Nationwide Multicenter Survey for Current Status of Endoscopic Thyroidectomy in Korea

ObjectivesWe evaluated the current status of endoscopic thyroidectomy procedures in Korea in terms of indications, contraindications, advantages, disadvantages, complications, and limitations of each approach.MethodsAn email survey, consisting of 15 questions, was sent to 29 experienced endoscopic thyroidectomy surgeons.ResultsThe most commonly used approach was the gasless transaxillary approach (66.7%), followed by the bilateral axillo-breast approach with gas insufflation (23.8%). The most common indication was less than 1 cm, single papillary thyroid cancer. The role of endoscopic thyroidectomy is not still established; some consider it a novel procedure (34.8%), others a transition to robotic thyroidectomy (34.8%).ConclusionOur results shed light on the general consensus of opinions about endoscopic thyroidectomy, such as the advantages, disadvantages, complications, limitations, and even its future role

Association between volume status assessed by bioelectrical impedance analysis, lung ultrasound, or weight change and mortality in patients with sepsis-associated acute kidney injury receiving continuous kidney replacement therapy

Background Fluid overload is an independent risk factor of mortality in patients with acute kidney injury (AKI) receiving continuous kidney replacement therapy (CKRT). However, the association between fluid status, as assessed by bioelectrical impedance analysis (BIA) or lung ultrasound, and survival in patients with AKI requiring CKRT has not been established. Methods We analyzed 36 participants with sepsis-associated AKI who received CKRT at a tertiary hospital. The main exposures were volume surrogates: 1) overhydration normalized by extracellular water (OH/ECW, L/L) assessed by BIA, 2) the number of B-lines measured by lung ultrasound, and 3) weight change ([body weight at CKRT initiation – body weight at admission] × 100/body weight at admission). The primary outcome was the 28-day mortality. Results Seventeen participants (47.2%) died within 28 days. There were no significant correlations between OH/ECW and weight change (R2 = 0.040, p = 0.24), number of B-lines and OH/ECW (R2 = 0.056, p = 0.16), or weight change and number of B-lines (R2 = 0.014, p = 0.49). Kaplan-Meier analyses revealed that patients in the highest tertile of OH/ECW showed a significantly lower cumulative 28-day survival probability than the others (the lowest + middle tertiles). The survival probability of participants in the highest tertile of the number of B-lines or weight change did not differ from that of their counterparts. In a multivariate Cox proportional hazard model, the hazard ratio for the highest tertile of OH/ECW was 3.83 (95% confidence interval, 1.04–14.03). Conclusion Volume overload assessed using BIA (OH/ECW) was associated with the 28-day survival rate in patients with sepsis-associated AKI who received CKRT

Optical biochemical sensor based on half-circled microdisk laser diode

In this study, a half-circled cavity based microdisk laser diode is proposed and demonstrated experimentally for an integrated photonic biochemical sensor. Conventional microdisk sensors have limitations in optical coupling and reproducibility. In order to overcome these drawbacks, we design a novel half-circled micro disk laser (HC-MDL) which is easy to manufacture and has optical output directionality. The Q-factor of the fabricated HC-MDL was measured as 7.72 × 106 using the self-heterodyne method and the side mode suppression ratio was measured as 23 dB. Moreover, gas sensing experiments were performed using the HC-MDL sensor. A wavelength shift response of 14.21 pm was obtained for 100 ppb dimethyl methylphosphonate (DMMP) gas and that of 14.70 pm was obtained for 1 ppm ethanol gas. These results indicate the possibility of highly sensitive gas detection at ppb levels using HC-MDL. This attractive feature of the HC-MDL sensor is believed to be very useful for a wide variety of optical biochemical sensor applications. © 2017 Optical Society of America.1

Mechanisms of an extraordinary East Asian summer monsoon event in July 2011

Previous studies have demonstrated that the strong East Asian summer monsoon results mainly from the westward intensification of the North Pacific subtropical high (NPSH), or equivalently, the enhancement of the western North Pacific subtropical high. However, during early July in 2011 a strong southerly or southeasterly moist flow gave rise to a large amount of precipitation over southwestern Japan and Korea and anomalous dry conditions over central China because of the extraordinary intensification of the NPSH to the north. The formation of the anomalous high that occurred to the east of central Japan during early July is very rare, and its physical mechanisms are investigated in this study. The regressed circulation anomalies and wave-activity flux vectors for July 2011 and data from the previous 32 years show that two teleconnection patterns due to Rossby wave trains are the most important mechanisms: Rossby wave propagation from the eastern North Atlantic and western Europe to East Asia following the North Eurasian jet and East Asian jet in the upper level, and northward propagation of Rossby waves forced by diabatic heating over the western North Pacific (WNP) region in the lower level. This simultaneous forcing of a significant negative phase of the summertime North Atlantic Oscillation in the higher latitudes and enhanced diabatic heating over the subtropical WNP is found to be the cause of the abnormal development of the anomalous high to the east of central Japan, resulting in extremely wet conditions in Korea and southern Japan and dry conditions in southern China

Good Glycemic Control Is Associated with Better Survival in Diabetic Patients on Peritoneal Dialysis: A Prospective Observational Study

BACKGROUND: The effect of glycemic control after starting peritoneal dialysis (PD) on the survival of diabetic PD patients has largely been unexplored, especially in Asian population. METHODS: We conducted a prospective observational study, in which 140 incident PD patients with diabetes were recruited. Patients were divided into tertiles according to the means of quarterly HbA1C levels measured during the first year after starting PD. We examined the association between HbA1C and all-cause mortality using Cox proportional hazards models. RESULTS: The mean age was 58.7 years, 59.3% were male, and the mean follow-up duration was 3.5 years (range 0.4-9.5 years). The mean HbA1C levels were 6.3%, 7.1%, and 8.5% in the 1(st), 2(nd), and 3(rd) tertiles, respectively. Compared to the 1(st) tertile, the all-cause mortality rates were higher in the 2(nd) [hazard ratio (HR), 4.16; 95% confidence interval (CI), 0.91-18.94; p = 0.065] and significantly higher in the 3(rd) (HR, 13.16; 95% CI, 2.67-64.92; p = 0.002) tertiles (p for trend = 0.005), after adjusting for confounding factors. Cardiovascular mortality, however, did not differ significantly among the tertiles (p for trend = 0.682). In contrast, non-cardiovascular deaths, most of which were caused by infection, were more frequent in the 2(nd) (HR, 7.67; 95% CI, 0.68-86.37; p = 0.099) and the 3(rd) (HR, 51.24; 95% CI, 3.85-681.35; p = 0.003) tertiles than the 1(st) tertile (p for trend = 0.007). CONCLUSIONS: Poor glycemic control is associated with high mortality rates in diabetic PD patients, suggesting that better glycemic control may improve the outcomes of these patients

The Effect of Competitive Advantage and Human Advantage on Industrial Competitive Strategy (Case Study: Smis in Gorontalo Province)

Small and Medium Industries (SMIs) have a strategic role in the Indonesian economy, as they earn 61.9 percent of the foreign exchange which goes to make up the nation\u27s Gross Domestic Product, and nationally they are able to absorb 97 percent of the workforce. The Global Competitiveness Report also notes that SMIs serve as the business units that affect every nation\u27s competitiveness. Considering this strategic role, the selection of a competitive strategy for these SMIs is absolutely necessary. Through an in-depth literature review, this study aims to explore what variables influence the competitive strategy of industries, particularly the SMIs. By using a Systematic Literature Review (SLR) with a total of 31 main literature (articles, papers and books), this study has found two dominant factors that influence industrial competitive strategy: Competitive advantage and human advantage, which are subsequently developed into six independent variables (construct variables), i.e. cost, delivery, product quality, product variety, know-how and innovativeness, with a total of 44 indicators. The results of measurements of the sample of SMIs in Gorontalo Province, using Structural Equation Modeling, found that both competitive advantage and human advantage jointly influence 40.2 percent of the industrial competitive strategies. These results indicate that competitive strategies, such as creating products with unique features, on-time delivery, flexibility in production, and employee involvement in the innovations, are indispensable to SMIs in order for them to produce quality products and be able to maintain their advantage

Effects of ambient temperature and rumen–protected fat supplementation on growth performance, rumen fermentation and blood parameters during cold season in Korean cattle steers

Objective This study was performed to evaluate whether cold ambient temperature and dietary rumen-protected fat (RPF) supplementation affect growth performance, rumen fermentation, and blood parameters in Korean cattle steers. Methods Twenty Korean cattle steers (body weight [BW], 550.6±9.14 kg; age, 19.7±0.13 months) were divided into a conventional control diet group (n = 10) and a 0.5% RPF supplementation group (n = 10). Steers were fed a concentrate diet (1.6% BW) and a rice straw diet (1 kg/d) for 16 weeks (January 9 to February 5 [P1], February 6 to March 5 [P2], March 6 to April 3 [P3], and April 4 to May 2 [P4]). Results The mean and minimum indoor ambient temperatures in P1 (−3.44°C, −9.40°C) were lower (p0.05). Ruminal ammonia nitrogen concentrations were higher (p<0.05) in cold winter than spring. Plasma cortisol concentrations were lower (p<0.05) in the coldest month than in the other months. Serum glucose concentrations were generally higher in colder months than in the other months but were unaffected by RPF supplementation. RPF supplementation increased both total cholesterol (p = 0.004) and high-density lipoprotein (HDL) concentrations (p = 0.03). Conclusion Korean cattle may not be significantly affected by moderate CS, considering that the growth performance of cattle remained unchanged, although variations in blood parameters were observed among the studied months. RPF supplementation altered cholesterol and HDL concentrations but did not affect growth performance

Transcatheter Arterial Embolization as Treatment for a Life-Threatening Retroperitoneal Hemorrhage Complicating Heparin Therapy

Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present in the absence of specific underlying pathology or trauma and is typically associated with anticoagulation therapy. We report a case of a 74-year-old female patient with a cerebral infarction related to atrial fibrillation who developed a spontaneous lumbar arterial hemorrhage complicating heparin therapy. The diagnosis was suggested by a computed tomography scan and confirmed by angiography. She was treated successfully with transcatheter embolization