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.

雖然乳腺肉瘤生物學(xué)各異，術(shù)前很難確診，需經(jīng)病理診斷。手術(shù)仍是本病主要的治療手段，對于腫塊較大，組織學(xué)分化差，淋巴轉(zhuǎn)移等含高危因素較多的患者應(yīng)行廣泛切除術(shù)；對于低危的患者可行腫瘤局部擴(kuò)大切除術(shù)；由于本病較少出現(xiàn)淋巴轉(zhuǎn)移，可不行淋巴結(jié)清掃術(shù)；對于惡性程度高，分化差的腫瘤，應(yīng)輔以放化療，減少患者復(fù)發(fā)，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.

常荊夫，小學(xué)趕上非典，初中趕上禽流感與武漢中考改革，高中遇上甲流，大學(xué)遇上2012的一輩人。喜愛文學(xué)，本科語言學(xué)專業(yè)，貫徹維特根斯坦初期的幾條原則，對于不可言說之物沉默相待，對于可以被言說的一切嘗試著更加文學(xué)和清晰的言說。

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）”技術(shù)是無線充電技術(shù)領(lǐng)域的研究熱點(diǎn)之一。美國麻省理工大學(xué)研發(fā)的Mag-MIMO（Magnetic-MIMO）無線充電系統(tǒng)首次將波束成形技術(shù)應(yīng)用于無線充電領(lǐng)域[3]?；谠摷夹g(shù)的無線充電系統(tǒng)，使得原本全向傳輸?shù)哪芰考袀鬏斨聊硞€(gè)或某些特定方向。這將有助于延長充電距離、提高充電效率，并增強(qiáng)抗干擾性[4]。

胡馬強(qiáng)把手朝下按了按，頗有領(lǐng)導(dǎo)的派頭，示意何澤不說了。然后把頭轉(zhuǎn)向一旁的李站長，說老李你是林木專家，做個(gè)中間人，說個(gè)價(jià)格？！李站長模棱兩可地說，黃金有價(jià)玉無價(jià)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.

文獻(xiàn)[1]公開了一種傳統(tǒng)的化學(xué)鎳廢水處理方法：在pH為10 ～ 12的條件下用雙氧水氧化化學(xué)鍍鎳廢水中的配位劑，鎳離子將生成氫氧化鎳沉淀，再以氧化鈣沉淀廢水中的磷酸根。該專利的發(fā)明者認(rèn)為處理后的廢水能夠滿足GB 21900-2008中“表3”的要求，但試驗(yàn)表明，對于含有檸檬酸的化學(xué)鍍鎳廢水，這種處理方法只能滿足“表2”的要求，即鎳的質(zhì)量濃度小于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) 兩種方法的原理相同,根據(jù)電機(jī)兩兩串聯(lián)自感的大小關(guān)系隨著轉(zhuǎn)子位置的變化每隔60°電角度發(fā)生一次變化;

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.

臨床常見的癥狀之一就是鼻出血,該病癥不僅由患者鼻部疾病引發(fā),也可以因全身疾病誘發(fā)所致,一般情況下患者鼻出血為單側(cè)鼻腔,但仍有少部分患者為雙側(cè)鼻腔出血;誘發(fā)因素主要與鼻腔異物、鼻部炎癥、鼻中隔偏曲、鼻部損傷有關(guān)。針對鼻出血量程度所引發(fā)的癥狀也不相同,鼻出血量較少患者臨床表征為涕中帶血,鼻出血量多患者可導(dǎo)致患者出現(xiàn)失血性休克,而反復(fù)鼻出血患者會出現(xiàn)貧血等病癥,嚴(yán)重影響患者日常生活。由此可見,有效的治療方案對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，教學(xué)《營養(yǎng)要均衡》一課時(shí)，以學(xué)校中學(xué)生身體狀況問卷為基礎(chǔ)，分析描述大部分同學(xué)的胖瘦除了遺傳因素以外，飲食是一個(gè)重要的因素。教師可要求學(xué)生對照均衡膳食“寶塔”并根據(jù)自身的實(shí)際情況制定相應(yīng)的“生活作息表”或者“健康食譜”，選擇食物均衡身體所需要的營養(yǎng)。并嚴(yán)格督促學(xué)生將自己所制定的健康目標(biāo)運(yùn)用到自身實(shí)踐之中，這樣不僅能培養(yǎng)學(xué)生良好的生活習(xí)慣，還能促使學(xué)生課外活動以及生活方式都朝著良性健康的方式轉(zhuǎn)變。

為適應(yīng)當(dāng)下文旅融合發(fā)展的需要，強(qiáng)化濟(jì)南大學(xué)文化產(chǎn)業(yè)的學(xué)科建設(shè)，強(qiáng)化旅游和文化創(chuàng)意的理論和實(shí)踐研究，為全省文化和旅游產(chǎn)業(yè)的發(fā)展提供服務(wù)和決策參考，促進(jìn)濟(jì)南大學(xué)與文旅企業(yè)的校企合作，11月23日，濟(jì)南大學(xué)旅游文化創(chuàng)意研究院正式成立。

(2)要學(xué)習(xí)國外先進(jìn)的技術(shù)和經(jīng)驗(yàn)，取長補(bǔ)短。我們要學(xué)習(xí)借鑒和吸收國外深部找礦的先進(jìn)理論、技術(shù)和成功經(jīng)驗(yàn)，結(jié)合已有地勘資料和具體項(xiàng)目有針對性地開展深部找礦的應(yīng)用研究工作。國外由于對深部找礦工作十分重視且開展較早，深部找礦理論和技術(shù)方法日趨成熟，學(xué)習(xí)他們的成功經(jīng)驗(yàn)，把他們先進(jìn)的理論、技術(shù)運(yùn)用到我們的實(shí)際工作中去，將會使我們少走彎路，在我們的找礦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.

這些熱斑同樣小到無法辨識，但它們會影響到熱團(tuán)塊，使其一側(cè)的熱量多于另一側(cè)。結(jié)果就是，根策爾博士的團(tuán)隊(duì)發(fā)現(xiàn)，當(dāng)熱斑繞著S2轉(zhuǎn)的時(shí)候，相對于S2所在的位置，那個(gè)熱團(tuán)塊的中心會出現(xiàn)能量轉(zhuǎn)移（或者說能量波動）的現(xiàn)象。

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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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