Notes

Implementation of an standardized robotic asst surgery education course load.
Data on colon capsule endoscopy (CCE) in evaluating the small bowel and colon concurrently are rare. This study aimed to evaluate the accuracy of CCE in assessing disease activity of the small bowel and colon in pediatric Crohn's disease (CD) by comparison with magnetic resonance enterography (MRE), small-intestine contrast US (SICUS), and ileocolonoscopy.

We prospectively enrolled 40 consecutive patients (22 male, 18 female, mean age 13.1 ± 3.1 years) with CD of the small bowel and colon. All underwent SICUS, MRE, CCE, and ileocolonoscopy sequentially over 5 days. All investigators were blinded to patient history and test results. Patients were classified as active or inactive for the small bowel and the colon according to specific criteria for each tool (simple endoscopic score for CD, Lewis score, US and magnetic resonance parameters of activity). For colon mucosa evaluation, ileocolonoscopy was the comparator. For the small bowel, a consensus panel was convened.

Sensitivity of CCE to detect colon inflammation was 89%, and specificity was 100%. The positive predictive value (PPV) and negative predictive value (NPV) of CCE for colon inflammation were 100% and 91%, respectively. In the small bowel, CCE showed 90% sensitivity, 94% specificity, with PPV and NPV of 95% and 90%, respectively. Accuracy parameters for SICUS (sensitivity 90%, specificity 83%) and MRE (sensitivity 85%, specificity 89%) were lower than those for CCE. No serious adverse events related to the CCE procedure or preparation were reported.

CCE is of great usefulness in evaluating both small bowel and colon mucosa in pediatric CD. This single, noninvasive tool makes it possible to evaluate the small-bowel and the colon concurrently with high diagnostic accuracy. Future multicenter studies need to define the role of CCE in the routine management of pediatric patients with CD. (

NCT02199626.).
NCT02199626.).
Remimazolam is an ultra-short-acting benzodiazepine currently being developed for procedural sedation and for induction and maintenance of anesthesia. This trial was the fourth study for procedural sedation. The aim was to compare the safety and efficacy profile of remimazolam and to refine suitable doses for subsequent phase III studies in this indication.

This was a randomized, double-blind, parallel group, active controlled clinical trial with 162 male and female patients, aged 18 to 70, scheduled to undergo a routine colonoscopy. Patients were randomized to receive 1 of 3 remimazolam doses or midazolam for sedation. Supplemental oxygen and 100 μg of fentanyl was given before procedures were started, and the colonoscopy commenced as soon as suitable sedation had been achieved (Modified Observer's Assessment of Alertness/Sedation score ≤3). Top-up doses of the study drug and/or fentanyl were allowed to maintain suitable sedation and/or analgesia. Response was defined as sufficient sedation, no rescue sedative, and no ventilation required.

This study showed that a single dose of remimazolam or midazolam, followed by top-up doses to maintain suitable sedation, provided adequate sedation with a high success rate (>92%) for the remimazolam groups, compared with 75% for the midazolam group (P = .007). There was no requirement for mechanical ventilation in any group, and procedure failures were all due to use of rescue sedative.

The high success rates and good safety profile of remimazolam observed in this study warrants further investigation and confirmation in phase III trials. (

NCT01145222.).
NCT01145222.).
Studies in adults have shown that postprocedural abdominal pain is reduced with the use of carbon dioxide (CO(2)) instead of air for insufflation during colonoscopy. The aim of our study was to compare postprocedural abdominal pain and girth in children undergoing colonoscopy using CO(2) or air for insufflation.

This was a prospective, randomized, double-blind study that included 76 consecutive pediatric patients undergoing colonoscopy for various indications. Patients were randomly assigned to either CO(2) or air insufflation. selleck chemicals At 2, 4, and 24 hours after the examination, the patients' pain was assessed by using the 11-point numerical rating scale. The waist circumference was measured 10 minutes and 2 and 4 hours after colonoscopy.

A significantly higher proportion of patients had no pain after colonoscopy in the CO(2) group compared with the air group (82 vs 37% at 2 hours and 95% vs. 63% at 4 hours, P < .001). Mean abdominal pain scores 2 and 4 hours after the procedure were statistically significantly lower in the CO(2) group compared with the control air group (0.5 vs 2.6 at 2 hours and 0.1 vs 1.2 at 4 hours, P < .001). There was no difference in waist circumference between the 2 groups at all time intervals.

The results of this randomized trial show clear benefits of CO(2) insufflation for colonoscopy in reducing postprocedural discomfort. (

NCT02407639.).
NCT02407639.).
The true efficacy of EUS-guided ethanol lavage (EEL) of pancreatic cystic neoplasms is unclear. This study aimed to assess long-term outcomes and adverse events of EEL by using a standardized protocol.

Single-center, prospective, pilot study in which participants with suspected mucinous cyst neoplasms or branch duct intraductal papillary mucinous neoplasms ≥1 cm in maximum diameter underwent EEL with 80% ethanol. Follow-up cross-sectional imaging was obtained to assess for changes in cyst volume.

Twenty-three patients underwent EEL (57% male, mean age 70 years). Mean duration of follow-up was 40 months (range 9-82 months). Mean calculated final concentration of ethanol achieved in treated cysts was 50% (range 0%-79%). Complete resolution of pancreatic cystic neoplasms occurred in 2 participants (9%). When stratified into those participants who achieved ≥80% versus <80% reduction in cyst volume, no statistically significant differences were seen with regard to patient demographics, cyst characteristics, or final concentration of ethanol achieved in the treated cyst. Greater decreases in cyst volume were seen in presumed nonmucinous cysts compared with presumed mucinous cysts (P = .006). Two early adverse events occurred. Five participants died during the study follow-up period (4 from nonpancreatic causes), including 1 participant who was diagnosed with pancreatic adenocarcinoma thought to have arisen from the treated branch duct intraductal papillary mucinous neoplasm 41 months after undergoing EEL.

As performed in this study, EEL therapy does not appear to be a promising method for prevention of malignancy in pancreatic cysts. Endoscopic methods that effectively and completely ablate pancreatic cystic neoplasms are needed. (

NCT02158039.).
NCT02158039.).Metal chemical fractions obtained by optimized BCR three-stage extraction procedure and multivariate analysis techniques were exploited for assessing 7 heavy metals (Cr, Pb, Cd, Co, Cu, Zn and Ni) in sediments from Gansu province, Ningxia and Inner Mongolia Autonomous Regions of the Yellow River in Northern China. The results indicated that higher susceptibility and bioavailability of Cr and Cd with a strong anthropogenic source were due to their higher availability in the exchangeable fraction. A portion of Pb, Cd, Co, Zn, and Ni in reducible fraction may be due to the fact that they can form stable complexes with Fe and Mn oxides. Substantial amount of Pb, Co, Ni and Cu was observed as oxidizable fraction because of their strong affinity to the organic matters so that they can complex with humic substances in sediments. The high geo-accumulation indexes (I(geo)) for Cr and Cd showed their higher environmental risk to the aquatic biota. Principal component analysis (PCA) revealed that high toxic Cr and Cd in polluted sites (Cd in S10, S11 and Cr in S13) may be contributed to anthropogenic sources, it was consistent with the results of dual hierarchical clustering analysis (DHCA), which could give more details about contributing sources.A novel biofilter that removes ammonia from air streams and converts it to nitrogen gas has been developed and operated continuously for 300 days. The ammonia from the incoming up-flow air stream is first absorbed into water and the carrier material, zeolite. A continuous gravity reflux of condensed water from the exit of the biofilter provides moisture for nitrifying bacteria to develop and convert dissolved ammonia (ammonium) to nitrite/nitrate. The down-flow of the condensed water reflux washes down nitrite/nitrate preventing ammonium and nitrite/nitrate accumulation at the top region of the biofilter. The evaporation caused by the inflow air leads to the accumulation of nitrite to extremely high concentrations in the bottom of the biofilter. The high nitrite concentrations favour the spontaneous chemical oxidation of ammonium by nitrite to nitrogen (N2). Tests showed that this chemical reaction was catalysed by the zeolite filter medium and allowed it to take place at room temperature. This study shows that ammonia can be removed from air streams and converted to N2 in a fully aerated single step biofilter. The process also overcomes the problem of microorganism-inhibition and resulted in zero leachate production.The long term impact of SRT (100-40 days) and recovery cleaning on membrane performance of an AnMBR treating authentic municipal wastewater in a large pilot plant was assessed. Successful operation of the pilot plant at a flux of 17 LMH was maintained for a period of 536 days during which the longest period of operation without recovery cleaning or membrane replacement was 178 days. Lower SRT (40 days) reduced the fouling propensity of the mixed liquor in terms of TSS concentration and the dewaterability indicators including colloidal COD (cCOD) concentration and capillary suction time (CST). Critical fluxes ranged from 21 to 23 LMH to 25-27 LMH for SRTs of 70 and 40 days respectively and this was consistent with the reduced concentrations of TSS and improved dewaterability under the latter conditions. Recovery cleaning was found to result in substantial reduction of resistance as indicated by both pilot plant operation and clean water flux tests. The long-term fouling rate was observed to be higher with cleaned membranes as compared to virgin membranes. The lower membrane fouling with virgin membranes suggested that accumulation of foulants, which were resistant to cleaning, caused the higher fouling rates for the cleaned membranes.Laboratory measurements for particle-size distribution of Decabromodiphenyl ether (BDE-209) were performed in a 0.5 m(3) sealed room at 25 °C. BDE-209 was manually bounded to ambient particles. An electrostatic field-sampler was employed to collect particles. The number of collected particles (n(i,j), i and j was the class of particle diameter and applied voltage on electrostatic field-sampler sampler, respectively) and the corresponding mass of BDE-209 in collected particles (m(∑i,j)) were determined in a series of 6 experiments. The particle-size distribution coefficient (ki) was calculated through equations related to n(i,j) and m(∑i,j), and the particle-size distribution of BDE-209 was determined by ki·n(i,j). Results revealed that BDE-209 distributed in particles of all size and were not affiliated with fine particles as in field measurements. The particle size-fraction should be taken into account when discussing the particle-size distribution of BDE-209 in ambient air due to the normalized coefficients (normalized to k1) and were approximately in the same order of magnitude for each diameter class.
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