Endoscopic subserosal dissection for gastric tumors: 18 cases in a single center.

BACKGROUND: Endoscopic submucosal dissection has technical limitations for the resection of gastric epithelial tumors with severe fibrosis and mixed or exophytic gastric subepithelial tumors (SETs). AIMS: To analyze the safety and effectiveness of endoscopic subserosal dissection (ESSD) for tumors growing in the subserosal space. METHODS: This observation study enrolled 18 patients who were diagnosed with gastric tumors and underwent ESSD at the Presbyterian Medical Center from 2010 to March 2019. RESULTS: A total of 18 patients were treated by ESSD. The mean age of the patients was 61.7 years. The mean length of the long axis of the tumor was 18.0 ± 5.0 mm. The mean operation time was 44 (range 11-167) min. The pathologic diagnosis was leiomyoma in nine cases (50.0%), gastrointestinal stromal tumor in six (33.3%), low-grade adenoma with severe fibrosis in two (11.1%), and schwannoma in one (5.6%). There were three cases of perforation, which were treated conservatively. The complete resection rate was 94%, and local or systemic tumor recurrence was not seen in a mean 70 months of follow-up. CONCLUSION: ESSD can be used for epithelial tumors with severe fibrosis and mixed or exophytic gastric SETs in the lesser curvature, cardia, or fundus that cannot be treated using standard methods.

Effects of Planting Density and Nitrogen Fertilization on the Growth of Forage Rice in Reclaimed and General Paddy Fields.

The purpose of this study is to identify the different effects exerted by planting density and nitrogen fertilization on high-salinity reclaimed paddy fields (RPF) and general paddy fields (GPFs), and to find the amount of fertilization and the planting density suitable for the growth of forage rice in each paddy field. Nitrogen fertilization with high-salt and low-salt soils, an untreated control plot, treatment with 200 kg/ha, 300 kg/ha, and 400 kg/ha, and planting densities of 30 cm × 10 cm and 30 cm × 16 cm, growth, and feed values were investigated. In both experimental locations, there was no significant change in the soil due to N treatment, but in the case of RPF, electrical conductivity (EC) decreased significantly from more than 5 dS/m to up to 2.87 dS/m during the yellow ripe stage due to the influence of floods and concentrated precipitation in the fields. In all soils, as both the amount of N treatment and the planting density increased, there was a proportional relationship in which the number of tillers and the dry weight also increased, with the occurrence of lodging also being increased. The dry weight, as expected, was 1.5 times higher at a planting distance of 10 cm, rather than 16 cm. In addition, in both locations, the N treatment led to an increase in the dry weight, but when N treatment reached 400 kg/ha (2.0), the dry weight decreased instead. Moreover, although there was no clear difference in feed value according to N treatment, in RPF, the neutral detergent fiber (NDF) was higher than 60%, the relative feed value (RFV) was less than 98, and the total digestible nutrient (TDN) was also low, confirming that the quality of rice was higher in GPF.

Application of Magnesium and Calcium Sulfate on Growth and Physiology of Forage Crops under Long-Term Salinity Stress.

Soil salinity is major threat to crop growth and reducing cultivated land areas and salt-resistant crops have been required to sustain agriculture in salinized areas. This original research was performed to determine the effectiveness of MgSO4 (MS) and CaSO4 (CS) for each species and assess changes in the physiology and growth of fodder crops after short and long-term salt stress. Six treatments (CON (control); NaCl (NaCl 100 mM); 1 MS (1 mM MgSO4 + 100 mM NaCl); 2 MS (2 mM MgSO4 + 100 mM NaCl); 7.5 CS (7.5 mM CaSO4 + 100 mM NaCl); and 10 CS (10 mM CaSO4 + 100 mM NaCl)) were applied to Red clover (Trifolium pratense) and Tall fescue (Festuca arundinacea) under greenhouse conditions. Cultivars were evaluated based on their dry weights, physiological parameters, forage quality, and ion concentrations. The biomass of both species decreased significantly under NaCl treatments and increased under the MS and CS treatments compared to solely salinity treatments. Salinity caused a decrease in the photosynthetic rate, but compared to CON, the MS and CS treatments yielded superior results. Moreover, the Na+/K+ ratio increased as Na+ concentration increased but crop quality (CP, NDF, ADF) did not show significant differences under salinity. Overall, we concluded that these T. pratense and F. arundinacea species demonstrated various responses to salinity, MS, and CS by different physiological and morphological parameters and it turned out to be efficient under salinity stress.

Correlation between endoscopic resection outcomes and endosonographic findings in gastric tumors with muscularis propria origin.

Endoscopic resection is an effective treatment for subepithelial tumors arising from the muscularis propria layer of the stomach. However, the invasion pattern revealed by the pathological examination of tumor specimens is often not consistent with the findings of preprocedural endoscopic ultrasounds (EUS). We compared the real growing patterns of tumors, as evaluated on histopathological examination, with their EUS images, and analyzed the outcomes of endoscopic resections in relation to the EUS findings. From January 2006 to June 2015, 32 patients underwent endoscopic resection for gastric tumors originating from the muscularis propria at our hospital. We divided the patients into 3 groups according to the location of the tumor as diagnosed using pre procedural EUS: submucosa (group I, n = 5), muscularis propria (group II, n = 14), and tumors extending into the outer cavity (group III, n = 13). Histopathological examination revealed 15 patients with gastrointestinal stromal tumors (GISTs), 14 with leiomyomas, and 3 with schwannomas. Accuracy of EUS in evaluating tumor invasion was 56%. Some tumors in groups I and II was removed by endoscopic submucosal dissection only. Muscular dissection was needed in 10 patients (71%) in group II and 9 patients (69%) in group III. Four patients (31%) in group III were found to have subserosal tumors. The complete resection rate was 88% (23 patients) among patients who underwent endoscopic submucosal dissection and endoscopic muscular dissection, and 67% (4 patients) among patients who underwent endoscopic subserosal dissection (ESSD). The tumor was completely removed in 12 patients (86%) in group II and 10 patients (77%) in group III. EUS accurately predicts the layer of the subepithelial tumor in the stomach; however, the pattern of invasion of surrounding structures is difficult to evaluate using EUS.

A comparative study of DA-9601 and misoprostol for prevention of NSAID-associated gastroduodenal injury in patients undergoing chronic NSAID treatment.

Misoprostol is reported to prevent non-steroidal anti-inflammatory drug (NSAID)-associated gastroduodenal complications. There is, however, limited information regarding the efficacy of DA-9601 in this context. We performed a comparative study on the relative efficacy of DA-9601 and misoprostol for prevention of NSAID-associated complications. In this multicenter, double-blinded, active-controlled, stratified randomized, parallel group, non-inferiority trial, 520 patients who were to be treated with an NSAID (aceclofenac, 100 mg, twice daily) over a 4-week period were randomly assigned to groups for coincidental treatment with DA-9601 (60 mg, thrice daily) (236 patients for full analysis) or misoprostol (200 µg, thrice daily) (242 patients for full analysis). [corrected]. The primary endpoint was the gastric protection rate, and secondary endpoints were the duodenal protection rate and ulcer incidence rate. Endpoints were assessed by endoscopy after the 4-week treatment period. Drug-related adverse effects, including gastrointestinal (GI) symptoms, were also compared. At week 4, the gastric protection rates with DA-9601 and misoprostol were 81.4 % (192/236) and 89.3 % (216/242), respectively. The difference between the groups was -14.2 %, indicating non-inferiority of DA-9601 to misoprostol. Adverse event rates were not different between the two groups; however, the total scores for GI symptoms before and after administration were significantly lower in the DA-9601 group than in the misoprostol group (-0.2 ± 2.8 vs 1.2 ± 3.2; p < 0.0001). DA-9601 is as effective as misoprostol in preventing NSAID-associated gastroduodenal complications, and has a superior adverse GI effect profile.