Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature...Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature of the colon. The main complications of ESD comprise postoperative perforation and hemorrhage, similar to endoscopic mucosal resection (EMR). In particular, the rate of perforation in ESD is higher than that in EMR. Perforation of the colon can cause fatal peritonitis. Endoscopic clipping is reported to be an efficient therapy for perforation. Most cases with perforation are treated conservatively without urgent surgical intervention. However, the rate of postoperative hemorrhage in ESD is similar to that in EMR. Endoscopic therapy including endoscopic clipping is performed and most of the cases are treated conservatively without blood transfusion. In blood examination, some degree of inflammation is detected after ESD. For the standardization of ESD, it is most important to decrease the rate of perforation. Adopting a safe strategy for ESD and a suitable choice of knife are both important waysof preventing perforation. Moreover, appropriate training and increasing experience can improve the endoscopic technique and can decrease the rate of perforation. In this review, we describe safe procedures in ESD to prevent complications, the complications of ESD and their management.展开更多
To evaluate the effect of organic manure application with chemical fertilizers on rice yield and soil fertility under long-term double-rice cropping system, a six year field experiment was conducted continually in the...To evaluate the effect of organic manure application with chemical fertilizers on rice yield and soil fertility under long-term double-rice cropping system, a six year field experiment was conducted continually in the paddy soil derived from Quaternary red clay in Hunan Province of southern China. Four different treatments, i.e., no nitrogen with chemical P and K （PK）, swine manure only （M）, N, P and K chemical fertilizers only （NPK）, and half chemical fertilizers combined with half swine manure （NPKM） with four replications were included. Each N, P and K application rate was the same at all the treatments （except the N application rate at PK） and N application rate was 150 kg N ha^-1. All fertilizers were applied to soil tillage layer with once application as baseal fertilizers. The nutrients uptake rate, grain yield, nitrogen use efficiency, and soil organic matter content at each treatment were investigated. The NPKM treatment achieved the highest mean annual yield of 12.2 t ha^-1 （68% higher than that of PK）. Higher dry matter accumulation and nutrients absorption were observed during the middle-late growth period in the NPKM treatment, with higher panicle number per unit and filled-grain number per panicle. Its average nitrogen use efficiency was 36.3% and soil organic matter increased by 18.5% during the experimental period in the NPKM treatment, which were significantly higher than those in the NPK treatment. Organic manure application with chemical fertilizers increased the yield and nitrogen use efficiency of rice, reduced the risk of environmental pollution and improved soil fertility greatly. It could be a good practical technique that protects the environment and raises the rice yield in this region.展开更多
Inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD) are characterized by ongoing mucosal inflammation in which dysfunction of the host immunologic response against dietary factors an...Inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD) are characterized by ongoing mucosal inflammation in which dysfunction of the host immunologic response against dietary factors and commensal bacteria is involved. The chronic in-flammatory process leads to disruption of the epithelial barrier, and the formation of epithelial ulceration. This permits easy access for the luminal microbiota and dietary antigens to cells resident in the lamina pro-pria, and stimulates further pathological immune cell responses. Cytokines are essential mediators of the interactions between activated immune cells and non-immune cells, including epithelial and mesenchymal cells. The clinical efficacy of targeting TNF-α clearly indicates that cytokines are the therapeutic targets in IBD patients. In this manuscript, we focus on the bio-logical activities of recently-reported cytokines [Inter-leukin (IL)-17 cytokine family, IL-31 and IL-32], which might play a role through interaction with TNF-α in the pathophysiology of IBD.展开更多
AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancrea...AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancreatic resection in our hospital.The prognostic factors after pancreatic resection were analyzed in all 195 patients.After excluding the censored cases within an observational period,the clinicopathological characteristics of 20 patients who survived ≥ 5(n = 20) and < 5(n = 76) years were compared.For this comparison,we analyzed the patients who underwent surgery before June 2008 and were observed for more than 5 years.For statistical analyses,the log-rank test was used to compare the cumulative survival rates,and the χ2 and Mann-Whitney tests were used to compare the two groups.The CoxHazard model was used for a multivariate analysis,and P values less than 0.05 were considered significant.A multivariate analysis was conducted on the factors that were significant in the univariate analysis.RESULTS: The median survival for all patients was 27.1 months,and the 5-year actuarial survival rate was 34.5%.The median observational period was 595 d.With the univariate analysis,the UICC stage was significantly associated with survival time,and the CA19-9 ≤ 200 U/m L,DUPAN-2 ≤ 180 U/m L,t u m o r s i ze ≤ 2 0 m m,R 0 re s e c t i o n,a b s e n c e o f lymph node metastasis,absence of extrapancreatic neural invasion,and absence of portal invasion were favorable prognostic factors.The multivariate analysis showed that tumor size ≤ 20 mm(HR = 0.40; 95%CI: 0.17-0.83,P = 0.012) and negative surgical margins(R0 resection)(HR = 0.48; 95%CI: 0.30-0.77,P = 0.003) were independent favorable prognostic factors.Among the 96 patients,20 patients survived for 5 years or more,and 76 patients died within 5 years after operation.Comparison of the 20 5-year survivors with the 76 non-survivors showed that lower concentrations of DUPAN-2(79.5 vs 312.5 U/mL,P = 0.032),tumor size ≤ 20 mm(35% vs 8%,P = 0.008),R0 resection(9展开更多
Of patients with severe exacerbation of chronic hepatitis B accompanied by jaundice and coagulopathy,20%-30%have a fatal outcome.In this report,we describe 2 cases of severe exacerbation of chronic hepatitis B with ja...Of patients with severe exacerbation of chronic hepatitis B accompanied by jaundice and coagulopathy,20%-30%have a fatal outcome.In this report,we describe 2 cases of severe exacerbation of chronic hepatitis B with jaundice and coagulopathy who were successfully treated with a combination of entecavir and corticosteroid.In both cases,rapid reductions in serum hepatitis B virus(HBV)-DNA levels were observed,and corticosteroid was stopped after serum HBV-DNA levels became undetectable.Entecavir treatment was continued.Generally,entecavir treatment reduced serum HBV-DNA levels rapidly,although the improvement in liver function was delayed by a few weeks.During this time lag,liver cell injury continued and the disease progressed.Corticosteroid suppressed the excessive host immune response and was useful for stopping progressive deterioration.A combination of entecavir and early-phase corticosteroid may be a useful treatment in severe exacerbation of chronic hepatitis B.展开更多
AIM: To investigate our learning curves of orthotopic liver transplantation (OLT) in rats and the most important factor for successful surgery. METHODS: We describe the surgical procedures for our rat OLT model, and d...AIM: To investigate our learning curves of orthotopic liver transplantation (OLT) in rats and the most important factor for successful surgery. METHODS: We describe the surgical procedures for our rat OLT model, and determined the operator learning curves. The various factors that contributed to successful surgery were determined. The most important surgical factors were evaluated between successful and unsuccessful surgeries.RESULTS: Learning curve data indicated that 50 cases were required for operator training to start a study. Operative time, blood loss, warm ischemic time, anhepatic phase, unstable systemic hemodynamic state, and body temperature after surgery significantly affected surgery success by univariate analysis, while the anhepatic phase was the most critical factor for success by multivariate analysis. CONCLUSION: OLT in rats is the only liver transplantation model that provides clinically relevant and reliable results. Shortened anhepatic phase is key to success in this model.展开更多
AIM- To immunohistochemicaUy examine micrometastasis and VEGF-C expression in hilar bile duct carcinoma （HBDC） and to evaluate the clinical significance of the results. METHODS： A total of 361 regional lymph nodes ...AIM- To immunohistochemicaUy examine micrometastasis and VEGF-C expression in hilar bile duct carcinoma （HBDC） and to evaluate the clinical significance of the results. METHODS： A total of 361 regional lymph nodes from 25 patients with node-negative HBDC were immunostained with an antibody against cytokeratins 8 and 18 （CAM 5.2）, and immunohistochemical staining of VEGF-C was performed in 34 primary resected tumors. RESULTS： Lymph node micrometastasis was detected in 6 （24%） of the 25 patients and 10 （2.8%） of the 361 lymph nodes. Patients with micrometastasis showed significantly poorer survival rates than those without （P= 0.025）. VEGF-C expression was positive in 17 （50%） of 34 HBDC, and significantly correlated with lymph node metastasis （P=0.042） and microscopic venous invasion （P=0.035）. CONCLUSIONS： It is suggested that immunohistochemically detected lymph node micrometastasis has an impact on the outcome of HBDC. VEGF-C expression is highly correlated with lymph node metastasis in HBDC and might therefore be a useful predictor.展开更多
AIM: To report a systematic review,establishing the available data to an unpublished 2a strength of evidence,better handling clinical practice.METHODS: A systematic review was performed using MEDLINE,EMBASE,Cochrane,L...AIM: To report a systematic review,establishing the available data to an unpublished 2a strength of evidence,better handling clinical practice.METHODS: A systematic review was performed using MEDLINE,EMBASE,Cochrane,LILACS,Scopus and CINAHL databases. Information of the selected studies was extracted on characteristics of trial participants,inclusion and exclusion criteria,interventions(mainly,mucosal resection and submucosal dissection vs surgical approach) and outcomes(adverse events,different survival rates,mortality,recurrence and complete resection rates). To ascertain the validity of eligible studies,the risk of bias was measured using the Newcastle-Ottawa Quality Assessment Scale. The analysis of the absolute risk of the outcomes was performed using the software Rev Man,by computingrisk differences(RD) of dichotomous variables. Data on RD and 95%CIs for each outcome were calculated using the Mantel-Haenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%,a subsequent assay was done and other findings were compiled.RESULTS: Eleven retrospective cohort studies were selected. The included records involved 2654 patients with early gastric cancer that filled the absolute or expanded indications for endoscopic resection. Threeyear survival data were available for six studies(n = 1197). There were no risk differences(RD) after endoscopic and surgical treatment(RD = 0.01,95%CI:-0.02-0.05,P = 0.51). Five-year survival data(n = 2310) showed no difference between the two groups(RD = 0.01,95%CI:-0.01-0.03,P = 0.46). Recurrence data were analized in five studies(1331 patients) and there was no difference between the approaches(RD = 0.01,95%CI:-0.00-0.02,P = 0.09). Adverse event data were identified in eight studies(n = 2439). A significant difference was detected(RD =-0.08,95%CI:-0.10--0.05,P < 0.05),demonstrating better results with endoscopy. Mortality data were obtained in four studies(n = 1107). There was 展开更多
A multi-fluid blast furnace model was simply introduced and was used to simulate several innovative ironmaking operations. The simulation results show that injecting hydrogen bearing materials, especially injecting na...A multi-fluid blast furnace model was simply introduced and was used to simulate several innovative ironmaking operations. The simulation results show that injecting hydrogen bearing materials, especially injecting natural gas and plastics, the hydrogen reduction is enhanced, and the furnace performance is improved simultaneously. Total heat input shows obvious decrease due to the decrease of heat consumption in direct reduction, solution loss and silicon transfer reactions. If carbon composite agglomerates are charged into the furnace, the temperature of thermal reserve zone will obviously decrease, and the reduction of iron-bearing burden materials will be retarded. However, the efficiency of blast furnace is improved just due to the decrease in heat requirements for solution loss, sinter reduction, and silicon transfer reactions, and less heat loss through top gas and furnace wall. Finally, the model is used to investigate the performance of blast furnace under the condition of top gas recycling together with plastics injection, cold oxygen blasting and carbon composite agglomerate charging. The lower furnace temperature, extremely accelerated reduction rate, drastically decreased CO2 emission and remarkably enhanced heat efficiency were obtained by using the innovative operations, and the blast furnace operation with superhigh efficiency can be realized.展开更多
The effectiveness of polyolefin-coated urea （Meister-5 and Meister-10; CU） in a wheat （Triticum aestivum L.）-maize （Zea mays L.） rotation system was studied in lysimeter plots located in the North China Plain fo...The effectiveness of polyolefin-coated urea （Meister-5 and Meister-10; CU） in a wheat （Triticum aestivum L.）-maize （Zea mays L.） rotation system was studied in lysimeter plots located in the North China Plain for three consecutive maizewheat-maize cropping seasons. An isotopic method was used to compare the fate of CU to that of non-coated urea （NCU）, and N application rates of 0, 100, 150 and 225 kg N ha-1 were evaluated. The results showed that the nitrogen use efficiency （15NUE） of CU was 13.3%-21.4% greater than that of NCU for the first crop. Alternatively, when the difference method was applied （apparent NUE）, no significant variations were observed among treatments in all three seasons. Although inorganic N leached from the 1.3 m layer was less than 1% of the total applied N, unidentified losses of 15N （losses of 15N = 15N applied as fertilizer - 15N absorbed by crops - 15N remaining in the 0-0.2 m layer - 15N leached from the 1.3 m layer） in CU-treated plots were 24.2%-26.5% lower than those of NCU-treated plots. The nitrate concentration in the 0-1.3 m layer of CU plots at the end of the experiment was 53% lower than that of NCU-treated plots. Thus, CU increased crop N uptake from fertilizer and reduced unidentified losses of applied N, which can reduce the risk of groundwater pollution.展开更多
Objective: To evaluate the total phenolic content and total antioxidant capacity of ethyl acetate extracts of 21 endophytic fungi isolated from five Sudanese medicinal plants: Calotropis procera, Catharanthus roseus, ...Objective: To evaluate the total phenolic content and total antioxidant capacity of ethyl acetate extracts of 21 endophytic fungi isolated from five Sudanese medicinal plants: Calotropis procera, Catharanthus roseus, Euphorbia prostrate, Vernonia amygdalina and Trigonella foenumgraecum. Methods: Crude extracts of endophytic fungi and their host plants were tested by classical Folin-Ciocalteu colorimetric method to determine the total phenolic content, also total antioxidant capacity was estimated using 1,1-diphenyl-2-picrylhydrazyl free radical scavenging in vitro method. Results: Among the endophytes, endophytic fungus Aspergillus sp. from Trigonella foenum-graecum seeds demonstrated the highest both total phenolic content in term of gallic acid equivalent(GAE) [(89.9±7.1 mg GAE/g)] and antioxidant activity for 1,1-diphenyl-2-picrylhydrazyl radical scavenging assay [IC50:(18.0±0.1 μg/m L)]. A high positive linear correlation(R2=0.999 1) was found between total antioxidant capacity and total phenolic content of endophytic fungi isolated from Vernonia amygdalina. Conclusions: The present study revealed that some endophytic fungi from the five Sudanese medicinal plants could be a potential source of novel natural antioxidant compounds.展开更多
AIM:To evaluate whether an endoscopy position detecting unit(UPD-3) can improve cecal intubation rates, cecal intubation times and visual analog scale(VAS) pain scores, regardless of the colonoscopist's level of e...AIM:To evaluate whether an endoscopy position detecting unit(UPD-3) can improve cecal intubation rates, cecal intubation times and visual analog scale(VAS) pain scores, regardless of the colonoscopist's level of experience.METHODS:A total of 260 patients(170 men and 90women)who underwent a colonoscopy were divided into the UPD-3-guided group or the conventional group(no UPD-3 guidance).Colonoscopies were performed by experts(experience of more than 1000colonoscopies)or trainees(experience of less than 100colonoscopies).Cecal intubation rates,cecal intubation times,insertion methods(straight insertion:shortening the colonic fold through the bending technique;roping insertion:right turn shortening technique)and patient discomfort were assessed.Patient discomfort during the endoscope insertion was scored by the VAS that was divided into 6 degrees of pain.RESULTS:The cecum intubation rates,cecal intubation times,number of cecal intubations that were performed in<15 min and insertion methods were not significantly different between the conventional group and the UPD-3-guided group.The number of patients who experienced pain during the insertion was markedly less in the UPD-3-guided group than in the conventional group.Univariate and multivariate analysis showed that the following factors were associated with lower VAS pain scores during endoscope insertion:insertion method(straight insertion)and UPD-3guidance in the trainee group.For the experts group,univariate analysis showed that only the insertion method(straight insertion)was associated with lower VAS pain scores.CONCLUSION:Although UPD-3 guidance did not shorten intubation times,it resulted in less patient painduring endoscope insertion compared with conventional endoscopy for the procedures performed by trainees.展开更多
AIM:To investigate the anti-oxidative and anti-fibrotic effects of aloe vera in patients with liver fibrosis.METHODS:Aloe vera high molecular weight fractions(AHM) were processed by patented hyper-dry system in combin...AIM:To investigate the anti-oxidative and anti-fibrotic effects of aloe vera in patients with liver fibrosis.METHODS:Aloe vera high molecular weight fractions(AHM) were processed by patented hyper-dry system in combination of freeze-dry technique with microwave and far infrared-ray radiation.Fifteen healthy volunteers as the control group and 40 patients were included.The patients were randomly subdivided into two equal groups:the conventional group was treated with placebo(starch),and AHM group was treated with 0.15 gm/d AHM,both for 12 consecutive weeks.The patients were investigated before and after treatment.Serum activity of aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(ALP),hyaluronic acid(HA),transforming growth factor-β(TGF-β) and matrixmetalloproteinase-2(MMP-2) were determined.The reduced glutathione(GSH) and malondialdehyde(MDA) levels in liver were assayed and the expression of hepatic α-smooth muscle actin(α-SMA) was identified by immunohistochemistry.RESULTS:At the start of the study,the hematoxylin and eosin staining revealed fibro-proliferated bile ductules,thick fibrous septa and dense inflammatory cellular infiltration in the patients before treatment.The use of AHM for 12 wk significantly ameliorated the fibrosis,inhibited the inflammation,and resulted in minimal infiltration and minimal fibrosis compared to the conventional group.The enzyme activities of the liver(ALT,AST and ALP) were attenuated after treatment in both groups,and the decrease in the AHM group was more significant as compared with the conventional group.Similar to the AST,the MDA levels were significantly higher before treatment,and were attenuated after treatment in both groups.In contrast,the hepatic glutathione content in the patients were decreased significantly in the AHM group compared to the controls.The serum levels of the fibrosis markers(HA,TGF-β and MMP-2) were also reduced significantly after treatment.The expression of α-SMA was modified in patients before and after treat展开更多
Image matting is to estimate the opacity of foreground objects from an image. A few deep learning based methods have been proposed for image matting and perform well in capturing spatially close information. However, ...Image matting is to estimate the opacity of foreground objects from an image. A few deep learning based methods have been proposed for image matting and perform well in capturing spatially close information. However, these methods fail to capture global contextual information, which has been proved essential in improving matting performance. This is because a matting image may be up to several megapixels, which is too big for a learning-based network to capture global contextual information due to the limit size of a receptive field. Although uniformly downsampling the matting image can alleviate this problem, it may result in the degradation of matting performance. To solve this problem, we introduce a natural image matting with the attended global context method to extract global contextual information from the whole image, and to condense them into a suitable size for learning-based network. Specifically, we first leverage a deformable sampling layer to obtain condensed foreground and background attended images respectively. Then, we utilize a contextual attention layer to extract information related to unknown regions from condensed foreground and background images generated by a deformable sampling layer. Besides, our network predicts a background as well as the alpha matte to obtain more purified foreground, which contributes to better qualitative performance in composition. Comprehensive experiments show that our method achieves competitive performance on both Composition-1k and the alphamatting.com benchmark quantitatively and qualitatively.展开更多
BACKGROUND Postoperative complications like remnant hepatic vein(HV)outflow block and liver torsion can occur after right hepatectomy.Hepatic falciform ligament fixation is typically used to prevent liver torsion.We r...BACKGROUND Postoperative complications like remnant hepatic vein(HV)outflow block and liver torsion can occur after right hepatectomy.Hepatic falciform ligament fixation is typically used to prevent liver torsion.We report a novel procedure to manage outflow block.CASE SUMMARY An 80-year-old man developed HV outflow block after remnant right hepatectomy,despite liver fixation and intraoperative HV flow check.He had a history of cholangiocellular carcinoma and had undergone posterior segmentectomy and choledojejunostomy.The falciform ligament fixation was inadequate to maintain liver position.Emergency surgery was performed,using an omental flap and mobilized right side colon with ileocecal region to prevent liver dislocation due to intraabdominal adhesion.His postoperative course was uneventful.CONCLUSION This is the first report providing a novel surgical procedure when the falciform ligament is insufficient for remnant liver fixation.展开更多
A class of side-chain type ferrocene macrocycles with a radially conjugated system is introduced in this study.The stereo configurations of these ferrocene rings were determined through single-crystal X-ray diffractio...A class of side-chain type ferrocene macrocycles with a radially conjugated system is introduced in this study.The stereo configurations of these ferrocene rings were determined through single-crystal X-ray diffraction analysis.Notably,in the solid state,the ferrocene rings exhibit a distinctive herringbone stacking pattern imposed by a ferrocene-to-ring host−guest interaction.Through UV−vis absorption spectroscopy,electrochemical measurements,and theoretical calculations,valuable insights into the electronic properties of these rings were obtained.In addition,the single crystal of macrocycle A_(2)B demonstrates a second-order nonlinear optical response.As a class of organometallic nanorings,this work holds great potential for further exploration in the fields of organometallic chemistry,molecular electronics,and host−guest chemistry.展开更多
AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent p...AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN metastasis.The patients had distant metastasis such as liver,lung,peritoneum,and paraaortic LN.Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan.All patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients.We evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTS For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor.Regarding cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis.展开更多
BACKGROUND Real-world data on tofacitinib(TOF)covering a period of more than 1 year for a sufficient number of Asian patients with ulcerative colitis(UC)are scarce.AIM To investigate the long-term efficacy and safety ...BACKGROUND Real-world data on tofacitinib(TOF)covering a period of more than 1 year for a sufficient number of Asian patients with ulcerative colitis(UC)are scarce.AIM To investigate the long-term efficacy and safety of TOF treatment for UC,including clinical issues.METHODS We performed a retrospective single-center observational analysis of 111 UC patients administered TOF at Hyogo Medical University as a tertiary inflammatory bowel disease center.All consecutive UC patients who received TOF between May 2018 and February 2020 were enrolled.Patients were followed up until August 2020.The primary outcome was the clinical response rate at week 8.Secondary outcomes included clinical remission at week 8,cumulative persistence rate of TOF administration,colectomy-free survival,relapse after tapering of TOF and predictors of clinical response at week 8 and week 48.RESULTS The clinical response and remission rates were 66.3%and 50.5%at week 8,and 47.1%and 43.5%at week 48,respectively.The overall cumulative clinical remission rate was 61.7%at week 48 and history of anti-tumor necrosis factor-alpha(TNF-α)agents use had no influence(P=0.25).The cumulative TOF persistence rate at week 48 was significantly lower in patients without clinical remission than in those with remission at week 8(30.9%vs 88.1%;P<0.001).Baseline partial Mayo Score was significantly lower in responders vs non-responders at week 8(odds ratio:0.61,95%confidence interval:0.45-0.82,P=0.001).Relapse occurred in 45.7%of patients after TOF tapering,and 85.7%of patients responded within 4 wk after re-increase.All 6 patients with herpes zoster(HZ)developed the infection after achieving remission by TOF.CONCLUSION TOF was more effective in UC patients with mild activity at baseline and its efficacy was not affected by previous treatment with anti-TNF-αagents.Most relapsed patients responded again after re-increase of TOF and nearly half relapsed after tapering off TOF.Special attention is needed for tapering and HZ.展开更多
When the graft volume is too small to satisfy the recipient’s metabolic demand, the recipient may thus experience small-for-size syndrome (SFSS). Because the occurrence of SFSS is determined by not only the liver gra...When the graft volume is too small to satisfy the recipient’s metabolic demand, the recipient may thus experience small-for-size syndrome (SFSS). Because the occurrence of SFSS is determined by not only the liver graft volume but also a combination of multiple negative factors, the definitions of small-for-size graft (SFSG) and SFSS are different in each institute and at each time. In the clinical setting, surgical inflow modulation and maximizing the graft outflow are keys to overcoming SFSS. Accordingly, relatively smaller-sized grafts can be used with surgical modification and pharmacological manipulation targeting portal circulation and liver graft quality. Therefore, the focus of the SFSG issue is now shifting from how to obtain a larger graft from the living donor to how to manage the use of a smaller graft to save the recipient, considering donor safety to be a priority.展开更多
The diagnostic criteria for colonic intraepithelial tumors vary from country to country.While intramucosal adenocarcinoma is recognized in Japan,in Western countries adenocarcinoma is diagnosed only if the tumor inva... The diagnostic criteria for colonic intraepithelial tumors vary from country to country.While intramucosal adenocarcinoma is recognized in Japan,in Western countries adenocarcinoma is diagnosed only if the tumor invades to the submucosa and accesses the muscularis mucosae.However,endoscopic therapy,including endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD),is used worldwide to treat adenoma and early colorectal cancer.Precise histopathological evaluation is important for the curativeness of these therapies as inappropriate endoscopic therapy causes local recurrence of the tumor that may develop into fatal metastasis.Therefore,colorectal ESD and EMR are not indicated for cancers with massive submucosal invasion.However,diagnosis of cancer with massive submucosal invasion by endoscopy is limited,even when magnifying endoscopy for pit pattern and narrow band imaging and flexible spectral imaging color of enhancement are performed.Therefore,occasional cancers with massive submucosal invasion will be treated by ESD and EMR.Precise histopathological evaluation of these lesions should be performed in order to determine the necessity of additional therapy,including surgical resection.展开更多
文摘Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature of the colon. The main complications of ESD comprise postoperative perforation and hemorrhage, similar to endoscopic mucosal resection (EMR). In particular, the rate of perforation in ESD is higher than that in EMR. Perforation of the colon can cause fatal peritonitis. Endoscopic clipping is reported to be an efficient therapy for perforation. Most cases with perforation are treated conservatively without urgent surgical intervention. However, the rate of postoperative hemorrhage in ESD is similar to that in EMR. Endoscopic therapy including endoscopic clipping is performed and most of the cases are treated conservatively without blood transfusion. In blood examination, some degree of inflammation is detected after ESD. For the standardization of ESD, it is most important to decrease the rate of perforation. Adopting a safe strategy for ESD and a suitable choice of knife are both important waysof preventing perforation. Moreover, appropriate training and increasing experience can improve the endoscopic technique and can decrease the rate of perforation. In this review, we describe safe procedures in ESD to prevent complications, the complications of ESD and their management.
基金the National Key Technologies R & D Program of China (2006BAD05B09, 2006BAD02A14)the National Ba- sic Research Program of China (2007CB109308)the China-Japan Collaboration Project
文摘To evaluate the effect of organic manure application with chemical fertilizers on rice yield and soil fertility under long-term double-rice cropping system, a six year field experiment was conducted continually in the paddy soil derived from Quaternary red clay in Hunan Province of southern China. Four different treatments, i.e., no nitrogen with chemical P and K （PK）, swine manure only （M）, N, P and K chemical fertilizers only （NPK）, and half chemical fertilizers combined with half swine manure （NPKM） with four replications were included. Each N, P and K application rate was the same at all the treatments （except the N application rate at PK） and N application rate was 150 kg N ha^-1. All fertilizers were applied to soil tillage layer with once application as baseal fertilizers. The nutrients uptake rate, grain yield, nitrogen use efficiency, and soil organic matter content at each treatment were investigated. The NPKM treatment achieved the highest mean annual yield of 12.2 t ha^-1 （68% higher than that of PK）. Higher dry matter accumulation and nutrients absorption were observed during the middle-late growth period in the NPKM treatment, with higher panicle number per unit and filled-grain number per panicle. Its average nitrogen use efficiency was 36.3% and soil organic matter increased by 18.5% during the experimental period in the NPKM treatment, which were significantly higher than those in the NPK treatment. Organic manure application with chemical fertilizers increased the yield and nitrogen use efficiency of rice, reduced the risk of environmental pollution and improved soil fertility greatly. It could be a good practical technique that protects the environment and raises the rice yield in this region.
文摘Inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD) are characterized by ongoing mucosal inflammation in which dysfunction of the host immunologic response against dietary factors and commensal bacteria is involved. The chronic in-flammatory process leads to disruption of the epithelial barrier, and the formation of epithelial ulceration. This permits easy access for the luminal microbiota and dietary antigens to cells resident in the lamina pro-pria, and stimulates further pathological immune cell responses. Cytokines are essential mediators of the interactions between activated immune cells and non-immune cells, including epithelial and mesenchymal cells. The clinical efficacy of targeting TNF-α clearly indicates that cytokines are the therapeutic targets in IBD patients. In this manuscript, we focus on the bio-logical activities of recently-reported cytokines [Inter-leukin (IL)-17 cytokine family, IL-31 and IL-32], which might play a role through interaction with TNF-α in the pathophysiology of IBD.
文摘AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancreatic resection in our hospital.The prognostic factors after pancreatic resection were analyzed in all 195 patients.After excluding the censored cases within an observational period,the clinicopathological characteristics of 20 patients who survived ≥ 5(n = 20) and < 5(n = 76) years were compared.For this comparison,we analyzed the patients who underwent surgery before June 2008 and were observed for more than 5 years.For statistical analyses,the log-rank test was used to compare the cumulative survival rates,and the χ2 and Mann-Whitney tests were used to compare the two groups.The CoxHazard model was used for a multivariate analysis,and P values less than 0.05 were considered significant.A multivariate analysis was conducted on the factors that were significant in the univariate analysis.RESULTS: The median survival for all patients was 27.1 months,and the 5-year actuarial survival rate was 34.5%.The median observational period was 595 d.With the univariate analysis,the UICC stage was significantly associated with survival time,and the CA19-9 ≤ 200 U/m L,DUPAN-2 ≤ 180 U/m L,t u m o r s i ze ≤ 2 0 m m,R 0 re s e c t i o n,a b s e n c e o f lymph node metastasis,absence of extrapancreatic neural invasion,and absence of portal invasion were favorable prognostic factors.The multivariate analysis showed that tumor size ≤ 20 mm(HR = 0.40; 95%CI: 0.17-0.83,P = 0.012) and negative surgical margins(R0 resection)(HR = 0.48; 95%CI: 0.30-0.77,P = 0.003) were independent favorable prognostic factors.Among the 96 patients,20 patients survived for 5 years or more,and 76 patients died within 5 years after operation.Comparison of the 20 5-year survivors with the 76 non-survivors showed that lower concentrations of DUPAN-2(79.5 vs 312.5 U/mL,P = 0.032),tumor size ≤ 20 mm(35% vs 8%,P = 0.008),R0 resection(9
文摘Of patients with severe exacerbation of chronic hepatitis B accompanied by jaundice and coagulopathy,20%-30%have a fatal outcome.In this report,we describe 2 cases of severe exacerbation of chronic hepatitis B with jaundice and coagulopathy who were successfully treated with a combination of entecavir and corticosteroid.In both cases,rapid reductions in serum hepatitis B virus(HBV)-DNA levels were observed,and corticosteroid was stopped after serum HBV-DNA levels became undetectable.Entecavir treatment was continued.Generally,entecavir treatment reduced serum HBV-DNA levels rapidly,although the improvement in liver function was delayed by a few weeks.During this time lag,liver cell injury continued and the disease progressed.Corticosteroid suppressed the excessive host immune response and was useful for stopping progressive deterioration.A combination of entecavir and early-phase corticosteroid may be a useful treatment in severe exacerbation of chronic hepatitis B.
基金Supported by The work at the Mayo Clinic, Florida was sup-ported by grants to Nguyen JH from the Deason Foundation, San-dra and Eugene Davenport, Mayo Clinic CD CRT-II, and NIH R01NS051646-01A2the work in Kyoto University Graduate School of Medicine was supported by grants of the Japan Society for the Promotion of Science, No. C20591523 the Uehara Memorial Foundation, No. 200940051, Tokyo, 171-0033, Japan
文摘AIM: To investigate our learning curves of orthotopic liver transplantation (OLT) in rats and the most important factor for successful surgery. METHODS: We describe the surgical procedures for our rat OLT model, and determined the operator learning curves. The various factors that contributed to successful surgery were determined. The most important surgical factors were evaluated between successful and unsuccessful surgeries.RESULTS: Learning curve data indicated that 50 cases were required for operator training to start a study. Operative time, blood loss, warm ischemic time, anhepatic phase, unstable systemic hemodynamic state, and body temperature after surgery significantly affected surgery success by univariate analysis, while the anhepatic phase was the most critical factor for success by multivariate analysis. CONCLUSION: OLT in rats is the only liver transplantation model that provides clinically relevant and reliable results. Shortened anhepatic phase is key to success in this model.
文摘AIM- To immunohistochemicaUy examine micrometastasis and VEGF-C expression in hilar bile duct carcinoma （HBDC） and to evaluate the clinical significance of the results. METHODS： A total of 361 regional lymph nodes from 25 patients with node-negative HBDC were immunostained with an antibody against cytokeratins 8 and 18 （CAM 5.2）, and immunohistochemical staining of VEGF-C was performed in 34 primary resected tumors. RESULTS： Lymph node micrometastasis was detected in 6 （24%） of the 25 patients and 10 （2.8%） of the 361 lymph nodes. Patients with micrometastasis showed significantly poorer survival rates than those without （P= 0.025）. VEGF-C expression was positive in 17 （50%） of 34 HBDC, and significantly correlated with lymph node metastasis （P=0.042） and microscopic venous invasion （P=0.035）. CONCLUSIONS： It is suggested that immunohistochemically detected lymph node micrometastasis has an impact on the outcome of HBDC. VEGF-C expression is highly correlated with lymph node metastasis in HBDC and might therefore be a useful predictor.
文摘AIM: To report a systematic review,establishing the available data to an unpublished 2a strength of evidence,better handling clinical practice.METHODS: A systematic review was performed using MEDLINE,EMBASE,Cochrane,LILACS,Scopus and CINAHL databases. Information of the selected studies was extracted on characteristics of trial participants,inclusion and exclusion criteria,interventions(mainly,mucosal resection and submucosal dissection vs surgical approach) and outcomes(adverse events,different survival rates,mortality,recurrence and complete resection rates). To ascertain the validity of eligible studies,the risk of bias was measured using the Newcastle-Ottawa Quality Assessment Scale. The analysis of the absolute risk of the outcomes was performed using the software Rev Man,by computingrisk differences(RD) of dichotomous variables. Data on RD and 95%CIs for each outcome were calculated using the Mantel-Haenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%,a subsequent assay was done and other findings were compiled.RESULTS: Eleven retrospective cohort studies were selected. The included records involved 2654 patients with early gastric cancer that filled the absolute or expanded indications for endoscopic resection. Threeyear survival data were available for six studies(n = 1197). There were no risk differences(RD) after endoscopic and surgical treatment(RD = 0.01,95%CI:-0.02-0.05,P = 0.51). Five-year survival data(n = 2310) showed no difference between the two groups(RD = 0.01,95%CI:-0.01-0.03,P = 0.46). Recurrence data were analized in five studies(1331 patients) and there was no difference between the approaches(RD = 0.01,95%CI:-0.00-0.02,P = 0.09). Adverse event data were identified in eight studies(n = 2439). A significant difference was detected(RD =-0.08,95%CI:-0.10--0.05,P < 0.05),demonstrating better results with endoscopy. Mortality data were obtained in four studies(n = 1107). There was
文摘A multi-fluid blast furnace model was simply introduced and was used to simulate several innovative ironmaking operations. The simulation results show that injecting hydrogen bearing materials, especially injecting natural gas and plastics, the hydrogen reduction is enhanced, and the furnace performance is improved simultaneously. Total heat input shows obvious decrease due to the decrease of heat consumption in direct reduction, solution loss and silicon transfer reactions. If carbon composite agglomerates are charged into the furnace, the temperature of thermal reserve zone will obviously decrease, and the reduction of iron-bearing burden materials will be retarded. However, the efficiency of blast furnace is improved just due to the decrease in heat requirements for solution loss, sinter reduction, and silicon transfer reactions, and less heat loss through top gas and furnace wall. Finally, the model is used to investigate the performance of blast furnace under the condition of top gas recycling together with plastics injection, cold oxygen blasting and carbon composite agglomerate charging. The lower furnace temperature, extremely accelerated reduction rate, drastically decreased CO2 emission and remarkably enhanced heat efficiency were obtained by using the innovative operations, and the blast furnace operation with superhigh efficiency can be realized.
基金Supported by the National Basic Research Program (973 Program) of China (No. 2007CB109302)the Special Fund for Agro-Scientific Research in the Public Interest, China (No. 201103007)the Japan-China Co-operation Project
文摘The effectiveness of polyolefin-coated urea （Meister-5 and Meister-10; CU） in a wheat （Triticum aestivum L.）-maize （Zea mays L.） rotation system was studied in lysimeter plots located in the North China Plain for three consecutive maizewheat-maize cropping seasons. An isotopic method was used to compare the fate of CU to that of non-coated urea （NCU）, and N application rates of 0, 100, 150 and 225 kg N ha-1 were evaluated. The results showed that the nitrogen use efficiency （15NUE） of CU was 13.3%-21.4% greater than that of NCU for the first crop. Alternatively, when the difference method was applied （apparent NUE）, no significant variations were observed among treatments in all three seasons. Although inorganic N leached from the 1.3 m layer was less than 1% of the total applied N, unidentified losses of 15N （losses of 15N = 15N applied as fertilizer - 15N absorbed by crops - 15N remaining in the 0-0.2 m layer - 15N leached from the 1.3 m layer） in CU-treated plots were 24.2%-26.5% lower than those of NCU-treated plots. The nitrate concentration in the 0-1.3 m layer of CU plots at the end of the experiment was 53% lower than that of NCU-treated plots. Thus, CU increased crop N uptake from fertilizer and reduced unidentified losses of applied N, which can reduce the risk of groundwater pollution.
基金the CNRS and the Ministère de l’Enseignement Superieur, for the financial support
文摘Objective: To evaluate the total phenolic content and total antioxidant capacity of ethyl acetate extracts of 21 endophytic fungi isolated from five Sudanese medicinal plants: Calotropis procera, Catharanthus roseus, Euphorbia prostrate, Vernonia amygdalina and Trigonella foenumgraecum. Methods: Crude extracts of endophytic fungi and their host plants were tested by classical Folin-Ciocalteu colorimetric method to determine the total phenolic content, also total antioxidant capacity was estimated using 1,1-diphenyl-2-picrylhydrazyl free radical scavenging in vitro method. Results: Among the endophytes, endophytic fungus Aspergillus sp. from Trigonella foenum-graecum seeds demonstrated the highest both total phenolic content in term of gallic acid equivalent(GAE) [(89.9±7.1 mg GAE/g)] and antioxidant activity for 1,1-diphenyl-2-picrylhydrazyl radical scavenging assay [IC50:(18.0±0.1 μg/m L)]. A high positive linear correlation(R2=0.999 1) was found between total antioxidant capacity and total phenolic content of endophytic fungi isolated from Vernonia amygdalina. Conclusions: The present study revealed that some endophytic fungi from the five Sudanese medicinal plants could be a potential source of novel natural antioxidant compounds.
文摘AIM:To evaluate whether an endoscopy position detecting unit(UPD-3) can improve cecal intubation rates, cecal intubation times and visual analog scale(VAS) pain scores, regardless of the colonoscopist's level of experience.METHODS:A total of 260 patients(170 men and 90women)who underwent a colonoscopy were divided into the UPD-3-guided group or the conventional group(no UPD-3 guidance).Colonoscopies were performed by experts(experience of more than 1000colonoscopies)or trainees(experience of less than 100colonoscopies).Cecal intubation rates,cecal intubation times,insertion methods(straight insertion:shortening the colonic fold through the bending technique;roping insertion:right turn shortening technique)and patient discomfort were assessed.Patient discomfort during the endoscope insertion was scored by the VAS that was divided into 6 degrees of pain.RESULTS:The cecum intubation rates,cecal intubation times,number of cecal intubations that were performed in<15 min and insertion methods were not significantly different between the conventional group and the UPD-3-guided group.The number of patients who experienced pain during the insertion was markedly less in the UPD-3-guided group than in the conventional group.Univariate and multivariate analysis showed that the following factors were associated with lower VAS pain scores during endoscope insertion:insertion method(straight insertion)and UPD-3guidance in the trainee group.For the experts group,univariate analysis showed that only the insertion method(straight insertion)was associated with lower VAS pain scores.CONCLUSION:Although UPD-3 guidance did not shorten intubation times,it resulted in less patient painduring endoscope insertion compared with conventional endoscopy for the procedures performed by trainees.
文摘AIM:To investigate the anti-oxidative and anti-fibrotic effects of aloe vera in patients with liver fibrosis.METHODS:Aloe vera high molecular weight fractions(AHM) were processed by patented hyper-dry system in combination of freeze-dry technique with microwave and far infrared-ray radiation.Fifteen healthy volunteers as the control group and 40 patients were included.The patients were randomly subdivided into two equal groups:the conventional group was treated with placebo(starch),and AHM group was treated with 0.15 gm/d AHM,both for 12 consecutive weeks.The patients were investigated before and after treatment.Serum activity of aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(ALP),hyaluronic acid(HA),transforming growth factor-β(TGF-β) and matrixmetalloproteinase-2(MMP-2) were determined.The reduced glutathione(GSH) and malondialdehyde(MDA) levels in liver were assayed and the expression of hepatic α-smooth muscle actin(α-SMA) was identified by immunohistochemistry.RESULTS:At the start of the study,the hematoxylin and eosin staining revealed fibro-proliferated bile ductules,thick fibrous septa and dense inflammatory cellular infiltration in the patients before treatment.The use of AHM for 12 wk significantly ameliorated the fibrosis,inhibited the inflammation,and resulted in minimal infiltration and minimal fibrosis compared to the conventional group.The enzyme activities of the liver(ALT,AST and ALP) were attenuated after treatment in both groups,and the decrease in the AHM group was more significant as compared with the conventional group.Similar to the AST,the MDA levels were significantly higher before treatment,and were attenuated after treatment in both groups.In contrast,the hepatic glutathione content in the patients were decreased significantly in the AHM group compared to the controls.The serum levels of the fibrosis markers(HA,TGF-β and MMP-2) were also reduced significantly after treatment.The expression of α-SMA was modified in patients before and after treat
基金supported by the National Natural Science Foundation of China under Grant No.62076162the Shanghai Municipal Science and Technology Major Project under Grant Nos.2021SHZDZX0102 and 20511100300.
文摘Image matting is to estimate the opacity of foreground objects from an image. A few deep learning based methods have been proposed for image matting and perform well in capturing spatially close information. However, these methods fail to capture global contextual information, which has been proved essential in improving matting performance. This is because a matting image may be up to several megapixels, which is too big for a learning-based network to capture global contextual information due to the limit size of a receptive field. Although uniformly downsampling the matting image can alleviate this problem, it may result in the degradation of matting performance. To solve this problem, we introduce a natural image matting with the attended global context method to extract global contextual information from the whole image, and to condense them into a suitable size for learning-based network. Specifically, we first leverage a deformable sampling layer to obtain condensed foreground and background attended images respectively. Then, we utilize a contextual attention layer to extract information related to unknown regions from condensed foreground and background images generated by a deformable sampling layer. Besides, our network predicts a background as well as the alpha matte to obtain more purified foreground, which contributes to better qualitative performance in composition. Comprehensive experiments show that our method achieves competitive performance on both Composition-1k and the alphamatting.com benchmark quantitatively and qualitatively.
文摘BACKGROUND Postoperative complications like remnant hepatic vein(HV)outflow block and liver torsion can occur after right hepatectomy.Hepatic falciform ligament fixation is typically used to prevent liver torsion.We report a novel procedure to manage outflow block.CASE SUMMARY An 80-year-old man developed HV outflow block after remnant right hepatectomy,despite liver fixation and intraoperative HV flow check.He had a history of cholangiocellular carcinoma and had undergone posterior segmentectomy and choledojejunostomy.The falciform ligament fixation was inadequate to maintain liver position.Emergency surgery was performed,using an omental flap and mobilized right side colon with ileocecal region to prevent liver dislocation due to intraabdominal adhesion.His postoperative course was uneventful.CONCLUSION This is the first report providing a novel surgical procedure when the falciform ligament is insufficient for remnant liver fixation.
基金supported from National Natural Science Foundation of China(No.22071025)the Natural Science Fund of Fujian Province,China(No.2022J011152).
文摘A class of side-chain type ferrocene macrocycles with a radially conjugated system is introduced in this study.The stereo configurations of these ferrocene rings were determined through single-crystal X-ray diffraction analysis.Notably,in the solid state,the ferrocene rings exhibit a distinctive herringbone stacking pattern imposed by a ferrocene-to-ring host−guest interaction.Through UV−vis absorption spectroscopy,electrochemical measurements,and theoretical calculations,valuable insights into the electronic properties of these rings were obtained.In addition,the single crystal of macrocycle A_(2)B demonstrates a second-order nonlinear optical response.As a class of organometallic nanorings,this work holds great potential for further exploration in the fields of organometallic chemistry,molecular electronics,and host−guest chemistry.
文摘AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN metastasis.The patients had distant metastasis such as liver,lung,peritoneum,and paraaortic LN.Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan.All patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients.We evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTS For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor.Regarding cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis.
文摘BACKGROUND Real-world data on tofacitinib(TOF)covering a period of more than 1 year for a sufficient number of Asian patients with ulcerative colitis(UC)are scarce.AIM To investigate the long-term efficacy and safety of TOF treatment for UC,including clinical issues.METHODS We performed a retrospective single-center observational analysis of 111 UC patients administered TOF at Hyogo Medical University as a tertiary inflammatory bowel disease center.All consecutive UC patients who received TOF between May 2018 and February 2020 were enrolled.Patients were followed up until August 2020.The primary outcome was the clinical response rate at week 8.Secondary outcomes included clinical remission at week 8,cumulative persistence rate of TOF administration,colectomy-free survival,relapse after tapering of TOF and predictors of clinical response at week 8 and week 48.RESULTS The clinical response and remission rates were 66.3%and 50.5%at week 8,and 47.1%and 43.5%at week 48,respectively.The overall cumulative clinical remission rate was 61.7%at week 48 and history of anti-tumor necrosis factor-alpha(TNF-α)agents use had no influence(P=0.25).The cumulative TOF persistence rate at week 48 was significantly lower in patients without clinical remission than in those with remission at week 8(30.9%vs 88.1%;P<0.001).Baseline partial Mayo Score was significantly lower in responders vs non-responders at week 8(odds ratio:0.61,95%confidence interval:0.45-0.82,P=0.001).Relapse occurred in 45.7%of patients after TOF tapering,and 85.7%of patients responded within 4 wk after re-increase.All 6 patients with herpes zoster(HZ)developed the infection after achieving remission by TOF.CONCLUSION TOF was more effective in UC patients with mild activity at baseline and its efficacy was not affected by previous treatment with anti-TNF-αagents.Most relapsed patients responded again after re-increase of TOF and nearly half relapsed after tapering off TOF.Special attention is needed for tapering and HZ.
文摘When the graft volume is too small to satisfy the recipient’s metabolic demand, the recipient may thus experience small-for-size syndrome (SFSS). Because the occurrence of SFSS is determined by not only the liver graft volume but also a combination of multiple negative factors, the definitions of small-for-size graft (SFSG) and SFSS are different in each institute and at each time. In the clinical setting, surgical inflow modulation and maximizing the graft outflow are keys to overcoming SFSS. Accordingly, relatively smaller-sized grafts can be used with surgical modification and pharmacological manipulation targeting portal circulation and liver graft quality. Therefore, the focus of the SFSG issue is now shifting from how to obtain a larger graft from the living donor to how to manage the use of a smaller graft to save the recipient, considering donor safety to be a priority.
文摘 The diagnostic criteria for colonic intraepithelial tumors vary from country to country.While intramucosal adenocarcinoma is recognized in Japan,in Western countries adenocarcinoma is diagnosed only if the tumor invades to the submucosa and accesses the muscularis mucosae.However,endoscopic therapy,including endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD),is used worldwide to treat adenoma and early colorectal cancer.Precise histopathological evaluation is important for the curativeness of these therapies as inappropriate endoscopic therapy causes local recurrence of the tumor that may develop into fatal metastasis.Therefore,colorectal ESD and EMR are not indicated for cancers with massive submucosal invasion.However,diagnosis of cancer with massive submucosal invasion by endoscopy is limited,even when magnifying endoscopy for pit pattern and narrow band imaging and flexible spectral imaging color of enhancement are performed.Therefore,occasional cancers with massive submucosal invasion will be treated by ESD and EMR.Precise histopathological evaluation of these lesions should be performed in order to determine the necessity of additional therapy,including surgical resection.
