Deep Muscle Layers Research Articles

Closure methods for large defects after gastrointestinal endoscopic submucosal dissection.

Nowadays, endoscopic submucosal dissection (ESD) is commonly performed for the removal of large gastrointestinal lesions. Endoscopic mucosal defect closure after ESD is vital to avoid adverse events. In recent years, many innovative instruments have emerged and proved to be beneficial. In this paper, we conducted a thorough literature review and summarized the closure methods for large-size post-ESD mucosal defects over decades. We separated these methods into five categories based on the operational principle: "side closure" method, "ring closure" method, "layered closure" method, "hand suturing closure" method, and "specially designed device closure" method. Side closure with clips assisted by instruments such as threads or loops is applicable for each segment of the gastrointestinal tract to prevent postoperative bleeding. If the defect tension is too large to close with the traditional side closure methods, zigzag closure and ring closure could be applied to gather the bilateral defect edges together and achieve continuous closure. In the stomach and rectum with a high risk of submucosal dead space between the submucosa and muscular layers, side closure methods with muscle layer grasping clip or layered closure methods could enable the involvement of the deep submucosa and muscle layers. The ring closure method and specially designed devices including over-the-scope clip, Overstitch, and X-tack could resolve perforation effectively. Individual closure method requires endoscope reinsertion or sophisticated operation, which may be limited by the deep location and the narrow lumen, respectively. Although specially designed devices are expected to offer promising prospectives, the cost-effectiveness remains to be a problem.

Measuring myofascial shear strain in chronic shoulder pain with ultrasound shear strain imaging: a case report.

Dysfunctional gliding of deep fascia and muscle layers forms the basis of myofascial pain and dysfunction, which can cause chronic shoulder pain. Ultrasound shear strain imaging may offer a non-invasive tool to quantitatively evaluate the extent of muscular dysfunctional gliding and its correlation with pain. This case study is the first to use ultrasound shear strain imaging to report the shear strain between the pectoralis major and minor muscles in shoulders with and without chronic pain. The shear strain between the pectoralis major and minor muscles during shoulder rotation in a volunteer with chronic shoulder pain was measured with ultrasound shear strain imaging. The results show that the mean ± standard deviation shear strain was 0.40 ± 0.09 on the affected side, compared to 1.09 ± 0.18 on the unaffected side (p<0.05). The results suggest that myofascial dysfunction may cause the muscles to adhere together thereby reducing shear strain on the affected side. Our findings elucidate a potential pathophysiology of myofascial dysfunction in chronic shoulder pain and reveal the potential utility of ultrasound imaging to provide a useful biomarker for shear strain evaluation between the pectoralis major and minor muscles.

Effects of exercise and cold-water exposure on microvascular muscle perfusion.

Microvascular blood flow (MBF) and its intramuscular regulation are of importance for physiological responsiveness and adaptation. The quantifiable in-vivo monitoring of MBF after cycling or systemic cold-water exposure may reveal new insights into capillary regulatory mechanisms. This study aimed to assess the role of exercise and cold therapy on MBF by using contrast-enhanced ultrasound (CEUS). Twenty healthy athletes were recruited and randomly assigned to an intervention (IG) or a control group (CG). MBF was quantified in superficial (rectus femoris, RF) and deep muscle layers (vastus intermedius, VI). Representative perfusion parameters (peak enhancement (PE) and wash-in area under the curve (WiAUC)) were measured after a standardized measurement protocol for both groups at resting conditions (t0) and after cycling (20 min., 70% Watt max, t1) for both groups, after cold-water immersion exposure for IG (15 min., 12°C) or after precisely 15 minutes of rest for CG (t2) and for both groups after 60 minutes of follow-up (t3). At t1, MBF in VI increased significantly compared to resting conditions in both groups in VI (p= 0.02). After the cold-water exposure (t2), there were no statistically significant changes in perfusion parameters as well as after 60 minutes of follow-up (t3) (p = 0.14). Cycling leads to an upregulation of MBF. However, cold exposure does not change the MBF. The implementation of CEUS during different physiological demands may provide deeper insight into intramuscular perfusion regulation and regenerative processes.

Homemade Dart Attacks in Hawai'i.

Over a 4.5-year period (September 2014 to March 2019), 7 patients presented to the State's only Level I Trauma Center with penetrating injuries inflicted by homemade metallic darts. Previously described in Micronesia, these are the first domestic cases of assaults utilizing this type of weaponry. Retrospective chart review was conducted for all patients who presented to our institution with a dart injury within the study period. Details regarding demographics, imaging, and patient management were collected and described herein. All 7 patients were male with a median age of 24.6years impaled with darts that penetrated through the deep muscle and tissue layers of the neck, torso, or extremity. Three patients required operative intervention and no mortalities were observed. The depth of penetration and proximity to vital structures highlight the potential for life-threatening injuries from these homemade darts.

Development of Novel Balloon-Integrated Optical Catheter for Endoscopic and Circumferential Laser Application.

The current study aims to demonstrate the feasibility of a novel balloon-integrated optical catheter (BIOC) to achieve endoscopic laser application for circumferential coagulation of a tubular tissue structure. Both optical and thermal numerical simulations were developed to predict the propagation of laser light and a spatio-temporal distribution of temperature in tissue. Ex vivo esophagus tissue was tested with 980nm laser light at 30 W for 90s for quantitative evaluations. In vivo porcine models were used to validate the performance of BIOC for circumferential and endoscopic laser coagulation of esophagus in terms of acute tissue responses post-irradiation. Optical simulations confirmed that a diffusing applicator was able to generate a circumferential light distribution in a tubular tissue structure. Both numerical and experimental results presented that the maximum temperature elevation occurred at 3-5mm (muscle layer) below the mucosa surface after 90 s irradiation. In vivo tests confirmed the circumferential delivery of laser light to a deep muscle layer as well as no evidence of thermal damage to the esophageal mucosa. The proposed BIOC can be a feasible optical device to provide circumferential laser irradiation as well as endoscopic coagulation of tubular esophagus tissue for clinical applications.

Surgical correction of polymelia in the perineal region of a 2-day-old indigenous bovine calf: a case report from Bangladesh

BackgroundPolymelia is an occasional and congenital malformation in bovine calves, characterized by the presence of single or multiple accessory limb(s) at various body regions, which are often called the supernumerary limb(s). One of these defects is known as pygomelia, where the additional limb is attached to the pelvis within the perineal region. This study describes such a case along with surgical management.Case presentationA 2-day-old indigenous bovine female calf of 22.7 kg BW was presented with an additional and non-functional fifth limb at the perineal region. The ectopic fifth limb was smaller in size than the other four normal limbs and was in a flexible hanging position. Other than this, the animal was apparently normal with a short and contracted tail. Clinical examinations involving the extension and flexion of the abnormal limb revealed no deep bony attachment/articulation with the pelvic girdle or the caudal spine. The curled tail having an S-shaped base indicated the skeletal defects in the caudal spine. Electrosurgery was performed under deep sedation with regional as well as local anesthesia, which exposed that the limb was internally seated into deep gluteal muscle layers with the attachments of fibrous connective tissues and cartilage to its proximal bony head and located partially to the left lateroventral extremity of the perineum without any direct involvement in the bony pelvis. Surgical excision was done to remove the supernumerary limb, and the wound was closed routinely. Postoperatively, the animal was provided with supportive medications for early healing and recovery. After 2 weeks of surgery, the calf completely recovered without any complications. The contracted tail and spine were left unaffected as no initial surgical maneuver was done due to the early age of the calf and would be considered for further long-term treatment options upon the growth and development with age.ConclusionsPygomelia of bovine calves is one of the rare congenital defects that can be found along with other developmental anomalies. However, this defect can be successfully corrected by surgical approaches following intensive postoperative care and management.

Efficacy of Yun-type pelvic floor optimal training therapy and PFMT on middle aged women with mild to moderate overactive bladder: a randomized controlled trial.

BackgroundThe symptoms of overactive bladder (OAB) are highly bothersome to patients. In behavioral therapy, traditional pelvic floor muscle training (PFMT) can be boring and monotonous, which can cause poor compliance. It’s important to establish a new safe and effective crotch-pelvic floor functional reconstruction training method [Yun-type pelvic floor optimal training (Yun-type training)] for OAB patients.MethodsThis randomized, double-blind, crossover trial recruited a total of 150 women with mild to moderate OAB. Patients were randomly assigned to receive Yun-type training (n=83) or PFMT (n=67). The intervention group was first given Yun-type training for 6 weeks, then switched to PFMT for 6 weeks after 2 weeks of elution. Patients in the control group were first treated with PFMT for 6 weeks, and changed to the use of Yun-type training for 6 weeks after 2 weeks of elution. The primary endpoint was overactive bladder symptom scores (OABSS) after 6 and 14 weeks of Yun-type training and PFMT.ResultsYun-type training could significantly improve OABSS compared with PFMT after 6 and 14 weeks (P<0.001). Yun-type training was associated with an improvement in urine, urgency, urge urinary incontinence (UUI), urogenital distress inventory-6 (UDI-6), patient’s perception of bladder condition (PPBC), voiding volume (VV), incontinence impact questionnaire-7 (IIQ-7), female sexual function index (FSFI), sexual desire, arousal, pain, satisfaction, pelvic floor muscle tone, type I muscle strength, type II muscle strength, and sex partner satisfaction as compared with PFMT after 6 and 14 weeks. Moreover, nocturia, maximum flow rate (Qmax), and climax in the Yun-type training group were significantly improved after 6 weeks, and the average flow rate (Qave) was improved after 14 weeks in the Yun-type training group.ConclusionsYun-type training could yield additional benefits on OAB symptoms, sexual function, and sex partner satisfaction as compared with PFMT. The superior sexual function resulting from Yun-type training can be explained by the fact that it can contract deep and superficial muscle layers, resulting in increased vaginal wall pressure and blood flow, which further improves FSFI and sex partner satisfaction. It could lead to a new non-invasive treatment for OAB patients.Trial RegistrationChinese Clinical Trial Registry ChiCTR-INR-17012192.

Black Esophagus (Acute Esophageal Necrosis) Caused by Liver Cirrhosis

Acute necrotizing esophagitis (black esophagus) is a rare clinical entity that is characterized by partial or total loss of the epithelium, ulceration up to the circumferential slough of all layers of the mucosa and submucosal, frequent involvement of deep muscle layers, and frequent perforations. Its blackish appearance in endoscopic examinations has given it the name of black esophagus. We describe a rare case of black esophagus caused by hepatic cirrhosis associated with gastric ulcer.

Deep and superficial cervical muscles respond differently to unstable motor skill tasks.

Biomechanical modelling and physiological studies suggest that various spinal muscle layers differ in their contribution to spine movement and stiffness. This study aimed to investigate the activation of deep and superficial muscles in stable and unstable task conditions. Nine healthy participants performed a task of controlling a metal ball on a plate fixed to the head in seated position. In unstable tasks, visual feedback was provided by mirrors to move the ball to the centre of the plate by small head movements and maintain the position for 3s. Task difficulty was adjusted in a stepwise progression of difficulty using five surfaces with materials of decreasing resistance. In the stable condition, the ball was fixed to the plate's centre. EMG was recorded with surface (sternocleidomastoid, anterior scalenes, upper trapezius) and fine-wire electrodes (rectus capitis posterior major, obliquus inferior, multifidus, semispinalis cervicis, splenius capitis). The outcome variable was root mean square (RMS) EMG during the part of the task when the ball was maintained in the centre position. Results revealed greater cervical muscle activity in the unstable than stable conditions (p<0.001, ηp2=0.746). Control of deep and superficial cervical muscles differed (p=0.003, ηp2=0.354). Deep cervical muscle activity was greater with unstable tasks, but did not differ with task difficulty. In contrast, superficial cervical muscle activity increased in a stepwise manner with increasing challenge. These results support the notion that the central nervous system uses different strategies for control of deep versus superficial muscle layers of the cervical spine in association with instability.

Neoadjuvant chemotherapy combined with radical surgery for stage IB2/IIA2 cervical squamous cell carcinoma: a prospective, randomized controlled study of 35 patients

ObjectiveThis study aimed to evaluate the clinical outcomes for patients with stage IB2/IIA2 cervical squamous cell carcinoma treated with neoadjuvant chemotherapy combined with radical surgery.MethodsA total of 68 patients with cervical squamous cell carcinoma were randomly divided into the experimental group (n = 35) and the control group (n = 33). The patients in the experimental group received paclitaxel plus cisplatin neoadjuvant chemotherapy for two cycles, then underwent radical hysterectomy and bilateral adnexectomy at 2 weeks post-chemotherapy. The control group only underwent radical hysterectomy and bilateral adnexectomy after the diagnosis of cervical squamous cell carcinoma. The toxic and side effects of chemotherapy in the experimental group were observed. Also, the operation method, operation time, blood loss, grade of wound healing, complications, and postoperative pathology were noted in the two groups. Primary foci and pelvic lymph node recurrence and distant metastasis were observed, and 3-year and 5-year survival rates were calculated.ResultsOnly one patient in the experiment had grade III bone marrow suppression; no other grade III and IV chemotherapy toxic reactions were observed. The operation was successfully completed in all patients. The operation time, intraoperative blood loss, placement of the ureteral catheter, bladder injury, ureteric injury, postoperative urinary tub, pelvic drainage tube indwelling time, anal exhaust time, postoperative complications, and metastatic ratio of lymph nodes were not significantly different between the two groups (P > 0.05). The number of dissected lymph nodes, deep myometrial invasion, and vascular tumor emboli showed a significant difference in the experimental group compared with the control group (P < 0.05). The 3-year disease-free survival (82.9% vs 81.9%), 5-year disease-free survival (71.4% vs 60.6%), 3-year overall survival (91.4% vs 87.8%), and 5-year overall survival (82.9% vs 75.6%) were not statistically significantly different between the experimental group and the control group (P > 0.05).ConclusionsNeoadjuvant chemotherapy in IB2/IIA2 stage cervical squamous cell carcinoma showed low toxic side effects. Radical surgery after chemotherapy is safe and feasible. It plays a coordinating role in reducing the tumor infiltration depth of the deep muscle layer and the incidence of vascular tumor emboli, reducing the use of postoperative adjuvant therapy, and improving the quality of life of patients, but does not improve the 3-year/5-year survival rate.

Gastric Mucosal Immune Profiling and Dysregulation in Idiopathic Gastroparesis.

INTRODUCTION:It is unclear how immune perturbations may influence the pathogenesis of idiopathic gastroparesis, a prevalent functional disorder of the stomach which lacks animal models. Several studies have noted altered immune characteristics in the deep gastric muscle layer associated with gastroparesis, but data are lacking for the mucosal layer, which is endoscopically accessible. We hypothesized that immune dysregulation is present in the gastroduodenal mucosa in idiopathic gastroparesis and that specific immune profiles are associated with gastroparesis clinical parameters.METHODS:In this cross-sectional prospective case-control study, routine endoscopic biopsies were used for comprehensive immune profiling by flow cytometry, multicytokine array, and gene expression in 3 segments of the stomach and the duodenal bulb. Associations of immune endpoints with clinical parameters of gastroparesis were also explored.RESULTS:The gastric mucosa displayed large regional variation of distinct immune profiles. Furthermore, several-fold increases in innate and adaptive immune cells were found in gastroparesis. Various immune cell types showed positive correlations with duration of disease, proton pump inhibitor dosing, and delayed gastric emptying.DISCUSSION:This initial observational study showed immune compartmentalization of the human stomach mucosa and significant immune dysregulation at the level of leukocyte infiltration in idiopathic gastroparesis patients that extends to the duodenum. Select immune cells, such as macrophages, may correlate with clinicopathological traits of gastroparesis. This work supports further mucosal studies to advance our understanding of gastroparesis pathophysiology.

Computational Fluid Dynamics (CFD)-Based Optimization of Injection Process during Endoscopic Mucosal Therapy.

Creation of a submucosal plane to separate the lesion from the deeper muscle layer in gastrointestinal tract is an integral and essential part of endoscopic resection therapies such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Thereby, an optimized submucosal injection technique is required to ensure a successful process. In this study, the computational fluid dynamics (CFD) technique is employed as a foundational step towards the development of a framework that can provide useful directions to optimize the injection process. Three different lifting agents, including Glycerol, Eleview®, and ORISE® gel have been used for this study. The role of different injection angles, injection dynamics, and effect of temperature are studied to understand the lifting characteristic of each agent. The study shows that Eleview® provides the highest lifting effect, including the initial injection period. To evaluate the impact of the injection process, two cases are simulated, termed static injection and dynamic injection. Under static injection, the injection angle is investigated from lower to higher angles of injection. In the dynamic injection, two cases are modulated, where a continuous change of injection angle from lower to higher degrees (denoted as clockwise) and vice-versa in the anti-clockwise direction are investigated. Increased lifting characteristics are observed at decreasing/lower angle of injection. Further, the correlation between temperature of the lifting agents and their lifting characteristics is investigated.

Objective Analysis of Neck Muscle Boundaries for Cervical Dystonia Using Ultrasound Imaging and Deep Learning.

To provide objective visualization and pattern analysis of neck muscle boundaries to inform and monitor treatment of cervical dystonia. We recorded transverse cervical ultrasound (US) images and whole-body motion analysis of sixty-one standing participants (35 cervical dystonia, 26 age matched controls). We manually annotated 3,272 US images sampling posture and the functional range of pitch, yaw, and roll head movements. Using previously validated methods, we used 60-fold cross validation to train, validate and test a deep neural network (U-net) to classify pixels to 13 categories (five paired neck muscles, skin, ligamentum nuchae, vertebra). For all participants for their normal standing posture, we segmented US images and classified condition (Dystonia/Control), sex and age (higher/lower) from segment boundaries. We performed an explanatory, visualization analysis of dystonia muscle-boundaries. For all segments, agreement with manual labels was Dice Coefficient (64 ± 21%) and Hausdorff Distance (5.7 ± 4mm). For deep muscle layers, boundaries predicted central injection sites with average precision 94 ± 3%. Using leave-one-out cross-validation, a support-vector-machine classified condition, sex, and age from predicted muscle boundaries at accuracy 70.5%, 67.2%, 52.4% respectively, exceeding classification by manual labels. From muscle boundaries, Dystonia clustered optimally into three sub-groups. These sub-groups are visualized and explained by three eigen-patterns which correlate significantly with truncal and head posture. Using US, neck muscle shape alone discriminates dystonia from healthy controls. Using deep learning, US imaging allows online, automated visualization, and diagnostic analysis of cervical dystonia and segmentation of individual muscles for targeted injection.

Assessment of commodities fishing in the trade network of the city of Sumy

Introduction. To date, one of the priority tasks of the agro-industrial complex of Ukraine is to provide the population with benign and safe environmental and veterinary-sanitary products of animal products. Aquaculture is one of the fastest growing industries in the rapidly developing agro-industrial complex. The mentioned industry is able to provide the population with high quality nutritious and dietary fishery products in a relatively short period. Fish products replenish the human diet with essential amino acids, polyunsaturated fatty acids, trace elements and other nutrients to meet the needs of the body. But important indicators are the quality and safety of fish and fish products. The use of hazardous fish products by humans can lead to human diseases. Therefore, research on determining the safety and quality of fish remains an important link.&#x0D; The goal of the work. The purpose of our research was to investigate commercial fish sold in the Sumy trade network and to carry out its veterinary and sanitary evaluation.&#x0D; Materials and methods of research. These studies were conducted under the conditions of the Department of Veterinary Expertise, Microbiology, Zohygiene and Safety and Quality of Livestock Products of Sumy National Agrarian University and in Sumy Regional State Laboratory of the State Consumer Service.&#x0D; Conducted research on commercial fish, which came to the sale in the trade network of the city of Sumy, namely in supermarkets, specialized stores and agri-food markets. Fresh, dried and frozen fish were studied.. &#x0D; Results of research and discussion. As a result of the study of the selected samples was found in live fish, namely the fathead, characteristic signs of postodiplastomosis. This disease manifested itself as small black spots on the body of a fish. It was also revealed in the study of carp in two specimens that the chronic course of aeromonosis was manifested by the presence of fissured ulcers on the body of the fish. Since the detection of the disease did not spoil the product indicators of fish, then all living fish are allowed to sell.&#x0D; When examining dried fish, no deviations from the requirements for dried fish were found in the submitted samples. All fish are identified as benign and admitted for sale.&#x0D; Studies of fresh frozen fish (hake) revealed the presence in the muscle tissue of the nematode Contracoecum squalii&#x0D; Affected fish are characterized by an increased content of microorganisms in the deep and superficial muscle layers, a doubtful or negative reaction to peroxidase, a doubtful or substandard reaction with a Nesler reagent, a doubtful or substandard reaction with sulfuric acid, acidification.&#x0D; Conclusions and prospects for further research: 1. In a study of 323 samples of live, dried, frozen fish, which entered the trade network in Sumy, it was found that 8 (2.47%) samples did not correspond to good-quality fish.2. Signs of diseases characteristic of aeromonosis (2 specimens), postodiplastomosis (1 specimen) and contracenosis (5 specimens) were established in the selected fish samples.3. A batch of hake (170 kg) in which the pathogen Contracoecum squalii was detected is not allowed for sale and is intended for technical disposal.&#x0D; In the future, it is planned to develop and implement a permanent monitoring system for the quality and safety of fish and fishery products that are commercially available.

Mucosal healing after high dose pantoprazole in acute corrosive injury of esophagus

INTRODUCTION : The ingestion of corrosive agents is still an important public health issue in our country. The GIT injuries caused by caustic agents can range from minor to fatal, or can lead to chronic disease with poor quality of life. Corrosive agents with a pH level less than two or more than twelve can rapidly penetrate the layers of the oesophagus and result in necrosis and scar formation in the mucosa. Acidic agents produce coagulation necrosis and eschar formation that may limit tissue penetration and may even spare the oesophagus when the transit is rapid. On the other hand, Alkaline agents when ingested produce liquefaction necrosis and can cause serious oesophageal injury by penetrating to deep muscle layers. The basic histopathologic reaction of tissue subjected to caustic burn is the synthesis, deposition and remodelling of collagen. Following full-thickness injuries to the oesophageal wall, the normal oesophagus is replaced by dense connective tissue. Collagen overproduction has been estimated to cause stenosis in half of the patients suffering severe burns. Consequently, when treating caustic burn injuries, it is necessary to prevent stenosis by inhibiting collagen synthesis or changing the properties of the deposited collagen. The optimal management protocol in the treatment of severe caustic injury remains controversial. The main goal of medical treatment is to inhibit inflammatory reaction or stricture formation secondary to oesophageal burning. Stricture formation is thought to be overcome by suppressing fibroplasia and scarring. Many agents directed at wound healing and stricture prevention have been used in several experimental studies in past. Results of such treatment protocols including steroids, antibiotics, heparin, indomethacin, sucralfate, vitamin E, as well as total parenteral nutrition are all controversial in treatment of corrosive burns. Randomised control trials on the role of proton pump inhibitors in caustic injuries of GIT are lacking. A few experimental studies have investigated the relationship between proton pump inhibitors and corrosive burns and has shown that proton pump inhibitors can reduce inflammation in early phase of caustic injury. Proton pump inhibitors, by decreasing gastric acid secretion and thereby GER can prevent worsening of corrosive injury. In addition proton pump inhibitors has also been shown to have anti-inflammatory and antioxidant properties. A prospective study from turkey on 13 patients have showed that omeprazole can be used effectively in treatment of acute corrosive injury of esophagus. There are no studies from India which have attempted to assess the usefulness of proton pump inhibitors in treatment of acute corrosive injury of esophagus. This prompted us to study the usefulness of pantoprazole in the treatment of patients presenting with acute corrosive injury of the oesophagus. AIM OF THE STUDY : To study the efficacy of high dose pantoprazole in causing mucosal healing after acute corrosive injury of esophagus. CONCLUSION : Treatment of corrosive injury is controversial and there are no definitive protocols. Intravenous proton pump inhibitors are widely used in treatment of corrosive injuries despite lack of evidence. Our study has demonstrated that effective mucosal healing can be achieved by intravenous proton pump inhibitor infusion. Though majority of patients in our study had minor grade of injury, 27% of the patients included in the study had 2b and 3a injury. When analysis is confined to these patients, 53% showed improvement by 1 grade, 33.3% showed improvement by 2 grades and 13.3% did not show improvement. Therefore it is evident from above that high dose pantoprazole is also beneficial in patients with higher grade of injury and may prevent late complications in these patients. A larger randomised placebo controlled trial in patients with higher grade of oesophageal injury is needed to determine if high dose pantoprazole should form standard of care in treatment of patients with acute corrosive injury of oesophagus.

25 IDENTIFICATION OF PATHOGENIC BACTERIA IN SEVERE CROHN’S DISEASE

Despite great advancements in therapy, it remains unclear why inflammation in the digestive system of patients suffering Crohn’s Disease (CD) is progressive and leads to complications (e.g., enteric fistulas) that are only alleviated by surgical removal of the damaged bowel. By using a three-dimensional profiling method, we recently discovered that surgically removed CD bowels have complex 3D-networks of microscopic lesions that follow principles of ‘geological caverns’. Because such lesions contain purulent debris (pus), inflammatory cells, and bacterial DNA, their collective presence with that of bacteria could explain CD progression and recurrence. The main objective of this study was to use standard and novel culture methods to determine if bacteria previously identified by DNA methods can be found alive in such microscopic cavernous fistulous tract lesions (CavFT) and could induce intestinal inflammation in mice prone to CD (SAMP1/YitFc). Stereomicroscopic samples from the ileum from 5 CD patients undergoing surgery were obtained under strict aseptic conditions for incubation of anaerobic bacteria. Transplantation experiments of purulent debris and of pure bacterial isolates were conducted in adult (55-wk-old) and young (6-week-old) germ-free SAMP mice to determine acute and chronic intestinal inflammatory responses and gut microbial growth dynamics. In vitro growth assays were conducted to determine the effect of oxygen exposure on bacterial viability, inhibition, and resilience. Single colony 16S rRNA gene Sanger sequencing was used for bacterial speciation. A remarkable array of viable, and cultivable bacteria from the dissected CavFT lesions were revealed from the ilea of CD patients that underwent surgery, but not from paired control mucosa samples. All isolates, with one exception (e.g., Enterococcus faecalis) were strict anaerobes, with a predominance of Bacteroidetes(e.g., compared to Clostridium, 6:1 ratio). Among the Bacteroidetes, Parabacteroides distasonis was present in two patients that exhibited a consistent pattern of pro-inflammatory activity in SAMP mice (3D-cobblestone formation, histological inflammation), when compared to Alistipes finegoldii and Lactobacillus salivarius, which was present as a dominant microbe in mucosal ulcers of a colonic CD. P. distasonis, deemed a slow-growing bacterium, survived prolonged exposure to oxygen (room air), showed the ability to invade the gut wall of germ-free SAMP mice, and stimulate the growth of other specific CavFT bacteria in vitro. Findings support that bacteria inhabiting CavFT in CD could play a perpetuating pathogenic role in CD, by initiating liquefactive ‘sinkhole’ lesions on mucosal surfaces, and by perpetuating microscopic ‘cavernous fistulous tract’ lesions in deep gut muscle layers, which could lead to chronic fistulas.

Processing techniques and safety analysis for transurethral resection of bladder lesions

Objective To evaluate the processing techniques and safety of ureteral stent after transurethral resection (TUR) of bladder lesions involving the ureteral orifice. Methods From January 2010 to August 2016, 42 cases of non-muscle invasive bladder tumor and 18 cases of glandular cystitis including 44 male and 16 female aged from 32 to 81 years(mean 55 years) were treated by TUR. Twenty-three cases of bladder tumor had single tumor and 19 cases had multiple tumors, and 37 cases were primary and 5 cases were recurrent. All the patients without preoperative hydronephrosis revealed by imageological examination.The lesions were resected into the deep muscle layer and involved ureteral orifice were resected during the procedure and after that a Double-J ureteral stent was placed in all cases.When looked for the ureteral orifice, we followed the ureteral peristalsis step by step, and found " concentric circles" muscle tissue.Then we used the guide wire as a guide for ureteral stenting. All the patients received one immediate intravesical instillation of 50 mg pirarubicin after TUR, and further scheme of adjuvant intravesical instillation was made according to the pathological diagnosis. Ureteral stents were removed 8~10 weeks after TUR, imageological examination were performed every three months. Results The operations were successful without complications. No serious adverse reaction occurred in adjuvant intravesical instillation chemotherapy. During the follow-up period of 4~60 months, no ureteral stricture and hydronephrosis occurred in all patients with ureteral stent, and the resected ureteral orifices recovered well with normal appearance and ejecting urine. Conclusions The ureteral orifice usually need to be removed during TUR for bladder lesions, and the way we following the ureteral peristalsis to resect the ureteral orifice is effective.Ureteral stenting after TUR of bladder lesions involving the ureteral orifice can prevent stricture at the ureterovesical junction without increasing the risk of tumor cell seeding along the upper urinary tract. Key words: Cystectomy; Urethra; Electrosurgery; Ureter

Relationship between needling layers and needling sensations in acupuncture

Based on the sancai (literally three talents referring to "earth", "human" and "heaven") and wuti (literally five organs referring to skin, muscle, vessel, tendon and bone, which correspond to five internal organs: lungs, spleen, heart, liver and kidney respectively) in Neijing (Internal Classic), as well as the tissue structure theory of modern anatomy, and in combination with the clinical practice of acupuncture by the author in the past over 30 years, it is proposed that four layers are divided in needling depth of acupuncture. The different needling sensations are induced at different layers. The first layer is the skin. When the needle is inserted into the skin, the main sensation is "pain". The second layer is the subcutaneous layer (superficial fascia). The needle tip at this layer generates a strong "swelling" sensation, which radiates along a certain direction. The third layer is the deep fascia and muscle layer. If the needle tip touches the deep fascia, there is a "heavy" feeling. If the needle tip goes into the muscle, an "acid" sensation will occur. The fourth layer is the periosteum and bone layer, which produces a strong sensation of "pain" when touched by the needle tip. In addition, each layer has blood vessels and nerve distribution. When the needle tip touches the blood vessels, a sense of "pain" happens. If the needle tip touches the nerve, there will be a sensation of numbness, which spreads along the direction of nerve conduction. On the contrary, through the patient's needling sensations, we can roughly know which layer and direction the needle tip goes. Better understanding of the relationship between the needling layers and needling sensations contributes to the further study of needling techniques, therapeutic effects of acupuncture and patient's sensations. It is significant for the regulations of needling sensations in patients.

The efficacy and safety of ureteral stenting after transurethral resection (TUR) of bladder tumors involving the ureteral orifice

Objective To evaluate the efficacy and safety of ureteral stenting after transurethral resection (TUR) of bladder tumors involving the ureteral orifice. Methods From March 2009 to November 2015, 34 cases of non-muscle invasive bladder tumor including 28 male and 6 female aged from 26 to 79 years(mean 51 years) were treated by TUR. 14 cases had single tumor and 20 had multiple tumors, and 29 were primary and 5 were recurrent. All the patients had tumors involving the ureteral orifice without preoperative hydronephrosis revealed by IVU or CTU examination. The tumors were resected into the deep muscle layer and the involved ureteral orifices were resected during the procedure, and after that a double-J ureteral stent was placed in 18 cases. All patients received one immediate intravesical instillation of 50mg epirubicin after TUR, and further scheme of adjuvant intravesical chemotherapy instillations were made according to the pathological diagnosis. Ureteral stents were removed 10-12 weeks after TUR, and cystoscopy and urinary tract ultrasound examinations were performed every 3 months for 1-2 years postoperatively. Results The operations were successful without complications. No serious adverse reaction occurred in immediate and further adjuvant intravesical chemotherapy. During the follow-up period of 3-71 months, no ureteral stricture, hydronephrosis or tumor recurrence in the upper urinary tract occurred in all the 18 patients with ureteral stent, and the resected ureteral orifices recovered well with normal appearance and ejecting urine. Hydronephrosis was observed in 3 of 16 patients without ureteral stent including 2 cases of nontumoral stenosis at the ureterovesical junction requiring ureteral reimplantation and 1 case of lower ureteral tumor on the involved side requiring nephroureterectomy and bladder cuff excision. No patient complained of symptoms secondary to vesicoureteral reflux or continuous unrelievable lower urinary tract symptoms. 2 cases of bladder tumor recurred out of the resected area. Conclusions Ureteral stenting after TUR of bladder tumors involving the ureteral orifice can prevent stricture at the ureterovesical junction without increasing the risk of tumor cell seeding along the upper urinary tract. The existence of a double-J ureteral stent does not increase complications of adjuvant intravesical chemotherapy, and also won't cause intolerable lower urinary tract symptoms. Key words: Urinary bladder neoplasms; Transitional cell carcinoma; Transurethral resection; Hydronephrosis; Neoplasm recurrence

Mechanisms of wound closure following acute arm injury in Octopus vulgaris.

BackgroundOctopoda utilise their arms for a diverse range of functions, including locomotion, hunting, defence, exploration, reproduction, and grooming. However the natural environment contains numerous threats to the integrity of arms, including predators and prey during capture. Impressively, octopoda are able to close open wounds in an aquatic environment and can fully regenerate arms. The regrowth phase of cephalopod arm regeneration has been grossly described; however, there is little information about the acute local response that occurs following an amputation injury comparable to that which frequently occurs in the wild.MethodsAdult Octopus vulgaris caught in the Bay of Naples were anaesthetised, the distal 10 % of an arm was surgically amputated, and wounded tissue was harvested from animals sacrificed at 2, 6, and 24 h post-amputation. The extent of wound closure was quantified, and the cell and tissue dynamics were observed histologically, by electron microscopy, as well as using ultrasound.ResultsMacroscopic, ultrasonic and ultrastructural analyses showed extensive and significant contraction of the wound margins from the earliest time-point, evidenced by tissue puckering. By 6 h post amputation, the wound was 64.0 ± 17.2 % closed compared to 0 h wound area. Wound edge epithelial cells were also seen to be migrating over the wound bed, thus contributing to tissue repair. Temporary protection of the exposed tip in the form of a cellular, non-mucus plug was observed, and cell death was apparent within two hours of injury. At earlier time-points this was apparent in the skin and deeper muscle layers, but ultimately extended to the nerve cord by 24 h.ConclusionsThis work has revealed that O. vulgaris ecologically relevant amputation wounds are rapidly repaired via numerous mechanisms that are evolutionarily conserved. The findings provide insights into the early processes of repair preparatory to regeneration. The presence of epithelial, chromatophore, vascular, muscle and neural tissue in the arms makes this a particularly interesting system in which to study acute responses to injury and subsequent regeneration.Electronic supplementary materialThe online version of this article (doi:10.1186/s40851-016-0044-5) contains supplementary material, which is available to authorized users.