Effects of nerve-sparing procedures on surgical margins after robot-assisted radical prostatectomy

BACKGROUND: Nerve-sparing (NS) techniques could potentially increase positive surgical margins (PSM) after robot-assisted radical prostatectomy (RARP). Nevertheless, the available studies have revealed ambiguous results among distinct groups. This study purposed to clarify the details of NS techniques to accurately estimate their influence on margin status. METHODS: We studied RARPs performed by one surgeon from 2010 to 2018. Surgical margins were evaluated by the laterality and levels of NS techniques in site-specific prostate lobes. The multivariable analysis evaluated the effects of nerve-sparing procedures, combined with other covariate factors, on margin status. RESULTS: Overall, four hundred nineteen RARPs involving 838 prostate lobes were analyzed. Notably, 181 patients (43.4%) had pT2-stage, and 236 (56.6%) had pT3-stage cancer. The PSM rates for patients who underwent unilateral, bilateral, and non NS procedures were 30.3%, 28.8%, and 50%, respectively (p = 0.233) or in stratification by pT2 (p = 0.584) and pT3 (p = 0.116) stage. The posterolateral PSM rates among site-specific prostate lobes were 10.9%, 22.4%, and 18.9% for complete, partial, and non NS techniques, respectively (p = 0.001). The partial NS group revealed a significant increase in PSM rate compared with the complete NS (OR 2.187, 95% CI 1.19-4.03) and non NS (OR 2.237, 95% CI 1.01-4.93) groups in site-specific prostate lobes. CONCLUSION: Partial NS procedures have a potential risk of increasing the PSM rate than complete and non NS procedures do. Therefore, correct case selection is required before performing partial NS techniques

Unusual dyspnea in a hemodialysis patient: A case report

The typical clinical symptoms of hemothorax include a rapid development of chest pain or dyspnea, which may be life-threatening without immediate management. As we know, spontaneous hemothorax, a collection of blood within the pleural cavity without previous history of trauma or other cause, which usually onsets suddenly. The early and accurate diagnosis of spontaneous hemothorax is imperative in clinical practice. We reported a middle-age male undergoing regular hemodialysis was referred to our emergency department due to unknown cause of dyspnea and acute respiratory failure. Chest radiography revealed bilateral patchy infiltration of lung. Pleural tap analysis showed exudative pleural effusion with numerous red blood cells. Video-assisted thoracic surgery (VATS) were performed and confirmed the final diagnosis of spontaneous hemothorax. He was then successfully treated with the surgery of VATS combined chest tube thoracostomy

Cerebral hemorrhagic infarction following cranioplasty in a shunted patient with tension pneumocephalus resulting from depressed skull and craniodural defect

SummaryA 34-year-old female sustained a severe traumatic brain injury that was treated with decompressive craniectomy and subsequent cranioplasty, then with ventriculoperitoneal shunt about 10 years previously. However, the skull flap was found to be depressed ever since. She was admitted to our hospital for a headache and left hemiparesis with sudden onset. The computed tomography scan displayed tension pneumocephalus in the right frontoparietal region. First, she underwent emergency burr hole drainage and placement of a subdural drain with external ventricular drainage tube. Then her symptoms improved considerably. Unfortunately, 6 months later she was admitted again to our hospital because of headache and left hemiparesis with sudden onset, and the brain computed tomography showed tension pneumocephalus in the right frontoparietal region. She underwent craniectomy to remove the previous depressed skull and simultaneous cranioplasty with Ti-Mesh. On the day of her operation, generalized seizure occurred and her consciousness deteriorated. The magnetic resonance imaging showed hemorrhagic infarction on both sides of the thalamus and the right parieto-occipital region. We think it probable that a sudden increase of cerebral blood flow in the cerebral hemisphere where the cranioplasty had been performed caused reperfusion injury and resulted in hemorrhagic infarction

Oxaliplatin-induced acquired long QT syndrome with torsades de pointes and myocardial injury in a patient with dilated cardiomyopathy and rectal cancer

AbstractA 67-year-old woman presented with a history of dilated cardiomyopathy with congestive heart failure since 2003, who subsequently developed lower rectal cancer (adenocarcinoma) with liver, bone, and lymph node metastasis. Abdominoperineal resection and hepatectomy were performed. The patient received two rounds of intravenous chemotherapy, including 12 and six courses of FOLFOX4 (5-fluorouracil, leucovorin, and oxaliplatin; 85 mg/m2 per cycle). She underwent a third round of intravenous FOLFOX4 because of tumor progression. During the 21st course of FOLFOX4 regimen, the patient developed ST segment depression in lead II and prolongation of QT interval with polymorphic ventricular tachycardia, torsades de pointes right after the start of oxaliplatin infusion. Immediate defibrillation and cardiopulmonary resuscitation were administered, and the patient regained spontaneous circulation and consciousness. Twelve-lead electrocardiogram showed ST segment elevation in III, aVF, and ST segment depression in V4–6 after resuscitation. To our knowledge, prolongation of QT interval with torsades de pointes and coronary spasm with myocardial injury that were stabilized in one patient following oxaliplatin infusion has not been reported. We present a patient with these rare complications

Whole-body vibration training effect on physical performance and obesity in mice

The purpose of this study was to verify the beneficial effects of whole-body vibration (WBV) training on exercise performance, physical fatigue and obesity in mice with obesity induced by a high-fat diet (HFD). Male C57BL/6 mice were randomly divided into two groups: normal group (n=6), fed standard diet (control), and experimental group (n=18), fed a HFD. After 4-week induction, followed by 6-week WBV of 5 days per week, the 18 obese mice were divided into 3 groups (n=6 per group): HFD with sedentary control (HFD), HFD with WBV at relatively low-intensity (5.6 Hz, 0.13 g) (HFD+VL) or high-intensity (13 Hz, 0.68 g) (HFD+VH). A trend analysis revealed that WBV increased the grip strength in mice. WBV also dose-dependently decreased serum lactate, ammonia and CK levels and increased glucose level after the swimming test. WBV slightly decreased final body weight and dose-dependently decreased weights of epididymal, retroperitoneal and perirenal fat pads and fasting serum levels of alanine aminotransferase, CK, glucose, total cholesterol and triacylglycerol. Therefore, WBV could improve exercise performance and fatigue and prevent fat accumulation and obesity-associated biochemical alterations in obese mice. It may be an effective intervention for health promotion and prevention of HFD-induced obesity

Ultrasound sonication with microbubbles disrupts blood vessels and enhances tumor treatments of anticancer nanodrug

Ultrasound (US) sonication with microbubbles (MBs) has the potential to disrupt blood vessels and enhance the delivery of drugs into the sonicated tissues. In this study, mouse ear tumors were employed to investigate the therapeutic effects of US, MBs, and pegylated liposomal doxorubicin (PLD) on tumors. Tumors started to receive treatments when they grew up to about 15 mm3 (early stage) with injection of PLD 10 mg/kg, or up to 50 mm3 (medium stage) with PLD 6 (or 4) mg/kg. Experiments included the control, PLD alone, PLD + MBs + US, US alone, and MBs + US groups. The procedure for the PLD + MBs + US group was that PLD was injected first, MB (SonoVue) injection followed, and then US was immediately sonicated on the tumor. The results showed that: (1) US sonication with MBs was always able to produce a further hindrance to tumor growth for both early and medium-stage tumors; (2) for the medium-stage tumors, 6 mg/kg PLD alone was able to inhibit their growth, while it did not work for 4 mg/kg PLD alone; (3) with the application of MBs + US, 4 mg/kg PLD was able to inhibit the growth of medium-stage tumors; (4) for early stage tumors after the first treatment with a high dose of PLD alone (10 mg/kg), the tumor size still increased for several days and then decreased (a biphasic pattern); (5) MBs + US alone was able to hinder the growth of early stage tumors, but unable to hinder that of medium stage tumors. The results of histological examinations and blood perfusion measurements indicated that the application of MBs + US disrupts the tumor blood vessels and enhances the delivery of PLD into tumors to significantly inhibit tumor growth

Continuous Production of Lipase-Catalyzed Biodiesel in a Packed-Bed Reactor: Optimization and Enzyme Reuse Study

An optimal continuous production of biodiesel by methanolysis of soybean oil in a packed-bed reactor was developed using immobilized lipase (Novozym 435) as a catalyst in a tert-butanol solvent system. Response surface methodology (RSM) and Box-Behnken design were employed to evaluate the effects of reaction temperature, flow rate, and substrate molar ratio on the molar conversion of biodiesel. The results showed that flow rate and temperature have significant effects on the percentage of molar conversion. On the basis of ridge max analysis, the optimum conditions were as follows: flow rate 0.1 mL/min, temperature 52.1°C, and substrate molar ratio 1 : 4. The predicted and experimental values of molar conversion were 83.31 ± 2.07% and 82.81 ± .98%, respectively. Furthermore, the continuous process over 30 days showed no appreciable decrease in the molar conversion. The paper demonstrates the applicability of using immobilized lipase and a packed-bed reactor for continuous biodiesel synthesis

Integration and Application of a Fiber-Optic Sensing System for Monitoring Debris Flows

This study presents an innovative fiber-optic sensing system for monitoring debris flows. The system mainly comprises an interrogator and four fiber Bragg grating accelerometers. The field tests show that signal-to-noise-ratio (SNR) of the fiber-optic sensor is 10 dB higher than that of a geophone. Following confirmation of the reliability of the proposed sensing system, the systems are deployed along the Ai-Yu-Zi and Chu-Shui Creeks in Nautou County, Taiwan, for monitoring debris flows. The four accelerometers are installed in series. The systems have detected several debris flows in 2012. The monitored data reveal that the frequency range of the acceleration of ground vibration is 10-150 Hz, which is the same as that of the velocity of ground vibration detected by a sensing system that includes geophones. Because the fiber-optic sensing system is more sensitive than the geophone system, the proposed fiber-optic sensing system is highly promising for use in monitoring natural disasters that generate ground vibrations.本研究藉由組合光纖光柵加速度計、解調儀、及其他相關元件，發展一套可偵測土 石流之光纖感測系統。現地測試結果顯示，與目前常用含地聲檢知器的土石流感測系統相較， 本系統所測得地表振動訊號之訊雜比比前者高10 dB。在測試系統量測效能後，將此系統分別 架設於南投縣信義鄉神木村之愛玉子溪及出水溪上。系統中採串連方式配置四個光纖加速度 計，並於2012 年監測到多場土石流。觀測結果顯示，光纖感測系統所測得土石流所造成地表 振動之加速度，與過去地聲檢知器所測得土石流地表振動速度，兩者頻率一樣，均為10–150 Hz。由於光纖光柵加速度計相較於地聲檢知器更為靈敏，因此，除了可應用於偵測土石流外， 也可應用於監測會產生地表振動的其他坡地災害，如：落石及山崩等