BACKGROUND Gastric wall necrosis is a rare complication of endoscopic treatment for bleeding gastric ulcer,which may exacerbate the patient’s condition once it occurs and may even require surgical intervention for tr...BACKGROUND Gastric wall necrosis is a rare complication of endoscopic treatment for bleeding gastric ulcer,which may exacerbate the patient’s condition once it occurs and may even require surgical intervention for treatment.CASE SUMMARY A 59-year-old man was admitted to our department with melena.Endoscopy revealed a giant ulcer in the gastric antrum with a visible vessel in its center,which was treated with sclerosants and tissue glue injection and resulted in necrosis of the gastric wall.CONCLUSION Injection of sclerosants and tissue glue may lead to gastric wall necrosis,which is a serious complication.Therefore,before administering this treatment to patients,we should consider other more effective methods of hemostasis to avoid gastric wall necrosis.展开更多
In the last decades,the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic interventions.Surgical pro...In the last decades,the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic interventions.Surgical procedures can be avoided in many cases by using endoscopically placed,Endoscopic ultrasonography-guided techniques and drainages.Endoscopic ultrasound enables the placement of transmural plastic and metal stents or nasocystic tubes for the drainage of peripancreatic fluid collections.The development of selfexpanding metal stents and exchange free delivering systems have simplified the drainage of pancreatic fluid collections.This review will discuss available therapeutic techniques and new developments.展开更多
We report a successful endoscopic ultrasonographyguided drainage of a huge infected multilocular walledoff necrosis(WON) that was treated by a modified single transluminal gateway transcystic multiple drainage(SGTMD) ...We report a successful endoscopic ultrasonographyguided drainage of a huge infected multilocular walledoff necrosis(WON) that was treated by a modified single transluminal gateway transcystic multiple drainage(SGTMD) technique. After placing a widecaliber fully covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula that was created by the wide-caliber metal stent enabled the insertion of a forward-viewing upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity. This modified SGTMD technique appears to be useful for seeking connection routes between subcavities of WON in some cases.展开更多
Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This critical review provides an overview of the cont...Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This critical review provides an overview of the continually expanding knowledge about WOPN, by review of current data from references identified in Medline and PubMed, to September 2009, using key words, such as WOPN, infected pseudocyst, severe pancreatitis, pancreatic abscess, acute necrotizing pancreatitis (ANP), pancreas, inflammation and alcoholism. WOPN comprises a later and local complication of ANP, occurring more than 4 wk after the initial attack, usually following development of pseudocysts and other pancreatic fluid collections. The mortality rate associated with WOPN is generally less than that of infected pancreatic necrosis. Surgical intervention had been the mainstay of treatment for infected peripancreatic fluid collection and abscesses for decades. Increasingly, percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography have been used, and encourag-ing results have recently been reported in the medical literature, rendering these techniques invaluable in the treatment of WOPN. Applying the recommended therapeutic strategy, which comprises early treatment with antibiotics combined with restricted surgical intervention, fewer patients with ANP undergo surgery and interventions are ideally performed later in the course of the disease, when necrosis has become well demarcated.展开更多
The ultimate reason why pancreatologists have strived to establish definitions for inflammatory pathologies of the pancreas is to improve patient care.Although the Atlanta Classification has been used for around for 1...The ultimate reason why pancreatologists have strived to establish definitions for inflammatory pathologies of the pancreas is to improve patient care.Although the Atlanta Classification has been used for around for 17 years,considerable misunderstanding of the key elements of the nomenclature still persists.While a recent article by Stamatakos et al aimed to deal with an entity not clearly def ined in the 1993 document,it is replete with factual and conceptual errors as well as contradictory statements.展开更多
BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of ...BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi. CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection. CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.展开更多
BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potential...BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potentially fatal condition.We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome.After three operations,the neonate survived and subsequently showed normal growth and development during infancy.CASE SUMMARY A male neonate(age:4 d)was hospitalized due to bloody stools and vomiting for 2 d,and abdominal distention for 1 d.Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops.Bowel alignment was abnormal with congestion and dilatation of the entire intestine,and clockwise mesentery volvulus(720°).The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer(approximately 5.5 cm),and a circular perforation(approximately 3 cm diameter)at the center of this defect.Ladd’s procedure was performed and gastric wall defect was repaired.Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum,and adhesion angulated between many small intestinal loops.We performed intestinal adhesiolysis,resection of necrotic intestine,and small bowel anastomosis.CONCLUSION This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines,and improve patient prognosis.展开更多
In a microfluidic system, flow slip velocity on a solid wall can be the same order of magnitude as the average velocity in a microchannel. The flow-electricity interaction in a complex microfluidic system subjected to...In a microfluidic system, flow slip velocity on a solid wall can be the same order of magnitude as the average velocity in a microchannel. The flow-electricity interaction in a complex microfluidic system subjected to joint action of wall slip and electro-viscous effect is an important topic. This paper presents an analytic solution of pressuredriven liquid flow velocity and flow-induced electric field in a two-dimensional microchannel made of different materials with wall slip and electro-viscous effects. The Poisson- Boltzmann equation and the Navier-Stokes equation are solved for the analytic solutions. The analytic solutions agree well with the numerical solutions. It was found that the wall slip amplifies the fow-induced electric field and enhances the electro-viscous effect on flow. Thus the electro-viscous effect can be significant in a relatively wide microchannel with relatively large kh, the ratio of channel width to thickness of electric double layer, in comparison with the channel without wall slip.展开更多
To investigate the chemical structure of cell wall mannan obtained from pathogenic yeast, Candida tropicalis NBRC 1400 (former antigenic standard strain, IFO 1400). As a result of two-dimensional NMR analysis, it was ...To investigate the chemical structure of cell wall mannan obtained from pathogenic yeast, Candida tropicalis NBRC 1400 (former antigenic standard strain, IFO 1400). As a result of two-dimensional NMR analysis, it was shown that the mannan of this strain is composed of α-1,6-, α-1,3-, α-1,2- and β-1,2-linked mannose residues. In this research, the mannan was subjected to three degradation procedures, acid-treatment, α-mannosidase, and acetolysis under two conditions in order to determine the chemical structure of the antigenic oligomannosyl side chains in this molecule. The 1H-nuclear magnetic resonance spectra of resultant oligosaccharides, pentaose and hexaose, demonstrated the existence of the oligomannosyl side chains corresponding to Manα1-3Manα1-2Manα1-2Manα1-2Man and Manα1-3Manα1-2Manα1-2Manα1-2Manα1-2Man, respectively, which have previously also been found in Candida albicans serotype A strain mannans. These findings indicate that C. tropicalis and C. albicans serotype A have no significant difference in the chemical structure of these cell wall mannans. Therefore, it can be interpreted that it is extremely difficult to distinguish both species by targeting the antigenic group in these mannans.展开更多
The preparation, characterization, and test of the first wall materials designed to be used in the fusion reactor have remained challenging problems in the material science. This work uses the firstprinciples method a...The preparation, characterization, and test of the first wall materials designed to be used in the fusion reactor have remained challenging problems in the material science. This work uses the firstprinciples method as implemented in the CASTEP package to study the influ ences of the doped titanium carbide on the structural sta bility of the WTiC material. The calculated total energy and enthalpy have been used as criteria to judge the structural models built with consideration of symmetry. Our simulation indicates that the doped TiC tends to form its own domain up to the investigated nanoscale, which implies a possible phase separation. This result reveals the intrinsic reason for the composite nature of the WTiC material and provides an explanation for the experimen tally observed phase separation at the nanoscale. Our approach also sheds a light on explaining the enhancing effects of doped components on the durability, reliability, corrosion resistance, etc., in many special steels.展开更多
基金Supported by Shenzhen Science and Technology Research and Development Fund,No.JSGG20210802153548040.
文摘BACKGROUND Gastric wall necrosis is a rare complication of endoscopic treatment for bleeding gastric ulcer,which may exacerbate the patient’s condition once it occurs and may even require surgical intervention for treatment.CASE SUMMARY A 59-year-old man was admitted to our department with melena.Endoscopy revealed a giant ulcer in the gastric antrum with a visible vessel in its center,which was treated with sclerosants and tissue glue injection and resulted in necrosis of the gastric wall.CONCLUSION Injection of sclerosants and tissue glue may lead to gastric wall necrosis,which is a serious complication.Therefore,before administering this treatment to patients,we should consider other more effective methods of hemostasis to avoid gastric wall necrosis.
文摘In the last decades,the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic interventions.Surgical procedures can be avoided in many cases by using endoscopically placed,Endoscopic ultrasonography-guided techniques and drainages.Endoscopic ultrasound enables the placement of transmural plastic and metal stents or nasocystic tubes for the drainage of peripancreatic fluid collections.The development of selfexpanding metal stents and exchange free delivering systems have simplified the drainage of pancreatic fluid collections.This review will discuss available therapeutic techniques and new developments.
基金Supported by The Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy,No.22590764 and No.25461035
文摘We report a successful endoscopic ultrasonographyguided drainage of a huge infected multilocular walledoff necrosis(WON) that was treated by a modified single transluminal gateway transcystic multiple drainage(SGTMD) technique. After placing a widecaliber fully covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula that was created by the wide-caliber metal stent enabled the insertion of a forward-viewing upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity. This modified SGTMD technique appears to be useful for seeking connection routes between subcavities of WON in some cases.
文摘Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This critical review provides an overview of the continually expanding knowledge about WOPN, by review of current data from references identified in Medline and PubMed, to September 2009, using key words, such as WOPN, infected pseudocyst, severe pancreatitis, pancreatic abscess, acute necrotizing pancreatitis (ANP), pancreas, inflammation and alcoholism. WOPN comprises a later and local complication of ANP, occurring more than 4 wk after the initial attack, usually following development of pseudocysts and other pancreatic fluid collections. The mortality rate associated with WOPN is generally less than that of infected pancreatic necrosis. Surgical intervention had been the mainstay of treatment for infected peripancreatic fluid collection and abscesses for decades. Increasingly, percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography have been used, and encourag-ing results have recently been reported in the medical literature, rendering these techniques invaluable in the treatment of WOPN. Applying the recommended therapeutic strategy, which comprises early treatment with antibiotics combined with restricted surgical intervention, fewer patients with ANP undergo surgery and interventions are ideally performed later in the course of the disease, when necrosis has become well demarcated.
文摘The ultimate reason why pancreatologists have strived to establish definitions for inflammatory pathologies of the pancreas is to improve patient care.Although the Atlanta Classification has been used for around for 17 years,considerable misunderstanding of the key elements of the nomenclature still persists.While a recent article by Stamatakos et al aimed to deal with an entity not clearly def ined in the 1993 document,it is replete with factual and conceptual errors as well as contradictory statements.
文摘BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi. CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection. CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.
文摘BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potentially fatal condition.We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome.After three operations,the neonate survived and subsequently showed normal growth and development during infancy.CASE SUMMARY A male neonate(age:4 d)was hospitalized due to bloody stools and vomiting for 2 d,and abdominal distention for 1 d.Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops.Bowel alignment was abnormal with congestion and dilatation of the entire intestine,and clockwise mesentery volvulus(720°).The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer(approximately 5.5 cm),and a circular perforation(approximately 3 cm diameter)at the center of this defect.Ladd’s procedure was performed and gastric wall defect was repaired.Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum,and adhesion angulated between many small intestinal loops.We performed intestinal adhesiolysis,resection of necrotic intestine,and small bowel anastomosis.CONCLUSION This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines,and improve patient prognosis.
基金supported by the National Natural Science Foundation of China(10872076)
文摘In a microfluidic system, flow slip velocity on a solid wall can be the same order of magnitude as the average velocity in a microchannel. The flow-electricity interaction in a complex microfluidic system subjected to joint action of wall slip and electro-viscous effect is an important topic. This paper presents an analytic solution of pressuredriven liquid flow velocity and flow-induced electric field in a two-dimensional microchannel made of different materials with wall slip and electro-viscous effects. The Poisson- Boltzmann equation and the Navier-Stokes equation are solved for the analytic solutions. The analytic solutions agree well with the numerical solutions. It was found that the wall slip amplifies the fow-induced electric field and enhances the electro-viscous effect on flow. Thus the electro-viscous effect can be significant in a relatively wide microchannel with relatively large kh, the ratio of channel width to thickness of electric double layer, in comparison with the channel without wall slip.
文摘To investigate the chemical structure of cell wall mannan obtained from pathogenic yeast, Candida tropicalis NBRC 1400 (former antigenic standard strain, IFO 1400). As a result of two-dimensional NMR analysis, it was shown that the mannan of this strain is composed of α-1,6-, α-1,3-, α-1,2- and β-1,2-linked mannose residues. In this research, the mannan was subjected to three degradation procedures, acid-treatment, α-mannosidase, and acetolysis under two conditions in order to determine the chemical structure of the antigenic oligomannosyl side chains in this molecule. The 1H-nuclear magnetic resonance spectra of resultant oligosaccharides, pentaose and hexaose, demonstrated the existence of the oligomannosyl side chains corresponding to Manα1-3Manα1-2Manα1-2Manα1-2Man and Manα1-3Manα1-2Manα1-2Manα1-2Manα1-2Man, respectively, which have previously also been found in Candida albicans serotype A strain mannans. These findings indicate that C. tropicalis and C. albicans serotype A have no significant difference in the chemical structure of these cell wall mannans. Therefore, it can be interpreted that it is extremely difficult to distinguish both species by targeting the antigenic group in these mannans.
基金finantially supported by the Science Foundation for International Cooperation of Sichuan Province (2014HH0016)the Fundamental Research Funds for the Central Universities (SWJTU2014: A0920502051113-10000)National Magnetic Confinement Fusion Science Program (2011GB112001)
文摘The preparation, characterization, and test of the first wall materials designed to be used in the fusion reactor have remained challenging problems in the material science. This work uses the firstprinciples method as implemented in the CASTEP package to study the influ ences of the doped titanium carbide on the structural sta bility of the WTiC material. The calculated total energy and enthalpy have been used as criteria to judge the structural models built with consideration of symmetry. Our simulation indicates that the doped TiC tends to form its own domain up to the investigated nanoscale, which implies a possible phase separation. This result reveals the intrinsic reason for the composite nature of the WTiC material and provides an explanation for the experimen tally observed phase separation at the nanoscale. Our approach also sheds a light on explaining the enhancing effects of doped components on the durability, reliability, corrosion resistance, etc., in many special steels.
