Time-Resolved Electrochemical Impedance Spectroscopy of Stochastic Nanoparticle Collision: Short Time Fourier Transform versus Continuous Wavelet Transform.

This work demonstrates the utilization of short-time Fourier transform (STFT), and continuous wavelet transform (CWT) electrochemical impedance spectroscopy (EIS) for time-resolved analysis of stochastic collision events of platinum nanoparticles (NPs) onto gold ultramicroelectrode (UME). The enhanced electrocatalytic activity is observed in both chronoamperometry (CA) and EIS. CA provides the impact moment and rough estimation of the size of NPs. The quantitative information such as charge transfer resistance (Rct ) relevant to the exchange current density of a single Pt NP is estimated from EIS. The CWT analysis of the phase angle parameter is better for NP collision detection in terms of time resolution compared to the STFT method.

A Simple Risk Scoring System for Predicting the Occurrence of Aspiration Pneumonia After Gastric Endoscopic Submucosal Dissection.

BACKGROUND: Aspiration pneumonia after endoscopic submucosal dissection (ESD) is rare, but can be fatal. We aimed to investigate risk factors and develop a simple risk scoring system for aspiration pneumonia. METHODS: We retrospectively reviewed medical records of 7833 patients who underwent gastric ESD for gastric neoplasm under anesthesiologist-directed sedation. Candidate risk factors were screened and assessed for significance using a least absolute shrinkage and selection operator (LASSO)-based method. Top significant factors were incorporated into a multivariable logistic regression model, whose prediction performance was compared with those of other machine learning models. The final risk scoring system was created based on the estimated odds ratios of the logistic regression model. RESULTS: The incidence of aspiration pneumonia was 1.5%. The logistic regression model showed comparable performance to the best predictive model, extreme gradient boost (area under receiver operating characteristic curve [AUROC], 0.731 vs 0.740). The estimated odds ratios were subsequently used for the development of the clinical scoring system. The final scoring system exhibited an AUROC of 0.730 in the test dataset with risk factors: age (≥70 years, 4 points), male sex (8 points), body mass index (≥27 kg/m2, 4 points), procedure time (≥80 minutes, 5 points), lesion in the lower third of the stomach (5 points), tumor size (≥10 mm, 3 points), recovery time (≥35 minutes, 4 points), and desaturation during ESD (9 points). For patients with total scores ranging between 0 and 33 points, aspiration pneumonia probabilities spanned between 0.1% and 17.9%. External validation using an additional cohort of 827 patients yielded AUROCs of 0.698 for the logistic regression model and 0.680 for the scoring system. CONCLUSIONS: Our simple risk scoring system has 8 predictors incorporating patient-, procedure-, and sedation-related factors. This system may help clinicians to stratify patients at risk of aspiration pneumonia after ESD.

Electrochemical Detection and Analysis of Various Current Responses of a Single Ag Nanoparticle Collision in an Alkaline Electrolyte Solution.

A single silver (Ag) nanoparticle (NP) collision was observed and analyzed in an alkaline solution using the electrocatalytic amplification (EA) method. Previously, the observation of a single Ag NP collision was only possible through limited methods based on a self-oxidation of Ag NPs or a blocking strategy. However, it is difficult to characterize the electrocatalytic activity of Ag NPs at a single NP level using a method based on the self-oxidation of Ag NPs. When using a blocking strategy, size analysis is difficult owing to the edge effect in the current signal. The fast oxidative dissolution of Ag NPs has been a problem for observing the staircase response of a single Ag NP collision signal using the EA method. In alkaline electrolyte conditions, Ag oxides are stable, and the oxidative dissolution of Ag NPs is sluggish. Therefore, in this study, the enhanced magnitude and frequency of the current response for single Ag NP collisions were obtained using the EA method in an alkaline electrolyte solution. The peak height and frequency of single Ag NP collisions were analyzed and compared with the theoretical estimation.

A cone-beam computed tomography evaluation of posterior available space in both arches relative to various skeletal patterns.

INTRODUCTION: This study aimed to evaluate the posterior available space (PAS) in both dental arches of adult patients with varying skeletal patterns using cone-beam computed tomography. METHODS: A sample of 114 adult patients (56 males and 58 females) was divided into 3 groups according to ANB angle and facial height ratio. Using C-mode cone-beam computed tomography images from these patients, maxillary PAS (MxPAS) and mandibular PAS (MnPAS) were measured in the distobuccal and palatal roots of the maxillary second molars and the distal roots of the mandibular second molars, respectively. The planes perpendicular to the tooth axes of the second molars in the coronal views and parallel to the posterior occlusal planes in the sagittal views were set at 3 heights of furcation, middle, and apex of the roots. For each plane, the shortest posterior distances from the roots to the inner and outer cortices were measured parallel to the furcation line connecting the furcations of the molars in the axial views. Posterior cortical bone thickness, defined as the distance from the inner cortex to the outer cortex, was measured. RESULTS: PAS was significantly greater in males than in females and in the maxilla than in the mandible (P <0.01). All MxPAS gradually increased from the furcation to the apex with significance (P <0.05), but there was no difference in MnPAS. MxPAS was significantly greater (P <0.05) in subjects with Class II and III malocclusion than subjects with Class I malocclusion, whereas MnPAS showed no difference. MxPAS showed no significant differences in facial height ratio, whereas MnPAS was significantly greater (P <0.05) at furcation in normovergent subjects than in others. Posterior cortical bone thickness was greater (P <0.001) in the mandible than in the maxilla. CONCLUSIONS: PAS was different according to sex and skeletal patterns. It would be helpful to evaluate PAS when distalizing the molars in either arch.

Predictive models for chronic kidney disease after radical or partial nephrectomy in renal cell cancer using early postoperative serum creatinine levels.

BACKGROUND: Several predictive factors for chronic kidney disease (CKD) following radical nephrectomy (RN) or partial nephrectomy (PN) have been identified. However, early postoperative laboratory values were infrequently considered as potential predictors. Therefore, this study aimed to develop predictive models for CKD 1 year after RN or PN using early postoperative laboratory values, including serum creatinine (SCr) levels, in addition to preoperative and intraoperative factors. Moreover, the optimal SCr sampling time point for the best prediction of CKD was determined. METHODS: Data were retrospectively collected from patients with renal cell cancer who underwent laparoscopic or robotic RN (n = 557) or PN (n = 999). Preoperative, intraoperative, and postoperative factors, including laboratory values, were incorporated during model development. We developed 8 final models using information collected at different time points (preoperative, postoperative day [POD] 0 to 5, and postoperative 1 month). Lastly, we combined all possible subsets of the developed models to generate 120 meta-models. Furthermore, we built a web application to facilitate the implementation of the model. RESULTS: The magnitude of postoperative elevation of SCr and history of CKD were the most important predictors for CKD at 1 year, followed by RN (compared to PN) and older age. Among the final models, the model using features of POD 4 showed the best performance for correctly predicting the stages of CKD at 1 year compared to other models (accuracy: 79% of POD 4 model versus 75% of POD 0 model, 76% of POD 1 model, 77% of POD 2 model, 78% of POD 3 model, 76% of POD 5 model, and 73% in postoperative 1 month model). Therefore, POD 4 may be the optimal sampling time point for postoperative SCr. A web application is hosted at https://dongy.shinyapps.io/aki_ckd . CONCLUSIONS: Our predictive model, which incorporated postoperative laboratory values, especially SCr levels, in addition to preoperative and intraoperative factors, effectively predicted the occurrence of CKD 1 year after RN or PN and may be helpful for comprehensive management planning.

Quality of Recovery of Patients Who Underwent Curative Pancreatectomy: Comparison of Total Intravenous Anesthesia Versus Inhalation Anesthesia Using the QOR-40 Questionnaire.

BACKGROUND: There has been increasing attention on the subjective recovery of patients undergoing cancer surgery. Total intravenous anesthesia (TIVA) and inhaled anesthesia with volatile anesthetics (INHA) are safe and common anesthetic techniques. Currently, TIVA and INHA have only been compared for less invasive and less complex surgeries. This prospective randomized trial aimed to compare the quality of recovery between TIVA and INHA in patients undergoing pancreatoduodenectomy (PD) or distal pancreatectomy (DP) using the Quality of Recovery (QOR)-40 questionnaire. METHODS: We enrolled 132 patients who were randomly assigned to either the desflurane (DES) (INHA, balanced anesthesia with DES and remifentanil infusion) or TIVA (effect-site target-controlled infusion of propofol and remifentanil) groups and completed the QOR-40 questionnaire postoperatively. RESULTS: The mean global QOR-40 score on postoperative day 3 was significantly higher in the TIVA group than in the DES group. In the PD group, the total QOR-40 score was significantly higher in the TIVA group than in the DES group. Moreover, the TIVA group had significantly higher scores in the physical comfort and psychological support QOR-40 dimensions than the DES group. CONCLUSION: TIVA provides better quality of recovery scores on POD 3 for patients undergoing curative pancreatectomy. CLINICAL TRIAL REGISTRATION NUMBER: NCT03447691.

Hemimandibular hyperplasia treatment with condylectomy and orthodontic camouflage treatment using miniplate.

A 13-year-old growing female patient presented with hemimandibular hyperplasia of the right side, Class III hypodivergent skeletal pattern, and severe facial asymmetry. Corrective surgery was deferred until her growth had been completed. When the patient was 16 years old, a low condylectomy was performed on the hyperplastic side of her mandible to prevent its progressive condylar hyperplasia, while simultaneous orthodontic camouflage treatment was performed with the intrusion of the maxillary right posterior teeth using temporary skeletal anchorage devices without additional orthognathic surgery. A low condylectomy caused anterior and lateral open bite after the downward and backward movement of the chin, which improved Class III appearance. The intrusion of the maxillary right posterior teeth followed by compensating extrusion of the mandibular posterior teeth contributed to improve the patient's facial asymmetry with correction of the transverse occlusal plane and lip canting. After 30 months of treatment, an acceptable esthetic outcome and functional occlusion were achieved. The treatment results were well maintained for 1-year retention.

Posterior Available Space for Uprighting Horizontally Impacted Mandibular Second Molars Using Orthodontic Microimplant Anchorage.

Treatment of horizontally and deeply impacted mandibular molars is challenging for both orthodontists and oral surgeons because of the limited access and anchorage control. We report on two patients who had horizontally and mesially impacted mandibular second molars (MM2s). Both patients were treated by a surgical orthodontic approach, and the crowns of the impacted teeth were brought into the arches by closed forced eruption. Mesially impacted MM2s were uprighted with orthodontic microimplants, inserted in the retromolar area, and then moved into their ideal position. The first patient was in an active growing stage, while the second patient was beyond the active growing stage. Therefore posterior available space (PAS) should be analyzed before treatment of impacted MM2s to prevent periodontal problems after uprighting of impacted teeth. If PAS is not enough for uprighting impacted MM2s, alternative treatment should be considered based on the stage of growth.

Mandibular condyle bone density in adolescents with varying skeletal patterns evaluated using cone-beam computed tomography: A potential predictive tool.

INTRODUCTION: The aim of this study was to evaluate the bone density of mandibular condyles in adolescents with varying skeletal patterns using cone-beam computed tomography. The null hypothesis was that there is no difference in the bone density of mandibular condyles in adolescents across various facial height ratios, ANB angle classifications, sexes, and age categories. METHODS: We divided 120 adolescent patients, 56 boys and 64 girls, into 3 groups according to 3 criteria: (1) age (early, 10 to <14 years; middle, 14 to <17 years; late, 17 to <20 years); (2) facial height ratio or Jarabak quotient (hyperdivergent: facial height ratio, <62%; normovergent: facial height ratio, 62% to ≤65%; and hypodivergent: facial height ratio, >65%); and (3) ANB angle classification (Class I, 1° to ≤4°; Class II, (>4°); and Class III, <1°). The total, cortical, and cancellous bone densities were measured and compared on the axial slice with the largest mediolateral diameter of the mandibular condyle using C-mode cone-beam computed tomography. RESULTS: Cortical bone density increased as age increased and showed statistically significant differences between the early and middle (P = 0.041) and the early and late adolescent groups (P = 0.031). Condylar bone density increased as facial height ratio decreased, and cancellous bone density showed statistically significant differences between the hyperdivergent and hypodivergent groups (P = 0.038). The cortical, cancellous, and total bone densities increased as ANB angle increased and showed statistically significant differences between the Class II and Class III groups (P = 0.022, P = 0.006, and P = 0.003, respectively). CONCLUSIONS: The null hypothesis was rejected. Condylar bone density increased as facial height ratio decreased and ANB angle increased. These findings may be useful in predicting the vertical and horizontal skeletal growth patterns of growing adolescents.

The Effects of Granulocyte-Colony Stimulating Factor on Regeneration in Nerve Crush Injuries in Rats.

Granulocyte-colony stimulating factor (G-CSF) is widely known to have a neuroprotective effect, but its effects on function and morphology in mechanical nerve injury are not well understood. The aim of this study was to confirm the time course of the functional changes and morphological effects of G-CSF in a rat model of nerve crush injury. Twelve-eight rats were divided into three group: sham-operated control group, G-CSF-treated group, and saline treated group. 2 weeks after the nerve crush injury, G-CSF was injected for 5 days. After 4 weeks, functional tests such as motor nerve conduction velocity (MNCV), mechanical and cold allodynia tests, and morphological studies were performed. G-CSF-treated rats had significantly improved nerve function including MNCV and mechanical and cold allodynia. In addition, G-CSF-treated rats had significantly higher the density of myelinated fibers than saline-treated rats. In conclusion, we found that 100 µg/kg administration of G-CSF promoted long-term functional recovery in a rat model of nerve crush injury.

A small Askin's tumor presenting with early onset of chest pain.

Most primitive neuroectodermal tumor of the chest wall destroy the rib, chest wall muscles, diaphragm, and lung or extend into the spinal compartment, resulting in a large-sized tumor and symptoms. In contrast, we recently encountered a rare case of Askin's tumor presenting with early-onset chest pain despite the small size. After resection of the tumor and adjuvant chemotherapy, the patient remains disease-free over 3 years of follow-up.

Association between preoperative lumbar skeletal muscle index and postoperative nausea and vomiting in patients undergoing pylorus-preserving pancreatoduodenectomy: a retrospective study.

BACKGROUND: Sarcopenia is associated with postoperative complications; however, its impact on the quality of postoperative recovery, such as postoperative nausea and vomiting (PONV) and pain, remains unclear. We investigated the association of preoperative lumbar skeletal muscle mass index (LSMI) with PONV, postoperative pain, and complications. METHODS: Medical records of 756 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD) were retrospectively reviewed. The skeletal muscle areas were measured on abdominal computed tomography (CT) images. LSMI was calculated by dividing the skeletal muscle area by the square of the patient's height. We analyzed the correlations between preoperative LSMI calibrated with confounding variables and PONV scores, PONV occurrence, pain scores, rescue analgesic administration, postoperative complications, and length of hospital stay. RESULTS: The median (1Q, 3Q) LSMI was 47.72 (40.74, 53.41) cm2/m2. The incidence rates of PONV according to time period were as follows: post-anesthesia care unit, 42/756 (5.6%); 0-6 h, 54/756 (7.1%); 6-24 h, 120/756 (15.9%); 24-48 h, 46/756 (6.1%); and overall, 234/756 (31.0%). The incidence of PONV was inversely correlated with LSMI 24-48 h post-surgery and overall. LSMI and PONV scores were negatively associated 6-24 h and 24-48 h post-surgery. There was no association between LSMI and postoperative pain scores, rescue analgesic administration, complications, or length of hospital stay. CONCLUSIONS: Preoperative LSMI was associated with PONV in patients undergoing PPPD. Therefore, LSMI measured on preoperative abdominal CT can be a predictive indicator of PONV. Appropriate PONV prophylaxis is necessary in patients with low LSMI before PPPD.

Bronchiectasis in active tuberculosis.

BACKGROUND: Bronchiectasis in tuberculosis (TB) is usually considered chronic traction bronchiectasis associated with healed scars. However, bronchiectasis can occasionally be seen in active TB. PURPOSE: To evaluate prevalence, appearance, and changes of bronchiectasis associated with active TB on computed tomography (CT). MATERIAL AND METHODS: A total of 391 patients with active TB who had undergone CT scans at the time of diagnosis were included in the study. Active TB was diagnosed when the sputum or the sample obtained by bronchoalveolar lavage tested positive using an acid-fast bacillus (AFB) smear test, polymerase chain reaction (PCR) test, or an AFB culture. The CT scans were reviewed focusing on bronchiectasis within consolidations or nodules. Cases with bronchiectasis beyond the consolidation or nodules were excluded from the study to exclude pre-existing traction bronchiectasis. The prevalence and appearance (cylindrical, varicose, cystic, and presence of focal erosion) of bronchiectasis and its time-dependent changes were analyzed. In addition, the presence of the feeding bronchus sign was checked. Here, the feeding bronchus sign was defined as a CT finding where the cavity communicates with the dilated airway. RESULTS: In 100 (25%) of the 391 patients, bronchiectasis was present within consolidations or nodules on CT. The shape of the bronchiectasis was cylindrical in all patients and focal erosions were revealed in 75 patients (75%). Nine patients had both cylindrical and varicose forms of the bronchiectasis. The feeding bronchus sign was observed in 42 patients (42%). Follow-up CT was performed on 19 of 100 patients. The bronchiectasis had progressed in 11 patients (58%), improved in four patients (21%), remained unchanged in one patient (5%), and could not be determined in the remaining three patients (16%). In nine patients, CT images prior to diagnosis were available, and in all these cases, bronchiectasis was newly developed. CONCLUSION: Bronchiectasis can be seen within active inflammation in one-fourth of active TB on CT. In association with active inflammation, bronchiectasis is mostly cylindrical with focal erosions, occasionally accompanied by the feeding bronchus sign.

Comparison of As, Ni, Zn, Cd, and Pb removals using treatment agents.

The removal of heavy metals, such as As, Ni, Zn, Cd and Pb, onto limestone, starfish, black shale and concrete from wastewater was studied. These materials, with a high capacity for heavy metals, can be obtained and employed as alternative low-cost substitutes. Various parameters, such as the neutralization capacity, changes in pH, redox potential and electric conductivity as a function of time, were quantified. Of the studied treatment agents, concrete showed high neutralization efficiency for acid mine drainage and maintained a pH value above 11. The adsorption of heavy metals was influenced by the compositions of the treatment agents. The experimental results of leaching revealed no significant follow-up release from any of the treatment agents. The results suggest that concrete could be used successfully for the treatment of mixed metal-contaminated wastes.

Observation and Analysis of Staircase Response of Single Palladium Nanoparticle Collision on Gold Ultramicroelectrodes.

Collision (or impact) of single palladium nanoparticles (Pd NPs) on gold (Au), copper (Cu), nickel (Ni), and platinum (Pt) ultramicroelectrodes (UMEs) were investigated via electrocatalytic amplification method. Unlike the blip responses of previous Pd NP collision studies, the staircase current response was obtained with the Au UME. The current response, including collision frequency and peak magnitude, was analyzed depending on the material of the UME and the applied potential. Adsorption factors implying the interaction between the Pd NP and the UMEs are suggested based on the experimental results.

Detection of pulmonary embolism using 64-slice multidetector-row computed tomography: accuracy and reproducibility on different image reconstruction parameters.

BACKGROUND: Direct comparison of different image reconstruction parameters to detect pulmonary embolism (PE) using 64-slice multidetector-row computed tomography (MDCT) is absent and the most accurate image reconstruction parameters have not yet been proven. PURPOSE: To compare different image reconstruction parameters for detecting PE using 64-slice MDCT in patients suspected of having an acute PE. MATERIAL AND METHODS: Forty patients who underwent pulmonary CT angiography with 64-slice MDCT for a suspected PE were included. Different image reconstruction parameters were used for each patient: axial and coronal images with slice thicknesses of 0.625 mm, 1.3 mm, and 2.5 mm and axial maximum intensity projection (MIP) images with slab thicknesses of 1.3 mm, 2.5 mm, and 5 mm. Four experienced radiologists reviewed the images. The diagnosis of a PE was based on consensus review of axial 0.625 mm slice thickness images by two chest radiologists with allowing multiplanar reconstruction. Accuracy and reproducibility (kappa value) were evaluated. RESULTS: In 15 of 40 patients, a PE was diagnosed. For detecting lobar PEs, axial images with a slice thickness of 1.25 mm and all coronal re-formatted images showed comparable results to axial images with a slice thickness of 0.625 mm. For detecting segmental PEs, axial images with a slice thickness of 1.25 mm and coronal images with a slice thickness of 0.625 mm re-formatted images showed comparable results to axial images of a slice thickness of 0.625 mm. For detecting subsegmental PEs, axial images with a slice thickness of 0.625 mm showed the highest sensitivity. Better reproducibility was obtained when the thinner slice thickness reconstructions were in axial and coronal images. However, reproducibility of MIP images with slab thicknesses of 2.5 mm and 5 mm was similar for detecting segmental and subsegmental PEs. CONCLUSION: Thin-slice reconstruction of less than 1 mm is mandatory for visualization of PE at the subsegmental level.

Effect of volatile and total intravenous anesthesia on syndecan-1 shedding after minimally invasive gastrectomy: a randomized trial.

This study aimed to compare the effects of volatile anesthesia and total intravenous anesthesia (TIVA) on syndecan-1 shedding in patients with gastric cancer undergoing minimally invasive gastrectomy. Patients were randomly assigned to either the Volatile (n = 68) or the TIVA (n = 68) group. Anesthesia was maintained with sevoflurane/remifentanil or propofol/remifentanil in the Volatile and TIVA groups, respectively. Serum syndecan-1 was evaluated at pre-operation, end of operation, and postoperative day (POD) 1. Inflammatory markers including white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), were also measured at pre-operation, end of operation, and POD 1, 2, 3, and 5. The TIVA group showed significantly lower levels of syndecan-1 at the end of the operation compared to the Volatile group; however, no difference was seen between the groups at POD 1. The WBC count and NLR were significantly lower in the TIVA group at the end of the operation than the Volatile group, but there were no differences between the groups at POD 1, 2, 3, and 5. CRP levels were similar between the groups at all time points. In conclusion, despite TIVA being superior to volatile anesthesia in protecting endothelial glycocalyx during the operation, both did not prevent postoperative syndecan-1 shedding after gastrectomy.Clinical trial registration number: NCT04183296 (ClinicalTrial.gov, 03/12/2019).

Immunomodulatory Effects of Perioperative Dexmedetomidine in Ovarian Cancer: An In Vitro and Xenograft Mouse Model Study.

BACKGROUND: The surgical stress response (SSR) causes immunosuppression which may cause residual tumor growth and micrometastasis after cancer surgery. We investigated whether dexmedetomidine affects cancer cell behavior and immune function in an ovarian cancer xenograft mouse model. METHODS: The effect of dexmedetomidine on cell viability and cell cycle was assessed using SK-OV-3 cells at drug concentrations of 0.5, 0.1, 5, and 10 µg mL-1. BALB/c nude mice were used for the ovarian cancer model with the Dexmedetomidine group (n=6) undergoing surgery with dexmedetomidine infusion and the Control group (n=6) with saline infusion for 4 weeks. Natural killer (NK) cell activity, serum proinflammatory cytokines, and cortisol were measured at predetermined time points and tumor burden was assessed 4 weeks after surgery. RESULTS: Dexmedetomidine had no effect on cell viability or cell cycle. Following a sharp decrease on postoperative day (POD) 1, NK cell activity recovered faster in the Dexmedetomidine group with significant difference vs. the Control group on POD 3 (P=0.028). In the Dexmedetomidine group, cortisol levels were lower on POD 3 (P=0.004) and TNF-α levels were lower at 4 weeks after surgery (P<0.001) compared to the Control group. The Dexmedetomidine group showed lower tumor burden at 4 weeks vs. the Control group as observed by both tumor weight (P<0.001) and the in vivo imaging system (P=0.03). CONCLUSIONS: Dexmedetomidine infusion may improve ovarian cancer surgery outcome by suppressing the SSR and stress mediator release. Further studies are needed to elucidate the mechanisms by which dexmedetomidine acts on cancer and immune cells.