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Background Postoperative pain control after the minimally invasive repair of pectus excavatum (MIRPE) is essential, but there is a controversy about a better analgesic method between epidural and intravenous (IV) analgesia. This systematic review and meta-analysis aimed to compare the effect of epidural versus IV analgesia following MIRPE. Methods We searched PubMed, MEDLINE, EMBASE, Cochrane Central Register, and ClinicalTrials.gov for randomized control trials (RCTs) dated up to 31st May 2021. The primary outcome was the area under the curve (AUC) of the weighted mean visual analog scale (VAS) after MIRPE. The secondary outcomes were postoperative nausea, operation time, total operating room time, and postoperative length of hospital stay. Results Four RCTs involving 243 patients were finally included in this meta-analysis. The AUC of the weighted mean VAS was 343.62 in the epidural group and 375.24 in IV group. Epidural group showed lower VAS than IV group at 12 hours (mean difference -0.99 [95% CI: -1.52, -0.47], P = 0.001, I2 = 0%), at 24 hours (mean difference -0.65 [95% CI: -1.15, -0.16], P = 0.009, I2 = 0%), and 48 hours (mean difference -0.81 [95% CI: -1.61, -0.01], P = 0.046, I2 = 46%) after the surgery. Conclusion Epidural analgesia after the MIRPE had a better analgesic effect than IV analgesia from 12 hours to 48 hours after surgery, and AUC of VAS was lower in the epidural group. However, IV analgesia may also be a viable option, and physicians should wisely choose analgesic modalities after MIRPE.

Background: Giant lip hemangioma is a rare disease that may cause difficulty in preoxygenation and ventilation when using face masks and intubation during general anesthesia induction.Case: A laparoscopic cholecystectomy was planned for a 77-year-old woman. The patient had a giant lower lip hemangioma that was 12 x 5 x 5 cm, which made preoxygenation and ventilation through a face mask impossible and put her at risk of hemangioma rupture. We preoxygenated her through a high-flow nasal cannula (HFNC). Following propofol and succinylcholine administration, we intubated the patient with a video laryngoscope without desaturation, hemangioma rupture, or CO2 retention. Conclusions: HFNC is a useful tool when difficult intubation is expected in patients who have problems using conventional face masks.

Background This study aimed to evaluate the efficacy and safety of a topical antioxidant cream containing tocotrienol after 1064-nm picosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment for environment-induced skin pigmentation.Methods A split-face study was conducted between December 2020 and March 2021 in 26 patients (25 women and one man) who were treated with a 1064-nm picosecond Nd:YAG laser. On the right side of the face, an antioxidant cream containing tocotrienol was applied after picosecond laser treatment, and on the left side, only picosecond laser treatment was performed. We compared the right and left sides of the face at 4 weeks after laser treatment using an automatic skin analysis device to investigate skin pigmentation. The melasma severity scores of the two sides were evaluated before and 4 weeks after picosecond laser treatment.Results The skin pigmentation score showed a significant difference between pretreatment and 4 weeks after picosecond laser treatment on both sides of the face (P0.05).Conclusions Our results show that, for the treatment of environment-induced skin pigmentation, the application of a tocotrienol-containing antioxidant cream after 1064-nm picosecond laser treatment can provide good results without any complications.

Background: Pilonidal sinus, occurring in 7% of the population, is a disease found in the cleavage of the buttocks, typically in young males after puberty. This study explored the utility of the leaf flap, a unilobed fasciocutaneous transposition flap, as a reconstructive method for treating pilonidal sinus on the sacrococcygeal area.Methods: We present cases of eight patients with pilonidal sinus who underwent unilobed fasciocutaneous transposition flap surgery. Patients complaining of an abscess in the sacrococcygeal region were initially treated with a minimal incision to drain the abscess, and 14 days of antibiotics administration. Afterwards, the patients were re-evaluated at the outpatient clinic and scheduled for a leaf flap procedure 4 weeks after drainage. Hospitalization, the time required for full activity, and complication rates were recorded.Results: Minor postoperative complications were observed in one patient (12.5%). The patient required re-suturing of his wound due to an infection and wound dehiscence. The mean hospitalization was 10 days (range, 5–23 days), and the period required to return to daily activities was 4 weeks.Conclusion: The leaf flap procedure is recommended because it is a relatively easy method for surgeons, and also because the flap has abundant perfusion. This surgical method was used as the first treatment of choice for sacrococcygeal pilonidal sinus, with the advantages of less patient discomfort, fast healing of the site and short hospitalization. Our results support the leaf flap surgery as a favored treatment for pilonidal sinus.

Drowsiness during driving is a severe problem that must be addressed to improve road safety. Numerous counter-measures have been proposed to resolve this issue like adaptive environmental settings (temperature, sound, and light). The objective of this study was to accurately predict the effects of exposure to different colors of light on human drowsiness by using functional near-infrared spectroscopy and other physical measurements (heart rate and eye closure). We targeted two regions of the brain (visual and pre-frontal cortices). Twenty-three healthy subjects were investigated to evaluate all variables related to the awakening state, and twenty-one healthy subjects were also examined in the drowsy state evaluation. Eventually, the ten most suitable subjects were exposed to red, green, and blue lights under drowsy conditions, according to the experimental paradigm. Dim light was maintained in the experimental premises before and after colored light exposure to limit the results to those produced only in response to the desired stimuli. Eye closure, heart rate, and changes in oxy and deoxy hemoglobin concentrations were measured to characterize the condition (awake/drowsy) of the subject. A support vector machine classifier was used to identify the classification accuracy of awake and drowsy states. In conclusion, exposure to blue light triggered the activation of oxy hemoglobin in targeted brain regions; however, deoxy hemoglobin was not significantly affected by exposure to any of the colored lights. Noticeably, our study revealed that blue light exposure is more effective at reducing drowsiness than exposure to red and green lights.

To find out if there are any differences in biomarkers between severe isolated right ventricular (RV) dysfunction and severe isolated left ventricular (LV) dysfunction after cardiac surgery using cardiopulmonary bypass.Observational study.Teaching hospital.A total of 46 patients who had severe isolated RV or LV dysfunction after cardiac surgery.The authors collected perioperative clinical and biomarker data.Severe isolated RV dysfunction patients (n = 20) had higher postoperative direct bilirubin (p = 0.030), total bilirubin (p = 0.044), glucose (p = 0.011), and international normalized ratio (INR) (p = 0.050) by repeated measure analysis of variance when compared with patients with severe isolated LV dysfunction (n = 26). The RV group also showed lower preoperative alanine transferase (19.3 ± 1.5 v 32.7 ± 4.2, p = 0.001), higher 4-hour INR (1.5 ± 0.3 v 1.4 ± 0.2, p = 0.008), and higher 48-hour INR (1.8 ± 0.4 v 1.4 ± 0.1, p0.001). None in the LV group died, whereas 4 patients in the RV group died (all of them had preoperative atrial fibrillation and underwent double valve replacement surgery).The authors observed biomarkers differences between severe isolated RV dysfunction and severe isolated RV dysfunction.

A 39-year-old pregnant patient with acute appendicitis was planned for emergency laparoscopic appendectomy in the second trimester of pregnancy. Preoperative two-dimensional transthoracic echocardiography revealed asymptomatic cor triatriatum sinisiter (CTS), dividing left atrium into two chambers. There was no associated cardiac anomaly, wall motion abnormality, or pulmonary hypertension. We report the case of a pregnant patient with CTS who uneventfully underwent laparoscopic appendectomy without invasive cardiac monitoring using total intravenous anesthesia.

Purpose – This study’s the ultimate goal is to analyze competitiveness improvement on multinational enterprises as firstly providing which factors are to strengthen or weaken competitiveness, secondly investigating if hypotheses development and research design is correct and thirdly finding significant implications for research and practices across country specific advantage. Design/methodology – Using feedback data provided by 250 firms, we extracted variable factors and hypotheses, which were empirically carried out by reliability and validity testing, correlation analysis, path analysis, and confirmatory factor analysis to prove which factors are to make the positive effect on the improvement of overseas subsidiaries’ management performance and competitiveness. Findings – Through proceeding empirical analysis study, we found out that technology management capability, knowledge management capability, and local management capability had a statistically significant effect on the improvement of overseas subsidiaries’ competitiveness, while linked activity capability revealed a negative effect. Originality/value – During business globalization, overseas investments and establishment of overseas subsidiaries have been essential. It is anticipated that this study results would be meaningful for analysis on multinational enterprises’ competitiveness and helpful in promoting their entry into Korean market and enhancing their competitiveness. This paper would also help Korea government develops new FDI model and induce more investment from global major companies to Korea region.

Objective Frontonasal dysplasia (FND) is a rare congenital condition. Its major features include hypertelorism, a large and bifid nasal tip, and a broad nasal root. We present our technique of septal L-strut reconstruction using costal cartilage. Design Retrospective review from June 2008 and August 2017. Methods Under general anesthesia, 6 patients with FND underwent septal reconstruction using costal cartilage via open rhinoplasty. We reconstructed the nasal and septal cartilaginous framework by placing columellar struts and cantilever-type grafts. Results The patients ranged in age from 6 to 13 years old. All were female. The follow-up period ranged from 8 months to 2 years; we encountered no postoperative complications (infection, nasal obstruction, or recurrence). All patients were satisfied with their nasal appearance. Conclusions Although the results were not entirely satisfactory from an esthetic point of view, we found that FND can be treated via septal reconstruction with costal cartilage and that the clinical outcomes are reliable and satisfactory. Our approach is a useful option for FND patients.

There have been several reports of foreign bodies being discovered in the intravenous set. In this case, the patient complained that he found a worm in his intravenous line. It was later confirmed as a long, white fibrin deposit by pathologic examination. This happened even though there was a non-return valve in the intravenous line. Also, since there were few red blood cells in the deposit, it did not look like a blood clot. In cases like this, we suggest that physicians keep this possibility in mind to reassure their patients.

Primitive neuroectodermal tumor (PNET) arising primarily in the lung is an extremely rare and aggressive malignancy with poor chances of patient survival. We present a case of long-term survival by a 29-year-old woman with PNET diagnosed after a hertological and immunohertochemical examination of a biopsy specimen obtained by performing video-assisted thoracic surgery. The patient underwent a left lower lung lobe lobectomy and 6 cycles of adjuvant chemotherapy. The patient has been free of any symptoms of the recurrence of the disease for 6 years after treatment completion.

Si surfaces were texturized with periodically arrayed oblique nanopillars using slanted plasma etching, and their optical reflectance was measured. The weighted mean reflectance (Rw) of the nanopillar-arrayed Si substrate decreased monotonically with increasing angles of the nanopillars. This may have resulted from the increase in the aspect ratio of the trenches between the nanopillars at oblique angles due to the shadowing effect. When the aspect ratios of the trenches between the nanopillars at 0&deg, (vertical) and 40&deg, (oblique) were equal, the Rw of the Si substrates arrayed with nanopillars at 40&deg, was lower than that at 0&deg, This study suggests that surface texturing of Si with oblique nanopillars reduces light reflection compared to using a conventional array of vertical nanopillars.

Objectives To investigate the effect of the application of therapeutic hypothermia (32-35°C) on survival and major clinical endpoints in critically ill patients. Data sources We searched online database and clinical trial registries dated up to April 30, 2019, and references of relevant studies. Study selection Low risk of bias randomized trials which compared hypothermia applied for at least 24 hours and conventional therapy in critically ill patients were included. We excluded trials investigating therapeutic hypothermia in indications already supported by international guidelines (adult cardiac arrest and hypoxic-ischemic encephalopathy of newborns) or intraoperative hypothermia. Data extraction Titles and abstracts were reviewed independently by two authors. If the articles seemed eligible, full-text articles were reviewed, and data were abstracted using a structured template. Data synthesis Our search retained 14 low risk of bias randomized trials (2,670 patients) performed in three different settings: traumatic brain injury, serious infections, and stroke. Therapeutic hypothermia was associated with an increase in mortality at longest follow-up available (432/1,375 [31%] vs 330/1,295 [25%]; risk ratio, 1.24; 95% CI, 1.10-1.39; p = 0.0004; I = 0%). Pooled results showed no difference of good neurologic outcome among survivors between the two treatment arms (493/1,142 [43%] vs 486/1,067 [46%]; risk ratio, 1.04; 95% CI, 0.97-1.12; p = 0.27; I = 1%). Arrhythmias were significantly increased among patients undergoing therapeutic hypothermia. We found no difference between groups in pneumonia, serious infections, any infection, hemorrhage, renal failure, deep vein thrombosis, and uncontrollable intracranial hypertension. Conclusions High-quality randomized evidence indicates that therapeutic hypothermia is associated with higher mortality and no difference in good neurologic outcome compared with normothermia in critically ill patients. Although there still might be a possibility that therapeutic hypothermia is beneficial in a specific setting, routine application of therapeutic hypothermia would better be avoided outside the settings indicated by international guidelines (adult cardiac arrest and hypoxic-ischemic encephalopathy of newborns).

Neighborhood decline is a critical issue in shrinking cities. Components of sustainable urbanism such as mixed land uses have risen as possible urban planning-based approaches to help mitigate urban and neighborhood decline. This research identifies examines if mixed land uses can help mitigate urban decline by using the tax delinquent status of single family houses as a proxy for decline in Dayton, Ohio, USA. Logistic regression models are utilized to estimate the probability of tax delinquency. The results suggest that the proximity to mixed land uses is associated with increasing or decreasing the probability of tax delinquent for single family lots. The number of commercial and industrial lots in a neighborhood also has effects on the probability of a lot becoming tax delinquent, but the specific types of commercial and industrial lots dictate the direction of effects. The existence of commercial apartment lots, retail lots, and industrial food and drink plant lots were shown to help decrease the probability of tax delinquent lots. Also, decreasing the amount of property tax applied to parcels can help to limit distress in neighborhoods. This research contributes to the ongoing efforts to stymie the amount of residential abandonment in depopulating and declining cities.

To support sustainable long-term developments and minimize urban sprawl, Low Impact Development (LID) practices have been highlighted for a long time. They are useful, but understanding on LID practices and broadening the LID applications among practitioners is another important task. The main purpose of this study is to understand local professionals’ perceptions on different LID techniques and awareness on their benefits, while also gathering opinions on barriers and incentives. An online survey was delivered to 91 recipients, a diverse pool of stakeholders involved in the Energy Corridor District (ECD) area in Houston, Texas. The majority of the respondents answered that they were familiar with LID. The techniques that have been applied to a larger extent are Detention Ponds and Bioswales. When asked about applying techniques in the future, Retention Ponds, Rain Gardens, Bioswales, and Detention Ponds are highly probable items. Decision-makers identified the major barriers as being the lack of incentives for their application, lack of knowledge of the client, and lack of knowledge of the development team. Education programs would be the most successful incentive, followed by financial incentives and innovations in policy systems. Urban planners have the most expertise in LID practices, followed by architects/landscape architects, while developers were found not to be very familiar with the concepts. This study understands the current and practical opinions about LID from the decision-makers. Different groups understand the importance of education and identified a major barrier as the lack of policy instruments. Some innovation in regulations may elevate proper LID practices.

Dexmedetomidine (DXM) has anti-inflammatory effects, which is considered an important mechanism of DXM-induced neuroprotection from cerebral ischemia/reperfusion injury. We determined whether the anti-inflammatory effects of DXM are associated with inhibition of the toll-like receptor (TLR)-4/nuclear factor kappa B (NF-κB) pathway in a rat model of transient global cerebral ischemia/reperfusion injury. Fifty rats were randomly assigned to one of five groups (10 rats/group): Group S received no treatment; Group C underwent transient global ischemia (10min); Group D received DXM 30min before ischemia; Group R received resatorvid, a selective TLR-4 antagonist, 30min before ischemia; and Group RD received resatorvid and DXM 30min before ischemia. The numbers of necrotic and apoptotic cells and the levels of TLR-4, NF-κB, and caspase-3 were assessed 1day after ischemia, and pro-inflammatory cytokines including tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6) were measured before ischemia and 2, 6, and 24h thereafter. The necrotic and apoptotic cell counts and levels of TLR-4, NF-κB, and caspase-3 were higher in Group C than in other groups. TNF-α were higher in Group C than in other groups 2h after ischemia, whereas IL-6 were higher in Group C 6h after ischemia. IL-1β was higher in Group C than in Group D 6 and 24h after ischemia. Our findings suggest that the anti-inflammatory action of DXM via inactivation of the TLR-4/NF-κB pathway, in part, may explain DXM-induced neuroprotection after cerebral ischemia.

A 25-year-old male patient who was infected with human immunodeficiency virus (HIV) underwent a condyloma excision under spinal anesthesia. The patient complained of suspicious postdural puncture headache. The patient did not respond to conservative management. Subsequently, the subdural hematoma (SDH) was found through magnetic resonance imaging. In response, an epidural blood patch was used to improve the symptoms and inhibit the enlargement of the SDH. The patient was discharged after it was confirmed that a headache had subsided without increasing SDH. Anesthesiologist should be aware of other causes of headaches after spinal anesthesia in HIV-infected patients and should carefully and accurately identify the cause.

Autologous blood cell salvage reduces the need for postoperative allogeneic blood transfusion and alleviates immunologic reactions, so the technique is commonly used in cardiac surgery. The continuous autotransfusion system is a type of blood cell salvage device. Although the processing program of continuous autotransfusion system includes filtering of several materials from suctioned blood, such as clots, leukocytes, cytokines, and complement, we identified some unexpected blood clots in the reinfusion bag. Pathologic examination revealed that the clots were composed of fibrin, red blood cell aggregates, and histiocytes. We report two cases of these abnormal findings during the use of CATSmart in cardiac surgery.

International audience; Our observations of landscape architecture students revealed a new phenomenon—interstices. Their bimanual interactions with a pen and touch surface involved various sustained hand gestures, interleaved between their regular commands. Positioning of the non-preferred hand indicates anticipated actions, including: sustained hovering near the surface; pulled back but still floating above the surface; and resting in their laps. We ran a second study with 14 landscape architect students which confirmed our observations, and uncovered a new interstice i.e. stabilizing the preferred hand while handwriting. We conclude with directions for future research and challenges for designers and researchers.

SEPARATION from cardiopulmonary bypass (CPB) after cardiac surgery is a progressive transition from full mechanical circulatory and respiratory support to spontaneous mechanical activity of the lungs and heart. During the separation phase, measurements of cardiac performance with transesophageal echocardiography (TEE) provide the rationale behind the diagnostic and therapeutic decision-making process. In many cases, it is possible to predict a complex separation from CPB, such as when there is known preoperative left or right ventricular dysfunction, bleeding, hypovolemia, vasoplegia, pulmonary hypertension, or owing to technical complications related to the surgery. Prompt diagnosis and therapeutic decisions regarding mechanical or pharmacologic support have to be made within a few minutes. In fact, a complex separation from CPB if not adequately treated leads to a poor outcome in the vast majority of cases. Unfortunately, no specific criteria defining complex separation from CPB and no management guidelines for these patients currently exist. Taking into account the above considerations, the aim of the present review is to describe the most common scenarios associated with a complex CPB separation and to suggest strategies, pharmacologic agents, and para-corporeal mechanical devices that can be adopted to manage patients with complex separation from CPB. The routine management strategies of complex CPB separation of 17 large cardiac centers from 14 countries in 5 continents will also be described.

Besides 5-aminolevulinic acid (5-ALA), liver enzyme elevation after brain tumor surgery can be caused by anesthesia and medications. In this retrospective study, we determined whether preoperative 5-ALA administration is associated with postoperative elevation of liver enzymes (PELE) in brain tumor patients and identified predictive factors for PELE in patients treated with 5-ALA. In 179 patients undergoing brain tumor surgery with preoperative normal values of liver enzymes, laboratory data on serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and total bilirubin (T.bil) levels were collected preoperatively and through postoperative day (POD) 45. Ninety-nine PELEs (ALT, 56; AST, 34; ALP, 5; and TB, 4) were observed in 62 (34.6%) patients. Four (4.2%) patients treated with 5-ALA showed grade 3 elevation of transaminases based on the Common Terminology Criteria for Adverse Effects. Preoperative 5-ALA treatment was predictive of PELE (odds ratio [95% confidence interval], 2.30 [1.14–4.67]; P = 0.021). In patients treated with 5-ALA (n = 95), 70 PELEs (ALT, 39; AST, 22; ALP, 5; and TB, 4) were observed in 41 (43.2%) patients and significant predictive factors for PELE were preoperative ALT level (1.10 [1.04–1.17]; P = 0.001) and body mass index (BMI, 1.29 [1.08–1.56]; P = 0.006). In patients treated with 5-ALA, 13 and 36 patients, of 39 patients whose maximum postoperative ALT levels > 40 U/L, showed the normal value of serum ALT on PODs 14 and 45, respectively. Only three patients showed ALT elevation > 40 U/L on PODs 15–45, with a downward trend. The use of 5-ALA for brain tumor surgery in patients with preoperative normal values of liver enzymes was associated with increased transient PELE, but a low incidence of severely elevated liver transaminases levels. When 5-ALA is administered to patients with the upper normal value of preoperative serum ALT and overweight, attention is paid to PELE.

Urban development pattern significantly impacts stream water quality by influencing pollutant generation, build-up, and wash-off processes. It is thus necessary to understand and predict stream water quality in accordance with different urban development patterns to effectively advise urban growth planning and policies. To do so, we collected pollutant concentration data on nitrate (NO3--N), total phosphate (TP), and Escherichia coli (E. coli) from 1047 sampling stations in the Texas Gulf Region. We utilized a Random Forest (RF) machine learning model to predict stream water quality under four planning scenarios with different urban densities and configurations. SHapley Additive exPlanations (SHAP) was used to prove the importance of urban development pattern in influencing stream water quality. The spatial variations of the impact of these patterns were explored with Geographically Weighted Regression (GWR). SHAP results indicated that Largest Patch Index (LPI), Patch Cohesion Index (COHESION), Splitting Index (SPLIT), and Landscape Division Index (DIVISION) were the most important urban development pattern metrics affecting stream water quality. The spatial variations of such patterns were shown to impact stream water quality depending on pollutants, seasonality, climate, and urbanization level. RF prediction results suggested that high density aggregated development was more effective in reducing TP and NO3--N concentrations than the current sprawl development, but had the potential risk of increasing E. coli pollution in the wet season. The results of this study provide empirical evidence and a potential mechanistic explanation that stream water quality degradation is a consequence of urban sprawl. Lastly, machine learning is a powerful tool for scenario prediction in land use planning to forecast environmental impacts under different urban development pattern scenarios.

Purpose In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. Methods In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3-4, 5-6, and 7-8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. Results Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8-96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. Conclusion Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression. Trial registration ClinicalTrials.gov Identifier: NCT01069211.

The impacts of flooding can be devastating. Huge financial burden often follows major storm events to recover from structural damage. Well-designed drainage systems allow for effective discharge of stormwater, reducing property losses and expenditures on recovery. However, a lack of empirical studies on the topic has impeded the determination of which drainage method might be the most effective in preventing or minimizing property losses from flooding. This study assessed the economic impacts of three drainage systems − storage-, conveyance-, and infiltration-based facilities – on reducing flood damage recorded from 2009 to 2012 by Federal Emergency Management Agency in the Buffalo Bayou watershed in Houston, Texas, USA. Ordinary least squares and spatial autoregressive models were developed with a group of variables featuring drainage system, housing structure, geophysical environment, and storm characteristics. The results show that storage-based systems outperform conveyance-based mechanisms. Infiltration-based facilities are found to be less effective in reducing property damage because green spaces disconnected from sewer systems are rapidly inundated after being saturated while excessive overflow is not properly drained. This study confirms that the performance of a drainage system varies by facility type and environmental setting. The results encourage the recovery of wetlands and integration of retention/detention basins into community development in flood-prone areas to prevent potential future economic losses.

Pulmonary thromboembolism (PTE) is rarely reported in Behçet's disease (BD) due to its distinctive thrombus-forming mechanism. In BD, the inflammation on vessel walls causes venous thrombosis. The thrombi are considered to be tethered to the inflamed walls making embolization less frequent. Thus, immunosuppressive agents are the mainstay of treatment. However, the necessity of anticoagulation therapy is controversial because of its uncertain efficacy of resolving thrombi and the possibility of fatal side effects of hemorrhage. A 25-year-old man with recurrent oral aphthae visited with abrupt onset of dyspnea and chest pain. Based on history, imaging studies and laboratory results, he was diagnosed with BD with vascular involvement and antiphospholipid syndrome (APS), causing PTE from deep vein thrombosis. The co-existing APS may have further promoted the thrombosis, shifting his blood profile toward the hypercoagulable state. Immunosuppressive therapy with glucocorticoid and azathioprine, and concomitant anticoagulation with warfarin were achieved successfully without any fatal complications. When atypical features of vascular involvement in BD develop, other coexisting diseases should be considered to design an optimal therapeutic plan.

Objective A randomized, double-blind, prospective study to evaluate the effect of anticholinergic drugs on thermoregulation in paediatric patients undergoing ambulatory anaesthesia with ketamine. Methods Patients were randomized to receive either 0.005 mg/kg glycopyrrolate or the equivalent volume of normal saline (placebo) at 30 min before ketamine anaesthesia. Body temperature was measured tympanically at baseline and at 0, 30, 60 and 90 min postoperatively. The quantity of saliva prodiced during surgery and incidence of fever were recorded. Results Body temperature was significantly higher in the glycopyrrolate group ( n = 42) than the placebo group ( n = 42) at 30, 60 and 90 min after surgery, and higher than baseline at 0, 30, 60 and 90 min after surgery. In the placebo group, body temperature was significantly higher than baseline at 0 and 30 min after surgery. Saliva secretion was significantly lower in the glycopyrrolate group than the placebo group. Conclusion Routine premedication with adjunctive anticholinergics should not be considered in paediatric patients receiving ketamine sedation due to the increased risk of fever. Trial registration number, Clinicaltrials.gov: NCT02430272

The RISPO (Remote Ischemic Preconditioning with Postconditioning Outcome) trial evaluated whether remote ischaemic preconditioning (RIPC) combined with remote ischaemic postconditioning (RIPostC) improves the clinical outcomes of patients undergoing cardiac surgery. This substudy of the RISPO trial aimed to evaluate the effect of RIPC with RIPostC on pulmonary function in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Sixty-five patients were enrolled (32: control and 33: RIPC-RIPostC). In the RIPC-RIPostC group, four cycles of 5min ischaemia and 5min reperfusion were administered before and after CPB to the upper limb. Peri-operative PaO2/FIO2 ratio, intra-operative pulmonary shunt, and dynamic and static lung compliance were determined.The mean PaO2/ FIO2 was significantly higher in the RIPC-RIPostC group at 24h after surgery [290 (96) vs. 387 (137), p=0.001]. The incidence of mechanical ventilation for longer than 48h was significantly higher in the control group (23% vs. 3%, p0.05). However, there were no significant differences in other pulmonary profiles, post-operative mechanical ventilation time, and duration of intensive care unit stay.In our study, RIPC-RIPostC improved the post-operative 24h PaO2/FIO2 ratio. Remote ischaemic preconditioning-Remote ischaemic postconditioning has limited and delayed pulmonary protective effects in cardiac surgery patients with CPB.

Portal biliopathy is defined as abnormalities in the extra- and intrahepatic ducts and gallbladder of patients with portal hypertension. This condition is associated with extrahepatic venous obstruction and dilatation of the venous plexus of the common bile duct, resulting in mural irregularities and compression of the biliary tree. Most patients with portal biliopathy remain asymptomatic, but approximately 10% of them advance to symptomatic abdominal pain, jaundice, and fever. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are currently used as diagnostic tools because they are noninvasive and can be used to assess the regularity, length, and degree of bile duct narrowing. Management of portal biliopathy is aimed at biliary decompression and reducing the portal pressure. Portal biliopathy has rarely been reported in Korea. We present a symptomatic case of portal biliopathy that was complicated by cholangitis and successfully treated with biliary endoscopic procedures.

Objective The aim of this study was to determine whether or not perioperative administration of sodium bicarbonate had a preventive effect on cardiac surgery-associated acute kidney injury (CSA-AKI) as shown in randomized controlled trials. Design The authors conducted a systematic review and meta-analysis using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and KoreaMed. Setting The authors searched MEDLINE, EMBASE, CENTRAL, and KoreaMed without language and date restrictions. They used both MeSH and free-text terms to identify relevant studies. Electronic searches were undertaken on July 31, 2014. Participants Five randomized controlled studies included in this review. Measurements and Main Results There were no differences in the development of CSA-AKI among patients in the sodium bicarbonate group compared with those in the control group (5 trials, 1,092 patients; n = 233 of 547 in sodium bicarbonate (SB) group versus 225 of 545 in control group (SC); risk ratio (RR), 0.95; 95% confidence interval (CI), 0.74-1.22. Also, there were no statistical differences in in-hospital mortality (3 trials, 573 patients; n = 21 of 288 in SB versus 14 of 285 in SC; RR, 1.44; 95% CI, 0.76-2.72), need for renal replacement therapy (4 trials, 1,000 patients; n = 21 of 503 in SB versus 23 of 497 in SC; RR, 0.90; 95% CI, 0.50-1.60), length of stay in the intensive care unit (ICU) (hours) (4 trials, n = 969 patients, weighted men difference (WMD), 2.17; 95% CI, -1.15-5.49), and length of ventilation (hours) (4 trials, 969 patients; WMD, 0.34; 95% CI,−0.80-1.48). Conclusions Perioperative administration of sodium bicarbonate did not reduce the rate of CSA-AKI in randomized controlled trials. Therefore, use of perioperative administration of sodium bicarbonate for the prevention of CSA-AKI is questionable.

The environmental benefits of having retention/detention ponds as major stormwater management facilities in a neighborhood have been well documented since the adoption of green infrastructure strategies in early 1990s. However, the capitalization effect of stormwater treatment ponds in real estate values still remains unclear. This study developed classic hedonic pricing and spatial econometric models to examine the capitalization effects of neighborhood-level detention and retention ponds using both cross-sectional and longitudinal housing prices. The housing market value from 2007 to 2016 was assessed in four subdivisions in Houston, Texas. A subdivision, located in the upper neighborhood, had retention ponds which were converted from detention ponds in 2011, while three subdivisions in the lower neighborhood had detention ponds over the same study period. The study results show that living near retention ponds has positive capitalization impacts on single-family housing prices, not only cross-sectionally but also longitudinally. In contrast, maintaining detention ponds depreciates housing values, and living nearby lowers the price increase over a decade. The findings in this study imply the importance of converting stormwater facilities into a park-like amenity to enhance aesthetic value and generate long-term economic benefits to a neighborhood.

Background/Aims: In the ABC classification system, group A consists of seronegative subjects without gastric corpus atrophy. This study aimed to determine the prevalence and characteristics of pseudo group A subjects. Methods: Group A subjects were identified among consecutive Korean adults who underwent a serum anti-Helicobacter pylori immunoglobulin G (IgG) test and pepsinogen (PG) assay on the day of endoscopy. Past infection was defined as the presence of either eradication history or endoscopic findings suggesting past infection (i.e., gastric xanthoma, metaplastic gastritis, or advanced atrophy >closed-type 1). Results: Among 2,620 group A subjects, 448 (17.1%) had eradication history, and 133 (5.1%) showed endoscopic findings suggesting past infection. Older age (odds ratio [OR], 1.148; 95% confidence interval [CI], 1.067 to 1.236) and earlier year of birth (OR, 1.086; 95% CI, 1.009 to 1.168) were independent risk factors for classification into pseudo group A, with cutoff points at 50.5 years and birth year of 1959.5, respectively. Positive H. pylori test findings were found in 22 subjects (3.1%) among the 715 subjects who underwent the urea breath test or Giemsa staining on the same day. Current infection was positively correlated with PG I and PG II levels (p

Low impact development (LID) has been increasingly practiced since its emergence in the 1990s. Although the hydrological benefits of LIDs have been extensively documented, the climate impact on LID performance remains unclear with increasing variations in spatial and temporal climate patterns. This systematic review contributes to providing a structured summary of research on how LID systems are sensitive to climate variability by empirical and hypothetical research approaches. The selected 46 peer-reviewed journal articles published between 2003 and 2017 were analyzed by key variables, including climatic factors, LID types, and hydrologic measures used to quantify LID performance. A conceptual framework formulated in this study synthesizes the relationship between climate and LID effectiveness. The results of weighted meta-analysis reveal a greater sensitivity of runoff volume to changing storm frequency than peak discharge rates, while the capacity of LID systems to reduce both volume and peak discharge rates diminishes with increasing storm intensity. Future explorations of the sensitivity of LIDs to climate fluctuations will help strategize LID installation for targeted storm patterns and flood mitigation goals. To enhance existing methods and make a balance between empirical and hypothetical knowledge, this study suggests future directions of research and encourages development of effective stormwater management policy.

Background Incomplete sesamoid reduction is a potential risk factor for the recurrence of hallux valgus. The purpose of this study was to radiologically investigate changes in sesamoid position after chevron osteotomy and the open lateral soft tissue procedure. Methods Sixty-eight feet that underwent operative correction for hallux valgus deformity were reviewed consecutively. The hallux valgus angle (HVA), first to second intermetatarsal angle (IMA), tibial sesamoid position (TSP), distance of the fibular sesamoid (DFS), and translation of the metatarsal head (TMH) were evaluated preoperatively and at final follow-up. Results While most parameters were significantly decreased after surgery, no significant change in DFS (correction − 1.45 mm, p = 0.08) was noted. The difference between preoperative and postoperative TSP values (ΔTSP) has a moderately positive correlation with difference in TMH values (ΔTMH) (Rho 0.475, p = .000). Other parameters were similarly correlated. Conclusions First, metatarsal bone realignment reduced the sesamoid, but its position, relative to the second metatarsal axis (DFS), was unchanged. The sesamoid is reduced by the lateral translation of the first metatarsal but not by medial sesamoid migration.

This project is to develop a comprehensive master plan incorporating key principles of sustainable urbanism for a business district in Houston, Texas, USA. The main design objectives are to create a livable and sustainable urban business center, to promote economic growth and to implement a streetscape design guideline to promote walkability and bikeability.