To compare radiofrequency (RF) ablation with nonanatomic resection (NAR) as first-line treatment in patients with a single Barcelona Clinic Liver Cancer (BCLC) stage 0 or A hepatocellular carcinoma ...(HCC) and to evaluate the long-term outcomes of both therapies.
This retrospective study was approved by the institutional review board. The requirement for informed consent was waived. Data were reviewed from 580 patients with HCCs measuring 3 cm or smaller (BCLC stage 0 or A) who underwent ultrasonographically (US) guided percutaneous RF ablation (n = 438) or NAR (n = 142) as a first-line treatment. Local tumor progression, intrahepatic distant recurrence, disease-free survival, and overall survival rates were analyzed by using propensity score matching to compare therapeutic efficacy. In addition, major complications and length of postoperative hospital stay were compared.
Before propensity score matching (n = 580), the 5-year cumulative rates of local tumor progression for RF ablation and NAR (20.9% vs 12.7%, respectively; P = .093) and overall survival rates (85.5% vs 90.9%, respectively; P = .194) were comparable, while the 5-year cumulative intrahepatic distant recurrence rates (62.7% vs 36.6%, respectively; P < .001) and disease-free survival rates (31.7% vs 61.1%, respectively; P < .001) in the NAR group were significantly better than those in the RF ablation group. After matching (n = 198), there were no significant differences in therapeutic outcomes between the RF ablation and NAR groups, including 5-year cumulative intrahepatic distant recurrence (47.0% vs 40.2%, respectively; P = .240) and disease-free survival rates (48.9% vs 54.4%, respectively; P = .201). RF ablation was superior to NAR for major complication rates and length of postoperative hospital stay (P < .001).
In patients with one BCLC stage 0 or A (≤ 3 cm) HCC who received RF ablation or NAR as first-line treatment, there were no significant differences in long-term therapeutic outcomes; however, RF ablation was associated with fewer major complications and a shorter hospital stay after treatment.
The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip ...fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries.
Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method.
A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost.
This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.
This study aimed to determine whether side branch (SB) wire jailing before main vessel (MV) stenting could prevent SB occlusion after the 1-stent strategy for bifurcation percutaneous coronary ...intervention.
The benefits of SB wire jailing in the 1-stent strategy remain unclear.
From the COBIS (Coronary Bifurcation Stenting) III registry, 1,890 patients with bifurcation lesions who underwent the 1-stent strategy using second-generation drug-eluting stents were identified and classified into 2 groups according to the use of SB wire jailing: wire jailing (n = 819) and non–wire jailing (n = 1,071). The incidence of SB occlusion (Thrombolysis In Myocardial Infarction flow grade <3) and target lesion failure (cardiac death, myocardial infarction, or target lesion revascularization) was compared.
The incidence of final SB occlusion was not significantly different between wire jailing (1.8%) vs non–wire jailing (2.9%; P = 0.182). However, wire jailing at the SB was a significant protective factor for SB occlusion after MV stenting on multivariate analysis and was significantly associated with a lower incidence of SB occlusion in patients with significant stenoses (≥60%) at the SB (5.1% vs 11.3%; odds ratio: 0.42; 95% CI: 0.19-0.89; P = 0.028) or MV (3.1% vs 6.2%; odds ratio: 0.49; 95% CI: 0.24-0.95; P = 0.039). During follow-up (median 52 months), the incidence of target lesion failure was not significantly different between wire jailing and non–wire jailing (7.6% vs 6.3%; P = 0.343).
During bifurcation percutaneous coronary intervention with the 1-stent strategy, wire jailing at the SB was associated with a lower rate of final SB occlusion following MV stenting in patients with severe stenoses at the SB or MV but not with overall bifurcation lesions. Long-term clinical outcomes were comparable between the 2 groups.
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The operations in the design lifecycle of a nuclear power plant targeted to be decommissioned lead to neutron activation. Operations in the decommissioning process include cutting, decontamination, ...disposal, and processing. Among these, cutting is done close to the target material, and thus workers are exposed to radiation. As there are only a few studies on pressurizers, there arises the need for further research to assess the radiation exposure dose. This study obtained the specifications of the AP1000 pressurizer of Westinghouse and the distribution of radionuclide inventory of a pressurizer in a pressurised water reactor for evaluation based on literature studies. A cutting scenario was created to develop an optimal method so that the cut pieces fill a radioactive solid waste drum with dimensions 0.571 m × 0.834 m. The estimated exposure dose, estimated using the tool VISIPLAN SW, in terms of the decontamination factor (DF) ranged from DF-0 to DF-100, indicating that DF-90 and DF-100 meet the ICRP recommendation on exposure dose 0.0057 mSv/h. At the end of the study, although flame cutting was considered the most efficient method in terms of cutting speed, laser cutting was the most reasonable one in terms of the financial aspects and secondary waste.
Background
Since the femoral artery frequently overlaps the femoral vein, femoral central venous catheterization carries the risk of arterial puncture in pediatric patients.
Aims
We evaluated the ...angle range of leg abduction with external hip rotation to minimize the overlap between the femoral artery and vein in pediatric patients undergoing general anesthesia.
Methods
Eighty‐two pediatric patients who underwent elective surgery with general anesthesia were enrolled in this study. Using ultrasonography, patients were divided into groups N (patients with non‐overlap) and O (patients with continuing overlap) based on the presence of non‐overlap range between the femoral artery and vein. The range minimizing the overlap was defined as the range without overlap in group N and as the range presenting the overlap that was less‐than‐half of the radius of the femoral vein in group O. By increasing the angle of leg abduction with external hip rotation, the starting and ending angles minimizing the overlap were found using ultrasonographic images.
Results
The angle range of leg abduction with external hip rotation minimizing the overlap between the femoral artery and vein was defined as the range from the maximum 99% confidence interval of starting angles to the minimum 99% confidence interval of ending angles, which was between 45° and 65° in group N and between 48° and 58° in group O, respectively.
Conclusion
Positioning patients in a range of 48° and 58° leg abduction with external hip rotation can minimize the overlap between the femoral artery and vein. However, the clinical usefulness of this positioning for femoral venous catheterization remains to be seen.
Objective
To compare the image quality, radiation dose, and diagnostic performance between low-dose (LD) and ultra-low-dose (ULD) lumbar-spine (L-spine) CT with iterative reconstruction (IR) for ...patients with chronic low back pain (LBP).
Methods
In total, 260 patients with chronic LBP who underwent L-spine CT between November 2015 and September 2016 were prospectively enrolled. Of these, 143 underwent LD-CT with IR and 117 underwent ULD-CT with IR. The patients were divided according to their body mass index (BMI) into BMI1 (<22.9 kg/m
2
), BMI2 (23.0–24.9 kg/m
2
), and BMI3 (≥25 kg/m
2
) groups. Two blinded radiologists independently evaluated the signal-to-noise ratio (SNR), qualitative image quality, and final diagnoses (lumbar disc disease and facet joint osteoarthritis). L-spine MRIs interpreted by consensus were used as the reference standard. All data were statistically analyzed.
Results
ULD protocol showed significantly lower SNR for all patients (
p
< 0.001) except the vertebral bodies and lower qualitative image quality for BMI3 patients (
p
≤ 0.033). There was no statistically significant difference between ULD (sensitivity, 95.1–98.1%; specificity, 92.5–98.7%; accuracy, 94.6–98.0%) and LD protocols (sensitivity, 95.6–100%; specificity, 95.5–98.9%; accuracy, 97.4–98.1%), (all
p
≥0.1) in the BMI1 and BMI2; while dose was 60–68% lower with the ULD protocol. Interobserver agreements were excellent or good with regard to image quality and final diagnoses.
Conclusions
For the BM1 and BMI2 groups, ULD-CT provided an acceptable image quality and exhibited a diagnostic accuracy similar to that of LD-CT. These findings suggest that it is a useful diagnostic tool for patients with chronic LBP who exhibit a BMI of <25 kg/m
2
.
A specimen of
Macaca
was discovered in the Sungho cave no. 3, Sungho County, North Hwanghae Province, the Democratic People’s Republic of Korea. The only available skull remains are represented by a ...mandible, which displays a combination of mandibular and dental features indicating that the specimen may belong to the species
Macaca
mulatta
. This discovery extends the geographical range of the genus
Macaca
.
Numerous epidemiological studies investigating gender-dependent clinical outcomes in sepsis have shown conflicting evidence. This study aimed to investigate the effect of gender on in-hospital ...mortality due to sepsis according to age group.
This study used data from the Korean Sepsis Alliance, an ongoing nationwide prospective multicenter cohort from 19 participating hospitals in South Korea. All adult patients diagnosed with sepsis in the emergency departments of the participating hospitals between September 2019 and December 2021 were included in the analysis. Clinical characteristics and outcomes were compared between male and female. Eligible patients were stratified by age into 19-50 years, 50-80 years, and ≥ 80 years old individuals.
During the study period, 6442 patients were included in the analysis, and 3650 (56.7%) were male. The adjusted odds ratio (OR) 95% confidence interval (CI) for in-hospital mortality for male compared with female was 1.15 (95% CI = 1.02-1.29). Interestingly, in the age 19-50 group, the risk of in-hospital mortality for males was significantly lower than that of females 0.57 (95% CI = 0.35-0.93). For female, the risk of death remained relatively stable until around age 80 (P for linearity = 0.77), while in males, there was a linear increase in the risk of in-hospital death until around age 80 (P for linearity < 0.01). Respiratory infection (53.8% vs. 37.4%, p < 0.01) was more common in male, whereas urinary tract infection (14.7% vs. 29.8%, p < 0.01) was more common in female. For respiratory infection, male had significantly lower in-hospital mortality than female in the age 19-50 groups (adjusted OR = 0.29, 95% CI = 0.12-0.69).
Gender may influence age-associated sepsis outcomes. Further studies are needed to replicate our findings and fully understand the interaction of gender and age on the outcomes of patients with sepsis.
Extractive chromatography for radiochemical separation of
111
In from Cd targets irradiated from charged particle accelerator was developed using D2EHPA-St-DVB extractant impregnated resin which was ...prepared from D2EHPA (bis (2-ethylhexyl) phosphoric acid), St(styrene) and DVB (divinyl benzene). For the separation of
111
In from Cd by the extractant impregnated resin, the separability of
111
In from natural metal cadmium targets has been evaluated by determining the extraction equilibrium constant and the adsorption band movement rate of those elements. The target sample solution (HNO
3
conc.; 2 mol·L
−1
) was adsorbed onto the column which was filled with synthesized D2EHPA-St-DVB extractant impregnated resin. The column was washed with HNO
3
solution (conc.; 1 mol·L
−1
) for removing Cd and
111
In was stripped with HCl solution (conc.; 6 mol·L
−1
). The nuclear purity of the separated
111
In was measured as 99.2% by gamma spectrometry and conformed to the requirements of nuclear pharmaceutical.
•100 and 200W-class SO-CFC shorts stacks were realized and operated on carbon fuel.•The SO-CFC short-stack produced maximum power of 224.4W at 750°C.•Both the stacks operated continuously for 200h to ...assess long-term degradation.•Achieved the scale-up of SO-CFC short stack with an improved efficiency.
Solid oxide based carbon fuel cells (SO-CFCs) offer clean and efficient utilization of carbon based fuels for energy conversion. In this work, we have realized and operated 100 and 200W-class solid oxide carbon fuel cell (SO-CFC) short stacks to investigate the fuel supply, electrochemical performance, continuous operation, long-term stability, and scale-up characteristics for SO-CFC based power generation systems. Different configurations for 100 and 200W class short stacks were employed for integrated Boudouard gasification and carbon fuel supply at the stack level. For the 100W class SO-CFC short stack, maximum stack power of 80.4, 93.5, and 111.5W was achieved at 700, 750, and 800°C, respectively, while the 200W class SO-CFC short stack produced maximum power of 224.4W at 750°C when operated on carbon fuel. Both SO-CFC short stacks were operated continuously at galvanostatic conditions to study the fuel supply conditions and long-term degradation behavior of the tubular cells in the short stacks. A postmortem analysis of the SO-CFC anode was also performed by SEM and XRD to elucidate the reasons for stack performance degradation during relatively longer operation with carbon fuels. Through a detailed analysis of the dry gasification in the integrated gasifier, the electrochemical performance of the SO-CFC stacks, and the post operation diagnosis of the cells, this study provides details on the important challenges in scaling-up SO-CFC technology from a single-cell to a several hundred watt power generation system.
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