Traction power systems(TPSs)play a vital role in the operation of electrified railways.The transformation of conventional railway TPSs to novel structures is not only a trend to promote the development of electrified ...Traction power systems(TPSs)play a vital role in the operation of electrified railways.The transformation of conventional railway TPSs to novel structures is not only a trend to promote the development of electrified railways toward high-efficiency and resilience but also an inevitable requirement to achieve carbon neutrality target.On the basis of sorting out the power supply structures of conventional AC and DC modes,this paper first reviews the characteristics of the existing TPSs,such as weak power supply flexibility and low-energy efficiency.Furthermore,the power supply structures of various TPSs for future electrified railways are described in detail,which satisfy longer distance,low-carbon,high-efficiency,high-reliability and high-quality power supply requirements.Meanwhile,the application prospects of different traction modes are discussed from both technical and economic aspects.Eventually,this paper introduces the research progress of mixed-system electrified railways and traction power supply technologies without catenary system,speculates on the future development trends and challenges of TPSs and predicts that TPSs will be based on the continuous power supply mode,employing power electronic equipment and intelligent information technology to construct a railway comprehensive energy system with renewable energy.展开更多
Dear Editor,We report a case of optic disc pit(ODP)associated with vitreomacular traction which has been successfully treated by a combined technique.We have obtained the written informed consent from the patient,and ...Dear Editor,We report a case of optic disc pit(ODP)associated with vitreomacular traction which has been successfully treated by a combined technique.We have obtained the written informed consent from the patient,and this case study is in accordance with the tenets of the Declaration of Helsinki.展开更多
This paper proposes a longitudinal protection scheme utilizing empirical wavelet transform(EWT)for a through-type cophase traction direct power supply system,where both sides of a traction network line exhibit a disti...This paper proposes a longitudinal protection scheme utilizing empirical wavelet transform(EWT)for a through-type cophase traction direct power supply system,where both sides of a traction network line exhibit a distinctive boundary structure.This approach capitalizes on the boundary’s capacity to attenuate the high-frequency component of fault signals,resulting in a variation in the high-frequency transient energy ratio when faults occur inside or outside the line.During internal line faults,the high-frequency transient energy at the checkpoints located at both ends surpasses that of its neighboring lines.Conversely,for faults external to the line,the energy is lower compared to adjacent lines.EWT is employed to decompose the collected fault current signals,allowing access to the high-frequency transient energy.The longitudinal protection for the traction network line is established based on disparities between both ends of the traction network line and the high-frequency transient energy on either side of the boundary.Moreover,simulation verification through experimental results demonstrates the effectiveness of the proposed protection scheme across various initial fault angles,distances to faults,and fault transition resistances.展开更多
Background: Testicular atrophy is recurrent after orchidopexy for intra-abdominal cryptorchidism due to damage to vessels. Fowlers-Stephens and Shehata methods proposed staged orchidopexy, but are still associated to ...Background: Testicular atrophy is recurrent after orchidopexy for intra-abdominal cryptorchidism due to damage to vessels. Fowlers-Stephens and Shehata methods proposed staged orchidopexy, but are still associated to a rate of atrophy greater than 10%. Purpose: We set out to present a new technique that preserves testicular vessels. Our study is aimed at investigating testicular vitality after surgery. Patients and Method: We reviewed files of boys who underwent orchidopexy for 2 years in our department. Those who have been operated for intra-abdominal cryptorchidism with the new technique and aged between 6 months and 14 years old were included in our study. We excluded boys who have been operated before 6 months and after 14 years old and those who did not respect their follow-up plane. Ultrasound (US) outcomes were used to measure testicular volumes and blood flow at each postoperative visit. The Sample population was divided into group A and group B representing testes that were followed respectively for 12 and 24 months. Results: 22 boys with 25 testes were included in our study;11 testes in group A and 14 testes in group B. In each group, we noted a significant difference of UDT volumes from the third month after surgery with respective P-values 0.05. There was no statistical difference between UDT and contra lateral testes volumes 12 months after surgery in group A and 24 months in group B with respective P-values of 0.07 and 0.72. All volume differential indexes were Conclusion: This method offers a new perspective in performing safe orchidopexy for intra abdominal undescended testes.展开更多
Increasing attention has been paid to the efficiency improvement of the induction traction system of high-speed trains due to the high demand for energy saving. In emergency self-propelled mode, however, the dc-link v...Increasing attention has been paid to the efficiency improvement of the induction traction system of high-speed trains due to the high demand for energy saving. In emergency self-propelled mode, however, the dc-link voltage and the traction power of the motor are significantly reduced, resulting in decreased traction efficiency due to the low load and low speed operations. Aiming to tackle this problem, a novel efficiency improved control method is introduced to the emergency mode of high-speed train traction system in this paper. In the proposed method, a total loss model of induction motor considering the behaviors of both iron and copper loss is established. An improved iterative algorithm with decreased computational burden is then introduced, resulting in a fast solving of the optimal flux reference for loss minimization at each control period. In addition, considering the parameter variation problem due to the low load and low speed operations, a parameter estimation method is integrated to improve the controller's robustness. The effectiveness of the proposed method on efficiency improvement at low voltage and low load conditions is demonstrated by simulated and experimental results.展开更多
BACKGROUND Complex and high-risk surgical complications pose pressing challenges in the clinical implementation and advancement of endoscopic full-thickness resection(EFTR).Successful perforation repair under endoscop...BACKGROUND Complex and high-risk surgical complications pose pressing challenges in the clinical implementation and advancement of endoscopic full-thickness resection(EFTR).Successful perforation repair under endoscopy,thereby avoiding surgical intervention and postoperative complications such as peritonitis,are pivotal for effective EFTR.AIM To investigate the effectiveness and safety of EFTR assisted by distal serosal inversion under floss traction in gastric submucosal tumors.METHODS A retrospective analysis of patients with gastric and duodenal submucosal tumors treated with EFTR assisted by the distal serosa inversion under dental floss traction from January 2023 to January 2024 was conducted.The total operation time,tumor dissection time,wound closure time,intraoperative bleeding volume,length of hospital stay and incidence of complications were analyzed.RESULTS There were 93 patients,aged 55.1±12.1 years.Complete tumor resection was achieved in all cases,resulting in a 100% success rate.The average total operation time was 67.4±27.0 min,with tumor dissection taking 43.6±20.4 min.Wound closure times varied,with gastric body closure time of 24.5±14.1 min and gastric fundus closure time of 16.6±8.7 min,showing a significant difference(P<0.05).Intraoperative blood loss was 2.3±4.0 mL,and average length of hospital stay was 5.7±1.9 d.There was no secondary perforation after suturing in all cases.The incidence of delayed bleeding was 2.2%,and the incidence of abdominal infection was 3.2%.No patient required other surgical intervention during and after the operation.CONCLUSION Distal serosal inversion under dental-floss-assisted EFTR significantly reduced wound closure time and intraoperative blood loss,making it a viable approach for gastric submucosal tumors.展开更多
High-level opening up and policies to attract foreign direct investment(FDI)were hot topics during the annual sessions of the National People’s Congress(NPC)and the Chinese People’s Political Consultative Conference...High-level opening up and policies to attract foreign direct investment(FDI)were hot topics during the annual sessions of the National People’s Congress(NPC)and the Chinese People’s Political Consultative Conference(CPPCC)National Committee,China’s key annual political meetings commonly known as Two Sessions.展开更多
Endoscopic submucosal dissection(ESD)procedure has a longer procedure time and higher perforation rate than endoscopic mucosal resection owing to technical complications,including a poor field of vision and inadequate...Endoscopic submucosal dissection(ESD)procedure has a longer procedure time and higher perforation rate than endoscopic mucosal resection owing to technical complications,including a poor field of vision and inadequate tension for the submucosal dissection plane.Various traction devices were developed to secure the visual field and provide adequate tension for the dissection plane.Two randomized controlled trials demonstrated that traction devices reduce colorectal ESD procedure time compared with conventional ESD(C-ESD),but they had limitations,including a single-center fashion.The CONNECT-C trial was the first multicenter randomized controlled trial comparing the C-ESD and traction device-assisted ESD(T-ESD)for colorectal tumors.In the T-ESD,one of the device-assisted traction methods(S-O clip,clip-with-line,and clip pulley)was chosen according to the operator’s discretion.The median ESD procedure time(primary endpoint)was not significantly different between C-ESD and T-ESD.For lesions≥30 mm in diameter or in cases treated by nonexpert operators,the median ESD procedure time tended to be shorter in T-ESD than in C-ESD.Although T-ESD did not reduce ESD procedure time,the CONNECT-C trial results suggest that T-ESD is effective for larger lesions and nonexpert operators in colorectal ESD.Compared with esophageal and gastric ESD,colorectal ESD has some difficulties,including poor endoscope maneuverability,which may be associated with prolonged ESD procedure time.T-ESD may not effectively improve these issues,but a balloon-assisted endoscope and underwater ESD may be promising options and these methods can be combined with T-ESD.展开更多
This paper presents the design optimization of a self-circulated ventilation system for an enclosed permanent magnet(PM)traction motor utilized in the propulsion systems for subway trains.In order to analyze accuratel...This paper presents the design optimization of a self-circulated ventilation system for an enclosed permanent magnet(PM)traction motor utilized in the propulsion systems for subway trains.In order to analyze accurately the machine's inherent cooling capacity when the train is running,the ambient airflow and the related heat transfer coefficient(HTC)are numerically investigated considering synchronously the bogie installation structure.The machine is preliminary cooled with air ducts set on the motor shell,and the fluidic-thermal field distributions with only the shell air duct cooling are numerically calculated.During simulations,the HTC obtained in the former steps is applied to the external surface of the machine to model the inherent cooling characteristic caused by the train movement.To reduce the temperature rise and thus guarantee the motor's working reliability,an internal self-circulated air cooling system is proposed according to the machine temperature distribution.The air enclosed in the end-caps is driven by the blades mounted on both sides of the rotor core and forms two air circuits to bring the excessive power losses generated in the heating components to cool regions.The fluid flow and temperature rise distributions of the cooling system's structural parameters are further improved by the Taguchi method in order to confirm the efficacy of the internal air cooling system.展开更多
AIM:To analyze the global scientific output concerning myopic traction maculopathy(MTM)and to summarize the research frontiers and hot topics of MTM related researches.METHODS:Data were collected for bibliometric and ...AIM:To analyze the global scientific output concerning myopic traction maculopathy(MTM)and to summarize the research frontiers and hot topics of MTM related researches.METHODS:Data were collected for bibliometric and visualization analyses from Web of Science(WOS)Core Collection.Exported records were analyzed for titles,publication years,research institutions,journal names,authors,keywords,and abstracts using CiteSpace software version 6.1.RESULTS:A total of 839 related studies were analyzed,the publication volume increased annually,with Asia the most active region of MTM research.Optical coherence tomography angiography,optical coherence tomography,macular hole,high myopia,macular buckling were identified as the focus of the current research.Progression,association,classification and shape were identified as the major research frontiers.CONCLUSION:MTM is a major cause of visual loss in pathological myopic eyes.During the preceding 17y,the number of annual publications in MTM research increased gradually.Studies on the progression nature of MTM,genome-wide association study and proper classification of MTM might still be the frontiers of MTM researches.展开更多
Trauma to the external genitalia by tearing is rare. We report the case of a 30-year-old patient, admitted to the emergency room for trauma of the external genitalia by traction following a blow and intentional injury...Trauma to the external genitalia by tearing is rare. We report the case of a 30-year-old patient, admitted to the emergency room for trauma of the external genitalia by traction following a blow and intentional injury. The authors highlight the lesions that can occur during this type of trauma and insist on the systematic search for urethral and cavernous lesions. Conclusion: Trauma to the external genitalia by intentional assault and battery is rare in our context. They occur most often in a young person and are frequently associated with damage to the corpora cavernosa and urethra.展开更多
Different traction devices that can provide a visual field and attain appropriate tension at the dissection plane during endoscopic submucosal dissection(ESD)have been developed.Clip-with-line(CWL)is a classic tractio...Different traction devices that can provide a visual field and attain appropriate tension at the dissection plane during endoscopic submucosal dissection(ESD)have been developed.Clip-with-line(CWL)is a classic traction device that can offer per-oral traction toward the direction where the line is drawn.A multicenter randomized controlled trial(CONNECT-E trial)comparing the conventional ESD and CWL-assisted ESD(CWL-ESD)for large esophageal tumors was conducted in Japan.This study showed that CWL-ESD was associated with a shorter procedure time(defined as the time from initiating submucosal injection to completing tumor removal)without increasing the risk of adverse events.Multivariate analysis revealed that whole-circumferential lesion and abdominal esophageal lesion were independent risk factors for technical difficulties,which were defined as a procedure time of>120 min,perforation,piecemeal resection,inadvertent incision(any accidental incision caused by the electrosurgical knife within the marked area),or handover to another operator.Therefore,techniques other than CWL should be considered for these lesions.Several studies have shown the usefulness of endoscopic submucosal tunnel dissection(ESTD)for such lesions.A randomized controlled trial conducted at five Chinese institutions showed that compared with the conventional ESD,ESTD had a significantly reduced median procedure time for lesions covering≥1/2 of the esophageal circumference.In addition,a propensity score matching analysis conducted at a single Chinese institution showed that compared with the conventional ESD,ESTD had a shorter mean resection time for lesions at the esophagogastric junction.With the appropriate use of CWL-ESD and ESTD,esophageal ESD can be performed more efficiently and safely.Moreover,the combination of these two methods may be effective.展开更多
基金supported in part by the Scientific Foundation for Outstanding Young Scientists of Sichuan under Grant No.2021JDJQ0032in part by the National Natural Science Foundation of China under Grant No.52107128in part by the Natural Science Foundation of Sichuan Province under Grant No.2022NSFSC0436.
文摘Traction power systems(TPSs)play a vital role in the operation of electrified railways.The transformation of conventional railway TPSs to novel structures is not only a trend to promote the development of electrified railways toward high-efficiency and resilience but also an inevitable requirement to achieve carbon neutrality target.On the basis of sorting out the power supply structures of conventional AC and DC modes,this paper first reviews the characteristics of the existing TPSs,such as weak power supply flexibility and low-energy efficiency.Furthermore,the power supply structures of various TPSs for future electrified railways are described in detail,which satisfy longer distance,low-carbon,high-efficiency,high-reliability and high-quality power supply requirements.Meanwhile,the application prospects of different traction modes are discussed from both technical and economic aspects.Eventually,this paper introduces the research progress of mixed-system electrified railways and traction power supply technologies without catenary system,speculates on the future development trends and challenges of TPSs and predicts that TPSs will be based on the continuous power supply mode,employing power electronic equipment and intelligent information technology to construct a railway comprehensive energy system with renewable energy.
文摘Dear Editor,We report a case of optic disc pit(ODP)associated with vitreomacular traction which has been successfully treated by a combined technique.We have obtained the written informed consent from the patient,and this case study is in accordance with the tenets of the Declaration of Helsinki.
基金supported by the National Natural Science Foundation of China(51767012)Curriculum Ideological and Political Connotation Construction Project of Kunming University of Science and Technology(2021KS009)Kunming University of Science and Technology Online Open Course(MOOC)Construction Project(202107).
文摘This paper proposes a longitudinal protection scheme utilizing empirical wavelet transform(EWT)for a through-type cophase traction direct power supply system,where both sides of a traction network line exhibit a distinctive boundary structure.This approach capitalizes on the boundary’s capacity to attenuate the high-frequency component of fault signals,resulting in a variation in the high-frequency transient energy ratio when faults occur inside or outside the line.During internal line faults,the high-frequency transient energy at the checkpoints located at both ends surpasses that of its neighboring lines.Conversely,for faults external to the line,the energy is lower compared to adjacent lines.EWT is employed to decompose the collected fault current signals,allowing access to the high-frequency transient energy.The longitudinal protection for the traction network line is established based on disparities between both ends of the traction network line and the high-frequency transient energy on either side of the boundary.Moreover,simulation verification through experimental results demonstrates the effectiveness of the proposed protection scheme across various initial fault angles,distances to faults,and fault transition resistances.
文摘Background: Testicular atrophy is recurrent after orchidopexy for intra-abdominal cryptorchidism due to damage to vessels. Fowlers-Stephens and Shehata methods proposed staged orchidopexy, but are still associated to a rate of atrophy greater than 10%. Purpose: We set out to present a new technique that preserves testicular vessels. Our study is aimed at investigating testicular vitality after surgery. Patients and Method: We reviewed files of boys who underwent orchidopexy for 2 years in our department. Those who have been operated for intra-abdominal cryptorchidism with the new technique and aged between 6 months and 14 years old were included in our study. We excluded boys who have been operated before 6 months and after 14 years old and those who did not respect their follow-up plane. Ultrasound (US) outcomes were used to measure testicular volumes and blood flow at each postoperative visit. The Sample population was divided into group A and group B representing testes that were followed respectively for 12 and 24 months. Results: 22 boys with 25 testes were included in our study;11 testes in group A and 14 testes in group B. In each group, we noted a significant difference of UDT volumes from the third month after surgery with respective P-values 0.05. There was no statistical difference between UDT and contra lateral testes volumes 12 months after surgery in group A and 24 months in group B with respective P-values of 0.07 and 0.72. All volume differential indexes were Conclusion: This method offers a new perspective in performing safe orchidopexy for intra abdominal undescended testes.
基金supported in part by the Science Foundation of the Chinese Academy of Railway Sciences under Grant Number:2023QT001。
文摘Increasing attention has been paid to the efficiency improvement of the induction traction system of high-speed trains due to the high demand for energy saving. In emergency self-propelled mode, however, the dc-link voltage and the traction power of the motor are significantly reduced, resulting in decreased traction efficiency due to the low load and low speed operations. Aiming to tackle this problem, a novel efficiency improved control method is introduced to the emergency mode of high-speed train traction system in this paper. In the proposed method, a total loss model of induction motor considering the behaviors of both iron and copper loss is established. An improved iterative algorithm with decreased computational burden is then introduced, resulting in a fast solving of the optimal flux reference for loss minimization at each control period. In addition, considering the parameter variation problem due to the low load and low speed operations, a parameter estimation method is integrated to improve the controller's robustness. The effectiveness of the proposed method on efficiency improvement at low voltage and low load conditions is demonstrated by simulated and experimental results.
文摘BACKGROUND Complex and high-risk surgical complications pose pressing challenges in the clinical implementation and advancement of endoscopic full-thickness resection(EFTR).Successful perforation repair under endoscopy,thereby avoiding surgical intervention and postoperative complications such as peritonitis,are pivotal for effective EFTR.AIM To investigate the effectiveness and safety of EFTR assisted by distal serosal inversion under floss traction in gastric submucosal tumors.METHODS A retrospective analysis of patients with gastric and duodenal submucosal tumors treated with EFTR assisted by the distal serosa inversion under dental floss traction from January 2023 to January 2024 was conducted.The total operation time,tumor dissection time,wound closure time,intraoperative bleeding volume,length of hospital stay and incidence of complications were analyzed.RESULTS There were 93 patients,aged 55.1±12.1 years.Complete tumor resection was achieved in all cases,resulting in a 100% success rate.The average total operation time was 67.4±27.0 min,with tumor dissection taking 43.6±20.4 min.Wound closure times varied,with gastric body closure time of 24.5±14.1 min and gastric fundus closure time of 16.6±8.7 min,showing a significant difference(P<0.05).Intraoperative blood loss was 2.3±4.0 mL,and average length of hospital stay was 5.7±1.9 d.There was no secondary perforation after suturing in all cases.The incidence of delayed bleeding was 2.2%,and the incidence of abdominal infection was 3.2%.No patient required other surgical intervention during and after the operation.CONCLUSION Distal serosal inversion under dental-floss-assisted EFTR significantly reduced wound closure time and intraoperative blood loss,making it a viable approach for gastric submucosal tumors.
文摘High-level opening up and policies to attract foreign direct investment(FDI)were hot topics during the annual sessions of the National People’s Congress(NPC)and the Chinese People’s Political Consultative Conference(CPPCC)National Committee,China’s key annual political meetings commonly known as Two Sessions.
文摘Endoscopic submucosal dissection(ESD)procedure has a longer procedure time and higher perforation rate than endoscopic mucosal resection owing to technical complications,including a poor field of vision and inadequate tension for the submucosal dissection plane.Various traction devices were developed to secure the visual field and provide adequate tension for the dissection plane.Two randomized controlled trials demonstrated that traction devices reduce colorectal ESD procedure time compared with conventional ESD(C-ESD),but they had limitations,including a single-center fashion.The CONNECT-C trial was the first multicenter randomized controlled trial comparing the C-ESD and traction device-assisted ESD(T-ESD)for colorectal tumors.In the T-ESD,one of the device-assisted traction methods(S-O clip,clip-with-line,and clip pulley)was chosen according to the operator’s discretion.The median ESD procedure time(primary endpoint)was not significantly different between C-ESD and T-ESD.For lesions≥30 mm in diameter or in cases treated by nonexpert operators,the median ESD procedure time tended to be shorter in T-ESD than in C-ESD.Although T-ESD did not reduce ESD procedure time,the CONNECT-C trial results suggest that T-ESD is effective for larger lesions and nonexpert operators in colorectal ESD.Compared with esophageal and gastric ESD,colorectal ESD has some difficulties,including poor endoscope maneuverability,which may be associated with prolonged ESD procedure time.T-ESD may not effectively improve these issues,but a balloon-assisted endoscope and underwater ESD may be promising options and these methods can be combined with T-ESD.
基金supported by the National Natural Science Foundation of China under Grant 52107007the China Scholarship Council under Grant 202008120084the“Chunhui Plan”Collaborative Research Project of Chinese Ministry of Education under Grant HZKY20220604。
文摘This paper presents the design optimization of a self-circulated ventilation system for an enclosed permanent magnet(PM)traction motor utilized in the propulsion systems for subway trains.In order to analyze accurately the machine's inherent cooling capacity when the train is running,the ambient airflow and the related heat transfer coefficient(HTC)are numerically investigated considering synchronously the bogie installation structure.The machine is preliminary cooled with air ducts set on the motor shell,and the fluidic-thermal field distributions with only the shell air duct cooling are numerically calculated.During simulations,the HTC obtained in the former steps is applied to the external surface of the machine to model the inherent cooling characteristic caused by the train movement.To reduce the temperature rise and thus guarantee the motor's working reliability,an internal self-circulated air cooling system is proposed according to the machine temperature distribution.The air enclosed in the end-caps is driven by the blades mounted on both sides of the rotor core and forms two air circuits to bring the excessive power losses generated in the heating components to cool regions.The fluid flow and temperature rise distributions of the cooling system's structural parameters are further improved by the Taguchi method in order to confirm the efficacy of the internal air cooling system.
基金Supported by Sichuan Administration of Traditional Chinese Medicine(No.2021MS422).
文摘AIM:To analyze the global scientific output concerning myopic traction maculopathy(MTM)and to summarize the research frontiers and hot topics of MTM related researches.METHODS:Data were collected for bibliometric and visualization analyses from Web of Science(WOS)Core Collection.Exported records were analyzed for titles,publication years,research institutions,journal names,authors,keywords,and abstracts using CiteSpace software version 6.1.RESULTS:A total of 839 related studies were analyzed,the publication volume increased annually,with Asia the most active region of MTM research.Optical coherence tomography angiography,optical coherence tomography,macular hole,high myopia,macular buckling were identified as the focus of the current research.Progression,association,classification and shape were identified as the major research frontiers.CONCLUSION:MTM is a major cause of visual loss in pathological myopic eyes.During the preceding 17y,the number of annual publications in MTM research increased gradually.Studies on the progression nature of MTM,genome-wide association study and proper classification of MTM might still be the frontiers of MTM researches.
文摘Trauma to the external genitalia by tearing is rare. We report the case of a 30-year-old patient, admitted to the emergency room for trauma of the external genitalia by traction following a blow and intentional injury. The authors highlight the lesions that can occur during this type of trauma and insist on the systematic search for urethral and cavernous lesions. Conclusion: Trauma to the external genitalia by intentional assault and battery is rare in our context. They occur most often in a young person and are frequently associated with damage to the corpora cavernosa and urethra.
文摘Different traction devices that can provide a visual field and attain appropriate tension at the dissection plane during endoscopic submucosal dissection(ESD)have been developed.Clip-with-line(CWL)is a classic traction device that can offer per-oral traction toward the direction where the line is drawn.A multicenter randomized controlled trial(CONNECT-E trial)comparing the conventional ESD and CWL-assisted ESD(CWL-ESD)for large esophageal tumors was conducted in Japan.This study showed that CWL-ESD was associated with a shorter procedure time(defined as the time from initiating submucosal injection to completing tumor removal)without increasing the risk of adverse events.Multivariate analysis revealed that whole-circumferential lesion and abdominal esophageal lesion were independent risk factors for technical difficulties,which were defined as a procedure time of>120 min,perforation,piecemeal resection,inadvertent incision(any accidental incision caused by the electrosurgical knife within the marked area),or handover to another operator.Therefore,techniques other than CWL should be considered for these lesions.Several studies have shown the usefulness of endoscopic submucosal tunnel dissection(ESTD)for such lesions.A randomized controlled trial conducted at five Chinese institutions showed that compared with the conventional ESD,ESTD had a significantly reduced median procedure time for lesions covering≥1/2 of the esophageal circumference.In addition,a propensity score matching analysis conducted at a single Chinese institution showed that compared with the conventional ESD,ESTD had a shorter mean resection time for lesions at the esophagogastric junction.With the appropriate use of CWL-ESD and ESTD,esophageal ESD can be performed more efficiently and safely.Moreover,the combination of these two methods may be effective.