OBJECTIVE:We compared surgical resection (SR) and radiofrequency ablation (RFA) as first-line treatment in patients with hepatocellular carcinoma (HCC) based on the risk of microvascular invasion ...(MVI).
BACKGROUND:The best curative treatment modality between SR and RFA in patients with HCC with MVI remains unclear.
METHODS:Data from 2 academic cancer center-based cohorts of patients with a single, small (≤3 cm) HCC who underwent SR were used to derive (n = 276) and validate (n = 101) prediction models for MVI using clinical and imaging variables. The MVI prediction model was developed using multivariable logistic regression analysis and externally validated. Early recurrence (<2 years) based on risk stratification between SR (n = 276) and RFA (n = 240) was evaluated via propensity score matching.
RESULTS:In the multivariable analysis, alpha-fetoprotein (≥15 ng/mL), protein induced by vitamin K absence-II (≥48 mAU/mL), arterial peritumoral enhancement, and hepatobiliary peritumoral hypointensity on magnetic resonance imaging were associated with MVI. Incorporating these factors, the area under the receiver operating characteristic curve of the predictive model was 0.87 (95% confidence interval0.82–0.92) and 0.82 (95% confidence interval0.74–0.90) in the derivation and validation cohorts, respectively. SR was associated with a lower rate of early recurrence than RFA based on the risk of MVI after propensity score matching (P < 0.05).
CONCLUSIONS:Our model predicted the risk of MVI in patients with a small (≤ 3 cm) HCC with high accuracy. Patients with MVI who had undergone RFA were more vulnerable to recurrence than those who had undergone SR.
To evaluate the prognostic value of ultrasound and MRI findings in patients with infantile hemangioma undergoing propranolol therapy.
This study was based on retrospective interpretation of ...prospectively acquired data. Thirty-eight consecutive patients (28 females and 10 males; mean age ± standard deviation, 3.2 ± 2.2 months) who underwent propranolol treatment for infantile hemangioma were included. Pre-treatment ultrasound images were assessed in terms of echogenicity, lesion height and vascularity. Presence of prominent intratumoral fat, non-fat septa, and enhancement pattern on MRI were retrospectively evaluated. Mann-Whitney test, chi-square, and Fisher's exact tests were used to compare imaging parameters between patients with treatment success and failure.
All patients underwent ultrasound and 15 patients underwent MRI. A total of 24 patients showed successful treatment. Between patients with treatment success and failure, there were significant differences in increased vascularity on pre-treatment ultrasound (19/24 vs. 6/14, p = 0.025), decreased vascularity on post-treatment ultrasound (21/24 vs. 5/14, p = 0.001), and prominent intratumoral fat on MRI (1/8 vs. 5/7 p = 0.033). There were no significant differences in echogenicity, lesion height on ultrasound, non-fat septa and MR enhancement pattern.
Increased vascularity on pre-treatment ultrasound was significantly associated with successful treatment for propranolol therapy in patients with infantile hemangioma, whereas prominent fat component on MRI was significantly associated with treatment failure.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In this article, the interior permanent magnet synchronous motor (IPMSM) using ferrite permanent magnet (PM) for micro-electric vehicle (EV) traction is proposed. The characteristics of V-type IPMSM ...using Nd PM and a motor of the same shape using ferrite PM were analyzed when applied to micro-EV traction, cases of power dissatisfaction with ferrite PM motor were derived, and improvement methods were presented. Based on the improvement method, the rotor outer diameter, PM layer, and PM ratio are considered in the initial design. After the initial design, a two-stage optimization method is introduced to reduce the number of samples required. The first optimization is performed considering the power of the driving area, mechanical stiffness analysis during high-speed rotation, and low-temperature demagnetization analysis of ferrite PM. Then the second optimization is performed considering the main operating points (MOPs) of the efficiency perspective and the MOPs of the frequency perspective through micro-EV model. Based on the design results, the possibility of a motor for micro-EV using ferrite PM is suggested by comparing performance with the existing motor using Nd PM. Experiments are conducted on the manufactured motor, and the validity of the design results is verified by comparing the test results and FEA results.
The surface crossing of bound and unbound electronic states in multidimensional space often gives rise to resonances in the continuum. This situation happens in the πσ*-mediated photodissociation ...reaction of 2-fluorothioanisole; optically-bright bound S
(ππ*) vibrational states of 2-fluorothioanisole are strongly coupled to the optically-dark S
(πσ*) state, which is repulsive along the S-CH
elongation coordinate. It is revealed here that the reactive flux prepared at such resonances in the continuum bifurcates into two distinct reaction pathways with totally different dynamics in terms of energy disposal and nonadiabatic transition probability. This indicates that the reactive flux in the Franck-Condon region may either undergo nonadiabatic transition funneling through the conical intersection from the upper adiabat, or follow a low-lying adiabatic path, along which multiple dynamic saddle points may be located. Since 2-fluorothioanisole adopts a nonplanar geometry in the S
minimum energy, the quasi-degenerate S
/S
crossing seam in the nonplanar geometry, which lies well below the planar S
/S
conical intersection, is likely responsible for the efficient vibronic coupling, especially in the low S
internal energy region. As the excitation energy increases, bound-to-continuum coupling is facilitated with the aid of intramolecular vibrational redistribution, along many degrees of freedom spanning the large structural volume. This leads to the rapid domination of the continuum character of the reactive flux. This work reports direct and robust experimental observations of the nonadiabatic bifurcation dynamics of the reactive flux occurring at resonances in the continuum of polyatomic molecules.
Abstract
The authors evaluated the efficacy, safety, and characteristics of patients who respond well to standard dose triple combination therapy including chlorthalidone 25 mg with telmisartan 80 mg ...plus amlodipine 5 mg in hypertensive patients. This is a multicenter, double‐blind, active‐controlled, phase 3, randomized trial. Patients are randomized to triple combination (telmisartan 40 mg/amlodipine 5 mg/chlorthalidone 12.5 mg, TEL/AML/CHTD group) or dual combination (telmisartan 40 mg/amlodipine 5 mg, TEL/AML group) treatment and then dose up titration to TEL 80/AML5/CHTD25mg and TEL80/AML5, respectively. The primary endpoint is the change of mean sitting systolic blood pressure (MSSBP) at week 8. A Target BP achievement rate, a response rate, and the safety endpoints are also evaluated. Total 374 patients (mean age = 60.9 ± 10.7 years, male = 78.3%) were randomized to the study. The baseline MSSBPs/diastolic BPs were 149.9 ± 12.2/88.5 ± 10.4 mm Hg. After 8 weeks treatment, the change of MSSBPs at week 8 are −19.1 ± 14.9 mm Hg (TEL/AML/CHTD) and −11.4 ± 14.7 mm Hg (TEL/AML) (
p
< .0001). The achievement rates of target BP (53.8% vs. 37.8%,
p
= .0017) and responder rate (54.8% vs. 35.6%,
p
= .0001) at week 8 were significantly higher in TEL/AML/CHTD. There are no serious adverse event and no one discontinued medication due to adverse event. Among the TEL 80/AML5/CHTD25mg treatment group, patients of female or age ≥ 65 years old showed higher rate of target BP achievement than relatively young male. (61.4 vs. 46.8%,
p
= .042) Our study showed standard dose triple combination of telmisartan 80 mg/amlodipine 5 mg/chlorthalidone 25 mg is efficacious and safe in treatment of primary hypertension. Target BP achievement with triple therapy would be facilitated in female or old age.
Objectives
We evaluated the usefulness of a fractional flow reserve (FFR) gradient across the stent (ΔFFRstent) for long‐term clinical outcomes after percutaneous coronary intervention (PCI) with a ...drug‐eluting stent (DES).
Background
The clinical meaning of a trans‐stent pressure gradient after DES implantation has not been estimated adequately.
Methods
FFR pull‐back and intravascular ultrasound (IVUS) were performed after successful PCI in 135 left anterior descending artery lesions. ΔFFRstent was defined as the FFR gradient across the stent. The ΔFFRstent/length was defined as the ΔFFRstent value divided by the total stent length multiplied by 10. Major adverse cardiac events (MACEs) were the composite of all‐cause death, target vessel‐related myocardial infarction, and target lesion revascularization.
Results
Despite successful PCI, ΔFFRstent > 0 was observed in 98.5% of cases. ΔFFRstent ≥ 0.04 and ΔFFRstent/length ≥ 0.009 predicted suboptimal stenting defined as final minimal stent area < 5.5 mm2. During 2,183 ± 898 days, the MACE‐free survival rate was significantly lower in patients with ΔFFRstent ≥ 0.04 and ΔFFRstent/length ≥ 0.009 compared to those with lower values (69.6 vs. 93.4%, log‐rank p = .031; 72.1 vs. 97.7%, log‐rank p = .003, respectively). ΔFFRstent/length ≥ 0.009 (hazard ratio 10.1, p = .032) was an independent predictor of MACE.
Conclusion
A trans‐stent FFR gradient was frequently observed. ΔFFRstent and ΔFFRstent/length are related to long‐term outcomes in DES‐treated patients.
This article proposes a rapid and optimum design method that considers axial flux leakage for a coaxial magnetic gear (CMG). Conventional CMG optimum design methods perform two-dimensional (2D) ...finite element analysis (FEA) to evade the long computational time of three-dimensional (3D) FEA. However, conventional design methods do not consider axial flux leakage and are therefore less accurate than computationally exhaustive optimum design through 3D FEA. Therefore, as an alternative to reduce computational time, this article proposes a method that considers axial flux leakage for predicting the CMG performance combining correlation coefficients and 2D FEA instead of 3D FEA. The correlation coefficient is determined as the ratio of the square of the radial direction air gap flux in the equivalent magnetic circuit (EMC) that considers axial flux leakage to the square of the radial direction air gap flux in the EMC that does not consider axial flux leakage. The electromagnetic performance of the CMG predicted by the proposed method is used to develop a surrogate model for reducing computational time during the optimum design process. Based on the surrogate model, the optimum CMG design is analyzed to fabricate a prototype, and the proposed design process is validated through experiments.
While recent studies have explored the maintenance of the effect of meditation on stress resilience, the underlying neural mechanisms have not yet been investigated. The present study conducted a ...highly controlled residential study of a 4-day meditation intervention to investigate the brain functional changes and long-term effects of meditation on mindfulness and resilience. Thirty participants in meditation practice and 17 participants in a relaxation retreat (control group) underwent magnetic resonance imaging scans at baseline and post-intervention and completed the Cognitive and Affective Mindfulness Scale (CAMS) and Resilience Quotient Test (RQT) at baseline, post-intervention, and the 3-month follow-up. All participants showed increased CAMS and RQT scores post-intervention, but only the meditation group sustained the enhancement after 3 months. Resting-state functional connectivity (rsFC) between the left rostral anterior cingulate cortex (rACC) and the dorsomedial prefrontal cortex (dmPFC), precuneus, and angular gyrus was significantly increased post-intervention in the meditation group compared with the relaxation group. The changes in rACC-dmPFC rsFC mediated the relationship between the changes in the CAMS and RQT scores and correlated with the changes in the RQT score both immediately and at 3 months post-intervention. Our findings suggest that increased rACC-dmPFC rsFC
meditation causes an immediate enhancement in resilience that is sustained. Since resilience is known to be associated with the preventative effect of various psychiatric disorders, the improvement in stress-related neural mechanisms may be beneficial to individuals at high clinical risk.
Conformer Specific Excited-State Structure of 3-Methylthioanisole Lee, Heesung; Kim, So-Yeon; Lim, Jean Sun ...
The journal of physical chemistry. A, Molecules, spectroscopy, kinetics, environment, & general theory,
06/2020, Letnik:
124, Številka:
23
Journal Article
Recenzirano
and
conformers of 3-methylthioanisole have been spectroscopically investigated to reveal the conformer specific structural changes upon the S
(ππ*)-S
excitation. The conformational cooling during the ...supersonic expansion is found to be quite efficient in the Ar carrier gas giving the
conformational isomer exclusively in the molecular beam, whereas both
and
conformers are populated in the jet when the sample is carried in Ne. Using the Stark deflector,
and
conformers are unambiguously identified, showing the distinct Stark deflection profiles according to their sufficiently different dipole moments of 1.013 or 1.670 D, respectively. For the
conformer, the methyl moiety on the
-position adopting the eclipsed geometry in S
transforms into the staggered geometry in S
to activate a series of the CH
torsional mode. A Hamiltonian with the one-dimensional sinusoidal torsional potential is solved using the free-rotor basis set to explain the experiment, giving the 3-fold torsional barrier of 34 and 304 cm
for S
and S
, respectively. For the
conformer, on the other hand, the CH
torsion is little activated in the S
-S
transition as both S
and S
adopt the staggered geometry at the minimum energy points. The doublet of each band of the
conformer is ascribed to tunneling split due to the very low CH
torsional barrier of 27 cm
in S
. It is found that the
conformer undergoes a planar to pseudoplanar structural change upon the S
-S
transition. Theoretical calculation based on the double-well model potential curve could explain the experiment quite well, suggesting that the SCH
moiety of the
conformer in S
becomes out-of-plane with respect to the plane of the phenyl moiety. This implies that excited-state predissociation dynamics of
and
conformers of the title molecule might be different.
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