Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia.

Peroral endoscopic myotomy (POEM) is one of the first-line treatment modalities along with pneumatic dilation and Heller myotomy for patients with achalasia. Endoscopists, especially trainees during the learning phase, commonly face difficulty in tissue plane dissection and selective myotomy while working near the esophagogastric junction, with increased risks of inadvertent injury, unexpected bleeding, and inadequate myotomy. To minimize the technical difficulty and improve the safety of POEM, we describe a protocol for using a scissor-type knife for the main steps of POEM, including mucosal incision, submucosal tunneling, myotomy, and hemostasis. The standard techniques used with the scissor-type knife involve grasping the target tissue, and then dissection or coagulation. The confirmation of the cutting line after grasping improves the accuracy and reliability of dissection, which is particularly useful for the selective myotomy of the internal circular muscle. Meanwhile, the scissor-type knife provides enhanced hemostatic capability and enables hemostasis and pre-coagulation without the device exchange for hemostatic forceps. Evaluation of the clinical outcomes in three patients who successfully received POEM using the scissor-type knife revealed no perioperative adverse events. At the 3-month follow-up, all patients achieved clinical success with postoperative Eckardt scores ranging from 0 to 1. In conclusion, the use of a scissor-type knife could minimize the technical difficulty and improve the safety of the POEM procedures, which may be suitable for trainees during the learning phase.

Cost-efficient snare-assisted peroral endoscopic myotomy in comparison of conventional endoscopic knife for treatment of achalasia: results of a randomized controlled trial.

BACKGROUND: To date, the ideal endoscopic knife for peroral endoscopic myotomy (POEM) with good performance and cost-effectiveness is still under investigation. The present study was aimed to evaluate the efficacy, safety, and cost-effectiveness of snare-assisted POEM, compared with the conventional endoscopic knife approach. METHODS: From May 2017 to December 2018, patients with achalasia presenting for POEM without previous endoscopic or surgical therapy were prospectively recruited in this randomized controlled trial. Patients were randomly allocated to receive POEM using either the snare (snare group) or HookKnife (conventional group). The primary outcome was clinical success (Eckardt score ≤ 3) at 12-month follow-up, powered for noninferiority with a margin of -15%. The secondary outcomes included adverse events (AEs), procedure-related parameters, clinical outcomes, and cost-effectiveness. RESULTS: A total of 75 patients with similar baseline characteristics between the snare (N = 37) and conventional (N = 38) groups were included. Clinical success at 12-month follow-up was achieved in 94.6% of patients in the snare group and 92.1% of patients in the conventional group (difference, 2.5% [95% CI, -8.7% to 13.7%]; P < 0.001 for noninferiority). No severe AEs occurred in both groups. The use of snare is associated with comparable procedure time (40.6 minutes vs. 42.5 minutes, P = 0.337), a lower frequency of hemostatic forceps use (27.0% vs. 68.4%, P < 0.001), and lower hospital costs ($4271.1 vs. $5327.3, P < 0.001). The cost-effectiveness plane revealed that 96.9% of snare-assisted POEM procedures offered more cost-savings and health utility benefits. CONCLUSIONS: The snare-assisted POEM was noninferior to the conventional endoscopic knife approach in terms of clinical efficacy, with comparable safety outcomes and cost-effective benefits.

Mechanisms of Traditional Chinese Medicine Bushenantai granules in promoting angiogenesis at the maternal-fetal interface of recurrent spontaneous abortion mice.

OBJECTIVE: To assess the effects of Bushenantai (BSAT) granule() on angiogenesis-related factors [E2, P, and vascular endothelial growth factor (VEGF)] at the maternal-fetal interface of recurrent spontaneous abortion (RSA) mice, and to evaluate the role of BSAT in promoting angiogenesis at the maternal-fetal interface by influencing the expression of sex hormones, and VEGF. METHODS: A mouse model with normal pregnancy and another with Clark's classic RSA were established. The RSA mice were randomly assigned to six groups: normal, model, progesterone, high-doseBSAT granule (BSAT-H), medium-dose-BSAT granule (BSAT-M), and low-dose-BSAT granule (BSAT-L) (n = 10 for each group). The embryo loss rate and the histopathological changes in the decidual tissues were measured. Serum levels of estrogen (E2), progesterone (P), and VEGF were detected by enzyme-linked immunosorbent assay. The mRNA and protein expressions of estradiol receptor (ER), progesterone receptor (PR), VEGF, and vascular endothelial growth factor receptor 2 (VEGFR2) in the decidual tissues were identified by immunohistochemistry, Western blotting, and quantitative reverse transcription polymerase chain reaction. RESULTS: The embryo loss rate in all groups that received BSAT treatment was reduced, while the number of blood vessels at decidual tissues was increased. The serum levels of E2, P and VEGF were elevated, and the mRNA and protein expressions of ER, PR, VEGF, and VEGFR2 in the decidual tissues were enhanced. CONCLUSION: BSAT can improve angiogenesis at the maternal-fetal interface and reduce the embryo loss rate, which may be associated with its ability to increase the serum levels of estrogen, progesterone, and VEGF, in addition to up-regulation of mRNA and protein expression of ER, PR, VEGF, and VEGFR2 in the decidual tissue.

Construction of swept source optical coherence tomography imaging system for root canal endoscopy and application in diagnosis of root fractures / 北京大学学报(医学版)

OBJECTIVE@#To construct swept source optical coherence tomography (SS-OCT) imaging system for root canal endoscopy, and to evaluate the accuracy of diagnosing artificial root fractures.@*METHODS@#An ultra-high-speed (40 kHz) swept laser source was developed based on the piezoelectric tuning filter and the Fourier domain mode locking (FDML) swept laser technology (patent number: 200620135940.2). Ultra-miniature gradient index lens technology (patent number: 201320241218.7) was used to create a thin endoscopic probe with a diameter of 0.86 mm for real-time image transmission. The SS-OCT light source had a wavelength of 1 310 nm and a bandwidth of 100 nm. The axial and transverse image resolutions were 15 μm and 25 μm, respectively. Artificial fractures were created on human mandibular premolars with single root and the premolar roots were prepared to 41 horizontal sections (1 mm thick). 27 root sections with fractures (width: 52-284 μm) and 14 the sections without fractures were observed under an optical stereomicroscope with a cold light source as the gold standard. The horizontal root sections were scanned by self-developed SS-OCT imaging system for root canal endoscopy with a central wavelength of 1 310 nm and bandwidth of 100 nm. The data were reconstructed with 30 μm thick slices at an interval of 30 μm. Two observers, a radiologist and an endodontist, were trained and independently evaluated all the reconstructed images blindly. The diagnostic performance of SS-OCT imaging system was calculated, and statistical analysis was performed.@*RESULTS@#SS-OCT root canal endoscopic imaging system composed of high-speed swept laser source, fiber coupler, endoscopic probe, reference arm and differential detector. Root sections could be scanned by SS-OCT and imaged in realtime at a depth of 1 to 2 mm. The kappa value for interobserver agreement was 0.792, and the intraobserver agreement was 1.000 and 0.709 for two observers respectively. All of 27 fractured root sections and 12 of 14 root sections without fractures were accurately diagnosed while 2 unfractured root sections were misdiagnosed. The sensitivity was 1.000 and the specificity was 0.857 for diagnosis of artificial root fractures by SS-OCT. The positive predictive value (PPV), negative predictive value (NPV) and the overall accuracy rate were 0.931, 1.000 and 0.951 respectively.@*CONCLUSION@#The swept source optical coherence tomography imaging system for root canal endoscopy is a promising imaging method for observing root fractures．.

Detection of root cracks after root canal preparation using rotary NiTi systems by optical coherence tomography (OCT) scan / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the accuracy of optical coherence tomography (OCT) in detecting root cracks after root canal instrumentation using histological gold standard.@*METHODS@#Twenty complete extracted human mandibular incisors that were free of caries, calculus, and root treatment were chosen and accessed coronally with a diamond bur, then mounted in resin blocks with alginate impression material using simulated periodontal ligaments, and the apex was exposed 3 mm. The teeth were stored in water at room temperature. Then the teeth were then instrumented to the major apical foramen (AF) at #30/0.09 using ProTaper Universal rotary nickel titanium system (Dentsply Maillefer, Ballaigues, Switzerland), irrigation with 1% sodium hypochlorite (NaOCl) by using a 26-gauge needle followed after each instrument. The apical root was scanned with 360° of rotation by Swept-Source Optical Coherence Tomography (SS-OCT) (wavelength: 1 310 nm, scan rate: 20 kHz, axial resolution: 16 μm) with driving device (stepper motor and lifting platform). The reconstruction images of axial planes 1, 2 and 3 mm from the apex were examined and the root cracks were blindly diagnosed by two observers. The horizontal section was performed at 1, 2 and 3 mm from the apex using low speed disc saw (Leica SP1600, Wetzlar, Germany). The presence of cracks was noted under an optical stereomicroscope (ZOOM-630E) with a cold light source using as gold standard to evaluate the accuracy of OCT in detecting root cracks after root canal instrumentation.@*RESULTS@#After canals instrumentation with ProTaper Universal rotary nickel titanium system to #30/0.09, root cracks were detected in 9 of 20 teeth by histological examination. Crack lines were observed on 13 of 60 horizontal sections and cracks on 12 of the 13 sections were detected by OCT. No cracks were observed in the other 47 of the 60 horizontal sections,none of which was misdiagnosed by OCT. The overall accuracy rate for detection of root cracks with OCT was 0.983, the sensitivity was 0.923, the specificity was 1.000, the positive predictive value (PPV) was 1.000 and the negative predictive value (NPV) was 0.979.@*CONCLUSION@#OCT may be a promising nondestructive imaging method for diagnosing root canal cracks after canal instrumentation.

Association of CYP3A4*18B and CYP3A5*3 polymorphism with cyclosporine-related liver injury in Chinese renal transplant recipients.

OBJECTIVE: The purpose of this study was to investigate the associations between CYP3A4*18B and CYP3A5*3 polymorphism and cyclosporine-related liver injuries in Chinese renal transplant recipients. METHODS: We genotyped 339 renal transplant recipients treated with a triple immunosuppressive regimen including cyclosporine for CYP3A4*18B and CYP3A5*3 polymorphism using the polymerase chain reaction restriction fragment length polymorphism assay. RESULTS: The incidence of liver injury in the study population was 36.9% (125/339). At 1 month after transplantation, the trough concentration of cyclosporine (C0) in the group with CYP3A4*1/*1(GG alleles) was significantly higher than in the group with CYP3A4*18B/*1 8B(AA alleles) (p < 0.05). At 3 months after transplantation, the C0 in the group with CYP3A4*1/*1 and group with CYP3A4*1/*18B was markedly higher than in the group with CYP3A4*18B/*18B (p < 0.05). The GG genotypes of CYP3A4*18B were more common in the liver injury group compared with the control group (p < 0.05). Univariate logistic regression analysis showed that subjects carrying the GG genotypes had a 5.136- and 2.528-fold higher risk of developing cyclosporine-related liver injury than those with the AA and GA genotypes. When adjusted for sex, the risk of the CYP3A4*18B genotypes was OR = 4.969 for GG compared to AA (p = 0.030), and OR = 2.634 for GG compared to GA (p = 0.025). However, no association was observed between CYP3A5*3 polymorphisms with cyclosporine-related liver injury. CONCLUSIONS: These results suggested that the wild type of CYP3A4*18B is a risk factor for the development of cyclosporine- related liver injuries in Chinese renal transplant recipients.

Wind tunnel tests for wind pressure distribution on gable roof buildings.

Gable roof buildings are widely used in industrial buildings. Based on wind tunnel tests with rigid models, wind pressure distributions on gable roof buildings with different aspect ratios were measured simultaneously. Some characteristics of the measured wind pressure field on the surfaces of the models were analyzed, including mean wind pressure, fluctuating wind pressure, peak negative wind pressure, and characteristics of proper orthogonal decomposition results of the measured wind pressure field. The results show that extremely high local suctions often occur in the leading edges of longitudinal wall and windward roof, roof corner, and roof ridge which are the severe damaged locations under strong wind. The aspect ratio of building has a certain effect on the mean wind pressure coefficients, and the effect relates to wind attack angle. Compared with experimental results, the region division of roof corner and roof ridge from AIJ2004 is more reasonable than those from CECS102:2002 and MBMA2006.The contributions of the first several eigenvectors to the overall wind pressure distributions become much bigger. The investigation can offer some basic understanding for estimating wind load distribution on gable roof buildings and facilitate wind-resistant design of cladding components and their connections considering wind load path.

[Effect of miR-542-3p on carcinogenesis induced by anti-benzo(a) pyrene-7,8-diol-9,10-epoxide].

OBJECTIVE: To explore the effect of miR-542-3p in malignant transformation of human bronchial epithelial cells (16HBE) induced by anti-benzo(a)pyrene-7,8-diol-9,10-epoxide (anti-BPDE). METHODS: The relative expression level of mature miR-542-3p in transformed cells (16HBE-T) and untransformed control cells (16HBE-N) was measured by real-time quantitative polymerase chain reaction (qRT-PCR). miRNA mimic was transiently transfected into 16HBE-T to change the expression level of miR-542-3p, and then the influenced changes of cell proliferation, cell cycle, apoptosis, and soft agar colony formation rate and the migration of transfected cells were analyzed. RESULTS: Before transfection, the expression level of mature miR-542-3p in 16HBE-T was lower (39.08 ± 6.95)% than it in 16HBE-N (t = 15.18, P < 0.05). In comparison with the 16HBE-T group, the expression level of miR-542-3p in miR-542-3p mimic-transfected group was (5.23 ± 0.55) fold (t = 17.37, P < 0.05) after transfection. Cell proliferation of mimic-transfected group was decreased to (62.06 ± 5.61)% (t = -17.28, P < 0.05), percentage of cells in G(0)/G(1) phase up to (74.76 ± 4.86)% (t = 4.53, P < 0.05), rate of colony formation degrade to (5.87 ± 0.67)% (t = -6.66, P < 0.05), coverage areas ratio decreased to (0.31 ± 0.08) (t = -6.78, P < 0.05). There was no change with apoptosis. CONCLUSION: Our studies showed that miR-542-3p played the role as a tumor suppressor, which led to a significant decrease in the proliferation capacity and degree of malignancy. These findings suggest aberrantly down-regulated miR-542-3p may be one critical factor that contributes to malignant transformation of 16HBE induced by anti-BPDE.