Current design codes specify the effective compressive strength of a column-slab connection when columns and slabs have different concrete compressive strengths. However, this approach assumes that ...no gravity load is applied to the slab. The gravity loads acting on the slab weakens the confinement of the slab-column connection and reduces the effective compressive strength of the column. Therefore, the effective compressive strength of the column specified in the current design code can be considered unsafe when gravity loads act on the slab, similar to the case of an actual structure. In this paper, the existing studies on slab-column connection, in which the gravity loads act on the slab, were comprehensively reviewed, and an effective compressive strength of the column based on the strain in the top slab reinforcement was proposed. In addition, three slab-column connections were fabricated, where the gravity loads acting on the slab and constraint condition of the slab were set as test variables, and axial load tests were conducted.
•This study proposed the effective compressive strengths of columns with slab loads.•Axial load tests with slab loads were conducted.•The proposed model provided good estimation of the effective column strength.•This study proposed a simplified model, and its accuracy was verified.
Objectives:
This study aimed to compare the characteristics of idiopathic unilateral vocal fold paralysis (IUVFP) in elderly versus younger patients, including the diagnostic yield of computed ...tomography (CT) scans for identifying the structural causes of IUVFP.
Methods:
We retrospectively analyzed medical records of the patients initially diagnosed with IUVFP in a single referral tertiary hospital. We compared patients’ baseline characteristics, initial symptoms, laryngoscopic findings, and prevalence of structural causes on CT scans with respect to age (younger, <65 years vs older, ⩾65 years).
Results:
One hundred forty-two patients were enrolled (90 younger, 52 older). Evident structural causes were more frequently found on CT in older patients than younger patients (40.4% vs 22.2%, P = .034). Among truly idiopathic cases (70 younger, 31 older), recovered vocal fold mobility was identified in 48.6% younger and 41.9% older patients (P = .666). There was no statistically significant difference in the characteristics between unrecovered and recovered subjects of the older patients with true IUVFP (all P > .05).
Conclusions:
The CT scans provided significantly higher diagnostic yields in older patients than younger patients. The degrees of symptoms and complications and likelihood of natural recovery did not significantly differ between younger and older patients with IUVFP.
Background/Aims: While switching strategies of P2Y12 receptor inhibitors (RIs) have sometimes been used in acute myocardial infarction (AMI) patients, the current status of in-hospital P2Y12RI ...switching remains unknown.
Methods: Overall, 8,476 AMI patients who underwent successful revascularization from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) were divided according to in-hospital P2Y12RI strategies, and net adverse cardiovascular events (NACEs), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), stroke, or thrombolysis in myocardial infarction (TIMI) major bleeding during hospitalization were compared.
Results: Patients with in-hospital P2Y12RI switching accounted for 16.5%, of which 867 patients were switched from clopidogrel to potent P2Y12RI (C-P) and 532 patients from potent P2Y12RI to clopidogrel (P-C). There were no differences in NACEs among the unchanged clopidogrel, the unchanged potent P2Y12RIs, and the P2Y12RI switching groups. However, compared to the unchanged clopidogrel group, the C-P group had a higher incidence of non-fatal MI, and the P-C group had a higher incidence of TIMI major bleeding. In clinical events of in-hospital P2Y12RI switching, 90.9% of non-fatal MI occurred during pre-switching clopidogrel administration, 60.7% of TIMI major bleeding was related to pre-switching P2Y12RIs, and 71.4% of TIMI major bleeding was related to potent P2Y12RIs. Only 21.6% of the P2Y12RI switching group switched to P2Y12RIs after a loading dose (LD); however, there were no differences in clinical events between patients with and without LD.
Conclusions: In-hospital P2Y12RI switching occurred occasionally, but had relatively similar clinical outcomes compared to unchanged P2Y12RIs in Korean AMI patients. Non-fatal MI and bleeding appeared to be mainly related to pre-switching P2Y12RIs.
Sporadic Creutzfeldt-Jakob disease (CJD) is clinically characterized by rapidly progressive dementia combined with other cardinal symptoms, such as myoclonus, visual or cerebellar disturbances, ...extrapyramidal or pyramidal disturbance, and akinetic mutism. However, as an initial manifestation, focal neurologic deficits other than the aforementioned or nonspecific generalized symptoms may lead to a misdiagnosis or a delayed diagnosis. The authors report a case of 66-year-old male patient with sporadic CJD who had dizziness, gaze-evoked nystagmus (GEN), and other central eye signs (impaired smooth pursuit, saccadic dysmetria) as an initial manifestation without dementia. The central eye signs led us to perform brain magnetic resonance images, which showed abnormal cortical high-signal intensity in both the cerebral and cerebellar hemispheres including the vestibulocerebellum. We reached a presumptive diagnosis of CJD, but the findings did not meet diagnostic criteria for probable CJD at that time. Three weeks after the initial work-ups, the patient presented with typical neurological findings of CJD: rapidly progressive dementia, akinetic mutism, and myoclonus of the left arm. Cerebrospinal fluid was positive for 14-3-3 protein, and electroencephalography showed periodic sharp wave complexes. In this patient, GEN and other central eye signs provided diagnostic clues for CJD. These unusual neurological manifestations may help physicians have a thorough knowledge of early deficits of CJD.
Purpose Quality of life (QOL) scores in cancer patients are associated with disease course and treatment outcomes. The aim of this study was to prospectively evaluate the associations between ...pretreatment QOL scores and survival or functional outcomes in patients with head and neck squamous cell carcinoma (HNSCC). Methods This prospective study enrolled a total of 141 patients with previously untreated HNSCC who underwent curative treatments from October 2010 to March 2012. Patients completed questionnaires on QOL including the European Organization of Research and Treatment of Cancer 30-item Core QOL questionnaire (EORTC QLQ-C30) and EORTC QOL questionnaire Head and Neck Cancer module (QLQ-H&N35). Univariate and multivariate analyses were used to identify QOL scores significantly associated with overall survival (OS), disease-free survival (DFS), and functional outcomes of gastrostomy or tracheostomy dependence. Results The 2-year OS and DFS rates were 82.3 and 78.0 %, respectively. The rates of gastrostomy and tracheostomy dependence were 9.2 and 14.9 %, respectively. After controlling for clinical factors, specific QOL indices of 'dyspnea' (hazard ratio 1.023 95 % confidence interval 1.006-1.039) and 'appetite loss' (1.020 1.005-1.034) were significantly associated with OS, while 'insomnia' (1.013 1.002-1.025) and 'appetite loss' (1.014 1.001-1.026) scores were significantly predictive of DFS (P < 0.05). Global health status score (0.967 0.935-1.000) and fatigue (1.048 1.010-1.086) were significantly associated with the dependence of tracheostomy (P < 0.05). There was no relationship between gastrostomy dependence and QOL indices. Conclusion This study provides evidence of significant relationships between certain pretreatment QOL measures and survival or functional outcomes in HNSCC patients.
Background
Currently, high-speed digital imaging (HSDI), especially endoscopic HSDI, is routinely used for the diagnosis of vocal cord disorders. However, endoscopic HSDI devices are usually large ...and costly, which limits access to patients in underdeveloped countries and in regions with inadequate medical infrastructure. Modern smartphones have sufficient functionality to process the complex calculations that are required for processing high-resolution images and videos with a high frame rate. Recently, several attempts have been made to integrate medical endoscopes with smartphones to make them more accessible to people in underdeveloped countries.
Objective
This study aims to develop a smartphone adaptor for endoscopes, which enables smartphone-based vocal cord imaging, to demonstrate the feasibility of performing high-speed vocal cord imaging via the high-speed imaging functions of a high-performance smartphone camera, and to determine the acceptability of the smartphone-based high-speed vocal cord imaging system for clinical applications in developing countries.
Methods
A customized smartphone adaptor optical relay was designed for clinical endoscopy using selective laser melting–based 3D printing. A standard laryngoscope was attached to the smartphone adaptor to acquire high-speed vocal cord endoscopic images. Only existing basic functions of the smartphone camera were used for HSDI of the vocal cords. Extracted still frames were observed for qualitative glottal volume and shape. For image processing, segmented glottal and vocal cord areas were calculated from whole HSDI frames to characterize the amplitude of the vibrations on each side of the glottis, including the frequency, edge length, glottal areas, base cord, and lateral phase differences over the acquisition time. The device was incorporated into a preclinical videokymography diagnosis routine to compare functionality.
Results
Smartphone-based HSDI with the smartphone-endoscope adaptor could achieve 940 frames per second and a resolution of 1280 by 720 frames, which corresponds to the detection of 3 to 8 frames per vocal cycle at double the spatial resolution of existing devices. The device was used to image the vocal cords of 4 volunteers: 1 healthy individual and 3 patients with vocal cord paralysis, chronic laryngitis, or vocal cord polyps. The resultant image stacks were sufficient for most diagnostic purposes. The cost of the device including the smartphone was lower than that of existing HSDI devices. The image processing and analytics demonstrated the successful calculation of relevant diagnostic variables from the acquired images. Patients with vocal pathologies were easily differentiable in the quantitative data.
Conclusions
A smartphone-based HSDI endoscope system can function as a point-of-care clinical diagnostic device. The resulting analysis is of higher quality than that accessible by videostroboscopy and promises comparable quality and greater accessibility than HSDI. In particular, this system is suitable for use as an accessible diagnostic tool in underdeveloped areas with inadequate medical service infrastructure.
Purpose
Cancer incidence in the elderly population has been continuously rising, and their treatment is an increasing concern among oncologists. This study aimed to evaluate the incidence and risk ...factors for morbidity and mortality after major oncological surgery in elderly patients with head and neck squamous cell carcinoma (HNSCC).
Methods
The 196 HNSCC patients aged 55 and older who underwent major curative surgery. Patients were categorized into three groups: far-old (≥75 years;
n
= 41); old (65–74 years;
n
= 72); or middle-aged (55–64 years;
n
= 83). The rates of early and late postoperative complications, hospital stays, and mortality were compared among groups. Univariate and multivariate analyses were performed to identify the factors associated with early postoperative complications.
Results
No study patients had mortality during surgery or within 3-month postoperation. Karnofsky performance status, frail functional status, comorbidity, and index cancer and noncancer mortality were the poorest in the far-old group. The far-old group demonstrated significantly higher rates of early overall complications, readmission within 1 month, and recurrence rates (
P
< 0.05 each). Multivariate analysis showed that age, postoperative hemoglobin, and C-reactive protein are independent predictors of early postoperative complications (
P
< 0.05 each).
Conclusions
In elderly patients, chronological age affects the increased risk of early postoperative morbidity and later mortality following major HNSCC surgery. In combination with these risk factors, older patients who are diagnosed with HNSCC should be carefully monitored in order to determine the potential occurrence of postsurgical complications.
Objectives/Hypothesis
Visualization of the vocal folds is essential when reaching a primary diagnosis of laryngeal disease. However, the examination is subjective and highly dependent on the ...experience of the treating physician. The present study is the development of objective tools for the diagnosis of laryngeal malignancy based on laryngeal texture analysis.
Study Design
Texture analysis using gray‐level co‐occurrence matrix (GLCM) in vocal fold images of 198 patients.
Methods
Vocal‐fold images were subjected to texture analysis using gray‐level co‐occurrence matrix (GLCM)‐based parameters, which were computed by a novel digital image‐processing program. Patients were divided into two groups: those with benign‐looking lesions and those with malignant‐looking lesions. Textural irregularities were compared using GLCM‐based parameters. The relationship between the texture‐analysis parameters and the diagnosis was then statistically evaluated.
Results
Texture irregularity was negatively correlated with energy and the inverse difference moment (IDM) and positively correlated with entropy, variance, contrast, dissimilarity, and mean values. All of the GLCM‐based parameters evaluated differed significantly according to the degree of differentiation of the benign‐ or malignant‐looking lesion (P < 0.001). Entropy had a sensitivity of 82.9% and a specificity of 82.2% at a cutoff value of 5.94; for variance, the sensitivity was 82.9% and the specificity was 84.5% at a cutoff value of 167.
Conclusion
GLCM‐based texture analysis of vocal‐fold lesions, especially in association with a differential diagnosis of benign and malignant‐looking diseases, contributes to achieving an objective image‐based analysis of vocal‐fold lesions. In addition, this approach can be used to create algorithms permitting a reproducible classification of laryngeal pathologies.
Level of Evidence
NA. Laryngoscope, 123:E45–E50, 2013
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