Primary Non-Function of Hepatic Allograft With Preexisting Microvesicular Steatosis/Foamy Degeneration and Mild Large-Droplet Macrovesicular Steatosis.

It has been established that more than mild large-droplet macrovesicular steatosis (LD-MAS) is associated with increased risk of graft non-function. In contrast, even severe small-droplet macrovesicular steatosis (SD-MAS) has been found to be less prognostically significant. It remains unclear if a donor liver with diffuse microvesicular steatosis is associated with an increased risk of graft dysfunction. A 56-year-old male with alcoholic cirrhosis was transplanted with a liver from a 42-year-old overweight male donor after brain death. The frozen section of the donor liver biopsy taken at harvest showed diffusely enlarged clear/foamy hepatocytes and mild LD-MAS (about 5-10% of total tissue). The reperfusion liver biopsy taken at time 0 of transplantation showed hemorrhage, pale and enlarged hepatocytes, and mild LD-MAS (about 10% of total tissue) with lipopeliosis. The graft became non-functional, and the patient was re-transplanted 24 h after the initial transplantation. Histologic examination of the failed liver allograft showed extensive hemorrhagic necrosis, neutrophilic inflammation, diffuse microvesicular steatosis, and large extracellular fat droplets (about 20% of total tissue). This case demonstrates that precautions are needed to avoid using livers with diffuse and severe microvesicular steatosis.

Studies on competitive adsorption characteristics of bisphenol A and 17α-ethinylestradiol on thermoplastic polyurethane by site energy distribution theory.

Compound pollution of microplastics and estrogens is a growing ecotoxicological problem in aquatic environments. The adsorption isothermal properties of bisphenol A (BPA) and 17α-ethinyl estradiol (EE2) on polyamide (TPU) in monosolute and bisolute systems were studied. Under the same adsorption concentration (1-4 mg L-1), EE2 had a greater adsorption capacity than BPA in the monsolute system. Compared to the energy distribution features of the adsorption sites of EE2 and BPA, the BPA adsorption sites were located in the higher energy area and were more evenly distributed than those of EE2, while the quantity of BPA adsorption sites was less than that of EE2. In the bisolute system, the average site energy, site energy inhomogeneity, and adsorption site numbers of BPA increased by 1.674, -17.166, and 16.793%, respectively. In comparison, the average site energy, site energy inhomogeneity, and adsorption sites numbers of EE2 increased by 2.267, 4.416, and 8.585%, respectively. The results showed that BPA and EE2 had a cooperative effect on the competitive adsorption of TPU. XPS analysis showed that BPA and EE2 had electron transfer on TPU, although the chemisorption effects and hydrogen bonds between BPA and TPU were more significant. Comparing the changes in the relative functional group content of TPU in monosolute and bisolute systems, BPA and EE2 were synergistically absorbed on TPU. This study can provide a theoretical reference for the study of competitive adsorption between coexisting organic pollutants.

Somatic mutations in FAT cadherin family members constitute an underrecognized subtype of colorectal adenocarcinoma with unique clinicopathologic features.

BACKGROUND: The FAT cadherin family members (FAT1, FAT2, FAT3 and FAT4) are conserved tumor suppressors that are recurrently mutated in several types of human cancers, including colorectal carcinoma (CRC). AIM: To characterize the clinicopathologic features of CRC patients with somatic mutations in FAT cadherin family members. METHODS: We analyzed 526 CRC cases from The Cancer Genome Atlas PanCancer Atlas dataset. CRC samples were subclassified into 2 groups based on the presence or absence of somatic mutations in FAT1, FAT2, FAT3 and FAT4. Individual clinicopathological data were collected after digital slide review. Statistical analysis was performed using t tests and chi-square tests. RESULTS: This CRC study cohort had frequent mutations in the FAT1 (10.5%), FAT2 (11.2%), FAT3 (15.4%) and FAT4 (23.4%) genes. Two hundred CRC patients (38.0%) harbored somatic mutations in one or more of the FAT family genes and were grouped into the FAT mutated CRC subtype. The FAT-mutated CRC subtype was more commonly located on the right side of the colon (51.0%) than in the rest of the cohort (30.1%, P < 0.001). It showed favorable clinicopathologic features, including a lower rate of positive lymph nodes (pN1-2: 33.5% vs 46.4%, P = 0.005), a lower rate of metastasis to another site or organ (pM1: 7.5% vs 16.3%, P = 0.006), and a trend toward an early tumor stage (pT1-2: 25.0% vs 18.7%, P = 0.093). FAT somatic mutations were significantly enriched in microsatellite instability CRC (28.0% vs 2.1%, P < 0.001). However, FAT somatic mutations in microsatellite stable CRC demonstrated similar clinicopathologic behaviors, as well as a trend of a better disease-free survival rate (hazard ratio = 0.539; 95% confidence interval: 0.301-0.967; log-rank P = 0.073). CONCLUSION: FAT cadherin family genes are frequently mutated in CRC, and their mutation profile defines a subtype of CRC with favorable clinicopathologic characteristics.

Regulation effects of hydrogen sulfide on ascorbate-glutathione cycle in naked oat leaves under saline-alkali stress.

Saline-alkali stress is one of the common abiotic stresses for plants. Hydrogen sulfide (H2S), as a gas signal, plays an important role in driving the responses of plants to saline-alkali stress. To explore the regulating effects of H2S on the ascorbate (AsA)-glutathione (GSH) cycle in naked oat (Avena nude) under saline-alkali stress, we used sodium hydrogen sulfide (NaHS) as donor of exogenous H2S and hydroxylamine (HA) as H2S synthesis inhibitor to examine the effects of H2S on plant growth, leaf reactive oxygen species, membrane lipid peroxidation, and antioxidants and key enzymes in the AsA-GSH cycle in "Dingyou 9" variety of naked oat under saline-alkali mixed stress. Results showed that spraying 50 µmol·L-1 NaHS could alleviate the inhibition of 50 mmol·L-1 saline-alkali mixed stress on the growth of naked oats, reduce the content of superoxide anions, H2O2, malondialdehyde, oxidized ascorbate (DHA), glutathione (GSH), and oxidized glutathione (GSSG) in leaves of naked oat under saline-alkali mixed stress, increase the ratio of AsA/DHA and GSH/GSSG, but did not affect the content of reduced ascorbic acid (AsA). Spraying NaHS significantly increased the activities of key enzymes, L-galactose dehydrogenase (GalDH) and L-galactono-1, 4-lactone dehydrogenase (GalLDH), for AsA synthesis pathways in naked oat leaves under salt-alkali mixed stress, as well as monodehydroascorbate reductase (MDHAR) in the AsA-GSH cycle, and decreased the activities of ascorbate peroxidase (APX) and dehydroascorbate reductase (DHAR), but did not affect the activities of ascorbate oxidase (AO) and glutathione reductase (GR). The addition of HA partially or completely relieved those aforementioned effects. Our results indicated that H2S could increase the efficiency of AsA-GSH cycle by promoting the synthesis of AsA and enhancing the activity of MDHAR, and reduce the oxidative damage of saline-alkali stress to naked oats.

Cul4b Promotes Progression of Malignant Cutaneous Melanoma Patients by Regulating CDKN2A.

Although several molecular targeted therapy and immunotherapy have been developed, cutaneous melanoma prognosis is still not satisfying. Cul4b promotes the progression of several malignant tumors by regulating cell proliferation. However, its prognostic role in malignant cutaneous melanoma has not been evaluated. In this study, immunohistochemistry was performed to assess the expression of Cul4b in a consecutive patient cohort. The prognostic role of Cul4b was estimated with univariate and multivariate analysis. Cul4b was knocked down in melanoma cell line to evaluate its role in promoting cell proliferation. The results revealed that Cul4b was highly expressed in some of the cutaneous malignant melanoma patients and high expression of Cul4b was associated with poor melanoma-specific overall survival and poor disease-free survival. Cul4b expression was associated with Breslow categories, Clark level, and Ki67 expression. Univariate and multivariate analysis revealed that Cul4b is an independent prognosis risk factor of cutaneous melanoma. Downregulation of Cul4b inhibited the proliferation ability of melanoma cells and downregulated the expression of CDKN2A. These results suggest that Cul4b plays an essential role in cutaneous melanoma progression and may serve as a promising treatment target.

Mutation of the chloroplast-localized phosphate transporter OsPHT2;1 reduces flavonoid accumulation and UV tolerance in rice.

Phosphorus (P) is an essential macronutrient required for plant development and production. The mechanisms regulating phosphate (Pi) uptake are well established, but the function of chloroplast Pi homeostasis is poorly understood in Oryza sativa (rice). PHT2;1 is one of the transporters/translocators mediating Pi import into chloroplasts. In this study, to gain insight into the role of OsPHT2;1-mediated stroma Pi, we analyzed OsPHT2;1 function in Pi utilization and photoprotection. Our results showed that OsPHT2;1 was induced by Pi starvation and light exposure. Cell-based assays showed that OsPHT2;1 localized to the chloroplast envelope and functioned as a low-affinity Pi transporter. The ospht2;1 had reduced Pi accumulation, plant growth and photosynthetic rates. Metabolite profiling revealed that 52.6% of the decreased metabolites in ospht2;1 plants were flavonoids, which was further confirmed by 40% lower content of total flavonoids compared with the wild type. As a consequence, ospht2;1 plants were more sensitive to UV-B irradiation. Moreover, the content of phenylalanine, the precursor of flavonoids, was also reduced, and was largely associated with the repressed expression of ADT1/MTR1. Furthermore, the ospht2;1 plants showed decreased grain yields at relatively high levels of UV-B irradiance. In summary, OsPHT2;1 functions as a chloroplast-localized low-affinity Pi transporter that mediates UV tolerance and rice yields at different latitudes.

Inflammatory bowel disease- and Barrett's esophagus-associated neoplasia: the old, the new, and the persistent struggles.

Early diagnosis of and adequate therapy for premalignant lesions in patients with inflammatory bowel disease (IBD) and Barrett's esophagus (BE) has been shown to decrease mortality. Endoscopic examination with histologic evaluation of random and targeted biopsies remains the gold standard for early detection and adequate treatment of neoplasia in both these diseases. Although eventual patient management (including surveillance and treatment) depends upon a precise histologic assessment of the initial biopsy, accurately diagnosing and grading IBD- and BE-associated dysplasia is still considered challenging by many general as well as subspecialized pathologists. Additionally, there are continuing updates in the literature regarding the diagnosis, surveillance, and treatment of these disease entities. This comprehensive review discusses the cancer risk, detailed histopathological features, diagnostic challenges, and updates as well as the latest surveillance and treatment recommendations in IBD- and BE-associated dysplasia.

Risk factors for colorectal neoplasia in patients with underlying inflammatory bowel disease: a multicenter study.

BACKGROUND: This study sought to evaluate the risk factors for the development of colitis-associated neoplasia (CAN) in Chinese patients with inflammatory bowel disease (IBD). METHODS: IBD patients who developed CAN between 1999 and 2016 were identified from eight medical centers. In addition to initial pathology evaluation, a CAN diagnosis was confirmed by two expert pathologists. Patients with CAN (n = 29) were compared with non-CAN controls (n = 87). Matching was performed for gender and IBD type with a ratio of three controls to one subject. RESULTS: Of the 29 patients with CAN, 8 (27.6%) had colorectal cancer (CRC), 20 (69.0%) had a final diagnosis of low-grade dysplasia and 1 (3.4%) had high-grade dysplasia. Multivariate analysis revealed that an older age at the time of IBD diagnosis and a longer IBD duration were independent risk factors for the development of CAN, with odds ratios of 1.09 [95% confidence interval (CI): 1.04-1.14, P < 0.001] and 1.14 (95% CI: 1.03-1.27, P = 0.013), respectively. Comparison between IBD patients with CRC and those with dysplasia indicated that the former were older at the time of IBD diagnosis (P = 0.012) and had longer IBD durations (P = 0.019). CONCLUSIONS: Older age at the time of IBD diagnosis and longer IBD duration were found to be associated with the development of CAN in IBD patients.

Sema3E/PlexinD1 signaling inhibits postischemic angiogenesis by regulating endothelial DLL4 and filopodia formation in a rat model of ischemic stroke.

Angiogenesis is a crucial defense response to hypoxia that regulates the process of raising the promise of long-term neurologic recovery during the management of stroke. A high expression of antiangiogenic factors leads to the loss of neovascularization capacity in pathologic conditions. We have previously documented an impairment of the cerebral vessel perfusion and neovascularization in the cortex neighboring the stroke-induced lesion, which was accompanied by an activation of semaphorin 3E (Sema3E)/PlexinD1 after ischemic stroke. In this study, we employed micro-optical sectioning tomography to fully investigate the details of the vascular pattern, including the capillaries. We found that after transient middle cerebral artery occlusion, inhibiting PlexinD1 signaling led to an organized recovery of the vascular network in the ischemic area. We then further explored the possible mechanisms. In vivo, Sema3E substantially decreased dynamic delta-like 4 (DLL4) expression. In cultured brain microvascular endothelial cells, Sema3E down-regulated DLL4 expression via inhibiting Ras-related C3 botulinum toxin substrate 1-induced JNK phosphorylation. At the microcosmic level, Sema3E/PlexinD1 signaling promoted F-actin disassembly and focal adhesion reduction by activating the small guanosine triphosphatase Ras homolog family member J by releasing RhoGEF Tuba from direct binding to PlexinD1, thus mediating endothelial cell motility and filopodia retraction. Our study reveals that Sema3E/PlexinD1 signaling, which suppressed endothelial DLL4 expression, cell motility, and filopodia formation, is expected to be a novel druggable target for angiogenesis during poststroke progression.-Zhou, Y.-F., Chen, A.-Q., Wu, J.-H., Mao, L., Xia, Y.-P., Jin, H.-J., He, Q.-W., Miao, Q. R., Yue, Z.-Y., Liu, X.-L., Huang, M., Li, Y.-N., Hu, B. Sema3E/PlexinD1 signaling inhibits postischemic angiogenesis by regulating endothelial DLL4 and filopodia formation in a rat model of ischemic stroke.

Interobserver Agreement in the Diagnosis of Inflammatory Bowel Disease-Associated Neoplasia in China in Comparison to Subspecialized American Gastrointestinal Pathologists.

BACKGROUND: The aim of this study was to evaluate the interobserver variability in diagnosing inflammatory bowel disease (IBD)-associated neoplasia among practicing pathologists from China using telepathology, a practice of remote diagnostic consultation increasingly used nationally and internationally, and its comparison with the interpretation of subspecialized gastrointestinal (GI) pathologists from the United States (US). METHODS: Eight GI pathologists from the US and 4 pathologists from China with an interest in GI pathology participated in this study. A total of 50 colonic biopsies from patients with a clinical history of IBD from 8 medical centers in China were included. All microscopic slides in each case were digitized using an Aperio system. One pathologist (XL) reviewed the digitized full-slide images, and selected areas of interest were captured at low, medium, and high magnifications at a resolution of 1712 × 1072 pixels and saved as tagged image file format (TIFF) files on read-only DVD. Each pathologist evaluated the images and selected the most appropriate diagnostic category for each case (negative, indefinite, low-grade dysplasia [LGD], high-grade dysplasia [HGD], and carcinoma). A Fleiss' kappa coefficient (K) analysis was performed to determine interobserver agreement and the agreement of each pathologist from China with the consensus diagnosis (defined as diagnostic agreement by at least 4 participating US GI pathologists). RESULTS: There was substantial interobserver agreement among 4 pathologists from China on the interpretation of IBD-associated neoplasia (kappa value 0.68, 95% confidence interval: 0.56-0.78). A consensus diagnosis included negative (n = 22), LGD (n = 22), HGD (n = 3), carcinoma (n = 2), and indefinite for dysplasia (n = 1). Using consensus diagnoses as references, the agreement between each pathologist from China and the consensus diagnosis was substantial with kappa values ranging from 0.75 to 0.80. CONCLUSIONS: This study reveals substantial interobserver agreement for the interpretation of colonic neoplasia in IBD using digitized images among Chinese pathologists as well as between each Chinese pathologist and a consensus diagnosis generated by US GI pathologists.

Lung Cancer with Concomitant Double Gene Mutation.

A patient presenting with concomitant epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation is very rare. We report a non-small cell lung cancer (NSCLC) patient with concomitant EGFR (exon 19-del) mutation and ALK rearrangement. The positron emission tomography-computed tomography (PET-CT) scan revealed a highly metabolic mass lesion in the left lower lobe, measured 5.0 cm in the largest dimension in the S6 segment. Transbronchial lung biopsy (TBLB) showed the pathological diagnosis of invasive adenocarcinoma. Thus, the patient underwent left lower lobectomy and hilar-mediastina lymph node dissection (pT2N0M0). The tumor harbor an ALK (D5F3 +) rearrangement and EGFR (exon 19-del) mutation. The patient initially received four cycles of chemotherapy (pemetrexed and carboplatin), and achieved partial response (PR).

Primary Merkel Cell Carcinoma on the Cheek: Three Case Reports.

Merkel cell carcinoma (MCC) is a rare aggressive cutaneous neuroendocrine carcinoma that typically arises in sunexposed areas of the skin. Herein, we present three cases of primary MCC of the cheek. Case 1 had multiple nodules and mild swelling on the left cheek and eyelids, the patient did not receive any treatment and died after 10 months. Case 2 presented with nodule on patient's left cheek, which increased gradually. The patient was treated with surgical resection from the tumor edge 0.3 cm and skin flap transplantation, she died after 21 months. Case 3 presented with a nodule without any symptoms on patient's left cheek, she was treated with surgical resection and the left cheek was reconstructed with a free flap of tissue. Outpatient follow-up did not show any recurrence and metastasis. The authors report the clinical, histopathological, therapy, prognosis features of MCC, and reviewed with literature.

Clinical significance and management of Barrett's esophagus with epithelial changes indefinite for dysplasia.

Barrett's esophagus (BE) is defined as the extension of salmon-colored mucosa into the tubular esophagus ≥ 1 cm proximal to the gastroesophageal junction with biopsy confirmation of intestinal metaplasia. Patients with BE are at increased risk of esophageal adenocarcinoma (EAC), and undergo endoscopic surveillance biopsies to detect dysplasia or early EAC. Dysplasia in BE is classified as no dysplasia, indefinite for dysplasia (IND), low grade dysplasia (LGD) or high grade dysplasia (HGD). Biopsies are diagnosed as IND when the epithelial abnormalities are not sufficient to diagnose dysplasia or the nature of the epithelial abnormalities is uncertain due to inflammation or technical issues. Specific diagnostic criteria for IND are not well established and its clinical significance and management has not been well studied. Previous studies have focused on HGD in BE and led to changes and improvement in the management of BE with HGD and early EAC. Only recently, IND and LGD in BE have become focus of intense study. This review summarizes the definition, neoplastic risk and clinical management of BE IND.

Adenocarcinoma of the lung with concomitant ALK fusion gene and EGFR gene mutation: A case report and literature review.

Targeted therapy is currently a very popular approach to cancer treatment. Personalized targeted therapy of non-small-cell lung cancer (NSCLC) is based on the mutation status of epithelial growth factor receptor (EGFR), Kirsten rat sarcoma viral oncogene homolog, B-Raf proto-oncogene and anaplastic lymphoma kinase (ALK) fusion gene, with different mutations requiring different treatment. Herein, we present a rare case of adenocarcinoma of the lung harboring EGFR- and ALK-activating mutations simultaneously. The patient is currently on pemetrexed and carboplatin chemotherapy and faring well; follow-up will be continued. It is recommended that the biological behavior of cancers with coexisting genetic mutations and their clinicopathological characteristics are more closely investigated in future studies, in order to determine the sensitivity of such cancers to targeted drugs and select the optimal agent.

Long-term variation of black carbon and PM2.5 in Beijing, China with respect to meteorological conditions and governmental measures.

Black carbon (BC) and PM2.5 were studied for nine years from 2005 to 2013 in the Beijing urban area. The overall weekly average mass concentrations of BC and PM2.5 were 4.3 and 66.8 µg/m³. PM2.5 annual means of the nine years are around 2 times of the standard (GB3095-2012) in China, and are 5-7 times higher than the WHO standard. The Beijing Olympic Games in 2008 was a milestone to mitigate aerosol pollution. Temporal distribution of BC shows a distinct declining trend, and annual mean mass concentrations of PM2.5 after 2008 were lower than those before 2008 but increased from 2011 to 2013. Wind rose plots show that high BC concentrations are usually associated with low wind speed of northeastern or southwestern winds, generally causing poor visibility. Governmental mitigation measures such as traffic restriction despite increased motor vehicle numbers and gasoline consumption and industry relocation with declining consumption of coal and coke were successful in reducing BC emissions. Annual mean of BC was reduced by 38% in 2013 compared to 2005. However, BC contamination in Beijing is still severe when compared to other urban areas around the world.

Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis.

Chronic proctitis refers to persistent or relapsing inflammation of the rectum, which results from a wide range of etiologies with various pathogenic mechanisms. The patients may share similar clinical presentations. Ulcerative proctitis, chronic radiation proctitis or proctopathy, and diversion proctitis are the 3 most common forms of chronic proctitis. Although the diagnosis of these disease entities may be straightforward in the most instances based on the clinical history, endoscopic, and histologic features, differential diagnosis may sometimes become problematic, especially when their etiologies and the disease processes overlap. The treatment for the 3 forms of chronic proctitis is different, which may shed some lights on their pathogenetic pathway. This article provides an overview of the latest data on the clinical features, etiologies, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis.

Disease course and management strategy of pouch neoplasia in patients with underlying inflammatory bowel diseases.

BACKGROUND: To evaluate the disease course and management strategy for pouch neoplasia. METHODS: Patients undergoing ileal pouch surgery for underlying ulcerative colitis who developed low-grade dysplasia (LGD), high-grade dysplasia, or adenocarcinoma in the pouch were identified. RESULTS: All eligible 44 patients were evaluated. Of the 22 patients with initial diagnosis of pouch LGD, 6 (27.3%) had persistence or progression after a median follow-up of 9.5 (4.1-17.6) years. Family history of colorectal cancer was shown to be a risk factor associated with persistence or progression of LGD (P = 0.03). Of the 12 patients with pouch high-grade dysplasia, 5 (41.7%) had a history of (n = 2, 16.7%) or synchronous (n = 4, 33.3%) pouch LGD. Pouch high-grade dysplasia either persisted or progressed in 3 patients (25.0%) after the initial management, during a median time interval of 5.4 (2.2-9.2) years. Of the 14 patients with pouch adenocarcinoma, 12 (85.7%) had a history of (n = 2, 14.3%) or synchronous dysplasia (n = 12, 85.7%). After a median follow-up of 2.1 (0.6-5.2) years, 6 patients with pouch cancer (42.9%) died. Comparison of patients with a final diagnosis of pouch adenocarcinoma (14, 32.6%), and those with dysplasia (29, 67.4%) showed that patients with adenocarcinoma were older (P = 0.04) and had a longer duration from IBD diagnosis or pouch construction to the detection of pouch neoplasia (P = 0.007 and P = 0.0013). CONCLUSIONS: The risk for progression of pouch dysplasia can be stratified. The presence of family history of colorectal cancer seemed to increase the risk for persistence or progression for patients with pouch LGD. The prognosis for pouch adenocarcinoma was poor.

Needle knife-assisted polypectomy in hot snare-resistant fibrotic inflammatory polyps / Polipectomia assistida por bisturi-agulha em pólipos inflamatórios fibróticos resistentes à cauterização por laço

BACKGROUND: Inflammatory polyps are common sequelae in patients with inflammatory bowel diseases (IBD). Those polyps can usually be removed with snare polypectomy. There were limited data evaluating the management of hot snare-resistant inflammatory polyps. METHODS: We reported on two cases with hot snare-resistant inflammatory polyps, one was a Crohn's disease (CD) patient with the polyp at the ileo-colonic anastomosis (ICA) and the other one was an ulcerative colitis (UC) patient with polyp at the pouch inlet. RESULTS: Sedated endoscopy was performed, which showed a large 2.5 cm pedunculated polyp at the ICA in the first patient and a large 5 cm pedunculated polyp at the pouch inlet in the second patient. Hot snare polypectomy was initially attempted, but failed in both patients. Then endoscopic needle knife polypectomy was performed, which helped complete polypectomy. Both procedures took approximately 25 minutes each. The patients tolerated the procedure well and continued to do well after the procedure. The final pathological diagnoses for both patients were inflammatory polyps with extensive fibrosis. CONCLUSIONS: Endoscopic needle knife-assisted polypectomy appeared to be an effective technique for the management of hot snare-resistant inflammatory polyps. (AU)

EXPERIÊNCIA: Pólipos inflamatórios são sequelas comuns em pacientes com doença intestinal inflamatória (DII). Geralmente esses pólipos podem ser removidos pela polipectomia por cauterização com laço. São limitados os dados que avaliam o tratamento de pólipos inflamatórios resistentes à cauterização por laço. MÉTODOS: Descrevemos dois casos com pólipos inflamatórios resistentes à cauterização por laço; um deles se tratava de paciente com doença de Crohn (DC) com o pólipo na anastomose íleo-colônica (AIC), e o outro era paciente de colite ulcerativa (CU) com pólipo na entrada da bolsa. RESULTADOS: Foi efetuada uma endoscopia com o paciente sedado, demonstrando um grande pólipo pedunculado (2,5 cm) na AIC do primeiro paciente e um grande pólipo pedunculado (5 cm) na abertura da bolsa no segundo paciente. Inicialmente, foi tentada polipectomia por cauterização com laço, que falhou nos dois pacientes. Foi então executada a polipectomia assistida por bisturi-agulha, que ajudou na polipectomia completa. Os dois procedimentos levaram 25 minutos cada. Os pacientes toleraram satisfatoriamente o procedimento e, depois da polipectomia, ficaram bem. Os diagnósticos patológicos finais para os dois pacientes foram pólipos inflamatórios com fibrose extensa. CONCLUSÕES: Ao que parece, a polipectomia endoscópica por bisturi-agulha é técnica efetiva para o tratamento de pólipos inflamatórios resistentes à cauterização por laço. (AU)

Management of ileal pouch prolapse with endoscopic hot snare / Tratamento de prolapso da bolsa ileal com alca diatermica endoscopica

Pouch prolapse is a complication following the creation of restorative proctocolectomy. There is a paucity of information in the literature pertaining to its management. An ileal J pouch patient with dyschezia presented to our Pouch Center. Under sedation, pouchoscopy was performed with a gastroscope. We detected an anterior distal pouch mucosal prolapse, 1.5 cm in diameter, blocking the anal canal. The prolapsed mucosa was excised with hot snare under a retroflex view. There was no bleeding or perforation. The entire procedure took 25 minutes. The patient tolerated the procedure well and was discharged home 30 minutes after post-procedural observation. The patient reported the resolution of the dyschezia symptom. The histopathological examination of excised specimen showed small bowel mucosa and sub-mucosa with changes compatible with mucosal prolapse. Endoscopic hot snare appears to be feasible in the management of pouch mucosal prolapse. (AU)

O prolapso da bolsa ileal é uma complicação que pode surgir após a criação da proctocolectomia restauradora. As informações na literatura são escassas quanto ao tratamento. Um paciente com bolsa ileal em "J" e apresentando disquezia deu entrada em nosso centro médico. Sob sedação, realizamos uma endoscopia da bolsa ileal. Detectamos uma bolsa distal anterior com prolapso da mucosa, com 1,5 cm de diâmetro, bloqueando o canal anal. O prolapso da mucosa foi retirado com alça diatérmica sob visão retroflexa. Não houve sangramento ou perfuração. A duração de todo o processo foi de 25 minutos. O paciente tolerou bem o procedimento e recebeu alta após 30 minutos de observação pós-procedimento. O paciente relatou a resolução do sintoma de disquezia. O exame histopatológico do espécime extirpado mostrou a mucosa e submucosa do intestino delgado com alterações compatíveis com o prolapso da mucosa. A alça diatérmica endoscópica parece ser viável no tratamento de prolapso da mucosa da bolsa ileal. (AU)

Anti-Escherichia coli O157:H7 properties of purple prairie clover and sainfoin condensed tannins.

Condensed tannins (CT) from purple prairie clover (PPC; Dalea purpurea Vent.) and sainfoin (SF; Onobrychis viciifolia) were assessed for anti-Escherichia coli activity by comparing their ability to react with proteins and liposome, cause cell aggregation, and alter outer membrane (OM) morphology and permeability. The PPC CT had greater (P < 0.01) protein-precipitating capacity than SF CT using either bovine serum albumin or ribulose 1,5-disphosphate carboxylase as model proteins. Minimum inhibitory concentration of PPC CT for two strains of E. coli and five strains of E. coli O157:H7 was four to six times lower than that of SF CT. E. coli exposed to 10 µg/mL of both CT had higher (P < 0.05) OM permeability than controls and was greater (P < 0.05) for PPC than for SF CT. Addition of both CT at 50 and 200 µg/mL caused cell aggregation which was more evident (P < 0.05) for PPC than for SF CT. Transmission electron microscopy showed electron dense material on the cell surface when cells were exposed to 50 µg/mL of PPC CT. The greater anti-E. coli activity of PPC than SF CT was due to its enhanced ability to precipitate protein that increased OM permeability and promoted cell aggregation.