The goal of the study was to determine whether endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) is comparable to conventional transpapillary stenting with endoscopic retrograde ...cholangiopancreatography (ERCP) in palliation of malignant distal biliary obstruction. Although ERCP for the palliation of malignant biliary obstruction is the standard of care, post-procedure pancreatitis and stent dysfunctions are not uncommon. While EUS-BD has garnered interest as a viable alternative when ERCP is impossible, its role as a primary palliation of malignant distal biliary obstruction is yet to be proven.
We performed random allocation to EUS-BD or ERCP in 125 patients with unresectable malignant distal biliary obstruction at four tertiary academic referral centers in South Korea.
Technical success rates were 93.8% (60/64) for EUS-BD and 90.2% (55/61) for ERCP (difference 3.6%, 95% 1-sided confidence interval lower limit -4.4%, P = 0.003 for noninferiority margin of 10%). Clinical success rates were 90.0% (54/60) in EUS-BD and 94.5% (52/55) in ERCP (P = 0.49). Lower rates of overall adverse events (6.3% vs 19.7%, P = 0.03) including post-procedure pancreatitis (0 vs 14.8%), reintervention (15.6% vs 42.6%), and higher rate of stent patency (85.1% vs 48.9%) were observed with EUS-BD. EUS-BD was also associated with more preserved quality of life (QOL) than transpapillary stenting after 12 weeks of the procedure.
This study demonstrated comparable technical and clinical success rates between EUS-BD and ERCP in relief malignant distal biliary obstruction. Substantially longer duration of patency coupled with lower rates of adverse events and reintervention, and more preserved QOL were observed with EUS-BD (cris.nih.go.kr, Identifier: KCT0001396, https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=9716<ype=&rtype= ).
We designed and prepared the imidazoline‐2‐thione containing OCl− probes, PIS and NIS, which operate through specific reactions with OCl− that yield corresponding fluorescent imidazolium ions. ...Importantly, we demonstrated that PIS can be employed to image OCl− generation in macrophages in a co‐culture system. We have also employed two‐photon microscopy and PIS to image OCl− in live cells and tissues, indicating that this probe could have wide biological applications.
Imaging in a co‐culture system: The first two‐photon fluorescence probes for hypochlorite were developed. The imidazoline‐2‐thione probes operate through specific reactions with OCl− that produce fluorescent products. Using the probes, imaging OCl− generation in macrophages in a co‐culture system was demonstrated.
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Background
Endoscopic ultrasound (EUS) is recommended for guiding the acquisition of pancreatic tissue in patients with suspected autoimmune pancreatitis (AIP). Data comparing EUS‐guided fine needle ...aspiration (FNA) and fine needle biopsy (FNB) sampling in the diagnosis of AIP are limited.
Methods
A comprehensive literature search of the PubMed, EMBASE, and Ovid MEDLINE databases was conducted until April 2020. The pooled rates of diagnostic yield for the histologic criteria of AIP, histologic tissue procurement, and adverse events were compared between FNA and FNB. Diagnostic yields were also compared between 19 gauge (G) and 22G needles.
Results
This meta‐analysis included nine studies comprising 309 patients with AIP who underwent FNA and seven studies comprising 131 patients who underwent FNB. The pooled diagnostic yields for level 1 or 2 histology criteria of AIP were 55.8% (95% confidence interval (CI) 37.0–73.9%, I2 = 91.1) for FNA and 87.2% (95% CI 68.8–98.1%, I2 = 69.4) for FNB (P = 0.030). The pooled histologic procurement rates for FNA and FNB were 91.3% (95% CI, 84.9–97.6%, I2 = 82.9) and 87.0% (95% CI, 77.8–96.1%, I2 = 40.0), respectively (P = 0.501). Adverse events were comparable between two groups. When analyzed by needle size, the diagnostic yield was better with a 19G needle than with a 22G needle (88.9% vs. 60.6%, P = 0.023).
Conclusions
The diagnostic yield may be better with FNB needles than with FNA needles for the diagnosis of AIP, despite the similar rate of histologic tissue procurement. A quantitative definition for the histologic sample adequacy for AIP may be warranted.
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A field-response-equivalent circuit is advantageous for explaining the field coupling mechanism of <inline-formula> <tex-math notation="LaTeX">H </tex-math></inline-formula>-field probes. Previous ...works have primarily explained the coupling between a field probe and the calibration kit. In this article, a field coupling circuit model is proposed in a generalized form to directly predict the voltage induced by the <inline-formula> <tex-math notation="LaTeX">H </tex-math></inline-formula>-field and the unwanted <inline-formula> <tex-math notation="LaTeX">E </tex-math></inline-formula>-field in the probe for the millimeter-wave (mm-wave) range. The field response circuit model is based on the loop impedance model and incident field response of a loop antenna in the form of a series expansion. This article reveals that the zero-mode response corresponds to <inline-formula> <tex-math notation="LaTeX">H </tex-math></inline-formula>-field coupling, whereas the first mode corresponds to <inline-formula> <tex-math notation="LaTeX">E </tex-math></inline-formula>-field coupling and is validated through the numerical simulation based on the circular loop antenna. The coupling of the fabricated <inline-formula> <tex-math notation="LaTeX">H </tex-math></inline-formula>-field probe is predicted based on the equivalent circuit model and the prediction matches numerical simulation and measurement results from 1 to 40 GHz. The equivalent circuit can be used to predict the probe field coupling with an error less than 4 dB. Finally, this article provides a generalized equivalent circuit as a tool to analyze and understand the probe field coupling quantitively. This article reuses some content from a thesis (Liu, 2021) in <xref rid="sec1" ref-type="sec">Sections I <xref rid="sec2" ref-type="sec"/>-<xref rid="sec3" ref-type="sec">III with permission.
Owing to the extreme toxicity of mercury, methods for its selective and sensitive sensing in solutions, and in live cells and tissues are in great demand. In this study, we developed a ...naphthalimide-based diphenylphosphinothioyl group-containing fluorescent and colorimetric probe that selectively detects mercury (Hg
2+
). Upon addition of mercury (Hg
2+
) to a solution of the probe, both a colorimetric change from colorless to yellow and a fluorescence change from blue to green (under a 365 nm hand-held UV lamp) occur, both of which can be observed using the "naked-eye". Furthermore, the probe possesses the capability of sensing intracellular mercury in both live cells and tissues using dual-emission channels and two-photon microscopy.
Owing to the extreme toxicity of mercury, methods for its selective and sensitive sensing in solutions, and in live cells and tissues are in great demand.
Many aspects of cell metabolism are controlled by acidic pH. We report a new family of small molecule and ratiometric two photon (TP) probes derived from benzimidazole (BH1–3 and BH1L) for monitoring ...acidic pH values. These probes are characterized by a strong two-photon excited fluorescence, a marked blue-to-green emission color change in response to pH, pK a values ranging from 4.9 to 6.1, a distinctive isoemissive point, negligible cytotoxicity, and high photostability, thereby allowing quantitative analysis of acidic pH. Moreover, we show that BH1L optimized as a lysosomal-targeted probe allows for direct, real-time estimation of the pH values inside lysosomal compartments in live cells as well as in living mouse brain tissues through the use of two-photon microscopy. These findings demonstrate that these probes will find useful applications in biomedical research.
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Objective
IgG4‐related disease (IgG4‐RD) can cause fibroinflammatory lesions in nearly any organ, leading to organ dysfunction and failure. The IgG4‐RD Responder Index (RI) was developed to help ...investigators assess the efficacy of treatment in a structured manner. The aim of this study was to validate the RI in a multinational investigation.
Methods
The RI guides investigators through assessments of disease activity and damage in 25 domains, incorporating higher weights for disease manifestations that require urgent treatment or that worsen despite treatment. After a training exercise, investigators reviewed 12 written IgG4‐RD vignettes based on real patients. Investigators calculated both an RI score as well as a physician's global assessment (PhGA) score for each vignette. In a longitudinal assessment, 3 investigators used the RI in 15 patients with newly active disease who were followed up over serial visits after treatment. We assessed interrater and intrarater reliability, precision, validity, and responsiveness.
Results
The 26 physician investigators included representatives from 6 specialties and 9 countries. The interrater and intrarater reliability of the RI was strong (0.89 and 0.69, respectively). Correlations (construct validity) between the RI and PhGA were high (Spearman's r = 0.9, P < 0.0001). The RI was sensitive to change (discriminant validity). Following treatment, there was significant improvement in the RI score (mean change 10.5 95% confidence interval (95% CI) 5.4–12, P < 0.001), which correlated with the change in the PhGA. Urgent disease and damage were captured effectively.
Discussion
In this international, multispecialty study, we observed that the RI is a valid and reliable disease activity assessment tool that can be used to measure response to therapy.
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Background & Aims Endoscopic ultrasound-guided transmural gallbladder drainage (EUS-GBD) is an alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute, ...high-risk, or advanced-stage cholecystitis who do not respond to initial medical treatment and cannot undergo emergency cholecystectomy. However, the technical feasibility, efficacy, and safety of EUS-GBD and PTGBD have not been compared. Methods Fifty-nine patients with acute cholecystitis, who did not respond to initial medical treatment and were unsuitable for an emergency cholecystectomy, were chosen randomly to undergo EUS-GBD (n = 30) or PTGBD (n = 29). The technical feasibility, efficacy, and safety of EUS-GBD and PTGBD were compared. Results EUS-GBD and PTGBD showed similar technical (97% 29 of 30 vs 97% 28 of 29; 95% 1-sided confidence interval lower limit, −7%; P = .001 for noninferiority margin of 15%) and clinical (100% 29 of 29 vs 96% 27 of 28; 95% 1-sided confidence interval lower limit, −2%; P = .0001 for noninferiority margin of 15%) success rates, and similar rates of complications (7% 2 of 30 vs 3% 1 of 29; P = .492 in the Fisher exact test) and conversions to open cholecystectomy (9% 2 of 23 vs 12% 3 of 26; P = .999 in the Fisher exact test). The median post-procedure pain score was significantly lower after EUS-GBD than after PTGBD (1 vs 5; P < .001 in the Mann–Whitney U test). Conclusions EUS-GBD is comparable with PTGBD in terms of the technical feasibility and efficacy; there were no statistical differences in the safety. EUS-GBD is a good alternative for high-risk patients with acute cholecystitis who cannot undergo an emergency cholecystectomy.
Optical imaging with fluorescence microscopy is a vital tool in the study of living systems. The most common method for cell imaging, one-photon microscopy (OPM), uses a single photon of higher ...energy to excite the fluorophore. However, two-photon microscopy (TPM), which uses two photons of lower energy as the excitation source, is growing in popularity among biologists because of several distinct advantages. Using TPM, researchers can image intact tissue for a long period of time with minimum interference from tissue preparation artifacts, self-absorption, autofluorescence, photobleaching, and photodamage. However, to make TPM a more versatile tool in biology, researchers need a wider variety of two-photon probes for specific applications. In this Account, we describe a series of two-photon probes that we developed that can visualize the distribution of intracellular metal ions, acidic vesicles, and lipid rafts in living cells and tissues. The development of these probes requires a significant two-photon cross section for the bright image and receptors (sensing moieties) that triggers the emission of the two-photon excited fluorescence upon binding with the ions or membrane in the living system. These probes also must be sensitive to the polarity of the environment to allow selective detection of cytosolic and membrane-bound probes. In addition, they need to be cell-permeable, water-soluble for the staining of cells and tissues, and highly photostable for long-term imaging. The resulting probesAMg1 (Mg2+), ACa1−ACa3 (Ca2+), AZn1 and AZn2 (Zn2+), AH1, AH2, and AL1 (acidic vesicles), and CL2 (membrane)use 2-acetyl-6-aminonaphthalene as the fluorophore and receptors for the target ions or membrane. All of these two-photon turn-on probes can detect the intracellular free metal ions, acidic vesicles, and lipid rafts at 100−300 μm depth in live tissues. Moreover, with ACa1-AM, we could simultaneously visualize the spontaneous Ca2+ waves in the somas of neurons and astrocytes at ∼120 μm depth in fresh hypothalamic slices for more than 1000 s without appreciable decay. Furthermore, AL1 could visualize the transport of the acidic vesicles between cell body and axon terminal along the axon in fresh rat hippocampal slices at ∼120 μm depth.
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