Research on Thermal Conductivity of Electrospun Polyacrilonitrile-Multi-Walled Carbon Nanotubes Composite Carbon Nanofiber Papers.

In recent decades, the rapid development of nanoscience and nanotechnology has accelerated materials with high thermal conductivity, such as composite carbon nanomaterials, since heat removal has become a crucial issue. In this work polyacrilonitrile (PAN) incorporated with alteration of mass fraction (0.3 wt%, 0.62 wt%, 0.92 wt%, 2.74 wt%) of the multi-walled carbon nanotubes (MWCNTs) were used to fabricate composite fibers via electrospinning. The stabilizing and carbonization reactions of composite nanofibers are conducted in tube furnace at 280 °C and 1000 °C. The structural features of flexible composite carbon nanofiber papers were characterized under scanning electron microscopy (SEM), X-ray powder diffraction (XRD) and Raman spectroscopy. Special attention of composite carbon nanofiber papers is given to cross-plane thermal conductivity and in-plane thermal conductivity and were measured via Flash Line Analyzer. The results proved that flexible composite carbon nanofiber papers are promising heat sink radiator for a variety of applications including flexible optical and electronic devices.

Comparative analysis of recurrence rates between intravesical gemcitabine and bacillus Calmette-Guérin induction therapy following transurethral resection of bladder tumors in patients with intermediate- and high-risk bladder cancer: A retrospective multicenter study.

PURPOSE: This study investigated the efficacy of intravesical gemcitabine as an alternative to bacillus Calmette-Guérin (BCG) therapy. MATERIALS AND METHODS: Data were retrospectively collected across seven institutions from February 1999 to May 2023. Inclusion criteria included patients with intermediate- or high-risk non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumors (TURBT) and received at least four sessions of intravesical gemcitabine or BCG induction therapy. Patient characteristics, complete remission (CR), occurrence, and progression rates were compared. RESULTS: In total, 149 patients were included in this study (gemcitabine, 63; BCG, 86). No differences were apparent between the two groups in baseline characteristics, except for the follow-up period (gemcitabine, 9.2±5.9 months vs. BCG, 43.9±41.4 months, p<0.001). There were no consistent significant differences observed between the two groups in the 3-month (gemcitabine, 98.4% vs. BCG, 95.3%; p=0.848), 6-month (94.9% vs. 90.0%, respectively; p=0.793) and 1-year CR rates (84.2% vs. 83.3%, respectively; p=0.950). Also, there was no significant statistical difference in progression-free survival between the two groups (p=0.953). The occurrence rates of adverse events were similar between the groups (22.2% vs. 22.1%; p=0.989); however, the rate of Clavien-Dindo grade 2 or higher was significantly higher in the BCG group (1.6% vs. 16.3%, respectively; p<0.001). CONCLUSIONS: Intravesical gemcitabine demonstrated efficacy comparable to BCG therapy for the first year in patients with intermediate- and high-risk NMIBC. However, long-term follow-up studies are warranted.

Risk Factors of Salvage Procedure for Refractory Morcellation During Holmium Laser Enucleation of the Prostate.

PURPOSE: We aimed to identify the risk factors for salvage procedure (SP) required for refractory adenomatous tissue resistant to morcellation during holmium laser enucleation of the prostate (HoLEP). METHODS: Patients who underwent HoLEP between January 2010 and April 2020 at Seoul National University Hospital were analyzed. SPs were defined as cases of conversion to resection of the prostatic tissue using an electrosurgical loop after morcellation or secondary morcellation a few days after surgery or conversion to open cystotomy. RESULTS: Among a total of 2,427 patients, 260 were identified as having SP (SP group) (transurethral resection-nodule [n = 250, 96.1%], secondary morcellation a few days after surgery [n = 9, 3.5%], and conversion to open cystotomy [n = 1, 0.4%]). Patients in the SP group were older and had higher 5-α reductase inhibitors use, higher prostate-specific antigen, larger total prostate volume, and larger transition zone volume (TZV) than those in the non-SP group. In the multivariable logistic regression analysis, only age and TZV were associated with SP. Compared to 40s and 50s, the odds ratios (ORs) were 3.84 in 60s (95% confidence interval [CI] 1.37-10.78, P = 0.011), 4.53 in 70s (95% CI, 1.62-12.62, P = 0.004), and 6.59 in 80s or older (95% CI, 2.23-19.46, P = 0.001). The ORs of the SP were analyzed per TZV quartile. Compared to TZV ≤ 20.3 mL, the OR was 3.75 in 32.0 mL < TZV ≤ 50.4 mL (95% CI, 2.00-7.04, P < 0.001) and 8.25 in 50.4 mL < TZV (95% CI, 4.06-16.77, P < 0.001). CONCLUSION: The risk of refractory morcellation increased in patients aged > 60 years or those with TZV > 32 mL. In order to more efficiently remove these resistant adenomas, it is necessary to develop more efficient morcellators in the future.

Dynamic behavior of water droplets on solid surfaces with pillar-type nanostructures.

In the present study, we investigated the static and dynamic behavior of water droplets on solid surfaces featuring pillar-type nanostructures by using molecular dynamics simulations. We carried out the computation in two stages. As a result of the first computational stage, an initial water cube reached an equilibrium state at which the water droplet showed different shapes depending on the height and the lateral and gap dimensions of the pillars. In the second computational stage, we applied a constant body force to the static water droplet obtained from the first computational stage and evaluated the dynamic behavior of the water droplet as it slid along the pillar-type surface. The dynamic behavior of the water droplet, which could be classified into three different groups, depended on the static state of the water droplet, the pillar characteristics (e.g., height and the lateral and gap dimensions of the pillars), and the magnitude of the applied body force. We obtained the advancing and receding contact angles and the corresponding contact angle hysteresis of the water droplets, which helped classify the water droplets into the three different groups.

Outcome of Patients With Elevated Prostate-Specific Antigen and Lower Urinary Tract Symptoms Receiving Holmium Laser Enucleation of the Prostate.

PURPOSE: This study investigated functional outcomes in lower urinary tract symptoms (LUTS), the incidence of incidental prostate cancer (PCa), and changes in prostate-specific antigen (PSA) levels after holmium laser enucleation of the prostate (HoLEP) in patients with elevated PSA and benign prostatic hyperplasia (BPH). METHODS: A retrospective review of a prospectively designed protocol for patients who underwent HoLEP at our institution from January 2010 to May 2020 was conducted. Patients were classified into low-PSA (<3.0 ng/mL) and high-PSA (≥3.0 ng/mL) groups at baseline. Follow-up for PSA was performed at the sixth postoperative month. Baseline and postoperative clinical parameters, functional parameters, PCa incidence, and postoperative changes in PSA were compared between the lowand high-PSA groups. RESULTS: The baseline PSA of 1,296 patients (mean age, 69.7±6.8 years) was 4.0±4.1 ng/mL, with 712 patients (55.0%) in the low-PSA group (1.6±0.8 ng/mL), and 584 patients (45.0%) in the high-PSA group (6.9±4.7 ng/mL). Incidental PCa was detected in 82 patients (6.3%), with a similar incidence in the low-PSA (41 patients, 5.9%) and high-PSA (41 patients, 7.0%) groups (P>0.05). At 6 months postoperatively, both groups showed significant improvements in the maximum flow rate, postvoid residual volume, and all domains of the International Prostate Symptom Score (P<0.05). At postoperative 6 months, the PSA level significantly decreased by 66.6%±23.6% in all patients (54.3%±23.9% in the low-PSA group; 79.6%±14.7% in the high-PSA group) (P<0.05), and the PSA levels of 1,264 patients (97.6%) had normalized. CONCLUSION: In patients with elevated PSA presenting with LUTS/BPH, our study demonstrated significant improvements in functional parameters and decreased PSA after HoLEP. The incidental PCa detection rate did not show a statistically significant difference between the low- and high-PSA groups. Timely surgery for LUTS/BPH without delay due to PSA monitoring should be considered.

Effectiveness of a newly-developed training module using 3D printing for the navigation during retrograde intrarenal surgery.

PURPOSE: This study aimed to evaluate the feasibility of the newly-developed three-dimensional (3D) printed training module for navigation during retrograde intrarenal surgery. MATERIALS AND METHODS: Two specialists provided orientation to all trainees. The 3D printing model consisted of eight calyces in each kidney. One navigation time started from the moment when the endoscope entered the ureter. After navigation was completed, the navigation time was recorded. The goal was to perform ten navigation times for each side, starting from the right or the left side at random. After the experiment, all trainees were asked to fill out a questionnaire. RESULTS: The average training period of all 17 trainees was 3.05±1.80 years. Eleven trainees (64.7%) had the experience of assisting surgery for <100 cases, and six trainees (35.3%) had the experience of assisting surgery for 100 to 500 cases. Nine trainees (52.9%) began training from the right, and eight trainees (47.1%) started from the left. The average navigation time of 308 trials was 153.4±92.6 seconds. The maximum and minimum navigation times were 354.3±177.2 seconds and 80.1±25.6 seconds. The mean navigation time of the first and the last trials of all trainees significantly decreased from 251.4±108.0 seconds to 93.9±33.2 seconds. The average reduction in navigation time was 201.3±133.3 seconds. Almost all trainees were satisfied with the training. CONCLUSIONS: The newly-developed 3D printing navigation training module seems to be adequate to improve surgical skills of flexible ureteroscopy.

Risk Factors for Transurethral Coagulation for Hemostasis During Holmium Laser Enucleation of the Prostate.

PURPOSE: We aimed to identify risk factors for transurethral coagulation (TUC) using bipolar electrocautery for hemostasis during holmium laser enucleation of the prostate (HoLEP) surgery for benign prostatic hyperplasia (BPH). METHODS: We analyzed the clinical outcomes of HoLEP surgery performed by a single surgeon between January 2010 and April 2020 at the Seoul National University Hospital. Patient characteristics and perioperative parameters were used to identify the risk factors for TUC. The TUC group was defined as a case of conversion to hemostasis using electrocautery during the hemostasis step after enucleation. RESULTS: Of 1,563 patients, 357 underwent TUC (TUC group; 22.8%) as an adjuvant (n=299, 19.1%) or salvage (n=58, 3.7%) therapy. Patients in the TUC group were older (mean±standard deviation, 70.6±7.3 years vs. 69.3±7.0 years; P=0.002), had more 5-alpha reductase inhibitor (5-ARI) use (35.6% vs. 25.9%, P<0.001), higher serum prostate-specific antigen (PSA) (5.4 ±4.8 ng/mL vs. 3.8 ±4.5 ng/mL, P <0.001), larger total prostate volume (TPV) (89.5 ±44.7 mL vs. 66.0 ±32.6 mL, P<0.001), and larger transitional zone volume (TZV) (57.3±34.9 mL vs. 37.7±24.2 mL, P<0.001) than those who did not undergo TUC (non-TUC group). In univariate logistic regression analysis, age, 5-ARI use, PSA, TPV, and TZV correlated with TUC, whereas in multivariate logistic regression analysis, only TZV was associated with TUC. The odds ratios (ORs) of TUC were analyzed per TZV quartile. Compared to TZV<22.3 mL, the OR was 2.42 in 34.1 mL≤TZV<53.5 mL (95% confidence interval [CI], 1.58-3.72; P<0.001), 5.17 in ≥53.5 mL (95% CI, 3.44-7.77; P<0.001). CONCLUSION: The risk of TUC during HoLEP surgery increases in patients with TZV >35 mL. Therefore, TUC may be potentially necessary in patients with a large transition zone volume in patients with BPH.

Geriatric assessment using the G8 to predict postoperative complications in patients undergoing major uro-oncologic surgery: Comparison with the Charlson Comorbidity Index.

OBJECTIVE: To evaluate the ability of the G8 assessment to predict postoperative complications in older adults undergoing major uro-oncologic surgery in comparison with the Charlson Comorbidity Index (CCI). MATERIALS AND METHODS: The study included patients ≥65 years old who underwent major uro-oncologic surgery between December 2017 and December 2019 and were enrolled in the Seoul National University Prospectively Enrolled Registry for Genitourinary Cancer (SUPER-GUC). Odds ratio (OR) smoothing was used to visualize risk according to G8 scores. Chi-square tests were used to compare postoperative complication rates according to G8 score or CCI category. RESULTS: A total of 657 patients undergoing radical prostatectomies (n = 372, 56.6%), partial/radical nephrectomies (n = 149, 22.7%), radical cystectomies (n = 76, 11.6%), and nephroureterectomies (n = 60, 9.1%) were included. Complication rates did not significantly differ between patients with CCI scores ≥1 and those with CCI scores of 0 (15.0% vs. 12.4%, p = 0.34). However, the complication rate was significantly higher in patients with G8 scores ≤14 than in those with G8 scores >14 (18.1% vs. 10.5%, p = 0.005). When the OR smoothing curve was used to divide patients into three groups based on G8 scores of <10, 10-14, and > 14, we observed significant differences in complication rates among the groups (37.5% vs. 16.9%. vs. 10.5%; p = 0.001). CONCLUSION: The G8 can aid in predicting postoperative complications in patients ≥65 years old. Comprehensive geriatric assessment is warranted in patients with G8 scores ≤14 prior to major uro-oncologic surgery. Older patients with G8 scores <10 should be counseled regarding the very high risk of surgery.

The effect of the degree of dual-task interference on gait, dual-task cost, cognitive ability, balance, and fall efficacy in people with stroke: A cross-sectional study.

ABSTRACT: This study was conducted to investigate the effects of the degree of dual-task (DT) interference on gait, dual-task cost (DTC), cognitive ability, balance, and fall efficacy in people with stroke.In this cross-sectional study, people with chronic stroke (N = 36) performed a DT gait assessment (gait and cognitive task). During the evaluation, DT interference in motor and cognition was evaluated simultaneously. Thus, the group with severe interference in both tasks (mutual interference) was compared with the group with mild interference in either.The main effects for the degree of motor interference were observed on gait performance, DTC in motor, time up and go, and trail-making test B. In the cognitive interference, the main effects were observed on correct response rate, DTC in cognition, time up and go, and trail-making test B. An interaction effect was observed in the trail-making test B.The degree of motor interference affected gait, balance ability, and executive function (EF), and the degree of cognitive interference influenced the correct response rate in the DT condition, balance ability, and EF. Furthermore, mutual interference led to a significant reduction in EF in people with stroke.

A study on the behavior of water droplet confined between an atomic force microscope tip and rough surfaces.

The atomic force microscope (AFM) is used for imaging, measuring, and manipulating matter at the nanoscale. It is well-known that water condenses between an AFM tip and a solid surface, thereby generating a pull-off force acting on the tip. We investigated the behavior of a water meniscus between the tip and a solid surface using molecular dynamics simulation. We considered ideally smooth surfaces and rough surfaces that are regularly structured and randomly generated with a standard deviation of 2 A. The characteristic energy values of the solid surfaces used in the study are 0.1, 0.5, 1.0, 1.5, 2.0, and 2.5 kcal/mol, and the tip-to-surface distance considered is in the range from 1.5 to 3.7 nm. The behavior of water confined between the tip and a solid surface depends on the characteristic energy of the solid surface, the tip-to-surface distance, and the shape of the solid surface. The contact angle, neck radius of the water meniscus, and absolute value of capillary force decreases as the tip-to-surface distance increases, regardless of the pattern of the solid surface. Compared to an ideally smooth surface, the effect of regularly structured roughness on the behavior of a water meniscus on a solid surface is significant, whereas the effect of randomly generated roughness is relatively small.

CdS/CdSe lateral heterostructure nanobelts by a two-step physical vapor transport method.

The two-dimensional heterostructure nanobelts with a central CdSe region and lateral CdS structures are synthesized by a two-step physical vapor transport method. The large growth rate difference between lateral CdS structures on both +/- (0001) sides of the CdSe region is found. The growth anisotropy is discussed in terms of the polar nature of the side +/- (0001) surfaces of CdSe. High-resolution transmission electron microscopy reveals the CdSe central region covered with non-uniform CdS layer/islands. From micro-photoluminescence measurements, a systematic blueshift of emission energy from the central CdSe region in accordance with the increase of lateral CdS growth temperature is observed. This result indicates that the intermixing rate in the CdSe region with CdS increases with the increase of lateral CdS growth temperature. In conventional CdSSe ternary nanostructures, morphology and emission wavelength were correlated parameters. However, the morphology and emission wavelength are independently controllable in the CdS/CdSe lateral heterostructure nanobelts. This structure is attractive for applications in visible optoelectronic devices.

Vertically oriented epitaxial germanium nanowires on silicon substrates using thin germanium buffer layers.

We demonstrate a method to realize vertically oriented Ge nanowires on Si(111) substrates. Ge nanowires were grown by chemical vapor deposition using Au nanoparticles to seed nanowire growth via a vapor-liquid-solid growth mechanism. Rapid oxidation of Si during Au nanoparticle application inhibits the growth of vertically oriented Ge nanowires directly on Si. The present method employs thin Ge buffer layers grown at low temperature less than 600 degrees C to circumvent the oxidation problem. By using a thin Ge buffer layer with root-mean-square roughness of approximately 2 nm, the yield of vertically oriented Ge nanowires is as high as 96.3%. This yield is comparable to that of homoepitaxial Ge nanowires. Furthermore, branched Ge nanowires could be successfully grown on these vertically oriented Ge nanowires by a secondary seeding technique. Since the buffer layers are grown under moderate conditions without any high temperature processing steps, this method has a wide process window highly suitable for Si-based microelectronics.

The effects of dynamic core-postural chain stabilization on respiratory function, fatigue and activities of daily living in subacute stroke patients: A randomized control trial.

BACKGROUND: Neurodevelopmental treatment (NDT) and dynamic core-postural chain stabilization (DCS)- based exercise is effective for improving core stability and postural control in stroke patients. However, no study has reported respiratory function, increased fatigue and ADL function in subacute stroke patients by training using NDT and DCS exercises. OBJECTIVE: To compare the effects of DCS and NDT exercises on respiratory function, fatigue and activities of daily living in individuals with hemiparetic stroke. METHODS: Thirty-one participants with hemiparetic stroke (17 male, 14 female; mean age 60.4±14.58 years; post-stroke duration, 7.2±2.2 weeks) participated in this study. The participants were randomly allocated into DCS (n = 16) and NDT (n = 15). Respiratory function was determined using forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). The fatigue severity scale (FSS) and functional independent measure (FIM) were used to evaluate fatigue severity and activities of daily living (ADL). Analysis of covariance (ANCOVA) was used to evaluate post-test differences in the DCS and NDT exercise groups. RESULTS: ANCOVA revealed the superior effects of DCS in respiratory function, as well as clinical FSS and FIM tests, compared with those of NDT (p < 0.05). CONCLUSIONS: The results suggest that DCS training was more effective than NDT training at improving respiratory function, fatigue severity and ADL via balanced co-activation of the diaphragm and increased diaphragm movement in individuals with hemiparetic stroke.

Effects of dynamic core-postural chain stabilization on diaphragm movement, abdominal muscle thickness, and postural control in patients with subacute stroke: A randomized control trial.

BACKGROUND: Neurodevelopmental treatment (NDT) and Dynamic neuromuscular stabilization (DNS)-based exercise is effective for improving core stability and postural control in stroke patients. OBJECTIVE: To compare the effects of DNS and conventional NDT exercises on diaphragm movement, abdominal muscle thickness, and postural control in stroke patients. METHODS: The participants were randomly allocated into DNS (n = 16) and NDT (n = 15) for 30 minutes each per day, 3 days a week for 4 weeks. Diaphragm movement and abdominal muscle thickness were determined using ultrasonography. The trunk impairment scale (TIS) and Berg Balance Scale (BBS) were used to measure postural control. The functional ambulation category (FAC) was used to evaluate gait ability. Analysis of covariance (ANCOVA) was used to evaluate post-test differences in the DNS and NDT exercise groups. RESULTS: ANCOVA revealed the superior effects of DNS in diaphragm movement and abdominal muscle thickness (transversus abdominis, internal oblique), as well as clinical BBS and FAC tests, compared with those of NDT (p < 0.05). CONCLUSIONS: This novel clinical trial suggests that DNS training was more effective than NDT training in improving postural movement control and gait ability via a balanced co-activation of the diaphragm and TrA/IO in stroke patients.

How to reduce 'double-firing'-induced scope damage by investigating the relationship between laser fiber core degradation and fiber jacket burn?

PURPOSE: 'Double-firing effect' in which laser firing occurs in the fiber tip and its proximal part is caused by different breakdown rates between fiber jackets and cores. This study investigated a new safe distance concept to prevent scope damage by analyzing the breakdown of the laser fiber jacket and cores. METHODS: Laser fibers were fixed in a benchtop simulation model. The fiber tip was in contact with uniform phantom stones and submerged in saline. Four different energy settings (1.0 or 2.0J x 10Hz or 30Hz) and two different fiber sizes (200 µm and 365 µm) were tested. After three minutes of use at each energy setting, the length of fiber shortening and jacket burn were measured. The fibers were stripped to measure the length of core degradation. RESULTS: Mean degradation lengths were 4.2 to 7.8 mm. There was no statistical difference in the mean lengths of fiber core degradation and jacket burn. However, core degradation was longer than the jacket burn in half of the samples. The mean difference in lengths between core degradation and jacket burn was 0.49 ± 0.90 mm. Lengths of core degradation and the jacket burn were longer at the setting of high-power energy and 200 µm fiber - 2J with 30 Hz. CONCLUSION: To reduce 'double-firing'-induced damage, the authors recommend that laser fiber should be cut 1.0 mm longer than visible jacket burn at high-power settings after 3-min continuous fragmentation. After cutting the fiber, the laser should be checked whether 'double-firing' is no more seen.

The growth and optical properties of CdSSe nanosheets.

We have investigated the growth of ternary CdSSe nanostructures by physical vapor transport, specifically aiming at the synthesis of CdSSe nanosheets. CdSSe nanostructures with various S mole fractions are grown at growth temperatures less than 800 degrees C and photoluminescence from these nanostructures covers the entire visible spectral range. Morphological evolution from nanowires to nanosheets is observed as increasing growth temperatures due to the change of relative dominance in the growth mechanism from vapor-liquid-solid to vapor-solid. Nanosheets whose widths extend several tens of micrometers are successfully synthesized. However, nanosheets show a strong suppression effect of S incorporation when the growth is dominated by the vapor-solid mechanism. A micro-photoluminescence study shows high optical quality of individual CdSSe nanostructures with polarization anisotropy ratios rho ~ 0.1. In addition, lateral heterostructure CdS/CdSe nanosheets are successfully synthesized by two step growth. Strong red and green emissions are observed by selective laser excitations focusing at the center and edge parts of these heterostructure nanosheets, respectively. These heterostructure CdS/CdSe nanosheets may be useful for multicolor light emitting devices.

Primary orbital tuberculosis on the lower eyelid with cold abscess.

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule (1.5× 1.2 cm) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.

Second-Line Systemic Treatment for Metastatic Urothelial Carcinoma: A Network Meta-Analysis of Randomized Phase III Clinical Trials.

Purpose: We aimed to evaluate and compare relative impacts of various second-line treatments on overall survival (OS) in metastatic urothelial carcinoma (mUC). Method: A literature search was conducted in PubMed, Embase, and the Cochrane Library for all articles published prior to December 2018 in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Seven randomized controlled trials with phase III design that met study eligibility criteria were selected for final analysis. A Bayesian framework network meta-analysis (NMA) was applied to indirectly compare the effect of each treatment on OS. Results: In NMA, atezolizumab (HR, 0.90; 95% CI, 0.57-1.40) and pembrolizumab (HR, 0.77, 95% CI, 0.48-1.20) showed no significant effect on OS improvement compared to vinflunine. Gemcitabine/paclitaxel combination (HR, 1.30; 95% CI, 0.80-1.90) and lapatinib (HR, 0.95; 95% CI, 0.57-1.60) was not significantly associated with OS improvement compared to atezolizumab and best supportive care, respectively. However, results of rankograms revealed that pembrolizumab and atezolizumab were the first and second rank therapeutic agents for OS improvement in post-platinum mUC. Conclusions: Our NMA results are inconclusive. The optimal second-line treatment for OS improvement could not be determined because there were no significant OS differences among evaluated therapeutic agents. However, the use of immunotherapeutic agents such as atezolizumab and pembolizumab may have priority for improving OS in second-line setting of mUC.

Short-term changes of human acellular dermal matrix (Megaderm) in a mouse model.

BACKGROUND: Physicians tend to overcorrect when applying the acellular dermal matrix for reconstructive option because of volume decrement problem after absorption comparing with initial volume. However, there are no studies on the exact volume decrement and absorption rate with commercial products in South Korea. To figure out absorption rate of acellular dermal matrix product in South Korea (Megaderm), authors designed this experiment. METHODS: Nine mice were used and randomly divided into three groups by the time with sacrificing. The implant (Megaderm) was tailored to fit a cuboid form (1.0 cm× 1.0 cm in length and width and 2.0 mm in thickness). A skin incision was made at anterior chest with blade #15 scalpel with exposing the pectoralis major muscle. As hydrated Megaderm was located upon the pectoralis major muscle, the skin was sutured with Ethilon #5-0. After the surgical procedure, each animal group was sacrificed at 4, 8, and 12 weeks, respectively, for biopsies and histological analysis of the implants. All samples were stained with routine hematoxylin and eosin staining and Masson's trichrome staining and the thickness were measured. A measurements were analyzed using Friedman test. Statistically, the correlation between thicknesses of Megaderm before and after implantation was analyzed. RESULTS: After sacrificing the animal groups at postoperative 4, 8, 12 weeks, the mean tissue thickness values were 2.10± 1.03 mm, 2.17± 0.21 mm, and 2.40± 0.20 mm (p= 0.368), respectively. The remaining ratios after absorption comparing with after initial hydrated Megaderm were 82.7%, 85.4%, and 94.5%, respectively. In histopathological findings, neovascularization and density of collagenous fiber was increased with time. CONCLUSION: Author's hypothesis was absorption rate of implant would be increased over time. But in this experiment, there is no statistical significance between mean absorption thickness of implant and the time (p= 0.368). Also it can be affected by graft site, blood supply, and animals that were used in the experiment.

Wound healing effect of regenerated oxidized cellulose versus fibrin sealant patch: An in vivo study.

BACKGROUND: Topical hemostatic agents are used when ligation, electrocauterization, or other conventional hemostatic methods are impractical. Because a hemostatic agent is a foreign body, it can cause foreign body reactions, inflammation, and infections that can interfere with the wound healing process. Therefore, we should select hemostatic agents after considering their effects on wound healing. Here, we compared the effects of hemostatic agents on wound healing in a rectus abdominis muscle defect in rats. METHODS: Twelve Sprague Dawley rats were subjected to creation of a 6 × 6 mm defect in the rectus abdominis muscle and divided into four groups: control group; group A, Tachosil fibrin sealant patch; group B, Surgicel Fibrillar oxidized regenerated cellulose; and group C, Surgicel Snow oxidized regenerated cellulose. For the histologic analysis, biopsies were performed on the 3rd, 7th, and 27th days. RESULTS: The foreign body reaction was the weakest in group A and most significant in group C. The inflammatory cell infiltration was the weakest in group A and similar in groups B and C. Muscle regeneration differed among periods. The rats in group A were the most active initially, while those in group C showed prolonged activity. CONCLUSION: Tachosil and Surgicel administration increased inflammation via foreign body reactions, but the overall wound healing process was not significantly affected. The increased inflammation in the Surgicel groups was due to a low pH. We recommend using Tachosil, because it results in less intense foreign body reactions than Surgicel and faster wound healing due to the fibrin action.