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A multimodal analgesia (MMA) protocol has shown the effect of postoperative pain control and reduced the postoperative opioid consumption. However, it was questionable whether MMA could replace opioid-based patient-controlled analgesia (PCA) for postoperative pain control. Therefore, this study aimed to investigate whether an MMA protocol is non-inferior to opioid-based PCA for pain management after a minimally invasive colorectal cancer surgery.A randomized, open-label, non-inferiority clinical trial was conducted on patients undergoing laparoscopic or robotic resection of colorectal cancer. The patients were randomly assigned to either the PCA or MMA group. The MMA protocol included pregabalin, tramadol, wound infiltration, and transversus abdominis plane block. The primary outcome was the numeric rating scale (NRS) score for pain at rest 24 h postoperatively.Ninety-seven patients were included in the intention-to-treat analysis. The mean difference in NRS score at rest at 24 h was 0.25 (95% confidence interval, - 0.61 to 1.11). This result demonstrated the non-inferiority of MMA to PCA in our non-inferiority margin (- 1). Compared with the PCA group, the median remifentanil dose (996 vs. 654 μg; p 0.001) and time in the post-anesthesia care unit (35 vs. 25 min; p 0.001) were significantly less in the MMA group.Our MMA protocol successfully controlled postoperative pain and was non-inferior to morphine-based PCA based on patient-reported pain intensity, with no significant increase in adverse events. These results will help construct a strategy to reduce conventional opioid prescriptions for pain management after a minimally invasive colorectal cancer surgery. Trial Registration Number Trial Registration Clinical Research Information Service Identifier: KCT0002593.

Background: The present study evaluated the clinical implications of adjuvant chemotherapy according to the mismatch repair (MMR) status and clinicopathologic features of patients with intermediate- and high-risk stage II colon cancer (CC).Methods: This study retrospectively reviewed 5,774 patients who were diagnosed with CC and underwent curative surgical resection at Kyungpook National University Chilgok Hospital. The patients were enrolled according to the following criteria: (1) pathologically diagnosed with primary CC; (2) stage II CC classified based on the 7th edition of the American Joint Committee on Cancer staging system; (3) intermediate- and high-risk features; and (4) available test results for MMR status. A total of 286 patients met these criteria and were included in the study. Results: Among the 286 patients, 54 (18.9%) were identified as microsatellite instability-high (MSI-H) or deficient MMR (dMMR). Although all the patients identified as MSI-H/dMMR showed better survival outcomes, T4 tumors and adjuvant chemotherapy were identified as independent prognostic factors for survival. For the intermediate-risk patients identified as MSI-low (MSI-L)/microsatellite stable (MSS) or proficient MMR (pMMR), adjuvant chemotherapy exhibited a significantly better disease-free survival (DFS) but had no impact on overall survival (OS). Oxaliplatin-containing regimens showed no association with DFS or OS. Adjuvant chemotherapy was not associated with DFS in intermediate-risk patients identified as MSI-H/dMMR. Conclusion: The current study found that the use of adjuvant chemotherapy was correlated with better DFS in MSI-L/MSS or pMMR intermediate-risk stage II CC patients.

Aim: This study evaluated the clinical implication of KRAS proto-oncogene, GTPase (KRAS) mutation variants in patients with resected colon cancer (CC). Patients and Methods: We retrospectively reviewed 482 patients diagnosed with CC who underwent curative surgical resection at Kyungpook National University Chilgok Hospital. The inclusion criteria were: Pathologically diagnosed with primary CC; stage I-III CC according to the 7th edition of American Joint Committee on Cancer staging system; and with available test results for KRAS mutation status. In total, 345 patients met these criteria and were included in this study. Results: Among the 345 patients, 140 (40.6%) exhibited KRAS mutations, with their incidences as follows: 90/140 (64.3%) in exon 2 codon 12, 37/140 (26.4%) in exon 2 codon 13, 1/140 (0.1%) in exon 3 codon 59, 7/140 (5.0%) in exon 3 codon 61, and 5/140 (3.6%) in exon 4 codon 146. KRAS mutation status was not a significant prognostic factor for disease-free survival or overall survival. Although there were no significant differences in survival between patients with exon 2 codon 12 and exon 2 codon 13 mutations, poorer disease-free survival (p=0.085) and overall survival (p=0.005) were seen in those with exon 3 codon 61 mutation than in others. Conclusion: KRAS mutation status was not correlated with survival, but exon 3 codon 61 mutation might be a factor for poor prognosis in patients after resection of CC.

Endoscopic tattooing with India ink is a popular method for identifying colonic lesions during minimally invasive surgery because it is highly challenging to localize lesions during laparoscopy. However, there is a perceived unmet need for the injection of India ink and carbon particle suspension due to various complications and inconstant durability during the perioperative period. In this study, carbon black-containing self-healing adhesive alginate/polyvinyl alcohol composite hydrogels were synthesized as endoscopic tattooing inks. Alginate (Alg) conjugated with phenylboronic acid (PBA) groups in the backbone was crosslinked with polyvinyl alcohol (PVA) because of the dynamic bonds between the phenylboronic acid in alginate and the cis-diol groups of PVA. The carbon black-incorporated Alg-PBA/PVA hydrogels exhibited self-healing and re-shapable properties, indicating that improved intraoperative localization could be achieved. In addition, the adhesive tattooing hydrogels were stably immobilized on the target regions in the intraperitoneal spaces. These carbon black-containing self-healing adhesive hydrogels are expected to be useful in various surgical procedures, including endoscopic tattooing.

The process of handling and bonding copper (Cu) and graphene inevitably creates defects. To use graphene/Cu composites as electronic devices with new physical properties, it is essential to evaluate the effect of such defects. Since graphene is an ultrathin anisotropic material having a hexagonal structure, an evaluation of graphene/Cu composites containing defects was conducted taking into account the inherent structural characteristics. The purpose of this study is to evaluate defects that may occur in the manufacturing process and to present a usable basic method for the stable design research and development of copper/graphene composites essential for commercialization of copper/graphene composites. In the future, when performing analytical calculations on various copper/graphene composites and defect shapes in addition to the defect conditions presented in this paper, it is considered that it can be used as a useful method considering defects that occur during application to products of desired thickness and size. Herein, density functional theory was used to evaluate the behavior of graphene/Cu composites containing defects. The density of states (DOS) values were also calculated. The analysis was implemented using three kinds of models comprising defect-free graphene and two- and four-layered graphene/Cu composites containing defects. DOS and Fermi energy levels were used to gage the effect of defects on electrical properties.

To evaluate whether robotic for middle or low rectal cancer produces an improvement in surgical outcomes compared with laparoscopic surgery in a randomized controlled trial (RCT).There is a lack of proven clinical benefit of robotic TME compared with a laparoscopic approach in the setting of multicenter RCTs.Between July 2011 and February 2016, patients diagnosed with an adenocarcinoma located10 cm from the anal verge and clinically rated T1-4aNxM0 were enrolled. The primary outcome was the completeness of TME assessed by a surgeon and a pathologist.The RCT was terminated prematurely because of poor accrual of data. In all, 295 patients were assigned randomly to a robot-assisted TME group (151 in R-TME) or a laparoscopy-assisted TME group (144 in L-TME). The rates of complete TME were not different between groups (80.7% in R-TME, 77.1% in L-TME). Pathologic outcomes including the circumferential resection margin (CRM) and the numbers of retrieved lymph nodes were not different between groups. In a subanalysis, the positive CRM rate was lower in the R-TME group (0% vs. 6.1% for L-TME; P=0.031). Among the recovery parameters, the length of opioid use was shorter in the R-TME group (P=0.028). There was no difference in the postoperative complication rate between the groups (12.0% for R-TME vs. 8.3% for L-TME).In patients with middle or low rectal cancer, robotic-assisted surgery did not significantly improve the TME quality compared with conventional laparoscopic surgery (ClinicalTrial.gov ID: NCT01042743).

This article presents 16-times frequency multiplier composing of two four-times frequency multipliers (quadrupler) in cascade connection. The proposed topology is new structure of tuned-frequency multiplier (TFM) for better harmonic rejection ratio (HRR) with wide frequency range and low power consumption. For accomplishing reliable output frequency band of 16–28 GHz, the whole band is divided into 64 subsidiary frequency bands by applying 6-bits digitally controlled capacitor-bank of LC -tuned tank. The proposed quadrupler is consisted of a harmonic generator (HG) and a cascode LC -tuned buffer. The proposed HG topology is based on double balanced mixer (DBM). Unlike typical mixer bias, the bottom differential pair devices of the proposed HG are C-class biased to generate more desired the fourth order harmonic. In addition, to reduce power consumption and frequency conversion gain variations for the whole target frequency band, negative- $g_{m}$ differential pair is added in parallel to enhance the equivalent parasitic parallel resistance of the HG LC -tank while keep it from oscillation. Great efforts have been contributed to minimize process variation effects by simple but relatively accurate capacitance calibration. Furthermore, each LC -tuned tank output amplitude is regulated by a loop to maintain same output swing for the best optimization of specifications such as power consumption and HRR. The proposed 16-times multiplier is fabricated on 65-nm complementary metal–oxide–semiconductor (CMOS) process and successfully tested. Chip die size 0.7 mm2 excluding input/output (I/O) pads and average power consumption is only 6 mW for 16–28 GHz frequency band. Also, negligible phase noise degradation is achieved.

Background Although many efforts have been made to decrease the incidence of anastomotic leak (AL), it remains one of the most serious complications of rectal cancer surgery. Many previous studies have reported an association between the ligation level of the inferior mesenteric artery (IMA) (high or low) and the incidence of AL after rectal cancer surgery. However, we cannot draw a solid conclusion because of the low quality and heterogeneity of those studies. Therefore, this study aims to investigate the impact of the IMA ligation level on the occurrence of AL after minimally invasive anterior resection of rectal cancer. Methods/design Patients with primary rectal cancer without distant metastases will be included after screening. They will be randomly assigned (1:1) to receive high or low ligation of the IMA. The primary endpoint is AL incidence; secondary endpoints are quality of life; urinary, sexual, and defecatory functions; and 3-year disease-free survival. We hypothesized that the incidence rate of AL would be 15% and 5% in the high- and low-ligation groups, respectively. With a two-sided α of 0.05 and a power of 0.8, the sample size is calculated to be 314 patients (157 per group), considering a 10% dropout rate. Discussion Although many studies have compared the short- and long-term outcomes of high and low ligation of the IMA in rectal cancer surgery, it is still debatable. This trial aims to help draw a more solid conclusion regarding the association between the IMA ligation level and AL incidence after rectal cancer surgery. We also hope to contribute to standardizing the method of rectal cancer surgery in this trial. Trial registration Clinical Research Information Service KCT0003523. Registered on February 18, 2019

There is a paucity of evidence on the value of intraperitoneal chemotherapy (IPC) following cytoreductive surgery (CRS) for colorectal peritoneal metastasis. This study aimed to evaluate the association between mitomycin C-IPC and survival outcomes following CRS.The institutional databases of two tertiary hospitals were reviewed to identify patients who underwent CRS for colorectal peritoneal metastasis. The outcomes of patients who underwent CRS without IPC were compared with those of patients who underwent CRS plus early postoperative intraperitoneal chemotherapy (EPIC) or CRS plus hyperthermic intraperitoneal chemotherapy (HIPEC). The primary endpoints were cancer-specific survival (CSS), progression-free survival (PFS), and peritoneal PFS (P-PFS).In 149 patients with peritoneal metastasis alone, EPIC and HIPEC use was significantly associated with better CSS, PFS, and P-PFS in the multivariate analysis. CSS was also significantly associated with perioperative systemic chemotherapy. Among 42 patients with both peritoneal and extraperitoneal metastases, CSS was independently related to the completeness of cytoreduction score, location of extraperitoneal metastasis, and grade 3-4 complications.Mitomycin C-IPC after CRS was associated with better survival outcomes than CRS alone in patients with resectable peritoneal metastasis of colorectal cancer. This study found that IPC had beneficial effects regarding P-PFS in patients with both peritoneal and extraperitoneal metastases.

BACKGROUND/AIM There are no clinically significant cutoff values of serum vitamin D levels and time points to predict the prognosis of colon cancer, particularly in patients who underwent curative surgical resection. PATIENTS AND METHODS We retrospectively analyzed serum vitamin D levels in 795 patients with stages I to III colon cancer who underwent curative surgical resection. RESULTS Patients with vitamin D levels below 12 ng/ml at one year after surgical resection demonstrated a significantly reduced disease-free survival (DFS) than those who did not have vitamin D deficiency (p=0.01). In the multivariate analysis, an age of 70 years or older [hazard ratio (HR)=1.992; p=0.001], pathologic stage (HR=3.739; p

An intraoperative air leak test (ALT) is commonly used to detect mechanical defects following a bowel anastomosis, although its efficacy is uncertain. This study aimed to evaluate the efficacy of ALT for preventing anastomotic leakage (AL) following rectal excision. We reviewed our database for patients with rectal cancers who had undergone curative surgery between January 2012 and January 2018. Patients were grouped according to whether or not an ALT was performed. Propensity score analyses were performed to compare outcomes for groups in a 1:1 case-matched cohort. In total, 1,191 patients underwent rectal excision; 438 (219 in each group) formed the case-matched cohort for analysis. The protective stoma rate was 16.0% and 14.6% in the ALT and the no-ALT groups, respectively (p = 0.791). In the ALT group, 2 patients (0.9%) showed a positive result and were treated with rectal tube drainage, resulting in no leakage. There was no significant between-group difference in postoperative AL rate (ALT group: 4.6%, no-ALT group: 4.1%, p = 1.000). ALT played a minimal role in preventing AL following rectal excision. Further studies are warranted to validate our results and clarify whether AL can be prevented with ALT or alternative methods.

Assays for cancer diagnosis via the analysis of biomarkers on circulating extracellular vesicles (EVs) typically have lengthy sample workups, limited throughput or insufficient sensitivity, or do not use clinically validated biomarkers. Here we report the development and performance of a 96-well assay that integrates the enrichment of EVs by antibody-coated magnetic beads and the electrochemical detection, in less than one hour of total assay time, of EV-bound proteins after enzymatic amplification. By using the assay with a combination of antibodies for clinically relevant tumour biomarkers (EGFR, EpCAM, CD24 and GPA33) of colorectal cancer (CRC), we classified plasma samples from 102 patients with CRC and 40 non-CRC controls with accuracies of more than 96%, prospectively assessed a cohort of 90 patients, for whom the burden of tumour EVs was predictive of five-year disease-free survival, and longitudinally analysed plasma from 11 patients, for whom the EV burden declined after surgery and increased on relapse. Rapid assays for the detection of combinations of tumour biomarkers in plasma EVs may aid cancer detection and patient monitoring.

An isolated tibial component revision could be a treatment option for isolated tibial side loosening; however, few studies have proved its efficacy. This study aimed to compare the clinical and radiological outcomes between isolated (tibial component) and total (femoral and tibial component) revision total knee arthroplasty (TKA).Between January 2008 and February 2017, 31 patients underwent revision TKA for isolated tibial side loosening; 14 underwent an isolated tibial component revision (isolated group) and 17 underwent total (both femoral and tibial components) revision surgery (total group). The postoperative range of motion (ROM), Western Ontario and McMaster Universities osteoarthritis (WOMAC) index, Knee Society knee score (KSKS), Knee Society function score (KSFS), and mechanical axis (MA) were compared between the two groups. The intraoperative tourniquet time and amount of blood drainage were also compared.The mean follow-up durations in the isolated and total groups were 40.7 and 56.1 months, respectively. Both groups had similar postoperative ROM, WOMAC index, KSKS, KSFS, and MA; however, significantly shorter tourniquet time (105.2 vs. 154.6 min, P 0.001) and less blood drainage (417.2 vs. 968.1 ml, P 0.001) were noted in the isolated group than in the total group.Isolated tibial component revision TKA for tibial component loosening showed comparable clinical and radiological outcomes to those of total revision TKA. The advantages of the isolated tibial component revision surgery were short operation time and small blood loss.Level III, Retrospective comparative study.

Background/Aims Belching disorder (BD) is clinically distinct from gastroesophageal reflux disease (GERD) with belching. Supragastric belching (SGB) is closely associated with reflux episodes. This study investigates belch characteristics in association with reflux, compared between patients with BD and those who had GERD with belching. Methods Impedance pH monitoring data from 10 patients with BD and 10 patients with GERD who exhibited belching were retrospectively analyzed. Belches were considered “isolated“ or “reflux-related” and acidic/non-acidic. Belch characteristics were compared between patients with BD and those with GERD. Results Symptomatic belches were more frequent in patients with BD than in patients with GERD (median, 160.5 vs 56.0, P < 0.05). SGB was the most common type in both groups; common subtypes comprised “isolated“ in patients with BD and “isolated during the reflux period” in patients with GERD. Reflux-related SGB was more common in patients with GERD than in BD (78.3% vs 45.2%, P < 0.005). Both “preceding belching” including the reflux period and acidic SGB were more common in patients with GERD than in BD (31.8% vs 8.6% and 38.1% vs 8.9%, both P < 0.05). Supragastric belch number positively correlated with all reflux episodes in patients with GERD (adjusted R2 = 0.572, P = 0.007). Conclusions BD is characterized by more belching, compared to GERD. SGB is more frequently associated with reflux in GERD than in BD; acidity may be related to GERD. In BD, SGB is typically non-acidic and unrelated to reflux. Distinct SGB characteristics may reflect different pathogenic mechanisms of reflux and associated symptoms.

Purpose: We analyzed the safety and feasibility of preoperative short-course radiotherapy (SCRT) followed by consolidation chemotherapy for patients with locally advanced rectal cancer (LARC).Methods: From April 2018 to May 2019, 19 patients with LACR were treated with SCRT followed by three cycles of consolidation chemotherapy with leucovorin, fluorouracil, and oxaliplatin (FOLFOX6) before surgery. Adjuvant chemotherapy relied on oxaliplatin. Tumor response, patient compliance, and toxicities were analyzed.Results: The median age was 60 years (range 44–71), and 16 of the patients were male. The median tumor height was 5 cm (range 0–9) from anal verge. All patients received a total dose of 25 Gy in five fractions. The number of cycles of FOLFOX6 before surgery was three in 17, four in one, five in one. Five patients required dose reductions in consolidation chemotherapy. The median interval between initiation of SCRT and surgery was 10.6 weeks (range 8.6–16.4). A pathologic complete response was seen in two patients (11%). Grade III toxicities to the preoperative treatment were seen in five patients (26%): diarrhea in two, a decreased white blood cell count in one, and anemia in two. Postoperative complications arising within 30 days developed in five patients (26%). During the median follow-up period of 20.4 months, there was no tumor recurrence. Conclusion: Preoperative SCRT followed by oxaliplatin-based consolidation chemotherapy showed acceptable toxicity and feasibility in patients with LARC. Prospective randomized trials are warranted to verify the efficacy and safety of this treatment strategy compared with conventional long-course concurrent chemoradiotherapy.

A standardized small bowel (SB) cleansing scale is currently not available. The aim of this study was to develop an automated calculation software for SB cleansing score using deep learning. Consecutively performed capsule endoscopy cases were enrolled from three hospitals. A 5-step scoring system based on mucosal visibility was trained for deep learning in the training set. Performance of the trained software was evaluated in the validation set. Average cleansing score (1.0 to 5.0) by deep learning was compared to clinical grading (A to C) reviewed by clinicians. Cleansing scores decreased as clinical grading worsened (scores of 4.1, 3.5, and 2.9 for grades A, B, and C, respectively, P P P

Mineral wool is an insulation material commonly used in passive fire protection (PFP) systems on offshore installations. Insulation materials have only been considered functional materials for thermal analysis in the conventional offshore PFP system design method. Hence, the structural performance of insulation has yet to be considered in the design of PFP systems. However, the structural elements of offshore PFP systems are often designed with excessive dimensions to satisfy structural requirements under external loads such as wind, fire and explosive pressure. To verify the structural contribution of insulation material, it was considered a structural material in this study. A series of material tensile tests was undertaken with two types of mineral wool at room temperature and at elevated temperatures for fire conditions. The mechanical properties were then verified with modified methods, and a database was constructed for application in a series of nonlinear structural and thermal finite-element analyses of an offshore bulkhead-type PFP system. Numerical analyses were performed with a conventional model without insulation and with a new suggested model with insulation. These analyses showed the structural contribution of the insulation in the structural behaviour of the PFP panel. The results suggest the need to consider the structural strength of the insulation material in PFP systems during the structural design step for offshore installations.

LiNixCoyAlzO2 (NCA) is one of the most promising candidates of cathode material for lithium ion batteries because of its high capacity, energy density, and low cost. However, Ni-rich NCA cathode materials suffer from side reaction (formation of lithium carbonate and hydrogen fluoride attack) between electrolyte and surface of electrode and irreversible phase transition leading to capacity fading and thermal instability. These problems could be improved by coating and doping of transition metal elements. Si doping contributes to stabilization of the unstable R-3m structure, and Ti coating is capable of prohibiting the direct physical contact of electrode with electrolyte. In this work, LiNi0.8Co0.15Al0.05O2 (NCA) cathode materials coated or/and doped by Ti and Si elements were fabricated by co-precipitation method using the ball-milling. The crystal structure, morphology and electrochemical properties are investigated using X-ray diffraction (XRD), scanning electron microscopy (FE-SEM), transmission electron microscopy (FE-TEM), and WBCS3000 (WonA tech Co., Ltd.). The EIS and charge/discharge results of Si doped and Ti coated NCA exhibited the lowest resistance value (147.19 Ω) and capacity retentions of 88% after 100 cycles at 0.5 C.

BACKGROUND An oxaliplatin-based chemotherapy regimen improves the survival outcomes of patients with stage III colon cancer. However, its complications are well-known. OBJECTIVE The purpose of this study was to distinguish between the survival outcomes of patients who underwent curative resection for stage III colon cancer with oxaliplatin chemotherapy and those who underwent such resection without oxaliplatin chemotherapy. DESIGN This was a retrospective analytical study based on prospectively collected data. SETTINGS This study used data on patients who underwent surgery at our hospital between January 2010 and December 2014. PATIENTS A cohort of 254 consecutive patients who underwent curative resection for stage III colon cancer was included in this study. The patients were divided into 2 groups: patients with isolated pericolic lymph node metastasis (n = 175) and those with extrapericolic lymph node metastasis (n = 79). MAIN OUTCOME MEASURES Clinicopathologic features and 3-year survival outcomes were analyzed with and without oxaliplatin therapy in the pericolic lymph node group. RESULTS The pericolic lymph node group showed significantly improved overall survival compared with the extrapericolic lymph node group at a median follow-up of 48.5 months (95.8% vs 77.8%; p < 0.001). In contrast, there was no significant difference in overall survival (99.0% vs 92.0%; p = 0.137) and disease-free survival (89.1% vs 88.2%; p = 0.460) between the oxaliplatin and nonoxaliplatin subgroups of the pericolic lymph node group. Multivariate analysis showed that the administration of oxaliplatin chemotherapy to the pericolic lymph node group did not lead to a significant difference in the overall survival (p = 0.594). LIMITATIONS The study was limited by its retrospective design and single institutional data analysis. CONCLUSIONS This study suggests that the anatomic extent of metastatic lymph nodes could affect patient prognosis, and the effect of oxaliplatin-based adjuvant chemotherapy may not be prominent in stage III colon cancer with isolated pericolic lymph node metastasis.

Li[NixCoyMnz]O2 (LiNCM) is one of the candidate cathode material that can replace the currently commercialized LiCoO2 (LCO) cathode material for lithium-ion batteries (LiBs). The morphological feature having primary particle and secondary sphere particle could affect structural stability, tap density and electrochemical performance of LiNCM. In this work, two LiNCM particles without or with the morphological collapse of the secondary particles were prepared by using a co-precipitation-assisted, solid-phase method and ball milling, and its morphological, structural and electrochemical characteristics were evaluated. The results of XRD, and FESEM demonstrated that the as-prepared two LiNCMs have a typical α-NaFeO2 layered structure and the two morphological features of secondary particles needed in this study. The results of electrochemical properties indicated that the LiNCM electrode without collapsed secondary particles have a good stability in cycle performance compared to that with collapse of secondary particles at 0.5, 1.0 and 2 C-rate. The capacity retention of without and with collapsed NCM was 55.8% and 27.3% after 200 cycles at 1 C-rate, respectively.

BACKGROUND The optimal lymph node dissection with central vascular ligation is an important part for oncological outcomes after laparoscopic right-sided colon cancer surgery. Few studies have examined the clinical value of indocyanine green fluorescence imaging-guided D3 dissection for right-sided colon cancer. OBJECTIVES We assessed the clinical value of indocyanine green fluorescence imaging-guided laparoscopic surgery in improving the radicality of lymph node dissection for right-sided colon cancer by comparing the outcomes of conventional laparoscopic surgery. DESIGN The data were retrospectively reviewed and analyzed. SETTING This study was conducted at a single university hospital. PATIENTS A 1:2 matched case-control study included 25 patients undergoing fluorescence imaging-guided laparoscopic surgery and 50 patients undergoing conventional laparoscopic surgery for clinical T3 or T4 right-sided colon cancer between June 2016 and December 2017. MAIN OUTCOME MEASURES The extent of D3 dissection and pathological results (tumor stage, lymph node yield, and number of metastatic lymph nodes) were analyzed. RESULTS The 2 groups were similar in baseline characteristics. The numbers of harvested pericolic and intermediate lymph nodes were not different between the 2 groups. The numbers of central lymph nodes (14 vs 7, p < 0.001) and total harvested lymph nodes (39 vs 30, p = 0.003) were significantly higher in the fluorescence group than in the conventional group. In the multivariate analysis, the use of indocyanine green fluorescence imaging was an independently related factor for the retrieval of higher numbers of overall and central lymph nodes. The number of metastatic lymph nodes was not significantly different between the 2 groups. LIMITATIONS The results of this study were limited by its small patient numbers and retrospective nature. CONCLUSIONS Real-time indocyanine green fluorescence imaging of lymph nodes may improve the performance of more radical D3 lymph node dissection during laparoscopic right hemicolectomy for advanced right-sided colon cancer. See Video Abstract at http://links.lww.com/DCR/B150. LA CIRUGIA LAPAROSCOPICA GUIADA POR IMAGENES DE FLUORESCENCIA VERDE INDOCIANINA PODRIA LOGRAR UNA DISECCION RADICAL D3 EN PACIENTES CON CANCER DE COLON AVANZADO DEL LADO DERECHO: La diseccion optima de los ganglios linfaticos con ligadura vascular central es una parte importante para los resultados oncologicos despues de la cirugia laparoscopica de cancer de colon del lado derecho. Pocos estudios han examinado el valor clinico de la diseccion D3 guiada por imagenes de fluorescencia verde indocianina para el cancer de colon del lado derecho.Evaluamos el valor clinico de la cirugia laparoscopica guiada por imagen de fluorescencia verde indocianina para mejorar la radicalidad de la diseccion de ganglios linfaticos para el cancer de colon del lado derecho mediante la comparacion de los resultados de la cirugia laparoscopica convencional.Los datos se revisaron y analizaron retrospectivamente.Este estudio se realizo en un solo hospital universitario.Un estudio de casos y controles emparejado 1:2 incluyo a 25 pacientes sometidos a cirugia laparoscopica guiada por imagenes de fluorescencia y 50 pacientes sometidos a cirugia laparoscopica convencional para cancer de colon derecho clinico T3 o T4 entre Junio de 2016 y Diciembre de 2017.Se analizo el alcance de la diseccion D3 y los resultados patologicos (estadio tumoral, rendimiento de los ganglios linfaticos y numero de ganglios linfaticos metastasicos).Los dos grupos fueron similares en las caracteristicas basicas. El numero de ganglios linfaticos pericolicos e intermedios recolectados no fue diferente entre los dos grupos. El numero de ganglios linfaticos centrales (14 vs 7, p < 0.001) y el total de ganglios linfaticos recolectados (39 vs 30, p = 0.003) fueron significativamente mayores en el grupo de fluorescencia que en el grupo convencional. En el analisis multivariante, el uso de imagenes de fluorescencia verde indocianina fue un factor independiente relacionado para la recuperacion de un mayor numero de ganglios linfaticos centrales y globales. El numero de ganglios linfaticos metastasicos no fue significativamente diferente entre los dos grupos.Los resultados de este estudio fueron limitados por su pequeno numero de pacientes y su naturaleza retrospectiva.Las imagenes de fluorescencia verde indocianina en tiempo real de los ganglios linfaticos pueden mejorar el rendimiento de la diseccion mas radical de los ganglios linfaticos D3 durante la hemicolectomia derecha laparoscopica para el cancer de colon avanzado del lado derecho. Consulte Video Resumen en http://links.lww.com/DCR/B150.

Introduction There are several medical elective programs for low-income countries especially in medically vulnerable places. The Hospital Central de Quelimane (HCQ) is a regional hospital in Quelimane, capital city of the province of Zambezia in Mozambique. The HCQ serves as a regional base hospital for urgent and severe patients. Methods Four emergency medicine (EM) residents participated in our 2017-2018 rotational program for HCQ, to share medical knowledge with the local medical doctors and support the demands of medical equipment skills and educational programs. We determined the current capabilities of HCQ and designed a rotational program in accordance with the demands in the following areas: resuscitation, trauma, critical care, and radiology. We also introduced continuous education programs and administrative methods for future development of education. Results Throughout the four rotations of our EM residents, we conducted daily education and several practical lessons based on the demands of the local doctors and equipment operation. The educational program was administered by an educational administrator who was responsible for updating the medical and technical knowledge of doctors. With our programs, the doctors of HCQ were able to perform resuscitation and critical protocols, including manipulating equipment such as mechanical ventilator and defibrillator. Conclusion The rotation program by the four residents was successful, in terms of sharing medical knowledge and equipment management, and filling gaps identified in the operation of a modern hospital.

The number of digital healthcare mobile applications in the market is exponentially increasing owing to the development of mobile networks and widespread usage of smartphones. However, only few of these applications have been adequately validated. Like many mobile applications, in general, the use of healthcare applications is considered safe; thus, developers and end users can easily exchange them in the marketplace. However, existing platforms are unsuitable for collecting reliable data for evaluating the effectiveness of the applications. Moreover, these platforms reflect only the perspectives of developers and experts, and not of end users. For instance, typical clinical trial data collection methods are not appropriate for participant-driven assessment of healthcare applications because of their complexity and high cost. Thus, we identified the need for a participant-driven data collection platform for end users that is interpretable, systematic, and sustainable, as a first step to validate the effectiveness of the applications. To collect reliable data in the participatory trial format, we defined distinct stages for data preparation, storage, and sharing. The interpretable data preparation consists of a protocol database system and semantic feature retrieval method that allow a person without professional knowledge to create a protocol. The systematic data storage stage includes calculation of the collected data reliability weight. For sustainable data collection, we integrated a weight method and a future reward distribution function. We validated the methods through statistical tests involving 718 human participants. The results of a validation experiment demonstrate that the compared methods differ significantly and prove that the choice of an appropriate method is essential for reliable data collection, to facilitate effectiveness validation of digital healthcare applications. Furthermore, we created a Web-based system for our pilot platform to collect reliable data in an integrated pipeline. We compared the platform features using existing clinical and pragmatic trial data collection platforms.

We aimed to evaluate whether a short distal resection margin (p p = 0.008). Subgroup analysis revealed that a distal resection margin of p = 0.001). A distal resection margin of

Lateral pelvic node dissection has significant technical difficulty and a high incidence of surgical morbidity. A steep learning curve is anticipated in performing lateral pelvic node dissection. However, no study has previously analyzed the learning curve and surgical skill acquisition for this complex procedure.We aimed to evaluate the learning process for performing robotic total mesorectal excision with lateral pelvic node dissection in patients with rectal cancer.This is a retrospective analysis of a prospectively collected database.This study was conducted at a tertiary cancer center.A total of 100 patients who underwent robotic total mesorectal excision with lateral pelvic node dissection between 2011 and 2017 were included.A cumulative sum analysis was calculated based on the number of unilateral retrieved lateral pelvic nodes. Operative time, estimated bloodloss, lateral pelvic node metastatic rate, postoperative morbidities, and local recurrence were also analyzed.Cumulative sum modeling suggested 4 learning phases: learning I (33 patients), learning II (19 patients), consolidation (30 patients), and competence (18 patients). In the consolidation and competence phases, we adopted fluorescence imaging and standardized the surgical procedure on the basis of anatomical planes. The competence phase had the greatest number of unilateral retrieved lateral pelvic nodes (12.8 vs 4.9, 8.2, and 10.4; p0.001). Urinary complications, including urinary retention and postoperative α-blocker usage, were more frequently observed in learning phase I than in the competence phase (39.4% vs 16.7%, p = 0.034). During the median follow-up of 44.2 months, local recurrence in the pelvic sidewall was observed in 4 patients from learning phase I and in 1 patient from learning phase II.This study was limited by its retrospective design.Completeness of the lateral pelvic node dissection procedure increased with the surgeon's experience and as new imaging systems and surgical technique standardization were implemented. Further studies are warranted to determine the oncologic outcomes associated with each phase. See Video Abstract at http://links.lww.com/DCR/B774.ANTECEDENTES:La disección linfática pélvica lateral tiene una dificultad técnica significativa y una alta incidencia de morbilidad quirúrgica. Se prevé una curva de aprendizaje muy pronunciada al realizar la disección linfática pélvica lateral. Sin embargo, ningún estudio ha analizado previamente la curva de aprendizaje y la adquisición de habilidades quirúrgicas para este procedimiento.OBJETIVOS:Nuestro objetivo fue evaluar el proceso de aprendizaje para realizar la escisión total de mesorrecto robótica con disección linfática pélvica lateral en pacientes con cáncer de recto.DISEÑO:Este es un análisis retrospectivo de una base de datos recopilada prospectivamente.AJUSTE:Este estudio se realizó en un centro oncológico terciario.PACIENTES:Un total de 100 pacientes fueron sometidos a escisión total de mesorrecto robótica con disección linfática pélvica lateral entre 2011 y 2017.PRINCIPALES MEDIDAS DE DESENLACE:Se calculó un análisis de suma acumulativa basado en el número unilateral de ganglios pélvicos laterales recuperados. También se analizaron el tiempo operatorio, la pérdida de sangre estimada, la tasa de metástasis ganglionares pélvicas laterales, las morbilidades postoperatorias y la recidiva local.RESULTADOS:El modelado total acumulativo sugirió cuatro fases de aprendizaje: aprendizaje I (33 pacientes), aprendizaje II (19 pacientes), consolidación (30 pacientes) y competencia (18 pacientes). En las fases de consolidación y competencia, adoptamos imágenes de fluorescencia y estandarizamos el procedimiento quirúrgico basado en planos anatómicos, respectivamente. La fase de competencia tuvo el mayor número de ganglios pélvicos laterales recuperados unilateralmente (12,8 frente a 4,9, 8,2 y 10,4; p0,001). Las complicaciones urinarias, incluida la retención urinaria y el uso posoperatorio de bloqueadores beta, se observaron con más frecuencia en la fase de aprendizaje I que en la fase de competencia (39,4% frente a 16,7%, p = 0,034). Durante la mediana de seguimiento de 44,2 meses, se observó una recidiva local en la pared lateral pélvica en cuatro pacientes de la fase de aprendizaje I y en un paciente de la fase de aprendizaje II.LIMITACIONES:Este estudio estuvo limitado por su diseño retrospectivo.CONCLUSIÓNES:La completitud del procedimiento de disección linfática pélvica lateral aumentó con la experiencia del cirujano y a medida que se implementaron nuevos sistemas de imágenes y estandarización de técnicas quirúrgicas. Se necesitan más estudios para determinar los resultados oncológicos asociados con cada fase. Consulte Video Resumen en http://links.lww.com/DCR/B774.

More than 25% of patients with node-negative colorectal cancer experience a recurrent disease even after curative surgery. This suggests the existence and oncologic influence of micrometastasis in regional lymph nodes or in distant organs. The objective of this study was to identify mesorectal lymph node micrometastases using an immunohistochemical analysis and to determine its prognostic value in node-negative rectal cancer after neoadjuvant chemoradiation.A total of 91 patients who received preoperative chemoradiation and radical resection for rectal cancer were included. Based on conventional hematoxylin and eosin staining, all patients had a node-negative disease. Mesorectal lymph nodes from resected specimens were re-evaluated to detect micrometastases by immunohistochemistry using anticytokeratin antibody AE1/AE3. The clinicopathologic data were collected from a prospectively maintained database of colorectal cancer patients and analyzed retrospectively.Micrometastases of mesorectal lymph nodes were detected in nine patients (9.9%). The three-year overall survival was similar regardless of micrometastasis (88.9% in the positive group versus 90.7% in the negative group, P = 0.681); however, the three-year disease-free survival was significantly poorer in the patients with micrometastases (40.0% versus 84.2%, P = 0.001). In the multivariate analysis, the advanced pT category (ypT3/T4 versus ypT0: hazard ratio [HR] 10.477, 95% confidence interval [CI] 1.102-99.594, P = 0.041) and micrometastases in mesorectal lymph nodes (HR 5.655, 95% CI 1.837-17.409, P = 0.003) were independent prognostic factors for disease-free survival.In node-negative rectal cancer after preoperative chemoradiation, immunohistochemically detected micrometastases of mesorectal lymph nodes were significantly correlated with poor disease-free survival.

The manual reading of capsule endoscopy (CE) videos in small bowel disease diagnosis is time-intensive. Algorithms introduced to automate this process are premature for real clinical applications, and multi-diagnosis using these methods has not been sufficiently validated. Therefore, we developed a practical binary classification model, which selectively identifies clinically meaningful images including inflamed mucosa, atypical vascularity or bleeding, and tested it with unseen cases. Four hundred thousand CE images were randomly selected from 84 cases in which 240,000 images were used to train the algorithm to categorize images binarily. The remaining images were utilized for validation and internal testing. The algorithm was externally tested with 256,591 unseen images. The diagnostic accuracy of the trained model applied to the validation set was 98.067%. In contrast, the accuracy of the model when applied to a dataset provided by an independent hospital that did not participate during training was 85.470%. The area under the curve (AUC) was 0.922. Our model showed excellent internal test results, and the misreadings were slightly increased when the model was tested in unseen external cases while the classified ‘insignificant’ images contain ambiguous substances. Once this limitation is solved, the proposed CNN-based binary classification will be a promising candidate for developing clinically-ready computer-aided reading methods.

NPU Scheduler Tiling memory transactions between internal memories and external memories Communicating with AP Host and other processing units

The west coast of South Korea is characterized by a wide macrotidal area with a maximum tidal range of ∼10 m. The sea surface elevation varies with the tidal phase, which leads to significant changes in the vertical structure of the physical, chemical, and biological properties of the water column, especially when the interaction by waves and/or the freshwater and sediment input from the river increases. Under such conditions, it is difficult to carry out continuous and consistent measurements of the vertical structures of the water qualities using a conventional observation system that is fixed to the seabed or sea surface because the thickness of the water column constantly changes. Based on the demand for long-term observations of the vertical structures of the water properties in macrotidal environments, the Intelligent Buoy System (INBUS) was developed by the Korea Institute of Ocean Science and Technology (KIOST). INBUS is a buoy equipped with an instrument frame, which is similar to other buoys that are fixed to the sea surface. During every measurement, INBUS detects the water depth and sends the frame down to the seabed to measure the water quality at every vertical level set up in the system. For example, if N levels are set in INBUS, the water depth of each measurement is divided by N layers and the instruments in the lifting frame measure the water properties of each of the N layers while they are descending to the bottom. Based on this procedure, the vertical structure of the water column is consistently measured in N layers regardless of changes of the water depth due to tides and waves. The lifting and measuring process is automatically controlled by INBUS once it is set up in the system. In addition, because INBUS allows bidirectional communication through code division multiple access (CDMA), the system can be controlled by stations on land. If the CDMA communication becomes inoperable owing to extreme wave conditions or the buoy is lost because of incidents such as a collision with a ship, the location of INBUS can be tracked by low-earth-orbit satellites.

Objective Smart glasses can provide sonographers with real-time ultrasound images. In the present study, we aimed to evaluate the utility of smart-glasses for ultrasound-guided peripheral venous access. Methods In this randomized, crossover-design, simulation study, 12 participants were recruited from the emergency department residents at a university hospital. Each participant attempted ultrasound-guided peripheral venous access on a pediatric phantom at intervals of 5 days with (glasses group) or without (non-glasses group) the use of smart glasses. In the glasses group, participants confirmed the ultrasound image through the lens of the smart glasses. In the non-glasses group, participants confirmed the ultrasound image through the display viewer located next to the phantom. Procedure time was regarded as the primary outcome, while secondary outcomes included the number of head movements for the participant, number of skin punctures, number of needle redirections, and subjective difficulty. Results No significant differences in procedural time were observed between the groups (non-glasses group: median time, 15.5 seconds; interquartile range [IQR], 10.3 to 27.3 seconds; glasses group: median time, 19.0 seconds; IQR, 14.3 to 39.3 seconds; P=0.58). The number of head movements was lower in the glasses group than in the non-glasses group (glasses group: median, 0; IQR, 0 to 0; non-glasses group: median, 4; IQR, 3 to 5; P

In this study, tidal stream energy resources of the Southwestern Sea of Korea were assessed using a numerical model, Modelo Hidrodinâmico (MOHID). This numerical model is based on the finite volume method, which allows numerical experiments on estuaries, coasts, and oceans. For the numerical experiment, we used grid data of at least 90 m resolution by applying bathymetry data created by the Korea Institute of Ocean Science & Technology (KIOST) and FES2012 data as a tidal boundary condition. Strong tidal currents occur in the Southwestern Sea of Korea due to the characteristics of the tidal systems of the West Sea and the South Sea, and the topographical characteristics of a Ria coast. These characteristics were appropriately reproduced by the numerical experiment. Accordingly, the average and maximum tidal currents calculated by the numerical model were used in the assessment. Two regions, Jangjuk and Maenggol-Geocha, were selected as the candidate areas for tidal stream energy development. In addition, the amounts of tidal stream energy resources were evaluated using geographical information system-based spatial analysis by applying the tidal current, depth data, and area of each region. The resource amounts were estimated to be 4,841 MW, with 5,743 tidal stream energy converters (TECs) for Jangjuk, and 3,497 MW, with 3,676 TECs for Maenggol-Geocha.