BACKGROUND At our academic tertiary care medical center, we have noted patients referred for endoscopic retrograde cholangiopancreatography(ERCP) who increasingly require advanced cannulation techniques. This trend is...BACKGROUND At our academic tertiary care medical center, we have noted patients referred for endoscopic retrograde cholangiopancreatography(ERCP) who increasingly require advanced cannulation techniques. This trend is noted despite increased endoscopist experience and annual ERCP volume over the same period.AIM To evaluate this phenomenon of perceived escalation in complexity of cannulation at ERCP and assessed potential underlying factors.METHODS Demographic/clinical variables and records of ERCP patients at the beginning(2008), middle(2013) and end(2018) of the last decade were reviewed retrospectively. Cannulation approaches were classified as "standard" or "advanced" and duodenoscope position was labeled as "standard"(short position) or "non-standard"(e.g., long, semi-long).RESULTS Patients undergoing ERCP were older in 2018 compared to 2008(69.7 ± 15.2 years vs 55.1 ± 14.7, P < 0.05). Increased ampullary distortion and peri-ampullary diverticula were noted in 2018(P < 0.001). ERCPs were increasingly performed with a non-standard duodenoscope position, from 2.2%(2008) to 5.6%(2013) and 16.1%(2018)(P < 0.001). Utilization of more than one advanced cannulation technique for a given ERCP increased from 0.7%(2008) to 0.9%(2013) to 6.6%(2018)(P < 0.001). Primary mass size > 4 cm, pancreatic uncinate mass, and bilirubin > 10 mg/d L predicted use of advanced cannulation techniques(P < 0.03 for each).CONCLUSION Complexity of cannulation at ERCP has sharply increased over the past 5 years, with an increased proportion of elderly patients and those with malignancy requiring advanced cannulation approaches. These data suggest that complexity of cannulation at ERCP may be predicted based on patient/ampulla characteristics. This may inform selection of experienced, high-volume endoscopists to perform these complex procedures.展开更多
One of the basic ingredients in conventional preparation of cuprates-based superconducting materials such as the Nd-Ba-Cu-O superconducting system, especially the Nd1Ba2Cu3O7-δ phase is Barium Carbonate (BaCO3). It h...One of the basic ingredients in conventional preparation of cuprates-based superconducting materials such as the Nd-Ba-Cu-O superconducting system, especially the Nd1Ba2Cu3O7-δ phase is Barium Carbonate (BaCO3). It has the potential to produce the carbon dioxide (CO2) air pollutant. Therefore it is necessary to look for other materials as the source of Ba atom which does not produce CO2 gas. In this research has been successfully made the Nd1Ba2Cu3O7-δ phase with the Barium Hydroxide Octahydrate (Ba(OH)2·8H2O) as a source of Ba atom. The results of the characterization XRD has been shown the main peaks of the Nd1Ba2Cu3O7-δ phase. Refinement of the XRD data by using Rietica software, obtained the value of GofF (Goodness of Fit) = 1.7023 and lattice parameter a ≈ b < c/3 with a value of c/3 = 3.9275 A.展开更多
文摘BACKGROUND At our academic tertiary care medical center, we have noted patients referred for endoscopic retrograde cholangiopancreatography(ERCP) who increasingly require advanced cannulation techniques. This trend is noted despite increased endoscopist experience and annual ERCP volume over the same period.AIM To evaluate this phenomenon of perceived escalation in complexity of cannulation at ERCP and assessed potential underlying factors.METHODS Demographic/clinical variables and records of ERCP patients at the beginning(2008), middle(2013) and end(2018) of the last decade were reviewed retrospectively. Cannulation approaches were classified as "standard" or "advanced" and duodenoscope position was labeled as "standard"(short position) or "non-standard"(e.g., long, semi-long).RESULTS Patients undergoing ERCP were older in 2018 compared to 2008(69.7 ± 15.2 years vs 55.1 ± 14.7, P < 0.05). Increased ampullary distortion and peri-ampullary diverticula were noted in 2018(P < 0.001). ERCPs were increasingly performed with a non-standard duodenoscope position, from 2.2%(2008) to 5.6%(2013) and 16.1%(2018)(P < 0.001). Utilization of more than one advanced cannulation technique for a given ERCP increased from 0.7%(2008) to 0.9%(2013) to 6.6%(2018)(P < 0.001). Primary mass size > 4 cm, pancreatic uncinate mass, and bilirubin > 10 mg/d L predicted use of advanced cannulation techniques(P < 0.03 for each).CONCLUSION Complexity of cannulation at ERCP has sharply increased over the past 5 years, with an increased proportion of elderly patients and those with malignancy requiring advanced cannulation approaches. These data suggest that complexity of cannulation at ERCP may be predicted based on patient/ampulla characteristics. This may inform selection of experienced, high-volume endoscopists to perform these complex procedures.
文摘One of the basic ingredients in conventional preparation of cuprates-based superconducting materials such as the Nd-Ba-Cu-O superconducting system, especially the Nd1Ba2Cu3O7-δ phase is Barium Carbonate (BaCO3). It has the potential to produce the carbon dioxide (CO2) air pollutant. Therefore it is necessary to look for other materials as the source of Ba atom which does not produce CO2 gas. In this research has been successfully made the Nd1Ba2Cu3O7-δ phase with the Barium Hydroxide Octahydrate (Ba(OH)2·8H2O) as a source of Ba atom. The results of the characterization XRD has been shown the main peaks of the Nd1Ba2Cu3O7-δ phase. Refinement of the XRD data by using Rietica software, obtained the value of GofF (Goodness of Fit) = 1.7023 and lattice parameter a ≈ b < c/3 with a value of c/3 = 3.9275 A.
