National trends in resection of the distal pancreas

AIM:To investigate national trends in distal pancreatectomy(DP) through query of three national patient care databases.METHODS:From the Nationwide Inpatient Sample(NIS,2003-2009),the National Surgical Quality Improvement Project(NSQIP,2005-2010),and the Surveillance Epidemiology and End Results(SEER,2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy.Utilization of laparoscopy was defined in NIS by the International Classification of Diseases,Ninth Revision correspondent procedure code;and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes.In SEER,patients were identified by the International Classification of Diseases for Oncology,Third Edition diagnosis codes and the SEER Program Code Manual,third edition procedure codes.We analyzed the databases with respect to trends of inpatient outcome metrics,oncologic outcomes,and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection.RESULTS:NIS,NSQIP and SEER identified 4242,2681 and 11 082 DP resections,respectively.Overall,laparoscopy was utilized in 15%(NIS) and 27%(NSQIP).No significant increase was seen over the course of the study.Resection was performed for malignancy in 59%(NIS) and 66%(NSQIP).Neither patient Body mass index nor comorbidities were associated with operative approach(P = 0.95 and P = 0.96,respectively).Mortality(3% vs 2%,P = 0.05) and reoperation(4% vs 4%,P = 1.0) was not different between laparoscopy and open groups.Overall complications(10% vs 15%,P < 0.001),hospital costs [44 741 dollars,interquartile range(IQR) 28 347-74 114 dollars vs 49 792 dollars,IQR 13 299-73 463,P = 0.02] and hospital length of stay(7 d,IQR 4-11 d vs 7 d,IQR 6-10,P < 0.001) were less when laparoscopy was utilized.One and two year survival after resection for malignancy were unchanged over the course of the study(ductal adenocarinoma 1-year 63.6% and 2-year 35.1%,P = 0.53;intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90% and 2-year 84%,P = 0.25).The majority of resections were performed in teaching hospitals(77% NIS and 85% NSQIP),but minimally invasive surgery(MIS) was not more likely to be used in teaching hospitals(15% vs 14%,P = 0.26).Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles(88% vs 43%,P < 0.001),but were no more likely to utilize MIS at resection.Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching(15% vs 14%,P = 0.72) and lower volume hospitals(14% vs 15%,P = 0.99).No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year(P = 0.17 and P = 0.96,respectively).CONCLUSION:There appears to be an overall underutilization of laparoscopy for DP.Centralization does not appear to be occurring.Survival and lymph node harvest have not changed.

A Survey on Performance Optimization of High-Level Synthesis Tools

Field-programmable gate arrays(FPGAs)have recently evolved as a valuable component of the heterogeneous computing.The register transfer level(RTL)design flows demand the designers to be experienced in hardware,resulting in a possible failure of time-to-market.High-level synthesis(HLS)permits designers to work at a higher level of abstraction through synthesizing high-level language programs to RTL descriptions.This provides a promising approach to solve these problems.However,the performance of HLS tools still has limitations.For example,designers remain exposed to various aspects of hardware design,development cycles are still time consuming,and the quality of results(QoR)of HLS tools is far behind that of RTL flows.In this paper,we survey the literature published since 2014 focusing on the performance optimization of HLS tools.Compared with previous work,we extend the scope of the performance of HLS tools,and present a set of three-level evaluation criteria,covering from ease of use of the HLS tools to promotion on specific metrics of QoR.We also propose performance evaluation equations for describing the relation between the performance optimization and the QoR.We find that it needs more efforts on the ease of use for efficient HLS tools.We suggest that it is better to draw an analogy between the HLS development process and the embedded system design process,and to provide more elastic HLS methodology which integrates FPGAs virtual machines.

Determination of symptoms associated with hiesho among young females using hie rating surveys

Objective： Hie （cold sensation） is one of the most well-known health complaints in Japan and elsewhere in East Asia. Those who suffer from severe hie are considered to have hiesho （cold disorder）. This study was conducted to determine symptoms associated with hie in young females using a survey consisting of the hie scale and hie diary. Methods： Two hundred and seventy-one participants were included for the analysis. Survey forms were distributed to the participants. Diagnosis of hiesho was determined by using the hie scale. A discriminant score of over -0.38 was considered hiesho. The Short Form-8 Health Survey Standard Version （SF-8） was used to measure health-related quality of life （QOL）. The participants were also asked to respond to the questionnaire evaluating 14 physical and emotional symptoms, utilizing a six-level Likert scale item. Results： The 1st factor （hie factor） was correlated with hie （r= 0.546）, dry mouth （r= 0.332）, lower- extremity edema （r = 0.450）, headrushes （r=0.470）, shoulder stiffness （r = 0.311 ）, headrushes with chills （r = 0.726）, and fatigue （r= 0.359）. Cronbach＇s α of the 1st factor was 0.748, which indicated reliability between the items. When hie factor was the dependent variable, standardized partial regression coefficient was β=-0.387 for physical component score （P 〈 0.001） and β=-0.243 for mental component score （P 〈 0.001 ）. Conclusion： This study indicated that hiesho symptoms among young female adults were associated with bodily pain and general health perceptions of the SF-8 QOL survey.