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Degenerative lumbar foraminal stenosis is relatively common condition in which the circumferential narrowing of the space available for the nerve root leads to back pain and radicular symptoms. The preferred surgical treatment to relieve the compression of the nerve root has not been established yet. Recently, several reports have shown good clinical outcomes in patients who underwent biportal endoscopic decompression for the treatment of degenerative lumbar foraminal stenosis. The floating-type biportal endoscopic technique could be used with various surgical instruments without docking in the narrowed foramen, unlike the full-endoscopic technique. Multiple sites can be accessed with more freedom in the approaching angle through triangulation and portal switching. We reviewed articles to understand putative outcome factors and discuss the appropriate indications for biportal endoscopic foraminal decompression. Lumbar lordosis, degenerative lumbar scoliosis, height of the posterior intervertebral disc and level of procedure were all related to clinical outcomes. The best indications and contraindications to the endoscopic foraminal decompression still depends on the surgeon’s skill level and evolving experience. However, we could suggest that biportal endoscopic spinal surgery is supposed to be an alternative treatment for foraminal decompression preserving motion and stability, and decreasing the need for fusion surgery in various lumbar degenerative disease.

OBJECTIVE:To establish the validity of sensor-based measures of work processes for predicting perceived mental and physical exertion of critical care nurses. MATERIALS AND METHODS:Repeated measures mixed-methods study in a surgical intensive care unit. Wearable and environmental sensors captured work process data. Nurses rated their mental (ME) and physical exertion (PE) for each four-hour block, and recorded patient and staffing-level workload factors. Shift was the grouping variable in multilevel modeling where sensor-based measures were used to predict nursing perceptions of exertion. RESULTS:There were 356 work hours from 89 four-hour shift segments across 35 bedside nursing shifts. In final models, sensor-based data accounted for 73% of between-shift, and 5% of within-shift variance in ME; and 55% of between-shift, and 55% of within-shift variance in PE. Significant predictors of ME were patient room noise (ß = 0.30, p < .01), the interaction between time spent and activity levels outside main work areas (ß = 2.24, p < .01), and the interaction between the number of patients on an insulin drip and the burstiness of speaking (ß = 0.19, p < .05). Significant predictors of PE were environmental service area noise (ß = 0.18, p < .05), and interactions between: entropy and burstiness of physical transitions (ß = 0.22, p < .01), time speaking outside main work areas and time at nursing stations (ß = 0.37, p < .001), service area noise and time walking in patient rooms (ß = -0.19, p < .05), and average patient load and nursing station speaking volume (ß = 0.30, p < .05). DISCUSSION:Analysis yielded highly predictive models of critical care nursing workload that generated insights into workflow and work design. Future work should focus on tighter connections to psychometric test development methods and expansion to a broader variety of settings and professional roles. CONCLUSIONS:Sensor-based measures are predictive of perceived exertion, and are viable complements to traditional task demand measures of workload.

Presenting Natovenator polydontus, a non-avian dinosaur from the Upper Cretaceous of Mongolia displaying morphology indicative of swimming behaviour.

Elderly patients with a history of chronic alcoholism presented to our hospital with episodes of melena, abdominal pain, and anemia. During admission, hemorrhagic cystic lesion at the pancreas was observed on abdominal CT. Transcatheter angiography confirmed active bleeding foci and arterial embolization was performed. After the procedure, the bleeding was resolved. The authors report two cases of hemosuccus pancreaticus and pancreaticocolic fistula associated with pancreatitis, a rare cause of gastrointestinal bleeding, treated with vascular intervention.

Abstract Broadband emissive I–III–VI quantum dots (QDs) are synthesized as efficient and stable I–III–VI QDs to be used as eco-friendly luminescent materials in various applications. Here, we introduce the additional passivation of zirconium isopropoxide (Zr(i-PrO)4) to improve the optical properties and environmental stability of green-emitting CuGaS2/ZnS (G-CGS/ZnS) and red-emitting CuInS2/ZnS (R-CIS/ZnS) QDs. The photoluminescence quantum yield (PLQY) of both resultant Zr(i-PrO)4-coated G-CGS/ZnS and R-CIS/ZnS QDs reaches similar values of ~ 95%. In addition, the photostability and thermal-stability of G-CGS/ZnS/Zr(i-PrO)4 and R-CIS/ZnS/Zr(i-PrO)4 QDs are improved by reducing the ligand loss via encapsulation of the ligand-coated QD surface with Zr(i-PrO)4. It is also proved that the Zr(i-PrO)4-passivated interlayer mitigates the further degradation of I-III-V QDs from ligand loss even under harsh conditions during additional hydrolysis reaction of aluminum tri-sec-butoxide (Al(sec-BuO)3), forming easy-to-handle G-CGS/ZnS and R-CIS/ZnS QD-embedded Al2O3 powders. Therefore, the introduction of a Zr(i-PrO)4 complex layer potentially provides a strong interlayer to mitigate degradation of I–III–VI QD-embedded Al2O3 hybrid powders as well as passivation layer for protecting I–III–VI QD.

Abstract The aim of the current study was to determine the prevalence of anatomic variant in cephalic arch on preoperative mapping venography and evaluate patency rates and predictors of patency in patients with brachiocephalic fistulas. The prevalence of anatomic variant in cephalic arch was retrospectively evaluated in 1004 consecutive patients who underwent bilateral preoperative mapping venography from July 2006 to December 2018 in a single center. The overall prevalence of anatomic variant in cephalic arch was 17.2% (173/1004). For patency analysis, 128 patients with brachiocephalic fistulas were divided into two groups: a standard anatomy (SA) group (n = 97) and a variant anatomy (VA) group (n = 31). There were no significant differences in clinical characteristics between the two groups. The primary patency rate did not differ significantly between the two groups. The secondary patency rate was significantly (p = 0.009) lower in the VA group than in the SA group. Older age (HR 1.03; 95% CI 1.01–1.05; p = 0.007) was a negative predictor of primary patency, and antiplatelet agent (HR 0.53; 95% CI 0.33–0.84; p = 0.007) and large-diameter cephalic vein (HR 0.52; 95% CI 0.31–0.86; p = 0.012) were positive predictors of primary patency. Older age (HR 1.04; 95% CI 1.01–1.07; p = 0.011) and anatomic variant in cephalic arch (HR 2.9; 95% CI 1.19–7.06; p = 0.019) were negative predictors of secondary patency. The current study provides insight into the clinical significance of anatomic variant in cephalic arch. Anatomic variant in cephalic arch should be considered as a potential risk factor for decreased patency of brachiocephalic fistula during preoperative planning.

BACKGROUND: Diabetes mellitus (diabetes) increases the risk of severe coronary artery calcification, which increases the complexity of percutaneous coronary intervention requiring rotational atherectomy (RA) by interfering with lesion preparation, and limiting final stent expansion. OBJECTIVE: Investigate 30-day and 18-month clinical outcomes in patients with and without diabetes treated with percutaneous coronary intervention requiring RA. DESIGN: Medical record review SETTING: Multicenter registry in South Korea PATIENTS AND METHODS: The ROtational atherectomy in Calcified lesions in Korea (ROCK) registry was a large, retrospective, multicenter study to assess RA treatment of severe coronary artery calcification. MAIN OUTCOME MEASURES: The primary endpoint was target-vessel failure including cardiac death, target-vessel myocardial infarction, and target-vessel revascularization. SAMPLE SIZE: 540 patients followed for a median of 16.1 months. RESULTS: Of the 540 patients, 305 had diabetes (56.5%). The diabetes group had a significantly higher frequency of multivessel disease; comorbidities such as hypertension, dyslipidemia, and chronic kidney disease; and lower ejection fraction of the left ventricle compared to the non-diabetes group (n=235). There were no significant differences in procedure success and complications observed between the two groups. Target vessel failure at 30 days between the diabetes and non-diabetes groups was not statistically significant in a multivariate Cox regression analysis (1.6% vs. 2.6%, adjusted hazard ratio [HR] 0.595, 95% confidence interval [CI] 0.154-2.300, P=.451). During an 18-month follow-up, the risk of target vessel failure was higher (12.5% vs. 8.9%) but the difference was not statistically significant (adjusted HR 1.393, 95% CI 0.782-2.482, P=.260). CONCLUSIONS: Patients with diabetes have a risk of complications comparable to patients without diabetes, and 30-day and 18-month clinical outcomes are similar in severe coronary artery calcification requiring RA, despite having more comorbidities. LIMITATIONS: Retrospective design. Sample size not based on power calculation. CONFLICT OF INTEREST: None.

Implementing person-centred care is often considered difficult in congested emergency rooms. The purpose of this study was to understand person-centred care experienced by emergency room nurses in depth and examine the essence of emergency room nurses’ lived experience of the person- centred care. Eight nurses working in the emergency room of a large hospital in South Korea and who had over six months of experience were surveyed via semi-structured interviews in February 2019. The data were transcribed and analysed using Colaizzi’s framework. The major findings related to person-centred care experiences among emergency room nurses were: (1) feeling distanced from patients; (2) guilt and frustration; (3) accepting patients’ symptoms and emotions as they are; (4) person-centred care as a domain of nursing that cannot be replaced by machines; and (5) nursing as an art wherein the minutest details make a difference. Providing person-centred practice in the emergency room is difficult, but it will not only improve the quality of patient care but also increase the job satisfaction of nurses. Based on an in-depth understanding of person-centred care experienced by emergency nurses, it will contribute to enhancing the quality of nursing care in the emergency room.

A compact ultra-wideband (UWB) chip antenna that has high isolation for multi-input multi-output (MIMO) systems is presented in this paper. The antenna is composed of a chip antenna, a printed circuit board, and an isolator stub. High isolation was obtained using a simple stub, and a low-frequency band was extended by applying a bandwidth extension patch to the chip antenna. The pulse performance of the proposed antenna was measured by changing the angle of the receiving antenna. The proposed antenna was simulated by applying a hand phantom. The effect of the grip position of the hand phantom on the reflection coefficient, isolation, and gain was analyzed. The measured impedance bandwidth was 2.45 GHz to 9 GHz. The proposed UWB MIMO antenna has a high isolation, greater than 25 dB, at the operating frequency. The antenna gain varied from 3 dBi to 4.5 dBi over the operating frequency range. The measured group delay variation was less than 1 ns. The measured pulse features have negligible chirp and a small dispersion.

Acute puerperal uterine inversion is a rare postpartum obstetric complication; however, without rapid diagnosis and appropriate management, it is life-threatening. Substantial bleeding hinders the verification of a partially inverted uterus, possibly delaying the treatment. Herein, we present the report of a 32-year-old female presenting with massive postpartum bleeding managed by uterine artery embolization. The peculiar course of the uterine artery bowing inferiorly along the inverted fundus during embolization could uncover the uterine inversion, which was not diagnosed by physical examination and CT. In conclusion, uterine artery embolization is not only an effective therapeutic strategy for postpartum hemorrhage but also a valuable tool for diagnosing uterine inversion.

Abstract We investigated the association between lung function and atrial fibrillation (AF) in 21,349 adults without AF aged ≥ 40 years who underwent spirometry. The study participants were enrolled from the Korean National Health and Nutritional Examination Survey between 2008 and 2016. The primary outcome was new-onset non-valvular AF identified from the National Health Insurance Service database. During the median follow-up of 6.5 years, 2.15% of participants developed new-onset AF. The incidence rate of AF per 1000 person-years was inversely related to the forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC quartile. After adjustment for multiple variables, the AF risk in the lowest FEV1 quartile was 1.64-fold higher than that in the highest quartile (hazard ratio (HR) 1.64 (95% confidence interval (CI) 1.26–2.12) for lowest FEV1 quartile). The lowest quartile of FVC had 1.56-fold higher AF risk than the highest quartile (HR 1.56 (95% CI 1.18–2.08) for lowest FVC quartile). Although the lowest FEV1/FVC quartile was associated with an increased risk of AF in the unadjusted model, this increased risk was not statistically significant in the multivariable analysis. Compared to those with normal lung function, participants with restrictive or obstructive lung function had 1.49 and 1.42-fold higher AF risks, respectively. In this large nationwide cohort study, both obstructive and restrictive patterns of reduced lung function were significantly associated with increased AF risk.

Abstract Background Transcatheter arterial chemoembolization (TACE) via the inferior phrenic artery has been recognized to have its own therapeutic role without causing serious procedural complications. We report a case of diaphragmatic perforation after repeated TACE sessions conducted via the right inferior phrenic artery. Case presentation A 43-year-old man diagnosed with hepatocellular carcinoma was admitted to the hospital with a chief complaint of cough. The patient underwent TACE via the right inferior phrenic artery 3 months prior and was discharged without specific complications. Physical examination revealed decreased breathing sounds in the right lower lung zone. Chest radiograph demonstrated a small right pleural effusion. Chest CT scan revealed a small diaphragmatic perforation. The patient was unable to undergo surgical exploration, and a follow-up CT scan after 2 months revealed progression of the right diaphragmatic perforation with massive herniation of omental fat into the thoracic cavity. Conclusions Although TACE via the inferior phrenic artery is a relatively safe procedure, it can be associated with rare but serious complications after repeated procedures. This is a rare case report of diaphragmatic perforation after TACE via the right inferior phrenic artery. Early recognition and prompt surgical management are essential to prevent catastrophic outcomes.

Abstract Background To demonstrate and analyze the relatively common imaging findings in this rare primary pleural angiosarcoma (PPA). Case presentation Three cases of PPA, proven by video-assisted thoracic surgery biopsies are retrospectively reviewed. Patients were all male. Age ranges from 65 to 75 years old age (mean; 69). Major chief complaints were dyspnea and chest pain. One has a history of colon cancer, the other has a tuberculosis history and the other has no known history. Multidetector chest CT and PET CT were all done. Immunohistochemical studies were performed including CD31, CD34, or factor VIII-related antigen, vimentin, and cytokeratin. We also review the literatures on recently published PPA. All masses were from 1 to 10 cm. All three patients had multiple pleural based masses, which were ovoid in shape with relatively sharp margin in unilateral hemithorax. Multiple small circumscribed pleural masses are limited in the pleural space in two patients, whereas two, huge lobulated masses about up to 10 cm were present with pleural and extrapleural involvement in one patient. In two patients with pleural mass only, multiple pleural masses were only seen in parietal pleura in one patient and were in both visceral and parietal pleura in one patient. Pleural effusion were found in one side in one patient and in both sides in one patient. One angiosarcoma was arised from chronic tuberculotic pleurisy sequelae. All pleural masses are heterogenous with irregular internal low densities in all patients. Hematogenous metastases were found in liver, vertebra, rib in one patient, and were in lungs with mediastinal lymph node metastases in the other patient. Three patients survived for longer than 3months after diagnosis, but continued to deteriorate rapidly. Two patients underwent chemotherapy after surgical excision, and the other one with multiple metastases treated chemotherapy after CT-guided biopsy, but eventually all died. As a result of comparative analysis of a total of 13 patients’ images including 10 cases previously published, there was pleural effusion in all except 2 cases. Conclusions PPA were all necrotic without any vascularized enhancing nature, and manifested as unilateral circumscribed or localized pleural-based masses.

Abstract The degeneration or loss of skeletal muscles, which can be caused by traumatic injury or disease, impacts most aspects of human activity. Among various techniques reported to regenerate skeletal muscle tissue, controlling the external cellular environment has been proven effective in guiding muscle differentiation. In this study, we report a nano-sized graphene oxide (sGO)-modified nanopillars on microgroove hybrid polymer array (NMPA) that effectively controls skeletal muscle cell differentiation. sGO-coated NMPA (sG-NMPA) were first fabricated by sequential laser interference lithography and microcontact printing methods. To compensate for the low adhesion property of polydimethylsiloxane (PDMS) used in this study, graphene oxide (GO), a proven cytophilic nanomaterial, was further modified. Among various sizes of GO, sGO (

Abstract A new ankylosaurid dinosaur, Tarchia tumanovae sp. nov., has been recovered from the Upper Cretaceous Nemegt Formation of Mongolia. It includes a well-preserved skull, dorsal, sacral, caudal vertebrae, sixteen dorsal ribs, ilia, a partial ischium, free osteoderms, and a tail club. The squamosal horns of T. tumanovae are divided into two layers, the external dermal layer and the underlying squamosal horn proper. The irregular ventral margin of the base of the upper dermal layer may represent a resorption surface, suggesting that the squamosal horns of some ankylosaurids underwent extreme ontogenetic remodeling. Localized pathologies on the dorsosacral ribs and the tail provide evidence of agonistic behaviour. The tail club knob asymmetry of T. tumanovae resulted from restricted bone growth due to tail club strikes. Furthermore, T. tumanovae had an anteriorly protruded shovel-shaped beak, which is a morphological character of selective feeders. Ankylosaurid diets shifted from low-level bulk feeding to selective feeding during the Baruungoyot and the Nemegt “age” (middle Campanian-lower Maastrichtian). This ankylosaurid niche shifting might have been a response to habitat change and competition with other bulk-feeding herbivores.

Feeding is the most important behavior that represents the health and welfare of weanling pigs. The early detection of feed refusal is crucial for the control of disease in the initial stages and the detection of empty feeders for adding feed in a timely manner. This paper proposes a real-time technique for the detection and recognition of small pigs using a deep-leaning-based method. The proposed model focuses on detecting pigs on a feeder in a feeding position. Conventional methods detect pigs and then classify them into different behavior gestures. In contrast, in the proposed method, these two tasks are combined into a single process to detect only feeding behavior to increase the speed of detection. Considering the significant differences between pig behaviors at different sizes, adaptive adjustments are introduced into a you-only-look-once (YOLO) model, including an angle optimization strategy between the head and body for detecting a head in a feeder. According to experimental results, this method can detect the feeding behavior of pigs and screen non-feeding positions with 95.66%, 94.22%, and 96.56% average precision (AP) at an intersection over union (IoU) threshold of 0.5 for YOLOv3, YOLOv4, and an additional layer and with the proposed activation function, respectively. Drinking behavior was detected with 86.86%, 89.16%, and 86.41% AP at a 0.5 IoU threshold for YOLOv3, YOLOv4, and the proposed activation function, respectively. In terms of detection and classification, the results of our study demonstrate that the proposed method yields higher precision and recall compared to conventional methods.

Time-restricted feeding (TRF) has emerged as a promising dietary approach in improving metabolic parameters associated with obesity, but its effect on immune cells under obesogenic condition is poorly understood. We conducted this study to determine whether TRF exerts its therapeutic benefit over obesity-induced myeloid cell production by analyzing hematopoietic stem and progenitor cells in bone marrow (BM) and immune cell profile in circulation. Male C57BL/6 mice were fed a low-fat diet (LFD) or high-fat diet (HFD) ad libitum for 6 weeks and later a subgroup of HFD mice was switched to a daily 10 h-TRF schedule for another 6 weeks. Mice on HFD ad libitum for 12 weeks had prominent monocytosis and neutrophilia, associated with expansion of BM myeloid progenitors, such as multipotent progenitors, pre-granulocyte/macrophage progenitors, and granulocyte/macrophage progenitors. TRF intervention in overweight and obese mice diminished these changes to a level similar to those seen in mice fed LFD. While having no effect on BM progenitor cell proliferation, TRF reduced expression of Cebpa, a transcription factor required for myeloid differentiation. These results indicate that TRF intervention may help maintain immune cell homeostasis in BM and circulation during obesity, which may in part contribute to health benefits associated with TRF.

BACKGROUND: Tobacco smoking and its harmful health effects also increase economic burdens globally. Surprisingly, despite the detrimental health consequences of smoking, some studies have shown better survival among smokers compared with non-smokers, a phenomenon called “smoker's paradox”. However, the impact of smoking status on clinical outcomes in severe calcified coronary artery disease (CAD) patients has yet to be reported. OBJECTIVES: Investigate the impact of smoking on clinical outcomes in calcified CAD receiving rotational atherectomy (RA). DESIGN: Retrospective review of medical records. SETTING: Multicenter registry in South Korea. PATIENTS AND METHODS: This multicenter registry included consecutive patients with calcified CAD who underwent RA at nine tertiary centers in Korea between January 2010 and October 2019. MAIN OUTCOME MEASURES: Target-vessel failure (TVF) which included the composite of cardiac death, target-vessel myocardial infarction (TVMI), and target-vessel revascularization (TVR). SAMPLE SIZE: 583 lesions in 540 patients followed for a median of 16.1 months. RESULTS: Lesions were divided into two groups: non-smokers (n=472, 81.0%) and smokers (n=111, 19.0%). TVF in the smoker group was significantly more frequent than in non-smoker group (log rank P=.016). The inverse probability of treatment weighting analysis also showed that smoking was significantly associated with a higher incidence of the primary outcome (HR: 1.617; 95% CI: 1.127–2.320; P=.009), cardiac death (HR 1.912; 95% CI: 1.105-3.311; P=.021), myocardial infarction (HR: 3.914; 95% CI: 1.884-8.132; P

The coronary sinus (CS) is the venous drainage system of the heart. CS ostium atresia is a rarely seen cardiac malformation. Congenital atresia of the CS is usually found together with persistent left superior vena cava (LSVC) and other cardiac malformations. However, isolated congenital atresia of the CS is very rare. We present a rare case of isolated congenital atresia of the CS connecting the left atrium and coronary veins without persistent LSVC in a 58-year-old female.

Abstract Background Human papilloma virus infection and tobacco smoking are the major risk factors for cervical cancer. There are limited studies searching other risk factors for cervical cancer and the results are not consistent. This study investigated the relations between cervical cancer and possible risk factors, including secondhand cigarette smoke exposure, diabetes, body mass index (BMI), and work schedule. Methods In this cross-sectional study, 29,557 women completed a cervical cancer questionnaire and were selected using 2010–2018 data from the Korea National Health and Nutrition Examination Survey. Details in secondhand smoke exposure, diabetes, BMI, and work schedule were assessed with participants’ health interviews and health-related surveys. Results Two hundred sixty-two women (0.89%) in the sample were diagnosed with cervical cancer. Domestic secondhand smoke exposure, diabetes, and high BMI significantly increased cervical cancer risk. Respective odds ratios and 95% confidence intervals were: 1.547 (1.042–2.297), 2.156 (1.535–3.027), and 1.036 (1.006–1.067). Weekly work hours, and work schedule were not significantly related to cervical cancer incidence. Conclusion Among Korean women, passive exposure to cigarette smoke at home, diabetes, and high BMI increase risk for cervical cancer.

Background Real‐world data on low baseline low‐density lipoprotein cholesterol (LDL‐C) levels and long‐term postdischarge cardiovascular outcomes in patients with acute coronary syndrome are limited. Methods and Results Of the 10 719 patients enrolled in the Korean registry of acute myocardial infarction between January 2004 and August 2014, we identified 5532 patients who were event free from death, recurrent myocardial infarction, or stroke during the in‐hospital period after successful percutaneous coronary intervention. The co–primary outcomes were 3‐point major adverse cardiovascular events (a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and cardiovascular death at 5 years. Of 5532 patients with acute myocardial infarction (mean age, 62.1±12.8 years; 75.0% men), 446 cardiovascular deaths (8.1%) and 695 three‐point major adverse cardiovascular events (12.6%) occurred at 5 years. In the continuous analysis of LDL‐C, the risk of cardiovascular events increased steeply as LDL‐C levels decreased from 100 mg/dL. For categorical analysis of LDL‐C (

Introduction We aimed to evaluate the efficacy and toxicity of the combination of 6 cycles of chemotherapy and radiation therapy compared with chemotherapy alone as postoperative adjuvant therapy for patients with stage III endometrial cancer. Methods This retrospective cohort study included patients with stage III endometrial cancer who received postoperative chemoradiotherapy or chemotherapy alone at 6 hospitals between January 2009 and December 2019. The progression-free survival (PFS) and overall survival (OS) for each treatment group were analyzed using the Kaplan–Meier method. We also assessed differences in toxicity profiles between the treatment groups. Results A total of 133 patients met the inclusion criteria. Of these, 80 patients (60.2%) received adjuvant chemoradiotherapy and 53 (39.8%) received chemotherapy alone. The PFS and OS did not differ significantly between the groups. For patients with stage IIIC endometrioid subtype, the chemoradiotherapy group had significantly longer PFS rate than did the chemotherapy alone group (log-rank test, P = .019), although there was no significant difference in the OS (log-rank test, P = .100). CRT was identified as a favorable prognostic factor for PFS in multivariate analysis (adjusted HR, .37; 95% CI, .16-.87; P = .022). Patients treated with chemoradiotherapy more frequently suffered from grade 4 neutropenia (73.8% vs 52.8%; P = .018) and grade 3 or worse thrombocytopenia (36.3% vs 9.4%; P = .001) compared with the chemotherapy alone group. There were no differences between the 2 treatment groups in the frequency of toxicity-related treatment discontinuation or dose reduction. Conclusion We confirmed that chemoradiotherapy yields longer progression-free survival than does chemotherapy alone for patients with stage IIIC endometrioid endometrial cancer, with an acceptable toxicity profile.

Cervicovaginal venous malformations are extremely rare. Sclerotherapy is proven to be effective for superficial venous malformations but not for venous malformations in the lower genital tract of female. A 52-year-old female presented with intermittent vaginal bleeding. The amount of vaginal bleeding gradually increased over 3 months. Contrast-enhanced pelvis CT showed several phleboliths and dilated vessels, but pelvic angiography showed no early draining veins, nidus, or feeding artery. We performed transvaginal direct puncture and ethanol sclerotherapy rather than surgical treatment because she wanted to preserve the uterus. After four sessions of sclerotherapy, she had significantly decreased vaginal bleeding without complications. Here, we report the first case of cervicovaginal venous malformations successfully treated with transvaginal direct puncture and ethanol sclerotherapy.

Congenital defects of the pericardium, which are generally asymptomatic, are rare disorders characterized by complete or partial absence of the pericardium. Here, we report a rare case of a 19-year-old male who was incidentally diagnosed with congenital absence of the left pericardium during examination for symptoms of pneumothorax. Chest radiography and CT revealed a collapsed left lung without any evidence of trauma, no unusual findings of free air spaces along the right side of the ascending aorta, heart shifted toward the left side of the thorax, and a shallow chest. Subsequent thoracoscopy confirmed the absence of the left pericardium and displacement of the heart toward the left thoracic cavity. We further discuss the correlation between radiologic images and surgical findings of a congenital pericardial defect associated with spontaneous pneumothorax.

The levoatriocardinal vein is an uncommon pulmonary venous abnormality that connects the left atrium or pulmonary vein with the systemic vein. It is distinct from partial anomalous pulmonary venous return in that the former forms a connection with the left atrium through the normal pulmonary vein whereas the latter involves pulmonary venous drainage to the systemic vein. Herein, we describe a case of the levoatriocardinal vein initially misdiagnosed as a pulmonary arteriovenous malformation using chest radiography and chest CT. The levoatriocardinal vein combined with pulmonary venous varix was confirmed using pulmonary angiography. To the best of our knowledge, this unusual coexistence of the levoatriocardinal vein and pulmonary venous varix has not been reported in English literature.

Abstract A new articulated postcranial specimen of an indeterminate ankylosaurid dinosaur from the Upper Cretaceous (middle-upper Campanian) Baruungoyot Formation from Hermiin Tsav, southern Gobi Desert, Mongolia includes twelve dorsal vertebrae, ribs, pectoral girdles, forelimbs, pelvic girdles, hind limbs, and free osteoderms. The new specimen shows that Asian ankylosaurids evolved rigid bodies with a decreased number of pedal phalanges. It also implies that there were at least two forms of flank armor within Ankylosauridae, one with spine-like osteoderms and the other with keeled rhomboidal osteoderms. Unique anatomical features related to digging are present in Ankylosauridae, such as dorsoventrally flattened and fusiform body shapes, extensively fused series of vertebrae, anteroposteriorly broadened dorsal ribs, a robust humerus with a well-developed deltopectoral crest, a short robust ulna with a well-developed olecranon process, a trowel-like manus, and decreased numbers of pedal phalanges. Although not fossorial, ankylosaurids were likely able to dig the substrate, taking advantage of it for self-defence and survival.

Abstract Gate-controlled amplifiable ultraviolet phototransistors have been demonstrated using AlGaN/GaN high-electron-mobility transistors (HEMTs) with very thin AlGaN barriers. In the AlGaN/GaN HEMTs, the dark current between the source and drain increases with increasing thickness of the AlGaN barrier from 10 to 30 nm owing to the increase in piezoelectric polarization-induced two-dimensional electron gas (2-DEG). However, the photocurrent of the AlGaN/GaN HEMT decreases with increasing thickness of the AlGaN barrier under ultraviolet exposure conditions. It can be observed that a thicker AlGaN barrier exhibits a much higher 2-DEG than the photogenerated carriers at the interface between AlGaN and GaN. In addition, regardless of the AlGaN barrier thickness, the source–drain dark current increases as the gate bias increases from − 1.0 to + 1.0 V. However, the photocurrent of the phototransistor with the 30 nm thick AlGaN barrier was not affected by the gate bias, whereas that of the phototransistor with 10 nm thick AlGaN barrier was amplified from reduction of the gate bias. From these results, we suggest that by controlling the gate bias, a thin AlGaN barrier can amplify/attenuate the photocurrent of the AlGaN/GaN HEMT-based phototransistor.

Slug flow is the most common multi-phase flow encountered in oil and gas industry. In this study, the hydrodynamic features of flow in pipes investigated numerically using computational fluid dynamic (CFD) simulations for the effect of slug flow on the vertical and bent pipeline. The compressible Reynold averaged Navier-Stokes (RANS) equation was used as the governing equation, with the volume of fluid (VOF) method to capture the outline of the bubble in a pipeline. The simulations were tested for the grid and time step convergence, and validated with the experimental and theoretical results for the main hydrodynamic characteristics of the Taylor bubble, i.e., bubble shape, terminal velocity of bubble, and the liquid film velocity. The slug flow was simulated with various air and water injection velocities in the pipeline. The simulations revealed the effect of slug flow as the pressure occurring in the wall of the pipeline. The peak pressure and pressure oscillations were observed, and those magnitudes and trends were compared with the change in air and water injection velocities. The mechanism of the peak pressures was studied in relation with the change in bubble length, and the maximum peak pressures were investigated for the different positions and velocities of the air and water in the pipeline. The pressure oscillations were investigated in comparison with the bubble length in the pipe and the oscillation was provided with the application of damping. The pressures were compared with the case of a bent pipe, and a 1.5 times higher pressures was observed due to the compression of the bubbles at the corner of the bent. These findings can be used as a basic data for further studies and designs on pipeline systems with multi-phase flow.

Abstract Zinc dendrite growth negatively affects zinc–bromine flow battery (ZBB) performance by causing membrane damage, inducing self-discharge. Herein, in a ZBB, a conventional polymer mesh was replaced with a titanium-based mesh interlayer; this provided additional abundant active sites for the Zn2+/Zn redox reaction and well-developed electrolyte flow channels, which resulted in improved reaction kinetics and suppressed Zn dendrite growth. Compared with a ZBB cell comprising a conventional polymer mesh and a carbon-based electrode, the ZBB cell using the titanium mesh interlayer and a carbon-based electrode showed significantly reduced frequency of the refreshing process, which occurs at regular cycling intervals during practical use for removing residual zinc dendrites in ZBB; also, the average energy efficiency at a current density of 40 mA cm−2 increased by 38.5%. Moreover, the modified ZBB cell exhibited higher energy efficiency at a high current density of 80 mA cm−2, which is an improvement of 14.7% than in case of the contemporary polymer mesh. Consequently, this study can provide helpful insights for new anode side structures including spacer mesh for developing high-performance ZBBs.

Objective: We investigated factors that could cause false-positive results when using the risk of ovarian malignancy algorithm (ROMA) for assessing ovarian cancer risk. Materials and methods: ROMA scores were calculated from patients followed surgery to remove a pelvic mass. We compared a false-positive group with a true-negative group of ROMA scores. Results: We analyzed 324 patients using medical records. There were 22 with an epithelial ovarian cancer (EOC), 15 with a borderline ovarian tumor, and 287 with benign disease. Twenty-nine (10.1%) of the patients with benign disease showed high-risk ROMA score (false positive) and 13/37 (35%) patients with EOC, or borderline ovarian tumor showed low ROMA scores (false negatives). The median serum triiodothyronine (T3) level of the false-positive ROMA group in patients with benign disease was lower than in the true-negative ROMA group (p

Purpose We evaluated the risk factors for progression to chronic complicated bronchopleural fistula (BPF) after pulmonary resection using follow-up CT. Materials and Methods We retrospectively reviewed 45 cases with BPF that had undergone pulmonary resection during 2010-2018. We compared the clinical and radiological characteristics of those with complicated BPF (n = 24) and those without complicated (sterilized) BPF (n = 21). The clinical and radiological risk factors for progression to chronic complicated BPF were examined by logistic regression analysis. Results The thickness of the pleural cavity wall (p = 0.022), the size of the pleural cavity (p = 0.029), and the size increase of BPF on follow-up (p = 0.012) were significantly different between the two groups. The risk factors for progression to chronic complicated BPF were age > 70 years (odds ratio, 6.43; 95% confidence interval, 1.2–33.7), the thickness of the cavity wall > 5 mm (odds ratio, 52.5; 95% confidence interval, 5.1–545.4), and an increase in the size of the pleural cavity on follow-up CT (odds ratio, 12.5; 95% confidence interval, 2.1–73.5), only in the univariate analysis. Conclusion The risk factors for progression to chronic complicated BPF can be evaluated using follow-up CT.

Air bubble entrainment is a phenomenon that can significantly reduce the efficiency of liquid motion in piping systems. In the present study, the bubble formation mechanism in a globe valve with 90% water fraction flow is explained by visualization study and pressure oscillation analysis. The shadowgraph imaging technique is applied to illustrate the unsteady flow inside the transparent valve. This helps to study the effect of bubbles induced by the globe valve on pressure distribution and valve flow coefficient. International Society of Automation (ISA) recommends locations for measuring pressure drop of the valve to determine its flow coefficient. This paper presents the comparison of the pressures at different locations along with the upstream and the downstream of the valve with the values at recommended positions by the ISA standard. The results show that in partially filled pipe flow, the discrepancies in pressure between different measurement locations in the valve downstream are significant at valve openings less than 30%. The aerated flow induces the oscillation in pressure and flow rate, which leads to the fluctuation in the flow coefficient of the valve. The flow coefficients have a linear relationship with the Reynolds number. For the same increase of Reynolds number, the flow coefficients grow faster with larger valve openings and level off at the opening of 50%.

Here we report a new articulated skeleton of Yamaceratops dorngobiensis (MPC-D 100/553) from the Khugenetjavkhlant locality at the Shine Us Khudag (Javkhlant Formation, ?Santonian-Campanian) of the eastern Gobi Desert, Mongolia, which represents the first substantially complete skeleton and the first juvenile individual of this taxon. The specimen includes a nearly complete cranium and large portions of the vertebral column and appendicular skeleton. Its skull is about 2/3 the size of the holotype specimen, based on mandibular length. Its juvenile ontogenetic stage is confirmed by multiple indicators of skeletal and morphological immaturity known in ceratopsians, such as the long-grained surface texture on the long bones, the smooth external surface on the postorbital, open neurocentral sutures of all caudal vertebrae, a large orbit relative to the postorbital and jugal, the low angle of the lacrimal ventral ramus relative to the maxillary teeth row, narrow frontal, and straight ventral edge of the dentary. Osteohistological analysis of MPC-D 100/553 recovered three lines of arrested growth, implying around 3 years of age when it died, and verified this specimen’s immature ontogenetic stage. The specimen adds a new autapomorphy of Yamaceratops, the anteroventral margin of the fungiform dorsal end of the lacrimal being excluded from the antorbital fossa. Furthermore, it shows a unique combination of diagnostic features of some other basal neoceratopsians: the ventrally hooked rostral bone as in Aquilops americanus and very tall middle caudal neural spines about or more than four times as high as the centrum as in Koreaceratops hwaseongensis, Montanoceratops cerorhynchus, and Protoceratops andrewsi. The jugal with the subtemporal ramus deeper than the suborbital ramus as in the holotype specimen is also shared with A. americanus, Liaoceratops yanzigouensis, and juvenile P. andrewsi. Adding 38 new scorings into the recent comprehensive data matrix of basal Neoceratopsia and taking into account the ontogenetically variable characters recovered Y. dorngobiensis as the sister taxon to Euceratopsia (Leptoceratopsidae plus Coronosauria). A second phylogenetic analysis with another matrix for Ceratopsia also supported this position. The new phylogenetic position of Y. dorngobiensis is important in ceratopsian evolution, as this taxon represents one of the basalmost neoceratopsians with a broad, thin frill and hyper-elongated middle caudal neural spines while still being bipedal.

In this study, a particle image velocimetry (PIV)-based pressure estimation method was investigated, with application to the wave-in-deck loading phenomenon. An experimental study was performed in a two-dimensional wave tank using a fixed deck structure under a focused wave, obtaining local pressures by pressure sensors, global loads by load cells, and instantaneous velocity fields using the PIV measurement technique. The PIV-based pressure estimation method was applied using the Euler equation as the governing equation, and the proper time step for the wave impact pressure was studied using the normalized root-mean-square deviation. The pressure estimation method showed good agreement for the local impact pressure in comparison with the measured pressure by the pressure sensors. However, some differences were observed in the peak pressure due to the limitations of the Euler equation and the sampling rate of the measurement system. Using the estimation method, the pressure fields during wave-in-deck loading were determined in the study, with an analysis of the mechanism of impact and negative pressure occurrence.