Risk of stricture after endoscopic submucosal dissection in the cervical esophagus and efficacy of local steroid injection for stricture prevention (with video).

BACKGROUND AND AIMS: There is a high incidence of stricture after endoscopic submucosal dissection (ESD) for cervical esophageal cancer. We aimed to elucidate the risk factors for stricture and to evaluate the efficacy of steroid injection for stricture prevention in the cervical esophagus. METHODS: We retrospectively analyzed 100 patients who underwent ESD for cervical esophageal cancer to (1) identify the factors associated with stricture among patients who did not receive steroid injection, and (2) compare the incidence of stricture between patients with and without steroid injection. RESULTS: Among 48 patients who did not receive steroid injection, there were significant differences in tumor size (P = .026), resection time (P = .028), and circumferential extent of the mucosal defect (P = .005) between patients with stricture (n = 5) and without stricture (n = 43). Compared with patients without steroid injection, patients with steroid injection had a significantly lower incidence of stricture when the post-ESD mucosal defect was <3/4 and ≥1/2 (40% versus 8%; P = .039). For the patients with a post-ESD mucosal defect of ≥3/4 (n = 13), local steroid injection was performed for all of them, and 6 (46%) developed stricture. CONCLUSIONS: Patients who underwent ≥1/2 circumferential resection were at high risk of cervical esophageal stricture. Steroid injection had a stricture prevention effect in patients with <3/4 and ≥1/2 circumferential resection, but seemed to be insufficient in preventing stricture in patients with ≥3/4 circumferential resection.

Size-dependent catalytic hydrogen production via methane decomposition and aromatization at a low-temperature using Co, Ni, Cu, Mo, and Ru nanometals.

Catalysts of methane decomposition to hydrogen and aromatization are inevitable for the development of natural gas applications. Metal catalysts have been developed to achieve highly efficient methane decomposition and aromatization under 1000 K using various substrates, such as zeolites and silica. Here, we performed a consecutive study on methane decomposition using Co-, Ni-, Cu-, Mo-, and Ru-based nanocatalysts in the bulk, on a SiO2 substrate, and in mesoporous SiO2. The crystallite sizes of the bulk nanocatalysts, and nanocatalysts on nonporous and mesoporous SiO2 were controlled to 80-85, 30-70, and 3-11 nm, respectively. The nanocatalysts on mesoporous SiO2 exhibited high activity on hydrogen and benzene productions via methane decomposition, owing to the nanosize effect of the nanocatalysts and adsorption potentials in the SiO2 mesopores. In particular, the Ni nanocatalysts on mesoporous SiO2 exhibited hydrogen production activity from 650 K, which was the lowest temperature, compared with those in previous reports on hydrogen production. In addition, the catalytic activity was maintained for over 15 h at 650 and 800 K with recyclability. The overoxidation of Ni species in the SiO2 mesopores might have promoted the transformation reaction of CH4 to CHx and prevented coking by the largeness of the SiO2 mesopores in comparison with microporous media.

Ankle positions and exercise intervals effect on the blood flow velocity in the common femoral vein during ankle pumping exercises.

[Purpose] The aim of this study was to identify the most effective method of performing ankle pumping exercises. [Subjects and Methods] The study subjects were 10 men. We measured time-averaged maximum flow velocity and peak systolic velocity in the common femoral vein using a pulse Doppler method with a diagnostic ultrasound system during nine ankle pumping exercises (three different ankle positions and three exercise intervals). Changes of blood flow velocity during ankle pumping exercises with different ankle positions and exercise intervals were compared. [Result] Peak systolic velocity of the leg-up position showed significantly lower values than those of the supine and head-up positions. For all exercise intervals, the increased amount of blood flow velocity in the leg-up position was significantly lower than that in the head-up and supine positions. [Conclusion] Ankle positions and exercise intervals must be considered when performing effective ankle pumping exercises.

Effect of elastic stockings and ankle positions on the blood velocity in the common femoral vein.

[Purpose] The aim of this study was to identify how to effectively use elastic stockings. [Subjects and Methods] Ten young healthy men participated in this study. Time-averaged maximum flow velocity in the common femoral vein was measured for 20 seconds using a pulse Doppler method with a diagnostic ultrasound system under six conditions (three different positions and with and without stockings). Changes of blood flow velocity were compared. [Results] Elastic stockings did not affect the blood flow velocity in the common femoral vein. For both the with stockings condition and without stockings condition, the time-averaged maximum flow velocity in the head-up position was significantly lower than that in the supine and leg-up positions. Time-averaged maximum flow velocity showed no significant difference between the supine position and leg-up position. [Conclusion] Elastic stockings did not affect the blood flow velocity in the common femoral vein, but ankle positions did affect it. Further studies of patients with venous insufficiency are needed.

Malnutrition suppresses improvements in depression symptoms in older adult patients with stroke undergoing convalescent rehabilitation.

BACKGROUND & AIMS: Depression symptoms are both prevalent and associated with poor prognosis in patients with convalescent stroke. Therefore, the improvement of depression symptoms is important for patients with convalescent stroke. This study aimed to examine whether malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and its components are associated with improvements in depression symptoms in patients with stroke undergoing rehabilitation. METHODS: This was a retrospective cohort study of older adult patients with convalescent stroke. Inclusion criteria comprised patients aged ≥65 years experiencing their first occurrence of stroke and admitted for rehabilitation therapy. Patients were classified into either the malnutrition or normal nutrition groups based on the diagnosis of malnutrition using the GLIM criteria. The Geriatric Depression Screening Scale (GDS)-15 was used to evaluate depression symptoms. The primary outcome of the study was the change in depression symptoms, indicating a change in GDS score from admission to discharge. The association between malnutrition diagnosed using the GLIM criteria and change in depression symptoms was assessed using multiple regression analysis. Additionally, associations with the constructs of the GLIM criteria were investigated. RESULTS: The malnutrition group comprised 64 (45%) patients, with a mean age of 78.2 years; 77 (54%) and 66 (46%) were males and females, respectively. Multiple regression analysis showed that malnutrition, diagnosed using the GLIM criteria (ß: -0.306, p < 0.001), was independently associated with changes in depression symptoms. Moreover, the GLIM criterion component of reduced muscle mass (ß: -0.235, p < 0.001) demonstrated a negative association with a change in depression symptoms. CONCLUSION: Malnutrition and reduced muscle mass, diagnosed using the GLIM criteria in patients with stroke undergoing convalescent rehabilitation, were found to suppress the improvement of depression symptoms.