Percutaneous placement of self-expandable metallic stents in patients with obstructive jaundice secondary to metastatic gastric cancer after gastrectomy

OBJECTIVE: To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. MATERIALS AND METHODS: Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. RESULTS: The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). CONCLUSION: Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure

The 5'-end transitional CpGs between the CpG islands and retroelements are hypomethylated in association with loss of heterozygosity in gastric cancers

BACKGROUND: A loss of heterozygosity (LOH) represents a unilateral chromosomal loss that reduces the dose of highly repetitive Alu, L1, and LTR retroelements. The aim of this study was to determine if the LOH events can affect the spread of retroelement methylation in the 5'-end transitional area between the CpG islands and their nearest retroelements. METHODS: The 5'-transitional area of all human genes (22,297) was measured according to the nearest retroelements to the transcription start sites. For 50 gastric cancer specimens, the level of LOH events on eight cancer-associated chromosomes was estimated using the microsatellite markers, and the 5'-transitional CpGs of 20 selected genes were examined by methylation analysis using the bisulfite-modified DNA. RESULTS: The extent of the transitional area was significantly shorter with the nearest Alu elements than with the nearest L1 and LTR elements, as well as in the extragenic regions containing a higher density of retroelements than in the intragenic regions. The CpG islands neighbouring a high density of Alu elements were consistently hypomethylated in both normal and tumor tissues. The 5'-transitional methylated CpG sites bordered by a low density of Alu elements or the L1 and LTR elements were hypomethylated more frequently in the high-level LOH cases than in the low-level LOH cases. CONCLUSION: The 5'-transitional methylated CpG sites not completely protected by the Alu elements were hypomethylated in association with LOH events in gastric cancers. This suggests that an irreversible unbalanced decrease in the genomic dose reduces the spread of L1 methylation in the 5'-end regions of genes

Efficacy of two different self-expanding nitinol stents for atherosclerotic femoropopliteal arterial disease (SENS-FP trial): study protocol for a randomized controlled trial

BACKGROUND: There have been few randomized control trials comparing the incidence of stent fracture and primary patency among different self-expanding nitinol stents to date. The SMART™ CONTROL stent (Cordis Corp, Miami Lakes, Florida, United States) has a peak-to-valley bridge and inline interconnection, whereas the COMPLETE™-SE stent (Medtronic Vascular, Santa Rosa, California, United States) crowns have been configured to minimize crown-to-crown interaction, increasing the stent's flexibility without compromising radial strength. Further, the 2011 ESC (European society of cardiology) guidelines recommend that dual antiplatelet therapy with aspirin and a thienopyridine such as clopidogrel should be administered for at least one month after infrainguinal bare metal stent implantation. Cilostazol has been reported to reduce intimal hyperplasia and subsequent repeat revascularization. To date, there has been no randomized study comparing the safety and efficacy of two different antiplatelet regimens, clopidogrel and cilostazol, following successful femoropopliteal stenting. METHODS/DESIGN: The primary purpose of our study is to examine the incidence of stent fracture and primary patency between two different major representative self-expanding nitinol stents (SMART™ CONTROL versus COMPLETE™-SE) in stenotic or occlusive femoropopliteal arterial lesion. The secondary purpose is to examine whether there is any difference in efficacy and safety between aspirin plus clopidogrel versus aspirin plus cilostazol for one month following stent implantation in femoropopliteal lesions. This is a prospective, randomized, multicenter trial to assess the efficacy of the COMPLETE™-SE versus SMART™ CONTROL stent for provisional stenting after balloon angioplasty in femoropopliteal arterial lesions. The study design is a 2x2 randomization design and a total of 346 patients will be enrolled. The primary endpoint of this study is the rate of binary restenosis in the treated segment at 12 months after intervention as determined by catheter angiography or duplex ultrasound. DISCUSSION: This trial will provide powerful insight into whether the design of the COMPLETE™-SE stent is more fracture-resistant or effective in preventing restenosis compared with the SMART™ CONTROL stent. Also, it will determine the efficacy and safety of aspirin plus clopidogrel versus aspirin plus cilostazol in patients undergoing stent implantation in femoropopliteal lesions. TRIAL REGISTRATION: Registered on 2 April 2012 with the National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT01570803)

Onset of Manic Episode during Chemotherapy with 5-Fluorouracil

The authors report a case of 5-Fluorouracil (5-FU) induced manic episode in an elderly female without any previous psychiatric history. The patient presented manic symptoms after 4th cycle of 5-FU chemotherapy after surgery of rectal cancer. After cessation of chemotherapy and administration of olanzapine and divalproex sodium, symptoms were subsided within 10 days

Integrated Replay Spoofing-aware Text-independent Speaker Verification

A number of studies have successfully developed speaker verification or presentation attack detection systems. However, studies integrating the two tasks remain in the preliminary stages. In this paper, we propose two approaches for building an integrated system of speaker verification and presentation attack detection: an end-to-end monolithic approach and a back-end modular approach. The first approach simultaneously trains speaker identification, presentation attack detection, and the integrated system using multi-task learning using a common feature. However, through experiments, we hypothesize that the information required for performing speaker verification and presentation attack detection might differ because speaker verification systems try to remove device-specific information from speaker embeddings, while presentation attack detection systems exploit such information. Therefore, we propose a back-end modular approach using a separate deep neural network (DNN) for speaker verification and presentation attack detection. This approach has thee input components: two speaker embeddings (for enrollment and test each) and prediction of presentation attacks. Experiments are conducted using the ASVspoof 2017-v2 dataset, which includes official trials on the integration of speaker verification and presentation attack detection. The proposed back-end approach demonstrates a relative improvement of 21.77% in terms of the equal error rate for integrated trials compared to a conventional speaker verification system.Comment: 9 pages, 2 figures, 6 tables, Published in MDPI Applied Sciences (SCIE

Pyruvate Dehydrogenase Kinase 4 Promotes Vascular Calcification via SMAD1/5/8 Phosphorylation

Vascular calcification, a pathologic response to defective calcium and phosphate homeostasis, is strongly associated with cardiovascular mortality and morbidity. In this study, we have observed that pyruvate dehydrogenase kinase 4 (PDK4) is upregulated and pyruvate dehydrogenase complex phosphorylation is increased in calcifying vascular smooth muscle cells (VSMCs) and in calcified vessels of patients with atherosclerosis, suggesting that PDK4 plays an important role in vascular calcification. Both genetic and pharmacological inhibition of PDK4 ameliorated the calcification in phosphate-treated VSMCs and aortic rings and in vitamin D3-treated mice. PDK4 augmented the osteogenic differentiation of VSMCs by phosphorylating SMAD1/5/8 via direct interaction, which enhances BMP2 signaling. Furthermore, increased expression of PDK4 in phosphate-treated VSMCs induced mitochondrial dysfunction followed by apoptosis. Taken together, our results show that upregulation of PDK4 promotes vascular calcification by increasing osteogenic markers with no adverse effect on bone formation, demonstrating that PDK4 is a therapeutic target for vascular calcification

Unveiling the Role of Ruthenium in Layered Sodium Cobaltite Toward High-Performance Electrode Enabled by Anionic and Cationic Redox

The effect of Ru substitution on the structure and electrochemical properties of P2-type Na0.67CoO2 is investigated. The first-discharge capacities of Na0.67CoO2 and Na0.6 [Co0.78Ru0.22]O2 materials are 128 and 163 mAh g−1 (23.5 mA g−1), respectively. Furthermore, the rate capability is improved due to the electro-conducting nature of Ru doping. Operando X-ray diffraction analysis reveals that the Na0.67CoO2 does not undergo a phase transition; however, multiple Na+/vacancy ordered superstructures within the P2 phase appear during Na+ extraction/insertion. In contrast, the Na0.6[Co0.78Ru0.22]O2 material undergoes a P2–OP4 phase transition during desodiation, with no formation of Na+/vacancy ordering within the P2 phase. The increased discharge capacity of Na0.6[Co0.78Ru0.22]O2 is most likely associated with additional cationic Ru4+/Ru5+ redox and increased anionic O2−/(O2n−) redox participation. Combined experimental (galvanostatic cycling, X-ray absorption spectroscopy, differential electrochemical mass spectrometry) and theoretical (density functional theory calculations) studies confirm that Ru substitution provokes the oxygen-redox reaction and that partial O2 release from the oxide lattice is the origin of the reaction. The findings provide new insight for improving the electrode performance of cathode materials via 4d Ru substitution and motivate the development of a new strategy for the design of high-capacity cathode materials for sodium-ion batteries.</p

Tetra-μ-benzoato-bis­[(6-methyl­quino­line)­copper(II)]

In the title compound, [Cu2(C7H5O2)4(C10H9N)2], the paddle-wheel-type dinuclear complex is constructed by four bridging benzoate groups and two terminal 6-methyl­quinoline ligands. The asymmetric unit contains one-half of the whole mol­ecule, and there is an inversion center at the mid-point of the Cu⋯Cu bond. The octa­hedral coordination of each Cu atom, with four O atoms in the equatorial plane, is completed by the N atom of the 6-methyl­quinoline mol­ecule [Cu—N = 2.212 (2) Å] and by another Cu atom [Cu⋯Cu = 2.6939 (13) Å]. The Cu atom lies 0.234 Å out of the plane of the four O atoms. The molecular packing is stabilized by one intramolecular C—H⋯O as well as C—H⋯π and π–π interactions