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Experiments on fire whirls generated by a gasoline pool fire in a vertical shaft were carried out. Vortex motions of swirling flame induced by buoyancy above the pool fires were observed to be more vigorous with increase in height. Upward flame motions were resulted due to increase in buoyancy. The phenomenon was described mathematically by solving the vorticity transport equation with reasonable assumptions and appropriate boundary conditions. Analysis gave swirling attenuation along the vertical direction. By measuring heat release rates and fire whirl diameters at different heights, vertical variation of circular speeds of fire whirls was derived.

Numerical studies on internal fire whirls (IFW) generated in a vertical shaft model with a single corner gap were reported in this paper. The generation of IFW, burning rate of fuel and temperature were studied experimentally first. Numerical simulations on medium-scale IFW were carried out using a fully-coupled large eddy simulation incorporating subgrid scale turbulence and a fire source with heat release rates compiled from experimental results. Typical transient flame shape was studied and then simulated numerically by using temperature. The dynamic phenomena of generation and development of IFW were simulated and then compared with experimental results. The predicted results were validated by comparing with experimental data, which demonstrated that an IFW can be simulated by Computational Fluid Dynamics. Numerical results for flame surface, temperature, and flame length agreed well with the experimental results. The IFW flame region and intermittent region were longer than those for an ordinary pool fire. The modified empirical formula for centerline temperature was derived. Variations of vertical and tangential velocity in axial and radial directions were also shown. The vortex core radius was found to be determined by the fuel bed size. Velocity field was not measured extensively due to resources limitation. Comparing measured temperature distribution with predictions is acceptable because temperature is related to the heat release rate, air flow and pressure gradient.

In family firms, where the family and the business domains are intertwined, conflicts from one domain can spill over to the other. Agency conflicts in the business domain can spread to the family domain and ruin the well-being of the families. Agency theorists suggest that corporate governance tools such as performance-based incentive pay and dividend payouts can be used to mitigate agency conflicts in widely-held firms. Previous studies in family firms, however, show inconclusive results. This paper aims to investigate whether incentive pay and dividend payouts alleviate agency conflicts in family firms, from an auditor’s perspective. Audit research shows that audit fees are higher for firms (auditees) with more severe agency problems. Thus, an audit fee premium (discount) can be a proxy for the severity (mildness) of agency conflicts. If a governance tool exacerbates (mitigates) agency conflicts in a family firm, it is expected to lead to an audit fee premium (discount). Using data from 150 largest listed companies in Hong Kong, the analyses show that the impacts of incentive pay and dividend payouts on audit fees are not uniform. Auditors view the governance tools as effective in mitigating agency conflicts only in some settings. This implies that the owning families should be cautious when implementing a governance tool. In some situations, a governance tool may aggravate agency conflicts in the business domain, which then can spill over to the family domain and adversely affect the family welfare.

Background The transvaginal natural orifice specimen extraction (NOSE) approach for right-side colon surgery has been proven to exhibit favorable short-term outcomes. However, thus far, no study has reported the advantages of transrectal NOSE for right-side colon surgery. The aim of this study was to compare the technical feasibility, safety, and short-term outcomes of minimally invasive right hemicolectomy using the transrectal NOSE method and those of conventional mini-laparotomy specimen extraction. Methods A study was conducted on consecutive patients who had minimally invasive right hemicolectomy either for malignancy or benign disease at Chang Gung Memorial Hospital, Linkou, Taiwan, between January 2017 and December 2018. The patients were divided into two groups: conventional surgery with specimen extraction using mini-laparotomy and NOSE surgery. Surgical outcomes, including complications, postoperative short-term recovery, and pain intensity, were analyzed. Results We enrolled 297 patients (151 males, mean age 64.9 ± 12.8 years) who had minimally invasive right hemicolectomy. Of these 297 patients, 272 patients had conventional surgery with specimen extraction through mini-laparotomy and 25 patients had NOSE surgery (23 transrectal, 2 transvaginal). The diagnosis of colon disease did not differ significantly between the conventional and NOSE groups. Postoperative morbidity and mortality rates were comparable. The postoperative hospital stay was significantly (p = 0.004) shorter in the NOSE group (median 5 days, range 3–17 days) than in the conventional group (median 7 days, range 3–45 days). Postoperative pain was significantly (p = 0.026 on postoperative day 1 and p = 0.002 on postoperative day 2) greater in the conventional group than in the NOSE group. Conclusions NOSE was associated with acceptable short-term surgical outcomes that were comparable to those of conventional surgery. NOSE results in less postoperative wound pain and a shorter hospital stay than conventional surgery. Larger studies are needed

To investigate the accuracy of ultrasound in characterising the type of mass and likelihood of malignancy in deep soft tissue masses. Five hundred seventy-nine deep soft tissue masses were prospectively studied by ultrasound. Masses (n = 137) with prior MRI or CT were not included. Following ultrasound examination, the likely nature of the mass as well as the confidence of the reporting radiologist (‘fully confident’ versus ‘not fully confident’) about the ultrasound diagnosis was recorded. Clinical and ultrasound diagnoses were compared with the histological diagnosis which was available in 134 (23%) of the 579 masses. Compared with histology, clinical and ultrasound accuracy for characterising the type of mass were 47% and 88% respectively when all differential diagnoses were considered. The radiologist was fully confident regarding the type of 436 (75%) of 579 masses and, in this setting, for those cases that could be compared with histology, diagnostic accuracy was 96%. For the remaining masses, where the radiologist was not fully confident, accuracy compared with histology was 58% for the first differential diagnosis and 80% for all differential diagnoses. For identifying malignancy, sensitivity, specificity, and positive and negative predictive value of ultrasound were 97%, 58%, 67%, and 99% respectively. Ultrasound alone was considered sufficient for diagnostic workup in over half of all deep soft tissue masses. Ultrasound is useful at characterising and recognising malignancy in deep soft tissue masses. Provided local practice patterns are favourable, ultrasound may be considered a first-line investigation in the diagnostic workup of deep soft tissue masses. • In three-quarters of cases, one can be fully confident about characterising the nature of deep soft tissue masses on ultrasound and, for those fully confident cases that could be compared with histology, the diagnostic accuracy of ultrasound was 96%. • Ultrasound can correctly recognise nearly all malignant deep soft tissue masses but some benign masses will also be considered possibly malignant. • Ultrasound alone was considered sufficient for imaging workup in over half of deep soft tissue masses.

Purpose To evaluate the presence of intravesical prostatic protrusion (IPP) and its thickness-to-height (T/H) ratio as a predictor for the clinical outcome and morbidity of prostatic artery embolization (PAE) for benign prostatic hyperplasia. Materials and Methods This was a prospective, single-center, institutional review board-approved study from June 2015 to December 2018 of 82 consecutive patients (age, 53–79 years; median, 66 years) with International Prostate Symptom Score (IPSS) ≥15 and quality-of-life (QOL) score ≥3. The presence of IPP and its T/H ratio were assessed on baseline magnetic resonance imaging for their correlation with the clinical outcomes of suboptimal IPSS (IPSS ≥10) and suboptimal QOL (QOL ≥3) up to 12 months after PAE and the occurrence of post-procedure complications (≤30 days), which caused a certain degree of urinary outflow obstruction. The chi-squared test was used for analysis. Results IPP was present in 57 of 82 patients (69.5%). The presence of IPP correlated with the occurrence of post-procedure complications (P = .009) but not with suboptimal IPSS at 12 months (P = .758). IPP with a T/H ratio ≤1.3 correlated with suboptimal IPSS at 12 months (P = .025) and suboptimal QOL at 6 months (P = .025) and 12 months (P = .008), as well as with the occurrence of post-procedure complications (P = .009). Conclusions IPP with a T/H ratio ≤1.3 predicted the occurrence of post-procedure complications with urinary obstruction. A T/H ratio ≤1.3 but not the presence of IPP alone predicted the clinical outcome up to 12 months after PAE.

Diabetes among working population brings to society concerns on productivity and social welfare cost, in addition to healthcare burden. While lower socio-economic status has been recognised as a risk factor of diabetes; occupation, compared with other socio-economic status indicators (e.g., education and income), has received less attention. There is some evidence from studies conducted in Europe that occupation is associated with diabetes risk, but less is known in Asia, which has different organisational cultures and management styles from the West. This study examines the association between occupation and diabetes risk in a developed Asian setting, which is experiencing an increasing number of young onset of diabetes and aging working population at the same time. This is a cross-sectional study of working population aged up to 65 with data from a population-based survey collecting demographic, socio-economic, behavioural and metabolic data from Hong Kong residents, through both self-administered questionnaires and clinical health examinations (1,429 participants). Non-skilled occupation was found to be an independent risk factor for diabetes, with an odds ratio (OR) of 3.38 (p < 0.001) and adjusted OR of 2.59 (p = 0.022) after adjusting for demographic, behavioural and metabolic risk factors. Older age (adjusted OR = 1.08, p < 0.001), higher body mass index (adjusted OR = 1.23, p < 0.001) and having hypertriglyceridemia (adjusted OR = 1.93, p = 0.033) were also independently associated with diabetes. Non-skilled workers were disproportionately affected by diabetes with the highest age-standardized prevalence (6.3%) among all occupation groups (4.9%-5.0%). This study provides evidence that non-skilled occupation is an independent diabetes risk factor in a developed Asian setting. Health education on improving lifestyle practices and diabetes screening should prioritise non-skilled workers, in particular through company-based and sector-based diabetes screening programmes. Diabetes health service should respond to the special needs of non-skilled workers, including service at non-office hour and practical health advice in light of their work setting.

Introduction Perineal descent is a phenomenon associated with anorectal dysfunction. It is diagnosed by defecography but subjected to manual measurements on the images/videos and interobserver bias. Fecobionics is a simulated feces for assessing important physiological parameters during defecation. Here, we translate Fecobionics into a new method for estimation of perineal descent based on electronic signals from the embedded inertial measurement units (IMUs). Methods A displacement measurement method by a combined zero-velocity update and gravity compensation algorithm from IMUs was developed. The method was verified in a robot model, which mimicked perineal descent motion. Results The method correlated well with the reference (R = 0.9789) and had a deviation from the peak displacement (range 0.25-2.5 cm) of -0.04 ± 0.498 cm. The method was further validated in 5 human experiments with comparison to the benchmark defecography technology (R = 0.79). Discussion The proposed technology is objective, i.e., electronic measurements rather than by fluoroscopy or MRI. The development may impact clinical practice by providing a resource-saving and objective technology for diagnosing perineal descent in the many patients suffering from anorectal disorders. The technology may also be used in colon experiments with Fecobionics and for other gastrointestinal devices containing IMUs such as ingestible capsules like the Smartpill.

BACKGROUND The aim of the International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology is to improve cytology practice. This study assessed cytologic diagnoses made with the system and its efficacy when it was applied by pathologists with different levels of experience. METHODS In all, 1080 cases of breast fine-needle aspiration biopsy (FNAB) over a period of 16 years were reviewed and reclassified with the system. The category distribution and the diagnostic performance were compared with the original diagnoses. The concordance rates for diagnoses from pathologists with different levels of experience were also determined. RESULTS The distribution of cytologic diagnoses made with the system was as follows: 11.7% were insufficient, 56.6% were benign, 20.1% were atypical, 6.1% were suspicious for malignancy, and 5.6% were malignant. The rates for the insufficient and atypical categories were lower than the original diagnosis rates (13.1% and 23.8%, respectively). Overall, 120 cases (11.1%) were recategorized. Among those recategorized as benign, suspicious, or malignant with follow-up data, 96.7% were correctly reclassified. A significant improvement in diagnostic performance was found with the system (P

Objectives There is increasing attention on association between eating patterns and diabetes control following global changes in eating patterns. There had been very limited research on the eating patterns of diabetic patients with employment, although working age population has seen the highest increase in diabetes incidence. This study aimed to identify workplace eating patterns in relation to glycaemic control among type 2 diabetic patients with employment. Methods This is a sequential mixed-methods study. The exploratory qualitative study involved focus group interviews with 31 type 2 diabetic patients with employment, which guided the design of a subsequent cross-sectional investigation involving 185 patients with employment. Thematic analysis was conducted on the qualitative data to identify workplace eating patterns most relevant to glycaemic control. Hierarchical multiple linear regression was performed to examine association between workplace eating pattern and glycaemic control, proxied by HbA1c. Results The focus group interviews identified frequency in the consumption of home-prepared meals (HPM) and meal hours as the major workplace eating patterns that affected glycaemic control. The cross-sectional study confirmed that regular consumption of HPM at workplace could explain variance of HbA1c, independent of socio-demographic factors, lifestyle factors and disease condition, with R2 = 0.146, F(14, 170) = 2.075, p = 0.015; adjusted R2 = 0.076. Patients who were female, in non-skilled occupation, on shift, with fixed work location and had break during work were more likely to consume HPM. Conclusions Consumption of HPM at workplace should be promoted to facilitate better glycaemic control by type 2 diabetic patients with employment, possibly through more practical dietary advice, and workplace accommodation in terms of space and facilities. In the context of COVID-19 pandemic, consumption of HPM also meant additional protection for diabetic patients through reducing close contact exposures in restaurants.

To investigate the accuracy of ultrasound in characterising the type of mass and likelihood of malignancy in deep soft tissue masses.Five hundred seventy-nine deep soft tissue masses were prospectively studied by ultrasound. Masses (n = 137) with prior MRI or CT were not included. Following ultrasound examination, the likely nature of the mass as well as the confidence of the reporting radiologist ('fully confident' versus 'not fully confident') about the ultrasound diagnosis was recorded. Clinical and ultrasound diagnoses were compared with the histological diagnosis which was available in 134 (23%) of the 579 masses.Compared with histology, clinical and ultrasound accuracy for characterising the type of mass were 47% and 88% respectively when all differential diagnoses were considered. The radiologist was fully confident regarding the type of 436 (75%) of 579 masses and, in this setting, for those cases that could be compared with histology, diagnostic accuracy was 96%. For the remaining masses, where the radiologist was not fully confident, accuracy compared with histology was 58% for the first differential diagnosis and 80% for all differential diagnoses. For identifying malignancy, sensitivity, specificity, and positive and negative predictive value of ultrasound were 97%, 58%, 67%, and 99% respectively. Ultrasound alone was considered sufficient for diagnostic workup in over half of all deep soft tissue masses.Ultrasound is useful at characterising and recognising malignancy in deep soft tissue masses. Provided local practice patterns are favourable, ultrasound may be considered a first-line investigation in the diagnostic workup of deep soft tissue masses.• In three-quarters of cases, one can be fully confident about characterising the nature of deep soft tissue masses on ultrasound and, for those fully confident cases that could be compared with histology, the diagnostic accuracy of ultrasound was 96%. • Ultrasound can correctly recognise nearly all malignant deep soft tissue masses but some benign masses will also be considered possibly malignant. • Ultrasound alone was considered sufficient for imaging workup in over half of deep soft tissue masses.

An internal fire whirl can be generated by a pool fire burning in a vertical shaft with a single corner gap of appropriate width. In an internal fire whirl, the flame height is an important characteristic in terms of fire safety. In this paper, a correlation expression of flame height with the width of a single corner gap was studied using reported experimental data in a 9-m tall vertical shaft model. A pool of gasoline fuel was burnt inside the shaft model to study the characteristics of flame swirling. An internal fire whirl was generated for gap widths lying between 0.11 m and 0.66 m, when the pool fire was 0.46 m diameter. The flame height was between 2.5 m and 3.2 m. From the experimental observations on flame swirling for different gap widths, coupled with three assumptions on variation of air entrainment velocity with height, an expression relating the flame height and the corner gap width was derived for the internal fire whirl using a set of compiled experimental data. The correlation expression obtained would be useful for fire safety design in vertical shafts.

Purpose It is hypothesized that intra-arterial administration of verapamil is a safe and effective way to reverse the flow in intraprostatic anastomoses to extraprostatic arteries without compromising treatment outcomes in prostatic artery embolization (PAE) for benign prostatic hypertrophy (BPH). Materials and Methods A prospective study of 62 prostate sides in 31 consecutive patients (median age, 66 y; range, 60–71 y) with symptomatic BPH was undertaken. Median prostate volume was 72.4 mL (range, 48.8–85.8 mL), median International Prostate Symptom Score was 21 (range, 15-23), and median urine peak flow rate was 4 mL/s (range, 2–6 mL/s). The arterial anastomoses were classified as types I–III according to vascular morphology. Treatment safety was assessed in terms of adverse events and complications, and treatment effectiveness was assessed in terms of success rate of angiographic flow reversal. Results The PAE procedure was successfully completed in all 31 patients (100%). Adverse events in both groups were transient and mild and did not necessitate prolonged hospitalization. There was no clinical evidence of any significant nontarget ischemic complication in either group. Intraprostatic anastomosis was diagnosed in 19 of 31 patients (61.3%) and 22 of 62 prostate sides (35.5%). Success rates of verapamil treatment were 88.9% overall (20 of 22) and 100% (19 of 19) in type II and III anastomoses. There was no difference between the treatment group and the control group in clinical, urologic, and imaging outcomes of PAE. Conclusions Intra-arterial verapamil treatment was probably safe and effective in causing flow reversal in type II and III intraprostatic anastomoses and in preventing ischemic complications in PAE for BPH without compromising PAE outcomes.

In this study, the effects of casting processes and heat treatments on the thermal conductivity of an Al-10 wt% Si-0.6 wt% Cu-0.9 wt% Fe-0.7 wt% Zn aluminum alloy were studied. Both gravity- and die-casting processes were used. The porosity in die castings was controlled by varying the injection pressure and plunger velocity. The porosity, microstructures, and thermal and electrical conductivities of the die castings were characterized. The thermal conductivity of gravity-cast material achieved 143.4 W m−1 K−1, whereas those of die-cast materials ranged from 110.8 to 126.8 W m−1 K−1. The die-cast aluminum alloys demonstrated considerably finer interconnecting precipitates than did the gravity castings. The closely spaced precipitates acted as barriers for thermal conduction, leading to reduced thermal conductivity. Die-casting pressures and velocities were controlled to form die castings with up to 3.73% porosity, which led to a 12.6% decrease in thermal conductivity. The die-cast Al alloys were then subject to solutionization (T4) and aging treatments (T6). The silicon precipitates were spheroidized, thus widening the paths for heat conduction. The thermal conductivity was greatly enhanced, increasing from 126.8 W m−1 K−1 in the die-cast condition to 151.6 W m−1 K−1 after 550 °C solutionizing and 4 h of aging at 200 °C. The thermal conductivity of the gravity-cast materials remained unchanged after the same heat treatments. Improving the thermal conductivity of die castings through proper heat treatments is crucial for aluminum alloys in rigorous heat-dissipating applications.

Background We aimed to evaluate the effectiveness of PAE in weaning of catheter and relieving obstructive urinary symptoms in patients with acute urinary retention (AUR) due to benign prostatic hypertrophy (BPH) and failed trial without catheter (TWOC). Materials and Methods In this prospective study approved by the institutional review board, a signed informed consent was obtained. Eighteen consecutive patients with AUR due to BPH and failed TWOC were recruited. Nineteen consecutive patients with BPH but without AUR were recruited as a control. Patients with CTA evidence of arterial occlusion or significant stenosis along the prostate artery access path were excluded. PAE was performed using microspheres (100–300 μm diameter). Outcome assessment included successful weaning of catheter in 2 weeks, procedure-related complications, change of symptomatology and urodynamic findings at 1 month as compared to baseline, percent non-perfused prostate volume, and prostate volume reduction on MRI at 2 weeks. Results Two patients in the study group and four in the control group were excluded due to arterial pathology. Embolization of bilateral prostate arteries was achieved in all patients in both the groups (100%). There was no complication. The catheter was successfully weaned in 87.5% (14/16) of patients within 14 days in the treatment group. There was no significant difference in patient demographics, prostate characteristics, and all outcome assessment parameters between both the groups. Conclusions PAE was probably safe and effective in weaning of catheter and relieving obstructive urinary symptoms in patients due to BPH, with treatment outcomes comparable to those without AUR.

To prospectively evaluate the accuracy of ultrasound in defining the specific nature of superficial soft tissue masses as well as determining malignancy. Eight hundred twenty-three superficial soft tissue masses were prospectively evaluated with ultrasound by one of five experienced musculoskeletal radiologists. The radiologist at the time of examination provided one to three specific differential diagnoses and the perceived level of confidence with regard to each diagnosis. Clinical and ultrasound diagnoses were compared with the histological diagnosis to determine accuracy. Tumor malignancy was determined by histology or clinical/imaging follow-up. Histological correlation was present for 219 (26.6%) of the 823 masses. Compared with histology, the accuracy of clinical and ultrasound examination for determining specific tumor type was 25.6% and 81.2% respectively considering all differential diagnoses provided. Radiologists were “fully confident” with the ultrasound diagnosis in 585 (71.1%) of 823 masses overall. In this setting, when compared with histology, the diagnostic accuracy of ultrasound was 95.5%. When the radiologist was “not fully confident,” accuracy was 41.3% for the first differential diagnosis and 60.9% for all differential diagnoses. Diagnostic accuracy improved with increasing radiologist experience. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for identifying malignant tumor were 93.3%, 97.9%, 45.2%, and 99.9% respectively. One can be “fully confident” at characterizing over two-thirds of superficial soft tissue masses based on ultrasound appearances and, in this setting, diagnostic accuracy is very high. Ultrasound examination is also highly accurate at discriminating benign from malignant superficial soft tissue masses.

The triangular fibrocartilage complex (TFCC) is a crucial structure for both maintaining the stability of the distal radioulnar joint (DRUJ) and acting as a cushion for axial loading of the ulnocarpal joint. Injury to the TFCC can lead to early degeneration of the DRUJ and ulnocarpal joint, with resultant chronic wrist pain and weakness. The TFCC is a moderately complex structure with several attachments to the adjacent bony and cartilaginous structures. Familiarity with the anatomy of the TFCC is a prerequisite for identification of TFCC tears. Several pitfalls can occur while assessing the TFCC on magnetic resonance imaging (MRI) if one is not familiar with the MRI appearances. This article illustrates key tips for diagnosing TFCC tears on MRI.

Gallbladder adenomyomatosis (GA) is increasingly encountered in clinical practice due to increasing use of imagings especially ultrasound (US). Clinicians need to know what is the implication of this condition and its proper management. GA is a degenerative and proliferative disease characterized by excessive epithelial proliferation associated with hypertrophy of muscularis propria. This leads to outpouchings of mucosa into or beyond the muscle layer forming intramural diverticula recognized as Rokitansky-Aschoff sinuses (RAS). Three types of GA are recognised: fundal, segmental and diffuse type. In fundal GA, there is focal thickening involving the GB fundus. In segmental GA, there is circumferential overgrowth of the GB wall that leads to formation of compartments. In diffuse GA, there is disseminated thickening and irregularity of the mucosa and muscularis. The pathogenesis of GA is unknown. It commonly occurs in middle age with equal sex distribution. Diagnosis of GA is by imagings showing thickened gallbladder wall containing cysts. Characteristic features are “comet-tail” artefacts and “twinkling” artefacts on US, “pearl-necklace sign” on magnetic resonance imaging (MRI) and “rosary sign” on computed tomography (CT). Cholecystectomy should be offered for symptomatic GA of any type. For asymptomatic GA, cholecystectomy may be considered for segmental type for its increased risk of malignancy and for diffuse type for its difficult visualization of any coexisting malignancy. Asymptomatic fundal GA can be safely observed with US. How frequent and how long should a fundal GA be monitored with US remains unknown. In case of diagnostic doubt, cholecystectomy should always be offered to avoid overlooked malignancy.

Background We investigated the feasibility of adding FOLFOXIRI to neoadjuvant chemoradiotherapy for patients (pts) with high risk rectal adenocarcinoma (T3-4 +/- node positivity, threatened margin and/or sphincter involvement). Methods Eligible patients were treated with 4 cycles of modified FOLFOXIRI (D1: CPT-11 165mg/m2, D1: oxaliplatin 85mg/m2, D1-2 200mg/m2 leucovorin, D1-2 5FU 400mg/m2 30min, then D1-2 5FU 600mg/m2 over 22hrs, with GCSF support), followed by capecitabine (825mg/m2 b.d) given concurrently during pre-operative radiotherapy (CRT, 50.4 Gy, 28 fr, 5 wks). Pts underwent surgery at planned 8-10 weeks after CRT, followed by adjuvant chemo. The primary endpoints were pathologic complete response rate (pCR) and objective response rate (ORR, RECIST ver 1.1). Results 40 eligible pts were enrolled (median age 60 yrs; male:female=82%:18%), 1 pt was excluded before starting treatment. Baseline stage distribution was stage II (10.2%), IIIB (64.1%) and IIIC (25.7%). Of the 39 pts evaluated for response (ITT), ORR to FOLFOXIRI was 38.5% (15 PRs, 24 SDs); ORR to CRT was 64.1% (25 PRs, 9 SDs, 1 PD, 4NA). Total of 28 pt (out of 38 evaluated, 73.7%) had a reduced overall TNM stage. Of the 27 pts who underwent surgery (18.5% had permanent stoma), pCR rate was 25.9%, 26 pts had negative and 1 pt had close margin, respectively. At median follow-up of 30.2 months, the 2-yr overall survival and relapse-free rates were 79.3% and 82.8%, respectively. The top three most common grade 3-4 toxicities: (1) To FOLFOXIRI were diarrhea (12%), neutropenia (7.7%) and hyponatremia (5.1%); (2) To CRT – diarrhea (2.5%), RT-dermatitis (2.5%) and rectal hemorrhage (2.5%). No treatment-related deaths or perioperative mortality were encountered. Conclusions In summary, neoadjuvant FOLFOXIRI followed by Cape-RT for high risk rectal cancer is feasible and the pCR rate compares favorably with the historic rate of 13.8% with CRT alone (Yeung et al. Hong Kong Med J 2016;22) This strategy is being evaluated in a randomized study. Clinical trial identification NCT01941641. Legal entity responsible for the study The Chinese University of Hong Kong. Funding Hong Kong Research Grant Council General Research Fund 471613. Disclosure All authors have declared no conflicts of interest.

Background Biologic therapies have revolutionised the treatment of immune-mediated diseases including inflammatory bowel disease [IBD] and rheumatological disorders. However, biologic treatments are associated with an increased risk of reactivation of latent tuberculosis. Data from regular monitoring for latent tuberculosis infection [LTBI] during biologic treatment are lacking. Methods Consecutive patients eligible for biologic therapies were screened for LTBI and prospectively followed up for 3 years. Incidence and risk factors of latent tuberculosis tests conversion (interferon gamma release assays [IGRA], tuberculin skin tests [TST], and chest radiography [CXR]) with clinical outcomes were studied. Results A total of 108 patients [83 IBD; 25 rheumatological disorders] were included. At baseline, 18/108 [16.7%] patients [five IBD; 13 rheumatological disorders] were tested positive for LTBI. Of these, 14/18 [77.8%] patients received isoniazid monotherapy for 9 months. Of the remainder, 17/90 [18.9%] patients had LTBI test conversion while on biologic therapies and of these 14/17 [82.4%] received isoniazid monotherapy for 9 months. Age, sex, smoking status, alcohol use, travel history, disease type, and immunosuppressive therapy were not associated with LTBI test conversion. In subjects with IGRA conversion, serial IGRA levels normalised after completion of isoniazid except in one patient whose IGRA remained persistently elevated despite isoniazid and who subsequently developed active TB. Conclusions Conversion of LTBI is common and occurred early during biologic therapy in an area with intermediate TB burden. Subjects with latent TB tests conversion and persistently high IGRA levels may have an increased risk of TB reactivation or development of active TB, and they require close observation or intensive workup for active TB.

Multi-access/Mobile Edge Computing (MEC) and fog computing are promising techniques to satisfy low latency requirements for emerging next generation applications. Moving computation entities closer to a user could reduce the overall serving latency. In terms of green communications, given the latency constraint, how to minimize the power consumption at the user equipment (UE) and the edge node (EN) sides is important. Considering several edge nodes, partially offloading a user’s task to one or more edge nodes is key. In this paper, a multi-node partial task offloading MEC scenario is discussed, in which UEs locally compute the task and share the remainder with other edge nodes. In addition, a green task distribution algorithm which minimizes the system power consumption is proposed, considering queueing, transmitting and computing delay. The simulation results show that the proposed algorithm minimizes the power consumption while meeting the latency requirements, and the power saving efficiency outperforms a binary offloading strategy. Moreover, the coupling effects between the latency requirements, offloading signal strength within the edge nodes, computation capability of edge nodes and the number of subcarriers used to transmit the offloading task are discussed.

This study investigated 30Al–Si, Al–Cu, Al–Fe, Al–Mg, Al–10Si–Cu, Al–10Si–Fe, and Al–10Si–Mg binary and ternary Al alloys, which are among the most commonly used commercial alloys. The thermal and electrical conductivity of the gravity castings of these alloys were measured. The results indicated that when 1 wt% Si, Cu, or Fe was mixed with commercial Al with 99.8 % purity, the thermal conductivity decreased from 213.5 Wm−1 K−1 to approximately 190–210 Wm−1 K−1. The thermal conductivity remained at a nearly constant level of 154–157 Wm−1 K−1 when the Si concentration exceeded 6 wt% in the Al–Si alloys. Regarding the Al–Mg alloys, the thermal conductivity did not change when the concentration of Mg was increased to 1 wt%. When the concentration of Mg exceeded 1 wt%, the thermal conductivity decreased greatly from 212.1 Wm−1 K−1 in the Al–1wt%Mg to 124.1 Wm−1 K−1 in the Al–5wt%Mg. This decrease occurred because the Mg-rich phase continuously impeded heat transfer at the grain boundaries. For the ternary Al alloys, when 0–1 wt% Fe or Cu was added to Al–10Si, the thermal conductivity increased slightly from 154 Wm−1 K−1 in Al–10Si to 162.7 Wm−1 K−1. The increase was due to the inclusion of Fe, which led to the formation of an Al x Fe y Si phase, reducing the solutes in the matrix phase. When the composition, morphology, amount, and distribution of all precipitates along with the matrix phase were taken into account, the effective medium approximations accurately interpreted the thermal conductivities of the Al alloys. Electrical conductivities were also measured and compared with thermal conductivities estimated using the Wiedemann–Franz law, and the results indicated close agreement. The Wiedemann–Franz law, however, often underestimates the thermal conductivity in Al alloys containing a high level of Si.

STUDY DESIGN Cohort study. OBJECTIVE To investigate the diagnostic capability of low-field magnetic resonance imaging (MRI) compared with high-field MRI for degenerative disease of the lumbar spine. SUMMARY OF BACKGROUND DATA Low-field MRI has several advantages over high-field magnetic resonance systems (easier installation, lower purchase, and maintenance cost). The diagnostic capability of low-field MRI for degenerative disease of the lumbar spine has not been compared with that of high-field MRI. METHODS Hundred patients (mean age: 56.3 yr, range: 32-80; F:M = 59:41) with neurogenic claudication or sciatica were studied. All patients underwent MRI of the lumbar spine on both low-field (0.25T) and high-field (1.5T or 3.0T) magnetic resonance systems. Intervertebral disc herniation, central canal, lateral recess, and exit foraminal stenosis as well as nerve root compression at L3-L4, L4-L5, and L5-S1 were evaluated by 2 radiologists for both low- and high-field systems using established reliable grading systems. RESULTS There was excellent agreement between low- and high- field MRI with regard to grading the presence and severity of disc herniation (r = 0.92-0.94; P < 0.05), central canal stenosis (r = 0.89-0.91; P < 0.05), lateral recess stenosis (r = 0.81-0.87; P < 0.05), and exit foramen stenosis (r = 0.81-0.89; P < 0.05). Descending or exiting nerve root compression occurred in 52% of patients at L3-L4, L4-L5, or L5-S1 levels, with good agreement between low-field and high-field MRI (r = 0.71-0.76; P < 0.05) for nerve root compression. CONCLUSION Excellent reliability between low- and high- field MRI was found for most features of lumbar disc degeneration, with good agreement for nerve root compression. 0.25T MRI was more susceptible to motion artifact, probably due to longer scanning time. LEVEL OF EVIDENCE 3.

The treatment and prognosis of soft tissue tumors is heavily dependent on tumor type. A specific tumor type cannot be determined clinically in most circumstances. Ultrasound (US) imaging is increasingly used as the first-line investigation for evaluation of soft tissue masses. With greater experience, most soft tissues masses, and particularly superficial soft tissue masses, can be definitively labeled, based on the US imaging appearances alone. This US diagnosis is based on an amalgamation of clinical and US imaging findings, rather than resting on a single sign alone. One should try to minimize labeling the US imaging appearances of any soft tissue mass as “nonspecific” since this adds little to what is already known. Putting a specific label onto a soft tissue mass, such as a lipoma, nerve sheath tumor, giant cell tumor of tendon sheath, or sarcoma, greatly enhances clinical efficiency with regard to management and outcome, reduces patient anxiety with regard to the possibility of malignancy, and minimizes the need for percutaneous biopsy. This chapter addresses the general approach to US imaging of soft tissue masses, highlighting common pitfalls in the US diagnosis of soft tissue tumors.

Purpose: Ketamine is a commonly abused recreational drug in Southeast Asia. There are emerging reports on ketamine abuse causing liver injury and biliary dilatation. This retrospective study aims to investigate the clinical and radiological features of this condition. Methods: A retrospective search in the database of our institute was performed from January 2008 to February 2014 for patients who were ketamine abusers, with deranged liver function and/or epigastric pain, and had computed tomography of the abdomen or magnetic resonance cholangiopancreatography. Patient demographics, clinical data, and radiological findings were reviewed. Results: Twenty-six patients (11 male and 15 female) were included in this study. Eighteen (69 %) patients had fusiform dilatation of the common bile ducts (CBDs) without evidence of intrinsic or extrinsic obstruction, and non-dilated intrahepatic ducts. The degree of CBD dilatation correlated with duration of abuse. In five patients who achieved abstinence, the CBD dilatation showed improvement. Conclusions: Ketamine-related cholangiopathy manifested as fusiform dilatation of the CBD without evidence of obstructive lesions. Severity of CBD dilatation appears to be correlated with the duration of ketamine, and the condition is potentially reversible in abstinent patients.

OBJECTIVE. The objective of our study was to evaluate the diagnostic accuracy of ultrasound in assessing musculoskeletal soft-tissue tumors superficial to the investing fascia. MATERIALS AND METHODS. Seven hundred fourteen superficial soft-tissue tumors evaluated with ultrasound by two musculoskeletal radiologists were retrospectively reviewed. In all ultrasound reports, the reporting radiologists provided one, two, or three diagnoses depending on their perceived level of diagnostic certainty. Two hundred forty-seven tumors had subsequent histologic correlation, thus allowing the accuracy of the ultrasound diagnosis to be determined. Images of the lesions with a discordant ultrasound diagnosis and histologic diagnosis were reviewed, and the ultrasound features were further classified as concordant with the known histologic diagnosis, concordant with the known histologic diagnosis with atypical features present, or discordant with the known histologic diagnosis. Four hundred sixty-seven tumors without path...

To investigate the diagnostic accuracy of oblique axial intermediate weighting MR imaging in detecting partial thickness anterior cruciate ligament (ACL) bundle tears.The study protocol was approved by the institutional ethics committee. Sixty-one subjects (43 male, 18 female; mean age 27.4 years; range 9 to 57 years) with clinically suspected ACL tear or meniscal tear between September 2009 and January 2011 were studied with MRI and arthroscopy. Detection of partial tear for the ACL as a whole and for each ACL bundle by protocol A (standard orthogonal sequences) and protocol B (standard orthogonal sequences plus oblique axial intermediate weighted imaging) was compared in a blinded fashion. Performance characteristics for protocol A and protocol B were compared using sensitivity, specificity, accuracy and ROC curves. A two-tailed p value of0.05 indicated statistical significance.Fifteen (24.6%) normal, 15 (24.6%) partial and 31 complete tears were diagnosed by arthroscopy. Sensitivity, specificity and accuracy of protocol A for the diagnosis of partial tear of the ACL was 33%, 87% and 74%, while for protocol B the values were 87%, 87% and 87% respectively. The area under the curve (AUC) for the diagnosis of partial ACL tear and individual bundle tear was higher for protocol B, although this difference did not reach statistical significance (p0.05).The addition of oblique axial imaging to standard MR imaging improves diagnostic accuracy for detecting partial tears of the ACL as well as individual bundle tears of the ACL.

Ferromagnetic/paramagnetic bilayer systems have been used to investigate inverse spin-Hall effect (ISHE) extensively with the technique of spin-pumping which is based on a mechanism driving the spin moment from ferromagnetic layers into paramagnetic layers via the ferromagnetic resonance procession. When the spin current is induced in the paramagnetic layer, a transversal electrical potential difference is generated and can be measured. Among many, platinum is the most effective paramagnetic metal with a strong inverse spin-Hall effect due to its strong spin-orbit coupling. In this work, we study ISHE in two kinds of bilayer films, Ni81Fe19(Py)/Pt and La0.7Sr0.3MnO3(LSMO)/Pt. Our experimental results show that the voltage induced by ISHE in LSMO/Pt ( ~ 1.0 μV) is one order smaller than that Py/Pt ( ~ 10 μV) at 100 mW of microwave power, despite the fact that LSMO has much higher spin polarization than Py. Based on our fitting results, the reason for the reduction of spin-pumping effect in LSMO/Pt may be the strong anomalous Hall Effect in LSMO.

Background Screening for latent tuberculosis (TB) is mandatory in inflammatory bowel disease (IBD) before starting anti-tumor necrosis factor therapy. Data on the utility of screening tests in populations with moderate background risk of TB are limited. This study aims to evaluate the performance of interferon-gamma release assay (IGRA) with QuantiFERON-TB Gold in IBD patients in a TB endemic region. Methods Two hundred sixty-eight consecutive adult IBD patients and 234 healthy controls were prospectively recruited. Detailed clinical history, chest x-ray findings, and IGRA results were documented for all individuals. The IGRA positive rates between IBD patients, with or without immunosuppressant, and healthy controls were compared. Results The IGRA result was positive in 21.9% of IBD patients and 19.2% of healthy controls (P = 0.535). IBD patients on immunosuppressive therapy had a significantly lower IGRA positive rate (13.0% versus 29.6%; P = 0.002) compared with immunosuppressant-naive IBD patients. This difference seemed to be most prominent for patients taking azathioprine (11.8% versus 27.3%, P = 0.006). Conclusions IGRA results are negatively impacted by immunosuppressive therapy. Current guidelines suggesting TB screening before anti-tumor necrosis factor therapy may be inadequate in patients already on immunosuppressive drugs. Latent TB testing seems best performed before the initiation of immunosuppressive therapies in IBD patients.

Ultrasonography is increasingly the first-line investigation for the assessment of soft tissue masses. With increasing experience, most soft tissues masses, particularly superficial soft tissue masses, can be specifically labeled based on their ultrasonographic appearances. This diagnosis is based on a conundrum of clinical and ultrasonographic findings rather than resting on a single sign alone. One should try to minimize labeling the ultrasonographic appearances as “nonspecific” because this adds little to what is already known. Putting a specific label on a soft tissue mass such as a lipoma, nerve sheath tumor, or giant cell tumor of tendon sheath minimizes the need for percutaneous biopsy, greatly enhances clinical efficiency with regard to discussions on management and outcome, as well as immediately reduces patient anxiety with regard to the presence of malignancy. This article addresses the general approach to ultrasonography of soft issue masses, highlighting in particular the common pitfalls encountered in their diagnosis.

A small electromagnetic sampling calorimeter, installed in the ZEUS experiment in 1995, significantly enhanced the acceptance for very low x and low Q 2 inelastic neutral current scattering, e+p → e+X, at HERA. A measurement of the proton structure function F2 and the total virtual photon-proton ( γ ∗ p ) cross-section is presented for 0.11 ≤ Q 2 ≤ 0.65 GeV2 and 2 × 10−6 ≤ x ≤ 6 × 10−5, corresponding to a range in the γ ∗ p c.m. energy of 100 ≤ W ≤ 230 GeV. Comparisons with various models are also presented.

Deep inelastic charged-current reactions have been studied ine+p ande−p collisions at a center of mass energy of about 300GeV in the kinematic regionQ2>200GeV2 andx>0.006 using the ZEUS detector at HERA. The integrated cross sections forQ2>200GeV2 are found to be \(\sigma _{e^ + p \to \bar \nu X} = 30.3_{ - 4.2 - 2.6}^{ + 5.5 + 1.6} pb\) and \(\sigma _{e^ - p \to \nu X} = 54.7_{ - 9.8 - 3.4}^{ + 15.9 + 2.8} pb\). Differential cross sections have been measured as functions of the variablesx, y andQ2. From the measured differential cross sectionsdσ/dQ2, theW boson mass is determined to be \(M_W = 79_{ - 7 - 4}^{ + 8 + 4} GeV\). Measured jet rates and transverse energy profiles agree with model predictions. A search for charged-current interactions with a large rapidity gap yielded one candidate event, corresponding to a cross section of \(\sigma _{e^ + p \to \bar \nu X} (Q^2 > 200 GeV^2 ; \eta _{\max }< 2.5) = 0.8_{ - 0.7}^{ + 1.8} \pm 0.1 pb\)

Our purpose is to compare ultrasound and fluoroscopic-guided approaches to the glenohumeral joint at the rotator cuff interval for magnetic resonance (MR) arthrography of the shoulder. Forty consecutive patients were prospectively studied. 20 patients underwent ultrasound-guided and 20 patients underwent fluoroscopic guided injection. Successful rate of ultrasound guidance is 95%. No significant difference in pain score and duration of injection between two methods (P>.05). Ultrasound-guided rotator cuff interval injection of the glenohumeral joint for MR arthrography is comparable with fluoroscopic-guided injection. Ultrasound is the preferred method as there is no ionizing radiation.

Appropriate selection of parents for the development of mapping populations is pivotal to maximizing the power of quantitative trait loci detection. Trait genotypic variation within a family is indicative of the family's informativeness for genetic studies. Accurate prediction of the most useful parental combinations within a species would help guide quantitative genetics studies. We tested the reliability of genotypic and phenotypic distance estimators between pairs of maize inbred lines to predict genotypic variation for quantitative traits within families derived from biparental crosses. We developed 25 families composed of ~200 random recombinant inbred lines each from crosses between a common reference parent inbred, B73, and 25 diverse maize inbreds. Parents and families were evaluated for 19 quantitative traits across up to 11 environments. Genetic distances (GDs) among parents were estimated with 44 simple sequence repeat and 2303 single-nucleotide polymorphism markers. GDs among parents had no predictive value for progeny variation, which is most likely due to the choice of neutral markers. In contrast, we observed for about half of the traits measured a positive correlation between phenotypic parental distances and within-family genetic variance estimates. Consequently, the choice of promising segregating populations can be based on selecting phenotypically diverse parents. These results are congruent with models of genetic architecture that posit numerous genes affecting quantitative traits, each segregating for allelic series, with dispersal of allelic effects across diverse genetic material. This architecture, common to many quantitative traits in maize, limits the predictive value of parental genotypic or phenotypic values on progeny variance.

A natural generalization of two-dimensional digital pulsecode modulations (DPCM) has been used to handle the compression of images for human eyes only. It shows that by ignoring the mean-square error (MSE) and wisely arranging the errors in the right place, a simple method can achieve very good results.