To develop a highly thermally conductive composite film, two types of ceramic fillers with different shapes were bound with cellulose nanofiber (CNF) composite fibrils densely covered with ...nanodiamond (ND) particles. A hexagonal boron nitride (h-BN) filler with a plate-like structure was oriented in the in-plane direction of the CNF/ND nanosheets, increasing the in-plane thermal conductivity of the h-BN-based composite film by 38.7% from 4.45 to 6.17 W/m K compared with the raw CNF/ND composite film. Conversely, the Al
2
O
3
particles inflected the CNF/ND nanosheets and lowered the orientation of the nanosheets. The in-plane thermal conductivity of the Al
2
O
3
-based composite film was lower than that of the CNF/ND film. To develop a highly thermally conductive CNF/ND/ceramic composite film, the ceramic filler should be oriented in the plane direction, and h-BN with a high thermal conductivity is a suitable filler.
Graphical abstract
Hepatic sinusoidal obstruction syndrome (SOS)/veno-occlusive disease is a life-threatening complication after hematopoietic stem cell transplantation (HSCT). We previously reported the efficacy of ...the Hokkaido Ultrasonography (US)-based scoring system (HokUS-10) for US findings. To establish easier-to-use criteria, we retrospectively evaluated US findings from 441 patients, including 30 patients with SOS using the HokUS-10 scoring system. Using logistic regression analysis, we established the novel diagnostic criteria HokUS-6. In the presence of ascites, US diagnosis was made in the presence of two of the following 6 parameters: moderate amount of ascites, the appearance of a paraumbilical vein blood flow signal, gallbladder wall thickening, portal vein dilatation, portal vein velocity decrease, and hepatic artery resistive index increase. The AUC, sensitivity, and specificity of HokUS-6 were 0.974 (95% confidence interval 0.962–0.990), 95.2%, and 96.9%, respectively. The scores were significantly higher in patients with severe SOS than in those with non-severe SOS (
p
= 0.013). Furthermore, the scores before HSCT were significantly higher in patients who developed SOS than in controls (
p
= 0.001). The HokUS-6 is an easy and useful way to diagnose and identify the risk of SOS.
A 57-year-old woman with a sudden-onset seizure was hospitalized. Brain magnetic resonance imaging findings led to a suspicion of leptomeningeal carcinomatosis (LMC) without a brain parenchymal ...tumor, and abdominal computed tomography showed a tumor in the pancreatic tail. Endoscopic ultrasonography-guided fine needle aspiration of the pancreatic mass revealed adenocarcinoma. Therefore, LMC from pancreatic ductal adenocarcinoma was strongly suspected. She received three courses of nab-paclitaxel plus gemcitabine and whole-brain radiation. Shortly thereafter, she developed a severe consciousness impediment and died. A pathological autopsy showed adenocarcinoma in a wide area of the leptomeninges.
The in-plane thermal conductivity of cellulose nanofiber (CNF) composite film densely covered with nanodiamond (ND) particles has been improved by using the wet-rotating disc milling (WRDM) process ...and optimizing the compositional ratio of ND and CNF. The aspect ratio of CNF fibrils was increased by 42% using the WRDM. Furthermore, the in-plane thermal conductivities of CNF and ND/CNF films composed of WRDM-assisted CNF fibrils were improved with the increase of the aspect ratio of CNF fibrils. In addition, the mass ratio of ND to CNF and the in-plane thermal conductivity of the ND/CNF composite film were enhanced by using the WRDM-assisted ND suspensions owing to the improvement of dispersibility of ND particles. Consequently, the in-plane thermal conductivity of the ND/CNF film increased by 82% from 2.67 to 4.85 W/m K with the increase of the aspect ratio of CNF fibrils, thus improving the dispersibility of ND particles and optimizing the compositional ratio of ND and CNF. The dense adsorption of ND particles on the surface of CNF fibrils with high aspect ratio led to the improvement of the in-plane thermal conductivity of the composite film.
Graphical abstract
When left ventricular filling pressure (LVFP) increases, the mitral valve opens early and precedes tricuspid valve opening in early diastole. The authors hypothesized that a visually assessed time ...sequence of atrioventricular valve opening could become a new marker of elevated LVFP. The aim of this study was to test the diagnostic ability of a novel echocardiographic scoring system, the visually assessed time difference between mitral valve and tricuspid valve opening (VMT) score, in patients with heart failure.
One hundred nineteen consecutive patients who underwent cardiac catheterization within 24 hours of echocardiographic examination were retrospectively analyzed as a derivation cohort. In addition, a prospective study was conducted to validate the diagnostic ability of the VMT score in 50 patients. Elevated LVFP was defined as mean pulmonary artery wedge pressure (PAWP) ≥ 15 mm Hg. The time sequence of atrioventricular valve opening was visually assessed and scored (0 = tricuspid valve first, 1 = simultaneous, 2 = mitral valve first). When the inferior vena cava was dilated, 1 point was added, and VMT score was ultimately graded as 0 to 3. Cardiac events were recorded for 1 year after echocardiography.
In the derivation cohort, PAWP was elevated with higher VMT scores (score 0, 10 ± 5; score 1, 12 ± 4; score 2, 22 ± 8; score 3, 28 ± 4 mm Hg; P < .001, analysis of variance). VMT score ≥ 2 predicted elevated PAWP with accuracy of 86% and showed incremental predictive value over clinical variables and guideline-recommended diastolic function grading. These observations were confirmed in the prospective validation cohort. Importantly, VMT score ≥ 2 discriminated elevated PAWP with accuracy of 82% in 33 patients with monophasic left ventricular inflow in the derivation cohort. Kaplan-Meier analysis demonstrated that patients with VMT scores ≥ 2 were at higher risk for cardiac events than those with VMT scores ≤ 1 (P < .001).
VMT scoring could be a novel additive marker of elevated LVFP and might also be associated with adverse outcomes in patients with heart failure.
•MV opening becomes early in accordance with elevated LVFP.•A VMT score using the time sequence of atrioventricular valve opening is proposed.•VMT score was associated with elevation of LVFP in patients with HF.•VMT score was also associated with future adverse events in HF.
Cases of foreign body ingestion are encountered relatively often in clinical settings; however, serious complications are rare. In such cases, mediastinal abscess due to esophageal perforation can ...become a life-threatening complication. Although highly invasive, surgery is often used as the first-line treatment. We herein report the case of a 65-year-old woman who presented with complaints of progressive odynophagia and dysphagia for 2 weeks following a fish meal. Enhanced cervicothoracic computed tomography demonstrated an enhanced round mass with peripheral contrasted margins. The mass was diagnosed as a mediastinal abscess resulting from esophageal perforation caused by a fish bone. Endoscopic ultrasound-guided abscess drainage (EUS-AD) was performed using a nasobiliary drainage tube (NDT). Two weeks later, the abscess had completely disappeared. EUS-AD was safe and effective in this case; furthermore, external drainage using NDT was suitable for this abscess located very close to the upper esophageal sphincter.
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•A composite film of cellulose nanofiber (CNF) and nanodiamond (ND) was prepared.•In the nanocomposite, CNF fibrils were densely covered with ND particles.•The nanostructure raised ...thermal conductivity of the composite film.
Thermally conductive and electrically insulating composite materials are required for thermal management in advanced electronic industry. The present work aimed at creating a composite film of cellulose nanofiber (CNF) and nanodiamond (ND) with superior thermal conductivity. The thermal conductivity of the prepared nanocomposite film was ∼2.7 Wm−1 K−1, which corresponds to triple of usual CNF/ND composites with similar composition. The distinct thermal conductivity is attributed to a unique nanostructure we made out in the nanocomposite film. The nanostructure can be characterized by CNF fibrils which are densely covered with ND particles.
Background:
Endoscopic submucosal dissection (ESD) for early gastric neoplasms is still a technically difficult and time-consuming procedure. Hybrid ESD (H-ESD) involves circumferential incision with ...partial submucosal dissection combined with subsequent mucosal resection by snaring, wherein the newly developed device allows us to perform H-ESD using a single device. This study aimed to determine the clinical outcomes of H-ESD compared with conventional ESD (C-ESD) for early gastric neoplasms.
Methods:
In this multi-center, retrospective study, using propensity score-matched analysis, we reviewed the charts of patients with early gastric neoplasms smaller than 20 mm treated with H-ESD or C-ESD at three hospitals between January 2017 and October 2018. The primary outcome was the procedure time, and the secondary outcomes were other factors, including the en bloc resection rate, complete resection rate, curative resection rate, and rate of adverse events.
Results:
Among 215 patients, 29 underwent H-ESD and 186 underwent C-ESD; 29 pairs were created by propensity score matching. In the H-ESD group, 82.8% of lesions met the absolute indication mucosal lesions limited to 20-mm diameter, dominated by differentiated adenocarcinoma without ulcer (scar) for endoscopic resection (ER). As a result, the procedure time of H-ESD was significantly shorter than that of C-ESD 20 (interquartile range, 12–27) min versus 40 (30–50) min; p < 0.001. There was no significant difference in the secondary outcomes between the two groups.
Conclusion:
H-ESD contributed to reduced procedure time. Therefore, H-ESD could be an alternative endoscopic treatment for gastric neoplasms when the lesion fulfils the absolute indication for ER.
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