Elucidation of microbial interactions, dynamics, and keystone microbes in high pressure anaerobic digestion.

High-pressure anaerobic digestion (HPAD) is a promising technology for producing biogas enriched with high methane content in a single-step process. To enhance HPAD performance, a comprehensive understanding of microbial community dynamics and their interactions is essential. For this, mesophilic batch high-pressurized anaerobic reactors were operated under 3 bars (H3) and 6 bars (H6). The experimental results showed that the effect of high-pressure (up to 6 bar) on acidification was negligible while methanogenesis was significantly delayed. Microbial analysis showed the predominance of Defluviitoga affiliated with the phylum Thermotogae and the reduction of Thiopseudomonas under high-pressure conditions. In addition, the microbial cluster pattern in H3 and H6 was significantly different compared to the CR, indicating a clear shift in microbial community structure. Moreover, Methanobacterium, Methanomicrobiaceae, Alkaliphilus, and Petrimonas were strongly correlated in network analysis, and they could be identified as keystone microbes in the HPAD reactor.

Ultrasonographic findings of the various diseases presenting as calf pain.

There are various causes of calf pain. The differential diagnoses affecting the lower leg include cystic lesions, trauma-related lesions, infection or inflammation, vascular lesions, neoplasms, and miscellaneous entities. Ultrasound (US) provide detailed anatomical information of the calf structures, and it offers the ability to confirm, other calf abnormalities, particularly when deep vein thrombosis (DVT) is ruled out. The purpose of this article is to review the causes of a painful calf presenting as DVT and incidental findings found as part of the work-up of DVT, and to provide a broad overview of US findings and clinical features of these pathologies.

Imaging findings of intravascular papillary endothelial hyperplasia presenting in extremities: correlation with pathological findings.

OBJECTIVE: To describe magnetic resonance imaging (MRI) and ultrasound (US) findings of intravascular papillary endothelial hyperplasia (IPEH) arising in extremities. MATERIALS AND METHODS: Six patients with IPEH confirmed by surgical resection were reviewed retrospectively. Before resection, 3 patients underwent both MRI and US and 3 patients underwent only MRI. Two radiologists retrospectively reviewed MR/US imaging results and correlated them with pathological features. RESULTS: The 6 IPEHs were diagnosed as 4 mixed forms and 2 pure forms. The pre-existing pathology of four mixed forms was intramuscular or intermuscular hemangioma. By MRI, the mixed form of IPEH (n = 4) revealed iso- to slightly high signal intensity containing nodule-like foci of high signal intensity on T1-weighted images (T1WI) and high signal intensity-containing nodule-like foci of low signal intensity on T2-weighted images (T2WI). The pure form of IPEH (n = 2) showed homogeneous iso- signal intensity on T1WI and high and low signal intensity containing nodule-like foci of low signal intensity on T2WI. On gadolinium-enhanced fat-suppressed T1WI, 50% of cases (n = 3: mixed forms) revealed peripheral, septal, and central enhancement. The other IPEHs (n = 3: 1 mixed and 2 pure forms) showed peripheral and septal enhancement or only peripheral enhancement. By US, two mixed forms of IPEH showed well-defined hypoechoic masses containing hyperechoic septa and central portion with vascularities. One pure form of IPEH was a homogeneous hypoechoic mass with septal and peripheral vascularities on color Doppler imaging. The foci of high signal intensity on T1WI, foci of low signal intensity on T2WI, and non-enhancing portions on MRI and the hypoechoic portion on US were histopathologically correlated with thrombi and the peripheral/septal or central enhancing areas on MRI, hyperechoic septa and the central portion on US, and septal/central or peripheral vascularities on color Doppler imaging corresponded to hypertrophic papillary epithelium and a fibrovascular core. CONCLUSIONS: Even though imaging findings of the pure form of IPEH are rather nonspecific, the mixed form of IPEH should be considered a possible diagnosis when a well-defined mass with T2 hyperintense signal containing nodule-like foci of low signal intensity, T1 iso- to slightly hyperintense signal containing nodule-like foci of high signal intensity, and peripheral/septal or central enhancement on MRI is seen in extremities, along with the US finding of a hypoechoic mass containing hyperechoic septa with vascularities.

Crisscross-configured dual stent placement for trisectoral drainage in patients with advanced biliary hilar malignancies.

PURPOSE: To evaluate technical success and clinical efficacy of crisscross-configured dual biliary stent implantation in patients with a biliary hilar tumor extending beyond the segmental ducts. MATERIALS AND METHODS: Between January 2002 and December 2006, two metallic stents were placed crossing each other in a hepatic hilum in 42 patients. One stent was placed between one right sectoral duct and the left hepatic duct and the other was placed between another right sectoral duct and the common bile duct. The patients ranged in age from 36 to 83 years (mean, 63.3 y) and included 26 men and 16 women. Technical success, clinical success, complications, and long-term results were analyzed by retrospective review. RESULTS: Stent placement was performed through two right accesses (n = 30), one right and one left access (n = 3), or two right accesses and one left access (n = 6). Successful "trisectoral" drainage was obtained with two stents in 41 patients (98%). In one case of initial technical failure, an additional stent was needed to connect the two previously placed stents. Clinical success was obtained in 34 of the remaining 36 patients (92%). No procedure-related major complication was observed. The median primary stent patency time was 187 days and the median patient survival time was 247 days. CONCLUSIONS: Crisscross-configured dual stent implantation is a feasible, safe, and effective method to maximize hepatic drainage with a minimal number of stents in patients with advanced biliary hilar malignancy.