Liver Parenchyma Perforation following Endoscopic Retrograde Cholangiopancreatography

Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective modality for the diagnosis and treatment of biliary and pancreatic diseases, it is still related with several severe complications. We report on the case of a female patient who developed liver parenchyma perforation following ERCP. She underwent ERCP with sphincterotomy and extraction of a common bile duct stone. Shortly after ERCP, abdominal distension was identified. Abdominal computed tomography revealed intraabdominal air leakage and leakage of contrast dye penetrating the liver parenchyma into the space around the spleen. Since periampullary perforation related to sphincterotomy could not be denied, she was referred for immediate surgery. Obvious perforation could not be found at surgery. Cholecystectomy, insertion of a T tube into the common bile duct, placement of a duodenostomy tube and drainage of the retroperitoneum were performed. She did well postoperatively and was discharged home on postoperative day 28. In conclusion, as it is well recognized that perforation is one of the most serious complication related to ERCP, liver parenchyma perforation should be suspected as a cause

Dynamic Analysis of Photosynthate Translocation Into Strawberry Fruits Using Non-invasive 11C-Labeling Supported With Conventional Destructive Measurements Using 13C-Labeling

In protected strawberry (Fragaria × ananassa Duch.) cultivation, environmental control based on the process of photosynthate translocation is essential for optimizing fruit quality and yield, because the process of photosynthate translocation directly affects dry matter partitioning. We visualized photosynthate translocation to strawberry fruits non-invasively with 11CO2 and a positron-emitting tracer imaging system (PETIS). We used PETIS to evaluate real-time dynamics of 11C-labeled photosynthate translocation from a 11CO2-fed leaf, which was immediately below the inflorescence, to individual fruits on an inflorescence in intact plant. Serial photosynthate translocation images and animations obtained by PETIS verified that the 11C-photosynthates from the source leaf reached the sink fruit within 1 h but did not accumulate homogeneously within a fruit. The quantity of photosynthate translocation as represented by 11C radioactivity varied among individual fruits and their positions on the inflorescence. Photosynthate translocation rates to secondary fruit were faster than those to primary or tertiary fruits, even though the translocation pathway from leaf to fruit was the longest for the secondary fruit. Moreover, the secondary fruit was 25% smaller than the primary fruit. Sink activity (11C radioactivity/dry weight [DW]) of the secondary fruit was higher than those of the primary and tertiary fruits. These relative differences in sink activity levels among the three fruit positions were also confirmed by 13C tracer measurement. Photosynthate translocation rates in the pedicels might be dependent on the sink strength of the adjoining fruits. The present study established 11C-photosynthate arrival times to the sink fruits and demonstrated that the translocated material does not uniformly accumulate within a fruit. The actual quantities of translocated photosynthates from a specific leaf differed among individual fruits on the same inflorescence. To the best of our knowledge, this is the first reported observation of real-time translocation to individual fruits in an intact strawberry plant using 11C-radioactive- and 13C-stable-isotope analyses

Development of the Japanese version of the Intensive Care Unit Trigger Tool to detect adverse events in critically ill patients

AimThe Intensive Care Unit Trigger Tool (ICUTT) was developed to detect adverse events (AEs) in intensive care unit (ICU) patients. The purpose of this study was to determine the validity and reliability of the Japanese version of the ICUTT (ICUTT-J).MethodsThe translation of ICUTT was carried out based on the guideline for translation of instruments. Subsequently, two review teams independently reviewed 50 patients\u27 medical records using the ICUTT-J, and agreement regarding the presence and number of AEs was evaluated to ensure reliability.ResultsThe ICUTT-J was submitted to the authors of the original ICUTT, who confirmed it as being equivalent to the original version. The item-content validity index and scale-content validity index were 1.00 and 1.00, respectively. Interrater reliability showed moderate agreement of κ = 0.52 in terms of the presence of AEs and linear weighting of κ = 0.49 (95% confidence interval, 0.28, 0.71) in terms of the number of AEs.ConclusionThis study\u27s findings suggest that the ICUTT-J is valid and moderately reliable for use in ICUs

Non-invasive 11C-imaging revealed the spatiotemporal variability in the translocation of photosynthates into strawberry fruits in response to increasing daylight integrals at leaf surface

The efficiency of photosynthate translocation from leaves to fruits directly affects dry matter partitioning. Therefore, controlling photosynthate translocation dynamics is critical for high-yield and high-quality fruits production. Accordingly, photosynthate translocation changes must be characterized using data obtained at a higher spatiotemporal resolution than that provided by conventional methods. In this study, 11C-photosynthates translocation into strawberry (Fragaria × ananassa Duch.) fruits in individual plants was visualized non-invasively and repeatedly using a positron-emission tracer imaging system (PETIS) to assess the spatiotemporal variability in the translocation dynamics in response to increasing daylight integrals (i.e., 0.5 h, 4.5 h, and 9 h exposures to 400 µmol m-2 s-1 at the leaf surface). Serial images of photosynthate translocation into strawberry fruits obtained from the PETIS confirmed that 11C-photosynthates were translocated heterogeneously into each fruit on the same inflorescence. The amount of translocated 11C-photosynthates and the translocation rate into each fruit significantly increased as the integrated light intensity at the leaf surface increased. An analysis of the pedicel of each fruit also confirmed that the photosynthate translocation rate increased. The cumulated photosynthesis in leaves increased almost linearly with during the light period, suggesting that an increase in the amount of photosynthates in leaves promotes the translocation of photosynthates from leaves, resulting in an increase in the photosynthate translocation rate in pedicels and enhanced photosynthate accumulation in fruits. Additionally, the distribution pattern of photosynthate translocated to fruits did not change during the light period, nor did the order of the sink activity (11C radioactivity / fruit dry weight), which is the driving force for the prioritization of the 11C-partitioning between competing organs, among fruits. Thus, this is the first study to use 11C-radioisotopes to clarify the spatiotemporal variability in photosynthate translocation from source leaves to individual sink fruits in vivo in response to increasing daylight integrals at a high spatiotemporal resolution

Dynamic Analysis of Photosynthate Translocation into Strawberry Fruits Using Non-invasive 11C-labeling Supported with Conventional Destructive Measurements Using 13C-labeling

In protected strawberry (Fragaria × ananassa Duch.) cultivation, environmental control based on the process of photosynthate translocation is essential for optimizing fruit quality and yield, because the process of photosynthate translocation directly affects dry matter partitioning. We visualized photosynthate translocation to strawberry fruits non-invasively with 11CO2 and a positron-emitting tracer imaging system (PETIS). We used PETIS to evaluate real-time dynamics of 11C-labeled photosynthate translocation from a 11CO2-fed leaf, which was immediately below the inflorescence, to individual fruits on an inflorescence in intact plant. Serial photosynthate translocation images and animations obtained by PETIS verified that the 11C-photosynthates from the source leaf reached the sink fruit within 1 h but did not accumulate homogeneously within a fruit. The quantity of photosynthate translocation as represented by 11C radioactivity varied among individual fruits and their positions on the inflorescence. Photosynthate translocation rates to secondary fruit were faster than those to primary or tertiary fruits, even though the translocation pathway from leaf to fruit was the longest for the secondary fruit. Moreover, the secondary fruit was 25% smaller than the primary fruit. Sink activity (11C radioactivity / dry weight [DW]) of the secondary fruit was higher than those of the primary and tertiary fruits. These relative differences in sink activity levels among the three fruit positions were also confirmed by 13C tracer measurement. Photosynthate translocation rates in the pedicels might be dependent on the sink strength of the adjoining fruits. The present study established 11C-photosynthate arrival times to the sink fruits and demonstrated that the translocated material does not uniformly accumulate within a fruit. The actual quantities of translocated photosynthates from a specific leaf differed among individual fruits on the same inflorescence. To the best of our knowledge, this is the first reported observation of real-time translocation to individual fruits in an intact strawberry plant using 11C-radioactive- and 13C-stable-isotope analyses