Clinical outcomes of nonthermal ablation, thermal ablation, and surgical stripping for varicose veins.

OBJECTIVE: The purpose of this study was to compare the clinical outcomes of radiofrequency ablation (RFA), cyanoacrylate closure (CAC), mechanochemical ablation (MOCA), and surgical stripping (SS) for incompetent saphenous veins and to determine a suitable treatment modality for a specific clinical situation. METHODS: We retrospectively reviewed the data of patients with varicose veins who underwent RFA, CAC, MOCA, or SS from January 2012 to June 2023. The clinical outcomes, including postoperative complications and the Aberdeen Varicose Vein Questionnaire score, were assessed. RESULTS: During the study period, 2866 patients with varicose veins were treated. Among them, 1670 patients (57.9%) were women. The mean age was 55.3 ± 12.9 years. RFA, CAC, MOCA, and SS were performed in 1984 (68.7%), 732 (25.4%), 78 (2.7%), and 88 (3.0%) patients, respectively. The complete target vein closure rate after RFA, CAC, and MOCA was 94.5%, 98%, and 98%, respectively. The absence of a target vein after SS was 98%. Deep vein thrombosis developed in four patients: one in the RFA group and three in CAC group. Surgical or endovenous procedure-induced thrombosis occurred in 2.3%, 4.8%, 6.4%, and 2.3% of the patients after RFA, CAC, MOCA, and SS, respectively. Phlebitis along the target vein occurred in 0.2% and 3.8% of patients after RFA and MOCA, respectively. A hypersensitivity reaction occurred in 3.7% of patients after CAC. Readmission was required for two patients who had undergone SS. Transient nerve symptoms developed in five (0.3%), zero, one (1.3%), and two (2.3%) patients after RFA, CAC, MOCA, and SS, respectively. After treatment, the Aberdeen Varicose Vein Questionnaire score improved significantly in all groups. CONCLUSIONS: The clinical outcomes with improvement in quality of life were comparable among the different treatment modalities. The proximity of the nerve or skin to the target vein is the most important factor in selecting a suitable treatment modality.

Incidence and Risk Factors of Iliac Artery Rupture during Aortoiliac Stenting.

Purpose: Aortoiliac occlusive disease (AIOD) is widely prevalent and leads to severe claudication or chronic limb-threatening ischemia. Stent placement for AIOD demonstrated excellent outcomes in terms of long-term patency. However, iliac artery rupture is the most fearful complication during the aortoiliac stenting (AIS). This study aimed to evaluate the incidence and risk factors of iliac artery rupture during AIS. Materials and Methods: A retrospective review of consecutive patients with AIOD treated with AIS from 2009 to 2021 was completed. We excluded patients with instent restenosis. All types of stents, including self-expanding stent (SES), balloon-expandable stent (BES), or balloon-expandable covered stent (CS), were used. Angiographic characteristics and procedural outcomes were analyzed. Procedural success was defined as the residual stenosis <30%. Results: A total of 242 patients (86.8% male; mean age 68.8±10.0 years) with de novo AIOD were treated with AIS. The procedural success rate was 100%. Rupture occurred in six patients (2.5%) and all ruptures were occurred in the external iliac artery (EIA). Stenting of the EIA and less calcified lesion were risk factors for iliac rupture (P=0.028). All cases of iliac artery rupture were successfully treated with the CSs. Overall primary patency rates were 98.0% and 93.4% at 12 and 36 months, respectively. Primary patency rates of SES, BES, and CS were 87.7%, 88.4%, and 100% at 36 months, respectively. Conclusion: The incidence of iliac artery rupture during AIS was 2.5%. Stent placement in the less calcified lesion and EIA was a risk factor for rupture during AIS. Placement of the CS can be the straightforward solution in case of iliac artery rupture during AIS.

A nationwide study of compliance of venoactive drugs in chronic venous disease patients.

Purpose: Venoactive drugs are widely used to improve the symptoms and signs of chronic venous disease. This study aimed to analyze the rate of adverse events after venoactive drug prescription and subsequent compliance and switching rates. Methods: Using the National Health Insurance Service database, individuals with at least one chronic venous disease code between January 2009 and December 2019 were identified, and 30% (2,216,780 individuals) of these were sampled. Finally, 1,551,212 patients were included, and we analyzed adverse events, compliance, and switching rates with 8 venoactive drugs, including Vitis vinifera extract, naftazone, micronized purified flavonoid fraction, Vitis vinifera leaf extract, diosmin, diobsilate calcium, bilberry fruit dried extract, and sulodexide. Results: The most commonly prescribed venoactive drug was Vitis vinifera extract (72.2%), followed by sulodexide (9.3%), and Vitis vinifera leaf dry extract (8.2%). Adverse event rates were significantly lower in the naftazone and diosmin groups (P = 0.001 and P = 0.002, respectively) and significantly higher in the Vitis vinifera leaf dry extract group (P = 0.009). Drug adherence to sulodexide was the highest throughout the study period, followed by billberry extract and dobesilate (all P < 0.001). For most drugs, the drug switching rate was low (<5.0%). Conclusion: Vitis vinifera extract was the most commonly prescribed venoactive drug in Korea, and drug adherence to sulodexide was the highest among all venoactive drugs. The adverse event rates were significantly lower in the naftazone and diosmin groups.

Physical fitness changes in adolescents due to social distancing during the coronavirus disease pandemic in Korea.

Background: At least 60 min of moderate-intensity physical activity per day is recommended for physical and mental health of adolescents. Schools are one of the most suitable places for promoting students' health as it is a place where vigorous physical activity occurs. However, the physical activity of students is threatened because schools are closed worldwide owing to the coronavirus disease (COVID-19) outbreak in 2019. Therefore, this study aimed to analyze the physical fitness changes in 27,782 Korean adolescents during the pandemic and present alternative education and health policies to the school. Methods: We included 29,882 middle school students (age: 13-15 years; males: 14,941, females: 12,841) in Korea from 2019 to 2021 . Participants' physical fitness at school was measured using the physical activity promotion system (PAPS) manual developed to measure students' physical fitness. Physical fitness variables included body mass index (BMI), 20 m shuttle run, handgrip strength, sit-and-reach, and 50 m run. Results: The COVID-19 pandemic has had a negative impact on the BMI and cardiorespiratory endurance of Korean middle school students. Specifically, male students' BMI increased, while body composition, cardiorespiratory endurance, and grip strength decreased significantly. Female students showed significant decreases in BMI and sit-and-reach test scores. It is clear that the physical fitness level of adolescents decreased by a greater degree after the COVID-19 pandemic than before, and the decrease in the physical fitness level of male students was noticeable. Therefore, a lesson strategy should be prepared that considers the contents and methods of physical education classes to improve the physical fitness level of male and female adolescents. Conclusions: Fitness-based classes suitable for online methods should be urgently added as alternative physical education classes to prepare for the second COVID-19 outbreak. In addition, it is necessary to create an environment in which physical activity is a possibility in physical education classes, in any situation using artificial intelligence and virtual reality.

Rapid hemostasis of the residual inguinal access sites during endovascular procedures: A case report.

BACKGROUND: In endovascular procedures including total percutaneous endovascular aneurysm repair (pEVAR), percutaneous access through the common femoral artery is most commonly performed. Access-site bleeding is a major concern in percutaneous techniques. Herein, we present a case of successful control of continuous oozing using a vascular closure device (VCD) and the application of Surgicel (Johnson & Johnson, United States) over the access tract. CASE SUMMARY: An 82-year-old man presented with an unruptured abdominal aortic aneurysm measuring 83 mm × 75 mm. The patient had a medical history of atrial fibrillation and was receiving rivaroxaban (15 mg/d). Routine pEVAR was performed using the preclose technique with ProGlide (Abbott, Santa Clara, CA, United States). Significant amount of bleeding was observed at the end of the procedure after the deployment of the closure device at the access site. A sheet of Surgicel was applied to the suture thread using a surgical needle. Surgicel was applied to the surface of the artery along the access tract using a pusher, and hemostasis was immediately attained. CONCLUSION: This simple technique is an excellent adjunct to control residual bleeding from the access site following VCD use.

Carbon dots surface chemistry drives fluorescent properties: New tools to distinguish isobaric peptides.

The possibility to design rational carbon dots surface functionalization for specific analytical and bioanalytical applications is hindered by the lack of a full knowledge of the surface chemical features driving fluorescent properties. In this model study, we have synthesized four different peptides, three of which are isobaric and not distinguishable by common MSMS experiments. After having characterized the peptides conformations by CD analyses, we have covalently bonded all four peptides to carbon dots by using different experimental procedures, which produce different functional groups on the carbon dots surface. The peptide orientations obtained on the differently functionalized surface of the nanoparticles were different and produced different fluorescent responses. The reported results indicate the possibility to design amino and carboxyl enriched surface carbon dots to answer specific chemical requirements, paving the way for the use of these nanoparticles as a versatile and useful new chemical and biochemical tool.

Impact of High-Intensity Circuit Resistance Exercise on Physical Fitness, Inflammation, and Immune Cells in Female Breast Cancer Survivors: A Randomized Control Trial.

Questions remain about whether resistance exercise has a positive effect on immune and inflammatory cells. The purpose of this study was to evaluate the effect of 12 weeks of high-intensity circuit resistance exercise (HCRE) on inflammation and immune cells, and physical fitness, of female breast cancer survivors (FBCSs). Thirty FBCSs were randomly assigned to the HCRE (n = 15) and control (n = 15) groups. HRCE was administered for 50 min a day, 2-3 times a week, for 12 weeks. The control group only performed activities of daily living during the study period. Baseline and post-intervention measures included body composition, muscular strength, muscular endurance, flexibility, reaction time, balance, inflammation, and immune cell measurements. The results showed that HCRE improved body mass index, body fat, muscle mass, grip strength, back muscle strength, sit-up, whole-body reaction, standing on one leg with eyes closed, Y-balance test, and NKCA in FBCSs. The improvement of physical strength and immune cells of FBCSs was achieved using the 12-week HRCE program. Future studies must analyze various exercise intensities and types, and should be conducted on other cancer survivors. In addition, strategies should be developed to allow FBCSs to participate in resistance training.

A Study on Minimizing Welding Deformation of Joints for the Sealing of Emission After-Treatment Structure.

As the environmental pollution issue has recently become significant, environmental regulations in Europe and the United States are being strengthened. Thus, there is a demand for the quality improvement of emission after-treatment systems to satisfy the strengthened environmental regulations. Reducing the amount of welding heat distortion by optimization of the welding order of each part could be a solution for quality improvement since the emission after-treatment system consists of many parts and each assembly is produced by welding individual ones. In this research, a method to derive a welding sequence that effectively minimizes welding deformation was proposed. A two-stage simulation was performed to obtain the optimal welding sequence. In the first stage, the welding sequence was derived by analyzing the number of welding groups in each assembly of a structure. The derived welding sequence was verified by performing a thermal elasto-plastic analysis and comparing it with the experimental results.

Impact of Synchronous Online Physical Education Classes Using Tabata Training on Adolescents during COVID-19: A Randomized Controlled Study.

This study aimed to investigate the effects of online physical education classes, using Tabata training, on middle school students' physical fitness. Fifty-four adolescents were randomly assigned to either the asynchronous online class group (AOCG, n = 24, age: 15.8 ± 0.4 years) or the synchronous online class group (SOCG, n = 24 age: 15.9 ± 0.3 years). The online physical education class lasted two days per week for 10 weeks. Recorded video lectures were conducted for the AOCG, and Tabata training for the SOCG, as real-time lecture methods. Baseline and post-online physical education class measures included muscular strength, muscular endurance, flexibility, balance, and cardiorespiratory fitness tests. The results showed that the synchronous online physical education class had a positive effect on the improvement of muscle mass, ankle strength (dorsiflexion), hip strength (abduction, flexion, extension, and external rotation), knee strength (extension and flexion), and balance (Y-balance test) in adolescents. These findings suggest that the physical fitness of adolescents can be sufficiently improved through appropriate online physical education class methods. Further research should focus on developing and evaluating different types of exercises for synchronous online physical education classes as a precautionary measure for the second wave of COVID-19.

Effect of Step Quenching on Multi-Step Aging Behavior in Al-Mg-Si Alloys.

Two types of nanoclusters were detected using DSC thermal analysis operating at -50 °C with liquid nitrogen. The formation of Cluster (1) was substantially suppressed by the formation of Cluster (2) during step quenching at 100 °C for 0.06 ks. The hardness increase was retarded for a period during two-step aging at 170 °C in the case of natural aging for 604.8 ks. The hardness decrease was determined to be due to the dissolution of nanoclusters in the early stage of two-step aging at 170 °C. On the other hand, hardness was directly increased in the step-quenched samples during multi-step aging at 170 °C. It is noted that Cluster (2) directly transforms into the strengthening phase. The bake hardening response is fairly enhanced by the formation of Cluster (2), which is formed by the step quenching process. It was confirmed that the step-quenched samples had a higher number of precipitates than the naturally-aged ones based on TEM images. The structure of the precipitate was identified to be the ß″ phase by analyzing HRTEM image.

Microstructure and texture of a nano-grained complex Al alloy fabricated by accumulative roll-bonding of dissimilar Al alloys.

An ultrafine grain (UFG) complex lamella aluminum alloy sheet was successfully fabricated by ARB process using AA1050 and AA6061. The lamella thickness of the alloy became thinner and elongated to the rolling direction with increasing the number of ARB cycles. By TEM observation, it is revealed that the aspect ratio of UFGs formed by ARB became smaller with increasing the number of ARB cycles. In addition, the effect of ARB process on the development of deformation texture at the quarter thickness of ARB-processed sheets was clarified. ARB process leaded to the formation of the rolling texture with shear texture and weak cube orientation. The subdivision of the grains to the rolling direction began to occur after 3 cycles of the ARB, resulting in formation of ultrafine grains with small aspect ratio. After 5 cycles, the ultrafine grained structure with the average grain diameter of 560 nm develops in almost whole regions of the sample.

Analgesic effectiveness of nerve block in shoulder arthroscopy: comparison between interscalene, suprascapular and axillary nerve blocks.

PURPOSE: Postoperative pain in arthroscopic shoulder surgery cannot be easily controlled with analgesics and nerve blocks. This study shows the analgesic effect of interscalene block (ISB) and suprascapular nerve block and axillary nerve block (SSNB + ANB) in patients under patient controlled analgesia (PCA). METHODS: Sixty-one patients (26 men and 35 women) who underwent arthroscopic rotator cuff repair were selected and allocated non-randomly to one of three groups: PCA only-group, PCA with ISB-group and PCA with SSNB + ANB-group. Visual analogue scale (VAS) score, degree of satisfaction, PCA usage and incidence of nausea and vomiting were evaluated at the recovery room, 8, 16 and 24 postoperative hours. RESULTS: The VAS score of the PCA only-group was highest at the recovery room. The VAS score of the PCA with ISB-group was the lowest, however, with large fluctuations over time. Although the VAS score of the PCA with SSNB + ANB-group was higher than that of the PCA with ISB-group, it was steadily lower than the PCA-only group, without any fluctuations. The degree of satisfaction of the PCA with ISB-group was highest at the recovery room. The number of times the PCA was used at the 8-h postoperative evaluation was largest in the PCA only-group. CONCLUSIONS: The initial 24 h after surgery plays a key role in controlling pain after arthroscopic shoulder surgery. PCA with SSNB + ANB is a better anaesthetic choice than PCA with ISB or PCA only during the initial 24 h of the postoperative period. LEVEL OF EVIDENCE: Clinical study, Level II.

Extraction of location coordinates of 3-D objects from computationally reconstructed integral images basing on a blur metric.

In this paper, a novel approach to effectively extract location coordinates of 3-D objects employing a blur metric has been proposed. With elemental images of 3-D objects, plane object images (POIs) were reconstructed along the output plane using the CIIR (computational integral imaging reconstruction) algorithm, in which only the POIs reconstructed on the output planes where 3-D objects were originally located are focused whereas the other ones are blurred. Therefore, by calculating these blur metrics of the reconstructed POIs depth data of 3-D objects could be extracted. That is, the blur metric is the lowest on the focused point, but it starts to increase as (fill in the blank) moves away from that point. Accordingly, by finding out the points of inflection in the map of blur metric variation, the output planes where the objects were located were finally detected. To show the feasibility of our proposed scheme, some experiments were carried out and its results are presented as well.

Blur-metric-based resolution enhancement of computationally reconstructed integral images.

A computational integral imaging reconstruction technique can reconstruct a set of plane images of three-dimensional (3-D) objects along the output plane, in which only the plane object image (POI) reconstructed on the right planes where the objects were positioned is highly focused, whereas the other POIs reconstructed away from these planes are unfocused and blurred. In fact, these blurred POIs act as additional noises to other object images reconstructed on different output planes, so that the resolution of reconstructed object images should be considerably deteriorated. In this paper, a novel approach is proposed to effectively reduce the blurred images occurring in the focused POIs by employing a blur metric. From the estimated blur metric of each reconstructed POI, the right output planes where the objects were located can be detected. In addition, with an estimated blur metric, focused POIs can be adaptively eroded by a simple gray level erosion operation because it reduces regional expansion caused by the blur effect. The gray values of the eroded POIs are then finally remapped by referencing the original POIs. Some experiments revealed an average increase of 1.95 dB in the peak signal-to-noise ratio in the remapped POIs compared with that of the originally reconstructed POIs, and that the original forms of the object images in the remapped POIs could be preserved even after they had gone through an erosion operation. This feasibility test of the proposed scheme finally suggests a possibility of its application to robust detection and recognition of 3-D objects in a scene.