Endoscopic polidocanol foam sclerobanding for the treatment of grade Ⅱ-Ⅲ internal hemorrhoids:A prospective,multi-center,randomized study

BACKGROUND Endoscopic rubber band ligation(ERBL)is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain.AIM To evaluate satisfaction,long-term recurrence,and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL.METHODS This was a prospective,multicenter,randomized study.A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding(EFSB)or an ERBL group.All patients were followed-up for 12 months.Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score(HSS)and a visual analog scale(VAS).Continuous variables were reported as medians and interquartile range.RESULTS One hundred and ninety-five patients were enrolled,with 98 in the EFSB group.HSS was lower in the EFSB group than in the ERBL group at 8 weeks[4.0(3.0-5.0)vs 5.0(4.0-6.0),P=0.003]and 12-month[2.0(1.0-3.0)vs 3.0(2.0-3.0),P<0.001]of follow-up.The prolapse recurrence rate was lower in the EFSB group at 12 months(11.2%vs 21.6%,P=0.038).Multiple linear regression analysis demonstrated that EFSB treatment[B=-0.915,95%confidence interval(CI):−1.301 to−0.530,P=0.001]and rubber band number(B=0.843,95%CI:0.595-1.092,P<0.001)were negatively and independently associated with the VAS score 24 hours post-procedure.The median VAS was lower in the EFSB group than in the ERBL[2.0(1.0-3.0)vs 3.0(2.0-4.0),P<0.001].CONCLUSION Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.

Endoscopic polidocanol foam sclerobanding for the treatment of Grade Ⅱ-Ⅲ internal hemorrhoids:The focus of clinical practice

We have read the article by Qu et al with great interest,as it presents an inte-gration of endoscopic polidocanol foam sclerotherapy with rubber band ligation in patients with Grade Ⅱ-Ⅲ internal hemorrhoids.The authors conducted a prospective,multicenter,randomized study to evaluate the long-term sympto-matic and endoscopic efficacy of this combined intervention.In this discussion,we focus on the procedural steps of this combined strategy and suggest potential avenues for future research.

Redefining hemorrhoid therapy with endoscopic polidocanol foam sclerobanding

Hemorrhoids are a common and painful condition,with conventional treatments such as endoscopic rubber band ligation(ERBL)and injection sclerotherapy often falling short due to high recurrence rates and significant post-operative pain.A clinical trial by Qu et al introduces a novel approach called endoscopic polidocanol foam sclerobanding(EFSB).This multicenter randomized trial involved 195 patients with grade II and III internal hemorrhoids and demonstrated that EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL.The study's strengths include its robust design,comprehensive outcome evaluation,and patient-centered approach.Despite limitations such as the single-blind design and relatively short follow-up period,the findings suggest that EFSB could enhance clinical practice by offering a more effective and patient-friendly treatment option.Further research is needed to validate these results and explore the long-term benefits and cost-effectiveness of EFSB.

药用植物丹参的核型分析和C-banding研究

采用传统的核型分析技术，分析了栽培丹参有丝分裂中期染色体的核型和C—banding。结果表明：丹参中期染色体长度为1．30-2．39μm，核型公式是2n=16=4m＋2sm＋2st，其核型为2A型；单套染色体组显示出19条清晰稳定的C—bands，其中包括13条末端带，1条着丝粒带和5条中间带。

Banding structure formation during directional solidification of Pb-Bi peritectic alloys

Directional solidification experiments on Pb-Bi peritectic alloys were carried out at very low growth rate （v=0.5 μm/s） and high temperature gradient （G=35 K/mm） in an improved Bridgman furnace. The banding structures were observed in both hypoperitectic and hyperperitectic compositions （Pb-xBi, x=26%, 28%, 30% and 34%）. Tree-like primary α phase in the center of the sample surrounded by the peritectic β phase matrix was also observed, resulting from the melt convection. The banding microstructure, however, is found to be transient after the tree-like structure and only the peritectic phase forms after a few bands. Composition variations in the banding structure are measured to determine the nucleation undercooling for both α and β phases. In a finite length sample, convection is shown to lead only to the transient formation of bands. In this transient banding regime, only a few bands with a variable width are formed, and this transient banding process can occur over a wide range of compositions inside the two-phase peritectic region.

A COMPARATIVE STUDY ON KARYOTYPES AND CHROMOSOME BANDING PATTERN OF THREE ODOR FROGS OF Rana

The chromosomes of three odor frogs, Luetuosae- group of Rana were analyzed by conventional, as well as Obanding and silver staining techniques. The three species here examined all had 26 chromosome karyotypes encompassing 5 large and 8 small homologous pairs. Differences among them were found in gross shapes of chromosomes and positions of secondary constrictions. Generally speaking, karyotypes of R. andersonii and R. grahami resembled each other, while the karyotype of R. tiannanensis differed from the former two in several respects.Analyses of karyotypes by C-banding technique indicated that, centromeric areas of every chromosome and interstitial parts of some chromosomes of each species were hetero-chromatinized, and differences of distribution of heterochromatin were found among species. In early metaphase plates of R. andersonii, much more heterochromatinized areas were observed, and when it reached late metaphase, the numbers of heterochromatin sections in each chromosome pair reduced to a limited level, e. g. centromeres and a few interstitial parts.The active nucleolar organizer regions (NORs) were localized in long arms of pair No. 10, in connection with secondary constrictions for R. andersonii and R. grahami as in other odor frogs previously reported, but in the long arm of pair No. 6 for R. tiannanensis.The cytogenetic and taxonomic implications of the findings were discussed based on comparisons with each other, and with published literature.

THE MICROSTRUCTURAL BANDING IN THE CENTER OF HOT ROLLLNG STRIP

The microstructural banding in steels is often found in hot rolling strips, which plays a very important role in mechanical properties. Much work has been done to investigate how the microstructural banding is formed during hot rolling. In the present study, the microstructure of hot rolling strips was examined in term of optical microscopy and transmission electron microscopy. Electron probe microanalysis was also used to decide the distribution of microchemical bands, by this means, the phases in these strips were found to be ferrite and pearlite. The average distance between the carbon lamellas in pearlite is about 0.06-0.1μm. It is also shown that microstructural banding in hot rolled carbon steel was closely related to the segregation of manganese and silicon into those bands. Based on the transformation kinetic, the simulated results pointed out that the thermodynamic stability of austenite would increase with the increasing of Mn, which led to a decrease of ferrite growth rate. The effect of Mn on the decomposition of austenite is attributed to segregation of Mn atoms along the ferrite/austenite phase boundary which causes a strong solute drag effect. The addition of Mn to steel decreases the activity of austenite, thereby it is beneficial to the formation of non-equilibrium phase, such as degenerate pearlite. The formation of banded structure on the hot rolled process was discussed.

Transversus abdominis plane infiltration for laparoscopic gastric banding: A pilot study

AIM: To estimate an effect size for the transversus abdominis plane(TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS: The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40(QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. RESULTS: Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range(IQR)] of 175.5(170-189) com-pared to 170(160-175) in the control group(P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median(IQR) of 7.5(2.5-11.5) mg iv morphine equivalents compared to 13(7-21.5) in the control group(P = 0.07). Correlation analysis(Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores,-0.49(P = 0.03). CONCLUSION: The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.

Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding

AIM:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).METHODS:Data relating to changes in body mass index(BMI)and procedural complications after RYGB(1995-2009;n=609;116M:493F;42.4±0.4 years)or LAGB(2004-2009;n=686;131M:555F;37.2±0.4years)were extracted from prospective databases.RESULTS:Pre-operative BMI was higher in RYGB than LAGB patients(46.8±7.1 kg/m2vs 40.4±4.2 kg/m2,P<001);more patients with BMI<35 kg/m2underwent LAGB than RYGB(17.1%vs 4.1%,P<0.0001).BMI decrease was greater after RYGB.There were direct relationships between weight loss and pre-operative BMI(P<0.001).Although there was no difference in weight loss between genders during the first 3-year post-surgery,male LAGB patients had greater BMI reduction than females(-8.2±4.3 kg/m2vs-3.9±1.9kg/m2,P=0.02).Peri-operative complications occurred more frequently following RYGB than LAGB(8.0%vs0.5%,P<0.001);majority related to wound infection.LAGB had more long-term complications requiring corrective procedures than RYGB(8.9%vs 2.1%,P<0.001).Conversion to RYGB resulted in greater BMI reduction(-9.5±3.8 kg/m2)compared to removal and replacement of the band(-6.0±3.0 kg/m2).Twelve months post-surgery,fasting glucose,total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.CONCLUSION:RYGB produces substantially greater weight loss than LAGB.Whilst peri-operative complications are greater after RYGB,long-term complication rate is higher following LAGB.

Cluster banding heat source model

Concept of duster banding heat source model is put forward for the problem of overmany increment steps in the process of numerical simulation of large welding structures, and expression of cluster banding heat source model is deduced based on energy conservation law. Because the expression of cluster banding heat source model deduced is suitable for random weld width, quantitative analysis of welding stress field for large welding structures which have regular welds can be made quickly.

Guard banding技术在计量校准中的实施探讨

做计量校准时,通常被校对象(UUT)的测量误差接近最大误差限的时候,评估这个校准点是否在允许误差范围内,是有一定困难的。该文探讨在校准工作中,利用Guard banding技术与逐点报告测量不确定度几种实施方法结合,具有一定的参考意义。

Cytogenetic analysis in two scallops (Bivalvia:Pectinidae) by PRINS and PI banding

Cytogenetic analysis was performed for the bay scallop （Argopecten irradians Lamarck 1819） and the Japanese scallop （Patinopecten yessoensis Jay 1857 ） by primed in situ labeling （PRINS） and propidium iodide （PI） banding techniques. The PRINS analysis revealed that major rRNA genes were clustered in two loci on the telomeric regions of the short arms on two acrocentric chromosome pairs in A. irradians and on two submetacentric pairs in P. yessoensis. The histone H3 gene sites differed in number and location between these two species. The C-band-like patterns revealed by PI staining varied considerably between these two species. A. irradians displayed terminal bands at long arms on all chromosomes, centromeric bands on some pairs and interstitial bands on five pairs. P. yessoensis exhibited only centromeric bands on all chromosomes. These results would contribute to the better understanding of karyotype evolution in A. irradians and P. yessoensis.

Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding

AIM: To study the accuracy of using high definition(HD) scope with narrow band imaging(NBI) vs standard white light colonoscope without NBI(ST), to predict the histology of the colon polyps, particularly those < 1 cm.METHODS: A total of 147 African Americans patients who were referred to Howard University Hospital for screening or, diagnostic or follow up colonoscopy, during a 12-mo period in 2012 were prospectively recruited. Some patients had multiple polyps and total number of polyps was 179. Their colonoscopies were performed by 3 experienced endoscopists who determined the size and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care. RESULTS: Of participants in the study, 55(37%) were male and median(interquartile range) of age was 56(19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were < 1 cm vs 87% in HD scope(P = 0.7). The ST scope had a positive predictive value(PPV) and positive likelihood ratio(PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope(68%) compare to ST scope(53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp(HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar.CONCLUSION: Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.

Rare cause of dysphagia after esophageal variceal banding: A case report

BACKGROUND Esophageal varices are a result of progressive liver disease and portal hypertension. Treatment can be performed with band ligation versus nonselective beta blockers depending on the size of varices, ability to tolerate medications and history of variceal bleeding. Band ligation is an effective intervention with rare but serious complications including bleeding, ulcers and rarely obstruction. Few cases of esophageal obstruction and necrosis caused by banding have been reported, each with varied management from conservative treatment to band removal.CASE SUMMARY An 89 years old woman with a past medical history of nonalcoholic steatohepatitis cirrhosis presented to the hospital with an inability to swallow one day after screening esophagogastroduodenoscopy where band ligation of esophageal varices was performed for primary prophylaxis. The patient was not able to tolerate her oral secretions. Initial blood work revealed a Model of End Organ Liver Disease score of 7. She was treated with sublingual nitroglycerin for esophageal spasm, a known complication after esophageal banding. When she failed to improve, esophagogastroduodenoscopy was performed and revealed the mucosa surrounding the banded varix was necrosed and blocking the lumen of the esophagus. The band was purposefully dislodged, revealing distal ulceration and stricturing. Within 72 h after band removal, she was tolerating an oral diet. Endoscopy performed 2 wk later revealed an intrinsic stenosis,measuring 8 mm in diameter by 1 cm in length, which was dilated.CONCLUSION Esophageal obstruction is a complication of variceal banding that should be considered in patients with inability to tolerate oral diet after banding.

Deformation banding in β working of two-phase TA15 titanium alloy

To study deformation banding inβworking of TA15titanium alloy,hot simulation compression experiments were carried out on a Gleeble3500thermal simulator,and the microstructure was investigated by optical microscopy(OM)and electron backscattered diffraction(EBSD).It is found that inβworking of TA15titanium alloy,deformation banding is still an important grain refinement mechanism up to temperature as high as0.7Tm(Tm is the melting temperature).Boundaries of deformation bands(DBBs)may be sharp or diffusive.Sharp DBBs retard discontinuous dynamic recrystallization(DDRX)by prohibiting nucleation,while the diffusive ones are sources of continuous dynamic recrystallization(CDRX).Deformation banding is more significant at high strain rate and large initial grain size.The average width of grain subdivisions is sensitive to strain rate but less affected by temperature and initial grain size.Multi-directional forging which produces crossing DDBs is potential to refine microstructure of small-size forgings.

Chromosome G-banding in SituHybridization of RFLP Marker umc58 Linked with the Gene hm1 Dictating Helminthosporium carbonum Susceptibility1 in Maize

The technique of simultaneous G banding and in situ hybridization has been developed in plants for the first time.Using this technique.RFLP marker umc58 closely linked with the hm1 gene dictating Helminthosporium carbonum susceptibility1 was localized onto 1L3(chromosome 1,long arm,the third band from the centromere to the end of the arm),5L5 and 9L5.Theresults demonstrated that umc58 was a tripli cated sequence.It was deduced that umc58 probably was in a duplicated region that includes a part of Helminthosporium carbonum susceptibility genes(hm1 and hm2),as the hybridization sites of umc58 in chro mosomes 1 and 9 were those at which the genes localize.The techniques of simultaneous G banding and ISH in plants are discussed.

P1 of strawberry vein banding virus, a multilocalized protein, functions as a movement protein and interacts with the coat protein

Although the complete nucleotide sequence of strawberry vein banding virus(SVBV) has been determined and bioinformatic analysis has revealed that the SVBV genome could encode seven proteins, the precise function of each protein is unclear. This study provided evidence that the P1 protein of SVBV(SVBV-P1) possesses the following features. Bioinformatic and subcellular localization analyses showed that SVBV-P1 is localized in the cytoplasm and cell walls of epidermal cells in Nicotiana benthamiana, and it forms inclusion bodies associated with microtubules and the endoplasmic reticulum. Dilution experiments demonstrated that SVBV-P1 could move from the original agro-infiltrated cells to adjacent cells in N. benthamiana leaves. Further trans-complementation experiments demonstrated that SVBV-P1 could facilitate the intercellular movement of a movement-deficient potato virus X mutant in N. benthamiana leaves. Finally, yeast twohybrid and bimolecular fluorescence complementation assays revealed that SVBV-P1 could interact with the SVBV coat protein, which is a major component of Caulimovirus virions. Results of the electrophoretic mobility shift assay indicated that SVBV-P1 lacks DNA-binding capability. In summary, the results suggest that SVBV-P1 is probably a movement protein of SVBV, providing new insights into the function of movement proteins of the Caulimovirus genus.

Failure transition of shear-to-dilation band of rock salt under triaxial stresses

Great potential of underground gas/energy storage in salt caverns seems to be a promising solution to support renewable energy.In the underground storage method,the operating cycle unfortunately may reach up to daily or even hourly,which generates complicated pressures on the salt cavern.Furthermore,the mechanical behavior of rock salt may change and present distinct failure characteristics under different stress states,which affects the performance of salt cavern during the time period of full service.To reproduce a similar loading condition on the cavern surrounding rock mass,the cyclic triaxial loading/unloading tests are performed on the rock salt to explore the mechanical transition behavior and failure characteristics under different confinement.Experimental results show that the rock salt samples pre-sent a diffused shear failure band with significant bulges at certain locations in low confining pressure conditions(e.g.5 MPa,10 MPa and 15 MPa),which is closely related to crystal misorientation and grain boundary sliding.Under the elevated confinement(e.g.20 MPa,30 MPa and 40 MPa),the dilation band dominates the failure mechanism,where the large-size halite crystals are crushed to be smaller size and new pores are developing.The failure transition mechanism revealed in the paper provides additional insight into the mechanical performance of salt caverns influenced by complicated stress states.

Splenic artery ligature associated with endoscopic banding for schistosomal portal hypertension

AIM: To propose a less invasive surgical treatment for schistosomal portal hypertension.