Background and Aims Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been proposed as an alternative management strategy for acute cholecystitis caused by malignant cystic duct ...obstruction in patients for whom surgery is not an option. This study aimed to compare the results of EUS-GBD with those of percutaneous transhepatic gallbladder drainage (PTGBD) for palliative management of malignant cystic duct obstruction with acute cholecystitis or symptomatic gallbladder hydrops. Methods Between November 2013 and November 2015, 14 patients with acute cholecystitis or symptomatic gallbladder hydrops as a result of malignant cystic duct obstruction underwent EUS-GBD with covered metal stents. Nineteen patients with acute cholecystitis as a result of malignant cystic duct obstruction who received PTGBD served as a control group. Patients’ medical records were reviewed retrospectively. Results The technical and clinical success rates of EUS-GBD were 85.7% (12/14) and 91.7% (11/12) and of PTGBD were 100% (19/19) and 86.4% (17/19), respectively. The groups had similar adverse event rates (28.5% and 21.1%, respectively). The average duration of stent patency in patients with EUS-GBD was 130.3 ± 35.3 days, and no patient required an additional procedure before death. In 6 of 17 patients (35.3%) with clinically successful PTGBD, the catheter was not removed until the end stage of life. Conclusions EUS-GBD is a feasible, safe, and effective modality for the treatment of malignant cystic duct obstruction in patients who are not indicated for surgery. It enables improved long-term quality of life in patients with advanced-stage cancer.
Our previous study shows that an essential amino acid (EAA)-enriched diet attenuates dexamethasone (DEX)-induced declines in muscle mass and strength, as well as insulin sensitivity, but does not ...affect endurance. In the present study, we hypothesized that the beneficial effects will be synergized by adding resistance exercise training (RET) to EAA, and diet-free EAA would improve endurance. To test hypotheses, mice were randomized into the following four groups: control, EAA, RET, and EAA+RET. All mice except the control were subjected to DEX treatment. We evaluated the cumulative rate of myofibrillar protein synthesis (MPS) using 2H2O labeling and mass spectrometry. Neuromuscular junction (NMJ) stability, mitochondrial contents, and molecular signaling were demonstrated in skeletal muscle. Insulin sensitivity and glucose metabolism using 13C6-glucose tracing during oral glucose tolerance tests were analyzed. We found that EAA and RET synergistically improve muscle mass and/or strength, and endurance capacity, as well as insulin sensitivity, and glucose metabolism in DEX-treated muscle. These improvements are accomplished, in part, through improvements in myofibrillar protein synthesis, NMJ, fiber type preservation, and/or mitochondrial biogenesis. In conclusion, free EAA supplementation, particularly when combined with RET, can serve as an effective means that counteracts the adverse effects on muscle of DEX that are found frequently in clinical settings.
In this study, we aimed to investigate the prospective associations and their shapes between the dietary intake of total flavonoids and their seven subclasses and hypertension risk in a prospective ...cohort, the KoGES_CArdioVascular disease Association Study (CAVAS), and to consider obesity status as an additional factor. A total of 10,325 adults aged 40 years and older were enrolled at baseline, and 2159 patients were newly diagnosed with hypertension during a median follow-up of 4.95 years. Cumulative dietary intake was estimated using a repeated food frequency questionnaire. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were estimated using modified Poisson models with a robust error estimator. We observed nonlinear inverse associations between total and seven subclasses of flavonoids and hypertension risk, although there was no significant association between total flavonoids and flavones with hypertension risk in the highest quartile. For men, these inverse associations tended to be pronounced in the high BMI group, particularly for anthocyanins and proanthocyanidins IRR (95% CI) in overweight/obese men: 0.53 (0.42-0.67) for anthocyanins; 0.55 (0.42-0.71) for proanthocyanidins. Our results suggested that consumption of dietary flavonoids may not be dose-responsive but is inversely associated with hypertension risk, particularly among overweight/obese men.
Although transrectal ultrasound (TRUS) imaging is widely used for screening and diagnosing prostate cancer, it is often not found on TRUS images, depending on its stage, size, and location. In ...addition, due to the weak echo signal and the low contrast of TRUS images, it is difficult to diagnose early-stage prostate cancers and distinguish malignant tumors from benign prostatic hyperplasia. For this reason, TRUS image-guided biopsy is mandatory to confirm the malignancy of the suspicious tumor, but the diagnostic accuracy of initial biopsy is only 20%-30%, so that the patients inevitably undergo repeated biopsies. TRUS-photoacoustic (TRUS-PA) imaging is one way to resolve those problems. However, the development of a TRUS-PA probe, in which an ultrasound array transducer and optical fibers are integrated, is demanding because the overall size of the probe should be as small as possible for the convenience of the patients, while providing the desired performances. Here, we report a recently developed TRUS-PA probe. The core element of the TRUS-PA is a miniaturized 128-element, 7-MHz convex array transducer of which size in the lateral and elevational directions is 11.4 and 5 mm, respectively. A new concept of a flexible printed circuit board was also developed to limit the size of the TRUS-PA probe to less than 15 mm. From the performance evaluation, it was found that the developed array with a field-of-view of 134° has a center frequency of 6.75 MHz, a −6-dB fractional bandwidth of 66%, and a crosstalk of less than −45 dB. In the tissue-mimicking phantom test and ex vivo experiments, the miniaturized convex array proved to be capable of providing combined US and PA images with acceptable imaging quality in spite of its small size.
Beauty treatment for skin requires a high-intensity focused ultrasound (HIFU) transducer to generate coagulative necrosis in a small focal volume (e.g., 1 mm³) placed at a shallow depth (3-4.5 mm ...from the skin surface). For this, it is desirable to make the F-number as small as possible under the largest possible aperture in order to generate ultrasound energy high enough to induce tissue coagulation in such a small focal volume. However, satisfying both conditions at the same time is demanding. To meet the requirements, this paper, therefore, proposes a double-focusing technique, in which the aperture of an ultrasound transducer is spherically shaped for initial focusing and an acoustic lens is used to finally focus ultrasound on a target depth of treatment; it is possible to achieve the F-number of unity or less while keeping the aperture of a transducer as large as possible. In accordance with the proposed method, we designed and fabricated a 7-MHz double-focused ultrasound transducer. The experimental results demonstrated that the fabricated double-focused transducer had a focal length of 10.2 mm reduced from an initial focal length of 15.2 mm and, thus, the F-number changed from 1.52 to 1.02. Based on the results, we concluded that the proposed double-focusing method is suitable to decrease F-number while maintaining a large aperture size.
Complete blockage of a coronary artery, called chronic total occlusion (CTO), frequently occurs due to atherosclerosis. To reopen the obstructed blood vessels with a stent, guidewire crossing is ...performed with the help of angiography that can provide the location of CTO lesions and the image of guidewire tip. Since angiography is incapable of imaging inside a CTO lesion, the surgeons are blind during guidewire crossing. For this reason, the success rate of guidewire crossing relies upon the proficiency of the surgeon, which is considerably reduced from 69.0% to 32.5% if extensive calcification, not penetrated by a guidewire, exists in CTO lesions. In this paper, a recently developed 40-MHz forward-looking intravascular ultrasound (FL⁻IVUS) transducer to visualize calcification within CTO lesions is reported. This transducer consists of a single element angled aperture and a guidewire passage. The aperture is spherically deformed to have a focal length of 3 mm in order to improve spatial resolution of FL⁻IVUS images. The angle between the beam direction and the axis of rotation is designed to be 30° to effectively visualize calcification within a CTO lesion as well as the blood vessel wall. The experimental results demonstrated that the developed FL⁻IVUS transducer facilitates visualization of calcification within CTO lesions and makes it possible to help the surgeon make decisions about whether to push the guidewire in order to cross the lesion or to change the surgical procedure.
Motivated by the growing interest in the Hyperloop system, we have researched a new mode of transportation that runs inside a vacuum tube at more than 1,000 km/h. A 2G high-temperature ...superconducting (HTS) magnet with a detachable cryocooling system has been developed to thrust and levitate the capsule train efficiently; it also reduces its weight. To compensate for performance losses due to increased operating temperature, the HTS coil shape of the on-board superconducting magnet is topologically optimized with respect to cost and performance. With a number of linear constraints converted from nonlinear superconductivity conditions, many linear topology optimization problems are solved, and then the most preferred design is determined by considering its shape, cost, and performance.
A new set of simply structured triphenylamine‐based small molecules are synthesized and evaluated as dopant‐free hole transporting materials (HTMs) for high‐performance perovskite solar cells (PSCs) ...and bulk heterojunction inverted organic solar cells (BHJ IOSCs). Surprisingly, the new amphiphilic‐type HTM‐1 (with internal hydrophilic groups and peripheral hydrophobic alkyl tails) showed better compatibility and performance than the actual target molecule, that is, HTM‐2 in PSCs and BHJ IOSCs. Importantly, the HTM‐1‐based dopant‐free PSCs and BHJ IOSCs exhibited high power conversion efficiencies (PCEs) of 11.45 % and 8.34 %, respectively. These performances are superior and comparable to those of standard HTMs Spiro‐OMeTAD (2,2′,7,7′‐tetrakis(N,N‐di‐p‐methoxyphenylamine)‐9,9′‐spirobifluorene) and PEDOT:PSS (poly(3,4‐ethylenedioxythiophene)/polystyrene sulfonate) in PSCs and BHJ IOSCs, respectively. The enhanced device performance of the HTM‐1‐based PSCs is ascribed to its strong affinity towards the perovskite, properly aligned energy levels with respect to the perovskite valence band, and excellent hole transporting behavior. In addition, the well‐organized energy levels of the HTMs showed excellent compatibility in BHJ IOSCs. The new amphiphilic‐type HTM‐based photovoltaic devices also showed long‐term air stability over 700 h. These promising results offer new and unexpected prospects for engineering the interface between the photoactive material and HTMs in PSCs and BHJ IOSCs.
A new amphiphilic‐type hole transport material HTM‐1 (with internal hydrophilic groups and peripheral hydrophobic alkyl tails) shows better compatibility and performance than the actual target molecule, that is, HTM‐2 and standard HTMs Spiro‐OMeTAD and PEDOT:PSS in perovskite solar cells and bulk heterojunction inverted organic solar cells.
Despite complete interruption of antegrade coronary artery flow in the setting of a chronic total occlusion (CTO), clinical recognition of myocardial infarction is often challenging. Using cardiac ...MRI, we investigated the frequency and extent of myocardial infarction in patients with CTO, and assessed their relationship with regional systolic function and the extent of angiographic collateral flow.
We included 170 consecutive patients (median age, 62 years) with angiographically documented CTO. Regional late gadolinium enhancement and wall motion score index were assessed by cardiac MRI with the use of a 17-segment model. Angiographic collateral flow was assessed by the collateral connection grade and the Rentrop score. Evidence of previous myocardial infarction was found in 25% of patients by ECG Q waves, in 69% by regional wall motion abnormality, and in 86% of patients by late gadolinium enhancement. Increased angiographic collateral flow was associated with a lower frequency of Q waves on ECG, and a lower regional wall motion score index, late gadolinium enhancement volume (%), and degree of late gadolinium enhancement transmurality (all P<0.001), as well.
The frequency of myocardial infarction in territories subtended by CTO is significantly higher than previously recognized. The degree of myocardial injury downstream epicardial CTO is inversely correlated with the degree of angiographic collaterals.
Aim
This study investigated whether prehospital advanced airway management (AAM) is associated with improved survival of out‐of‐hospital cardiac arrest (OHCA) compared with conventional ...bag–valve–mask (BVM) ventilation.
Methods
We investigated the neurologically favorable survival of adult patients with OHCA who underwent BVM or AAM using the Korean Cardiac Arrest Research Consortium (KoCARC), a multicenter OHCA registry of Korea. The differences in clinical characteristics were adjusted by matching or weighting the clinical propensity for use of AAM or by least absolute shrinkage and selection operator (LASSO). The primary outcome was 30‐day survival with neurologically favorable status defined by cerebral performance category 1 or 2.
Results
Of the 9,616 patients enrolled (median age = 71 years; 65% male), there were 6,243 AAM and 3,354 BVM patients. In unadjusted analysis, the 30‐day neurologically favorable survival was lower in the AAM group compared with the BVM group (5.5% vs. 10.0%; hazard ratio HR = 1.21, 95% confidence interval CI = 1.16 to 1.27; all p < 0.001). In propensity score matching–adjusted analysis, these differences were not found (9.6% vs. 10.0%; HR = 0.98, 95% CI = 0.93 to 1.03, p > 0.05). Inverse probability of treatment weighting‐ and LASSO‐adjusted analyses replicated these results.
Conclusions
In this nationwide real‐world data analysis of OHCA, the 30‐day neurologically favorable survival did not differ between prehospital AAM and BVM after adjustment for clinical characteristics.
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