Intussusception as a Presentation of Anisakis Infestation in the Global Era of Raw Fish Consumption: A Case Report and Literature Review.

Anisakiosis, also known as Anisakis larvae infestation, is an increasing parasitic infestation due to the worldwide spread of raw fish and shellfish consumption habits. We present a rare presentation of intestinal intussusception as a preoperative diagnosis and noticed it postoperatively due to Anisakis larvae. A 43-year-old man presented to the emergency department with abdominal pain around the umbilicus and vomiting for several hours. On physical examination at presentation, he had tenderness in the lower abdomen. His radiological studies showed a right-sided pseudo-kidney sign and ileo-colonic intussusception on ultrasound echography. His computed tomography images added findings of submucosal edema and wall thickening in the terminal ileum, swollen regional lymph nodes, and ascites. An urgent laparotomy was performed for ileo-colonic intussusception of an unknown cause. During the laparotomy, the ileocecal intussusception was manually reduced after dissecting the adhesion due to the previous appendectomy, and a partial ileotomy was undertaken using the Endo-GIA automatic anastomosis device. At the resected ileal wall surface, the presence of Anisakis larvae was noticed, and anisakidosis was diagnosed. The dietary history taken post-operatively revealed that he had eaten salmon, bonito, and squid sashimi four days prior to his emergency department visit. His postoperative course was uneventful, and he was discharged from the hospital on the fifth day postoperatively. Anisakiosis must be in the differential diagnosis of intussusception, and eating history seems like a cue to diagnose, and it might be meaningful to clinicians.

Visualizing Ribbon-to-Ribbon Heterogeneity of Chemically Unzipped Wide Graphene Nanoribbons by Silver Nanowire-Based Tip-Enhanced Raman Scattering Microscopy.

Graphene nanoribbons (GNRs), a quasi-one-dimensional form of graphene, have gained tremendous attention due to their potential for next-generation nanoelectronic devices. The chemical unzipping of carbon nanotubes is one of the attractive fabrication methods to obtain single-layered GNRs (sGNRs) with simple and large-scale production.  The authors recently found that unzipping from double-walled carbon nanotubes (DWNTs), rather than single- or multi-walled, results in high-yield production of crystalline sGNRs. However, details of the resultant GNR structure, as well as the reaction mechanism, are not fully understood due to the necessity of nanoscale spectroscopy. In this regard, silver nanowire-based tip-enhanced Raman spectroscopy (TERS) is applied for single GNR analysis and investigated ribbon-to-ribbon heterogeneity in terms of defect density and edge structure generated through the unzipping process.  The authors found that sGNRs originated from the inner walls of DWNTs showed lower defect densities than those from the outer walls. Furthermore, TERS spectra of sGNRs exhibit a large variety in graphitic Raman parameters, indicating a large variation in edge structures. This work at the single GNR level reveals, for the first time, ribbon-to-ribbon heterogeneity that can never be observed by diffraction-limited techniques and provides deeper insights into unzipped GNR structure as well as the DWNT unzipping reaction mechanism.

Remote Excitation of Tip-Enhanced Photoluminescence with a Parallel AgNW Coupler.

Tip-enhanced photoluminescence (TEPL) microscopy allows for the correlation of scanning probe microscopic images and photoluminescent spectra at the nanoscale level in a similar way to tip-enhanced Raman scattering (TERS) microscopy. However, due to the higher cross-section of fluorescence compared to Raman scattering, the diffraction-limited background signal generated by far-field excitation is a limiting factor in the achievable spatial resolution of TEPL. Here, we demonstrate a way to overcome this drawback by using remote excitation TEPL (RE-TEPL). With this approach, the excitation and detection positions are spatially separated, minimizing the far-field contribution. Two probe designs are evaluated, both experimentally and via simulations. The first system consists of gold nanoparticles (AuNPs) through photoinduced deposition on a silver nanowire (AgNW), and the second system consists of two offset parallel AgNWs. This latter coupler system shows a higher coupling efficiency and is used to successfully demonstrate RE-TEPL spectral mapping on a MoSe2/WSe2 lateral heterostructure to reveal spatial heterogeneity at the heterojunction.

A useful modality of CT angiography image to identify medical emergency in isolated celiac artery dissection type I: A case report with longest follow-up and literature review.

Symptomatic isolated celiac artery (CA) dissection (SICAD) is an extremely rare form of visceral artery dissection. It is diagnosed by a contrast abdominal computed tomography (CT) scan showing a CA dissection (CAD). There are 4 types of CAD: Type I-IV. Type I has entry and re-entry and no true luminal narrowing. All types other than type I have entry and re-entry. They have true lumen compression and true lumen constriction due to false lumen. We report a case with the longest follow-up, 120 months after symptom onset, without evidence of CAD exacerbation. A 56-year-old man presented with a sudden onset of abdominal and back pain. He had a past medical history of left pneumothorax, pulmonary tuberculosis at the age of 23, and hypertension on medication since the age of 46. On physical examination, he had mild muscle rebound tenderness in the epigastric region. The curved multiplanar reconstruction (MPR) of the urgent 3-dimensional contrast-enhanced abdominal computed tomography angiography (CTA) showed an isolated celiac artery dissection type I. Given the risk of emergency surgery for total occlusion of the CA, conservative management with analgesics during hospitalization resolved the abdominal pain, and the patient was discharged 3 days later. Subsequently, a total of 5 CTAs were performed over 120 months, but no worsening of CA arterial dissection and CA occlusion findings were observed. In type I SICAD cases, arterial dissection, and CA occlusion may progress, in which case emergency stenting or endovascular treatment may be indicated, and close follow-up such as CTA is required.

A light-mediated covalently patterned graphene substrate for graphene-enhanced Raman scattering (GERS).

We report covalently patterned graphene with acetic acid as a new potential candidate for graphene-enhanced Raman scattering (GERS). Rhodamine 6G molecules in direct contact with the covalently modified region show an enormous enhancement (∼25 times) compared to the pristine region at 532 nm excitation. The GERS enhancement with respect to the layer thickness of the probed molecule, excitation wavelength, and covalently attached groups is discussed.

Using temporal changes in MR images to determine treatment options for complex liver cysts.

The prevalence of hepatic cyst (HC) ranges from 2.5 to 4.7%. Among them, HCs with with symptoms occur in 15%. Extrahepatic rupture of HCs with hemorrhagic shock and death may occur. Early detection of intracystic hemorrhage is necessary to prevent lifethreatening complications. In this case, a 77-year-old woman underwent regular checkups. Her ultrasound (US) showed multiple hepatic cysts (HCs). The largest HC was 80 mm in diameter and located in segment 8 of the right lobe. Her prognostic nutritional index (PNI) was 41.7, indicating high surgical morbidity and mortality after surgery. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) were added to identify intra- and extra-cystic anatomy. Compared to MDCT, MRI was able to identify intra-cystic heterogeneous low and high intensity. These findings were interpreted to indicate acute to chronic intra-cystic hemorrhage. As a complication of the rupture and death, an anterior segmentectomy with segmentectomy with cholecystectomy was planned and performed. Her postoperative course was uneventful and she was discharged on day 16. The life-threatening complex HCs include intra-cystic hemorrhage, rupture, hemorrhagic shock and death. To prevent these, we would like to emphasize that MRI appears to be superior to US or CT in providing accurate information on the time course of intra-cystic hemorrhage from hemoglobin to hemosiderin changes to guide urgent surgical intervention of hepatectomy to prevent HC rupture and prevent HC rupture and death.

Task appeared in COVID-19 pandemic when tele-healthcare saved neurosurgical lives in rural area - A case reports and literature review.

In rural areas, the medical resources are extremely limited not only pandemic but non-pandemic period. Tele-healthcare system using digital technology-based telemedicine is widely used across various medical specialties. To solve limitation of medical resources in hospital located in remote isolated areas, telehealthcare system using smart application has been applied to access expert opinions in pre-coronavirus disease (COVID-19) era since 2017. The COVID-19 has spread also in this island during COVID-19 period. We have experienced three consecutive neuroemergency patients. Their ages and final diagnoses were: 98 years with subdural hematoma (case 1), 76 years with post-traumatic subarachnoid hemorrhage (case 2), and 65 years with cerebral infarction (case 3), respectively. The tele-counseling could save two of three transportations to tertiary hospital and also save 6,000 US dollars per case for transportation by helicopter. From these three cases counseled through smart app which has been started to use 2 years before COVID-19 emerged in 2020, what this case series would report are the following two viewpoints: (1) medicoeconomic benefits exist in tele-healthcare system in COVID-19 era and (2) developing telehealthcare systems must be prepared that is available even when the electricity system has been shut down, for instance solar system that could. This system must be developed when non-disaster period for disaster days of natural disasters and human-related disasters including wars and terrorisms.

SERS Endoscopy for Monitoring Intracellular Drug Dynamics.

Understanding the dynamics and distribution of medicinal drugs in living cells is essential for the design and discovery of treatments. The tools available for revealing this information are, however, extremely limited. Here, we report the application of surface-enhanced Raman scattering (SERS) endoscopy, using plasmonic nanowires as SERS probes, to monitor the intracellular fate and dynamics of a common chemo-drug, doxorubicin, in A549 cancer cells. The unique spatio-temporal resolution of this technique reveals unprecedented information on the mode of action of doxorubicin: its localization in the nucleus, its complexation with medium components, and its intercalation with DNA as a function of time. Notably, we were able to discriminate these factors for the direct administration of doxorubicin or the use of a doxorubicin delivery system. The results reported here show that SERS endoscopy may have an important future role in medicinal chemistry for studying the dynamics and mechanism of action of drugs in cells.

Liquid-phase photo-induced covalent modification (PICM) of single-layer graphene by short-chain fatty acids.

We report an efficient photo-induced covalent modification (PICM) of graphene by short-chain fatty acids (SCFAs) with an alkyl chain at the liquid-solid interface for spatially resolved chemical functionalization of graphene. Light irradiation on monolayer graphene under an aqueous solution of the SCFAs with an alkyl chain efficiently introduces sp3-hybridized defects, where the reaction rates of PICM are significantly higher than those in pure water. Raman and IR spectroscopy revealed that a high density of methyl, methoxy, and acetate groups is covalently attached to the graphene surface while it was partially oxidized by other oxygen-containing functional groups, such as OH and COOH. A greater downshift of the G-band in Raman spectra was observed upon the PICM with longer alkyl chains, suggesting that the charge doping effect can be controlled by the alkyl chain length of the SCFAs. The systematic research and exploration of covalent modification in SCFAs provide new insight and a potentially facile method for bandgap engineering of graphene.

Length-Controllable Gold-Coated Silver Nanowire Probes for High AFM-TERS Scattering Activity.

Tip-enhanced Raman scattering (TERS) microscopy is an advanced technique for investigation at the nanoscale that provides topographic and chemical information simultaneously. The TERS probe plays a crucial role in the microscopic performance. In the recent past, the development of silver nanowire (AgNW) based TERS probes solved the main tip fabrication issues, such as low mechanical strength and reproducibility. However, this fabrication method still suffers from low control of the protruded length of the AgNW. In this work, a simple water-air interface electrocutting method is proposed to achieve wide controllability of the length. This water cutting method was combined with a succedent Au coating on the AgNW surface, and the probe achieved an up to 100× higher enhancement factor (EF) and a 2× smaller spatial resolution compared to pristine AgNW. Thanks to this excellent EF, the water-cut Au-coated AgNW probes were found to possess high TERS activity even in the nongap mode, enabling broad applications.

Useful classification of intussusception for preoperative 3D-MDCT images, type M or W: a case report and a novel classification.

A 67-year old male with intussusception due to sigmoid colonic caner was treated. For making correct classification of antegrade or retrograde type, multidetector-computed tomography in longitudinal views seemed optimal to demonstrate anatomical type. This radiological modality made to identify this instead of ultrasound sonography (US) could reveal details of surrounding information. Under intestinal obstruction due to intussusception, cancer-related information such as lymph nodal involvement could be visible using not US but MDCT because of air collection around lesions. His preoperative MDCT revealed antegrade type intussusception with cancerous mass at the leading point and no nodal involvements. Under general anesthesia, he has undertaken laparotomy to resect intussuscepted sigmoid colonic lesion successfully without delaying of surgical procedure. For correct preoperative identification of antero-retrograde type of intussusception using MDCT, safer surgical procedure could be provided. For these purposes, the authors classified these into 2 types, type M and W from longitudinal views of intussuscepted lesions using 3D-MDCT. This classification might be helpful for clinicians to diagnose type of intussusception and provide preoperative information of cancerous involvements with vessels and lymph nodal involvements to consider surgical option.

Prognostic nutritional index as outcome predictor in patients with iliopsoas abscess.

Cases with iliopsoas abscess (IPA) in a single hospital-based cases were reviewed and compared with clinical profiles of published hospital-based IPA series. To verify usefulness of prognostic nutritional index (PNI) used to predict outcome and severity of IPA, this study was performed. This study consists of 2 parts: Study 1 - Case review of IPA series in a single hospital: 7 cases with IPA treated in a single hospital in sequential 5 years were collected (series 1) and their clinical profiles compared. Study 2 - Review of hospital-based literature: A search of the PubMed database from 1990 to the present was performed, using the Boolean expression ([Psoas OR iliopsoas] AND [abscess] AND [hospital-based]). Two hospital-based case series were collected. The clinical profiles of 2 series were compared with series 1 to draw predictive factors of outcome and deciding treatment modality, medical or surgical. Study 1 - Analyzing 7 IPA cases, average age was 76.7 years old (varying from 64 to 91) and the lifesaving rate was 86%. PNI < 45, calculated with serum albumin (Alb) and total lymphocyte count, and larger cumulative abscess volume (CAV) measured by computed tomography seem outcome predictors. Study 2 - Analyzing 2 hospital-based IPA series (series 2 and 3), series 2 reviewed isolated IPA cases without any comorbidities and series 3 reviewed IPA cases with cardiovascular disorders. Among 3 series including ours, series 1 showed oldest case and longer length of hospitalization. Series 3 showed the highest mortality among 3 because it collected IPA with cardiovascular comorbidities. PNI seems predictors of outcome and disease activity in patients with IPA and might indicate treated with surgical intervention.

A Cancer-Pain Analgesia as Prolonging Strategy of Surviving Time after Failure of Adjuvant Chemotherapy in Patient with Progressive Bone-Metastatic Hepatocellular Carcinoma.

The hepatocellular carcinoma (HCC) with intrahepatic and bone metastasis shows poor survival of averagely 3 months. The bone metastasis and HCC itself might cause cancer-associated pain. An intrathecal (IT) analgesia might contribute to improve QOL and prolong surviving time (ST). A 71-year-old male presented with temperature and appetite loss continuing for 2 months. He looked pale and malaise. Computed tomography and tumor markers elevation confirmed diagnosis of HCC stage IV. To treat him, molecularly targeted therapy was started but abandoned because of side effects of life-threatening convulsions and loss of consciousness. Since this time, pain control strategy was planned as advance care plan. After dermal and oral opioids were administered, IT analgesia was introduced to conquer uncontrollable pelvic pain due to metastatic osteolytic lesions. Owing to IT analgesia against severe cancer-related pain, he had lived for 46 months. Comparing with reviews in which average ST is 3 months, this is the case with the longer ST in bone-metastatic HCC. From our experience, it must be emphasized that relieving cancer-related pain strategy for patients with progressive bone-metastatic HCC might contribute to prolong ST longer when adjuvant therapy has been failed.

A radiological footprint equivalent to liquefactive necrosis observed in the course of disappearing liver metastases in rectal cancer: A case report and review of the literature.

A 72-year-old female diagnosed with rectal cancer treated with a surgical procedure was reported. As 3 liver metastases (LMs) appeared in multidetector CT, adjuvant chemotherapy using Bevacizumab combined with modified FOLFOX-6 was completed. LMs were changed to cystic lesions during the follow-up period, consistent with liquefactive necrosis. These cystic lesions that appeared in the course of disappearing LMs (DLMs) were identified by CT as homogeneous low signal intensity in hepatocyte specific Gd-enhanced MRI. This might be pathognomonic radiological footprint equivalent to liquefactive necrosis observed in the process of DLM and must be carefully followed in the course of radiological complete response. The radiological changing findings of LMs to cystic changes, high sensitivity of detecting DLM, and limitations of Gd-MRI might be meaningful to clinicians.

All-Optical and One-Color Rewritable Chemical Patterning on Pristine Graphene under Water.

We report a facile all-optical method for spatially resolved and reversible chemical modification of a graphene monolayer. A tightly focused laser on graphene under water introduces an sp3-type chemical defect by photo-oxidation. The sp3-type defects can be reversibly restored to sp2 carbon centers by the same laser with higher intensity. The photoreduction occurs due to laser-induced local heating on the graphene. These optical methods combined with a laser direct writing technique allow photowriting and erasing of a well-defined chemical pattern on a graphene canvas with a spatial resolution of about 300 nm. The pattern is visualized by Raman mapping with the same excitation laser, enabling an optical read-out of the chemical information on the graphene. Here, we successfully demonstrate all-optical Write/Read-out/Erase of chemical functionalization patterns on graphene by simply adjusting the one-color laser intensity. The all-optical method enables flexible and efficient tailoring of physicochemical properties in nanoscale for future applications.

Gold-coated silver nanowires for long lifetime AFM-TERS probes.

Tip-enhanced Raman scattering (TERS) microscopy is an advanced technique for investigation at the nanoscale because of its excellent properties, such as its label-free functionality, non-invasiveness, and ability to simultaneously provide topographic and chemical information. The probe plays a crucial role in TERS technique performance. Widely used AFM-TERS probes fabricated with metal deposition suffer from relatively low reproductivity as well as limited mapping and storage lifetime. To solve the reproducibility issue, silver nanowire (AgNW)-based TERS probes were developed, which, thanks to the high homogeneity of the liquid-phase synthesis of AgNW, can achieve high TERS performance with excellent probe reproductivity, but still present short lifetime due to probe oxidation. In this work, a simple Au coating method is proposed to overcome the limited lifetime and improve the performance of the AgNW-based TERS probe. For the Au-coating, different [Au]/[Ag] molar ratios were investigated. The TERS performance was evaluated in terms of changes in the enhancement factor (EF) and signal-to-noise ratio through multiple mappings and the storage lifetime in air. The Au-coated AgNWs exhibited higher EF than pristine AgNWs and galvanically replaced AgNWs with no remarkable difference between the two molar ratios tested. However, for longer scanning time and multiple mappings, the probes obtained with low Au concentration showed much longer-term stability and maintained a high EF. Furthermore, the Au-coated AgNW probes were found to possess a longer storage lifetime in air, allowing for long and multiple TERS mappings with one single probe.

Successful preoperative identification of fish bone causing appendicitis using 3-dimensional multidetector-CT.

A 79 years male with fishbone-induced acute appendicitis was treated surgically with laparoscopic procedure. In preoperative diagnostic study, 3-dimensional multidetector-computed tomography (3D-MDCT) demonstrated the foreign body in the appendix and 3D-reconstructed images seemed fishbone with sharp-pointed dorsal fin directing to the tip of the appendix. With these findings, surgical indication of appendectomy was confirmed and laparoscopic appendectomy was performed. He made a full recovery and was discharged in a satisfactory condition following 7 days of post-operative treatment. From this case experience, 3D-MDCT seems helpful to visualize details of foreign bodies in the appendix, and valuable to confirm surgical indication of complicated acute appendicitis.

A case of influenza-associated invasive aspergillosis with cerebral hemorrhage due to infectious vasculopathy.

An invasive aspergillosis (IA) primarily occurs among immunocompromised patients. Recently with an influenzae infection prevalently spreading, influenzae-associated invasive aspergillosis (IAIA) has been reported occasionally. By contrast, neuroleptic malignant syndrome (NMS) occurs rarely in psychiatric patients who are treated with Olanzapine. We report a 43 years old male with psychiatric disorder who had developed IAIA followed by NMS and cerebral hemorrhage as the result of aspergillus invasion to cerebral vessels. He had also super-infection of COVID-19, 13 months later to be saved completely after invasive mechanical respiratory supports. From clinical aspects, we would emphasize that it is of importance to find earlier co-occurrence of IAIA patients with cerebral hemorrhage due to secondary infectious vasculopathy of IA.

A Staged Operation as a Surgical Strategy for a Patient with Type VI Isolated Superior Mesenteric Artery Dissection.

An isolated superior mesenteric artery (SMA) dissection (ISMAD) is extremely rare among visceral artery dissections. Its diagnosis is made by abdominal contrast CT scan which shows SMA occlusion partially or completely. The ISMAD is classified into 6 types: type I-V has partial occlusion and treated medically using antiplatelets or anticoagulants. On the other hand, type VI has complete occlusion and must be treated by urgent surgical operation. We present a 67-year-old female who presented with sudden onset abdominal pain and melena. An urgent contrast CT revealed type VI ISMAD. She underwent 3 staged operations as follows: (1) first, as laparotomy showed pale color in almost the extensive length of the small intestine, arterial bypassing of SMA was undertaken using SMA to the right common iliac artery bypass; (2) as the second-look operation on the next day, the terminal ileum was resected, and the remaining small intestine was able to be preserved. However, when the abdomen was tried to be closed, systemic blood pressure decreased to pre-shock condition, so the abdominal wall was closed at skin level with silastic sheet. (3) As the third-look operation on the 7th day, ileostomy was created, and the abdominal wall was safely closed. The postoperative course was uneventful. This case study shows that SMA grafting and staged operations might be an option to preserve the length of the small intestine when ISMAD is diagnosed as type VI.