Chinese text classification by combining Chinese-BERTology-wwm and GCN.

Text classification is an important and classic application in natural language processing (NLP). Recent studies have shown that graph neural networks (GNNs) are effective in tasks with rich structural relationships and serve as effective transductive learning approaches. Text representation learning methods based on large-scale pretraining can learn implicit but rich semantic information from text. However, few studies have comprehensively utilized the contextual semantic and structural information for Chinese text classification. Moreover, the existing GNN methods for text classification did not consider the applicability of their graph construction methods to long or short texts. In this work, we propose Chinese-BERTology-wwm-GCN, a framework that combines Chinese bidirectional encoder representations from transformers (BERT) series models with whole word masking (Chinese-BERTology-wwm) and the graph convolutional network (GCN) for Chinese text classification. When building text graph, we use documents and words as nodes to construct a heterogeneous graph for the entire corpus. Specifically, we use the term frequency-inverse document frequency (TF-IDF) to construct the word-document edge weights. For long text corpora, we propose an improved pointwise mutual information (PMI*) measure for words according to their word co-occurrence distances to represent the weights of word-word edges. For short text corpora, the co-occurrence information between words is often limited. Therefore, we utilize cosine similarity to represent the word-word edge weights. During the training stage, we effectively combine the cross-entropy and hinge losses and use them to jointly train Chinese-BERTology-wwm and GCN. Experiments show that our proposed framework significantly outperforms the baselines on three Chinese benchmark datasets and achieves good performance even with few labeled training sets.

Transcription Factor Sox9 Exacerbates Kidney Injury through Inhibition of MicroRNA-96-5p and Activation of the Trib3/IL-6 Axis.

INTRODUCTION: Our study investigated the possible mechanisms of the role of the transcription factor Sox9 in the development and progression of kidney injury through regulation of the miR-96-5p/Trib3/IL-6 axis. METHODS: Bioinformatics analysis was performed to identify differentially expressed genes in kidney injury and normal tissues. An in vivo animal model of kidney injury and an in vitro cellular model of kidney injury were constructed using LPS induction in 8-week-old female C57BL/6 mice and human normal renal tubular epithelial cells HK-2 for studying the possible roles of Sox9, miR-96-5p, Trib3, and IL-6 in kidney injury. RESULTS: Sox9 was highly expressed in both mouse and cellular models of kidney injury. Sox9 was significantly enriched in the promoter region of miR-96-5p and repressed miR-96-5p expression. Trib3 was highly expressed in both mouse and cellular models of kidney injury and promoted inflammatory responses and kidney injury. In addition, Trib3 promoted IL-6 expression, which was highly expressed in kidney injury, and promoted the inflammatory response and extent of injury in kidney tissue. In vivo and in vitro experiments confirmed that the knockdown of Sox9 improved the inflammatory response and fibrosis of mouse kidney tissues and HK-2 cells, while the ameliorative effect of silencing Sox9 was inhibited by overexpression of IL-6. CONCLUSION: Collectively, Sox9 up-regulates miR-96-5p-mediated Trib3 and activates the IL-6 signaling pathway to exacerbate the inflammatory response, ultimately promoting the development and progression of kidney injury.

Selective serotonin reuptake inhibitors combined with traditional Chinese medicine for premature ejaculation: A systematic review and meta-analysis.

BACKGROUND: Premature ejaculation (PE) is still a tough problem in drug treatment. Many clinical trials have proven that traditional Chinese medicine (TCM) has a significant effect in the treatment of PE. This article aims to provide the latest evidence for the efficacy and safety of TCM combined with selective serotonin reuptake inhibitors (SSRIs) in the treatment of PE. METHODS: We looked for randomized controlled trials (RCTs) from China National Knowledge Infrastructure, Wanfang, VIP Database, MEDLINE, PubMed, Web of Science, EMBASE, and Cochrane Library until June 30, 2022. STATA 15.1 software was used to analyze all data for this article. The quality of the included articles was evaluated using the Cochrane Reviewer's Handbook 5.3. RESULTS: Finally, we selected 16 high-quality RCTs in our meta-analysis, which containing 889 patients. Meta-analysis suggested that, compared with SSRIs alone, combination of TCM with SSRIs increased significantly intravaginal ejaculation latencv time and the scores of ejaculation control ability, sexual life satisfaction, PE-related distress, and communication difficulties between partners related to PE. Also, there was no significant difference in adverse effects between the two groups. In addition, the results of publication bias test showed that no significant bias occurred. CONCLUSION: The combined use of TCM and SSRIs has significant effect in the treatment of PE compared with SSRIs monotherapy and was generally well tolerated. Due to the small sample size, multicenter and large sample RCT is still needed in the future to further confirm the effectiveness and safety of TCM combined with SSRIs in the treatment of PE.

Exploring the pharmacological mechanism of Shengjing capsule on male infertility by a network pharmacology approach.

BACKGROUND: Shengjing capsule (SJC) is a traditional Chinese medicine (TCM) and has gained widespread clinical application for the treatment of male infertility (MI). However, the pharmacological mechanism of SJC against MI remains vague to date. METHOD: The active ingredients of SJC and their targets were identified from the database, and MI-related genes were retrieved from several databases. Protein-protein interaction (PPI) data were obtained to construct the PPI networks. The candidate targets of SJC against MI were identified through topological analysis of the PPI network. Functional enrichment analysis of candidate targets was performed, and the key target genes were identified from the gene-pathway network. RESULTS: We identified 154 active ingredients and 314 human targets of SJC, as well as 564 MI-related genes. Eight pharmacological network diagrams illustrating the interactions among herbs, active ingredients, targets, and pathways, were constructed. The four dominating network maps included a compound-target network of SJC, a compound-anti-MI targets network, a candidate targets PPI network, a pathway-gene network, and a drug-key compounds-hub targets-pathways network. Systematic analysis indicated that the targets of SJC in the treatment of MI mainly involved RPS6, MAPK1, MAPK3, MDM2, and DDX5. Pathway enrichment analysis showed that SJC had the potential to impact multiple biological pathways, such as cancer-related pathways, viral/bacterial infection-related pathways, and signal transduction-related pathways. CONCLUSION: Our results preliminarily revealed the pharmacological basis and molecular mechanism SJC in treating MI, but further experimental research is required to verify these findings.

The Clinical Efficacy of Percutaneous Nephrolithotomy and Flexible Ureteroscopic Lithotripsy in the Treatment of Calyceal Diverticulum Stones: A Meta-Analysis.

BACKGROUND: The clinical efficacy of percutaneous nephrolithotomy (PCNL) and flexible ureteroscopic lithotripsy (FURL) in the treatment of calyceal diverticulum stones (CDs) remains controversial. We performed a meta-analysis to assess the clinical efficacy of PCNL and FURL in the treatment of CDs. METHODS: We searched a number of relevant electronic databases including China National Knowledge Infrastructure (CNKI), MEDLINE, PubMed, Web of Science, EMBASE, and Cochrane Library until January 31, 2022. STATA 15.1 software was used to analyze all data for this article. The quality of these studies was assessed by the Newcastle-Ottawa Scale (ranged from 0 to 9 stars). RESULTS: Finally, we selected 11 high-quality studies in our meta-analysis,which containing 486 patients. Meta-analysis showed that PCNL had higher stone-free rate [OR=3.55, 95% CI: 2.07 -6.10, P = 0.000], symptom-free rate [OR=3.56, 95% CI: 1.51 -8.38, p= 0.004], while it was slightly inferior to the FURL in bleeding volume [SMD = 1.27, 95% CI: (0.67,1.87), P = 0.000], hospital stay [SMD =2.86, 95% CI: 1.75-3.97, P = 0.000] and complication rate [OR =1.92, 95% CI: 1.10-3.33, P = 0.021], and there was no significant difference in operative time [SMD = -0.011, 95% CI: (-0.41,0.39), P = 0.957]. CONCLUSION: PCNL is safe and effective in the treatment of CDs, which can be considered as the first choice for the clinical treatment of CDs.

Analytical Model of Hole Diameter and Self-Guiding Machining Mechanism of BTA Deep Hole Drilling.

The goal of this study was to explore the self-guided machining mechanism of boring and trepanning association (BTA) deep hole drilling and realize precise control of the machining quality. The motion analysis method was used to analyze the center motion trajectory of the drill during the entrance, and the self-guiding mechanism and hole-forming mechanism of BTA deep hole drilling were revealed. Considering the bending deformation of the drilling tube and the tool structure parameters, according to the elastic-plastic deformation theory and Hertzian contact theory, a novel analytical model of the extrusion contact between the guide pads and the hole wall of the BTA deep hole drilling was established for the theoretical prediction of the extrusion deformation and the machining hole diameter. Combined with the finite element method (FEM) simulation model, the variation law of the contact inclination angle, contact stress, and extrusion deformation of the guide pads and the hole wall with the drilling conditions were studied. The total extrusion deformation between the guide pad and the hole wall was between 10 and 50 µm. The maximum error between the FEM simulation results and the test results was 18.1%, and the maximum error between the analytical model results and the test results was 23.6%. The simulation and experimental results showed that the established extrusion contact model could accurately predict the extrusion deformation of the hole wall and the machining hole diameter.

Perineural invasion detected in prostate biopsy is a predictor of positive surgical margin of radical prostatectomy specimen: A meta-analysis.

The role of perineural invasion detected by puncture biopsy of prostate cancer remains controversial. We performed a meta-analysis to assess the relationship between positive perineural invasion at prostate biopsy and positive surgical margins (PSM) after radical prostatectomy. We searched a number of relevant electronic databases including Web of Science, Medline, PubMed, Embase, and the Cochrane Library until 31 March 2021. STATA 15.1 software was used to analyse all data for this article. The quality of these studies was assessed by the Newcastle-Ottawa Scale (ranged from 0 to 9 stars). Finally, we selected 13 high-quality studies in our meta-analysis, which contain 8283 patients. Overall pooled analysis proposed that biopsy perineural invasion was related to a higher risk of the positive surgical margins after radical prostatectomy in prostate cancer (RR: 1.73; 95% CI: 1.56-1.92; z = 10.30, p = 0.000). Moreover, the outcomes of the publication bias checkout testified that without significant bias arose (Egger's test: 0.086 > 0.05; Begg's test: 0.59 > 0.05). The existing evidence indicates that higher incidence of positive surgical margins in patients who had perineural invasion was detected in prostate biopsy.

Advances in Chip-Based Quantum Key Distribution.

Quantum key distribution (QKD), guaranteed by the principles of quantum mechanics, is one of the most promising solutions for the future of secure communication. Integrated quantum photonics provides a stable, compact, and robust platform for the implementation of complex photonic circuits amenable to mass manufacture, and also allows for the generation, detection, and processing of quantum states of light at a growing system's scale, functionality, and complexity. Integrated quantum photonics provides a compelling technology for the integration of QKD systems. In this review, we summarize the advances in integrated QKD systems, including integrated photon sources, detectors, and encoding and decoding components for QKD implements. Complete demonstrations of various QKD schemes based on integrated photonic chips are also discussed.

A Comparison of Incomplete Resection Rate of Large and Small Colorectal Polyps by Cold Snare Polypectomy.

BACKGROUND & AIMS: There are limited data regarding the safety and efficacy of cold snare polypectomy (CSP) for large colorectal polyps. We evaluated factors affecting the clinical outcomes of CSP for polyps between 5 and 15 mm in size. METHODS: This was a prospective single-center observational study involving 1000 patients undergoing colonoscopy. Polyps (5-15 mm) were removed using CSP, and biopsies were taken from the resection margin. The primary outcome was the incomplete resection rate (IRR), and was determined by the presence of residual neoplasia on biopsy. Correlations between IRR and polyp size, morphology, histology, and resection time were assessed by generalized estimating equation model. RESULTS: A total of 440 neoplastic polyps were removed from 261 patients. The overall IRR was 2.27%, 1.98% for small (5-9 mm) vs 3.45% for large (10-15 mm) polyps (P = .411). In univariate analysis, the IRR was more likely to be related to sessile serrated lesions (odds ratio [OR], 6.93; 95% confidence interval [CI], 1.88-25.45; P = .004), piecemeal resection (OR, 11.83; 95% CI, 1.20-116.49; P = .034), and prolonged resection time >60 seconds (OR, 7.56; 95% CI, 1.75-32.69; P = .007). In multivariable regression analysis, sessile serrated lesions (OR, 6.45; 95% CI, 1.48-28.03; P = .013) and resection time (OR, 7.39; 95% CI, 1.48-36.96; P = .015, respectively) were independent risk factors for IRR. Immediate bleeding was more frequent with resection of large polyps (6.90% vs 1.42%; P = .003). No recurrence was seen on follow-up colonoscopy in 37 cases with large polyps. CONCLUSIONS: CSP is safe and effective for removal of colorectal polyps up to 15 mm in size, with a low IRR. (ClinicalTrials.gov; Number: NCT03647176).

Mussel-inspired and aromatic disulfide-mediated polyurea-urethane with rapid self-healing performance and water-resistance.

Although lots of methods have been developed for self-healing materials, it remains a formidable challenge to achieve a thermosetting material with water-insensitive and self-healing properties at room temperature. Nature always provides intelligent strategies for developing advanced materials with superior properties. Herein, a novel self-healable polyurea-urethane was rationally designed by combining mussel adhesive protein-mimetic structure and dynamic aromatic disulfide bonds. It achieves high self-healing efficiency of 98.4% at room temperature for only 6 h and 90% at 60℃ for only 30 min without any external stimuli. Impressively, this self-healing capability possesses exceptional water-resistance, which presents high self-healing efficiency of 98.1% for 2 h and 82.1% for 6 h in 60℃ and 25℃ water, respectively. Besides, the designed polyurea-urethane exhibits excellent mechanical properties such as high elongation at break of 2400%, notch-insensitive stretching elongation of 1500% and notable recovery capability. This strategy shows promising application potential in solid propellants, protective coating, electronic skin, soft sensors and other water-resistant devices.

Bioinspired modified graphene oxide/polyurethane composites with rapid self-healing performance and excellent mechanical properties.

Self-healing efficiency and mechanical strength are always a pair of mechanical contradictions of a polymer. Herein, a series of novel mussel-inspired modified graphene oxide/polyurethane composites were successfully fabricated via rational molecular design and introducing hyperbranched polymer-modified graphene oxide. The composites exhibit outstanding self-healing performances with a self-healing efficiency of 87.9%. Especially, their self-healing properties possess exceptional water-insensitivity, which presents a high self-healing efficiency of 92.5% under 60 °C water for 2 h and 74.6% under 25 °C water for 6 h. Furthermore, the tensile strength of the composites increased by 107.7% with a high strain of 2170%. In addition, the composites show a remarkable recovery capability of 76.3% and 83.7% under tensile and compression loading, respectively, after 20 cycles. This strategy shows prominent application potential in high-performance solid propellants, protective coating, electronic skin, soft sensors and other water-insensitive devices.

Hyperbranched polyamide modified graphene oxide-reinforced polyurethane nanocomposites with enhanced mechanical properties.

As is well known, it is difficult to simultaneously improve both the strength and elongation at break of polymers filled with nanomaterials. This work obtained high-performance composites with enhanced strength and elongation at break via cross-linking hydroxyl-terminated polybutadiene (HTPB) chains with hyperbranched-polyamide-modified graphene oxide (HGO), and the preparation, characterization, and mechanical properties of the composites serving as a composite solid-propellant binder have been described in detail. Compared with pure HTPB polyurethane (P-HTPB), the tensile strength and elastic modulus of the composite containing 0.1 wt% HGO (H-0.1/HTPB) increase by 57.8% and 65.3%, respectively. Notably, the elongation at break of the H-0.1/HTPB composite can reach up to 1292.6%, which is even higher than that of P-HTPB. Moreover, the capabilities of the composites to resist deformation have also been enhanced significantly. The glass transition temperatures of the composites are still extremely low (∼-73 °C), which is beneficial for their applications. It can be expected that this study can provide an effective fabrication approach and strategy for preparing high-performance polyurethane composites.

Network Pharmacology-Based Strategy to Investigate Pharmacological Mechanisms of Qiaoshao Formula for Treatment of Premature Ejaculation.

BACKGROUND: Qiaoshao (QS) formula, a traditional Chinese medicine (TCM) comprising seven herbs, has been clinically proven to have a favorable treatment effect on premature ejaculation (PE). However, its underlying pharmacological mechanisms in the treatment of PE need to be further clarified. METHODS: In the present study, a network pharmacology-based strategy was adopted. The active compounds of QS formula were obtained from the Chinese medicine database, and the potential targets of these compounds were collected from the DrugBank database to construct compound-compound targets network. PE-related targets were identified from human disease databases and used to construct the protein-protein interaction (PPI) networks. Compound-disease target PPI network was constructed by merging the PPI network of disease-targets and compound-targets. Cluster and enrichment analyses were performed on the PPI network of disease targets and compound-disease targets. The influence of QS formula on serum 5-HT, NO, oxytocin, and thyroid hormones of PE patients was verified. RESULTS: Four primary pharmacological networks of QS formula were constructed, including the compound-compound targets network, PPI network of PE-related targets and compound-disease targets, and the QS-PE mechanism network. The module and pathway enrichment analyses revealed that the QS formula had the potential to affect varieties of biological process and pathways, such as nitric oxide biosynthetic process, oxytocin, thyroid hormone, TNF, PI3K-Akt, and the HIF-1 signaling pathway, that play an important role in the pathogenesis of PE. Meanwhile, the QS formula has been clinically confirmed to regulate the serum level of 5-HT, NO, oxytocin, and TT in PE patients. CONCLUSION: This study preliminarily discovered the potential targets and pathways of QS formula in the treatment of PE, which laid a good foundation for further experimental research.

Vitamins combined with traditional Chinese medicine for male infertility: A systematic review and meta-analysis.

BACKGROUND: Male infertility is a tough problem in medicine. This article aims to provide the latest evidence for the efficacy and safety of traditional Chinese medicine (TCM) combined with vitamins in the treatment of male infertility. METHOD: All randomized controlled trials (RCTs) that used TCM combined with vitamins for male infertility treatment were included in databases of China National Knowledge Infrastructure (CNKI), Wanfang, VIP Database, China Biology Medicine disc (CBM), MEDLINE, EMBASE, and Cochrane Library. The quality of the included articles was evaluated using the Cochrane Reviewer's Handbook 5.3, and meta-analysis was performed using Stata 15. RESULTS: A total of 14 eligible studies with 1488 patients were included in this meta-analysis. The results suggested that, compared with vitamin E or vitamin E + C alone, combination of TCM with vitamins increased significantly sperm concentration, sperm motility, sperm viability, liquefaction time of semen, the activity of acrosome enzyme, and the pregnancy rate of patients with male infertility. Three kinds of TCM (Shengjing capsule, Huanshao capsule, and compound Xuanju capsule) showed significant improvement for male infertility in terms of pregnancy rate, sperm concentration, or sperm motility. In addition, the results of the publication bias test demonstrated that no significant bias occurred. CONCLUSION: Traditional Chinese medicine combined with vitamins has significant efficacy in the treatment of male infertility with no increase in side effects. The specific implementing regulations still need more long-term, multicenter, randomized, and double-blind clinical trials.

Influence of Thermally-Accelerated Aging on the Dynamic Mechanical Properties of HTPB Coating and Crosslinking Density-Modified Model for the Payne Effect.

Hydroxyl terminated polybutadiene (HTPB) coating is widely used in a solid rocket motor, but an aging phenomenon exists during long-term storage, which causes irreversible damage to the performance of this HTPB coating. In order to study the effect of aging on the dynamic mechanical properties of the HTPB coating, the thermally-accelerated aging test was carried out. The variation of maximum elongation and crosslinking density with aging time was obtained, and a good linear relationship between maximum elongation and crosslinking density was found by correlation analysis. The changing regularity of dynamic mechanical properties with aging time was analyzed. It was found that with the increase of aging time, Tg of HTPB coating increased, Tα, tan ß and tan α decreased, and the functional relationships between the loss factor parameters and crosslinking density were constructed. The storage modulus and loss modulus of HTPB coating increased with the increase of aging time, and decreased with the increase of pre-strain. The aging enhanced the Payne effect of HTPB coating, while the pre-strain had a weakening effect. In view of the Payne effect of HTPB coating, the crosslinking density was introduced into Kraus model as aging evaluation parameter, and the crosslinking density modified models with and without pre-strain were established. The proposed models can effectively solve the problem that the Kraus model has a poor fitting effect under the condition of small strain (generally less than 1%) and on the loss modulus, which have improved the correlations between the fitting results and the test results.

Recyclable low-temperature phase change microcapsules for cold storage.

Recyclable low-temperature phase change microcapsules (LTPCMs) have the potential applications in the short-distance cold chain transportation due to their reliable reusability in cold storage. Herein, LTPCMs are synthesized via in-situ suspension copolymerization of styrene and methyl methacrylate in absence of harm substances, providing the non-crosslinking copolymer shells. n-Dodecane, n-tridecane and n-tetradecane, inducing the microphase separation of non-crosslinking copolymers, are successfully encapsulated to achieve n-do-LTPCMs, n-tri-LTPCMs and n-tetra-LTPCMs, which respectively bear the high phase change enthalpy of 110.53 J·g-1 at -8.69 °C, 38.33 J·g-1/93.71 J·g-1 at -17.61 °C/-4.96 °C and 166.79 J·g-1 at 8.59 °C and subsequently show the cold-discharging periods of 30 min, 40 min and 120 min. The multiple circulation of cold-discharging process indicates the excellent recyclability for cold storage owing to their unchanged cold-discharging period. Especially, n-tetra-LTPCM-65 bears the best comprehensive cold-storing performance in all the previously reported LTPCMs, such as narrow cold-discharging temperature range of 3-4 °C, long cold-discharging period of 69-120 min and low cold-discharging capacity of 33.4 J·g-1·K-1. This work successfully provided the recyclable LTPCMs for cold storage in the short-distance cold chain transportation.

High CHD9 expression is associated with poor prognosis in clear cell renal cell carcinoma.

Clear cell renal cell carcinoma (ccRCC) is the most common subtype of renal cell carcinoma. The chromo-helicase-DNA binding proteins (CHDs), containing nine members named CHD1-9, act as regulators of the chromatin remodeling process and gene expression. To determine the correlation between CHD9 expression and ccRCC, we performed an immunohistochemical staining in a tissue microarray (TMAs) containing tissue samples from 88 ccRCC patients. The results showed that cytoplasm CHD9 expression was statistically decreased in tumor tissues compared to adjacent tissues (8.54±2.90 vs 12.61±2.05, P=0.000), while nuclear CHD9 expression was upregulated in the tumor tissues (1.47±2.93 vs 0.29±1.24, P=0.000). A univariate analysis found that cytoplasm CHD9 expression in cancer tissues was correlated with the patients' pathological grading (P=0.002, r=0.330), the clinical stages (P=0.02, r=0.250) and the T grading (P=0.024, r=0.241) significantly. In addition, cytoplasm CHD9 expression in non-tumor tissues was correlated with the ccRCC patients' pathological grading (P=0.031, r=-0.231) significantly. Patients with high cytoplasm CHD9 expression had a significantly worse prognosis than those with low cytoplasm CHD9 expression levels (59.7% vs 85.7%, P=0. 042). In conclusion, our study indicated the important role of CHD9 in ccRCC and suggested CHD9 may be a potential biomarker for prognostic prediction and a new target for therapy.

Predictive factors for technically difficult endoscopic submucosal dissection in large colorectal tumors.

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) for colorectal tumors is dangerous, particularly those that are large. However, the technical difficulty in resecting large tumors in the colonrectum has seldom been investigated. MATERIALS AND METHODS: Between October 2012 and January 2015, 36 consecutive large colorectal tumors were resected by ESD at the endoscopic center of PLA Army General Hospital. Five factors were investigated in predicting the technical difficulty in resecting such tumors. RESULTS: En bloc resection, complete (R0) resection, and curative resection rates were 83.33% (30/36), 80.56% (29/36), and 77.78% (28/36), respectively. Tumor location in a flexure was risk a factor for difficult ESD in the colonrectum as measured by perforation (4.55, 0.09-6.25), non-en bloc resection (4.94, 0.10, 9.45), and dissection speed (ß±SE: 1.75±0.05). When tumor size increased, the perforation rate also increased (9.93, 0.96-10.32). CONCLUSION: ESD was more technically demanding in flexures for resecting large colorectal tumors, and for large tumor effective technique to close perforation is essential. Our study will guide endoscopists in using ESD to remove large colorectal tumors.

Traction with dental floss and endoscopic clip improves trainee success in performing gastric endoscopic submucosal dissection (ESD): a live porcine study (with video).

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is a prolonged procedure with serious adverse events. The clip with line traction method was reported to improve ESD. However, there was no comparison with conventional ESD especially for trainees. We report here on the feasibility and efficacy of traction using dental floss with endoscopic clip to facilitate ESD versus conventional method for ESD trainees. METHODS: Twenty simulated gastric lesions, paired with location and size, were created in porcine stomachs using a standard template. After a circular incision was made, submucosal dissection (control, n = 10) was performed with standard ESD, while the study (clip, n = 10) was performed with traction using dental floss and endoclip. Primary outcome was speed of submucosal dissection. Secondary outcome included frequency of submucosal injection and adverse event. RESULTS: Compared with controls, median procedure time was significantly shorter in the clip group (5.6 ± 1.1 vs. 13.6 ± 2.5 min, P = 0.003), with a significantly faster submucosal dissection time (1.8 ± 0.3 vs. 0.6 ± 0.1 cm(2)/min, P = 0.001) and less frequent submucosal injection (5.7 ± 0.6 vs. 8.5 ± 1.0 times, P = 0.024). There were no perforations in either group, but less adverse events (bleeding and injury to muscularis propria) in the clip group (1 vs. 7, P = 0.068, α = 0.1). CONCLUSIONS: Traction provided by dental floss and endoclip improves visualization of the submucosal layer during ESD. It allows a faster and safer gastric ESD especially among trainees in the early learning phase.

Propofol sedation versus no sedation in detection of pharyngeal and upper gastrointestinal superficial squamous cell carcinoma using endoscopic narrow band imaging: a multicenter prospective trial.

Intravenous propofol can provide a superior quality of sedation compared to standard sedation for upper gastrointestinal endoscopy. However, the utility of propofol sedation for the endoscopic early detection of superficial pharyngeal and esophageal squamous cell carcinoma has not been investigated. In a multicenter, prospective trial, 255 patients with esophageal squamous cell carcinomas (ESCCs) were assigned to receive propofol sedation or no sedation according to their own willingness. The primary aim was to compare the detection rates of superficial cancer in the pharyngeal region and the esophagus between two groups. The secondary aim was to evaluate factors associated with technical adequacy. The detection rate was higher in the propofol sedation vs. no sedation group for H&N region (6.06% vs. 2.40%), but not significantly (P=0.22). However, the small lesion (less than 10 mm in diameter) detection rate was higher in sedation vs. no sedation group for H&N region (88.89% vs. 33.33%; P=0.048). The median time for pharyngeal observation in the sedation group was faster than in the no sedation group (20.6 s vs. 44.3 s; P<0.001). Ninety-five percent of H&N region evaluations were totally complete in sedation compared with sixty percent in the no sedation group (P<0.001). The overall p value indicated that only smoking habit was associated with incomplete pharyngeal observation (P<0.05), and it was more difficult to accomplish a complete pharyngeal observation in patients who smoked more than 10 packs per day. Intravenous propofol sedation compared to no intravenous sedation during conventional upper gastrointestinal endoscopy can facilitate a more complete pharyngeal examination and increase the detection rate of superficial H&N squamous cell carcinoma in high risk patients.