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Background/Aim: Sarcopenia increases the mortality in patients with cirrhosis. Approximately 60% of zinc is accumulated in skeletal muscle. We aimed to determine the role of subclinical zinc deficiency on sarcopenia development in patients with cirrhosis. Patients and Methods: We enrolled 151 patients with cirrhosis and divided them into the group with normal serum zinc levels (Group N: 80-130 μg/dl; n=38) and group with subclinical zinc deficiency (Group D

Currently, there are no reports on the learning curve of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using dedicated plastic stents. Therefore, we evaluated the outcomes of EUS-HGS using dedicated plastic stents at tertiary referral centers during the initial development phase of EUS-HGS.Endoscopic retrograde cholangiopancreatography (ERCP) was strictly prioritized over EUS-HGS. Twenty-three consecutive patients treated using EUS-HGS with a 7-Fr dedicated plastic stent over 4 years beginning in 2018 were analyzed retrospectively.The most common primary disease was pancreatic cancer, and the most common reason for difficulty in ERCP was duodenal obstruction, followed by surgically altered anatomy. The overall technical success rate of EUS-HGS was 95.7% (22/23). One failed case was converted to EUS-guided choledochoduodenostomy. The clinical success rate was 90.9% (20/22). Adverse events (AEs) related to the procedure were observed in four (17.4%) patients, including mild biliary peritonitis in three (13.0%) and mild cholangitis in one (4.3%) patient; all patients received conservative therapy. No serious AEs, such as stent migration, bleeding, or gastrointestinal perforation, were observed. Recurrent biliary obstruction (RBO) was observed in eight (34.8%) patients. Of these, HGS stent replacement was performed in four patients, and other treatments were performed in the remaining four patients. Another four (17.4%) patients did not develop RBO but underwent periodic HGS stent replacement.EUS-HGS using a dedicated plastic stent was performed safely even in its initial phase of introduction. The approach using this stent can be useful in case of ERCP failure for biliary decompression because of the high feasibility and low risk of serious adverse events.

Serial pancreatic juice aspiration cytological examination (SPACE) via endoscopic retrograde cholangiopancreatography is a useful diagnostic method for early-stage pancreatic cancer, such as carcinoma in situ that are difficult to diagnose by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). However, the diagnostic accuracy of SPACE is low, which is attributed to problems regarding specimen treatment. Hence, we evaluated the diagnostic efficacy of liquid-based cytology (LBC) in pancreatic juice cytology for pancreatic cancer.We retrospectively analyzed 24 patients with suspected pancreatic cancer that was difficult to diagnose by endoscopic ultrasound-guided fine needle aspiration who underwent SPACE using LBC between April 2017 and April 2021.The most common reason for performing SPACE was localized stenosis of the main pancreatic duct without a mass. Eleven patients were diagnosed with malignancy after surgical resection, nine of whom had pancreatic ductal adenocarcinoma. Ten patients were diagnosed as benign after a follow-up of more than 1 year. The nine cases of malignancy were diagnosed before surgical resection by SPACE using LBC, with a sensitivity of 81.8% and specificity of 100%. The overall diagnostic accuracy was 91.7%. A total of 152 LBC examinations were performed via SPACE, with an adequate sample collection rate of 88.9%. No adverse events, including acute pancreatitis, occurred after endoscopic retrograde cholangiopancreatography.SPACE with LBC offers good diagnostic efficacy in patients with pancreatic cancer that is difficult to diagnose by endoscopic ultrasound-guided fine needle aspiration.

Glycogenic hepatopathy (GH) is a rare complication of poorly controlled type 1 diabetes mellitus (T1DM), and is characterized by elevated liver enzymes, hepatomegaly, and glycogen accumulation. We herein present the case of a 23-year-old man with poorly controlled T1DM who had liver dysfunction. Imaging studies showed severe hepatomegaly and fatty liver. The examination of a liver biopsy specimen revealed fatty droplets, ballooning, inflammation, and mild fibrosis. Subsequent periodic acid-Schiff (PAS) staining after diastase digestion confirmed GH. In this case, the improvement of hyperglycemia, not HbA1c, resulted in the improvement of the patient's liver function. This is the first report on the use of continuous glucose monitoring in patients with GH to show that continuous hyperglycemia may worsen GH.

The Space–Time Variational Multiscale (ST-VMS) method was introduced to function as a moving-mesh method. It is the VMS version of the Deforming-Spatial-Domain/Stabilized ST (DSD/SST) method. It has reasonably good turbulence modeling features and serves as a core computational method. The ST Slip Interface (ST-SI) method was introduced to addresses the challenge involved in high-resolution representation of the boundary layers near spinning solid surfaces. The mesh covering a spinning solid surface spins with it and thus maintains the high-resolution representation near it. The ST-TC method was introduced for moving-mesh computation of flow problems with topology changes, such as contact between solid surfaces. It deals with the TC while maintaining high-resolution boundary layer representation near solid surfaces. The “ST-SI-TC” method we introduce here integrates the ST-SI and ST-TC methods in the ST-VMS framework. It enables accurate flow analysis when we have a spinning solid surface that is in contact with a solid surface. We present two test computations with the ST-SI-TC method, and they are both with models of flow around a rotating tire with road contact and prescribed deformation, one with a 2D model, and one with a 3D model.

Fluid mechanics computation of heart valves with an interface-tracking (moving-mesh) method was one of the classes of computations targeted in introducing the space---time (ST) interface tracking method with topology change (ST-TC). The ST-TC method is a new version of the Deforming-Spatial-Domain/Stabilized ST (DSD/SST) method. It can deal with an actual contact between solid surfaces in flow problems with moving interfaces, while still possessing the desirable features of interface-tracking methods, such as better resolution of the boundary layers. The DSD/SST method with effective mesh update can already handle moving-interface problems when the solid surfaces are in near contact or create near TC, if the "nearness" is sufficiently "near" for the purpose of solving the problem. That, however, is not the case in fluid mechanics of heart valves, as the solid surfaces need to be brought into an actual contact when the flow has to be completely blocked. Here we extend the ST-TC method to 3D fluid mechanics computation of heart valve models. We present computations for two models: an aortic valve with coronary arteries and a mechanical aortic valve. These computations demonstrate that the ST-TC method can bring interface-tracking accuracy to fluid mechanics of heart valves, and can do that with computational practicality.

To address the computational challenges associated with contact between moving interfaces, such as those in cardiovascular fluid–structure interaction (FSI), parachute FSI, and flapping-wing aerodynamics, we introduce a space–time (ST) interface-tracking method that can deal with topology change (TC). In cardiovascular FSI, our primary target is heart valves. The method is a new version of the deforming-spatial-domain/stabilized space–time (DSD/SST) method, and we call it ST-TC. It includes a master–slave system that maintains the connectivity of the “parent” mesh when there is contact between the moving interfaces. It is an efficient, practical alternative to using unstructured ST meshes, but without giving up on the accurate representation of the interface or consistent representation of the interface motion. We explain the method with conceptual examples and present 2D test computations with models representative of the classes of problems we are targeting.

Hazard map systems provide bicycle riders with information regarding hazardous locations. Conventional hazard map systems use data on previous accidents and inhabitant interviews to identify hazardous locations. This conventional interview approach, however, is subjective and information regarding past accidents cannot identify potentially hazardous locations. Therefore, this paper proposes a new hazard detection method that uses a probe bicycle equipped with specially designed sensors to automatically detect hazardous locations. We implemented a prototype evaluation system that confirmed good detecting accuracy.