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Fulltext Evaluation of Interfacial Fracture Toughness and Interfacial Shear Strength of Typha Spp. Fiber/Polymer Composite by Double Shear Test Method

Ikramullah, Rizal S, Nakai Y, Shiozawa D, Khalil HPSA, Huzni S, et al.

Materials (Basel), 2019 Jul 10;12(14).
PMID: 31295885 DOI: 10.3390/ma12142225

The aim of this paper is to evaluate the Mode II interfacial fracture toughness and interfacial shear strength of Typha spp. fiber/PLLA and Typha spp. fiber/epoxy composite by using a double shear stress method with 3 fibers model composite. The surface condition of the fiber and crack propagation at the interface between the fiber and the matrix are observed by scanning electron microscope (SEM). Alkali treatment on Typha spp. fiber can make the fiber surface coarser, thus increasing the value of interfacial fracture toughness and interfacial shear strength. Typha spp. fiber/epoxy has a higher interfacial fracture value than that of Typha spp. fiber/PLLA. Interfacial fracture toughness on Typha spp. fiber/PLLA and Typha spp. fiber/epoxy composite model specimens were influenced by the matrix length, fiber spacing, fiber diameter and bonding area. Furthermore, the interfacial fracture toughness and the interfacial fracture shear stress of the composite model increased with the increasing duration of the surface treatment.
Fulltext Expert Consensus on the Management of Brain Arteriovenous Malformations

Kato Y, Dong VH, Chaddad F, Takizawa K, Izumo T, Fukuda H, et al.

Asian J Neurosurg, 2019 11 25;14(4):1074-1081.
PMID: 31903343 DOI: 10.4103/ajns.AJNS_234_19

Brain arteriovenous malformations (bAVMs) are complex, heterogeneous, and uncommon intracranial lesions. They can be treated by one or a combination of the following treatment modalities, namely embolization, radiosurgery, or microsurgical resection. In Spetzler-Martin Grade 4 and 5 arteriovenous malformations (AVMs), conservative management may be the best option. A group of experts in the management of AVMs of different disciplines gathered in January 2019 in Hanoi to compile the "Expert Consensus on the Management of Brain Arteriovenous Malformations".
Asian consensus statements on endoscopic management of walled-off necrosis. Part 2: Endoscopic management

Isayama H, Nakai Y, Rerknimitr R, Khor C, Lau J, Wang HP, et al.

J Gastroenterol Hepatol, 2016 Sep;31(9):1555-65.
PMID: 27042957 DOI: 10.1111/jgh.13398

Walled-off necrosis (WON) is a new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high-quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 27 experts from eight Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 2 of this statement focused on the endoscopic management of WON.
The Asian consensus statements on endoscopic management of walled-off necrosis Part1: Epidemiology, diagnosis and treatment

Isayama H, Nakai Y, Rerknimitr R, Khor C, Lau J, Wang HP, et al.

J Gastroenterol Hepatol, 2016 Apr 4.
PMID: 27044023 DOI: 10.1111/jgh.13394

Walled-off necrosis (WON) is a relatively new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high-quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 25 experts from 8 Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 1 of this statement focused on the epidemiology, diagnosis and timing of intervention.
Fulltext Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture

Angsuwatcharakon P, Kulpatcharapong S, Moon JH, Ramchandani M, Lau J, Isayama H, et al.

HPB (Oxford), 2022 Jan;24(1):17-29.
PMID: 34172378 DOI: 10.1016/j.hpb.2021.05.005

BACKGROUND: Indeterminate strictures pose a therapeutic dilemma. In recent years, cholangioscopy has evolved and the availability of cholangioscopy has increased. However, the position of cholangioscopy in the diagnostic algorithm to diagnose malignancy have not been well established. We aim to develop a consensus statement regarding the clinical role of cholangioscopy in the diagnosis of indeterminate biliary strictures.
METHODS: The international experts reviewed the evidence and modified the statements using a three-step modified Delphi method. Each statement achieves consensus when it has at least 80% agreement.
RESULTS: Nine final statements were formulated. An indeterminate biliary stricture is defined as that of uncertain etiology under imaging or tissue diagnosis. When available, cholangioscopic assessment and guided biopsy during the first round of ERCP may reduce the need to perform multiple procedures. Cholangioscopy are helpful in diagnosing malignant biliary strictures by both direct visualization and targeted biopsy. The absence of disease progression for at least 6 months is supportive of non-malignant etiology. Direct per-oral cholangioscopy provides the largest accessory channel, better image definition, with image enhancement but is technically demanding. Image enhancement during cholangioscopy may increase the diagnostic sensitivity of visual impression of malignant biliary strictures. Cholangioscopic imaging characteristics including tumor vessels, papillary projection, nodular or polypoid mass, and infiltrative lesions are highly suggestive for neoplastic/malignant biliary disease. The risk of cholangioscopy related cholangitis is higher than in standard ERCP, necessitating prophylactic antibiotics and ensuring adequate biliary drainage. Per-oral cholangioscopy may not be the modality of choice in the evaluation of distal biliary strictures due to inherent technical difficulties.
CONCLUSION: Evidence supports that cholangioscopy has an adjunct role to abdominal imaging and ERCP tissue acquisition in order to evaluate and diagnose indeterminate biliary strictures.