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Chen X, Wu Z, He Y, Hao Z, Wang Q, Zhou K, Zhou W, Wang P, Shan F, Li Z, Ji J, Fan Y, Li Z, Yue S. Accurate and Rapid Detection of Peritoneal Metastasis from Gastric Cancer by AI-Assisted Stimulated Raman Molecular Cytology. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023:e2300961. [PMID: 37114845 PMCID: PMC10375130 DOI: 10.1002/advs.202300961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/04/2023] [Indexed: 06/19/2023]
Abstract
Peritoneal metastasis (PM) is the mostcommon form of distant metastasis and one of the leading causes of death in gastriccancer (GC). For locally advanced GC, clinical guidelines recommend peritoneal lavage cytology for intraoperative PM detection. Unfortunately, current peritoneal lavage cytology is limited by low sensitivity (<60%). Here the authors established the stimulated Raman molecular cytology (SRMC), a chemical microscopy-based intelligent cytology. The authors firstly imaged 53 951 exfoliated cells in ascites obtained from 80 GC patients (27 PM positive, 53 PM negative). Then, the authors revealed 12 single cell features of morphology and composition that are significantly different between PM positive and negative specimens, including cellular area, lipid protein ratio, etc. Importantly, the authors developed a single cell phenotyping algorithm to further transform the above raw features to feature matrix. Such matrix is crucial to identify the significant marker cell cluster, the divergence of which is finally used to differentiate the PM positive and negative. Compared with histopathology, the gold standard of PM detection, their SRMC method could reach 81.5% sensitivity, 84.9% specificity, and the AUC of 0.85, within 20 minutes for each patient. Together, their SRMC method shows great potential for accurate and rapid detection of PM from GC.
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Affiliation(s)
- Xun Chen
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
- School of Engineering Medicine, Beihang University, 100191, Beijing, China
| | - Zhouqiao Wu
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, 100142, Beijing, China
| | - Yexuan He
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Zhe Hao
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Qi Wang
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, 100142, Beijing, China
| | - Keji Zhou
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Wanhui Zhou
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Pu Wang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Fei Shan
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, 100142, Beijing, China
| | - Zhongwu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, 100142, Beijing, China
| | - Jiafu Ji
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, 100142, Beijing, China
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
- School of Engineering Medicine, Beihang University, 100191, Beijing, China
| | - Ziyu Li
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, 100142, Beijing, China
| | - Shuhua Yue
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
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Ioannidis A, Arvanitidis K, Filidou E, Valatas V, Stavrou G, Michalopoulos A, Kolios G, Kotzampassi K. The Length of Surgical Skin Incision in Postoperative Inflammatory Reaction. JSLS 2019; 22:JSLS.2018.00045. [PMID: 30518991 PMCID: PMC6251478 DOI: 10.4293/jsls.2018.00045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background and Objectives: Surgery provokes inflammatory and immune responses, so efforts have been made to reduce host response by using less invasive techniques. The purpose of this experimental study was to investigate the surgical stress induced by skin incision and the role of liver response in this process. Methods: Seventy male anesthetized Wistar rats were subjected to a midline incision confined strictly to the skin (dermis) of either 1 cm long (n = 20), 10 cm long (n = 20), or no incision (n = 20) or served as controls (n = 10). Skin trauma was left open for a 20-minutes period, and then was meticulously sutured. At 3 and 24 hours later, laparotomy was performed on half the rats of each group, for blood and liver sampling. In serum and liver homogenates, cytokine-induced neutrophil chemoattractant (CINC)1/interleukin (IL)-8 and tumor necrosis factor (TNF)-α levels were measured with enzyme-linked immunosorbent assays and nitric oxide (NO) using a Griess reaction. Results: Skin trauma was found to significantly (P < .01) increase all inflammatory mediators tested (CINC1/IL-8, TNF-α, NO) in serum of operated rats versus controls, the increase being proportionally dependent on the length of skin incision. In liver homogenates, CINC1/IL-8 was significantly (P < .01) increased in operated animals versus controls, similarly to serum levels. In contrast, liver TNF-α levels were inversely related to serum levels, and a significant (P < .01) decrease in TNF-α was observed in liver homogenates of operated animals compared with the controls, indicating that the increased TNF-α in blood reflects liver TNF-α secretion. Conclusion: Our findings suggest that inflammatory and immune reactions induced by skin-only surgical trauma are closely correlated to the length of skin incision.
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Affiliation(s)
- Aristidis Ioannidis
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Eirini Filidou
- Laboratory of Pharmacology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vassilis Valatas
- Gastroenterology Laboratory, Medical Department, University of Crete, Heraklion, Greece
| | - George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - George Kolios
- Laboratory of Pharmacology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Katerina Kotzampassi
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Comparison of Inflammatory Response to Transgastric and Transcolonic NOTES. Gastroenterol Res Pract 2016; 2016:7320275. [PMID: 27403157 PMCID: PMC4923531 DOI: 10.1155/2016/7320275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/22/2016] [Indexed: 11/17/2022] Open
Abstract
Aims. The aim of our study was to determine the physiologic impact of NOTES and to compare the transgastric and transcolonic approaches. Methods. Thirty pigs were randomized to transgastric, transcolonic, or laparoscopic peritoneoscopy. Blood was drawn and analyzed for C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin- (IL-) 1β, IL-6, WBCs, and platelets. Results. Endoscopic closure with an OTSC was successful in all 20 animals. The postoperative course was uneventful in all animals. CRP values rose on day 1 in all animals and slowly declined to baseline levels on day 14 with no differences between the groups (P > 0.05, NS). The levels of TNF-α were significantly increased in the transcolonic group (P < 0.01); however this difference was already present prior to the procedure and remained unchanged. No differences were observed in IL1-β and IL-6 values. There was a temporary rise of WBC on day 1 and of platelets on day 7 in all groups (P > 0.05, NS). Conclusions. Transgastric, transcolonic, and laparoscopic peritoneoscopy resulted in similar changes in systemic inflammatory markers. Our findings do not support the assumption that NOTES is less invasive than laparoscopy.
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Trindade A, Beck C, Ataíde M, Schiochet F, Gerardi D, Brun M, Driemeier D, Zlotowski P, Cardoso M, Cirne-Lima E, Contesini E. Transrectal endoscopy with three different techniques of rectal suture associate: NOTES survival study with liver biopsy in a swine model. ARQ BRAS MED VET ZOO 2015. [DOI: 10.1590/1678-4162-7893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - C.A.C. Beck
- Universidade Federal do Rio Grande do Sul, Brazil
| | - M.W. Ataíde
- Universidade Federal do Rio Grande do Sul, Brazil
| | - F. Schiochet
- Universidade Federal do Rio Grande do Sul, Brazil
| | - D.G. Gerardi
- Universidade Federal do Rio Grande do Sul, Brazil
| | - M.V. Brun
- Universidade Federal de Santa Maria, Brazil
| | - D. Driemeier
- Universidade Federal do Rio Grande do Sul, Brazil
| | - P. Zlotowski
- Universidade Federal do Rio Grande do Sul, Brazil
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Wang ZK, Yang YS, Zhang XL, Sun G, Hyder Q, Wu LL, Tang P, Li W. Comparison in efficacy between pure NOTES peritoneoscopy with small or large endoscope and laparoscopy. J Dig Dis 2014; 15:628-35. [PMID: 25244524 DOI: 10.1111/1751-2980.12187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy and systematic impact of different sized endoscopes for pure transgastric natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy relative to laparoscopy. METHODS A total of 15 dogs were randomly assigned to the small-sized endoscope (SS), large-sized endoscope (LS) and standard laparoscopy (SL) groups. The procedure time, visualization scores for abdominal organs, gastric incision healing times and procedure-associated complications were recorded. Blood samples were collected at 1 h preoperation and at 1 h, 12 h, 2 days and 7 days postoperation. Serum tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels as well as peripheral white blood cell (WBC) counts were analyzed. RESULTS Peritoneoscopy was successfully performed with both pure transgastric NOTES and laparoscopy. The peritoneoscopy required less time to complete in the SL group (44.0 ± 7.0 min) than the LS (83.0 ± 28.9 min) and SS (106.6 ± 81.3 min) groups (P < 0.01), but no statistical difference was observed between the SS and LS groups (P > 0.05). The visualization scores of peritoneal organs among the three groups did not differ significantly (P > 0.05). The gastric incision exhibited satisfactory healing in both the SS and LS groups. Moreover, serum TNF-α and IL-6 levels and WBC counts at each time point were similar among the three groups (P > 0.05). CONCLUSIONS Small-sized endoscope is not superior to a large-sized one for pure transgastric NOTES peritoneoscopy. Pure transgastric NOTES is not less invasive or less time-consuming than laparoscopy.
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Affiliation(s)
- Zi Kai Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
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Bai Y, Qiao WG, Zhu HM, He Q, Wang N, Cai JQ, Jiang B, Zhi FC. Role of transgastric natural orifice transluminal endoscopic surgery in the diagnosis of ascites of unknown origin (with videos). Gastrointest Endosc 2014; 80:807-16. [PMID: 24818547 DOI: 10.1016/j.gie.2014.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 03/14/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) has been established in animal models and human studies. OBJECTIVE The aim of this study was to assess the feasibility and efficacy of applying transgastric NOTES to diagnose patients with ascites of unknown origin. DESIGN Prospective study. SETTING Two university and teaching hospitals. PATIENTS Patients with ascites of unknown origin. INTERVENTIONS Diagnostic transgastric NOTES. MAIN OUTCOME MEASUREMENTS Characteristic of ascites cases, conditions of the abdominal cavity, diagnostic accuracy, adverse events, and follow-up time. RESULTS Transgastric NOTES was performed successfully in 78 patients with ascites of unknown origin, and 72 cases (92.3%) were clearly diagnosed. They included malignant tumors (39 cases), tuberculous peritonitis (28 cases), chronic hepatic inflammation (3 cases), necrotizing lymphadenitis (1 case), and eosinophilic serositis of the small intestine (1 case). In addition, there were 6 nondiagnostic cases, and no severe adverse events were found. LIMITATIONS Nonrandomized control analysis. CONCLUSION Transgastric NOTES in combination with biopsy can elucidate the causes of ascites of unknown origin in the majority of cases. Therefore, it is a feasible and effective approach to access the peritoneal cavity and also a valuable modality to detect the cause of diseases with ascites of unknown origin.
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Affiliation(s)
- Yang Bai
- Guangdong Provincial Key Laboratory of Gastroenterology, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei-guang Qiao
- Guangdong Provincial Key Laboratory of Gastroenterology, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui-ming Zhu
- Department of Gastroenterology, The Second Affiliated Clinical Medical College, Shenzhen People's Hospital, Shenzhen, China
| | - Qiong He
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Na Wang
- Department of Gastroenterology, The Second Affiliated Clinical Medical College, Shenzhen People's Hospital, Shenzhen, China
| | - Jian-qun Cai
- Guangdong Provincial Key Laboratory of Gastroenterology, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bo Jiang
- Guangdong Provincial Key Laboratory of Gastroenterology, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fa-chao Zhi
- Guangdong Provincial Key Laboratory of Gastroenterology, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Rezende M, Montero EFDS, Salomão R, Brunialti M, Rodrigues R, Gomes G, Libera AD, Ferrari A, Libera ED. Acute inflammatory response to transgastric natural orifice transluminal endoscopic surgery peritoneoscopy: an experimental study in swine. Clinics (Sao Paulo) 2013; 68:1433-9. [PMID: 24270956 PMCID: PMC3812549 DOI: 10.6061/clinics/2013(11)09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 05/19/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the impact of transgastric peritoneal access on plasma biomarkers of acute inflammatory response in comparison to laparoscopy. METHODS This was a prospective and comparative study in a porcine model. Transgastric peritoneal access performed by natural orifice transluminal endoscopic surgery was compared with laparoscopy. Laparotomy and sham groups were used as positive and negative controls, respectively. Thirty-four pigs were assigned to receive transgastric natural orifice transluminal endoscopic surgery (n = 12), laparoscopy (n = 8), laparotomy (n = 8) or a sham procedure involving only anesthesia (n = 6). In the natural orifice transluminal endoscopic surgery group, peritoneoscopy was performed with a gastroscope via transgastric access. Blood samples were collected at baseline and 1, 3, 6, 9 and 24 h after the surgical procedure for measurement of interleukins 1β, 6 and 10 and tumor necrosis factor-α. A complete blood count was performed, and C-reactive protein levels were measured at baseline and at 24 h. RESULTS All surgical and endoscopic procedures were performed without major complications. Peritoneal cavity inventory showed no signs of peritonitis in any animal. Interleukin 1β, interleukin 10 and tumor necrosis factor-α levels were below the threshold of detection. The mean level of interleukin 6 was statistically significantly higher in the laparotomy group than in the other groups (p<0.05), with no significant differences among the sham, laparoscopy and natural orifice transluminal endoscopic surgery groups (p>0.05). C-reactive protein analysis indicated significant increases in all groups, with no differences among the groups. Complete blood count analysis showed no differences among the groups. CONCLUSIONS Based on the observed interleukin 6 patterns, the systemic inflammatory response resulting from transgastric peritoneal access by natural orifice transluminal endoscopic surgery is similar in intensity to the response that occurs after laparoscopy.
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Affiliation(s)
- Marcelo Rezende
- Gastroenterology Division, São Paulo Federal University (UNIFESP), São PauloSP, Brazil
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