Applying basic principles of surgery may pave the way for more effective endoscopic bariatric techniques

Abstract Background and study aims In the last decade, gastroenterologists have been attempting to use endoscopy to reproduce the great success of traditional surgical suture techniques. Despite recent advances, we still lack a reliable method that results in a permanent suture with minimal incidence of suture failure. This was an experimental study in pigs with an innovative technique that applied basic surgical concepts to endoscopy to evaluate the effectiveness of a novel suture technique. Methods The procedures were performed on six live pigs under general anesthesia. Endoscopic mucosal resection (EMR) first was performed in the stomach, exposing the submucosal or muscularis propria layers. A novel device, a transparent chamber cap (DASE), was developed to aspirate the gastric wall, allowing the sutures to reach deep layers. The aspiration was performed with a standard gastroscope to which the novel cap was distally attached. Three sutures aligned were defined as a plication. Each pig received two or three plications and was placed on a liquid diet for 14 days after the procedure. The pigs were sacrificed at 4 and 8 weeks and the sutures were reviewed. Results The technique was feasible in all animals. Of 16 plications, only one failed. One perforation occurred after EMR. There were no other complications or adverse events. Permanent fusion of the gastric wall was confirmed by histology in all cases. Conclusions This study showed that basic principles of surgery can be applied endoscopically to ensure a permanent suture with reduced chances of failure. These findings can help to pave the way for more effective bariatric endoscopic techniques.

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On the Track of New Endoscopic Alternatives for the Treatment of Selected Gastric GISTs—A Pilot Study

Medicina ◽

10.3390/medicina57060625 ◽

2021 ◽

Vol 57 (6) ◽

pp. 625

Author(s):

Artur Raiter ◽

Katarzyna M. Pawlak ◽

Katarzyna Kozłowska-Petriczko ◽

Jan Petriczko ◽

Joanna Szełemej ◽

...

Keyword(s):

Pilot Study ◽

Endoscopic Resection ◽

Tumour Size ◽

Gastric Wall ◽

Muscularis Propria ◽

R0 Resection ◽

Hybrid Technique ◽

Endoscopic Techniques ◽

Gastric Gists ◽

Type Iii

Background and Objectives: GISTs (Gastrointestinal stromal tumors) are the most common mesenchymal gastrointestinal tract tumours and are mainly located in the stomach. Their malignant potential depends on size, location, and type. Endoscopic techniques are a less invasive modality for patients not eligible for surgery. ESD (endoscopic submucosal dissection) is mainly used for the removal of smaller GISTs, with intraluminal growth and a more superficial location. Thus, R0 resection capability in some cases may be not sufficient, limited by tumour size, location in the gastric wall, and its connection level with the muscularis propria. In such cases, an endoscopic full-thickness resection can become a new alternative. In this retrospective pilot study, we evaluated ESD and hybrid resection techniques in terms of safety, efficacy, and disease recurrence for selected types of gastric GISTs. Materials and Methods: A retrospective comparison was conducted in a group of patients who underwent ESD or a hybrid technique combining endoscopic resection with endoscopic suturing using the OverStitch system (HT) for type II or III gastric GISTs. A total of 21 patients aged 70 ± 8 years underwent endoscopic resection. Seventeen lesions were treated with ESD and four with the HT. Results: R0 resection was achieved in all patients treated using HT (type III lesions) and in 53% of those treated with ESD (p = 0.08). None of the type III lesions treated with ESD were excised with R0. Lesions treated with R0 ESD resections were significantly smaller (1.76 ± 0.35 cm) than those with R1 ESD resections (2.39 ± 0.40 cm) (p < 0.01). The mean lesion size treated with the HT was 2.88 ± 0.85 cm. Conclusions: HT may be a new resection modality for large gastric GISTs with high muscularis propria connection grades. Further studies are required to evaluate its safety and efficacy and to form precise inclusion criteria for endoscopic resection techniques.

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Brahms, Beethoven, and a Reassessment of the Famous Footsteps

Nineteenth-Century Music Review ◽

10.1017/s1479409820000270 ◽

2021 ◽

pp. 1-14

Author(s):

Styra Avins

Keyword(s):

Alternative View ◽

Great Success ◽

Substantial Evidence ◽

Specific Instance ◽

Powerful Effect ◽

History Of ◽

Compositional History ◽

Primary Focus ◽

The Way ◽

Musical Forces

To speak of Brahms and Beethoven in the same breath is almost a cliché: Brahms was intimately conscious of Beethoven's music from early youth. This article describes the details of his youthful involvement, the compositions he had in his repertoire as well as those other works which had a powerful effect on his development. By age 20, Brahms was frequently compared to Beethoven by people who met him or heard him play. My interest is in the way he was influenced by Beethoven and the manner in which he eventually found his own voice. The compositional history of his First Symphony provides the primary focus: its long gestation, and the alleged quote by Brahms given in Max Kalbeck's massive biography: ‘I'll never write a symphony, you have no idea what it feels like … to hear the footsteps of a giant behind one’. The reference is presumably to Beethoven, but there exists no corroborating evidence that Brahms ever said those words. They gained credence as one writer after another simply accepted Kalbeck's word. Yet substantial evidence exists that in writing his biography, Kalbeck distorted and even invented ‘facts’ when it suited his purposes, including a specific instance dealing with writing a symphony. An alternative view of the symphony's long gestation is based on a view of Brahms's compositional history. He wrote for musical forces he knew at first hand, and only from 1872 to 1875 did he have command of an orchestra. Intriguingly, while fulfilling the contemporary accepted demands of a symphony after Beethoven, Brahms devised an unusual strategy for the final movement, the basis of its great success.

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REKONSTRUKSI IJTIHĀD DALAM ILMU UṢŪL AL-FIQH

Al-Ahkam ◽

10.21580/ahkam.2012.22.2.9 ◽

2012 ◽

Vol 22 (2) ◽

pp. 161

Author(s):

Rokhmadi Rokhmadi

Keyword(s):

Islamic Law ◽

The Other ◽

Basic Principles ◽

The Law ◽

The Way

Al-Qur’an and Sunnah, needs of understanding and extracting optimally, so that the contents of law can be applied for the benefit of people. The way- to understand and to extract the contents in these two sources- called ijtihād. Thus, ijtihād is needed on istinbāṭ of law from many arguments of the texts (naṣ), eventhough it is qaṭ’ī in which the uṣūliyyūn have agreed that it is not the area for re-extracting to the law (ijtihādiyyah). The problem in this case is that even a qaṭ’ī argument according to the most of uṣūliyyūn has not been qaṭ’ī argument in the other uṣūliyyūn opinion. Reconstruction of ijtihād becomes an alternative, with some considerations: First, weight and tightening the requirements to become a mujtahid, which is almost impossible controlled by someone at the present time; Second, the increasing complexity of the problems faced by the ummat which is very urgent to get the solution; Third, let the period without ijtihād (vacuum of mujtahid) is contrary to the basic principles of Islamic law are always sāliḥ li kulli zamān wa makān. This paper present to discuss further about the urgency of the reconstruction of ijtihād in the challenge of modernity.***Al-Qur<ins cite="mailto:hasan" datetime="2015-02-17T11:11">’</ins>an maupun <ins cite="mailto:hasan" datetime="2015-02-17T11:11">s</ins>unnah sangat membutuhkan pemahaman dan penggalian secara optimal agar isi kandungan hukumnya dapat diterapkan bagi kemaslahatan umat. Cara untuk menggali dan mengeluarkan isi kandungan yang ada dalam kedua sumber tersebut dinamakan ijtihād. Ijtihād sangat dibutuhkan pada setiap isti<ins cite="mailto:muthohar" datetime="2015-01-29T05:30">n</ins><del cite="mailto:muthohar" datetime="2015-01-29T05:30"></del>bāṭ hukum dari dalil naṣ, sekalipun dalil naṣ tersebut bersifat qaṭ'ī yang oleh para uṣūliyyūn sudah disepakati tidak menjadi wilayah untuk dijitihadi lagi. Permasalahannya adalah bahwa sesuatu dalil naṣ yang sudah bersifat qaṭ'ī sekalipun oleh sebagian besar uṣūliyyūn, belum tentu dipandang qaṭ'ī oleh sebagian uṣūliyyūn yang lain. Rekonstruksi ijtihād menjadi sebuah alternatif, dengan beberapa pertimbangan: Pertama, berat dan ketatnya persyaratan-persyaratan menjadi seorang mujtahid, yang hampir tidak mungkin dikuasai oleh seseorang pada masa sekarang; Kedua, semakin kompleksnya permasalahan yang dihadapi oleh ummat yang sangat mendesak untuk mendapatkan solusi; Ketiga, membiarkan satu periode tanpa ijtihād (kevakuman mujtahid) adalah bertentangan dengan prinsip dasar hukum Islam yang selalu sāliḥ li kulli zamān wa makān. Tulisan ini hadir untuk mendiskusikan lebih jauh tentang urgensi rekonstruksi ijtihād dalam menghadapi tantangan modernitas.***Keywords: ijtihād, qaṭ'ī, ẓannī, uṣūl al-fiqh

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Endoscopic ultrasound (EUS) in staging and follow-up of patients with malt lymphoma treated conservatively

Acta chirurgica iugoslavica ◽

10.2298/aci0501083p ◽

2005 ◽

Vol 52 (1) ◽

pp. 83-89 ◽

Cited By ~ 5

Author(s):

A.R. Pavlovic ◽

M. Krstic ◽

D. Tomic ◽

Milos Bjelovic ◽

R. Jesic ◽

...

Keyword(s):

Helicobacter Pylori ◽

Malt Lymphoma ◽

Gastric Wall ◽

Gastric Lymphoma ◽

Eradication Therapy ◽

Muscularis Propria ◽

Wall Thickening ◽

Low Grade ◽

Ann Arbor

Background: Endoscopic ultrasonography (EUS) is an important tool for diagnosis and pretreatment staging of primary gastric lymphoma. The aim of the study was to evaluate the diagnostic importance of endosonography (EUS)in gastric lymphoma; to assess the depth of tumoral infiltration in low-grade gastric lymphoma of mucosa-associated lymphoid tissue (MALT) and to assess EUS response to medical treatment (Cyclophosphamid/Mabtera and/or anti-Helicobacter pylori therapy). Methods: 26 patients with MALT gastric lymphoma were investigated by EUS. Six of them were evaluated after the eradication of Helicobacter pylori infection and 20 after and during the cyclophosphamide/Mabtera and anti H.pylori treatment. EUS staging was compared with histopathology. Tumors were staged according to the 2000 TNM and modified Ann Arbor classification. Results: Six patients were treated with anti - Helicobacter pylori eradication therapy. Full regression of lymphoma was observed in 2 of 6 (33.3%) patients, which was endoscopicaly and histologicaly proved. EUS correlated with histology in all (6/6). In 20 patients treated with cyclophosphamide/Mabtera therapy, EUS revealed regression of lymphoma in 14 cases. Positive correlation with histology was found in 11 patients (11/14; 78%). The initial EUS showed an increased wall thickness more than 5mm in 24 of 26 patients (92%). The thickening was predominantly of mucosa and submucosa and in 11 patients extended the muscularis propria. After the therapy, the gastric wall thickening returned to normal in 14 patients, however, 3 of them still had positive histology findings. In 2 cases, during the follow-up, the EUS showed remained thickening of gastric wall, whereas biopsies were negative. Six months later histology revealed progressive low-grade MALT lymphoma in this cases. Conclusion: EUS appears to be a sensitive procedure for initial staging and assessment of treatment response and long-term follow up in patients with gastric lymphoma. The importance of EUS lies in ability to detect relapse early, too.

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4. Snakes

Reptiles: A Very Short Introduction ◽

10.1093/actrade/9780198806417.003.0004 ◽

2019 ◽

pp. 61-81

Author(s):

T. S. Kemp

Keyword(s):

Reproductive Behaviour ◽

Great Success ◽

Main Aspect ◽

Worldwide Distribution ◽

The Way

The roughly 3,500 species of snakes are really a group of limbless lizards, although they are so distinctive, with so many unique features, that they are placed in their own reptile subclass, Ophidia or Serpentes. They have a worldwide distribution, occupying habitats from deserts to rainforests and seas. ‘Snakes’ describes how snakes feed, move, and make sense of their surroundings, as well as their social and reproductive behaviour. The main aspect of snake biology that accounts for their great success as hunting organisms is the way they acquire and ingest their food. The rear-fanged (colubrids) and front-fanged groups (elapids and viperids) are described along with their venom production.

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Geology Emerges as a Science

10.1093/oso/9780197502464.003.0002 ◽

2021 ◽

pp. 6-33

Author(s):

Elisabeth Ervin-Blankenheim

Keyword(s):

Twentieth Century ◽

Sixteenth Century ◽

Da Vinci ◽

Leonardo Da Vinci ◽

Basic Principles ◽

Charles Lyell ◽

The Earth ◽

Forms Of Life ◽

Principles Of Geology ◽

The Way

This chapter and the next one cover the way in which geology came to be a science in its own right, spanning the early centuries of geology. Lives of crucial individual scientists from the sixteenth century to the beginning of the twentieth century are discussed by relating the stories and discoveries of each, commencing with Leonardo da Vinci and continuing with the European geologists, including Nicholaus Steno, Abraham Werner, James Hutton, Charles Lyell, and early fossilists such as Etheldred Benet. Steno, Werner, Hutton and Lyell, and other early geologists revealed and wrote about the basic principles of geology, painstakingly untangling and piecing together the threads of the Earth’s vast history. They made sense of jumbled sequences of rocks, which had undergone dramatic changes since they were formed, and discerned the significance of fossils, found in environments seemingly incongruous to where the creatures once lived, as ancient forms of life. They set the stage for further research on the nature of the Earth and life on it, providing subsequent generations of geologists and those who study the Earth the basis on which to refine and flesh out the biography of the Earth.

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The Importance of the Setting in Meeting Regression in Psycho-Analysis

The Collected Works of D. W. Winnicott ◽

10.1093/med:psych/9780190271398.003.0009 ◽

2016 ◽

pp. 85-90

Author(s):

Donald W. Winnicott

Keyword(s):

Necessary Conditions ◽

Basic Principles ◽

As If ◽

The Way

In this seminar, Winnicott describes his personal views in relation to meeting the condition of clinical regression in psychoanalysis. Winnicott reminds his students that he accepts the basic principles of psychoanalysis as laid down by Freud but adds that, in some cases, the psychoanalytic setting and the careful maintenance of that setting (reliability and management) are as important as the way the analyst deals verbally with the material. He suggests that in this kind of work with regressed patients it is as if the patient gradually seduces the analyst into collusion with the infant within the patient, the infant who received inadequate attention at the earliest stages. The patient is not there to work in a productive way with the analyst, except when the analyst provides these necessary conditions.

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How to speak critically about poverty

Radical Hope ◽

10.1332/policypress/9781447354895.003.0003 ◽

2020 ◽

pp. 45-54

Author(s):

Michal Krumer-Nevo

Keyword(s):

Social Workers ◽

Service Users ◽

Basic Principles ◽

The Way

This is the first of the four chapters that comprise Part One of the book, which is dedicated to the issue of transformation. This chapter focuses on the transformation of the professional spoken vocabulary regarding poverty. Through a close look at the words that social workers use to describe service users in poverty, links are made between language (rhetoric), attitudes, and practice. The chapter presents an overview of six basic principles of the paradigm and translates them to guidelines regarding the way in which social workers should speak about and with service users. It urges social workers to be aware of the language they use and to change it.

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Inheriting Chinese and Christian Traditions in Global Context: a Confucian-Protestant Perspective

Religion and Theology ◽

10.1163/157430103x00141 ◽

2003 ◽

Vol 10 (1) ◽

pp. 1-23

Author(s):

Pan-Chiu Lai

Keyword(s):

Basic Principles ◽

Global Context ◽

Theological Concept ◽

The Way

AbstractThis article offers an analysis of the problems and tensions in the endeavour to inherit Chinese and Christian traditions in contemporary global and Chinese contexts. Through an investigation of the theological concept of tradition and the Chinese, mainly Confucian, understanding of the transmission of the Way, this article argues that it is possible to inherit the Protestant and Confucian traditions at the same time, without violating the basic principles of the two traditions. It also argues that an integration of the Protestant and Confucian traditions will be beneficial to the development of the two traditions.

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Endoscopic ultrasound in the evaluation of gastric small lymphocytic mucosa-associated lymphoid tumors.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.5.1761 ◽

1997 ◽

Vol 15 (5) ◽

pp. 1761-1766 ◽

Cited By ~ 36

Author(s):

A C Pavlick ◽

H Gerdes ◽

C S Portlock

Keyword(s):

Antibiotic Therapy ◽

Endoscopic Ultrasound ◽

Gastric Wall ◽

Muscularis Propria ◽

Cancer Center ◽

Low Grade ◽

Lymphoma Treatment ◽

Therapeutic Recommendations ◽

H Pylori ◽

Lymphoid Aggregates

PURPOSE Low-grade, small lymphocytic lymphomas of the mucosa-associated lymphoid tissue (MALT) have recently been shown to be associated with Helicobacter pylori infections. Regression of these tumors has been reported with antibiotic therapy. Here we evaluate endoscopic ultrasound (EUS) as on objective method to evaluate pretreatment disease and posttherapy response. MATERIALS AND METHODS We retrospectively reviewed 20 patients initially diagnosed elsewhere with MALT lymphoma. All patients had their initial endoscopic biopsies (EGDs) reviewed at Memorial Sloan-Kettering Cancer Center (MSKCC). All patients had EUS performed at the time of consultation and on completion of therapy if treated at our center. Antral biopsies were stained with a modified Steiner preparation to determine infection by H pylori. RESULTS Gastric low-grade lymphoma was confirmed in 16 of 20 patients; 11 of 16 had previously received antibiotic therapy for biopsy-positive H pylori infection. All gastric lymphomas had an abnormal EUS: eight with discrete tumor masses and eight with gastric wall infiltration (submucosa, n = 4; muscularis propria, n = 3; serosa, n = 1). On completion of lymphoma treatment with chemotherapy, radiotherapy, or surgery, 11 of 16 patients underwent follow-up EUS. Five patients received care elsewhere and did not return for posttreatment EUS. The gastric wall was normal with no evidence of disease on EUS-guided biopsy in eight of 11 patients. The remaining three patients had abnormal gastric walls. One was biopsy-negative and two had residual lymphoma. Four patients were found to have benign lymphoid aggregates in association with H pylori on initial EGD and EUS biopsies. All four patients were previously untreated with antibiotics. EUS showed prominent mucosa, but no significant findings within the gastric wall. CONCLUSION EUS appears useful to stage objectively and evaluate therapeutic outcome in the management of gastric, low-grade MALT lymphomas. It also helps to distinguish benign lymphoid aggregates from lymphoma associated with H pylori infection. EUS findings may have a significant impact on assessment and therapeutic recommendations.

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