Validation of Diagnostic Thresholds for Compensated Advanced Chronic Liver Disease Using Supersonic Shear Imaging.

Background The Society of Radiologists in Ultrasound (SRU) has proposed thresholds for acoustic radiation force impulse techniques to diagnose compensated advanced chronic liver disease (cACLD). However, the diagnostic performance of these thresholds has not been extensively validated. Purpose To validate the SRU thresholds in patients with chronic liver disease who underwent supersonic shear imaging and, if suboptimal diagnostic performance is observed, to identify optimal values for diagnosing cACLD. Materials and Methods This retrospective single-center study included high-risk patients with chronic liver disease who had liver stiffness (LS) measurements and had undergone endoscopy or liver biopsy between January 2018 and December 2021. Patients were randomly allocated to test and validation sets. cACLD was defined as varices at endoscopy and/or severe fibrosis or cirrhosis at liver biopsy. The diagnostic performance of the SRU guidelines was evaluated, and optimal threshold values were identified using receiver operating characteristic (ROC) curve analysis. Results A total of 1180 patients (median age, 57 years [IQR, 50-64 years]; 761 men), of whom 544 (46%) had cACLD, were included. With the SRU recommended thresholds of less than 9 kPa and greater than 13 kPa in the test set (n = 786), the sensitivity and specificity for ruling out and ruling in cACLD were 81% (303 of 374 patients; 95% CI: 77, 85) and 92% (380 of 412 patients; 95% CI: 89, 94), respectively. In ROC curve analysis, the identified optimal threshold values were less than 7 kPa and greater than 12 kPa, showing 91% sensitivity (340 of 374 patients; 95% CI: 88, 93) for ruling out cACLD and 91% specificity (373 of 412 patients; 95% CI: 87, 93) for ruling in cACLD, respectively. In the validation set (n = 394), the optimal thresholds showed 91% sensitivity (155 of 170 patients; 95% CI: 86, 95) and 92% specificity (206 of 224 patients; 95% CI: 88, 95). Conclusion Compared with the SRU guidelines, the dual LS threshold values of less than 7 kPa and greater than 12 kPa were better for diagnosing cACLD. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Barr in this issue.

Impact of nonalcoholic fatty liver disease on the risk of gallbladder polyps in lean and non-obese individuals: A cohort study.

BACKGROUND: The association between non-obese or lean nonalcoholic fatty liver disease (NAFLD) and gallbladder polyps (GBPs) has not yet been evaluated. We aimed to determine whether NAFLD is an independent risk factor for the development of GBPs, even in non-obese and lean individuals. METHODS: We analyzed a cohort of 331 208 asymptomatic adults who underwent abdominal ultrasonography (US). The risk of GBP development was evaluated according to the obesity and NAFLD status. RESULTS: The overall prevalence of NAFLD and GBPs ≥ 5 mm was 28.5% and 2.9%, respectively. The prevalence of NAFLD among 160 276 lean, 77 676 overweight and 93 256 obese participants was 8.2%, 31.2%, and 61.1%, respectively. Individuals with NAFLD had a significantly higher incidence of GBPs with a size of ≥ 5 mm [adjusted odds ratio (OR) = 1.18; 95% confidence interval (CI): 1.11-1.25]. A higher body mass index and its categories were also significantly associated with an increased risk of GBPs ≥ 5 mm. Moreover, risk of GBPs ≥ 5 mm was significantly increased even in NAFLD individuals who are not obese (lean: adjusted OR = 1.36, 95% CI: 1.19-1.54; overweight: adjusted OR = 1.14, 95% CI: 1.03-1.26, respectively). CONCLUSIONS: Non-obese/lean NAFLD is an independent risk factor for GBP development, suggesting that NAFLD may play an important role in the pathogenesis of GBPs regardless of the obesity status. Therefore, a more thorough evaluation for GBPs may be necessary when hepatic steatosis is detected on abdominal US, even in non-obese or lean individuals.

Enhancement of Electromagnetic Wave Shielding Effectiveness by the Incorporation of Carbon Nanofibers-Carbon Microcoils Hybrid into Commercial Carbon Paste for Heating Films.

Carbon microcoils (CMCs) were formed on stainless steel substrates using C2H2 + SF6 gas flows in a thermal chemical vapor deposition (CVD) system. The manipulation of the SF6 gas flow rate and the SF6 gas flow injection time was carried out to obtain controllable CMC geometries. The change in CMC geometry, especially CMC diameter as a function of SF6 gas flow injection time, was remarkable. In addition, the incorporation of H2 gas into the C2H2 + SF6 gas flow system with cyclic SF6 gas flow caused the formation of the hybrid of carbon nanofibers-carbon microcoils (CNFs-CMCs). The hybrid of CNFs-CMCs was composed of numerous small-sized CNFs, which formed on the CMCs surfaces. The electromagnetic wave shielding effectiveness (SE) of the heating film, made by the hybrids of CNFs-CMCs incorporated carbon paste film, was investigated across operating frequencies in the 1.5-40 GHz range. It was compared to heating films made from commercial carbon paste or the controllable CMCs incorporated carbon paste. Although the electrical conductivity of the native commercial carbon paste was lowered by both the incorporation of the CMCs and the hybrids of CNFs-CMCs, the total SE values of the manufactured heating film increased following the incorporation of these materials. Considering the thickness of the heating film, the presently measured values rank highly among the previously reported total SE values. This dramatic improvement in the total SE values was mainly ascribed to the intrinsic characteristics of CMC and/or the hybrid of CNFs-CMCs contributing to the absorption shielding route of electromagnetic waves.

"Elbow-Lock" Chest Compression Method in the Setting of Single Rescuer Pediatric Cardiopulmonary Resuscitation: A Crossover Simulation Study.

BACKGROUND: We designed a new 1-handed chest compression method, the "elbow-lock" chest compression (ELCC), for a single rescuer in pediatric cardiopulmonary resuscitation (CPR). Then, we compared the effectiveness between the ELCC and standard chest compression (SCC) method. METHODS: This prospective, randomized controlled, crossover simulation trial studied 34 emergency medical professionals, including physicians, nurses, and EMTs. We compare the quality of chest compression and fatigue point time between the ELCC and the SCC. RESULTS: Participants who performed the ELCC method maintained a proper depth of compression compared with SCC method (50.0 ± 0.3 mm vs 40.5 ± 0.4 mm, P < 0.001). However, the 2 methods did not differ in terms of compression velocity since neither reached the standard velocity (96.7 ± 7.1/minutes vs 91.7 ± 7.0/minutes, P < 0.016). With respect to the overall score, ELCC was more effective than the SCC (91.6 ± 3.7% vs 85.3 ± 8.8%, P = 0.002). In addition, the fatigue point time was slower in the ELCC group than the SCC group (7.3 ± 0.3/minutes vs 6.1 ± 0.4/minutes, P < 0.001). CONCLUSIONS: The single rescuer ELCC method is an effective alternative to the SCC method for pediatric CPR because the ELCC method can prevent elbow flexion.Trial registration: Our research is simulation manikin study. So we do not need to "trial registration".

Inter-reader reliability of CT Liver Imaging Reporting and Data System according to imaging analysis methodology: a systematic review and meta-analysis.

OBJECTIVES: To establish inter-reader reliability of CT Liver Imaging Reporting and Data System (LI-RADS) and explore factors that affect it. METHODS: MEDLINE and EMBASE databases were searched from January 2014 to March 2020 to identify original articles reporting the inter-reader reliability of CT LI-RADS. The imaging analysis methodology of each study was identified, and pooled intraclass correlation coefficient (ICC) or kappa values (κ) were calculated for lesion size, major features (arterial-phase hyperenhancement [APHE], nonperipheral washout [WO], and enhancing capsule [EC]), and LI-RADS categorization (LR) using random-effects models. Subgroup analyses of pooled κ were performed for the number of readers, average reader experience, differences in reader experience, and LI-RADS version. RESULTS: In the 12 included studies, the pooled ICC or κ of lesion size, APHE, WO, EC, and LR were 0.99 (0.96-1.00), 0.69 (0.58-0.81), 0.67 (0.53-0.82), 0.65 (0.54-0.76), and 0.70 (0.59-0.82), respectively. The experience and number of readers varied: studies using readers with ≥ 10 years of experience showed significantly higher κ for LR (0.82 vs. 0.45, p = 0.01) than those with < 10 years of reader experience. Studies with multiple readers including inexperienced readers showed significantly lower κ for APHE (0.55 vs. 0.76, p = 0.04) and LR (0.45 vs. 0.79, p = 0.02) than those with all experienced readers. CONCLUSIONS: CT LI-RADS showed substantial inter-reader reliability for major features and LR. Inter-reader reliability differed significantly according to average reader experience and differences in reader experience. Reported results for inter-reader reliability of CT LI-RADS should be understood with consideration of the imaging analysis methodology. KEY POINTS: • The CT Liver Imaging Reporting and Data System (LI-RADS) provides substantial inter-reader reliability for three major features and category assignment. • The imaging analysis methodology varied across studies. • The inter-reader reliability of CT LI-RADS differed significantly according to the average reader experience and the difference in reader experience.

Multiparametric MRI for prediction of treatment response to neoadjuvant FOLFIRINOX therapy in borderline resectable or locally advanced pancreatic cancer.

OBJECTIVES: To identify multiparametric MRI biomarkers to predict the tumor response to neoadjuvant FOLFIRINOX therapy in patients with borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). METHODS: From May 2016 to March 2018, adult patients with BR or LA PDAC were prospectively enrolled in this study. They received eight cycles of FOLFIRINOX therapy and underwent multiparametric MRI twice (at baseline and after the second cycle). MRI evaluations included dynamic contrast-enhanced MRI, intravoxel incoherent motion diffusion-weighted imaging, and assessment of T2* relaxivity (R2*) and the change in T1 relaxivity (ΔR1, equilibrium phase R1 minus non-enhanced R1) of the tumors. Factors to predict the responders determined by the best overall response during FOLFIRINOX therapy and those to predict progression-free survival (PFS) and overall survival (OS) were evaluated using multivariable logistic regression and the Cox proportional hazard model. RESULTS: Forty-one patients (mean age, 60.3 years ± 9.3; 24 men) were included. Among the clinical and MRI factors, the baseline ΔR1 (adjusted odds ratio, 31.07; p = 0.008) was the only independent predictor for tumor response. The baseline ΔR1 was also an independent predictor for PFS (adjusted hazard ratio, 0.40; p = 0.033) along with R0 resection. The use of a cutoff ΔR1 value of ≥ 1.31 s-1 enabled prognostic stratification (median PFS, 16.0 months vs.10.0 months; p = 0.029; median OS, 34.9 months vs. 16.6 months; p = 0 .023, respectively). CONCLUSIONS: The baseline tumor ΔR1 value may be useful to predict tumor response and survival in patients with BR or LA PDAC receiving FOLFIRINOX neoadjuvant therapy. KEY POINTS: • Baseline ΔR1 was an independent predictor for tumor response (adjusted odds ratio, 31.07; p = 0.008) and progression-free survival (adjusted hazard ratio, 0.40; p = 0.033) in patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma receiving neoadjuvant FOLFIRINOX therapy. • The criterion of baseline ΔR1 value ≥ 1.31 s-1 allowed for the prediction of favorable tumor response and survival outcome after neoadjuvant FOLFIRINOX therapy.

CT-determined resectability of borderline resectable and unresectable pancreatic adenocarcinoma following FOLFIRINOX therapy.

OBJECTIVES: We aimed to assess the ability of CT-determined resectability, as defined by a recent version of NCCN criteria, and associated CT findings to predict margin-negative (R0) resection in patients with PDAC after neoadjuvant FOLFIRINOX chemotherapy. METHODS: Sixty-four patients (36 men and 28 women; mean age, 58.8 years) with borderline resectable or unresectable PDAC who received neoadjuvant FOLFIRINOX were evaluated retrospectively. CT findings were independently assessed by two abdominal radiologists according to NCCN criteria (version 3. 2019). Tumor resectability was classified as resectable, borderline resectable, or unresectable, and change in resectability was classified as regression, stability, or progression. The associations of R0 resection rate with CT-determined resectability and change in resectability categories were evaluated, as were the sensitivity and specificity of NCCN criteria for R0 resection. Factors associated with R0 resection were identified by logistic regression analysis. RESULTS: R0 resection rate did not differ significantly among the resectable, borderline resectable, or unresectable PDAC (67-73%, p = 0.95) or among PDAC with regression, stability, or progression (56-77%, p = 0.39). The sensitivity and specificity for R0 resection were 67% and 37%, respectively, for resectability (resectable/borderline vs. unresectable) and 80% and 21%, respectively, for changes in resectability (regression/stable vs. progression). Low-contrast enhancement of soft tissue contacting artery (≤ 46.4 HU) was independently associated with R0 resection (p = 0.01). CONCLUSION: CT-determined resectability after neoadjuvant FOLFIRINOX chemotherapy was relatively insensitive and non-specific for predicting R0 resection. Low-contrast enhancement of soft tissue contacting artery may increase the ability of CT to predict R0 resection. KEY POINTS: • Margin-negative resection rate of pancreatic cancer following FOLFIRINOX therapy did not differ among each resectability (67-73%, p = 0.95) based on NCCN criteria or changes in resectability categories (56-77%, p = 0.39). • The sensitivity and specificity for margin-negative resection were 67% and 37% for resectability (resectable/borderline vs. unresectable) and 80% and 21% for changes in resectability (regression/stable vs. progression). • Low-contrast enhancement of soft tissue contacting artery (≤ 46.4 HU) was independently associated with margin-negative resection (p = 0.01).

Changes in the pattern of suicide attempters visiting the emergency room after COVID-19 pandemic: an observational cross sectional study.

BACKGROUND: This study aimed to find out the change in the rate and pattern of suicide attempts during severe acute respiratory syndrome COVID-19 pandemic period. METHODS: This study was a retrospective analysis of data collected as a part of an emergency room-based post-suicide management program. The data were collected through interviews and from medical records of suicide attempts, maintained in the emergency room, from January 19 to October 31, 2020, during the "COVID-19 period," and those who attempted suicide from January 19 to October 31, 2019 "pre-COVID-19 period." We extracted educational background, marital status, occupation, presence of domestic partner, history of mental illness, alcohol consumption, history of previous suicide attempts; suicide attempt method and location (i.e., at home or a place other than home) at the time of attempt, and whether the attempt was a mass suicide. In addition, we compared patient severity between "COVID-19 period" and "pre-COVID-19 period" using the initial KTAS (South Korean triage and acuity scale) level, consciousness level, and systolic blood pressure. In 2012, KTAS was developed through the Ministry of Health and Welfare's research project to establish triage system in South Korea. RESULTS: The analysis of the number of suicide attempts during "pre-COVID-19 period" and " COVID-19 period" showed that the number of suicide attempts during "COVID-19 period" (n = 440) increased compared to the "pre-COVID-19 period" (n = 400). Moreover, the method of suicide attempts during "COVID-19 period" included overdose of drugs such as hypnotics, antipsychotics, and pesticides that were already possessed by the patient increased compared to the "pre-COVID-19 period" (P < 0.05). At the time of the visit to the emergency room, high KTAS level, low level of consciousness, and low systolic blood pressure, were observed, which were significantly different between "COVID-19 period" and "pre-COVID-19 period" (P < 0.05). CONCLUSION: With the worldwide COVID-19 virus spread, suicide rate and suicide attempts at home have significantly increased. In addition, patient severity was higher in the "COVID-19 period" than that in the "pre-COVID-19 period." The increasing suicide attempt rate should be controlled by cooperation between the emergency room and regional organizations.

Tunable Cherenkov Radiation of Phonon Polaritons in Silver Nanowire/Hexagonal Boron Nitride Heterostructures.

Polaritons in two-dimensional (2D) materials have shown their unique capabilities to concentrate light into deep subwavelength scales. Precise control of the excitation and propagation of 2D polaritons has remained a central challenge for future on-chip nanophotonic devices and circuits. To solve this issue, we exploit Cherenkov radiation, a classic physical phenomenon that occurs when a charged particle moves at a velocity greater than the phase velocity of light in that medium, in low-dimensional material heterostructures. Here, we report an experimental observation of Cherenkov phonon polariton wakes emitted by superluminal one-dimensional plasmon polaritons in a silver nanowire and hexagonal boron nitride heterostructure using near-field infrared nanoscopy. The observed Cherenkov radiation direction and radiation rate exhibit large tunability through varying the excitation frequency. Such tunable Cherenkov phonon polaritons provide opportunities for novel deep subwavelength-scale manipulation of light and nanoscale control of energy flow in low-dimensional material heterostructures.

Selective and ATP-competitive kinesin KIF18A inhibitor suppresses the replication of influenza A virus.

The influenza virus is one of the major public health threats. However, the development of efficient vaccines and therapeutic drugs to combat this virus is greatly limited by its frequent genetic mutations. Because of this, targeting the host factors required for influenza virus replication may be a more effective strategy for inhibiting a broader spectrum of variants. Here, we demonstrated that inhibition of a motor protein kinesin family member 18A (KIF18A) suppresses the replication of the influenza A virus (IAV). The expression of KIF18A in host cells was increased following IAV infection. Intriguingly, treatment with the selective and ATP-competitive mitotic kinesin KIF18A inhibitor BTB-1 substantially decreased the expression of viral RNAs and proteins, and the production of infectious viral particles, while overexpression of KIF18A enhanced the replication of IAV. Importantly, BTB-1 treatment attenuated the activation of AKT, p38 MAPK, SAPK and Ran-binding protein 3 (RanBP3), which led to the prevention of the nuclear export of viral ribonucleoprotein complexes. Notably, administration of BTB-1 greatly improved the viability of IAV-infected mice. Collectively, our results unveiled a beneficial role of KIF18A in IAV replication, and thus, KIF18A could be a potential therapeutic target for the control of IAV infection.

Interreader Agreement of Liver Imaging Reporting and Data System on MRI: A Systematic Review and Meta-Analysis.

BACKGROUND: Use of the Liver Imaging Reporting and Data System (LI-RADS) is increasing, but the reported results for interreader agreement seem quite variable. PURPOSE: To systematically determine the interreader agreement of LI-RADS on magnetic resonance imaging (MRI) and to determine the sources of heterogeneity between the reported results. STUDY TYPE: Systematic review and meta-analysis. SUBJECTS: Fifteen original articles with 2968 lesions. FIELD STRENGTH: 1.5T and 3.0T. ASSESSMENT: Two reviewers independently performed the data extraction. The reviewers identified and reviewed the original articles reporting the interreader agreement of LI-RADS using MRI. STATISTICAL TESTS: The meta-analytic pooled intraclass correlation coefficient (ICC) for lesion size and kappa value (κ) for major features (arterial-phase hyperenhancement [APHE], nonperipheral washout [WO], enhancing capsule [EC]) and LI-RADS categorization (LR) were calculated using the random-effects model. Sensitivity analysis and meta-regression analysis were performed to explore the cause of study heterogeneity. RESULTS: The meta-analytic pooled ICC of lesion size was 0.97 (95% confidence interval [CI], 0.94-1.00). Meta-analytic pooled κ of APHE, WO, EC, and LR were 0.72 (95% CI, 0.62-0.82), 0.69 (95% CI, 0.60-0.78), 0.66 (95% CI, 0.58-0.74), and 0.70 (95% CI, 0.56-0.85), respectively. Substantial study heterogeneity was noted in all five variables (I2 ≥ 89.1%, P < 0.001). Study design, type, and clarity of blinding review were factors that significantly influenced study heterogeneity (P ≤ 0.05). DATA CONCLUSION: LI-RADS demonstrated overall substantial interreader agreement for major features and the category on MRI, but showed heterogeneous results between studies. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:795-804.

Ancillary features in the Liver Imaging Reporting and Data System: how to improve diagnosis of hepatocellular carcinoma ≤ 3 cm on magnetic resonance imaging.

OBJECTIVES: To determine the strength of association with hepatocellular carcinoma (HCC) of each ancillary feature (AF) in LI-RADS version 2018, and to develop an appropriate strategy for applying AFs to improve the diagnosis of HCC ≤ 3 cm on gadoxetate-enhanced MRI. METHODS: A total of 385 nodules (283 HCCs, 18 non-HCC malignancies, 84 benign nodules) of ≤ 3 cm in 266 patients at risk for HCC who underwent gadoxetate-enhanced MRI in 2016 were retrospectively evaluated. Two radiologists independently evaluated the presence/absence of AFs, and assigned a LI-RADS category to each nodule. Diagnostic odds ratio (DOR) of each AF was assessed. To improve the diagnostic performance for HCC, various criteria were developed based on the number of AFs favoring malignancy in general or HCC in particular. Generalized estimating equation models were used to compare the diagnostic performance of each criterion with that of the major features (MFs) only. RESULT: All AFs favoring HCC in particular and malignancy in general were more common in the HCC group than in the non-HCC group. Of these AFs, hepatobiliary-phase hypointensity had the strongest association with HCC (DOR, 21.82; 95% confidence interval, 5.59-85.20). When we applied AFs in addition to MFs, the new criterion (with a number of AFs ≥ 4) had significantly higher sensitivity (80.6% vs. 70.0%; p < 0.001) than MFs only, without significant lower specificity (85.3% vs. 90.2%; p = 0.060). CONCLUSIONS: The AFs varied in the strengths of association with HCC. More strict application of AFs (AFs ≥ 4) in LR-3 may improve the diagnostic performance for probable HCC ≤ 3 cm. KEY POINTS: • The ancillary features (AFs) in the Liver Imaging Reporting and Data System version 2018 showed variable frequencies of occurrence and strengths of association with hepatocellular carcinoma (HCC). • Of the various AFs, hepatobiliary-phase hypointensity had the highest frequency and strongest association with HCC on gadoxetate disodium-enhanced MRI. • When applying AFs in addition to major features, a criterion of four or more AFs significantly increased the sensitivity for diagnosing HCC, without a significantly decreased specificity, especially in LR-3 observations.

Arterial subtraction images of gadoxetate-enhanced MRI improve diagnosis of early-stage hepatocellular carcinoma.

BACKGROUND & AIMS: Although gadoxetate disodium-enhanced magnetic resonance imaging (MRI) shows higher sensitivity for diagnosing hepatocellular carcinoma (HCC), its arterial-phase images may be unsatisfactory because of weak arterial enhancement. We investigated the clinical effectiveness of arterial subtraction images from gadoxetate disodium-enhanced MRI for diagnosing early-stage HCC using the Liver Imaging Reporting and Data System (LI-RADS) v2018. METHODS: In 258 patients at risk of HCC who underwent gadoxetate disodium-enhanced MRI in 2016, a total of 372 hepatic nodules (273 HCCs, 18 other malignancies, and 81 benign nodules) of 3.0 cm or smaller were retrospectively analyzed. Final diagnosis was assessed histopathologically or clinically (marginal recurrence after treatment or change in lesion size on follow-up imaging). The detection rate for arterial hyperenhancement was compared between ordinary arterial-phase and arterial subtraction images, and the benefit of arterial subtraction images in diagnosing HCC using LI-RADS was assessed. RESULTS: Arterial subtraction images had a significantly higher detection rate for arterial hyperenhancement than ordinary arterial-phase images, both for all hepatic nodules (72.3% vs. 62.4%, p <0.001) and HCCs (91.9% vs. 80.6%, p <0.001). Compared with ordinary arterial-phase images, arterial subtraction images significantly increased the sensitivity of LI-RADS category 5 for diagnosis of HCC (64.1% [173/270] vs. 55.9% [151/270], p <0.001), without significantly decreasing specificity (92.9% [91/98] vs. 94.9% [93/98], p = 0.155). For histopathologically confirmed lesions, arterial subtraction images significantly increased sensitivity to 68.8% (128/186) from the 61.3% (114/186) of ordinary arterial-phase images (p <0.001), with a minimal decrease in specificity to 84.8% (39/46) from 89.1% (41/46) (p = 0.151). CONCLUSIONS: Arterial subtraction images of gadoxetate disodium-enhanced MRI can significantly improve the sensitivity of early-stage HCC diagnosis using LI-RADS, without a significant decrease in specificity. LAY SUMMARY: Gadoxetate disodium-enhanced magnetic resonance imaging is an imaging technique with a high sensitivity for the diagnosis of hepatocellular carcinoma. However, arterial-phase images may be unsatisfactory because of weak arterial enhancement. We found that using arterial subtraction images led to clinically meaningful improvements in the diagnosis of early-stage hepatocellular carcinoma.

Anti-viral activity of compounds from Agrimonia pilosa and Galla rhois extract mixture.

Hepatitis C virus (HCV) infection is a significant health problem, with a worldwide prevalence of about 170 million. Recently, the development of direct acting antiviral (DAA) as a therapeutic agent for HCV has been rapidly increasing. However, DAA has a side effect and is costly. Therefore, it is still necessary to develop a therapeutic agent to treat HCV infection using products. Agrimonia pilosa (AP) and Galla rhois (RG) are traditional medicines and are known to display therapeutic activity on various diseases. Notably, they have been reported to have an anti-viral effect on HBV and influenza virus infections. It is expected that anti-viral activity will increase when two extracts are mixed. To investigate their anti-viral activity, the expression level of HCV Core 1b and NS5A was measured. Remarkably, AP, RG, and their mixed compound (APRG64) strongly inhibited the expression of viral proteins, which led us to identify their metabolites. A total of 14 metabolites were identified using liquid chromatography mass spectrometry (LC-MS). These metabolites were evaluated for their anti-HCV activity to identify active ingredients. In conclusion, our results unveiled that anti-HCV activity of Agrimonia pilosa and Galla rhois extract mixture could lead to the development of a novel therapy for HCV infection.

Mid-IR broadband supercontinuum generation from a suspended silicon waveguide.

Mid-infrared light provides numerous unexpected opportunities in scientific discoveries because this wavelength region covers the fingerprints of various molecular vibrational resonances. However, the light generation efficiency and bandwidth have been a long-standing bottleneck which has limited the development so far. Moreover, the light source that can be integrated with other components such as wavelength filters, detectors, and electronics, will be the key factor toward the future practical applications. Here, we propose an all-air-cladding silicon-rib waveguide to experimentally reveal the nonlinear performance of supercontinuum generation. By tuning the waveguide dispersion parameters with simulation, a continuous broad spectrum of 1.32 octave (2-5 µm) was observed with a pump pulse wavelength of 4 µm. To further investigate our device characteristics, multiple conditions were set by varying the interaction length, pump power, and waveguide dimension, which revealed the nonlinear phenomenon in the waveguide.

Endovenous Thermal Ablation of Recurrent Varicose Veins due to Residual Great Saphenous Venous Insufficiency After Saphenous Venous Surgery: A Comparative Study.

BACKGROUND: Redo surgery for recurrent varicose veins of the great saphenous vein (GSV) is technically more challenging than the initial surgery. OBJECTIVE: To compare 980 and 1,470-nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) for the treatment of residual GSV insufficiency after saphenofemoral ligation ± stripping. MATERIALS AND METHODS: Thirty-seven limbs in 29 patients with recurrent varicose veins were retrospectively evaluated. Patients were divided into 3 groups: 980-nm EVLA (group A), 1,470-nm EVLA (group B), and RFA (group C). Duplex ultrasonography, Venous Clinical Severity Score (VCSS), and adverse events were examined at intervals of 1 week, 1, 3, 6, and 12 months. RESULTS: Complete closure was achieved in 35 (94.6%) limbs at 12 months. Venous Clinical Severity Score decrease in group C (3.6 ± 0.5) was significantly (p < .017) greater compared with that of group A (2.6 ± 0.9). Ecchymosis grade was significantly (p < .017) lower in group C (0.1 ± 0.3) than that in group A (1.6 ± 1.5). CONCLUSION: Endovenous thermal ablation using EVLA or RFA is safe and effective for treatment of recurrent varicose veins resulting from residual GSV insufficiency after saphenous venous surgery. The RFA is superior to 980-nm EVLA in terms of postprocedural ecchymosis and improvement in VCSS.

Goos-Hänchen Shift and Even-Odd Peak Oscillations in Edge-Reflections of Surface Polaritons in Atomically Thin Crystals.

Two-dimensional surface polaritons (2DSPs), such as graphene plasmons, exhibit various unusual properties, including electrical tunability and strong spatial confinement with high Q-factor, which can enable tunable photonic devices for deep subwavelength light manipulations. Reflection of plasmons at the graphene's edge plays a critical role in the manipulation of 2DSP and enables their direct visualization in near-field infrared microscopy. However, a quantitative understanding of the edge-reflections, including reflection phases and diffraction effects, has remained elusive. Here, we show theoretically and experimentally that edge-reflection of 2DSP exhibits unusual behaviors due to the presence of the evanescent waves, including an anomalous Goos-Hänchen phase shift as in total internal reflections and an unexpected even-odd peak amplitude oscillation from the wave diffraction at the edge. Our theory is not only valid for plasmons in graphene but also for other 2D polaritons, such as phonon polaritons in ultrathin boron nitride flakes and exciton polariton in two-dimensional semiconductors.

Coupled One-Dimensional Plasmons and Two-Dimensional Phonon Polaritons in Hybrid Silver Nanowire/Silicon Carbide Structures.

Surface plasmons (SPs) and phonon polaritons (PhPs) are two distinctive quasiparticles resulting from the strong coupling of photons with electrons and optical phonons, respectively. In this Letter, we investigate the interactions between one-dimensional (1D) plasmons in silver nanowires with two-dimensional (2D) surface phonon polaritons of the silicon carbide (SiC) substrate. Using near-field infrared spectroscopy of the silver nanowire-SiC heterostructure at wavelengths close to the phonon resonance of SiC, we observe that the 1D plasmon dispersion is strongly modified by the 2D phonon polaritons in SiC. In particular, we observe for the first time well-defined 1D plasmon oscillations with the plasmon wavelengths longer than the free-space photon wavelengths due to the 1D plasmon-2D phonon polariton coupling. Our work demonstrates that unusual polariton behavior can emerge from interactions between polariton excitons of different dimensionality, which can enable new ways to engineer plasmons in hybrid structures.

Soliton-dependent plasmon reflection at bilayer graphene domain walls.

Layer-stacking domain walls in bilayer graphene are emerging as a fascinating one-dimensional system that features stacking solitons structurally and quantum valley Hall boundary states electronically. The interactions between electrons in the 2D graphene domains and the one-dimensional domain-wall solitons can lead to further new quantum phenomena. Domain-wall solitons of varied local structures exist along different crystallographic orientations, which can exhibit distinct electrical, mechanical and optical properties. Here we report soliton-dependent 2D graphene plasmon reflection at different 1D domain-wall solitons in bilayer graphene using near-field infrared nanoscopy. We observe various domain-wall structures in mechanically exfoliated graphene bilayers, including network-forming triangular lattices, individual straight or bent lines, and even closed circles. The near-field infrared contrast of domain-wall solitons arises from plasmon reflection at domain walls, and exhibits markedly different behaviours at the tensile- and shear-type domain-wall solitons. In addition, the plasmon reflection at domain walls exhibits a peculiar dependence on electrostatic gating. Our study demonstrates the unusual and tunable coupling between 2D graphene plasmons and domain-wall solitons.

Ultrasensitive terahertz sensing of gold nanoparticles inside nano slot antennas.

We introduce a robust control method of terahertz (THz) transmission by tuning filling factors of Au nanoparticles (AuNPs) inside nano slot antennas. AuNPs in sub-100 nm diameters were spread over the nano slot antennas, followed by sweeping them into the slots. AuNPs can be efficiently localized and inserted into nano slots where the THz fields are greatly enhanced, by a "squeegee" made of the polydimethylsiloxane (PDMS). The sweeping of the AuNPs results in further dramatic reduction of THz transmission by suppressing the fundamental resonance mode of the nano slot, as compared to a typical random dropping case. It definitely works for an accurate THz transmission control, as well as the removal of unwanted ions that occasionally confuse signal accuracy from the target signals. Our approach provides a complete reinterpretation of sample deposition for further steady demands in developing ultrasensitive terahertz (THz) molecule sensors.