Feasibility of endoscopic submucosal dissection for gastric and colorectal lesions: Initial experience from the Gastrocentro - Unicamp

OBJECTIVE: Endoscopic submucosal dissection is a technique developed in Japan for en bloc resection with a lower rate of recurrence. It is considered technically difficult and performed only in specialized centers. This study sought to report the initial experience from the Gastrocentro - Campinas State University for the treatment of gastric and colorectal lesions by endoscopic submucosal dissection. MATERIALS AND METHODS: The guidelines of the Japanese Association of Gastric Cancer were used as evaluative criteria. For colorectal lesions, the recommended standards proposed by Uraoka et al. and Saito et al. were employed. The practicability of the method, the development of complications and histological analysis of the specimens were evaluated. RESULTS: Sixteen patients underwent endoscopic submucosal dissection from June 2010 to April 2011; nine patients were treated for gastric lesions, and seven were treated for colorectal lesions. The average diameter of the gastric lesions was 28.6 mm, and the duration of resection was 103 min without complications. All lesions presented lesion-free margins. Of the seven colorectal tumors, four were located in the rectum and three were located in the colon. The average size was 26 mm, and the average procedure time was 163 min. Two complications occurred during the rectal resection procedures: perforation, which was treated with an endoscopic clip, and controlled bleeding. One of the lesions presented a compromised lateral margin without relapse after 90 days. Depth margins were all free of lesions. CONCLUSION: Endoscopic submucosal dissection at our institution achieved high success rates, with few complications in preliminary procedures. The procedure also made appropriate lesion staging possible

Validation of a quantitative FFQ for a study of diet and risk of colorectal adenoma among Japanese Brazilians

OBJECTIVE: To assess the validity of a 161-item quantitative FFQ (QFFQ) that was developed to evaluate dietary risk factors for a colorectal adenoma case–control study. DESIGN: A cross-sectional validation study of the QFFQ against 4 d food diary using Pearson correlation coefficients, cross-classification, weighted k statistics and Bland–Altman plotting. SETTING: Two hospitals in Sa˜o Paulo, Brazil. SUBJECTS: Ninety-seven healthy Japanese-Brazilian adults (40–75 years) were recruited. One participant was excluded from the analysis due to unusual energy intake report. RESULTS: Mean daily nutrient intakes from the QFFQ were higher than from the food diary. The mean Pearson correlation coefficient for nutrient intakes between the QFFQ and the average of the 4 d food diary was 0?43, and increased to 0?45 after correcting correlations for attenuation due to residual day-to-day variation in the food diary measurements. Adjustment for total energy and further adjustment for age and gender decreased the correlation; however, 77% of observations remained in the same or adjacent quartiles with a mean weighted k of 0?22. Bland–Altman plots on loge-transformed data showed no linear trend between the differences and means for energy, fat, protein, total folate and vitamin C. Compared with the food diary, the QFFQ showed consistently reasonable performance for dietary fibre, total folate, retinol, riboflavin and vitamin C. CONCLUSIONS: This investigation supports the relative validity of the QFFQ as a method for assessing long-term dietary intake. The instrument will be a useful tool in the analysis of diet–adenoma associations in the case–control study

Pyloric Brunner’s gland hamartoma with atypical hyperplasia

Brunner’s gland hamartoma (BGH) is an extremely rare benign digestive tumor, \ud generally located in the duodenal bulb. We report the case of a 51-year-old \ud asymptomatic man with a large pedunculated BGH arising from the pylorus. It \ud was successfully removed en bloc by endoscopic resection

Soil surface temperatures reveal moderation of the urban heat island effect by trees and shrubs

Urban areas are major contributors to air pollution and climate change, causing impacts on human health that are amplified by the microclimatological effects of buildings and grey infrastructure through the urban heat island (UHI) effect. Urban greenspaces may be important in reducing surface temperature extremes, but their effects have not been investigated at a city-wide scale. Across a midsized UK city we buried temperature loggers at the surface of greenspace soils at 100 sites, stratified by proximity to city centre, vegetation cover and land-use. Mean daily soil surface temperature over 11 months increased by 0.6 °C over the 5 km from the city outskirts to the centre. Trees and shrubs in non-domestic greenspace reduced mean maximum daily soil surface temperatures in the summer by 5.7 °C compared to herbaceous vegetation, but tended to maintain slightly higher temperatures in winter. Trees in domestic gardens, which tend to be smaller, were less effective at reducing summer soil surface temperatures. Our findings reveal that the UHI effects soil temperatures at a city-wide scale, and that in their moderating urban soil surface temperature extremes, trees and shrubs may help to reduce the adverse impacts of urbanization on microclimate, soil processes and human health

ICAR: endoscopic skull‐base surgery

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The apoptosis-inducing granulocyte-macrophage colony-stimulating factor (GM-CSF) analog E21R functions through specific regions of the heterodimeric GM-CSF receptor, and requires interleukin-1 beta converting enzyme-like proteases.

The granulocyte-macrophage colony-stimulating factor (GM-CSF) analog E21R induces apoptosis of hemopoietic cells. We examined the GM-CSF receptor subunit requirements and the signaling molecules involved. Using Jurkat T cells transfected with the GM-CSF receptor we found that both receptor subunits were necessary for E21R-induced apoptosis. Specifically, the 16 membrane-proximal residues of the alpha subunit were sufficient for apoptosis. This sequence could be replaced by the corresponding sequence from the interleukin-2 receptor common gamma subunit, identifying this as a conserved cytokine motif necessary for E21R-induced apoptosis. Cells expressing the alpha subunit and truncated betac mutants showed that the 96 membrane-proximal residues of betac were sufficient for apoptosis. E21R, in contrast to GM-CSF, did not alter tyrosine phosphorylation of betac, suggesting that receptor-associated tyrosine kinases were not activated. Consistent with this, E21R decreased the mitogen-activated protein kinase ERK (extracellular signal-regulated kinase). E21R-induced apoptosis was independent of Fas/APO-1 (CD95) and required interleukin-1beta-converting enzyme (ICE)-like proteases. In contrast, Bcl-2, which protects cells from growth factor deprivation-induced cell death, did not prevent this apoptosis. These findings demonstrate the GM-CSF receptor and ICE-like protease requirements for E21R-induced apoptosis