Search

Objectives: The purpose of this study was to investigate the efficacy and safety of temporary prophylactic intravascular balloon occlusion of the common iliac arteries (CIA) before planned cesarean hysterectomy for controlling operative blood loss in abnormal placentation. Materials and methods: A retrospective study of 13 pregnant women at risk for placenta accreta identified using sequential obstetric ultrasonography and magnetic resonance imaging from January 2007 to December 2009 was performed. Temporary prophylactic intravascular balloon catheterization of the bilateral CIA before cesarean hysterectomy was performed by interventional radiologists. The maximum duration of occlusion time of CIA must not exceed 60 minutes. The primary outcome for this study included estimated blood loss and secondary outcomes included the development of thromboembolism, disseminated intravascular coagulation and surgical complications. Results: Among these13 patients, the mean age of the patients was 32.8 ± 0.7 years (range 29–37 years). The mean gestational age at cesarean hysterectomy was 32.2 ± 0.9 weeks (range 28–36 weeks), and the mean intraoperative blood loss was 1902.3 ± 578.8 mL (range 500–8000 mL). Operative bleeding was controlled by conservative treatment without additional surgery in two cases. Importantly, two patients (15.8%) had severe complications possibly related to the interventional procedure. One patient was noted to have a popliteal artery thrombosis. A second patient had an external iliac artery thrombosis with 80–90% occlusion. Both patients required antithrombotic treatment without sequelae. Conclusion: With limited experience in this small series, we observed a statistically significant reduction in operative blood loss after the use of temporary prophylactic balloon occlusion of the CIA technique compared with historical controls of similar demographic characteristics previously published (1902.3 ± 578.8 mL, range 500–8000 mL vs. 4445.7 ± 996.48 mL, range 1040–15,000 mL, p = 0.0402). Additionally, two patients had arterial thrombosis. These preliminary findings are based on a small number of patients, and therefore further investigation is needed to determine the effectiveness and safety of this new technique.

Objective: There is little prospective experience in the conservative treatment of placenta percreta during the first trimester in order to preserve uterine fertility. We describe herein our experience with uterine artery embolization (UAE) in the management of placenta percreta at 9 weeks of gestation. Case Report: A 36-year-old woman, gravida 3, para 1, was referred for ultrasonographic evaluation because of suspected molar pregnancy due to persistent vaginal spotting at 9 weeks of gestation. A Grade 3+ lacunar flow pattern with multiple bizarre and large irregular sonolucent spaces were observed. Color Doppler imaging revealed extensive turbulent lacunar blood flow perfusing throughout the whole surrounding uteroplacental tissues and fetus. The patient was informed of the situation and she had a strong desire to avoid surgery. Conservative management with bilateral UAE was performed using polyvinyl alcohol particles to promote involution and shedding of the abnormally adherent placenta. However, an unsatisfactory vessel-occluding effect caused by extensive collateral supply was still detected after repeated UAE. We, therefore, performed hysterectomy, and the patient had an uneventful postoperative course. Conclusion: The efficacy and complications of UAE as a therapeutic modality for the conservative management of invasive placentation in the first trimester of pregnancy are not clear, as this is the first report of its kind. However, although UAE had failed in this case, it may still be a useful procedure as a prophylactic measure before surgical intervention, and hysterectomy can also be performed for better control of operative hemorrhage.

Escalator-related injuries are common among metro passengers in urban cities. In this study, a motion graphic promoting escalator safety principles was developed and used to investigate college students' behavioural intentions regarding escalator safety. The unified theory of acceptance and use of technology (UTAUT) model was adopted as the study framework. A behavioural intention questionnaire and a motion graphic based on the UTAUT model were developed in this study. The UTAUT model was examined using a stepwise regression approach. In total, 146 college students participated in this study. The students' performance expectancy, effort expectancy, social influence and facilitating conditions predicted their behavioural intentions regarding escalator safety. Gender moderated the effect of performance expectancy on behavioural intention, and motion graphics learning experience moderated the effects of performance expectancy, effort expectancy, social influence and facilitating conditions on behavioural intention. This study attempted to empirically identify the main factors affecting passengers' attitudes toward escalator safety-related behaviour. The results have implications for the design of motion graphics for escalator safety education as part of the public service announcements of metro systems.

BackgroundTirapazamine (TPZ) is a hypoxia activated drug that may be synergistic with transarterial embolization (TAE). The primary objective was to evaluate the safety of combining TPZ and TAE in patients with unresectable HCC and determine the optimal dose for Phase II.MethodsThis was a Phase 1 multicenter, open-label, non-randomized trial with a classic 3+3 dose escalation and an expansion cohort in patients with unresectable HCC, Child Pugh A, ECOG 0 or 1. Two initial cohorts consisted of I.V. administration of Tirapazamine followed by superselective TAE while the remaining three cohorts underwent intraarterial administration of Tirapazamine with superselective TAE. Safety and tolerability were assessed using NCI CTCAE 4.0 with clinical, imaging and laboratory examinations including pharmacokinetic (PK) analysis and an electrocardiogram 1 day pre-dose, at 1, 2, 4, 6, 10, and 24 hours post-TPZ infusion and an additional PK at 15- and 30-minutes post-TPZ. Tumor responses were evaluated using mRECIST criteria.ResultsTwenty-seven patients (mean [range] age of 66.4 [37-79] years) with unresectable HCC were enrolled between July 2015 and January 2018. Two patients were lost to follow-up. Mean tumor size was 6.53 cm ± 2.60 cm with a median of two lesions per patient. Dose limiting toxicity and maximum tolerated dose were not reached. The maximal TPZ dose was 10 mg/m2 I.V. and 20 mg/m2 I.A. One adverse event (AE) was reported in all patients with fatigue, decreased appetite or pain being most common. Grade 3-5 AE were hypertension and transient elevation of AST/ALT in 70.4% of patients. No serious AE were drug related. Sixty percent (95% CI=38.7-78.9) achieved complete response (CR), and 84% (95% CI=63.9-95.5) had complete and partial response per mRECIST for target lesions.DiscussionTAE with TPZ was safe and tolerable with encouraging results justifying pursuit of a Phase II trial.

Developed in early 1980s, transarterial chemoembolization (TACE) with Lipiodol was adopted globally after large-scale randomized control trials and meta-analyses proving its effectiveness were completed. Also known as “conventional TACE” (cTACE), TACE is currently the first-line treatment for patients with unresectable intermediate stage hepatocellular carcinoma (HCC) and delivers both ischemic and cytotoxic effects to targeted tumors. Although new technology and clinical studies have contributed to a more comprehensive understanding of when and how to apply this widely-adopted therapeutic modality, some of these new findings and techniques have yet to be incorporated into a guideline appropriate for Taiwan. In addition, differences in the underlying liver pathologies and treatment practices for transcatheter embolization between Taiwan and other Asian or Western populations have not been adequately addressed, with significant variations in the cTACE protocols adopted in different parts of the world. These mainly revolve around the amount and type of chemotherapeutic agents used, the type of embolic materials, reliance on Lipiodol, and the degree of selectiveness in catheter positioning. Subsequently, interpreting and comparing results obtained from different centers in a systematic fashion remain difficult, even for experienced practitioners. To address these concerns, we convened a panel of experts specializing in different aspects of HCC treatment to devise modernized recommendations that reflect recent clinical experiences, as well as cTACE protocols which are tailored for use in Taiwan. The conclusions of this expert panel are described herein.

Cetacean health may be potentially affected by anthropogenic sound. We have initiated investigations on the effect of low-frequency underwater sound on immunological gene transcript profiles of captive bottlenose dolphins (Tursiops truncatus) using a probe-based quantitative gene expression assay. Six immunologic genes (IL-2Rα, -4, -10, -12, TNFα and IFNγ) were selected for analysis using two validated housekeeping genes (PGK1 and HPRT1) as reference genes. Twenty-four blood samples from six clinically healthy individuals and six blood samples from individuals after sound exposures were available. The gene transcript profile of sound-exposed dolphins was consistent with a stress-induced TH2 shift profile as compared to controls. This study may lead to better understanding of the effects of anthropogenic sound on immune responses of cetaceans.

This paper proposes a high-precision permanent magnet (PM) motor primarily used for the satellite attitude control. Considering aerospace applications, the dynamic response, weight and torque ripple are primarily concerns. To achieve the fast response and low ripple, a stator with slotless windings is designed to achieve the ripple free torque production. However, slotless windings contain visible leakage fluxes which might decrease the torque production. In this paper, several design methods are proposed to decrease leakage fluxes by concentrating the flux linkage under slotless topology. First, leakage fluxes caused by slotless windings are minimized through the radial-flux dual-rotor topology. This topology results in the flux linkage concentration in the air gap because two rotors are used separately for flux transmitter and receiver. It is concluded that the dual-rotor is well suited for a slotless windings motor to maximize the air gap flux linkage. Second, Halbach array magnets are chosen to realize the sinusoidal flux linkage distribution. Different array angles are analyzed to minimize the torque ripple. It is shown that the 22.5deg array angle results in the lowest torque ripple among three different Halbach magnets. More importantly, the average torque output is higher comparing to conventional radial magnet magnetization. Although several optimization methods have been developed on the motor geometric design, very few researches focus on the design of dual-rotor slotless windings and air gap length. This design approach further decreases leakage fluxes. In this paper, finite element analysis (FEA) is used for the satellite motor design. In addition, a motor prototype is built for experimental tests.

Quantitative RT-PCR is often used as a research tool directed at gene transcription. Selection of optimal housekeeping genes (HKGs) as reference genes is critical to establishing sensitive and reproducible qRT-PCR-based assays. The current study was designed to identify the appropriate reference genes in blood leukocytes of bottlenose dolphins (Tursiops truncatus) for gene transcription research. Seventy-five blood samples collected from 7 bottlenose dolphins were used to analyze 15 candidate HKGs (ACTB, B2M, GAPDH, HPRT1, LDHB, PGK1, RPL4, RPL8, RPL18, RPS9, RPS18, TFRC, YWHAZ, LDHA, SDHA). HKG stability in qRT-PCR was determined using geNorm, NormFinder, BestKeeper and comparative delta Ct algorithms. Utilization of RefFinder, which combined all 4 algorithms, suggested that PGK1, HPRT1 and RPL4 were the most stable HKGs in bottlenose dolphin blood. Gene transcription perturbations in blood can serve as an indication of health status in cetaceans as it occurs prior to alterations in hematology and chemistry. This study identified HKGs that could be used in gene transcript studies, which may contribute to further mRNA relative quantification research in the peripheral blood leukocytes in captive cetaceans.

Abstract Background For hepatocellular carcinoma (HCC), liver resection is a classical curative modality, despite its technical complexity. The incidence of HCC in the oldest old people (aged ≥ 85 years) is rising along with the global increase in life expectancy. Currently, no report has addressed liver resection for HCC in this aged population. Patients and methods We conducted a retrospective review of 1889 patients receiving curative liver resection for newly diagnosed HCC from 1992 to 2016. At the time of operation, 1858 of them were aged

Facial expressions of pain are composed of a subset of pain-indicative muscle movements. Amongst this subset, contracting the muscles surrounding the eyes (orbicularis oculi muscle) is the most frequent response and has been linked specifically to pain intensity, a fundamental aspect of the sensory dimension of pain. To further explore this link, the present study used functional magnetic resonance imaging (fMRI) to test the hypothesis that orbicularis oculi activation during pain reflects the magnitude of brain responses in areas being involved in processing the sensory dimension of pain.Facial and brain (BOLD) responses to experimentally-induced heat pain applied to the left lower leg were assessed in twenty-two healthy participants after verbal suggestions were given to specifically increase perceived pain intensity and in control conditions involving no suggestion.Increases in pain intensity produced the expected changes in facial responses characterized by a stronger contraction of the orbicularis oculi muscle. A regression model further demonstrated that stronger increases in orbicularis oculi activity reflected a larger increase in the BOLD response to the noxious stimulus in the leg area of the primary somatosensory cortex (S1) and a larger decrease in medial prefrontal activity consistent with previous finding suggesting disinhibition. Importantly, the positive coupling of orbicularis oculi with S1 activity was not accounted for by changes in other facial muscles.These results are consistent with the notion that facial expressions of pain differentially encode the multi-dimensional pain experience and reflect, at least partly, the activity of the spino-thalamo-cortical pathway targeting the primary somatosensory cortex.

Demanding tasks can influence following behaviors but the underlying mechanisms remain largely unclear. In the present functional magnetic resonance imaging (fMRI) study, we used multivariate pattern analyses (MVPA) to compare patterns of brain activity associated with pain in response to noxious stimuli administered after a task requiring cognitive control (Stroop) and evaluate their functional interaction based on a mediation analysis model. We found that performing a difficult cognitive task leads to subsequent increases in pain and pain-related multivariate responses across the brain and within the anterior mid-cingulate cortex (aMCC). Moreover, an aMCC pattern predictive of task performance was further reactivated during pain and predicted ensuing increases in pain-related brain responses. This suggests functional interactions between distinct but partly co-localized neural networks underlying executive control and pain. These findings offer a new perspective on the functional role of the cingulate cortex in pain and cognition and provide a promising framework to investigate dynamical interactions between partly overlapping brain networks.

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

The intravoxel incoherent motion (IVIM) model may enhance the clinical value of multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (PCa). However, while past IVIM modeling studies have shown promise, they have also reported inconsistent results and limitations, underscoring the need to further enhance the accuracy of IVIM modeling for PCa detection. Therefore, this study utilized the control point registration toolbox function in MATLAB to fuse T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) MRI images with whole-mount pathology specimen images in order to eliminate potential bias in IVIM calculations. Sixteen PCa patients underwent prostate MRI scans before undergoing radical prostatectomies. The image fusion method was then applied in calculating the patients’ IVIM parameters. Furthermore, MRI scans were also performed on 22 healthy young volunteers in order to evaluate the changes in IVIM parameters with aging. Among the full study cohort, the f parameter was significantly increased with age, while the D* parameter was significantly decreased. Among the PCa patients, the D and ADC parameters could differentiate PCa tissue from contralateral normal tissue, while the f and D* parameters could not. The presented image fusion method also provided improved precision when comparing regions of interest side by side. However, further studies with more standardized methods are needed to further clarify the benefits of the presented approach and the different IVIM parameters in PCa characterization.