Antioxidative and immunity-enhancing effects of heat-killed probiotic Enterococcus faecium KU22001 without toxin or antibiotic resistance.

This study evaluated the probiotic properties, safety profile, and antioxidative and immune system-enhancing effects of Enterococcus faecium strains isolated from human infant feces. E. faecium KU22001, E. faecium KU22002, and E. faecium KU22005 exhibited potential probiotic properties; however, to eliminate concerns about toxin production and antibiotic resistance, the E. faecium strains were heat-treated prior to experimental usage. E. faecium KU22001 showed the highest antioxidant activity and lowest reactive oxygen species production among the three strains. The immune system-enhancing effects of heat-killed E. faecium strains were evaluated using a nitric oxide assay. E. faecium KU22001 induced an increase in the mRNA expression of inducible nitric oxide synthase, cyclooxygenase-2, and proinflammatory cytokines, including tumor necrosis factor-α, interleukin-1ß, and interleukin-6 in RAW 264.7 cells. Furthermore, E. faecium KU22001 activated the mitogen-activated protein kinase pathway, which was a key regulator of the immune system. These results demonstrate the potential use of E. faecium KU22001 as a multifunctional food material.

Enhanced control efficacy of Bacillus subtilis NM4 via integration of chlorothalonil on potato early blight caused by Alternaria solani.

Early blight caused by Alternaria solani is a common foliar disease of potato around the world, and serious infections result in reduced yields and marketability due to infected tubers. The major aim of this study is to figure out the synergistic effect between microorganism and fungicides and to evaluate the effectiveness of Bacillus subtilis NM4 in the control of early blight in potato. Based on its colonial morphology and a 16S rRNA analysis, a bacterial antagonist isolated from kimchi was identified as B. subtilis NM4 and it has strong antifungal and anti-oomycete activity against several phytopathogenic fungi and oomycetes. The culture filtrate of strain NM4 with the fungicide effectively suppressed the mycelial growth of A. solani, with the highest growth inhibition rate of 83.48%. Although exposure to culture filtrate prompted hyphal alterations in A. solani, including bulging, combining it with the fungicide caused more severe hyphal damage with continuous bulging. Surfactins and fengycins, two lipopeptide groups, were isolated and identified as the main compounds in two fractions using LC-ESI-MS. Although the surfactin-containing fraction failed to inhibit growth, the fengycin-containing fraction, alone and in combination with chlorothalonil, restricted mycelial development, producing severe hyphal deformations with formation of chlamydospores. A pot experiment combining strain NM4, applied as a broth culture, with fungicide, at half the recommended concentration, resulted in a significant reduction in potato early blight severity. Our results indicate the feasibility of an integrated approach for the management of early blight in potato that can reduce fungicide application rates, promoting a healthy ecosystem in agriculture.

Out-of-pocket costs associated with chronic respiratory diseases in Korean adults.

OBJECTIVES: Chronic respiratory diseases (CRDs) are a burden on both individuals and society. While previous literature has highlighted the clinical burden and total costs of care, it has not addressed patients' direct payments. This study aimed to estimate the incremental healthcare costs associated with patients with CRDs, specifically out-of-pocket (OOP) costs. METHODS: We used survey data from the 2019 Korea Health Panel Survey to estimate the total OOP costs of CRDs by comparing the annual hospitalizations, outpatient visits, emergency room visits, and medications of patients with and without CRDs. Generalized linear regression models controlled for differences in other characteristics between groups. RESULTS: We identified 222 patients with CRDs, of whom 166 were aged 65 years and older. Compared with the non-CRD group, CRD patients spent more on OOP costs (238.3 USD on average). Incremental costs were driven by outpatient visits and medications, which are subject to a coinsurance of 30% or more and may include items not covered by public insurance. Moreover, CRD patients aged 50-64 years incurred the highest incremental costs. DISCUSSION: The financial burden associated with CRDs is significant, and outpatient visits and medications constitute the largest components of OOP spending. Policymakers should introduce appropriate strategies to reduce CRD-associated burdens.

Baccaramiones A-D, Four Highly Oxygenated and Rearranged Trinorditerpenoids from Baccaurea ramiflora.

Baccaramiones A-D (1-4), four highly oxygenated and rearranged trinorditerpenoids, were isolated from Baccaurea ramiflora. Compound 1 is a 1(10 → 5)-abeo-15,16,17-trinor-ent-abietane featuring a unique 5/6/6 spirocyclic scaffold, and 2-4 are the first example of a novel 20(10 → 5)-abeo-15,16,17-trinor-ent-abietane skeleton. Their structures were established by spectroscopic analysis, X-ray crystallography, and electronic circular dichroism calculations. A plausible biosynthetic pathway for 1-4 was proposed. Interestingly, compounds 3 and 4 exhibited significant immunosuppressive activities against concanavalin A-induced T cell proliferation and lipopolysaccharide-induced B cell proliferation in vitro.

Butyl succinate-mediated control of Bacillus velezensis ce 100 for apple anthracnose caused by Colletotrichum gloeosporioides.

AIMS: Microbial biocontrol agents have become an effective option to mitigate the harmfulness of chemical pesticides in recent years. This study demonstrates the control efficacy of Bacillus velezensis CE 100 on the anthracnose causal agent, Colletotrichum gloeosporioides. METHODS AND RESULTS: In vitro antifungal assays revealed that the culture filtrate and volatile organic compounds of B. velezensis CE 100 strongly restricted the mycelial development of C. gloeosporioides. Moreover, a bioactive compound, butyl succinate, was isolated from the n-butanol crude extract of B. velezensis CE 100 (bce), and identified by liquid chromatography-electrospray ionization hybrid ion-trap and time-of-flight mass spectrometry (LC-ESI-QTOF-MS) and one-dimensional (1D) and two-dimensional (2D) nuclear magnetic resonance (NMR). Treatment with purified butyl succinate at a concentration of 300 µg mL-1 strongly controlled conidial germination of C. gloeosporioides with an inhibition rate of 98.66%, whereas butyl succinate at a concentration of 400 µg mL-1 showed weak antifungal action on the mycelial growth of C. gloeosporioides with an inhibition rate of 31.25%. Scanning electron microscopy revealed that the morphologies of butyl succinate-treated hyphae and conidia of C. gloeosporioides were severely deformed with shriveled and wrinkled surfaces. Furthermore, butyl succinate was able to control carbendazim-resistant C. gloeosporioides, demonstrating that it could be a promising agent for the suppression of other carbendazim-resistant fungal pathogens. An in vivo biocontrol assay demonstrated that the strain ce 100 broth culture and butyl succinate showed higher control efficacy on apple anthracnose than bce. CONCLUSIONS: Our findings provide insight into the antifungal potential of B. velezensis  ce 100 and its butyl succinate for efficient control of phytopathogenic fungi, such as C. gloeosporiodes, in plant disease protection. This is the first study to demonstrate the antifungal potential of bacteria-derived butyl succinate for control of C. gloeosporioides.

Sumatranins A-J: Lignans with Immunosuppressive Activity from Cleistanthus sumatranus.

Chemical investigation of the twigs of Cleistanthus sumatranus (Phyllanthaceae) led to the isolation of 10 undescribed lignans, sumatranins A-J (1-10). Compounds 1-4 are unprecedented furopyran lignans characterized by a unique 2,3,3a,9a-tetrahydro-4H-furo[2,3-b]chromene heterotricyclic framework. Compounds 9 and 10 are rare 9'-nor-dibenzylbutane lignans. Structures were established based on analyses of spectroscopic data, X-ray crystallographic data, and experimental ECD spectra. Immunosuppressive assays revealed compounds 3 and 9 displayed moderate inhibitory effects with good selectivity indexes against LPS-induced B lymphocyte proliferation.

Clinical Outcomes of Patients with Benign Peptic Ulcer Bleeding After an Emergency Endoscopy Based on Patient Location.

BACKGROUND AND AIMS: In the efforts toward reducing bleeding-related mortality, it is crucial to determine the risk factors for rebleeding after endoscopic hemostasis in benign peptic ulcer (BPU). METHODS: Between 2013 and 2017, the medical records of 864 BPU patients were selected from 5076 who had undergone emergency endoscopy for suspected upper gastrointestinal bleeding. Patients who visited the emergency room or were hospitalized for other illnesses were selected. The primary end point was rebleeding within 30 days after initial endoscopy. The risk factors of rebleeding and subgroup analyses according to patient location were evaluated. RESULTS: Among 864 BPU bleeding patients, rebleeding after completion of BPU bleeding occurred in 140 (16.2%). Initial indicators of hypotension (OR 1.878, p = 0.005) and Forrest classes Ia (OR 25.53, p < 0.001), Ib (OR 27.91, p = 0.005), IIa (OR 21.41, p < 0.001), and IIb (OR 23.74, p < 0.001) were independent risk factors of rebleeding compared to Forrest class III, and being inpatients (OR 1.75, p = 0.01). Compared to the outpatients, the inpatients showed significantly higher rebleeding rates (25.6% vs 13.8%, p < 0.001), predictive bleeding scores, red blood transfusion counts, proportion of Forrest classes Ia, Ib, and IIb (p < 0.001), and overall mortality rates (68.8% vs 34.0%, p < 0.001). CONCLUSIONS: Patient location was a novel predictive factor of BPU rebleeding. Particularly, being an inpatient correlated with increased rebleeding. Furthermore, Forrest classes Ia, Ib, IIa, and IIb were predictive of rebleeding not only the included BPUs, but also in the inpatient or outpatient groups.

Circularly Polarized Light Can Override and Amplify Asymmetry in Supramolecular Helices.

Circularly polarized light (CPL) is an inherently chiral entity and is considered one of the possible deterministic signals that led to the evolution of homochirality. While accumulating examples indicate that chirality beyond the molecular level can be induced by CPL, not much is yet known about circumstances where the spin angular momentum of light competes with existing molecular chiral information during the chirality induction and amplification processes. Here we present a light-triggered supramolecular polymerization system where chiral information can both be transmitted and nonlinearly amplified in a "sergeants-and-soldiers" manner. While matching handedness with CPL resulted in further amplification, we determined that opposite handedness could override molecular information at the supramolecular level when the enantiomeric excess was low. The presence of a critical chiral bias suggests a bifurcation point in the homochirality evolution under random external chiral perturbation. Our results also highlight opportunities for the orthogonal control of supramolecular chirality decoupled from molecular chirality preexisting in the system.

Circularly Polarized Light-Driven Supramolecular Chirality.

Introduction of asymmetry into a supramolecular system via external chiral stimuli can contribute to the understanding of the intriguing homochirality found in nature. Circularly polarized light (CPL) is regarded as a chiral physical force with right- or left-handedness. It can induce and modulate supramolecular chirality due to preferential interaction with one enantiomer. Herein, this review focuses on the photon-to-matter chirality transfer mechanisms at the supramolecular level. Thus, asymmetric photochemical reactions are reviewed, and the creation of a chiral bias upon CPL irradiation is discussed. Furthermore, the possible mechanisms for the amplification and propagation of the bias into the supramolecular level are outlined based on the nature of the photochromic building block. Representative examples, including azobenzene derivatives, polydiacetylene, bicyclic ketone, polyfluorenes, Cn -symmetric molecules, and inorganic nanomaterials, are presented.

Spicatulides A-G, Phenolic-Monoterpenoid Hybrids from Chloranthus spicatus.

Spicatulides A-G (1-7), seven new phenolic-monoterpenoid hybrid molecules, along with two known compounds, 8 and 9, were isolated and identified from Chloranthus spicatus. Compound 1 represents an unprecedented skeleton featuring an aryl-fused 2-oxabicyclo[4.3.1]decane moiety, and compound 2 is the first example of a denudaquinol-normonoterpenoid adduct. Their structures with absolute configurations were elucidated on the basis of spectroscopic data analyses and TDDFT-ECD calculations. Compounds 3, 5, 6, and 9 exhibited the activity of reducing lipogenesis in HepG2 cells in a dose-dependent manner.

Diterpenoids from Sauropus spatulifolius Leaves with Antimicrobial Activities.

As a plant used in both food and medicine, Sauropus spatulifolius is consumed widely as a natural herbal tea, food source, and Chinese medicine. Inspired by its extensive applications, we conducted a systematic phytochemical study of the leaves of S. spatulifolius. Thirteen new diterpenoids, sauspatulifols A-M (1-13), including four ent-cleistanthane-type diterpenoids (1-4), eight 15,16-di-nor-ent-cleistanthane-type diterpenoids (5-12), and one 17-nor-ent-pimarane-type diterpenoid (13) as well as one known diterpenoid, cleistanthol (14), were isolated. All of these diterpenoids feature a 2α,3α-dihydroxy unit within the A ring, and their structures were elucidated by spectroscopic data analysis, electronic circular dichroism calculations, and single-crystal X-ray diffraction analysis. Compound 14 displayed moderate inhibitory activity against Staphylococcus aureus, Staphylococcus epidermidis, Bacillus subtilis, and Shigella flexneri with the same minimum inhibitory concentration value of 12 µg/mL as well as activity against vesicular stomatitis virus and influenza A virus.

Part Affinity Fields and CoordConv for Detecting Landmarks of Lumbar Vertebrae and Sacrum in X-ray Images.

With the prevalence of degenerative diseases due to the increase in the aging population, we have encountered many spine-related disorders. Since the spine is a crucial part of the body, fast and accurate diagnosis is critically important. Generally, clinicians use X-ray images to diagnose the spine, but X-ray images are commonly occluded by the shadows of some bones, making it hard to identify the whole spine. Therefore, recently, various deep-learning-based spinal X-ray image analysis approaches have been proposed to help diagnose the spine. However, these approaches did not consider the characteristics of frequent occlusion in the X-ray image and the properties of the vertebra shape. Therefore, based on the X-ray image properties and vertebra shape, we present a novel landmark detection network specialized in lumbar X-ray images. The proposed network consists of two stages: The first step detects the centers of the lumbar vertebrae and the upper end plate of the first sacral vertebra (S1), and the second step detects the four corner points of each lumbar vertebra and two corner points of S1 from the image obtained in the first step. We used random spine cutout augmentation in the first step to robustify the network against the commonly obscured X-ray images. Furthermore, in the second step, we used CoordConv to make the network recognize the location distribution of landmarks and part affinity fields to understand the morphological features of the vertebrae, resulting in more accurate landmark detection. The proposed network was evaluated using 304 X-ray images, and it achieved 98.02% accuracy in center detection and 8.34% relative distance error in corner detection. This indicates that our network can detect spinal landmarks reliably enough to support radiologists in analyzing the lumbar X-ray images.

Antifungal Potential of Bacillus velezensis CE 100 for the Control of Different Colletotrichum Species through Isolation of Active Dipeptide, Cyclo-(D-phenylalanyl-D-prolyl).

Colletotrichum species are important fungal pathogens causing anthracnose of tropical and subtropical fruit and vegetable crops. Dual culture assay indicated that Bacillus velezensis CE 100 was a strong antagonist against C. acutatum, C. coccodes, C. dematium, and C. gloeosporioides. The volatile organic compounds produced by B. velezensis CE 100 affected mycelial growth of Colletotrichum species tested in our study and caused twisted hyphal structures of all these fungal species. Chloroform crude compounds of B. velezensis CE 100 inhibited four Colletotrichum species in a concentration-dependent manner and induced severe damage in hyphal morphology of these fungal pathogens, including swelling, bulging, and multiple branching. Moreover, the active cyclic dipeptide, cyclo-(D-phenylalanyl-D-prolyl), was isolated from chloroform crude extract and identified by nuclear magnetic resonance (NMR) and mass spectrometry. The inhibitory effect of cyclo-(D-phenylalanyl-D-prolyl) on conidial germination of C. gloeosporioides occurred in a concentration-dependent manner. The conidial germination rate was completely inhibited by a concentration of 3 mg/mL of cyclo-(D-phenylalanyl-D-prolyl). Scanning electron micrographs revealed that the exposure to cyclic dipeptide resulted in seriously deformed hyphae and conidia with shriveled surfaces in dipeptide-treated C. gloeosporioides. Therefore, active dipeptide-producing B. velezensis CE 100 is a promising biocontrol agent for Colletotrichum species causing anthracnose.

Sublyratins A-O, Labdane-Type Diterpenoids from Croton sublyratus.

Fifteen new labdane-type diterpenoids, sublyratins A-O (1-15), along with four known analogues (16-19) were isolated from the aerial parts of Croton sublyratus. Their structural assignments were challenging due to the stereoisomeric features evident and were achieved by analyzing comprehensively the spectroscopic data and electronic circular dichroism spectra and using X-ray crystallographic analysis. Compounds 9 and 16-18 displayed cytotoxic activity against the HL-60 cell line with IC50 values of 1.5-2.8 µM.

Hierarchically Well-Developed Porous Graphene Nanofibers Comprising N-Doped Graphitic C-Coated Cobalt Oxide Hollow Nanospheres As Anodes for High-Rate Li-Ion Batteries.

Hierarchically well-developed porous graphene nanofibers comprising N-doped graphitic C (NGC)-coated cobalt oxide hollow nanospheres are introduced as anodes for high-rate Li-ion batteries. For this, three strategies, comprising the Kirkendall effect, metal-organic frameworks, and compositing with highly conductive C, are applied to the 1D architecture. In particular, NGC layers are coated on cobalt oxide hollow nanospheres as a primary transport path of electrons followed by graphene-nanonetwork-constituting nanofibers as a continuous and secondary electron transport path. Superior cycling performance is achieved, as the unique nanostructure delivers a discharge capacity of 823 mAh g-1 after 500 cycles at 3.0 A g-1 with a low decay rate of 0.092% per cycle. The rate capability is also noteworthy as the structure exhibits high discharge capacities of 1035, 929, 847, 787, 747, 703, 672, 650, 625, 610, 570, 537, 475, 422, 294, and 222 mAh g-1 at current densities of 0.5, 1.5, 3, 5, 7, 10, 12, 15, 18, 20, 25, 30, 40, 50, 80, and 100 A g-1 , respectively. In view of the highly efficient Li+ ion/electron diffusion and high structural stability, the present nanostructuring strategy has a huge potential in opening new frontiers for high-rate and long-lived stable energy storage systems.

Liver receptor homolog-1 regulates mouse superoxide dismutase 2.

Liver receptor homolog-1 (LRH-1) is a nuclear receptor that plays an important role in the regulation of bile acid biosynthesis, cholesterol reverse transport, steroidogenesis, and exocrine pancreatic enzyme production. In the current study, previously published data from a genome wide analysis of LRH-1 binding in the liver were re-analyzed to identify new LRH-1 targets and propose new roles for LRH-1 in the liver. Superoxide dismutase 2 (Sod2) was identified, which contains putative LRH-1 binding sites in the proximal promoter. When hepatocytes were treated with the LRH-1 agonist RJW101, Sod2 expression was dramatically increased and reactive oxygen species (ROS) production, which was induced by a high concentration of palmitate, was significantly reduced. A LRH-1 binding site was mapped to -288/-283 in the Sod2 promoter, which increased Sod2 promoter activity in response to LRH-1 and its agonist. LRH-1 binding to this site was confirmed using a chromatin immunoprecipitation assay. These results suggest that Sod2 is a target gene of LRH-1, and that LRH-1 agonists can mediate a reduction in ROS production and oxidative stress driven by an excess of fatty acids, as exhibited in nonalcoholic fatty liver disease.

Effects of a complex rehabilitation program on edema status, physical function, and quality of life in lower-limb lymphedema after gynecological cancer surgery.

OBJECTIVE: The purpose of this study was to investigate the effects of a complex rehabilitation (CR) program and complex decongestive therapy (CDT) on edema status, physical function, and quality of life in patients with unilateral lower-limb lymphedema after gynecologic cancer surgery. METHODS: In this randomized pilot study, 40 patients with secondary unilateral lymphedema, after gynecologic surgery for cervical, endometrial, or ovarian cancer, that had been diagnosed based on clinical assessment and 10% volume differences between the legs were randomly assigned to the CDT (n=20) and CDT combined with CR (CRCDT; n=20) groups. CR comprised stretching, strengthening, and aerobic exercises performed for 40min, five times a week for 4weeks. Intensive CDT was administered by a physical therapist during weeks 0-2 and by the patients themselves during weeks 2-4. Limb volume, bioimpedance, muscular strength, EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30) score, 30-s chair stand test, muscular strength, and GCLQ-K (Korean version of the Gynecological Cancer Lymphedema Questionnaire) score were assessed at baseline and after 4weeks of treatment. RESULTS: The edema status, fatigue, pain, and GCLQ-K scores were significantly improved in both groups after the 4-week intervention (P<0.05). Physical function and fatigue in EORTC QLQ-C30 and the 30-s chair stand test and quadriceps muscle strength were significantly improved in the CRCDT group compared with the CDT group (P<0.05). CONCLUSIONS: CR improves physical function, fatigue, and muscular strength without increasing edema status in patients with unilateral lower-limb lymphedema after gynecologic cancer surgery.

New Korean isolates of Pepper mild mottle virus (PMMoV) differ in symptom severity and subcellular localization of the 126 kDa protein.

Two isolates of Pepper mild mottle virus (PMMoV) were selected from a nationwide survey of pepper fields in South Korea in 2014 and 2015, in which Cucumber mosaic virus was also detected; the two PMMoV isolates, Sangcheong 47 (S-47, KX399390) and Jeongsong 76 (J-76, KX399389), share ~99% nucleotide and amino acid identity and are closely related to Japanese and Chinese isolates at the nucleotide level. Amino acid sequence comparisons revealed 99.73, 99.81, 98.44, and 100% identity in the ORF1, ORF2, MP, and CP, respectively, between S-47 and J-76. In addition, we generated infectious clones of S-47 and J-76, and T7 promoter driven transcripts of each inoculated to Nicotiana benthamiana produced very severe symptoms, whereas only mild symptoms developed in Capsicum annuum. Gene silencing suppressor function of 126 kDa and cytoskeleton-connected plasmodesmata localization of movement protein of S-47 and J-76 showed no difference between isolates, whereas 126 kDa of J-76 clearly formed intracellular aggregates not observed with S-47 126 kDa protein. Differences between these isolates in 126/183 kDa-related functions including subcellular localization suggest that differential interactions with host proteins may affect symptom development in C. annuum.

Whole brain radiation dose reduction for primary central nervous system lymphoma patients who achieved partial response after high-dose methotrexate based chemotherapy.

Background: The whole brain radiotherapy (WBRT) dose for primary central nervous system lymphoma (PCNSL) patients who achieved complete response after induction chemotherapy was recently reduced to 23.4 Gy, but the optimal radiation dose for patients who achieved partial response (PR) is controversial. The aim of this study was to investigate the feasibility of reduced-dose WBRT for patients who achieved PR. Method: We retrospectively reviewed the medical records of PCNSL patients who were treated with high-dose methotrexate based chemotherapy. We compared treatment outcomes between the patients who received WBRT at either 36 Gy or 45 Gy. Results: The overall survival (OS) and intracranial progression-free survival (IC-PFS) was 66.3% and 42.6% at 5 years, respectively. There was no significant difference in treatment outcomes between the patients who received 36 Gy and 45 Gy, especially among patients who achieved PR. Three-year OS was 100% and 83.3% for 36 Gy and 45 Gy group, respectively (P = 0.313). Three-year IC-PFS was 60.0% and 66.7% for 36 Gy and 45 Gy group, respectively (P = 0.916). Conclusion: Findings of our study might provide a possibility for dose-reduction in patients achieving PR to induction chemotherapy, which may in turn reduce delayed neurologic sequelae. However, the number of patients included in this study was too small to lead to a concrete conclusion, thus further study is needed.

Radiofrequency Ablation with an Internally Cooled Monopolar Directional Electrode: Ex Vivo and in Vivo Experimental Studies in the Liver.

PURPOSE: To evaluate the feasibility of using an internally cooled directional electrode (ICDE) to create sufficient directional ablation in the desired area and to investigate whether use of the ICDE reduces thermal injury to the adjacent organs. MATERIALS AND METHODS: The animal care and use committee approved this animal study. In ex vivo studies of bovine livers and colons, temperature was measured in both ablation and nonablation directions with the ICDE, temperature at the liver-colon interface and the presence of burns on the colon were evaluated with each ICDE and internally cooled conventional electrode (ICCE), and the ablation area with the use of three ICDEs in the switching multichannel mode was evaluated. In an in vivo study of 10 pigs, 11 ablations were performed by using three ICDEs in the switching multichannel mode. In addition, the difference in thermal injury to the gallbladder and stomach was compared between use of the ICDE and the ICCE. Mann-Whitney test and the Fisher exact test were used for statistical analysis. RESULTS: In the ex vivo study, the hepatic temperature in the nonablation direction was lower than 50°C; temperature higher than 47°C was maintained for less than 3 minutes, even 0.5 cm away from the ICDE; and the temperature at the liver-colon interface did not increase above 50°C. In the switching multichannel mode, a fused coagulation zone was created. In the in vivo study, confluent ablation was created in the inner circle of three ICDEs with a mean interelectrode distance of less than 2.6 cm. Use of the ICDE did not create a moderate-to-severe gallbladder wall injury in any of the pigs, but use of the ICCE caused injury in three of the five pigs (P > .05). The ICDE caused moderate-to-severe gastric wall injury at one of eight ablations, and the ICCE caused injury at eight of nine ablations (P < .05). CONCLUSION: Use of an ICDE can create a sufficient ablation in the desired direction and can decrease thermal injury to the adjacent organs.