“Fish are in intimate contact with their microbial rich en


“Fish are in intimate contact with their microbial rich environment and have a unique physical barrier composed of skin and skin mucus which act as a first line of defense against attachment and penetration by potentially harmful agents. Fish skin mucus, comprising a number of immune components constitutively expressed such as lysozyme, immunoglobulin, complement, carbonic anhydrase, lectins, crinotoxins, calmodulin, C-reactive

protein, proteolytic enzymes and peptides, which have bactericidal activities (Alexander and Ingram, 1992; Whyte, 2007). The epithelial skin mucus layers are therefore considered http://www.selleckchem.com/products/ipilimumab.html a key component of fish innate defense mechanisms (Ellis, 1981). The mucosal immunity is especially important for the host defense response to invasive pathogens, moreover several fish species possess venomous apparatuses that provide protection against predators during feeding or when fish are stressed or provoked. Catfish present long and robust saw-toothed stings in the dorsal (one) and pectoral (two, one in each fin) fins. These venomous apparatuses are made of a very rigid bone structure, surrounded by a tegumentary sheath (Halstead, 1970; Figueiredo and Menezes, 1978). Sting venoms show a great variety of toxins that are responsible for several symptoms observed following envenomation of human victims. The integumentary sheath overlying the spine ruptures, and venom is released into the wound-along with skin mucus. Apart

from the involvement with defense against pathogens, the possible contribution of skin mucus components to the development of injuries caused by venomous fish species has not Pictilisib clinical trial Lepirudin been investigated. The fish Cathorops spixii, belonging to the Ariidae family, is probably the most common catfish on the Brazilian coast ( Eiras-Stofella & Fank-de-Carvalho, 2002). There are records of its occurrence along the Western Atlantic

litoral, from the Central American seacoast to the south of Brazil ( Figueiredo and Menezes, 1978; Batista and Rêgo, 1996; Chaves and Corrêa, 1998; Isaac and Moura, 1998; Tijaro et al., 1998; Azevedo et al., 1999), and it is found throughout the year on the seashores of Parana State, southern Brazil. The accidents provoked by C. spixii on fishermen and swimmers are characterized by persistent cutaneous oedema, erythema at the wound site, pain, and radiation of pain to the root of the member. Systemic symptoms may also be present, including, cold sweats, malaise, fever, nausea, vomiting, psychomotor agitation, and secondary infection may be sequelae ( Haddad and Martins, 2006). In our previous study (Junqueira et al., 2007) we demonstrated that both types of defense components (skin mucus or sting venom) in C. spixii posses a different capacity of eliciting inflammatory reactions in mice: skin mucus induced the recruitment of neutrophils immediately after injection followed later by macrophage infiltration. In contrast, the cellular infiltration elicited by sting venom was rapidly resolved.

Indeed, the terms “provisional” and “permanent” used in the GMRMP

Indeed, the terms “provisional” and “permanent” used in the GMRMP are in opposition to the adaptive management concept. In particular, use of the term “permanent” has created a serious misinterpretation about the foundations of adaptive management, which could result in future resistance by stakeholders (or decision-makers) to adaptation of the zoning design. The lessons learned through Natural Product Library price the identification and analyses of issues in the previous section are fundamental to adapt and improve the zoning system in the GMR. This section provides some paths to the future, drawing on lessons learned from the GBRMP [42] and [11], as well as from the recommendations and guidelines provided

by Hilborn et al. [37]; Wilen [43]; Gilliand and Laffoley [44]; Charles and Wilson [35]; and Douvere and Ehler [10]. The find more most important step to improve the GMR’s zoning is adopting a strategic

and integrated long-term plan-based approach, which considers the “bigger picture” needed to adopt an EBSM for GMR’s fisheries management. The process followed in Australia’s GBRMP to establish a large, comprehensive, and representative network of no-take areas within a broader spatial management framework, represents a successful example of the practical adoption of an EBSM to manage a multiple-use marine reserve. According to Fernandes et al. [42], the key success factors that were central to review and adapt the GBRMP zoning were: focusing initial communication on the problems to be addressed; applying the precautionary principle; using independent experts; facilitating input to decision making; conducting extensive and participatory consultation; having an existing marine park that encompassed much of the ecosystem; having legislative Tolmetin power under federal law; developing high-level support; ensuring agency priority and ownership; and being able to address the issue of displaced fishers. These factors of success should be carefully evaluated in the context of Galapagos and used, if appropriate, to

evaluate and to adapt the GMR’s zoning. The reality that no-take zones represent only one of multiple management tools available for the successful implementation of EBSM must be emphasized. A portfolio approach, based on a judicious combination of management tools, provides a more robust approach to resource governance [45]. Indeed, a recent integrated assessment of the status, trends, and solutions in marine fisheries worldwide found that a combination of traditional approaches (catch quotas, community-based management) coupled with strategically placed fishing closures, more selective fishing gear, ocean zoning, and economic incentives is the best potential solution to restore marine fisheries and ecosystems [6]. Furthermore, having seen in Galapagos that zoning is a useless management tool if it is not appropriately enforced, it is worthwhile to adopt the insight of Hilborn et al.

Further, this null effect of awareness is consistent with Joorden

Further, this null effect of awareness is consistent with Joordens and Merikle’s (1992) finding that brief masked primes (57 msec) produce the Jacoby–Whitehouse effect whether participants are told of the

primes’ existence in advance (“aware” instructions) or not (“unaware instructions”). While previous fMRI studies have implicated the hippocampus as well as parietal cortex in recollection, we did not find activity in hippocampus for the R Hit > K Hit comparison that survived whole-brain correction (though it is likely to have had survived correction for a smaller search space, e.g., hippocampi alone). Nonetheless, the hippocampus was clearly identified by the CR > K Hit comparison, and further examination suggested that it also showed greater activity for R Hits than K Hits. Indeed, the U-shaped pattern across click here R Hit, K Hit and CR judgment types has been observed in numerous previous fMRI studies,

and often interpreted in terms of hippocampal involvement in both (1) the recollection of studied items and (2) the encoding of novel, unstudied items (with evidence of the latter occurring even during a recognition memory test; Buckner et al., 2011; Stark and Okado, 2003). Indeed, using intracranial electroencephalography (EEG) during a recognition memory test, we have recently found both recollective and novelty effects in hippocampus, but with different latencies (Staresina et al., 2012): An early, pre-recognition-decision Z-VAD-FMK ic50 recollection effect and a later, post-recognition-decision novelty effect, which would simply summate to produce the U-shaped pattern in the magnitude of the BOLD response (at least, using the standard fMRI analysis P-type ATPase employed here). The present fMRI findings reinforce these previous findings, and go further in that the lack of an effect

of conceptual priming in hippocampus, in contrast with that found in the parietal regions, further supports a functional dissociation between the roles of hippocampus and parietal cortices during recollection/recall (Ramponi et al., 2011). The regions showing greater BOLD responses for K Hits than Correct Rejections are broadly consistent with many previous fMRI studies of the basic “old-new” effect, particularly in that they appeared to be driven by the distinction between Hits and Correct Rejections, rather than between Remembering and Knowing. Most notable in this respect are the more superior parietal regions, which concur with many previous dissociations between inferior and superior parietal activations during recognition memory (Wagner et al., 2005; Cabeza et al., 2008). Nonetheless, it should be noted that Hits and Correct Rejections differ not only in the study status of the target item, but also in the “old-new” decision given (and possibly perceived “targetness”; Herron et al., 2004).

Mortality is prevented by immediate fluid and electrolyte replace

Mortality is prevented by immediate fluid and electrolyte replacement ( Levin et al., 2000; this website Menezes et al., 2006). The toxic effects of Jatropha species have also been reported

in domestic animals. J. curcas seeds are toxic when given experimentally to calves ( Ahmed and Adam, 1979a), goats ( Adam and Magzoub, 1975) and sheep ( Ferreira et al., 2011). The leaves of J. gossypiifolia are also toxic when given experimentally to sheep ( Oliveira et al., 2008). Poisoning has been reported in cattle and in sheep that have ingested oil extraction residues from J. curcas seeds ( Völker, 1950). Clinically, poisoning by Jatropha spp. is characterized by digestive, cardiac, and pulmonary disorders ( Ferreira et al., 2011). The ethanol extract from J. gossypiifolia causes digestive disorders, incoordination, paralysis and depression in rats ( Mariz et al., 2011). Jatropha spp. contains different active components including saponins, tannins, lectins, phytate, RG7204 in vivo forbol esters, alkaloids, and proteases with antinutritional effects that may have medicinal activity and probably under certain conditions might also be toxic ( Makkar et al.,

1997; Barahona et al., 2010; Ferreira et al., 2011). The two main toxic components of J. curcas are curcin, a lectin that interferes with protein synthesis and that causes gastroenteritis, and phorbol esters, which are activators of mutagenesis, cell growth and inflammation ( Makkar et al., 1997;

Barahona et al., 2010). J. mutabilis, J. ribifolia, and J. mollissima are endemic in the semiarid region of northeastern Brazil ( Oliveira, 2011), but the toxicity of these species has not been reported. In addition, poisonings by Jatropha spp. have not been reported in grazing animals. The objectives of this study were: 1) to report the poisoning of goats by J. ribifolia in pastures invaded by the plant; 2) to reproduce experimentally J. ribifolia poisoning in goats. Epidemiological data and the history of the outbreak were collected on visits to the affected farms in the municipality of Juazeiro, State of Bahia, Northeastern Brazil. During the visits, performed during the dry seasons of 2009 and 2010, the pastures were inspected, affected animals were examined clinically, Acyl CoA dehydrogenase and one affected goat was euthanized and necropsied. The poisoning occurred in a 2600-ha area that was inhabited by 1500 goats from 5 flocks belonging to different owners. According to one of the farmers, poisoning by J. ribifolia had occurred since the dry season of 2007. This farmer stated that in 2008, 240 of the flock of 500 goats were affected by the poisoning, and 200 died. During the 2010 dry season, 80 out of 400 goats died after exhibiting clinical signs of the intoxication. In the same year, in another flock from the same area, 40 out of approximately 400 goats were affected, 25 died and 15 recovered after their removal from the area.

3) Most AMPs are an amphipathic and this property is a key role

3). Most AMPs are an amphipathic and this property is a key role in antimicrobial activity by microbial

membrane interaction. In fact, it was previously demonstrated that the pleurocidin had a α-helical structure in the membrane-mimetic condition [36]. Similarly, NMR structural studies that covered all of the Plc-2 peptide sequence showed that in an aqueous solution the Plc presents a random coil conformation [37]. However, it assumed an α-helical structure in TFE and in dodecylphosphocholine (DPC) micelles [22]. Thus, the Plc-2 α-helical structure described in this work is similar to that for many other AMPs, which cause lysis and release of intracellular contents by binding to the surface of bacterial membranes. this website The α-helical structure produces a significant destabilizing effect upon membranes, which insert themselves into the membrane by binding more efficiently than other structural configurations [19]. This conclusion is also in agreement with a report from Yamada and Natori [41], in which the fragment corresponding to the α-helical region of sapecin B, a derived peptide belonging to the insect defensin

family, showed broad antibacterial activity. However, antimicrobial activity is not restricted exclusively to α-helical structures. Lee et al. [27] attributed the activity of the AMP tenecin to a fragment (amino acids 29–43) located in a β-sheet region of the peptide. Similarly other authors founded that the antimicrobial activity of some peptides was establish in amphipathic beta-sheet segments BMS-354825 [19]. Microbial cell surfaces such as membranes or cell wall are composed of various components, and they exhibited significant differences in surface components between bacteria and fungi. Therefore, it may be possible the membrane composition influences the activity of an AMP by influencing preferential interactions with α-helical or β-sheet (-)-p-Bromotetramisole Oxalate structures. Some known AMP can

induce abnormal morphological changes in the hyphae structure of phytopathogenic fungi [3] and human pathogenic fungi [20]. In our study, we chose to examine two fungi examined Alternaria sp. and F. oxysporum that are of economical importance. The abnormal morphological changes in membrane structure of hyphae were evaluated in vivo with the fluorescent membrane probe SG. This probe was used to assess cell permeation of fungi treated with both peptides. All the fungi showed identical fluorescent staining. Cellular membranes were compromised and also disrupted if the fungal structures were incubated with pleurocidin or Plc-2. The MIC and MFC values measured illustrate the relative antifungal potency of the two peptides with MIC values quite comparable to the conventional fungicide captan. The highest inhibitory activity of the two peptides was observed against Colletotrichum sp., and the lowest inhibition was noted against A. ochraceus ( Table 2).

, 2002) The assays were performed in triplicate and the venom en

, 2002). The assays were performed in triplicate and the venom encapsulation efficiency (EE%) was calculated using Eq. (1) ( Gan et al., 2005): equation(1) EE%=(totalamountprotein−freeamountproteininsupernatant)(totalamountprotein)×100

Experimental mice were immunized for 6 weeks with 100 μL of subcutaneous injections administered bilaterally in the lumbar region with T. serrulatus venom in different concentrations (5.0 or 10.0%), encapsulated in chitosan nanoparticles or associated with the aluminum hydroxide. The experimental mice were bled by cardiac puncture. Blood samples in the absence of an anticoagulant, were incubated at 37 °C for 30 min and then at 4 °C for Thiazovivin molecular weight 2 h for clot retraction. Then the samples were centrifuged at 15,000 × g for 5 min at 4 °C and the supernatant (serum) collected and stored at −20 °C. Antigen-specific

serum antibody responses were measured 1 week following the booster vaccination by ELISA. The ELISA assay was performed following the protocol of eBioscience. The plate was sensitized with 100 μL/well of capture antibody in coating buffer, the plate was sealed and incubated overnight at 4 °C. After this step, the wells were washed twice with wash buffer solution with 400 μL. The wells were blocked with 250 μL of blocking buffer and incubated at room temperature for 2 h. After washing the plate again two-fold serial dilutions of the standards were performed with assay click here buffer to make the standard curve. For each well 100 μL of assay buffer were added to the blank wells and 90 μL added to the sample wells, after this 10 μL/well of prediluted samples were added in assay buffer to the appropriate wells and 50 μL/well of diluted detection-antibody

was added to all wells. The plate was sealed and incubated at room temperature for 3 h. After washing, substrate was added and the plate incubated at room temperature for 15 min. The reaction was stopped and the plate read at 450 nm. The molecular protein profile of T. serrulatus venom was determined by polyacrylamide gel electrophoresis and sodium dodecyl sulfate (SDS-PAGE) either and is shown in Fig. 1. This data showed several protein fractions, divided into low and medium molecular weight comprising of around 30.0–60.0 kDa. The particles were formed spontaneously by intra- and intermolecular bonds between the phosphate groups of TPP and the amine of chitosan (Gan and Wang, 2007). The formation of an opalescent final dispersion was observed, characteristic of the presence of nanoparticles (Gan et al., 2005), which was confirmed by particle size analysis. The nature of interactions between the chitosan and TPP was established with FT-IR spectroscopy, since any kind of physicochemical interaction between chitosan and TPP will automatically lead to frequency shifts or splitting in absorption bands. FT-IR spectra of chitosan nanoparticles and chitosan matrix are shown in Fig. 2.

Hargreaves-Allen et al [71] suggest that MPAs are unlikely to be

Hargreaves-Allen et al. [71] suggest that MPAs are unlikely to be successful if there are high levels of conflict, numerous uncontrollable external stressors, or alternative forms of development and livelihoods

are not possible Governance is the structural, institutional, ideological, and procedural umbrella under which development programs and management practices operate. Natural resource governance can be defined as “the interactions among structures, processes and traditions that determine how power and responsibilities are exercised, how decisions are taken, and how citizens or other stakeholders have their say” [110]. Governance determines how and whether the interactions of structures, processes, and institutions Selleck PD0332991 coalesce to solve societal and environmental problems [111] and [112]. Effective governance requires the design of institutions that are instrumental in “encourag[ing] people to choose to behave in a manner that provides for certain strategic policy outcomes, particularly biodiversity conservation objectives, to be fulfilled” [37] and [113].

Governance can be evaluated based on whether it effectively supports the achievement of MPA outcomes and also whether it engages with the principles of “good” governance—including legitimacy, transparency, accountability, inclusiveness, fairness, integration, capability, and adaptability [102] and [110]. OSI-744 mouse The importance of these guiding principles is generally supported by the recent literature on MPA governance, management, and development. The following section will explore three aspects of governance that are required to establish a solid base for management and development and the achievement of beneficial socio-economic and environmental outcomes from MPAs: (1) the creation

of an enabling institutional and organizational environment; (2) the process of implementation and design of MPAs; and, (3) the choice of management structures and MPA design (i.e., strict no-take, multiple use, multiple use with no-take zone). The concept of institutions often refers to both “soft” and “hard” institutions BCKDHA such as norms, rules, policies, and laws after [114]. Institutions are manifest in formalized organizations (e.g., governmental, non-governmental, and community based organizations) and structures (e.g., co-management and MPA format) and the interactions amongst these bodies. Institutions and organizations can act as drivers, constraints, or supports for effective MPA management and local development depending on the level of institutional linkage, congruence, coordination, and cooperation across scales [73], [100] and [115]. The harmonization of legal frameworks and mandates, policies at various levels, local rules and regulations, cultural norms and individual attitudes is both a challenge and an imperative for enabling effective management and development. As Camargo et al.

DSC results are presented in Table 4 and Fig  1 and Fig  2 All t

DSC results are presented in Table 4 and Fig. 1 and Fig. 2. All the flour samples exhibited at least two endothermic peaks at different temperatures, with the exception of severe extrusion flour. They are referred to hereafter

as transitions 1, 2 and 3 (Tp1, Tp2, Tp3). The first Tp for whole and defatted native amaranth flour were similar (76 °C) and coincided with the paste temperature obtained by RVA. Some authors (Baker & Rayas-Duarte, 1998) have reported that the gelatinization temperature of amaranth starch was higher than wheat or rice starches. They have suggested there are more organized regions in amaranth as higher temperatures were needed to record a melting transition. learn more These Tp and their respective δH could indicate starch gelatinization whereas the other small peaks could be attributable

to protein denaturation. In fact, Baker and Rayas-Duarte (1998) reported a Tp for amaranth starch of around 70 °C and Kong et al. (2009) observed Tp for fifteen selleck kinase inhibitor cultivars of amaranth which ranged from 68 °C to 78 °C. Martínez and Añón (1996) reported different temperatures for amaranth protein denaturation. Albumin and glutelin presented Tp of 64 °C and 70 °C, respectively, which indicate lower thermal stability. It was also observed a higher Tp (in excess of 90 °C), corresponding to globulin, albumin-2 and glutelin subfraction that are more thermostable. However, it is worth noting that these comparisons to the present work are not straightforward because in this case all amaranth fractions must be considered and also distinct water:starch proportions were used. Initially, it was thought that the small endothermic peak observed for whole native flour could be attributed to an amylose–lipid complex. However, this peak still occurred after defatting at the same temperature (defatted native flour),

indicating that it was not related to the lipid content of SPTLC1 the flour. In addition, lipid–amylose complexes start to melt only at temperatures approaching 110 °C (Doublier, Paton, & Llamas, 1987) and the waxy characteristic of amaranth flour starch did not confirm this hypothesis, again suggesting denaturation of thermostable protein, as outlined earlier. It is noteworthy that Okechukwu and Rao (1997) also reported two DSC peaks in a study with cowpea protein plus starch (cowpea and corn) gels, the first peak being due to starch gelatinization and second to protein denaturation. The absence of an endothermic peak at around 70 °C for extruded flours could indicate total degradation of starch that occurred prior to the extrusion process. Indeed, these results agree with those discussed previously in that the extruded flours also showed a very small peak and low final viscosity compared to native flours. González, Carrarra et al. (2007) reported similar values of enthalpy for an extruded amaranth starch-rich fraction to those observed in this study.

Commercial carriers Kaldnes™ K1 (Anoxkaldnes™, Sweden), made of h

Commercial carriers Kaldnes™ K1 (Anoxkaldnes™, Sweden), made of high density polyethylene (density 950 kg/m3; surface area 500 m2/m3), were used as inert supports. The carriers were autoclaved at 121 °C for 20 min until used. Sunflower (Helianthus annuus) seeds were obtained from a local market Afatinib and the shells were collected after normal human consumption of the seeds. The sunflower seed shells (SS) were autoclaved at 121 °C for 20 min before use. The chemical

composition of the SS according to Gullón et al. [6] is 23 ± 0.15% glucan, 29.4 ± 0.0016% klason lignin, 25.8 ± 0.07% hemicelluloses, 5.40 ± 0.03% extractives and 4 ± 0.15% ash. Cultivation was carried out in cotton-plugged Erlenmeyer flasks (250 mL) containing 3 g of Kaldnes™ K1 carriers or 1.5 g SS, according to the experiment, and 20 mL of culture medium. The culture medium composition was the same as that of the medium M1 described in Rodriguez-Couto [16] and consisted of 10 g/L glucose, 20 g/L yeast extract, 0.9 g/L

(NH4)2SO4, 2 g/L KH2PO4, 0.5 g/L MgSO4·7H2O, 0.1 g/L CaCl2·2H2O, 0.5 g/L KCl and 0.5 g/L thiamine hydrochloride in 0.05 M citrate–phosphate buffer (pH 4.5). To boost laccase production 0.5 mM Cu+2 was added to the cultures on the 3rd cultivation day [18]. Inoculation was carried out directly in the Erlenmeyer flasks. Three agar plugs (diameter, 7 mm), from a 7-day grown fungus on PDA, per Erlenmeyer were used as inoculum. The Erlenmeyer flasks were incubated statically under an air atmosphere at 30 °C and in complete darkness. Glucose consumption, Bak apoptosis measured as reducing sugars, was determined with the dinitrosalicylic acid reagent (DNS) using d-glucose as a standard according to the method described by Miller [11]. Laccase activity

was spectrophotometrically determined as described by Niku-Paavola et al. [12] with 2,2′-azino-di-[3-ethyl-benzo-thiazolin-sulphonate] (ABTS) as a substrate. One activity unit (U) was defined as the amount of enzyme very that oxidised 1 μmol of ABTS per min. The activities were expressed in U/L. Manganese-dependent peroxidase activity was spectrophotometrically assayed at 468 nm by the method of Kuwahara et al. [9]. The reaction was started by adding 0.4 mM H2O2. One activity unit (U) was defined as 1 μmol of 2,6-dimethoxyphenol oxidised per minute and the activities were expressed in U/L. Lignin peroxidase activity was spectrophotometrically determined at 310 nm according to Tien and Kirk [22]. The reaction was starting by adding 0.4 mM H2O2. One activity unit (U) was defined as 1 μmol of veratryl alcohol oxidised in 1 min and the activities were reported as U/L. The dyes used were the textile dyes Bemaplex Navy M-T (CI Acid Blue 193), an acid chromium-complex dye and Bezaktiv Blue BA (CI Reactive Blue 235), a reactive copper-complex dye. They were a kind gift of CTH R. Beilich GmbH (Barcelona, Spain). They were used as received, without further purification.

In nonlifting cases, because of underlying fibrosis endoscopic su

In nonlifting cases, because of underlying fibrosis endoscopic submucosal dissection may be necessary for complete resection.14 Figure options Download full-size image Download high-quality image (240 K) Download as PowerPoint slide Fig. 48. Ensuring complete resection. Close endoscopic visualization of the surroundings of the resection area to ensure complete resection cannot be overemphasized. In this case, indigo carmine is applied EPZ5676 to delineate its borders. EMR is performed, showing significant fibrosis. However, close inspection of the defect borders shows residual lesion

(arrows). Repeat snare of the site is immediately performed to achieve complete resection. Argon plasma coagulation is then used to coagulate the base and edges of the resection. Figure options Download full-size image Download high-quality image (284 K) Download as PowerPoint slide Fig. 49. Evaluation of the surroundings is critical. Following resection, close inspection of the resection defect borders should be performed, and any residual neoplasia removed. In addition, the mucosa

around the site should be biopsied to exclude the presence of invisible dysplasia. Figure options Download full-size image Download high-quality image (315 K) Download as PowerPoint slide Fig. 50. Multiple nonpolypoid neoplasms can be endoscopically resected during a single procedure. A 62-year-old patient with long-standing Crohn’s colitis underwent surveillance colonoscopy Vincristine mw that showed multiple neoplasms distributed throughout the colon. (1A to 1C) and (2A to 2E) illustrate details of diagnosis Progesterone and resection of the lesions. Chromoendoscopy using indigo carmine 0.4% was used for delineation of the borders and examination of the epithelial surface. En bloc EMR resections were performed (1C, 2E). Histopathology showed LGD within chronic colitis. Figure options Download full-size image Download

high-quality image (543 K) Download as PowerPoint slide Fig. 51. Endoscopic resection in patients with Crohn or ulcerative colitis can be very difficult because of underlying thickened mucosa and fibrosis. Multiple biopsies for removal of such lesions must be avoided. EMR is usually the most appropriate endoscopic therapy, noting still the high level of difficulty and risk in endoscopic resection of IBD lesions. Endoscopic submucosal dissection may be necessary for complete resection in some cases, such as shown here. Following injection of the submucosa, there is minimal lifting. Thus, a dual knife is used to make a circumferential incision around the lesion border and dissect the fibrosis submucosally, after which a snare is used to remove the lesion in one piece. Figure options Download full-size image Download high-quality image (195 K) Download as PowerPoint slide Fig. 52. Severe fibrosis in Crohn’s or ulcerative colitis can make endoscopic removal technically difficult.