Surgical Management of Giant Scalp Neurofibroma After Ultra-Selective Embolization of Nutrient Artery.

OBJECTIVES: Neurofibroma, a common benign tumor in soft tissue, continues to grow, so it often appears to be giant. Surgical management of giant neurofibroma is a challenge due to the risk of excessive bleeding. Embolization of tumor's nutrient artery may reduce the blood loss in operation. This study introduces the surgical management of giant scalp neurofibroma with preoperative ultra-selective embolization of nutrient artery. METHODS: From January 2006 to December 2013, 9 patients with giant scalp neurofibroma were enrolled into the study. Digital subtraction angiography (DSA) showed tumor's nutrient artery. Ultra-catheter was inserted into the nutrient artery and its branches as close as possible to the tumor. Then ultra-selective embolization was performed with gelatin sponge particles. Surgical removal of tumor was performed in 3 days after embolization. The wound was repaired by skin graft. RESULTS: All of the 9 patients underwent successful DSA and ultra-selective embolization. Among them, occipital artery was embolized in 3 patients (left side in 1 patient and right side in 2 patients). Both occipital artery and superficial temporal artery were embolized in 6 patients (left side in 2 patients, right side in 3 patients, and both side in 1 patient). No complications, such as ectopic embolism, occurred in the patients. All of the tumors were resected completely without blood transfusion. The skin graft survived very well on the wounds. CONCLUSIONS: Preoperative ultra-selective embolization of nutrient artery is a feasible, safe, and effective method to reduce the blood loss in operation and facilitate the surgical management of giant scalp neurofibroma.

How well have China's recent five-year plans been implemented for energy conservation and air pollution control?

This study evaluates how well China's 11th and 12th Five-Year Plans have been implemented in terms of energy conservation and air pollution control and deconstructs the effects of the economic, energy, and environmental policies included in the Plans. A "counterfactual" comparative-scenario method is deployed, which assumes a business as usual scenario in which the changes in economic, energy, and environmental parameters are "frozen", and then reactivates them one by one, with the help of LEAP modeling. It is found that during the 11th Five-Year Plan period, the binding targets were basically achieved. Economic growth put a great strain upon the energy demand and the environment, but energy policy made a decisive contribution by promoting energy efficiency and structure. Environmental policy promoted the deployment of end-of-pipe treatment which led to the control of certain air pollutants but at the expense of an increase in energy use and in the emission of other pollutants. During the ongoing 12th Five-Year Plan period, energy policy's potential for efficiency improvement is shrinking, but economic policy is restraining economic growth thus making a positive contribution. Environmental policy attempts to enforce multipollutant reduction, but there is still insufficient focus on the cocontrol of different pollutants and CO2.

Efficacy, Safety, Patient Experience, and Tolerability of Risankizumab Administered by On-Body Injector for Moderate to Severe Crohn's Disease.

INTRODUCTION: In patients with moderate to severe Crohn's disease (CD), intravenous induction and subcutaneous maintenance dosing with risankizumab was efficacious and well tolerated. Long-term management of CD via self-administration of risankizumab using an on-body injector (OBI) may improve treatment adherence through convenience and ease of use. METHODS: Within the FORTIFY maintenance study, 46 patients from the United States (US) sites participated in an open-label extension Substudy and received 180 mg or 360 mg risankizumab delivered subcutaneously via OBI [360 mg (2.4 mL, 150 mg/mL) or 180 mg (1.2 mL, 150 mg/mL)]. At the Week 0 visit, patients were trained (pre-injection) by site staff, using Instructions for Use (IFU) and a training video, to self-administer risankizumab at Weeks 0 (on site), 8 (at home), and 16 (on site). Key objectives of the Substudy 4 were to assess OBI usability (observer rating of successful self-administration), hazard-free self-injection at Weeks 0 and 16, and patient rating of acceptability using the Self-Injection Assessment Questionnaire (SIAQ) at Weeks 0, 8, and 16. Additionally, the proportion of patients in clinical remission (CD Activity Index < 150) was collected at Weeks 0 and 16. RESULTS: All patients successfully self-administered risankizumab via OBI, including two patients who successfully self-administered with a second OBI (i.e., required two injection attempts). Acceptability of self-injection was high. Two patients (n = 2) experienced a use-related hazard. Stable clinical remission was observed with both risankizumab doses. Two patients experienced injection site reactions; neither was related to the OBI per investigator's assessment. Two device-related adverse events related to topical adhesive reactions were reported, both mild and resolved. No new safety risks were observed. CONCLUSION: The efficacy and safety of maintenance risankizumab delivered via OBI and OBI usability support the use of this device in patients with moderate to severe CD. TRIAL REGISTRATION: ClinicalTrials.gov identifiers NCT03105102 (FORTIFY).

Changes in running mechanics using conventional shoelace versus elastic shoe cover.

The purpose of this study was to determine whether there are differences in the perceived comfort, plantar pressure, and rearfoot motion between laced running shoes and elastic-covered running shoes. Fifteen male amateur runners participated in the study. Each participant was assigned laced running shoes and elastic-covered running shoes for use during the study. The perceived comfort, plantar loading, and rearfoot motion control of each type of shoes during running were recorded. When the laced running shoes and elastic-covered running shoes were compared, the elastic-covered running shoes were given a lower perceived comfort rating in terms of shoe length, width, heel cup fitting, and forefoot cushioning. The elastic-covered running shoes also recorded higher peak plantar pressure in the lateral side of the forefoot, as well as larger maximum rearfoot pronation. Overall, shoelaces can help runners obtain better foot-shoe fit. They increase the perceived comfort, and decrease the maximum pronation and plantar pressure. Moreover, shoelaces may help prevent injury in running by allowing better control of the aforementioned factors.

Transcatheter arterial embolization for postoperative arterial complications after pelvic or hip surgery.

PURPOSE: We aimed to study the technical and clinical outcome of urgent transcatheter arterial embolization (TAE) for postoperative arterial complications after pelvic or hip surgery, and to accumulate additional experience about the role of embolization for these injuries. METHODS: Patients who received TAE procedure for arterial complications after pelvic or hip surgery between September 1st, 2002 and December 1st, 2014 were screened on medical records and included in the analysis. Angiographic findings included active contrast agent extravasation, pseudoaneurysm formation, arteriovenous fistula, and other suspicious signs such as sighting of coarse margin or distortion of vessels. Embolic agents consisted of coils, gelatin sponge, and polyvinyl alcohol. Technical success was defined as complete occlusion of targeted artery through angiography, and clinical success as sustained resolution of symptoms. RESULTS: A total of 22 patients (15 males, 19-76 years old) were enrolled. Prior to TAE, 12 patients developed hemorrhagic shock and the remaining 10 patients had hemorrhage-related pain, hematoma, or anemia. Contrast agent extravasation occurred in 12 cases, pseudoaneurysm formation in 5 cases, and other suspicious signs in 5 cases. Injury occurred in the internal iliac artery stem in 6 cases, inferior gluteal artery in 6 cases and superior gluteal artery in 6 cases. Multiple vascular lesions appeared in 5 cases. After TAE, technical success occurred in 22 patients and clinical success in 21 patients (95.5%). A 36-year-old woman died of irreversible multiple organ failure; no other severe procedure-related complications were recorded. CONCLUSION: TAE is safe and effective for postoperative arterial complications after pelvic or hip surgery.

[Surgical treatment of 475 patients with periampullary carcinoma].

OBJECTIVE: To compare of the outcome of all patients who received surgical treatment in one institute for periampullary carcinoma during different intervals over the past 40 years. METHODS: Retrospective review of 475 patients suffering from periampullary carcinoma in intervals 1958 approximately 1976, 1977 approximately 1987, 1988 approximately 1998 and 1999 approximately 2003 is presented. RESULTS: In interval 1958 approximately 1976, for 128 patients, the tumor resection rate was: pancreatic carcinoma (PC) 26.6% (21/79), ampullary carcinoma (AC) 86.2% (25/29), distal bile duct cancer (DBDC) 38.5% (5/13), and duodenal cancer (DC) 57.1% (4/7). In interval 1977 approximately 1987, for 70 patients, the tumor resection rate was: PC 26.7% (16/60), AC 66.7% (4/6), DBDC 100% (1/1), and DC 66.7% (2/3). In interval 1988 approximately 1998, for 147 patients, the tumor resection rate was: PC 20.2% (22/109), AC 75.0% (12/16), DBDC 50.0% (2/4), and DC 66.7% (12/18). In interval 1999 approximately 2003, for 130 patients, the tumor resection rate was: PC 20.4% (20/98), AC 100% (4/4), DBDC 75.0% (12/16), and DB 83.3% (10/12). Cumulatively, from 1958 to 2003, the incidence of DBDC has become significantly higher, and the average of total bilirubin level (TBIL) has gradually been going downward, the average of blood transfusion during operation and the diameter of resected tumor has been becoming smaller. From 1999 to 2003, none of the 130 periampullary carcinoma patients had received biliary drainage before operation. CONCLUSION: Mortality and complication have become significantly lower because of effective improvement in the perioperative preparation and the care after surgery of periampullary cancer in the recent years. Even though the accurate diagnosis has become increasing earlier than before, the resection rate and prognosis of periampullary carcinoma remain poor.

Improvement in visual function and quality of life following a blindness prevention surgery program in a rural area of Eastern China.

The aim of this study was to assess the changes in visual function (VF) and quality of life (QOL) among patients following blindness prevention surgery in a rural area of Eastern China. The prospective study selected cataract patients via mobile eye screening camps. VF and QOL questionnaires originally developed by Fletcher et al were completed prior to and 6 months after surgery. Small-incision cataract surgery (SICS) with posterior chamber intraocular lens (IOL) implantation was performed on patients by a blindness prevention surgery group. The VF and QOL scores of 178 cataract patients preoperatively were 48.58±31.18 and 65.97±26.77, respectively. The scores decreased in proportion to decreasing vision status. The VF and QOL scale scores were significantly correlated with the vision grade of the patient (rVF=-17.2093, t=-10.87, P<0.001, rQOL=-13.1399, t=-8.87, P<0.001) and age (rVF=-0.6505, t=-3.87, P<0.001, rQOL=- 0.3309, t=-2.10, P=0.037). A total of 131 patients responded to the second survey, VF and QOL scores increased significantly over a six-month postoperative period (VF=83.21±16.40, P<0.001; QOL=86.53±16.33, P<0.001). The VF scale scores were correlated with the grade of vision and residence area, the QOL scale scores were correlated with the grade of vision and gender. The VF and QOL of patients were significantly improved by performing SICS with posterior chamber IOL implantation collectively in a short period in rural areas of Eastern China. It is important to follow-up cataract patients postoperatively as untreated complications of the surgery may affect the stability of VF and QOL postoperatively.

[Treatment of bromoamine acid wastewater by combined ALR-BAC process].

Combined ALR-BAC was used to treat bromoamine acid wastewater. The results showed that the ALR system could run steadily for over 1 months at the BAA concentration 650 mg x L(-1) after one-month acclimation, the decoloration rate of BAA was reached to about 90% within 12 h, and the removal rate of COD was about 50%, the precipitation performance of the suspended microorganism was good. When the influent bromoamine acid concentration was above 200 mg x L(-1), the decolorization products of BAA were easy to undergo auto-oxidation and the yellow intermediate products which were difficult to biodegrade were formed. The BAC process could inhibit the auto-oxidation of the decolorization products effectively, and the decolorization products could be biodegraded gradually. When there were no added sulphate, the concentrations of Br- and SO4(2-) were increased as the COD concentration reduced. Ultimately, the release rates of Br- and SO4(2-) were 72.2% and 66.9%, the COD removal efficiency was about 85.7%.

Decolorization of azo dyes by Rhodobacter sphaeroides.

Rhodobacter sphaeroides AS1.1737 decolorized more than 90% of several azo dyes (200 mg dyes l(-1)) in 24 h. The optimal culture conditions were: anaerobic illumination (1990 1x), peptone as carbon source, temperature 35-40 degrees C and pH 7-8. Intracellular crude enzyme from this strain had azoreductase activity, optimized temperature as 45-50 degrees C, and decolorization kinetics which were consistent with a ping-pong mechanism.