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.
Current guidelines recommend dual antiplatelet therapy (DAPT) of aspirin plus a P2Y12 inhibitor for at least 12 months after implantation of drug-eluting stents (DES) in patients with acute coronary ...syndrome. However, available data about the optimal duration of DAPT in patients with acute coronary syndrome undergoing percutaneous coronary intervention are scant. We aimed to investigate whether a 6-month duration of DAPT would be non-inferior to the conventional 12-month or longer duration of DAPT in this population.
We did a randomised, open-label, non-inferiority trial at 31 centres in South Korea. Patients were eligible if they had unstable angina, non-ST-segment elevation myocardial infarction, or ST-segment elevation myocardial infarction, and underwent percutaneous coronary intervention. Enrolled patients were randomly assigned, via a web-based system by computer-generated block randomisation, to either the 6-month DAPT group or to the 12-month or longer DAPT group, with stratification by site, clinical presentation, and diabetes. Assessors were masked to treatment allocation. The primary endpoint was a composite of all-cause death, myocardial infarction, or stroke at 18 months after the index procedure in the intention-to-treat population. Secondary endpoints were the individual components of the primary endpoint; definite or probable stent thrombosis as defined by the Academic Research Consortium; and Bleeding Academic Research Consortium (BARC) type 2–5 bleeding at 18 months after the index procedure. The primary endpoint was also analysed per protocol. This trial is registered with ClinicalTrials.gov, number NCT01701453.
Between Sept 5, 2012, and Dec 31, 2015, we randomly assigned 2712 patients; 1357 to the 6-month DAPT group and 1355 to the 12-month or longer DAPT group. Clopidogrel was used as a P2Y12 inhibitor for DAPT in 1082 (79·7%) patients in the 6-month DAPT group and in 1109 (81·8%) patients in the 12-month or longer DAPT group. The primary endpoint occurred in 63 patients in the 6-month DAPT group and in 56 patients in the 12-month or longer DAPT group (cumulative event rate 4·7% vs 4·2%; absolute risk difference 0·5%; upper limit of one-sided 95% CI 1·8%; pnon-inferiority=0·03 with a predefined non-inferiority margin of 2·0%). Although all-cause mortality did not differ significantly between the 6-month DAPT group and the 12-month or longer DAPT group (35 2·6% patients vs 39 2·9%; hazard ratio HR 0·90 95% CI 0·57–1·42; p=0·90) and neither did stroke (11 0·8% patients vs 12 0·9%; 0·92 0·41–2·08; p=0·84), myocardial infarction occurred more frequently in the 6-month DAPT group than in the 12-month or longer DAPT group (24 1·8% patients vs ten 0·8%; 2·41 1·15–5·05; p=0·02). 15 (1·1%) patients had stent thrombosis in the 6-month DAPT group compared with ten (0·7%) in the 12-month or longer DAPT group (HR 1·50 95% CI 0·68–3·35; p=0·32). The rate of BARC type 2–5 bleeding was 2·7% (35 patients) in the 6-month DAPT group and 3·9% (51 patients) in the 12-month or longer DAPT group (HR 0·69 95% CI 0·45–1·05; p=0·09). Results from the per-protocol analysis were similar to those from the intention-to-treat analysis.
The increased risk of myocardial infarction with 6-month DAPT and the wide non-inferiority margin prevent us from concluding that short-term DAPT is safe in patients with acute coronary syndrome undergoing percutaneous coronary intervention with current-generation DES. Prolonged DAPT in patients with acute coronary syndrome without excessive risk of bleeding should remain the standard of care.
Abbott Vascular Korea, Medtronic Vascular Korea, Biosensors Inc, and Dong-A ST.
Biportal endoscopic spinal surgery (BESS) is a minimally invasive spinal surgery, which is basically similar to microscopic spinal surgery in terms of the use of floating technique and technically ...similar to conventional percutaneous endoscopic spinal surgery in terms of the use of endoscopic or arthroscopic instruments. Using two independent portals (viewing and working) and maintaining a certain distance from the bony and neural structures allow closer access to the target lesion through a panoramic view by free handling of the scope and instruments rather than through a fixed view by docking into the Kambin's triangle. Minimally invasive surgery allows for reduced dissection and inevitable muscle injury, preserving stability and reducing risks of restabilization. The purpose of fusion surgery is the same as that of the three surgical techniques stated above. Its wider range of view helps to overcome limitations of conventional endoscopic spinal surgery and to supplement the weak points of microscopic spinal surgery, such as limited working space in a tubular retractor and difficulty in accessing the contralateral area. This technique provides an alternative to unilateral or bilateral decompression of lumbar central spinal stenosis, foraminal stenosis, low-grade spondylolisthesis, and adjacent segment degeneration. Early clinical outcomes are promising despite potential for complications, such as dural tearing and postoperative epidural hematoma, similar to other procedures. Merits of BESS include decreased postoperative infection rate due to continuous irrigation throughout the procedure and decreased need for fusion surgery for one- or two-level lumbar stenosis by wide sublaminar and foraminal decompression with minimal sacrifice of stabilizing structures.
Human sweat contains vast physiological information, which has been a promising resource for on‐body and real‐time health monitoring. Wearable sweat sensors have recently attracted an ever‐increasing ...interest due to their promising capabilities for continuously tracking changes in health status. However, the commercialization of sweat sensors is seriously hindered by drawbacks of materials including high manufacturing and consumables costs, complex integration technology, as well as limited electrochemical signal transduction. In this review, sweat sensing principles are elaborately interpreted, and the latest advances in functional materials for biomarkers sensing in sweat are systematically summarized. Subsequently, the complex structure–activity relationships between various functional materials and sensing capabilities are further elucidated by coupling chemical structures, geometrics, electrochemical properties, and approaches for materials manufacturing. Furthermore, the integration of each component into sensing device for sweat detection and analysis is also discussed. Finally, challenges and opportunities for wearable sweat sensors are delineated in the development of future personalized and predictive healthcare.
Wearable electrochemical sweat sensors have emerged as a type of promising electronic device for continuous monitoring human health. This article reviews the recent progress on various materials for electrochemical sweat sensing. Structure‐activity relationships of sensing materials, approaches for materials manufacturing, and integration of devices are discussed. Challenges and future research directions are also identified.
Ionogels are good candidates for flexible electronics owing to their excellent mechanical and electrical properties, including stretchability, high conductivity, and stability. In this study, ...conducting ionogels comprising a double network (DN) of poly(N‐isopropylacrylamide‐co‐N,N′‐diethylacrylamide)/chitosan which are further reinforced by the ionic and covalent crosslinking of the chitosan network by tripolyphosphate and glutaraldehyde, respectively, are prepared. Based on their excellent mechanical properties and high conductivity, the developed DN ionogels are envisioned as stretchable ionic conductors for extremely stretchable alternating‐current electroluminescent (ACEL) devices. The ACEL device fabricated with the developed ionogel exhibits stable working operation under an ultrahigh elongation of over 1200% as well as severe mechanical deformations such as bending, rolling, and twisting. Furthermore, the developed ACEL devices also display stable luminescence over 1000 stretch/release cycles or at temperatures as harsh as 200 °C.
A super stretchable electroluminescent device is successfully fabricated with double‐network ionogel as a soft electrode owing to its excellent mechanical robustness and electrical conductivity. The fabricated device exhibits extremely stable light‐emitting operation even at high elongation as well as demonstrating mechanical, electrical, and thermal stability, which can be applied to new types of stretchable light display and sensors.
This article concerns the estimation algorithms of battery's parameters and state of charge (SOC) and it is twofold. First, we present a simple variable length block wise least square estimation ...algorithm by considering locally linear SOC and open circuit voltage (OCV) relation on the run. The proposed algorithm can estimate accurately the parameters and follow the parameter changes. After estimating the battery parameters, SOC is directly computed from the combination of estimated parameters and SOC-OCV relation. This estimation scheme, which assumes hysteresis effect is negligible, is an online method. Second, if the hysteresis effect is considered in the model, we present an additional least square optimization problem to estimate SOC accurately. In this case, some parameters are tuned up in an offline way. Our approach compared with the extended Kalman filter based estimation method. The algorithms are validated by experiments with real data obtained from lab tests.
Recently, bipolar host materials are the most promising candidates for achieving high performance phosphorescent organic light‐emitting diodes (PHOLEDs) in order to maximize recombination efficiency. ...However, the development of host material with high triplet energy (E
T) is still a great challenge to date to overcome the limitations associated with the present PHOLEDs. Herein, a highly efficient donor‐π‐acceptor (D‐π‐A) type bipolar host (4′‐(9H‐carbazol‐9‐yl)‐2,2′‐dimethyl‐1,1′‐biphenyl‐4‐yl)diphenylphosphine oxide (m‐CBPPO) comprising of carbazole, 2,2′‐dimethylbiphenyl and diphenylphosphoryl as D‐π‐A unit, respectively, is developed. Interestingly, a high E
T of 3.02 eV is observed for m‐CBPPO due to highly twisted conformation. Furthermore, the new host material is incorporated in PHOLEDs as emissive layer with a new carbene type Ir(cb)3 material as a deep‐blue emitter. The optimized devices show an excellent external quantum efficiency (EQE) of 24.8% with a notable Commission internationale de l'éclairage (x, y) ≤ 0.15, (0.136, 0.138) and high electroluminescence performance with extremely low efficiency roll‐off. Overall, the above EQE is the highest reported for deep‐blue PHOLEDs with very low efficiency roll‐off and also indicate the importance of appropriate host for the development of high performance deep‐blue PHOLEDs.
Highly efficient deep‐blue‐phosphorescent organic light‐emitting diodes are developed using bipolar host materials. A high quantum efficiency of 24.8% with a deep‐blue Commission internationale de l'éclairage (CIE)(x, y) (0.136, 0.138) is achieved. To the best of the knowledge, this is the highest reported external quantum efficiency for deep‐blue emitting phosphors with CIE (x, y) ≤0.15 using a bipolar host so far.
To realize wearable displays and interactive soft robots, significant research efforts are focused on developing highly deformable alternating‐current electroluminescent (ACEL) devices. Although soft ...emission layers are well developed, designing stretchable, conductive, and transparent soft electrodes remains challenging. In this study, ionic hydrogels are prepared comprising a double network (DN) of poly(N‐hydroxyethylacrylamide‐co‐acrylamide)/crosslinked chitosan swollen in aqueous lithium bis(trifluoromethanesulfonyl) imide. Owing to the finely tuned DN structure of the polymeric crosslinker and transparent electrolyte, the developed ionic hydrogels exhibit remarkable stretchability (1400%), excellent optical transmittance (>99%), and high conductivity (1.95 × 10−2 Sm−1). Based on the high performance of the ionic hydrogels, ACEL devices are fabricated with an emission layer containing phosphor microparticles and demonstrate stable, high luminance under extreme deformation, and ultra‐high elongation. The excellent transparency of the ionic hydrogel further enables the fabrication of novel soft ACEL devices with tandem structures by stacking several emission and electrode layers, in which each emission layer is independently controlled with a switch circuit.
Highly stretchable alternating current electroluminescent devices are developed based on soft electrodes comprising ionic hydrogels with a double‐network structure. Their high optical transparency and mechanical robustness allow extreme deformability and high stretchability over 1400% as well as a multi‐stacked structure, meeting the requirements of a soft electrode for future wearable devices.
•Zirconia products printed by additive manufacturing using zirconia suspensions.•Sintered specimens using zirconia suspensions had inferior physical properties.•Light scattering makes some distortion ...and cause geometrical overgrowth.•Future challenges include increasing precision and bending strength.
The objectives of the present study were: (1) to analyze the dispersion and optical properties of suspensions with various volume fractions of zirconia, and (2) to assess the influence of zirconia volume fraction on the microstructure and physical properties of products produced by the additive manufacturing and sintering process.
Zirconia specimens were fabricated by an additive manufacturing technique using a DLP (digital light processing) system. The zirconia suspensions were divided into six groups based on zirconia volume fraction within the range of 48–58vol%.
The maximum volume fraction of zirconia in suspensions possible for printing was 58vol%. The cure depth of the zirconia suspensions decreased as the volume fraction increased. The cure depth was greater than 100μm after 15s photocuring in all groups. Geometrical overgrowth tended to increase gradually as the volume fraction of zirconia increased within the range of 28.55–36.94%. The 3-point bending strength of the specimens increased as the volume fraction of zirconia in the suspension increased, reaching a maximum value of 674.74±32.35MPa for a volume fraction of 58vol%. Cracks were observed on the surfaces of zirconia specimens and these cracks increased in number as zirconia volume fraction decreased.
In this experiment, the viscosity of zirconia suspensions sharply increased from a volume fraction of 54vol%. Because of the very high viscosity, 58vol% was the maximum volume fraction possible for additive manufacturing. After polymerization, all specimens showed some distortion due to geometrical overgrowth. The maximum 3-point bending strength was 674.74±32.35MPa for a volume fraction of 58vol%. But the maximum strength of sintered zirconia prepared by additive manufacturing is inferior to that of conventionally sintered zirconia.
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