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We report the first case of using an anterior scalene plane block at the superior trunk level achieving phrenic nerve blockade to treat intolerable referred shoulder pain after liver Radiofrequency Ablation (RFA) of a diaphragm-abutting liver tumor despite prevention with a full-dose non-steroidal anti-inflammatory drug. The anterior scalene plane block rapidly alleviated pain without significant complications.

Background/purpose: Hepatic encephalopathy (HE), a major neuropsychiatric complication in advanced liver disease, is associated with poor prognosis. Sarcopenia, characterized by a decline in muscle mass, strength, and physical performance, is prevalent in liver cirrhosis. This study aims to explore whether sarcopenia is associated with HE in cirrhotic patients. Methods: PubMed and EMBASE were searched for relevant cohort and case-control studies investigating the association between sarcopenia and HE up to July 2018. Data of patients' characteristics, definition of low muscle mass, and protocols of grading/diagnosing HE were retrieved. The primary outcome was estimated by a pooled odds ratio (OR) and its 95% confidence interval (CI), using a random effect model. Results: The meta-analysis enrolled 6 studies, comprising 1795 patients. Sarcopenia was positively associated with the presence of HE (OR 2.74 with a 95% CI, 1.87 to 4.01). The association was less likely to be influenced by differences in research designs, focused study outcomes, muscle mass measurements, and protocols of grading/diagnosing HE. There was lack of evidence supporting higher serum ammonia levels in patients with sarcopenia. Conclusion: In patients with liver cirrhosis, there is a significant association between sarcopenia and HE. A greater number of prospective studies are necessary to clarify whether the association remains even after adjusting relevant confounders and to suggest effective prevention of HE in patients with coexisting sarcopenia. Keywords: Liver, Malnutrition, Skeletal muscle, Neurology, Ammonia

To describe patient characteristics associated with preoperative anxiety and subsequently assess the relationship between preoperative anxiety and postoperative anxiety, pain, sleep quality, nausea and vomiting.The study collected data from patients undergoing elective operation from 12 hospitals in China. The State-Trait Anxiety Inventory (STAI) and the Athens Insomnia Scale (AIS) were used to assess anxiety and sleep quality before surgery. Evaluations of anxiety, pain, sleep quality, nausea and vomiting were quantified using the Visual Analogue Scale on postoperative days 1 and 2.Data from 997 patients were analyzed. Preoperatively, 258 (25.9%) patients had high anxiety (STAI-State44). Multivariate analyses showed a significant relationship between high anxiety and female gender (OR: 1.66, 95% CI: 1.08-2.57, p = 0.02), highly invasive surgery (OR: 2.29, 95% CI: 1.29-4.06, p = 0.005), higher trait anxiety (OR: 1.24, 95% CI: 1.20-1.28, p 0.001) and insomnia (AIS ≥ 6, OR: 1.79, 95% CI: 1.17-2.76, p = 0.008). Preoperative anxiety demonstrated a negative correlation with postoperative anxiety following highly invasive surgery; this became a positive relationship following less invasive surgery. Preoperative anxiety was also positively related to postoperative pain and poor sleep quality. The correlation between preoperative anxiety and postoperative nausea and vomiting was not statistically significant.Female gender, highly invasive surgery, higher trait anxiety and insomnia are independent risk factors for high preoperative anxiety. Surgical invasiveness influences association between pre- and postoperative anxiety. Higher preoperative anxiety is related to poorer sleep quality and more severe pain postoperatively.

First-principles calculations based on density functional theory (DFT) and the generalized gradient approximation (GGA) have been used to study the adsorption of CO and NO molecules on the Cu2O(1 1 1) surface in the presence of oxygen vacancy. The calculations employ slab geometry and periodic boundary conditions with partial relaxation of atom positions. Two molecular orientations, X- and O-down (X = C, N), at two distinct sites, Cu1C and oxygen vacancy sites, have been considered. Total energy calculations indicate that the Cu1C position is relatively more favored than the oxygen vacancy site. The predicted binding energies are 144.5 kJ mol−1 (CO) and 124.1 kJ mol−1 (NO), respectively. The C–O and N–O stretching frequencies are unequally red-shifted upon adsorption. Upon adsorption at Cu1C site, CO molecule was found to bind to Cu1C atoms in vertical configuration whereas NO molecule adsorption in tilted mode. While upon adsorption at oxygen vacancy site, CO and NO molecules are both vertical to the Cu2O(1 1 1) surface. Interestingly, we found that their adsorption properties on oxygen vacancy site are dependent on the defect density. As the density of defective sites increased, the adsorption energies of the defect-XO configuration increase and the N–O bond is continuously weakened whereas the C–O bond remains constant. Therefore, such a process favors the dissociation of the NO molecule and has a small influence on the adsorbed CO molecule.

The identifiability of spatial variable coefficients for vibration string and Euler-Bernoulli beam are considered. It is shown that the coefficients can be determined by means of boundary control and observation in finite time duration. These results can be considered as the generalization of infinite time coefficients identifiability through the application of Ingham-Beurling theorem.

Background & Aims : Hepatitis B virus (HBV) genotype C is associated with the development of hepatocellular carcinoma (HCC), compared with genotype B. This study aims to investigate whether HBV genotypes influence the clinicopathologic features and long-term prognosis of patients after curative resection of HCC. Methods : Stored serum samples from 62 patients with HBV-related HCC were tested for HBV genotype using a molecular method. Results : Sixty of 62 patients (96.8%) undergoing curative resection of HCC were infected with genotype B or C. Concomitant cirrhosis was encountered more frequently in patients with genotype C. During a mean follow-up period of 26.3 ± 9.8 months, patients with genotype B had a lower overall tumor recurrence rate than those with genotype C (22% vs. 46%; P = 0.04). Stepwise multiple Cox proportional hazards regression analysis showed that multiplicity of tumor (hazard ratio, 6.84; 95% confidence interval [CI], 1.45–32.2; P = 0.02) was associated with tumor recurrence, whereas genotype C and age were associated with borderline significance (P = 0.06). Stratified analysis showed that genotype C was still associated with tumor recurrence in cirrhotic patients with borderline significance by univariate analysis (hazard ratio, 3.8; 95% CI, 0.84–17.6; P = 0.07). However, cumulative 2-year survival rates were similar between patients with genotype B and C (92% vs. 85%; P = 0.23). Conclusions : Our data suggest that patients with HCC with genotype C have a greater tumor recurrence rate after curative resection of HCC compared with those with genotype B. Prolonged follow-up is needed to clarify the impact of HBV genotype on postoperative outcome.

The mechanisms and technical methods of plastic precision cropping are studied in this paper. Through the finite element analysis and experimental studies on the process of cropping under axial load, strain and stress distributions and the propagating process of plastic deformation of cropping under axial load as well as the effects of the technical factors such a the axial load, clearance, relative length of the cropped parts, etc., on the cropping process and quality are revealed.

In this paper, different methods to implement brittle precision cropping of metal materials are discussed in an all-around way. On this basis, a new kind of brittle precision cropping method, called low impact stress cropping method (LISC), is developed. Taking advantage of the effects of notch and speed, this method, in the sensitive stress state established by an appropriate way of loading, can make the material separate quickly and regularly. It has the advantages of being high in efficiency and accuracy, low in energy consumption and easy to use in production. It can be used directly in precision billet production for cold-extrusion, etc. This method, from a general point of view, opens a new technical branch for engineering application of fracture mechanics. The basic theory, technical key points, as well as the equipment for practical realization of this method are discussed in detail in this paper.

The Controlled Fracture Technique studies how to prepare artificial cracks as well as how to make them propagate along the given path to realize the aim of precision separation of continuous interface of materials. It is of vital significance for billet production in the metalworking field. This paper introduces in detail the basic principles, such as the theory of artificial notching (cracking), the theory of regular fracturing etc. of the Controlled Fracture Technique. The methods of rotatory bending cropping and Low Impact Stress Cropping (LISC) presented in this paper, are free from the drawbacks of traditional shearing methods and have the advantages of being high in efficiency and accuracy, low in energy consumption, and feasible to use in production.

Background & Aims The efficacy of treatment of Helicobacter pylori infection has decreased steadily because of increasing resistance to clarithromycin, metronidazole, and levofloxacin. Resistance to amoxicillin is generally low, and high intragastric pH increases the efficacy of amoxicillin, so we investigated whether a combination of a high-dose proton pump inhibitor and amoxicillin (dual therapy) was more effective than standard first-line or rescue therapies in eradicating H pylori . Methods We performed a large-scale multihospital trial to compare the efficacy of a high-dose dual therapy (HDDT) with that of standard therapies in treatment-naive (n = 450) or treatment-experienced (n = 168) patients with H pylori infection. Treatment-naive patients were randomly assigned to groups given HDDT (rabeprazole 20 mg and amoxicillin 750 mg, 4 times/day for 14 days, group A1), sequential therapy for 10 days (group B1), or clarithromycin-containing triple therapy for 7 days (group C1). Treatment-experienced patients were randomly assigned to groups given HDDT for 14 days (group A2), sequential therapy for 10 days (B2), or levofloxacin-containing triple therapy for 7 days (C2). H pylori infection was detected by using the 13 C-urea breath test. We evaluated factors associated with treatment outcomes. Results In the intention-to-treat analysis, H pylori was eradicated in 95.3% of patients in group A1 (95% confidence interval [CI], 91.9%−98.8%), 85.3% in B1 (95% CI, 79.6%−91.1%), and 80.7% in group C1 (95% CI, 74.3%−87.1%). Infection was eradicated in 89.3% of patients in group A2 (95% CI, 80.9%−97.6%), 51.8% in group B2 (95% CI, 38.3%−65.3%), and 78.6% (95% CI, 67.5%−89.7%) in group C2. The efficacy of HDDT was significantly higher than that of currently recommended regimens, irrespective of CYP2C19 genotype. Bacterial resistance to drugs was associated with treatment failure. There were no significant differences between groups in adverse events or patient adherence. Conclusions HDDT is superior to standard regimens as empirical first-line or rescue therapy for H pylori infection, with similar safety profiles and tolerability. ClinicalTrials.gov number: NCT01163435.

Background: The increased primary and acquired resistance rates of H. pylori to clarithromycin, metronidazole, and levofloxacin have resulted in a significant reduction in the efficacy of various anti-H. pylori regimens. We recently demonstrated that an optimized high-dose dual therapy (HDDT) is superior to the standard triple therapy (TT) or sequential therapy (ST) for H. pylori infection in a large-scale multi-hospital, randomized, comparative study (Clinical Gastro & Hepato, in press). Because the global prevalence of primary and acquired resistance to amoxicillin (AMO) is rare, we hypothesize that HDDT can be used repeatedly and empirically for H. pylori treatment without a reduction of eradication efficacy. Aim: To evaluated the cumulative efficacy of repeated HDDT treatment for first-line and rescue antiH. pylori therapy. Methods: A total of 618 patients with H. pylori infection diagnosed by endoscopy with biopsy for histology examination and bacterial culture were recruited in this multi-hospital study and were randomly allocated to receive HDDT, TT, or ST for therapy. As reported in our previous study, H. pylori was eradicated in 143 out of 150 (95.3%; 95% C.I. 92.9-97.8) treatment-naive patients receiving the first course of HDDT (rabeprazole 20 mg + AMO 750 mg, qid for 14 days). Six patients who failed in the first HDDT treatment received the second course of HDDT. For treatment-experienced patients, 68 out of 84 patients failed in TT and 25 out of 45 patients failed in ST received the first course of HDDT. The second course of HDDT was used again if the first course failed. Four to eight weeks after termination of each treatment, H. pylori infection status was examined by the C13-urea breath test. The E-test was used to evaluate the antibiotics resistances of H. pylori strains before and after failed treatment of repeated HDDT. Results: Five out of 6 treatment-naive patients had successfully H. pylori eradication by a second course of HDDT, resulting in a cumulative eradication rate of 98.7% (148/150; 95% C.I. 97.3-100.0) in the intention-to-treat (ITT) analysis, and 99.3% (148/149; 95% C.I. 98.4-100.3) in perprotocol (PP) analysis. For the treatment-experienced patients, H. pylori was successfully eradicated in 90.3% (84/93; 95% C.I. 85.9-94.7) of patients with first course of HDDT treatment. Seven out of 9 patients who failed in the first HDDT treatment achieved H. pylori eradication with a second course of HDDT. The cumulative eradication rate was 97.8% (91/ 93; 95% C.I. 95.7-100.0) in both ITT and PP analyses. The susceptibility of H. pylori to antibiotics did not significantly impact eradication rates. Conclusion: HDDT consisting of a PPI and AMO given four times daily is highly efficacious when it is used repeatedly for H. pylori eradication. Thus, H. pylori susceptibility testing may be avoided by using HDDT.