EUS-guided gastroenterostomy with a lumen apposing self-expandable metallic stent relieves gastric outlet obstruction - a Scandinavian case series

BACKGROUND

EUS-guided gastroenterostomy (EUS-GE) with lumen-apposing metallic stents (LAMS) in patients with gastric outlet obstruction (GOO) has proven to be an alternative to luminal stenting in the duodenum and surgical gastroenterostomy. In severely ill patients, the method can provide improved quality of life (QoL) and symptom relief by restoration of the luminal passage of fluid and nutrients to the small intestine.

AIM

To assess the technical and clinical success and safety of EUS-GE.

MATERIAL AND METHODS

A dual center retrospective case series of 33 consecutive patients with GOO due to malignant (n = 28) or non-malignant conditions (n = 5). The patients were treated with EUS-GE using cautery enhanced LAMS. Procedures were performed guided by EUS and fluoroscopy in general anesthesia or conscious sedation.

RESULTS

Technical success was achieved in all patients. The median procedure time was 71 min and the median hospital stay was three days. Thirty (91%) patients were able to resume oral nutrition after the procedure. Ten patients (30%) experienced adverse events (AEs), including migration of the stent, bleeding, and infection. Four patients had fatal AEs (12%). All stent-related AEs were handled endoscopically. Five patients (15%) needed re-intervention. The median survival time for patients with malignant obstruction was 8.5 weeks (0.5-76), and 13 patients with obstructing malignancies lived 12 weeks or longer.

CONCLUSION

EUS-GE is a minimally invasive and efficient method for restoration of the gastrointestinal passage and may improve palliative care for patients with GOO. The method has potential hazards and should only be offered in expert centers that regularly perform the procedure.

A compact electron beam ion trap in support of high-temperature plasma diagnostics based on conduction-cooled superconducting coils

Spectroscopic diagnostics of future fusion reactor plasmas require information on impurity line emissions, especially for relevant high-Z metal elements (e.g., tungsten). These materials will be widely used as plasma facing components for their high heat tolerance and low sputtering yield. Based on an electron beam ion trap, a compact impurity spectra platform is developed to mimic the high-temperature environment of a fusion reactor. The proposed platform can deliver a focused e-beam at energies over 30 keV using a confining magnetic field of ∼1.0 T generated by two superconducting coils (NbTi). Cooled by a closed-loop cryocooler, the coils can avoid the usage of a complicated cryogenic system involving the handling of liquid helium. For spectroscopic studies of highly charged ions, a spherically curved crystal spectrometer is proposed to measure a wavelength range around 2-4 Å covering the typical wavelength range expected to be emitted by metal ions in a fusion plasma. This paper reports the design and development progress of the platform.

Hybridized Radial and Edge Coupled 3D Plasmon Modes in Self-Assembled Graphene Nanocylinders

Current graphene-based plasmonic devices are restricted to 2D patterns defined on planar substrates; thus, they suffer from spatially limited 2D plasmon fields. Here, 3D graphene forming freestanding nanocylinders realized by a plasma-triggered self-assembly process are introduced. The graphene-based nanocylinders induce hybridized edge (in-plane) and radial (out-of-plane) coupled 3D plasmon modes stemming from their curvature, resulting in a four orders of magnitude stronger field at the openings of the cylinders than in rectangular 2D graphene ribbons. For the characterization of the 3D plasmon modes, synchrotron nanospectroscopy measurements are performed, which provides the evidence of preservation of the hybridized 3D graphene plasmons in the high precision curved nanocylinders. The distinct 3D modes introduced in this paper, provide an insight into geometry-dependent 3D coupled plasmon modes and their ability to achieve non-surface-limited (volumetric) field enhancements.

Electron Beam Maneuvering of a Single Polymer Layer for Reversible 3D Self-Assembly

Reversible self-assembly that allows materials to switch between structural configurations has triggered innovation in various applications, especially for reconfigurable devices and robotics. However, reversible motion with nanoscale controllability remains challenging. This paper introduces a reversible self-assembly using stress generated by electron irradiation triggered degradation (shrinkage) of a single polymer layer. The peak position of the absorbed energy along the depth of a polymer layer can be modified by tuning the electron energy; the peak absorption location controls the position of the shrinkage generating stress along the depth of the polymer layer. The stress gradient can shift between the top and bottom surface of the polymer by repeatedly tuning the irradiation location at the nanoscale and the electron beam voltage, resulting in reversible motion. This reversible self-assembly process paves the path for the innovation of small-scale machines and reconfigurable functional devices.

A novel boron ketoiminate-based conjugated polymer with large Stokes shift: AIEE feature and cell imaging application

A novel π-extended boron ketoiminate-based conjugated polymer with a typical AIEE feature has been successfully synthesized and used for cell imaging application.

Self-Assembled 3D Nanosplit Rings for Plasmon-Enhanced Optofluidic Sensing

Plasmonic sensors are commonly defined on two-dimensional (2D) surfaces with an enhanced electromagnetic field only near the surface, which requires precise positioning of the targeted molecules within hotspots. To address this challenge, we realize segmented nanocylinders that incorporate plasmonic (1-50 nm) gaps within three-dimensional (3D) nanostructures (nanocylinders) using electron irradiation triggered self-assembly. The 3D structures allow desired plasmonic patterns on their inner cylindrical walls forming the nanofluidic channels. The nanocylinders bridge nanoplasmonics and nanofluidics by achieving electromagnetic field enhancement and fluid confinement simultaneously. This hybrid system enables rapid diffusion of targeted species to the larger spatial hotspots in the 3D plasmonic structures, leading to enhanced interactions that contribute to a higher sensitivity. This concept has been demonstrated by characterizing an optical response of the 3D plasmonic nanostructures using surface-enhanced Raman spectroscopy (SERS), which shows enhancement over a 22 times higher intensity for hemoglobin fingerprints with nanocylinders compared to 2D nanostructures.

Electron Irradiation Driven Nanohands for Sequential Origami

Sequence plays an important role in self-assembly of 3D complex structures, particularly for those with overlap, intersection, and asymmetry. However, it remains challenging to program the sequence of self-assembly, resulting in geometric and topological constrains. In this work, a nanoscale, programmable, self-assembly technique is reported, which uses electron irradiation as "hands" to manipulate the motion of nanostructures with the desired order. By assigning each single assembly step in a particular order, localized motion can be selectively triggered with perfect timing, making a component accurately integrate into the complex 3D structure without disturbing other parts of the assembly process. The features of localized motion, real-time monitoring, and surface patterning open the possibility for the further innovation of nanomachines, nanoscale test platforms, and advanced optical devices.

Assessing adaptation measures on agricultural water productivity under climate change: A case study of Huai River Basin, China

This study explored an integrated framework to assess the effectiveness of adaptation measures on the water productivity (WP) of the agricultural water management (AWM) system in the Huai river basin of China considering climate change impact. The adaptation measures include optimization of cropping pattern (OCP) and upgradation of irrigation techniques (UIT). The delta change method was used to downscale the climate variables from RCP4.5 and RCP8.5 of general circulation models (GCMs) during 2021-2050, the water footprint theory was used to estimate the spatial distribution of blue water to calculate the WP, and the nonlinear optimization model was used to seek optimal cropping pattern aiming at maximizing the system's WP. The changes in WP due to climate change and adaptation measures (e.g. combinations of OCP and UIT) were compared. Results indicated that WP under RCP4.5 and RCP8.5 would be 4.56% and 6.51% lower than those under the benchmark scenario, respectively. The mitigation rates to the negative impact of climate change on WP under RCP4.5 and RCP8.5 would be (1) 3.05% and 3.37% for the combination of spay irrigation technique and OCP, and (2) 4.34% and 4.59% for the combination of drip irrigation technique and OCP, respectively. It was revealed that the combination of drip irrigation and cropping pattern optimization could largely offset the adverse effect from climate change on WP under RCP4.5. Under such a scenario, the total plant areas of wheat and maize would reduce over the basin and so would the net export of crops in the basin; this would lead to a decrease in the crop trade benefit of 7.07 × 10⁹ $ and a relief of 7.50 × 10⁹ m³ of blue water loss. This study results could offer strategic decision support for long-term sustainable AWM of Huai river basin in a changing environment.

An oriented built-in electric field induced by cobalt surface gradient diffused doping in MgIn2S4 for enhanced photocatalytic CH4 evolution

Co gradient doping in MgIn₂S₄ creates an oriented built-in electric field for efficiently extracting carriers from the inside to the surface.

Manipulating topological transformations of polar structures through real-time observation of the dynamic polarization evolution

Topological structures based on controllable ferroelectric or ferromagnetic domain configurations offer the opportunity to develop microelectronic devices such as high-density memories. Despite the increasing experimental and theoretical insights into various domain structures (such as polar spirals, polar wave, polar vortex) over the past decade, manipulating the topological transformations of polar structures and comprehensively understanding its underlying mechanism remains lacking. By conducting an in-situ non-contact bias technique, here we systematically investigate the real-time topological transformations of polar structures in PbTiO₃/SrTiO₃ multilayers at an atomic level. The procedure of vortex pair splitting and the transformation from polar vortex to polar wave and out-of-plane polarization are observed step by step. Furthermore, the redistribution of charge in various topological structures has been demonstrated under an external bias. This provides new insights for the symbiosis of polar and charge and offers an opportunity for a new generation of microelectronic devices.

Direct observation of the dynamic evolution of polar domain structures at atomic level remains challenging. Here, the authors report the observation of real-time topological transformations of polar structures in PbTiO₃/SrTiO₃ multilayers.

Optical creation of a supercrystal with three-dimensional nanoscale periodicity

Stimulation with ultrafast light pulses can realize and manipulate states of matter with emergent structural, electronic and magnetic phenomena. However, these non-equilibrium phases are often transient and the challenge is to stabilize them as persistent states. Here, we show that atomic-scale PbTiO₃/SrTiO₃ superlattices, counterpoising strain and polarization states in alternate layers, are converted by sub-picosecond optical pulses to a supercrystal phase. This phase persists indefinitely under ambient conditions, has not been created via equilibrium routes, and can be erased by heating. X-ray scattering and microscopy show this unusual phase consists of a coherent three-dimensional structure with polar, strain and charge-ordering periodicities of up to 30 nm. By adjusting only dielectric properties, the phase-field model describes this emergent phase as a photo-induced charge-stabilized supercrystal formed from a two-phase equilibrium state. Our results demonstrate opportunities for light-activated pathways to thermally inaccessible and emergent metastable states.

Intracellular manipulation and measurement with multipole magnetic tweezers

The capability to directly interrogate intracellular structures inside a single cell for measurement and manipulation is important for understanding subcellular and suborganelle activities, diagnosing diseases, and developing new therapeutic approaches. Compared with measurements of single cells, physical measurement and manipulation of subcellular structures and organelles remain underexplored. To improve intracellular physical measurement and manipulation, we have developed a multipole magnetic tweezers system for micromanipulation involving submicrometer position control and piconewton force control of a submicrometer magnetic bead inside a single cell for measurement in different locations (spatial) and different time points (temporal). The bead was three-dimensionally positioned in the cell using a generalized predictive controller that addresses the control challenge caused by the low bandwidth of visual feedback from high-resolution confocal imaging. The average positioning error was quantified to be 0.4 μm, slightly larger than the Brownian motion–imposed constraint (0.31 μm). The system is also capable of applying a force up to 60 pN with a resolution of 4 pN for a period of time longer than 30 min. The measurement results revealed that significantly higher stiffness exists in the nucleus’ major axis than in the minor axis. This stiffness polarity is likely attributed to the aligned actin filament. We also showed that the nucleus stiffens upon the application of an intracellularly applied force, which can be attributed to the response of structural protein lamin A/C and the intracellular stress fiber actin filaments.

Nano-Architecture Driven Plasmonic Field Enhancement in 3D Graphene Structures

The limited spatial coverage of the plasmon enhanced near-field in 2D graphene ribbons presents a major hurdle in practical applications. In this study, diverse self-assembled 3D graphene architectures are explored that induce hybridized plasmon modes by simultaneous in-plane and out-of-plane coupling to overcome the limited coverage in 2D ribbons. While 2D graphene can only demonstrate in-plane, bidirectional coupling through the edges, 3D architectures benefit from fully symmetric 360° coupling at the apex of pyramidal graphene, orthogonal four-directional coupling in cubic graphene, and uniform cross-sectional radial coupling in tubular graphene. The 3D coupled vertices, edges, surfaces, and volume induce corresponding enhancement modes that are highly dependent on the shape and dimensions comprising the 3D geometries. The hybridized modes introduced through the 3D coupling amplify the limited plasmon response in 2D ribbons to deliver nondiffusion limited sensors, high efficiency fuel cells, and extreme propagation length optical interconnects.

Ion-Induced Localized Nanoscale Polymer Reflow for Three-Dimensional Self-Assembly

Thermal reflow of polymers is a well-established phenomenon that has been used in various microfabrication processes. However, present techniques have critical limitations in controlling the various attributes of polymer reflow, such as the position and extent of reflow, especially at the nanoscale. These challenges primarily result from the reflow heat source supplying heat energy to the entire substrate rather than a specific area. In this work, a focused ion beam (FIB) microscope is used to achieve controllable localized heat generation, leading to precise control over the nanoscale polymer reflow. Through the use of the patterning capability of FIB microscopy, dramatically different reflow performances within nanoscale distances of each other are demonstrated in both discrete periodic and continuous polymer structures. Further, we utilize a self-assembly process induced by nanoscale polymer reflow to realize 3D optical devices, specifically, vertically aligned nanoresonators and graphene-based nanocubes. HFSS and Comsol simulations have been carried out to analyze the advantages of the polymer-based 3D metamaterials as opposed to those fabricated with a metallic hinge. The simulation results clearly demonstrate that the polymer hinges have a dual advantage; first, the removal of any interference from the transmission spectrum leading to strong and distinct resonance peaks and, second, the elimination of parasitic leeching of the enhanced field by the metallic hinge resulting in stronger volumetric enhancement. Thus, the 2-fold advantages existing in 3D polymer-hinge optical metamaterials can open pathways for applications in 3D optoelectronic devices and sensors, vibrational molecular spectroscopy, and other nanoscale 3D plasmonic devices.

Fabrication of Three-Dimensional Graphene-Based Polyhedrons via Origami-Like Self-Folding

The assembly of two-dimensional (2D) graphene into three-dimensional (3D) polyhedral structures while preserving the graphene's excellent inherent properties has been of great interest for the development of novel device applications. Here, fabrication of 3D, microscale, hollow polyhedrons (cubes) consisting of a few layers of 2D graphene or graphene oxide sheets via an origami-like self-folding process is described. This method involves the use of polymer frames and hinges, and aluminum oxide/chromium protection layers that reduce tensile, spatial, and surface tension stresses on the graphene-based membranes when the 2D nets are transformed into 3D cubes. The process offers control of the size and shape of the structures as well as parallel production. In addition, this approach allows the creation of surface modifications by metal patterning on each face of the 3D cubes. Raman spectroscopy studies show the method allows the preservation of the intrinsic properties of the graphene-based membranes, demonstrating the robustness of our method.

Dibenzothiophene-S,S-Dioxide-Based Conjugated Polymers: Highly Efficient Photocatalyts for Hydrogen Production from Water under Visible Light

Three dibenzothiophene-S,S-dioxide-based alternating copolymers were synthesized by facile Suzuki polymerization for visible light-responsive hydrogen production from water (> 420 nm). Without addition of any cocatalyst, FluPh2-SO showed a photocatalytic efficiency of 3.48 mmol h^-1 g-¹ , while a larger hydrogen evolution rate (HER) of 4.74 mmol h^-1 g^-1 was achieved for Py-SO, which was ascribed to the improved coplanarity of the polymer that facilitated both intermolecular packing and charge transport. To minimize the possible steric hindrance of FluPh2-SO by replacing 9,9'-diphenylfluorene with fluorene, Flu-SO exhibited a more red-shifted absorption than FluPh2-SO and yielded the highest HER of 5.04 mmol h^-1 g^-1 . This work highlights the potential of dibenzothiophene-S,S-dioxide as a versatile building block and the rational design strategy for achieving high photocatalytic efficiency.

Advanced Continuous Flow Platform for On-Demand Pharmaceutical Manufacturing

As a demonstration of an alternative to the challenges faced with batch pharmaceutical manufacturing including the large production footprint and lengthy time-scale, we previously reported a refrigerator-sized continuous flow system for the on-demand production of essential medicines. Building on this technology, herein we report a second-generation, reconfigurable and 25 % smaller (by volume) continuous flow pharmaceutical manufacturing platform featuring advances in reaction and purification equipment. Consisting of two compact [0.7 (L)×0.5 (D)×1.3 m (H)] stand-alone units for synthesis and purification/formulation processes, the capabilities of this automated system are demonstrated with the synthesis of nicardipine hydrochloride and the production of concentrated liquid doses of ciprofloxacin hydrochloride, neostigmine methylsulfate and rufinamide that meet US Pharmacopeia standards.

Enabling shape memory and healable effects in a conjugated polymer by incorporating siloxane via dynamic imine bond

A copolymer of poly(fluorene-co-benzothiadiazole) and poly(dimethylsiloxane) was synthesized via dynamic imine bonds, which showed shape memory, healable and degradable effects.