Endoscopic papillectomy for synchronous adenoma of the major and minor duodenal papilla.

OBJECTIVES: Synchronous adenomas of the major and minor duodenal papilla are seldom reported. The aim of this study was to describe the characteristics of synchronous major and minor papilla adenomas and to evaluate the safety and efficacy of endoscopic papillectomy (EP) for the management of the disease. METHODS: Consecutive patients who underwent endoscopy for synchronous major and minor papilla adenomas from January 1, 2013 to August 31, 2023 were analyzed retrospectively. Patients' characteristics, clinical manifestations, laboratory, imaging and endoscopic findings were collected. RESULTS: The nine patients with synchronous major and minor papilla adenomas had an average age of 50.78 ± 10.70 years. The diameter of major and minor papilla adenomas was 12.11 ± 3.41 mm and 6.11 ± 1.05 mm, respectively. Most major papilla adenomas had R0 horizontal margins (n = 8), while R0 vertical margins were achieved in all patients. While minor papilla adenomas were resected with both R0 horizontal and vertical margins in all patients. Post-EP bleeding was observed in one patient, which was classified as mild. Post-EP hyperamylasemia and pancreatitis was observed in two and four patients, respectively; the latter consisted of three with mild pancreatitis and one with severe pancreatitis. No perforation was observed. The mean follow-up duration was 9.22 ± 5.99 months. Histologically confirmed recurrence at the resection site was detected in one patient at 3 months after the procedure. CONCLUSIONS: Synchronous major and minor papilla adenomas may not be as rare as previously speculated. EP may be an effective and safe alternative modality for their management.

Rare squamous cell carcinoma of the jejunum causing perforated peritonitis: A case report.

BACKGROUND: Adenocarcinoma has the highest incidence among malignant tumors of the small intestine (SI). Squamous cell carcinoma (SCC) often occurs in organs covered with squamous epithelium. Primary or metastatic SCC originating from the SI is very rare, with very few cases reported in the literature. CASE SUMMARY: This case report involves a 69-year-old man who developed abdominal pain after lunch. After admission, an abdominal computed tomography scan revealed perforation of the alimentary canal and multiple abnormal low-density lesions in the liver. During laparotomy, an approximately 4 cm × 3 cm-sized solid tumor was found in the jejunum, located 30 cm from the Treitz ligament, with a perforation. An intestinal segment of approximately 15 cm was removed, including the perforated portion. The pathological result was SCC. In combination with liver imaging, a diagnosis of SI SCC with multiple liver metastases was considered. The patient died from hepatic failure 1 mo after the operation. CONCLUSION: SI tumors are very rare compared to those originating in other digestive organs. Due to its insidious onset, the diagnosis of this disease is usually delayed. Clinicians must pay close attention to digestive symptoms such as persistent abdominal pain and melena.

Esophageal superficial adenosquamous carcinoma resected by endoscopic submucosal dissection: A rare case report.

BACKGROUND: Adenosquamous carcinoma (ASC), which is comprised of squamous cell carcinoma (SCC) and adenocarcinoma elements, is a rare histological type of esophageal carcinoma. Few reports have focused on the endoscopic findings and the effectiveness of the endoscopic treatment of early ASC. CASE SUMMARY: A 77-year-old man underwent esophagogastroduodenoscopy for heartburn. A flat lesion with an uneven and slightly elevated central portion was found in the distal esophagus. Magnifying endoscopy with narrow-band imaging showed a well-demarcated brownish area with dendritically branched abnormal vessels and highly irregular intrapapillary capillary loops. A histopathological diagnosis of SCC was obtained by endoscopic biopsy. Endoscopic ultrasonography revealed a hypoechoic mass confined to the mucosa layer. The lesion was suspected to be SCC with invasion into the muscularis mucosa. The lesion was resected en bloc by endoscopic submucosal dissection and histologically diagnosed as esophageal ASC limited within the muscularis mucosa, which was completely resected without lymphovascular or neural invasion. The SCC element was the pre-dominant element. The adenocarcinoma element formed ductal and nested structures distributed in a focal pattern. The patient underwent only endoscopic submucosal dissection and has been under annual endoscopic and radiographic surveillance for 3 years without recurrence. CONCLUSION: For early ASC confined within the mucosal layer, complete endoscopic resection might also be a curative treatment.

[Simulation for balanced effect of soil and water resources on cultivated land in Naoli River Basin, Northeast China under the RCPs climate scene]. / RCPsæ°”å€™æƒ æ™¯ä¸‹æŒ åŠ›æ²³æµåŸŸè€•åœ°æ°´åœŸèµ„æºå¹³è¡¡æ•ˆåº”æ¨¡æ‹Ÿ.

Under the scenarios of climate change, balancing the land and water resources is one of the key problems needed to be solved in land development. To reveal the water dynamics of the cultivated land in Naoli River Basin, we simulated the future scenarios by using the future land use simulation model based on Landsat Satellite images, the DEM data and the meteorological data. Results showed that the growth rate of cultivated land gradually decreased. It showed different changing characteristics in different time periods, which led to different balancing effect between land and water resources. In 1990, the water dynamics of the cultivated land resources was in good state, At the same time, the adjustment of crops structure caused the paddy fields increased dramatically. During 2002 to 2014, the cultivated land that in moderate and serious moisture shortage state increased slightly, the water deficit was deteriorating to a certain degree, and maintained sound development of water profit and loss situation gradually. By comparing the simulation accuracy with different spatial resolutions and time scales, we selected 200 m as the spatial resolution of the simulation, and simulated the land use status in 2038. The simulation results showed that the cultivated land's water profit and loss degree in the river basin showed significant polarization characteristic, in that the water profit and loss degree of the cultivated land would be further intensified, the area with the higher grades of moisture profit and loss degree would distribute more centralized, and partially high evaluated grades for the moisture shortage would expand. It is needed to develop the cultivated land irrigation schemes and adjust the cultivated land in Naoli River Basin to balance soil and water resources.

[Clinicopathological screening of Lynch syndrome: a report of 2 cases and literature review].

Lynch syndrome is an autosomal dominant genetic disease characterized by the early onset of colon cancer, endometrial cancer and other tumors caused by a genetic mutation within DNA mismatch repair (MMR) genes. A small subgroup (approximately 3%-5%) of endometrial cancer and colorectal cancer is related to Lynch syndrome. Identification of these patients in clinical practice will be of great benefit to the relatives and patients themselves. We reported two cases, and reviewed the literature and clinical diagnostic guideline. MMR protein was lost in the tumors. Meanwhile the two cases had different clinicopathological characteristics. Together with the literature, our findings may suggest that the MMR protein expression, associated molecular alterations and clinicopathological features and biological behavior of endometrial cancer and colorectal cancer related to Lynch syndrome are different. Thus the algorithm for detection the patients at highest risk is different. To detect the MMR loss by immunohistochemistry is a practicalscreening method.

[Effects of intermittent hypoxic exposure on the parameter of erythrocyte and serum hypoxia inducible factor-1 alpha and erythropoietin levels].

AIM: To investigate the effects of intermittent hypoxic exposure and normoxic convalescence on the parameter of erythrocyte and serum hypoxia inducible factor-1 alpha (HIF-1alpha) and erythropoietin (EPO) levels. METHODS: Rat models of intermittent hypoxic exposure were established, combined with the clinical research on volunteers experiencing the intermittent plateau work. Blood samples for red blood cell (RBC) counts, hemoglobin (Hb) and hematocrit (HCT) were collected, serum HIF-1alpha and EPO levels were measured using enzyme linked immunosorbent assay. RESULTS: RBC counts, Hb concentration and HCT were significantly higher than the normoxic group (P < 0.05), after exposure of rats to hypoxia from 7 to 28 days. Compared with the normoxic group, serum HIF-1alpha levels were higher in the group of IH3, 7, 14 days, and EPO had a corresponding increase in the group of IH3, 7 days. Then, a decrease was observed in parameter of erythrocyte and serum HIF-1alpha and EPO levels after 14 days normoxic convalescence treat. In volunteers studies, RBC counts in 8 months group and Hb concentration in 2 years group were significantly higher than the plain group (P < 0.05). Compared with the plain group, EPO had no significant differences in any of plateau group. CONCLUSION: Intermittent hypoxic exposure can enhance serum hypoxia inducible factor-1 alpha and erythropointin levels and the generation of red blood cells, which leads to an increase in hemoglobin concentration and hematocrit. The results have changed with the hypoxic exposure period prolonged. Normoxic convalescence after intermittent hypoxic exposure can make the related indexes reduced, and contribute to the organism recovery.