Tangled plastic biliary stents removed using a rendezvous method

Biliary stents are used to facilitate the drainage of bile into the digestive tract, most often in the palliation of malignant biliary obstruction, but also in benign conditions such as biliary fistulas or benign biliary strictures. Temporary multiple double-pigtail biliary stenting is a safe method for treating large, difficult common bile duct (CBD) stones in elderly patients; it helps reduce stone size and facilitates successful duct clearance. We report a new technique for retrieving two tangled plastic biliary stents using rendezvous endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage

Development of Highly Reliable Power and Communication System for Essential Instruments Under Severe Accidents in NPP

AbstractThis article proposes a highly reliable power and communication system that guarantees the protection of essential instruments in a nuclear power plant under a severe accident. Both power and communication lines are established with not only conventional wired channels, but also the proposed wireless channels for emergency reserve. An inductive power transfer system is selected due to its robust power transfer characteristics under high temperature, high pressure, and highly humid environments with a large amount of scattered debris after a severe accident. A thermal insulation box and a glass-fiber reinforced plastic box are proposed to protect the essential instruments, including vulnerable electronic circuits, from extremely high temperatures of up to 627°C and pressure of up to 5 bar. The proposed wireless power and communication system is experimentally verified by an inductive power transfer system prototype having a dipole coil structure and prototype Zigbee modules over a 7-m distance, where both the thermal insulation box and the glass-fiber reinforced plastic box are fabricated and tested using a high-temperature chamber. Moreover, an experiment on the effects of a high radiation environment on various electronic devices is conducted based on the radiation test having a maximum accumulated dose of 27 Mrad

Sex-related impact on clinical outcomes of patients treated with drug-eluting stents according to clinical presentation: Patient-level pooled analysis from the GRAND-DES registry

Background: The contribution of sex and initial clinical presentation to the long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated. Methods: Individual patient data from 5 Korean-multicenter drug-eluting stent (DES) registries (The GRAND-DES) were pooled. A total of 17,286 patients completed 3-year follow-up (5216 women and 12,070 men). The median follow-up duration was 1125 days (interquartile range 1097–1140 days), and the primary endpoint was cardiac death at 3 years. Results: The clinical indication for PCI was stable angina pectoris (SAP) in 36.8%, unstable angina pectoris (UAP) or non-ST-segment elevation myocardial infarction (NSTEMI) in 47.4%, and STEMI in 15.8%. In all groups, women were older and had a higher proportion of hypertension and diabetes mellitus compared with men. Women presenting with STEMI were older than women with SAP, with the opposite seen in men. There was no sex difference in cardiac death for SAP or UAP/NSTEMI. In STEMI patients, the incidence of cardiac death (7.9% vs. 4.4%, p = 0.001), all-cause mortality (11.1% vs. 6.9%, p = 0.001), and minor bleeding (2.2% vs. 1.2%, p = 0.043) was significantly higher in women. After multivariable adjustment, cardiac death was lower in women for UAP/NSTEMI (HR 0.69, 95% CI 0.53–0.89, p = 0.005), while it was similar for STEMI (HR 0.97, 95% CI 0.65–1.44, p = 0.884). Conclusions: There was no sex difference in cardiac death after PCI with DES for SAP and UAP/NSTEMI patients. In STEMI patients, women had worse outcomes compared with men; however, after the adjustment of confounders, female sex was not an independent predictor of mortality

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Clinical Practice Guideline for Common Bile Duct Stones: Diagnosis and Treatment

Common bile duct (CBD) stone is a biliary disease with an increasing incidence in Korea. Many advances have been made in diagnosis and treatment according to the development of imaging equipment and various devices to diagnose and treat CBD stones. The Korean Society for Pancreatobiliary Association has developed clinical practice guidelines for the diagnosis and treatment of CBD stones to assist clinicians in their management. The guidelines were divided into three parts: evaluation of CBD stones, endoscopic management of CBD stones, and endoscopic management of difficult and recurrent CBD stones. The purpose of this review is to summarize and present the diagnosis and treatment guidelines for CBD stones established in Korea

Anastomotic stricture after liver transplantation: It is not Achilles’ heel anymore!

Biliary-tract complications, such as biliary strictures, anastomotic leaks, choledocholithiasis, and biliary casts, can occur after liver transplantation (LT). Of these complications, biliary strictures are regarded as an Achilles’ heel. Recently, treatment of anastomotic biliary stricture (ABS) has transitioned from conventional surgical revision to a nonsurgical treatment modality. Endoscopic serial balloon dilatation and/or multiple plastic stent replacements are highly effective and are now regarded as the first-line treatments. However, if the patient has undergone anastomosis by means of a hepaticojejunostomy, percutaneous treatment is performed. With recent technological advances and the rendezvous method, the clinical success rates of endoscopic and percutaneous ABS treatments have increased, but these methods fail in some patients who have total obstruction of anastomotic stricture. For these patients, magnetic compression anastomosis (MCA) has been suggested as an alternative method. Animal and human studies have demonstrated the safety and efficacy of MCA, and advancements in these nonsurgical methods have increased the clinical success rate of ABS. This review focuses on ABSs that develop after LT and discusses the clinical results of various nonsurgical methods and future directions