Monocyte-to-lymphocyte ratio as a determinant of survival in patients with gastric cancer undergoing gastrectomy: A cohort study.

The monocyte-to-lymphocyte ratio (MLR) is an important prognostic determinant of various malignancies. However, the prognostic role of MLR in patients with gastric cancer undergoing gastrectomy remains unclear. Patients with stage I to III gastric cancer who underwent curative-intent gastric resection were enrolled in this study. Cox regression analysis was used to determine the independent variables for overall survival (OS) and disease-free survival (DFS). The established models were validated internally. Inter-model comparisons were performed using the integrated area under the receiver operating characteristic curve and the concordance index. Multivariate Cox regression analysis revealed that age, tumor-node-metastasis (TNM) stage, perineural invasion, serum albumin level, and MLR were prognostic factors for OS and DFS and constituted the full model. The full model was internally validated using calibration curves and decision curve analysis. The integrated area under the curve and concordance index of the full model outperformed those of TNM stage. The full model was a significant determinant of OS and DFS. Additionally, the full model was suggested to outperform TNM stage in predicting patient survival outcomes.

Invasive Mucormycosis Involving the Laryngopharynx After Bone Marrow Transplantation.

ABSTRACT: Invasive larynx or pharyngeal fungal infections are rare. We report an invasive fungal laryngopharyngitis patient who complained of a persistent sore throat after an allogenic bone marrow transplant and a haploidentical stem cell transplant. An antifungal gargle was used after finding necrotic changes extending from the right soft palate to the aryepiglottic fold. Biopsy and culture suggested a fungal infection with suspicious mucormycosis. imaging showed the right oropharynx, supraglottis, and the para- pharnygeal space were involved. After initiating liposomal amphotericin В for 4 days, wide excisional debridement, and a partial pharyngectomy with an anterolateral thigh free flap including the deep fascia were performed. Amphotericin B and posaconazole were used subsequently. Pathology assessment indicated invasive mucormycosis. There was no recurrence for 9 months. Mucormycosis is a fatal opportunistic infection often seen in immunocompromised patients. Rapid detection, radical resection, and reconstruction can save the patient from a life-threatening fungal infection of the laryngopharynx.

Diagnostic Accuracies of Laryngeal Diseases Using a Convolutional Neural Network-Based Image Classification System.

OBJECTIVES/HYPOTHESIS: There may be an interobserver variation in the diagnosis of laryngeal disease based on laryngoscopic images according to clinical experience. Therefore, this study is aimed to perform computer-assisted diagnosis for common laryngeal diseases using deep learning-based disease classification models. STUDY DESIGN: Experimental study with retrospective data METHODS: A total of 4106 images (cysts, nodules, polyps, leukoplakia, papillomas, Reinke's edema, granulomas, palsies, and normal cases) were analyzed. After equal distribution of diseases into ninefolds, stratified eightfold cross-validation was performed for training, validation process and remaining onefold was used as a test dataset. A trained model was applied to test sets, and model performance was assessed for precision (positive predictive value), recall (sensitivity), accuracy, F1 score, precision-recall (PR) curve, and PR-area under the receiver operating characteristic curve (PR-AUC). Outcomes were compared to those of visual assessments by four trainees. RESULTS: The trained deep neural networks (DNNs) outperformed trainees' visual assessments in discriminating cysts, granulomas, nodules, normal cases, palsies, papillomas, and polyps according to the PR-AUC and F1 score. The lowest F1 score and PR-AUC of DNNs were estimated for Reinke's edema (0.720, 0.800) and nodules (0.730, 0.780) but were comparable to the mean of the two trainees' F1 score with the best performances (0.765 and 0.675, respectively). In discriminating papillomas, the F1 score was much higher for DNNs (0.870) than for trainees (0.685). Overall, DNNs outperformed all trainees (micro-average PR-AUC = 0.95; macro-average PR-AUC = 0.91). CONCLUSIONS: DNN technology could be applied to laryngoscopy to supplement clinical assessment of examiners by providing additional diagnostic clues and having a role as a reference of diagnosis. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2558-2566, 2021.

Synthesis and Characterization of Cation-Exchange Fibers with Radiation-Induced Grafting of Glycidyl Methacrylate onto Cotton Cellulose.

Conventional ion exchange beads are used for purification and demineralization of water and for various other applications in the chemical synthesis, hydrometallurgy, and agricultural industries. However, there are some disadvantages associated with ion exchange beads, such as distillation causing porosity during solvent removal, pre-swelling of beads to allow for core functionalization, and pre-swelling of beads overnight prior to end use. Fibrous ion exchange materials have advantages over the conventional ion exchange beads, including simplification of the overall preparation. In this study, a cation-exchange fiber was prepared by a radiation-induced grafting method. Glycidyl methacrylate (GMA) was grafted onto cotton cellulose using a pre-irradiation method by electronbeam irradiation. Sequential treatment with sulfonic acid was performed to react with the cation pollutants. The degree of grafting increased up to 812% with the increase of absorbed dose, reaction time and monomer concentration. It was found that the sulfonation reaction occurred smoothly with 10% sodium sulfite solution, and a high 2.0 meq/g ion exchange capacity was obtained from 140% GMA-grafted non-woven cotton fabric.

Preparation and Study on Nickel Oxide Reduction of Polyacrylonitrile-Based Carbon Nanofibers by Thermal Treatment.

Carbon materials containing magnetic nanopowder have been attractive in technological applications such as electrochemical capacitors and electromagnetic wave shielding. In this study, polyacrylonitrile (PAN) fibers containing nickel nanoparticles were prepared using an electrospinning method and thermal stabilization. The reduction of nickel oxide was investigated under a nitrogen atmosphere within a temperature range of 600 to 1,000 °C. Carbon nanofibers containing nickel nanoparticles were characterized by FE-SEM, EDS, XRD, TGA, and VSM. It was found that nickel nanoparticles were formed by a NiO reduction in PAN as a function of the thermal treatment. These results led to an increase in the coercivity of nanofibers and a decrease in the remanence magnetization.

Analysis of oxygen vacancy in Co-doped ZnO using the electron density distribution obtained using MEM.

Oxygen vacancy (VO) strongly affects the properties of oxides. In this study, we used X-ray diffraction (XRD) to study changes in the VO concentration as a function of the Co-doping level of ZnO. Rietveld refinement yielded a different result from that determined via X-ray photoelectron spectroscopy (XPS), but additional maximum entropy method (MEM) analysis led it to compensate for the difference. VO tended to gradually decrease with increased Co doping, and ferromagnetic behavior was not observed regardless of the Co-doping concentration. MEM analysis demonstrated that reliable information related to the defects in the ZnO-based system can be obtained using X-ray diffraction alone.

Analysis of expert consultation referrals for anesthesia-related issues (December 2008-July 2010): KSA legislation committee report.

BACKGROUND: Since 2009, database construction of anesthesia-related adverse events has been initiated through the legislation committee of the Korean Society of Anesthesiologists (KSA), based on expert consultation referrals provided by police departments, civil courts, and criminal courts. METHODS: This study was a retrospective descriptive analysis of expert consultation referrals on surgical anesthesia-related cases between December 2008 and July 2010. RESULTS: During the given period, 46 surgical anesthesia-related cases were referred to the KSA legislation committee for expert consultation. Because six cases were excluded due to insufficient data, 40 cases were included in the final analysis. Of 40 cases, 29 (72.5%) resulted in death. Respiratory events were most common in both surviving/disabled and dead patients (36.4 vs. 51.7%, respectively; P > 0.05). Overall, respiratory depression due to the drugs used for monitored anesthesia care (MAC) was the most common specific mechanism (25%), in which all but one case (profound brain damage) resulted in death. In all of these cases, surgeons or physicians provided MAC without the help of anesthesiologists. CONCLUSIONS: Overall, the most common damaging mechanism was related to respiratory depression due to sedatives or anesthetics used for MAC. Almost all MAC injury cases are believed to be preventable with the use of additional or better monitoring and an effective response to initial physiological derangement. Thus, it is essential to establish practical MAC guidelines and adhere to these guidelines strictly to reduce the occurrence of severe anesthesia-related adverse outcomes.

The effect of mechanical ventilation tidal volume during pneumoperitoneum on shoulder pain after a laparoscopic appendectomy.

BACKGROUND: Postlaparoscopic shoulder pain (PLSP) frequently occurs after various laparoscopic surgical procedures. Its mechanism is commonly assumed to be overstretching of the diaphragmatic muscle fibers due to the pressure of a pneumoperitoneum, which causes phrenic nerve-mediated referred pain to the shoulder. Based on this hypothesis, we speculated that during inspiration, the lung could squeeze out the phrenic nerve with carbon dioxide gas against the constantly pressurized abdominal cavity with increasing tidal volume (V(T)). Thus, we examined whether mechanical ventilation with a low V(T) (LTV, V(T) 7 ml/kg) during a pneumoperitoneum might reduce PLSP in patients undergoing laparoscopic appendectomy compared with ventilation with the traditional V(T) (TTV, V(T) 10 ml/kg). METHODS: In a prospective trial, 64 adult patients undergoing laparoscopic appendectomy were randomly assigned to two groups of 32 each (LTV and TTV groups). Intravenous ketorolac was used as a postoperative rescue analgesic. The 2-, 4-, 24-, and 48-h postoperative incidence and severity of PLSP, severity of surgical pain, and need for rescue analgesia was assessed. RESULTS: The overall incidence of PLSP was similar in both groups (57.1% in the LTV group vs. 65.5% in the TTV group). Compared with the TTV group, the incidence and PLSP verbal rating scale (VRS) did not decrease in the LTV group throughout the study period. No statistically significant differences were observed in the VRS surgical pain score, the cumulative ketorolac consumption at each time point, or the time to first rescue analgesia. CONCLUSIONS: Mechanical ventilation with a reduced 7 ml/kg V(T) during a pneumoperitoneum does not reduce the frequency and severity of PLSP after laparoscopic appendectomy compared with ventilation with the traditional V(T) (10 ml/kg).