BACKGROUND Superficial esophageal squamous cell carcinoma(ESCC)is defined as cancer infiltrating the mucosa and submucosa,regardless of regional lymph node metastasis(LNM).Endoscopic resection of superficial ESCC is s...BACKGROUND Superficial esophageal squamous cell carcinoma(ESCC)is defined as cancer infiltrating the mucosa and submucosa,regardless of regional lymph node metastasis(LNM).Endoscopic resection of superficial ESCC is suitable for lesions that have no or low risk of LNM.Patients with a high risk of LNM always need further treatment after endoscopic resection.Therefore,accurately assessing the risk of LNM is critical for additional treatment options.AIM To analyze risk factors for LNM and develop a nomogram to predict LNM risk in superficial ESCC patients.METHODS Clinical and pathological data of superficial ESCC patients undergoing esophagectomy from January 1,2009 to January 31,2016 were collected.Logistic regression analysis was used to predict LNM risk factors,and a nomogram was developed based on risk factors derived from multivariate logistic regression analysis.The receiver operating characteristic(ROC)curve was used to obtain the accuracy of the nomogram model.RESULTSA total of 4660 patients with esophageal cancer underwent esophagectomy.Of these,474 superficial ESCC patientswere enrolled in the final analysis,with 322 patients in the training set and 142 patients in the validation set.Theprevalence of LNM was 3.29%(5/152)for intramucosal cancer and increased to 26.40%(85/322)for submucosalcancer.Multivariate logistic analysis showed that tumor size,invasive depth,tumor differentiation,infiltrativegrowth pattern,tumor budding,and lymphovascular invasion were significantly correlated with LNM.Anomogram using these six variables showed good discrimination with an area under the ROC curve of 0.789(95%CI:0.737-0.841)in the training set and 0.827(95%CI:0.755-0.899)in the validation set.CONCLUSIONWe developed a useful nomogram model to predict LNM risk for superficial ESCC patients which will facilitateadditional decision-making in treating patients who undergo endoscopic resection.展开更多
Automatic segmentation of early esophagus cancer(EEC)in gastrointestinal endoscopy(GIE)images is a critical and challenging task in clinical settings,which relies primarily on labor-intensive and time-consuming routin...Automatic segmentation of early esophagus cancer(EEC)in gastrointestinal endoscopy(GIE)images is a critical and challenging task in clinical settings,which relies primarily on labor-intensive and time-consuming routines.EEC has often been diagnosed at the late stage since early signs of cancer are not obvious,resulting in low survival rates.This work proposes a deep learning approach based on the U-Net++method to segment EEC in GIE images.A total of 2690 GIE images collected from 617 patients at the Digestive Endoscopy Center,West China Hospital of Sichuan University,China,have been utilized.The experimental result shows that our proposed method achieved promising results.Furthermore,the comparison has been made between the proposed and other U-Net-related methods using the same dataset.The mean and standard deviation(SD)of the dice similarity coefficient(DSC),intersection over union(IoU),precision(Pre),and recall(Rec)achieved by the proposed framework were DSC(%)=94.62±0.02,IoU(%)=90.99±0.04,Pre(%)=94.61±0.04,and Rec(%)=95.00±0.02,respectively,outperforming the others.The proposed method has the potential to be applied in EEC automatic diagnoses.展开更多
AIM To evaluate the clinical outcomes of patients who underwent endoscopic submucosal tunnel dissection(ESTD) for esophageal squamous cell carcinoma(ESCC) and precancerous lesions.METHODS ESTD was performed in 289 pat...AIM To evaluate the clinical outcomes of patients who underwent endoscopic submucosal tunnel dissection(ESTD) for esophageal squamous cell carcinoma(ESCC) and precancerous lesions.METHODS ESTD was performed in 289 patients. The clinical outcomes of the patients and pathological features of the lesions were retrospectively reviewed.RESULTS A total of 311 lesions were included in the analysis. The en bloc rate, complete resection rate, and curative resection rate were 99.04%, 81.28%, and 78.46%, respectively. The ESTD procedure time was 102.4 ± 35.1 min, the mean hospitalization time was 10.3 ± 2.8 d, and the average expenditure was 3766.5 ± 846.5 dollars. The intraoperative bleeding rate was 6.43%, the postoperative bleeding rate was 1.61%, the perforation rate was 1.93%, and the postoperative infection rate was 9.65%. Esophageal stricture and positive margin were severe adverse events, with an incidence rate of 14.79% and 15.76%, respectively. No tumor recurrence occurred during the follow-up period. CONCLUSION ESTD for ESCC and precancerous lesions is feasible and relatively safe, but for large mucosal lesions, the rate of esophageal stricture and positive margin is high.展开更多
BACKGROUND Adverse events during endoscopic submucosal dissection(ESD)of superficial esophageal neoplasms,such as perforation and bleeding,have been welldocumented.However,the Mallory-Weiss Tear(MWT)during esophageal ...BACKGROUND Adverse events during endoscopic submucosal dissection(ESD)of superficial esophageal neoplasms,such as perforation and bleeding,have been welldocumented.However,the Mallory-Weiss Tear(MWT)during esophageal ESD remains under investigation.AIM To investigate the incidence and risk factors of the MWT during esophageal ESD.METHODS From June 2014 to July 2017,patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed.The clinicopathological characteristics of the patients were collected.Patients were divided into an MWT group and non-MWT group based on whether MWT occurred during ESD.The incidence of MWTs was determined,and the risk factors for MWT were then further explored.RESULTS A total of 337 patients with 373 lesions treated by ESD were analyzed.Twenty patients developed MWTs during ESD(5.4%).Multivariate analysis identified that female sex(OR=5.36,95%CI:1.47-19.50,P=0.011)and procedure time longer than 88.5 min(OR=3.953,95%CI:1.497-10.417,P=0.005)were independent risk factors for an MWT during ESD.The cutoff value of the procedure time for an MWT was 88.5 min(sensitivity,65.0%;specificity,70.8%).Seven of the MWT patients received endoscopic hemostasis.All patients recovered satisfactorily without surgery for the laceration.CONCLUSION The incidence of MWTs during esophageal ESD was much higher than expected.Although most cases have a benign course,fatal conditions may occur.We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region.展开更多
AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.METHODS: In this cross-sectional study, 517 difficult colonoscope insertions(Grade C, Kudo's difficulty classif...AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.METHODS: In this cross-sectional study, 517 difficult colonoscope insertions(Grade C, Kudo's difficulty classification) screened from 37800 colonoscopy insertions were collected from April 2004 to June 2014 by three 4th-level(Kudo's classification) colonoscopists. The following common factors for the incomplete insertion were excluded: structural obstruction of the colon or rectum, insufficient colon cleansing, discontinuation due to patient's discomfort or pain, severe colon disease with a perforation risk(e.g., severe ischemic colonopathy). All the excluded patients were re-scheduled if permission was obtained from the patients whose intubation had failed. If the repeat intubations were still a failure because of the difficult operative techniques, those patients were also included in this study. The patient's age, sex, anesthesia and colonoscope type were recorded before colonoscopy. During the colonoscopic examination, the influencing factors of fixation, tortuosity, laxity and redundancy of the colon were assessed, and the insertion time(> 10 min or ≤ 10 min) were registered. The insertion time was analyzed by t-test, and other factors were analyzed by univariate and multivariate logistic regression.RESULTS: Three hundred and twenty-two(62.3%) of the 517 insertions were complete in the colonoscope insertion into the ileocecum, but 195(37.7%) failed in the insertion. Fixation, tortuosity, laxity or redundancy occurred during the colonoscopic examination. Multivariate logistic regression analysis revealed that fixation(OR = 0.06, 95%CI: 0.03-0.16, P < 0.001) and tortuosity(OR = 0.04, 95%CI: 0.02-0.08, P < 0.001) were significantly related to the insertion into the ileocecum in the left hemicolon; multivariate logistic regression analysis also revealed that fixation(OR = 0.16, 95%CI: 0.06-0.39, P < 0.001), tortuosity(OR0.23, 95%CI: 0.13-0.43, P < 0.001), redundancy(OR = 0.12, 95%CI: 0.05-0.26, P < 0.001) and sex(OR = 0.35, 95%CI: 0.20-0.63, P < 0.001) were significantly related to the insertion into the ileocecum in the right hemicolon. Prolonged insertion time(> 10 min) was an unfavorable factor for the insertion into the ileocecum.CONCLUSION: Colonoscopy should be discontinued if freedom of the colonoscope body's insertion and rotation is completely lost, and the insertion time is prolonged over 30 min.展开更多
An efficient and low-cost supported Pt catalyst for hydrogenation of niroarenes was prepared with colloid Pt precursors andα-Fe2O3 as a support.The catalyst with Pt content as low as 0.2 wt%exhibits high activities,c...An efficient and low-cost supported Pt catalyst for hydrogenation of niroarenes was prepared with colloid Pt precursors andα-Fe2O3 as a support.The catalyst with Pt content as low as 0.2 wt%exhibits high activities,chemoselectivities and stability in the hydrogenation of nitrobenzene and a variety of niroarenes.The conversion of nitrobenzene can reach 3170 molconv h^–1 molPt^–1 under mild conditions(30°C,5 bar),which is much higher than that of commercial Pt/C catalyst and many reported catalysts under similar reaction conditions.The spatial separation of the active sites for H2 dissociation and hydrogenation should be responsible for the high chemoselectivity,which decreases the contact possibility between the reducible groups of nitroarenes and Pt nanoparticles.The unique surface properties ofα-Fe2O3 play an important role in the reaction process.It provides active sites for hydrogen spillover and reactant adsorption,and ultimately completes the hydrogenation of the nitro group on the catalyst surface.展开更多
BACKGROUND Although early esophageal squamous cell carcinoma(EESCC)with cirrhosis is a relatively rare clinical phenomenon,the management of EESCC in cirrhotic patients continues to be a challenge.AIM To evaluate the ...BACKGROUND Although early esophageal squamous cell carcinoma(EESCC)with cirrhosis is a relatively rare clinical phenomenon,the management of EESCC in cirrhotic patients continues to be a challenge.AIM To evaluate the feasibility,safety,efficacy and long-term survival outcomes of endoscopic submucosal tunnel dissection(ESTD)for treating EESCC in patients with cirrhosis.METHODS This was a single-center retrospective cohort study.We examined 590 EESCC patients who underwent ESTD between July 14,2014,and May 26,2021,from a large-scale tertiary hospital.After excluding 25 patients with unclear lesion areas or pathological results,the remaining 565 patients were matched at a ratio of 1:3 by using propensity score matching.A total of 25 EESCC patients with comorbid liver cirrhosis and 75 matched EESCC patients were ultimately included in the analysis.Parametric and nonparametric statistical methods were used to compare the differences between the two groups.The Kaplan–Meier method was used to create survival curves,and differences in survival curves were compared by the log-rank test.RESULTS Among 25 patients with liver cirrhosis and 75 matched noncirrhotic patients,there were no significant differences in intraoperative bleeding(P=0.234),30-d post-ESTD bleeding(P=0.099),disease-specific survival(P=0.075),or recurrence-free survival(P=0.8196).The mean hospitalization time and costs were significantly longer(P=0.007)and higher(P=0.023)in the cirrhosis group than in the noncirrhosis group.The overall survival rate was significantly lower in the cirrhosis group(P=0.001).CONCLUSION ESTD is technically feasible,safe,and effective for patients with EESCC and liver cirrhosis.EESCC patients with Child-Pugh A disease seem to be good candidates for ESTD.展开更多
目的:对2000年至2020年Web of Science收录的成人体外膜氧合(ECMO)相关研究文献进行可视化分析,以解析和追踪成人ECMO技术领域相关热点和前沿。方法:检索2000至2020年在Web of Science核心合集数据库收录的成人ECMO相关研究文献,运用Cit...目的:对2000年至2020年Web of Science收录的成人体外膜氧合(ECMO)相关研究文献进行可视化分析,以解析和追踪成人ECMO技术领域相关热点和前沿。方法:检索2000至2020年在Web of Science核心合集数据库收录的成人ECMO相关研究文献,运用CiteSpace可视化工具,从高影响力国家/地区、机构、作者、高频关键词及突变术语等方面解析成人ECMO技术研究的热点与前沿。结果:最终纳入2058篇以成人ECMO为主题的文献,相关文献年发表量呈现增长趋势,美国发文量位居首位。该领域研究多热点集中在COVID-19、抗凝作用、临床试验。同时,院内心脏骤停、指南、急性呼吸衰竭是成人ECMO研究的前沿领域,代表未来研究发展趋势。结论:临床试验、体外心肺复苏、急性呼吸衰竭、冠状病毒感染方面的研究是成人ECMO技术研究的前沿和热点。展开更多
针对家庭总线系统(home bus system,HBS)通讯回路采用黑盒测试其可靠性存在测评工作量大的问题,本文主要对HBS通讯回路硬件电路进行仿真分析。通过对HBS通讯回路的技术研究,利用专业的仿真软件Stspice,建立HBS通讯回路3个核心仿真模型,...针对家庭总线系统(home bus system,HBS)通讯回路采用黑盒测试其可靠性存在测评工作量大的问题,本文主要对HBS通讯回路硬件电路进行仿真分析。通过对HBS通讯回路的技术研究,利用专业的仿真软件Stspice,建立HBS通讯回路3个核心仿真模型,提出一种新的白盒测试方式。测试结果表明,采用白盒测试方法,将HBS通讯回路的评测工作量缩减50%,其测试方法远优于现有的黑盒测试方式,而且该方法能够有效定位硬件电路的故障区域,解决了HBS通讯回路在不同商用空调基板上应用的适应性问题。该研究对多联机中央空调HBS回路的可靠性评价具有一定的指导意义。展开更多
AIM: To investigate and evaluate the feasibility of the computer-aided screening diagnosis for enteric lesions in the capsule endoscopy (CE).METHODS: After developing a series of algorithms for the screening diagnosis...AIM: To investigate and evaluate the feasibility of the computer-aided screening diagnosis for enteric lesions in the capsule endoscopy (CE).METHODS: After developing a series of algorithms for the screening diagnosis of the enteric lesions in CE based on their characteristic colors and contours, the normal and abnormal images obtained from 289 patients were respectively scanned and diagnosed by the CE readers and by the computer-aided screening for the enteric lesions with the image-processed software (IPS). The enteric lesions shown by the images included esoenteritis, mucosal ulcer and erosion, bleeding, space-occupying lesions, angioectasia, diverticula, parasites, etc. The images for the lesions or the suspected lesions confirmed by the CE readers and the computers were collected, and the effectiveness rate of the screening and the number of the scanned images were evaluated, respectively.RESULTS: Compared with the diagnostic results obtained by the CE readers, the total effectiveness rate (sensitivity) in the screening of the commonly-encountered enteric lesions by IPS varied from 42.9% to 91.2%, with a median of 74.2%, though the specificity and the accuracy rates were still low, and theimages for the rarely-encountered lesions were difficult to differentiate from the normal images. However, the number of the images screened by IPS was 5000 on average, and only 10%-15% of the original images were left behind. As a result, a large number of normal images were excluded, and the reading time decreased from 5 h to 1 h on average.CONCLUSION: Though the total accuracy and specificity rates by the computer-aided screening for the enteric lesions with IPS are much lower than those by the CE readers, the computer-aided screening diagnosis can exclude a large number of the normal images and confine the enteric lesions to 5000 images on average, which can reduce the workload of the readers in the scanning of the images. This computer-aided screening technique can make a correct diagnosis as efficiently as possible in most of the patients.展开更多
Catalysts can accelerate the chemical reaction rate and effectively promote the molecules transformation,which is of great significance in the research of chemical industry and material science.The extreme utilization...Catalysts can accelerate the chemical reaction rate and effectively promote the molecules transformation,which is of great significance in the research of chemical industry and material science.The extreme utilization of reactive sites has led to the emergence and development of atomically dispersed materials(ADMs).The highly active coordination unsaturated metal sites and fully utilized metal atoms make ADMs show great potential in catalytic reactions.The adjustment of coordination environment and electronic structure provides more possibilities for constructing reactive centers with different properties.This review summarized the application and research progress of ADMs in different fields.The design strategy and structure–activity relationship of ADMs for specific reactions were summarized and analyzed.Moreover,we also provided advices for the challenges and opportunities faced by ADMs in catalytic reactions.展开更多
Spontaneously polarized crystals with intrinsic electric dipole moment have attracted immense interest as excellent functional materials for extensive applications.It is of great significance to engineer sustainable s...Spontaneously polarized crystals with intrinsic electric dipole moment have attracted immense interest as excellent functional materials for extensive applications.It is of great significance to engineer sustainable spontaneously polarized materials with fascinating characteristics and performance for activating air and water.Herein,a novel strategy based on the synergy of mechanical activation(MA)and biomimetic mineralization(BM)was created to construct spontaneously polarized ceramic.MA induced the structural damage of clay and promoted the dissolution of ions and the release of free proteins,contributing to the formation of silicate precursor in BM process.After high temperature firing,the silicate precursor in clay was converted to form KCa_(3)AlCa_(3)Si_(4)O_(16)(hexagonal crystal system,L^(6)symmetry type,and P63 space group)in the resulting spontaneously polarized ceramic.The non-centrosymmetric structure of KCa_(3)AlCa_(3)Si4O_(16)and the high intrinsic electric dipole moments contributed by K(1)polyhedrons resulted in high spontaneous polarization(0.2322μC/cm^(2))and far-infrared emissivity(0.951)of spontaneously polarized ceramic.In air,spontaneously polarized ceramic can activate H_(2)O and O_(2)molecules to form negative air ions owing to surface electric field.In water,spontaneously polarized ceramic can disaggregate large water clusters to form small water clusters ascribed to surface electric field and far-infrared emission;water pH can be regulated from weak acidity to approximate neutrality via the capture of electrons by H+ions to produce releasable hydrogen gas.This work provides great promise for rational design and synthesis of spontaneously polarized materials for functional applications.展开更多
Recently,Cu-based single-atom catalysts(SACs)have garnered increasing attention as substitutes for platinum-based catalysts in the oxygen reduction reaction(ORR).Therefore,a facile,economical,and efficient synthetic m...Recently,Cu-based single-atom catalysts(SACs)have garnered increasing attention as substitutes for platinum-based catalysts in the oxygen reduction reaction(ORR).Therefore,a facile,economical,and efficient synthetic methodology for the preparation of a high-performance Cu-based SAC electrocatalyst for the ORR is extremely desired,but is also significantly challenging.In this study,we propose a ball-milling method to synthesize isolated metal SACs embedded in S,N-codoped nanocarbon(MNSDC,M=Cu,Fe,Co,Ni,Mn,Pt,and Pd).In particular,the Cu-NSDC SACs exhibit high electrochemical activity for the ORR with half-wave potential(E_(1/2))of 0.84 V(vs.reversible hydrogen electrode(RHE),20 mV higher than Pt/C)in alkaline electrolyte,excellent stability,and electrocatalytic selectivity.Density functional theory(DFT)calculations demonstrated that the desorption of OH*intermediates was the rate-determining step over Cu-NSDC.This study creates a pathway for high-performance ORR single atomic electrocatalysts for fuel cell applications and provides opportunities to convert biowaste materials into commercial opportunities.展开更多
Improving the transfer hydrogenation of N-heteroarenes is of key importance for various industrial pro-cesses and remains a challenge so far.We reported here a microcapsule-pyrolysis strategy to quasi-continuous synth...Improving the transfer hydrogenation of N-heteroarenes is of key importance for various industrial pro-cesses and remains a challenge so far.We reported here a microcapsule-pyrolysis strategy to quasi-continuous synthesis S,N co-doped carbon supported Co single atom catalysts(Co/SNC),which was used for transfer hydrogenation of quinoline with formic acid as the hydrogen donor.Given the unique ge-ometric and electronic properties of the Co single atoms,the excellent catalytic activity,selectivity and stability were observed.Benefiting from the quasi-continuous synthesis method,the as-obtained cata-lysts provide a reference for the large-scale preparation of single atom catalysts without amplification ef-fect.Highly catalytic performances and quasi-continuous preparation process,demonstrating a new and promising approach to rational design of atomically dispersed catalysts with maximum atomic efficiency in industrial.展开更多
基金the National Natural Science Foundation of China,No.82173253the Sichuan Province Science and Technology Support Program,No.2022YFH0003 and No.2023NSFSC1900+1 种基金the Postdoctoral Research Foundation of West China Hospital,No.2021HXBH020and the Medico-Engineering Cooperation Funds from the University of Electronic Science and Technology of China and West China Hospital of Sichuan University,No.HXDZ22005.
文摘BACKGROUND Superficial esophageal squamous cell carcinoma(ESCC)is defined as cancer infiltrating the mucosa and submucosa,regardless of regional lymph node metastasis(LNM).Endoscopic resection of superficial ESCC is suitable for lesions that have no or low risk of LNM.Patients with a high risk of LNM always need further treatment after endoscopic resection.Therefore,accurately assessing the risk of LNM is critical for additional treatment options.AIM To analyze risk factors for LNM and develop a nomogram to predict LNM risk in superficial ESCC patients.METHODS Clinical and pathological data of superficial ESCC patients undergoing esophagectomy from January 1,2009 to January 31,2016 were collected.Logistic regression analysis was used to predict LNM risk factors,and a nomogram was developed based on risk factors derived from multivariate logistic regression analysis.The receiver operating characteristic(ROC)curve was used to obtain the accuracy of the nomogram model.RESULTSA total of 4660 patients with esophageal cancer underwent esophagectomy.Of these,474 superficial ESCC patientswere enrolled in the final analysis,with 322 patients in the training set and 142 patients in the validation set.Theprevalence of LNM was 3.29%(5/152)for intramucosal cancer and increased to 26.40%(85/322)for submucosalcancer.Multivariate logistic analysis showed that tumor size,invasive depth,tumor differentiation,infiltrativegrowth pattern,tumor budding,and lymphovascular invasion were significantly correlated with LNM.Anomogram using these six variables showed good discrimination with an area under the ROC curve of 0.789(95%CI:0.737-0.841)in the training set and 0.827(95%CI:0.755-0.899)in the validation set.CONCLUSIONWe developed a useful nomogram model to predict LNM risk for superficial ESCC patients which will facilitateadditional decision-making in treating patients who undergo endoscopic resection.
基金supported by the National Natural Science Foundation under Grants No.62271127,No.61872405,and No.81171411Natural Science Foundation of Sichuan Province,China under Grant No.23NSFSC0627Medico-Engineering Cooperation Funds from University of Electronic Science and Technology of China and West China Hospital of Sichuan University under Grants No.ZYGX2022YGRH011 and No.HXDZ22005.
文摘Automatic segmentation of early esophagus cancer(EEC)in gastrointestinal endoscopy(GIE)images is a critical and challenging task in clinical settings,which relies primarily on labor-intensive and time-consuming routines.EEC has often been diagnosed at the late stage since early signs of cancer are not obvious,resulting in low survival rates.This work proposes a deep learning approach based on the U-Net++method to segment EEC in GIE images.A total of 2690 GIE images collected from 617 patients at the Digestive Endoscopy Center,West China Hospital of Sichuan University,China,have been utilized.The experimental result shows that our proposed method achieved promising results.Furthermore,the comparison has been made between the proposed and other U-Net-related methods using the same dataset.The mean and standard deviation(SD)of the dice similarity coefficient(DSC),intersection over union(IoU),precision(Pre),and recall(Rec)achieved by the proposed framework were DSC(%)=94.62±0.02,IoU(%)=90.99±0.04,Pre(%)=94.61±0.04,and Rec(%)=95.00±0.02,respectively,outperforming the others.The proposed method has the potential to be applied in EEC automatic diagnoses.
基金Supported by the Science and Technology Department of Sichuan Province for Scientific Research,No.2015SZ0123
文摘AIM To evaluate the clinical outcomes of patients who underwent endoscopic submucosal tunnel dissection(ESTD) for esophageal squamous cell carcinoma(ESCC) and precancerous lesions.METHODS ESTD was performed in 289 patients. The clinical outcomes of the patients and pathological features of the lesions were retrospectively reviewed.RESULTS A total of 311 lesions were included in the analysis. The en bloc rate, complete resection rate, and curative resection rate were 99.04%, 81.28%, and 78.46%, respectively. The ESTD procedure time was 102.4 ± 35.1 min, the mean hospitalization time was 10.3 ± 2.8 d, and the average expenditure was 3766.5 ± 846.5 dollars. The intraoperative bleeding rate was 6.43%, the postoperative bleeding rate was 1.61%, the perforation rate was 1.93%, and the postoperative infection rate was 9.65%. Esophageal stricture and positive margin were severe adverse events, with an incidence rate of 14.79% and 15.76%, respectively. No tumor recurrence occurred during the follow-up period. CONCLUSION ESTD for ESCC and precancerous lesions is feasible and relatively safe, but for large mucosal lesions, the rate of esophageal stricture and positive margin is high.
文摘BACKGROUND Adverse events during endoscopic submucosal dissection(ESD)of superficial esophageal neoplasms,such as perforation and bleeding,have been welldocumented.However,the Mallory-Weiss Tear(MWT)during esophageal ESD remains under investigation.AIM To investigate the incidence and risk factors of the MWT during esophageal ESD.METHODS From June 2014 to July 2017,patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed.The clinicopathological characteristics of the patients were collected.Patients were divided into an MWT group and non-MWT group based on whether MWT occurred during ESD.The incidence of MWTs was determined,and the risk factors for MWT were then further explored.RESULTS A total of 337 patients with 373 lesions treated by ESD were analyzed.Twenty patients developed MWTs during ESD(5.4%).Multivariate analysis identified that female sex(OR=5.36,95%CI:1.47-19.50,P=0.011)and procedure time longer than 88.5 min(OR=3.953,95%CI:1.497-10.417,P=0.005)were independent risk factors for an MWT during ESD.The cutoff value of the procedure time for an MWT was 88.5 min(sensitivity,65.0%;specificity,70.8%).Seven of the MWT patients received endoscopic hemostasis.All patients recovered satisfactorily without surgery for the laceration.CONCLUSION The incidence of MWTs during esophageal ESD was much higher than expected.Although most cases have a benign course,fatal conditions may occur.We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region.
文摘AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.METHODS: In this cross-sectional study, 517 difficult colonoscope insertions(Grade C, Kudo's difficulty classification) screened from 37800 colonoscopy insertions were collected from April 2004 to June 2014 by three 4th-level(Kudo's classification) colonoscopists. The following common factors for the incomplete insertion were excluded: structural obstruction of the colon or rectum, insufficient colon cleansing, discontinuation due to patient's discomfort or pain, severe colon disease with a perforation risk(e.g., severe ischemic colonopathy). All the excluded patients were re-scheduled if permission was obtained from the patients whose intubation had failed. If the repeat intubations were still a failure because of the difficult operative techniques, those patients were also included in this study. The patient's age, sex, anesthesia and colonoscope type were recorded before colonoscopy. During the colonoscopic examination, the influencing factors of fixation, tortuosity, laxity and redundancy of the colon were assessed, and the insertion time(> 10 min or ≤ 10 min) were registered. The insertion time was analyzed by t-test, and other factors were analyzed by univariate and multivariate logistic regression.RESULTS: Three hundred and twenty-two(62.3%) of the 517 insertions were complete in the colonoscope insertion into the ileocecum, but 195(37.7%) failed in the insertion. Fixation, tortuosity, laxity or redundancy occurred during the colonoscopic examination. Multivariate logistic regression analysis revealed that fixation(OR = 0.06, 95%CI: 0.03-0.16, P < 0.001) and tortuosity(OR = 0.04, 95%CI: 0.02-0.08, P < 0.001) were significantly related to the insertion into the ileocecum in the left hemicolon; multivariate logistic regression analysis also revealed that fixation(OR = 0.16, 95%CI: 0.06-0.39, P < 0.001), tortuosity(OR0.23, 95%CI: 0.13-0.43, P < 0.001), redundancy(OR = 0.12, 95%CI: 0.05-0.26, P < 0.001) and sex(OR = 0.35, 95%CI: 0.20-0.63, P < 0.001) were significantly related to the insertion into the ileocecum in the right hemicolon. Prolonged insertion time(> 10 min) was an unfavorable factor for the insertion into the ileocecum.CONCLUSION: Colonoscopy should be discontinued if freedom of the colonoscope body's insertion and rotation is completely lost, and the insertion time is prolonged over 30 min.
基金supported by the National Natural Science Foundation of China(21473073,21473074)‘‘13th Five-Year’’ Science and Technology Research of the Education Department of Jilin Province(2016403)+1 种基金the Development Project of Science and Technology of Jilin Province(20170101171JC,20180201068SF)the Open Project of State Key Laboratory of Inorganic Synthesis and Preparative Chemistry(201703)~~
文摘An efficient and low-cost supported Pt catalyst for hydrogenation of niroarenes was prepared with colloid Pt precursors andα-Fe2O3 as a support.The catalyst with Pt content as low as 0.2 wt%exhibits high activities,chemoselectivities and stability in the hydrogenation of nitrobenzene and a variety of niroarenes.The conversion of nitrobenzene can reach 3170 molconv h^–1 molPt^–1 under mild conditions(30°C,5 bar),which is much higher than that of commercial Pt/C catalyst and many reported catalysts under similar reaction conditions.The spatial separation of the active sites for H2 dissociation and hydrogenation should be responsible for the high chemoselectivity,which decreases the contact possibility between the reducible groups of nitroarenes and Pt nanoparticles.The unique surface properties ofα-Fe2O3 play an important role in the reaction process.It provides active sites for hydrogen spillover and reactant adsorption,and ultimately completes the hydrogenation of the nitro group on the catalyst surface.
基金Supported by the Sichuan Science and Technology Program,No.22GJHZ0177 and No.2019YJ0102.
文摘BACKGROUND Although early esophageal squamous cell carcinoma(EESCC)with cirrhosis is a relatively rare clinical phenomenon,the management of EESCC in cirrhotic patients continues to be a challenge.AIM To evaluate the feasibility,safety,efficacy and long-term survival outcomes of endoscopic submucosal tunnel dissection(ESTD)for treating EESCC in patients with cirrhosis.METHODS This was a single-center retrospective cohort study.We examined 590 EESCC patients who underwent ESTD between July 14,2014,and May 26,2021,from a large-scale tertiary hospital.After excluding 25 patients with unclear lesion areas or pathological results,the remaining 565 patients were matched at a ratio of 1:3 by using propensity score matching.A total of 25 EESCC patients with comorbid liver cirrhosis and 75 matched EESCC patients were ultimately included in the analysis.Parametric and nonparametric statistical methods were used to compare the differences between the two groups.The Kaplan–Meier method was used to create survival curves,and differences in survival curves were compared by the log-rank test.RESULTS Among 25 patients with liver cirrhosis and 75 matched noncirrhotic patients,there were no significant differences in intraoperative bleeding(P=0.234),30-d post-ESTD bleeding(P=0.099),disease-specific survival(P=0.075),or recurrence-free survival(P=0.8196).The mean hospitalization time and costs were significantly longer(P=0.007)and higher(P=0.023)in the cirrhosis group than in the noncirrhosis group.The overall survival rate was significantly lower in the cirrhosis group(P=0.001).CONCLUSION ESTD is technically feasible,safe,and effective for patients with EESCC and liver cirrhosis.EESCC patients with Child-Pugh A disease seem to be good candidates for ESTD.
文摘目的:对2000年至2020年Web of Science收录的成人体外膜氧合(ECMO)相关研究文献进行可视化分析,以解析和追踪成人ECMO技术领域相关热点和前沿。方法:检索2000至2020年在Web of Science核心合集数据库收录的成人ECMO相关研究文献,运用CiteSpace可视化工具,从高影响力国家/地区、机构、作者、高频关键词及突变术语等方面解析成人ECMO技术研究的热点与前沿。结果:最终纳入2058篇以成人ECMO为主题的文献,相关文献年发表量呈现增长趋势,美国发文量位居首位。该领域研究多热点集中在COVID-19、抗凝作用、临床试验。同时,院内心脏骤停、指南、急性呼吸衰竭是成人ECMO研究的前沿领域,代表未来研究发展趋势。结论:临床试验、体外心肺复苏、急性呼吸衰竭、冠状病毒感染方面的研究是成人ECMO技术研究的前沿和热点。
文摘针对家庭总线系统(home bus system,HBS)通讯回路采用黑盒测试其可靠性存在测评工作量大的问题,本文主要对HBS通讯回路硬件电路进行仿真分析。通过对HBS通讯回路的技术研究,利用专业的仿真软件Stspice,建立HBS通讯回路3个核心仿真模型,提出一种新的白盒测试方式。测试结果表明,采用白盒测试方法,将HBS通讯回路的评测工作量缩减50%,其测试方法远优于现有的黑盒测试方式,而且该方法能够有效定位硬件电路的故障区域,解决了HBS通讯回路在不同商用空调基板上应用的适应性问题。该研究对多联机中央空调HBS回路的可靠性评价具有一定的指导意义。
基金Supported by A Grant offered by West China Hospital, Sichuan University, No. 2007SZ018
文摘AIM: To investigate and evaluate the feasibility of the computer-aided screening diagnosis for enteric lesions in the capsule endoscopy (CE).METHODS: After developing a series of algorithms for the screening diagnosis of the enteric lesions in CE based on their characteristic colors and contours, the normal and abnormal images obtained from 289 patients were respectively scanned and diagnosed by the CE readers and by the computer-aided screening for the enteric lesions with the image-processed software (IPS). The enteric lesions shown by the images included esoenteritis, mucosal ulcer and erosion, bleeding, space-occupying lesions, angioectasia, diverticula, parasites, etc. The images for the lesions or the suspected lesions confirmed by the CE readers and the computers were collected, and the effectiveness rate of the screening and the number of the scanned images were evaluated, respectively.RESULTS: Compared with the diagnostic results obtained by the CE readers, the total effectiveness rate (sensitivity) in the screening of the commonly-encountered enteric lesions by IPS varied from 42.9% to 91.2%, with a median of 74.2%, though the specificity and the accuracy rates were still low, and theimages for the rarely-encountered lesions were difficult to differentiate from the normal images. However, the number of the images screened by IPS was 5000 on average, and only 10%-15% of the original images were left behind. As a result, a large number of normal images were excluded, and the reading time decreased from 5 h to 1 h on average.CONCLUSION: Though the total accuracy and specificity rates by the computer-aided screening for the enteric lesions with IPS are much lower than those by the CE readers, the computer-aided screening diagnosis can exclude a large number of the normal images and confine the enteric lesions to 5000 images on average, which can reduce the workload of the readers in the scanning of the images. This computer-aided screening technique can make a correct diagnosis as efficiently as possible in most of the patients.
基金supported by the National Key R&D Program of China(No.2018YFA0702003)the National Natural Science Foundation of China(Nos.21890383 and 21871159)+1 种基金the Science and Technology Key Project of Guangdong Province of China(No.2020B010188002)the China Postdoctoral Science Foundation(No.2022M721796).
文摘Catalysts can accelerate the chemical reaction rate and effectively promote the molecules transformation,which is of great significance in the research of chemical industry and material science.The extreme utilization of reactive sites has led to the emergence and development of atomically dispersed materials(ADMs).The highly active coordination unsaturated metal sites and fully utilized metal atoms make ADMs show great potential in catalytic reactions.The adjustment of coordination environment and electronic structure provides more possibilities for constructing reactive centers with different properties.This review summarized the application and research progress of ADMs in different fields.The design strategy and structure–activity relationship of ADMs for specific reactions were summarized and analyzed.Moreover,we also provided advices for the challenges and opportunities faced by ADMs in catalytic reactions.
基金the National Natural Science Foundation of China(nos.22008041 and 22178074)the Natural Science Foundation of Guangxi Province,China(nos.2019GXNSFDA245020 and 2020GXNSFGA297001).
文摘Spontaneously polarized crystals with intrinsic electric dipole moment have attracted immense interest as excellent functional materials for extensive applications.It is of great significance to engineer sustainable spontaneously polarized materials with fascinating characteristics and performance for activating air and water.Herein,a novel strategy based on the synergy of mechanical activation(MA)and biomimetic mineralization(BM)was created to construct spontaneously polarized ceramic.MA induced the structural damage of clay and promoted the dissolution of ions and the release of free proteins,contributing to the formation of silicate precursor in BM process.After high temperature firing,the silicate precursor in clay was converted to form KCa_(3)AlCa_(3)Si_(4)O_(16)(hexagonal crystal system,L^(6)symmetry type,and P63 space group)in the resulting spontaneously polarized ceramic.The non-centrosymmetric structure of KCa_(3)AlCa_(3)Si4O_(16)and the high intrinsic electric dipole moments contributed by K(1)polyhedrons resulted in high spontaneous polarization(0.2322μC/cm^(2))and far-infrared emissivity(0.951)of spontaneously polarized ceramic.In air,spontaneously polarized ceramic can activate H_(2)O and O_(2)molecules to form negative air ions owing to surface electric field.In water,spontaneously polarized ceramic can disaggregate large water clusters to form small water clusters ascribed to surface electric field and far-infrared emission;water pH can be regulated from weak acidity to approximate neutrality via the capture of electrons by H+ions to produce releasable hydrogen gas.This work provides great promise for rational design and synthesis of spontaneously polarized materials for functional applications.
基金supported by the National Key Research and Development Program Nanotechnology Specific Project(No.2020YFA0210900)the National Natural Science Foundation of China(Nos.21908255,22078371,22108315,21938001,and 21961160741)+3 种基金the Guangdong Provincial Key R&D Programme(No.2019B110206002)the Science and Technology Key Project of Guangdong Province(No.2020B010188002)the Guangdong Basic and Applied Basic Research Foundation(No.2020A1515110864)the Guangdong Natural Science Foundation(No.2021A1515010163).
文摘Recently,Cu-based single-atom catalysts(SACs)have garnered increasing attention as substitutes for platinum-based catalysts in the oxygen reduction reaction(ORR).Therefore,a facile,economical,and efficient synthetic methodology for the preparation of a high-performance Cu-based SAC electrocatalyst for the ORR is extremely desired,but is also significantly challenging.In this study,we propose a ball-milling method to synthesize isolated metal SACs embedded in S,N-codoped nanocarbon(MNSDC,M=Cu,Fe,Co,Ni,Mn,Pt,and Pd).In particular,the Cu-NSDC SACs exhibit high electrochemical activity for the ORR with half-wave potential(E_(1/2))of 0.84 V(vs.reversible hydrogen electrode(RHE),20 mV higher than Pt/C)in alkaline electrolyte,excellent stability,and electrocatalytic selectivity.Density functional theory(DFT)calculations demonstrated that the desorption of OH*intermediates was the rate-determining step over Cu-NSDC.This study creates a pathway for high-performance ORR single atomic electrocatalysts for fuel cell applications and provides opportunities to convert biowaste materials into commercial opportunities.
基金financial support from the National Natural Science Foundation of China(Nos.22078371,21938001,21961160741)Guangdong Provincial Key R&D Programme(No.2019B110206002)+4 种基金Special fund for Local Science and Technology Development by the Central Government,Local Innovative and Research Teams Project of Guangdong Pearl River Talents Pro-gram(No.2017BT01C102)the NSF of Guang-dong Province(No.2020A1515011141)the National key Research and Development Program Nanotechnology Specific Project(No.2020YFA0210900)the Science and Technology Key Project of Guangdong Province,China(No.2020B010188002)The Project Supported by Guangdong Natural Science Foundation(No.2021A1515010163).
文摘Improving the transfer hydrogenation of N-heteroarenes is of key importance for various industrial pro-cesses and remains a challenge so far.We reported here a microcapsule-pyrolysis strategy to quasi-continuous synthesis S,N co-doped carbon supported Co single atom catalysts(Co/SNC),which was used for transfer hydrogenation of quinoline with formic acid as the hydrogen donor.Given the unique ge-ometric and electronic properties of the Co single atoms,the excellent catalytic activity,selectivity and stability were observed.Benefiting from the quasi-continuous synthesis method,the as-obtained cata-lysts provide a reference for the large-scale preparation of single atom catalysts without amplification ef-fect.Highly catalytic performances and quasi-continuous preparation process,demonstrating a new and promising approach to rational design of atomically dispersed catalysts with maximum atomic efficiency in industrial.