Emergency endoscopic variceal ligation in cirrhotic patients with blood clots in the stomach but no active bleeding or stigmata increases the risk of rebleeding

Background/Aims This study aimed to evaluate the efficacy and safety of emergency variceal ligation for the prevention of rebleeding in cirrhotic patients who are found on initial endoscopy to have blood clots in the stomach but no actively bleeding esophageal and gastric varices or stigmata. Methods This study included 28 cirrhotic patients who underwent emergency prophylactic EVL and 41 who underwent an elective intervention between January 2009 and June 2014. Clinical outcomes were analyzed, including the rebleeding, 6-week mortality, and rebleeding-free survival rates. Results The rebleeding rate was higher in the emergency than in the elective group (28.6% vs. 7.3%, P=0.041). Multivariate analysis showed that emergency prophylactic EVL (odds ratio [OR] = 7.4, 95% confidence interval [CI]=1.634.8, P=0.012) and Child-Pugh score C (OR=10.6, 95% CI=1.4-80.8, P=0.022) were associated with rebleeding. In the emergency group, the gastric varices were associated with rebleeding (OR=12.0, 95% CI=1.7-83.5, P=0.012). Conclusions Emergency EVL may be associated with variceal rebleeding when blood clots are present in the stomach without active esophageal and gastric variceal bleeding or stigmata. Elective intervention should be considered as a safer strategy for preventing variceal rebleeding in this situation

Bone marrow metastasis presenting as bicytopenia originating from hepatocellular carcinoma

The bone is a common site for metastasis in hepatocellular carcinoma (HCC). However, bone marrow metastasis from HCC is rarely reported, and its frequency is unclear. Here we report a rare case of bone marrow metastasis that presented as bicytopenia originating from HCC without bone metastasis. A 58-year-old man was admitted for investigation of a liver mass with extensive lymph node enlargement that was detected when examining his general weakness and weight loss. Laboratory findings revealed anemia, thrombocytopenia, mild elevated liver enzymes, normal prothrombin time percentage and high levels of tumor markers (α-fetoprotein and des-γ-carboxyprothrombin). Abdominal computed tomography showed multiple enhanced masses in the liver and multiple enlarged lymph nodes in the abdomen. A bone marrow biopsy revealed only a few normal hematopoietic cells and abundant tumor cells. Despite its rarity, bone marrow metastasis should always be suspected in HCC patients even if accompanied by cirrhosis

Improved survival rates in patients with H1N1 acute respiratory failure in Korea between 2009 and 2016.

There was a pandemic of influenza A (H1N1) in 2009; in Korea, there was also an H1N1 epidemic in 2016. We aim to investigate whether survival had improved in the setting of recent advances in intensive care unit (ICU) management. We conducted a retrospective analysis of acute respiratory failure patients with H1N1 influenza pneumonia in 2016 and 2009 respectively at two tertiary referral hospitals in Korea. A total of 28 patients were treated in 2016, and 34 in 2009. There was no significant difference in SOFA scores on ICU admission day. In-hospital mortality was significantly lower in patients of 2016 compared to those of 2009 (18% vs. 44% P = 0.028). By multivariable analyses, the treatment year 2016 was associated with a greater likelihood of survival. Compared to the patients treated in 2009, those treated in 2016 were one seventh as likely to die after adjusting for other clinical variables (hazard ratio for mortality, 0.15; 95% confidence interval. 0.03-0.63, P = 0.010). Improved survival in patients who underwent extracorporeal membrane oxygenation treatment (in-hospital mortality, 17% vs. 60%, P = 0.242) and decreased tidal volumes during mechanical ventilation (median 5.4 mL/kg vs. median 9.2 mL/kg, P = 0.018) were observed in 2016 compared to 2009. Treatment outcomes for patients with H1N1 acute respiratory failure improved from 2009 to 2016 in two tertiary referral centers in South Korea

Adsorption Capacity and Desorption Efficiency of Activated Carbon for Odors from Medical Waste

Five types of odor-emitting exhaust gases from medical waste were selected, and their adsorption capacity and desorption efficiency were investigated using activated carbon. The selected gases included polar gases (hydrogen sulfide (H2S) and ammonia (NH3)) and non-polar gases (acetaldehyde (AA), methyl mercaptan (MM), and trimethylamine (TMA))). Commercial activated carbon with a specific surface area of 2276 m2/g was used as the adsorbent. For the removal of odor from medical waste, we investigated: (1) the effective adsorption capacity of a single gas (3 gas concentration and flow rate, and (3) the desorption rate using NH3 gas. The values of the effective adsorption capacity of the single gas were in the following order: H2S 3 3 gas showed an increasing trend with NH3 concentration. Therefore, securing optimal conditions for adsorption/desorption is imperative for the highly efficient removal of odor from medical waste

Pre-Treatment Methods for Regeneration of Spent Activated Carbon

Spent activated carbon (SAC) usually exhibits a low specific surface area due to its high ash contents. In this study, pre-treatments, such as heat and acid treatments, were optimized to improve this feature. The heat pre-treatment did not reduce the ash content, nor did it increase the surface area. Because metallic ions adsorbed in SACs turn into ash upon the heat treatment. In the acid pre-treatment, the volatiles and fixed carbon were increased with decreasing ash contents. In this study, it was found that the surface area increase was correlated with the ratio between fixed carbon and ash. Among the pre-treatment methods, the combined heat and acid pre-treatment method highly increased the ratio, and therefore led to the surface area increase. Additionally, the acid pre-treatment was carried out using different types of acid (organic and inorganic acids) solutions to further improve the surface areas. The organic acid treatment caused a significant structural collapse compared to the inorganic acid treatment, decreasing the surface area. In particular, H3PO4 effectively removed ashes adsorbed on the activated carbon surface and regenerated the exhausted activated carbon. Both the heat and acid pre-treatments before chemical activation resulted in the positive effects such as strong desorption of pollutants and ashes within the internal structure of the activated carbon. Therefore, the regeneration introduced in this study is methodically the best method to regenerate SAC and maintain a stable structure

The Effects of Methane Storage Capacity Using Upgraded Activated Carbon by KOH

In this study, a feasible experiment on adsorbed natural gas (ANG) was performed using activated carbons (ACs) with high surface areas. Upgraded ACs were prepared using chemical activation with potassium hydroxide, and were then applied as adsorbents for methane (CH4) storage. This study had three principal objectives: (i) upgrade ACs with high surface areas; (ii) evaluate the factors regulating CH4 adsorption capacity; and (iii) assess discharge conditions for the delivery of CH4. The results showed that upgraded ACs with surface areas of 3052 m2/g had the highest CH4 storage capacity (0.32 g-CH4/g-ACs at 3.5 MPa), which was over two times higher than the surface area and storage capacity of low-grade ACs (surface area = 1152 m2/g, 0.10 g-CH4/g-ACs). Among the factors such as surface area, packing density, and heat of adsorption in the ANG system, the heat of adsorption played an important role in controlling CH4 adsorption. The released heat also affected the CH4 storage and enhanced available applications. During the discharge of gas from the ANG system, the residual amount of CH4 increased as the temperature decreased. The amount of delivered gas was confirmed using different evacuation flow rates at 0.4 MPa, and the highest efficiency of delivery was 98% at 0.1 L/min. The results of this research strongly suggested that the heat of adsorption should be controlled by both recharging and discharging processes to prevent rapid temperature change in the adsorbent bed

Optimization of Nickel-Based Catalyst Composition and Reaction Conditions for the Prevention of Carbon Deposition in Toluene Reforming

In this study, nickel-based reforming catalysts were synthesized for the reforming of toluene, a major component of thinners and widely used as an organic solvent. The reaction characteristics of these catalysts were investigated by both steam reforming and auto-thermal reforming. Reforming aromatic hydrocarbons like toluene to produce synthesis gas is difficult because carbon deposition also occurs, and the deposition of carbon lowers the activity of the catalyst and causes a pressure drop during the reaction process. In order to maintain a stable reforming process, a catalytic reaction technique capable of suppressing carbon deposition is required. Steam reforming and auto-thermal reforming of toluene were used in this study, and the temperature of the catalyst bed was remarkably reduced, due to a strong endothermic reaction during the reforming process. By using scanning electric microscopy (SEM), X-ray diffraction (XRD), and temperature-programmed oxidation analysis, it is shown that carbon deposition was markedly generated due to a catalyst bed temperature decrease. In this study, optimum conditions for catalyst composition and the reforming reaction are proposed to suppress the formation of carbon on the catalyst surface, and to remove the generated carbon from the process. In addition, ceria and zirconia were added as catalytic promoters to inhibit carbon deposition on the catalyst surface, and the carbon deposition phenomena according to the catalyst’s promoter content were investigated. The results showed that the carbon deposition inhibition function of CeO2, via its redox properties, is insignificant in steam reforming, but is notably effective in the auto-thermal reforming of toluene