BACKGROUND For recurrent achalasia after initial peroral endoscopic myotomy(POEM)failure,repeat POEM(Re-POEM)has been reported as a treatment option.However,severe esophageal interlayer adhesions caused by previous pr...BACKGROUND For recurrent achalasia after initial peroral endoscopic myotomy(POEM)failure,repeat POEM(Re-POEM)has been reported as a treatment option.However,severe esophageal interlayer adhesions caused by previous procedures impede the successful establishment of a submucosal tunnel and lead to aborted Re-POEM procedures.Our team previously described POEM with simultaneous submucosal and muscle dissection(POEM-SSMD)as a feasible solution for achalasia with severe interlayer adhesions.AIM To investigate the effectiveness and safety of Re-POEM with simultaneous submucosal and muscle dissection(Re-POEM-SSMD).METHODS A total of 1049 patients with achalasia who underwent successful endoscopic myotomy at the Digestive Endoscopic Center of Chinese PLA General Hospital from December 2014 to May 2022 were reviewed.Patients with recurrent achalasia who experienced initial POEM clinical failure were retrospectively included in this study.The primary endpoint was retreatment clinical success,defined as an Eckardt score≤3 during the postretreatment follow-up and no need for additional treatment.Procedure-related adverse events,changes in manometric lower esophageal sphincter(LES)pressure and reflux complications,as well as procedure-related parameters,were recorded.RESULTS Sixteen patients underwent Re-POEM(9 patients)or Re-POEM-SSMD(7 patients)successfully at a median of 45.5 mo(range,4-95 mo)after initial POEM.During a median followup period of 31 mo(range,7-96 mo),clinical success(Eckardt score≤3)was achieved in 8(88.9%)and 6(85.7%)patients after Re-POEM and Re-POEM-SSMD,respectively(P=0.849).The median Eckardt score dropped from 4(range,3-8)at preretreatment to 1(range,0-5)at postretreatment in the Re-POEM group(P=0.025)and from 5(range,2-8)to 2(range,0-4)in the Re-POEM-SSMD group(P<0.001).The mean manometric LES pressure decreased from 23.78±9.04 mmHg to 11.45±5.37 mmHg after Re-POEM(P<0.001)and from 26.80±7.48 mmHg to 11.05±4.38 mmHg after Re-POEM-SSMD(P<0.001).No serious adverse events were recorded in both groups.CONCLUSION In conclusion,Re-POEM-SSMD appears to be a safe and effective salvage therapy for recurrent achalasia with severe interlayer adhesions.展开更多
With Al foil,Cu foil and steel mesh as the metal interlayers,respectively,three types of alumina/epoxy/metal laminated composites were fabricated with epoxy resin adhesive as a binder via a simple process.The impact t...With Al foil,Cu foil and steel mesh as the metal interlayers,respectively,three types of alumina/epoxy/metal laminated composites were fabricated with epoxy resin adhesive as a binder via a simple process.The impact tests were performed and the fracture patterns and impact response of all the three laminates were analyzed.The experimental results indicate that the absorbed energy is mainly determined by metal interlayer.The peak load depends on not only alumina substrate but also metal interlayer.The Al2O3/epoxy/Cu laminates sustain the maximum peak load and Al2O3/epoxy/steel mesh laminates have the largest threshold energy for penetration.The fracture analysis shows that the main damage modes are Al2O3 matrix cracking and metal deformation for lower impact energies,and complete breakage and penetration for higher impact energies.展开更多
Three-dimensional(3 D)printing has had a large impact on various fields,with fused deposition modeling(FDM)being the most versatile and cost-effective 3 D printing technology.However,FDM often requires sacrificial sup...Three-dimensional(3 D)printing has had a large impact on various fields,with fused deposition modeling(FDM)being the most versatile and cost-effective 3 D printing technology.However,FDM often requires sacrificial support structures,which significantly complicates the processing and increases the cost.Furthermore,poor layer-to-layer adhesion greatly affects the mechanical stability of 3D-printed objects.Here,we present a new Print-Healing strategy to address the aforementioned challenges.A polymer ink(Cu-DOU-CPU)with synergetic triple dynamic bonds was developed to have excellent printability and room-temperature self-healing ability.Objects with various shapes were printed using a simple compact 3D printer,and readily assembled into large sophisticated architectures via self-healing.Triple dynamic bonds induce strong binding between layers.Additionally,damaged printed objects can spontaneously heal,which significantly elongates their service life.This work paves a simple and powerful way to solve the key bottlenecks in FDM 3D printing,and will have diverse applications.展开更多
文摘BACKGROUND For recurrent achalasia after initial peroral endoscopic myotomy(POEM)failure,repeat POEM(Re-POEM)has been reported as a treatment option.However,severe esophageal interlayer adhesions caused by previous procedures impede the successful establishment of a submucosal tunnel and lead to aborted Re-POEM procedures.Our team previously described POEM with simultaneous submucosal and muscle dissection(POEM-SSMD)as a feasible solution for achalasia with severe interlayer adhesions.AIM To investigate the effectiveness and safety of Re-POEM with simultaneous submucosal and muscle dissection(Re-POEM-SSMD).METHODS A total of 1049 patients with achalasia who underwent successful endoscopic myotomy at the Digestive Endoscopic Center of Chinese PLA General Hospital from December 2014 to May 2022 were reviewed.Patients with recurrent achalasia who experienced initial POEM clinical failure were retrospectively included in this study.The primary endpoint was retreatment clinical success,defined as an Eckardt score≤3 during the postretreatment follow-up and no need for additional treatment.Procedure-related adverse events,changes in manometric lower esophageal sphincter(LES)pressure and reflux complications,as well as procedure-related parameters,were recorded.RESULTS Sixteen patients underwent Re-POEM(9 patients)or Re-POEM-SSMD(7 patients)successfully at a median of 45.5 mo(range,4-95 mo)after initial POEM.During a median followup period of 31 mo(range,7-96 mo),clinical success(Eckardt score≤3)was achieved in 8(88.9%)and 6(85.7%)patients after Re-POEM and Re-POEM-SSMD,respectively(P=0.849).The median Eckardt score dropped from 4(range,3-8)at preretreatment to 1(range,0-5)at postretreatment in the Re-POEM group(P=0.025)and from 5(range,2-8)to 2(range,0-4)in the Re-POEM-SSMD group(P<0.001).The mean manometric LES pressure decreased from 23.78±9.04 mmHg to 11.45±5.37 mmHg after Re-POEM(P<0.001)and from 26.80±7.48 mmHg to 11.05±4.38 mmHg after Re-POEM-SSMD(P<0.001).No serious adverse events were recorded in both groups.CONCLUSION In conclusion,Re-POEM-SSMD appears to be a safe and effective salvage therapy for recurrent achalasia with severe interlayer adhesions.
基金Funded by the Science and Technology Program of Guangdong Province of China(No.2012B091000107)the Subproject of China Education&Equipment Resource System(No.CERS-1-2)
文摘With Al foil,Cu foil and steel mesh as the metal interlayers,respectively,three types of alumina/epoxy/metal laminated composites were fabricated with epoxy resin adhesive as a binder via a simple process.The impact tests were performed and the fracture patterns and impact response of all the three laminates were analyzed.The experimental results indicate that the absorbed energy is mainly determined by metal interlayer.The peak load depends on not only alumina substrate but also metal interlayer.The Al2O3/epoxy/Cu laminates sustain the maximum peak load and Al2O3/epoxy/steel mesh laminates have the largest threshold energy for penetration.The fracture analysis shows that the main damage modes are Al2O3 matrix cracking and metal deformation for lower impact energies,and complete breakage and penetration for higher impact energies.
基金supported by the National Natural Science Foundation of China(21991123,52073049 and 51703148)the Natural Science Foundation of Shanghai(20ZR1402500 and18ZR1401900)+4 种基金the Belt&Road Young Scientist Exchanges Project of Science and Technology Commission Foundation of Shanghai(20520741000)Shanghai Belt and Road Joint Laboratory of Advanced Fiber and Low-dimension Materials(Donghua University(DHU),18520750400)the Fundamental Research Funds for the Central UniversitiesDHU Distinguished Young Professor Program(LZA2019001)the Open Research Fund of Shanghai Center for High-performance Fibers and Composites and the Center for Civil Aviation Composites of Donghua University。
文摘Three-dimensional(3 D)printing has had a large impact on various fields,with fused deposition modeling(FDM)being the most versatile and cost-effective 3 D printing technology.However,FDM often requires sacrificial support structures,which significantly complicates the processing and increases the cost.Furthermore,poor layer-to-layer adhesion greatly affects the mechanical stability of 3D-printed objects.Here,we present a new Print-Healing strategy to address the aforementioned challenges.A polymer ink(Cu-DOU-CPU)with synergetic triple dynamic bonds was developed to have excellent printability and room-temperature self-healing ability.Objects with various shapes were printed using a simple compact 3D printer,and readily assembled into large sophisticated architectures via self-healing.Triple dynamic bonds induce strong binding between layers.Additionally,damaged printed objects can spontaneously heal,which significantly elongates their service life.This work paves a simple and powerful way to solve the key bottlenecks in FDM 3D printing,and will have diverse applications.
