目的分析肌肉萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)患者运动中枢、感觉中枢反馈的血氧水平依赖功能磁共振成像(blood oxygen level-dependent functional magnetic resonance imaging,BOLD-fMRI)时间-信号强度曲线(time-intensity curve,TIC)类型及运动、感觉中枢反馈TIC的相关性.材料与方法经临床确诊的ALS患者18位(ALS组)与18位年龄、性别匹配的健康志愿者(对照组),被试者均知情同意且为右利足,分别嘱右足拇趾规律背伸、钝头竹签规律刺激右小腿下段背侧皮肤,行大脑BOLD扫描检测运动、感觉中枢反馈,统计比较两组大脑运动、感觉最高反馈区各TIC类型分布,并根据TIC斜率等级评分通过斯皮尔曼相关分析ALS组运动最高反馈区、感觉最高反馈区TIC类型的相关性.结果大脑运动最高反馈区下降型TIC:ALS组>对照组(P<0.001),水平型TIC:ALS组<对照组(P<0.001),上升型TIC:ALS组=对照组(P=1.00);大脑感觉最高反馈区下降型TIC:ALS组<对照组(P=0.221),水平型TIC:ALS组<对照组(P<0.001),上升型TIC:ALS组>对照组(P<0.001);ALS组运动最高反馈区与感觉最高反馈区TIC斜率具有负相关性(P<0.05).结论在ALS的BOLD-fMRI中,运动中枢反馈表现为下降型TIC多见,感觉中枢反馈呈上升型TIC多见,二者TIC斜率间具有较强的负相关性.

Objectives: Malnutrition is an independent risk factor for the prognosis of patients with amyotrophic lateral sclerosis (ALS). Complete high-caloric nutrition is emerging as an instrument for dietary intervention in disease prevention. Our aim was to evaluate the beneficial effects of complete high-caloric nutrition on nutritional status and prognosis in ALS patients undergoing percutaneous gastrostomy. Methods: Forty patients with ALS following percutaneous gastrostomy were randomized to receive either routine diet alone (the control group) or complete high-caloric nutrition combined with routine diet (the Ensure group) for six months. Body weight, body mass index (BMI), nutritional indicator proteins, lipid levels and total lymphocyte count were measured before intervention and after six months of intervention. At 12 months of follow-up, Kaplan-Meier survival was generated to evaluate the beneficial effects of complete high-caloric nutrition on prognosis. Results: After adjustment for baseline, compared with routine diet, body weight, total lymphocyte count and nutritional indicator proteins including transferrin, albumin, hemoglobin, and prealbumin were significantly increased at six months of intervention (all P<0.05). However, we found no significant changes in total cholesterol, triglycerides, low- or high-density lipoprotein cholesterol or BMI during the intervention in either group (all P>0.05). Interestingly, the cumulative survival rate of ALS patients in the Ensure group was significantly better than that of ALS patients in the control group (P<0.05). Conclusions: The findings of our study suggest that high-caloric nutrition offers potential for improvement of nutritional status and prolonged life. However, no evidence was found for a blood lipid-improving effect of complete high-caloric nutrition.

OBJECTIVE:To investigate the effectiveness, safety, adverse events (AEs), and outcomes of percutaneous radiologic gastrostomy (PRG) in patients with dysphagia caused by cerebral infarction.STUDY DESIGN:An interventional study.PLACE AND DURATION OF STUDY:Department of Interventional Oncology, Dahua Hospital, and the Department of Internal medicine, Changqiao Community Health Service Center, Shanghai, China, from January 2016 and December 2019.METHODOLOGY:This study included sixty patients with cerebral infarction-induced dysphagia aged between 49-79 years. All patients were equally and randomly divided into the observation group (PRG group) and the control group (NFT group). Early and long-term results of PRG and nasal feeding tube (NFT) treatment were assessed.RESULTS:No significant differences in serum albumin, prealbumin, haemoglobin, and circumference of triceps (p>0.05) were observed between the two groups before treatment. After treatment, both serum albumin, prealbumin, haemoglobin, and the circumference of the triceps increased in the PRG group compared with the NFT group (p<0.05), indicating better nutrition status. The adverse events (AEs) rate of the PRG group (3.33%, 1/30) was significantly lower than the NFT group (30%, 9/30, p=0.005). The comfort level of the PRG group (93.33%, 28/30) was significantly higher than the NFT group (53.33%, 16/30, p<0.001).CONCLUSION:Percutaneous radiologic gastrostomy can improve the nutritional status of patients with dysphagia caused by cerebral infarction. It can reduce the incidence of AE and improve the comfort level.KEY WORDS:Percutaneous Gastroscopy, Gastrostomy, Dysphagia, Nutrition status, Complications.

多数神经系统疾病患者存在营养问题,其一,神经系统疾病患者常伴有意识障碍和吞咽困难,容易出现呛咳、吸入性肺炎等情况,严重时甚至会导致窒息,危及患者生命安全;其二,营养不良或缺乏又不利于疾病恢复,反而可能造成基础病变恶化或产生严重的并发症,预后不良[1].对无法自主进食、需长期进行肠外营养的神经系统疾病患者而言,肠内环境的紊乱和营养缺乏会导致肠绒毛减少、肠黏膜萎缩,进而发生肠胃溃疡,影响患者机体功能的正常恢复[2].全肠内营养是一种安全、经济、符合生理结构的营养支持疗法,在临床工作中被广泛使用.常见的鼻饲管营养管极易造成患者误吸,使得吸入性肺炎发生风险增加,同时鼻饲管会影响患者呼吸并产生不适感,因而拔管率较高.相关研究指出,鼻饲管法不适用于需要长期实施肠内营养支持治疗的患者.近年来,内镜下胃造瘘术以创伤小、效果好而受到患者欢迎.本研究选择行胃造瘘术后和行鼻饲管后继续治疗的神经系统疾病患者为研究对象,观察其对营养状况和并发症的影响,现报告如下.

目的:观察高热量营养支持对胃造瘘术后肌萎缩侧索硬化症(ALS)患者营养状况及生存率的影响.方法:选择2019年1～12月在我院行经皮胃造瘘术的ALS患者30例作为研究对象,采用随机数字表法分为常规喂食组(对照组)、常规喂食+全安素高热量营养组(研究组),每组各15例.所有患者均定期随访,比较两组患者术后1、3、6个月体重增加情况;比较两组患者术前、术后1、3、6个月血清转铁蛋白、白蛋白水平,术前、术后6个月血清胆固醇(TC)、甘油三脂(TG)水平;记录两组患者术后3、6、12个月生存率.结果:研究组患者术后1、3、6个月体重较术前增加幅度分别为(1.073±0.115)、(1.808±0.203)、(2.339±0.262)kg,对照组患者术后1、3、6个月体重较术前增加幅度分别为(0.704±0.104)、(1.246±0.197)、(1.522±0.241)kg,研究组患者术后1、3、6个月体质量增加幅度均大于对照组(P<0.05).两组患者术后1、3、6个月血清转铁蛋白、白蛋白水平均高于术前(P<0.05),且研究组患者术后1、3、6个月血清转铁蛋白、白蛋白水平均高于对照组(P<0.05).研究组患者术后6个月血清TC、TG水平均高于术前(P<0.05),且高于对照组患者术后6个月TC、TG水平(P<0.05).研究组术后3、6个月生存率分别为100.00％、93.33％,对照组同期分别为100.00％、86.67％,差异均无统计学意义(P>0.05).研究组术后12个月生存率为86.67％,高于对照组的66.67％(P<0.05).结论:全安素高热量营养支持可改善胃造瘘术后ALS患者的营养状况和血脂水平,进一步增加体重并提高生存率.

Drug-eluting stent (DES) is a promising strategy for esophageal cancer. However, full-covered drug-loaded stents cause damage to non-tumor tissue in the esophagus, and the development controlled-release system to prevent non-tumor tissue injure is currently a major challenge. Here, in situ mineralized manganese dioxide coating on Ce6 embedded electrospun fibers covered stent was developed for effective tumor therapy via intraluminal photodynamic therapy (PDT), which could reduce phototoxicity to normal esophageal tissue. Oxidation of manganese ions, which was previously swelled between fibers, was used to accomplish mineralization. After implantation, the manganese dioxide coating in situ reacts with tumor endogenous H+ and H2O2, which, on the one hand, could effectively alleviate the hypoxic microenvironment which leads to resistance to PDT, and on the other hand, could expose the Ce6-fibers below the coating for intraluminal PDT. In addition, due to the slow degradation of the coating, this stent could own sustained photodynamic performance for up to one month. Notably, the PDT efficiency of the stent was investigated on orthotopic rabbit esophageal cancer models. Overall, this work suggests that in situ mineralized manganese dioxide coated electrospun fibers covered stent may provide a new strategy for advanced esophageal cancer patients as a functional drug delivery platform.

BACKGROUND The aim of this study was to assess the value of different 1.5 T MRI apparent diffusion coefficient (ADC) and exponential apparent diffusion coefficient (EADC) values in diagnosing the stages of liver cirrhosis. Sprague-Dawley (SD) rats were randomly divided into the experimental group and the control group. METHODS The experimental group was injected with thioacetamide intraperitoneally 3 times per week. After routine MR scanning, diffusion-weighted imaging (DWI) was processed by spin echo-echo planar imaging (SE-EPI) to generate the ADC value and EADC image. The liver ADC and EADC values of rats were measured in the control and experimental groups, followed by Masson staining and hematoxylin and eosin staining. Furthermore, immunohistochemistry was performed to detect Ki-67 and PCNA expression in liver tissues. RESULTS In the control group, the differences in ADC and EADC values between the liver fibrosis and cirrhosis group were different. The ADC values of the liver fibrosis stage I-II, III-IV, and cirrhosis rats in the experimental group were lower than the control group, while the EADC values were higher than the control group. The ADC values of the liver fibrosis stage III-IV group and cirrhosis nodules group were lower than the control group. There were significant differences in EADC values between the cirrhotic nodule groups and the control group. CONCLUSIONS DWI-ADC values showed a negative correlation between SD rat liver fibrosis and cirrhosis pathology classification.

Hepatocarcinogenesis is a highly complicated process that is promoted by a series of oncogenes. Our study aims to identify novel oncogenes promoting hepatocellular carcinoma (HCC) by bioinformatic analysis and experimental validation. Here, we reported that S100 calcium binding protein A10 (S100A10) was screened out as a potential novel oncogene in HCC by integrated analysis of OEP000321 dataset and the Cancer Genome Atlas (TCGA)-Liver-Cancer data. Furthermore, S100A10 was highly expressed in HCC samples and observably associated with patients’ overall survival (OS). Overexpression of S100A10 in Hep3B and Huh-7 increased the cell proliferation, whereas downregulation of S100A10 in SK-Hep-1 and HepG2 cells reduced the cell viability to almost stop growing. In vivo tumor growth assays showed that S100A10-overexpressing Hep3B cells had a larger tumor size than control. Moreover, S100A10 overexpression promoted Hep3B cells migration and invasion, and S100A10 knockdown inhibited SK-Hep-1 cells migration and invasion, in vitro. In conclusion, it is demonstrated that S100A10 is a novel oncogene in HCC, indicating a possible novel therapeutic strategy of HCC.

OBJECTIVE:To explore the effects of total enteral nutrition (TEN) via nasal feeding and percutaneous radiologic gastrostomy (PRG) on the nutritional status, quality of life, and prognosis in long-term bedridden patients with dysphagia after cerebral infarction. METHODS:One hundred and sixty long-term bedridden patients with dysphagia after cerebral infarction were randomly divided into a control group (CG, n=80) and an observation group (OG, n=80). The CG was administered TEN via nasal feeding, and the OG was administered TEN via PRG. The two groups' results were compared. RESULTS:The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores in the OG were lower than the corresponding scores in the CG at 3 and 6 months after the TEN (P < 0.05). The OG had a higher proportion of high compliance, but a lower proportion of both moderate and low compliance than the CG (P < 0.05). The total incidence of TEN intolerance was 8.75% in the OG, lower than the 20.00% in the CG (P < 0.05). The AST, ALB, ALT, TBIL, Scr, and BUN levels showed no significant differences between the OG and the CG at 3 and 6 months after the TEN (P > 0.05). The IgM, IgG, IgA, hemoglobin, total protein, albumin, and transferrin levels showed no significant differences between the OG and the CG at 3 and 6 months after the TEN (P > 0.05). The incidence of catheterization complications was 20.00% in the OG, higher than the 8.75% in the CG (P < 0.05). The OG had higher SF-36 scores than the CG at 6 months after the TEN (P < 0.05). CONCLUSION:Both nasal feeding and TEN via PRG can effectively improve patients' nutritional status, enhance their immune function, and improve their liver and renal function, but TEN after PRG is more effective at reducing intolerance and promoting quality of life in long-term bedridden patients with dysphagia after cerebral infarction. However, TEN after PRG will also increase the occurrence of recent complications, complications that should get additional clinical attention.

Surgical resection has been suggested as an effective and first-line treatment of renal cell carcinoma (RCC). However, operation is quite difficult for the patients with stage of middle-late or hypervascularized tumors. Transarterial chemoembolization (TACE) plays an important role in decreasing the size of tumors before surgery. In this work, we prepared an injectable drug-delivery system of doxorubicin-loaded temperature sensitive hydrogel for transarterial chemoembolization in RCC. The sol-gel transition behavior and rheologic analysis showed that the doxorubicin-loaded temperature sensitive hydrogel had good temperature sensitivity. Then, The X-ray experiment of hydrogel showed excellent visibility under the digital subtraction angiography and computed tomography scans in vitro and in vivo. Moreover, the studies of embolization in beagle's right kidney showed good properties in embolizing of renal arteries. In TACE therapy studies of rabbit VX2 renal tumors, angiography, computed tomography and histopathological analysis verified that TACE therapy of doxorubicinloaded temperature sensitive hydrogel had excellent embolic efficiency as a result of repressing the tumor growth. This hydrogel could provide valuable option in the treatment of renal cell carcinoma before surgery.

目的 探讨C臂椎形束CT(CBCT)引导下经皮腹腔神经丛阻滞术在上腹部顽固性癌痛的应用价值.方法 将43例均有顽固性上腹痛晚期癌症患者,按患者病例单双号随机分为A、B两组.A组22例行CBCT引导下经皮腹腔神经丛无水乙醇阻滞术,B组21例行常规CT(CCT)引导下经皮腹腔神经丛无水乙醇阻滞术.比较两组手术时间、有效辐射剂量、止痛有效率及并发症.结果 A组与B组手术时间分别为(31±11) min、(42±13) min,两组手术时间比较差异有统计学意义(P＜0.05).CBCT组的辐射剂量为(2.9±1.6) mSv,CCT为(4.0±0.7) mSv,两组差异有统计学意义(P＜0.05).两组2周、1个月止痛有效率分别为100％、95.4％,100％、95.2％,两组止痛有效率无明显差别,两组并发症无明显差别.结论 CBCT引导下经皮腹腔神经丛阻滞术能有效治疗上腹部顽固性癌痛,能减少手术时间并降低辐射剂量,值得进一步研究和推广.

Objective: Percutaneous endoscopic gastrostomy (PEG) and radiologically inserted gastrostomy (RIG) have gained increasing popularity among clinicians and motor neuron disease (MND) patients for maintaining adequate nutritional intake. However, there is no consistent evidence of the efficacy and safety of the two techniques in MND patients. We carried out a systematic review and meta-analysis to examine the technical success rates, complication rates and 30-day mortality of MND patients receiving PEG and RIG. Methods: We searched PubMed, EMBASE, the Cochrane Library, Web of Science and Scopus from inception to September 12, 2019 for comparative studies on the efficacy and safety of PEG and RIG in MND patients. The primary outcome was technical success rate and the secondary outcomes were complication rates and 30-day mortality. Results: Seven studies (n = 603) were included. Pooled technical success rates were 90.15% in patients receiving PEG and 96.76% in patients undergoing RIG. There was a statistically significant difference in the technical success rate between RIG and PEG, strongly favoring RIG [(OR = 3.96, 95% CI (1.31to 12.02); P =.02]. Pooled major complication rates were 2.19% in patients receiving PEG and 0.07% in patients undergoing RIG, with no statistical difference (P =.08). Pooled procedure-related 30-day mortality rates were 5.31% in patients receiving PEG and 6.00% in patients undergoing RIG, with no statistically significant difference (P =.75). No publication bias was noted. Conclusion: The present meta-analysis demonstrated that, compared to PEG, RIG has a higher technical success rate and has a comparable mortality outcome and safety profile.

Paclitaxel-eluting covered metal stents (PECMSs) and metallic stents covered with a paclitaxel-incorporated membrane (MSCPMs) have been developed to increase stent patency by preventing tumor ingrowth. However, few studies have compared their efficacy and safety compared with conventional covered metal stents (CMSs). This study aimed to compare differences in efficacy and safety between PECMS/MSCPM and CMS by meta-analysis. A search of PubMed and Embase was conducted for randomized controlled trials of PECMS/MSCPM and CMS in patients with malignant biliary obstructions published between January 1966 and August 2017. A meta-analysis was performed to compare clinical outcomes and complications between stent types. A total of 221 patients from three studies were included. There were no significant differences between PECMS/MSCPM and CMS in stent patency duration (P = 0.128) or survival time (P = 0.363). Risk did not differ between PECMS/MSCPM and CMS for stent malfunction (hazard ratio [HR]: 1.13, 95% confidence interval [CI]: 0.63-2.02, P = 0.677 for all stent malfunction; HR: 1.39, 95% CI: 0.68-2.85, P = 0.362 for stent occlusion caused by tumor ingrowth; HR: 0.80, 95% CI: 0.34-1.91, P = 0.617 for stent occlusion caused by distal stent migration or sludge impaction), or complications (HR: 1.54, 95% CI: 0.70-3.39, P = 0.280 for all complications; HR: 0.42, 95% CI: 0.14-1.30, P = 0.131 for pancreatitis). The exception was cholangitis-like symptoms, the risk for which was higher in PECMS/MSCPM compared with CMS (HR: 3.93, 95% CI: 1.08-14.29, P = 0.038). Although PECMS/MSCPM may be associated with higher risk of cholangitis-like symptoms, the overall results were similar between PECMS/MSCPM and CMS. Further studies are warranted in larger populations of patients. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

BACKGROUND Stent insertion can effective alleviate the symptoms of benign esophageal strictures (BES). Magnesium alloy stents are a good candidate because of biological safety, but show a poor corrosion resistance and a quick loss of mechanical support in vivo. AIM To test the therapeutic and adverse effects of a silicone-covered magnesium alloy biodegradable esophageal stent. METHODS Fifteen rabbits underwent silicone-covered biodegradable magnesium stent insertion into the benign esophageal stricture under fluoroscopic guidance (stent group). The wall reconstruction and tissue reaction of stenotic esophagus in the stent group were compared with those of six esophageal stricture models (control group). Esophagography was performed at 1, 2, and 3 weeks. Four, six, and five rabbits in the stent group and two rabbits in the control groups were euthanized, respectively, at each time point for histological examination. RESULTS All stent insertions were well tolerated. The esophageal diameters at immediately, 1, 2 and 3 wk were 9.8 ± 0.3 mm, 9.7 ± 0.7 mm, 9.4 ± 0.8 mm, and 9.2 ± 0.5 mm, respectively (vs 4.9 ± 0.3 mm before stent insertion; P < 0.05). Magnesium stents migrated in eight rabbits [one at 1 wk (1/15), three at 2 wk (3/11), and four at 3 wk (4/5)]. Esophageal wall remodeling (thinner epithelial and smooth muscle layers) was found significantly thinner in the stent group than in the control group (P < 0.05). Esophageal injury and collagen deposition following stent insertion were similar and did not differ compared to rabbits with esophageal stricture and normal rabbits (P > 0.05). CONCLUSION Esophageal silicone-covered biodegradable magnesium stent insertion is feasible for BES without causing severe injury or tissue reaction. Our study suggests that insertion of silicone-covered magnesium esophageal stent is a promising approach for treating BES.

Transcatheter intra-arterial therapy (TIT) has become valuable in the battle against primary and secondary hepatic malignancies. However, the lack of a mechanism to visualize real-time drug release and avoid fast metabolic clearance of chemotherapeutic agents is the primary barrier to TIT for hepatocellular carcinoma. Here, a specific near-infrared (NIR) fluorescent prodrug platform, that is, DSPE-mPEG/DCM-S-Pt micelles (DCM-S-Pt@PEG), to assist TIT in direct administration to large mammals like rabbits, is presented. DCM-S-Pt@PEG consists of a NIR fluorophore for tracing drug release, a nonspecific antitumor drug cisplatin for hepatocellular carcinoma treatment, a glutathione-activatable disulfide linker, and a DSPE-mPEG nano-micelle carrier for controllable drug release. DCM-S-Pt@PEG can make the drug accumulation in tumor tissues enhance the therapeutic effect by: i) specific delivery of prodrug to hepatic tumor tissues through the femoral artery by TIT, ii) sustained drug-release from the biodegradable lipid DSPE-mPEG micelle to minimize metabolic clearance, and iii) cancer biomarker-activated drug release. It provides a promising strategy to assist TIT in treating unresectable devastating hepatocellular carcinoma administration in the rabbit model, rather than common mouse model.

Objective To study the mechanical properties and degradation behavior of biodegradable silicon-covered magnesium alloy stent in vitro,to investigate the technical feasibility of its implantation into rabbit esophagus and to observe the tissue reaction in vivo.Methods The mechanical compression recovery properties and the degradation behavior of biodegradable silicon-covered magnesium alloy stent were tested in vitro.A total of 30 healthy Holland rabbits were randomly divided into silicon-covered magnesium alloy stent group (n=15) and control group (n=15).For rabbits in the silicon-covered magnesium alloy stent group fluoroscopy-guided insertion of the stent into the lower third segment of esophagus was conducted,while for rabbits in the control group no intervention was adopted.One,2 and 4 weeks after the implantation of the stent,esophagography was performed for all rabbits of both groups,and each time every 5 rabbits from both groups were sacrificed,the specimens were collected and sent for histological examinations.Results In vitro test indicated that biodegradable silicon-covered magnesium alloy stent had good flexibility and elasticity,and in phosphate-buffered saline with pH 4.0 or pH 7.4 it degraded more slowly than bare magnesium alloy stent.In vivo test showed that the stent implantation could be well tolerated by all experimental rabbits.Before stent insertion the esophageal diameter was(9.2±0.8) mm,and at one,2 and 4 weeks after stent insertion the esophageal diameters were (9.7±0.7) mm,(9.6±0.8) mm and (9.6±0.5) mm respectively (P＞0.05).In the silicon-covered magnesium alloy stent group,stent displacement occurred in 6 rabbits in one week (n=l),2weeks (n=1) and 4 weeks (n=4).After stent implantation,the tissue reactions such as esophageal wall injury,collagen deposition,etc.were not obviously different from those in the control group (P＞0.05).Conclusion It is technically feasible to insert silicon-covered magnesium alloy stent into the rabbit's esophagus,the stent can provide sufficient support for at least 2 weeks,the stent displacement rate is low and acceptable,and no severe esophageal wall injury and collagen deposition are observed.

Objective To discuss the clinical application of percutaneous radiologic gastrostomy (PRG) in treating dysphagia associated with amyotrophic lateral sclerosis (ALS),and to evaluate its safety and improvement effect on patient's nutritional status in ALS patients with pulmonary insufficiency.Methods The clinical data of 51 ALS patients who received PRG were retrospectively analyzed.The success rate of surgery and postoperative complications were recorded.All patients were regularly followed up,and the longterm complications as well as the one-,3-and 6-month mortality rates after the surgery were documented.The improvement of patient's nutritional status was evaluated.Results PRG was successfully accomplished in all 51 patients,the technical success rate was 100％.Mild postoperative complications occurred in 7 patients (13.73％) and severe massive hemorrhage in one patient (2.0％).After PRG,no signs or symptoms of impaired respiratory function were observed.No death occurred in one month and in 3 months after PRG.Six months after PRG,three patients died(6.8 ％,3/44).One month after PRG,31 patients had an increase in body weight of more than 1 kg,and the mean BMI was increased from preoperative t8.60±2.14 to postoperative 19.27±1.81 (one month after PRG),19.17±1.93 (3 month after PRG) and 18.89±2.33 (6 month after PRG).Conclusion For the performance of PRG no gastroscopy or anesthesia is needed,thus,the risk of aspiration asphyxia can be reduced in ALS patients complicated by pulmonary insufficiency and the success rate as well as the safety can be improved.Therefore,this technique is an effective means to ensure that the ALS patients with pulmonary insufficiency can get adequate energy intake to improve their nutritional status.

Stent implantation is a well-accepted alternative to treat benign luminal disease (BLD). Current stents are often fabricated from plastic, mental and biodegradable materials, and the latter two have wider clinical application. Self-expanding plastic and mental stents possessed many disadvantages such as stent migration, tissue hyperplasia, in-stent restenosis and are difficult to remove, which catalyzes the development of biodegradable stent (BDS). In fact, BDS are not required to be removed upon implementation and leaves no residues in tissue after complete biodegradation compared to metallic or plastic stents. In vascular system, BDS, also termed bioresorbable vascular scaffold (BVS) have also been used to treat luminal stenotic or occlusive lesions in cardiovascular system, peripheral arteries system and veins. In nonvascular system, BDS, with either bare or covered designs, was employed for the treatment of occlusion, stenosis, anastomosis, leak, fistula or perforation of digestive (esophagus, gastrointestinal, biliary, pancreatobiliary, hepatobiliary), respiratory (airway), and urinary (ureteral, urethral). However, the weak radial force, in-stent thrombosis and restenosis become main issues of BDS or BVS and restrict its further clinical application. Therefore, more intensive researches are expected on the strengthening of the radial force of BDS and development of novel drug eluting techniques on its surface to prevent thrombus or restenosis. In this review it is given an updated outline of the use of BDS to treat BLD in a minimal invasive way and explore its advantages and disadvantages for a vast range of fields ranging from cardiovascular to digestive and urinary system. Further discussion to foster the investigation and development of this approach in clinical is also provided.

目的 探讨一种新的兔食管良性狭窄模型构建方法——自制内镜注射针经喉镜注射氢氧化钠(NaOH)构建食管良性狭窄模型,为支架置入体内相关介入研究提供实验基础.方法 自制注射针:将一次性胃镜注射针外层导管去除,取含针头端长约70 mm内芯导管,将针头剪至2 mm长并磨成斜坡状,去除针柄及部分塑料管,然后接上内芯导管无针头端.选择2～3 kg健康兔10只,3％戊巴比妥(1 ml/kg)经耳缘静脉注射麻醉,左侧卧位固定于DSA操作台;透视下将泥鳅导丝插入胃腔,8 mm×40 mm球囊置于食管下段贲门处,喉镜下距球囊近端约l cm处选取环周4个点,经自制内镜注射针分别注入1.5％NaOH 0.25 ml.术后2周和4周分别作喉镜及造影检查;术后4周处死实验兔,取材作组织病理学检查.结果 术后2周喉镜检查显示食管中下段溃疡形成,无明显狭窄;造影显示食管中下段管壁不光整.术后4周喉镜显示食管中下段瘢痕形成、食管狭窄;造影显示食管中下段局部狭窄;组织病理学检查提示局部溃疡、黏膜下层增厚、瘢痕形成.食管管径狭窄率为平均49.54％ (44.89％～56.65％);狭窄长度造影测量为平均18.0 mm(14.6～22.8 mm),标本测量为平均16.3 mm(13.1～21.1 mm).结论 自制内镜注射针经喉镜注射1.5％ NaOH可成功构建兔食管良性狭窄模型,方法简单易行,狭窄程度和部位易控.