Optimal Insertion Depth of Gastric Decompression Tube with a Thermistor for Patients Undergoing Laparoscopic Surgery in Trendelenburg Position.

Monitoring core temperature is crucial for maintaining normothermia during general anesthesia. Insertion of a gastric decompression tube (GDT) may be required during laparoscopic surgery. Recently, a newly designed GDT with a thermistor for monitoring esophageal temperature has been introduced. The purpose of the present study was to evaluate the optimal insertion depth of a GDT with a thermistor. Forty-eight patients undergoing elective laparoscopic surgery in the Trendelenburg position were included in the study. The GDT was inserted to a depth of nose-earlobe-xiphoid distance (NEX) + 12 cm and withdrawn sequentially, 2 cm at a time, at 5-min intervals. Temperatures of the GDT thermistor were compared with the core temperature of the tympanic membrane (TM) using Bland and Altman analysis. The correlation between optimal insertion depth of the GDT and anatomical distance (cricoid cartilage to the carina, CCD; carina to the left hemidiaphragm, CLHD) was evaluated, and a mathematical model to predict the optimal insertion depth of the GDT with a thermistor was calculated. Temperatures of TM and GDT thermistor at NEX + 4 cm showed good agreement and strong correlation, but better agreement and stronger correlation were seen at the actual location with the most minor temperature differences. The optimal insertion depth of the GDT was estimated as -15.524 + 0.414 × CCD - 0.145 × CLHD and showed a strong correlation with the actual GDT insertion depth (correlation coefficient 0.797, adjusted R2 = 0.636). The mathematical formula using CCD and CLHD would be helpful in determining the optimal insertion depth of a GDT with a thermistor.

[A Case of Intramural Hematoma of the Esophagus Mimicking Acute Coronary Syndrome].

Intramural hematoma of the esophagus is a rare condition that can be spontaneous or secondary to trauma, toxic ingestion, or intervention. If it is the spontaneous type, it usually presents initially with epigastric pain, hematemesis or dysphagia. We present a case of intramural hematoma of the esophagus mimicking acute coronary syndrome. A 63-year-old man presented with severe acute chest pain. He has four coronary stents that were inserted five years ago, from a different hospital, and is on dual antiplatelet agents. Coronary angiography was performed immediately under the suspicion of acute coronary syndrome, and we found that there was no obvious clogging of the coronary arteries. Next, chest computed tomography was performed due to suspected aortic dissection, and the result was also negative. Four days later, endoscopy was performed and intramural hematoma covered with large ulcers was diagnosed.

Endoscopic ultrasound without tissue acquisition has poor accuracy for diagnosing gastric subepithelial tumors.

Incidental gastric subepithelial tumor (SET) is frequently found during endoscopy. Although endoscopic ultrasonography (EUS) can provide useful information, its diagnostic accuracy varies. Most of the potentially malignant tumors observed on EUS are hypoechoic lesions. Therefore, we aimed to investigate the diagnostic accuracy of EUS for hypoechoic lesions located in the submucosa or proper muscle layer. We also evaluated various characteristics for potential associations with diagnostic accuracy.A retrospective review was conducted of the medical records of 99 patients who were diagnosed with gastric SET and who underwent EUS with pathologic confirmation between March 2008 and April 2015. After reviewing the endoscopic and pathologic findings, we attempted to analyze factors that were associated with the diagnostic accuracy of EUS.The mean ±â€Šstandard deviation size of the lesions was 20.0 ±â€Š12.7 mm. The most common location was the upper third of the stomach (43.4%). The overall accuracy of EUS was 66.7%. No statistically significant difference in EUS accuracy was observed according to the location, size, or layer of the lesion. The following pathologic diagnostic methods were used: EUS-guided fine needle aspiration (3.0%), forceps biopsy (16.2%), deep tissue biopsy using cap-assisted mucosal resection (8.1%), endoscopic submucosal dissection (25.2%), and operation (47.5%). The accuracy of EUS according to the expected diagnosis of the lesion was 77.1% for gastrointestinal stromal tumor, 50% for neuroendocrine tumor, and 50% for ectopic pancreas.Although EUS is a useful tool for gastric SET in clinical practice, the accuracy of diagnostic EUS is suboptimal. When considering whether to treat gastric SET, the decision should be made based on the pathologic diagnosis.

Reversible phase modulation and hydrogen storage in multivalent VO2 epitaxial thin films.

Hydrogen, the smallest and the lightest atomic element, is reversibly incorporated into interstitial sites in vanadium dioxide (VO2), a correlated oxide with a 3d(1) electronic configuration, and induces electronic phase modulation. It is widely reported that low hydrogen concentrations stabilize the metallic phase, but the understanding of hydrogen in the high doping regime is limited. Here, we demonstrate that as many as two hydrogen atoms can be incorporated into each VO2 unit cell, and that hydrogen is reversibly absorbed into, and released from, VO2 without destroying its lattice framework. This hydrogenation process allows us to elucidate electronic phase modulation of vanadium oxyhydride, demonstrating two-step insulator (VO2)-metal (HxVO2)-insulator (HVO2) phase modulation during inter-integer d-band filling. Our finding suggests the possibility of reversible and dynamic control of topotactic phase modulation in VO2 and opens up the potential application in proton-based Mottronics and novel hydrogen storage.

Insights into cationic ordering in Re-based double perovskite oxides.

Cationic ordering in Sr2FeReO6 (SFRO) and Sr2CrReO6 (SCRO) is investigated using magnetic property measurement, atomic-scale imaging, and first-principles calculations. We find that the nature of cationic ordering strongly depends on the host oxides, although they have the same crystal symmetry and chemical formula. Firstly, adding Re is effective to enhance the cationic ordering in SFRO, but makes it worse in SCRO. Secondly, the microscopic structure of antisite (AS) defects, associated with the level of cationic ordering, is also distinguishable; the AS defects in SFRO are clustered in the form of an antiphase-boundary-like feature, while they are randomly scattered in SCRO. Interestingly, we observe that the clustered AS defects deteriorate the ferromagnetism more than the scattered defects. Our findings elevate the importance of the AS defect configuration as well as the amount of defects in terms of magnetic property.