 94 patients(86.2%), and there was therapeutic success in 90 patients(82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth Ⅱ gastroenterostomy and Braun anastomosis.展开更多
AIM To present patients who developed small-bowel malignancy at the level of the gastrointestinal anastomosis decades after a subtotal gastrectomy for ulcer,to review relevant literature,and to attempt to interpret th...AIM To present patients who developed small-bowel malignancy at the level of the gastrointestinal anastomosis decades after a subtotal gastrectomy for ulcer,to review relevant literature,and to attempt to interpret the reasons those cancers developed to these postsurgical non-gastric sights.METHODS For the current retrospective study and review of literature,the surgical and histopathological records dated from January 1,1993 to December 31,2017 of our department were examined,searching for patients who have undergone surgical treatment of small-bowel malignancy to identify those who have undergone subtotal gastrectomy for benign peptic ulcer.A systematic literature search was also conducted using Pub Med,EMBASE,and Cochrane Library to identify similar cases.RESULTS We identified three patients who had developed smallintestine malignancy at the level of the gastrointestinal anastomosis decades after a subtotal gastrectomy with Billroth Ⅱ gastroenterostomy for benign peptic ulcertwo patients with adenocarcinoma originated in the Braun anastomosis and one patient with lymphoma of the efferent loop.All three patients were submitted to surgical resection of the tumor with Roux-en-Y reconstruction of the digestive tract.In the literature review,we only found one case of primary small-intestinal cancer that originated in the efferent loop after Billroth Ⅱ gastrectomy because of duodenal ulcer but none reporting Braun anastomosis adenocarcinoma following partial gastrectomy for benign disease.We also did not find any case of efferent loop lymphoma following gastrectomy.CONCLUSION Anastomotic gastric cancer following distal gastrectomy for peptic ulcer is a well-established clinical entity.However,malignancies of the afferent or efferent loop of the gastrointestinal anastomosis are extremely uncommon.The substantial diversion of the potent carcinogenic pancreaticobiliary secretions through the Braun anastomosis and the stomach hypochlorhydria,allowing the formation of carcinogenic factors from food,are the two most prominent pathogenetic mechanisms for those tumors.展开更多
Post-gastrectomy anastomosis site obstruction is a relatively rare complication after a subtotal gastrectomy.We present a case of a 75-year-old man who underwent a truncal vagotomy, omental patch, gastrojejunostomy, a...Post-gastrectomy anastomosis site obstruction is a relatively rare complication after a subtotal gastrectomy.We present a case of a 75-year-old man who underwent a truncal vagotomy, omental patch, gastrojejunostomy, and Braun anastomosis for duodenal ulcer perforation and a gastric outlet obstruction.Following the 10 th postoperative day, the patient complained of abdominal discomfort and vomiting.We diagnosed post-gastrectomy anastomosis site obstruction by an upper gastrointestinal series and an upper endoscopic examination.We inserted a self-expandable metallic stent(SEMS) at the anastomosis site.The stent was fully expanded after deployment.On the day following the stent insertion, the patient began to eat, and his abdominal discomfort was resolved.This paper describes the successful management of post-gastrectomy anastomosis site obstruction with temporary placement of a SEMS.展开更多
White adipose tissue(WAT) stores energy and also plays an important endocrine role in producing adipokines for communication with the peripheral and central nervous system. WAT consists of the major lipogenic unilocul...White adipose tissue(WAT) stores energy and also plays an important endocrine role in producing adipokines for communication with the peripheral and central nervous system. WAT consists of the major lipogenic unilocular adipocytes and the minor populations of beige and brite multilocular adipocytes. These multilocular adipocytes express thermogenic genes and have phenotypic similarity with thermogenic brown adipose tissue. According to a current paradigm, multilocular adipocytes have a thermogenic function in WAT. In this mini review, we discuss data revealing heterogeneity among multilocular cell subsets in WAT and their functions beyond thermogenesis. We propose a hypothetical neuroendocrine role for multilocular adipocytes subsets in the formation of adaptive sensory-sympathetic circuits between the central nervous system and adipose tissue, which activate lipolysis and thermogenesis in WAT in high energy demand situations.展开更多
Objective To study the arrhythmia induced by stimulation of nicotine-sensitive neurons in cardiac ganglial plexuses. Methods When nicotine (100 μg ) was injected into canine right atrial ganglial plexus (RAGP) and ga...Objective To study the arrhythmia induced by stimulation of nicotine-sensitive neurons in cardiac ganglial plexuses. Methods When nicotine (100 μg ) was injected into canine right atrial ganglial plexus (RAGP) and ganglial plexus between aorta and pulmonary artery (A-PGP) in 33 anesthetized open-chest dog, electrocardiogram, atrial force and ventricular intramyocardial pressures (IMP) were recorded. The responses were also recorded following administration of atropine or propranolol and after heart acute decentralization. Results Ventricular arrhythmia (VA) was induced by injections of nicotine into A-PGP, but not by injections of nicotine into RAGP in 13 dogs. Atrioventricilar (A-V) block was induced by nicotine activating RAGP in 10 dogs, but not by nicotine activating A-PGP. Propranolol could reduce the frequency of VA elicited by stimulating A-PGP, atropine could reduce the frequency of A-V block elicited by stimulating RAGP. After acute decentralization, VA was still induced by activation of A-PGP in 9 dogs, but A-V block elicited by stimulating RAGP was decreased. Conclusion VA is induced by stimulating N receptor in cardiac nicotine-sensitive efferent sympathetic neurons of ventricular ganglial plexus (A-PGP), and then modifying β receptor of ventricles. A-V block is elicited by stimulating N receptor in atrial ganglial plexus (RAGP), then modifying M receptor of A-V node not only via efferent parasympathetic neurons, but also via afferent pathway.展开更多
AIM:To study the role of capsaicin-sensitive afferent nerves in Helicobacter pylori (H.pylori) positive chronic gastritis before and after eradication.METHODS:Gastric biopsy samples were obtained from corpus and antru...AIM:To study the role of capsaicin-sensitive afferent nerves in Helicobacter pylori (H.pylori) positive chronic gastritis before and after eradication.METHODS:Gastric biopsy samples were obtained from corpus and antrum mucosa of 20 healthy human subjects and 18 patients with H.pylori positive chronic gastritis (n=18) before and after eradication.Tradi-tional gastric mucosal histology (and Warthin-Starry silver impregnation) and special histochemical examina-tions were carried out.Immunohistochemistry for cap-saicin receptor (TRVP1),calcitonin gene-related peptide (CGRP) and substance P (SP) were carried out by the labeled polymer immunohistological method (Lab VisionCo.,USA) using polyclonal rabbit and rat monoclonal antibodies (Abcam Ltd.,UK).RESULTS:Eradication treatment was successful in 16 patients (89%).Seven patients (7/18,39%) re-mained with moderate complaints,meanwhile 11 pa-tients (11/28,61%) had no complaints.At histological evaluation,normal gastric mucosa was detected in 4 patients after eradication treatment (4/18,22%),and moderate chronic gastritis could be seen in 14 (14/18,78%) patients.Positive immuno-staining for capsaicin receptor was seen in 35% (7/20) of controls,89% (16/18,P < 0.001) in patients before and 72% (13/18,P < 0.03) after eradication.CGRP was positive in 40% (8/20) of controls,and in 100% (18/18,P < 0.001) of patients before and in 100% (18/18,P < 0.001) after eradication.The immune-staining of gastric mucosa for substance-P was positive in 25% (5/20) of healthy con-trols,and in 5.5% (3/18,P > 0.05) of patients before and in 0% of patients (0/18,P > 0.05) after H.pylori eradication.CONCLUSION:Distibution of TRVP1 and CGRP is altered during the development of H.pylori positive chronic gastritis.The immune-staining for TRVP1,CGRP and SP rwemained unchanged before and after H.py-lori eradication treatment.The capsaicin-sensitive affer-entation is an independent from the eradication treat-ment.The 6 wk time period might not be enough time for the restituion of chronic H.pylori positive chronic gastritis.The H.pylori infection might not represent the main pathological factor in the development of chronic展开更多
Aims: To investigate whether intravesical lower pH induces a micturition threshold reflex change of anaesthetized rats. Methods: Thirteen female rats, anaesthetized by a-chloralose and paralyzed by pancurone bromide w...Aims: To investigate whether intravesical lower pH induces a micturition threshold reflex change of anaesthetized rats. Methods: Thirteen female rats, anaesthetized by a-chloralose and paralyzed by pancurone bromide were used for the experiments. The micturition threshold volume was determined by repeated cystometry. Simultaneously bladder afferent activities in four and efferent activities in seven rats were recorded from the exposed pelvic nerve to the bladder. Results: Cystometry with acidic saline at pH 3 and 4 induced a significant decrease in micturition threshold volume. The mean value of these groups of test showed that bladder compliance, micturition threshold pressure and maximal micturition contraction pressure were decreased significantly comparing with the controls. There were no changes in all other parameters recorded from afferent and efferent, e.g. afferent threshold volume, afferent or efferent activity at the micturition threshold and their peak activity at the micturition contraction. Conclusions: Acidic solution provoked sensitivity but reduced the force of the contractility to the urinary bladder. The effect was presented without a detectable change in the firing properties of bladder Ad mechanoreceptor afferents. It is proposed that proton sensitive bladder receptors with unmyelinated afferent were stimulated by the acidic solution and that the micturition reflex was facilitated by afferent inflow from such receptors. The findings were clinically important in choosing the medium for urodynamic examination.展开更多
Sensing the direction of origin of a sound in space has long been attributed to the delay between arrival times between the two ears. This, now discredited two dimensional theory, was put to rest by the observation th...Sensing the direction of origin of a sound in space has long been attributed to the delay between arrival times between the two ears. This, now discredited two dimensional theory, was put to rest by the observation that a person deaf in one ear can locate sounds in three dimensional space. We present here a new theory of sound localization that has the re-quired three dimensional measurement. It is a theory that interprets the well researched biological structure of the mammalian cochlea in a new and logical way, which leads to a deeper understanding of how sound localization functions.展开更多
Restorative proctocolectomy with ileal pouch–anal anastomosis has become the surgical treatment of choice for patients with refractory ulcerative colitis,colitis-associated dysplasia or familial adenomatous polyposis...Restorative proctocolectomy with ileal pouch–anal anastomosis has become the surgical treatment of choice for patients with refractory ulcerative colitis,colitis-associated dysplasia or familial adenomatous polyposis.There are various pouch disorders and associated complications.Floppy pouch complex is defined as the presence of pouch prolapse,afferent limb syndrome,enterocele,redundant loop and folding pouch on pouchoscopy,gastrografin pouchogramor defecography.Common clinical presentation includes dyschezia,bloating,abdominal pain,straining or the sense of incomplete evacuation.Each disorder has its own unique endoscopic,radiographic and manometry findings.A range of therapeutic options are available for the management of the various causes of a pouch.展开更多
文摘Efferent loop syndrome is a very rare postgastrectomy syndrome that can occur following Billroth-Ⅱor Rouxen-Y reconstruction.The most common loop syndrome after gastric surgery is afferent loop syndrome;however,efferent loop syndrome has been reported in rare cases.Here,we report a case of efferent loop obstruction that occurred after postoperative adhesiolysis of a small-bowel obstruction.The patient had undergone a partial gastrectomy with BillrothⅡanastomosis and gastric ulcer perforation 30 years prior.The efferent loop obstruction was successfully resolved by the insertion of a double pigtail stent.To the best of our knowledge,this is the first case in the literature describing the treatment of efferent loop obstruction.
文摘The epididymis is divided into caput, corpus and cauda regions, organized into intraregional segments separated by connective tissue septa （CTS）. In the adult rat and mouse these segments are highly differentiated. Regulation of these segments is by endocrine, lumicrine and paracrine factors, the relative importance of which remains under investigation. Here, the ability of the CTS to limit signaling in the interstitial compartment is reviewed as is the effect of 15 days of unilateral efferent duct ligation （EDL） on ipsilateral segmental transcriptional profiles. Inter-segmental microperifusions of epidermal growth factor （EGF）, vascular endothelial growth factor （VEGFA） and fibroblast growth factor 2 （FGF2） increased phosphorylation of mitogen activated protein kinase （MAPK） in segments 1 and 2 of the rat epididymis and the effects of all factors were limited by the CTS separating the segments. Microan＇ay analysis of segmental gene expression determined the effect of 15 days of unilateral EDL on the transcriptome-wide gene expression of rat segments 1-4. Over 11 000 genes were expressed in each of the four segments and over 2 000 transcripts in segment 1 responded to deprivation of testicular lumicrine factors. Segments 1 and 2 of control tissues were the most transcriptionally different and EDL had its greatest effects there. In the absence of lumicrine factors, all four segments regressed to a transcriptionally undifferentiated state, consistent with the less differentiated histology. Deprivation of lumicrine factors could stimulate an individual gene＇s expression in some segments yet suppress it in others. Such results reveal a higher complexity of the regulation of rat epididymal segments than that is generally appreciated. （Asian J Androl 2007 July; 9： 565-573）
文摘A phytobezoar is one of the intraluminal causes of gastric outlet obstruction,especially in patients with previous gastric surgery and/or gastric motility disorders.Before the proton pump inhibitor era,vagotomy,pyloroplasty,gastrectomy and gastrojejunostomy were commonly performed procedures in peptic ulcer patients.One of the sequelae of gastrojejunostomy is phytobezoar formation.However,a bezoar causing gastric outlet obstruction is rare even with giant gastric bezoars.We report a rare case of gastric outlet obstruction due to a phytobezoar obstructing the efferent limb of the gastrojejunostomy site.This phytobezoar which consisted of a whole piece of okra(lady finger vegetable) was successfully removed by endoscopic snare.To the best of our knowledge,this is the first case of okra bezoar-related gastrojejunostomy efferent limb obstruction reported in the literature.
基金supported by the National Natural Science Foundation of China(31400946,31771156,91632303/H09,91732304 and 31830035)Strategic Priority Research Program of the Chinese Academy of Sciences(XDB32030200)。
文摘The accessory olfactory bulb(AOB), located at the posterior dorsal aspect of the main olfactory bulb(MOB), is the first brain relay of the accessory olfactory system(AOS), which can parallelly detect and process volatile and nonvolatile social chemosignals and mediate different sexual and social behaviors with the main olfactory system(MOS). However, due to its anatomical location and absence of specific markers, there is a lack of research on the internal and external neural circuits of the AOB. This issue was addressed by singlecolor labeling and fluorescent double labeling using retrograde rAAVs injected into the bed nucleus of the stria terminalis(BST), anterior cortical amygdalar area(ACo), medial amygdaloid nucleus(MeA), and posteromedial cortical amygdaloid area(PMCo) in mice. We demonstrated the effectiveness of this AOB projection neuron labeling method and showed that the mitral cells of the AOB exhibited efferent projection dispersion characteristics similar to those of the MOB. Moreover, there were significant differences in the number of neurons projected to different brain regions, which indicated that each mitral cell in the AOB could project to a different number of neurons in different cortices. These results provide a circuitry basis to help understand the mechanism by which pheromone information is encoded and decoded in the AOS.
文摘The innervation of cholinergic efferent fibers in the vestibular endorgans of the rat was investigated using a modified preembedding immunostaining technique of immunoelectron microscopy. A monoclonal antibody to choline acetyltransferase (ChAT) was used as a marker of cholinergic fibers. It was found that there were four types of cholinergic innervation in the vestibular endorgans of the rat: (1) cholinergic nerve endings formed axo-dendritic synapses with afferent chalice surrounding the type I sensory hair cells; (2) cholinergic nerve endings formed axo-somatic synapses with type Ⅱ hair cells; (3) cholinergic fibers synapse with afferent nerve fibers and (4) a synaptic contact developed between cholinergic nerve endings. The results demonstrated that a multiform innervation of the cholinergic efferents exists in the rat vestibular periphery.
基金Work supported by a grant of the University of Chile(UI-10/16)to EA。
文摘Background:The activation of the medial olivocochlear reflex reduces the cochlear gain,which is manifested perceptually as decreased auditory sensitivity.However,it has remained unclear whether the extent of this suppression varies according to the cochlear region involved.Here we aims to assess the magnitude of contralateral efferent suppression across human cochlea,at low levels,and its impact on hearing sensitivity.Methods:Assuming that acoustic stimulation activates the contralateral medial olivocochlear reflex,we evaluated the magnitude of the suppressive effect as a function of frequency in 17 subjects with normal hearing.Absolute thresholds were measured for bursts tones of various durations(10,100,and 500 ms)and frequencies(250,500,1000,4000,and 8000 Hz)in the presence or absence of contralateral white noise at 60 d B SPL.Results:We found that contralateral noise raised the absolute threshold for the burst tones evaluated.The effect was greater at lower than higher frequencies(3.85 d B at 250 Hz vs.2.22 d B at 8000 Hz).Conclusions:Our findings suggest that in humans,the magnitude of this suppression varies according to the cochlear region stimulated,with a greater effect towards the apex(lower frequencies)than the base(higher frequencies)of the cochlea.
文摘Objective:Contralateral suppression of oto acoustic emission (OAE) is referred as activation of efferent system. Previous literature mentioned about the importance of contra-lateral suppression of OAEs as a tool to assess efferent system in different groups of popula-tion. There is dearth of literature to explore the efferent system function in experienced musicians exposed to rock music using TEOAEs and DPOAEs. Methods:Two groups of participant (14 rock musicians and 14 non-musicians) in the age range of 18e25 years were involved in the study. Contralateral suppression of TEOAEs and DPOAEs were measured using ILO (Version 6) in both groups. Results: Descriptive statistics showed higher suppression of TEOAEs and DPOAEs in rock-musicians at most of the frequencies in comparison to non-musicians. For DPOAE measures, Mann Whitney U test results revealed significantly greater DPOAE suppression only at 1 kHz and 3 kHz in rock-musicians compared to non-musicians. For within group comparison, Kruskal Wallis test results revealed there were significant difference observed across most of the fre-quencies i.e. at 1 kHz, 3 kHz and 6 kHz. For TEOAE measures, Mann Whitney U test results re-vealed that only at 2 kHz, TEOAE suppression in rock-musician was significantly greater compared to non-musicians. Similarly, Kuskal Wallis test results revealed that within group there were no significant differences observed for most of the frequencies except 2 kHz. Conclusions:Based on the above finding, present study concludes that rock musicians are hav-ing better efferent system compared to non-musicians. No suppression effect at few fre-quencies probably indicates more vulnerability at those frequencies. Contralateral suppression of DPOAE shows more significant finding in comparison to contralateral suppression of TEOAEs in present study.
文摘It has been revealed in recent years that contralateral acoustic stimulation can affect cochlear active mechanisms through activating medial olivocochlear system (MOC) of the cochlear efferent nerve fibers. The MOC is therefore postulated to exert protective effects on outer hair cells (OHCs) under intense sound condition. In this study the effects of 4 kHz intense tone exposure on distortion product otoacoustic emissions (DPOAEs) in guinea pigs with and without contralateral white noise stimulation were observed so that to investigate the protective effects of MOC on OHCs. The results showed that DPOAEs obviously deceased after the intense tone exposure in all animals, while both the amplitude reduction and the affected frequency range of DPOAEs were smaller in animals with simultaneously delivered contralateral white noise during the tone exposure than that in animals without colltralateral acoustic stimulation. The above results may suggest some protective nature of the contralateral sound stimulating effects which might be mediated through the activity of MOC. These perhaps can serve as the evidence that the protective mechanism against intense sound operates in the outer hair cells which are strongly innervated by MOC
基金Supported by Leading Talent program of Shanghai,Sailing program of Shanghai science and technology commission NO.14YF1403000
文摘AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroenterostomy with Braun anastomosis(n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic ret-rograde cholangiopancreatography(ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triplelumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the "open-channel" guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.RESULTS: For the patients with Billroth Ⅱ gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients(85%) and there was therapeutic success in 16 patients(80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth Ⅱ gastroenterostomy, there was failure in accessing the papilla in 15 patients(13.8%). ERCP was unsuccessful because of tumor infiltration(6 patients), a long afferent loop(9 patients), and cannulation failure(4 patients). The papilla was successfully accessed in 94 patients(86.2%), and there was therapeutic success in 90 patients(82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth Ⅱ gastroenterostomy and Braun anastomosis.
文摘AIM To present patients who developed small-bowel malignancy at the level of the gastrointestinal anastomosis decades after a subtotal gastrectomy for ulcer,to review relevant literature,and to attempt to interpret the reasons those cancers developed to these postsurgical non-gastric sights.METHODS For the current retrospective study and review of literature,the surgical and histopathological records dated from January 1,1993 to December 31,2017 of our department were examined,searching for patients who have undergone surgical treatment of small-bowel malignancy to identify those who have undergone subtotal gastrectomy for benign peptic ulcer.A systematic literature search was also conducted using Pub Med,EMBASE,and Cochrane Library to identify similar cases.RESULTS We identified three patients who had developed smallintestine malignancy at the level of the gastrointestinal anastomosis decades after a subtotal gastrectomy with Billroth Ⅱ gastroenterostomy for benign peptic ulcertwo patients with adenocarcinoma originated in the Braun anastomosis and one patient with lymphoma of the efferent loop.All three patients were submitted to surgical resection of the tumor with Roux-en-Y reconstruction of the digestive tract.In the literature review,we only found one case of primary small-intestinal cancer that originated in the efferent loop after Billroth Ⅱ gastrectomy because of duodenal ulcer but none reporting Braun anastomosis adenocarcinoma following partial gastrectomy for benign disease.We also did not find any case of efferent loop lymphoma following gastrectomy.CONCLUSION Anastomotic gastric cancer following distal gastrectomy for peptic ulcer is a well-established clinical entity.However,malignancies of the afferent or efferent loop of the gastrointestinal anastomosis are extremely uncommon.The substantial diversion of the potent carcinogenic pancreaticobiliary secretions through the Braun anastomosis and the stomach hypochlorhydria,allowing the formation of carcinogenic factors from food,are the two most prominent pathogenetic mechanisms for those tumors.
文摘Post-gastrectomy anastomosis site obstruction is a relatively rare complication after a subtotal gastrectomy.We present a case of a 75-year-old man who underwent a truncal vagotomy, omental patch, gastrojejunostomy, and Braun anastomosis for duodenal ulcer perforation and a gastric outlet obstruction.Following the 10 th postoperative day, the patient complained of abdominal discomfort and vomiting.We diagnosed post-gastrectomy anastomosis site obstruction by an upper gastrointestinal series and an upper endoscopic examination.We inserted a self-expandable metallic stent(SEMS) at the anastomosis site.The stent was fully expanded after deployment.On the day following the stent insertion, the patient began to eat, and his abdominal discomfort was resolved.This paper describes the successful management of post-gastrectomy anastomosis site obstruction with temporary placement of a SEMS.
基金supported by NIH grants R21OD017244(to OZ)the National Center for Research Resources UL1RR025755(to OZ and AL)+5 种基金UL1TR001070(to OZ and AL)NCIP30CA16058(OSUCCC)(to OZ and AL)the NIH Roadmap for Medical Research(to OZ and AL)supported by the SEED Grant from College of Education and Human EcologyAccelerator Grant from Office for Technology and CommercializationBrain Injury program from the Ohio State University(to OZ and AL)
文摘White adipose tissue(WAT) stores energy and also plays an important endocrine role in producing adipokines for communication with the peripheral and central nervous system. WAT consists of the major lipogenic unilocular adipocytes and the minor populations of beige and brite multilocular adipocytes. These multilocular adipocytes express thermogenic genes and have phenotypic similarity with thermogenic brown adipose tissue. According to a current paradigm, multilocular adipocytes have a thermogenic function in WAT. In this mini review, we discuss data revealing heterogeneity among multilocular cell subsets in WAT and their functions beyond thermogenesis. We propose a hypothetical neuroendocrine role for multilocular adipocytes subsets in the formation of adaptive sensory-sympathetic circuits between the central nervous system and adipose tissue, which activate lipolysis and thermogenesis in WAT in high energy demand situations.
文摘Objective To study the arrhythmia induced by stimulation of nicotine-sensitive neurons in cardiac ganglial plexuses. Methods When nicotine (100 μg ) was injected into canine right atrial ganglial plexus (RAGP) and ganglial plexus between aorta and pulmonary artery (A-PGP) in 33 anesthetized open-chest dog, electrocardiogram, atrial force and ventricular intramyocardial pressures (IMP) were recorded. The responses were also recorded following administration of atropine or propranolol and after heart acute decentralization. Results Ventricular arrhythmia (VA) was induced by injections of nicotine into A-PGP, but not by injections of nicotine into RAGP in 13 dogs. Atrioventricilar (A-V) block was induced by nicotine activating RAGP in 10 dogs, but not by nicotine activating A-PGP. Propranolol could reduce the frequency of VA elicited by stimulating A-PGP, atropine could reduce the frequency of A-V block elicited by stimulating RAGP. After acute decentralization, VA was still induced by activation of A-PGP in 9 dogs, but A-V block elicited by stimulating RAGP was decreased. Conclusion VA is induced by stimulating N receptor in cardiac nicotine-sensitive efferent sympathetic neurons of ventricular ganglial plexus (A-PGP), and then modifying β receptor of ventricles. A-V block is elicited by stimulating N receptor in atrial ganglial plexus (RAGP), then modifying M receptor of A-V node not only via efferent parasympathetic neurons, but also via afferent pathway.
基金Supported by Grant Baross (REG_DD_KFI_09,CAPSATAB,Hungary)
文摘AIM:To study the role of capsaicin-sensitive afferent nerves in Helicobacter pylori (H.pylori) positive chronic gastritis before and after eradication.METHODS:Gastric biopsy samples were obtained from corpus and antrum mucosa of 20 healthy human subjects and 18 patients with H.pylori positive chronic gastritis (n=18) before and after eradication.Tradi-tional gastric mucosal histology (and Warthin-Starry silver impregnation) and special histochemical examina-tions were carried out.Immunohistochemistry for cap-saicin receptor (TRVP1),calcitonin gene-related peptide (CGRP) and substance P (SP) were carried out by the labeled polymer immunohistological method (Lab VisionCo.,USA) using polyclonal rabbit and rat monoclonal antibodies (Abcam Ltd.,UK).RESULTS:Eradication treatment was successful in 16 patients (89%).Seven patients (7/18,39%) re-mained with moderate complaints,meanwhile 11 pa-tients (11/28,61%) had no complaints.At histological evaluation,normal gastric mucosa was detected in 4 patients after eradication treatment (4/18,22%),and moderate chronic gastritis could be seen in 14 (14/18,78%) patients.Positive immuno-staining for capsaicin receptor was seen in 35% (7/20) of controls,89% (16/18,P < 0.001) in patients before and 72% (13/18,P < 0.03) after eradication.CGRP was positive in 40% (8/20) of controls,and in 100% (18/18,P < 0.001) of patients before and in 100% (18/18,P < 0.001) after eradication.The immune-staining of gastric mucosa for substance-P was positive in 25% (5/20) of healthy con-trols,and in 5.5% (3/18,P > 0.05) of patients before and in 0% of patients (0/18,P > 0.05) after H.pylori eradication.CONCLUSION:Distibution of TRVP1 and CGRP is altered during the development of H.pylori positive chronic gastritis.The immune-staining for TRVP1,CGRP and SP rwemained unchanged before and after H.py-lori eradication treatment.The capsaicin-sensitive affer-entation is an independent from the eradication treat-ment.The 6 wk time period might not be enough time for the restituion of chronic H.pylori positive chronic gastritis.The H.pylori infection might not represent the main pathological factor in the development of chronic
文摘Aims: To investigate whether intravesical lower pH induces a micturition threshold reflex change of anaesthetized rats. Methods: Thirteen female rats, anaesthetized by a-chloralose and paralyzed by pancurone bromide were used for the experiments. The micturition threshold volume was determined by repeated cystometry. Simultaneously bladder afferent activities in four and efferent activities in seven rats were recorded from the exposed pelvic nerve to the bladder. Results: Cystometry with acidic saline at pH 3 and 4 induced a significant decrease in micturition threshold volume. The mean value of these groups of test showed that bladder compliance, micturition threshold pressure and maximal micturition contraction pressure were decreased significantly comparing with the controls. There were no changes in all other parameters recorded from afferent and efferent, e.g. afferent threshold volume, afferent or efferent activity at the micturition threshold and their peak activity at the micturition contraction. Conclusions: Acidic solution provoked sensitivity but reduced the force of the contractility to the urinary bladder. The effect was presented without a detectable change in the firing properties of bladder Ad mechanoreceptor afferents. It is proposed that proton sensitive bladder receptors with unmyelinated afferent were stimulated by the acidic solution and that the micturition reflex was facilitated by afferent inflow from such receptors. The findings were clinically important in choosing the medium for urodynamic examination.
文摘Sensing the direction of origin of a sound in space has long been attributed to the delay between arrival times between the two ears. This, now discredited two dimensional theory, was put to rest by the observation that a person deaf in one ear can locate sounds in three dimensional space. We present here a new theory of sound localization that has the re-quired three dimensional measurement. It is a theory that interprets the well researched biological structure of the mammalian cochlea in a new and logical way, which leads to a deeper understanding of how sound localization functions.
基金supported by the Ed and Joey Story Endowed Chair.
文摘Restorative proctocolectomy with ileal pouch–anal anastomosis has become the surgical treatment of choice for patients with refractory ulcerative colitis,colitis-associated dysplasia or familial adenomatous polyposis.There are various pouch disorders and associated complications.Floppy pouch complex is defined as the presence of pouch prolapse,afferent limb syndrome,enterocele,redundant loop and folding pouch on pouchoscopy,gastrografin pouchogramor defecography.Common clinical presentation includes dyschezia,bloating,abdominal pain,straining or the sense of incomplete evacuation.Each disorder has its own unique endoscopic,radiographic and manometry findings.A range of therapeutic options are available for the management of the various causes of a pouch.
