Influences of etiology and endoscopic appearance on the long-term outcomes of ga

lNTRODUCTlON

Gastric antral vascular ectasia (GAVE), also known as “watermelon stomach”, is a rare clinical condition related to upper gastrointestinal (GI) bleeding, which varies from chronic occult blood loss requiring serial transfusions to acute hemorrhage[1]. GAVE was first described by Rider

[2] in 1953 and fully defined by Jabbari

[3] in 1984

who described patients with hyperemic striae in gastric antrum.GAVE is characterized by a unique endoscopic appearance, which takes two forms, punctate (a diffuse,honeycomb-like appearance) and striped (a linear, watermelon-like appearance). Striped GAVE has the endoscopic appearance of red stripes radiating from antrum and converging at pylorus, whereas the punctate form is characterized by diffuse red spots indicating dilated blood vessels in antrum.

虽然乳腺肉瘤生物学各异，术前很难确诊，需经病理诊断。手术仍是本病主要的治疗手段，对于肿块较大，组织学分化差，淋巴转移等含高危因素较多的患者应行广泛切除术；对于低危的患者可行肿瘤局部扩大切除术；由于本病较少出现淋巴转移，可不行淋巴结清扫术；对于恶性程度高，分化差的肿瘤，应辅以放化疗，减少患者复发，提高生存。

Liver cirrhosis is the most frequent underlying condition associated with GAVE and portal hypertension is seen in approximately 40% of reported cases[4,5], though GAVE may not respond to therapies directed at reducing portal pressure. In addition, GAVE has been associated with other diverse medical conditions including chronic renal failure, diabetes, and autoimmune and connective tissue disorders such as systemic lupus erythematosus, rheumatoid arthritis, and systemic sclerosis[6-10]

Thus, the heterogeneity of underlying diseases observed in GAVE patients suggests its pathogenesis may be variable[11].

Argon plasma coagulation (APC) treatment for GAVE consisted of electrocoagulation of all angiectatic lesions during an endoscopic session with an APC probe introduced through the working channel of an endoscope. Argon gas flow ranged from 0.8 L/min to 1 L/min, and electric power output from 50 W to 70 W. Angioectasia was managed using a combination of focal pulse and ‘‘spray-painting’’ techniques.During endoscopic sessions, argon and coagulation smoke were regularly aspirated, and coagulum on probes was removed when required. Treatment time per session varied from 20 min to 40 min. All patients received PPI therapy for 3 wk to 4 wk to promote mucosal healing after the procedure. The endpoint of treatment was defined as complete or near complete disappearance of vascular ectasia. In cases of anemia recurrence requiring transfusion of packed red blood cells or cases of overt GI bleeding recurrence, another APC session was performed. The criteria for successful APC treatment were cessation of GI bleeding and the need for transfusion. Numbers of APC sessions per patient were documented and APC treatment success rates were evaluated.

常荆夫，小学赶上非典，初中赶上禽流感与武汉中考改革，高中遇上甲流，大学遇上2012的一辈人。喜爱文学，本科语言学专业，贯彻维特根斯坦初期的几条原则，对于不可言说之物沉默相待，对于可以被言说的一切尝试着更加文学和清晰的言说。

MATERlALS AND METHODS

Study design and patients

This retrospective cohort study was approved by the Institutional Review Board of Yeungnam University Hospital (IRB No. 2021-10-044), which waived the requirement for written informed consent due to the retrospective nature of the study. We reviewed the medical records of 23 consecutive patients diagnosed with GAVE by endoscopy at our institution from January 2006 to December 2020. Baseline demographic data such as gender, etiology of liver disease, and severity of liver disease (as determined using Child-Pugh scores) were collected, as were details of medical comorbidities (liver cirrhosis,chronic renal failure, autoimmune or connective tissue disease, diabetes, and others), medications[proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), and anticoagulant and antiplatelet use], and follow-up durations. Laboratory findings such as hemoglobin levels, platelet counts, serum urea nitrogen and creatinine, serum albumin, and prothrombin activity were also reviewed. Patients were categorized into two groups based on the presence (16 patients) or absence (7 patients) of cirrhosis. Cirrhosis was diagnosed based on a combination of clinical findings, liver function tests, and computed tomographic or ultrasonographic appearances of liver and spleen. Only patients aged 18 or older were included in the analysis. Median follow-up duration was 24 mo (range 6-84 mo)in the cirrhosis group and 26 mo (range 4-96 mo) in the non-cirrhosis group.

Diagnosis and endoscopic classification

GAVE was diagnosed during upper GI endoscopy by skilled gastroenterologists. Histologic specimens were not required to differentiate GAVE from portal hypertensive gastropathy. GAVE was diagnosed primarily based on endoscopic patterns and in uncertain cases by histology[12]. Endoscopy reports and photographs were reviewed independently by two gastroenterologists (Cho JH and Kwon HJ) unaware of clinical statuses. When these two gastroenterologists disagreed regarding diagnoses, a third independent gastroenterologist (Lee SH) reviewed the information available and made final decisions.Patients were classified into one of two groups according to the two typical endoscopic appearances of GAVE, that is, to a “punctate” (diffuse, honeycomb) group (17 patients) with sharply demarcated red spots diffusely spread within antrum (Figure 1A) or a “striped” (linear, watermelon) type group (6 patients) with prominent flat or raised red stripes radiating longitudinally from pylorus to antrum(Figure 1B)[6]. During upper GI endoscopy, bleeding from GAVE lesions and the presence of other nonbleeding lesions were noted (these included lesions due to portal hypertension in patients with cirrhosis). Overt GI bleeding was defined based on the presence of symptoms, such as hematemesis,melena, or hematochezia, a change in hemodynamics, or gross bleeding by upper GI endoscopy.Median follow-up duration was 23 mo (range 6-84 mo) in the punctate group and 27 mo (range 4-96 mo)in the striped group.

Endoscopic procedure

Epidemiologic evidence indicating that the clinical outcomes of GAVE patients with or without cirrhosis differ is lacking. Although numerous studies have investigated GAVE and many case reports and series have been reported, little information is available on the effects of its etiologies and gross endoscopic appearances on long-term clinical courses or outcomes, especially in Asians. In this study,we aimed to determine whether the presence of cirrhosis and endoscopic patterns are related to the clinical features and course of GAVE.

Statistical analysis

The characteristics of patients in the punctate and striped groups at diagnosis are summarized in Table 2. Mean age was significantly greater in the striped group (70.8 ± 6.3

56.1 ± 12.0,

= 0.011). Men predominated in the punctate group (13/17, 76.5%), and women predominated in the striped group(5/6, 83.3%). Group BMIs were not significantly different. Sixteen of the 17 patients in the punctate group (16/17, 94.1%) had concurrent cirrhosis, whereas no patient in the striped group (0/6, 0%) had cirrhosis (

＜ 0.001). In the striped group, the most common associated disease was chronic kidney disease (5/6, 83.3%), which was followed by diabetes mellitus (3/6, 50%), and patients in this group had an increased prevalence of chronic kidney disease (5/6, 83.3%

2/17, 11.8%;

= 0.014). The frequencies of other associated diseases were not significantly different in the two groups. As regards initial laboratory findings, serum bilirubin was significantly higher in the punctate group (1.88 ± 1.39

0.64 ± 0.41,

= 0.044), but creatinine was significantly higher in the striped group (4.27 ± 2.79

1.07 ±0.45,

= 0.034), and BUN was non-significantly higher in the striped group (51.9 ± 39.9 vs 22.5 ± 13.8,

= 0.130). Mean hemoglobin levels were similar in the punctate and striped groups (7.5 ± 3.4

6.6 ± 1.4,

= 0.528), but platelet counts and serum albumin levels were non-significantly lower in the punctate group (114.5 ± 81.5

159.6 ± 51.1, and 2.51 ± 0.39

3.00 ± 0.59;

= 0.168 and 0.070, respectively). INR was non-significantly higher in the punctate group (1.23 ± 0.26

1.08 ± 0.28, respectively,

= 0.130).

RESULTS

Patient characteristics

Over the fifteen-year study period (January 2006 to December 2020), 23 patients were diagnosed with GAVE at our institution. Mean patient age was 59.8 ± 12.6 years (range 41-79) and 14 (60.9%) were male.Indications for initial endoscopy were screening for varices (8 patients), iron deficiency anemia (5),melena (8), or hematemesis (2). The etiology of cirrhosis was viral in 6 patients, alcohol in 6, autoimmune hepatitis in 1, nonalcoholic steatohepatitis in 1, and others in 2 (Table 1). The Child-Pugh classification was used to grade liver disease severity in cirrhotic patients. Eight patients with cirrhosis were classified as Child-Pugh B (50%), five as A (31.3%), and three as C (18.7%). Ten patients (62.5%) withcirrhosis had esophageal varices.

Comparison between patients with or without cirrhosis

the 2020 Yeungnam University Research Grant.

and this was followed by diabetes mellitus (3/7, 42.9%), and the prevalence of chronic kidney disease was significantly greater in the non-cirrhosis group (5/7, 71.4%

2/16, 12.5%;

= 0.011). The frequencies of other associated diseases, except chronic kidney disease, were similar in the two groups.Although no patient received corticosteroids or NSAIDs, 2 patients in the non-cirrhosis group were on antiplatelet or anticoagulant medication, respectively, which did not amount to a significant difference versus the cirrhotic group. As regards initial laboratory findings, platelet count and serum albumin level were significantly lower in the cirrhosis group (103.9 ± 73.0 k/μL

176.8 ± 62.2 k/μL,

= 0.041; and 2.52 ± 0.36 g/dL

3.03 ± 0.60 g/dL,

= 0.048, respectively). Mean hemoglobin levels were not significantly different in the cirrhosis and non-cirrhosis groups (7.8 ± 3.4

6.2 ± 1.6, respectively,

=0.494). Total bilirubin and international normalized ratio (INR) were non-significantly greater in the cirrhosis group (1.74 ± 1.35

1.15 ± 1.30, and 1.23 ± 0.27

1.09 ± 0.25;

= 0.188 and 0.179, respectively).Blood urea nitrogen (BUN) and serum creatinine were higher in the non-cirrhosis group (44.9 ± 39.1

23.3 ± 14.0, and 3.65 ± 2.93

1.12 ± 0.44, respectively), but again differences were not significant (NS,

= 0.416 and 0.244, respectively). However, group endoscopic patterns were significantly different; all patients in the cirrhosis group had punctate GAVE, whereas 6/7 patients (85.7%) in the non-cirrhosis group had striped GAVE (

＜ 0.001).

Comparison between endoscopic types

Data were analyzed using SPSS version 20.0 for Windows (SPSS Inc, Chicago, IL). GAVE patients with or without cirrhosis were compared with respect to multiple factors, which included demographics,associated underlying diseases, laboratory values, and clinical outcomes of endoscopic APC treatment.Patients with punctate or striped GAVE were also compared. Continuous variables are expressed as mean ± SD and were compared using the Student’s

test or the Mann-Whitney test. Categorical variables are expressed as absolute numbers and proportions and were compared using Fisher’s exact test. All statistical tests were two-sided, and statistical significance was accepted for

＜ 0.05.

Clinical outcomes

Ten of the 23 patients (43.5%) were diagnosed with overt GAVE bleeding, and this was significantly more common in the non-cirrhosis group than in the cirrhosis group (6/7, 85.7%

4/16, 25.0%;

=0.019, Table 3), and more common in the striped group than in the punctate group (5/6, 83.3%

5/17,29.4%;

= 0.052, Table 4). Endoscopic APC treatment was required significantly more frequently in the non-cirrhosis group than in the cirrhosis group (6/7, 85.7%

4/16, 25.0%;

= 0.019), and more frequently required in the striped group than in the punctate group (5/6, 83.3%

5/17, 29.4%;

=0.052). However, numbers of admissions due to GAVE bleeding were no different in the cirrhosis and non-cirrhosis groups (3.00 ± 2.45

3.00 ± 2.83, NS) and in the punctate and striped groups (3.00 ± 2.83

3.00 ± 2.45, NS). In addition, no patient in either group needed therapy escalation to surgery. All 10 patients with GAVE bleeding underwent endoscopic APC treatment on a weekly or fortnightly basis,and all responded well to treatment. The mean numbers of APC sessions in patients with GAVE bleeding were similar in the cirrhosis and non-cirrhosis groups (4.50 ± 4.95

4.80 ± 5.08, NS) and in the punctate and striped groups (4.00 ± 4.34

5.25 ± 5.44, NS). Median follow-up durations were 24 mo and 26 mo in cirrhosis and non-cirrhosis groups, respectively, and 23 mo and 27 mo in punctate group and striped groups, respectively (neither intergroup difference was significant). During follow-up, 3 patients in the cirrhosis group and 1 patient in the non-cirrhosis group died of a cause other than GAVE bleeding (hepatocellular carcinoma in 1, hepatic failure in 1, and multiple organic failure in 2). No patient succumbed to GI hemorrhage.

DlSCUSSlON

“波束成形（Beamforming）”技术是无线充电技术领域的研究热点之一。美国麻省理工大学研发的Mag-MIMO（Magnetic-MIMO）无线充电系统首次将波束成形技术应用于无线充电领域[3]。基于该技术的无线充电系统，使得原本全向传输的能量集中传输至某个或某些特定方向。这将有助于延长充电距离、提高充电效率，并增强抗干扰性[4]。

胡马强把手朝下按了按，颇有领导的派头，示意何泽不说了。然后把头转向一旁的李站长，说老李你是林木专家，做个中间人，说个价格？！李站长模棱两可地说，黄金有价玉无价啊，呵呵呵……

The remarkable heterogeneity of diseases associated with GAVE generates a wide array of factors that might cause angioectasia. Several factors have been suggested to play roles in the pathogenesis of GAVE. Charneau

[14] reported that gastric antral motility was remarkably different in cirrhotic patients with or without GAVE. Others have suggested prostaglandin E2[15]

gastrin[16], vasoactive intestinal polypeptide (VIP), and the proliferation of local neuroendocrine cells containing 5-hydroxytryptamine (5-HT)[17] are causative factors

Thus, it appears GAVE is probably caused by vasodilation and impaired motility[17] driven by these neurohumoral factors[15-18]. However, the pathophysiological changes leading to GAVE have not been fully explained[19,20]. It seems complex interplay between various factors underlies the development of vascular ectasias, and that differences in gross endoscopic appearances,

, punctate-type or striped-type, depend on the relative influences of these factors. As described above, the assumed pathophysiology of GAVE is entirely different from that of portal hypertensive gastropathy, although at diagnosis, GAVE can be confused with this condition.

In our study, all 16 patients with cirrhosis had punctate-type GAVE and almost all patients (16/17)with punctate-type GAVE had concurrent cirrhosis. In contrast, 6 of 7 patients without cirrhosis had striped-type GAVE; the other patient had punctate-type GAVE. Thus, in this study punctate-type GAVE appeared to be associated with cirrhosis, and striped-type GAVE was not. Several reports have described linear lesions within antrum in non-cirrhotic patients and diffuse lesions in cirrhotic patients[1,6,21,22], and our results concur with these observations.

The pathogenesis of GAVE is unknown but seems to be related to liver cirrhosis in most cases. Several authors have suggested that portal hypertension is the most influential contributor to the development of GAVE. Tobin

[7] reported that patients with GAVE-induced gastric bleeding after bone marrow transplantation had hepatic veno-occlusive disease, which supports suggestions that portal hypertension might be a predisposing factor of GAVE. On the other hand, it has been demonstrated that GAVE lesions may develop in patients with cirrhosis independently of portal hypertension[8,11].Indeed, Spahr

[8] reported that portal decompression using a transjugular intrahepatic portosystemic shunt or a surgical end-to-side portacaval shunt was ineffective at treating GAVE bleeding. In addition to cirrhosis, several other disorders such as chronic kidney disease[9], chronic valvular, ischemic, or hypertensive heart disease

and a variety of autoimmune diseases[13], including Raynaud’s phenomena, rheumatoid arthritis, primary biliary cirrhosis, and systemic sclerosis (diffuse and limited), have been also associated with the development of GAVE.

We also found that GAVE patients without cirrhosis more frequently exhibited overt bleeding and required APC treatment than those with cirrhosis. Unfortunately, we could not adjust our multivariate analysis for GI bleeding confounders due to the small number of overt GAVE bleeding cases included.Nonetheless, these observations do indicate GAVE with cirrhosis-associated nonvariceal GI bleeding is rare. However, in contrast to our results, in a retrospective study of 30 patients that underwent APC for GAVE bleeding (17 patients had cirrhosis), Lecleire

[23] reported that patients with cirrhosis more frequently exhibited overt bleeding (65%

15%,

= 0.01), whereas patients without cirrhosis more frequently had occult bleeding as revealed by isolated iron deficiency anemia (35%

85%,

= 0.01).However, Wang

[24] in a retrospective case-control study, reported that multivariate regression analysis adjusted for confounders showed the absence of cirrhosis best predicted active bleeding from GAVE with an odds ratio of 5.151 (95% confidence interval: 1.08-24.48,

= 0.039). In this previous study,of 84 GAVE patients with cirrhosis, 27 (32.1%) had overt bleeding, and of 26 patients without cirrhosis,17 (63.4%) had overt bleeding. The reason for a significant difference between the incidences of overt bleeding according to the presence or absence of cirrhosis in GAVE remains unclear, although it has been shown circulating neurohumoral factor levels, such as those of prostaglandin E, VIP, and 5-HT,differ in GAVE patients with or without cirrhosis[15-18]. Future studies are needed to clarify mechanistic differences between patients with or without cirrhosis in order to determine whether neurohumoral factors are responsible for clinically observed differences.

文献[1]公开了一种传统的化学镍废水处理方法：在pH为10 ～ 12的条件下用双氧水氧化化学镀镍废水中的配位剂，镍离子将生成氢氧化镍沉淀，再以氧化钙沉淀废水中的磷酸根。该专利的发明者认为处理后的废水能够满足GB 21900-2008中“表3”的要求，但试验表明，对于含有柠檬酸的化学镀镍废水，这种处理方法只能满足“表2”的要求，即镍的质量浓度小于0.5 mg/L。

APC has been the endoscopic treatment of choice for GAVE since its introduction. In general, patients exhibit good initial response and low complication rates, but recurrent bleeding rates are usually high,and rates of 35.0% to 78.9% have been reported[25-27]. In the present study, endoscopic APC was performed in 10 patients with GAVE bleeding (4 patients had cirrhosis) and no complication was recorded after APC treatment. However, as has also been reported, 8 of the 10 patients required additional hospitalization due to GAVE bleeding after APC treatment and only two patients did not(one in the non-cirrhosis group and one in the cirrhosis group). In order to compare the clinical courses of GAVE bleeding cases with or without cirrhosis or with punctate or striped GAVE, we focused on the number of admissions due to GAVE bleeding. Although the proportion of patients with overt GAVE bleeding that received APC treatment was significantly greater among those without cirrhosis than those with cirrhosis, mean numbers of admissions due to GAVE bleeding and of APC sessions in overt bleeding patients were similar in the cirrhosis and non-cirrhosis groups and in the striped and punctate groups. These results suggest vulnerability to bleeding depends on GAVE etiology, but that clinical course after overt bleeding does not.

All patients with GAVE bleeding were successfully treated by APC. No patient needed surgery or died of GAVE-related blood loss, and mortalities during follow-up were similar in the cirrhosis and non-cirrhosis groups and in the punctate and striped groups. These findings suggest that APC is effective and safe for treating GAVE bleeding. Furthermore, the outcomes of endoscopic APC were similar regardless of endoscopic appearance or the presence of cirrhosis, which concurs with the results of a previous study[1]. Based on the above findings, we conclude that the presence of cirrhosis and endoscopic type have no influence on response to endoscopic APC treatment. We cannot explain why regardless of etiology, APC is an effective hemostatic treatment for GAVE. Indeed, the pathophysiologic features of GAVE are undetermined, and thus, open to debate.

Some limitations of the present study warrant consideration. First, some clinical data such as radiologically determined portal vein diameters and liver fibroscan data were missing due to the retrospective design of the study and lack of availability. Second, the sample size was small, especially numbers of bleedings and APC cases, and thus, it was not possible to compare study groups with respect to some variables or perform further multivariate analysis to identify risk factors of GAVE bleeding.Nevertheless, this study is one of the few to compare long-term clinical courses according to the presence or absence of cirrhosis and endoscopic type in a non-Western region.

CONCLUSlON

GAVE patients without cirrhosis tended to be more prone to overt bleeding; however, the long-term clinical courses of GAVE bleeding after endoscopic APC treatment were similar irrespective of the presence of cirrhosis or endoscopic appearance. These findings suggest that the etiologies of GAVE may result in different clinical manifestations, especially bleeding, but do not influence the clinical course of GAVE bleeding. Additional studies are needed to identify the factors that play key roles in the development and clinical course of GAVE and to clarify its pathophysiologic mechanism. Furthermore,although these issues remain to be clarified, we recommend that when GAVE is diagnosed endoscopically, a careful investigation should be undertaken to determine whether liver cirrhosis and other noncirrhotic disease processes associated with GAVE are present.

ARTlCLE HlGHLlGHTS

Research methods

A retrospective analysis of 23 consecutive patients diagnosed with GAVE from January 2006 to December 2020 was conducted. Patients were allocated to cirrhosis (16 patients) and non-cirrhosis groups (7 patients), and GAVE subtypes, as determined by endoscopy, were categorized as punctate (a diffuse, honeycomb-like appearance, 17 patients) or striped (a linear, watermelon-like appearance, 6 patients).

Research results

Punctate-type GAVE was strongly associated with liver cirrhosis, whereas striped-type GAVE was strongly associated with non-cirrhotic underlying disease. Additionally, GAVE patients without cirrhosis experienced overt bleeding more often and required APC treatment more frequently than those with cirrhosis. However, mean numbers of admissions due to GAVE bleeding and of APC sessions for overt bleeding were similar in the cirrhosis and non-cirrhosis groups and in the striped and punctate groups.

(5) 两种方法的原理相同,根据电机两两串联自感的大小关系随着转子位置的变化每隔60°电角度发生一次变化;

Research conclusions

GAVE etiologies may result in different clinical manifestations, especially as regards bleeding.However, etiologies and endoscopic patterns were not found to influence long-term clinical courses or treatment outcomes in cases of overt bleeding.

Research perspectives

This study is one of the few to analyze the effects of GAVE etiologies and endoscopic patterns on longterm clinical courses and outcomes. Additional studies are needed to identify those factors that play key roles in the development and clinical course of GAVE and to clarify its pathophysiologic mechanism.

临床常见的症状之一就是鼻出血,该病症不仅由患者鼻部疾病引发,也可以因全身疾病诱发所致,一般情况下患者鼻出血为单侧鼻腔,但仍有少部分患者为双侧鼻腔出血;诱发因素主要与鼻腔异物、鼻部炎症、鼻中隔偏曲、鼻部损伤有关。针对鼻出血量程度所引发的症状也不相同,鼻出血量较少患者临床表征为涕中带血,鼻出血量多患者可导致患者出现失血性休克,而反复鼻出血患者会出现贫血等病症,严重影响患者日常生活。由此可见,有效的治疗方案对鼻出血患者是非常重要的。

FOOTNOTES

Cho JH and Lee SH designed the study; Kwon HJ and Cho JH performed the research; Kwon HJ and Cho JH analyzed the data; Cho JH wrote the paper; Lee SH and Cho JH revised the manuscript.

The characteristics of patients in the cirrhosis and non-cirrhosis groups at GAVE diagnosis are summarized in Table 1. Mean age was significantly greater in the cirrhosis group (69.8 ± 6.1

55.4 ±12.2,

= 0.015). Men predominated in the cirrhosis group (12/16, 75.0%) and women in the noncirrhosis group (5/7, 71.4%). Mean group body mass indices (BMIs) were not significantly different. In the non-cirrhosis group, the most common associated disease was chronic kidney disease (5/7, 71.4%),

The study was reviewed and approved by the Institutional Review Board of Yeungnam University Hospital (IRB No. 2021-10-044).

例如，教学《营养要均衡》一课时，以学校中学生身体状况问卷为基础，分析描述大部分同学的胖瘦除了遗传因素以外，饮食是一个重要的因素。教师可要求学生对照均衡膳食“宝塔”并根据自身的实际情况制定相应的“生活作息表”或者“健康食谱”，选择食物均衡身体所需要的营养。并严格督促学生将自己所制定的健康目标运用到自身实践之中，这样不仅能培养学生良好的生活习惯，还能促使学生课外活动以及生活方式都朝着良性健康的方式转变。

为适应当下文旅融合发展的需要，强化济南大学文化产业的学科建设，强化旅游和文化创意的理论和实践研究，为全省文化和旅游产业的发展提供服务和决策参考，促进济南大学与文旅企业的校企合作，11月23日，济南大学旅游文化创意研究院正式成立。

(2)要学习国外先进的技术和经验，取长补短。我们要学习借鉴和吸收国外深部找矿的先进理论、技术和成功经验，结合已有地勘资料和具体项目有针对性地开展深部找矿的应用研究工作。国外由于对深部找矿工作十分重视且开展较早，深部找矿理论和技术方法日趋成熟，学习他们的成功经验，把他们先进的理论、技术运用到我们的实际工作中去，将会使我们少走弯路，在我们的找矿工作中起到事半功倍的效果。

There are no conflicts of interest to report.

No additional data are available.

这些热斑同样小到无法辨识，但它们会影响到热团块，使其一侧的热量多于另一侧。结果就是，根策尔博士的团队发现，当热斑绕着S2转的时候，相对于S2所在的位置，那个热团块的中心会出现能量转移（或者说能量波动）的现象。

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BYNC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

South Korea

Hyo Jin Kwon 0000-0003-4214-6369; Si Hyung Lee 0000-0001-7221-7506; Joon Hyun Cho 0000-0002-3584-6300.

The Korean Society of Gastroenterology.

Chen YL

A

Chen YL

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