Pleural Effusion after Percutaneous Radiofrequency Ablation for Hepatic Malignancies

AbstractBackground and AimsRadiofrequency ablation (RFA) can play an important role in the treatment of primary or metastatic liver tumors. Currently, percutaneous RFA is generally regarded as a safe, effective, and minimally invasive procedure. This study aimed to evaluate the presence and course of pleural effusion after monopolar RFA.MethodsFrom October 2008 to July 2013, a total of 54 patients (28 male and 26 female, mean age 65.2) treated with monopolar RFA were included in our study. 47 patients were diagnosed with hepatocellular carcinoma, 4 patients with hepatic metastasis, and 3 patients had other diagnoses. There were a total of 115 sessions of treatment and 199 liver tumors to be treated (1.73 ± 1.02 tumors treated per session). The tumor size ranged from 0.8 cm to 5.0 cm (mean 2.31 cm, standard deviation 1.04 cm). Thereafter, a follow-up ultrasound was performed within 24 hours subsequent to ablation to evaluate the presence of pleural effusion. The degree of pleural effusion was assessed by chest X-ray.ResultsFifteen (13.0%) treatment sessions in 14 patients showed right-sided pleural effusion after ablations. One patient had a large amount of effusion, while other patients manifested a minimal to small amount of effusion. There were 5 patients that experienced delayed resolution of pleural effusion; one patient (0.87%) had a minimal amount of pleural effusion even after one month. Overall, there was no pneumothorax, or periprocedural morality. Age, gender, tumor numbers, tumor sizes, and complete ablation of target tumors were similar among groups presenting with or without pleural effusion. Tumor locations associated with S78 segments abutting the diaphragm or right lobe of the liver were not associated with development of pleural effusion. Only the duration of ablation time had a marginal trend toward significance (p = 0.051).ConclusionsThe transient appearance of right-sided pleural effusion after percutaneous RFA for hepatic malignancies was not infrequent. However, refractory pleural effusion was rare

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

A Study on Medical Data Analysis

流行病學在人類疾病的來源和疾病發生原因上的研究上提供了科學的法則，確實為了大眾的健康照護研究建立的重要的旅程碑。流行病學從研究資料的收集到資料的分析上都有科學上的方法和法則，但是在這樣嚴謹的法則下所得到研究成果被醫療從事人員視為是他們的醫療知識，卻沒有將這些寶貴的研究成果大量的透過電腦系統來提供疾病治療或是治療方法的風險評估上的輔助建議，很多非常有經驗的醫師在疾病的醫治上憑藉著個人經驗而非透過風險評估或是依循治療準則。因為即使是在現在有大量醫學研究成果以電子文件方式來傳播的今天，只有為數不多的治療上的風險評估預測法則被建立在電腦系統上，以致於很難被大量的使用，綜合以上的觀察，在本論文中以流行病學研究法則為基礎，提供了一套方法步驟來預測婦科子宮鏡手術的成功率。 大致上來說，從醫院的病人資料庫收集的資料被分成兩類資料，病人在手術的過程中有出現併發症或經過五年的追蹤中有再復發的現象並進行第二次手術被歸成一類，而沒有併發症或是再復發的病人是另一類，從這兩類的病人之中，透過卡方測試的方法來找出手術時的危險因子,並將這危險因子放入邏輯式迴歸分析中，進而得到透過這些危險因子所建立起來的手術成功率的預測公式。 總結以上的說明，本論文提供了一套清楚的規則如何得到會影響到手術成功與否的危險因子，並找出手術成功率預測的公式。這個數學上公式很適合套用到實證醫學的領域上，進而提高醫療服務的品質。Epidemiology is the study of causal inferences of the health problems and the occurrence of illness on people. It is considered as the cornerstone of scientific public health research based on scientific disciplines. These disciplines include study design, data collection and statistical models. However, the results of studies through these scientific disciplines are used as medical knowledge to the health-care workers. Unfortunately, these precious research results are not used widely through the computer systems to supply decision supports, such as risk assessment of surgical operations. Many well-knowledge doctors decide their treatment polices to their patients by their experienced knowledge without the risk assessment or following the guidelines of treatment. Even though many well research results are announced to the world in an electronic documentation manner, only a few risk predictions of disease treatments have been supported by the computer system so far. Based on these observations, this dissertation proposes an epidemiological scheme for the success rate prediction of surgery in gynecology. In general, the medical data are collected from the hospital's database; the retrospective cohort study is to category the patients' records into surgical complication and not surgical complication groups after the surgical operation with a 5-year followed-up. The chi-square test is used to find out the risk factors (predictors) by comparing the outcome of these two cohorts. Then the risk factors are applied to the logistic regression model to construct a prediction function of the success rate of the hysteroscopic surgery based on the risk factors. In conclusion, this dissertation proposes a clear method to construct a prediction function based on risk factors. This procedure of prediction model can be feasible to decision supports in the evidence-based medicine to make a high quality medical service.Acknowledgement...................................... i 中文摘要............................................. ii Abstract............................................. iii Table of Contents.................................... v List of Figures...................................... vi List of Tables....................................... vii Chapter 1 Introduction.............................. 1 1.1 Motivation...................................... 1 1.2 Overview of proposed approach................... 1 1.3 Dissertation Organization....................... 2 Chapter 2 Background................................ 3 2.1 Study design.................................... 7 2.1.1 Case-control study............................ 8 2.1.2 Cohort study.................................. 9 2.2 Source population and sampling.................. 12 2.3 Validity........................................ 14 2.3.1 Confounding control........................... 15 2.4 Statistical models.............................. 16 2.4.1 Chi-square test statistic..................... 16 2.4.2 The Fisher exact test and Yates'' correction... 17 2.4.3 The Mantel-Haenszel statistic................. 18 2.4.4 Regression model.............................. 21 Chapter 3 Factors associated with operative hysteroscopy outcome in patients with uterine adhesions or submucosal myomas............................................... 24 3.1 Materials and methods........................... 24 3.1.1 Statistical analysis.......................... 26 3.2 Results......................................... 26 3.3 Discussion...................................... 30 3.4 Summary......................................... 33 Chapter 4 Conclusion and future works............... 34 4.1 Conclusion...................................... 34 4.2 Future works.................................... 34 Bibliography......................................... 3

Comparison of CO2 fluxes determining with the eddy covariance system and the CO2 partial pressure gradient between the air-sea interfaces

近年來開放式二氧化碳偵測系統在海洋觀測二氧化碳通量已有許多國內外學者的使用，且有相當的文獻。而傳統海洋二氧化碳通量之觀測是利用封閉性的二氧化碳偵測儀器。本文嘗試在生態圈較為明顯的水體比較兩者的二氧化碳通量，分別做了三個案例；第一個案例將開放式渦流協變性系統與封閉性Underway PCO2系統架設於台南市七股區黑面琵鷺保育中心的水池進行觀測。結果顯示二氧化碳通量以開放式二氧化碳偵測儀的二氧化碳通量會大於Underway PCO2系統所計算的二氧化碳通量2個order，而且通量方向相反。第二個案例加入了大氣梯度法來比較二氧化碳通量方向與數值。大氣梯度法的結果是其二氧化碳通量方向與趨勢和開放式二氧化碳偵測儀相似，而通量數值大於開放式二氧化碳偵測儀8倍左右，但通量方向仍與Underway PCO2不一致。案例三為架設在附近的魚塭，其生態活動較為明顯，二氧化碳通量應該比較強，使兩系統的通量會相同。案例三為開放式二氧化碳偵測儀器與Underway PCO2系統比較兩套系統計算出的二氧化碳通量。開放式二氧化碳偵測儀器所計算的二氧化碳通量為負值(SINK)，而Underway PCO2系統計算的二氧化碳通量為正值(SOURCE)，且水體中的二氧化碳濃度有明顯的日夜週期變化。 加入國外學者John Prytherch發展的PKT校正法，目的為校正相對濕度對二氧化碳濃度的影響。本文利用前面案例一與案例三的資料來做PKT校正。案例一與案例三的PKT校正結果，PKT校正能夠將WPL校正過後所受到相對濕度影響所造成的偏差所校正回正確值，其PKT校正後的二氧化碳通量會小於只有經過WPL校正的二氧化碳通量。且本實驗在5月14日通量數值與Underway pCO2系統所計算的二氧化碳通量數值相當接近，但是通量方向仍是相反。 最後將Underway pCO2系統二氧化碳通量計算法加入pH參數，以及利用1.5米的大氣二氧化碳濃度帶入Underway PCO2系統，其結果會與渦流協變性系統之二氧化碳通量結果相近，通量方向與數值有一致性。Open path CO2 analyzer has been used in CO2 flux measurements over ocean recently. CO2 flux has been estimated by close path CO2 analyzer for decades. To compare the CO2 flux of open path and close path methods, three experiments were set in the study: (1) using open path eddy covariance system (ECS) and close path Underway pCO2 system to measure CO2 fluxes over pool in Black-faced Spoonbill Conservation Association in Cigu Dist. The results showed that the CO2 flux of open path CO2 analyzer is up to 100 times larger than that of close path, but the direction of flux is opposite; (2) in the second case, the third method, profile method was added to estimate CO2 flux. The result of profile method showed that the tendency of flux is the same as ECS, but the flux of profile method is about 8 times larger than open path, however, direction of flux was still inconsistent with Underway pCO2 system; (3) the results of the experiment in a fish pond which has stronger ecosphere activities showed that the flux of open path is positive (sink), and it's negative (source) for close path method. In addition, the diurnal cycle of CO2 concentration is obvious where it is lower in the daytime and higher at night. The PKT Method was used to calibrate the effect between relative humidity and CO2 concentration in case (1) and case (3). In both cases, PKT Method can correct the biases resulted from the relative humidity after WPL correction, the CO2 flux after calibrating by PKT Method was smaller than WPL calibration method, and the flux in May 14th is similar to the flux of Underway pCO2 system, but the direction of flux is still opposite. After adding pH parameter and CO2 atmospheric concentration measured at 1.5 m into the CO2 flux calculation of Underway pCO2 system, the results showed that the flux and the direction of flux will be consistent with ECS.致謝 III 摘要 IV ABSTRACT V 目錄 VI 表目錄 X 圖目錄 XI 1.1 研究緣起 1 1.2 研究目的 4 第二章 文獻回顧 5 2.1 大氣微量氣體之擴散現象 5 2.2通量觀測法比較 14 2.2.1 梯度量測法 (Gradient Method) 14 2.2.2渦流協變性系統 (Eddy Covariance System) 16 第三章 研究理論與實驗方法 20 3.1 座標系統 21 3.2 海洋平台校正方法 26 3.3 WPL校正 30 3.4 地表能量收支平衡 31 3.5 水下二氧化碳（UNDERWAY FCO2）連續實際測定 33 3.6 海氣交換之碳通量計算 36 3.7 實驗設備 36 3.7.1渦流協變性系統儀器（Eddy Covariance System） 36 高頻反應系統（High Response Subsystem） 36 3.7.2採樣設備 39 3.8 實驗場址 43 第四章 案例研究 44 4.1 案例一 : 於台南七股鄉黑面琵鷺保育中心進行初步研究 44 4.1.1 實驗目的 44 4.1.2 實驗儀器架設情況 44 4.1.3氣象因子觀測 48 4.1.4.渦流協變性系統計算通量 52 4.1.5 Underway PCO2系統計算通量 56 4.1.6比較渦流協變性系統與Underway PCO2系統之大氣二氧化碳濃度 61 4.1.7 比較渦流協變性系統與Underway PCO2系統之二氧化碳通量 63 4.2 案例二 : 於台南七股鄉黑面琵鷺保育中心加入梯度法之研究 65 4.2.1實驗目的 65 4.2.2 實驗場址及背景介紹 65 4.2.3氣象因子觀測 69 4.2.4.渦流協變性系統計算通量 73 4.2.5梯度法計算通量 80 4.2.6 Underway PCO2計算通量 85 4.2.7 比較渦流協變性系統與Underway PCO2系統與梯度法計算之二氧化碳通量 94 4.3案例三 : 於台南七股鄉魚塭比較ECS與UNDERWAY PCO2計算二氧化 碳通量之研究 96 4.3.1實驗目的 96 4.3.2 實驗場址及背景介紹 96 4.3.3氣象因子觀測 100 4.3.4.渦流協變性系統計算通量 104 4.3.5 Underway PCO2計算通量 107 4.3.6比較渦流協變性系統與Underway PCO2系統之二氧化碳通量 112 第五章 PKT校正法 114 5.1 原理說明 114 5.2 案例一加入PKT校正 114 5.3案例三加入PKT校正 116 5.4PKT校正法離群值的原因 118 5.4.1案例一:非離群值存在 118 第六章 傳統PCO2通量計算法加入PH參數 121 第七章 結論與建議 126 7.1結論 126 7.2建議 128 參考文獻 12

A Novel Contrast Enhancement Technique on Palm Bone Images

Contrast enhancement plays a fundamental role in image processing. Many histogram-based techniques are widely used for contrast enhancement of given images, due to their simple function and effectiveness. However, the conventional histogram equalization (HE) methods result in excessive contrast enhancement, which causes natural looking and satisfactory results for a variety of low contrast images. To solve such problems, a novel multi-histogram equalization technique is proposed to enhance the contrast of the palm bone X-ray radiographs in this paper. For images, the mean-variance analysis method is employed to partition the histogram of the original grey scale image into multiple sub-histograms. These histograms are independently equalized. By using this mean-variance partition method, a proposed multi-histogram equalization technique is employed to achieve the contrast enhancement of the palm bone X-ray radiographs. Experimental results show that the multi-histogram equalization technique achieves a lower average absolute mean brightness error (AMBE) value. The multi-histogram equalization technique simultaneously preserved the mean brightness and enhanced the local contrast of the original image

Multi-objective optimization of an on-road bicycle frame by uniform design and compromise programming

With the rapid changes in manufacturing technology of bicycle, the safety and performance of a bicycle are important and remarkable research subjects. In this study, an innovative and integrated optimization procedure for multi-objective optimization of an on-road bicycle frame is presented. The multiple objectives are to reduce the bicycle frame’s permanent deformations and to decrease the bicycle frame’s mass. First, uniform design of experiments is applied to create a set of sampling points in the design space of control factors. Second, three-dimensional solid models of bicycle frames are constructed and permanent deformations of bicycle frames under dropping-mass and dropping-frame impact test simulations are measured by ANSYS and ANSYS/LS-DYNA. Third, Kriging interpolation is used to transform the discrete relations between input control factors and output measures to continuous surrogate models. Fourth, compromise programming and mixture uniform design of experiments are used to integrate the multiple-objective functions into one compromise objective function. Finally, generalized reduced gradient algorithm is employed to solve the optimization problem. After executing the innovative optimization procedure, an optimized on-road bicycle frame is obtained. Comparing with the original design, the frame’s permanent deformations and mass are reduced. Therefore, both consolidation and lightweight of on-road bicycle frame are achieved