Autofluorescence endoscopy for detection of high-grade dysplasia in short-segment Barrett's esophagus

BACKGROUND: The occurrence of precancerous lesions, such as high-grade dysplasia, in patients with short-segment Barrett's esophagus is controversial. This study assessed the efficacy of autofluorescence endoscopy for detection of high-grade dysplasia in short-segment Barrett's esophagus. METHODS: A total of 34 patients (28 men, 6 women; age range 40-77 years) with histopathologically proven short-segment Barrett's esophagus were studied. Autofluorescence endoscopy was performed by using monochromatized blue light (425-455 nm) filtered from a conventional xenon light source. A total of 136 and 109 biopsy specimens were taken from Barrett's mucosa under control, respectively, white light endoscopy and autofluorescence endoscopy. RESULTS: High-grade dysplasia was found in 9 (8.3%) autofluorescence-guided biopsy specimens, which was significantly greater than the number of white light endoscopy-guided biopsy specimens with this finding (one positive biopsy specimen, 0.7% of total biopsy specimens obtained). Autofluorescence endoscopy detected high-grade dysplasia in 7 patients, 6 more than were identified with white light endoscopy. In the one patient with high-grade dysplasia detected by white light endoscopy-guided biopsy specimens, autofluorescence-guided biopsy specimens revealed only low-grade dysplasia. CONCLUSION: Autofluorescence endoscopy in patients with short-segment Barrett's esophagus increases the detection rate of high-grade dysplasia.     

Implantable cardioverter-defibrillator efficacy in patients with heart failure and left ventricular dysfunction (from the MADIT II population)

The Multicenter Automatic Defibrillator Implantation Trial II demonstrated a significant 31% reduction in the risk of mortality in postinfarction patients with low ejection fraction (EF < or =30%). Recently, results from the Sudden Death in Heart Failure Trial indicated that a subgroup of patients with New York Heart Association (NYHA) class III heart failure had less benefit from an implantable cardioverter-defibrillator (ICD) than patients with less advanced heart failure. This study evaluates the association between NYHA class, EF, and blood urea nitrogen (BUN) levels as measures of heart failure and left ventricular dysfunction, and ICD benefit in reducing mortality as well as the association of these parameters with ICD therapy for ventricular tachyarrhythmias. NYHA class I was identified in 442 patients (36%), class II in 425 (35%), and class III in 350 patients (29%). EF < or =20% was present in 472 patients (38%), EF of 21% to 25% in 359 patients (29%), and EF of 26% to 30% in 401 patients (33%). BUN < or =25 mg/dl was present in 850 patients (70%) and >25 mg/dl in 368 patients (30%). Patients with higher NYHA class and BUN had higher mortality (34%) and a higher risk of arrhythmic events (33% to 35%) than patients in lower functional groups (16% to 20%). EF did not differentiate the risk. There was no evidence for significant interactions between mortality, ICD therapy, and tested parameters. In conclusion, patients with more advanced heart failure have a higher risk of mortality and arrhythmic events than patients with less severe disease. However, there is no significant difference in the benefit from ICD therapy among the above subgroups of patients in the Multicenter Automatic Defibrillator Implantation Trial.     

Left main coronary artery stenting in a ninety year old female with recurrent acute coronary syndrome -- a case report

A case of a ninety year old female with recurrent acute coronary syndrome is presented. Coronary angiography revealed critical left main coronary artery stenosis which was successfully treated with angioplasty and stent implantation. Data from literature on the left main stenting in the elderly are discussed.     

The clinical characteristics of coronary artery fistula anomalies in children and adults: A 24‐year experience

Objectives: The aim of our work is to investigate the clinical characteristics of coro‐ nary artery fistula (CAF) anomalies in South Vietnam.
Methods: This is a retrospective analysis of 119 patients with diagnosis of definite CAF between January 1992 and April 2016. The demographic, clinical, echocardio‐ graphic, and angiographic characteristics and management of CAF with short‐term outcomes are described.
Results: The median age was 15 years (range, 1‐79 years), with 49 male (41%) and 70 female (59%). There were 77 symptomatic patients (64.7%) and 91 patients (76.5%) who presented with a murmur. The electrocardiogram was abnormal in 45.4% and cardiac enlargement or increased pulmonary vasculature were seen in 76 patients (63.9%) on chest X‐ray. The sensitivity of echocardiography for CAF diagnosis was 79%. The source of the fistula was most often from the RCA (54%), most commonly to right atrium (34.5%) or right ventricle (31.1%). In comparison with surgery, tran‐ scatheter closure had a shorter hospital length of stay (5.4 ± 3.8 days vs 12.6 ± 6.5 days, P = .02) and better postprocedural left ventricular ejection fraction (67.9 ± 8.1% vs 62.9 ± 6.0%, P = .03).
Conclusion: The majority of fistula in this study originated from the RCA and termi‐ nated in the right atrium or the right ventricle. Transcatheter and surgical closure are both relatively safe and effective, with the potential for shortened length of hospital stay following transcatheter closure.     

Analysis of the acidity index and integrated intragastric acidity in 645 patients presenting with gastroesophageal reflux disease symptoms

Objective. In a recent study of patients receiving proton-pump inhibitor (PPI) therapy, a new parameter, the acidity index, was described as being less complicated to calculate and of comparable accuracy (r=0.93) to integrated intragastric acidity (IA) in assessing intragastric pH control. The aim of this study was to correlate AI with IA using a large database of ambulatory 24-h pH-metry studies in untreated patients presenting with gastroesophageal reflux disease (GERD) symptoms. Material and methods. We retrospectively analyzed 645 studies obtained from 1995 to 2001. Daytime (0800?h–2200?h), night-time (2200?h–0800?h) and 24-h IA and AI were calculated according to age, gender and the presence or absence of GERD, and correlations between these parameters were assessed using linear regression with F-statistic values, p-values and Akaike's Information Criterion values. GERD was defined as total esophageal pH time <4.0, 5?cm above the lower esophageal sphincter, for ≥4.2% of the day. IA and AI were calculated as follows: IA (mmol.h/l)?=?∑(acid in mmol/l at time “t”?+?acid in mmol/l at time “t???1”)/2×(“t”–“t???1”); AI=(%time pH?Results. Overall, the mean 24-h IA value was 882.0±820.0?mmol.h/l (daytime 392.0±400.0, night-time 490.0±486.0). The mean 24-h AI value was 102.0±87.0 (daytime 86.0±80.0, night-time 120.0±114.0, p<0.001). The mean 24-h IA value was 1057.0±829.4?mmol.h/l (daytime 459.8±406.0, night-time 597.2±500.4, p<0.001) in GERD patients and 713.0±775.0?mmol.h/l (daytime 326.0±383.0, night-time 387.0±448.5) in non-GERD patients (p<0.001). The mean 24-h AI value was 122.1±88.1 (daytime 101.4±82.5, night-time 145.3±120.7) in GERD patients and 83.0±81.0 (daytime 71.0±73.9, night-time 96.4±102.6) in non-GERD patients (p<0.001). Our statistical modeling demonstrated that the correlation between the acidity index and IA becomes progressively poorer with increasing values of acidity. Conclusions. We conclude that gastric acid production assessed by both IA and AI is higher during evening hours in comparison with daytime hours and the difference between night-time and daytime values is statistically significant. In addition, gastric acid production assessed by both IA and AI is significantly higher in GERD patients than non-GERD patients. This difference is primarily due to differences in nocturnal acid production. The AI correlates poorly with measured IA, especially at higher levels of gastric acidity. Therefore, AI is not an acceptable surrogate for IA in assessing gastric acid production.     

Eicosanoids in exhaled breath condensate and BAL fluid of patients with sarcoidosis

BACKGROUND: Measurement of inflammatory mediators in exhaled breath condensate (EBC) is an easy and noninvasive diagnostic method, which has gained popularity in the past few years. However, the source of these mediators is not precisely defined. It has been only presumed that inflammatory cells present in the airway lumen are the main source. Therefore, the aim of this study was to verify the relationship between EBC and BAL fluid (BALF) eicosanoids, and the percentage, number, and activity of cells in BALF. METHODS: In 28 sarcoidosis patients and 17 healthy subjects, 8-isoprostane, cysteinyl leukotrienes (CysLTs), and leukotriene B4 (LTB4) were measured in EBC by enzyme immunoassay. Eicosanoids were also examined in BALF in the study group. Cell count, percentage, and superoxide production by BALF cells were estimated. RESULTS: The mean (+/- SEM) CysLT and 8-isoprostane concentrations were higher in the sarcoidosis group (6.5 +/- 0 vs 27.82 +/- 6.65 pg/mL, respectively; and 2.67 +/- 0.16 vs 13.95 +/- 2.59 pg/mL, respectively). There were positive correlations between EBC and BALF 8-isoprostane concentration (r = 0.68, p < 0.0001) and LTB4 concentration (r = 0.43; p = 0.026). EBC LTB4 levels correlated with the number of lymphocytes per milliliter of BALF. The percentage and number of eosinophils in BALF correlated with EBC 8-isoprostane and BALF CysLT concentrations. No positive correlation was found between concentrations of EBC eicosanoids and percentages BALF lymphocytes, BALF macrophages, or superoxide production. CONCLUSIONS: The levels of 8-isoprostane and CysLT are elevated in EBC in sarcoidosis patients; however, a lack of correlation with BALF lymphocyte percentage does not encourage us to recommend the measurement of eicosanoids as activity markers. The positive correlation of EBC 8-isoprostane and BALF CysLT concentrations with the percentage of eosinophils in BALF, and the higher percentage of eosinophils in BALF from patients with grade 3 sarcoidosis, may suggest the possible prognostic value.     

Functionalization of Zeolite NaP1 for Simultaneous Acid Red 18 and Cu(II) Removal

The efficiency of azo dye Acid Red 18 (AR18) and Cu(II) ions simultaneous removal from an aqueous solution on NaP1CS and NaP1H was investigated, taking into account the effect of the phase contact time, pH, initial concentration, temperature, and interfering ions presence. Zeolite denoted as NaP1CS was modified by chitosan (CS) and zeolite denoted as NaP1H was modified by hexadecyltrimethylammonium bromide (HDTMA). In order to characterize sorption properties of NaP1CS, the obtained sorbent was characterized using Fourier transform infrared spectroscopy (FTIR) and nitrogen adsorption/desorption (ASAP). The kinetic parameters were determined by means of the pseudo first order (PFO), pseudo second order (PSO), and intraparticle diffusion (IPD) kinetic models. To present the adsorption data, three different isotherm models (Langmuir, Freundlich and Dubinin-Radushkevich) were used. The desorption process was also examined. It was found that for sorbent NaP1CS the pseudo second order (PSO) kinetic model and the Langmuir isotherm fitted best the experimental data. Moreover, it was noted that the acidic pH is appropriate to achieve the best sorption properties of NaP1CS for Cu(II) and NaP1H for AR18 and Cu(II). The thermodynamic parameters indicate an endothermic process. The most effective solution for the desorption process was found to be 1 M HCl. The results indicate that simultaneous removal of dye AR18 and Cu(II) on modified zeolite NaP1CS or NaP1H is possible and proceeds with a very good efficiency. The obtained zeolites could effectively adsorb AR18 an Cu(II) simultaneously, but their adsorption abilities were rather different.     

Broadband Near-Infrared Luminescence in Lead Germanate Glass Triply Doped with Yb3+/Er3+/Tm3+

This paper deals with broadband near-infrared luminescence properties of lead germanate glass triply doped with Yb³⁺/Er³⁺/Tm³⁺. Samples were excited at 800 nm and 975 nm. Their emission intensities and lifetimes depend significantly on Er³⁺ and Tm³⁺ concentrations. For samples excited at 800 nm, broadband emissions corresponding to the overlapped ³H₄ → ³F₄ (Tm³⁺) and ⁴I_13/2 → ⁴I_15/2 (Er³⁺) transitions centered at 1.45 µm and 1.5 µm was identified. Measurements of decay curves confirm reduction of ³H₄ (Tm³⁺), ²F_5/2 (Yb³⁺) and ⁴I_13/2 (Er³⁺) luminescence lifetimes and the presence of energy-transfer processes. The maximal spectral bandwidth equal to 269 nm for the ³F₄ → ³H₆ transition of Tm³⁺ suggests that our glass co-doped with Yb³⁺/Er³⁺/Tm³⁺ is a good candidate for broadband near-infrared emission. The energy transfer from ⁴I_13/2 (Er³⁺) to ³F₄ (Tm³⁺) and cross-relaxation processes are responsible for the enhancement of broadband luminescence near 1.8 µm attributed to the ³F₄ → ³H₆ transition of thulium ions in lead germanate glass under excitation of Yb³⁺ ions at 975 nm.     

Structural Properties of Thin ZnO Films Deposited by ALD under O-Rich and Zn-Rich Growth Conditions and Their Relationship with Electrical Parameters

The structural, optical, and electrical properties of ZnO are intimately intertwined. In the present work, the structural and transport properties of 100 nm thick polycrystalline ZnO films obtained by atomic layer deposition (ALD) at a growth temperature (T_g) of 100–300 °C were investigated. The electrical properties of the films showed a dependence on the substrate (a-Al₂O₃ or Si (100)) and a high sensitivity to T_g, related to the deviation of the film stoichiometry as demonstrated by the RT-Hall effect. The average crystallite size increased from 20–30 nm for as grown samples to 80–100 nm after rapid thermal annealing, which affects carrier scattering. The ZnO layers deposited on silicon showed lower strain and dislocation density than on sapphire at the same T_g. The calculated half crystallite size (D/2) was higher than the Debye length (L_D) for all as grown and annealed ZnO films, except for annealed ZnO/Si films grown within the ALD window (100–200 °C), indicating different homogeneity of charge carrier distribution for annealed ZnO/Si and ZnO/a-Al₂O₃ layers. For as grown films the hydrogen impurity concentration detected via secondary ion mass spectrometry (SIMS) was 10²¹ cm⁻³ and was decreased by two orders of magnitude after annealing, accompanied by a decrease in Urbach energy in the ZnO/a-Al₂O₃ layers.     

Cutting Forces and Tool Wear Investigation during Turning of Sintered Nickel-Cobalt Alloy with CBN Tools

This article describes issues related to the machining of parts made of sintered nickel-cobalt alloy. Longitudinal turning with a CBN (cubic boron nitride) tool was analyzed. The results of experiments showed the influence of cutting parameters in the field of finishing machining on the values of cutting forces and specific cutting force, taking into account the wear of the cutting edge. Measurements and analysis of the topography and roughness parameters of the machined surface, as well as the cutting tool wear, were presented. The microscopic examination showed that the average grain size of the sintered nickel-cobalt alloy was 3.22 ± 0.1 (μm). The presence of the hardening state variability of the material during machining, as well as the value of the cutting force fluctuation as a function of the tool wear VB, were stated. The specific cutting force values increased to a small degree for the tool wear in the range of VB = 0–0.2 mm, and reached similar values in the range k_c = 5500–7500 N/mm². The specific cutting force values increased significantly for wear VB > 0.2 mm and were characterized by a large variability. The occurring phenomena were analyzed and several explanations were proposed. A recommendation was developed for the machining of parts made of sintered nickel-cobalt alloy. The Taguchi method was used in the experiment methodology.