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Background Previous studies have suggested improved efficiency and patient outcomes with 125I seed compared with hookwire localization (HWL) in breast-conserving surgery, but high-level evidence of superior surgical outcomes is lacking. The aim of this multicentre pragmatic RCT was to compare re-excision and positive margin rates after localization using 125I seed or hookwire in women with non-palpable breast cancer. Methods Between September 2013 and March 2018, women with non-palpable breast cancer eligible for breast-conserving surgery were assigned randomly to preoperative localization using 125I seeds or hookwires. Randomization was stratified by lesion type (pure ductal carcinoma in situ (DCIS) or other) and study site. Primary endpoints were rates of re-excision and margin positivity. Secondary endpoints were resection volumes and weights. Results A total of 690 women were randomized at eight sites; 659 women remained after withdrawal (125I seed, 327; HWL, 332). Mean age was 60.3 years in the 125I seed group and 60.7 years in the HWL group, with no difference between the groups in preoperative lesion size (mean 13.2 mm). Lesions were pure DCIS in 25.9 per cent. The most common radiological lesion types were masses (46.9 per cent) and calcifications (28.2 per cent). The localization modality was ultrasonography in 65.5 per cent and mammography in 33.7 per cent. The re-excision rate after 125I seed localization was significantly lower than for HWL (13.9 versus 18.9 per cent respectively; P = 0.019). There were no significant differences in positive margin rates, or in specimen weights and volumes. Conclusion Re-excision rates after breast-conserving surgery were significantly lower after 125I seed localization compared with HWL. Registration number: ACTRN12613000655741 (http://www.ANZCTR.org.au/).

Gastrointestinal nematodes can cause assorted health problems to human and other primates. The status of gastrointestinal nematodes in non-human primates remained less documented in Malaysia. This study aimed to determine the occurrence of gastrointestinal nematodes recovered from the fecal samples of captive non-human primates at the Matang Wildlife Centre (MWC), Sarawak. Fresh fecal samples were collected from 60 non-human primates of six species (i.e. Orangutan, Bornean gibbon, Silvered Leaf monkey, Slow loris, Pig-tailed macaque, and Long-tailed macaque) and processed using simple fecal floatation method and fecal sedimentation method. This study shows high prevalence of nematode infection (=50%) and co-infection (22 from 45 infected individuals) in all species of captive non-human primates found in MWC, except one individual of young Silvered Leaf monkey was negative for nematode. From these, eight genera of 11 species and one unknown nematode larvae were recovered and among them Oesophagostomum sp., Ascaris sp., and Strongyloides sp. were the most common nematodes infecting the non-human primates. All the Bornean gibbon (n=7) were found to be infected with nematodes. Moreover, Long-tailed macaques at the centre were heavily infected by Ascaris sp. (number of total count, n

This paper discussed on the performance of new end mill geometry design in terms of cutting force and cutting temperature when machining NAK80 pre-hardened steel. An experimental test was conducted using 10 mm six flute carbide end mill, coated with TiSi under dry condition. It was found that design 2 and design 3 tools recorded the highest cutting force of 489.06 N and 544.39 N at the cutting speed of 50 m/min and 100 m/min, respectively. The same trend was also observed for cutting temperature, whereby, design 2 and design 3 recorded the highest cutting temperature of 366 and 660 °C at the cutting speed of 50 and 100 m/min, respectively. Overall, design 5 outperformed other design by reducing the cutting force and cutting temperature.

Background The aim was to determine the cost-effectiveness of radioguided occult lesion localization using 125I-labelled seeds (125I seeds) versus hookwire localization in terms of incremental cost per reoperation avoided for women with non-palpable breast cancer undergoing breast-conserving surgery. Methods This study was based on a multicentre RCT with eight study sites comprising seven public hospitals and one private hospital. An Australian public health system perspective was taken. The primary effectiveness outcome for this study was reoperations avoided. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were used to explore uncertainty. The willingness to pay (additional cost of localization using 125I seeds justified by reoperation cost avoided) was set at the weighted, top-down cost of reoperation. Costs were in 2019 Australian dollars ($1 was equivalent to €0.62). Results The reoperation rate was 13.9 (95 per cent confidence interval 10.7 to 18.0) per cent for the 125I seed group and 18.9 (14.8 to 23.8) per cent for the hookwire localization group. The ICER for 125I seed versus hookwire localization was $4474 per reoperation averted. The results were most sensitive to uncertainty around the probability of reoperation. Accounting for transition probability and cost uncertainty for 125I seed localization, there was a 77 per cent probability that using 125I seeds would be cost-effective, with a willingness to pay of $7693 per reoperation averted. Conclusion Radioguided occult lesion localization using 125I seeds is likely to be cost-effective, because the marginal (additional) cost compared with hookwire localization is less than the cost of reoperations avoided.

Drilling is the metal cutting process that are widely used in industrial sector such as in aerospace, automotive and manufacturing to produce a various of durable parts. Stainless steels in general are regarded as difficult to machine materials due to their high tendency to work harden; their toughness and relatively low thermal conductivity. In this research, the experimental setup for the effect of various parameters on drill performance in term of cutting force and surface roughness. Stainless steel 316L used as workpiece and uncoated tungsten carbide drill bit as the tool. From the experimental investigation, the results show that internal coolant with helix angle of 40 and feed rate of 0.1 mm/rev condition is the best drilling condition in term of thrust force and surface roughness. By observation on experiment, MQL coolant condition give highest thrust force while internal coolant is best condition to have most minimum force. For internal coolant, MQL and external supply, the optimum helix angle to obtain low surface roughness is 15° and 40°.

This study aimed to investigate the subjective health complaints (SHC) in the teaching profession of Hong Kong. On the basis of the SHC inventory, a questionnaire was prepared for data collection through a mail survey. A total of 1710 usable questionnaires were returned by the primary or secondary school teachers. The results showed that 99.5% (n = 1702) of respondents suffered at least one type of the 39 single health problems on the total SHC scale during the preceding 30 days. The 10 most frequently reported health complaints among the teachers were tiredness, eyestrain, anxiety, sleep problems, voice disorder, shoulder pain, neck pain, headache, cold/flu, and lower-back pain. With the exception of the category of pseudoneurological complaints, primary school teachers showed a statistically higher prevalence in reporting problems in 6 of 7 subscales. The 5 most severe complaints were tiredness, eyestrain, sleep problems, shoulder pain, and voice disorder.

Retroperitoneal fatty tumours are uncommon occurrences in current urologic practice, the differentials being lipomas, liposarcomas and extra-renal angiomyolipomas (AML). We report an unusual case of a 48-year-old Chinese female who presented with a 6.2 kg giant mixed-type liposarcoma in the left perinephric space, invading into the renal cortex and parenchyma. Extirpative surgery with left radical nephrectomy was performed, and histology confirmed liposarcoma with both myxoid and well-differentiated elements. The patient remains well and disease-free at 6-month follow-up. We review the literature on the diagnosis and management of these perinephric lipomatous lesions. We also discuss the diagnostic dilemma in differentiating such malignancies from benign angiomyolipomas in the perinephric area on conventional radiological imaging, and its direct implications with respect to extent of surgery and renal preservation.

The present study was developed to comprehensively investigate the occupational health problems among teachers of primary and secondary schools in Hong Kong. A random sample of 1,710 respondents was generated from the database of Hong Kong Professional Teachers’ Union (HKPTU) members. A self‐administrated questionnaire was designed and sent by mail to the teachers of primary and secondary schools in HK. The results indicated that comparing with one year and five years ago, 91.6% and 97.3% of the responding teachers reported an increase of perceived stress level, respectively. Heavy workload and time pressure, education reforms, external school review, pursuing further education, and managing students’ behaviour and learning were the most frequently reported sources of work stress. The four most frequently reported stress management activities were sleeping, talking to neighbors and friends, self‐relaxing, and watching television, while the least frequently reported activity was doing more exercises or sports.

Neural networks are ubiquitous tool for classification. This paper presents a study of classifying EMG signal patterns using back-propagation and radial basis neural networks. Since the pattern of the EMG signal elicited may differ depending on the activity of the muscle movement. Therefore, the purpose of this study was to demonstrate the effectiveness of the neural networks on discriminating the patterns of certain activities to their respective category. Experiments were carried out on a selected muscle. Five subjects were asked to perform several series of voluntary movement with the respect to the muscle concerned. From the EMG data obtained, four statistical features are computed and are applied to the networks. Comparison is made based on the elements of the networks and the classification rate achieved. Generally, both networks are well performed in discriminating different EMG signal patterns with the successful rate of 88% and 89.33% respectively.

We report two rare cases of isolated spontaneous intraperitoneal bladder rupture following normal vaginal delivery without concomitant uterine rupture. Two primigravidas, aged 32 years and 34 years, presented following vaginal delivery with abdominal distension and acute renal failure. The initial diagnosis in both cases was severe urosepsis. Definitive diagnosis was achieved after 48 hours. Comparison was made with two of the cases found in the literature and all four cases were reviewed. Laparotomy and bladder repair were performed in all patients with no adverse outcome reported. Two of them were diagnosed only during laparotomy. Key diagnostic clinical features were acute renal failure, new-onset ascites and bowel ileus with sepsis. This rare but life-threatening condition is often diagnosed late. Prompt laparotomy and bladder repair are necessary to prevent an adverse outcome.

We report a 35-year-old Chinese woman with clear cell sarcoma of the rectus sheath aponeurosis presenting as a tender anterior abdominal mass. She was treated with wide local excision. Local recurrence and distant metastasis occurred within two months of the onset of the complaint. Clear cell sarcoma is a rare cancer with a propensity for slow progressive invasion. They occur most commonly in the extremities, and the majority of patients are young adults. This case report demonstrates an unusual site of occurrence for clear cell sarcoma.

Grade 4 cystoceles are among the most challenging to achieve a successful repair for gynaecologists. The high rate of recurrence of severe prolapse encouraged surgeons to use meshes. Only recently have meshes been used transvaginally for pelvic organ prolapse. The aim of our pilot study was therefore to determine the effectiveness of transvaginal anterior colporrhaphy reinforced with prolene mesh in the treatment of severe or recurrent cystoceles by looking at their primary surgical outcomes as well as their complications.This was a retrospective study conducted by the urogynaecology unit at KK Women's and Children's Hospital (KKWCH) in Singapore based on operations performed from April 2002 to December 2003. The inclusion criterion was that women had to have at least a grade 4 or recurrent grade 3 cystocele and had undergone a vaginal anterior colporrhaphy reinforced with prolene mesh. The women were further subdivided into 3 groups depending on whether vaginal hysterectomies were performed or not as well as the absence or presence of the uterus.Thirty-seven patients with severe cystoceles underwent this procedure. The 3 mean follow-up times for the 3 groups ranged from 14.4 to 19.2 months (range, 2 to 32). Overall for the 3 groups, 75.7% were cured with no or grade 1 cystocele, 18.9% had asymptomatic grade 2 cystocele while 5.4% developed grade 3 or 4 cystocele. There were no mesh erosions.Transvaginal anterior colporrhaphy reinforced with a tension-free prolene mesh in the treatment of severe or recurrent cystoceles is simple, safe, easily performed and is associated with a low failure rate and morbidity.

The influence of pulse voltage on the accuracy of charge density distribution in the pulsed electroacoustic technique (PEA) is discussed. It is shown that significant error can be introduced if a low dc voltage and high pulse voltage are used to calibrate charge density. However, our main focus in the present paper is to deal with one of the practical situations where space charge exists in the material prior to any measurements. The conventional calibration method can no longer be used to calibrate the charge density due to the interference by the charge on the electrode induced by space charge. A method has been proposed which is based on two measurements. Firstly, the sample containing the charge is measured without any applied voltage. The second measurement is carried out with a small external applied voltage. The applied voltage should be small enough so there is no disturbance of the existing charge in the sample. The difference of the two measurements can be used for calibration. An additional advantage of the proposed method avoids the influence of the pulse voltage on calibration and therefore gives a more accurate representation of space charge. The proposed method has been validated.

Calibration is an important part of procedures to accurate measurements of space charge in solid dielectrics. The pulsed electroacoustic (PEA) technique is one of the mostly used techniques due to its simplicity in construction, low cost and easy to implement for both plaque and cable samples. A novel method has been proposed which enables the PEA technique to be used in the presence of space charge. It is based on two measurements. Firstly, the sample with the presence of charge is measured without any applied voltage. The second measurement is carried out with a small dc applied voltage. The applied voltage should be small enough so there is no disturbance on the existing charge in the sample. The difference of the two measurements can be used for calibration. The additional advantage of the proposed method avoids the influence of the pulse voltage on calibration. A 200 µm LDPE sample was stressed at 8 kV for 60 minutes to produce a significant amount of charge in the sample. The proposed method has been used to calculate the residual charge and the result has been compared with the conventional method.

A 34-year-old man presented with a two-month history of intermittent fever and left loin pain. A large left suprarenal mass was detected on computed tomography and magnetic resonance imaging. Blood pressure, serum electrolytes, serum cortisol and urinary catecholamines were normal. Laparoscopic adrenalectomy was planned but the mass was found to be an isolated adrenal abscess due to Nocardiosis. He was later found to have AIDS. The clinical utility of various imaging modalities and management of adrenal cysts are reviewed.

This paper reports on the result of space charge evolution in cross-linked polyethylene (XLPE) planar samples approximately 220 µm thick. The space charge measurement technique used in this study is the pulsed electroacoustic method. There are two phases to this experiment. In the first phase, the samples were subjected to dc 30 kVdc mm −1 and ac (sinusoidal) electric stress levels of 30 kVpk mm −1 at frequencies of 1, 10 and 50 Hz ac. In addition, ac space charge under 30 kVrms mm −1 and 60 kVpk mm −1 electric stress at 50 Hz was also investigated. The volts-off results showed that the amount of charge trapped in XLPE sample under dc electric stress is significantly bigger than samples under ac stress even when the applied ac stresses are substantially higher. The second phase of the experiment involves studying the dc space charge evolution in samples that were tested under ac stress during the first phase of the experiment. Ac ageing causes positive charge to become more dominant over negative charge. It was also discovered that ac ageing creates deeper traps, particularly for negative charge. This paper also gives a brief overview of the data processing methods used to analyse space charge under ac electric stress. (Some figures in this article are in colour only in the electronic version)