The author of this volume has developed a standardized magnifying endoscopy technique that enables endoscopists to constantly visualize the microanatomy subepithelial capillaries and the epithelial structure within the stomach. With this technology, it has become easy to obtain magnified endoscopic findings. Techniques differ, however, depending upon the endoscopist. Endoscopists around the world do not have a standardized magnifying endoscopy technique, which is mandatory for the scientific analysis of their findings.
In addition, there is no logical explanation for how and which microanatomies are visualized by magnifying endoscopy with narrow-band imaging in the glandular epithelium of the stomach. This inconsistency results in considerable confusion among researchers and clinicians and a lack of terminology for the purposes of analysis. The price of the product can be seen on PriceCheck. How to pay Our listed shops offer various methods of payments which are displayed on their websites.
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You are welcome to contact the merchant directly for clarity. See pricecheck. Quoting Unfortunately PriceCheck does not provide quotes. For a formal quotation make contact with any of the merchants selling the product. The gastric unit needs to deliver gastric acid and pepsin to the gastric mucosa. The 2D plane i. Therefore, these closed curves represent an instantaneous state of transportation of the liquid. The least action principle examines these closed curves that sense all geometric shapes and chooses the one with the least action.
From a transport efficiency perspective, the larger the closed curve, the higher the gastric gland's transport efficiency. According to isoperimetric inequality, the assumptions for the circumference of the closed curve are fixed in our model, and the most suitable geometric shape of these closed curves is a circle. In short, the circle has the least action in a 2D plane from a transport efficiency perspective. Therefore, we can show the geometric pattern of the cross-sectional diagram in an ideal state Figure 2A.
Now, suppose that we imagine that many similar 2D spaces overlap along a straight line parallel to the gastric mucosal surface. Thus, we can gain many cylinders Figure 2B. However, from our pathologist's perspective Montgomery and Voltaggio, , these gastric glands are a coiled and complex structure rather than a simple structure consisting of straight tubes that are perpendicular to the gastric mucosa in 3D space. Therefore, according to the principle of least action, we need to identify what these cylinders' spatial arrangement is in an ideal setting.
From an evolutionary perspective, gastric acid secretion may put humans at an evolutionary advantage.
We need to produce enough gastric acid to filter microbes in a short time Beasley et al. Figure 2. These four conceptual diagrams show the derivation process of these stereoscopic structures of gastric glands in an ideal state based on the principle of least action. A According to isoperimetric inequality, we delineated an ideal geometrical morphology of the gastric gland in 2D space.
B Let us suppose there are many similar 2D spaces like Figure 2A overlapping along a straight line that is parallel to the gastric mucosal surface, which gives us many cylinders. From the least action principle, these cylinders are parallel to the gastric mucosal surface. Its real state is disorganized and chaotic.
A gastric unit consists of several glands that open into a common pit. However, if we apply that definition, our model becomes more complex in what was already a very complex environment.
Since magnifying endoscopy of the stomach, or zoom gastroscopy, was first performed at the beginning of the 21st century, there have been numerous findings. Editorial Reviews. From the Back Cover. Since magnifying endoscopy of the stomach, or zoom gastroscopy, was first performed at the beginning of the 21st.
Our aim is to find the mechanism for the formation of the crypt opening of the gastric mucosa, not the stereoscopic structures of the gastric gland. For simplification, we assume that a single pit is connected to a single gland. We can prove that these cylinders are parallel to the gastric mucosa with the help of some properties of triangles and the fact that the pit tends to be perpendicular to the x-axis with the help of the least action principle extended mathematical analysis procedure and Figure 3.
Figure 3. We can think of cylinders as rectangles in a 2D plane.
We now return to our original question. Thus far, our model has been based on the fundic gland's microstructure. Therefore, the next logical thing to do is to determine the structure of the mucosa surface as the connection between fundic glands and pyloric glands from a pathological perspective.
Fortunately, multiple white flat lesions Uedo et al. If we look closely at multiple white flat lesions, it is safe to assume that the micro-surface structures of the multiple white flat lesions are similar to the antral gastric mucosa.
Furthermore, if this assumption is true, then the morphological features of the crypt opening on the multiple white flat lesions are linear or a reticular groove, just as with the antral gastric mucosa. Figure 4. These two pictures show the mucosal surface structure of the fundus of the stomach with the help of magnified endoscopy with narrow-band imaging NBI-ME. A There are some different morphological characteristics of gastric crypt openings. B This image shows the morphological characteristics of a flat white lesion. There are huge differences in the epithelial structures between background fundic gland mucosa and multiple white flat lesions.
In addition, as described by Uedo et al. The characteristics of hyperplastic lesions suggest that continuous regeneration Hoffmann, via proliferation and differentiation of stem cells is responsible for multiple white flat lesions. Additionally, dysregulated regeneration causes intestinal metaplasia. The appearance of whitish elevated patches in the antrum often represents intestinal metaplasia on magnified narrow-band imaging.
The same characteristic is observed on multiple white flat lesions Uedo et al. This coincidence allows us to associate continuous regeneration with multiple white flat lesions.
Hence, in our model, we need to demonstrate only that the morphological features of the crypt opening on the multiple white flat lesions are linear or a reticular groove based on continuous regeneration. Approximately 60 years ago, Leblond et al found that the isthmus and neck are the major sites of gastric stem and progenitor cells Stevens and Leblond, However, it is difficult to determine the isthmus and neck's location because the gastric gland is a complex spatial structure.
Fortunately, for our model, we can look for some clues about the isthmus and neck's location based on pathology. According to a Japanese experts' view Oyama, , each cancer cell in poorly differentiated adenocarcinoma spreads laterally at the isthmus and neck of the gland. If the latter is true, half of the cancer cells move more vertically in pathological sections.
Therefore, the latter is far removed from the direction of the poorly differentiated adenocarcinoma's invasion in the cross-sectional diagram Figure 5. In addition, we already know that several glands share a single pit. According to gland fission's formation mechanism McDonald et al. Thus, it is reasonable that we place the replication zone of gastric stem cells at the bottom of the pit in our model Figure 2C.
Figure 5. Gastric signet ring cell carcinoma confined to the mucosal layer in the picture. If we carefully observe the diffuse-type gastric cancer distribution area, the lateral length of the distribution area is far longer than the longitudinal length.