Publications by authors named "Quan-Lin Li"

107 Publications

Management of an esophagopleural fistula after resection of giant submucosal tumor of the cardia.

Endoscopy 2022 Aug 4. Epub 2022 Aug 4.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

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http://dx.doi.org/10.1055/a-1881-3793DOI Listing
August 2022

Endoscopic Resection of Upper Gastrointestinal Extraluminal Tumors.

Gastrointest Endosc 2022 Jun 17. Epub 2022 Jun 17.

Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address:

Background And Aims: Endoscopic resection is a feasible treatment for gastrointestinal extraluminal tumors, but remains a challenging procedure with limited data. In this study, we assessed the safety and efficacy of endoscopic resection for extraluminal tumors in the upper gastrointestinal tract.

Methods: From May 2016 to December 2021, 109 patients undergoing endoscopic resection for extraluminal tumors in the upper gastrointestinal tract were retrospectively included. Clinicopathological characteristics, procedure-related parameters, adverse events (AEs), and follow-up outcomes were analyzed.

Results: The en bloc tumor resection rate was 94.5% and the en bloc retrieval rate was 86.2%. Statistical analysis revealed tumor size ≥3.0 cm and irregular shape as significant risk factors for piecemeal extraction. Resection time and suture time were 46.8±33.6 and 20.6±20.1 min, respectively. Large tumor size was significantly associated with a longer procedure duration. Five patients (4.6%) experienced major AEs, including recurrent laryngeal nerve injury, hydrothorax, major bleeding, local peritonitis, duodenal leakage, and repeat endoscopic surgery for tumor extraction. Minor AEs occurred in 13 patients (11.9%). Irregular tumor shape and tumor location (duodenum) were significantly associated with AE occurrence. Mean postoperative hospital stay was 4.7±3.3 days. No recurrence or metastasis was observed during the mean follow-up period of 31.8±15.2 months.

Conclusion: Endoscopic resection is a safe and feasible therapeutic approach for upper gastrointestinal extraluminal tumors. Tumor size, shape, and location impact the difficulty and safety of the procedure. Endoscopic resection of duodenal tumors is also feasible but associated with an increased risk of AEs, compared with tumors in other locations.
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http://dx.doi.org/10.1016/j.gie.2022.06.020DOI Listing
June 2022

Submucosal tunneling endoscopic septum division for esophageal diverticulum with a median follow-up of 39 months: a multicenter cohort study.

Gastrointest Endosc 2022 Jun 6. Epub 2022 Jun 6.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.

Background And Aims: Submucosal tunneling endoscopic septum division (STESD) is an endoscopic minimally invasive technique for treating esophageal diverticulum. The objectives of this study were to evaluate the safety and efficacy of STESD and its impact on patients' quality of life.

Methods: This study included consecutive patients who underwent STESD for esophageal diverticulum from April 2016 to August 2020 in two centers (Zhongshan Hospital, Fudan University and Tianjin First Central Hospital). Esophagogram and endoscopic examination were performed before STESD and 30 days after STESD. Patients completed the 36-item Short Form survey (SF-36) before STESD and 1 year after surgery. Clinical symptoms were assessed via telehealth every 6 months until August 2021. Costamagna and Eckardt scores were used to evaluate changes in symptoms.

Results: A total of 21 patients were included. Mucosal injury 1-2 cm below the septum occurred in two patients. No severe surgical adverse events were observed. Median duration of follow-up was 39 months (range, 12-63 months). Total SF-36 scores increased from 118.7±18.6 before STESD to 132.4±9.1 at 1 year after the procedure (p=0.007). SF-36 subscales of general health (p=0.002), vitality (p=0.004), social functioning (p=0.030), and mental health (p=0.020) improved significantly after STESD. The mean Costamagna score decreased from 3.83±1.33 to 1.67±1.51 (p=0.010), while the mean Eckardt score decreased from 3.50±0.90 to 1.25±1.76 (p=0.002). One patient developed symptom recurrence at 10 months after STESD.

Conclusions: STESD is a safe and valid endoscopic minimally invasive surgery for esophageal diverticulum, which can reduce symptoms and improve quality of life.
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http://dx.doi.org/10.1016/j.gie.2022.05.021DOI Listing
June 2022

Submucosal tunneling endoscopic biopsy and myotomy for management of unknown esophageal stenosis.

Gastroenterol Rep (Oxf) 2022 30;10:goac021. Epub 2022 May 30.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, P. R. China.

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http://dx.doi.org/10.1093/gastro/goac021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9155210PMC
May 2022

Erratum: A scoring system to support surgical decision-making for cardial submucosal tumors.

Endosc Int Open 2022 Apr 24;10(4):C5. Epub 2022 May 24.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

[This corrects the article DOI: 10.1055/a-1775-7976.].
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http://dx.doi.org/10.1055/a-1848-2266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9129921PMC
April 2022

Enteric Nervous System: The Bridge Between the Gut Microbiota and Neurological Disorders.

Front Aging Neurosci 2022 19;14:810483. Epub 2022 Apr 19.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

The gastrointestinal (GI) tract plays an essential role in food digestion, absorption, and the mucosal immune system; it is also inhabited by a huge range of microbes. The GI tract is densely innervated by a network of 200-600 million neurons that comprise the enteric nervous system (ENS). This system cooperates with intestinal microbes, the intestinal immune system, and endocrine systems; it forms a complex network that is required to maintain a stable intestinal microenvironment. Understanding how gut microbes influence the ENS and central nervous system (CNS) has been a significant research subject over the past decade. Moreover, accumulating evidence from animal and clinical studies has revealed that gut microbiota play important roles in various neurological diseases. However, the causal relationship between microbial changes and neurological disorders currently remains unproven. This review aims to summarize the possible contributions of GI microbiota to the ENS and CNS. It also provides new insights into furthering our current understanding of neurological disorders.
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http://dx.doi.org/10.3389/fnagi.2022.810483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9063565PMC
April 2022

Endoscopic Removal of a Perforating and Embedded Foreign Body in the Duodenum.

Am J Gastroenterol 2022 May 5. Epub 2022 May 5.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

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http://dx.doi.org/10.14309/ajg.0000000000001823DOI Listing
May 2022

Landscape of esophageal submucosal tunneling endoscopic resection-related adverse events in a standardized lexicon: a large volume of 1701 cases.

Surg Endosc 2022 Apr 25. Epub 2022 Apr 25.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

Background: Submucosal tunneling endoscopic resection (STER) has been widely applied for esophageal submucosal tumors. This large volume study aims to provide a standard landscape of STER-related AEs for reference.

Methods: 1701 patients with esophageal SMTs undergoing STER were included at Zhongshan Hospital, Fudan University. Data of clinical characteristics and adverse events were collected and analyzed in depth. Adverse events were recorded by ASGE lexicon and graded by ASGE grading/Clavien-Dindo system. Risk factors for major AEs were analyzed by univariate and multivariate logistic regression.

Results: Three hundred and twenty (18.8%) patients with 962 cases of adverse events were observed. Accordingly, 84 (5.0%) were classified as major AEs (moderate and severe) by ASGE grading and 37 (2.2%) were classified as major AEs (grades III-V) by Clavien-Dindo grading. First 1 year operation, distance > 6 cm from incision to tumor, piecemeal resection, partially extraluminal location, mucosal injury, and operation time > 60 min were included in the risk score model for major AEs of STER, with 57.1% sensitivity and 87.5% specificity.

Conclusions: STER was a safe procedure for diagnosis and treatment of esophageal SMTs with a total 18.8% incidence of AEs, among which only 5.0% were major AEs requiring therapeutic measurements.
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http://dx.doi.org/10.1007/s00464-022-09241-7DOI Listing
April 2022

A scoring system to support surgical decision-making for cardial submucosal tumors.

Endosc Int Open 2022 Apr 14;10(4):E468-E478. Epub 2022 Apr 14.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

Submucosal tunneling endoscopic resection (STER) and non-tunneling techniques are two alternative options for the treatment of cardial submucosal tumors (SMTs). We aimed to establish a regression model and develop a simple scoring system (Zhongshan Tunnel Score) to help clinicians make surgical decisions for cardial submucosal tumors. A total of 246 patients who suffered cardial SMTs and received endoscopic resection were included in this study. All of them were randomized into either the training cohort (n = 147) or the internal validation cohort (n = 99). Then, the scoring system was proposed based on multivariate logistic regression analysis in the training cohort and assessed in the validation cohort. Of 246 patients, 97 were treated with STER and the others with non-tunneling endoscopic resection. In the training stage, four factors were weighted with points based on the β coefficient from the regression model, including irregular morphology (-2 points), ulcer (2 points), the direction of the gastroscope (-2 points for forward direction and 1 point for reverse direction), and originating from the muscularis propria (-2 points). The patients were categorized into low-score (< -4), medium-score (-4 to -3) and high-score (> -3) groups, and those with low scores were more likely to be treated with STER. Our score model performed satisfying discriminatory power in internal validation (Area under the receiver-operator characteristic curve, 0.829; 95 % confidence interval, 0.694-0.964) and goodness-of-fit in the Hosmer-Lemeshow test (  = .4721). This scoring system could provide clinicians the references for making decisions about the treatment of cardial submucosal tumors.
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http://dx.doi.org/10.1055/a-1775-7976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010105PMC
April 2022

Comparison of safety and short-term outcomes between endoscopic and laparoscopic resections of gastric gastrointestinal stromal tumors with a diameter of 2-5 cm.

J Gastroenterol Hepatol 2022 Jul 5;37(7):1333-1341. Epub 2022 Apr 5.

Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

Background And Aim: Developments of endoscopic techniques brought the possibility of endoscopic resection for gastrointestinal stromal tumors (GISTs) of larger sizes. We aim to compare safety and short-term outcomes between endoscopic and laparoscopic resections of gastric GISTs with a diameter of 2-5 cm.

Methods: This is a single-center, retrospective cohort study. The clinical data, perioperative conditions, and the adverse events of patients who underwent endoscopic or laparoscopic resection for gastric GIST of 2-5 cm in Zhongshan Hospital, Fudan University, from January 2016 to December 2020 were retrospectively reviewed.

Results: A total of 346 patients were reviewed; 12 patients who failed to accomplish the planned procedure were excluded; 182 underwent laparoscopic resection; and 152 underwent endoscopic resection. Significant differences exist in the tumor size between the laparoscopic group (3.43 ± 0.86 cm) and the endoscopic group (2.78 ± 0.73 cm) (P < 0.01). Compared with laparoscopic resection, endoscopic resection was associated with faster recovery (P < 0.01), shorter hospital stays (P < 0.01), and lower cost (P < 0.01). The incidence of Clavien-Dindo grade II-V adverse events in the endoscopic group (3/152) was significantly lower than that in the laparoscopic group (12/182) (P = 0.04). After a propensity score matching analysis, the endoscopic group showed similar incidences of complications with the laparoscopic group, while the advantages over laparoscopic resection in postoperative hospital stay, time to first oral intake, and hospitalization expenses remained significant (P < 0.01).

Conclusions: Endoscopic resection is a safe and cost-effective method for 2-5 cm of gastric GISTs compared with laparoscopic resection.
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http://dx.doi.org/10.1111/jgh.15834DOI Listing
July 2022

Repeat endoscopic submucosal dissection as salvage treatment for local recurrence of esophageal squamous cell carcinoma after initial endoscopic submucosal dissection.

Gastrointest Endosc 2022 07 1;96(1):18-27.e1. Epub 2022 Mar 1.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.

Background And Aims: Local recurrence of esophageal squamous cell carcinoma (ESCC) after endoscopic resection does not have an established treatment. The efficacy and safety of repeat endoscopic submucosal dissection (ESD) for recurrent ESCC were determined in the study.

Methods: Forty-three consecutive patients with 45 locally recurrent superficial ESCC lesions undergoing repeat ESD and 909 first ESD lesions for propensity score matching (PSM) at Zhongshan Hospital between January 2011 and January 2020 were retrospectively enrolled. After PSM (1:2), operation-related parameters were compared between repeat ESD and first ESD. In the repeat ESD group, the Kaplan-Meier method and log-rank tests were used for identification of risk factors for local recurrence after repeat ESD.

Results: As compared with propensity score-matched first ESD, rates of complete resection (86.7% vs 97.8%, P = .02) and curative resection (86.7% vs 96.7%, P = .06) were lower and procedure duration (54.8 ± 21.7 minutes vs 46.2 ± 20.6 minutes, P = .67) and hospital stay (4.3 ± 1.8 days vs 2.9 ± 1.4 days, P = .25) were longer in the repeat ESD group. The en-bloc resection rate (93.3% vs 98.8%, P > .11) remained comparable. Adverse events including bleeding (4.4% vs 0%, P = .11), perforation (.0% vs .0%, P > .99), and stricture (6.7% vs 2.2%, P = .33) presented with no difference. The 5-year overall survival rate and recurrence-free survival rate for repeat ESD was 100% and 86.0%, respectively. Multiplicity was significantly associated with recurrence after repeat ESD (P = .01).

Conclusions: Repeat esophageal ESD showed favorable short- and long-term outcomes and thus provides an alternative choice for recurrent superficial ESCC.
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http://dx.doi.org/10.1016/j.gie.2022.02.043DOI Listing
July 2022

Submucosal tunneling cecetomy in a dog: is it applicable for appendectomy in human?

Endoscopy 2022 Feb 15. Epub 2022 Feb 15.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

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http://dx.doi.org/10.1055/a-1740-3980DOI Listing
February 2022

Long-term prognosis of small gastric gastrointestinal stromal tumors with high histological grade: a longitudinal nested cohort study.

Surg Endosc 2022 06 8;36(6):4042-4049. Epub 2022 Feb 8.

Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.

Background And Aims: Gastrointestinal stromal tumors (GIST) are mostly seen in the stomach. Clinical data on GISTs ≤ 2 cm with > 5 mitosis/50 HPFs are limited. This study aimed to analyze small GISTs with high histological grades to gain a more comprehensive understanding of their clinical characteristics with long-term follow-up.

Methods: This was a nested cohort study of patients with gastric GISTs ≤ 2 cm and > 5 mitosis/50 HPFs. Individuals with endoscopically resected gastric specimens diagnosed as GISTs between January 2008 and July 2019 were enrolled. We analyzed baseline clinicopathological characteristics, perioperative characteristics, risk of recurrence, and metastasis during follow-up.

Results: A total of 55 patients diagnosed with gastric GISTs ≤ 2 cm and > 5 mitosis/50 HPFs were enrolled. The mean tumor size was 1.6 ± 0.4 cm (median 1.7 cm, range 0.8-2.0 cm). ESD was performed in 33 patients (60.0%) and EFTR in 22 patients (40.0%). Mean mitotic figures were 8.9/50 HPFs. Postoperative bleeding in one patient (1.8%) was the only severe adverse event. The mean follow-up period was 61.2 ± 33.9 months (median 53 months, range 13-133 months). Five patients (5/55, 9.1%) received additional therapies, including partial gastrectomy and adjuvant Imatinib. Only two patients (2/55, 3.6%) showed signs of recurrence. We observed no significant difference regarding baseline clinical characteristics and recurrence among GISTs with mitosis < 10/50 HPF and ≥ 10/50 HPF. No patient had signs of metastasis during follow-up.

Conclusion: Endoscopic resection of gastric GISTs ≤ 2 cm with > 5 mitosis/50 HPFs has a low risk of recurrence and metastasis in the long term. Endoscopic resection of GISTs is safe and feasible.
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http://dx.doi.org/10.1007/s00464-021-08725-2DOI Listing
June 2022

Severe septic shock after colonoscopic polypectomy.

J Dig Dis 2022 Feb 3;23(2):130-132. Epub 2022 Feb 3.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

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http://dx.doi.org/10.1111/1751-2980.13080DOI Listing
February 2022

Transgastric Endoscopic Resection of a Superficial Pancreatic Tumor: The First Report in Human Beings.

Am J Gastroenterol 2022 03;117(3):373-374

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

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http://dx.doi.org/10.14309/ajg.0000000000001603DOI Listing
March 2022

Novel technique for treating intussuscepted intestinal Meckel's diverticulum: enteroscopic intestinal diverticulum dissection (EIDD).

Endoscopy 2021 Dec 21. Epub 2021 Dec 21.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

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http://dx.doi.org/10.1055/a-1704-6783DOI Listing
December 2021

Transesophageal endoscopic resection of mediastinal cysts (with video).

Gastrointest Endosc 2022 Apr 4;95(4):642-649.e2. Epub 2021 Dec 4.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

Background And Aims: Primary mediastinal cysts are infrequent lesions derived from a variety of mediastinal organs or structures. Complete surgical resection is the treatment of choice even in asymptomatic patients to prevent severe adverse events (AEs) and to establish the diagnosis. Transesophageal endoscopic resection of benign mediastinal tumors has been proven feasible. The aim of this study was to evaluate the feasibility, safety, and efficacy of transesophageal endoscopic surgery for mediastinal cysts.

Methods: From January 2016 to May 2021, patients with mediastinal cysts who underwent transesophageal endoscopic resection were retrospectively included. Clinicopathologic characteristics, procedure-related parameters, AEs, and follow-up outcomes were analyzed.

Results: Ten patients with mediastinal cysts were included in this study. The mean cyst size was 3.3 ± 1.3 cm. Histopathology revealed 3 bronchogenic cysts (30.0%), 4 esophageal duplication cysts (40.0%), 2 gastroenteric cysts (20.0%), and 1 lymphatic cyst (10.0%). All procedures were performed uneventfully without conversion to traditional surgery. En-bloc resection was achieved in 6 patients (60.0%). Aggressive resection was avoided to prevent damage to the surrounding vital organs. Mean resection time and suture time were 58.0 ± 36.4 minutes and 5.4 ± 1.0 minutes, respectively. No major pneumothorax, bleeding, mucosal injury, or fistula occurred. One patient had a transient febrile episode (>38.5°C). Mean postoperative hospital stay was 2.7 ± .9 days. No residual or recurrent lesions were observed in any patient during a mean follow-up period of 29.8 ± 19.5 months.

Conclusions: Transesophageal endoscopic surgery appears to be a feasible, safe, effective, and much less invasive approach for mediastinal cyst resection. Larger prospective studies are required to fully assess the efficacy and safety of this novel technique.
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http://dx.doi.org/10.1016/j.gie.2021.11.031DOI Listing
April 2022

Endoscopic submucosal dissection for giant esophageal lipomatous tumors.

J Gastroenterol Hepatol 2022 Feb 30;37(2):358-362. Epub 2021 Nov 30.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

Background And Aim: Thoracotomy is the foremost choice of giant esophageal lipomatous tumors in previous studies, but it is highly traumatic and possibly diminishes the quality of patients' lives. To minimize such impacts, a minimally invasive method without loss of curability is desirable for giant lipomatous tumors of the esophagus. With recent progress in endoscopic techniques and devices, endoscopic submucosal dissection (ESD) has been successfully used to remove esophageal or gastric submucosal tumors. In our study, we aimed to evaluate the clinical impact of ESD for giant esophageal lipomatous tumors.

Methods: Design, single-center, retrospective study; setting, academic medical center; patients, six patients with six giant lipomatous tumors of the esophagus between February 2013 and December 2020; interventions, ESD; and main outcome measurements, procedure duration, en bloc resection rate, complications, local recurrence, and distant metastases.

Results: Endoscopic en bloc resections of esophageal lipomatous tumors were successfully performed in all patients, with a mean duration of 56.5 ± 26.0 min. All en bloc resection lesions showed both lateral and deep tumor-free margins. The average maximum diameter of the esophageal lipomatous tumors was 171.7 ± 66.2 mm. No complications such as bleeding and perforations happened during hospitalization with 4.0 ± 1.6 days. Besides, local recurrence and distant metastasis have not occurred during the follow-up period.

Conclusions: Endoscopic submucosal dissection is a safe and effective way to dissect giant lipomatous tumors of the esophagus thoroughly.
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http://dx.doi.org/10.1111/jgh.15737DOI Listing
February 2022

Anthropomorphic Reaching Movement Generating Method for Human-Like Upper Limb Robot.

IEEE Trans Cybern 2021 Oct 18;PP. Epub 2021 Oct 18.

How to generate anthropomorphic reaching movement remains a challenging problem in service robots and human motor function repair/reconstruction equipment. However, there is no universally accepted computational model in the literature for reproducing the motion of the human upper limb. In response to the problem, this article presents a computational framework for generating reaching movement endowed with human motion characteristics that imitated the mechanism in the control and realization of human upper limb motions. This article first establishes the experimental paradigm of human upper limb functional movements and proposes the characterization of human upper limb movement characteristics and feature movement clustering methods in the joint space. Then, according to the specific task requirements of the upper limb, combined with the human sensorimotor model, the estimation method of the human upper limb natural postures was established. Next, a continuous task parametric model matching the characteristic motion class is established by using the Gaussian mixture regression method. The anthropomorphic motion generation method with the characteristics of the smooth trajectory and the ability of natural obstacle avoidance is proposed. Finally, the anthropomorphic motion generation method proposed in this article is verified by a human-like robot. The measurement index of the human-likeness degree of the trajectory is given. The experimental results show that for all four tested tasks, the human-likeness degrees were greater than 90.8%, and the trajectories' jerk generated by this method is very similar to the trajectories' jerk of humans, which validates the proposed method.
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http://dx.doi.org/10.1109/TCYB.2021.3107341DOI Listing
October 2021

Natural orifice transluminal endoscopic mediastinal surgery: NOTEMS, a promising field for endotherapy.

Endoscopy 2022 Jul 9;54(7):E357-E359. Epub 2021 Aug 9.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

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http://dx.doi.org/10.1055/a-1540-5732DOI Listing
July 2022

Correction to: Nexus between agro-ecological efficiency and carbon emission transfer: evidence from China.

Environ Sci Pollut Res Int 2021 Aug;28(32):44581

College of Economics and Management, Shenzhen University, Shenzhen, Guangdong Province, China.

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http://dx.doi.org/10.1007/s11356-021-14461-wDOI Listing
August 2021

Prenatal diagnosis of complete vascular ring using high-definition flow render mode and spatiotemporal image correlation.

Echocardiography 2021 03 15;38(3):488-492. Epub 2021 Feb 15.

Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China.

Vascular rings (VRs) are defined as congenital abnormalities of the aortic arch and its branches. VR can form a ring that may compress the esophagus and trachea, which likely result in feeding difficulties and respiratory distress. Physicians performing fetal echocardiography are knowledgeable about VRS and can provide this information to pediatric cardiothoracic surgeons. However, VRs are rare and can be missed. The three vessels and trachea (3VT) view used to diagnose VRs has been reported in the literature multiple times but in a small series. We diagnosed three cases of VRs using high-definition (HD) flow render mode and spatiotemporal image correlation (STIC). The composition of the VRs and vessel connections were shown more intuitively. This article reports our experience of the following related cases. In addition, postnatal imaging features of VRs were also evaluated.
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http://dx.doi.org/10.1111/echo.14919DOI Listing
March 2021

The etiology of achalasia: An immune-dominant disease.

J Dig Dis 2021 Mar;22(3):126-135

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

There is accumulating evidence suggesting that an autoimmune component is involved in esophageal achalasia. An increase in immune cells, cytokines, chemokines, and autoimmune antibodies in serum and infiltration of immune cells in tissues support the view that immune-mediated inflammation is a crucial pathogenesis of inhibitory neuron degeneration in the lower esophageal sphincter. Infection of viruses such as the herpes virus family has been suspected of provoking the autoimmune reaction. Meanwhile, previous reports on immunogenetics have proposed that specific risk alleles on the human leukocyte antigen complex define the susceptible population to achalasia. In this study we reviewed current knowledge regarding the immune-related factors of achalasia, including immunology, viral infection and immunogenetic variations.
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http://dx.doi.org/10.1111/1751-2980.12973DOI Listing
March 2021

Controlled hypertension under hemostasis prevents post-gastric endoscopic submucosal dissection bleeding: a prospective randomized controlled trial.

Surg Endosc 2021 10 4;35(10):5675-5685. Epub 2021 Feb 4.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.

Background: Endoscopic submucosal dissection (ESD) is a prominent minimally invasive operative technique for treating early gastrointestinal tumors but can result in postoperative bleeding. We conducted a randomized controlled trial to determine whether increasing blood pressure under hemostasis during gastric ESD to identify potential bleeding spots reduces the risk of post-ESD bleeding.

Methods: In this randomized, controlled, single-blinded clinical trial, 309 patients with early gastric cancer who were admitted to a hospital to undergo ESD were recruited from March 2017 to February 2018 and were randomized into intervention and control groups. In the control group, patients underwent normal ESD. In the intervention group, we increased patients' blood pressure to 150 mmHg for 5 min using a norepinephrine pump (0.05 μg/kg/min initial dose) after the specimen was extracted during the ESD operation to identify and coagulate potential bleeding spots with hot biopsy forceps. Our primary outcome was the incidence of postoperative bleeding over 60-day follow-up.

Results: The incidence of post-ESD bleeding was lower in the intervention group (1.3%, 2/151) than in the control group (10.1%, 16/158, p = 0.01). Deeper tumor invasion was associated with a higher risk of post-ESD bleeding (5.3% in mucosal/submucosal layer 1 group vs. 12.5% in submucosal layer 2/muscularis propria group, p < 0.001). Multi-factor but not univariate analysis showed that proton pump inhibitor administration three times per day may be a better choice than twice per day.

Conclusion: Increasing blood pressure under hemostasis during ESD to identify and coagulate potential bleeding spots could reduce the risk of delayed bleeding after gastric ESD.
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http://dx.doi.org/10.1007/s00464-020-08256-2DOI Listing
October 2021

NETO2 promotes esophageal cancer progression by inducing proliferation and metastasis via PI3K/AKT and ERK pathway.

Int J Biol Sci 2021 1;17(1):259-270. Epub 2021 Jan 1.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, No. 180 FengLin Road, Shanghai 200032, China.

Esophageal squamous cell carcinoma (ESCC) causes aggressive and lethal malignancies with extremely poor prognoses, and accounts for about 90% of cases of esophageal cancer. Neuropilin and tolloid-like 2 (NETO2) protein coding genes have been associated with various human cancers. Nevertheless, little information is reported about the phenotypic expression and its clinical significance in ESCC progression. Here, our study found that NETO2 expression in ESCC patients was associated with tumor clinical stage and lymph node metastasis status. Gain-of-function and loss-of-function analyses showed that NETO2 stimulated ESCC cell proliferation while suppressing apoptosis and enhanced tumor growth . Moreover, knockdown of NETO2 significantly inhibited migration and invasion in combination with regulation of epithelial-mesenchymal transition (EMT) related markers. Mechanistically, overexpression of NETO2 increased the phosphorylation of ERK, PI3k/AKT, and Nuclear factor erythroid-2-related factor 2(Nrf2), whereas silencing NETO2 decreased the phosphorylation of these targets. Our data suggest that Nrf2 was a critical downstream event responsible for triggering the PI3K/AKT and ERK signaling pathways and plays a crucial role in NETO2-mediated tumorigenesis. Taken together, NETO2 acts as an oncogene and might serve as a novel therapeutic target or prognostic biomarker in ESCC patients.
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http://dx.doi.org/10.7150/ijbs.53795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757043PMC
January 2022

Endoscopic removal of entirely embedded esophagus-penetrating foreign bodies (with video).

J Gastroenterol Hepatol 2021 Jul 14;36(7):1899-1904. Epub 2021 Jan 14.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

Background And Aim: Traditionally, surgery is the only choice for esophageal foreign bodies (FBs) penetrating into the mediastinum or cervical para-esophageal space. Recent progress in endoscopic techniques and devices has made it possible to perform endoscopic procedures in the mediastinum. Here, we describe a novel method to remove the entirely embedded esophagus-penetrating FBs through an endoscopic approach.

Methods: Patients who underwent endoscopic removal of entirely embedded esophagus-penetrating FBs were prospectively enrolled between December 2018 and June 2020. All procedures were performed by using five major steps: localization of the FB; mucosal incision; wound debridement, myotomy, and FB exposure; FB extraction; and closure of the esophageal wound.

Results: A total of five cases of entirely embedded esophagus-penetrating FBs were evaluated, two in children and three in adults. All FBs were successfully removed and extracted using a therapeutic endoscope and a hook knife or a hybrid knife and a grasping forceps as accessories. The average procedure time was 19.0 ± 12.4 min (range 10-40 min). The major surgical procedure was avoided in all patients. The average length of hospital stay was 3.8 ± 2.5 days (range 2-8 days). There were no severe short-term adverse events after all procedures. During the 1 month and 3 months follow-up, no patient developed long-term adverse events including stenosis of the esophagus and fistula formation.

Conclusions: Endoscopic approach was a safe and effective way to remove entirely embedded esophagus-penetrating FBs.
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http://dx.doi.org/10.1111/jgh.15392DOI Listing
July 2021

Nexus between agro-ecological efficiency and carbon emission transfer: evidence from China.

Environ Sci Pollut Res Int 2021 Apr 20;28(15):18995-19007. Epub 2020 Jun 20.

College of Economics and Management, Shenzhen University, Shenzhen, Guangdong, People's Republic of China.

The economy of China is growing rapidly. With this overwhelming growth, the country is experiencing a higher level of carbon emissions. Amid this backdrop, China is under immense pressure to reduce carbon emissions up to a sustainable level. This study adapted 31 provincial panel data from 2007 to 2017 using factor analysis system SBM-undesirable model to calculate the agro-ecological output of each province respectively and used a carbon transfer network impact analysis panel to calculate ecological performance impacts. Results show that (1) overall agro-ecological efficiency in China shows an upward trend but regional differences are evident. The efficiency in the eastern region is higher than that in the central and western regions but the extent of informatization in the central region is higher than that in the western region. (2) Informatization will significantly promote agro-ecological efficiency. (3) Changes in agricultural planting structure, agricultural value-added per capita, employment of human capital in the agricultural sector, and agricultural scale management are also important factors affecting agro-ecological growth. (4) China's amount of carbon transfer is growing year by year, and energy-intensive areas and heavy industry bases are undertaking carbon transfer from the eastern coastal regions; (5) Jiangsu, Henan, and Hebei (Hubei) have the highest centers between 2007 and 2012; (6) inter-provincial carbon transmission is concentrated mainly in the metal smelting and rolling processing industries as well as in the coal, heat, and supply industries.
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http://dx.doi.org/10.1007/s11356-020-09614-2DOI Listing
April 2021

Endoscopic transgastric cholecystectomy: a novel approach for minimally invasive cholecystectomy.

Endoscopy 2021 Feb 5;53(2):E50-E51. Epub 2020 Jun 5.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

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http://dx.doi.org/10.1055/a-1180-7661DOI Listing
February 2021

Short- and long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell cancer in patients with prior gastrectomy.

Surg Endosc 2021 05 19;35(5):2229-2239. Epub 2020 May 19.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China.

Background: The surgery for esophageal cancer arising after prior gastrectomy is technically difficult with high morbidity and mortality. Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic treatment for superficial SCC with high curative resection rate. But few studies are concerned about ESD under these circumstances. The aim of this study was to elucidate the short- and long-term outcomes of ESD for superficial esophageal squamous cell cancer (SCC) in patients with prior gastrectomy.

Methods: From January 2009 to January 2019, 37 patients with prior gastrectomy who underwent ESD for superficial esophageal SCC were retrospectively enrolled at the Zhongshan Hospital, Fudan University in Shanghai, China. Rates of en bloc resection, complete resection, curative resection, incidence of postoperative bleeding, perforation and postoperative stricture were evaluated as short-term outcomes. Overall survival, and local recurrence-free survival were evaluated as long-term outcomes.

Results: The rate of en bloc resection, complete resection and curative resection were 94.6%, 86.5% and 78.4%, respectively. No perforation was observed. 1 (2.7%) patient experienced postoperative bleeding. During the median observation of 43 months, 3 (8.6%) patients experienced esophageal stricture, successfully managed by balloon dilation. 3(8.6%) patients had local recurrence after ESD with 5-year local recurrence-free survival rate of 91.4%. During the observation period, 4 patients died of other reasons. The 1, 3, 5-year overall survival rates were 97.1%, 97.1% and 91.4%.

Conclusions: The short-term outcomes indicate ESD is technically difficult with lower resection completeness in patients after gastrectomy, while the long-term outcomes are rather favorable.
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http://dx.doi.org/10.1007/s00464-020-07636-yDOI Listing
May 2021

Multiplex immunoassays reveal increased serum cytokines and chemokines associated with the subtypes of achalasia.

Neurogastroenterol Motil 2020 06 5;32(6):e13832. Epub 2020 Mar 5.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

Background: Achalasia is an esophageal motility disorder with unknown etiology. Previous findings indicate that immune-mediated inflammatory process causes inhibitory neuronal degeneration. This study was designed to evaluate levels of serological cytokines and chemokines in patients with achalasia.

Methods: We collected information from forty-seven patients with achalasia who underwent peroral endoscopic myotomy. Control samples were collected from forty-seven age- and sex-matched healthy people. The concentrations of serological cytokines and chemokines were analyzed by Luminex xMAP immunoassay. Serological and clinical data were compared between groups.

Key Results: Compared with healthy controls, achalasia patients had significantly increased concentrations of eleven cytokines and chemokines, namely, TGF-ß1 (P < .001), TGF-ß2 (P < .001), TGF-ß3 (P < .001), IL-1ra (P < .001), IL-17 (P = .005), IL-18 (P < .001), IFN-γ (P < .001), MIG (P < .001), PDGF-BB (P < .001), IP-10 (P = .003), and SCGF-B (P < .001). Gene ontology (GO) and network functional enrichment analysis revealed regulation of signaling receptor activity and receptor-ligand activity were the most related pathways of these cytokines and chemokines. Levels of twelve cytokines and chemokines were significantly increased in type III compared with I/II achalasia, namely, TGF-ß2, IL-1ra, IL-2Ra, IL-18, MIG, IFN-γ, SDF-1a, Eotaxin, PDGF-BB, IP-10, MCP-1, and TRAIL.

Conclusions And Inferences: Patients with achalasia exhibited increased levels of serological cytokines and chemokines. Levels of cytokines and chemokines were significantly increased in type III than in type I/II achalasia. Cytokines and chemokines might contribute to the inflammatory development of achalasia.
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http://dx.doi.org/10.1111/nmo.13832DOI Listing
June 2020
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