Background
With improved short-term surgical outcomes, laparoscopic distal gastrectomy has rapidly gained popularity. However, the safety and feasibility of laparoscopic total gastrectomy (LTG) has ...not yet been proven due to the difficulty of the technique. This single-arm prospective multi-center study was conducted to evaluate the use of LTG for clinical stage I gastric cancer.
Methods
Between October 2012 and January 2014, 170 patients with pathologically proven, clinical stage I gastric adenocarcinoma located at the proximal stomach were enrolled. Twenty-two experienced surgeons from 19 institutions participated in this clinical trial. The primary end point was the incidence of postoperative morbidity and mortality at postoperative 30 days. The severity of postoperative complications was categorized according to Clavien–Dindo classification, and the incidence of postoperative morbidity and mortality was compared with that in a historical control.
Results
Of the enrolled patients, 160 met criteria for inclusion in the full analysis set. Postoperative morbidity and mortality rates reached 20.6% (33/160) and 0.6% (1/160), respectively. Fifteen patients (9.4%) had grade III or higher complications, and three reoperations (1.9%) were performed. The incidence of morbidity after LTG in this trial did not significantly differ from that reported in a previous study for open total gastrectomy (18%).
Conclusions
LTG performed by experienced surgeons showed acceptable postoperative morbidity and mortality for patients with clinical stage I gastric cancer.
Side‐chain fluorination of polymers is demonstrated as a highly effective strategy to improve the efficiency of all‐polymer solar cells from 2.93% (nonfluorinated P1) to 7.13% (fluorinated P2). This ...significant enhancement is achieved by synergistic improvements in open‐circuit voltage, charge generation, and charge transport, as fluorination of the donor polymer optimizes the band alignment and the film morphology.
In this paper, the optimal design for a permanent magnet-assisted synchronous reluctance motor (PMA-SynRM) is proposed in terms of efficiency, maximum torque, and minimum torque pulsations. Design ...variables, objective functions, and constraints are selected for this optimal design, which is divided into two steps. Step I utilizes the pole/slot combination of the PMA-SynRM and winding methods. The chosen 4-pole/36-slot model with distributed winding maximizes the rated efficiency. In Step II, the optimal design of the stator parameters is obtained using the response surface method and the precise torque and torque ripple are calculated using the finite-element analysis (FEA). The proposed stator slot openings are minimized to minimize the air-gap flux leakage, and consequently, realize a smooth electromagnetic torque. Finally, a few FEA results are validated by experimental results.
We performed an in-depth examination of pathogenic germline variants (PGVs) and somatic variants in DNA damage response (DDR) genes in hepatocellular carcinoma (HCC) to explore their clinical and ...genomic impacts.
We used a merged whole-exome or RNA sequencing data set derived from in-house ( n = 230) and The Cancer Genome Atlas ( n = 362) databases of multiethnic HCC samples. We also evaluated synthetic lethal approaches targeting mutations in homologous recombination (HR) genes using HCC cells selected from five genomic databases of cancer cell lines. A total of 110 PGVs in DDR pathways in 96 patients were selected. Of the PGV carriers, 44 were HR-altered and found to be independently associated with poorer disease-free survival after hepatectomy. The most frequently altered HR gene in both germline and somatic tissues was POLQ , and this variant was detected in 22.7% (10/44) and 23.8% (5/21) of all the corresponding carriers, respectively. PGVs in HR were significantly associated with upregulation of proliferation and replication-related genes and familial risk of HCC. Samples harboring PGVs in HR with loss of heterozygosity were most strongly correlated with the genomic footprints of deficient HR, such as mutation burden and denovoSig2 (analogous to Catalogue of Somatic Mutations in Cancer COSMIC 3), and poor outcome. Pharmacologic experiments with HCC cells defective in BRCA2 or POLQ suggested that tumors with this phenotype are synthetic lethal with poly(ADP-ribose) polymerase inhibitors.
Our findings suggest that germline HR defects in HCC tend to confer a poor prognosis and result in distinctive genomic scarring. Tests of the clinical benefits of HR-directed treatments in the affected patients are needed.
We aimed to investigate the relationship between pesticide exposure and cognitive decline in a rural South Korean population. From July 2015 to December 2017, 200 randomly selected Korean Farmers ...Cohort study participants were recruited and of these, 169 participants were analyzed. Pesticide exposure was investigated using a standardized questionnaire, and the Korean-Montreal Cognitive Assessment (K-MoCA) was conducted. Cognitive decline was more frequent among those directly exposed to pesticides (P = 0.057). Pesticide exposure and cognitive decline were positively correlated in the group with direct exposure versus no exposure (crude odds ratio OR, 2.66; 95% confidence interval CI, 1.17-6.04); this relationship was insignificant after adjustment (adjusted OR, 1.50; 95% CI, 0.57-3.92). There was a significant difference in the K-MoCA scores for each group based on pesticide exposure (P = 0.003). When we stratified by age, differences in the K-MoCA scores depending on the degree of pesticide exposure in the those aged 60 to 69 years were identified. Overall, there was a tendency towards an association between pesticide exposure and cognitive decline in rural Korean adult farmers. In our study, chronic pesticide exposure tended to have a greater impact in certain age group (60-69 years) than in those under 60 and over 70.
Background
Laparoscopic distal gastrectomy for early gastric cancer has been widely accepted, but laparoscopic total gastrectomy has still not gained popularity because of technical difficulty and ...unsolved safety issue. We conducted a single-arm multicenter phase II clinical trial to evaluate the safety and the feasibility of laparoscopic total gastrectomy for clinical stage I proximal gastric cancer in terms of postoperative morbidity and mortality in Korea. The secondary endpoint of this trial was comparison of surgical outcomes among the groups that received different methods of esophagojejunostomy (EJ).
Methods
The 160 patients of the full analysis set group were divided into three groups according to the method of EJ, the extracorporeal circular stapling group (EC;
n
= 45), the intracorporeal circular stapling group (IC;
n
= 64), and the intracorporeal linear stapling group (IL;
n
= 51). The clinicopathologic characteristics and the surgical outcomes were compared among these three groups.
Results
There were no significant differences in the early complication rates among the three groups (26.7% vs. 18.8% vs. 17.6%, EC vs. IC vs. IL;
p
= 0.516). The length of mini-laparotomy incision was significantly longer in the EC group than in the IC or IL group. The anastomosis time was significantly shorter in the EC group than in the IL group. The time to first flatus was significantly shorter in the IL group than in the EC group. The long-term complication rate was not significantly different among the three groups (4.4% vs. 12.7% vs. 7.8%; EC vs. IC vs. IL;
p
= 0.359), however, the long-term incidence of EJ stenosis in IC group (10.9%) was significantly higher than in EC (0%) and IL (2.0%) groups (
p
= 0.020).
Conclusions
The extracorporeal circular stapling and the intracorporeal linear stapling were safe and feasible in laparoscopic total gastrectomy, however, intracorporeal circular stapling increased EJ stenosis.
Our hospital experienced the first healthcare-associated COVID-19 outbreak in Seoul at the time the first COVID-19 cases were confirmed in Korea. The first confirmed COVID-19 patient was a hospital ...personnel who was in charge of transferring patients inside our hospital. To contain the virus spread, we shutdown our hospital, and tested all inpatients, medical staff members, and employees.
We retrospectively analyzed the results of SARS-CoV-2 RT-PCR testing according to the contact history, occupation, and presence of respiratory symptoms. Closed-circuit television (CCTV) was reviewed in the presence of an epidemiologist to identify individuals who came into contact with confirmed COVID-19 patients.
A total of 3,091 respiratory samples from 2,924 individuals were obtained. Among 2,924 individuals, two inpatients, and one caregiver tested positive (positivity rate, 0.1%). Although all confirmed cases were linked to a general ward designated for pulmonology patients, no medical staff members, medical support personnel, or employees working at the same ward were infected. Contact with confirmed COVID-19 cases was frequent among inpatients and medical support personnel. The most common contact area was the general ward for pulmonology patients and medical support areas, including clinical and imaging examination rooms. Finally, the total number of hospital-associated infections was 14, consisting of four diagnosed at our hospital and ten diagnosed outside the hospital.
The robust control of the COVID-19 outbreak further minimized the transmission of SARS-CoV-2 in the hospital and local communities. However, there was also a debate over the appropriate period of hospital shutdown and testing of all hospital staff and patients. Future studies are required to refine and establish the in-hospital quarantine and de-isolation guidelines based on the epidemiological and clinical settings.
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