内镜黏膜下剥离术治疗直径2 cm以上结直肠粗短蒂息肉的疗效评价

目的 探讨内镜黏膜下剥离术(ESD)治疗直径2 cm以上结直肠短粗蒂息肉的安全性和有效性。方法 回顾性分析浙江省慈溪市人民医院2015年1月到2017年6月行ESD治疗的直径2 cm以上结直肠粗短蒂息肉患者的临床资料,包括临床病理资料,并发症发生情况,以及有无局部复发或远处转移等。结果 共40例患者纳入研究,息肉直径2.0~4.0 cm,平均2.8 cm,均成功进行ESD,整块切除率100.0%。手术时间7~60 min,平均25.1 min。术中26例（65.0%）出现动脉搏动性出血,均经内镜下热活检钳电凝止血成功。术中无穿孔、无内镜无法处理的大出血发生,术后无迟发性出血及迟发性穿孔,无中转外科手术病例。术后住院时间1~4 d,平均1.3 d。术后病理提示,23例(57.5%)为腺瘤伴低级别上皮内瘤变, 15例(37.5%)为高级别上皮内瘤变,2例（5.0%）为浸润黏膜下层浅层的早期癌。所有切除标本的侧切缘和基底切缘无肿瘤累及,病灶完整切除率100.0%。患者术后随访时间4~24个月, 平均10.2个月,无局部复发和远处转移病例。结论 ESD治疗较大结直肠粗短蒂息肉安全有效。     

内镜黏膜下剥离术治疗消化道病灶56例疗效分析

目的探讨内镜黏膜下剥离术（ESD）治疗消化道病灶的疗效和安全性。方法内镜检查发现的消化道病灶病例患者为入选对象,术前行染色内镜和超声内镜检查,确定病变范围和深度,常规行术前评估,观察手术时间、手术成功率及并发症发生率,并进行术后随访。结果 2008年12月~2009年6月我院共实施ESD手术56例进入观察,切除标本平均直径（2.56±0.69）cm,平均手术操作时间（70.24±28.35）min;手术完整剥离成功率94.6%,术中穿孔发生率5.4%,迟发性穿孔率3.6%。1例发生迟发型出血,行手术治疗。术后随访率92.9%,随访患者中6个月内切面愈合率91.3%,12个月内切面愈合率达100%。结论 ESD治疗消化道病灶病变局部的复发率低,并发症少。     

内镜黏膜下剥离术治疗上消化道间质瘤的临床观察

目的探讨内镜黏膜下剥离术(ESD)治疗上消化道间质瘤的疗效和安全性。方法选取昆山市第一人民医院在2011年10月至2018年1月间收治的25例上消化道间质瘤作为研究对象,应用Dual刀、IT刀进行ESD治疗,一次性完整剥离切除病变。结果 25例上消化道间质瘤中,位于胃窦7例、胃底5例、胃体7例、贲门1例、食管5例。病变大小为0.8～3.0cm,平均(1.6±0.6)cm。25例病变均一次性完整剥离。ESD手术时间为30～98min,平均(55.8±18.5)min。3例术中出现消化道穿孔,2例应用和谐夹及尼龙绳圈套扎成功闭合,1例行腹腔镜修补术。所有患者术中出血量均100mL,术后均未出现迟发性穿孔和迟发性出血。结论 ESD治疗上消化道间质瘤安全、有效。     

体内牵引技术辅助内镜切除右半结肠病变的应用

目的评价体内牵引技术在右半结肠病变内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)中的辅助效果及安全性。方法2018年间,因右半结肠病变内于山东大学齐鲁医院接受ESD治疗,其中采用体内牵引技术辅助的11例病例纳入回顾性分析,包括线圈牵引辅助6例(线圈牵引组)和弹力环牵引辅助5例(弹力环牵引组),总结手术时间、剥离时间、病灶完整切除情况以及术中并发症发生情况。结果线圈牵引组(n=6)病灶直径2.0~3.5 cm,手术时间15~35 min,其中剥离时间10~30 min;弹力环牵引组(n=5)病灶直径3.5~5.0 cm,手术时间20~60 min,其中剥离时间15~55 min。11例病灶均一次性完整切除,创面无穿孔和迟发性出血等并发症。结论体内牵引技术辅助ESD切除右半结肠病变安全可行,其中弹力环具有自身弹力回缩特点,尤适合用于病灶较大者。     

内镜黏膜下剥离术后短期内胃镜检查对防治迟发性出血的价值评价

目的 探讨胃黏膜病变内镜黏膜下剥离术(ESD)后短期内再行胃镜检查在防治迟发性出血中的临床价值.方法 回顾性分析2011年5月至11月间,行ESD治疗的67例胃黏膜病变患者的临床资料,患者年龄31～84岁,中位年龄63岁.所有患者术后第1天、第3天常规胃镜复查,观察有无创面迟发性出血,并给予适当处理及随访.结果 67例患者中,病变位于贲门5例、胃体6例、胃底3例、胃窦35例、胃角16例、残胃2例.病变最大直径2.0 -7.0cm,平均(3.73±1.24)cm.ESD术中无大量出血和穿孔等并发症,术后9.0％(6/67)的患者发生迟发性出血,5例发生在术后第3天,1例在术后第4天.迟发性出血者中Forrest分级Ⅰb2例,Ⅱb4例,均经内镜下成功止血.本组中迟发性出血的发生率远高于既往仅根据患者的临床表现判断迟发性出血所得的出血发生率,但从随访结果看,两者治疗效果及安全性相当.结论 ESD术后迟发性出血的实际发生率较高,但大多无临床症状,无严重不良后果,故可以不常规行ESD术后短期内胃镜检查,以减轻患者的痛苦和精神负担.     

新型磁力锚导引系统在内镜黏膜下剥离术中的应用:动物预实验

目的 评估新型磁力锚导引系统在猪模型内镜黏膜下剥离术（ESD）中的应用价值及安全性。方法 2名熟练ESD操作者在2只实验猪直肠进行磁力锚牵引辅助下ESD,记录分析操作时间、切除效率、完整切除率、并发症等。结果 共完成ESD操作5例,病灶开始标记至完整剥离平均时间为26.6 min,单位时间切除率（0.38±0.1）cm2/min。病灶均完整切除且无穿孔和迟发性出血发生。结论 磁力锚牵引辅助ESD能有效暴露黏膜下层,提供直视下切除,是一项安全有效的辅助技术。     

内镜吻合夹在封闭医源性肠道穿孔中的应用

目的 探讨内镜吻合夹（over-the-scope clip,OTSC）在闭合医源性肠道穿孔中的疗效。方法 对应用OTSC夹封闭肠道穿孔患者的临床资料进行回顾性分析。结果 20例患者穿孔长径为1.0~4.0 cm,均在内镜下一次成功闭合,平均封闭时间为9.1 min,平均住院6.5 d,术后无迟发性穿孔、出血等并发症发生,无病患死亡。结论 使用OTSC封闭医源性肠道穿孔是一种安全、有效的治疗方法。     

内镜黏膜下剥离术治疗结直肠侧向发育型息肉的疗效分析

目的探讨采用内镜黏膜下剥离术(ESD)治疗结直肠侧向发育型息肉的应用价值。 方法回顾性分析2018年1月至2019年12月经内蒙古消化病研究所内镜中心行肠镜检查发现的45例结直肠侧向发育型息肉患者,应用IT刀、Hook刀行ESD治疗。将ESD成功率、剥离病变大小、手术时间、手术并发症及复发率等纳入观察范围。 结果45例结直肠病变接受ESD,其中,2例病变黏膜下注射后病变托举差,术中剥离困难且容易出血转外科手术。术后病理证实,3例癌变且基底仍有肿瘤残留,行外科手术扩大切除。ESD成功率88.9%(40/45)。病变直径为1.5～6.3 cm,平均3.6 cm;ESD手术时间为31～125 min,平均67 min。3例术后有便血,其中1例保守治疗失败,内镜下成功电凝止血,ESD术后出血发生率7%(3/43)。4例在ESD治疗中有小穿孔,应用软组织夹成功缝合穿孔,未转开腹手术,ESD穿孔发生率为9.3%(4/43)。术后40例患者均随访,创面基本愈合,无病变残留和复发。 结论ESD治疗结直肠侧向发育型息肉疗效可靠,能完整切除较大的病变,提供完整的病理学资料且复发率低。出血和穿孔是其主要的短期并发症。     

内镜黏膜下剥离术在诊治胃上皮内瘤变中的价值

目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)在诊治胃上皮内瘤变(gastric intraepithelial neoplasia,GIN)中的价值。方法回顾性分析2012年1月-2013年8月南京医科大学附属苏州医院收治的32例行ESD治疗的GIN患者,并比较ESD治疗前后的病理差异,总结整块病灶切除率、切除病灶直径、手术操作时间、术中术后并发症、复发率。结果 (1)完整切除率100%(32/32);切除病灶直径1.1~5.2 cm,平均(2.3±1.2)cm;从黏膜下注射至完整剥离结束时间10~75 min,平均(35.0±16.5)min;术中无穿孔发生,术中出血率12.5%(4/32),予以止血等对症治疗后好转。无迟发性出血,32例患者均完成3~12个月随访,无病变残留或复发。(2)32例GIN患者行ESD治疗,术前低级别GIN 26例,高级别GIN 6例。行ESD后病理发现26例低级别GIN中有1例黏膜内癌,3例高级别GIN;6例高级别GIN中有2例黏膜内癌,癌变发现率为9.4%(3/32),总病理升级率为18.8%(6/32)。结论 ESD治疗GIN能及时发现胃早癌,且能安全、有效地根治。     

内镜黏膜下剥离术治疗结直肠神经内分泌瘤效果观察

目的：探讨内镜黏膜下剥离术（ ESD ）治疗结直肠神经内分泌瘤（ NET ）效果及安全性。方法对21例结直肠NET（肿瘤直径4～12 mm,位于结肠9例,位于直肠12例）患者行ESD治疗,分析手术效果及随访结果。结果21例ESD术中均单次完整剥离切除肿瘤,时间15～50（25．5±10．8）min,术中出血量（20．4±12．5）mL,所有患者均经电凝止血成功,1例术后3 d出现迟发性出血,出血量约100 mL,经禁食、药物治疗后出血停止。无肠穿孔发生,无手术相关死亡。术后病理NET G1级19例,G2级2例,基底和切缘均未见肿瘤累及,病理检查示肿瘤完整切除率100％。术后随访6～54个月,患者均存活且未见局部复发和远处转移。结论 ESD治疗直径小于1 cm的结直肠NET效果确切,且较为安全。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.