AIM: To identify the actual clinical management and associated factors of delayed perforation after gastric endoscopic submucosal dissection(ESD).METHODS: A total of 4943 early gastric cancer(EGC) patients underwent E...AIM: To identify the actual clinical management and associated factors of delayed perforation after gastric endoscopic submucosal dissection(ESD).METHODS: A total of 4943 early gastric cancer(EGC) patients underwent ESD at our hospital between January 1999 and June 2012. We retrospectively assessed the actual management of delayed perforation. In addition, to determine the factors associated with delayed perforation, after excluding 123 EGC patients with perforations that occurred during the ESD procedure, we analyzed the following clinicopathological factors among the remaining 4820 EGC patients by comparing the ESD cases with delayed perforation and the ESD cases without perforation: age, sex, chronological periods, clinical indications for ESD, status of the stomach, location, gastric circumference, tumor size, invasion depth, presence/absence of ulceration, histological type, type of resection, and procedure time.RESULTS: Delayed perforation occurred in 7(0.1%) cases. The median time until the occurrence of delayed perforation was 11 h(range, 6-172 h). Three(43%) of the 7 cases required emergency surgery, while four were conservatively managed without surgical intervention. Among the 4 cases with conservative management, 2 were successfully managed endoscopically using the endoloop-endoclip technique. The median hospital stay was 18 d(range, 15-45 d). There were no delayed perforation-related deaths. Based on a multivariate analysis, gastric tube cases(OR = 11.0; 95%CI: 1.7-73.3; P = 0.013) were significantly associated with delayed perforation.CONCLUSION: Endoscopists must be aware of not only the identified factors associated with delayed perforation, but also how to treat this complicationeffectively and promptly.展开更多
Endoscopic ultrasound (EUS) devices were first designed and manufactured more than 30 years ago, and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion o...Endoscopic ultrasound (EUS) devices were first designed and manufactured more than 30 years ago, and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers. We review the present status, the methods, and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer. EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma. The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer, and 83%-94% for submucosal invasive cancer. But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low, making it difficult to confirm minute submucosal invasion. The accuracy of EUS using high-frequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS, although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions, undifferentiated cancer, concomitant ulceration, expanded indications, type 0-I?lesions, and lesions located in the upper-third of the stomach. A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification. Although EUS using high-frequency ultrasound probes has limitations, it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection.展开更多
AIM: To evaluate the efficacy of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. METHODS: Between July 2007 and March 2009, 27 consecutive superficial esophageal squamous cell neop...AIM: To evaluate the efficacy of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. METHODS: Between July 2007 and March 2009, 27 consecutive superficial esophageal squamous cell neoplasms in 25 enrolled patients were treated by endoscopic submucosal dissection. The therapeutic efficacy, complications, and follow-up results were assessed. RESULTS: The mean size of the lesions was 21 ± 13 mm (range 2-55 mm); the mean size of the resection specimens was 32 ± 12 mm (range 10-70 mm). The enblock resection rate was 100% (27/27), and en block resection with tumor-free lateral/basal margins was 88.9% (24/27). Perforation occurred in 1 patient who was managed by conservative medical treatments. None of the patients developed local recurrence or distant metastasis in the follow-up period. CONCLUSION: Endoscopic submucosal dissection is applicable to superficial esophageal squamous cell neoplasms with promising results.展开更多
Recently, we reported a case of gastric mucosaassociated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal bl... Recently, we reported a case of gastric mucosaassociated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost. The 67-year-old female was diagnosed with gastric MALT lymphoma. The patient received eradication therapy for H. pylori. Conventional endoscopy revealed multiple ill-delineated brownish depressions in the stomach and cobblestonelike mucosa was observed at the greater curvature to the posterior wall of the upper gastric body 7 mo after successful eradication. Unsuccessful treatment of gastric MALT lymphoma was suspected on conventional endoscopy. Conventional endoscopic observations found focal depressions and cobblestone-like appearance, and these lesions were subsequently observed using magnified endoscopy combined with narrow band imaging to identify abnormal vessels presenting with a TLA within the lesions. Ten biopsies were taken from the area where abnormal vessels were present within these lesions. Ten biopsies were also taken from the lesions without abnormal vessels as a control. A total of 20 biopsy samples were evaluated to determine whether the diagnosis of MALT lymphoma could be obtained histologically from each sample. A positive diagnosis was obtained in 8/10 TLA (+) sites and in 2/10 TLA(-) sites. Target biopsies of the site with abnormal blood vessels can potentially improve diagnostic accuracy of gastric MALT lymphoma.展开更多
Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediat...Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively.We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure.In December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection.Intensive conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.展开更多
In 2018,the STAR collaboration collected data from^(96)_(44)Ru+^(96)_(44)Ru and^(96)_(40)Zr+^(96)_(40)Zr at√^(S)NN=200 Ge V to search for the presence of the chiral magnetic effect in collisions of nuclei.The isobar ...In 2018,the STAR collaboration collected data from^(96)_(44)Ru+^(96)_(44)Ru and^(96)_(40)Zr+^(96)_(40)Zr at√^(S)NN=200 Ge V to search for the presence of the chiral magnetic effect in collisions of nuclei.The isobar collision species alternated frequently between 9644 Ru+^(96)_(44)Ru and^(96)_(40)Zr+^(96)_(40)Zr.In order to conduct blind analyses of studies related to the chiral magnetic effect in these isobar data,STAR developed a three-step blind analysis procedure.Analysts are initially provided a"reference sample"of data,comprised of a mix of events from the two species,the order of which respects time-dependent changes in run conditions.After tuning analysis codes and performing time-dependent quality assurance on the reference sample,analysts are provided a species-blind sample suitable for calculating efficiencies and corrections for individual≈30-min data-taking runs.For this sample,species-specific information is disguised,but individual output files contain data from a single isobar species.Only run-by-run corrections and code alteration subsequent to these corrections are allowed at this stage.Following these modifications,the"frozen"code is passed over the fully un-blind data,completing the blind analysis.As a check of the feasibility of the blind analysis procedure,analysts completed a"mock data challenge,"analyzing data from Au+Au collisions at√^(S)NN=27 Ge V,collected in 2018.The Au+Au data were prepared in the same manner intended for the isobar blind data.The details of the blind analysis procedure and results from the mock data challenge are presented.展开更多
AIM: To investigate whether magnifying endoscopy with narrow band imaging (ME-NBI) is useful for evaluating the area of superficial, depressed- or flat-type differentiated adenocarcinoma of the stomach. METHODS: This ...AIM: To investigate whether magnifying endoscopy with narrow band imaging (ME-NBI) is useful for evaluating the area of superficial, depressed- or flat-type differentiated adenocarcinoma of the stomach. METHODS: This procedure was performed in Saitama Medical University International Medical Center, Japanese Red Cross Kumamoto Hospital and Kitakyushu Municipal Medical Center. The subjects were 31 patients in whom biopsy findings, from superficial, depressed- or flat-type gastric lesion, suggested differentiated adenocarcinoma in the above 3 hospitals between January and December 2009. Biopsy was performed on the lesion and non-lesion sides of a boundary (imaginary boundary) visualized on ME-NBI. The results were pathologically investigated. We evaluated the accuracy of estimating a demarcation line (DL) on ME-NBI in comparison with biopsy findings as a gold standard. RESULTS: The DL that could be recognized at 2 points on the orifice and anal sides of each lesion during ME-NBI was consistent with the pathological findings in 22 patients with 0-IIc lesions, 7 with 0-IIb lesions, and 2 with 0-IIb + IIc lesions, showing an accuracy of 100%. CONCLUSION: The results suggest the usefulness of ME-NBI for evaluating the area of superficial, depressed- and flat-type differentiated adenocarcinoma of the stomach.展开更多
Potentilla viscosa J. Don is widely distributed over the districts of Baicheng and Yanbian in Jilin Province. The root of P. viscosa can be used for the treatment of hepatitis. In our chemical investigation of tannin,...Potentilla viscosa J. Don is widely distributed over the districts of Baicheng and Yanbian in Jilin Province. The root of P. viscosa can be used for the treatment of hepatitis. In our chemical investigation of tannin, we isolated seven compounds. Now we will describe them as follows.展开更多
Narrow band imaging(NBI) is a new image enhancement system employing optic digital methods to enhance images of blood vessels on mucosal surfaces,allowing improved visualization of mucosal surface structures.Studies ... Narrow band imaging(NBI) is a new image enhancement system employing optic digital methods to enhance images of blood vessels on mucosal surfaces,allowing improved visualization of mucosal surface structures.Studies have progressed over the last several years,and the clinical usefulness has been demonstrated.NBI has become frequently applied for preoperative diagnosis before endoscopic submucosal dissection(ESD) of digestive tract cancers,as well as for assessment of the range of ESD for en-bloc resection of large lesions.Consensus has been reached with regard to the usefulness of NBI for detecting micro-lesions of esophageal squamous cell carcinoma indicated for ESD,for the diagnosis of the range and depth.NBI has also been attracting attention for diagnosing gastric cancer based on the observation of micro blood vessels on the mucosal surface and mucosal surface microstructures.The usefulness of NBI has been reported in relation to various aspects of colon cancer,including diagnoses of the presence,quality,range,and depth of lesions.However,as NBI has not surpassed diagnostic methods based on magnifying observation combined with the established and widely employed dye method,its role in ESD is limited at present.Although NBI is very useful for the diagnosis of digestive tract cancers,comprehensive endoscopic diagnosis employing the combination of conventional endoscopy including dye spraying,EUS,and NBI may be important and essential for ESD.展开更多
Purpose: To evaluate quantitatively, by means of ultrasound biomicroscopy (UBM), changes in the anterior segment con-figuration, including the ciliary processes, induced by cataract surgery in eyes with primary angle ...Purpose: To evaluate quantitatively, by means of ultrasound biomicroscopy (UBM), changes in the anterior segment con-figuration, including the ciliary processes, induced by cataract surgery in eyes with primary angle closure. Design: Retrospective interventional case series. Participants: Thirty-one eyes of 31 patients with primary angle closure or primary angle-closure glaucoma were treated with cataract surgery. Before cataract surgery, 10 eyes had been treated with laser peripheral iridotomy, and 1 with laser peripheral iridoplasty. Methods: Configuration of the anterior chamber was examined by means of UBM before and at 3 months after cataract surgery. Main Outcome Measures: Using UBM, anterior chamber depth (ACD), angle opening distance at points 500 μ m from the scleral spur (AOD500), and trabecular-ciliary process distance (TCPD) were measured. Results: Not only ACD and AOD500, but also TCPD, increased significantly after cataract surgery, compared with measurements obtained before surgery (P < 0.001). Postoperative AOD500 was correlated significantly with postoperative TCPD (r=0.72, P < 0.001) and with the amount of change of TCPD caused by cataract surgery (▲ TCPD)(r=0.52, P < 0.01). Conclusions: Cataract surgery attenuated anterior positioning of the ciliary processes in eyes with primary angle closure,concomitant with significant widening of the angle. Cataract surgery resulted in not only complete dissolution of lens volume and pupillary block, but also attenuation of the anterior positioning of the ciliary processes, all of which contributed to postoperative widening of the anglein eyes with primary angle closure.展开更多
AIM:To clarify the gender differences about the clini-cal features and risk factors of low-dose aspirin (LDA) (81-100 mg daily)-associated peptic ulcer in Japanese patients.METHODS: There were 453 patients under treat...AIM:To clarify the gender differences about the clini-cal features and risk factors of low-dose aspirin (LDA) (81-100 mg daily)-associated peptic ulcer in Japanese patients.METHODS: There were 453 patients under treatment with LDA (298 males, 155 females) who underwent esophagogastroduodenoscopy at the Department of Gastroenterology and Hepatology of Hiratsuka City Hospital between January 2003 and December 2007. They had kept taking the LDA or started treatmentduring the study period and kept taking LDA during the whole period of observation. Of these, 119 patients (87 males, 32 females) were diagnosed as having LDA-associated peptic ulcer. We examined the clinical factors associated with LDA-associated peptic ulcer in both sexes.RESULTS: A history of peptic ulcer was found to be the risk factor for LDA-associated peptic ulcer common to both sexes. In female patients, age greater than 70 years (prevalence ORs 8.441, 95% CI: 1.797-33.649, P = 0.0069) was found to be another significant risk fac-tor, and the time to diagnosis as having LDA-associat-ed peptic ulcer by endoscopy was significantly shorter than that in the male patients (P = 0.0050). CONCLUSION: We demonstrated gender differences about the clinical features and risk factors of LDA-asso-ciated peptic ulcer. Special attention should be paid to aged female patients taking LDA.展开更多
AIM: To reveal the frequency, characteristics and prognosis of chronic intestinal pseudo-obstruction (CIP) in mitochondrial disease patients. METHODS: Between January 2000 and December 2010, 31 patients (13 males and ...AIM: To reveal the frequency, characteristics and prognosis of chronic intestinal pseudo-obstruction (CIP) in mitochondrial disease patients. METHODS: Between January 2000 and December 2010, 31 patients (13 males and 18 females) were di-agnosed with mitochondrial diseases at our hospital. We conducted a retrospective review of the patients' sex, subclass of mitochondrial disease, age at onset of mitochondrial disease, frequency of CIP and the age at its onset, and the duration of survival. The age at onset or at the first diagnosis of the disorder that led to the clinical suspicion of mitochondrial disease was also examined. RESULTS: Twenty patients were sub-classified with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS), 8 with chronic progressive external ophthalmoplegia (CPEO), and 3 with myoclonus epilepsy associated with ragged-red fibers (MERRF). Nine patients were diagnosed with CIP, 8 of the 20 (40.0%) patients with MELAS, 0 of the 8 (0.0%) patients with CPEO, and 1 of the 3 (33.3%) patients with MERRF. The median age (range) at the diagnosis and the median age at onset of mitochondrial disease were 40 (17-69) and 25 (12-63) years in patients with CIP, and 49 (17-81) and 40 (11-71) years in patients without CIP. During the survey period, 5 patients (4 patients with MELAS and 1 with CPEO) died. The cause of death was cardiomyopathy in 2 patients with MELAS, cerebral infarction in 1 patient with MELAS, epilepsy and aspiration pneumonia in 1 patient with MELAS, and multiple metastases from gastric cancer and aspiration pneumonia in 1 patient with CPEO. CONCLUSION: Patients with CIP tend to have disorders that are suspected to be related to mitochondrial diseases at younger ages than are patients without CIP.展开更多
AIM: To evaluate the effect of a relaxing visual distraction alone on patient pain, anxiety, and satisfaction during colonoscopy.METHODS: This study was designed as an endoscopistblinded randomized controlled trial wi...AIM: To evaluate the effect of a relaxing visual distraction alone on patient pain, anxiety, and satisfaction during colonoscopy.METHODS: This study was designed as an endoscopistblinded randomized controlled trial with 60 consecutively enrolled patients who underwent elective colonoscopy at Yokohama City University Hospital, Japan. Patients were randomly assigned to two groups: group 1 watched a silent movie using a head-mounted display, while group 2 only wore the display. All of the colonoscopies were performed without sedation. We examined pain, anxiety, and the satisfaction of patients before and after the procedure using questionnaires that included the Visual Analog Scale. Patients were also asked whether they would be willing to use the same method for a repeat procedure.RESULTS: A total of 60 patients were allocated to two groups. Two patients assigned to group 1 and one patient assigned to group 2 were excluded after the randomization. Twenty-eight patients in group 1 and 29 patients in group 2 were entered into the final analysis. The groups were similar in terms of gender, age, history of prior colonoscopy, and pre-procedural anxiety score. The two groups were comparable in terms of the cecal insertion rate, the time to reach the cecum, the time needed for the total procedure, and vital signs. The median anxiety score during the colonoscopy didnot differ significantly between the two groups(median scores, 20 vs 24). The median pain score during the procedure was lower in group 1, but the difference was not significant(median scores, 24.5 vs 42). The patients in group 1 reported significantly higher median post-procedural satisfaction levels, compared with the patients in group 2(median scores, 89 vs 72, P = 0.04). Nearly three-quarters of the patients in group 1 wished to use the same method for repeat procedures, and the difference in rates between the two groups was statistically significant(75.0% vs 48.3%, P = 0.04). Patients with greater levels of anxiety before the procedure tended to feel a pain展开更多
A 39-year-old 34-week-pregnant woman was referred to our hospital for preterm labor and fetal dysfunction. Fetal middle cerebral artery systolic maximum blood flow velocity was high, so fetal anemia was suspected. Blo...A 39-year-old 34-week-pregnant woman was referred to our hospital for preterm labor and fetal dysfunction. Fetal middle cerebral artery systolic maximum blood flow velocity was high, so fetal anemia was suspected. Blood type was O-type Rh (+) and fetal hemoglobin was 0.4%;tests for irregular antibody and human parvovirus B19 IgM were negative. A high brightness echoic mass was observed in fetal stomach bubble, and amniotic fluid appeared bright. Labor suppression was disabled, and emergency cesarean section was performed. Amniotic fluid turbidity was observed, and on suctioning the stomach content of the infant, turbid amniotic fluid containing blood was obtained. On placental pathological examination, the cause of bloody amniotic fluid was not identified. The infant’s hemoglobin level was low at 8.7 g/dL, so the infant received red cell concentrate, with improvement of general condition.展开更多
Mix-cumulants of conserved charge distributions are sensitive observables for probing properties of the QCD medium and phase transition in heavy-ion collisions.To perform precise measurements,efficiency correction is ...Mix-cumulants of conserved charge distributions are sensitive observables for probing properties of the QCD medium and phase transition in heavy-ion collisions.To perform precise measurements,efficiency correction is one of the most important step.In this study,using the binomial efficiency model,we derive efficiency correction formulas for mutually exclusive and inclusive variables.The UrQMD model is applied to verify the validity of these formulas for different types of correlations.Furthermore,we investigate the effect of the multiplicity loss and contamination emerging from the particle identifications.This study provides important steps toward future measurements of mixed-cumulants in relativistic heavy-ion collisions.展开更多
The field of endoscopy has progressed markedly and become widespread in recent years, and the role of minimally invasive endoscopic treatment has become increasingly more important with the increase in the number of p...The field of endoscopy has progressed markedly and become widespread in recent years, and the role of minimally invasive endoscopic treatment has become increasingly more important with the increase in the number of patients in whom gastric cancer is detected at an early stage. In addition, the characteristics of early gastric cancer, which can be curably treated by mucosal resection alone just as by surgical cancer resection, were clarified, and endoscopic submucosal dissection (ESD) was developed as a highly curable, minimally invasive treatment, that is gaining popularity. In this paper, we describe the technical details and complications of ESD for early gastric cancer, including their management.展开更多
A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in 2001.The lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,w...A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in 2001.The lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,with an ulcer finding.Although the tumor was confined to the mucosa with no evidence of lymphovascular involvement,the ESD was regarded as a noncurative resection due to the histological type,tumor size,and existence of an ulcer finding(as indicated by the 2010 Japanese gastric cancer treatment guidelines,ver.3).Despite strong recommendation for subsequent gastrectomy,the patient refused surgery.An alternative follow-up routine was designed,which included five years of biannual clinical examinations to detect and measure serum tumor markers and perform visual assessment of recurrence by endoscopy and computed tomography scan after which the examinations were performed annually.The patient's condition remained stable for eight years,until a complaint of back pain in 2010 prompted further clinical investigation.Bone scintigraphy indicated increased uptake.Histological examination of biopsy specimens taken from the lumbar spine revealed adenocarcinoma resembling the carcinoma cells from the EGC that had been treated previously by ESD,and which was consistent with immunohistochemical findings of gastrointestinal tract cancer.Thus,the diagnosis of bone metastasis from EGC was made.The reported rates of EGC recurrence in surgically resected cases range 1.4%-3.4%,but among these bone metastasis is very rare.To our knowledge,this is the first reported case of bone metastasis from EGC following a non-curative ESD and occurring after an eight-year disease-free interval.展开更多
When heavy-duty commercial vehicles(HDCVs)must engage in emergency braking,uncertain conditions such as the brake pressure and road profile variations will inevitably affect braking control.To minimize these uncertain...When heavy-duty commercial vehicles(HDCVs)must engage in emergency braking,uncertain conditions such as the brake pressure and road profile variations will inevitably affect braking control.To minimize these uncertainties,we propose a combined longitudinal and lateral controller method based on stochastic model predictive control(SMPC)that is achieved via Chebyshev–Cantelli inequality.In our method,SMPC calculates braking control inputs based on a finite time prediction that is achieved by solving stochastic programming elements,including chance constraints.To accomplish this,SMPC explicitly describes the probabilistic uncertainties to be used when designing a robust control strategy.The main contribution of this paper is the proposal of a braking control formulation that is robust against probabilistic friction circle uncertainty effects.More specifically,the use of Chebyshev–Cantelli inequality suppresses road profile influences,which have characteristics that are different from the Gaussian distribution,thereby improving both braking robustness and control performance against statistical disturbances.Additionally,since the Kalman filtering(KF)algorithm is used to obtain the expectation and covariance used for calculating deterministic transformed chance constraints,the SMPC is reformulated as a KF embedded deterministic MPC.Herein,the effectiveness of our proposed method is verified via a MATLAB/Simulink and TruckSim co-simulation.展开更多
High transverse momentum(pT)particle production is suppressed owing to the parton(jet)energy loss in the hot dense medium created in relativistic heavy-ion collisions.Redistribution of energy at low-to-modest pT has b...High transverse momentum(pT)particle production is suppressed owing to the parton(jet)energy loss in the hot dense medium created in relativistic heavy-ion collisions.Redistribution of energy at low-to-modest pT has been difficult to measure,owing to large anisotropic backgrounds.We report a data-driven method for background evaluation and subtraction,exploiting the away-side pseudorapidity gaps,to measure the jetlike correlation shape in Au+Au collisions at √sNN=200 GeV in the STAR experiment.The correlation shapes,for trigger particles pT>3GeV/c and various associated particle pT ranges within 0.5<pT<10GeV/c,are consistent with Gaussians,and their widths increase with centrality.The results indicate jet broadening in the medium created in central heavy-ion collisions.展开更多
With tremendous research advances in biomedical application,liquid metals(LM)also offer fantastic chemistry for synthesis of novel nano-composites.Herein,as a pioneering trial,litchi-shaped heterogeneous eutectic gall...With tremendous research advances in biomedical application,liquid metals(LM)also offer fantastic chemistry for synthesis of novel nano-composites.Herein,as a pioneering trial,litchi-shaped heterogeneous eutectic gallium indium-Au nanoparticles(EGaIn-Au NPs),served as effective radiosensitizer and photothermal agent for radio-photothermal cancer therapy,have been successfully prepared using in situ interfacial galvanic replacement reaction.The enhanced photothermal conversion efficiency and boosted radio-sensitization effect could be achieved with the reduction of Au nanodots onto the eutectic gallium indium(EGaIn)NPs surface.Most importantly,the growth of tumor could be effectively inhibited under the combined radio-photothermal therapy mediated by EGaIn-Au NPs.Inspired by this approach,in situ interfacial galvanic replacement reaction may open a novel strategy to fabricate LM-based nano-composite with advanced multi-functionalities.展开更多
文摘AIM: To identify the actual clinical management and associated factors of delayed perforation after gastric endoscopic submucosal dissection(ESD).METHODS: A total of 4943 early gastric cancer(EGC) patients underwent ESD at our hospital between January 1999 and June 2012. We retrospectively assessed the actual management of delayed perforation. In addition, to determine the factors associated with delayed perforation, after excluding 123 EGC patients with perforations that occurred during the ESD procedure, we analyzed the following clinicopathological factors among the remaining 4820 EGC patients by comparing the ESD cases with delayed perforation and the ESD cases without perforation: age, sex, chronological periods, clinical indications for ESD, status of the stomach, location, gastric circumference, tumor size, invasion depth, presence/absence of ulceration, histological type, type of resection, and procedure time.RESULTS: Delayed perforation occurred in 7(0.1%) cases. The median time until the occurrence of delayed perforation was 11 h(range, 6-172 h). Three(43%) of the 7 cases required emergency surgery, while four were conservatively managed without surgical intervention. Among the 4 cases with conservative management, 2 were successfully managed endoscopically using the endoloop-endoclip technique. The median hospital stay was 18 d(range, 15-45 d). There were no delayed perforation-related deaths. Based on a multivariate analysis, gastric tube cases(OR = 11.0; 95%CI: 1.7-73.3; P = 0.013) were significantly associated with delayed perforation.CONCLUSION: Endoscopists must be aware of not only the identified factors associated with delayed perforation, but also how to treat this complicationeffectively and promptly.
文摘Endoscopic ultrasound (EUS) devices were first designed and manufactured more than 30 years ago, and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers. We review the present status, the methods, and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer. EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma. The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer, and 83%-94% for submucosal invasive cancer. But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low, making it difficult to confirm minute submucosal invasion. The accuracy of EUS using high-frequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS, although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions, undifferentiated cancer, concomitant ulceration, expanded indications, type 0-I?lesions, and lesions located in the upper-third of the stomach. A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification. Although EUS using high-frequency ultrasound probes has limitations, it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection.
文摘AIM: To evaluate the efficacy of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. METHODS: Between July 2007 and March 2009, 27 consecutive superficial esophageal squamous cell neoplasms in 25 enrolled patients were treated by endoscopic submucosal dissection. The therapeutic efficacy, complications, and follow-up results were assessed. RESULTS: The mean size of the lesions was 21 ± 13 mm (range 2-55 mm); the mean size of the resection specimens was 32 ± 12 mm (range 10-70 mm). The enblock resection rate was 100% (27/27), and en block resection with tumor-free lateral/basal margins was 88.9% (24/27). Perforation occurred in 1 patient who was managed by conservative medical treatments. None of the patients developed local recurrence or distant metastasis in the follow-up period. CONCLUSION: Endoscopic submucosal dissection is applicable to superficial esophageal squamous cell neoplasms with promising results.
文摘 Recently, we reported a case of gastric mucosaassociated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost. The 67-year-old female was diagnosed with gastric MALT lymphoma. The patient received eradication therapy for H. pylori. Conventional endoscopy revealed multiple ill-delineated brownish depressions in the stomach and cobblestonelike mucosa was observed at the greater curvature to the posterior wall of the upper gastric body 7 mo after successful eradication. Unsuccessful treatment of gastric MALT lymphoma was suspected on conventional endoscopy. Conventional endoscopic observations found focal depressions and cobblestone-like appearance, and these lesions were subsequently observed using magnified endoscopy combined with narrow band imaging to identify abnormal vessels presenting with a TLA within the lesions. Ten biopsies were taken from the area where abnormal vessels were present within these lesions. Ten biopsies were also taken from the lesions without abnormal vessels as a control. A total of 20 biopsy samples were evaluated to determine whether the diagnosis of MALT lymphoma could be obtained histologically from each sample. A positive diagnosis was obtained in 8/10 TLA (+) sites and in 2/10 TLA(-) sites. Target biopsies of the site with abnormal blood vessels can potentially improve diagnostic accuracy of gastric MALT lymphoma.
文摘Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively.We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure.In December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection.Intensive conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.
文摘In 2018,the STAR collaboration collected data from^(96)_(44)Ru+^(96)_(44)Ru and^(96)_(40)Zr+^(96)_(40)Zr at√^(S)NN=200 Ge V to search for the presence of the chiral magnetic effect in collisions of nuclei.The isobar collision species alternated frequently between 9644 Ru+^(96)_(44)Ru and^(96)_(40)Zr+^(96)_(40)Zr.In order to conduct blind analyses of studies related to the chiral magnetic effect in these isobar data,STAR developed a three-step blind analysis procedure.Analysts are initially provided a"reference sample"of data,comprised of a mix of events from the two species,the order of which respects time-dependent changes in run conditions.After tuning analysis codes and performing time-dependent quality assurance on the reference sample,analysts are provided a species-blind sample suitable for calculating efficiencies and corrections for individual≈30-min data-taking runs.For this sample,species-specific information is disguised,but individual output files contain data from a single isobar species.Only run-by-run corrections and code alteration subsequent to these corrections are allowed at this stage.Following these modifications,the"frozen"code is passed over the fully un-blind data,completing the blind analysis.As a check of the feasibility of the blind analysis procedure,analysts completed a"mock data challenge,"analyzing data from Au+Au collisions at√^(S)NN=27 Ge V,collected in 2018.The Au+Au data were prepared in the same manner intended for the isobar blind data.The details of the blind analysis procedure and results from the mock data challenge are presented.
文摘AIM: To investigate whether magnifying endoscopy with narrow band imaging (ME-NBI) is useful for evaluating the area of superficial, depressed- or flat-type differentiated adenocarcinoma of the stomach. METHODS: This procedure was performed in Saitama Medical University International Medical Center, Japanese Red Cross Kumamoto Hospital and Kitakyushu Municipal Medical Center. The subjects were 31 patients in whom biopsy findings, from superficial, depressed- or flat-type gastric lesion, suggested differentiated adenocarcinoma in the above 3 hospitals between January and December 2009. Biopsy was performed on the lesion and non-lesion sides of a boundary (imaginary boundary) visualized on ME-NBI. The results were pathologically investigated. We evaluated the accuracy of estimating a demarcation line (DL) on ME-NBI in comparison with biopsy findings as a gold standard. RESULTS: The DL that could be recognized at 2 points on the orifice and anal sides of each lesion during ME-NBI was consistent with the pathological findings in 22 patients with 0-IIc lesions, 7 with 0-IIb lesions, and 2 with 0-IIb + IIc lesions, showing an accuracy of 100%. CONCLUSION: The results suggest the usefulness of ME-NBI for evaluating the area of superficial, depressed- and flat-type differentiated adenocarcinoma of the stomach.
文摘Potentilla viscosa J. Don is widely distributed over the districts of Baicheng and Yanbian in Jilin Province. The root of P. viscosa can be used for the treatment of hepatitis. In our chemical investigation of tannin, we isolated seven compounds. Now we will describe them as follows.
文摘 Narrow band imaging(NBI) is a new image enhancement system employing optic digital methods to enhance images of blood vessels on mucosal surfaces,allowing improved visualization of mucosal surface structures.Studies have progressed over the last several years,and the clinical usefulness has been demonstrated.NBI has become frequently applied for preoperative diagnosis before endoscopic submucosal dissection(ESD) of digestive tract cancers,as well as for assessment of the range of ESD for en-bloc resection of large lesions.Consensus has been reached with regard to the usefulness of NBI for detecting micro-lesions of esophageal squamous cell carcinoma indicated for ESD,for the diagnosis of the range and depth.NBI has also been attracting attention for diagnosing gastric cancer based on the observation of micro blood vessels on the mucosal surface and mucosal surface microstructures.The usefulness of NBI has been reported in relation to various aspects of colon cancer,including diagnoses of the presence,quality,range,and depth of lesions.However,as NBI has not surpassed diagnostic methods based on magnifying observation combined with the established and widely employed dye method,its role in ESD is limited at present.Although NBI is very useful for the diagnosis of digestive tract cancers,comprehensive endoscopic diagnosis employing the combination of conventional endoscopy including dye spraying,EUS,and NBI may be important and essential for ESD.
文摘Purpose: To evaluate quantitatively, by means of ultrasound biomicroscopy (UBM), changes in the anterior segment con-figuration, including the ciliary processes, induced by cataract surgery in eyes with primary angle closure. Design: Retrospective interventional case series. Participants: Thirty-one eyes of 31 patients with primary angle closure or primary angle-closure glaucoma were treated with cataract surgery. Before cataract surgery, 10 eyes had been treated with laser peripheral iridotomy, and 1 with laser peripheral iridoplasty. Methods: Configuration of the anterior chamber was examined by means of UBM before and at 3 months after cataract surgery. Main Outcome Measures: Using UBM, anterior chamber depth (ACD), angle opening distance at points 500 μ m from the scleral spur (AOD500), and trabecular-ciliary process distance (TCPD) were measured. Results: Not only ACD and AOD500, but also TCPD, increased significantly after cataract surgery, compared with measurements obtained before surgery (P < 0.001). Postoperative AOD500 was correlated significantly with postoperative TCPD (r=0.72, P < 0.001) and with the amount of change of TCPD caused by cataract surgery (▲ TCPD)(r=0.52, P < 0.01). Conclusions: Cataract surgery attenuated anterior positioning of the ciliary processes in eyes with primary angle closure,concomitant with significant widening of the angle. Cataract surgery resulted in not only complete dissolution of lens volume and pupillary block, but also attenuation of the anterior positioning of the ciliary processes, all of which contributed to postoperative widening of the anglein eyes with primary angle closure.
文摘AIM:To clarify the gender differences about the clini-cal features and risk factors of low-dose aspirin (LDA) (81-100 mg daily)-associated peptic ulcer in Japanese patients.METHODS: There were 453 patients under treatment with LDA (298 males, 155 females) who underwent esophagogastroduodenoscopy at the Department of Gastroenterology and Hepatology of Hiratsuka City Hospital between January 2003 and December 2007. They had kept taking the LDA or started treatmentduring the study period and kept taking LDA during the whole period of observation. Of these, 119 patients (87 males, 32 females) were diagnosed as having LDA-associated peptic ulcer. We examined the clinical factors associated with LDA-associated peptic ulcer in both sexes.RESULTS: A history of peptic ulcer was found to be the risk factor for LDA-associated peptic ulcer common to both sexes. In female patients, age greater than 70 years (prevalence ORs 8.441, 95% CI: 1.797-33.649, P = 0.0069) was found to be another significant risk fac-tor, and the time to diagnosis as having LDA-associat-ed peptic ulcer by endoscopy was significantly shorter than that in the male patients (P = 0.0050). CONCLUSION: We demonstrated gender differences about the clinical features and risk factors of LDA-asso-ciated peptic ulcer. Special attention should be paid to aged female patients taking LDA.
基金Health and Labour Sciences Research Grants for Research on Intractable Diseases, awarded to Nakajima A, from the Ministry of Health, Labour and Welfare of Japan
文摘AIM: To reveal the frequency, characteristics and prognosis of chronic intestinal pseudo-obstruction (CIP) in mitochondrial disease patients. METHODS: Between January 2000 and December 2010, 31 patients (13 males and 18 females) were di-agnosed with mitochondrial diseases at our hospital. We conducted a retrospective review of the patients' sex, subclass of mitochondrial disease, age at onset of mitochondrial disease, frequency of CIP and the age at its onset, and the duration of survival. The age at onset or at the first diagnosis of the disorder that led to the clinical suspicion of mitochondrial disease was also examined. RESULTS: Twenty patients were sub-classified with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS), 8 with chronic progressive external ophthalmoplegia (CPEO), and 3 with myoclonus epilepsy associated with ragged-red fibers (MERRF). Nine patients were diagnosed with CIP, 8 of the 20 (40.0%) patients with MELAS, 0 of the 8 (0.0%) patients with CPEO, and 1 of the 3 (33.3%) patients with MERRF. The median age (range) at the diagnosis and the median age at onset of mitochondrial disease were 40 (17-69) and 25 (12-63) years in patients with CIP, and 49 (17-81) and 40 (11-71) years in patients without CIP. During the survey period, 5 patients (4 patients with MELAS and 1 with CPEO) died. The cause of death was cardiomyopathy in 2 patients with MELAS, cerebral infarction in 1 patient with MELAS, epilepsy and aspiration pneumonia in 1 patient with MELAS, and multiple metastases from gastric cancer and aspiration pneumonia in 1 patient with CPEO. CONCLUSION: Patients with CIP tend to have disorders that are suspected to be related to mitochondrial diseases at younger ages than are patients without CIP.
文摘AIM: To evaluate the effect of a relaxing visual distraction alone on patient pain, anxiety, and satisfaction during colonoscopy.METHODS: This study was designed as an endoscopistblinded randomized controlled trial with 60 consecutively enrolled patients who underwent elective colonoscopy at Yokohama City University Hospital, Japan. Patients were randomly assigned to two groups: group 1 watched a silent movie using a head-mounted display, while group 2 only wore the display. All of the colonoscopies were performed without sedation. We examined pain, anxiety, and the satisfaction of patients before and after the procedure using questionnaires that included the Visual Analog Scale. Patients were also asked whether they would be willing to use the same method for a repeat procedure.RESULTS: A total of 60 patients were allocated to two groups. Two patients assigned to group 1 and one patient assigned to group 2 were excluded after the randomization. Twenty-eight patients in group 1 and 29 patients in group 2 were entered into the final analysis. The groups were similar in terms of gender, age, history of prior colonoscopy, and pre-procedural anxiety score. The two groups were comparable in terms of the cecal insertion rate, the time to reach the cecum, the time needed for the total procedure, and vital signs. The median anxiety score during the colonoscopy didnot differ significantly between the two groups(median scores, 20 vs 24). The median pain score during the procedure was lower in group 1, but the difference was not significant(median scores, 24.5 vs 42). The patients in group 1 reported significantly higher median post-procedural satisfaction levels, compared with the patients in group 2(median scores, 89 vs 72, P = 0.04). Nearly three-quarters of the patients in group 1 wished to use the same method for repeat procedures, and the difference in rates between the two groups was statistically significant(75.0% vs 48.3%, P = 0.04). Patients with greater levels of anxiety before the procedure tended to feel a pain
文摘A 39-year-old 34-week-pregnant woman was referred to our hospital for preterm labor and fetal dysfunction. Fetal middle cerebral artery systolic maximum blood flow velocity was high, so fetal anemia was suspected. Blood type was O-type Rh (+) and fetal hemoglobin was 0.4%;tests for irregular antibody and human parvovirus B19 IgM were negative. A high brightness echoic mass was observed in fetal stomach bubble, and amniotic fluid appeared bright. Labor suppression was disabled, and emergency cesarean section was performed. Amniotic fluid turbidity was observed, and on suctioning the stomach content of the infant, turbid amniotic fluid containing blood was obtained. On placental pathological examination, the cause of bloody amniotic fluid was not identified. The infant’s hemoglobin level was low at 8.7 g/dL, so the infant received red cell concentrate, with improvement of general condition.
基金Supported by the National Key Research and Development Program of China(2020YFE0202002,2018YFE0205201)the National Natural Science Foundation of China(12122505,11890711,11861131009)Ito Science Foundation and JSPS KAKENHI(25105504,19H05598)。
文摘Mix-cumulants of conserved charge distributions are sensitive observables for probing properties of the QCD medium and phase transition in heavy-ion collisions.To perform precise measurements,efficiency correction is one of the most important step.In this study,using the binomial efficiency model,we derive efficiency correction formulas for mutually exclusive and inclusive variables.The UrQMD model is applied to verify the validity of these formulas for different types of correlations.Furthermore,we investigate the effect of the multiplicity loss and contamination emerging from the particle identifications.This study provides important steps toward future measurements of mixed-cumulants in relativistic heavy-ion collisions.
文摘The field of endoscopy has progressed markedly and become widespread in recent years, and the role of minimally invasive endoscopic treatment has become increasingly more important with the increase in the number of patients in whom gastric cancer is detected at an early stage. In addition, the characteristics of early gastric cancer, which can be curably treated by mucosal resection alone just as by surgical cancer resection, were clarified, and endoscopic submucosal dissection (ESD) was developed as a highly curable, minimally invasive treatment, that is gaining popularity. In this paper, we describe the technical details and complications of ESD for early gastric cancer, including their management.
文摘A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in 2001.The lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,with an ulcer finding.Although the tumor was confined to the mucosa with no evidence of lymphovascular involvement,the ESD was regarded as a noncurative resection due to the histological type,tumor size,and existence of an ulcer finding(as indicated by the 2010 Japanese gastric cancer treatment guidelines,ver.3).Despite strong recommendation for subsequent gastrectomy,the patient refused surgery.An alternative follow-up routine was designed,which included five years of biannual clinical examinations to detect and measure serum tumor markers and perform visual assessment of recurrence by endoscopy and computed tomography scan after which the examinations were performed annually.The patient's condition remained stable for eight years,until a complaint of back pain in 2010 prompted further clinical investigation.Bone scintigraphy indicated increased uptake.Histological examination of biopsy specimens taken from the lumbar spine revealed adenocarcinoma resembling the carcinoma cells from the EGC that had been treated previously by ESD,and which was consistent with immunohistochemical findings of gastrointestinal tract cancer.Thus,the diagnosis of bone metastasis from EGC was made.The reported rates of EGC recurrence in surgically resected cases range 1.4%-3.4%,but among these bone metastasis is very rare.To our knowledge,this is the first reported case of bone metastasis from EGC following a non-curative ESD and occurring after an eight-year disease-free interval.
文摘When heavy-duty commercial vehicles(HDCVs)must engage in emergency braking,uncertain conditions such as the brake pressure and road profile variations will inevitably affect braking control.To minimize these uncertainties,we propose a combined longitudinal and lateral controller method based on stochastic model predictive control(SMPC)that is achieved via Chebyshev–Cantelli inequality.In our method,SMPC calculates braking control inputs based on a finite time prediction that is achieved by solving stochastic programming elements,including chance constraints.To accomplish this,SMPC explicitly describes the probabilistic uncertainties to be used when designing a robust control strategy.The main contribution of this paper is the proposal of a braking control formulation that is robust against probabilistic friction circle uncertainty effects.More specifically,the use of Chebyshev–Cantelli inequality suppresses road profile influences,which have characteristics that are different from the Gaussian distribution,thereby improving both braking robustness and control performance against statistical disturbances.Additionally,since the Kalman filtering(KF)algorithm is used to obtain the expectation and covariance used for calculating deterministic transformed chance constraints,the SMPC is reformulated as a KF embedded deterministic MPC.Herein,the effectiveness of our proposed method is verified via a MATLAB/Simulink and TruckSim co-simulation.
文摘High transverse momentum(pT)particle production is suppressed owing to the parton(jet)energy loss in the hot dense medium created in relativistic heavy-ion collisions.Redistribution of energy at low-to-modest pT has been difficult to measure,owing to large anisotropic backgrounds.We report a data-driven method for background evaluation and subtraction,exploiting the away-side pseudorapidity gaps,to measure the jetlike correlation shape in Au+Au collisions at √sNN=200 GeV in the STAR experiment.The correlation shapes,for trigger particles pT>3GeV/c and various associated particle pT ranges within 0.5<pT<10GeV/c,are consistent with Gaussians,and their widths increase with centrality.The results indicate jet broadening in the medium created in central heavy-ion collisions.
基金supported by grants of the National Natural Science Foundation of China(Nos.5197116,81671829).
文摘With tremendous research advances in biomedical application,liquid metals(LM)also offer fantastic chemistry for synthesis of novel nano-composites.Herein,as a pioneering trial,litchi-shaped heterogeneous eutectic gallium indium-Au nanoparticles(EGaIn-Au NPs),served as effective radiosensitizer and photothermal agent for radio-photothermal cancer therapy,have been successfully prepared using in situ interfacial galvanic replacement reaction.The enhanced photothermal conversion efficiency and boosted radio-sensitization effect could be achieved with the reduction of Au nanodots onto the eutectic gallium indium(EGaIn)NPs surface.Most importantly,the growth of tumor could be effectively inhibited under the combined radio-photothermal therapy mediated by EGaIn-Au NPs.Inspired by this approach,in situ interfacial galvanic replacement reaction may open a novel strategy to fabricate LM-based nano-composite with advanced multi-functionalities.
