Scan the quick response (QR) code to the left with your mobile device to watch this article's video abstract and others. Don't have a QR code reader? Get one by searching 'QR Scanner' in your mobile device's app store. E ndoscopic submucosal dissection (ESD) is an expert endoscopic technique for en bloc resection of mucosal cancers in the esophagus, stomach, and colon. 1-3 During the procedure, the ESD operator must concentrate on the endoscopy monitor to avoid complications and to complete the treatment. However, in some situations, it becomes difficult to operate the endoscope during ESD, and the operator may be forced to view the monitor from a difficult posture. When performing ESD, the operator must also monitor the patient's vital signs carefully. This sometimes requires the operator to turn his or her eyes from the endoscopy monitor to the vital signs monitor. At such times, the operator's concentration on the endoscopy monitor can be disturbed during ESD.A head-mounted display (HMD) augments the visual world and aids in visual task completion. Some clinical studies have reported that an HMD is useful in laparoscopic surgery. The HMD provides freedom from gazing at a stationary monitor, which improves the surgeon's ergonomic position. 4 A high-resolution HMD in laparoscopic surgery can offer significantly better image quality and allow faster task performance than an overhead display. 5 We have performed ESD using a high-resolution HMD, which allows us to focus on the endoscopy monitor more easily, and we have evaluated the efficacy of using the HMD in ESD. Description of TechnologyFor the purpose of this study, we used a medical HMD system (HMM 300MT; Sony, Tokyo, Japan) that has been developed for laparoscopic surgery. In this system, the HMD image processing unit is connected to an endoscopic camera. The ESD operator can wear the device and continue to move his or her body freely and flexibly. A gap was created at the bottom of the device to enable the wearer to view both the images inside the HMD and the area immediately below them with the smallest of eye movements (Figure 1). The image quality of the HMD was superior to that of a standard monitoring display because the new unit maximizes the technological advantages of organic light-emitting diode panels to provide an extremely detailed image representation of the target area. This product is also equipped with a picture-inpicture feature, which enables a second image to show in a window while the image from the endoscope is kept as the main image. Video DescriptionThe HMD does not require the operator performing ESD to turn the eyes to the primary display outside the HMD. In conventional ESD, the operator generally checks the images on an external monitor during ESD, which restricts the operator's posture and movement in some cases. However, the HMD enables the operator to position himself or herself flexibly while performing ESD, which supports smooth workflow procedures. The operator's view during ESD is Figure 1. The endoscopic submucosal dissect...
xidative modification of lipoproteins has been implicated in the formation of early lesions of atherosclerosis 1 and several lines of evidence support a role for oxidative stress and inflammation in atherogenesis. 2 The oxidizability of low-density lipoprotein (LDL) ex vivo is reportedly enhanced in men with an increased risk for developing atherosclerosis, such as those with hypertension, hypercholesterolemia, diabetes mellitus and smoking, as well as in patients with coronary heart diseases. [3][4][5][6][7][8][9] However, the intensity of the oxidative stress in the presence of various kinds of risk factor has not yet been compared. Vitamin E is the most readily available naturally occurring, lipid-soluble antioxidant, although other antioxidants such as flavonoids are also potent. 10,11 Vitamin E is consumed when LDL is oxidized 10 and among the vitamin E or tocopherol family the biological activity of -tocopherol is highest. As exhaustion of the -tocopherol concentration by increased lipid oxidative stress, such as free radical production, should cause a low serum concentration of this antioxidant, the -tocopherol status may provide an indirect marker or mirror image of the extent of oxidative stress.To determine whether oxidative stress is actually accentuated, the serum concentration of -tocopherol was compared between apparently healthy subjects with and without various coronary risk factors such as smoking, hypertension, dyslipidemia, glucose intolerance and obesity. Methods Study PatientsThe studied population comprised town workers in Daioh, Shima county, Mie-prefecture, Japan and staff members of its related institute (Yuyuen) who underwent an annual medical examination in 2002. Of 257 subjects 189 agreed to participate in this study: 6 of these subjects on vitamin E supplementation were excluded and samples from 13 other subjects were not studied because of technical problems related to hemolysis or insufficient serum; 2 subjects with suspected systemic disease or complications were excluded. Finally 168 apparently healthy subjects, comprising 73 men and 95 women with a mean age of 42± 11 years (range: 20-73 years), were selected for the study. Subjects who were under treatment with medications for hypertension (14), hyperlipidemia (3) or diabetes mellitus (1), were included unless complications were present. Patients receiving insulin treatment or with hemoglobin A1C >7.0% were not included, nor were patients receiving antioxidants or lipid-lowering drugs. Written informed consent was obtained from all the participants and the study protocol was approved by the ethics committee of the institute. Serum AnalysisVenous samples were obtained after overnight fasting. Methods and ResultsTo examine whether oxidative stress is increased in the presence of various coronary risk factors, serum -tocopherol concentrations were determined in 168 apparently healthy subjects recruited from Daioh town (73 men and 95 women, mean age: 42±11 years). The -tocopherol concentration (mg/g lipids) was significantly lower ...
A woman, aged 78, was admitted to hospital for endoscopic balloon dilatation of a tight esophageal stricture caused by reflux esophagitis. As the stricture was difficult to dilate and she refused surgery, she was treated by placement of a self-expanding metal stent. After the procedure, dysphagia resolved and the patient returned to a normal diet. Although she remained asymptomatic, upper gastrointestinal endoscopy was repeated after 29 months. Within the stent, the patient had an elevated and somewhat nodular lesion that extended from the proximal to the distal end of the stent (Fig. 1). Biopsies only revealed inflammatory tissue. The unusual mucosal bridge was also shown on a barium swallow X-ray (Fig. 2). This inflammatory bridge seems likely to be an unusual tissue reaction to the presence of the metallic stent.There is only limited information on the use of self-expanding metal stents for the treatment of benign esophageal strictures. One issue is the type of stent because there is variation in the potential for endoscopic extraction. After stent placement, most patients experience good relief from dysphagia. Early complications appear to be uncommon but include chest pain and stent migration. The latter may also occur after weeks or months. Additional late complications include the development of strictures at the ends of the stent, usually the proximal end. This appears to be due to mucosal hypertrophy and granulation tissue, presumably caused by irritation from the stent. An extension of this process seems likely to have resulted in the mucosal bridge illustrated below. Rare complications include erosion of the stent through the esophageal wall or into the aorta with the development of infections or severe bleeding, respectively.
The relationship between host immune state and hepatic inflammation and infection pattern of the Duck hepatitis B virus (DHBV) was investigated by experimental transmission of DHBV into 98 Japanese 7-day-old ducklings that had been pretreated with immunoregulatory drugs including cyclophosphamide, OK 432, and a steroid hormone. Immunosuppressive treatment with cyclophosphamide revealed an extension of the viremic period associated with an absence of inflammatory changes in the liver. Although immunostimulating treatment with OK 432 showed a remarkable accumulation of inflammatory cells in the liver, the viremic period was not shortened. Treatment with a steroid used as a immunosuppressant did not suppress the hepatitis; moreover, it increased viral DNA replication and extended the viremic period. This phenomenon of viral replication seemed to be caused by the direct effects of the steroid. Alteration of DHBV infection by modifying the host immune state is quite similar to that of hepatitis B virus (HBV) in humans. In DHBV infection, the host immune state seemed to have a considerable role in determining the infection pattern and degree of hepatitis activity. DHBV may be a helpful model of HBV for studying host-viral interaction and the immunological mechanism of viral hepatitis.
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