| 1 | Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures显示文摘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. | Mohamed Mortagy Neal Mehta Mansour A Parsi Seiichiro Abe Tyler Stevens John J Vargo Yutaka Saito Amit Bhatt | 2017 | World Journal of Gastroenterology2017，23，16： | 12 |
| 6 | LIV-4:A novel model for predicting transplant-free survival in critically ill cirrhotics显示文摘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 disease.Prognostication of short-term mortality is important in order to identify patients at highest risk of death.None 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 patients.We believe a survival model meeting these requirements can be developed,to guide therapeutic decision-making and contribute to cost-effective healthcare resource utilization.AIM To identify markers that best identify likelihood of survival and to determine the performance of existing survival models.METHODS Consecutive cirrhotic patients admitted to a United States quaternary care center ICU between 2008-2014 were included and comprised the training cohort.Demographic data and clinical laboratory test collected on admission to ICU were analyzed.Area 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 2015-2017.RESULTS Of 436 patients,119(27.3%)died in the hospital.In 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 mortality.Derived 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,which performed with AUROCs of 0.81,0.80,and 0.77,respectively.Patients in the internal validation cohort were substantially sicker,as evidenced by higher Model for End-Stage Liver Disease,Model for End-Stage Liver Disease-Sodium,Acute Physiology and Chronic Health Evaluation III,SOFA and LIV-4 scores.Despite these differences,the LIV-4 score remained significantly higher in subjects who expired during the hospital stay and exhibited good prognostic values in the validation cohort with an AUROC of 0.80.CONCLUSION LIV-4,a validated model for predicting mortality in cirrhotic patients on admission to the ICU,performs better than alternative liver and ICU-specific survival scores. | 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 | 2020 | World Journal of Hepatology2020，12，6： | 0 |
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