The scope of management of malignant gastric outlet obstruction is ever-expanding.The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes.Wi...The scope of management of malignant gastric outlet obstruction is ever-expanding.The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes.With technical success rates close to 96%,stent placement for palliating gastric obstruction has ensured a median survival of about 2 months post-deployment of gastro-duodenal stents.Understanding the correct concept of palliation is the need of the hour in management.Identifying the right patient for palliation,selecting the appropriate intervention and auditing the outcome are vital in delivering optimal care.Also,newer procedures such as endoscopic gastro-enterostomy offer promising outcomes in palliative care.展开更多
Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojeju...Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojejunostomy(SGJ)and the minimally invasive nature of endoscopic methods.Compared to enteral stenting,EUS-GE shows superior outcomes,including higher long-term patency,lower symptom recurrence,and fewer reinterventions.It also demonstrates comparable or better efficacy than SGJ,with faster oral intake,shorter hospital stays,and reduced complications.However,EUS-GE requires specialized expertise,and long-term outcome data remain limited,so further research is needed to refine protocols and optimize patient selection.展开更多
Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,...Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,shorter hospita-lization,and earlier chemotherapy initiation.However,its long-term efficacy is limited by stent occlusion,which typically occurs 2-4 months post-procedure,due to tumor ingrowth,overgrowth,or food impaction.Covered stents can reduce tumor ingrowth but increase the migration risk,particularly in patients receiving chemotherapy.This review provides a comprehensive comparison of duodenal stenting,surgical gastrojejunostomy,and endoscopic ultrasound-guided gastroen-terostomy,by discussing their clinical outcomes,advantages,and limitations.We further explore stent selection based on stricture characteristics,optimal placement techniques,post-procedural management,and for handling complic-ations including occlusion,migration,bleeding,and perforation.Additionally,we address technical challenges and troubleshooting strategies,including mana-gement of guidewire-induced perforation,incomplete stent expansion,and bile duct obstruction for overlapping biliary and duodenal stricture cases.Despite its widespread clinical use,no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively.By providing a clinically oriented,practical guide,this review serves as a valuable resource for endoscopists and gastroenterologists,facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.展开更多
BACKGROUND Groove pancreatitis(GP)is a rare focal chronic pancreatitis of the pancreaticoduodenal groove that is usually diagnosed in chronic alcoholics.However,it is often difficult to differentiate from pancreatic o...BACKGROUND Groove pancreatitis(GP)is a rare focal chronic pancreatitis of the pancreaticoduodenal groove that is usually diagnosed in chronic alcoholics.However,it is often difficult to differentiate from pancreatic or periampullary cancers.In this study,we report a case of GP with the rare symptom of severe gastric outlet obstruction.CASE SUMMARY A 68-year-old man presented to our institution with severe gastric outlet obstruction accompanied by vomiting persisted for 3 days,severe electrolyte imbalance,and altered mental status with cardiac arrest.Differential diagnosis of cancers of the ampulla of Vater or duodenum was difficult due to discordant findings from preoperative imaging and an endoscopic biopsy of the lesion.In addition,the gastric outlet obstruction did not improve with conservative treatment;therefore,pancreatoduodenectomy was performed.Postoperatively,the histological findings revealed multiple cystic lesions in the duodenal wall that were collectively diagnosed as GP.The patient underwent a follow-up 3 years postoperatively and was found to have no postoperative sequelae.CONCLUSION In this case of GP,pancreatoduodenectomy safely treated severe gastric outlet obstruction when a cancer diagnosis could not be excluded.展开更多
Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting ...Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting and surgical gastrojejunostomy,EUS-GE offers comparable technical and clinical success while providing longer-lasting patency,fewer adverse events,and lower reintervention rates.The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome.EUSGE enables rapid recovery and early resumption of oral intake,which is crucial for oncologic patients.However,the procedure remains technically demanding,and optimal techniques,device selection,and management of complications are still under investigation.This mini-review summarizes current evidence,compares EUS-GE with alternative therapies,discusses patient selection and procedural aspects,and outlines key areas for future research.展开更多
Objective:To observe the effect of Xipayimaizibizi oral liquid(XP)in an overactive bladder(OAB)experimental rat model and to explore its pharmacological mechanisms.Methods:Network pharmacology was used to explore the ...Objective:To observe the effect of Xipayimaizibizi oral liquid(XP)in an overactive bladder(OAB)experimental rat model and to explore its pharmacological mechanisms.Methods:Network pharmacology was used to explore the potential mechanisms of action of XP.The rats underwent bladder outlet obstruction surgery and were administered the corresponding drug concentrations by gavage for 4 weeks.The study observed the body weight,water intake,bladder and kidney indices(to evaluate their general status),urination behavior pattern(to observe frequency and urgency),and urodynamics(to measure bladder parameters).Hematoxylin and eosin and Masson's trichome staining were used to observe changes in the bladder structure.Enzyme-linked immunosorbent assay was used to measure the levels of nerve growth factor,brain-derived neurotrophic factor,and acetylcholine in the urine.The key targets involved in these mechanisms were validated using reverse transcription-quantitative polymerase chain reaction,immunohistochemistry,and western blot in vivo/vitro experiments.Result:Network pharmacological analysis predicted that XP may alleviate OAB by affecting the cholinergic synapse and calcium signaling pathways.XP treatment significantly reduced the bladder index,improved urine behavior and urodynamic parameters,decreased the neurotransmitters in urine,and reduced the thickness of the bladder wall and collagen ratio.These results indicate that XP can alleviate OAB symptoms and improve the bladder structure.In vivo/vitro experiments further demonstrated that XP can inhibit targets,such as muscarinic acetylcholine receptor 2,and participate in cholinergic synapses to further regulate the parasympathetic nervous system.It can also reduce the overexpression of Ca^(2+) caused by agonists,inhibit targets such as transient receptor potential vanilloid type 1,and participate in calcium signaling pathways to maintain Ca^(2+) homeostasis.Conclusion:These results suggest that XP inhibited bladder overactivity by maintaining Ca^(2+) homeostasis and regulating the parasympathetic nervous system.展开更多
Background:Bladder outlet obstruction(BOO)is a prevalent urinary system disease main caused by benign prostatic hyperplasia(BPH)in males.Traditional Chinese medicine(TCM)Danzhi qing’e decoction(DZQE)has the functions...Background:Bladder outlet obstruction(BOO)is a prevalent urinary system disease main caused by benign prostatic hyperplasia(BPH)in males.Traditional Chinese medicine(TCM)Danzhi qing’e decoction(DZQE)has the functions of strengthening“Yang Qi”(one of the fundamental concept in TCM,representing the active,warming,and energizing force within the body.It governs physiological functions,maintains body temperature,and promotes vitality.Balanced“Yang Qi”supports immunity and metabolism,while deficiency may lead to fatigue,cold intolerance,or weakened resilience),promoting blood circulation,and removing blood stasis,and nourishing yin based on the TCM theory.Previous studies have found that it significantly improved BPH and regulate urinary function in estrogen and androgen-induced rats.However,it is unclear whether DZQE has an inhibitory effect on BOO rats.Methods:Male Wistar rats underwent retropubic partial bladder neck ligation to induce BOO.DZQE extract(2.7/5.4 g/kg)was administered orally for 35 days.Anesthetized rats underwent cystometry to assess BOO and treatment effects on urinary parameters.Bladder histopathology,fibrosis,and PCNA expression were evaluated via HE,Masson’s,and IHC staining.Western blot quantified bladder tissue levels of choline acetyltransferase(ChAT),rho-associated protein kinase 1(ROCK1),myosin light chain kinase(MLCK),myosin light chain 2(MLC-2),extracellular signal-regulated kinase(ERK),proliferating cell nuclear antigen(PCNA),B-cell lymphoma-2(Bcl-2),and Bcl-2 related X protein(Bax).Primary bladder smooth muscle cells were cultured,exposed to hydrostatic pressure(HP,3 h/24 h)using a custom apparatus to mimic BOO,and treated with DZQE components for Western blot analysis of ROCK1,MLCK,ERK,PCNA,and Bax.Results:The bladder hyperplasia,bladder index(BI)increased,and histopathological alteration were easily observed in BOO group,which were significantly inhibited by DZQE administration.DZQE also significantly inhibited the up-regulation of maximum voiding pressure(MVP)and down-regulation of residual urine volume(RV)observed in BOO rats.The expressions of ChAT and MLCK and the activation of ERK were much increased,while the expressions of ROCK1,MLC-2 and Bax were obviously decreased in BOO rats,all of which were then significantly inhibited by DZQE.In rat bladder smooth muscle cells(RBSMC),3 h or 24 h duration of HP successfully simulated the BOO compensation and decompensation respectively in vitro.DZQE or its active components reduced the abnormal gene expressions in HP stimulated RBSMC.Conclusion:DZQE improves the urinary function in BOO rats mainly through the activation of ERK.Bakuchiol,salvianolic acid A,kaempferol,and tanshinoneⅡA are possibly the important active components of its therapeutic effects.展开更多
BACKGROUND Mycobacterium tuberculosis(TB)is the causative agent of TB,a chronic granulo-matous illness.This disease is prevalent in low-income countries,posing a significant global health challenge.Gastrointestinal TB...BACKGROUND Mycobacterium tuberculosis(TB)is the causative agent of TB,a chronic granulo-matous illness.This disease is prevalent in low-income countries,posing a significant global health challenge.Gastrointestinal TB is one of the three forms.The disease can mimic other intra-abdominal conditions,leading to delayed diagnosis owing to the absence of specific symptoms.While gastric outlet obs-truction(GOO)remains a frequent complication,its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy.Gastroduodenal TB can cause upper gastrointestinal hemorrhage,obstruction,and malignancy-like tumors.CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain,distension,nausea,vomiting,and weight loss,prompting a referral to a gastroenterologist clinic.Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation.However,treatment was interrupted,possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes.Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall.Resection revealed gastric wall effacement with TB.CONCLUSION Primary gastric TB is rare,frequently leading to GOO.Given its rarity,suspicions should be promptly raised when encountering relevant symptoms,often requiring surgical intervention for diagnosis and treatment.展开更多
Malignant gastric outlet obstruction(mGOO)is a major condition affecting patients with periampullary tumors,including pancreatic cancer.The current treatment options include surgical gastroenterostomy,endoscopic stent...Malignant gastric outlet obstruction(mGOO)is a major condition affecting patients with periampullary tumors,including pancreatic cancer.The current treatment options include surgical gastroenterostomy,endoscopic stenting and more recently EUS-guided gastroenterostomy.Most studies comparing the outcomes of the three procedures focus on technical success,clinical success and safety.Several“occult”outcomes relevant to the patient’s viewpoints and perspective may ultimately impact on cancer-related and overall survival,such as body mass composition,nutritional biomarkers,chemotherapy tolerance and patient-reported quality of life.The aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.展开更多
Gastroduodenal tuberculosis(GD-TB)is exceptionally rare.The clinical manifestations of gastrointestinal TB are diverse and non-specific,which makes diagnosis difficult,leading to delayed diagnosis and high mortality.A...Gastroduodenal tuberculosis(GD-TB)is exceptionally rare.The clinical manifestations of gastrointestinal TB are diverse and non-specific,which makes diagnosis difficult,leading to delayed diagnosis and high mortality.As a peer-reviewer of World Journal of Clinical Cases,I would like to share my opinion on the article published by this journal.The patient had no family history of TB or contact with people with TB.Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient.The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.展开更多
First of all,I would like to congratulate Vilas-Boas et al on an interesting publication.In this letter the authors write about very interesting topics in the management of patients with malignant gastric outlet obstr...First of all,I would like to congratulate Vilas-Boas et al on an interesting publication.In this letter the authors write about very interesting topics in the management of patients with malignant gastric outlet obstruction(GOO).GOO developed in up to 20%of patients with advanced hepatopancreatobiliary disease both in benign and malignant form.For this reason,the issue is very current.I fully agree with Vilas-Boas et al that technical aspect of the procedures(surgeon’s view)often differs from the patient’s view(regarding such factors as cancerrelated survival,overall survival,body mass composition,nutritional biomarkers,chemotherapy tolerance and patient-reported quality of life).The mentioned factors should be taken into account when interpreting the effectiveness of treatment modalities for malignant GOO(mGOO),which should be also considered in the future studies in this subject.In my opinion,all above mentioned factors could be summarized in one term:“Improving quality of life of patients with mGOO”.展开更多
This research delves into the hurdles and strategies aimed at augmenting the market involvement of smallholder carrot farmers in Nakuru County, Kenya. Employing a Multinomial Logit (MNL) model, it scrutinizes the fact...This research delves into the hurdles and strategies aimed at augmenting the market involvement of smallholder carrot farmers in Nakuru County, Kenya. Employing a Multinomial Logit (MNL) model, it scrutinizes the factors influencing the selection of marketing outlets among carrot farmers. The findings unveil that a significant majority (81%) of surveyed farmers actively participate in diverse market outlets, encompassing the farm gate, cleaning point, local market, external market, and export market. Notably, pivotal buyers include aggregators, brokers, wholesalers, retailers, and consumers, with transactions predominantly occurring at the farm level. Additionally, the analysis discerns substantial influences of socio-economic characteristics, experiential factors, and geographical proximity on farmers’ choices of market outlets. Specifically, gender, age, land size, farming experience, and distance to markets emerge as critical determinants. Moreover, the study delves into the examination of market margins along the carrot value chain, shedding light on the potential profitability of carrot farming in the region. Remarkably, higher average gross margins are identified in export and external markets, signaling lucrative prospects for farmers targeting these segments. However, disparities in profit distribution between farmers and traders underscore the necessity for interventions to ensure equitable value distribution throughout the value chain. These findings underscore the imperative for tailored interventions to tackle challenges and foster inclusive agricultural development. Strategies such as farmer organizations, contracting, and vertical integration are advocated to enhance market access and profitability for smallholder carrot farmers. Thus, this study enriches our comprehension of the dynamics within carrot value chains and provides valuable insights for policymakers and development practitioners aiming to uplift rural livelihoods and bolster food security.展开更多
In this editorial,we comment on the in-press article in the World Journal of Gas-trointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction(mGOO).The original theory of treatment involves...In this editorial,we comment on the in-press article in the World Journal of Gas-trointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction(mGOO).The original theory of treatment involves bypassing the obstruction or reenabling the patency of the passage.Conventional surgical gastroenterostomy provides long-term relief of symptoms in selected patients,with substantial morbidity and a considerable rate of delayed gastric emptying.Endoscopic stenting was introduced as an alternative minimally invasive proce-dure with less procedural morbidity and rapid clinical improvement;however,it presented a high rate of long-term recurrence.Therefore,challenges remain in the treatment of mGOO patients to improve clinical outcomes.Endoscopic ultra-sound-guided gastroenterostomy has recently emerged as a promising method because of the combined effects of surgery and endoscopy,whereas stomach-partitioning gastrojejunostomy has been reported as a modified surgical proce-dure to reduce the rate of delayed gastric emptying.In decision-making regarding the treatment of choice,it should be taken into account that mGOO might be accompanied by a variety of pathological conditions,including cancer cachexia,anorexia,malabsorption,and etc.,all of which can also lead to the characteristic symptoms and poor nutritional status of mGOO.The treatment plan should consider comprehensive aspects of patients to achieve practical improve-ments in prognosis and the quality of life.展开更多
BACKGROUND Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has recently emerged as an alternative treatment for gastric outlet obstruction(GOO)in selected patients.AIM To report the initial experience of EUS-GE ...BACKGROUND Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has recently emerged as an alternative treatment for gastric outlet obstruction(GOO)in selected patients.AIM To report the initial experience of EUS-GE in patients with GOO.METHODS This study was a retrospective,observational,multicenter study in which the data from 10 patients who underwent EUS-GE due to GOO between September 2021 and May 2023 were collected.We analyzed technical success,clinical success,adverse events,and survival.Technical success was defined as adequate positioning and deployment of the stent.Clinical success was defined as the patient’s ability to tolerate oral intake without vomiting 7 d after the procedure.Postprocedural adverse events were recorded.RESULTS Eleven procedures in 10 patients with GOO were included.The mean age of the patients was 67.5 years(range:56-77 years).Malignant GOO was present in 9 patients.Technical success was achieved in 9/11 procedures(82%).Among them,clinical success was achieved in 9 patients(100%).Adverse events occurred in 1 patient(9%).The median survival was 3 months(n=7;range:1-8 months).CONCLUSION EUS-GE is a feasible therapeutic option in the treatment of GOO.展开更多
By using the meteorological data in the pollution boundary layer which was observed in two ground observation sites:coast and land in the river outlet area of Grand Liao River during January-February in 2007,the daily...By using the meteorological data in the pollution boundary layer which was observed in two ground observation sites:coast and land in the river outlet area of Grand Liao River during January-February in 2007,the daily change characteristics of pollute boundary layer in winter in the area were discussed. The results showed that the pollute boundary layer in the river outlet area of Grand Liao River was affected by the sea and land. In the certain weather condition,maybe the sea-land breeze appeared in the low altitude which was below 200 m in the coastal zone. The stability change in the different height in the coastal zone was more stable than in the land zone,and the wind field change in the area was mainly in 300 m low altitude. At night,the temperature inversion often appears in the area,and the thickness of temperature inversion layer is stably during 200-300 m. The thermal internal boundary layer penetrated deeply into the land about 10 km,and the height could reach 800 m. The atmospheric diffusion ability in the coastal area was weaker and stronger in the land area.展开更多
To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the ...To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index （BOO1） greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score （IPSS）, uroflowmetry, post-void residual volume （PVR） check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive （IPSSO） and irritative （IPSSI） subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients＇ symptoms should be considered in deciding treatment modality.展开更多
As agricultural eco-tourism development played a vital role in promoting rural economic and social development and constructing new harmonious countryside,the paper had analyzed environmental problem produced during i...As agricultural eco-tourism development played a vital role in promoting rural economic and social development and constructing new harmonious countryside,the paper had analyzed environmental problem produced during its development,pointed out that blind development of agricultural eco-tourism had seriously destroyed resources and ecological environment and that tourist infrastructure construction and urbanization had ruined rural unique natural landscape.In view of current situation of environment,it also studied reasons causing environmental disruption,which lied in insufficient guidance and support of government,deficient scientific development planning and management system,and poor environmental consciousness of tourist operators and tourists.On this basis,it summarized that agricultural eco-tourism development should follow principles of sustainable development,synchronization between development and protection,and coordination between tourism development and environmental protection.It concluded proper ways to develop agricultural eco-tourism,and emphasized that it should draw up scientific and reasonable development planning,enhance government's macro-administration,establish and perfect ecological compensation mechanism,and strive to cultivate people's environmental awareness.展开更多
The main goal of the safe power outlet project is to make power outlets smart and integrate it to all old and new electrical wiring of homes and offices to eliminate the costs.Using the designed socket,home and office...The main goal of the safe power outlet project is to make power outlets smart and integrate it to all old and new electrical wiring of homes and offices to eliminate the costs.Using the designed socket,home and office electrical appliances can be smarten and controlled remotely through wireless technology.The device designed in this project,is a smart power outlet that supports Wi-Fi connection and the user can connect directly to it and control it by the specific mobile application.There is no need for any other interfaces such as a modem or router,and the user can connect directly to the device.This is the innovative part of the project making it different from the conventional power outlets on the market.All home and office appliances running on AC power can be connected to a safe outlet directly and without an interface;they can be controlled via wireless network by mobiles.This device smartens all old and conventional outlets without making any changes in wiring.It also enables the control via Wi-Fi on the outlets.展开更多
文摘The scope of management of malignant gastric outlet obstruction is ever-expanding.The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes.With technical success rates close to 96%,stent placement for palliating gastric obstruction has ensured a median survival of about 2 months post-deployment of gastro-duodenal stents.Understanding the correct concept of palliation is the need of the hour in management.Identifying the right patient for palliation,selecting the appropriate intervention and auditing the outcome are vital in delivering optimal care.Also,newer procedures such as endoscopic gastro-enterostomy offer promising outcomes in palliative care.
文摘Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojejunostomy(SGJ)and the minimally invasive nature of endoscopic methods.Compared to enteral stenting,EUS-GE shows superior outcomes,including higher long-term patency,lower symptom recurrence,and fewer reinterventions.It also demonstrates comparable or better efficacy than SGJ,with faster oral intake,shorter hospital stays,and reduced complications.However,EUS-GE requires specialized expertise,and long-term outcome data remain limited,so further research is needed to refine protocols and optimize patient selection.
文摘Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,shorter hospita-lization,and earlier chemotherapy initiation.However,its long-term efficacy is limited by stent occlusion,which typically occurs 2-4 months post-procedure,due to tumor ingrowth,overgrowth,or food impaction.Covered stents can reduce tumor ingrowth but increase the migration risk,particularly in patients receiving chemotherapy.This review provides a comprehensive comparison of duodenal stenting,surgical gastrojejunostomy,and endoscopic ultrasound-guided gastroen-terostomy,by discussing their clinical outcomes,advantages,and limitations.We further explore stent selection based on stricture characteristics,optimal placement techniques,post-procedural management,and for handling complic-ations including occlusion,migration,bleeding,and perforation.Additionally,we address technical challenges and troubleshooting strategies,including mana-gement of guidewire-induced perforation,incomplete stent expansion,and bile duct obstruction for overlapping biliary and duodenal stricture cases.Despite its widespread clinical use,no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively.By providing a clinically oriented,practical guide,this review serves as a valuable resource for endoscopists and gastroenterologists,facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.
文摘BACKGROUND Groove pancreatitis(GP)is a rare focal chronic pancreatitis of the pancreaticoduodenal groove that is usually diagnosed in chronic alcoholics.However,it is often difficult to differentiate from pancreatic or periampullary cancers.In this study,we report a case of GP with the rare symptom of severe gastric outlet obstruction.CASE SUMMARY A 68-year-old man presented to our institution with severe gastric outlet obstruction accompanied by vomiting persisted for 3 days,severe electrolyte imbalance,and altered mental status with cardiac arrest.Differential diagnosis of cancers of the ampulla of Vater or duodenum was difficult due to discordant findings from preoperative imaging and an endoscopic biopsy of the lesion.In addition,the gastric outlet obstruction did not improve with conservative treatment;therefore,pancreatoduodenectomy was performed.Postoperatively,the histological findings revealed multiple cystic lesions in the duodenal wall that were collectively diagnosed as GP.The patient underwent a follow-up 3 years postoperatively and was found to have no postoperative sequelae.CONCLUSION In this case of GP,pancreatoduodenectomy safely treated severe gastric outlet obstruction when a cancer diagnosis could not be excluded.
文摘Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting and surgical gastrojejunostomy,EUS-GE offers comparable technical and clinical success while providing longer-lasting patency,fewer adverse events,and lower reintervention rates.The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome.EUSGE enables rapid recovery and early resumption of oral intake,which is crucial for oncologic patients.However,the procedure remains technically demanding,and optimal techniques,device selection,and management of complications are still under investigation.This mini-review summarizes current evidence,compares EUS-GE with alternative therapies,discusses patient selection and procedural aspects,and outlines key areas for future research.
基金supported by the Natural Science Foundation in Xinjiang Uygur Autonomous Region(Urumqi,China,2023D01F38).
文摘Objective:To observe the effect of Xipayimaizibizi oral liquid(XP)in an overactive bladder(OAB)experimental rat model and to explore its pharmacological mechanisms.Methods:Network pharmacology was used to explore the potential mechanisms of action of XP.The rats underwent bladder outlet obstruction surgery and were administered the corresponding drug concentrations by gavage for 4 weeks.The study observed the body weight,water intake,bladder and kidney indices(to evaluate their general status),urination behavior pattern(to observe frequency and urgency),and urodynamics(to measure bladder parameters).Hematoxylin and eosin and Masson's trichome staining were used to observe changes in the bladder structure.Enzyme-linked immunosorbent assay was used to measure the levels of nerve growth factor,brain-derived neurotrophic factor,and acetylcholine in the urine.The key targets involved in these mechanisms were validated using reverse transcription-quantitative polymerase chain reaction,immunohistochemistry,and western blot in vivo/vitro experiments.Result:Network pharmacological analysis predicted that XP may alleviate OAB by affecting the cholinergic synapse and calcium signaling pathways.XP treatment significantly reduced the bladder index,improved urine behavior and urodynamic parameters,decreased the neurotransmitters in urine,and reduced the thickness of the bladder wall and collagen ratio.These results indicate that XP can alleviate OAB symptoms and improve the bladder structure.In vivo/vitro experiments further demonstrated that XP can inhibit targets,such as muscarinic acetylcholine receptor 2,and participate in cholinergic synapses to further regulate the parasympathetic nervous system.It can also reduce the overexpression of Ca^(2+) caused by agonists,inhibit targets such as transient receptor potential vanilloid type 1,and participate in calcium signaling pathways to maintain Ca^(2+) homeostasis.Conclusion:These results suggest that XP inhibited bladder overactivity by maintaining Ca^(2+) homeostasis and regulating the parasympathetic nervous system.
基金supported by The National Key Research and Development Project of China(No.2023YFC3504302)the National Natural Science Foundation of China(General Program No.82074105).
文摘Background:Bladder outlet obstruction(BOO)is a prevalent urinary system disease main caused by benign prostatic hyperplasia(BPH)in males.Traditional Chinese medicine(TCM)Danzhi qing’e decoction(DZQE)has the functions of strengthening“Yang Qi”(one of the fundamental concept in TCM,representing the active,warming,and energizing force within the body.It governs physiological functions,maintains body temperature,and promotes vitality.Balanced“Yang Qi”supports immunity and metabolism,while deficiency may lead to fatigue,cold intolerance,or weakened resilience),promoting blood circulation,and removing blood stasis,and nourishing yin based on the TCM theory.Previous studies have found that it significantly improved BPH and regulate urinary function in estrogen and androgen-induced rats.However,it is unclear whether DZQE has an inhibitory effect on BOO rats.Methods:Male Wistar rats underwent retropubic partial bladder neck ligation to induce BOO.DZQE extract(2.7/5.4 g/kg)was administered orally for 35 days.Anesthetized rats underwent cystometry to assess BOO and treatment effects on urinary parameters.Bladder histopathology,fibrosis,and PCNA expression were evaluated via HE,Masson’s,and IHC staining.Western blot quantified bladder tissue levels of choline acetyltransferase(ChAT),rho-associated protein kinase 1(ROCK1),myosin light chain kinase(MLCK),myosin light chain 2(MLC-2),extracellular signal-regulated kinase(ERK),proliferating cell nuclear antigen(PCNA),B-cell lymphoma-2(Bcl-2),and Bcl-2 related X protein(Bax).Primary bladder smooth muscle cells were cultured,exposed to hydrostatic pressure(HP,3 h/24 h)using a custom apparatus to mimic BOO,and treated with DZQE components for Western blot analysis of ROCK1,MLCK,ERK,PCNA,and Bax.Results:The bladder hyperplasia,bladder index(BI)increased,and histopathological alteration were easily observed in BOO group,which were significantly inhibited by DZQE administration.DZQE also significantly inhibited the up-regulation of maximum voiding pressure(MVP)and down-regulation of residual urine volume(RV)observed in BOO rats.The expressions of ChAT and MLCK and the activation of ERK were much increased,while the expressions of ROCK1,MLC-2 and Bax were obviously decreased in BOO rats,all of which were then significantly inhibited by DZQE.In rat bladder smooth muscle cells(RBSMC),3 h or 24 h duration of HP successfully simulated the BOO compensation and decompensation respectively in vitro.DZQE or its active components reduced the abnormal gene expressions in HP stimulated RBSMC.Conclusion:DZQE improves the urinary function in BOO rats mainly through the activation of ERK.Bakuchiol,salvianolic acid A,kaempferol,and tanshinoneⅡA are possibly the important active components of its therapeutic effects.
文摘BACKGROUND Mycobacterium tuberculosis(TB)is the causative agent of TB,a chronic granulo-matous illness.This disease is prevalent in low-income countries,posing a significant global health challenge.Gastrointestinal TB is one of the three forms.The disease can mimic other intra-abdominal conditions,leading to delayed diagnosis owing to the absence of specific symptoms.While gastric outlet obs-truction(GOO)remains a frequent complication,its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy.Gastroduodenal TB can cause upper gastrointestinal hemorrhage,obstruction,and malignancy-like tumors.CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain,distension,nausea,vomiting,and weight loss,prompting a referral to a gastroenterologist clinic.Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation.However,treatment was interrupted,possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes.Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall.Resection revealed gastric wall effacement with TB.CONCLUSION Primary gastric TB is rare,frequently leading to GOO.Given its rarity,suspicions should be promptly raised when encountering relevant symptoms,often requiring surgical intervention for diagnosis and treatment.
文摘Malignant gastric outlet obstruction(mGOO)is a major condition affecting patients with periampullary tumors,including pancreatic cancer.The current treatment options include surgical gastroenterostomy,endoscopic stenting and more recently EUS-guided gastroenterostomy.Most studies comparing the outcomes of the three procedures focus on technical success,clinical success and safety.Several“occult”outcomes relevant to the patient’s viewpoints and perspective may ultimately impact on cancer-related and overall survival,such as body mass composition,nutritional biomarkers,chemotherapy tolerance and patient-reported quality of life.The aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.
基金Supported by Shenyang Science and Technology Plan Project,No.23-408-3-01The Natural Science Foundation of Liaoning Province,No.2022-MS-435.
文摘Gastroduodenal tuberculosis(GD-TB)is exceptionally rare.The clinical manifestations of gastrointestinal TB are diverse and non-specific,which makes diagnosis difficult,leading to delayed diagnosis and high mortality.As a peer-reviewer of World Journal of Clinical Cases,I would like to share my opinion on the article published by this journal.The patient had no family history of TB or contact with people with TB.Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient.The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.
文摘First of all,I would like to congratulate Vilas-Boas et al on an interesting publication.In this letter the authors write about very interesting topics in the management of patients with malignant gastric outlet obstruction(GOO).GOO developed in up to 20%of patients with advanced hepatopancreatobiliary disease both in benign and malignant form.For this reason,the issue is very current.I fully agree with Vilas-Boas et al that technical aspect of the procedures(surgeon’s view)often differs from the patient’s view(regarding such factors as cancerrelated survival,overall survival,body mass composition,nutritional biomarkers,chemotherapy tolerance and patient-reported quality of life).The mentioned factors should be taken into account when interpreting the effectiveness of treatment modalities for malignant GOO(mGOO),which should be also considered in the future studies in this subject.In my opinion,all above mentioned factors could be summarized in one term:“Improving quality of life of patients with mGOO”.
文摘This research delves into the hurdles and strategies aimed at augmenting the market involvement of smallholder carrot farmers in Nakuru County, Kenya. Employing a Multinomial Logit (MNL) model, it scrutinizes the factors influencing the selection of marketing outlets among carrot farmers. The findings unveil that a significant majority (81%) of surveyed farmers actively participate in diverse market outlets, encompassing the farm gate, cleaning point, local market, external market, and export market. Notably, pivotal buyers include aggregators, brokers, wholesalers, retailers, and consumers, with transactions predominantly occurring at the farm level. Additionally, the analysis discerns substantial influences of socio-economic characteristics, experiential factors, and geographical proximity on farmers’ choices of market outlets. Specifically, gender, age, land size, farming experience, and distance to markets emerge as critical determinants. Moreover, the study delves into the examination of market margins along the carrot value chain, shedding light on the potential profitability of carrot farming in the region. Remarkably, higher average gross margins are identified in export and external markets, signaling lucrative prospects for farmers targeting these segments. However, disparities in profit distribution between farmers and traders underscore the necessity for interventions to ensure equitable value distribution throughout the value chain. These findings underscore the imperative for tailored interventions to tackle challenges and foster inclusive agricultural development. Strategies such as farmer organizations, contracting, and vertical integration are advocated to enhance market access and profitability for smallholder carrot farmers. Thus, this study enriches our comprehension of the dynamics within carrot value chains and provides valuable insights for policymakers and development practitioners aiming to uplift rural livelihoods and bolster food security.
文摘In this editorial,we comment on the in-press article in the World Journal of Gas-trointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction(mGOO).The original theory of treatment involves bypassing the obstruction or reenabling the patency of the passage.Conventional surgical gastroenterostomy provides long-term relief of symptoms in selected patients,with substantial morbidity and a considerable rate of delayed gastric emptying.Endoscopic stenting was introduced as an alternative minimally invasive proce-dure with less procedural morbidity and rapid clinical improvement;however,it presented a high rate of long-term recurrence.Therefore,challenges remain in the treatment of mGOO patients to improve clinical outcomes.Endoscopic ultra-sound-guided gastroenterostomy has recently emerged as a promising method because of the combined effects of surgery and endoscopy,whereas stomach-partitioning gastrojejunostomy has been reported as a modified surgical proce-dure to reduce the rate of delayed gastric emptying.In decision-making regarding the treatment of choice,it should be taken into account that mGOO might be accompanied by a variety of pathological conditions,including cancer cachexia,anorexia,malabsorption,and etc.,all of which can also lead to the characteristic symptoms and poor nutritional status of mGOO.The treatment plan should consider comprehensive aspects of patients to achieve practical improve-ments in prognosis and the quality of life.
文摘BACKGROUND Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has recently emerged as an alternative treatment for gastric outlet obstruction(GOO)in selected patients.AIM To report the initial experience of EUS-GE in patients with GOO.METHODS This study was a retrospective,observational,multicenter study in which the data from 10 patients who underwent EUS-GE due to GOO between September 2021 and May 2023 were collected.We analyzed technical success,clinical success,adverse events,and survival.Technical success was defined as adequate positioning and deployment of the stent.Clinical success was defined as the patient’s ability to tolerate oral intake without vomiting 7 d after the procedure.Postprocedural adverse events were recorded.RESULTS Eleven procedures in 10 patients with GOO were included.The mean age of the patients was 67.5 years(range:56-77 years).Malignant GOO was present in 9 patients.Technical success was achieved in 9/11 procedures(82%).Among them,clinical success was achieved in 9 patients(100%).Adverse events occurred in 1 patient(9%).The median survival was 3 months(n=7;range:1-8 months).CONCLUSION EUS-GE is a feasible therapeutic option in the treatment of GOO.
基金Supported by The Special Project of Public Welfare Industry(Meteorology)of Science and Technology Ministry(GYHY200806020)The National Natural Science Fund(40975084)The Science Research Fund of Liaoning Meteorological Bureau(2008008)
文摘By using the meteorological data in the pollution boundary layer which was observed in two ground observation sites:coast and land in the river outlet area of Grand Liao River during January-February in 2007,the daily change characteristics of pollute boundary layer in winter in the area were discussed. The results showed that the pollute boundary layer in the river outlet area of Grand Liao River was affected by the sea and land. In the certain weather condition,maybe the sea-land breeze appeared in the low altitude which was below 200 m in the coastal zone. The stability change in the different height in the coastal zone was more stable than in the land zone,and the wind field change in the area was mainly in 300 m low altitude. At night,the temperature inversion often appears in the area,and the thickness of temperature inversion layer is stably during 200-300 m. The thermal internal boundary layer penetrated deeply into the land about 10 km,and the height could reach 800 m. The atmospheric diffusion ability in the coastal area was weaker and stronger in the land area.
文摘To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index （BOO1） greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score （IPSS）, uroflowmetry, post-void residual volume （PVR） check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive （IPSSO） and irritative （IPSSI） subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients＇ symptoms should be considered in deciding treatment modality.
基金Supported by Part of Research Results of Special Program of Humane Social Science Fund of Guizhou Education Department(09ZX084)~~
文摘As agricultural eco-tourism development played a vital role in promoting rural economic and social development and constructing new harmonious countryside,the paper had analyzed environmental problem produced during its development,pointed out that blind development of agricultural eco-tourism had seriously destroyed resources and ecological environment and that tourist infrastructure construction and urbanization had ruined rural unique natural landscape.In view of current situation of environment,it also studied reasons causing environmental disruption,which lied in insufficient guidance and support of government,deficient scientific development planning and management system,and poor environmental consciousness of tourist operators and tourists.On this basis,it summarized that agricultural eco-tourism development should follow principles of sustainable development,synchronization between development and protection,and coordination between tourism development and environmental protection.It concluded proper ways to develop agricultural eco-tourism,and emphasized that it should draw up scientific and reasonable development planning,enhance government's macro-administration,establish and perfect ecological compensation mechanism,and strive to cultivate people's environmental awareness.
文摘The main goal of the safe power outlet project is to make power outlets smart and integrate it to all old and new electrical wiring of homes and offices to eliminate the costs.Using the designed socket,home and office electrical appliances can be smarten and controlled remotely through wireless technology.The device designed in this project,is a smart power outlet that supports Wi-Fi connection and the user can connect directly to it and control it by the specific mobile application.There is no need for any other interfaces such as a modem or router,and the user can connect directly to the device.This is the innovative part of the project making it different from the conventional power outlets on the market.All home and office appliances running on AC power can be connected to a safe outlet directly and without an interface;they can be controlled via wireless network by mobiles.This device smartens all old and conventional outlets without making any changes in wiring.It also enables the control via Wi-Fi on the outlets.
