Hepatocellular carcinoma detected by regular surveillance: Does timely confirmation of diagnosis matter?

AbstractBackgroundAlthough current guidelines recommended surveillance of hepatocellular carcinoma, prognosis in patients undergoing enhanced follow-up has yet to be evaluated.AimsExamine outcomes of hepatocellular carcinoma diagnosed during enhanced follow-up.MethodsDuring 2010–2012, 194 patients underwent ultrasonography surveillance were diagnosed with hepatocellular carcinoma and divided into: (A) immediate diagnosis (N=105, 54.1%) after positive ultrasonography, (B) enhanced follow-up: (N=38, 19.6%) for initial negative recall procedures, (C) late call back: (N=28, 14.4%) recall procedures were deferred after positive ultrasonography, and (D) beyond ultrasonography: (N=23, 11.9%) surveillance ultrasonography had been negative.ResultsMedian time from positive ultrasonography to confirmation of hepatocellular carcinoma were 9.5 months (2–67) in the Group B and 6.5 months (3–44) in the Group C. Stage distribution and 3-year survival rates were similar amongst all Groups. Surveillance intervals longer than 6 months were associated with the non-curative stage (3.7% vs. 12.5%, p=0.04). Nine (4.6%) patients underwent surveillance were diagnosed as Barcelona-Clinic Liver Cancer stage C.ConclusionEnhanced follow-up by current guidelines is appropriate that treatment can be deferred until a definite diagnosis. Despite optimal surveillance interval and recall policies, few non-curative stage diagnoses seemed inevitable under current standard of care

A Simple Model for Cavity Enhanced Slow Lights in Vertical Cavity Surface Emission Lasers

We develop a simple model for the slow lights in Vertical Cavity Surface Emission Lasers (VCSELs), with the combination of cavity and population pulsation effects. The dependences of probe signal power, injection bias current and wavelength detuning for the group delays are demonstrated numerically and experimentally. Up to 65 ps group delays and up to 10 GHz modulation frequency can be achieved in the room temperature at the wavelength of 1.3 $\mu$m. The most significant feature of our VCSEL device is that the length of active region is only several $\mu$m long. Based on the experimental parameters of quantum dot VCSEL structures, we show that the resonance effect of laser cavity plays a significant role to enhance the group delays

Adoption of mobile applications for identifying tourism destinations by travellers: an integrative approach

The purpose of the study is to provide an assessment of both how consumers adopt mobile tourism apps and how consumers use those apps to orient customer intentions to visit tourism destinations. The technology acceptance model (TAM) is used to explore customer intentions to adopt tourism apps. A survey of 630 tourism respondents found that the e-servicescape environment and e-word-of-mouth communication play major roles in determining intentions to adopt tourism apps and to visit tourism destinations. Perceived ease of use and perceived usefulness tend to be moderators of the effects of the e-servicescape environment and e-word-of-mouth communication on attitudes towards using apps. The results may be important references to conduct further validations, and critical for marketing managers when designing specific criteria to enhance mobile apps and their adoption. The different managerial implications – including apps to differential marketing tools, improving attitudes towards using tourism apps, and segmenting customers in order to design marketing strategies – are considered

The Liquid Sensor Using Thin Film Bulk Acoustic Resonator with C-Axis Tilted AlN Films

Dual-mode thin film bulk acoustic resonator (TFBAR) devices are fabricated with c-axis tilted AlN films. To fabricate dual-mode TFBAR devices, the off-axis RF magnetron sputtering method for the growth of tilted piezoelectric AlN thin films is adopted. In this report, the AlN thin films are deposited with tilting angles of 15° and 23°. The frequency response of the TFBAR device with 23° tilted AlN thin film is measured to reveal its ability to provide dual-mode resonance. The sensitivities of the longitudinal and shear modes to mass loading are calculated to be 2295 Hz cm2/ng and 1363 Hz cm2/ng with the mechanical quality factors of 480 and 287, respectively. The sensitivities of the longitudinal and shear modes are calculated to be 0 and 15 Hz cm2/μg for liquid loading

Clinical significance of erythromycin-resistant Campylobacter jejuni in children

Campylobacter has been recognized as the common cause of bacterial gastroenteritis in many countries. Increasing erythromycin resistance in Campylobacter jejuni infection is noted recently, but severe case was rarely reported. In this study, we aimed to clarify the clinical significance of the resistant strain of C jejuni in children. We reviewed the charts of children who were diagnosed with C jejuni enteritis in our hospital from January 2000 to December 2005, including 326 patients (117 males and 209 females). All the cases had positive stool culture. We divided them into two groups, the sensitive group (a total of 306 cases) and resistant group (a total of 20 cases), according to the drug sensitivity. We analyzed the clinical manifestations and laboratory data between the two groups. The mean age was 3.79±3.24 years in the sensitive group and 3.03±2.84 years in the resistant group. There was no significant difference between the two groups in clinical presentations and laboratory examinations. No mortality was found, and one case was initially presented with colonic perforation. This report demonstrates that infection by erythromycin-resistant strains of C jejuni has no clinical significance in children, despite the probably increased emergence of erythromycin resistance

Comparing the outcomes of two strategies for colorectal tumor detection: Policy-promoted screening program versus health promotion service

AbstractBackgroundThe Taiwanese government has proposed a population-based colorectal tumor detection program for the average-risk population. This study's objectives were to understand the outcomes of these screening policies and to evaluate the effectiveness of the program.MethodsWe compared two databases compiled in one medical center. The “policy-promoted cancer screening” (PPS) database was built on the basis of the policy of the Taiwan Bureau of National Health Insurance for cancer screening. The “health promotion service” (HPS) database was built to provide health check-ups for self-paid volunteers. Both the PPS and HPS databases employ the immunochemical fecal occult blood test (iFOBT) and colonoscopy for colorectal tumor screening using different strategies. A comparison of outcomes between the PPS and HPS included: (1) quality indicators—compliance rate, cecum reaching rate, and tumor detection rate; and (2) validity indicators—sensitivity, specificity, positive, and negative predictive values for detecting colorectal neoplasms.ResultsA total of 10,563 and 1481 individuals were enrolled in PPS and HPS, respectively. Among quality indicators, there was no statistically significant difference in the cecum reaching rate between PPS and HPS. The compliance rates were 56.1% for PPS and 91.8% for HPS (p < 0.001). The advanced adenoma detection rates of PPS and HPS were 1.0% and 3.6%, respectively (p < 0.01). The carcinoma detection rates were 0.3% and 0.4%, respectively (p = 0.59). For validity indicators, PPS provides only a positive predictive value for colorectal tumor detection. HPS provides additional validity indicators, including sensitivity, specificity, positive predictive value, and negative predictive value, for colorectal tumor screening.ConclusionIn comparison with the outcomes of the HPS database, the screening efficacy of the PPS database is even for detecting colorectal carcinoma but is limited in detecting advanced adenoma. HPS may provide comprehensive validity indicators and will be helpful in adjusting current policies for improving screening performance