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Abstract  Selective internal radiation (SIR) therapy using 90yttrium microspheres is effective for treating selected cases of unresectable liver malignancies with little morbidity. We herein report two cases illustrating a very rare complication of SIR. A 68-year-old patient with inoperable recurrent hepatocellular carcinoma received one treatment of SIR with 90yttrium microspheres and 4 months later presented with obstructive jaundice. Percutaneous transhepatic cholangiography revealed diffusely dilated intrahepatic ducts with multiple biliary strictures. Hepatic angiography showed normal hepatic arterial branches with no evidence of vascular insufficiency. Liver biopsy finally revealed cholestasis, cholangitis, and fibrosis, consistent with radiation-induced damage. Another 56-year-old patient with unresectable colorectal liver metastases presented with cholangitis 4 weeks after SIR. Ultrasonography showed no biliary dilatation, and endoscopic retrograde cholangiopancreatography demonstrated a normal biliary tree. Liver biopsy subsequently confirmed radiation-induced cholangitis. [ABSTRACT FROM AUTHOR]

A cross-region prediction model named SeisEML (an acronym for Seismological Ensemble Machine Learning) has been developed in this paper to predict the peak ground acceleration (PGA) at a given site during an earthquake. The SeisEML model consists of hybridized models, kernel-based algorithms, tree regression algorithms, and regression algorithms. The model ablation study is conducted to examine the performance and the selection of meta-machine learning models in the SeisEML. The training and testing dataset consists of 20852 and 6256 accelerograms recorded by the Kyoshin Network, Japan. The mean absolute error (MAE) and root mean square error (RMSE) have been utilized to compare the predicted peak ground acceleration (PGA) for the test data. The SeisEML model yields approximately half the MAE and RMSE values obtained with conventional attenuation relations. The SeisEML model has been used to compute Japan's iso acceleration contour map of three earthquakes ( M JMA 7.4, 6.6, and 6.1). The qualitative comparison of iso acceleration contours obtained from actual and predicted PGA using SeisEML clearly shows that the model can reliably predict the PGA distribution during an earthquake compared to the regional ground motion prediction equation (GMPE). The cross-region prediction was performed on the datasets of the Iranian earthquakes using SeisEML. The comparison of predicted and observed peak ground acceleration in terms of MAE and RMSE shows that the machine learning model's performance is superior to the regional attenuation relation. The predictions of PGA from the developed ML model indicate that this trained model has the potential for predicting regional and global scenarios with similar tectonic setups. The ML model developed in this paper can considerably enhance the reliability of PGA prediction for seismic hazard mapping of any region and can serve as a reliable substitute for GMPEs. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive approach has been increasingly applied in liver resection. However, laparoscopic major hepatectomy is technically demanding and is practiced only in expert centers around the world. Conversely, use of robot may help to overcome the difficulty and facilitate major hepatectomy.Methods: Between September 2010 and March 2019, 151 patients received robotic hepatectomy for various indications in our center. 36 patients received robotic hemihepatectomy: 26 left hepatectomy and 10 right hepatectomy. During the same period, 737 patients received open hepatectomy and out of these, 173 patients received open hemihepatectomy. A propensity score-matched analysis was performed in a 1:1 ratio.Results: After matching, there were 36 patients each in the robotic and open group. The two groups were comparable in demographic data, type of hemihepatectomy, underlying pathology, size of tumor, and background cirrhosis. Conversion was needed in 3 patients (8.3%) in the robotic group. There was no operative mortality. The operative blood loss and resection margin were similar. Though not significantly different, there was a higher rate of complications in the robotic group (36.1% vs. 22.2%) and this difference was mostly driven by higher intra-abdominal collection (16.7% vs. 5.6%) and bile leak (5.6% vs. 2.8%). Operative time was significantly longer (400.8 ± 136.1 min vs 255.4 ± 74.4 min, P < 0.001) but the postoperative hospital stay was significantly shorter (median 5 days vs 6.5 days, P = 0.040) in the robotic group. When right and left hepatectomy were analyzed separately, the advantage of shorter hospital stay remained in left but not right hepatectomy. For patients with hepatocellular carcinoma, there was no difference between the two groups in 5-year overall and disease-free survival.Conclusion: Compared with the open approach, robotic hemihepatectomy has longer operation time but shorter hospital stay. Thus, use of robot is feasible and effective in hemihepatectomy with the benefit of shorter hospital stay. [ABSTRACT FROM AUTHOR]

An earlier article, inspired by overflow models in telecommunication systems with multiple streams of telephone calls, proposed a new analytical model for a network of intensive care units (ICUs), and a new patient referral policy for such networks to reduce the blocking probability of external emergency patients without degrading the quality of service (QoS) of canceled elective operations, due to the more efficient use of ICU capacity overall. In this work, we use additional concepts and insights from traditional teletraffic theory, including resource sharing, trunk reservation, and mutual overflow, to design a new patient referral policy to further improve ICU network efficiency. Numerical results based on the analytical model demonstrate that our proposed policy can achieve a higher acceptance level than the original policy with a smaller number of beds, resulting in improved service for all patients. In particular, our proposed policy can always achieve much lower blocking probabilities for external emergency patients while still providing sufficient service for internal emergency and elective patients. In addition, we provide new accurate and computationally efficient analytical approximations for QoS evaluation of ICU networks using our proposed policy. We demonstrate numerically that our new approximation method yields more accurate, robust and conservative results overall than the traditional approximation. Finally, we demonstrate how our proposed approximation method can be applied to solve resource planning and optimization problems for ICU networks in a scalable and computationally efficient manner. [ABSTRACT FROM AUTHOR]

The impact of thermal and chemical pretreatments on the physicochemical, rheological, and functional properties of sweet potato flour was investigated. The chemical pretreatment consisted in dipping peeled sweet potatoes in 1 % ( w/ v) calcium chloride (CaCl), while the thermal pretreatment was achieved by blanching them in tap water at 90 °C for 1 min. Composition in flour moisture, protein, fat, non-reducing sugars, and starch was determined using standard methods. Particle size, color, gelatinization, and rheological properties were analyzed. The water absorption index (WAI) and water solubility index (WSI), as well as the swelling capacity (SC) and sorption isotherms, were determined. The reducing sugar content of sweet potato flour was slightly higher in CaCl-pretreated (SSPCaCl) samples than that in blanched (SSPB) and control (SSP) samples. However, the lightness of the SSPB sample was lower than that of the SSPCaCl and SSP samples. SSPCaCl sample had the higher value of enthalpy of gelatinization and elasticity modulus G′. The SC was higher in blanched samples. A slight increase in the constant of water binding energy ( C) was observed after the CaCl treatment and a marked increase for the blanched sample. Owing to the differences induced by blanching and CaCl pretreatments, CaCl-pretreated flour samples are more suitable for bread-making processes and can also be used in food formulations. [ABSTRACT FROM AUTHOR]

Background: Mirizzi syndrome (MS) is a rare complication of gallstone disease. Despite the fact that successful laparoscopic treatments have been reported, open surgery remains the gold standard approach for this disease due to technical difficulties involved. Methods: A minimally invasive strategy combining endoscopic retrograde cholangiopancreatography (ERCP) and robotic surgery for the management of MS was implemented in early 2012. This consisted of a preoperative ERCP for definitive diagnosis and endoscopic stent insertion. Robotic surgical approach was used during operation to facilitate gall bladder removal and suture of defect over common duct. ERCP was repeated postoperatively for stent removal. Patient demographics and treatment outcomes were collected prospectively. A historical cohort of patients with MS who underwent conventional surgery between 1999 and 2011 was identified for comparison of treatment outcomes. Results: Five patients with MS were managed with this strategy. Robotic subtotal cholecystectomy was successfully performed in all the patients without conversion or morbidity. When compared with a historical cohort of 17 patients who underwent surgery for MS, this group of patients had significantly less conversion and shorter hospital stay though the operation time was longer. It also showed less blood loss and less postoperative complications but these were not statistically significant. Conclusion: Mirizzi syndrome can be effectively managed with a minimally invasive approach by adopting a robot-assisted surgery together with a planned pre- and postoperative ERCP. [ABSTRACT FROM AUTHOR]