Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.234
Filtrar
1.
Am J Physiol Gastrointest Liver Physiol ; 318(4): G673-G681, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32003605

RESUMO

Impaired manganese (Mn) homeostasis can result in excess Mn accumulation in specific brain regions and neuropathology. Maintaining Mn homeostasis and detoxification is dependent on effective Mn elimination. Specific metal transporters control Mn homeostasis. Human carriers of mutations in the metal transporter ZIP14 and whole body Zip14-knockout (WB-KO) mice display similar phenotypes, including spontaneous systemic and brain Mn overload and motor dysfunction. Initially, it was believed that Mn accumulation due to ZIP14 mutations was caused by impaired hepatobiliary Mn elimination. However, liver-specific Zip14-KO mice did not show systemic Mn accumulation or motor deficits. ZIP14 is highly expressed in the small intestine and is localized to the basolateral surface of enterocytes. Thus, we hypothesized that basolaterally localized ZIP14 in enterocytes provides another route for the elimination of Mn. Using wild-type and intestine-specific Zip14-KO (I-KO) mice, we have shown that ablation of intestinal Zip14 is sufficient to cause systemic and brain Mn accumulation. The lack of intestinal ZIP14-mediated Mn excretion was compensated for by the hepatobiliary system; however, it was not sufficient to maintain Mn homeostasis. When supplemented with extra dietary Mn, I-KO mice displayed some motor dysfunctions and brain Mn accumulation based on both MRI imaging and chemical analysis, thus demonstrating the importance of intestinal ZIP14 as a route of Mn excretion. A defect in intestinal Zip14 expresssion likely could contribute to the Parkinson-like Mn accumulation of manganism.NEW & NOTEWORTHY Mn-induced parkinsonism is recognized as rising in frequency because of both environmental factors and genetic vulnerability; yet currently, there is no cure. We provide evidence in an integrative animal model that basolaterally localized ZIP14 regulates Mn excretion and detoxification and that deletion of intestinal ZIP14 leads to systemic and brain Mn accumulation, providing robust evidence for the indispensable role of intestinal ZIP14 in Mn excretion.


Assuntos
Proteínas de Transporte de Cátions/metabolismo , Transtornos Neurológicos da Marcha/induzido quimicamente , Mucosa Intestinal/metabolismo , Manganês/toxicidade , Animais , Transporte Biológico , Encéfalo/metabolismo , Encéfalo/patologia , Proteínas de Transporte de Cátions/genética , Relação Dose-Resposta a Droga , Genótipo , Inflamação/induzido quimicamente , Manganês/administração & dosagem , Camundongos , Camundongos Knockout , Membrana Serosa/metabolismo
2.
PLoS One ; 15(1): e0225958, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940352

RESUMO

BACKGROUND: Peritoneal recurrence is one of the most frequent recurrent diseases in gastric cancer. Although the exposure of cancer cells to the serosal surface is considered a common risk factor for peritoneal recurrence, there are some cases of peritoneal recurrence without infiltration to the serosal surface even after curative surgery. This study sought to clarify the risk factors of peritoneal recurrence in the absence of invasion to the serosal surface. MATERIALS AND METHODS: Ninety-six patients with gastric cancer who underwent curative surgery were enrolled. In all 96 cases, the depth of tumor invasion was subserosal (T3). The microscopic distance from the tumor invasion front to the serosa (DIFS) was measured using tissue slides by H&E staining and pan-cytokeratin staining. E-cadherin expression was evaluated by immunohistochemical staining. RESULTS: Among the 96 patients, 16 developed peritoneal recurrence after curative surgery. The DIFS of the tumors with peritoneal recurrence (156±220 µm) was significantly shorter (p = 0.011) than that without peritoneal recurrence (360±478 µm). Peritoneal recurrence was significantly correlated with DIFS ≤234 µm (p = 0.023), but not with E-cadherin expression. The prognosis of DIFS ≤234 µm was significantly poorer than that of DIFS >234 µm (log rank, p = 0.007). A multivariate analysis of the patients' five-year overall survival revealed that DIFS ≤234 µm and lymph node metastasis were significantly correlated with survival (p = 0.005, p = 0.032, respectively). CONCLUSION: The measurement of the DIFS might be useful for the prediction of peritoneal recurrence in T3-gastric cancer patients after curative surgery.


Assuntos
Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/patologia , Membrana Serosa/patologia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Idoso , Caderinas/metabolismo , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Recidiva , Fatores de Risco , Neoplasias Gástricas/metabolismo , Análise de Sobrevida
3.
Am J Obstet Gynecol ; 222(4): 379.e1-379.e11, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31730756

RESUMO

BACKGROUND: The development of new management strategies for women presenting with placenta accreta spectrum requires quality epidemiology data, which have so far been limited by the high variability in clinical and histopathologic data confirming the diagnosis at birth. OBJECTIVE: To evaluate the role of a new methodologic approach for the correlation of clinical and pathological data for women with a history of prior cesarean delivery diagnosed prenatally with placenta previa accreta. MATERIALS AND METHODS: A modified pathologic technique for gross examination of hysterectomy specimens with placenta in situ consisting of intraoperative examination, immediate postoperative examination, and guided histologic sampling was used prospectively in a cohort of 24 patients with singleton pregnancies complicated by placenta low-lying/placenta previa accreta. Maternal characteristics, detailed ultrasound findings, surgical outcomes, and histopathologic examination were compared with those of a group of 24 patients with similar clinical characteristics and in whom a standard pathologic examination method was used. RESULTS: The median reporting time for obtaining the complete histopathology results including the microscopic examination was significantly shorter (7 versus 15 days; P < .001) and the median number of samples taken for histologic examination significantly lower (4 versus 14 samples; P < .001) in the study group than in the controls. The number of histologic slides showing villous invasion was significantly higher (2 versus 1 slide; P = .002), and the ratio of the number of samples taken to the numbers of slides confirming villous invasion was significantly lower (2 versus 9; P < .001) in the study group than in the controls. In all cases in the study group, intraoperative examination identified a dense tangled bed of vessels or multiple vessels running laterally and cranio-caudally in the uterine serosa above the placental insertion that were no longer visible during immediate gross postoperative examination of the hysterectomy specimens. Immediate postoperative dissection enables the differential diagnosis between focal and large increta areas, and between abnormally adherent placenta and invasive placenta accreta. CONCLUSION: Valuable clinical information on the serosal vascularity, uterine dehiscence, and extension of the accreta area is added with the description of the macroscopic examination during the surgical procedure and immediate dissection of the specimen. This methodological approach is cost-effective and increases the quality of the histologic sampling. It thus provides more accurate correlations with the clinical data and more accurate epidemiologic data collection. Perinatal pathologists should be part of multidisciplinary teams involved the management placenta accreta spectrum disorders.


Assuntos
Vasos Sanguíneos/patologia , Placenta Acreta/patologia , Placenta Prévia/patologia , Membrana Serosa/irrigação sanguínea , Adulto , Cesárea , Dissecação , Feminino , Técnicas Histológicas , Humanos , Histerectomia , Miométrio/diagnóstico por imagem , Miométrio/patologia , Patologia/métodos , Fotografação , Placenta Acreta/diagnóstico por imagem , Placenta Acreta/cirurgia , Placenta Prévia/diagnóstico por imagem , Placenta Prévia/cirurgia , Gravidez , Estudos Prospectivos , Fatores de Tempo , Ultrassonografia Pré-Natal
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(7): 601-608, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31302955

RESUMO

Since the introduction of endoscopic submucosal dissection (ESD) in China in 2006, endoscopic minimally invasive treatment has experienced a booming development for more than 10 years, and its indications are gradually being expanded from inside the lumen to outside the lumen, from the superficial layer to the deep layer, from organic diseases to functional diseases. This article summaries the development of endoscopic minimally invasive resection in the past 10 years, from the perspective of mucosa, submucosa, muscularis, serosal and even extraluminal lesions, respectively, to introduce the role of endoscopic minimally invasive treatment. For mucosal lesions, ESD has become a first-line treatment for early gastric cancer; endoscopic treatment of colorectal lesions is still controversial in Europe and the United States, but is gradually being accepted. For submucosal tumors(SMT), the Expert Consensus for Endoscopic Diagnosis and Treatment of Submucosal Tumors in China (version 2018) was published in 2018, and the principles and related technical rules for gastrointestinal SMT have been highlighted. For serosal and even extraluminal lesions, natural orifice transluminal endoscopic surgery (NOTES) and tunnel endoscopic surgery, mainly including endoscopic myotomy (POEM) and endoscopic transmucosal tunneling tumor resection (STER), showed potential for development in preliminary studies, and showed good results in cholecystectomy, appendectomy, achalasia, gastroparesis and even extra-gastrointestinal tumor resection. This article describes the various endoscopic treatment techniques, and looks into their application prospects and future challenges.


Assuntos
Doenças do Sistema Digestório/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Membrana Mucosa/cirurgia , Membrana Serosa/cirurgia
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(5): 401-405, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31104421

RESUMO

Membrane anatomy is in broad sense the anatomy of the mesentery and its bed, both of which are consisted of fascia membrane or/and serous membrane. Although the traditional mesentery has the definition of mesentery, people unconsciously identify them according to their "fan-shaped" and "free" characteristics. The "generalized mesentery" we propose refers to the fascia and/or serosa, envelope-like organs and their blood vessels, suspending to the posterior wall of the body, regardless of its shape, free or not. So the main points of the anatomy are as follows.(1) Organs or tissues with their feeding structures are enveloped by the fascia membrane or/and serous membrane, suspending to posterior wall of the body, to form different shapes of the mesentery in broad sense, and most of them are buried in the mesentery bed. (2) Cancer metastasis type V of in the gut moves in the envelop of the mesentery in broad sense.(3) Intraoperative breach of the envelop membrane not only results in intraoperative bleeding, but also cancer cell leakage from the mesentery. (4) The cancer of gut can be divided into cancer in the mesentery, cancer out of the mesentery and cancer at edge of the mesentery based on this anatomy. Radical tumor resection is effective for cancer in the mesentery, which should not be artificially breached into those of cancer out of the mesentery. The essence of neoadjuvant chemoradiation is to push cancer at edge of the mesentery back inside the mesentery.(5) Based on such anatomy, radical gut tumor operations are divided into D2/D3 procedure, without emphasizing the integrity of the mesentery during lymphatic dissection; CME procedure, which emphasizes the integrity of the mesentery but does not strictly define the extent of lymphatic dissection; D2/D3 + CME procedure, which strictly defines the integrity of the mesentery and the extent of lymphatic dissection.(6)For gastrointestinal tumors of the same T stage, shorter mesentery indicates worse prognosis.(7) For gastrointestinal tumors with the same T stage and the same length of mesentery, the more mesentery buried in the mesentery bed, the worse prognosis. (8) The above seven principles are universal in the organs of the body cavity (and even all internal organs).Membrane anatomy, unlike traditional "plane surgery" , is completely different from the "anatomy of the membrane..." described by Japanese scholars, but mainly bases on generalized mesentery and mesentery bed, meanwhile inherent life events can be accurately defined and confirmed.


Assuntos
Antineoplásicos/farmacologia , Neoplasias do Sistema Digestório/patologia , Neoplasias do Sistema Digestório/cirurgia , Mesentério/patologia , Antineoplásicos/uso terapêutico , Dissecação , Fáscia/patologia , Humanos , Mesentério/anatomia & histologia , Mesentério/efeitos dos fármacos , Mesentério/cirurgia , Estadiamento de Neoplasias , Prognóstico , Membrana Serosa/patologia
6.
Turk J Med Sci ; 49(3): 782-788, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31062940

RESUMO

Background/aim: This study aimed to investigate the relationship between the iodine concentration (IC) of perigastric fat tissue as assessed by dual-energy computed tomography (DECT) and serosal invasion of gastric cancer. Materials and methods: A total of 41 patients underwent preoperative staging evaluation for gastric cancer using DECT between July 2015 and March 2018. Patients were divided into 2 groups based on pathology results: serosal invasion (stage T4a) and intact serosa (stages T1­T3). Cutoff values, the diagnostic efficacy of IC in the perigastric fat tissue, and the perigastric fat tissue/tumor (P/T) ratio were determined. Results: Among the 41 patients, 22 had stage T4a gastric cancer and 19 patients had gastric cancer with a stage lower than T4a. The mean IC of perigastric fat tissue and the P/T ratio were significantly higher in patients with serosal invasion than in those with intact serosa (P < 0.001). During the arterial phase, the area under the curve (AUC) was 0.915 and 0.854 for the IC of perigastric fat tissue and the P/T ratio, respectively. During the venous phase, the AUC was 0.890 and 0.876 for the IC of perigastric fat tissue and the P/T ratio, respectively. Conclusion: The IC in the perigastric fat tissue seems to be a reliable indicator for serosal invasion of gastric cancer.


Assuntos
Membrana Serosa/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Gordura Intra-Abdominal/química , Gordura Intra-Abdominal/diagnóstico por imagem , Iodo/análise , Iodo/química , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Membrana Serosa/patologia , Neoplasias Gástricas/patologia
7.
Surg Oncol ; 28: 167-173, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30851895

RESUMO

BACKGROUND: To date, it has been unclear whether laparoscopic gastrectomy (LG) is suitable for patients with serosa-positive (pT4a) gastric cancer. The purpose of this study was to compare the surgical and long-term oncologic outcomes of LG and open gastrectomy for pT4a gastric cancer. METHODS: We prospectively collected data from 987 patients with pathological confirmed pT4a gastric cancer who underwent LG or OG at our institution between June 2009 and May 2015. A 1:1 matched propensity score matching (PSM) analysis was performed to reduce confounding bias. The primary outcome was 5-year overall survival (OS). RESULTS: After PSM, a well-balanced cohort of 202 pairs patients was analyzed. The LG group showed a longer operation time (261.42 vs. 171.00 min, P = 0.001), less blood loss (185.47 vs. 217.84 ml, P = 0.000), and shorter postoperative hospital stay (7.56 vs. 8.22 days, P = 0.007). The overall complication rate was 14.4% in the LG group and 16.3% in the OG group (P = 0.581). The minor (grade II) and severe (grade ≥ IIIa) complication rates were similar (LG, 6.9% vs. OG, 9.9%, P = 0.282; LG, 7.4% vs. OG, 6.4%, P = 0.695, respectively). The LG and OG groups showed similar survival 5-year OS and 5-year Disease-free survival (DFS) rates (44.6% vs. 42.1%, P = 0.403; 40.1 vs. 37.6%, P = 0.321, respectively). The recurrence rate and pattern did not differ between the two groups during the follow-up stage (P > 0.05). CONCLUSIONS: For patients with pT4a gastric cancer, LG with D2 lymph node dissection can be a safe and feasible procedure in terms of surgical and long-term oncologic outcomes.


Assuntos
Adenocarcinoma/mortalidade , Gastrectomia/mortalidade , Laparoscopia/mortalidade , Excisão de Linfonodo/mortalidade , Recidiva Local de Neoplasia/mortalidade , Membrana Serosa/patologia , Neoplasias Gástricas/mortalidade , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias , Prognóstico , Pontuação de Propensão , Estudos Prospectivos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida
8.
Ann Surg Oncol ; 26(6): 1772-1778, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30767177

RESUMO

BACKGROUND: According to 8th AJCC/UICC TNM criteria, stage IIB includes pT1N3M0, pT2N2M0, pT3N1M0, and pT4aN0M0, which includes not only early gastric cancer but also locally advanced cancer. There are currently no data about whether there is any additional impact of serosal exposed cancer without nodal metastasis (pT4aN0) on patients' survival outcomes compared with other subgroups in IIB. METHODS: Patients who underwent radical gastrectomy for gastric cancer patients were enrolled, including 427 patients in stage IIB; 20 (4.68%), 104 (24.35%), 172 (40.28%), and 131 (30.67%) patients were classified as pT1N3a, pT2N2, pT3N1, and pT4aN0, respectively. Clinicopathological characteristics, recurrence pattern, and survival and recurrence rates were analyzed according to the TNM subgroups. RESULTS: Cancer-specific and relapse-free survival were significantly worse in serosal exposed cancer than in nonserosal exposed cancer in stage IIB (P = 0.019 and P = 0.015). Recurrence rate was highest in the pT4aN0 subgroup (29.0%) in stage IIB, and peritoneal metastasis was the most common pattern. Survival outcomes of the pT4aN0 subgroup were not significantly different from those of the stage IIIA or pT4aN1 subgroups. CONCLUSIONS: Patients with serosal exposed cancer without nodal metastasis shows worse cancer specific and disease-free survival with higher incidence of peritoneal metastasis than other subgroups in stage IIB. Further surveillance studies, including staging laparoscopy and active adjuvant therapy, are required in this subgroup of patients.


Assuntos
Gastrectomia/mortalidade , Recidiva Local de Neoplasia/patologia , Neoplasias Peritoneais/patologia , Membrana Serosa/patologia , Neoplasias Gástricas/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Neoplasias Peritoneais/cirurgia , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida
9.
Ann R Coll Surg Engl ; 101(4): 249-255, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30602290

RESUMO

BACKGROUND: For patients with gastric cancer intraoperative macroscopic serosal change is not always consistent with pathological T stage. We investigated whether macroscopic serosal change is associated with unfavourable prognosis of patients with gastric cancer. METHODS: We reviewed 856 patients with stage T3 gastric cancer who underwent curative gastrectomy in our institution. All patients were classified as serosa negative and serosa positive according to the macroscopic serosal change during the operation. The prognostic difference between two groups was compared and clinicopathologic features were analysed. RESULTS: The percentage of macroscopic serosal change accounted for 55.7% of all patients. Compared with normal serosal surface, the patients with macroscopic serosal change had larger tumour size, more extensive stomach involvement and more advanced stage N. The prognosis of stage T3 with macroscopic serosal change was significantly poorer than that of those with normal serosal surface, especially for those with stages T3N0 and T3N1. Multivariate analysis identified macroscopic serosal change as an independent factor associated with unfavourable prognosis of stage T3 cancer. CONCLUSION: Although the depth of tumour invasion mainly depends on pathological evaluation after surgery, the prognostic significance of intraoperative macroscopic serosal change should not be ignored for those patients with subserosal invasion.


Assuntos
Neoplasias Gástricas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Membrana Serosa/patologia , Estômago/patologia , Estômago/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
11.
Aktuelle Urol ; 50(3): 268-273, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-30357763

RESUMO

BACKGROUND: In 2008, Kälble et al. presented the "serosa-lined and tapered ileum" ("Fulda nipple") as a new continence mechanism of the modified MAINZ-Pouch-I. In accordance with the principle of Abol-Enein, a tapered ileum segment is embedded into a serosa-lined tunnel consisting of a second "U"-shaped ileum segment. Thus a combination of continence mechanism and pouch augmentation - which can be applied to all forms of pouches - was established. PATIENTS AND METHODS: We report on 21 patients who received a serosa-lined and tapered ileum at the Department of Urology of the University Hospital of Bonn for different indications. The aim of this study was to evaluate this technique, especially with regard to stenosis and incontinence rates in the long-term follow up.  RESULTS: At a mean follow-up period of 37 months, stoma stenosis occurred in 33 % of the cases. Incontinence was observed in 21 % (n = 4) of the cases. Remarkably, two of these patients suffered from incontinence due to the phenomenon of "nipple gliding". CONCLUSION: The long-term analysis shows similar stenosis and incontinence rates compared to the two best-established techniques - submucosally embedded appendix and intussuscepted ileum. Despite limitations due to the small number of cases, the Fulda nipple is at least a safe alternative as a "second-line technique" in cases where the initial method has failed.


Assuntos
Íleo/cirurgia , Complicações Pós-Operatórias/etiologia , Membrana Serosa , Derivação Urinária/métodos , Coletores de Urina , Adolescente , Adulto , Idoso , Estudos de Coortes , Constrição Patológica/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Incontinência Urinária/etiologia , Adulto Jovem
12.
Pathol Oncol Res ; 25(3): 1143-1152, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30478720

RESUMO

All too often, conventional immunocytochemistry (ICC) via an antibody on cytological samples is limited to a few smears due to scant cellularity. To circumvent these limitations, this study employed a cell-type-specific aptamer as the core tool in ICC protocols for a timely and highly specific ICC diagnosis. S6, an aptamer against A549 lung carcinoma cells, was adopted instead of antibodies in this study for differentiating cancer cells in serosal fluids. Here, we developed three different strategies for discriminating the adenocarcinoma cells in effusion cytology specimens using the S6 aptamer in ICC. These strategies included a biotin-labeled S6 aptamer, an FAM-labeled S6 aptamer, and an activatable S6 aptamer. A total of 112 serosal fluid specimens with known diagnoses were evaluated by all three modes of use of the S6 aptamer. ICC procedures based on biotin-labeled or FAM-labeled S6 aptamers required time-consuming washing to avoid interference from nonspecific adsorption. ICC procedures based on an activatable S6 aptamer probe showed a weak fluorescence signal in the absence of target cells, but the procedures showed a strong fluorescence signal due to alteration of the conformation without any complicated washing steps, in the presence of targets. The specificity and sensitivity are higher in all three different ICC protocols based on the S6 aptamer than those for antibody protocols for differentiating adenocarcinoma cells in clinical effusion cytology. ICC based on cell-type-specific aptamers, instead of on a panel of a set of antibodies, is promising as an auxiliary method for the diagnosis of cancer.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico , Aptâmeros de Nucleotídeos/química , Líquido Ascítico/metabolismo , Fluorescência , Imuno-Histoquímica/métodos , Neoplasias Pulmonares/diagnóstico , Membrana Serosa/metabolismo , Células A549 , Adenocarcinoma de Pulmão/metabolismo , Técnicas Biossensoriais , Citodiagnóstico , Humanos , Neoplasias Pulmonares/metabolismo
13.
Gastrointest Endosc ; 89(4): 806-815.e1, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30452913

RESUMO

BACKGROUND AND AIMS: According to guidelines, endoscopic resection should only be performed for patients whose early gastric cancer invasion depth is within the mucosa or submucosa of the stomach regardless of lymph node involvement. The accurate prediction of invasion depth based on endoscopic images is crucial for screening patients for endoscopic resection. We constructed a convolutional neural network computer-aided detection (CNN-CAD) system based on endoscopic images to determine invasion depth and screen patients for endoscopic resection. METHODS: Endoscopic images of gastric cancer tumors were obtained from the Endoscopy Center of Zhongshan Hospital. An artificial intelligence-based CNN-CAD system was developed through transfer learning leveraging a state-of-the-art pretrained CNN architecture, ResNet50. A total of 790 images served as a development dataset and another 203 images as a test dataset. We used the CNN-CAD system to determine the invasion depth of gastric cancer and evaluated the system's classification accuracy by calculating its sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS: The area under the receiver operating characteristic curve for the CNN-CAD system was .94 (95% confidence interval [CI], .90-.97). At a threshold value of .5, sensitivity was 76.47%, and specificity 95.56%. Overall accuracy was 89.16%. Positive and negative predictive values were 89.66% and 88.97%, respectively. The CNN-CAD system achieved significantly higher accuracy (by 17.25%; 95% CI, 11.63-22.59) and specificity (by 32.21%; 95% CI, 26.78-37.44) than human endoscopists. CONCLUSIONS: We constructed a CNN-CAD system to determine the invasion depth of gastric cancer with high accuracy and specificity. This system distinguished early gastric cancer from deeper submucosal invasion and minimized overestimation of invasion depth, which could reduce unnecessary gastrectomy.


Assuntos
Carcinoma/patologia , Mucosa Gástrica/patologia , Gastroscopia/métodos , Redes Neurais de Computação , Neoplasias Gástricas/patologia , Inteligência Artificial , Carcinoma/diagnóstico , Carcinoma/cirurgia , Diagnóstico por Computador/métodos , Ressecção Endoscópica de Mucosa , Feminino , Gastrectomia , Mucosa Gástrica/cirurgia , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Invasividade Neoplásica , Curva ROC , Sensibilidade e Especificidade , Membrana Serosa/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia
14.
Appl Immunohistochem Mol Morphol ; 27(1): e5-e8, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-27941567

RESUMO

A 72-year-old woman presented with a mass on the right axilla. This was thought to be an occult breast cancer case, and the patient was treated with modified radical mastectomy, followed by hormonotherapy. Two years later she presented with incarcerated umbilical hernia. Pathology revealed Sister Mary Joseph's nodule inside the hernia sac. Further evaluation revealed that the primary tumor was papillary serous carcinoma of the peritoneal surface. The patient received adjuvant chemotherapy. Two years later the metastatic tumor was located on the other breast. The disease progressed gradually, and the patient eventually died from disseminated disease. This case is extraordinary in that it first presented with axillary metastasis without abdominal involvement and then later metastasized to the other breast after a long disease-free period.


Assuntos
Neoplasias da Mama/diagnóstico , Hérnia Umbilical/diagnóstico , Neoplasias Peritoneais/diagnóstico , Membrana Serosa/patologia , Nódulo da Irmã Maria José/diagnóstico , Idoso , Líquido Ascítico/patologia , Carcinogênese , Carcinoma Papilar , Diagnóstico Diferencial , Doença , Evolução Fatal , Feminino , Humanos , Metástase Neoplásica
15.
Eur Surg Res ; 60(5-6): 248-256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31935725

RESUMO

INTRODUCTION: Intestinal blood flow is often named as a key factor in the pathophysiology of anastomotic leakage. The distribution between mucosal and serosal microperfusion during surgery remains to be elucidated. OBJECTIVE: The aim of this study was to assess if the mucosal microcirculation of the intestine is more vulnerable to a surgical hit than the serosal microcirculation during surgery. METHODS: In an observational cohort study (n = 9 patients), the microcirculation of the bowel serosa and mucosa was visualized with incident dark-field imaging during surgery. At the planned anastomosis, the following microcirculatory parameters were determined: microvascular flow index (MFI), percentage of perfused vessels (PPV), perfused vessel density (PVD), and total vessel density (TVD). Data are presented as median (interquartile range [IQR]). RESULTS: Perfusion parameters and vessel density were significantly higher for the mucosa than the serosal microcirculation at the planned site for anastomosis or stoma. Mucosal MFI was 3.00 (IQR 3.00-3.00) compared to a serosal MFI of 2.75 (IQR 2.21-2.94), p = 0.03. The PPV was 99% (IQR 98-100) versus 92% (IQR 66-94), p = 0.01. The TVD was 16.77 mm/mm2 (IQR 13.04-18.01) versus 10.42 mm/mm2 (IQR 9.36-11.81), p = 0.01, and the PVD was 15.44 mm/mm2 (IQR 13.04-17.78) versus 9.02 mm/mm2 (IQR 6.43-9.43), p = 0.01. CONCLUSIONS: The mucosal microcirculation was preserved, while lower perfusion of the serosa was found at the planned anastomosis or stoma during surgery. Further research is needed to link our observations to the clinically relevant endpoint of anastomotic leakage.


Assuntos
Abdome/cirurgia , Anastomose Cirúrgica/métodos , Mucosa Intestinal/irrigação sanguínea , Microcirculação/fisiologia , Membrana Serosa/irrigação sanguínea , Idoso , Feminino , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade
16.
J Popul Ther Clin Pharmacol ; 26(4): e32-e36, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31909574

RESUMO

Post-pancreaticoduodenectomy hemorrhage has an estimated incidence of 5% and a mortality rate of 11-38%. Vascular erosion resulting from pancreatic leak and skeletonization of the arterial wall during pancreatic mobilization may be the two possible mechanisms responsible for this complication, which most commonly affects the gastroduodenal artery stump. A novel technique of wrapping up the gastroduodenal artery stump into the jejunal serosa to decrease postoperative hemorrhage is presented.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Duodeno/cirurgia , Jejuno/cirurgia , Pancreatectomia/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Hemorragia Pós-Operatória/prevenção & controle , Idoso , Duodeno/irrigação sanguínea , Feminino , Humanos , Jejuno/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Pancreatectomia/tendências , Pancreaticoduodenectomia/tendências , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Membrana Serosa/irrigação sanguínea , Membrana Serosa/cirurgia , Estômago/irrigação sanguínea , Estômago/cirurgia
17.
Tech Coloproctol ; 22(10): 793-800, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30413998

RESUMO

BACKGROUND: Recognition of a non-viable bowel during colorectal surgery is a challenging task for surgeons. Identifying the turning point in serosal microcirculatory deterioration leading up to a non-viable bowel is crucial. The aim of the present study was to determine whether sidestream darkfield (SDF) imaging can detect subtle changes in serosal microcirculation of the sigmoid after vascular transection during colorectal surgery. METHODS: A prospective observational clinical study was performed at a single medical centre. All eligible participants underwent laparoscopic sigmoid resection and measurements were taken during the extra-abdominal phase. Microcirculation was measured at the transected bowel and 20 cm proximal to this point. Microcirculatory parameters such as Microvascular Flow Index (MFI), proportion of perfused vessels (PPV), perfused vessel density (PVD), total vessel density (TVD) and the Heterogeneity Index were determined. Data are presented as median (interquartile range) or mean ± standard deviation. RESULTS: A total of 60 SDF images were acquired for 10 patients. Perfusion parameters and perfused vessel density were significantly lower at the transected bowel compared with the non-transected measurements [MFI 2.29 (1.96-2.63) vs 2.96 (2.73-3.00), p = 0.007; PPV 74% (55-83) vs 94% (86-97), p = 0.007; and PVD 7.61 ± 2.99 mm/mm2 versus 10.67 ± 1.48 mm/mm2, p = 0.009]. Total vessel density was similar between the measurement locations. CONCLUSIONS: SDF imaging can identify changes of the bowel serosal microcirculation. Significantly lower serosal microcirculatory parameters of the vascular transected bowel was seen compared with the non-transected bowel. The ability of SDF imaging to detect subtle differences holds promise for future research on microvascular cut-off values leading to a non-viable bowel.


Assuntos
Colo Sigmoide/cirurgia , Técnicas de Diagnóstico Cardiovascular , Cuidados Intraoperatórios/métodos , Membrana Serosa/irrigação sanguínea , Membrana Serosa/diagnóstico por imagem , Idoso , Colo Sigmoide/irrigação sanguínea , Estudos de Viabilidade , Feminino , Humanos , Masculino , Microcirculação/fisiologia , Pessoa de Meia-Idade , Estudos Prospectivos
18.
Elife ; 72018 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-30375972

RESUMO

Extraembryonic tissues contribute to animal development, which often entails spreading over embryo or yolk. Apart from changes in cell shape, the requirements for this tissue spreading are not well understood. Here, we analyze spreading of the extraembryonic serosa in the scuttle fly Megaselia abdita. The serosa forms from a columnar blastoderm anlage, becomes a squamous epithelium, and eventually spreads over the embryo proper. We describe the dynamics of this process in long-term, whole-embryo time-lapse recordings, demonstrating that free serosa spreading is preceded by a prolonged pause in tissue expansion. Closer examination of this pause reveals mechanical coupling to the underlying yolk sac, which is later released. We find mechanical coupling prolonged and serosa spreading impaired after knockdown of M. abdita Matrix metalloprotease 1. We conclude that tissue-tissue interactions provide a critical functional element to constrain spreading epithelia.


Assuntos
Dípteros/embriologia , Embrião não Mamífero/metabolismo , Membranas Extraembrionárias/metabolismo , Saco Vitelino/embriologia , Âmnio/citologia , Âmnio/embriologia , Animais , Blastoderma/citologia , Forma Celular , Dípteros/genética , Regulação da Expressão Gênica no Desenvolvimento , Proteínas de Insetos/genética , Proteínas de Insetos/metabolismo , Membrana Serosa/citologia , Membrana Serosa/embriologia , Imagem com Lapso de Tempo
19.
Arthropod Struct Dev ; 47(6): 643-654, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30268728

RESUMO

We aimed to describe the development and ultrastructure of the thickened serosa and serosal cuticle formed beneath the embryo of Plecoptera, using Scopura montana of Scopuridae as a euholognathan representative. Using transmission electron microscopy, we found that the egg membranes were composed of a thick exochorion, a thicker endochorion consisting of two sublayers, and an extremely thin vitelline membrane. The egg membrane construction represents a groundplan feature of the euholognathan egg membranes. The serosa converges beneath the embryo to form a thickened serosa, comprising cells in a radial arrangement, in association with the formation of the amnioserosal fold. The thickened serosa then deposits the thickened serosal cuticle, consisting of four layers differing in fine structure and electron density. After achieving its secretory function, the thickened serosa then disintegrates, and the liberated serosal cells float for a short period in the peripheral region of the egg inside. Collectively, our findings should provide the basis for further characterization of the serosal structures concerned, but we were unable to corroborate previous studies assigning the thickened serosa and serosal cuticle in Plecoptera to the water absorption function.


Assuntos
Embrião não Mamífero/ultraestrutura , Insetos/ultraestrutura , Animais , Microscopia Eletrônica de Transmissão , Óvulo/ultraestrutura , Membrana Serosa/ultraestrutura
20.
Acta Medica (Hradec Kralove) ; 61(2): 41-46, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30216181

RESUMO

The aim of this study is to describe an entity of primary hydrocele accompanied with fibrosis, thickening and hemorrhagic infiltration of parietal layer of tunica vaginalis (PLTV). During a 4-year period (2011-2014), 94 boys (2.5-14 years old) underwent primary hydrocele repair. Hydrocele was right sided in 55 (58.5 %), left sided in 26 (28.7%) and bilateral in 12 patients (13.8%). Eighty three out of 94 patients (88.30%) had communicating hydrocele and the rest eleven patients (11.7%) had non-communicating. Our case group consists of 8 patients (8.51%) based on operative findings consistent with PLTV induration, thickening and hemorrhagic infiltration. Preoperative ultrasonography did not reveal any pathology of the intrascrotal structures besides hydrocele. There weren't hyperechoic reflections or septa within the fluid. Evaluation of thickness of the PLTV was not feasible. Presence of lymph or exudate was excluded after fluid biochemical analysis. Tunica vaginalis histological examination confirmed thickening, hemorrhagic infiltration and inflammation, while there was absence of mesothelial cells. Immunochemistry for desmin was positive, excluding malignant mesothelioma. One patient underwent high ligation of the patent processus vaginalis and PLTV sheath fenestration, but one year later, he faced a recurrence. An elective second surgery was conducted via scrotal incision and Jaboulay operation was performed. The latter methodology was our treatment choice in other 7 out of 8 patients. During a 2-year postoperative follow-up, no other patient had any recurrence. We conclude that in primary hydrocele with macroscopic features indicative of tunica vaginalis inflammation, reversion of the tunica should be a part of operative strategy instead of sheath fenestration, in order to minimize the recurrence.


Assuntos
Membrana Serosa/patologia , Hidrocele Testicular/cirurgia , Adolescente , Criança , Pré-Escolar , Hemorragia/patologia , Humanos , Hiperplasia , Inflamação/patologia , Masculino , Estudos Prospectivos , Membrana Serosa/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA