Adjuvant Radiofrequency Ablation Along With Stenting Versus Stenting Alone for Biliary Tree Drainage in Patients With Malignant Biliary Strictures: A Systemic Review and Meta-analysis.

OBJECTIVE: This metanalysis aims to assess the efficacy and safety of biliary stenting along with radiofrequency ablation compared with stents alone to treat malignant biliary obstruction (MBO) due to extrahepatic biliary strictures secondary to cholangiocarcinoma, pancreatic cancer, and metastatic cancer. METHODS: A systemic search of major databases through April 2022 was done. All original studies were included comparing radiofrequency ablation with stenting versus stenting alone for treating malignant biliary strictures. The primary outcomes of interest were the difference in the mean stent patency and overall survival (OS) days between the 2 groups. The secondary outcome was to compare the adverse events of the 2 groups. The mean difference in the stent patency and OS days was pooled by using a random-effect model. We calculated the odds ratio to compare the adverse events between the 2 groups. RESULTS: A total of 13 studies with 1339 patients were identified. The pooled weighted mean difference in stent patency was 43.50 days (95% CI, 25.60-61.41), favoring the RFA plus stenting. Moreover, the pooled weighted mean difference in OS was 90.53 days (95% CI, 49.00-132.07), showing improved survival in the RFA group. Our analysis showed no statistically significant difference in adverse events between the 2 groups OR 1.13 (95% CI, 0.90-1.42). CONCLUSION: Our analysis showed that RFA, along with stent, is safe and is associated with improved stent patency and overall patient survival in malignant biliary strictures. More robust prospective studies should assess this association further.

Vibrationally resolved two-photon electronic spectra including vibrational pre-excitation: Theory and application to VIPER spectroscopy with two-photon excitation.

Following up on our previous work on vibrationally resolved electronic absorption spectra including the effect of vibrational pre-excitation [von Cosel et al., J. Chem. Phys. 147, 164116 (2017)], we present a combined theoretical and experimental study of two-photon-induced vibronic transitions in polyatomic molecules that are probed in the VIbrationally Promoted Electronic Resonance experiment using two-photon excitation (2P-VIPER). In order to compute vibronic spectra, we employ time-independent and time-dependent methods based on the evaluation of Franck-Condon overlap integrals and Fourier transformations of time-domain correlation functions, respectively. The time-independent approach uses a generalized version of the FCclasses method, while the time-dependent approach relies on the analytical evaluation of Gaussian moments within the harmonic approximation, including Duschinsky rotation effects. For the Coumarin 6 dye, two-dimensional 2P-VIPER experiments involving excitation to the lowest-lying singlet excited state (S1) are presented and compared with corresponding one-photon VIPER spectra. In both cases, coumarin ring modes and a CO stretch mode show VIPER activity, albeit with different relative intensities. Selective pre-excitation of these modes leads to a pronounced redshift of the low-frequency edge of the electronic absorption spectrum, which is a prerequisite for the VIPER experiment. Theoretical analysis underscores the role of interference between Franck-Condon and Herzberg-Teller effects in the two-photon experiment, which is at the root of the observed intensity distribution.

Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients With Liver Cirrhosis: Analysis of Trends and Outcomes From the National Inpatient Sample Database.

GOALS: We aimed to assess outcomes of patients with liver cirrhosis who underwent therapeutic or diagnostic endoscopic retrograde cholangiopancreatography (ERCP) to determine whether these patients had different outcomes relative to patients without cirrhosis. BACKGROUND: ERCP is an important procedure for treatment of biliary and pancreatic disease. However, ERCP is relatively technically difficult to perform when compared with procedures such as esophagogastroduodenoscopy or colonoscopy. Little is known about how ERCP use affects patients with liver cirrhosis. STUDY: Using patient records from the National Inpatient Sample (NIS) database, we identified adult patients who underwent ERCP between 2009 and 2014 using International Classification of Disease, Ninth Revision coding and stratified data into 2 groups: patients with liver cirrhosis and those without liver cirrhosis. We compared baseline characteristics and multiple outcomes between groups and compared outcomes of diagnostic versus therapeutic ERCP in patients with cirrhosis. A multivariate regression model was used to estimate the association of cirrhosis with ERCP outcomes. RESULTS: A total of 1,038,258 hospitalizations of patients who underwent ERCP between 2009 and 2014 were identified, of which 31,294 had cirrhosis and 994,681 did not have cirrhosis. Of the patients with cirrhosis, 21,835 (69.8%) received therapeutic ERCP and 9459 (30.2%) received diagnostic ERCP. Patients with cirrhosis had more ERCP-associated hemorrhages (2.5% vs. 1.2%; P <0.0001) compared with noncirrhosis patients but had lower incidence of perforations (0.1% vs. 0.2%; P <0.0001) and post-ERCP pancreatitis (8.6% vs. 7%; P <0.0001). Cholecystitis was the same between groups (2.3% vs. 2.3%; P <0.0001). In patients with cirrhosis, those who received therapeutic ERCP had higher post-ERCP pancreatitis (7.9% vs. 5.1%; P <0.0001) and ERCP-associated hemorrhage (2.7% vs. 2.1%; P <0.0001) but lower incidences of perforation and cholecystitis (0.1% vs. 0.3%; P <0.0001) and cholecystitis (1.9 vs. 3.1%; P <0.0001) compared with those who received diagnostic ERCP. CONCLUSIONS: Use of therapeutic ERCP in patients with liver cirrhosis may lead to higher risk of complications such as pancreatitis and postprocedure hemorrhage, whereas diagnostic ERCP may increase the risk of pancreatitis and cholecystitis in patients with cirrhosis. Comorbidities in cirrhosis patients may increase the risk of post-ERCP complications and mortality; therefore, use of ERCP in cirrhosis patients should be carefully considered, and further studies on this patient population are needed.

A Triplet Label Extends Two-Dimensional Infrared Spectroscopy from Pico- to Microseconds.

In conventional two-dimensional infrared (2D-IR) spectroscopy, the inherently short vibrational lifetimes limit the time window to observe molecular dynamics typically to tens of picoseconds. The rather complex dynamics of organized molecular systems (e.g., glass formers, polymers, membranes, proteins), however, span a wide range of timescales from femto- to microseconds and beyond. Vibrationally Promoted Electronic Resonance (VIPER) 2D-IR negates the limitations of 2D-IR spectroscopy, for its signal decays with the electronic lifetime. Here, we present 2-Isopropylthioxanthone as the first VIPER 2D-IR probe to exploit intersystem crossing, thereby covering even the microsecond timescale. We achieved the required signal-to-noise ratio and resolution by introducing the Fourier-transform approach to the VIPER 2D-IR pulse sequence. Now, we are in a position to monitor dynamics via spectral diffusion several orders of magnitude beyond the vibrational lifetime of 2D-IR labels.

Tensile response of Ultra High Performance PE Fiber Reinforced Concretes (PE-UHPFRC) under imposed shrinkage deformations.

PE-UHPFRC is a new Ultra High-Performance Fiber Reinforced Concrete (UHPFRC), which is developed to reduce the environmental impact of conventional UHPFRC by replacing the steel fibers with synthetic ones and reducing the clinker content in the mix. The development of the dynamic elastic modulus, the evolution of free autogenous deformations and the eigenstresses development with age, under full and partial restraint conditions, were investigated for PE-UHPFRC and the results were put into perspective with that for conventional UHPFRC with steel fibers. Furthermore, the tensile responses of different mixes under imposed shrinkage were compared and discussed. The results showed a shorter setting time and consequently an earlier initiation of elastic modulus development for PE-UHPFRC compared with that of conventional UHPFRC. Furthermore, the developed eigenstresses under full restraint conditions in a PE-UHPFRC layer compared with that for conventional UHPFRC were reduced by more than 70%, which is highly beneficial especially for cast-in-place rehabilitation applications.

Minor criteria for atopic dermatitis in children.

Atopic dermatitis (AD) is a common pruritic, eczematous skin disorder that runs a chronic and relapsing course. Major and minor criteria exist as guideline for arriving at a diagnosis of AD. Minor features vary with ethnicity and genetic background and can be used to aid diagnosis. A descriptive study was conducted including 210 patients of 1-12 years age who had concurrent or past history of AD according to criteria of Hanifin and Rajka. This study was conducted in the department of Dermatology of three different Hospitals of Bangladesh. Out of 33 sub-criteria of Hanifin and Rajka, 20 of which were examined encompassed tendency towards cutaneous infection, environmental factor, high IgE level, intolerance of wool, xerosis, infra-orbital fold, ichthyosis, early age of onset, itch on sweating, palmer hyperlinearity, food hypersensitivity, keratosis pilaris, pityriasis alba, facial erythema, cheilitis, hand eczema, foot eczema, intolerance of lipid solvent, scalp scaling and infra-auricular fissure. Out of 20 examined minor criteria, most common was cutaneous infection in 168(80.0%) patients followed by coursed influenced by environmental factor in 140(66.7%), high IgE level in 126(60.0%), intolerance of wool in 105(50.0%), xerosis in 92(43.8%), infra-orbital fold in 83(39.5%), ichthyosis in 72(34.3%), early age of onset in 65(31.0%), itch on sweating in 56(26.7%), palmary hyperlinearity in 52(24.8%), food hypersensitivity in 40(19.0%), keratosis pilaris in 31(14.8%), pityriasis alba in 30(14.3%), facial erythema in 25(1.9%), cheilitis in 22(10.5%), hand eczema in 19(9.0%), foot eczema in 16(7.6%), intolerance of lipid solvent in 14(6.7% ), scalp scaling in 11(5.2%) and infra-auricular fissure in 10(4.8%). These features were present singly or in combination. The result evidenced that minor criteria are many a times important for the diagnosis where major criteria are uncertain.

Efficient Excitation of Micro/Nano Resonators and Their Higher Order Modes.

We demonstrate a simple and flexible technique to efficiently activate micro/nano-electromechanical systems (MEMS/NEMS) resonators at their fundamental and higher order vibration modes. The method is based on the utilization of the amplified voltage across an inductor, L, of an LC tank resonant circuit to actuate the MEMS/NEMS resonator. By matching the electrical and mechanical resonances, significant amplitude amplification is reported across the resonators terminals. We show experimentally amplitude amplification up to twelve times, which is demonstrated to efficiently excite several vibration modes of a microplate MEMS resonator and the fundamental mode of a NEMS resonator.

Neutron capture cross-section measurement for the 186W(n,gamma)187W reaction at 0.0536eV energy.

The thermal neutron-induced activation cross section for the (186)W(n,gamma)(187)W reaction was measured at 0.0536eV neutron energy using TRIGA Mark-II research reactor, Atomic Energy Research Establishment, Savar, Dhaka, Bangladesh. The (197)Au(n,gamma)(198)Au monitor reaction induced in a high-purity gold foil was used to determine the effective neutron beam intensity. The activities induced in sample and monitor foils were measured nondestructively by a high-resolution HPGe gamma-ray detector. The present experimental cross-section value is the first one at 0.0536eV. The obtained new cross section that amounts to 26.6+/-1.6b is 2% higher than the recently reported data in ENDF/B-VII and 5% lower than that of JENDL-3.3.

Prevalence and characterization of Trypanosoma species from livestock of Cholistan desert of Pakistan.

Trypanosomiasis is one of the most pathogenic infection of livestock caused by several Trypanosoma species. The current study aims to determine the current prevalence of trypanosomiasis in livestock of Cholistan desert, Pakistan by molecular characterization. A total 272 animals, 61 camels, 59 cattle, 50 goats, 50 sheep and 52 donkeys that were bled and processed for thin smear microscopy, packed cell volume (PCV), DNA extraction, PCR, formol gel test and for cryo preservation. For diagnosis and molecular characterization, three sets of primers including TBR, RoTat 1.2, TRYP4 were used which detect their targets including repeated satellite DNA region, variant surface glycoprotein (VSG) gene and the ITS ribosomal DNA sequence of microbe. According to results, 6.2% animals were positive by microscopy, 51.1% by formol gel, 54.7% by PCV and 36.7% by PCR. The results of this study support the idea that PCR is a sensitive, robustic and reliable technique to diagnose trypanosomiasis and it should be added in conventional setup along with microscopy to avoid false negative and positive results. The PCR based order of prevalence of trypanosomiasis in Cholistani livestock was sheeps>camels>donkeys>goats>cattle. Similary, on the basis of thin smear microscopy the prevalence of trypanosomiasis was donkeys>camels>sheep>goats>cattle. It was observed that Trypanosoma evansi is the most prevalent specie involved in trypanosomiasis in Cholistani livestock.

Microelectromechanical reprogrammable logic device.

In modern computing, the Boolean logic operations are set by interconnect schemes between the transistors. As the miniaturization in the component level to enhance the computational power is rapidly approaching physical limits, alternative computing methods are vigorously pursued. One of the desired aspects in the future computing approaches is the provision for hardware reconfigurability at run time to allow enhanced functionality. Here we demonstrate a reprogrammable logic device based on the electrothermal frequency modulation scheme of a single microelectromechanical resonator, capable of performing all the fundamental 2-bit logic functions as well as n-bit logic operations. Logic functions are performed by actively tuning the linear resonance frequency of the resonator operated at room temperature and under modest vacuum conditions, reprogrammable by the a.c.-driving frequency. The device is fabricated using complementary metal oxide semiconductor compatible mass fabrication process, suitable for on-chip integration, and promises an alternative electromechanical computing scheme.

Anti-HIV activity of a glycoprotein from first trimester placental tissue.

Human Immunodeficiency Virus-1 (HIV-1) transmission from a mother to the offspring during pregnancy is highly complex and a variable process in part due to the presence of several anti-HIV factors. In this study, we report an early pregnancy-associated protein (early pregnancy associated protein-1, Epap-1) with an apparent molecular weight of 90 kDa in placental tissue of pregnant women during the first trimester. Epap-1 was isolated and purified using Sambucus nigra agarose lectin affinity chromatography. Epap-1 strongly inhibits HIV-1(MN), HIV-1(91US056), HIV-1(VB-7) replication in vitro while it exhibits low activity with HIV-1(VB-66) strain. The molecular analysis of action of Epap-1 shows that it affects HIV-CD4 binding through inhibition of CD4-gp120 interaction.

Multicentric ovarian and extraovarian cystadenofibroma.

A case of multicentric ovarian and diffuse pelvic cystadenofibroma is described. Despite multicentricity, the histologic findings are completely benign. Electron microscopy was performed and possible mesothelial origin is discussed.

Carcinoma of the uterine cervix resembling lymphoepithelioma.

A case of cervical carcinoma with marked lymphocytic infiltration is described. The tumor is histologically similar to lymphoepithelioma of the nasopharyngeal region or medullary carcinoma of the breast. This tumor may have a favorable prognosis. Only two Japanese groups have reported this tumor as a distinctive entity. One such case is reported herein.

Adenocarcinoma arising in female urethral diverticulum.

Cancer arising from a female urethral diverticulum is rare, and because of its rarity, a review of the medical literature reveals significant nonuniformity in its management. We report an additional 2 cases of this disease, one of which has an even rarer feature of being mucin-producing. The management of our 2 cases is presented in detail and in line with the management of female urethral cancer. From our extensive literature search, diverticulectomy alone showed poor results with the highest rate of recurrence (67%). Extensive surgery, either in the form of cystourethrectomy or anterior exenteration, offered results comparable with those of combined therapy (diverticulectomy and full course of irradiation for early cases; preoperative irradiation followed by cystourethrectomy for late cases). Individualization of radiation treatment and cooperative effort between urologist and radiation oncologist are essential if best results are to be achieved.

Cholesterol granuloma of the petrous apex and sphenoidal sinus: a case report.

A case of a cholesterol granuloma located in the petrous apex and eroding into the sphenoidal sinus is reported. Cholesterol granuloma is thought to occur when pneumatized cells in the temporal bone become obstructed. Although usually occurring in the middle ear, it can occur in the petrous apex. The diagnosis and surgical management are discussed.

Fine-needle aspiration diagnosis of extragonadal choriocarcinoma with immunoperoxidase studies.

A case of extragonadal choriocarcinoma in a 30-yr-old man was diagnosed by fine-needle aspiration (FNA) biopsy with immunoperoxidase studies. FNA diagnosis in this case resulted in prompt treatment of rapidly growing metastases without the need for an invasive diagnostic procedure.

Cytomorphologic changes in split-course radiation-treated bronchogenic carcinomas.

The cellular changes produced by radiation therapy were studied in cytologic specimens from seven patients with bronchogenic carcinoma: squamous-cell carcinoma (four patients), adenocarcinoma (two patients), and small-cell undifferentiated carcinoma (one patient). Cytologic samples were obtained from sputum and bronchoscopic examination in patients before and after they received a course of radiation. The cells were studied by light microscopy. An increase in the percentage of columnar cells was detected in five of seven patients independent of the latency of cytologic sampling posttherapy. The percentage of macrophages was unchanged in patients sampled at 15, 18, and 24 mo after the last radiation dose; leukocytes were decreased in relative frequency in the majority of patients studied. Following irradiation, moderately atypical and severely atypical metaplastic cells were increased in relative frequency (48% versus 15% and 19% versus 3%, respectively) and malignant cells were decreased (40% versus 22%) or absent in all patients, irrespective of the type of carcinoma. Nuclear vacuolation, nuclear enlargement, loss of chromatin texture, and rupture of the chromatinic rim were seen in atypical and cancer cells. Infiltration of cancer cells by leukocytes was observed in two of four patients with squamous-cell carcinoma. In all treated patients, morphologic observations indicated that irradiation produces similar damage to "normal" bronchial epithelial cells although such changes are less apparent at longer time intervals following therapy.

Cytologic diagnosis of seminoma metastatic to the central nervous system. A case report.

Seminoma cells detected in the cerebrospinal fluid of a patient who had a seminoma of the testis with widespread metastases are described.

Fine needle aspiration diagnosis of benign metastasizing leiomyoma of the lung. A case report.

Percutaneous fine needle aspiration biopsy was performed on a woman with multiple bilateral lung nodules. The cytology and histology showed a benign spindle cell tumor compatible with benign metastasizing leiomyoma. The patient had a history of hysterectomy 14 years earlier for a cellular leiomyoma with atypia. No significant mitosis was present in either the uterine tumor or lung metastasis.

Fine needle aspiration in stromal sarcoma of the breast. Light and electron microscopic findings with histologic correlation.

Stromal sarcoma of the breast, according to current concepts, is a rare lesion arising from the stroma surrounding the ductal epithelium. A case of this neoplasm is reported, with light and electron microscopic findings in fine needle aspirates and correlation with histologic findings. The findings, similar to those previously reported for stromal sarcoma of the breast, included a less-pleomorphic morphologic picture than is seen in malignant fibrous histiocytoma, but a more primitive ultrastructural appearance.