Muscle Layer Research Articles

Verification of effect of analytical conditions of shear wave velocity on ability to evaluate microstructure

In this study, the relationship between the analytical conditions of shear wave velocity (SWV) and the evaluation ability of microstructure were verified by FDTD simulation. By adding acoustic radiation force (ARF) to the left edge of the simulation space, which mimicked various fatty livers with different fat mass, shear waves propagating in the lateral direction were simulated in each liver. SWV was calculated using the time difference calculated by the cross-correlation method from two timewaves laterally located in the simulation. By varying the resolution of the SWV evaluation, the effect of scattering and refraction of shear waves in fat droplets, etc. on the macroscopic shear propagation was evaluated. Although shear waves could be evaluated stably when tracking shear waves at the spatial step (time width) of the clinical device level, the effects of individual fatty substances were strongly indicated when tracking in the microscopic sense of 10 μm (50 ns). When there was a thick fat layer or a sparse muscle layer near the body surface, the irradiation of ARFI did not work as expected and the evaluation accuracy of SWV decreased.

Comparative study of purgative pharmacological effects and mechanisms of Moringa oleifera leaves and Rhei Radix et Rhizoma

Moringa oleifera leaves are known for their "Virechana"(purgative) effect in Ayurvedic medicine in India. This study compared the purgative effects and mechanisms of M. oleifera leaves with the reference Rhei Radix et Rhizoma to establish a foundation for the further application of M. oleifera leaves in traditional Chinese medicine(TCM). Using network pharmacology and molecular docking methods, this study identified the material basis, common targets, and signaling pathways through which Rhei Radix et Rhizoma and M. oleifera leaves exerted their purgative pharmacological effects. A low-fiber diet-induced constipation mouse model was established to measure fecal parameters and small intestinal propulsion rate, and histological changes in the colon were observed using HE staining. Relative expression levels of relevant genes and target proteins were assessed using RT-qPCR and immunohistochemistry, respectively. The results showed that mapping the targets of Rhei Radix et Rhizoma and M. oleifera leaves onto the biological process network of constipation revealed close proximity, indicating that they may exert their therapeutic effects on constipation through similar biological processes. Molecular docking results indicated that compounds such as sennoside C and isoquercitrin could target serine/threonine protein kinases(AKT1) and mitogen-activated protein kinase 3(MAPK3), thereby affecting MAPK and calcium signaling pathways to promote defecation. Animal experiments demonstrated that both M. oleifera leaves and Rhei Radix et Rhizoma increased the number of fecal pellets and water content in constipated mice, improved small intestine motility, colon mucosal thickness, and muscle layer thickness, upregulated the gene expression levels of AKT1 and MAPK3 in the colon, and downregulated the expression of AQP3 protein. These findings suggest that M. oleifera leaves and Rhei Radix et Rhizoma share similarities in their therapeutic efficacy and mechanisms for treating constipation. Using Rhei Radix et Rhizoma as a reference can provide a better understanding of the characteristics of the "Virechana"(purgative) effect of M. oleifera leaves in TCM.

Histomorphometric study of seminiferous tubules and epididymis in adult ram

This research set out to examine the epididymis and seminiferous tubules of adult male Rams, use both histological and histomorphometric methods. For this purpose, ten paired of testis of healthy adult local rams were taken from local abattoir in Fallujah. Tissue was removed and cut into tiny pieces from different parts of the testicles before being put in Bouin's solution. The tissue samples were processed by common paraffin technique then stained with routine H & E stain as well as Masson's trichrome stain. According to the results of the present histological analysis, the ram's testis is enclosed by a capsule of thick irregular connective tissue, and its lobules are separated by trabecular and interlobular septa, with seminiferous tubules and interstitial tissue making up each lobule. Spermatogenic cells and Sertoli cells border the seminiferous tubules. Spermatozoa develop from spermatogenic cells. Spermatogonia are the earliest stages of spermatogenic cells; they are tiny, spherical cells with black, spherical nuclei that sit on the basement membrane. Primary spermatocytes, which are bigger cells with often-distinct chromatin, are generated during mitosis in the spermotogonia. Because of their rapid second meiotic division and subsequent formation of haploid spermatids, secondary spermatocytes are seldom seen. Clustered near the seminiferous tubule's lumen, the spermatids are spherical cells with pale nuclei. There are less Sertoli cells (sustentacular cells) than spermatogenic cells. The nucleus is oval or triangular in shape and pale in colour, with a large nucleolus. Leydig cells are found in the connective tissue between neighbouring tubules. Epithelium that is pseudostratified lines the epididymis. The stereocilia are long cytoplasmic structures that extend into the lumen. Circular smooth muscle is present in varying amounts, and the epithelium is supported by a connective tissue lamina propria.In conclusion, the current study concluded that the thickness of the epithelium of epididymis was decrease toward the tail while the thickness of the smooth muscle layer was increase toward the tail.

HISTOLOGICAL ALTERATIONS IN THE BODY WALL OF EARTHWORM ALLOLOBOPHORA CALIGINOSA EXPOSED TO DIMETHOATE INSECTICIDES

Dimethoate is an organophosphorus insecticide with contact and systemic action used against a broad range of insects in agriculture. Dimethoate is highly mobile in soil. Its residues have been detected in soils, sediments, and water due to their non-regulated usage practice. Therefore, it affects the beneficial organisms that live in the soil, such as the earthworm. Earthworms are considered as soil engineers because of their ability to modify soils and plant communities, as earthworms ingest large amounts of soil and organic matter, they are continuously exposed to contaminants through their alimentary surfaces. The earthworm Allolobophora caliginosa was exposed to Dimethoate and the concentrations were range from 0.05 to 2.5 ppm. The changes in the body wall were represented by the appearance of vacuolated in the epidermis layer and muscle layers, the epidermis separating from the muscle layer then the cells were destroyed, and the effect increased by increasing the concentration of the pesticides.

Endoscopic intermuscular dissection (EID) for removing early rectal cancers and benign fibrotic rectal lesions.

In the current era of screening colonoscopy and increasing incidence of early rectal cancer, interventional endoscopy moves toward resections in deeper planes than the submucosal layer. Several reports support the use of endoscopic intermuscular dissection (EID) instead of endoscopic submucosal dissection (ESD) for the removal of deeply invasive rectal submucosal cancers. The resection plane into the intermuscular space, the space between the longitudinal (external) and circular (internal) muscle layer, allows radical removal of rectal invasive submucosal cancers. Furthermore, the technique offers the potential for dissection of scarred and severe fibrotic lesions in the rectum by cutting deeper and performing a partial myectomy avoiding the narrow submucosal space. We present 23 cases ofEIDs both for deeply invasive rectal cancers and benign rectal lesions. This is the first report in the literature of EID resections for malignant and benign disease, including cases of severely fibrotic rectal lesions.

P14 A rare adverse event of eosinophilic fasciitis secondary to immune checkpoint inhibitor therapy

P14 A rare adverse event of eosinophilic fasciitis secondary to immune checkpoint inhibitor therapy

A study on the congruence and proximity of the sling and clasp fibres at the cardio-esophageal junction of the stomach.

The cardio-oesophageal sphincter that is located in close longitudinal proximity to the origin of the lesser curvature of the stomach has a unique pattern of external muscle fibres whose inner oblique layer would normally form an elongated sling and the middle partially circular layer would form a projecting clasp into the already existing muscular sling of the former congruently, which would result in the formation of an anatomical sphincter in that area that would normally be devoid of the external longitudinal muscle layer coat. Certain authors have disagreed with the notion of this standard literature and have proposed that the clasp and sling fibres need not necessarily be congruent and may even remain independent of each other with partial contributions from the longitudinal muscle layers as well that may arise tangentially in different populations, which may in turn contribute to reflux oesophagitis in that population. Hence, the clasp and sling fibre muscular patterns were observed in six formalin-embalmed cadavers at the department of anatomy in a tertiary care institute as part of routine dissections in series, and the findings were then reported. At the junction of the lesser curvature of the stomach with the oesophagus, all six cadavers showed a longitudinal sling pattern as opposed to the conventional oblique sling. The circular muscle layer was found to be merged with the outer longitudinal muscle layer to form the sling that pulled away from the clasp, resulting in a loss of congruency for the same. The clasp fibres, however, were found to be contributed by the inner oblique muscle layer. The conventional perpendicular or tangential merging of the clasp with the sling was not observed; instead, an obtuse, blunt angular merging of the clasp with the sling was observed. The deviation of the sling from the clasp could indicate a lack of a proper fit between them at the cardio-oesophageal sphincter. The lack of robustness in the attachment of the clasp to the sling may possibly contribute to the diminished taut pull of the clasp in this subset of the population. These would be significant determinants for a predisposition to reflux oesophagitis and Barrett's oesophagus.

COMPUTATIONAL MODELING OF A LAYERED AORTIC MEDIAL WALL CONSIDERING EFFECTIVE RESIDUAL STRESSES

We previously developed a simplified finite element (FE) “unit” model to reproduce the mechanical interaction between the smooth muscle layer and elastic lamina (EL) in the aortic media. Nevertheless, whether this simplified FE model can represent the structure of a real medial wall and whether its modeling technique can help in developing a highly sophisticated and structure-based aortic FE model should be determined. Therefore, this study aimed to computationally represent EL buckling in the aortic medial ring at an unloaded state based on the integrated unit models and reproduce transmural variations in EL waviness across the vascular wall. We confirmed that the inner and outer layers of the medial wall were relatively subjected to compressive and tensile residual stresses, respectively, at the unloaded state, implying that the ring model will open spontaneously when it is radially cut. In addition, the residual stresses computed under such a stress-free condition were comparable to the analytically estimated values, partially supporting the validity of our modeling approach. Although further study is still required, the information obtained in this study will greatly improve the understanding of basic aortic physiology and pathophysiology and provide a basis for performing more sophisticated computational modeling of the aortic wall.

Comparative Anatomical and Histological study of gall bladder in Mallard (Anas platyrhynchos) and Broiler fowl (Gallus gallus )

The current study was investigated anatomical and histological description of gall bladder of two specious which different in nutrition and life habitat Mallard (Anas platyrhnchos) aquatic life bird, and broiler fowl (Gallus gallus) wild life bird ,used ten bird of each specious ,anatomical result founded the gall bladder is located at the visceral surface right lobe of liver at right side of abdominal cavity, and composed of three parts head, neck and body, gall bladder in both specious appeared with dark green color. Gall bladder of mallard has balloon shape more elongated organ while in Gallus gallus is pear shape, the mean weight of gall bladder in mallard (1.91±0.56 g) , length (3.07±0.505 cm) and width (3.07±0.5 cm ) while broiler fowl weight of gall bladder (8.24±2.88 g), length (3.31±0.8 cm)and width (3.56±1.32 cm ) .Histologically; Gall bladder in mallard has three main layers: tunica mucosa, tunica muscularis and tunica adventitia ,tunica mucosa which lined by simple columnar epithelium non-ciliated with goblet cells and the lamina propria-submucosa composed of loos connective tissue , tunica muscularis was a thick layer of muscles (smooth muscles) and adventitia made of loos connective tissue , while gall bladder of Gallus gallus domesticus has three layer; tunica mucosa, lamina propria -submucosa, tunica muscularis and adventitia , tunica mucosa which lined by simple columnar epithelia non- ciliated without goblet cells , with present lamina propria -submucosa fused with lamina propria ,and thin layer of tunica muscularis and adventitia made of loos connective tissue .

Effects of low-dose filtered kretek cigarette smoke on bronchial smooth muscle in male Sprague-Dawley rats

BackgroundKretek cigarettes contain less nicotine and tar than conventional cigarettes. Exposure to cigarette smoke occurs mainly in the respiratory tract, resulting in histometric changes. The aim of this study was to evaluate the effect of filtered kretek cigarette smoke on bronchial histometric measurements in male Sprague-Dawley rats. MethodsAn experimental laboratory study was conducted involving 18 male Sprague-Dawley rats, aged 2-3 months, ranging from 150 to 250 grams in body weight. They were randomized into group 1 (controls) and experimental groups 2 and 3. Group 2 was exposed to filtered cigarette smoke at a dose of 1 stick/day and group 3 to 2 sticks/day. Treatment time for all groups was 30 days. Observation of bronchial histometric measurements of the lumen include, length, width, area, and perimeter. In addition, the bronchial mucosal and smooth muscle layers were also measured. The one way-ANOVA test was used to analyze the data. ResultsThe mean area and mean perimeter of the bronchial lumen of the rats were significantly greater in group 1 than in groups 2 and 3 (p=0.000). The mean bronchial smooth muscle area of the rats in group 1 was smaller than the mean in group 2, which was in turn smaller than the mean in group 3 (p=0.000). Apparently the rats in the treatment groups had undergone bronchoconstriction. ConclusionExposure to filtered kretek cigarette smoke at a dose of 1 stick/day as well as 2 sticks/day for 30 days caused bronchial mucosal hyperplasia and bronchoconstriction in male rats.

Accurate Plane Fat Grafting in Gluteal Augmentation: An Anatomic Study.

The safety of gluteal fat grafting is a global concern in plastic surgery. The goal of this study was to test whether fat grafting to the buttocks with Auto Stop Reach (ASR) technology prevents penetration from the subcutaneous space into the fascia and muscle layers of the buttocks. Fat transfer simulation was performed with blue dye on 8 fresh tissue cadaver buttocks by 3 board-certified plastic surgeons (S.S.K., S.C., B.W.). An open control was utilized to visualize the process in the different anatomic layers, and all of the other procedures were performed blindly, akin to live surgery. After blue dye transfer reached maximum capacity (ranging from 400-800 mL per buttock), dissection of the anatomical layers of the buttocks was performed to determine the plane(s) of injection. Blue dye fat transfer injection to the buttocks did not penetrate the gluteal fascia or muscle layers from the subcutaneous space while using ASR. Auto Stop Reach technology supports the safety of gluteal fat transfer in the subcutaneous space by board-certified plastic surgeons.

Long-term aspirin administration suppresses inflammation in diabetic cystopathy.

Diabetic cystopathy (DCP) is one of the most common and troublesome urologic complications of diabetes mellitus, characterized by chronic low-grade inflammatory response. However, the correlation between inflammation and disease progression remains ambiguous and effective drugs interventions remain deficient. Herein, during 12-week study, 48 male Sprague-Dawley rats were randomly assigned to four groups: negative control (NC), NC treated with aspirin (NC+Aspirin), DCP, and DCP treated with aspirin (DCP+Aspirin). Type 1 diabetes mellitus was established by intraperitoneal injection of streptozotocin (65 mg/kg). After 2 weeks modeling, the rats in treatment groups received daily oral aspirin (100 mg/kg/d). After 10 weeks of treatment, aspirin ameliorated pathological weight loss and bladder weight increase in diabetic rats, accompanied by a 16.5% decrease in blood glucose concentrations. H&E, Masson, immunohistochemistry and transmission electron microscopy revealed that a dilated bladder with thickened detrusor smooth muscle (DSM) layer, inflammatory infiltration, fibrosis and ultrastructural damage were observed in diabetic rats, which were obviously ameliorated by aspirin. The dynamic investigations at 4, 7 and 10 weeks revealed inflammation gradually increased as the disease progresses. After 10 weeks of treatment, the expression of TNF-α, IL-1β, IL-6, and NF-κB has been decreased to 78%, 39.7%, 44.1%, 33.3% at mRNA level and 67.6%, 76.7%, 71.4%, 67.1% at protein level, respectively (DCP+Aspirin vs. DCP, p < 0.01). Aspirin partially restored the increased expression of inflammatory mediators in bladder DSM of diabetic rats. The study provided insight into long-term medication therapies, indicating that aspirin might serve as a potential strategy for DCP treatment.

Central role of ubiquitin-specific protease 8 in leptin signaling pathway in pulmonary arterial hypertension

Leptin receptor (ObR-b) is overexpressed in pulmonary artery smooth muscle cells (PA-SMCs) from patients with pulmonary arterial hypertension (PAH) and is implicated in both mechanisms that contribute to pulmonary vascular remodeling: hyperproliferation and inflammation. Our aim was to investigate the role of ubiquitin-specific peptidase 8 (USP8) in ObR-b overexpression in PAH. We performed in situ and in vitro experiments in human lung specimens and isolated PA-SMCs combined with 2 different in vivo models in rodents and we generated a mouse with an inducible USP8 deletion specifically in smooth muscles. Our results showed an upregulation of USP8 in the smooth muscle layer of distal pulmonary arteries from patients with PAH, and upregulation of USP8 expression in PAH PA-SMCs, compared to controls. USP8 inhibition in PAH PA-SMCs significantly blocked both ObR-b protein expression level at the cell surface as well as ObR-b-dependant intracellular signaling pathway as shown by a significant decrease in pSTAT3 expression. USP8 was required for ObR-b activation in PA-SMCs and its inhibition prevented Ob-mediated cell proliferation through STAT3 pathway. USP8 inhibition by the chemical inhibitor DUBs-IN-2 protected against the development of experimental PH in the 2 established experimental models of PH. Targeting USP8 specifically in smooth muscle cells in a transgenic mouse model also protected against the development of experimental PH. Our findings highlight the role of USP8 in ObR-b overexpression and pulmonary vascular remodeling in PAH.

Ecotoxicological effects of co-exposure biodegradable microplastics polylactic acid with cadmium are higher than conventional microplastics polystyrene with cadmium on the earthworm

Microplastics (MPs) are plastic fragments with particle sizes <5 mm, ubiquitously distributed in terrestrial environments. However, the negative effects of MPs, such as joint-pollution with heavy metals on soil fauna remain controversial. This study investigated survival rate, growth, reproduction, avoidance behavior, histology, biochemical assays, comet assay, qPCR, Cd content, and IBR index. We found that six types of traditional MPs (PC, PP, PVC, LDPE, PET and PS, and PLA (a biodegradable microplastics)) had no adverse effects on earthworm growth, survival and reproduction. Moreover, we found that earthworms exhibit an avoidance behavior towards PLA. Both PS and PLA can exacerbated Cd pollution, leading to loose circular muscle layer, DNA damage in coelomocytes, and impaired antioxidant system due to increased reactive oxygen species (ROS). mRNA level of HSP70 increased under joint-pollution of both PS and Cd or PLA and Cd compared to Cd treatment alone. MPs enhanced Cd accumulation in earthworms in Cd-contaminated soil. Notably, the Integrated Biomarkers Response index revealed that the toxicity of joint PLA and Cd was greater than the joint effect of PS and Cd, which might violate the original intention of biodegradable plastics having non-toxic influence on the soil fauna. Our findings provide new insights into the ecotoxicological effects of MPs, the joint ecotoxicological effects of MPs and Cd on earthworms, and the ecological risks of MPs to soil fauna.

ERG K+ channels mediate a major component of action potential repolarization in lymphatic muscle

Smooth muscle cells in the walls of collecting lymphatic vessels fire spontaneous action potentials (APs), which conduct rapidly over the muscle layer to initiate contractions that propel lymph. Several ion channels have been implicated in the currents underlying the AP spike and the preceding diastolic depolarization, but the molecular identities of K+ channels involved in AP repolarization are unknown. Based on previous studies of other rhythmically active smooth muscles, we hypothesized that ether-a-go-go related gene (ERG) K+ channels (Kv11) play an important role in repolarization of the AP in lymphatic muscle. Message for one or more ERG channel isoforms was detected by RT-PCR analysis of lymphatic vessels from mice, rats and humans. Membrane potential recordings in smooth muscle cells of rat and human lymphatics revealed that nanomolar concentrations of ERG-1 inhibitors (E-4031 and BeKm-1) prolonged the duration of the AP plateau (normally ~ 1 s in duration) and induced multiple spikes, whereas ERG-1 activators (ICA-105574 and RPR-260243) shortened the plateau and could completely inhibit spontaneous APs. At relatively high inhibitor concentrations, the AP plateau duration lasted as long as 24 s. ERG activators reversed the effects of ERG inhibitors and vice-versa. In pressure myograph studies, ERG channel inhibition prolonged the diastolic repolarization phase of the contraction cycle and reduced the frequency of spontaneous contractions. This is the first evidence for a specific K+ channel contributing to the AP in lymphatic muscle. Our results imply that lymphatic contractile dysfunction may occur in long QT type II patients with mutations that result in ERG channel loss-of-function or impaired trafficking of the channel to the cell membrane.

Connexin 37, 40, 43 and Pannexin 1 Expression in the Gastric Mucosa of Patients with Systemic Sclerosis.

Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis of the skin and internal organs. Although its pathogenesis is not fully understood, connexins (Cxs) and pannexins (Panx) could be involved in the process of fibrosis. We analyzed the protein expression of Cx37, Cx40, Cx43, and Panx1 in the gastric mucosa of patients with SSc and healthy volunteers, using immunofluorescence staining. Protein levels of Cx37 were slightly increased, while the levels of Cx40 were significantly decreased in the lamina propria of the gastric mucosa of SSc patients compared to the controls. The changes were proportional to SSc severity, with the most prominent changes found in patients with severe diffuse cutaneous SSc. No differences in Cx43 or Panx1 levels were found between the analyzed groups of samples. The lack of changes in Cx43 expression, which has been previously associated with fibrosis, could be due to the weak expression of Cx43 in the gastric mucosa in general. Further studies on full-thickness gastric biopsies containing muscle layers and animal SSc models are needed to fully elucidate the role of Cxs and Panxs in SSc-associated fibrosis.

Progesterone control of myometrial contractility

During pregnancy, the primary function of the uterus is to be quiescent and not contract, which allows the growing fetus to develop and mature. A uterine muscle layer, myometrium, is composed of smooth muscle cells (SMCs). Before the onset of labor contractions, the uterine SMCs experience a complex biochemical and molecular transformation involving the expression of contraction-associated proteins. Labor is initiated when genes in SMCs are activated in response to a combination of hormonal, inflammatory and mechanical signals. In this review, we provide an overview of molecular mechanisms regulating the process of parturition in humans, focusing on the hormonal control of the myometrium, particularly the steroid hormone progesterone. The primary reason for discussing the regulation of myometrial contractility by progesterone is the importance of the clinical problem of preterm birth. It is thought that the hormonal mechanisms regulating premature uterine contractions represent an untimely triggering of the normal events occurring during term parturition. Yet, our knowledge of the complex and redundant hormonal pathways controlling uterine contractile activity leading to delivery of the neonate remains incomplete. Finally, we introduce recent animal studies using a novel class of drugs, Selective Progesterone Receptor Modulators, targeting progesterone signaling to prevent premature myometrial contractions.

Effects of low-intensity extracorporeal shock wave therapy on lipopolysaccharide cystitis in a rat model of interstitial cystitis/bladder pain syndrome.

To investigate the effect of low-intensity extracorporeal shock wave therapy (LiESWT) on lipopolysaccharide (LPS)-induced cystitis in an animal model of interstitial cystitis/bladder pain syndrome (IC/BPS). Sprague-Dawley rats were divided into three groups: control, cystitis (LPS group, intravesical injection of LPS (1mg) twice), and cystitis with LiESWT (LiESWT group). On the third and fourth days, LiESWT was administered (0.12mJ/mm2, 300 shots each time) on the lower abdomen toward the bladder. On the seventh day, the rats underwent pain assessment and a metabolic cage study. Subsequently, a continuous cystometrogram (CMG) was performed under urethane anaesthesia. Immunohistochemical studies were also performed, including S-100 staining, an immunohistochemical marker of Schwann cells in the bladder. In the LPS group, the pain threshold in the lower abdomen was significantly lower than that in the control group. In the metabolic cage study, the mean voided volume in the LPS group significantly increased. The CMG also revealed a significant decrease in bladder contraction amplitude, compatible with detrusor underactivity in the LPS group. Immunohistochemical studies showed inflammatory changes in the submucosa, increased fibrosis, and decreased S-100 stain-positive areas in the muscle layer of the LPS group. In the LiESWT group, tactile allodynia and bladder function were ameliorated, and S-100 stain-positive areas were increased. By restoring nerve damage, LiESWT improved lower abdominal pain sensitivity and bladder function in an LPS-induced cystitis rat model. This study suggests that LiESWT may be a new therapeutic modality for IC/BPS.

World-first report of low anterior resection for rectal cancer with the hinotori™ Surgical Robot System: a case report

BackgroundThe hinotori™ Surgical Robot System was approved for use in colorectal cancer surgery in Japan in 2022. This robot has advantages, such as an operation arm with eight axes, an adjustable arm base, and a flexible three-dimensional viewer, and is expected to be utilized in rectal cancer surgery. Herein, we report the world's first surgery for rectal cancer using the hinotori™ Surgical Robot System.Case presentationA 71-year-old woman presented to our hospital with bloody stools. A colonoscopy revealed type 2 advanced cancer in the rectum, and a histological examination exposed a well-differentiated adenocarcinoma. Abdominal enhanced computed tomography divulged rectal wall thickening without significant swelling of the lymph nodes or distant metastasis. Pelvic magnetic resonance imaging showed tumor invasion beyond the intrinsic rectal muscle layer. The patient was diagnosed with cStage IIa (cT3N0M0) rectal cancer and underwent low anterior resection using the hinotori™ Surgical Robot System. Based on an adequate simulation, surgery was safely performed with appropriate port placement and arm base-angle adjustment. The operating time was 262 min, with a cockpit time of 134 min. Subsequently, the patient was discharged 10 days postoperatively without complications. The pathological diagnosis was pStage IIA (cT3N0M0) and the circumferential resection margin was 6 mm.ConclusionsWe report the first case of low anterior resection for rectal cancer using the hinotori™ Surgical Robot System, in which a safe and appropriate oncological surgery was performed.

Endoscopic diagnosis and treatment of superficial non-ampullary duodenal epithelial tumors: A review.

The surface of the small bowel mucosa is covered more than any other section of the digestive canal; however, the overall prevalence of small bowel tumors of the whole gastrointestinal tract is evidently low. Owing to the improvement in endoscopic techniques, the prevalence of small bowel tumors has increased across multiple countries, which is mainly due to an increase in duodenal tumors. Superficial non-ampullary duodenal epithelial tumors (SNADETs) are defined as tumors originating from the non-ampullary region in the duodenum that share similarities and discrepancies with their gastric and colorectal counterparts in the pathogenesis and clinicopathologic characteristics. To date, white light endoscopy (WLE) remains the cornerstone of endoscopic diagnosis for SNADETs. Besides, narrow-band imaging (NBI) techniques and magnifying endoscopy (ME) have been widely used in the clinic and endorsed by multiple guidelines and consensuses for SNADETs' evaluation. Confocal laser endomicroscopy (CLE), endocytoscopy (ECS), and artificial intelligence (AI) are also up-and-coming methods, showing an exceptional value in the diagnosis of SNADETs. Similar to the endoscopic treatment for colorectal polyps, the choices for SNADETs mainly include cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and laparoscopic endoscopic cooperative surgery (LECS). However, owing to the narrow lumen, rich vascularity, weak muscle layer, abundant Brunner's gland, and the hardship of endoscope control, the duodenum ranks as one of the most dangerous operating areas in the digestive tract. Therefore, endoscopists must anticipate the difficulties in endoscopic maneuverability, remain aware of the increased risk of complications, and then select the appropriate treatment according to the advantages and disadvantages of each method.