Endoscopic submucosal dissection versus surgery for T1b esophageal carcinoma: a single-center retrospective study.

INTRODUCTION: Endoscopic submucosal dissection (ESD) is a preferred treatment option for superficial esophageal squamous cell carcinoma (SESCC). However, only few studies compared long-term survival outcomes of ESD with surgery, especially for T1b SESCC. This study compared the overall survival (OS), disease-free survival (DSS), recurrence-free survival (RFS), and complication rates of both, to evaluate the value of ESD in patients with T1b SESCC. METHODS: We reviewed patients who underwent ESD (n = 47) or surgery (n = 73) for T1b SESCC at Affiliated Hospital of Nanjing University of Chinese Medicine from 2009 to 2021. To increase the precision of our results interpretation, subgroups were analyzed according to the depth of tumor invasion and elderly people. RESULTS: In the ESD and surgery groups, the overall mortality rates were 0/100 and 12.3/100 person years, incidence rates of recurrence were 2.13/100 and 11/100 person years, respectively. Kaplan-Meier survival analysis revealed no significant different in OS, DSS and RFS. Charlson comorbidity index (CCI) and depth of submucosal invasion were identified as risk factors for cancer recurrence in multivariate analysis. For elderly people, no significant differences were found in OS, DSS and RFS between different treatments. CONCLUSION: ESD are related to lower complication rates and shorter hospital stay than surgery in long-term outcomes for patients with pT1b SESCC. But in pT1b-SM2 patients, we still need long-term follow-up.

Pathological characteristics and long-term prognosis of submucosal infiltrating carcinoma of the colon and rectum below 2 cm confirmed by endoscopic submucosal dissection.

The purpose of this study was to explore the correlation between additional surgery and the clinicopathological characteristics of colorectal cancer, as well as its impact on patient prognosis. A total of 119 patients with early colorectal cancer were selected and divided into an additional surgery group (28 cases) and a non-additional surgery group (91 cases). According to the tumor size, the patients were further divided into a large diameter group (54 cases, d≥1 cm and <2 cm) and a small diameter group (65 cases, d<1 cm). The clinical and pathological characteristics as well as the prognosis of the patients were statistically analyzed. The results showed that infiltration type, depth of infiltration, and tumor size were correlated with additional surgery (P<0.05). Infiltration type and depth of infiltration were closely related to additional surgery. Differentiation degree, infiltration type, and depth of infiltration were correlated with tumor diameter. Infiltration type was closely related to tumor size. Age, depth of infiltration, and tumor size were correlated with patient survival rates. Infiltration type and depth of infiltration were closely related to patient survival rate (P<0.05). They were independent risk factors affecting patient prognosis. The 5-year disease-free survival rates were 73.33% and 72.5%, respectively, with no statistically significant difference. Infiltration type and depth of infiltration were independent risk factors for recurrence in colorectal cancer patients, while depth of infiltration was an independent risk factor for the 5-year survival rate after surgery. They can be used to predict the prognosis of colorectal cancer and guide clinical treatment as a supplement to the traditional staging of colorectal cancer.

An unusual cause of hemorrhagic shock in a 14-year-old child.

A 14-year-old girl underwent colonoscopy due to repeated flesh-washing watery stools and dull pain around the umbilicus for 10 days. She felt tired for 1 month with no other significant discomfort. The hemoglobin (Hb) is 66g/L, and the red blood cell (RBC) count was 3.24*10^12/L in routine blood tests at admission. Abdominal computed tomography (CT) images showed submucosal tumor (SMT) in the descending colon. The abdominal computed tomography (CT) images showed submucosal tumor (SMT) in the descending colon. The SMT, supplied by the superior and inferior mesenteric arteries, showed significant enhancement at the arterial stage. It did not reveal any bowel wall thickening, enlarged lymph nodes, or ascites, suggesting that the SMT was probably a benign submucosal lesion. The submucosal tumor lesion measured in size 25*25mm located at the descending colon. Endoscopic ultrasonography imaging showed a mixed hyperechoic with a regular edge, originating from the submucosa and closely related to the muscularis propria. There were no evident features of malignancy or metastasis. Endoscopic full-thickness resection (EFR) was carried out for en bloc resection. The tumor was located in the submucosa with a clear boundary and intact capsule. The tumor cells exhibited acinar and nested patterns with abundant thin-walled blood vessels. These tumor cells were epithelioid, displaying abundant clear or eosinophilic cytoplasm. The nuclei were round or oval. Immunohistochemical analysis revealed that the tumor cells showed positive staining for HMB-45 and TFE3, but were negative for SMA.

Is histological healing more clinically valuable than endoscopic healing in Crohn's disease?

OBJECTIVES: Small bowel (SB) endoscopic healing has not been well explored in patients with Crohn's disease (CD). This study aimed to assess the clinical utility of SB endoscopic mucosal and histological healing in patients with CD. METHODS: In total, 99 patients with CD in clinical-serological remission were retrospectively followed after they underwent colonoscopy and double-balloon enteroscopy. Time until clinical relapse (CD activity index of >150 with an increase of >70 points) and serological relapse (abnormal elevation of C-reactive protein levels) constituted the primary endpoints. RESULTS: Of the 99 patients, 75 (74.7%) exhibited colonoscopic healing and 43 (43.4%) exhibited SB endoscopic healing. Clinical relapse, serological relapse, hospitalization, and surgery occurred in 8 (18.6%), 11 (25.6%), 11 (25.6%), and 2 (4.6%) patients, respectively. Of the 43 patients who exhibited SB endoscopic healing, 21 (48.8%) achieved histological healing. Clinical relapse, serological relapse, hospitalization, and surgery occurred in 4 (19.0%), 7 (33.3%), 7 (33.3%), and 1 (4.8%) patient, respectively. There was no statistically significant difference in the number of patients who relapsed, were hospitalized, or underwent surgery between those who exhibited histological healing and those who did not. CONCLUSION: A substantial number of patients who were in clinical-serological remission did not undergo SB endoscopic healing, and the lesions increased their risk of clinical relapse. Thus, endoscopic healing may be of greater clinical value than histological healing when evaluating the remission of patients with CD.

Biomarkers of Metabolomics in Inflammatory Bowel Disease and Damp-Heat Syndrome: A Preliminary Study.

Aims: This study aims to investigate the potential biomarkers of inflammatory bowel disease (IBD) and IBD with damp-heat syndrome (IBD-DH) by metabolomics. Methods: Plasma and urine samples were collected from 15 healthy controls and 30 IBD patients, including 15 IBD-DH and 15 IBD with spleen deficiency syndrome (IBD-SD), which was coded as SF8G and SF70 according to the International Classification of Diseases Eleventh Revision (ICD-11) issued by World Health Organization. Pseudotargeted metabolomics method was used based on ultra-high-performance liquid chromatography-high-resolution mass spectrometry and triple-quadrupole mass spectrometry. Results: Under the condition of false discovery rate (FDR) < 0.05, variable importance projection (VIP) > 1.0, and fold change (FC) > 1.5 or < 2/3, we found 57 plasma differential metabolites and 20 urinary differential metabolites in IBD. Then, with area under the curve (AUC) ≥ 0.85 and FC ≥ 2 or ≤ 0.3, 11 potential biomarkers were identified, such as acylcarnitine (ACar 20:4, ACar 18:1, and ACar 20:3), 3-indoleacetic acid, hippuric acid, and dehydroepiandrosterone sulfate, which is related to intestinal microbiota and immune response. However, less obvious differences were observed in IBD-DH when compared with IBD-SD. Under the condition of FDR < 0.2, VIP >1.0, and FC > 1.5 or < 2/3, we identified 16 plasma differential metabolites. In urine samples, IBD-DH and IBD-SD had the same metabolite pattern. With AUC ≥ 0.80, 7 differential plasma metabolites, mainly glycerophospholipids, were identified in IBD-DH. Kyoto Encyclopedia of Genes and Genomes analysis indicated that metabolic pathways, such as citrate cycle and amino acids metabolism, were mainly responsible for the distinction between IBD and healthy controls, whereas glycerophospholipid metabolism perturbation was not only a manifestation of IBD but also an important pathway to distinguish two subtypes defined by traditional medicine, IBD-DH and IBD-SD. Conclusion: In this study, we found that several metabolites of aromatic acids and lipid derivatives could act as potential biomarkers to discriminate IBD from healthy controls. Glycerophospholipids metabolites might be used to differentiate IBD-DH from IBD-SD.

Endoscopic submucosal dissection for exploration and removal of a gastric buried foreign body.

Foreign body (FB) fully embedded in the gastrointestinal tissue forming a buried FB is rare, characterized by deceiving endoscopic appearances, e.g., erosion, ulceration, or subepithelial lesion. Conventional endoscopic removal is challenging in this circumstance under which surgery is usually indicated. We reported a gastric buried FB that treated via endoscopic submucosal dissection.

Successful treatment of an enormous rectal mucosa-associated lymphoid tissue lymphoma by endoscopic full-thickness resection: A case report.

BACKGROUND: Colorectal mucosa-associated lymphoid tissue lymphoma (MALToma), a rare kind of nongastric MALToma, lacks consensus on its endoscopic features and standard therapies. According to previous studies on the clinical characteristics and outcomes of colorectal MALToma, endoscopic resection remains a good therapeutic strategy. CASE SUMMARY: A 71-year-old woman suffered intermittent hematochezia for 1 mo, accompanied with abdominal pains but without weight loss, fever, chills or fatigue. Colonoscopy showed a massive hemispheric mass with rough and hyperemic mucosa in the lower rectum. Narrow-band imaging magnifying endoscopy detected some branching abnormal blood vessels and disappearance of glandular structure, which was similar with the tree-like appearance sign in gastric MALToma. Endoscopic ultrasonography revealed the lesion to be hypoechoic, boundary-defined, and echo uniform inside, originating from the muscularis propria. Abdominal enhanced computed tomography (CT) demonstrated a soft tissue mass with defined boundary. No enlarged superficial lymph nodes were detected by B-mode ultrasound. C13-urea breath test and serum Helicobacter pylori antibody were both negative. The patient underwent endoscopic full-thickness resection. Postoperative pathological analysis indicated colorectal MALToma. The patient remained asymptomatic after discharge, and follow-up positron emission tomography-CT and colonoscopy showed no residual lesion, remnants or lymph node metastasis. CONCLUSION: This case provides new information on the specific endoscopic features of colorectal MALToma and an alternative treatment for patients.

Photosynthetic light and CO2 utilization and C4 traits of two novel super-rice hybrids.

Characteristics of photosynthetic light and CO2 use efficiency from seedling to heading stage, and C4 pathway enzyme activities in both flag leaves and lemma were compared between two newly developed super-rice hybrids (Oryza sativa L.), Liangyoupeijiu and Hua-an 3, and a traditional rice hybrid, Shanyou 63. At seedling and tillering stages, Liangyoupeijiu and Hua-an 3 had higher net photosynthetic rates (Pn) and light saturated assimilation rates (Asat) than did Shanyou 63, at both normal (360 micromol mol(-1)) and doubled (720 micromol mol(-1)) CO2 concentrations. At the heading stage, the flag leaves of all three rice hybrids had similar Pn and Asat. However, the two super-rice hybrids had higher apparent quantum yield (AQY) and carboxylation efficiency (CE) during all three typical developmental stages, and higher quantum yield of CO2 fixation (PhiCO2) at the tillering and heading stages. In addition, Liangyoupeijiu showed significantly higher activities of the C(4) pathway enzymes in both flag leaves and lemmas than did Shanyou 63. As a result, flag leaves of the two super-rice hybrids had higher Pn at morning, noontime and late afternoon during the daily cycle. Since most of the grain yield of rice comes from the photosynthesis of flag leaves, the similar Asat and much higher AQY, CE and PhiCO2 at heading stage of the two super-rice hybrids indicates that higher photosynthetic efficiency rather than higher photosynthetic capacity may be the primary factor contributing to their higher grain yields.

Photosynthetic characteristics and tolerance to photo-oxidation of transgenic rice expressing C(4) photosynthesis enzymes.

The photosynthetic characteristics of four transgenic rice lines over-expressing rice NADP-malic enzyme (ME), and maize phosphoenolpyruvate carboxylase (PC), pyruvate,orthophosphate dikinase (PK), and PC+PK (CK) were investigated using outdoor-grown plants. Relative to untransformed wild-type (WT) rice, PC transgenic rice exhibited high PC activity (25-fold increase) and enhanced activity of carbonic anhydrase (more than two-fold increase), while the activity of ribulose-bisphosphate carboxylase/oxygenase (Rubisco) and its kinetic property were not significantly altered. The PC transgenic plants also showed a higher light intensity for saturation of photosynthesis, higher photosynthetic CO(2) uptake rate and carboxylation efficiency, and slightly reduced CO(2) compensation point. In addition, chlorophyll a fluorescence analysis indicates that PC transgenic plants are more tolerant to photo-oxidative stress, due to a higher capacity to quench excess light energy via photochemical and non-photochemical means. Furthermore, PC and CK transgenic rice produced 22-24% more grains than WT plants. Taken together, these results suggest that expression of maize C(4) photosynthesis enzymes in rice, a C(3) plant, can improve its photosynthetic capacity with enhanced tolerance to photo-oxidation.

Characterization of photosynthesis, photoinhibition and the activities of C(4) pathway enzymes in a superhigh-yield rice, Liangyoupeijiu.

Characteristics of photosynthetic gas exchange, photoinhibition and C(4) pathway enzyme activities in both flag leaves and lemma were compared between a superhigh-yield rice (Oryza sativa L.) hybrid, Liangyoupeijiu and a traditional rice hybrid, Shanyou63. Liangyoupeijiu had a similar light saturated assimilation rate (Asat) to Shanyou63, but a much higher apparent quantum yield (AQY), carboxylation efficiency (CE) and quantum yield of CO(2) fixation (PhiCO(2)). Liangyoupeijiu also showed a higher resistance to photoinhibition and higher non-radiative energy dissipation associated with the xanthophyll cycle than Shanyou63 when subjected to strong light. In addition, Liangyoupeijiu had higher activities of the C(4) pathway enzymes in both flag leaves and lemmas than Shanyou63. These results indicate that higher light and CO(2) use efficiency, higher resistance to photoinhibition and C(4) pathway in both flag leaf and lemma may contribute to the higher yield of the superhigh-yield rice hybrid, Liangyoupeijiu.