Laparoscopic transdiaphragmatic RFA for hepatic tumor

Background: It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported. Methods: Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months. Results: The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients. Conclusions: Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence

Fault Location Analysis of Ungrounded Distribution System Based on Residual Voltage Distribution

AbstractThis paper proposes a new method for determining the location of single-phase-toground faults of ungrounded distribution systems based on residual voltage distribution. The possible faulted line segment and fault location are determined by comparing the phase angles of faulted phase voltages against a faulted phase reference angle, and the faulted phase voltages are determined as the difference between the fault caused residual voltage of all phases and the shunt caused residual voltage of un-faulted phases. The method determines the fault location solely based on the voltages and currents measured during the fault, and associated series impedance and shunt impedances of line segments. It does not require any measurements or information for the load demands and pre-fault conditions. Numerical examples are given to demonstrate the effectiveness of the proposed method

Elemental Diet in Lap Colon

Purpose: An amino acid-containing elemental diet (ED) does not require digestion for nutritional absorption, making it a good option for patients with gastrointestinal malabsorption. We conducted a randomized trial to confirm that perioperative ED enhanced the recovery of patients undergoing laparoscopic colectomy. Methods: Patients in the intervention arm received commercially available ED from the day prior to surgery until postoperative day (POD) 3, whereas patients in the control group received a conventional perioperative diet program. To verify the endpoints, "estimated minimum length of stay in hospital after surgery" (emLOS) was defined as the number of days necessary to reach all the five criteria; namely, "sufficient oral intake", "sufficient pain control", "withdrawal of intravenous alimentation", "no abnormal findings in routine examinations", and "no rise in fever". Results: A total of 102 patients were randomized, 94 of whom were analyzed (ED 45, control 49). There was no morbidity or mortality. Shorter emLOS (POD 4 vs. POD 7; p = 0.018), earlier resumption of sufficient oral intake (POD 3 vs. POD 4; p = 0.034) and faster recovery to defecation (2.2 vs. 3.1 days; p = 0.005) were observed in the ED group vs. the control group. Conclusions: The perioperative ingestion of ED by patients undergoing laparoscopic colectomy is safe and can reduce the postoperative hospital stay by supporting the acceleration of oral intake

Evaluation of dry matter production and yield in early-sown wheat using near-isogenic lines for the vernalization locus Vrn-D1

Wheat (Triticum aestivum L.) grain yield is predicted to decrease in the future because of an increase in air temperature globally. To clarify the effects of the vernalization response gene in wheat to warmer winters, we compared dry matter production and grain yield between spring wheat ‘Asakazekomugi’ and its winter-type near-isogenic line (NIL) carrying different alleles of the vernalization response gene Vrn-D1 under early-, standard-, and late-sowing conditions. Under early-sowing conditions, dry matter production of the NIL carrying the winter allele of Vrn-D1, named Asa (Vrn-D1b), exceeded that of ‘Asakazekomugi’ from mid-March (after stem elongation in Asa (Vrn-D1b)) when the temperatures rose. Tiller number and leaf area index under early-sowing conditions were consistently higher in Asa (Vrn-D1b) than in ‘Asakazekomugi’ from mid-March onward. It was suggested that the early-sown ‘Asakazekomugi’ could not effectively absorb solar radiation to produce dry matter because of the acceleration of stem elongation caused by the Vrn-D1 gene during the cold season. The grain yield of Asa (Vrn-D1b) with early sowing was higher than with standard sowing. In contrast, the grain yield of ‘Asakazekomugi’ was lower in the early-sown crop than in the crop sown at the standard date. These results suggested that the higher grain yield of Asa (Vrn-D1b) than that of ‘Asakazekomugi’ under early-sown conditions could be due to Asa (Vrn-D1b) maintaining high dry matter production after the jointing stage by suppressing acceleration of growth caused by warm conditions after sowing. Abbreviations CGR: crop growth rate; HI: harvest index; LAI: leaf area index; NIL: near-isogenic line; SNP: single-nucleotide polymorphis