Conventional endoscopic retrograde cholangiopancreaticography vs the Olympus V-scope system

AIM: To compare the new Olympus V-scope (VS) to conventional endoscopic retrograde cholangiopancreati-cography (ERCP). METHODS: Forty-nine patients with previous endoscopic papillotomy who were admitted for interventional ERCP for one of several reasons were included in this single-centre, prospective randomized study. Consecutive patients were randomized to either the VS group or to the conventional ERCP group. ERCP-nave patients who had not undergone papillotomy were excluded. The main study parameters were interventional examination time, X-ray time and dose, and premedication dose (all given below as the median, range) and were investigated in addition to each patient's clinical outcome and complications. Subjective scores to assess each procedure were also provided by the physicians and endoscopy assistants who carried out the procedures. A statistical analysis was carried out using the Wilcoxon rank-sum test.RESULTS: Twenty-five patients with 50 interventions were examined with the VS ERCP technique, and 24 patients with 47 interventions were examined using the conventional ERCP technique. There were no significant differences between the two groups regarding the age, sex, indications, degree of ERCP difficulty, or interventions performed. The main study parameters in the VS group showed a nonsignificant trend towards a shorter interventional examination time (29 min, 5-50 min vs 31 min, 7-90 min, P = 0.28), shorter X-ray time (5.8 min, 0.6-14.1 min vs 6.1 min, 1.6-18.8 min, P = 0.48), and lower X-ray dose (1351 cGy/m2 , 159-5039 cGy/m2 vs 1296 cGy/m2 , 202.2-6421 cGy/m 2 , P = 0.34). A nonsignificant trend towards fewer adverse events occurred in the VS group as compared with the conventional ERCP group (cholangitis: 12% vs 16%, P = 0.12; pain: 4% vs 12.5%, P = 0.33; post-ERCP pancreatitis: 4% vs 12.5%, P = 0.14). In addition, there were no statistically significant differences in assessment by the physicians and endoscopy assistants using subjective questionnaires.CONCLUSION: ERCP using the short-guidewire V-system did not significantly improve ERCP performance or patient outcomes, but it may reduce and simplify the ERCP procedure in difficult settings.

Multipurpose use of the over-the-scope-clip system(“Bear claw”) in the gastrointestinal tract:Swiss experience in a tertiary center

AIM:To evaluate the outcome of over-the-scope-clip system(OTSC)for endoscopic treatment of various indications in daily clinical practice in Switzerland.METHODS:This prospective,consecutive case series was conducted at a tertiary care hospital from September 2010 to January 2014.Indications for OTSC application were fistulae,anastomotic leakage,perforation,unroofed submucosal lesion for biopsy,refractory bleeding,and stent fixation in the gastrointestinal(GI)tract.Primary technical success was defined as the adequate deployment of the OTSC on the target lesion.Clinical success was defined as resolution of the problem;for instance,no requirement for surgery or further endoscopic intervention.In cases of recurrence,retreatment of a lesion with a second intervention was possible.Complications were classified into those related to sedation,endoscopy,or deployment of the clip.RESULTS:A total of 28 OTSC system applications werecarried out in 21 patients[median age 64 years(range42-85),33%females].The main indications were fistulae(52%),mostly after percutaneous endoscopic gastrostomy tube removal,and anastomotic leakage after GI surgery(29%).Further indications were unroofed submucosal lesions after biopsy,upper gastrointestinal bleeding,or esophageal stent fixation.The OTSC treatments were applied either in the upper(48%)or lower(52%)GI tract.The mean lesion size was 8 mm(range:2-20 mm).Primary technical success and clinical success rates were 85%and 67%,respectively.In53%of cases,the suction method was used without accessories(e.g.,twin grasper or tissue anchor).No endoscopy-related or OTSC-related complications were observed.CONCLUSION:OTSC is a useful tool for endoscopic closure of various GI lesions,including fistulae and leakages.Future randomized prospective multicenter trials are warranted.

Endoscopic closure of a gastrocolic fistula using the over-the-scope-clip-system

Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough tensile force to keep fibrotic defects larger than 5 mm approximated. Herein we present a case of successful endoscopic closure of a gastrocolic fistula in a severely malnourished patient with complex post-surgical upper GI anatomy. We strongly believe that this device is a major breakthrough for the management of various types of discontinuity defects or fistulas. In addition, we show the usefulness of placing a direct jejunostomy using the double balloon enteroscopy (DBE) technique during the same procedure. The concept of providing direct jejunal feedings while allowing for upper gas-trointestinal bowel rest to promote the healing of the minimally invasive endoscopic operation is novel. Thus, our case is unique and exemplifies the utility of mini-mally invasive endoscopic endoluminal surgery.

First report of colonoscopic closure of a gastrocolocutaneous PEG migration with over-the-scope-clip-system

Percutaneous endoscopic gastrostomy(PEG) is a common practice for long-term nutrition of patients who are unable to take oral food. We report of an 85-year old man with a history of recurrent larynx carcinoma and hemicolectomy many years ago due to unknown reason. Laryngectomy was indicated. Preoperatively a PEG was inserted endoscopically after an abdominal ultrasonography without abnormal findings. Few months after PEG insertion, the patient was evaluated for diarrhea and insufficient feeding without signs of infection or peritonism. An upper endoscopy and computed tomography scan confirmed a buried bumper syndrome with migration of the PEG tube into the colon as a rare complication. He underwent successful colonoscopic removal of the internal bumper and closure of the colonic orifice of the fistula with the over-the-scope-clip system(OTSC). OTSC is an endoscopic device for treatment of bleeding, perforation, leak and fistula in the gastrointestinal tract. To the best of our knowledge, this is the first report of the use of OTSC for colonoscopic closure of a gastrocolocutaneous fistula due to a buried bumper syndrome with transcolonic PEG tube migration.

白蛋白RNA Scope检测在肝内胆管癌组织学分型中的应用

目的探讨白蛋白RNA Scope检测在不同肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)组织学分型中的应用及临床价值。方法收集病理诊断为ICC的组织蜡块259例,制作组织芯片,其中组织学分型大胆管亚型62例,小胆管亚型126例,细胆管亚型71例;另收集病理诊断为原发性肝细胞癌和肝脏转移性癌的组织蜡块52例,其中原发性肝细胞癌22例,肝脏转移性癌30例,将包含肿瘤组织的石蜡样本制成3μm厚的组织切片,行白蛋白RNA Scope检测。结果所有样本均成功进行白蛋白RNA Scope检测。259例ICC中,白蛋白RNA Scope检测127例阳性,总阳性率为49.03%。大胆管亚型、小胆管亚型和细胆管亚型中白蛋白mRNA表达的均值和95%CI分别为68.06(45.48~90.65)、57.02(41.12~72.92)和26.41(11.17~41.64),细胆管亚型中白蛋白mRNA的表达最低。22例原发性肝细胞癌中白蛋白mRNA均阳性,30例肝脏转移性癌中白蛋白mRNA均阴性。预后方面,ICC中白蛋白mRNA表达组和未表达组在组织学分型和生存期上差异均有统计学意义,白蛋白表达组和未表达组患者的总生存期均值和95%CI分别为43.514个月(28.992~58.036)和54.944个月(45.499~64.392)。结论在ICC中,白蛋白mRNA表达可提示组织学分型,有助于临床分型的诊断;与白蛋白未表达组相比,白蛋白表达组ICC患者预后较差。

Division of Township Grade System and Scope of Influence:A Case Study of Dafang County

At the township level,combining Voronoi diagram and breaking point theory,this paper divides township grade system and its scope of influence in Dafang County of Guizhou Province,and discusses the grade system from small scale perspective.Results show that Dafang County takes Dafang Town as the center,Dashi Town in the north and Shachang Township in the east as auxiliary part,Sanyuan Township,Zhuyuan Township,Babao Township,Pudi Township,Lihua Township,and Dingxin Township as cooperative part,to drive development of 36 townships in Dafang County.Thus,it basically reflects township grade of Dafang County,accords with current development situation,provides certain reference value for system planning and economic zoning of small scale regions,and it is able to improve the accuracy of scope division by completing attribute data and revision of many methods.

基于SCOPE模型的樟子松人工林日光诱导叶绿素荧光及初级生产力模拟与评估

【目的】检验SCOPE(Soil Canopy Observation of Photosynthesis and Energy fluxes)模型用于模拟樟子松人工林的日光诱导叶绿素荧光(sun-induced chlorophyll fluorescence,SIF)和植被总初级生产力(gross primary productivity,GPP)动态变化的可能性。【方法】对科尔沁沙地南缘樟子松人工林,基于样地SIF、GPP及气象协同观测数据,利用SCOPE模型模拟SIF与GPP的日变化与季节变化,评估了SCOPE模型在典型晴天、典型多云日、整个观测期的模拟效果。【结果】结果显示,利用气象观测数据及冠层参数(入射短波辐射、气温、大气实际水汽压、CO_(2)浓度及叶面积指数),可驱动SCOPE模型模拟樟子松人工林的SIF与GPP。典型晴天日与多云日的SIF模拟值和实测值的R^(2)分别为0.42与0.52,RMSE分别为0.19与0.18 W·m^(-2)·μm^(-1)·sr^(-1);GPP模拟值和观测值的R^(2)分别为0.78与0.89,RMSE分别为1.87与2.57μmol·m^(-2)·s^(-1)。在季节尺度上,SIF和GPP模拟值和观测值的R^(2)分别为0.50、0.72,RMSE分别为0.19 W·m^(-2)·μm^(-1)·sr^(-1)和2.64μmol·m^(-2)·s^(-1)。在整个观测期,多云日的SIF(R^(2)=0.31,RMSE=0.22 W·m^(-2)·μm^(-1)·sr^(-1))与GPP(R^(2)=0.80,RMSE=2.42μmol·m^(-2)·s^(-1))的模拟效果优于晴天日(SIF:R^(2)=0.30,RMSE=0.26 W·m^(-2)·μm^(-1)·sr^(-1),GPP:R^(2)=0.64,RMSE=3.64μmol·m^(-2)·s^(-1))。SIF模拟值总体高于观测值,当SIF强度较低时易对SIF高估,反之则易低估。GPP的模拟精度较高,模型对较低与较高GPP有所低估,对中间值有所高估。【结论】SCOPE模型可用于日尺度与季节尺度的SIF与GPP模拟,且多云日的模拟精度更高。SCOPE模型对樟子松人工林的GPP模拟结果优于SIF,推测SIF模拟精度较低的原因可能是模型对SIF的模拟是基于阔叶植物的辐射传输过程。未来应发展针对针叶植物的SIF辐射传输模型,为针叶林的辐射传输与荧光遥感监测提供模型基础。

Data Scale, Data Scope and Platform Enterprise Performance: Insights from Digital Platform M&As

Data is a key asset for digital platforms,and mergers and acquisitions(M&As)are an important way for platform enterprises to acquire it.The types of data obtained from intra-industry and cross-sector M&As differ,as does the extent to which they interact within or between platforms.The impact of such data on corporate market performance is an important question to consider when selecting strategies for digital platform M&As.Based on our research on advertising-driven platforms,we developed a two-stage Hotelling game model for comparing the market performance effects of intra-industry M&As and cross-sector M&As for digital platforms.We carried out an empirical test using relevant data from advertising-driven digital platforms between 2009 and 2021,as well as a case study on Baidu’s M&A activities.Our research discovered that intra-industry M&As driven by“data economies of scale”and cross-sector M&As driven by“data economies of scope”are both beneficial to the market performance of platform enterprises.Intra-industry M&As have a more significant positive effect on the market performance of platform enterprises because the same types of data are easier to integrate and develop the“network effect of data scale”.From a data factor perspective,this paper reveals the inherent economic logic by which different types of M&As influence the market performance of digital platforms,as well as policymaking recommendations for all digital platforms to select M&A strategies based on data scale,data scope,and the network effect of data.

Glide Scope视频喉镜在全麻气管插管中的应用

目的观察Glide Scope视频喉镜在全麻气管插管中应用的可行性。方法 60例择期手术准备行全麻气管插管患者,ASAⅠ～Ⅱ级,随机分为G组和P组,每组30例,术前处理和麻醉诱导相同。G组采用Glide Scope视频喉镜进行气管插管,P组采用普通直接喉镜进行气管插管。观察两组患者声门显露程度、插管次数、插管时间及手术前(T1)、诱导后(T2)、插管后1min(T3)、3 min(T4)、5 min(T5)的收缩压(SBP)、舒张压(DBP)、心率(HR)和插管操作引起的相关并发症。结果声门显露:G组30例均为1级。P组1级17例,2级7例,3级6例,两者相比差异有显著性(P<0.05)。插管时间:G组为(30±13)s,P组为(26±19)s,两组相比差异无显著性。血流动力学的变化两组无差异,但在T3时P组HR上升与术前(T1)相差异有显著性(P<0.05)。插管引起的相关并发症两组无差异。结论应用Glide Scope视频喉镜气管插管操作简单便捷,声门显露容易清晰,对咽喉部的刺激小,值得在临床推广应用。

Glide Scope视频喉镜在双腔支气管导管插管中的临床应用

目的评价Glide Scope视频喉镜应用于左侧双腔支气管导管插管中的应用价值。方法 ASA分级为Ⅰ、Ⅱ级择期胸科手术患者50例,随机平均分为Glide Scope视频喉镜(GSVL)组、Macintosh直接喉镜(MDLS)组,每组25例。分别观察Glide Scope视频喉镜和Macintosh型直接喉镜插左侧双腔支气管的到位情况、插管所用时间、气管损伤情况。结果 GSVL组25例均一次插入左主支气管,MDLS组2例旋转错位,4例反向错位,19例一次插入左主支气管,成功率为76%,两组比较差异有显著性(P<0.05);GSVL组较MDLS组的气管插管时间平均延长14s,GSVL组气管损伤发生率低于MDLS组,两组比较差异无显著性(P<0.05)。结论 G1ide Scope视频喉镜用于左侧双腔支气管插管时更容易暴露声门,插管成功率较高,且气管损伤小,但不能缩短插管时间。

Glide Scope可视喉镜与直接喉镜行气管插管对插管时间及咽喉损伤的影响

直视喉镜是全麻下气管插管最常用的工具，也是麻醉医生处理气道时的核心技能，尽管直视喉镜是气管插管的金标准，但意外的困难插管会增加病死率[1,2]。GlideScope可视喉镜（GS）是一种较新的插管工具，它可将气管插管整个过程变成可视操作，具有简便性、可控性和可视性，明显提高咽喉的暴露，减少对舌根部和咽喉部的刺激，然而关于插管时间以及对咽喉损伤没有明确定论[3,4]。

阻塞性睡眠呼吸暂停综合征患者Glide Scope视频喉镜和Macintosh喉镜气管插管效果比较

目的:比较Glide Scope视频喉镜与Macintosh喉镜在阻塞性睡眠呼吸暂停综合征(OSAS)患者引导气管插管中的应用效果。方法:择期行悬雍垂腭咽成形术的OSAS患者60例,分为Glide Scope视频喉镜组(G组,n=30)和Macintosh喉镜组(M组,n=30)。术前应用改良Mallampati法对所有患者进行气道评估,诱导后分别用两种喉镜引导经鼻气管插管,记录Cormack-Lehane分级、插管时间及插管前后平均动脉压(pMA)、心率(fH)变化情况,计算首次插管成功率。结果:G组声门显露程度优于M组(Z=3.907,P<0.001),插管后G组pMA和fH的变化较M组明显轻微(t=2.473、2.647,P<0.05),首次插管成功率G组(86.7%)明显高于M组(63.3%)。结论:与Macintosh喉镜相比,Glide Scope视频喉镜能明显改善OSAS患者临床插管条件,可作为一种有效的插管工具推广应用。

SCOPE模式在断指再植术患者健康教育中的应用

目的应用SCOPE模式实施断指再植术患者健康教育计划,探讨该模式对断指再植术患者健康教育计划进度、计划活动内容、患者参与率和知、信、行等方面的影响。方法将68例患者分为常规组(常规模式组)和对照组(应用SCOPE模式组),分别应用常规教育方法与SCOPE模式实施健康教育计划,对比两组患者计划实施效果。结果两组患者健康教育计划实施效果对比差异有统计学意义(P<0.05)。结论 SCOPE模式能有效实现断指再植患者健康教育预期目标,保证健康教育质量,是一种科学的健康教育实施模式。

21世纪炼焦新技术——SCOPE21工艺

分析了传统焦炭生产工艺中存在的问题,指出21世纪焦炭生产技术开发的发展方向,主要集中在弱黏煤的有效利用和环境改善、降低能耗方面。SCOPE21工艺是一种适应21世纪要求的炼焦技术,重点介绍了其实验室、中试与工业化试验相关情况及实际设备的概念设计与经济性能。

NI-SCOPE的虚拟数字信号分析仪实现

基于LabVIEW软件开发平台,利用NI-SCOPE实现了一种多功能虚拟数字信号分析仪,该分析仪既有数字存储示波器的所有功能,还具有加窗滤波、频谱分析等信号分析功能,是传统示波器和信号分析仪器的结合。该分析仪界面友好,功能齐全,操作简单,具有较高的应用价值。

Glide Scope视频喉镜在气管插管患者留置胃管中的应用

目的探讨Glide Scope视频喉镜在气管插管患者留置胃管中的应用效果。方法将80例气管插管状态下需留置胃管的患者分为对照组和观察组各40例,对照组采用常规方法留置胃管,观察组在Glide Scope视频喉镜辅助下留置胃管,比较两组1次置管成功率和操作用时。结果观察组胃管置入操作用时较对照组短,1次置管成功率较对照组高,差异均有统计学意义(P<0.01);对照组有8例患者进行了3次以上的操作才置管成功。结论Glide Scope视频喉镜用于气管插管后患者留置胃管的操作,能提高置管1次成功率,缩短操作时间。

SCOPE21的研发与工业应用现状

简述了新一代炼焦技术SCOPE21的研发背景。介绍了SCOPE21的工艺流程和三个研发阶段,并对比分析了SCOPE21的试验装置、可行性研究装置与实际工业化应用的各项技术经济指标。阐述了SCOPE21的技术优势。

The Scope of Business Writing

With the chief aim to list a brief description on business writing,such thesis mainly deal with the content and skill in this field.Business writing locates a role in business world which cannot be ignored by any other means.In case a successful business manager desires to be achievable,the business letters ought to be treated seriously.Some popular forms of writing are also included and simply illustrated in lieu the basic requirement meeting from some of those readers.Obviously we learners and teachers are hopefully required to set great store by the mentioned scope of utilization.

High/Scope课程的解读

High/Scope课程开发于1962年,但它随着时代的发展不断进步着,超越着。直到今天,对我国学前教育仍然有重要的借鉴作用。本文就High/Scope课程编制中的"发展视点"、课程目标、课程组织、课程实施四个纬度上进行了阐释。

基于High Scope理论对幼儿园区域活动问题的解读

纵观当前幼儿园，区域活动已经成为幼儿固组织活动的主要形式。幼教工作者们为幼儿精心设置了各种各样的活动区让幼儿自由游戏，以促进他们各种能力的发展。但笔者在某幼儿园的观察过程中发现，如今教师对活动区的利用似乎偏离了预期的轨道，悖离了设置活动区的宗旨．本文拟从High Scope理论中“一日活动”的组织出发，对当前幼儿园区域活动中存在的个别问题进行解读，试图为幼儿园区域活动的开展提出建议，真正的让幼儿在活动区中收获成长与快乐．