BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)ha...BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)has emerged as a safe and effective approach in this patient population.This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBEERCP in patients with surgically altered anatomy(SAA),building on previously published evidence.AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short-and long-scope double-balloon enteroscopy(DBE).METHODS A comprehensive search of PubMed,EMBASE,and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy.A random-effects model was applied to conduct a meta-analysis of proportions.The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale.Heterogeneity was evaluated using the inconsistency statistic(I2).Publication bias was examined using funnel plots and Egger’s regression test.RESULTS A total of 40 studies were included,comprising 10 cohort studies and 30 case series,including 2689 patients who underwent 3478 procedures.The surgical procedures were primarily classified into three categories:Roux-en-Y reconstruction(including hepaticojejunostomy,gastric bypass,and choledochojejunostomy,etc.)in 1156 cases;pancreaticoduodenectomy(performed using either the Whipple or Child technique)in 549 cases;and Billroth II anastomosis in 265 cases.The combined success rate for reaching the papilla was 92%(95%CI:89%-95%).The overall enteroscopy success rate was 89%(95%CI:85%-92%).The pooled diagnostic success rate was 90%(95%CI:85%-95%),while the therapeutic success rate reached 92%(95%CI:89%-95%).Adverse events reported in 5.7%of patients(95%CI:4.1%-7.5%).Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate,enteroscopy success,and procedural success.No significant differences were observed between groups in diagnostic success or adverse events.CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA.Compared to long-scope DBE,short-scope DBE shows greater clinical promise;however,further randomized controlled trials are warranted to validate these findings.展开更多
There are abundant igneous gas reservoirs in the South China Sea with significant value of research,and lithology classification,mineral analysis and porosity inversion are important links in reservoir evaluation.Howe...There are abundant igneous gas reservoirs in the South China Sea with significant value of research,and lithology classification,mineral analysis and porosity inversion are important links in reservoir evaluation.However,affected by the diverse lithology,complicated mineral and widespread alteration,conventional logging lithology classification and mineral inversion become considerably difficult.At the same time,owing to the limitation of the wireline log response equation,the quantity and accuracy of minerals can hardly meet the exploration requirements of igneous formations.To overcome those issues,this study takes the South China Sea as an example,and combines multi-scale data such as micro rock slices,petrophysical experiments,wireline log and element cutting log to establish a set of joint inversion methods for minerals and porosity of altered igneous rocks.Specifically,we define the lithology and mineral characteristics through core slices and mineral data,and establish an igneous multi-mineral volumetric model.Then we determine element cutting log correction method based on core element data,and combine wireline log and corrected element cutting log to perform the lithology classification and joint inversion of minerals and porosity.However,it is always difficult to determine the elemental eigenvalues of different minerals in inversion.This paper uses multiple linear regression methods to solve this problem.Finally,an integrated inversion technique for altered igneous formations was developed.The results show that the corrected element cutting log are in good agreement with the core element data,and the mineral and porosity results obtained from the joint inversion based on the wireline log and corrected element cutting log are also in good agreement with the core data from X-ray diffraction.The results demonstrate that the inversion technique is applicable and this study provides a new direction for the mineral inversion research of altered igneous formations.展开更多
Introduction The East Kunlun Orogenic Belt is located in the northeastern part of the Qinghai–Tibet Plateau(Li et al.,2007),stretching from the East Kunlun to the Elashan area in an east–west direction(Guo et al.,20...Introduction The East Kunlun Orogenic Belt is located in the northeastern part of the Qinghai–Tibet Plateau(Li et al.,2007),stretching from the East Kunlun to the Elashan area in an east–west direction(Guo et al.,2018).It is an important part of the Central Orogenic Belt(Xiong et al.,2023).It is considered one of the important gold mineralization regions in the Tethys tectonic domain(Norbu et al.,2023)and an essential potential base for mineral resources in China.Wulonggou and Gouli gold mines have been discovered successively,earning the reputation of the"Golden Belt of Qinghai Province"(Feng et al.,2004;He et al.,2023).展开更多
The extraction of valuables from waste has gained momentum.Thermal infuence alters both the organic and inorganic components of coal.Insufficient knowledge on the association of rare earth elements(REEs)with the paren...The extraction of valuables from waste has gained momentum.Thermal infuence alters both the organic and inorganic components of coal.Insufficient knowledge on the association of rare earth elements(REEs)with the parent matrix of thermally altered high-ash coals(63%ash)limits the potential for such coals being utilized for isolation of valuables.In this study,we analyzed the distribution and occurrence modes of REEs within a magmatically altered high-ash coal via nine-step sequential extraction,combining Tessier and BCR methods.The total concentration of REEs in the coal sample,on whole coal basis,was found to be 820 ppm,which is significantly higher than the world average.Major mineral oxides were deduced to be those of Si,Fe,Al,Ca,Mg,and Ti.Sequential extraction confirmed that about 66%of HREE and 25%of LREE were included in the residual fraction.LREEs were concluded to be primarily in ionic form,whereas HREEs were speculated to be associated with the TiO_(2) phase.XRD analyses showed that thermal alteration affected the dolomite phase specifically,which selectively got removed where carbonate-bound elements were assessed.Petrographic analysis supported the magmatic influence and demonstrated the presence of mosaic structures and pores containing unfused vitrinite,with a reflectance value of 3.6.To summarize,the present study pertaining to delineation of association of valuables in high-ash heat-altered coals from an Eastern coalfeld in India can potentially open up new avenues for utilizing such coals,which are otherwiseconsidered waste.展开更多
To fill the gap of the nomenclature of altered igneous rocks,a new exhaustive multidimensional classification scheme consistent with the International Union of Geological Sciences(IUGS)is proposed.Our procedure is bas...To fill the gap of the nomenclature of altered igneous rocks,a new exhaustive multidimensional classification scheme consistent with the International Union of Geological Sciences(IUGS)is proposed.Our procedure is based on an extensive database of major element compositions of a total of 32948 relatively fresh rock samples.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types o...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types of reconstruction,cannulating a papilla with a reverse orientation,and performing therapeutic interventions with uncommon endoscopic accessories.The development of endoscopic techniques has led to higher success rates in this group of patients.Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction;however,these success rate is lower in long-limb reconstruction.ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length;however,it must be performed by a highly experienced and skilled endoscopist.Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography,but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy.Laparoscopic-assisted ERCP has an almost 100%success rate in longlimb reconstruction because of the use of a conventional side-view duodenoscope,which is compatible with standard accessories.This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy.This review focuses on the advantages,disadvantages,and outcomes of various procedures that are suitable in different situations and reconstruction types.Emerging new techniques and their outcomes are also discussed.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine.Recently,many studies have reported that balloonenteroscope-assisted ERC...Endoscopic retrograde cholangiopancreatography(ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine.Recently,many studies have reported that balloonenteroscope-assisted ERCP(BEA-ERCP) is a safe and effective procedure.However,further improvements in outcomes and the development of simplified procedures are required.Percutaneous treatment,Laparoscopy-assisted ERCP,endoscopic ultrasoundguided anterograde intervention,and open surgery are effective treatments.However,treatment should be noninvasive,effective,and safe.We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications.BEA-ERCP still requires high expertiselevel techniques and is far from a routinely performed procedure.Various techniques have been proposed to facilitate scope insertion(insertion with percutaneous transhepatic biliary drainage(PTBD) rendezvous technique,Short type single-balloon enteroscopes with passive bending section,Intraluminal injection of indigo carmine,CO2 inflation guidance),cannulation(PTBD or percutaneous transgallbladder drainage rendezvous technique,Dilation using screw drill,Rendezvous technique combining DBE with a cholangioscope,endoscopic ultrasound-guided rendezvous technique),and treatment(overtube-assisted technique,Short type balloon enteroscopes) during BEA-ERCP.The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients.A standard procedure for ERCP yet to be established for patients with a reconstructed intestine.At present,BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as firstline treatment.In this article,we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP) in patients with surgically altered anatomy is challenging. Several operative interventions of both the gastrointestinal tract and the biliary and/or pancreatic sys...Endoscopic retrograde cholangiopancreatography(ERCP) in patients with surgically altered anatomy is challenging. Several operative interventions of both the gastrointestinal tract and the biliary and/or pancreatic system lead to altered anatomy, rendering ERCP more difficult or even impossible with a conventional side-viewing duodenoscope. Adapted endoscopes are avail-able to reach the biliopancreatic system and to perform ERCP in patients with altered anatomy. However, both technical difficulties and complications determine the procedure's success. Different technical approaches have been described and are highly dependent on local expertise and endoscopic equipment. Standard-ized practical guidelines are currently unavailable. This review focuses on the challenges encountered during ERCP in patients with altered anatomy and how to deal with them. The first challenge is reaching the papilla or the bilioenteric/pancreatoenteric anastomosis in the patient with postoperative altered anatomy. The sec-ond challenge is the cannulation of the biliopancreatic system and performing all conventional ERCP interven-tions and the third challenge is the control of possible complications. The available literature data on this topicis reviewed and illustrated with clinical cases.展开更多
In recent years,the close relationship between uranium and Ti-Fe oxides in the sandstonetype uranium deposits has been extensively recognized.However,the altered characteristics of ilmenite and its relationship with u...In recent years,the close relationship between uranium and Ti-Fe oxides in the sandstonetype uranium deposits has been extensively recognized.However,the altered characteristics of ilmenite and its relationship with uranium enrichment still remain unclear.With this paper based on heavymineral sorting of uranium ore selected from the Tarangaole-Nalinggou deposit in the northeastern Ordos Basin,electron probe,backscattering image,energy spectrum and scanning electron microscopy were systematically performed.The ilmenite in the sandstone can be divided into four groups,including unaltered,weakly altered,moderately altered,and strongly altered ilmenite.The alteration of ilmenite in uranium ores is notably more intense than that of the surrounding rocks.In addition,weakly,moderately,and strongly altered ilmenite associated with uranium minerals in uranium ores demonstrate that the more intensity ilmenite altered,the closer its relationship with uranium minerals is.The ilmenite has likely been somewhat altered before mineralization,and the alteration intensifies by later exposure related to an oxygencontaining fluid.The alteration mechanism comprises a process of competitive diffusion between Fe^(2+)and O_(2)-ions.In the early stage,Fe ions was mainly diffused on the particle surface.Subsequently,diffusion of O ions into the particles began to be dominate.Most of the leached iron is stripped or carried away by fluid.In an alkaline and reductive environment,the remaining iron is reduced to form the surrounding pyrite,and TiO_(2)in a form of titanium sol recrystallizes(i.e.,anatase).Backscattering images show that uranium and altered ilmenite are close in space.Coffinite is often distributed along the edges of altered ilmenite as burrs in shape.Colloidal or knitted coffinite associated with anatase is formed in the voids of altered ilmenite.The chemical composition of altered ilmenite varies considerably from the core to edge,and the mineral assemblage sequence is from girdle with ilmenite,to leucosphenite,to anatase,and to coffinite.There is no brannerite that is symbiotic with altered ilmenite.It is considered to be a uranium-containing titanium mineral aggregate caused by the reduction and adsorption of uranium.As the altered product of ilmenite,TiO_(2)is an aggregation agent,increasing the concentration of uranium by adsorption.Together with Fe^(2+)and S_(2)-in secondary pyrite,this aggregate creates a uranium-rich environment in the microzone for the formation of coffinite.Therefore,the alteration of ilmenite plays a geochemical role in the processes of sedimentary,diagenesis and mineralization,in which Fe is removed,Ti is enriched,and U is adsorbed and reduced.展开更多
Hydrocarbon micro-seepage can cause oxidation reduction reactions and produce altered minerals in surface sediments and soft. The typical altered minerals mapping by their diagnostic spectral features on hyper-spectra...Hydrocarbon micro-seepage can cause oxidation reduction reactions and produce altered minerals in surface sediments and soft. The typical altered minerals mapping by their diagnostic spectral features on hyper-spectral images is an important tool for the petroleum exploration industry. In this study, the airborne hyper-spectral data were used to investigate the altered minerals induced by hydrocarbon micro-seepages by spectral feature fitting （SFF） in the loess coverage area of Xifeng Oflfield. The results re- veal that the distribution region of the altered minerals induced by hydrocarbon micro-seepage is larger than the known oilfield exploration area. The potential hydrocarbon micro-seepage region was also re- vealed by the distribution of altered minerals besides the known hydrocarbon area. A fast index was pro- posed by the absorption depths of clay and carbonate minerals for assessment of hydrocarbon micro- seepage. And it gave much clearer boundaries for the hydrocarbon micro-seepage in the loess coverage area than those by the altered mineral mapping. In addition, some field samples were analyzed by X-ray diffrac- tion （XRD） and atomic absorption spectrophotometer to validate the results. Within the extents of hydro- carbon micro-seepage, there are lower contents of ferric iron and higher contents of carbonate minerals in these samples. Therefore, it is satisfactory to have the airborne hyper-spectral data to outline the extents of hydrocarbon micro-seepage for further hydrocarbon exploration in the loess coverage area.展开更多
To understand how differentially methylated genes（DMGs）might affect the pathogenesis of Kashin-Beck disease（KBD）.Genome-wide methylation profiling of whole blood from 12matched KBD and controls pairs was performed...To understand how differentially methylated genes（DMGs）might affect the pathogenesis of Kashin-Beck disease（KBD）.Genome-wide methylation profiling of whole blood from 12matched KBD and controls pairs was performed using a high-resolution Infinium 450 K methylation array.In total,97 CpG sites were differentially展开更多
BACKGROUND Intravascular large B-cell lymphoma(IVLBCL)is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings.Early diagnosis is critical to altering the disea...BACKGROUND Intravascular large B-cell lymphoma(IVLBCL)is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings.Early diagnosis is critical to altering the disease course as early treatment with chemoimmunotherapy is required to prevent a rapidly fatal outcome.Strategies including improved awareness of this clinical entity through publication of cases with unique presentations are essential to prompt consideration of IVLBCL early in the disease workup.Here,we present a case of IVLBCL presenting with altered mental status and systemic organ dysfunction.CASE SUMMARY A 61-year-old male patient presented with flu-like symptoms and a high fever.He experienced rapid clinical deterioration with liver,kidney failure,and shock despite rapid antibiotic administration and supportive care.A broad infectious workup was negative.Intracranial imaging revealed nonspecific changes to the corpus callosum suspicious for vasculitis.Renal biopsy was non-diagnostic.After further progression of his symptoms,the family elected to withdraw care and the patient died shortly thereafter.Post-mortem analysis revealed clear multi-organ involvement by IVLBCL,prompting re-examination of the ante-mortem renal biopsy that also identified IVLBCL involvement.CONCLUSION IVLBCL is a rare disease.Communication with specialties and early biopsy is critical to establishing the diagnosis and initiating therapy.展开更多
BACKGROUND： Altered mental status （AMS） is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly ...BACKGROUND： Altered mental status （AMS） is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly challenging for emergency physicians. The aim of this study is to provide a framework for the assessment of AMS patients. This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS： This is a prospective cohort observational study. We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24 months （June 2009 to June 2011）. Demographic characteristics, clinical manifestations, assessment approaches, causative factors, emergency treatments and outcomes were collected prospectively.RESULTS： In 1934 patients with AMS recruited, accounting for 0.93% of all emergency department （ED） patients, 1 026 （53.1%） were male, and 908 （46.9%） female. Their average age was 51.95±15.71 years. Etiologic factors were neurological （n=641; 35.0%）, pharmacological and toxicological （n=421; 23.0%）, systemic and organic （n=266; 14.5%）, infectious （n=167; 9.1%）, endocrine/metabolic （n=145; 7.9%）, psychiatric （n=71; 3.9%）, traumatic （n=38; 2.1%）, and gynecologic and obstetric （n=35; 1.9%）. Total mortality rate was 8.1% （n=156）. The death rate was higher in elderly patients （≥60） than in younger patients （10.8% vs. 6.9%, P=-0.003）.CONCLUSION： Patients with AMS pose a challenge for ED physicians. The most frequently encountered diagnostic categories causing AMS were primary CNS disorders, intoxication, organ system dysfunction, and endocrine/metabolic diseases. AMS has a high fatality rate in the ED. AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects. Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.展开更多
Igneous intrusion into coal-bearing strata can cause an abrupt increase of temperature-pressure and trigger hydrothermal circulation at the igneous rock-coal contact zone. The conductive heat of intruded lnagma and co...Igneous intrusion into coal-bearing strata can cause an abrupt increase of temperature-pressure and trigger hydrothermal circulation at the igneous rock-coal contact zone. The conductive heat of intruded lnagma and convective migration of secondary hydrothermal fluids have been observed to significantly alter the concentrations and modes of occurrence of mercury （Hg） in thermally-intruded coals.展开更多
Following severe traumatic brain injury .（sTBI）, patients may remain in a coma, vegetative state （VS）, or minimally conscious state （MCS）, all of which are also clinically termed disorders of consciousness. Pati...Following severe traumatic brain injury .（sTBI）, patients may remain in a coma, vegetative state （VS）, or minimally conscious state （MCS）, all of which are also clinically termed disorders of consciousness. Patients in a coma show complete disability in the arousal system and fail to achieve awareness spontaneously; yet true coma represents a transient state and rarely lasts longer than a month [1]. The VS （also known as unresponsive wakefulness syndrome）, characterized as a state with spontaneous or stimulus-induced eye-opening but the patient appears totally unaware of self and environment, may persist for months or years [2]. In contrast, the MCS is evidenced by preserved and reproducible signs of awareness as well as sleep-wake cycles, suggesting better recovery than coma and VS. Considering that no signs of consciousness are detectable, patients in a VS suffer from a high rate of misdiagnosis [3].展开更多
AIM: To investigate the clinical and pathological significance of altered retinoblastoma (Rb) encoding protein (pRb) in gastric carcinoma. METHODS: Expression of altered pRb was analyzed in 91 patients with gastric ad...AIM: To investigate the clinical and pathological significance of altered retinoblastoma (Rb) encoding protein (pRb) in gastric carcinoma. METHODS: Expression of altered pRb was analyzed in 91 patients with gastric adenocarcinoma by immunohistochemistry. RESULTS: Sixty-five percent (59/91) of the tumors were positively stained and the staining in tumor nuclei of gastric carcinoma ranged 0%-90%. Moreover, strong expression of altered pRb was found in 35% (6/17), 24% (5/21), 17% (8/46) and 0% (0/7) of T1, T2, T3 and T4 gastric carcinomas, respectively. altered pRb expression was inversely correlated with the depth of tumor invasion (P = 0.047). Degree of immunoreactivity had no significant correlation with tumor grade, node metastasis and distant metastasis. In terms of prognostic significance, univariate analysis showed that poor differentiation [41 (66.1%) vs 34 (42.5%) P = 0.051], advanced tumor stage (P < 0.001) and weakly altered pRb expression [17 (80.5%) vs 58 (49.6%) P = 0.044] were associated with worse prognosis in these patients. However, multivariate analysis revealed that advanced tumor stage was the only independent poor prognostic factor (P < 0.001). CONCLUSION: The mutation of Rb gene is frequent in gastric carcinoma. The expression of altered pRb inversely correlates with tumor invasion and is not an independent prognostic marker in gastric adenocarcinoma.展开更多
Dear Editor Despite remarkable advances in our understanding of brain functions,the neural substrates and correlates of consciousness remain unclear[1].It has been argued that classical physics is intrinsically incapa...Dear Editor Despite remarkable advances in our understanding of brain functions,the neural substrates and correlates of consciousness remain unclear[1].It has been argued that classical physics is intrinsically incapable of explaining the holistic aspects of consciousness.展开更多
BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology.Sta...BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology.Standard endoscopy as well as push endoscopy can be a challenge in those with altered anatomy given inaccessible areas as well as perforation risk.Single and double balloon enteroscopy can be warranted in this patient population in instances of obscure GI bleed.AIM To assess the safety and diagnostic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy.METHODS A search was conducted through PubMed,MEDLINE,Google Scholar,Scopus,and Embase with the key words“enteroscopy,”“obscure bleeding,”and“altered anatomy,”to identify relevant articles in English with no restricted time frame.A search within the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles.Study types included in the review were prospective and retrospective reviews,case series,and case reports.The reference lists of these papers were also reviewed to find further papers that were applicable.The authors extracted the data from the studies that fit inclusion criteria.Data of interest included type of study,type of procedure,and type of altered anatomy,as well as the number of patients with any diagnostic or therapeutic intervention.Data was also recorded on procedure tolerance and complications.The data was analyzed with descriptive statistics.RESULTS Our literature search yielded 14 studies that were included.There were 68 procedures performed with 61 unique patients subjected to these procedures.Forty-four(65%)of the procedures were double balloon,21(31%)were single balloon,and 3(4%)were classified as through the scope balloon assisted.The most common altered anatomy types included Gastric Bypass Roux-en-Y,Pylorus Sparing Whipple,Orthotopic Liver Transplantation with Roux-en-Y,and Gastrojejunostomy Roux-en-Y.The procedures were successfully performed in each patient.There were 5(7%)procedures that were complicated by perforation.Amongst the available data,the diagnostic yield was 48/59(81%)and a therapeutic yield of 39/59(66%).One patient was recommended surgical revision of their altered anatomy following enteroscopy.CONCLUSION Balloon enteroscopy is a useful diagnostic modality in investigating obscure GI bleeding within those with surgically altered anatomy;however,precautions must be taken as this population may have increased perforation risk.展开更多
Introduction: In the setting of an extra-adrenal malignancy, it is a recognized clinical challenge to try and distinguish a benign adrenal mass from a metastatic deposit. Current non-invasive diagnostic tools for adre...Introduction: In the setting of an extra-adrenal malignancy, it is a recognized clinical challenge to try and distinguish a benign adrenal mass from a metastatic deposit. Current non-invasive diagnostic tools for adrenal gland evaluation include CT, MRI, PET and PET-CT. Diagnostic interpretative error can occur as evaluations rarely have complete cytologic or histologic correlation for concordance purposes. Aims: To establish the performance characteristics of non-contrast CT attenuation values (Hounsfield units-HU) and the optimal PET-CT maximum standard uptake value (SUVmax) for predicting adrenal malignancy when correlated with adrenal gland endoscopic ultrasound fine needle aspiration (EUS FNA) cytology results. Methods: A prospectively maintained EUS database was reviewed to identify consecutive patients who underwent a left adrenal gland FNA. Non-contrast CT attenuation values and SUVmax scores were calculated. EUS FNA cytology results were used as the reference standard for determining the presence of benign versus malignant adrenal gland status. Results: Sixty-two patients (69 ± 11 years) underwent adrenal EUS FNA, 34 (54.8%) of whom had a clinically suspected or established extra-adrenal malignancy. Non-invasive imaging was suggestive of abnormal adrenal morphology or altered PET-CT FDG activity in 45 (72.6%) patients. Elevated attenuation values (≥10 HU) by non-enhanced CT had a sensitivity and specificity of 100% and 34.6%, respectively. The SUVmax for malignant altered morphology was significantly higher than that for benign lesions [(8.5 ± 3.1 vs 3.3 ± 0.7;(p = 0.0001)]. ROC curve analysis indicated that an optimum cutoff SUVmax of ≥4.1 (AUC 0.92) yielded the best power distinction for malignancy with a sensitivity and specificity of 89% and 100%. Conclusion: When evaluating altered adrenal morphology by non-invasive methods, the performance characteristics of elevated CT attenuation values are suboptimal. But by adopting a SUVmax cut-off value of ≥4.1 could potentially improve such characteristics to detect malignancy.展开更多
基金Supported by Department of Science and Technology of Liaoning Province,No.2024JH2/102600288 and No.2022JH2/101500013。
文摘BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)has emerged as a safe and effective approach in this patient population.This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBEERCP in patients with surgically altered anatomy(SAA),building on previously published evidence.AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short-and long-scope double-balloon enteroscopy(DBE).METHODS A comprehensive search of PubMed,EMBASE,and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy.A random-effects model was applied to conduct a meta-analysis of proportions.The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale.Heterogeneity was evaluated using the inconsistency statistic(I2).Publication bias was examined using funnel plots and Egger’s regression test.RESULTS A total of 40 studies were included,comprising 10 cohort studies and 30 case series,including 2689 patients who underwent 3478 procedures.The surgical procedures were primarily classified into three categories:Roux-en-Y reconstruction(including hepaticojejunostomy,gastric bypass,and choledochojejunostomy,etc.)in 1156 cases;pancreaticoduodenectomy(performed using either the Whipple or Child technique)in 549 cases;and Billroth II anastomosis in 265 cases.The combined success rate for reaching the papilla was 92%(95%CI:89%-95%).The overall enteroscopy success rate was 89%(95%CI:85%-92%).The pooled diagnostic success rate was 90%(95%CI:85%-95%),while the therapeutic success rate reached 92%(95%CI:89%-95%).Adverse events reported in 5.7%of patients(95%CI:4.1%-7.5%).Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate,enteroscopy success,and procedural success.No significant differences were observed between groups in diagnostic success or adverse events.CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA.Compared to long-scope DBE,short-scope DBE shows greater clinical promise;however,further randomized controlled trials are warranted to validate these findings.
基金The project was supported by the National Natural Science Foundation of China(Grant No.42204122).
文摘There are abundant igneous gas reservoirs in the South China Sea with significant value of research,and lithology classification,mineral analysis and porosity inversion are important links in reservoir evaluation.However,affected by the diverse lithology,complicated mineral and widespread alteration,conventional logging lithology classification and mineral inversion become considerably difficult.At the same time,owing to the limitation of the wireline log response equation,the quantity and accuracy of minerals can hardly meet the exploration requirements of igneous formations.To overcome those issues,this study takes the South China Sea as an example,and combines multi-scale data such as micro rock slices,petrophysical experiments,wireline log and element cutting log to establish a set of joint inversion methods for minerals and porosity of altered igneous rocks.Specifically,we define the lithology and mineral characteristics through core slices and mineral data,and establish an igneous multi-mineral volumetric model.Then we determine element cutting log correction method based on core element data,and combine wireline log and corrected element cutting log to perform the lithology classification and joint inversion of minerals and porosity.However,it is always difficult to determine the elemental eigenvalues of different minerals in inversion.This paper uses multiple linear regression methods to solve this problem.Finally,an integrated inversion technique for altered igneous formations was developed.The results show that the corrected element cutting log are in good agreement with the core element data,and the mineral and porosity results obtained from the joint inversion based on the wireline log and corrected element cutting log are also in good agreement with the core data from X-ray diffraction.The results demonstrate that the inversion technique is applicable and this study provides a new direction for the mineral inversion research of altered igneous formations.
基金supported by Qinghai Provincial Association for Science and Technology Youth Science and Technology Talent Support Project(Grant No.2023QHSKXRCTJ47)Exploration Foundation of Qinghai Province(Grant No.2023085029ky004)。
文摘Introduction The East Kunlun Orogenic Belt is located in the northeastern part of the Qinghai–Tibet Plateau(Li et al.,2007),stretching from the East Kunlun to the Elashan area in an east–west direction(Guo et al.,2018).It is an important part of the Central Orogenic Belt(Xiong et al.,2023).It is considered one of the important gold mineralization regions in the Tethys tectonic domain(Norbu et al.,2023)and an essential potential base for mineral resources in China.Wulonggou and Gouli gold mines have been discovered successively,earning the reputation of the"Golden Belt of Qinghai Province"(Feng et al.,2004;He et al.,2023).
文摘The extraction of valuables from waste has gained momentum.Thermal infuence alters both the organic and inorganic components of coal.Insufficient knowledge on the association of rare earth elements(REEs)with the parent matrix of thermally altered high-ash coals(63%ash)limits the potential for such coals being utilized for isolation of valuables.In this study,we analyzed the distribution and occurrence modes of REEs within a magmatically altered high-ash coal via nine-step sequential extraction,combining Tessier and BCR methods.The total concentration of REEs in the coal sample,on whole coal basis,was found to be 820 ppm,which is significantly higher than the world average.Major mineral oxides were deduced to be those of Si,Fe,Al,Ca,Mg,and Ti.Sequential extraction confirmed that about 66%of HREE and 25%of LREE were included in the residual fraction.LREEs were concluded to be primarily in ionic form,whereas HREEs were speculated to be associated with the TiO_(2) phase.XRD analyses showed that thermal alteration affected the dolomite phase specifically,which selectively got removed where carbonate-bound elements were assessed.Petrographic analysis supported the magmatic influence and demonstrated the presence of mosaic structures and pores containing unfused vitrinite,with a reflectance value of 3.6.To summarize,the present study pertaining to delineation of association of valuables in high-ash heat-altered coals from an Eastern coalfeld in India can potentially open up new avenues for utilizing such coals,which are otherwiseconsidered waste.
基金funded by DGAPA-PAPIIT grant IN100816 and IER-UNAM internal grant to the first author.
文摘To fill the gap of the nomenclature of altered igneous rocks,a new exhaustive multidimensional classification scheme consistent with the International Union of Geological Sciences(IUGS)is proposed.Our procedure is based on an extensive database of major element compositions of a total of 32948 relatively fresh rock samples.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types of reconstruction,cannulating a papilla with a reverse orientation,and performing therapeutic interventions with uncommon endoscopic accessories.The development of endoscopic techniques has led to higher success rates in this group of patients.Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction;however,these success rate is lower in long-limb reconstruction.ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length;however,it must be performed by a highly experienced and skilled endoscopist.Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography,but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy.Laparoscopic-assisted ERCP has an almost 100%success rate in longlimb reconstruction because of the use of a conventional side-view duodenoscope,which is compatible with standard accessories.This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy.This review focuses on the advantages,disadvantages,and outcomes of various procedures that are suitable in different situations and reconstruction types.Emerging new techniques and their outcomes are also discussed.
文摘Endoscopic retrograde cholangiopancreatography(ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine.Recently,many studies have reported that balloonenteroscope-assisted ERCP(BEA-ERCP) is a safe and effective procedure.However,further improvements in outcomes and the development of simplified procedures are required.Percutaneous treatment,Laparoscopy-assisted ERCP,endoscopic ultrasoundguided anterograde intervention,and open surgery are effective treatments.However,treatment should be noninvasive,effective,and safe.We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications.BEA-ERCP still requires high expertiselevel techniques and is far from a routinely performed procedure.Various techniques have been proposed to facilitate scope insertion(insertion with percutaneous transhepatic biliary drainage(PTBD) rendezvous technique,Short type single-balloon enteroscopes with passive bending section,Intraluminal injection of indigo carmine,CO2 inflation guidance),cannulation(PTBD or percutaneous transgallbladder drainage rendezvous technique,Dilation using screw drill,Rendezvous technique combining DBE with a cholangioscope,endoscopic ultrasound-guided rendezvous technique),and treatment(overtube-assisted technique,Short type balloon enteroscopes) during BEA-ERCP.The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients.A standard procedure for ERCP yet to be established for patients with a reconstructed intestine.At present,BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as firstline treatment.In this article,we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.
文摘Endoscopic retrograde cholangiopancreatography(ERCP) in patients with surgically altered anatomy is challenging. Several operative interventions of both the gastrointestinal tract and the biliary and/or pancreatic system lead to altered anatomy, rendering ERCP more difficult or even impossible with a conventional side-viewing duodenoscope. Adapted endoscopes are avail-able to reach the biliopancreatic system and to perform ERCP in patients with altered anatomy. However, both technical difficulties and complications determine the procedure's success. Different technical approaches have been described and are highly dependent on local expertise and endoscopic equipment. Standard-ized practical guidelines are currently unavailable. This review focuses on the challenges encountered during ERCP in patients with altered anatomy and how to deal with them. The first challenge is reaching the papilla or the bilioenteric/pancreatoenteric anastomosis in the patient with postoperative altered anatomy. The sec-ond challenge is the cannulation of the biliopancreatic system and performing all conventional ERCP interven-tions and the third challenge is the control of possible complications. The available literature data on this topicis reviewed and illustrated with clinical cases.
基金financially supported by projects under the National Key Research and Development Program of China(No.2018YFC0604200)the Open Fund Project of State Key Laboratory of Nuclear Resources and Environment (No.2020NRE10)+3 种基金the National Key Infrastructure Development Plan (No.2015CB453006)the China Geological Survey (Nos.DD20190119,DD20221678)the International Geoscience Programme (No.IGCP-675)the National Nature Science Foundation of China (No.92162212)
文摘In recent years,the close relationship between uranium and Ti-Fe oxides in the sandstonetype uranium deposits has been extensively recognized.However,the altered characteristics of ilmenite and its relationship with uranium enrichment still remain unclear.With this paper based on heavymineral sorting of uranium ore selected from the Tarangaole-Nalinggou deposit in the northeastern Ordos Basin,electron probe,backscattering image,energy spectrum and scanning electron microscopy were systematically performed.The ilmenite in the sandstone can be divided into four groups,including unaltered,weakly altered,moderately altered,and strongly altered ilmenite.The alteration of ilmenite in uranium ores is notably more intense than that of the surrounding rocks.In addition,weakly,moderately,and strongly altered ilmenite associated with uranium minerals in uranium ores demonstrate that the more intensity ilmenite altered,the closer its relationship with uranium minerals is.The ilmenite has likely been somewhat altered before mineralization,and the alteration intensifies by later exposure related to an oxygencontaining fluid.The alteration mechanism comprises a process of competitive diffusion between Fe^(2+)and O_(2)-ions.In the early stage,Fe ions was mainly diffused on the particle surface.Subsequently,diffusion of O ions into the particles began to be dominate.Most of the leached iron is stripped or carried away by fluid.In an alkaline and reductive environment,the remaining iron is reduced to form the surrounding pyrite,and TiO_(2)in a form of titanium sol recrystallizes(i.e.,anatase).Backscattering images show that uranium and altered ilmenite are close in space.Coffinite is often distributed along the edges of altered ilmenite as burrs in shape.Colloidal or knitted coffinite associated with anatase is formed in the voids of altered ilmenite.The chemical composition of altered ilmenite varies considerably from the core to edge,and the mineral assemblage sequence is from girdle with ilmenite,to leucosphenite,to anatase,and to coffinite.There is no brannerite that is symbiotic with altered ilmenite.It is considered to be a uranium-containing titanium mineral aggregate caused by the reduction and adsorption of uranium.As the altered product of ilmenite,TiO_(2)is an aggregation agent,increasing the concentration of uranium by adsorption.Together with Fe^(2+)and S_(2)-in secondary pyrite,this aggregate creates a uranium-rich environment in the microzone for the formation of coffinite.Therefore,the alteration of ilmenite plays a geochemical role in the processes of sedimentary,diagenesis and mineralization,in which Fe is removed,Ti is enriched,and U is adsorbed and reduced.
基金supported by the National High Technology Research and Development Program of China(No.2012AA12A308)China Geological Surveys(No.1212011087112)
文摘Hydrocarbon micro-seepage can cause oxidation reduction reactions and produce altered minerals in surface sediments and soft. The typical altered minerals mapping by their diagnostic spectral features on hyper-spectral images is an important tool for the petroleum exploration industry. In this study, the airborne hyper-spectral data were used to investigate the altered minerals induced by hydrocarbon micro-seepages by spectral feature fitting （SFF） in the loess coverage area of Xifeng Oflfield. The results re- veal that the distribution region of the altered minerals induced by hydrocarbon micro-seepage is larger than the known oilfield exploration area. The potential hydrocarbon micro-seepage region was also re- vealed by the distribution of altered minerals besides the known hydrocarbon area. A fast index was pro- posed by the absorption depths of clay and carbonate minerals for assessment of hydrocarbon micro- seepage. And it gave much clearer boundaries for the hydrocarbon micro-seepage in the loess coverage area than those by the altered mineral mapping. In addition, some field samples were analyzed by X-ray diffrac- tion （XRD） and atomic absorption spectrophotometer to validate the results. Within the extents of hydro- carbon micro-seepage, there are lower contents of ferric iron and higher contents of carbonate minerals in these samples. Therefore, it is satisfactory to have the airborne hyper-spectral data to outline the extents of hydrocarbon micro-seepage for further hydrocarbon exploration in the loess coverage area.
基金supported by grants from the National Natural Science Foundation of China(No.81273007)
文摘To understand how differentially methylated genes（DMGs）might affect the pathogenesis of Kashin-Beck disease（KBD）.Genome-wide methylation profiling of whole blood from 12matched KBD and controls pairs was performed using a high-resolution Infinium 450 K methylation array.In total,97 CpG sites were differentially
文摘BACKGROUND Intravascular large B-cell lymphoma(IVLBCL)is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings.Early diagnosis is critical to altering the disease course as early treatment with chemoimmunotherapy is required to prevent a rapidly fatal outcome.Strategies including improved awareness of this clinical entity through publication of cases with unique presentations are essential to prompt consideration of IVLBCL early in the disease workup.Here,we present a case of IVLBCL presenting with altered mental status and systemic organ dysfunction.CASE SUMMARY A 61-year-old male patient presented with flu-like symptoms and a high fever.He experienced rapid clinical deterioration with liver,kidney failure,and shock despite rapid antibiotic administration and supportive care.A broad infectious workup was negative.Intracranial imaging revealed nonspecific changes to the corpus callosum suspicious for vasculitis.Renal biopsy was non-diagnostic.After further progression of his symptoms,the family elected to withdraw care and the patient died shortly thereafter.Post-mortem analysis revealed clear multi-organ involvement by IVLBCL,prompting re-examination of the ante-mortem renal biopsy that also identified IVLBCL involvement.CONCLUSION IVLBCL is a rare disease.Communication with specialties and early biopsy is critical to establishing the diagnosis and initiating therapy.
文摘BACKGROUND： Altered mental status （AMS） is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly challenging for emergency physicians. The aim of this study is to provide a framework for the assessment of AMS patients. This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS： This is a prospective cohort observational study. We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24 months （June 2009 to June 2011）. Demographic characteristics, clinical manifestations, assessment approaches, causative factors, emergency treatments and outcomes were collected prospectively.RESULTS： In 1934 patients with AMS recruited, accounting for 0.93% of all emergency department （ED） patients, 1 026 （53.1%） were male, and 908 （46.9%） female. Their average age was 51.95±15.71 years. Etiologic factors were neurological （n=641; 35.0%）, pharmacological and toxicological （n=421; 23.0%）, systemic and organic （n=266; 14.5%）, infectious （n=167; 9.1%）, endocrine/metabolic （n=145; 7.9%）, psychiatric （n=71; 3.9%）, traumatic （n=38; 2.1%）, and gynecologic and obstetric （n=35; 1.9%）. Total mortality rate was 8.1% （n=156）. The death rate was higher in elderly patients （≥60） than in younger patients （10.8% vs. 6.9%, P=-0.003）.CONCLUSION： Patients with AMS pose a challenge for ED physicians. The most frequently encountered diagnostic categories causing AMS were primary CNS disorders, intoxication, organ system dysfunction, and endocrine/metabolic diseases. AMS has a high fatality rate in the ED. AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects. Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.
基金supported by the National Natural Science Foundation of China(grants No.41373108 and 41602167)
文摘Igneous intrusion into coal-bearing strata can cause an abrupt increase of temperature-pressure and trigger hydrothermal circulation at the igneous rock-coal contact zone. The conductive heat of intruded lnagma and convective migration of secondary hydrothermal fluids have been observed to significantly alter the concentrations and modes of occurrence of mercury （Hg） in thermally-intruded coals.
基金supported by grants from the National Natural Science Foundation of China(81671143)the Science and Technology Plan of Zhejiang Province(2017C03011),China
文摘Following severe traumatic brain injury .（sTBI）, patients may remain in a coma, vegetative state （VS）, or minimally conscious state （MCS）, all of which are also clinically termed disorders of consciousness. Patients in a coma show complete disability in the arousal system and fail to achieve awareness spontaneously; yet true coma represents a transient state and rarely lasts longer than a month [1]. The VS （also known as unresponsive wakefulness syndrome）, characterized as a state with spontaneous or stimulus-induced eye-opening but the patient appears totally unaware of self and environment, may persist for months or years [2]. In contrast, the MCS is evidenced by preserved and reproducible signs of awareness as well as sleep-wake cycles, suggesting better recovery than coma and VS. Considering that no signs of consciousness are detectable, patients in a VS suffer from a high rate of misdiagnosis [3].
文摘AIM: To investigate the clinical and pathological significance of altered retinoblastoma (Rb) encoding protein (pRb) in gastric carcinoma. METHODS: Expression of altered pRb was analyzed in 91 patients with gastric adenocarcinoma by immunohistochemistry. RESULTS: Sixty-five percent (59/91) of the tumors were positively stained and the staining in tumor nuclei of gastric carcinoma ranged 0%-90%. Moreover, strong expression of altered pRb was found in 35% (6/17), 24% (5/21), 17% (8/46) and 0% (0/7) of T1, T2, T3 and T4 gastric carcinomas, respectively. altered pRb expression was inversely correlated with the depth of tumor invasion (P = 0.047). Degree of immunoreactivity had no significant correlation with tumor grade, node metastasis and distant metastasis. In terms of prognostic significance, univariate analysis showed that poor differentiation [41 (66.1%) vs 34 (42.5%) P = 0.051], advanced tumor stage (P < 0.001) and weakly altered pRb expression [17 (80.5%) vs 58 (49.6%) P = 0.044] were associated with worse prognosis in these patients. However, multivariate analysis revealed that advanced tumor stage was the only independent poor prognostic factor (P < 0.001). CONCLUSION: The mutation of Rb gene is frequent in gastric carcinoma. The expression of altered pRb inversely correlates with tumor invasion and is not an independent prognostic marker in gastric adenocarcinoma.
基金supported by the National Natural Science Foundation of China (31640034)the Sci-Tech Support Plan of Hubei Province, China (2014BEC086)the Research Team Fund of the South-Central University for Nationalities, China (XTZ15014)
文摘Dear Editor Despite remarkable advances in our understanding of brain functions,the neural substrates and correlates of consciousness remain unclear[1].It has been argued that classical physics is intrinsically incapable of explaining the holistic aspects of consciousness.
文摘BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology.Standard endoscopy as well as push endoscopy can be a challenge in those with altered anatomy given inaccessible areas as well as perforation risk.Single and double balloon enteroscopy can be warranted in this patient population in instances of obscure GI bleed.AIM To assess the safety and diagnostic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy.METHODS A search was conducted through PubMed,MEDLINE,Google Scholar,Scopus,and Embase with the key words“enteroscopy,”“obscure bleeding,”and“altered anatomy,”to identify relevant articles in English with no restricted time frame.A search within the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles.Study types included in the review were prospective and retrospective reviews,case series,and case reports.The reference lists of these papers were also reviewed to find further papers that were applicable.The authors extracted the data from the studies that fit inclusion criteria.Data of interest included type of study,type of procedure,and type of altered anatomy,as well as the number of patients with any diagnostic or therapeutic intervention.Data was also recorded on procedure tolerance and complications.The data was analyzed with descriptive statistics.RESULTS Our literature search yielded 14 studies that were included.There were 68 procedures performed with 61 unique patients subjected to these procedures.Forty-four(65%)of the procedures were double balloon,21(31%)were single balloon,and 3(4%)were classified as through the scope balloon assisted.The most common altered anatomy types included Gastric Bypass Roux-en-Y,Pylorus Sparing Whipple,Orthotopic Liver Transplantation with Roux-en-Y,and Gastrojejunostomy Roux-en-Y.The procedures were successfully performed in each patient.There were 5(7%)procedures that were complicated by perforation.Amongst the available data,the diagnostic yield was 48/59(81%)and a therapeutic yield of 39/59(66%).One patient was recommended surgical revision of their altered anatomy following enteroscopy.CONCLUSION Balloon enteroscopy is a useful diagnostic modality in investigating obscure GI bleeding within those with surgically altered anatomy;however,precautions must be taken as this population may have increased perforation risk.
文摘Introduction: In the setting of an extra-adrenal malignancy, it is a recognized clinical challenge to try and distinguish a benign adrenal mass from a metastatic deposit. Current non-invasive diagnostic tools for adrenal gland evaluation include CT, MRI, PET and PET-CT. Diagnostic interpretative error can occur as evaluations rarely have complete cytologic or histologic correlation for concordance purposes. Aims: To establish the performance characteristics of non-contrast CT attenuation values (Hounsfield units-HU) and the optimal PET-CT maximum standard uptake value (SUVmax) for predicting adrenal malignancy when correlated with adrenal gland endoscopic ultrasound fine needle aspiration (EUS FNA) cytology results. Methods: A prospectively maintained EUS database was reviewed to identify consecutive patients who underwent a left adrenal gland FNA. Non-contrast CT attenuation values and SUVmax scores were calculated. EUS FNA cytology results were used as the reference standard for determining the presence of benign versus malignant adrenal gland status. Results: Sixty-two patients (69 ± 11 years) underwent adrenal EUS FNA, 34 (54.8%) of whom had a clinically suspected or established extra-adrenal malignancy. Non-invasive imaging was suggestive of abnormal adrenal morphology or altered PET-CT FDG activity in 45 (72.6%) patients. Elevated attenuation values (≥10 HU) by non-enhanced CT had a sensitivity and specificity of 100% and 34.6%, respectively. The SUVmax for malignant altered morphology was significantly higher than that for benign lesions [(8.5 ± 3.1 vs 3.3 ± 0.7;(p = 0.0001)]. ROC curve analysis indicated that an optimum cutoff SUVmax of ≥4.1 (AUC 0.92) yielded the best power distinction for malignancy with a sensitivity and specificity of 89% and 100%. Conclusion: When evaluating altered adrenal morphology by non-invasive methods, the performance characteristics of elevated CT attenuation values are suboptimal. But by adopting a SUVmax cut-off value of ≥4.1 could potentially improve such characteristics to detect malignancy.
