To analyze our initial results of hand-assisted laparoscopic living donor nephrectomy, executed by a skilled gastrointestinal surgeon.
A total of 22 consecutive patients underwent the hand-assisted ...laparoscopic living donor nephrectomy between December 2014 and January 2017. We retrospectively analyze the patient's perioperative clinical data, which were collected prospectively.
The right kidney was harvested in 12 patients. The mean operative time and intraoperative blood loss was 241.0 ± 43.4 minutes (range, 140–310 min) and 293.2 ± 203.1 mL (range, 50–700 mL), respectively. The mean warm ischemic time was 288.4 ± 103.4 seconds (range, 179–610 s). Postoperative complications included chyle leakage in 2 patients who were left kidney donors and oliguria in 1 patient who was a right kidney donor. All patients recovered with conservative care, and the mean hospital stay was 7.5 ± 1.7 days. The mean creatinine level was 0.7 ± 0.2 mg/dL before surgery, 1.1 ± 0.3 mg/dL at postoperative day (POD) 1, and 1.0 ± 0.2 mg/dL after discharge. The mean glomerular filtration rate was 97.9 ± 18.2 mL/min/1.73 m2 before surgery, 60.7 ± 10.4 at POD 1, and 67.3 ± 11.1 after discharge. Operation time was not associated with patient body mass index and case number. No significant differences, other than postoperative complications, were found in the perioperative data for the side of kidney donation.
A skilled surgeon with experience in laparoscopic abdominal surgery (such as gastrectomy or colectomy) might safely perform hand-assisted donor nephrectomy. However, we could not identify a clear case number to complete the learning curve.
•Left donor nephrectomy requires longer operation time than the right side: 247.7 ± 28.1 minutes vs 235.8 ± 53.7 minutes.•The mean blood loss was 293.2 ± 203.1 mL, and the mean warm ischemic time was 288.4 ± 103.4 seconds.•There are 3 morbidities (1 oliguria and 2 chyle leakages) in 22 total cases.•There was no correlation between operation time and body mass index.•After 10 cases of donor nephrectomy, operation time and warm ischemic time were decreased significantly.
When an electronic system has strong correlations and a large spin-orbit interaction, it often exhibits a plethora of mutually competing quantum phases. How a particular quantum ground state is ...selected out of several possibilities is a very interesting question. However, equally fascinating is how such a quantum entangled state breaks up due to perturbation. This important question has relevance in very diverse fields of science from strongly correlated electron physics to quantum information. Here we report that a quantum entangled dimerized state or valence bond crystal (VBC) phase of Li2RuO3 shows nontrivial doping dependence as we perturb the Ru honeycomb lattice by replacing Ru with Li. Through extensive experimental studies, we demonstrate that the VBC phase melts into a valence bond liquid phase of the RVB (resonating valence bond) type. This system offers an interesting playground where one can test and refine our current understanding of the quantum competing phases in a single compound.
Aim To investigate the dark choledochal ring sign on T2-weighted imaging (T2WI) as an indicator for pancreatic ductal adenocarcinoma (PDAC) among periampullary carcinomas. Materials and methods Sixty ...patients with surgically confirmed periampullary cancers 30 PDACs, 15 distal common bile duct (CBD) cancers, 13 ampullary cancers, and two duodenal cancers who underwent liver magnetic resonance imaging (MRI) were included in this study. Two reviewers independently evaluated unenhanced and gadoxetic acid-enhanced MRI (T1WI image set), and a combined T2WI and T1WI image set for differentiation between PDAC and other periampullary carcinomas using a rating scale, and the presence of the dark choledochal ring sign on T2WI, for all 60 tumours. Results In PDAC, the dark choledochal ring sign on T2WI was considered positive in 23 cases by observer 1 and 24 cases by observer 2, but only in one or two CBD cancers, as determined by each observer, respectively. This resulted in sensitivities of 76.7% and 80% and specificities of 96.7% and 93.3% for observer 1 and 2, respectively, in the diagnosis of PDAC. Adding T2WI correctly led to a change of diagnosis in three and four cases of PDAC by each observer, respectively. Thus, there were significant differences between the two image sets for both observers in distinguishing between PDAC and other periampullary carcinomas ( p = 0.02). Conclusion The presence of the dark choledochal ring sign on axial T2WI could be a complementary imaging feature indicative of PDAC to differentiate PDAC from other periampullary carcinomas at MRI.
The geochemistry of sediment samples from Korean and Chinese rivers provides source indicators enabling these river materials to be identified within the sediment load of the Yellow Sea. Elements ...enriched in Chinese river sediments relative to those in Korean rivers include Ca, Na, Sr, and Cu. Korean river sediments have higher Al, K, Ba, and Li concentrations, but extremely low Ca concentrations. Direct comparisons of these elemental concentrations in Yellow Sea sediments become difficult due to grain-size effects and the presence of biogenic materials and pollutants that produce significant variation in the data. The concentrations of Fe, Mg, Ti, V, and Co with respect to Al are distinctly different in both groups of river sediments and the correlations of these elements with Al display different linear regression trends for both groups of river sediments indicating differences in composition. These differences, especially in Fe and Mg, provide a basis for discriminating sediment sources of the Yellow Sea. Further, the grain-size normalization, using these two liner regression lines, enables the source areas to be differentiated more clearly in the Yellow and East China Seas.
The purpose of this study was to evaluate the change in sagittal tibiotalar alignment after total ankle arthroplasty (TAA) for osteoarthritis and to investigate factors affecting the restoration of ...alignment. This retrospective study included 119 patients (120 ankles) who underwent three component TAA using the Hintegra prosthesis. A total of 63 ankles had anterior displacement of the talus before surgery (group A), 49 had alignment in the normal range (group B), and eight had posterior displacement of the talus (group C). Ankles in group A were further sub-divided into those in whom normal alignment was restored following TAA (41 ankles) and those with persistent displacement (22 ankles). Radiographic and clinical results were assessed. Pre-operatively, the alignment in group A was significantly more varus than that in group B, and the posterior slope of the tibial plafond was greater (p < 0.01 in both cases). The posterior slope of the tibial component was strongly associated with restoration of alignment: ankles in which the alignment was restored had significantly less posterior slope (p < 0.001). An anteriorly translated talus was restored to a normal position after TAA in most patients. We suggest that surgeons performing TAA using the Hintegra prosthesis should aim to insert the tibial component at close to 90° relative to the axis of the tibia, hence reducing posterior soft-tissue tension and allowing restoration of normal tibiotalar alignment following surgery.
Aim To assess the value of fusion imaging of real-time ultrasonography (US) with liver computed tomography (CT)/magnetic resonance imaging (MRI) images for planning US of radiofrequency ablation ...(RFA) in improving conspicuity of the lesions and reducing false-positive detection of local tumour progression (LTP) found after transcatheter arterial chemoembolization (TACE) or RFA of hepatocellular carcinoma (HCC). Materials and methods This study was approved by the institutional review board and informed consent was waived. Fifty patients with LTP (mean ± SD, 1.5 ± 0.6 cm; range 0.5–3 cm) detected at follow-up CT or MRI were included. Planning US was performed by two radiologists using conventional US first and fusion imaging later in the same session. False-positive detection rates were assessed using conventional US based on the results of fusion imaging. The number cases of initially invisible tumours on conventional US that became visible after image fusion were also evaluated. The true-positive detection rate and conspicuity scores of the index tumours were compared between conventional US and fusion imaging. Results On conventional US, 40 (80%) out of 50 HCCs with LTP were identified. However, the false-positive detection rate of conventional US was 12.5% (5/40). Out of 10 initially invisible HCCs with LTP on conventional US, six (60%) became visible after image fusion. The true-positive detection rate on conventional US was 70% (35/50), whereas it was increased to 92% (46/50) after image fusion ( p = 0.0026). Conclusion Fusion imaging can improve the conspicuity of lesions and reduce the false-positive detection of LTP after TACE or RFA.
Curative-intent therapies for hepatocellular carcinoma (HCC) include radiofrequency ablation (RFA), liver resection (LR), and liver transplantation (LT). Controversy exists in treatment selection for ...early-stage tumours. We sought to evaluate the oncologic outcomes of patients who received either RFA, LR, or LT as first-line treatment for solitary HCC ≤ 3 cm in an intention-to-treat analysis.
All patients with solitary HCC ≤ 3 cm who underwent RFA, LR, or were listed for LT between Feb-2000 and Nov-2018 were analyzed. Cox regression analysis was then performed to compare intention-to-treat (ITT) survival by initial treatment allocation and disease-free survival (DFS) by treatment received in patients eligible for all three treatments.
A total of 119 patients were identified (RFA n = 83; LR n = 25; LT n = 11). The overall intention-to-treat survival was similar between the three groups. The overall DFS was highest for the LT group. This was significantly higher than RFA (p = 0.02), but not statistically significantly different from LR (p = 0.14). After multivariable adjustment, ITT survival was similar in the LR and LT groups relative to RFA (LR HR:1.13, 95%CI 0.33–3.82; p = 0.80; LT HR:1.39, 95%CI 0.35–5.44; p = 0.60). On multivariable DFS analysis, only LT was better relative to RFA (LR HR:0.52, 95%CI 0.26–1.02; p = 0.06; LT HR:0.15, 95%CI 0.03–0.67; p = 0.01). Compared to LR, LT was associated with a numerically lower hazard on multivariable DFS analysis, though this did not reach statistical significance (HR 0.30, 95%CI 0.06–1.43; p = 0.13)
For treatment-naïve patients with solitary HCC ≤ 3 cm who are eligible for RFA, LR, and LT, adjusted ITT survival is equivalent amongst the treatment modalities, however, DFS is better with LR and LT, compared with RFA. Differences in recurrence between treatment modalities and equipoise in ITT survival provides support for a future prospective trial in this setting.
•Ablation, resection, and transplantation can cure hepatocellular carcinoma (HCC).•For patients with solitary HCC≤3 cm controversy exists in treatment selection.•Ablation, resection, and transplantation have similar intention-to-treat survival.•The disease-free survival is better with liver resection and liver transplantation.
Objective: to compare the clinical efficacy of complex therapy, including a combination of a nonsteroidal anti-inflammatory drug (NSAID) with a muscle relaxant and B vitamins in acute musculoskeletal ...back pain (MSBP).Patients and methods. We enrolled 66 patients with acute MSBP, 27 men and 39 women, mean age – 52.8 29.4; 68.8 years. All patients had different pain localization: 36 (54.5%) – lumbodynia, 22 (33.3%) – cervicodynia, 8 (12.2%) – thoracodynia. Visual analog scale (VAS) was used to assess pain intensity. Patients in the 1st group (n=32) were prescribed with complex therapy, including Russian drugs meloxicam (Amelotex 15 mg per day), tolperison (Kalmirex), and a neurotropic multivitamin supplement Compligam B. Patients in the 2nd group (n=34) received a combination of only two of the three drugs. We assessed pain intensity with VAS, disability duration, and treatment effectiveness from the doctor's and patient's perspectives. Results and discussion. After 5 days of treatment, pain regression was noted in both groups; pain reduction by 50% or more from the initial level prevailed in 1st group (p=0.03). A rapid NSAID dose decrease prevailed in the 1st group; from the 5th to the 10th day, all patients switched to the 7.5 mg meloxicam dose. The duration of temporary disability in the 1st group was less than 7 days, in the 2nd group – 9 days (p<0.05). Complex therapy in group 1 was more effective than therapy in group 2, according to doctors and patients (p<0.05). Conclusion. The combination of NSAID with a muscle relaxant and B vitamins can reduce the duration and the incidence of adverse drug reactions of NSAID therapy, and reduce the duration of temporary disability.
Pentacene organic thin-film transistors (OTFTs) have demonstrated the highest performance among TFTs with an organic semiconductor channel. High operating voltages (20-100 V), stemming from poor ...capacitive coupling between gate electrode and channel, are a major limitation, particularly for portable battery-powered device applications. OTFTs fabricated on flexible polymer substrates, often characterized by rough surfaces, benefit from the use of high-K dielectrics given the ability to accommodate thicker films which ensure the pinhole-free and good coverage without need to increase operating voltage. As we demonstrate, pyrochlore structured thin films can provide the requisite high dielectric constant coupled with excellent leakage current characteristics, while remaining compatible with the processing requirements of flexible OTFTs. The introduction of an extremely thin parylene film between the BZN dielectric and the pentacene semiconductor markedly shifts the threshold voltage, making it possible to fabricate both enhancement (E) and depletion (D) TFTs. We report the successful fabrication of low-voltage (<2 V) organic transistors and depletion-load inverter using a 200-nm-thick pyrochlore gate dielectric, Bi/sub 1.5/Zn/sub 1.0/Nb/sub 1.5/O/sub 7/ (BZN), prepared by a room temperature process. The inverters with depletion load were successfully operated under 5 V with excellent noise margin.
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