Background
The prognostic nutritional index (PNI) and Charlson comorbidity index (CCI) have been useful for predicting the prognosis based on nutritional condition and comorbidities in surgery and ...endoscopic mucosal dissection. The age-adjusted CCI (ACCI) has also been reported to be useful in surgery, but it has not been applied to endoscopic treatment. We therefore clarified the prognostic factors associated with ampullary tumors treated with endoscopic papillectomy (EP).
Methods
From January 2003 to December 2020, 236 patients who underwent EP for sporadic ampullary tumors at Nagoya University Hospital were included in this study. The 5-year survival and ability to predict the prognosis were evaluated in terms of the sex, PNI, ACCI, final pathological diagnosis, and intraductal extension.
Results
During a median follow-up period of 1558 days, 17 patients died. No patient died of the primary disease. The 5-year survival rate was 91.1%. In a univariate analysis, only a high ACCI (≥ 5) was extracted as a significant prognostic factor (Odds ratio, 12.2; 95% confidence interval, 3.81–39.3;
p
< 0.001). The 5-year survival rates for a low ACCI (≤ 4) and high ACCI were 96.6% and 73.5%, respectively (
p
< 0.001).
Conclusions
A high ACCI is an important prognostic factor associated with the 5-year survival and a risk of death from other illness. Ampullary tumors suitable for EP are less likely to be a prognostic factor, and treatment-free follow-up may be acceptable in patients with a high ACCI.
Abstract
This study aimed to evaluate the feasibility and efficacy of Endoscopic ultrasound elastography-guided fine needle biopsy (EUS-EG-FNB) for the diagnosis of pancreatic mass lesions. EUS-EG ...images were classified into heterogeneous and homogeneous groups. For the heterogeneous group, EUS-FNB was separately performed in both hard areas and soft areas. Only samples obtained during the first two passes (hard/soft areas) were used to compare the diagnostic accuracy as well as the quality and quantity of the specimens. We investigated the association of EUS-EG findings using strain histogram analysis with the histological findings. Fifty-five patients were enrolled including 25 patients with heterogeneous group. The homogeneous group had significantly lower mean strain value (hard) lesions. The adequate sampling rates from hard and soft areas were 88 and 92%, respectively (
P
= 0.6374). Comparison of the diagnostic accuracy and the quality and quantity of the histological core between hard and soft areas showed no significant differences. In pancreatic adenocarcinoma cases, the proportion of fibrous stroma in the core tissue was significantly correlated with the elasticity of the region. (R
2
= 0.1226:
P
= 0.0022) EUS-EG may reflect tissue composition in pancreatic tumors, however, EUS-EG did not affect either the quality and quantity of the tissues obtained.
Clinical Trial Registry No
: UMIN-000033073.
The addition effects of cyclodextrin (CD) and methylated cyclodextrin (Me-CD) on the structure and mechanical properties of PLLA were investigated. Inclusion complexes (IC) of α, β and γ-CD and PLLA ...were prepared. The formation of IC was confirmed from
13
C NMR chemical shifts and the number of peaks for α, β and γ-CD/PLLA IC. 10% of α, β and γ-CD/PLLA IC were mixed with PLLA and formed into films. The tensile test of the obtained films revealed the breaking strain is improved up to 350%. Me-CD was mixed with PLLA and prepared into films. The breaking strain of the films reached up to 250% and the addition effect was largest for Me-γ-CD10. From DSC measurements, one melting peak was observed and the peak moved to lower temperature as the amount of Me-CD increased. These results indicate Me-CD distributes homogeneously in PLLA. Solid state NMR of Me-α, β and γ-CD50 gave broad peaks and the molecular mobility of the mobile component increased. Therefore, Me-α, β and γ-CD do not form IC, but act as the plasticizer for PLLA.
Background/Aims. The usefulness of macroscopic on-site evaluation (MOSE) during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has been reported, but a specific method for MOSE has not ...been established. We aimed to investigate the usefulness of MOSE using a stereomicroscope (S-MOSE) for the diagnosis of solid pancreatic lesions (SPLs). Methods. We reviewed a total of 60 consecutive patients who underwent both S-MOSE and rapid on-site cytopathological evaluation (ROSE) during EUS-FNB between July 2019 and October 2020, and the usefulness of S-MOSE in comparison with histology was evaluated. A 22-gauge Franseen needle was used to perform EUS-FNB in all patients, and only the specimens obtained by the first pass were evaluated. The final diagnosis was based on the surgical specimen or the clinical course consistent with the EUS-FNB results. Results. The final diagnoses of the 60 patients included 45 patients with pancreatic ductal adenocarcinoma, 6 with autoimmune pancreatitis, 4 with mass-forming pancreatitis, 1 with pancreatic metastasis, 2 with pancreatic neuroendocrine tumor, and 2 with intraductal papillary mucinous carcinoma. The histological diagnostic accuracy of the first pass of EUS-FNB was 83.3% (50/60). The agreement between the S-MOSE and the histological diagnosis was 90% (54/60). The positive predictive value of S-MOSE for histological diagnosis was 90.7%, which can be an indicator of when to stop the EUS-FNB procedure. There were no immediate or delayed adverse events reported after the FNB based on the chart and medical visit history review. Conclusion. In the EUS-FNB of SPLs, S-MOSE can be an alternative to ROSE for specimen evaluation and has the potential to shorten the procedure time.
Objectives
Endoscopic submucosal dissection (ESD) in the duodenum is challenging. The water pressure method (WP‐ESD) has been developed with a decreased rate of perforation. However, details of ...perioperative adverse events of WP‐ESD are unknown. The purpose of this study was to clarify the frequency and related factors of fecal incontinence and oral regurgitation during WP‐ESD.
Methods
A chart‐based retrospective analysis was performed on 43 patients who underwent duodenal WP‐ESD. The saline volume given into the body was calculated in all cases. All adverse events during WP‐ESD until 6 weeks were extracted, and factors related to intraoperative fecal incontinence or oral regurgitation were analyzed. The frequency of fecal incontinence and oral regurgitation was also compared to those of 83 conventional ESD cases.
Results
In WP‐ESD, intraoperative fecal incontinence occurred in 12 (28%), oral regurgitation in six (14%), and aspiration pneumonia in one patient. For fecal incontinence, the infusion speed (saline volume divided by resection time) around 17 mL/min was a significant factor in multivariable analysis. For oral regurgitation, only tumor size was a significant factor in univariate analysis (P = 0.027). Significant difference was observed in the frequency of fecal incontinence between WP‐ESD and conventional ESD (28% vs. 0%, P < 0.001), but no difference was observed in oral regurgitation or aspiration pneumonia.
Conclusions
Intraoperative fecal incontinence is a unique adverse event of WP‐ESD related to the infusion speed. WP‐ESD did not pose a risk for oral regurgitation, but we should be aware of the risk in large tumor cases.
Poly(L-lactic acid) (PLLA) is a biodegradable plastic and one of the most famous plastics made from biobased materials. However, its physical strength is insufficient compared to general-purpose ...plastics. In this study, the effect of methylcyclodextrin (MeCD) addition on the structure and physical properties, especially the drawing behavior, of PLLA was investigated. Through thermal analysis, it was found that MeCD addition lowers the crystallinity and enhances the mobility of PLLA. The sample containing approximately 17% MeCD was drawn to more than 1000% at 60 °C, although PLLA fractured at a strain of less than 100%. Differential scanning calorimetry (DSC)-Raman in situ measurements also revealed decreases in the glass transition temperature (T g), cold crystallization temperature (T c), and melting point (T m), and improvement in structural distribution with temperature. DSC-Raman measurements simultaneously supplied information about crystallinity and thermal properties. Thus, it was concluded that MeCD had high affinity for PLLA, and the addition of MeCD increased the amorphous component of PLLA and enhanced the drawability.
Full Monte Carlo (FMC) calculation of dose distribution has been recognized to have superior accuracy, compared with the pencil beam algorithm (PBA). However, since the FMC methods require long ...calculation time, it is difficult to apply them to routine treatment planning at present. In order to improve the situation, a simplified Monte Carlo (SMC) method has been introduced to the dose kernel calculation applicable to dose optimization procedure for the proton pencil beam scanning. We have evaluated accuracy of the SMC calculation by comparing a result of the dose kernel calculation using the SMC method with that using the FMC method in an inhomogeneous phantom. The dose distribution obtained by the SMC method was in good agreement with that obtained by the FMC method. To assess the usefulness of SMC calculation in clinical situations, we have compared results of the dose calculation using the SMC with those using the PBA method for three clinical cases of tumor treatment. The dose distributions calculated with the PBA dose kernels appear to be homogeneous in the planning target volumes (PTVs). In practice, the dose distributions calculated with the SMC dose kernels with the spot weights optimized with the PBA method show largely inhomogeneous dose distributions in the PTVs, while those with the spot weights optimized with the SMC method have moderately homogeneous distributions in the PTVs. Calculation using the SMC method is faster than that using the GEANT4 by three orders of magnitude. In addition, the graphic processing unit (GPU) boosts the calculation speed by 13 times for the treatment planning using the SMC method. Thence, the SMC method will be applicable to routine clinical treatment planning for reproduction of the complex dose distribution more accurately than the PBA method in a reasonably short time by use of the GPU‐based calculation engine.
PACS number(s): 87.55.Gh
Non-wetting behavior of liquid Zn alloy sometimes occurs on high-tensile strength steels that usually contain Si and Mn. Many studies have been undertaken to improve the wettability of liquid Zn. In ...this work, we applied the sessile drop method to measure the change in contact angle and diameter of liquid Zn droplets wetted on steels containing Si and Mn with time. We could then quantitatively evaluate the wettability of those steels using liquid Zn. Si weakens the work of adhesion and spreading velocity of liquid Zn on steels. Mn, however, has a small effect on the contact angle and the work of adhesion but occasionally increases the spreading velocity even when Si content is high in steels.
Since it has been pointed out that liquid Zn alloy sometimes exhibits non-wetting behavior on high-tensile strength steels usually containing Si and Mn, there have been several studies to improve the ...wettability of liquid Zn. Although those studies evaluated the wettability qualitatively by observation of the surface of galvanized steels or exfoliation testing of Zn on steel substrates, it is further required to evaluate the wettability of liquid Zn on steels by measuring the contact angle, work of adhesion, spreading velocity etc. which are usually used to assess the general wetting behavior. In the present work, we applied a sessile drop method to measure the change in contact angle and diameter of liquid Zn droplets wetted on steels containing Si and Mn with time to evaluate quantitatively the dynamic wetting behavior of liquid Zn on steel substrates.
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