Colo-rectal endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD®): A multicenter Italian experience.

BACKGROUND AND AIM: Endoscopic full-thickness resection(EFTR) with FTRD® in colo-rectum may be useful for several indications.The aim was to assess its efficacy and safety. MATERIAL AND METHODS: In this retrospective multicenter study 114 patients were screened; 110 (61M/49F, mean age 68 ±â€¯11 years, range 20-90) underwent EFTR using FTRD®. Indications were:residual/recurrent adenoma (39), incomplete resection at histology (R1 resection) (26), non-lifting lesion (12), adenoma involving the appendix (2) or diverticulum (2), subepithelial lesions(10), suspected T1 carcinoma (16), diagnostic resection (3). Technical success (TS: lesion reached and resected), R0 resection (negative lateral and deep margins),EFTR rate(all layers documented in the specimen) and safety have been evaluated. RESULTS: TS was achieved in 94.4% of cases. EFTR was achieved in 91% with lateral and deep R0 resection in 90% and 92%. Mean size of specimens was 20 mm (range 6-42). In residual/recurrent adenomas, final analysis revealed: low-risk T1 (11), adenoma with low-grade dysplasia (LGD) (24) and high-grade dysplasia (HGD) (3), scar tissue (1). Histology reports of R1 resections were: adenoma with LGD (6), with HGD (1), low-risk (6) and high-risk (1) T1, scar tissue (12). Non-lifting lesions were diagnosed as: adenoma with HGD (3), low-risk (7) and high risk (2) T1. Adverse clinical events occurred in 12 patients (11%),while adverse technical events in11%. Three-months follow-up was available in 100 cases and residual disease was evident in only seven patients. CONCLUSIONS: EFTR using FTRD® seems to be a feasible, effective and safe technique for treating selected colo-rectal lesions. Comparative prospective studies are needed to confirm these promising results.

In Saccharomyces cerevisiae, impaired PRPP synthesis is accompanied by valproate and Li+ sensitivity.

The biosynthetic intermediate PRPP (phosphoribosylpyrophosphate) has a central role in cellular biochemistry since it links carbon and nitrogen metabolism. Its importance may be reflected in the fact that, in the Saccharomyces cerevisiae (yeast) genome, there are five unlinked genes, PRS1-PRS5, each of which is theoretically capable of encoding the enzyme synthesizing PRPP. Interference with the complement of PRS genes in S. cerevisiae has far-reaching consequences for yeast physiology and has uncovered unexpected metabolic links including cell wall integrity and phospholipid metabolism.

Ramifications of impaired PRPP synthesis in Saccharomyces cerevisiae.

The model eukaryote Saccharomyces cerevisiae is well suited to investigate the causes of metabolic disturbance. PRPP [5-phospho-D-ribosyl-1(alpha)-pyrophosphate] may be regarded as a junction of carbon and nitrogen metabolism. As a result of this central position, perturbations in its synthesis can give rise to many unexpected cellular events, such as impaired cell integrity. We have taken advantage of S. cerevisiae's genetic tractability to investigate the metabolic links responsible for connecting the biochemical intermediate PRPP to apparently unrelated cellular functions. This approach provides insight into the co-ordination of different biological processes.