Endoscopic Resection with One-Port Placement: A Newly Developed Technique for the Safe Management of Advanced Endoscopic Resection for Gastric Gastrointestinal Stromal Tumors.

INTRODUCTION: Endoscopic full-thickness resection (EFTR) without laparoscopic assistance (pure EFTR) is an emerging, less invasive treatment for gastrointestinal stromal tumors (GISTs). However, the technique has seldom been performed outside China because of concerns regarding pneumoperitoneum, maintenance of endoscopic view, and endoscopic suturing. This study aimed to evaluate the efficacy and safety of endoscopic resection with one-port placement (EROPP) for gastric GISTs. METHODS: This retrospective study included 17 patients with gastric GISTs originating from the muscularis propria who underwent EROPP between 2019 and 2022. One camera port was inserted in the umbilicus before initiating the endoscopic procedure to maintain intra-abdominal pressure, which was monitored and adjusted via this port. While allowing for conversion to laparoscopic surgery if needed, EFTR was performed as follows: (1) circumferential incision of the mucosal and submucosal layers around the lesion was performed by typical endoscopic submucosal dissection; (2) an intentional perforation and subsequent seromuscular resection was made using dental floss and an endo-clip for traction; and (3) closure of the gastric full-thickness defect was performed with an over-the-scope clip (OTSC) after peroral retrieval of the specimen. We retrospectively assessed the short-term outcomes and safety. RESULTS: All procedures were completed successfully without conversion to laparoscopic surgery. The median size of the resected tumors was 23 mm (range, 8-35 mm), the median resection time was 36 min (range, 22-95 min), and closure time was 18 min (range, 10-45 min). The rates of en bloc and complete resection were 100% and 88%, respectively. In 2 cases, another port was added to aspirate the leaking fluid or check the condition of the endoscopic closure. All gastric defects were endoscopically closed, mainly using OTSCs. The recovery course for all patients was uneventful, and no adverse events were reported. CONCLUSIONS: EROPP is a safe and minimally invasive treatment for gastric GISTs and appears to be suitable for introducing EFTR procedures.

[A Clinical Study of Orofacial Defect Reconstruction Using a Modified Submental Island Flap following Oral Cancer Resection].

INTRODUCTION: Pedicled flaps are used in orofacial defect reconstruction in older patients and patients with underlying diseases. The submental island flap(SIF)is one type of cervical pedicled flap; however, the modified submental island flap (MSIF), which includes mylohyoid muscle, is a simpler and safer type. Here, we report a clinical study of orofacial defect reconstruction using the MSIF following oral cancer resection. PATIENTS AND METHODS: From January 2019 to December 2020, we retrospectively examined 10 cases of reconstruction using the MSIF following oral squamous cell carcinoma resection. RESULTS: The study population consisted of 7 men and 3 women with a mean age of 76.0(66-88)years. The primary sites were lower gingiva(n=5), tongue(n=3), and buccal mucosa in(n=2). Surgical procedures included marginal mandibulectomy( n=3), segmental mandibulectomy(n=1), partial glossectomy(n=2), hemiglossectomy(n=1), buccal mucosa resection(n=2), and combined partial glossectomy and segmental mandibulectomy(n=1). The average flap size was 61.4×36.0 mm. The average time of flap elevation was 32.4(23-50)minutes. During orofacial surgery using the MSIF, organs adjacent to the primary site could also be reconstructed. There were no complications in any patients. CONCLUSION: The MSIF is useful for orofacial defect reconstruction in older patients and patients with underlying diseases.

Prediction of Hepatocellular Carcinoma Development after Hepatitis C Virus Eradication Using Serum Wisteria floribunda Agglutinin-Positive Mac-2-Binding Protein.

We aimed to clarify the association between a novel serum fibrosis marker, Wisteria floribunda agglutinin-positive Mac-2-binding protein (WFA⁺-M2BP), and hepatocellular carcinoma (HCC) development in 355 patients with chronic hepatitis C who achieved sustained virologic response (SVR) through interferon-based antiviral therapy. Pretreatment serum WFA⁺-M2BP levels were quantified and the hazard ratios (HRs) for HCC development were retrospectively analyzed by Cox proportional hazard analysis. During the median follow-up time of 2.9 years, 12 patients developed HCC. Multivariate analysis demonstrated that high serum WFA⁺-M2BP (≥2.80 cut off index (COI), HR = 15.20, p = 0.013) and high fibrosis-4 (FIB-4) index (≥3.7, HR = 5.62, p = 0.034) were independent risk factors for HCC development. The three- and five-year cumulative incidence of HCC in patients with low WFA⁺-M2BP were 0.4% and 0.4%, respectively, whereas those of patients with high WFA⁺-M2BP were 7.7% and 17.6%, respectively (p < 0.001). In addition, combination of serum WFA⁺-M2BP and FIB-4 indices successfully stratified the risk of HCC: the five-year cumulative incidences of HCC were 26.9%, 6.8%, and 0.0% in patients with both, either, and none of these risk factors, respectively (p < 0.001). In conclusion, pretreatment serum WFA⁺-M2BP level is a useful predictor for HCC development after achieving SVR.

Specific partial reduction of geranylgeranyl diphosphate by an enzyme from the thermoacidophilic archaeon Sulfolobus acidocaldarius yields a reactive prenyl donor, not a dead-end product.

Geranylgeranyl reductase from Sulfolobus acidocaldarius was shown to catalyze the reduction of geranylgeranyl groups in the precursors of archaeal membrane lipids, generally reducing all four double bonds. However, when geranylgeranyl diphosphate was subjected to the reductase reaction, only three of the four double bonds were reduced. Mass spectrometry and acid hydrolysis indicated that the allylic double bond was preserved in the partially reduced product derived from geranylgeranyl diphosphate. Thus, the reaction product was shown to be phytyl diphosphate, which is a substrate for archaeal prenyltransferases, unlike the completely reduced compound phytanyl diphosphate.

Differential roles of internal and terminal double bonds in docosahexaenoic acid: Comparative study of cytotoxicity of polyunsaturated fatty acids to HT-29 human colorectal tumor cell line.

The role of the double bonds in docosahexaenoic acid (22:6(Δ4,7,10,13,16,19); DHA) in cytotoxic lipid peroxidation was studied in a superoxide dismutase-defective human colorectal tumor cell line, HT-29. In a conventional culture, DHA and other polyunsaturated fatty acids (PUFAs) were found to induce acute lipid peroxidation and subsequent cell death. PUFAs that lack one or both the terminal double bonds (Δ19 and Δ4) but share Δ7,10,13,16 such as 22:5(Δ7,10,13,16,19), 22:5(Δ4,7,10,13,16), and 22:4(Δ7,10,13,16) were more effective than DHA. Lipid peroxidation and cell death were completely inhibited, except by 22:4(Δ7,10,13,16) when radical-mediated reactions were suppressed by culturing cells in 2% O(2) in the presence of vitamin E. DHA and C22:5 PUFAs but not 22:4(Δ7,10,13,16) were efficiently incorporated in phosphatidylinositol, regardless of the culturing conditions. These and other results suggested that the internal unsaturations Δ7,10,13,16 were sensitive to lipid peroxidation, whereas the terminal ones Δ19 and Δ4 appeared to be involved in assimilation into phospholipids.