Factors of easy and difficult cecal intubation during unsedated colonoscopy.

BACKGROUND AND AIMS: difficulty of cecal intubation should be a main indicator for the need of sedated colonoscopy and skilled endoscopists. The present study aimed to explore the factors associated with easy and difficult cecal intubation in unsedated colonoscopy. METHODS: all consecutive patients who underwent unsedated colonoscopy at our department by the same endoscopist from December 3, 2020 to August 30, 2022 were retrospectively collected. Age, gender, body mass index (BMI), reasons for colonoscopy, position change, Boston Bowel Preparation Scale score, cecal intubation time (CIT) and major colonoscopic findings were analyzed. CIT < 5 min, CIT 5-10 min and CIT > 10 min or failed cecal intubation were defined as easy, moderate and difficult cecal intubation, respectively. Logistic regression analyses were performed to identify independent factors associated with easy and difficult cecal intubation. RESULTS: overall, 1,281 patients were included. The proportions of easy and difficult cecal intubation were 29.2 % (374/1,281) and 27.2 % (349/1,281), respectively. Multivariate logistic regression analysis found that age ≤ 50 years, male, BMI > 23.0 kg/m2 and the absence of position change were independently associated with easy cecal intubation, and that age > 50 years, female, BMI ≤ 23.0 kg/m2, position change, and insufficient bowel preparation were independently associated with difficult cecal intubation. CONCLUSIONS: some convenient factors independently associated with easy and difficult cecal intubation have been identified, which will be potentially helpful to determine whether a colonoscopy should be sedated and a skilled endoscopist should be selected. The current findings should be further validated in large-scale prospective studies.

Aerosol Sauter mean diameter measurement based on the light scattering response of the combined particle volume-surface area.

The relationship between the numerical of Sauter mean diameter (SMD) and aerosol distribution parameters, as well as its physical significance are lacking in detailed research. Meanwhile, existing method is not widely used for SMD accurate measurement due to many restrictions on the incident light wavelengths. In this study, we analyzed the relationship between SMDs and the mean and median values of the lognormal, normal, and Weibull distributions with different parameters. It is found that SMD can be directly used to substitute the mean particle size in lognormal distributions with slight deviations. A new method for aerosol SMD measurement with no wavelength limitation based on the light scattering response of the combined volume-surface area of particles is proposed. SMD inversion results show that this method reduces the error caused by inconsistent integration of the wavelength of incident light and particle size in existing measurements, because has no limitation on the wavelength of incident light. SMDs of N-Heptane combustion smokes measured using the developed sensor indicates that our proposed SMD measurement method effectively compensates the shortcomings of the existing method and improves the measurement accuracy, with the minimum and average errors of 8.9% and 14.78%, respectively.

The Incidence of Acute Pancreatitis After Device Assisted Enteroscopy: a Systematic Review and Meta-analysis.

Background: The diagnosis of small bowel diseases is challenging and device assisted enteroscopy (DAE) is a technique for visualizing the entire small bowel. DAE is considered as a safe procedure and the reported rate of adverse events associated with DAE in the literature is low. Objective: The present study tried to investigate the actual incidence of AP after DAE with a systematic review and meta-analysis of available relevant studies. Methods: Studies were searched through the PubMed, EMBASE, and Cochrane library databases. The following data were extracted from all eligible studies: author, country, publication year, publication type, study design, type of DAE used, route of DAE, number of patients with AP after DAE, and number of patients with hyperamylasemia after DAE.A random-effects model with RStudio version 4.2.0 was performed in all analyses. Heterogeneity was assessed using the I2 test. The risk of bias was assessed by the Newcastle-Ottawa Scale criteria and the publication bias was assessed by the Egger test. Results: Twenty three studies involving a total of 11145 patients were included in the analysis. The overall, pooled AP rate after DAE was 1% (95% CI:0-1%). There was significant heterogeneity among the studies (I2 = 65%; P < 0.01).The pooled AP rate was 1% (95% CI:0-2 %)in peroral route group. The pooled proportion of patients having hyperamylasemia after DAE was 29% (95% CI: 16-46%).Among the patients who had hyperamylasemia AP were identified in 2% (95% CI: 0-6%) of patients. Conclusion: The incidence of AP after DAE is about 1%. Hyperamylasemia is a common change in the patients undergoing DAE and only 2% of the patients with hyperamylasemia present with AP.

Factors of easy and difficult cecal intubation during unsedated colonoscopy

Background and aims: difficulty of cecal intubation should be a main indicator for the need of sedated colonoscopy and skilled endoscopists. The present study aimed to explore the factors associated with easy and difficult cecal intubation in unsedated colonoscopy. Methods: all consecutive patients who underwent unsedated colonoscopy at our department by the same endoscopist from December 3, 2020 to August 30, 2022 were retrospectively collected. Age, gender, body mass index (BMI), reasons for colonoscopy, position change, Boston Bowel Preparation Scale score, cecal intubation time (CIT) and major colonoscopic findings were analyzed. CIT < 5 min, CIT 5-10 min and CIT > 10 min or failed cecal intubation were defined as easy, moderate and difficult cecal intubation, respectively. Logistic regression analyses were performed to identify independent factors associated with easy and difficult cecal intubation. Results: overall, 1,281 patients were included. The proportions of easy and difficult cecal intubation were 29.2 % (374/1,281) and 27.2 % (349/1,281), respectively. Multivariate logistic regression analysis found that age ≤ 50 years, male, BMI > 23.0 kg/m2 and the absence of position change were independently associated with easy cecal intubation, and that age > 50 years, female, BMI ≤ 23.0 kg/m2, position change, and insufficient bowel preparation were independently associated with difficult cecal intubation. Conclusions: some convenient factors independently associated with easy and difficult cecal intubation have been identified, which will be potentially helpful to determine whether a colonoscopy should be sedated and a skilled endoscopist should be selected. The current findings should be further validated in large-scale prospective studies. (AU)

Copper-Catalyzed Cross-Coupling of Alkyl and Phosphorus Radicals for C(sp3)-P Bond Formation.

A CuI-catalyzed cross-coupling of alkyl- and phosphorus-centered radicals for C(sp3)-P bond formation is introduced. Diacyl peroxides, generated in situ from aliphatic acids and H2O2, serve as a source for alkyl radicals and also an initiator for the generation of phosphorus radicals from H-P(O) compounds.

CryoETGAN: Cryo-Electron Tomography Image Synthesis via Unpaired Image Translation.

Cryo-electron tomography (Cryo-ET) has been regarded as a revolution in structural biology and can reveal molecular sociology. Its unprecedented quality enables it to visualize cellular organelles and macromolecular complexes at nanometer resolution with native conformations. Motivated by developments in nanotechnology and machine learning, establishing machine learning approaches such as classification, detection and averaging for Cryo-ET image analysis has inspired broad interest. Yet, deep learning-based methods for biomedical imaging typically require large labeled datasets for good results, which can be a great challenge due to the expense of obtaining and labeling training data. To deal with this problem, we propose a generative model to simulate Cryo-ET images efficiently and reliably: CryoETGAN. This cycle-consistent and Wasserstein generative adversarial network (GAN) is able to generate images with an appearance similar to the original experimental data. Quantitative and visual grading results on generated images are provided to show that the results of our proposed method achieve better performance compared to the previous state-of-the-art simulation methods. Moreover, CryoETGAN is stable to train and capable of generating plausibly diverse image samples.

Understanding Pixel-Level 2D Image Semantics With 3D Keypoint Knowledge Engine.

Pixel-level 2D object semantic understanding is an important topic in computer vision and could help machine deeply understand objects (e.g., functionality and affordance) in our daily life. However, most previous methods directly train on correspondences in 2D images, which is end-to-end but loses plenty of information in 3D spaces. In this paper, we propose a new method on predicting image corresponding semantics in 3D domain and then projecting them back onto 2D images to achieve pixel-level understanding. In order to obtain reliable 3D semantic labels that are absent in current image datasets, we build a large scale keypoint knowledge engine called KeypointNet, which contains 103,450 keypoints and 8,234 3D models from 16 object categories. Our method leverages the advantages in 3D vision and can explicitly reason about objects self-occlusion and visibility. We show that our method gives comparative and even superior results on standard semantic benchmarks.

Copper-Catalyzed Vicinal Cyano-, Thiocyano-, and Chlorophosphorylation of Alkynes: A Phosphinoyl Radical-Initiated Approach for Difunctionalized Alkenes.

A copper-catalyzed difunctional cyano-, thiocyano-, and chlorophosphorylation reaction of alkynes with P(O)-H compounds and coupling partners (TBACN, TMSNCS, TMSCl) is described. The reaction introduces versatile groups (-P(O)R2 and -CN, -SCN, or -Cl) to form tri- and tetrasubstituted alkenyl phosphine oxides/phosphonates regio- and stereoselectively.

Overexpression of miR-221 stimulates proliferation of rat neural stem cell with activating Phosphatase and tensin homolog/protein kinase B signaling pathway.

Neural stem cells (NSCs) are self-renewing, multipotent cells, and remain in our brains throughout life. They could be activated by brain damage and involved in the central nervous system (CNS) repair and motor functional recovery. Previous research demonstrated that miR-221 could regulate proliferation, differentiation, and survival. However, the effect of miR-221 on NSCs remains unknown. In this study, we showed that overexpression of miR-221 inhibited the expression of phosphatase and tensin homolog (PTEN) protein and increased the phosphorylation level of protein kinase B (AKT). More importantly, an AKT-specific inhibitor abolished the effect of miR-221 on the phosphorylation level of AKT. 5-Bromo-2-deoxyUridine (BrdU) incorporation assay and Cyclin D1 expression showed that miR-221 overexpression further promoted the NSCs proliferation. However, knocking down miR-221 inhibited cell proliferation. The AKT-specific inhibitor also blocked the proliferative efficiency of miR-221. These results demonstrated that miR-221 overexpression promoted the proliferation of cultured rat NSCs, for which the PTEN/AKT pathway activation was one possible mechanism. Our research may provide a novel investigating strategy to improve stem cell treatment for CNS diseases.

Copper-Catalyzed Oxidative sp3-Carbon Radical Cross-Coupling with Trialkylphosphites Leading to α-Phosphonyl 1,3-Dicarbonyl Compounds.

A copper-catalyzed radical Csp3-H/P(OR)3 cross-coupling reaction for the formation of Csp3-P bonds is described. A range of 1,3-dicarbonyl compounds and trialkylphosphites were coupled in this fashion to give the corresponding products in moderate to good yields. This protocol provides direct access to α-phosphonyl 1,3-dicarbonyl compounds.

Visible Light-Mediated Photocatalytic Metal-Free Cross-Coupling Reaction of Alkenyl Carboxylic Acids with Diarylphosphine Oxides Leading to ß-Ketophosphine Oxides.

A new visible light-mediated photocatalytic decarboxylative oxyphosphorylation of cinnamic acids with diarylphosphine oxides is described. This reaction is performed under mild conditions to afford the corresponding ß-ketophosphine oxides.

Phosphinoyl Radical-Initiated 1,2-Bifunctional Thiocyanodiphenylphosphinoylation of Alkenes.

1,2-Bifuctional thiocyanodiphenylphosphinoylation of alkenes is established through the phosphinoyl radical addition followed by Cu-catalyzed thiocyanation. This one-pot reaction is applicable to a range of aromatic, aliphatic, and cyclic alkenes to afford thiocyanodiphenylphosphinoylated compounds in satisfactory yields.

"All-Inside" Arthroscopic Treatment of Tillaux-Chaput Fractures: Clinical Experience and Outcomes Analysis.

We investigated all-inside ankle arthroscopy for Tillaux-Chaput fractures. We retrospectively evaluated 19 patients (12 males [63.2%] and 7 [36.8%] females; 11 right [57.9%] and 8 left [42.1%] ankles) treated from May 2013 to January 2016. Their mean age was 28.1 (range 10 to 55) years. Sixteen (84.2%) had single Tillaux-Chaput fractures and 3 (15.8%) had combined proximal fibular fractures; 17 (89.5%) were diagnosed radiographically and 2 (10.5%) by computed tomography. Anterolateral and anteromedial ankle arthroscopy was used for closed reduction and internal fixation with 1 or 2 Herbert screws. Joint function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. All 19 patients healed by first intention without nerve, vessel, or tendon injuries. The follow-up was 19.0 (range 12 to 25) months; fracture union was achieved by 23.5 (range 12 to 36) weeks. At the last follow-up, the 19 patients had no restrictions in ankle function and range of motion, with no ankle or walking pain. The AOFAS score changed from 52.8 to 91.7 points, with an excellent/good rate of 100%. These results suggest that anterolateral and anteromedial all-inside ankle arthroscopy is a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures.

Superficial Radial Nerve Transection Improves Sensory Outcomes in First Dorsal Metacarpal Artery Flaps.

BACKGROUND: This article reports the operative technique and clinical effect of repairing thumb pulp defects using a modified first dorsal metacarpal artery flap method. In this method, the dorsal branches of the radial and ulnar proper digital nerves of the index finger were preserved but the superficial branches of the radial nerve were transected. METHODS: Data obtained from 121 patients with thumb pulp defects who were admitted to the authors' hospital from June of 2011 to December of 2014 were retrospectively analyzed. Patients were divided into two groups based on whether the superficial branches of the radial nerve were transected. The dorsal branches of the radial and ulnar proper digital nerves of the index finger and the proper digital nerves in the wound were coapted using the end-to-end style. Static two-point discrimination, Semmes-Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, allachesthesia, and patient satisfaction were compared between the two groups. RESULTS: The authors observed significant differences in static two-point discrimination, Semmes-Weinstein monofilament flap score, pain of finger pulp, allachesthesia duration, and patient satisfaction (p < 0.05). The transection group presented slightly better discriminatory sensation in the flap and higher patient satisfaction. In addition, the duration of allachesthesia in the transection group was significantly shorter than that in the preservation group. CONCLUSION: In the repair of thumb pulp defects using a modified first dorsal metacarpal artery flap carrying the dorsal branches of the radial and ulnar proper digital nerves of the index finger, transecting the superficial branches of the radial nerve achieved better clinical outcome compared with preserving them. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Copper-catalyzed TEMPO oxidative cleavage of 1,3-diketones and ß-keto esters for the synthesis of 1,2-diketones and α-keto esters.

A copper-catalyzed efficient and practical method has been developed for the synthesis of 1,2-diketones and α-keto esters. TEMPO was used as a radical initiator and scavenger, oxidizing the cleavage of α-methylene of 1,3-diketones and ß-keto esters to form 1,2-diketones and α-keto esters. This method provided a general way for the formation of 1,2-dicarbonyl compounds.

Organocatalytic Enantioselective Oxidative C-H Alkenylation and Arylation of N-Carbamoyl Tetrahydropyridines and Tetrahydro-ß-carbolines.

The first organocatalytic enantioselective C-H alkenylation and arylation reactions of N-carbamoyl tetrahydropyridines and tetrahydro-ß-carbolines (THCs) are described. The metal-free processes represent an efficient and straightforward approach to a variety of structurally and electronically diverse α-substituted tetrahydropyridines and THCs in good yields with excellent regio- and enantioselectivities. Preliminary control experiments provide important insights into the reaction mechanism.

Highly enantioselective catalytic cross-dehydrogenative coupling of N-carbamoyl tetrahydroisoquinolines and terminal alkynes.

The first catalytic asymmetric cross-dehydrogenative coupling of cyclic carbamates and terminal alkynes has been established. The reaction features high enantiocontrol and excellent functional group tolerance and displays a wide range of structurally and electronically diverse carbamates as well as terminal alkynes. N-Acyl hemiaminals were identified as the reactive intermediates through preliminary control experiments. Employing readily removable carbamates as substrates rather than traditionally adopted N-aryl amines allows applications in complex molecule synthesis and therefore advances the C-H functionalization strategy to a synthetically useful level.

[Effects of vitamin E and magnesium on glucolipid metabolism in obese rats ].

OBJECTIVE: To investigate the effects of vitamin E (VE ) and magnesium entantion on glucolipid metabolism in obese rats. METHODS: Seventy-four rats were randomly divided into five groups (normal control group positive E group, Mg group, VE plus Mg group). The doses of V(E) and Mg were 0.23 g/kg feed and 0.31 g/kg feed respectively. They were slaughtered after feed for 67 weeks. Calculate the lipid ratio. Examined the level of serum lipid, plasma glucose, serum insulin, insulin sensitivity index, and the activity of hexokinase and pyruvate kinase. The results of each group were analyzed by One-Way ANOVA and analysis of variance of factorial design. RESULTS: The rat model with nutritional obesity was successfully established that the weight of positive control group was about 20% higher than normal control group. The lipid ratio and plasma triglyceride of VE plus Mg group were 13. 29% and 0. 6 mmol/L respectively, which were significantly lower than that of positive control group (17.24% and 1. 18 mmol/L) (P < 0.05), and the plasma triglyceride of VE plus Mg group was significantly lower than that of VE group (1. 07mmol/ L) (P <0.05). The activity of hexokinase of V~E group and VE plus Mg group were 63. 67 U/L and 64. 61 U/L respectively, significantly higher than that of positive control group (42.79 U/L) and Mg group (44.02 U/L) (P <0.05). CONCLUSION: Supplementation of VE combined with Mg can effectively improve the fat content and triglyceride of obese rats, better than VE alone. Supplementation of VE and Mg is beneficial to obese rats to improve the activity of hexokinase, and adding VE is better than Mg alone.