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To evaluate the characteristics of sarcopenic dysphagia (SD) and the prognosis of swallowing function in convalescent rehabilitation hospital patients; and to investigate the association between malnutrition severity and SD.A prospective, multi-center, cohort study.We extracted registry data from the Japanese Sarcopenic Dysphagia Database, focusing on patients admitted to convalescent rehabilitation hospitals.A total of 207 participants were recruited and stratified according to the presence or absence of SD. Next, the participants were divided into groups based on nutrition status using the Global Leadership Initiative on Malnutrition criteria: normal nutrition, moderate malnutrition, and severe malnutrition. We also compared the outcomes between patients with SD (SD group) and those without SD (no-SD group) according to malnutrition status.The Food Intake LEVEL Scale (FILS) score was the outcome measure. Higher scores on the FILS indicate better swallowing function. We compared the patient characteristics between the SD and non-SD groups among all patients and then according to the severity of malnutrition.A total of 207 patients were recruited. 11 were diagnosed with normal nutrition, 72 with moderate malnutrition, and 124 with severe malnutrition. There were 128 participants with SD and 79 participants without SD; the prevalence of SD was 61.8%. Hip fracture was the most common disease among the SD patients (34.4%). The median time to the end of follow-up was 73.5 days for the SD group and 84.0 days for the no-SD group. There was no significant difference in the FILS score between the SD and no-SD groups, but the increase in the FILS score was significantly lower in the SD group than the no-SD group among patients with severe malnutrition after adjusting for confounding factors (age, sex, FILS at admission, BMI, cognitive functional independence measure, and care level before onset) (β = -0.206, p = 0.011, 95% confidence interval = -0.723, -0.098).Orthopedic diseases are the most common type of disease among SD patients in convalescent rehabilitation hospitals. Swallowing dysfunction was particularly severe in malnourished patients with SD. This result suggests the importance of the definition of SD for malnourished patients. We should practice nutritional management as soon as possible in severely malnourished patients diagnosed with SD.

Low-dose aspirin is recommended by the U.S. Preventive Services Task Force for primary prevention of colorectal cancer in certain individuals. However, broader implementation will require improved precision prevention approaches to identify those most likely to benefit. The major urinary metabolite of PGE2, 11α-hydroxy-9,15-dioxo-2,3,4,5-tetranor-prostane-1,20-dioic acid (PGE-M), is a biomarker for colorectal cancer risk, but it is unknown whether PGE-M is modifiable by aspirin in individuals at risk for colorectal cancer. Adults (N = 180) who recently underwent adenoma resection and did not regularly use aspirin or NSAIDs were recruited to a double-blind, placebo-controlled, randomized trial of aspirin at 81 or 325 mg/day for 8–12 weeks. The primary outcome was postintervention change in urinary PGE-M as measured by LC/MS. A total of 169 participants provided paired urine samples for analysis. Baseline PGE-M excretion was 15.9 ± 14.6 (mean ± S.D, ng/mg creatinine). Aspirin significantly reduced PGE-M excretion (−4.7 ± 14.8) compared with no decrease (0.8 ± 11.8) in the placebo group (P = 0.015; mean duration of treatment = 68.9 days). Aspirin significantly reduced PGE-M levels in participants receiving either 81 (−15%; P = 0.018) or 325 mg/day (−28%; P < 0.0001) compared with placebo. In 40% and 50% of the individuals randomized to 81 or 325 mg/day aspirin, respectively, PGE-M reduction reached a threshold expected to prevent recurrence in 10% of individuals. These results support that aspirin significantly reduces elevated levels of PGE-M in those at increased colorectal cancer risk to levels consistent with lower risk for recurrent neoplasia and underscore the potential utility of PGE-M as a precision chemoprevention biomarker. The ASPIRED trial is registered as NCT02394769.

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Background In patients with pancreas adenocarcinoma (PDAC), performing endoscopic ultrasound (EUS)-guided fiducial placement at the time of initial EUS-guided biopsies may obviate a second procedure, streamline care, and improve resource utilization. However, the safety of this combined approach is understudied. Methods We retrospectively identified and reviewed cases at a single institution in which patients with PDAC underwent EUS-guided biopsy and same session fiducial placement. Patient and procedural characteristics were abstracted. Intraprocedural and postprocedural adverse events were classified according to the American Society for Gastrointestinal Endoscopy Lexicon for Adverse Events. The percentage of "definite" and "probable" adverse events occurring within 14 days of the procedure was calculated. Results Thirty-three patients were included in this series (median age 64, 42% male). The median numbers of biopsies performed and fiducials placed were 3 (range 2-7) and 4 (range 1-4), respectively, per patient. A 22-gauge needle was used for the majority of biopsies (81.8%) and all fiducial placements (100%). No definite and one probable adverse event of mild postprocedural pain was noted (3.0%, 1/33). There were no episodes of significant bleeding, pancreatitis or infection. Fiducials were successfully used in the administration of radiation to all patients. Conclusion We report a low risk of adverse events in the setting of combined EUS-guided biopsy and fiducial placement. In the appropriate setting, this approach may streamline care for patients with PDAC while avoiding time, cost, and risks associated with an additional procedure or impacting radiation therapy. Larger, controlled studies are needed to validate the safety and efficacy of this combined approach.

Histopathologic analysis of biopsy specimens obtained via white light endoscopy (WLE) is the gold standard for the diagnosis of several mucosal diseases in the upper gastrointestinal (GI) tract. However, this standard of care entails a series of critical shortcomings such as missing depth information, high costs, time inefficiency, low-resolution imaging in vivo, high sampling variability, missing intrinsic tissue-specific contrast, and anesthesia related risk. In the quest for a diagnostic technology to replace the current standard of care, in vivo optical endomicroscopy has emerged as a promising alternative. This paper tells the story of a cluster of optical microscopy-based modalities invented, further developed, or first-validated in the laboratory of Dr. Guillermo J. Tearney (Tearney Lab) at the Wellman Center for Photomedicine of Massachusetts General Hospital over the past two decades, that combined lead to a novel method for diagnosis of eosinophilic esophagitis (EoE). Rather than being a comprehensive literature review, this paper aims to describe the translational journey towards a disease specific diagnostic and research tool for this increasingly recognized yet poorly understood immune-mediated disorder of the esophagus.

Low-dose aspirin is recommended by the U.S. Preventive Services Task Force for primary prevention of colorectal cancer in certain individuals. However, broader implementation will require improved precision prevention approaches to identify those most likely to benefit. The major urinary metabolite of PGE2, 11α-hydroxy-9,15-dioxo-2,3,4,5-tetranor-prostane-1,20-dioic acid (PGE-M), is a biomarker for colorectal cancer risk, but it is unknown whether PGE-M is modifiable by aspirin in individuals at risk for colorectal cancer. Adults (N = 180) who recently underwent adenoma resection and did not regularly use aspirin or NSAIDs were recruited to a double-blind, placebo-controlled, randomized trial of aspirin at 81 or 325 mg/day for 8–12 weeks. The primary outcome was postintervention change in urinary PGE-M as measured by LC/MS. A total of 169 participants provided paired urine samples for analysis. Baseline PGE-M excretion was 15.9 ± 14.6 (mean ± S.D, ng/mg creatinine). Aspirin significantly reduced PGE-M excretion (−4.7 ± 14.8) compared with no decrease (0.8 ± 11.8) in the placebo group (P = 0.015; mean duration of treatment = 68.9 days). Aspirin significantly reduced PGE-M levels in participants receiving either 81 (−15%; P = 0.018) or 325 mg/day (−28%; P < 0.0001) compared with placebo. In 40% and 50% of the individuals randomized to 81 or 325 mg/day aspirin, respectively, PGE-M reduction reached a threshold expected to prevent recurrence in 10% of individuals. These results support that aspirin significantly reduces elevated levels of PGE-M in those at increased colorectal cancer risk to levels consistent with lower risk for recurrent neoplasia and underscore the potential utility of PGE-M as a precision chemoprevention biomarker. The ASPIRED trial is registered as NCT02394769.

This study aimed to investigate whether inflammation affects the outcome of swallowing ability to improve treatment for sarcopenic dysphagia.A retrospective observational cohort study was performed using data from the Japanese sarcopenic dysphagia database.The database was constructed using data from 19 hospitals and one home visiting rehabilitation team.Patients with sarcopenic dysphagia with measurements of C-reactive protein (CRP) and serum albumin (Alb) were included.Patients were assigned to two groups using CRP, Alb, and the Japanese modified Glasgow Prognostic Score (mGPS). The Food Intake LEVEL Scale (FILS) was measured at the times of admission and follow-up (FILS follow-up) to assess swallowing function.A total of 197 patients were included. Mean or median values of each parameter were as follows: age: 83.8±8.7, Alb: 3.2 ± 0.6 g/dL, CRP: 8.0 [3.0, 29.0] mg/L, mGPS: 1 [1-2], FILS: 7 [6-8], FILS follow-up: 8 [7-8], and duration of follow-up: 57.0 [27.0, 85.0] days. The FILS score at follow-up was significantly lower in the high CRP group (≥ 5.0 mg/L) than in the low CRP group (5.0 mg/L) (p = 0.01). Further, the FILS score at follow-up was significantly lower in the high mGPS group (class; 2) than in the low mGPS group (class; 0 and 1) (p = 0.03). In the multiple linear regression analyses without FILS at baseline, CRP and mGPS were independent risk factors for FILS follow-up. When FILS at baseline was entered, CRP and mGPS were not an independent risk factors for FILS follow-up.Inflammation could modify the outcome of the patients with sarcopenic dysphagia. Inflammation may be an important risk factor in evaluating patients with sarcopenic dysphagia.

To investigate the prevalence of hoarseness and its association with the severity of dysphagia in patients with sarcopenic dysphagia.Cross-sectional study using the Japanese sarcopenic dysphagia database.19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation team.287 patients with sarcopenic dysphagia, aged 20 years and older.Sarcopenic dysphagia was diagnosed using a reliable and validated diagnostic algorithm for the condition. The presence and characteristics of hoarseness classified as breathy, rough, asthenic, and strained were assessed. The prevalence of hoarseness and the relationship between hoarseness and Food Intake LEVEL Scale (FILS) were examined. Order logistic regression analysis adjusted for age, sex, naso-gastric tube, and handgrip strength was used to examine the relationship between hoarseness and FILS at baseline and at follow-up.The mean age was 83 ± 10 years. Seventy-four (26%) patients had hoarseness, while 32 (11%), 20 (7%), 22 (8%), and 0 (0%) patients had breathy, rough, asthenic, and strained hoarseness, respectively. Median FILS at the initial evaluation was 7 (interquartile range, 5-8). Hoarseness (β=0.747, 95% confidence intervals= 0.229, 1.265, p=0.005), age, sex, naso-gastric tube, and handgrip strength were associated independently with baseline FILS, while hoarseness (β=0.213, 95% confidence intervals= -0.324, 0.750, p=0.438) was not associated independently with the FILS at follow-up.Hoarseness was associated with the severity of dysphagia at baseline, however not a prognostic factor for sarcopenic dysphagia. Resistance training of swallowing and respiratory muscles and voice training as part of rehabilitation nutrition might be useful for treating sarcopenic dysphagia.

To examine the relationship between sarcopenia and fecal incontinence in patients with dysphagia.Cross-sectional study using the Japanese sarcopenic dysphagia database.19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation center.460 dysphagic patients, aged 20 years and older.Sarcopenia was diagnosed by the 2019 criteria of the Asian Working Group for Sarcopenia. Fecal incontinence was assessed by health care professionals at baseline according to the definition of the Japanese Practice Guidelines for Fecal Incontinence. We examined whether there was a significant difference between the rate of fecal incontinence in patients with/without sarcopenia. Age, sex, type of dwelling, Barthel index, Charlson comorbidity index (CCI), calf circumference, handgrip strength, body mass index, malnourishment, C-reactive protein level, serum albumin level, and delivery of enteral nutrition by nasogastric and/or gastrostomy tube were measured. To examine the relationship between sarcopenia and fecal incontinence, logistic regression analysis was performed with adjustments for age, sex, sarcopenia, CCI, enteral nutrition, and dwelling.The mean age of patients was 81 ± 10 years. Of the 460 study patients, 404 (88%) patients had sarcopenia and 104 had fecal incontinence (23%). The rate of fecal incontinence was higher in the sarcopenia group than the non-sarcopenia group (25% vs. 7%, P = 0.003). Logistic regression analysis showed that sarcopenia was independently associated with fecal incontinence (odds ratio: 3.114, 95% confidence interval: 1.045, 9.282).The prevalence of fecal incontinence was 23% in patients with dysphagia. Sarcopenia was independently associated with fecal incontinence, which suggests the presence of anal sarcopenia. Defecation control should be assessed in patients with sarcopenia.

We report 75As NMR experiments in heavily electron-doped LaFePnO0.75H0.25 (Pn=As1−x Sb x and As1−x′ P x′ ) compounds with the maximum T c max ( ∼ 33.1 K ) , and compare with the previous results in lightly electron-doped LaFePn(O,F) compounds. The Tc of this series can be sensitively controlled by the pnictogen height (hPn ) through the substitution at Pn site, and the electron doping level through the substitution at the O site with H or F. In heavily electron-doped LaFePnO(La1111) compounds, we found that spin fluctuations at low-energies were moderately suppressed upon cooling in the Sb-substituted high Tc compounds with high hPn (x ≥ 0), although they are completely suppressed in P-substituted non-superconducting compounds (x′ ≥ 0.2) with lower hPn . This feature is largely different from that in the lightly doped La1111 compounds with the well-nested Fermi surfaces, where the spin fluctuations are critically enhanced upon cooling. Here, we present the characteristics of spin fluctuations over wide doping region of La1111-based compounds, and discuss the relationship with the superconductivity.

This research describes the gene expression of molecules related to inflammation and bone metabolism in all patients submitted to dental implant surgery attended at a Brazilian institution. A convenience sample was collected over 2 years. The bone samples were processed for extraction of total RNA and reverse transcription of cDNA. Relative quantification by real-time polymerase chain reaction of target genes was performed. The sample was characterized demographically and according heath conditions. The patients were grouped. The control group was composed of 17 healthy patients, 6 patients were included in the antihypertensive therapy group, 3 were smokers, another 3 were smokers and were under antihypertensive treatment, and 3 were ex-smokers (smoked for 10 years but had quit for at least 5 years). The ex-smoker group presented the highest values, and the Hypertensive group presented the lowest values of Macrophage colony-stimulating factor, Osteonectin, Bone Morphogenetic Protein II, and Integrin. All smokers demonstrated expression values comparable to the Control group. The highest expression values of Osteopontin, RUNX, and Alkaline Phosphatase were observed in the Hypertensive and the Smoker group, while the lowest values were found in the Hypertensive group. Smokers, Ex-smokers, and the Control group demonstrated similar values. As conclusion, gene downregulation was observed in patients under anti-hypertensive therapy. Smoke seems to reduce expression of genes involve in bone formation and increase genes responsible for resorptive activity. This pattern of genic expression may be involved in higher implant loss, observed in smokers. Stop smoke seems to return expression of some of these genes. Esta investigación describe la expresión génica de moléculas de la inflamación y el metabolismo óseo en pacientes sometidos a cirugía de implantes dentales tratados en una institución brasileña. Se recogió una muestra de conveniencia durante 2 años. Las muestras de hueso se procesaron para la extracción del ARN total y la transcripción inversa del ADNc. Se realizó la cuantificación relativa por reacción en cadena de la polimerasa, en tiempo real, de los genes diana. Los pacientes fueron agrupados em: sanos, grupo en terapia antihipertensiva, grupo fumadores, grupo fumadores y estaban en tratamiento antihipertensivo y grupo exfumadores (fumaban durante 10 años, pero dejar de fumar durante al menos 5 años). El grupo de exfumadores tuvo las expresiones más altas y el grupo de hipertensos tuvo los valores más bajos de Factor estimulante de colonias de macrófagos, osteonectina, proteína morfogenética ósea e integrina. Todos los fumadores demostraron valores de expresión comparables a los del grupo de control. Los valores más altos de expresión de Osteopontina, RUNX y fosfatasa alcalina se observaron en los grupos Hipertenso y Fumador, mientras que los valores más bajos se encontraron en el grupo Hipertenso. Fumadores, exfumadores y el grupo Control mostraron valores similares. Como conclusión, el humo parece reducir la expresión de genes implicados en la formación ósea y aumentar los genes responsables de la actividad de resorción. Este patrón de expresión génica puede estar involucrado en una mayor pérdida de implantes, observada en fumadores. Detener el humo parece devolver la expresión de algunos de estos genes. Esta pesquisa descreve a expressão gênica de moléculas relacionadas à inflamação e ao metabolismo ósseo em todos os pacientes submetidos à cirurgia de implante dentário atendidos em uma instituição brasileira. Uma amostra de conveniência foi coletada ao longo de 2 anos. As amostras ósseas foram processadas para extração do RNA total e transcrição reversa do cDNA. A quantificação relativa por reação em cadeia da polimerase, em tempo real, dos genes alvo, foi realizada. Os pacientes foram agrupados. O grupo controle foi composto por 17 pacientes saudáveis, 6 foram incluídos no grupo em terapia anti-hipertensiva, 3 eram fumantes, outros 3 eram fumantes e estavam em tratamento anti-hipertensivo e 3 eram ex-fumantes (fumaram por 10 anos, mas pararam de fumar por pelo menos 5 anos). O grupo ex-fumante apresentou as maiores expressões e o grupo Hipertenso apresentou os menores valores de Fator estimulador de colônias de macrófagos, Osteonectina, Proteína Morfogenética Óssea II e Integrina. Os maiores valores de expressão de Osteopontina, RUNX e fosfatase alcalina foram observados no grupo Hipertenso e Fumante, enquanto os menores valores foram encontrados no grupo Hipertenso. Fumantes, Ex-fumantes e o grupo Controle demonstraram valores semelhantes. Como conclusão o fumo parece reduzir a expressão de genes envolvidos na formação óssea e aumentar genes responsáveis pela atividade reabsortiva. Esse padrão de expressão gênica pode estar envolvido na maior perda de implantes observada em fumantes. Parar de fumar parece retornar a expressão de alguns desses genes.

Celiac disease (CD) is an autoimmune disease that damages the small intestine's villi upon gluten ingestion. Intestinal biopsy via esophagogastroduodenoscopy is the current diagnostic gold standard for CD, but this procedure requires sedation and suffers from sampling error. Here, we conducted a clinical study to test whether image biomarkers derived from duodenal OCT tethered capsule endomicroscopy (TCE) can be used to diagnose CD. Results showed a statistically significant difference in OCT image metrics (villus height & width, contrast, and homogeneity with p

The aim of this study was to identify the incidence of fractures in single crowns placed in individuals with chronic tooth wear. The sample selection was performed based on the evaluation of 218 patient records rehabilitated with single crowns placed by the same professional from a private clinic. After exclusion criteria, 43 individuals (18 males and 25 females) were included and a total of 112 single crowns distributed in both jaws. Three ceramic systems were evaluated: 34 feldspathic all-ceramic, 38 metal-ceramic with a core in gold electropositive alloy, and 40 In-Ceram Alumina. The intraoral photograph analysis adopted a diagnosis method of tooth wear according to the morphological variations of the teeth. Of the 112 crowns evaluated, 47 were placed in male and 65 in female patients, aged between 21 to 74 years (mean 27.5 years old). The variables gender (p = 0.83), presence of chronic tooth wear (p = 0.91), ceramic system (p = 0.24) and crown location (p = 0.86) did not present a statistically difference. However, the variables pulp vitality (p = 0.04) and survi val time (p = 0.01) presented a statistically significant difference. The evaluated ceramic systems can be considered as alternativ es of restorative material, even in individuals with clinical characteristics suggestive of chronic tooth wear.

Background & Aims Tethered capsule endomicroscopy (TCE) involves swallowing a small tethered pill that implements optical coherence tomography (OCT) imaging, procuring high resolution images of the whole esophagus. Here, we demonstrate and evaluate the feasibility and safety of TCE and a portable OCT imaging system in patients with Barrett’s esophagus (BE) in a multi-center (5-site) clinical study. Methods Untreated patients with BE as per endoscopic biopsy diagnosis were eligible to participate in the study. TCE procedures were performed in unsedated patients by either doctors or nurses. After the capsule was swallowed, the device continuously obtained 10-μm-resolution cross-sectional images as it traversed the esophagus. Following imaging, the device was withdrawn through mouth, and disinfected for subsequent reuse. BE lengths were compared to endoscopy findings when available. OCT-TCE images were compared to volumetric laser endomicroscopy (VLE) images from a patient who had undergone VLE on the same day as TCE. Results 147 patients with BE were enrolled across all sites. 116 swallowed the capsule (79%), 95/114 (83.3%) men and 21/33 (63.6%) women (P = .01). High-quality OCT images were obtained in 104/111 swallowers (93.7%) who completed the procedure. The average imaging duration was 5.55 ± 1.92 minutes. The mean length of esophagus imaged per patient was 21.69 ± 5.90 cm. A blinded comparison of maximum extent of BE measured by OCT-TCE and EGD showed a strong correlation (r = 0.77-0.79). OCT-TCE images were of similar quality to those obtained by OCT-VLE. Conclusions The capabilities of TCE to be used across multiple sites, be administered to unsedated patients by either physicians or nurses who are not expert in OCT-TCE, and to rapidly and safely evaluate the microscopic structure of the esophagus make it an emerging tool for screening and surveillance of BE patients. Clinical trial registry website and trial number: NCT02994693 and NCT03459339.

Objective: An ideal biomechanics minimizes the stress between implant and bone that can provide success for osseointegrated implants. This study evaluated the strain concentration in surrounding tissue and stress in the components of two implants with different prosthetic connections through an in vitro and in silico methods. Methods: Twenty polyurethane blocks were divided into two groups (n=10) followed by the installation of internal hexagon (IH) (AS Technology – Titanium Fix, Sao Jose dos Campos, Brazil) or locking taper implants (LT) (Bicon Dental Implants). For strain gauge (SG) method, four sensors were placed around the implants. For finite element analysis (FEA), the same block was modeled and analyzed. An axial load (30 kgf) was applied for both methodologies. The values of stress and strain were analyzed for correlation to SG. Results: For SG, LT presented a mean of strain most aggressive (-932) than IH (-632). For FEA, LT showed less stress (-547) then IH (-1169). Conclusion: For two implant’s system, microstrain values capable to induce unwanted bone remodeling were not measured. However, for IH implant, the presence of a retention screw has the disadvantage to concentrate stress while a solid abutment dissipates the axial load through the implant that suggests a better performance for LT group. Keywords: Finite elements analyses; Dental implant; Strain gauge.

The present study evaluated the displacement and strain generated in an implant- supported fixed prosthesis under axial and non-axial loads using two methods.Three implants were inserted in a resin block. The Digital Image Correlation (DIC) was used to measure displacement and strain generated on the surface of the resin blocks for the different load applications (500N, 1 image/second). A 3-dimensional model was constructed and a load of 500 N was applied at an axial point and a non-axial point through finite element analysis (FEA).Both methods gave similar trends for the strains, and both gave slightly higher strains with non-axial loading. FEA predicted higher strain magnitude (±11%) in comparison with DIC, but with the same mechanical behavior. According to ANOVA, the loading influenced the strain concentration. Higher strain was generated for non-axial loading around the implant nearest to the loading.For implant-retained cantilever fixed prosthesis, the same load applied in the lever arm induces higher strain in the cervical area of the last implant, which suggests more damaging potential than a load applied at the center of the prosthesis.

We report NMR experiments on heavily electron-doped Fe-based superconductor in comparison with the results on the parent Fe-based compounds. The typical parent Fe-based compound LaFe(As1-x′P x′)O exhibits the re-emergent antiferromagnetic (AFM) order at x′ ~ 0.6 (AFM2) separated from the parent AFM order at x′ =0 (AFM1). Systematic 31P-NMR study on [Sr4Sc2O6]Fe2(As1−x P x )2 (SrSc42622), which has local lattice parameters of iron-pnictogen (FePn) layer similar to the series of LaFe(As1−x′/P x′)O, also revealed that the presence of AFM1 order is universal for most of parent Fe-based compounds. In contrast, the static AFM2 order was absent in this series, however, the dynamical low-energy AFM spin fluctuations are enhanced at around x ~ 0.8, indicating that the onset of the static AFM2 is quite sensitive to the local lattice parameters of FePn layer. In order to elucidate the further universality and diversity, we have carried out 77Se-NMR measurement on Li x (NH3)yFe2−δ Se2 (Tc = 44 K) in heavily electron-doped regime. Although the spin fluctuations at low energies does not significantly develops upon cooling, the moderate spin fluctuations were extracted at high temperatures from comparison of the temperature (T) dependences of Knight shift and nuclear relaxation rate (1/T 1 T). We discuss the universality and diversity of the relationship between the Tc and the characteristics of the spin fluctuations in the Fe-based compounds from a microscopic point of the NMR measurements.

A 37-year-old woman presented to the hospital with a 3-day history of right upper quadrant pain (RUQP), which worsened with deep breathing. On examination, she had fever (38°C) and RUQ tenderness. Laboratory tests showed white-cell count of 8.1 × 109/L and C-reactive protein level of 29.4 mg/L. Liver profiles were within normal range (aspartate aminotransferase 20 U/L and alanine aminotransferase 22 U/L). Immediately, contrastenhanced computed tomography (CECT) was performed (Figure 1). What is your diagnosis?

Background and objective Diagnosis of esophageal diseases is often hampered by sampling errors that are inherent in endoscopic biopsy, the standard of care. Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal endomicroscopy technology that has the potential to visualize cellular features from large regions of the esophagus, greatly decreasing the likelihood of sampling error. In this paper, we report results from a pilot clinical study imaging the human esophagus in vivo with a prototype SECM endoscopic probe. Materials and methods In this pilot clinical study, six patients undergoing esophagogastroduodenoscopy (EGD) for surveillance of Barrett's esophagus (BE) were imaged with the SECM endoscopic probe. The device had a diameter of 7 mm, a length of 2 m, and a rapid-exchange guide wire provision for esophageal placement. During EGD, the distal portion of the esophagus of each patient was sprayed with 2.5% acetic acid to enhance nuclear contrast. The SECM endoscopic probe was then introduced over the guide wire to the distal esophagus and large-area confocal images were obtained by helically scanning the optics within the SECM probe. Results Large area confocal images of the distal esophagus (image length = 4.3-10 cm; image width = 2.2 cm) were rapidly acquired at a rate of ∼9 mm2 /second, resulting in short procedural times (1.8-4 minutes). SECM enabled the visualization of clinically relevant architectural and cellular features of the proximal stomach and normal and diseased esophagus, including squamous cell nuclei, BE glands, and goblet cells. Conclusions This study demonstrates that comprehensive spectrally encoded confocal endomicroscopy is feasible and can be used to visualize architectural and cellular microscopic features from large segments of the distal esophagus at the gastroesophageal junction. By providing microscopic images that are less subject to sampling error, this technology may find utility in guiding biopsy and planning and assessing endoscopic therapy. Lasers Surg. Med. 49:233-239, 2017. © 2016 Wiley Periodicals, Inc.

In the divertor region, the plasma contains deuterium (D) ion and tritium (T) ion in an open magnetic field. The effect of D ion and T ion on the electric potential near the wall in plasma with magnetic field decreasing toward a wall is investigated analytically. The distribution of the electric potential is obtained by plasma-sheath equation, where D ion and T ion are considered. The potential distribution depends on the parameters such as the profile of the magnetic field, the temperatures of D ion and T ion, and the amount rate of T ion to D ion. The particle distribution also is shown. (© 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Environmental enteric dysfunction (EED) is a pathological condition of the small intestine that is endemic to low- and middle-income countries (LMICs). EED is thought to interfere with nutrient absorption and enteropathogen exclusion, resulting in altered immune response, increased infection, and limited neurological and physical development. Biopsy of the small intestine is the current diagnostic gold standard for diagnosis yet is untenable due to lack of availability in these countries. Endoscopic biopsy is further problematic since EED-related stunting can only be reversed if diagnosed in the first two years of life when endoscopy must be conducted under anesthesia in advanced medical care settings. Thus, there is an unmet need for a minimally invasive technology for obtaining small intestinal biopsies in unsedated infants in LMICs. To address this need, we have developed an OCT image-guided trans-nasal cryobiopsy device. The device comprises a dual-lumen 1.2 mm outer diameter (OD) probe, terminated by a metal tip, through which Freon is injected. The device is introduced through the lumen of a novel liquid-metal transnasal imaging tube that passively transits to the small intestine. M-mode OCT image guidance is used to determine when the metal tip is in contact with the mucosa so that cryobiopsies may be efficiently acquired. We have conducted feasibility experiments using this device in 10 swine in vivo, demonstrating residual bleeding that is comparable to conventional excisional biopsy, tissue sampling volumes that are greater than or equal to those of conventional biopsy, and high-quality histopathology. These results suggest that this transnasal cryobiopsy technique may be suitable for infants in low-resource settings where EED is prevalent, due to its simplicity and its ability to be used in unsedated subjects.

Upper endoscopy is a standard technique for imaging, sampling, and treating gastrointestinal tissue. Endoscopy is frequently requiring the subjects who undergo the procedure be consciously sedated. Sedation necessitates that the endoscopy procedure be conducted in a specialized setting to mitigate complications should they arise. Endoscopy is further problematic for infants and young children (aged 0-24 months) who sometimes need to be anesthetized. These issues motivate alternative methods for upper gastrointestinal tract visualization and biopsy that do not require conscious sedation/anesthesia. To address this need, we have developed a double lumen 6.5 Fr transnasal introduction catheter (TNIC). During transnasal insertion, real-time OCT imaging provides confirmation of the anatomical location of the device. Once in the stomach, a safe and high-density liquid metal fills a balloon at the distal tip of the TNIC, allowing it to passively transit through stomach into the small intestine. Once properly positioned, OCT-guided instruments for imaging and biopsy can be inserted through main lumen of the TNIC, performing many of the functions of conventional endoscopy and advanced endomicroscopy. To test the feasibility of the TNIC, we conducted a clinical study using the first version of the device in 4 unsedated normal volunteers. Results showed detailed OCT endomicroscopy images of the esophagi and duodena. These results suggest that TNIC may be an effective, less invasive method for the diagnosis of upper GI tract conditions.

Colorectal cancer is the second leading cause of cancer deaths in the United States and causes over 50,000 deaths annually. The standard of care for colorectal cancer detection and prevention is an optical colonoscopy and polypectomy. However, over 20% of the polyps are typically missed during a standard colonoscopy procedure and 60% of colorectal cancer cases are attributed to these missed polyps. Surface topography plays a vital role in identification and characterization of lesions, but topographic features often appear subtle to a conventional endoscope. Chromoendoscopy can highlight topographic features of the mucosa and has shown to improve lesion detection rate, but requires dedicated training and increases procedure time. Photometric stereo endoscopy captures this topography but is qualitative due to unknown working distances from each point of mucosa to the endoscope. In this work, we use deep learning to estimate a depth map from an endoscope camera with four alternating light sources. Since endoscopy videos with ground truth depth maps are challenging to attain, we generated synthetic data using graphical rendering from an anatomically realistic 3D colon model and a forward model of a virtual endoscope with alternating light sources. We propose an encoder-decoder style deep network, where the encoder is split into four branches of sub-encoder networks that simultaneously extract features from each of the four sources and fuse these feature maps as the network goes deeper. This is complemented by skip connections, which maintain spatial consistency when the features are decoded. We demonstrate that, when compared to monocular depth estimation, this setup can reduce the average NRMS error for depth estimation in a silicone colon phantom by 38% and in a pig colon by 31%.

While the most common method used to evaluate and survey patients with Barrett’s Esophagus (BE) is endoscopic biopsy, this procedure is invasive, time-consuming, and suffers from sampling errors. Moreover, it requires patient sedation that increases cost and mandates its operation in specialized settings. Our lab has developed a new imaging tool termed tethered capsule endomicroscopy (TCE) that involves swallowing a tethered capsule which utilizes optical coherence tomography (OCT) to obtain three-dimensional microscopic (10µm) images of the entire esophageal wall as it traverses the luminal organ via peristalsis or is retrieved by pulling up tether. As opposed to endoscopy, TCE procedure is non-invasive, doesn’t require patient sedation and mitigates sampling error by evaluating the microscopic structure of the entire esophagus. The merits of TCE make it a suitable device to investigate the microscopic natural history of BE in a longitudinal manner. Here, we present our initial experience of a multicenter (5-site) clinical trial to study the microscopic natural history of BE. The TCE device used for the study is the new generation capsule with the ball lens optical configuration and a distal scan stepper motor, which provides 30µm (lateral) resolution and 40Hz imaging rate. The portable OCT imaging system is a custom in-house built swept source system and provides 7µm (axial) at a 100 kHz A-line rate with a center wavelength of ~1310 nm. To date, we have successfully enrolled 69 subjects at all sites (MGH: 33, Columbia University: 11, Kansas City VA: 10, Mayo Jacksonville: 8, Mayo Rochester: 7) and 59 have swallowed the capsule (85.5%). There have been no reported adverse events associated with TCE procedure. High-quality OCT images were reliably obtained from patients who swallowed the device, and BE tissues were identified by expert readers. Our initial experience with TCE in a multicenter study demonstrates that this technology is easy to use and efficient in multiple clinical settings. Completion of this longitudinal study is likely to provide new insights on the temporal progression of BE that may impact management strategies.

International audience; Tethered capsule endomicroscopy (TCE) is an emerging screening technology that comprehensively obtains microstructural OCT images of the gastrointestinal (GI) tract in unsedated patients. To advance clinical adoption of this imaging technique, it will be important to validate TCE images with co-localized histology, the current diagnostic gold standard. One method for co-localizing OCT images with histology is image-targeted laser marking, which has previously been implemented using a driveshaft-based, balloon OCT catheter, deployed during endoscopy. In this paper, we present a TCE device that scans and targets the imaging beam using a low-cost stepper motor that is integrated inside the capsule. In combination with a 4-laser-diode, high power 1430/1450 nm marking laser system (800 mW on the sample and 1s pulse duration), this technology generated clearly visible marks, with a spatial targeting accuracy of better than 0.5 mm. A laser safety study was done on swine esophagus ex vivo, showing that these exposure parameters did not alter the submucosa, with a large, 4-5x safety margin. The technology was demonstrated in living human subjects and shown to be effective for co-localizing OCT TCE images to biopsies obtained during subsequent endoscopy.

Patients with many different digestive diseases undergo repeated EGDs throughout their lives. Tethered capsule endomicroscopy (TCE) is a less-invasive method for obtaining high-resolution images of the GI mucosa for diagnosis and treatment planning of GI tract diseases. In this article, we present our results from a single-center study aimed at testing the safety and feasibility of TCE for imaging the esophagus, stomach, and duodenum.After being swallowed by a participant without sedation, the tethered capsule obtains cross-sectional, 10 μm-resolution, optical coherence tomography images as the device traverses the alimentary tract. After imaging, the device is withdrawn through the mouth, disinfected, and reused. Safety and feasibility of TCE were tested, focusing on imaging the esophagus of healthy volunteers and patients with Barrett's esophagus (BE) and the duodenum of healthy volunteers. Images were compared with endoscopy and histopathology findings when available.Thirty-eight patients were enrolled. No adverse effects were reported. The TCE device swallowing rate was 34 of 38 (89%). The appearance of a physiologic upper GI wall, including its microscopic pathology, was visualized with a tissue coverage of 85.4% ± 14.9% and 90.3% ± 6.8% in the esophagus of BE patients with and without endoscopic evidence of a hiatal hernia, respectively, as well as 84.8% ± 7.4% in the duodenum. A blinded comparison of TCE and endoscopic BE measurements showed a strong to very strong correlation (r = 0.7-0.83; P .05) for circumferential extent and a strong correlation (r = 0.77-0.78; P .01) for maximum extent (Prague classification). TCE interobserver correlation was very strong, at r = 0.92 and r = 0.84 (P .01), for Prague classification circumferential (C) and maximal (M) length measurements, respectively.TCE is a safe and feasible procedure for obtaining high-resolution microscopic images of the upper GI tract without endoscopic assistance or sedation.

A laboratory colony of Oncopeltus fasciatus was found to be infected by Leptomonas oncopelti. The flagellates form a carpet attached to the cuticular intima of the rectal glands of adult bugs. The epithelial cells of these glands are characterized by infolded apical plasma membranes associated with mitochondria; the overlying cuticular intima shows endocuticular canals. The Leptomonas are attached by hemidesmosomes, located most often at the tip of the flagella. The Protozoa multiply by budding and the resultant straphangers cling to the parental flagellum. Adhesion of the flagellates to the cuticular lining is so strong that detaching flagellates carry with them the outer part of the epicuticle. Epicuticle repair presumably occurs through the endocuticular canals.

Background and Aims The adenoma detection rate (ADR) is the most important quality metric for colonoscopy. Numerous factors are known to influence ADR. However, no data on the effect of monitor size on ADR exist. The aim of this study was to compare the ADR and polyp detection rate (PDR) achieved using 2 different-size video monitors (19-inch diagonal and 32-inch diagonal). Methods In a single-center, prospective, randomized clinical trial, endoscopists were randomized on a daily basis to perform routine ambulatory colonoscopies with either a 32-inch diagonal or a 19-inch diagonal video monitor. Results The study was conducted between October 2013 and April 2014 in an outpatient center of a tertiary referral hospital. Fifteen endoscopists performed 1795 outpatient colonoscopies (mean age, 55 years; 56% women; screening, 56%). There was no substantial difference in baseline patient characteristics between the 2 arms. The overall ADR (27.4% vs 27.9%; P = .80) and PDR (32.8% vs 34.4%; P = .50) were not significantly different between the 32-inch and 19-inch monitor group, respectively. The findings were not significantly altered when stratified by indication, cecal intubation, bowel preparation, operator experience, and time of endoscopy as well as in a multivariable model that included these variables as potential confounders (all P > .05). Overall, the ADR and PDR for each individual endoscopist did not appear to be influenced by monitor size. Conclusions The results of this trial do not support the notion that larger video monitors improve ADR. Future efforts to increase ADR should focus on other aspects of colonoscopy. (Clinical trial registration number: NCT01952418.)

Tethered capsule endomicroscopy (TCE) is a new method for performing comprehensive microstructural OCT imaging of gastrointestinal (GI) tract in unsedated patients in a well-tolerated and cost-effective manner. These features of TCE bestow it with significant potential to improve the screening, surveillance and management of various upper gastrointestinal diseases. To achieve clinical adoption of this imaging technique, it is important to validate it with co-registered histology, the current diagnostic gold standard. One such method for co-registering OCT images with histology is laser cautery marking, previously demonstrated using a balloon-centering OCT catheter that operates in conjunction with sedated endoscopy. With laser marking, an OCT area of interest is identified on the screen and this target is marked in the patient by exposing adjacent tissue to laser light that is absorbed by water, creating superficial, visible marks on the mucosal surface. Endoscopy can then be performed after the device is removed and biopsies taken from the marks. In this talk, we will present the design of a tethered capsule laser marking device that uses a distal stepper motor to perform high precision (< 0.5 mm accuracy) laser targeting and high quality OCT imaging. Ex vivo animal tissue tests and pilot human clinical studies using this technology will be presented.

Colorectal cancer is the second leading cause of cancer deaths in the United States. Identifying and removing premalignant lesions via colonoscopy can significantly reduce colorectal cancer mortality. Unfortunately, the protective value of screening colonoscopy is limited because more than one quarter of clinically-important lesions are missed on average. Most of these lesions are associated with characteristic 3D topographical shapes that appear subtle to a conventional colonoscope. Photometric stereo endoscopy captures this 3D structure but is inherently qualitative due to the unknown working distances from each point of the object to the endoscope. In this work, we use deep learning to estimate the depth from a monocular endoscope camera. Significant amounts of endoscopy data with known depth maps is required for training a convolutional neural network for deep learning. Moreover, this training problem is challenging because the colon texture is patient-specific and cannot be used to efficiently learn depth. To resolve these issues, we developed a photometric stereo endoscopy simulator and generated data with ground truth depths from a virtual, texture-free colon phantom. These data were used to train a deep convolutional neural field network that can estimate the depth for test data with an accuracy of 84%. We use this depth estimate to implement a smart photometric stereo algorithm that reconstructs absolute depth maps. Applying this technique to an in-vivo human colonoscopy video of a single polyp viewed at varying distance, initial results show a reduction in polyp size measurement variation from 15.5% with conventional to 3.4% with smart photometric reconstruction.

In order to make the predictive simulation tools for the extracted beam current and emittance in the Linac4 H− ion source, we have launched the development of the integrated model for the H− ion beam formation and extraction process. More specifically, our 3D KEIO-Beam Formation and eXtraction (3D KEIO-BFX) is coupled with the NINJA, IBSIMU and TRAVEL. The extracted H− ion beam current and co-extracted electron current obtained by the integrated model have shown reasonable agreement with the experiments. peerReviewed

The purpose of this study is to investigate the extraction mechanisms of the H− ions in the Linac4 negative ion source by using an improved two-dimensional in real space and three-dimensional in velocity space Particle in Cell (2D3V-PIC) model. In this model, the following collision processes of the surface produced H− (Hsp−) ions have been introduced and the effects of the collisions on H− extraction have been analyzed: elastic (Hsp− - H2) and charge exchange (Hsp− - H). It is shown that the extracted Hsp− current increases due to the flow reversal of the Hsp ions caused by these collisions.The purpose of this study is to investigate the extraction mechanisms of the H− ions in the Linac4 negative ion source by using an improved two-dimensional in real space and three-dimensional in velocity space Particle in Cell (2D3V-PIC) model. In this model, the following collision processes of the surface produced H− (Hsp−) ions have been introduced and the effects of the collisions on H− extraction have been analyzed: elastic (Hsp− - H2) and charge exchange (Hsp− - H). It is shown that the extracted Hsp− current increases due to the flow reversal of the Hsp ions caused by these collisions.

The negative ion beam optics is studied quantitatively from the viewpoints of the heat loads due to the beam halo in the accelerator and the emittance of the negative ion beam by using the 3D3V PIC model combined with a Monte Carlo calculation, in which negative ion beam from plasma meniscus formation to the beam acceleration is modeled. As for the heat loads of the A2G and the GRG, the simulation result almost agrees with the experimental result. The simulation result indicates that the secondary electrons from the extractor also contribute to the heat load of the A1G. Moreover, the normalized rms emittance of the negative ion beam after the exit of the GRG are estimated to be around 0.25π mm mrad, which are compatible with the typical values of the negative ion sources.

Background & aims A common limiting factor in the throughput of gastrointestinal endoscopy units is the availability of space for patients to recover post-procedure. This study sought to identify predictors of abnormally long recovery time after colonoscopy performed with procedural sedation. In clinical research, this type of study would be performed using only one regression modeling approach. A goal of this study was to apply various "machine learning" techniques to see if better prediction could be achieved. Methods Procedural data for 31,442 colonoscopies performed on 29,905 adult patients at Massachusetts General Hospital from 2011 to 2015 were analyzed to identify potential predictors of long recovery times. These data included the identities of hospital personnel, and the initial statistical analysis focused on the impact of these personnel on recovery time via multivariate logistic regression. Secondary analyses included more information on patient vitals both to identify secondary predictors and to predict long recoveries using more complex techniques. Results In univariate analysis, the endoscopist, procedure room nurse, recovery room nurse, and surgical technician all showed a statistically significant relationship to long recovery times, with p-value below 0.0001 in all cases. In the multivariate logistic regression, the most significant predictor of a long recovery time was the identity of the recovery room nurse, with the endoscopist also showing a statistically significant relationship with a weaker effect. Complex techniques led to a negligible improvement over simple techniques in prediction of long recovery periods. Conclusion The hospital personnel involved in performing a colonoscopy show a strong association with the likelihood of a patient spending an abnormally long time recovering from the procedure, with the most pronounced effect for the nurse in the recovery room. The application of more advanced approaches to improve prediction in this clinical data set only yielded modest improvements.

Background & Aims Although treatment of T1a esophageal adenocarcinoma (EAC) is shifting from esophagectomy to endoscopic therapy, T1b EACs are considered too high risk to be treated endoscopically. We investigated the effectiveness and cost effectiveness of esophagectomy vs endoscopic therapy for T1a and T1b EACs, and the effects of age and comorbidities, using a decision analytic Markov model. Methods We developed a model to simulate a hypothetical cohort of men 75 years old with Charlson comorbidity index scores of 0 and either T1aN0M0 or T1bN0M0 EAC, as a base case. We used the model to compare the effects of esophagectomy vs serial endoscopic therapy. We performed sensitivity analyses based on age at diagnosis of 60–85 years, comorbidity indices of 0–2, and utilities. Post-procedure cancer-specific mortality was derived from the Surveillance, Epidemiology, and End Results Medicare database. Results In the T1a base case, esophagectomy yielded more unadjusted life years than endoscopic therapy (6.97 vs 6.81), but fewer quality-adjusted life years (QALYs, 4.95 for esophagectomy vs 5.22 for endoscopic therapy). In the T1b base case, esophagectomy yielded more unadjusted life years than endoscopic therapy (5.73 vs 5.01) and QALYs (4.07 vs 3.85 for endoscopic therapy), but was not cost effective (incremental cost-effectiveness ratio $156,981). Sensitivity analyses showed endoscopic therapy optimized QALYs for patients more than 80 years old with a comorbidity index of 1 or 2, or if the ratio of post-esophagectomy to post-endoscopic therapy utilities was below 0.875. Conclusion In a Markov model, we showed that endoscopic therapy of T1a EAC yields more QALYs and is more cost effective than esophagectomy for patients of all ages and comorbidity indices tested. In contrast, selection of therapy for T1b EAC depends on age and comorbidities, due to surgical mortality and the competing risk of non-cancer death.

Purpose: In radiation therapy,treatment planning for patients is performed using pre‐acquired CTimages. However, many patients with head‐and‐neck (H&N) cancer have tumor shrinkage and/or weight loss during their treatment course. Daily positional error of patients also causes unexpected deviations from the planning. Thus, it is essential to evaluate actual delivereddose for accurate clinical dosimetric consequence. In this study, actual delivereddose for an H&N site was determined by direct point dose measurement with metal‐oxide‐semiconductor field‐effect transistor(MOSFET) detectors using IGRT procedure. We experimentally evaluated usefulness of the IGRT procedure for accurate irradiations. Methods:Treatment processes from planning to beam delivery were performed for an H&N site of an anthropomorphic phantom. The MOSFET detectors were fixed inside the phantom in advance. Then, the anthropomorphic phantom was immobilized with a mould and mask and scanned by simulation‐CT. Beam irradiation condition was field size of 12 cm × 12 cm, gantry angle of 0°, 90° and 330°, and 6 MV X‐ray. Dose distribution was calculated with superposition algorithm with 2 mm calculation grid. Before the dose measurement, the anthropomorphic phantom was positioned using a localization system of mega‐voltage cone‐beam CT (MVCBCT). The MOSFET detectors were exposed five times according to a treatment plan. Measured doses with the MOSFET detectors were compared with calculated doses.Results: Using the MVCBCT, the set‐up of the anthropomorphic phantom was achieved within 1 mm in all directions of anterior/posterior, left/right, and superior/inferior. The calculated doses agreed well to the measured doses within ±3% even in evaluated region with high dose gradient. Conclusions: The actual delivereddose for an H&N site of an anthropomorphic phantom was evaluated experimentally with the MOSFET detectors. The IGRT procedure was useful for accurate irradiations.

Celiac disease (CD) affects around 1% of the global population and can cause serious long-term symptoms including malnutrition, fatigue, and diarrhea, amongst others. Despite this, it is often left undiagnosed. Currently, a tissue diagnosis of CD is made by random endoscopic biopsy of the duodenum to confirm the existence of microscopic morphologic alterations in the intestinal mucosa. However, duodenal endoscopic biopsy is problematic because the morphological changes can be focal and endoscopic biopsy is plagued by sampling error. Additionally, tissue artifacts can also an issue because cuts in the transverse plane can make duodenal villi appear artifactually shortened and can bias the assessment of intraepithelial inflammation. Moreover, endoscopic biopsy is costly and poorly tolerated as the patient needs to be sedated to perform the procedure. Our lab has previously developed technology termed tethered capsule OCT endomicroscopy (TCE) to overcome these diagnostic limitations of endoscopy. TCE involves swallowing an optomechanically-engineered pill that generates 3D images of the GI tract as it traverses the lumen of the organ via peristalsis, assisted by gravity. In several patients we have demonstrated TCE imaging of duodenal villi, however the current TCE device design is not optimal for CD diagnosis as the villi compress when in contact with the smooth capsule’s wall. In this work, we present methods for structuring the outer surface of the capsule to improve the visualization of the villi height and crypt depth. Preliminary results in humans suggest that new TCE capsule enables better visualization of villous architecture, making it possibly to comprehensively scan the entire duodenum to obtain a more accurate tissue diagnosis of CD.