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Validation of non-invasive brain temperature estimation models during swine therapeutic hypothermia
Sung, Dong Suk,Sim, Soo Young,Jin, Hyung Won,Kwon, Woon Yong,Kim, Kyung Su,Kim, Taegyun,Jung, Yoon Sun,Ko, Jung-In,Shin, So Mi,Suh, Gil Joon,Park, Kwang Suk IOP 2019 PHYSIOLOGICAL MEASUREMENT Vol.40 No.2
<P> <I>Objectives</I>: This paper introduces a mathematical model that can estimate deep brain temperature during therapeutic hypothermia (TH) based on a double sensor method (DSM). Although the cerebral temperature is more important than the non-cerebral core temperature during TH, pulmonary artery (PA), rectal, and esophageal measurements (i.e. the typical core temperature measurement locations) have all been used for target temperature management. This is because there is no safe means of measuring the exact brain temperature. <I>Approach</I>: We applied a double sensor thermometer to the subject’s forehead to measure the cerebral temperature non-invasively. Invasive and non-invasive brain temperature readings were acquired for 11 pigs, seven of which were used to develop an optimal model using jackknife resampling and four of which were used to test the model. <I>Main results</I>: The logit model exhibited the best performance of 0.134 °C root mean square error and a 0.993 Lin’s concordance correlation coefficient (CCC). Each test dataset had acceptable results in that each 95% limit of agreement was within the range of clinical acceptance of [−0.5 °C, 0.5 °C]. Three of the four datasets yielded an ‘almost perfect’ score for Lin’s CCC. <I>Significance</I>: Only a small number of studies have compared invasively and non-invasively measured brain temperatures, while most previous studies have concentrated on comparison with the core temperature. Furthermore, the possibility of measuring the exact brain temperature safely during TH using a DSM is shown in this work.</P>
( Sung Won Lee ),( Hae Lim Lee ),( Jung Hyun Kwon ),( Jun Suh Lee ),( Young Chul Yoon ),( Yu Ri Shin ),( Hye Ji Kim ),( Eun Chung ),( Young Woon Kim ),( Jeong Won Jang ),( Soon Woo Nam ),( Nam Ik Han 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Intraoperative radiofrequency ablation (RFA) is one of the treatment options for hepatocellular carcinoma (HCC) patients with relatively poor liver function to undergo surgical resection or when percutaneous approach for RFA is not feasible due to the difficult location of the tumor. The aim of this study is to investigate the clinical outcomes of intraoperative RFA compared to surgical resection. Methods: A total of 76 consecutive patients who received either intraoperative RFA (n=23) or surgical resection (n=53) with curative intent at the Incheon St Mary``s hospital from June 2012 to September 2015 were enrolled. Disease free survival and overall survival rates were analyzed. Results: The median follow-up period was 20.1 months (range, 0.9-41.5). The mean baseline Model for End-Stage Liver Disease (MELD) score was higher in the RFA group compared to the resection group (11.5±4.7 vs. 7.8±1.5, p=0.001). The resection group consisted of larger tumors with the median diameter of 2.7cm (range, 1-16) compared to 2cm (range, 1-5) of the RFA group (p=0.002). However, there was no difference in the number of tumors and the tumor stage between the two groups. The disease free survival rates at 6 and 12 months were 81.6%, 74.8% in the RFA group and 92.2%, 86.2% in the resection group, respectively (p=0.256). The overall survival rates at one year were 91.3% in the RFA group and 94.3% in the resection group, respectively (p=0.635). In the RFA group, 5 patients (21.7%) received liver transplantation (LT) after median interval of 10.9 months (range, 9.2~26.4) since the intraoperative RFA. Conclusions: The patients who received intraoperative RFA presented with relatively poor liver function but the disease free survival and overall survival rates were non-inferior compared to the patients who underwent resection. Therefore, intraoperative RFA may be considered as a useful option for patients ineligible to percutaneous RFA and surgical resection, or as a bridge therapy before liver transplantation.
Feasibility and safety of nerve stimulator attachment to energy-based devices: A porcine model study
Shin, Sung-Chan,Sung, Eui-Suk,Choi, Sung-Won,Kim, Sung-Dong,Jung, Da-Woon,Kim, Seok-Hyun,Ro, Jung Hoon,Lee, Jin-Choon,Lee, Byung-Joo Elsevier 2017 International journal of surgery Vol.48 No.-
<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Recently, several energy-based devices (EBDs) have been developed and applied in the context of thyroid surgery. EBDs can reduce operation time, blood loss, and postoperative pain. Compared to conventional electrocautery, EBDs operate at a relatively lower temperature and produce minimal lateral tissue damage. Yet, during device operation, the tip of the EBD is hot enough to cause thermal nerve damage, increasing the need for surgeons to be cautious about EBD application. To increase the safety of EBDs, we attached nerve stimulators to the tips of two EBDs and compared them to conventional monopolar nerve stimulation using a porcine model.</P> <P><B>Methods</B></P> <P>Three piglets (30–40 kg) underwent total thyroidectomy after orotracheal intubation with a nerve integrity monitor (NIM) electromyography (EMG) endotracheal tube. Nerve stimulators were attached to two EBDs (Harmonic Focus<SUP>®</SUP>+ and LigaSure™). After dissection and identification of six recurrent laryngeal nerves in the three piglets, both of the EBDs with attached nerve stimulators and a conventional monopolar nerve stimulator were applied near the nerve and EMG parameters were recorded using the NIM 3.0 system. The stimulus intensity was varied from 5 mA to 1 mA and the maximum distance and amplitude at which nerve detection was achieved were measured.</P> <P><B>Results</B></P> <P>There were no statistically significant differences between the maximum distance or mean amplitude obtained from nerve stimulators attached to EBDs and those obtained from the conventional nerve stimulator. Additionally, there were no adverse EMG events related to the use of nerve stimulators attached to EBDs.</P> <P><B>Conclusions</B></P> <P>Attachment of a nerve stimulator to an EBD for nerve detection during thyroidectomy was as safe and effective as attachment of a conventional nerve stimulator. Use of a nerve stimulator attachment may reduce the likelihood of EBD-associated nerve damage during thyroid surgery.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Nerve stimulator-EBDs showed efficacy and safety comparable to those of conventional monopolar probes. </LI> <LI> Nerve stimulator-EBD has the potential to reduce the likelihood of EBDs related thermal RLN injury. </LI> <LI> Nerve stimulator-EBD would have particular utility for endoscopic or robotic thyroid surgery. </LI> </UL> </P>
Sang Gon Kim,Seonghyu Shin,Gun-Ho Jung,Seong-Guk Kim,Chung-Guk Kim,Mi-Ok Woo,Min Ju Lee,Jin-Seok Lee,Beom-Young Son,Woon-Ho Yang,Young-up Kwon,Kang-Bo Shim 한국작물학회 2016 한국작물학회지 Vol.61 No.3
In monsoon climates, persistent shade is a troublesome weather condition with an impact on the growth and yield of corn (Zea mays L.). We imposed 7, 14, 21, and 28 days of consecutive shade (CS) on Gwangpyeongok and P3394 corn hybrids at the beginning of the kernel filling stages. Shade had little impact on leaf area and dry matter accumulation in the stem and leaves. However, dry matter accumulation in the ear was severely reduced by approximately 28% and 53% after 14 and 28 days of CS, respectively. For the components of grain yield, 7 and 14 days of shade did irreparable damage to the number of filled kernels, the kernel number per ear row, and the percent of filled kernels, but did little damage or reversible damage after removal of the shade to the 100-grain weight and the row number per ear. Shade significantly reduced the relative growth rate (RGR) due to a decrease in the net assimilation rate (NAR). These results suggest that source activity limitation by shade during the kernel filling stages leads to the inhibition of sink activity and size. The yield of biomass, ear, and grain logistically declined as the length of CS increased. Probit analysis revealed that the number of days of CS needed to cause 25% and 50% reductions in grain yield were 3.7 and 23.1, respectively. These results suggest that the plant yield loss induced by shade at the beginning of the kernel filling stages is mainly achieved within the first 7 days of consecutive shade.
Simple Tests to Predict Hepatic Fibrosis in Nonalcoholic Chronic Liver Diseases
( Woon Geon Shin ),( Sang Hoon Park ),( Sun Young Jun ),( Jae One Jung ),( Joon Ho Moon ),( Jong Pyo Kim ),( Kyoung Oh Kim ),( Cheol Hee Park ),( Tai Ho Hahn ),( Kyo Sang Yoo ),( Jong Hyeok Kim ),( Ch 대한소화기기능성질환·운동학회 2007 Gut and Liver Vol.1 No.2
Background/Aims: Several simple tests for hepatic fibrosis employ indirect markers. However, the efficacy of using direct and indirect serum markers to predict significant fibrosis in clinical practice is inconclusive. We analyzed the efficacy of a previously reported indirect marker of hepatic fibrosis - the aspartate aminotransferase to platelet ratio index (APRI) - in patients with nonalcoholic chronic liver diseases (CLDs). Methods: A total of 134 patients who underwent a percutaneous liver biopsy with a final diagnosis of chronic hepatitis B (n=93), chronic hepatitis C (n=18), or nonalcoholic fatty liver disease (n=23) were enrolled. A single-blinded pathologist staged fibrosis from F0 to F4 according to the METAVIR system, with significant hepatic fibrosis defined as a METAVIR fibrosis score of ≥2. Results: The mean area under the receiver operating characteristic curve (AUROC) of APRI for predicting significant fibrosis in nonalcoholic CLDs was 0.84 [95% confidence interval (CI), 0.78-0.91]. APRI yielded the highest mean AUROC in the patients with chronic hepatitis B (0.85; 95% CI, 0.771-0.926). The positive predictive value of APRI ≥ 1.5 for predicting significant fibrosis was 89%. The negative predictive value of APRI <0.5 for excluding significant fibrosis was 80%. Conclusions: APRI might be a simple and noninvasive index for predicting significant fibrosis in nonalcoholic CLDs. (Gut and Liver 2007;1:145-150)
Shin, Dong-Yeop,Byun, Byung Hyun,Kim, Kyeong Min,Kang, Joo Hyun,Lim, Ilhan,Kim, Byung Il,Lee, Seung-Sook,Choi, Chang Woon,Kang, Hye Jin,Lim, Sang Moo Springer-Verlag 2016 Cancer chemotherapy and pharmacology Vol.78 No.4
<P>Purpose The aim of this study was to assess the clinical activity and toxicity of I-131-rituximab as consolidation therapy for patients with diffuse large B-cell lymphoma (DLBCL) who were treated with R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone). Methods Patients who had been diagnosed with advanced stage (Ann Arbor III or IV) or bulky stage II DLBCL and achieved complete or partial response after six to eight cycles of R-CHOP were enrolled. Results A total of 16 patients were enrolled and treated with a single dose of I-131-rituximab as consolidation therapy after the completion of six or eight cycles of R-CHOP between December 2005 and June 2011. This trial was terminated before the scheduled enrollment owing to low recruitment. Among the 16 patients who were treated with consolidative I-131-rituximab, 6 achieved complete response (CR) after three cycles of R-CHOP, and another 9 patients further achieved CR after the completion of six or eight cycles of R-CHOP. During the median follow-up period of 73 months, only four patients (25 %) experienced relapse. Two-year relapse-free survival was 88 %, and 5-year relapse-free survival was 81 %. Grade 3 or 4 treatment-related toxicity occurred in four patients and included neutropenia and thrombocytopenia. Conclusions I-131-rituximab showed promising efficacy as consolidation treatment for patients with DLBCL. A future randomized phase III study to confirm our results is warranted.</P>