Background and Aims Few studies have directly compared the efficacy of sedated‐ and un‐sedated endoscopic variceal ligation (EVL) for acute variceal bleeding. We aimed to determine whether sedation during EVL in patients with variceal bleeding is safe and effective. Methods We analyzed data from patients who underwent EVL for acute variceal bleeding according to sedation in six hospitals of Hallym University Medical Center. The primary endpoint was treatment failure, defined as a failure to control bleeding, death during EVL, or rebleeding within 5 days. Secondary endpoints included the procedure time, adverse events, and 30‐day mortality. Results Of 1,300 patients who were included, only 430 (33.1%) received sedation during EVL. Propofol alone was used for sedation in 85% of sedated‐EVLs. The mean procedure time in the sedation group was shorter than that of the non‐sedation group (12.4 ± 9.5 min versus 13.8 ± 9.4 min, P = 0.010). The proportion of treatment failure did not differ between the groups (7.4% versus 9.1%, P = 0.374). In the multivariable analysis, an AIMS65 score ≥2 and blood transfusion within 72 hours were associated with treatment failure of EVL; however, the use of sedation was not (odds ratio [95% confidence interval (CI)] = 0.96 [0.60–1.51]). Adverse events during EVL and hepatic encephalopathy did not differ between the two groups. Sedation also did not affect the 30‐day mortality (hazard ratio [95% CI] = 0.99 [0.66–1.47]). Conclusion Sedation reduced the procedure time of EVL. Sedation is safe to use during EVL for variceal bleeding in patients with cirrhosis.

No abstract

No abstract

The steam generator in a nuclear power plant is a large heat exchanger that uses heat from reactor to generate steam to drive the turbine generators. Rupture of a steam generator tube can result in release of fission products to environment. Therefore, an accurate integrity assessment of the steam generator tubes with cracks is of great importance for maintaining safety of a nuclear power plant. The steam generator tubes are supported at periodic intervals by support plates and rotations of the tubes are constrained. Although it was reported that the limit load for a circumferential crack was significantly affected by boundary condition of the tube, existing limit load solutions do not include the constraining effect of tube supports. This paper provides detailed limit load solutions for circumferential cracks in steam generator tubes considering the actual boundary conditions to simulate the constraining effect of the tube supports. Such solutions are developed based on three dimensional (3D) finite element analyses. The resulting limit load solutions are given in a polynomial form, and thus can be simply used in practical integrity assessment of the steam generator tubes.