Response of serum cytokines in patients undergoing laparoscopic cholecystectomy

The clinical observation that a laparoscopic cholecystectomy is a minimally invasive operation has not been demonstrated on a biochemical basis. Interleukin-6, a known endogenous pyrogen and hepatocyte-stimulating protein, correlates with the significance of surgical trauma. Utilizing the IL-6 immunoassay, we studied this biochemical parameter of trauma to compare its response in laparoscopic vs open cholecystectomy. Sixteen patients who underwent only laparoscopic cholecystectomy showed peak IL-6 concentrations of 51 pg/ml (22-86) vs a peak IL-6 concentration of 124 pg/ml (56-225) for open cholecystectomy. Six additional patients who underwent an ERCP followed by laparoscopic cholecystectomy showed a dramatic rise in peak IL-6 concentration to 315 pg/ml (15-634). These results biochemically confirm the true minimal invasiveness of laparoscopic cholecystectomy. The findings in the ERCP-followed-by-laparoscopic-cholecystectomy group support the theory that two invasive procedures in close proximity may prime the cytokine system in its response to surgical trauma.     

Improvements in finite-element simulation for stamping and application to the forming of laser-welded blanks

During stamping-die design, the formability in sheet-metal forming process has been evaluated by the geometrical functions in ‘Die-Face CAD’, which has been developed and improved by Toyota Motor Corporation. When evaluation by these functions is difficult, formability has been estimated by performing experiments using test dies in which the forming defects are similar to those in the actual process.

A numerical method has been developed in order to substitute numerical analysis for experiments using test dies for the accurate prediction of defects in sheet-metal forming. The elastic-plastic FEM with the commercial code ‘JNIKE3D’ has been improved in the areas of: (1) the material constitutive equation; (2) the consideration of the pressure distribution on the blank-holder; and (3) the evaluation of breakage initiation. Using the improved method, the square-cup drawing process and the hemming process have been analyzed. Numerical results for strain, breakage initiation, and hemming deflection were in good agreement with experimental results. The formability of laser-welded blanks and the most efficient process to form them were evaluated also using the improved method.     

Clonal expansion of T-cells in measles

Videolaparoscopic cholecystectomy is considered the treatment of choice for simple cholelithiasis. Now many surgeons consider the laparscopic procedure usable also in the complicated biliary lithiasis like acute cholecystitis and choledocholithiasis. The authors report their recent experience of the laparoscopic treatment of biliary lithiasis, regarding 221 non-selected patients (69% symptomatic cholelithiasis, 20% chronic cholecystitis, 4.5% acute cholecystitis, 4.5% coledocolithiasis, 2% hydrops). The diagnostic-therapeutic protocol and the results are described and compared with the beginning of their experience, when they treated only symptomatic gallbladder stone disease, and with the reports of the literature. The authors concluded that the laparoscopic procedure is a good chance for the surgeon in the treatment of all cases of benign biliary disease. But, in particular for patients with choledocholithiasis, he has be able to know all the diagnostic and therapeutic possibilities, to choose the best in every single case.     

Superfluid Phase Transition of 3He-4He Mixture Films Adsorbed on Alumina Powder

The superfluid phase transition of ³ He- ⁴ He mixture films adsorbed on 500 Å alumina powder has been studied for mixture films whose superfluid thickness is less than a monolayer. The transitions are found to be controlled by the Kosterlitz-Thouless critical line, but a strong broadening of the transition is observed as the ³ He concentration is increased. Analyzing the broadening in terms of a KT vortex-pair theory modified for the the finite powder size yields a vortex core parameter which increases nearly linearly with added ³ He. Also observed in these measurements is a temperature-dependent and ³ He-dependent depletion of the superfluid density at low temperatures, which is thought to arise from the high-frequency ripplon/third sound excitations of the film.     

Correcting the bias of clerkship timing on academic performance

OBJECTIVES: To document the time-of-year bias in National Board of Medical Examiners subject examination (NBME) scores in a third-year pediatrics clerkship and to develop a grading method that neutralizes the bias. DESIGN: Interventional modeling of final grades. SETTING: University-based medical school. SUBJECTS AND METHODS: During each of the past 3 academic years, we conducted six 2-month pediatric clerkships for third-year students. To counter the time-of-year bias, NBME scores, clinical evaluations, and departmental examination scores for the current rotation were pooled with those from the rotations from the same time of year during the previous 2 years. Final grades for the current rotation were determined by cutoff points derived from that entire 3-year pool. We analyzed this approach by testing the time-of-year effects on NBME scores, clinical evaluations, and final grades while maintaining step 1 of the US Medical Licensing Examination as a preclinical baseline control. RESULTS: The scores for step 1 of the US Medical Licensing Examination did not differ significantly by time of year. Clinical evaluations and NBME scores showed significant upward trends as the academic year progressed. By contrast, according to design, final grades showed no significant time-of-year trend. CONCLUSIONS: Our results support previous reports of significant improvements in NBME scores across the academic year. Our method of computing final grades corrects for this time-of-year bias by judging students only in relation to those who took the rotation at the same time of year. It is our belief that the prevalence and significance of the time-of-year trend warrants such an adjustment in grading to help minimize the academic disadvantage faced by students early in their clinical training.     

Octree-R: an adaptive octree for efficient ray tracing

Ray tracing requires many ray-object intersection tests. A way of reducing the number of ray-object intersection tests is to subdivide the space occupied by objects into many nonoverlapping subregions, called voxels, and to construct an octree for the subdivided space. We propose the Octree-R, an octree-variant data structure for efficient ray tracing. The algorithm for constructing the Octree-R first estimates the number of ray-object intersection tests. Then, it partitions the space along the plane that minimizes the estimated number of ray-object intersection tests. We present the results of experiments for verifying the effectiveness of the Octree-R. In the experiment, the Octree-R provides a 4% to 47% performance gain over the conventional octree. The result shows the more skewed the object distribution (as is typical for real data), the more performance gain the Octree-R achieves