上消化道内镜诊疗黏膜准备的现状及争议问题

我国是食管癌和胃癌的高发国家,但上消化道早期肿瘤的检出率较低。实现上消化道肿瘤早诊早治的关键,是高质量的上消化道内镜诊疗。但在内镜诊疗过程中,常因黏膜准备不充分导致疾病漏诊和误诊。目前,关于肠道准备方法,国内外已有多项指南进行规范,但上消化道黏膜准备方法尚无权威性指南规范。临床实践中,不同医疗机构采用的准备方法差别较大,黏膜准备效果有一定差异,在某些方面还存在较多争议。该文对国内外上消化道黏膜准备的现况和争议问题进行归纳总结,期望为临床规范的制订提供参考,同时,也有助于为后续相关课题研究提供思路。

Small intestinal hemangioma:Endoscopic or surgical intervention? A case report and review of literature

BACKGROUND Hemangioma of the small intestine is a rare vascular malformation. Before the advent of capsule endoscopy(CE) and balloon-assisted enteroscopy(BAE), preoperative diagnosis of this disease was extremely difficult.CASE SUMMARY In this study, we report a 24-year-old female with a large transmural small bowel cavernous hemangioma, which was diagnosed with CE and BAE preoperatively and removed successfully using minimally invasive surgery. Meanwhile, we perform a literature review of the studies about intestinal hemangiomas published after 2000. Literature review revealed that 91.9% of the lesions were diagnosed preoperatively by CE and/or BAE and 45.9% of them were treated endoscopically, which is a marked improvement compared to before 2000. Therefore, CE and BAE are useful modalities for the preoperative diagnosis of hemangiomas in the small intestine. CONCLUSION Endoscopic treatment of intestinal hemangioma is generally prudent and might be suitable for multiple, relatively small lesions.

Rosuvastatin inhibits the smooth muscle cell proliferation by targeting TNFα mediated Rho kinase pathway

ObjectiveTo 调查是否肿瘤坏死 Factor-alpha ( TNF&#x003b1 ；)能够激活导致光滑的肌肉房间增长和 Rosuvastatin 的干预功能的 Rho kinase 小径，并且由光滑的肌肉房间是的 Rosuvastatin.MethodsWistar 出生不满一月的婴儿老鼠澄清机制和反动脉粥样硬化的干预举止有教养，并且房间增长的活动被甲基 thiazolyl tetrazolium ( MTT )决定。在 TNF&#x003b1 的刺激以后的 Rho kinase 基因的表示；被 RT-PCR 评估。西方的污点方法被用来测量增殖的房间的蛋白质表示在 TNF&#x003b1 以后的原子抗原(PCNA ) ；在光滑的肌肉 cell.ResultsThe TNF&#x003b1 的刺激和 Rosuvastatin 干预；刺激显著地提高了 Rho kinase 的表示并且在光滑的肌肉房间增加了 PCNA 蛋白质的表示(P &#x0003c；0.05 ) 。而另外的 Rosuvastatin 管理禁止了，这些效果断然与延长处理被相关上述效果(P &#x0003c；0.05 ) TNF&#x003b1 的 .ConclusionsThe 激活；调停的 Rho kinase 发信号小径能显著地支持光滑的肌肉房间增长，并且 Rosuvastatin 不能仅仅禁止这条小径而且导致的增长。

Special Section on Energy-Efficient Technologies:NoC Circuits, Architectures, and Systems

Energy consumption has been one of the major challenges and concerns for the electronic devices design, especially in high-performance multi- and many-core systems. A highly integrated many-core chip is prone to be extremely high-power consumption that exceeds the chip＇s power budget set leaded by cooling, packaging and/or the capacity of the power supply. When this situation happens, various parts of the many-core chip will have to be deliberately switched off （darkened） so that the chip is still in compliance with its power budget, which is referred as ＂dark silicon＂. Therefore, the research on energy efficient computing is a current trend and will continue to be an active area in the coming years.

Inaudible Sound Covert Channel with Anti-Jamming Capability: Attacks vs. Countermeasure

When an inaudible sound covert channel(ISCC)attack is launched inside a computer system,sensitive data are converted to inaudible sound waves and then transmitted.The receiver at the other end picks up the sound signal,from which the original sensitive data can be recovered.As a forceful countermeasure against the ISCC attack,strong noise can be used to jam the channel and literally shut down any possible sound data transmission.In this paper,enhanced ISCC is proposed,whose transmission frequency can be dynamically changed.Essentially,if the transmitter detects that the covert channel is being jammed,the transmitter and receiver both will switch to another available frequency and re-establish their communications,following the proposed communications protocol.Experimental results show that the proposed enhanced ISCC can remain connected even in the presence of a strong jamming noise source.Correspondingly,a detection method based on frequency scanning is proposed to help to combat such an anti-jamming sound channel.With the proposed countermeasure,the bit error rate(BER)of the data communications over enhanced ISCC soars to more than 48%,essentially shutting down the data transmission,and thus neutralizing the security threat.

Energy Efficient Run-Time Incremental Mapping for 3-D Networks-on-Chip

3-D Networks-on-Chip （NoC） emerge as a potent solution to address both the interconnection and design complexity problems facing future Multiprocessor System-on-Chips （MPSoCs）. Effective run-time mapping on such 3-D NoC-based MPSoCs can be quite challenging, as the arrival order and task graphs of the target applications are typically not known a priori, which can be further complicated by stringent energy requirements for NoC systems. This paper thus presents an energy-aware run-time incremental mapping algorithm （ERIM） for 3-D NoC which can minimize the energy consumption due to the data communications among processor cores, while reducing the fragmentation effect on the incoming applications to be mapped, and simultaneously satisfying the thermal constraints imposed on each incoming application. Specifically, incoming applications are mapped to cuboid tile regions for lower energy consumption of communication and the minimal routing. Fragment tiles due to system fragmentation can be gleaned for better resource utilization. Extensive experiments have been conducted to evaluate the performance of the proposed algorithm ERIM, and the results are compared against the optimal mapping algorithm （branch-and-bound） and two heuristic algorithms （TB and TL）. The experiments show that ERIM outperforms TB and TL methods with significant energy saving （more than 10%）, much reduced average response time, and improved system utilization.

Investigation on the relationship between hydraulic loss and vortex evolution in pump mode of a pump-turbine

Hydraulic loss and vorticity are two most common methods in analyzing the flow characteristics in hydro-machine,i.e.,centrifugal pump,Francis turbine,etc.While the relationship and correlation between hydraulic loss and vortex evolution are not uncovered yet.In this study,hydraulic loss is regarded as the combination of dissipation effect and transportation effect in flow domains.Meanwhile,vorticityωcan be decomposed into two parts,namely the Liutex partω_(R),the shear partωs,of whichω_(R)is regarded as the third-generation vortex identification method for its precise and rigorous definition of local rigid rotation part of fluid.Based on the dimensional analysis,two new physical quantities related to vorticity(ω,ω_(R)andωS),namely enstrophyΩ,vorticity transport intensity T are adopted to express the energy characteristic in vortex evolution process.Finally,operating points at pump mode of an ultra-high head reversible pump-turbine are selected as the research object and the numerical results calculated using SST k-ωturbulence model are consistent well with the experimental data.Pearson correlation coefficient is adopted to evaluate the correlation between hydraulic loss and vortex evolution in main flow regions.Results show that apart from the spiral casing domain,the enstrophy of shear partΩs has very strong correlation with dissipation effect and Liutex transport intensity TR has stronger correlation with transportation effect when compared with other forms of vorticity.The correlation between Liutex transport intensity TR and transportation effect is strong in stay/guide vanes(SGVs)while reduce to medium level in runner and draft tube domains.In spiral casing domain,all forms of vorticity show weak or very weak correlation with transportation effect.Based on the proposed method,we believe that the relationship and correlation between hydraulic loss and vortex evolution in other hydraulic machineries can also be clearly investigated.

Identification of Newly Diagnosed Diabetes and Prediabetes Using Fasting Plasma Glucose and Urinary Glucose in a Chinese Population： A Multicenter Cross-Sectional Study

Background： Although fasting plasma glucose （FPG） has been highly recommended as the sole test for diabetes screening, the efficacy of FPG alone for diabetes screening is potentially limited due to its low sensitivity. The aim of this study was to improve the efficacy of FPG for diabetes screening using urinary glucose （UG）. Methods： This study was initiated on November 12, 2015, and ended on June 28, 2016. A representative sample of individuals aged between 18 and 65 years, with no history of diabetes, from 6 cities in Jiangsu Province participated in this study. A 75-g oral glucose tolerance test was used to diagnose diabetes. All urine samples were collected within 2 h of oral glucose loading to measure UG. Partial correlation analyses were used to evaluate the associations between UG and other glycemic variables, including FPG, 2-h plasma glucose （2h-PG）, and glycated hemoglobin A 1 c, after adjustment for age. Tile perfbnnance of UG was evaluated using a receiver operating characteristic （ROC） curve analysis. Results： Of the 7485 individuals included, 8% were newly diagnosed with diabetes and 48.7% had prediabetes. The areas under the ROC curves for UG were 0.75 for estimation of 2h-PG ≥7.8 mmol/L and 0,90 for 2h-PG ≥11.1 mmol/L, respectively. The sensitivity and specificity of UG were 52.3% and 87.8%, respectively, for 2h-PG ≥7.8 mmol/L （cutoff point ≥130 mg）, and 83.5% and 87.5%, respectively, for 2h-PG ≥11.1 mmol/L （cutoff point ≥ 178.5 mg）. The combination of FPG and UG demonstrated a significantly higher sensitivity than that of FPG alone for the identification of diabetes （[483/597] 80.9% vs. [335/597] 56.1%, x2 = 85.0, P 〈 0.001） and glucose abnormalities （[2643/4242] 62.3% vs. [2365/4242] 55.8%, x2 = 37.7 P 〈 0.001）. Conclusions： The combination of UG and FPG substantially improves the efficacy of using FPG alone for diabetes screening; this combination might be a practical screening tool and is worth being recommended in the future.

The prevalence and associated factors of simple hepatic cysts in Shanghai:a population-based cross-sectional study

To the Editor:Simple hepatic cyst is a common reason for consultation with gastroenterologists and hepatologists.Although most patients have a benign course,some suffer from serious complications,such as intracystic infection,hemorrhage,and even rupture,or symptoms caused by severe oppression of the surrounding tissues and organs.Understanding the prevalence of,and characteristics of,and factors associated with simple hepatic cysts is helpful for better treatment of symptomatic patients.The reported prevalence of the disease varies widely,ranging from 2.5%to 18.0%,and most of them were based on hospital surveys.[1,2,3,4]As an asymptomatic disease in most cases,simple hepatic cysts are usually discovered incidentally on abdominal imaging.Therefore,surveys based on hospital populations cannot represent true prevalence.Furthermore,due to the absence of healthy controls,surveys with hospital populations have been unable to identify associated factors for simple hepatic cysts.[1,2,3,4].

Lipohypertrophy:prevalence,clinical consequence,and pathogenesis

Insulin treatment has many cutaneous alterations and skin-related adverse effect,lipohypertrophy(LH)is the commonest among them.[1]LH has the definition with a tumor-like lump,visible and touchable,adipose tissue at the site of insulin injection.[2]It might result from the lipogenic effect of repeated insulin exposure.[3,4]Injecting insulin into the tissue with LH weakens insulin physiological function,and leads to a resulting excess glucose exposure,glycemic modifiability,and an increased risk of hypoglycemia.[5]Unfortunately,there is limited information about the pathophysiology of LH in insulin users.As a result,reports of prevalence,clinical consequence,and pathogenesis are needed.