Purpose
Occult inguinal hernias (IH) predispose peritoneal dialysis (PD) patients to the symptomatic IH formation after starting PD, which may cause complications. We conducted a retrospective study ...to assess the benefit/risk profile of routine laparoscopic examination for occult IH (RLEOH) with a synchronous repair in patients receiving PD catheter placement.
Methods
432 patients were enrolled in this study. Patients with an internal hernia sac at all sizes were deemed to have occult IH. We retrospectively reviewed data including demographic characteristics and operative details. We also measured incidence rates of symptomatic IH, metachronous IH repair, and catheter survival over a follow-up period after starting PD.
Results
These patients were classified into the RLEOH group (
n
= 365) and the non-RLEOH group (
n
= 67). The RLEOH group was subdivided into occult IH with a synchronous repair (
n
= 17; the subgroup A), no occult IH (
n
= 339; the subgroup B), and occult IH without a synchronous repair (
n
= 9; the subgroup C). The incidence rates of symptomatic IH developed after staring PD in subgroups A, B, and C were 0, 5.6, and 22.2%, respectively, whereas that in the non-RLEOH group was 13.4%. The RLEOH group had a reduced hazard ratio for metachronous IH repair compared with the non-RLEOH group (HR = 0.426; 95% CI 0.195–0.930,
p
= 0.032). None of our patients suffered from herniorrhaphy-related complications.
Conclusion
RLEOH with a synchronous repair during PD catheter insertion confers clinical benefits in reducing the risk of developing IH after starting PD and the need for a metachronous repair. This is a safe and reasonable approach.
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► The deformation behavior of new near β titanium alloy Ti-7333 has been studied. ► The constitutive equations are constructed and activation energies are calculated. ► The Ti-7333 ...alloy exhibits weaker deformation resistance than Ti-5553 and Ti-1023. ► The processing map of Ti-7333 alloy has been generated and analyzed. ► DRV, globularization, DRX and flow localization are the deformation mechanisms.
The hot deformation behavior of Ti-7333 titanium alloy in the temperature range of 770–970°C and strain rate range of 10−3-10 s−1 has been investigated by hot compressive testing on the Gleeble-3800 thermal and mechanical simulator. The results show that the maximum stress decreases with decreasing strain rate and increasing temperature. The flow curves characteristic under different deformation parameters show obvious different. And discontinuous yielding occurs to the alloy at a higher strain rate for all the experimental temperatures. The flow behaviors are described by the hyperbolic sine constitutive equation and the hot deformation activation energies in (α+β) and β region are calculated as 333.74kJ/mol and 213.83kJ/mol, respectively. By comparing with similar alloys such as Ti-5553 and Ti-1023, the new near β titanium alloy Ti-7333 exhibits weaker deformation resistance. Based on the dynamic materials model, the processing map is generated, which shows that there are three domains of peak efficiency. The highest peak efficiency of power dissipation of 65% occurs at about 855°C/0.001s−1. Dynamic recovery and dynamic recrystallization occur during hot compression deformation and the degree of dynamic recrystallization is dependent sensitively on deformation temperature and strain rate. In the instability regimes, the material exhibits flow instabilities manifested in the form of flow localizations.
A new near β titanium alloy Ti–7Mo–3Nb–3Cr–3Al (Ti-7333) with ultrahigh tensile strength and reasonable ductility after subtransus solution followed by aging treatment has been developed in China. ...The fracture toughness tests were carried out on the material at room temperature in order to understand the fracture mechanism. The results show that Ti-7333 alloy has a high fracture toughness value (>140MPa·m1/2) under the β solution followed by slow cooling, and then aging heat treatment process. Meanwhile, the elongation and reduction of area remain at about 19% and 45% respectively, and its corresponding tensile strength maintains at about 1000MPa. The microstructure observation and analyses show that the intragranular α phase laths and grain boundary α become coarser roughly with the increasing of aging temperature, whereas, the continuity of grain boundary α is subjected to change and turned to zigzag. The coarser and longer intragranular α and more multidirectional arrangement of the colony of α lamellae, as well as discontinuous α precipitates on the grain boundary lead to a more tortuous crack propagation path and higher fracture toughness. In addition, the bigger the size of the plastic zone of the crack tip is, the higher fracture toughness it has. Compare with other similar alloys (Ti-5553, Ti-1023, VT22, etc.), Ti-7333 exhibits higher fracture toughness and close tensile strength. That indicates that Ti-7333 alloy has excellent combinations of mechanical properties and giant competitiveness.
The fracture surface of Ti-7333 alloy under different aging treatments: (a) 520°C, (b) 540°C, (c) 600°C, and (d) 650°C. Display omitted
•The fracture mechanism of a new near β titanium alloy Ti-7333 has been investigated.•The mechanical tests and SEM/TEM microstructure observation are corporately employed.•The crack propagation path and plastic zone of the crack tip are the essential factors.•Ti-7333 alloy exhibits higher fracture toughness than Ti-5553, Ti-1023, VT22, etc.
Unlike hospitals or the community, nursing homes provide a unique healthcare environment for patients. There have been no reports regarding methicillin-resistant Staphylococcus aureus (MRSA) carriage ...among nursing home residents and staff in Taiwan. From May to November 2012, a total of 523 subjects, including 360 residents and 163 staff, in 14 nursing homes in Taiwan were surveyed for nasal MRSA carriage. Overall, the nasal MRSA carriage rate was 20.1%, with 20.3% for residents and 19.6% for staff. For residents, age >60 years (adjusted OR 2.268; 95% CI 1.185–4.342; p 0.013) and the presence of chronic wounds (adjusted OR 2.449; 95% CI 1.082–5.544; p 0.032) were the significant risk factors for MRSA carriage in multivariate models. Among the 105 MRSA isolates, 11 pulsed-field gel electrophoresis (PFGE) patterns were identified, except for five isolates untypeable by SmaI digestion, with one major pattern; nine isolates (8.6%) possessed staphylococcal cassette chromosome (SCCmec) type II or III, 66 isolates type IV or V, and 21 isolates unidentified types. The clone characterized as PFGE pattern BM sequence type 45 was the most common clone, accounting for 50% of the isolates, and was multiresistant, including to ciprofloxacin. Intra-institutional and inter-institutional transmission of MRSA was documented by molecular methods. It was shown conclusively that one-fifth of residents and staff in nursing homes in Taiwan harboured MRSA, mostly ST45 strains, in their nares. Intra-institutional and inter-institutional transmission of MRSA was documented.
Cytosine methylation is responsive to various biotic- and abiotic-stresses, which may produce heritable epialleles. Nitrogen (N)-deficiency is an abiotic stress being repeatedly experienced by ...plants. To address possible epigenetic consequences of N-deficiency-stress, we investigated the stability of cytosine methylation in rice (
Oryza sativa L.) subsequent to a chronic (a whole-generation) N-deficiency at two levels, moderate (20
mg/L) and severe (10
mg/L), under hydroponic culture. MSAP analysis revealed that locus-specific methylation alteration occurred in leaf-tissue of the stressed plants (S
0) experiencing either level of N-deficiency, which was validated by gel-blotting. Analysis on three non-stressed self-fed progenies (S
1, S
2 and S
3) by gel-blotting indicated that
ca. 50% of the altered methylation patterns in somatic cells (leaf) of the stressed S
0 plants were recaptured in S
1, which were then stably inherited to S
2 and S
3. Bisulfite sequencing of two variant MSAP loci with homology to low-copy retrotransposons on one stressed plant (S
0) and its non-stressed progenies (S
1 and S
2) showed that whereas one locus exhibited limited and non-heritable CHH methylation alteration, the other locus manifested dramatic heritable hypermethylation at nearly all cytosine sites within the assayed region. Intriguingly, when two groups of S
2 plants descended from the same N-deficiency-stressed S
0 plant were re-subjected to the stress, the group inheriting the modified methylation patterns showed enhanced tolerance to the N-deficiency-stress compared with the group bearing the original patterns. Our results thus demonstrate heritability of an acquired adaptive trait in rice, which was accompanied by epigenetic inheritance of modified cytosine methylation patterns, implicating an epigenetic basis underlying the inheritance of an acquired trait in plants.
Accretionary orogens contain key evidence for the conversion of oceanic to continental crust. The late tectonic history and closure time of the Palaeo-Asian Ocean are recorded in the Mazongshan ...subduction–accretion complex in the southern Beishan margin of the Central Asian Orogenic Belt. We present new data on the structure, petrology, geochemistry and zircon U–Pb isotope ages of the Mazongshan subduction–accretion complex, which is a tectonic mélange with a block-in-matrix structure. The blocks are of serpentinized peridotite, basalt, gabbro, basaltic andesite, chert and seamount sediments within a matrix that is mainly composed of fore-arc-trench turbidites. U–Pb zircon ages of two gabbros are 454.6 ± 2.5 Ma and 434.1 ± 3.6 Ma, an andesite has a U–Pb zircon age of 451.3 ± 3.5 Ma and a tuffaceous slate has the youngest U–Pb zircon age of 353.6 ± 5.1 Ma. These new isotopic ages, combined with published data on ophiolitic mélanges from central Beishan, indicate that the subduction–accretion of Beishan in the southernmost Central Asian Orogenic Belt lasted until Late Ordovician – Early Carboniferous time. Structure and age data demonstrate that the younging direction of accretion was southwards and that the subduction zone dipped continuously to the north. Accordingly, these results record the conversion of oceanic to continental crust in the southern Beishan accretionary collage.
To analyse the computed tomography (CT) and magnetic resonance imaging (MRI) features of malignant thymic germ cell tumours (GCTs), in order to improve the accuracy of diagnosis of these tumours.
...Twenty-two patients (20 men, two women; age, 28 ± 8.64 years) with malignant thymic GCTs confirmed at histopathology were enrolled retrospectively, and their CT and MRI findings were analysed.
According to the CT findings, malignant thymic GCTs usually manifest as a bulky mass that typically grows to both sides of the midline (20/22, 90.9%), with irregular shape (15/22, 68.2%), lobulation (12/22, 50%), ill-defined margin (9/22, 40.9%), and incomplete capsule (21/22, 95.5%). Twenty masses revealed heterogeneous density with multifocal necrosis or cystic change in 19 (86.4%). Most cases (16/18, 88.9%) showed mild to moderate enhancement, and the branch-like vessel was found in 14 (14/18, 77.8%) cases. The minimum apparent diffusion coefficient (ADCmin) and mean apparent diffusion coefficient (ADCmean) values in 14 patients were (1.13 ± 0.45) and (1.37 ± 0.49) × 10−3 mm2/s, respectively. Compared with CT findings, the incidences of an incomplete capsule, heterogeneous signal, and necrotic or cystic change on MRI images occurred in all patients with malignant thymic GCT. In addition, peritumoural oedema was found in all 14 (100%) cases.
MRI is superior to CT in showing incomplete capsule, peritumoural oedema, heterogeneous signal, and necrotic or cystic change of GCTs. Branch-like enhancement and multifocal necrosis may help the diagnosis of malignant thymic GCTs.
•Branch-like vessels are valuable in diagnosis of malignant thymic germ cell tumor.•The vast majority of malignant thymic germ cell tumor occur in males.•MRI is superior to CT in evaluating malignant thymic germ cell tumor.
Transmission Electron Microscope (TEM) and Electron Backscattered Diffraction (EBSD) are employed to explore the influence of deformation conditions on microstructure and the deformation mechanism of ...a new near β titanium alloy Ti-7333 after hot compression tests which at temperatures ranging from 770 to 970°C and strain rates ranging from 0.001 to 10s−1. The results showed that the effect of deformation parameters on microstructure evolution is significantly. Both increasing the temperature and decreasing the strain rate seem to promote the dynamic recrystallization process. The mechanism is dominated by dynamic recovery, globularization and dynamic recrystallization. The globularization trend of α phase is more remarkable deformed at higher temperature and lower strain rate. And reverse, the lower temperature and higher strain rate are more favorable to α phase refinement. The fraction of low-angle grain boundaries in the deformation microstructure decreases with the increasing of temperature and decreasing of strain rate. It illustrates the low-angle grain boundaries would turn to high-angle grain boundaries during deformation. The expression of the size of recrystallized grains Dr and parameter Z is obtained by regression analysis as lnDr=8.79964−0.33663lnZ. All the deformed samples present strong 〈001〉 and weak 〈111〉 fiber texture. With the increasing of temperature and decreasing of strain rate, the 〈001〉 texture strengthens gradually and 〈111〉 texture weakens gradually until extinction.
The microstructure and compressive properties of AlCoCrCuFeNi high-entropy alloy aged at temperatures ranging from 500 to 1000
°C were investigated. The BCC and FCC phase structures remain unchanged ...after aging the AlCoCrCuFeNi alloy at temperatures below 645
°C. Aging the alloy at elevated temperature causes the structure gradually to transform from stabilized BCC to FCC. Also, as the aging temperature increases, the yield strength of the material decreases but plastic strain increases. When the alloy was aged at 1000
°C, the plastic strain even reaches 27%.
We measured a set of π±Σ∓, π0Σ0, and π−Σ0 invariant mass spectra below and above the K¯N mass threshold in K−-induced reactions on deuteron. The measured πΣ mass spectral shape is well reproduced via ...the two-step mechanism, i.e., a neutron knocked out at a forward angle from a deuteron by an incident K−, with the K¯ recoiled backward reacting with the residual nucleon to produce π and Σ. We deduced the S-wave K¯N→πΣ and K¯N→K¯N scattering amplitudes in the isospin 0 channel in the framework of a K¯N and πΣ coupled channel. We find that a resonance pole corresponding to Λ(1405) is located at 1417.7−7.4+6.0 (fitting errors)−1.0+1.1 (systematic errors) + −26.1−7.9+6.0 (fitting errors)−2.0+1.7 (systematic errors) i MeV/c2, closer to the K¯N mass threshold than the value determined by the Particle Data Group.
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