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Limb thrombus formation is a complication that can occur after endovascular aortic repair (EVAR), and its clinical significance has continued to be debated. Our objective was to report the incidence of limb thrombus after EVAR and determine the association of specific demographic, anatomic, and/or graft variables.A retrospective analysis of EVAR patients at a single tertiary center between January 2010 and December 2018 was performed to determine the limb thrombus rate. Demographic, graft, and anatomic variables were analyzed for an association with limb thrombus.A total of 301 patients were included. The average follow-up was 27.6 ± 4.9 months. The mean age was 76.5 ± 0.5 years, and 85% were men. Limb thrombus occurred in 22 patients (7.3%). Of these 22 patients, 11 (50.0%) had had occlusive limb thrombus, 14 (63.6%) were symptomatic, and 17 (77.3%) had required intervention. The patients with limb thrombus were younger (69.8 ± 1.3 years vs 77.1 ± 0.5 years; P .0001) and more likely to be smokers (10.2% vs 5.2%; P = .10). The incidence of limb thrombus with the Alpha graft (10.7%; Cook Medical Inc, Bloomington, IN) was compared with that with non-Cook grafts (4.0%; P = .07). The average common iliac artery diameter for patients with and without limb thrombus was 14.1 mm and 16.1 mm, respectively (P .01). Right-sided limb thrombus was more likely in smaller right iliac arteries (14.7 ± 0.9 cm vs 17.0 ± 0.6 cm; P .05), with a similar finding on the left (13.6 ± 0.9 cm vs 15.2 ± 0.4 cm; P = .13). Unilateral limb thrombus was almost twice as likely on the main body side than on the contralateral side (11 vs 6). Limb thrombus was not associated with aortoiliac disease (odds ratio [OR], 1.31; 95% confidence interval [CI], 0.37-4.62), limb extension (OR, 0.47; 95% CI, 0.06-3.62), or nonmatching limb heights (OR, 1.36; 95% CI, 0.54-3.43). Limb thrombus was also not associated with increased 30-day mortality (P.05).Limb thrombus formation is a complication that can occur after EVAR (7.3%). In our study, limb thrombus was seen more frequently in younger patients and those who smoked. Cook Alpha grafts had a thrombus formation rate of 10.7%, which was not significantly higher than that with other brands. Limb thrombus was more likely in smaller iliac arteries and on the main body side.

KMRC011 is a novel Toll‐like receptor 5 agonist under development as a treatment for acute radiation syndrome (ARS). The aim of this first‐in‐human study was to investigate the tolerability, pharmacokinetics, and pharmacodynamics of a single intramuscular dose of KMRC011 in healthy subjects. A randomized, single‐blind, placebo‐controlled, single dose‐escalation study was conducted with the starting dose of 5 μg. Eight (4 only for 5 μg cohort) subjects per cohort were randomly assigned to KMRC011 or placebo in a 3:1 ratio. Dose‐limiting toxicity (DLT) was assessed throughout the study. Serum concentrations of KMRC011, granulocyte colony‐stimulating factor (G‐CSF), and interleukin‐6 (IL‐6) were measured up to 48 h postdose. Based on safety review, the dose of KMRC011 escalated up to 20 μg, and consequently, a total of 4 dose levels (5, 10, 15, and 20 μg) were explored. The most common adverse event was injection site reaction, showing no dose‐related trend. Three DLTs (2 cases of hepatic enzyme increased and 1 of pyrexia) were observed; 1 in the 15 μg cohort and 2 in the 20 μg cohort. A developed method could not detect any KMRC011 in serum. KMRC011 15 μg and 20 μg showed significant increases of G‐CSF, IL‐6, and absolute neutrophil counts, compared with the placebo. A single intramuscular administration of KMRC011 ranging from 5 to 15 μg was tolerated in healthy subjects. Doses of KMRC011 equal to or greater than 15 μg exerted TLR5 agonist‐like activities by increasing serum G‐CSF and IL‐6. It suggests that KMRC011 has the potential for a treatment for ARS.

The maximal aortic diameter has been used as a key indication for whether to repair abdominal aortic aneurysms (AAAs). Aortic tortuosity has been proposed as another factor to consider. In the present study, we compared the degree of aortic tortuosity in ruptured AAAs with that of unruptured AAAs using computed tomography.We performed a retrospective review of a prospectively maintained database of patients who had undergone AAA repair from December 2014 to December 2019. Patients with a ruptured aneurysm (rAAA) were matched with patients with a nonruptured AAA (nrAAA) with the same maximal aneurysm diameter and age. The degree of aortic tortuosity, defined as the maximum lateral deviation from the aortic centerline, was measured on preoperative coronal computed tomography scans.During a 5-year period, 572 AAA cases were identified. The aortic tortuosity of the 25 rAAA cases was compared with that of a matched control group of 31 nrAAAs, selected by the same mean maximum diameter of 8.4 cm and similar patient age. In the rAAA group, the mean age was 74.8 years (84% men). In the nrAAA group, the mean age was 76.3 years (88% men). The mean aortic tortuosity for the rAAA and nrAAA groups was 9.3 ± 7.9 mm and 18.0 ± 11.2 mm, respectively (P .01).Greater aortic tortuosity was seen in the nrAAA cases compared with the rAAA cases at the same matched aneurysm size. Thus, aortic tortuosity might confer a reduced rupture risk. Further studies with larger cohorts are needed to verify this observation.

Dysphagia aortica is a rare entity defined as difficulty in swallowing due to external compression by the aorta. Aneurysmal dysphagia aortica successfully treated with thoracic endovascular aortic repair (TEVAR) is exceedingly rare. We report the case of a 74-year-old woman with known thoracoabdominal aneurysm who presented with acute shortness of breath and 3-month history of dysphagia. Computed tomography angiography revealed aneurysmal growth and massive esophageal dilation. She underwent TEVAR and visceral debranching, which led to complete symptom resolution correlated with sac regression. We also present a comprehensive review of the literature with a focus on cases of aneurysmal dysphagia aortica treated with TEVAR. Keywords: Dysphagia, Dysphagia aortica, Aortic aneurysm, Thoracic endovascular aortic repair, Endovascular therapy

To investigate the diagnostic performance and usefulness of texture analysis in differentiating angiomyolipoma (AML) without visible fat from clear cell renal cell carcinoma (ccRCC) on four-phase contrast-enhanced computed tomography (CECT).Seventeen patients with AML without visible fat and 50 patients with ccRCC of size ≤4.5 cm who had also undergone preoperative four-phase CECT were included in this study. The histogram, grey-level co-occurrence matrix (GLCM), and grey-level run length matrix (GLRLM) were evaluated. Sequential feature selection (SFS) and support vector machine (SVM) classifier with leave-one-out cross validation were used.Using the SFS and SVM classifiers, five texture features were selected; mean (unenhanced), standard deviation (unenhanced and excretory), cluster prominence (nephrographic), and long-run high grey-level emphasis (corticomedullary). Diagnostic performance of the five selected texture features for all CT phases was as follows: 82% sensitivity, 76% specificity, 85% accuracy, and 85 area under the receiver operating characteristic curve (AUC). In the subgroup analysis, the AUCs of each phase were significantly0.5 (p0.05). In the pairwise comparison of AUCs between four phases, there were no significant differences between the four phases except the unenhanced and corticomedullary phases (p=0.015), i.e., the unenhanced phase showed slightly higher AUC than the corticomedullary phase.Texture analysis of small renal masses (≤4.5 cm) on four-phase CECT can accurately differentiate AML without visible fat from ccRCC and showed good diagnostic performance for both the unenhanced and enhanced phases.

Background Combined liver and kidney transplant is a very complex surgery. To date, there has been no report on the intraoperative management of patients with impaired cardiac function undergoing simultaneous ABO-compatible liver and ABO-incompatible kidney transplant from 2 living donors. Case Report A 60-year-old man underwent simultaneous ABO-compatible liver and ABO-incompatible kidney transplant from 2 living donors because of IgA nephropathy and alcoholic liver cirrhosis. The preoperative cardiac findings revealed continuous aggravation, shown by large left atrial enlargement, severe left ventricular hypertrophy, a very prolonged QT interval, and a calcified left anterior descending coronary artery. Severe hypotension with very weak pulsation and severe bradycardia developed, with an irregular junctional rhythm noted immediately after the liver graft was reperfused. Although epinephrine was administered as a rescue drug, hemodynamics did not improve, and central venous pressure and mean pulmonary arterial pressure increased to potentially fatal levels. Emergency phlebotomy via the central line was performed. Thereafter, hypotension and bradycardia recovered gradually as the central venous pressure and mean pulmonary arterial pressure decreased. The irregular junctional rhythm returned to a sinus rhythm, but the QTc interval was slightly more prolonged. Because of poor cardiac capacity, the volume and rate of fluid infusion were increased aggressively to maintain appropriate kidney graft perfusion after confirming vigorous urine production of the graft. Conclusions A heart with impaired function due to both end-stage liver and kidney diseases may be less able to withstand surgical stress. Further study on cardiac dysfunction will be helpful for the management of patients undergoing complex transplant surgery.

Background: Adequate seal for thoracic endovascular aortic repair (TEVAR) commonly requires landing in zone 2, but can prove to be challenging due to the tortuous and angulated anatomy of the region. Objectives: Our objective was to determine the proximal landing accuracy of zone 2-targeted TEVARs following carotid-subclavian revascularization (CSR) and its impact on clinical outcomes. Methods: Retrospective review of patients that underwent CSR for zone 2 endograft delivery at a tertiary institute between January 2008 and March 2018 was conducted. Technical outcomes were assessed by examining the incidence of intraoperative corrective maneuvers, 1a endoleaks and reinterventions. Distance to target and incidence of LSA stump filling were examined as radiographic markers of landing accuracy. Results: Zone 2-targeted TEVAR with CSR was performed in 53 patients for treatment of dissections (49%), aneurysms (30%) or trauma (21%). Nine (17%) cases required intraoperative corrective procedures: 5 (9%) proximal cuffs due to type 1a endoleak and 4 (8%) left common carotid artery (LCCA) stenting due to inadvertent coverage. Cases performed using higher resolution hybrid fluoroscopy machine compared to mobile C-arm were associated with increased proximal cuff use (OR 8.8; 95% CI 1.2-62.4). Average distance between the proximal edge of the covered graft to LCCA was 8 ± 1 mm and larger distances were not associated with higher rates of 1a endoleak. Twenty-eight (53%) cases of antegrade LSA stump filling were noted on follow-up imaging, but were not associated with higher rates of reinterventions (OR 0.8, 95% CI [0.2-4.6]). Three (6%) patients had a stroke within 30 days and 4 (8%) patients expired within 1 month. Intraoperative corrective maneuvers, post-operative 1a endoleak and reinterventions were not associated with higher rates of stroke or mortality. Conclusion: Using current endografts and imaging modalities, zone 2-targeted TEVARs have suboptimal technical accuracy.

Background There is no clear consensus on the recommended second-line treatment for patients with metastatic pancreatic cancer who have disease progression following gemcitabine-based therapy. We retrospectively evaluated the clinical outcomes of liposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin (FL) and FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin) in patients who had failed on the first-line gemcitabine-based therapy. Patients and methods From January 2015 to August 2019, 378 patients with MPC who had received nal-IRI/FL (n = 104) or FOLFIRINOX (n = 274) as second-line treatment across 11 institutions were included in this retrospective study. Results There were no significant differences in baseline characteristics between groups, except age and first-line regimens. With a median follow-up of 6 months, the median progression-free survival (PFS) was 3.7 months with nal-IRI/FL versus 4.6 months with FOLFIRINOX (P = 0.44). Median overall survival (OS) was 7.7 months with nal-IRI/FL versus 9.7 months with FOLFRINOX (P = 0.13). There was no significant difference in PFS and OS between the two regimens in the univariate and multivariate analyses. The subgroup analysis revealed that younger age (, Highlights • This multicenter retrospective study investigated nal-IRI/FL and FOLFIRINOX outcomes after gemcitabine-based therapy. • We found no significant differences in outcome between nal-IRI/FL and FOLFIRINOX treatment. • Both regimens were well tolerated; however, neutropenia and peripheral neuropathy were more frequent with FOLFIRINOX. • Age (cut-off, 70 years) showed differential efficacy between chemotherapy regimens.

Researchers have tested Lignocellulose derived material (LDMs) from different sources ranging from agricultural to wood in order to facilitate the adsorption of chemical contaminants, such as heavy metals and dyes from water bodies, to eradicate water contamination. However, different methods have been employed to modify the nature of the LDMs to enable their suitability for contaminants removal. Among all these methods, acid modification of LDMs has gained a lot of attention. This review focused on the use of acid modification LDMs for the removal of anionic and cationic dyes, and heavy metals in water. The characteracerization techniques employed in studying the morphology and functional groups of the LDMs were discussed. The adsorption dynamics and mechanisms of reported studies were extensively summarized. The reported adsorption capacity of unmodified LDMs in the available liturature is in the range of 4.44–156.00 mg/g while for the modified is between 80.05–250.01 mg/g for dye removal. The adsorption capacity of modified LDMs reported was 1.60–18.03 times higher than the unmodified because of additional functional groups such as -SO3 from sulphuric acid modification. Finally, the future outlook and challenges of this method were pulled together.

Objectives Gout care remains highly suboptimal, contributing to an increased global disease burden. To understand barriers to gout care, our aim was to provide a systematic review and thematic synthesis of qualitative studies worldwide reporting provider and patient perspectives and experiences with management. Methods We conducted a mapped search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Social Sciences Citation Index databases and selected qualitative studies of provider and patient perspectives on gout management. We used thematic synthesis to combine the included studies and identify key themes across studies. Results We included 20 studies that reported the experiences and perspectives of 480 gout patients and 120 providers spanning five different countries across three continents. We identified three predominant provider themes: knowledge gaps and management approaches; perceptions and beliefs about gout patients; and system barriers to optimal gout care (e.g. time constraints and a lack of incentives). We also identified four predominant themes among gout patients: limited gout knowledge; interactions with health-care providers; attitudes towards and experiences with taking medication; and practical barriers to long-term medication use. Conclusion Our systematic review of worldwide literature consistently identified gaps in gout knowledge among providers, which is likely to contribute to patients' lack of appropriate education about the fundamental causes of and essential treatment approaches for gout. Furthermore, system barriers among providers and day-to-day challenges of taking long-term medications among patients are considerable. These factors provide key targets to improve the widespread suboptimal gout care.

Background and aims Early diagnosis of arteriosclerosis is fundamental for the prevention of cardiovascular morbidity and mortality. The current study was performed to identify major predictors of arteriosclerosis and to assess the association between arterial stiffness as measured by cardio-ankle vascular index (CAVI) and muscle mass deficit (MMD) estimated by bioelectrical impedance analysis (BIA) in middle-aged men. Methods and results Data were gathered from 3356 middle-aged men who visited a health promotion center. CAVI was measured as an index of arterial stiffness. Body composition analysis was performed using BIA. MMD was positively associated with CAVI in the regression model. The odds ratios for high-CAVI (≥9.0) rose with MMD grade in a dose-dependent manner after adjusting for age, lifestyle factors and current medication use. The estimated mean CAVI rose as MMD grade increased (P for trend >0.001). Conclusions MMD estimated from BIA was positively associated with arterial stiffness in middle-aged men. These findings show a close interaction between low muscle mass and cardiovascular risk.

AIMS: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an ion channelopathy characterized by ventricular arrhythmia during exertion or stress. Mutations in RYR2-coded Ryanodine Receptor-2 (RyR2) and CASQ2-coded Calsequestrin-2 (CASQ2) genes underlie CPVT1 and CPVT2, respectively. However, prognostic markers are scarce. We sought to better characterize the phenotypic and genotypic spectrum of CPVT, and utilize molecular modelling to help account for clinical phenotypes. METHODS AND RESULTS: This is a Pediatric and Congenital Electrophysiology Society multicentre, retrospective cohort study of CPVT patients diagnosed at

Background The indication, composition and timing of administration of non-resuscitation fluid in septic shock have so far received little attention and accordingly the potential to reduce this source of fluid is unknown. The objective of the study was to quantify and characterize non-resuscitation fluid administered to patients with septic shock. Methods This prospective observational study was performed in eight intensive care units in Sweden and Canada during 4 months in 2018. Adult patients with septic shock within 24 h of admission to the intensive care unit were eligible for inclusion. Non-resuscitation fluids were defined as fluids other than colloids, blood products and crystalloids at a rate ≥ 5 ml/kg/h. Indication, volume and type of fluid were recorded during the first 5 days after admission. A maximum of 30 patients could be included per centre. To estimate the potential to reduce administration of non-resuscitation fluid, a pragmatic “restrictive” protocol for administration of non-resuscitation fluids was devised based on the most restrictive practice already in place for non-resuscitation fluids at any of the participating centres. Data are presented as median (interquartile range [IQR]). Results A total of 200 patients were included in the study and the 30-day mortality was 35%. Patients received a total of 7870 (4060–12,340) ml of non-resuscitation fluids and 2820 (1430–4580) of resuscitation fluids during the observation period. Median volumes of non-resuscitation and resuscitation fluids were similar at day 1 (1620 [710–2320] and 1590 [520–3000]) ml, respectively) and non-resuscitation fluids represented the largest source of fluid from day 2 and onwards after admission to the ICU. Vehicles for drugs such as vasoactive drugs and antibiotics constituted the largest fraction of non-resuscitation fluids (2400 [1270–4030] ml) during the 5-day observation period. Modelling suggested that volume of non-resuscitation fluids could be reduced by 2840 (1270–4900) ml during the first 5 days of admission to the ICU, mainly through reducing maintenance fluids. Conclusions Non-resuscitation fluids constitute the major fraction of fluids administered in the ICU to patients suffering from septic shock and may represent the largest modifiable target to reduce fluid overload.

A predictive biomarker of immune checkpoint inhibitor (ICI)-based treatments in hepatocellular carcinoma (HCC) has not been clearly demonstrated. In this study, we focused on the infiltration and programmed death ligand 1 (PD-L1) expression of tumor-associated macrophages (TAMs) in the tumor microenvironment of HCC. Immunohistochemistry demonstrated that PD-L1 was preferentially expressed on CD68+ macrophages in the tumor microenvironment of HCC, suggestive of its expression in TAMs rather than in T cells or tumor cells (P &lt, 0.05). A co-culture experiment using activated T cells and M2 macrophages confirmed a significant increase in T cell functionality after the pretreatment of M2 macrophages with anti-PD-L1. Syngeneic mouse model experiments demonstrated that TAMs expressed PD-L1 and tumors treated with anti-PD-L1 showed smaller diameters than those treated with IgG. In these mice, anti-PD-L1 treatment increased activation markers in intratumoral CD8+ T cells and reduced the size of the TAM population. Regarding nivolumab-treated patients, three of eight patients responded to the anti-PD-1 treatment. The percentage of Ki-67-positive CD4+ and CD8+ T cells was higher in responders than non-responders after nivolumab. Overall, PD-L1 expression on TAMs may be targeted by immune-based HCC treatment, and ICI treatment results in the reinvigoration of exhausted CD8+ T cells in HCC.

Angiomyolipomas (AMLs) are relatively rare hamartomatous or benign tumors that occasionally occur as part of tuberous sclerosis complex (TSC). Mutations in either of the two genes, TSC 1 and TSC 2, have been attributed to the development of TSC. Between 1994 and January 2009, 83 patients were diagnosed with AML at the Samsung Medical Center. In that group of patients, 5 (6%) had AML with TSC (AML-TSC). Mutational analysis of the TSC 2 gene was performed using 7 samples from the 5 AML-TSC patients and 14 samples from 14 patients with sporadic AML without TSC (AML-non-TSC). From this analysis, mutations in TSC genes were identified in 5 samples from the AML-TSC patients (mutation detection rate = 71%) and 3 samples from AML-non-TSC patients (mutation detection rate = 21%). In the case of AML-TSC, 6 mutations were found including 3 recurrent mutations and 3 novel mutations, while in the case of AML-non-TSC, 4 mutations were identified once, including 1 novel mutation. Also MLPA analysis of the TSC2 gene showed that TSC2 exon deletion is more frequently observed in AML-TSC patients than in AML-non-TSC patients. This is the first mutation and multiplex ligation-dependent probe amplification (MLPA) analyses of TSC 2 in Korean AMLs that focus on TSC. This study provides data that are representative of the distribution of mutations and exon deletions at TSC genes in clinically diagnosed AML-TSC cases of the Korean population.

Background Despite gout9s well-known pathogenesis and the availability of effective urate-lowering therapy (ULT), management remains poor. However, limited research has sought to improve care among this patient population. An in-depth understanding of provider and patient perspectives on barriers to the delivery of optimal gout care is critical to informing the development of evidence-based interventions to effectively improve disease management and patient outcomes. Objectives To systematically review and thematically synthesize qualitative studies to date reporting provider and patient barriers to gout management. Methods We conducted a mapped search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Social Sciences Citation Index databases and selected qualitative studies reporting provider and patient perspectives on gout management. Thematic synthesis was used to combine the source studies and identify key themes across studies. Two authors independently read and annotated the data and after discussion agreed on an initial coding framework. Concepts were organized into descriptive themes, and the relationships between these descriptive themes were further explored to develop higher-order analytical themes. Results Our search strategy retrieved 2,750 articles after the removal of duplicates. After full-text review, 20 studies spanning several geographic settings worldwide (i.e., the US, the UK, New Zealand, Australia, and the Netherlands) met all inclusion criteria and were included in our systematic review. Of these, 16 studies reported gout patient perspectives (n=480 patients), while only 7 studies reported provider perspectives (n=120 providers, including general practitioners, rheumatologists and other specialists, and allied health professionals). Thematic synthesis identified three predominant interlocking analytical themes among providers: (a) knowledge gaps and management approaches, (b) perceptions and beliefs about gout patients, and (c) system barriers to optimal gout care (Table 1). We further identified four predominant themes among gout patients: (a) limited gout knowledge (e.g., the “curable” nature of gout), (b) attitudes toward taking medication, (c) interactions with healthcare providers, and (d) practical barriers to chronic medication use (Table 1). Conclusions Our thematic synthesis identified several barriers to gout care, particularly knowledge gaps among both providers and patients as well as implementation barriers to the provision of optimal care. Knowledge translation initiatives emphasizing the “curable” nature of gout targeting both providers and patients as well as strategies to reduce system barriers and support regular medication use are urgently needed to improve gout care. Acknowledgements This study was supported in part by a grant from the Canadian Institutes of Health Research (PCS 146388). We wish to thank the Arthritis Patient Advisory Board of Arthritis Research Canada for providing their consumer input into this project. Disclosure of Interest None declared

An analysis procedure is proposed to improve the prediction accuracy of springback as well as to evaluate the structural stability of the tooling used for fabricating a side sill part from UHSS. The analysis couples the stamping analysis and the subsequent analysis of the tool structural. The deformation and stress results for the tool structure are obtained from the proposed analysis procedure. The results show that the amount of deformation and stresses are so high that the tool structure must be reinforced and the tooling design must consider structural stability. Springback is predicted with CAE in order to compare the prediction accuracy between the given tool geometry and the geometry from the structural analysis. The simulation results with the deformed tool can predict the experimental springback tendency accurately.

Background Early predicting the pathologic complete response (pCR) after neoadjuvant chemotherapy in patients with locally advanced breast cancer (LABC) is closely associated with clinical outcomes. However, conventional metabolic parameters using baseline 18F-FDG PET/CT have failed to accurately predict the pCR. Breast cancer stem cells (CSCs) are known for their established role in chemoresistance. We designed a new PET parameter for CSC metabolism (MTVcsc) from pretreatment 18F-FDG PET/CT by using distinctive glucose metabolism between CSCs and differentiated cancer cells, and aimed to evaluate the prognostic value of the MTVcsc. Methods A total of 71 patients with LABC who underwent initial 18F-FDG PET/CT before NAC were included in this study. The SUV values of single voxels within the primary tumor were clustered by performing k-means clustering using R version 3.5.3 and MTVcsc was derived by calculating the volume of the most glycolytic cluster. The predictive values of the MTVcsc, as well as clinicopathologic and conventional metabolic parameters (SUVmax, MTV, TLG) for pCR, were analyzed by multivariable logistic regression. Results Seventeen patients were excluded from the final analysis due to small tumor size ( Table: 301P . Parameters Univariable analysis Multivariable analysis OR 95% CI P value OR 95% CI P value Ki-67 Low, 1.00 5.57 1.06-29.27 0.043 Molecular subtype Luminal A and B HER2 positive Triple negative 1.00 1.00 11.46 2.07-63.36 0.005 13.7 1.75-107.36 0.013 6.55 1.05-40.67 0.044 17.42 1.41-215.04 0.026 Metabolic parameters SUVmax Metabolic tumor volume (MTV) Total lesion glycolysis (TLG) MTVcsc 0.98 0.83-1.16 0.814 0.98 0.94-1.02 0.281 0.99 0.98-1.00 0.231 0.29 0.10-0.89 0.031 0.21 0.05-0.82 0.025 Conclusions MTVcsc, a novel PET parameter for CSC metabolism, provides predictive value for pCR. By further stratifying LABC patients with a combination of MTVcsc and molecular subtype at initial staging workup, achieving pCR after NAC can be early predicted more accurately. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

A series of finite element analyses of the rolling process were performed and a neural network algorithm was employed to calculate the amount of ski-effect for an arbitrary thickness of incoming material in the roll gap. Pilot hot plate rolling tests were also conducted to verify the usefulness of the finite element analyzes conducted in this study. In these experiments, plates with thicknesses varying from 25 to 65 mm were tested. In addition, a number of rolling reductions of up to 31% were examined. Finally, a number of circumferential upper and lower rolls were investigated. Experimental validations demonstrated that the neural network algorithm predicted the proper amount of ski when rolling conditions(material thickness, reduction ratio, roll velocity differential) changed arbitrarily.

Donor hepatectomy for living donor liver transplantation accompanies physio-morphological changes of the liver and spleen. Therefore, the long-term consequences of these organs should be characterized to ensure donor's safety. A total of 382 right liver harvests for liver transplantation were performed from October 2000 to February 2011. Clinical parameters across donor operations were compared, and the associations were investigated. The remaining liver grew continually, reaching 81.5 ± 11.2 % of the entire liver until 6 months after donation. The spleen grew to 143.1 ± 28.8 % of the pre-donation value within 1 week after surgery, and thereafter, its size decreased gradually to 130.6 ± 25.1 % at 6 months. At 6 months post-donation, 48.1 % (114/237) of donors showed an increase of ≥30 % in splenic volume, and 15.9 % (50/315) of donors exhibited a decrease of ≥30 % in platelet count. However, patients with splenic enlargement and/or decrease in platelet count at 6 months post-donation were not different in liver function, liver regeneration, or overall complications. Although splenic enlargement and/or decrease in platelet count can persist for more than 6 months after donation in patient population after donor right hepatectomy, such a change did not impact donor's safety.

Background and aims Metabolic syndrome (MS) is associated with insulin resistance in all parts of its natural history, which is accompanied by oxidative stress. Bilirubin is a potent endogenous antioxidant and cytoprotectant. The current study was performed to identify the major predictors of the total bilirubin level and to assess the relationships between the total bilirubin levels and MS in Korean adults. Methods and results This is a cross-sectional study involving 12342 adults aged 20 years and over who visited a Health Promotion Center. Physical examinations and laboratory tests including total and direct bilirubin levels were performed. MS was defined based on the modified NCEP-ATP III definition and the determinations of the Korean Society for the Study of Obesity. The results showed that hemoglobin had the strongest influence on the total bilirubin levels after adjusting for age, gender, and all other variables. The high-bilirubin group (≥15.4 μmol/L in males and ≥12.1 μmol/L in females) was associated with significantly decreased odds of MS compared to the low-bilirubin group (OR 0.74 [95% CI 0.64–0.86]). High levels of bilirubin also were negatively associated with abdominal obesity and hypertriglyceridemia. The total bilirubin levels decreased with an increase in the number of MS components after adjustment for all covariates. Conclusion Within the physiological range, the serum total bilirubin level was negatively associated with the MS in subjects without overt metabolic or cardiovascular diseases. This may be partially due to the negative association between the total bilirubin level and abdominal obesity and hypertriglyceridemia.

The flange hub is a main component in an automotive steering system. In general, the flange hub are fabricated by mechanical machining, which is a process where material waste is inevitable. It is well-known that a net-shape cold forging cannot only reduce material waste but can also improve the mechanical strength of the final product. Thus, a forging process design was conducted for production of a flange hub. Significant spring-back occurs around the flange due to its small thickness in conjunction with the residual stresses after forging. In order to achieve the required dimensional accuracy, a process design with appropriate spring-back control is needed. In this study, a modification of the forging die was designed based on FE analysis with the purpose of spring-back compensation. Four kinds of different die designs were evaluated and the optimum design has two times less spring-back than the initial design. The compensation angle of the optimum design is 0.5 degrees. The results have been experimentally confirmed by cold forging of a flange hub and comparing the amount of spring-back between the actual component and the FE analysis.

The flange hub is a main component of an automotive steering system. Dimensional precision of the flange hub is very important for precise control of the steering force. Consequently, the process design for precision forming of a flange hub is required. The teeth of the flange hub are generally formed by bending. In this study, the formability of flange bending was investigated using FE simulations. For the optimum process conditions, the flange is bent by movement of an insert die, and the die angle and bending length are selected as 90° and 4mm respectively. Key Words : Bending, Disk type of Flange, FE Simulation, Bending Length 1. 서 해서는론 치는 플랜지 허브는 자동차, 항공, 기계 부품 등의 다양한 곳에서 동력 전달 부품용으로 쓰이고 있다. 플랜지 허브(Flange hub)는 동력 전달 시 에너지 소비를 감소시키고, 동력전달 장치의 경량화를 위해 무게 감소가 요구된다. 플랜지 허브가 동력을 정확하게 전달하고 구동 효율을 향상시키기 위해서는 정밀하게 제조 되어야 한다. 일반적으로 플랜지 허브는 기계가공으로 생산 되어지기 때문에 소재이용률이 현저히 낮다. 정형 냉간 단조를 통해서 플랜지 허브를 생산하게 되면 기계가공으로 생산 할 때보다 소재이용률 향상이 되고, 기계적 강도가 증가될 것으로 예측된다. 냉간 단조로 성형이 되는 플랜지 허브는 공정이 진행됨에 따라 가공경화가 지속적으로 발생이 되고 지속적인 가공경화를 통해서 단조품 크랙(Creak)이 발생한다. 그러한 결함을 해소하기 위초기소재의치수및불량률에영향을미여러가지설계변수에대한최적화가선행되어야 한다. 냉간공정으로 성형되는 플랜지 허브는 구동력을 전달 할 수 있는 치형을 성형하기 위해 굽힘 성형을 하게 된다. 굽힘 성형에서는 굽혀지는 판재의 바깥 면에서는 인장을 받고, 안쪽 면에서는 압축을 받게 된다. 이론적으로는 바깥면과 안쪽면이 받는 변형률의 크기는 서로 같다고 알려져 있다. 굽힘 성형에는 여러 굽힘 방법이 있다. U자 L자 굽힘 등 여러가지 방법으로 굽힘성형에 이용되어지고 있다. 특히 판재 모서리를 굽히는 플랜지 굽힘은 방사형 플랜지 끝단부의 정형 굽힘에 사용된다. 플랜징 굽힘은 원주방향으로 압축응력을 받으며 너무 과도하면 플랜지부가 찢어진다. 원형의 플랜지가 찢어짐 없이 굽힘 성형이 이루어 지는게 중요하다[1~5]. 본 연구 대상인 방사형 플랜지는 벌크 소재로