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We present a case of iatrogenic iliac vein rupture with venous thrombosis during total hip arthroplasty that was endovascularly treated with the insertion of covered and uncovered stents, aspiration, and balloon maceration of the thrombus. We describe in detail, with a schematic diagram, an endovascular treatment method that can be performed under local anesthesia alone and explain how to overcome the situation when the diameter of the covered stent is inadequate to cover the iliac vein.

In this case report, the authors present three cases of post-tracheostomy site bleeding successfully treated using embolization, supplemented by CT and angiography images. This report highlights that embolization can be a viable alternative when surgical or endoscopic interventions fail or are not applicable in cases of post-tracheostomy bleeding.

In this report, we present a case of a radiotherapy-induced tracheoesophageal fistula treated with the fluoroscopy-guided insertion of a covered stent through the gastrostomy route using both the antegrade and retrograde approaches. The initial antegrade endoscopic and fluoroscopic stent insertion procedure failed due to severe esophageal stricture. Compared to the endoscopic approaches, fluoroscopy-guided radiologic procedures are generally less invasive and more successful because they allow for a better understanding of the anatomy outside the lumen during the procedure and enable the use of devices with smaller diameters.

Abstract R2R3-MYB transcription factors (TFs) are known to play a key role in regulating the expression of structural genes involved in plant flavonoid biosynthesis. However, the regulatory networks and related genes controlling isoflavonoid biosynthesis in soybean are poorly understood. We previously reported that ethephon application increases the production of isoflavonoids in soybean leaves. In this study, we attempted to identify a potential regulatory gene that positively controls isoflavonoid production in response to ethephon treatment in soybean (Glycine max L.). RNA sequencing (RNA-seq) revealed that ethephon application led to the upregulation of 22 genes, including the genes for R2R3-MYB TFs, related to isoflavonoid biosynthesis in soybean plants. Ethephon treatment highly induced the expression of GmMYB108, and its expression was exclusively enriched in flowers as determined using in silico and real-time quantitative PCR analyses. Furthermore, GmMYB108 overexpression resulted in an intense accumulation of anthocyanins as well as total flavonoid production in the leaf tissues of transgenic Arabidopsis plants. In addition, GmMYB108 overexpression increased the transcript levels of several genes involved in the biosynthesis of anthocyanins and their regulatory pathways in Arabidopsis. These results suggest that GmMYB108 is a potential positive regulator of the biosynthesis of flavonoids and anthocyanins in soybean flowers.

Purpose: Positive margins after breast-conserving surgery are associated with poor oncological outcomes and warrant additional surgery. This study aimed to evaluate the effectiveness of high-dose radiation therapy for positive margins by comparing local recurrence between patients with positive and negative margins. Methods: We retrospectively evaluated 550 patients treated with adjuvant radiation therapy after breast-conserving surgery for invasive breast cancer between 2013 and 2019. The total equivalent dose in 2 Gy fractions (EQD2) to the tumor bed ranged from 65.81 to 66.25 Gy for positive margins and 59.31–61.81 Gy for negative margins. The differences in local recurrence between the positive and negative margin groups were analyzed. Results: After a median follow-up of 58 months, the crude local recurrence rate was 7.3% in the positive margin group (n = 55) and 2.4% in the negative margin group (n = 495). Positive margins were associated with higher local recurrence without statistical significance in the entire cohort (p = 0.062). Among patients aged

If the cause of the bile leakage after hepaticojejunostomy is accidental non-anastomosis of one bile duct, it is unlikely that the leakage will resolve spontaneously, and reoperation may be necessary. However, if the patient has contraindications to surgery, other treatments should be considered. In this case report, we describe a new percutaneous tract creation between the isolated right bile duct and Roux-en-Y afferent jejunal loop in a patient who underwent hepaticojejunostomy, and the right bile duct was accidentally not anastomosed with the jejunal loop.

Based on statistics available in Korea, trauma centers play a critical role in treatment of patients with trauma. Interventional radiologists in trauma centers perform various procedures, including embolization, which constitutes the basic treatment for control of hemorrhage, although interventions such as stent graft insertion may also be used. Although emergency interventional procedures have been used conventionally, rapid and effective hemorrhage control is important in patients with trauma. Therefore, it is important to accurately understand and implement the concept of damage control interventional radiology, which has gained attention in recent times, to reduce preventable trauma-induced mortality rates.

Traumatic pelvic injuries usually include high-energy crush injuries and are associated with significant morbidity and mortality. Mortality rates range from 6% to 15% and increase to 36%– 54% in cases of fractures that result in increased pelvic volume. Therefore, retroperitoneal hemorrhage can spiral and progress to hemorrhagic shock. Pelvic hemorrhage most commonly occurs secondary to disrupted pelvic veins or fractured bones, and 10%–20% of cases involve arterial injuries. Owing to extensive bleeding and limitations of surgery for pelvic hemorrhage, interventional treatment is at the forefront of pelvic hemorrhage management. CT is an accurate indicator of active hemorrhage in patients with pelvic trauma that affects the diagnosis and management, including interventions. Identification of the site of hemorrhage is necessary for focused interventional treatment. The current trend toward a more conservative approach for treatment of pelvic trauma and advances in interventional radiology in the field of pelvic trauma may favor widespread use of interventional treatment for patients with pelvic injuries. In this review, we discuss therapeutic modalities available to the interventional radiologist and common angiographic treatment strategies and techniques.

Traumatic iliac venous injury is rare but can be fatal. Although surgical management is considered a primary treatment method, urgent treatment is required when deep venous thrombosis and subsequent phlegmasia cerulea dolens is combined. It is difficult to treat by surgical management, and pharmaceutic thrombolysis cannot be applied due to the trauma history. Here, we describe a case of unilateral traumatic iliac venous injury and subsequent diffuse venous thrombosis in the affected iliofemoral and infrapopliteal veins, combined with phlegmasia cerulea dolens, treated with endovascular management, including bare metal stent insertion and aspiration thrombectomy.

Abstract Early diagnosis of deep venous thrombosis is essential for reducing complications, such as recurrent pulmonary embolism and venous thromboembolism. There are numerous studies on enhancing efficiency of computer-aided diagnosis, but clinical diagnostic approaches have never been considered. In this study, we evaluated the performance of an artificial intelligence (AI) algorithm in the detection of iliofemoral deep venous thrombosis on computed tomography angiography of the lower extremities to investigate the effectiveness of using the clinical approach during the feature extraction process of the AI algorithm. To investigate the effectiveness of the proposed method, we created synthesized images to consider practical diagnostic procedures and applied them to the convolutional neural network-based RetinaNet model. We compared and analyzed the performances based on the model’s backbone and data. The performance of the model was as follows: ResNet50: sensitivity = 0.843 (± 0.037), false positives per image = 0.608 (± 0.139); ResNet152 backbone: sensitivity = 0.839 (± 0.031), false positives per image = 0.503 (± 0.079). The results demonstrated the effectiveness of the suggested method in using computed tomography angiography of the lower extremities, and improving the reporting efficiency of the critical iliofemoral deep venous thrombosis cases.

Background The coronavirus disease 2019 (COVID-19) outbreak has had a major impact worldwide. Several countries have implemented restrictions on social interaction (“social distancing”). Several studies have reported that the epidemiology of trauma patients, such as those with facial bone fractures, has changed after COVID-19 pandemic. This study aimed to further explore these specific changes. Methods This was a retrospective study of patients who presented to a single institution with facial bone fractures between January 1, 2016, and December 31, 2020. Baseline patient demographics, clinical information, type of fracture, etiology, and operative management were compared before and after COVID-19. Results Of all cases, 3,409 occurred before COVID-19, and 602 occurred after COVID-19. Since the outbreak of COVID-19, the number of patients with facial fractures has not decreased significantly. A significant increase was noted in fractures that occurred outdoors (p

A 57-year-old man presented with a pigmented papule, 0.4 cm in diameter, on the left lower eyelid. Skin biopsy revealed a basal cell carcinoma, which was excised through a wide excision followed by a full-thickness skin graft (FTSG). Two weeks after the surgery, an erythematous nodule developed in the lower margin of the graft recipient site. The nodule size increased rapidly over 2 weeks, becoming dome-shaped with a central hyperkeratotic plug. A diagnosis of keratoacanthoma (KA) was made, and surgical excision was performed. Histological findings revealed a large, well-differentiated squamous tumor with a central keratin-filled crater and buttress. The human papilloma virus (HPV) genotyping results were negative. Risk factors for KA include trauma, old age, exposure to ultraviolet (UV) radiation, immunosuppression, and HPV infection. KA has most often been reported to develop at the donor site. Although the pathogenesis of KA is unclear, trauma is believed to act as a second insult to a preceding oncogenic insult, such as exposure to UV radiation, resulting in a koebnerization. Herein, we report a case of solitary KA at a FTSG recipient site. This report presents information that may provide guidance during dermatologic surgeries.

PURPOSETo investigate the image quality of lower extremity computed tomography angiography (LE-CTA) using a reconstruction algorithm for monoenergetic images (MEIs) to evaluate peripheral arterial disease (PAD) at different kiloelectron volt (keV) levels.METHODSA total of 146 consecutive patients who underwent LE-CTA on a dual-energy scanner to obtain MEIs at 40, 50, 60, 70, and 80 keV were included. The overall image quality, segmental image quality of the arteries and PAD segments, venous contamination, and metal artifacts from prostheses, which may compromise quality, were analyzed.RESULTSThe mean overall image quality of each MEI was 2.9 ± 0.7, 3.6 ± 0.6, 3.9 ± 0.3, 4.0 ± 0.2, and 4.0 ± 0.2 from 40 to 80 keV, respectively. The segmental image quality gradually increased from 40 to 70–80 keV until reaching its highest value. Among 295 PAD segments in 68 patients, 40 (13.6%) were scored at 1–2 at 40 keV and 13 (4.4%) were scored at 2 at 50 keV, indicating unsatisfactory image quality due to the indistinguishability between high-contrast areas and arterial calcifications. The segments exhibiting metal artifacts and venous contamination were reduced at 70–80 keV (2.6 ± 1.2, 2.7 ± 0.5) compared with at 40 keV (2.4 ± 1.1, 2.5 ± 0.7).CONCLUSIONThe LE-CTA method using a reconstruction algorithm for MEIs at 70–80 keV can enhance the image quality for PAD evaluation and improve mitigate venous contamination and metal artifacts.

Peripheral arterial disease (PAD) is common in elderly patients. Lower-extremity CT angiography (LE-CTA) can be useful for detecting PAD and planning its treatment. PAD can also be accurately evaluated on reconstructed monoenergetic images (MEIs) from low kiloelectron volt (keV) to high keV images using dualenergy CT. Low keV images generally provide higher contrast than high keV images but also feature more severe image noise. The noise-reduced virtual MEI reconstruction algorithm, called the Mono+ technique, was recently introduced to overcome such image noise. Therefore, this pictorial review aimed to present the imaging findings of PAD on LE-CTA and compare low and high keV images with those subjected to the Mono+ technique. We found that, in many cases, the overall and segmental image qualities were better and metal artifacts and venous contamination were decreased in the high keV images.

Introduction: The root of Cratoxylum cochinchinense has been widely used as Chinese folk medicine to cure fevers, burns, and abdominal complications because it contains various bioactive metabolites such as xanthones, triterpenes, and flavonoids. In this study, we estimated bacterial neuraminidase inhibition with a series of xanthones from C. cochinchinense. BNA has connected to various biological functions such as pathogenic bacteria infection inflammatory process after infection and biofilm formation.Methods: The identification of xanthones (1–6) bearing geranyl and prenyl groups was established by spectroscopic data using UV, IR, NMR, and HREIMS. BNA inhibitory modes of isolated xanthones were investigated by Double-reciprocal plots. Moreover, the competitive inhibitor was evaluated the additional kinetic modes determined by kinetic parameters (k3, k4, and Kiapp). The molecular docking (MD) and molecular dynamics simulations (MDS) studies also provided the critical information regarding the role of the geranyl and prenyl groups against BNA inhibition.Results: A series of xanthones (1–6) appended prenyl and geranyl groups on the A-ring were isolated, and compounds 1–3 were shown to be new xanthones. The analogues within this series were highly inhibited with excellent affinity against bacterial neuraminidase (BNA). A subtle change in the prenyl or geranyl motif affected the inhibitory potency and behavior significantly. For example, the inhibitory potency and binding affinity resulting from the geranyl group on C4: xanthone 1 (IC50 = 0.38 μM, KA = 2.4434 × 105 L·mol−1) were 100-fold different from those of xanthone 3 (IC50 = 35.8 μM, KA = 0.0002 × 105 L·mol−1). The most potent compound 1 was identified as a competitive inhibitor which interacted with BNA under reversible slow-binding inhibition: Kiapp = 0.1440 μM, k3 = 0.1410 μM−1s−1, and k4 = 0.0203 min−1. The inhibitory potencies (IC50) were doubly confirmed by the binding affinities (KA).Discussion: This study suggests the potential of xanthones derived from C. cochinchinense as promising candidates for developing novel BNA inhibitors. Further research and exploration of these xanthones may contribute to the development of effective treatments for bacterial infections and inflammatory processes associated with BNA activity.

Core needle biopsy of breast masses is a common procedure for tissue diagnosis of breast lesions. The incidence of complications is low, with pseudoaneurysm (PA) after core biopsy has been described in the literature, and the subsequent need for surgical management. Ultrasonography is the most common modality used for not only diagnosis but also treatment of a PA. Color Doppler images show a heterogeneous echoic lesion with whirling flow inside of the lesion. We describe a patient whose breast PA that developed after core needle biopsy was successfully treated with sonographically-guided intravascular glue embolization.

Purpose This study aimed to evaluate the natural growth of subepithelial tumors of the small bowel detected on CT. Materials and Methods Consecutive patients who were suspected of having subepithelial tumors of the small bowel between January 2005 and December 2020 were reviewed. Eligible patients with suspected small (< 30 mm) subepithelial tumors on at least two CT evaluations were included in the analysis. The patients’ data on demographic characteristics, tumoral characteristics, and tumoral size changes during the follow-up were collected. Results This study included 64 patients with suspected small subepithelial tumors (n = 64) of the small bowel. After a median follow-up of 15.8 months, the diameter and volume growth rates were 0.02 mm/month and 1.5 mm3/month, respectively. A significant correlation was observed between the initial size and the growth rate of the small bowel subepithelial tumors. The group of large-sized tumors (initial diameter ≥ 10 mm) tended to show lobulated contours, heterogeneous enhancement, and necrotic changes more frequently than the group of small-sized tumors (initial diameter < 10 mm). Conclusion Small bowel subepithelial tumors measuring less than 10 mm grew more slowly than those measuring 10–30 mm.

Background: The purpose of this study was to compare the performance between noncontrast-enhanced computed tomography (NECT) plus abdominal ultrasound (US) (NECT + US) with contrast-enhanced computed tomography (CECT) for the detection of hepatic metastasis in breast cancer patient with postsurgical follow-up. Methods: A total of 1470 patients without already diagnosed hepatic metastasis were included. All patients underwent US and multiphase CECT including the NECT. Independent reviewers analyzed images obtained in four settings, namely, abdominal US, NECT, NECT + US, and CECT and recorded liver metastases using a 5-grade scale of diagnostic confidence. Sensitivity, specificity (diagnostic performance), and area under the receiver operating characteristic curve (AUC, diagnostic confidence) were calculated. Interoperator agreement was calculated using the kappa test. Results: Reference standards revealed no metastases in 1108/1470 patients, and metastasis was detected in 362/1470 patients. Abdominal US (P < 0.01) and NECT (P = 0.01) significantly differed from CECT, but NECT + US did not significantly differ from CECT in terms of sensitivity (P = 0.09), specificity (P = 0.5), and AUC (P = 0.43). After an additional review of abdominal US, readers changed the diagnostic confidence scores of 106 metastatic lesions diagnosed using NECT. Interobserver agreements were good or very good in all four settings. Additional review of abdominal US with NECT allowed a change in the therapeutic plan of 108 patients. Conclusion: Abdominal US + NECT showed better diagnostic performance for the detection of hepatic metastases than did NECT alone; its diagnostic performance and confidence were similar to those of CECT.

Objectives Body protective compound-157 (BPC-157) is a stable gastric pentadecapeptide that has been effective in trials aiming to increase wound healing capabilities and decrease inflammatory cell influx, including studies on the healing of muscles and tendons. There are no studies about the effect of BPC-157 on pain transmission via nociception. This study examined the antinociceptive effects of BPC-157 using formalin tests and immunohistochemistry. Methods Rats were randomly divided into the control, morphine and BPC-157 groups. Pain behavior was quantified periodically at 5- and 35- min intervals (representative values of phases 1 and 2) by counting the number of flinches exhibited by the injected paw after injection. The dorsal root ganglia (DRG) and spinal cords (SC) were collected, and then, the number of cytokine-positive cells was determined via immunostaining. Results BPC-157 dose-dependently decreased the number of flinches during phase 1 but did not decrease the number of flinches during phase 2. During phase 1, interleukin-1β (IL-1β) in the DRG tissue was significantly different in the morphine, 10 μg/kg BPC-157, and 20 μg/kg BPC-157 groups. During phase 2, statistical significance was achieved in the DRG tissue in the morphine, 20 μg/kg BPC-157, and 40 μg/kg BPC-157 groups. During phase 1, interleukin-6 was significantly different in the DRG tissue in the morphine group and the SC tissue in the 10 μg/kg BPC-157 group. During phase 2, statistical significance was achieved in the morphine group and the BPC-157 20 μg/kg group in both the DRG and SC tissues. There were no significant differences in tumor necrosis factor-α between the DRG and SC tissues. Conclusions BPC-157 was effective during phase 1 but not during phase 2, as determined by the formalin test. BPC-157 decreased the expression of IL-1β in the DRG tissue in phases 1 and 2.

Introduction: Research and development efforts regarding passive lower-limb exoskeletons are actively ongoing to reduce work-related musculoskeletal disorders (WMDSs) from improper and prolonged posture. The aims of this study were to evaluate the effects of passive lower-limb exoskeletons and working heights on muscle activity and subjective comfort ratings. Methods: In this study, 20 males performed a 10-min drilling task for three levels of working height (60, 85, and 110 cm), and three levels of intervention (WO: without exoskeleton, WCEX, and WCC) were used as independent variables. The EMG data of eight muscles and subjective discomfort ratings in each of the six body parts were analyzed in this study. Results: The results of this study confirm that the effect of wearing a lower-limb exoskeleton device may vary depending on the muscle type and working height. Overall, the positive effects of wearing were generally observed in the lower-limb muscles, whereas the muscle activity of the upper limbs showed an increasing trend when wearing the device at a height of 85 cm or more. Conclusions: Therefore, to obtain positive effects in both the upper- and lower-limb muscles, using the lower-limb exoskeletons at a working height of 85 cm or less is recommended.

Inflammatory-related diseases are becoming increasingly prevalent, leading to a growing focus on the development of anti-inflammatory agents, with a particular emphasis on creating novel structural compounds. In this study, we present a highly efficient synthetic method for direct N-arylation to produce a variety of N(2)-arylindazol-3(2H)-ones 3, which exhibit anti-inflammatory activity. The Chan–Evans–Lam (CEL) coupling of N(1)-benzyl-indazol-3-(2H)-ones 1 with arylboronic acids 2 in the presence of a copper complex provided the corresponding N(2)-arylindazol-3(2H)-ones 3 in good-to-excellent yields, as identified with NMR, MS, and X-ray crystallography techniques. The cell viability and anti-inflammatory effects of the synthesized compounds (3 and 5) were briefly assessed using the MTT method and Griess assay. Among them, compounds 5 exhibited significant anti-inflammatory effects with negligible cell toxicity.

Abundance of metabolites in plant is a critical factor toward being functional food stuff. Salicylic acid (SA) treatment led significant changes in levels of the secondary metabolites in soybean roots. Notably, the exposure of 3 mM of SA aqueous solution to soybean plants for 24 h resulted in distinctive increases in the levels of coumestrol (16-fold, 0.3–4.8 mg/g DW) and daidzein (7-fold, 1.2–8.9 mg/g DW) in roots part. These changes were systematically investigated by LC-ESI-TOF/MS analysis to afford a clear difference of PLS-DA score, heatmap, and box plots. Quantitative analysis showed that SA treatment played to stimulate biosynthesis of coumestrol as well as hydrolysis of its glycosides (coumestrin and malonylcoumestrin). The highly improved anti-LDL oxidation effect was observed in the SA treated soybean roots in the three different assay systems. It might be rationalized by the increased levels of coumestrol and daidzein.

Abstract Purpose To evaluate the safety, efficacy, and long-term outcome of bronchial artery embolization (BAE) in the treatment of non-massive hemoptysis and the prognostic factors associated with recurrent bleeding. Materials and methods From March 2005 to September 2014, BAE was performed in 233 patients with non-massive hemoptysis. All patients had a history of persistent or recurrent hemoptysis despite conservative medical treatment. We assessed the technical and clinical success, recurrence, prognostic factors related to recurrent bleeding, recurrence-free survival rate, additional treatment, and major complications in all the patients. Results Technical success was achieved in 224 patients (96.1%), and clinical success was obtained in 219 (94.0%) of the 233 patients. In addition, 64 patients (27.5%) presented hemoptysis recurrence with median time of 197 days after embolization. Tuberculosis sequelae and presence of aberrant bronchial artery or non-bronchial systemic collaterals were significantly related to recurrent bleeding (p

Background: Excellent success rates with short-term outcomes are noted for laparoscopic ureteral reconstruction (LUR) for iatrogenic ureteral injury. This multi-institutional study assessed the medium-term (>1 year) outcomes and compared three surgical techniques of LUR. Methods: Patients who underwent LUR at five tertiary hospitals between January 2007 and June 2016 were retrospectively analyzed. Patients with active abdominopelvic inflammatory disease, history of urothelial cancer, and tumor recurrence and those who received adjuvant chemotherapy or radiotherapy were excluded. Results: The success rates of LUR for 61 patients at 3 months postoperatively and at the last follow-up (at least 12 months postoperatively) were 100% and 95.1%, respectively. No significant difference was noted in the success rates of the three types of LUR. LUR was mainly performed in response to the demands of the primary surgeon responsible for the iatrogenic injury (33 of 45 cases, 73.3%). The vesicoureteral reflux (VUR) incidence was higher in the refluxing laparoscopic ureteroneocystostomy (LUN) group (40%) than in the anti-refluxing LUN group (15%, odds ratio: 1.5, p = 0.252). None of the patients in the LUN groups received treatment for VUR during the follow-up. The laparoscopic end-to-end ureteroureterostomy (LEEU) group had shorter operative time (p

Coronary artery fistula is an abnormal communication between the coronary artery and either the cardiac chamber or the great vessel. In particular, the coronary-to-pulmonary artery fistula can be supplied by either one or both coronary arteries and drains to the pulmonary trunk. We report a unique case of fistula originating from both coronary arteries and draining into both sinuses of the main pulmonary artery in a 57-year-old female who experienced chronic chest pain and palpitation. Dilated and tortuous fistulas were found in coronary angiography and coronary computed tomography angiography examinations. To aid early diagnosis and clinical management, radiologists should be aware of the characteristic radiologic findings.

Liver injury is a common consequence of blunt abdominopelvic trauma. Contrast-enhanced CT allows for the rapid detection and evaluation of liver injury. The treatment strategy for blunt liver injury has shifted from surgical to nonoperative management, which has been widely complemented by interventional management to treat both liver injury and its complications. In this article, we review the major imaging features of liver injury and the role of interventional management for the treatment of liver injury.

Background Only a few studies have evaluated the differences between varying concentrations of a fixed dose of local anesthetics. This study was conducted to compare the effects of two different concentrations of a fixed dose of ropivacaine used in ultrasound-guided interscalene brachial plexus block. Methods This prospective, randomized, double-blind study included 62 patients who underwent arthroscopic surgery under general anesthesia. The patients were randomly assigned to receive ultrasound-guided interscalene block with 75 mg of ropivacaine at one of two concentrations: 0.75% (10 ml; Group C) or 0.375% (20 ml; Group V). Time to onset of sensory blockade, degree of blockade, pulmonary function changes, analgesic duration of the interscalene block, postoperative opioid requirement within 24 h, postoperative pain scores, satisfaction, and incidence of complications were recorded. Results Although the time to onset of sensory blockade was shorter for Group C (P = 0.015), successful blockade was achieved at 30 min after the interscalene block in both groups. The analgesic duration of the interscalene block was not significantly different between the groups. The amount of opioid used within 24 h after surgery was significantly reduced for Group V compared with Group C (P = 0.016). The rest of the parameters did not show any significant differences between the two groups. Conclusions Compared with 10 ml of 0.75% ropivacaine, interscalene block with 20 ml of 0.375% ropivacaine could be effective for the reduction of postoperative opioid requirement within 24 h after surgery despite it might not prolong the analgesic duration.

Background Sore throat and hoarseness frequently occur following general anesthesia with tracheal intubation and are effectively reduced when dexamethasone is used prophylactically. Alchemilla vulgaris in glycerine (Neo Mucosal Activator®) suppresses inflammatory response, possibly relieving sore throat. Methods We enrolled 94 patients (age ≥ 18 years) scheduled for thoracic surgery using double-lumen tube intubation. Before intubation, 0.2 mg/kg of dexamethasone was administered intravenously and 2 ml of normal saline was sprayed into the oropharyngeal cavity (Group D; n = 45), or 0.04 ml/kg normal saline was administered intravenously and 1 g of Neo Mucosal Activator® mixed with 1 ml of normal saline was sprayed into the oropharyngeal cavity (Group N; n = 43), in a double blind and prospectively randomized manner. Postoperative sore throat and hoarseness were recorded using a numeral rating scale and a 4-point scale to detect a change in voice quality following tracheal extubation (at 1, 6, and 24 h). The primary outcome was the incidence of sore throat at 24 h following surgery. The secondary outcomes were incidence and severity of sore throat and hoarseness. Results There were no significant differences in the incidence of sore throat at 24 h following surgery (57.8% vs. 46.5%; P = 0.290) or in the incidence and intensity of sore throat and hoarseness at 1, 6, and 24 h following surgery between the groups. Conclusions A. vulgaris in glycerine did not significantly differ from dexamethasone for preventing sore throat and hoarseness owing to intubation.

Abstract Background Calcium increases the probability of transmitter release at the neuromuscular junction. It is not known whether there is a dose-dependent relationship between the dosage of calcium gluconate and the probability of transmitter release for non-depolarizing neuromuscular blockade (NMB) recovery by acetylcholinesterase inhibitors (AchEIs). This study compared the neuromuscular recovery time and the incidence of postoperative residual curarization (PORC) according to the dosage of calcium gluconate co-administered with neostigmine in three patient groups. Methods Patients were randomly allocated to a control group, a 5 mg/kg calcium gluconate group (calcium 5 group), or a 10 mg/kg calcium gluconate group (calcium 10 group). In patients with a TOF ratio (TOFr) between 0.2–0.7, 0.04 mg/kg of neostigmine was administered and both 0.2 mg of glycopyrrolate and 0.4 mg of atropine per 1 mg of neostigmine were administered. And additional 5 or 10 mg/kg of calcium gluconate were administrated to the calcium 5 and 10 groups. The primary endpoint was neuromuscular recovery time (the time between reversal and TOFr≥0.9). The secondary endpoints were the incidence of PORC at 5, 10, and 20 min after reversal administration and the train-of-four ratio (TOFr) at each time point. Results The neuromuscular recovery time was 5.3 min in the control group, 3.9 min in the calcium 5 group, and 4.1 min in the calcium 10 group, respectively (P = 0.004). The incidence of PORC at 5 min after neostigmine administration was 12 in the control group, 4 in the calcium 5 group, and 4 in the calcium 10 group, respectively, with statistical significance (P = 0.014). Conclusions The co-administration of calcium gluconate with neostigmine safely promoted early NMB recovery, and the neuromuscular recovery time of the calcium 10 group tended to be more evenly distributed than that of the calcium 5 group. Trial registration https://cris.nih.go.kr/cris/index.jsp(KCT0004182 ). Date of registration: August 122,019.

Spontaneous renal artery thrombosis is a rare cause of flank pain and can have fatal consequences. We report a case of acute renal artery thrombosis in a 61-year-old man who experienced flank pain and had no medical history. A contrast-enhanced computed tomography scan revealed total thrombotic occlusion of the left renal artery. The patient was taken to interventional radiology, and an urgent catheter-directed thrombolysis of the renal artery was performed. The procedure was successful, with the subsequent arteriogram demonstrating a substantial decrease of the thrombus extent and the recanalization of the left renal artery. This case highlights that emergency renal artery thrombolysis is an effective and safe treatment for acute occlusion of the renal artery.

Background Reversal of neuromuscular blockade (NMB) at the end of surgery is important for reducing postoperative residual NMB; this is associated with an increased risk of postoperative pulmonary complications (PPCs). Moreover, PPCs are associated with poor prognosis after video-assisted thoracoscopic surgery (VATS) for lobectomy. We compared the effects of two reversal agents, sugammadex and neostigmine, on the incidence of PPCs and duration of hospital stay in patients undergoing VATS lobectomy. Methods After VATS lobectomy was completed under neuromuscular monitoring, the sugammadex group (n = 46) received sugammadex 2 mg/kg, while the neostigmine group (n = 47) received neostigmine 0.05 mg/kg with atropine 0.02 mg/kg after at least the third twitch in response to the train of four stimulation. The primary outcome was incidence of PPCs. The secondary outcomes were duration of hospital stay and intensive care unit (ICU) admission. Results There was no significant difference in the incidence of PPCs for both the sugammadex and neostigmine groups (32.6% and 40.4%, respectively; risk difference = 0.08; 95% confidence interval = [−0.12, 0.27]; P = 0.434). The lengths of hospital (P = 0.431) and ICU (P = 0.964) stays were not significantly different between the two groups. Conclusions The clinical use of sugammadex and neostigmine in NMB reversal for patients undergoing VATS lobectomy was not significantly different in the incidence of PPCs and duration of hospital and ICU stay.

Abstract Background Duplication of the superficial femoral artery (SFA) is an extremely rare anatomic variation, with few case studies reported. We report one case of the duplicated SFA, discovered by both ultrasonography (US) and computed tomography angiography (CTA). We also reviewed literatures concerning 6 cases of the duplicated SFA (including our present case), and summarized the clinical and imaging features of the anatomic variation. Case presentation A 55-year-old woman presented to our hospital with an intermittent cramp in the lateral aspect of the right leg. The patient underwent Doppler US examination on bilateral lower extremity arteries and veins to examine potential vascular abnormality. Incidentally, US discovered the duplicated left SFA and CTA of bilateral lower extremities revealed the anatomic orientation, course, length, diameter and distance of the duplicated left SFA. It was revealed to be divided into two trunks with similar luminal diameter and courses parallel. They reunited at distal thigh level. The findings of US and CTA examination did not correspond with the symptom of the patient, and the patient was discharged. Conclusion We report a rare case of the duplicated SFA diagnosed with the combinations of US and CTA examination, which served as valuable imaging methods to detect and diagnose the vascular anatomic variation in lower extremities.

Purpose: This study aimed to assess the clinical outcomes of prostatic urethral lift in Korean patients with bothersome lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Materials and Methods: Thirty-two men with symptomatic BPH were consecutively treated in a tertiary care center in Korea. To be included in the present analysis, patients had to meet the following criteria: age ≥50 years, International Prostatic Symptom Score (IPSS) >12, and prostate volume between 30 mL and 80 mL. Patients were evaluated up to a median followup period of 1 year post-procedure. The primary outcomes included symptom relief, improvement of quality of life (QOL), and preservation of sexual function. Results: All procedures were finished with a mean of 2.2 implants without any serious complication. The numbers of patients diagnosed with diabetes mellitus, hypertension, and ischemic heart disease were 16 (50.0%), 24 (75.0%), and 9 (28.1%), respectively. Patients experienced symptom relief by 1 week that was sustained for 12 months. The mean IPSS, QOL, and maximum flow rate improved to 43%, 70%, and 25% by 1 week, and to 41%, 60%, and 32% by 12 months (p

Bacterial neuraminidase (BNA) plays a pivotal role in the pathogenesis of several microbial diseases including biofilm formation. The aim of this study is to reveal the neuraminidase inhibitory potential of metabolites from Helminthostachys zeylanica (L.) Hook. which have diverse biological activities including PTP1B and α-glucosidase. The six ugonins (1–6) from the target plant showed significant neuraminidase inhibition. The inhibitory potencies were observed at a nanomolar level of 35–50 nM, which means they are 100 times more active than their corresponding mother compounds (eriodyctiol and luteolin). A detailed kinetic study revealed that all ugonins were reversible noncompetitive inhibitors. An in-depth investigation of the most potent compound 1 showed its time-dependent inhibition with the isomerization model having k5 = 0.0103 min−1, k6 = 0.0486 min−1, and Kiapp = 0.062 μM. The binding affinities (Ksv) were agreed closely with our prediction based on the inhibitory potencies. Particularly, ugonin J (1) blocked the biofilm formation of E. coli dose-dependently up to 150 µM without the inhibition of bacteria. The major compounds (1–6) in the extract were characterized by UPLC-ESI-Q-TOF/MS.

Abdominal aortic aneurysm (AAA) is a fatal clinical condition with high mortality. Computed tomography angiography (CTA) imaging is the preferred minimally invasive modality for the long-term postoperative observation of AAA. Accurate segmentation of the thrombus region of interest (ROI) in a postoperative CTA image volume is essential for quantitative assessment and rapid clinical decision making by clinicians. Few investigators have proposed the adoption of convolutional neural networks (CNN). Although these methods demonstrated the potential of CNN architectures by automating the thrombus ROI segmentation, the segmentation performance can be further improved. The existing methods performed the segmentation process independently per 2D image and were incapable of using adjacent images, which could be useful for the robust segmentation of thrombus ROIs. In this work, we propose a thrombus ROI segmentation method to utilize not only the spatial features of a target image, but also the volumetric coherence available from adjacent images. We newly adopted a recurrent neural network, bi-directional convolutional long short-term memory (Bi-CLSTM) architecture, which can learn coherence between a sequence of data. This coherence learning capability can be useful for challenging situations, for example, when the target image exhibits inherent postoperative artifacts and noises, the inclusion of adjacent images would facilitate learning more robust features for thrombus ROI segmentation. We demonstrate the segmentation capability of our Bi-CLSTM-based method with a comparison of the existing 2D-based thrombus ROI segmentation counterpart as well as other established 2D- and 3D-based alternatives. Our comparison is based on a large-scale clinical dataset of 60 patient studies (i.e., 60 CTA image volumes). The results suggest the superior segmentation performance of our Bi–CLSTM-based method by achieving the highest scores of the evaluation metrics, e.g., our Bi-CLSTM results were 0.0331 higher on total overlap and 0.0331 lower on false negative when compared to 2D U-net++ as the second-best.

Intensive investigation of phytochemicals from edible Melicope glabra leaves provided a series of O-alkylated quercetins (1–13). The quercetin 1 bearing prenyl and methyl motif showed potent inhibition to human acetylcholinesterase (hAChE) with mixed type I mode, while quercetin was inactive. The position of methyl group was also a critical factor to hAChE inhibition: 1 (4′-O-methyl, IC50 = 12.7 μM) vs 2 (3′-O-methyl, IC50 = 119 μM). Inhibitory potency was doubly confirmed with the binding affinity (KSV) based on fluorescence quenching. O-Methyl groups on quercetin were observed to influence β-secretase (BACE1) inhibition. Thus, O-methylated quercetins (4–6) displayed potential inhibitions against BACE1 with IC50 values of 1.3, 4.1, and 14.1 μM, respectively. All compounds (3–6) have noncompetitive mode to BACE1. Additionally, all quercetin derivatives (1–13) had antioxidant potentials against different radical sources (ABTS, ORAC and FRAP). The UPLC-ESI-Q-TOF/MS indicated that the leaves part had promising metabolites towards hAChE and BACE1 inhibitions, which are the most predominant phytochemicals.

In this research, a radiation detection backpack to be used discreetly or by a wide range of users was developed using array silicon-photomultiplier (SiPM) and CsI (Tl), and its characteristics were evaluated. The R-squared value, which indicates the responsiveness of a detector based on the signal intensity, was determined to be 0.981, indicating a good linear responsivity. The energy resolutions for gamma radiation energies of Co-57 (122 keV), Ba-133 (356 keV), Cs-137 (662 keV), and Co-60 (1332 keV) were found to be 13.40, 10.50, 6.77, and 3.16%, respectively. These results confirm good energy resolution characteristics. Furthermore, in the case of mixed sources, the gamma radiation peaks were readily distinguishable, and the R-squared value for energy linearity was calculated to be 0.999, demonstrating an exceptional energy linearity. Further research based on the results of this study would enable the commercialization of lightweight SiPM-based wireless radiation detection backpacks that can be used for longer durations by replacing the photomultiplier tube, which is mainly used as the optical sensor in existing radiation detection backpacks. Keywords: Array silicon photomultiplier, CsI (Tl), Radiation detection backpack, Real time, Wireless

Background/Aims Parathyroid hormone (PTH) is an important factor influencing immunologic dysfunction, but the effect of PTH level on infection-related outcomes remains unclear in incident dialysis. Methods We evaluated a multicenter prospective cohort study of 1,771 incident dialysis patients (1,260 hemodialysis and 511 peritoneal dialysis) in Korea. Patients were divided into three groups based on serum intact PTH (iPTH) level. The primary outcomes were all-cause and infection-related mortality and multivariate Cox regression analysis was performed to evaluate the role of iPTH in all-cause and infection-related mortality. Results During the follow-up period of 27.3 months, 175 patients (9.9%) died, and infection-related death represented 20% of all-cause mortality. Both all-cause mortality and infection-related mortality rates (p < 0.001 and p = 0.003, by logrank) were markedly higher in patients with serum iPTH < 150 pg/mL than in the other groups. Multivariate Cox regression analysis revealed that patients with serum iPTH < 150 pg/mL remained at higher risk for infection-related mortality than patients in the target range of 150 ≤ iPTH < 300 pg/mL, after adjusting for confounding variables (hazard ratio [HR], 2.52; 95% confidence interval, 1.06 to 5.99; p = 0.04). The HR of infection-related mortality in patients with serum iPTH < 150 pg/mL was significantly higher in patients with low serum phosphorus, low Ca × P product, low serum alkaline phosphatase and those older than 65 years. Conclusions Low serum iPTH level is an independent predictor of infection-related mortality in incident dialysis patients.

Background The supraglottic airway device is an appropriate alternative to tracheal intubation in laparoscopic surgery. We compared the Baska MaskⓇ with i-gelⓇ by measuring the oropharyngeal leak pressure (OLP) and hemodynamic and respiratory parameters during laparoscopic cholecystectomy. Methods A total of 97 patients were randomly allocated to either i-gel group (n = 49) or Baska Mask group (n = 48). Insertion time, number of insertion attempts, fiber-optic view of the glottis, and OLP were recorded. Heart rate, mean arterial pressure, peak airway pressure (PAP), lung compliance, and perioperative complications were assessed before, during, and after pneumoperitoneum. Results There were no significant differences between the two groups regarding demographic data, insertion time, fiber-optic view of the glottis, and the use of airway manipulation. The OLP was higher in the Baska Mask group than in the i-gel group (29.6 ± 6.8 cmH2O and 26.7 ± 4.5 cmH2O, respectively; P = 0.014). Heart rate, mean arterial pressure, PAP, and lung compliance were not significantly different between the groups. The incidence of perioperative complications was small and not statistically significant. Conclusions Both the i-gel and Baska Mask provided a satisfactory airway during laparoscopic cholecystectomy. Compared with the i-gel, the Baska Mask demonstrated a higher OLP.

Background Woake’s syndrome (WS) is a recurrent nasal polyposis, accompanied by broadening of the nose, frontal sinus aplasia, dyscrinia, and bronchiectasis. There has been no previous report on anesthetic management in patients with WS. Case We describe a case involving a 13-year-old male patient with WS who was scheduled for septorhinoplasty for necrotic ethmoiditis. Anesthesia was induced and maintained with propofol and remifentanil using a target-controlled infusion device. The anesthetic considerations of this rare syndrome and the advantages of an intravenous infusion method over local and volatile anesthesia for these patients are discussed. We report on caveats, such as pulmonary dysfunction during the anesthetic management, and nasal structural problems encountered in WS patients. Conclusions Given that conventional inhaled anesthesia reduces ciliary movement and that local anesthesia with sedative has several disadvantages, perioperative control and precautions against respiratory infections by using antibiotics, and preventing cilio-depressant actions, are important for anesthetic management.

Electrohydrodynamic (EHD) inkjet printing is an efficient technique for printing multiple sensors in a multifaceted area. It can be applied to various fields according to the shape of the printing result and the algorithm employed. In this study, temperature sensors capable of detecting heat sources were fabricated. Inks suitable for EHD inkjet printing were produced, and optimal parameters for printing were determined. Printing was performed using the corresponding parameters, and various printing results were obtained. Furthermore, an experiment was conducted to confirm the temperature measurement characteristics of the results and the tolerance of the sensor. Grid-type sensors were fabricated based on the results, and the sensor characteristics were confirmed in an orthogonal form. Heat was applied to arbitrary positions. Resistance to changes due to heat was measured, and the location at which the heat was generated was detected by varying the change in resistance. Through this study, efficient heat control can be achieved, as the location of the heat source can be identified quickly.

Diabetic foot ulcers (DFUs) and their life-threatening complications, such as necrotizing fasciitis (NF) and osteomyelitis (OM), increase the healthcare cost, morbidity and mortality in patients with diabetes mellitus. While the early recognition of these complications could improve the clinical outcome of diabetic patients, it is not straightforward to achieve in the usual clinical settings. In this study, we proposed a classification model for diabetic foot, NF and OM. To select features for the classification model, multidisciplinary teams were organized and data were collected based on a literature search and automatic platform. A dataset of 1581 patients (728 diabetic foot, 76 NF, and 777 OM) was divided into training and validation datasets at a ratio of 7:3 to be analyzed. The final prediction models based on training dataset exhibited areas under the receiver operating curve (AUC) of the 0.80 and 0.73 for NF model and OM model, respectively, in validation sets. In conclusion, our classification models for NF and OM showed remarkable discriminatory power and easy applicability in patients with DFU.

ObjectiveWe compared the image quality according to the radiation dose on computed tomography (CT) venography at 80 kVp using advanced modeled iterative reconstruction for deep vein thrombus and other specific clinical conditions considering standard-, low-, and ultralow-dose CT.MethodsIn this retrospective study, 105 consecutive CT venography examinations were included using a third-generation dual-source scanner in the dual-source mode in tubes A (reference mAs, 210 mAs at 70%) and B (reference mAs, 90 mAs at 30%) at a fixed 80 kVp. Two radiologists independently reviewed each observation of standard- (100% radiation dose), low- (70%), and ultralow-dose (30%) CT. The objective quality of large veins and subjective image quality regarding lower-extremity veins and deep vein thrombus were compared between images according to the dose. In addition, the CT dose index volumes were displayed from the images.ResultsFrom the patients, 24 presented deep vein thrombus in 69 venous segments of CT examinations. Standard-dose CT provided the lowest image noise at the inferior vena cava and femoral vein compared with low- and ultralow-dose CT (p < 0.001). There were no differences regarding subjective image quality between the images of popliteal and calf veins at the three doses (e.g., 3.8 ± 0.7, right popliteal vein, p = 0.977). The image quality of the 69 deep vein thrombus segments showed equally slightly higher scores in standard- and low-dose CT (4.0 ± 0.2) than in ultralow-dose CT (3.9 ± 0.4). The CT dose index volumes were 4.4 ± 0.6, 3.1 ± 0.4, and 1.3 ± 0.2 mGy for standard-, low-, and ultralow-dose CT, respectively.ConclusionsLow- and ultralow-dose CT venography at 80 kVp using an advanced model based iterative reconstruction algorithm allows to evaluate deep vein thrombus and perform follow-up examinations while showing an acceptable image quality and reducing the radiation dose.

Femoral nerve blocks (FNBs) are used as safe and useful procedures to control severe postoperative pain from total knee arthroplasty (TKA). Various adjuvants have been used to prolong the duration of the local anesthetic blockade. This study evaluated whether a low dose of naloxone administered with local anesthetics prolongs the duration of FNB. A prospective, randomized double-blind controlled study was conducted with 74 patients undergoing unilateral TKA. Through a single-bolus administration guided by ultrasound, the control group (group C) received 20 mL of 0.375% ropivacaine, while the naloxone group (group N) received 20 mL of 0.375% ropivacaine with 100 ng of naloxone. The time elapsed before the first analgesia request, the total amount of opioids consumed at 24 h postoperatively, the onset time of the sensory blockade, the visual analog pain scale (VAS) scores after arriving at the recovery room, after 6, 12, 18, and 24 h at rest and after 12, 18, and 24 h of activity, the quadricep strength before the FNB procedure and at 12 and 24 h postoperatively, the quality of sleep on the first night after surgery, the satisfaction score, and the incidence of postoperative complications were recorded. The time elapsed before the first analgesia request was significantly longer in group N (735.5 ± 187.2 min) than that in group C (602.6 ± 210.4 min) (P=0.003). The total dose of supplementary opioids consumed at 24 h postoperatively was significantly lower in group N (312.4 ± 141.7 μg) than that in group C (456.5 ± 279.5 μg) (P=0.007). Lower VAS scores were recorded in group N than that in group C at rest and during knee activity (rest, 12 h, P=0.001, 18 h, P=0.043; activity, 12 h, P=0.001). The addition of a low dose of naloxone to ropivacaine for FNB significantly delayed the first request for rescue analgesia and decreased the opioid consumption within 24 h, without significant complications.

An automotive seat is a key component which not only provides restraint and support for its occupant, but also mitigates vibration. Since an automotive seat is in constant contact with the vehicle occupant, its dynamic comfort is of great importance in automotive seat designs. In this study, three automotive seats with different foam firmnesses were evaluated to understand how the foam firmness, through different foam formulations, affected the seat vibration performance and perceived dynamic comfort in a laboratory (study 1) and field setting (study 2). In a repeated-measures laboratory based study, whole-body vibration (per ISO 2631-1), self-reported body discomfort, and seating comfort were measured and compared among the three automotive seats while participants were exposed to tri-axial, field-measured, automotive vibration and X-Y-Z axis 1–30 Hz sine sweeps. In a subsequent ride-and-drive field study, the two seats that received the highest comfort ratings from the laboratory study were installed in two identical vehicles and whole body vibration (WBV) and self-reported seating comfort were evaluated by the participants. The results showed that the foam firmness significantly affected WBV measures and self-reported comfort (p < 0.05). This study demonstrated that altering foam formulation can be an effective way of further improving dynamic vibration and seat comfort performance.

Knotting of a pulmonary artery catheter (PAC) is a rare, but well-known complication of pulmonary artery (PA) catheterization. We report a case of a double-knotted PAC with a large loop in a patient with hepatocellular carcinoma (HCC) undergoing liver transplantation, which has been rarely reported in the literature. A PAC was advanced under pressure wave form guidance. PAC insertion was repeatedly attempted and the PAC was inserted 80 cm deep even though PAC should be normally inserted 45 to 55 cm deep. However, since no wave change was observed, we began deflating and pulling the balloon. At the 30-cm mark, the PAC could no longer be pulled. Fluoroscopy confirmed knotting of the PAC after surgery (The loop-formed PAC was shown in right internal jugular vein); thus, it was removed. For safe PA catheterization, deep insertion or repeated attempts should be avoided when the catheter cannot be easily inserted into the pulmonary artery. If possible, the insertion of PACs can be performed more safely by monitoring the movement of the catheter under fluoroscopy or transesophageal echocardiography.

The elevated risk for thromboembolic events in cancer patients has been well documented. Chemotherapy is considered to be one of the most important risk factors for cardiovascular complications such as arrhythmias, cardiomyopathy, angina, and myocardial infarction. However, acute aortic thrombosis is an extremely rare complication in patients receiving chemotherapy. The authors report a case of acute aortic thrombosis after adjuvant capecitabine chemotherapy for colon cancer.