This is a case of an 85-year-old female patient who presented with a 1-week history of nausea, intermittent bilious vomiting and anorexia. Imaging confirmed the diagnosis of Bouveret syndrome caused by two large gallstones. Conventional endoscopic methods successfully extracted the impacted stones from the duodenum into the stomach but were unable to extract the stones from the stomach. A mini-transverse laparotomy and gastrotomy were performed to finally extract the stones.

Sterilized hollow-fiber membranes are used in hemodialysis, ultrafiltration, bioprocessing, and tissue engineering applications that require a stable and biocompatible surface. In this study, we demonstrated significant changes in the fiber physicochemical properties with different methods of sterilization. Commercial polysulfone (PS) hollow fibers containing poly(vinyl pyrrolidone) were subjected to standard ethylene oxide (ETO), sodium hypochlorite (bleach), and electron-beam (e-beam) sterilization techniques followed by analysis of the surface hydrophilicity, morphology, and water-retention ability. E-beam sterilization rendered more hydrophilic fibers with water contact angles near 47 compared to the ETO-and bleachtreated fibers, which were each near 56. Atomic force microscopy revealed lumen root mean square (rms) roughness values near 19 nm for all three sterilization methods;however, e-beam-sterilized and bleach-treated fibers had significantly higher ($ 106 nm) rms values for the outer wall compared to the ETO-sterilized fibers ($ 39 nm). The increased hydrophilicity and surface area of the e-beamsterilized fiber were reflected by a greater water evaporation rate than that of the ETO-treated fiber. These results demonstrate that common sterilization methods may significantly and distinctly alter the polymer membrane physicochemical properties, which may, in turn, impact the performance and, in particular, surface fouling. For tissue engineering and bioprocessing applications, these changes may be leveraged to promote cell adhesion and spreading.

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