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Background: Adult small bowel intussusception usually has an aetiology that leads to small bowel obstruction. Here, we aimed to identify the clinicopathological features of adult small bowel intussusception managed with Balloon-Assisted Enterosopy (BAE) and to explore the clinical usefulness of BAE for the management of small bowel intussusception.Method: We retrospectively analysed the clinical data of 13 patients who were diagnosed with adult small bowel intussusception at Korea University Guro Hospital between 2010 and 2019.Results: The type of intussusception was ileoileal in eight (61.5%) patients and jejunal-jejunal in five (38.5%) patients. Eight cases of small bowel intussusception (61.5%; five idiopathic causes, two Peutz-Jeghers polyps, and one Crohn’s disease) were successfully managed with BAE. The remaining five patients underwent laparoscopic small bowel resection due to management of the primary aetiology (two diffuse large B-cell lymphoma, one lipomatosis, one Peutz-Jeghers polyps, and one angiomyolipoma).Concusions: In many cases, adult small bowel intussusception had a benign and idiopathic aetiology. The diagnosis and treatment of adult small bowel intussusception with BAE may reduce the requirement for small bowel resection in selected patients.

The physicochemical and biofunctional properties of crab chitosan nanoparticles of two different sizes (Nano A and B) manufactured by dry milling method were evaluated for commercialization. The deacetylation degrees (DD) of Nano A, B and the control chitosan were 90.9, 93.0, and 92.7% respectively whereas their molecular weights (M(w)) were 43.9, 44.7 and 208.8 kDa. The average sizes of the dispersed Nano A, B and the control chitosan in cetyltrimethylammonium chloride were 735.9, 849.4 and 2,382.4 nm, respectively, which were lower than 1441.7, 2935.6 and 6832.9 nm of the intact chitosans. Chitosan nanoparticles had mild tyrosinase, antioxidant and angiotensin I converting enzyme (ACE), but weak collagenase, elastase and beta-glucuronidase inhibitory activity. However, Nano A had strong alpha-glucosidase inhibitory activity, which was comparable to that of acarbose, a commercial alpha-glucosidase inhibitor. In addition, the minimum inhibitory concentrations (MICs) of chitosan and its nanoparticles ranged from 30 to > 200 microg/mL against each four gram-positive and gram-negative bacteria. Therefore, crab chitosan nanoparticles could be used as a nutraceutical, cosmeceutical or pharmaceutical product.

We fabricated multi-walled carbon nanotube (MWNT) reinforced polyurethane (PU) nanofiber (MWNT-PU) web via electrospinning. In order to optimize the electrospinning conditions, we investigated the effects of various parameters including kind of solvent, viscosity of the spinning solution, and flow rate on the spinnability and properties of nanofiber. N,N-dimethylformamide (DMF), tetrahydrofuran (THF) and their mixture with various volume ratio were used as the spinning solvent. Morphology of the nanofiber was studied using scanning electron microscope (SEM) and transmission electron microscope (TEM), confirming successful fabrication of MWNT-PU nanofiber web with uniform dispersion of MWNT in longitudinal direction of the fiber. The MWNT-PU nanofiber web exhibited two times higher tensile strength than PU nanofiber web. We also fabricated electrically conducting MWNT-PU nanofiber web by coating poly(3,4-ehtylenedioxythiophene) (PEDOT) on the surface of MWNT-PU nanofiber web for electromagnetic interference (EMI) shielding application. The electromagnetic interference shielding effectiveness (EMI SE) was quite high as 25 dB in the frequency range from 50 MHz to 10 GHz.

Aberrant fibroblast growth factor receptor (FGFR) activation/expression is a common feature in lung cancer (LC). In this study, we evaluated the antitumor activity of and the mechanisms underlying acquired resistance to two potent selective FGFR inhibitors, AZD4547 and BAY116387, in LC cell lines. The antitumor activity of AZD4547 and BAY1163877 was screened in 24 LC cell lines, including 5 with FGFR1 amplification. Two cell lines containing FGFR1 amplifications, H1581 and DMS114, were sensitive to FGFR inhibitors (IC50m). Clones of FGFR1-amplified H1581 cells resistant to AZD4547 or BAY116387 (H1581AR and H1581BR cells, respectively) were established. Receptor tyrosine kinase (RTK) array and immunoblotting analyses showed strong overexpression and activation of Met in H1581AR/BR cells, compared with that in the parental cells. Gene set enrichment analysis against the Kyoto Encyclopedia of Genes and Genomes (KEGG) database showed that cytokine–cytokine receptor interaction pathways were significantly enriched in H1581AR/BR cells, with Met contributing significantly to the core enrichment. Genomic DNA quantitative PCR and fluorescent in situ hybridization analyses showed MET amplification in H1581AR, but not in H1581BR, cells. Met amplification drives acquired resistance to AZD4547 in H1581AR cells by activating ErbB3. Combination treatment with FGFR inhibitors and an anaplastic lymphoma kinase (ALK)/Met inhibitor, crizotinib, or Met-specific short interfering RNA (siRNA) synergistically inhibited cell proliferation in both H1581AR and H1581BR cells. Conversely, ectopic expression of Met in H1581 cells conferred resistance to AZD4547 and BAY1163877. Acquired resistance to FGFR inhibitors not only altered cellular morphology, but also promoted migration and invasion of resistant clones, in part by inducing epithelial-to-mesenchymal transition. Taken together, our data suggest that Met activation is sufficient to bypass dependency on FGFR signaling. Concurrent inhibition of the Met and FGFR pathways may have synergistic clinical benefits when targeting FGFR-dependent LC.

The intravenous injection of microemulsion propofol to induce anaesthesia causes more intense and frequent pain than lipid emulsion propofol. This study investigated whether different target effect-site concentrations of remifentanil could prevent pain due to microemulsion propofol injection. In total, 96 patients were randomly assigned to one of three groups receiving target effect-site concentrations of remifentanil 0 (control group), 4 or 6 ng/ml, followed by injection with microemulsion propofol. Remifentanil pretreatment significantly reduced the incidence and severity of injection pain compared with the control group. Although no difference in pain reduction between the two remifentanil-treated groups was observed, those receiving a target effect-site concentration of 6 ng/ml exhibited an increased rate of complications, compared with those receiving 4 ng/ml. In conclusion, prior administration of remifentanil at a target effect-site concentration of 4 ng/ml is a useful strategy to decrease the injection pain of microemulsion propofol.

This study evaluated the influence of diabetes on the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and body mass index (BMI). Simultaneous NT-proBNP and echocardiographic Doppler examinations were performed in 1117 patients with dyspnoea undergoing cardiac catheterization. Patients were divided into BMI ≥ 25 kg/m2 (obese), 23 − 25 kg/m2 (overweight) and < 23 kg/m2 (non-obese) groups. In the 803 non-diabetic patients, mean plasma NT-proBNP levels in non-obese, overweight and obese patients showed a significant negative correlation with BMI (862.3 ± 228.8 pg/ml, 611.5 ± 149.7 pg/ml, 278.3 ± 172.5 pg/ml, respectively). In the 314 patients with diabetes, there was no correlation between BMI and NT-proBNP. This study demonstrated that obese patients had reduced concentrations of NT-proBNP compared with non-obese patients, despite having higher left ventricular filling pressures. NT-proBNP was not reduced in obese patients with diabetes. These results suggest that factors other than cardiac status impact on NT-proBNP concentration.

Objective: To evaluate the feasibility and effects of acupuncture on insomnia, anxiety, and depression in women with Chronic Liver Disease. Patients and Methods: Twenty-four women patients over the age of 18 years who had liver disease complicated by psychiatric disorders such as insomnia, anxiety, and depression were randomly assigned to either the treatment group (n=12) or the control group (n=12). In the treatment group, acupuncture was performed 3 times per week for 4 weeks (12 sessions in total). In control group, there was no acupuncture but the same assessment with treatment group. Insomnia, anxiety, and depression were measured using the National Cancer Center (NCC) scoring system. We assessed deterioration of liver disease using the Child score and blood tests. Results: In the treatment group, the mean NCC insomnia, anxiety, and depression scores decreased significantly over the treatment period; control group scores did not decrease significantly. After 12 acupuncture treatments, the total NCC score for insomnia, anxiety, and depression was significantly lower in the treatment group compared with that of the control group. After the trial, liver function of neither group got worse. Conclusions: These results suggest that acupuncture treatment may be beneficial in improving insomnia, anxiety, and depression among patients with chronic liver disease without worsening of liver function. Further study with a larger sample size including male participants is needed to confirm our findings.

Background: The significance of silent infarcts (SIs) is unknown in very elderly patients with first-ever acute ischemic stroke. Methods: Fifty patients aged 80 years and older with first-ever acute ischemic stroke were studied. The conventional risk factors for stroke, the scores of age-related white matter changes, and the findings on echocardiography were compared between patients with and without SIs. Results: Thirty-eight patients (76%) had one or more SIs. The patients without SIs frequently had atrial fibrillation (50% vs. 13.2%, p = 0.014) or spontaneous echo contrast or thrombi on echocardiography (57.1% vs. 0%, p = 0.026) and showed lower scores on age-related white matter changes (0.5 ± 0.67 vs. 1.13 ± 0.58, p = 0.002) than did patients with SIs. There were no differences in other risk factors for stroke between the two groups. Conclusion: In patients aged 80 years and older, the absence of SIs with a first-ever acute ischemic stroke may suggest the presence of cardiac embolic sources or atrial fibrillation.

During SPECT studies of the abdomen with Tc-99m labeled autologous leukocytes, the authors had observed false defects involving the vertebral bodies of the lower thoracic spine in two patients. To investigate this "count loss" artifact, a phantom simulating liver, spleen, and spine was constructed. Four clinical situations were simulated by positioning cylinders in the different locations: normal spine-spleen model, normal liver-spine-spleen model, spine-enlarged spleen model, and enlarged liver-spine-enlarged spleen model. SPECT studies were performed at different concentration ratios between the spleen and the spine on the disparate models with varying distance from the spleen to the spine. The results showed that the count loss artifact is not only related to the concentration ratio between the structures but also is related to the size, position, and distance between the structures. The correction steps for this artifact include: 1) identifying average count value of the spine and spleen from ECT sinogram count data, and 2) replacing the original high-count value in the spleen by the count value close to the average value at the region of the spine in the 120 raw projection data. Using these new modified ECT data, the reconstructed orthogonal images are almost free of the count loss artifact.

Statins have marked beneficial effects on lipid profile, but also have pleiotropic actions. A previous study in an iodine-deficient area suggested that statin use is associated with reduced thyroid volume and nodularity. We performed this study to investigate how long-term statin use in type 2 diabetic patients affects thyroid nodularity in iodine-sufficient area.We recruited euthyroid type 2 diabetic patients, receiving statin therapy continuously for at least 5 years (statin group) and, age and sex matched statin-naive type 2 diabetic patients (control group). Subjects with past history of cancer, thyroid disease or treatment with lithium or amiodarone; family history of thyroid cancer; palpable goiter or thyroid nodule, and/or positive thyroperoxidase antibody were excluded. The prevalence, number, and volume of thyroid nodules, size of thyroid were evaluated in all subjects by high resolution ultrasound.Prevalence of non-palpable thyroid nodules of statin group (n=70) and control group (n=98) were 51 and 53% , respectively. There was no difference of prevalence, number, and volume of non-palpable thyroid nodules and size of thyroid between statin and control group. But, the patients aged between 60 and 65 years from statin group showed lower prevalence of non-palpable thyroid nodules than the patients with same age interval from control group (4 out of 12 patients, 33% , statin group; 19 out of 27 patients, 70% , control group; P=0.04).Long-term statin use in elderly type 2 diabetic patients was associated with lesser prevalence of thyroid nodules in an iodine-sufficient area. Our data might support a possible antiproliferative effect of statins on thyroid in old type 2 diabetic patients. But, the effect was not as strong as that in an iodine-deficient area and further studies with enough numbers of subjects and revised design will be needed.

In a 12-month phase 3 study in patients with relapsing-remitting multiple sclerosis (RRMS), TRANSFORMS, fingolimod showed greater efficacy on relapse rates and MRI outcomes compared with interferon beta-1a. We had two aims in our extension: to compare year 2 with year 1 in the switched patients to assess the effect of a change from interferon beta-1a to fingolimod, and to compare over 24 months the treatment groups as originally randomised to assess the effect of delaying the start of treatment with fingolimod. METHODS: Patients randomly assigned to receive 0.5 mg or 1.25 mg daily oral fingolimod in the core study continued with the same treatment in our extension; patients who originally received 30 μg weekly intramuscular interferon beta-1a were randomly reassigned (1:1) to receive either 0.5 mg or 1.25 mg fingolimod. The initial randomisation and dose of fingolimod assigned for the extension remained masked to the patients and investigators. As in the core study, re-randomisation was done centrally in blocks of six and stratified according to site. Our efficacy endpoints were annualised relapse rate (ARR), disability progression, and MRI outcomes. Our within-group analyses were based on the intention-to-treat and safety populations that entered our extension study. Our between-group analyses were based on the intention-to-treat and safety populations from the core study. This study is registered with ClinicalTrials.gov, number NCT00340834. FINDINGS: 1027 patients entered our extension and received the study drug, and 882 completed 24 months of treatment. Patients receiving continuous fingolimod showed persistent benefits in ARR (0.5 mg fingolimod [n=356], 0.12 [95% CI 0.08-0.17] in months 0-12 vs 0.11 [0.08-0.16] in months 13-24; 1.25 mg fingolimod [n=330], 0.15 [0.10-0.21] vs 0.11 [0.08-0.16]; however, in patients who initially received interferon beta-1a, ARR was lower after switching to fingolimod compared with the previous 12 months (interferon beta-1a to 0.5 mg fingolimod [n=167], 0.31 [95% CI 0.22-0.43] in months 0-12 vs 0.22 [0.15-0.31], in months 13-24 p=0.049; interferon beta-1a to 1.25 mg fingolimod [n=174], 0.29 [0.20-0.40] vs 0.18 [0.12-0.27], p=0.024). After switching to fingolimod, numbers of new or newly enlarging T2 and gadolinium (Gd)-enhancing T1 lesions were significantly reduced compared with the previous 12 months of interferon beta-1a therapy (p

Cell-permeable peptides (CPPs) promote the transduction of nonpermissive cells by recombinant adenovirus (rAd) to improve the therapeutic efficacy of rAd. In this study, branched oligomerization of CPPs significantly enhanced the transduction of human mesenchymal stem cells (MSCs) by rAd in a CPP type-independent manner. In particular, tetrameric CPPs increased transduction efficiency at 3000-5000-fold lower concentrations than did monomeric CPPs. Although branched oligomerization of CPPs also increases cytotoxicity, optimal concentrations of tetrameric CPPs required for maximum transduction are at least 300-1000-fold lower than those causing 50% cytotoxicity. Furthermore, although only approximately 60% of MSCs were maximally transduced at 500 muM of monomeric CPPs,95% of MSCs were transduced with 0.1 muM of tetrameric CPPs. Tetrameric CPPs also significantly increased the formation and net surface charge of CPP/rAd complexes, as well as the binding of rAd to cell membranes at a greater degree than did monomeric CPPs, followed by rapid internalization into MSCs. In a critical-size calvarial defect model, the inclusion of tetrameric CPPs in ex vivo transduction of rAd expressing bone morphogenetic protein 2 into MSCs promoted highly mineralized bone formation. In addition, MSCs that were transduced with rAd expressing brain-derived neurotrophic factor in the presence of tetrameric CPPs improved functional recovery in a spinal cord injury model. These results demonstrated the potential for tetrameric CPPs to provide an innovative tool for MSC-based gene therapy and for in vitro gene delivery to MSCs.

We report the observation of an isotriplet of excited charmed baryons, decaying into Lambda(+)(c)pi(-), Lambda(+)(c)pi(0), and Lambda(+)(c)pi(+). We measure the mass differences M(Lambda(+)(c)pi)-M(Lambda(+)(c)) and widths to be 515.4(+3.2+2.1)(-3.1-6.0) MeV/c(2), 61(+18+22)(-13-13) MeV for the neutral state; 505.4(+5.8+12.4)(-4.6-2.0) MeV/c(2), 62(+37+52)(-23-38) MeV for the charged state; and 514.5(+3.4+2.8)(-3.1-4.9) MeV/c(2), 75(+18+12)(-13-11) MeV for the doubly charged state, where the uncertainties are statistical and systematic, respectively. These results are obtained from a 281 fb(-1) data sample collected with the Belle detector near the Upsilon(4S) resonance, at the KEKB asymmetric energy e(+)e(-) collider.

False perfusion defects simulating Alzheimer's disease can be attributed to skull thickness and head holders of a SPECT scan table. Brain phantom SPECT was performed using a different type of head holder in order to evaluate the effect of attenuation due to head holders and skull thickness on brain SPECT. Skull thickness was measured in 10 normal or non-Alzheimer's patients and 10 patients with suspected Alzheimer's disease. Visual and quantitative analysis of regional perfusion showed a 19% count loss due to attenuation by commercially available head holders and average skull thickness, less than 18% count difference between frontal-temporal and parietal-occipital skull in non-Alzheimer's disease patients, and more than 22% count difference observed in suspected Alzheimer's patients.

Dual isotope brain SPECT was performed in a patient with recurrent brain tumor (grade II astrocytoma). In this case, a good coregistration of brain perfusion and tumor images was obtained because Tc-99m HMPAO and the Tl-201 chloride imaging were done simultaneously using a Triad SPECT unit. This method might play an important clinical role in the evaluation of patients with recurrent brain tumors.