Objectives . Endoscopic submucosal dissection (ESD) for early colorectal neoplasms is regarded as a difficult technique and should commence after receiving the experiences of ESD in the stomach. The implementation of colorectal ESD in countries where early gastric cancer is uncommon might therefore be difficult. The aim is to delineate the feasibility and the learning curve of colorectal ESD performed by a colonoscopist with limited experience of gastric ESD. Methods . The first fifty cases of colorectal ESD, which were performed by a single colonoscopist between July 2010 and April 2013, were enrolled. Results . The mean of age was 64 (±9.204) years with mean size of neoplasm at 33 (±12.63) mm. The mean of procedure time was 70.5 (±48.9) min. The rates of en bloc resection, R0 resection, and curative resection were 86%, 86%, and 82%, respectively. Three patients had immediate perforation, but no patient developed delayed perforation or delayed bleeding. Conclusion . Our result disclosed that it is feasible for colorectal ESD to be performed by a colonoscopist with little experience of gastric ESD through satisfactory training and adequate case selection.
Because noise can interfere with downstream analysis, image denoising has come to occupy an important place in the image processing toolbox. The most accurate state-of-the-art denoisers typically train on a representative dataset. But gathering a training set is not always feasible, so interest has grown in blind zero-shot denoisers that train only on the image they are denoising. The most accurate blind-zero shot methods are blind-spot networks, which mask pixels and attempt to infer them from their surroundings. Other methods exist where all neurons participate in forward inference, however they are not as accurate and are susceptible to overfitting. Here we present a hybrid approach. We first introduce a semi blind-spot network where the network can see only a small percentage of inputs during gradient update. We then resolve overfitting by introducing a validation scheme where we split pixels into two groups and fill in pixel gaps using domino tilings. Our method achieves an average PSNR increase of $0.28$ and a three fold increase in speed over the current gold standard blind zero-shot denoiser Self2Self on synthetic Gaussian noise. We demonstrate the broader applicability of Pixel Domino Tiling by inserting it into a preciously published method.
Aims. To assess the effects of exercise intervention on nurses’ health‐related physical fitness. Background. Regular exercise that includes gymnastics or aerobics has a positive effect on fitness. In Taiwan, there are not much data which assess the effects of exercise intervention on nurses’ health‐related physical fitness. Many studies have reported the high incidence of musculoskeletal disorders (MSDs) in nurses However, there has been limited research on intervention programs that are designed to improve the general physical fitness of nurses. Design. A quasi‐experimental study was conducted at a medical centre in central Taiwan. Methods. Ninety nurses from five different units of a hospital volunteered to participate in this study and participated in an experimental group and a control group. The experimental group engaged in a three‐month intervention program consisting of treadmill exercise. Indicators of the health‐related physical fitness of both groups were established and assessed before and after the intervention. Results. Before intervention, the control group had significantly better grasp strength, flexibility and durability of abdominal muscles than the experimental group ( p < 0·05). After the intervention, logistic regression was used to adjust for marital status, work duration, regular exercise and workload and found that the experimental group performed significantly better ( p < 0·05) on body mass index, grasp strength, flexibility, durability of abdominal and back muscles and cardiopulmonary function. Conclusions. This study demonstrates that the development and implementation of an intervention program can promote and improve the health‐related physical fitness of nurses. Relevance to clinical practice. It is suggested that nurses engage in an exercise program while in the workplace to lower the risk of MSDs and to promote working efficiency.
Rectal neuroendocrine tumors (NETs) account for one‐third of all digestive NETs and are often incidentally found during colonoscopy. They also carry the risk of metastasis. Given their subepithelial growth, complete removal, R0 resection, is a challenge for endoscopists. Inadequate endoscopic management would lead to incomplete removal and additional complications for surveillance. The aim of this study is to compare R0 resection rates among all endoscopic methods. The database of our pathology department was reviewed from January 2005 to July 2015. Diagnoses of carcinoid and NETs located at rectum were enrolled. NETs removed by endoscopy were further selected for analysis. R0 resection was defined as being free of tumor at lateral and vertical margins on pathological examination. Three methods of endoscopic management were performed for our patients; these were snare polypectomy, endoscopic submucosal resection‐ligation assisted (ESMR‐L), and endoscopic submucosal dissection (ESD). In all, 48 rectal NETs were diagnosed. Thirty‐six rectal NETs were removed by endoscopy. Pathology validated hepatic metastasis was found in a patient with18 mm tumor size and G2 mitosis. The R0 resection rates for snare polypectomy, ESMR‐L, and ESD were 33.3% (6/18), 90.9% (10/11), and 100% (7/7) respectively ( P = 0.001). Procedure time for the ESMR‐L group (5.36 min) was shorter than the ESD group (38.86 min) ( P < 0.001). Percentage of patients receiving endoscopic ultrasonography before endoscopic management also revealed significant differences among the three groups (3/18, 16.7%; 6/11, 54.5%; 7/7, 100%; P = 0.001). ESD offered the highest R0 resection rate, followed by ESMR‐L and snare polypectomy. However, ESMR‐L has shorter procedure time.
Aquagenic urticaria, a type of physical urticaria, is quite rare and only about 50 cases have been reported in the medical literature. It was first described by Shelley and Rawnsley in 1964. Wheals occur when a patient's skin makes contact with any type of water within 30 minutes of exposure, and can last for 30 minutes to 2 hours after cessation of exposure. Aquagenic urticaria most commonly develops on the trunk and upper limbs. It is sometimes associated with pruritus and an uncomfortable prickling or burning sensation. To the best of our knowledge, no case of aquagenic urticaria from Taiwan has been reported. Herein, we present a young Taiwanese male patient diagnosed with aquagenic urticaria.
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