Survival Results and Prognostic Factors in T4 N0-3 Non-small Cell Lung Cancer Patients According to the AJCC 7^th Edition Staging System

Arslan, Deniz,Bozcuk, Hakan,Gunduz, Seyda,Tural, Deniz,Tattli, Ali Murat,Uysal, Mukremin,Goksu, Sema Sezgin,Bassorgun, Cumhur Ibrahim,Koral, Lokman,Coskun, Hasan Senol,Ozdogan, Mustafa,Savas, Burhan Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.6

Background: The American Joint Committee on Cancer (AJCC) published a new staging system ($7^{th}$ edition) in 2009. In our study, we evaluated the survival results and prognostic factors among T4 local advanced non-small cell lung cancer (LA-NSCLC) patients in a large heterogeneous group, in accordance with this new system. Materials and Methods: We retrospectively evaluated the files of 122 T4 N0-3 M0 LA-NSCLC patients, identified according to the new staging system, treated at two centers between November 2003 and June 2012. Variables correlating with univariate survival at p<0.20 were later included in multivariate Cox regression analysis. Here, selection of relevant predictors of survival was carried out in accordance with the likelihood ratio formula with p<0.05 regarded as significant. Results: The median age was 60 and the median follow-up period was 17.4 months. Median overall survival (OS) was 18.3 months, the 1 year overall survival (OS) rate was 72%, and the 5 year OS rate was 28%. Statistically significant predictors of survival were (p<0.20) ECOG-PS (Eastern Cooperative Oncology Group Performance Status), age, T4 factor subgroup, stage and primary treatment in OS univariate analysis. On multivariate analysis for OS ECOG-PS (p=0.001), diagnostic stage (p=0.021), and primary treatment (p=0.004) were significant. In the group receiving non-curative treatment, the median OS was 11.0 months, while it was 19.0 months in the definitive RT group and 26.6 months in the curative treatment group. There was a significant difference between the non-curative group and the groups which had definitive RT and curative operations (respectively p<0.001 and p=0.001) in terms of OS, but not between the groups which had definitive RT and curative operations. The median event free survival (EFS) rate was 9.9 months, with rates of 46% and 19% at 3 and 5 years, respectively. On univariate analysis of EFS rate with ECOG-PS, weight loss and staging, statistical significance was found only for thorax computerized tomography (CT)+18F-fluorodeoxy-glucose positron emission tomography-CT (PET-CT) use, stage and primary treatment (p<0.20). In multivariate analysis with EFS, only the primary treatment was statistically significant (p=0.001). In the group receiving non-curative treatment, the median EFS was 10.5 months while in the curative operation group it was 14.7 months. When all the primary treatment groups were taken into consideration, grade III/IV side effect swas observed in 57 patients (46.6%). Esophagitis was most prominent among those that received definitive radiotherapy. Conclusions: Independent prognostic factors among these 122 heterogeneous LA-NSCLC T4 N0-3 M0 patients were age at diagnosis, ECOG-PS, stage and primary treatment, the last also being a significant prognostic indicator of EFS. Our findings point to the importance of appropriate staging and a multidisciplinary approach with modern imaging methods in this patient group. In those with T4 lesions, treatment selection and the effective use of curative potential should be the most important goal of clinical care.

Selection of Voltage Vectors in Three-Level Five-Phase Direct Torque Control for Performance Improvement

Tatte, Yogesh N.,Aware, Mohan V. The Korean Institute of Power Electronics 2016 JOURNAL OF POWER ELECTRONICS Vol.16 No.6

This paper presents a Direct Torque Control (DTC) strategy for the five-phase induction motor driven by a three-level five-phase inverter in order to improve the performance of the five-phase induction motor. In the proposed DTC technique, only 22 voltage vectors out of 243 available voltage vectors in a three-level five-phase inverter are selected and are divided in 10 sectors each with a width of $36^{\circ}$. The four different DTC combinations (DTC-I, II, III and IV) for a three-level five-phase induction motor drive are investigated for improving the performance of five-phase induction motor. All four of the DTC strategies utilize a combination of the same large and zero voltage vectors, but with different medium voltage vectors. Out of these four techniques, DTC-II gives the best performance when compared to the others. This DTC-II technique is analyzed in detail for improvements in the performance of five-phase induction motor in terms of torque ripple, x-y stator flux and Total Harmonics Distortion (THD) of the stator phase current when compared to its two-level counterparts. To verify the effectiveness of the proposed three-level five-phase DTC control strategy, a DSP based experimental system is build. Simulation and experimental results are provided in order to validate the proposed DTC technique.

Development of a control experiment support system for small movable objects using PIC

Lye Tatt Cheah,Toru Asai 제어로봇시스템학회 2006 제어로봇시스템학회 국제학술대회 논문집 Vol.2006 No.10

The impact of variations in care and complications within a colorectal Enhanced Recovery After Surgery program on length of stay

James Wei Tatt Toh,Jack Cecire,Kerry Hitos,Karen Shedden,Fiona Gavegan,Nimalan Pathmanathan,Toufic El Khoury,Angelina Di Re,Annelise Cocco,Alex Limmer,Tom Liang,Kar Yin Fok,James Rogers,Edgardo Solis 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.1

Purpose: Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay (LOS). Methods: This study was a single-center review of the first 200 consecutive patients recruited into our prospectively collected ERAS database. The primary outcome of this study was to examine the rate of compliance to ERAS interventions and the impact of these interventions on LOS. The secondary outcome was to assess the impact of complications (anastomotic leak, ileus, and surgical site infections) on LOS. ERAS interventions, rate of adherence, LOS, readmissions, morbidity, and mortality were recorded, and statistical analysis was performed. Results: ERAS variations and complications significantly influenced patient LOS on both univariate and multivariate analysis. ERAS interventions identified as the most important strategies in reducing LOS included laparoscopic surgery, mobilization twice daily postoperative day (POD) 0 to 1, discontinuation of intravenous fluids on POD 0 to 1, upgrading to solid diet by POD 0 to 2, removal of indwelling catheter by POD 0 to 2, avoiding nasogastric tube reinsertion and removing drains early. Both major and minor complications increased LOS. Anastomotic leak and ileus were associated with the greatest increase in LOS. Conclusion: Seven high-yield ERAS interventions reduced LOS. Major and minor complications increased LOS. Reducing variations in care and complications can improve outcomes following colorectal surgery.

Selection of Voltage Vectors in Three-Level Five-Phase Direct Torque Control for Performance Improvement

Yogesh N. Tatte,Mohan V. Aware 전력전자학회 2016 JOURNAL OF POWER ELECTRONICS Vol.16 No.6

This paper presents a Direct Torque Control (DTC) strategy for the five-phase induction motor driven by a three-level five-phase inverter in order to improve the performance of the five-phase induction motor. In the proposed DTC technique, only 22 voltage vectors out of 243 available voltage vectors in a three-level five-phase inverter are selected and are divided in 10 sectors each with a width of 36˚. The four different DTC combinations (DTC-I, II, III and IV) for a three-level five-phase induction motor drive are investigated for improving the performance of five-phase induction motor. All four of the DTC strategies utilize a combination of the same large and zero voltage vectors, but with different medium voltage vectors. Out of these four techniques, DTC-II gives the best performance when compared to the others. This DTC-II technique is analyzed in detail for improvements in the performance of five-phase induction motor in terms of torque ripple, x-y stator flux and Total Harmonics Distortion (THD) of the stator phase current when compared to its two-level counterparts. To verify the effectiveness of the proposed three-level five-phase DTC control strategy, a DSP based experimental system is build. Simulation and experimental results are provided in order to validate the proposed DTC technique.

FRT Control Method Including Islanding Detection in PCS Model for Photovoltaic Generation

Miyazaki, Takahiro,Cheng, Wai Tatt,Yoshimura, Kazuaki,Taoka, Hisao,Kawasaki, Shoji,Matsuki, Junya The Korean Institute of Electrical Engineers 2013 The Journal of International Council on Electrical Vol.3 No.3

In this study, we made experiments by the simulated PV system for understanding the cause of disconnection when instantaneous voltage sag occurs. Moreover, it is understood that the PCS with the voltage phase jump detection method which is one of the main causes of the disconnection. We modeled it in the simulation. When fault occurs, even though the residual voltage is more than 20 % and the voltage sag time is within 1.0 sec, the PCS disconnected by the voltage phase jump detection was confirmed in the simulation results. If a large number of PV systems are interconnected in the power system, we verified through the simulation that the interaction caused by the disconnection which generated by the voltage phase jump detection. We proposed threshold limit value of islanding detection. The validity of proposed method was verified through the simulation in this study.

Metronidazole in the Management of Post-Open Haemorrhoidectomy Pain: Systematic Review

Angelina Di Re,James Wei Tatt Toh,Jonathan Iredell,Grahame Ctercteko 대한대장항문학회 2020 Annals of Coloproctolgy Vol.36 No.1

Purpose: Open haemorrhoidectomy is associated with significant postoperative pain. Metronidazole is commonly prescribed in the postoperative period as an adjunct to analgesia in pain management. Methods: In our systematic review, studies were identified using PubMed/MEDLINE, Embase/Ovid and Cochrane Register of Controlled Trials databases. Studies were included if they were randomised controlled trials (RCTs) involving interventions with oral metronidazole at any dose over any time period. The primary outcome was pain score (visual analogue scale, VAS) after open haemorrhoidectomy. Secondary outcomes included time to return to normal daily activities, additional analgesia usage, and postoperative complications. Results: Of 14 RCTs reviewed, 4 met inclusion criteria and were selected. The studies comprised 336 study subjects and 169 subjects were randomised to metronidazole while 167 were in the control group. There was a significant reduction in VAS across all time points, with maximal reduction seen on day 5 posthaemorrhoidectomy (mean difference, -2.28; 95% confidence interval, -2.49 to -2.08; P < 0.001). There was no difference in incidence of complications (P = 0.13). The Cochrane Risk of Bias Tool showed 3 of 4 of the studies had a risk of bias. Conclusion: Metronidazole may be associated with decreased pain but there is insufficient evidence from RCTs to provide a strong grade of recommendation. Further RCTs are required.

Safely navigating kidney transplantation during the COVID-19 pandemic: the Singapore General Hospital’s experience

Carolyn Shan-Yeu Tien,Ian Tatt Liew,Quan Yao Ho,Sobhana Thangaraju,Maslinna Binte Abdul Rahman,Constance Lee,Nicole Chelsi Xin Hui Leah,Xia He,Li Ting Siew,Terence Yi Shern Kee 대한이식학회 2023 Korean Journal of Transplantation Vol.37 No.2

Background: The coronavirus disease 2019 (COVID-19) pandemic curtailed transplant activities worldwide, driven by concerns about increased COVID-19-related mortality among kidney transplant recipients (KTRs), infections originating from donors, and decreased availability of surgical and intensive care resources as healthcare resources are reallocated for pandemic response. We examined the outcomes of KTRs at our center before and during the COVID-19 pandemic. Methods: We conducted a retrospective single-center cohort study examining the characteristics and outcomes of patients undergoing kidney transplantation during two periods: January 1, 2017 to December 31, 2019 (pre-COVID-19 era) and January 1, 2020 to June 30, 2022 (COVID-19 era). We reviewed perioperative and COVID-19 infection-related outcomes in both groups. Results: A total of 114 transplants were performed during the pre-COVID-19 era, while 74 transplants were conducted during the COVID-19 era. No differences in baseline demographics were observed. Additionally, there were no significant differences in perioperative outcomes, except for a longer cold ischemia time during the COVID-19 era. However, this did not result in an increased incidence of delayed graft function. Among the KTRs infected with COVID-19 during the pandemic era, no severe complications such as pneumonia, acute kidney injury, or death were reported. Conclusions: With the global transition to an endemic phase of COVID-19, it is imperative to revitalize organ transplant activities. Effective containment workflow, good vaccination uptake, and prompt COVID-19 treatment are essential to ensure that transplants can proceed safely.

Can men with prostates sized 80 mL or larger be managed conservatively?

Alvin Lee,Han Jie Lee,Keong Tatt Foo 대한비뇨의학회 2017 Investigative and Clinical Urology Vol.58 No.5

Purpose: To analyze the long-term clinical outcomes of men with large prostate sizes of 80 mL and greater who were managed conservatively. Materials and Methods: We retrospectively analyzed men with prostate sizes of 80 mL and greater from our electronic hospital database. Clinical parameters such as age, International Prostate Symptom Score (IPSS), quality of life (QoL) scoring, serum prostate-specific antigen (PSA), uroflowmetry variables, and transabdominal ultrasound findings were evaluated. These parameters were compared at entry to our study and at the patient's latest follow-up visit. Results: For the 50 men included in our analysis, mean age was 68 years, median PSA was 9.9 ng/mL, and median prostate volume was 94 mL. Seven men underwent upfront prostate surgery, whereas the other 43 were managed conservatively, predominantly with pharmacotherapy (98%). Only serum PSA, QoL scores, and postvoid residual urine demonstrated a significant reduction at the end of a median follow-up period of 62 months. Fourteen men (33%) were considered to have progressed clinically, with 8 experiencing retention of urine and 6 having symptomatic deterioration. Of the 35 men who were still receiving conservative treatment at the end of the follow-up period, 24 men (69%) had a peak flow rate of 10 mL/s or greater, a QoL score of 3 or less, and mild to moderate (IPSS, 0–19) symptoms. Conclusions: Although the incidence of clinical progression in men with prostate sizes of 80 mL and greater is high, there is still a role for conservative management with pharmacotherapy.

Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study

Swati Vijayan,Quan Yao Ho,Choong Hou Koh,Ian Tatt Liew,Sobhana Thangaraju,Ningyan Wong,Yann Shan Keh,Zi Hui Sharel Ong,Jia Qin Tan,Khung Keong Yeo,Terrance Siang Jin Chua,Terence Kee 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.3

Background: Cardiac evaluation before deceased donor kidney transplant (DDKT) remains a matter of debate. Data on Asian countries and countries with prolonged waiting times are lacking. This study aimed to assess the outcomes of patients referred for DDKT after a cardiac evaluation at an Asian tertiary transplant center. Methods: This single-center retrospective review analyzed patients who were referred for waitlist placement and underwent cardiac stress testing between January 2009 and December 2015. Patients with cardiac symptoms were excluded. The primary outcome was three-point major adverse cardiovascular events (MACE), a composite of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death. Results: Of 468 patients referred for DDKT, 198 who underwent cardiac stress testing (myocardial perfusion studies in 159 patients and stress echocardiography in 39 patients) were analyzed. MACE occurred in 20.7% of the patients over a median follow-up of 4.6 years. Cardiac stress tests were positive for ischemia in 19.7% of the patients. Coronary angiography was performed in 63 patients, including 29 patients with diabetic kidney disease and negative cardiac stress tests. Significant coronary artery disease (CAD) was detected in 27 patients (42.8%), of whom 18 underwent revascularization. MACE was associated with significant CAD on coronary angiography in the multivariable analysis. Cardiac stress test results were not associated with MACE. Amongst diabetic patients who had negative cardiac stress tests, 37.9% had significant CAD on coronary angiography. Conclusions: The cardiovascular disease burden is significant amongst DDKT waitlist candidates. Pretransplant cardiac screening may identify patients with significant CAD at higher risk of MACE.