Management of gastric outlet obstruction:Focusing on endoscopic approach

Gastric outlet obstruction(GOO)is a medical condition characterized by epigastric pain and postprandial vomiting due to mechanical obstruction.The obstructions typically involved in GOO can be benign or malignant.Peptic ulcer disease is the most common cause of benign GOO,and malignant causes include gastric cancer,lymphoma,and gastrointestinal stromal tumor.With the eradication of Helicobacter pylori(H.pylori)and the use of proton pump inhibitors,the predominant causes have changed from benign to malignant diseases.Treatment of GOO depends on the underlying cause:Proton pump inhibitors,H.pylori eradication,endoscopic treatments including balloon dilatation or the placement of self-expandable stents,or surgery.

Material Characterization of Ni Base Alloy for Very High Temperature Reactor

The generation of highly efficient electricity and the production of massive hydrogen are possible using a very high temperature reactor （VHTR） among generation IV nuclear power plants. The structural material for an intermediate heat exchanger （IHX） among numerous components should be endurable at high temperature of up to 950 °C during long-term operation. Impurities inevitably introduced in helium as a coolant facilitate the material degradation by corrosion at high temperature. In the present work, the surface reactions available under controlled impure helium at 950 °C were investigated based on the thermodynamics and the corrosion tests were performed in a temperature range of 850-950 °C during 10-250 h for commercial Alloy 617 as a candidate material for an IHX. Moreover, the mechanical property and microstructure for nickel-based alloys fabricated in laboratory were evaluated as a function of the processing parameters such as hot rolling and heat treatment conditions. From the reaction rate constant obtained from an impure helium control system for a material evaluation, it was predicted that the outer oxide layer thickness, internal oxide depth, and carbide- depleted zone depth reach about 116, 600 and 1000 μm, respectively when Alloy 617 is exposed to an impure helium environment at 950 ~C for 20 years. For Ni-Cr-Co-Mo alloy, subsequent annealing and a combination of cold working and subsequent annealing following solution annealing caused increases in the grain boundary carbide coverage and size. The angular distribution of the grain boundary as well as the carbide distribution was also changed leading to a consequent improvement of the mechanical property at 950 °C in air.

What is the appropriate strategy for diagnosing NAFLD using ultrasonography in obese children?

Background:The aim of this study is to identify obese children who are candidates for a potential diagnosis of non-alcoholic fatty liver disease (NAFLD).Methods:We enrolled 242 obese children (122 boys and 120 girls) aged 7-16 years who were examined with abdominal ultrasonography in our pediatric obesity clinic.We compared patients in the normal group with those in the NAFLD group (mild disease,moderate to severe disease) and identified the optimal anthropometric parameters among height,weight,body mass index (BMI),waist circumference,hip circumference,waist to height ratio (WHtR),and waist to hip ratio to predict NAFLD using a receiver operating characteristic curve analysis.We also investigated risk factors associated with NAFLD for the anthropometric parameters and the biochemical model using logistic regression.Results:The high-and low-risk groups for hepatic steatosis relative to a WHtR of 0.56 as the standard point showed significant differences in hepatic steatosis severity grade (P<0.001),BMI (P=0.004),hip circumference (P=0.090),aspartate aminotransferase (P<0.001),alanine aminotransferase (P<0.001),triglycerides (P=0.001),and the triglyceride to high-density lipoprotein (HDL) cholesterol ratio (P=0.006).Risk factors for hepatic steatosis on logistic regression analysis were male sex (odds ratio:3.68,95% confidence interval:1.76-7.70),WHtR >0.56 (2.25,1.05-4.81),and waist circumference >90th percentile (20.22,9.21-44.36) in the anthropometric parameter model and elevated alanine aminotransferase levels (boys >25.8 U/L,girls >22.1 U/L) (6.93,2.52-19.03),hypertriglyceridemia (>110 mg/dL) (3.80,1.23-11.75),and triglyceride to HDL cholesterol ratio >3 (9.23,2.95-8.83) in the biochemical parameter model.Conclusions:A diagnostic approach to hepatic steatosis is recommended as part of the proper screening and stratification of risk factors in obese children.WHtR is a simple and convenient method of effectively identifying obese children who are candidates for hepatic steatosis screening.

Safety of acupotomy in a real-world setting:A prospective pilot and feasibility study

Objective:Acupotomy is a modern acupuncture method that includes modern surgical methods.Since acupotomy is relatively more invasive than filiform acupuncture treatment,it is important to establish the safety profile of this practice.To justify further large-scale prospective observational studies,this preliminary study was performed to assess the feasibility of the approach and investigate the safety profile and factors potentially associated with adverse events(AEs).Methods:This was a prospective pilot study that assessed the feasibility of a large-scale forthcoming safety study on acupotomy treatment in a real-world setting.The feasibility(call response rate,dropout rate,response rate for each variable and recruitment per month)and safety profile(incidence,type,severity and causality of AEs,and factors potentially associated with AEs)were measured.Results:A total of 28 participants joined the study from January to May 2018.A follow-up assessment was achieved in 258(1185 treatment points)out of 261 sessions(1214 treatment points).The response rate via telephone on the day after treatment was 87.3%.There were 8 systemic AEs in all the sessions(8/258;3.11%)and 27 local AEs on the total points treated(27/1185;2.28%).Severe AEs did not occur.Total AE and local AE occurrence were associated with blade width and the number of needle stimulations per treatment point.Conclusion:The findings suggest that it could be feasible to analyze the safety of acupotomy in a realworld setting.Moreover,the primary data on some relevant AEs could be determined.We are planning large-scale prospective studies based on these findings.Trial registration:Clinical Research Information Service(CRIS)KCT0002849(https://cris.nih.go.kr/cris/search/detailSearch.do/11487).