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Background and Study Aims: Although peroral endoscopic myotomy (POEM) is credited with high success rates in the treatment of achalasia, persistent/recurrent symptoms may occasionally develop afterwards. Our purpose was to evaluate the feasibility, safety, and efficacy of repeat peroral endoscopic myotomy (Re-POEM) as salvage therapy after initial POEM failure.Patients and Methods: Fifteen patients with persistence/recurrence of symptoms after previous POEM (Eckardt symptom score ≥ 4) were retrospectively selected from a prospectively maintained database housing a total of 1454 consecutive patients with achalasia. The primary endpoint was symptom relief during follow-up, defined by an Eckardt score of ≤ 3. Secondary outcome measures were procedure-related adverse events, change in manometric lower esophageal sphincter (LES) pressure, and reflux symptoms before and after Re-POEM.Results: All patients underwent successful Re-POEM a mean of 13.5 months (range 4 - 37 months) after execution of their primary POEM procedures. Mean operative time was 41.5 minutes (range 28 - 62 minutes). One instance of submucosal tunnel infection was successfully managed with conservative treatment. During a mean follow-up period of 11.3 months (range 3 - 18 months), therapeutic success was achieved in all patients. The mean symptom score pretreatment was 5.6 (range 4 - 8), compared with a post-treatment mean of 1.2 (range 0 - 3; P < 0.001). Mean LES pressure also declined from 25.0 mmHg to 9.5 mmHg after Re-POEM (P < 0.001). The overall clinical reflux complication rate of Re-POEM was 33.3 %.Conclusions: Re-POEM appears safe and effective as a salvage option after initial POEM failure, conferring short-term symptom relief and being free of serious complications in all patients. [ABSTRACT FROM AUTHOR]

Worldwide, peroral endoscopic myotomy (POEM) has achieved remarkable initial outcomes in the treatment of achalasia. In China, POEM has developed very quickly since the first case was performed in our center in August 2010. With experience, we have successfully performed POEM for special cases (such as pediatric patients, patients with sigmoidtype esophagus, and patients with recurrent symptoms after previous surgery) and have altered our technique to achieve long-term symptom remission and simplify the POEM procedure. These changes include posterior wall incision, full-thickness myotomy, a “push-and-pull” technique for myotomy, and water-jet assisted POEM. In this article, our experiences in POEM are summarized, including changes in technique, applications of the procedure, and the management of possible complications. [ABSTRACT FROM AUTHOR]

Background: Rapamycin is an attractive approach for the treatment and prevention of HCC recurrence after liver transplantation. However, the objective response rates of rapamycin achieved with single-agent therapy were modest, supporting that rapamycin resistance is a frequently observed characteristic of many cancers. Some studies have been devoted to understanding the mechanisms of rapamycin resistance, however, the mechanisms are cell-type-dependent and studies on rapamycin resistance in HCC are extremely limited. Methodology/Principal Findings: The anti-tumor sensitivity of rapamycin was modest in vitro and in vivo. In both human and rat HCC cells, rapamycin up-regulated the expression and phosphorylation of PDGFRb in a time and dose-dependent manner as assessed by RT-PCR and western blot analysis. Using siRNA mediated knockdown of PDGFRb, we confirmed that subsequent activation of AKT and ERK was PDGFRb-dependent and compromised the anti-tumor activity of rapamycin. Then, blockade of this PDGFRb-dependent feedback loop by sorafenib enhanced the anti-tumor sensitivity of rapamycin in vitro and in an immunocompetent orthotopic rat model of HCC. Conclusions: Activation of PI3K/AKT and MAPK pathway through a PDGFRβ-dependent feedback loop compromises the anti-tumor activity of rapamycin in HCC, and blockade of this feedback loop by sorafenib is an attractive approach to improve the anti-tumor effect of rapamycin, particularly in preventing or treating HCC recurrence after liver transplantation. [ABSTRACT FROM AUTHOR]

The article presents case study of a 11-month-old girl who had been delivered at full term and had showed normal growth and development features in the first five months, and mentions that later when the patient showed symptoms such as vomiting, cough and fever, achalasia was diagnosed. [ABSTRACT FROM AUTHOR]

In this paper, a unified approach for studying block-structured fluid models is proposed by means of the RG -factorization. When the stochastic environment (or background) is assumed to be a quasi-birth-and death (QBD) process, with either infinitely many levels or finitely many levels, the Laplace transform for the stationary probability distribution of the buffer content is expressed in terms of the R -measure. At the same time, the Laplace-Stieltjes transforms for both the conditional distribution and the conditional mean of a first passage time in such a fluid queue are derived by the same approach. [ABSTRACT FROM AUTHOR]

The article discusses submucosal fibrosis in achalasia patients followed by the causes and impact on peroral endoscopic myotomy (POEM).

Background and aims Peroral endoscopic myotomy (POEM) is now an established treatment for esophageal achalasia. The standard protocol ensures a smooth operation in most patients, but technical challenges and failures exist and little is known about the incidence, causes, and impact of aborted procedures. Here, using a large patient cohort, we attempted to answer these questions. Methods All patients admitted for planned POEM between August 2010 and July 2015 underwent chart review. Aborted POEM was defined as the inability to finish the procedure after submucosal injection. The cause of the failure, clinical course, management, and follow-up data were analyzed. Results Thirteen of the 1693 POEMs (0.77 %) were aborted. Out of the 13 failures, 12 (92.3 %) were due to severe submucosal fibrosis, which precluded tunneling, and one (7.7 %) was due to atrial fibrillation related to the electric current of the endoscopic knife. Submucosal fibrosis, prior Heller myotomy, and age ( ≥ 60 years) were related to technical failure, while a disease duration of ≥ 6 years, sigmoid esophagus, mucosal edema, and prior interventions were risk factors for the presence of fibrotic changes. In turn, fibrosis was correlated with a prolonged operation, longer hospital stay, more mucosal injuries, and more major perioperative adverse events. Finally, the yearly frequency of aborted POEMs decreased after the second year as operators became more experienced. Conclusions Aborted POEM is a rare event and is largely due to the presence of submucosal fibrosis, which not only causes increased procedural difficulties, but also gives rise to major adverse events. [ABSTRACT FROM AUTHOR]

The hydronephrotic kidney, resulting from a ureteropelvic junction obstruction (UPJO), presents commonly as a clinical condition, with the presence of usually no more than 1-2 liters in the collecting system, but a very small number of cases of giant hydronephroses (GHs) has been reported in adults. A GH is defined as the adult renal pelvis containing >1 liter of urine, or at least 1.5% of the body weight. In the majority of cases, the range of the hydronephrotic kidney remains restricted to the renal area. However, the patient described in the present case report had a range for the hydronephrotic kidney which occupied almost the entire abdominal cavity (~24 l), and cases such as these are rarely presented; therefore the aim of the present case study was to document a clear case of GH resulting from UPJO, also accompanied by a review of the current literature. [ABSTRACT FROM AUTHOR]

Background and Study Aims: Submucosal tunneling endoscopic resection (STER) has become a potential option for the endoscopic treatment of a selected group of patients with submucosal tumors (SMTs) originating from the muscularis propria layer in the upper gastrointestinal tract. The aim of this retrospective study was to analyze the incidence and management of STER-related complications.Patients and Methods: From January 2011 to August 2013, 290 patients with upper gastrointestinal SMTs treated by STER were included in the study. Clinicopathological characteristics and complication data were collected and analyzed retrospectively.Results: Mucosal injury occurred in three cases (1.0 %) and major bleeding occurred in five cases (1.7 %). The gas-related complications were very common; however, only nine cases of major pneumothorax (> 30 % lung collapse) needed therapeutic intervention (3.1 %). Thoracic effusion occurred in 49 patients, 11 of whom had low grade fever or segmental atelectasis that required thoracentesis and drainage (3.8 %). Thus, although the overall incidence of complications was 23.4 % (68/290), only 10.0 % of procedures (29/290) required intervention for complications. Based on the statistical analysis, irregular shape, tumor in the deep muscularis propria layer, long procedure time, and air insufflation were risk factors of STER-related major complications.Conclusion: Although the incidence of STER-related complications was relatively high, most of these complications were minor and did not require therapeutic intervention. STER is a safe technique for the treatment of upper gastrointestinal SMTs. [ABSTRACT FROM AUTHOR]

Background: Growing evidence suggests that arsenic trioxide (As2O3) induces apoptosis and inhibits tumor cell growth in prostate cancer (PCa), although details of the mechanism are still inconclusive. We investigated the antitumor effect of As2O3 in human PCa cell lines LNCaP and PC3 and the underlying mechanisms by focusing on the Wnt signaling pathway. Methods: The effect of As2O3 on the viability and apoptosis of PCa cells was investigated by cholecystokinin-8 and flow cytometry. The expression of the related proteins in the Wnt signaling pathway and the downstream target genes of the Wnt signaling pathway was examined by Western blot and quantitative real-time PCR assay. The methylation status of the SFRP1 gene promoter was assessed by bisulfite sequencing. Results: As2O3 inhibited the viability of PCa cells and induced apoptosis of PCa cells in a dosedependent manner. The protein level of phospho-glycogen synthase kinase-3β was upregulated, whereas the protein level of β-catenin and the mRNA levels of c-MYC, MMP-7, and COX-2 were downregulated in a dose-dependent manner in PCa cells treated with As2O3. In addition, As2O3 upregulated the protein and mRNA levels of secreted frizzled related protein-1, and increased the demethylation of the SFRP1 gene promoter. Conclusion: Our results suggest that As2O3 may inhibit cell viability and induce apoptosis through reactivating the Wnt inhibitor secreted frizzled related protein-1 in both androgendependent and -independent human PCa. [ABSTRACT FROM AUTHOR]

Objective: The objective was to evaluate the clinical value of submucosal tunneling endoscopic resection (STER) for the treatment of submucosal tumors (SMTs) originating from the muscular propria (MP) in the rectum. Patients and Methods: The clinicopathological data of 12 cases with rectal SMTs originating from the MP layer performed STER in our center from January 2012 to June 2014 were analyzed retrospectively. Results: Three males and nine females (M/F, 1/3) were studied in this series. The median age of the patients was 53.5 (range, 41-84) years. The tumors located 5-10 cm from the anal verge. En bloc STER was performed successfully in all of the 12 cases. The median size of resected specimens was 1.4 cm (range 1.0-3.0 cm). The median procedure time was 49.5 min (range 40-70 min). Three patients developed low fever after the operation and were all recovered after receiving intravenous antibiotics. One of these three cases developed mucosa perforation, which was closed immediately with metal clips. One patient developed subcutaneous emphysema in one lower limb, which disappeared with conservative treatments 2 weeks after the STER procedure. The median hospital stays were 3.1 (range 2-8) days. Postoperative pathological outcomes revealed schwannoma in 3 cases, leiomyoma in 2 cases, stromal tumor in 5 cases, and proliferation of collagen fibers nodular degeneration in 2 cases. No lesion residual or recurrence was found during postoperative follow-up of 4-33 months. Conclusion: STER is a feasible, safe, and effective method for treating SMTs originating from the MP layer in the rectum. [ABSTRACT FROM AUTHOR]

Endoscopic resection of colonic submucosal tumors (SMTs) is challenging and carries a high risk of perforation. In this prospective pilot study we aimed to evaluate the feasibility, safety, and efficacy of endoscopic full-thickness resection of colonic SMTs. The study enrolled 19 consecutive patients with colonic SMTs 3cmin size or smaller. In 18 of the 19 patients full-thickness resection was carried out endoscopically with the entire tumor capsule intact. In 16 of these18 patients, fullthickness resection was carried out and the colonic wall defect closed all endoscopically; in the other 2 patients, laparoscopic closure was needed. Two cases of local peritonitis were managed with conservative treatment. No deaths occurred within 30 days, and no recurrence was detected after a median of 18 months' follow-up. Endoscopic full-thickness resection is a novel method enabling resection of colonic SMTs. The colonic wall mucosal defect can be closed endoscopically in the majority of cases. It appears to be a safe and effective endoscopic technique for managing these tumors, which traditionally are managed by colonic resection. [ABSTRACT FROM AUTHOR]

The article provides information on a study which investigated the expression and role of CD151, a hydrophobic protein, and/or N-methyl-N'-nitro-N-nitroso-guanidine (MET) protein (c-MET) in intraheptic cholangiocarcinoma (ICC). A review of the related literature on ICC and transmembrane 4 superfamily (TM4SF) proteins is offered. It describes the methods utilized by the research authors. The findings of the study are discussed in detail. It observes the implication of overexpression of CD151 in metastasis/invasion of ICC.