Search

Abstract Background KLASS (the Korean Laparoendoscopic Gastrointestinal Surgery Study) is a time-honored study group that has established laparoscopic surgery for gastrointestinal disease in Korea and has performed some important studies for the rationale of laparoscopic gastrointestinal surgery. A multi-center RCT (randomized controlled trial) to compare the quality of life (QOL) of patients undergoing totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer, named as KLASS 07, has been currently prepared in Korea. Methods Patients diagnosed as gastric cancer, with clinical stage IA (T1N0M0) or IB (T1N1M0 / T2N0M0) according to the 7th edition of the Americal Joint Committee on Cancer System, were randomized to receive either TLDG or LADG. For surgical quality control, the surgeons participating in this trial had to have performed at least 50 gastrectomies and at least 30 gastrectomies annually (regardless of open or laparoscopic surgery for gastric cancer). The patients who are allocated to TLDG group undergo intracorporeal anastomosis and those who are assigned to LADG undergo extracorporeal anastomosis for gastrointestinal reconstruction. Discussion Thirty-one surgeons from 26 institutions were engaged in this trial. The primary endpoint is 30-day morbidity, and secondary endpoint is QOL assessed by the questionnaire score. The KLASS 07 trial is the first multi-center RCT to investigate whether there are significant and quantifiable differences between the QOL of TLDG and LADG. The findings from this trial are expected to be the critical clues for designing the detailed procedures during laparoscopic surgery for gastric cancer. Trial registration The protocol of KLASS 07 (CKLASS 01) was registered in http://register.clinicaltrials.gov as NCT03393182 (Date of registration: January 2nd, 2018.).

Small bowel obstruction is a clinical condition commonly caused by postoperative adhesion, volvulus, intussusceptions, and hernia. Small bowel obstruction due to bezoars is clinically uncommon, accounting for approximately 2-4% of all obstructions. Computed tomography (CT) is a useful method in diagnosing the cause of small bowel obstruction. However, small bowel obstruction caused by bezoars may not be detected by an abdominal CT examination. Herein, we report a rare case of small bowel obstruction by Aloe vera bezoars, which were undetected by an abdominal CT. Phytobezoars should be included in the differential diagnosis of small bowel obstruction in patients with predisposing factors, such as excessive consumption of high-fiber food and diabetes.

The aging of explosive charges in pyrotechnic mechanical devices (PMDs) significantly affects the reliability of their performance. Aging decreases the explosive power of explosive charges via pre-oxidation by external sources of oxygen. In this study, the flame temperature was calculated based on the amount of added oxygen source, and the effect of aging was quantified in terms of the performance of explosive charges. Three primary explosive charges (THPP, ZPP, and BKNO3) were selected, and the explosion was assumed to have occurred in a closed adiabatic system. The flame temperature decreased with increasing oxygen addition, suggesting that the aging decreased the pressure exerted by the PMDs. The explosive power decreased in the following order: ZPP >> THPP > BKNO3 (4100 >> 3260 > 3050 K), and it was decreased by aging as follows: ZPP >> BKNO3 > THPP (802 >> 219 > 95 K per mole of added water). As a result, ZPP is appropriate for the generation of the huge thrust of PMDs despite its increased susceptibility to aging, while THPP is superior for reliable PMD performance.

The aging mechanism of explosive charges in pyrotechnic mechanical devices (PMDs) is pre-oxidations of their fuels (TiH2 for THPP, Zr for ZPP, and B for BKNO3) by external oxygen. The effect of water on the aging of explosive charges was thus investigated by TEM-EDS/XPS and DFT-based molecular modeling under accelerated aging with 71 °C and 100% relative humidity. The formation of oxide shell and its thickness on the surface of fuels by the aging were observed by TEM-EDS. It failed to detect any oxide on the surface of TiH2 (no sign of Ti-O peaks in XPS) regardless of the aging time, while the thickness of oxide shell increases linearly with the time for ZPP and is saturated at a certain point for BKNO3. It suggested that THPP is highly robust to aging compared to the others (the order of THPP >> BKNO3 > ZPP). Then, DFT-based vacuum slab calculations visualized the diffusion of oxygen from the surface of fuels into the interior, confirming that the activation barrier for the oxygen diffusion is much lower for Zr and B than TiH2 (37, 107, and 512 kcal/mol for Zr, B, and TiH2, respectively), in agreement with experimental results.

The processus vaginalis within the inguinal canal forms the canal of Nuck, which is a homolog of the processus vaginalis in women. Incomplete obliteration of the processus vaginalis causes indirect inguinal hernia or hydrocele of the canal of Nuck, a very rare condition in women. Here, we report 2 cases of hydrocele of the canal of Nuck that were diagnosed with ultrasonography in both cases and magnetic resonance imaging in 1 case to confirm the sonographic diagnosis. High ligation and hydrocelectomy were conducted in both patients. In 1 patient, 14 months later, the occurrence of contralateral inguinal hernia was suspected, but did not require surgery. The other patient had a history of surgery for left inguinal hernia 11 months before the occurrence of right hydrocele of the canal of Nuck. In both cases, the occurrence of an inguinal hernia on the contralateral side was noted.