Gastrointestinal Stromal Tumors (GIST) – Endoscopic Image, Endoscopic Ultrasound, and Value of Endoscopic-Guided Fine-Needle Aspiration

AbstractStromal or mesenchymal neoplasms affecting the gastrointestinal (GI) tract typically present as subepithelial neoplasms. The most common group consists of neoplasms that are collectively referred to as GI stromal tumors (GISTs). They are most often located in the stomach and proximal small intestine.1 Because all GISTs are now regarded as potentially malignant (especially those larger than 1 cm), consensus classifications focus on stratifying lesions (clinicopathobiologic risk categorization) according to the relative risk of recurrence and metastasis.2 This article is part of an expert video encyclopedia

RIGHTING OF CHINESE MITTEN CRABS (ERIOCHEIR SINENSIS) AND THEIR MODELS

The usage of unmanned underwater vehicles for marine tasks is continuously growing and bioinspired stabilizing systems shall help them to gain and keep a stable position during work. Therefore the righting maneuver of E. sinensis has been studied. These crabs are able to perform a 180°-rotation with an angular velocity of 4.30 s−1 when falling underwater from a supine starting position. High-speed particle image velocimetry has shown, that propulsive forces with a peak of 0.021 ± 0.001 N were produced by the hind legs to initiate and stop the rotation. In a numerical multibody simulation a constant force of 0.009 N acting for 0.2 s leads to the same rotation. In order to prove this mechanism, it was implemented into a robotic system. Its mean density of 1.15 g/cm3 deviates not more than 4% from the biological and numerical models. It can complete a 180°-turn within 1.03 ± 0.12 s with a rotational velocity of up to 4.25 s−1

Editors\u27 Choice—Understanding Chemical Stability Issues between Different Solid Electrolytes in All-Solid-State Batteries

Sulfide-based solid electrolytes (SE) are quite attractive for application in all-solid-state batteries (ASSB) due to their high ionic conductivities and low grain boundary resistance. However, limited chemical and electrochemical stability demands for protection on both cathode and anode side. One promising concept to prevent unwanted reactions and simultaneously improve interfacial contacting at the anode side consists in applying a thin polymer film as interlayer between Li metal and the SE. In the present study, we investigated the combination of polyethylene oxide (PEO) based polymer films with the sulfide-based SE Li10SnP2S12 (LSPS). We analyzed their compatibility using both electrochemical and chemical techniques. A steady increase in the cell resistance during calendar aging indicated decomposition reactions at the interfaces. By means of X-ray photoelectron spectroscopy and further analytical methods, the formation of polysulfides, P–[S]n–P like bridged PS43− units and sulfite, SO32−, was demonstrated. We critically discuss potential reasons and propose a plausible mechanism for the degradation of LSPS with PEO. The main objective of this paper is to highlight the importance of understanding interfaces in ASSBs not only from an electrochemical perspective, but also from a chemical point of view

Slurry-Based Processing of Solid Electrolytes: A Comparative Binder Study

Limited energy density of today\u27s Li-ion battery technologies demands for novel cell technologies, such as the all-solid-state battery (ASSB). In order to achieve high energy densities and enable large-scale processing, thin and flexible solid electrolyte (SE) layers have to be implemented. This study focuses on slurry-based processing of the sulfidic solid electrolyte Li$_{10}$SnP$_{2}$S$_{12}$ (LSPS). Various polymers were investigated concerning their suitability as binders for thin and freestanding SE sheets. We conducted a parameter study in order to optimize e.g. LSPS-to-binder ratio, solids content and porosity. Significant differences were found with regard to the minimum amount of binder required for mechanically stable sheets as well as the homogeneity, density and flexibility of the resulting SE layers. The impacts of binder type and weight fraction on ionic conductivity were examined through lithium diffusion measurements. Impedance analysis was conducted in comparison, proving sufficiently high ionic conductivity for potential application of the SE sheets in ASSB. This work highlights the important role of the polymeric binder in slurry-based processing of SEs and gives an impression how important a well-considered selection of parameters is to achieve good processing properties as well as desirable features for the final SE sheet

Combined sedation with midazolam/propofol for gastrointestinal endoscopy in elderly patients

<p>Abstract</p> <p>Background</p> <p>Although gastrointestinal endoscopy with sedation is increasingly performed in elderly patients, data on combined sedation with midazolam/propofol are very limited for this age group.</p> <p>Methods</p> <p>We retrospectively analyzed 454 endoscopic procedures in 347 hospitalized patients ≥ 70 years who had received combined sedation with midazolam/propofol. 513 endoscopic procedures in 397 hospitalized patients < 70 years during the observation period served as controls. Characteristics of endoscopic procedures, co-morbidity, complications and mortality were compared.</p> <p>Results</p> <p>Elderly patients had a higher level of co-morbidity and needed lower mean propofol doses for sedation. We observed no major complication and no difference in the number of minor complications. The procedure-associated mortality was 0%; the 28-day mortality was significantly higher in the elderly (2.9% vs. 1.0%).</p> <p>Conclusions</p> <p>In this study on elderly patients with high level co-morbidity, a favourable safety profile was observed for a combined sedation with midazolam/propofol with a higher sensitivity to propofol in the elderly.</p

Double-blinded, randomized controlled trial comparing real versus placebo acupuncture to improve tolerance of diagnostic esophagogastroduodenoscopy without sedation: a study protocol

<p>Abstract</p> <p>Background</p> <p>Sedation prior to performance of diagnostic esophagogastroduodenoscopy (EGDE) is widespread and increases patient comfort. But 98% of all serious adverse events during EGDEs are ascribed to sedation. The S3 guideline for sedation procedures in gastrointestinal endoscopy published in 2008 in Germany increases patient safety by standardization. These new regulations increase costs because of the need for more personnel and a prolonged discharge procedure after examinations with sedation. Many patients have difficulties to meet the discharge criteria regulated by the S3 guideline, e.g. the call for a second person to escort them home, to resign from driving and working for the rest of the day, resulting in a refusal of sedation. Therefore, we would like to examine if an acupuncture during elective, diagnostic EGDEs could increase the comfort of patients refusing systemic sedation.</p> <p>Methods/Design</p> <p>A single-center, double blinded, placebo controlled superiority trial to compare the success rates of elective, diagnostic EGDEs with real and placebo acupuncture. All patients aged 18 years or older scheduled for elective, diagnostic EGDE who refuse a systemic sedation are eligible. 354 patients will be randomized. The primary endpoint is the rate of successful EGDEs with the randomized technique. Intervention: Real or placebo acupuncture before and during EGDE. Duration of study: Approximately 24 months.</p> <p>Discussion</p> <p>Organisation/Responsibility The ACUPEND - Trial will be conducted in accordance with the protocol and in compliance with the moral, ethical, and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989) and Good Clinical Practice (GCP). The Interdisciplinary Endoscopy Center (IEZ) of the University Hospital Heidelberg is responsible for design and conduct of the trial, including randomization and documentation of patients' data. Data management and statistical analysis will be performed by the independent Institute for Medical Biometry and Informatics (IMBI) and the Center of Clinical Trials (KSC) at the Department of General, Visceral and Transplantation Surgery, University of Heidelberg.</p> <p>Trial registration</p> <p>The trial is registered at Germanctr.de (DRKS00000164) on December 10^th2009. The first patient was randomized on February 2^nd2010.</p