The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

Background. The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA. Methods. Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale. Results. The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery. Conclusion. This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale

Sorafenib for hepatocellular carcinoma patients beyond Milan criteria after orthotopic liver transplantation: a case control study

<p>Abstract</p> <p>Background</p> <p>Orthotopic liver transplantation (OLT) is one of the most effective treatments for patients with hepatocellular carcinoma (HCC) within the Milan criteria. However, for patients beyond these criteria, the recurrence rate is higher and the prognosis is worse. Sorafenib is the only drug showing survival benefits in advanced HCC patients; however, its role in patients beyond the Milan criteria after OLT remains unclear and requires further investigation.</p> <p>Methods</p> <p>As a case-control study, we retrospectively analyzed 17 Chinese patients beyond Milan criteria undergoing OLT for HCC. These patients were stratified into adjuvant (n = 5), palliative (n = 6), and control groups (n = 6).</p> <p>Results</p> <p>Nine of 11 patients who received sorafenib after OLT needed dose reduction due to more than grade 2 side effects. The disease-free survival rates for patients with or without adjuvant sorafenib were 100% versus 37.5% (p = 0.034) at 6 months, 66.7% versus 9.4% (p = 0.026) at 12 months, and 66.7% versus 0.0% (p = 0.011) at 18 months, respectively. The overall survival rates for patients in palliative and control groups were 66.7% versus 40.0% (p = 0.248) at 6 months, 66.7% versus 40.0% (p = 0.248) at 12 months, and 50.0% versus 20.0% (p = 0.17) at 18 months, respectively. Patients in the adjuvant group had better overall survival rates than those in the palliative and control groups (p = 0.031) at 24-month follow-up.</p> <p>Conclusions</p> <p>Adjuvant sorafenib could possibly extend both disease-free and overall survival for HCC patients beyond Milan criteria after OLT.</p

Heparinization on pericardial substitutes can reduce adhesion and epicardial inflammation in the dog

AbstractObjective: Primary concerns about currently available pericardial substitutes include adhesion and epicardial reaction. The purpose of this study is to evaluate host reaction to pericardial substitutes with and without incorporating slow heparin release. Methods: To avoid biologic variation among these pericardial patches, we made a composite of six membranes. The composite membrane consisted of epoxy-fixed patches with (1) or without (2) ionically bound heparin, a glutaraldehyde-fixed patch with (3) or without (4) ionically bound heparin, an expanded polytetrafluoroethylene patch (5), and a polyester polymeric patch (6). Ten recipient dogs weighing from 12 to 19 kg (mean 13.6 kg) were used to assess the composite membranes as pericardial substitutes. The implanted composite membranes were retrieved 1 week (one dog), 2 weeks (one dog), 4 weeks (one dog), 8 weeks (one dog), and 12 weeks (six dogs) after implantation. Results: Overall, the synthetic patches had a more notable inflammatory reaction than the biologic patches with or without ionically bound heparin. The heparin-bound patches caused significantly less inflammation than their nonheparinized counterparts. The heparinized porcine patches cross-linked with different compounds were found to have less fibrous formation than the nonheparinized patches and the synthetic patches. Conclusions: Heparinized pericardial substitutes may cause less adhesion and inflammatory reaction than nonheparinized material. (J Thorac Cardiovasc Surg 1998;115:1111-20

Static behaviour of two-tiered Dou-Gong system reinforced by super-elastic alloy

Dou-Gong system in Asian timber structures play an important role in resisting seismic action. Traditional carpentry in Asia uses timber pegs to connect components which enables relative movement between components, and hence provide friction to dissipate energy in an earthquake. This method however has some short falls such as inadequate stiffness to resist large lateral force and therefore the structures tend to exhibit permanent deformation after the earthquakes. This study proposes a new technique by using super-elastic alloy bars to replace the conventional wooden peg connections to enhance the seismic performance of the structures. Static push-over experiments were conducted on full scaled two-tiered Dou-Gong systems and the high-strength steel and conventional wood pegs as benchmarks. The ultimate stiffness of Dou-Gong system has shown increase by using both high-strength steel and super-elastic alloy bars, but only super-elastic alloy can provide a consistent high damping ratio. This technique also involves pre-strain the super-elastic alloy and the outcomes of this series of experiments have shown that pre-strain in the super-elastic alloy can significantly increase the damping ratio in the structure and hence more energy is dissipated. The results of this paper can be used in the projects of timber structures with Dou-Gong system

Efficient Fuzzy C-Means Architecture for Image Segmentation

This paper presents a novel VLSI architecture for image segmentation. The architecture is based on the fuzzy c-means algorithm with spatial constraint for reducing the misclassification rate. In the architecture, the usual iterative operations for updating the membership matrix and cluster centroid are merged into one single updating process to evade the large storage requirement. In addition, an efficient pipelined circuit is used for the updating process for accelerating the computational speed. Experimental results show that the the proposed circuit is an effective alternative for real-time image segmentation with low area cost and low misclassification rate