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We describe a case of total arch replacement with frozen elephant trunk for chronic type B aortic dissecting aneurysm, which resulted in inadvertent landing of the frozen elephant trunk into the false lumen. A radiofrequency puncture system-assisted controlled endovascular fenestration of the dissection flap was performed at the upper abdominal aorta and subsequent thoracic endovascular stenting, successfully redirecting the blood flow from the false to the true lumen. Our case illustrated a possible way to seal distal reentry in chronic type B aortic dissection.

促肾上腺皮质激素（ACTH）是一种由脑垂体前叶分泌的多肽类激素，其在维持儿童的免疫系统、神经系统和内分泌系统的稳定等方面发挥至关重要的作用。国内外研究已证实ACTH对儿童微小病变性肾病、膜性肾病、系膜增生性肾小球肾炎、局灶节段性肾小球硬化、糖尿病肾病、遗传性肾病等多种肾脏性疾病具有一定的治疗作用。本综述将针对ACTH在儿童肾病，尤其在肾病综合征方面的应用进行全面深入的阐述。.

Pulmonary nodules beneath the pleura can be hard to visualize or palpate, especially during the uniportal thoracoscopic surgery. Conventionally, thoracic surgeons would use adjuvant modalities to localize the lesion preoperatively, of which computed tomography-guided hookwire implantation has been adopted most widely due to its feasibility and high success rate. However, procedure-associated complications such as pneumothorax and wire dislodgement can cause patient discomfort or localization failure. Occasionally more healthy tissue is resected than needed to guarantee the lesion is removed and with an adequate margin. A thoracotomy is necessary for specific scenario. With the development of imaging technology, it is now possible to replace the traditional workflow carried out in the radiology suite by centralizing the hookwire placement and uniportal minimally-invasive pulmonary resection inside the hybrid theater which equipped with advanced imaging devices. Theoretically, the advanced intra-operative imaging-guided techniques help to precisely locate and resection pulmonary lesion in a potentially tissue-sparing and quick paradigm.

The current study aimed to examine the role and mechanism of a conserved long noncoding RNA termed NORAD (noncoding RNA activated by DNA damage, also named LINC00657) in gastric cancer (GC) progression.Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to determine the expression level of relevant genes in GC cell lines. Cell proliferation was examined by cell counting kit-8 (CCK-8) assays. Cell migration and invasion were detected by transwell migration and invasion assays. Protein levels of the indicated genes were detected by Western blotting. Cell apoptosis was examined by flow cytometry.Results showed that NORAD knockdown decreased cell proliferation, migration and invasion but increased cell apoptosis. NORAD knockdown affected the expression of genes related to apoptosis and Epithelial-Mesenchymal Transition (EMT). In addition, NORAD's depletion resulted in reduced Ras Homolog Family Member A (RhoA) and Rho-associated coiled-coil containing protein kinase 1 (ROCK1) expression. Furthermore, NORAD's expression was positively correlated with RhoA and ROCK1 expressions in GC based on The Cancer Genome Atlas (TCGA) database.Our results demonstrate the oncogenic role of NORAD in gastric cancer progression.

With the advent of advanced technology in performing diagnostics for lung cancer, an incremental increase in the number of patients with oligometastatic disease is currently being managed with intent to cure. As treatment of selected types of patients with oligometastasis show favourable outcomes, the past notion of managing these patients palliatively is fast becoming extinct. Selection of patients based on established criterion together with surgical metastasectomy combined with multiple ablative techniques with or without systemic chemotherapy offers a reasonable rate of treatment success which provides basis for treating such patient population. As more evidence becomes available to suggest that the oligometastatic state of lung cancer does exist, and are potentially curable, a better understanding of the condition is necessary for clinicians, and surgeons to provide optimal care. In this review we present some of the clinical basis which may cause a paradigm shift in management of patients with oligometastatic lung disease.

Background Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair. Methods We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative ( n = 60) or functional ( n = 6) mitral regurgitation had Memo 3D ( n = 32) or Memo 3D ReChord ( n = 34) rings implanted. Results Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up. Conclusions Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.

Uniportal video-assisted thoracic surgery (VATS) lung wedge resection usually requires three devices, thoracoscope, lung retracting instrument and an endo-stapler cutter to perform the procedure. With advances in miniaturization of the thoracoscope and lung retracting instruments, a major limitation to operating through a smaller uniportal incision has become the endo-stapler. We describe the surgical technique for uniportal VATS laser lung resection which uses a much narrower laser catheter device to replace the endo-stapler for resection. The new approach to limited lung resection can potentially reduce instrument fencing and the uniportal incision wound size, while achieving satisfactory hemostasis and pneumostasis.

HURT questionnaire. (PDF 105Â kb)

Functional tricuspid regurgitation remains a dilemma in patients presenting with left sided valvular disease. The decision for intervening is not clear cut in patients with mild/moderate regurgitation and in patients with severe regurgitation, placement of an annuloplasty ring may not be sufficient for a durable result due to leaflet tethering. There is no doubt that there is a trend for earlier intervention in patients with a dilated tricuspid annulus but minimal regurgitation but longer term follow up is required to assess the impact of this on long term outcomes.

Bandgap engineering is necessary for the application of InSb in long wavelength infrared photodetection. InSbN alloys hetero-eptiaxially were therefore deposited on GaAs substrate by metal-organic chemical vapor deposition (MOCVD), expecting a large band gap reduction by N incorporation for long wavelength infrared photodetection. The effects of post annealing treatment on the structural and optical properties of the grown InSbN alloy have been well studied. Photoluminescence measurement (PL) indicated that the longest PL wavelength obtained at 10 K is ~ 7.2 μm for the InSbN alloys, which manifests an extension of PL wavelength as large as ~ 1.8 μm in comparison to the undoped InSb epilayers, suggesting a successful band gap reduction by the N incorporation. X-ray photoelectron spectroscopy (XPS) measurements show that three kinds of nitrogen bonds co-exist in the alloys and their percentages vary with annealing conditions. This observation can explain the peak shifts of X-ray diffraction (XRD) and PL spectra. The comparison to our previous works reveals that the InSbN alloys grown on GaAs substrate can achieve more nitrogen incorporation and band gap reduction than the alloys grown on InSb and GaSb substrates. Accepted version

Background Transcatheter aortic valve implantation has been established as a safe and effective treatment option for patients at high or prohibitive surgical risk. However, some patients may not be suitable for the transfemoral approach due to severe iliofemoral disease or aneurysmal disease of the thoracoabdominal aorta. The aim of this case series was to evaluate the feasibility and clinical outcomes of the transaortic approach. Methods From May 2015 to June 2016, 5 patients (mean age 78.4 ± 3.9 years) with severe symptomatic aortic stenosis underwent transaortic transcatheter aortic valve implantation after a heart team discussion. They were considered to be at high surgical risk and ineligible for the transfemoral approach due to iliofemoral or thoracoabdominal aortic disease. Results A CoreValve Evolut R was successfully deployed in all 5 patients. We performed 4 right mini-parasternal incisions and one J-incision partial sternotomy. None of the patients required permanent pacemaker implantation, one required reopening of the mini-parasternal incision for postoperative bleeding. Follow-up echocardiography one month after the procedure showed improvement in the mean aortic gradient (from 63.2 to 8.3 mm Hg) and aortic valve area (from 0.62 to 2.2 cm2). None of the patients had more than mild paravalvular leakage. There was no intraoperative or 30-day mortality. Conclusion Transaortic transcatheter aortic valve implantation is a safe and feasible option for patients with severe aortic stenosis who are considered unsuitable for transfemoral aortic valve implantation.

During the 2014 Youth Olympic Games in Nanjing, the local government implemented a series of emission control measures. Fixed-effect model and generalized additive model were conducted to evaluate the association between control measures and health benefits. Daily non-accidental mortality decreased from 71 deaths per day before taking control measures to 61 during the under-control period. Interim measures reduced SO2, NO2, PM2.5, PM10 by 6.63%, 12.96%, 8.72% and 10.30%, while comprehensive measures further reduced pollutants by 12.19%, 8.89%, 25.05% and 30.86%. A μg/m3 decrease in SO2, NO2, PM2.5, PM10 was associated with decreases in all-cause mortality of 2.91%(95%CI:1.57%,4.24%), 1.36%(95%CI:0.62%,2.11%), 0.55%(95%CI:0.23%,0.87%) and 0.39%(95%CI: 0.15%,0.62%). According to the calculation, the game specifically reduced about 1000 acute deaths from all cause and produced about 500 million USD of benefits, demonstrating a statistically significant association between air quality controls and health benefits. The result also shows that relevant controls to deal with NO2 and PM should be taken more stringently in heavily polluted cities.

SUMMARYThe aim of this study was to characterize updated HIV subtypes in Yunnan to determine their origins and distribution within the population. RT–PCR of both thegagandenvgenes were sequenced from Yunnan province inhabitants newly diagnosed with HIV-1. Sequence data from 290 samples were used for statistical analysis of subtype distribution and phylogenetic tree construction. Distribution data were adjusted to account for different geographical distributions of HIV-1 subtypes in the population. Phylogenetic analysis revealed six HIV-1 subtypes in Yunnan, including eight types of unique recombination forms (URFs). The most prevalent subtypes in this province, CRF07_BC (18·9%), CRF08_BC (39·1%), CRF01_AE (22·4%), and URFs (subtype C, 5·9% and subtype B, 4·5%), were all recombinants. We found significant differences in the distribution of these HIV-1 subtypes not only geographically, but also between various ethnic groups and with respect to transmission routes. Our findings indicate a complex population of HIV-1 subtypes, URFs, and recombinant subtypes in Yunnan province. This diversity could make the prevention and control of HIV infection in Yunnan more difficult due to the possibility of virus recombination or infection by multiple subtypes.

The advancement of imaging technology has recently facilitated single port minimally-invasive thoracic surgery techniques. Cone-beam computed tomography (CBCT) shows promising results in visualizing the target lesion and its surrounding critical anatomy, with an error of less than 2 mm. The integration of CBCT with the operating room (OR) to form the hybrid OR, provides unparalleled real-time imaging of the patient, which can be used with electromagnetic navigation bronchoscopy to confirm successful navigation and increase procedural accuracy particularly for small peripheral pulmonary targets. Furthermore, implantation of hookwires or microcoils that are widely used to localize the lesion can take place in the hybrid suite, eliminating the common complications and discomfort associated with the conventional workflow carried out in the radiology suite. Displacement leading to localization failure can be also reduced, and sublobar resection will be performed without resecting a larger area of parenchyma than desired. This one-stop, paradigm-shifting concept for simultaneously diagnosing and managing small pulmonary lesions in the hybrid OR can lead to reduced invasiveness and improved patient care.

Video-assisted thoracic surgery (VATS) is widely adopted in acute management of patient with thoracic trauma, but its use in penetrating thoracic injuries with retained foreign bodies were rarely reported. We described three of such cases using VATS as the first line approach. Identification of injuries, control of bleeders, clot evacuation, resection of damaged lung parenchyma and safe retrieval of foreign bodies were all performed via complete VATS within short operative time. Patient were uneventfully discharged during early post-operative period. We suggest that, for haemodynamically stable patients, VATS offers a safe and minimally-invasive alternative to conventional thoracotomy for penetrating thoracic injury with retained foreign bodies.

A 66-year-old man presented with acute type I respiratory failure, and was diagnosed to have a huge mass occupying the right atrium (RA) of the heart, with no evidence of pulmonary embolism. Intra-operative transesophageal echocardiogram identified a patent foramen ovale (PFO) with right-to-left shunt apart from a huge right atrial tumor arising from the atrioventricular groove. The tumor was debulked, and the patent foramen was closed. Patient had an uneventful recovery and WAS discharged on post-operative day 7. Pathology revealed diffuse large B-cell lymphoma (DLBCL). The patient was further treated with adjuvant chemotherapy and remained well 1 year after surgery. This case illustrates the importance of meticulous echocardiographic examination to look for any intracardiac shunts in the case of hypoxemia associated with a right-sided cardiac tumor. We advocate surgery as the most important initial management to maximize survival, as it allows correction of any hemodynamic sequelae, and simultaneous attainment of definite histological diagnosis for guidance of adjuvant therapy.

Background. Yoga Empowers Seniors Study (YESS) quantified physical demands associated with yoga performance using biomechanical methods. This study evaluated the efficacy of the program on physical function outcomes.Methods. Twenty community-dwelling older adults aged 70.7 ± 3.8 years attended biweekly 60-minute Hatha yoga classes for 32 weeks. Four domains of the physical measurements including (1) functional performance, (2) flexibility, (3) muscle strength, and (4) balance were taken at the baseline, 16-week and 32-week time points. Repeated-measures ANOVA omnibus tests and Tukey’s post hoc tests were employed to examine the differences in each outcome variable across the 3 time points.Results. Improved timed chair stands (p<0.01), 8-foot up and go (p<0.05), 2-min step test (p<0.05), and vertical reach (p=0.05) performance were evident. Isometric knee flexor strength (p<0.05) and repetitions of the heel rise test (p<0.001) also increased following the 32-week intervention. Both flexibility and balance performance remained unchanged.Conclusions. Significant improvements in physical function and muscle-specific lower-extremity strength occur with the regular practice of a modified Hatha yoga program designed for seniors. These adaptations corresponded with the previously reported biomechanical demands of the poses.

SummaryBackground Functional dyspepsia (FD) is a common disease without an established optimal treatment. Aim To determine (i) the effect of acupuncture in relieving FD symptoms and improving life quality; (ii) the effect difference between acupoint and non-acupoint; and (iii) the effect difference among different acupoints. Methods A total of 712 eligible patients were included and randomly assigned to six groups (Group A: specific acupoints of the stomach meridian; Group B: non-specific acupoints of the stomach meridian; Group C: specific acupoints of alarm and transport points; Group D: specific acupoints of the gallbladder meridian; Group E: sham acupuncture of non-acupoints; and Group F: itopride). A treatment period of 4 weeks (continuous five sessions per week), and a follow-up period of 12 weeks were arranged. The outcomes were the (i) patients’ response, (ii) symptoms improvement measured using the Symptom Index of Dyspepsia and (iii) quality-of-life improvement based on Nepean Dyspepsia Index. Results All groups had an improvement in dyspepsia symptoms and the QoL at the end of treatment, and the improvement was sustained for 4 weeks and 12 weeks. The overall response rate was significantly higher in acupuncture group A (70.69%), and lower in sham acupuncture group (34.75%), compared with itopride and other acupuncture groups. Similarly, the difference in symptoms and QoL improvement was significant between group A and the other acupuncture groups. Conclusions Acupuncture is effective in the treatment of functional dyspepsia, and is superior to non-acupoint puncture. The benefit of acupuncture relies on acupoint specificity.

Yoga is considered especially suitable for seniors because poses can be modified to accommodate practitioners’ capabilities and limitations. In this study, biomechanical assessments on healthy seniors ( 𝑛 = 2 0 ; 7 0 . 1 ± 3 . 8 yr) were used to quantify the physical demands, (net joint moments of force [JMOFs] and muscular activation in the lower extremities) associated with the performance of 3 variations (introductory, intermediate, advanced) of 2 classical Hatha yoga poses – Tree and One-Leg Balance (OLB). ANOVA and Cohen's- d were used to contrast the postural variations statistically. The advanced (single-limb, without additional support) versions were hypothesized to generate the greatest demands, followed by the intermediate (single-limb [Tree] and bilateral-limb [OLB] with support) and introductory (bilateral-limb) versions. Our findings, however, suggest that common, long-held conceptions about pose modifications can be counter-intuitive. There was no difference between the intermediate and advanced Tree variations regarding hip and knee JMOFs in both the sagittal and frontal planes ( 𝑃 = 0 . 1 3 –0.98). Similarly, OLB introductory and intermediate variations induced sagittal JMOFs that were in the opposite direction of the classic advanced pose version at the hip and knee ( 𝑃 . 0 0 1 ; 𝑑 = 0 . 9 8 –2.36). These biomechanical insights provide evidence that may be used by instructors, clinicians and therapists when selecting pose modifications for their yoga participants.

The dissociative photoionization of vinyl bromide (C2H3Br) has been investigated by photoionization mass spectrometry (PIMS) and time-of-flight threshold photoelectron-photoion coincidence (TOF-TPEPICO) spectrometry using synchrotron radiation. The photoionization efficiency curves of the three most abundant ions, i.e. C2H3Br+, C 2 H 3 + and C 2 H 2 + , are measured and analyzed in detail. A C 2 H 3 + / Br - photoion-pair formation process has been detected for the first time. Some arguments are provided in favor of the electronic excitation of the C 2 H 3 + fragment and of the isomerization of the C 2 H 2 + ions. The breakdown diagram for these ions in the 9.8–21 eV photon energy range, derived from TOF-TPEPICO mass spectra, is discussed. The involvement of the successive C2H3Br+ ionic states and the role of autoionization of C2H3Br Rydberg states are emphasized. For the two minor HBr+ and Br+ fragment ions only the breakdown diagrams are measured and appearance energies are derived.

The triaxial superdeformed rotational bands in the odd–odd Lu 160 ∼ 168 isotopes are investigated by performing the configuration dependent three-dimensional total routhian surface calculations. About fifty low lying triaxial superdeformed bands have been found for these odd–odd nuclei within the excitation energy of 3 MeV above the normal deformed yrast bands. The calculated equilibrium elongation, triaxial and hexadecapole deformations for these triaxial superdeformed bands are close to the values of e 2 ∼ 0.4 , γ ∼ 20 ° and e 4 ∼ 0.03 , respectively. The configurations of calculated triaxial superdeformed bands have been assigned based on the total routhian surface calculations and the analysis of quasiparticle routhians in the rotating frame. The observed yrast triaxial superdeformed band of 164Lu, where the linking transitions between superdeformed and normal deformed states are measured, have been reproduced by the present calculation in the relative energy to the normal deformed band. We show that the stability of superdeformed triaxial shapes in the odd–odd Lu isotopes is similar to that presented in odd–even Lu nuclei, and thus the wobbling excitations could be expected to occur in odd–odd Lu isotopes. The deformation driving effect of the proton high-j low-K orbit play an important role in the formation of the triaxial superdeformed states in both odd–odd and odd–even Lu isotopes, while the shell effect is a fundamental factor for the triaxial superdeformed shapes. The shell gaps and the positions of the deformation driving intruder orbits which are responsible for the triaxial superdeformed minima have been localized, particularly, the neutron N = 94 gap and the position of the proton [ 660 ] 1 / 2 orbit in the deformed single particle diagram provide the basis for a microscopic understanding of the observed triaxial superdeformed bands in the mass region.

Asian countries have been active in adopting and utilizing uniportal video-assisted thoracic surgery (VATS) for management of pulmonary and mediastinal pathologies. With accumulation of experience, the benefits of uniportal over conventional VATS are becoming more established through scientific studies. The limit in terms of safety and feasibility of uniportal VATS for more complex thoracic surgical condition continue to expand, as surgeons are more prepared to extend the applications of the approach beyond their comfort zone. Early diagnosis and treatment of small lung nodules have been facilitated by the safety of non-intubated technique and the availability of accurate localization adjuncts.

Posterior mediastinal lesions represent a relatively small proportion of the case loads in thoracic surgery. As the minimally-invasive approaches to the lung and anterior mediastinum continued to advance and improve, many of those techniques can also be employed for posterior mediastinal lesions. Single-port video-assisted thoracic surgery and robot-assisted thoracic surgery are the two leading techniques in this field. Due to the lower incidence of posterior mediastinal lesions and the heterogeneity of the pathologies, evidence for their application is limited. Nevertheless, the available literature demonstrated high safety and effectiveness of these new approaches for surgical management of posterior mediastinal lesions with satisfactory short-term outcomes comparable to their conventional counterparts. Based on the promising early results, more evidence is expected to consolidate the role of these new techniques for posterior mediastinal lesions.

Starch granules found at the centre of fish crackers ('keropok') which contained from 0 to 10% fish did not gelatinize after 2 h steaming. This was because of water movement from the centre to the periphery during steaming. A fish protein network started to develop in dough with a 15% fish content and this entrapped water molecules. These water molecules helped to complete gelatinization. The viscoelastic properties of keropok' dough increased with an increasing fish to starch ratio and also because of the formation of a fish-protein network in the dough. Le keropok ou le cracker au poisson est un snack populaire en Malaisie et dans les regions du Sud Est de l'Asie. Le produit est fabrique en formant une pâte a partir d'un melange d'amidon, de chair de poisson pulverisee et d'eau. La pâte est formee, chauffee par vapeur d'eau pour gelatiniser l'amidon, coupee en tranches fines et sechee. Avant la consommation, les tranches sont frites dans de l'huile bouillante. Frequemment, des granules d'amidon dans le centre des crakers, qui contient de 0 a 10 % de poisson, ne gelatinisent pas apres 2h de traitement a la vapeur. C'est a cause du mouvement de l'eau du centre a la peripherie pendant cette etape. Cette etude evalue l'influence des proteines de poisson sur la gelatinisation de l'amidon dans le keropok. Les proprietes viscoelastiques du keropok augmentent quand la teneur en poisson est augmentee grâce a la formation d'un reseau de proteines de poisson dans la pâte.

Summary The use of pre-gelatinized tapioca starch for the manufacture of ‘keropok’ by drumdrying has been investigated. Processing variables were examined by using five different slurries of water: starch, with ratios of 50:50, 60:40, 70:30, 80:20, and 90:10 at four different temperatures: 120.2°C, 133.5°C, 143.6°C, and 151.8°C. Only ‘keropok’ made from a slurry with a water: starch ratio of 70:30 pre-gelatinized at 133.5°, 143.6°C and 151.8°C had linear expansion greater than the minimum acceptable value of 77%. ‘Keropok’ containing pre-gelatinized starch produced at 133.5°C was the most acceptable to a sensory panel.

Proteins from Oreochromis mossambicus, a freshwater fish, were hydrolysed, using alkalase 0.61, to produce a soluble, spray-dried hydrolysate. The hydrolysis was carried out at 50°C, using a ratio of one part water and one part fish mince, an enzyme:substrate ratio of 1:50 at pH 8.0. Reaction was terminated by heating to 90°C for 20min. After neutralization, the soluble fraction obtained after centrifugation was spray dried in a mini spray-drier, at an air inlet temperature of 170°C and a feed rate of 41−1. The spray-dried hydrolysate was incorporated into crackers which are fried before eating. Ten per cent hydrolysate was found to give maximum linear expansion. Sensory evaluation with 20 experienced assessors showed that in terms of appearance, crispiness and colour, crackers with hydrolysate had the highest scores, compared to crackers made with O. mossambicus and Sciaena sp. (Jewfish). There were no significant differences in overall acceptability in all three samples. Crackers with hydrolysate also had the highest nitrogen content.

‘Keropok’ production is an important cottage industry in Malaysia. However, production methods used are poor, resulting in inferior quality products which have uneven expansion characteristics, dark objectionable colours and varying shapes, sizes and thicknesses. This paper describes a method that can be used to upgrade ‘keropok’ production. Basically it is an adaptation from sausage production technology. Products from this method were superior in terms of appearance, shape and linear expansion and were more acceptable to taste panellists.

Investigation of processing of dry-salted fish is described. The use of a satisfactory ratio of salt to fish, optimization of salting time and the use of mechanical driers to reduce drying time, insect infestation and microbial spoilage were investigated. Results indicated that oven-dried fish salted at 10% and 20% levels were most acceptable. The corresponding sun-dried samples had an undesirable odour, flavour and texture due to their higher moisture contents. At the 30% and 40% salt levels for both processes, the differences were less pronounced, but the samples that were sun-dried were more acceptable mainly as a result of a better appearance.

Thoracic endovascular aortic repair (TEVAR) offers a less invasive treatment for aortic arch aneurysms. Clinical challenges arise when there is inadequate proximal landing for zone 1 TEVAR, such that a median sternotomy with total aortic debranching is required before stent deployment. The chimney technique was reported as an alternative approach to stent the arch branches and avoid sternotomy, but it was still associated with considerable chance of a type IA endoleak. We report a case of aortic arch aneurysm with an inadequate proximal landing for zone 1 TEVAR that was treated with debranching of head and neck vessels followed by TEVAR and preemptive and targeted coil embolization of the arch aneurysmal sac. Postoperative computed tomography showed no significant endoleak, and the patient had an unremarkable recovery.

A 57-year-old man was incidentally found to have a dissected diverticulum of Kommerell originating from aberrant origin of right subclavian artery during follow-up for treated colon cancer. A right carotid-axillary bypass was followed by embolization of aberrant artery and the diverticulum by deployment of multiple detachable coils using the Penumbra Ruby System (Penumbra, Alameda, CA). Angiography after embolization showed exclusion of flow to the aberrant artery and a patent right carotid-axillary bypass. The patient recovered uneventfully and remained well for 12 weeks after the operation, without any complications. We believe this targeted endovascular approach can avoid complications related to the coverage of thoracic aorta and reduce the risk of access vessel trauma.

This study aims to research the effect of dihydroartemisinin on the proliferation, metastasis and apoptosis in human osteosarcoma cells 143B and the underlying mechanism. This study designed five groups for experiment and control, using dimethylsulfoxide (DMSO), and docosahexaenoic acid (DHA) at concentrations of 15, 25, 35 μmol.L-1 respectively. Experiments including methyl thiazolyl tetrazolium (MTT) assay, clone formation assay, Hoechst 33258 staining assay, luciferase reporter plasmid assay, Western blot and scratch test were carried out. In addition, SPSS 18.0 software from IBM was used for statistical analysis and all the data obtained from the experiments were expressed as mean ± SD, and variance was used to compare the difference between the groups. DHA is proved to be able to inhibit the proliferation and metastasis of osteosarcoma cells, as well as leaving a positive effect on apoptosis in the cytomorphosis. It achieves regulation over the human osteosarcoma cells by keeping the expression of related protein under control.

The design of a novel ultrawideband printed-circuit antenna is presented. By using a stepped-patch in combination with multiple resonating elements, a bandwidth of more than 150% is obtained. The performance is demonstrated through measurements and calculations with a commercially available field solver. A phase center analysis shows very small variations over the entire available bandwidth

Biomechanical studies were designed to determine the dynamic progression of the uterine cervix of pregnant rats at various stages of gestation and to determine its functions in retaining the fetus while at the same time undergoing characteristic softening to allow for dilatation at parturition. Whole cervices from Sprague-Dawley rats at 10, 15, and 21 days gestation and at 3 days postpartum were subjected to detailed biomechanical studies. Tension–length change, tension–diameter, pressure–area, stress–diameter, and stress–strain curves were calculated using analytical methods adopted from vascular mechanics. The circular diameter of the tissue was greatly increased as pregnancy advanced. Cervix volume increased, while tissue wall stress and cervix pressure were both maintained in a constant range throughout pregnancy. The compliance increased until term. The rat cervix undergoes two mechanical changes, a change in mechanical properties and a increase in volume, that allow it to maintain its two physiological functions of: (a) softening in preparation for delivery, and (b) at the same time remaining undilated in order to maintain fetuses in utero.

Trade between nations has been globalized since establishing the WTO(World Trade Organization). By lowering trading barriers under the WTO`s system, trade in goods has been gradually increased It requires global logistic system that transports goods in between nations. To save cost of product, cargo of product is containerized and container ships to carry container cargo is going to be bigger: In the market, there are many vendors to provide artificial intelligent modules to operate container terminal. In order to integrate automated container terminal system easily and successfully, this thesis proposes high-level XML/ JMS( eXtensive Markup Language/Java Message Service) communication model and multi-agent based system architecture to share knowledges, solve problems, and active objectives by cooperating between autonomous and intelligent agents that are developed by 3rd party companies in the market. This thesis analyzed current situation of advanced automated container terminal with case studies on implemented systems and difficulties to develop automated container terminal system, reviewed technologies of intelligent agent, communication and automation that unmaned automated container terminal is required.

A single crystal of Ag–36.7 at.% Al aged within the hexagonal close-packed (h.c.p.) δ-phase region of the phase diagram at 366 K was investigated by diffuse X-ray scattering. Diffuse scattering maxima were found at 2 k F positions where k F is the Fermi wave number along 〈1 1 0] . The contributions from short-range order scattering, linear size-effect scattering, Huang scattering and thermal diffuse scattering were separated by least-squares fitting of the corresponding Fourier series. In crystals modeled on the basis of 40 Warren–Cowley short-range order parameters, nearest-neighbor configurations are found which are characteristic of a superstructure introduced by Neumann as a possible ground-state structure of h.c.p. Ag–Al. Effective pair interaction parameters of the first 12 shells determined by the inverse Monte Carlo method were used in Monte Carlo simulations. For the Neumann structure, an order–disorder transition temperature of ∼100 K is estimated.

X-ray absorption near edge structure (XANES), utilizing both electron yield and X-ray fluorescence detectors, and X-ray photoelectron spectroscopy (XPS) were used to follow chloride uptake by oxide-covered aluminum in 0.1 M NaCl solutions. The aluminum samples were polarized at selected potentials below (less positive than) the pitting potential. The electron yield XANES and XPS showed multiple peaks. The XPS chloride spectra showed two distinct sets of doublets. One doublet is related to chloride on the surface and the second is related to chloride incorporated in the oxide film. The XANES results also showed two peaks which are attributed to chloride on the surface and in the bulk of the oxide.

We report two cases of gestational choriocarcinoma, following term pregnancies initially presented with feto-maternal hemorrhage. In both cases, the diagnosis was not made until the patients presented with complications postpartum. Presentations of reported gestational choriocarcinoma cases associated with feto-maternal hemorrhage were reviewed. We conclude that massive feto-maternal hemorrhage merits a high index of suspicion for such a diagnosis.