Background
Peroral endoscopic myotomy (POEM) is a novel, minimally invasive treatment for esophageal achalasia. We retrospectively examined and evaluated the results following POEM to verify the ...technique’s efficacy and safety.
Methods
We retrospectively analyzed data for patients who underwent POEM at eight Japanese facilities between September 2008 and October 2015. Pre- and postoperative assessments 3 months and 1 year after POEM included patient interviews, endoscopy, and manometry.
Results
A total of 1346 patients underwent POEM during the study period. Achalasia was the straight type in 1105 patients (82%) and the sigmoid type in 241 patients (18%). The average patient age was 47.2 years (range 3–95 years); 617 patients (46%) were men and 729 (54%) were women. Previous treatment included balloon dilatation in 381 patients (28%) and Heller–Dor operation in 43 patients (3%). The average operation time was 99.6 min. The mean length of the myotomy in the esophageal body was 10.8 cm, and the myotomy extended into the stomach a mean of 2.8 cm. The response rate (Eckardt score ≤ 3) was 95.1% 3 months postoperatively and 94.7% 1 year postoperatively. We noted 50 adverse events (3.7%) of Clavien–Dindo classification grade ≤ IIIa, and all resolved with conservative treatment. There were no Clavien–Dindo classification grade ≥ IIIb adverse events. After POEM, erosive esophagitis according to the Los Angeles classification was absent in 37% of the patients, grade A in 33%, B in 24%, C in 6%, and D in 0.2%. Symptomatic gastroesophageal reflux disease after POEM was confirmed in 14.8% of the patients; both erosive esophagitis and symptomatic gastroesophageal reflux disease responded to treatment with a proton-pump inhibitor.
Conclusion
Our results confirmed the safety and efficacy of POEM in a large patient series and support POEM as the first-line and standard treatment for esophageal achalasia.
For several decades, hydroxyl function containing polymer surfaces have been modified using isocyanate primers to improve the adhesion properties. In this study, sum frequency generation spectroscopy ...was applied to study epoxy polymer/isocyanate solution interfaces, confirming the presence of chemical bonds at the joining interfaces.
Sum frequency generation spectroscopy was applied to confirm the presence of a chemical bond at the joining interfaces, suggesting that MDI primers can serve as a chemical bridge for urethane adhesives.
Per-Oral Endoscopic Myotomy: A Series of 500 Patients Inoue, Haruhiro, MD, PhD; Sato, Hiroki, MD, PhD; Ikeda, Haruo, MD ...
Journal of the American College of Surgeons,
08/2015, Letnik:
221, Številka:
2
Journal Article
Recenzirano
Background After the first case of per-oral endoscopic myotomy (POEM) at our institution in 2008, the procedure was quickly accepted as an alternative to surgical myotomy and is now established as an ...excellent treatment option for achalasia. This study aimed to examine the safety and outcomes of POEM at our institution. Study Design Per-oral endoscopic myotomy was performed on 500 consecutive achalasia patients at our institution between September 2008 and November 2013. A review of prospectively collected data was conducted, including procedure time, myotomy location and length, adverse events, and patient data with short- (2 months) and long-term (1 and 3 years) follow-up. Results Per-oral endoscopic myotomy was successfully completed in all patients, with adverse events observed in 3.2%. Two months post-POEM, significant reductions in symptom scores (Eckardt score 6.0 ± 3.0 vs 1.0 ± 2.0, p < 0.0001) and lower esophageal sphincter (LES) pressures (25.4 ± 17.1 vs 13.4 ± 5.9 mmHg, p < 0.0001) were achieved, and this persisted at 3 years post-POEM. Gastroesophageal reflux was seen in 16.8% of patients at 2 months and 21.3% at 3-year follow-up. Conclusions Per-oral endoscopic myotomy was successfully completed in all cases, even when extended indications (extremes of age, previous interventions, or sigmoid esophagus) were used. Adverse events were rare (3.2%), and there were no mortalities. Significant improvements in Eckardt scores and LES pressures were seen at 2 months, 1 year, and 3 years post-POEM. Based on our large series, POEM is a safe and effective treatment for achalasia; there are relatively few contraindications, and the procedure may be used as either first- or second-line therapy.
Studying multiple properties of a material concurrently is essential for obtaining a comprehensive understanding of its behavior and performance. However, this approach presents certain challenges. ...For instance, simultaneous examination of various properties often necessitates extensive experimental resources, thereby increasing the overall cost and time required for research. Furthermore, the pursuit of desirable properties for one application may conflict with those needed for another, leading to trade-off scenarios. In this study, we focused on investigating adhesive joint strength and elastic modulus, both crucial properties directly impacting adhesive behavior. To determine elastic modulus, we employed a non-destructive indentation method for converting hardness measurements. Additionally, we introduced a specimen apparatus preparation method to ensure the fabrication of smooth surfaces and homogeneous polymeric specimens, free from voids and bubbles. Our experiments utilized a commercially available bisphenol A-based epoxy resin in combination with a Poly(propylene glycol) curing agent. We generated an initial dataset comprising experimental results from 32 conditions, which served as input for training a machine learning model. Subsequently, we used this model to predict outcomes for a total of 256 conditions. To address the high deviation in prediction results, we implemented active learning approaches, achieving a 50% reduction in deviation while maintaining model accuracy. Through our analysis, we observed a trade-off boundary (Pareto frontier line) between adhesive joint strength and elastic modulus. Leveraging Bayesian optimization, we successfully identified experimental conditions that surpassed this boundary, yielding an adhesive joint strength of 25.2 MPa and an elastic modulus of 182.5 MPa.
With an increasing demand for adhesives, the durability of joints has become highly important. The fatigue resistance of adhesives has been investigated mainly for epoxies, but in recent years many ...other resins have been adopted for structural adhesives. Therefore, understanding the fatigue characteristics of these resins is also important. In this study, the cyclic fatigue behavior of a two-part acrylic-based adhesive used for structural bonding was investigated using a fracture-mechanics approach. Fatigue tests for mode I loading were conducted under displacement control using double cantilever beam specimens with varying bond-line thicknesses. When the fatigue crack growth rate per cycle,
/
, reached 10
mm/cycle, the fatigue toughness reduced to 1/10 of the critical fracture energy. In addition, significant changes in the characteristics of fatigue crack growth were observed varying the bond-line thickness and loading conditions. However, the predominance of the adhesive thickness on the fatigue crack growth resistance was confirmed regardless of the initial loading conditions. The thicker the adhesive bond line, the greater the fatigue toughness.
Background
Achalasia has been reported to be associated with esophageal cancers (ECs). However, owing to the rarity of achalasia, details of achalasia-related ECs are not well investigated.
Method
...The incidence of ECs in Japanese patients with achalasia and achalasia-related esophageal motility disorders (EMDs) was estimated, and risk factors for achalasia-related ECs were determined. Characteristics of ECs and treatment courses were also analyzed.
Results
Between 2010 and 2019, 2714 Japanese patients with achalasia and achalasia-related EMDs were recorded in 7 high-volume centers; 24 patients (21 men, 3 women) developed ECs. The incidence of ECs was estimated at 0.078 and 0.28 per 100 person-years from the onset and the diagnosis of disease, respectively. Kaplan–Meier estimate suggested that, in addition to a long history of achalasia, advanced age, male sex, and regular alcohol consumption were statistically significant risk factors for EC development. A prevalence of 40 ECs (12.5% multiple lesions, and 22.7% metachronal lesions) was also noted, predominantly distributed over the thoracic esophagus. All were histologically diagnosed as squamous cell carcinoma. Superficial ECs were successfully treated with endoscopic treatment in all cases, except one. Achalasia-related Barret esophagus was extremely rare, and Barret adenocarcinoma was not detected in our cohort.
Conclusion
The high relative risk of ECs was clarified in Japanese achalasia patients, although the absolute risk remained low. Therefore, surveillance endoscopy may be recommended in limited patients with several aforementioned risk factors determined. Superficial cancer can be treated with endoscopic treatment. Multiple and metachronal ECs should be screened.
Adhesives used in aircrafts degrade because of moisture. To understand the fractures at the adhesive interface, moisture diffusion coefficients must be estimated, which is challenging and has not yet ...been reported. In this study, we prepared double cantilever beam specimens using an aluminum adherend and epoxy adhesives, immersed them in a hot bath, and observed the resultant fracture surfaces. The distance of moisture penetration at the interface was estimated from the fracture morphology, and the diffusion coefficient for moisture penetration into the adhesive was measured using a bulk immersion test. Both these values were used to determine the moisture diffusion coefficient at the adhesive interface, which was ∼3 times higher than that of the bulk. The relationship between immersion temperature and moisture diffusion coefficient of the adhesive interface adhered to the Arrhenius equation, as same as that of bulk.
•Fracture surfaces of immersed DCB shows interfacial fracture at the edge owing to moisture intrusion.•The moisture diffusion coefficient on the adhesive interface was calculated from the observation of the fracture surface.•The moisture diffusion coefficient at the adhesive interface, which was ∼3 times higher than that of the bulk.•The activation energy for moisture diffusion in the adhesive interface and the bulk was the same.•The effect of surface treatment on the water diffusion coefficient of the adhesive interface in the adherend was unclear.
Introduction
Although teriparatide (TPTD) and exercise may improve osteoporosis, muscle atrophy, and fat metabolism during ageing, the effects of treatment with a combination of TPTD and exercise on ...these factors remain unclear. Therefore, this study examined the effects of TPTD and exercise on bone, skeletal muscle, and fat in ovariectomized and tail-suspended rats.
Materials and methods
Seven-month-old female Wistar rats were ovariectomized and subjected to tail suspension. The rats were then randomized into one of the following four groups (n = 20/group) after 4 weeks: control group, treated with TPTD vehicle and no exercise; TPTD group (30 µg/kg TPTD, 3 days/week); Exercise group (treadmill at 12 m/min, 60 min/day, 5 days/week); and Combined group treated with TPTD and treadmill exercise. After 1 and 8 weeks of treatment, bone, skeletal muscle, and fat tissue parameters were evaluated.
Results
TPTD improved bone mineral density (BMD), bone structure, bone strength at the femoral metaphysis, and the percentage of skeletal muscle mass, and decreased the percentage of fat mass and the adipose volume in the bone marrow. Treadmill exercise increased BMD, bone strength of cancellous bone, and the percentage of skeletal muscle mass, and decreased the percentage of fat mass as seen on dual-energy X-ray absorptiometry. Furthermore, combined treatment significantly affected BMD, bone structure, and bone strength of cortical bone at the femoral diaphysis.
Conclusion
TPTD or treadmill exercise improved bone, skeletal muscle, and fat mass. Combination therapy with TPTD and exercise had synergistic effects on BMD, structure, and bone strength in ovariectomized, tail-suspended rats.
To evaluate the long-term efficacy and factors involved in the recurrence and persistence of subretinal fluid (SRF) after half-dose photodynamic therapy (PDT) for chronic central serous ...chorioretinopathy (CSC).
In this retrospective observational case series, 79 eyes (73 patients) with chronic CSC were treated with half-dose PDT and followed up for at least 3 years. They were divided into successful (64 eyes) and unsuccessful (15 eyes) groups based on SRF absorption and disease recurrence after one PDT session. Age, best-corrected visual acuity (BCVA), central foveal thickness, neuroretinal thickness, height of SRF, subfoveal choroidal thickness, window defect area detected by fluorescein angiography, and PDT spot area were compared between the groups. Factors associated with PDT success and BCVA at 3 years were investigated.
LogMAR BCVA improved from 0.21±0.24 to 0.08±0.16 (P<0.001) at 3 years after PDT. Compared with the unsuccessful group, the successful group had a significantly younger mean age (50.5±9.7 vs. 56.5±9.1 years, P = 0.032) and better baseline BCVA (0.18±0.23 vs. 0.32±0.25, P = 0.034). Other parameters were not significantly different. Multivariate analyses showed that unsuccessful PDT was significantly associated with lower baseline BCVA (P = 0.026) and older age (P = 0.029) and that BCVA at 3 years after PDT was positively associated with baseline BCVA (P<0.001).
Half-dose PDT has a long-term efficacy in chronic CSC. Relatively early PDT may improve anatomic and functional outcomes of chronic CSC.
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