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Background Fully covered self-expandable metal stents (FCSEMSs) are widely used for endoscopic treatment of distal malignant biliary obstruction (dMBO). We aimed to assess the efficacy of anchoring an external plastic stent to an FCSEMS in dMBO. Methods A multicenter retrospective cohort study was performed in patients with dMBO to compare stent patency between FCSEMSs and FCSEMSs with an externally anchored plastic stent (EPS). For external anchoring, a 7-Fr double-pigtail plastic stent (DPPS) was placed first in the bile duct, then an FCSEMS was deployed side-by-side. Results Among a total of 185 patients, 65 had an FCSEMS alone and 120 had an FCSEMS with an EPS. The median stent patency was significantly longer in the FCSEMS with an EPS group than in the FCSEMS only group (342 vs. 240 days; P = 0.04). The rate of stent migration was significantly lower in the FCSEMS with an EPS group than in the FCSEMS only group (10.8 % vs. 27.7 %; P = 0.01). There were no significant differences in the rates of stent occlusion and adverse events between the two groups. Conclusions A novel and simple technique of anchoring an external plastic stent may decrease the risk of FCSEMS migration and prolong stent patency, without significantly increasing the adverse events rate in dMBO.

The acaricidal activities of 86 plant extracts were investigated under laboratory conditions. The ethanol extract of Dioscorea japonica Thunb. root showed the strongest acaricidal activity, with 89.3% mortality against two-spotted spider mite, Tetranychus urticae Koch adults at a 2 mg/ml concentration. Bioassay-guided isolation of D. japonica root extract using silica gel open column chromatography, gas chromatography (GC), and gas chromatography–mass spectrometry (GC–MS) identified palmitic acid as the primary active compound. The acaricidal activities of palmitic acid against T. urticae were 91.2% and 69.7% at concentrations of 1 and 0.5 mg/ml, respectively. Among nine saturated fatty acids with carbon chains ranging from C8 to C26, the most vigorous acaricidal activity was observed with octanoic acid, followed by palmitic acid, and decanoic acid at a 1 mg/ml concentration. The acaricidal activity of the other fatty acids was less than 40% mortality at a 1 mg/ml concentration. These results indicate that a suitable carbon length is essential for fatty acids to exhibit acaricidal activity. The acaricidal efficacy of Eungjinssag (EJSG), an organic agricultural material authorized for the management of mites in the Republic of Korea, was compared to D. japonica root extract. At concentrations above 1 mg/ml, the acaricidal activity of D. japonica root extract was stronger than that of EJSG. The results of this study show that D. japonica root extract and palmitic acid are promising candidates as new environmentally-friendly control agents against two-spotted spider mite, which is one of the most severely damaging agricultural arthropod pests.

Objective: To compare the therapeutic outcomes of repeated radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) as rescue therapy for the treatment of local tumor progression (LTP) after initial RFA for hepatocellular carcinoma (HCC). Methods: This retrospective study evaluated 44 patients who had LTP as initial tumor recurrence after RFA and underwent repeated RFA (n = 23) or TACE (n = 21) for local disease control. Local disease control and overall survival rates were evaluated using the Kaplan–Meier method. A Cox proportional-hazards regression model was used to identify the independent prognostic factors. The local disease control rate after the first rescue therapy and the number of rescue therapies applied until the last follow-up were also evaluated. Results: Local disease control after rescue therapy for LTP was significantly higher with repeated RFA than with TACE (p < 0.001). Treatment type was a significant factor for local disease control (p < 0.001). The overall survival rates after rescue therapy were not significantly different between the two treatments (p = 0.900). The local disease control rate after the first rescue therapy was significantly higher with RFA than with TACE (78.3% vs 23.8%, p < 0.001). The total number of rescue therapies applied was significantly higher in the TACE group than that in the repeated RFA group (median 3 vs 1, p < 0.001). Conclusion: Repeated RFA as rescue therapy for LTP after initial RFA for HCC was more efficient and had significantly better local disease control than TACE. Advances in knowledge: Even if LTP occurs after initial RFA, it should not be considered a failure of RFA, and repeated RFA should be performed over TACE if possible for more effective local disease control.

Although the direct synthesis of hydrogen peroxide (DSHP) is a potential alternative to the current anthraquinone auto-oxidation process, the low H2O2 selectivity of the former presents a major challenge. Previous studies have reported that the addition of halides improves the H2O2 selectivity of Pd-based catalysts. In this study, the H2O2 selectivity of Pd/SiO2 and PdBrx/SiO2 catalysts was observed to increase with the Br content. Furthermore, density functional theory (DFT) calculations on clean and Br-adsorbed Pd (1 1 1), (1 0 0), and (2 1 1) surfaces confirmed that the activation energies of the side reactions on the Pd (1 1 1) surface increased slightly after Br adsorption, whereas those of the main reactions were less affected. The repulsion between Br and O on the Pd (1 0 0) surface increased the O2 dissociation barrier by changing reaction configurations. Considering that the Pd (1 0 0) surface adsorbed O2 more strongly than did the Pd (1 1 1) surface, inhibiting O2 dissociation on the Pd (1 0 0) surface improved the H2O2 selectivity of PdBrx/SiO2 catalysts. On the Pd (2 1 1) surface, Br blocked an edge site and induced the reactions on the Pd (1 1 1) surface. In conclusion, DFT calculation confirmed that the repulsion and site blocking by adsorbed Br improved the H2O2 selectivity of PdBrx/SiO2 catalysts.

Purpose: To evaluate the difference in each retinal layer thickness in central retinal vein occlusion (CRVO) with resolved macular edema after intravitreal antivascular endothelial growth factor injection and normal contralateral eyes..Methods: Patients with ischemic and nonischemic CRVO whose macular edema resolved after intravitreal antivascular endothelial growth factor injections and did not recur for at least 6 months, and a normal contralateral eye were enrolled. Each retinal layer thickness between CRVO and normal contralateral eyes was compared according to Early Treatment Diabetic Retinopathy Study subfields using spectral domain optical coherence tomography.Results: The thicknesses of outer nuclear layer, photoreceptor layer, and retinal pigment epithelium in central ring, ganglion cell layer, inner plexiform layer, outer nuclear layer, and photoreceptor layer in the inner ring, and ganglion cell layer in the outer ring of CRVO eyes were significantly thinner than those of normal contralateral eyes (all p < 0.05). Whereas, inner nuclear layer and outer plexiform layer thicknesses in central ring of CRVO eyes were 23.86 ± 8.8 and 25.76 ± 7.6 μm, respectively, which was significantly thicker than those of normal contralateral eyes (19.52 ± 7.7 and 22.76 ± 6.5 μm; p = 0.019 and p = 0.043, respectively). Additionally, the mean best-corrected visual acuity of CRVO eyes were significantly correlated with photoreceptor layer thickness in central ring (p = 0.005).Conclusions: In CRVO eyes with resolved macular edema, the outer retinal layers were thinner as well as inner retinal layers, whereas inner plexiform layer and outer nuclear layer were thicker than normal fellow eyes. Additionally, photoreceptor layer thickness in foveal area had a significant impact on visual acuity in CRVO.

Liquid-based cytology (LBC) has been shown to improve the diagnostic efficacy of brush cytology for thyroid, cervical and pancreatic cancer. To evaluate the diagnostic performance of LBC for biliary tract cancer, we compared it with conventional smears and forceps biopsies.A retrospective study was conducted of all consecutive patients who underwent brush cytology under ERCP from January 2010 to April 2020. The primary outcome was the diagnostic efficacy of conventional smears and LBC. The difference between the two groups was corrected using inverse probability weighting (IPW). The secondary outcome was the sensitivity and specificity of brush cytology and forceps biopsy. The secondary outcome was evaluated in patients who underwent both methods.Among 162 patients, conventional smears were performed in 70 patients and LBC was performed in 92 patients. In the primary analysis using IPW, the sensitivity of conventional smears and LBC was 56.00% and 78.26% respectively (P = 0.009). The specificity was 100% for both methods. The accuracy was 66.15% for conventional smears and 83.33% for LBC (P = 0.012). In the secondary analysis, the sensitivity of conventional smears versus forceps biopsies was 62.16% versus 78.38% (P = 0.034) and 81.16% for both LBC and forceps biopsies. The specificity of both cytological examination and forceps biopsies was 100%.Liquid-based cytology demonstrated better sensitivity and accuracy than conventional smears. Moreover, its diagnostic performance was close to that of forceps biopsies.

Background: Autofluorescence lifetime (AFL) imaging, a robust technique that enables label-free molecular investigation of biological tissues, is being introduced into the field of cardiovascular diagnostics. However, detailed AFL characteristics of coronary arteries remain elusive and there is a lack of methodology enabling such characterization. Methods: We developed multispectral fluorescence lifetime imaging microscopy (FLIM) based on analog-mean-delay. Freshly sectioned coronary arteries and atheromas, harvested from 5 swine models, were imaged using FLIM and stained to label lipids, macrophages, collagen, and smooth muscle cells. The components were quantitated from digitized histological images and compared with the corresponding FLIM. Multispectral AFL parameters derived from 2 different spectral bands (390 nm and 450 nm) were analyzed. Results: FLIM provided a wide field-of-view, high-resolution AFL imaging of frozen sections. Principal compositions of coronary arteries, such as tunica media, tunica adventitia, elastic laminas, smooth muscle cell–enriched fibrous plaque, lipid-rich core, and foamy macrophages, were well visualized in FLIM images and were found to have each different AFL spectra. In particular, proatherogenic components including lipids and foamy macrophages exhibited significantly different AFL values compared with plaque-stabilizing collagen- or smooth muscle cell–enriched tissues ( P 0.87). Conclusions: FLIM provided detailed pixel-level AFL investigation of the complex composition of coronary artery and atheroma. Our FLIM strategy enabling an automated, comprehensive visualization of multiple plaque components from unlabeled sections will be highly useful to efficiently evaluate ex vivo samples without the need for histological staining and analysis.

Backgrounds and Objectives Endoscopic ultrasound-guided ethanol ablation (EUS-EA) has recently been introduced for the management of solid pancreatic tumors, including pancreatic neuroendocrine tumors (PNETs) and solid pseudopapillary tumors (SPTs). The study aims to evaluate the efficacy and predictive factors for response of EUS-EA in solid pancreatic tumors. Methods Between October 2015 and July 2021, 72 patients who underwent EUS-EA for solid pancreatic tumors were included. The study outcomes were to evaluate the efficacy of EUS-EA with complete remission (CR) and objective response, and their predictive factors. Results During follow-up, 47 patients were diagnosed with PNETs and 25 with SPTs. Eight cases reached CR and 48 reached objective response. When compared with SPTs, PNETs showed similar duration to reach CR (median not reached; p = 0.319), but shorter duration to reach objective response (PNETs: median 20.6 months, 95%CI 10.26–30.88; SPTs: median 47.7 months, 95%CI 18.14–77.20; p = 0.018). Ethanol dosage > 0.35 ml/cm3 shortened the duration to reach CR (median not reached; p = 0.026) and objective response (median 42.5 months, 95%CI 25.34–59.66 vs. 19.6 months, 95%CI 10.17–29.09; p = 0.006). CR had no significant predictive factors, but PNETs showed significant predictive factors for objective response (HR 3.34, 95%CI 1.07–10.43; p = 0.038). Twenty-seven patients experienced adverse events, and there were two severe cases. Conclusion EUS-EA for pancreatic solid lesions seems feasible as a local treatment for patients who refuse or are unfit for surgery. Additionally, PNETs seem to be the better candidate for EUS-EA.

Brown adipose tissue (BAT) plays a pivotal role in maintaining body temperature and energy homeostasis. BAT dysfunction is associated with impaired metabolic health. Here, we show that Ssu72 phosphatase is essential for mRNA translation of genes required for thermogenesis in BAT. Ssu72 is found to be highly expressed in BAT among adipose tissue depots, and the expression level of Ssu72 is increased upon acute cold exposure. Mice lacking adipocyte Ssu72 exhibit cold intolerance during acute cold exposure. Mechanistically, Ssu72 deficiency alters cytosolic mRNA translation program through hyperphosphorylation of eIF2α and reduces translation of mitochondrial oxidative phosphorylation (OXPHOS) subunits, resulting in mitochondrial dysfunction and defective thermogenesis in BAT. In addition, metabolic dysfunction in Ssu72-deficient BAT returns to almost normal after restoring Ssu72 expression. In summary, our findings demonstrate that cold-responsive Ssu72 phosphatase is involved in cytosolic translation of key thermogenic effectors via dephosphorylation of eIF2α in brown adipocytes, providing insights into metabolic benefits of Ssu72.

Background To identify the reliability of each retinal layer thickness measurement in epiretinal membrane (ERM) patients with ectopic inner foveal layers (EIFLs). Methods Subjects were divided into two groups: ERM patients with EIFLs (Group 1) and without EIFLs (Group 2). The retinal layer thickness was measured twice, and intraclass correlation coefficient (ICC) and coefficient of variation (CV) values were calculated. Results In Group 1, the CVs of the nerve fiber layer (NFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), and outer nuclear layer (ONL) were 22.39%, 13.12%, 13.37%, 13.21%, 15.09%, and 11.94%, while the ICCs were 0.431, 0.550, 0.440, 0.286, 0.279, and 0.503, respectively. In Group 2, the CVs were 18.20%, 10.59%, 10.65%, 13.27%, 14.75%, and 10.37%, while the ICCs were 0.788, 0.834, 0.830, 0.715, 0.226, and 0.439, respectively. The average central macular thickness (CMT) was significantly correlated with the CVs of NFL (coefficient = 0.317; P P P = 0.042) in Group 1. Conclusions The reproducibility of the inner retinal layer thickness measurements in ERM patients with EIFLs was low compared to those without EIFLs. The reproducibility of the outer retinal layer thickness measurements, including OPL and ONL, was poor regardless of the presence of EIFLs in ERM patients. Additionally, the thicker the CMT in patients with EIFLs, the lower the reproducibility of the inner retinal layer thickness measurements.

A moving window decision-making algorithm is proposed for the cleaning schedule optimization of heat exchanger network system subject to fouling in refinery crude preheat train. This algorithm is designed by incorporating the moving window scheme into a conventional multi-period optimal control problem (OCP) framework and has a distinct feature that it can efficiently handle a complex problem where a long-time horizon is considered. When compared with the conventional multi-period OCP method using fixed time horizon, our algorithm always shows an excellent performance regarding the computational time, still finding a compatible optimal solution. In our moving window decision-making algorithm, it is important to determine the optimal moving window size for the given time horizon as it significantly influences the optimization performance.

Near-infrared (NIR) photodetectors have interesting roles in optical fiber communications and biomedical applications. Conventional NIR photodetectors have been realized using InGaAs and Ge, of which the cut-off wavelengths exceed 1500 nm. Si-based photodetectors exhibit limited external quantum efficiency at wavelengths longer than 1000 nm. By synthesizing a CuInSe2 compound on a glass substrate, photodetectors that can detect optical wavelengths longer than 1100 nm have been realized in this study. The bandgap energies of the CuInSe2 thin films were tuned by varying the Cu/In ratio from 1.02 to 0.87. The longest cut-off wavelength (1309 nm) was obtained from a CuInSe2 thin film having a Cu/In ratio of 0.87. The responsivity of the photodiode was measured under the illumination of a 1064 nm laser light. The photo responses exhibited linear response up to 2.33 mW optical illumination and a responsivity of 0.60 A/W at −0.4 V.

Background Recently introduced no-touch radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) has the potential to improve local tumor control. Purpose To evaluate midterm clinical outcomes of monopolar no-touch RFA in single HCCs 2.5 cm or smaller. Materials and Methods In this multicenter clinical trial (

In papermaking, pre-flocculation of fillers such as ground calcium carbonate (GCC) improves the tensile strength of paper sheets. However, the pre-flocculated fillers mostly suffer from the instability of the floc shape such as the decrease in floc diameter with time elapse after preparation and no improvement of bulk and stiffness. The addition of calcium compounds such as calcium oxide or calcium hydroxide to the pre-flocculated GCC, and injection with carbon dioxide caused pre-flocculated GCC flocs to be covered with newly formed calcium carbonate. This product, called post hybrid calcium carbonate (pHCC), was found to be more stable in size and gave better sheet strength than the pre-flocculated ones. Furthermore, pHCC gave remarkably higher bulk and stiffness than the pre-flocculated flocs did without impairing smoothness that was essential in printing paper. The proper use of pHCC in papermaking could allow the production of high loaded paper with more than 10% higher filler contents, which could reduce paper production cost and save drying energy. The proportion of the newly formed calcium carbonate in pHCC, turbulence intensity at preparation stage, and the effect of storage time were investigated.

Type 2 diabetes mellitus (T2DM) and hypertension (HTN) are both relatively common systemic diseases and cause damage to the retina, such as inner retina reduction and microvascular impairment. The purpose of this study was to identify peripapillary retinal nerve fiber layer (pRNFL) damage by diabetic neurodegeneration and the effects of HTN on the pRNFL thickness in patients with T2DM without clinical diabetic retinopathy. Subjects were divided into three groups: healthy control subjects (group 1), patients with T2DM (group 2), and patients with both diabetes and HTN (group 3). The pRNFL thickness was measured using optical coherence tomography and compared among each group. Linear regression analyses were performed to identify factors associated with pRNFL thickness. A total of 325 eyes were included: 143 eyes in the group 1, 126 eyes in group 2, and 56 eyes in group 3. The mean pRNFL thicknesses of each group were 96.1 ± 7.7, 94.4 ± 8.6, and 91.6 ± 9.6 μm, respectively (P = 0.003). In multivariate linear analyses, diabetes duration (β = −0.236; P = 0.018) and HTN (β = −3.766; P = 0.008) were significant factors affecting the pRNFL thickness in groups 2 and 3. Additionally, the HTN duration was significantly correlated with pRNFL thickness in group 3 (R2 = 0.121; P = 0.008). In conclusion, patients with T2DM with HTN showed thinner pRNFL thickness than those with T2DM only. Additionally, the duration of HTN was significantly correlated with pRNFL thickness in patients with both diabetes and HTN.

The purpose of this study was to identify how chronic hypertension (HTN) and hypertensive retinopathy (HTNR) have different effects on retinal damage including inner retinal thinning and microvasculature impairment. The subjects were divided into three groups: controls, HTN patients without HTNR (HTN group), and patients with relieved HTNR (HTNR group). The ganglion cell-inner plexiform layer (GC-IPL) thickness, vessel density (VD), and GC-IPL/VD ratio were compared among the groups. A total of 241 eyes were enrolled; 101 in the control group, 92 in the HTN group, and 48 in the HTNR group. The mean GC-IPL thicknesses were 83.5 ± 5.7, 82.1 ± 6.2, and 75.9 ± 10.7 μm in each group, respectively (P −1 in each group, respectively (P = 0.001). The GC-IPL/VD ratio was 4.10 ± 0.33, 4.20 ± 0.40, and 3.88 ± 0.56 in each group, respectively (P P = 0.013) and systolic blood pressure (SBP) (B = −0.012, P = 0.004) were significantly associated with the GC-IPL/VD ratio. In conclusion, inner retinal reduction and retinal microvasculature impairment were observed in patients with HTN and HTNR, and the GC-IPL/VD ratio of HTNR patients was significantly lower than that of HTN patients, indicating more prominent damage to the inner retina than microvasculature in HTNR patients. Additionally, the GC-IPL/VD ratio was significantly associated with SBP in HTNR patients, so more strict BP control is required in HTNR patients.

To investigate the impact of the combination of type 2 diabetes (DM) and high myopia on inner retinal layer thickness of the macular area. The patients were divided into four groups: control (group 1), patients with DM without high myopia (group 2), patients with high myopia without DM (group 3), and patients with DM and high myopia (group 4). Ganglion cell complex (GCC) thickness was compared among the groups. Linear regression analysis was performed to identify factors associated with GCC thickness. A total of 194 eyes were enrolled: 59 in group 1, 52 in group 2, 49 in group 3, and 34 in group 4. The average parafovea GCC thicknesses were 113.9 ± 10.4, 112.4 ± 11.2, 112.2 ± 7.8, and 102.6 ± 15.1 μm (P

To analyze the clinical features of refractory age-related macular degeneration (AMD) patients associated with the response to three consecutive loading doses of anti-vascular endothelial growth factor (VEGF).A retrospective chart review was performed on typical exudative AMD patients treated by three consecutive anti-VEGF injections. The patients were divided into a group without residual fluid on optical coherence tomography (OCT) images (Group 1) and a group with residual fluid (Group 2). We analyzed qualitative and quantitative morphological features of OCT and OCT angiography (OCTA). We performed univariate and multivariate logistic regression analyses to identify factors associated with the treatment response.We enrolled a total of 90 patients (Group 1: n = 60 , Group 2: n = 30). Under OCT, the choroidal thickness (CT) differed significantly between groups 1 and 2 (246.60 ± 67.67 vs. 286.90 ± 40.92 µm, p = 0.001). Under OCTA, The presence of branching (48.3% vs. 73.3%, p = 0.024), loops (31.7% vs. 66.7%, p = 0.002) and a peripheral arcade (40.0% vs. 76.7%, p = 0.001) differed significantly. Logistic regression analysis showed that the initial CT (B = 0.012; p = 0.007), presence of loops (B = 1.289; p = 0.015) and peripheral arcade (B = 1.483; p = 0.008) significantly affected the anti-VEGF treatment response.A thicker choroid and the presence of loops and a peripheral arcade were significantly associated with a poorer response to three loading anti-VEGF injections in typical exudative AMD patients.

We aimed to analyse the retinal microvasculature and choriocapillaris according to the dry age-related macular degeneration (AMD) stage and to identify factors associated with their microvasculatures.Patients were divided into four groups: normal controls, early, intermediate and advanced AMD groups. The vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris was compared using optical coherence tomography angiography among the groups. Linear regression analysis was performed to identify factors associated with the VD.The VDs of the SCP were 22.1 ± 5.7, 19.1 ± 5.4, 18.0 ± 6.4 and 12.2 ± 6.4% (p 0.001); the VDs of the DCP were 22.4 ± 4.5, 20.7 ± 4.3, 18.1 ± 5.3 and 14.6 ± 5.8% (p 0.001); the VDs of the choriocapillaris were 29.4 ± 3.7, 26.4 ± 4.8, 24.5 ± 4.9 and 24.2 ± 3.7% (p 0.001) in the control, early, intermediate, and advanced groups, respectively. AMD stage and age were significantly associated with the VDs of all layers, and the VDs of the SCP and DCP were associated with visual acuity (both p 0.001). Additionally, hypertension was associated with the VDs of the DCP (p = 0.027) and choriocapillaris (p = 0.024).The retinal microvasculature and choriocapillaris tended to become more impaired as the AMD stage progressed. Age was significantly associated with the microvasculature impairments of all layers, and hypertension was significantly associated with impairments of the DCP microvasculature and choriocapillaris.

Measuring and controlling the force required to grip a nerve is required to avoid any undesired neurological damage caused by an excessive suction force applied to the tissue. We aimed to develop a suction-based nerve gripper that can measure the suction force applied to the gripped peripheral nerve. A tiny force sensor can be incorporated by casting a soft material on a barometric pressure sensor chip and embedding it in the suction tip. In this study, a suction tip was designed based on a parametric analysis. The sensing characteristics and performance were evaluated experimentally. The experimental results demonstrate that a suction tip exhibits a force measurement capacity of approximately 2.8 N with a controlled suction force at 0.1 N intervals. The practical applicability of the proposed gripper was assessed based on an in vivo experiment performed on small animal subjects.