Endoscopic submucosal dissection with a novel high viscosity injection solution (LiftUp) in an ex vivo model: a prospective randomized study

Introduction  Endoscopic submucosal dissection (ESD) is increasingly being used in the western world. Submucosal injectates are an essential tool for the ESD procedure. In this study, we evaluated a novel copolymer injectate (LiftUp, Ovesco, Tübingen Germany) in an established ESD model (EASIE-R) in comparison to existing submucosal injectables. Materials and methods  We conducted a prospective, randomized ex vivo study performing ESD with three injectates: LiftUp, hydroxyethyl starch (HAES 6 %) and normal saline solution (NaCl 0.9 %). A total of 60 artificial lesions, each 3 × 3 cm in size, were resected in an ex vivo porcine model, utilizing one of the three studied injectates (n = 20 ESDs per injectate). Study parameters were: en bloc resection rate, perforation rate, lifting property, time of injection, injectate volume, general ESD procedure time, and overall procedure time. Results  All 60 lesions were successfully resected using the standard ESD technique. LiftUp had no procedure related perforations, one perforation occurred in the HAES group, and two perforations in the NaCl group ( P  > 0.05). Furthermore, adequate lifting was achieved in 16/20 (80 %) using LiftUp, 6/20 (30 %) in the HAES group and 6/20 (30 %) in the NaCl group ( P  < 0.0002). En bloc resection was achieved in 19 (95 %) with LiftUp, in 20 (100 %) with HAES, and in 16 (80 %) with NaCl. General ESD procedure time and overall procedure time were not different among the three groups. Conclusion  LiftUp appears to be a safe alternative to established fluids for ESD. It had a significantly improved lifting effect and required significantly less injected volume compared to well-established lifting solutions

Cellular Automata Applications in Shortest Path Problem

Cellular Automata (CAs) are computational models that can capture the essential features of systems in which global behavior emerges from the collective effect of simple components, which interact locally. During the last decades, CAs have been extensively used for mimicking several natural processes and systems to find fine solutions in many complex hard to solve computer science and engineering problems. Among them, the shortest path problem is one of the most pronounced and highly studied problems that scientists have been trying to tackle by using a plethora of methodologies and even unconventional approaches. The proposed solutions are mainly justified by their ability to provide a correct solution in a better time complexity than the renowned Dijkstra's algorithm. Although there is a wide variety regarding the algorithmic complexity of the algorithms suggested, spanning from simplistic graph traversal algorithms to complex nature inspired and bio-mimicking algorithms, in this chapter we focus on the successful application of CAs to shortest path problem as found in various diverse disciplines like computer science, swarm robotics, computer networks, decision science and biomimicking of biological organisms' behaviour. In particular, an introduction on the first CA-based algorithm tackling the shortest path problem is provided in detail. After the short presentation of shortest path algorithms arriving from the relaxization of the CAs principles, the application of the CA-based shortest path definition on the coordinated motion of swarm robotics is also introduced. Moreover, the CA based application of shortest path finding in computer networks is presented in brief. Finally, a CA that models exactly the behavior of a biological organism, namely the Physarum's behavior, finding the minimum-length path between two points in a labyrinth is given.Comment: To appear in the book: Adamatzky, A (Ed.) Shortest path solvers. From software to wetware. Springer, 201

The Cells Start Walking: Moving Objects in CDL++

ns typically contain objects, which are moving around. The first question is: can these applications also be mapped to the classical CA model. The answer is yes, but the mapping is somewhat artificial, and difficult to understand. E.g. in the traffic simulation an empty site &quot;transports&quot; a car from a neighbour site containing the car. This means that instead of the car the empty neighbour plays the active role in the movement. As can be seen by this example, there is a demand of describing such applications in a non artifical, easy to understand and concise way where the user is freed from the CA corset. The second question is: which problems arise, if a cell receives more than one request to change its state in a different way. It is clear, that such conflict situations must be resolved in a clear way. 2 The problem 2.1 Moving objects Discrete CA applications as mentioned above deal with discrete objects like molecules, particles or cars. These objects are n

JCASim - a Java system for simulating cellular automata

. The program system JCASim is a general-purpose system for simulating cellular automata in Java. It includes a stand-alone application and an applet for web presentations. The cellular automata can be specified in Java, in CDL, or using an interactive dialogue. The system supports many different lattice geometries (1-D, 2-D square, hexagonal, triangular, 3-D), neighborhoods, boundary conditions, and can display the cells using colors, text, or icons. We show several examples to demonstrate the wide applicability of the simulation system. 1 Introduction The concept of cellular automata is about fifty years old. In this period of time, a large number of people have written programs to simulate cellular automata (CA). Most of these programs were written to simulate one specific CA, but a significant number of simulation systems have been created for the simulation of &quot;any&quot; cellular automaton. An overview is given in [9]. Two systems we would like to single out developed around speciall..

Laser Lithotripsy — The New Wave

Currently more than 90% of all common bile duct concrements can he removed via the endoscopic retrograde route by means of endoscopic papillotomy, stone extraction by baskets and balloon catheters, or mechanical lithotripsy. Oversized, very hard or impacted stones however often st ill resist conventional endoscopic therapy. Laser lithotripsy represents a promising new endoscopic approach to the nonsurgical treatment of those common bile duct stones. Currently only short-pulsed laser systems with high power peaks but low potential for thermal tissue damage are used for stone fragmentation. Systems in clinical applications are the pulsed free-running-mode neodymium YAG (Nd:YAG) laser (1064 nm, 2 ms) and the dye laser (504 nm, 1 to 1.5 μs). Energy transmission via highly flexible 200 ìm quartz fibres allows an endoscopic retrograde approach to the stone via conventional duodenoscope or mother-baby-scope systems. New systems currently in preclinical and first clinical testing are the Q-switched Nd:YAG laser (1064 nm, 20 ns) and the Alexandrite laser (700 to 815 nm, 30 to 500 ns). By means of extremely short nanosecond pulses (10-9 s) for the induction of local shock waves at the stone surface, possible tissue damage is even more reduced. No complications have been reported so far after applying laser lithotripsy clinically in about 120 patients worldwide. Compared to extracorporeal shock wave treatment, laser lithotripsy can be executed in any endoscopy unit in the scope of the endoscopic pretreatment and does not require general anesthesia, which is often necessary for extracorporeal shock wave lithotripsy