Objective To investigate the diagnostic value of narrow?band imaging in patients with nonampullary duodenal superficial elevated lesions. Methods Analysis were limited to respondents diagnosed with nonampullary duodenal superficial elevated lesions on endoscopic examination. The lesion distribution, fusion, diameter, vascular and surface pattern were evaluated and compared with NBI mode according to pathological group. Results 72 cases were collected, 35 (48.61%) cases were inflammation, 17 (23.61%) cases were heterotopic gastric mucosa, 12 (16.67%) cases were gastric duodenal metaplasia and 8 (11.11%) cases were adenoma. Among the four types of duodenal lesion, solitary adenomatous lesions were observed more frequently and larger in diameter. Surface pattern of inflammatory lesions were consistent with the surrounding mucosa. Vascular pattern and fusion may be helpful to differential some superficial elevated lesions. Conclusion Nonampullary duodenal superficial elevated lesions can be identified preliminarily by NBI. Meanwhile, diagnosis accuracy and positive rate can be improved by target biopsy.

Objective To study the clinical efficacy and safety of endoscopic selective varies devascularization prospectively. Methods 180 cases of cirrhosis with esophagogastric variceal endoscopic treatment were included in the prospective analysis. They were treated with selective source of blood vessel devascularization using modified sandwich method (lauromacrogol-tissue adhesive-saline). The improvement rates, effective rates, significant effective rates, rebleeding rates and rates of complications were observed. Results One month after treatment, the significant effective rate of varices was 67.8% (122/180), effective rate was 30.0% (54/180), inefficient rate was 2.2% (4/180) and improvement rate was 97.8% (176/180). Within two weeks after treatment, the rebleeding rate was 3.3% (6/180). Within three months after treatment, the rebleeding rate was 7.2% (13/180). No serious complications occurred. The incidence of overall complication was 37.8% (68/180). Conclusion Endoscopic selective varies devascularization has good efficacy and safety, and is worth promoting.

Clinical practice using associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) or its modified procedures in treatment of primary hepatocellular carcinoma(HCC) with insufficient future liver remnant(FLR) in the past 10 years has failed to meet our expectations both in achieving decreased perioperative complications and mortality.The efficacy of ALPPS in improving long-term survival outcome of HCC still remains poor.Due to the trauma of two surgery within a short period,and patients with inadequate FLR are all diagnosed at advanced disease stages,ALPPS can only achieve surgical rather than biological tumor-curability.Previous studies have demonstrated comparable 5-year survival rates between early and advanced stages of HCC who underwent regional treatments.Therefore,tumor biological conversion is the key strategy prior to liver remnant volume conversion in improving treatment outcomes for HCC patients with insufficient FLR.Target therapy,immunotherapy together with locally treatment were expected to improve the conversion efficacy.Looking back at the development of ALPPS for the last decade,the rapid proliferation of FLR should be passed on,while the technology costs high risks and result in poor long-term outcome must be cautiously selected.
Carcinoma, Hepatocellular/surgery* ; Hepatectomy ; Humans ; Ligation ; Liver ; Liver Neoplasms/surgery* ; Portal Vein/surgery* ; Technology ; Treatment Outcome

OBJECTIVETo develop a specific SARS virus-targeted antibody preparation for emergent prophylaxis and treatment of SARS virus infection.

METHODSBy using phage display technology, we constructed a naive antibody library from convalescent SARS patient lymphocytes. To obtain the neutralizing antibody to SARS virus surface proteins, the library panning procedure was performed on purified SARS virions and the specific Fab antibody clones were enriched by four rounds of repeated panning procedure and screened by highthroughput selection. The selected Fab antibodies expressed in the periplasma of E. coli were soluble and further purified and tested for their binding properties and antiviral function to SARS virus. The functional Fab antibodies were converted to full human IgG antibodies with recombinant baculovirus/insect cell systems and their neutralizing activities were further determined.

RESULTSAfter four rounds of the panning, a number of SARS-CoV virus-targeted human recombinant Fab antibodies were isolated from the SARS patient antibody library. Most of these were identified to recognize both natural and recombinant SARS spike (S) proteins, two Fab antibodies were specific for the virus membrane (M) protein, only one bound to SARS-CoV nucleocapsid protein. The SARS-CoV S and M protein-targeted Fab or IgG antibodies showed significant neutralizing activities in cytopathic effect (CPE) inhibition neutralization test, these antibodies were able to completely neutralize the SARS virus and protect the Vero cells from CPE after virus infection. However, the N protein-targeted Fab or IgG antibodies failed to neutralize the virus. In addition, the SARS N protein-targeted human Fab antibody reacted with the denatured N proteins, whereas none of the S and M protein specific neutralizing antibodies did. These results suggested that the S and M protein-specific neutralizing antibodies could recognize conformational epitopes which might be involved in the binding of virions to cellular receptors and the fusion activity of the virus.

CONCLUSIONThe SARS-CoV spike protein and membrane proteins are able to elicite efficient neutralizing antibodies in SARS patients. The neutralizing antibodies we generated in this study may be more promising candidates for prophylaxis and treatment of SARS infection.

Amino Acid Sequence ; Animals ; Antibodies, Viral ; immunology ; Cercopithecus aethiops ; Humans ; Membrane Glycoproteins ; immunology ; Neutralization Tests ; Peptide Library ; Protein Binding ; Protein Engineering ; Recombinant Proteins ; immunology ; SARS Virus ; immunology ; Severe Acute Respiratory Syndrome ; immunology ; virology ; Spike Glycoprotein, Coronavirus ; Vero Cells ; Viral Envelope Proteins ; immunology ; Viral Matrix Proteins ; immunology