Is the double-ligation method safe and effective in laparoscopic paediatric inguinal hernia repair? A retrospective cohort study.

INTRODUCTION: Laparoscopic paediatric hernia repair has since been performed more frequently. Recently, a double-ligation method was introduced to prevent recurrence in laparoscopic surgery. The objective of our study was to compare the postoperative outcomes of patients who underwent double and single ligations. PATIENTS AND METHODS: We performed a retrospective review of patients with inguinal hernia who underwent laparoscopic paediatric inguinal hernia repair from 2014 to 2018 at our institution. Patients were divided into two groups and underwent single ligation and double ligation. RESULTS: Three hundred and six patients (single-ligation group: 142 and double-ligation group: 164) were included. Four patients experienced recurrence, and the recurrence rate was 1.29%. The recurrence rate was significantly higher in the single-ligation group. There were no statistically significant differences in the postoperative complications between the two groups. CONCLUSION: Double-ligation method in laparoscopic paediatric hernia repair was relatively safe and helpful.

Predicting the Recurrence of Gastric Cancer Using the Textural Features of Perigastric Adipose Tissue on [18F]FDG PET/CT.

This study aimed to assess the relationship between the histopathological and textural features of perigastric adipose tissue (AT) on 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) and to evaluate the prognostic significance of perigastric AT textural features in predicting recurrence-free survival (RFS) in patients with gastric cancer. Sixty-nine patients with gastric cancer who underwent staging [18F]FDG PET/CT and subsequent curative surgery were retrospectively reviewed. Textural features of perigastric AT were extracted from PET images. On histopathological analysis, CD4, CD8, and CD163 cell infiltration and matrix metalloproteinase-11 and interleukin-6 (IL-6) expression in perigastric AT were graded. The degree of CD163 cell infiltration in perigastric AT was significantly correlated with the mean standardized uptake value (SUV), SUV histogram entropy, grey-level co-occurrence matrix (GLCM) energy, and GLCM entropy of perigastric AT. The degree of IL-6 expression in the perigastric AT was significantly correlated with the mean and median SUVs of perigastric AT. In multivariate survival analysis, GLCM entropy, GLCM dissimilarity, and GLCM homogeneity of perigastric AT were significant predictors of RFS. The textural features of perigastric AT on [18F]FDG PET/CT significantly correlated with inflammatory response in perigastric AT and were significant prognostic factors for predicting RFS in patients with gastric cancer.

Improving Room Temperature Ionic Conductivity of Na3-xKxZr2Si2PO12 Solid-Electrolytes: Effects of Potassium Substitution.

The battery safety and cost remain major challenges for developing next-generation rechargeable batteries. All-solid-state sodium (Na)-ion batteries are a promising option for low-cost as well as safe rechargeable batteries by using abundant resources and solid electrolytes. However, the operation of solid-state batteries is limited due to the low ionic conductivity of solid electrolytes. Therefore, it is essential to develop new compounds that feature a high ionic conductivity and chemical stability at room temperature. Herein, we report a potassium-substituted sodium superionic conductor solid electrolyte, Na3-xKxZr2Si2PO12 (0 ≤ x ≤ 0.2), that exhibits an ionic conductivity of 7.734 × 10-4 S/cm-1 at room temperature, which is more than 2 times higher than that of the undoped sample. The synchrotron powder diffraction patterns with Rietveld refinements revealed that the substitution of large K-ions resulted in an increased unit cell volume, widened the Na diffusion channel, and shortened the Na-Na distance. Our work demonstrates that substituting a larger cation on the Na site effectively widens the ion diffusion channel and consequently increases the bulk ionic conductivity. Our findings will contribute to improving the ionic conductivity of the solid electrolytes and further developing safe next-generation rechargeable batteries.

Percutaneous Transcholecystic Removal of Common Bile Duct Stones: Case Series in 114 Patients.

Purpose To evaluate the safety and effectiveness of percutaneous transcholecystic removal of common bile duct (CBD) stones in 114 patients. Materials and Methods This retrospective study was approved by the institutional review board. From September 2011 through February 2017, 114 consecutive patients (68 men, 46 women; mean age, 73 years) underwent percutaneous transcholecystic removal of CBD stones. All patients had acute cholangitis or cholecystitis. Stones were extracted through a 12-F sheath by using a Wittich nitinol stone basket uder fluoroscopic guidance. Technical success rates, complications, and long-term follow-up were evaluated. Results Technical success was achieved in 96 of 114 (84.2%) patients. In 18 patients, stone removal was unsuccessful due to failure of cystic duct cannulation (n = 11), proximal migration of the CBD stone (n = 3), multiple CBD stones (n = 3), and low insertion of the cystic duct (n = 1). No major procedure-related complications were seen. During the mean follow-up of 644 days (range, 11-2206 days), CBD stones recurred in 12 patients after a mean of 884 days (range, 439-1799 days) after the procedure. Conclusion Percutaneous transcholecystic removal of common bile duct stones seems to be a safe and effective method. © RSNA, 2018 Online supplemental material is available for this article . See also the editorial by vanSonnenberg and Panchanathan in this issue.

Suppressing Polysulfide Dissolution via Cohesive Forces by Interwoven Carbon Nanofibers for High-Areal-Capacity Lithium-Sulfur Batteries.

Nanostructural design renders several breakthroughs for the construction of high-performance materials and devices including energy-storage systems. Although attempts made toward electrode engineering have improved the existing drawbacks, nanoengineering is still hindered by some issues. To achieve practical applications of lithium-sulfur (Li-S) batteries, it is difficult to attain a high areal capacity with stable cycling. Physical encapsulation via nanostructural design not only can resolve the issue of lithium polysulfide dissolution during the electrochemical cycling, but also can offer significant contact resistance, which in turn can decrease the kinetics, particularly at a high sulfur loading. Thus, we demonstrate an electrospun carbon nanofiber (CNF) matrix for a sulfur cathode. This simple design enables a high mass loading of 10.5 mg cm-2 with a high specific capacity and stable cycling. The CNF-sulfur complex can deliver a high areal capacity of greater than 7 mAh cm-2, which is related to the excellent electrical conductivity of one-dimensional species. Moreover, we have observed that the reacted sulfur species have adhered well to the junction of the CNF network with specific wetting angles, which are induced by the cohesive force between the narrow gaps in the matrix that trapped the viscous polysulfides during cycling. The results of this study open new avenues for the design of high-areal-capacity Li-S batteries.

Enhancing the Sequential Conversion-Alloying Reaction of Mixed Sn-S Hybrid Anode for Efficient Sodium Storage by a Carbon Healed Graphene Oxide.

To date, the possible depletion of lithium resources has become relevant, giving rise to the interest in Na-ion batteries (NIBs) as promising alternatives to Li-ion batteries. While extensive investigations have examined various transition metal oxides and chalcogenides as anode materials for NIBs, few of these have been able to utilize their high specific capacity in sodium-based systems because of their irreversibility in a charge/discharge process. Here, the mixed Sn-S nanocomposites uniformly distributed on reduced graphene oxide are prepared via a facile hydrothermal synthesis and a unique carbothermal reduction process, producing ultrafine nanoparticle with the size of 2 nm. These nanocomposites are experimentally confirmed to overcome the intrinsic drawbacks of tin sulfides such as large volume change and sluggish diffusion kinetics, demonstrating an outstanding electrochemical performance: an excellent specific capacity of 1230 mAh g-1 , and an impressive rate capability (445 mAh g-1 at 5000 mA g-1 ). The electrochemical behavior of a sequential conversion-alloying reaction for the anode materials is investigated, revealing both the structural transition and the chemical state in the discharge/charge process. Comprehension of the reaction mechanism for the mixed Sn-S/rGO hybrid nanocomposites makes it a promising electrode material and provides a new approach for the Na-ion battery anodes.

Adipose Tissue Quantification Improves the Prognostic Value of GLIM Criteria in Advanced Gastric Cancer Patients.

The present study investigated whether the risk of recurrence after curative surgery could be further stratified by combining the Global Leadership Initiative on Malnutrition (GLIM) criteria and changes in subcutaneous (SAT) and visceral (VAT) adipose tissue mass after surgery in patients with advanced gastric cancer (AGC). This study retrospectively analyzed 302 patients with AGC who underwent curative surgery. Based on the GLIM criteria, patients were classified into malnourished and non-malnourished groups. The cross-sectional areas of SAT and VAT were measured from preoperative and 6-month post-operative computed tomography (CT) images. Multivariate survival analyses demonstrated that GLIM-defined malnutrition (p = 0.008) and loss of VAT after surgery (p = 0.008) were independent risk factors for recurrence-free survival (RFS). Evaluation of the prognostic value of combining the two independent predictors showed that malnourished patients with a marked loss of VAT had the worst 5-year RFS rate of 35.2% (p < 0.001). Preoperative GLIM-defined malnutrition and a loss of VAT during the first 6 months after surgery were independent predictors for RFS in patients with AGC. Changes in the VAT area after surgery could further enhance the prognostic value of the GLIM criteria for predicting the risk of gastric cancer recurrence.

Is wide excision really needed? Correlation between resection margin and recurrence in benign phyllodes tumors of the breast.

Purpose: Phyllodes tumors are similar to fibroadenomas in imaging and in pathological characteristics and are difficult to identify preoperatively. The purpose of this study was to analyze the recurrence rate after excision stratified by the surgical margin width and to propose and emphasize the "wait and watch" treatment strategy for benign phyllodes tumors. Methods: We performed a retrospective cohort study of patients diagnosed with benign phyllodes tumors by surgical excision between January 2000 and December 2022 at our institution. The medical and histopathological records were reviewed. Results: The results were obtained using the Cox proportional hazard regression and logistic regression. Resection margin status and recurrence were the independent variables. In each variable selection model, the resection margin was positive or less than 1 cm, and the recurrence rate was 3.7 and 1.04 times higher than the control group, but the difference was not statistically significant in 2 analyses. Conclusion: The surgical resection margin status of benign phyllodes tumors did not significantly affect locoregional recurrence. Therefore, follow-up imaging at short intervals without additional surgery is a feasible clinical option when the surgical resection margin is positive or less than 1 cm.

Mitigating grain growth in fully stabilized zirconia via a two-step sintering strategy for esthetic dental restorations.

Overall, 8-mol% yttria-stabilized zirconia (8YSZ), unlike 3YSZ, is optically transparent and stable against low-temperature degradation but has insufficient mechanical properties due to its large grain size. The influence of the grain size of 8YSZ on mechanical properties was investigated to develop an 8YSZ suitable for dental restoration. Modulation of the grain size and relative density was achieved via a two-step sintering (TSS) process, and the corresponding kinetic window was established. The conditions of TSS employed herein yielded a relative density of more than 99% while maintaining a small grain size of 0.75 µm. On the other hand, the highest biaxial strength and the highest total transmittance attained were 833 MPa and 34.6% (1-mm-thick, 39.1% for a 0.5-mm thick sample) in the TSS 8YSZ with a grain size of 1.25 µm. These results suggest that strength has improved only when grain size reduction and increased relative density are achieved at the same time. The results demonstrate that the ceramic processing method has a significant effect on the mechanical and optical properties of 8YSZ needed for dental restoration and provide a new insight that contrasts previous studies focused on the starting material.

The Impact of Pre-Chemotherapy Body Composition and Immunonutritional Markers on Chemotherapy Adherence in Stage III Colorectal Cancer Patients.

Patients with colorectal cancer (CRC) often fail to complete full-course chemotherapy with a standard dose due to various reasons. This study aimed to determine whether body composition affects chemotherapy adherence in patients with CRC. The medical records of 107 patients with stage III CRC who underwent adjuvant folinic acid, fluorouracil and oxaliplatin (FOLFOX) chemotherapy at a single center between 2014 and 2018 were analyzed retrospectively. Blood test results for selected immunonutritional markers were analyzed and body composition was measured through computed tomography. Univariate and multivariate analyses were performed on low and high relative dose intensity (RDI) groups, based on an RDI of 0.85. In the univariate analysis, a higher skeletal muscle index was correlated with a higher RDI (p = 0.020). Psoas muscle index was also higher in patients with high RDI than in those with low RDI (p = 0.026). Fat indices were independent of RDI. Multivariate analysis was performed for the aforementioned factors and results showed that age (p = 0.028), white blood cell count (p = 0.024), and skeletal muscle index (p = 0.025) affected RDI. In patients with stage III CRC treated with adjuvant FOLFOX chemotherapy, a decrease in RDI was related to age, white blood cell count, and skeletal muscle index. Therefore, if we adjust the drug dosage in consideration of these factors, we can expect an increased treatment efficiency in patients by increasing chemotherapy compliance.

Relationship of FDG Uptake of the Reticuloendothelial System with Tumor Immune Microenvironment and Prognosis in Patients with Gastric Cancer.

2-deoxy-2-[18F]fluoro-D-glucose (FDG) uptake of the reticuloendothelial system, including the bone marrow (BM) and spleen, on positron emission tomography/computed tomography (PET/CT) has been shown to be a significant prognostic factor in diverse malignancies. However, the relationship between FDG uptake of the BM and spleen and histopathological findings, including the tumor immune microenvironment, has not been fully evaluated. This study aimed to investigate the relationship of FDG uptake in the BM and spleen with histopathological findings and recurrence-free survival (RFS) in patients with gastric cancer. Seventy patients with gastric cancer who underwent pre-operative FDG PET/CT and subsequent curative surgery were retrospectively enrolled. On image analysis, the BM-to-liver uptake ratio (BLR) and spleen-to-liver uptake ratio (SLR) were measured from PET/CT images, and on immunohistochemical analysis, the densities of immune cell infiltration in the tumor tissue were graded. The BLR and SLR showed significant positive correlations with the grades of CD163 cell and CD8 cell infiltration in the tumor tissue, respectively (p < 0.05). In multivariate survival analysis, both BLR and SLR were significant predictors of RFS (p < 0.05). FDG uptake in the BM and spleen might be potential imaging biomarkers for evaluating tumor immune microenvironment conditions and predicting RFS in patients with gastric cancer.

Expression of miR-221 and miR-18a in patients with hepatocellular carcinoma and its clinical significance.

Purpose: Recently, microRNA (miRNA) has been evaluated to provide a new diagnostic and therapeutic modality hepatocellular carcinoma (HCC) and other tumors. They are small non-coding RNA molecules that function as transcriptional and post-transcriptional regulators of gene expression by silencing target genes. The aim of this study was to evaluate the clinical significance of microRNA-18a, 221 (miR-18a, miR-221) expression in HCC formalin-fixed paraffin-embedded (FFPE) tissue. Methods: miR-18a and miR-221 expressions were assessed by reverse transcription and real-time quantitative reverse transcription polymerase chain reaction in 50 pairs of FFPE HCC and the adjacent noncancerous liver tissues. And we evaluated the expression level in HCC tissues as compared with their adjacent noncancerous counterparts. And the relationship between miR-18a, miR-221 level and clinicopathological data and survival rates were analyzed. Results: miR-221 and miR-18a were overexpressed in HCC tissue as compared with their adjacent noncancerous liver tissue (P<0.001). miR-221 expression was found to be correlated with larger tumor size (P=0.048). miR-18a expression was correlated with modified Union for International Cancer Control stage (P=0.05). The overall survival (P=0.02) of HCC patients with high miR-221 expression was significantly poorer compared to those patients with low expression. Multivariate analyses demonstrated that miR-221 may be a poor prognostic factor of HCC patients. Conclusion: High expression of miR-221 in FFPE tissues could provide significance for prognosis of HCC patients. Although, miR-18a expression was significantly upregulated in HCC tissues, they are not correlated with prognosis. Further large prospective studies are needed to determine their clinical significance.

Jejunogastric intussusception after totally laparoscopic distal gastrectomy for gastric cancer: a rare case report and review of the literature.

Jejunogastric intussusception (JGI) is a rare complication of gastric surgery, with most cases occurring in the form of long-term complications following gastric surgeries. We present a case of JGI in a 74-year-old man who presented with progressive abdominal pain and distention, and was admitted to our hospital. The patient had undergone a totally laparoscopic distal gastrectomy with a Billroth II gastrojejunostomy 9 days previously. Computed tomography and endoscopic findings revealed the presence of a small bowel loop within the gastric lumen, which we failed to reduce in size. We performed an emergency laparoscopic exploration and immediate reduction of the JGI. The efferent and afferent loops were then fixed to the mesentery and the stomach. The postoperative course was uneventful and the patient remained asymptomatic during the 1-year follow-up period.

Appendiceal mucocele masquerading as an epithelial borderline ovarian tumor: a case report and literature review.

Appendiceal mucocele is a rare mucin-producing neoplasm of appendiceal origin. Due to its location and imaging findings, appendiceal mucocele is easily confused with tumors of the right adnexa. We present a rare case of a patient initially misdiagnosed with an ovarian tumor intraoperatively diagnosed as an appendiceal mucocele and successfully treated. A 66-year-old postmenopausal woman was admitted to the gynecology department for an asymptomatic pelvic mass. Preoperative pelvic imaging showed an 8-cm cystic mass. Exploratory laparoscopy for the suspected epithelial borderline tumor from the right ovary revealed a cystic mass in the right pelvic area and normal uterus, fallopian tubes, and ovaries. Intraoperative consultation with the general surgery department confirmed the appendiceal origin. Laparoscopic appendectomy was performed. Histopathological examination confirmed a low-grade mucinous neoplasm of appendiceal origin. The patient was discharged on a postoperative day 5 without complications. The outpatient follow-up performed 1 month later showed no evidence of disease progression. Despite the use of advanced diagnostic tools, appendiceal mucocele may be confused for ovarian malignancies. Because the clinical features of appendiceal mucocele are nonspecific, clinicians and radiologists know the specific imaging findings. A multidisciplinary approach including general surgery, gynecology, and radiology is required for preoperative diagnosis and treatment.

Eliciting Specific Electrochemical Reaction Behavior by Rational Design of a Red Phosphorus Electrode for Sodium-Ion Batteries.

Due to the demand to upgrade from lithium-ion batteries (LIB), sodium-ion batteries (SIB) have been paid considerable attention for their high-energy, cost-effective, and sustainable battery system. Red phosphorus is one of the most promising anode candidates for SIBs, with a high theoretical specific capacity of 2596 mAh g-1 and in the discharge potential range of 0.01-0.8 V; however, it suffers from a low electrical conductivity, a substantial expansion of volume (~300%), and sluggish electron/ion kinetics. Herein, we have designed a well-defined electrode, which consists of red phosphorus, nanowire arrays encapsulated in the vertically aligned carbon nanotubes (P@C NWs), which were fabricated via a two-step, anodized-aluminum oxide template. The designed anode achieved a high specific capacity of 2250 mAh g-1 (87% of the theoretical capacity), and a stepwise analysis of the reaction behavior between sodium and red phosphorus was demonstrated, both of which have not been navigated in previous studies. We believe that our rational design of the red phosphorus electrode elicited the specific reaction mechanism revealed by the charge-discharge profiles, rendered excellent electrical conductivity, and accommodated volume expansion through the effective nano-architecture, thereby suggesting an efficient structure for the phosphorus anode to advance in the future.

Enlarged lymph nodes diagnosed with Langerhans cell histiocytosis found in a direct inguinal hernia: a case report.

It is unusual that an unexpected mass is encountered within a hernia sac. This report describes a patient diagnosed with Langerhans cell histiocytosis (LCH) after surgery for an inguinal hernia. A 64-year-old male patient presented with inguinal mass over a 1-year period. Direct inguinal hernias were found in both sides, and enlarged lymph nodes were found in both hernia sacs. Laparoscopic totally extraperitoneal repair was done, and one enlarged lymph node within inguinal hernia sac was excised for diagnostic purposes. Microscopic findings showed the distinctive cytologic features of Langerhans cells and immunohistochemical staining are positive for CD1a and S-100. LCH is a rare disorder, and the involvement of the lymph nodes with no other sites of disease is uncommon. To the best of our knowledge, this is the first report of LCH within an inguinal hernia sac. Multidisciplinary approach should be considered to provide better detection and treatment.

The efficacy of laparoscopic cholecystectomy without discontinuation in patients on antithrombotic therapy.

PURPOSE: Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries in the world today. However, there is no consensus regarding whether LC can be performed in patients with acute cholecystitis while on antithrombotic therapy. The objective of our study was to describe postoperative outcomes of patients who underwent emergent LC without interruption to antithrombotic therapy. METHODS: We performed a retrospective review of patients who underwent LC for acute cholecystitis while on antithrombotic therapy from 2010 to 2015 at Soonchunhyang Universtiy Cheonan Hospital. Patients were divided into 2 groups as underwent emergent LC and elective LC. RESULTS: A total of 67 patients (emergent group, 22; elective group, 45) were included in the analysis. Elective group had significantly longer duration between the admission and operation (8 [7-10] days vs. 2 [1-3] days, P < 0.001) and longer duration of antithrombotic drugs discontinuation (7 days vs. 1 [0-3] days, P < 0.001). Emergent group had significantly more postoperative anemia (6 patients vs. 0 patient, P = 0.001) and 3 of 6 patients received packed RBC transfusion in postoperative period. However, there was no significant difference in length of postoperative stays, length of intensive care unit stays and mortality rates. CONCLUSION: Emergent LC without interruption to antithrombotic therapy was relatively safe and useful. A well-designed multicenter study is needed to confirm the safety and efficacy of LC without suspension of antithrombotic therapy and to provide a simple guideline.

A flexible energy harvester based on a lead-free and piezoelectric BCTZ nanoparticle-polymer composite.

Lead-free piezoelectric 0.5(Ba0.7Ca0.3)TiO3-0.5Ba(Zr0.2Ti0.8)O3 (BCTZ) nanoparticles (NPs) composed of earth-abundant elements were adopted for use in a flexible composite-based piezoelectric energy harvester (PEH) that can convert mechanical deformation into electrical energy. The solid-state synthesized BCTZ NPs and silver nanowires (Ag NWs) chosen to reduce the toxicity of the filler materials were blended with a polydimethylsiloxane (PDMS) matrix to produce a piezoelectric nanocomposite (p-NC). The naturally flexible polymer-based p-NC layers were sandwiched between two conductive polyethylene terephthalate plastic substrates to achieve a flexible energy harvester. The BCTZ NP-based PEH effectively generated an output voltage peak of ∼15 V and a current signal of ∼0.8 µA without time-dependent degradation. This output was adequate to operate a liquid crystal display (LCD) and to turn on six blue light emitting diodes (LEDs).