Better view by detachable string magnetically controlled capsule endoscopy for esophageal observation: a retrospective comparative study

Magnetically controlled capsule endoscopy (MCE) system has been used to screen gastric lesions. However, the visualization performance of MCE in the esophagus has not been investigated systematically. String method improved the ability of capsule endoscopy (CE) for esophageal observing; however, the string attachment is complicated and cannot be detached with the CE inside the esophagus. We used a modified string, called detachable string attached to MCE. The aim of the study was to compare the observation performance of MCE with and without the detachable string. A total of 238 participants with upper gastrointestinal symptoms and a healthy check who refused esophagogastroduodenoscopy examination were retrospectively divided into the detachable string MCE group and the MCE alone group from June 2016 to May 2018. A suction cap with a thin, hollow string was attached to the MCE system in the detachable string group. Circumferential visualization of the esophagus including the upper, middle, and lower esophagus and Z-line, and esophageal focal lesion, as well as the recording time, safety and tolerability of the procedure, were assessed. The circumferential visualization of the upper, middle, and lower esophagus and Z-line was more efficient in the detachable string MCE group than in the MCE alone group (P < 0.001). In all, 31 esophageal lesions were detected in the detachable string MCE group, which was more than that in the MCE alone group (10, P < 0.001). The mean recording time was 305 seconds in the string MCE group, which was longer than that in the MCE alone group (48.5 seconds, P < 0.001). In seven participants (6.1%) in the detachable string MCE group, the capsule could not be separated from the string. Detachable string MCE showed better performance in terms of observation of the esophagus. Detachable string MCE can be used to screen for esophageal diseases as an alternative method in the future.

The Feasibility Study of Megavoltage Computed Tomographic (MVCT) Image for Texture Feature Analysis

Purpose: To determine whether radiomics texture features can be reproducibly obtained from megavoltage computed tomographic (MVCT) images acquired by Helical TomoTherapy (HT) with different imaging conditions.

Methods: For each of the 195 textures enrolled, the mean intrapatient difference, which is considered to be the benchmark for reproducibility, was calculated from the MVCT images of 22 patients with early-stage non-small-cell lung cancer. Test–retest MVCT images of an in-house designed phantom were acquired to determine the concordance correlation coefficient (CCC) for these 195 texture features. Features with high reproducibility (CCC > 0.9) in the phantom test–retest set were investigated for sensitivities to different imaging protocols, scatter levels, and motion frequencies using a wood phantom and in-vitro animal tissues.

Results: Of the 195 features, 165 (85%) features had CCC > 0.9. For the wood phantom, 124 features were reproducible in two kinds of scatter materials, and further investigations were performed on these features. For animal tissues, 108 features passed the criteria for reproducibility when one layer of scatter was covered, while 106 and 108 features of in-vitro liver and bone passed with two layers of scatter, respectively. Considering the effect of differing acquisition pitch (AcP), 97 features extracted from wood passed, while 103 and 59 features extracted from in-vitro liver and bone passed, respectively. Different reconstruction intervals (RI) had a small effect on the stability of the feature value. When AcP and RI were held consistent without motion, all 124 features calculated from wood passed, and a majority (122 of 124) of the features passed when imaging with a “fine” AcP with different RIs. However, only 55 and 40 features passed with motion frequencies of 20 and 25 beats per minute, respectively.

Conclusion: Motion frequency has a significant impact on MVCT texture features, and features from MVCT were more reproducibility in different scatter conditions than those from CBCT. Considering the effects of AcP and RI, the scanning protocols should be kept consistent when MVCT images are used for feature analysis. Some radiomics features from HT MVCT images are reproducible and could be used for creating clinical prediction models in the future.

Sustained pain hypersensitivity in the stressed colon: Role of mast cell-derived nerve growth factor-mediated enteric synaptic plasticity

BACKGROUND

Sustained pain hypersensitivity is the hallmark of stressed colon which could be partially explained by central sensitization with synaptic plasticity, the key mechanism of memory. We previously identified that synaptic plasticity of enteric nerve system (ENS) contributed to peripheral pain maintaining in the gut. However, the mechanisms of enteric "memory" formation remain elusive.

METHODS

In this study, rats were exposed to water avoidance stress (WAS) or sham stress (SS), with cromolyn sodium or physiological saline injected intraperitoneally 30 minutes before stress every day. The abdominal withdrawal reflex scores, mesenteric afferent nerve activity, enteric neural c-fos expression, and enteric synaptic plasticity were assessed, and mast cell infiltration and degranulation. Furthermore, colonic mucosal mediators-induced enteric synaptic plasticity and the role of mast cell-derived nerve growth factor (NGF), tryptase, and histamine were investigated via ex vivo longitudinal muscle-myenteric plexus (LMMP) organotypic culture.

KEY RESULTS

It is shown that mast cell stabilizing inhibited WAS-induced visceral hypersensitivity through enhancing visceral pain threshold, decreasing spontaneous and distention-induced mesenteric afferent firing, and downregulating enteric neural activation (c-fos). Importantly, WAS led to evident enteric synaptic plasticity, but decreased by cromolyn. Water avoidance stress-derived mucosal supernatants markedly enhanced the c-fos expression and enteric synaptic plasticity in LMMP tissues, which could be eliminated by mast cell inhibition or NGF neutralization, but not tryptase or histamine blocking.

CONCLUSIONS & INFERENCES

In conclusion, mast cells/NGF pathway may be the key regulator of synaptic plasticity of ENS and participate in the formation of chronic stress-induced sustained visceral hypersensitivity.

Negative impact of hepatitis B surface seroclearance on prognosis of hepatitis B-related primary liver cancer

AIM

To assess the impact of hepatitis B surface (HBsAg) seroclearance on survival outcomes in hepatitis B-related primary liver cancer.

METHODS

Information from patients with hepatitis B-related liver cancer admitted in our hospital from 2008-2017 was retrieved. Cases diagnosed with HBsAg (-) and HBcAb (+) liver cancer were included in the HBsAg seroclearance (SC) group. HBsAg (+) liver cancer patients strictly matched for liver cancer stage (AJCC staging system, 8^th edition), Child-Pugh score, and first diagnosis/treatment method (surgery, ablation and TACE) were assigned to the HBsAg non-seroclearance (NSC) group. Then, clinical, pathological and survival data in both groups were assessed.

RESULTS

The SC and NSC groups comprised of 72 and 216 patients, respectively. Patient age (P < 0.001) and platelet count (P = 0.001) in the SC group were significantly higher than those of the NSC group. SC group patients who underwent surgery had more intrahepatic cholangiocarcinoma (ICC) and combined HCC-CC (CHC) cases than the NSC group, but no significant differences in tumor cell differentiation and history of liver cirrhosis were found between the two groups. The numbers of interventional treatments were similar in both groups (4.57 vs 5.07, P > 0.05). Overall survival was lower in the SC group than the NSC group (P = 0.019), with 1-, 3-, and 5-year survival rates of 82.1% vs 85.1%, 43.2% vs 56.8%, and 27.0% vs 45.2%, respectively. Survival of patients with AJCC stage I disease in the SC group was lower than that of the NSC group (P = 0.029).

CONCLUSION

Seroclearance in patients with hepatitis B-related primary liver cancer has protective effects with respect to tumorigenesis, cirrhosis, and portal hypertension but confers worse prognosis, which may be due to the frequent occurrence of highly malignant ICC and CHC.

Effects of megavoltage computed tomographic scan methodology on setup verification and adaptive dose calculation in helical TomoTherapy

Background

To evaluate the effect of pretreatment megavoltage computed tomographic (MVCT) scan methodology on setup verification and adaptive dose calculation in helical TomoTherapy.

Methods

Both anthropomorphic heterogeneous chest and pelvic phantoms were planned with virtual targets by TomoTherapy Physicist Station and were scanned with TomoTherapy megavoltage image-guided radiotherapy (IGRT) system consisted of six groups of options: three different acquisition pitches (APs) of ‘fine’, ‘normal’ and ‘coarse’ were implemented by multiplying 2 different corresponding reconstruction intervals (RIs). In order to mimic patient setup variations, each phantom was shifted 5 mm away manually in three orthogonal directions respectively. The effect of MVCT scan options was analyzed in image quality (CT number and noise), adaptive dose calculation deviations and positional correction variations.

Results

MVCT scanning time with pitch of ‘fine’ was approximately twice of ‘normal’ and 3 times more than ‘coarse’ setting, all which will not be affected by different RIs. MVCT with different APs delivered almost identical CT numbers and image noise inside 7 selected regions with various densities. DVH curves from adaptive dose calculation with serial MVCT images acquired by varied pitches overlapped together, where as there are no significant difference in all p values of intercept & slope of emulational spinal cord (p = 0.761 & 0.277), heart (p = 0.984 & 0.978), lungs (p = 0.992 & 0.980), soft tissue (p = 0.319 & 0.951) and bony structures (p = 0.960 & 0.929) between the most elaborated and the roughest serials of MVCT. Furthermore, gamma index analysis shown that, compared to the dose distribution calculated on MVCT of ‘fine’, only 0.2% or 1.1% of the points analyzed on MVCT of ‘normal’ or ‘coarse’ do not meet the defined gamma criterion. On chest phantom, all registration errors larger than 1 mm appeared at superior-inferior axis, which cannot be avoided with the smallest AP and RI. On pelvic phantom, craniocaudal errors are much smaller than chest, however, AP of ‘coarse’ presents larger registration errors which can be reduced from 2.90 mm to 0.22 mm by registration technique of ‘full image’.

Conclusions

AP of ‘coarse’ with RI of 6 mm is recommended in adaptive radiotherapy (ART) planning to provide craniocaudal longer and faster MVCT scan, while registration technique of ‘full image’ should be used to avoid large residual error. Considering the trade-off between IGRT and ART, AP of ‘normal’ with RI of 2 mm was highly recommended in daily practice.

Electronic supplementary material

The online version of this article (10.1186/s13014-018-0989-y) contains supplementary material, which is available to authorized users.

Electromigration and morphological changes in Ag nanostructures

Electromigration (EM) as a structuring tool was investigated in Ag nanowires (width 300 nm, thickness 25 nm) and partly in notched and bow-tie Ag structures on a Si(1 0 0) substrate in ultra-high vacuum using a four-tip scanning tunneling microscope in combination with a scanning electron microscope. From simulations of Ag nanowires we got estimates of temperature profiles, current density profiles, EM and thermal migration (TM) mass flux distributions within the nanowire induced by critical current densities of 10⁸ A cm^-2. At room temperature, the electron wind force at these current densities by far dominates over thermal diffusion, and is responsible for formation of voids at the cathode and hillocks at the anode side. For current densities that exceed the critical current densities necessary for EM, a new type of wire-like structure formation was found both at room temperature and at 100 K for notched and bow-tie structures. This suggests that the simultaneous action of EM and TM is structure forming, but with a very small influence of TM at low temperature.

Giant gastrointestinal stromal tumour of the stomach: a case report with surgical treatment

We report a case of giant gastrointestinal stromal tumour of the stomach in a 71-year-old woman, with emphasis on its going through surgical resection. The physical examination and radiological findings revealed that a giant mass occupied most of the abdominal cavity. The patient underwent an en-block resection of the mass, partial resection of the distal stomach and Billroth II gastrojejunostomy. The pathological diagnosis was gastrointestinal stromal tumour. The patient had a long-term disease-free survival. We emphasise that complete surgical resection is the only effective radical treatment approach for giant gastrointestinal stroma of the stomach. In some cases, we still have the opportunity for resection of these tumours because of their expansive growth, even though the lesions are very large.

[Reoperation for residual aneurysm of coronary anastomosis after Bentall procedure]

Objective: To introduce a new operative method for residual aneurysm of coronary anastomosis after Bentall procedure. Methods: Between March 2011 and December 2012, six patients in Beijing Anzhen Hospital with residual aneurysm of coronary anastomosis (CT showed goldfish eye sign at the openings of coronary) after Bentall procedure underwent the operation of concentric circular patch procedure under cardiopulmonary bypass. Femoral artery, right atrium and upper right pulmonary artery cannulation were used for cardiopulmonary bypass, and the artificial vessel was transected after cardiac arrest. A concentric circular patch was pruned, whose outside diameter was slightly larger than the aneurysm and the inside diameter was equal to the openings of coronary. The outer edge of the patch was anastomosed to the outer edge of the aneurysm (opening of artificial vessel in primary surgery) with 4-0 prolene. The inner edge of the patch was anastomosed to the openings of coronary with 5-0 prolene. Results: All patients had clinical recovery. Postoperative CT demonstrated the disappearance of residual aneurysm during follow-up (the goldfish eye sign disappeared). Conclusion: The concentric circular patch procedure is a feasible treatment for residual aneurysm of coronary anastomosis.

[Surgical treatment of aortic dissection with lower extremity ischemia]

Objective: To explore the clinical outcome of the surgical treatment for aortic dissection with lower extremity ischemia. Methods: Between March 2009 and April 2013, 14 patients with type A aortic dissection and lower extremity ischemia underwent Sun's procedure in Beijing Anzhen Hospital. Ascending aorta-iliac artery bypass, ascending aorta-femoral artery bypass, femoral-femoral artery bypass and axillary -femoral artery bypass were performed on some severe patients at the same time. Results: Two death occurred, and the others were improved or recovered from symptoms. Follow-up was complete with an average time of 24 months and no aortic relevant complications occurred. Conclusion: As for patients with type A aortic dissection and lower extremity ischemia, simultaneous radical femoral artery bypass procedure is effective in improving their survival rate and quality of life.

How does four-dimensional computed tomography spare normal tissues in non-small cell lung cancer radiotherapy by defining internal target volume?

BACKGROUND

To investigate how the four-dimensional computed tomography (4DCT) technique spares normal tissues in non-small cell lung cancer (NSCLC) radiotherapy by defining individualized internal target volume (ITV).

MATERIALS AND METHODS

Gross tumor volume (GTV) and clinical target volume (CTV) were contoured on all 10 respiratory phases of 4DCT scans in 10 patients with peripheral NSCLC. Both 3D and 4D treatment plans were performed for each patient using planning target volume (PTV)3D (derived from a single CTV plus conventional margins) and PTV4D (derived from 4D internal target volume, which included all 10 CTVs plus setup margins). Dose volume histogram and normal tissue complication probability (NTCP) values were compared for the lung, heart, and spinal cord between 3D and 4D treatment plans.

RESULTS

The average PTV of the 4D (127.56 ± 70.79) was less than the 3D plans (147.65 ± 76.89). The 4D spared more surrounding normal tissues than the 3D plans, especially in the lung. Compared with 3D plans, V5, V10, V20 and V30 of the total lung decreased from 41.25%, 37.75%, 24.25%, 17.00% to 38.13%, 33.00%, 21.25%, 15.13%, respectively. Without increasing the NTCP of the lung significantly, the 4D plans allowed us to increase the average prescription dose from 60 Gy to 66.00 ± 4.62 Gy.

CONCLUSIONS

4DCT based plans can reduce the target volumes, spare more normal tissues, and allow dose escalation compared with 3D plans in NSCLC radiotherapy.

Genetic analysis of BMP4 gene in Chinese Han female population with premature ovarian insufficiency

The bone morphogenetic protein 4 (BMP4) gene is related to development of female reproductive organs in animal models. However, to date, there has been no consensus on the relationship between mutations in BMP4 and premature ovarian insufficiency (POI) in human beings. To analyze variations in BMP4 in Chinese women with POI, we sequenced two coding regions of BMP4 in 99 Han Chinese women with POI after DNA extraction and amplification by polymerase chain reaction (PCR). We found no any mutation in the BMP4 coding regions. Only one SNP rs17563 was detected among women with POI. However, the allele frequency of rs17563 presented no significant differences between POI patients and the international HapMap Project data for CHB and CHD. Our findings suggest that the BMP4 gene may not represent a risk factor in the development of POI among Chinese Han women.

Electroacupuncture improves burn-induced impairment in gastric motility mediated via the vagal mechanism in rats

BACKGROUND

Delayed gastric emptying (GE) is common in patients with severe burns. This study was designed to investigate effects and mechanisms of electroacupuncture (EA) on gastric motility in rats with burns.

METHODS

Male rats (intact and vagotomized) were implanted with gastric electrodes, chest and abdominal wall electrodes for investigating the effects of EA at ST-36 (stomach-36 or Zusanli) on GE, gastric slow waves, autonomic functions, and plasma interleukin 6 (IL-6) 6 and 24 h post severe burns.

KEY RESULTS

(i) Burn delayed GE (P < 0.001). Electroacupuncture improved GE 6 and 24 h post burn (P < 0.001). Vagotomy blocked the EA effect on GE. (ii) Electroacupuncture improved burn-induced gastric dysrhythmia. The percentage of normal slow waves was increased with EA 6 and 24 h post burn (P = 0.02). (iii) Electroacupuncture increased vagal activity assessed by the spectral analysis of heart rate variability (HRV). The high-frequency component reflecting vagal component was increased with EA 6 (P = 0.004) and 24 h post burn (P = 0.03, vs sham-EA). (iv) Electroacupuncture attenuated burn-induced increase in plasma IL-6 at both 6 (P = 0.03) and 24 h post burn (P = 0.003).

CONCLUSIONS & INFERENCES

Electroacupuncture at ST-36 improves gastric dysrhythmia and accelerates GE in rats with burns. The improvement seems to be mediated via the vagal pathway involving the inflammatory cytokine IL-6.

Trends in seroprevalence of antibodies to pandemic influenza H1N1 (2009) virus among patients seeking care in China

We determined seroprevalence of antibodies to pandemic influenza H1N1 (2009) virus in outpatients in China from December 2009 to March 2010. Serum antibody titers were determined by a hemagglutination-inhibition (HI) assay using the seroprevalence data for 2006-2008 (1.2%) as baseline. The overall seroprevalence was 7.6%, 18.6%, 20.5%, and 20.0% in December 2009, January 2010, February 2010, and March 2010, respectively. In comparison of monthly data, the seroprevalence values for the first three months exhibited statistically significant differences. As for the age-specific seroprevalence, the individuals aged demic virus.