Feasibility and safety of a self-developed sleeve for the endoscopic removal of refractory foreign body incarceration

ObjectiveThis study aimed to assess the feasibility and safety of a novel self-designed sleeve for the endoscopic removal of a refractory incarcerated foreign body in the upper gastrointestinal tract (UGIT).MethodsAn interventional study was conducted between June and December 2022. A total of 60 patients who underwent an endoscopic removal of a refractory incarcerated foreign body from the UGIT were randomly allocated to the self-developed sleeve and the conventional transparent cap. The study evaluated and compared the operation time, successful removal rate, new injury length at the entrance of the esophagus, new injury length at the impaction site, visual field clarity, and postoperative complications between the two groups.ResultsThe success rates of the two cohorts in the foreign body removal display no significant discrepancy (100% vs. 93%, P = 0.529). Nevertheless, the methodology of the novel overtube-assisted endoscopic foreign body removal has culminated in a significant reduction in the removal duration [40 (10, 50) min vs. 80 (10, 90) min, P = 0.01], reduction in esophageal entrance traumas [0 (0, 0) mm vs. 4.0 (0, 6) mm, P < 0.001], mitigation of injuries at the location of the foreign body incarceration [0 (0, 2) mm vs. 6.0 (3, 8) mm, P < 0.001], an enhanced visual field (P < 0.001), and a decrement in postoperative mucosal bleeding (23% vs. 67%, P < 0.001). The self-developed sleeve effectively negated the advantages of incarceration exclusion during removal.ConclusionThe study findings support the feasibility and safety of the self-developed sleeve for the endoscopic removal of a refractory incarcerated foreign body in the UGIT, with advantages over the conventional transparent cap

Net expression inhibits the growth of pancreatic ductal adenocarcinoma cell PL45 in vitro and in vivo.

Pancreatic ductal adenocarcinoma has a poor prognosis due to late diagnosis and a lack of effective therapeutic options. Thus, it is important to better understand its molecular mechanisms and to develop more effective treatments for the disease. The ternary complex factor Net, which exerts its strong inhibitory function on transcription of proto-oncogene gene c-fos by forming ternary complexes with a second transcription factor, has been suspected of being involved in pancreatic cancer and other tumors biology. In this study, we found that the majority of pancreatic ductal adenocarcinoma tissues and cell lines had weak or no expression of Net, whereas significantly high level of Net expression occurred in paired adjacent normal tissues we studied. Furthermore, using in vitro and in vivo model systems, we found that overexpression of Net inhibited cell growth and survival and induced cell apoptosis in human pancreatic ductal adenocarcinoma cell PL45; the mechanisms by which Net inhibited the cell cycle progression were mainly through P21-Cyclin D1/CDK4 Pathway. Our data thus suggested that Net might play an important role in pancreatic carcinogenesis, possibly by acting as a tumor suppressor gene

Net is down-regulated in pancreatic ductal adenocarcinoma.

<p>(A) Immunohistochemical analysis of Net, c-fos and Ras expression in pancreatic ductal adenocarcinoma tissues (top row) and matched adjacent normal tissue samples (bottom row). a and b is H&E staining with low resolution (×100); c, d denote the expression of Net representative with high resolution (×200); e, f denote the expression of c-fos representative with high resolution (×200); g, h denote the expression of Ras representative with high resolution (×200). (B) Expression of Net was examined at mRNA and protein levels using RT-PCR and western blotting on human pancreatic ductal adenocarcinoma tissues (T) and matched adjacent normal tissue samples (N) (presentive 5 cases of 36). (C) Expression of Net was examined at mRNA and protein levels using RT-PCR and western blotting in pancreatic cancer cell lines (SW1990, PANC-1 and PL45) and human pancreatic cell hTERT-HPNE. PDAT, pancreatic ductal adenocarcinoma tissues; NAT, normal adjacent tissue.</p

The effects of Net expression on tumor growth in vivo.

<p>(A) Tumor size was measured every three days interval in each group. (B) Weight of dissectable xenograft tumors was measured in each group. (C) Expression of Net, c-fos and P21 in mRNA levels in xenograft tissues. (D) Representative H&E staining, histological staining of Net, c-fos and P21, PCNA staining and TUNEL assay in xenogrft tissues. (E) Index of PCNA and apoptosis were accounted in xenograft tumour tissues. *p<0.05, **p<0.01.</p

The possible regulatory model of effect of Net on pancreatic ductal adenocarcinoma.

<p>Net inhibits the growth of pancreatic ductal adenocarcinoma cell by inhibiting the expression of c-fos, subsequently inactivating the transcription activity of AP-1, followed by activation of p21 to antagonize the effects of Cyclin D/CDK4 on cell cycle progression, and ultimately leading to cell death. On the contrary, phosphorylation of Net is activated by intra or extracellular stimulation signals through Ras-MAPKs pathway, which results in downregulation of Net expression and lack of inhibitory ability on c-fos transcription, thus promoting cell proliferation.</p

Diagnostic accuracy of linked colour imaging versus white light imaging for early gastric cancers: a prospective, multicentre, randomized controlled trial study

Linked colour imaging (LCI) is a novel new image-enhanced endoscopy (IEE) technology that produces bright and vivid images. The aim of this study was to assess the ability of LCI to improve the diagnostic accuracy of early gastric cancer (EGC) relative to white light imaging (WLI). We performed this study on patients undergoing screening endoscopy from 12 medical institutions in China. Patients were randomly assigned to receive WLI followed by LCI or LCI followed by WLI. The primary outcome was to compared the diagnostic accuracy between LCI and WLI for EGC/high-grade intraepithelial neoplasms. Secondary outcomes included the numbers of suspicious lesions, neoplastic lesions and examination time by using LCI detected versus using WLI. A total of 1924 patients were randomly selected, and 1828 were included in the analysis. The diagnostic accuracy for EGC, which was 78.8% by using LCI and 68.4% by using WLI (p n = 1235 vs. 1036, p = .031), especially among differentiated EGC (p = .013). LCI greatly shortened the examination time compared with WLI (p = .019). LCI has better accuracy and shorter examination time in diagnosing EGC than WLI (Clinical trial registration: NCT03092414).Key messagesCompared with white light imaging (WLI), the diagnostic accuracy, sensitivity and specificity increased by using LCI.More lesions were detected by LCI alone than by WLI alone, especially among differentiated EGC.LCI may be used as a screening tool for routine clinical observation. Compared with white light imaging (WLI), the diagnostic accuracy, sensitivity and specificity increased by using LCI. More lesions were detected by LCI alone than by WLI alone, especially among differentiated EGC. LCI may be used as a screening tool for routine clinical observation.</p