Comparative analysis of outcomes after multiport and single-port laparoscopic colectomy in emergency situations: Is single-port laparoscopic colectomy safe and feasible?

SummaryBackground/ObjectiveAlthough consensus has been reached on the superiority of laparoscopy for a majority of conditions underlying acute abdominal pain, the safety and feasibility of single-port laparoscopic colectomy (SPLC) in emergency situations have not been determined.MethodsA prospective electronic database of all emergency patients who underwent either multiport laparoscopic colectomy (MPLC) or SPLC between April 2006 and December 2014 was used to compare the surgical outcomes of these operative methods.ResultsDuring the study period, 31 MPLCs and 76 SPLCs were performed. These two operative methods resulted in similar operating times, transfusion amounts, lengths of stay, postoperative complications, attainment of lymph nodes, and proximal and distal cut margins. However, the SPLC group had a shorter time to first flatus (2.8±1.9 days vs. 3.8±1.5 days, p=0.005), earlier reinitiation of free oral fluids (3.2±2.1 days vs. 4.4±1.8 days, p=0.002), and lesser requirement of narcotic analgesics (2.5±3.9 times vs. 4.7±4.8 times, p=0.017).ConclusionSPLC could be a safe and effective alternative to MPLC, even in emergency situations when performed by surgeons who have overcome the learning curve associated with single-port laparoscopic techniques. The tendency toward earlier returns to bowel function and decreased incidence of postoperative analgesic use would be potential benefits of SPLC in emergency situations

Enhanced magnetic and thermoelectric properties in epitaxial polycrystalline SrRuO3 thin film

Transition metal oxide thin films show versatile electrical, magnetic, and thermal properties which can be tailored by deliberately introducing macroscopic grain boundaries via polycrystalline solids. In this study, we focus on the modification of the magnetic and thermal transport properties by fabricating single- and polycrystalline epitaxial SrRuO3 thin films using pulsed laser epitaxy. Using epitaxial stabilization technique with atomically flat polycrystalline SrTiO3 substrate, epitaxial polycrystalline SrRuO3 thin film with crystalline quality of each grain comparable to that of single-crystalline counterpart is realized. In particular, alleviated compressive strain near the grain boundaries due to coalescence is evidenced structurally, which induced enhancement of ferromagnetic ordering of the polycrystalline epitaxial thin film. The structural variations associated with the grain boundaries further reduce the thermal conductivity without deteriorating the electronic transport, and lead to enhanced thermoelectric efficiency in the epitaxial polycrystalline thin films, compared with their single-crystalline counterpart.Comment: 24 pages, 5 figure

The Characteristics of Metallo-β-Lactamase-Producing Gram-Negative Bacilli Isolated from Sputum and Urine: A Single Center Experience in Korea

Metallo-β-lactamase (MBL) production usually results in high-level resistance to most β-lactams, and a rapid spread of MBL producing major gram-negative pathogens is a matter of particular concern worldwide. However, clinical data are scarce and most studies compared MBL producer (MP) with MBL non-producer (MNP) strains which included carbapenem susceptible isolates. Therefore, we collected clinical data of patients in whom imipenem-nonsusceptible Pseudomonas aeruginosa (PA) and Acinetobacter baumannii (AB) were isolated from sputum or urine, and investigated MBL production and the risk factors related with MBL acquisition. The antimicrobial susceptibility patterns were also compared between MPs and imipenem-nonsusceptible MNPs (INMNP). Among the 176 imipenem-nonsusceptible isolates, 12 MPs (6.8%) were identified. There was no identifiable risk factor that contributed to the acquisition of MPs when compared to INMNPs, and case-fatalities were not different between the two groups. The percentage of susceptible isolates was higher among MPs for piperacilin/tazobactam and fluoroquinolones while that of ceftazidime was higher in INMNPs (p < 0.05). As regards to aztreonam, which has been known to be a uniquely stable β-lactam against MBLs, susceptibility was preserved in only two isolates (16.7%) among MPs, and was not higher than that of INMNPs (23.2%). In conclusion, the contribution of MBLs to imipenem non-susceptibility in PA/ABs isolated from sputum and urine was relatively limited, and there was no significant risk factor associated with acquisition of MPs compared with INMNPs. However, limited susceptibility to aztreonam implies that MPs may hold additional resistance mechanisms, such as extended spectrum β-lactamases, AmpC β-lactamases, or other non-enzymatic mechanisms

Evaluation of a Sodium–Water Reaction Event Caused by Steam Generator Tubes Break in the Prototype Generation IV Sodium-cooled Fast Reactor

AbstractThe prototype generation IV sodium-cooled fast reactor (PGSFR) has been developed by the Korea Atomic Energy Research Institute. This reactor uses sodium as a reactor coolant to transfer the core heat energy to the turbine. Sodium has chemical characteristics that allow it to violently react with materials such as a water or steam. When a sodium–water reaction (SWR) occurs due to leakage or breakage of steam generator tubes, high-pressure waves and corrosive reaction products are produced, which threaten the structural integrity of the components of the intermediate heat-transfer system (IHTS) and the safety of the primary heat-transfer system (PHTS). In the PGSFR, SWR events are included in the design-basis event. This event should be analyzed from the viewpoint of the integrities of the IHTS and fuel rods. To evaluate the integrity of the IHTS based on the consequences of the SWR, the behaviors of the generated high-pressure waves are analyzed at the major positions of a failed IHTS loop using a sodium–water advanced analysis method-II code. The integrity of the fuel rods must be consistently maintained below the safety acceptance criteria to avoid the consequences of the SWR. The integrity of the PHTS is evaluated using the multidimensional analysis of reactor safety-liquid metal reactor code to model the whole plant

Enhanced magnetic and thermoelectric properties in epitaxial polycrystalline SrRuO3 thin film

Transition metal oxide thin films show versatile electrical, magnetic, and thermal properties which can be tailored by deliberately introducing macroscopic grain boundaries via polycrystalline solids. In this study, we focus on the modification of the magnetic and thermal transport properties by fabricating single- and polycrystalline epitaxial SrRuO3 thin films using pulsed laser epitaxy. Using epitaxial stabilization technique with atomically flat polycrystalline SrTiO3 substrate, epitaxial polycrystalline SrRuO3 thin film with crystalline quality of each grain comparable to that of single-crystalline counterpart is realized. In particular, alleviated compressive strain near the grain boundaries due to coalescence is evidenced structurally, which induced enhancement of ferromagnetic ordering of the polycrystalline epitaxial thin film. The structural variations associated with the grain boundaries further reduce the thermal conductivity without deteriorating the electronic transport, and lead to enhanced thermoelectric efficiency in the epitaxial polycrystalline thin films, compared with their single-crystalline counterpart.Comment: 24 pages, 5 figure

Factors Associated with HIV-1 Proviral DNA Loads in Patients with Undetectable Plasma RNA Load

To evaluate factors associated with human immunodeficiency virus type 1 (HIV-1) proviral DNA load, we conducted a cross-sectional study of 36 chronically HIV-1-infected individuals with undetectable plasma viral RNA. We used real-time polymerase chain reaction to determine the number of HIV-1 proviral DNA copies per 106 peripheral blood mononuclear cells. The mean level of plasma viral RNA when the CD4+ T cell count was above 500 cells/µL without highly active antiretroviral therapy (HAART) was significantly associated with proviral DNA load at the time of undetectable plasma HIV RNA with HAART. Strategies to reduce the level of plasma viral RNA when patients' CD4+ T cell counts are above 500 cells/µL without HAART could help reduce HIV-1 proviral DNA load

Optimal Continuous Positive Airway Pressure Level in Korean Patients with Obstructive Sleep Apnea Syndrome

ObjectivesThe aim of this study was to investigate optimal continuous positive airway pressure (CPAP) level, to examine the factors affecting optimal CPAP level, and to develop a predictive equation for optimal CPAP level in Korean patients with obstructive sleep apnea syndrome (OSAS).MethodsA total of 202 patients with OSAS who underwent successful manual titration for CPAP treatment were included in this study. Correlations between the optimal CPAP level and baseline data including anthropometric and polysomnographic variables were analyzed. A predictive equation for optimal CPAP level was developed based on anthropometric and polysomonographic data.ResultsThe mean optimal CPAP level in 202 patients with OSAS was 7.8±2.3 cm H2O. The mean optimal CPAP level in the mild, moderate, and severe OSAS groups was 6.0±1.3, 7.4±1.9, and 9.1±2.1 cm H2O, respectively. The apneahypopnea index (AHI) (r=0.595, P<0.001), arousal index (r=0.542, P<0.001), minimal SaO2 (r=-0.502, P<0.001), body mass index (BMI) (r=0.494, P<0.001), neck circumference (r=0.265, P<0.001), and age (r=-0.164, P=0.019) were significantly correlated with optimal CPAP level. The best predictive equation according to stepwise multiple linear regression analysis was: Optimal CPAP level (cm H2O)=0.681+(0.205×BMI)+(0.040×AHI). Forty-two percent of the variance in the optimal CPAP level was explained by this equation (R2=0.42, P<0.001).ConclusionA predictive equation for optimal CPAP level in Korean patients with OSAS was developed using AHI and BMI, which can be easily measured during the diagnostic process

Clinical Review of Endogenous Endophthalmitis in Korea: A 14-Year Review of Culture Positive Cases of Two Large Hospitals

PURPOSE: To identify the clinical features and outcomes of endogenous endophthalmitis in Korea. MATERIALS AND METHODS: We reviewed 18 patients with endogenous endophthalmitis at 2 Korean hospitals, treated over a 14 year period between January 1993 and December 2006. RESULTS: The comorbidities observed in these cases were diabetes mellitus and liver cirrhosis. The most common pathogens, which were found in 7 patients each (38.9%), were Klebsiella pneumonia and Pseudomonas aeruginosa. All patients were treated with systemic antibiotics and fortified topical antibiotics. A surgical approach including vitrectomy was performed in 9 cases (50.0%). The prognosis was generally poor, and visual acuity improved slightly in 6 patients (33.3%). CONCLUSION: In this study, diabetes mellitus and Klebsiella pneumonia showed a close relationship with endogenous endophthalmitis, respectively. Endogenous endophthalmitis is a serious risk to sight and careful attention to establishing the diagnosis and management may decrease the ocular morbidity.ope