Endoscopic submucosal dissection for removal of superficial gastrointestinal neoplasms: A technical review

PubMed Central

Matsui, Noriaki; Akahoshi, Kazuya; Nakamura, Kazuhiko; Ihara, Eikichi; Kita, Hiroto

2012-01-01

Endoscopic submucosal dissection (ESD) is now the most common endoscopic treatment in Japan for intramucosal gastrointestinal neoplasms (non-metastatic). ESD is an invasive endoscopic surgical procedure, requiring extensive knowledge, skill, and specialized equipment. ESD starts with evaluation of the lesion, as accurate assessment of the depth and margin of the lesion is essential. The devices and strategies used in ESD vary, depending on the nature of the lesion. Prior to the procedure, the operator must be knowledgeable about the treatment strategy(ies), the device(s) to use, the electrocautery machine settings, the substances to inject, and other aspects. In addition, the operator must be able to manage complications, should they arise, including immediate recognition of the complication(s) and its treatment. Finally, in case the ESD treatment is not successful, the operator should be prepared to apply alternative treatments. Thus, adequate knowledge and training are essential to successfully perform ESD. PMID:22523613

Endoscopic submucosal dissection for esophageal granular cell tumor using the clutch cutter

PubMed Central

Komori, Keishi; Akahoshi, Kazuya; Tanaka, Yoshimasa; Motomura, Yasuaki; Kubokawa, Masaru; Itaba, Soichi; Hisano, Terumasa; Osoegawa, Takashi; Nakama, Naotaka; Iwao, Risa; Oya, Masafumi; Nakamura, Kazuhiko

2012-01-01

Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the deficiencies of fixing the knife to the target lesion, and of compressing it. These shortcomings can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (Clutch Cutter®, Fujifilm, Japan) which can grasp and incise the targeted tissue using an electrosurgical current. Esophagogastroduodenoscopy on a 59-year-old Japanese man revealed a 16mm esophageal submucosal nodule with central depression. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. The histologic diagnosis of the specimen obtained by biopsy was granular cell tumor. It was safely and accurately resected without unexpected incision by ESD using the CC. No delayed hemorrhage or perforation occurred. Histological examination confirmed that the granular cell tumor was completely excised with negative resection margin.We report herein a case of esophageal granular cell tumor successfully treated by an ESD technique using the CC. PMID:22267979

Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma.

PubMed

Miwata, Tomohiro; Oka, Shiro; Tanaka, Shinji; Kagemoto, Kenichi; Sanomura, Yoji; Urabe, Yuji; Hiyama, Toru; Chayama, Kazuaki

2016-09-01

Endoscopic submucosal dissection (ESD) is used to perform en block resection for esophageal squamous cell carcinoma, but it is strongly associated with postoperative stenosis, especially during entire circumferential resection. This study aimed to clarify the risk factors for refractory postoperative stenosis after entire circumferential esophageal ESD. Nineteen patients who underwent entire circumferential esophageal ESD from February 2006 to December 2013 at Hiroshima University Hospital were divided into two groups: refractory postoperative stenosis [≥6 endoscopic balloon dilation (EBD) procedures, 12 lesions in 12 patients] and non-refractory postoperative stenosis (≤5 EBD procedures, 7 lesions in 7 patients). We retrospectively examined the patient factors (age, sex, alcohol consumption, smoking index, and chemoradiation therapy history), tumor factors (location, macroscopic type, fibrosis, and depth), and treatment factors (mean procedure time, entire circumferential resection diameter, muscle layer damage, and steroid administration method) between the two groups. Muscle layer damage (p = 0.019) and ≥5 cm of longitudinal mucosal defect length after entire circumferential esophageal ESD (p = 0.010) were significant factors associated with the refractory group. Regarding the patient and tumor factors, there were no significant differences between the two groups. Our data suggest that refractory post-ESD stenosis occurs after entire circumferential esophageal ESD with muscle layer damage and ≥5 cm of longitudinal mucosal defect length.

Randomized comparative evaluation of endoscopic submucosal dissection self-learning software in France and Japan.

PubMed

Pioche, Mathieu; Rivory, Jérôme; Nishizawa, Toshihiro; Uraoka, Toshio; Touzet, Sandrine; O'Brien, Marc; Saurin, Jean-Christophe; Ponchon, Thierry; Denis, Angélique; Yahagi, Naohisa

2016-12-01

Background and study aim: Endoscopic submucosal dissection (ESD) is currently the reference method to achieve an en bloc resection for large lesions; however, the technique is difficult and risky, with a long learning curve. In order to reduce the morbidity, training courses that use animal models are recommended. Recently, self-learning software has been developed to assist students in their training. The aim of this study was to evaluate the impact of this tool on the ESD learning curve. Methods: A prospective, randomized, comparative study enrolled 39 students who were experienced in interventional endoscopy. Each student was randomized to one of two groups and performed 30 ESDs of 30 mm standardized lesions in a bovine colon model. The software group used the self-learning software whereas the control group only observed an ESD procedure video. The primary outcome was the rate of successful ESD procedures, defined as complete en bloc resection without any perforation and performed in less than 75 minutes. Results: A total of 39 students performed 1170 ESDs. Success was achieved in 404 (70.9 %) in the software group and 367 (61.2 %) in the control group ( P  = 0.03). Among the successful procedures, there were no significant differences between the software and control groups in terms of perforation rate (22 [4.0 %] vs. 29 [5.1 %], respectively; P  = 0.27) and mean (SD) procedure duration (34.1 [13.4] vs. 32.3 [14.0] minutes, respectively; P  = 0.52). For the 30th procedure, the rate of complete resection was superior in the software group (84.2 %) compared with the control group (50.0 %; P  = 0.01). Conclusion: ESD self-learning software was effective in improving the quality of resection compared with a standard teaching method using procedure videos. This result suggests the benefit of incorporating such software into teaching programs. © Georg Thieme Verlag KG Stuttgart · New York.

Large early gastric cancers treated by endoscopic submucosal dissection with an insulation-tipped diathermic knife.

PubMed

Chang, Chun-Chao; Tiong, Cheng; Fang, Chia-Lang; Pan, Shiann; Liu, Jean-Dean; Lou, Horng-Yuan; Hsieh, Ching-Ruey; Chen, Sheng-Hsuan

2007-03-01

It is difficult to remove a large early gastric cancer (> or = 3 cm) in one-piece resection using conventional endoscopic mucosal resection. We tried to use an insulation-tipped (IT) diathermic knife to dissect these lesions. IT-endoscopic submucosal dissection (ESD) was performed in four aging patients with gastric malignancy. All lesions could be removed in one-piece resection by IT-ESD, although three of them exhibited remarkable fibrosis and ulceration. Three cases experienced curative treatment with IT-ESD after the pathologic evaluation, but it was not curative in one case because the pathology showed angiolymphatic invasion. This patient refused additional surgery in consideration of existing major systemic diseases. At 3 months to 1 year of follow-up, endoscopy showed no evidence of residual cancer. IT-ESD is effective in the treatment of large early gastric cancer and is an alternative treatment for early gastric cancer patients who are at risk for major operation.

Clinical features and outcomes of delayed perforation after endoscopic submucosal dissection for early gastric cancer.

PubMed

Hanaoka, N; Uedo, N; Ishihara, R; Higashino, K; Takeuchi, Y; Inoue, T; Chatani, R; Hanafusa, M; Tsujii, Y; Kanzaki, H; Kawada, N; Iishi, H; Tatsuta, M; Tomita, Y; Miyashiro, I; Yano, M

2010-12-01

Perforation is a major complication of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). However, there have been no reports on delayed perforation after ESD for EGC. We aimed to elucidate the incidence and outcomes of delayed perforation after ESD. Clinical courses in 1159 consecutive patients with 1329 EGCs who underwent ESD were investigated. Delayed perforation occurred in six patients (0.45 %). All these patients had complete en bloc resection without intraoperative perforation during ESD. Five of six perforations were located in the upper third of the stomach, while one lesion was found in the middle third. Symptoms of peritoneal irritation with rebound tenderness presented within 24 h after ESD in all cases. One patient did not require surgery because the symptoms were localized, and recovered with conservative antibiotic therapy by nasogastric tube placement. The remaining five patients required emergency surgery. There was no mortality in this case series. © Georg Thieme Verlag KG Stuttgart · New York.

Do you have what it takes for challenging endoscopic submucosal dissection cases?

PubMed Central

Kim, Kyoung-Oh; Kim, Sung Jung; Kim, Tae Hyeon; Park, Jong-Jae

2011-01-01

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric cancer (EGC), especially in Korea and Japan. The criteria for the therapeutic use of ESD for EGC have been expanded recently. However, attention should be drawn to the technical feasibility of the ESD treatment which depends on a lesion’s location, size or fibrosis level, or operator’s experience. In the case of a lesion with a high level of difficulty, a more experienced operator is required. Thus, the treatment for a lesion with a high level of difficulty should be performed according to the degree of the operator’s experience. In this paper, the authors describe the ESD procedure for lesions with a high level of difficulty. PMID:21987603

Endoscopic submucosal dissection in the West: Current status and future directions.

PubMed

Ma, Michael X; Bourke, Michael J

2018-05-01

Endoscopic submucosal dissection (ESD) was first conceptually described almost 30 years ago in Japan and is now widely practiced throughout East Asia. ESD expands the boundaries of endoscopic resection (ER) by allowing en bloc resection of large early neoplastic lesions within the gastrointestinal tract (GIT). This offers advantages over other ER techniques by facilitating definitive histological staging and curative treatment of early cancer in selected cases. Indeed, the experience of ESD in Eastern countries is significant, and excellent outcomes from high-volume centers are reported. The potential benefits of ESD are recognized by Western endoscopists, but its adoption has been limited. A number of factors contribute to this, including epidemiological differences in GIT neoplasia between Western and Eastern populations and limitations in training opportunities. In this review, we discuss the role of ESD, its current status and the future in Western endoscopic practice. © 2017 Japan Gastroenterological Endoscopy Society.

Endoscopic submucosal dissection for esophageal squamous cell neoplasms.

PubMed

Fujishiro, Mitsuhiro; Kodashima, Shinya; Goto, Osamu; Ono, Satoshi; Niimi, Keiko; Yamamichi, Nobutake; Oka, Masashi; Ichinose, Masao; Omata, Masao

2009-04-01

Endoscopic submucosal dissection (ESD) has gradually gained acceptance as one of the standard treatments for early esophageal cancer, as well as for early gastric cancer in Japan, but standardization of the knowledge is still incomplete. The final goal to perform ESD is not to resect the lesion in an en bloc fashion, but to save the patient from esophageal cancer-related death. Thus, the indications should be considered based on the entire patient, not just the target lesion itself, and pre-, peri- and postoperative management of the patient is also very important, as well as technical aspects of ESD. In terms of the techniques of ESD, owing to refinement of the procedural strategy, invention of the devices, and the learning curve, acceptable safety and favorable middle-term efficacy have been obtained. We believe that ESD will become a standard treatment for early esophageal cancer not only in Japan but also worldwide in the near future.

The low incidence of bacteremia after esophageal endoscopic submucosal dissection (ESD) obviates the need for prophylactic antibiotics in esophageal ESD.

PubMed

Kawata, Noboru; Tanaka, Masaki; Kakushima, Naomi; Takizawa, Kohei; Imai, Kenichiro; Hotta, Kinichi; Matsubayashi, Hiroyuki; Tsukahara, Mika; Kawamura, Ichiro; Kurai, Hanako; Ono, Hiroyuki

2016-11-01

Although a high incidence of bacteremia after esophageal endoscopic procedures has been reported, the incidence of bacteremia associated with esophageal endoscopic submucosal dissection (ESD) remains unknown. Therefore, we investigated the incidence of bacteremia associated with esophageal ESD. From April 2013 to March 2014, patients who underwent esophageal ESD were enrolled prospectively. Two sets of blood cultures were collected from patients at the following time points: (1) immediately after ESD; (2) the next morning; and (3) when fever ≥38 °C was present after ESD. A total of 424 blood culture sets were collected from 101 patients. Six patients had positive blood cultures immediately after ESD (4 %, 7/202 sets). Another patient had a positive blood culture the next morning (0.5 %, 1/202 sets). Ten patients (10 %) developed a post-ESD fever ≥38 °C, and blood cultures from these patients were all negative (0/20 sets). The seven patients with positive blood cultures had no post-ESD fever or infectious symptoms. Growth of Bacteroides thetaiotaomicron was only observed in one patient (1 %) with positive blood cultures immediately after ESD, and this patient was diagnosed with transient bacteremia. The other six patients were considered to have contaminants in their blood cultures. Thus, the incidence of bacteremia after esophageal ESD was 1 % [95 % confidence interval (CI) 0-5 %]. No patient had infectious symptoms, and none required antibiotics after ESD. The incidence of bacteremia after esophageal ESD was low and post-ESD fever was not associated with bacteremia. We conclude that use of routine prophylactic antibiotics to patients undergoing esophageal ESD is unnecessary. UMIN000012908.

Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications

PubMed Central

Yoshida, Naohisa; Yagi, Nobuaki; Naito, Yuji; Yoshikawa, Toshikazu

2010-01-01

Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature of the colon. The main complications of ESD comprise postoperative perforation and hemorrhage, similar to endoscopic mucosal resection (EMR). In particular, the rate of perforation in ESD is higher than that in EMR. Perforation of the colon can cause fatal peritonitis. Endoscopic clipping is reported to be an efficient therapy for perforation. Most cases with perforation are treated conservatively without urgent surgical intervention. However, the rate of postoperative hemorrhage in ESD is similar to that in EMR. Endoscopic therapy including endoscopic clipping is performed and most of the cases are treated conservatively without blood transfusion. In blood examination, some degree of inflammation is detected after ESD. For the standardization of ESD, it is most important to decrease the rate of perforation. Adopting a safe strategy for ESD and a suitable choice of knife are both important ways of preventing perforation. Moreover, appropriate training and increasing experience can improve the endoscopic technique and can decrease the rate of perforation. In this review, we describe safe procedures in ESD to prevent complications, the complications of ESD and their management. PMID:20379999

Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

PubMed Central

Song, Byeong Gu; Lee, Bong Eun; Jeon, Hye Kyung; Baek, Dong Hoon; Song, Geun Am

2017-01-01

Aims To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the remnant stomach (GEN-RS) after various types of partial gastrectomy. Methods This study included 29 patients (31 lesions) who underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively to assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events. Results The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous gastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors involving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The procedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range, 6–58 months), there was no recurrence in any case. Conclusions ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the complete resection rate decreases for lesions involving the suture lines. PMID:28592968

Endoscopic submucosal dissection of a rectal carcinoid tumor using grasping type scissors forceps

PubMed Central

Akahoshi, Kazuya; Motomura, Yasuaki; Kubokawa, Masaru; Matsui, Noriaki; Oda, Manami; Okamoto, Risa; Endo, Shingo; Higuchi, Naomi; Kashiwabara, Yumi; Oya, Masafumi; Akahane, Hidefumi; Akiba, Haruo

2009-01-01

Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the inability to fix the knife to the target lesion, and compression of the lesion. These can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (GSF), which can grasp and incise the targeted tissue using electrosurgical current. Colonoscopy on a 55-year-old woman revealed a 10-mm rectal submucosal nodule. The histological diagnosis of the specimen obtained by biopsy was carcinoid tumor. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. It was safely and accurately resected without unexpected incision by ESD using a GSF. No delayed hemorrhage or perforation occurred. Histological examination confirmed the carcinoid tumor was completely excised with negative resection margin. PMID:19418591

Novel strategy of endoscopic submucosal dissection using an insulation-tipped knife for early gastric cancer: near-side approach method

PubMed Central

Mori, Genki; Nonaka, Satoru; Oda, Ichiro; Abe, Seiichiro; Suzuki, Haruhisa; Yoshinaga, Shigetaka; Nakajima, Takeshi; Saito, Yutaka

2015-01-01

Background and study aims: Endoscopic submucosal dissection (ESD) using insulation-tipped knives (IT knives) to treat gastric lesions located on the greater curvature of the gastric body remains technically challenging because of the associated bleeding, control of which can be difficult and time consuming. To eliminate these difficulties, we developed a novel strategy which we have called the “near-side approach method” and assessed its utility. Patients and methods: We reviewed patients who underwent ESD for solitary early gastric cancer located on the greater curvature of the gastric body from January 2003 to September 2014. The technical results of ESD were compared between the group treated with the novel near-side approach method and the group treated with the conventional method. Results: This study included 238 patients with 238 lesions, 118 of which were removed using the near-side approach method and 120 of which were removed using the conventional method. The median procedure time was 92 minutes for the near-side approach method and 120 minutes for the conventional method. The procedure time was significantly shorter in the near-side approach method arm. Although, the procedure time required by an experienced endoscopist was not significantly different between the two groups (100 vs. 110 minutes), the near-side approach group showed significantly shorter procedure time for a less-experienced endoscopist (90 vs. 120 minutes). Conclusions: The near-side approach method appears to require less time to complete gastric ESD than the conventional method using IT knives for technically challenging lesions located on the greater curvature of the gastric body, especially if the procedure is performed by less-experienced endoscopists. PMID:26528496

En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video).

PubMed

Antillon, Mainor R; Bartalos, Christopher R; Miller, Marc L; Diaz-Arias, Alberto A; Ibdah, Jamal A; Marshall, John B

2008-02-01

Endoscopic submucosal dissection (ESD) was recently developed in Japan for en bloc removal of laterally spreading tumors (LSTs). Although initially used for gastric tumors, ESD has now been applied to lesions elsewhere in the gut. Recent reports from Japan included removal of colorectal lesions up to 10 cm. To show the feasibility of ESD to remove en bloc, very large LSTs of the rectum, even when there is involvement to the dentate line. Case report. The procedure was performed at an American GI unit. The patient was admitted to the hospital after the procedure for observation. A 53-year-old patient, with a 14-cm tubulovillous adenoma of the rectum, which, at its maximal extent, involved two thirds of the circumference of the rectum. The tumor extended distally to the dentate line. En bloc submucosal dissection with a conventional needle-knife to remove the neoplasm. Completeness of en bloc removal of the tumor and subsequent follow-up endoscopy that showed no residual neoplasm. The tumor was able to be removed en bloc by ESD. The distal margin included squamous mucosa. At a 2.5-week endoscopic follow-up, a 3-mm focus of residual polyp was seen and removed. At the time of the last follow-up, there was complete healing of the wound and no residual neoplasm. Single case. This case demonstrated the feasibility of using ESD to remove large laterally spreading rectal tumors, including when there was involvement to the dentate line (and the dissection line must include squamous mucosa of the anal canal). ESD is a promising alternative to conventional surgical techniques; however, additional published experience is needed.

Prospective, randomized comparison of a prototype endoscope with deflecting working channels versus a conventional double-channel endoscope for rectal endoscopic submucosal dissection in an established experimental simulation model (with video).

PubMed

Jung, Yunho; Kato, Masayuki; Lee, Jongchan; Gromski, Mark A; Chuttani, Ram; Matthes, Kai

2013-11-01

A prototype endoscope was designed to improve visualization and dissection of tissue with the use of 2 working channels with different deflections. To evaluate the efficacy and operability of a prototype endoscope in comparison with a conventional double-channel endoscope for rectal endoscopic submucosal dissection (ESD). Randomized, prospective, controlled, ex vivo study. Academic medical center. A total of 80 standardized artificial lesions measuring 3 × 3 cm were created approximately 5 cm from the anal verge in fresh ex vivo porcine colorectal specimens. Two endoscopists each completed 20 cases with the prototype endoscope and 20 cases with the conventional endoscope. An independent observer recorded procedure time, specimen size, en bloc resection, and perforation rate. For the ESD novice, the mean submucosal dissection time (10.5 ± 3.8 vs 14.9 ± 7.3 minutes; P = .024) and total procedure time (18.1 ± 5.2 vs 23.6 ± 8.2 minutes; P = .015) were significantly shorter in the prototype group in comparison with the conventional group. For the ESD expert, there was no significant difference between the mean circumferential resection, submucosal dissection, and total procedure time (prototype group 14.2 ± 6.0 minutes, conventional group 14.2 ± 8.8 minutes; P = .992). The overall perforation and en bloc resection rates were not significantly different between groups. Ex vivo study. In this ex vivo prospective comparison study, there was a technical advantage for the ESD novice with the prototype endoscope that resulted in a shorter procedure time, which was not observed for cases performed by the ESD expert. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Experimental application of pulsed laser-induced water jet for endoscopic submucosal dissection: mechanical investigation and preliminary experiment in swine.

PubMed

Sato, Chiaki; Nakano, Toru; Nakagawa, Atsuhiro; Yamada, Masato; Yamamoto, Hiroaki; Kamei, Takashi; Miyata, Go; Sato, Akira; Fujishima, Fumiyoshi; Nakai, Masaaki; Niinomi, Mitsuo; Takayama, Kazuyoshi; Tominaga, Teiji; Satomi, Susumu

2013-05-01

A current drawback of endoscopic submucosal dissection (ESD) for early-stage gastrointestinal tumors is the lack of instruments that can safely assist with this procedure. We have developed a pulsed jet device that can be incorporated into a gastrointestinal endoscope. Here, we investigated the mechanical profile of the pulsed jet device and demonstrated the usefulness of this instrument in esophageal ESD in swine. The device comprises a 5-Fr catheter, a 14-mm long stainless steel tube for generating the pulsed water jet, a nozzle and an optical quartz fiber. The pulsed water jet was generated at pulse rates of 3 Hz by irradiating the physiological saline (4°C) within the stainless steel tube with an holmium-doped yttrium-aluminum-garnet (Ho:YAG) laser at 1.1 J/pulse. Mechanical characteristics were evaluated using a force meter. The device was used only for the part of submucosal dissection in the swine ESD model. Tissues removed using the pulsed jet device and a conventional electrocautery device, and the esophagus, were histologically examined to assess thermal damage. The peak impact force was observed at a stand-off distance of 40 mm (1.1 J/pulse). ESD using the pulsed jet device was successful, as the tissue specimens showed precise dissection of the submucosal layer. The extent of thermal injury was significantly lower in the dissected bed using the pulsed jet device. The results showed that the present endoscopic pulsed jet system is a useful alternative for a safe ESD with minimum tissue injury. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.

Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video).

PubMed

Yoshida, Masao; Takizawa, Kohei; Suzuki, Sho; Koike, Yoshiki; Nonaka, Satoru; Yamasaki, Yasushi; Minagawa, Takeyoshi; Sato, Chiko; Takeuchi, Chihiro; Watanabe, Ko; Kanzaki, Hiromitsu; Morimoto, Hiroyuki; Yano, Takafumi; Sudo, Kosuke; Mori, Keita; Gotoda, Takuji; Ono, Hiroyuki

2018-05-01

The aim of this study was to clarify whether dental floss clip (DFC) traction improves the technical outcomes of endoscopic submucosal dissection (ESD). A superiority, randomized control trial was conducted at 14 institutions across Japan. Patients with single gastric neoplasm meeting the indications of the Japanese guidelines for gastric treatment were enrolled and assigned to receive conventional ESD or DFC traction-assisted ESD (DFC-ESD). Randomization was performed according to a computer-generated random sequence with stratification by institution, tumor location, tumor size, and operator experience. The primary endpoint was ESD procedure time, defined as the time from the start of the submucosal injection to the end of the tumor removal procedure. Between July 2015 and September 2016, 640 patients underwent randomization. Of these, 316 patients who underwent conventional ESD and 319 patients who underwent DFC-ESD were included in our analysis. The mean ESD procedure time was 60.7 and 58.1 minutes for conventional ESD and DFC-ESD, respectively (P = .45). Perforation was less frequent in the DFC-ESD group (2.2% vs .3%, P = .04). For lesions located in the greater curvature of the upper or middle stomach, the mean procedure time was significantly shorter in the DFC-ESD group (104.1 vs 57.2 minutes, P = .01). Our findings suggest that DFC-ESD does not result in shorter procedure time in the overall patient population, but it can reduce the risk of perforation. When selectively applied to lesions located in the greater curvature of the upper or middle stomach, DFC-ESD provides a remarkable reduction in procedure time. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Treatment of gastric epithelial tumours by endoscopic submucosal dissection using an insulated-tip diathermic knife

PubMed Central

Hua, Xu Li; Bo, Qian Jun; Gen, Gu Liu; Fei, Lu; Min, Wang Ya; Ming, Li Yu; Sheng, Lu Hua

2011-01-01

BACKGROUND: Endoscopic submucosal dissection (ESD) is a promising technique for the treatment of large, pre- and early malignant gastrointestinal lesions. OBJECTIVE: To assess the rates of en bloc resection, incidence of complications, procedure times and therapeutic outcomes of ESD using an insulated-tip diathermic knife; and to investigate predictors of these outcomes based on the final pathological features of biopsy specimens. METHODS: One hundred twenty patients with endoscopically suspected gastric epithelial tumours who were treated with ESD from January 2006 to December 2009 were evaluated. RESULTS: The mean diameter of the gastric epithelial tumours in the present cohort was 1.88 cm. The mean diameter of the resected specimens was 3.33 cm. The en bloc resection rate was 90% (108 of 120). The median length of the operation was 64.6 min. The bleeding and perforation complication rates were 5.0% (six of 120) and 2.5% (three of 120), respectively. Of 10 gastric tumours initially diagnosed as adenocarcinoma on biopsy, four were found to be low-grade dysplasia and six were found to be high-grade dysplasia after resection and final pathological examination. A total of 112 (93.33%) patients underwent curative treatment, eight patients (6.67%) underwent noncurative treatment with ESD, and two patients (1.67%) experienced local recurrence and subsequently underwent surgery. CONCLUSIONS: ESD is a promising local curative treatment option for gastric epithelial tumours, but still carries the risks of bleeding and/or perforation. Differences in the interpretation of histological results among different pathologists and/or between biopsy specimens before ESD and the en bloc tissue specimens after ESD will result in discrepancies. PMID:21321682

Supportive techniques and devices for endoscopic submucosal dissection of gastric cancer.

PubMed

Sakurazawa, Nobuyuki; Kato, Shunji; Fujita, Itsuo; Kanazawa, Yoshikazu; Onodera, Hiroyuki; Uchida, Eiji

2012-06-16

The indications for endoscopic treatment have expanded in recent years, and relatively intestinal-type mucosal stomach carcinomas with a low potential for metastasis are now often resected en bloc by endoscopic submucosal dissection (ESD), even if they measure over 20 mm in size. However, ESD requires complex maneuvers, which entails a long operation time, and is often accompanied by complications such as bleeding and perforation. Many technical developments have been implemented to overcome these complications. The scope, cutting device, hemostasis device, and other supportive devices have been improved. However, even with these innovations, ESD remains a potentially complex procedure. One of the major difficulties is poor visualization of the submucosal layer resulting from the poor countertraction afforded during submucosal dissection. Recently, countertraction devices have been developed. In this paper, we introduce countertraction techniques and devices mainly for gastric cancer.

Complete closure of artificial gastric ulcer after endoscopic submucosal dissection by combined use of a single over-the-scope clip and through-the-scope clips (with videos).

PubMed

Maekawa, Satoshi; Nomura, Ryosuke; Murase, Takayuki; Ann, Yasuyoshi; Harada, Masaru

2015-02-01

A 5-7 day hospital stay is usually needed after endoscopic submucosal dissection (ESD) of gastric tumor because of the possibility of delayed perforation or bleeding. The aim of this study was to evaluate the efficacy of combined use of a single over-the-scope clip (OTSC) and through-the-scope clips (TTSCs) to achieve complete closure of artificial gastric ulcer after ESD. We prospectively studied 12 patients with early gastric cancer or gastric adenoma. We performed complete closure of post-ESD artificial gastric ulcer using a combination of a single OTSC and TTSCs. Mean size of post-ESD artificial ulcer was 54.6 mm. The mean operating time for the closure procedure was 15.2 min., and the success rate was 91.7 % (11/12). Patients who underwent complete closure of post-ESD artificial gastric ulcer could be discharged the day after ESD and the closing procedure. Complete closure of post-ESD artificial gastric ulcer using a combination of a single OTSC and TTSCs is useful for shortening the period of hospitalization and reducing treatment cost.

Esophageal Motility after Extensive Circumferential Endoscopic Submucosal Dissection for Superficial Esophageal Cancer.

PubMed

Kuribayashi, Yasutaka; Iizuka, Toshiro; Nomura, Kosuke; Furuhata, Tsukasa; Yamashita, Satoshi; Matsui, Akira; Kikuchi, Daisuke; Mitani, Toshifumi; Kaise, Mitsuru; Hoteya, Shu

2018-06-05

Endoscopic submucosal dissection (ESD) for superficial esophageal cancer is sometimes extensive, and in our experience, patients not infrequently present with dysphagia after ESD even in the absence of esophageal stricture. The aim of this study was to evaluate esophageal motility using high-resolution manometry (HRM) in patients with and without dysphagia after extensive circumferential ESD. HRM was performed in a total of 52 patients who had undergone ESD for superficial esophageal cancer and a mucosal defect after ESD exceeded more than two-thirds of the esophageal circumference. The frequency and type of esophageal dysmotility and the relationship between esophageal motility and dysphagia were evaluated. Esophageal dysmotility was observed in 13 patients (25%): jackhammer esophagus in 4, esophagogastric junction outflow obstruction in 4, absent contractility in 2, and distal esophageal spasm, ineffective esophageal motility, and fragmented peristalsis in 1 patient each. Of the 22 patients with dysphagia after ESD, 9 (41%) had esophageal dysmotility. Of the 30 patients without dysphagia after ESD, 4 (13%) had esophageal dysmotility. The relationship between dysmotility and dysphagia was significant (p = 0.025). Esophageal dysmotility exists in approximately one-quarter of patients after extensive circumferential ESD, which is associated with dysphagia in the absence of esophageal stricture. © 2018 S. Karger AG, Basel.

Infected Aneurysm after Endoscopic Submucosal Dissection.

PubMed

Gen, Shiko; Usui, Ryuichi; Sasaki, Takaya; Nobe, Kanako; Takahashi, Aya; Okudaira, Keisuke; Ikeda, Naofumi

2016-01-01

A 79-year-old man on hemodialysis was hospitalized for further investigation. Early gastric cancer was diagnosed by gastrointestinal endoscopy and endoscopic submucosal dissection (ESD) was performed. Fever and abdominal pain thereafter developed, and a severe inflammatory response was observed on a blood test. Contrast computed tomography (CT) showed ulcer-like projections and soft tissue surrounding the aorta, from the celiac to left renal artery. An infected aneurysm was diagnosed. Although infected aneurysms developing after laparoscopic cholecystectomy or biopsy of contiguous esophageal duplication cyst have been reported, those developing after ESD have not. When fever and abdominal pain develop after ESD, an infected aneurysm should be considered and contrast CT performed.

Endoscopic therapy for early gastric cancer: Standard techniques and recent advances in ESD

PubMed Central

Kume, Keiichiro

2014-01-01

The technique of endoscopic submucosal dissection (ESD) is now a well-known endoscopic therapy for early gastric cancer. ESD was introduced to resect large specimens of early gastric cancer in a single piece. ESD can provide precision of histologic diagnosis and can also reduce the recurrence rate. However, the drawback of ESD is its technical difficulty, and, consequently, it is associated with a high rate of complications, the need for advanced endoscopic techniques, and a lengthy procedure time. Various advances in the devices and techniques used for ESD have contributed to overcoming these drawbacks. PMID:24914364

Leiomyosarcoma of the stomach treated by endoscopic submucosal dissection.

PubMed

Sato, Takao; Akahoshi, Kazuya; Tomoeda, Naru; Kinoshita, Norikatsu; Kubokawa, Masaru; Yodoe, Kentaro; Hiraki, Yuka; Oya, Masafumi; Yamamoto, Hidetaka; Ihara, Eikichi

2018-03-02

There have been no reports of primary leiomyosarcoma of the stomach treated by endoscopic submucosal dissection (ESD). We report an extremely rare case of gastric leiomyosarcoma that was successfully treated by ESD. An asymptomatic 74-year-old female underwent esophagogastroduodenoscopy for screening in December 2013. A centrally depressed submucosal tumor 10 mm in diameter was detected at the posterior wall of the upper gastric body. Follow-up esophagogastroduodenoscopy conducted 5 months later showed that the tumor diameter had increased to 15 mm. Endoscopic ultrasound revealed a hypoechoic mass located in the second to the middle of the third layer. Endoscopic ultrasound-guided fine-needle aspiration demonstrated a myogenic tumor. The tumor was completely resected by ESD without complications. Immunohistopathological diagnosis of the resected specimen was gastric leiomyosarcoma derived from the muscularis mucosae, with negative lateral and vertical margins. No local recurrence or metastasis has been detected at 36 months after ESD. This is the first report of gastric leiomyosarcoma treated by ESD in the English language literature.

Prevention of esophageal strictures after endoscopic submucosal dissection

PubMed Central

Kobayashi, Shinichiro; Kanai, Nobuo; Ohki, Takeshi; Takagi, Ryo; Yamaguchi, Naoyuki; Isomoto, Hajime; Kasai, Yoshiyuki; Hosoi, Takahiro; Nakao, Kazuhiko; Eguchi, Susumu; Yamamoto, Masakazu; Yamato, Masayuki; Okano, Teruo

2014-01-01

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have recently been accepted as less invasive methods for treating patients with early esophageal cancers such as squamous cell carcinoma and dysplasia of Barrett’s esophagus. However, the large defects in the esophageal mucosa often cause severe esophageal strictures, which dramatically reduce the patient’s quality of life. Although preventive endoscopic balloon dilatation can reduce dysphagia and the frequency of dilatation, other approaches are necessary to prevent esophageal strictures after ESD. This review describes several strategies for preventing esophageal strictures after ESD, with a particular focus on anti-inflammatory and tissue engineering approaches. The local injection of triamcinolone acetonide and other systemic steroid therapies are frequently used to prevent esophageal strictures after ESD. Tissue engineering approaches for preventing esophageal strictures have recently been applied in basic research studies. Scaffolds with temporary stents have been applied in five cases, and this technique has been shown to be safe and is anticipated to prevent esophageal strictures. Fabricated autologous oral mucosal epithelial cell sheets to cover the defective mucosa similarly to how commercially available skin products fabricated from epidermal cells are used for skin defects or in cases of intractable ulcers. Fabricated autologous oral-mucosal-epithelial cell sheets have already been shown to be safe. PMID:25386058

Endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms

PubMed Central

Zhai, Ya-Qi; Li, Hui-Kai; Linghu, En-Qiang

2016-01-01

Endoscopic submucosal dissection (ESD) is a well-established treatment for superficial esophageal squamous cell neoplasms (SESCNs) with no risk of lymphatic metastasis. However, for large SESCNs, especially when exceeding two-thirds of the esophageal circumference, conventional ESD is time-consuming and has an increased risk of adverse events. Based on the submucosal tunnel conception, endoscopic submucosal tunnel dissection (ESTD) was first introduced by us to remove large SESCNs, with excellent results. Studies from different centers also reported favorable results. Compared with conventional ESD, ESTD has a more rapid dissection speed and R0 resection rate. Currently in China, ESTD for large SESCNs is an important part of the digestive endoscopic tunnel technique, as is peroral endoscopic myotomy for achalasia and submucosal tunnel endoscopic resection for submucosal tumors of the muscularis propria. However, not all patients with SESCNs are candidates for ESTD, and postoperative esophageal strictures should also be taken into consideration, especially for lesions with a circumference greater than three-quarters. In this article, we describe our experience, review the literature of ESTD, and provide detailed information on indications, standard procedures, outcomes, and complications of ESTD. PMID:26755889

Severe splenic rupture after colorectal endoscopic submucosal dissection

PubMed Central

Herreros de Tejada, Alberto; Giménez-Alvira, Luis; Van den Brule, Enrique; Sánchez-Yuste, Rosario; Matallanos, Pilar; Blázquez, Esther; Calleja, Jose L; Abreu, Luis E

2014-01-01

Splenic rupture (SR) after colonoscopy is a very rare but potentially serious complication. Delayed diagnosis is common, and may increase morbidity and mortality associated. There is no clear relation between SR and difficult diagnostic or therapeutic procedures, but it has been suggested that loop formation and excessive torquing might be risk factors. This is a case of a 65-year-old woman who underwent endoscopic submucosal dissection (ESD) for lateral spreading tumor in the descending colon, and 36 h afterwards presented symptoms and signs of severe hypotension due to SR. Standard splenectomy was completed and the patient recovered uneventfully. Colorectal ESD is usually a long and position-demanding technique, implying torquing and loop formation. To our knowledge this is the first case of SR after colorectal ESD reported in the literature. Endoscopists performing colorectal ESD in the left colon must be aware of this potential complication. PMID:25071360

Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids.

PubMed

Tanaka, Shinwa; Toyonaga, Takashi; Morita, Yoshinori; Hoshi, Namiko; Ishida, Tsukasa; Ohara, Yoshiko; Yoshizaki, Tetsuya; Kawara, Fumiaki; Umegaki, Eiji; Azuma, Takeshi

2016-07-21

To evaluate the feasibility and safety of endoscopic submucosal dissection (ESD) for lower rectal lesions with hemorrhoids. The outcome of ESD for 23 lesions with hemorrhoids (hemorrhoid group) was compared with that of 48 lesions without hemorrhoids extending to the dentate line (non-hemorrhoid group) during the same study period. Median operation times (ranges) in the hemorrhoid and non-hemorrhoid groups were 121 (51-390) and 130 (28-540) min. The en bloc resection rate and the curative resection rate in the hemorrhoid group were 96% and 83%, and they were 100% and 90% in the non-hemorrhoid group, respectively. In terms of adverse events, perforation and postoperative bleeding did not occur in both groups. In terms of the clinical course of hemorrhoids after ESD, the rate of complete recovery of hemorrhoids after ESD in lesions with resection of more than 90% was significantly higher than that in lesions with resection of less than 90%. ESD on lower rectal lesions with hemorrhoids could be performed safely, similarly to that on rectal lesions extending to the dentate line without hemorrhoids. In addition, all hemorrhoids after ESD improved to various degrees, depending on the resection range.

Management of early colonic neoplasia: where are we now and where are we heading?

PubMed

Longcroft-Wheaton, Gaius; Bhandari, Pradeep

2017-03-01

There have been considerable advances in the endoscopic treatment of colorectal neoplasia. The development of endoscopic submucosal dissection and full thickness resection techniques is changing the way benign disease and early cancers are managed. This article reviews the evidence behind these new techniques and discusses where this field is likely to move in the future. Areas covered: A PubMed literature review of resection techniques for colonic neoplasia was performed. The clinical and cost effectiveness of endoscopic mucosal resection (EMR) is examined. The development of endoscopic submucosal dissection (ESD) and knife assisted resection is described and issues around training reviewed. Efficacy is compared to both EMR and transanal endoscopic microsurgery. The future is considered, including full thickness resection techniques and robotic endoscopy. Expert commentary: The perceived barriers to ESD are falling, and views that such techniques are only possible in Japan are disappearing. The key barriers to uptake will be training, and the development of educational programmes should be seen as a priority. The debate between TEMS and ESD will continue, but ESD is more flexible and cheaper. This will become less significant as the number of endoscopists trained in ESD grows and some TEMS surgeons may shift across towards ESD.

Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video).

PubMed

Emura, Fabian; Mejía, Juan; Donneys, Alberto; Ricaurte, Orlando; Sabbagh, Luis; Giraldo-Cadavid, Luis; Oda, Ichiro; Saito, Yutaka; Osorio, Camilo

2015-11-01

Large multicenter gastric cancer endoscopic submucosal dissection (ESD) studies conducted at major Japanese institutions have reported en bloc resection, en bloc tumor-free margin resection, and curative resection rates of 92.7% to 96.1%, 82.6% to 94.5%, and 73.6% to 85.4%, respectively, with delayed bleeding and perforation rates of 0.6% to 6.0% and 3.6% to 4.7%, respectively. Although ESD is currently an alternative treatment in some countries, particularly in Asia, it remains uncertain whether ESD therapeutic outcomes in Western endoscopy settings can be comparable to those achieved in Japan. To evaluate the ESD therapeutic outcomes for differentiated early gastric cancer (EGC) in a Western endoscopy setting. Consecutive case series performed by an expertly trained Western endoscopist. Fifty-three patients with 54 lesions. ESD for early gastric cancers (T1) satisfying expanded inclusion criteria. En bloc resection, en bloc tumor-free margin resection, and curative resection rates were 98%, 93%, and 83%, respectively. The delayed bleeding rate was 7%, and the perforation rate was 4%. The mean patient age was 67 years, and the mean tumor size was 19.8 mm, with 54% of the lesions located in the lesser curvature. The median procedure time was 61 minutes, with ESD procedures 60 minutes or longer associated with submucosal fibrosis (P < .001) and tumor size 25 mm or larger (P = .03). In every ESD procedure, both circumferential incision and submucosal dissection were performed by using a single knife. Two of the 4 delayed bleeding cases required surgery, and all perforations were successfully managed by using endoscopic clips. Long-term outcome data are currently unavailable. ESD for differentiated EGC resulted in favorable therapeutic outcomes in a Western endoscopy setting comparable to those achieved at major Japanese institutions. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Esophageal triamcinolone acetonide-filling method: a novel procedure to prevent stenosis after extensive esophageal endoscopic submucosal dissection (with videos).

PubMed

Shibagaki, Kotaro; Ishimura, Norihisa; Oshima, Naoki; Mishiro, Tsuyoshi; Fukuba, Nobuhiko; Tamagawa, Yuji; Yamashita, Noritsugu; Mikami, Hironobu; Izumi, Daisuke; Taniguchi, Hideaki; Sato, Shuichi; Ishihara, Shunji; Kinoshita, Yoshikazu

2018-02-01

Endoscopic submucosal dissection (ESD) for extensive esophageal carcinomas may cause severe stenosis requiring endoscopic balloon dilations (EBDs). A standard prevention method has not been established. We propose the esophageal triamcinolone acetonide (TA)-filling method as a novel local steroid administration procedure. We enrolled 22 consecutive patients with early esophageal cancer who were treated using either subcircumferential or circumferential ESD (15 and 7 procedures, respectively) in this case series. Esophageal TA filling was performed on the day after ESD and 1 week later and was performed again if mild stenosis was found on follow-up. EBD with TA filling was performed only for severe stenosis that prevented endoscope passage. The primary endpoint was the incidence of severe stenosis. Secondary endpoints were the total number of EBDs and additional TA filling, dysphagia score, time to stenosis and to complete re-epithelialization, and any adverse events. The incidence of severe stenosis was 4.5% (1/22; confidence interval, .1%-22.8%), and EBD was performed 2 times in 1 patient. Mild stenosis was found in 9 patients. Additional TA filling was performed in 45.5% of patients (10/22; median, 5 times; range, 1-13). The dysphagia score deteriorated to 1 to 2 in 31.8% (7/22) but showed a final score of 0 after complete re-epithelialization in 90.9% (20/22). The median time to stenosis was 3 weeks (range, 3-4) and that to complete re-epithelialization was 7 weeks (range, 4-36). No severe adverse events occurred. The esophageal TA-filling method is highly effective for preventing severe stenosis after extensive esophageal ESD. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Technical feasibility of endoscopic submucosal dissection of gastrointestinal epithelial neoplasms with a splash-needle.

PubMed

Fujishiro, Mitsuhiro; Kodashima, Shinya; Goto, Osamu; Ono, Satoshi; Muraki, Yosuke; Kakushima, Naomi; Omata, Masao

2008-12-01

Endoscopic submucosal dissection (ESD) permits the resection of large gastrointestinal epithelial neoplasms and neoplasms with submucosal fibrosis in an en bloc manner. However, the high frequency of complications accompanying ESD and its complex processes suggests that the process requires improvement. A total of 22 consecutive patients with gastrointestinal epithelial neoplasms were enrolled during a 6-month period to evaluate a novel endosurgical knife for ESD. This novel knife is known as the "splash-needle," and it is thin, short needle with a water-irrigation function. The technical results revealed that the rates of bloc resection and en bloc resection with tumor-free lateral/basal margins (R0 resection) were 91% (20/22) and 82% (18/22), respectively. There was no significant bleeding or perforation during or after ESD. The median operation time was 60 minutes (range, 20 to 210). The splash-needle is a promising novel endosurgical knife that is useful for less complicated ESD. The accumulation of knowledge and cases verifying its usefulness is necessary, and a study comparing the knife with first-generation endosurgical knives is also warranted.

Changes in esophageal motility after endoscopic submucosal dissection for superficial esophageal cancer: a high-resolution manometry study.

PubMed

Takahashi, K; Sato, Y; Takeuchi, M; Sato, H; Nakajima, N; Ikarashi, S; Hayashi, K; Mizuno, K-I; Honda, Y; Hashimoto, S; Yokoyama, J; Terai, S

2017-11-01

The effect of endoscopic submucosal dissection (ESD) on esophageal motility remains unknown. Therefore, the aim of this study is to elucidate changes in esophageal motility after ESD along with the cause of dysphagia using high-resolution manometry (HRM). This is a before-and-after trial of the effect of ESD on the esophageal motility. Twenty patients who underwent ESD for superficial esophageal carcinoma were enrolled in this study. Patients filled out a questionnaire about dysphagia and underwent HRM before and after ESD. Results before and after ESD were compared. Data were obtained from 19 patients. The number of patients who complained of dysphagia before and after ESD was 1/19 (5.3%) and 6/19 (31.6%), respectively (P = 0.131). Scores from the five-point Likert scale before and after ESD were 0.1 ± 0.5 and 1.0 ± 1.6, respectively (P = 0.043). The distal contractile integral (DCI) before and after ESD and the number of failed, weak, or fragmented contractions were not significantly different. However, in five patients with circumferential ESD, DCI was remarkably decreased and the frequency of fail, weak, or fragmented contractions increased. Univariate regression analysis showed a relatively strong inverse correlation of ΔDCI with the circumferential mucosal defect ratio {P < 0.01, standardized regression coefficient (r) = -0.65}, the number of stricture preventions (P < 0.01, r = -0.601), and the number of stricture resolutions (P < 0.01, r = -0.77). This HRM study showed that impairment of esophageal motility could be caused by ESD. The impairment of esophageal motility was conspicuous, especially in patients with circumferential ESD and subsequent procedures such as endoscopic triamcinolone injection and endoscopic balloon dilatation. Impaired esophageal motility after ESD might explain dysphagia. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A pilot study using an infrared imaging system in prevention of post-endoscopic submucosal dissection ulcer bleeding.

PubMed

Yoshida, Yukinaga; Matsuda, Koji; Tamai, Naoto; Yoshizawa, Kai; Nikami, Toshiki; Ishiguro, Haruya; Tajiri, Hisao

2014-01-01

Endoscopic submucosal dissection (ESD) for superficial gastric neoplasm is a curative method. The aim of this study was to detect potential nonbleeding visible vessels (NBVVs) by using an infrared imaging (IRI) system. A total of 24 patients (25 lesions) were consecutively enrolled between March 2010 and December 2010. The day after ESD, endoscopist A (K.M.), who was blinded to the actual procedure of ESD, performed esophagogastroduodenoscopy (EGD) of the post-ESD ulcer base using the IRI system. Endoscopist A marked gray/blue points in the hard-copy images with the IRI system. After the first procedure, endoscopist B (Y.Y.), who was blinded to the results recorded by endoscopist A, performed a second EGD with white light endoscopy and administered water-jet pressure with the maximum level of an Olympus flushing pump onto the post-ESD ulcer base. This test can cause iatrogenic bleeding via application of pressure to NBVV in the post-ESD ulcer. The IRI system detected 58 gray points and 71 blue points. The post-ESD ulcer was divided into the central area and the peripheral area. There were 14 gray points (24 %) in the central area and 44 gray points (76 %) in the peripheral area. There were 19 blue points (27 %) in the central area and 52 blue points (73 %) in the peripheral area. There was no significant difference when comparing the distribution of gray points and blue points. Bleeding occurred with a water-jet pressure in 11 of 58 gray points and in none of the blue points (P = 0.000478). Among the gray points, bleeding in response to a water-jet pressure occurred in 2 points in the central area and in 9 points in the peripheral area. The IRI system detects visible vessels (VVs) that are in no need of coagulation as blue points, and VVs have a potential risk of bleeding as gray points.

Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis

PubMed Central

Facciorusso, Antonio; Antonino, Matteo; Di Maso, Marianna; Muscatiello, Nicola

2014-01-01

AIM: To compare endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early gastric cancer (EGC). METHODS: Computerized bibliographic search was performed on PubMed/Medline, Embase, Google Scholar and Cochrane library databases. Quality of each included study was assessed according to current Cochrane guidelines. Primary endpoints were en bloc resection rate and histologically complete resection rate. Secondary endpoints were length of procedure, post-treatment bleeding, post-procedural perforation and recurrence rate. Comparisons between the two treatment groups across all the included studies were performed by using Mantel-Haenszel test for fixed-effects models (in case of low heterogeneity) or DerSimonian and Laird test for random-effects models (in case of high heterogeneity). RESULTS: Ten retrospective studies (8 full text and 2 abstracts) were included in the meta-analysis. Overall data on 4328 lesions, 1916 in the ESD and 2412 in the EMR group were pooled and analyzed. The mean operation time was longer for ESD than for EMR (standardized mean difference 1.73, 95%CI: 0.52-2.95, P = 0.005) and the “en bloc” and histological complete resection rates were significantly higher in the ESD group [OR = 9.69 (95%CI: 7.74-12.13), P < 0.001 and OR = 5.66, (95%CI: 2.92-10.96), P < 0.001, respectively]. As a consequence of its greater radicality, ESD provided lower recurrence rate [OR = 0.09, (95%CI: 0.05-0.17), P < 0.001]. Among complications, perforation rate was significantly higher after ESD [OR = 4.67, (95%CI, 2.77-7.87), P < 0.001] whereas the bleeding incidences did not differ between the two techniques [OR = 1.49 (0.6-3.71), P = 0.39]. CONCLUSION: In the endoscopic therapy of EGC, ESD showed a superior efficacy but higher complication rate with respect to EMR. PMID:25400870

Precordial skin burns after endoscopic submucosal dissection for gastric tube cancer.

PubMed

Miyagi, Motoshi; Yoshio, Toshiyuki; Hirasawa, Toshiaki; Ishiyama, Akiyoshi; Yamamoto, Yorimasa; Tsuchida, Tomohiro; Fujisaki, Junko; Igarashi, Masahiro

2015-11-01

Endoscopic submucosal dissection (ESD) is useful as a minimally invasive treatment option for early gastric cancer. ESD is also used in the management of postoperative remnant gastric cancers in the stomach and gastric tube cancers. Perforation and delayed bleeding have been the main complications of ESD reported in the management of gastric tube cancer. However, in the current literature, there is no description of precordial skin burns caused by electrical coagulation. While we treated 22 patients with gastric tube cancers by ESD from 2005 to 2014, we experienced five skin burns in four patients after ESD. We retrospectively analyzed clinical characteristics of precordial skin burn as a complication of ESD. All skin burns occurred in patients reconstructed using a presternal route, whose incidence of precordial skin burn was 55.6%. In all cases, lesions were located in the upper or middle third of gastric tubes irrespective of their direction. Skin burn developed on postoperative day (POD) 1 or POD 2, taking 4-7 days to heal and was accompanied by high fever in 60% of cases. The present study suggests that when carrying out ESD for gastric tube cancer using the presternal route, it is necessary to consider the occurrence of a precordial skin burn as a possible complication. © 2015 The Authors. Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.

Current status of endoscopic submucosal dissection for early gastric cancer in Korea: role and benefits.

PubMed

Kim, Sang Gyun; Lyu, Da Hyun; Park, Chan Mi; Lee, Na Rae; Kim, Jiyoung; Cha, Youngju; Jung, Hwoon-Yong

2018-06-21

This study was aimed to investigate the current clinical status of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in Korea based on a National Health Insurance (NHI) database between 2011 and 2014. The claims data of ESD for EGC in Korean NHI were reviewed using material codes of Health Insurance Review and Assessment Service between November 2011 and December 2014. The current clinical status was analyzed in terms of treatment pattern, in-hospital length of stay (LOS), total medical costs, and en bloc resection rate according to the hospital type. A total of 23,828 cases of ESD for EGC were evaluated. ESD was performed in 67.4% of cases in tertiary care hospitals, 31.8% in general hospitals, and 0.8% in hospitals, respectively. The median LOS was 5 days, and total median medical costs was approximately 1,300 US dollars. En bloc resection rate was 99%; 8.5% of cases underwent additional treatment within 90 days ESD, and 5.5% in 91 to 365 days after ESD. The clinical status was not significantly different according to the year and hospital type. A majority of ESD for EGC were performed in tertiary care hospitals in Korea. The clinical status showed excellent clinical outcomes and did not differ by the year and between the types of hospitals in Korea.

High Dose Proton Pump Inhibitor Infusion Versus Bolus Injection for the Prevention of Bleeding After Endoscopic Submucosal Dissection: Prospective Randomized Controlled Study.

PubMed

Choi, Cheol Woong; Kang, Dae Hwan; Kim, Hyung Wook; Hong, Joung Boom; Park, Su Bum; Kim, Su Jin; Cho, Mong

2015-07-01

A high dose of continuous intravenous infusion of proton pump inhibitor (PPI) is the standard treatment for peptic ulcer bleeding. The optimal dose for the prevention of bleeding after endoscopic submucosal dissection (ESD) is unclear. The purpose of this study was to determine whether stronger acid suppression more effectively prevents bleeding and high risk ulcer stigma (HRS) after gastric ESD. A total of 273 patients who underwent ESD were randomly assigned to one of two treatment groups: the continuous infusion group and the bolus injection group. Second-look endoscopy was performed on the following day after ESD. The incidences and risk factors of HRS identified by second-look endoscopy and delayed bleeding were analyzed. There were no differences in the incidences of HRS and delayed bleeding between two treatment groups. The incidence of HRS was 15.8 % (43/273) and the gross morphology (flat or depressed) was identified as a significant factor associated with HRS. The incidence of delayed bleeding was 8.4 % (23/273) and the gross morphology (flat) and the presence of submucosal invasive cancer were identified as the associated risk factors for delayed bleeding. The incidences of delayed bleeding and HRS identified by second-look endoscopy were not affected by PPI infusion methods. Flat or depressed morphologic lesions and submucosal invasive cancer should be closely monitored.

Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection

PubMed Central

Jang, Mi Young; Oh, Wang Guk; Ko, Sung Jun; Han, Shang Hoon; Baek, Hoon Ki; Lee, Young Jae; Kim, Ji Woong; Jung, Gum Mo; Cho, Yong Keun

2013-01-01

Background/Aims Endoscopic submucosal dissection (ESD) has become accepted as a minimally invasive treatment for gastric neoplasms. However, the development of synchronous or metachronous gastric lesions after endoscopic resection has become a major problem. We investigated the characteristics of multiple gastric neoplasms in patients with early gastric cancer (EGC) or gastric adenoma after ESD. Methods In total, 512 patients with EGC or gastric adenoma who had undergone ESD between January 2008 and December 2011 participated in this study. The incidence of and factors associated with synchronous and metachronous gastric tumors were investigated in this retrospective study. Results In total, 66 patients (12.9%) had synchronous lesions, and 13 patients (2.5%) had metachronous lesions. Older (> 65 years) subjects had an increased risk of multiple gastric neoplasms (p = 0.012). About two-thirds of the multiple lesions were similar in macroscopic and histological type to the primary lesions. The median interval from the initial lesions to the diagnosis of metachronous lesions was 31 months. The annual incidence rate of metachronous lesions was approximately 3%. Conclusions We recommend careful follow-up in patients of advanced age (> 65 years) after initial ESD because multiple lesions could be detected in the remnant stomach. Annual surveillance might aid in the detection of metachronous lesions. Large-scale, multicenter, and longer prospective studies of appropriate surveillance programs are needed. PMID:24307844

Endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: short- to long-term outcomes.

PubMed

Kuwai, Toshio; Yamaguchi, Toshiki; Imagawa, Hiroki; Sumida, Yuki; Takasago, Takeshi; Miyasako, Yuki; Nishimura, Tomoyuki; Iio, Sumio; Yamaguchi, Atsushi; Kouno, Hirotaka; Kohno, Hiroshi; Ishaq, Sauid

2017-09-01

Background and study aims  Endoscopic submucosal dissection (ESD) for colorectal neoplasms remains challenging because of technical issues imposed by the complex anatomical features of the large intestine. We evaluated the feasibility, and the short- and long-term clinical outcomes of ESD for early colorectal neoplasms performed using the Stag-beetle Knife Jr. (SB Knife Jr.) Patients and methods  We retrospectively assessed 228 patients who underwent ESD for 247 colorectal lesions with the SB Knife Jr. Clinicopathological characteristics of the neoplasms, complications, and various short- and long-term outcomes were evaluated. Results  Mean tumor size was 34.3 mm and median procedure time was 76 minutes. The SB Knife Jr. achieved 98.4 % en bloc resection, 93.9 % complete resection, and 85.4 % curative resection. No perforations occurred during the procedure, and a delayed bleeding rate of 2.4 % was observed. Long-term outcomes were favorable with no distant recurrence, 1.1 % local recurrence, a 5-year overall survival rate of 94.1 % and 5-year tumor-specific survival rate of 98.6 % in patients with cancer. Conclusions  ESD using the SB Knife Jr. is technically efficient and safe in treating early colorectal neoplasms and is associated with favorable short- and long-term outcomes. © Georg Thieme Verlag KG Stuttgart · New York.

Endoscopic submucosal dissection for early gastric cancer on the lesser curvature in upper third of the stomach is a risk factor for postoperative delayed gastric emptying.

PubMed

Yoshizaki, Tetsuya; Obata, Daisuke; Aoki, Yasuhiro; Okamoto, Norihiro; Hashimura, Hiroki; Kano, Chise; Matsushita, Megumi; Kanamori, Atsushi; Matsumoto, Kei; Tsujimae, Masahiro; Momose, Kenji; Eguchi, Takaaki; Okuyama, Shunsuke; Yamashita, Hiroshi; Fujita, Mikio; Okada, Akihiko

2018-02-07

Advances in Endoscopic submucosal dissection (ESD) technology have established ESD for early gastric cancer as a safe and stable technique. However, ESD may induce delayed gastric emptying and the cause of food residue retention in the stomach after ESD is not clear. This study aimed to clarify risk factors for delayed gastric emptying with food retention after gastric ESD. We retrospectively examined for food residue in the stomach 1 week after ESD was performed for early gastric carcinoma at Osaka Saiseikai Nakatsu Hospital from February 2008 to November 2016. Food residue was observed in 68 (6.1%) of 1114 patients who underwent gastric ESD. The percentage of lesions located on the lesser curvature of the upper third of the stomach was 45.6% (31/68) in the food residue group and 3.5% (37/1046) in the non-food residue group, which was significantly different (P < 0.01). Multivariate logistic regression analysis revealed that lesions on the lesser curvature of the upper third of the stomach (Odds ratio [OR] 23.31, 95% confidence interval [CI] 12.60-43.61, P < 0.01), post-ESD bleeding (OR 4.25, 95%CI 1.67-9.80, P < 0.01), submucosal invasion (OR 2.80, 95%CI 1.34-5.63, P < 0.01), and age over 80 years (OR 2.34, 95%CI 1.28-4.22, P < 0.01) were independent risk factors for food retention after gastric ESD. Of the 68 patients, 3 had food residue in the stomach on endoscopic examination for follow-up observation after the ESD ulcer had healed. Delayed gastric emptying with food retention after gastric ESD was associated with lesions located in the lesser curvature of the upper stomach, submucosal invasion of the lesion, age older than 80 years, and post-ESD bleeding, though it was temporary in most cases.

[The Efficiency and Complications of ESD and ESTD in the Treatment of Large Esophageal Mucosal Lesions].

PubMed

Wang, Jin; Qin, Jin-yu; Guo, Tian-jiao; Gan, Tao; Wang, Yi-ping; Wu, Jun-chao

2015-11-01

To study the efficiency and complications of endoscopic submucosal dissection (ESD) and endoscopic submucosal tunnel dissection (ESTD) in the treatment of large esophageal mucosal lesions. The clinical data were collected from the patients who received ESD or ESTD for the treatment of early esophageal lesions in our hospital during January 1, 2014 to July 15, 2015, including the en bloc resection rate, curative resection rate, postoperative complication rate, the risk factors of complications were explored by univariate and multivariate analysis. A total of 50 patients were involved in the study, ESD or ESTD were performed successfully in 53 times, including 6 cases of ESD,47 cases of ESTD, The average age was (61.9 +/- 6.8) yr., the average operating time was (83.57 +/- 32.33) min, the average dissected lesion was (14.82 +/- 3.18) cm2, En bloc resection rate was 94.34%, the curative rate was 84.90%. There were 1 case of bleeding, 1 case of perforation, 45 (84.90%) cases of fever, 13 cases (24.53%) of esophageal stricture. The severity of stricture was associated with the operation time Codds ratio (OR) = 1.040, 95% confidence interal (CI): 1.007-1.075) and esophageal circumference (OR=9.972, 95% CI: 1.221-81.416). The residual resection margin appeared in 8 patients, and the lesion area (OR=1.145, 95% CI: 1.013-1.294) was the only risk factor. ESD and ESTD are safe and effective in the treatment of early esophageal lesions, but seems have relatively high incidence of esopgageal stricture and residual resection margin in the treatment of large esophageal lesions.

A novel technique using high energy synchronous double-wave laser in endoscopic submucosal dissection of patients with superficial esophageal neoplasm.

PubMed

Yao, Jun; Li, Jun; Wang, Peng; Liu, Feng; Li, Zhaoshen

2018-06-08

BACKGROUND : Endoscopic submucosal dissection (ESD) has been widely used to treat superficial esophageal neoplasms (SENs). Intraoperative bleeding is one of the main concerns that makes ESD in the esophagus more difficult and time consuming with higher complication rates. We introduced a novel laser endoknife system that enabled better intraoperative hemostasis, and preliminarily investigated its feasibility in ESD for patients with SENs.  17 consecutive patients with SENs were prospectively enrolled. The laser endoknife system was used in marking and submucosal dissection. Data on therapeutic outcomes were collected and analyzed.  The median diameter of the lesions was 2.5 cm and of the resected specimens was 3.0 cm. The median procedure time was 48 minutes. Histologic evaluation revealed 15 high grade intraepithelial neoplasias and two squamous cell carcinomas. No intraoperative bleeding occurred during laser cutting and no significant complications occurred postoperatively. Curative R0 resection was achieved in all patients.  Our new laser endoknife system was feasible in the submucosal dissection of SENs and showed great prospects for future application. © Georg Thieme Verlag KG Stuttgart · New York.

High-density collagen patch prevents stricture after endoscopic circumferential submucosal dissection of the esophagus: a porcine model.

PubMed

Aoki, Shigehisa; Sakata, Yasuhisa; Shimoda, Ryo; Takezawa, Toshiaki; Oshikata-Miyazaki, Ayumi; Kimura, Hiromi; Yamamoto, Mihoko; Iwakiri, Ryuichi; Fujimoto, Kazuma; Toda, Shuji

2017-05-01

Extensive excision of the esophageal mucosa by endoscopic submucosal dissection (ESD) frequently evokes a luminal stricture. This study aimed to determine the efficacy of a high-density collagen patch for the prevention of esophageal stricture in extensive ESD. Six pigs underwent circumferential esophageal ESD under general anesthesia. In 3 pigs, artificial ulcers were covered by 2 collagen patches. The other 3 pigs underwent circumferential ESD only. The 2 collagen patches were settled onto the ulcer surface using a general endoscope and instruments. The collagen patch-treated group showed significantly better patency rates on both the oral and anal sides of the wound area compared with the control group at day 14. The mucosal re-epithelization ratio was significantly promoted, and the extent of mucosal inflammation and fibrosis was significantly decreased with the collagen patch treatment in the wound area. The frequency of cells positive α-smooth muscle actin was significantly reduced in the collagen patch-treated group compared with the control group. We have established a high-density collagen device that can reduce the esophageal stricture associated with extensive ESD. This easy-to-handle device would be useful during superficial esophageal cancer treatment by ESD. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Splash M-knife versus Flush Knife BT in the technical outcomes of endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis.

PubMed

Esaki, Mitsuru; Suzuki, Sho; Hayashi, Yasuyo; Yokoyama, Azusa; Abe, Shuichi; Hosokawa, Taizo; Ogino, Haruei; Akiho, Hirotada; Ihara, Eikichi; Ogawa, Yoshihiro

2018-02-27

Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer. A new multi-functional ESD device was developed to achieve complete ESD with a single device. A metal plate attached to its distal sheath achieves better hemostasis during the procedure than the other needle-knife device, Flush Knife BT®, that has been conventionally used. The aim of this study was to compare the technical outcomes of ESD for early gastric cancer using the Splash M-Knife® with those using the Flush Knife BT. We conducted a retrospective review of the case records of 149 patients with early gastric cancer treated with ESD using the needle-type ESD knives between January 2012 and August 2016 at Kitakyushu Municipal Medical Center. Lesions treated with ESD using the Splash M-knife (ESD-M) and the Flush Knife BT (ESD-F) were compared. Multivariate analyses and propensity score matching were used to compensate for the differences in age, gender, underlying disease, antithrombotic drug use, lesion location, lesion position, macroscopic type, tumor size, presence of ulceration, operator level and types of electrosurgical unit used. The primary endpoint was the requirement to use hemostatic forceps in the two groups. The secondary endpoints of procedure time, en bloc and complete resection rates, and adverse events rates were evaluated for the two groups. There were 73 patients in the ESD-M group, and 76 patients in the ESD-F group. Propensity score matching analysis created 45 matched pairs. Adjusted comparisons between the two groups showed a significantly lower usage rate of hemostatic forceps in the ESD-M group than in the ESD-F group (6.7% vs 84.4%, p < 0.001). Treatment outcomes showed an en bloc resection rate of 100% in both groups; complete resection rate of 95.6% vs 100%, p = 0.49; median procedure time of 74.0 min vs 71.0 min, p = 0.90; post-procedure bleeding of 2.2% vs 2.2%, p = 1, in the ESD-M and ESD-F groups, respectively. There were no perforations in either group. ESD-M appeared to reduce the usage of hemostatic forceps during ESD for early gastric cancer without increasing the adverse effects. Thus, it may contribute to a reduction in the total ESD cost.

Successful Endoscopic Submucosal Dissection of a Large Terminal Ileal Lipoma

PubMed Central

Noda, Hisatsugu; Ogasawara, Naotaka; Tamura, Yasuhiro; Kondo, Yoshihiro; Izawa, Shinya; Ebi, Masahide; Funaki, Yasushi; Sasaki, Makoto; Kasugai, Kunio

2016-01-01

A 78-year-old woman who had recurrent right lower abdominal pain for about 1 year underwent computed tomography (CT) because of a follow-up observation 1 year after right breast cancer surgery. CT revealed a tumor in the colon. The patient was referred to our hospital for detailed examinations. An abdominal CT showed a low-density tumor of approximately 30 mm in the ascending colon, and the CT density inside the tumor was same as that of fatty tissues. A subsequent colonoscopy showed a submucosal tumor (SMT) in the proximal ascending colon developing from the terminal ileum. A colonoscopic ultrasonography revealed that the SMT was a high-echoic mass mainly localized in the submucosal layer. Based on the findings from CT, colonoscopy, and colonoscopic ultrasonography, the SMT was diagnosed as a pedunculated lipoma originating from the terminal ileum and treated with endoscopic submucosal dissection (ESD) because of recurrent abdominal pain. The 40-mm tumor was resected en bloc without complications. ESD may be more appropriate than polypectomy and surgery for removal of small intestinal tumors, because ESD allows direct visualization of the cutting line and exactly dissects the submucosal layers without damaging the muscular layers. ESD is a potentially useful treatment to remove intestinal lipomas. PMID:27843426

Locoregional mitomycin C injection for esophageal stricture after endoscopic submucosal dissection.

PubMed

Machida, H; Tominaga, K; Minamino, H; Sugimori, S; Okazaki, H; Yamagami, H; Tanigawa, T; Watanabe, K; Watanabe, T; Fujiwara, Y; Arakawa, T

2012-06-01

This prospective study aimed to evaluate the feasibility and safety of locoregional mitomycin C (MMC) injection to treat refractory esophageal strictures after endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. Patients with dysphagia and strictures that were refractory to repeated endoscopic balloon dilation (EBD) were eligible. After EBD, MMC was injected into the dilated site. Between June 2009 and August 2010, five patients were recruited. The treatment was performed once in two patients and twice in three patients with recurrent dysphagia or restenosis. In all patients, passing a standard endoscope through the site was easy and the dysphagia grade improved (grade 3→1 in 3 patients, grade 4→2 in 2 patients). No serious complications were noted. During the observation period of 4.8 months, neither recurrent dysphagia nor re-stricture appeared in any of the patients. The combination of locoregional MMC injections and EBD is feasible and safe for the treatment of esophageal strictures after ESD.Recently, endoscopic submucosal dissection (ESD) has been developed and accepted as a new endoscopic treatment for gastrointestinal tumors. ESD is a promising treatment for superficial esophageal carcinoma (SEC), and it has a reliable en bloc resection rate. However, the application of ESD for widespread lesions is challenging because of the high risk of the development of severe strictures, which lead to a low quality of life after ESD. Although endoscopic balloon dilation (EBD) is effective for benign strictures, it needs to be performed frequently until the dysphagia disappears 1. Mitomycin C (MMC), which is a chemotherapeutic agent derived from some Streptomyces species 2, reduces scar formation when topically applied to a surgical lesion. MMC has been applied to treat strictures in a variety of anatomical locations, including a variety of organs 3. The aim of this study was to prospectively evaluate both the feasibility and the safety of locoregional MMC injection therapy in patients with refractory esophageal strictures after ESD for SEC. © Georg Thieme Verlag KG Stuttgart · New York.

[A Case of Combined Treatment Approach of Endoscopic Submucosal Dissection and Transanal Minimally Invasive Surgery for Radiation Induced Rectal Cancer].

PubMed

Miyake, Toru; Sonoda, Hiromichi; Shimizu, Tomoharu; Ueki, Tomoyuki; Mori, Haruki; Takebayashi, Katsushi; Kaida, Sachiko; Yamaguchi, Tsuyoshi; Iida, Hiroya; Ban, Hiromitsu; Tani, Masaji

2018-04-01

It is hard to determine treatment strategy for radiation induced carcinoma, because radiation cause fibrosis to adjacent organ.The patient was in the 70's, who underwent 70 Gy radiation therapy for prostate cancer 5 years ago.He visited hospital because of fecal occult blood.Endoscopic examination revealed laterally spreading tumor(LST)in rectal front wall, and he referred to our hospital in purpose of endoscopic submucosal dissection(ESD).We performed ESD for LST, following transanal minimally invasive surgery to suture mucosal defect.He discharged out hospital 9 days after operation without any adverse event except anal pain.Suturing of mucosal defect after ESD might be potent to prevent postoperative complications in radiation induced rectal cancer.

The efficacy of endoscopic submucosal dissection for colorectal tumors extending to the dentate line.

PubMed

Matsumoto, Satohiro; Mashima, Hirosato

2017-06-01

Although endoscopic submucosal dissection (ESD) is becoming the mainstay of the treatment strategies, rather than surgical treatment, for colorectal tumors extending to the dentate line, ESD is technically more difficult. This study was aimed at assessing the usefulness of ESD for the treatment of colorectal tumors extending to the dentate line. This study included 531 patients with colorectal tumors who underwent colorectal ESD between 2008 and 2015. They were divided into three groups: rectal tumors extending to the dentate line (anorectal group), those not extending to the dentate line (proximal rectal group), and colonic tumors (colonic group), and a retrospective comparative analysis was carried out. Of the total patients, 18 (3.4%) had lesions extending to the dentate line area. The procedure times were 103.4 ± 84.0, 80.4 ± 64.3, and 71.8 ± 52.3 min, respectively (P = 0.0318). All the patients in the anorectal group were operated by operators who had performed at least 20 colorectal ESDs (P < 0.0001). No significant difference among the three groups was found in the en bloc resection rate, complete resection rate, or curative resection rate. Although no significant difference in the incidence of perforation was observed among the three groups, intraoperative bleeding was observed in 61% of the patients in the anorectal group (P < 0.0001). ESD is an effective treatment strategy for colorectal tumors extending to the dentate line. However, it seems that anorectal ESD, which is technically more difficult than colorectal ESD, should be performed by operators with ample experience in performing ESD.

Time trend of medical economic outcomes of endoscopic submucosal dissection for gastric cancer in Japan: a national database analysis.

PubMed

Murata, Atsuhiko; Okamoto, Kohji; Muramatsu, Keiji; Matsuda, Shinya

2014-04-01

Little information is available on the analysis of chronological changes in medical economic outcomes of endoscopic submucosal dissection (ESD) for gastric cancer. This study aimed to investigate the recent time trend of medical economic outcomes of ESD for gastric cancer based on the Japanese administrative database. A total of 32,943 patients treated with ESD for gastric cancer were referred to 907 hospitals from 2009 to 2011 in Japan. We collected patients' data from the administrative database to compare ESD-related complications, risk-adjusted length of stay (LOS), and medical costs during hospitalization. The study periods were categorized into three groups: 2009 (n = 9,727), 2010 (n = 11,052), and 2011 (n = 12,164). No significant difference was observed in ESD-related complications between three study periods (p = 0.496). However, mean LOS and medical costs during hospitalization of patients with ESD were significantly lower in 2011 than in 2009 and 2010 (p < 0.001). Multiple linear regression analysis showed that patients who received ESD in 2011 had a significantly shorter LOS and lower medical costs during hospitalization compared with those in 2009. The unstandardized coefficient of patients with ESD in 2011 for LOS was -0.78 days [95 % confidence interval (CI), -0.89 to -0.65; p ≤ 0.001], while that of those for medical costs during hospitalization was -290.5 US dollars (95 % CI, -392.3 to -188.8; p ≤ 0.001). This study showed that the complication rate of ESD was stable, whereas the LOS and medical costs of patients were significantly reduced from 2009 to 2011.

Proper muscle layer damage affects ulcer healing after gastric endoscopic submucosal dissection.

PubMed

Horikawa, Yohei; Mimori, Nobuya; Mizutamari, Hiroya; Kato, Yuhei; Shimazu, Kazuhiro; Sawaguchi, Masayuki; Tawaraya, Shin; Igarashi, Kimihiro; Okubo, Syunji

2015-11-01

Endoscopic submucosal dissection (ESD) is the established therapy for superficial gastrointestinal neoplasms. However, management of the artificial ulcers associated with ESD has become important and the relationship between ulcer healing factors and treatment is still unclear. We aimed to evaluate ESD-related artificial ulcer reduction ratio at 4 weeks to assess factors associating with ulcer healing after ESD that may lead to optimal treatment. Between January 2009 and December 2013, a total of 375 lesions fulfilled the expanded criteria for ESD. We defined ulcer reduction rate <90% as (A) poor-healing group; and rate ≥90% as (B) well-healing group. After exclusion, 328 lesions were divided into two groups and analyzed. These two groups were compared based on clinicopathological/endoscopic features, concomitant drugs, and treatment. Ulcer reduction rate was significantly correlated with factors related to the ESD procedure (i.e. procedure time, submucosal fibrosis, and injury of the proper muscle layer, in univariate analysis. Multivariate logistic regression analysis showed that submucosal fibrosis (F2) (P = 0.03; OR, 16.46; 95% CI, 1.31-206.73) and injury of the proper muscle layer (P = 0.01; OR, 4.27; 95% CI, 2.04-8.92) were statistically significant predictors of delayed healing. This single-center retrospective study indicated that ESD-induced artificial ulcer healing was affected by submucosal fibrosis and injury of the proper muscle layer, which induced damage to the muscle layer. Therefore, the preferable pharmacotherapy can be determined on completion of the ESD procedure. © 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.

Nuclear artifacts in gastric endoscopic submucosal dissection specimens: A clinicopathological study

PubMed Central

MATSUKUMA, SUSUMU; TAKEO, HIROAKI; SATO, KIMIYA

2014-01-01

To delineate the characteristics of nuclear artifacts associated with endoscopic submucosal dissection (ESD), we examined 97 gastric ESD specimens from 79 patients. In 69 of the specimens (71%), multinucleated figures and/or atypical mitotic-like figures, including tripolar-like and bizarre spindles, were found in the peripheral portions close to the marking areas. These nuclear figures were mostly recognizable as artifacts, but were infrequently (13 specimens) accompanied by other nuclear alterations and/or architectural abnormalities, mimicking dysplasia. However, in the deep cut sections, the dysplastic characteristics tended to disappear and coagulative or degenerative findings became more prominent. These nuclear artifacts were not found in 69 age- and gender-matched control gastrectomy specimens without ESD. Multinucleated artifacts were associated with the size of the ESD specimens (P=0.003), frequency of marking (P<0.001) and a history of ‘previous’ marking 1–6 days prior to ESD (P<0.001); however, they were not associated with age, ESD procedure time, or ‘fresh’ marking on the day of the ESD. Atypical mitosis-like characteristics were associated with a history of ‘fresh’ (P=0.007) as well as ‘previous’ (P=0.002) marking, but not with other variables. Dysplasia-like artifacts were associated with older age only (P=0.031). Follow-up data of all the patients with nuclear artifacts showed no aggressive behavior. Therefore, we concluded that these nuclear changes were ESD-related artifacts. Particularly in older patients, these changes may simulate dysplasia and must be distinguished from true dysplasia or neoplasia. PMID:25054062

Endoscopic transgastric drainage of a gastric wall abscess after endoscopic submucosal dissection

PubMed Central

Dohi, Osamu; Dohi, Moyu; Inoue, Ken; Gen, Yasuyuki; Jo, Masayasu; Tokita, Kazuhiko

2014-01-01

A 63-year-old woman was referred to our hospital for further examination because of an incidental finding of early gastric cancer. Endoscopic submucosal dissection (ESD) was successfully performed for complete resection of the tumor. On the first post-ESD day, the patient suddenly complained of abdominal pain after an episode of vomiting. Abdominal computed tomography (CT) showed delayed perforation after ESD. The patient was conservatively treated with an intravenous proton pump inhibitor and antibiotics. On the fifth post-ESD day, CT revealed a gastric wall abscess in the gastric body. Gastroscopy revealed a gastric fistula at the edge of the post-ESD ulcer, and pus was found flowing into the stomach. An intradrainage stent and an extradrainage nasocystic catheter were successfully inserted into the abscess for endoscopic transgastric drainage. After the procedure, the clinical symptoms and laboratory test results improved quickly. Two months later, a follow-up CT scan showed no collection of pus. Consequently, the intradrainage stent was removed. Although the gastric wall abscess recurred 2 wk after stent removal, it recovered soon after endoscopic transgastric drainage. Finally, after stent removal and oral antibiotic treatment for 1 mo, no recurrence of the gastric wall abscess was found. PMID:24574787

Efficacy of a Novel Narrow Knife with Water Jet Function for Colorectal Endoscopic Submucosal Dissection

PubMed Central

Inada, Yutaka; Rani, Rafiz Abdul; Naito, Yuji; Azuma, Takeshi; Itoh, Yoshito

2017-01-01

Backgrounds With respect to the knife's design in colorectal endoscopic submucosal dissection (ESD), diameter, water jet function, and electric power are important because these relate to efficient dissection. In this study, we analyzed a novel, narrow ball tip-typed ESD knife with water jet function (Flush knife BT-S, diameter: 2.2 mm, length: 2000 mm, Fujifilm Co., Tokyo, Japan) compared to a regular diameter knife (Flush knife BT, diameter: 2.6 mm, length: 1800 mm). Methods In laboratory and clinical research, electric power, knife insertion time, vacuum/suction amount with knife in the endoscopic channel, and water jet function were analyzed. We used a knife 2.0 mm long for BT-S and BT knives. Results The BT-S showed faster mean knife insertion time (sec) and better vacuum amount (ml/min) compared to the BT (insertion time: 16.7 versus 21.6, p < 0.001, vacuum amount: 38.0 versus 14.0, p < 0.01). Additionally, the water jet function of the BT-S was not inferior. In 39 colorectal ESD cases in two institutions, there were mean 4.7 times (range: 1–28) of knife insertion. Suction under knife happened 59% (23/39) and suction of fluid could be done in 100%. Conclusions Our study showed that the narrow knife allows significantly faster knife insertion, better vacuum function, and effective clinical results. PMID:29081793

Clinical relevance of aberrant polypoid nodule scar after endoscopic submucosal dissection

PubMed Central

Arantes, Vitor; Uedo, Noriya; Pedrosa, Moises Salgado; Tomita, Yasuhiko

2016-01-01

AIM To describe a series of patients with aberrant polypoid nodule scar developed after gastric endoscopic submucosal dissection (ESD), and to discuss its pathogenesis and clinical management. METHODS We reviewed retrospectively the endoscopic database of two academic institutions located in Brazil and Japan and searched for all patients that underwent ESD to manage gastric neoplasms from 2003 to 2015. The criteria for admission in the study were: (1) successful en bloc ESD procedure with R0 and curative resection confirmed histologically; (2) postoperative endoscopic examination with identification of a polypoid nodule scar (PNS) at ESD scar; (3) biopsies of the PNS with hyperplastic or regenerative tissue, reviewed by two independent experienced gastrointestinal pathologists, one from each Institution. Data were examined for patient demographics, Helicobacter pylori status, precise neoplastic lesion location in the stomach, tumor size, histopathological assessment of the ESD specimen, and postoperative information including medical management, endoscopic and histological findings, and clinical outcome. RESULTS A total of 14 patients (10 men/4 women) fulfilled the inclusion criteria and were enrolled in this study. One center contributed with 8 cases out of 60 patients (13.3%) from 2008 to 2015. The second center contributed with 6 cases (1.7%) out of 343 patients from 2003 to 2015. Postoperative endoscopic follow-up revealed similar findings in all patients: A protruded polypoid appearing nodule situated in the center of the ESD scar surrounded by convergence of folds. Biopsies samples were taken from PNS, and histological assessment revealed in all cases regenerative and hyperplastic tissue, without recurrent tumor or dysplasia. Primary neoplastic lesions were located in the antrum in 13 patients and in the angle in one patient. PNS did not develop in any patient after ESD undertaken for tumors located in the corpus, fundus or cardia. All patients have been followed systematically on an annual basis and no malignant recurrence in the ESD scar has been identified (mean follow-up period: 45 mo). CONCLUSION PNS may occur after ESD for antral lesions and endoscopically look concerning, especially for the patient or the family doctor. However, as long as curative R0 resection was successfully achieved and histology demonstrates only regenerative and hyperplastic tissue, PNS should be viewed as a benign alteration that does not require any type of intervention, other than endoscopic surveillance. PMID:27668074

Laparoscopic-endoscopic cooperative surgery is a safe and effective treatment for superficial nonampullary duodenal tumors.

PubMed

Kyuno, Daisuke; Ohno, Keisuke; Katsuki, Shinichi; Fujita, Tomoki; Konno, Ai; Murakami, Takeshi; Waga, Eriko; Takanashi, Kunihiro; Kitaoka, Keisuke; Komatsu, Yuya; Sasaki, Kazuaki; Hirata, Koichi

2015-11-01

The use of endoscopic submucosal dissection (ESD) for duodenal neoplasms has increased in recent years, but delayed perforation and bleeding are also known to frequently occur. We present two cases in which duodenal adenoma was successfully treated with laparoscopic-endoscopic cooperative surgery. ESD was combined with laparoscopic seromuscular sutures. The lesions in both cases were located in the second portion of the duodenum. The patients requested resection of the lesion, and we performed laparoscopic-endoscopic cooperative surgery. After the laparoscopic surgeon mobilized the duodenum, the endoscopic surgeon performed ESD for the duodenal tumor without perforation. The laparoscopic surgeon sutured the duodenal wall in the seromuscular layer to strengthen the ulcer bed after ESD. Histopathological studies confirmed that the surgical margins were tumor-free in both cases. The patients were discharged with no complications. This unique laparoscopic-endoscopic cooperative procedure is a safe and effective method for resecting superficial nonampullary duodenal tumors. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

Treatment of over 20 mm gastric cancer by endoscopic submucosal dissection using an insulation-tipped diathermic knife

PubMed Central

Hirasaki, Shoji; Kanzaki, Hiromitsu; Matsubara, Minoru; Fujita, Kohei; Ikeda, Fusao; Taniguchi, Hideaki; Yumoto, Eiichiro; Suzuki, Seiyuu

2007-01-01

AIM: To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD) for the treatment of patients with over 20 mm early gastric cancer (EGC). METHODS: A total of 112 patients with over 10 mm EGC were treated with IT-ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 5 year period from January 2002 to December 2006, including 40 patients with over 20 mm EGC. We compared patient backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, perforation rate between patients with over 20 mm EGC [over 20 mm group (21-40 mm)] and the remaining patients (under 20 mm group). RESULTS: We found no significant difference in the rate of underlying cardiopulmonary disease (over 20 mm group vs under 20 mm group, 5.0% vs 5.6%), one-piece resection rate (95% vs 96%), CR rate (85% vs 89%), operation time (72.3 min vs 66.5 min), bleeding rate (5% vs 4.2%), and perforation rate (0% vs 1.4%) between the 2 groups. Three patients in each group had submucosal invasion and two in each groups underwent additional surgery. CONCLUSION: There was no significant difference in the outcome resulting from IT-ESD between the 2 groups. Our study proves that IT-ESD is a feasible treatment for patients with over 20 mm mucosal gastric cancer although the long-term outcome should be evaluated in the future. PMID:17663514

Cost comparison between surgical treatments and endoscopic submucosal dissection in patients with early gastric cancer in Korea.

PubMed

Kim, Younhee; Kim, Young Woo; Choi, Il Ju; Cho, Joo Young; Kim, Jong Hee; Kwon, Jin Won; Lee, Ja Youn; Lee, Na Rae; Seol, Sang Yong

2015-03-01

This study was conducted to evaluate whether medical costs can be reduced using endoscopic submucosal dissection (ESD) instead of conventional surger-ies in patients with early gastric cancer (EGC). Pa-tients who underwent open gastrectomy (OG), laparoscopy-assisted gastrectomy (LAG), and ESD for EGC were recruited from three medical institutions in 2009. For macro-costing, the medical costs for each patient were derived from the ex-penses incurred during the patient's hospital stay and 1-year follow-up. The overall costs in micro-costing were determined by multiplying the unit cost with the resources used during the patients' hospitalization. A total of 194 patients were included in this study. The hospital stay for ESD was 5 to 8 days and was significantly shorter than the 12-day hospital stay for OG or the 11- to 17-day stay for LAG. Using macro-costing, the average medical costs for ESD during the hospital stay ranged from 2.1 to 3.4 million Korean Won (KRW) per patient, and the medical costs for conventional surgeries were estimated to be between 5.1 million and 8.2 million KRW. There were no significant differences in the 1-year follow-up costs between ESD and conventional surger-ies. ESD patients had lower medical costs than those patients who had conventional surgeries for EGC with conservative indications. (Gut Liver, 2015;9174-180).

Efficacy of treatment with rebamipide for endoscopic submucosal dissection-induced ulcers

PubMed Central

Takayama, Masaki; Matsui, Shigenaga; Kawasaki, Masanori; Asakuma, Yutaka; Sakurai, Toshiharu; Kashida, Hiroshi; Kudo, Masatoshi

2013-01-01

AIM: To prospectively compare the healing rates of endoscopic submucosal dissection (ESD)-induced ulcers treated with either a proton-pump inhibitor (PPI) or rebamipide. METHODS: We examined 90 patients with early gastric cancer who had undergone ESD. All patients were administered an intravenous infusion of the PPI lansoprazole (20 mg) every 12 h for 2 d, followed by oral administration of lansoprazole (30 mg/d, 5 d). After 7-d treatment, the patients were randomly assigned to 2 groups and received either lansoprazole (30 mg/d orally, n = 45; PPI group) or rebamipide (300 mg orally, three times a day; n = 45; rebamipide group). At 4 and 8 wk after ESD, the ulcer outcomes in the 2 groups were compared. RESULTS: No significant differences were noted in patient age, underlying disease, tumor location, Helicobacter pylori infection rate, or ESD-induced ulcer size between the 2 groups. At both 4 and 8 wk, the healing rates of ESD-induced ulcers were similar in the PPI-treated and the rebamipide-treated patients (4 wk: PPI, 27.2%; rebamipide, 33.3%; P = 0.5341; 8 wk: PPI, 90.9%; rebamipide, 93.3%; P = 0.6710). At 8 wk, the rates of granulation lesions following ulcer healing were significantly higher in the PPI-treated group (13.6%) than in the rebamipide-treated group (0.0%; P = 0.0103). Ulcer-related symptoms were similar in the 2 treatment groups at 8 wk. The medication cost of 8-wk treatment with the PPI was 10945 yen vs 4889 yen for rebamipide. No ulcer bleeding or complications due to the drugs were observed in either treatment group. CONCLUSION: The healing rate of ESD-induced ulcers was similar with rebamipide or PPI treatment; however, rebamipide treatment is more cost-effective and prevents granulation lesions following ulcer healing. PMID:24039365

The expansion of endoscopic submucosal dissection in France: A prospective nationwide survey

PubMed Central

Barret, Maximilien; Lepilliez, Vincent; Coumaros, Dimitri; Chaussade, Stanislas; Leblanc, Sarah; Ponchon, Thierry; Fumex, Fabien; Chabrun, Edouard; Bauret, Paul; Cellier, Christophe; Coron, Emmanuel; Bichard, Philippe; Bulois, Philippe; Charachon, Antoine; Rahmi, Gabriel; Bellon, Serge; Lerhun, Marc; Arpurt, Jean-Pierre; Koch, Stéphane; Napoleon, Bertrand; Vaillant, Eric; Esch, Anouk; Farhat, Said; Robin, Francoise; Kaddour, Nadira

2016-01-01

Introduction Early reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time. Material and methods All consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow-up data were recorded. The results obtained over three years were compared to previously published data covering the 2008–2010 period. Results Between November 2010 and June 2013, 319 ESD cases performed in 314 patients (62% male, mean (±SD) age 65.4 ± 12) were analyzed and compared to 188 ESD cases in 188 patients (61% male, mean (±SD) age 64.6 ± 13) performed between January 2008 and October 2010. The mean (±SD) lesion size was 39 ± 12 mm in 2010–2013 vs 32.1 ± 21 for 2008–2010 (p = 0.004). En bloc resection improved from 77.1% to 91.7% (p < 0.0001) while R0 en bloc resection remained stable from 72.9% to 71.9% (p = 0.8) over time. Complication rate dropped from 29.2% between 2008 and 2010 to 14.1% between 2010 and 2013 (p < 0.0001), with bleeding decreasing from 11.2% to 4.7% (p = 0.01) and perforations from 18.1% to 8.1% (p = 0.002) over time. No procedure-related mortality was recorded. Conclusions In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates. PMID:28405321

Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study

PubMed Central

Arimoto, Jun; Higurashi, Takuma; Kato, Shingo; Fuyuki, Akiko; Ohkubo, Hidenori; Nonaka, Takashi; Yamaguchi, Yoshikazu; Ashikari, Keiichi; Chiba, Hideyuki; Goto, Shungo; Taguri, Masataka; Sakaguchi, Takashi; Atsukawa, Kazuhiro; Nakajima, Atsushi

2018-01-01

Background and study aims  Colorectal cancer (CRC) is one of the most common neoplasms and endoscopic submucosal dissection (ESD) is an effective treatment for early-stage CRC. However, it has been observed that patients undergoing ESD often complain of pain, even if ESD has been successfully performed. Risk factors for such pain still remain unknown. The aim of this study was to explore the risk factors for post-colorectal ESD coagulation syndrome (PECS). Patients and methods  This was a prospective multicenter observational trial (UMIN000016781) conducted in 106 of 223 patients who underwent ESD between March 2015 and April 2016. We investigated age, sex, tumor location, ESD operation time, lesion size, duration of hospitalization, and frequency of PECS. We defined PECS as local abdominal pain (evaluated on a visual analogue scale) in the region corresponding to the site of the ESD that occurred within 4 days of the procedure. Results  PECS occurred in 15/106 (14.2 %), and 10 were women ( P  = 0.01, OR: 7.74 [1.6 – 36.4]), 7 had lesions in the cecum ( P  < 0.001, OR: 20.6 [3.7 – 115.2]), and 9 in whom ESD operation time was > 90 min ( P  = 0.002, OR: 10.3 [2.4 – 44.6]). Frequency of deviation from the prescribed clinical path was significantly higher (47 % [7/15] vs. 2 % [2/91], P  < 0.001, OR: 38.9 [6.9 – 219.6]), and hospital stay was significantly longer in the PECS group.  Conclusions  Female gender, location of lesion in the cecum, and ESD operation time > 90 minutes were significant risk factors independent of PECS. These findings are important to management of PECS.  PMID:29527556

A randomized controlled trial of prophylactic antibiotics in the prevention of electrocoagulation syndrome after colorectal endoscopic submucosal dissection.

PubMed

Lee, Sang Pyo; Sung, In-Kyung; Kim, Jeong Hwan; Lee, Sun-Young; Park, Hyung Seok; Shim, Chan Sup; Ki, Hyun Kyun

2017-08-01

Endoscopic submucosal dissection (ESD) is currently commonly performed, but colorectal ESD has a substantial risk of adverse events, including post-ESD electrocoagulation syndrome (PEECS). We investigated whether the use of prophylactic antibiotics can reduce the occurrence of PEECS. Patients who underwent colorectal ESD were randomly assigned to 1 of 2 treatment regimens. Ampicillin and/or sulbactam mixed with normal saline solution was administered 1 hour before ESD in group 1 then additionally injected every 8 hours twice more. In group 2, normal saline solution without antibiotics was administered following the same schedule. We investigated the characteristics of the patients and tumors, the incidence of PEECS, laboratory findings, and the visual analog scale (VAS) score for abdominal pain measured on the morning after ESD. A total of 100 cases (50 per group) were finally analyzed, and 97 tumors were successfully resected en bloc. The number of patients having C-reactive protein (CRP) levels ≥1 mg/dL and the number of patients having VAS scores for abdominal pain ≥1 were greater in group 2 than in group 1 (P = .008 and .023, respectively). The incidence of PEECS in group 2 also was higher than that in group 1 (1 and 8 in groups 1 and 2, respectively; P = .031). The prophylactic use of ampicillin and/or sulbactam in colorectal ESD is associated with reduced risk of PEECS, decreased CRP levels, and decreased abdominal pain. The use of prophylactic antibiotics in colorectal ESD may be an effective tool for reducing the risk of PEECS. (Clinical trial registration number: KCT0001102.). Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Risk Factors of Post-Endoscopic Submucosal Dissection Electrocoagulation Syndrome for Colorectal Neoplasm.

PubMed

Ito, Sayo; Hotta, Kinichi; Imai, Kenichiro; Yamaguchi, Yuichiro; Kishida, Yoshihiro; Takizawa, Kohei; Kakushima, Naomi; Tanaka, Masaki; Kawata, Noboru; Yoshida, Masao; Ishiwatari, Hirotoshi; Matsubayashi, Hiroyuki; Ono, Hiroyuki

2018-06-04

Colorectal endoscopic submucosal dissection (ESD) is used for the treatment of large colorectal superficial neoplasms. However, there have been no large studies on electrocoagulation syndrome developing after colorectal ESD. The aim of this study was to clarify the incidence and clinical risk factors of post-ESD electrocoagulation syndrome (PECS). A total of 692 patients (median age, 70 years; 395 men) with 692 lesions, who underwent colorectal ESD at a tertiary cancer center between July 2010 and December 2015 were eligible. PECS was clinically diagnosed based on the presence of localized abdominal tenderness matching the ESD enforcement site, and fever (>37.5°C) or an inflammatory response (C-reactive protein level >0.5 mg/dL or leukocytosis >10000 cells/μL), without obvious findings of perforation, which developed at >6 h post-ESD. Outcomes of the procedure, the incidence of PECS, and risk factors associated with PECS were assessed. The incidence of PECS was 4.8% (33 patients), and all patients improved by conservative treatment. On multivariate analysis, the female sex (odds ratio [OR] 2.6; 95% confidence interval [95% CI], 1.2-5.7), tumor location at the cecum (OR 14.5; 95% CI: 3.7-53.7 vs rectum), and the presence of submucosal fibrosis (OR 2.8; 95% CI: 1.1-7.5) were found to be independent risk factors of PECS. This study identified the risk factors for PECS. Patients with high risk factors of PECS require careful management after colorectal ESD. This article is protected by copyright. All rights reserved.

Risk factors and management of positive horizontal margin in early gastric cancer resected by en bloc endoscopic submucosal dissection.

PubMed

Numata, Norifumi; Oka, Shiro; Tanaka, Shinji; Kagemoto, Kenichi; Sanomura, Yoji; Yoshida, Shigeto; Arihiro, Koji; Shimamoto, Fumio; Chayama, Kazuaki

2015-04-01

Although endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric cancer (EGC), there is no consensus regarding the management of positive horizontal margin (HM) despite en bloc ESD. The aim of the current study was to identify the risk factors and optimal management of positive HM in EGCs resected by en bloc ESD. A total of 890 consecutive patients with 1,053 intramucosal EGCs resected by en bloc ESD between April 2005 and June 2011. Clinicopathological data were retrieved retrospectively to assess the positive HM rate, local recurrence rate, risk factors for positive HM, and outcomes of treatment for local recurrent tumor. Positive HM was defined as a margin with direct tumor invasion (type A), the presence of cancerous cells on either end of 2-mm-thick cut sections (type B), or an unclear tumor margin resulting from crush or burn damage (type C). The positive HM rate was 2.0% (21/1,053). The local recurrence rate was 0.3% (3/1,053). All local recurrent tumors were intramucosal carcinomas, and were resected curatively by re-ESD. Multivariate analysis with logistic regression showed tumor location in the upper third of the stomach and lesions not matching the absolute indication to be independent risk factors for positive HM. The risk factors for HM positivity in cases of EGC resected by en bloc ESD are tumor location in the upper third of the stomach and dissatisfaction of the absolute indication for curative ESD.

Retrospective study: The diagnostic accuracy of conventional forceps biopsy of gastric epithelial compared to endoscopic submucosal dissection (STROBE compliant).

PubMed

Lu, Chao; Lv, Xueyou; Lin, Yiming; Li, Dejian; Chen, Lihua; Ji, Feng; Li, Youming; Yu, Chaohui

2016-07-01

Conventional forceps biopsy (CFB) is the most popular way to screen for gastric epithelial neoplasia (GEN) and adenocarcinoma of gastric epithelium. The aim of this study was to compare the diagnostic accuracy between conventional forceps biopsy and endoscopic submucosal dissection (ESD).Four hundred forty-four patients who finally undertook ESD in our hospital were enrolled from Jan 1, 2009 to Sep 1, 2015. We retrospectively assessed the characteristics of pathological results of CFB and ESD.The concordance rate between CFB and ESD specimens was 68.92% (306/444). Men showed a lower concordance rate (63.61% vs 79.33%; P = 0.001) and concordance patients were younger (P = 0.048). In multivariate analysis, men significantly had a lower concordance rate (coefficient -0.730, P = 0.002) and a higher rate of pathological upgrade (coefficient -0.648, P = 0.015). Locations of CFB did not influence the concordance rate statistically.The concordance rate was relatively high in our hospital. According to our analysis, old men plus gastric fundus or antrum of CFB were strongly suggested to perform ESD if precancerous lesions were found. And young women with low-grade intraepithelial neoplasia could select regular follow-up.

Risk factors of delayed ulcer healing after gastric endoscopic submucosal dissection.

PubMed

Lim, Joo Hyun; Kim, Sang Gyun; Choi, Jeongmin; Im, Jong Pil; Kim, Joo Sung; Jung, Hyun Chae

2015-12-01

Although post-endoscopic submucosal dissection (ESD) iatrogenic ulcer is known to heal faster than peptic ulcer, some iatrogenic ulcers show delayed healing. The aim of this study was to clarify risk factors of delayed ulcer healing after gastric ESD. We retrospectively reviewed medical records of all patients who had ESD for gastric neoplasms (866 adenomas and 814 early gastric cancers) between January 2005 and February 2011. Of 1680 subjects, 95 had delayed ulcer healing in 3-month follow-up. Multivariate analysis showed that diabetes (OR 1.743; 95% CI 1.017-2.989, p = 0.043), coagulation abnormality (OR 3.195; 95% CI 1.535-6.650, p = 0.002), specimen size greater than 4 cm (OR 2.999; 95% CI 1.603-5.611, p = 0.001), and electrocoagulation (OR 7.149; 95% CI 1.738-29.411, p = 0.006) were revealed to be independent risk factors of delayed ulcer healing. Meanwhile, persistent Helicobacter pylori infection was not related to the delayed ulcer healing. Large iatrogenic ulcer by ESD with massive hemostasis, especially in patients with diabetes mellitus or coagulation abnormalities, tends to take more than 3 months to heal. For such cases, initial dosage increment of PPI or addition of other anti-ulcer agents after ESD may be beneficial.

Endoscopic submucosal dissection using flexknife.

PubMed

Kodashima, Shinya; Fujishiro, Mitsuhiro; Yahagi, Naohisa; Kakushima, Naomi; Omata, Masao

2006-01-01

Although the standard treatment for early-stage gastrointestinal tumors is still surgical resection, endoscopic resection has been accepted for some of these lesions, especially in Japan. However, the indication was limited until recently to achieve en bloc resection and prevent local recurrence. To overcome the disadvantage of endoscopic resection with conventional endoscopic mucosal resection (EMR), several investigators, including us, have developed a new endoscopic resection technique: endoscopic submucosal dissection (ESD). ESD is a remarkable technique that enables to remove the lesions en bloc regardless of size, shape, coexisting ulcer, and location. Nowadays, several knives are available for ESD, such as the needle knife, insulation-tipped (IT) knife, Hookknife, triangle-tipped (TT) knife, and Flexknife. Each of them has some merits and demerits, and the ways to use the knives are different. We summarize here how to use the Flexknife, which we made ourselves in cooperation with the Olympus Company, and how we use the technique in our hospital.

High pressure jet injection of viscous solutions for endoscopic submucosal dissection (ESD): first clinical experience.

PubMed

Pioche, Mathieu; Lépilliez, Vincent; Déprez, Pierre; Giovannini, Marc; Caillol, Fabrice; Piessevaux, Hubert; Rivory, Jérôme; Guillaud, Olivier; Ciocîrlan, Mihai; Salmon, Damien; Lienhart, Isabelle; Lafon, Cyril; Saurin, Jean-Christophe; Ponchon, Thierry

2015-08-01

Long lasting elevation is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water jet injection of saline solution or by viscous macromolecular solutions. In a previous animal study, we assessed the Nestis Enki II system to combine jet injection and viscous solutions. In the present work, we used this combination in humans in different sites of the digestive tract. We retrospectively report all of the consecutive ESD procedures performed with jet injection of viscous solutions in four centers. Information was collected about the lesion, the procedure, the histological result, and the outcomes for the patient. In total, 45 resections were completed by six operators: five experts and one beginner with only one previous experience in human ESD. Lesions were located in the esophagus (10), the stomach (11), the duodenum (1), the colon (1) and the rectum (22). Average maximal lesion diameter was 4.8 cm (SD 2.4, range 2 - 11 cm), average lesion surface area was 19.8 cm(2) (SD 17.7, range 2.2 - 72 cm(2)), and average duration of procedure was 79.9 min (SD 50.3 min, range 19 - 225 min). ESD could be conducted while the endoscope was retroflexed at its maximum in 26 cases. Four adverse events were observed: two diminutive perforations and two delayed bleeding occurrences treated conservatively. The R0 resection rate was 91.1 %. The catheter was obstructed in six occurrences of bleeding. Endoscopic submucosal dissection using high pressure injection of viscous macromolecular solutions is safe and effective in different parts of the digestive tract. It does not impede working with the endoscope in the maximal retroflexed position.

Endoscopic submucosal dissection for early esophageal neoplasms using the stag beetle knife

PubMed Central

Kuwai, Toshio; Yamaguchi, Toshiki; Imagawa, Hiroki; Miura, Ryoichi; Sumida, Yuki; Takasago, Takeshi; Miyasako, Yuki; Nishimura, Tomoyuki; Iio, Sumio; Yamaguchi, Atsushi; Kouno, Hirotaka; Kohno, Hiroshi; Ishaq, Sauid

2018-01-01

AIM To determine short- and long-term outcomes of endoscopic submucosal dissection (ESD) using the stag beetle (SB) knife, a scissor-shaped device. METHODS Seventy consecutive patients with 96 early esophageal neoplasms, who underwent ESD using a SB knife at Kure Medical Center and Chugoku Cancer Center, Japan, between April 2010 and August 2016, were retrospectively evaluated. Clinicopathological characteristics of lesions and procedural adverse events were assessed. Therapeutic success was evaluated on the basis of en bloc, histologically complete, and curative or non-curative resection rates. Overall and tumor-specific survival, local or distant recurrence, and 3- and 5-year cumulative overall metachronous cancer rates were also assessed. RESULTS Eligible patients had dysplasia/intraepithelial neoplasia (22%) or early cancers (squamous cell carcinoma, 78%). The median procedural time was 60 min and on average, the lesions measured 24 mm in diameter, yielding 33-mm tissue defects. The en bloc resection rate was 100%, with 95% and 81% of dissections deemed histologically complete and curative, respectively. All procedures were completed without accidental incisions/perforations or delayed bleeding. During follow-up (mean, 35 ± 23 mo), no local recurrences or metastases were observed. The 3- and 5-year survival rates were 83% and 70%, respectively, with corresponding rates of 85% and 75% for curative resections and 74% and 49% for non-curative resections. The 3- and 5-year cumulative rates of metachronous cancer in the patients with curative resections were 14% and 26%, respectively. CONCLUSION ESD procedures using the SB knife are feasible, safe, and effective for treating early esophageal neoplasms, yielding favorable short- and long-term outcomes. PMID:29686470

Rebamipide solution: a novel submucosal injection material to promote healing speed and healing quality of ulcers induced by endoscopic submucosal dissection.

PubMed

Fujimoto, Ai; Uraoka, Toshio; Nishizawa, Toshihiro; Shimoda, Masayuki; Goto, Osamu; Ochiai, Yasutoshi; Maehata, Tadateru; Akimoto, Teppei; Mitsunaga, Yutaka; Sasaki, Motoki; Yamamoto, Hiroyuki; Yahagi, Naohisa

2018-04-01

Rebamipide is administered perorally to protect the gastric mucosa. We assessed the efficacy and safety of a novel rebamipide solution as a submucosal injection material for endoscopic submucosal dissection (ESD) using an in vivo porcine model. An endoscopist blinded to the test agents performed ESDs of hypothetical 30 mm lesions using a 2% rebamipide solution at 2 sites (rebamipide group) and a saline solution at 2 other sites (control group) in the stomachs of 8 pigs. The technical outcomes were compared between the 2 groups. The gastric ulcer stages were evaluated by endoscopy once weekly for 4 weeks after the ESD to determine the healing score (1-6). The pigs were killed at 1 week (n = 2), 2 weeks (n = 2), and 4 weeks (n = 4) after the ESD for pathologic evaluation of ESD-induced ulcers and scarring. There were no significant differences in any of the technical outcomes between the 2 groups, and no adverse events related to the ESD in any of the animals. The healing score was significantly higher in the rebamipide group than in the control group at 2 weeks (P = .027), 3 weeks (P = .034), and 4 weeks (P = .012). In the histopathologic assessment, fibrosis was significantly less extensive in the rebamipide group than in the control group at 2 weeks (P = .02) and 4 weeks (P = .04). The rebamipide solution appeared to promote both the speed and quality of healing of ESD-induced ulcers by suppressing fibrosis. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study.

PubMed

Hatta, Waku; Gotoda, Takuji; Oyama, Tsuneo; Kawata, Noboru; Takahashi, Akiko; Yoshifuku, Yoshikazu; Hoteya, Shu; Nakagawa, Masahiro; Hirano, Masaaki; Esaki, Mitsuru; Matsuda, Mitsuru; Ohnita, Ken; Yamanouchi, Kohei; Yoshida, Motoyuki; Dohi, Osamu; Takada, Jun; Tanaka, Keiko; Yamada, Shinya; Tsuji, Tsuyotoshi; Ito, Hirotaka; Hayashi, Yoshiaki; Nakamura, Tomohiro; Nakaya, Naoki; Shimosegawa, Tooru

2018-05-01

We have established a risk-scoring system, termed the "eCura system," for the risk stratification of lymph node metastasis in patients who have received noncurative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We aimed to clarify whether this system contributes to the selection of patients requiring radical surgery after ESD. Between 2000 and 2011, 1,969 patients with noncurative ESD for EGC were included in this multicenter study. Depending on the treatment strategy after ESD, we had patients with no additional treatment (n = 905) and those with radical surgery after ESD (n = 1,064). After the application of the eCura system to these patients, cancer recurrence and cancer-specific mortality in each risk category of the system were compared between the two patient groups. Multivariate Cox analysis revealed that in the high-risk category, cancer recurrence was significantly higher (hazard ratio = 3.13, p = 0.024) and cancer-specific mortality tended to be higher (hazard ratio = 2.66, p = 0.063) in patients with no additional treatment than in those with radical surgery after ESD, whereas no significant differences were observed in the intermediate-risk and low-risk categories. In addition, cancer-specific survival in the low-risk category was high in both patient groups (99.6 and 99.7%). A limitation of this study is that it included a small number of cases with undifferentiated-type EGC (292 cases). The eCura system is a useful aid for selecting the appropriate treatment strategy after noncurative ESD for EGC. However, caution is needed when applying this system to patients with undifferentiated-type EGC.

Radiofrequency Ablation Versus Endoscopic Submucosal Dissection in Treating Large Early Esophageal Squamous Cell Neoplasia

PubMed Central

Wang, Wen-Lun; Chang, I-Wei; Chen, Chien-Chuan; Chang, Chi-Yang; Mo, Lein-Ray; Lin, Jaw-Town; Wang, Hsiu-Po; Lee, Ching-Tai

2015-01-01

Abstract Radiofrequency ablation (RFA) and endoscopic submucosal dissection (ESD) can potentially be applied for early esophageal squamous cell neoplasia (ESCN); however, no study has directly compared these 2 modalities. We retrospectively enrolled the patients with flat-type “large” (length ≥3 cm extending ≥1/2 of the circumference of esophagus) early ESCNs treated endoscopically. The main outcome measurements were complete response at 12 months, and adverse events. Of a total of 65 patients, 18 were treated with RFA and 47 with ESD. The procedure time of RFA was significantly shorter than that of ESD (126.6 vs 34.8 min; P < 0.001). The complete resection rate of ESD and complete response rate after primary RFA were 89.3% and 77.8%, respectively. Based on the histological evaluation of the post-ESD specimens showed 14 of 47 (29.8%) had histological upstaging compared with the pre-ESD biopsies, and 4 of them had lymphovascular invasion requiring chemoradiation or surgery. After additional therapy for residual lesions, 46 (97.9%) patients in the ESD group and 17 (94.4%) patients in the RFA group achieved a complete response at 12 months. Four patients (8.5%) developed major procedure-related adverse events in the ESD group, but none in the RFA group. In patients with lesions occupying more than 3/4 of the circumference, a significantly higher risk of esophageal stenosis was noted in the ESD group compared with RFA group (83% vs 27%, P = 0.01), which required more sessions of dilatation to resolve the symptoms (median, 13 vs 3, P = 0.04). There were no procedure-related mortality or neoplastic progression in either group; however, 1 patient who received ESD and 1 who received RFA developed local recurrence during a median follow-up period of 32.4 (range, 13–68) and 18.0 (range, 13–41) months, respectively. RFA and ESD are equally effective in the short-term treatment of early flat large ESCNs; however, more adverse events occur with ESD, especially in lesions extending more than 3/4 of the circumference. RFA does not allow for pathology to evaluate the curability after ablation, and thus currently the use for invasive ESCNs should be conservative until longer follow-up studies are available. PMID:26656367

Step-up training for colorectal and gastric ESD and the challenge of ESD training in the proximal colon: results from a German Center.

PubMed

Ebigbo, Alanna; Probst, Andreas; Römmele, Christoph; Messmann, Helmut

2018-05-01

The endoscopic submucosal dissection (ESD) of cancerous and precancerous lesions in the gastrointestinal (GI) tract is an effective but difficult-to-learn procedure, especially for Western endoscopists. We developed a step-up training protocol and evaluated its outcome on a single endoscopist using specific performance measures. The training protocol included a 12-month period of 50 observational and supervised ESD cases as well as 24 animal procedures. After completion of the protocol, ESD competency was evaluated in the first 30 independent ESD cases. Majority of lesions were located in the stomach and rectum. Performance measures included R0-resection rate, complication rate and resection speed. R0 resection rate was 93 %, complication rate was 7 % and median resection speed was 6,77 cm 2 /h. 1 case of delayed perforation with subsequent hemicolectomy occurred in the descending colon. The ESD step-up training protocol used in this study on a single endoscopist showed excellent outcomes for lesions in the rectum and stomach. However, ESD training in the upper colon remains a challenge.

Current status of colonic endoscopic mucosal resection in the west and the interface with endoscopic submucosal dissection.

PubMed

Bourke, Michael

2009-07-01

Endoscopic Mucosal Resection (EMR) is now widely practised by western endoscopists to treat large sessile colonic polyps or laterally spreading tumours. Despite its widespread application, the technique of colonic EMR is not standardised. A lesion specific endoscopic treatment approach is also lacking. For lesions larger than 25mm, EMR is limited by its inability to achieve en-bloc resection. En-bloc resection has many theoretical advantages including more accurate histological assessment, reduced recurrence and potentially curative treatment for low risk submucosal invasive neoplasia particularly in patients with significant co-morbidity. Hence, Japanese endoscopists, having pioneered endoscopic submucosal dissection (ESD) in the upper gastrointestinal tract for the en-bloc resection of superficial neoplasia, now advocate the use of ESD for laterally spreading tumours of the colon greater than 25-30mm. This treatment strategy is not widely accepted or practised in the west and has its own inherent problems. The absence of suitable gastric lesions on which to develop ESD skills is also another significant barrier to the development of colonic ESD. It is also possible that modification and refinement in EMR technique may increase the size limit for colonic EMR.

Risk factors for under-diagnosis of gastric intraepithelial neoplasia and early gastric carcinoma in endoscopic forceps biopsy in comparison with endoscopic submucosal dissection in Chinese patients.

PubMed

Xu, Guifang; Zhang, Weijie; Lv, Ying; Zhang, Bin; Sun, Qi; Ling, Tingsheng; Zhang, Xiaoqi; Zhou, Zhihua; Wang, Lei; Huang, Qin; Zou, Xiaoping

2016-07-01

Differences in pathologic diagnosis between endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) for gastric intraepithelial neoplasia (GIN) and early gastric carcinoma (EGC) in Chinese patients remain unknown. The aim of the study was to investigate risk factors for under-diagnosed pathology in initial EFB, compared to final ESD. We reviewed endoscopic and histopathologic findings for tumor location, size, macroscopic pattern, nodularity, erythema, erosion, GIN (low and high grade), and EGC diagnosed with the WHO criteria. Differences in those features between EFB and ESD were compared and risk factors for under-diagnosis by EFB were analyzed. Although concordant in most (74.9 %) cases between EFBs and ESDs, pathological diagnoses in 57 (25.1 %) cases were upgraded in ESDs. Compared to the concordant group, the lesion size ≥2 cm, and depressed and excavated patterns were significantly more frequent in the upgraded group. Further multivariate regression analysis demonstrated the depressed pattern and lesion size ≥2 cm as independent risk factors for upgraded pathology with the odds ratio of 5.778 (95 % confidence interval 2.893-11.542) and 2.535 (95 % confidence interval 1.257-5.111), respectively. Lesion size ≥2.0 cm and the depressed pattern at initial EFB were independent risk factors for pathologic upgrade to advanced diseases in ESD. Therefore, these endoscopic characteristics should be considered together with the initial EFB diagnosis to guide the optimal clinical management of patients with GIN and EGC.

Endoscopic submucosal dissection for superficial esophageal neoplasms using the stag beetle knife.

PubMed

Fujinami, H; Hosokawa, A; Ogawa, K; Nishikawa, J; Kajiura, S; Ando, T; Ueda, A; Yoshita, H; Sugiyama, T

2014-01-01

Endoscopic submucosal dissection (ESD) is an accepted standard treatment for early gastric cancer but is not widely used in the esophagus because of technical difficulties. To increase the safety of esophageal ESD, we used a scissors-type device called the stag beetle (SB) knife. The aim of this study was to determine the efficacy and safety of ESD using the SB knife. We performed a single-center retrospective, uncontrolled trial. A total of 38 lesions were excised by ESD from 35 consecutive patients who were retrospectively divided into the following two groups according to the type of knife used to perform ESD: the hook knife (hook group) was used in 20 patients (21 lesions), and the SB knife (SB group) was used in 15 patients (17 lesions). We evaluated and compared the operative time, lesion size, en bloc resection rate, pathological margins free rate, and complication rate in both groups. The operative time was shorter in the SB group (median 70.0 minutes [interquartile range, 47.5-87.0]) than in the hook group (92.0 minutes [interquartile range, 63.0-114.0]) (P = 0.019), and the rate of complications in the SB group was 0% compared with 45.0% in the hook group (P = 0.004). However, the lesion size, en bloc resection rate, and pathological margins free rate did not differ significantly between the two groups. In conclusion, ESD using the SB knife was safer than that using a conventional knife for superficial esophageal neoplasms. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Delayed bleeding and hemorrhage of mucosal defects after gastric endoscopic submucosal dissection on second-look endoscopy.

PubMed

Ono, Shoko; Ono, Masayoshi; Nakagawa, Manabu; Shimizu, Yuichi; Kato, Mototsugu; Sakamoto, Naoya

2016-04-01

Although second-look endoscopy is performed within several days after gastric endoscopic submucosal dissection (ESD), there has been no evidence supporting the usefulness of the intervention. We investigated the relationship between delayed bleeding and hemorrhage of mucosal defects after ESD on second-look endoscopy and analyzed risk factors of active bleeding on second-look endoscopy. A total of 441 consecutive ESD cases with gastric cancer or adenoma were retrospectively analyzed. Second-look endoscopy was performed in the morning after the day of ESD. Bleeding of mucosal defects on second-look endoscopy was classified according to the Forrest classification, and active bleeding was defined as Forrest Ia or Ib. Delayed bleeding was defined as hematemesis or melena after second-look endoscopy. A total of 406 second-look endoscopies were performed, and delayed bleeding occurred in 11 patients. The incidence rate of delayed bleeding after second-look endoscopy in patients with Forrest Ia or Ib was significantly higher than that in patients with Forrest IIa, IIb or III (7.69 vs. 2.02 %, p < 0.05). Complication of a histological ulcer, large size of the resected specimen and long ESD procedure time were shown to be risk factors for hemorrhage of mucosal defects after ESD on second-look endoscopy by univariate analysis. Multivariate analysis indicated that only large size of the resected specimen was a risk factor. In a specimen size of >35 mm, the odds ratio of active bleeding on second-look endoscopy was 1.9. Active bleeding of mucosal defects on second-look endoscopy is a risk factor for delayed bleeding.

Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer.

PubMed

Kishida, Yoshihiro; Kakushima, Naomi; Kawata, Noboru; Tanaka, Masaki; Takizawa, Kohei; Imai, Kenichiro; Hotta, Kinichi; Matsubayashi, Hiroyuki; Ono, Hiroyuki

2015-10-01

Endoscopic dilation (ED) is used for the treatment of benign strictures caused by reflux esophagitis or anastomotic stenosis after esophagectomy. Esophageal stenosis is a major complication after endoscopic submucosal dissection (ESD) of large superficial esophageal cancer, but little is known regarding the incidence of complications of ED for stenosis caused by esophageal ESD. This was a retrospective study conducted at a single institution. From September 2002 to December 2012, a total of 1,337 ED procedures were performed for stenosis after esophageal ESD in 121 patients. The incidence of complications of ED and related clinical characteristics were analyzed. The incidence of bleeding was 0.8 % (1/121) per patient and 0.07 % (1/1,337) per procedure. The incidence of perforation was 4.1 % (5/121) per patient and 0.37 % (5/1,337) per procedure. Perforation occurred at a median of third time of ED procedures (range 2-9 procedures) and at a median of 18 days (range 8-29 days) after ESD. There were no significant characteristics correlated to perforation, such as location, circumferential extent, or diameter of mucosal defect after ESD. The total number of ED procedures was significantly larger among perforation cases (37, range 6-57) compared with those without perforation (7, range 1-70) (p = 0.01), and the treatment duration tended to be longer (190 vs. 69 days, respectively). The incidence of bleeding caused by ED for esophageal stenosis after ESD was very low. Relevant risk of perforation should be considered for patients requiring multiple ED procedures.

Does immunohistochemical staining have a clinical impact in early gastric cancer conducted endoscopic submucosal dissection?

PubMed Central

Jeon, Seong Ran; Cho, Joo Young; Bok, Gene Hyun; Lee, Tae Hee; Kim, Hyun Gun; Cho, Won Young; Jin, So Young; Kim, Yeon Soo

2012-01-01

AIM: To evaluate clinicopathologic parameters and the clinical significance related lymphovascular invasion (LVI) by immunohistochemical staining (IHCS) in endoscopic submucosal dissection (ESD). METHODS: Between May 2005 and May 2010, a total of 348 lesions from 321 patients (mean age 63 ± 10 years, men 74.6%) with early gastric cancer (EGC) who met indication criteria after ESD were analyzed retrospectively. The 348 lesions were divided into the absolute (n = 100, differentiated mucosal cancer without ulcer ≤ 20 mm) and expanded (n = 248) indication groups after ESD. The 248 lesions were divided into four subgroups according to the expanded ESD indication. The presence of LVI was determined by factor VIII-related antigen and D2-40 assessment. We compared LVI IHCS-negative group with LVI IHCS-positive in each group. RESULTS: LVI by hematoxylin-eosin staining (HES) and IHCS were all negative in the absolute group, while was observed in only the expanded groups. The positive rate of LVI by IHCS was higher than that of LVI by HES (n = 1, 0.4% vs n = 11, 4.4%, P = 0.044). LVI IHCS-positivity was observed when the cancer invaded to the mucosa 3 (M3) or submucosa 1 (SM1) levels, with a predominance of 63.6% in the subgroup that included only SM1 cancer (P < 0.01). In a univariate analysis, M3 or SM1 invasion by the tumor was significantly associated with a higher rate of LVI by IHCS, but no factor was significant in a multivariate analysis. There were no cases of tumor recurrence or metastasis during the median 26 mo follow-up. CONCLUSION: EGCs of the absolute group are immunohistochemically stable. The presence of LVI may be carefully examined by IHCS in an ESD expanded indication group with an invasion depth of M3 or greater. PMID:22969232

Endoscopic submucosal dissection for early Barrett’s neoplasia

PubMed Central

Barret, Maximilien; Cao, Dalhia Thao; Beuvon, Frédéric; Leblanc, Sarah; Terris, Benoit; Camus, Marine; Coriat, Romain; Chaussade, Stanislas

2015-01-01

Introduction The possible benefit of endoscopic submucosal dissection (ESD) for early neoplasia arising in Barrett’s esophagus remains controversial. We aimed to assess the efficacy and safety of ESD for the treatment of early Barrett’s neoplasia. Methods All consecutive patients undergoing ESD for the resection of a visible lesion in a Barrett’s esophagus, either suspicious of submucosal infiltration or exceeding 10 mm in size, between February 2012 and January 2015 were prospectively included. The primary endpoint was the rate of curative resection of carcinoma, defined as histologically complete resection of adenocarcinomas without poor histoprognostic factors. Results Thirty-five patients (36 lesions) with a mean age of 66.2 ± 12 years, a mean ASA score of 2.1 ± 0.7, and a mean C4M6 Barrett’s segment were included. The mean procedure time was 191 ± 79 mn, and the mean size of the resected specimen was 51.3 ± 23 mm. En bloc resection rate was 89%. Lesions were 12 ± 15 mm in size, and 81% (29/36) were invasive adenocarcinomas, six of which with submucosal invasion. Although R0 resection of carcinoma was 72.4%, the curative resection rate was 66% (19/29). After a mean follow-up of 12.9 ± 9 months, 16 (45.7%) patients had required additional treatment, among whom nine underwent surgical resection, and seven further endoscopic treatments. Metachronous lesions or recurrence of cancer developed during the follow-up period in 17.2% of the patients. The overall complication rate was 16.7%, including 8.3% perforations, all conservatively managed, and no bleeding. The 30-day mortality was 0%. Conclusion In this early experience, ESD yielded a moderate curative resection rate in Barrett’s neoplasia. At present, improvements are needed if ESD is to replace piecemeal endoscopic mucosal resection in the management of Barrett’s neoplasia. PMID:27087948

Amniotic Membrane Grafts for the Prevention of Esophageal Stricture after Circumferential Endoscopic Submucosal Dissection

PubMed Central

Barret, Maximilien; Pratico, Carlos Alberto; Camus, Marine; Beuvon, Frédéric; Jarraya, Mohamed; Nicco, Carole; Mangialavori, Luigi; Chaussade, Stanislas; Batteux, Frédéric; Prat, Frédéric

2014-01-01

Background and Aims The prevention of esophageal strictures following circumferential mucosal resection remains a major clinical challenge. Human amniotic membrane (AM) is an easily available material, which is widely used in ophthalmology due to its wound healing, anti-inflammatory and anti-fibrotic properties. We studied the effect of AM grafts in the prevention of esophageal stricture after endoscopic submucosal dissection (ESD) in a swine model. Animals and Methods In this prospective, randomized controlled trial, 20 swine underwent a 5 cm-long circumferential ESD of the lower esophagus. In the AM Group (n = 10), amniotic membrane grafts were placed on esophageal stents; a subgroup of 5 swine (AM 1 group) was sacrificed on day 14, whereas the other 5 animals (AM 2 group) were kept alive. The esophageal stent (ES) group (n = 5) had ES placement alone after ESD. Another 5 animals served as a control group with only ESD. Results The prevalence of symptomatic strictures at day 14 was significantly reduced in the AM group and ES groups vs. the control group (33%, 40% and 100%, respectively, p = 0.03); mean esophageal diameter was 5.8±3.6 mm, 6.8±3.3 mm, and 2.6±1.7 mm for AM, ES, and control groups, respectively. Median (range) esophageal fibrosis thickness was 0.87 mm (0.78–1.72), 1.19 mm (0.28–1.95), and 1.65 mm (0.7–1.79) for AM 1, ES, and control groups, respectively. All animals had developed esophageal strictures by day 35. Conclusions The anti-fibrotic effect of AM on esophageal wound healing after ESD delayed the development of esophageal stricture in our model. However, this benefit was of limited duration in the conditions of our study. PMID:24992335

Limited Effect of Rebamipide in Addition to Proton Pump Inhibitor (PPI) in the Treatment of Post-Endoscopic Submucosal Dissection Gastric Ulcers: A Randomized Controlled Trial Comparing PPI Plus Rebamipide Combination Therapy with PPI Monotherapy

PubMed Central

Nakamura, Kazuhiko; Ihara, Eikichi; Akiho, Hirotada; Akahoshi, Kazuya; Harada, Naohiko; Ochiai, Toshiaki; Nakamura, Norimoto; Ogino, Haruei; Iwasa, Tsutomu; Aso, Akira; Iboshi, Yoichiro; Takayanagi, Ryoichi

2016-01-01

Background/Aims The ability of endoscopic submucosal dissection (ESD) to resect large early gastric cancers (EGCs) results in the need to treat large artificial gastric ulcers. This study assessed whether the combination therapy of rebamipide plus a proton pump inhibitor (PPI) offered benefits over PPI monotherapy. Methods In this prospective, randomized, multicenter, open-label, and comparative study, patients who had undergone ESD for EGC or gastric adenoma were randomized into groups receiving either rabeprazole monotherapy (10 mg/day, n=64) or a combination of rabeprazole plus rebamipide (300 mg/day, n=66). The Scar stage (S stage) ratio after treatment was compared, and factors independently associated with ulcer healing were identified by using multivariate analyses. Results The S stage rates at 4 and 8 weeks were similar in the two groups, even in the subgroups of patients with large amounts of tissue resected and regardless of CYP2C19 genotype. Independent factors for ulcer healing were circumferential location of the tumor and resected tissue size; the type of treatment did not affect ulcer healing. Conclusions Combination therapy with rebamipide and PPI had limited benefits compared with PPI monotherapy in the treatment of post-ESD gastric ulcer (UMIN Clinical Trials Registry, UMIN000007435). PMID:27282261

Antigravity ESD - double-balloon-assisted underwater with traction hybrid technique.

PubMed

Sharma, Sam K; Hiratsuka, Takahiro; Hara, Hisashi; Milsom, Jeffrey W

2018-06-01

 Complex colorectal polyps or those positioned in difficult anatomic locations are an endoscopic therapeutic challenge. Underwater endoscopic submucosal dissection (UESD) is a potential technical solution to facilitate efficient polyp removal. In addition, endoscopic tissue retraction has been confined to limited methods of varying efficacy and complexity. The aim of this study was to evaluate the efficiency of a unique UESD technique for removing complex polyps using double-balloon-assisted retraction (R).  Using fresh ex-vivo porcine rectum, 4-cm polyps were created using electrosurgery and positioned at "6 o'clock" within an established ESD model. Six resections were performed in each group. Underwater techniques were facilitated using a novel double-balloon platform (Dilumen, Lumendi, Westport, Connecticut, United States).  UESD-R had a significantly shorter total procedural time than cap-assisted ESD and UESD alone (24 vs. 58 vs. 56 mins). UESD-R produced a dissection time on average of 5 minutes, attributed to the retraction provided. There was also a subjective significant reduction in electrosurgical smoke with the underwater techniques contributing to improved visualization.  Here we report the first ex-vivo experience of a unique double-balloon endoscopic platform optimized for UESD with tissue traction capability. UESD-R removed complex lesions in significantly shorter time than conventional means. The combined benefits of UESD and retraction appeared to be additive when tackling complex polyps and should be studied further.

Fabricated autologous epidermal cell sheets for the prevention of esophageal stricture after circumferential ESD in a porcine model.

PubMed

Kanai, Nobuo; Yamato, Masayuki; Ohki, Takeshi; Yamamoto, Masakazu; Okano, Teruo

2012-10-01

Endoscopic submucosal dissection (ESD) is an accepted treatment for early esophageal carcinoma. However, resection of a large mucosal area, as with circumferential ESD, induces severe stricture formation. To evaluate the efficacy of cultured autologous epidermal cell sheets to prevent severe esophageal constriction after circumferential ESD. Animal study. University institute. Eight pigs underwent circumferential esophageal ESD while under general anesthesia. In 4 pigs, fabricated autologous epidermal cell sheets were endoscopically transplanted to the central ESD sites immediately after the ESD. The other 4 pigs underwent circumferential ESD only. Necropsy and histological assessment were performed at 1 and 2 weeks post-ESD. Weight gain, degree of mucosal constriction, and histological assessments. All pigs in the control group showed severe esophageal constriction after 2 weeks. The control and transplanted groups had weight gains of -10.3% and 0.3% (P = .03), respectively, and the mean degrees of constriction were 88% and 56% (P < .01), respectively. Early re-epithelialization and mild fibrosis in the muscularis were observed in the transplanted group. Animal study, small sample size. Fabricated autologous skin epidermal cell sheets would be useful in preventing severe esophageal constriction after circumferential ESD. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in remnant stomach or gastric tube.

PubMed

Nishide, N; Ono, H; Kakushima, N; Takizawa, K; Tanaka, M; Matsubayashi, H; Yamaguchi, Y

2012-06-01

Little information exists regarding the optimal treatment of early gastric cancer (EGC) in a remnant stomach or gastric tube. The aim of this study was to assess the feasibility and clinical outcomes of endoscopic submucosal dissection (ESD) for EGC in a remnant stomach and gastric tube. Between September 2002 and December 2009, ESD was performed in 62 lesions in 59 patients with EGC in a remnant stomach (48 lesions) or gastric tube (14 lesions). Clinicopathological data were retrieved retrospectively to assess the en bloc resection rate, complications, and outcomes. Treatment results were assessed according to the indications for endoscopic resection, and were compared with those of ESD performed in a whole stomach during the same study period. The en bloc resection rates for lesions within the standard and expanded indication were 100 % and 93 %, respectively. Postoperative bleeding occurred in five patients (8 %). The perforation rate was significantly higher (18 %, 11 /62) than that of ESD in a whole stomach (5 %, 69 /1479). Among the perforation cases, eight lesions involved the anastomotic site or stump line, and ulcerative changes were observed in five lesions. The 3-year overall survival rate was 85 %, with eight deaths due to other causes and no deaths from gastric cancer. A high en bloc resection rate was achieved by ESD for EGC in a remnant stomach or gastric tube; however, this procedure is still technically demanding due to the high complication rate of perforation. © Georg Thieme Verlag KG Stuttgart · New York.

Efficacy of treatment with rebamipide for endoscopic submucosal dissection-induced ulcers.

PubMed

Takayama, Masaki; Matsui, Shigenaga; Kawasaki, Masanori; Asakuma, Yutaka; Sakurai, Toshiharu; Kashida, Hiroshi; Kudo, Masatoshi

2013-09-14

To prospectively compare the healing rates of endoscopic submucosal dissection (ESD)-induced ulcers treated with either a proton-pump inhibitor (PPI) or rebamipide. We examined 90 patients with early gastric cancer who had undergone ESD. All patients were administered an intravenous infusion of the PPI lansoprazole (20 mg) every 12 h for 2 d, followed by oral administration of lansoprazole (30 mg/d, 5 d). After 7-d treatment, the patients were randomly assigned to 2 groups and received either lansoprazole (30 mg/d orally, n = 45; PPI group) or rebamipide (300 mg orally, three times a day; n = 45; rebamipide group). At 4 and 8 wk after ESD, the ulcer outcomes in the 2 groups were compared. No significant differences were noted in patient age, underlying disease, tumor location, Helicobacter pylori infection rate, or ESD-induced ulcer size between the 2 groups. At both 4 and 8 wk, the healing rates of ESD-induced ulcers were similar in the PPI-treated and the rebamipide-treated patients (4 wk: PPI, 27.2%; rebamipide, 33.3%; P = 0.5341; 8 wk: PPI, 90.9%; rebamipide, 93.3%; P = 0.6710). At 8 wk, the rates of granulation lesions following ulcer healing were significantly higher in the PPI-treated group (13.6%) than in the rebamipide-treated group (0.0%; P = 0.0103). Ulcer-related symptoms were similar in the 2 treatment groups at 8 wk. The medication cost of 8-wk treatment with the PPI was 10945 yen vs 4889 yen for rebamipide. No ulcer bleeding or complications due to the drugs were observed in either treatment group. The healing rate of ESD-induced ulcers was similar with rebamipide or PPI treatment; however, rebamipide treatment is more cost-effective and prevents granulation lesions following ulcer healing.

The expansion of endoscopic submucosal dissection in France: A prospective nationwide survey.

PubMed

Barret, Maximilien; Lepilliez, Vincent; Coumaros, Dimitri; Chaussade, Stanislas; Leblanc, Sarah; Ponchon, Thierry; Fumex, Fabien; Chabrun, Edouard; Bauret, Paul; Cellier, Christophe; Coron, Emmanuel; Bichard, Philippe; Bulois, Philippe; Charachon, Antoine; Rahmi, Gabriel; Bellon, Serge; Lerhun, Marc; Arpurt, Jean-Pierre; Koch, Stéphane; Napoleon, Bertrand; Vaillant, Eric; Esch, Anouk; Farhat, Said; Robin, Francoise; Kaddour, Nadira; Prat, Frédéric

2017-02-01

Early reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time. All consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow-up data were recorded. The results obtained over three years were compared to previously published data covering the 2008-2010 period. Between November 2010 and June 2013, 319 ESD cases performed in 314 patients (62% male, mean (±SD) age 65.4 ± 12) were analyzed and compared to 188 ESD cases in 188 patients (61% male, mean (±SD) age 64.6 ± 13) performed between January 2008 and October 2010. The mean (±SD) lesion size was 39 ± 12 mm in 2010-2013 vs 32.1 ± 21 for 2008-2010 ( p  = 0.004). En bloc resection improved from 77.1% to 91.7% ( p  < 0.0001) while R0 en bloc resection remained stable from 72.9% to 71.9% ( p  = 0.8) over time. Complication rate dropped from 29.2% between 2008 and 2010 to 14.1% between 2010 and 2013 ( p  < 0.0001), with bleeding decreasing from 11.2% to 4.7% ( p  = 0.01) and perforations from 18.1% to 8.1% ( p  = 0.002) over time. No procedure-related mortality was recorded. In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates.

A novel fully synthetic and self-assembled peptide solution for endoscopic submucosal dissection-induced ulcer in the stomach.

PubMed

Uraoka, Toshio; Ochiai, Yasutoshi; Fujimoto, Ai; Goto, Osamu; Kawahara, Yoshiro; Kobayashi, Naoya; Kanai, Takanori; Matsuda, Sachiko; Kitagawa, Yuko; Yahagi, Naohisa

2016-06-01

Endoscopic submucosal dissection (ESD) can remove early stage GI tumors of various sizes en bloc; however, success requires reducing the relatively high postprocedure bleeding rate. The aim of this study was to assess the safety and efficacy of a novel, fully synthetic, and self-assembled peptide solution that functions as an extracellular matrix scaffold material to facilitate reconstruction of normal tissues in ESD-induced ulcers. Consecutive patients who underwent gastric ESD were prospectively enrolled. Immediately after the resection, the solution was applied to the site with a catheter. Gastric ulcers were evaluated by endoscopy and classified as active, healing, or scarring stages at weeks 1, 4, and 8 after ESD. Forty-seven patients with 53 lesions, including 14 (29.8%) previously on antithrombotic therapy and 2 (4.3%) requiring heparin bridge therapy, were analyzed; 2 patients were excluded, 1 with perforations and 1 with persistent coagulopathy. The mean size of the en bloc resected specimens was 36.5 ± 11.3 mm. The rate of post-ESD bleeding was 2.0% (1/51; 95% CI, 0.03-10.3). Transitional rate to the healing stage of ESD-induced ulcers at week 1 was 96% (49/51). Subsequent endoscopies demonstrated the scarring stage in 19% (9/48) and 98% (41/42) at weeks 4 and 8, respectively. No adverse effects related to this solution occurred. The use of this novel peptide solution may potentially aid in reducing the delayed bleeding rate by promoting mucosal regeneration and speed of ulcer healing after large endoscopic resections in the stomach. Further studies, particularly randomized controlled studies, are needed to fully evaluate its efficacy. ( 000011548.). Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Scissor-type knife significantly improves self-completion rate of colorectal endoscopic submucosal dissection: Single-center prospective randomized trial.

PubMed

Yamashina, Takeshi; Takeuchi, Yoji; Nagai, Kengo; Matsuura, Noriko; Ito, Takashi; Fujii, Mototsugu; Hanaoka, Noboru; Higashino, Koji; Uedo, Noriya; Ishihara, Ryu; Iishi, Hiroyasu

2017-05-01

Colorectal endoscopic submucosal dissection (C-ESD) is recognized as a difficult procedure. Recently, scissors-type knives were launched to reduce the difficulty of C-ESD. The aim of this study was to evaluate the efficacy and safety of the combined use of a scissors-type knife and a needle-type knife with a water-jet function (WJ needle-knife) for C-ESD compared with using the WJ needle-knife alone. This was a prospective randomized controlled trial in a referral center. Eighty-five patients with superficial colorectal neoplasms were enrolled and randomly assigned to undergo C-ESD using a WJ needle-knife alone (Flush group) or a scissor-type knife-supported WJ needle-knife (SB Jr group). Procedures were conducted by two supervised residents. Primary endpoint was self-completion rate by the residents. Self-completion rate was 67% in the SB Jr group, which was significantly higher than that in the Flush group (39%, P = 0.01). Even after exclusion of four patients in the SB Jr group in whom C-ESD was completed using the WJ needle-knife alone, the self-completion rate was significantly higher (63% vs 39%; P = 0.03). Median procedure time among the self-completion cases did not differ significantly between the two groups (59 vs 51 min; P = 0.14). No fatal adverse events were observed in either group. In this single-center phase II trial, scissor-type knife significantly improved residents' self-completion rate for C-ESD, with no increase in procedure time or adverse events. A multicenter trial would be warranted to confirm the validity of the present study. © 2016 Japan Gastroenterological Endoscopy Society.

Optimal duration of fasting period after endoscopic submucosal dissection for gastric epithelial neoplasia: A prospective evaluation.

PubMed

Oh, Kwang Hoon; Lee, Sang Jin; Park, Jong Kyu

2017-08-01

There are currently no standardized guidelines for adequately determining the fasting period following gastric endoscopic submucosal dissection (ESD). The aim of this study was to determine the appropriate fasting period. The enrolled patients were randomized into a short and a long-fasting group. In the short-fasting group, patients had fasted until the day after the ESD. In the long-fasting group, patients had fasted until 2 days after the ESD. A second-look endoscopy was performed immediately prior to starting to eat meals. The primary end-point was the measurement of discomfort-related ESD after starting meals such as epigastric pain, heartburn, regurgitation, nausea and vomiting. Secondary end-points included the bleeding rate after starting meals, hospital stay, patient satisfaction and hemostasis upon second-look endoscopy. We analyzed data from 101 of 110 randomized patients. Both groups demonstrated similar baseline characteristics. There were no significant differences in reports of epigastric pain, heartburn, regurgitation, nausea and vomiting after starting meals. Both groups demonstrated similar hemostasis rates upon second-look endoscopy (26% vs 31.4%, P = 0.551) and bleeding rate (4% vs 0%, P = 0.149). The duration of hospital stay was significantly shorter in the short-fasting group (4.3 days vs 5.1 days, P < 0.001), and patient satisfaction was greater (P = 0.003) than in the long-fasting group. A short fasting protocol does not cause discomfort related to ESD or influence post-ESD bleeding. Moreover, the short fasting protocol results in shorter hospital stays and greater patient satisfaction. © 2017 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm.

PubMed

Yamashina, Takeshi; Takeuchi, Yoji; Uedo, Noriya; Hamada, Kenta; Aoi, Kenji; Yamasaki, Yasushi; Matsuura, Noriko; Kanesaka, Takashi; Akasaka, Tomofumi; Yamamoto, Sachiko; Hanaoka, Noboru; Higashino, Koji; Ishihara, Ryu; Iishi, Hiroyasu

2016-03-01

Endoscopic submucosal dissection (ESD) is a promising treatment for large gastrointestinal superficial neoplasms, although it is technically difficult, and perforation and delayed bleeding are well-known adverse events. However, there have been no large studies about electrocoagulation syndrome after colorectal ESD. The aim of this study was to evaluate the incidence and clinical significant risk factors of post-ESD coagulation syndrome (PECS). This was a retrospective cohort study conducted in a referral cancer center. A total of 336 patients with colorectal neoplasms (143 adenomas or serrated lesions and 193 carcinomas) underwent ESD from January 2011 to June 2013. Incidence, outcome, and factors associated with occurrence of PECS were investigated. Occurred in 32 patients (9.5%). The median time until PECS was 15.5 h, and the median period of PECS was 32.5 h. Fever (≥37.6 °C) after ESD was found in 41% of the PECS group and 9% of the non-PECS group (P < 0.001). All PECS cases were managed conservatively. On multivariate analysis, female patients (odds ratio [OR] = 3.2, P = 0.002), lesion location at ascending colon and cecum (OR = 3.5, P = 0.001), and resected specimen ≥40 mm (OR = 2.1, P = 0.05) were independent risk factors for PECS. Occurred in 32 patients (9.5%) with colorectal ESD; however, all cases had a good outcome with conservative management. Female sex, tumor location at the ascending colon and cecum, and resected specimen ≥40 mm were independently significant risk factors for PECS. © 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

CO2 insufflation versus air insufflation for endoscopic submucosal dissection: A meta-analysis of randomized controlled trials.

PubMed

Li, Xuan; Dong, Hao; Zhang, Yifeng; Zhang, Guoxin

2017-01-01

Carbon dioxide (CO2) insufflation is increasingly used for endoscopic submucosal dissection (ESD) owing to the faster absorption of CO2 as compared to that of air. Studies comparing CO2 insufflation and air insufflation have reported conflicting results. This meta-analysis is aimed to assess the efficacy and safety of use of CO2 insufflation for ESD. Clinical trials of CO2 insufflation versus air insufflation for ESD were searched in PubMed, Embase, the Cochrane Library and Chinese Biomedical Literature Database. We performed a meta-analysis of all randomized controlled trials (RCTs). Eleven studies which compared the use of CO2 insufflation and air insufflation, with a combined study population of 1026 patients, were included in the meta-analysis (n = 506 for CO2 insufflation; n = 522 for air insufflation). Abdominal pain and VAS scores at 6h and 24h post-procedure in the CO2 insufflation group were significantly lower than those in the air insufflation group, but not at 1h and 3h after ESD. The percentage of patients who experienced pain 1h and 24h post-procedure was obviously decreased. Use of CO2 insufflation was associated with lower VAS scores for abdominal distention at 1h after ESD, but not at 24h after ESD. However, no significant differences were observed with respect to postoperative transcutaneous partial pressure carbon dioxide (PtcCO2), arterial blood carbon dioxide partial pressure (PaCO2), oxygen saturation (SpO2%), abdominal circumference, hospital stay, white blood cell (WBC) counts, C-Reactive protein (CRP) level, dosage of sedatives used, incidence of dysphagia and other complications. Use of CO2 insufflation for ESD was safe and effective with regard to abdominal discomfort, procedure time, and the residual gas volume. However, there appeared no significant differences with respect to other parameters namely, PtcCO2, PaCO2, SpO2%, abdominal circumference, hospital stay, sedation dosage, complications, WBC, CRP, and dysphagia.

Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis.

PubMed

Facciorusso, Antonio; Antonino, Matteo; Di Maso, Marianna; Muscatiello, Nicola

2014-11-16

To compare endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early gastric cancer (EGC). Computerized bibliographic search was performed on PubMed/Medline, Embase, Google Scholar and Cochrane library databases. Quality of each included study was assessed according to current Cochrane guidelines. Primary endpoints were en bloc resection rate and histologically complete resection rate. Secondary endpoints were length of procedure, post-treatment bleeding, post-procedural perforation and recurrence rate. Comparisons between the two treatment groups across all the included studies were performed by using Mantel-Haenszel test for fixed-effects models (in case of low heterogeneity) or DerSimonian and Laird test for random-effects models (in case of high heterogeneity). Ten retrospective studies (8 full text and 2 abstracts) were included in the meta-analysis. Overall data on 4328 lesions, 1916 in the ESD and 2412 in the EMR group were pooled and analyzed. The mean operation time was longer for ESD than for EMR (standardized mean difference 1.73, 95%CI: 0.52-2.95, P = 0.005) and the "en bloc" and histological complete resection rates were significantly higher in the ESD group [OR = 9.69 (95%CI: 7.74-12.13), P < 0.001 and OR = 5.66, (95%CI: 2.92-10.96), P < 0.001, respectively]. As a consequence of its greater radicality, ESD provided lower recurrence rate [OR = 0.09, (95%CI: 0.05-0.17), P < 0.001]. Among complications, perforation rate was significantly higher after ESD [OR = 4.67, (95%CI, 2.77-7.87), P < 0.001] whereas the bleeding incidences did not differ between the two techniques [OR = 1.49 (0.6-3.71), P = 0.39]. In the endoscopic therapy of EGC, ESD showed a superior efficacy but higher complication rate with respect to EMR.

Usefulness of underwater endoscopic submucosal dissection in saline solution with a monopolar knife for colorectal tumors (with videos).

PubMed

Nagata, Mitsuru

2018-05-01

Generally, colorectal endoscopic submucosal dissection (ESD) is performed with a monopolar knife with CO 2 supply from an endoscope. There are few case reports about underwater ESD (UESD) in saline solution with a bipolar knife. The usefulness and safety of UESD in saline solution with a monopolar knife are unclear. The present study aimed to investigate the usefulness and safety of UESD in saline solution with a monopolar knife for colorectal tumors. This retrospective, observational study on UESD for colorectal tumors included 26 colorectal tumors from 24 patients treated with UESD at our department between October 2015 and February 2017. The characteristics of patients, factors associated with ESD difficulty, treatment results, and variations in blood test data before and after UESD were analyzed. En bloc resection was successful in all lesions without any serious adverse events. The median major diameter of the resected specimens was 30 mm (interquartile range [IQR], 28-35) and of the tumor 22.5 mm (IQR, 17.8-25.3). The median procedure time was 60 minutes (IQR, 45-111) and median speed of dissection 10.4 mm 2 /min (IQR, 6.4-12.2). No cases of perforation occurred. Post-ESD bleeding occurred in only 1 case, and endoscopic hemostasis was achieved. There was no case of electrolyte imbalance requiring treatment after UESD. UESD in saline solution with a monopolar knife for colorectal tumors is useful and safe. UESD has potential advantages that should be further assessed. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Bio-sheet graft therapy for artificial gastric ulcer after endoscopic submucosal dissection: an animal feasibility study.

PubMed

Kwon, Chang-Il; Kim, Gwangil; Ko, Kwang Hyun; Jung, Yunho; Chung, Il-Kwun; Jeong, Seok; Lee, Don Haeng; Hong, Sung Pyo; Hahm, Ki Baik

2015-04-01

Various bio-sheet grafts have been attempted either to accelerate healing of artificial ulcers or to prevent adverse events after endoscopic submucosal dissection (ESD), but neither prospective nor mechanistic studies were available. To evaluate the substantial effect of a bio-sheet graft on artificial ulcer healing and its feasibility as an endoscopic treatment modality. Preclinical, in vivo animal experiment and proof-of-concept study. Animal laboratory. Three mini-pigs, Sus scrofa, mean age 14 months. Multiple ulcers sized 2.5 cm in diameter were generated by ESD in 3 mini-pigs and were assigned randomly into the following 3 groups; control group, bio-sheet group, or combination (bio-sheet plus drug) group. Bio-sheet grafts or bio-sheet plus drug combinations were applied on the artificial ulcers immediately after the ESD. Feasibility and efficacy of endoscopic bio-sheet graft therapy for the management of artificial ulcers and the evaluation of healing conditions based on histology changes in the remaining gastric bed tissues harvested from the stomachs. Thirty-three ESD specimens were obtained. On an image analysis of the ratio of healed area in the remaining gastric bed tissue compared with the matched dissected gastric mucosa, the control group showed the most significant improvement in healing activity among the 3 groups (P < .05), whereas the severity of inflammation in the remaining ulcer tissue was significantly attenuated in bio-sheet and combination groups (P < .05). Animal model. Although the bio-sheet grafts provided physical protection from gastric acid attack as reflected in the attenuated inflammation on the ulcer beds, unexpected delayed ulcer healing was noted in the bio-sheet graft group because of its physical hindrance of the healing process. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

EMR is not inferior to ESD for early Barrett’s and EGJ neoplasia: An extensive review on outcome, recurrence and complication rates

PubMed Central

Komeda, Yoriaki; Bruno, Marco; Koch, Arjun

2014-01-01

Background and study aims In recent years, it has been reported that early Barrett’s and esophagogastric junction (EGJ) neoplasia can be effectively and safely treated using endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Multiband mucosectomy (MBM) appears to be the safest EMR method. The aim of this systematic review is to assess the safety and efficacy of MBM compared with ESD for the treatment of early neoplasia in Barrett’s or at the EGJ. Methods A literature review of studies published up to May 2013 on EMR and ESD for early Barrett’s esophagus (BE) neoplasia and adenocarcinoma at the EGJ was performed through MEDLINE, EMBASE and the Cochrane Library. Results on outcome parameters such as number of curative resections, complications and procedure times are compared and reported. Results A total of 16 studies met the inclusion criteria for analysis in this study. There were no significant differences in recurrence rates when comparing EMR (10/380, 2.6 %) to ESD (1/333, 0.7 %) (OR 8.55; 95 %CI, 0.91 – 80.0, P = 0.06). All recurrences after EMR were treated with additional endoscopic resection. The risks of delayed bleeding, perforation and stricture rates in both groups were similar. The procedure was considerably less time-consuming in the EMR group (mean time 36.7 min, 95 %CI, 34.5 – 38.9) than in the ESD group (mean time 83.3 min, 95 %CI, 57.4 – 109.2). Conclusions The MBM technique for EMR is as effective as ESD when comparing outcomes related to recurrence and complication rates for the treatment of early Barrett’s or EGJ neoplasia. The MBM technique is considerably less time-consuming. PMID:26135261

Bispectral Index Monitoring during Anesthesiologist-Directed Propofol and Remifentanil Sedation for Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial

PubMed Central

Park, Woo Young; Shin, Yang-Sik; Lee, Sang Kil; Kim, So Yeon; Lee, Tai Kyung

2014-01-01

Purpose Endoscopic submucosal dissection (ESD) is a technically difficult and lengthy procedure requiring optimal depth of sedation. The bispectral index (BIS) monitor is a non-invasive tool that objectively evaluates the depth of sedation. The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol, and thus reduce the incidence of sedation- and/or procedure-related complications. Materials and Methods A total of 180 patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups. The control group (n=90) was monitored by the Modified Observer's Assessment of Alertness and Sedation scale and the BIS group (n=90) was monitored using BIS. The total doses of propofol and remifentanil, the need for rescue propofol, and the rates of complications were recorded. Results The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group (47.8% vs. 30.0%, p=0.014). There were no significant differences in the incidence of sedation- and/or procedure-related complications. Conclusion BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures. However, this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation. PMID:25048506

A novel device for endoscopic submucosal dissection, the Fork knife

PubMed Central

Kim, Hyun Gun; Cho, Joo Young; Bok, Gene Hyun; Cho, Won Young; Kim, Wan Jung; Hong, Su Jin; Ko, Bong Min; Kim, Jin Oh; Lee, Joon Seong; Lee, Moon Sung; Shim, Chan Sup

2008-01-01

AIM: To introduce and evaluate the efficacy and technical aspects of endoscopic submucosal dissection (ESD) using a novel device, the Fork knife. METHODS: From March 2004 to April 2008, ESD was performed on 265 gastric lesions using a Fork knife (Endo FS®) (group A) and on 72 gastric lesions using a Flexknife (group B) at a single tertiary referral center. We retrospectively compared the endoscopic characteristics of the tumors, pathological findings, and sizes of the resected specimens. We also compared the en bloc resection rate, complete resection rate, complications, and procedure time between the two groups. RESULTS: The mean size of the resected specimens was 4.27 ± 1.26 cm in group A and 4.29 ± 1.48 cm in group B. The en bloc resection rate was 95.8% (254/265 lesions) in group A and 93.1% (67/72) in group B. Complete ESD without tumor cell invasion of the resected margin was obtained in 81.1% (215/265) of group A and in 73.6% (53/72) of group B. The perforation rate was 0.8% (2/265) in group A and 1.4% (1/72) in group B. The mean procedure time was 59.63 ± 56.12 min in group A and 76.65 ± 70.75 min in group B (P < 0.05). CONCLUSION: The Fork knife (Endo FS®) is useful for clinical practice and has the advantage of reducing the procedure time. PMID:19034979

Efficacy of a Novel Narrow Knife with Water Jet Function for Colorectal Endoscopic Submucosal Dissection.

PubMed

Yoshida, Naohisa; Toyonaga, Takashi; Murakami, Takaaki; Hirose, Ryohei; Ogiso, Kiyoshi; Inada, Yutaka; Rani, Rafiz Abdul; Naito, Yuji; Kishimoto, Mitsuo; Ohara, Yoshiko; Azuma, Takeshi; Itoh, Yoshito

2017-01-01

With respect to the knife's design in colorectal endoscopic submucosal dissection (ESD), diameter, water jet function, and electric power are important because these relate to efficient dissection. In this study, we analyzed a novel, narrow ball tip-typed ESD knife with water jet function (Flush knife BT-S, diameter: 2.2 mm, length: 2000 mm, Fujifilm Co., Tokyo, Japan) compared to a regular diameter knife (Flush knife BT, diameter: 2.6 mm, length: 1800 mm). In laboratory and clinical research, electric power, knife insertion time, vacuum/suction amount with knife in the endoscopic channel, and water jet function were analyzed. We used a knife 2.0 mm long for BT-S and BT knives. The BT-S showed faster mean knife insertion time (sec) and better vacuum amount (ml/min) compared to the BT (insertion time: 16.7 versus 21.6, p < 0.001, vacuum amount: 38.0 versus 14.0, p < 0.01). Additionally, the water jet function of the BT-S was not inferior. In 39 colorectal ESD cases in two institutions, there were mean 4.7 times (range: 1-28) of knife insertion. Suction under knife happened 59% (23/39) and suction of fluid could be done in 100%. Our study showed that the narrow knife allows significantly faster knife insertion, better vacuum function, and effective clinical results.

[Comparison on Oral versus Intravenous Proton Pump Inhibitors for Prevention of Bleeding after Endoscopic Submucosal Dissection of Gastric Lesions].

PubMed

Jung, Yeoun Su; Kim, Kyeong Ok; Lee, Si Hyung; Jang, Byung Ik; Kim, Tae Nyeun

2016-02-01

Although intravenous proton pump inhibitor (PPI) has been used for the prevention of post endoscopic submucosal dissection (ESD) bleeding, the route of administration has not been confirmed. The aim of the present study was to compare the efficacy of intravenous and oral PPI administration for the prevention of delayed post ESD bleeding. Total 166 consecutive patients were randomly assigned to 30 mg lansoprazol twice a day (PO group) and 120 mg pantoprazole intravenous injection (IV group) for 48 hours. Finally, 65 patients in PO group and 87 patients in IV group were analyzed. After ESD, all patients underwent follow up endoscopy after 24 hours and were observed the symptoms of bleeding up to 60 days after ESD. Age, sex and use of anticoagulants were not different between groups. At follow up endoscopy after 24 hours, oozing and exposed vessel was noted in 4.6% of PO group and 8.0% of IV group and there was no significant difference. Delayed bleeding occurred in 4 of 65 patients (6.2%) in the PO group and 8 of 87 patients (9.2%) in the IV group (p>0.999). By multivariate analysis, oozing or exposed vessels at follow up endoscopy were risk factors for delayed bleeding (OR=17.5, p=0.022). There was no significant difference in the delayed bleeding, length of hospital stay according to the administration route. Bleeding stigmata at follow up endoscopy was risk factor of delayed bleeding. Oral PPI administration can cost-effectively replace IV PPI for prevention of post ESD bleeding.

Animal feasibility study of an innovated splash-needle for endoscopic submucosal dissection in the upper gastrointestinal tract.

PubMed

Fujishiro, Mitsuhiro; Sugita, Noriyuki

2013-01-01

The high frequency of complications accompanying endoscopic submucosal dissection (ESD) and its complex processes suggest that the process requires improvement. The objective of the present study was to investigate the feasibility of an innovated splash-needle for ESD. An animal feasibility study with a living pig was conducted. Six resections per portion (esophagus and upper, middle, and lower thirds of the stomach) in a total of 24 resections were carried out by using an original splash-needle or an innovated splash-needle. Major innovations were a thicker part in the middle of the knife and a metal plate on the tip of the sheath to obtain more coagulation ability. Injection solution in the submucosal layer was also changed due to possible influence on the outcomes. Main outcome measurements were entire procedure time, cutting speed, and frequency of bleeding during ESD. All the 24 resections were completed without complications. Among the obtained data, only mean cutting speeds were significantly influenced by location of the simulated lesion, which revealed that ESD at the upper third was significantly quicker than that at the lower third (P = 0.01), and ESD at the esophagus was significantly slower than that at the three parts of the stomach (P < 0.01). There was no significant difference between the different knives in each variable. The innovated splash-needle will be feasible for human use, although the safety and advantages in clinical settings must be elucidated by proper comparative studies with existing knives in humans. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.

Combination of water-jet dissection and needle-knife as a hybrid knife simplifies endoscopic submucosal dissection.

PubMed

Lingenfelder, Tobias; Fischer, Klaus; Sold, Moritz G; Post, Stefan; Enderle, Markus D; Kaehler, Georg F B A

2009-07-01

The safety and efficacy of endoscopic submucosal dissection (ESD) is very dependent on an effective injection beneath the submucosal lamina and on a controlled cutting technique. After our study group demonstrated the efficacy of the HydroJet in needleless submucosal injections under various physical conditions to create a submucosal fluid cushion (Selective tissue elevation by pressure = STEP technique), the next step was to develop a new instrument to combine the capabilities of an IT-Knife with a high-pressure water-jet in a single instrument. In this experimental study, we compared this new instrument with a standard ESD technique. Twelve gastric ESD were performed in six pigs under endotracheal anesthesia. Square areas measuring 4-cm x 4-cm were marked out on the anterior and posterior wall in the corpus-antrum transition region. The HybridKnife was used as an standard needle knife with insulated tip (i.e., the submucosal injection was performed with an injection needle and only the radiofrequency (RF) part of the HybridKnife was used for cutting (conventional technique)) or the HybridKnife was used in all the individual stages of the ESD, making use of the HybridKnife's combined functions (HybridKnife technique). The size of the resected specimens, the operating time, the frequency with which instruments were changed, the number of bleeding episodes, and the number of injuries to the gastric wall together with the subjective overall assessment of the intervention by the operating physician were recorded. The resected specimens were the same size, with average sizes of 16.96 cm(2) and 15.85 cm(2) resp (p = 0.8125). Bleeding episodes have been less frequent in the HybridKnife group (2.83 vs. 3.5; p = 0.5625). The standard knife caused more injuries to the lamina muscularis propria (0.17 vs. 1.33; p = 0.0313). The operating times had a tendency to be shorter with the HybridKnife technique (47.18 vs. 58.32 minute; p = 0.0313). The combination of a needle-knife with high-pressure water-jet dissection improved the results of endoscopic submucosal dissection in this experimental setting. Because the frequency of complications is still high, further improvements to the instrument are necessary.

A comparative study of grasping-type scissors forceps and insulated-tip knife for endoscopic submucosal dissection of early gastric cancer: a randomized controlled trial

PubMed Central

Nagai, Kengo; Uedo, Noriya; Yamashina, Takeshi; Matsui, Fumi; Matsuura, Noriko; Ito, Takashi; Yamamoto, Sachiko; Hanaoka, Noboru; Takeuchi, Yoji; Higashino, Koji; Ishihara, Ryu; Iishi, Hiroyasu

2016-01-01

Background and study aims: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is technically difficult for beginners. Few comparative studies of technical feasibility, efficacy, and safety using various devices have been reported. This study evaluated the feasibility, efficacy, and safety of ESD for EGC < 2 cm using grasping-type scissors forceps (GSF) or insulated-tip knife (IT2) for three resident endoscopists. Patients and methods: This was a randomized phase II study in a cancer referral center. A total of 108 patients with 120 EGCs were enrolled with the following characteristics: differentiated-type mucosal EGC, without ulcers or scars, < 2 cm (86 men, 22 women; median age 72 years). All lesions were stratified according to operator and tumor location (antrum or corpus), assigned randomly to two groups (GSF or IT2), and resected by ESD. Self-completion rate, complete resection rate, procedure time, and adverse events were evaluated as main outcome measures. Results: There was no difference in self-completion rate between the IT2 group (77 %, 47/61, P = 0.187) and the GSF group (66 %, 37/56). Also, there were no differences in en bloc resection rate (98 %, 60/61 vs. 93 %, 52/56, P = 0.195) and adverse events (3.3 %, 2/61 vs. 7.1 %, 4/56, P = 0.424). Median (min [range]) procedure time in the IT2 group (47 [33 – 67], P = 0.003) was shorter than that in the GSF group (66 [40 – 100]). Limitations of this study were the small sample size and single center design. Conclusions: ESD with GSF did not show a statistically significant advantage in improvement of self-completion rate over IT2. (Study registration: UMIN 000005048) PMID:27556074

Usefulness of IT knife nano for endoscopic submucosal dissection of large colo-rectal lesions.

PubMed

Suzuki, T; Hara, T; Kitagawa, Y; Yamaguchi, T

2016-01-01

Endoscopic submucosal dissection (ESD) is currently widely conducted for the treatment of early gastrointestinal -cancers. Due to the characteristic anatomy of the large intestine, needle- tip type devices such as Dual knife are mainly used in colorectal ESD. On the other hand, the non- needle-tip type IT knife is a unique device with an insulated tip, and has been reported to be safe, efficacious and speedy when used in gastric ESD. A new model of IT knife, IT knife nano, anticipated to be useful for esophageal and colorectal ESD has become available, but its usefulness has not been reported. Therefore, we performed this study to evaluate the usefulness of IT knife nano for ESD of large colorectal lesions. Previous studies have shown that a tumor size of 40 mm or above significantly prolongs treatment time and is a factor of treatment difficulty. We selected colorectal lesions of 40 mm and above, and compared 32 lesions treated with Dual knife alone before IT knife nano was available (No-IT group) and 40 cases treated with IT knife nano as a second knife after IT knife nano became available (IT group). We assessed en bloc resection rate, complete en bloc resection rate, complication rate and treatment time. The en bloc resection rates in No-IT group and IT group were 100% and 97.5%, respectively, with no significant difference. The respective median treatment time was 70 min and 51 min, and was significantly shortened in IT group (P < 0.05). The respective rates of procedure- related perforation were 3.1% and 0% ; in IT group suggesting a tendency of reduced incidence. Use of IT knife nano in ESD for large colorectal -lesions achieves the same levels of efficacy and safety as conventional device, with the additional merit of shortening treatment time. © Acta Gastro-Enterologica Belgica.

Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer meeting expanded indication including undifferentiated-type tumors: a criteria-based analysis.

PubMed

Lee, Sunpyo; Choi, Kee Don; Han, Minkyu; Na, Hee Kyong; Ahn, Ji Yong; Jung, Kee Wook; Lee, Jeong Hoon; Kim, Do Hoon; Song, Ho June; Lee, Gin Hyug; Yook, Jeong-Hwan; Kim, Byung Sik; Jung, Hwoon-Yong

2018-05-01

Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) meeting the expanded indication is considered investigational. We aimed to compare long-term outcomes of ESD and surgery for EGC in the expanded indication based on each criterion. This study included 1823 consecutive EGC patients meeting expanded indication conditions and treated at a tertiary referral center: 916 and 907 patients underwent surgery or ESD, respectively. The expanded indication included four discrete criteria: (I) intramucosal differentiated tumor, without ulcers, size >2 cm; (II) intramucosal differentiated tumor, with ulcers, size ≤3 cm; (III) intramucosal undifferentiated tumor, without ulcers, size ≤2 cm; and (IV) submucosal invasion <500 μm (sm1), differentiated tumor, size ≤3 cm. We selected 522 patients in each group by propensity score matching and retrospectively evaluated each group. The primary outcome was overall survival (OS); the secondary outcomes were disease-specific survival (DSS), recurrence-free survival (RFS), and treatment-related complications. In all patients and subgroups meeting each criterion, OS and DSS were not significantly different between groups (OS and DSS, all patients: p = 0.354 and p = 0.930; criteria I: p = 0.558 and p = 0.688; criterion II: p = 1.000 and p = 1.000; criterion III: p = 0.750 and p = 0.799; and criterion IV: p = 0.599 and p = 0.871). RFS, in all patients and criterion I, was significantly shorter in the ESD group than in the surgery group (p < 0.001 and p < 0.003, respectively). The surgery group showed higher rates of late and severe treatment-related complications than the ESD group. ESD may be an alternative treatment option to surgery for EGCs meeting expanded indications, including undifferentiated-type tumors.

Efficacy of deep biopsy for subepithelial lesions in the upper gastrointestinal tract.

PubMed

Vaicekauskas, Rolandas; Stanaitis, Juozas; Valantinas, Jonas

2016-01-01

Accurate diagnosis of subepithelial lesions (SELs) in the gastrointestinal tract depends on a variety of methods: endoscopy, endoscopic ultrasound and different types of biopsy. Making an error-free diagnosis is vital for the subsequent application of an appropriate treatment. To evaluate the efficacy of deep biopsy via the endoscopic submucosal dissection (ESD) technique for SELs in the upper gastrointestinal tract. It was a case series study. Deep biopsy via the ESD technique was completed in 38 patients between November 2012 and October 2014. Thirty-eight SELs in the upper gastrointestinal tract of varying size (very small ≤ 1 cm, small 1-2 cm and large ≥ 2 cm) by means of the ESD technique after an incision with an electrosurgical knife of the overlying layers and revealing a small part of the lesion were biopsied under direct endoscopic view. Deep biopsy via the ESD technique was diagnostic in 28 of 38 patients (73.3%; 95% CI: 59.7-89.7%). The diagnostic yield for SELs with a clear endophytic shape increased to 91.3%. An evident endophytic appearance of a subepithelial lesion, the mean number of biopsied samples (6.65 ±1.36) and the total size in length of all samples per case (19.88 ±8.07 mm) were the main criteria influencing the positiveness of deep biopsy in the diagnostic group compared to the nondiagnostic one (p = 0.001; p = 0.025; p = 0.008). Deep biopsy via the ESD technique is an effective and safe method for the diagnosis of SELs especially with a clear endophytic appearance in a large number of biopsied samples.

Efficacy and safety of proton pump inhibitors (PPIs) plus rebamipide for endoscopic submucosal dissection-induced ulcers: a meta-analysis.

PubMed

Wang, Jun; Guo, Xufeng; Ye, Chuncui; Yu, Shijie; Zhang, Jixiang; Song, Jia; Cao, Zhuo; Wang, Jing; Liu, Min; Dong, Weiguo

2014-01-01

To compare the efficacy of proton pump inhibitors (PPIs) with rebamipide versus PPIs alone for the treatment of ulcers after endoscopic submucosal dissection (ESD). PubMed, Web of Science, Medline, Embase, the Cochrane Central Register of Controlled Trials and China Naitonal Knowledge Infrastructure were searched up to the end of October 2013 in order to identify all randomized controlled trials reporting the effects of PPIs plus rebamipide on healing ulcers after ESD. The outcome measurement was complete ulcer healing. A total of six studies involving 724 patients were included. The pooled data suggested a significantly higher rate of ulcer healing after endoscopic therapy among patients treated with PPIs plus rebamipide than among those treated with PPIs alone [odds ratio (OR)=2.40, 95% confidence interval (CI): 1.68-3.44]. The subgroup analysis showed PPI plus rebamipide therapy to be more effective in healing ESD-induced ulcers than treatment with PPIs alone after both four (OR=2.22, 95%CI: 1.53-3.24) and eight weeks of treatment (OR=3.19, 95%CI: 1.22-8.31). In addition, the combination therapy was found to be significantly more effective than the use of PPIs alone for all ESD ulcers greater than 20 mm in size (OR=4.77, 95%CI: 2.22-10.26). There were no significant differences between the treatment groups with regard to ulcer location (low, middle or upper stomach) or the presence of absence of H. pylori infection. No serious adverse events were observed in either group. The results of this meta-analysis suggest that treatment with PPIs plus rebamipide is superior to PPI monotherapy for healing ESD-induced ulcers over four weeks, particularly large ulcers. However, more well-designed trials are needed to confirm these findings.

Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group.

PubMed

Tamaru, Yuzuru; Oka, Shiro; Tanaka, Shinji; Hiraga, Yuko; Kunihiro, Masaki; Nagata, Shinji; Furudoi, Akira; Ninomiya, Yuki; Asayama, Naoki; Shigita, Kenjiro; Nishiyama, Soki; Hayashi, Nana; Chayama, Kazuaki

2016-10-01

The lower rectum close to the dentate line has distinct characteristics, making endoscopic submucosal dissection (ESD) of tumors challenging. We assessed clinical outcomes of ESD for such patients with hemorrhoids. Sixty-four patients (mean age, 68 years) underwent ESD for anorectal tumors close to the dentate line. We divided patients into those with (Group A, 45 patients) and without hemorrhoids (Group B, 19 patients). We examined en bloc and histological en bloc resection rates, procedure time, complication rates, and postoperative prognosis after ESD. The mean tumor size was 43 mm. Histologic diagnoses were adenoma (42 %, 27/64), carcinoma in situ (44 %, 28/64), and T1 carcinoma (14 %, 9/64). There was no significant difference in en bloc resection (93 %, 42/45 vs. 95 %, 18/19) or postoperative bleeding rates (16 %, 7/45 vs. 11 %, 2/19) between Groups A and B, respectively. The mean procedural durations were 120 and 124 min, respectively, in Groups A and B. No perforations occurred. There was no significant difference in postoperative anal pain rate between Groups A (18 %, 8/45) and B (16 %, 3/19), and it resolved within a few days in all cases. There was one case of stricture in Group B. Two patients with T1 carcinoma underwent additional surgery, one underwent chemotherapy, and five had no additional treatment. No recurrence occurred during the follow-up period of 38 months. ESD is safe and effective for anorectal tumors close to the dentate line in patients with hemorrhoids.

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion.

PubMed

Ikeda, Atsuki; Hoshi, Namiko; Yoshizaki, Tetsuya; Fujishima, Yoshimi; Ishida, Tsukasa; Morita, Yoshinori; Ejima, Yasuo; Toyonaga, Takashi; Kakechi, Yoshihiro; Yokosaki, Hiroshi; Azuma, Takeshi

2015-01-01

The standard treatment for submucosal esophageal cancer is esophagectomy or chemoradiotherapy (CRT). However, these treatment modalities could deteriorate the general condition and quality of life of the patients who are intolerant to invasive therapy. It is therefore important and beneficial to develop less invasive treatment protocols for these patients. The study included 43 patients who were clinically suspected of mucosa or submucosal esophageal cancer but underwent endoscopic submucosal dissection (ESD) as a primary treatment, due to the patients' poor performance statuses and/or preferences for less invasive therapy. According to the pathological findings and patient's general condition, whether the patient underwent additional treatments or remained hospitalized without additional treatments was thereafter decided for each patient. We retrospectively analyzed the outcomes of these patients. Fifteen patients underwent additional surgery, 11 patients underwent CRT/radiation therapy (RT) and 17 patients were followed without additional treatments. During the 3-year follow-up period, the relapse-free survival rates in the patients who received or did not receive additional treatments were 88% and 64%, respectively (95% confidence interval, 0.45-0.76, p=0.04). The relapse-free and overall survival rates in the patients with additional treatments were equivalent or superior to those described in previous reports of the standard treatments. Preceding ESD contributed to reduce the local relapse significantly to approximately 3.5% and additional CRT-related toxicities. Preceding ESD is very effective for the local control of cancer, and useful for histologically confirming the high-risk factors of relapse, such as ≥submucosal layer 2 (SM2) invasion and lymphovascular involvements. ESD with additional therapy may be a promising strategy for optimizing the selection of therapy depending on the patient's general condition.

Amniotic membrane grafts for the prevention of esophageal stricture after circumferential endoscopic submucosal dissection.

PubMed

Barret, Maximilien; Pratico, Carlos Alberto; Camus, Marine; Beuvon, Frédéric; Jarraya, Mohamed; Nicco, Carole; Mangialavori, Luigi; Chaussade, Stanislas; Batteux, Frédéric; Prat, Frédéric

2014-01-01

The prevention of esophageal strictures following circumferential mucosal resection remains a major clinical challenge. Human amniotic membrane (AM) is an easily available material, which is widely used in ophthalmology due to its wound healing, anti-inflammatory and anti-fibrotic properties. We studied the effect of AM grafts in the prevention of esophageal stricture after endoscopic submucosal dissection (ESD) in a swine model. In this prospective, randomized controlled trial, 20 swine underwent a 5 cm-long circumferential ESD of the lower esophagus. In the AM Group (n = 10), amniotic membrane grafts were placed on esophageal stents; a subgroup of 5 swine (AM 1 group) was sacrificed on day 14, whereas the other 5 animals (AM 2 group) were kept alive. The esophageal stent (ES) group (n = 5) had ES placement alone after ESD. Another 5 animals served as a control group with only ESD. The prevalence of symptomatic strictures at day 14 was significantly reduced in the AM group and ES groups vs. the control group (33%, 40% and 100%, respectively, p = 0.03); mean esophageal diameter was 5.8±3.6 mm, 6.8±3.3 mm, and 2.6±1.7 mm for AM, ES, and control groups, respectively. Median (range) esophageal fibrosis thickness was 0.87 mm (0.78-1.72), 1.19 mm (0.28-1.95), and 1.65 mm (0.7-1.79) for AM 1, ES, and control groups, respectively. All animals had developed esophageal strictures by day 35. The anti-fibrotic effect of AM on esophageal wound healing after ESD delayed the development of esophageal stricture in our model. However, this benefit was of limited duration in the conditions of our study.

Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis.

PubMed

Oliveira, J F; Moura, E G H; Bernardo, W M; Ide, E; Cheng, S; Sulbaran, M; Santos, C M L; Sakai, P

2016-07-01

Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review. A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD. We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies, n = 85), the preventive therapy decreased the risk of stenosis (risk difference = -0.36, 95 % CI -0.55 to -0.18, P = 0.0001). Two studies (one randomized and one non-randomized, n = 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = -8.57, 95 % CI -13.88 to -3.25, P < 0.002). There were no significant differences in the three RCT studies (n = 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI -0.09 to 0.14, P = 0.68). The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.

A Novel Telemanipulated Robotic Assistant for Surgical Endoscopy: Preclinical Application to ESD.

PubMed

Zorn, Lucile; Nageotte, Florent; Zanne, Philippe; Legner, Andras; Dallemagne, Bernard; Marescaux, Jacques; de Mathelin, Michel

2018-04-01

Minimally invasive surgical interventions in the gastrointestinal tract, such as endoscopic submucosal dissection (ESD), are very difficult for surgeons when performed with standard flexible endoscopes. Robotic flexible systems have been identified as a solution to improve manipulation. However, only a few such systems have been brought to preclinical trials as of now. As a result, novel robotic tools are required. We developed a telemanipulated robotic device, called STRAS, which aims to assist surgeons during intraluminal surgical endoscopy. This is a modular system, based on a flexible endoscope and flexible instruments, which provides 10 degrees of freedom (DoFs). The modularity allows the user to easily set up the robot and to navigate toward the operating area. The robot can then be teleoperated using master interfaces specifically designed to intuitively control all available DoFs. STRAS capabilities have been tested in laboratory conditions and during preclinical experiments. We report 12 colorectal ESDs performed in pigs, in which large lesions were successfully removed. Dissection speeds are compared with those obtained in similar conditions with the manual Anubiscope platform from Karl Storz. We show significant improvements ( ). These experiments show that STRAS (v2) provides sufficient DoFs, workspace, and force to perform ESD, that it allows a single surgeon to perform all the surgical tasks and those performances are improved with respect to manual systems. The concepts developed for STRAS are validated and could bring new tools for surgeons to improve comfort, ease, and performances for intraluminal surgical endoscopy.

A randomized trial to determine the diagnostic accuracy of conventional vs. jumbo forceps biopsy of gastric epithelial neoplasias before endoscopic submucosal dissection; open-label study.

PubMed

Jeon, Hyo Keun; Ryu, Ho Yoel; Cho, Mee Yon; Kim, Hyun-Soo; Kim, Jae Woo; Park, Hong Jun; Kim, Moon Young; Baik, Soon Koo; Kwon, Sang Ok; Park, Su Yeon; Won, Sung Ho

2014-10-01

Larger biopsy specimens or increasing the number of biopsies may improve the diagnostic accuracy of gastric epithelial neoplasia (GEN). The aims of this study was to compare the diagnostic accuracies between conventional and jumbo forceps biopsy of GEN before endoscopic submucosal dissection (ESD) and to confirm that increasing the number of biopsies is useful for the diagnosis of GEN. The concordance rate between EFB and ESD specimens was not significantly different between the two groups [83.1 % (54/65) in JG vs. 79.1 % (53/67) in CG]. On multivariate analyses, two or four EFBs significantly increased the cumulating concordance rate [coefficients; twice: 5.1 (P = 0.01), four times: 5.9 (P = 0.02)]. But, the concordance rate was decreased in high grade dysplasia (coefficient -40.32, P = 0.006). One hundred and sixty GENs from 148 patients were randomized into two groups and finally 67 GENs in 61 patients and 65 GENs in 63 patients were allocated to the conventional group (CG) or jumbo group (JG), respectively. Four endoscopic forceps biopsy (EFB) specimens were obtained from each lesion with conventional (6.8 mm) forceps or jumbo (8 mm) forceps. The histological concordance rate between 4 EFB specimens and ESD specimens was investigated in the two groups. Before ESD, the diagnostic accuracy of GENs was significantly increased not by the use of jumbo forceps biopsy but by increasing the number of biopsies.

Outcomes of Endoscopic Submucosal Dissection vs Esophagectomy for T1 Esophageal Squamous Cell Carcinoma in a Real-world Cohort.

PubMed

Zhang, Yiqun; Ding, Han; Chen, Tao; Zhang, Xiaocen; Chen, Wei-Feng; Li, Quanlin; Yao, Liqing; Korrapati, Praneet; Jin, Xue-Juan; Zhang, Yong-Xing; Xu, Mei-Dong; Zhou, Ping-Hong

2018-04-25

Esophagectomy is the standard treatment for early-stage esophageal squamous cell carcinoma (EESCC), but patients who undergo this procedure have high morbidity and mortality. Endoscopic submucosal dissection (ESD) is a less-invasive procedure for treatment of EESCC, but is considered risky because this tumor frequently metastasizes to the lymph nodes. We aimed to directly compare outcomes of patients with EESCC treated with ESD vs esophagectomy. We performed a retrospective cohort study of patients with T1a-m2/m3, or T1b EESCCs who underwent ESD (n=322) or esophagectomy (n=274) from October 1, 2011 through September 31, 2016 at Zhongshan Hospital in Shanghai, China. The primary outcome was all-cause mortality at the end of follow up (minimum of 6 months). Secondary outcomes included operation time, hospital stay, cost, perioperative mortalities/severe non-fatal adverse events, requirement for adjuvant therapies, and disease-specific mortality and cancer recurrence or metastasis at the end of the follow up period. Patients who underwent ESD were older (mean 63.5 years vs 62.3 years for patients receiving esophagectomy; P=.006) and a greater proportion was male (80.1% vs 70.4%; P=.006) and had a T1a tumor (74.5% vs 27%; P=.001). A lower proportion of patients who underwent ESD had perioperative mortality (0.3% vs 1.5% of patients receiving esophagectomy; P=.186) and non-fatal severe adverse events (15.2% vs 27.7%; P=.001)-specifically lower proportions of esophageal fistula (0.3% of patients receiving ESD vs 16.4% for patients receiving esophagectomy; P=.001) and pulmonary complications (0.3% vs 3.6%; P=.004). After a median follow-up time of 21 months (range, 6-73 months), there were no significant differences between treatments in all-cause mortality (7.4% for ESD vs 10.9%; P=.209) or rate of cancer recurrence or metastasis (9.1% for ESD vs 8.9%; P=.948). Disease-specific mortality was lower among patients who received ESD (3.4%) vs patients who patients who received esophagectomy (7.4%) (P=.049). In Cox regression analysis, depth of tumor invasion was the only factor associated with all-cause mortality (T1a-m3 or deeper vs T1a-m2: hazard ration, 3.54; P=.04). In a retrospective study of patients with T1am2/m3 or T1b EESCCs treated with ESD (n=322) or esophagectomy (n=274), we found lower proportions of patients receiving ESD to have perioperative adverse events or disease specific mortality after a median follow up time of 21 months. We found no difference in overall survival or cancer recurrence or metastasis in patients with T1a or T1b ESCCs treated with ESD vs esophagectomy. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Endoscopic submucosal dissection for early esophageal neoplasms using the stag beetle knife.

PubMed

Kuwai, Toshio; Yamaguchi, Toshiki; Imagawa, Hiroki; Miura, Ryoichi; Sumida, Yuki; Takasago, Takeshi; Miyasako, Yuki; Nishimura, Tomoyuki; Iio, Sumio; Yamaguchi, Atsushi; Kouno, Hirotaka; Kohno, Hiroshi; Ishaq, Sauid

2018-04-21

To determine short- and long-term outcomes of endoscopic submucosal dissection (ESD) using the stag beetle (SB) knife, a scissor-shaped device. Seventy consecutive patients with 96 early esophageal neoplasms, who underwent ESD using a SB knife at Kure Medical Center and Chugoku Cancer Center, Japan, between April 2010 and August 2016, were retrospectively evaluated. Clinicopathological characteristics of lesions and procedural adverse events were assessed. Therapeutic success was evaluated on the basis of en bloc , histologically complete, and curative or non-curative resection rates. Overall and tumor-specific survival, local or distant recurrence, and 3- and 5-year cumulative overall metachronous cancer rates were also assessed. Eligible patients had dysplasia/intraepithelial neoplasia (22%) or early cancers (squamous cell carcinoma, 78%). The median procedural time was 60 min and on average, the lesions measured 24 mm in diameter, yielding 33-mm tissue defects. The en bloc resection rate was 100%, with 95% and 81% of dissections deemed histologically complete and curative, respectively. All procedures were completed without accidental incisions/perforations or delayed bleeding. During follow-up (mean, 35 ± 23 mo), no local recurrences or metastases were observed. The 3- and 5-year survival rates were 83% and 70%, respectively, with corresponding rates of 85% and 75% for curative resections and 74% and 49% for non-curative resections. The 3- and 5-year cumulative rates of metachronous cancer in the patients with curative resections were 14% and 26%, respectively. ESD procedures using the SB knife are feasible, safe, and effective for treating early esophageal neoplasms, yielding favorable short- and long-term outcomes.

Usefulness of a novel slim type FlushKnife-BT over conventional FlushKnife-BT in esophageal endoscopic submucosal dissection

PubMed Central

Ohara, Yoshiko; Toyonaga, Takashi; Hoshi, Namiko; Tanaka, Shinwa; Baba, Shinichi; Takihara, Hiroshi; Kawara, Fumiaki; Ishida, Tsukasa; Morita, Yoshinori; Umegaki, Eiji; Azuma, Takeshi

2017-01-01

AIM To investigated the usefulness of a novel slim type ball-tipped FlushKnife (FlushKnife-BTS) over ball-tipped FlushKnife (FlushKnife-BT) in functional experiments and clinical practice. METHODS In order to evaluate the functionality of FlushKnife-BTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between FlushKnife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using FlushKnife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were analyzed. RESULTS Functional experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with FlushKnife-BTS was 7.7-fold faster than that with conventional FlushKnife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushKnife-BTS. The waterjet flushing speed was faster with the use of FlushKnife-BT. In clinical practice, a comparison of 6 and 7 ESD using FlushKnife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm2/min (range 19.6-30.3) in the BT group and 44.2 mm2/min (range 15.5-55.4) in the BTS group (P = 0.0633). However, the median treatment speed was significantly faster with FlushKnife-BTS when the resection size was larger than 1000 m2 (n = 4, median 24.2 mm2/min, range 19.6-27.7 vs n = 4, median 47.4 mm2/min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15) (P = 0.0065). CONCLUSION Our results indicate that FlushKnife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspiration and knife insertion during ESD and reducing the frequency of knife removal and reinsertion. PMID:28321167

Endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy.

PubMed

Nonaka, Satoru; Oda, Ichiro; Makazu, Makomo; Haruyama, Shin; Abe, Seiichiro; Suzuki, Haruhisa; Yoshinaga, Shigetaka; Nakajima, Takeshi; Kushima, Ryoji; Saito, Yutaka

2013-07-01

Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) after surgical gastrectomy is a technically difficult procedure because of the limited working space in the remnant stomach as well as the presence of severe gastric fibrosis and staples under the suture line. We evaluated clinical results including long-term outcomes to determine the feasibility and effectiveness of ESD for EGC in the remnant stomach of patients after gastrectomy. Retrospective study. National Cancer Center Hospital, Tokyo, Japan. We investigated patients undergoing ESD for EGC in the remnant stomach from 1997 to 2011. We examined the patient characteristics, endoscopic findings, technical results, adverse events, and histopathologic results including curability and evaluations of Helicobacter pylori gastritis in addition to the rates of local recurrence, metachronous gastric cancer, overall survival, and cause-specific survival. A total of 128 consecutive patients with 139 lesions had previously undergone 87 distal (68%), 25 proximal (19.5%) and 16 pylorus-preserving gastrectomies (12.5%). The median period from the original gastrectomy to the subsequent ESD for EGC in the remnant stomach was 5.7 years (range 0.6-51 years), the median tumor size was 13 mm (range 1-60 mm), and the median procedure time was 60 minutes (range 15-310 minutes). There were 131 en bloc resections (94%), with curative resections achieved for 109 lesions (78%); 22 lesions (16%) resulted in non-curative resections, and 8 lesions (6%) had only a horizontal margin positive or had inconclusive results. A total of 118 patients (92%) were assessed as H pylori gastritis-positive, with 7 patients (5%) negative. Adverse events included 2 cases of delayed bleeding (1.4%) and 2 perforations (1.4%), with 1 patient requiring emergency surgery. The 5-year overall and cause-specific survival rates were 87.3% and 100%, respectively, during a median follow-up period of 4.5 years (range 0-13.7 years), with no deaths from EGC in the remnant stomach. Single-center, retrospective study. ESD for EGC in the remnant stomach of patients after gastrectomy was a feasible and effective therapeutic method and should become the standard treatment in such cases, based on the favorable long-term outcomes. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Local steroid injection into the artificial ulcer created by endoscopic submucosal dissection for gastric cancer: prevention of gastric deformity.

PubMed

Mori, H; Rafiq, K; Kobara, H; Fujihara, S; Nishiyama, N; Kobayashi, M; Himoto, T; Haba, R; Hagiike, M; Izuishi, K; Okano, K; Suzuki, Y; Masaki, T

2012-07-01

Endoscopic submucosal dissection (ESD) of large gastric lesions results in an extensive artificial ulcer that can lead to marked gastric deformity. The aim of the current study was to evaluate therapeutic efficacy in the prevention of gastric deformity of local triamcinolone acetonide (TCA) injection into the extensive artificial ulcer following ESD. A total of 45 patients who were diagnosed with early gastric cancer were enrolled. Patients were randomly assigned by the sealed-envelope randomization method to either local TCA injections (n = 21) or sham-control (n = 20) groups. Two clips were placed at the two maximum outer edges of the artificial ulcer after the lesion had been resected (Day 0). Local TCA injections were performed on postoperative Day 5 and Day 12. The distance between the two clips was measured by endoscopic measuring forceps on Days 5, 12, 30, and 60. Granulation formation and gastric deformity were evaluated by visual analog scale (VAS) on Days 30 and 60. Local TCA injection did not alter clip-to-clip distance on postoperative Day 60, and formation of flat granulation tissue over the ulcer was followed by regenerative mucosa without any gastric deformity. The sham-control group showed significant shortening of clip-to-clip distance compared with the local steroid-injected group and protruded forms of granulation tissue with mucosal convergence. Histological evaluation revealed prominent growth of neovessels, swelling, and marked increases in endothelial cells in the local steroid-injected group compared with the sham-control group. Local steroid injection into the floor of a post-ESD artificial ulcer promotes the formation of granulation tissue at an early stage of the healing process leading to regeneration of gastric mucosa without mucosal convergence or gastric deformity. © Georg Thieme Verlag KG Stuttgart · New York.

The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer.

PubMed

Miyahara, Koji; Hatta, Waku; Nakagawa, Masahiro; Oyama, Tsuneo; Kawata, Noboru; Takahashi, Akiko; Yoshifuku, Yoshikazu; Hoteya, Shu; Hirano, Masaaki; Esaki, Mitsuru; Matsuda, Mitsuru; Ohnita, Ken; Shimoda, Ryo; Yoshida, Motoyuki; Dohi, Osamu; Takada, Jun; Tanaka, Keiko; Yamada, Shinya; Tsuji, Tsuyotoshi; Ito, Hirotaka; Aoyagi, Hiroyuki; Shimosegawa, Tooru

2018-06-05

The role of an undifferentiated component in submucosal invasion and submucosal invasion depth (SID) for lymph node metastasis (LNM) of early gastric cancer (EGC) with deep submucosal invasion (SID ≥500 μm from the muscularis mucosa) after endoscopic submucosal dissection (ESD) has not been fully understood. This study aimed to clarify the risk factors (RFs), including these factors, for LNM in such patients. We enrolled 513 patients who underwent radical surgery after ESD for EGC with deep submucosal invasion. We evaluated RFs for LNM, including an undifferentiated component in submucosal invasion and the SID, which was subdivided into 500-999, 1,000-1,499, 1,500-1,999, and ≥2,000 µm. LNM was detected in 7.6% of patients. Multivariate analysis revealed that an undifferentiated component in submucosal invasion (OR 2.22), in addition to tumor size >30 mm (OR 2.51) and lymphatic invasion (OR 3.07), were the independent RFs for LNM. However, the SID was not significantly associated with LNM. An undifferentiated component in submucosal invasion was one of the RFs for LNM, in contrast to SID, in patients who underwent ESD for EGC with deep submucosal invasion. This insight would be helpful in managing such patients. © 2018 S. Karger AG, Basel.

Colorectal endoscopic submucosal dissection (ESD) in the West - when can satisfactory results be obtained? A single-operator learning curve analysis.

PubMed

Spychalski, Michał; Skulimowski, Aleksander; Dziki, Adam; Saito, Yutaka

2017-12-01

Up to date we lack a detailed description of the colorectal endoscopic submucosal dissection (ESD) learning curve, that would represent the experience of the Western center. The aim of this study was to define the critical points of the learning curve and to draw up lesions qualification guidelines tailored to the endoscopists experience. We have carried out a single center prospective study. Between June 2013 and December 2016, 228 primary colorectal lesions were managed by ESD procedure. In order to create a learning curve model and to carry out the analysis the cases were divided into six periods, each consisting of 38 cases. The overall en bloc resection rate was 79.39%. The lowest en bloc resection rate (52.36%) was observed in the first period. After completing 76 procedures, the resection rate surged to 86% and it was accompanied by the significant increase in the mean procedure speed of ≥9 cm 2 /h. Lesions localization and diameter had a signification impact on the outcomes. After 76 procedures, en bloc resection rate of 90.9 and 90.67% were achieved for the left side of colon and rectum, respectively. In the right side of colon statistically significant lower resection rate of 67.57% was observed. We have proved that in the setting of the Western center, colorectal ESD can yield excellent results. It seems that the key to the success during the learning period is 'tailoring' lesions qualification guidelines to the experience of the endoscopist, as lesions diameter and localization highly influence the outcomes.

New endoscopic platform for endoluminal en bloc tissue resection in the gastrointestinal tract (with videos).

PubMed

Kantsevoy, Sergey V; Bitner, Marianne; Piskun, Gregory

2016-07-01

Endoscopic removal of gastrointestinal tract lesions is increasingly popular around the world. We evaluated feasibility, safety, effectiveness, and user learning curve of new endoscopic platform for complex intraluminal interventions. A novel system, consisting of expandable working chamber with two independent instrument guides (LIG), was inserted into colon. Simulated colonic lesions were removed with endoscopic submucosal (ESD) and submuscular (ESmD) dissection. In all nine in vivo models, an intraluminal chamber and its dynamic tissue retractors (via LIG) provided a stable working space with excellent visualization and adequate access to target tissue. Endoscopic platform facilitated successful completion of 11 en bloc ESDs (mean size 43.0 ± 11.3 mm, mean time 46.3 ± 41.2 min) and eight ESmD (mean size 50.0 ± 14.1 mm, mean time 48.0 ± 21.2 min). The learning curve for ESD using this platform demonstrated three phases: rapid improvement in procedural skills took place during the first three procedures (mean ESD time 98.7 ± 40.0 min). A plateau phase then occurred (procedures 4-7) with mean procedure time 42.0 ± 13.4 min (p = 0.04), followed by another sharp improvement in procedural skills (procedures 8-11) requiring only 16.3 ± 11.4 min (p = 0.03) to complete ESD. Especially dramatic (p = 0.002) was the time difference between the first three procedures (mean time 98.7 ± 40.0 min) and subsequent eight procedures (mean time 29.1 ± 17.9 min). A newly developed endoscopic platform provides stable intraluminal working space, dynamic tissue retraction, and instrument triangulation, improving visualization and access to the target tissue for safer and more effective en bloc endoscopic submucosal and submuscular dissection. The learning curve for ESD was markedly facilitated by this new endoscopic platform.

Retrospective study

PubMed Central

Lu, Chao; Lv, Xueyou; Lin, Yiming; Li, Dejian; Chen, Lihua; Ji, Feng; Li, Youming; Yu, Chaohui

2016-01-01

Abstract Conventional forceps biopsy (CFB) is the most popular way to screen for gastric epithelial neoplasia (GEN) and adenocarcinoma of gastric epithelium. The aim of this study was to compare the diagnostic accuracy between conventional forceps biopsy and endoscopic submucosal dissection (ESD). Four hundred forty-four patients who finally undertook ESD in our hospital were enrolled from Jan 1, 2009 to Sep 1, 2015. We retrospectively assessed the characteristics of pathological results of CFB and ESD. The concordance rate between CFB and ESD specimens was 68.92% (306/444). Men showed a lower concordance rate (63.61% vs 79.33%; P = 0.001) and concordance patients were younger (P = 0.048). In multivariate analysis, men significantly had a lower concordance rate (coefficient −0.730, P = 0.002) and a higher rate of pathological upgrade (coefficient −0.648, P = 0.015). Locations of CFB did not influence the concordance rate statistically. The concordance rate was relatively high in our hospital. According to our analysis, old men plus gastric fundus or antrum of CFB were strongly suggested to perform ESD if precancerous lesions were found. And young women with low-grade intraepithelial neoplasia could select regular follow-up. PMID:27472723

Endoscopic submucosal dissection for early Barrett's neoplasia.

PubMed

Barret, Maximilien; Cao, Dalhia Thao; Beuvon, Frédéric; Leblanc, Sarah; Terris, Benoit; Camus, Marine; Coriat, Romain; Chaussade, Stanislas; Prat, Frédéric

2016-04-01

The possible benefit of endoscopic submucosal dissection (ESD) for early neoplasia arising in Barrett's esophagus remains controversial. We aimed to assess the efficacy and safety of ESD for the treatment of early Barrett's neoplasia. All consecutive patients undergoing ESD for the resection of a visible lesion in a Barrett's esophagus, either suspicious of submucosal infiltration or exceeding 10 mm in size, between February 2012 and January 2015 were prospectively included. The primary endpoint was the rate of curative resection of carcinoma, defined as histologically complete resection of adenocarcinomas without poor histoprognostic factors. Thirty-five patients (36 lesions) with a mean age of 66.2 ± 12 years, a mean ASA score of 2.1 ± 0.7, and a mean C4M6 Barrett's segment were included. The mean procedure time was 191 ± 79 mn, and the mean size of the resected specimen was 51.3 ± 23 mm. En bloc resection rate was 89%. Lesions were 12 ± 15 mm in size, and 81% (29/36) were invasive adenocarcinomas, six of which with submucosal invasion. Although R0 resection of carcinoma was 72.4%, the curative resection rate was 66% (19/29). After a mean follow-up of 12.9 ± 9 months, 16 (45.7%) patients had required additional treatment, among whom nine underwent surgical resection, and seven further endoscopic treatments. Metachronous lesions or recurrence of cancer developed during the follow-up period in 17.2% of the patients. The overall complication rate was 16.7%, including 8.3% perforations, all conservatively managed, and no bleeding. The 30-day mortality was 0%. In this early experience, ESD yielded a moderate curative resection rate in Barrett's neoplasia. At present, improvements are needed if ESD is to replace piecemeal endoscopic mucosal resection in the management of Barrett's neoplasia.

Endoscopic submucosal dissection as treatment for early gastric cancer: Experience at two centers in Lima, Peru.

PubMed

Chirinos Vega, J A; Vargas, G; Alcántara, C; Zapata, J

2018-02-09

The aim of the present study was to evaluate the feasibility of endoscopic submucosal dissection (ESD) and determine the clinical and pathologic characteristics of early gastric cancers and premalignant lesions treated with that technique at the Hospital Nacional of the Department of Health and a private clinic in Lima, Peru. A descriptive study of all pre-malignant and malignant gastric lesions treated with ESD at the Gastroenterology Service of the Hospital Arzobispo Loayza and the Clínica Angloamericana was conducted within the time frame of January 2012 and January 2017. A total of 13 lesions were resected through ESD: 8 adenocarcinomas (61.53%), 3 adenomas with high-grade dysplasia (23%), and 2 adenomas with low-grade dysplasia (15.38%). Twelve lesions (92.3%) were located in the lower third of the stomach. Slightly elevated lesions (Paris classification IIa) (4 lesions, 30.76%) and mixed slightly elevated lesions with a depressed component (IIa+IIc) (4 lesions, 30.76%) predominated. The mean size of the resected specimens was 35mm. Complete resection of all lesions was achieved in 11 cases (84.6%) and en bloc resection was carried out in 11 cases (84.6%). Resection was curative in 6 cases (75%), from the total of 8 resected adenocarcinomas. One case of perforation was the only complication reported (7.6%) and it was surgically resolved. The feasibility and efficacy of ESD for the treatment of early gastric cancer was demonstrated at two healthcare centers in Lima, Peru. The complication rate was similar to that reported in the international medical literature. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

A Case-Control Study of Esomeprazole Plus Rebamipide vs. Omeprazole Plus Rebamipide on Post-ESD Gastric Ulcers.

PubMed

Bunno, Maki; Gouda, Kyosuke; Yamahara, Kunihiro; Kawaguchi, Masanori

2013-01-01

Endoscopic submucosal dissection (ESD) is useful for treating gastric tumors. Several trials have shown the efficacy of 4 or 8 weeks of proton pump inhibitor (PPI) administration for post-ESD ulcers. However, if the size of the post-ESD ulcer is larger than predicted, PPI administration alone might not be sufficient for the ulcer to heal within 4 weeks. There is no report about the efficacy of post-ESD gastric ulcers by esomeprazole. We examined retrospectively the efficacy of a combination therapy of esomeprazole plus rebamipide, a mucosal-protective antiulcer drug, on the acceleration of post-ESD ulcer healing comparing with omeprazole plus rebamipide. We reviewed the medical records of patients who underwent ESD for gastric neoplasia. We conducted a case-control study to compare the healing rates within 4 weeks effected by esomeprazole plus rebamipide (group E) and omeprazole plus rebamipide (group O). The sizes of the artificial ulcers were divided into normal-sized or large-sized. The baseline characteristics did not differ significantly between the two groups except age and sex. Stage S1 disease was observed in 27.6% and 38.7% of patients after 4 weeks of treatment in the group E and O, respectively. In large-sized artificial ulcers, the healing rate of stage S1 in group E is significantly higher than that in group O in 4 weeks.(25% VS 0%:P = 0.02). The safety and efficacy profiles of esomeprazole plus rebamipide and omeprazole and rebamipide are similar for the treatment of ESD-induced ulcers. In large-sized ulcers, esomeprazole plus rebamipide promotes ulcer healing.

Limited Effect of Rebamipide in Addition to Proton Pump Inhibitor (PPI) in the Treatment of Post-Endoscopic Submucosal Dissection Gastric Ulcers: A Randomized Controlled Trial Comparing PPI Plus Rebamipide Combination Therapy with PPI Monotherapy.

PubMed

Nakamura, Kazuhiko; Ihara, Eikichi; Akiho, Hirotada; Akahoshi, Kazuya; Harada, Naohiko; Ochiai, Toshiaki; Nakamura, Norimoto; Ogino, Haruei; Iwasa, Tsutomu; Aso, Akira; Iboshi, Yoichiro; Takayanagi, Ryoichi

2016-11-15

The ability of endoscopic submucosal dissection (ESD) to resect large early gastric cancers (EGCs) results in the need to treat large artificial gastric ulcers. This study assessed whether the combination therapy of rebamipide plus a proton pump inhibitor (PPI) offered benefits over PPI monotherapy. In this prospective, randomized, multicenter, open-label, and comparative study, patients who had undergone ESD for EGC or gastric adenoma were randomized into groups receiving either rabeprazole monotherapy (10 mg/day, n=64) or a combination of rabeprazole plus rebamipide (300 mg/day, n=66). The Scar stage (S stage) ratio after treatment was compared, and factors independently associated with ulcer healing were identified by using multivariate analyses. The S stage rates at 4 and 8 weeks were similar in the two groups, even in the subgroups of patients with large amounts of tissue resected and regardless of CYP2C19 genotype. Independent factors for ulcer healing were circumferential location of the tumor and resected tissue size; the type of treatment did not affect ulcer healing. Combination therapy with rebamipide and PPI had limited benefits compared with PPI monotherapy in the treatment of post-ESD gastric ulcer (UMIN Clinical Trials Registry, UMIN000007435).

Location characteristics of early gastric cancer treated with endoscopic submucosal dissection.

PubMed

Kang, Dae Hwan; Choi, Cheol Woong; Kim, Hyung Wook; Park, Su Bum; Kim, Su Jin; Nam, Hyeong Seok; Ryu, Dae Gon

2017-11-01

The timely detection of early gastric cancer (EGC) is important in performing endoscopic submucosal dissection (ESD). We attempted to determine the location characteristics of regions where EGC is frequently detected and analyzed the EGC characteristics associated with that location. We retrospectively reviewed the medical records of patients with EGC treated by ESD between November 2008 and August 2016. We retrospectively investigated and analyzed 647 EGC lesions. The patients' mean age was 66.7 ± 10.8 years. The patient population was predominantly male (77.1%, 499/647). A well-to-moderately differentiated carcinoma was observed in 97.2% of patients. The common site of carcinoma occurrence was the lower part of the stomach (the antrum and lower third of body, 89.6%). Among the stomach hemispheres, the lesser curvature side was the most frequent site of EGC (43.9%). The posterior side of EGC was more frequent than anterior side of EGC (20.4 vs. 15.6%, respectively). Submucosal invasive EGC was more frequent in the mid-to-upper parts of stomach than lower part of stomach (odds ratio 1.919; confidence interval 1.014-3.623; p = 0.045). Most EGCs that are resectable with ESD were found in the lower part and in the lesser curvature of the stomach. The submucosal invasive EGC was more frequent in the mid-to-upper part of stomach.

Selective mucosal ablation using CO2 laser for the development of novel endoscopic submucosal dissection: comparison of continuous wave and nanosecond pulsed wave

NASA Astrophysics Data System (ADS)

Ishii, K.; Watanabe, S.; Obata, D.; Hazama, H.; Morita, Y.; Matsuoka, Y.; Kutsumi, H.; Azuma, T.; Awazu, K.

2010-02-01

Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment technique for small early gastric cancers. Procedures are carried out using some specialized electrosurgical knifes with a submucosal injection solution. However it is not widely used because its procedure is difficult. The objective of this study is to develop a novel ESD method which is safe in principle and widely used by using laser techniques. In this study, we used CO2 lasers with a wavelength of 10.6 μm for mucosal ablation. Two types of pulse, continuous wave and pulsed wave with a pulse width of 110 ns, were studied to compare their values. Porcine stomach tissues were used as a sample. Aqueous solution of sodium hyaluronate (MucoUpR) with 50 mg/ml sodium dihydrogenphosphate is injected to a submucosal layer. As a result, ablation effect by CO2 laser irradiation was stopped because submucosal injection solution completely absorbed CO2 laser energy in the invasive energy condition which perforates a muscle layer without submucosal injection solution. Mucosal ablation by the combination of CO2 Laser and a submucosal injection solution is a feasible technique for treating early gastric cancers safely because it provides a selective mucosal resection and less-invasive interaction to muscle layer.

[Laparoscopic Proximal Gastrectomy as a Surgical Treatment for Upper Third Early Gastric Cancer].

PubMed

Park, Do Joong; Park, Young Suk; Ahn, Sang Hoon; Kim, Hyung Ho

2017-09-25

Recently, the incidence of upper third gastric cancer has increased, and with it the number of endoscopic submucosal dissection (ESD) procedures performed has been increasing. However, if ESD is not indicated or non-curable, surgical treatment may be necessary. In the case of lower third gastric cancer, it is possible to preserve the upper part of the stomach; however, in the case of upper third gastric cancer, total gastrectomy is still the standard treatment option, regardless of the stage. This is due to the complications associated with upper third gastric cancer, such as gastroesophageal reflux after proximal gastrectomy rather than oncologic problems. Recently, the introduction of the double tract reconstruction method after proximal gastrectomy has become one of the surgical treatment methods for upper third early gastric cancer. However, since there has not been a prospective comparative study evaluating its efficacy, the ongoing multicenter prospective randomized controlled trial (KLASS-05) comparing laparoscopic proximal gastrectomy with double tract reconstruction and laparoscopic total gastrectomy is expected to be important for determining the future of treatment of upper third early gastric cancer.

Lymph node metastasis after endoscopic submucosal dissection of a differentiated gastric cancer confined to the mucosa with an ulcer smaller than 30 mm.

PubMed

Fujii, Hiroyuki; Ishii, Eiji; Tochitani, Shinako; Nakaji, So; Hirata, Nobuto; Kusanagi, Hiroshi; Narita, Makoto

2015-01-01

In the expanded indications for endoscopic resection, Japanese guidelines for gastric cancer include differentiated cancers confined to the mucosa with an ulcer <30 mm. We describe a patient with lymph node metastasis after curative endoscopic submucosal dissection (ESD) for a tumor of this indication. The patient was a 70-year-old man with chronic hepatitis C. He underwent ESD for early gastric cancer in May 2010. Pathology revealed a moderately differentiated adenocarcinoma, 22 × 17 mm in size, that was confined to the mucosa with an ulcer. The horizontal and vertical margins were negative for the tumor. We diagnosed thiscase as curative resection of expanded indication and followed this patient with endoscopy, abdominal ultrasonography (AUS) or enhanced computed tomography (CT) approximately every 6 months. After 17 months, lymph node metastasis was detected with AUS and CT and diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy in August 2011. Distal gastrectomy with D2 dissection was carried out in December 2011. Although it is low, the possibility of recurrence should be borne in mind after endoscopic treatment of early gastric cancer, despite its inclusion in the expanded indications for endoscopic resection. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

PubMed

Pimentel-Nunes, Pedro; Dinis-Ribeiro, Mário; Ponchon, Thierry; Repici, Alessandro; Vieth, Michael; De Ceglie, Antonella; Amato, Arnaldo; Berr, Frieder; Bhandari, Pradeep; Bialek, Andrzej; Conio, Massimo; Haringsma, Jelle; Langner, Cord; Meisner, Søren; Messmann, Helmut; Morino, Mario; Neuhaus, Horst; Piessevaux, Hubert; Rugge, Massimo; Saunders, Brian P; Robaszkiewicz, Michel; Seewald, Stefan; Kashin, Sergey; Dumonceau, Jean-Marc; Hassan, Cesare; Deprez, Pierre H

2015-09-01

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system 1 2 was adopted to define the strength of recommendations and the quality of evidence. 1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when they are smaller than 10 mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality evidence). 2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may be considered in selected cases, such as lesions larger than 15 mm, poorly lifting tumors, and lesions at risk for submucosal invasion (strong recommendation, moderate quality evidence). 3 ESGE recommends endoscopic resection for the treatment of gastric superficial neoplastic lesions that possess a very low risk of lymph node metastasis (strong recommendation, high quality evidence). EMR is an acceptable option for lesions smaller than 10 - 15 mm with a very low probability of advanced histology (Paris 0-IIa). However, ESGE recommends ESD as treatment of choice for most gastric superficial neoplastic lesions (strong recommendation, moderate quality evidence). 4 ESGE states that the majority of colonic and rectal superficial lesions can be effectively removed in a curative way by standard polypectomy and/or by EMR (strong recommendation, moderate quality evidence). ESD can be considered for removal of colonic and rectal lesions with high suspicion of limited submucosal invasion that is based on two main criteria of depressed morphology and irregular or nongranular surface pattern, particularly if the lesions are larger than 20 mm; or ESD can be considered for colorectal lesions that otherwise cannot be optimally and radically removed by snare-based techniques (strong recommendation, moderate quality evidence). © Georg Thieme Verlag KG Stuttgart · New York.

Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors

PubMed Central

Ichikawa, Daisuke; Komatsu, Shuhei; Dohi, Osamu; Naito, Yuji; Kosuga, Toshiyuki; Kamada, Kazuhiro; Okamoto, Kazuma; Itoh, Yoshito; Otsuji, Eigo

2016-01-01

AIM To assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery (LECS) for early non-ampullary duodenal tumors. METHODS Twelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small (less than 10 mm) submucosal tumors (SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection (ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique. RESULTS Two SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected en bloc. The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced via manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications (Clavien-Dindo classification grade III or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient. CONCLUSION LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors. PMID:28058023

Comparison of the efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection

PubMed Central

Kim, Namo; Yoo, Young-Chul; Lee, Sang Kil; Kim, Hyunzu; Ju, Hyang Mi; Min, Kyeong Tae

2015-01-01

AIM: To compare the efficacy and safety of sedation protocols for endoscopic submucosal dissection (ESD) between dexmedetomidine-remifentanil and propofol-remifentanil. METHODS: Fifty-nine patients scheduled for ESD were randomly allocated into a dexmedetomidine-remifentanil (DR) group or a propofol-remifentanil (PR) group. To control patient anxiety, dexmedetomidine or propofol was infused to maintain a score of 4-5 on the Modified Observer’s Assessment of Alertness/Sedation scale. Remifentanil was infused continuously at a rate of 6 μg/kg per hour in both groups. The ease of advancing the scope into the throat, gastric motility grading, and satisfaction of the endoscopist and patient were assessed. Hemodynamic variables and hypoxemic events were compared to evaluate patient safety. RESULTS: Demographic data were comparable between the groups. The hemodynamic variables and pulse oximetry values were stable during the procedure in both groups despite a lower heart rate in the DR group. No oxygen desaturation events occurred in either group. Although advancing the scope into the throat was easier in the PR group (“very easy” 24.1% vs 56.7%, P = 0.010), gastric motility was more suppressed in the DR group (“no + mild” 96.6% vs 73.3%, P = 0.013). The endoscopists felt that the procedure was more favorable in the DR group (“very good + good” 100% vs 86.7%, P = 0.042), whereas patient satisfaction scores were comparable between the groups. En bloc resection was performed 100% of the time in both groups, and the complete resection rate was 94.4% in the DR group and 100% in the PR group (P = 0.477). CONCLUSION: The efficacy and safety of dexmedetomidine and remifentanil were comparable to propofol and remifentanil during ESD. However, the endoscopists favored dexmedetomidine perhaps due to lower gastric motility. PMID:25834336

Efficacy and complication of endoscopic submucosal dissection for superficial esophageal carcinoma: a systematic review and meta-analysis

PubMed Central

2014-01-01

Aim For patients with superficial esophageal carcinoma, ESD was one of treatment modalities to remove the lesion safely and effectively. We perform this meta-analysis to determine the efficacy and incidence of complication of ESD for patients with superficial esophageal carcinoma. Method Articles were searched in MEDLINE (PubMed and Ovid), Cochrane Database of Systemic Reviews, Google scholar, and Web of Science. Two reviewers independently searched and extracted data. Meta-analysis of the efficacy of ESD was analyzed by calculating pooled en bloc and R0 resection rate. Incidence of complications such as perforation, stenosis and mediastinal emphysema was also calculated. Pooling was conducted using either fixed-effects model or random-effects model depending on the heterogeneity across studies. Results 21 studies (1152 patients and 1240 lesions) were included in this analysis. The pooled en bloc resection rate was 99% (95% CI 99%-100%). Stratified by tumor size, en bloc resection rates did not show any significant difference. The pooled R0 resection rate was 90% (95% CI 87%-93%). The pooled R0 resection rate was 85% (95% CI, 80%-90%) for large tumor and 92% (95% CI, 87%-93%) for small tumor (p < 0.001). Stenosis served as the most common reported complication with pooled incidence of 5% (95% CI 3-8%), followed by perforation (1%, 95% CI 0-1%) and mediastinal emphysema (0% CI 0-1%). The incidence of postoperative stenosis decreased significantly after 2011 (2%, 95% CI 0-3%) compared with that before 2011 (9%, 95% CI 3-8%) (p < 0.001). Conclusion ESD was an efficient modality for treating superficial esophageal carcinoma, with perfect en bloc and R0 resection rate and low complication rate. The most common complication of ESD was stenosis. Although recurrence rate was low, patients should be maintained in a scheduled surveillance program. PMID:24885614

Importance of histological evaluation in endoscopic resection of early colorectal cancer

PubMed Central

Yoshida, Naohisa; Naito, Yuji; Yagi, Nobuaki; Yanagisawa, Akio

2012-01-01

The diagnostic criteria for colonic intraepithelial tumors vary from country to country. While intramucosal adenocarcinoma is recognized in Japan, in Western countries adenocarcinoma is diagnosed only if the tumor invades to the submucosa and accesses the muscularis mucosae. However, endoscopic therapy, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), is used worldwide to treat adenoma and early colorectal cancer. Precise histopathological evaluation is important for the curativeness of these therapies as inappropriate endoscopic therapy causes local recurrence of the tumor that may develop into fatal metastasis. Therefore, colorectal ESD and EMR are not indicated for cancers with massive submucosal invasion. However, diagnosis of cancer with massive submucosal invasion by endoscopy is limited, even when magnifying endoscopy for pit pattern and narrow band imaging and flexible spectral imaging color of enhancement are performed. Therefore, occasional cancers with massive submucosal invasion will be treated by ESD and EMR. Precise histopathological evaluation of these lesions should be performed in order to determine the necessity of additional therapy, including surgical resection. PMID:22532932

Usefulness of a novel slim type FlushKnife-BT over conventional FlushKnife-BT in esophageal endoscopic submucosal dissection.

PubMed

Ohara, Yoshiko; Toyonaga, Takashi; Hoshi, Namiko; Tanaka, Shinwa; Baba, Shinichi; Takihara, Hiroshi; Kawara, Fumiaki; Ishida, Tsukasa; Morita, Yoshinori; Umegaki, Eiji; Azuma, Takeshi

2017-03-07

To investigated the usefulness of a novel slim type ball-tipped FlushKnife (FlushKnife-BTS) over ball-tipped FlushKnife (FlushKnife-BT) in functional experiments and clinical practice. In order to evaluate the functionality of FlushKnife-BTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between FlushKnife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using FlushKnife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were analyzed. Functional experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with FlushKnife-BTS was 7.7-fold faster than that with conventional FlushKnife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushKnife-BTS. The waterjet flushing speed was faster with the use of FlushKnife-BT. In clinical practice, a comparison of 6 and 7 ESD using FlushKnife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm 2 /min (range 19.6-30.3) in the BT group and 44.2 mm 2 /min (range 15.5-55.4) in the BTS group ( P = 0.0633). However, the median treatment speed was significantly faster with FlushKnife-BTS when the resection size was larger than 1000 m 2 ( n = 4, median 24.2 mm 2 /min, range 19.6-27.7 vs n = 4, median 47.4 mm 2 /min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15) ( P = 0.0065). Our results indicate that FlushKnife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspiration and knife insertion during ESD and reducing the frequency of knife removal and reinsertion.

Update on Difficult Polypectomy Techniques.

PubMed

Ngamruengphong, Saowanee; Pohl, Heiko; Haito-Chavez, Yamile; Khashab, Mouen A

2016-01-01

Endoscopists often encounter colon polyps that are technically difficult to resect. These lesions traditionally were managed surgically, with significant potential morbidity and mortality. Recent advances in endoscopic techniques and instruments have allowed endoscopists to safely and effectively remove colorectal lesions with high technical and clinical success and potentially avoid invasive surgery. Endoscopic mucosal resection (EMR) has gained acceptance as the first-line therapy for large colorectal lesions. Endoscopic submucosal dissection (ESD) has been reported to be associated with higher rate of en bloc resection and less risk of short-time recurrence, but with an increased risk of adverse events. Therefore, the role of colorectal ESD should be restricted to lesions with high-risk morphologic features of submucosal invasion. In this article, we review the recent literature on the endoscopic management of difficult colorectal neoplasms.

The effect of sequential therapy with lansoprazole and ecabet sodium in treating iatrogenic gastric ulcer after endoscopic submucosal dissection: a randomized prospective study.

PubMed

Ahn, Ji Yong; Choi, Chang Hwan; Lee, Jang Wook; Park, Sung Jin; Kim, Jeong Wook; Chang, Sae Kyung; Han, Seung Bong

2015-02-01

Ecabet sodium (ES) is a new non-systemic anti-ulcer agent belonging to the category of gastroprotective agents. In this study we aimed to compare the efficacy of a combination therapy with lansoprazole (LS) followed by ES with LS alone in treating endoscopic submucosal dissection (ESD)-induced iatrogenic gastric ulcers. Patients diagnosed with gastric adenomas or early gastric cancer were randomly divided into either the LS group (30 mg once daily for 4 weeks; n = 45) or the LS + ES group (LS 30 mg once daily for one week followed by ES 1500 mg twice daily for 3 weeks; n = 45). Four weeks after ESD, a follow-up endoscopy was conducted to evaluate the proportions of ulcer reduction and ulcer stages in the two groups. In all, 79 patients were included in the final analyses. Both treatment modalities were well-tolerated in most patients, with a drug compliance of over 80%. There were no significant differences between the two groups in terms of the proportions of ulcer reduction (0.9503 ± 0.1215 in the LS group vs 0.9192 ± 0.0700 in the LS + ES group, P = 0.169) or ulcer stage (P = 0.446). The prevalence of adverse events related to drugs and bleeding were also similar between the two groups. Sequential therapy with LS + ES is as effective as LS alone against ESD-induced gastric ulcers. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

ADSC-sheet Transplantation to Prevent Stricture after Extended Esophageal Endoscopic Submucosal Dissection.

PubMed

Perrod, Guillaume; Pidial, Laetitia; Camilleri, Sophie; Bellucci, Alexandre; Casanova, Amaury; Viel, Thomas; Tavitian, Bertrand; Cellier, Chirstophe; Clément, Olivier; Rahmi, Gabriel

2017-02-10

In past years, the cell-sheet construct has spurred wide interest in regenerative medicine, especially for reconstructive surgery procedures. The development of diversified technologies combining adipose tissue-derived stromal cells (ADSCs) with various biomaterials has led to the construction of numerous types of tissue-engineered substitutes, such as bone, cartilage, and adipose tissues from rodent, porcine, or human ADSCs. Extended esophageal endoscopic submucosal dissection (ESD) is responsible for esophageal stricture formation. Stricture prevention remains challenging, with no efficient treatments available. Previous studies reported the effectiveness of mucosal cell-sheet transplantation in a canine model and in humans. ADSCs are attributed anti-inflammatory properties, local immune modulating effects, neovascularization induction, and differentiation abilities into mesenchymal and non-mesenchymal lineages. This original study describes the endoscopic transplantation of an ADSC tissue-engineered construct to prevent esophageal stricture in a swine model. The ADSC construct was composed of two allogenic ADSC sheets layered upon each other on a paper support membrane. The ADSCs were labeled with the PKH67 fluorophore to allow probe-based confocal laser endomicroscopy (pCLE) monitoring. On the day of transplantation, a 5-cm and hemi-circumferential ESD known to induce esophageal stricture was performed. Animals were immediately endoscopically transplanted with 4 ADSC constructs. The complete adhesion of the ADSC constructs was obtained after 10 min of gentle application. Animals were sacrificed on day 28. All animals were successfully transplanted. Transplantation was confirmed on day 3 with a positive pCLE evaluation. Compared to transplanted animals, control animals developed severe strictures, with major fibrotic tissue development, more frequent alimentary trouble, and reduced weight gain. In our model, the transplantation of allogenic ADSCs, organized in double cell sheets, after extended ESD was successful and strongly associated with a lower esophageal stricture rate.

Role of observation of live cases done by Japanese experts in the acquisition of ESD skills by a western endoscopist.

PubMed

Draganov, Peter V; Chang, Myron; Coman, Roxana M; Wagh, Mihir S; An, Qi; Gotoda, Takuji

2014-04-28

To evaluate the role of observation of experts performing endoscopic submucosal dissection (ESD) in the acquisition of ESD skills. This prospective study is documenting the learning curve of one Western endoscopist. The study consisted of three periods. In the first period (pre-observation), the trainee performed ESDs in animal models in his home institution in the United States. The second period (observation) consisted of visit to Japan and observation of live ESD cases done by experts. The observation of cases occurred over a 5-wk period. During the third period (post-observation), the trainee performed ESD in animal models in a similar fashion as in the first period. Three animal models were used: live 40-50 kg Yorkshire pig, explanted pig stomach model, and explanted pig rectum model. The outcomes from the ESDs done in the animal models before and after observation of live human cases (main study intervention) were compared. Statistical analysis of the data included: Fisher's exact test to compare distributions of a categorical variable, Wilcoxon rank sum test to compare distributions of a continuous variable between the two groups (pre-observation and post-observation), and Kruskal-Wallis test to evaluate the impact of lesion location and type of model (ex-vivo vs live pig) on lesion removal time. The trainee performed 38 ESDs in animal model (29 pre-observation/9 post-observation). The removal times post-observation were significantly shorter than those pre-observation (32.7 ± 15.0 min vs 63.5 ± 9.8 min, P < 0.001). To minimize the impact of improving physician skill, the 9 lesions post-observation were compared to the last 9 lesions pre-observation and the removal times remained significantly shorter (32.7 ± 15.0 min vs 61.0 ± 7.4 min, P = 0.0011). Regression analysis showed that ESD observation significantly reduced removal time when controlling for the sequence of lesion removal (P = 0.025). Furthermore, it was also noted a trend towards decrease in failure to remove lesions and decrease in complications after the period of observation. This study did not find a significant difference in the time needed to remove lesions in different animal models. This finding could have important implications in designing training programs due to the substantial difference in cost between live animal and explanted organ models. The main limitation of this study is that it reflects the experience of a single endoscopist. Observation of experts performing ESD over short period of time can significantly contribute to the acquisition of ESD skills.

Useful strategies to prevent severe stricture after endoscopic submucosal dissection for superficial esophageal neoplasm.

PubMed

Uno, Kaname; Iijima, Katsunori; Koike, Tomoyuki; Shimosegawa, Tooru

2015-06-21

The minimal invasiveness of endoscopic submucosal dissection (ESD) prompted us to apply this technique to large-size early esophageal squamous cell carcinoma and Barrett's adenocarcinoma, despite the limitations in the study population and surveillance duration. A post-ESD ulceration of greater than three-fourths of esophageal circumference was advocated as an important risk factor for refractory strictures that require several sessions of dilation therapy. Most of the preoperative conditions are asymptomatic, but dilatation treatment for dysphagia associated with the stricture has potential risks of severe complications and a worsening of quality of life. Possible mechanisms of dysphasia were demonstrated based on dysmotility and pathological abnormalities at the site: (1) delayed mucosal healing; (2) severe inflammation and disorganized fibrosis with abundant extracellular matrices in the submucosa; and (3) atrophy in the muscularis proper. However, reports on the administration of anti-scarring agents, preventive dilation therapies, and regenerative medicine demonstrated limited success in stricture prevention, and there were discrepancies in the study designs and protocols of these reports. The development and consequent long-term assessments of new prophylactic technologies on the promotion of wound healing and control of the inflammatory/tumor microenvironment will require collaboration among various research fields because of the limited accuracy of preoperative staging and high-risk of local recurrence.

Useful strategies to prevent severe stricture after endoscopic submucosal dissection for superficial esophageal neoplasm

PubMed Central

Uno, Kaname; Iijima, Katsunori; Koike, Tomoyuki; Shimosegawa, Tooru

2015-01-01

The minimal invasiveness of endoscopic submucosal dissection (ESD) prompted us to apply this technique to large-size early esophageal squamous cell carcinoma and Barrett’s adenocarcinoma, despite the limitations in the study population and surveillance duration. A post-ESD ulceration of greater than three-fourths of esophageal circumference was advocated as an important risk factor for refractory strictures that require several sessions of dilation therapy. Most of the preoperative conditions are asymptomatic, but dilatation treatment for dysphagia associated with the stricture has potential risks of severe complications and a worsening of quality of life. Possible mechanisms of dysphasia were demonstrated based on dysmotility and pathological abnormalities at the site: (1) delayed mucosal healing; (2) severe inflammation and disorganized fibrosis with abundant extracellular matrices in the submucosa; and (3) atrophy in the muscularis proper. However, reports on the administration of anti-scarring agents, preventive dilation therapies, and regenerative medicine demonstrated limited success in stricture prevention, and there were discrepancies in the study designs and protocols of these reports. The development and consequent long-term assessments of new prophylactic technologies on the promotion of wound healing and control of the inflammatory/tumor microenvironment will require collaboration among various research fields because of the limited accuracy of preoperative staging and high-risk of local recurrence. PMID:26109798

Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments

PubMed Central

Hirasawa, Kingo; Sato, Chiko; Makazu, Makomo; Kaneko, Hiroaki; Kobayashi, Ryosuke; Kokawa, Atsushi; Maeda, Shin

2015-01-01

Various procedure-related adverse events related to colonoscopic treatment have been reported. Previous studies on the complications of colonoscopic treatment have focused primarily on perforation or bleeding. Coagulation syndrome (CS), which is synonymous with transmural burn syndrome following endoscopic treatment, is another typical adverse event. CS is the result of electrocoagulation injury to the bowel wall that induces a transmural burn and localized peritonitis resulting in serosal inflammation. CS occurs after polypectomy, endoscopic mucosal resection (EMR), and even endoscopic submucosal dissection (ESD). The occurrence of CS after polypectomy or EMR varies according previous reports; most report an occurrence rate around 1%. However, artificial ulcers after ESD are largely theoretical, and CS following ESD was reported in about 9% of cases, which is higher than that for CS after polypectomy or EMR. Most cases of post-polypectomy syndrome (PPS) have an excellent prognosis, and they are managed conservatively with medical therapy. PPS rarely develops into delayed perforation. Delayed perforation is a severe adverse event that often requires emergency surgery. Since few studies have reported on CS and delayed perforation associated with CS, we focused on CS after colonoscopic treatments in this review. Clinicians should consider delayed perforation in CS patients. PMID:26380051

Imaging indicator for ESD safety testing.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Whinnery, LeRoy L.,; Nissen, April; Keifer, Patrick N.

2013-05-01

This report describes the development of a new detection method for electrostatic discharge (ESD) testing of explosives, using a single-lens reflex (SLR) digital camera and a 200-mm macro lens. This method has demonstrated several distinct advantages to other current ESD detection methods, including the creation of a permanent record, an enlarged image for real-time viewing as well as extended periods of review, and ability to combine with most other Go/No-Go sensors. This report includes details of the method, including camera settings and position, and results with wellcharacterized explosives PETN and RDX, and two ESD-sensitive aluminum powders.

A case of gastric hamartomatous inverted polyp resected endoscopically

PubMed Central

Dohi, Moyu; Gen, Yasuyuki; Yoshioka, Mika

2016-01-01

We report the case of a 55-year-old woman with a tumor in the greater curvature of the upper gastric body. The tumor was incidentally found on an upper gastrointestinal X-ray series performed during a routine medical examination. Whereas endoscopy revealed a gastric submucosal tumor (SMT), endoscopic ultrasonography demonstrated a heterogeneous tumor with small, cystic, hypoechoic spots originating from the second layer. The patient was clinically asymptomatic, with no contributory family history or abnormal laboratory data. The results of a physical examination, abdominal computed tomography, and plain chest radiography were all unremarkable. Although the endoscopic tumor type was determined to be SMT, the tumor was successfully resected by endoscopic submucosal dissection (ESD) and subsequently diagnosed as a gastric hamartomatous inverted polyp (GHIP). The findings of the present case highlight the importance of considering GHIP as a diagnosis and indicate the utility of en bloc resection of GHIP with ESD. PMID:27556064

MicroRNA‑499 rs3746444 A/G polymorphism functions as a biomarker to predict recurrence following endoscopic submucosal dissection in primary early gastric cancer.

PubMed

Shi, Huiyong; Yang, Xiangshan; Zhen, Yanan; Huo, Shoujun; Xiao, Ruixue; Xu, Zhongfa

2017-05-01

The aim of the present study was to investigate the molecular mechanism, including the potential regulatory and signaling pathways, of platelet‑derived growth factor receptor β (PDGFRB), which underlies the recurrence of early gastric cancer (EGC) following endoscopic submucosal dissection (ESD). Online microRNA (miRNA) target prediction tools were used, which identified PDGFRB as the candidate target gene of miR‑499a in gastric cancer cells, and PFGRBR was then confirmed as the direct gene using a luciferase reporter assay system. The Kaplan‑Meier method was used to plot recurrence‑free curves, which were compared between genotype groups. A negative regulatory association between miR‑499a and PDGFRB was established by investigating the relative luciferase activity at different concentrations of miR‑499a mimics. Furthermore, as the rs3746444 polymorphism has been previously reported to interfere with the expression of miR‑499a, the present study investigated the expression levels of different genotypes, including TT (n=20), TC (n=9) and CC (n=3), the results of which supported the hypothesis that the presence of the minor allele (C) of the rs3746444 polymorphism compromised the expression of miR‑499a. The present study also performed polymerase chain reaction and western blot analyses to examine the mRNA and protein expression levels of PFGRBR among different genotypes or cells treated with different concentrations of miR‑499a mimics/inhibitors, which indicated the negative regulatory association between miR‑499a and PDGFRB. The present study also investigated the relative viabilities of EGC cells transfected with miR‑499a mimics (50 and 100 nM) and miR‑499a inhibitors (100 nM), and confirmed that miR‑499a negatively interfered with the viability of the EGC cells. The miR‑499a rs3746444 polymorphism was also recognized as a biomarker to predict recurrence following ESD in patients with EGC via analyzing the recurrence‑free rates among patients with EGC with different genotypes. The results showed that PDGFRB was validated as a target of miR‑499a, and rs3746444 was identified as a potential biomarker to predict the recurrence of EGC following ESD.

Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors.

PubMed

Ichikawa, Daisuke; Komatsu, Shuhei; Dohi, Osamu; Naito, Yuji; Kosuga, Toshiyuki; Kamada, Kazuhiro; Okamoto, Kazuma; Itoh, Yoshito; Otsuji, Eigo

2016-12-21

To assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery (LECS) for early non-ampullary duodenal tumors. Twelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small (less than 10 mm) submucosal tumors (SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection (ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique. Two SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected en bloc . The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced via manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications (Clavien-Dindo classification grade III or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient. LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors.

Utility of double endoscopic intraluminal operation for esophageal cancer.

PubMed

Sohda, Makoto; Saito, Hideyuki; Yoshida, Tomonori; Kumakura, Yuji; Honjyo, Hiroaki; Hara, Keigo; Ozawa, Daigo; Suzuki, Shigemasa; Tanaka, Naritaka; Sakai, Makoto; Miyazaki, Tatsuya; Fukuchi, Minoru; Kuwano, Hiroyuki

2017-08-01

Endoscopic submucosal dissection (ESD) is a more difficult technique for esophageal cancer than for gastric cancer because the working space for esophageal ESD is small. Further, the difficulty level gradually increases depending on the size of the carcinoma. To overcome these difficulties, double endoscopic intraluminal operation (DEILO), which enables the resection of mucosal lesions using two fine endoscopes and monopolar shears, was reported previously. Here, we report the utility of DEILO for esophageal cancer. A total of 26 esophageal cancer patients (19 men and seven women) with 26 lesions treated using DEILO between 2011 and 2014 at Gunma University Hospital were included. We evaluated the utility and safety of DEILO for early esophageal cancer. For all patients (100%), the DEILO procedure was performed successfully, and en bloc resection was achieved. The median operation time, postoperative hospital stay, and the longitudinal dimension of resected specimens were 123 min (range 45-236 min), 5 days, and 32 mm, respectively. Perioperative perforation, pneumothorax, and mediastinal emphysema were not recognized. Only one patient was diagnosed with a postoperative hemorrhage, but the bleeding was successfully treated by bleeding vessel coagulation. DEILO has good utility as a technique of ESD for early esophageal cancers. Additional improvement and advancement of the procedure will increase the indication of DEILO.

Methodology to model the energy and greenhouse gas emissions of electronic software distributions.

PubMed

Williams, Daniel R; Tang, Yinshan

2012-01-17

A new electronic software distribution (ESD) life cycle analysis (LCA) methodology and model structure were constructed to calculate energy consumption and greenhouse gas (GHG) emissions. In order to counteract the use of high level, top-down modeling efforts, and to increase result accuracy, a focus upon device details and data routes was taken. In order to compare ESD to a relevant physical distribution alternative, physical model boundaries and variables were described. The methodology was compiled from the analysis and operational data of a major online store which provides ESD and physical distribution options. The ESD method included the calculation of power consumption of data center server and networking devices. An in-depth method to calculate server efficiency and utilization was also included to account for virtualization and server efficiency features. Internet transfer power consumption was analyzed taking into account the number of data hops and networking devices used. The power consumed by online browsing and downloading was also factored into the model. The embedded CO(2)e of server and networking devices was proportioned to each ESD process. Three U.K.-based ESD scenarios were analyzed using the model which revealed potential CO(2)e savings of 83% when ESD was used over physical distribution. Results also highlighted the importance of server efficiency and utilization methods.

Examining the Stationarity Assumption for Statistically Downscaled Climate Projections of Precipitation

NASA Astrophysics Data System (ADS)

Wootten, A.; Dixon, K. W.; Lanzante, J. R.; Mcpherson, R. A.

2017-12-01

Empirical statistical downscaling (ESD) approaches attempt to refine global climate model (GCM) information via statistical relationships between observations and GCM simulations. The aim of such downscaling efforts is to create added-value climate projections by adding finer spatial detail and reducing biases. The results of statistical downscaling exercises are often used in impact assessments under the assumption that past performance provides an indicator of future results. Given prior research describing the danger of this assumption with regards to temperature, this study expands the perfect model experimental design from previous case studies to test the stationarity assumption with respect to precipitation. Assuming stationarity implies the performance of ESD methods are similar between the future projections and historical training. Case study results from four quantile-mapping based ESD methods demonstrate violations of the stationarity assumption for both central tendency and extremes of precipitation. These violations vary geographically and seasonally. For the four ESD methods tested the greatest challenges for downscaling of daily total precipitation projections occur in regions with limited precipitation and for extremes of precipitation along Southeast coastal regions. We conclude with a discussion of future expansion of the perfect model experimental design and the implications for improving ESD methods and providing guidance on the use of ESD techniques for impact assessments and decision-support.

Electrostatic Evaluation: SCAPE Suit Materials

NASA Technical Reports Server (NTRS)

Buhler, Charles; Calle, Carlos

2005-01-01

The surface resistivity tests are performed per the requirements of the ESD Association Standard Test Method ESD STM11.11*. These measurements are taken using a PRS-801 resistance system with an Electro Tech System (ETS) PRF-911 concentric ring resistance probe. The tests require a five pound weight on top of cylindrical electrodes and were conducted at both ambient and low humidity conditions. In order for materials to "pass" resistivity tests the surface of the materials must either be conductive or statically dissipative otherwise the materials "fail" ESD. Volume resistivity tests are also conducted to measure conductivity through the material as opposed to conductivity along the surface. These tests are conducted using the same PRS-801 resistance system with the Electro Tech System PRF-911 concentric ring resistance probe but are performed in accordance with ESD Association Standard Test Method ESD STM11.l2**.

Clinical outcomes of endoscopic submucosa dissection for high-grade dysplasia from endoscopic forceps biopsy.

PubMed

Ryu, Dae Gon; Choi, Cheol Woong; Kang, Dae Hwan; Kim, Hyung Wook; Park, Su Bum; Kim, Su Jin; Nam, Hyeong Seok

2017-07-01

Although the Vienna Classification recommends endoscopic resection for gastric high-grade dysplasia (HGD), many resected lesions are diagnosed as gastric cancer after endoscopic resection. This study aims to evaluate the clinical outcomes of gastric HGD identified by endoscopic forceps biopsy (EFB) after endoscopic submucosal dissection (ESD) and factors associated with discrepant results. From December 2008 to July 2015, a total of 427 lesions diagnosed as initial HGD by EFB were enrolled. The rate of early gastric cancer (EGC) and factors predicting diagnosis upgrade were analyzed retrospectively. Tumors ranged between 2 and 65 mm in size (median 12.59). En bloc and complete resection rates were 97.4 and 95.3%, respectively. The diagnostic discrepancy rate was 76.3%. Upgrade and downgrade rates of pathological diagnoses were 66.5 and 9.8%, respectively. Central depression (OR 4.151), nodular surface (OR 5.582), surface redness (OR 2.926), lesion location (upper third of the stomach) (OR 3.894), and tumor size ≥10 mm (OR 2.287) were significantly associated with EGC. Nodular surface (OR 2.746), submucosal fibrosis (OR 3.958), lesion location (upper third of the stomach) (OR 6.652), and tumor size ≥10 mm (OR 4.935) significantly predicted invasive submucosal cancer. Central depression, nodular surface, surface redness, lesion location, large tumor size, and submucosal fibrosis were associated with EGC or submucosal cancer. Caution must be used in treating lesions with these features with ESD.

Prospective trial of biodegradable stents for refractory benign esophageal strictures after curative treatment of esophageal cancer.

PubMed

Yano, Tomonori; Yoda, Yusuke; Nomura, Shogo; Toyosaki, Kayo; Hasegawa, Hiromi; Ono, Hiroyuki; Tanaka, Masaki; Morimoto, Hiroyuki; Horimatsu, Takahiro; Nonaka, Satoru; Kaneko, Kazuhiro; Sato, Akihiro

2017-09-01

Biodegradable stents are reportedly effective for refractory benign esophageal strictures; however, little is known about their use in patients with refractory stricture after endoscopic submucosal dissection (ESD) or chemoradiotherapy (CRT) for esophageal cancer. This study aimed to evaluate the effectiveness of biodegradable stents for these patients. Patients with refractory benign esophageal stricture with a dysphagia score (DS) of 2 or worse and for whom the passage of a standard size endoscope was not possible were eligible. The primary endpoint was the proportion of those who improved their DSs (% DS improved) at 12 weeks after stent placement, and the secondary endpoints were the proportion of those who improved their DSs at 24 weeks, dysphagia-free survival (DFS), and adverse events. Eighteen patients (men:women, 15:3; median age, 72 years; range, 53-80) were enrolled. Twelve patients improved their DS at 12 weeks (% DS improved, 66.7%; 90% CI, 44.6%-84.4%). Also, 8 of 11 patients (72.7%) after esophagectomy, 4 of 6 patients (66.7%) after ESD, and 3 of 4 patients (75%) after CRT improved at 12 weeks. Three patients who were treated with esophagectomy maintained their DS improvement at 24 weeks (% DS improved, 16.7%; 95% CI, 3.6%-41.4%). The median DFS was 14.1 weeks (95% CI, 13.0-19.0). One patient who had ESD and CRT developed an esophagobronchial fistula 3 months after stent placement. Biodegradable stents are effective and tolerable for refractory benign esophageal strictures after treatment for esophageal cancer; however, long-term efficacy was limited, especially after ESD or CRT. (Clinical trial registration number: UMIN000008054.). Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Combining eastern and western practices for safe and effective endoscopic resection of large complex colorectal lesions.

PubMed

Emmanuel, Andrew; Gulati, Shraddha; Burt, Margaret; Hayee, Bu'Hussain; Haji, Amyn

2018-05-01

Endoscopic resection of large colorectal polyps is well established. However, significant differences in technique exist between eastern and western interventional endoscopists. We report the results of endoscopic resection of large complex colorectal lesions from a specialist unit that combines eastern and western techniques for assessment and resection. Endoscopic resections of colorectal lesions of at least 2 cm were included. Lesions were assessed using magnification chromoendoscopy supplemented by colonoscopic ultrasound in selected cases. A lesion-specific approach to resection with endoscopic mucosal resection or endoscopic submucosal dissection (ESD) was used. Surveillance endoscopy was performed at 3 (SC1) and 12 (SC2) months. Four hundred and sixty-six large (≥20 mm) colorectal lesions (mean size 54.8 mm) were resected. Three hundread and fifty-six were resected using endoscopic mucosal resection and 110 by ESD or hybrid ESD. Fifty-one percent of lesions had been subjected to previous failed attempts at resection or heavy manipulation (≥6 biopsies). Nevertheless, endoscopic resection was deemed successful after an initial attempt in 98%. Recurrence occurred in 15% and could be treated with endoscopic resection in most. Only two patients required surgery for perforation. Nine patients had postprocedure bleeding; only two required endoscopic clips. Ninety-six percent of patients without invasive cancer were free from recurrence and had avoided surgery at last follow-up. Combining eastern and western practices for assessment and resection results in safe and effective organ-conserving treatment of complex colorectal lesions. Accurate assessment before and after resection using magnification chromoendoscopy and a lesion-specific approach to resection, incorporating ESD where appropriate, are important factors in achieving these results.

[A Case of Lymph Node Metastasis of Rectal Laterally Spreading Tumor with Mucosal Cancer after Endoscopic Submucosal Dissection].

PubMed

Ushigome, Hajime; Fujimoto, Yoshiya; Suzuki, Shinsuke; Minami, Hironori; Miyanari, Shun; Murahashi, Satoshi; Fukuoka, Hironori; Nagasaki, Toshiya; Akiyoshi, Takashi; Konishi, Tsuyoshi; Nagayama, Satoshi; Fukunaga, Yosuke; Ueno, Masashi; Chino, Akiko; Igarashi, Masahiro

2017-11-01

A screening fecal occult blood test was positive in a 76-year-old female. Colonoscopy showed laterally spreading tumor (LST)over 15 cm at lower rectum. endoscopic submucosal dissection(ESD)was performed. Pathological findings showed LST-G, 150×100 mm, adenocarcinoma(tub1-tub2), tubular adenoma, moderate-severe atypia, Tis(M), ly(-), v(-), HMX, VMX. Two years later CT detected one swollen lymph node at mesorectum and PET-CT showed FDG up take at the lymph node. We diagnosed lymph node metastasis, performed laparoscopic very low anterior resection. Pathological findings showed one lymph node metastasis, but there were no residual cancer at rectum. We cut the surgical specimen at 5mm intervals because of it's big size. It might be impossible with this procedure to detect SM invasion at this specimen.

Predictive factors suggesting an underestimation of gastric lesions initially diagnosed as adenomas by forceps biopsy.

PubMed

Ko, Sung Jun; Yang, Min A; Yun, So Hee; Park, Moon Sik; Han, Shang Hoon; Cho, Jin Woong

2016-03-01

The endoscopic forceps biopsy of gastric lesion may provide inadequate specimens for a correct diagnosis of the entire lesion. Therefore, a histologic discrepancy may exist between specimens obtained by forceps biopsy and by endoscopic resection. The aim of this study was to evaluate the endoscopic characteristics of an underestimation in gastric carcinomas initially diagnosed as adenomas by forceps biopsy. We retrospectively reviewed 431 lesions diagnosed as gastric adenomas by forceps biopsy and resected by endoscopic submucosal dissection (ESD) between January 2008 and December 2011. The endoscopic findings were reviewed for location, size, gross appearance, ulceration, and surface color. We compared these variables between the adenoma group and the carcinoma group, as defined by the post-resection pathological findings. The mean patient age was 65.63±9.30 years in the adenoma group and 64.75±10.30 years in the carcinoma group. The mean size of the lesion was 21.04±8.65 mm in the adenoma group and 22.06±7.46 mm in the carcinoma group. In the multivariate analysis, high-grade dysplasia from endoscopic forceps biopsy and red discoloration were significant variables associated with carcinoma in post-resection histology. Gastric adenomatous lesions with endoscopic characteristics of surface redness and high-grade dysplasia on forceps biopsy should be resected completely by ESD because of the high possibility of an underestimation after ESD.

ESD and Education for All: Synergies and Potential Conflicts

ERIC Educational Resources Information Center

Gadotti, Moacir

2010-01-01

This paper analyses how Education for Sustainable Development (ESD) can assist in increasing access to quality education and discusses how it can contribute to the content and learning methods on the Education for All (EFA) agenda. It explores both the tensions and the common ground between ESD and EFA, and identifies the potential synergies…

Entrance surface dose measurements using a small OSL dosimeter with a computed tomography scanner having 320 rows of detectors.

PubMed

Takegami, Kazuki; Hayashi, Hiroaki; Yamada, Kenji; Mihara, Yoshiki; Kimoto, Natsumi; Kanazawa, Yuki; Higashino, Kousaku; Yamashita, Kazuta; Hayashi, Fumio; Okazaki, Tohru; Hashizume, Takuya; Kobayashi, Ikuo

2017-03-01

Entrance surface dose (ESD) measurements are important in X-ray computed tomography (CT) for examination, but in clinical settings it is difficult to measure ESDs because of a lack of suitable dosimeters. We focus on the capability of a small optically stimulated luminescence (OSL) dosimeter. The aim of this study is to propose a practical method for using an OSL dosimeter to measure the ESD when performing a CT examination. The small OSL dosimeter has an outer width of 10 mm; it is assumed that a partial dose may be measured because the slice thickness and helical pitch can be set to various values. To verify our method, we used a CT scanner having 320 rows of detectors and checked the consistencies of the ESDs measured using OSL dosimeters by comparing them with those measured using Gafchromic™ films. The films were calibrated using an ionization chamber on the basis of half-value layer estimation. On the other hand, the OSL dosimeter was appropriately calibrated using a practical calibration curve previously proposed by our group. The ESDs measured using the OSL dosimeters were in good agreement with the reference ESDs from the Gafchromic™ films. Using these data, we also estimated the uncertainty of ESDs measured with small OSL dosimeters. We concluded that a small OSL dosimeter can be considered suitable for measuring the ESD with an uncertainty of 30 % during CT examinations in which pitch factors below 1.000 are applied.

ESD Implementation at the School Organisation Level, Part 2--Investigating the Transformative Perspective in School Leaders' Quality Strategies at ESD Schools

ERIC Educational Resources Information Center

Mogren, Anna; Gericke, Niklas

2017-01-01

Previous research has suggested that adopting a transformative school organisation perspective when implementing ESD may be more productive than the previously recommended transmissive perspectives, but it is not clear how transformative perspectives could be introduced. To address this issue, we conducted an empirical mixed methods study of…

Practicing ESD at School: Integration of Formal and Nonformal Education Methods Based on the Earth Charter (Belarusian Experience)

ERIC Educational Resources Information Center

Savelava, Sofia; Savelau, Dmitry; Cary, Marina Bakhnova

2010-01-01

The Earth Charter represents the philosophy and ethics necessary to create a new period of human civilization. Understanding and adoption of this new vision is the most important mission of education for sustainable development (ESD). This article argues that for successful implementation of ESD principles at school, the school education system…

Differential Diagnosis of Erythmato-Squamous Diseases Using Classification and Regression Tree

PubMed Central

Maghooli, Keivan; Langarizadeh, Mostafa; Shahmoradi, Leila; Habibi-koolaee, Mahdi; Jebraeily, Mohamad; Bouraghi, Hamid

2016-01-01

Introduction: Differential diagnosis of Erythmato-Squamous Diseases (ESD) is a major challenge in the field of dermatology. The ESD diseases are placed into six different classes. Data mining is the process for detection of hidden patterns. In the case of ESD, data mining help us to predict the diseases. Different algorithms were developed for this purpose. Objective: we aimed to use the Classification and Regression Tree (CART) to predict differential diagnosis of ESD. Methods: we used the Cross Industry Standard Process for Data Mining (CRISP-DM) methodology. For this purpose, the dermatology data set from machine learning repository, UCI was obtained. The Clementine 12.0 software from IBM Company was used for modelling. In order to evaluation of the model we calculate the accuracy, sensitivity and specificity of the model. Results: The proposed model had an accuracy of 94.84% ( Standard Deviation: 24.42) in order to correct prediction of the ESD disease. Conclusions: Results indicated that using of this classifier could be useful. But, it would be strongly recommended that the combination of machine learning methods could be more useful in terms of prediction of ESD. PMID:28077889

ESD and lifelong learning: a case study of the Shangri-la Institute's current engagement with the Bazhu community in Diqing, China

NASA Astrophysics Data System (ADS)

Liu, Yunhua; Constable, Alicia

2010-06-01

This article argues that ESD should be integrated into lifelong learning and provides an example of how this might be done. It draws on a case study of a joint project between the Shangri-la Institute and the Bazhu community in Diqing, southwest China, to analyse a community-based approach to Education for Sustainable Development and assess its implications for lifelong learning. The article examines the different knowledge, skills and values needed for ESD across the life span and asserts the need for these competencies to be informed by the local context. The importance of linking ESD with local culture and indigenous knowledge is emphasised. The article goes on to propose methods for integrating ESD into lifelong learning and underscore the need for learning at the individual, institutional and societal levels in formal, non-formal and informal learning settings. It calls for institutional changes that link formal, non-formal and informal learning through the common theme of ESD, and establish platforms to share experiences, reflect on these and thereby continually improve ESD.

A study of the initial oxidation of evaporated thin films of aluminum by AES, ELS, and ESD

NASA Technical Reports Server (NTRS)

Bujor, M.; Larson, L. A.; Poppa, H.

1982-01-01

The room temperature, low pressure, oxidation of evaporated aluminum thin films has been studied by AES, ELS, and ESD. ESD was the most sensitive of the three methods to characterize a clean aluminum surface. Two oxidation stages were distinguished in the 0-3000 L oxygen exposure range. Between 0 and 50 L, the chemisorption of oxygen atoms was characterized by a fast decrease of the 67 eV AES Al peak and the 10 eV surface plasmon peak, and by a simultaneous increase of the oxygen AES and ESD signals. After 50 L, a change in slope in all AES and ESD signal variations was attributed to the slow growth of a thin layer of aluminum oxide, which after 3000 L was still only a few angstroms thick.

Practical calibration curve of small-type optically stimulated luminescence (OSL) dosimeter for evaluation of entrance skin dose in the diagnostic X-ray region.

PubMed

Takegami, Kazuki; Hayashi, Hiroaki; Okino, Hiroki; Kimoto, Natsumi; Maehata, Itsumi; Kanazawa, Yuki; Okazaki, Tohru; Kobayashi, Ikuo

2015-07-01

For X-ray diagnosis, the proper management of the entrance skin dose (ESD) is important. Recently, a small-type optically stimulated luminescence dosimeter (nanoDot OSL dosimeter) was made commercially available by Landauer, and it is hoped that it will be used for ESD measurements in clinical settings. Our objectives in the present study were to propose a method for calibrating the ESD measured with the nanoDot OSL dosimeter and to evaluate its accuracy. The reference ESD is assumed to be based on an air kerma with consideration of a well-known back scatter factor. We examined the characteristics of the nanoDot OSL dosimeter using two experimental conditions: a free air irradiation to derive the air kerma, and a phantom experiment to determine the ESD. For evaluation of the ability to measure the ESD, a calibration curve for the nanoDot OSL dosimeter was determined in which the air kerma and/or the ESD measured with an ionization chamber were used as references. As a result, we found that the calibration curve for the air kerma was determined with an accuracy of 5 %. Furthermore, the calibration curve was applied to the ESD estimation. The accuracy of the ESD obtained was estimated to be 15 %. The origin of these uncertainties was examined based on published papers and Monte-Carlo simulation. Most of the uncertainties were caused by the systematic uncertainty of the reading system and the differences in efficiency corresponding to different X-ray energies.

Differential Diagnosis of Erythmato-Squamous Diseases Using Classification and Regression Tree.

PubMed

Maghooli, Keivan; Langarizadeh, Mostafa; Shahmoradi, Leila; Habibi-Koolaee, Mahdi; Jebraeily, Mohamad; Bouraghi, Hamid

2016-10-01

Differential diagnosis of Erythmato-Squamous Diseases (ESD) is a major challenge in the field of dermatology. The ESD diseases are placed into six different classes. Data mining is the process for detection of hidden patterns. In the case of ESD, data mining help us to predict the diseases. Different algorithms were developed for this purpose. we aimed to use the Classification and Regression Tree (CART) to predict differential diagnosis of ESD. we used the Cross Industry Standard Process for Data Mining (CRISP-DM) methodology. For this purpose, the dermatology data set from machine learning repository, UCI was obtained. The Clementine 12.0 software from IBM Company was used for modelling. In order to evaluation of the model we calculate the accuracy, sensitivity and specificity of the model. The proposed model had an accuracy of 94.84% (. 24.42) in order to correct prediction of the ESD disease. Results indicated that using of this classifier could be useful. But, it would be strongly recommended that the combination of machine learning methods could be more useful in terms of prediction of ESD.

The implementation of education for sustainable development in Sweden: investigating the sustainability consciousness among upper secondary students

NASA Astrophysics Data System (ADS)

Berglund, Teresa; Gericke, Niklas; Rundgren, Shu-Nu Chang

2014-09-01

Background: Sustainable development (SD) is a complex idea, based on environmental, economic and social dimensions. In line with SD, education for sustainable development (ESD) is an approach to teaching that combines cognitive and affective domains and aims to build empowerment abilities. Purpose: The purpose of this article is to investigate effects of the implementation of ESD in Sweden, in terms of developing students' sustainability consciousness (SC). Two groups of students were included: one was from schools with a profile of ESD and the other one was from comparable schools without explicit ESD-profile. Sample: A total of 638 students from upper secondary schools (grade 12) in science-related or social science-related programs participated in the study. Design and methods: A procedure was created for the selection of schools considered to be the most active in using an ESD approach as well as comparable schools with no explicit ESD approach. During spring 2013, the students responded to a questionnaire based on sustainability knowingness, attitudes and behaviors within the environmental, economic and social dimensions of SD that together constitute the concept of SC. Data were analyzed using SPSS software. Results: The results indicate that there are significant differences in SC between students from schools that teach with an ESD approach compared to students from regular schools. Furthermore, a significant difference between the two groups of students was found in the underlying economic dimension of SC. No significant differences were found in the environmental and social dimensions of SC. Conclusions: Although the results show that ESD-profiled schools have effect on students' SC, the effects are relatively small. Therefore, the effects and nature of the implementation of ESD are discussed.

Challenging the Concept of Ethical Literacy within Education for Sustainable Development (ESD): Storytelling as a Method within Sustainability Didactics

ERIC Educational Resources Information Center

Franck, Olof; Osbeck, Christina

2018-01-01

Ethical literacy seems to be used, within Education for Sustainable Development (ESD), in various ways, some more general and others morally specific, emphasising individuals' responsibility. The overarching aim of this paper is to present some prerequisites for the development of narrative methods that focus on the vision of a good society…

BIMOS transistor solutions for ESD protection in FD-SOI UTBB CMOS technology

NASA Astrophysics Data System (ADS)

Galy, Philippe; Athanasiou, S.; Cristoloveanu, S.

2016-01-01

We evaluate the Electro-Static Discharge (ESD) protection capability of BIpolar MOS (BIMOS) transistors integrated in ultrathin silicon film for 28 nm Fully Depleted SOI (FD-SOI) Ultra Thin Body and BOX (UTBB) high-k metal gate technology. Using as a reference our measurements in hybrid bulk-SOI structures, we extend the BIMOS design towards the ultrathin silicon film. Detailed study and pragmatic evaluations are done based on 3D TCAD simulation with standard physical models using Average Current Slope (ACS) method and quasi-static DC stress (Average Voltage Slope AVS method). These preliminary 3D TACD results are very encouraging in terms of ESD protection efficiency in advanced FD-SOI CMOS.

Preliminary results of antiscarring therapy in the prevention of postendoscopic esophageal mucosectomy strictures

PubMed Central

Wu, Yuhsin; Schomisch, Steve J.; Cipriano, Cassandra; Chak, Amitabh; Lash, Richard H.; Ponsky, Jeffrey L.

2015-01-01

Background Esophageal endoscopic submucosal dissection (ESD) is an effective minimally invasive therapy for early esophageal cancer and high-grade Barrett dysplasia. However, esophageal stricture formation after circumferential or large ESD has limited its wide adoption. Mitomycin C (MMC), halofuginone (Hal), and transforming growth factor β3 (TGF-β3) exhibits antiscarring effects that may prevent post-ESD stricture formation. Methods Using endoscopic mucosectomy (EEM) technique, an 8- to 10-cm-long circumferential esophageal mucosal segment was excised in a porcine model. The site was either untreated (control, n = 6) or received 40 evenly distributed injections of antiscarring agent immediately and at weeks 1 and 2. High and low doses were used: MMC 5 mg (n = 2), 0.5 mg (n = 2); Hal 5 mg (n = 2), 1.5 mg (n = 2), 0.5 mg (n = 2); TGF-β3 2 μg (n = 2), 0.5 μg (n = 2). The degree of stricture formation was determined by the percentage reduction of the esophageal lumen on weekly fluoroscopic examination. Animals were euthanized when strictures exceeded 80 % or the animals were unable to maintain weight. Results The control group had a luminal diameter reduction of 78.2 ± 10.9 % by 2 weeks and were euthanized by week 3. Compared at 2 weeks, the Hal group showed a decrease in mean stricture formation (68.4 % low dose, 57.7 % high dose), while both TGF-β3 dosage groups showed no significant change (65.3 % low dose, 76.2 % high dose). MMC was most effective in stricture prevention (53.6 % low dose, 35 % high dose). Of concern, the esophageal wall treated with high-dose MMC appeared to be necrotic and eventually led to perforation. In contrast, low dose MMC, TGF-β3 and Hal treated areas appeared re-epithelialized and healthy. Conclusions Preliminary data on MMC and Hal demonstrated promise in reducing esophageal stricture formation after EEM. More animal data are needed to perform adequate statistical analysis in order to determine overall efficacy of antiscarring therapy. PMID:24100858

Migratory life histories explain the extreme egg-size dimorphism of Eudyptes penguins

PubMed Central

Williams, Tony D.

2016-01-01

When successive stages in the life history of an animal directly overlap, physiological conflicts can arise resulting in carryover effects from one stage to another. The extreme egg-size dimorphism (ESD) of Eudyptes penguins, where the first-laid A-egg is approximately 18–57% smaller than the second-laid B-egg, has interested researchers for decades. Recent studies have linked variation in this trait to a carryover effect of migration that limits the physiology of yolk production and egg sizes. We assembled data on ESD and estimates of migration–reproduction overlap in penguin species and use phylogenetic methods to test the idea that migration–reproduction overlap explains variation in ESD. We show that migration overlap is generally restricted to Eudyptes relative to non-Eudyptes penguins, and that this overlap (defined as the amount of time that egg production occurs on land versus at sea during homeward migration) is significantly and positively correlated with the degree of ESD in Eudyptes. In the non-Eudyptes species, however, ESD was unrelated to migration overlap as these species mostly produce their clutches on land. Our results support the recent hypothesis that extreme ESD of Eudyptes penguins evolved, in part, as a response to selection for a pelagic overwinter migration behaviour. This resulted in a temporal overlap with, and thus a constraint on, the physiology of follicle development, leading to smaller A-egg size and greater ESD. PMID:27708146

Effect of aminoalkyl methacrylate copolymer E/HCl on in vivo absorption of poorly water-soluble drug.

PubMed

Yoshida, Takatsune; Kurimoto, Ippei; Yoshihara, Keiichi; Umejima, Hiroyuki; Ito, Naoki; Watanabe, Shunsuke; Sako, Kazuhiro; Kikuchi, Akihiko

2013-11-01

This study aimed to investigate in vivo absorption of tacrolimus formulated as a solid dispersion using Eudragit E®/HCl (E-SD). E-SD is an aminoalkyl methacrylate copolymer that can be dissolved under neutral pH conditions. E-SD was used alone as a solid dispersion carrier and/or was mixed with tacrolimus primarily dispersed with hydroxypropylmethylcellulose (HPMC). Tacrolimus was formulated with E-SD at several different ratios. Formulations with tacrolimus/E-SD ratio of 1/3 showed higher in vivo absorption, compared to tacrolimus dispersed in the excipients (primarily HPMC) found in commercially available tacrolimus capsules, using a rat in situ closed loop method. Good correlation was observed between in vitro drug solubility and in vivo drug absorption. In vitro solubility tests and rat oral absorption studies of tacrolimus/HPMC solid dispersion formulations were also conducted after mixing the HPMC dispersion with several ratios of E-SD. E-SD/tacrolimus/HPMC formulations yielded high in vitro drug solubility but comparatively low in vivo absorption. Dog oral absorption studies were conducted using capsules containing a formulation of tacrolimus/E-SD at a ratio of 1/5. The E-SD formulation-containing capsule showed higher in vivo drug absorption than tacrolimus dispersed in the standard HPMC capsule. These studies report enhancement of the in vivo absorption of a poorly water-soluble drug following dispersion with E-SD when compared to formulation in HPMC.

Migratory life histories explain the extreme egg-size dimorphism of Eudyptes penguins.

PubMed

Crossin, Glenn T; Williams, Tony D

2016-10-12

When successive stages in the life history of an animal directly overlap, physiological conflicts can arise resulting in carryover effects from one stage to another. The extreme egg-size dimorphism (ESD) of Eudyptes penguins, where the first-laid A-egg is approximately 18-57% smaller than the second-laid B-egg, has interested researchers for decades. Recent studies have linked variation in this trait to a carryover effect of migration that limits the physiology of yolk production and egg sizes. We assembled data on ESD and estimates of migration-reproduction overlap in penguin species and use phylogenetic methods to test the idea that migration-reproduction overlap explains variation in ESD. We show that migration overlap is generally restricted to Eudyptes relative to non-Eudyptes penguins, and that this overlap (defined as the amount of time that egg production occurs on land versus at sea during homeward migration) is significantly and positively correlated with the degree of ESD in Eudyptes In the non-Eudyptes species, however, ESD was unrelated to migration overlap as these species mostly produce their clutches on land. Our results support the recent hypothesis that extreme ESD of Eudyptes penguins evolved, in part, as a response to selection for a pelagic overwinter migration behaviour. This resulted in a temporal overlap with, and thus a constraint on, the physiology of follicle development, leading to smaller A-egg size and greater ESD. © 2016 The Author(s).

Changes in entrance surface dose in relation to the location of shielding material in chest computed tomography

NASA Astrophysics Data System (ADS)

Kang, Y. M.; Cho, J. H.; Kim, S. C.

2015-07-01

This study examined the effects of entrance surface dose (ESD) on the abdomen and pelvis of the patient when undergoing chest computed tomography (CT) procedure, and evaluated the effects of ESD reduction depending on the location of radiation shield. For CT scanner, the 64-slice multi-detector computed tomography was used. The alderson radiation therapy phantom and optically stimulated luminescence dosimeter (OSLD), which enabled measurement from low to high dose, were also used. For measurement of radiation dose, the slice number from 9 to 21 of the phantom was set as the test range, which included apex up to both costophrenic angles. A total of 10 OSLD nanoDots were attached for measurement of the front and rear ESD. Cyclic tests were performed using the low-dose chest CT and high-resolution CT (HRCT) protocol on the following set-ups: without shielding; shielding only on the front side; shielding only on the rear side; and shielding for both front and rear sides. According to the test results, ESD for both front and rear sides was higher in HRCT than low-dose CT when radiation shielding was not used. It was also determined that, compared to the set-up that did not use the radiation shield, locating the radiation shield on the front side was effective in reducing front ESD, while locating the radiation shield on the rear side reduced rear ESD level. Shielding both the front and rear sides resulted in ESD reduction. In conclusion, it was confirmed that shielding the front and rear sides was the most effective method to reduce the ESD effect caused by scatter ray during radiography.

Fundamental study on the characteristics of a radiophotoluminescence glass dosemeter with no energy compensation filter for measuring patient entrance doses in cardiac interventional procedures.

PubMed

Kato, Mamoru; Chida, Koichi; Moritake, Takashi; Koguchi, Yasuhiro; Sato, Tadaya; Oosaka, Hajime; Tosa, Tetsuo; Kadowaki, Ken

2014-12-01

Cardiac interventional procedures have been increasing year by year. However, radiation skin injuries have been still reported. There is a necessity to measure the patient entrance skin dose (ESD), but an accurate dose measurement method has not been established. To measure the ESD, a lot of radiophotoluminescence dosemeters (RPLDs) provide an accurate measurement of the direct actual ESD at the points they are arrayed. The purpose of this study was to examine the characteristics of RPLD to measure the ESD. As a result, X-ray permeable RPLD (with no tin filter) did not interfere with the percutaneous coronary intervention procedure. The RPLD also had good fundamental performance characteristics. Although the RPLD had a little energy dependence, it showed excellent dose and dose-rate linearity, and good angular dependence. In conclusion, by calibrating the energy dependence, RPLDs are useful dosemeter to measure the ESD in cardiac intervention. © The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Sex and the Catasetinae (Darwin's favourite orchids).

PubMed

Pérez-Escobar, Oscar Alejandro; Gottschling, Marc; Whitten, W Mark; Salazar, Gerardo; Gerlach, Günter

2016-04-01

Two sexual systems are predominant in Catasetinae (Orchidaceae), namely protandry (which has evolved in other orchid lineages as well) and environmental sex determination (ESD) being a unique trait among Orchidaceae. Yet, the lack of a robust phylogenetic framework for Catasetinae has hampered deeper insights in origin and evolution of sexual systems. To investigate the origins of protandry and ESD in Catasetinae, we sequenced nuclear and chloroplast loci from 77 species, providing the most extensive data matrix of Catasetinae available so far with all major lineages represented. We used Maximum Parsimony, Maximum Likelihood and Bayesian methods to infer phylogenetic relationships and evolution of sexual systems. Irrespectively of the methods used, Catasetinae were monophyletic in molecular phylogenies, with all established generic lineages and their relationships resolved and highly supported. According to comparative reconstruction approaches, the last common ancestor of Catasetinae was inferred as having bisexual flowers (i.e., lacking protandry and ESD as well), and protandry originated once in core Catasetinae (comprising Catasetum, Clowesia, Cycnoches, Dressleria and Mormodes). In addition, three independent gains of ESD are reliably inferred, linked to corresponding loss of protandry within core Catasetinae. Thus, prior gain of protandry appears as the necessary prerequisite for gain of ESD in orchids. Our results contribute to a comprehensive evolutionary scenario for sexual systems in Catasetinae and more generally in orchids as well. Copyright © 2015 Elsevier Inc. All rights reserved.

Nonampullary duodenal adenoma: Current understanding of its diagnosis, pathogenesis, and clinical management

PubMed Central

Lim, Chul-Hyun; Cho, Young-Seok

2016-01-01

Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis (FAP), but nonampullary sporadic duodenal adenomas (SDAs) are rare. Emerging evidence shows that duodenal adenomas, regardless of their anatomic location and whether they are sporadic or FAP-related, share morphologic and molecular features with colorectal adenomas. The available data suggest that duodenal adenomas develop to duodenal adenocarcinomas via similar mechanisms. The optimal approach for management of duodenal adenomas remains to be determined. The techniques for endoscopic resection of duodenal adenoma include snare polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and argon plasma coagulation ablation. EMR may facilitate removal of large duodenal polyps. Although several studies have reported cases of successful ESD for duodenal adenomas, the procedure is technically difficult to perform safely because of the anatomical properties of the duodenum. Although current clinical practice recommends endoscopic resection of all large duodenal adenomas in patients with FAP, endoscopic treatment is usually insufficient to guarantee a polyp-free duodenum. Surgery is indicated for FAP patients with severe polyposis or nonampullary SDAs or FAP-related polyps not amenable to endoscopic resection. Further studies are needed to develop newer endoscopic techniques to guide diagnostic and therapeutic decisions for future management of nonampullary duodenal adenomas. PMID:26811631

Management of a large mucosal defect after duodenal endoscopic resection

PubMed Central

Fujihara, Shintaro; Mori, Hirohito; Kobara, Hideki; Nishiyama, Noriko; Matsunaga, Tae; Ayaki, Maki; Yachida, Tatsuo; Masaki, Tsutomu

2016-01-01

Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract (GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection (ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment. PMID:27547003

Novel 3D-printing technique for caps to enable tailored therapeutic endoscopy.

PubMed

Ko, Weon Jin; Song, Ga Won; Hong, Sung Pyo; Kwon, Chang-il; Hahm, Ki Baik; Cho, Joo Young

2016-03-01

To evaluate the feasibility of a tailored endoscopic cap created using 3D-printing technology that is customized according to esophagogastric lesions of each patient. Tailored endoscopic caps, which were designed and fabricated with a 3D printer, were inserted in 35 patients. The types of cap were side-hole cap made for cap-assisted endoscopic mucosal resection (EMRC), oblique-head cap designed for endoscopic submucosal dissection (ESD), wide-head cap used for Trucut biopsy (TCB), and narrow-tip cap to facilitate peroral endoscopic myotomy (POEM). EMRC in the esophagus and gastroesophageal junction was carried out using a side-hole cap in seven patients. Median total procedure time for successful removal of lesions was 14 min (range 8-50 min). Gastric ESD was carried out using with an oblique-head cap in 16 patients, for which the median total procedure time was 53 min. TCB in the esophagus was done using a wide-head cap in eight patients. While carrying out POEM for tunneling, a narrow-tip cap was used in four patients with achalasia. Based on the current proof-of-concept study, we anticipate that creating a tailored endoscopic cap is feasible for therapeutic endoscopy. © 2015 Japan Gastroenterological Endoscopy Society.

[Endoscopic full-thickness resection].

PubMed

Meier, B; Schmidt, A; Caca, K

2016-08-01

Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (>2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.

Critical Review of the ECSS-E-ST-20-07C ESD Test Set-Up for Testing Spacecraft Equipment

NASA Astrophysics Data System (ADS)

Pelissou, P.; Daout, B.; Romero, C.; Wolf, K.-F. J.

2016-05-01

Satellite equipment needs to be immune to electrostatic discharges (ESD) likely to occur in flight. Testing the susceptibility against ESD on spacecraft equipment is therefore an important part of the EMC test program. The test method according to ECSS-E-ST- 20-07C [1], which is commonly used in space industry, leaves undesirable degrees of freedom on how the test is performed, which in turn has an influence on the injected current and therefore on the test results. Because of the indirect coupling of ESD to circuits, the current waveform applied during the test and its repeatability are of high importance. In the frame of an ESTEC research contract (4000109887/13/NL/GLC), a critical review of the ECSS-E-ST-20-07C is performed to identify the influence factors which have an impact on the test repeatability.

Evaluation Tool for the Application of Discovery Teaching Method in the Greek Environmental School Projects

ERIC Educational Resources Information Center

Kalathaki, Maria

2015-01-01

Greek school community emphasizes on the discovery direction of teaching methodology in the school Environmental Education (EE) in order to promote Education for the Sustainable Development (ESD). In ESD school projects the used methodology is experiential teamwork for inquiry based learning. The proposed tool checks whether and how a school…

Retrieval of phytoplankton cell size from chlorophyll a specific absorption and scattering spectra of phytoplankton.

PubMed

Zhou, Wen; Wang, Guifen; Li, Cai; Xu, Zhantang; Cao, Wenxi; Shen, Fang

2017-10-20

Phytoplankton cell size is an important property that affects diverse ecological and biogeochemical processes, and analysis of the absorption and scattering spectra of phytoplankton can provide important information about phytoplankton size. In this study, an inversion method for extracting quantitative phytoplankton cell size data from these spectra was developed. This inversion method requires two inputs: chlorophyll a specific absorption and scattering spectra of phytoplankton. The average equivalent-volume spherical diameter (ESD v ) was calculated as the single size approximation for the log-normal particle size distribution (PSD) of the algal suspension. The performance of this method for retrieving cell size was assessed using the datasets from cultures of 12 phytoplankton species. The estimations of a(λ) and b(λ) for the phytoplankton population using ESD v had mean error values of 5.8%-6.9% and 7.0%-10.6%, respectively, compared to the a(λ) and b(λ) for the phytoplankton populations using the log-normal PSD. The estimated values of C i ESD v were in good agreement with the measurements, with r 2 =0.88 and relative root mean square error (NRMSE)=25.3%, and relatively good performances were also found for the retrieval of ESD v with r 2 =0.78 and NRMSE=23.9%.

Identifying Key Elements of Community-Based ESD: ESD-J's Projects to Collect ESD in Practice in Japan and Asia

ERIC Educational Resources Information Center

Noguchi, Fumiko

2010-01-01

Since its establishment in 2003, the Japan Council on the UN Decade of Education for Sustainable Development (ESD-J) has paid close attention to informal learning processes in community-based efforts to promote local sustainable development. ESD-J carried out two projects to collect information on and visualise community-based ESD practice: the…

Education for Sustainable Development and Normativity: A Transactional Analysis of Moral Meaning-Making and Companion Meanings in Classroom Communication

ERIC Educational Resources Information Center

Ostman, Leif

2010-01-01

The purpose of the present article is to present and illustrate two different ways of analysing the normativity and discursivity of classroom communication during education for sustainable development (ESD). The two types of analysis can provide important knowledge for discussions of ESD in relation to morals and democracy. Both methods are based…

Hierarchical and hybrid energy storage devices in data centers: Architecture, control and provisioning.

PubMed

Sun, Mengshu; Xue, Yuankun; Bogdan, Paul; Tang, Jian; Wang, Yanzhi; Lin, Xue

2018-01-01

Recently, a new approach has been introduced that leverages and over-provisions energy storage devices (ESDs) in data centers for performing power capping and facilitating capex/opex reductions, without performance overhead. To fully realize the potential benefits of the hierarchical ESD structure, we propose a comprehensive design, control, and provisioning framework including (i) designing power delivery architecture supporting hierarchical ESD structure and hybrid ESDs for some levels, as well as (ii) control and provisioning of the hierarchical ESD structure including run-time ESD charging/discharging control and design-time determination of ESD types, homogeneous/hybrid options, ESD provisioning at each level. Experiments have been conducted using real Google data center workloads based on realistic data center specifications.

Hierarchical and hybrid energy storage devices in data centers: Architecture, control and provisioning

PubMed Central

Xue, Yuankun; Bogdan, Paul; Tang, Jian; Wang, Yanzhi; Lin, Xue

2018-01-01

Recently, a new approach has been introduced that leverages and over-provisions energy storage devices (ESDs) in data centers for performing power capping and facilitating capex/opex reductions, without performance overhead. To fully realize the potential benefits of the hierarchical ESD structure, we propose a comprehensive design, control, and provisioning framework including (i) designing power delivery architecture supporting hierarchical ESD structure and hybrid ESDs for some levels, as well as (ii) control and provisioning of the hierarchical ESD structure including run-time ESD charging/discharging control and design-time determination of ESD types, homogeneous/hybrid options, ESD provisioning at each level. Experiments have been conducted using real Google data center workloads based on realistic data center specifications. PMID:29351553

Assessment of Reproducibility of Laser Electrospray Mass Spectrometry using Electrospray Deposition of Analyte

NASA Astrophysics Data System (ADS)

Sistani, Habiballah; Karki, Santosh; Archer, Jieutonne J.; Shi, Fengjian; Levis, Robert J.

2017-05-01

A nonresonant, femtosecond (fs) laser is employed to desorb samples of Victoria blue deposited on stainless steel or indium tin oxide (ITO) slides using either electrospray deposition (ESD) or dried droplet deposition. The use of ESD resulted in uniform films of Victoria blue whereas the dried droplet method resulted in the formation of a ring pattern of the dye. Laser electrospray mass spectrometry (LEMS) measurements of the ESD-prepared films on either substrate were similar and revealed lower average relative standard deviations for measurements within-film (20.9%) and between-films (8.7%) in comparison to dried droplet (75.5% and 40.2%, respectively). The mass spectral response for ESD samples on both substrates was linear (R2 > 0.99), enabling quantitative measurements over the selected range of 7.0 × 10-11 to 2.8 × 10-9 mol, as opposed to the dried droplet samples where quantitation was not possible (R2 = 0.56). The limit of detection was measured to be 210 fmol.

Purification and substrate specificity of polymorphic forms of esterase D from human erythrocytes.

PubMed Central

Scott, E M; Wright, R C

1978-01-01

Esterase D (EsD), purified from human erythrocytes and tested with a variety of substrates, hydrolyzed only triacetin, tributyrin, and certain soluble aryl esters of aliphatic acids. Esters of 4-methylumbelliferone were easily the best substrates. When the three genetically different isozymes were compared, the less common forms, EsD 2 and EsD 2-1, were less stable than EsD 1. With some substrates, the Michaelis constant of the EsD 2 form differed from that of the EsD 1 form. The EsD 2-1 hybrid form was usually, but not invariably, intermediate in properties. The physiologic significance of the genetic variability of this enzyme is unknown. PMID:623100

Local resection of the stomach for gastric cancer.

PubMed

Kinami, Shinichi; Funaki, Hiroshi; Fujita, Hideto; Nakano, Yasuharu; Ueda, Nobuhiko; Kosaka, Takeo

2017-06-01

The local resection of the stomach is an ideal method for preventing postoperative symptoms. There are various procedures for performing local resection, such as the laparoscopic lesion lifting method, non-touch lesion lifting method, endoscopic full-thickness resection, and laparoscopic endoscopic cooperative surgery. After the invention and widespread use of endoscopic submucosal dissection, local resection has become outdated as a curative surgical technique for gastric cancer. Nevertheless, local resection of the stomach in the treatment of gastric cancer in now expected to make a comeback with the clinical use of sentinel node navigation surgery. However, there are many issues associated with local resection for gastric cancer, other than the normal indications. These include gastric deformation, functional impairment, ensuring a safe surgical margin, the possibility of inducing peritoneal dissemination, and the associated increase in the risk of metachronous gastric cancer. In view of these issues, there is a tendency to regard local resection as an investigative treatment, to be applied only in carefully selected cases. The ideal model for local resection of the stomach for gastric cancer would be a combination of endoscopic full-thickness resection of the stomach using an ESD device and hand sutured closure using a laparoscope or a surgical robot, for achieving both oncological safety and preserved functions.

Feasibility of electrospray deposition for rapid screening of the cocrystal formation and single step, continuous production of pharmaceutical nanococrystals.

PubMed

Emami, Shahram; Siahi-Shadbad, Mohammadreza; Barzegar-Jalali, Mohammad; Adibkia, Khosro

2018-06-01

This study employed electrospray deposition (ESD) for simultaneous synthesis and particle engineering of cocrystals. Exploring new methods for the efficient production of cocrystals with desired particle properties is an essential demand. The possibility of cocrystal formation by ESD was examined for indomethacin-saccharin, indomethacin-nicotinamide, naproxen-nicotinamide, and naproxen-iso-nicotinamide cocrystals. Solutions of the drug and coformer at stoichiometric ratios were sprayed to a high electric field which caused rapid evaporation of the solvent and the formation of fine particles. The phase purity, size, and morphology of products were compared with reference cocrystals. Experiments were performed to evaluate the effects of stoichiometric ratio, concentration and solvent type on the cocrystal formation. Physical stability and dissolution properties of the electrosprayed cocrystals were also compared with reference cocrystals. ESD was found to be an efficient and rapid method to produce cocrystals for all studied systems other than indomethacin-nicotinamide. Pure cocrystals only formed at a specific drug:coformer ratio. The solvent type has a weak effect on the cocrystal formation and morphology. Electrosprayed cocrystals exhibited nano to micrometer sizes with distinct morphologies with comparable physical stability with reference cocrystals. Nanococrystals of indomethacin-saccharin with a mean size of 219 nm displayed a threefold higher dissolution rate than solvent evaporated cocrystal. ESD successfully was utilized to produce pure cocrystals of poorly soluble drugs with different morphologies and sizes ranging from nano to micrometer sizes in one step. This study highlighted the usefulness of ESD for simultaneous preparation and particle engineering of pharmaceutical cocrystals.

Consulting the UK ESD Community on an ESD Indicator to Recommend to Government: An Insight into the Micro-Politics of ESD

ERIC Educational Resources Information Center

Huckle, John

2009-01-01

In 2006 the author was contracted to research possible approaches to a UK indicator of education for sustainable development (ESD). This article describes and seeks to explain the response of government advisers and influential members of the UK ESD community to the approaches he proposed. While the UK strategy for sustainable development called…

ESD protection design for advanced CMOS

NASA Astrophysics Data System (ADS)

Huang, Jin B.; Wang, Gewen

2001-10-01

ESD effects in integrated circuits have become a major concern as today's technologies shrink to sub-micron/deep- sub-micron dimensions. The thinner gate oxide and shallower junction depth used in the advanced technologies make them very vulnerable to ESD damages. The advanced techniques like silicidation and STI (shallow trench insulation) used for improving other device performances make ESD design even more challenging. For non-silicided technologies, a certain DCGS (drain contact to gate edge spacing) is needed to achieve ESD hardness for nMOS output drivers and nMOS protection transistors. The typical DCGS values are 4-5um and 2-3um for 0.5um and 0.25um CMOS, respectively. The silicidation reduces the ballast resistance provided by DCGS with at least a factor of 10. As a result, scaling of the ESD performance with device width is lost and even zero ESD performance is reported for standard silicided devices. The device level ESD design is focused in this paper, which includes GGNMOS (gate grounded NMOS) and GCNMOS (gate coupled NMOS). The device level ESD testing including TLP (transmission line pulse) is given. Several ESD issues caused by advanced technologies have been pointed out. The possible solutions have been developed and summarized including silicide blocking, process optimization, back-end ballasting, and new protection scheme, dummy gate/n-well resistor ballsting, etc. Some of them require process cost increase, and others provide novel, compact, and simple design but involving royalty/IP (intellectual property) issue. Circuit level ESD design and layout design considerations are covered. The top-level ESD protection strategies are also given.

Search and Retrieval Index to EOS/ESD Symposium Proceedings - 1979 to 1984.

DTIC Science & Technology

1985-04-15

This book contains indexes used in searching for information contained in papers produced in Electrical Overstress/Electrostatic Discharge (EOS/ESD) Symposium 1979 to 1984. These indexes are the Alphabetical List of Index Terms, Subject Index, Author Index , Corporate Index, Keywords in Title Index, and Chronological List of Papers Index. These indexes provide a clear, easy-to-read, and concise method of searching for and

Expanding Role of Third Space Endoscopy in the Management of Esophageal Diseases.

PubMed

Yang, Dennis; Draganov, Peter V

2018-03-01

OPINION STATEMENT: "Third space" endoscopy, also commonly referred as submucosal endoscopy, is founded on the principle that the deeper layers of the gastrointestinal (GI) tract can be accessed by tunneling in the submucosal space without compromising the integrity of the overlying mucosa. Peroral endoscopic myotomy (POEM), endoscopic submucosal dissection (ESD), and submucosal tunneling endoscopic resection (STER) are innovative techniques within the field of third space endoscopy in the management of esophageal disorders. POEM has become an accepted minimally invasive therapy for achalasia and related motility disorders with excellent short-term results, with early studies yielding similar efficacy to surgical myotomy and increased durability when compared to pneumatic balloon dilation (PBD). Data are needed to establish long-term outcomes with POEM, with particular interest on the incidence of gastroesophageal reflux, which appears to be higher than initially anticipated. ESD, a mature endoscopic resection technique in Asia, has recently gained traction in the West as a viable option for the management of early Barrett's esophagus (BE) neoplasia. Compared to standard endoscopic mucosal resection (EMR), ESD allows the en bloc resection of lesions irrespective of size, which may facilitate histological interpretation and reduce recurrence rates. Large prospective randomized controlled trials are needed to validate the efficacy and safety of this technique and to further define its role in the endoscopic armamentarium in early BE neoplasia. STER is an attractive technique that theoretically permits the resection of subepithelial esophageal tumors (SETs) arising from the deeper GI layers. Initial studies from highly experienced endoscopic centers support its technical feasibility and safety, although these results should be interpreted with caution due to variability arising from small numbers and heterogeneity among studies. Overall, third space endoscopy is an expanding field within endoscopic therapeutics for the treatment of esophageal diseases. While initial results have been very promising, large prospective studies, long-term data, and structured training programs with the establishment of competency parameters are needed before third space endoscopy can be advocated outside of highly specialized centers.

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer.

PubMed

Myung, Yu Sik; Hong, Su Jin; Han, Jae Pil; Park, Kyung Woo; Ko, Bong Min; Lee, Moon Sung

2017-01-01

In ulcerative early gastric cancer, improvement and exacerbation of ulceration repeat as a malignant cycle. Moreover, early gastric cancer combined with ulcer is associated with a low curative resection rate and high risk of adverse events. The aim of this study was to investigate the ulcer healing rate and clinical outcomes with the administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer. A total of 136 patients with differentiated early gastric cancer with ulcer who met the expanded indications for endoscopic submucosal dissection were reviewed between June 2005 and June 2014. Eighty-one patients were given PPI before endoscopic submucosal dissection and 55 patients were not given PPI. The complete ulcer healing rate was significantly different between the two groups (59.3 % vs. 23.6 %, P < 0.001). The procedure time was 38.1 ± 35.7 and 50.8 ± 50.2 min (P = 0.047). However, no significant differences were detected in the en bloc resection rate, complete resection rate, and adverse events including bleeding and perforation. Multivariate analysis showed that administration of PPI (OR = 10.83, P < 0.001) and mucosal invasion (OR = 24.43, P < 0.001) were independent factors that predicted complete healing of ulceration. The calculated accuracy for whether complete healing of the ulcer after PPI administration can differentiate mucosal from submucosal invasion was 75.3 %. Administration of PPI before ESD in differentiated EGC meeting the expanded criteria is effective to heal the ulcer lesion and reduce the mean procedure time. Complete healing of the ulcer after PPI administration suggests mucosal cancer.

Deoxyelephantopin from Elephantopus scaber L. induces cell-cycle arrest and apoptosis in the human nasopharyngeal cancer CNE cells

DOE Office of Scientific and Technical Information (OSTI.GOV)

Su, Miaoxian; Chung, Hau Yin, E-mail: anthonychung@cuhk.edu.hk; Food and Nutritional Sciences Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong SAR

2011-07-29

Highlights: {yields} Deoxyelephantopin (ESD) inhibited cell proliferation in the human nasopharyngeal cancer CNE cells. {yields} ESD induced cell cycle arrest in S and G2/M phases via modulation of cell cycle regulatory proteins. {yields} ESD triggered apoptosis by dysfunction of mitochondria and induction of both intrinsic and extrinsic apoptotic signaling pathways. {yields} ESD also triggered Akt, ERK, and JNK signaling pathways. -- Abstract: Deoxyelephantopin (ESD), a naturally occurring sesquiterpene lactone present in the Chinese medicinal herb, Elephantopus scaber L. exerted anticancer effects on various cultured cancer cells. However, the cellular mechanisms by which it controls the development of the cancer cellsmore » are unavailable, particularly the human nasopharyngeal cancer CNE cells. In this study, we found that ESD inhibited the CNE cell proliferation. Cell cycle arrest in S and G2/M phases was also found. Western blotting analysis showed that modulation of cell cycle regulatory proteins was responsible for the ESD-induced cell cycle arrest. Besides, ESD also triggered apoptosis in CNE cells. Dysfunction in mitochondria was found to be associated with the ESD-induced apoptosis as evidenced by the loss of mitochondrial membrane potential ({Delta}{Psi}m), the translocation of cytochrome c, and the regulation of Bcl-2 family proteins. Despite the Western blotting analysis showed that both intrinsic and extrinsic apoptotic pathways (cleavage of caspases-3, -7, -8, -9, and -10) were triggered in the ESD-induced apoptosis, additional analysis also showed that the induction of apoptosis could be achieved by the caspase-independent manner. Besides, Akt, ERK and JNK pathways were found to involve in ESD-induced cell death. Overall, our findings provided the first evidence that ESD induced cell cycle arrest, and apoptosis in CNE cells. ESD could be a potential chemotherapeutic agent in the treatment of nasopharyngeal cancer (NPC).« less

NASA Workmanship Hot Topics: Water Soluble Flux and ESD Charge Device Model

NASA Technical Reports Server (NTRS)

Plante, Jeannette F.

2009-01-01

This slide presentation reviews two topics of interest to NASA Workmanship: (1) Water Soluble Flux (WSF) and Electrostatic Discharge (ESD) safety. In the first topic, WSF, the presentation reviews voiding and the importance of cleanliness in using WSF for welding and soldering operations. The second topic reviews the NASA-HDBK-8739.21 for Human Body Model, and Machine Model safety methods, and challenges associated with the Charged Device Model (CDM)

Challenges of Implementing ESD in the Education Sector; Experiences in Norway

NASA Astrophysics Data System (ADS)

Sandås, Astrid; Benedict, Faye

This article presents and reflects on Norwegian experiences over a period of about 15 years with implementing the Norwegian national strategy for education for sustainable development (ESD) in the education system. We extract lessons about integration of ESD into education systems. After an introduction to central ideas of sustainable development and ESD, the article discusses the need for appropriate strategies and instruments. Key factors are collaboration to allow pupils and schools to actively contribute to a positive development locally and globally, interdisciplinary approaches to complex sustainability issues, and appropriate use of the ICT and other media. ESD programmes and activities should support school development and build the capacity of schools and teachers for integration of ESD.

Multiple Geographical Origins of Environmental Sex Determination enhanced the diversification of Darwin's Favourite Orchids.

PubMed

Pérez-Escobar, Oscar Alejandro; Chomicki, Guillaume; Condamine, Fabien L; de Vos, Jurriaan M; Martins, Aline C; Smidt, Eric C; Klitgård, Bente; Gerlach, Günter; Heinrichs, Jochen

2017-10-10

Environmental sex determination (ESD) - a change in sexual function during an individual life span driven by environmental cues - is an exceedingly rare sexual system among angiosperms. Because ESD can directly affect reproduction success, it could influence diversification rate as compared with lineages that have alternative reproductive systems. Here we test this hypothesis using a solid phylogenetic framework of Neotropical Catasetinae, the angiosperm lineage richest in taxa with ESD. We assess whether gains of ESD are associated with higher diversification rates compared to lineages with alternative systems while considering additional traits known to positively affect diversification rates in orchids. We found that ESD has evolved asynchronously three times during the last ~5 Myr. Lineages with ESD have consistently higher diversification rates than related lineages with other sexual systems. Habitat fragmentation due to mega-wetlands extinction, and climate instability are suggested as the driving forces for ESD evolution.

Second Breakdown of 18V Grounded Gate NMOS induced by the Kirk Effect under Electrostatic Discharge

NASA Astrophysics Data System (ADS)

Jeon, Byung-Chul; Lee, Seung-Chul; Han, Min-Koo

2003-09-01

Electrostatic Discharge (ESD) failure mechanisms of 18V grounded gate NMOS (GGNMOS) for liquid crystal display driver IC (LDI) applications are investigated and effects of layout design parameters on the ESD immunity level are analyzed. Experimental results show that 18V GGNMOS exhibits snapback characteristics and the ESD immunity level is rather high when XO (N-drift overlap over n+ source/drain) is sufficiently large, while GGNMOS does not exhibit the sustaining region and is very vulnerable to ESD stress when XO is relatively small. Simulation results show that the ESD failure mechanism of 18V GGNMOS could be the low-temperature second breakdown induced by the Kirk effect. It is inferred that a certain amount of XO is indispensable to ensure snapback characteristics and high ESD immunity level. Simulation results also show that the ESD immunity level is increased as drain contact to gate space (DCGS) is increased.

A Priority for ESD Research: Influencing Adult Citizens

ERIC Educational Resources Information Center

Monroe, Martha C.

2007-01-01

Research in the disciplines of education, science education, and environmental education has a rich history. While research in Education for Sustainable Development (ESD) may be related to these traditions, there is a need for ESD to carve a new niche that promotes high quality and effective ESD programmes. With an eye towards practice and applied…

Vascular density of superficial esophageal squamous cell carcinoma determined by direct observation of resected specimen using narrow band imaging with magnifying endoscopy.

PubMed

Kikuchi, D; Iizuka, T; Hoteya, S; Nomura, K; Kuribayashi, Y; Toba, T; Tanaka, M; Yamashita, S; Furuhata, T; Matsui, A; Mitani, T; Inoshita, N; Kaise, M

2017-11-01

Observation of the microvasculature using narrow band imaging (NBI) with magnifying endoscopy is useful for diagnosing superficial squamous cell carcinoma. Increased vascular density is indicative of cancer, but not many studies have reported differences between cancerous and noncancerous areas based on an objective comparison. We observed specimens of endoscopic submucosal dissection (ESD) using NBI magnification, and determined the vascular density of cancerous and noncancerous areas. A total of 25 lesions of esophageal squamous cell carcinoma that were dissected en bloc by ESD between July 2013 and December 2013 were subjected to NBI magnification. We constructed a device that holds an endoscope and precisely controls the movement along the vertical axis in order to observe submerged specimens by NBI magnification. NBI image files of both cancerous (pathologically determined invasion depth, m1/2) and surrounding noncancerous areas were created and subjected to vascular density assessment by two endoscopists who were blinded to clinical information. The invasion depth was m1/2 in 20, m3/sm1 in four and sm2 in one esophageal cancer lesion. Mean vascular density was significantly increased in cancerous areas (37.6 ± 16.3 vessels/mm2) compared with noncancerous areas (17.6 ± 10.0 vessels/mm2) (P < 0.05). The correlation coefficients between vascular density determined by two endoscopists were 0.86 and 0.81 in cancerous and noncancerous areas, respectively. Receiver operating curve (ROC) analysis revealed that the area under the curve (AUC) of vascular density was 0.895 (95% CI, 0.804-0.986). For this ROC curve, sensitivity was 78.3% and specificity was 87.0% when the cutoff value of vascular density was 26 vessels/mm2. NBI magnification confirmed significant increases in vascular density in cancerous areas compared with noncancerous areas in esophageal squamous cell carcinoma. The rates of agreement between vascular density values determined by two independent operators were high. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Delving into Key Dimensions of ESD through Analyses of a Middle School Science Textbook

ERIC Educational Resources Information Center

Sahin, Elvan

2016-01-01

Uncertainties and debates regarding the term of sustainable development are still going on, and similarly, the notion of education for sustainable development (ESD) is open to debate. There has been an attempt to make the concept of ESD evident, which is quite challenging. Palmer (1998) stated the appropriateness of ESD within environmental…

ESD Implementation at the School Organisation Level, Part 1--Investigating the Quality Criteria Guiding School Leaders' Work at Recognized ESD Schools

ERIC Educational Resources Information Center

Mogren, Anna; Gericke, Niklas

2017-01-01

Research on Education for Sustainable Development (ESD) implementation tends to focus primarily on student and teacher outcomes, and there have been few studies on leadership practices at the school organisation level that provide information on how quality in education contributes to ESD implementation. To address this issue, we conducted an…

Electrostatic Discharge Effects on Thin Film Resistors

NASA Technical Reports Server (NTRS)

Sampson, Michael J.; Hull, Scott M.

1999-01-01

Recently, open circuit failures of individual elements in thin film resistor networks have been attributed to electrostatic discharge (ESD) effects. This paper will discuss the investigation that came to this conclusion and subsequent experimentation intended to characterize design factors that affect the sensitivity of resistor elements to ESD. The ESD testing was performed using the standard human body model simulation. Some of the design elements to be evaluated were: trace width, trace length (and thus width to length ratio), specific resistivity of the trace (ohms per square) and resistance value. However, once the experiments were in progress, it was realized that the ESD sensitivity of most of the complex patterns under evaluation was determined by other design and process factors such as trace shape and termination pad spacing. This paper includes pictorial examples of representative ESD failure sites, and provides some options for designing thin film resistors that are ESD resistant. The risks of ESD damage are assessed and handling precautions suggested.

Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture

PubMed Central

Kono, Yoshiyasu; Takenaka, Ryuta; Kawahara, Yoshiro; Okada, Hiroyuki; Hori, Keisuke; Kawano, Seiji; Yamasaki, Yasushi; Takemoto, Koji; Miyake, Takayoshi; Fujiki, Shigeatsu; Yamamoto, Kazuhide

2014-01-01

AIM: To investigate the usefulness of chromoendoscopy, using an acetic acid indigocarmine mixture (AIM), for gastric adenoma diagnosed by forceps biopsy. METHODS: A total of 54 lesions in 45 patients diagnosed as gastric adenoma by forceps biopsy were prospectively enrolled in this study and treated by endoscopic submucosal dissection (ESD) between January 2011 and January 2012. AIM-chromoendoscopy (AIM-CE) was performed followed by ESD. AIM solution was sprinkled and images were recorded every 30 s for 3 min. Clinical characteristics such as tumor size (< 2 cm, ≥ 2 cm), surface color in white light endoscopy (WLE) (whitish, normochromic or reddish), macroscopic appearance (flat or elevated, depressed), and reddish change in AIM-CE were selected as valuables. RESULTS: En bloc resection was achieved in all 54 cases, with curative resection of fifty two lesions (96.3%). Twenty three lesions (42.6%) were diagnosed as well-differentiated adenocarcinoma and the remaining 31 lesions (57.4%) were gastric adenoma. All adenocarcinoma lesions were well-differentiated tubular adenocarcinomas and were restricted within the mucosal layer. The sensitivity of reddish color change in AIM-CE is significantly higher than that in WLE (vs tumor size ≥ 2 cm, P = 0.016, vs normochromic or reddish surface color, P = 0.046, vs depressed macroscopic type, P = 0.0030). On the other hand, no significant differences were found in the specificity and accuracy. In univariate analysis, normochromic or reddish surface color in WLE (OR = 3.7, 95%CI: 1.2-12, P = 0.022) and reddish change in AIM-CE (OR = 14, 95%CI: 3.8-70, P < 0.001) were significantly related to diagnosis of early gastric cancer (EGC). In multivariate analysis, only reddish change in AIM-CE (OR = 11, 95%CI: 2.3-66, P = 0.0022) was a significant factor associated with diagnosis of EGC. CONCLUSION: AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy. PMID:24803824

Carbon Nanotube/Space Durable Polymer Nanocomposite Films for Electrostatic Charge Dissipation

NASA Technical Reports Server (NTRS)

Smith, J. G., Jr.; Watson, K. A.; Thompson, C. M.; Connell, J. W.

2002-01-01

Low solar absorptivity, space environmentally stable polymeric materials possessing sufficient electrical conductivity for electrostatic charge dissipation (ESD) are of interest for potential applications on spacecraft as thin film membranes on antennas, solar sails, large lightweight space optics, and second surface mirrors. One method of imparting electrical conductivity while maintaining low solar absorptivity is through the use of single wall carbon nanotubes (SWNTs). However, SWNTs are difficult to disperse. Several preparative methods were employed to disperse SWNTs into the polymer matrix. Several examples possessed electrical conductivity sufficient for ESD. The chemistry, physical, and mechanical properties of the nanocomposite films will be presented.

Prediction of Helicobacter pylori status by conventional endoscopy, narrow-band imaging magnifying endoscopy in stomach after endoscopic resection of gastric cancer.

PubMed

Yagi, Kazuyoshi; Saka, Akiko; Nozawa, Yujiro; Nakamura, Atsuo

2014-04-01

To reduce the incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer, Helicobacter pylori eradication therapy has been endorsed. It is not unusual for such patients to be H. pylori negative after eradication or for other reasons. If it were possible to predict H. pylori status using endoscopy alone, it would be very useful in clinical practice. To clarify the accuracy of endoscopic judgment of H. pylori status, we evaluated it in the stomach after endoscopic submucosal dissection (ESD) of gastric cancer. Fifty-six patients treated by ESD were enrolled. The diagnostic criteria for H. pylori status by conventional endoscopy and narrow-band imaging (NBI)-magnifying endoscopy were decided, and H. pylori status was judged by two endoscopists. Based on the H. pylori stool antigen test as a diagnostic gold standard, conventional endoscopy and NBI-magnifying endoscopy were compared for their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Interobserver agreement was assessed in terms of κ value. Interobserver agreement was moderate (0.56) for conventional endoscopy and substantial (0.77) for NBI-magnifying endoscopy. The sensitivity, specificity, PPV, and NPV were 0.79, 0.52, 0.70, and 0.63 for conventional endoscopy and 0.91, 0.83, 0.88, and 0.86 for NBI-magnifying endoscopy, respectively. Prediction of H. pylori status using NBI-magnifying endoscopy is practical, and interobserver agreement is substantial. © 2013 John Wiley & Sons Ltd.

Radiation risk assessment in neonatal radiographic examinations of the chest and abdomen: a clinical and Monte Carlo dosimetry study

NASA Astrophysics Data System (ADS)

Makri, T.; Yakoumakis, E.; Papadopoulou, D.; Gialousis, G.; Theodoropoulos, V.; Sandilos, P.; Georgiou, E.

2006-10-01

Seeking to assess the radiation risk associated with radiological examinations in neonatal intensive care units, thermo-luminescence dosimetry was used for the measurement of entrance surface dose (ESD) in 44 AP chest and 28 AP combined chest-abdominal exposures of a sample of 60 neonates. The mean values of ESD were found to be equal to 44 ± 16 µGy and 43 ± 19 µGy, respectively. The MCNP-4C2 code with a mathematical phantom simulating a neonate and appropriate x-ray energy spectra were employed for the simulation of the AP chest and AP combined chest-abdominal exposures. Equivalent organ dose per unit ESD and energy imparted per unit ESD calculations are presented in tabular form. Combined with ESD measurements, these calculations yield an effective dose of 10.2 ± 3.7 µSv, regardless of sex, and an imparted energy of 18.5 ± 6.7 µJ for the chest radiograph. The corresponding results for the combined chest-abdominal examination are 14.7 ± 7.6 µSv (males)/17.2 ± 7.6 µSv (females) and 29.7 ± 13.2 µJ. The calculated total risk per radiograph was low, ranging between 1.7 and 2.9 per million neonates, per film, and being slightly higher for females. Results of this study are in good agreement with previous studies, especially in view of the diversity met in the calculation methods.

[Current Status of Endoscopic Resection of Early Gastric Cancer in Korea].

PubMed

Jung, Hwoon Yong

2017-09-25

Endoscopic resection (Endoscopic mucosal resection [EMR] and endoscopic submucosal dissection [ESD]) is already established as a first-line treatment modality for selected early gastric cancer (EGC). In Korea, the number of endoscopic resection of EGC was explosively increased because of a National Cancer Screening Program and development of devices and techniques. There were many reports on the short-term and long-term outcomes after endoscopic resection in patients with EGC. Long-term outcome in terms of recurrence and death is excellent in both absolute and selected expanded criteria. Furthermore, endoscopic resection might be positioned as primary treatment modality replacing surgical gastrectomy. To obtain these results, selection of patients, perfect en bloc procedure, thorough pathological examination of resected specimen, accurate interpretation of whole process of endoscopic resection, and rational strategy for follow-up is necessary.

Submucosal tunneling using endoscopic submucosal dissection for peritoneal access and closure in natural orifice transluminal endoscopic surgery: a porcine survival study.

PubMed

Yoshizumi, F; Yasuda, K; Kawaguchi, K; Suzuki, K; Shiraishi, N; Kitano, S

2009-08-01

Safe peritoneal access and gastric closure are the most important concerns in the clinical application of natural orifice transluminal endoscopic surgery (NOTES). We aimed to clarify the feasibility of a submucosal tunnel technique using endoscopic submucosal dissection (ESD) for transgastric peritoneal access and subsequent closure for NOTES. Seven female pigs, each weighing about 40 kg were included in the study. The following procedures were performed: (i) after injection of normal saline into the submucosa, the mucosa was cut with a flex knife; (ii) the submucosal layer was dissected using an insulation-tipped electrosurgical knife to make a narrow longitudinal 50-mm submucosal tunnel; (iii) a small incision was made at the end of the tunnel and enlarged with a dilation balloon. After transgastric peritoneoscopy, the mucosal incision site was closed with clips. The following outcome measures were used: (a) evaluation of the technical feasibility of making a submucosal tunnel; (b) clinical monitoring for 7 days; (c) follow-up endoscopy and necropsy; and (d) peritoneal fluid culture. Natural orifice transluminal endoscopic peritoneoscopy with a submucosal tunnel was successfully carried out in all pigs. The pigs recovered well, without signs of peritonitis. Follow-up endoscopy showed healing of mucosal incision sites without open defects. Necropsy revealed no findings of peritonitis, confirming completeness of gastric closure; there was a thin scar in one pig and adhesion of the omentum in six pigs. Peritoneal fluid culture demonstrated no bacterial growth. The submucosal tunnel technique is feasible and effective for transgastric peritoneal access and closure.

A Critical Review of Education for Sustainable Development (ESD) in Japan: Beyond the Practice of Pouring New Wine into Old Bottles

ERIC Educational Resources Information Center

Nagata, Yoshiyuki

2017-01-01

Japan stands as a rare country in which ESD has been incorporated as mainstream policy. However, looking back on the United Nations Decade of Education for Sustainable Development (UNDESD), ESD has not brought about the transformation in Japan that one expects ESD to aim for, despite this support at the policy level. The cause may be that pouring…

The baseline pressure of intracranial pressure (ICP) sensors can be altered by electrostatic discharges

PubMed Central

2011-01-01

Background The monitoring of intracranial pressure (ICP) has a crucial role in the surveillance of patients with brain injury. During long-term monitoring of ICP, we have seen spontaneous shifts in baseline pressure (ICP sensor zero point), which are of technical and not physiological origin. The aim of the present study was to explore whether or not baseline pressures of ICP sensors can be affected by electrostatics discharges (ESD's), when ESD's are delivered at clinically relevant magnitudes. Methods We performed bench-testing of a set of commercial ICP sensors. In our experimental setup, the ICP sensor was placed in a container with 0.9% NaCl solution. A test person was charged 0.5 - 10 kV, and then delivered ESD's to the sensor by touching a metal rod that was located in the container. The continuous pressure signals were recorded continuously before/after the ESD's, and the pressure readings were stored digitally using a computerized system Results A total of 57 sensors were tested, including 25 Codman ICP sensors and 32 Raumedic sensors. When charging the test person in the range 0.5-10 kV, typically ESD's in the range 0.5 - 5 kV peak pulse were delivered to the ICP sensor. Alterations in baseline pressure ≥ 2 mmHg was seen in 24 of 25 (96%) Codman sensors and in 17 of 32 (53%) Raumedic sensors. Lasting changes in baseline pressure > 10 mmHg that in the clinical setting would affect patient management, were seen frequently for both sensor types. The changes in baseline pressure were either characterized by sudden shifts or gradual drifts in baseline pressure. Conclusions The baseline pressures of commercial solid ICP sensors can be altered by ESD's at discharge magnitudes that are clinically relevant. Shifts in baseline pressure change the ICP levels visualised to the physician on the monitor screen, and thereby reveal wrong ICP values, which likely represent a severe risk to the patient. PMID:21859487

SU-E-P-57: Radiation Doses Assessment to Paediatric Patients for Some Digital Diagnostic Radiology Examination in Emergency Department in Qatar

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abdallah, I; Aly, A; Al Naemi, H

Purpose: The aim of this study was to evaluate radiation doses to pediatric patients undergoing standard radiographic examinations using Direct Digital Radiography (DDR) in Paediatric emergency center of Hamad General Hospital (HGH) in state of Qatar and compared with regional and international Dose Reference Levels (DRLs). Methods: Entrance Skin Dose (ESD) was measured for 2739 patients for two common X-ray examinations namely: Chest AP/PA, Abdomen. Exposure factors such as kV, mAs and Focal to Skin Distance (FSD) were recorded for each patient. Tube Output was measured for a range of selected kV values. ESD for each individual patient was calculatedmore » using the tube output and the technical exposure factors for each examination. The ESD values were compared with the some international Dose Reference Levels (DRL) for all types of examinations. Results: The most performed procedure during the time of this study was chest PA/PA (85%). The mean ESD values obtained from AP chest, PA chest and AP abdomen ranged 91–120, 80–84 and 209 – 659 µGy per radiograph for different age’s groups respectively. Two protocols have been used for chest AP and PA using different radiological parameters, and the different of ESD values for chest PA and were 41% for 1 years old child, 57% for 5 years old for chest AP. Conclusion: The mean ESD were compared with those found in literature and were found to be comparable. The radiation dose can be reduced more for Chest AP and PA examination by optimization of each investigation and hence more studies are required for this task. The results presented will serve as a baseline data needed for deriving local reference doses for pediatric X-ray examinations in this local department and hence it can be applied in the whole Qatar.« less

Investigation of the Entrance Surface Dose and Dose to Different Organs in Lumbar Spine Imaging

PubMed Central

Sina, S; Zeinali, B; Karimipoorfard, M; Lotfalizadeh, F; Sadeghi, M; Zamani, E; Faghihi, R

2014-01-01

Background: Dose assessment using proper dosimeters is especially important in radiation protection optimization and imaging justification in diagnostic radiology. Objective: The aim of this study is to obtain the Entrance Skin Dose (ESD) of patients undergoing lumbar spine imaging using two thermoluminescence dosimeters TLD-100 (LiF: Mg, Ti) and GR-200 (LiF: Mg, Cu, P) and also to obtain the absorbed dose to different organs in lumbar spine imaging with several views. Methods: To measure the ESD values of the patients undergoing lumbar spine imaging, the two TLD types were put on their skin surface. The ESD values for different views of lumbar spine imaging were also measured by putting the TLDs at the surface of the Rando phantom. Several TLD chips were inserted inside different organs of Rando phantom to measure the absorbed dose to different organs in lumbar spine imaging. Results: The results indicate that there is a close agreement between the results of the two dosimeters. Based on the results of this experiment, the ESD dose of the 16 patients included in this study varied between 2.71 mGy and 26.29 mGy with the average of 11.89 mGy for TLD-100, and between 2.55 mGy and 27.41 mGy with the average of 12.32 mGy for GR-200 measurements. The ESDs obtained by putting the two types of TLDs at the surface of Rando phantom are in close agreement. Conclusion: According to the results, the GR200 has greater sensitivity than the TLD-100. PMID:25599058

High ESD Breakdown-Voltage InP HBT Transimpedance Amplifier IC for Optical Video Distribution Systems

NASA Astrophysics Data System (ADS)

Sano, Kimikazu; Nagatani, Munehiko; Mutoh, Miwa; Murata, Koichi

This paper is a report on a high ESD breakdown-voltage InP HBT transimpedance amplifier IC for optical video distribution systems. To make ESD breakdown-voltage higher, we designed ESD protection circuits integrated in the TIA IC using base-collector/base-emitter diodes of InP HBTs and resistors. These components for ESD protection circuits have already existed in the employed InP HBT IC process, so no process modifications were needed. Furthermore, to meet requirements for use in optical video distribution systems, we studied circuit design techniques to obtain a good input-output linearity and a low-noise characteristic. Fabricated InP HBT TIA IC exhibited high human-body-model ESD breakdown voltages (±1000V for power supply terminals, ±200V for high-speed input/output terminals), good input-output linearity (less than 2.9-% duty-cycle-distortion), and low noise characteristic (10.7pA/√Hz averaged input-referred noise current density) with a -3-dB-down higher frequency of 6.9GHz. To the best of our knowledge, this paper is the first literature describing InP ICs with high ESD-breakdown voltages.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kercel, S.W.; Baylor, V.M.; Labaj, L.E.

Enclosed Space Detection System (ESDS) is a fast, inexpensive, and reliable device for detecting human occupants hidden in vehicles. Operation requires less than two minutes. ESDS is used to foil attempts at smuggling illegal aliens, terrorists, and escaping prisoners. It is being tested at nuclear weapons facilities and has been operated at several prisons and international border crossings. ESDS is the first practical electronic alternative to physical searches of vehicles for hidden passengers. At critical checkpoints, a thorough physical search of a single fully loaded truck requires a team of from two to six people, and may take as longmore » as eight hours. Despite this level of security, experience has shown that the search can occasionally be foiled. Due to the enormous time and expense of thorough physical searches of vehicles, they are seldom conducted at any but the most critical of locations, simply leaving many sites vulnerable to crime and terrorism. Prior to the development of the ESDS, the only other effective alternative to physical search was the use of specially-trained canines, which can be vastly superior to the physical search in both time and accuracy. However, as discussed in this paper, canine inspection is not really a competitive substitute for ESDS because canine reliability (80% at most) is not as high as that of the ESDS (99%+), while the costs, training requirements, and operator skill needed are significantly higher with canines than with the ESDS. In addition, the ESDS has straightforward self-diagnostic tests to ensure the system is operating correctly; such tests are not currently available with either canine or human inspectors. ESDS offers an attractive supplement or alternative to meet current security requirements for vehicle searches at portals at government, nuclear, industrial, and other facilities where concealed persons may pose a threat either by entering or leaving.« less

Energy-selective SESD imaging utilizing a CMA. [Scanning Electron Stimulated Desorption with Cylindrical Mirror Analyzer

NASA Technical Reports Server (NTRS)

Larson, L. A.; Soria, F.; Poppa, H.

1980-01-01

A particularly simple conversion of a scanning Auger system for ESD ion energy distributions and scanning ESD has been developed. This approach combines the advantages of the small spot-size electron guns and mapping systems developed for SAM with the capability of ESD for the detection of hydrogen. Our intended use for the device is detection and mapping of surface concentrations of hydrogen on metals. The characteristics of SESD are illustrated with the preliminary results of an investigation into the ESD properties of hydrogenic adsorbates on Nb. It is shown that the ESDIED exhibit distinct differences indicative of the surface preparation, and that the ESD ion angular distributions have an effect on the observed contrast relationships in SESD.

[Estimation of Maximum Entrance Skin Dose during Cerebral Angiography].

PubMed

Kawauchi, Satoru; Moritake, Takashi; Hayakawa, Mikito; Hamada, Yusuke; Sakuma, Hideyuki; Yoda, Shogo; Satoh, Masayuki; Sun, Lue; Koguchi, Yasuhiro; Akahane, Keiichi; Chida, Koichi; Matsumaru, Yuji

2015-09-01

Using radio-photoluminescence glass dosimeter, we measured the entrance skin dose (ESD) in 46 cases and analyzed the correlations between maximum ESD and angiographic parameters [total fluoroscopic time (TFT); number of digital subtraction angiography (DSA) frames, air kerma at the interventional reference point (AK), and dose-area product (DAP)] to estimate the maximum ESD in real time. Mean (± standard deviation) maximum ESD, dose of the right lens, and dose of the left lens were 431.2 ± 135.8 mGy, 33.6 ± 15.5 mGy, and 58.5 ± 35.0 mGy, respectively. Correlation coefficients (r) between maximum ESD and TFT, number of DSA frames, AK, and DAP were r=0.379 (P<0.01), r=0.702 (P<0.001), r=0.825 (P<0.001), and r=0.709 (P<0.001), respectively. AK was identified as the most useful parameter for real-time prediction of maximum ESD. This study should contribute to the development of new diagnostic reference levels in our country.

Laparoscopic and endoscopic cooperative surgery for gastrointestinal tumor

PubMed Central

Ishibashi, Rei; Mitsui, Takashi; Aikou, Susumu; Kodashima, Shinya; Yamashita, Hiroharu; Yamamichi, Nobutake; Hirata, Yoshihiro; Fujishiro, Mitsuhiro; Seto, Yasuyuki; Koike, Kazuhiko

2017-01-01

With technological progress of endoscopic submucosal dissection (ESD) in the last decade, several laparoscopic and endoscopic cooperative surgeries (LECS) for gastrointestinal tumor have recently been developed. LECS is definitely favorable to the minimization of surgical margin, which leads to functional and anatomical preservation of gastrointestinal tract. LECS for gastrointestinal tumor is mainly sorted by two categories: exposure procedures and non-exposure procedures between endoluminal and extraluminal spaces. Exposure procedures have the potential risk of gastric contents or tumor cells spilling out over the abdominal cavity, because the stomach wall has to be perforated intentionally during the procedure. In order to avoid the potential these risks, non-exposure procedures have been developed. Currently, the LECS concept has rapidly permeated for treatment of gastrointestinal tumor due to its certainty and safety, although there is still room for improvement to lessen its technical difficulty. This review describes the current LECS for gastrointestinal tumor based on the several articles. PMID:28616402

Analysis of a concentric-tube robot design and feasibility for endoscopic deployment

NASA Astrophysics Data System (ADS)

Ponten, Ryan; Black, Caroline B.; Russ, Andrew J.; Rucker, D. Caleb

2017-03-01

An intraluminal endoscopic approach is desirable for most colonoscopic procedures and is growing in favor for other surgeries as tools are enhanced. Flexible robotic manipulators could further enhance the dexterity and precision of commercial endoscopic systems. In this paper, we explore the capabilities of concentric tube robots to work as tool manipulators at the tip of a colonoscope to perform endoscopic submucousal dissection (ESD) and endoscopic full thickness resection (EFTR). We provide an overview of the kinematic modeling of these manipulators, a design of a prototype manipulator and the transmission actuation system. Our analysis examines the workspace and stiffness of these manipulators being controlled at the tip of a colonoscope. We compare the results to reported surgical requirements and propose solutions for enhancing their effectiveness including notching tubes with a larger Young's Modulus. We also determine the resolution and accuracy of the actuation system.

Effects of electrostatic discharge on three cryogenic temperature sensor models

NASA Astrophysics Data System (ADS)

Courts, S. Scott; Mott, Thomas B.

2014-01-01

Cryogenic temperature sensors are not usually thought of as electrostatic discharge (ESD) sensitive devices. However, the most common cryogenic thermometers in use today are thermally sensitive diodes or resistors - both electronic devices in their base form. As such, they are sensitive to ESD at some level above which either catastrophic or latent damage can occur. Instituting an ESD program for safe handling and installation of the sensor is costly and it is desirable to balance the risk of ESD damage against this cost. However, this risk cannot be evaluated without specific knowledge of the ESD vulnerability of the devices in question. This work examines three types of cryogenic temperature sensors for ESD sensitivity - silicon diodes, Cernox{trade mark, serif} resistors, and wire wound platinum resistors, all manufactured by Lake Shore Cryotronics, Inc. Testing was performed per TIA/EIA FOTP129 (Human Body Model). Damage was found to occur in the silicon diode sensors at discharge levels of 1,500 V. For Cernox{trade mark, serif} temperature sensors, damage was observed at 3,500 V. The platinum temperature sensors were not damaged by ESD exposure levels of 9,900 V. At the lower damage limit, both the silicon diode and the Cernox{trade mark, serif} temperature sensors showed relatively small calibration shifts of 1 to 3 K at room temperature. The diode sensors were stable with time and thermal cycling, but the long term stability of the Cernox{trade mark, serif} sensors was degraded. Catastrophic failure occurred at higher levels of ESD exposure.

Can ESD Reach the Year 2020?

ERIC Educational Resources Information Center

Lenglet, Frans

2014-01-01

In order to have long-term impact ESD concepts, practices and policies should move into societal, policy and research arenas with high visibility and traction. In the process of going "transboundary", the ESD label may fade but the practice and organization of social and collaborative learning may gain.

Effect of egg storage duration and brooding temperatures on chick growth, intestine morphology and nutrient transporters.

PubMed

Yalcin, S; Gursel, I; Bilgen, G; Horuluoglu, B H; Gucluer, G; Izzetoglu, G T

2017-10-01

The effects of egg storage duration (ESD) and brooding temperature (BT) on BW, intestine development and nutrient transporters of broiler chicks were investigated. A total of 396 chicks obtained from eggs stored at 18°C for 3 days (ESD3-18°C) or at 14°C for 14 days (ESD14-14°C) before incubation were exposed to three BTs. Temperatures were initially set at 32°C, 34°C and 30°C for control (BT-Cont), high (BT-High) and low (BT-Low) BTs, respectively. Brooding temperatures were decreased by 2°C each at days 2, 7, 14 and 21. Body weight was measured at the day of hatch, 2, 7, 14, 21, 28 and 42. Cloacal temperatures of broilers were recorded from 1 to 14 days. Intestinal morphology and gene expression levels of H+-dependent peptide transporter (PepT1) and Na-dependent glucose (SGLT1) were evaluated on the day of hatch and 14. Cloacal temperatures of chicks were affected by BTs from days 1 to 8, being the lowest for BT-Low chicks. BT-High resulted in the heaviest BWs at 7 days, especially for ESD14-14°C chicks. This result was consistent with longer villus and larger villus area of ESD14-14°C chicks at BT-High conditions. From 14 days to slaughter age, BT had no effect on broiler weight. ESD3-18°C chicks were heavier than ESD14-14°C chicks up to 28 days. The PepT1 and SGLT1 expression levels were significantly higher in ESD3-18°C chicks than ESD14-14°C on the day of hatch. There was significant egg storage by BT interaction for PepT1 and SGLT1 transporters at day 14. ESD14-14°C chicks had significantly higher expression of PepT1 and SGLT1 at BT-Low than those at BT-Cont. ESD14-14°C chicks upregulated PepT1 gene expression 1.15 and 1.57-fold at BT-High and BT-Low, respectively, compared with BT-Cont, whereas PepT1 expression was downregulated 0.67 and 0.62-fold in ESD3-18°C chicks at BT-High and BT-Low. These results indicated that pre-incubation egg storage conditions and BTs affected intestine morphology and PepT1 and SGLT1 nutrient transporters expression in broiler chicks.

Paget's disease of bone resembling bone metastasis from gastric cancer.

PubMed

Shimoyama, Yasuyuki; Kusano, Motoyasu; Shimoda, Yoko; Ishihara, Shingo; Toyomasu, Yoshitaka; Ohno, Tetsuro; Mochiki, Erito; Sano, Takaaki; Hirato, Junko; Mori, Masatomo

2011-08-01

A 74-year-old man had an endoscopic type 0'-IIc tumor in the upper gastric body on the greater curvature and biopsy showed the tumor to be a well-differentiated adenocarcinoma (Group 5). He was referred to us for endoscopic submucosal dissection (ESD). Endoscopy revealed fold convergency, fold swelling, and fusion of the fold, indicating tumor invasion into the submucosa, which was outside the indications for ESD. In addition, there was an increase of serum bone-type alkaline phosphatase (ALP-III and ALP-IV) and urinary cross-linked N-terminal telopeptide of type I collagen (a bone metabolism marker), while (18)F-fluorodeoxyglucose positron emission tomography showed increased uptake in the left pelvis and Th10, suggesting bone metastases. We first diagnosed gastric cancer with bone metastases; however, the symptoms suggested pathological bone fracture and no bone pain. Therefore, a computed tomography-guided aspiration bone biopsy was performed to exclude the possibility of Paget's disease of bone. Biopsy specimens revealed no tumor and a mosaic pattern. No increased uptake of (18)F-FAMT (L-[3-(18)F] α-methyltyrosine) supported a diagnosis of no bone metastases from gastric cancer. We finally diagnosed gastric cancer accompanied by Paget's disease of bone and performed a laparoscopy-assisted proximal gastrectomy. The pathological diagnosis was U less 0-IIb, and U post 0-IIc ypT1a (M) N0H0P0M0 yp stage IA. In gastric cancer patients with suspected bone metastasis, we also need to consider Paget's disease of bone.

Moving beyond the EE and ESD Disciplinary Debate in Formal Education

ERIC Educational Resources Information Center

McKeown, Rosalyn; Hopkins, Charles

2007-01-01

Many educators think of Education for Sustainable Development (ESD) on a disciplinary level--what is Environmental Education's (EE) contribution to a more sustainable future? Briefly, we describe differences and similarities between EE and ESD. Next, we examine four levels of activity--disciplinary, whole school, educational system, and…

Military Handbook: Electrostatic Discharge Control Handbook for Protection of Electrical and Electronic Parts, Assemblies and Equipment (Excluding Electrically Initiated Explosive Devices (Metric)

DTIC Science & Technology

1994-07-31

everything that is received in ESD protective packaging materials treated as ESDS? YES/NO 40.1.13 Is the use of personal hygiene products , food, drinks...Does the training explain why food, drinks, smoking, personal hygiene products or common plastics are not to be used in ESD protective work areas? YES...trays? YES/NO 40.5.13 Are drinking, eating, smoking, the use of personal hygiene products and common plastics prohibited in the ESD protected work area

Education for Sustainable Development and retention: unravelling a research agenda

NASA Astrophysics Data System (ADS)

Lotz-Sisitka, Heila

2010-06-01

This paper considers the question of what education for sustainable development (ESD) research might signify when linked to the concept of "retention", and how this relation (ESD and retention) might be researched. It considers two different perspectives on retention, as revealed through educational research trajectories, drawing on existing research and case studies. Firstly, it discusses an ESD research agenda that documents retention by focusing on the issue of keeping children in schools. This research agenda is typical of the existing discourses surrounding Education for All (EFA). It then discusses a related ESD research agenda that focuses more on the pedagogical and curricular aspects of retention, as this provides for a deeper understanding of how ESD can contribute to improving the quality of teaching and learning within a wider EFA retention agenda.

Longevity enhances selection of environmental sex determination.

PubMed

Bull, J J; Bulmer, M G

1989-12-01

Environmental sex determination (ESD) is a mechanism in which an individual develops as male or female largely in response to some environmental effect experienced early in life. Its forms range from sex determination by egg incubation temperature in reptiles to sex determination of photoperiod in amphipods. Previous theoretical work as suggested that ESD is favored by natural selection if the fitness consequences of the early environmental experience differ for males and females, so that an individual benefits by being male under some conditions and female under others. A drawback of ESD is that it enables climatic changes to influence the population sex ratio, and such fluctuations select against ESD. This study employed numerical analyses to investigate the balance between these two opposing forces. The negative impact of climatic fluctuations appears to depend greatly on species longevity: substantial between-year fluctuations are of little consequence in selecting against ESD in long-lived species because annual sex ratio fluctuations tend to cancel and thus alter the total population sex ratio only slightly. Thus, if a species is sufficiently long-lived, extreme ESD can be maintained despite only a weak advantage. This result offers one explanation for the failure to demonstrate an advantage for the extreme forms of ESD observed in reptiles.

Improving the analyte ion signal in matrix-assisted laser desorption/ionization imaging mass spectrometry via electrospray deposition by enhancing incorporation of the analyte in the matrix.

PubMed

Malys, Brian J; Owens, Kevin G

2017-05-15

Matrix-assisted laser desorption/ionization (MALDI) is widely used as the ionization method in high-resolution chemical imaging studies that seek to visualize the distribution of analytes within sectioned biological tissues. This work extends the use of electrospray deposition (ESD) to apply matrix with an additional solvent spray to incorporate and homogenize analyte within the matrix overlayer. Analytes and matrix are sequentially and independently applied by ESD to create a sample from which spectra are collected, mimicking a MALDI imaging mass spectrometry (IMS) experiment. Subsequently, an incorporation spray consisting of methanol is applied by ESD to the sample and another set of spectra are collected. The spectra prior to and after the incorporation spray are compared to evaluate the improvement in the analyte signal. Prior to the incorporation spray, samples prepared using α-cyano-4-hydroxycinnamic acid (CHCA) and 2,5-dihydroxybenzoic acid (DHB) as the matrix showed low signal while the sample using sinapinic acid (SA) initially exhibited good signal. Following the incorporation spray, the sample using SA did not show an increase in signal; the sample using DHB showed moderate gain factors of 2-5 (full ablation spectra) and 12-336 (raster spectra), while CHCA samples saw large increases in signal, with gain factors of 14-172 (full ablation spectra) and 148-1139 (raster spectra). The use of an incorporation spray to apply solvent by ESD to a matrix layer already deposited by ESD provides an increase in signal by both promoting incorporation of the analyte within and homogenizing the distribution of the incorporated analyte throughout the matrix layer. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Method and apparatus for electrospark deposition

DOEpatents

Bailey, Jeffrey A.; Johnson, Roger N.; Park, Walter R.; Munley, John T.

2004-12-28

A method and apparatus for controlling electrospark deposition (ESD) comprises using electrical variable waveforms from the ESD process as a feedback parameter. The method comprises measuring a plurality of peak amplitudes from a series of electrical energy pulses delivered to an electrode tip. The maximum peak value from among the plurality of peak amplitudes correlates to the contact force between the electrode tip and a workpiece. The method further comprises comparing the maximum peak value to a set point to determine an offset and optimizing the contact force according to the value of the offset. The apparatus comprises an electrode tip connected to an electrical energy wave generator and an electrical signal sensor, which connects to a high-speed data acquisition card. An actuator provides relative motion between the electrode tip and a workpiece by receiving a feedback drive signal from a processor that is operably connected to the actuator and the high-speed data acquisition card.

The Rs4938723 Polymorphism Reduces Expression of MicroRNA-34b and Increases the Risk of Recurrence after Endoscopic Dissection in Early Gastric Cancer.

PubMed

Yu, Kuaiyun

2017-01-01

In respect to the effect of MET1 upon the recurrence of Early gastric cancer (EGC) after endoscopic dissection (ESD) treatment, we aimed to investigate the molecular mechanism, including the potential regulator and signaling pathways of MET1 in this study. We searched the miRNA database online (www.mirdb.org) with the "seed sequence" located within the 3'-UTR of the target gene, and then validated MET1 to be the direct gene via luciferase reporter assay system. Real-time PCR and western-blot were used to determine the expression of miR-34b mRNA and MET1 mRNA and protein in different treating group. MET1 was the direct gene of miR-34b by searching the miRNA database online and constructing luciferase reporter. We also investigated the negative regulatory relationship between miR-34b and MET1 via studying the relative luciferase activity at different concentrations of miR-34b mimics. Further, since rs4938723 polymorphism was previously reported to be interfering with the expression of miR-34b, we investigated the expression level of different genotypes including TT (N=20), TC (N=9) and CC (N=3), which supported the hypothesis that the presence of minor allele (C) of rs4938723 polymorphism compromised the expression of miR-34b. Meanwhile, we also conducted real time PCR and Western blot analysis to study the mRNA and protein expression level of MET1 among different genotypes or cells treated with different concentration of miR-34b mimics/inhibitors, indicating the negative regulatory relationship between miR-34b and MET1.We also investigated the relative viability of EGC cells when transfected with miR-34b mimics (50nM and 100nM) and miR-34b inhibitors (100nM) to validate miR-34b to be negatively interfering with the viability of EGC cells. These data confirmed miR-34b rs4938723 polymorphism was also recognized as a biomarker to predict recurrence after ESD in EGC patients via analysis upon the recurrence-free rate among different genotypes of EGC patients. © 2017 The Author(s). Published by S. Karger AG, Basel.

Shaping the GAP: Ideas for the UNESCO Post-2014 ESD Agenda

ERIC Educational Resources Information Center

Taylor, Jim

2014-01-01

This paper explores how ESD activities may be viewed on a continuum from "causal" approaches, seeking to cause change in others, to "enabling" orientations where efforts are made to enable people to implement the principles of ESD and respond to the environmental challenges they face from their own context. An enabling…

Outlook on Research in Education for Sustainable Development

ERIC Educational Resources Information Center

Grasel, Cornelia; Bormann, Inka; Schutte, Kerstin; Trempler, Kati; Fischbach, Robert

2013-01-01

This article provides an overview of current research on Education for Sustainable Development (ESD). It shows a lack of correspondence between ESD research and recent debates in educational research. Research on ESD has established as a field of research with insufficient relations to other fields in educational research. Based on the overview…

Education for Sustainable Development (ESD): The Turn away from "Environment" in Environmental Education?

ERIC Educational Resources Information Center

Kopnina, Helen

2012-01-01

This article explores the implications of the shift of environmental education (EE) towards education for sustainable development (ESD) in the context of environmental ethics. While plural perspectives on ESD are encouraged both by practitioners and researchers of EE, there is also a danger that such pluralism may sustain dominant political…

No-Self, Natural Sustainability and Education for Sustainable Development

ERIC Educational Resources Information Center

Wang, Chia-Ling

2017-01-01

This article explores the significance of sustainability and several ways in which education for sustainable development (ESD) can be considered. It presents several issues related to the theories of sustainability and ESD, which are generated based on a firm concept of anthropocentrism. ESD has been used for developing a scientific understanding…

Challenging the Focus of ESD: A Southern Perspective of ESD Guidelines

ERIC Educational Resources Information Center

de Andrade, Daniel Fonseca

2011-01-01

In parallel to the 2009 World Conference on Education for Sustainable Development held in Bonn, Germany, UNESCO organised a group of 25 young education for sustainable development (ESD)-engaged people from 25 countries to bring perceptions, demands, suggestions and contributions to the conference. Prior to the conference the group was divided into…

ESD testing of the 8S actuator (u)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mchugh, Douglas C

2010-12-03

The 8S actuator is a hot-wire initiated explosive component used to drive the W76-1 2X Acorn 1V valve. It is known to be safe from human electrostatic discharge (ESD) pin-to-pin and all pin-to-cup stimuli as well as 1 amp/1 watt safe. However low impedance (furniture) ESD stimuli applied pin-to-pin has not been evaluated. Components were tested and the results analyzed. The 8S actuator has been shown to be immune to human and severe furniture ESD, whether applied pin-to-pin or pin-to-cup.

Understanding the failure mechanisms of microwave bipolar transistors caused by electrostatic discharge

NASA Astrophysics Data System (ADS)

Jin, Liu; Yongguang, Chen; Zhiliang, Tan; Jie, Yang; Xijun, Zhang; Zhenxing, Wang

2011-10-01

Electrostatic discharge (ESD) phenomena involve both electrical and thermal effects, and a direct electrostatic discharge to an electronic device is one of the most severe threats to component reliability. Therefore, the electrical and thermal stability of multifinger microwave bipolar transistors (BJTs) under ESD conditions has been investigated theoretically and experimentally. 100 samples have been tested for multiple pulses until a failure occurred. Meanwhile, the distributions of electric field, current density and lattice temperature have also been analyzed by use of the two-dimensional device simulation tool Medici. There is a good agreement between the simulated results and failure analysis. In the case of a thermal couple, the avalanche current distribution in the fingers is in general spatially unstable and results in the formation of current crowding effects and crystal defects. The experimental results indicate that a collector-base junction is more sensitive to ESD than an emitter-base junction based on the special device structure. When the ESD level increased to 1.3 kV, the collector-base junction has been burnt out first. The analysis has also demonstrated that ESD failures occur generally by upsetting the breakdown voltage of the dielectric or overheating of the aluminum-silicon eutectic. In addition, fatigue phenomena are observed during ESD testing, with devices that still function after repeated low-intensity ESDs but whose performances have been severely degraded.

Partial differential equation methods for stochastic dynamic optimization: an application to wind power generation with energy storage.

PubMed

Johnson, Paul; Howell, Sydney; Duck, Peter

2017-08-13

A mixed financial/physical partial differential equation (PDE) can optimize the joint earnings of a single wind power generator (WPG) and a generic energy storage device (ESD). Physically, the PDE includes constraints on the ESD's capacity, efficiency and maximum speeds of charge and discharge. There is a mean-reverting daily stochastic cycle for WPG power output. Physically, energy can only be produced or delivered at finite rates. All suppliers must commit hourly to a finite rate of delivery C , which is a continuous control variable that is changed hourly. Financially, we assume heavy 'system balancing' penalties in continuous time, for deviations of output rate from the commitment C Also, the electricity spot price follows a mean-reverting stochastic cycle with a strong evening peak, when system balancing penalties also peak. Hence the economic goal of the WPG plus ESD, at each decision point, is to maximize expected net present value (NPV) of all earnings (arbitrage) minus the NPV of all expected system balancing penalties, along all financially/physically feasible future paths through state space. Given the capital costs for the various combinations of the physical parameters, the design and operating rules for a WPG plus ESD in a finite market may be jointly optimizable.This article is part of the themed issue 'Energy management: flexibility, risk and optimization'. © 2017 The Author(s).

Uncovering phantom shocks in cardiac patients with an implantable cardioverter defibrillator.

PubMed

Bilanovic, Ana; Irvine, Jane; Kovacs, Adrienne H; Hill, Ann; Cameron, Doug; Katz, Joel

2013-06-01

Implantable cardioverter defibrillator recipients sometimes report "phantom shocks" (PSs), defined as a reported shock lacking objective evidence. The aim of this study was to describe the subjective experience of PSs and their psychosocial correlates using a mixed methods approach. PS participants were matched on sex and age with individuals who received objective shocks only (OSO). Participants were interviewed and completed measures of posttraumatic stress disorder (PTSD Checklist-Civilian Version), depression and anxiety (Hospital Anxiety and Depression Scale), disease-specific distress (Cardiac Anxiety Questionnaire-CAQ), and social desirability (Socially Desirable Response Set-SDRS). Interviews were analyzed using interpretative phenomenological analysis (IPA). Seventeen male patients participated (PS: n = 9; OSO: n = 8). Three themes emerged from IPA: (1) PS as a somatic experience, (2) the emotional impact of PSs, and (3) searching for meaning. Quantitative analyses showed that both groups exhibited elevated trauma and anxiety levels. Effect size differences (ESD) suggested a medium ESD on depression (P = 0.176, ηp (2) = 0.118) and PTSD (avoidance: P = 0.383, ηp (2) = 0.055, numbing: P = 0.311, ηp (2) = 0.068), and a large ESD on SDRS (P = 0.081, ηp (2) = 0.189), where PS participants, comparatively, exhibited elevated levels. A medium ESD was detected on CAQ-fear (P = 0.237, ηp (2) = 0.092) where OSO participants exhibited greater heart-focused worry. The qualitative and quantitative findings of this mixed method study show convergence in terms of the emotional factors associated with the experience of PSs. PSs are often reported to be indistinguishable from objective shocks, evoking alarm, frustration, and confusion, forcing the individual to face the uncertainties of what to them is a novel and confusing experience. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

Education for Sustainable Development in German Science Education: Past-Present-Future

ERIC Educational Resources Information Center

Bögeholz, Susanne; Böhm, Marko; Eggert, Sabina; Barkmann, Jan

2013-01-01

In this paper, we trace selected strands of the German path to Education for Sustainable Development (ESD). We start by addressing pre-ESD research, and move to the concept of "Gestaltungskompetenz," the core concept of German ESD. The concept had to be realigned as to become more compatible with international research on learning…

Education as a Global "Soft Power" for Sustainable Development

ERIC Educational Resources Information Center

Sayamov, Yury Nikolayevich

2013-01-01

Purpose: The purpose of this paper is to analyse various aspects of education for sustainable development (ESD) drawing attention to the approaching end of the UN Decade on ESD (DESD) in 2014 and to the necessity of the continuation of ESD activities. Defining the internationalisation of education as an ever more significant part of globalisation,…

Examining the Literature to Reveal the Nature of Community EE/ESD Programs and Research

ERIC Educational Resources Information Center

Aguilar, Olivia M.

2018-01-01

Interest in community environmental education (EE) and community education for sustainable development (ESD) is increasing, as evidenced by the increase in studies examining community EE/ESD approaches and NAAEE's current development of the Community EE Guidelines for Excellence. Thus, the purpose of this paper is to: (1) provide a review of…

Engaging Mindfully with the Commons: A Case of Caribbean Teachers' Experience with ESD

ERIC Educational Resources Information Center

Down, Lorna

2015-01-01

A study of teachers' responses to Education for Sustainable Development (ESD) in a graduate course in Literature and Education for Sustainable Development, at the School of Education, The University of the West Indies, Mona, revealed that ESD can change indifference to the "commons" to one of mindfulness about local and global…

ESD Professional Development of University Educators in Serbia, Croatia and Macedonia: A Comparative Analysis

ERIC Educational Resources Information Center

Nikolic, Vesna; Milutinovic, Slobodan; Nedanovski, Pece; Mrnjaus, Kornelija

2017-01-01

Purpose: The paper aims to deal with the education for sustainable development (ESD) competences of university educators. The purpose of this paper is to provide a comparative analysis of opportunities for the development of ESD competences in higher education (HE) institutions in Serbia, Croatia and Macedonia. In addition, the paper explores the…

Current State and Future Prospects of Education for Sustainable Development (ESD) in Japan

ERIC Educational Resources Information Center

Tanaka, Haruhiko

2017-01-01

The UN Decade of Education for Sustainable Development (ESD) ran from 2005 to 2014. This study concerns the concepts of Sustainable Development (SD) and ESD. The term "sustainable development" was coined by the Brundtland Commission in 1987 as the key word in integrating environment and development. SD achieved international consensus at…

Tracing Sustainability: An International Comparison of ESD Implementation into Lower Secondary Education

ERIC Educational Resources Information Center

Bagoly-Simó, Péter

2013-01-01

With the progress of the DESD, increasing numbers of researchers have been developing indicators to effectively measure the implementation of ESD in formal, informal and non-formal education. This paper aims to measure the implementation of ESD in secondary school curricula in three countries carrying the fingerprints of a developed (Germany),…

Contributions of Education for Sustainable Development (ESD) to Quality Education: A Synthesis of Research

ERIC Educational Resources Information Center

Laurie, Robert; Nonoyama-Tarumi, Yuko; Mckeown, Rosalyn; Hopkins, Charles

2016-01-01

This research is a synthesis of studies carried out in 18 countries to identify contributions of education for sustainable development (ESD) to quality education. Five common questions were used for the interviews in each country to solicit education leaders and practitioners' views on the outcome and implementation of ESD. The analysis revealed…

Early Supported Discharge/Hospital At Home For Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Review and Meta-Analysis.

PubMed

Echevarria, Carlos; Brewin, Karen; Horobin, Hazel; Bryant, Andrew; Corbett, Sally; Steer, John; Bourke, Stephen C

2016-08-01

A systematic review and meta-analysis was performed to assess the safety, efficacy and cost of Early Supported Discharge (ESD) and Hospital at Home (HAH) compared to Usual Care (UC) for patients with acute exacerbation of COPD (AECOPD). The structure of ESD/HAH schemes was reviewed, and analyses performed assuming return to hospital during the acute period (prior to discharge from home treatment) was, and was not, considered a readmission. The pre-defined search strategy completed in November 2014 included electronic databases (Medline, Embase, Amed, BNI, Cinahl and HMIC), libraries, current trials registers, national organisations, key respiratory journals, key author contact and grey literature. Randomised controlled trials (RCTs) comparing ESD/HAH to UC in patients admitted with AECOPD, or attending the emergency department and triaged for admission, were included. Outcome measures were mortality, all-cause readmissions to 6 months and cost. Eight RCTs were identified; seven reported mortality and readmissions. The structure of ESD/HAH schemes, particularly selection criteria applied and level of support provided, varied considerably. Compared to UC, ESD/HAH showed a trend towards lower mortality (RRMH = 0.66; 95% CI 0.40-1.09, p = 0.10). If return to hospital during the acute period was not considered a readmission, ESD/HAH was associated with fewer readmissions (RRMH = 0.74, 95% CI: 0.60-0.90, p = 0.003), but if considered a readmission, the benefit was lost (RRMH = 0.84; 95% CI 0.69-1.01, p = 0.07). Costs were lower for ESD/HAH than UC. ESD/HAH is safe in selected patients with an AECOPD. Further research is required to define optimal criteria to guide patient selection and models of care.

Age Induced Effects on ESD Characteristics of Solar Array Coupons After Combined Space Environmental Exposures

NASA Technical Reports Server (NTRS)

Wright, Kenneth H.; Schneider, Todd A.; Vaughn, Jason A.; Hoang, Bao; Funderburk, Victor V.; Wong, Frankie; Gardiner, George

2012-01-01

A set of multi-junction GaAs/Ge solar array test coupons provided by Space Systems/Loral were subjected to a sequence of 5-year increments of combined space environment exposure tests. The test coupons capture an integrated design intended for use in a geosynchronous (GEO) space environment. A key component of this test campaign is performing electrostatic discharge (ESD) tests in the inverted gradient mode. The protocol of the ESD tests is based on the ISO standard for ESD testing on solar array panels [ISO-11221]. The test schematic in the ISO reference has been modified with Space System/Loral designed circuitry to better simulate the on-orbit operational conditions of its solar array design. Part of the modified circuitry is to simulate a solar array panel coverglass flashover discharge. All solar array coupons used in the test campaign consist of four cells constructed to form two strings. The ESD tests were performed at the beginning-of-life (BOL) and at each 5-year environment exposure point until end-of-life (EOL) at 15 years. The space environmental exposure sequence consisted of ultra-violet radiation, electron/proton particle radiation, thermal cycling, and Xenon ion thruster plume erosion. This paper describes the ESD test setup and the importance of the electrical test design in simulating the on-orbit operational conditions. Arc inception voltage results along with ESD test behavior from the BOL condition through the 15th year age condition are discussed. In addition, results from a Xenon plasma plume exposure test with an EOL coupon under the full ESD test condition will be discussed.

How education for sustainable development is implemented in Germany: Looking through the lens of educational governance theory

NASA Astrophysics Data System (ADS)

Bormann, Inka; Nikel, Jutta

2017-12-01

The United Nations (UN) Decade of Education for Sustainable Development (ESD) aimed to integrate the principles, values and practices of sustainable development into all aspects of education and learning around the world. The authors of this article address the implementation process of ESD in Germany during the UN Decade (2005-2014). By undertaking a meta-analysis of the findings of four related sub-studies they carried out during a three-year project funded by the German Federal Ministry of Education and Research, the authors contribute to the understanding of the process of transferring the concept of ESD within a multi-level education system. They investigated this process at two levels - the federal state (a sub-national entity in Germany) and the communal level. Drawing on educational governance theory, the authors unveil principles, norms, rules and procedures in the coordination of action within constellations of heterogeneous actors contributing to the implementation of ESD in their social entities. The outcome of the meta-analysis describes an emerging governance regime in ESD, taking into consideration the following features impacting the coordination of action being carried out by the actors involved: (1) the understanding of the normative concept of ESD as content of negotiation; (2) the perceived opportunity for actors to gain and increase appreciation within the field of ESD as an incentive for and driver of engagement; and (3) the dynamic quality of the set-up, rules and principles of the coordination of action, which renders these subject to situative changes. In the final part of the paper, the findings are discussed from the perspectives of the theory of transfer and the current empirical basis of ESD policy and governance.

Results Of Insulation Resistance Between Solar Cell String Gaps Without RTV Adhesive Grout After Electrostatic Discharge Tests With Cover Glass Flashover

NASA Astrophysics Data System (ADS)

Hoang, Bao; Wong, Frankie; Redick, Tod; Masui, Hirokazu; Endo, Taishi; Toyoda, Kazuhiro; Cho, Mengu

2011-10-01

A series of electrostatic discharge (ESD) tests was performed on solar array test coupons consisting of Advanced Triple Junction InGaP2/InGaAs/Ge solar cells. The motivation for these tests was to evaluate the effects of ESD on solar array design without room temperature vulcanized (RTV) adhesive grout between the string-to-string parallel gaps. To investigate the threshold of permanently sustained secondary arcs, various combinations of gap width, load voltage and string current were tested in a vacuum chamber equipped with an electron beam gun. This ESD test program included the ESD test circuit with simulated panel coverglass flashover. Although ESD events did not result in permanent sustained arcs, the insulation resistance between strings was found to decrease as the number of secondary arcs accumulated in the gap.

High efficiency and enhanced ESD properties of UV LEDs by inserting p-GaN/p-AlGaN superlattice

NASA Astrophysics Data System (ADS)

Huang, Yong; Li, PeiXian; Yang, Zhuo; Hao, Yue; Wang, XiaoBo

2014-05-01

Significantly improved electrostatic discharge (ESD) properties of InGaN/GaN-based UV light-emitting diode (LED) with inserting p-GaN/p-AlGaN superlattice (p-SLs) layers (instead of p-AlGaN single layer) between multiple quantum wells and Mg-doped GaN layer are reported. The pass yield of the LEDs increased from 73.53% to 93.81% under negative 2000 V ESD pulses. In addition, the light output power (LOP) and efficiency droop at high injection current were also improved. The mechanism of the enhanced ESD properties was then investigated. After excluding the effect of capacitance modulation, high-resolution X-ray diffraction (XRD) and atomic force microscope (AFM) measurements demonstrated that the dominant mechanism of the enhanced ESD properties is the material quality improved by p-SLs, which indicated less leakage paths, rather than the current spreading improved by p-SLs.

An Interdisciplinary Approach to Environmental and Sustainability Education: Developing Geography Students' Understandings of Sustainable Development Using Poetry

ERIC Educational Resources Information Center

Walshe, Nicola

2017-01-01

Education for sustainable development (ESD) persists as an important concept within international policy and yet, despite considerable debate, there remains a lack of consensus as to a pedagogy for ESD in schools. This paper presents findings from a study investigating how an interdisciplinary approach to ESD in England developed one class of 16-…

Tracing Sustainability: Education for Sustainable Development in the Lower Secondary Geography Curricula of Germany, Romania, and Mexico

ERIC Educational Resources Information Center

Bagoly-Simó, Péter

2014-01-01

Over the last two decades Education for Sustainable Development (ESD) has received increasing attention. Due to the close affinity that geography as a school subject shares with both theoretical constructs and methodologies of ESD, geography has assumed a key position in the implementation of ESD in formal education. Still, little attention has so…

An ESD Pathway to Quality Education in the Cyprus Primary Education Context

ERIC Educational Resources Information Center

Kadji-Beltran, Chrysanthi; Christodoulou, Nicoletta; Zachariou, Aravella; Lindemann-Matthies, Petra; Barker, Susan; Kadis, Costas

2017-01-01

This research is based on the rationale that the well-defined framework of education for sustainable development (ESD), its connection with real life and its specific integration in the educational policies and curricula can help to enhance quality education (QE) in a meaningful and identifiable way. In a first step, the common ground of ESD and…

Operationalizing sustainability in urban coastal systems: a system dynamics analysis.

PubMed

Mavrommati, Georgia; Bithas, Kostas; Panayiotidis, Panayiotis

2013-12-15

We propose a system dynamics approach for Ecologically Sustainable Development (ESD) in urban coastal systems. A systematic analysis based on theoretical considerations, policy analysis and experts' knowledge is followed in order to define the concept of ESD. The principles underlying ESD feed the development of a System Dynamics Model (SDM) that connects the pollutant loads produced by urban systems' socioeconomic activities with the ecological condition of the coastal ecosystem that it is delineated in operational terms through key biological elements defined by the EU Water Framework Directive. The receiving waters of the Athens Metropolitan area, which bears the elements of typical high population density Mediterranean coastal city but which currently has also new dynamics induced by the ongoing financial crisis, are used as an experimental system for testing a system dynamics approach to apply the concept of ESD. Systems' thinking is employed to represent the complex relationships among the components of the system. Interconnections and dependencies that determine the potentials for achieving ESD are revealed. The proposed system dynamics analysis can facilitate decision makers to define paths of development that comply with the principles of ESD. Copyright © 2013 Elsevier Ltd. All rights reserved.

Direct measurement of a patient's entrance skin dose during pediatric cardiac catheterization

PubMed Central

Sun, Lue; Mizuno, Yusuke; Iwamoto, Mari; Goto, Takahisa; Koguchi, Yasuhiro; Miyamoto, Yuka; Tsuboi, Koji; Chida, Koichi; Moritake, Takashi

2014-01-01

Children with complex congenital heart diseases often require repeated cardiac catheterization; however, children are more radiosensitive than adults. Therefore, radiation-induced carcinogenesis is an important consideration for children who undergo those procedures. We measured entrance skin doses (ESDs) using radio-photoluminescence dosimeter (RPLD) chips during cardiac catheterization for 15 pediatric patients (median age, 1.92 years; males, n = 9; females, n = 6) with cardiac diseases. Four RPLD chips were placed on the patient's posterior and right side of the chest. Correlations between maximum ESD and dose–area products (DAP), total number of frames, total fluoroscopic time, number of cine runs, cumulative dose at the interventional reference point (IRP), body weight, chest thickness, and height were analyzed. The maximum ESD was 80 ± 59 (mean ± standard deviation) mGy. Maximum ESD closely correlated with both DAP (r = 0.78) and cumulative dose at the IRP (r = 0.82). Maximum ESD for coiling and ballooning tended to be higher than that for ablation, balloon atrial septostomy, and diagnostic procedures. In conclusion, we directly measured ESD using RPLD chips and found that maximum ESD could be estimated in real-time using angiographic parameters, such as DAP and cumulative dose at the IRP. Children requiring repeated catheterizations would be exposed to high radiation levels throughout their lives, although treatment influences radiation dose. Therefore, the radiation dose associated with individual cardiac catheterizations should be analyzed, and the effects of radiation throughout the lives of such patients should be followed. PMID:24968708

Clearing the Path That Has Been Laid: A Conceptualisation of Education for Sustainable Development

ERIC Educational Resources Information Center

Bentham, Hayley

2013-01-01

Education for sustainable development (ESD) has become so crucial that we have tried to smear it on anything and everything that is teachable. The consequence is that almost everything we do may be said to contain weak attributes of ESD even if we know nothing significant about it. This paper attempts to reveal an understanding of ESD that is…

Contribution of Kobe University to the Regional Centre of Expertise (RCE) on Education for Sustainable Development (ESD) Hyogo-Kobe

ERIC Educational Resources Information Center

Itoh, Masayuki; Suemoto, Makoto; Matsuoka, Koji; Ito, Atsushi; Yui, Kiyomitsu; Matsuda, Tsuyoshi; Ishikawa, Masanobu

2008-01-01

Purpose: The purpose of this paper is to introduce the Regional Centre of Expertise (RCE) on education for sustainable development (ESD) Hyogo-Kobe, and the contribution of Kobe University as a model case. An attempt to develop and implement a new ESD programme in higher education is also reported. Design/methodology/approach: A brief description…

Modeling of ESD events from polymeric surfaces

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pfeifer, Kent Bryant

2014-03-01

Transient electrostatic discharge (ESD) events are studied to assemble a predictive model of discharge from polymer surfaces. An analog circuit simulation is produced and its response is compared to various literature sources to explore its capabilities and limitations. Results suggest that polymer ESD events can be predicted to within an order of magnitude. These results compare well to empirical findings from other sources having similar reproducibility.

Injectable Drug Eluting Elastomeric Polymer: A Novel Submucosal Injection Material

PubMed Central

Tran, Richard T.; Palmer, Michael; Tang, Shou-Jiang; Abell, Thomas L.; Yang, Jian

2011-01-01

Background Biodegradable hydrogels can deliver therapeutic payloads with great potentials in endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) to yield improvements in efficacy and foster mucosal regeneration. Objective To assess the efficacy of an injectable drug eluting elastomeric polymer (iDEEP) as a submucosal injection material. Design Comparative study among 3 different solutions using material characterization tests, ex vivo and in vivo porcine models. Setting Academic hospital. Interventions 30 gastric submucosal cushions were achieved with saline (0.9%), sodium hyaluronate (0.4%), and iDEEP (n = 10) in ex vivo porcine stomachs. Four porcine gastric submucosal cushions were then performed in vivo using iDEEP. Main outcome measurements Maximum injection pressure, Rebamipide release rate, submucosal elevation duration, and assessment of in vivo efficacy by en bloc resection. Results No significant difference in injection pressures between iDEEP (28.9 ± 0.3 PSI) and sodium hyaluronate (29.5 ± 0.4 PSI, P > .05) was observed. iDEEP gels displayed a controlled release of Rebamipide up to 2 weeks in vitro. The elevation height of iDEEP (5.7 ± 0.5 mm) was higher than saline (2.8 ± 0.2 mm, P < .01) and SH (4.2 ± 0.2 mm, P < .05). All EMR procedures were successfully performed after injection of iDEEP, and a large gel cushion was noted after the resection procedure. Limitations Benchtop, ex vivo, and non-survival pig study. Conclusions A novel injection solution was evaluated for endoscopic resection. These results suggest that iDEEP may provide a significant step towards the realization of an ideal EMR and ESD injection material. PMID:22301346

One hundred and one over-the-scope-clip applications for severe gastrointestinal bleeding, leaks and fistulas.

PubMed

Wedi, Edris; Gonzalez, Susana; Menke, Detlev; Kruse, Elena; Matthes, Kai; Hochberger, Juergen

2016-02-07

To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip (OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas. From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients (48.8%) presented with severe upper-gastrointestinal (GI) bleeding, 3 (3.6%) patients with lower-GI bleeding, 7 patients (8.3%) underwent perforation closure, 18 patients (21.4%) had prevention of secondary perforation, 12 patients (14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection (ESD) and 3 patients (3.6%) had an intervention on a chronic fistula. In 78/84 patients (92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients (89.28%). The overall mortality in the study patients was 11/84 (13.1%) and was seen in patients with life-threatening upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41 (85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases (57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18 (100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen (2%). This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.

Vertical phase separation of 6,13-bis(triisopropylsilylethynyl) pentacene/poly(methyl methacrylate) blends prepared by electrostatic spray deposition for organic field-effect transistors

NASA Astrophysics Data System (ADS)

Onojima, Norio; Hara, Kazuhiro; Nakamura, Ayato

2017-05-01

Blend films composed of 6,13-bis(triisopropylsilylethynyl) pentacene (TIPS pentacene) and poly(methyl methacrylate) (PMMA) were prepared by electrostatic spray deposition (ESD). ESD is considered as an intermediate process between dry and wet processes since the solvent present in small droplets can almost be evaporated before arriving at the substrate. Post-drying treatments with the time-consuming evaporation of residual solvents can be omitted. However, it is still not clear that a vertically phase-separated structure can be formed in the ESD process since the vertical phase separation of the blend films is associated with the solvent evaporation. In this study, we fabricated bottom-gate, top-contact organic field-effect transistors based on the blend films prepared by ESD and the devices exhibited transistor behavior with small hysteresis. This result demonstrates that the vertical phase separation of a blend film (upper TIPS pentacene active layer/bottom PMMA gate insulator) can occur in the facile one-step ESD process.

ESD prevention, combating ESD problem — Solutions

NASA Astrophysics Data System (ADS)

Duban, M.

2002-12-01

In today's Electronic equipment manufacturing, managing an ESD (Electro static Discharge) plan is an integral part of a complete quality program. Every body has been in presence of static electricity one day or an other. But a discharge on a body of man is only felt when the potential of charge before the discharge is higher than 3000 volts but components can have a sensitivity less than 20 Volts !

Mechanism of Electro-Static Discharge (ESD) Sensitivity of Reactive Powders and Its Mitigation

DTIC Science & Technology

2011-03-14

motivated by both safety requirements for handling flammable gas mixtures and convenience of using spark discharge as a controlled energy igniter for...On the other hand, experimental tests of ESD ignition sensitivity for non-aerosolized powders are among the most commonly used safety assessments...materials, including nanomaterials for a variety of applications. Current protocols used for ESD ignition sensitivity testing, e.g., described in

Review of Exploration Systems Development (ESD) Integrated Hazard Development Process. Volume 1; Appendices

NASA Technical Reports Server (NTRS)

Smiles, Michael D.; Blythe, Michael P.; Bejmuk, Bohdan; Currie, Nancy J.; Doremus, Robert C.; Franzo, Jennifer C.; Gordon, Mark W.; Johnson, Tracy D.; Kowaleski, Mark M.; Laube, Jeffrey R.

2015-01-01

The Chief Engineer of the Exploration Systems Development (ESD) Office requested that the NASA Engineering and Safety Center (NESC) perform an independent assessment of the ESD's integrated hazard development process. The focus of the assessment was to review the integrated hazard analysis (IHA) process and identify any gaps/improvements in the process (e.g., missed causes, cause tree completeness, missed hazards). This document contains the outcome of the NESC assessment.

Review of Exploration Systems Development (ESD) Integrated Hazard Development Process. Appendices; Volume 2

NASA Technical Reports Server (NTRS)

Smiles, Michael D.; Blythe, Michael P.; Bejmuk, Bohdan; Currie, Nancy J.; Doremus, Robert C.; Franzo, Jennifer C.; Gordon, Mark W.; Johnson, Tracy D.; Kowaleski, Mark M.; Laube, Jeffrey R.

2015-01-01

The Chief Engineer of the Exploration Systems Development (ESD) Office requested that the NASA Engineering and Safety Center (NESC) perform an independent assessment of the ESD's integrated hazard development process. The focus of the assessment was to review the integrated hazard analysis (IHA) process and identify any gaps/improvements in the process (e.g. missed causes, cause tree completeness, missed hazards). This document contains the outcome of the NESC assessment.

Electrostatic Discharge (ESD) Susceptibility of Electronic Devices

DTIC Science & Technology

1983-01-01

determined by knowing the thermal environment in which the component is to operate. However, ESD is not that predictable . It is considered a random... predicted where a part may experience an ESD pulse during usage? (3) What effect does stressing a device with different models have on its propensity for...relatively low ESO threshold voltages (i.e., < 7000 volts) tend to be consistently high compared with their predicted level using EMP data. But at

Electron-stimulated desorption study of hydrogen-exposed aluminum films

NASA Technical Reports Server (NTRS)

Park, CH.; Bujor, M.; Poppa, H.

1984-01-01

H2 adsorption of evaporated clean and H2-exposed aluminum films is investigated by using the electron-stimulated desorption (ESD) method. A strong H(+)ESD signal is observed on a freshly evaporated aluminum surface which is clean according to previously proposed cleanlines criteria. An increased H(+) yield on H2 exposure is also observed. However, the increasing rate of H(+) emission could be directly correlated with small increases in H2O partial pressure during H2 exposure. It is proposed that the oxidation of aluminum by water vapor and subsequent adsorption of H2 or water is the primary process of the enhanced high H(+) yield during H2 exposure.

pH-dependent structural change of the extracellular sensor domain of the DraK histidine kinase from Streptomyces coelicolor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yeo, Kwon Joo; Kim, Eun Hye; Hwang, Eunha

2013-02-15

Highlights: ► We described the biochemical and biophysical properties of the extracellular sensory domain (ESD) of DraK histidine kinase. ► The ESD of DraK showed a reversible pH-dependent conformational change in a wide pH range. ► The E83 is an important residue for the pH-dependent conformational change. -- Abstract: Recently, the DraR/DraK (Sco3063/Sco3062) two-component system (TCS) of Streptomycescoelicolor has been reported to be involved in the differential regulation of antibiotic biosynthesis. However, it has not been shown that under which conditions and how the DraR/DraK TCS is activated to initiate the signal transduction process. Therefore, to understand the sensing mechanism,more » structural study of the sensory domain of DraK is highly required. Here, we report the biochemical and biophysical properties of the extracellular sensory domain (ESD) of DraK. We observed a reversible pH-dependent conformational change of the ESD in a pH range of 2.5–10. Size-exclusion chromatography and AUC (analytical ultracentrifugation) data indicated that the ESD is predominantly monomeric in solution and exists in equilibrium between monomer and dimer states in acidic condition. Using NMR (nuclear magnetic resonance) and CD (circular dichroism) spectroscopy, our findings suggest that the structure of the ESD at low pH is more structured than that at high pH. In particular, the glutamate at position 83 is an important residue for the pH-dependent conformational change. These results suggest that this pH-dependent conformational change of ESD may be involved in signal transduction process of DraR/DraK TCS.« less

Early supported discharge services for stroke patients: a meta-analysis of individual patients' data.

PubMed

Langhorne, Peter; Taylor, Gillian; Murray, Gordon; Dennis, Martin; Anderson, Craig; Bautz-Holter, Erik; Dey, Paola; Indredavik, Bent; Mayo, Nancy; Power, Michael; Rodgers, Helen; Ronning, Ole Morten; Rudd, Anthony; Suwanwela, Nijasri; Widen-Holmqvist, Lotta; Wolfe, Charles

Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (p<0.0001). There were also significant improvements in scores on the extended activities of daily living scale and in the odds of living at home and reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patients with mild to moderate disability. Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as shortening hospital stays.

Superfund record of decision amendment (EPA Region 4): Hercules 009 Landfill, Brunswick, GA, August 14, 1998

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1999-03-01

This memorandum serves to present the Hercules 009 Landfill Superfund Site Explanation of Significant Difference (ESD) for concurrence. The Record of Decision (ROD) was signed on March 25, 1993 (PB94-964070). The ESD amends the ROD by changing the type of cover to be placed on the treated landfill soils and sludges. The ESD also explains EPA`s justification for determining the appropriate treatment depth in the landfill cells.

Electrostatic Discharge Test of Multi-Junction Solar Array Coupons After Combined Space Environmental Exposures

NASA Technical Reports Server (NTRS)

Wright, Kenneth H.; Schneider, Todd; Vaughn, Jason; Hoang, Bao; Funderburk, Victor V.; Wong, Frankie; Gardiner, George

2010-01-01

A set of multi-junction GaAs/Ge solar array test coupons were subjected to a sequence of 5-year increments of combined environmental exposure tests. The test coupons capture an integrated design intended for use in a geosynchronous (GEO) space environment. A key component of this test campaign is conducting electrostatic discharge (ESD) tests in the inverted gradient mode. The protocol of the ESD tests is based on the ISO/CD 11221, the ISO standard for ESD testing on solar array panels. This standard is currently in its final review with expected approval in 2010. The test schematic in the ISO reference has been modified with Space System/Loral designed circuitry to better simulate the on-orbit operational conditions of its solar array design. Part of the modified circuitry is to simulate a solar array panel coverglass flashover discharge. All solar array coupons used in the test campaign consist of 4 cells. The ESD tests are performed at the beginning of life (BOL) and at each 5-year environment exposure point. The environmental exposure sequence consists of UV radiation, electron/proton particle radiation, thermal cycling, and ion thruster plume. This paper discusses the coverglass flashover simulation, ESD test setup, and the importance of the electrical test design in simulating the on-orbit operational conditions. Results from 5th-year testing are compared to the baseline ESD characteristics determined at the BOL condition.

The barriers encountered by teachers implementing education for sustainable development: discipline bound differences and teaching traditions

NASA Astrophysics Data System (ADS)

Borg, Carola; Gericke, Niklas; Höglund, Hans-Olof; Bergman, Eva

2012-07-01

Background : According to the Swedish curriculum teachers in all subjects have a responsibility to integrate a holistic perspective of sustainable development (SD) and teach according to an education for sustainable development (ESD) approach. However previous research has shown that teachers from different subjects perceive SD differently. Purpose : The study aimed at investigating if and how teachers' subject area influences their ability to implement a holistic perspective of ESD; we investigated both the impact of teaching traditions and the barriers that teachers experienced. Sample : A stratified sample of 224 Swedish upper secondary schools participated. An online questionnaire was sent and answered by a total of 3229 teachers at these schools. In total, there were 669 science teachers, 373 social science teachers, 483 language teachers, 713 vocational and esthetical-practical teachers, and 739 teachers from other disciplines who participated in the survey. Design and methods : The questionnaire consisted of questions requiring Likert-scale responses and multiple-choice questions. The data from the questionnaire were analyzed using Pearson's Chi-square test and one-way ANOVA. The significance level accepted was p < 0.05. Results : Teachers were influenced by their own subject traditions. Science teachers in our study were grounded in the fact-based tradition and lectures were the most common teaching method used. The teaching tradition of the social science teachers seemed to be most in line to an ESD approach. Many language teachers (41%) stated they did not include SD issues in their teaching at all. Among the barriers identified, the most common obstacles were that the teachers lacked inspiring examples of how to include SD in their teaching and that they lacked the necessary expertise about SD. Conclusion : This study highlights the need for the management within schools to create opportunities for teachers to work collaboratively when teaching ESD. It is also important to provide further training that is adjusted to the needs of different disciplines.

Characteristics of electromagnetic interference generated by arc discharges. [in spacecraft

NASA Technical Reports Server (NTRS)

Leung, Philip

1986-01-01

Electromagnetic interference (EMI) signatures resulting from arc discharges are characterized, and the effects of electrostatic discharges (ESDs) on the design of spacecraft systems are investigated. EMI characterization experiments were performed on Mylar, Teflon, Kapton, fused silica, and fiberglass in a vacuum chamber with acrylic walls; the experimental design and procedures are described. Discharge current pulses and RF spectra generated by the sample materials are examined. The relation between the magnitude of EMI generated during an ESD event and the material, environment, and geometry is studied. The solar-array/plasma interaction is analyzed; particular attention is given to the rate of discharge as a function of plasma density. The physical mechanisms of ESD-generated EMI are discussed. The data reveal that ESD parameters are dependent on the test environment.

Intraocular straylight screening in medical testing centres for driver licence holders in Spain

PubMed Central

Michael, Ralph; Barraquer, Rafael I.; Rodríguez, Judith; Tuñi i Picado, Josep; Jubal, Joan Serra; González Luque, Juan Carlos; van den Berg, Tom

2010-01-01

Purpose To test the performance of the C-quant straylight meter during the daily routine work in medical testing centres for driver license applicants and driver license holders in Spain. Methods Altogether 914 subjects, of which 376 younger than 35 years, 428 between 35 and 60 years and 110 over 60 years were measured with the C-quant in three medical testing centres (Barcelona, Zaragoza and Palma de Mallorca) in 2006. Technicians were instructed once and the measurements were done during the daily routine work. We recorded: age, BCVA, self-reported subjective blinding at night; and from the C-quant: straylight parameter (log s), measurement quality parameters (ESD, Q) and test duration. Results Total C-quant test duration increases slightly with age from a mean of 7 min (< 35 years) to a mean of 9 min (> 60). At first attempt, 82 % of all subjects produced reliable results (ESD < 0.12). The straylight parameter for this group was independent of ESD and ESD was independent of total test duration. The known age dependence of the straylight parameter and the weak correlation with BCVA was confirmed. The distribution of subjective blinding at night was very different between test centres. Subjects with “very strong” subjective blinding had significantly higher straylight values than subjects with “no” subjective blinding. Subjects avoiding night driving had significant higher straylight values than subjects driving at night. Conclusion The C-quant measure is reasonable fast. Good subject instruction is important to get first attempt reliable results. Self-reported subjective blinding results depend strongly on the interviewer.

Internal charging analysis tools, NUMIT 2.0 and 3D NUMIT, and those applications on Europa Clipper and Juno missions

NASA Astrophysics Data System (ADS)

Kim, W.; Chinn, J. Z.; Katz, I.; Jun, I.; Garrett, H. B.

2016-12-01

One of the major concerns in the spacecraft design due to natural space environment interaction is the internal charging in dielectric materials and floating conductors, especially for missions encountering a high radiation environment such as NASA's Juno and proposed Europa Clipper Missions. Sufficiently energetic electrons can penetrate the spacecraft structure or electronics chassis and stop within dielectrics and floating conductors. Electrons can accumulate in dielectrics over time due to the dielectrics' very low conductivity. If the electric field resulting from a charge buildup becomes higher than the breakdown threshold of the dielectric, discharge may occur, potentially damaging near-by sensitive electronics. Indeed, numerous spacecraft anomalies and failures have been attributed to this phenomenon, referred to as internal electrostatic discharge (iESD). Therefore, accurate assessment of the risk of iESD for a given space environment and dielectric geometry is important for spacecraft reliability. To evaluate the risk of iESD, we developed a general three dimensional internal charge analyses method, 3D NUMIT by combining a Monte Carlo radiation transport simulation tool such as MCNPX or GEANT4 and a commercial FEA software such as COMSOL. Also for a simple and fast internal charging assessment, we significantly improved the widely used one dimensional internal charging assessment code, NUMIT and named NUMIT 2.0. We will show the new features of NUMIT 2.0 and the capability of 3D NUMIT with several examples of applications of those tools to iESD assessments on Juno and Europa Clipper Missions.

A characterization study of a hydroxylated polycrystalline tin oxide surface

NASA Technical Reports Server (NTRS)

Hoflund, Gar B.; Grogan, Austin L., Jr.; Asbury, Douglas A.; Schryer, David R.

1989-01-01

In this study Auger electron spectroscopy, electron spectroscopy for chemical analysis (ESCA) and electron-stimulated desorption (ESD) have been used to examine a polycrystalline tin oxide surface before and after annealing in vacuum at 500 C. Features due to surface hydroxyl groups are present in both the ESCA and ESD spectra, and ESD shows that several chemical states of hydrogen are present. Annealing at 500 C causes a large reduction in the surface hydrogen concentration but not complete removal.

Systemic Inflammatory Response After Natural Orifice Translumenal Surgery: Transvaginal Cholecystectomy in a Porcine Model

PubMed Central

Fan, Joe K. M.; Tong, Daniel K. H.; HO, David W. Y.; Luk, John; Law, Simon

2009-01-01

Objective: We analyzed circulating TNF-α and IL-6 to determine systemic inflammatory responses associated with transvaginal cholecystectomy in a porcine model. Methods: Six female pigs were used for a survival study after transvaginal cholecystectomy (NOTES group) using endoscopic submucosal dissection (ESD) instruments and a single-channel endoscope. Blood was drawn preoperatively and 24 hours and 48 hours postoperatively. Four pigs were used as controls. In addition, laparoscopic cholecystectomy was performed in 2 pigs for laparoscopic control. Results: In all 6 pigs in the NOTES group, no major intraoperative complications occurred. No significant differences were found between control, laparoscopic, and NOTES groups in terms of preoperative IL-6 level (P=0.897) and at 24 hours (P=0.790), and 48 hours postoperatively (P=0.945). Similarly, there was no significant difference in mean preoperative (P=0.349) and mean day 2 postoperative TNF-α levels (P=0.11). But a significant increase in day 1 postoperative TNF-α levels in the laparoscopic group compared with that in the control and NOTES groups was observed (P=0.049). One limitation of our study is that the sample size was relatively small. Conclusion: NOTES is safe in animal models in terms of anatomical and cellular level changes with minimal systemic inflammatory host responses elicited. Further study needs to be carried out in humans before NOTES can be recommended for routine use. PMID:19366533

Characterisation of soils under long-term crop cultivation without fertilisers: a case study in Japan.

PubMed

Nakatsuka, Hiroko; Tamura, Kenji

2016-01-01

Certain farms in Japan, namely unfertilised farms (UFs), have been able to maintain high productivity for over 40 years without applying fertilisers or composts. This study aimed to characterise the physicochemical, biological and micromorphological properties of soil in UFs compared with control farms in Eniwa and Nariita and to identify characteristics that are associated with crop productivity. In UFs, no plough pan was observed. The thickness of the effective soil depth (ESD) of UFs was greater than that of CFs. The concentrations of soil organic carbon, total nitrogen and nitrate-nitrogen in ESD of UFs were higher than those in ESD of CFs. Soil microstructure observations indicated the strong development of a granular microstructure with large amounts of void space and a high fractal dimension in both surface and subsoil horizons of UFs. Dry yield had a strong correlation with ESD thickness and fractal dimension of voids. Thus, the management of unfertilised cultivation promoted the development of soil aggregation in both A and B horizons. The increase in ESD, soil pore spaces and complexity with the development of subsoil structure improved the productivity of unfertilised cultivation.

Triboelectric Charging in Simulated Mars Environment

NASA Technical Reports Server (NTRS)

Lee, R.; Barile, R.

1999-01-01

Triboelectric charging of nonconducting materials followed by sudden electrostatic discharge (ESD) can damage electronic equipment and become ignition hazard to combustible materials. Mars atmosphere has near zero humidity and therefore natural charge bleeding to surroundings is anticipated to be limited. Potential mitigation of ESD problems has been conjectured based upon strong extraterrestrial radiation on Mars compared to earth. A hypothesis was formulated that ESD problem is less significant in simulated Mars condition since strong radiation and presence of argon will generate an ionized environment; this will be conducive to rapid bleeding of static charge into the surroundings.

Bone response adjacent to calcium phosphate electrostatic spray deposition coated implants: an experimental study in goats.

PubMed

Manders, Peter J D; Wolke, Joop G C; Jansen, John A

2006-10-01

A new technique to deposit calcium phosphate (CaP) coatings onto titanium substrates has been developed recently. This electrostatic spray deposition (ESD) technique seems to be very promising. It appears to have clinical advantages such as an inexpensive and simple set-up, high deposition efficiency and the possibility to synthesize layers with a defined surface morphology. The aim of this study was to examine biological properties and osteoconductivity of ESD CaP coatings when inserted into the femoral condyle of a goat. Twenty-four implants with two gaps, i.e. 1 or 2 mm, were inserted into the femoral condyles of six goats. The implants were coated on one side with either a commercially available plasma-sprayed hydroxyapatite (HAPS) coating or an ESD carbonate apatite (CAESD) coating. The other side of the implant was always left uncoated (Ti). Twelve weeks after implantation the animals were sacrificed and the characteristics of bone ingrowth and bone contact were evaluated. At 3 months, histological and quantitative histomorphometrical measurements demonstrated more bone ingrowth and bone contact for coated sites as compared with uncoated sites. Statistical testing revealed that for both the 1 and 2 mm gaps HAPS (plasma-sprayed hydroxyapatite) as well as CAESD (ESD carbonate apatite) -coated surfaces always had a significantly higher (P<0.05) amount of bone contact than uncoated Ti surfaces. On HAPS surfaces always significantly more bone was present than on CAESD surfaces. Further statistical testing revealed a significant difference in bone ingrowth between the HAPS as well as CAESD and Ti 1+2 mm gap specimens (P<0.05). Further, HAPS 1 mm gaps showed more bone ingrowth than CAESD 1 mm gaps. No significant difference existed between HAPS and CAESD 2 mm gaps. On the basis of our observations, we conclude that the used ESD technique is a promising new method to deposit CaP coatings onto titanium substrates. On the other hand, plasma-spray HA-coated implants have a still more favourable effect on the bone response.

Development of Energy-Saving Devices for a 20,000DWT River-Sea Bulk Carrier

NASA Astrophysics Data System (ADS)

Chen, Kunpeng; Gao, Yuling; Huang, Zhenping; Dong, Guoxiang

2018-05-01

A reduction of fuel consumption and an increase in efficiency are currently required for river-sea bulk carriers. Pre-swirl and ducted stators are widely used devices in the industry and efficiency gains can be obtained for single-screw and twin-screw vessels. Based on the hydrodynamic characteristics of the 20,000DWT river-sea bulk carrier, in this study, we proposed, designed, and tested a series of pre-swirl energy-saving devices (ESDs). The experimental results demonstrate that the proposed ESDs improved the propulsive efficiency and reduced the delivered power. The results confirm the success of our ESD for the 20,000DWT river-sea bulk carrier. We validated the role of Reynolds-averaged Navier-Stokes (RANS) computational fluid dynamics (CFD) in the twin-skeg river-sea vessel ESD design and found the circumferential arrangement and number of stators to be important factors in the design process.

Bait and the susceptibility of American lobsters Homarus americanus to epizootic shell disease.

PubMed

Bethoney, N David; Stokesbury, Kevin D E; Stevens, Bradley G; Altabet, Mark A

2011-05-24

Shell disease (SD) has been observed in lobster populations for almost a hundred years, but recently, rates of an epizootic form of shell disease (ESD) have increased in the southern New England (USA) area. A large proportion of fish in the diet of American lobsters Homarus americanus has been linked to increased rates of SD. Therefore, the use of fish as lobster bait may be linked to increased ESD rates in lobsters. Lobsters from the western portion of Martha's Vineyard, MA (41 degrees N, 71 degrees W), were randomly divided into 3 groups of 16 and exposed to dietary treatments (100% herring; 48% crab, 48% blue mussel and 4% plant matter; or 50% herring, 24% crab, 24% mussel, 2% plant matter) to determine if lobster tissue delta15N levels reflected diet. The results of the feeding experiment confirmed that differences in diet are observed in the delta15N levels of lobster muscle tissue. The delta15N levels of tissue samples from 175 wild lobsters with varying degrees of ESD were unrelated to ESD severity but did indicate lobsters were eating large amounts of fish (bait). This result does not support the speculation that fish used as bait is contributing to ESD outbreaks in portions of the southern New England area.

Role of initial coherence on entanglement dynamics of two qubit X states

NASA Astrophysics Data System (ADS)

V, Namitha C.; Satyanarayana, S. V. M.

2018-02-01

Bipartite entanglement is a necessary resource in most processes in quantum information science. Decoherence resulting from the interaction of the bipartite system with environment not only degrades the entanglement, but can result in abrupt disentanglement, known as entanglement sudden death (ESD). In some cases, a subsequent revival of entanglement is also possible. ESD is an undesirable feature for the state to be used as a resource in applications. In order to delay or avoid ESD, it is necessary to understand its origin. In this work we investigate the role of initial coherence on entanglement dynamics of a spatially separated two qubit system in a common vacuum reservoir with dipolar interaction. We construct two classes of X states, namely, states with one photon coherence (X 1) and states with two photon coherence (X 2). Considering them as initial states, we study entanglement dynamics under Markov approximation. We find for states in X 1, ESD time, revival time and time over which the state remains disentangled increase with increase in coherence. On the other hand for states in X 2, with increase in coherence ESD time increases, revival time remains same and time of disentanglement decreases. Thus, states with two photon coherence are better resources for applications since their entanglement is robust against decoherence compared to states with one photon coherence.

Exploration Systems Development (ESD) Approach to Enterprise Risk Management

NASA Technical Reports Server (NTRS)

Bauder, Stephen P.

2014-01-01

The National Aeronautics and Space Administration (NASA) Exploration Systems Development (ESD) Division has implemented an innovative approach to Enterprise Risk Management under a unique governance structure and streamlined integration model. ESD's mission is to design and build the capability to extend human existence to deep space. The Enterprise consists of three Programs: Space Launch System (SLS), Orion, and Ground Systems Development and Operations (GSDO). The SLS is a rocket and launch system that will be capable of powering humans, habitats, and support systems to deep space. Orion will be the first spacecraft in history capable of taking humans to multiple destinations within deep space. GSDO is modernizing Kennedy's spaceport to launch spacecraft built and designed by both NASA and private industry. ESD's approach to Enterprise Risk Management is commensurate with affordability and a streamlined management philosophy. ESD Enterprise Risk Management leverages off of the primary mechanisms for integration within the Enterprise. The Enterprise integration approach emphasizes delegation of authority to manage and execute the majority of cross-program activities and products to the individual Programs, while maintaining the overall responsibility for all cross-program activities at the Division. The intent of the ESD Enterprise Risk Management approach is to improve risk communication, to avoid replication and/or contradictory strategies, and to minimize overhead process burden. This is accomplished by the facilitation and integration of risk information within ESD. The ESD Division risks, Orion risks, SLS risks, and GSDO risks are owned and managed by the applicable Program. When the Programs have shared risks with multiple consequences, they are jointly owned and managed. When a risk is associated with the integrated system that involves more than one Program in condition, consequence, or mitigation plan, it is considered an Exploration Systems Integration (ESI) Risk. An ESI risk may require visibility and risk handling by multiple organizations. The Integrated Risk Working Group (IRWG) is a small team of Risk experts that are responsible for collaborating and communicating best practices. In addition, the forum facilitates proper integration of risks across the Enterprise. The IRWG uses a Continuous Risk Management approach for facilitating the identification, analysis, planning, tracking, and controlling of ESI Risks. The ESD Division, Programs, and Integrated Task Teams identify ESI Risks. The IRWG maintains a set of metrics for understanding Enterprise Risk process and the overall Risk Posture. The team is also actively involved in the modeling of risk for Enterprise Performance Management. With the Enterprise being constrained in Schedule and Budget, and with significant technical complexity, the appropriate use of Risk Management techniques is crucial to the success of the Enterprise. The IRWG achieves this through the modified approach, providing a forum for collaboration on risks that cross boundaries between the separate entities.

Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: A systematic review

PubMed Central

Sgourakis, George; Gockel, Ines; Lang, Hauke

2013-01-01

AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. “Neural networks” as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the “feature selection and root cause analysis”, was used to identify the most important predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559), P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P < 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P < 0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). CONCLUSION: Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma in-situ component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection. PMID:23539431

Femtosecond spectroscopy probes the folding quality of antibody fragments expressed as GFP fusions in the cytoplasm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Didier, P.; Weiss, E.; Sibler, A.-P.

2008-02-22

Time-resolved femtosecond spectroscopy can improve the application of green fluorescent proteins (GFPs) as protein-folding reporters. The study of ultrafast excited-state dynamics (ESD) of GFP fused to single chain variable fragment (scFv) antibody fragments, allowed us to define and measure an empirical parameter that only depends on the folding quality (FQ) of the fusion. This method has been applied to the analysis of genetic fusions expressed in the bacterial cytoplasm and allowed us to distinguish folded and thus functional antibody fragments (high FQ) with respect to misfolded antibody fragments. Moreover, these findings were strongly correlated to the behavior of the samemore » scFvs expressed in animal cells. This method is based on the sensitivity of the ESD to the modifications in the tertiary structure of the GFP induced by the aggregation state of the fusion partner. This approach may be applicable to the study of the FQ of polypeptides over-expressed under reducing conditions.« less

DEVELOPMENT OF ELECTRO-ACOUSTIC SOIL DECONTAMINATION (ESD) FOR IN-SITU APPLICATIONS

EPA Science Inventory

The technical feasibility of electro-acoustic soil decontamination process through lab experiments demonstrated the removal/-concentration of heavy metals such as cadmium and zinc. Results of the decane contaminated soils were, however, inconclusive. The ESD process is based on t...

Developing Partnerships with the Community for Coastal ESD

ERIC Educational Resources Information Center

Kawabe, Midori; Kohno, Hiroshi; Ikeda, Reiko; Ishimaru, Takashi; Baba, Osamu; Horimoto, Naho; Kanda, Jota; Matsuyam, Masaji; Moteki, Masato; Oshima, Yayoi; Sasaki, Tsuyoshi; Yap, Minlee

2013-01-01

Purpose: The purpose of this paper is to draw lessons for developing community-university partnerships from experiences in promoting coastal education for sustainable development (ESD). Design/methodology/approach: Qualitative data collected from two coastal community outreach projects were analyzed. Findings: The outreach projects improved the…

Incorporating hydrologic data and ecohydrologic relationships in ecological site descriptions

USDA-ARS?s Scientific Manuscript database

The purpose of this paper is to recommend a framework and methodology for inclusion of key ecohydrologic feedbacks and relationships in Ecological Site Descriptions (ESDs) and thereby enhance the utility of ESDs for assessing rangelands and guiding resilience-based management strategies. Resilience...

Measurement of Entrance Surface Dose on an Anthropomorphic Thorax Phantom Using a Miniature Fiber-Optic Dosimeter

PubMed Central

Yoo, Wook Jae; Shin, Sang Hun; Jeon, Dayeong; Hong, Seunghan; Sim, Hyeok In; Kim, Seon Geun; Jang, Kyoung Won; Cho, Seunghyun; Youn, Won Sik; Lee, Bongsoo

2014-01-01

A miniature fiber-optic dosimeter (FOD) system was fabricated using a plastic scintillating fiber, a plastic optical fiber, and a multi-pixel photon counter to measure real-time entrance surface dose (ESD) during radiation diagnosis. Under varying exposure parameters of a digital radiography (DR) system, we measured the scintillating light related to the ESD using the sensing probe of the FOD, which was placed at the center of the beam field on an anthropomorphic thorax phantom. Also, we obtained DR images using a flat panel detector of the DR system to evaluate the effects of the dosimeter on image artifacts during posteroanterior (PA) chest radiography. From the experimental results, the scintillation output signals of the FOD were similar to the ESDs including backscatter simultaneously obtained using a semiconductor dosimeter. We demonstrated that the proposed miniature FOD can be used to measure real-time ESDs with minimization of DR image artifacts in the X-ray energy range of diagnostic radiology. PMID:24694678

Measurement of entrance surface dose on an anthropomorphic thorax phantom using a miniature fiber-optic dosimeter.

PubMed

Yoo, Wook Jae; Shin, Sang Hun; Jeon, Dayeong; Hong, Seunghan; Sim, Hyeok In; Kim, Seon Geun; Jang, Kyoung Won; Cho, Seunghyun; Youn, Won Sik; Lee, Bongsoo

2014-04-01

A miniature fiber-optic dosimeter (FOD) system was fabricated using a plastic scintillating fiber, a plastic optical fiber, and a multi-pixel photon counter to measure real-time entrance surface dose (ESD) during radiation diagnosis. Under varying exposure parameters of a digital radiography (DR) system, we measured the scintillating light related to the ESD using the sensing probe of the FOD, which was placed at the center of the beam field on an anthropomorphic thorax phantom. Also, we obtained DR images using a flat panel detector of the DR system to evaluate the effects of the dosimeter on image artifacts during posteroanterior (PA) chest radiography. From the experimental results, the scintillation output signals of the FOD were similar to the ESDs including backscatter simultaneously obtained using a semiconductor dosimeter. We demonstrated that the proposed miniature FOD can be used to measure real-time ESDs with minimization of DR image artifacts in the X-ray energy range of diagnostic radiology.

ESD robustness improving for the low-voltage triggering silicon-controlled rectifier by adding NWell at cathode

NASA Astrophysics Data System (ADS)

Jin, Xiangliang; Zheng, Yifei; Wang, Yang; Guan, Jian; Hao, Shanwan; Li, Kan; Luo, Jun

2018-01-01

The low-voltage triggering silicon-controlled rectifier (LVTSCR) device is widely used in on-chip electrostatic discharge (ESD) protection owing to its low trigger voltage and strong current-tolerating capability per area. In this paper, an improved LVTSCR by adding a narrow NWell (NW2) under the source region of NMOS is discussed, which is realized in a 0.5-μm CMOS process. A 2-dimension (2D) device simulation platform and a transmission line pulse (TLP) testing system are used to predict and characterize the proposed ESD protection devices. According to the measurement results, compared with the preliminary LVTSCR, the improved LVTSCR elevates the second breakdown current (It2) from 2.39 A to 5.54 A and increases the holding voltage (Vh) from 3.04 V to 4.09 V without expanding device area or sacrificing any ESD performances. Furthermore, the influence of the size of the narrow NWell under the source region of NMOS on holding voltage is also discussed.

Superfund record of decision amendment (EPA region 9): Litchfield Airport Area, AKA: Phoenix-Goodyear Airport, Goodyear/Avondale, AZ, December 22, 1995

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1997-03-01

This document provides a brief background of the site, a summary of the remedy selected in the 1989 ROD (PB90-203498) and how that remedy was modified by the 1991 (PB95-463105) and 1993 (PB95-963104) ESDs, a description of how this ESD affects the remedy originally selected by EPA in the 1989 ROD, and an explanation of why EPA is making these changes to the ROD. EPA is issuing this third ESD to the 1989 ROD in order to take into account information received by EPA after EPA`s issuance of the 1991 and 1993 ESDs. The southern portion of the site consistsmore » of the Loral Defense Systems-Arizona (Loral) property and the Phoenix-Goodyear Airport property and any groundwater contamination emanating from these areas. The northern portion of the site consists of the Unidynamics property and any groundwater contamination emanating from these areas.« less

Experience in colon sparing surgery in North America: advanced endoscopic approaches for complex colorectal lesions.

PubMed

Gorgun, Emre; Benlice, Cigdem; Abbas, Maher A; Steele, Scott

2018-07-01

Need for colon sparing interventions for premalignant lesions not amenable to conventional endoscopic excision has stimulated interest in advanced endoscopic approaches. The aim of this study was to report a single institution's experience with these techniques. A retrospective review was conducted of a prospectively collected database of all patients referred between 2011 and 2015 for colorectal resection of benign appearing deemed endoscopically unresectable by conventional endoscopic techniques. Patients were counseled for endoscopic submucosal dissection (ESD) with possible combined endoscopic-laparoscopic surgery (CELS) or alternatively colorectal resection if unable to resect endoscopically or suspicion for cancer. Lesion characteristic, resection rate, complications, and outcomes were evaluated. 110 patients were analyzed [mean age 64 years, female gender 55 (50%), median body mass index 29.4 kg/m 2 ]. Indications for interventions were large polyp median endoscopic size 3 cm (range 1.5-6.5) and/or difficult location [cecum (34.9%), ascending colon (22.7%), transverse colon (14.5%), hepatic flexure (11.8%), descending colon (6.3%), sigmoid colon (3.6%), rectum (3.6%), and splenic flexure (2.6%)]. Lesion morphology was sessile (N = 98, 93%) and pedunculated (N = 12, 7%). Successful endoscopic resection rate was 88.2% (N = 97): ESD in 69 patients and CELS in 28 patients. Complication rate was 11.8% (13/110) [delayed bleeding (N = 4), perforation (N = 3), organ-space surgical site infection (SSI) (N = 2), superficial SSI (N = 1), and postoperative ileus (N = 3)]. Out of 110 patients, 13 patients (11.8%) required colectomy for technical failure (7 patients) or carcinoma (6 patients). During a median follow-up of 16 months (range 6-41 months), 2 patients had adenoma recurrence. Advanced endoscopic surgery appears to be a safe and effective alternative to colectomy for patients with complex premalignant lesions deemed unresectable with conventional endoscopic techniques.

Application of ecological site information to transformative changes on Great Basin sagebrush rangelands

USDA-ARS?s Scientific Manuscript database

Ecological Site Description (ESD) concepts are broadly applicable and provide a necessary framework to inform and guide rangeland management decisions. In this paper, we demonstrate how understanding and quantification of key vegetation, hydrology, and soil relationships in the ESD context can info...

National assessment and critiques of state-and-transition models: The baby with the bathwater

USDA-ARS?s Scientific Manuscript database

Ecological site descriptions (ESDs) have been characterized as the world’ s largest land management framework. They comprise a database and document collection used throughout the United States to provide management guidance in rangelands and, increasingly, in forests, wetlands, and croplands. ESDs ...

Downscaling reanalysis data to high-resolution variables above a glacier surface (Cordillera Blanca, Peru)

NASA Astrophysics Data System (ADS)

Hofer, Marlis; Mölg, Thomas; Marzeion, Ben; Kaser, Georg

2010-05-01

Recently initiated observation networks in the Cordillera Blanca provide temporally high-resolution, yet short-term atmospheric data. The aim of this study is to extend the existing time series into the past. We present an empirical-statistical downscaling (ESD) model that links 6-hourly NCEP/NCAR reanalysis data to the local target variables, measured at the tropical glacier Artesonraju (Northern Cordillera Blanca). The approach is particular in the context of ESD for two reasons. First, the observational time series for model calibration are short (only about two years). Second, unlike most ESD studies in climate research, we focus on variables at a high temporal resolution (i.e., six-hourly values). Our target variables are two important drivers in the surface energy balance of tropical glaciers; air temperature and specific humidity. The selection of predictor fields from the reanalysis data is based on regression analyses and climatologic considerations. The ESD modelling procedure includes combined empirical orthogonal function and multiple regression analyses. Principal component screening is based on cross-validation using the Akaike Information Criterion as model selection criterion. Double cross-validation is applied for model evaluation. Potential autocorrelation in the time series is considered by defining the block length in the resampling procedure. Apart from the selection of predictor fields, the modelling procedure is automated and does not include subjective choices. We assess the ESD model sensitivity to the predictor choice by using both single- and mixed-field predictors of the variables air temperature (1000 hPa), specific humidity (1000 hPa), and zonal wind speed (500 hPa). The chosen downscaling domain ranges from 80 to 50 degrees west and from 0 to 20 degrees south. Statistical transfer functions are derived individually for different months and times of day (month/hour-models). The forecast skill of the month/hour-models largely depends on month and time of day, ranging from 0 to 0.8, but the mixed-field predictors generally perform better than the single-field predictors. At all time scales, the ESD model shows added value against two simple reference models; (i) the direct use of reanalysis grid point values, and (ii) mean diurnal and seasonal cycles over the calibration period. The ESD model forecast 1960 to 2008 clearly reflects interannual variability related to the El Niño/Southern Oscillation, but is sensitive to the chosen predictor type. So far, we have not assessed the performance of NCEP/NCAR reanalysis data against other reanalysis products. The developed ESD model is computationally cheap and applicable wherever measurements are available for model calibration.

Empirical-statistical downscaling of reanalysis data to high-resolution air temperature and specific humidity above a glacier surface (Cordillera Blanca, Peru)

NASA Astrophysics Data System (ADS)

Hofer, Marlis; MöLg, Thomas; Marzeion, Ben; Kaser, Georg

2010-06-01

Recently initiated observation networks in the Cordillera Blanca (Peru) provide temporally high-resolution, yet short-term, atmospheric data. The aim of this study is to extend the existing time series into the past. We present an empirical-statistical downscaling (ESD) model that links 6-hourly National Centers for Environmental Prediction (NCEP)/National Center for Atmospheric Research (NCAR) reanalysis data to air temperature and specific humidity, measured at the tropical glacier Artesonraju (northern Cordillera Blanca). The ESD modeling procedure includes combined empirical orthogonal function and multiple regression analyses and a double cross-validation scheme for model evaluation. Apart from the selection of predictor fields, the modeling procedure is automated and does not include subjective choices. We assess the ESD model sensitivity to the predictor choice using both single-field and mixed-field predictors. Statistical transfer functions are derived individually for different months and times of day. The forecast skill largely depends on month and time of day, ranging from 0 to 0.8. The mixed-field predictors perform better than the single-field predictors. The ESD model shows added value, at all time scales, against simpler reference models (e.g., the direct use of reanalysis grid point values). The ESD model forecast 1960-2008 clearly reflects interannual variability related to the El Niño/Southern Oscillation but is sensitive to the chosen predictor type.

pH-dependent structural change of the extracellular sensor domain of the DraK histidine kinase from Streptomyces coelicolor.

PubMed

Yeo, Kwon Joo; Kim, Eun Hye; Hwang, Eunha; Han, Young-Hyun; Eo, Yumi; Kim, Hyun Jung; Kwon, Ohsuk; Hong, Young-Soo; Cheong, Chaejoon; Cheong, Hae-Kap

2013-02-15

Recently, the DraR/DraK (Sco3063/Sco3062) two-component system (TCS) of Streptomycescoelicolor has been reported to be involved in the differential regulation of antibiotic biosynthesis. However, it has not been shown that under which conditions and how the DraR/DraK TCS is activated to initiate the signal transduction process. Therefore, to understand the sensing mechanism, structural study of the sensory domain of DraK is highly required. Here, we report the biochemical and biophysical properties of the extracellular sensory domain (ESD) of DraK. We observed a reversible pH-dependent conformational change of the ESD in a pH range of 2.5-10. Size-exclusion chromatography and AUC (analytical ultracentrifugation) data indicated that the ESD is predominantly monomeric in solution and exists in equilibrium between monomer and dimer states in acidic condition. Using NMR (nuclear magnetic resonance) and CD (circular dichroism) spectroscopy, our findings suggest that the structure of the ESD at low pH is more structured than that at high pH. In particular, the glutamate at position 83 is an important residue for the pH-dependent conformational change. These results suggest that this pH-dependent conformational change of ESD may be involved in signal transduction process of DraR/DraK TCS. Copyright © 2013 Elsevier Inc. All rights reserved.

Environmental Sciences Division annual progress report for period ending September 30, 1991

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-04-01

This progress report summarizes the research and development activities conducted in the Environmental Sciences Division of Oak Ridge National Laboratory during the period October 1, 1990, through September 30, 1991. The report is structured to provide descriptions of current activities and accomplishments in each of the division`s major organizational units. Following the sections describing the organizational units is a section devoted to lists of information necessary to convey the scope of the work in the division. The Environmental Sciences Division (ESD) at Oak Ridge National Laboratory (ORNL) conducts environmental research and analyses associated with both energy technology development and themore » interactions between people and the environment. The division engages in basic and applied research for a diverse list of sponsors. While the US Department of Energy (DOE) is the primary sponsor ESD staff also perform research for other federal agencies, state agencies, and private industry. The division works collaboratively with federal agencies, universities, and private organizations in achieving its research objectives and hosts a large number of visiting investigators from these organizations. Given the diverse interdisciplinary specialization of its staff, ESD provides technical expertise on complex environmental problems and renders technical leadership for major environmental issues of national and local concern. This progress report highlights many of ESD`s accomplishment in these and other areas in FY 1991.« less

An innovative architectural design to enhance the electrochemical performance of La2NiO4+δ cathodes for solid oxide fuel cell applications

NASA Astrophysics Data System (ADS)

Sharma, Rakesh K.; Burriel, Mónica; Dessemond, Laurent; Martin, Vincent; Bassat, Jean-Marc; Djurado, Elisabeth

2016-06-01

An architectural design of the cathode microstructure based on combining electrostatic spray deposition (ESD) and screen-printing (SP) techniques has demonstrated to be an innovative strategy to enhance the electrochemical properties of La2NiO4+δ (LNO) as oxygen electrode on Ce0.9Gd0.1O2-δ (CGO) electrolyte for solid oxide fuel cells. For this purpose, the influence of the ESD process parameters on the microstructure has been systematically investigated. Electrochemical performances of four selected cathode microstructures are investigated: (i) 3-D coral nanocrystalline (average particle size ∼ 100 nm) LNO film grown by ESD; (ii) 3-D coral nanocrystalline film (average particle size ∼ 150 nm) grown by ESD with a continuous nanometric dense interface; (iii) porous screen-printed LNO film (average particle size ∼ 400 nm); and (iv) 3-D coral nanocrystalline film (average particle size ∼ 150 nm) with a continuous nanometric dense interface prepared by ESD topped by a LNO current collector prepared by SP. A significant reduction in the polarization resistance (Rpol) is obtained (0.08 Ω cm2 at 700 °C) for 3-D coral topped by the SP layer. Moreover LNO is found to be stable and compatible with CGO up to 800 °C for only 10 days duration in air, making it potentially suitable for SOFCs cathode application.

The Development of ESD-Related Competencies in Supportive Institutional Frameworks

ERIC Educational Resources Information Center

de Haan, Gerhard

2010-01-01

Although Education for Sustainable Development (ESD) is a matter of global importance, the requirements and needs of people differ according to their regional circumstances. (Not only) in Germany--in keeping with the increasingly international focus of "output" evaluations--one dominant educational debate has centred on effective ways of…

Incorporating hydrologic data and ecohydrologic relationships into ecological site descriptions

Treesearch

C. Jason Williams; Frederick B. Pierson; Kenneth E. Spaeth; Joel R. Brown; Osama Z. Al-Hamdan; Mark A. Weltz; Mark A. Nearing; Jeffrey E. Herrick; Jan Boll; Pete Robichaud; David C. Goodrich; Phillip Heilman; D. Phillip Guertin; Mariano Hernandez; Haiyan Wei; Stuart P. Hardegree; Eva K. Strand; Jonathan D. Bates; Loretta J. Metz; Mary H. Nichols

2016-01-01

The purpose of this paper is to recommend a framework and methodology for incorporating hydrologic data and ecohydrologic relationships in Ecological Site Descriptions (ESDs) and thereby enhance the utility of ESDs for assessing rangelands and guiding resilience-based management strategies. Resilience-based strategies assess and manage ecological state...

Levels of Indicator Development for Education for Sustainable Development

ERIC Educational Resources Information Center

Rode, Horst; Michelsen, Gerd

2008-01-01

The article summarizes some considerations about the development of indicators for education for sustainable development (ESD). It reflects the present state of discussion, especially from a German perspective, and includes present developments in the area of quality criteria and standards for ESD. These discussion threads only denote the…

Education for Sustainable Human Development: Towards a Definition

ERIC Educational Resources Information Center

Landorf, Hilary; Doscher, Stephanie; Rocco, Tonette

2008-01-01

Three years into the Decade of Education for Sustainable Development, there has been considerable discussion regarding education for sustainable development (ESD) at a policy level, yet very few countries and communities have moved to integrate ESD into their educational curriculum. In this article we argue that the conceptualization and…

Education for Sustainable Development: Connecting the Dots for Sustainability

ERIC Educational Resources Information Center

Gokool-Ramdoo, Sushita; Rumjaun, Anwar Bhai

2017-01-01

Critical pedagogy, practitioner experience and a regulatory perspective are employed to scrutinize the notion of Education for Sustainable Development (ESD) as it occurs in the literature. They promote understanding of the challenges impeding the completion of unfinished ESD businesses. In response to practitioner-expressed needs, this paper…

40 CFR 35.4270 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Explanation of Significant Differences (ESD) means the document issued by the agency leading a cleanup that describes to the public significant changes made to a Record of Decision after the ROD has been signed. The ESD must also summarize the information that led to the changes and affirm that the revised remedy...

Digital Citizenship in the Afterschool Space: Implications for Education for Sustainable Development

ERIC Educational Resources Information Center

Howard, Patrick

2015-01-01

Education for sustainable development (ESD) challenges traditional curricula and formal schooling in important ways. ESD requires systemic thinking, interdisciplinarity and is strengthened through the contributions of all disciplines. As with any transformative societal and technological shift, new questions arise when educators are required to…

Civic Education for Sustainable Development

ERIC Educational Resources Information Center

Ohlmeier, Bernhard

2015-01-01

Education for sustainable development (ESD) often fails to consider the political dimension. To address this gap, this paper focuses on a specific political approach to ESD. The model presented is derived from the four sustainable growth targets of German Development Policy. Instead of relying on a neo-classical or neo-liberal economic paradigm,…

Education for Sustainable Development in Vietnam: Lessons Learned from Teacher Education

ERIC Educational Resources Information Center

Kieu, Thi Kinh; Singer, Jane; Gannon, Tracey Jean

2016-01-01

Purpose: The purpose of this paper is to identify challenges in education for sustainable development (ESD) implementation in teacher education institutions (TEIs) in Vietnam and propose some appropriate solutions to advance ESD in training teachers toward sustainability. Design/methodology/approach The authors interviewed ten lecturers and 75…

Turkish Student Science Teachers' Conceptions of Sustainable Development: A Phenomenography

ERIC Educational Resources Information Center

Kilinc, Ahmet; Aydin, Abdullah

2013-01-01

In creating a society whose citizens have sustainable lifestyles, education for sustainable development (ESD) plays a key role. However, the concept of sustainable development (SD) has developed independently from the input of educators; therefore, ESD presents current teachers with many challenges. At this point, understanding how stakeholders in…

Integration of Sustainability in Engineering Education: Why Is PBL an Answer?

ERIC Educational Resources Information Center

Guerra, Aida

2017-01-01

Purpose: Education for sustainable development (ESD) is one of the challenges engineering education currently faces. Engineering education needs to revise and change its curriculum to integrate ESD principles and knowledge. Problem based learning (PBL) has been one of the main learning pedagogies used to integrate sustainability in engineering…

Peace Education, ESD and the Earth Charter: Interconnections and Synergies

ERIC Educational Resources Information Center

Toh, Swee-Hin; Cawagas, Virginia Floresca

2010-01-01

This article provides a review of how the values and principles of the Earth Charter initiative relate to two specific innovative movements of educational transformation, namely peace education and education for sustainable development (ESD). The interconnections and synergies between these movements and the Earth Charter are highlighted.…

Effects of Contextual Factors on ESD in Teacher Education

ERIC Educational Resources Information Center

Atmaca, Çagla

2017-01-01

Education for sustainable development (ESD) guides and empowers educators to reshape their thinking style and move towards a sustainable future. It has attracted a lot of attention and been studied in different perspectives. However, contextual factors have not been studied in relation to sustainable development for teacher education. Therefore,…

Globalisation and Education for Sustainable Development: Emancipation from Context and Meaning

ERIC Educational Resources Information Center

Bengtsson, Stefan L.; Östman, Leif O.

2013-01-01

This article tries to contribute to the critical debate on the ideological and globalising potential of education for sustainable development (ESD), which exists in the research field of environmental education, by highlighting potential contradictions in the argumentation for ESD's ideological and globalising tendency. Further, the authors…

When Businesses Go to School: Neoliberalism and Education for Sustainable Development

ERIC Educational Resources Information Center

Manteaw, Bob Offei

2008-01-01

This paper foregrounds education for sustainable development (ESD) and corporate social responsibility (CSR) as emergent discourses that need conscious efforts to align their ideals. While it explores the capacity of ESD to make significant contribution towards educational thinking and practice, it does so recognising that current neoliberalists'…

Cadaveric dissection as an educational tool for anatomical sciences in the 21st century.

PubMed

Ghosh, Sanjib Kumar

2017-06-01

Anatomical education has been undergoing reforms in line with the demands of medical profession. The aim of the present study is to assess the impact of a traditional method like cadaveric dissection in teaching/learning anatomy at present times when medical schools are inclining towards student-centered, integrated, clinical application models. The article undertakes a review of literature and analyzes the observations made therein reflecting on the relevance of cadaveric dissection in anatomical education of 21st century. Despite the advent of modern technology and evolved teaching methods, dissection continues to remain a cornerstone of anatomy curriculum. Medical professionals of all levels believe that dissection enables learning anatomy with relevant clinical correlates. Moreover dissection helps to build discipline independent skills which are essential requirements of modern health care setup. It has been supplemented by other teaching/learning methods due to limited availability of cadavers in some countries. However, in the developing world due to good access to cadavers, dissection based teaching is central to anatomy education till date. Its utility is also reflected in the perception of students who are of the opinion that dissection provides them with a foundation critical to development of clinical skills. Researchers have even suggested that time has come to reinstate dissection as the core method of teaching gross anatomy to ensure safe medical practice. Nevertheless, as dissection alone cannot provide uniform learning experience hence needs to be complemented with other innovative learning methods in the future education model of anatomy. Anat Sci Educ 10: 286-299. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

A simple, cheap, one-minute method to mount insect pins for use as sharp-tipped probes in plant dissection.

PubMed

Frohlich, Michael W

2005-08-01

A new method is presented for twist mounting insect pins onto standard dissecting (teasing) needles. Insect pins, with their sharp points, are ideal for fine dissection of plants, especially of shoot tips and early developing flower buds. Twist mounting makes them convenient and effective dissecting tools to prepare specimens for SEM.

Electro-spray deposition of a mesoporous TiO2 charge collection layer: toward large scale and continuous production of high efficiency perovskite solar cells.

PubMed

Kim, Min-cheol; Kim, Byeong Jo; Yoon, Jungjin; Lee, Jin-wook; Suh, Dongchul; Park, Nam-gyu; Choi, Mansoo; Jung, Hyun Suk

2015-12-28

The spin-coating method, which is widely used for thin film device fabrication, is incapable of large-area deposition or being performed continuously. In perovskite hybrid solar cells using CH(3)NH(3)PbI(3) (MAPbI(3)), large-area deposition is essential for their potential use in mass production. Prior to replacing all the spin-coating process for fabrication of perovskite solar cells, herein, a mesoporous TiO(2) electron-collection layer is fabricated by using the electro-spray deposition (ESD) system. Moreover, impedance spectroscopy and transient photocurrent and photovoltage measurements reveal that the electro-sprayed mesoscopic TiO(2) film facilitates charge collection from the perovskite. The series resistance of the perovskite solar cell is also reduced owing to the highly porous nature of, and the low density of point defects in, the film. An optimized power conversion efficiency of 15.11% is achieved under an illumination of 1 sun; this efficiency is higher than that (13.67%) of the perovskite solar cell with the conventional spin-coated TiO(2) films. Furthermore, the large-area coating capability of the ESD process is verified through the coating of uniform 10 × 10 cm(2) TiO(2) films. This study clearly shows that ESD constitutes therefore a viable alternative for the fabrication of high-throughput, large-area perovskite solar cells.

Reviewing Strategies in/for ESD Policy Engagement: Agency Reclaimed

ERIC Educational Resources Information Center

Lotz-Sisitka, Heila

2016-01-01

In this response article, I draw on critical realist perspectives to engage with the argument put forward in Bengtsson's study, which sees agency as an ontological necessity for Education for Sustainable Development (ESD) policy engagement. Bengtsson supports a notion of the logic of contingent action over the logic of power as dominance,…

The Collaborative Production of Meaningful Measure(ment)s: Preliminary Insights into a Work in Progress

ERIC Educational Resources Information Center

Bormann, Inka; Michelsen, Gerd

2010-01-01

This article introduces a tri-national research and development project which aims to develop indicators for the cross-sectoral and interdisciplinary educational task "education for sustainable development" (ESD). These indicators are meant to help monitor the implementation of ESD efforts in schools and institutions of higher education…

Children's Voices about the State of the Earth

ERIC Educational Resources Information Center

Engdahl, Ingrid; Rabusicova, Milada

2011-01-01

This article presents a large project on Education for Sustainable Development (ESD). The project was organised by OMEP, the World Organisation for Early Childhood Education, where the authors were the appointed as project coordinators. The purpose of ESD is to reorient education towards sustainability. The aims of the project were to gather…

Computation of an ESD-induced E-field Envirnoment and Definition of a Current Injector Test set-up at Equipment Level

NASA Astrophysics Data System (ADS)

Marque, J. P.; Issac, F.; Parmantier, J. P.; Bertuol, S.

1998-11-01

The ESD-induced electromagnetic field on a S/C is computed using the 3D PIC code GEODE. Typical E-field waveforms are deduced and a new susceptibility test at equipment level is proposed as an alternative to the plane wave approach.

Functions, Use and Effects of Embedded Support Devices in Printed Distance Learning Materials.

ERIC Educational Resources Information Center

Martens, Rob; And Others

1996-01-01

To support distance learning, printed materials for the course are enriched with embedded support devices (ESD) such as schemes, illustrations, examples, questions, or margin texts. Results of 3 studies involving 900 Dutch university students indicated that students used and appreciated ESD, and that they led to better study results. (SLD)

Learning Our Way to Sustainability

ERIC Educational Resources Information Center

Wals, Arjen E. J.

2011-01-01

Should environmental education (EE) and education for sustainable development (ESD) try to change students' behaviours or should it focus on capacity building and critical thinking? The latter is more likely to lead to a citizenry that can examine new challenges and act wisely. New forms of learning are entering the arena of EE and ESD such as…

Transformative Sustainability Learning: Cultivating a Tree-Planting Ethos in Western Kenya

ERIC Educational Resources Information Center

Bull, Marijoan

2013-01-01

Given the fundamental objective of ESD--perspective change--it is increasingly being aligned with the theoretical foundation of Mezirow's Transformative Learning. In 2008, Sipos et al. built upon this connection by proposing a matrix of learning objectives to assess ESD in formal settings. These objectives, grouped under the title of…

Education for Sustainable Development in South Africa: A Model Case Scenario

ERIC Educational Resources Information Center

Teise, K.; le Roux, A.

2016-01-01

Education for Sustainable Development (ESD) is an educational approach that, by being a catalyst of social change, promotes sustainability. Although South African education policy and practice appear to be oriented towards ESD, the concept is contested, and ragged with ambiguity and vagueness. Because the transformation of South African education…

Criteria and Indicators as Negotiated Knowledge and the Challenge of Transfer

ERIC Educational Resources Information Center

Bormann, Inka

2007-01-01

This paper aims to understand the effects on which criteria and indicators for (education for) sustainable development [(E)SD] are based in terms of knowledge transfer. Therefore, (E)SD criteria and indicators in general are regarded as negotiated and established knowledge, incorporating expectations. As such, this knowledge can be spread…

Practical Pedagogy for Embedding ESD in Science, Technology, Engineering and Mathematics Curricula

ERIC Educational Resources Information Center

Hopkinson, Peter; James, Peter

2010-01-01

Purpose--The purpose of this paper is to review and highlight some recent examples of embedding education for sustainable development (ESD), within science and related curricula in ways that are meaningful and relevant to staff and students and reflect on different embedding strategies and discourses. Design/methodology/approach--A review of…

Opportunities for Teaching Sustainable Development through the Chemistry Component of CAPS Physical Sciences

ERIC Educational Resources Information Center

Tsakeni, Maria

2018-01-01

The realisation that education may, in part, have contributed to non-sustainable environmental practices warrants rethinking about what learners experience at school. One approach could involve the promotion of education for sustainable development (ESD). This study analysed the opportunities to integrate ESD presented by the chemistry component…

Earth Charter, ESD and Chinese Philosophies

ERIC Educational Resources Information Center

Liu, Yunhua; Constable, Alicia

2010-01-01

This article examines the relationship between the Earth Charter and education for sustainable development (ESD), as part of the UN Decade of Education for Sustainable Development. The areas of shared interest between the two are assessed and the invaluable nature of the Earth Charter as a resource outlining global values and principles for a…

Accounting Manual for Educational Service Districts in the State of Washington

ERIC Educational Resources Information Center

Lunghofer, Daniel S.

2010-01-01

This manual provides principles that are an integral part of the accounting requirements for educational service districts (ESDs) in the state of Washington. They are in conformance with generally accepted accounting principles, except where referenced in the ESD principles that follow. This manual provides guidance on the following topics:(1)…

Management Information System for ESD Program Offices.

DTIC Science & Technology

1978-03-01

Management Information System (MIS) functional requirements for the ESD Program Office are defined in terms of the Computer-Aided Design and Specification Tool. The development of the computer data base and a description of the MIS structure is included in the report. This report addresses management areas such as cost/budgeting, scheduling, tracking capabilities, and ECP

Education for Sustainable Development: A Movement towards Pedagogies of Civic Compassion

ERIC Educational Resources Information Center

Warwick, Paul

2016-01-01

This article explores the moral imperative for a renewed vision of schooling in the twenty-first century, from the standpoint of Education for Sustainable Development (ESD). ESD advocates for teaching and learning spaces underpinned by civic compassion in the sense of "an active concern for well-being". This paradigm of education seeks…

The Co-Evolution of ESD and EE

ERIC Educational Resources Information Center

Monroe, Martha C.

2012-01-01

William B. Stapp, a major author of the founding documents of environmental education (EE), foreshadowed the triple concerns of education for sustainable development (ESD) with environment, social justice and economic health. Yet EE in the USA tended to follow the advocacy orientation of the environmental movement of the 1970s and later, following…

Exploring the Current Position of ESD in UK Higher Education Institutions

ERIC Educational Resources Information Center

Fiselier, Evelien S.; Longhurst, James W. S.; Gough, Georgina K.

2018-01-01

Purpose: The purpose of this paper is to consider the position of education for sustainable development in the UK Higher Education (HE) sector with respect to the Quality Assurance Agency (QAA) and Higher Education Academy (HEA) Guidance for education for sustainable development (ESD). Design/methodology/approach: By means of a mixed-method…

Professional Development of University Educators in ESD: A Study from Pedagogical Styles

ERIC Educational Resources Information Center

Callejas Restrepo, Maria Mercedes; Blanco-Portela, Norka; Ladino-Ospina, Yolanda; Tuay Sigua, Rosa Nidia; Vargas, Kenneth Ochoa

2017-01-01

Purpose: The aim of this paper is to present a vision for university educator professional development, based on self-analysis of pedagogical styles and production of knowledge about the practices that promote education for sustainable development (ESD). Design/methodology/approach: The "STSE" course is part of the department's…

Building ESD in Latin America

ERIC Educational Resources Information Center

Journal of Education for Sustainable Development, 2007

2007-01-01

To encourage efforts for furthering the UN DESD agenda in Latin America, a meeting titled "Building Education for Sustainable Development" was held in Costa Rica from 31 October to 2 November 2006. Plenary sessions were interspersed with working groups to look at how ESD can be integrated in formal and non-formal education systems, and…

A Collaborative Action Research Project towards Embedding ESD within the Higher Education Curriculum

ERIC Educational Resources Information Center

Cebrián, Gisela

2017-01-01

Purpose: This paper aims to present a collaborative action research project conducted at the University of Southampton with the aim to promote curriculum and professional development in education for sustainable development (ESD) and learn from everyday practices of academics. Design/methodology/approach: An action research approach guided by…

How Education Can Be Used to Improve Sustainability Knowledge and Thinking among Teenagers

ERIC Educational Resources Information Center

Brazier, Randolph James

2014-01-01

Significant progress has been made with respect to Education for Sustainable Development (ESD) in tertiary education institutions, particularly universities. There are also examples of ways in which sustainability has been incorporated into secondary schools and curricula, but with varying levels of success. ESD that has been incorporated in…

ESD as a Means to Strengthen the Sustainable Management of Marginal Drylands in Egypt

ERIC Educational Resources Information Center

Salem, Boshra B.

2012-01-01

The objective of this article is to present results of and lessons learnt from implementing education for sustainable development (ESD) in marginal drylands, based on experiences from the TEMPUS IV project, Education for Sustainable Development beyond the Campus (EDUCAMP), in Egypt and the multinational project, Sustainable Development of Marginal…

Ultrasonic versus monopolar energy-based surgical devices in terms of surgical smoke and lateral thermal damage (ULMOST): a randomized controlled trial.

PubMed

Choi, Chahien; Do, In-Gu; Song, Taejong

2018-04-09

The purpose of this study was to compare the degree of surgical smoke or vapor and lateral thermal damage caused by two different energy-based surgical devices (ESDs) used in colpotomy during total laparoscopic hysterectomy. Patients undergoing laparoscopic hysterectomy were randomly assigned to an ultrasonic ESD group (n = 20) or monopolar ESD group (n = 20). Colpotomy was performed using the assigned ESD. The degree of surgical smoke or vapor obstructing the laparoscopic view was assessed by two independent reviewers using a 5-point Likert scale, in which a higher score indicates worse visibility. The degree of the lateral thermal damage was measured as the width from the point of instrument application to the margins of the unchanged nearby tissue using a light microscope. The baseline characteristics did not statistically differ between the two groups. The degree of surgical smoke or vapor obstructing vision was 1.2 ± 0.8 points in the ultrasonic group and 3.9 ± 0.7 points in the monopolar groups (p < 0.001). The lateral thermal damage was significantly increased in the monopolar group compared to in the ultrasound group (1500 µm [1200-2500 µm] vs. 950 µm [650-1725 µm], p = 0.037). Ultrasonic ESD had better laparoscopic visibility and caused less lateral thermal damage during colpotomy compared to monopolar device.

Epigenetic modification and inheritance in sexual reversal of fish.

PubMed

Shao, Changwei; Li, Qiye; Chen, Songlin; Zhang, Pei; Lian, Jinmin; Hu, Qiaomu; Sun, Bing; Jin, Lijun; Liu, Shanshan; Wang, Zongji; Zhao, Hongmei; Jin, Zonghui; Liang, Zhuo; Li, Yangzhen; Zheng, Qiumei; Zhang, Yong; Wang, Jun; Zhang, Guojie

2014-04-01

Environmental sex determination (ESD) occurs in divergent, phylogenetically unrelated taxa, and in some species, co-occurs with genetic sex determination (GSD) mechanisms. Although epigenetic regulation in response to environmental effects has long been proposed to be associated with ESD, a systemic analysis on epigenetic regulation of ESD is still lacking. Using half-smooth tongue sole (Cynoglossus semilaevis) as a model-a marine fish that has both ZW chromosomal GSD and temperature-dependent ESD-we investigated the role of DNA methylation in transition from GSD to ESD. Comparative analysis of the gonadal DNA methylomes of pseudomale, female, and normal male fish revealed that genes in the sex determination pathways are the major targets of substantial methylation modification during sexual reversal. Methylation modification in pseudomales is globally inherited in their ZW offspring, which can naturally develop into pseudomales without temperature incubation. Transcriptome analysis revealed that dosage compensation occurs in a restricted, methylated cytosine enriched Z chromosomal region in pseudomale testes, achieving equal expression level in normal male testes. In contrast, female-specific W chromosomal genes are suppressed in pseudomales by methylation regulation. We conclude that epigenetic regulation plays multiple crucial roles in sexual reversal of tongue sole fish. We also offer the first clues on the mechanisms behind gene dosage balancing in an organism that undergoes sexual reversal. Finally, we suggest a causal link between the bias sex chromosome assortment in the offspring of a pseudomale family and the transgenerational epigenetic inheritance of sexual reversal in tongue sole fish.

SU-E-I-09: Application of LiF:Mg,Cu (TLD-100H) Dosimeters for in Diagnostic Radiology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sina, S; Zeinali, B; Karimipourfard, M

Purpose: Accurate dosimetery is very essential in diagnostic radiology. The goal of this study is to verify the application of LiF:Mg,Cu,P (TLD100H) in obtaining the Entrance skin dose (ESD) of patients undergoing diagnostic radiology. The results of dosimetry performed by TLD-100H, were compared with those obtained by TLD100, which is a common dosimeter in diagnostic radiology. Methods: In this study the ESD values were measured using two types of Thermoluminescence dosimeters (TLD-100, and TLD-100H) for 16 patients undergoing diagnostic radiology (lumbar spine imaging). The ESD values were also obtained by putting the two types of TLDs at the surface ofmore » Rando phantom for different imaging techniques and different views (AP, and lateral). The TLD chips were annealed with a standard procedure, and the ECC values for each TLD was obtained by exposing the chips to equal amount of radiation. Each time three TLD chips were covered by thin dark plastic covers, and were put at the surface of the phantom or the patient. The average reading of the three chips was used for obtaining the dose. Results: The results show a close agreement between the dose measuered by the two dosimeters.According to the results of this study, the TLD-100H dosimeters have higher sensitivities (i.e.signal(nc)/dose) than TLD-100.The ESD values varied between 2.71 mGy and 26.29 mGy with the average of 11.89 mGy for TLD-100, and between 2.55 mGy and 27.41 mGy with the average of 12.32 mGy for measurements. Conclusion: The TLD-100H dosimeters are suggested as effective dosimeters for dosimetry in low dose fields because of their higher sensitivities.« less

SU-F-J-16: Planar KV Imaging Dose Reduction Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gershkevitsh, E; Zolotuhhin, D

Purpose: IGRT has become an indispensable tool in modern radiotherapy with kV imaging used in many departments due to superior image quality and lower dose when compared to MV imaging. Many departments use manufacturer supplied protocols for imaging which are not always optimised between image quality and radiation dose (ALARA). Methods: Whole body phantom PBU-50 (Kyoto Kagaku ltd., Japan) for imaging in radiology has been imaged on Varian iX accelerator (Varian Medical Systems, USA) with OBI 1.5 system. Manufacturer’s default protocols were adapted by modifying kV and mAs values when imaging different anatomical regions of the phantom (head, thorax, abdomen,more » pelvis, extremities). Images with different settings were independently reviewed by two persons and their suitability for IGRT set-up correction protocols were evaluated. The suitable images with the lowest mAs were then selected. The entrance surface dose (ESD) for manufacturer’s default protocols and modified protocols were measured with RTI Black Piranha (RTI Group, Sweden) and compared. Image quality was also measured with kVQC phantom (Standard Imaging, USA) for different protocols. The modified protocols have been applied for clinical work. Results: For most cases optimized protocols reduced the ESD on average by a factor of 3(range 0.9–8.5). Further reduction in ESD has been observed by applying bow-tie filter designed for CBCT. The largest reduction in dose (12.2 times) was observed for Thorax lateral protocol. The dose was slightly increased (by 10%) for large pelvis AP protocol. Conclusion: Manufacturer’s default IGRT protocols could be optimised to reduce the ESD to the patient without losing the necessary image quality for patient set-up correction. For patient set-up with planar kV imaging the bony anatomy is mostly used and optimization should focus on this aspect. Therefore, the current approach with anthropomorphic phantom is more advantageous in optimization over standard kV quality control phantoms and SNR metrics.« less

Cross sectional study of serum selenium concentration and esophageal squamous dysplasia in western Kenya.

PubMed

Pritchett, Natalie R; Burgert, Stephen L; Murphy, Gwen A; Brockman, John D; White, Russell E; Lando, Justus; Chepkwony, Robert; Topazian, Mark D; Abnet, Christian C; Dawsey, Sanford M; Mwachiro, Michael M

2017-12-08

Low serum selenium status has been associated with increased risk of esophageal squamous cell carcinoma (ESCC). East Africa is a region of high ESCC incidence and is known to have low soil selenium levels, but this association has not previously been evaluated. In this study we assessed the association of serum selenium concentration and the prevalence of esophageal squamous dysplasia (ESD), the precursor lesion of ESCC, in a cross-sectional study of subjects from Bomet, Kenya. 294 asymptomatic adult residents of Bomet, Kenya completed questionnaires and underwent endoscopy with Lugol's iodine staining and biopsy for detection of ESD. Serum selenium concentrations were measured by instrumental neutron activation analysis. Odds ratios (OR) and confidence intervals (95% CI) for associations between serum selenium and ESD were calculated using unconditional logistic regression. The mean serum selenium concentration was 85.5 (±28.3) μg/L. Forty-two ESD cases were identified (14% of those screened), including 5 (12%) in selenium quartile 1 (Q1), 5 (12%) in Q2, 15 (36%) in Q3, and 17 (40%) in Q4. Higher serum selenium was associated with prevalence of ESD (Q4 vs Q1: OR: 3.03; 95% CI: 1.05-8.74) and this association remained after adjusting for potential confounders (Q4 vs Q1: OR: 3.87; 95% CI: 1.06-14.19). This is the first study to evaluate the association of serum selenium concentration and esophageal squamous dysplasia in an African population at high risk for ESCC. We found a positive association between higher serum selenium concentration and prevalence of ESD, an association contrary to our original hypothesis. Further work is needed to better understand the role of selenium in the etiology of ESCC in this region, and to develop effective ESCC prevention and control strategies.

The baseline pressure of intracranial pressure (ICP) sensors can be altered by electrostatic discharges.

PubMed

Eide, Per K; Bakken, André

2011-08-22

The monitoring of intracranial pressure (ICP) has a crucial role in the surveillance of patients with brain injury. During long-term monitoring of ICP, we have seen spontaneous shifts in baseline pressure (ICP sensor zero point), which are of technical and not physiological origin. The aim of the present study was to explore whether or not baseline pressures of ICP sensors can be affected by electrostatics discharges (ESD's), when ESD's are delivered at clinically relevant magnitudes. We performed bench-testing of a set of commercial ICP sensors. In our experimental setup, the ICP sensor was placed in a container with 0.9% NaCl solution. A test person was charged 0.5-10 kV, and then delivered ESD's to the sensor by touching a metal rod that was located in the container. The continuous pressure signals were recorded continuously before/after the ESD's, and the pressure readings were stored digitally using a computerized system A total of 57 sensors were tested, including 25 Codman ICP sensors and 32 Raumedic sensors. When charging the test person in the range 0.5-10 kV, typically ESD's in the range 0.5-5 kV peak pulse were delivered to the ICP sensor. Alterations in baseline pressure ≥ 2 mmHg was seen in 24 of 25 (96%) Codman sensors and in 17 of 32 (53%) Raumedic sensors. Lasting changes in baseline pressure > 10 mmHg that in the clinical setting would affect patient management, were seen frequently for both sensor types. The changes in baseline pressure were either characterized by sudden shifts or gradual drifts in baseline pressure. The baseline pressures of commercial solid ICP sensors can be altered by ESD's at discharge magnitudes that are clinically relevant. Shifts in baseline pressure change the ICP levels visualised to the physician on the monitor screen, and thereby reveal wrong ICP values, which likely represent a severe risk to the patient.

Methyl farnesoate synthesis is necessary for the environmental sex determination in the water flea Daphnia pulex.

PubMed

Toyota, Kenji; Miyakawa, Hitoshi; Hiruta, Chizue; Furuta, Kenjiro; Ogino, Yukiko; Shinoda, Tetsuro; Tatarazako, Norihisa; Miyagawa, Shinichi; Shaw, Joseph R; Iguchi, Taisen

2015-09-01

Sex-determination systems can be divided into two groups: genotypic sex determination (GSD) and environmental sex determination (ESD). ESD is an adaptive life-history strategy that allows control of sex in response to environmental cues in order to optimize fitness. However, the molecular basis of ESD remains largely unknown. The micro crustacean Daphnia pulex exhibits ESD in response to various external stimuli. Although methyl farnesoate (MF: putative juvenile hormone, JH, in daphnids) has been reported to induce male production in daphnids, the role of MF as a sex-determining factor remains elusive due to the lack of a suitable model system for its study. Here, we establish such a system for ESD studies in D. pulex. The WTN6 strain switches from producing females to producing males in response to the shortened day condition, while the MFP strain only produces females, irrespective of day-length. To clarify whether MF has a novel physiological role as a sex-determining factor in D. pulex, we demonstrate that a MF/JH biosynthesis inhibitor suppressed male production in WTN6 strain reared under the male-inducible condition, shortened day-length. Moreover, we show that juvenile hormone acid O-methyltransferase (JHAMT), a critical enzyme of MF/JH biosynthesis, displays MF-generating activity by catalyzing farnesoic acid. Expression of the JHAMT gene increased significantly just before the MF-sensitive period for male production in the WTN6 strain, but not in the MFP strain, when maintained under male-inducible conditions. These results suggest that MF synthesis regulated by JHAMT is necessary for male offspring production in D. pulex. Our findings provide novel insights into the genetic underpinnings of ESD and they begin to shed light on the physiological function of MF as a male-fate determiner in D. pulex. Copyright © 2015 Elsevier Ltd. All rights reserved.

Preparation and Properties of Nanocomposites Prepared From Shortened, Functionalized Single-Walled Carbon Nanotubes

NASA Technical Reports Server (NTRS)

Smith, J. G., Jr.; Delozier, D. M.; Watson, K. A.; Connell, J. W.; Yu, Aiping; Haddon, R. C.; Bekyarova, E.

2006-01-01

As part of a continuing materials development activity, low color space environmentally stable polymeric materials that possess sufficient electrical conductivity for electrostatic charge dissipation (ESD) have been investigated. One method of incorporating sufficient electrical conductivity for ESD without detrimental effects on other polymer properties of interest (i.e., optical and thermo-optical) is through the incorporation of single-walled carbon nanotubes (SWNTs). However, SWNTs are difficult to fully disperse in the polymer matrix. One means of improving dispersion is by shortening and functionalizing SWNTs. While this improves dispersion, other properties (i.e., electrical) of the SWNTs can be affected which can in turn alter the final nanocomposite properties. Additionally, functionalization of the polymer matrix can also influence nanocomposite properties obtained from shortened, functionalized SWNTs. The preparation and characterization of nanocomposites fabricated from a polyimide, both functionalized and unfunctionalized, and shortened, functionalized SWNTs will be presented.

Evaluating an extended rehabilitation service for stroke patients (EXTRAS): study protocol for a randomised controlled trial.

PubMed

Rodgers, Helen; Shaw, Lisa; Cant, Robin; Drummond, Avril; Ford, Gary A; Forster, Anne; Hills, Katie; Howel, Denise; Laverty, Anne-Marie; McKevitt, Christopher; McMeekin, Peter; Price, Christopher

2015-05-05

Development of longer term stroke rehabilitation services is limited by lack of evidence of effectiveness for specific interventions and service models. We describe the protocol for a multicentre randomised controlled trial which is evaluating an extended stroke rehabilitation service. The extended service commences when routine 'organised stroke care' (stroke unit and early supported discharge (ESD)) ends. This study is a multicentre randomised controlled trial with health economic and process evaluations. It is set within NHS stroke services which provide ESD. Participants are adults who have experienced a new stroke (and carer if appropriate), discharged from hospital under the care of an ESD team. The intervention group receives an extended stroke rehabilitation service provided for 18 months following completion of ESD. The extended rehabilitation service involves regular contact with a senior ESD team member who leads and coordinates further rehabilitation. Contact is usually by telephone. The control group receives usual stroke care post-ESD. Usual care may involve referral of patients to a range of rehabilitation services upon completion of ESD in accordance with local clinical practice. Randomisation is via a central independent web-based service. The primary outcome is extended activities of daily living (Nottingham Extended Activities of Daily Living Scale) at 24 months post-randomisation. Secondary outcomes (at 12 and 24 months post-randomisation) are health status, quality of life, mood and experience of services for patients, and quality of life, experience of services and carer stress for carers. Resource use and adverse events are also collected. Outcomes are undertaken by a blinded assessor. Implementation and delivery of the extended stroke rehabilitation service will also be described. Semi-structured interviews will be conducted with a subsample of participants and staff to gain insight into perceptions and experiences of rehabilitation services delivered or received. Allowing for 25% attrition, 510 participants are needed to provide 90% power to detect a difference in mean Nottingham Extended Activities of Daily Living Scale score of 6 with a 5% significance level. The provision of longer term support for stroke survivors is currently limited. The results from this trial will inform future stroke service planning and configuration. This trial was registered with ISRCTN (identifier: ISRCTN45203373 ) on 9 August 2012.

Measuring Education for Sustainable Development: Experiences from the University of Bristol

ERIC Educational Resources Information Center

Tierney, Aisling; Tweddell, Hannah; Willmore, Chris

2015-01-01

Purpose: The purpose of this paper is to explore how education for sustainable development (ESD) was measured in the taught curriculum at the University of Bristol (UoB), providing comparison to other methods of measurement and how measurements were used to engage academics in considering the visibility of the penetration of sustainable…

Assessing Preschools Using the Eco-Schools Program in Terms of Educating for Sustainable Development in Early Childhood Education

ERIC Educational Resources Information Center

Korkmaz, Aysel; Guler Yildiz, Tulin

2017-01-01

This study assesses the practices and environmental properties of preschools implementing the Eco-Schools program, targeting education for sustainable development (ESD) in terms of the program's environmental, sociocultural, and economic pillars. Qualitative and quantitative methods were used. The sample group, determined through criterion…

Nanometer-Scale Dissection of Chromosomes by Atomic Force Microscopy Combined with Heat-Denaturing Treatment

NASA Astrophysics Data System (ADS)

Tsukamoto, Kazumi; Kuwazaki, Seigo; Yamamoto, Kimiko; Shichiri, Motoharu; Yoshino, Tomoyuki; Ohtani, Toshio; Sugiyama, Shigeru

2006-03-01

We have developed a method for dissecting chromosome fragments with a size of a few hundred nanometers by atomic force microscopy (AFM). By using this method, we demonstrated reproducible dissections of silkworm chromosomes in the pachytene phase. The dissected fragments were successfully recovered on the cantilever tips, as confirmed by fluorescent microscopy using fluorescent stained chromosomes. To recover dissected chromosome fragments from a larger chromosome, such as the human metaphase chromosome of a somatic cell, heat denaturation was found to be effective. Further improvements in this method may lead to a novel tool for isolating valuable genes and/or investigating local genome structures in the near future.

Teaching and Learning for Sustainable Development: ESD Research in Technology Education

ERIC Educational Resources Information Center

Pavlova, Margarita

2013-01-01

When education for sustainable development (ESD) emerged as part of the educational agenda in the international arena, it was associated with significant shifts in the educational debate about the purpose and nature of education and with the need to respond to crises caused by the modern idea of progress. Scientists from different fields warn…

Technical Reliability Studies. EOS/ESD Technology Abstracts

DTIC Science & Technology

1981-01-01

MECHANISMS MELAMINE MESFETS MICROWAVE MIS 15025 AUTOMATIC MACHINE PRECAUTIONS FOR HOS/OiOS 15006 INSTRUCTIONS FOR INSTALLATION AND...ELIMINATION OF EOS INDUCED SECONDARY FAILURE MECHANISMS 15000 USE OF MELAMINE WORK-SURFACE FOR ESD POTENTIAL BLEED OFF 16141 MICROWAVE NANOSECOND... microwave devices, optoelectronics, and selected nonelectronic parts employed in military, space and commercial applications. In addition, a System

Climate Change Education and Education for Sustainable Development in the Republic of Korea: A Status Report

ERIC Educational Resources Information Center

Sung, Junghee

2015-01-01

The Republic of Korea (ROK) has officially declared its national vision of green growth, and actively develops and implements policies related to education for sustainable development (ESD), green growth education (GGE) and climate change education (CCE). Over the Decade of ESD, the ROK experienced three administrations which have taken different…

Education for Sustainable Development: The Impact of an Out-Door Program on Student Teachers

ERIC Educational Resources Information Center

Zacharious, Aravella; Valanides, Nicos

2006-01-01

The study used an outdoor program for promoting Education for Sustainable Development (ESD) in primary education and investigated the extent to which primary student teachers were prepared to deal with ESD. It also investigated the impact of an outdoor program on primary student teachers' knowledge and attitudes towards sustainable issues, and on…

Securing the Place of Educating for Sustainable Development within Existing Curriculum Frameworks: A Reflective Analysis

ERIC Educational Resources Information Center

Metz, Don; McMillan, Barbara; Maxwell, Mona; Tetrault, Amanda

2010-01-01

Educating for sustainable development (ESD) is generally found within existing disciplinary frameworks. In this paper, our intent is to compare the views and practices of environmental educators who pursue ESD from a perspective different from what is occurring in our own constituency. We collected data on curriculum, teaching perspectives and…

Business Opportunities Guide

DTIC Science & Technology

1987-01-01

Electronic Systems Division Business Opportunities Guide. We remain committed to providing industry the best information possible on pending ESD...Commander Justific ill,):, By_ D.is’ * . ’ . Dist, : :,. ELECTRONIC SYSTEMS DIVISION BUSINESS OPPORTUNITIES GUIDE The complex Command, Control...Communications (C) systems necessary for tomorrow’s Air Foice can only be developed by a stronq’ESD/industry team. Our first Business Opportunities Guide

Research in Environmental Education and Education for Sustainable Development in Germany: The State of the Art

ERIC Educational Resources Information Center

Seybold, Hansjorg; Rieb, Werner

2006-01-01

This article outlines the state of the art in German research on environmental education and education for sustainable development (ESD). Empirical German research on the importance of environmental education and ESD for schools is analysed in relation to three research fields. First, survey research describes the practice of environmental…

SRM propellant, friction/ESD testing

NASA Technical Reports Server (NTRS)

Campbell, L. A.

1989-01-01

Following the Pershing 2 incident in 1985 and the Peacekeeper ignition during core removal in 1987, it was found that propellant can be much more sensitive to Electrostatic Discharges (ESD) than ever before realized. As a result of the Peacekeeper motor near miss incident, a friction machine was designed and fabricated, and used to determine friction hazards during core removal. Friction testing with and electrical charge being applied across the friction plates resulted in propellant ignitions at low friction pressures and extremely low ESD levels. The objective of this test series was to determine the sensitivity of solid rocket propellant to combined friction pressure and electrostatic stimuli and to compare the sensitivity of the SRM propellant to Peacekeeper propellant. The tests are fully discussed, summarized and conclusions drawn.

Environmental Sciences Division annual progress report for period ending September 30, 1994

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1994-12-31

This progress report summarizes the research and development activities conducted in the Environmental Sciences Division (ESD) of Oak Ridge National Laboratory during fiscal year (FY) 1994, which extended from October 1, 1993, through September 30, 1994. The report is structured to provide descriptions of current activities and accomplishments in each of the division`s major organizational units. Following the sections describing the organizational units are sections highlighting ESD Scientific, Technical, and Administrative Achievement awards and listing information necessary to covey the scope of the work in the division. An organizational chart of staff and long-term guests who wee in ESD atmore » the end of FY 1994 is located in the final section of the report.« less

Effect of surface polishing and vacuum firing on electron stimulated desorption from 316LN stainless steel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Malyshev, Oleg B., E-mail: oleg.malyshev@stfc.ac.uk; Hogan, Benjamin T.; Pendleton, Mark

2014-09-01

The reduction of thermal outgassing from stainless steel by surface polishing or vacuum firing is well-known in vacuum technology, and the consequent use of both techniques allows an even further reduction of outgassing. The aim of this study was to identify the effectiveness of surface polishing and vacuum firing for reducing electron-stimulated desorption (ESD) from 316LN stainless steel, which is a frequently used material for particle accelerator vacuum chambers and components. It was found that, unlike for thermal outgassing, surface polishing does not reduce the ESD yield and may even increase it, while vacuum firing of nonpolished sample reduces onlymore » the H{sub 2} ESD yield by a factor 2.« less

Continuous electron stimulated desorption using a ZrO2/Ag permeation membrane

NASA Technical Reports Server (NTRS)

Outlaw, R. A.; Hoflund, Gar B.; Davidson, M. R.

1989-01-01

During the development of an atomic oxygen beam generator for laboratory simulation of the atmospheric conditions in low earth orbit, a new technique for performing electron stimulated desorption (ESD) in a continuous manner has been developed. In this technique, oxygen permeates through an Ag membrane at elevated temperature thereby providing a continuous supply of oxygen atoms to the 1000-A ZrO2 coating at the vacuum interface. ESD then results in a large peak of neutral O2 molecules which ultimately decay into steady-state desorption. The ESD signal is linear with respect to primary beam flux (0.035 O2 molecules per electron at a primary beam energy of 1 keV) but nonlinear with respect to primary beam energy.

Analysis of colonoscopic perforations at a local clinic and a tertiary hospital.

PubMed

Sagawa, Toshihiko; Kakizaki, Satoru; Iizuka, Haruhisa; Onozato, Yasuhiro; Sohara, Naondo; Okamura, Shinichi; Mori, Masatomo

2012-09-21

To define the clinical characteristics, and to assess the management of colonoscopic complications at a local clinic. A retrospective review of the medical records was performed for the patients with iatrogenic colon perforations after endoscopy at a local clinic between April 2006 and December 2010. Data obtained from a tertiary hospital in the same region were also analyzed. The underlying conditions, clinical presentations, perforation locations, treatment types (operative or conservative) and outcome data for patients at the local clinic and the tertiary hospital were compared. A total of 10  826 colonoscopies, and 2625 therapeutic procedures were performed at a local clinic and 32  148 colonoscopies, and 7787 therapeutic procedures were performed at the tertiary hospital. The clinic had no perforations during diagnostic colonoscopy and 8 (0.3%) perforations were determined to be related to therapeutic procedures. The perforation rates in each therapeutic procedure were 0.06% (1/1609) in polypectomy, 0.2% (2/885) in endoscopic mucosal resection (EMR), and 3.8% (5/131) in endoscopic submucosal dissection (ESD). Perforation rates for ESD were significantly higher than those for polypectomy or EMR (P < 0.01). All of these patients were treated conservatively. On the other hand, three (0.01%) perforation cases were observed among the 24  361 diagnostic procedures performed, and these cases were treated with surgery in a tertiary hospital. Six perforations occurred with therapeutic endoscopy (perforation rate, 0.08%; 1 per 1298 procedures). Perforation rates for specific procedure types were 0.02% (1 per 5500) for polypectomy, 0.17% (1 per 561) for EMR, 2.3% (1 per 43) for ESD in the tertiary hospital. There were no differences in the perforation rates for each therapeutic procedure between the clinic and the tertiary hospital. The incidence of iatrogenic perforation requiring surgical treatment was quite low in both the clinic and the tertiary hospital. No procedure-related mortalities occurred. Performing closure with endoscopic clipping reduced the C-reactive protein (CRP) titers. The mean maximum CRP titer was 2.9 ± 1.6 mg/dL with clipping and 9.7 ± 6.2 mg/dL without clipping, respectively (P < 0.05). An operation is indicated in the presence of a large perforation, and in the setting of generalized peritonitis or ongoing sepsis. Although we did not experience such case in the clinic, patients with large perforations should be immediately transferred to a tertiary hospital. Good relationships between local clinics and nearby tertiary hospitals should therefore be maintained. It was therefore found to be possible to perform endoscopic treatment at a local clinic when sufficient back up was available at a nearby tertiary hospital.

Reducing/Eliminating ESD Hazards During Pyro Operations

NASA Technical Reports Server (NTRS)

Soriano, Jose Francisco; Kelley, J. D. (Technical Monitor)

2001-01-01

Several safety concerns have occurred during pyro operations at 30% or lower RH in the OPF area based on the increase of electrostatic discharge (ESD). These concerns targeted the safety of personnel, flight hardware, and ground support equipment (GSE). Two proposed methods considered to control ESDs during pyro operations at 30% or lower RH are the use of an ionizer blower and to increase the moisture content. In order to demonstrate that the ionizer is effective in neutralizing static charge, a series of experimental runs were conducted in the Electrostatics Laboratory located in the Operations & Checkout (O&C) Building at NASA Kennedy Space Center (KSC). The effectiveness of the ionizer blower was evaluated based upon the time lapse of a charged metal plate from initial 1000 to 400 volts. Distance, RH, and angle of attack were studied. A full factorial experiment (2(exp 3) = 8) was conducted. Since we did not have a statistical analysis program, such as SAS, available, calculations were done manually based on the method of ANOVA (Analysis of Variances), but R(exp 2) (fitness of curve) was not obtained. As conjectured, distance was found to be the major influencial variable. Therefore, we concluded that the best possible combination of situations would be to position the ionizer blower as close as possible and facing directly into the charged plate. This scenario resulted in the quickest discharge rate, which would be the most beneficial during pyro operations below 30% RH. The second method of increasing the moisture content in the work environment through a modification of the OPF ECS current configuration appeared to be dependent on budget constraints and currently not planned to be modified. Finally, some recommendations are discussed such as to test the ionizer in an actual field experiment with a mockup pyro connector and a technician with all the NASA KSC Safety-compliant PPE to assess the realistic effectiveness of the ionizer blower.

The role of volume charging of dielectrics in the occurrence of electrostatic discharges on spacecraft

NASA Astrophysics Data System (ADS)

Chirskaia, Natalia; Novikov, Lev; Voronina, Ekaterina

2016-07-01

Most recent works consider the occurrence of electrostatic discharges (ESD) on the surface of the spacecraft due to spacecraft charging as a consequence of its surface interaction with the surrounding space plasma and solar radiation [1]. At the same time, low-orbit spacecraft are simultaneously exposed to the hot magnetospheric plasma with the typical energies of the particles ~ 0.1 - 50 keV and to the particles of the Earth radiation belts (ERB) with a typical energy in the range of 0.1-10 MeV. Electrons of ERB with these energies penetrate into spacecraft dielectrics on the order of a few millimeters in depth and create an embedded charge with their own electric field. It has been shown in a number of papers that exactly a volume charge of the electrons of ERB can be the cause of ESD on spacecraft [2,3]. In this work we present the results of calculation of the dose rate and, correspondingly, the radiation conductivity in a typical spacecraft dielectrics, arising under the action of the hot magnetospheric plasma and electrons of ERB. Using software packages based on Monte Carlo methods and on the solution of equations of charge transport in spacecraft dielectrics, it is shown that in a number of areas of the Earth's magnetosphere the ESD can occur under the action of the ERB electrons. The results of present work can provide a basis for creation of the standard, characterizing the emergence of ESR on spacecraft due to volume charging of dielectrics and describing the methods of laboratory tests of spacecraft dielectrics. L.S. Novikov, A.A. Makletsov, and V.V. Sinolits, Comparison of Coulomb-2, NASCAP-2K, MUSCAT and SPIS codes for geosynchronous spacecraft charging, Advances in Space Research, 2016, V. 57, Is. 2, pp. 671-680. Wrenn G.L., Smith R.J.K. The ESD Threat to GEO Satellites: Empirical Models for Observed Effects Due to Both Surface and Internal Charging. Proc. ESA Symp. "Environment Modelling for Space-based Applications", ESTEC Noordwijk, The Netherlands, 1996, pp. 121-124. Paulmier, T., Dirassen, B., Arnaout, M., Payan, D., Balcon, N., Radiation-Induced Conductivity of Space Used Polymers Under High Energy Electron Irradiation, Plasma Science, IEEE Transactions, 2015, V. 43, No. 9, pp.2907-2914.

Recycle dynamics during centrifugal compressor ESD, start-up and surge control

DOE Office of Scientific and Technical Information (OSTI.GOV)

Botros, K.K.; Jones, B.J.; Richards, D.J.

1996-12-31

Recycle systems are important components in the operation of centrifugal compressor stations. They are essential during a start-up operation, for surge protection and for emergency shutdown (ESD). These operations are inherently dynamic where interactions between equipment, control and gas flow occur in a complex manner with the associated risk of compressor surge. Of particular importance are the effects or recycle system capacity, the recycle valve characteristics, check valve dynamic behavior, piping geometry and capacitance around the compressor unit, and the performance characteristics of the centrifugal compressor itself. This paper presents numerical results of the effects of some of these parametersmore » on surge control, ESD and unit startup. These parameters are: (1) The effects of damping the surge control flow signal in an attempt to suppress the signal noise, on the integrity of the surge control system; (2) The effects of recycle valve characteristics, stroke time and valve capacity on ESD; (3) The effects of recycle line size on ESD; and (4) The effects of the recycle valve closing time (or rate) on the startup operation, with the intent of shortening this time to minimum for environmental reasons. Results were obtained from the solution of the pertinent dynamic equations describing the gas and equipment dynamics which has been verified against field and laboratory measurements. The samples presented in this paper were applied to a 24 MW natural gas compressor station on the NOVA Gas Transmission system, and to a scale-down laboratory model. Influence of other parameters from this investigation were published elsewhere and are cited in the reference section.« less

Extended evaluation on the ES-D3 cell differentiation assay combined with the BeWo transport model, to predict relative developmental toxicity of triazole compounds.

PubMed

Li, Hequn; Flick, Burkhard; Rietjens, Ivonne M C M; Louisse, Jochem; Schneider, Steffen; van Ravenzwaay, Bennard

2016-05-01

The mouse embryonic stem D3 (ES-D3) cell differentiation assay is based on the morphometric measurement of cardiomyocyte differentiation and is a promising tool to detect developmental toxicity of compounds. The BeWo transport model, consisting of BeWo b30 cells grown on transwell inserts and mimicking the placental barrier, is useful to determine relative placental transport velocities of compounds. We have previously demonstrated the usefulness of the ES-D3 cell differentiation assay in combination with the in vitro BeWo transport model to predict the relative in vivo developmental toxicity potencies of a set of reference azole compounds. To further evaluate this combined in vitro toxicokinetic and toxicodynamic approach, we combined ES-D3 cell differentiation data of six novel triazoles with relative transport rates obtained from the BeWo model and compared the obtained ranking to the developmental toxicity ranking as derived from in vivo data. The data show that the combined in vitro approach provided a correct prediction for in vivo developmental toxicity, whereas the ES-D3 cell differentiation assay as stand-alone did not. In conclusion, we have validated the combined in vitro approach for developmental toxicity, which we have previously developed with a set of reference azoles, for a set of six novel triazoles. We suggest that this combined model, which takes both toxicodynamic and toxicokinetic aspects into account, should be further validated for other chemical classes of developmental toxicants.

Education for Sustainable Development in Higher Education: State-of-the-Art, Barriers and Challenges

ERIC Educational Resources Information Center

Fernández-Sánchez, Gonzalo; Bernaldo, María Olga; Castillejo, Ana; Manzanero, Ana María

2014-01-01

Education for Sustainable Development (ESD) is a new educational paradigm that allows Universities to lead and respond to social needs towards a more sustainable life. The ESD is a global preparedness and complex phenomena in relation to the effects of human activity on the environment, society and economy in spatial (global, regional and local)…

The European Virtual Seminar on Sustainable Development as an Opportunity for Staff ESD Competence Development within University Curricula

ERIC Educational Resources Information Center

de Kraker, Joop; Dlouhá, Jana; Machackova Henderson, Laura; Kapitulcinová, Dana

2017-01-01

Purpose: The purpose of this paper is to assess the current and potential value of the European Virtual Seminar on Sustainable Development (EVS) as an opportunity for professional development in Education for Sustainable Development (ESD) for teaching staff at university level. Design/methodology/approach: The paper presents and reflects on the…

Personality, Moral Purpose, and the Leadership of an Education for Sustainable Development

ERIC Educational Resources Information Center

Bottery, Mike; Wright, Nigel; James, Sarah

2012-01-01

This paper describes how two primary head teachers, nationally recognised as role models for the development of an education for sustainable development (ESD) in their schools, manage the implementation of this area. In doing so, it shows how they adopt two very different approaches to ESD and to their job generally, and suggests that whilst there…

Starting the Pluralistic Tradition of Teaching? Effects of Education for Sustainable Development (ESD) on Pre-Service Teachers' Views on Teaching about Sustainable Development

ERIC Educational Resources Information Center

Andersson, Klas

2017-01-01

There is currently a well-established belief among politicians, scholars and university representatives that educational systems can produce positive attitudes towards sustainable development (SD) among citizens. This article investigates whether Education for Sustainable Development (ESD) in teacher education has effects on pre-service teachers'…

Analysing Key Debates in Education and Sustainable Development in Relation to ESD Practice in Viet Nam

ERIC Educational Resources Information Center

Balls, Emily

2016-01-01

This article is based on qualitative field research carried out in Ha Noi, Viet Nam, in 2013 for an MA dissertation in Education and International Development at the UCL Institute of Education. It analyses interpretations of education for sustainable development (ESD) in Viet Nam, relating these to key debates around instrumental and democratic…

Embedding Education for Sustainable Development in Higher Education: A Case Study Examining Common Challenges and Opportunities for Undergraduate Programmes

ERIC Educational Resources Information Center

Jones, Paula; Trier, Colin J.; Richards, Jonathan P.

2008-01-01

This paper explores the perceptions of academics and students towards embedding Education for Sustainable Development (ESD) into undergraduate degree programmes in the School for Earth, Ocean and Environmental Science (SEOES) at the University of Plymouth. The main purpose of the research was to identify current ESD related teaching and learning…

Learning for and about Sustainability in Higher Education--A Regional Perspective Based on Experiences from the Baltic and the Mediterranean

ERIC Educational Resources Information Center

Scoullos, Michael; Malotidi, Vicky; Lindroos, Paula; Suomalainen, Sinikka

2017-01-01

Purpose: The purpose of the paper is to present and compare collective efforts of higher education institutions working through regional networks in introducing and promoting education for sustainable development (ESD) and environmental education (EE) in two most significant EU boarder regions. Efforts to support EE/ESD in higher education are…

Techniques for Teaching Standard English Composition to English as a Second Dialect Students.

ERIC Educational Resources Information Center

Edwards, Thomas O.

English as a second dialect (ESD) students are those who have developed linguistic patterns from their parents and other members of their cultural milieu. Since the ESD students seldom find themselves in a setting that demands the use of standard English, they come to higher education with a well developed linguistic pattern that is alien to…

Education for Sustainable Development: Assessment of the Current Situation at the Faculty of Engineering of Notre Dame University--Louaize

ERIC Educational Resources Information Center

Salem, Talal; Harb, Jacques

2012-01-01

There is a growing need to incorporate educational sustainable development (ESD) principles into engineering education. This paper identifies engineering competencies within the Faculty of Engineering at Notre Dame University--Louaize and the means to shift towards sustainability. ESD tools are used to carry the analysis, keeping in mind the…

Branding the Green Education: Challenges Facing Implementation of Education for Sustainable Development in Egypt

ERIC Educational Resources Information Center

Ramzy, Omar; Wahieb, Rasha

2012-01-01

Due to the scarcity in natural resources and the demand for green labour and economy, education for sustainable development (ESD) gained a great importance in developed countries, let alone developing ones. From this point of view, this paper is studying the possibility of infusing ESD in Egypt after one and a half years since January 2011 youth…

Biogeochemical Cycles for Combining Chemical Knowledge and ESD Issues in Greek Secondary Schools Part II: Assessing the Impact of the Intervention

ERIC Educational Resources Information Center

Koutalidi, Sophia; Psallidas, Vassilis; Scoullos, Michael

2016-01-01

In searching for effective ways to combine science/chemical education with EE/ESD, new didactic materials were designed and produced focussing on biogeochemical cycles and their connection to sustainable development. The materials were experimentally applied in 16 Greek schools under the newly introduced compulsory "school project" which…

How Education for Sustainable Development Is Implemented in Germany: Looking through the Lens of Educational Governance Theory

ERIC Educational Resources Information Center

Bormann, Inka; Nikel, Jutta

2017-01-01

The United Nations (UN) Decade of Education for Sustainable Development (ESD) aimed to integrate the principles, values and practices of sustainable development into all aspects of education and learning around the world. The authors of this article address the implementation process of ESD in Germany during the UN Decade (2005-2014). By…

Learning for a Change: Exploring the Relationship between Education and Sustainable Development

ERIC Educational Resources Information Center

Vare, Paul; Scott, William

2007-01-01

Whether we view sustainable development as our greatest challenge or a subversive litany, every phase of education is now being urged to declare its support for education for sustainable development (ESD). In this paper, we explore the ideas behind ESD and, building on work by Foster and by Scott and Gough, we argue that it is necessary now to…

KSC Electrostatic Discharge (ESD) Issues

NASA Technical Reports Server (NTRS)

Buhler, Charles

2008-01-01

Discussion of key electrostatic issues that have arisen during the past few years at KSC that the Electrostatics Laboratory has studied. The lab has studied in depth the Space Shuttle's Thermal Control System Blankets, the International Space Station Thermal Blanket, the Pan/Tilt Camera Blankets, the Kapton Purge Barrier Curtain, the Aclar Purge Barrier Curtain, the Thrust Vector Controller Blankets, the Tyvek Reaction Control System covers, the AID-PAK and FLU-9 pyro inflatable devices, the Velostat Solid Rocket Booster mats, and the SCAPE suits. In many cases these materials are insulating meaning that they might be a source of unsafe levels of electrostatic discharge (ESD). For each, the lab provided in-depth testing of each material within its current configuration to ensure that it does not cause an ESD concern that may violate the safety of the astronauts, the workers and equipment for NASA. For example the lab provides unique solutions and testing such as Spark Incendivity Testing that checks whether a material is capable of generating a spark strong enough to ignite a flammable gas. The lab makes recommendations to changes in specifications, procedures, and material if necessary. The lab also consults with a variety of non-safety related ESD issues for the agency.

Contributions to the UN Decade of Education for Sustainable Development. Environmental Education, Communication and Sustainability. Volume 33

ERIC Educational Resources Information Center

Goncalves, Fernando J., Ed.; Pereira, Ruth, Ed.; Leal Filho, Walter, Ed.; Miranda Azeiteiro, Ulisses, Ed.

2012-01-01

This book presents essential learning approaches. It introduces educational and training activities, as well as various innovative methods aiming at the development of practical skills, in order to strengthen the continuous process of environmental education, and in particular the education for sustainable development (ESD). In doing so, it…

Importance and Effectiveness of Student Health Services at a South Texas University

ERIC Educational Resources Information Center

McCaig, Marilyn M.

2013-01-01

The study examined the health needs of students at a south Texas university and documented the utility of the student health center. The descriptive study employed a mixed methods explanatory sequential design (ESD). The non-probability sample consisted of 140 students who utilized the university's health center during the period of March 23-30,…

From environment to sustainable development: China's strategies for ESD in basic education

NASA Astrophysics Data System (ADS)

Zhang, Tiedao

2010-06-01

This paper intends to provide an overview of the reorientation of education in China in the period 1998-2009 with regard to development issues. During this time, the focus has shifted gradually from the environment and health to education for sustainable development. The article centres on highlighting the main interventions and strategies adopted by China's schools to make this reorientation possible, including: the introduction of new visions of sustainable development and project planning; the establishment of organisational mechanisms and capacity-building measures for their implementation in the field; the integration of ESD into teaching and learning processes; the maintenance of an action-research mechanism for innovations; and the sharing of lessons with both the national and the international community in order to make the implementation of ESD more effective.

Outcome of Radiation Monotherapy for High-risk Patients with Stage I Esophageal Cancer.

PubMed

Shirakawa, Yasuhiro; Noma, Kazuhiro; Maeda, Naoaki; Tanabe, Shunsuke; Kuroda, Shinji; Kagawa, Shunsuke; Katsui, Kuniaki; Katayama, Norihisa; Kanazawa, Susumu; Fujiwara, Toshiyoshi

2017-04-01

Currently, chemoradiation is the most widely used nonsurgical treatment for esophageal cancer. However, some patients, particularly the very elderly or those with severe vital organ dysfunction, face difficulty with the chemotherapy component. We therefore examined the outcome of radiation therapy (RT) alone for patients with esophageal cancer at our facility. Between January 2005 and December 2014, 84 patients underwent RT at our hospital, and 78 of these patients received concomitant chemotherapy. The remaining 6 patients underwent RT alone; these patients were considered to be high-risk and to have no lymph node metastasis (stage I). Five of them received irradiation up to a curative dose: 4 showed a complete response (CR) and 1 showed a partial response (PR). Of the patients exhibiting CR, 3 are currently living recurrence-free, whereas 1 patient underwent endoscopic submucosal dissection (ESD) as salvage therapy for local recurrence, with no subsequent recurrence. High-risk stage I esophageal cancer patients can be treated radically with RT alone under certain conditions. In the future, to broaden the indications for RT monotherapy to include some degree of advanced cancers, a novel concurrent therapy should be identified.

Biological Ablation of Sentinel Lymph Node Metastasis in Submucosally Invaded Early Gastrointestinal Cancer

PubMed Central

Kikuchi, Satoru; Kishimoto, Hiroyuki; Tazawa, Hiroshi; Hashimoto, Yuuri; Kuroda, Shinji; Nishizaki, Masahiko; Nagasaka, Takeshi; Shirakawa, Yasuhiro; Kagawa, Shunsuke; Urata, Yasuo; Hoffman, Robert M; Fujiwara, Toshiyoshi

2015-01-01

Currently, early gastrointestinal cancers are treated endoscopically, as long as there are no lymph node metastases. However, once a gastrointestinal cancer invades the submucosal layer, the lymph node metastatic rate rises to higher than 10%. Therefore, surgery is still the gold standard to remove regional lymph nodes containing possible metastases. Here, to avoid prophylactic surgery, we propose a less-invasive biological ablation of lymph node metastasis in submucosally invaded gastrointestinal cancer patients. We have established an orthotopic early rectal cancer xenograft model with spontaneous lymph node metastasis by implantation of green fluorescent protein (GFP)-labeled human colon cancer cells into the submucosal layer of the murine rectum. A solution containing telomerase-specific oncolytic adenovirus was injected into the peritumoral submucosal space, followed by excision of the primary rectal tumors mimicking the endoscopic submucosal dissection (ESD) technique. Seven days after treatment, GFP signals had completely disappeared indicating that sentinel lymph node metastasis was selectively eradicated. Moreover, biologically treated mice were confirmed to be relapse-free even 4 weeks after treatment. These results indicate that virus-mediated biological ablation selectively targets lymph node metastasis and provides a potential alternative to surgery for submucosal invasive gastrointestinal cancer patients. PMID:25523761

Real-time monitoring of focused ultrasound blood-brain barrier opening via subharmonic acoustic emission detection: implementation of confocal dual-frequency piezoelectric transducers

NASA Astrophysics Data System (ADS)

Tsai, Chih-Hung; Zhang, Jia-Wei; Liao, Yi-Yi; Liu, Hao-Li

2016-04-01

Burst-tone focused ultrasound exposure in the presence of microbubbles has been demonstrated to be effective at inducing temporal and local opening of the blood-brain barrier (BBB), which promises significant clinical potential to deliver therapeutic molecules into the central nervous system (CNS). Traditional contrast-enhanced imaging confirmation after focused ultrasound (FUS) exposure serves as a post-operative indicator of the effectiveness of FUS-BBB opening, however, an indicator that can concurrently report the BBB status and BBB-opening effectiveness is required to provide effective feedback to implement this treatment clinically. In this study, we demonstrate the use of subharmonic acoustic emission detection with implementation on a confocal dual-frequency piezoelectric ceramic structure to perform real-time monitoring of FUS-BBB opening. A confocal dual-frequency (0.55 MHz/1.1 MHz) focused ultrasound transducer was designed. The 1.1 MHz spherically-curved ceramic was employed to deliver FUS exposure to induce BBB-opening, whereas the outer-ring 0.55 MHz ceramic was employed to detect the subharmonic acoustic emissions originating from the target position. In stage-1 experiments, we employed spectral analysis and performed an energy spectrum density (ESD) calculation. An optimized 0.55 MHz ESD level change was shown to effectively discriminate the occurrence of BBB-opening. Wideband acoustic emissions received from 0.55 MHz ceramics were also analyzed to evaluate its correlations with erythrocyte extravasations. In stage-2 real-time monitoring experiments, we applied the predetermined ESD change as a detection threshold in PC-controlled algorithm to predict the FUS exposure intra-operatively. In stage-1 experiment, we showed that subharmonic ESD presents distinguishable dynamics between intact BBB and opened BBB, and therefore a threshold ESD change level (5.5 dB) can be identified for BBB-opening prediction. Using this ESD change threshold detection as a surrogate to on/off control the FUS exposure in stage-2 experiments, we demonstrated both excellent sensitivity (92%) and specificity (92.3%) in discriminating BBB-opening occurrence can be obtained in animal treatments, while concurrently achieving a high positive predicted value (95.8%). Wideband ESD was also highly correlated with the occurrence and level of erythrocyte extravasations (r 2  =  0.81). The proposed system configuration and corresponding analysis based on subharmonic acoustic emissions has the potential to be implemented as a real-time feedback control structure for reliable indication of intact FUS-BBB opening for CNS brain drug delivery.

Real-time monitoring of focused ultrasound blood-brain barrier opening via subharmonic acoustic emission detection: implementation of confocal dual-frequency piezoelectric transducers.

PubMed

Tsai, Chih-Hung; Zhang, Jia-Wei; Liao, Yi-Yi; Liu, Hao-Li

2016-04-07

Burst-tone focused ultrasound exposure in the presence of microbubbles has been demonstrated to be effective at inducing temporal and local opening of the blood-brain barrier (BBB), which promises significant clinical potential to deliver therapeutic molecules into the central nervous system (CNS). Traditional contrast-enhanced imaging confirmation after focused ultrasound (FUS) exposure serves as a post-operative indicator of the effectiveness of FUS-BBB opening, however, an indicator that can concurrently report the BBB status and BBB-opening effectiveness is required to provide effective feedback to implement this treatment clinically. In this study, we demonstrate the use of subharmonic acoustic emission detection with implementation on a confocal dual-frequency piezoelectric ceramic structure to perform real-time monitoring of FUS-BBB opening. A confocal dual-frequency (0.55 MHz/1.1 MHz) focused ultrasound transducer was designed. The 1.1 MHz spherically-curved ceramic was employed to deliver FUS exposure to induce BBB-opening, whereas the outer-ring 0.55 MHz ceramic was employed to detect the subharmonic acoustic emissions originating from the target position. In stage-1 experiments, we employed spectral analysis and performed an energy spectrum density (ESD) calculation. An optimized 0.55 MHz ESD level change was shown to effectively discriminate the occurrence of BBB-opening. Wideband acoustic emissions received from 0.55 MHz ceramics were also analyzed to evaluate its correlations with erythrocyte extravasations. In stage-2 real-time monitoring experiments, we applied the predetermined ESD change as a detection threshold in PC-controlled algorithm to predict the FUS exposure intra-operatively. In stage-1 experiment, we showed that subharmonic ESD presents distinguishable dynamics between intact BBB and opened BBB, and therefore a threshold ESD change level (5.5 dB) can be identified for BBB-opening prediction. Using this ESD change threshold detection as a surrogate to on/off control the FUS exposure in stage-2 experiments, we demonstrated both excellent sensitivity (92%) and specificity (92.3%) in discriminating BBB-opening occurrence can be obtained in animal treatments, while concurrently achieving a high positive predicted value (95.8%). Wideband ESD was also highly correlated with the occurrence and level of erythrocyte extravasations (r (2)  =  0.81). The proposed system configuration and corresponding analysis based on subharmonic acoustic emissions has the potential to be implemented as a real-time feedback control structure for reliable indication of intact FUS-BBB opening for CNS brain drug delivery.

Biology teachers' dissection practices and the influences that lead to their adoption: An exploratory research

NASA Astrophysics Data System (ADS)

Milano, Regina Nicole

The lack of resolution in the on-going animal dissection debate inspired this mixed methods study to identify Connecticut secondary biology teachers' dissection practices and the influences that lead to their adoption. Qualitative findings indicate past experiences, managing objections to dissection, school culture, goals of biology teaching and ethics as major influences on dissection practices with 58.4% (n=7) of the sample dissecting and 41.6% not dissecting (n=5). Quantitative findings reveal gender, standards and curriculum, advantages of dissection and experiences as a student as major influences on dissection practices with 71.9% (n=92) of the sample dissecting and 28.1% (n=36) not dissecting. The study concludes that dissection policies are necessary and imminent in Connecticut school districts. Furthermore, it advises teacher-initiated, qualitative and quantitative assessments to expose disparities between student dissection perspectives and their own, prior to conducting dissection. Finally, it provides suggestions for addressing potential differences including administrative involvement.

Electrostatic Discharge Training Manual

DTIC Science & Technology

1980-09-01

CAN BE MOLDED INTO FORMED SHAPES. FIBERBOARD, MELAMINE LAMINATES AND OTHER MATERIALS (LAMINATED OR HOMOGENEOUS) CAN BE CONSTRUCTED INTO BOXES AND...COVERED WITH, ESD PROTECTIVE MATERIALS SUCH AS METAL, MIL-B-81705 TYPE II, MIL-P- 82646 (REFERENCES 17, 16), MELAMINE LAMINATES OR OTHER ESD PROTECTIVE...CONDUCTANCE IN AVALANCHE MICROWAVE OSCILLATORS", IEEE TRANSACTIONS ON ELECTRON DEVICES, ED-i5, JUNE 1968. 32. HOLM, R., ELECTRIC CONTACTS HANDBOOK, BERLIN

Education for Sustainable Development in the UK: Making the Connections between the Environment and Development Agendas

ERIC Educational Resources Information Center

Bourn, Douglas

2008-01-01

Education for Sustainable Development (ESD) is an initiative that dates back to the early 1990s. Whilst policy statements at this time referred to ESD as a bringing together of environmental and development education, in the UK, as in most other industrialized countries, it has been the environmental agenda that has tended to dominate. In the UK,…

What Kind of Actions Are Appropriate? Eco-School Teachers' and Instructors' Ranking of Sustainability-Promoting Actions as Content in Education for Sustainable Development (ESD)

ERIC Educational Resources Information Center

Stagell, Ulrica; Almers, Ellen; Askerlund, Per; Apelqvist, Magnus

2014-01-01

Based on the consideration that learning about different action alternatives and strategies are essential parts of ESD, this quantitative study focuses Eco-School teachers' and instructors' views on including different sustainability-promoting actions in teaching practices. Direct actions, and actions that take place in the private sphere were…

UN Global Action Programme and Education for Sustainable Development: A Critical Appraisal of the Evidence Base

ERIC Educational Resources Information Center

Fischer, Daniel; Aubrecht, Elisabeth Lena; Brück, Maria; Ditges, Laura; Gathen, Lea; Jahns, Maximilian; Petersmann, Moritz; Rau, Jörn; Wellmann, Christiane

2015-01-01

The United Nations (UN) proclaimed the years 2005 to 2014 the World Decade on Education for Sustainable Development (ESD). As a follow up on the World Decade, the UN launched a Global Action Programme (GAP) that is designed to set the framework for international activities on ESD. The GAP focuses on five priority areas that are of high relevance…

VO-ESD: a virtual observatory approach to describe the geomagnetic field temporal variations with application to Swarm data

NASA Astrophysics Data System (ADS)

Saturnino, Diana; Langlais, Benoit; Amit, Hagay; Mandea, Mioara; Civet, François; Beucler, Éric

2017-04-01

A complete description of the main geomagnetic field temporal variation is crucial to understand dynamics in the core. This variation, termed secular variation (SV), is known with high accuracy at ground magnetic observatory locations. However the description of its spatial variability is hampered by the globally uneven distribution of the observatories. For the past two decades a global coverage of the field changes has been allowed by satellites. Their surveys of the geomagnetic field have been used to derive and improve global spherical harmonic (SH) models through some strict data selection schemes to minimise external field contributions. But discrepancies remain between ground measurements and field predictions by these models. Indeed, the global models do not reproduce small spatial scales of the field temporal variations. To overcome this problem we propose a modified Virtual Observatory (VO) approach by defining a globally homogeneous mesh of VOs at satellite altitude. With this approach we directly extract time series of the field and its temporal variation from satellite measurements as it is done at observatory locations. As satellite measurements are acquired at different altitudes a correction for the altitude is needed. Therefore, we apply an Equivalent Source Dipole (ESD) technique for each VO and each given time interval to reduce all measurements to a unique location, leading to time series similar to those available at ground magnetic observatories. Synthetic data is first used to validate the new VO-ESD approach. Then, we apply our scheme to measurements from the Swarm mission. For the first time, a 2.5 degrees resolution global mesh of VO times series is built. The VO-ESD derived time series are locally compared to ground observations as well as to satellite-based model predictions. The approach is able to describe detailed temporal variations of the field at local scales. The VO-ESD time series are also used to derive global SH models. Without regularization these models describe well the secular trend of the magnetic field. The derivation of longer VO-ESD time series, as more data will be made available, will allow the study of field temporal variations features such as geomagnetic jerks.

Science Teachers and the Dissection Debate: Perspectives on Animal Dissection and Alternatives

ERIC Educational Resources Information Center

Oakley, Jan

2012-01-01

This study investigated Ontario science and biology teachers' practices and attitudes toward animal dissection and dissection alternatives. The data was collected through a mixed methods approach involving online surveys (n = 153) and subsequent telephone interviews (n = 9) with secondary school science and biology teachers. The findings indicate…

Culture-independent analysis of bacterial communities in hemolymph of American lobsters with epizootic shell disease.

PubMed

Quinn, Robert A; Smolowitz, Roxanna; Chistoserdov, Andrei Y

2013-03-26

Epizootic shell disease (ESD) of the American lobster Homarus americanus H. Milne Edwards, 1837 is a disease of the carapace that presents grossly as large, melanized, irregularly shaped lesions, making the lobsters virtually unmarketable because of their grotesque appearance. We analyzed the bacterial communities present in the hemolymph of lobsters with and without ESD using nested-PCR of the 16S rRNA genes followed by denaturing gradient gel electrophoresis. All lobsters tested (n = 42) had bacterial communities in their hemolymph, and the community profiles were highly similar regardless of the sampling location or disease state. A number of bacteria were detected in a high proportion of samples and from numerous locations, including a Sediminibacterium sp. closely related to a symbiont of Tetraponera ants (38/42) and a Ralstonia sp. (27/42). Other bacteria commonly encountered included various Bacteroidetes, Pelomonas aquatica, and a Novosphingobium sp. One bacterium, a different Sediminibacterium sp., was detected in 20% of diseased animals (n = 29), but not in the lobsters without signs of ESD (n = 13). The bacteria in hemolymph were not the same as those known to be present in lesion communities except for the detection of a Thalassobius sp. in 1 individual. This work demonstrates that hemolymph bacteremia and the particular bacterial species present do not correlate with the incidence of ESD, providing further evidence that microbiologically, ESD is a strictly cuticular disease. Furthermore, the high incidence of the same species of bacteria in hemolymph of lobsters may indicate that they have a positive role in lobster fitness, rather than in disease, and further investigation of the role of bacteria in lobster hemolymph is required.

Electron Stimulated Desorption Yields at the Mercury's Surface Based On Hybrid Simulation Results

NASA Astrophysics Data System (ADS)

Travnicek, P. M.; Schriver, D.; Orlando, T. M.; Hellinger, P.

2016-12-01

In terms of previous research concerning the solar wind sputtering process, most of the focus has been on ion sputtering by precipitating solar wind protons, however, precipitating electrons can also result in the desorption of neutrals and ions from Mercury's surface and represents a potentially significant source of exospheric and heavy ion components. Electron stimulated desorption (ESD) is not bound by optical selection rules and electron impact energies can vary over a much wider range, including core-level excitations that easily lead to multi-electron shake up events that can cascade into localized multiple charged states that Coulomb explode with extreme kinetic energy release (up to 8 eV = 186,000 K). While considered for the lunar exosphere, ESD has not been adequately studied or quantified as a producer of neutrals and ions. ESD is a well known process which involves the excitation (often ionization) of a surface target followed by charge ejection, bond breaking and ion expulsion due to the resultant Coulomb repulsion. Though the role of ESD processes has not been discussed much with respect to Mercury, the impinging energetic electrons that are transported through the magnetosphere and precipitate can induce significant material removal. Given the energetics and the wide band-gap nature of the minerals, the departing material may also be primarily ionic. The possible role of 5 eV - 1 keV electron stimulated desorption and dissociation in "weathering" the regolith can be significant. ESD yields will be calculated based on the ion and electron precipitation profiles for the already carried out hybrid and electron simulations. Neutral and ion cloud profiles around Mercury will be calculated and combined with those profiles expected from PSD and MIV.

Visualizing Science Dissections in 3D: Contextualizing Student Responses to Multidimensional Learning Materials in Science Dissections

NASA Astrophysics Data System (ADS)

Walker, Robin Annette

A series of dissection tasks was developed in this mixed-methods study of student self-explanations of their learning using actual and virtual multidimensional science dissections and visuo-spatial instruction. Thirty-five seventh-grade students from a science classroom (N = 20 Female/15 Male, Age =13 years) were assigned to three dissection environments instructing them to: (a) construct static paper designs of frogs, (b) perform active dissections with formaldehyde specimens, and (c) engage with interactive 3D frog visualizations and virtual simulations. This multi-methods analysis of student engagement with anchored dissection materials found learning gains on labeling exercises and lab assessments among most students. Data revealed that students who correctly utilized multimedia text and diagrams, individually and collaboratively, manipulated 3D tools more effectively and were better able to self-explain and complete their dissection work. Student questionnaire responses corroborated that they preferred learning how to dissect a frog using 3D multimedia instruction. The data were used to discuss the impact of 3D technologies, programs, and activities on student learning, spatial reasoning, and their interest in science. Implications were drawn regarding how to best integrate 3D visualizations into science curricula as innovative learning options for students, as instructional alternatives for teachers, and as mandated dissection choices for those who object to physical dissections in schools.

Effects of Concentration of Nanoscale Tin-Doped Indium Oxide on Electrical Breakdown of High-Resistance Liquid Crystal

NASA Astrophysics Data System (ADS)

Liang, Bau-Jy; Liu, Don-Gey; Chang, Chih-Yuan; Shie, Wun-Yi

2011-05-01

According to our previous study, a high concentration of nanoscale tin-doped indium oxide (ITO) may be beneficial for protecting liquid crystal (LC) against attacks by electrostatic discharge (ESD). In this study, the influence of high-voltage stresses in an ESD test was investigated for cells doped with different concentrations of ITO. It was found that nano-ITO with a concentration of 0.4% in weight ratio deteriorated the physical properties of LC of transparency transition and charge retention. However, our experiment showed that the capability of ESD protection for the doped LC was still improved at the ITO concentration of 0.4 wt %. This finding supports the proposed model in our previous report. The role of ITO in the LC is not always beneficial, as discussed in this paper.

An Investigative Alternative to Single-Species Dissection in the Introductory Biology Laboratory

ERIC Educational Resources Information Center

Carlin, Joel L.

2010-01-01

Dissections of single species (e.g., fetal pig) are a common student learning activity in introductory biology courses. Such dissections demonstrate location of anatomical parts and provide dissection practice but provide less opportunity for student critical thinking, numeracy and demonstration of the scientific method. A comparative anatomy lab…

Developing an Instrument for Identifying Secondary Teachers' Beliefs about Education for Sustainable Development in China

ERIC Educational Resources Information Center

Yang, Guang; Lam, Chi-Chung; Wong, Ngai-Ying

2010-01-01

Education for Sustainable Development (ESD) has been recently recognized as an important area in the new Chinese educational reform. As teachers play a pivotal role, knowing and developing an effective and easy-to-use instrument for tapping teachers' beliefs is essential. This article reports an attempt to develop an instrument with mixed methods.…

Integrating Sustainable Development Concept into Science Education Program Is Not Enough; We Need Competent Science Teachers for Education for Sustainable Development--Turkish Experience

ERIC Educational Resources Information Center

Karaarslan, Güliz; Teksöz, Gaye

2016-01-01

In order to educate science teachers for a sustainable future, recent discussions are going on related to collaboration between science education and education for sustainable development (ESD). Still, ESD has been in a development stage and needs to be improved in terms of developing teacher competencies. Therefore, in this study we focused on…

Education Service Districts in Oregon. A Progress Report to the 61st Legislative Assembly, as Required by Chapter 445, Oregon Laws 1979, House Bill 2393, ORS 334.175 Sec. 2.

ERIC Educational Resources Information Center

Oregon State Dept. of Education, Salem.

Through a wide variety of programs and services, Oregon's 25 educational service districts (ESDs) link the state Department of Education with local school districts while helping districts provide a cost-effective education and fostering equal educational opportunity statewide. This report lists the general ESD programs and services required by…

Grounding Headphones for Protection Against ESD

NASA Technical Reports Server (NTRS)

Peters, John; Youngquist, Robert C.

2004-01-01

A simple alternative technique has been devised protecting delicate equipment against electrostatic discharge (ESD) in settings in which workers wear communication headsets. In the original setting in which the technique was devised, the workers who wear the headsets also wear anti-ESD grounding straps on their wrists. The alternative technique eliminates the need for the wrist grounding straps by providing for grounding through the headsets. In place of the electrically insulating foam pads on the headsets, one installs pads made of electrically conductive foam like that commonly used to protect electronic components. Grounding wires are attached to the conductive foam pads, then possibly to the shielding cable which may be grounded to the backshell on the connector. The efficacy of this technique in protecting against ESD has been verified in experiments. The electrical resistance of the pads is a few megohms - about the same as that of a human body between the fingers of opposite hands and, hence, low enough for grounding. The only drawback of the technique is that care must be taken to place the foam pads in contact with the user s skin: any hair that comes between the foam pads and the skin must be pushed aside because hair is electrically insulating and thus prevents adequate grounding.

High Current ESD Test of Advanced Triple Junction Solar Array Coupon

NASA Technical Reports Server (NTRS)

Wright, Kenneth H., Jr.; Schneider, Todd A.; Vaughn, Jason A.; Hoang, Bao; Wong, Frankie

2014-01-01

Testing was conducted on an Advanced Triple Junction (ATJ) coupon that was part of a risk reduction effort in the development of a high-powered solar array design by Space Systems Loral, LLC (SSL). The ATJ coupon was a small, 4-cell, two-string configuration of flight-type design that has served as the basic test coupon design used in previous SSL environmental aging campaigns. The objective of the present test was to evaluate the performance of the coupon after being subjected to induced electrostatic discharge (ESD) testing at two string voltages (100 V, 150 V) and four string currents (1.65 A, 2.0 A, 2.475 A, and 3.3 A). An ESD test circuit, unique to SSL solar array design, was built that simulates the effect of missing cells and strings in a full solar panel with special primary arc flashover circuitry. A total of 73 primary arcs were obtained that included 7 temporary sustained arcs (TSA) events. The durations of the TSAs ranged from 50 micro-seconds to 2.75 milli-seconds. All TSAs occurred at a string voltage of 150 V. Post-ESD functional testing showed that no degradation occurred due to the TSA events. These test results point to a robust design for application to a high-current, high-power mission.

Sac surgery results as a function of preoperative distress level.

PubMed

Tyagi, Isha; Goyal, Amit; Syal, Rajan

2006-10-01

To evaluate the postoperative status of the patients after endolymphatic sac decompression (ESD) for intractable unilateral definite Ménière's disease (MD) using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1995 criteria and to discuss the current status of ESD in the management of MD, especially after the wide use of intratympanic administration of gentamicin for the treatment of intractable MD. Retrospective questionnaire-based analysis. Thirty-nine patients who had undergone ESD between 1996 and May 2003 at Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India, were evaluated via a set format according to AAO-HNS 1995 guidelines. Their preoperative and postoperative data were compared. We found significant improvement in functional level scales (FLSs) in 84.6%, Class A vertigo control in 82%, and improved disability outcome in 87% of cases after surgery at a median postoperative follow-up of 29 months. All the patients showing significant improvement in FLS were preoperatively in scale 4 or more, and all the patients whose treatment failed were in scale 3 or less. We recommend continued use of ESD in indicated patients. We found a positive relation between preoperative distress level of the patient and postoperative improvement in FLSs; any such relationship should be investigated with a larger sample.

Improving marine disease surveillance through sea temperature monitoring, outlooks and projections

PubMed Central

Maynard, Jeffrey; van Hooidonk, Ruben; Harvell, C. Drew; Eakin, C. Mark; Liu, Gang; Willis, Bette L.; Williams, Gareth J.; Dobson, Andrew; Heron, Scott F.; Glenn, Robert; Reardon, Kathleen; Shields, Jeffrey D.

2016-01-01

To forecast marine disease outbreaks as oceans warm requires new environmental surveillance tools. We describe an iterative process for developing these tools that combines research, development and deployment for suitable systems. The first step is to identify candidate host–pathogen systems. The 24 candidate systems we identified include sponges, corals, oysters, crustaceans, sea stars, fishes and sea grasses (among others). To illustrate the other steps, we present a case study of epizootic shell disease (ESD) in the American lobster. Increasing prevalence of ESD is a contributing factor to lobster fishery collapse in southern New England (SNE), raising concerns that disease prevalence will increase in the northern Gulf of Maine under climate change. The lowest maximum bottom temperature associated with ESD prevalence in SNE is 12°C. Our seasonal outlook for 2015 and long-term projections show bottom temperatures greater than or equal to 12°C may occur in this and coming years in the coastal bays of Maine. The tools presented will allow managers to target efforts to monitor the effects of ESD on fishery sustainability and will be iteratively refined. The approach and case example highlight that temperature-based surveillance tools can inform research, monitoring and management of emerging and continuing marine disease threats. PMID:26880840

Improving marine disease surveillance through sea temperature monitoring, outlooks and projections.

PubMed

Maynard, Jeffrey; van Hooidonk, Ruben; Harvell, C Drew; Eakin, C Mark; Liu, Gang; Willis, Bette L; Williams, Gareth J; Groner, Maya L; Dobson, Andrew; Heron, Scott F; Glenn, Robert; Reardon, Kathleen; Shields, Jeffrey D

2016-03-05

To forecast marine disease outbreaks as oceans warm requires new environmental surveillance tools. We describe an iterative process for developing these tools that combines research, development and deployment for suitable systems. The first step is to identify candidate host-pathogen systems. The 24 candidate systems we identified include sponges, corals, oysters, crustaceans, sea stars, fishes and sea grasses (among others). To illustrate the other steps, we present a case study of epizootic shell disease (ESD) in the American lobster. Increasing prevalence of ESD is a contributing factor to lobster fishery collapse in southern New England (SNE), raising concerns that disease prevalence will increase in the northern Gulf of Maine under climate change. The lowest maximum bottom temperature associated with ESD prevalence in SNE is 12 °C. Our seasonal outlook for 2015 and long-term projections show bottom temperatures greater than or equal to 12 °C may occur in this and coming years in the coastal bays of Maine. The tools presented will allow managers to target efforts to monitor the effects of ESD on fishery sustainability and will be iteratively refined. The approach and case example highlight that temperature-based surveillance tools can inform research, monitoring and management of emerging and continuing marine disease threats. © 2016 The Authors.

Quantitative ESD Guidelines for Charged Spacecraft Derived from the Physics of Discharges

NASA Technical Reports Server (NTRS)

Frederickson, A. R.

1992-01-01

Quantitative guidelines are proposed for Electrostatic Discharge (ESD) pulse shape on charged spacecraft. The guidelines are based on existing ground test data, and on a physical description of the pulsed discharge process. The guidelines are designed to predict pulse shape for surface charging and internal charging on a wide variety of spacecraft structures. The pulses depend on the area of the sample, its capacitance to ground, and the strength of the electric field in the vacuum adjacent to the charged surface. By knowing the pulse shape, current vs. time, one can determine if nearby circuits are threatened by the pulse. The quantitative guidelines might be used to estimate the level of threat to an existing spacecraft, or to redesign a spacecraft to reduce its pulses to a known safe level. The experiments which provide the data and the physics that allow one to interpret the data will be discussed, culminating in examples of how to predict pulse shape/size. This method has been used, but not confirmed, on several spacecraft.

Estimating pediatric entrance skin dose from digital radiography examination using DICOM metadata: A quality assurance tool

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brady, S. L., E-mail: samuel.brady@stjude.org; Kaufman, R. A., E-mail: robert.kaufman@stjude.org

Purpose: To develop an automated methodology to estimate patient examination dose in digital radiography (DR) imaging using DICOM metadata as a quality assurance (QA) tool. Methods: Patient examination and demographical information were gathered from metadata analysis of DICOM header data. The x-ray system radiation output (i.e., air KERMA) was characterized for all filter combinations used for patient examinations. Average patient thicknesses were measured for head, chest, abdomen, knees, and hands using volumetric images from CT. Backscatter factors (BSFs) were calculated from examination kVp. Patient entrance skin air KERMA (ESAK) was calculated by (1) looking up examination technique factors taken frommore » DICOM header metadata (i.e., kVp and mA s) to derive an air KERMA (k{sub air}) value based on an x-ray characteristic radiation output curve; (2) scaling k{sub air} with a BSF value; and (3) correcting k{sub air} for patient thickness. Finally, patient entrance skin dose (ESD) was calculated by multiplying a mass–energy attenuation coefficient ratio by ESAK. Patient ESD calculations were computed for common DR examinations at our institution: dual view chest, anteroposterior (AP) abdomen, lateral (LAT) skull, dual view knee, and bone age (left hand only) examinations. Results: ESD was calculated for a total of 3794 patients; mean age was 11 ± 8 yr (range: 2 months to 55 yr). The mean ESD range was 0.19–0.42 mGy for dual view chest, 0.28–1.2 mGy for AP abdomen, 0.18–0.65 mGy for LAT view skull, 0.15–0.63 mGy for dual view knee, and 0.10–0.12 mGy for bone age (left hand) examinations. Conclusions: A methodology combining DICOM header metadata and basic x-ray tube characterization curves was demonstrated. In a regulatory era where patient dose reporting has become increasingly in demand, this methodology will allow a knowledgeable user the means to establish an automatable dose reporting program for DR and perform patient dose related QA testing for digital x-ray imaging.« less

Multi-Stream Saline-Jet Dissection Using a Simple Irrigation System Defines Difficult Tissue Planes

PubMed Central

Ng, Philip CH

2010-01-01

Introduction: Single-stream hydro-jet dissection is increasingly used in various laparoscopic procedures, but its use requires special equipment. We describe a simple method for using an irrigation system for saline-jet tissue dissection as a useful adjunct prior to adhesiolysis. Material and Methods: Intraabdominal adhesions prolong laparoscopic procedures, because tissue planes are difficult to identify. We performed multi-jet saline dissection (MSSJ) between 2000 and 2009 in more than 500 patients during laparoscopy involving hernias, gallbladders, appendices, and intestinal obstructions. We use a standard suction irrigation probe, which is attached to a 1-liter saline bag with an inflatable cuff around to create a pressure of 250mm Hg to 300mm Hg. In effect, this is the standard setup generally used for irrigation. After using saline dissection, tissue planes can be better defined and the structures can then be separated. Result and Discussion: Using this method, we have successfully identified tissue planes in spite of dense adhesions, and our conversion rates to open have been reduced dramatically. This method is relatively safer than other modalities of tissue dissection, such as diathermy, ultrasonic, blunt or sharp dissection. The disadvantage is that with tissues saturated with saline it becomes more difficult to use diathermy hemostasis. Care has to be exercised in monitoring the temperature and volume of the fluid used. PMID:20529528

Electrospark Deposition for Depot- and Field-Level Component Repair and Replacement of Hard Chromium Plating

DTIC Science & Technology

2008-02-01

with an ASAP proprietary process. Corrosion applications frequently are addressed with iron- aluminide and nickel alloys such as Inconel 625 alloy...IN625) and Hastelloy C-22. Wear applications commonly treated with ESD include cutting edges of chipper knives, saw teeth, and mower blades ; wear...Applications for ESD repair include components of steel, stainless steel, nickel- and cobalt-based superalloys, aluminum, Monel, titanium , and magnesium

ESD Protective Material and Equipment: A Critical Review

DTIC Science & Technology

1982-04-01

having touched it. It is also of utmost importance that the resistivity of the work surface not change appreciably with changes in temperature , humidity...settings, e.g., temperature . No attempt was made to estimate the relative ease of heat-sealability of the bag materials, all of which use polyethylene...weapon in the battle against ESD. They function in two different ways. First, they reduce the materials’ coefficient of friction by increasing surface

Spacecraft Charging Standard Report.

DTIC Science & Technology

1980-09-30

SSPM include: SAMPLE POTENTIAL (with respect to S/C ground) Aluminized Kapton -2.0 kV Silvered Teflon -4.0 kV Astroquartz -3.7 kV 50.3 Analysis. As...and potential gradients on the space vehicle (candidate spacecraft locations for ESD tests) (The NASCAP computer code, when validated, will be useful...The coupling analysis should then determine as a minimum: I. electromagnetic fields generated interior to the space vehicle due to ESD 2. induced

Sensitivity Testing of RDX/Aluminum Powdered Explosive Mixtures for the Improved Dispersed Explosives (IDX) Project

DTIC Science & Technology

1993-04-01

perpendicular to the pipe axis. During assembly, the threads are lubricated and Teflon tape is used for sealing. Aluminum witness plates (25.4 mm thick...3.3 Electrostatic Discharge ( ESD ) ................................. 7 4. INTERMEDIATE-SCALE SENSITIVITY TESTING ..................... 8 4.1 Card Gap...tests include the DWIT, friction, and electrostatic discharge ( ESD ) tests. The purpose of these tests is to enable the researcher to ensure that the

Charging/discharge events in coated spacecraft polymers during electron beam irradiation in a scanning electron microscope

NASA Astrophysics Data System (ADS)

Czeremuszkin, G.; Latrèche, M.; Wertheimer, M. R.

2001-12-01

Spacecraft, such as those operating in geosynchronous orbit (GEO), can be subjected to intense irradiation by charged particles, for example high-energy (e.g. 20 keV) electrons. The surfaces of dielectric materials (for example, polymers used as "thermal blankets") can therefore become potential sites for damaging electrostatic discharge (ESD) pulse events. We simulate these conditions by examining small specimens of three relevant polymers (polyimide, polyester and fluoropolymer), both bare and coated, in a scanning electron microscope (SEM). The coatings examined include commercial indium-tin oxide (ITO), and thin films of SiO 2 and a-Si:H deposited by plasma-enhanced chemical vapor deposition (PECVD). All coatings are found to greatly modify the observed ESD behavior, compared with that of the bare polymer counterparts. These observations are explained in terms of the model for ESD pulses proposed by Frederickson.

Effect of Electrostatic Discharge on Electrical Characteristics of Discrete Electronic Components

NASA Technical Reports Server (NTRS)

Wysocki, Phil; Vashchenko, Vladislav; Celaya, Jose; Saha, Sankalita; Goebel, Kai

2009-01-01

This article reports on preliminary results of a study conducted to examine how temporary electrical overstress seed fault conditions in discrete power electronic components that cannot be detected with reliability tests but impact longevity of the device. These defects do not result in formal parametric failures per datasheet specifications, but result in substantial change in the electrical characteristics when compared with pristine device parameters. Tests were carried out on commercially available 600V IGBT devices using transmission line pulse (TLP) and system level ESD stress. It was hypothesized that the ESD causes local damage during the ESD discharge which may greatly accelerate degradation mechanisms and thus reduce the life of the components. This hypothesis was explored in simulation studies where different types of damage were imposed to different parts of the device. Experimental results agree qualitatively with the simulation for a number of tests which will motivate more in-depth modeling of the damage.

Chasing our tails: psychological, institutional and societal paradoxes in natural resource management, sustainability, and climate change in Australia.

PubMed

Browne, A L; Bishop, B J

2011-06-01

Natural Resource Management (NRM) and Ecologically Sustainable Development (ESD) have been guiding frameworks in Australia for a number of decades. Recently, NRM and ESD have become central to climate change mitigation. In this paper, we explore the psychological paradoxes that function within climate change settings, with particular attention devoted to the way that research and development reinforces these paradoxes by advocating for participatory forms of inquiry. Paradox emerges in NRM at psychological, institutional, and organisational levels. Paradoxes are also features of different forms of democracy such as neoliberal and participatory democracy. Although NRM, ESD and climate change are often conceptualised as distinct issue domains, these policy areas are fundamentally interconnected in both theory and in practice. This interconnection between these policy and research settings, reflections on paradox, and the experience of incorporating community psychology into the paradoxical settings of NRM and climate change are captured in this paper.

A comparison of retention of anatomical knowledge in an introductory college biology course: Traditional dissection vs. virtual dissection

NASA Astrophysics Data System (ADS)

Taeger, Kelli Rae

Dissection has always played a crucial role in biology and anatomy courses at all levels of education. However, in recent years, ethical concerns, as well as improved technology, have brought to the forefront the issue of whether virtual dissection is as effective or whether it is more effective than traditional dissection. Most prior research indicated the two methods produced equal results. However, none of those studies examined retention of information past the initial test of knowledge. Two groups of college students currently enrolled in an introductory level college biology course were given one hour to complete a frog dissection. One group performed a traditional frog dissection, making cuts in an actual preserved frog specimen with scalpels and scissors. The other group performed a virtual frog dissection, using "The Digital Frog 2" software. Immediately after the dissections were completed, each group was given an examination consisting of questions on actual specimens, pictures generated from the computer software, and illustrations that neither group had seen. Two weeks later, unannounced, the groups took the same exam in order to test retention. The traditional dissection group scored significantly higher on two of the three sections, as well as the total score on the initial exam. However, with the exception of specimen questions (on which the traditional group retained significantly more information), there was no significant difference in the retention from exam 1 to exam 2 between the two groups. These results, along with the majority of prior studies, show that the two methods produce, for the most part, the same end results. Therefore, the decision of which method to employ should be based on the goals and preferences of the instructor(s) and the department. If that department's goals include: Being at the forefront of new technology, increasing time management, increasing student: teacher ratio for economic reasons, and/or ethical issues, then the choice should be the use of computer software. If the goals include: Students gaining a 3-dimensional feel for the location and relationship of parts to one another, students being able to see various naturally occurring anomalies, and increased experience with manipulation of dissection tools, then the choice should be dissection of actual specimens. It is important to note, however, that regardless of which method is chosen, the effectiveness of that method is very much dependent on the skill and enthusiasm of the instructor.

Frozen Elephant Trunk and Antegrade Visceral Debranching in the Surgical Treatment of Type B Aortic Dissection: An Alternative Method

PubMed Central

Tuncer, Altug; Akbulut, Mustafa; Adademir, Taylan; Tas, Serpil; Ak, Adnan; Arslan, Özgür; Erden, Benay; Şişmanoğlu, Mesut

2016-01-01

Intervention is inevitable in complicated Type B aortic dissections. Classical surgical procedures and endovascular interventions are far from ideal treatments due to their high risk of periprocedural complications and mortality. There is often a need for alternative method in cases of difficult anatomy. We present the combined use of frozen elephant trunk and antegrade visceral debranching methods in the treatment of a 54-year-old male patient with complicated Type B aortic dissection. PMID:28516092

An Example of Learning about Plastics and Their Evaluation as a Contribution to Education for Sustainable Development in Secondary School Chemistry Teaching

ERIC Educational Resources Information Center

Burmeister, Mareike; Eilks, Ingo

2012-01-01

This paper describes the development and evaluation of a secondary school lesson plan for chemistry education on the topic Education for Sustainable Development (ESD). The lessons focus both on the chemistry of plastics and on learning about the societal evaluation of competing, chemistry-based industrial products. A specific teaching method was…

Impacts of ESD Reliability by Different Layout Engineering in the 0.25-μm 60-V High-Voltage LDMOS Devices

NASA Astrophysics Data System (ADS)

Chen, Shen-Li; Lin, Chun-Ju; Yu-Ting, Huang

2018-02-01

How to effectively enhance the reliability robustness in high-voltage (HV) BCD [(bipolar) complementary metal-oxide semiconductor (CMOS) diffusion metaloxide semiconductor (DMOS)] processes is an important issue. Influences of layouttype dependences on anti-electrostatic discharge (ESD) robustness in a 0.25-μm 60-V process will be studied in this chapter, which includes, in part (1), the traditional striped-type n-channel lateral-diffused MOSFET (nLDMOS), waffle-type nLDMOS, and nLDMOS embedded with a "p-n-p"-arranged silicon-controlled rectifier (SCR) devices in the drain side; and in part (2) a p-channel LDMOS (pLDMOS) with an embedded "p-n-p-n-p"-arranged-type SCR in the drain side (diffusion regions of the drain side is P+-N+-P+-N+-P+). Then, these LDMOS devices are used to evaluate the influence of layout architecture on trigger voltage (Vt1), holding voltage (Vh), and secondary breakdown current (It2). Eventually, the sketching of the layout pattern of a HV LDMOS is a very important issue in the anti-ESD consideration. Also, in part (1), the waffle-type nLDMOS DUT contributes poorly to It2 robustness due to the non-uniform turned-on phenomenon and a narrow channel width per unit finger. Therefore, the It2 robustness of a waffle-type nLDMOS device is decreased about 17% as compared to a traditional striped-type nLDMOS device (reference DUT-1). The ESD abilities of traditional stripedtype and waffle-type nLDMOS devices with an embedded SCR ("p-n-p"-manner arrangement in the drain side) are better than a traditional nLDMOS 224.4% in average. Noteworthy, the nLDMOS-SCR with the "p-n-p" -arranged-type in the drainend is a good structure for the anti-ESD reliability especially in HV usages. Furthermore, in part (2) this layout manner of P+ discrete-island distributions in the drain-side have some impacts on the anti-ESD and anti-latch-up (LU) immunities. All of their It2 values have reached above 6 A; however, the major repercussion is that the Vh value will be decreased about 66.7 73.7%.

Services for reducing duration of hospital care for acute stroke patients.

PubMed

2005-04-18

Stroke patients conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed which offer patients in hospital an early discharge with rehabilitation at home (early supported discharge (ESD)). To establish the effects and costs of ESD services compared with conventional services. We searched the Cochrane Stroke Group's trials register (last searched August 2004) and obtained further information from individual trialists. Randomised controlled trials recruiting stroke patients in hospital to receive either conventional care or any service intervention which has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care. Two reviewers scrutinised trials and categorised them on their eligibility. Standardised individual patient data was then sought from the primary trialists. Results were analysed for all trials and for subgroups of patients and services; in particular whether the intervention was provided by a co-ordinated multidisciplinary team (co-ordinated ESD team) or not. Outcome data are currently available for 11 trials (1597 patients). Patients tended to be a selected elderly group with moderate disability. The ESD group showed significant reductions (P < 0.0001) in the length of hospital stay equivalent to approximately 8 days. Overall, the odds ratios (OR) (95% confidence interval (CI)) for death, death or institutionalisation, death or dependency at the end of scheduled follow up were OR 0.90, 95% CI 0.64 to 1.27, P = 0.56, OR 0.74, 95% CI 0.56 to 0.96, P = 0.02 and OR 0.79, 95% CI 0.64 to 0.97, P = 0.02, respectively. The greatest benefits were seen in the trials evaluating a co-ordinated ESD team and in stroke patients with mild-moderate disability. Improvements were also seen in patients' extended activities of daily living scores (standardised mean difference 0.12, 95% CI 0.00 to 0.25, P = 0.05) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02) but no statistically significant differences were seen in carers' subjective health status, mood or satisfaction with services. Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long term dependency and admission to institutional care as well as reducing the length of hospital stay. No adverse impact was observed on the mood or subjective health status of patients or carers.

Digital report in an anatomy laboratory: a new method for team-based dissection, reporting, and evaluation.

PubMed

Oh, Chang-Seok; Kim, Kyong-Jee; Chung, Eilho; Choi, Hong-Joo

2015-04-01

Digital report (DR), a new method for students' dissection report, has been introduced to replace the traditional method in the anatomy laboratory. Laboratory tasks were assigned to groups of five students, and each group was asked to make a DR of their dissection tasks and upload it on the website for the anatomy course developed by the authors' institution. For creating the DR, students were instructed to take photographs of their findings with digital cameras, to mark the orientation and label the structures on the photograph. Students were assessed as a group by evaluating the DR. All the photographs of the DR were saved to construct a database that can be used by the students who will take the anatomy course in the following years. A questionnaire consisting of 14 questions was administered at the end of the anatomy course to evaluate the effectiveness of the DR. The results of the student survey showed that the DR was useful for making the students participate more actively in the teamwork for dissection, and for making dissection reports by referring to the DR made by the students from previous years. The DR was also more helpful for the anatomy teacher to assess student learning in the anatomy laboratory than conventional practical examinations and paper-based dissection reports. DR, a paperless report of team-based dissection, is concurrent with the 'digital' age and is in line with the need for a more systematic and objective evaluation of students' dissection.

ESD/MITRE Software Acquisition Symposium Proceedings; an ESD/Industry Dialogue held in Bedford, Massachusetts on May 6-7, 1986

DTIC Science & Technology

1986-05-07

Cycle? Moderator: Christine M. Anderson Dennis D. Doe Manager of Engineering Software and Artificial Intelligence Boeing Aerospace Company In... intelligence systems development pro- cess affect the life cycle? Artificial intelligence developers seem to be the last haven for people who don’t...of Engineering Software and Artificial Intelligence at the Boeing Aerospace Company. In this capacity, Mr. Doe is the focal point for software

Rapid Solidification of a New Generation Aluminum-Lithium Alloy via Electrospark Deposition

NASA Astrophysics Data System (ADS)

Heard, David W.; Boselli, Julien; Gauvin, Raynald; Brochu, Mathieu

Electrospark deposition (ESD) is a rapid solidification processing technique capable of depositing a metal onto a conductive substrate. The short pulse duration and high pulse frequency, combined with the small amount of material transferred during each pulse, results in high cooling rates being realized, on the order of 105-106 C/sec. This study investigates the ability to induce solute trapping behavior, for a new generation aluminum-lithium alloy, AA2199, using ESD.

Prenatal developmental toxicity testing of petroleum substances: Application of the mouse embryonic stem cell test (EST) to compare in vitro potencies with potencies observed in vivo.

PubMed

Kamelia, Lenny; Louisse, Jochem; de Haan, Laura; Rietjens, Ivonne M C M; Boogaard, Peter J

2017-10-01

Prenatal developmental toxicity (PDT) as observed with some petroleum substances (PS) has been associated with the presence of 3-7 ring polycyclic aromatic hydrocarbons (PAHs). In the present study, the applicability of ES-D3 cell differentiation assay of the EST to evaluate in vitro embryotoxicity potencies of PS and gas-to-liquid (GTL) products as compared to their in vivo potencies was investigated. DMSO-extracts of a range of PS, containing different amounts of PAHs, and GTL-products, which are devoid of PAHs, were tested in the ES-D3 cell proliferation and differentiation assays of the EST. The results show that PS inhibited the differentiation of ES-D3 cells into cardiomyocytes in a concentration-dependent manner at non-cytotoxic concentrations, and that their potency was proportional to their PAH content. In contrast, as expected, GTL-products did not inhibit ES-D3 cell viability or differentiation at all. The in vitro PDT potencies were compared to published in vivo PDT studies, and a good correlation was found between in vitro and in vivo results (R 2 =0.97). To conclude, our results support the hypothesis that PAHs are the primary inducers of the PDT in PS. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Arabidopsis E3 Ubiquitin Ligase HOS1 Negatively Regulates CONSTANS Abundance in the Photoperiodic Control of Flowering[W

PubMed Central

Lazaro, Ana; Valverde, Federico; Piñeiro, Manuel; Jarillo, Jose A.

2012-01-01

The Arabidopsis thaliana early in short days6 (esd6) mutant was isolated in a screen for mutations that accelerate flowering time. Among other developmental alterations, esd6 displays early flowering in both long- and short-day conditions. Fine mapping of the mutation showed that the esd6 phenotype is caused by a lesion in the HIGH EXPRESSION OF OSMOTICALLY RESPONSIVE GENES1 (HOS1) locus, which encodes a RING finger–containing E3 ubiquitin ligase. The esd6/hos1 mutation causes decreased FLOWERING LOCUS C expression and requires CONSTANS (CO) protein for its early flowering phenotype under long days. Moreover, CO and HOS1 physically interact in vitro and in planta, and HOS1 regulates CO abundance, particularly during the daylight period. Accordingly, hos1 causes a shift in the regular long-day pattern of expression of FLOWERING LOCUS T (FT) transcript, starting to rise 4 h after dawn in the mutant. In addition, HOS1 interacts synergistically with CONSTITUTIVE PHOTOMORPHOGENIC1, another regulator of CO protein stability, in the regulation of flowering time. Taken together, these results indicate that HOS1 is involved in the control of CO abundance, ensuring that CO activation of FT occurs only when the light period reaches a certain length and preventing precocious flowering in Arabidopsis. PMID:22408073

A new data format for the commissioning phase of the ATLAS detector

NASA Astrophysics Data System (ADS)

Köneke, Karsten; ATLAS Collaboration

2010-04-01

In the commissioning phase of the ATLAS experiment, low-level Event Summary Data (ESD) are analyzed to evaluate the performance of the individual subdetectors, the performance of the reconstruction and particle identification algorithms, and to obtain calibration coefficients. In the grid model of distributed analysis, these data must be transferred to Tier-1 and Tier-2 sites before they can be analyzed. However, the large size of ESD (approxeq1 MByte/event) constrains the amount of data that can be distributed on the grid and is available on disks. In order to overcome this constraint and make the data fully available, new data sets — collectively known as Derived Physics Data (DPD) — have been designed. Each DPD set contains a subset of the ESD data, tailored to specific needs of the subdetector and object reconstruction and identification performance groups. Filtering algorithms perform a selection based on physics contents and trigger response, further reducing the data volume. Thanks to these techniques, the total volume of DPD to be distributed on the grid amounts to 20% of the initial ESD data. An evolution of the tools developed in this context serves to produce another set of DPDs that are specifically tailored for physics analysis. All selection criteria and other relevant information is stored inside these DPDs as meta-data and a connection to external databases is also established.

Environmental Sciences Division annual progress report for period ending September 30, 1991

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-04-01

This progress report summarizes the research and development activities conducted in the Environmental Sciences Division of Oak Ridge National Laboratory during the period October 1, 1990, through September 30, 1991. The report is structured to provide descriptions of current activities and accomplishments in each of the division's major organizational units. Following the sections describing the organizational units is a section devoted to lists of information necessary to convey the scope of the work in the division. The Environmental Sciences Division (ESD) at Oak Ridge National Laboratory (ORNL) conducts environmental research and analyses associated with both energy technology development and themore » interactions between people and the environment. The division engages in basic and applied research for a diverse list of sponsors. While the US Department of Energy (DOE) is the primary sponsor ESD staff also perform research for other federal agencies, state agencies, and private industry. The division works collaboratively with federal agencies, universities, and private organizations in achieving its research objectives and hosts a large number of visiting investigators from these organizations. Given the diverse interdisciplinary specialization of its staff, ESD provides technical expertise on complex environmental problems and renders technical leadership for major environmental issues of national and local concern. This progress report highlights many of ESD's accomplishment in these and other areas in FY 1991.« less

Coupled Physical and Digital Cadaver Dissection Followed by a Visual Test Protocol Provides Insights into the Nature of Anatomical Knowledge and Its Evaluation

ERIC Educational Resources Information Center

Hisley, Kenneth C.; Anderson, Larry D.; Smith, Stacy E.; Kavic, Stephen M.; Tracy, J. Kathleen

2008-01-01

This research effort compared and contrasted two conceptually different methods for the exploration of human anatomy in the first-year dissection laboratory by accomplished students: "physical" dissection using an embalmed cadaver and "digital" dissection using three-dimensional volume modeling of whole-body CT and MRI image sets acquired using…

Ethical views, attitudes and reactions of Romanian medical students to the dissecting room.

PubMed

Bob, M H; Popescu, Codruţa Alina; Armean, M S; Suciu, Soimita Mihaela; Buzoianu, Anca Dana

2014-01-01

Our objective was to evaluate the attitudes and views of first year medical students towards cadaver dissection in anatomy learning and discuss various findings in relation with ethical problems). The study was conducted at the "Iuliu Hat ieganu" University of Medicine and Pharmacy, during the academic year 2012-2013 at the end of the second semester. There were 121 first year medical students included. We developed a questionnaire to asses among other, the degree of fear, anxiety and stress in the dissection room, methods of coping, ethical aspects of dissection and hand it to the students. 34.7% of students experienced different levels of fear on exposure to the dissection room practical sessions. Many students experienced anxiety in reaction to dissection. In the first semester most students reported physical and behavioral reaction towards certain stimuli, with a decrease in the second semester. Recurring visual images of cadavers, reported by 57% of students in the first semester, dropped to 44.6% in the second semester. Students used most frequently the "rationalization and emotional detachment" as a coping method. Anatomists, most often the firsts who need to be aware of emotional and ethical issues, need to explain in detail the steps necessary for dissection and that dissection is performed with the respect of legislation, ethics and human rights.

Comparison between the effects of positive noncatastrophic HMB ESD stress in n-channel and p-channel power MOSFET's

NASA Astrophysics Data System (ADS)

Zupac, Dragan; Kosier, Steven L.; Schrimpf, Ronald D.; Galloway, Kenneth F.; Baum, Keith W.

1991-10-01

The effect of noncatastrophic positive human body model (HBM) electrostatic discharge (ESD) stress on n-channel power MOSFETs is radically different from that on p-channel MOSFETs. In n-channel transistors, the stress causes negative shifts of the current-voltage characteristics indicative of positive charge trapping in the gate oxide. In p-channel transistors, the stress increases the drain-to-source leakage current, probably due to localized avalanche electron injection from the p-doped drain.

Report on Medical Activities for the Automated AFEES Program

DTIC Science & Technology

1976-03-10

Systems Division, DRI, Hanscom AFB, MA 01731. esd, usaf ltr, 8 oct 1976 ’ OS o> OS © © >- CD UJ ESD-TR-76-I35 v/ REPORT ON MEDICAL ...StCUWITY CUAStlFICATION OF THIS PAGt(Whm, DM* Bmlmtt) chMging Mdioftl, mental and adainlatrativ« prooAdurea^Th« medical Intent of the above...direction ia farther amplified in Program Meririnndum dated 18 Oet 74, vhlch required a medical data base, printing of 8F 88 andW 95, and operational

Identification of type IV collagen exposure as a molecular imaging target for early detection of thoracic aortic dissection

PubMed Central

Xu, Ke; Xu, Chen; Zhang, Yanzhenzi; Qi, Feiran; Yu, Bingran; Li, Ping; Jia, Lixin; Li, Yulin; Xu, Fu-jian; Du, Jie

2018-01-01

Thoracic aortic dissection (TAD) is an aggressive and life-threatening vascular disease and there is no effective means of early diagnosis of dissection. Type IV collagen (Col-IV) is a major component of the sub-endothelial basement membrane, which is initially exposed followed by endothelial injury as early-stage event of TAD. So, we want to build a noninvasive diagnostic method to detect early dissection by identifying the exposed Col-IV via MRI. Methods: Col-IV-targeted magnetic resonance/ fluorescence dual probe (Col-IV-DOTA-Gd-rhodamine B; CDR) was synthesized by amide reaction and coordination reaction. Flow cytometry analysis was used to evaluate the cell viability of SMC treated with CDR and fluorescence assays were used to assess the Col-IV targeting ability of CDR in vitro. We then examined the sensitivity and specificity of CDR at different stages of TAD via MRI and bioluminescence imaging in vivo. Results: The localization of Col-IV (under the intima) was observed by histology images. CDR bound specifically to Col-IV-expressing vascular smooth muscle cells and BAPN-induced dissected aorta. The CDR signal was co-detected by magnetic resonance imaging (MRI) and bioluminescence imaging as early as 2 weeks after BAPN administration (pre-dissection stage). The ability to detect rupture of dissected aorta was indicated by a strong normalized signal enhancement (NSE) in vivo. Moreover, NSE was negatively correlated with the time of dissection rupture after BAPN administration (r2 = 0.8482). Conclusion: As confirmed by in vivo studies, the CDR can identify the exposed Col-IV in degenerated aorta to monitor the progress of aortic dissection from the early stage to the rupture via MRI. Thus, CDR-enhanced MRI proposes a potential method for dissection screening, and for monitoring disease progression and therapeutic response. PMID:29290819

Rapid and sensitive detection of early esophageal squamous cell carcinoma with fluorescence probe targeting dipeptidylpeptidase IV

PubMed Central

Onoyama, Haruna; Kamiya, Mako; Kuriki, Yugo; Komatsu, Toru; Abe, Hiroyuki; Tsuji, Yosuke; Yagi, Koichi; Yamagata, Yukinori; Aikou, Susumu; Nishida, Masato; Mori, Kazuhiko; Yamashita, Hiroharu; Fujishiro, Mitsuhiro; Nomura, Sachiyo; Shimizu, Nobuyuki; Fukayama, Masashi; Koike, Kazuhiko; Urano, Yasuteru; Seto, Yasuyuki

2016-01-01

Early detection of esophageal squamous cell carcinoma (ESCC) is an important prognosticator, but is difficult to achieve by conventional endoscopy. Conventional lugol chromoendoscopy and equipment-based image-enhanced endoscopy, such as narrow-band imaging (NBI), have various practical limitations. Since fluorescence-based visualization is considered a promising approach, we aimed to develop an activatable fluorescence probe to visualize ESCCs. First, based on the fact that various aminopeptidase activities are elevated in cancer, we screened freshly resected specimens from patients with a series of aminopeptidase-activatable fluorescence probes. The results indicated that dipeptidylpeptidase IV (DPP-IV) is specifically activated in ESCCs, and would be a suitable molecular target for detection of esophageal cancer. Therefore, we designed, synthesized and characterized a series of DPP-IV-activatable fluorescence probes. When the selected probe was topically sprayed onto endoscopic submucosal dissection (ESD) or surgical specimens, tumors were visualized within 5 min, and when the probe was sprayed on biopsy samples, the sensitivity, specificity and accuracy reached 96.9%, 85.7% and 90.5%. We believe that DPP-IV-targeted activatable fluorescence probes are practically translatable as convenient tools for clinical application to enable rapid and accurate diagnosis of early esophageal cancer during endoscopic or surgical procedures. PMID:27245876

Design Specifications for Adaptive Real-Time Systems

DTIC Science & Technology

1991-12-01

TICfl \\ E CT E Design Specifications for JAN’\\ 1992 Adaptive Real - Time Systems fl Randall W. Lichota U, Alice H. Muntz - December 1991 \\ \\\\/ 0 / r...268-2056 Technical Report CMU/SEI-91-TR-20 ESD-91-TR-20 December 1991 Design Specifications for Adaptive Real - Time Systems Randall W. Lichota Hughes...Design Specifications for Adaptive Real - Time Systems Abstract: The design specification method described in this report treats a software

Introducing Education for Sustainable Development in the Undergraduate Laboratory: Quantitative Analysis of Bioethanol Fuel and Its Blends with Gasoline by Using Solvatochromic Dyes

ERIC Educational Resources Information Center

Galgano, Paula D.; Loffredo, Carina; Sato, Bruno M.; Reichardt, Christian; El Seoud, Omar A.

2012-01-01

The concept of "Education for Sustainable Development", ESD, has been introduced in a period where chemistry education is undergoing a major change, both in emphasis and methods of teaching. Studying an everyday problem, with an important socio-economic impact in the laboratory is a part of this approach. Presently, the students in many…

Impact of target-to-background ratio, target size, emission scan duration, and activity on physical figures of merit for a 3D LSO-based whole body PET/CT scanner.

PubMed

Brambilla, M; Matheoud, R; Secco, C; Sacchetti, G; Comi, S; Rudoni, M; Carriero, A; Inglese, E

2007-10-01

The aim of our work is to describe the way in which physical figures of merit such as contrast-to-noise ratio (CNR) behave when varying acquisition parameters such as emission scan duration (ESD) or activity at the start of acquisition (A(acq)) that in clinical practice can be selected by the user, or object properties such as target dimensions or target-to-background (T/B) ratio, which depend uniquely on the intrinsic characteristics of the object being imaged. Figures of merit, used to characterize image quality and quantitative accuracy for a 3D-LSO based PET/CT scanner, were studied as a function of ESD and A(acq) for different target sizes and T/B ratios using a multivariate approach in a wide range of conditions approaching the ones that can be encountered in clinical practice. An annular ring of water bags of 3 cm thickness was fitted over an IEC phantom in order to obtain counting rates similar to those found in average patients. The average scatter fraction (SF) of the modified IEC phantom was similar to the mean SF measured on patients with a similar scanner. A supplemental set of micro-hollow spheres was positioned inside the phantom. The NEMA NU 2-2001 scatter phantom was positioned at the end of the IEC phantom to approximate the clinical situation of having activity that extends beyond the scanner. The phantoms were filled with a solution of water and 18F (12 kBq/mL) and the spheres with various T/B ratios of 22.5, 10.3, and 3.6. Sequential imaging was performed to acquire PET images with varying background activity concentrations of about 12, 9, 6.4, 5.3, and 3.1 kBq/mL, positioned on the linear portion of the phantom's NECR curve, well below peak NECR of 61.2 kcps that is reached at 31.8 kBq/mL. The ESD was set to 1, 2, 3, and 4 min/bed. With T/B ratios of 3.6, 10.3, and 22.5, the 13.0, 8.1, and 6.5 mm spheres were detectable for the whole ranges of background activity concentration and ESD, respectively. The ESD resulted as the most significant predictor of CNR variance, followed by T/B ratio and the cross sectional area of the given sphere. Only last comes A(acq) with a weight more than halved with respect to ESD. Thus, raising ESD seems to be much more effective than raising A(acq) in order to obtain higher CNR, which is the physical figure of merit closely related with target detectability, at least in the simple task of the signal known exactly background known exactly model.

Entanglement dynamics of two independent Jaynes-Cummings atoms without the rotating-wave approximation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen Qinghu; Department of Physics, Zhejiang University, Hangzhou 310027; Yang Yuan

2010-11-15

Entanglement evolution of two independent Jaynes-Cummings atoms without the rotating-wave approximation (RWA) is studied by a numerically exact approach. Previous results based on the RWA are essentially modified in the strong-coupling regime (g{>=}0.1), which has been reached in the recent experiments on the flux qubit coupled to the LC resonator. For the initial Bell state with anticorrelated spins, entanglement sudden death (ESD) is absent in the RWA but does appear in the present numerical calculation without the RWA. Aperiodic entanglement evolution in the strong-coupling regime is observed. The strong atom-cavity coupling facilitates the ESD. The sign of the detuning playsmore » an essential role in the entanglement evolution for strong coupling, which is irrelevant in the RWA. Analytical results based on an unitary transformation are also given, which could not modify the RWA picture essentially. It is suggested that the activation of the photons may be the origin of ESD in this system.« less

Nesting fidelity and molecular evidence for natal homing in the freshwater turtle, Graptemys kohnii

PubMed Central

Freedberg, Steven; Ewert, Michael A; Ridenhour, Benjamin J; Neiman, Maurine; Nelson, Craig E

2005-01-01

Numerous studies of sea turtle nesting ecology have revealed that females exhibit natal homing, whereby they imprint on the nesting area from which they hatch and subsequently return there to nest as adults. Because freshwater turtles comprise the majority of reptiles known to display environmental sex determination (ESD), the study of natal homing in this group may shed light on recent evolutionary models of sex allocation that are predicated on natal homing in reptiles with ESD. We examined natal homing in Graptemys kohnii, a freshwater turtle with ESD, using mitochondrial sequencing, microsatellite genotyping and mark and recapture of 290 nesting females. Females showed high fidelity to nesting areas, even after being transplanted several kilometres away. A Mantel test revealed significant genetic isolation by distance with respect to nesting locations (r=0.147; p<0.05), suggesting that related females nest in close proximity to one another. The patterns of fidelity and genotype distributions are consistent with homing at a scale that may affect population sex ratios. PMID:16006324

Effects of Support Groups for Individuals with Early-Stage Dementia and Mild Cognitive Impairment: An Integrative Review.

PubMed

Jao, Ying-Ling; Epps, Fayron; McDermott, Caroline; Rose, Karen M; Specht, Janet K

2017-01-01

Support groups have demonstrated promising outcomes for individuals with mild cognitive impairment (MCI) and early-stage dementia (ESD) in previous literature reviews. However, evidence has not been updated since 2007. The current review aimed to update current evidence on the use and effects of support groups for individuals with MCI and ESD and their care partners. A literature search was conducted in seven databases and 18 eligible research articles were retrieved. Support groups showed positive impacts on participant acceptance of cognitive impairment; performance and satisfaction of meaningful activity; resilience; self-help; and care partner coping self-efficacy, perceived support, and preparation and task effectiveness. Findings also revealed that support groups were well accepted by participants and care partners. Few studies included ethnic diversity, limiting the generalizability of findings. Further large-scale studies are needed to confirm the effects of support groups for individuals with MCI and ESD in all populations. [Res Gerontol Nurs. 2017; 10(1):35-51.]. Copyright 2016, SLACK Incorporated.

Entrance surface dose in cerebral interventional radiology procedures

NASA Astrophysics Data System (ADS)

Barrera-Rico, M.; López-Rendón, X.; Rivera-Ordóñez, C. E.; Gamboa-deBuen, I.

2012-10-01

At the Instituto Nacional de Neurología y Neurocirugía (INNN) diagnostic as well as therapeutic procedures of interventional radiology are carried out. Since the procedures can last from some minutes to several hours, the absorbed dose for the patient could increase dangerously. An investigation had begun in order to determine the entrance surface dose (ESD) using 25 thermoluminiscent dosimeters TLD-100 and 8 strips of 15 ×1 cm2 of Gafchromic XR-QA2 film bound in a holder of 15×15 cm2 in the posteroanterior (PA) and lateral (LAT) positions during all the procedure. The results show that maximum ESD could be from 0.9 to 2.9 Gy for the PA position and between 1.6 and 2.5 Gy for the lateral position. The average ESD was between 0.7 and 1.3 Gy for the PA position, and from 0.44 to 1.1 Gy for the lateral position in a therapeutic procedure.

NASA Earth Science Partnerships - A Multi-Level Approach to Effectively Collaborating with Communities and Organizations to Utilize Earth Science Data for Societal Benefit

NASA Astrophysics Data System (ADS)

Favors, J.

2016-12-01

NASA's Earth Science Division (ESD) seeks to develop a scientific understanding of the Earth as a dynamic, integrated system of diverse components that interact in complex ways - analogous to the human body. The Division approaches this goal through a coordinated series of satellite and airborne missions, sponsored basic and applied research, technology development, and science education. Integral to this approach are strong collaborations and partnerships with a spectrum of organizations that produce substantive benefit to communities - both locally and globally. This presentation will showcase various ways ESD approaches partnering and will highlight best practices, challenges, and provide case studies related to rapid partnerships, co-location of scientists and end-user communities, capacity building, and ESD's new Partnerships Program which is built around taking an innovative approach to partnering that fosters interdisplinary teaming & co-production of knowledge to broaden the applicability of Earth observations and answer new, big questions for partners and NASA, alike.

Microporous Ti implant compact coated with hydroxyapatite produced by electro-discharge-sintering and electrostatic-spray-deposition.

PubMed

Jo, Y J; Kim, Y H; Jo, Y H; Seong, J G; Chang, S Y; Van Tyne, C J; Lee, W H

2014-11-01

A single pulse of 1.5 kJ/0.7 g of atomized spherical Ti powder from 300 μF capacitor was applied to produce the porous-surfaced Ti implant compact by electro-discharge-sintering (EDS). A solid core surrounded by porous layer was self-consolidated by a discharge in the middle of the compact in 122 μsec. Average pore size, porosity, and compressive yield strength of EDS Ti compact were estimated to be about 68.2 μm, 25.5%, and 266.4 MPa, respectively. Coatings with hydroxyapatite (HAp) on the Ti compact were conducted by electrostatic-spray-deposition (ESD) method. As-deposited HAp coating was in the form of porous structure and consisted of HAp particles which were uniformly distributed on the Ti porous structure. By heat-treatment at 700 degrees C, HAp particles were agglomerated each other and melted to form a highly smooth and homogeneous HAp thin film consisted of equiaxed nano-scaled grains. Porous-surfaced Ti implant compacts coated with highly crystalline apatite phase were successfully obtained by using the EDS and ESD techniques.

Dissecting genome-wide association signals for loss-of-function phenotypes in sorghum flavonoid pigmentation traits

USDA-ARS?s Scientific Manuscript database

Genome-wide association studies (GWAS) are a powerful method to dissect the genetic basis of traits, though in practice the effects of complex genetic architecture and population structure remain poorly understood. To compare mapping strategies we dissect the genetic control of flavonoid pigmentatio...

Efficient Performance of Electrostatic Spray-Deposited TiO2 Blocking Layers in Dye-Sensitized Solar Cells after Swift Heavy Ion Beam Irradiation.

PubMed

Sudhagar, P; Asokan, K; Jung, June Hyuk; Lee, Yong-Gun; Park, Suil; Kang, Yong Soo

2011-12-01

A compact TiO2 layer (~1.1 μm) prepared by electrostatic spray deposition (ESD) and swift heavy ion beam (SHI) irradiation using oxygen ions onto a fluorinated tin oxide (FTO) conducting substrate showed enhancement of photovoltaic performance in dye-sensitized solar cells (DSSCs). The short circuit current density (Jsc = 12.2 mA cm(-2)) of DSSCs was found to increase significantly when an ESD technique was applied for fabrication of the TiO2 blocking layer, compared to a conventional spin-coated layer (Jsc = 8.9 mA cm(-2)). When SHI irradiation of oxygen ions of fluence 1 × 10(13) ions/cm(2) was carried out on the ESD TiO2, it was found that the energy conversion efficiency improved mainly due to the increase in open circuit voltage of DSSCs. This increased energy conversion efficiency seems to be associated with improved electronic energy transfer by increasing the densification of the blocking layer and improving the adhesion between the blocking layer and the FTO substrate. The adhesion results from instantaneous local melting of the TiO2 particles. An increase in the electron transport from the blocking layer may also retard the electron recombination process due to the oxidized species present in the electrolyte. These findings from novel treatments using ESD and SHI irradiation techniques may provide a new tool to improve the photovoltaic performance of DSSCs.

Efficient Performance of Electrostatic Spray-Deposited TiO2 Blocking Layers in Dye-Sensitized Solar Cells after Swift Heavy Ion Beam Irradiation

PubMed Central

2011-01-01

A compact TiO2 layer (~1.1 μm) prepared by electrostatic spray deposition (ESD) and swift heavy ion beam (SHI) irradiation using oxygen ions onto a fluorinated tin oxide (FTO) conducting substrate showed enhancement of photovoltaic performance in dye-sensitized solar cells (DSSCs). The short circuit current density (Jsc = 12.2 mA cm-2) of DSSCs was found to increase significantly when an ESD technique was applied for fabrication of the TiO2 blocking layer, compared to a conventional spin-coated layer (Jsc = 8.9 mA cm-2). When SHI irradiation of oxygen ions of fluence 1 × 1013 ions/cm2 was carried out on the ESD TiO2, it was found that the energy conversion efficiency improved mainly due to the increase in open circuit voltage of DSSCs. This increased energy conversion efficiency seems to be associated with improved electronic energy transfer by increasing the densification of the blocking layer and improving the adhesion between the blocking layer and the FTO substrate. The adhesion results from instantaneous local melting of the TiO2 particles. An increase in the electron transport from the blocking layer may also retard the electron recombination process due to the oxidized species present in the electrolyte. These findings from novel treatments using ESD and SHI irradiation techniques may provide a new tool to improve the photovoltaic performance of DSSCs. PMID:27502653

Building a cloud based distributed active archive data center

NASA Astrophysics Data System (ADS)

Ramachandran, Rahul; Baynes, Katie; Murphy, Kevin

2017-04-01

NASA's Earth Science Data System (ESDS) Program serves as a central cog in facilitating the implementation of NASA's Earth Science strategic plan. Since 1994, the ESDS Program has committed to the full and open sharing of Earth science data obtained from NASA instruments to all users. One of the key responsibilities of the ESDS Program is to continuously evolve the entire data and information system to maximize returns on the collected NASA data. An independent review was conducted in 2015 to holistically review the EOSDIS in order to identify gaps. The review recommendations were to investigate two areas: one, whether commercial cloud providers offer potential for storage, processing, and operational efficiencies, and two, the potential development of new data access and analysis paradigms. In response, ESDS has initiated several prototypes investigating the advantages and risks of leveraging cloud computing. This poster will provide an overview of one such prototyping activity, "Cumulus". Cumulus is being designed and developed as a "native" cloud-based data ingest, archive and management system that can be used for all future NASA Earth science data streams. The long term vision for Cumulus, its requirements, overall architecture, and implementation details, as well as lessons learned from the completion of the first phase of this prototype will be covered. We envision Cumulus will foster design of new analysis/visualization tools to leverage collocated data from all of the distributed DAACs as well as elastic cloud computing resources to open new research opportunities.

Towards in vivo TLD dosimetry in mammography.

PubMed

Warren-Forward, H M; Duggan, L

2004-05-01

While phantoms are used for quality control assessment of the mammography unit, in vivo dose measurements are necessary to account for the variation in size and composition of the female breast. The use of thermoluminescent dosimeters (TLDs) in mammography has been limited due to TLD visibility. The aim of this current investigation was to access the suitability of a paper-thin LiF:Mg,Cu,P TLD (GR-200F) for in vivo dosimetric mammography measurements. The visibility of GR-200F has been directly compared with LiF:Mg,Cu,P TLDs (GR-200A) using a number of commercially available phantoms. The phantoms of thickness 2-5 cm were imaged over the range of tube potentials (24-28 kVp) used clinically. Both types of TLD were placed on the surface of the phantoms allowing assessment of visibility, entrance surface dose (ESD) and field homogeneity. In vivo assessment of ESD and visibility was also carried out on a volunteer undergoing a routine mammography examination. The positions of the GR-200F TLDs were not identified either on the image of the Leeds TOR(MAM) phantom or the patient mammograms. The average ESD for the Leeds phantom was 8.8 mGy, while the patient ESD was 13 mGy. It is now possible to perform in vivo measurements with the potential of increasing the accuracy of the doses measured for women that do not conform to a standard breast thickness or density.

What was the ancestral sex-determining mechanism in amniote vertebrates?

PubMed

Johnson Pokorná, Martina; Kratochvíl, Lukáš

2016-02-01

Amniote vertebrates, the group consisting of mammals and reptiles including birds, possess various mechanisms of sex determination. Under environmental sex determination (ESD), the sex of individuals depends on the environmental conditions occurring during their development and therefore there are no sexual differences present in their genotypes. Alternatively, through the mode of genotypic sex determination (GSD), sex is determined by a sex-specific genotype, i.e. by the combination of sex chromosomes at various stages of differentiation at conception. As well as influencing sex determination, sex-specific parts of genomes may, and often do, develop specific reproductive or ecological roles in their bearers. Accordingly, an individual with a mismatch between phenotypic (gonadal) and genotypic sex, for example an individual sex-reversed by environmental effects, should have a lower fitness due to the lack of specialized, sex-specific parts of their genome. In this case, evolutionary transitions from GSD to ESD should be less likely than transitions in the opposite direction. This prediction contrasts with the view that GSD was the ancestral sex-determining mechanism for amniote vertebrates. Ancestral GSD would require several transitions from GSD to ESD associated with an independent dedifferentiation of sex chromosomes, at least in the ancestors of crocodiles, turtles, and lepidosaurs (tuataras and squamate reptiles). In this review, we argue that the alternative theory postulating ESD as ancestral in amniotes is more parsimonious and is largely concordant with the theoretical expectations and current knowledge of the phylogenetic distribution and homology of sex-determining mechanisms. © 2014 Cambridge Philosophical Society.

Crystal structure of human esterase D: a potential genetic marker of retinoblastoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Dong; Li, Yang; Song, Gaojie

2009-07-10

Retinoblastoma (RB), a carcinoma of the retina, is caused by mutations in the long arm of chromosome 13, band 13q14. The esterase D (ESD) gene maps at a similar location as the RB gene locus and therefore serves as a potential marker for the prognosis of retinoblastoma. Because very little is known about the structure and function of ESD, we determined the 3-dimensional structure of the enzyme at 1.5 {angstrom} resolution using X-ray crystallography. ESD shows a single domain with an {alpha}/{beta}-hydrolase fold. A number of insertions are observed in the canonical {alpha}/{beta}-hydrolase fold. The active site is located inmore » a positively charged, shallow cleft on the surface lined by a number of aromatic residues. Superimposition studies helped identify the typical catalytic triad residues -- Ser-153, His264, and Asp230 -- involved in catalysis. Mutagenesis of any of the catalytic triad residues to alanine abolished the enzyme activity. Backbone amides of Leu54 and Met150 are involved in the formation of the oxyanion hole. Interestingly, a M150A mutation increased the enzyme activity by 62%. The structure of human ESD determined in this study will aid the elucidation of the physiological role of the enzyme in the human body and will assist in the early diagnosis of retinoblastoma. Wu, D., Li, Y., Song, G., Zhang, D., Shaw, N., Liu, Z. J. Crystal structure of human esterase D: a potential genetic marker of retinoblastoma.« less

Steering operational synergies in terrestrial observation networks: opportunity for advancing Earth system dynamics modelling

NASA Astrophysics Data System (ADS)

Baatz, Roland; Sullivan, Pamela L.; Li, Li; Weintraub, Samantha R.; Loescher, Henry W.; Mirtl, Michael; Groffman, Peter M.; Wall, Diana H.; Young, Michael; White, Tim; Wen, Hang; Zacharias, Steffen; Kühn, Ingolf; Tang, Jianwu; Gaillardet, Jérôme; Braud, Isabelle; Flores, Alejandro N.; Kumar, Praveen; Lin, Henry; Ghezzehei, Teamrat; Jones, Julia; Gholz, Henry L.; Vereecken, Harry; Van Looy, Kris

2018-05-01

Advancing our understanding of Earth system dynamics (ESD) depends on the development of models and other analytical tools that apply physical, biological, and chemical data. This ambition to increase understanding and develop models of ESD based on site observations was the stimulus for creating the networks of Long-Term Ecological Research (LTER), Critical Zone Observatories (CZOs), and others. We organized a survey, the results of which identified pressing gaps in data availability from these networks, in particular for the future development and evaluation of models that represent ESD processes, and provide insights for improvement in both data collection and model integration. From this survey overview of data applications in the context of LTER and CZO research, we identified three challenges: (1) widen application of terrestrial observation network data in Earth system modelling, (2) develop integrated Earth system models that incorporate process representation and data of multiple disciplines, and (3) identify complementarity in measured variables and spatial extent, and promoting synergies in the existing observational networks. These challenges lead to perspectives and recommendations for an improved dialogue between the observation networks and the ESD modelling community, including co-location of sites in the existing networks and further formalizing these recommendations among these communities. Developing these synergies will enable cross-site and cross-network comparison and synthesis studies, which will help produce insights around organizing principles, classifications, and general rules of coupling processes with environmental conditions.

Removal of large hydatid cysts with balloon-assisted modification of Dowling's method: technical report.

PubMed

Ulutas, Murat; Cinar, Kadir; Secer, Mehmet

2015-07-01

Delivery of hydatid cysts, especially large ones, without rupture is very important and there is still no 100% successful method. After the hydatid cyst was reached, starting near the surface working around the cyst toward the base, a Foley probe was advanced and, in the region of desired dissection, the balloon of the Foley probe was inflated, and adhesion bands were freed to allow dissection. We believe our balloon-aided dissection technique is a method that increases the chances of delivering hydatid cysts, with no calcification and secondary infection, without rupture.

A Laboratory Manual for Stepwise Cerebral White Matter Fiber Dissection.

PubMed

Koutsarnakis, Christos; Liakos, Faidon; Kalyvas, Aristotelis V; Sakas, Damianos E; Stranjalis, George

2015-08-01

White matter fiber dissection is an important method in acquiring a thorough neuroanatomic knowledge for surgical practice. Previous studies have definitely improved our understanding of intrinsic brain anatomy and emphasized on the significance of this technique in modern neurosurgery. However, current literature lacks a complete and concentrated laboratory guide about the entire dissection procedure. Hence, our primary objective is to introduce a detailed laboratory manual for cerebral white matter dissection by highlighting consecutive dissection steps, and to stress important technical comments facilitating this complex procedure. Twenty adult, formalin-fixed cerebral hemispheres were included in the study. Ten specimens were dissected in the lateromedial and 10 in the mediolateral direction, respectively, using the fiber dissection technique and the microscope. Eleven and 8 consecutive and distinctive dissection steps are recommended for the lateromedial and mediolateral dissection procedures, respectively. Photographs highlighting various anatomic landmarks accompany every step. Technical recommendations, facilitating the dissection process, are also indicated. The fiber dissection technique, although complex and time consuming, offers a three-dimensional knowledge of intrinsic brain anatomy and architecture, thus improving both the quality of microneurosurgery and the patient's standard of care. The present anatomic study provides a thorough dissection manual to those who study brain anatomy using this technique. Copyright © 2015 Elsevier Inc. All rights reserved.

A Modified Dissection Method to Preserve Neck Structures

ERIC Educational Resources Information Center

Hankin, Mark H.; Stoller, Jeremy L.

2009-01-01

The neck is not only one of the more challenging anatomical regions to dissect but also has important application to clinical conditions, diseases, and procedures. In this study, we describe two simple modifications for dissection of the neck that (1) aid in the identification and preservation of the cutaneous branches of the cervical plexus and…

Sandia National Laboratories Small-Scale Sensitivity Testing (SSST) Report: Calcium Nitrate Mixtures with Various Fuels.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Phillips, Jason Joe

Based upon the presented sensitivity data for the examined calcium nitrate mixtures using sugar and sawdust, contact handling/mixing of these materials does not present hazards greater than those occurring during handling of dry PETN powder. The aluminized calcium nitrate mixtures present a known ESD fire hazard due to the fine aluminum powder fuel. These mixtures may yet present an ESD explosion hazard, though this has not been investigated at this time. The detonability of these mixtures will be investigated during Phase III testing.

Building A Cloud Based Distributed Active Data Archive Center

NASA Technical Reports Server (NTRS)

Ramachandran, Rahul; Baynes, Katie; Murphy, Kevin

2017-01-01

NASA's Earth Science Data System (ESDS) Program facilitates the implementation of NASA's Earth Science strategic plan, which is committed to the full and open sharing of Earth science data obtained from NASA instruments to all users. The Earth Science Data information System (ESDIS) project manages the Earth Observing System Data and Information System (EOSDIS). Data within EOSDIS are held at Distributed Active Archive Centers (DAACs). One of the key responsibilities of the ESDS Program is to continuously evolve the entire data and information system to maximize returns on the collected NASA data.

Common approach to solving SGEMP, DEMP, and ESD survivability

NASA Technical Reports Server (NTRS)

Ling, D.

1977-01-01

System Generated Electromagnetic Pulse (SGEMP) and Dispersed Electromagnetic Pulse DEMP) are nuclear generated spacecraft environments. Electrostatic discharge (ESD) is a natural spacecraft environment resulting from differential charging in magnetic substorms. All three phenomena, though differing in origin, result in the same problem to the spacecraft and that is Electromagnetic Interference (EMI). A common design approach utilizing a spacecraft structural Faraday Cage is presented which helps solve the EMI problem. Also, other system design techniques are discussed which minimize the magnitude of these environments through control of materials and electrical grounding configuration.

Safety and performance enhancement circuit for primary explosive detonators

DOEpatents

Davis, Ronald W [Tracy, CA

2006-04-04

A safety and performance enhancement arrangement for primary explosive detonators. This arrangement involves a circuit containing an energy storage capacitor and preset self-trigger to protect the primary explosive detonator from electrostatic discharge (ESD). The circuit does not discharge into the detonator until a sufficient level of charge is acquired on the capacitor. The circuit parameters are designed so that normal ESD environments cannot charge the protection circuit to a level to achieve discharge. When functioned, the performance of the detonator is also improved because of the close coupling of the stored energy.

Prevalence of Post-tonsillectomy Bleeding as Day-case Surgery with Combination Method; Cold Dissection Tonsillectomy and Bipolar Diathermy Hemostasis

PubMed Central

Faramarzi, Abolahassan; Heydari, Seyed Taghi

2010-01-01

Objective Post-tonsillectomy hemorrhage remains an important factor in determining the safety of performing tonsillectomy as a day case procedure. The aim of this study was to determine the safety of day case tonsillectomy by using combination method, cold dissection tonsillectomy and bipolar diathermy hemostasis. Methods A prospective randomized clinical study conducted on the patients who had undergone day case tonsillectomy (DCT). There were two groups (DCT and control group) each group consisting of 150 cases. Tonsillectomy was performed by using combination method; cold dissection and hemostasis was achieved by ligation of vessels with bipolar electerocautery. Findings We found 3 cases of post-tonsillectomy bleeding in DCT group and 4 cases in the control group. There was no statistically significant difference in the rate of post-operative hemorrhage between the two groups. Conclusion The findings suggest the safety of the combination of cold dissection tonsillectomy and bipolar diathermy hemostasis as day case tonsillectomy. PMID:23056702

The NASA Earth Science Program and Small Satellites

NASA Technical Reports Server (NTRS)

Neeck, Steven P.

2015-01-01

Earth's changing environment impacts every aspect of life on our planet and climate change has profound implications on society. Studying Earth as a single complex system is essential to understanding the causes and consequences of climate change and other global environmental concerns. NASA's Earth Science Division (ESD) shapes an interdisciplinary view of Earth, exploring interactions among the atmosphere, oceans, ice sheets, land surface interior, and life itself. This enables scientists to measure global and climate changes and to inform decisions by Government, other organizations, and people in the United States and around the world. The data collected and results generated are accessible to other agencies and organizations to improve the products and services they provide, including air quality indices, disaster prediction and response, agricultural yield projections, and aviation safety. ESD's Flight Program provides the spacebased observing systems and supporting infrastructure for mission operations and scientific data processing and distribution that support NASA's Earth science research and modeling activities. The Flight Program currently has 21 operating Earth observing space missions, including the recently launched Global Precipitation Measurement (GPM) mission, the Orbiting Carbon Observatory-2 (OCO-2), the Soil Moisture Active Passive (SMAP) mission, and the International Space Station (ISS) RapidSCAT and Cloud-Aerosol Transport System (CATS) instruments. The ESD has 22 more missions and instruments planned for launch over the next decade. These include first and second tier missions from the 2007 Earth Science Decadal Survey, Climate Continuity missions to assure availability of key climate data sets, and small-sized competitively selected orbital missions and instrument missions of opportunity belonging to the Earth Venture (EV) Program. Small satellites (500 kg or less) are critical contributors to these current and future satellite missions. Some examples are the aforementioned Orbiting Carbon Observatory-2 (OCO-2), the Gravity Recovery and Climate Experiment Follow On (GRACE FO), and the Cyclone Global Navigation Satellite System (CYGNSS) microsatellite constellation. Small satellites also support ESD in space validation and risk reduction of enabling technologies (components and systems). The status of the ESD Flight Program and the role of small satellites will be discussed.

Combining virtual observatory and equivalent source dipole approaches to describe the geomagnetic field with Swarm measurements

NASA Astrophysics Data System (ADS)

Saturnino, Diana; Langlais, Benoit; Amit, Hagay; Civet, François; Mandea, Mioara; Beucler, Éric

2018-03-01

A detailed description of the main geomagnetic field and of its temporal variations (i.e., the secular variation or SV) is crucial to understanding the geodynamo. Although the SV is known with high accuracy at ground magnetic observatory locations, the globally uneven distribution of the observatories hampers the determination of a detailed global pattern of the SV. Over the past two decades, satellites have provided global surveys of the geomagnetic field which have been used to derive global spherical harmonic (SH) models through some strict data selection schemes to minimise external field contributions. However, discrepancies remain between ground measurements and field predictions by these models; indeed the global models do not reproduce small spatial scales of the field temporal variations. To overcome this problem we propose to directly extract time series of the field and its temporal variation from satellite measurements as it is done at observatory locations. We follow a Virtual Observatory (VO) approach and define a global mesh of VOs at satellite altitude. For each VO and each given time interval we apply an Equivalent Source Dipole (ESD) technique to reduce all measurements to a unique location. Synthetic data are first used to validate the new VO-ESD approach. Then, we apply our scheme to data from the first two years of the Swarm mission. For the first time, a 2.5° resolution global mesh of VO time series is built. The VO-ESD derived time series are locally compared to ground observations as well as to satellite-based model predictions. Our approach is able to describe detailed temporal variations of the field at local scales. The VO-ESD time series are then used to derive global spherical harmonic models. For a simple SH parametrization the model describes well the secular trend of the magnetic field both at satellite altitude and at the surface. As more data will be made available, longer VO-ESD time series can be derived and consequently used to study sharp temporal variation features, such as geomagnetic jerks.

Education for sustainable development at the university level: Interactions of the need for community, fear of indoctrination, and the demands of work

NASA Astrophysics Data System (ADS)

Qablan, Ahmad

The goal of this study was to describe the factors that influence education for sustainable development (ESD) in American universities. Cultural Historical Activity Theory (CHAT) was employed as the theoretical lens to analyze the activity of ESD (Engestrom & Miettinen 1999). Data were collected by focusing on two university professors through a series of interviews, classroom observations, and artifacts. The findings of the study demonstrated that both professors encountered serious contradictions in their activity of ESD. These contradictions were both contextual and personal in origin and caused the professors to reshape the object of their teaching activity. The contextual contradictions originated from rules of the professors' institution, their inner and outer communities, and the division of labor in their work environment. The thematic analysis of the data revealed that the contextual contradictions included demanding work responsibilities, emphasis on research over teaching, and lack of community to consider teaching in general and specifically for ESD. The personal contradictions arose from the professors' personal philosophies, perspectives, and visions of sustainable development. Again the thematic analysis revealed the personal contradictions arose from the professors' conceptions of teaching and learning, fear of indoctrination, and again lack of community to support the consideration of teaching. Due to these contradictions in their activity systems, both professors narrowed their sustainability objects to address only one side of sustainability paradigm (the science component), changing the outcomes of their teaching activity to that of preparing environmentally informed citizens. While one professor focused on his new object of delivering environmental knowledge, the other professor adopted a mitigation strategy of focusing on the dual object of sustainability and delivering environmental knowledge. The study offers several strategies to resolve the personal and contextual contradictions identified in this study. Specifically addressed are strategies to alleviate their fear of indoctrination and to access surrounding teaching communities. It also offers strategies focusing on contextual contradictions: establishing ESD communities inside the university and changing faculty incentive and reward structures within the university.

Testing Protocol Proposal to Identify and Evaluate Candidate Materials to Substitute for Silverized Teflon in Thermal Control Applications

NASA Technical Reports Server (NTRS)

Losure, Nancy S.

1996-01-01

Electrostatic discharge (ESD) has been shown to be the primary cause of several glitches in spacecraft operations. It appears that charged particles encountered in the natural environment in certain orbits can collect on the outer surfaces of a spacecraft, building up a charge of several thousand volts. If the potential exceeds the breakdown voltage of the charged material, then an ESD will occur. ESD events involving relatively low voltages, on the order of 100 V, have been shown to damage electronic components. When ESD occurs, electronic and electrical components can be damaged, computer instructions can be garbled, and ablation of material from the spacecraft may occur; degrading both the performance of the thermal control blankets, and the cleanliness of any surfaces on which the detritus becomes deposited. There appear to be six ways to prevent or mitigate the effects of ESD: (1) Choose an orbit where charging is not a problem; (2) Carry extra electromagnetic shielding; (3) Provide redundancy in components and programming; (4) Provide for active dissipation of the charge, by generating a plasma with which to bathe susceptible surfaces; (5) Provide for passive dissipation from a plasma contactors on the susceptible surfaces; and (6) Provide thermal control blankets that do not hold a charge, i.e., that are conductive enough to bleed a charge off harmlessly. These six options are discussed in detail in Losure (1996). Of these six options, number 1 is not always practical, given other requirements of the mission; 2, 3, 4 and 5 will require that extra mass in the form of shielding, etc., be carried by the spacecraft. The most attractive option from a mass and energy point of view seems to be that of finding a material which matches the other performance characteristics of the current thermal control blankets without their tendency to build up an electrostatic charge. The goal of this paper is to describe and justify a testing program which will lead to the approval of materials of this kind.

Non-thermal Processes in the Formation of Mercury's Tenuous Exosphere

NASA Astrophysics Data System (ADS)

Schaible, M. J.; Bennett, C.; Jones, B. M.; Orlando, T. M.

2017-12-01

Recent observations from the MESSENGER spacecraft orbiting Mercury have established that a quasi-trapped population of ions and electrons with 1-10 keV energy exists at a distance of about 1.5 RM (RM is Mercury's radius) around much of the planet. Recent observations from the Fast Imaging Plasma Spectrometer (FIPS), taken < 400 km from the surface, have shown a plasma cusp with energetic heavy ions (i.e. Na+ and O+ groups). The sources of these ions are not clear. A newly developed global kinetic transport model suggests that electron-stimulated desorption (ESD), and possibly light ion stimulated desorption (ISD), can directly yield ions that can be transported and dynamically accelerated to the plasma cusp regions observed by FIPS. Neutrals desorbed from the surface by ESD, ISD, photon-stimulated desorption (PSD) and meteorite impact may also be photoionized and transported/injected into the cusp region. Though the relative importance of these mechanisms in the formation of Mercury's tenuous atmosphere and the subsequent effects on the exosphere/magnetosphere dynamics are not known, it is likely that all of these contribute significantly. The goals of this work are to measure desorption cross-sections and ejection velocities for Na+, O+, and water group ions under relevant electron and ion bombardment energies. This program utilizes state-of-the art surface science capabilities to probe the role of ESD and ISD as a source of ions and neutrals present in the exosphere of Mercury. The experimental chamber is equipped with a dosing system, a cryogenic cooled temperature controlled sample holder, as well as pulsed ion and electron sources. The ESD and ISD ion yields and velocity measurements are obtained directly by sampling with a time-of-flight mass spectrometer. The measured ESD ion yields from adsorbate covered Mercury surface analogs such as the sulfur bearing minerals MgS, Na2S and K2S are low. Additionally, ISD experiments using incident protons also yielded low ion signals. These results implicate PSD and neutral desorption as dominant processes. The information obtained from these experiments can be directly incorporated into model simulations for comparison with data recently obtained by the FIPS instrument.

Social learning as a key factor in sustainability transitions: The case of Okayama City

NASA Astrophysics Data System (ADS)

Didham, Robert J.; Ofei-Manu, Paul; Nagareo, Masaaki

2017-12-01

The Okayama Education for Sustainable Development (ESD) Project is an ongoing initiative in Okayama City, Japan, established in 2005 by the Regional Centre of Expertise (RCE) Okayama and the Okayama Municipal Government with the aim "to create a community where people learn, think and act together towards realising a sustainable society". With a diverse participant base of over 240 organisations - including community learning centres ( kominkans), schools, universities and non-governmental organisations (NGOs) - this initiative has administered numerous programmes. It has engaged a large and diverse group of citizens from Okayama City in exploring sustainability issues through collective discussion, envisioning and practice with the aim of living more sustainable lives. The decade-long experience of the Okayama ESD Project has gained international attention, and the "Okayama Model" is considered an inspiring example of community-based ESD due to the positive changes it has supported. In this article, the Okayama ESD Project is presented as a case study on effective social learning for sustainability. In particular, the practical efforts made are examined to provide insights into how various elements of a social learning process were strengthened and linked to create active learning cycles among community members. In addition, the conditions for creating an effective learning community are investigated, while the practical actions taken are examined in relation to creating an effective social learning process. Finally, this article presents the important role which social learning has played in Okayama City's transition to sustainability and identifies the key efforts made to address and link each of these elements of social learning into a dynamic cycle.

Membrane protein stability can be compromised by detergent interactions with the extramembranous soluble domains

PubMed Central

Yang, Zhengrong; Wang, Chi; Zhou, Qingxian; An, Jianli; Hildebrandt, Ellen; Aleksandrov, Luba A; Kappes, John C; DeLucas, Lawrence J; Riordan, John R; Urbatsch, Ina L; Hunt, John F; Brouillette, Christie G

2014-01-01

Detergent interaction with extramembranous soluble domains (ESDs) is not commonly considered an important determinant of integral membrane protein (IMP) behavior during purification and crystallization, even though ESDs contribute to the stability of many IMPs. Here we demonstrate that some generally nondenaturing detergents critically destabilize a model ESD, the first nucleotide-binding domain (NBD1) from the human cystic fibrosis transmembrane conductance regulator (CFTR), a model IMP. Notably, the detergents show equivalent trends in their influence on the stability of isolated NBD1 and full-length CFTR. We used differential scanning calorimetry (DSC) and circular dichroism (CD) spectroscopy to monitor changes in NBD1 stability and secondary structure, respectively, during titration with a series of detergents. Their effective harshness in these assays mirrors that widely accepted for their interaction with IMPs, i.e., anionic > zwitterionic > nonionic. It is noteworthy that including lipids or nonionic detergents is shown to mitigate detergent harshness, as will limiting contact time. We infer three thermodynamic mechanisms from the observed thermal destabilization by monomer or micelle: (i) binding to the unfolded state with no change in the native structure (all detergent classes); (ii) native state binding that alters thermodynamic properties and perhaps conformation (nonionic detergents); and (iii) detergent binding that directly leads to denaturation of the native state (anionic and zwitterionic). These results demonstrate that the accepted model for the harshness of detergents applies to their interaction with an ESD. It is concluded that destabilization of extramembranous soluble domains by specific detergents will influence the stability of some IMPs during purification. PMID:24652590

[Spanish version of the Satisfaction With Decision scale: cross-cultural adaptation, validity and reliability].

PubMed

Chabrera, Carolina; Areal, Joan; Font, Albert; Caro, Mónica; Bonet, Marta; Zabalegui, Adelaida

2015-01-01

The aim of this study is to develop a Spanish version of the Satisfaction With Decision scale (SWDs) and analyse the psychometric properties of validity and reliability. An observational, descriptive study and validation of a tool to measure satisfaction with the decision. Urology, Radiation oncology, and Medical oncology Departments of the Hospital Universitari Germans Trias i Pujol, Institut Català d'Oncologia and the Institut Oncològic del Vallès - Hospital General de Catalunya. A total of 170 participants diagnosed with prostate cancer, and who could read and write in Spanish and gave their informed consent. A translation, back-translation and cross-cultural adaptation to Spanish was performed on the SWDs. The content validity, criterion validity, construct validity and reliability (internal consistency and stability) of the Spanish version were evaluated. The SWDs contains 6 items with 5-item Likert scales. A Spanish version (ESD) was obtained that was linguistically and conceptually equivalent to the original version. Criterion validity, the ESD correlated with "satisfaction with the decision" using a linear analogue scale, was significant (r=0.63, P<.01) for all items. The factorial analysis showed a unique dimension to explain 82.08% of the variance. The ESD showed excellent results in terms of internal consistency (Cronbach alpha=0.95) and good test-retest reliability with intraclass correlation coefficient of 0.711. The ESD is a validated Spanish scale to measure the satisfaction with the decisions taken in health, and demonstrates a correct validity and reliability. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

The Role and Evolution of NASA's Earth Science Data Systems

NASA Technical Reports Server (NTRS)

Ramapriyan, H. K.

2015-01-01

One of the three strategic goals of NASA is to Advance understanding of Earth and develop technologies to improve the quality of life on our home planet (NASA strategic plan 2014). NASA's Earth Science Data System (ESDS) Program directly supports this goal. NASA has been launching satellites for civilian Earth observations for over 40 years, and collecting data from various types of instruments. Especially since 1990, with the start of the Earth Observing System (EOS) Program, which was a part of the Mission to Planet Earth, the observations have been significantly more extensive in their volumes, variety and velocity. Frequent, global observations are made in support of Earth system science. An open data policy has been in effect since 1990, with no period of exclusive access and non-discriminatory access to data, free of charge. NASA currently holds nearly 10 petabytes of Earth science data including satellite, air-borne, and ground-based measurements and derived geophysical parameter products in digital form. Millions of users around the world are using NASA data for Earth science research and applications. In 2014, over a billion data files were downloaded by users from NASAs EOS Data and Information System (EOSDIS), a system with 12 Distributed Active Archive Centers (DAACs) across the U. S. As a core component of the ESDS Program, EOSDIS has been operating since 1994, and has been evolving continuously with advances in information technology. The ESDS Program influences as well as benefits from advances in Earth Science Informatics. The presentation will provide an overview of the role and evolution of NASAs ESDS Program.

Combined Space Environmental Exposure Tests of Multi-Junction GaAs/Ge Solar Array Coupons

NASA Technical Reports Server (NTRS)

Hoang, Bao; Wong, Frankie; Corey, Ron; Gardiner, George; Funderburk, Victor V.; Gahart, Richard; Wright, Kenneth H.; Schneider, Todd; Vaughn, Jason

2010-01-01

A set of multi-junction GaAs/Ge solar array test coupons were subjected to a sequence of 5-year increments of combined environmental exposure tests. The purpose of this test program is to understand the changes and degradation of the solar array panel components, including its ESD mitigation design features in their integrated form, after multiple years (up to 15) of simulated geosynchronous space environment. These tests consist of: UV radiation, electrostatic discharge (ESD), electron/proton particle radiation, thermal cycling, and ion thruster plume exposures. The solar radiation was produced using a Mercury-Xenon lamp with wavelengths in the UV spectrum ranging from 230 to 400 nm. The ESD test was performed in the inverted-gradient mode using a low-energy electron (2.6 - 6 keV) beam exposure. The ESD test also included a simulated panel coverglass flashover for the primary arc event. The electron/proton radiation exposure included both 1.0 MeV and 100 keV electron beams simultaneous with a 40 keV proton beam. The thermal cycling included simulated transient earth eclipse for satellites in geosynchronous orbit. With the increasing use of ion thruster engines on many satellites, the combined environmental test also included ion thruster exposure to determine whether solar array surface erosion had any impact on its performance. Before and after each increment of environmental exposures, the coupons underwent visual inspection under high power magnification and electrical tests that included characterization by LAPSS, Dark I-V, and electroluminescence. This paper discusses the test objective, test methodologies, and preliminary results after 5 years of simulated exposure.

NASA's Earth Science Flight Program overview

NASA Astrophysics Data System (ADS)

Neeck, Steven P.; Volz, Stephen M.

2011-11-01

NASA's Earth Science Division (ESD) conducts pioneering work in Earth system science, the interdisciplinary view of Earth that explores the interaction among the atmosphere, oceans, ice sheets, land surface interior, and life itself that has enabled scientists to measure global and climate changes and to inform decisions by governments, organizations, and people in the United States and around the world. The ESD makes the data collected and results generated by its missions accessible to other agencies and organizations to improve the products and services they provide, including air quality indices, disaster management, agricultural yield projections, and aviation safety. In addition to four missions now in development and 14 currently operating on-orbit, the ESD is now developing the first tier of missions recommended by the 2007 Earth Science Decadal Survey and is conducting engineering studies and technology development for the second tier. Furthermore, NASA's ESD is planning implementation of a set of climate continuity missions to assure availability of key data sets needed for climate science and applications. These include a replacement for the Orbiting Carbon Observatory (OCO), OCO-2, planned for launch in 2013; refurbishment of the SAGE III atmospheric chemistry instrument to be hosted by the International Space Station (ISS) as early as 2014; and the Gravity Recovery and Climate Experiment Follow-On (GRACE FO) mission scheduled for launch in 2016. The new Earth Venture (EV) class of missions is a series of uncoupled, low to moderate cost, small to medium-sized, competitively selected, full orbital missions, instruments for orbital missions of opportunity, and sub-orbital projects.

Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer.

PubMed

Jeong, Jae-Uk; Nam, Taek-Keun; Kim, Hyeong-Rok; Shim, Hyun-Jeong; Kim, Yong-Hyub; Yoon, Mee Sun; Song, Ju-Young; Ahn, Sung-Ja; Chung, Woong-Ki

2016-09-05

After local excision of early rectal cancer, revision radical resection is recommended for patients with high-risk pathologic stage T1 (pT1) or pT2 cancer, but the revision procedure has high morbidity rates. We evaluated the efficacy of adjuvant concurrent chemoradiotherapy (CCRT) for reducing recurrence after local excision in these patients. Eighty-three patients with high-risk pT1 or pT2 rectal cancer underwent postoperative adjuvant CCRT after local excision. We defined high-risk features as pT1 having tumor size ≤3 cm, and/or resection margin (RM) ≤3 mm, and/or lymphovascular invasion (LVI), and/or non-full thickness excision such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or unknown records regarding those features, or pT2 cancer. Radiotherapy was administered with a median dose of 50.4 Gy in 1.8 Gy fraction size over 5-7 weeks. Concurrent 5-fluorouracil and leucovorin were administered for 4 days in the first and fifth weeks of radiotherapy. The median interval between local excision and radiotherapy was 34 (range, 11-104) days. Fifteen patients (18.1 %) had stage pT2 tumors, 22 (26.5 %) had RM of ≥3 mm, and 21 (25.3 %) had tumors of ≥3 cm in size. Thirteen patients (15.7 %) had LVI. Transanal excision was performed in 58 patients (69.9 %) and 25 patients (30.1 %) underwent EMR or ESD. The median follow-up was 61 months. The 5-year overall survival (OS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS) rates for all patients were 94.9, 91.0, and 89.8 %, respectively. Multivariate analysis did not identify any significant factors for OS or LRFS, but the only significant factor affecting DFS was the pT stage (p = 0.027). In patients with high-risk pT1 rectal cancer, adjuvant CCRT after local excision could be an effective alternative treatment instead of revision radical resection. However, patients with pT2 stage showed inferior DFS compared to pT1.