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Radiofrequency ablation (RFA) of medium-sized (3–5 cm) hepatocellular carcinoma (HCC) is suboptimal. Switching monopolar RFA (SW-RFA) enlarges the ablative volume to better cover larger tumors. This study aims to compare the long-term outcomes of medium-sized HCC treated by either SW-RFA or single-monopolar RFA (S-RFA). We retrospectively reviewed 139 cases (147 medium-size HCC) between 2008 and 2014. Under propensity score matching, a total of 43 paired patients with medium-size HCC and balanced clinical variables treated by either SW-RFA or S-RFA were selected for comparison. SW-RFA showed a higher rate of achieving an adequate safety margin (p = 0.002). After a mean follow-up period of 40.4 months, SW-RFA produced significantly lower global RFA failure rates (p < 0.001) and better overall survival (p = 0.005) compared to S-RFA. SW-RFA was independently associated with a decreased risk of global RFA failure (hazard ratio [HR]: 0.136, 95% confidence interval [CI]: 0.030–0.607, p = 0.009) and improved overall survival (HR: 0.337, 95% CI: 0.152–0.747, p = 0.007). By last follow-up, the SW-RFA group maintained a superior tumor-free rate (p = 0.010) and fewer progressions to Barcelona Clinic Liver Cancer stage C (p = 0.011). Major complication rates were comparable in both groups (SW-RFA: 2.3% vs. S-RFA: 4.7%, p = 1.000). The switching multi-monopolar ablation technique could be beneficial for patients with medium-sized HCCs given sustained control of larger tumors with better overall survival. • Switching monopolar ablation could provide a sustained local tumor control and better overall survival than single-monopolar ablation for the medium-sized hepatocellular carcinoma. • Compared to single-monopolar ablation, switching monopolar ablation could create a larger homogeneous coagulation volume by using a shorter total ablation time to achieve a higher rate of adequate safety margin for a medium-sized HCC. • Patients with medium-sized HCC can be maintained at a higher rate of tumor-free status and at a lower risk of progression into BCLC stage C in the follow-up period after ablation by switching monopolar than by single-monopolar ablation.

Alpha-methylacyl-coenzyme A-racemase (AMACR), also known as p504s, is overexpressed in prostatic adenocarcinoma and is frequently used in combination with basal cell markers to aid in diagnosing difficult prostate adenocarcinoma cases. In this retrospective method comparison study, we examined the sensitivity and specificity of the ready-to-use anti-p504s (SP116) Rabbit Monoclonal Primary Antibody compared to the monoclonal rabbit anti-human AMACR clone 13H4 in prostatic adenocarcinoma samples. De-identified prostatic adenocarcinoma tissue samples were stained with either the SP116 or 13H4 antibody clone in combination with the VENTANA Basal Cell Cocktail (34βE12+p63) and scored as positive or negative for prostatic adenocarcinoma. The scoring pathologist was blinded to the known historical diagnosis of each sample. The scoring pathologist correctly diagnosed each sample regardless of which p504s clone was used. Both assays using either clone were 100% concordant in their sensitivity and specificity. This study demonstrates that the ready-to-use anti-p504s (SP116) Rabbit Monoclonal Primary Antibody is equivalent to clone 13H4 concentrate when used according to package insert instructions in combination with the VENTANA Basal Cell Cocktail (34βE12+p63) to aid pathologists in the diagnosis of prostatic adenocarcinoma.

Objectives The objectives of this study were to determine the primary technique effectiveness (PTE), to compare the complete response and local recurrence rates between conspicuous and inconspicuous tumors using single and switching electrodes of real-time virtual sonography (RVS)-assisted radiofrequency ablation (RFA) in conspicuous and inconspicuous hepatic tumors under conventional ultrasonography (US). Subjects and method We compared the complete ablation of inconspicuous tumors with and without anatomical landmark (N = 54) with conspicuous liver tumors (N = 272). Conventional US imaging was done initially, and then these images were fused with CT or MRI arterial-venous-wash-out cross-sectional studies and synchronized with real-time US images. Results RVS-assisted RFA was technically feasible in all patients. The PTE rate after the first ablation was 94% (245/261) for conspicuous tumors, 88% (7/8) in inconspicuous tumors with landmark, and 78% (36/46) in inconspicuous tumors without landmark. The complete response (p = 0.1912 vs. p = 0.4776) and local recurrence rate (p = 0.1557 vs. p = 0.7982) were comparable in conspicuous tumors of both HCC and liver metastasis group when single or multiple switching was used. The cumulative local recurrence in the conspicuous and inconspicuous tumors of the HCC group (p = 0.9999) was almost parallel after 12 (10% vs. 4%) and 24 (13% vs. 4%) months of follow-up. In the liver metastasis group, the cumulative local recurrence for conspicuous tumors (p = 0.9564) was nearly equal after 12 and 24 months of monitoring (24% vs. 27%) while no recurrence was incurred for the inconspicuous tumors. Conclusion RVS-assisted RFA is an effective tool for the treatment of conspicuous and inconspicuous HCC and hepatic metastasis.

To observe the time-effect relationship of moxibustion for primary dysmenorrhea (PD) due to stagnation and congelation of cold-damp, thus explore the optimal choice of moxibustion duration, and provide evidence for achieving satisfactory efficacy in moxibustion treatment. A total of 90 patients with PD due to stagnatin and congelation of cold-damp were divided into three groups by the random number table method, with 30 cases in each group. All the patients in the three groups were given moxibustion treatment at Guanyuan (CV 4), 20 min in group A, 40 min in group B and 60 min in group C. The changes in the pain measurement score in the three groups were observed after treatment. After treatment, there were significant differences in the clinical efficacy among the three groups (P

This brief presents an energy-efficient elliptic curve cryptography (ECC) processor for Internet of Things (IoT) security applications. The proposed processor supports dual-field computations, and employs various design techniques across the algorithm, architecture, and arithmetic circuit levels to minimize power and energy consumption. The proposed elliptic curve point multiplication (ECPM) algorithm employs signed binary representation (SBR) with the m-ary method to reduce both area and energy consumption, while avoiding attack from simple power analysis (SPA). In addition, the proposed hybrid modular arithmetic architecture effectively increases the hardware utilization to reduce both area and energy cost. Finally, the proposed processor uses an energy-efficient data flow to further minimize memory overhead for group operations. The proposed ECC processor achieves 51.6% and 50.5% lower energy consumption for each $GF(p)$ and $GF(2^{m})$ ECPM operation, respectively, when compared to state-of-the-art ECC designs.

Background Two types of screw trajectories are commonly used in lumbar surgery. Both traditional trajectory (TT) and cortical bone trajectory (CBT) were shown to provide equivalent pull-out strengths of a screw. CBT utilizing a laterally-directed trajectory engaging only cortical bone in the pedicle is widely used in minimal invasive spine posterior fusion surgery. It has been demonstrated that CBT exerts a lower likelihood of violating the facet joint, and superior pull-out strength than the TT screws, especially in osteoporotic vertebral body. No design yet to apply this trajectory to dynamic fixation. To evaluate kinetic and kinematic behavior in both static and dynamic CBT fixation a finite element study was designed. This study aimed to simulate the biomechanics of CBT-based dynamic system for an evaluation of CBT dynamization. Methods A validated nonlinearly lumbosacral finite-element model was used to simulate four variations of screw fixation. Responses of both implant (screw stress) and tissues (disc motion, disc stress, and facet force) at the upper adjacent (L3-L4) and fixed (L4-L5) segments were used as the evaluation indices. Flexion, extension, bending, and rotation of both TT and CBT screws were simulated in this study for comparison. Results The results showed that the TT static was the most effective stabilizer to the L4-L5 segment, followed by CBT static, TT dynamic, and the CBT dynamic, which was the least effective. Dynamization of the TT and CBT fixators decreased stability of the fixed segment and alleviate adjacent segment stress compensation. The 3.5-mm diameter CBT screw deteriorated stress distribution and rendered it vulnerable to bone-screw loosening and fatigue cracking. Conclusions Modeling the effects of TT and CBT fixation in a full lumbosacral model suggest that dynamic TT provide slightly superior stability compared with dynamic CBT especially in bending and rotation. In dynamic CBT design, large diameter screws might avoid issues with loosening and cracking.

Background & aims: Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) patients. Variceal bleeding is a life-threatening complication and may alter the initial treatment plan. This study was aimed to elucidate the risk factors for variceal bleeding in HCC patients receiving TACE treatment. Methods: From 2005 to 2016, a total of 1233 treatment-naive HCC patients receiving first time TACE treatment in Chang Gung Memorial Hospital, Linkou medical center were recruited. Pre-TACE status including baseline characteristics, prior history of ascites, and parameters for liver function evaluation were analyzed. All the variables were compared between patients with and without variceal bleeding. Results: Among the 1233 patients, the median age was 63.7 (range 25.8–91.5) years old, and 73.5% were male. Variceal bleeding events were documented in 19 patients (1.5%) within 3 months post TACE treatment. Patients with younger age, cirrhosis, pre-treatment ascites and advanced fibrosis status (higher MELD score, CTP score, ALBI grade, FIB-4 and APRI score) were more likely to encounter post-treatment variceal bleeding. Multivariate Cox regression analysis revealed existence of ascites (adjusted HR: 4.859 (1.947–12.124), p = 0.001), and higher FIB-4 score (adjusted HR: 4.481 (1.796–11.179), p = 0.001) were the independent predictive factors for variceal bleeding. Patients with post-TACE variceal bleeding are more likely to encounter tumor progression (42.1% vs. 20.3%, p = 0.039) and mortality owing to GI bleeding (15.8% vs. 3%, p = 0.032). Conclusion: The incidence of post-TACE variceal bleeding was 1.5%. Patients with post-TACE variceal bleeding have poorer TACE treatment response. The pre-treatment ascites and FIB-4 score are the independent predictors for post-TACE variceal bleeding. Keywords: Ascites, Gastrointestinal bleeding, Mortality, Portal hypertension, Treatment response

The impact of prolonged post-ablation fever (PAF) defined as persistent fever > 24 h after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) had not been described before. This study aims to investigate the impact of prolonged PAF on early tumor recurrence in HCC patients after RFA. From 2013 to 2015, a total of 135 patients with HCC meeting Milan criteria and all the tumors having confirmed complete ablation after RFA were enrolled. Study endpoint was any HCC recurrence within 1 year after ablation. Cox regression analysis was applied for multivariate analysis to determine the independent predictors of 1-year tumor recurrence. Post-ablation fever occurred in 42 (31.1%) patients after RFA, while prolonged PAF was found in 22 (16.3%) patients. Fifty-eight (42.8%) patients occurred any tumor recurrence within 1 year after complete ablation. Patients with prolonged PAF had a significantly higher rate of HCC recurrence within 1 year (72.7% vs. 37.1%, p = 0.002) and had a significantly shorter time-to-recurrence interval (19.6 vs. 40.5 months, Log rank test, p = 0.002) than those who had no prolonged PAF. Multivariate analysis by Cox regression showed the previous HCC recurrence history (aHR: 1.792, p = 0.0284), baseline AFP > 20 ng/ml (aHR: 1.868, p = 0.0211) and prolonged PAF (aHR: 2.092, p = 0.0138) were associated with early recurrence. Prolonged PAF may associate with early HCC recurrence after complete ablation by RFA. Patients with prolonged PAF need to be more clinical attentions.

Background and aims Sorafenib is the first proved target therapy that shows significant survival benefit in advanced hepatocellular carcinoma. This study was aimed to investigate whether add-on sorafenib be beneficial for those experienced transarterial chemoembolization refractoriness. Methods From 2005 to 2016, a total of 656 treatment-naive hepatocellular carcinoma patients receiving transarterial chemoembolization treatment were recruited. Transarterial chemoembolization refractoriness was defined as progressive disease after two consecutive of transarterial chemoembolization treatment within 6 months. Patient's baseline characteristics, tumor burden, and parameters for liver function evaluation during treatment were analyzed. All the variables were compared between patients with and without transarterial chemoembolization refractoriness, as well as with and without add-on sorafenib. Results Among the 656 patients, the median age was 62.5 (range 27.3-91.5) years old, and 74.5% were male. Transarterial chemoembolization refractoriness events were documented in 202 patients (30.8%). After multivariate logistic regression analysis, tumor size ≧5 cm, baseline alpha-fetoprotein level ≧200 mg/dl, elevation of alpha-fetoprotein ≧20%, and elevation of Child-Turcotte-Pugh score ≧2 points after first transarterial chemoembolization were the independent predictive factors for transarterial chemoembolization refractoriness. Twenty-two patients (10.9%) received add-on sorafenib treatment and 146 (72.3%) patients continued transarterial chemoembolization treatment alone. After 1:2 propensity score matching, patients with add-on sorafenib therapy had significantly longer median overall survival than transarterial chemoembolization treatment alone (23.1 vs. 11.0 months, log-rank P = 0.001). Conclusion The tumor size, baseline alpha-fetoprotein, and elevation of alpha-fetoprotein and Child-Turcotte-Pugh score after first transarterial chemoembolization were the predictors for transarterial chemoembolization refractoriness. For patients with transarterial chemoembolization refractoriness, add-on sorafenib achieved better survival benefit than transarterial chemoembolization treatment alone.

The intending island service restoration method is one of the core technologies of self-healing control for smart distribution systems, which aims to maximize the restoration of the out-of-service loads in the out-of-service area without faults quickly. For this reason, a topology-weighted directional traversal intending island recovery method considering the uncertainty of distributed generation sources is proposed. First, divide the network level of the power-loss feeder and calculate the interval power flow of the feeder before the fault, and obtain the power flow direction when the active and reactive power of the faulted branch is the smallest so as to determine whether the distributed generation supply in the non-faulty power-loss area can restore all load power supply. If not, to determine the island recovery plan, continue to compare the distributed generation supply and the load capacity at all levels, and give priority to recovering loads with higher importance levels and smaller network levels. The traversal of the topological authority and direction effectively reduces the island recovery time and can make full use of the distributed generation output to maximize the recovery of the non-faulty power-loss area. Taking the PG&E 69-node system as an example and using the BFGS trust region algorithm to calculate the island power flow without unbalanced nodes for verification, the results show that this method consumes less time and can restore more load power supply than the existing island recovery method, which verifies the method’s effectiveness and reasonability.

The objective of this study is to identify the attractive quality factors affecting MOBA game design, thus meeting consumers’ requirements and effectively improving their satisfaction. The factor analysis was carried out based on the results of 116 subjects’ evaluation of various quality attributes. According to the principal components analysis, the coefficient values of gameplay factor, usability factor, sociability factor, and sensuality factor were 0.302, 0.347, 0.442, and 0.345 respectively, and had a positive effect on satisfaction. Among these factors, sociability factor had slightly higher satisfaction evaluation than other factors. With Arena of Valor as the object of research, the application feasibility of the study was explored and verified by case study.

Although targeted agents are recommended as the first-line treatments for advanced hepatocellular carcinoma (aHCC), systemic chemotherapy or hepatic arterial infusion chemotherapy (HAIC) are still being used in Asian countries. Beside economic considerations, it was found that targeted drugs could not significantly prolong overall survival in aHCC patients with distant metastasis. In addition, chemotherapy could achieve complete response in a small proportion of patients. Here, we aimed to investigate whether combination of three previously identified single nucleotide polymorphism (SNP) predictors (GALNT14-rs9679162, WWOX-rs13338697, and rs6025211) could guide our choice between systemic chemotherapy, HAIC, and targeted agents in aHCC patients. A cohort of 237 real-world aHCC patients (171 receiving systemic chemotherapy followed by various anticancer treatments including sorafenib; 66 receiving HAIC) were included for outcome analysis. By combining the three SNP markers with or without addition of two clinical criteria (tumor diameter 10.5 months). In conclusion, pre-test for the 3-SNP signature in aHCC patients could identify potential systemic chemotherapy or HAIC responders. Chemotherapy non-responders still benefited from subsequent sorafenib treatment. Accordingly, we propose a roadmap for aHCC patients when chemotherapy or HAIC is to be used.

Background An increasing number of studies support cancer stem cells as the reason for chemoresistance to sorafenib therapy in hepatocellular carcinoma (HCC), but the mechanism is still unclear. In this study, the mechanism of sorafenib resistance in cancer stem cells was examined by in vitro experiments and xenograft mouse model. Methods The expression of cancer stem cell markers in the Chang liver cell line and PLC/PRF/5 and HepG2 hepatoma cell lines were compared by immunoblot assay before and after sorafenib treatment in vitro. As a xenograft mouse model, subcutaneous injection of hepatoma cells followed by sorafenib therapy was performed in NU/NU mice. The effects of sorafenib therapy on tumor growth and cancer stem cell markers were studied. Angiogenesis associated with cancer stem cells was studied by immunoblot and immunohistochemistry assay. Results The expression of cancer stem cell markers was higher in PLC/PRF/5 and HepG2 cells than Chang liver cells, indicating that these hepatoma cells had more stemness-related characteristics. The cancer stem cell markers were upregulated in the hepatoma cell lines following sorafenib treatment in vitro. In the xenograft model, tumors from PLC/PRF/5 and HepG2 cells with high E-cadherin expression were more resistance to sorafenib therapy. However, the expression of cancer stem cell markers was not significantly different after sorafenib therapy in these tumors. Furthermore, we found that sorafenib therapy induced angiogenesis within tumors from high E-cadherin expressing hepatoma cells. Conclusion The mechanism of chemoresistance in sorafenib therapy in HCC may be the tumor angiogenesis associated with high E-cadherin expression in cancer stem cells.

Background: Secondary prevention of hepatocellular carcinoma (HCC) among patients with chronic hepatitis C (CHC) who achieve sustained virologic response (SVR) with interferon-based therapy has been proved effective. However, tertiary prevention with PegIFN/RBV therapy of HCC recurrence seems limited effect in CHC-HCC patients post curative therapies. This study aims to investigate the timing and impact of PegIFN/RBV treatment on prevention of HCC recurrence in patients after RFA treatment. Methods: From 2013 to 2016, a total of 137 CHC-HCC patients from a 508 patient based cohort receiving complete RFA treatment in Chang Gung Memorial Hospital, Linkou Medical Center were retrospectively recruited. Pre-RFA patient demographics were analyzed by cox regression analysis for prediction on tumor recurrence. Statistics analysis was performed with SPSS V.20 (IBM, USA). Results: The mean age of the 137 patients were 69.6 year-old and 71.5% of patients were cirrhotic. After propensity score matching, one hundred and two patients were enrolled into the analysis. Fifty-one patients (50%) received PegIFN/RBV therapy and twenty-seven patients (52.9%) achieved SVR. Patients who could achieve SVR had lower tumor recurrence rate than non-SVR and untreated groups (29.6% vs. 66.7% vs. 49.0%, P = 0.030). The effect is more prominent in those achieve SVR prior to compared with after RFA despite not reach statistically significant (26.1% vs. 50.0%, P = 0.334). Conclusion: Timely treatment with SVR achievement has the lowest tumor recurrence rate in CHC-HCC patients. Secondary prevention might be even more important than tertiary prevention in CHC patients, especially regarding prevention of post RFA HCC recurrence. Keywords: Radiofrequency ablation, Haptocellular carcinoma, Peginterferon and ribavirin, Prognosis

Background while both negative and positive impacts of caregiving on health have been reported, findings regarding caregiver’s mortality may be biased by the lack of consideration of changes in their health and caregiving status during follow-up. This study examines the impact of caregiving on the risk of death in older men, allowing for caregiving-transition by individuals and adjusting for changes over time in their health status. Methods data from 1639 men age ≥70 years old from the Concord Health and Ageing in Men Project (CHAMP) were collected between baseline (2005–07), 2-year and 5-year follow-up and linked to death records up to 30 September 2015. A time-varying Cox proportional hazards model was used to examine the risk of death from caregiving between 2005 and 2015, adjusting for baseline education, history of myocardial infarction, congestive heart failure, and risk factors which may change over time (age, income, self-rated overall health, number of morbidities, physical disability, depression and anxiety). Results the average follow-up was 7.39 years (SD = 2.95) with 495 deaths observed. There was no significant difference in all-cause mortality between caregivers and non-caregivers in the multivariable model (HR: 0.95, 95% CI: 0.67–1.32, P = 0.73). Conclusions this study addressed the dynamic caregiving role and covariates which has been rarely considered in the literature. While there is concern that when older people take on a caring role their health suffers, we found no difference in mortality between older male caregivers and non-caregivers when we accounted for transitions in their caregiving status. NHMRC and Ageing and Alzheimer’s Institute, Australia

The sequencing of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in patients with EGFR mutation-positive (EGFRm+) non-small cell lung cancer (NSCLC) remains a matter of controversy. This cohort study analyzed the overall survival (OS) and progression-free survival (PFS) of afatinib compared with erlotinib and gefitinib first-line. EGFRm+, advanced NSCLC patients treated with either afatinib, erlotinib or gefitinib were retrospectively analyzed. A total of 107 patients were included. There was no statistically significant difference in PFS among the 3 groups. In the ≥ 60 years age group, the afatinib group had longer survival compared to the gefitinib group (p = 0.01). Median OS were 19.1, 22.9, and 35.6 months for gefitinib, erlotinib, and afatinib groups, respectively, with statistical significance between the gefitinib and afatinib groups (p = 0.009). Patients on afatinib also had longer median OS than erlotinib and gefitinib pooled together (35.5 versus 21.4 months; hazard ratio = 0.54, p = 0.016), despite similar median PFS. In conclusion, afatinib is a better choice compared to gefitinib or erlotinib for EGFRm+ patients. The OS obtained with afatinib is just 3 months shorter than osimertinib in the FLAURA trial. Direct comparison studies with osimertinib are still needed to determine optimal sequencing.

Due to the emergence of AMD GPUs and their adoption in upcoming exascale systems (e.g. Frontier), it is pertinent to have scientific applications and communication middlewares ported and optimized for these systems. Radeon Open Compute (ROCm) platform is an open-source suite of libraries tailored towards writing high-performance software for AMD GPUs. GPU-aware MPI, has been the de-facto standard for accelerating HPC applications on GPU clusters. The state-of-the-art GPU-aware MPI libraries have evolved over the years to support NVIDIA CUDA platforms. Due to the recent emergence of AMD GPUs, it is equally important to add support for AMD ROCm platforms. Existing MPI libraries do not have native support for ROCm-aware communication. In this paper, we take up the challenge of designing a ROCm-aware MPI runtime within the MVAPICH2-GDR library. We design an abstract communication layer to interface with CUDA and ROCm runtimes. We exploit hardware features such as PeerDirect, ROCm IPC, and large-BAR mapped memory to orchestrate efficient GPU-based communication. We further augment these mechanisms by designing software-based schemes yielding optimized communication performance. We evaluate the performance of MPI-level point-to-point and collective operations with our proposed ROCm-aware MPI Library and Open MPI with UCX on a cluster of AMD GPUs. We demonstrate 3–6\(\times \) and 2\(\times \) higher bandwidth for intra- and inter-node communication, respectively. With the rocHPCG application, we demonstrate approximately 2.2\(\times \) higher GFLOPs/s. To the best of our knowledge, this is the first research work that studies the tradeoffs involved in designing a ROCm-aware MPI library for AMD GPUs.

A 63-year-old female patient with a history of pulmonary heart disease underwent radiofrequency ablation because of a persistent atrial flutter. Endocardial mapping with the carto3 system confirmed atrial flutter counterclockwise reentry around the tricuspid annulus. Routine ablation of the cavo-tricuspid isthmus line to bi-directional block was performed. However, tachycardia with the same cycle length was induced again. After remapping, the tachycardia was confirmed to be focal atrial tachycardia located in the crista terminalis. After ablation, the tachycardia was terminated and could not be induced again.

Background: Taiwan medical centers mainly use "Central Pharmacy" to carry out pharmaceutical operations and human resources management. The pharmacy is a 24-hour medication supply center for all units in the Hospital. Therefore, how to make the pharmacy run continuously in the potential impact of COVID-19 pandemic is an important issue in the epidemic prevention of the medical center. The purpose of this study is to design to reduce the incidence of cross or cluster infection in the event of nosocomial infection and to maintain the continuous operation of pharmaceutical service.Methods: The planning of "isolation and triage" of pharmaceutical operations is based on the epidemic level of COVID-19, the closing situation of outpatient service, the number of outpatients receiving medicine service and the number of inpatient beds.Results: After the overall planning, in the case of the low epidemic level (level A1), the emergency pharmacy took advance deployment, and fixed personnel was assigned to work in fixed location in the isolation, while other units started the isolation mode in the case of the moderate epidemic level (level B). Grouping mode was added for the severe epidemic level (level C). Different management measures should be planned according to the different level of risk area evaluated by the infection control center.Conclusions: In this study, the risk reduction management mechanism of "isolation and triage" was effectively used to make proper manpower allocation and work planning for all pharmaceutical service in Hospital.

In recent years, Artificial Intelligence (AI) has revolutionized almost every field – from automotive industry to electrical industry, continuously affecting the dynamics of society and the lives of consumers. Among the countless applications of AI, AI at the edge provides the ideal solution for specific workload acceleration. Despite the development of various techniques for surveillance in maritime scenarios, automatic maritime vehicle classification of visual surveillance remains a challenge owing to the small dataset, as well as complex, unconstrained, and diverse nature of such scenarios. To date, only a few studies have investigated edge computing in maritime vehicle classification with edge device. In this paper, data augmentation is applied to deal with the small dataset problem because of a lack of images of military ships. Furthermore, the implementation of deep-learning-based edge computing in maritime vehicle classification through the use of NVIDIA Jetson Nano is proposed.

To investigate the outcomes of radiofrequency ablation (RFA) following artificial ascites (AA) and artificial pleural effusion (AP) creation for hepatocellular carcinoma (HCC) in high-risk locations. Eligible patients were divided into 2 study periods (non-AAAP and AAAP groups) with AAAP performed in the latter period. Local tumor progression, primary technique effectiveness and complications were compared between patients with and without AAAP. Cumulative probability of local tumor progression and overall survival were estimated with Kaplan–Meier curves. One hundred thirty-eight patients with 195 tumors were evaluated. AAAP was performed in 48 patients with 76 tumors. Local tumor progression rates at 12 and 24 months were 9.3% and 22.2% in the non-AAAP group versus 5.5% and 9% in the AAAP group (p

Background and Aim Extrahepatic metastasis (EHM) of hepatocellular carcinoma (HCC) leads to a worse prognosis. We aimed to develop a nomogram based on noninvasive pretreatment clinical data to predict EHM of HCC sooner. Methods Three cohorts containing 1820, 479, and 988 HCC patients were enrolled from three hospitals in different regions in Taiwan and served as the training and validation cohorts. Pretreatment clinical data were analyzed by Cox regression modeling for independent risk factors of EHM. Results Platelet count ≥ 200 × 103/μL, serum alfa-fetoprotein ≥ 100 ng/dL, tumor size ≥ 3 cm, tumor number > 1, and macrovascular invasion were independent risk factors for EHM and were used to develop a nomogram. This nomogram had concordance indices of 0.733 (95% confidence interval [CI]: 0.688-0.778) and 0.739 (95% CI: 0.692-0.787) for the prediction of EHM during a 5-year follow-up duration in the training and validation cohorts, respectively. A nomogram score > 61 implied a high risk of EHM (hazard ratio [HR] = 3.83; 95% CI: 2.77-5.31, P

The elimination of chronic hepatitis C infection (CHC) by pegylated interferon plus ribavirin (Peg-IFN/RBV) decreases hepatocellular carcinoma (HCC) recurrence rate. However, the tertiary prevention of HCC recurrence by direct acting antiviral agents (DAA) remains controversial. This study aims to compare the tertiary prevention effect between DAA and Peg-IFN/RBV in CHC-HCC patients. Three hundred and one patients who received curative HCC treatment were retrospectively recruited. The recurrence incidence rate (IR) was compared among patients either receiving Peg-IFN/RBV or DAA regimen or untreated by three timeframes (I: from HCC treatment to antiviral therapy, II: during antiviral therapy, III: after antiviral therapy). The prevention effect between Peg-IFN/RBV and DAA were compared in frame II and III after propensity score matching (PSM) with age, tumor staging, HCC treatment modality, and cirrhotic status. Before PSM, the recurrence IRs in three arms were comparable in frame I, while being lower in the Peg-IFN/RBV and DAA arm compared to the untreated arm in frame II. In frame III, the tertiary prevention effect lasted in the Peg-IFN/RBV arm (p &lt, 0.001), but diminished in the DAA arm (p = 0.135) compared to untreated patients. After PSM, the HCC recurrence IR was higher in the DAA arm than the Peg-IFN/RBV arm in frame II (2724 vs. 666 per 104 person-years, log-rank p = 0.042) and III (5259 vs. 3278 per 104 person-years, log-rank p = 0.048). Preantiviral ALBI grade therapy is the only predictor for postantiviral therapy HCC recurrence. In conclusion, the tertiary prevention effect of HCC recurrence was not durable in DAA-treated patients, but persisted in Peg-IFN/RBV treatment patients.

Background Androgen deprivation therapy (ADT) in the treatment of prostate cancer may be associated with an increased risk of thromboembolic disease. The aim of our study was to investigate the association of ADT in the treatment of prostate cancer with ischemic stroke risk. Methods We identified individuals older than 20 years of age who were newly diagnosed with prostate cancer between January 1, 2005, and December 31, 2012. Patients who experienced ischemic stroke or transient ischemic stroke before the index date were excluded. Patients who received at least one prescription for ADT within 6 months were defined as the ADT user group. Patients who did not receive at least one prescription for ADT within 6 months were defined as the ADT nonuser group. The patients were followed until the first occurrence of one of the primary outcome measures (ischemic stroke or death) or until December 31, 2013. The primary composite outcome was the time to any cause of death or ischemic stroke. Results There was no significant difference in the primary composite outcomes in the prostate cancer patients between the ADT user and nonuser groups. Prostate cancer patients who received ADT had a higher mortality rate than those who were not treated with ADT, and the adjusted hazard ratio was 1.907 (95% confidence interval: 1.278–2.844; P = 0.0016) after adjusting for age, comorbidities and comedication use. Conclusion ADT in the treatment of prostate cancer may not be associated with an increased risk of ischemic stroke. The differences in thromboembolic effects in cardiovascular disease and ischemic stroke secondary to ADT should be further discussed and evaluated prospectively.

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality in Taiwan. To help clinical physicians to manage patients with HCC, the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan produced the management consensus guideline for HCC. Methods: The recommendations focus on nine important issues on management of HCC, including surveillance, diagnosis, staging, surgery, local ablation, transarterial chemoembolization/transarterial radioembolization/hepatic arterial infusion chemotherapy, systemic therapy, radiotherapy, and prevention. Results: The consensus statements were discussed, debated and got consensus in each expert team. And then the statements were sent to all of the experts for further discussion and refinement. Finally, all of the experts were invited to vote for the statements, including the level of evidence and recommendation. Conclusion: With the development of the management consensus guideline, HCC patients could benefit from the optimal therapeutic modality. Keywords: Diagnosis, Hepatocellular carcinoma, Staging, Surveillance, Treatment

Adjuvant pegylated interferon plus ribavirin treatment (PegIFN/RBV) reduces recurrence and prolongs survival in early stage hepatocellular carcinoma (HCC) patients with chronic hepatitis C (CHC) infection receiving resection or ablation. However, the impact of antiviral therapy in intermediate and advanced stage of CHC-HCC patients is uncertain. This study aimed to investigate the impact PegIFN/RBV treatment on recurrence-free interval and survival in patients with HCC receiving transarterial chemoembolization (TACE). From 2010 to 2013, 274 CHC patients from a 1073 patient-based cohort composed of freshly diagnosed HCC and receiving TACE treatment the Chang Gung Memorial Hospital, Linkou Medical Center were recruited. Propensity score matching (PSM) (age, gender, AST to Platelet Ratio Index (APRI), tumour size, tumour number and Child-Turcotte-Pugh score) with the ratio 1:2 for patients with and without PegIFN/RBV treatment was performed. Statistics were performed with SPSS V.20 (IBM, USA). After matching, 153 patients were analysed and 27 patients (17.6%) achieved sustained virologic response (SVR). The 2-year cumulative overall survival rate and recurrence-free survival rate among patients with SVR, non-SVR, and untreated were 85.2% vs 58.3% vs 69.6% (P=.001) and 73.3% vs 53.8% vs 58.5% (P=.013). By Cox regression analysis, non-SVR, untreated, increase CTP score and nonresponder to TACE were independent factors related to mortality. The SVR achieved by PegIFN/RBV treatment markedly improves survival and reduces tumour recurrence in CHC-HCC patients receiving TACE treatment after complete response.

Kuang-Ming Liao,1,* Tien-Yu Lin,2,3 Yaw-Bin Huang,2,3 Chen-Chun Kuo,2,* Chung-Yu Chen2,3 1Department of Internal Medicine, ChiMei Medical Center, Chiali, Tainan, 2School of Pharmacy, Kaohsiung Medical University, 3Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Republic of China *These authors contributed equally tothis work Objective: β-Blockers are safe and improve survival in patients with both congestive heart failure (CHF) and COPD. However, the superiority of different types of β-blockers is still unclear among patients with CHF and COPD. The association between β-blockers and CHF exacerbation as well as COPD exacerbation remains unclear. The objective of this study was to compare the outcome of different β-blockers in patients with concurrent CHF and COPD. Patients and methods: We used the National Health Insurance Research Database in Taiwan to conduct a retrospective cohort study. The inclusion criteria for CHF were patients who were>20years old and were diagnosed with CHF between January 1, 2005 and December 31,2012. COPD patients included those who had outpatient visit claims ≥2 times within 365days or 1 claim for hospitalization with a COPD diagnosis. A time-dependent Cox proportional hazards regression model was applied to evaluate the effectiveness of β-blockers in the study population. Results: We identified 1,872 patients with concurrent CHF and COPD. Only high-dose bisoprolol significantly reduced the risk of death and slightly decreased the hospitalization rate due to CHF exacerbation (death: adjusted hazard ratio [aHR]=0.51, 95% confidence interval [CI]=0.29–0.89; hospitalization rate due to CHF exacerbation: aHR=0.48, 95% CI=0.23–1.00). No association was observed between β-blocker use and COPD exacerbation. Conclusion: In patients with concurrent CHF and COPD, β-blockers reduced mortality, CHF exacerbation, and the need for hospitalization. Bisoprolol was found to reduce mortality and CHF exacerbation compared to carvedilol and metoprolol. Keywords: congestive heart failure, COPD, β-blockers, acute exacerbation

Objective To explore differences between older male caregivers and non‐caregivers on health status, health behaviours and well‐being, including symptoms of anxiety. Methods Data were collected through self‐completed questionnaires and face‐to‐face interviews with 1705 community living men aged ≥70 in the Concord Health and Ageing in Men Project. Results Eleven per cent of older men were caregivers, of whom 81.7% were looking after their wives or partners. Older male caregivers did not have worse physical health or more depressive symptoms than non‐caregivers, but being a caregiver was associated with increased likelihood of reporting anxiety symptoms (OR: 2.32, 95% CI: 1.39–3.87). Caregivers had similar levels and frequencies of leisure activities but did more housework activities than non‐caregivers. Conclusion Higher anxiety levels were the main adverse health condition in older male caregivers. Strategies to assist minimising anxiety for caregivers should be a target of interventions. NHMRC, Ageing and Alzheimer's Institute, Cognitive Decline Partnership Centre (CDPC)

Background: Local tumor progression (LTP) in early-stage hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) remains high. Tumor feeding artery ablation (FAA) before target tumor ablation was reported to reduce LTP in patients with HCC >3 cm. The aim of our study is to investigate whether FAA before target tumor ablation may reduce LTP in HCC

Background To evaluate kinetic and kinematic behavior in both static and dynamic CBT fixation a finite element study was designed. Two types of screw trajectories are commonly used in lumbar surgery. Both traditional trajectory (TT) and cortical bone trajectory (CBT) provide equivalent pull-out strengths of a screw. Dynesys fixation of TT screws, but not dynamization of CBT screws, has been used extensively in lumbar surgery. This study aimed to simulate the biomechanics of CBT-based dynamic system for an evaluation of CBT dynamization. Methods A validated nonlinearly lumbosacral finite-element model was used to simulate four variations of screw fixation. Responses of both implant (screw stress) and tissues (disc motion, disc stress, and facet force) at the upper adjacent (L3-L4) and fixed (L4-L5) segments were used as the evaluation indices. Flexion, extension, bending, and rotation of both TT and CBT screws were simulated in this study for comparison. Results The results showed that the TT static was the most effective stabilizer to the L4-L5 segment, followed by CBT static, TT dynamic, and the CBT dynamic, which was the least effective. Dynamization of the TT and CBT fixators decreased stability of the fixed segment and alleviate adjacent segment stress compensation. The 3.5-mm diameter CBT screw deteriorated stress distribution and rendered it vulnerable to bone-screw loosening and fatigue cracking. Conclusions A systematic analysis of the effects of TT and CBT fixation constructs on kinematic and kinetic responses in a full lumbosacral model is currently lacking. This study examined both the static fixation effect and its dynamic counterpart and identified that dynamization of CBT have slightly inferior structural stiffness than dynamic TT and cautious preoperative evaluation is essential if 3.5-mm diameter CBT screws are used. Therefore, 4.5-mm or 5.5-mm diameter CBT screws, or as big as tolerated, are recommended to avoid loosening and cracking.

Concentrator photovoltaics (CPV) technology is a highly promising solar power, but high-manufacture cost limits its development. In order to make the cost of CPV system more competitive, INER presents a new type CPV module called micro-CPV which simplifies the procedure of assembling frames and reduces customized components by adopting high power LED packaging process. It can greatly reduce development costs and enhance reliability. This paper compares the outdoor performance of micro-CPV and photovoltaics (PV) systems installed in six places in Taiwan. The results show that the conversion efficiency of PV module is slightly decreased with the increasing of solar irradiance, and the root cause may be temperature. Compared with PV module, the conversion efficiency of micro-CPV module is stable in high solar irradiance. However, the conversion efficiency of micro-CPV module shows unstable and scattered in low solar irradiance which is sensitive to solar spectrum. Lastly, we found that the direct normal irradiance (DNI) value can reach 1000 W/m2 in high altitude region and the relative energy yield of micro-CPV system is higher than that of PV system.

Introduction: The purpose of this study is to assess the efficacy of high-flow nasal cannula (HFNC) compared with non-invasive positive pressure ventilation (NPPV) in prevention of extubation failure in patients with prolonged mechanical ventilation. Methods: This is a prospective, randomized control, single center, clinical trial. Patients who were prolonged mechanically ventilated (>14 days) had been transferred to stepdown unit for weaning. A total of 40 patients were enrolled in our study. After extubation, patients were randomly assigned to HFNC or NPPV treatment group. The major clinical outcomes measured were re-intubation rate, in hospital mortality and length of non-invasive ventilation time after extubation. Patient who had neuromuscular disorders, central respiratory drive disorders, tracheostomy and signed “do not resuscitate” were excluded. Results: The reintubation rate was significantly higher in HFNC group (NPPV 0% vs. HFNC 25%, p =.008), the length of NPPV support after extubation was shorter in NPPV group compared to HFNC group (NPPV 13-hrs vs. HFNC 20-hrs, p =.001). The physiologic variables at one hour after extubation, including PaO2/FiO2, PaCO2, were significantly improved in NPPV group than HFNC group. However, there were no diference in length of hospital stay and mortality. Conclusion: Compared with NPPV, HFNC has higher reintubation rate than NPPV. Our study demonstrated that for those patients who were prolonged mechanically ventilated, NPPV should be applied rather than HFNC after extubation to reduce the extubation failure.

Strong coupling between quantum emitters and cavities is of particular interest because of the potential application in quantum devices such as quantum gates and single photon sources. The quantum gate based on the strong coupling between a single atom and a cavity has been realized. The atoms based systems require precise control of the atoms which are difficult to be integrated and scaled up on a single chip. For the solid state system, strong coupling between a photonic crystal cavity and a single quantum dot has been demonstrated at cryogenic temperature. Recently, the plasmonic nanocavity provides a platform for strong coupling at the ambient temperature due to its extremely small mode volume. However, to precisely position a single emitter into a high field region of a plasmonic nanocavity is still challenging. In this work, a few fluorophores are embedded into a plasmonic nanocavity through the oligonucleotides. A plasmonic nanocavity consists of a functionalized nanoparticle and a metal film. Among 45 fluorophore-embedded nanocavities we measured, 20% of them show clear mode splitting. On the contrary, for the controls, none of the nanocavities shows mode splitting. We believe that some of the molecules have been strongly coupled to the plasmonic nanocavity. The EM simulation shows the mode volume is extremely small, which means only a few molecules can be located in the high field region. With the improvement of the molecule design, the deterministic strong coupling can be realized based on this configuration for quantum devices.

Image is one of the most important ways for users to express their emotions on social networks. In this paper, we use the deep convolutional neural networks to solve the problem of image sentiment analysis from visual content. Because training a neural network requires a large number of data sets to provide good training performance, we cannot obtain such a real human emotion training set, because emotions are subjective, and multiple people need to provide annotations for the images, which requires a lot of manpower. This study proposes to incorporate synthetic face images into the training set to substantially increase the size of the training set. We use only synthetic face images, real facial images, and mixtures of synthetic and real facial images in the training set. Our experiments show that by using only 4026 real images, where each image is supplemented by the synthetic image to the same data set size (Anger: 1063 + 937 true, Disgust: 1857 + 143 true, Fear: 1802 + 198 true, Happy: 2000 true, Sad: 1252 + 748 true) total of 10,000 images, can reach 87.79%, 74.19%, 86.99%, 79.80% average testing accuracy in each testing set in human face sentiment classification.

Although a diffuse-type giant cell tumor is a rare benign lesion, when it develops it tends to localize to the tendons of the hand and foot. In this study, we report the case of a 41-year-old male patient who was diagnosed with diffuse-type paratenon giant cell tumor involving the Achilles tendon. The duration of the bilateral tumors was 8 years. He visited first affiliated Hospital of Wenzhou Medical University for medical attention. Both his Achilles tendons required removal. The reconstructed Achilles tendon was replaced using tissue derived from the knee and foot. Postoperatively, the patient recovered well and regained full range of motion in the ankle. The use of autografts may shorten patients' recovery period.

A neurofeedback system adjusting an individual’s attention is an effective treatment for attention-deficit/hyperactivity disorder (ADHD). In current studies, an accurate measure of the level of human attention is one of the key issues that arouse much interest. This paper proposes a novel optimized complex network method (OCNM) for measuring an individual’s attention level using single-electrode electroencephalography (EEG) signals. A time-delay embedding algorithm was used to reconstruct EEG data epochs into nodes of the OCNM network. Euclidean distances were calculated between each two nodes to decide edges of the network. Three key parameters influencing OCNM, i.e., delaying time, embedding dimension, and connection threshold, were optimized for each individual. The average degree and clustering coefficient of the constructed network were extracted as a feature vector and were classified into two patterns of concentration and relaxation using an LDA classifier. In the offline experiments of six subjects, the classification performance was tested and compared with an attention meter method (AMM) and an α + β + δ + θ + R method. The experimental results showed that the proposed OCNM achieved the highest accuracy rate (80.67% versus 70.58% and 68.88%). This suggests that the proposed method can potentially be used for EEG-based neurofeedback systems with a single electrode.

e16113 Background: Management of advanced hepatocellular carcinoma (HCC) remains a challenge. IMbrave150, a pivotal trial reported impressive overall survival benefit using combination strategy of atezolizumab and bevacizumab compared to sorafenib. We wonder the efficacy and safety when combining radiotherapy with immune checkpoint inhibitors (ICIs), which radiation might provide better local treatment and possible trigger abscopal effect. The aim of this study is retrospectively reporting the real-world efficacy and tolerability of proton beam or photon radiation plus ICIs in patients with advance stage HCC. Methods: We retrospectively reviewed all BCLC stage C HCC patients who have received combination therapy with ICIs plus proton or photon therapy with well documented basic characteristics and prompt treatment efficacy evaluation between 1st of January 2016 to 31st of October 2019 at a single medical center in Taiwan. 20 patients had ICIs plus proton and 32 patients had ICIs plus photon were included for analysis. Overall survival (OS) and progression free survival (PFS) were evaluated by Kaplan-Meier estimator. Results: Baseline characteristics were generally similar between ICIs plus proton or ICIs plus photon, while most patients in proton group did not receive prior systemic treatment and had less local therapies prior ICIs combine with radiotherapy. Median follow-up time was 10.7 months. The median Progression free survival (PFS) was not reached in ICIs plus proton group and 3.6 months (95% CI 2.7-4.6) in ICIs plus photon group (P = 0.007). The median OS was not reach in ICIs plus proton group and 12.1months (95% CI 6.4-17.7) in ICIs plus photon group (P = 0.007). Comparing ICIs plus proton group versus photon group, objective tumor response is 50% versus 9%, disease control rate is 80% versus 47% in each group. During follow-up, 7 patients (35%) in proton group achieved complete remission (CR). There was difference in radiation filed, 19 patients (95%) in proton group and 15 patients (47%) in photon group targeted on liver tumors, and more patient received > 50Gy treatment dose in proton group compared to photon group (90% versus 20%). Proton group has lower failure rate in both inner- or out-field compared to photon group. Grade 1 to grade 2 skin-dermatological and gastrointestinal toxicity remained the most frequent reported adverse events in both groups. There are only one therapy related grade 3 dermatitis in ICIs plus proton group and one grade 3 hepatitis, one grade 5 pneumonitis in ICIs plus photon group. Conclusions: This study reported real-world efficacy and safety of ICIs in combination with proton or photon therapy. Most adverse events were manageable. The combination of ICIs and proton therapy has impressive CR rate and OS benefit. Further prospective randomized trial is warranted for confirm our finding.

BACKGROUND: The transsacrococcygeal (TSC) approach in rectal gastrointestinal stromal tumour (GIST) resection is clinically challenging and controversial, and we evaluated its value in the present study. METHODS: We enrolled patients who underwent rectal GIST resection by the TSC approach during 2008–2018. The clinicopathological index, surgical outcome, and prognosis were analysed. Prognostic information was obtained from medical records and follow-up data. Anal function was evaluated by the low anterior resection syndrome (LARS) score. RESULTS: Among 88 rectal GIST patients over the 10-year study period, 17 who underwent the TSC approach were analysed. The median age was 55 (range, 26–73) years. In total, 15 patients received preoperative imatinib neoadjuvant therapy for 232 (30–690) days. The tumours were exogenous in 14 patients and intramural in 3 patients. The mean initial tumour size and preoperative tumour size were 6.4±2.2 and 4.2±1.7 cm, respectively. The operative time and blood loss were 130.2±47.4 min and 44.6±36.0 mL, respectively. Of the 17 patients 7 had postoperative complications (within 30 days postoperatively), and the complications of 5 patients were cured by conservative treatment. Only 1 patient was lost to follow-up, and the others had a good oncological prognosis at recent follow-up evaluations. All patients had LARS scores ≤9 points at 1 year after the operation. CONCLUSIONS: The TSC approach can result in a good oncological prognosis, usually does not affect anal function, and is particularly suitable for exogenous middle and low rectal GISTs. However, it might cause some controlled complications. Hence, careful patient selection is necessary for this operation.

Background Pneumomediastinum is an abnormal accumulation of air within the mediastinum. Herein, we report a rare case in which a patient initially developed pneumomediastinum and extensive subcutaneous emphysema after bronchoscopic bronchioloalveolar lavage (BAL). The condition then progressed to abdominal compartment syndrome leading to death. Case presentation An 80-year-old man with acute respiratory failure caused by severe pneumonia and septic shock, was admitted to our intensive care unit. Bronchoscopic BAL was performed for microbiological specimen collection. The patient developed subcutaneous emphysema after the procedure, and pneumomediastinum was identified on subsequent chest radiography. The patient initially received supportive care. However, he experienced persistent hypotension, which did not respond to vigorous fluid replacement and high dose vasopressor treatment. Physical examination revealed distended, tense abdomen with diffuse tympanic sound upon percussion. Computer tomography scan showed extensive subcutaneous emphysema, massive air accumulation in the retroperitoneal cavity, near total collapse of the inferior vena cava, and left sided shifting of intra-abdominal organs. The impression was tension pneumoperitoneum with abdominal compartment syndrome. The patient eventually died of refractory hypotension. Conclusions Iatrogenic injury is a rare condition. The common complications include hypoxia, bleeding, infection, arrhythmia, subcutaneous emphysema, and pneumomediastinum, and these can be managed conservatively. However, more complex and life-threatening conditions can be caused by tracheal perforation or alveolar rupture, and can lead to pneumothorax, pneumoperitoneum, or even abdominal compartment syndrome. A high level of suspicion is needed for early detection, and immediate decompression is required to prevent death.

Based on stimulated Brillouin scattering (SBS), the slow light effect in photonic crystal fibre (PCF), which is filled with highly nonlinear liquid-carbon disuphide in the core region, is investigated. Maximum allowable pump power for undistorted output pulse, minimum value of pump power required to initiate the SBS effect, Brillouin gain and time-tonic delay experienced by the pulse in the designed liquid-core photonic crystal fibre, are all calculated numerically. We have found that the maximum time-delay up to ∼134.4 ns at 1.064 μm can be obtained using 1 m long liquid-core PCF pumped with only 65.8 mW, which is lower than the value reported in the literature for achieving such a high delay time. The results indicate that liquid-core PCF is capable of generating tunable time-delay that is adjusted by the pump power and structural parameters of the proposed liquid-core PCF.

Background For marginally operable stage IIIA non–small-cell lung cancer (NSCLC), surgery might not be done as planned after neoadjuvant concurrent chemoradiotherapy (CCRT) for reasons (unresectable or medically inoperable conditions, or patient refusal). This study aims to investigate the outcomes of a phased CCRT protocol established to maximize the operability of marginally operable stage IIIA NSCLC and to care for reassessed inoperable patients, in comparison with continuous-course definitive CCRT. Materials and Methods Forty-seven patients with marginally operable stage IIIA NSCLC receiving CCRT were included. Twenty-eight patients were treated with our phased CCRT protocol, including neoadjuvant CCRT followed by surgery (group A, n = 16) or, for reassessed inoperable patients, maintenance chemotherapy and split-course CCRT boost (group B, n = 12). The other 19 were treated with continuous-course definitive CCRT (group C). Overall survival (OS) and progression-free survival (PFS) were analyzed. Results Among all, median OS and PFS were 35.6 and 12.8 months, respectively (median follow-up, 22.3 months). The median OS of group A (not reached) was better than that of group B (34.4 months) and group C (15.2 months) ( P = .009). On multivariate analysis, performance status 0 to 1 (hazard ratio [HR], 0.026; P P = .003), and group A (HR, 0.199; P = .033) were independent prognostic factors. The OS of group B (HR, 0.450; 95% confidence interval, 0.118-1.717; P = .243) was not statistically different from that of group C. Conclusions For marginally operable stage IIIA NSCLC, our phased CCRT strategy may optimize survival by maximizing operability and maintain an acceptable survival for reassessed inoperable patients by split-course CCRT boost following maintenance chemotherapy.

In the paper, the optical fiber F-P acoustic emission sensing probe has been proposed to monitor online space-time progress of femtosecond laser plasma shock wave for the first time, the structure of sensing probe is microstructure with full optical fiber probes without glue, it can measure weak acoustic emission high frequency signal on femtosecond laser plasma shock wave. In the process of femtosecond laser ablating copper, iron and aluminum, we research and analyze the plasma shock wave acoustic emission signal change regulation under different laser pulse energy and different distance between the laser and the optical fiber sensing probe, and we analyze the feature of the acoustic emission signal spectrum. Experiment establishes a kind of new optical fiber sensing measurement method for femtosecond laser plasma shock wave acoustic emission signal.

Acute hepatitis C exacerbations can occur in cancer patients carrying hepatitis C virus (HCV) when receiving systemic chemotherapy. However, clinical studies evaluating these complications remain rare due to the lack of clinically proven effective and tolerable anti-HCV treatments at late cancer stages. Furthermore, no data were available regarding hepatitis C exacerbation in advanced hepatocellular carcinoma (HCC) patients receiving chemotherapy. To address this issue, 48 patients with HCV-related advanced HCC, who underwent systemic chemotherapy using 5- fluorouracil, cisplatin, and mitoxantrone from 2008 to 2014 were analyzed. Nine patients developed acute hepatitis exacerbations defined by HCV-RNA elevation ≥10-fold and alanine transaminase (ALT) elevation ≥5-fold of the upper normal limit. Six were genotype 1b and 3 were genotype 2. Three patterns of clinical courses were observed including single episode of exacerbation (n = 5), fluctuated flares (n = 3), and delayed exacerbation (n = 1). Hepatic failure developed in five patients. Patients with acute exacerbations were less likely to have pretreatment ascites (11.1% vs. 53.8%; P = 0.028) and displayed a lower baseline ALT (44.1 ± 28.5 U/L vs. 72.6 ± 19.2 U/L; P = 0.007). Paradoxically, despite a high risk of hepatic failure, occurrence of hepatitis C exacerbation was associated with a favorable overall survival (P = 0.027; 22.8 vs. 5.4 months). In conclusion, hepatitis C exacerbation can occur in HCC patients receiving chemotherapy, leading to liver failure. However, the flare was associated with a better overall survival, possibly due to its association with a better baseline liver function. J. Med. Virol. 89:153-160, 2017. © 2016 Wiley Periodicals, Inc.

Shift in large fluid volumes and massive blood loss during liver transplantation frequently leads to rapid changes in hemoglobin (Hb) concentration; thus, to ensure adequate tissue oxygenation, accurate and rapid determination of Hb concentration is essential in transplant recipients. The Radical-7 Pulse CO-Oximeter provides a noninvasive and continuous way to monitor Hb concentration (SpHb) in real time and is an ideal candidate for use during liver transplantation. In this study, we assessed the relationship between SpHb and total Hb (tHb) obtained from arterial blood samples during surgery.Forty patients undergoing liver transplantation were enrolled in this study. tHb and time-matched SpHb were measured at 5 different phases throughout surgery. Paired SpHb and tHb levels were assessed using linear regression, Bland-Altman analysis, and the Critchley polar plot method.A total of 161 paired measurements with sufficient signal quality were analyzed. The correlation between SpHb and tHb was 0.59 (P .001). Bland-Altman analysis revealed that a bias between SpHb and tHb was 2.28 g/dL, and limits of agreement (LoA) were from -0.78 to 5.34 g/dL. Trending analysis showed that 87% of data were located within the acceptable trending area, indicating that the trending ability was not satisfied.The Radical-7 Pulse CO-Oximeter was not sufficient to monitor Hb levels and trends during liver transplantation surgery in our cohort. In particular, in critical patients and in those with low Hb levels, invasive Hb measurement should be used for assessment.

Liver transplant recipients often have violent hemodynamic fluctuation during surgery that may be related to perioperative and postoperative morbidity. Because there are some considerations for the risk of the pulmonary arterial catheter (PAC), the conventional invasive device for cardiac output (CO) measurement, a reliable and minimally invasive alternative is required. We validated the reliability of CO measurements with the use of a minimally invasive FloTrac system with the latest fourth-generation algorithm in liver transplant recipients.Forty liver transplant recipients without atrial fibrillation, valvular pathology, or intracardiac shunt were recruited in this prospective, observational study. CO values measured by use of PAC with continuous thermodilution method (COTh) and FloTrac devices (COFT) were collected simultaneously throughout the operation for reliability validation.Four hundred pairs of CO data points were collected in total. The linear regression analysis showed a high correlation coefficient (73%, P .001). However, the percent error between COTh and COFT was 42.2%, which is worse than the established interchangeability criterion of 30%. The concordance rates were calculated at 89% and 59% by 4-quadrant plot and polar plot analysis, respectively. Neither met the preset validation criteria (92% for the 4-quadrant plot and90% for polar plot analyses).Our study demonstrates that the CO measurements in liver transplant recipients by the latest FloTrac system and the PAC do not meet the recognized interchangeability criterion. Although the result showed improvement in linear regression analysis, it failed to display a qualified trending ability.

Metallization of polyethylene terephthalate (PET) textiles was realized by conducting the catalyzation step in supercritical CO2 and using an organometallic compound, palladium bis-hexafluoracetylacetonate (Pd(hfa)2, as source of the palladium catalyst for the later Ni-P deposition step. Electrical resistance of the Ni-P/PET was evaluated before and after adhesion and high temperature incubation tests to reveal durability of the Ni-P/PET. Electrical resistances of the Ni-P/PET prepared at 343 K did not vary much after two cycles of the tape adhesion test when the deposition time was longer than 1.0 h. The Ni-P/PET metallized at 343 K for 2.0 h retained a low electrical resistance at 0.038 Ω after the high temperature incubation test at 414 K. The supercritical CO2 catalyzation was confirmed to be an effective method to metallize PET textile.