Investigation of the Supercapacitor Performance of Ni0.8Co0.15Al0.02(OH)2 from the Co-Precipitation Method.

Herein, Ni0.8Co0.15Al0.05(OH)2 materials, a by-product in the preparation of the precursor of cathode materials for lithium ion batteries, were employed as supercapacitor electrodes. The reaction time was changed from 2 to 48 h to produce hydroxide products, which were analyzed using physical and electrochemical methods. The hydroxide material reacted for 2 h exhibited a good average particle strength of 34.3 MPa with a particle size of 7 µm. When used as a supercapacitor electrode, the 2 h-reacted hydroxide electrode presented a high capacitance of 244.7 F g-1 at a current density of 0.5 A g-1 with a typical pseudocapacitive behavior, indicative of a highly suitable supercapacitor electrode material.

Interobserver variability and accuracy of high-definition endoscopic diagnosis for gastric intestinal metaplasia among experienced and inexperienced endoscopists.

Accurate diagnosis of gastric intestinal metaplasia is important; however, conventional endoscopy is known to be an unreliable modality for diagnosing gastric intestinal metaplasia (IM). The aims of the study were to evaluate the interobserver variation in diagnosing IM by high-definition (HD) endoscopy and the diagnostic accuracy of this modality for IM among experienced and inexperienced endoscopists. Selected 50 cases, taken with HD endoscopy, were sent for a diagnostic inquiry of gastric IM through visual inspection to five experienced and five inexperienced endoscopists. The interobserver agreement between endoscopists was evaluated to verify the diagnostic reliability of HD endoscopy in diagnosing IM, and the diagnostic accuracy, sensitivity, and specificity were evaluated for validity of HD endoscopy in diagnosing IM. Interobserver agreement among the experienced endoscopists was "poor" (κ = 0.38) and it was also "poor" (κ = 0.33) among the inexperienced endoscopists. The diagnostic accuracy of the experienced endoscopists was superior to that of the inexperienced endoscopists (P = 0.003). Since diagnosis through visual inspection is unreliable in the diagnosis of IM, all suspicious areas for gastric IM should be considered to be biopsied. Furthermore, endoscopic experience and education are needed to raise the diagnostic accuracy of gastric IM.

A fatal case of hepatitis B virus (HBV) reactivation during long-term, very-low-dose steroid treatment in an inactive HBV carrier.

Hepatitis B virus (HBV) may be reactivated after chemotherapy or immunosuppressive therapy, and therefore administration of antiviral agents before such treatment is recommended. Most reported cases of reactivation are associated with high doses of immunosuppressive agents or combination therapy. We present a case of a previously inactive HBV carrier with an acute severe flare-up during a long-term, very-low-dose (2.5 mg/day) steroid treatment for rheumatoid arthritis. We suggest that even a minimal dose of single-regimen oral steroid can cause reactivation of indolent, inactive HBV.

The Miss Rate for Colorectal Adenoma Determined by Quality-Adjusted, Back-to-Back Colonoscopies.

BACKGROUND/AIMS: Colonoscopy is considered to be the gold standard for detecting adenomatous polyps. Polyps are missed during colonoscopic examination at a rate that varies from 6% to 27%. The adenoma miss rate affects colonoscopic surveillance intervals and procedural quality. We aimed to assess the adenoma miss rate and the variables affecting the rate using same-day, quality-adjusted, back-to-back colonoscopies. METHODS: This prospective study was performed at a single institution and included 149 patients. Two consecutive same-day colonoscopies were performed by two experienced endoscopists. The adenoma miss rates and variables affecting the missed adenomas, including polyp characteristics and procedure times, were evaluated. RESULTS: The miss rates of polyps, adenomas, and advanced adenomas were 16.8%, 17%, and 5.4%, respectively. The smaller polyps and increased number of polyps detected during the first colonoscopy were more likely to be missed. A longer insertion time during the colonoscopy was correlated with an increased adenoma detection rate. CONCLUSIONS: There was a significant miss rate in the detection of colonic adenomas even in quality-adjusted, back-to-back colonoscopies. The adenoma miss rate can be reduced with a sufficient observation time during colonoscopic insertion. The development of specific technological methods to reduce the adenoma miss rate is necessary.

Graduated injection needles and snares for polypectomy are useful for measuring colorectal polyp size.

BACKGROUND: Accurate measurement of polyp size during colonoscopy is important; however, visual estimation of polyp size is inaccurate, and it is cumbersome to use additional accessories to measure polyp size whenever polyps are detected. AIMS: To evaluate the accuracy and usefulness of graduated devices that can also be used for polypectomy. METHODS: The ends of the outer sheath of the injection needles and snares were marked at intervals of 5mm (total 30mm). Four endoscopists measured 53 polyps of 36 patients in the following manner: visual estimation, estimation with biopsy forceps, and measurement with graduated devices. Actual size of all polyps measured through a calliper was used as reference standard. RESULTS: The difference between actual size and size measured by visual estimation was statistically significant (1.27mm, P<0.001), whilst the differences between actual size and size measured by biopsy forceps (0.06mm, P=1.00) or graduated devices (0.15mm, P=0.620) were not. The linear correlation between the estimates and the actual sizes showed that the graduated device gave the largest positive linear correlation (0.986, P<0.001) of the three measurement methods tested. CONCLUSIONS: The graduated devices are efficient methods when measuring polyp size and performing polypectomy in a single step.

The timing of bowel preparation is more important than the timing of colonoscopy in determining the quality of bowel cleansing.

AIMS: We aimed to compare the quality of bowel preparation and cecal intubation rates between morning and afternoon colonoscopies and to evaluate the difference in quality of bowel preparation according to the intervals between starting and ending intake of bowel preparation agent and the initiation of colonoscopy. METHODS: In this prospective study, 300 outpatients were instructed to drink PEG solution starting either at 5:00 a.m. (morning group) or at 8:00 a.m. (afternoon group) on the same day. The time when PEG intake was started and completed, and when colonoscopy was begun were recorded. The quality of bowel preparation was assessed using the Ottawa bowel preparation scale. RESULTS: There was no significant difference in the Ottawa scale between the morning and the afternoon groups (p = 0.14). Patients with intervals of 7 h or less between the initiation of PEG intake and the start of colonoscopy had a better quality of bowel preparation than those with intervals of more than 7 h (p = 0.03). In addition, patients with intervals of 4 h or less between the end of PEG intake and the start of colonoscopy had a better quality of bowel preparation than those with intervals of more than 4 h (p = 0.02). CONCLUSIONS: The time of day at which colonoscopy is performed, whether during the morning or the afternoon, does not have a significant impact on the quality of bowel preparation. The quality of bowel preparation is significantly better in patients with a shorter time between bowel preparation and the start of colonoscopy.

[Fulminant hepatic failure with hepatitis B virus reactivation after rituximab treatment in a patient with resolved hepatitis B].

It is well known that the reactivation of hepatitis B virus (HBV) may occur as an acute hepatitis after chemotherapy or immunosuppressive therapy. Although most of these cases have been reported in HBsAg-positive patients, there have been a few reports of HBV reactivation in HBsAg-negative patients. There have been concerns for the need to screen the reactivation as well as anti-viral prophylaxis in HBsAg-negative patients with possible HBV occult infection who are planning to undergo chemotherapy or immunosuppressive therapy. Rituximab, an anti-CD20 monoclonal antibody, is effective in the treatment of non-Hodgkins lymphoma. However, rituximab can affect the immunity against HBV, consequently increasing viral replication. In fact, there have been reports of HBV reactivation after treatment with rituximab. Here, we report a case of HBV reactivation following rituximab plus systemic chemotherapy in diffuse large B cell lymphoma patient who was HBsAg negative, anti-HBs positive, and anti-HBc positive, ultimately leading to treatment-unresponsive fulminant hepatic failure.

[A case of extranodal histiocytic sarcoma of stomach mimicking gastric adenocarcinoma].

Histiocytic sarcoma is a rare malignant neoplasm that originates from a histiocytic hematopoietic lineage characterized by histiocytic differentiation and its corresponding immunophenotypic features. Patients with histiocytic sarcoma usually have a poor prognosis due to its aggressive clinical behavior. Here we report a rare case of extranodal histiocytic sarcoma of the stomach which was confirmed through immunohistochemical staining. A 71-year- old man was presented with epigastric pain. Gastroscopy, abdominal CT, and EUS revealed a mass located on the posterior wall of upper body and fundus of the stomach. Grossly, grayish white solid masses were seen extending down to the submucosal layer. Microscopically, the tumor cells had eosinophilic cytoplasm, abundant vacuole, and mitosis. Immunohistochemical staining revealed that the tumor cells were positive for LCA, CD68, and lysozyme. Early detection and accurate diagnosis of this rare neoplasm is important because it can make a great difference in prognostic outcomes. To make an accurate and definitive diagnosis, immunohistochemical staining is essential in the confirmation of histiocytic origin.

Chest wall metastasis from unknown primary site of hepatocellular carcinoma.

Previous reports of a solitary metastatic hepatocellular carcinoma have been rare. Because this tumor has a different treatment modality and prognosis, an accurate differential diagnosis is essential. Here we report a rare case of a solitary chest wall metastasis from unknown primary site of hepatocellular carcinoma. It involves a 51-year-old man who was admitted to our hospital because of a palpable left upper chest wall mass. The mass was resected and pathologic examination confirmed a diagnosis of metastatic hepatocellular carcinoma. Despite our investigation, no evidence was found that indicated the primary origin of the hepatocellular carcinoma. Four months later, the patient was admitted again because of spinal cord compression at the third and fourth thoracic vertebrae. Emergent decompressive laminectomy was performed and microscopic features revealed the same pathology as the initial chest wall mass resected 4 months earlier. After one year, a follow-up abdominal computed tomography (CT) still revealed no evidence of primary hepatocellular carcinoma.

Acute pancreatitis due to hypertriglyceridemia: report of 2 cases.

Hypertriglyceridemia (HTG) is a rare but well known cause of acute pancreatitis (AP), which can be a life- threatening complication if the degree of HTG is severe enough. It might be primary in origin or secondary to alcohol abuse, diabetes mellitus, pregnancy, or drugs. A serum triglyceride (TG) level of more than 1,000 to 2,000 mg/dL in patients with type I, IV, or V hyperlipidemia (Fredrickson's classification) is the identifiable risk factor. HTG-induced AP typically presents as an episode of AP or recurrent AP. The clinical course of HTG-induced AP is not different from other causes. Routine management of HTG-induced AP should be similar to other causes. A thorough family history of lipid abnormalities should be obtained, and an attempt to identify secondary causes should be made. The mainstay of treatment includes dietary restriction of fatty meal and lipid-lowering medications (mainly fibric acid derivatives). Although there are limited experiences with plasmapheresis, lipid apheresis, heparinization and insulin application, these can support the treatment of HTG- induced AP. We report two cases of HTG-induced AP which were successfully treated by plasmapheresis.

Adult-onset Still's disease with disseminated intravascular coagulation and multiple organ dysfunctions dramatically treated with cyclosporine A.

Severe systemic manifestations of adult onset Still's disease (AOSD) are often fatal and occasionally related to hemophagocytic syndrome (HS). We describe the case of a 49-yr-old woman with AOSD presenting with non-remitting high fever, confusion, jaundice, hepatosplenomegaly, serositis, azotemia, pancytopenia, coagulopathy with disseminated intravascular coagulation (DIC), hyperferritinemia, acute acalculous cholecystitis and ileocolitis noted in computed tomographic images. The patient had a history of herpes zoster developed prior to the admission, but there is no history of diarrhea or abdominal pain. Although bone marrow examination was not performed due to hemorrhagic diathesis, we suspected AOSD-associated HS on the basis of clinical course without detectable infectious agents in cultures or serologic studies. Intravenous immunoglobulin, pulse methylprednisolone, oral cyclosporine A (CsA) and ceftriaxone brought about transient improvement of fever and confusion, but the disease progressed. After increasing CsA dose, all previously mentioned abnormalities disappeared rapidly. Accordingly, we believe that DIC and multiple organ dysfunctions might have been the complications of HS but not that of sepsis, and that CsA can be used as a first-line therapy in case of life-threatening situations.