Navigating the microbial community in the trachea-oropharynx of breast cancer patients with or without neoadjuvant chemotherapy (NAC) via endotracheal tube: has NAC caused any change?

Background: We compare the diversity and niche specificity of the microbiome in the trachea-oropharynx microbiome of malignant breast neoplasm with or without neoadjuvant chemotherapy (NAC) via NGS analysis. Methods: We prospectively collected a total of 40 endotracheal tubes intubated from subjects, of whom 20 with NAC treated breast cancer (NAC group) and 20 with breast cancer without NAC (Non-NAC group). We generated 16S rRNA-based microbial profiles in IlluminaTM platform and alpha diversity indices were compared between groups. For the comparison of taxa abundance, linear discriminant analysis effect size method with Kruskal-Wallis test was used. The distribution of variables between the two groups was compared using the Mann-Whitney test. For beta diversity analysis, PERMANOVA was used. Results: Among the diversity indices, the NAC group showed significantly lower Chao1, Inverse Simpson, and Shannon indices than the Non-NAC group. The three most frequent taxa of all two groups were Streptococcus (20.4%), followed by Veillonella (11.9%), and Prevorella (10.4%). This order was the same in NAC and non-NAC groups. Conclusion: Here, we provide the first comparison data of the respiratory tract microbiome of breast cancer patients with or without NAC via NGS analysis. This study ultimately seeks to contribute to future studies on the lower respiratory tract in cancer patients with cytotoxic chemotherapy by establishing reliable control data.

Uncovering the centrality of mono-dentate SO32-/SO42- modifiers grafted on a metal vanadate in accelerating wet NOX reduction and poison pyrolysis.

NOX rarely binds with labile oxygens of catalytic solids, whose Lewis acidic (LA) species possess higher binding strengths with NH3 (ENH3) and H2O than Brönsted acidic counterparts (BA--H+; -OH), oftentimes leading to elevate energy barrier (EBARRIER) and weaken H2O tolerance, respectively. These limit NH3-assisted wet NOX reduction via Langmuir-Hinshelwood-type or Eley-Rideal (ER)-type model on LA species, while leaving ER-type analogue on BA--H+ species proper to reduce wet NOX. Given hard-to-regulate strength/amount of -OH species and occasional association between ENH3 and EBARRIER, Ni1V2O6 (Ni1) was rationally chosen as a platform to isolate mono-dentate SO32-/SO42- species for use as BA--H+ bonds via protonation to increase collision frequency (k'APP,0) alongside with disclosure of advantages of SO32-/SO42--functionalized Ni1V2O6 (Ni1-S) over Ni1 in reducing wet NOX. Ni1-S outperformed Ni1 in achieving a larger BA--H+ quantity (k'APP,0↑), increasing H2O tolerance, and elevating oxygen mobility, thus promoting NOX reduction activity/consequences under SO2-excluding gases. V2O5-WO3 composite simulating a commercial catalyst could isolate mono-dentate SO32-/SO42- species and served as a control (V2O5-WO3-S) for comparison. Ni1-S was superior to V2O5-WO3-S in evading ammonium (bi-)sulfate (AS/ABS) poison accumulation and expediting AS/ABS pyrolysis efficiency, thereby improving AS/ABS resistance under SO2-including gases, while enhancing resistance against hydro-thermal aging.

Strain hardening recovery mediated by coherent precipitates in lightweight steel.

We investigated the effect of κ-carbide precipitates on the strain hardening behavior of aged Fe-Mn-Al-C alloys by microstructure analysis. The κ-carbides-strengthened Fe-Mn-Al-C alloys exhibited a superior strength-ductility balance enabled by the recovery of the strain hardening rate. To understand the relation between the κ-carbides and strain hardening recovery, dislocation gliding in the aged alloys during plastic deformation was analyzed through in situ tensile transmission electron microscopy (TEM). The in situ TEM results confirmed the particle shearing mechanism leads to planar dislocation gliding. During deformation of the 100 h-aged alloy, some gliding dislocations were strongly pinned by the large κ-carbide blocks and were prone to cross-slip, leading to the activation of multiple slip systems. The abrupt decline in the dislocation mean free path was attributed to the activation of multiple slip systems, resulting in the rapid saturation of the strain hardening recovery. It is concluded that the planar dislocation glide and sequential activation of slip systems are key to induce strain hardening recovery in polycrystalline metals. Thus, if a microstructure is designed such that dislocations glide in a planar manner, the strain hardening recovery could be utilized to obtain enhanced mechanical properties of the material.

Comparative study of HSOA-/SOA2- versus H3-BPO4B- functionalities anchored on TiO2-supported antimony oxide-vanadium oxide-cerium oxide composites for low-temperature NOX activation.

TiO2-supported antimony oxide-vanadium oxide-cerium oxide (SVC) imparts Lewis acidic (L)/Brönsted acidic (B) sites, labile (Oα)/mobile oxygens (OM), and oxygen vacancies (OV) for selective catalytic NOX reduction (SCR). However, these species are harmonious occasionally, readily poisoned by H2O/sulfur/phosphorus/carbon, thus limiting SCR performance of SVC. Herein, a synthetic means is reported for immobilizing HSOA-/SOA2- (A= 3-4) or H3-BPO4B- (B= 1-3) on the L sites of SVC to form SVC-S and SVC-P. HSOA-/SOA2-/H3-BPO4B- acted as additional B sites with distinct characteristics, altered the properties of Oα/OM/OV species, thereby affecting the SCR activities and performance of SVC-S and SVC-P. SVC-P activated Langmuir-Hinshelwood-typed SCR better than SVC-S, as demonstrated by a greater Oα-directed pre-factor and smaller binding energy between Oα and NO. Meanwhile, SVC-S provided a larger B-directed pre-factor, thereby outperforming SVC-P in activating Eley-Rideal-typed SCR that dictated the overall SCR activities. Compared with SVC-S, SVC-P contained fewer OV species, yet, had higher OM mobility, thus enhancing the overall redox cycling feature, while providing greater Brönsted acidity. Consequently, the resistance of SVC-P to H2O or soot were greater than or similar to that of SVC-S. Conversely, SVC-S revealed greater tolerance to hydro-thermal aging and SO2 than SVC-P. This study highlights the pros and cons of HSOA-/SOA2-/H3-BPO4B- functionalities in tailoring the properties of metal oxides in use as SCR catalysts.

Efficacy and safety of modified tract dilation technique using simultaneous pulling of proximal and distal ends of a guidewire for percutaneous nephrolithotomy in modified supine position.

PURPOSE: Recently, the needs for supine percutaneous nephrolithotomy (PCNL) have become more increased because of an easy approach for endoscopic combined intrarenal surgery. However, making a nephrostomy tract during supine PCNL is more difficult than prone position due to movable kidney. To overcome this limitation, we used a modified nephrostomy tract dilation (MTD) technique using guidewire traction. MATERIALS AND METHODS: From January 2014 to June 2019, a total of 259 patients underwent PCNL in the modified supine position. Among them, the MTD technique was performed in 171 patients. For the MTD technique, two hydrophilic guidewires were passed from the nephrostomy tract and brought out through the urethra, then both proximal and distal ends were contralaterally pulled with tension for the easy placement of a fascia-cutting needle and a balloon catheter. We analyzed the efficacy of this technique in comparison with the conventional method. RESULTS: Intraoperative radiation exposure time (RET) (68.87 vs. 212.11 s) and hospital stay (5.90 vs. 6.74 days) were significantly shorter, while the success rate (77.2% vs. 63.6%) was significantly higher in the MTD group. Multivariate analysis showed that only the maximal stone diameter (odds ratio [OR], 1.928; 95% confidence interval [CI], 1.314-2.828; p=0.001) and MTD technique (OR, 0.017; 95% CI, 0.007-0.040; p<0.001) were independent factors for predicting short RET (<120 s). CONCLUSIONS: This study demonstrated that MTD technique can be effectively and safely performed in modified supine position PCNL, and it can be helpful in reducing RET and enhancing success rates.

Nanoscale light element identification using machine learning aided STEM-EDS.

Light element identification is necessary in materials research to obtain detailed insight into various material properties. However, reported techniques, such as scanning transmission electron microscopy (STEM)-energy dispersive X-ray spectroscopy (EDS) have inadequate detection limits, which impairs identification. In this study, we achieved light element identification with nanoscale spatial resolution in a multi-component metal alloy through unsupervised machine learning algorithms of singular value decomposition (SVD) and independent component analysis (ICA). Improvement of the signal-to-noise ratio (SNR) in the STEM-EDS spectrum images was achieved by combining SVD and ICA, leading to the identification of a nanoscale N-depleted region that was not observed in as-measured STEM-EDS. Additionally, the formation of the nanoscale N-depleted region was validated using STEM-electron energy loss spectroscopy and multicomponent diffusional transformation simulation. The enhancement of SNR in STEM-EDS spectrum images by machine learning algorithms can provide an efficient, economical chemical analysis method to identify light elements at the nanoscale.

A new class of lightweight, stainless steels with ultra-high strength and large ductility.

Steel is the global backbone material of industrialized societies, with more than 1.8 billion tons produced per year. However, steel-containing structures decay due to corrosion, destroying annually 3.4% (2.5 trillion US$) of the global gross domestic product. Besides this huge loss in value, a solution to the corrosion problem at minimum environmental impact would also leverage enhanced product longevity, providing an immense contribution to sustainability. Here, we report a leap forward toward this aim through the development of a new family of low-density stainless steels with ultra-high strength (> 1 GPa) and high ductility (> 35%). The alloys are based on the Fe-(20-30)Mn-(11.5-12.0)Al-1.5C-5Cr (wt%) system and are strengthened by dispersions of nano-sized Fe3AlC-type κ-carbide. The alloying with Cr enhances the ductility without sacrificing strength, by suppressing the precipitation of κ-carbide and thus stabilizing the austenite matrix. The formation of a protective Al-rich oxide film on the surface lends the alloys outstanding resistance to pitting corrosion similar to ferritic stainless steels. The new alloy class has thus the potential to replace commercial stainless steels as it has much higher strength at similar formability, 17% lower mass density and lower environmental impact, qualifying it for demanding lightweight, corrosion resistant, high-strength structural parts.

ERRATUM: Correction of Figure 1: Outcomes of surgical treatments for rectovaginal fistula and prognostic factors for successful closure: a single-center tertiary hospital experiences.

[This corrects the article on p. 149 in vol. 97, PMID: 31508396.].

Investigating multi-functional traits of metal-substituted vanadate catalysts in expediting NOX reduction and poison degradation at low temperatures.

Catalysts are severely poisoned by ammonium sulfate (AS) and ammonium bisulfate (ABS) during selective catalytic NOX reduction (SCR) at low temperatures. To circumvent this issue, metal-substituted vanadates (MV2O6, M = Mn, Co, Ni, or Cu) supported on TiO2 were synthesized and functionalized with SOY2- to form M1 (S) catalysts (Y = 3 or 4). The Mn1 (S) could balance pre-factor and energy barrier required for the SCR, thereby exhibiting the highest NOX consumption rate (activity) among the M1 (S) catalysts. The Mn1 (S) also had desirable redox property, leading to the best SCR performance maximum-obtainable at low temperatures. Notably, the Mn1 (S) substantially reduced the thermal energy needed to decompose AS/ABS poisons. Such unique feature of the Mn1 (S) was pronounced when the Mn1 (S) was promoted by Sb (Mn1-Sb (S)). The resulting Mn1-Sb (S) showed the best SCR performance among all catalysts tested. The Mn1-Sb (S) could minimize the deposition of AS/ABS on the surface and unprecedentedly recovered its performance after regeneration even in the presence of NOX, NH3, SO2, and H2O at 260-280 °C. The temperatures required for the regeneration of the Mn1-Sb (S) were reduced by 100 °C or more in comparison with those of SCR catalysts reported previously.

Effect of bupivacaine on postoperative pain and analgesics use after single-incision laparoscopic appendectomy: double-blind randomized study.

PURPOSE: Local anesthetics can decrease postoperative pain after appendectomy. This study sought to verify the efficacy of bupivacaine on postoperative pain and analgesics use after single-incision laparoscopic appendectomy (SILA). METHODS: Between March 2014 and October 2015, 68 patients with appendicitis agreed to participate in this study. After general anesthesia, patients were randomized to bupivacaine or control (normal saline) groups. The assigned drugs were infiltrated into subcutaneous tissue and deep into anterior rectus fascia. Postoperative analgesics use and pain scores were recorded using visual analogue scale (VAS) by investigators at 1, 8, and 24 hours and on day 7. All surgeons, investigators and patients were blinded to group allocation. RESULTS: Thirty patients were allocated into the control group and 37 patients into bupivacaine group (one patient withdrew consent before starting anesthesia). Seven from the control group and 4 from the bupivacaine group were excluded. Thus, 23 patients in the control group and 33 in the bupivacaine group completed the study. Preoperative demographics and operative findings were similar. Postoperative pain and analgesics use were not different between the 2 groups. Subgroup analysis determined that VAS pain score at 24 hours was significantly lower in the bupivacaine group (2.1) than in the control group (3.8, P = 0.007) when surgery exceeded 40 minutes. During immediate postoperative period, bupivacaine group needed less opioids (9.1 mg) than control (10.4 mg). CONCLUSION: Bupivacaine did not decrease pain and analgesics use. When surgery exceeded 40 minutes, bupivacaine use might be associated with less pain and less analgesics use.

Omental Torsion and Infarction Secondary to Omental Hernia in the Right Inguinal Canal.

Omental torsion secondary to inguinal hernia has rarely been reported as a cause of acute abdominal pain. However, in our case, omental infarction due to prolonged inguinal hernia-associated omental torsion led to the formation of a large omental mass with marginal fibrosis, and the patient presented with chronic abdominal pain. A 74-year-old man presented with complaints of lower abdominal pain for 1 month; subsequently, bilateral inguinal hernias were identified through inguinal ultrasonography. CT scans revealed that the greater omentum was trapped within the right inguinal canal, leading to omental torsion. The greater omentum, distal to the pedicle, appeared as a 30 cm-sized oblong fibrofatty mass in the right lower abdomen and pelvic cavity. Laparoscopic omentectomy with hernia repair was successfully performed.

A rare pericytic tumor of the kidney: The first case in Korea.

INTRODUCTION: A pericytic tumor is a group of mesenchymal neoplasm found in superficial tissues and only rarely described in viscera. The family of pericytic tumors includes glomus tumors and variants, myopericytoma including myofibroma, and angioleiomyoma etc. The renal pericytic tumor is extremely rare, and only few comprehensive discussions about this entity have been done. PRESENTATION OF CASE: A 58-year-old man was transferred to our institute with suspicions of renal cell carcinoma. The kidney dynamic computed tomography scan showed a 3 cm sized solid mass in the upper pole of the right kidney. Laparoscopic radical nephrectomy was performed due to the deep-seated mass. Pathological result confirmed that the kidney mass was renal pericytic tumor. DISCUSSION: Although general biological behavior of published renal pericytic tumors is likely to be benign, the clinicopathologic experiences are very limited. Therefore, we should evaluate the malignant potential of the entity according to the parameters proposed for soft tissue tumors, including tumor location, tumor size, growth pattern, cellularity, cytological atypia, and mitotic figures with atypical forms. The current case shows several worrisome features, including an extremely rare tumor location, partially infiltrative growth, and a mildly increased proliferating index, which resulted in it being classified as an uncertain malignant potential. CONCLUSION: We described the first case of renal pericytic tumor, addressing uncertain malignant potential, in a Korean male, which would be a distinct mesenchymal neoplasm differentiating from other groups of perivascular tumor families based on histological and immunohistochemical features.

Clinical significance of the De Ritis ratio for detecting prostate cancer in a repeat prostate biopsy.

Purpose: We evaluated factors predicting a positive repeat biopsy result in patients with an initial negative prostate biopsy result. Materials and Methods: This study included 124 patients in whom prostate cancer (PCa) was not detected in the initial transrectal ultrasound-guided prostate biopsy and who underwent repeat biopsy from January 2011 to December 2017. Patients without PCa in both initial and repeat prostate biopsies were designated as group 1 (n=82), and those in whom PCa was detected on a repeat prostate biopsy were designated as group 2 (n=42). Among group 2 patients, 6 had insignificant PCa according to the Epstein criteria and were combined with group 1 patients to make up group A (n=88). Patients with significant PCa were categorized as group B (n=36). We compared clinicopathologic characteristics between the groups. Results: Multivariate analysis showed that age (p=0.018) and detection of atypical small acinar proliferation (ASAP) or ≥3 cores of high-grade prostatic intraepithelial neoplasia (HGPIN) (p=0.011) on the initial biopsy were predictive factors for a positive result on a repeat biopsy. When we compared group A and group B, age (p=0.004) and the De Ritis ratio (p=0.024) were significantly higher in group B in the multivariate analysis. Conclusions: Age and the detection of ASAP or ≥3 cores of HGPIN on the initial biopsy were associated with detection of PCa on a repeat biopsy. Age and the De Ritis ratio were found to be predictive factors for the detection of clinically significant PCa on a repeat biopsy.

Direct observation of dislocation plasticity in high-Mn lightweight steel by in-situ TEM.

To gain the fundamental understanding of deformation mechanisms in an aluminum-containing austenitic high-Mn steel (Fe-32Mn-8.9Al-0.78 C (wt.%)), in-situ straining transmission electron microscopy (TEM) analysis is conducted. The in-situ observation during the deformation demonstrates that the plastic deformation is accommodated by the pronounced planar dislocation gliding followed by the formation of slip bands (SBs) and highly dense dislocation walls (HDDWs). Experimental evidences of the glide plane softening can be obtained from the interaction between the gliding perfect dislocations and the L'12 ordered precipitates in the austenite matrix. Furthermore, the observation of the localized cross-slip of dislocations at the slip band intersections enables to understand why slip bands are extensively developed without mutual obstructions between the slip bands. The enhanced strain hardening rate of the aluminum-containing austenitic high-Mn steels can be attributed to the pronounced planar dislocation glides followed by formation of extensive slip band which prevent premature failure by suppressing strain localization.

Outcomes of surgical treatments for rectovaginal fistula and prognostic factors for successful closure: a single-center tertiary hospital experiences.

PURPOSE: Rectovaginal fistula can result from various causes and diverse surgical procedures have developed as a result. We investigated the outcomes of surgical treatments for rectovaginal fistula according to causes and procedures. METHODS: Between 1998 and 2016, 92 patients underwent 128 operations for rectovaginal fistula. Prospectively collected data were recorded, and a retrospective review was conducted. RESULTS: The median age was 49 years, and low fistula occurred in 58 patients (63.0%). The most common cause was radiation therapy, followed by pelvic operation, birth injury, perineal operation, cancer invasion, and trauma. The most common procedure during the first operation was diverting ostomy alone, followed by transanal rectal advancement flap, sphincteroplasty with perineoplasty, bowel resection, fistulectomy with seton placement, and Martius flap. Thirty-one patients (33.7%) experienced successful closure after the first operation. Repeated operations were performed in 16 patients (17.4%), including gracilis muscle transpositions, stem cell injections, and Martius flaps. The overall success rate was 42.4% (n = 39). Radiation therapy and pelvic operation as cause of fistula were significantly poor prognostic factors (P = 0.010, P = 0.045) and Crohn disease had a tendency for poor prognostic factors (P = 0.058). CONCLUSION: Radiation therapy and pelvic operation for cancer were more common causes than birth injury, and these causes of rectovaginal fistula were the most important prognostic factors. An individualized approach and repeated surgeries with complex or newly developed procedures, even among high-risk causes of fistula, may be necessary to achieve successful closure.

Changes in Weight and Health-Related Behavior Using Smartphone Applications in Patients With Colorectal Polyps.

OBJECTIVE: To assess the effectiveness of using a smartphone application for weight loss as well as a change in health-related behavior in patients with colorectal polyps over 3 months. DESIGN: Randomized, controlled pilot trial. SETTING: The Department of Family Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea. PARTICIPANTS: Adults aged 25-65 years who were diagnosed with colorectal polyps. INTERVENTIONS: A comparison of smartphone application data, with exercise and food intake diary data over 3 months. MAIN OUTCOME MEASURES: Primary outcomes were weight reduction and an increase in physical activity. Secondary outcomes included changes in dietary intake, such as that of vegetables, fruits, and fatty food. ANALYSIS: Student t test was used for continuous variables, and chi-square test for categorical variables. RESULTS: Participants using the smartphone application experienced significant weight reduction compared with participants in the control group (mean change = -1.25 vs -0.42 kg; SD = 0.42 vs 1.23 kg). Moreover, use of the application and strict adherence to it significantly increased the level of physical activity (mean change = 1.57 vs 0.71 strenuous exercises/wk; SD = 1.09 vs 0.96 strenuous exercise/wk). CONCLUSIONS AND IMPLICATIONS: Smartphone applications could be potential tools for weight control and physical activity in patients with colorectal polyps. Future larger randomized, controlled trials over a prolonged period are warranted to confirm these findings.

Effect of tungsten on the oxidation of alumina-forming austenitic stainless steel.

As more W replaced Mo in alumina-forming austenitic stainless steels, weight gain by oxidation decreased after 336 h at 1053 K. Electron microscopy revealed slower growth of scale in the presence of more numerous second phases by W addition. The retardation of oxidation was attributed to the necessary partitioning of W in front of the metal-oxide interface. The W-rich second phases interacted with growing oxides and finally transformed to fine particles of metallic W alloy within the scale.

Investigation of the Localized Corrosion and Passive Behavior of Type 304 Stainless Steels with 0.2⁻1.8 wt % B.

The pitting corrosion resistance and passive behavior of type 304 borated stainless steels (Febalance⁻18Cr⁻12Ni⁻1.5Mn⁻(0.19, 0.78, and 1.76 wt %)B) manufactured through conventional ingot metallurgy were investigated. The alloys were composed of an austenitic matrix and Cr2B phase, and the volume fraction of Cr2B increased from 1.68 to 22.66 vol % as the B content increased from 0.19 to 1.76 wt %. Potentiodynamic polarization tests measured in aqueous NaCl solutions revealed that the pitting corrosion resistance was reduced as the B content increased and the pits were initiated at the matrix adjacent to the Cr2B phase. It was found that the reduced resistance to pitting corrosion by B addition was due to the formation of more defective and thinner passive film and increased pit initiation sites in the matrix.

Clinical significance of microRNA-21 expression in disease progression of patients with hepatocellular carcinoma.

AIM: Aberrant microRNA (miR) expression is associated with hepatocellular carcinoma (HCC). MATERIALS & METHODS: Here, we investigated the clinical significance of miR-21 and miR-31 for HCC-specific prognostic effect. HCC patients (n = 93) who underwent liver biopsy or surgical resection were enrolled, and HCC tissues and paired adjacent nontumor liver tissues were collected and analyzed for miRs expression. RESULTS: MiR-21 expression was significantly upregulated in HCC tissues relative to nontumor tissues. Both miR-21 and miR-31 expression in HCC tissues did not predict overall survival; however, miR-21 was considered an independent predictor of disease progression together with portal vein thrombosis and higher Barcelona Clinical Liver Cancer stage. CONCLUSION: Elevated miR-21 expression might represent a biomarker for HCC prognosis.

Totally laparoscopic associating liver partition and portal vein ligation for staged hepatectomy using anterior approach in HCC patient with Type II portal vein anomaly: a case report.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has gradually developed because of rapid hypertrophy of the future liver remnant volume (FLR) in spite of high morbidity. To minimize the patient's postoperative pain and morbidity including wound complication caused by two consecutive major abdominal operations, we adopted a totally laparoscopic approach and used a composite mesh graft. Also, to maximize the oncologic efficacy, we adopted the "anterior approach" technique. A 44-year-old woman with large hepatitis B-related hepatocellular carcinoma (HCC) in her right lobe was transferred to our hospital for surgical treatment. Preoperatively predicted FLR by a CT scan was 21% and type II portal vein anomaly was detected. A totally laparoscopic approach was planned. During the first stage operation, right anterior and posterior portal veins were meticulously dissected and tied. After parenchymal transection by the "anterior approach" technique, two glissonian pedicles of the right liver were individually isolated. A composite mesh graft was used to prevent severe adhesion on both liver partition surfaces. During the second-stage operation, 9 days after the first stage operation, the two isolated glissonian pedicles were initially transected. After full mobilization of the right lobe, the right hepatic vein was also transected. The right lobe was removed through the Pfannenstiel incision. She was discharged 7 days after the second stage operation. Her postoperative course was uneventful and there was no HCC recurrence for 15 months after hepatectomy. A totally laparoscopic ALPPS procedure can be a feasible technique that ensures patient safety and oncologic superiority, even in patients with complicated anatomical variation.