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We report a novel use of transcatheter aortic valve replacement (TAVR) for valve-in-valve tricuspid valve replacement. A man in his 50s with prohibitive risks for surgical intervention underwent this procedure to improve severe, symptomatic tricuspid stenosis. Though current literature is limited to case reports, the Valve-in-Valve International Database (VIVID) reports similar mortality rates between surgical and transcutaneous replacement. As a novel, off-label procedure, there is limited operator experience. Nonetheless, in non-operative or high-risk patients, similar outcomes are noted in between transcatheter tricuspid valve replacement and surgical replacement. This registry sets the framework for further studies with the possibility of observing outcomes as operator experience increases, while highlighting the feasibility of the procedure.

A man in his early 60s with Takakura stage IIIB varus ankle arthritis underwent four combined procedures (Dwyer’s osteotomy with lateral displacement, superficial/deep deltoid ligament release, anterior talofibular ligament/calcaneofibular ligament reconstruction with suture tape augmentation and posterior tibial tendon lengthening). Decreased talar tilt and talar centre lateral shifting and improved hindfoot varus were observed 2 years postoperatively. Also, excellent clinical outcome could be achieved.

Background: Controversies exist among liver surgeons regarding clinical outcomes of the laparoscopic versus the robotic approach for major complex hepatectomies. The authors therefore designed a study to examine and compare the perioperative outcomes of laparoscopic left hepatectomy or extended left hepatectomy (L-LH/L-ELH) versus robotic left hepatectomy or extended left hepatectomy (R-LH/R-ELH) using a large international multicenter collaborative database. Methods: An international multicenter retrospective analysis of 580 patients undergoing L-LH/L-ELH or R-LH/R-ELH at 25 specialized hepatobiliary centers worldwide was undertaken. Propensity score-matching (PSM) was used at a 1:1 nearest-neighbor ratio according to 15 perioperative variables, including demographics, tumor characteristics, Child-Pugh score, presence of portal hypertension, multiple resections, histologic diagnosis, and Iwate difficulty grade. Results: Before the PSM, 190 (32 %) patients underwent R-LH/R-ELH, and 390 (68 %) patients underwent L-LH/L-ELH. After the matching, 164 patients were identified in each arm without significant differences in demographics, preoperative variables, medical history, tumor pathology, tumor characteristics, or Iwate score. Regarding intra- and postoperative outcomes, the rebotic approach had significantly less estimated blood loss (EBL) (100 ml [IQR 200 ml] vs 200 ml [IQR 235 ml]; p = 0.029), fewer conversions to open operations (n = 4 [2.4 %] vs n = 13, [7.9 %]; p = 0.043), and a shorter hospital stay (6 days [IQR 3 days] vs 7 days [IQR 3.3 days]; p = 0.009). Conclusion: Both techniques are safe and feasible in major hepatic resections. Compared with L-LH/L-ELH, R-LH/R-ELH is associated with less EBL, fewer conversions to open operations, and a shorter hospital stay.

Dihydrogen sulfide (H2S) gas has a flammable nature and is one of the most toxic and dangerous gases. Even small concentrations can be fatal to humans. Herein, we investigated the H2S gas-sensing features of commercial pristine cerium oxide (CeO2 ) and gadolinium (Gd)-doped CeO2 (GDC) nanoparticles. First, the sensing materials were well-characterized using various methods including X-ray photoelectron spectroscopy, transmission electron microscopy and X-ray diffraction to gain insight into their chemical composition, morphology, phases, and crystallinity, respectively. In the next step, gas sensors were fabricated using a top electrode (Au/Ti) configuration. Preliminary H2S-gas-sensing studies revealed that GDC gas sensor had a superior gas response to H2S gas than the pristine CeO2 gas sensor at 350°C. The responses of the pristine CeO2 gas sensor to 20 ppm H2S gas was 1.542, while the response of the GDC gas sensor to the aforementioned H2S concentration was 3.489. In addition, the GDC sensor exhibited good selectivity to H2S gas among C2H5OH, C7H8 and NH3 gases. Also, we investigated the response of the sensor in up to 60% relative humidity. The enhanced response of the GDC gas sensor to H2S gas was mainly related to the formation of oxygen defects as a result of Gd-doping in CeO2 . Also, good selectivity to H2S was related to the sensing temperature, the higher reactivity of H2S relative to other gases and the small bond energy of H-SH. This study demonstrates the promising ability of Gd-doping to enhance the H2S gas-sensing characteristics of CeO2 , which can be applied to other similar systems based on semiconducting metal oxides.

The preemptive visceral analgesic effect of regional nerve block has not been adequately investigated to date. We evaluated the preemptive visceral analgesic effect of thoracic paravertebral block (TPVB) in patients undergoing laparoscopic cholecystectomy (LC) in whom pre-incisional rectus sheath block (RSB) was used to minimize somatic surgical pain.In this prospective, randomized, assessor-blind study, 70 patients scheduled for elective LC were randomly assigned to the pre-TPVB (n=35) or the post-TPVB (n=35) group. Both groups received pre-incisional RSB, and patients in the pre-TPVB group received TPVB before skin incision while those in the post-TPVB group received TPVB after skin closure. The primary outcome was the total rescue analgesic consumption (morphine equianalgesic dose) during the 24 hours post-surgery. The secondary outcomes were the cumulative analgesic consumption and pain intensity for 24 hours after surgery, and adverse events.Pre-TPVB significantly reduced total rescue analgesic consumption (estimated mean [95% confidence interval (CI)]) during the 24 hours after surgery than post-TPVB (16.9 [14.5, 19.3] vs. 25.3 [22.8, 27.7] mg, estimated difference: -8.3 [-11.8, -4.9], P0.001). The cumulative rescue analgesic consumption was significantly lower in the pre-TPVB group from 2 to 24 hours after surgery (P0.001). The postoperative pain intensity was significantly lower in the pre-TPVB group as well at 0.5, 1, 2, and 6 hours after surgery. There were no adverse events associated with analgesics, RSB, or TPVB.Pre-incisional TPVB conferred a significant preemptive visceral analgesic effect in patients undergoing LC, and significantly reduced the amount of postoperative opioid consumption.

Background/Aims: Administrative databases provide valuable information for large-cohort studies. This study aimed to evaluate the diagnostic accuracy of an administrative database for resected gastric adenomas.Methods: Data of patients who underwent endoscopic resection for benign gastric lesions were collected from three hospitals. Gastric adenoma cases were identified in the hospital database using International Classification of Diseases (ICD) 10-codes. The non-adenoma group included patients without gastric adenoma codes. The diagnostic accuracy for gastric adenoma was analyzed based on the pathological reports of the resected specimen.Results: Among 5,095 endoscopic resections with codes for benign gastric lesions, 3,909 patients were included in the analysis. Among them, 2,831 and 1,078 patients were allocated to the adenoma and non-adenoma groups, respectively. Regarding the overall diagnosis of gastric adenoma with ICD-10 codes, the sensitivity, specificity, positive predictive value, and negative predictive value were 98.7%, 88.5%, 95.2%, and 96.8%, respectively. There were no significant differences in these parameters between the tertiary and secondary centers.Conclusions: Administrative codes of gastric adenoma, according to ICD-10 codes, showed good accuracy and can serve as a useful tool to study prognosis of these patients in real-world data studies in the future.

Edible insects are a potential and sustainable protein resource. Various extraction methods are used to process edible insects. However, the residue fraction is discarded after protein extraction because of its poor functional properties, despite having a high protein content. This study was conducted to improve the functional properties of re-extracted protein from the raw and hydrolysed protein extraction residues, and to demonstrate the most effective condition of extraction buffer. Residues from Hermetia illucens L. protein water extraction and enzymatic hydrolysis extraction were hydrated using different pH buffers (0.1 M HCl, distilled water, and 0.1 M NaOH). Compared to the pH of the extract from the re-dissolved residue, the proteins from hydrolysed samples were acidic. Changes in colour values were observed for the different buffers and hydrolysis conditions applied. Protein solubility, foaming properties, and emulsifying properties of the protein improved after hydrolysis. In conclusion, hydrolysed protein extraction using the swelling method under alkaline conditions may improve the protein functionality of the residue fraction in H. illucens.

For homeland security, radiation portal monitors (RPMs) have been widely used to detect illegal radioactive materials at seaports, airports, nuclear facilities and other highly secured establishments. In general, commercial RPMs are based on a large plastic (i.e. PVT-polyvinyl toluene) scintillator detector and the associated electronics. In order to detect radioactive materials passing through the RPM, the alarm criterion should be set according to the background level, which depends on the operating location due to not only composition differences in soil and rocks but also weather variation (i.e. rainfall and temperature). It is well known that RPM background signal level increases with rainfall and that the PVT signal depends on the temperature due to scintillation light yield variation. In this study, the background signal level of two commercial RPMs (models: 4525-3800 and 7000, Ludlum), both of which are installed and operated at the Incheon and Donghae ports in Korea, was analysed by reference to a 3-year database of minute-to-minute RPM background signals and a rainfall-and-temperature database provided by the Korea Meteorological Administration (KMA). In terms of rainfall, the variation of the background signal level was examined with reference to the amount of rainfall. The averaged variation in the background signal level, which was as high as ~20% as a function of the amount of rainfall, was found to be dependent on a region’s specific concentration of 222Rn in the atmosphere. In terms of temperature, the background signal level varied by ~4.7% within the temperature range of −5 to 30°C for the four studied sites (i.e. two sites per region for the Incheon and Donghae regions). Knowledge of the dependency of RPM background signal level on rainfall amount and temperature could be used to achieve more realistic estimation of the background radiation level for optimising commercial RPMs’ alarm criteria.

Purpose: Patient-specific molecular alterations leading to PARP inhibitor (PARPi) resistance are relatively unexplored. In this study, we analyzed serially collected circulating tumor DNA (ctDNA) from patients with BRCA1/2 mutations who received PARPis to investigate the resistance mechanisms and their significance in postprogression treatment response and survival. Experimental Design: Patients were prospectively enrolled between January 2018 and December 2021 (NCT05458973). Whole-blood samples were obtained before PARPi administration and serially every 3 months until progression. ctDNA was extracted from the samples and sequenced with a 531-gene panel; gene sets for each resistance mechanism were curated. Results: Fifty-four patients were included in this analysis. Mutation profiles of genes in pre-PARPi samples indicating a high tumor mutational burden and alterations in genes associated with replication fork stabilization and drug efflux were associated with poor progression-free survival on PARPis. BRCA hypomorphism and reversion were found in 1 and 3 patients, respectively. Among 29 patients with matched samples, mutational heterogeneity increased postprogression on PARPis, showing at least one postspecific mutation in 89.7% of the patients. These mutations indicate non-exclusive acquired resistance mechanisms—homologous recombination repair restoration (28%), replication fork stability (34%), upregulated survival pathway (41%), target loss (10%), and drug efflux (3%). We observed poor progression-free survival with subsequent chemotherapy in patients with homologous recombination repair restoration (P = 0.003) and those with the simultaneous involvement of two or more resistance mechanisms (P = 0.040). Conclusions: Analysis of serial ctDNAs highlighted multiple acquired resistance mechanisms, providing valuable insights for improving postprogression treatment and survival.

A cochleate formulation was developed to enhance the oral bioavailability of revaprazan (RVP). Dimyristoyl phosphatidylcholine (DMPC) liposome containing dicetyl phosphate (DCP) successfully formed a cochleate after treatment with CaCl2, whereas that containing sodium deoxycholate did not. Cochleate was optimised using a D-optimal mixture design with three independent variables—DMPC (X1, 70.58 mol%), cholesterol (X2, 22.54 mol%), and DCP (X3, 6.88 mol%)—and three response variables: encapsulation efficiency (Y1, 76.92%), released amount of free fatty acid at 2 h (Y2, 39.82%), and released amount of RVP at 6 h (Y3, 73.72%). The desirability function was 0.616, showing an excellent agreement between the predicted and experimental values. The cylindrical morphology of the optimised cochleate was visualised, and laurdan spectroscopy confirmed the dehydrated membrane interface, showing an increased generalised polarisation value (approximately 0.5) over small unilamellar vesicle of RVP (RVP-SUV; approximately 0.1). The optimised cochleate showed greater resistance to pancreatic enzyme than RVP-SUV. RVP was released in a controlled manner, achieving approximately 94% release in 12 h. Following oral administration in rats, the optimised cochleate improved the relative bioavailability of RVP by approximately 274%, 255%, and 172% compared to RVP suspension, a physical mixture of RVP and the cochleate, and RVP-SUV, respectively. Thus, the optimised cochleate formulation might be a good candidate for the practical development of RVP.

Objective : Owing to advances in critical care treatment, the overall survival rate of preterm infants born at a gestational age (GA) 7 days after birth) for infants with severe IVH significantly improved over time, decreasing from 39.1% in phase I to 14.3% in phase II (p=0.043). A history of hypotension treated with vasoactive medication within 1 week after birth (adjusted odds ratio, 7.39; p=0.025) was found to be an independent risk factor for mortality. When comparing major morbidities of surviving infants, those in phase II were significantly more likely to have undergone surgery for necrotizing enterocolitis (NEC) (29.2% vs. 0.0%; p=0.027). Additionally, rates of late-onset sepsis (45.8% vs. 14.3%; p=0.049) and central nervous system infection (25.0% vs. 0.0%; p=0.049) were significantly higher in phase II survivors than in phase I survivors.Conclusion : In-hospital mortality in preterm infants with severe IVH decreased over the last decade, whereas major neonatal morbidities increased, particularly surgical NEC and sepsis. This study suggests the importance of multidisciplinary specialized medical and surgical neonatal intensive care in preterm infants with severe IVH.

The recent identification of the cell-surface protein DSC1 (desmocollin 1) as a negative regulator of HDL (high-density lipoprotein) biogenesis has attracted us to revisit the old HDL biogenesis hypothesis: HDL biogenesis reduces atherosclerosis. The location and function of DSC1 suggest that DSC1 is a druggable target for the promotion of HDL biogenesis, and the discovery of docetaxel as a potent inhibitor of the DSC1 sequestration of apolipoprotein A-I has provided us with new opportunities to test this hypothesis. The FDA-approved chemotherapy drug docetaxel promotes HDL biogenesis at low-nanomolar concentrations that are far lower than used in chemotherapy. Docetaxel has also been shown to inhibit atherogenic proliferation of vascular smooth muscle cells. In accordance with these atheroprotective effects of docetaxel, animal studies have shown that docetaxel reduces dyslipidemia-induced atherosclerosis. In the absence of HDL-directed therapies for atherosclerosis, DSC1 constitutes an important new target for the promotion of HDL biogenesis, and the DSC1-targeting compound docetaxel serves as a model compound to prove the hypothesis. In this brief review, we discuss opportunities, challenges, and future directions for using docetaxel in the prevention and treatment of atherosclerosis.