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Aim: Pancreas cancer continues to carry a poor prognosis. Hospitalized patients with advanced chronic pancreatic illnesses increasingly receive palliative care due to its perceived clinical benefits. Meanwhile, a growing proportion of elderly patients are reportedly receiving life-sustaining procedures. Temporal trends in the utilization of life-sustaining procedures and palliative care consultation among dying patients with advanced chronic pancreatic illnesses in US hospitals were examined.Methods and Materials: A serial, cross-sectional analysis was carried out using the National Inpatient Sample Database. Decedents 18 years and older with a principal diagnosis of pancreas cancer or other advanced chronic pancreatic illnesses from 2005 through 2014. The compound annual growth rates (CAGRs) and Cochrane-Armitage correction of χ2 statistic were used. The receipt of life-sustaining systemic procedures, intra-abdominal local procedures and surgeries, and palliative care consultation were examined. Multilevel multivariate logistic regressions were performed to examine the association of various procedures with the utilization of palliative care consultation.Results: Among 77 394 183 hospitalizations, 29 515 patients were examined. The CAGRs of systemic procedures, intra-abdominal procedures, surgeries, and palliative care were -4.19% (P = .008), 2.17%, -1.40%, and 14.03% (P < .001), respectively. The receipt of systemic procedures (odds ratio [OR] = 2.40, 95% confidence interval [CI], 2.08-2.74), local intra-abdominal procedures (OR = 1.46, 95% CI, 1.27-1.70), and surgeries (OR = 2.51, 95% CI, 2.07-3.05) was associated with palliative care consultation (Ps < .001).Conclusions: Among adults with pancreatic cancer or other advanced chronic pancreatic illnesses in the US hospitals from 2005 to 2014, the utilization of life-sustaining systemic procedures decreased while the prevalence of palliative care consultation increased. [ABSTRACT FROM AUTHOR]

In this study, numerical simulations are conducted in order to analyze the capsizing of roll-on/roll-off passenger ship, Sewol, which occurred on 16 April 2014. Since little is known about the reason of ship capsize, numerical simulation aims to the finding of possible scenarios which can cause this tragic accident. To this end, 4-degree-of-freedom (surge, sway, yaw, and roll motions) maneuvering equations are solved. The hydrodynamic coefficients obtained from a similar ship are applied and the WISH-Maneuver program of Seoul National University is used to perform the numerical simulation. The present analysis utilizes the probabilistic approach, which considers various physical variables and involves the simulation of a large number of cases using different combinations of the variables. The total number of simulation cases is over 70 millions, and the simulation results that are close to the conditions of the actual accident situation are selected. Through this process, the effects of the simulation variables are investigated and the potential causes of the accident are identified. The results show the hydrostatic instability of the ship in the operational condition owing to cargo overload and insufficient ballast water, which raised the vertical center of gravity. The reduced stability combined with large starboard steering angle and cargo movement during large heel may have been the decisive reason of capsizing. [ABSTRACT FROM AUTHOR]

Achieving an R0 resection can be difficult for hilar cholangiocarcinoma (HC) because of the anatomic structures of the hepatic hilum and frequent tumor infiltration. The aim of this study was to evaluate the margin status of bile duct resected in HC and prognostic impact of R1 resection. Between 2000 and 2009, 245 patients underwent operation for HC at Asan Medical Center. We retrospectively analyzed the clinicopathologic features and surgical outcomes, focusing on the proximal margin status, of 162 cases of patients with curative intention. Curative resections were achieved in 125 (52.1%) patients, and R1 resections were performed in 43 (26.5%). Proximal ductal margin states were classified as free margin (73.5%), carcinoma in situ (3.7%), and invasive carcinoma (22.8%). The 3- and 5-year survival rates of the R1 group (39.5% and 34.9%) were not significantly different from the rates of the R0 group (55.5% and 44.5%, respectively). Multivariate analysis showed lymph node metastasis (P = 0.001) and histologic differentiation (P = 0.001) were independent predictors of patient survival. The aggressive surgical approach based on liver resection including caudate lobe may increase the number of patients eligible for a curative chance and improve long-term survival even if the microscopically positive margin is still achieved. [ABSTRACT FROM AUTHOR]

A ruptured pseudoaneurysm is the most serious and life-threatening cause of post-pancreatoduodenectomy (PD) hemorrhages. We have evaluated the clinical course and management of pseudoaneurysms after PD. Of 586 patients who underwent PD for periampullary tumors in Asan Medical Center between March 2003 and March 2011, 27 experienced pseudoaneurysmal bleeding. Bleeding developed at a median of 21 days (range, 8 to 45 days) after surgery, including 9 patients who developed bleeding more than 4 weeks after surgery. Before development of bleeding, 26 patients showed pancreatic fistula. Bleeding was developed from the gastroduodenal artery stump in 12 patients, the common hepatic artery in eight, the proper hepatic artery in five, and the left hepatic artery in two. Of the angiographic group, 21 patients underwent with microcoil embolization, four underwent stent insertion, and one experienced technical failure. Only one patient required emergent laparotomy without angiography. Of 25 patients with angiographic procedures, all patients achieved hemostasis. The mortality rate was 22.2 per cent (6 patients). Delayed hemorrhage after PD is closely associated with pancreatic fistula and carried a significantly higher mortality rate. The patients with pancreatic fistula should be carefully monitored, even more than 4 weeks after surgery. Selective microcoil embolization or stent graft is effective for pseudoaneurysmal bleeding. [ABSTRACT FROM AUTHOR]

The aims of this study were to clarify the distribution and spread pattern of metastatic nodes and to evaluate the importance of the number, ratio, and location of positive nodes in ampullary adenocarcinoma. We analyzed the clinicopathologic data and survival of 52 patients who received curative pancreatoduodenectomy for ampullary adenocarcinoma between June 1994 and May 2009. Metastatic lymph nodes were found in 32 (61.5%) patients. The median number of evaluated nodes and positive nodes were 26 (range 10-60) and two (fange 1-15), respectively. The most commonly involved nodes were the posterior pancreaticoduodenal nodes (26 patients) followed by the anterior pancreaticoduodenal nodes (11 patients). No positive hepatoduodenal and common hepatic artery nodes were found. In univariate analysis, number of positive nodes, and their ratio and location were significantly associated with survival. Only the factor of three or more metastatic nodes had the independent power in predicting a poor outcome in multivariate analysis (P < 0.001). Ampullary adenocarcinoma first spreads to the posterior pancreaticoduodenal nodes and then the anterior nodes. The number of positive lymph nodes, rather than their ratio and location, independently affects survival after curative resection in patients with ampullary carcinoma. [ABSTRACT FROM AUTHOR]

Surface modification of Ti-based metals is an important issue in improving the bone cell responses and bone-implant integration. Blasting Ti with granules (mostly alumina) is commonly used to prepare a clean surface and provide a level of roughness. In this study, glass granules with a bioactive composition were used as the blasting source to improve the surface bioactivity and biocompatibility of a Ti substrate. Bioactive glass particles with a composition of 70SiO2 · 25CaO · 5P2O5 were prepared using a sol--gel method. A Ti disc was blasted with glass particles using a dental blasting unit (BG-Ti). A Ti disc blasted with commercial spherical-shaped glass (G-Ti) and a disc without blasting (Ti) were also prepared for comparison. The blasted Ti contained a large number of glass particles after the blasting process. The surface roughness of the samples in ascending order was G-Ti > BG-Ti > Ti. Murine-derived preosteoblasts (MC3T3-E1) were seeded on the samples, and the cell growth, differentiation, and mineralization behaviors were observed. The osteoblastic cells attached well and spread actively over all the sample groups with extensive cytoskeletal processes. The level of cell growth on the BG-Ti showed a continual increase with culturing up to 7 days, showing good cell viability. However, there was no significant difference (ANOVA, p < 0.05) with respect to the G-Ti and Ti groups. In particular, the alkaline phosphatase (AP) activity of the cells was significantly higher on the BG-Ti than on the other groups after culturing for 14 days. Moreover, the mineralization behavior of the cells, as assessed by Alizarin S Red, was superior on the BG-Ti to that observed on the other groups after culturing for 14 and 28 days. Overall, the blasting of Ti with a bioactive glass composition is considered beneficial for producing substrates with enhanced osteogenic potential. [ABSTRACT FROM AUTHOR]

Angiotensin-convening enzyme (ACE) inactivates bradykinin, substance P, anti neurokinin A, which are thought to play important roles in the pathogenesis of inflammatory diseases. Expression of angiotensinogen, a precursor of angiotensin, is enhanced by augmented secretion of proinflammatory cytokines (eg, interleukin-1) in the site of inflammation. Insertion or deletion (I/D) ACE and M235T angiotensinogen gene polymorphisms were reported to be associated with atopy in a Czech population. Using polymerase chain reaction restriction fragment length polymorphism and SNaPshot typing analysis, we investigated the frequencies of the genotypes and alleles of the ACE gene in 137 patients with allergic rhinitis, of the M235T angiotensinogen gene in 186 patients with allergic rhinitis, and of both in 219 healthy control subjects. There was no difference in the frequency of the DD genotype of the ACE gene in the controls and patients (odds ratio, 1.32 [0.66–2.601; p > .05). The D allele was more frequent in patients, but the difference was not statistically significant (odds ratio, 1.21 [0.89–1.641; p > .05). There was no difference in the frequency of the TT genotype of the angiotensinogen gene in the controls and patients (odds ratio, 1.01 [0.38–2.69]; p > .05). The T allele was more frequent in patients, but the difference was not statistically significant (odds ratio, 1.110 [0.78–1.55]; p > .05). Our results indicate that polymorphisms in the genes for ACE and angiotensinogen may not be related to the development of allergic rhinitis in the Korean population. [ABSTRACT FROM AUTHOR]

The article presents a case of a 65-year-old female who was brought to a hospital due to persistent left-sided facial swelling, pain and sensation of fullness for three months. She underwent nasal endoscopy and computed tomography (CT) that revealed slight bulging of the medial wall of her left maxillary sinus into the inferior meatus and two mucocele-like lesions. She was eventually diagnosed with postoperative maxillary sinus mucoceles (POMM) or postoperative cheek cysts.

The article presents a case of a 69-year-old male who was presented to a hospital due to chronic nasal obstruction, mucopurulent rhinorrhea, headache, and anosmia. Based on endoscopic examination, he has a massive polyposis obstructing both middle and superior meati and extending to the posterior choanae on both sides. He was eventually diagnosed with nasal polyps and he underwent a bilateral endoscopic sinus surgery (ESS).

The article discusses the case of a 51-year-old woman with right-sided headaches and postnatal drip. Topics covered include the results of her nasal endoscopy and coronal computed tomography (CT) scans, the conduct of endoscopic sinus surgery on the patient and the prescription of antibiotics and a topical steroid after the surgery. Also mentioned is the importance of the agger nasi cell (ANC) which affects frontal recess anatomy.

The article describes the case of a 53 year old man presented to the Department of Otolaryngology for evaluation of mild right-sided facial pain. He had routine extraction of the upper right first permanent molar 8 days earlier where the palatal root was fractured. A coronal computed tomography showed a foreign body in the right maxillary sinus ostium which can be removed via an endoscopic approach. He declined and was prescribed with amoxicillin/clavulanate 500/125 mg 3 times daily for 7 days.

The article describes the case of a 15-year-old boy with a headache in the right side of his head and nasal obstruction. Topics discussed include findings on nasal endoscopy and computed tomography (CT) of the nose and paranasal sinuses, endoscopic sinus surgery performed on the patient, and result of the resection of the Haller cell.

The article describes the case of a 24 year old woman presented for evaluation of a 5-month history of a persistent right-sided pressure sensation in her cheek. Computed tomography (CT) revealed a cystic mass in the right maxillary sinus that contained calcification. She underwent removal of the mass through a transoral route and a piecemeal was performed since the mass was firmly attached to the sinus mucosa. The patient's symptoms resolved after the removal of the cyst.

The article presents a case study of 17-year-old boy having a one year history of intermittent localized pain over his right cheek. Computed tomography of cheek of a boy showed a bony mass, unerupted tooth and patent maxillary sinus ostium. He underwent the surgical operation for the removal of mass to provide cavity for the maxillary sinus. The article discusses the risk of growing osteomas in young adults and in maxillary sinus osteoma the extension of anterior may cause facial deformity.

The article describes the case of a 52-year-old female patient with a history of left nasal obstruction and recurrent minor epistaxis and was diagnosed as extranasopharyngeal angiofibroma or atypical angiofibroma. The diagnosis was confirmed after performing nasal endoscopy, coronal computed tomography (CT), magnetic resonance imaging (MRI) and histopathological examination. It is suggested that this angiofibroma should be differentiated from hemangioma.

The article discusses a case of scar sarcoidosis and an analysis of one infected with it. Scar sarcoidosis is defined as a rare type of cutaneous sarcoidosis where old scars become infected with noncaseating epitheloid cell granulomas for unknown reasons, though it is linked to herpes zoster infections, surgery, and tattooing, among others. The case involves a 40-year-old man with the condition on his right hand which he had for 2 months. A detailed description of the symptoms, analysis and treatment, which involves surgery and a follow up, is included.