BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing...BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing(EPSS)has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects.However,details regarding the efficacy of endoscopic pre-purse-string suture(P-EPSS)are unknown,especially that it offers several advantages over conventional EPSS(C-EPSS).AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations,and evaluate the efficacy of P-EPSS.METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS(n=63)or C-EPSS(n=117)between July 2014 and June 2020.The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size,location,and morphology,incidence of complete closure,intraoperative perforation,and delayed adverse events were evaluated.Data on the features and clinical course of cases with adverse events were collected for further analysis.RESULTS Patients with lesion size larger than 3 cm,lesions located at the fundus of stomach,or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure.The P-EPSS group showed a significantly higher proportion of intraoperative perforation(56%vs 17%)and a much shorter procedure time(9.06±6.14 min vs 14.84±7.25 min).Among adverse events,the incidence of delayed perforation(5%vs 4%;P=0.82)and delayed bleeding(3%vs 4%;P=0.96)did not differ significantly between the groups.Multivariate analysis revealed that lesions with incomplete closure[odds ratio(OR)=21.33;95%confidence interval(CI):5.45-83.45;P<0.01]or size greater than 3 cm(OR=3.14;95%CI:1.08-9.18;P=0.039)showed a statistical tendency to result in an increase in delayed adverse events.CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect.PEPSS could shorten the procedure and yield complete closure of mucosal defects.Rather than closure-type selection,incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.展开更多
BACKGROUND Secure transluminal closure remains a fundamental barrier to endoscopic surgery.It has been reported that through-the-scope clips were used to secure the incision of the gallbladder during natural orifice t...BACKGROUND Secure transluminal closure remains a fundamental barrier to endoscopic surgery.It has been reported that through-the-scope clips were used to secure the incision of the gallbladder during natural orifice transluminal endoscopic cholecystolithotomy and were left in the body post-operation.The over-the-scope clip(OTSC)is favored for its rapid deployment and strong anchoring capabilities.Nevertheless,OTSCs are difficult to remove once implanted.The Senscure Biotechnology in China has developed a detachable over-the-scope clip(D-OTSC)for this purpose.Here,we utilized the D-OTSC to successfully close a full-thickness sigmoid defect exceeding 1 cm in diameter.Subsequently,the clip was completely removed postoperatively,yielding favorable clinical outcomes.CASE SUMMARY We present the case of a 51-year-old female patient who underwent natural orifice transluminal endoscopic cholecystolithotomy.The sigmoid incision was closed using a D-OTSC.Postoperative recovery was uneventful,with no abdominal infection or bleeding.The D-OTSC was subsequently removed via enteroscopy in the outpatient department one month later.CONCLUSION The utilization of D-OTSC presents a viable option for closing colonic mucosal incisions ranging from 1 cm to 2 cm.展开更多
Recently,the high incidence of oral mucosal defects and the subsequent functional impairments have attracted widespread attention.Controlling scaffold geometry pattern has been proposed as a strategy to promote cell b...Recently,the high incidence of oral mucosal defects and the subsequent functional impairments have attracted widespread attention.Controlling scaffold geometry pattern has been proposed as a strategy to promote cell behavior and facilitate soft tissue repair.In this study,we innovatively construct an integrated dual-layer heterogeneous polycaprolactone(PCL)scaffold using melt electrowriting(MEW)technology.The outer layer was disordered,while the inner layer featured oriented fiber patterns:parallel(P-par),rhombic(P-rhomb),and square(P-sq).Our findings revealed that the P-rhomb and P-sq scaffolds exhibited superior surface wettability,roughness,and tensile strength compared to the pure disordered PCL scaffolds(P)and P-par.Compared to the commercial collagen membranes,the outer layer of PCL can effectively inhibit bacterial adhesion and biofilm formation.Furthermore,the P-rhomb and P-sq groups demonstrated higher gene and protein expression levels related to cell adhesion and cell migration rates than did the P and P-par groups.Among them,P-sq plays an important role in inducing the differentiation of gingival fibroblasts into myofibroblasts rich inα-smooth muscle actin(α-SMA).Additionally,P-sq could reduce inflammation,promote epithelial regeneration,and accelerate wound healing when used in full-thickness oral mucosal defects in rabbits.Overall,the integrated dual-layer heterogeneous PCL scaffold fabricated by MEW technology effectively inhibited bacterial adhesion and guided tissue regeneration,offering advantages for clinical translation and large-scale production.This promising material holds important potential for treating full-thickness mucosal defects in a bacteria-rich oral environments.展开更多
Organismal survival depends on a well-balanced immune system and maintenance of host–microbe mutualism.The finetuned relationship between the gut microbiota and host immunity is constantly challenged by opportunistic...Organismal survival depends on a well-balanced immune system and maintenance of host–microbe mutualism.The finetuned relationship between the gut microbiota and host immunity is constantly challenged by opportunistic bacteria testing the integrity of gastrointestinal(GI)barrier defenses.Barrier dysfunction reduces immunological tolerance towards otherwise innocuous microbes;it is a process that may instigate chronic inflammation.Paradoxically,sustained inflammation further diminishes barrier function,enabling bacterial translocation to extra-intestinal tissues.Once translocated,these bacteria stimulate systemic inflammation,thereby compromising organ function.While genetic risk alleles associate with barrier dysfunction,environmental stressors are key triggers of GI inflammation and associated breakdown in immune tolerance towards resident gut microbes.As dietary components dictate substrate availability,they also orchestrate microbiota composition and function,including migratory and pro-inflammatory potential,thus holding the capacity to fuel both GI and extra-intestinal inflammation.Additionally,Western diet consumption may weaken barrier defenses via curbed Paneth cell function and diminished host-defense peptide secretion.This review focuses on intervenable niches of host–microbe interactions and mucosal immunity with the ambition to provide a framework of plausible strategies to improve barrier function and regain tolerance in the inflamed mucosa via nutritional intervention.展开更多
基金the National Natural Science Foundation of China,No.82172737 and 82003277Shanghai Municipal Education Commission,No.16411950403 and 19411951605。
文摘BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing(EPSS)has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects.However,details regarding the efficacy of endoscopic pre-purse-string suture(P-EPSS)are unknown,especially that it offers several advantages over conventional EPSS(C-EPSS).AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations,and evaluate the efficacy of P-EPSS.METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS(n=63)or C-EPSS(n=117)between July 2014 and June 2020.The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size,location,and morphology,incidence of complete closure,intraoperative perforation,and delayed adverse events were evaluated.Data on the features and clinical course of cases with adverse events were collected for further analysis.RESULTS Patients with lesion size larger than 3 cm,lesions located at the fundus of stomach,or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure.The P-EPSS group showed a significantly higher proportion of intraoperative perforation(56%vs 17%)and a much shorter procedure time(9.06±6.14 min vs 14.84±7.25 min).Among adverse events,the incidence of delayed perforation(5%vs 4%;P=0.82)and delayed bleeding(3%vs 4%;P=0.96)did not differ significantly between the groups.Multivariate analysis revealed that lesions with incomplete closure[odds ratio(OR)=21.33;95%confidence interval(CI):5.45-83.45;P<0.01]or size greater than 3 cm(OR=3.14;95%CI:1.08-9.18;P=0.039)showed a statistical tendency to result in an increase in delayed adverse events.CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect.PEPSS could shorten the procedure and yield complete closure of mucosal defects.Rather than closure-type selection,incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.
基金Supported by Natural Science Foundation of Fujian Province,China,No.2021J01545.
文摘BACKGROUND Secure transluminal closure remains a fundamental barrier to endoscopic surgery.It has been reported that through-the-scope clips were used to secure the incision of the gallbladder during natural orifice transluminal endoscopic cholecystolithotomy and were left in the body post-operation.The over-the-scope clip(OTSC)is favored for its rapid deployment and strong anchoring capabilities.Nevertheless,OTSCs are difficult to remove once implanted.The Senscure Biotechnology in China has developed a detachable over-the-scope clip(D-OTSC)for this purpose.Here,we utilized the D-OTSC to successfully close a full-thickness sigmoid defect exceeding 1 cm in diameter.Subsequently,the clip was completely removed postoperatively,yielding favorable clinical outcomes.CASE SUMMARY We present the case of a 51-year-old female patient who underwent natural orifice transluminal endoscopic cholecystolithotomy.The sigmoid incision was closed using a D-OTSC.Postoperative recovery was uneventful,with no abdominal infection or bleeding.The D-OTSC was subsequently removed via enteroscopy in the outpatient department one month later.CONCLUSION The utilization of D-OTSC presents a viable option for closing colonic mucosal incisions ranging from 1 cm to 2 cm.
基金funded by the Key Research and Development Program of Zhejiang Province(2021C03059 and 2024C03081)the National Natural Science Foundation of China(81801024)the Research and Development Project of Stomatology Hospital Zhejiang University School of Medicine(RD2023JXXK01).
文摘Recently,the high incidence of oral mucosal defects and the subsequent functional impairments have attracted widespread attention.Controlling scaffold geometry pattern has been proposed as a strategy to promote cell behavior and facilitate soft tissue repair.In this study,we innovatively construct an integrated dual-layer heterogeneous polycaprolactone(PCL)scaffold using melt electrowriting(MEW)technology.The outer layer was disordered,while the inner layer featured oriented fiber patterns:parallel(P-par),rhombic(P-rhomb),and square(P-sq).Our findings revealed that the P-rhomb and P-sq scaffolds exhibited superior surface wettability,roughness,and tensile strength compared to the pure disordered PCL scaffolds(P)and P-par.Compared to the commercial collagen membranes,the outer layer of PCL can effectively inhibit bacterial adhesion and biofilm formation.Furthermore,the P-rhomb and P-sq groups demonstrated higher gene and protein expression levels related to cell adhesion and cell migration rates than did the P and P-par groups.Among them,P-sq plays an important role in inducing the differentiation of gingival fibroblasts into myofibroblasts rich inα-smooth muscle actin(α-SMA).Additionally,P-sq could reduce inflammation,promote epithelial regeneration,and accelerate wound healing when used in full-thickness oral mucosal defects in rabbits.Overall,the integrated dual-layer heterogeneous PCL scaffold fabricated by MEW technology effectively inhibited bacterial adhesion and guided tissue regeneration,offering advantages for clinical translation and large-scale production.This promising material holds important potential for treating full-thickness mucosal defects in a bacteria-rich oral environments.
基金supported by the Novo Nordisk Foundation[grant number:NNF17OC0026698].
文摘Organismal survival depends on a well-balanced immune system and maintenance of host–microbe mutualism.The finetuned relationship between the gut microbiota and host immunity is constantly challenged by opportunistic bacteria testing the integrity of gastrointestinal(GI)barrier defenses.Barrier dysfunction reduces immunological tolerance towards otherwise innocuous microbes;it is a process that may instigate chronic inflammation.Paradoxically,sustained inflammation further diminishes barrier function,enabling bacterial translocation to extra-intestinal tissues.Once translocated,these bacteria stimulate systemic inflammation,thereby compromising organ function.While genetic risk alleles associate with barrier dysfunction,environmental stressors are key triggers of GI inflammation and associated breakdown in immune tolerance towards resident gut microbes.As dietary components dictate substrate availability,they also orchestrate microbiota composition and function,including migratory and pro-inflammatory potential,thus holding the capacity to fuel both GI and extra-intestinal inflammation.Additionally,Western diet consumption may weaken barrier defenses via curbed Paneth cell function and diminished host-defense peptide secretion.This review focuses on intervenable niches of host–microbe interactions and mucosal immunity with the ambition to provide a framework of plausible strategies to improve barrier function and regain tolerance in the inflamed mucosa via nutritional intervention.
