Endoscopic submucosal dissection(ESD)has emerged as a pivotal therapeutic modality for early gastrointestinal(GI)cancers,providing a minimally invasive approach with curative potential.This technique enables the en bl...Endoscopic submucosal dissection(ESD)has emerged as a pivotal therapeutic modality for early gastrointestinal(GI)cancers,providing a minimally invasive approach with curative potential.This technique enables the en bloc resection of neoplastic lesions confined to the mucosa and submucosa,thereby preserving organ function and reducing the need for more radical surgical interventions.ESD provides diagnostic clarity and enhances patient survival rates when performed by skilled practitioners in the early stages of GI cancers such as esophageal,gastric,and colorectal carcinomas.This article examines the indications,procedural advancements,technical considerations,and outcomes associated with ESD in early GI cancers.The challenges and complications that can arise are also highlighted.Additionally,we discuss the evolving role of novel techniques and adjunctive therapies to improve safety and efficacy.As the field progresses,ESD remains a cornerstone in managing early GI cancers,offering patients a promising option for organ preservation and long-term survival.展开更多
The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc...The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.展开更多
BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized ...BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.展开更多
Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic sub...Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are widely used to manage early-stage EC and Barrett’s esophagus.However,their comparative efficacyand safety remain debated.This study aims to systematically compare the safety and efficacyof ESD and EMR in the treatment of early EC and Barrett’s esophagus.Methods:A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines.Databases,including MEDLINE(via PubMed),Google Scholar,and the Cochrane Library were searched for studies published up to October 2024.Twenty-two studies involving 3309 patients(1425 with ESD and 1884 with EMR)met the inclusion criteria.The outcomes assessed included en bloc resection,R0 resection,curative resection,local recurrence,bleeding,perforation,and stricture formation.Risk ratios(RR)with 95%CIs were calculated via a random-effects model via RevMan 5.4.Results:ESD significantlyoutperformed EMR in en bloc resection(RR=2.22,95%CI:1.69–2.90;p<0.001),R0 resection(RR=1.93,95%CI:1.28–2.91;p=0.002),and curative resection rates(RR=2.29,95%CI:1.52–3.46;p<0.001).ESD was associated with lower local recurrence in patients with squamous cell carcinoma(SCC)(RR=0.13,95%CI:0.06–0.30;p<0.001),whereas recurrence was greater in patients with Barrett’s esophagus(RR=1.67,95%CI:1.30–2.14;p<0.001).No significant difference was observed in bleeding rates;however,ESD was associated with a greater risk of perforation(RR=2.94,95%CI:1.31–6.60;p=0.009).Conclusion:ESD is more effective than EMR in achieving complete and curative resections for early EC and SCC,particularly for lesions>20 mm.However,it has a higher complication rate,especially perforation.Careful patient selection and procedural expertise are essential when choosing between the two techniques.展开更多
The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded st...The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass(RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status postRYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.展开更多
AIM: To determine an appropriate compartmentalization of endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) for duodenal tumors.
Three new triterpenes, 3β,21α-dihydroxylupen-18（19）-en （1）, 3β,25-dihydroxytirucalla- 7,23（24）-dien （2）, and 21α-hydroxy-19α-hydrogentaraxastero1-20（30）-en （3） were obtained from an ethyl acetate extr...Three new triterpenes, 3β,21α-dihydroxylupen-18（19）-en （1）, 3β,25-dihydroxytirucalla- 7,23（24）-dien （2）, and 21α-hydroxy-19α-hydrogentaraxastero1-20（30）-en （3） were obtained from an ethyl acetate extract of the whole plant of Siyekucai （Ixeris chinensis）. The structures of 1-3 were determined by spectroscopic methods （EIMS, IR, 1D and 2D NMR）.展开更多
BACKGROUND Large appendiceal orifice polyps are traditionally treated surgically.Recently,endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)have been utilized as alternative resection technique...BACKGROUND Large appendiceal orifice polyps are traditionally treated surgically.Recently,endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)have been utilized as alternative resection techniques.AIM To evaluate the efficacy and safety of endoscopic resection techniques for the management of large appendiceal orifice polyps.METHODS This was a retrospective observational study conducted to assess the feasibility and safety of EMR and ESD for large appendiceal orifice polyps.This project was approved by the Baylor College of Medicine Institutional Review Board.Patients who underwent endoscopic resection of appendiceal orifice polyps≥1 cm from 2015 to 2022 at a tertiary referral endoscopy center in the United States were enrolled.The main outcomes of this study included en bloc resection,R0 resection,post resection adverse events,and polyp recurrence.RESULTS A total of 19 patients were identified.Most patients were female(53%)and Caucasian(95%).The mean age was 63.3±10.8 years,and the average body mass index was 28.8±6.4.The mean polyp size was 25.5±14.2 mm.74%of polyps were localized to the appendix(at or inside the appendiceal orifice)and the remaining extended into the cecum.68%of polyps occupied≥50%of the appendiceal orifice circumference.The mean procedure duration was 61.6±37.9 minutes.Polyps were resected via endoscopic mucosal resection,endoscopic submucosal dissection,and hybrid procedures in 5,6,and 8 patients,respectively.Final pathology was remarkable for tubular adenoma(n=10)[one with high grade dysplasia],sessile serrated adenoma(n=7),and tubulovillous adenoma(n=2)[two with high grade dysplasia].En bloc resection was achieved in 84%with an 88%R0 resection rate.Despite the large polyp sizes and challenging procedures,89%(n=17)of patients were discharged on the same day as their procedure.Two patients were admitted for post-procedure observation for conservative pain management.Eight patients underwent repeat colonoscopy without evidence of residual or recurrent adenomatous polyps.CONCLUSION Our study highlights how endoscopic mucosal resection,endoscopic submucosal dissection,and hybrid procedures are all appropriate techniques with minimal adverse effects,further validating the utility of endoscopic procedures in the management of large appendiceal polyps.展开更多
基于前后张驰逼近(Back and Forth Nudging,简称BFN)和集合卡尔曼滤波(En KF)方法,构建了一种新的同化方法 HBFNEn KF(Hybrid Back and Forth Nudging En KF)混合同化方法,并将此同化系统分别与通道浅水模式(shallow water model)和全...基于前后张驰逼近(Back and Forth Nudging,简称BFN)和集合卡尔曼滤波(En KF)方法,构建了一种新的同化方法 HBFNEn KF(Hybrid Back and Forth Nudging En KF)混合同化方法,并将此同化系统分别与通道浅水模式(shallow water model)和全球浅水模式对接,检验了HBFNEn KF同化方法的有效性。同时,对比了集合均方根滤波(En SRF)、HNEn KF(Hybrid Nudging En KF)、HBFNEn KF三种方法在有误差模式中的同化效果。试验结果表明:HBFNEn KF同化方法保留了HNEn KF方法的同化连续性,解决了En KF同化不连续不平滑的问题,同时还有着更快的收敛速度;当采用单变量分析试验时,HBFNEn KF方法的优势最为明显,表明HBFNEn KF能够较好地保持不同模式变量间的平衡。此外,增量场尺度分析结果表明:相比En SRF,HBFNEn KF在大尺度范围有更好的同化效果,同时能够避免在中小尺度范围内出现大量的虚假增量。展开更多
The main raw material utilized in wood adhesives comes from petrochemical extractives.However,due to the excessive dependence on petrochemical resources and the adverse impact on the ecosystem and human wellbeing,ther...The main raw material utilized in wood adhesives comes from petrochemical extractives.However,due to the excessive dependence on petrochemical resources and the adverse impact on the ecosystem and human wellbeing,there is an increasing trend to develop byproduct protein-based adhesives in the current global food safety context.In this research,flaxseed meal was subjected to pretreatment,and trimethylolpropane triglycidyl ether(TTE)and ethylenediamine(EN)were utilized as crosslinkers to establish a more compact adhesive layer and to prevent water intrusion.The pretreatment decreased the FM/UB viscosity by 60%compared to FM.The combination of CD analysis indicated that the Urea-NaOH pretreatment effectively stretched the flaxseed meal protein.According to Fourier transform infrared(FTIR)spectroscopy,X-ray diffraction(XRD),and differential scanning calorimetry(DSC)were used to analyze the resulting adhesive’s reaction mechanism and thermal response.Furthermore,the physical properties of the adhesive were characterized using wet shear strength testing and SEM observation.Remarkably,the dry bond strength increased from 0.72 to 2.12 MPa,representing a 194.4%increase.The wet bonding strength of the adhesive was improved from 0.22 to 1.21 MPa,representing a 550%increase compared to the original flaxseed protein-based adhesive,which far exceeded the minimum requirement for plywood of Type II(≥0.7 MPa,by GB/T 9846-2015).This study demonstrated an eco-friendly and sustainable method for the development of protein adhesives as viable substitutes for petrochemical resins.展开更多
研究了民间草药甜草O ldenlandia cantonensisHow的化学成分。从乙醇提取物的乙酸乙酯洗脱部分得到新的五环三萜urs-12-en-29-αoic ac id-3β-ol。该化合物结构通过NMR、IR、MS等波谱数据综合解析确定。研究了urs-12-en-29-αoic ac i...研究了民间草药甜草O ldenlandia cantonensisHow的化学成分。从乙醇提取物的乙酸乙酯洗脱部分得到新的五环三萜urs-12-en-29-αoic ac id-3β-ol。该化合物结构通过NMR、IR、MS等波谱数据综合解析确定。研究了urs-12-en-29-αoic ac id-3β-ol对重组人DNA拓扑异构酶Ⅰ、肝癌细胞BEL-7402和胃腺癌细胞MCG-803的抑制作用,效果显著,IC50值分别为12.0×10-6、6.5×10-6、8.0×10-6g/mL。由V(石油醚)∶V(乙酸乙酯)=20∶1洗脱得到的低极性成分进行了气相色谱-质谱分析,共鉴定60个化合物,其中长链脂肪族化合物,如烷烃、饱和及不饱和羧酸(酯)含量较丰富,占36.16%,萜类和甾体类化合物分别占6.42%和9.28%。展开更多
AIM: To compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for the treatment of colorectal tumors.
Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone features.In recent years,variable m...Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone features.In recent years,variable methods have emerged that have attributed to higher stone removal success rates,reduced cost and lower adverse events.In this review,we outline a stepwise approach in CBD stone management.As first line therapy,endoscopic sphincterotomy and large balloon dilation are recommended,due to a 30%-50%reduction of the use of mechanical lithotripsy.On the other hand,cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence.As discussed,findings suggest that management needs to be tailored to the patient’s characteristics and anatomical conditions.Furthermore,we evaluate the management of CBD stones in various surgical altered anatomy(Billroth II,Roux-en-Y and Roux-en-Y gastric bypass).Moreover,we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use,rather than following a failed management option.In addition,we discuss the importance of dissecting other techniques,such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed.In conclusion,we recognize that endoscopic sphincterotomy and large balloon dilation,mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones,but emerging techniques are in rapid evolution with encouraging results.展开更多
文摘Endoscopic submucosal dissection(ESD)has emerged as a pivotal therapeutic modality for early gastrointestinal(GI)cancers,providing a minimally invasive approach with curative potential.This technique enables the en bloc resection of neoplastic lesions confined to the mucosa and submucosa,thereby preserving organ function and reducing the need for more radical surgical interventions.ESD provides diagnostic clarity and enhances patient survival rates when performed by skilled practitioners in the early stages of GI cancers such as esophageal,gastric,and colorectal carcinomas.This article examines the indications,procedural advancements,technical considerations,and outcomes associated with ESD in early GI cancers.The challenges and complications that can arise are also highlighted.Additionally,we discuss the evolving role of novel techniques and adjunctive therapies to improve safety and efficacy.As the field progresses,ESD remains a cornerstone in managing early GI cancers,offering patients a promising option for organ preservation and long-term survival.
文摘The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.
文摘BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.
文摘Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are widely used to manage early-stage EC and Barrett’s esophagus.However,their comparative efficacyand safety remain debated.This study aims to systematically compare the safety and efficacyof ESD and EMR in the treatment of early EC and Barrett’s esophagus.Methods:A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines.Databases,including MEDLINE(via PubMed),Google Scholar,and the Cochrane Library were searched for studies published up to October 2024.Twenty-two studies involving 3309 patients(1425 with ESD and 1884 with EMR)met the inclusion criteria.The outcomes assessed included en bloc resection,R0 resection,curative resection,local recurrence,bleeding,perforation,and stricture formation.Risk ratios(RR)with 95%CIs were calculated via a random-effects model via RevMan 5.4.Results:ESD significantlyoutperformed EMR in en bloc resection(RR=2.22,95%CI:1.69–2.90;p<0.001),R0 resection(RR=1.93,95%CI:1.28–2.91;p=0.002),and curative resection rates(RR=2.29,95%CI:1.52–3.46;p<0.001).ESD was associated with lower local recurrence in patients with squamous cell carcinoma(SCC)(RR=0.13,95%CI:0.06–0.30;p<0.001),whereas recurrence was greater in patients with Barrett’s esophagus(RR=1.67,95%CI:1.30–2.14;p<0.001).No significant difference was observed in bleeding rates;however,ESD was associated with a greater risk of perforation(RR=2.94,95%CI:1.31–6.60;p=0.009).Conclusion:ESD is more effective than EMR in achieving complete and curative resections for early EC and SCC,particularly for lesions>20 mm.However,it has a higher complication rate,especially perforation.Careful patient selection and procedural expertise are essential when choosing between the two techniques.
文摘The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass(RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status postRYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.
文摘AIM: To determine an appropriate compartmentalization of endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) for duodenal tumors.
文摘Three new triterpenes, 3β,21α-dihydroxylupen-18（19）-en （1）, 3β,25-dihydroxytirucalla- 7,23（24）-dien （2）, and 21α-hydroxy-19α-hydrogentaraxastero1-20（30）-en （3） were obtained from an ethyl acetate extract of the whole plant of Siyekucai （Ixeris chinensis）. The structures of 1-3 were determined by spectroscopic methods （EIMS, IR, 1D and 2D NMR）.
文摘BACKGROUND Large appendiceal orifice polyps are traditionally treated surgically.Recently,endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)have been utilized as alternative resection techniques.AIM To evaluate the efficacy and safety of endoscopic resection techniques for the management of large appendiceal orifice polyps.METHODS This was a retrospective observational study conducted to assess the feasibility and safety of EMR and ESD for large appendiceal orifice polyps.This project was approved by the Baylor College of Medicine Institutional Review Board.Patients who underwent endoscopic resection of appendiceal orifice polyps≥1 cm from 2015 to 2022 at a tertiary referral endoscopy center in the United States were enrolled.The main outcomes of this study included en bloc resection,R0 resection,post resection adverse events,and polyp recurrence.RESULTS A total of 19 patients were identified.Most patients were female(53%)and Caucasian(95%).The mean age was 63.3±10.8 years,and the average body mass index was 28.8±6.4.The mean polyp size was 25.5±14.2 mm.74%of polyps were localized to the appendix(at or inside the appendiceal orifice)and the remaining extended into the cecum.68%of polyps occupied≥50%of the appendiceal orifice circumference.The mean procedure duration was 61.6±37.9 minutes.Polyps were resected via endoscopic mucosal resection,endoscopic submucosal dissection,and hybrid procedures in 5,6,and 8 patients,respectively.Final pathology was remarkable for tubular adenoma(n=10)[one with high grade dysplasia],sessile serrated adenoma(n=7),and tubulovillous adenoma(n=2)[two with high grade dysplasia].En bloc resection was achieved in 84%with an 88%R0 resection rate.Despite the large polyp sizes and challenging procedures,89%(n=17)of patients were discharged on the same day as their procedure.Two patients were admitted for post-procedure observation for conservative pain management.Eight patients underwent repeat colonoscopy without evidence of residual or recurrent adenomatous polyps.CONCLUSION Our study highlights how endoscopic mucosal resection,endoscopic submucosal dissection,and hybrid procedures are all appropriate techniques with minimal adverse effects,further validating the utility of endoscopic procedures in the management of large appendiceal polyps.
文摘基于前后张驰逼近(Back and Forth Nudging,简称BFN)和集合卡尔曼滤波(En KF)方法,构建了一种新的同化方法 HBFNEn KF(Hybrid Back and Forth Nudging En KF)混合同化方法,并将此同化系统分别与通道浅水模式(shallow water model)和全球浅水模式对接,检验了HBFNEn KF同化方法的有效性。同时,对比了集合均方根滤波(En SRF)、HNEn KF(Hybrid Nudging En KF)、HBFNEn KF三种方法在有误差模式中的同化效果。试验结果表明:HBFNEn KF同化方法保留了HNEn KF方法的同化连续性,解决了En KF同化不连续不平滑的问题,同时还有着更快的收敛速度;当采用单变量分析试验时,HBFNEn KF方法的优势最为明显,表明HBFNEn KF能够较好地保持不同模式变量间的平衡。此外,增量场尺度分析结果表明:相比En SRF,HBFNEn KF在大尺度范围有更好的同化效果,同时能够避免在中小尺度范围内出现大量的虚假增量。
文摘The main raw material utilized in wood adhesives comes from petrochemical extractives.However,due to the excessive dependence on petrochemical resources and the adverse impact on the ecosystem and human wellbeing,there is an increasing trend to develop byproduct protein-based adhesives in the current global food safety context.In this research,flaxseed meal was subjected to pretreatment,and trimethylolpropane triglycidyl ether(TTE)and ethylenediamine(EN)were utilized as crosslinkers to establish a more compact adhesive layer and to prevent water intrusion.The pretreatment decreased the FM/UB viscosity by 60%compared to FM.The combination of CD analysis indicated that the Urea-NaOH pretreatment effectively stretched the flaxseed meal protein.According to Fourier transform infrared(FTIR)spectroscopy,X-ray diffraction(XRD),and differential scanning calorimetry(DSC)were used to analyze the resulting adhesive’s reaction mechanism and thermal response.Furthermore,the physical properties of the adhesive were characterized using wet shear strength testing and SEM observation.Remarkably,the dry bond strength increased from 0.72 to 2.12 MPa,representing a 194.4%increase.The wet bonding strength of the adhesive was improved from 0.22 to 1.21 MPa,representing a 550%increase compared to the original flaxseed protein-based adhesive,which far exceeded the minimum requirement for plywood of Type II(≥0.7 MPa,by GB/T 9846-2015).This study demonstrated an eco-friendly and sustainable method for the development of protein adhesives as viable substitutes for petrochemical resins.
文摘研究了民间草药甜草O ldenlandia cantonensisHow的化学成分。从乙醇提取物的乙酸乙酯洗脱部分得到新的五环三萜urs-12-en-29-αoic ac id-3β-ol。该化合物结构通过NMR、IR、MS等波谱数据综合解析确定。研究了urs-12-en-29-αoic ac id-3β-ol对重组人DNA拓扑异构酶Ⅰ、肝癌细胞BEL-7402和胃腺癌细胞MCG-803的抑制作用,效果显著,IC50值分别为12.0×10-6、6.5×10-6、8.0×10-6g/mL。由V(石油醚)∶V(乙酸乙酯)=20∶1洗脱得到的低极性成分进行了气相色谱-质谱分析,共鉴定60个化合物,其中长链脂肪族化合物,如烷烃、饱和及不饱和羧酸(酯)含量较丰富,占36.16%,萜类和甾体类化合物分别占6.42%和9.28%。
文摘AIM: To compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for the treatment of colorectal tumors.
文摘Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone features.In recent years,variable methods have emerged that have attributed to higher stone removal success rates,reduced cost and lower adverse events.In this review,we outline a stepwise approach in CBD stone management.As first line therapy,endoscopic sphincterotomy and large balloon dilation are recommended,due to a 30%-50%reduction of the use of mechanical lithotripsy.On the other hand,cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence.As discussed,findings suggest that management needs to be tailored to the patient’s characteristics and anatomical conditions.Furthermore,we evaluate the management of CBD stones in various surgical altered anatomy(Billroth II,Roux-en-Y and Roux-en-Y gastric bypass).Moreover,we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use,rather than following a failed management option.In addition,we discuss the importance of dissecting other techniques,such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed.In conclusion,we recognize that endoscopic sphincterotomy and large balloon dilation,mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones,but emerging techniques are in rapid evolution with encouraging results.
