Analysis of prognostic factors for postoperative complications and mortality in elderly patients undergoing emergency surgery for intestinal perforation or irreversible intestinal ischemia.

Purpose: Because the global geriatric population continues to increase, the assessment of emergency surgical outcomes in elderly patients with acute peritonitis will become more important. Methods: A retrospective review was conducted on the data of 174 elderly patients who underwent emergency surgery for intestinal perforation or intestinal infarction between June 2010 and November 2022. We conducted an analysis of the risk factors associated with postoperative complications and mortality by evaluating the characteristics of patients and their surgical outcomes. Results: In our study, most patients (94.3%) had preexisting comorbidities, and many patients (84.5%) required transfer to the intensive care unit following emergency surgery. Postoperative complications were observed in 84 individuals (48.3%), with postoperative mortality occurring in 29 (16.7%). Multivariate analysis revealed preoperative acute renal injury, hypoalbuminemia, and postoperative ventilator support as significant predictors of postoperative mortality. Conclusion: When elderly patients undergo emergency surgery for intestinal perforation or infarction, it is important to recognize that those with preoperative acute renal injury, hypoalbuminemia, and a need for postoperative ventilator support have a poor prognosis. Therefore, these patients require intensive care from the early stages of treatment.

Building an annotated corpus for automatic metadata extraction from multilingual journal article references.

Bibliographic references containing citation information of academic literature play an important role as a medium connecting earlier and recent studies. As references contain machine-readable metadata such as author name, title, or publication year, they have been widely used in the field of citation information services including search services for scholarly information and research trend analysis. Many institutions around the world manually extract and continuously accumulate reference metadata to provide various scholarly services. However, manually collection of reference metadata every year continues to be a burden because of the associated cost and time consumption. With the accumulation of a large volume of academic literature, several tools, including GROBID and CERMINE, that automatically extract reference metadata have been released. However, these tools have some limitations. For example, they are only applicable to references written in English, the types of extractable metadata are limited for each tool, and the performance of the tools is insufficient to replace the manual extraction of reference metadata. Therefore, in this study, we focused on constructing a high-quality corpus to automatically extract metadata from multilingual journal article references. Using our constructed corpus, we trained and evaluated a BERT-based transfer-learning model. Furthermore, we compared the performance of the BERT-based model with that of the existing model, GROBID. Currently, our corpus contains 3,815,987 multilingual references, mainly in English and Korean, with labels for 13 different metadata types. According to our experiment, the BERT-based model trained using our corpus showed excellent performance in extracting metadata not only from journal references written in English but also in other languages, particularly Korean. This corpus is available at http://doi.org/10.23057/47.

Anesthetics management of a renal angiomyolipoma using pulse pressure variation and non-invasive cardiac output monitoring: A case report.

BACKGROUND: Hypovolemic shock can lead to life-threatening organ dysfunction, and adequate fluid administration is a fundamental therapy. Traditionally, parameters such as vital signs, central venous pressure, and urine output have been used to estimate intravascular volume. Recently, pulse pressure variation (PPV) and non-invasive cardiac monitoring devices have been introduced. In this case report, we introduce a patient with massive active bleeding from giant renal angiomyolipoma (AML). During emergent nephrectomy, we used non-invasive cardiac monitoring with CSN-1901 (Nihon Kohden, Tokyo, Japan) and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management. CASE SUMMARY: A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension. AML was diagnosed by computed tomography, and emergent nephrectomy was scheduled. Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring. During the surgery, 6000 mL of estimated blood loss occurred. Along with the patient's vital signs and laboratory results, we monitored cardiac output, cardiac output, stroke volume, stroke volume index with a non-invasive cardiac monitoring device, and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding. CONCLUSION: In addition to traditional parameters, non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provide guidance for intraoperative management of hypovolemic shock patients.

Anesthesia for ovarian teratoma resection using remimazolam and remifentanil in a patient with anti-N-methyl-D-aspartate receptor encephalitis -two case reports.

BACKGROUND: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a type of autoimmune encephalitis that causes characteristic symptoms through the formation of antibodies against NMDA receptors. If ovarian teratomas are detected, surgical removal under general anesthesia is often considered. Many general anesthetic agents inhibit NMDA receptors. As such, anesthetic agents may have unexpected effects on disease progression. For anesthesiologists, providing general anesthesia for these patients is challenging and there are few studies on which anesthetic is most appropriate. CASE: Two female patients were diagnosed with anti-NMDA receptor encephalitis and ovarian teratomas. Successful teratoma resection was performed under general anesthesia using remimazolam and remifentanil. After the surgery, one patient showed some improvement but died a month later. The other patient progressively improved over time. CONCLUSIONS: Remimazolam and remifentanil are useful general anesthetic agents for patients with anti-NMDA receptor encephalitis. Further studies are warranted.

Design of an Optical Transparent Absorber and Defect Diagnostics Analysis Based on Near-Field Measurement.

To reduce the electromagnetic wave interference caused by cavity resonance or electromagnetic wave leakage, herein, an optical transparent radar absorbing structure (RAS) was designed using transparent conductive oxides (TCOs) with a high optical transmittance and electrical conductivity, and a procedure was proposed for detecting possible defects in the fabrication and operation and for assessing the influence of the defects on the electromagnetic performance. To detect locally occurring defects in planar and three-dimensional absorbing structures, a measurement system based on an open-ended near-field antenna capable of producing small beam spots at a close distance was constructed. Moreover, the reflection characteristics of the transparent RAS were derived from a simplified multiple reflection equation, and the derived results were compared with the analysis results of an equivalent circuit model to predict the surface resistance of the TCO coating layer, based on which the presence of defects could be confirmed. By using the experimental results, the predicted surface resistance results of the coating layer and the results measured using a non-contact sheet resistance meter were compared and were found to correspond, thereby confirming the effectiveness of the proposed defect detection method.

Vastly enhanced photoresponsivities of phase-controlled tin sulfide thin films.

Herein, we reveal extraordinary enhancements in the photoresponsivities of tin sulfide (SnxSy) grown on SiO2/Si wafers through post-phase transformations induced by electron beam irradiation (EBI) and crystallization. Amorphous SnxSy thin films were formed by room-temperature sputtering, and as-deposited films were subsequently transformed into hexagonal SnS2 and orthorhombic SnS phases by EBI at 600 and 800 V respectively, for only one minute. The use of a low-energy electron beam was sufficient to fabricate a SnxSy photodetector, with no additional heating required. Less than 10 nm thick SnxSy films with well-defined layer structures and stable surface morphologies were obtained through EBI at 600 and 800 V. The resulting phase-controlled SnS thin-film photodetector prepared using 800 V-EBI exhibited a 40 000-fold increase in photoresponsivity; when illuminated by a 450 nm light source, the active SnS-layer-containing photodetector demonstrated a photoresponsivity of 33.2 mA W-1.

Exceptionally Uniform and Scalable Multilayer MoS2 Phototransistor Array Based on Large-Scale MoS2 Grown by RF Sputtering, Electron Beam Irradiation, and Sulfurization.

Two-dimensional molybdenum disulfide (MoS2) has emerged as a promising material for optoelectronic applications because of its superior electrical and optical properties. However, the difficulty in synthesizing large-scale MoS2 films has been recognized as a bottleneck in uniform and reproducible device fabrication and performance. Here, we proposed a radio-frequency magnetron sputter system, and post-treatments of electron beam irradiation and sulfurization to obtain large-scale continuous and high-quality multilayer MoS2 films. Large-area uniformity was confirmed by no deviation of electrical performance in fabricated MoS2 thin-film transistors (TFTs) with an average on/off ratio of 103 and a transconductance of 0.67 nS. Especially, the photoresponsivity of our MoS2 TFT reached 3.7 A W-1, which is a dramatic improvement over that of a previously reported multilayer MoS2 TFT (0.1 A W-1) because of the photogating effect induced by the formation of trap states in the band gap. Finally, we organized a 4 × 4 MoS2 phototransistor array with high photosensitivity, linearity, and uniformity for light detection, which demonstrates the great potential of 2D MoS2 for future-oriented optoelectronic devices.

Hierarchical multi-level block copolymer patterns by multiple self-assembly.

Uniform, well-ordered sub-20 nm patterns can be generated by the templated self-assembly of block copolymers (BCPs) with a high Flory-Huggins interaction parameter (χ). However, the self-assembled BCP monolayers remain limited in the possible structural geometries. Here, we introduce a multiple self-assembly method which uses di-BCPs to produce diverse morphologies, such as dot, dot-in-honeycomb, line-on-dot, double-dot, pondering, dot-in-pondering, and line-on-pondering patterns. To improve the diversity of BCP morphological structures, we employed sphere-forming and cylinder-forming poly(styrene-block-dimethylsiloxane) (PS-b-PDMS) BCPs with a high χ. The self-assembled mono-layer and double-layer SiOx dot patterns were modified at a high temperature (∼800 °C), showing hexagonally arranged (dot) and double-hexagonally arranged (pondering) SiOx patterns, respectively. We successfully obtained additional new nanostructures (big-dot, dot-in-honeycomb, line-on-dot, pondering, dot-in-pondering, and line-on-pondering types) through a second self-assembly of cylinder-forming BCPs using the dot and pondering patterns as guiding templates. This simple approach can likely be extended to the multiple self-assembly of many other BCPs with good functionality, significantly contributing to the development of various nanodevices.

Atomic rearrangement of a sputtered MoS2 film from amorphous to a 2D layered structure by electron beam irradiation.

We synthesised a crystalline MoS2 film from as-sputtered amorphous film by applying an electron beam irradiation (EBI) process. A collimated electron beam (60 mm dia.) with an energy of 1 kV was irradiated for only 1 min to achieve crystallisation without an additional heating process. After the EBI process, we observed a two-dimensional layered structure of MoS2 about 4 nm thick and with a hexagonal atomic arrangement on the surface. A stoichiometric MoS2 film was confirmed to grow well on SiO2/Si substrates and include partial oxidation of Mo. In our experimental configuration, EBI on an atomically thin MoS2 layer stimulated the transformation from a thermodynamically unstable amorphous structure to a stable crystalline nature with a nanometer grain size. We employed a Monte Carlo simulation to calculate the penetration depth of electrons into the MoS2 film and investigated the atomic rearrangement of the amorphous MoS2 structure.

Manipulation of TiO2 Nanotubes in a Transparent Dielectrophoretic Device.

A DEP device with a transparent oxide thin film electrode was fabricated by a photolithography process and sputtering deposition with indium tin oxide (ITO). In order to form a fine ITO electrode pattern, we manipulated the negative slope using a photoresist by controlling the intensity of the ultra-violet radiation and the exposure time. In this study, the motions of a 1 microm polystyrene sphere and TiO2 nanotube were observed as a function of the applied voltage and the frequency. The findings confirm that TiO2 nanotubes can be manipulated by a p-DEP force and that they can be effectively aligned under conditions of 10 V(p-p) at 750 Hz.

Antifibrotic Therapies: Where Are We Now?

Fibrosis is the wound-healing response of tissues to injury. Extensive characterization of organ fibrosis mechanisms has identified common core pathways in renal, pulmonary, skin, and liver fibrosis that offer novel antifibrotic approaches across tissues, in addition to organ-specific and/or disease-specific pathways. A growing number of small molecules and biologics have been identified that are reaching clinical trials for one or more fibrotic diseases, making new antifibrotic options for liver fibrosis an emerging reality. The accelerating pace of drug development, which will also include drug repurposing or combination therapies, heightens the need for novel methods for noninvasive fibrosis assessment without liver biopsy, which is critical to establishing surrogate endpoints for patients in clinical trials who have a low risk of hepatic decompensation. In this article the authors review mechanisms of liver fibrosis and outline potential therapeutic targets and antifibrotic therapies in preclinical studies and clinical trials.

A low temperature Co-fired ceramic-based dielectrophoretic device for manipulating micro and nanostructure materials.

A dielectophoretic (DEP) device fabricated by a conventional low temperature co-fired ceramic (LTCC) process, for manipulating micro and nanostructure materials, such as spherical polystyrene microspheres, titanium dioxide (TiO2) nanotubes, and silver (Ag) nanowires, is described. To generate a non-uniform electric field, a castellated electrode configuration was applied to the LTCC-based DEP device using a screen printing method. The actual motions of the micro and nanostructure materials under both a positive and a negative DEP force were observed in detail and the findings compared with numerical simulation data for the electric field distribution. The performance of the LTCC-based DEP device for separating and trapping was evaluated and potential applications are discussed.

Antifibrotic effects of magnesium lithospermate B on hepatic stellate cells and thioacetamide-induced cirrhotic rats.

Magnesium lithospermate B (MLB) is one of the major active components of Salvia miltiorrhizae. The anti-oxidative effects of Salvia miltiorrhizae have been previously reported. The aim of this study was to investigate the effect of purified MLB on hepatic fibrosis in rats and on the fibrogenic responses in hepatic stellate cells (HSCs). Hepatic fibrosis was induced in rats by intraperitoneal thioacetamide (TAA) injections over a period of 8 or 12 weeks. MLB was orally administered daily by gavage tube. Serum AST and ALT levels in TAA+ MLB group were significantly lower than those in TAA only group at week 8. Hepatic fibrosis was significantly attenuated in TAA+MLB group than in TAA only group at week 8 or 12. Activation of HSCs was also decreased in TAA+MLB group as compared to TAA only group. Hepatic mRNA expression of α-smooth muscle actin (α-SMA), TGF-ß1, and collagen α1(I) was significantly decreased in TAA+MLB group as compared to TAA only group. Incubation with HSCs and MLB (>or=100 µM) for up to 48 h showed no cytotoxicity. MLB suppressed PDGF-induced HSC proliferation. MLB inhibited NF-ΚB transcriptional activation and monocyte chemotactic protein 1 (MCP-1) production in HSCs. MLB strongly suppressed H(2)O(2)-induced reactive oxygen species (ROS) generation in HSCs, and MLB inhibited type I collagen secretion in HSCs. We concluded that MLB has potent antifibrotic effect in TAA-treated cirrhotic rats, and inhibits fibrogenic responses in HSCs. These data suggest that MLB has potential as a novel therapy for hepatic fibrosis.

Impact of sex, age and BMI on depth and diameter of the infraclavicular axillary vein when measured by ultrasonography.

BACKGROUND AND OBJECTIVE: The axillary vein is another option for central venous catheterisation, with less chance of accidental arterial puncture as there is a greater distance between artery and vein, and from vein to rib cage, compared with other sites. Better success, lower complication rates and faster access can be achieved with ultrasound guidance which is becoming the established technique for central venous catheterisation. We measured two key factors for successful infraclavicular axillary venous catheterisation: depth and diameter of the infraclavicular axillary vein in its medial part using ultrasound. METHODS: We recruited 98 patients, classified according to sex, age and BMI. Groups were divided according to BMI as follows: group 1 (≤20 kg m⁻²), group 2 (20.01-25.00 kg m⁻²) and group 3 (>25 kg m⁻²); and these were further subdivided according to age: 20-39 years, 40-59 years and 60-80 years. The depth and diameter of the infraclavicular axillary vein was measured at a point between the medial third and midpoint of the clavicle. RESULTS: Vein diameter was significantly different between men and women (P = 0.005), whereas depth showed no significant difference. In the BMI subgroups, there was a significant difference in depth (P < 0.001), and a trend to significant difference in diameter (P = 0.056). However, age-specific differences in depth and diameter were not observed. CONCLUSION: During catheterisation of infraclavicular axillary vein, real-time visualisation of the needle tip when using ultrasound to gauge vein depth and diameter may diminish major complications such as pneumothorax and artery puncture.

Interfacial reactions of nano-structured Cu-doped indium oxide/indium tin oxide ohmic contacts to p-GaN.

Interfacial microstructure and elemental diffusion of Cu-doped indium oxide (CIO)/indium tin oxide (ITO) ohmic contacts to p-type GaN for light-emitting diodes (LEDs) were investigated using cross-sectional transmission electron microscopy (XTEM), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction. The CIO/ITO contacts gave specific contact resistances of approximately 10(-4) omegacm2 and transmittance greater than 95% at a wavelength of 405 nm when annealed at 630 degrees C for 1 min in air. After annealing at 630 degrees C, multi-component oxides composed of Ga2O3-In2O3, Ga2O3-CuO, and In2O3-CuO formed at the interface between p-GaN and ITO. Formation of multi-component oxides reduced the barrier height between p-GaN and ITO due to their higher work functions than that of ITO, and caused Ga in the GaN to diffuse into the CIO/ITO layer, followed by generation of acceptor-like Ga vacancies near the GaN surface, which lowered contact resistivity of the CIO/ITO contacts to p-GaN after the annealing.

Specific mutations in the enhancer II/core promoter/precore regions of hepatitis B virus subgenotype C2 in Korean patients with hepatocellular carcinoma.

Recently, hepatitis B virus (HBV) genotypes and mutations have been reported to be related to hepatocellular carcinoma (HCC). This cross-sectional case-control study examined the relationship between HCC and mutations in the enhancer II/core promoter and precore regions of HBV by comparing 135 Korean HCC patients infected with HBV genotype C2 (HBV/C2; HCC group) with 135 age-, sex-, and hepatitis B e antigen (HBeAg) status-matched patients without HCC (non- HCC group). Age and sex were also matched between HBeAg-positive and -negative patients. The prevalence of T1653, A1689, V1753, T1762/A1764, T1846, A1850, C1858, and A1896 mutations was evaluated in this population. The prevalence of the T1653 mutation in the box alpha region, the T1689 [corrected] mutation in between the box alpha and beta regions, and the T1762/A1764 mutations in the basal core promoter region was significantly higher in the HCC group compared to the non-HCC group (8.9% vs. 2.2%, P = 0.017; 19.3% vs. 4.4%, P < 0.001; and 60.7% vs. 22.2%; P < 0.001). Among HBeAg-negative patients, the frequency of the T1653 mutation was higher in the HCC group. Regardless of HBeAg status, the prevalence of the T1689, [corrected] and T1762/A1764 mutations was higher in the HCC group than in the non-HCC group. However, no association was observed between mutations in the precore region and HCC. Upon multivariate analysis, the presence of the T1653, T1689, [corrected] and T1762/A1764 mutations was an independent predictive factor for HCC. The addition of the T1653 or T1689 [corrected] mutation to T1762/A1764 increased the risk of HCC. In conclusion, the T1653, T1689, [corrected] and/or T1762/A1764 mutations were associated with the development of HCC in Korean patients infected with HBV/C2.

Role of serum prothrombin induced by vitamin K absence or antagonist-II in the early detection of hepatocellular carcinoma in patients with chronic hepatitis B virus infection.

OBJECTIVE: The role of serum prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II) in the early detection of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection has not yet been clearly identified. The purpose of the study was to evaluate the sensitivity and specificity of PIVKA-II, alone or in combination with alpha-fetoprotein (AFP), for the detection of HCC during surveillance, and to determine whether PIVKA-II was a significant risk factor for patient survival. MATERIAL AND METHODS: During surveillance, 106 HCC cases and 100 non-HCC cases of chronic HBV infection were included. Sensitivity and specificity of AFP and PIVKA-II were obtained through cut-off values of 20 ng/ml and 40 mAU/ml, respectively. The Cox proportional hazards model was used to determine whether PIVKA-II would be a significant risk factor for patient survival. RESULTS: The sensitivity rates of AFP and PIVKA-II were 57.5% (61/106) and 51.9% (55/106), respectively. Of 45 patients negative for AFP, 22 were positive for PIVKA-II. A combination of AFP and PIVKA-II increased the sensitivity to 78.3% (83/106). The specificities of AFP and PIVKA-II were 88.0% and 97.0%, respectively. PIVKA-II was not a significant risk factor for patient survival after multivariate analysis. CONCLUSIONS: PIVKA-II can be used as a tumor marker for the early detection of HCC in patients with chronic HBV infection, especially in combination with AFP.

MDM2 and p53 polymorphisms are associated with the development of hepatocellular carcinoma in patients with chronic hepatitis B virus infection.

A single-nucleotide polymorphism (SNP) in the promoter region of MDM2, SNP 309, is associated with hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus infection. The effect of p53 codon 72 polymorphism Arg72Pro on HCC risk remains inconsistent. This study evaluated the association of MDM2 and p53 polymorphisms with the presence and early onset of HCC in Korean patients with chronic hepatitis B virus (HBV) infection. In total, 583 consecutive patients with chronic HBV infection were classified according to the presence (n = 287) or absence (n = 296) of HCC. The MDM2 SNP 309 and p53 Arg72Pro were genotyped using restriction fragment length polymorphism method. The MDM2 G/G and p53 Pro/Pro genotypes were more frequent in HCC group than in non-HCC group (P < 0.001 and P = 0.004, respectively). Multivariate analysis for the presence of HCC revealed that the odds ratio (OR) for MDM2 G/G over T/T was 4.89 (P < 0.001) and that of p53 Pro/Pro over Arg/Arg was 3.03 (P = 0.006). Combined MDM2 G/G and p53 Pro/Pro had a synergistic effect on HCC risk, with an OR of 20.78 (P < 0.001). The mean age of tumor onset in patients with MDM2 G/G genotype was 50.9 years compared with 55.1 with T/T genotype (P = 0.018) and that with p53 Pro/Pro was 49.7 years compared with 52.9 with Arg/Arg (P = 0.040). Thus, MDM2 SNP 309 and p53 Arg72Pro are associated with the early development of HCC in Korean patients with chronic HBV infection.

What is the role of diagnostic laparoscopy in a gastroenterology unit?

BACKGROUND: Diagnostic laparoscopy is known to be a relatively safe invasive procedure. However, its use has decreased owing to the development of imaging techniques, and fewer gastroenterologists now practice diagnostic laparoscopy. Our aim was to examine the role of diagnostic laparoscopy in a gastroenterology unit in the era of advanced imaging techniques. METHODS: We retrospectively reviewed 855 diagnostic laparoscopy cases. Its safety and efficacy were evaluated for various indications. RESULTS: No mortality was observed, and complications were noted in ten patients (1.2%). Among the indications were evaluation of chronic liver disease (n = 673), liver tumor (n = 15), ascites of unknown origin and peritoneal disease (n = 142), and staging of intra-abdominal malignancy (n = 25). In patients with chronic liver disease, 461 were diagnosed as having chronic viral hepatitis, based on clinical data including imaging studies, but the diagnosis was changed to cirrhosis after a laparoscopic exam in 69 patients (15.0%). In patients with ascites of unknown origin and peritoneal disease, the diagnostic yield was 87.2% (123/141). In 24 (19.5%) of the 123 patients, the diagnosis changed or the less probable diagnosis was confirmed after laparoscopic examination. The confirmed diagnoses were mainly primary peritoneal disease, including peritoneal tuberculosis, in 17 patients, peritoneal metastatic carcinoma in five, and mesothelioma in two. CONCLUSIONS: Diagnostic laparoscopy in a gastroenterology unit is safe and useful, especially for confirmation of liver cirrhosis and primary peritoneal disease evaluation.