Predictors of Choledocholithiasis in Cholecystectomy Patients and Their Cutoff Values and Prediction Model in Korea in Comparison with the 2019 ASGE Guidelines.

Background/Aims: : In 2019, the American Society for Gastrointestinal Endoscopy (ASGE) established clinical predictors for choledocholithiasis. Our study was designed to evaluate these predictors within the Korean clinical context, establish cutoff values, and develop a predictive model. Methods: : This retrospective study analyzed patients who underwent laparoscopic cholecystectomy. The relationships between choledocholithiasis and predictors including age, blood tests, and imaging findings were assessed through univariate and multivariate logistic regression analyses. We established Korean cutoff values for these predictors and developed a scoring system for choledocholithiasis using a multivariate logistic regression. The performance of this scoring system was then compared with that of the 2019 ASGE guidelines through a receiver operating characteristic curve. Results: : We established Korean cutoff values for age (>70 years), alanine aminotransferase (>26.5 U/L), aspartate aminotransferase (>28.5 U/L), gamma-glutamyl transferase (GGT; >82.5 U/L), alkaline phosphatase (ALP; >77.5 U/L), and total bilirubin (>0.95 mg/dL). In the multivariate analysis, only age >70 years, GGT >77.5 U/L, ALP >77.5 U/L, and common bile duct dilatation remained significant. We then developed a new Korean risk stratification model from the multivariate analysis, with an area under the curve of 0.777 (95% confidence interval, 0.75 to 0.81). Our model was stratified into the low-risk, intermediate-risk, and high-risk groups with the scores being <1.0, 1.0-5.5, and >5.5, respectively. Conclusions: : Predictors of choledocholithiasis in cholecystectomy patients and their cutoff values in Korean should be adjusted and further studies are needed to develop appropriate guidelines.

Visualizing the Low-Energy Electronic Structure of Prototypical Hybrid Halide Perovskite through Clear Band Measurements.

Organic-inorganic hybrid perovskites (OIHPs) are a promising class of materials that rival conventional semiconductors in various optoelectronic applications. However, unraveling the precise nature of their low-energy electronic structures continues to pose a significant challenge, primarily due to the absence of clear band measurements. Here, we investigate the low-energy electronic structure of CH3NH3PbI3 (MAPI3) using angle-resolved photoelectron spectroscopy combined with ab initio density functional theory. We successfully visualize the electronic structure of MAPI3 near the bulk valence band maximum by using a laboratory photon source (He Iα, 21.2 eV) at low temperature and explore its fundamental properties. The observed valence band exhibits a highly isotropic and parabolic band characterized by small effective masses of 0.20-0.21 me, without notable spectral signatures associated with a large polaron or the Rashba effect, subjects that are intensely debated in the literature. Concurrently, our spin-resolved measurements directly disprove the giant Rashba scenario previously suggested in a similar perovskite compound by establishing an upper limit for the Rashba parameter (αR) of 0.28 eV Å. Our results unveil the unusually complex nature of the low-energy electronic structure of OIHPs, thereby advancing our fundamental understanding of this important class of materials.

Efficacy of GV1001 with gemcitabine/capecitabine in previously untreated patients with advanced pancreatic ductal adenocarcinoma having high serum eotaxin levels (KG4/2015): an open-label, randomised, Phase 3 trial.

BACKGROUND: The TeloVac study indicated GV1001 did not improve the survival of advanced pancreatic ductal adenocarcinoma (PDAC). However, the cytokine examinations suggested that high serum eotaxin levels may predict responses to GV1001. This Phase III trial assessed the efficacy of GV1001 with gemcitabine/capecitabine for eotaxin-high patients with untreated advanced PDAC. METHODS: Patients recruited from 16 hospitals received gemcitabine (1000 mg/m2, D 1, 8, and 15)/capecitabine (830 mg/m2 BID for 21 days) per month either with (GV1001 group) or without (control group) GV1001 (0.56 mg; D 1, 3, and 5, once on week 2-4, 6, then monthly thereafter) at random in a 1:1 ratio. The primary endpoint was overall survival (OS) and secondary end points included time to progression (TTP), objective response rate, and safety. RESULTS: Total 148 patients were randomly assigned to the GV1001 (n = 75) and control groups (n = 73). The GV1001 group showed improved median OS (11.3 vs. 7.5 months, P = 0.021) and TTP (7.3 vs. 4.5 months, P = 0.021) compared to the control group. Grade >3 adverse events were reported in 77.3% and 73.1% in the GV1001 and control groups (P = 0.562), respectively. CONCLUSIONS: GV1001 plus gemcitabine/capecitabine improved OS and TTP compared to gemcitabine/capecitabine alone in eotaxin-high patients with advanced PDAC. CLINICAL TRIAL REGISTRATION: NCT02854072.

1D Magnetic MX3 Single-Chains (M = Cr, V and X = Cl, Br, I).

Magnetic materials in reduced dimensions are not only excellent platforms for fundamental studies of magnetism, but they play crucial roles in technological advances. The discovery of intrinsic magnetism in monolayer 2D van der Waals systems has sparked enormous interest, but the single-chain limit of 1D magnetic van der Waals materials has been largely unexplored. This paper reports on a family of 1D magnetic van der Waals materials with composition MX3 (M = Cr, V, and X = Cl, Br, I), prepared in fully-isolated fashion within the protective cores of carbon nanotubes. Atomic-resolution scanning transmission electron microscopy identifies unique structures that differ from the well-known 2D honeycomb lattice MX3 structure. Density functional theory calculations reveal charge-driven reversible magnetic phase transitions.

Modulation of Phonons and Excitons Due to Moiré Potentials in Twisted Bilayer of WSe2/MoSe2.

The application of two-dimensional materials has been expanded by introducing the twisted bilayer (TBL) system. However, the landscape of the interlayer interaction in hetero-TBLs has not yet been fully understood, while that in homo-TBLs has been extensively studied, with the dependence on the twist angle between the constituent layers. Here, we present detailed analyses on the interlayer interaction that depends on the twist angle in WSe2/MoSe2 hetero-TBL via Raman and photoluminescence studies combined with first-principles calculation. We observe interlayer vibrational modes, moiré phonons, and the interlayer excitonic states that evolve with the twist angle and identify different regimes with distinct characteristics of such features. Moreover, the interlayer excitons that appear strong in the hetero-TBLs with twist angles near 0° or 60° have different energies and photoluminescence excitation spectra for the two cases, which results from different electronic structures and carrier relaxation dynamics. These results would enable a better understanding of the interlayer interaction in hetero-TBLs.

Tuning the Sharing Modes and Composition in a Tetrahedral GeX2 (X = S, Se) System via One-Dimensional Confinement.

The packing and connectivity of tetrahedral units are central themes in the structural and electronic properties of a host of solids. Here, we report one-dimensional (1D) chains of GeX2 (X = S or Se) with modification of the tetrahedral connectivity at the single-chain limit. Precise tuning of the edge- and corner-sharing modes between GeX2 blocks is achieved by diameter-dependent 1D confinement inside a carbon nanotube. Atomic-resolution scanning transmission electron microscopy directly confirms the existence of two distinct types of GeX2 chains. Density functional theory calculations corroborate the diameter-dependent stability of the system and reveal an intriguing electronic structure that sensitively depends on tetrahedral connectivity and composition. GeS2(1-x)Se2x compound chains are also realized, which demonstrate the tunability of the system's semiconducting properties through composition engineering.

Terahertz Spectroscopy and DFT Analysis of Phonon Dynamics of the Layered Van der Waals Semiconductor Nb3 X 8 (X = Cl, I).

We have conducted a terahertz spectroscopic study and a density functional theory analysis of the phonon dynamics of the layered van der Waals semiconductors Nb3Cl8 and Nb3I8. Several infrared-active phonon modes were observed in the terahertz region, and their frequencies were found to be in excellent agreement with our first-principles lattice dynamics calculations. For Nb3Cl8, the observed phonon spectra are consistent with a structural transition at 90 K from the high-temperature P3̅m1 phase to the low-temperature R3̅m phase. Also, our study confirmed that the structural and magnetic transitions were coupled in Nb3Cl8. For Nb3I8, which is nonmagnetic at and below room temperature, no significant temperature or magnetic field dependence was observed in the phonon spectra. Our study provides an intriguing connection between the structural properties and the paramagnetic-nonmagnetic transitions in Nb3Cl8 and Nb3I8.

Experimental and Computational Approaches to Sulfonated Poly(arylene ether sulfone) Synthesis Using Different Halogen Atoms at the Reactive Site.

Engineering thermoplastics, such as poly(arylene ether sulfone), are more often synthesized using F-containing monomers rather than Cl-containing monomers because the F atom is considered more electronegative than Cl, leading to a better condensation polymerization reaction. In this study, the reaction's spontaneity improved when Cl atoms were used compared to the case using F atoms. Specifically, sulfonated poly(arylene ether sulfone) was synthesized by reacting 4,4'-dihydroxybiphenyl with two types of biphenyl sulfone monomers containing Cl and F atoms. No significant difference was observed in the structural, elemental, and chemical properties of the two copolymers based on nuclear magnetic resonance spectroscopy, Fourier transform infrared spectroscopy, thermogravimetric analysis, X-ray diffraction, transmission electron microscopy, and electrochemical impedance spectroscopy. However, the solution viscosity and mechanical strength of the copolymer synthesized with the Cl-terminal monomers were slightly higher than those of the copolymer synthesized with the F-terminal monomers due to higher reaction spontaneity. The first-principle study was employed to elucidate the underlying mechanisms of these reactions.

Resonantly Enhanced Electromigration Forces for Adsorbates on Graphene.

We investigate the electromigration forces for weakly bonded adsorbates on graphene by using density-functional based calculations. We find that the nature of electromigration forces on an adsorbate critically depends on the energy level alignment between the adsorbate state and the Fermi level of the graphene. For a resonant adsorbate, whose frontier orbitals lie close to the Fermi level, the electromigration force is dominated by the electron wind force that is strongly enhanced along the electron flow direction, irrespective of the sign of the adsorbate charge. For a nonresonant adsorbate, the electromigration force is essentially the direct force that depends on the adsorbate charge. We also show that the magnitude of electromigration forces can be continuously tunable through electrostatic gating for resonant adsorbates. Our results provide new insight for understanding and controlling how nanoscale objects behave in or on host materials.

Fuel cell performance improvement via the steric effect of a hydrocarbon-based binder for cathode in proton exchange membrane fuel cells.

In this study, a sulfonated poly(ether sulfone) having cardo-type fluorenyl groups (FL-SPES) was investigated as a cathodic binder to improve fuel cell performance via increased the oxygen diffusion in the cathode. The maximum power density achieved by using the membrane electrode assembly (MEA) prepared with FL-SPES with a low ion exchange capacity (IEC) of 1.31 meq g-1 was 520 mW cm-2, which is more than twice as high as that of BP-SPES (210 mW cm-2) having typical biphenyl groups with a similar IEC. At high IEC of 1.55 meq g-1, the power density obtained by using BP-SPES was improved to 454 mW cm-2 but remained lower than that of FL-SPES. In addition, although the IEC, swelling degree, and specific resistance were similar to each other, the gas permeability of FL-SPES was improved by approximately three times compared to that of BP-SPES. The steric structure of cardo-type FL-SPES increased the free volume between the polymer backbones, leading to an increase in gas transfer. Consequently, oxygen diffusion was promoted at the cathode, resulting in improved fuel cell performance.

Comparison of one-stage laparoscopic common bile duct exploration plus cholecystectomy and two-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for concomitant gallbladder and common bile duct stones in patients over 80 years old.

Purpose: This study was performed to compare the safety and efficacy of one-stage laparoscopic common bile duct exploration (LCBDE) plus laparoscopic cholecystectomy (LC) with those of endoscopic sphincterotomy (EST) plus LC for concomitant gallbladder (GB) and common bile duct (CBD) stones in elderly patients. Methods: This single-center retrospective study reviewed the medical records of patients aged >80 years who were diagnosed with concomitant GB and CBD stones between January 2010 and December 2020. Results: Of the 137 patients included in this study, 46 underwent one-stage LCBDE + LC and 91 underwent two-stage EST + LC. The frequency of previous gastrectomy (23.9% vs. 5.5%, p = 0.002) and multiple stones (76.1% vs. 49.5%, p = 0.003) was higher in the LCBDE + LC group than in the EST + LC group. Further, patients in LCBDE + LC group had larger CBD stones (11.9 mm vs. 6.0 mm, p < 0.001). There were no significant differences in the clearance (91.3% vs. 95.6%, p = 0.311) and recurrence (4.3% vs. 8.8%, p = 0.345) rates between the groups. The incidence of posttreatment overall complications (17.4% vs. 22.0%, p = 0.530) and total hospital stay (12.7 days vs. 11.7 days, p = 0.339) were similar in the two groups. Conclusion: One-stage LCBDE + LC is a safe and effective treatment for concomitant GB and CBD stones, even in elderly patients, and may be considered as the first treatment option in elderly patients with previous gastrectomy, multiple large (≥ 15 mm) CBD stones, or inability to cooperate with endoscopic procedures.

Dichotomy of Electron-Phonon Coupling in Graphene Moiré Flat Bands.

Graphene moiré superlattices are outstanding platforms to study correlated electron physics and superconductivity with exceptional tunability. However, robust superconductivity has been measured only in magic-angle twisted bilayer graphene (MA-TBG) and magic-angle twisted trilayer graphene (MA-TTG). The absence of a superconducting phase in certain moiré flat bands raises a question on the superconducting mechanism. In this work, we investigate electronic structure and electron-phonon coupling in graphene moiré superlattices based on atomistic calculations. We show that electron-phonon coupling strength λ is dramatically different among graphene moiré flat bands. The total strength λ is very large (λ>1) for MA-TBG and MA-TTG, both of which display robust superconductivity in experiments. However, λ is an order of magnitude smaller in twisted double bilayer graphene (TDBG) and twisted monolayer-bilayer graphene (TMBG) where superconductivity is reportedly rather weak or absent. We find that the Bernal-stacked layers in TDBG and TMBG induce sublattice polarization in the flat-band states, suppressing intersublattice electron-phonon matrix elements. We also obtain the nonadiabatic superconducting transition temperature T_{c} that matches well with the experimental results. Our results clearly show a correlation between strong electron-phonon coupling and experimental observations of robust superconductivity.

Lung Disease Diagnostic Model Through IgG Sensitization to Microbial Extracellular Vesicles.

PURPOSE: Recently, there has been a rise in the interest to understand the composition of indoor dust due to its association with lung diseases such as asthma, chronic obstructive pulmonary disease (COPD) and lung cancer. Furthermore, it has been found that bacterial extracellular vesicles (EVs) within indoor dust particles can induce pulmonary inflammation, suggesting that these might play a role in lung disease. METHODS: We performed microbiome analysis of indoor dust EVs isolated from mattresses in apartments and hospitals. We developed diagnostic models based on the bacterial EVs antibodies detected in serum samples via enzyme-linked immunosorbent assay (ELISA) in this analysis. RESULTS: Proteobacteria was the most abundant bacterial EV taxa observed at the phylum level while Pseudomonas, Enterobacteriaceae (f) and Acinetobacter were the most prominent organisms at the genus level, followed by Staphylococcus. Based on the microbiome analysis, serum anti-bacterial EV immunoglobulin G (IgG), IgG1 and IgG4 were analyzed using ELISA with EV antibodies that targeted Staphylococcus aureus, Acinetobacter baumannii, Enterobacter cloacae and Pseudomonas aeruginosa. The levels of anti-bacterial EV antibodies were found to be significantly higher in patients with asthma, COPD and lung cancer compared to the healthy control group. We then developed a diagnostic model through logistic regression of antibodies that showed significant differences between groups with smoking history as a covariate. Four different variable selection methods were compared to construct an optimal diagnostic model with area under the curves ranging from 0.72 to 0.81. CONCLUSIONS: The results of this study suggest that ELISA-based analysis of anti-bacterial EV antibodies titers can be used as a diagnostic tool for lung disease. The present findings provide insights into the pathogenesis of lung disease as well as a foundation for developing a novel diagnostic methodology that synergizes microbial EV metagenomics and immune assays.

Nernst-Planck analysis of reverse-electrodialysis with the thin-composite pore-filling membranes and its upscaling potential.

To properly design reverse electrodialysis (RED) stacks, modeling of ion transport and prediction of power generation on the single RED stack are very important. Currently, the Nernst-Planck equation is widely adopted to simulate ion transport through IEMs. However, applying typical Nernst-Planck equation is not proper to analyze ion transport through the heterogeneous thin-composite pore-filling membrane because of the non-conductive site in the membrane matrix. Herein, we firstly introduced modified Nernst-Planck equation by addressing conductive traveling length (CTL) to simulate the ion transport through the thin-composite pore-filling membranes and the performance of a single RED stack with the same membranes. Also, 100 cell-pairs of RED stacks were assembled to validate modified Nernst-Planck equation according to the flow rate and membrane types. Under the OCV condition, the conductivity of the effluents was measured to validate the modified Nernst-Planck equation, and differences between modeling and experiments were less than 1.5 mS/cm. Theoretical OCV and current density were estimated by using modified Nernst-Planck equation. In particular, hydrophobicity on the surface of the heterogeneous membrane was considered to describe ion transport through the pore-filling membranes. Moreover, power generation from RED stacks was calculated according to the flow rate and the number of cell pairs.

Role of Electric Fields on Enhanced Electron Correlation in Surface-Doped FeSe.

Electron-doped high-T_{c} FeSe reportedly has a strong electron correlation that is enhanced with doping. It has been noticed that significant electric fields exist inevitably between FeSe and external donors along with electron transfer. However, the effects of such fields on the electron correlation are yet to be explored. Here we study potassium- (K-) dosed FeSe layers using density-functional theory combined with dynamical mean-field theory to investigate the roles of such electric fields on the strength of the electron correlation. We find, very interestingly, that the electronic potential-energy difference between the topmost Se and Fe atomic layers, generated by local electric fields of ionized K atoms, weakens the Se-mediated hopping between Fe d orbitals. Since it is the dominant hopping channel in FeSe, its reduction narrows the Fe d bands near the Fermi level, enhancing the electron correlation. This effect is orbital dependent and occurs in the topmost FeSe layer only. We also find the K dosing may increase the Se height, enhancing the electron correlation further. These results shed new light on the comprehensive study of high-T_{c} FeSe and other low-dimensional systems.

Plasmacytoid Dendritic Cells Contribute to the Protective Immunity Induced by Intranasal Treatment with Fc-fused Interleukin-7 against Lethal Influenza Virus Infection.

Developing a novel vaccine that can be applied against multiple strains of influenza virus is of utmost importance to human health. Previously, we demonstrated that the intranasal introduction of Fc-fused IL-7 (IL-7-mFc), a long-acting cytokine fusion protein, confers long-lasting prophylaxis against multiple strains of influenza A virus (IAV) by inducing the development of lung-resident memory-like T cells, called TRM-like cells. Here, we further investigated the mechanisms of IL-7-mFc-mediated protective immunity to IAVs. First, we found that IL-7-mFc treatment augments the accumulation of pulmonary T cells in 2 ways: recruiting blood circulating T cells into the lung and expanding T cells at the lung parenchyma. Second, the blockade of T cell migration from the lymph nodes (LNs) with FTY720 treatment was not required for mounting the protective immunity to IAV with IL-7-mFc, suggesting a more important role of IL-7 in T cells in the lungs. Third, IL-7-mFc treatment also recruited various innate immune cells into the lungs. Among these cells, plasmacytoid dendritic cells (pDCs) play an important role in IL-7-mFc-mediated protective immunity through reducing the immunopathology and increasing IAV-specific cytotoxic T lymphocyte (CTL) responses. In summary, our results show that intranasal treatment with IL-7-mFc modulates pulmonary immune responses to IAV, affecting both innate and adaptive immune cells.

Erratum: Plasmacytoid Dendritic Cells Contribute to the Protective Immunity Induced by Intranasal Treatment with Fc-fused Interleukin-7 against Lethal Influenza Virus Infection.

[This corrects the article on p. 343 in vol. 17, PMID: 29093655.].

Acetic acid chromoendoscopy for determining the extent of gastric intestinal metaplasia.

BACKGROUND AND AIMS: The diagnosis of gastric intestinal metaplasia (IM) is currently performed by histologic assessment of multiple endoscopic biopsies, methylene blue chromoendoscopy, or narrow-band imaging with magnification. However, practical and readily available methods are lacking. We assessed the diagnostic accuracy and reproducibility of acetic acid chromoendoscopy (AAC) for determining the extent of gastric IM. METHODS: One hundred twenty-six participants were enrolled. The participants underwent screening EGD with 1.5% acetic acid instillation for the detection of acetowhite reaction. Subsequently, targeted biopsies were performed at the 5 standard intra-gastric locations of the updated Sydney system. The accuracy of AAC was calculated using the histology results as a reference. Two endoscopists, each of whom was blinded to the other's result, determined the presence or absence of acetowhite reaction. RESULTS: The overall diagnostic accuracy of AAC was 89.0%, and the sensitivity and specificity were 77.6% and 94.4%, respectively. The specificity for the gastric body was >94%. The proportion of extensive IM, a strong risk factor for gastric cancer, increased from 0.9% to 18.1% when AAC was used instead of conventional EGD alone (P < .001). Endoscopically determined atrophy had a negative effect on the diagnosis of AAC (odds ratio, 3.012; 95% confidence interval, 1.625-5.583). There was substantial inter- and intra-observer agreement. CONCLUSIONS: AAC is a valid and reproducible tool for determining the extent of gastric IM and may serve as a practical method of identifying populations at high risk of gastric cancer. (Clinical trial registration number: NCT01499576.).

Intravaginal Administration of Fc-Fused IL7 Suppresses the Cervicovaginal Tumor by Recruiting HPV DNA Vaccine-Induced CD8 T Cells.

PURPOSE: The induction of tissue-localized virus-specific CD8 T-cell response is essential for the development of an effective therapeutic vaccine against genital diseases, such as cervical cancer and genital herpes. Here, we aimed to elucidate the immunologic role of IL7 in the induction of mucosal cellular immunity. EXPERIMENTAL DESIGN: IL7 was engineered through Fc fusion to enhance mucosal delivery across the genital epithelial barrier. The immunomodulatory role of IL7 was evaluated by monitoring the kinetics of various immune cells and measuring the expression of chemokines and cytokines after intravaginal administration of Fc-fused IL7 (IL7-Fc). The antitumor effects of intramuscular human papillomavirus (HPV) DNA vaccine or topical IL7-Fc alone or in a combinational regimen on mice survival were compared using a orthotopic cervical cancer model. RESULTS: Intravaginal treatment of IL7-Fc, but not native IL7, induces upregulation of chemokines (CXCL10, CCL3, CCL4, and CCL5), cytokines (IFNγ, TNFα, IL6, and IL1ß), and an adhesion molecule (VCAM-1) in the genital tract, leading to the recruitment of several leukocytes, including CD4, CD8, γδ T cells, and dendritic cells. Importantly, in this murine cervical cancer model, topical administration of IL7-Fc after intramuscular HPV DNA vaccination increases the number of HPV-specific CD8 T cells in the genital mucosa, but not in the spleen, leading to stronger antitumor activity than the HPV DNA vaccine alone. CONCLUSIONS: Our findings provide an important insight into the immunomodulatory role of IL7-Fc via topical application and the design of therapeutic vaccine regimen that induces effective genital-mucosal CD8 T-cell responses. Clin Cancer Res; 22(23); 5898-908. ©2016 AACR.