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Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures

World Journal of Gastroenterology 2017年第16期23卷 2883-2890页

作者： Mohamed Mortagy neal mehta Mansour A Parsi Seiichiro Abe Tyler Stevens John J Vargo Yutaka Saito Amit Bhatt Department of Internal Medicine Homer Stryker MD School of MedicineWestern Michigan UniversityKalamazooMI 49008United States Department of Internal Medicine Medicine InstituteCleveland ClinicClevelandOH 44195United States Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicClevelandOH 44195United States Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan

Endoscopic submucosal dissection(ESD) is a wellestablished, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection(MAGESD) has potential benefits compared to other current traction methods. MAG-ESD offers dynamic tissue retraction independent of the endoscope mimicking a surgeon's "second hand". Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology.

关键词： Endoscopic submucosal dissection Gastric cancer Magnetic anchor guidance Esophageal cancer Magnets Traction Natural orifice transluminal endoscopic surgery

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LIV-4:A novel model for predicting transplant-free survival in critically ill cirrhotics

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World Journal of Hepatology 2020年第6期12卷 298-311页

作者： Christina C Lindenmeyer Gianina Flocco Vedha Sanghi Rocio Lopez Ahyoung J Kim Fadi Niyazi neal A mehta Aanchal Kapoor William D Carey Eduardo Mireles-Cabodevila Carlos Romero-Marrero Department of Gastroenterology Hepatology and NutritionCleveland ClinicClevelandOH 44195United States Department of Internal Medicine Cleveland ClinicClevelandOH 44195United States Department of Quantitative Health Sciences Cleveland ClinicClevelandOH 44106United States Department of Critical Care Medicine Cleveland ClinicClevelandOH 44195United States

BACKGROUND Critically ill patients with cirrhosis,particularly those with acute decompensation,have higher mortality rates in the intensive care unit(ICU)than patients without chronic liver *** of short-term mortality is important in order to identify patients at highest risk of *** of the currently available prognostic models have been widely accepted for use in cirrhotic patients in the ICU,perhaps due to complexity of calculation,or lack of universal variables readily available for these *** believe a survival model meeting these requirements can be developed,to guide therapeutic decision-making and contribute to cost-effective healthcare resource *** To identify markers that best identify likelihood of survival and to determine the performance of existing survival *** Consecutive cirrhotic patients admitted to a United States quaternary care center ICU between 2008-2014 were included and comprised the training *** data and clinical laboratory test collected on admission to ICU were *** under the curve receiver operator characteristics(AUROC)analysis was performed to assess the value of various scores in predicting inhospital mortality.A new predictive model,the LIV-4 score,was developed using logistic regression analysis and validated in a cohort of patients admitted to the same institution between *** Of 436 patients,119(27.3%)died in the *** multivariate analysis,a combination of the natural logarithm of the bilirubin,prothrombin time,white blood cell count,and mean arterial pressure was found to most accurately predict in-hospital *** from the regression coefficients of the independent variables,a novel model to predict inpatient mortality was developed(the LIV-4 score)and performed with an AUROC of 0.86,compared to the Model for End-Stage Liver Disease,Chronic Liver Failure-Sequential Organ Failure Assessment,and Royal Free Hospital Score,wh

关键词： Risk stratification Resource allocation Intensive care unit Acute-on-chronic liver failure Modeling Mortality

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Large non-pedunculated colorectal polyp management: The elephant in the room

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World Journal of Gastroenterology 2024年第25期30卷 3126-3131页

作者： Shirley X Jiang neal Shahidi Department of Medicine University of British ColumbiaVancouver V6Z 2K5BCCanada

Minimally invasive innovations have transformed *** to colorectal cancer(CRC),there has been a shift towards less invasive surgical techniques and use of endoscopic resection as an alternative for low risk T1 *** role of endoscopic resection is however much more extensive:It is now considered the first line management strategy for most large(≥20 mm)non-pedunculated colorectal polyps,the majority of which are *** is due to the well-established efficacy,safety,and cost-effectiveness of endoscopic techniques compared to *** endoscopic modalities now exist with distinct risk-benefit profiles and their outcomes are further improved by site-specific technical modifications,auxiliary techniques,and adverse event miti-gation *** capacity continues to evolve with emerging endoscopic techniques and expanding applications,particularly in the confines of a multi-disciplinary setting.

关键词： Cancer Colonoscopy Endoscopy Polyp Endoscopic mucosal resection Endoscopic submucosal dissection

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Reflections on Studying Huang Di Nei Jing in the West

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Chinese Medicine and Culture 2024年第1期7卷 72-76页

作者： Edward neal Apricot Grove Educational Services Portland 97213the United States of America Xinglin Institute for Early East Asian Medicine Portland 97213the United States of America

Huang Di Nei Jing(《黄帝内经》The Yellow Emperor’s Inner Classic) has been the source text of Chinese medicine knowledge and innovation for over two thousand years. Despite this key relevance, many of its ideas and practices have proven difficult to understand and implement fully into clinical practice. Cultural and language differences can be compounded with these challenges but may also present new opportunities for advancement and insight when studied by researchers outside of the originating culture. This article introduces the method of Classical-Text Archaeology and delves into the author’s two-decade journey of researching this text, with a discussion on cultural differences and issues of medical scholarship.

关键词： Huang Di Nei Jing Chinese medicine Nei Jing nature-based medicine Classical text research Global health Medical anthropology Classical-Text Archaeology

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Gastric cystica profunda:Another indication for minimally invasive endoscopic resection techniques?

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World Journal of Gastroenterology 2024年第27期30卷 3278-3283页

作者： Harjot K Bedi Douglas Motomura neal Shahidi Department of Medicine University of British ColumbiaVancouver V6Z 2K5BCCanada

Gastric cancer presents a significant global health burden,as it is the fifth most common malignancy and fourth leading cause of cancer mortality *** in incidence rates across regions underscores the multifactorial etiology of this *** overall 5-year survival rate remains low despite advances in its diagnosis and *** surgical gastrectomy was previously standard-of-care,endoscopic resection techniques,including endoscopic mucosal resection and endoscopic submucosal dissection(ESD)have emerged as effective alternatives for early *** to surgical resection,endoscopic resection techniques have comparable 5-year survival rates,reduced treatment-related adverse events,shorter hospital stays and lower *** also enables en bloc resection,thus affording organ-sparing curative endoscopic resection for early *** this editorial,we comment on the recent publication by Geng et al regarding gastric cystica profunda(GCP).GCP is a rare gastric pseudotumour with the potential for malignant *** presents a diagnostic challenge due to its nonspecific clinical manifestations and varied endoscopic *** are several gaps in the literature regarding the diagnosis and management of GCP which warrants further research to standardize patient *** in endoscopic resection techniques offer promising avenues for GCP and early gastric cancers.

关键词： Early gastric cancer Endoscopy Endoscopic submucosal dissection Gastric cystica profunda

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T1 colorectal cancer management in the era of minimally invasive endoscopic resection

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World Journal of Gastrointestinal Oncology 2024年第6期16卷 2284-2294页

作者： Shirley Xue Jiang Aein Zarrin neal Shahidi Department of Medicine University of British ColumbiaVancouver V6Z2K5British ColumbiaCanada Division of Gastroenterology St.Paul’s HospitalVancouver V6Z2K5British ColumbiaCanada

T1 colorectal cancer(CRC),defined by tumor invasion confined to the submucosa,has historically been managed by *** understanding of recurrence and lymph node metastases risk,coupled with advances in endoscopic resection techniques,have led to an increasing capacity for organ-sparing local *** invasive management of T1 CRC begins with optical evaluation of the lesion to diagnose invasive disease and quantify depth of invasion,which informs therapeutic decision *** selection between various available endoscopic resection techniques depends upon lesion characteristics,technique risk-benefit profiles,and location-specific *** endoscopic resection,established histopathology features determine the risk of recurrence and subsequent management including surveillance or adjuvant surgical *** management of non-operative candidates deviates from conventional recommendations with emerging treatment strategies in select populations.

关键词： Cancer Colonoscopy Endoscopy Polyp Surgery

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Endohepatology:Arrival at the frontier of interventional endosonography

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World Journal of Gastroenterology 2024年第18期30卷 2397-2401页

作者： Shane P Selvanderan Eric Lam neal Shahidi Department of Medicine University of British ColumbiaVancouver V6Z 1Y6BCCanada

Endohepatology describes the emerging field where diagnostic and therapeutic endoscopic ultrasound(EUS)are used for the diagnosis and management of liver disease and its *** this editorial we comment on the article by Gadour et *** spectrum of EUS-guided procedures includes liver parenchymal and lesional biopsy,abscess drainage,treatment of focal liver lesions,diagnosis of portal hypertension and management of gastric *** data suggest that the application of EUS to hepatology is technically feasible and safe,heralding the arrival at a new frontier for *** data,specifically randomised trials comparing EUS to interventional radiology techniques,and continued partnership between endoscopy and hepatology are required to see this field establish itself outside expert tertiary centres.

关键词： Cancer Cirrhosis Endoscopy Endoscopic ultrasound Liver disease

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Double-nylon purse-string suture technique: Another addition to the endoscopist's toolbox for full-thickness defect closure

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World Journal of Gastroenterology 2024年第25期30卷 3152-3154页

作者： Angad Walia Roberto Paolo Trasolini neal Shahidi Department of Medicine University of British ColumbiaVancouver V6Z2K5BCCanada

Iatrogenic perforation is the most feared adverse event in *** the expansion of interventional endoscopy in favor of traditional surgery,it is now more crucial than ever to develop effective defect closure *** has culminated in the dissemination of multiple novel closure technologies,including through-the-scope clips,over-the-scope clips,through-the-scope suturing and over-the-scope suturing *** this editorial,we comment on the recent publication by Wang and colleagues discussing the performance of the double-nylon purse-string suture technique in the closure of large(>3 cm)gastric full-thickness *** technique offers a promising,practical and cost-effective approach to closure of large full-thickness defects that can be readily imple-mented across diverse healthcare settings.

关键词： Cancer Endoscopy Endoscopic full-thickness resection Perforation

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An intelligent active probing and trace-back scheme for IoT anomaly detection

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Digital Communications and Networks 2024年第1期10卷 168-181页

作者： Luying Wang Lingyi Chen neal N.Xiong Anfeng Liu Tian Wang Mianxiong Dong School of Computer Science and Engineering Central South UniversityChangsha 410083China Department of Computer Science and Mathematics Sul Ross State UniversityAlpineTX 79830USA Artificial Intelligence and Future Networks Beijing Normal University&UICZhuhai 519087China Department of Information and Electronic Engineering Muroran Institute of TechnologyMuroran 050-8585Japan

Due to their simple hardware,sensor nodes in IoT are vulnerable to attack,leading to data routing blockages or malicious tampering,which significantly disrupts secure data *** Intelligent Active Probing and Trace-back Scheme for IoT Anomaly Detection(APTAD)is proposed to collect integrated IoT data by recruiting Mobile Edge Users(MEUs).(a)An intelligent unsupervised learning approach is used to identify anomalous data from the collected data by MEUs and help to identify anomalous nodes.(b)Recruit MEUs to trace back and propose a series of trust calculation methods to determine the trust of nodes.(c)The last,the number of active detection packets and detection paths are designed,so as to accurately identify the trust of nodes in IoT at the minimum cost of the network.A large number of experimental results show that the recruiting cost and average anomaly detection time are reduced by 6.5 times and 34.33%respectively,while the accuracy of trust identification is improved by 20%.

关键词： Anomaly detection Internet of things Integrating data collection Mobile edge users Intelligent

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Therapeutic nucleic acids in regenerative medicine and tissue repair

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Nano Research 2024年第10期17卷 8942-8976页

作者： Qimanguli Saiding Duotian Qin Soohwan An Dylan neal Patel Muhammad Muzamil Khan Na Kong Wei Tao Center for Nanomedicine and Department of Anesthesiology Brigham and Women’s HospitalHarvard Medical SchoolBostonMassachusetts 02115USA

In the vanguard of biomedical innovation,regenerative medicine emerges as a transformative paradigm,concentrating its efforts on rectifying tissue deficits and functional aberrations in patients through the strategic augmentation of endogenous cellular *** to this approach is nucleic acid therapy,which offers a novel pathway for tissue regeneration by modulating key signaling *** one of the most effective ways to regulate cell function,nucleic acids are crucial for various tissue regeneration;however,their in vivo therapeutic applications face substantial challenges,including nuclease degradation,cell membrane impermeability,and targeted intracellular ***-based gene delivery systems offer a solution for stable and localized drug delivery by enabling the controlled overexpression of therapeutic nucleic acids,producing functional regulatory *** review presents examples of nucleic acid applications in regenerative medicine,highlighting the synergy between nucleic acids and biomaterial *** underlines the importance of nucleic acid delivery techniques,the choice of therapeutic nucleic acids,and biomaterials for advancing tissue *** latest developments in designing nucleic acid biomaterial-based delivery vehicles are explored,the mechanism of nucleic acids in tissue regeneration is elucidated,and their limitations are discussed while considering future directions for the clinical translation of nucleic acid-based therapeutics.

关键词： tissue repair nucleic acids biomaterials delivery systems regenerative medicine

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