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Contraindications for video capsule endoscopy

World Journal of Gastroenterology 2016年第45期22卷 9898-9908页

作者： Dirk Bandorski Niehls Kurniawan Peter Baltes Reinhard Hoeltgen Matthias Hecker Dominik Stunder Martin Keuchel University of Giessen and Marburg Lung Center Member of the German Center for Lung Research (DZL) Clinic for Internal Medicine Bethesda Krankenhaus Bergedorf Klinikum Westmünsterland St. Agnes-Hospital Bocholt Rhede Medical Clinic 1 Cardiology/Electrophysiology Research Center for Bioelectromagnetic Interaction (femu) Institute of Occupational and Social Medicine RWTH Aachen University Hospital

Video capsule endoscopy(VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn's disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication. Endoscopic placement of the capsule should be considered in patients with swallowing disorders to avoid aspiration. Esophageal or gastric motility disorders may require endoscopic capsule transport or application of prokinetics if the real-time viewer proofs delayed transit. In pregnant women, VCE should be restricted to urgent cases where diagnosis cannot be postponed after delivery, as data on safety are missing. There is theoretical and clinical evidence that patients with implanted cardiac devices such as a pacemaker, cardioverters or left heart assist devices, can safely undergo VCE in spite of still existing contraindication by manufacturers. Children from the age of 2 years have safely undergone VCE. Although video capsules are not proven safe with magnetic resonance imaging(MRI), first single cases of patients incidentally undergoing MRI with an incorporated capsule have been reported, showing susceptibility artifacts but no signs of clinical harm.

关键词： Video capsule endoscopy Contraindications Stenosis Pacemaker Aspiration Pregnancy Magnetic resonance imaging

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Alternative uses of lumen apposing metal stents

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World Journal of Gastroenterology 2020年第21期26卷 2715-2728页

作者： Prabin Sharma Thomas R McCarty Ankit Chhoda Antonio Costantino Caroline Loeser Thiruvengadam Muniraj Marvin Ryou Christopher C Thompson Department of Gastroenterology and Hepatology Yale-New Haven Health-Bridgeport HospitalBridgeportCT 06610United States Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States Department of Internal Medicine Yale-New Haven Health-Bridgeport HospitalBridgeportCT 06708United States Section of Digestive Diseases Yale University School of MedicineNew HavenCT 06520United States

The advent of lumen apposing metal stents(LAMS)has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological *** procedures have garnered popularity due to their minimally invasive nature,higher technical and clinical success rate and lower rate of adverse *** virtue of their unique design,LAMS provide more efficient drainage,serve as conduit for endoscopic access,are associated with lower rates of leakage and are easy to be *** used for drainage of pancreatic fluid collections,the use of LAMS has been extended to gallbladder and biliary drainage,treatment of luminal strictures,creation of gastrointestinal fistulae,pancreaticobiliary drainage,improved access for surgically altered anatomy,and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid *** new indications of endosonographic techniques and LAMS continue to evolve,this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.

关键词： Lumen apposing metal stents Walled off necrosis Gallbladder drainage Biliary drainage Gastric access temporary for endoscopy Gastric outlet obstruction Therapeutic endoscopy

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Catheter-based renal denervation： treating hypertension or beyond？

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Chinese Medical Journal 2014年第6期127卷 1166-1169页

作者： Felix Mahfoud Dominik Linz Michael B(o)hm Department of Internal Medicine Saarland University Homburg 66421 Germany

The sympathetic nervous system regulates cardiac output,blood pressure(BP)and volume,electrolyte balance,and the composition of body *** afferent nervous signals to the brain are regulated by mechano-sensitive

关键词： renal sympathetic denervation hypertension sympathetic nervous system

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Engineering complex systems applied to risk management in the mining industry

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International Journal of Mining Science and Technology 2017年第4期27卷 611-616页

作者： Domingues Maria S.Q. Baptista Adelina L.F. Diogo Miguel Tato CERENA - Centre for Natural Resources and the Environment Faculty of Engineering University of Porto Porto 4200-465 Portugal CLEGI-Centre Lusiada of Research and Development in Engineering and Industrial Management University Lusiada-North Vila Nova de Famalicao 4760-108 Portugal

Related to complexity, there is a wide diversity of concepts, ranging from ‘‘systemic" to ‘‘complex", implying a need for a unified terminology. Per different authors, the main drivers of complexity can be found in human behaviour and uncertainty. This complexity, structural or dynamic can be organizational, technological, or nested in their relationship. ISO international standard 31000:2009 definition of risk management ‘‘coordinated activities to direct and control an organization with regard to risk", when applied to economic sectors, industry, services, project, or activity, it requires the use of models or theories as guidelines. Therefore, as its basic elements comprehend human behaviour and/or uncertainty, risk management to be effective and adapted as much as possible to reality, must be operational within complex systems, as already demonstrated in different R&D environments. Risk management faces demanding challenges when approaching specific and endogenous needs, such as the mining sector. This paper presents a multivariable function analysis methodology approach based on complex system modelling and through real data corresponding to a risk management tool in the mining sector.

关键词： Risk Risk management Complex systems Mining Decision making

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Endovascular thrombectomy for stroke: current best practice and future goals

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Stroke & Vascular Neurology 2016年第1期1卷 16-22页

作者： Bruce C V Campbell Geoffrey A Donnan Peter J Mitchell Stephen M Davis Department of Medicine and Neurology Melbourne Brain Centre at the Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia The Florey Institute of Neuroscience and Mental Health University of MelbourneParkvilleVictoriaAustralia Department of Radiology Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia

Endovascular thrombectomy for large vessel ischaemic stroke substantially reduces disability,with recent positive randomised trials leading to guideline changes *** review discusses in detail the evidence provided by recent randomised trials and metaanalyses,the remaining areas of uncertainty and the future directions for *** data from existing trials have demonstrated the robust benefit of endovascular thrombectomy for internal carotid and proximal middle cerebral artery *** remains for more distal occlusions where the efficacy of alteplase is greater,less tissue is at risk and the safety of endovascular procedures is less *** artery occlusion was excluded from the trials,but with a dire natural history and proof of principle that rapid reperfusion is effective,it seems reasonable to continue treating these patients pending ongoing trial *** has been no evidence of heterogeneity in treatment effect in clinically defined subgroups by age,indeed,those aged>80 years have at least as great an overall reduction in disability and reduced *** there was no heterogeneity across the range of baseline stroke severities included in the *** that routine use of general anaesthesia reduces the benefit of endovascular thrombectomy is increasing and conscious sedation is generally preferred unless severe agitation or airway compromise is *** impact of time delays has become clearer with description of onset to imaging and imaging to reperfusion *** in the onset to imaging reduce the proportion of patients with salvageable brain ***,in the presence of favourable imaging,rapid treatment appears beneficial regardless of the onset to imaging time *** to reperfusion delays lead to decay in the clinical benefit achieved,particularly in those with less robust collateral *** brain imaging options to assess prognosis have various advantages and disadvan

关键词： routine epoch benefit

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