Clinical diagnostic advances in intestinal anastomotic techniques:Hand suturing,stapling,and compression devices

The development of intestinal anastomosis techniques,including hand suturing,stapling,and compression anastomoses,has been a significant advancement in surgical practice.These methods aim to prevent leakage and minimize tissue fibrosis,which can lead to stricture formation.The healing process involves various phases:hemostasis and inflammation,proliferation,and remodeling.Mechanical staplers and sutures can cause inflammation and fibrosis due to the release of profibrotic chemokines.Compression anastomosis devices,including those made of nickel-titanium alloy,offer a minimally invasive option for various surgical challenges and have shown safety and efficacy.However,despite advancements,anastomotic techniques are evaluated based on leakage risk,with complications being a primary concern.Newer devices like Magnamosis use magnetic rings for compression anastomosis,demonstrating greater strength and patency compared to stapling.Magnetic technology is also being explored for other medical treatments.While there are promising results,particularly in animal models,the realworld application in humans is limited,and further research is needed to assess their safety and practicality.

Novel diagnostic imaging techniques and applications in anterior uveitis,intermediate uveitis,and scleritis

Uveitis can cause significant visual morbidity and often affects younger adults of working age.Anterior uveitis,or inflammation limited to the anterior chamber(AC),iris,and/or ciliary body comprises the majority of uveitis cases.Current clinical biomarkers and conventional grading scales for intraocular inflammation are mostly subjective and have only a moderate degree of interobserver reliability,and as such they have significant limitations when used in either clinical practice or research related to uveitis.In recent years,novel imaging techniques and applications have emerged that can supplement exam findings to detect subclinical disease,monitor quantitative biomarkers of disease progression or treatment effect,and provide overall a more nuanced understanding of disease entities.The first part of this review discusses automated algorithms for optical coherence tomography(OCT)image processing and analysis as a means to assess and describe intraocular inflammation with higher resolution than that afforded by conventional AC and vitreous cell ordinal grading scales.The second half of the review focuses on anterior segment OCT and OCT angiography(OCTA)in scleritis and iritis,especially with regards to their ability to directly image and characterize the pathologic structures and vasculature underlying these diseases.Finally,we briefly review experimental animal research with promising but more distant human clinical applications,including in vivo molecular microscopy of inflammatory markers and investigation of gold nanoparticles as a potential contrast agent in OCT imaging.Imaging modalities are discussed in the broader context of trends within the field of uveitis towards greater objectivity and quantifiable outcome measures and biomarkers.

Concomitant atypical knee gout and seronegative rheumatoid arthritis:A case report

BACKGROUND Gout and seronegative rheumatoid arthritis(SNRA)are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported.Limited information is available regarding the clinical management and prognosis of these combined diseases.CASE SUMMARY A 57-year-old woman with a 20-year history of joint swelling,tenderness,and morning stiffness who was negative for rheumatoid factor and had a normal uric acid level was diagnosed with SNRA.The initial regimen of methotrexate,leflunomide,and celecoxib alleviated her symptoms,except for those associated with the knee.After symptom recurrence after medication cessation,her regimen was updated to include iguratimod,methotrexate,methylprednisolone,and folic acid,but her knee issues persisted.Minimally invasive needle-knife scope therapy revealed proliferating pannus and needle-shaped crystals in the knee,indicating coexistent SNRA and atypical knee gout.After postarthroscopic surgery to remove the synovium and urate crystals,and following a tailored regimen of methotrexate,leflunomide,celecoxib,benzbromarone,and allopurinol,her knee symptoms were significantly alleviated with no recurrence observed over a period of more than one year,indicating successful management of both conditions.CONCLUSION This study reports the case of a patient concurrently afflicted with atypical gout of the knee and SNRA and underscores the significance of minimally invasive joint techniques as effective diagnostic and therapeutic tools in the field of rheumatology and immunology.

Peritoneal fluid indocyanine green test for diagnosis of gut leakage in anastomotic leakage rats and colorectal surgery patients

BACKGROUND Application of indocyanine green(ICG)fluorescence has led to new developments in gastrointestinal surgery.However,little is known about the use of ICG for the diagnosis of postoperative gut leakage(GL).In addition,there is a lack of rapid and intuitive methods to definitively diagnose postoperative GL.AIM To investigate the effect of ICG in the diagnosis of anastomotic leakage in a surgical rat GL model and evaluate its diagnostic value in colorectal surgery patients.METHODS Sixteen rats were divided into two groups:GL group(n=8)and sham group(n=8).Approximately 0.5 mL of ICG(2.5 mg/mL)was intravenously injected postoperatively.The peritoneal fluid was collected for the fluorescence test at 24 and 48 h.Six patients with rectal cancer who had undergone laparoscopic rectal cancer resection plus enterostomies were injected with 10 mL of ICG(2.5 mg/mL)on postoperative day 1.Their ostomy fluids were collected 24 h after ICG injection to identify the possibility of the ICG excreting from the peripheral veins to the enterostomy stoma.Participants who had undergone colectomy or rectal cancer resection were enrolled in the diagnostic test.The peritoneal fluids from drainage were collected 24 h after ICG injection.The ICG fluorescence test was conducted using OptoMedic endoscopy along with a near-infrared fluorescent imaging system.RESULTS The peritoneal fluids from the GL group showed ICG-dependent green fluorescence in contrast to the sham group.Six samples of ostomy fluids showed green fluorescence,indicating the possibility of ICG excreting from the peripheral veins to the enterostomy stoma in patients.The peritoneal fluid ICG test exhibited a sensitivity of 100%and a specificity of 83.3%for the diagnosis of GL.The positive predictive value was 71.4%,while the negative predictive value was 100%.The likelihood ratios were 6.0 for a positive test result and 0 for a negative result.CONCLUSION The postoperative ICG test in a drainage tube is a valuable and simple technique for the diagnosis of GL.Hence,it should be employed in clinical settings in patients with suspected GL.

Insight into the Electrochemical Behaviors of NCM811|SiO-Gr Pouch Battery through Thickness Variation

LiNi0.8Co0.1Mn0.1O2(NCM811)|SiOx-graphite(SiO-Gr.)battery chemistry is of intensive attention because its achievable practical energy density is approaching impressively 300 Wh Kg^(-1).However,it still suffers rapid capacity fades during repeated cycles,both chemical,electrochemical and mechanical irreversibility contribute.A comprehensive understanding behind the fading behavior of the cell chemistry is required before fully realize the benefits of this chemistry.Herein,the in-situ thickness variation is introduced as a diagnostic technique and is performed on 5-55 Ah NCM811|SiO-Gr cells.With the help of Li reference electrode and in-situ X-ray diffraction device,the correspondence between thickness variation and the electrode potential is carefully investigated.Firstly,the NCM811|SiO-Gr cell is characterized with the maximum cell thickness at around 80%state-of-charge(SOC)in the discharge process,rather than at 100%SOC.Secondly,the electrochemical behaviors during rate charge/discharge are diagnosed,and a Li platting signal is resolved from thickness variation profile at 2C.This work confirms that the thickness monitoring is a nondestructive and informative complement to conventional diagnostic techniques for failure analysis of pouch cells.

Molecular diagnosis and therapy for occult peritoneal metastasis in gastric cancer patients

To apply an individualized oncological approach to gastric cancer patients,the accurate diagnosis of disease entities is required.Peritoneal metastasis is the most frequent mode of metastasis in gastric cancer,and the tumor-node-metastasis classification includes cytological detection of intraperitoneal cancer cells as part of the staging process,denoting metastatic disease.The accuracy of cytological diagnosis leaves room for improvement;therefore,highly sensitive molecular diagnostics,such as an enzyme immunoassay,reverse transcription polymerase chain reaction,and virusguided imaging,have been developed to detect minute cancer cells in the peritoneal cavity.Molecular targeting therapy has also been spun off from basic research in the past decade.Although conventional cytologyis still the mainstay,novel approaches could serve as practical complementary diagnostics to cytology in near future.

A clinicopathological analysis in unsuspected gallbladder carcinoma: A report of 23 cases

AIM： To study the clinicopathological characteristics of unsuspected gallbladder carcinoma （UGC）. METHODS： We retrospectively studied 23 cases of UGC in Tongji Hospital, and compared their clinicopathological characteristics with 33 cases of preoperatively diagnosed gallbladder carcinoma （PDGC）. RESULTS： The proportion of UGC coexisting with cholecystolithiasis was significantly higher than that of PDGC （x^2 = 13.53, P 〈 0.01）. The infection rate of hepatitis B virus was 21.74% （5/23） in UGC and 30.30% （10/33） in PDGC. Nine （39.13%） of 23 patients with UGC and 8/33 （24.24） PDGC had contact with schistosome pestilent water. The rate of multiple pregnancies was 56.52% （13/23） in the patients with UGC and 42.42% （14/33） in PDGC. The primary location of the UGC was mostly in the neck and body of the gallbladder, and that of the PDGC was often in the body and bottom. The incidence of Nevin stage I and 11 UGC was significantly higher than that of PDGC （x^2 = 4.44, P 〈 0.05 and 2 = 4.96, P 〈 0.05） while that of Nevin stage V UGC was significantly lower than that of PDGC （x^2 = 7.59, P 〈 0.01）. According to the grading of carcinoma, the incidence of well-differentiated UGC was significantly higher than that of PDGC （2 = 4.16, P 〈 0.05）, and that of poorlydifferentiated UGC was significantly lower than that of PDGC （x^2 = 4.48, P 〈 0.05）.CONCLUSION： There are different characteristics between UGC and PDGC, such as in primary location, malignant degree and incidence of coexistence with cholecystolithiasis. Cholecystolithiasis, hepatitis B, schistosome and multiple pregnancies were high risk factors for gallbladder carcinoma.

Mismatch negativity,social cognition,and functional outcomes in patients after traumatic brain injury

Mismatch negativity is generated automatically, and is an early monitoring indicator of neuronal integrity impairment and functional abnormality in patients with brain injury, leading to decline of cognitive function. Antipsychotic medication cannot affect mismatch negativity. The present study aimed to explore the relationships of mismatch negativity with neurocognition, daily life and social functional outcomes in patients after brain injury. Twelve patients with traumatic brain injury and 12 healthy controls were recruited in this study. We examined neurocogni-tion with the Wechsler Adult Intelligence Scale-Revised China, and daily and social functional outcomes with the Activity of Daily Living Scale and Social Disability Screening Schedule, re-spectively. Mismatch negativity was analyzed from electroencephalogram recording. The results showed that mismatch negativity amplitudes decreased in patients with traumatic brain injury compared with healthy controls. Mismatch negativity amplitude was negatively correlated with measurements of neurocognition and positively correlated with functional outcomes in patients after traumatic brain injury. Further, the most signiifcant positive correlations were found be-tween mismatch negativity in the fronto-central region and measures of functional outcomes. The most signiifcant positive correlations were also found between mismatch negativity at the FCz electrode and daily living function. Mismatch negativity amplitudes were extremely positive-ly associated with Social Disability Screening Schedule scores at the Fz electrode in brain injury patients. These experimental ifndings suggest that mismatch negativity might efifciently relfect functional outcomes in patients after traumatic brain injury.

Tc-99m ciprofloxacin imaging in diagnosis of chronic bacterial prostatitis

Aim: To investigate the value of Tc-99m ciprofloxacin imaging in the differential diagnosis of chronic bacterial prostatitis. Methods: The study included 4 normal subjects as the negative controls, 2 patients with acute prostatitis or cystourethritis as the positive controls and 59 patients diagnosed as chronic bacterial prostatitis or chronic pelvic pain syndrome by traditional laboratory tests. In every subject, the single photon emission computerized tomography images were obtained 3 h after intravenous injection of Tc-99m Ciprofloxacin. The results of the imaging were compared with those of laboratory tests. Results: On the images, negative uptake was observed in all normal subjects, while strong hot uptake, in the whole prostate of acute prostatitis patients and in the whole urethra of acute cystourethritis patients. In 13 (68 %) of 19 patients categorized as chronic bacterial prostatitis by standard laboratory tests, hot uptake with less intensity than that of acute prostatitis was observed in the prostate area around the prostatic urethra. Negative uptake in the prostate was observed in 6 of 19 patients (32 %) categorized as chronic bacterial prostatitis. Interestingly, hot uptake in the prostate was exhibited in 28 (70 %) of the 40 patients categorized as chronic pelvic pain syndrome. Conclusion: Tc-99m ciprofloxacin imaging is helpful in the differential diagnosis of prostatitis syndrome.

Rate and yield of repeat upper endoscopy in patients with dyspepsia

AIM: To determine the rate and yield of repeat esophagogastroduodenoscopy (EGD) for dyspepsia in clinical practice,whether second opinions drive its use,and whether it is performed at the expense of colorectal cancer screening.METHODS: We performed a retrospective cohort study of all patients who underwent repeat EGD for dyspepsia from 1996 to 2006 at the University of California,San Francisco endoscopy service.RESULTS: Of 24 780 EGDs,5460 (22%) were performed for dyspepsia in 4873 patients.Of these,451 patients (9.3%) underwent repeat EGD for dyspepsia at a median 1.7 (interquartile range,0.8-3.1) years after initial EGD.Signif icant f indings possibly related to dyspepsia were more likely at initial (29%) vs repeat EGD (18%) [odds ratio (OR),1.45;95% confidence interval (CI): 1.20-1.75,P < 0.0001],and at repeat EGD if the initial EGD had reported such f indings (26%) than if it had not (14%) (OR,1.32;95% CI: 1.08-1.62,P = 0.0015).The same endoscopist performed the repeat and initial EGD in 77% of cases.Of patients aged 50 years or older,286/311 (92%) underwent lower endoscopy.CONCLUSION: Repeat EGD for dyspepsia occurred at a low but substantial rate,with lower yield than initial EGD.Optimizing endoscopy use remains a public health priority.

Detection of Helicobacter pylori resistance to clarithromycin and fluoroquinolones in Brazil:A national survey

AIM To evaluate bacterial resistance to clarithromycin and fluoroquinolones in Brazil using molecular methods.METHODS The primary antibiotic resistance rates of Helicobacter pylori(H. pylori) were determined from November 2012 to March 2015 in the Southern,South-Eastern,Northern,North-Eastern,and Central-Western regions of Brazil. Four hundred ninety H. pylori patients [66% female,mean age 43 years(range: 18-79)] who had never been previously treated for this infection were enrolled. All patients underwent gastroscopy with antrum and corpus biopsies and molecular testing using Geno Type Helico DR(Hain Life Science,Germany). This test was performed to detect the presence of H. pylori and to identify point mutations in the genes responsible for clarithromycin and fluoroquinolone resistance. The molecular procedure was divided into three steps: DNA extraction from the biopsies,multiplex amplification,and reverse hybridization. RESULTS Clarithromycin resistance was found in 83(16.9%) patients,and fluoroquinolone resistance was found in 66(13.5%) patients. There was no statistical difference in resistance to either clarithromycin or fluoroquinolones(P = 0.55 and P = 0.06,respectively) among the different regions of Brazil. Dual resistance to clarithromycin and fluoroquinolones was found in 4.3%(21/490) of patients. The A2147 G mutation was present in 90.4%(75/83),A2146 G in 16.9%(14/83) and A2146 C in 3.6%(3/83) of clarithromycin-resistant patients. In 10.8%(9/83) of clarithromycin-resistant samples,more than 01 mutation in the 23 S r RNA gene was noticed. In fluoroquinolone-resistant samples,37.9%(25/66) showed mutations not specified by the Geno Type Helico DR test. D91 N mutation was observed in 34.8%(23/66),D91 G in 18.1%(12/66),N87 K in 16.6%(11/66) and D91 Y in 13.6%(9/66) of cases. Among fluoroquinolone-resistant samples,37.9%(25/66) showed mutations not specified by the Geno Type Helico DR test. CONCLUSION The H. pylori clarithromycin resistance rate in Brazil is at the borderline(15%-20%) for applying the standard triple therapy. The fluoroquinolone resistance rate(13.5%) is equally concerning.

First prospective European study for the feasibility and safety of magnetically controlled capsule endoscopy in gastric mucosal abnormalities

BACKGROUND While capsule endoscopy(CE)is the gold standard diagnostic method of detecting small bowel(SB)diseases and disorders,a novel magnetically controlled capsule endoscopy(MCCE)system provides non-invasive evaluation of the gastric mucosal surface,which can be performed without sedation or discomfort.During standard SBCE,passive movement of the CE may cause areas of the complex anatomy of the gastric mucosa to remain unexplored,whereas the precision of MCCE capsule movements inside the stomach promises better visualization of the entire mucosa.AIM To evaluate the Ankon MCCE system’s feasibility,safety,and diagnostic yield in patients with gastric or SB disorders.METHODS Of outpatients who were referred for SBCE,284(male/female:149/135)were prospectively enrolled and evaluated by MCCE.The stomach was examined in the supine,left,and right lateral decubitus positions without sedation.Next,all patients underwent a complete SBCE study protocol.The gastric mucosa was explored with the Ankon MCCE system with active magnetic control of the capsule endoscope in the stomach,applying three standardized pre-programmed computerized algorithms in combination with manual control of the magnetic movements.RESULTS The urea breath test revealed Helicobacter pylori positivity in 32.7%of patients.The mean gastric and SB transit times with MCCE were 0 h 47 min 40 s and 3 h 46 min 22 s,respectively.The average total time of upper gastrointestinal MCCE examination was 5 h 48 min 35 s.Active magnetic movement of the Ankon capsule through the pylorus was successful in 41.9%of patients.Overall diagnostic yield for detecting abnormalities in the stomach and SB was 81.9%(68.6%minor;13.3%major pathologies);25.8%of abnormalities were in the SB;74.2%were in the stomach.The diagnostic yield for stomach/SB was 55.9%/12.7%for minor and 4.9%/8.4%for major pathologies.CONCLUSION MCCE is a feasible,safe diagnostic method for evaluating gastric mucosal lesions and is a promising non-invasive screening tool to decrease morbidity and mortality in upper gastrointestinal diseases.

Laser-produced plasma helium-like titanium Kα x-ray source and its application to Rayleigh-Taylor instability study

Several experiments are performed on the ShenGuang-Ⅱ laser facility to investigate an x-ray source and test radiography concepts. X-ray lines emitted from laser-produced plasmas are the most practical means of generating these high intensity sources. By using a time-integrated space-resolved keV spectroscope and pinhole camera, potential helium-like titanium Kα x-ray backlighting （radiography） line source is studied as a function of laser wavelength, ratio of pre-pulse intensity to main pulse intensity, and laser intensity （from 7.25 to ～ 11.3 × 10^15 W/cm2）. One-dimensional radiography using a grid consisting of 5 #m Au wires on 16 μm period and the pinhole-assisted point projection is tested. The measurements show that the size of the helium-like titanium Ka source from a simple foil target is larger than 100 ~m, and relative x-ray line emission conversion efficiency ~x from the incident laser light energy to helium- like titanium K-shell spectrum increases significantly with pre-pulse intensity increasing, increases rapidly with laser wavelength decreasing, and increases moderately with main laser intensity increasing. It is also found that a gold gird foils can reach an imaging resolution better than 5-μm featured with high contrast. It is further demonstrated that the pinhole-assisted point projection at such a level will be a novel two-dimensional imaging diagnostic technique for inertial confinement fusion experiments.

Multiplex ligation-dependent probe amplification for rapid detection of deletions and duplications in the dystrophin gene

Objective：Duchenne muscular dystrophy （DMD） and Becker muscular dystrophy （BMD） are X-linked disorders caused by mutations in the dystrophin gene. The majority of recognized mutations are copy number changes of individual exons. The objective of the present study was to assess the multiplex ligation-dependent probe amplification （MLPA） effects of detection of gene mutations. Methods： Samples of 20 control males and 80 males and their mothers referred to our diagnostic facility on the clinical suspi- cion of DMD or BMD were tested by MLPA and multiplex PCR. Results ： The mean DQs for all peak of 20 control male samples was 1.02 （range from 0.83 to 1.21） by MLPA. Deletions or duplications were iden- tified in 6 out of 31 families that had been previously tested as negative by multiplex PCR. One case of complex rearrangement involving a duplication of two regions： dupEX3-9 and dupEX 17-41 were found by MLPA. Conclusions： MLPA is a highly sensitive method and rapid alternative to multiplex PCR for detec- tion of DMD and BMD.

Mucosal patterns of Helicobacter pylori-related gastritis without atrophy in the gastric corpus using standard endoscopy

AIM:To identify the mucosal patterns of Helicobacter pylori(H.pylori )-related gastritis in the gastric corpus using standard endoscopy and to evaluate their reproducibility.METHODS:A total of 112 consecutive patients underwent upper gastrointestinal endoscopy.The endoscopists classified the endoscopic findings into 4 patterns.In the second part of the study,90 images were shown to 3 endoscopists in order to evaluate the inter-observer and intra-observer variability in image assessment.RESULTS:The mucosal patterns of the gastric bodywere categorized into 4 types.Type 1 pattern was defined as cleft-like appearance,type 2 as regular arrangement of red dots,type 3 pattern as the mosaic mucosal pattern and type 4 pattern as the mosaic pattern with a focal area of hyperemia.Type 1 and type 2 mucosal patterns were statistically significant in predicting H.pylorinegative status as compared with other mucosal types(χ 2 = 12.79 and 61.25 respectively,P < 0.01).Type 3 and type 4 mucosal patterns were statistically significant in predicting a H.pylori-positive status as compared with other mucosal types(χ 2 = 21.22 and 11.02 respectively,P < 0.01).Furthermore,the sensitivity,specificity,positive and negative predictive values of type 3 plus type 4 patterns for predicting H.pylori-positive gastric mucosa were 100%,86%,94%,and 100%,respectively.The mean κ values for inter-and intra-observer agreement in assessing the various endoscopic patterns were 0.808(95% CI,0.678-0.938) and 0.826(95% CI,0.727-0.925) respectively.CONCLUSION:Our study suggests that mucosal patterns in H.pylori-infected gastric mucosa without atrophy can be reliably identified using standard endoscopy in the gastric corpus.

The Question of Short Lower Limb and Long Lower in Manual Therapy: An Overview

The purpose of this paper is to review relevant literature concerning limb length inequalities in adults and to make recommendations for assessment and intervention based on the literature and our own clinical experience. The research was carried out on PUB MED, Non-English articles and duplicates in the databases were not included. Limb length inequality and common classification criteria are defined and etiological factors are present. Common methods of detecting limb length inequality include model manual technics. This work has the purpose of describing a well standardized therapeutic in the form of practical guidance. The approach we describe provides standardized model evaluation for leg lower limb in order to be used in rehabilitation clinic.

Cardiac risk stratification of the liver transplant candidate:A comprehensive review

Cardiovascular diseases(CVD)form a principal consideration in patients with end-stage liver disease(ESLD)undergoing evaluation for liver transplant(LT)with prognostic implications in the peri-and post-transplant periods.As the predominant etiology of ESLD continues to evolve,addressing CVD in these patients has become increasingly relevant.Likewise,as the number of LTs increase by the year,the proportion of older adults on the waiting list with competing comorbidities increase,and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles.The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri-and post-transplant periods.The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability.This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization.We hope that this will reinforce the importance of cardiovascular optimization prior to LT,prevent futile LT in those with advanced CVD beyond the stage of optimization,and thereby use the finite resources prudently.

Safety and efficacy of wireless capsule endoscopy in patients with surgically altered upper gastrointestinal anatomy

Background:Wireless capsule endoscopy(WCE)is an effective,minimally invasive tool used for evaluation of the small intestine.To date,there are no studies evaluating the diagnostic yield of WCE in patients with surgically altered upper gastrointestinal anatomy.Aim:To evaluate the diagnostic yield,technical success and safety of WCE in patients with surgically altered upper gastrointestinal anatomy.Methods:Retrospective chart review of all patients with surgically altered upper GI anatomy who underwent WCE between 2006 and 2016 at the Medical University of South Carolina.Technical success,diagnostic yield,adverse events and therapeutic yield data was collected.Results:Thirty-one cases met inclusion criteria.Two were excluded as they did not undergo WCE due to failed patency capsule.The mean age was 58(69%female).The capsule was ingested in 18 cases and endoscopically placed in 11.The most common surgical anatomy was Roux-en-Y gastric bypass(n=13).Technical success,defined as the capsule reaching the cecum,was achieved in 89.7%of cases.The diagnostic yield was 44.8%,with the most common finding being angioectasia.No intra-or postprocedural adverse events were noted.Discussion:Capsule endoscopy in patients with surgically altered upper GI anatomy appears to show no elevated risk of adverse events and shows similar technical success and diagnostic yield as in patients with native anatomy.

The sound of blood:photoacoustic imaging in blood analysis

Blood analysis is a ubiquitous and critical aspect of modern medicine.Analyzing blood samples requires invasive techniques,various testing systems,and samples are limited to relatively small volumes.Photoacoustic imaging(PAI)is a novel imaging modality that utilizes non-ionizing energy that shows promise as an alternative to current methods.This paper seeks to review current applications of PAI in blood analysis for clinical use.Furthermore,we discuss obstacles to implementation and future directions to overcome these challenges.Firstly,we discuss three applications to cellular analysis of blood:sickle cell,bacteria,and circulating tumor cell detection.We then discuss applications to the analysis of blood plasma,including glucose detection and anticoagulation quantification.As such,we hope this article will serve as inspiration for PAI's potential application in blood analysis and prompt further studies to ultimately implement PAI into clinical practice.

Relationship between tissue type plasminogen activator and coronary vulnerable plaque in patients with acute coronary syndrome： virtual histological study

Background The association between vulnerability of plaque assessed with intravascular ultrasound （IVUS） and plasma levels of fibrinolytic biomarkers was determined in patients with acute coronary syndrome （ACS）. However, few data are available on the relationship between the levels of tissue type plasminogen activator （t-PA） and virtual histological intravascular ultrasound （VH-IVUS） signs of plaque instability. Methods Eighty-nine patients with ACS were enrolled in the study. Blood was collected to measure t-PA levels by liquid phase bead flow cytometry. Eighty-nine nonbifurcate lesions （identified by coronary angiography and ECG） were investigated using IVUS before catheterization. IVUS radiofrequency data obtained with a 20 MHz catheter were analyzed with IVUS virtual histological software. The areas of plaque and media were calculated and lesions were classified into two groups： VH-IVUS derived thin cap fibroatheroma （VH-TCFA） and non-VH-TCFA plaque. Results Plasma t-PA level in the patients with TCFA was significantly lower than that with non-TCFA （（1489 ± 715） pg/ml vs （2163 ± 1004） pg/ml）. Decreased plasma levels of t-PA were associated with plaque vulnerability. Plasma levels of t-PA correlated negatively with plaque plus media and necrotic core in plaque in patients with ACS. Conclusions t-PA is an independent risk factor and a powerful predictor of vulnerable plaques. Decreased levels of t-PA may reflect instability of atherosclerotic plaques and might therefore serve as noninvasive determinants of those at high risk for consequent adverse events.