Efficacy and safety of esophageal submucosal tumors treated with internal traction method-assisted submucosal tunneling endoscopic resection: a single-center, single-blind, randomized controlled study.

BACKGROUND AND OBJECTIVES: Submucosal tunnel endoscopic resection (STER) is an effective technique for treating esophageal submucosal tumors, but the efficacy and safety of treating esophageal submucosal tumors with internal traction method-assisted STER have not been determined. The objectives of this study were to assess the feasibility, safety, and efficacy of internal traction method-assisted STER for the removal of esophageal submucosal tumors. PATIENTS AND METHODS: Eighty patients who underwent STER for esophageal submucosal tumors were included in the study. They were randomized and assigned to the two groups. The dual-knife method was used for STER. Forty patients underwent conventional STER (control group) and 40 underwent internal traction method-assisted STER in which self-made rubber band traction with clips was used (study group). In the study group, one end of the self-made rubber band was fixed on the surface of esophageal submucosal tumors with a clip, and the other end of the self-made rubber band was set on the anal side of the contralateral esophageal wall with a clip. RESULTS: STER was successful in all cases. Lesion features and demographics were similar between the two groups. In addition, broad exposure of the submucosal tissue was obtained by applying tension to the self-made rubber band traction with clips. The en bloc resection rate and complete resection rate were both 100% in the study group. However, the en bloc resection rate and complete resection rate were 85.0% and 100%, respectively, in the control group. Complications, such as perforation and pneumomediastinum, were significantly reduced in the study group, and there was a significant difference in the number of occurrences of bleeding, operation duration, fasting time, and patient length of stay between the study group and control group (P < 0.05). During the mean 13.7 month follow-up, there were no patients with esophageal fistula, recurrence, or distant metastasis in either group. CONCLUSIONS: This original study showed that esophageal submucosal tumors could be effectively and safely treated with internal traction method-assisted STER, and this technique might be superior to conventional STER due to its fewer complications, shorter operation duration, and shorter inpatient length of stay.

Robust Building Extraction for High Spatial Resolution Remote Sensing Images with Self-Attention Network.

Building extraction from high spatial resolution remote sensing images is a hot spot in the field of remote sensing applications and computer vision. This paper presents a semantic segmentation model, which is a supervised method, named Pyramid Self-Attention Network (PISANet). Its structure is simple, because it contains only two parts: one is the backbone of the network, which is used to learn the local features (short distance context information around the pixel) of buildings from the image; the other part is the pyramid self-attention module, which is used to obtain the global features (long distance context information with other pixels in the image) and the comprehensive features (includes color, texture, geometric and high-level semantic feature) of the building. The network is an end-to-end approach. In the training stage, the input is the remote sensing image and corresponding label, and the output is probability map (the probability that each pixel is or is not building). In the prediction stage, the input is the remote sensing image, and the output is the extraction result of the building. The complexity of the network structure was reduced so that it is easy to implement. The proposed PISANet was tested on two datasets. The result shows that the overall accuracy reached 94.50 and 96.15%, the intersection-over-union reached 77.45 and 87.97%, and F1 index reached 87.27 and 93.55%, respectively. In experiments on different datasets, PISANet obtained high overall accuracy, low error rate and improved integrity of individual buildings.

Potentiality of Using Luojia 1-01 Nighttime Light Imagery to Investigate Artificial Light Pollution.

The successful launch of Luojia 1-01 complements the existing nighttime light data with a high spatial resolution of 130 m. This paper is the first study to assess the potential of using Luojia 1-01 nighttime light imagery for investigating artificial light pollution. Eight Luojia 1-01 images were selected to conduct geometric correction. Then, the ability of Luojia 1-01 to detect artificial light pollution was assessed from three aspects, including the comparison between Luojia 1-01 and the Suomi National Polar-Orbiting Partnership Visible Infrared Imaging Radiometer Suite (NPP-VIIRS), the source of artificial light pollution and the patterns of urban light pollution. Moreover, the advantages and limitations of Luojia 1-01 were discussed. The results showed the following: (1) Luojia 1-01 can detect a higher dynamic range and capture the finer spatial details of artificial nighttime light. (2) The averages of the artificial light brightness were different between various land use types. The brightness of the artificial light pollution of airports, streets, and commercial services is high, while dark areas include farmland and rivers. (3) The light pollution patterns of four cities decreased away from the urban core and the total light pollution is highly related to the economic development. Our findings confirm that Luojia 1-01 can be effectively used to investigate artificial light pollution. Some limitations of Luojia 1-01, including its spectral range, radiometric calibration and the effects of clouds and moonlight, should be researched in future studies.

A method of spatial mapping and reclassification for high-spatial-resolution remote sensing image classification.

This paper presents a new classification method for high-spatial-resolution remote sensing images based on a strategic mechanism of spatial mapping and reclassification. The proposed method includes four steps. First, the multispectral image is classified by a traditional pixel-based classification method (support vector machine). Second, the panchromatic image is subdivided by watershed segmentation. Third, the pixel-based multispectral image classification result is mapped to the panchromatic segmentation result based on a spatial mapping mechanism and the area dominant principle. During the mapping process, an area proportion threshold is set, and the regional property is defined as unclassified if the maximum area proportion does not surpass the threshold. Finally, unclassified regions are reclassified based on spectral information using the minimum distance to mean algorithm. Experimental results show that the classification method for high-spatial-resolution remote sensing images based on the spatial mapping mechanism and reclassification strategy can make use of both panchromatic and multispectral information, integrate the pixel- and object-based classification methods, and improve classification accuracy.

Retention Time of Endoscopic Nasobiliary Drainage and Symptomatic Choledocholithiasis Recurrence After Endoscopic Retrograde Cholangiopancreatography: A Single-center, Retrospective Study in Fuyang, China.

BACKGROUND AND OBJECTIVES: Endoscopic nasobiliary drainage (ENBD) is usually retained for several days after choledocholithiasis is removed by endoscopic retrograde cholangiopancreatography (ERCP). ENBD placement provides reliable biliary drainage and perfusion, prevents pancreatitis, and allows for cholangiography. However, it has not been established whether retention time of ENBD is associated with symptomatic choledocholithiasis recurrence after ERCP. For this reason, we estimated the effect of ENBD retention time on symptomatic choledocholithiasis recurrence after ERCP. PATIENTS AND METHODS: A total of 1016 patients in whom choledocholithiasis had been diagnosed and ERCP had been performed to remove choledocholithiasis were retrospectively reviewed. Their ENBD retention time was 4.01±1.53 days. They were divided into group 1 (n=570) and group 2 (n=446) according to the mean value. Cumulative recurrence rates of symptomatic choledocholithiasis after ERCP were compared between the 2 groups. To identify independent factors associated with symptomatic choledocholithiasis recurrence, various likely predictors associated with the intergroup differences were also recorded. RESULTS: There were 570 patients with ENBD retention time ≤4.01 days (group 1) and 446 patients with ENBD retention time >4.01 days (group 2). No statistically significant differences between the 2 groups were evident in terms of demographic factors and laboratory results, except for amylase (AMY) and opening diet time after ERCP. The median (interquartile range) follow-up was 23.7 (14.6, 32.13) months (range: 4.3 to 70 mo) in group 1 and 23.7 (14.6, 31.2) months (range: 4.2 to 69.4 mo) in group 2 ( P =0.762). The cumulative recurrence rates of symptomatic choledocholithiasis were 3.1% (2.5% vs. 3.8%) at month 20, 6.7% (5.1% vs. 8.7%) at month 40, and 8.2% (6.7% vs. 10.1%) at month 60 for groups 1 and 2, respectively ( P =0.048). By multivariate analysis, being in group 1 reduced symptomatic choledocholithiasis recurrence, with a hazard ratio of 0.641 (95% confidence interval: 0.416-0.987, P =0.044). CONCLUSIONS: This preliminary study showed that symptomatic choledocholithiasis recurrence may be associated with ENBD retention time after ERCP, particularly for duration of ENBD more than 4.01 days.

Efficacy and Safety of Small Bowel Submucosal Tumors Treated by Endoscopic Submucosal Dissection or Endoscopic Full-thickness Resection During Single-balloon Enteroscopy: Prospective Data From a Single-center Study.

BACKGROUND AND OBJECTIVES: Single-balloon enteroscopy (SBE) is a safe and effective modality for the diagnosis and therapeutic treatment of small bowel disorders. However, the efficacy and safety of treating small bowel submucosal tumors (SMTs) with endoscopic submucosal dissection (ESD) or endoscopic full-thickness resection (EFTR) during SBE have not been determined. Hence, the primary aim of this study was to prospectively evaluate the therapeutic yield of SBE in patients with SMTs. PATIENTS AND METHODS: Twenty-one patients with SMTs were enrolled in this study. Regarding the sex distribution, there were 12 men (57.1%) and 9 women (42.9%). Regarding the age distribution, 42.9% of the patients were 60 years old or older and 57.1% of the patients were under 60 years old. The preoperative characteristics of SMTs were summarized and analyzed, the complete resection incidence of SMTs was determined, and the incidence of postoperative complications was collected. ESD-related and EFTR-related complications and the duration of follow-up after leaving hospital were also summarized and analyzed. The efficacy and safety of SMTs treated by ESD or EFTR during SBE were calculated as percentages. RESULTS: Among the 21 patients, 10 (47.6%) underwent EFTR and 11 (52.4%) underwent ESD. The mean diameter of SMTs was 113.50 mm (range: 80 to 160 mm). Anterograde and retrograde SBE were conducted in 11 and 10 patients, respectively. The mean follow-up time was 49.3 days (range: 6.0 to 129 d). The complete resection rate of SMTs was 100%. The complete suture rate of SMTs wound was 100%. The SMTs pathology of all patients showed that the margin-negative (R0) resection was 100%. The incidence of physical discomfort complications (ie, infection/fever, abdominal pain, and abdominal distension) of ESD and EFTR was 5 (23.8%) on day 1, 1 (4.8%) on day 2, and 1 (4.8%) on day 3 after operation. Only 1 (4.8%) patient with EFTR had abdominal pain on the sixth day after leaving hospital, and the visual analog scale/score was 1 point, meaning the pain was easily tolerated by the patient. Twenty (95.2%) patients had no abdominal discomfort after leaving hospital. No patients needed additional surgery because of complications after ESD or EFTR during SBE. CONCLUSIONS: This preliminary study showed that SMTs can be safely and effectively treated by ESD or EFTR during SBE, particularly SMTs <160 mm in diameter.

Metformin Use and Survival in Patients with Advanced Extrahepatic Cholangiocarcinoma: A Single-Center Cohort Study in Fuyang, China.

AIMS: Metformin is an oral antidiabetic agent that has been widely prescribed for the treatment of type II diabetes. In recent years, anticancer properties of metformin have been revealed for numerous human malignancies. However, there are few indications available regarding the feasibility and safety of these studies in an advanced extrahepatic cholangiocarcinoma (EHCC) population. This study is aimed at evaluating the feasibility, safety, and value of metformin use and survival in patients with advanced EHCC. METHODS: All patients with advanced EHCC observed at Fuyang People's Hospital between January 2015 and November 2020 were included in the study. Case data, clinical information, and imaging results were abstracted from the self-administered questionnaire and electronic medical record. All patients were divided into study subjects and control subjects, and the study subjects were given metformin, 0.5 g, three times a day, while control subjects were without metformin. The metformin use and survival time of the subjects were asked by telephone, out-patient, or door-to-door visit, after they left the hospital. RESULTS: One hundred and thirty-three study cases and 589 controls were included in the analysis. This study showed that metformin use cannot improve the overall survival rate of patients with advanced EHCC ([95% CI]: -17.05-0.375, t = -1.889, P value = 0.061), but the survival time of patients with drainage treatment from control group (n = 496) was significantly shorter than that of patients with drainage treatment from the study group (n = 113), and the difference was statistically significant (z = -2.230, P value = 0.026). There were significant differences between metformin used before or after the diagnosis of advanced EHCC (OR[95% CI], 3.432[2.617-4.502]; P value = 0.001) in survival time. And there was significant difference between the duration of metformin use and survival prognosis (OR[95% CI], 2.967[1.383-6.368]; P = 0.005). CONCLUSION: Metformin can improve the survival of advanced EHCC patients who underwent drainage treatment, especially for metformin use after diagnosis of advanced EHCC and long duration of metformin.

Fabrication of 2D Metal-Organic Framework Nanosheets with Highly Colloidal Stability and High Yield through Coordination Modulation.

2D metal-organic frameworks (MOFs) are promising 2D materials with a wide range of applications due to their unique physical and chemical properties. However, 2D MOFs are prone to stacking due to their ultrathin thickness, and the high-yield preparation method of 2D MOFs is highly demanded. In this work, a rapid and scalable method is novelistically presented to prepare 2D MOFs with highly colloidal stability and high yield through coordination modulation at room temperature. A well-ordered CuBDC-MBA nanosheet (BDC, 1,4-benzenedicarboxylic; MBA, 4-methoxybenzoic acid) fabricated by introducing MBA as a modulator exhibits extremely stable colloid suspension for 6 months and the yield of well-dispersed CuBDC-MBA is higher than 88.6%. As MBA successfully participates in synthetic coordination of CuBDC-MBA and is presumably installed on the edge of 2D MOFs with low MBA content due to anisotropic growth, CuBDC-MBA and CuBDC are similar with respect to nanosheet morphology, integrated crystal structure, and porosity. Moreover, well-dispersed CuBDC-MBA shows higher catalytic effectiveness for the cycloaddition reaction of CO2 with 1.5 times higher yield than CuBDC. Thus, this method can provide a new idea based on coordination modulation to directly fabricate 2D MOFs with purposeful properties.

Integrative analysis of hepatic metabolomic and transcriptomic data reveals potential mechanism of nonalcoholic steatohepatitis in high-fat diet-fed mice.

BACKGROUND: Due to the complex pathogenesis, the molecular mechanism of nonalcoholic steatohepatitis (NASH) remains unclear. In this study, we aimed to reveal the comprehensive metabolic and signaling pathways in the occurrence of NASH. METHODS: C57BL/6 mice were treated with high-fat diet for 4 months to mimic the NASH phenotype. After the treatment, the physiochemical parameters were evaluated, and the liver tissues were prepared for untargeted metabolomic analysis with ultraperformance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry. Then, three relevant Gene Expression Omnibus (GEO) datasets were selected for integrative analysis of differentiated messenger RNA and metabolites. RESULTS: The levels of phosphatidylethanolamine (PE) (16:1(9Z)/20:4(5Z,8Z,11Z,14Z)), oleic acid, and sphingomyelin (SM) (d18:0/12:0) were significantly increased, and the content of adenosine was severely reduced in NASH mice. The integrated interpretation of transcriptomic and metabolomic data indicated that the glycerophospholipid metabolism and necroptosis signaling were evidently affected in the development of NASH. The high level of SM (d18:0/12:0) may be related to the expression of acid sphingomyelinase (ASMase), and the elevated arachidonic acid was coordinated with the upregulation of cytosol phospholipase A2 (cPLA2) in the necroptosis pathway. CONCLUSIONS: In summary, the inflammatory response, necroptosis, and glycerophospholipid may serve as potential targets for mechanistic exploration and clinical practice in the treatment of NASH.