This study aimed to assess the severity of appendicitis during the coronavirus disease 2019 (COVID-19) pandemic, as patients with appendicitis may procrastinate seeking medical attention during the ...pandemic.
Information on patients with appendicitis who were treated at the Taipei City Hospital during the COVID-19 pandemic (January 1, 2020 to June 30, 2020) was retrieved. Patients who were diagnosed with appendicitis and treated at the same hospital from January 1, 2019 to July 1, 2019 were designated as the control group. Multivariate logistic regression analysis was conducted to assess changes in the severity of appendicitis (at a 2-week interval) between the two groups.
We identified 307 (study group: 149; control group: 158) consecutive patients with appendicitis. The mean age was 46.2 +- 19.8 years. Between the two groups, there were no significant differences in age, sex, comorbidity, surgery type (laparoscopic or open appendectomy) or surgery time. The number of patients in the study group decreased between January 29, 2020 and April 21, 2020, which paralleled the period of spikes in the confirmed COVID-19 cases and restricted daily activities. The percentage of uncomplicated and complicated appendicitis (excluding mild appendicitis or normal appendix) in the study group increased between February 26 and March 10, as well as between April 8 and April 21. In the multivariate regression analysis, the odds of uncomplicated and complicated appendicitis increased in three bi-weeks for the study group but not in the control group.
The severity of acute appendicitis might increase during the COVID-19 pandemic, because patients with mild appendicitis (or abdominal pain) may hesitate to seek help.
For a finite/infinite family of closed convex sets with nonempty intersection in Hilbert space, we consider the (bounded) linear regularity property and the linear convergence property of the ...projection-based methods for solving the convex feasibility problem. Several sufficient conditions are provided to ensure the bounded linear regularity in terms of the interior-point conditions and some finite codimension assumptions. A unified projection method, called Algorithm B-EMOPP, for solving the convex feasibility problem is proposed, and by using the bounded linear regularity, the linear convergence results for this method are established under a new control strategy introduced here.
This study compared the prognostic significance of staging between the American Joint Committee on Cancer 8th edition Tumor, Node, Metastasis (TNM) staging system and the Barcelona Clinic Liver ...Cancer (BCLC) classification in patients with hepatocellular carcinoma (HCC). The study population comprised patients with liver cancer registered in the Taiwan Cancer Database from 2007 to 2013 and was followed up until December 31, 2016. The study included patients with HCC, with known staging in both TNM and BCLC systems, and with follow‐up >1 month. Primary endpoint was overall survival. Univariate and multivariate Cox proportional hazards model were constructed to investigate the significance of staging by two systems. Goodness‐of‐fit of model was evaluated via Akaike's information criterion (AIC), the lower the better. Among 73,136 patients with newly diagnosed liver cancer, a total of 37,062 patients with HCC (25.6% underwent surgery) were eligible. The mean age and overall survival of this cohort were 63.9 years and 27.2%, respectively. Overall survivals for stages I, II, III, and IV (the TNM system) were 54.5%, 34.9%, 10.3%, and 6.4%, respectively. Overall survivals for stages A, B, C, and D (the BCLC classification) were 54.5%, 29.2%, 9.8%, and 4.0%, respectively. The median follow‐up time was 59.4 months. Multivariate Cox proportional hazards model revealed that both systems predicted overall survival, cancer‐specific survival, disease‐free survival, and local recurrence‐free rate well. Values of ΔAIC of the BCLC classification and the TNM system were lower for the surgery group and nonsurgery group, respectively. The TNM system (8th edition) predicted long‐term outcome better than the BCLC classification in patients with HCC. But in patients treated initially with surgery, the BCLC classification outperformed the 8th edition of the TNM system.
Implications for Practice
This work demonstrates that the Tumor, Node, Metastasis (TNM) system (8th edition) and the Barcelona Clinic Liver Cancer (BCLC) classification both predict long‐term outcome significantly in patients with hepatocellular carcinoma but that the TNM system (8th edition) predicts long‐term outcome better than the BCLC classification. For patients treated initially with surgery, BCLC classification outperforms in 8th edition TNM system in predicting long‐term outcome.
This article compares long‐term outcome predictability between two frequently used staging systems, the American Joint Commission on Cancer (AJCC) 8th edition TNM staging system and the Barcelona Clinic Liver Cancer (BCLC) staging classification, in patients with hepatocellular carcinoma.
A hierarchical microstructure strengthened high entropy superalloy (HESA) with superior cost specific yield strength from room temperature up to 1,023 K is presented. By phase transformation pathway ...through metastability, HESA possesses a hierarchical microstructure containing a dispersion of nano size disordered FCC particles inside ordered L1
precipitates that are within the FCC matrix. The average tensile yield strength of HESA from room temperature to 1,023 K could be 120 MPa higher than that of advanced single crystal superalloy, while HESA could still exhibit an elongation greater than 20%. Furthermore, the cost specific yield strength of HESA can be 8 times that of some superalloys. A template for lighter, stronger, cheaper, and more ductile high temperature alloy is proposed.
In this paper, we investigate the radius of robust feasibility of system of uncertain convex inequalities by the Minkowski function. We firstly establish an upper bound and a lower bound for radius ...of robust feasibility of the system of uncertain convex inequalities. Exact formulas of radius of robust feasibility of the system are derived under the nonsymmetric and symmetric assumptions of the uncertain sets. We also obtain a characterization on the positiveness of radius of robust feasibility for the system. Lastly, explicit tractable formulas for computing the radius of robust feasibility of the system are presented when the uncertain sets are ellipsoids, polytopes, boxes and unit ball, respectively.
The present study systematically analyzed and evaluated the variations in chemical speciation, pollution assessment, and source identification of heavy metals in sediments of Huangpu River. The ...methods employed included heavy metal concentration, chemical speciation and Cu isotopic compositions analysis. Results showed that the chemical speciation of sediment-bound heavy metals, characterized by significant seasonal variation, shifted from non-residual fractions dominating in spring and summer to residual fractions dominating in autumn and winter. Precipitation was identified as an important factor influencing the chemical speciation of sediment-bound heavy metals. Furthermore, ratio of the secondary phase to the primary phase, RSP (=Cnon-residual/Cresidual) values in Huangpu River sediments were higher than 1 in spring and summer, indicating that sediment-bound heavy metals in Huangpu River were mainly composed of non-residual fractions and could potentially be released into the river water. Principal component analysis (PCA) revealed that navigation, traffic, agricultural, and industrial activities could be the potential sources of heavy metal pollution. Notably, the δ65Cu values in Huangpu River sediments were observed to be isotopically lighter (from −0.37 to +0.18 ‰), suggesting that navigation might be the primary pollution source. These results will not only provide guidance in reducing heavy metal concentrations, but also serve as a crucial basis for policy making regarding heavy metal control.
•Seasonal heavy metal speciation and δ65Cu in Huangpu River sediment were studied.•Speciation of sediment heavy metals varied evidently in different seasons.•Sediment heavy metals were non-residual fractions dominating in spring and summer.•Precipitation plays a key role in chemical speciation of heavy metals.•δ65Cu showed that navigation might be the main source of Cu in Huangpu River.
We applied Simmons-Balluffi methods, positron measurements, and neutron diffraction to estimate the vacancy of CoCrFeNi and CoCrFeMnNi high-entropy alloys (HEAs) using Cu as a benchmark. The ...corresponding formation enthalpies and associated entropies of the HEAs and Cu were calculated. The vacancy-dependent effective free volumes in both CoCrFeNi and CoCrFeMnNi alloys are greater than those in Cu, implying the easier formation of vacancies by lattice structure relaxation of HEAs at elevated temperatures. Spatially resolved synchrotron X-ray measurements revealed different characteristics of CoCrFeNi and CoCrFeMnNi HEAs subjected to quasi-equilibrium conditions at high temperatures. Element-dependent behavior revealed by X-ray fluorescence (XRF) mapping indicates the effect of Mn on the Cantor Alloy.
We examined fatigue-crack-growth behaviors of CoCrFeMnNi high-entropy alloys (HEAs) under as-fatigued and tensile-overloaded conditions using neutron-diffraction measurements coupled with diffraction ...peak-profile analyses. We applied both high-resolution transmission electron microscopy (HRTEM) and neutron-diffraction strain mapping for the complementary microstructure examinations. Immediately after a single tensile overload, the crack-growth-retardation period was obtained by enhancing the fatigue resistance, as compared to the as-fatigued condition. The combined mechanisms of the overload-induced larger plastic deformation, the enlarged compressive residual stresses and plastic-zone size, the crack-tip blunting ahead of the crack tip, and deformation twinning governed the pronounced macroscopic crack-growth-retardation behavior following the tensile overload. A remarkable fracture surface of highly-periodic serrated features along the crack-propagation direction was found in the crack-growth region immediately after the tensile overload. Moreover, a transition of plastic deformation from planar dislocation slip-dominated to twinning-dominated microstructures in the extended plastic zone was clearly observed at room temperature in the overloaded condition, in accordance with the simulated results by a finite element method (FEM). The above tensile overload-induced simultaneously combined effects in the coarse-grained CoCrFeMnNi shed light on the improvement of fatigue resistance for HEAs applications.
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In this paper, we propose an alternated inertial general splitting method with linearization for a split feasibility problem. Four rules of inertial parameters and relaxation parameters are ...discussed, where the adaptive inertial parameters are firstly investigated. The convergence of the proposed method is established under standard conditions. The numerical examples are presented to test four choices of the parameters and illustrate the advantage of our methods. An application in signal processing is presented to illustrate the recovery of the proposed algorithm for the sparse signal.
Background
Combined hepatocellular‐cholangiocarcinoma (HCC‐CC) is an aggressive primary liver cancer. However, the clinical features are not clearly understood because of limited literature and the ...complex nature of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).
Methods
The records of 100,754 patients with newly diagnosed liver cancer between 2004 and 2013 were obtained from the Taiwan Cancer Registry. The primary outcome measures were overall survival and local recurrence‐free survival. The median follow‐up time was 60 months (29–120 months).
Results
HCC‐CC tended to share some characteristics with HCC, including increased frequency of stage I cases, high individual tumor rates, and similar patterns of viral hepatitis B and hepatitis C infections. In contrast, HCC‐CC showed malignant behavior similar to that of CC, as high‐grade tumor cell differentiation and presentation of jaundice were predominant in HCC‐CC and CC compared with HCC. Overall survival and local recurrence‐free survival rates of HCC‐CC were between HCC and CC rates. The mortality rate of HCC‐CC was 79.2% (HCC, 77.5%; CC, 93.5%) and the local recurrence rate of HCC‐CC was 65.3% (HCC, 74.6%; CC, 88.4%). Surgical treatment was an independent factor for the long‐term prognosis of HCC‐CC, whereas transarterial chemoembolization (TAcE) promoted survival in both surgical and nonsurgical groups.
Conclusion
Our data confirmed that, although it reflects the malignant behavior of CC, HCC‐CC should mainly be characterized as a subtype of HCC. With careful selection of patients, curative resection and TAcE might benefit the survival of patients with HCC‐CC.
Implications for Practice
Combined hepatocellular‐cholangiocarcinoma (HCC‐CC) is a rare cancer that shares demographic characteristics, as well as survival probabilities, with both hepatocellular carcinoma and cholangiocarcinoma. It occurs frequently in patients with hepatitis B virus infection, cirrhotic liver background, and early‐stage disease. Compared with 20% of initial resection rates of its counterparts, HCC‐CC has higher initial resection rate (55%). Although short‐term overall survival is inferior to HCC, its long‐term overall survival is similar with HCC.
This article analyzes population‐based data of a study that aimed to determine the clinical prognosis of and to address the lack of comprehensive information on combined hepatocellular‐cholangiocarcinoma.
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