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A quantitative analytical method to discriminate among the various types of cancerous esophagus tissue is essential for accurate cancer staging. This paper reports on the use of ratiometric nonlinear optical microscopy to reveal the ratio of two-photon excited fluorescence (TPEF) to second harmonic generation (SHG) and forward to backward (F/B) SHG from single collagen fibers only in submucosa of esophageal squamous cell carcinoma. This makes it possible to accurately differentiate among the four stages of esophageal cancer, providing results that are in good agreement with histopathology. Furthermore, it is confirmed by polarization-dependent SHG that the varied SHG response in esophageal cancer tissues is mainly from the shrinkage in diameter of collagen fibers instead of the collagen triple helixes altered by cancer cells. Based on the results of TPEF/SHG and F/B SHG ratio, they can cooperatively improve the precision of diagnostics on esophageal cancer and could be transferred to other types of cancer diseases with changed collagen fibers. Impact statement The issue of classifying esophageal cancer at various developmental stages is crucial for determining the optimized treatment protocol for the patients, as well as the prognosis. Precision improvement in staging esophageal cancer keeps seeking quantitative and analytical imaging methods that could augment histopathological techniques. In this work, we used nonlinear optical microscopy for ratiometric analysis on the intrinsic signal of two-photon excited fluorescence (TPEF) and second harmonic generation (SHG) from single collagen fibers only in submucosa of esophageal squamous cell carcinoma (ESCC). The blind tests of TPEF/SHG and forward (F)/backward (B) SHG were demonstrated to compare with the histology conclusion. The discussion of sensitivity and specificity was provided via statistical comparison between the four stages of esophageal cancer. To the best of our knowledge, this is the first study of using these two ratios in combination for staging ESCC.

To investigate the determinants related to the ability to drive a motorized mobility scooter after a stroke.The study was a cross-sectional study. The ability to drive a motorized mobility scooter was measured with the Power Mobility Clinical Driving Assessment. The independent variables included cognitive functions measured by the Color Trails Test and reaction time test, visual functions measured by a visual acuity test and visual field test, and motor functions measured with a dynamometer, the Box and Block Test, and the Functional Independence Measure.The correlation analyses revealed that the Power Mobility Clinical Driving Assessment scores had significant correlations with reaction time (The reaction time, binocular visual field, and grip strength of the unaffected hand were the most significant determinants related to the ability to drive a motorized mobility scooter after a stroke. IMPLICATIONS FOR REHABILITATIONMotorized mobility scooter driving ability for stroke patients is correlated with demographics (age, mobility scooter driving experience, time since last drive) and cognitive, visual and motor functions (reaction time, binocular visual field, visual acuity, and the grip strength of unaffected hand).Primary determinants of motorized mobility scooter driving ability for stroke patients include reaction time, binocular visual field, and grip strength of the unaffected hand.Comprehensive assessments incorporating cognitive, visual and motor functions are needed to evaluate the ability to drive a motorized mobility scooter after a stroke.

Today, the most serious threat to global health is the continuous outbreak of respiratory diseases, which is called Coronavirus Disease 2019 (COVID-19). The outbreak of COVID-19 has brought severe challenges to public health and has attracted great attention from the research and medical communities. Most patients infected with COVID-19 will have fever. Therefore, the monitoring of body temperature has become one of the most important basis for pandemic prevention and testing. Among them, the measurement of body temperature is the most direct through the Forehead Thermometer, but the measurement speed is relatively slow. The cost of fast-checking body temperature measurement equipment, such as infrared body temperature detection and face recognition temperature machine, is too high, and it is difficult to build Disease Surveillance System (DSS). To solve the above-mentioned problems, the Intelligent pandemic prevention Temperature Measurement System (ITMS) and Pandemic Prevention situation Analysis System (PPAS) are proposed in this study. ITMS is used to detect body temperature. However, PPAS uses big data analysis techniques to prevent pandemics. In this study, the campus field is used as an example, in which ITMS and PPAS are used. In the research, Proof of Concept (PoC), Proof of Service (PoS), and Proof of Business (PoB) were carried out for the use of ITMS and PPAS in the campus area. From the verification, it can be seen that ITMS and PPAS can be successfully used in campus fields and are widely recognized by users. Through the verification of this research, it can be determined that ITMS and PPAS are indeed feasible and capable of dissemination. The ITMS and PPAS are expected to give full play to their functions during the spread of pandemics. All in all, the results of this research will provide a wide range of applied thinking for people who are committed to the development of science and technology.

Alcohol is an important risk factor for the development of second esophageal squamous-cell carcinoma (ESCC) in head and neck squamous-cell carcinoma (HNSCC) patients. However, the influence of tea consumption is uncertain. We prospectively performed endoscopic screening in incident HNSCC patients to identify synchronous esophageal neoplasm. In total, 987 patients enrolled between October 2008 and December 2017 and were analyzed. In vitro studies were conducted to investigate the effect of epigallocatechin gallate (EGCG) on the betel alkaloid, arecoline-stimulated carcinogenesis in two ESCC cell lines. There were 151 patients (15.3%) diagnosed to have synchronous esophageal neoplasm, including 88 low-grade dysplasia, 30 high-grade dysplasia and 33 squamous-cell carcinoma (SCC). Tea consumption was associated with a significantly lower risk of having esophageal high-grade dysplasia or SCC in HNSCC patients, especially those who were betel nut chewers, alcohol drinkers or cigarette smokers (all adjusted odds ratio were 0.5, p-values: 0.045, 0.045 and 0.049 respectively). In vitro studies indicated that EGCG suppressed arecoline-induced ESCC cell proliferation and colony formation through the inhibition of the Akt and ERK1/2 pathway in a reactive oxygen species-independent manner. In conclusion, tea consumption may protect against the development of second esophageal neoplasms among HNSCC patients, especially those who regularly consume betel nuts, alcohol and cigarettes.

This study presents a method to identify early esophageal cancer within endoscope using hyperspectral imaging technology. The research samples are three kinds of endoscopic images including white light endoscopic, chromoendoscopic, and narrow-band endoscopic images with different stages of pathological changes (normal, dysplasia, dysplasia - esophageal cancer, and esophageal cancer). Research is divided into two parts: first, we analysis the reflectance spectra of endoscopic images with different stages to know the spectral responses by pathological changes. Second, we identified early cancerous lesion of esophagus by principal component analysis (PCA) of the reflectance spectra of endoscopic images. The results of this study show that the identification of early cancerous lesion is possible achieve from three kinds of images. In which the spectral characteristics of NBI endoscopy images of a gray area than those without the existence of the problem the first two, and the trend is very clear. Therefore, if simply to reflect differences in the degree of spectral identification, chromoendoscopic images are suitable samples. The best identification of early esophageal cancer is using the NBI endoscopic images. Based on the results, the use of hyperspectral imaging technology in the early endoscopic esophageal cancer lesion image recognition helps clinicians quickly diagnose. We hope for the future to have a relatively large amount of endoscopic image by establishing a hyperspectral imaging database system developed in this study, so the clinician can take this repository more efficiently preliminary diagnosis.

Ingestion of mushrooms from the genus Amanita can present detrimental consequences to the human body. The mushroom is frequently found in the coastal Pacific Northwest, Pennsylvania, New Jersey, and Ohio. Amanitin, one of the two distinct toxins isolated from the Amanita mushroom, is responsible for the majority of symptoms and signs seen with mushroom poisoning. Clinically, ingestion of these mushrooms can result in a wide range of clinical symptoms including nausea, vomiting, crampy abdominal pain, and diarrhea. There have been several case reports of patients who developed severe hepatic failure that required liver transplantation. Thus, it is important to recognize the symptoms early and treat the patients with the available agents including multidose activated charcoal, N-acetylcysteine, penicillin G, and Silybum. Through an extensive literature search, we found no published literature on amatoxin poisoning in the state of Texas. With new cases of amatoxin poisoning emerging in the state, it is important for healthcare providers and workers to have a better awareness and early recognition of the detrimental effects of Amanita species poisoning and to be educated to provide the proper care for this group of patients.

Typical atrial flutter (AFL) is a common atrial arrhythmia that may cause significant symptoms and serious adverse effects including embolic stroke, myocardial ischemia and infarction, and rarely a tachycardia-induced cardiomyopathy as a result of rapid atrioventricular conduction. As a result of the well-defined anatomic and electrophysiological substrate, and the relative pharmacologic resistance of typical AFL, radiofrequency catheter ablation has emerged in the past decade as a safe and effective first-line treatment. This article reviews the electrophysiology of typical AFL and the techniques currently used for its diagnosis and management.

Recent case series have shown that enteroscopy is safe and effective to remove entrapped small bowel foreign bodies. However, the optimal timing for the foreign body retrieval in terms of duration of entrapment and when to consider surgical intervention are unknown. In this case series, we report that antegrade and retrograde enteroscopy can be used safely to retrieve foreign bodies entrapped in the small bowel for longer than 70 days. In total, 20 patients (mean age, 48 years; 11 females) with entrapped foreign bodies in the small intestine underwent antegrade, retrograde, or combined double balloon enteroscopy for retrieval of objects. Symptoms prompted removal of entrapped, nonsharp objects in all patients and included abdominal pain, nausea, and vomiting. The mean time of entrapment was 83 days (range, 4-272 days). There were 15 cases of retained video capsule endoscopy (VCE) with a mean entrapment time of 106 days (range, 7-272 days). Two VCEs could not be removed safely with enteroscopy. Other retained small bowel objects included in this study were nails and fish hooks. Their average entrapment time was 13 days (range, 4-43 days). Of the 30 enteroscopies, there was only 1 case (3%) with a complication (perforation). According to this case series, experienced endoscopists can safely and effectively retrieve foreign bodies in the small bowel, particularly VCE, that are retained for extended periods of time.

Maternal smoking during pregnancy is known to be a significant contributor to developmental neurological health problems in the offspring. In animal studies, nicotine treatment via injection during gestation has been shown to produce episodic hypoxia in the developing fetus. Nicotine delivery via mini osmotic pump, while avoiding effects due to hypoxia-ischemia, it also provides a steady level of nicotine in the plasma. In the present study timed-pregnant Sprague-Dawley rats (300-350 g) were treated with nicotine (3.3 mg/kg, in bacteriostatic water via s.c. implantation of mini osmotic pump) from gestational days (GD) 4-20. Control animals were treated with bacteriostatic water via s.c. implantation of mini osmotic pump. Offspring on postnatal day (PND) 30 and 60, were evaluated for changes in the ligand binding for various types of nicotinic acetylcholine receptors and neuropathological alterations. Neurobehavioral evaluations for sensorimotor functions, beam-walk score, beam-walk time, incline plane and grip time response were carried out on PND 60 offspring. Beam-walk time and forepaw grip time showed significant impairments in both male and female offspring. Ligand binding densities for [3H]epibatidine, [3H]cytisine and [3H]alpha-bungarotoxin did not show any significant changes in nicotinic acetylcholine receptors subtypes in the cortex at PND 30 and 60. Histopathological evaluation using cresyl violet staining showed significant decrease in surviving Purkinje neurons in the cerebellum and a decrease in surviving neurons in the CA1 subfield of hippocampus on PND 30 and 60. An increase in glial fibrillary acidic protein (GFAP) immuno-staining was observed in cerebellum white matter as well as granular cell layer of cerebellum and the CA1 subfield of hippocampus on PND 30 and 60 of both male and female offspring. These results indicate that maternal exposure to nicotine produces significant neurobehavioral deficits, a decrease in the surviving neurons and an increased expression of GFAP in cerebellum and CA1 subfield of hippocampus of the offspring on PND 30 and 60. The results show that although 60-day-old male and female rat offspring of mothers exposed to nicotine during gestation did not differ from control in body weight gain or nicotinic acetylcholine receptors ligand binding, they exhibited significant sensorimotor deficits that were consistent with the neuropathological alterations seen in the brain. These neurobehavioral and pathological deficits indicate that maternal nicotine exposure may produce long-term adverse health effects in the offspring.

Background: The effect of bradykinin on intracellular free Ca2+ levels ([Ca2+]i) in MG63 human osteosarcoma cells was explored using fura-2 as a Ca2+ dye. Methods/Results: Bradykinin (0.1 nM–1 µM) increased [Ca2+]i in a concentration-dependent manner with an EC50 value of 0.5 nM. The [Ca2+]i signal comprised an initial peak and a fast decay which returned to baseline in 2 min. Extracellular Ca2+ removal inhibited the peak [Ca2+]i signals by 35 ± 3%. Bradykinin (1 nM) failed to increase [Ca2+]i in the absence of extracellular Ca2+ after cells were pretreated with thapsigargin (an endoplasmic reticulum Ca2+ pump inhibitor; 1 µM). Bradykinin (1 nM)-induced intracellular Ca2+ release was nearly abolished by inhibiting phospholipase C with 2 µM 1-(6-((17β-3-methoxyestra-1,3,5(10)-trien-17-yl)amino)hexyl)-1H-pyrrole-2,5-dione (U73122). The [Ca2+]i increase induced by 1 nM bradykinin in Ca2+- free medium was abolished by 1 nM HOE 140 (a B2 bradykinin receptor antagonist) but was not altered by 100 nM Des-Arg-HOE 140 (a B1 bradykinin receptor antagonist). Pretreatment with 1 pM pertussis toxin for 5 h in Ca2+ medium inhibited 30 ± 3% of 1 nM bradykinin-induced peak [Ca2+]i increase. Conclusions: Together, this study shows that bradykinin induced [Ca2+]i increases in a concentration-dependent manner, by stimulating B2 bradykinin receptors leading to mobilization of Ca2+ from the thapsigargin-sensitive stores in a manner dependent on inositol-1,4,5-trisphosphate, and also by inducing extracellular Ca2+ influx. The bradykinin response was partly coupled to a pertussis toxin-sensitive G protein pathway.

Alcoholic liver disease (ALD) encompasses hepatic steatosis, which may progress to alcoholic hepatitis, fibrosis, and cirrhosis. It remains a leading cause of morbidity and mortality in the US and worldwide. The severity of liver disease correlates with plasma levels of bacterial products in patients, and experimental ALD depends on the level of gut derived bacterial products in rodents. Since intestinal decontamination and deficiency of bacterial product receptors or their downstream signaling molecules protect from alcohol-induced liver disease, bacterial translocation, qualitative and quantitative changes of the enteric microbiome are considered as being of fundamental importance in the pathogenesis of ALD. Recent enhancements in diagnostic technologies provide a better insight into these shifts. This review highlights vital events in ALD such as bacterial translocation, the importance of Toll-like receptor (TLR) signaling, intestinal bacterial overgrowth and changes in the intestinal microbiome. Furthermore, a treatment trial section of patients reviews possible future options of therapy for ALD modifying the enteric microbiome.

Natriuretic peptides have prognostic value across a wide spectrum of cardiovascular diseases and may predict cognitive dysfunction in patients with cardiovascular disease, even in the absence of previous stroke. Little is known about the association of natriuretic peptides with cognitive function in community-dwelling adults. We assessed the association between N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and cognitive function in community-dwelling ambulatory older adults in the Rancho Bernardo Study.We studied 950 men and women, aged 60 years and older, who attended a research clinic visit where a medical history and examination were performed, and blood for cardiovascular disease risk factors and NT-proBNP levels were obtained. Three cognitive function tests were administered: the Mini Mental State Examination (MMSE), Trail-Making Test B (Trails B), and Category Fluency.Participants with high NT-proBNP levels (≥450 pg/mL; n=198) were older and had a higher prevalence of coronary heart disease (12% vs 30%), and stroke (5% vs 11%; P≤.001 for both). In unadjusted analyses, all 3 cognitive function test scores were significantly associated with NT-proBNP levels (P.001). After adjusting for age, sex, education, hypertension, body mass index, exercise, alcohol use, smoking, low density lipoprotein cholesterol, creatinine clearance, and previous cardiovascular disease, elevated NT-proBNP levels remained independently associated with poor cognitive performance on MMSE (odds ratio [OR] 2.0; 95% confidence interval [CI], 1.1-3.6; P=.02) and Trails B (OR 1.7; 95% CI, 1.2-2.7; P=.01), but not Category Fluency (OR 1.4; 95% CI, 0.9-2.2; P=.19). Results were unchanged after excluding the 6% of participants with a history of stroke.NT-proBNP levels were strongly and independently associated with poor cognitive function in community-dwelling older adults.

Cardiovascular disease has emerged as one of the most prominent causes of morbidity and mortality among adult populations. As medical advances have enabled more patients to survive post-myocardial insult, the prevalence of congestive heart failure (CHF) has exploded. It is now estimated that 5 million people in the USA live with CHF, and that approximately 550 000 new cases are diagnosed each year.1 Hospitalisations for heart failure have increased dramatically from 402 000 in 1979 to 1 101 000 in 2004 (National Hospital Discharge Survey), and the cost of CHF is now estimated at US$56 billion a year, 70% of which is due to hospitalisation.1 Among a variety of proposed heart failure treatment modalities, cardiac biomarkers have emerged as powerful adjuncts to standardised clinical care in the diagnosis, prognosis, and treatment of acute heart failure (AHF). B-type natriuretic peptide (BNP) is first synthesised in the myocytes as a 132 amino acid intracellular precursor known as preproBNP. During decompensation, volume overload and high pulmonary capillary wedge pressure cause the ventricle walls to stretch, triggering the cleavage and release of preproBNP as the biologically active 32 amino acid hormone BNP and its inactive N-terminal fragment (NT-proBNP). Once released, BNP has pronounced natriuretic, diuretic, and vasodilating properties, working to dramatically reduce volume overload and hypertension in patients. BNP is then believed to be removed quickly from circulation (half-life of 22 min) by both NP receptor endocytosis and endopeptidase enzymatic degradation.2 In contrast, NT-proBNP is suspected to be cleared from the plasma largely by renal excretion, and thus has slower fluctuations in circulating concentrations as well as a notably longer half-life of 60–120 min.2 In general, BNP and NT-proBNP values are reasonably correlated, and either can be used in patient care settings as long as their respective absolute values and cut points are not used interchangeably. In …

Background: Successful mitral isthmus (MI) ablation may reduce recurrence of atrial fibrillation (AF) and macro-reentrant atrial tachycardia (AT) after pulmonary vein isolation (PVI) for AF. Objective: To determine if achieving bidirectional MI conduction block (MIB) during circumferential pulmonary vein ablation (CPVA) plus left atrial linear ablation (LALA) affects development of AT. Methods: Sixty consecutive patients with persistent (n = 25) or paroxysmal (n = 35) AF undergoing CPVA plus LALA at the MI and LA roof were evaluated in a prospective, nonrandomized study. Results: PVI was achieved in all patients. Bidirectional MI block was achieved in 50 of 60 patients (83%). During 18 ± 5 months follow-up, 12 patients (20%) developed recurrent AF and 15 (25%) developed AT. Patients in whom MIB was not achieved at initial ablation had four times higher risk of developing AT (P = 0.008, 95% confidence interval 1.43–11.48) versus patients with MIB. In 12 patients with AT undergoing repeat ablation, 22 ATs were identified, with reentry involving the MI in nine, the LA roof in six, and the ridge between the LA appendage and left PVs in seven. In patients with MIB at initial ablation, recovery of MI conduction was seen in eight of 13 undergoing repeat ablation. Conclusions: AT occurring after CPVA plus LALA is often due to incomplete MI ablation, but may also occur at the LA roof, and ridge between the LA appendage and left PVs. Failure to achieve MI block increases the risk of developing AT. Resumption of MI conduction may also be a mechanism for AT recurrence. (PACE 2010; 460–468)

Most studies evaluating the efficacy of atrial fibrillation (AF) ablation report follow-up periods of 1 year to 2 years, but few report long-term results ofor =5 years after ablation. Therefore, we evaluated the long-term efficacy (i.e.,5 years) of segmental antrum pulmonary vein isolation (PVI) for paroxysmal AF. Seventy-one patients (60 +/- 10 years, 56 men) who underwent PVI for paroxysmal AF from January 1, 2002, to August 31, 2003, were followed for at least 5 years after their index ablation procedure. Five-year outcomes were determined at last clinic visit, by telephone encounters, and by cardiac monitoring when available. After 1 ablation, off antiarrhythmic drugs, 61 patients (86%) were free of symptomatic AF at 12 months, 56 patients (79%) at 24 months, and 40 patients (56%) at 63 +/- 5 months. Sixteen patients (22.5%) had AF recur after the second year after ablation. Thirty-one patients underwentor =1 repeat ablations (1.6 +/- 0.9 per patient). After multiple procedures, 58 patients (81%) were free of symptomatic AF off antiarrhythmic drugs at 63 +/- 5 months after their initial ablation; however, in 18 of these patients who received multiple ablation procedures, mean duration of follow-up after the last ablation was only 13.5 +/- 2.1 months. In conclusion, overall 5-year outcome after PVI for paroxysmal AF is similar to that previously reported for shorter-term follow-up (or =2 years). However, late recurrences2 years after initial ablation were frequent, and repeat ablation was often required to maintain freedom from symptomatic AF.

Background and aims: The presence of fibrosis on liver biopsy is a prognostic tool for management of liver disease. AST/PLT ratio index (APRI) has been shown to be a useful tool to non-invasively predict fibrosis. Hepatoportal pressure gradient (HPPG) measurements have been used as an instrument to predict complications from cirrhosis. To the best of our knowledge, there has been no prior study comparing HPPG measurements to APRI scores. We aimed to elucidate the relationship between APRI scores and HPPG measurements. Methods: We retrospectively reviewed liver biopsy results of patients (n = 125) between 2009 and 2011. Patients who had no coinciding liver function tests within one week of liver biopsy (n=25) and those without coinciding measurements of hepatic venous pressures (n =58) were also excluded. A total of 67 patients were analyzed. The AST platelet ratio (APRI) were obtained and compared to HPPG =10 (n=13) mmHg. Results: Median age was 60 (range 30-80) and 38 (59%) were male. Hepatitis C was present in 35 (52%) of patients, 13 of whom had undergone liver transplantation with recurrence of hepatitis C. Table 1 shows the etiology of liver diagnoses. Mean APRI score was 0.52 + 0.51 in patients who had HPPG =10, p =0.04. Pearson's correlation between APRI score and HPPG measurement was 0.27, p = 0.03. Conclusions: AST/platelet ratio index (APRI) has been shown to be an important noninvasive diagnostic marker for fibrosis. There is a significant relationship between APRI scores and the severity of hepatoportal pressures. Etiology of liver disease diagnoses in our patients

Predictors and Significance of Endoclip Retention After Endoscopic Mucosal Resection (EMR) of Large (>20 mm) Colon Polyp Wei-Chung Chen*, Nirav Thosani, Sachin Batra, Gottumukkala S. Raju Gastroenterology, Hepatology and Nutrition, The University of Texas Medical School at Houston, Houston, TX; The Methodist Hospital, Houston, TX; The UT MD Anderson Cancer Center, Houston, TX Background and Aim: Endoclips are commonly used to prevent bleeding and close the defect after endoscopic mucosal resection (EMR). There is growing concern that clip closure may result in tumor in-growth (“buried glands) and prolonged clip retention may interfere with treatment of residual polyps. Our goal is to report prolonged endoclip after EMR, to identify factors predictive of clip retention, and to assess whether clip retention results in tumor ingrowth and recurrence. Method: We performed a retrospective review of prospectively maintained database of all colonic EMR performed by GSR at the UT MD Anderson Cancer Center (6/2009 6/2102). Database contained information regarding patient demographic, referral pattern, polyp characteristics, EMR technique, complications, pathology report and follow up colonoscopy details. All continuous variables were described as medians and IQR and compared using Wilcoxon rank sum test. All categorical variables were listed as frequency and percentages and compared using fisher’s exact test. Results: Of 73 consecutive patients (93 polyps) with polyp size greater than 20 mm, 7 patients (14 polyps) were referred for surgical resection without EMR. Endoscopic Mucosal Resection, was undertaken in 78 polyps in 66 patients (33 men and 33 women). Majority of EMRs were undertaken in the right colon (n 56; 72%) for flat lesions (Paris classification 0-IIa: n 65; 84%) Patient demographic, polyp characteristics and EMR details are shown in (Table 1). Clip Closure of EMR Defect was undertaken in 74 of 78 EMRs. The median number of clips per EMR was 6 (IQR of 4 to 8). Delayed bleeding was noted in 3 cases (3.85%) after resection, which required hospitalization and transfusions; and one patient required endoscopic clip application. Colonoscopy Follow up was performed in 66 EMR cases between 3 to 6 months. Clip Retention was observed in 6 of 63 EMR cases (total 9 retained clips; 1 clip in 3 cases and 2 clips in 3 cases) at follow up colonoscopy. The total clip retention rate was 9.52%. Among patients with retained clips, none of them had recurrence of neoplasia based on histopathology from biopsies obtained at scar site. Predictors of Clip Retention: None of the patient demographic, polyp characteristics and EMR details predicted clip retention. (Table 2). Conclusion: Overall endoclip retention rate at 6 months is low (9.52%) and is not associated with recurrence of neoplasia. None of the clinical and endoscopic factors predict clip retention.