Endohepatology: The endoscopic armamentarium in the hand of the hepatologist.

ABSTRACT: Recent advances in the field of hepatology include new and effective treatments for viral hepatitis. Further effort is now being directed to other disease entities, such as non-alcoholic fatty liver disease, with an increased need for assessment of liver function and histology. In fact, with the evolving nomenclature of fat-associated liver disease and the emergence of the term "metabolic-associated fatty liver disease" (MAFLD), new diagnostic challenges have emerged as patients with histologic absence of steatosis can still be classified under the umbrella of MAFLD. Currently, there is a growing number of endoscopic procedures that are pertinent to patients with liver disease. Indeed, interventional radiologists mostly perform interventional procedures such as percutaneous and intravascular procedures, whereas endoscopists focus on screening for and treatment of esophageal and gastric varices. EUS has proven to be of value in many areas within the realm of hepatology, including liver biopsy, assessment of liver fibrosis, measurement of portal pressure, managing variceal bleeding, and EUS-guided paracentesis. In this review article, we will address the endoscopic applications that are used to manage patients with chronic liver disease.

In-situ construction of binder-free MnO2/MnSe heterostructure membrane for high-performance energy storage in pseudocapacitors.

Manganese (Mn)-based oxides are considered suitable positive electrode materials for supercapacitors (SCs). However, their cycle stability and specific capacitance are significantly hindered by key restrictions such as structural instability and low conductivity. Herein, we demonstrated a novel nanorod (NR)-shaped heterostructured manganese dioxide/manganese selenide membrane (MnO2/MnSe) on carbon cloth (CC) (denoted as MnO2/MnSe-NR@CC) with a high aspect ratio by a straightforward and facile hydrothermal process. Experiments have demonstrated that doping selenium atoms to oxygen sites reduce electronegativity, increasing the intrinsic electronic conductivity of MnO2, decreasing electrostatic interactions with electrolyte ions, and thus boosting the reaction kinetics. Further, the selenium doping results in an amorphous surface with extensive oxygen defects, which contributed to the emergence of additional charge storage sites with pseudocapacitive characteristics. As expected, novel heterostructured MnO2/MnSe-NR@CC as an electrode for SC exhibits a high capacitance of 740.63 F/g at a current density of 1.5 A/g, with excellent cycling performance (93% capacitance retention after 5000 cycles). The MnO2/MnSe-NR@CC exhibited outstanding charge storage capability, dominating capacitive charge storage (84.6% capacitive at 6 mV/s). To examine the practical applications of MnO2/MnSe-NR@CC-ASC as a positive electrode, MnO2/MnSe-NR@CC//AC device was fabricated. The MnO2/MnSe-NR@CC//AC-ASC device performed exceptionally well, with a maximum capacitance of 166.66 F/g at 2 A/g, with a capacitance retention of 94%, after 500 GCD cycles. Additionally, it delivers an energy density of 75.06 Wh/kg at a power density of 1805.1 W/kg and maintains 55.044 Wh/kg at a maximum power density of 18,159 W/kg. This research sheds fresh information on the anionic doping method and has the potential to be applied to the synthesis of positive electrode materials for energy storage applications.

In Situ Nitrogen Functionalization of 2D-Ti3C2Tx-MXenes for High-Performance Zn-Ion Supercapacitor.

Zinc (Zn) ion supercapacitors (ZISCs) have attracted considerable attention as a viable energy storage technology because they are cost-effective, safe, and environmentally friendly. However, cathode materials with suitable properties are rare and need to be explored. In this regard, metal carbides (MXenes) are a good choice for capacitive energy storage, but they exhibit low capacitance. The energy storage performance of MXenes can be bossed using functionalization with heteroatom doping, e.g., nitrogen (N), to simultaneously modify ZISCs' fundamental characteristics and electrochemical properties. Herein, we present an in-situ N-functionalization of Ti3C2Tx-MXene via a hydrothermal reaction with urea (denoted as N-Ti3C2Tx-MXene). N-functionalization into Ti3C2Tx-MXene raised Ti3C2Tx-MXene's interlayer spacing and boosted the Zn-ion storage in 1 M ZnSO4 electrolyte. The N-Ti3C2Tx-MXene electrode delivered an excellent specific capacitance of 582.96 F/g at 1 A/g and retained an outstanding cycle stability of 94.62% after 5000 cycles at 10 A/g, which is 1.8 times higher than pristine Ti3C2Tx-MXene at identical conditions. Moreover, the N-Ti3C2Tx-MXene//Zn device demonstrated a maximum capacitance of 153.55 F/g at 1 A/g, retained 92% of its initial value after 5000 cycles, and its Coulombic efficiency was ~100%. This strategy considerably reduced Ti3C2Tx-MXene nanosheet restacking and aggregation and enhanced electrochemical performance. Further, this research elucidated N-Ti3C2Tx-MXene's charge-storage process and offered a fresh approach to the rational design of novel electrode materials for ZISCs.

Binder-Free Zinc-Iron Oxide as a High-Performance Negative Electrode Material for Pseudocapacitors.

The interaction between cathode and anode materials is critical for developing a high-performance asymmetric supercapacitor (SC). Significant advances have been made for cathode materials, while the anode is comparatively less explored for SC applications. Herein, we proposed a high-performance binder-free anode material composed of two-dimensional ZnFe2O4 nanoflakes supported on carbon cloth (ZFO-NF@CC). The electrochemical performance of ZFO-NF@CC as an anode material for supercapacitor application was examined in a KOH solution via a three-electrode configuration. The ZFO-NF@CC electrode demonstrated a specific capacitance of 509 F g-1 at 1.5 A g-1 and was retained 94.2% after 10,000 GCD cycles. The ZFO-NF@CC electrode showed exceptional charge storage properties by attaining high pseudocapacitive-type storage. Furthermore, an asymmetric SC device was fabricated using ZFO-NF@CC as an anode and activated carbon on CC (AC@CC) as a cathode with a KOH-based aqueous electrolyte (ZFO-NF@CC||AC@CC). The ZFO-NF@CC||AC@CC yielded a high specific capacitance of 122.2 F g-1 at a current density of 2 A g-1, a high energy density of 55.044 Wh kg-1 at a power density of 1801.44 W kg-1, with a remarkable retention rate of 96.5% even after 4000 cycles was attained. Thus, our results showed that the enhanced electrochemical performance of ZFO-NF@CC used as an anode in high-performance SC applications can open new research directions for replacing carbon-based anode materials.

Flower-like Highly Open-Structured Binder-Free Zn-Co-Oxide Nanosheet for High-Performance Supercapacitor Electrodes.

Scientific research is being compelled to develop highly efficient and cost-effective energy-storing devices such as supercapacitors (SCs). The practical use of SC devices is hindered by their low energy density and poor rate capability due to the binding agents in fabricating electrodes. Herein, we proposed flower-like highly open-structured binder-free ZnCo2O4 micro-flowers composed of nanosheets supported in nickel foam (ZnCoO@NF) with improved rate capability up to 91.8% when current varied from 2 to 20 A·g-1. The ZnCoO@NF electrode exhibited a superior specific capacitance of 1132 F·g-1 at 2 A·g-1 and revealed 99% cycling stability after 7000 cycles at a high current density of 20 A·g-1. The improved performance of the ZnCoO@NF electrode is attributed to the highly stable structure of the micro/nano-multiscale architecture, which provides both the high conduction of electrons and fast ionic transportation paths simultaneously.

Hydrothermal Synthesis of Binder-Free Metallic NiCo2O4 Nano-Needles Supported on Carbon Cloth as an Advanced Electrode for Supercapacitor Applications.

It is of great significance to design electrochemical energy conversion and storage materials with excellent performance to fulfill the growing energy demand. Bimetallic cobalt/nickel-based electrode materials exhibit excellent electrical conductivity compared to mono oxides. However, their potential as electrode materials for high-performance supercapacitors (SCs) is limited because of their poor cycling stability and high-capacity fading. This work demonstrates the synthesis of binder-free bimetallic NiCo2O4 nano-needles supported on CC (NCO@CC) via a facile and scalable hydrothermal process. Excellent electrical conductivity and interconnected nanostructure of NCO@CC nano-needles provide the fast transfer of electrons with numerous channels for ion diffusion. Owing to such features, the binder-free NCO@CC electrode for SC discloses excellent specific capacitance (1476 Fg-1 at 1.5 Ag-1) with 94.25% capacitance retention even after 5000 cycles. From these outstanding electrochemical performances, it can be inferred that NCO@CC nano-needle array-structured electrodes may be potential candidates for SC applications.

Treatment With Endoscopic Ultrasound (EUS)-Guided Transesophageal Coil Embolization Without Sclerotherapy: A Novel Therapy for Giant Distal Esophageal Hemangioma.

Giant esophageal hemangiomas are rare. The extent is usually in the mediastinum but may spread down to the upper abdomen. Such vascular pathology is hard to treat and typically to be resected along with the organs it is attached to. Here we report a novel way of treatment of giant distal esophageal hemangioma that was considered difficult for resection due to its anatomical spread. With endoscopic ultrasound (EUS) guidance, a few coils were placed in the hemangioma, which lead to stasis of blood and a significant reduction in the size of the lesion in over three months.

Binder-Free Porous 3D-ZnO Hexagonal-Cubes for Electrochemical Energy Storage Applications.

Considerable efforts are underway to rationally design and synthesize novel electrode materials for high-performance supercapacitors (SCs). However, the creation of suitable materials with high capacitance remains a big challenge for energy storage devices. Herein, unique three-dimensional (3D) ZnO hexagonal cubes on carbon cloth (ZnO@CC) were synthesized by invoking a facile and economical hydrothermal method. The mesoporous ZnO@CC electrode, by virtue of its high surface area, offers rich electroactive sites for the fast diffusion of electrolyte ions, resulting in the enhancement of the SC's performance. The ZnO@CC electrode demonstrated a high specific capacitance of 352.5 and 250 F g-1 at 2 and 20 A g-1, respectively. The ZnO@CC electrode revealed a decent stability of 84% over 5000 cycles at 20 A g-1 and an outstanding rate-capability of 71% at a 10-fold high current density with respect to 2 A g-1. Thus, the ZnO@CC electrode demonstrated improved electrochemical performance, signifying that ZnO as is promising candidate for SCs applications.

Fluoroquinolone Resistance Among Isolates of Mycobacterium tuberculosis in Khyber Pakhtunkhwa, Pakistan.

Fluoroquinolones (FQs) are broad-spectrum second-line antimicrobial drugs commonly used in the treatment of tuberculosis (TB). Data on FQ resistance in the Khyber Pakhtunkhwa (KP) province of Pakistan, a high-burden country, are scarce. This study aimed to analyze the resistance to FQs in this specific geographic area. Samples were collected from 25 districts of KP from 2014 to 2019. Data regarding suspected TB patients were collected from their guardians or secondary caregivers. All the samples were subjected to decontamination and digestion processing. Drug susceptibility testing (DST) was performed according to the standard minimum inhibitory concentration for ofloxacin (OFX), levofloxacin (LEV), and moxifloxacin (MOX), taken as 2, 1, and 1 µg/mL, respectively. For the 5,759 clinical samples collected from 25 districts, DST was conducted for a total of 3,158 samples. Out of the total DSTs, the OFX profile was available for 2,983, MOX profile for 2,290, and LEV profile for 544 samples. OFX and LEV resistance was found to be evenly distributed and has remained the same for the past few years, whereas MOX resistance increased from 1% in 2017 to 4% in 2019. Among a total of 807 OFX-resistant isolates, 218 (27%) were observed to be monoresistant to OFX, whereas 589 (73%) isolates were resistant to OFX and at least one other anti-TB drug. Drug resistance to OFX was higher in multidrug-resistant TB (MDR-TB), that is, 428 (53%). It was concluded that resistance to MOX has been increasing, whereas OFX resistance is much higher in MDR cases. FQ resistance needs to be continuously monitored to avoid further side effects. This study provides useful information for better management of FQ resistance with reference to the global TB control program 2030.

Extrapulmonary tuberculosis in Pakistan- A nation-wide multicenter retrospective study.

BACKGROUND: Pakistan is fifth among high burden countries for tuberculosis. A steady increase is seen in extrapulmonary tuberculosis (EPTB), which now accounts for 20% of all notified TB cases. There is very limited information on the epidemiology of EPTB. This study was performed with the aim to describe the demographic characteristics, clinical manifestations and treatment outcomes of EPTB patients in Pakistan. METHOD: We performed descriptive analysis on routinely collected data for cohorts of TB patients registered nationwide in 2016 at health facilities selected using stratified convenient sampling. FINDINGS: Altogether 54092 TB including 15790 (29.2%) EPTB cases were registered in 2016 at 50 study sites. The median age was 24 years for EPTB and 30 years for PTB patients. The crude prevalence of EPTB in females was 30.5% (95%CI; 29.9-31.0) compared to 27.9% (95%CI; 27.3-28.4) in males. The likelihood of having EPTB (OR), was 1.1 times greater for females, 2.0 times for children, and 3.3 times for residents of provinces in the North-West. The most common forms of EPTB were pleural (29.6%), lymphatic (22.7%) and abdominal TB (21.0%). Pleural TB was the most common clinical manifestation in adults (34.2%) and abdominal TB in children (38.4%). An increase in the prevalence of pleural and osteoarticular and decline in lymphatic and abdominal TB was observed with advancing age. Diversity in demography and clinical manifestations were noted between provinces. The treatment success rate for all type EPTB was significantly high compared to bacteriology confirmed PTB with the exception of EPTB affecting CNS with a high mortality rate. CONCLUSIONS: The study provides an insight into demography, clinical manifestations and treatment outcomes of EPTB. Further studies are needed to explain significant diversities observed between provinces, specific risk factors and challenges concerning EPTB management.