Search

Background: Evidence of the advantages of robotic pancreaticoduodenectomy (RPD) over laparoscopic pancreaticoduodenectomy (LPD) is limited. Thus, this study aimed to compare the surgical outcomes of laparoscopic reconstruction L-recon) versus robotic reconstruction (R-recon) in patients with soft pancreas and small pancreatic duct. Method: Among 429 patients treated with minimally invasive pancreaticoduodenectomy (MIPD) between October 2012 and June 2020 by three surgeons at three institutions, 201 patients with a soft pancreas and a small pancreatic duct (< 3 mm) were included in this study. Results: Sixty pairs of patients who underwent L-recon and R-recon were selected after propensity score matching. The perioperative outcomes were comparable between the reconstruction approaches, with comparable clinically relevant postoperative pancreatic fistula (CR-POPF) rates (15.0% [L-recon] vs. 13.3% [R-recon]). The sub-analysis according to the type of MIPD procedure also showed comparable outcomes, but only a significant difference in postoperative hospital stay was identified. During the learning curve analysis using the cumulative summation by operation time (CUSUMOT), two surgeons who performed both L-recon and R-recon procedures reached their first peak in the CUSUMOT graph earlier for the R-recon group than for the L-recon group (i.e., 20th L-recon case and third R-recon case of surgeon A and 43rd L-recon case and seventh R-recon case of surgeon B). Surgeon C, who only performed R-recon, demonstrated the first peak in the 22nd case. The multivariate regression analysis for risk factors of CR-POPF showed that the MIPD procedure type, as well as other factors, did not have any significant effect. Conclusion: Postoperative pancreatic fistula rates and the overall perioperative outcomes of L-recon and R-recon were comparable in patients with soft-textured pancreas and small pancreatic duct treated by experienced surgeons. [ABSTRACT FROM AUTHOR]

Sarcopenia is becoming prevalent in an increasing number of older adults undergoing total knee replacement (TKR) surgery. Metal implants may overestimate lean mass (LM) measured using dual-energy X-ray absorptiometry (DXA). This study aimed to examine the effects of TKR on LM measurements according to automatic metal detection (AMD) processing. The participants from Korean Frailty and Aging Cohort Study, who had underwent TKR were enrolled. A total of 24 older adults (mean age 76.4 ± 4.0 years, 92% female) were included in the analysis. The SMI with AMD processing was 6.1 ± 0.6 kg/m2, which was lower than that without AMD processing of 6.5 ± 0.6 kg/m2 (p < 0.001). The LM of the right leg with AMD processing was lower than that without AMD in 20 participants who had underwent TKR surgery on the right (5.5 ± 0.2 kg vs. 6.0 ± 0.2 kg, p < 0.001), and that of the left leg was also lower in with AMD processing than in without AMD processing in 18 participants who had underwent TKR surgery on the left (5.7 ± 0.2 kg vs. 5.2 ± 0.2 kg, p < 0.001). Only one participant was classified as having low muscle mass without AMD processing, but this came to four after AMD processing. LM assessment in individuals who had TKR could be significantly different according to the use of AMD. [ABSTRACT FROM AUTHOR]

In this paper, we propose a lensless three-dimensional (3D) imaging under photon-starved conditions using diffraction grating and computational photon counting method. In conventional 3D imaging with and without the lens, 3D visualization of objects under photon-starved conditions may be difficult due to lack of photons. To solve this problem, our proposed method uses diffraction grating imaging as lensless 3D imaging and computational photon counting method for 3D visualization of objects under these conditions. In addition, to improve the visual quality of 3D images under severely photon-starved conditions, in this paper, multiple observation photon counting method with advanced statistical estimation such as Bayesian estimation is proposed. Multiple observation photon counting method can estimate the more accurate 3D images by remedying the random errors of photon occurrence because it can increase the samples of photons. To prove the ability of our proposed method, we implement the optical experiments and calculate the peak sidelobe ratio as the performance metric. [ABSTRACT FROM AUTHOR]

The global environmental issues caused by plastic incineration are continuously increasing, along with the demand for polyethylene terephthalate (PET)—27 million metric tons of PET was demanded in 2020.Therefore, PET recycling has emerged as the core of the global circular economy. In particular, PET recycling methods are categorized into two pathways: mechanical and chemical recycling, wherein mechanical recycling is more efficient than chemical recycling. However, PET undergoes heat-induced degradations during mechanical recycling such as reduction in molecular weight (MW) and viscosity. Therefore, feasible methods are required to overcome such challenges. This article details the mechanical recycling process of PET using a chain-extending extrusion method. Accordingly, various chain extenders (CEs) were reviewed to identify their effects on recycled PET (rPET) properties and reactive extrusion processes. Moreover, we detailed the recent progress in the reactive extrusion method used for PET recycling based on the effects of various CEs on rPET properties. [ABSTRACT FROM AUTHOR]

A new soft x-ray (SXR) array diagnostic system has been developed on versatile experiment spherical torus (VEST) for measurements of 2D SXR emissivity profile and identification of poloidal mode structure. Through tomographic inversion techniques, 2D SXR emissivity profile can be acquired from the line-integrated SXR data, which enables the visualization of mode structure of plasma instability, such as the magnetohydrodynamics mode. The SXR array diagnostic system consists of two 20-channel arrays positioned at the middle and the top on the same poloidal plane for horizontal and vertical lines of sight, respectively. Each array of the diagnostic system uses absolute extreme ultraviolet photodiode array as the detector. To apply appropriate filters (up to four) for different energy regimes without breaking the vacuum, a filter wheel and its rotatable vacuum feed-through are installed behind the pinhole. SXR data are acquired with a digitizer at the sampling rate of up to 125 MHz. Finally, we discuss initial measurement data obtained from Ohmic plasma in VEST. [ABSTRACT FROM AUTHOR]

An ultrafast charge exchange spectroscopy (UFCES) system has been designed for measuring fluctuations in ion temperature and toroidal rotation velocity. The UFCES on the KSTAR tokamak is a powerful tool for investigating plasma instabilities and long-wavelength turbulence related to ion temperature gradient and flow. The UFCES system is designed to measure the C VI line (n = 8 → 7, λ0 = 529.05 nm) from the charge exchange reaction between a deuterium-heating neutral beam and the intrinsic carbon impurity in KSTAR. The ion temperature and toroidal rotation velocity at two radial positions will be observed simultaneously with UFCES. The key difference between the UFCES system and conventional charge exchange spectrometers is the application of high-throughput collection optics, a high-efficiency transmission grating combined with prisms, and a high-speed detector. We use a comprehensive spectrum simulation code with input parameters of KSTAR's plasmas and a neutral beam injection system to estimate the performance of the designed UFCES system. The results simulated with the code show that the diagnostic achieves a turbulence-relevant time resolution of 10 µs with a high enough signal-to-noise ratio. Furthermore, a preliminary test is performed using a complementary metal–oxide semiconductor camera and Ne spectral lamp to confirm the linear dispersion and curvature radius. [ABSTRACT FROM AUTHOR]

Discharge with an external magnetic field is promising for various applications of low-temperature plasmas from electric propulsion to semiconductor processes owing to high plasma density. It is essential to understand plasma transport across the magnetic field because plasma confinement under the field is based on strong magnetization of light electrons, maintaining quasi-neutrality through the inertial response of unmagnetized ions. In such a partially magnetized plasma, different degrees of magnetization between electrons and ions can create instability and make the confinement and transport mechanisms more complex. Theoretical studies have suggested a link between the instability of various frequency ranges and plasma confinement, whereas experimental work has not been done so far. Here, we experimentally study the magnetic confinement properties of a partially magnetized plasma considering instability. The plasma properties show non-uniform characteristics as the magnetic field increases, indicating enhanced magnetic confinement. However, the strengthened electric field at the edge of the plasma column gives rise to the Simon–Hoh instability, limiting the plasma confinement. The variation of the edge-to-center plasma density ratio (h-factor) with the magnetic field clearly reveals the transition of the transport regime through triggering of the instability. Eventually, the h-factor reaches an asymptotic value, indicating saturation of magnetic confinement. [ABSTRACT FROM AUTHOR]

• Creatinine and cystatin C are potential biomarkers for sarcopenia screening. • Predicted skeletal muscle mass predicted sarcopenia with the highest accuracy. • Predicted skeletal muscle mass was also associated with a lower sarcopenia risk. • Creatinine- and cystatin-C–based indices may help in detecting sarcopenia early. Several creatinine- and cystatin-C–based indices have been proposed as sarcopenia predictors. This study aimed to compare serum creatinine- and cystatin-C–based indices as screening biomarkers for sarcopenia in community-dwelling older adults. A cross-sectional study was conducted on 945 participants aged between 70 and 84 years (men=47.5%; mean age=76.0 ± 3.9 years) from the Korean Frailty and Aging Cohort Study. The serum creatinine-to-cystatin-C ratio estimated glomerular filtration rate (eGFR) ratio (eGFR cystatin-C /eGFR creatinine), sarcopenia index (serum creatinine × eGFR creatinine), predicted skeletal muscle mass index (pSMI), and total body muscle mass index (TBMM) were compared. The prevalence of sarcopenia was 19.9% in men and 14.0% in women. The pSMI and TBMM showed higher correlations with appendicular lean mass and grip strength in men (pSMI: r s =0.356–0.701, p < 0.001; TBMM: r s =0.320–0.730, p < 0.001) and women (pSMI: r s =0.299–0.669, p < 0.001; TBMM: r s =0.256–0.658, p < 0.001) than the other indices. The area under the receiver operating characteristic curves (AUC) of the serum indices for predicting sarcopenia showed the highest accuracy for pSMI (men: AUC=0.77, p < 0.001; women: AUC=0.71, p < 0.001). After adjusting for potential confounders, pSMI was associated with the likelihood of sarcopenia in both men (odds ratio [OR]=0.170; 95% confidence interval [CI]=0.103–0.279) and women (OR=0.167; 95% CI=0.087–0.321). pSMI and TBMM accurately determined sarcopenia than the other indices. Furthermore, a higher pSMI was strongly associated with a decreased risk of sarcopenia compared to TBMM. These findings suggest pSMI as a potential biomarker for sarcopenia screening in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate risk factors for lymph node (LN) or distant metastasis after non-curative endoscopic resection (ER) of undifferentiated-type early gastric cancer (EGC). Methods: Of 1124 patients who underwent ER for undifferentiated-type gastric cancer at 18 tertiary hospitals across six geographic areas in Korea between 2005 and 2014, 634 with non-curative ER beyond the expanded criteria were retrospectively enrolled. According to the treatment after ER, patients were divided into additional surgery (n = 270) and follow-up (n = 364) groups. The median follow-up duration was 59 months for recurrence and 84 months for mortality. Results: LN metastasis was found in 6.7% (18/270) of patients at surgery. Ulcer [odds ratio (OR) 3.83; 95% confidence interval (CI) 1.21–12.13; p = 0.022] and submucosal invasion (OR 10.35; 95% CI 1.35–79.48; p = 0.025) were independent risk factors. In the follow-up group, seven patients (1.9%) developed LN or distant recurrence. Ulcer [hazard ratio (HR) 7.60; 95% CI 1.39–35.74; p = 0.018], LVI (HR 6.80; 95% CI 1.07–42.99; p = 0.042), and positive vertical margin (HR 6.71; 95% CI 1.28–35.19; p = 0.024) were independent risk factors. In the overall cohort, LN metastasis rates were 9.6% in patients with two or more risk factors and 1.2% in those with no or one risk factor. Conclusions: LVI, ulcer, submucosal invasion, and positive vertical margin are independently associated with LN or distant metastasis after non-curative ER of undifferentiated-type EGC. Surgical resection is strongly recommended for patients with two or more risk factors. [ABSTRACT FROM AUTHOR]

We report that the field homogeneity of a large-scale metal-clad no-insulation all-ReBa2Cu3O7−x magnet is reproducible after occasional operating conditions, in this case the current ramp down/up and magnet warm-up/cool-down conditions. First, we shimmed the magnet by cylindrically arraying ferromagnetic shims on the wall of the room-temperature bore of the magnet to improve the spatial field homogeneity. As a result, the field homogeneity of the magnet was improved from 557.7 to 14.1 ppm in a 10 mm diameter spherical volume. The resultant acquisition of field homogeneity tremendously enhanced from an inhomogeneous state greatly degraded by screening currents qualified us to study the temporal stability of the field homogeneity. We used a magnet-energizing protocol with the field drift minimized to shrink a nuclear magnetic resonance (NMR) lineshape into a much narrower super-imposable lineshape. We demonstrate the technique by NMR experiments, showing excellent reproducibility in every case, presenting strong evidence of recovery to certain time-unvarying field gradients and to a state of homogeneity. These findings suggest a new route for high-resolution high-temperature superconducting NMR and magnetic-resonance-imaging magnet technology. [ABSTRACT FROM AUTHOR]

Endoscopic resection techniques require the use of submucosal injection. Normal saline and sodium hyaluronate solutions are mainly used for this purpose, but an ideal solution has not yet been developed. The aim of this study was to assess a new solution, MC-003—a novel submucosal injection solution developed with sodium alginate as the main ingredient. Normal saline, a commercial sodium hyaluronate solution (Endo-Ease), and MC-003 were examined. A total of 18 gastric submucosal cushions were created in the stomachs of six pigs. The height of mucosal elevation was measured sequentially using endoscopic sonography. After euthanizing the animals either 2 h or 5 days after the procedure, pathologic examination was performed for each injection site. Although not statistically significant over the entire study period, MC-003 showed a superior result to normal saline and an equivalent result to Endo-Ease in the submucosal cushion height and its rate of decrease. There were no adverse outcomes after injection of the three solutions and there was no pathologically identified detrimental change in the resected specimens. MC-003 creates a sufficient submucosal fluid cushion without apparent tissue damage. It can be considered as an effective submucosal injection material. [ABSTRACT FROM AUTHOR]

A deep understanding of the kinetic properties of the electrons in a magnetic nozzle (MN), which is attracting attention as an acceleration stage for thrusters, is of great significance as it directly contributes to the development of the MN performance. In the sense that a conversion of the electron momentum to the ion kinetic energy determines the characteristics of the MN, fundamental research on the kinetic feature of a magnetically expanding plasma has focused on the spatial distribution of the electron properties and proposed directions to the desired application. Unlike the common perception of this importance, various research groups have proposed contradictory arguments based on their theoretical approaches regarding the ion beam acceleration from the viewpoint of heat flow of electrons. We point out that the main reason for the absence of a theoretical consensus for the nozzle efficiency improvements arises from the lack of the clear interpretation of the plasma properties by focusing only on the final state of the electrons. In this Letter, time-resolved measurement of the electron energy distributions has been performed to grasp a detailed series of expansion processes. It has been revealed that the effective potential well gradually formed by the self-generated electric field acts as a limiting factor in the motion of electrons; this effect attributes to the changes of the electron energy distribution represented as the accumulation of the trapped electrons. The accumulation over the entire region diminishes the degree of the cooling rate of a system and decreases the electric field in the downstream region initially generated by the adiabatic expansion. The present study emphasizes that the kinetic features of an MN are strongly affected by the non-stationary motion of the trapped electrons; thus, the temporal behavior of the trapped electrons must be considered for prediction and analysis of nozzle performances. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) is widely used for large superficial gastrointestinal tumors. Epigastric pain is a frequent complication of ESD. However, little is known about its incidence and associated factors. This study evaluated pain incidence and characteristics of patients with pain after gastric ESD.Methods: We retrospectively analyzed a prospectively collected registry of clinical, endoscopic, and pathologic results of patients who underwent ESD for gastric adenoma or cancer from January 2010 to December 2015. A Visual Analogue Scale (VAS) was used to assess pain immediately after, and 2, 12, and 24 h after ESD. The primary outcome was the use of painkillers (VAS score > 4). Analyzed data included age, sex, pathology, specimen and tumor size, procedure time, and tumor location.Results: Of 1226 patients, 461 (36.4%) needed a painkiller at least once after ESD (pain group). Compared with the no pain group, the pain group had more females, less alcohol consumption, larger tumor and specimen size, and more antral lesions. In multivariate analysis, female sex (OR 1.559, 95% CI 1.217-1.996, p < 0.001), antral tumor location (OR 1.780, 95% CI 1.398-2.265, p < 0.001), and procedure time over 30 min (OR 1.443, 95% CI 1.130-1.842, p = 0.003) were predictive factors for pain.Conclusion: This study showed that a considerable number of patients needed one or more painkiller doses after gastric ESD. The factors affecting pain included sex, procedure time, and lesion location. Endoscopists should use preemptive or aggressive pain management in high-risk patients after ESD. [ABSTRACT FROM AUTHOR]

Abstract We analyzed the effect of modified mono-vision prescription on the occupational progressive addition lenses (OPALs) in presbyopia for indoor use as a method to solve the inconvenience caused by the decrease in the intermediate and the near distances' vision when the PALs worn. To analyze the effect, 37 subjects (57.22 ± 5.18 years) were selected who were wearing PALs and had working hours over 6 h per day on average at intermediate and near distances. Entire tests were carried out with regard to three cases: subjects wearing PALs, occupational progressive addition lenses (OPALs), and prescription for modified mono-vision of OPALs. In order to compare visual performance of three cases, our study evaluated corrected visual acuity and subjective satisfaction at far, intermediate and near distances, stereo-acuity and phoria at far and near distances. The results showed that the prescription of modified mono-vision of OPALs could be useful when applied to the clinical practices for prescribing presbyopic correction. [ABSTRACT FROM AUTHOR]

Rhus verniciflua is commonly known as a lacquer tree in Korea. The bark of R. verniciflua has been used as an immunostimulator in traditional medicine, but also causes allergic dermatitis due to urushiol derivatives. For the development of active natural resources with less toxicity, the antibacterial activity of various parts of R. verniciflua such as bark, lignum, leaves and fruit, together with chemical composition, were investigated. Among the various parts of R. verniciflua, lignum showed the most potent antibacterial activity against fish pathogenic bacteria such as Edwardsiella tarda, Vibrio anguillarum and Streptococcus iniae. Measurement of total phenolic content and flavonoid content clearly showed a high content of phenolic and flavonoids in lignum among the various parts of R. verniciflua. Further analysis showed a close correlation between antibacterial activity and phenolic content. In addition, methyl gallate and fustin, the major constituents of bark and lignum, showed antibacterial activity, which suggested phenolic constituents as active constituents. The content of urushiols, however, was highest in bark, but there was a trace amount in lignum. LC-MS-MS and PCA analysis showed good discrimination with the difference of phenolic composition in various parts of R. verniciflua. Taken together, phenolic compounds are responsible for the antibacterial activity of R. verniciflua. The lignum of R. verniciflua contains high content of phenolic compounds with less urushiols, which suggests efficient antibacterial activity with less toxicity. Therefore, the lignum of R. verniciflua is suggested as a good source for antibacterial material to use against fish bacterial diseases. [ABSTRACT FROM AUTHOR]

This paper reports the effects of a current sweep cycle method on reducing the screening current induced field (SCF) in a (RE)Ba2Cu3Ox (REBCO) coil. The screening current induced field in a REBCO coil causes two major problems: temporal magnetic field drift and a reduction of the central magnetic field. This is a critical problem in relation to REBCO coils, which require a homogeneous and stable magnetic field, during, for instance, nuclear magnetic resonance (NMR) and magnetic resonance imaging (MRI) applications (Itoh et al., 2013; Hemmi et al., 2005; Hahn et al., 2008; Amemiya et al., 2008; Otsuka et al., 2011; Yang et al., 2013; Ahn et al., 2009; Koyama et al., 2009; Kajikawa et al., 2015). In an effort to circumvent the SCF problem, the current sweep cycle method is investigated based on experiments in this study. The experimental results show that a greater SCF reduction in a REBCO coil can be obtained by increasing the overshooting of the current sweep cycle. [ABSTRACT FROM AUTHOR]

We propose a novel approach for intermediate elemental image reconstruction in integral imaging. To reconstruct intermediate elemental images, we introduce a null elemental image whose pixels are all zero. In the proposed method a number of null elemental images are inserted into a given elemental image array. The elemental image array with null elemental images is convolved with the δ-function sequence. The convolution result shows that the proposed method provides an efficient structure to expand an elemental image array. The resulting elemental image array from the proposed method can supply three-dimensional information for an object at a specific depth. In addition, the proposed method provides adjustable parameters, which can be utilized in design of integral imaging systems. The feasibility of the proposed method has been confirmed through preliminary experiments and theoretical analysis. [ABSTRACT FROM AUTHOR]

This paper reports the feasibility of the impregnation of no-insulation (NI) high-temperature superconducting (HTS) coils using an electrically conductive epoxy resin. Recently, several studies of HTS coils without turn-to-turn insulation have been reported for field coils used in rotating machines such as motors and generators. The NI winding technique enhances the thermal stability of the HTS coil without requiring complicated protection techniques because the quench current is automatically bypassed through the turn-to-turn contacts within the HTS coil. Nevertheless, there is still a question as to whether the NI technique can be applied to rotating machines. To utilize an HTS coil under high mechanical loads such as field coils for rotating machines, the HTS tapes must be stabilized mechanically. For HTS field coils intended for use in rotating machines, epoxy impregnation is generally necessary to protect the HTS field coil from mechanical disturbances caused by the magnetic field and rotational vibration of the rotor to enhance the mechanical stability [1], [2] . However, the NI HTS coil cannot be fabricated by wet winding using epoxy resin because epoxy resins such as Stycast 2850 FT and CTD 521 are electrically insulating materials. This study examines the electrical stability of an NI HTS coil impregnated with an epoxy resin containing electrically conductive particles. The results are likely to present useful data for the application of electrically conductive epoxy impregnated NI HTS coils to rotating machines. [ABSTRACT FROM PUBLISHER]

Because low-temperature superconducting (LTS) magnets can conduct large electric current and generate intense magnetic fields under cryogenic conditions, such magnets are used in many applications such as MRI, nuclear magnetic resonance spectrometers, and mass spectrometers. However, an abnormal termination called “quench” disturbs the normal operation and increases the magnet temperature. To protect the LTS magnet from excessive heat, the maximum temperature of a magnet under the quench process should be calculated. The design of a superconducting magnet protection system is performed according to the calculated maximum temperature. This is why accurate estimation of magnet temperature is important. The quench process of a superconducting magnet involves complex physical mechanisms, which requires a thermal–electrical simulation using computational analysis. We propose a highly efficient and reliable three-dimensional quench calculation method that can calculate the magnet temperature in the quench process. The LTS magnet is divided into many unit nodes; multiphysics analysis at each node is carried out with respect to the elapsed time. To verify the feasibility of the simulation, LTS magnet quench experimental results were compared with the simulation results. This study has the potential to develop a computational method for heat propagation analysis of a superconducting magnet. [ABSTRACT FROM PUBLISHER]

As technology scales below 32 nm, manufacturers began to integrate both CPU and GPU cores in a single chip, i.e., single-chip heterogeneous processor (SCHP), to improve the throughput of emerging applications. In SCHPs, the CPU and the GPU share the total chip power budget while satisfying their own power constraints, respectively. Consequently, to maximize the overall throughput and/or power efficiency, both power budget and workload should be judiciously allocated to the CPU and the GPU. In this paper, we first demonstrate that optimal allocation of power budget and workload to the CPU and the GPU can provide 13 percent higher throughput than the optimal allocation of workload alone for a single-program workload scenario. Second, we also demonstrate that asymmetric power allocation considering per-program characteristics for a multi-programmed workload scenario can provide 9 percent higher throughput or 24 percent higher power efficiency than the even power allocation per program depending on the optimization objective. Last, we propose effective runtime algorithms that can determine near-optimal or optimal combinations of workload and power budget partitioning for both single- and multi-programmed workload scenarios; the runtime algorithms can achieve 96 and 99 percent of the maximum achievable throughput within 5-8 and 3-5 kernel invocations for single- and multi-programmed workload cases, respectively. [ABSTRACT FROM PUBLISHER]

In this paper, we propose image visualization method of photon counting confocal microscopy using statistical estimation. Since high power coherent light source is used to record sectional images from micro-objects in conventional confocal microscopy, it may cause damage for a structure of micro-objects. Thus, low power coherent light source may be required. However, in low light level environment, it is difficult to capture sectional images of micro-objects. On the other hand, photon counting imaging technique can detect sectional images of micro-objects in photon-starved conditions. Therefore, in this paper, we apply a photon counting imaging technique to conventional confocal microscopy for visualization of micro-objects. Photon counting detection can be modeled by statistical process. To visualize micro-objects under photon-starved conditions, statistical estimation methods such as maximum likelihood estimation can be used. In addition, we present color photon counting imaging system which considers different carried photon energy with each basic color channels. To prove and evaluate our method, we show simulation results for image visualization of photon counting confocal microscopy and calculate mean square error. [ABSTRACT FROM AUTHOR]

In this paper, we propose a new approach for viewing angle enhancement in a parallax barrier based one-dimensional (1D) integral imaging display system. The viewing angle in a parallax barrier integral imaging system is defined by the angle between the center of slit and exit ray from elemental image. In this regard, we employ a refractive index medium between the elemental image plane and parallax barrier. Thus, the use of a refractive index medium allows us to increase the angle of exit ray, and may result in a viewing angle enhancement of display system. To test the feasibility of the proposed method, experiments are carried out and the results are comparatively analyzed with the conventional method. Experimental results reveal that the proposed method outperforms the conventional method. [ABSTRACT FROM AUTHOR]

In this paper, we propose a new fast computational integral imaging reconstruction (CIIR) scheme without the deterioration of the spatial filtering effect by combined use of spatial filtering and rearrangement of elemental image pixels. In the proposed scheme, the elemental image array (EIA) recorded by lenslet array is spatially filtered through the convolution of depth-dependent delta function array for a given depth. Then, the spatially filtered EIA is reconstructed as the 3D slice image using pixels of the elemental image rearrangement technique. Our scheme provides both the fast calculation with the same properties of the conventional CIIR and the improved visual quality of the reconstructed 3D slice image. To verify our scheme, we perform preliminary experiments and compare other techniques. [ABSTRACT FROM AUTHOR]

Background and Study Aims: Endoscopic high-frequency soft coagulation is used to manage visible bleeding or nonbleeding vessels during endoscopic submucosal dissection. The aim of the present study was to compare the efficacy of hemostasis by soft coagulation (using hemostatic forceps) with argon plasma coagulation (APC), in a prospective randomized trial.Patients and Methods: From January 2013 to June 2014, 276 patients were randomly assigned into two groups: epinephrine injection plus APC (the APC group); or epinephrine injection plus soft coagulation using hemostatic forceps (the HFSC group). As the primary outcome we compared recurrent bleeding rates within 30 days after initial hemostasis in a noninferiority design.Results: After exclusion, 75 patients in the APC group and 76 in the HFSC group were finally evaluated. In the APC group 72 patients (96 %) were successfully treated with the assigned treatment alone vs. 73 (96 %) in the HFSC group. Initial endoscopic hemostasis using a single or combined modality was achieved in all patients. Recurrent bleeding within 30 days was experienced by five patients (6.7 %) and seven patients (9.2 %) in the AFC and HFSC groups, respectively (P = 0.563), and within 7 days by three patients (4.0 %) and five patients (6.6 %), respectively (P = 0.719). We found no significant difference in the rates of adverse events (1.3 % vs. 2.6 %) or mortality (2.7 % vs. 2.6 %) between the groups.Conclusions: The efficacy and safety of soft coagulation using endoscopic hemostatic forceps is not inferior to APC when used to treat patients with bleeding peptic ulcers. Clinicaltrials.gov NCT02020603. [ABSTRACT FROM AUTHOR]

Four polyacrylates with sulfur-containing side chains were prepared to examine the changes in refractive index (RI) induced by sulfur oxidation. Linear alkyl sulfides and alicyclic sulfides, such as 1,3-dithiolane and 1,4-dithiane, were introduced to impart large RIs to polyacrylates. Oxidation of the sulfur polymers by O 3 and m -chloroperoxybenzoic acid led to the formation of the corresponding sulfoxide and sulfone polymers, respectively. Sulfur oxidation occurred completely, which was highlighted by the oxidized polymer exhibiting a refractive index comparable to a polymer that was synthesized using a sulfone monomer. The RI of the linear sulfur polymer increased and decreased due to the formation of sulfoxide and sulfone polymers, respectively. The Abbe number of the polymer with a linear sulfide side chain was 33.4, which increased to 48.7 after oxidation. [ABSTRACT FROM AUTHOR]

In this paper, we propose a new 3-D computational reconstruction method in diffraction grating imaging. Diffraction grating imaging has advantages in terms of system complexity in generating a parallax image array (PIA) for 3-D imaging. In general, a computational reconstruction of 3-D images isś implemented with a back-projection algorithm of PIA. Therefore, the PIA obtained by a camera array and a lens array based system requires the process of defining and extracting the individual parallax image region in advance. However, since the PIA in a diffraction grating imaging is generated by a single optical element, so there is no suitable method to detect the region of individual parallax images from captured PIA. In addition, it is almost impossible to extract individual parallax image regions when parallax images of different orders overlap each other in the PIA. As a 3-D computational reconstruction method that solves this problem in diffraction grating imaging, we propose a method of extracting a spatially filtered PIA from an original PIA. The proposed method theoretically derives the periodicity and intensity of a PIA by optically analyzing the acquisition process of a PIA. Reconstruction of 3-D object image is realized through the superposition by convolution of parallax images with the same period. The proposed 3-D computational reconstruction may be an optimized method for diffraction grating imaging because it does not require the extraction of individual parallax image regions. The proposed theoretical analysis and computational reconstruction verified the usefulness in 3-D imaging through the optical experimental results. [ABSTRACT FROM AUTHOR]

This paper describes a computational 3-D imaging system based on diffraction grating imaging with laser sources of multiple wavelengths. It was proven that a diffraction grating imaging system works well as a 3-D imaging system in our previous studies. The diffraction grating imaging system has advantages such as no spherical aberration and a low-cost system, compared with the well-known 3-D imaging systems based on a lens array or a camera array. However, a diffraction grating imaging system still suffers from noises, artifacts, and blurring due to the diffraction nature and illumination of single wavelength lasers. In this paper, we propose a diffraction grating imaging system with multiple wavelengths to overcome these problems. The proposed imaging system can produce multiple volumes through multiple laser illuminators with different wavelengths. Integration of these volumes can reduce noises, artifacts, and blurring in grating imaging since the original signals of 3-D objects inside these volumes are integrated by our computational reconstruction method. To apply the multiple wavelength system to a diffraction grating imaging system efficiently, we analyze the effects on the system parameters such as spatial periods and parallax angles for different wavelengths. A computational 3-D imaging system based on the analysis is proposed to enhance the image quality in diffraction grating imaging. Optical experiments with three-wavelength lasers are conducted to evaluate the proposed system. The results indicate that our diffraction grating imaging system is superior to the existing method. [ABSTRACT FROM AUTHOR]

Background: There is a lack of national-level research on alcohol consumption and the epidemiology of alcoholic liver disease (ALD) in South Korea. This study aims to address the critical public health issue of ALD by focusing on its trends, incidence, and outcomes, using nationwide claims data. Methods: Utilizing National Health Insurance Service data from 2011 to 2017, we calculated the population's overall drinking amount and the incidence of ALD based on ICD-10 diagnosis codes. Results: From 2011 to 2017 in South Korea, social drinking increased from 15.7% to 16.5%, notably rising among women. High-risk drinking remained around 16.4%, decreasing in men aged 20–39 but not decreased in men aged 40–59 and steadily increased in women aged 20–59. The prevalence of ALD in high-risk drinkers (0.97%) was significantly higher than in social drinkers (0.16%). A 3-year follow-up revealed ALD incidence of 1.90% for high-risk drinkers and 0.31% for social drinkers. Women high-risk drinkers had a higher ALD risk ratio (6.08) than men (4.18). The economic burden of ALD was substantial, leading to higher healthcare costs and increased hospitalization. Progression rates to liver cirrhosis and hepatocellular carcinoma (HCC) in ALD patients were 23.3% and 2.8%, respectively, with no gender difference in cirrhosis progression. Conclusions: The study revealed a concerning rise in alcohol consumption among South Korean women and emphasizes the heightened health risks and economic burdens associated with high-risk drinking, especially concerning ALD and its complications. [ABSTRACT FROM AUTHOR]

Managing complications of liver cirrhosis such as varices needing treatment (VNT) and clinically significant portal hypertension (CSPH) demands precise and non-invasive diagnostic methods. This study assesses the efficacy of spleen stiffness measurement (SSM) using a 100-Hz probe for predicting VNT and CSPH, aiming to refine diagnostic thresholds. A retrospective analysis was conducted on 257 cirrhotic patients, comparing the diagnostic performance of SSM against traditional criteria, including Baveno VII, for predicting VNT and CSPH. The DeLong test was used for statistical comparisons among predictive models. The success rate of SSM@100 Hz was 94.60%, and factors related to SSM failure were high body mass index and small spleen volume or length. In our cohort, the identified SSM cut-off of 38.9 kPa, which achieved a sensitivity of 92% and a negative predictive value (NPV) of 98% for detecting VNT, is clinically nearly identical to the established Baveno threshold of 40 kPa. The predictive capability of the SSM-based model for VNT was superior to the LSM ± PLT model (p = 0.017). For CSPH prediction, the SSM model notably outperformed existing non-invasive tests (NITs), with an AUC improvement and significant correlations with HVPG measurements (obtained from 49 patients), highlighting a correlation coefficient of 0.486 (p < 0.001) between SSM and HVPG. Therefore, incorporating SSM into clinical practice significantly enhances the prediction accuracy for both VNT and CSPH in cirrhosis patients, mainly due to the high correlation between SSM and HVPG. SSM@100 Hz can offer valuable clinical assistance in avoiding unnecessary endoscopy in these patients. [ABSTRACT FROM AUTHOR]

Electric vehicle (EVs), which use an electric motor, are expected to replace internal combustion engine vehicles. However, to date EVs are not highly attractive to consumers due to their unsatisfactory battery charging characteristics and high cost. In particular, the existing conductive charging method makes it more difficult to spread EVs due to the inconvenience of charging and the risk of electric shock. The wireless power transfer (WPT) system can eliminate all of the charging troubles of EVs. However, the WPT systems in existing EVs have large air gaps between the transmitter coil and the receiver coil, posing a hurdle that prevents success. The large air gap cause issues such as a loose coupling, low efficiency, and troublesome electromagnetic compatibility (EMC). An in-wheel WPT system can serve as a solution to address the issues arising due to the large air gap. In this paper, we propose a magnetic coupler structure of an in-wheel WPT system for EV applications. A design of two coils is introduced, in which the transmitter coil and receiver coil are designed based on a design method. Moreover, the pad structure according to the ferromagnetic core geometry is designed and discussed. The aim of this research is to find a suitable configuration of the magnetic coupler for an in-wheel WPT system. The values of the coupling coefficients according the magnetic coupler structure are determined. This paper is expected to provide a good reference for further research, including work on the manufacturing of a prototype. [ABSTRACT FROM AUTHOR]

Simple Summary: Further information is necessary regarding the influence of besifovir (BSV), a new nucleotide analogue, on the occurrence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). When we compared the HCC incidence in non-cirrhotic CHB patients receiving BSV with the predicted number derived from the REACH-B (risk estimation for HCC in CHB) model, the standardized incidence ratio (SIR) was significantly reduced to 0.128 at 7 years. The incidence of HCC in patients with cirrhosis was compared using the GAG-HCC (guide with age, gender, HBV DNA, core promotor mutation, and cirrhosis) model, and the SIR was significantly decreased to 0.371 at 7.5 years. HCC prediction was available for BSV-treated patients using existing models. We concluded that BSV decreases the risk of HCC in patients with CHB, and HCC risk prediction models are applicable. No information is available regarding the influence of besifovir (BSV), a new nucleotide analogue, on the occurrence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). This study evaluated the reduced risk of HCC in patients undergoing BSV treatment. A total of 188 patients with CHB were treated with BSV for up to 8 years. We prospectively assessed the incidence of HCC compared with the risk from prediction models. During the follow-up, 5 patients developed HCC: 1 of 139 patients with non-cirrhotic CHB, and 4 of 49 patients with liver cirrhosis. We compared the HCC incidence in non-cirrhotic and cirrhotic patients with the predicted number derived from the REACH-B (risk estimation for HCC in CHB) model and GAG-HCC (guide with age, gender, HBV DNA, core promotor mutation, and cirrhosis) model, respectively. The standardized incidence ratio (SIR) was 0.128 (p = 0.039) at 7 years in non-cirrhotic CHB patients, and the SIR was 0.371 (p = 0.047) at 7.5 years in cirrhotic patients, suggesting a significantly decreased HCC incidence in both groups. HCC prediction was available for BSV-treated patients using existing models. In conclusion, BSV decreased the risk of HCC in patients with CHB, and prediction models were applicable. Clinical trial registry website and trial number: ClinicalTrials.gov no: NCT01937806. [ABSTRACT FROM AUTHOR]

Background: Dissection of the uncinate process is one of the most challenging procedures in laparoscopic pancreaticoduodenectomy and is also oncologically important to secure the retroperitoneal resection margin. In this study, we introduced a traction method that could provide stable lateral traction of the uncinate process to elevate it to allow better visualization of the retroperitoneal resection margin between the uncinate process and the superior mesenteric artery. Methods: The pancreatic head and duodenal unit were encircled using a 25-cm-long nylon tape and an elastic rubber band was used to tract it. The elastic power of the rubber band induces gradual automatic self-traction that allows the surgeon to proceed with the dissection without any other manipulation. With the help of this traction method, both of the operator's hands were free from the traction. Results: This video demonstrated the setting for the application of our self-traction method and how it can be used to achieve a proper operative field during uncinate process dissection. Conclusion: This simple traction method could allow better exposure of the operative field and provide a stable operative environment. [ABSTRACT FROM AUTHOR]

Currently, studies of flux switching machines are actively underway owing to several advantages of these machines, including their sturdy rotor structure and high output capability. This paper deals with an outer-rotor hybrid-excited flux-switching machine (FSM). The proposed machine embraces a homopolar structure and utilizes permanent magnets (PMs) for field excitation and a high-temperature superconducting (HTS) coil for flux regulation. The stator houses the HTS field coil, PMs, and armature windings. The outer rotor consists solely of an iron core. Thus, the machines are cost effective and can serve as a solution to the design and fabrication complexities of field current supplying and cooling systems. In this paper, the machine performance outcomes are analyzed using the 3D finite element method (FEM), and the validity of the proposed machine is verified. [ABSTRACT FROM AUTHOR]

Background and Aim: This study investigated the usefulness of near‐focus narrowband imaging (NF‐NBI) for determining gastric tumor margins compared with indigo carmine chromoendoscopy (ICC) before endoscopic submucosal dissection (ESD). Methods: This prospective randomized controlled trial was conducted at seven teaching hospitals in Korea. Patients with gastric adenoma or differentiated adenocarcinoma undergoing ESD were enrolled and randomly assigned to the NF‐NBI or ICC group. A marking dot was placed on the most proximal margin of the tumor before ESD. The primary endpoint was delineation accuracy, which was defined as presence of marking dots within 1 mm of the tumor margin under microscopic observation. Results: A total of 200 patients in the NF‐NBI group and 195 patients in the ICC group were included. The delineation accuracy rate was 84.5% in the NF‐NBI group and 81.0% in the ICC group (P = 0.44). However, the distance from the marking dot to the margin of the tumor was significantly shorter in the NF‐NBI group than in the ICC group (0.8 ± 0.8 vs 1.2 ± 1.3 mm, P < 0.01). Even after adjustment of other clinicopathological factors that are associated with difficulty of tumor delineation, NF‐NBI did not show significant association with accurate delineation (odds ratio of 0.86, P = 0.60). Conclusions: This prospective multicenter study showed that NF‐NBI is not superior to ICC in terms of accurately delineating gastric tumors (NCT02661945). [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) recurrence after liver resection depends upon the stage and histological grade of the tumor and the expression of certain biomarkers. However, it remains unclear which of these factors has the highest predictive value regarding HCC recurrence after surgical resection. Methods: This study investigated the associations among clinicopathological characteristics, expression of biomarkers, and HCC recurrence after liver resection. Fifty-four patients having undergone liver resection for HCC were enrolled prospectively, and their data were analyzed retrospectively. Evaluated variables were clinical data, laboratory findings, modified Union for International Cancer Control (UICC) stage, vascular invasion, histological differentiation, and immunohistochemical staining for fibroblast growth factor receptor 2 (FGFR2), vascular endothelial growth factor, and tumor-necrosis-factor-related apoptosis-inducing ligand receptors 1 and 2. Results: Mean patient age was 58.6 years (range, 30–71), and the mean and SD for follow-up duration were 51.2 ± 34.8 months. Cumulative 1-, 3-, and 5-year recurrence rates were 32.9%, 53.6%, and 68.1%, respectively. In univariate analysis, FGFR2 (p = 0.026) and Edmonson-Steiner grade (E-S grade) (p = 0.030) were associated with recurrence after resection in HCC patients. In multivariate analyses, increased FGFR2 expression (p = 0.017) was the only significant predictor of HCC recurrence. Conclusions: High FGFR2 expression had marginal association with poor E-S grade (p = 0.056). More intensive surveillance of HCC recurrence is warranted in HCC patients with increased FGFR2 expression. [ABSTRACT FROM AUTHOR]

Background and aims: The recent surge in demand for screening endoscopy has led to an increased detection of gastric subepithelial tumors (SETs). According to current guideline, SETs less than 2 cm in size are recommended for periodic surveillance. In light of recent advancement in therapeutic endoscopy in resection of small SET, we analyzed the histopathological features and the effectiveness of endoscopic resection for these small SETs. Methods: Retrospectively study was performed on 74 patients who underwent endoscopic resection of gastric small (≤ 2 cm) upper gastrointestinal tract SETs. The outcomes including histopathology and en bloc resection were analyzed. Results: The mean SET size was 11.69 ± 5.11 mm. The mean procedure time was 81.26 ± 42.53 min. Of the 74 patients, 28 patients had leiomyomas, 26 had gastrointestinal stromal tumors (GISTs), 14 had ectopic pancreas, 4 had lipomas, and 2 had neuroendocrine tumors. Among those with GIST, two patients exhibited high-risk histology. All patients underwent successful and uneventful endoscopy. Conclusions: Endoscopic resection can be recommended even for the small gastric SETs. In our study, we found that SETs with a size of less than 2 cm have significant proportion of GISTs which harbor malignant transformation potential. [ABSTRACT FROM AUTHOR]

Background and aims: This study aimed to evaluate whether the use of antiplatelet agents increases the risk of bleeding after gastric endoscopic submucosal dissection (ESD) and to determine the appropriate time to discontinue antiplatelet agents to minimize complications. Methods: This retrospective observational study utilized a collected dataset of patients who underwent ESD for gastric adenoma and cancer between January 2010 and December 2020. Patients were classified into three groups according to antiplatelet agent use and discontinuation status. We investigated the risk of post-ESD bleeding with different interruption times and antiplatelet agent types. Results: Of 1879 patients, 1389 were non-users, 190 were in the continuous group, and 203 were in the interrupted group. The rates of overall and delayed bleeding were significantly higher in patients who continued or were interrupted within three days before ESD than in the non-users and interrupted group (6.3% vs. 1.2%, p < 0.001, 6.3% vs. 2.5%, p = 0.01, respectively). Significant differences in delayed bleeding between the continuous and interrupted groups decreased with longer cessation periods. In multivariate analysis, continuous antiplatelet agents were still the strongest risk factor for bleeding (OR 2.81, 95% CI 1.14–6.90). Lower third location and longer procedure times were also independent risk factors for post-ESD bleeding (OR 2.75; 95% CI 1.08–6.97; OR 1.02; 95% CI 1.01–1.02). Conclusion: Continuous antiplatelet agent use increases the risk of delayed bleeding after gastric ESD. Therefore, the optimal timing of interruption, rather than the type of antiplatelet agent, should be considered to avoid an additional risk of bleeding and thromboembolism. [ABSTRACT FROM AUTHOR]

Background/Aims: A high-fat diet (HFD) can cause intestinal inflammation and alter the gut microbiota; probiotics, however, are known to have anti-inflammatory effects. This study aimed to investigate the response of rat colon to HFD and the effect of Clostridium butyricum on HFD-induced intestinal inflammation and production of short-chain fatty acids (SCFAs) according to sex. Methods: Male and female 6-week-old Fischer-344 rats were fed a chow diet or HFD for 8 weeks, and Biovita or three different concentrations of C. butyricum were orally gavaged. The levels of tight junction proteins (TJPs), inflammatory markers in the ascending colonic mucosa, and bile acids (BAs) and SCFAs in stool were measured. Results: HFD significantly increased the histological inflammation scores and fat proportions. Fecal BA levels were higher in the HFD group than in the control group, with a more prominent increase in deoxycholic acid/cholic acid after probiotics administration in females; however, no statistically significant differences were observed. TJPs showed an opposite response to HFD depending on sex, and tended to increase and decrease after HFD in males and females, respectively. The HFD-reduced TJPs were recovered by probiotics, with some statistical significance in females. HFD-decreased butyric acid in stools appeared to be recovered by probiotics in males, but not in females. The expression of inflammatory markers (TNF-α) was increased by HFD in males and decreased with medium-concentration probiotic supplementation. The opposite was observed in females. MPO was increased by HFD in both sexes and decreased by probiotic supplementation. Conclusions: The probiotic C. butyricum improved indicators of HFD-induced colonic inflammation such as levels of inflammatory markers and increased the production of SCFAs and the expression of TJPs. These effects tended to be more pronounced in male rats, showing sex difference. [ABSTRACT FROM AUTHOR]

Background: Failure of Helicobacter pylori (H. pylori) eradication is principally caused by antimicrobial resistance. Nowadays, multidrug resistance could be a major determinant of eradication failure. To assess minimal inhibitory concentration (MIC), antimicrobial resistance rates and trends in H. pylori isolated from patients with upper gastrointestinal disease with long‐term period. Materials and Methods: Patients who had H. pylori colonies isolated from culture were consecutively enrolled during the period of 2003–2022. From each patient, one to ten isolates were collected from culture of mucosal biopsy. MIC test was performed for amoxicillin, clarithromycin, metronidazole, tetracycline, levofloxacin, and moxifloxacin using agar dilution method. Trends in MIC distribution, prevalence of resistances with single and multiple were investigated which were suspected to be related to the failure of empirical H. pylori eradication treatment. Results: From 2003 to 2022, a total of 873 patients were enrolled and 2735 H. pylori isolates were successfully collected. Increase in the primary resistance rate was found in clarithromycin (16.1%–31.0%, p =.022), metronidazole (30.6%–38.1%, p < 0.001), and both of levofloxacin and moxifloxacin (7.3%–35.7%, p < 0.001). The prevalence of multidrug resistance to both clarithromycin and metronidazole (9.2%–37.9%, p < 0.001), clarithromycin and fluoroquinolone (2.8%–41.7%, p < 0.001), and clarithromycin, metronidazole, and fluoroquinolone (1.4%–28.2%, p < 0.001) was found to significantly increase. Conclusions: The prevalence of multiple resistance against H. pylori in Korea is ongoing. Its trend should be considered when establishing an empirical treatment strategy (ClinicalTrials. gov: NCT05247112). [ABSTRACT FROM AUTHOR]

Although lactose-free dairy products for the clinical management of lactose intolerance (LI) are widely available, scientific evidence on their efficacy is still lacking. This study comparatively analyzed the efficacy of flavored lactose-free milk (LFM) and whole milk (WM) in reducing symptoms in South Korean adults with LI. This prospective study was conducted in adults suspected of LI. All screened participants underwent the hydrogen breath test (HBT) using 570 mL of chocolate-flavored WM (20 g of lactose) and responded to a symptom questionnaire. LI was confirmed when the ΔH2 peak exceeded 16 ppm above baseline values and with the occurrence of symptoms after WM consumption. The participants who were diagnosed with LI underwent the HBT again with 570 mL of chocolate-flavored LFM (0 g of lactose), followed by the symptom questionnaire survey after 1 week. After excluding 40 participants who did not meet the diagnostic criteria for LI and 2 who were lost to follow-up, a total of 28 lactose-intolerant individuals were enrolled in the study. The ΔH2 values in the first HBT were significantly higher than those in the second HBT (33.3 ± 21.6 ppm vs. 8.6 ± 6.3 ppm, P < .001). Similarly, there was a significant reduction in the total symptom score in the second HBT (4.18 ± 1.51 vs. 0.61 ± 0.98, P < .001). Flavored LFM is well tolerated in South Korean adults diagnosed with LI based on the HBT and symptom questionnaire results. Therefore, LFM may be a viable alternative to WM. [ABSTRACT FROM AUTHOR]

Background: During treatment for peptic ulcer bleeding (PUB), it is imperative to determine the effect of antiplatelet agents on recurrent bleeding in order to balance risks and benefits.Aims: We compared the rate of recurrent bleeding in antiplatelet users and non-users.Methods: This retrospective study analyzed prospectively collected data from PUB patients treated by endoscopic modalities between August 2007 and December 2014. We evaluated and compared the rate of recurrent bleeding within 30 days in antiplatelet users and non-users; we also categorized antiplatelet users into continuation (≤3 days) and withdrawal (>3 days) groups.Results: A total of 490 patients were enrolled in the study, 302 (61.6 %) and 188 (38.4 %) in the non-user and antiplatelet user groups, respectively. The recurrent bleeding rate among antiplatelet users (10.1 %) was significantly higher than that among non-users (5.0 %; p = 0.029). Among 188 antiplatelet users, 51 (27.1 %) and 137 (72.9 %) were assigned to the continuation and withdrawal groups, respectively. The rate of recurrent bleeding did not differ significantly between groups (11.7 vs. 5.9 %, p = 0.241). Multivariate analysis revealed chronic kidney disease as a risk factor [odds ratio (OR) 2.890, 95 % confidence interval (CI) 1.079-7.742, p = 0.035]. However, antiplatelet use (OR 1.691, 95 % CI 0.813-3.517, p = 0.160) was not.Conclusions: This study highlights the need for clinicians to consider underlying diseases in antiplatelet users under the appropriate antiplatelet therapy during the post-hemostasis period. Furthermore, the optimal time to resume antiplatelet agents may be 3 days after successful endoscopic hemostasis in patients with PUB. [ABSTRACT FROM AUTHOR]

Background: The platelet-to-white blood cell ratio (PWR) is a hematologic marker of the systemic inflammatory response. Recently, the PWR was revealed to have a role as an independent prognostic factor for mortality in patients with hepatitis B virus (HBV)-related acute-on-chronic failure (ACLF) and HBV-related liver cirrhosis (LC) with acute decompensation (AD). However, the prognostic role of the PWR still needs to be investigated in LC patients with AD. In this study, we analyzed whether the PWR could stratify the risk of adverse outcomes (death or liver transplantation (LT)) in these patients. Methods: A prospective cohort of 1670 patients with AD of liver cirrhosis ((age: 55.2 ± 7.8, male = 1226 (73.4%)) was enrolled and evaluated for 28-day and overall adverse outcomes. Results: During a median follow-up of 8.0 months (range, 1.9–15.5 months), 424 (25.4%) patients had adverse outcomes (death = 377, LT = 47). The most common etiology of LC was alcohol use (69.7%). The adverse outcome rate was higher for patients with a PWR ≤ 12.1 than for those with a PWR > 12.1. A lower PWR level was a prognostic factor for 28-day adverse outcomes (PWR: hazard ratio 1.707, p = 0.034) when adjusted for the etiology of cirrhosis, infection, ACLF, and the MELD score. In the subgroup analysis, the PWR level stratified the risk of 28-day adverse outcomes regardless of the presence of ACLF or the main form of AD but not for those with bacterial infection. Conclusions: A lower PWR level was associated with 28-day adverse outcomes, indicating that the PWR level can be a useful and simple tool for stratifying the risk of 28-day adverse outcomes in LC patients with AD. [ABSTRACT FROM AUTHOR]

Background: The eradication rate of clarithromycin-based standard triple therapy (STT) for Helicobacter pylori infection has decreased due to clarithromycin resistance (CR). We evaluated the cost-effectiveness of tailored therapy according to CR test results, and compared the results of STT with those of empirical bismuth quadruple therapy (BQT). Methods: The prospectively collected data of 490 H. pylori-positive patients with chronic gastritis or peptic ulcer disease were retrospectively analyzed. Among them, 292 patients underwent CR testing using dual-priming oligonucleotide-based polymerase chain reaction. The tailored group (n = 292) consisted of patients treated with STT for 7 days and BQT for 10 days as per their CR test results. The remaining patients were assigned to the empirical group (n = 198) and received BQT for 10 days without a CR test. The eradication rate, adverse events and medical costs associated with H. pylori eradication therapy were investigated. Results: In the tested patients (tailored group), the CR-positive rate was 32.2% (n = 94/292). The eradication rate according to an intention-to-treat analysis was 87.7% in the tailored group and 91.8% in the empirical group (P = 0.124); the respective rates were 94.4% and 97.9% by per-protocol analysis (P = 0.010). The frequency of adverse events was lower in the empirical group than the tailored group (35.1% vs. 52.7%, P < 0.001). Total per capita medical costs were $406.50 and $503.50, respectively. Conclusions: Ten-day empirical BQT was more effective, safer, and less expensive than tailored therapy based on a CR test for H. pylori eradication. [ABSTRACT FROM AUTHOR]

Background: Undifferentiated-type early gastric cancer (UD EGC) shows lower curative resection rates after endoscopic submucosal dissection (ESD). Additional surgery is recommended after non-curative resection. We evaluated the long-term outcomes of ESD followed by additional surgery after non-curative resection in UD EGC compared to those for surgery as initial treatment. Methods: We reviewed 1139 UD EGC patients who underwent ESD at 18 hospitals and 1956 patients who underwent surgery at two hospitals between February 2005 and May 2015. We enrolled 636 patients with non-curative ESD and 1429 surgery subjects beyond the curative ESD criteria. Among them, 133 patients with additional surgery after ESD (ESD + OP group) and 252 patients without additional surgery (ESD-only group) were matched 1:1 using propensity scores to patients with surgery as initial treatment (surgery group). Overall survival (OS) and recurrence-free survival (RFS) were compared. Results: Signet ring cell carcinoma and poorly differentiated adenocarcinoma (PDA) were observed in 939 and 1126 cases, respectively. OS was significantly longer in the surgery group than in the ESD + OP group, especially for PDA. However, RFS was shorter in the ESD-only group than those in the ESD + OP and surgery groups. RFS did not differ significantly between the ESD + OP and surgery groups. Compared to the surgery group, the ESD-only and ESD + OP groups had an overall hazard ratio for RFS of 3.58 (95% confidence interval 1.44–8.88) and 0.46 (0.10–2.20), respectively. Conclusions: ESD followed by additional surgery after non-curative resection showed comparable cancer-specific outcomes to initial surgery in UD EGC. [ABSTRACT FROM AUTHOR]

Background and Aim: Besifovir dipivoxil maleate (BSV) was reported to have comparable antiviral efficacy and superior renal and bone safety to tenofovir disoproxil fumarate (TDF) in chronic hepatitis B (CHB) patients. The present study aims to evaluate changes of liver histology and intrahepatic covalently closed circular DNA (cccDNA) levels by BSV treatment in comparison with TDF therapy. Methods: This is a subset study of the phase 3 trial comparing BSV with TDF. Among them, only CHB patients willing to participate in a histologic evaluation study were enrolled. Liver histologic examination and intrahepatic cccDNA quantification were performed. Results: A total of 46 CHB patients received liver biopsies (BSV, n = 29; TDF, n = 17). After 48 weeks of treatment, virological response rate was comparable between the groups (P = 0.707). Follow‐up liver biopsies showed that necroinflammation was significantly improved in the both groups. However, the histological response rate defined as the proportion of subjects whose modified histologic activity index score decreased by ≥ 2 without deterioration in fibrosis was higher in the BSV group than in the TDF group (77.8% vs 36.4%, P = 0.048). The proportion of subjects with Ishak fibrosis score 3 or more decreased from 77.7% to 55.5% in the BSV and that decreased from 72.7% to 45.4% in the TDF group. The intrahepatic cccDNA significantly decreased from baseline after 48 weeks of BSV or TDF treatment (P < 0.001) without intergroup differences (P = 0.349). Conclusions: The BSV therapy improves hepatic histology and decreases intrahepatic cccDNA in CHB patients. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) is an effective treatment for early gastric cancer (EGC); however, its curative resection rate is low for undifferentiated-type EGC. We developed and externally validated a prediction model for curative ESD of undifferentiated-type EGC. Methods: In this cross-sectional study, we included 448 patients who underwent ESD for undifferentiated-type EGC at 18 hospitals in Korea between 2005 and 2015 in the development cohort and 1342 patients who underwent surgery at two hospitals in the validation cohort. A prediction model was developed using the logistic regression model. Results: Endoscopic tumor size 1–2 cm (odds ratio [OR], 2.40; 95% confidence interval [CI] 1.54–3.73), tumor size > 2 cm (OR, 14.00; 95% CI 6.81–28.77), and proximal tumor location from the lower to upper third of the stomach (OR, 1.45; 95% CI 1.03–2.04) were independent predictors of non-curative ESD. A six-score prediction model was developed by assigning points to endoscopic tumor size > 2 cm (five points), tumor size 1–2 cm (two points), upper third location (two points), and middle third location (one point). The rate of curative ESD ranged from 70.6% (score 0) to 11.6% (score 5) with an area under the receiver operating characteristic curve (AUC) of 0.720 (95% CI 0.673–0.766). The model also showed good performance in the validation cohort (AUC, 0.775; 95% CI 0.748–0.803). Conclusions: This six-score prediction model may help in predicting curative ESD and making informed decisions about the treatment selection between ESD and surgery for undifferentiated-type EGC. [ABSTRACT FROM AUTHOR]

We prospectively investigated the changes of liver stiffness (LS) and the occurrence of hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) eradication using direct antiviral agents (DAA) over three years. LS measurement using transient elastography and serum fibrosis surrogate markers before treatment and at 48, 96, 144 weeks after starting direct-acting antivirals (DAA) according to the protocol were evaluated. Patients were also compared with historical cohort treated with pegylated interferon (peg-IFN). Sustained viral response (SVR) was observed in 95.8%. LS value in the patients achieving SVR significantly decreased over time (19.4 ± 12.9 kPa [baseline], 13.9 ± 9.1 kPa [48 weeks], 11.7 ± 8.2 kPa [96 weeks], 10.09 ± 6.23 [144 weeks], all p < 0.001). With matched analysis, the decrease in LS value was significantly larger in DAA group than peg-IFN group at both 48 weeks (29% vs. 9%) and 96 weeks (39% vs. 17%). The incidence of HCC was not significantly different between DAA and peg-IFN groups (5.5% vs. 5.4%) at 144 weeks. HCV eradication with DAA can lead to improvement of liver stiffness over time. The regression of fibrosis was greater in the group with DAA than peg-IFN. Clinical trials registration: ClinicalTrials.gov (NCT02865369). [ABSTRACT FROM AUTHOR]

The initial neutral beam heating experiment in Versatile Experiment Spherical Torus (VEST) has been conducted via neutral beam characterizations such as neutralization efficiency, beam fraction, and shine-through loss. For the neutralization efficiency and shine-through loss estimation, a secondary electron emission (SEE) detector, which can be used in rapidly changing plasma, has been developed. The measurement results of the monatomic fraction by Doppler shift spectroscopy and the neutralization efficiency by SEE detector are 65%, and 70%, respectively. The shine-through loss measurement shows that the injection of a 12 keV neutral beam into a typical ohmic discharge of VEST results in a large amount of shine-through loss. To reduce the shine-through loss, a new target plasma discharge (0.17 T, 120 kA, 13 ms) with increased plasma density of ~ 2 × 10 19 m − 3 is developed by providing additional gas injection. The electron-heating effect has been successfully observed for this target plasma with a 200 kW neutral beam injection at the beam energy of 12 keV. The electron temperature increases from 20 to 68 eV without significant density change when the neutral beam is injected. [ABSTRACT FROM AUTHOR]

Background: Failure of second or third‐line eradication treatment against Helicobacter pylori (H. pylori) is principally caused by antimicrobial resistance and reduced treatment adherence. Aims: To evaluate the efficacy and safety of culture‐based rescue eradication treatments in patients who have previously experienced failed eradication treatment. Methods: Patients who had persistent H. pylori infection following at least one eradication treatment were recommended to undergo culture analysis to determine the minimal inhibitory concentrations of various antimicrobials via endoscopic resection. Consenting patients were assigned one of four therapeutic treatments based on an algorithm determined by antimicrobial resistance. These treatments consisted of 7 or 14‐day administration of clarithromycin‐containing proton pump inhibitor (PPI) triple therapy; esomeprazole, moxifloxacin, and amoxicillin (MEA) therapy; esomeprazole, bismuth, metronidazole, and tetracycline (quadruple) therapy; or lansoprazole, rifabutin, and amoxicillin (RLA) therapy. Eradication efficacy, adherence, and adverse events were assessed aside clinical outcomes. Results: A total of 132 patients were enrolled, with 84 patients completing the study. The overall resistance rates to amoxicillin, clarithromycin, metronidazole, and moxifloxacin were 13.1%, 83.3%, 47.6%, and 71.4%, respectively. The patients were allocated to the PPI triple (n = 11), MEA (n = 15), quadruple (n = 53), or RLA triple (n = 5) therapy group. The eradication rates in the intention‐to‐treat and per‐protocol analyses were 90.5% (76 of 84 patients) and 93.8% (76 of 81 patients), respectively. Nausea was the most frequent adverse event (25.0%). Conclusions: As a rescue therapy, culture‐based susceptibility‐guided eradication treatment was both effective and safe, even for patients exhibiting high antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background/aim: We investigated alterations in the expression of serum exosomal miRNAs with the progression of liver fibrosis and evaluated their clinical applicability as biomarkers. Methods: This study prospectively enrolled 71 patients who underwent liver biopsy at an academic hospital in Korea. Exosomes were extracted from serum samples, followed by next-generation sequencing (NGS) of miRNAs and targeted real-time quantitative polymerase chain reaction. A model was derived to discriminate advanced fibrosis based on miRNA levels and the performance of this model was evaluated. Validation of the effect of miRNA on liver fibrosis in vitro was followed. Results: NGS data revealed that exosomal miR-660-5p, miR-125a-5p, and miR-122 expression were changed significantly with the progression of liver fibrosis, of which miR-122 exhibited high read counts enough to be used as a biomarker. The level of exosomal miR-122 decreased as the pathologic fibrosis grade progressed and patients with biopsy-proven advanced fibrosis had significantly lower levels of exosomal miR-122 (P < 0.001) than those without advanced fibrosis. Exosomal miR-122 exhibited a fair performance in discriminating advanced fibrosis especially in combination with fibrosis-4 score and transient elastography. In a subgroup of patients with a non-viral etiology of liver disease, the performance of exosomal miR-122 as a biomarker was greatly improved. Inhibition of miR-122 expression increased the proliferation of the human hepatic stellate cell line, LX-2, and upregulated the expression of various fibrosis related proteins. Conclusion: Exosomal miR-122 may serve as a useful non-invasive biomarker for liver fibrosis, especially in patients with non-viral etiologies of chronic liver disease. [ABSTRACT FROM AUTHOR]