Prognosis of Single Early-Stage Hepatocellular Carcinoma (HCC) with CEUS Inconclusive Imaging (LI-RADS LR-3 and LR-4) Is No Better than Typical HCC (LR-5)

The American College of Radiology (ACR) released the Liver Imaging Report and Data System (LI-RADS) scheme, which categorizes hepatic nodules in risk classes from LR-1 to LR-5 (according to the degree of risk to be HCC) and LR-M (probable malignancy not specific for HCC). The aim of this study was to test whether HCC with different LR patterns on CEUS have different overall survival (OS) and recurrence-free survival (RFS). We retrospectively enrolled 167 patients with the first definitive diagnosis of single HCC (by using CT/MRI or histological techniques if CT/MRI were inconclusive) for whom CEUS examination was available. The median size of HCC lesions was 2.2 cm (range 1.0–7.2 cm). According to CEUS LI-RADS classification, 28 patients were in LR-3, 48 in LR-4, 83 in LR-5, and 8 in LR-M. Patient liver function and nodule characteristics were not statistically different between CEUS LI-RADS classes. Using univariate analysis, CEUS LI-RADS class was not found to be a predictor of survival (p = 0.347). In conclusion, HCC showing the CEUS LI-RADS classes LR-3 and LR-4 have no better clinical outcome than typical HCC. Such data support the EASL policy, aimed at conclusive diagnostic investigations of indeterminate nodules up to obtaining histological proof to avoid leaving aggressive HCC not timely treated.

Investigation of the disperse composition and strength of granules of instant drinks

В условиях высокой занятости населения возникает необходимость развития более сбалансированного питания. Одним из таких продуктов могут выступать инстантированные напитки на основе плодово-ягодного сырья. Подавляющее большинство таких продуктов на рынке представлено в виде многокомпонентного гранулятора с заданными показателями качества. При производстве таких продуктов используются грануляторы различного типа, однако для малых производств, которые могут быстро переориентироваться на выпуск новой продукции, более перспективными являются грануляторы периодического действия, например, роторные смесители-грануляторы. Однако при анализе получаемого дисперсного состава было выявлено, что продукт имеет нестабильный гранулометрический состав. В работе исследовались дисперсный состав и прочность гранулированного продукта, полученного в роторном смесителе-грануляторе. В результате литературно-патентного обзора была предложена модернизация известного гранулятора и определен дисперсный состав получаемых гранул. В результате проведенных исследований было выявлено, что гранулометрический состав готовой продукции стал более стабилен по сравнению с прототипом оборудования. При анализе прочности получаемых гранул не было выявлено существенного изменения, однако была выявлена зависимость прочности на раздавливание от частоты вращения рабочих органов, так при увеличении частоты вращения лопасти выше 2000 мин-1 наблюдался рост прочности гранул. Также при увеличении частоты вращения происходит рост мелкодисперсной фракции в готовой продукции. Обработка полученных результатов исследований позволила получить экспериментально статистическую модель зависимости среднемедианного размера получаемых гранул от режимных параметров и свойств связующего раствора. In conditions of high employment of the population, it becomes necessary to develop more balanced nutrition. One of the types of such foods can be instantized drinks based on fruit and berry raw materials. An overwhelming majority of these foods on the market are presented in the form of a multicomponent granules with specified quality indicators. When manufacturing such foods granulators of different types are used, however, for minor productions that can be quickly reorientated to the release of new foodstuffs, periodical activity granulators are more promising, for example, rotary mixers-granulators. However, when analyzing the resulting dispersed composition, it was revealed that the foodstuff has an unstable particle size distribution. The work investigated the dispersed composition and strength of the granular staff obtained in a rotary mixer-granulator. As a result of the literature and patent review, the modernization of the well-known granulator was proposed and the dispersed composition of the resulting granules was determined. As a result of the research carried out, it was revealed that the granulometric composition of the finished staff became stabler in comparison with the prototype of the equipment. When analyzing the strength of the granules obtained, no significant change was revealed, however, the dependence of the crushing strength of the working bodies’ rotational speed was revealed, so, with an increase in the blade’s rotational speed over 2000 RPM, an increase in the strength of the granules was observed. Also, with an increase in the rotational speed, an increase in the fine fraction in the product finished occurs. The processing of the research results obtained made it possible to obtain an experimental statistical model of the dependence of the average median size of the granules obtained on the operating parameters and the properties of the binder solution.

Retroperitoneal Liposarcoma Presenting as Bilateral Inguinal Hernias

Liposarcoma is one of the most common soft tissue sarcomas and has multiple subtypes, including atypical, well-differentiated, and dedifferentiated liposarcoma1. These tumors most commonly occur in the extremities and the retroperitoneum2, and account for 20% of all retroperitoneal tumors3. Retroperitoneal liposarcoma is very rare overall, occurring in 2.5 per one million people4. Patients will present from symptoms of mass effect due to the uncontrolled growth in the large potential space of the retroperitoneum, with its median size being around 30 cm5. The mainstay of treatment for this type of tumor is resection to a negative margin6. This is a case report describing a retroperitoneal liposarcoma presenting with bilateral inguinal hernias containing intraperitoneal fat from mass effect.

The Myth and Reality of Teacher Shortage in India: An Investigation Using 2019-20 Data

This paper examines the widespread perception in India that the country has an acute teacher shortage of about one million teachers in public elementary schools, a view repeated in India’s National Education Policy 2020. Using official DISE data, we show that teacher vacancies cannot be equated with teacher shortages: while the number of teacher vacancies (in teacher-deficit schools) is 766,487, the number of teacher surpluses (in surplus-teacher schools) is 520,141, giving a net deficit of only 246,346 teachers in the country. Secondly, removing estimated fake student numbers from enrolment data greatly reduces the required number of teachers and raises the number of surplus teachers, converting the net deficit of 246,346 teachers into an estimated net surplus of 98,371 teachers. Thirdly, if we both remove estimated fake enrolment and also make a hypothetical change to the teacher allocation rule to adjust for the phenomenon of emptying public schools (which has slashed the national median size of public schools to a mere 63 students, and rendered many schools ‘tiny’), the estimated net teacher surplus rises to 239,800 teachers. Fourthly, we show that if government does fresh recruitment to fill the supposed approximately one-million vacancies as promised in National Education Policy 2020, the already modest national mean pupil-teacher-ratio of 25.1 would fall to 19.9, at a permanently increased fiscal cost of nearly Rupees 637 billion (USD 8.7 billion) per year in 2019-20 prices, which is higher than the individual GDPs of 50 countries that year. The paper highlights the major efficiencies that can result from evidence-based policy on minimum viable school-size, teacher allocation norms, permissible maximum pupil teacher ratios, and teacher deployment.

Synthesis of gold nanoparticles by the spark discharge method for visible plasmonics

This work demonstrates synthesis of metal Au nanoparticles with a plasmon resonance in the visible optical region by the spark discharge method in atmosphere of argon of purity 6.0. With raising of sintering temperature from 25 to 950 °C, the morphology of synthesized Au nanoparticles changed from agglomerates to individual particles with decreasing the median size from 270 to 90 nm according to aerosol spectrometer. While by transmission electron microscopy primary nanoparticles with a gold crystalline structure with sizes in range from 5 to 120 nm were observed. Synthesized nanoparticles ensembles had broad absorption peaks with maximum in the visible optical region with peak positions approximately at 490 nm. High temperature sintered particles had a spherical shape and an additional absorption peak at approximately 640 nm.

Safety and Efficacy of Vacuum Bottle Plus Catheter for Drainage of Iatrogenic Pneumothorax

Iatrogenic pneumothorax is common after thoracic procedures. For pneumothorax larger than 15%, simple aspiration is suggested. This clinical trial (NCT03724721) assessed the safety and efficacy of vacuum bottle plus non-tunneled catheter air drainage, which has long been performed in many institutions. From August 2018 to February 2020, patients older than 20 years of age who developed iatrogenic pneumothorax were prospectively enrolled. Totally 21 patients underwent vacuum bottle plus catheter drainage. The median size of pneumothorax was 19.6%, as measured by Rhea’s method. Of the 21 patients, 15 had successful air drainage, and the remaining 6 patients required subsequent pigtail placement. The end-expiratory intrapleural pressure of all patients remained less than -20 cmH2O during drainage. The median duration of hospitalization was 2 (interquartile range [IQR], 1-4) days. No procedure-related complication was observed. A retrospective analysis of patients who received conservative treatment showed that the median duration of hospitalization was longer in patients with larger pneumothorax (1 day vs. 5 days [IQR, 1-1 day vs. 3-7 days]). This study showed that vacuum bottle plus catheter drainage of iatrogenic pneumothorax is a safe and efficient procedure. It is recommended as initial management of stable iatrogenic pneumothorax with size larger than 15%.

Imaging characteristics of pathologically proven adrenal adenomas with myelolipomatous degeneration: correlation with clinical and pathologic features

Objectives: Adrenal adenoma with myelolipomatous degeneration (AMD) is a rarely reported and often overlooked entity. The aim of this study is to improve understanding of these lesions by characterizing the imaging findings with pathologic and clinical correlation. Methods: In the largest series to date, we report 11 nodules in 11 patients confirmed with a pathologic diagnosis of AMD. The available cross-sectional imaging and histopathologic features were reviewed by two radiologists and two pathologists, respectively. Clinical and laboratory data for each patient were obtained from the electronic medical records, when available. Results: All 11 patients had a CT prior to resection or biopsy of the adrenal nodule, with five having received an adrenal mass protocol study. An MRI was available in three patients. The median size of the nodules on imaging was 4.5 cm (range 2.8–8.7) and all but one had macroscopic fat. The largest focus of macroscopic fat had a median size of 0.7 cm (range 0.2–1.6) and on average was 14.4% the size of the tumor, using greatest dimensions. Four (36.4%) patients had a diagnosis of Cushing syndrome prior to nodule resection. Conclusions: Not all adrenal nodules with macroscopic fat on imaging are pure myelolipomas. An AMD should be considered, especially if the foci of fat are small and other features an adenoma are present. Some may also be associated with Cushing syndrome. Advances in knowledge: Myelolipomatous degeneration within an adrenal adenoma has only rarely been previously reported with very few reports emphasizing the imaging features. There may be an association with cortisol hypersecretion and improved recognition of this entity could lead to changes in clinical management.

Efficacy and safety of cap-assisted endoscopic mucosal resection for treatment of nonlifting colorectal polyps

Background Suboptimal lifting increases complexity of endoscopic mucosal resection (EMR) for benign colorectal polyps. Cap-assisted EMR (EMR-C) may allow fibrotic polyp tissue to be captured in the snare. This study evaluated the efficacy and safety of EMR-C for benign nonlifting colorectal polyps. Methods This was a multicenter study, which prospectively registered all EMR-C procedures (2016–2018) for presumed benign nonlifting colorectal polyps. Results 70 nonlifting polyps with a median size of 25 mm (interquartile range [IQR] 15–40) were treated with EMR-C. Complete polyp removal was achieved in 68 (97.1 %), including 47 (67.1 %) with EMR-C alone. Overall, 66 polyps showed benign histology, and endoscopic follow-up after a median of 6 months (IQR 6–10) showed recurrence in 19.7 %. First (n = 10) and second (n = 2) benign recurrences were all treated endoscopically. Deep mural injury type III–V occurred in 7.4 % and was treated successfully with clips. Conclusion EMR-C may be an alternative therapeutic option for removal of benign nonlifting polyp tissue. Although recurrence still occurs, repeat endoscopic therapy usually leads to complete polyp clearance.

Determination of Fire Parameters of Polyamide 12 Powder for Additive Technologies

The use of additive technologies keeps growing. Increasingly, flammable powder materials are also used in additive technologies, and there is a risk of explosion or fire when using them. The current article deals with the determination of fire parameters of a powder sample of polyamide Sinterit PA12 Smoth in accordance with the EN 14034 and EN ISO/IEC 80079-20-2 standards. For that purpose, a sample at a median size of 27.5 µm and a humidity of 0% wt. was used. The measurements showed that the maximum explosion pressure of the PA12 polyamide sample was 6.78 bar and the value of the explosion constant Kst was 112.2 bar·m·s−1. It was not possible to determine the MIT value of the settled dust, since the melting point of polyamide sample is low. The MIT of the dispersed dust was 450 °C. Based on the measured results, it can be stated that the powdered polyamide PA12 poses a risk in terms of explosions and fires. Therefore, when using polyamide PA12 in additive technologies, it is necessary to ensure an effective explosion prevention.

327 Relative Benefits of Extracorporeal Shockwave Lithotripsy (ESWL) Compared to Observation in Acute Renal Colic

Aim NICE guidance recommends patients with renal colic be offered surgical treatment, including extracorporeal shockwave lithotripsy (ESWL), within 48 hours if pain is uncontrolled or stones unlikely to pass. We compared outcomes for ureteric stone passage after ESWL with those of observation to ascertain the relative benefits of ESWL. Method We collected data on stone location, size, and number of ESWL treatments required prospectively over 18 months. Stone passage was confirmed radiologically. Data were compared with MIMIC, a multi-centre collaborative study examining spontaneous stone passage after observation alone. Results 166 patients had ESWL for ureteric stones. Median size was 6.5mm (IQR 5.0-8.0mm). 57.2% (N = 95) were proximal stones. Smaller stones required fewer treatments (P = 0.003). Patients with a ureteric stone <5mm required median 1.0 ESWL treatments (IQR 1.0-2.0). Ureteric stones 5-7mm had median 1.0 treatments (IQR 1.0-2.0) and stones >7mm median 2.0 treatments (IQR 1.0-2.0). Compared to MIMIC, patients with ESWL for stones <5mm were 11% more likely to achieve stone clearance (100.0% vs 89.0%, P = 0.001). ESWL for 5-7mm stones had 28.1% greater clearance compared to observation (77.1% vs. 49.0%, P < 0.001) and ESWL for stones >7mm 21% greater likelihood of clearance (50.0% vs. 29.0%, P < 0.001). Proximal ureteric stones were 16.4% more likely to pass with ESWL than observation (68.4% vs 52%, P = 0.02). Distal stones showed similar passage with ESWL (77.5%) and observation (83.0%), P = 0.43. Conclusions Proximal ureteric stones and those >5mm stones benefit most from ESWL. Results aid identification of patients whose stones are less likely to pass and warrant urgent review to consider ESWL.