Endoscopic detection and diagnostic strategies for minute gastric cancer:A real-world observational study

BACKGROUND Minute gastric cancers(MGCs)have a favorable prognosis,but they are too small to be detected by endoscopy,with a maximum diameter≤5 mm.AIM To explore endoscopic detection and diagnostic strategies for MGCs.METHODS This was a real-world observational study.The endoscopic and clinicopathological parameters of 191 MGCs between January 2015 and December 2022 were retrospectively analyzed.Endoscopic discoverable opportunity and typical neoplastic features were emphatically reviewed.RESULTS All MGCs in our study were of a single pathological type,97.38%(186/191)of which were differentiated-type tumors.White light endoscopy(WLE)detected 84.29%(161/191)of MGCs,and the most common morphology of MGCs found by WLE was protruding.Narrow-band imaging(NBI)secondary observation detected 14.14%(27/191)of MGCs,and the most common morphology of MGCs found by NBI was flat.Another three MGCs were detected by indigo carmine third observation.If a well-demarcated border lesion exhibited a typical neoplastic color,such as yellowish-red or whitish under WLE and brownish under NBI,MGCs should be diagnosed.The proportion with high diagnostic confidence by magnifying endoscopy with NBI(ME-NBI)was significantly higher than the proportion with low diagnostic confidence and the only visible groups(94.19%>56.92%>32.50%,P<0.001).CONCLUSION WLE combined with NBI and indigo carmine are helpful for detection of MGCs.A clear demarcation line combined with a typical neoplastic color using nonmagnifying observation is sufficient for diagnosis of MGCs.MENBI improves the endoscopic diagnostic confidence of MGCs.

Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Pathological diagnosis and immunohistochemical analysis of minute pulmonary meningothelial-like nodules:A case report

BACKGROUND Minute Pulmonary Meningothelial-like Nodules(MPMNs)are rare benign pulmonary nodules,which are more common in elderly women and have a higher detection rate in lung tissues of patients with lung malignant diseases.Its origin is not yet clear.At present,there are few reports on the diagnostic methods such as imaging and pathological manifestations of MPMNs.This article reports a 70-year-old female patient with pulmonary adenocarcinoma combined with MPMNs and reviews of the relevant literature.CASE SUMMARY A 70-year-old women was admitted to our institution with feeling sour in her back and occasional cough for more than 2 mo.Computerized electronic scanning scan and 3D reconstruction images in our institution showed there were multiple ground-glass nodules in both of her two lungs.The biggest one was in the apicoposterior segment of left upper lobe,about 2.5 mm×9 mm in size.We performed thoracoscopic resection of the left upper lung apicoposterior segment of the patient,and the final pathological report was minimally invasive adenocarcinoma.Re-examination of high resolution computed tomography 21 mo after surgery showed multiple ground-glass nodules in both lungs,and a new groundglass nodule was found in the superior segment of the right lower lobe.We took pathological biopsy of the right upper lung and right lower lung nodules for the patient under thoracoscopy.The histomorphology of the right lower lobe nodule showed multiple lesions in the lung tissue,and the small foci in the alveolar septum were distributed in mild form of the aggregation of short spindle cells.The immunohistochemistry showed that the lesion was epithelial membrane antigen(EMA)(+),somatostatin receptor 2a(SSTR2a)(+),S-100(-),chromogranin A(-),Syn(-),cytokeratin(-)and HMB-45(-).The final diagnosis was minimally invasive adenocarcinoma,accompanied by MPMNs.We recommend that patients continue to receive treatment after surgery and to do regular follow-up observations.CONCLUSION The imaging manifestations of MPMNs are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of MPMNs immunohistochemistry and shows that MPMNs are positive for EMA,SSTR2a,and progesterone receptor.

Six Minute Walk Test to assess functional capacity in chronic liver disease patients

AIM: To examine the utility of Six Minute Walk Test (6MWT) in patients with chronic liver disease (CLD). METHODS: Two hundred and fifty subjects between the ages of 18 and 80 (mean 47) years performed 6MWT and the Six Minute Walk Distance (6MWD) was measured. RESULTS: The subjects were categorized into four groups. Group A (n = 45) healthy subjects (control); group B (n = 49) chronic hepatitis B patients; group C (n = 54) chronic hepatitis C patients; group D (n = 98) liver cirrhosis patients. The four groups differed in terms of 6MWDs (P < 0.001). The longest distance walked was 421 ± 47 m by group A, then group B (390 ± 53 m), group C (357 ± 72 m) and group D (306 ± 111 m). The 6MWD correlated with age (r = -0.482, P < 0.01), hemoglobin (r = +0.373, P < 0.001) and albumin (r = +0.311, P < 0.001) levels. The Child-Pugh classification was negatively correlated with the 6MWD in cirrhosis (group D) patients (r = -0.328, P < 0.01). At the end of a 12 mo follow-up period, 15 of the 98 cirrhosis patients had died from disease complications. The 6MWD for the surviving cirrhotic patients was longer than for non-survivors (317 ± 101 vs 245 ± 145 m, P = 0.021; 95% CI 11-132). The 6MWD was found to be an independent predictor of survival (P = 0.024). CONCLUSION: 6MWT is a useful tool for assessing physical function in CLD patients. We suggest that 6MWD may serve as a prognostic indicator in patients with liver cirrhosis.

Minute signet ring cell carcinoma occurring in gastric hyperplastic polyp

We describe a 45-year-old woman with minute signet ring cell carcinoma occurring in a gastric hyperplastic polyp. A biopsy specimen obtained from the gastric hyperplastic polyp revealed signet ring cell carcinoma. Endoscopic mucosal resection (EMR) was performed to confirm the diagnosis. Histological examination of the EMR specimen revealed focal signet ring cell carcinoma in the hyperplastic polyp. There are few cases of gastric hyperplastic polyp associated with signet ring cell carcinoma.

Recycling of minute metal scraps by semisolid processing:Manufacturing of design materials

As a new attempt to recycle minute metal scraps, the possibility of manufacturing design materials by semisolid extrusion processing was shown.A design material with an intended shape, such as a character or petal shape, was manufactured using minute metal scraps.Similarly, a design material with an intended color pattern for each metal, such as red copper in a white aluminum matrix, resembling grainlike wood, was manufactured by mixing two or more types of minute metal scrap.In addition, secondary design materials, which have engraved patterns on the surface of the target metal made by an electric discharge machine using the above primary design material as an electrode, were manufactured.

Genetic Analysis and Mapping of Dominant Minute Grain Gene Mi3(t) in Rice

Grain size, determined chiefly by grain length, is one of the main factors affecting the grain yield in rice production. To study the trait of rice grain size, F1 and F2 populations were developed from crosses Shuhui 881/Y34 and Shuhui 527/Y34, and genetic analysis for minute grain was performed. The F1 populations showed minute grains, and grain size segregations in the two F2 populations were both in accordance with the ratio of 3：1, indicating that minute grain in Y34 was controlled by a completely dominant gene. By using the F2 population from Shuhui 881/Y34, this dominant gene, tentatively designated as Mi3（t）, was mapped based on SSR markers in the interval between RM282 （genetic distance of 5.1 cM） and RM6283 （genetic distance of 0.9 cM） on the short arm of chromosome 3.

Clinicopathological features of minute pharyngeal lesions diagnosed by narrow-band imaging endoscopy and biopsy

AIM:To evaluate the utility of magnified narrow-band imaging(NBI) endoscopy for diagnosing and treating minute pharyngeal neoplasia.METHODS:Magnified NBI gastrointestinal examinations were performed by the first author.A magnification hood was attached to the tip of the endoscope for quick focusing.Most of the examinations were performed under sedation.Magnified NBI examinations were performed for all of the pharyngeal lesions that had noticeable brownish areas under unmagnified NBI observation,and an intrapapillary capillary loop(IPCL) classification was made.A total of 93 consecutive pharyngeal lesions were diagnosed as IPCL type Ⅳ and were suspected to represent dysplasia.Sixty-two lesions of approximately 1 mm in diameter were biopsied in the clinic,and 17 lesions with larger diameters were resected by endoscopic submucosal dissection(ESD) at the Hiroshima University Hospital.In addition to the histological diagnoses,the lesion diameters were microscopically measured in 45 of the 62 biopsies.Thirtyfour of the 62 biopsied patients received endoscopic follow up.RESULTS:Minute pharyngeal lesions were diagnosed in 93 of approximately 3000 patients receiving magnified NBI examinations at the clinic.Of the 93 patients with IPCL type Ⅳ lesions,80 were men,and 13 were women.Fifty-six were drinkers,and 57 were smokers.Two had esophageal cancer.Twenty-one lesions were located on the posterior hypopharyngeal wall,and 72 lesions were located on the posterior oropharyngeal wall.All 93 lesions were flat and showed similar findings in the magnified and unmagnified NBI examinations.Although almost all of the IPCL type Ⅳ lesions showed faint redness when examined under white light,it was difficult to diagnose the lesions using only this technique because the contrast was weaker than that achieved in the NBI examinations.Of the 93 lesions,only 3 had diameters greater than 2.1 mm.Sixty-two lesions of approximately 1 mm were biopsied in the clinic,whereas 17 larger lesions were treated by ESD at the Hiroshima University Hospital.Of the 79 pharyngeal lesions that were biopsied or resected by ESD,5 were histologically diagnosed as high-grade dysplasia,39 were diagnosed as low-grade dysplasia,and 39 were determined to be non-dysplastic lesions.There were no cancerous lesions.Histologically,abnormal cell size variations and increased nuclear size were observed in all of the high-grade dysplasia lesions,while the incidence of these findings in the low-grade dysplasia lesions was low.Of the 62 biopsied lesions,45 were microscopically measurable.The measured diameters ranged from 0.1 to 2.0 mm.The dysplasia ratios increased with the diameters.A follow-up endoscopic examination of the 34 biopsied patients found the rate of complete resection by biopsy to be 79%.The largest lesion in which complete resection was expected was a low-grade dysplasia of 1.9 mm in diameter.CONCLUSION:Minute pharyngeal lesions suspected to be dysplasia that are identified by NBI magnifying endoscopy should be biopsied to determine the diagnosis and further treatment.

Value of the 6 minute walk test in predicting multi vessel coronary arterial disease

The 6 minute walk test (6MWT) is well established in the clinical assessment of heart failure, pulmonary hypertension and COPD. Its value as a submaximal stress test in the risk stratification of chronic stable ischaemic syndromes is as yet not validated. 95 patients undergoing coronary angiography for assessment of chronic stable angina performed the 6MWT according to a modified protocol. The gamma correlation test indicated a moderately significant relationship between ECG changes plus symptoms at the end of the 6MWT and multi vessel coronary arterial disease. The T wave changes showed no significant correlation. Hence the 6MWT is a useful tool in the risk stratification of stable ischaemic syndromes which can be safely performed in a general ward prior to hospital discharge. It would be a useful preliminary test before planning a programme of cardiac rehabilitation.

Trans-Thoracic Echocardiographic Aortic Blood Flow Peak Velocity Variation, Distance Minute, Aortic Velocity Time Integral and Postoperative Outcome in Pediatric Surgical Patients—An Observational Pilot Study Protocol

Background: A Randomized Controlled Trial (RCT) has been elaborated where goal directed fluid and hemodynamic therapy (GDFHT) will be realized with trans-thoracic echocardiographic aortic blood flow peak velocity variation (ΔVpeak) and distance minute (DM) to guide fluid therapy and hemodynamics in high risk pediatric surgical patients. This RCT will clarify the impact of GDFHT with ΔVpeak and DM on postoperative outcome in terms of morbidity, length of stay in the intensive care unit (LOSICU), length of mechanical ventilation (LMV) and length of hospital stay (LOS) in children. To determine values of ΔVpeak, DM and VTI predictive of these postoperative outcomes, an observational pilot study will be realized. This pilot study is described here. The primary objective of this study is to determine values of ΔVpeak, DM and ITV predictive of postoperative outcome in children in terms of morbidity. The secondary objectives are to determine values of ΔVpeak, DM and ITV predictive of LOSICU, LMV, LOS, intraoperative, postoperative fluid administration and vasoactive-inotropic therapy. Methods: 500 - 1000 children aged less than 18 years will be included prospectively. Statistic analysis will be realized with XLSTAT 2019.4.2 software or plus. Results and Conclusions: This trial protocol will determine values of ΔVpeak, DM and ITV with echocardiography predictive of postoperative outcome in children.

Correlation analysis of five factors influencing minute volume during high frequency jet ventilation on lung modal: a laboratory study

Five factors influencing minute volume during high frequency jet ventilation were studied on lung modal by stepwise regression analysis. Among these factors, driving pressure is of the greatest dominance. Others are inspiratory and expiratory time ratio, tube diameter, frequency of ventilation and needle distanee, in the order of their impact. A formula was also developed for predicting the parameters.The result is quite satisfactory.

Academic Minutes for the 2nd World Integrative Medicine Congress

The modern research on basic concept inTCM deeply explored The papers in this congress are referring tothe research on Zhenghou(syndrome)theory,Five Element theory and Four Diagnosis theory by

Molecular docking of DS-3032B,a mouse double minute 2 enzyme antagonist with potential for oncology treatment development

BACKGROUND It is known that p53 suppression is an important marker of poor prognosis of cancers,especially in solid tumors of the breast,lung,stomach,and esophagus;liposarcomas,glioblastomas,and leukemias.Because p53 has mouse double minute 2(MDM2)as its primary negative regulator,this molecular docking study seeks to answer the following hypotheses:Is the interaction between DS-3032B and MDM2 stable enough for this drug to be considered as a promising neoplastic inhibitor?AIM To analyze,in silico,the chemical bonds between the antagonist DS-3032B and its binding site in MDM2.METHODS For molecular docking simulations,the file containing structures of MDM2(receptor)and the drug DS-3032B(ligand)were selected.The three-dimensional structure of MDM2 was obtained from Protein Data Bank,and the one for DS-3032B was obtained from PubChem database.The location and dimensions of the Grid box was determined using AutoDock Tools software.In this case,the dimensions of the Grid encompassed the entire receptor.The ligand DS-3032B interacts with the MDM2 receptor in a physiological environment with pH 7.4;thus,to simulate more reliably,its interaction was made with the calculation for the prediction of its protonation state using the MarvinSketch®software.Both ligands,with and without the protonation,were prepared for molecular docking using the AutoDock Tools software.This software detects the torsion points of the drug and calculates the angle of the torsions.Molecular docking simulations were performed using the tools of the AutoDock platform connected to the Vina software.The analyses of the amino acid residues involved in the interactions between the receptor and the ligand as well as the twists of the ligand,atoms involved in the interactions,and type,strength,and length of the interactions were performed using the PyMol software(pymol.org/2)and Discovery Studio from BIOVIA®.RESULTS The global alignment indicated crystal structure 5SWK was more suitable for docking simulations by presenting the p53 binding site.The three-dimensional structure 5SWK for MDM2 was selected from Protein Data Bank and the three-dimensional structure of DS-3032B was selected from PubChem(Compound CID:73297272;Milademetan).After molecular docking simulations,the most stable conformer was selected for both protonated and non-protonated DS-3032B.The interaction between MDM2 and DS-3032B occurs with high affinity;no significant difference was observed in the affinity energies between the MDM2/pronated DS-3032B(-9.9 kcal/mol)and MDM2/non-protonated DS-3032B conformers(-10.0 kcal/mol).Sixteen amino acid residues of MDM2 are involved in chemical bonds with the protonated DS-3032B;these 16 residues of MDM2 belong to the p53 biding site region and provide high affinity to interaction and stability to drugprotein complex.CONCLUSION Molecular docking indicated that DS-3032B antagonist binds to the same region of the p53 binding site in the MDM2 with high affinity and stability,and this suggests therapeutic efficiency.

Validation of a 2 Minute Step Test for Assessing Functional Improvement

Introduction: Although many cardiopulmonary patients require home care services, the 6-minute walk test (6MWT) is unusable in most dwellings for objectively evaluating exercise capacity because it requires a 20 - 30 meter hallway. To meet this need, we developed a 2-minute step test (2MST): stepping up and down an 8 inch step for 2 minutes (1 step = bilateral step up + step down). Purpose: Evaluate the statistical validity, reproducibility, and sensitivity of the 2MST in assessing exercise capacity. Method: We compared the heart rate, oxygen saturation and perceived exertion obtained during performance of 2MST with those obtained during the 6MWT. Results: Comparing 2MST and 6MWT in 158 subjects for validity, r = 0.925 (P Conclusion: The 2MST is valid, reproducible, sensitive, safe, well-tolerated, and is a suitable substitute for the 6MWT.

The First Four Minutes

When do people decide whether or not they want to become friends?During their first four minutes together, according to a book by Dr.Leonard Zunin. In his book. Contact①: The First Four Minutes, heoffers this advice to anyone interested in starting new friendships: 'Everytime you meet someone in a social situation, give him your

针锋相对——88 Minutes(英文)

人的一生会有很多个88分钟。如果你还有88分钟可以活,你将做些什么?本部影片由好莱坞著名"老戏骨"ALPACINO主演,受到生命只有"88分钟"的死亡威胁,主人翁上演了一场生死时速。本文节选的是影片的高潮部分,Jack与凶手一场斗智斗勇的对话,揭示了所有事件的来龙去脉。

Do investors care about auditor assignments?Evidence from last-minute changes to signing auditors

Against the background of China’s strengthening of finance and accounting supervision,this study examines the practice among listed companies of changing signing auditors at the last minute and explores whether Chinese investors can capture this information in a timely manner.We find that China’s capital market responds significantly negatively to these last-minute changes,implying that investors perceive a potential negative impact of this behavior.Crosssectional analyses suggest that the characteristics of the change event,recent corporate events,and accounting firm capability significantly affect the stock price response.Furthermore,in terms of the individual characteristics of signing auditors,external investors appear to comprehensively consider busyness level,industry experience,and the timing of the change to determine the causes and effects of the auditor change and make different market reactions accordingly.In addition,consistent with investor perceptions,we find that last-minute changes significantly impair the quality of financial statements,indicating that external investors’judgments based on information about changes in signing auditors are rational and effective.

Contribution of minute axillary lymph nodes to accurate staging for patients with breast cancer

Background Axillary lymph node metastasis is a very important metastatic pathway in breast cancer and its accurate detection is important for staging tumour and guiding therapy. However, neither the accuracy of routine detection of lymph node in surgical specimens nor the significance of minute lymph node with metastases in breast cancer is clear. A modified method for conveniently detecting minute lymph node in specimens of axUlary dissections in patients with breast cancer was used to analyze their influence on staging breast cancer.Methods Lymph nodes in fresh, unfixed, specimens of axillary dissections from 127 cases of breast cancer were detected routinely. Then the axillary fatty tissues were cut into 1 cm thick pieces, soaked in Carnoy＇s solution for 6 to 12 hours, taken out and put on a glass plate. Minute lymph nodes were detected by light of bottom lamp and examined by routine pathology.Results Lymph nodes （n= 2483, 19.6±8.0 per case） were found by routine method. A further 879 lymph nodes up to 6 mm （781 〈 3 mm, 6.9±5.3 per case, increasing mean to 26.5±9.7） were found from the axillary tissues after soaking in Carnoy＇s solution. By detection of minute lymph nodes, the stages of lymph node metastasis in 7 cases were changed from pathological node （pN） stage pN0 to pN1 in 4 cases, from pN1 to pN2 in 2 and from pN2 to pN3 in 1.Conclusions The accurate staging of axillary lymph node metastasis can be obtained routinely with number of axillary lymph nodes in most cases of breast cancer. To avoid neglecting minute lymph nodes with metastases, small axillary nodes should be searched carefully in the cases of earlier breast cancer with no swollen axillary nodes. Treatment with Camoy＇s solution can expediently detect minute axillary nodes and improve the accurate staging of lymph nodes in breast cancer.