Search

We studied the impact of socioeconomic status (SES) on mortality in hepatocellular carcinoma patients and analyzed the effect of SES on initial treatment allocation.A cohort study was conducted using data from the National Health Insurance Service- National Sample Cohort of Korea. A total of 3,032 hepatocellular carcinoma patients who were newly diagnosed between January 2003 and December 2013 were included. Income level was categorized as Medical Aid and ≤30th, 31st-70th, or70th percentile as an SES indicator.The proportion of Medical Aid was 4.3%. The highest risks of all-cause mortality associated with Medical Aid were evident in the transcatheter arterial chemoembolization group (fully adjusted hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.25 to 4.58), the other treatments group (fully adjusted HR, 2.86; 95% CI, 1.85 to 4.41), and the no treatment group (fully adjusted HR, 2.69; 95% CI, 1.79 to 4.04) but not in the curative treatment group. An association between the lower-income percentile and higher liver cancer-specific mortality was also observed, except in the curative treatment group. The association between income percentile and all-cause mortality was nonlinear, with a stronger association in the lower-income percentiles than in the higher income percentiles (p-value for nonlinear spline terms0.05).Patients in the lower SES group, especially patients not eligible for curative treatment, had an increased risk of mortality. In addition, the association between SES and the risk for mortality was stronger in the lower-income percentile than in the moderate to higher income percentiles.

Recombinant Escherichia coli (E. coli) strain that produces phytochelatin (PC) and/or metallothionein (MT) can synthesize various metal nanoparticles (NPs) by reducing metal ions. Here we report in vivo biosynthesis of iron oxide nanocomposites (NCs) using recombinant E. coli. We designed a strategy of biosynthesizing iron oxide NCs by first internalizing chemically synthesized iron oxide NPs, followed by the reduction of added metal ions on the surface of internalized NPs by PC and/or MT in E. coli. For this, chemically synthesized Fe

Purpose: To evaluate if the mechanical injection of saline is effective in restoring patency of a totally implantable venous access port (TIVAP) with an intraluminal occlusion. Materials and methods: From January 2017 to June 2019, 64 cases of dysfunction of a TIVAP were referred to interventional radiology. Among these, 16 cases showed normal function of the TIVAP, 19 cases the showed the appearance of a fibroblastic sheath, and 29 cases showed intraluminal occlusion. Mechanical recanalization was performed for intraluminal occlusion of the TIVAP with an indeflator and a 20G non-coring needle. Linograms were performed in all recanalized cases. The success or failure of recanalization and the pressure of the indeflator were recorded. Linograms were evaluated for breakage or migration of catheters. Medical records were retrospectively reviewed. Results: Among the 29 intraluminal occlusion cases, 24 cases (82.7%) were recanalized by mechanical recanalization via an indeflator. The pressure of the indeflator ranged from 29 to 220 psi (median: 118 psi). Linograms revealed breakage of the catheter of the TIVAP in two failed cases. The median interval from implantation to dysfunction was 405 days (range: 43–1723 days). The median interval from last use to dysfunction was 8 days (mean: 15.4 days; range: 1–119 days). The median re-occlusion free period after successful mechanical recanalization was 100.5 days (range: 6–859 days). Conclusion: In the absence of an available thrombolytic agent, mechanical injection of saline was a tolerable alternative method for restoring occluded catheters and sustaining the function of catheters. Because breakage of the catheter can occur during mechanical recanalization of a TIVAP, a linogram should follow the procedure.

Background and Objectives: The coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to be a pandemic even in 2022. As the initial symptoms of COVID-19 overlap with those of infections from other respiratory viruses, an accurate and rapid diagnosis of COVID-19 is essential for administering appropriate treatment to patients. Currently, the most widely used method for detecting respiratory viruses is based on real-time polymerase chain reaction (PCR) and includes reverse-transcription real-time quantitative PCR (RT-qPCR). However, RT-qPCR assays require sophisticated facilities and are time-consuming. This study aimed to develop a real-time quantitative loop-mediated isothermal amplification (RT-qLAMP) assay and compare its analytical performance with RT-qPCR. Materials and Methods: A total of 315 nasopharyngeal swabs from patients with symptoms of respiratory infections were included in this study. A primary screening of the specimens was performed using RT-qPCR. RNA/DNA from standard strains for respiratory viruses and heat-inactivated preparations of standard strains for SARS-CoV-2 were used to evaluate the accuracy and target specificity of the RT-qLAMP assay. Results: We successfully developed an RT-qLAMP assay for seven respiratory viruses: respiratory syncytial virus (RSV) A, RSV B, adenovirus, influenza (Flu) A (H1N1 and H3N2), Flu B, and SARS-CoV-2. RT-qLAMP was performed in a final reaction volume of 9.6 µL. No cross-reactivity was observed. Compared with the RT-PCR results, the sensitivity and specificity of the RT-qLAMP assay were 95.1% and 100%, respectively. The agreement between the two methods was 97.1%. The median amplification time to RT-qLAMP positivity was 22:34 min (range: 6:80–47:98 min). Conclusions: The RT-qLAMP assay requires a small number of reagents and samples and is performed with an isothermal reaction. This study established a fast, simple, and sensitive test that can be applied to point-of-care testing devices to facilitate the detection of respiratory viruses, including SARS-CoV-2.

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

The use of the smartphone is an ideal platform to realize the future point-of-care (POC) diagnostic system. Herein, we propose an integrated smartphone-based genetic analyzer. It consists of a smartphone and an integrated genetic analysis unit (i-Gene), in which the power of the smartphone was utilized for heating the gene amplification reaction, and the camera function was used for imaging the colorimetric change of the reaction for quantitative and multiplex foodborne pathogens. The housing of i-Gene was fabricated by using a 3D printer, which was equipped with a macro lens, white LEDs, a disposable microfluidic chip for loop-mediated isothermal amplification (LAMP), a thin-film heater, and a power booster. The i-Gene was installed on the iPhone in alignment with a camera. The LAMP mixture for Eriochrome Black T (EBT) colorimetric detection was injected into the LAMP chip to identify Escherichia coli O157:H7, Salmonella typhimurium, and Vibrio parahaemolyticus. The proportional–integral–derivative controller-embedded film heater was powered by a 5.0 V power bank to maintain 63 °C for the LAMP reaction. When the LAMP proceeded, the color was changed from violet to blue, which was real-time monitored by the smartphone complementary metal oxide semiconductor camera. The images were transported to the desktop computer via Wi-Fi. The quantitative LAMP profiles were obtained by plotting the ratio of green/red intensity versus the reaction time. We could identify E. coli O157:H7 with a limit of detection of 101 copies/μL within 60 min. Our proposed smartphone-based genetic analyzer offers a portable, simple, rapid, and cost-effective POC platform for future diagnostic markets.

We study the configuration behaviors of non-spherical lens-shaped particles at a fluid-fluid interface. The attachment energies of truncated spheres and biconvex particles are calculated numerically to determine the thermodynamically stable configuration of the particles at the interface. When the particle is rotated 180° perpendicular to the interface, two energy minima are observed in the attachment energy profile. One corresponds to equilibrium and the other to a metastable orientation. The high energy barrier between the two energy minima indicates that the particle with the metastable condition is not spontaneously converted to the equilibrium state, such that the interface adsorption and orientation behaviors of the particles are irreversible and are determined stochastically. A further comprehensive investigation of the interfacial pinning phenomena of the truncated or biconvex boundary and free-rotation of the particles is also performed for different wettability and geometric factors. This study offers simple design rules for the synthesis of anisotropic particles used as a solid surfactant.

A novel microfluidic droplet generator is proposed, which can control the droplet size through turning an integrated micrometer head with ease, and the size of the produced micro-droplet can be automatically and real-time monitored by an open-sourced software and off-the-shelf hardware.

Background Thoracic endovascular aneurysm repair (TEVAR) has been used as a primary treatment for blunt traumatic aortic injury (TAI). However, the outcomes of midterm surveillance of Seal® stent-graft durability for TAI have not been extensively studied. Thus, we aimed to report the midterm outcomes of TEVAR using the Seal® stent graft for blunt TAI. Methods Patients with blunt TAI treated with TEVAR using the Seal® thoracic stent graft between 2007 and 2013 in Korea were included. Midterm outcomes included technical/clinical success, in-hospital death, aorta/procedure/device-related adverse events, secondary procedures, and 30-day and all-cause mortality. Results A total of 99 patients (54% men; mean age, 48 years) were included. Grade III or higher injuries were present in 95% of patients, including 15 free ruptures of the thoracic aorta, and 64% of injuries were located in zone III. The median procedure and hospitalization duration were 90 min and 11 days, respectively. The technical success rate was 98%. The number of in-hospital mortalities (n = 8) and stroke (n = 2) were observed at 30 days. Late stroke and paraplegia (>30 days) were not observed during the mean 49 ± 26 months of follow-up (median, 48 months; range, 0–117 months). There were no aorta-related mortalities or conversions to open repair. Secondary procedures were performed in 8 patients, all of which were carotid-subclavian bypasses for delayed left subclavian occlusion. The all-cause mortality rate was 5% at 30 days and 8% at 1 year. The survival rate was 95% at 30 days, 92% at 1 year, 92% at 3 years, and 89% at 5 years. One type Ia endoleak occurred at 18 months after the procedure. Conclusions TEVAR with the Seal® stent graft for TAI showed favorable midterm outcomes. The incidence of major adverse events after the procedure was low.

In this study, we proposed an advanced point-of-care molecular diagnostic technology to evaluate the acute rejection (AR) in kidney transplanted patients. On the contrary to the conventional PCR method, we developed a colorimetric loop mediated isothermal amplification (LAMP) for quantitative analysis of the six biomarkers related to AR (CD3ϵ, IP-10, Tim-3-HAVCR2, CXCL9, PSMB9, C1QB) with a reference gene (18S rRNA). Using urinary cDNA samples of transplanted patients, it turned out that three biomarkers among six, namely IP-10, Tim-3-HAVCR2 and C1QB, have significant discrepancy in quantity between the stable graft (STA) patient and the AR patient. The AR prediction model using these three biomarkers was established, which could estimate the immune-rejection in the patients with 93.3% of accuracy. For the point-of-care (POC) molecular diagnostics for the AR evaluation, we constructed a centrifugal microfluidic platform, in which the RNA extraction from the clinical urinary samples, the quantitative reverse-transcription (RT)-LAMP reaction, and the data analysis based on the AR prediction model could be performed in a serial order. Ten blind clinical samples were analyzed on the POC genetic analyzer, showing 100% match with the validated qPCR data. Thus, the proposed advanced molecular diagnostic platform enables us to perform the timely treatment for the transplanted patients who are suffering from the allograft failure and side effects such as infection and malignancy.

Flow-focusing droplet generators have been extensively employed for the generation of monodisperse droplets. However, the droplet device is usually designed with an application-specific performance that includes prescribed droplet size and generation frequency. To achieve an ideal device, cost- and time-inefficient iterations for the chip design and fabrication are usually needed. In this study, we take an advantage of 3D printing technology to rapidly prototype the droplet device that enables the facile control of the droplet size as well as the droplet generation frequency. Our device was designed with a screw-and-nut combination and the gap height (h

In this study, the MoS2 nanoparticles grown on crumpled 3D graphene microball (3D GM–MoS2) was synthesized using a microfluidic droplet generator with thermal evaporation-driven capillary compression and hydrothermal reaction. The morphology and size of 3D GM–MoS2 are controlled by the concentration of nano-sized graphene oxide (GO) and the flow rate of oil phase on the droplet generator. The 3D GM–MoS2 with fully sphere-shape and uniform size (~ 5 µm), and homogeneous growth of MoS2 nanoparticles could be synthesized at the flow rate of the oil phase of 60 µL/min with the optimized GO concentration of 1.0 mg/mL, and (NH4)2MoS4 concentration of 2.0 mg/mL.

To investigate the technical feasibility of a novel exoskeleton Seal® stent-graft and analyze early histologic changes in the porcine abdominal aorta. Six pigs received an abdominal stent-graft (Group I), and six received an iliac branch stent-graft (Group II). Groups were subdivided as follows: Group Ia, which received three bifurcated main-body stent-grafts; Group Ib, which received three bifurcated main-body stent-grafts with both iliac graft-stents; Group IIa, which received three simple uni-iliac tapered stent-grafts; and Group IIb, which received three uni-iliac tapered tapered stent-grafts with right straight limb and left branched limb. Statistical analyses were performed with the Wilcoxon signed-rank test and mixed-model regression analysis. The primary technical success rate (

A We propose a novel quantitative assay for colorimetric loop-mediated isothermal amplification (LAMP) based on the shift of UV-vis spectral absorbance of Eriochrome black T (EBT) dye. The colorimetric LAMP assay provides on-and-off result of the LAMP reaction, not quantitative information. Since the quantification of the initial copy number of DNA is of importance for genetic diagnostics, we, for the first time, demonstrated how to quantify the DNA in the EBT mediated LAMP reaction. Due to the structral change of the EBT-Mg complexes, the color of the LAMP mixture is changed from violet to sky blue as the LAMP reaction proceeds. We noticed that the maxium absorption peak before and after the LAMP reaction is distinct, and accordingly shifted from 570 nm to 640 nm. We utilized the ratio between two particular absorbance (A640/A570) of EBT as an indicator for the LAMP process, and plotted it versus the reaction time. We used serially diluted DNA samples and produced quantitative calibration curves (the threshold time versus the initial copy number of DNA). Therefore, we could quantify the copy number of template DNAs in the EBT-mediated colorimetric LAMP reaction simply by measuring the two UV-vis absorption values at 570 nm and 640 nm.

An integrated microfluidic device, consisting of a solid-phase extraction (SPE) unit for metal ion pretreatment, a micropump, a micromixer, and a detachable graphene oxide quantum dot (GOQD) array chip was constructed for selective and sensitive detection of As3+, Cd2+, and Pb2+. The entire process could be sequentially and automatically completed by actuating a pneumatic micropump. Effect of the pH for metal ion capture and pumping scheme for recovery efficiency were investigated on a chip. The ion As3+, Cd2+, and Pb2+ whose concentrations ranged from 10−2 µM to 102 µM were successfully recovered with high efficiency over 80%. Monoplex and multiplex detection of As3+, Cd2+, and Pb2+ were then executed on a GOQD array chip. The target metal ions were specifically captured on the DNA aptamer linked GOQD array, which results in the fluorescence quenching of GOQD due to the electron transfer from the GOQD to metal ions under the laser irradiation. The proposed integrated SPE-GOQD array based microdevice could perform As3+, Cd2+, and Pb2+ detection with detection limits of 5.03 nM, 41.1 nM, and 4.44 nM, respectively. Simultaneous multiplex detection for binary or ternary mixture of As3+, Cd2+, and Pb2+ was performed, and the proposed integrated microdevice also showed high recovery values ranging from 83.52% to 128.3% from the environmental samples.

We aimed to evaluate the feasibility and safety of long-term balloon indwelling technique for the treatment of single benign biliary stricture. Five patients with single benign biliary stricture were included from December 2014 to November 2016. The patients were three men and two women with a mean age of 50 years (range, 30–65 years). A balloon catheter was inserted into the drainage catheter and emerged through the side hole of the catheter so that the balloon and drainage catheters could be placed together at the stricture site. Follow-up fluoroscopic examination was performed at least once every 2 weeks to evaluate the adequacy of expansion and location of the balloon. The balloon was reinflated at each session, and then removed after an approximately two-month indwelling period. The catheters used were 10–16 French and the diameter of indwelling balloons were 4–8 mm. The primary technical and clinical success rates were 100%. Maintenance of the balloon location was achieved in 25 of 26 follow-up fluoroscopic examinations (mean, 5.2 times per patient) with a rate of 96.1%. The mean follow-up period after successful removal of the balloon was 542.2 days (range, 93–1042 days), and there were no recurrences in the five cases. The long-term balloon indwelling technique is a good way to induce maximal dilatation at the stricture site without large diameter skin and subcutaneous tract dilatation and can be successfully used for single benign biliary stricture.

In this study, we report the highest mobility in the reduced graphene oxide- (rGO-) based TFTs embedded with Au NPs. In addition, we fabricated a reduced graphene oxide memory device (rGO-capacitor), a reduced graphene oxide thin film transistor (rGO-TFT), and a reduced graphene oxide memory thin film transistor (rGO-MTFT) and characterized their electrical performances. While the rGO-TFT device was investigated for nonambipolar channel performance, the rGO-capacitor and rGO-MTFT were examined for nonvolatile memory capabilities in a metal-graphene-insulator-silicon (MGIS) structure. The incorporation of the gold nanoparticles (Au NPs) between the rGO and an insulator silicon dioxide (SiO2) layer served as a charging element. The rGO-capacitor revealed the memory effect of hysteretic capacitance-voltage (C-V) loops, and the flat-band voltage shift ( Δ V FB ) was measured as 0.1375 V after 100 s retention time. The rGO-TFT shows the p-channel characteristics with high hole mobility of 16.479 cm2/V⋅s. The threshold voltage shift ( Δ V th ) of the rGO-MTFT was detected as 5.74 V from 10 V to -30 V sweep, demonstrating high mobility of 22.887 cm2/V⋅s.

We introduce a novel centrifugal disc for purifying nucleic acid (NA) in a high-throughput manner to perform the human sex-typing of forensic samples. The centrifugal disc was designed with double-sided etched channels to fabricate 30 extraction units, which was capable of purifying 30 forensic samples in a single run. In order to introduce the washing solution (70% ethanol) and the elution buffer for the 30 extraction units in an automatic manner, we designed the aliquoting chambers that were connected with a zigzag delivery channel. The super-hydrophobic zigzag-shaped aliquot structure plays a crucial role in automatically dividing the washing solution and the elution buffer into 30 aliquots with one injection shot. The Whatman glass filter paper was used as an NA extraction matrix and sophisticated passive valves were equipped to avoid the overflowing of these buffers to the neighboring chamber during the injection. To operate the disc, we developed a portable workstation that consists of a buffer storage system, a buffer injection system, and a spinning unit. The entire process was automatically operated by the in-house portable workstation. Genomic DNA extraction using thirty forensic samples was completed in 10 min. Using the purified genomic DNA, we performed a loop-mediated isothermal amplification (LAMP) reaction for sex-typing by targeting the human alphoid repeat sequence of the Y-chromosome and the human 18S rRNA. The combination of the high-throughput centrifugal disc for NA extraction and the LAMP reaction enables us to complete the genetic sex-typing in 30 min.

Research on stage-sequential shifts across multiple latent classes can be challenging in part because it may not be possible to observe the particular stage-sequential pattern of a single latent class variable directly. In addition, one latent class variable may affect or be affected by other latent class variables and the associations among multiple latent class variables are not likely to be directly observed either. To address this difficulty, we propose a multivariate latent class analysis for longitudinal data, joint latent class profile analysis (JLCPA), which provides a principle for the systematic identification of not only associations among multiple discrete latent variables but sequential patterns of those associations. We also propose the recursive formula to the EM algorithm to overcome the computational burden in estimating the model parameters, and our simulation study shows that the proposed algorithm is much faster in computing estimates than the standard EM method. In this work, we apply a JLCPA using data from the National Longitudinal Survey of Youth 1997 in order to investigate the multiple drug-taking behavior of early-onset drinkers from their adolescence, via young adulthood, to adulthood.

Recent advances in the development of hybrid organic–inorganic halide perovskite quantum dots (HP-QDs) have proven their versatility and potential applications in photovoltaics and light sources through compositional tuning. However, the compositional complexity for mixed-cation and/or mixed-halide HP-QDs would require repetitive optimization processes to obtain the desired perovskite crystals via traditional batch-scale chemistry, causing prolonged time, labor, and cost. To address this issue, we herein report a dynamic flow chemistry synthetic system operated with the on-and-off feedback control with hysteresis algorithm to produce methylammonium lead trihalide perovskite quantum dots (MAPbBrXI3-X QDs with 0 ≤ X ≤ 3), automatically showing a target emission wavelength. We set up the target photoluminescent (PL) emission wavelength of the MAPbBrXI3-X QDs and started with an arbitrary flow rate of the bromide and iodide precursor solution. The PL emission wavelength of the synthesized perovskites was in-situ monitored in the flow cell equipped with a miniaturized optical detector. By comparing the measured wavelength with the target one, the controlling algorithm recalculated to adjust the flow rates of the bromide and iodide precursor solution accordingly. Then, the PL emission wavelength of the newly synthesized MAPbBrXI3-X QDs was detected again in real-time, and the iterative feedback control process was repeated until the observed wavelength was matched with the user-defined emission target. Thus, the desired MAPbBrXI3-X QDs could be obtained eventually through the feedback control in an automatic manner, suggesting an advanced flow chemistry synthetic platform to produce on-demanded nanomaterials with high efficiency.

We propose a novel high-throughput screening platform using a centrifugal microfluidic device for producing combinatorial tri-metallic catalysts. The centrifugal device was designed to perform 60 reactions under different conditions on a single device. As a model to search for an optimal tri-metallic catalyst, we synthesized a variety of Pd@AuPt nanoparticles (NPs), in which Pd nanocubes served as a core, and Au and Pt atoms formed a shell. The centrifugal microfluidic device was etched on the top and bottom sides, in which two zigzag-shaped microchannels were patterned on the top side, and 60 reaction chambers were fabricated on the bottom side. Through the sophisticated zigzag-shaped microchannels, Pt2+ ion and Pd nanocube solutions were injected into the channel in one shot, and the centrifugal force equally and automatically divided the injected solutions into 60 aliquots during the rotation. By controlling the sophisticated channel dimensions and designing the passive valve structure, the Pt2+ ion, Pd nanocube, and Au3+ solutions were loaded into the reaction chamber in sequential order depending on the programmed rotational direction and speed. Therefore, the ratio of Au to Pt to synthesize Pd@AuPt core–shell NPs was changed from 0.028 : 1 to 12 : 1, and accordingly, the resultant 60 types of Pd@AuPt catalysts presented with different ratios of metal atom compositions. Then, we screened the catalytic activity of the Pd@AuPt NPs for generating H2O2 according to the degree of coating of Au and Pt, and the Pd@AuPt catalyst with the Au/Pt ratio at 0.5 turned out to be the most effective.

Background: The incidence of venous thrombosis based on access route after implantation of the totally implanted venous access port (TIVAP) is controversial. Symptomatic TIVAP-related venous thrombosis remains relatively rare. However, characteristics of symptomatic axillary vein thrombosis after TIVAP implantation via access of the axillary vein has not been reported. Objectives: In this historical cohort study, the incidence and characteristics of venous thrombosis associated with TIVAP via the axillary vein in cancer patients were evaluated. Patients and Methods: A total of 4,773 TIVAPs were placed via the axillary vein in patients with various types of cancer between May 2012 and July 2018. Eighteen patients experienced symptomatic venous thrombosis associated with TIVAPs. Radiologic findings for venous thrombosis were evaluated using computed tomography (CT) including scans of the axillary vein. Medical records were retrospectively reviewed. Results: The prevalence of symptomatic thrombosis was 0.38% (18/4,773). The patients with symptomatic venous thrombosis included 14 males and four females. Among the 18 patients, the most common types of cancer were lung cancer (n = 7) and pancreatic cancer (n = 4), with the incidence rates of 0.79% (lung cancer, 7/882) and 1.58% (pancreatic cancer, 4/253), respectively. The median time between placement of the TIVAP and diagnosis of thrombosis was 35.5 days (range: 6 - 292 days). All symptomatic patients had thrombosis in the axillary vein on CT images. Symptoms were improved in all patients with treatment including removal of TIVAP at the time of diagnosis and following anticoagulation therapy. From the multiple binary logistic regression, pancreatic cancer and lung cancer were statistically significant risk factors of symptomatic axillary vein thrombosis. Conclusion: After insertion of TIVAPs through the axillary vein, symptomatic axillary vein thrombosis rarely developed. Pancreatic cancer and lung cancer were associated with the risk of symptomatic axillary vein thrombosis.

A micro-capillary electrophoresis (μCE) system is one of the widely adopted techniques in the molecular diagnostics and DNA sequencing due to the benefits of high resolution, rapid analysis, and low reagent consumption, but due to the requirements of bulky high-power suppliers and an expensive laser-induced fluorescence detector module, the conventional set-up of μCE system is not adequate for point-of-care (POC) molecular diagnostics. In this study, we constructed a miniaturized and integrated μCE system which can be manipulated by a smartphone. The smartphone not only powers two boost converters and an excited laser, but also controls the relay for the power switch. Moreover, the complementary metal-oxide-semiconductor (CMOS) camera of the smartphone was used for detecting the fluorescence signal of amplicons amplified with reverse transcription-polymerase chain reaction (RT-PCR). We also developed a web-based application so that the raw data of the recorded fluorescence intensity versus the running time can display typical capillary electropherograms on the smartphone. The total size of the hand-held μCE system was 9.6 cm [Width] × 22 cm [Length] × 15.5 cm [Height], and the weight was ∼1 kg, which is suitable for POC DNA testing. In the integrated smartphone-associated μCE system, we could accurately analyze two genes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), namely N gene and S gene along with two bracket ladders in 6 min to identify SARS-CoV-2. Such an advanced μCE platform can be applied for a variety of on-site molecular diagnostics fields with user-friendliness.

Purpose: To evaluate the clinical outcomes and complications of totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy. Materials and methods: A total of 176 totally implantable venous access ports were placed via the axillary vein in 171 patients with head and neck malignancy between May 2012 and June 2015. The patients included 133 men and 38 women, and the mean age was 58.8 years (range: 19–84 years). Medical records were retrospectively reviewed. Results: This study included a total of 93,237 totally implantable venous access port catheter-days (median 478 catheter-days, range: 13–1380 catheter-days). Of the 176 implanted totally implantable venous access port, complications developed in nine cases (5.1%), with the overall incidence of 0.097 events/1000 catheter-days. The complications were three central line-associated blood-stream infection cases, one case of keloid scar at the needling access site, and five cases of central vein stenosis or thrombosis on neck computed tomography images. The 133 cases for which neck computed tomography images were available had a total of 59,777 totally implantable venous access port catheter-days (median 399 catheter-days, range: 38–1207 catheter-days). On neck computed tomography evaluation, the incidence of central vein stenosis or thrombosis was 0.083 events/1000 catheter-days. Thrombosis developed in four cases, yielding an incidence of 0.067 events/1000 catheter-days. All four patients presented with thrombus in the axillary or subclavian vein. Stenosis occurred in one case yielding an incidence of 0.017 events/1000 catheter-days. One case was catheter-related brachiocephalic vein stenosis, and the other case was subclavian vein stenosis due to extrinsic compression by tumor progression. Of the nine complication cases, six underwent port removal. Conclusion: These data indicate that totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy is safe and feasible, with a low axillary vein access-related complication rate.

The effect of catheter diameter on left innominate vein stenosis in breast cancer patients after totally implantable venous access port placement.Purpose:To evaluate the effect of catheter diameter on left innominate vein stenosis in breast cancer patients after placement of totally implantable venous access ports.Materials and methods:Totally implantable venous access ports were placed via the left internal jugular vein in 241 women with right breast cancer from January 2010 to December 2014 (mean age, 51.5 years; range, 19–83 years). There were 67 totally implantable venous access ports with a 6.5F catheter and 142 totally implantable venous access ports with an 8F catheter. Medical records were retrospectively reviewed. The presence of significant left innominate vein stenosis and tip location of the catheter was evaluated on chest computed tomography images. Statistical analysis was performed.Results:Left innominate vein stenosis developed in 1 (1.5%) and 13 (9.2%) patients after implantation with 6.5 and 8F catheters, respectively. Difference in the cumulative incidence of left innominate vein stenosis was statistically significant between the two groups (log rank test p-value: 0.002). In Cox regression analysis, the hazard ratio for left innominate vein stenosis was 20.766 ( p = 0.005) for an 8F catheter.Conclusion:The incidence of left innominate vein stenosis was higher after implantation of totally implantable venous access ports with 8F catheter rather than with 6.5F catheter. Considering that using 8F catheter versus 6.5F catheter has no advantage in terms of performance of the device, the results of our study suggest that ports with catheters >7F should be avoided.

We present a portable genetic analyzer with an integrated centrifugal disc which is equipped with a glass-filter extraction column for purifying nucleic acid (NA) and multiple reaction chambers for analyzing major feline upper respiratory tract disease (FURTD) pathogens. We targeted four kinds of FURTD including Feline herpesvirus 1 (FHV), Mycoplasma felis (MPF), Bordetella bronchiseptica (BDB), and Chlamydophila felis (CDF). The portable genetic analyzer consists of a spinning motor, two pairs of Peltier heaters, two Minco heater, fluorescent optics, a touchscreen, and software for data analysis, so loop-mediated isothermal amplification (LAMP) or polymerase chain reaction (PCR) can be performed. The overall size of the genetic analyzer was 28 cm × 28 cm × 26 cm and the weight was 10 kg, which was deliverable for point-of-care testing (POCT). Owing to the sophisticated microchannel design and spinning program, the serial injection of the sample solution, the washing solution, and the elution solution was executed through a glass filter membrane for nucleic acid (NA) extraction, and then the cocktail with the purified genome was aliquoted into 9 reaction chambers for LAMP or PCR. The whole process for the LAMP reaction or the PCR was completed within 1.5 h. The fluorescence profiles by a scanning mode showed the matched results between the LAMP and the PCR.

Rapid and accurate testing tools for SARS-CoV-2 detection are urgently needed to prevent the spreading of the virus and to take timely governmental actions. Internet of things (IoT)-based diagnostic devices would be an ideal platform for point-of-care (POC) screening of COVID-19 and ubiquitous healthcare monitoring for patients. Herein, we present an advanced IoT-based POC device for real-time direct reverse-transcription-loop mediated isothermal amplification assay to detect SARS-CoV-2. The diagnostic system is miniaturized (10 cm [height] × 9 cm [width] × 5.5 cm [length]) and lightweight (320 g), which can be operated with a portable battery and a smartphone. Once a liquid sample was loaded into an integrated microfluidic chip, a series of sample lysis, nucleic amplification, and real-time monitoring of the fluorescent signals of amplicons were automatically performed. Four reaction chambers were patterned on the chip, targeting As1e, N, E genes and a negative control, so multiple genes of SARS-CoV-2 could be simultaneously analyzed. The fluorescence intensities in each chamber were measured by a CMOS camera upon excitation with a 488 nm LED light source. The recorded data were processed by a microprocessor inside the IoT-based POC device and transferred and displayed on the wirelessly connected smartphone in real-time. The positive results could be obtained using three primer sets of SARS-CoV-2 with a limit of detection of 2 × 101 genome copies/μL, and the clinical sample of SARS-CoV-2 was successfully analyzed with high sensitivity and accuracy. Our platform could provide an advanced molecular diagnostic tool to test SARS-CoV-2 anytime and anywhere.

Purpose To evaluate the presence and causes of left brachiocephalic vein (LBCV) steno-occlusive lesions in patients with loss of normal waveform in Doppler ultrasound of the left internal jugular vein (LIJV). Materials and Methods We performed Doppler ultrasound of both internal jugular veins in 1912 patients who received an implantable venous access port from August 2013 to January 2016. Among them, 106 patients showed loss of normal Doppler waveforms of the LIJV (56 men and 50 women; mean age, 61.4 ± 11.6 years). We retrospectively analyzed the presence and causes of the LBCV steno-occlusive lesions on contrast-enhanced chest computed tomography (CT) images. Results LBCV steno-occlusive lesions were present in 82 patients (77.4%). The causes of these lesions were anatomic structures (n = 70, 85.4%), tumorous lesions (n = 11, 13.4%), and thrombus (n = 1, 1.2%). The anterior anatomic structures to the LBCV causing stenosis were bony structures (n = 50), right upper lobe (n = 11), and mediastinal fat (n = 9). The posterior anatomic structures to the LBCV resulting in stenosis were right brachiocephalic artery (n = 58), left common carotid artery (n = 7), and aortic arch (n = 5). The tumorous lesions resulting in stenosis were mediastinal lymph node (n = 5), thymic lesions (n = 3), lymphoma (n = 1), lung cancer (n = 1), and bone tumor (n = 1). Conclusions It is necessary to suspect steno-occlusive lesion of the LBCV from various causes and to use caution when performing central venous catheterization in cases with loss of a normal Doppler waveform.

Since the foodborne pathogenic bacteria cause serious diseases and socio-economic losses throughout the world, the molecular diagnosis of foodborne poisoning pathogen in the early stage is essential for preventing excessive damages. In this study, a colorimetric based foodborne pathogen detection on the centrifugal microdevice was demonstrated in a high throughput manner. The developed centrifugal microdevice consists of a sample reservoir, a spiral shaped sample injection microchannel, 24 aliqouting chambers (2.5 μL each), cross capillary valves, and 24 reaction chambers on a single device. Once the sample was loaded, the rotation speed at 850 rpm allowed the sample solution to be divided into 24 aliqouting chambers. Then, the samples loaded in the aliqouting chambers could be injected into the reaction chambers at 5000 rpm evenly. The centrifugal device was placed in an oven at 66 °C for target gene amplification. As a gene amplification method, loop mediated isothermal amplification (LAMP) was used in which specific primer sets targeting three kinds of foodborne pathogens (Escherichia coli O157:H7, Salmonella typhimurium, and Vibrio parahaemolyticus) were included. The presence of each pathogen was identified by Eriochrome Black T (EBT)-mediated colorimetric change from purple to sky blue with the naked eye, and the color of each reaction chamber was analyzed by a ratiometric image processing method. Green/Red (G/R) and Blue/Red (B/R) ratios were set as the criteria to differentiate negative results from positive ones. The threshold values for G/R (0.915

We report the extraordinary photoluminescence (PL) behavior of high-quality graphene quantum dots (GQDs) prepared with a graphite intercalation compound method: the alternating PL peak shifts (redshift-blueshift-redshift) with increasing the excitation wavelength. The PL peak position is redshift in the excitation wavelength range 250–270 nm, subsequently blueshift in 270–290 nm, and again redshift in the range 290–330 nm. This unconventional optical response of the GQDs is attributed to two types of energy states: intrinsic states formed by localized sp 2 carbon subdomains and extrinsic states created by various oxygen-functional groups. The PL behavior of GQDs shows different tendencies according to the size and amount of oxygen-functional groups. Furthermore, since the extrinsic states of GQDs can be inactivated under acidic condition, its extraordinary PL behavior of high-quality GQDs with varying excitation wavelength largely recedes. On the other hand, we clearly observed these alternating PL shift behaviors when localized sp 2 carbon subdomains with intrinsic emission are artificially formed by reducing oxygen-functional groups in graphene oxide quantum dots, which have mostly the extrinsic PL originated from the energy states of various oxygen-functional groups. The results offer experimental evidence for the existence of localized sp 2 carbon subdomains and provide key information that clarifies the electronic structure of GQDs and their derivatives.

Point-of-care (POC) molecular diagnostics plays a pivotal role for the prevention and treatment of infectious diseases. In spite of recent advancement in microfluidic based POC devices, there are still rooms for development to realize rapid, automatic and cost-effective sample-to-result genetic analysis. In this study, we propose an integrated rotary microfluidic system that is capable of performing glass microbead based DNA extraction, loop mediated isothermal amplification (LAMP), and colorimetric lateral flow strip based detection in a sequential manner with an optimized microfluidic design and a rotational speed control. Rotation direction-dependent coriolis force and siphon valving structures enable us to perform the fluidic control and metering, and the use of the lateral flow strip as a detection method renders all the analytical processes for nucleic acid test simplified and integrated without the need of expensive instruments or human intervention. As a proof of concept for point-of-care DNA diagnostics, we identified the food-borne bacterial pathogen which was contaminated in water or milk. Not only monoplex Salmonella Typhimurium but also multiplex Salmonella Typhimurium and Vibrio parahaemolyticus were analysed on the integrated rotary genetic analysis microsystem with a limit of detection of 50 CFU in 80min. In addition, three multiple samples were simultaneously analysed on a single device. The sample-to-result capability of the proposed microdevice provides great usefulness in the fields of clinical diagnostics, food safety and environment monitoring.

Purpose To test the hypothesis that mechanical injection of saline is safe and effective in restoring patency of totally implantable venous access ports (TIVAPs) with clot occlusion. We devised an experimental port model for the evaluation of mechanical TIVAP recanalization prior to its clinical application. Materials and Methods The clot TIVAP occlusion model was constructed by filling the catheter with swine blood and incubating it at 37.5°C. The model was incubated for different lengths of time ranging from 1 day to 7 days. Each incubation time point included 20 ports. Total catheter occlusion of the TIVAPs was assessed with a 10-mL saline syringe equipped with a non-coring needle. Occlusion was defined as no passage of saline through the catheter when it was aspirated and infused gently with the 10-mL saline syringe. Pressure was evaluated during recanalization with an indeflator. Histological examination was performed on the clot obtained during recanalization. Results Among the 140 total experimental ports, 65 occlusions (46.4%) were detected. Of these 65 occlusions, 56 (86.1%) were recanalized by mechanical saline pressure via the indeflator. The indeflator pressure ranged from 29 pound per square-inch (psi) to 265 psi at mechanical catheter recanalization (mean: 110 psi). Histologically, all specimens from the model ports exhibited a similar appearance; specifically, erythrocytes, cells, and fibrin were evenly scattered throughout the clot. Conclusions Our data indicate that it is feasible to generate a TIVAP clot occlusion model with swine blood. Moreover, mechanical recanalization was suitable for resolving occluded catheters without thrombolytic agents.