Recent years have witnessed transformative changes brought about by artificial intelligence(AI)techniques with billions of parameters for the realization of high accuracy,proposing high demand for the advanced and AI ...Recent years have witnessed transformative changes brought about by artificial intelligence(AI)techniques with billions of parameters for the realization of high accuracy,proposing high demand for the advanced and AI chip to solve these AI tasks efficiently and powerfully.Rapid progress has been made in the field of advanced chips recently,such as the development of photonic computing,the advancement of the quantum processors,the boost of the biomimetic chips,and so on.Designs tactics of the advanced chips can be conducted with elaborated consideration of materials,algorithms,models,architectures,and so on.Though a few reviews present the development of the chips from their unique aspects,reviews in the view of the latest design for advanced and AI chips are few.Here,the newest development is systematically reviewed in the field of advanced chips.First,background and mechanisms are summarized,and subsequently most important considerations for co-design of the software and hardware are illustrated.Next,strategies are summed up to obtain advanced and AI chips with high excellent performance by taking the important information processing steps into consideration,after which the design thought for the advanced chips in the future is proposed.Finally,some perspectives are put forward.展开更多
High-water-cut mature reservoirs typically serve as the“ballast”for ensuring China’s annual crude oil production of 200 million tons.Despite the use of water flooding and chemical methods,over 40%of crude oil remai...High-water-cut mature reservoirs typically serve as the“ballast”for ensuring China’s annual crude oil production of 200 million tons.Despite the use of water flooding and chemical methods,over 40%of crude oil remains unexploited.It is critical to develop efficient revolutionary technologies to further enhance oil recovery(EOR)by a large percentage in high-water-cut mature reservoirs.To address this issue,the potential of vertical remaining oil in Daqing Oilfield is first analyzed from massive monitoring data.Using molecular dynamics simulation to design optimal synthetic routine,a copolymer without flu-orine or silicon is synthesized by modifying vinyl acetate(VAc)with maleic anhydride(MA)and styrene(St),and treated as a supercritical CO_(2)(scCO_(2))thickener.The underlying EOR mechanism of the scCO_(2) thickener is thereafter clarified by high-temperature,high-pressure oil displacement experiments.The EOR effect by thickened scCO_(2) flooding in a typical high-water-cut mature reservoir is predicted,and future technological advancements of the technique are ultimately discussed.Results show that the ver-tical remaining oil enriched in weakly swept zones is a primary target for further EOR in high-water-cut mature reservoirs.The copolymer typically exhibits good solubility,strong dispersion stability,and high thickening effect in scCO_(2).Under an ambient pressure of 10 MPa and a temperature of 50℃,the disso-lution of copolymer at a mass concentration of 0.2%can effectively increase the viscosity of scCO_(2) by 39.4 times.Due to the synergistic effect between expanding vertical swept volume and inhibiting gas channel-ing,crude oil recovery can be further enhanced by 23.1%for a typical high-water-cut mature reservoir when the scCO_(2) viscosity is increased by 50 times.Our understandings demonstrate that the thickened scCO_(2) flooding technology has significant technical advantages in high-water-cut mature reservoirs,with challenges and future development directions in field-scale applications also highlighted.展开更多
BACKGROUND Intrahepatic and extrahepatic bile duct stones(BDSs)have a high rate of residual stones,a high risk of recurrence,and a high rate of reoperation.It is very important to take timely and effective surgical in...BACKGROUND Intrahepatic and extrahepatic bile duct stones(BDSs)have a high rate of residual stones,a high risk of recurrence,and a high rate of reoperation.It is very important to take timely and effective surgical intervention for patients.AIM To analyze the efficacy,postoperative rehabilitation,and quality of life(QoL)of patients with intra-and extrahepatic BDSs treated with endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic papillary balloon dilation(EPBD)+laparoscopic hepatectomy(LH).METHODS This study selected 114 cases of intra-and extrahepatic BDSs from April 2021 to April 2024,consisting of 55 cases in the control group receiving laparoscopic common bile duct exploration and LH and 59 cases in the observation group treated with ERCP+EPBD+LH.Efficacy,surgical indicators[operation time(OT)and intraoperative blood loss(IBL)],postoperative rehabilitation(time for body temperature to return to normal,time for pain relief,and time for drainage to reduce jaundice),hospital stay,medical expenses,and QoL[Gastrointestinal Quality of Life Index(GIQLI)]were comparatively analyzed.Further,Logistic regression analysis was conducted to analyze factors influencing the QoL of patients with intra-and extrahepatic BDSs.RESULTS The data demonstrated a higher overall effective rate in the observation group compared to the control group(P=0.011),together with notably reduced OT,less IBL,shorter body temperature recovery time,pain relief time,time for drainage to reduce jaundice,and hospital stay(all P<0.05).The postoperative GIQLI of the observation group was more significantly increased compared to the control group(P<0.05).The two groups demonstrated no marked difference in medical expenses(P>0.05).CONCLUSION The above indicates that ERCP+EPBD+LH is effective in treating patients with intra-and extrahepatic BDSs,which is conducive to postoperative rehabilitation and QoL improvement,with promising prospects for clinical promotion.展开更多
AIM： To determine the prognostic value of lymphatic and/or blood vessel invasion （LBVI） in patients with stage 11 gastric cancer. METHODS： From January 2001 to December 2006, 487 patients with histologically confi...AIM： To determine the prognostic value of lymphatic and/or blood vessel invasion （LBVI） in patients with stage 11 gastric cancer. METHODS： From January 2001 to December 2006, 487 patients with histologically confirmed primary gas- tric adenocarcinoma were diagnosed with stage 11 gas- tric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery, Fudan University Shanghai Cancer Center. All patients underwent curative gastrectomy with standard lymph node （LN） dissection. Fifty-one patients who died in the postoperative period, due to various complications or other conditions, were excluded. Clinicopathologicalfindings and clinical outcomes were analyzed. Patients were subdivided into four groups according to the status of LBVI and LN metastases. These four patient groups were characterized with regard to age, sex, tumor site, pT category, tumor grading and surgical procedure （subtotal resection vs total resection）, and compared for 5-year overall survival by univariate and multivariate analysis. RESULTS： The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years （range： 23-88 years）. The 5-year overall survival rates were 50.7% and the median survival time was 62 too. Stage Ⅱ a cancer was observed in 334 patients, including 268 T3N0, 63 T2N1, and three TIN2, and stage Ⅱb was observed in 102 patients, including 49 patients T3N1, 51 T2N2, one TIN3, and one T4aN0. The incidence of LBVI was 28.0% in stage II gastric cancer with 19.0% （51/269） and 42.5% （71/167） in LN-negative and LN- positive patients, respectively. In 218 patients （50.0%）, there was neither a histopathologically detectable LBVI nor LN metastases （LBVI-/LN-, group I）; in 51 patients （11.7%）, LBVI with no evidence of LN me- tastases was detected （LBVILN-, group 11）. In 167 patients （38.3%）, LN metastases were found. Among those patients, LBVI was not determined in 96 patients （22.0%） （LBVI-γLN, group Ⅲ）, and was determined in 71 patients （16.3%） （LBVI＋LN＋, group Ⅳ）. Correla- tion analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI （P 〈 0.001）. The overall 5-year sur- vival was significantly longer in LN-negative patients compared with LN-positive patients （56.1% vs 42.3%, P = 0.015）. There was a significant difference in the overall 5-year survival between LBVI-positive and LBVI- negative tumors （39.6% vs 54.8%, P = 0.006）. Overall 5-year survival rates in each group were 58.8% （ Ⅰ）, 45.8% （Ⅱ）, 45.7% （Ⅲ） and 36.9% （Ⅳ）, and there was a significant difference in overall survival between the four groups （P=-0.009）. Multivariate analysis in stage 11 gastric cancer patients revealed that LBVI in- dependently affected patient prognosis in LN-negativepatients （P = 0.018） but not in LN-positive patients （P = 0.508）. CONCLUSION： In LN-negative stage 11 gastric cancer patients, LBVI is an additional independent prognostic markeF, and may provide useful information to identify patients with poorer prognosis.展开更多
Liver transplantation(LT)has emerged as a curative strategy for hepatocellular carcinoma(HCC),but contributes to a higher predisposition to HCC recurrence in the immunosuppression context,especially for tumors beyond ...Liver transplantation(LT)has emerged as a curative strategy for hepatocellular carcinoma(HCC),but contributes to a higher predisposition to HCC recurrence in the immunosuppression context,especially for tumors beyond the Milan criteria.Although immunotherapy has dramatically improved survival for immunocompetent patients and has become the standard of care for a variety of tumors,including HCC,it is mainly used outside the scope of organ transplantation owing to potentially fatal allograft rejection.Nevertheless,accumulative evidence has expanded the therapeutic paradigms of immunotherapy for HCC,from downstaging or bridging management in the pretransplant setting to the salvage or adjuvant strategy in the posttransplant setting.Generally,immunotherapy mainly includes immune checkpoint inhibitors(ICIs),adoptive cell transfer(ACT)and vaccine therapy.ICIs,followed by ACT,have been most investigated in LT,with some promising results.Because of the complex tumor microenvironment and immunoreactivity when immunosuppressants are combined with immunotherapy,it is difficult to reach formulations for immunosuppressant adjustment and the optimal selection of immunotherapy as well as patients.In addition,the absence of effective biomarkers for identifying rejection and tumor response is still an unresolved barrier to successful clinical immunotherapy applications for LT.In this review,we comprehensively summarize the available evidence of immunotherapy used in LT that is specific to HCC.Moreover,we discuss clinically concerning issues regarding the concurrent goals of graft protection and antitumor response.展开更多
BACKGROUND Hepatic epithelioid angiomyolipoma(HEAML) is a rare liver disease and is easily misdiagnosed. Enhanced recognition of HEAML is beneficial to the differential diagnosis of rare liver diseases.CASE SUMMARY We...BACKGROUND Hepatic epithelioid angiomyolipoma(HEAML) is a rare liver disease and is easily misdiagnosed. Enhanced recognition of HEAML is beneficial to the differential diagnosis of rare liver diseases.CASE SUMMARY We presented two cases of HEAML in Changzheng Hospital, Naval Medical University, and then collected and analyzed all reports about HEAML recorded in PubMed, MEDLINE, China Science Periodical Database, and VIP database from January 2000 to March 2018. A total of 409 cases of HEAML in 97 reports were collected, with a ratio of men to women of 1:4.84 and an age range from 12 years to 80 years(median 44 years). Among the patients with clinical symptoms mentioned, 61.93%(205/331) were asymptomatic, 34.74%(115/331) showed upper or right upper quadrant abdomen discomfort, while a few of them showed abdominal mass, gastrointestinal symptoms, low fever, or weight loss. The misdiagnosis rate of HEAML was as high as 40.34%(165/409) due to its nonspecific imaging findings. Most of the tumors were solitary and round in morphology, with clear boundaries. Ultrasound scan indicated low echo with internal nonuniformity and rich blood supply in most cases. Computer tomography/magnetic resonance imaging enhanced scan showed varied characteristics. The ratio of fast wash-in and fast wash-out, fast wash-in and slow wash-out, and delayed enhancement was roughly 4:5:1. A definite diagnosis of HEAML depended on the pathological findings of the epithelioid cells in lesions and the expression of human melanoma black 45, smooth muscle actin,melanoma antigen, and actin by immunohistochemical staining. HEAML had a relatively low malignant rate of 3.91%. However, surgical resection was the main treatment for HEAML, due to the difficulty diagnosing before operation.CONCLUSION HEAML is a rare and easily misdiagnosed disease, and it should be diagnosed carefully, taking into account clinical course, imaging, pathological,and immunohistochemical findings.展开更多
Ectopic adrenal cortical neoplasms are extremely rare. Ectopic adrenocortical tissue can be found in locations such as the celiac axis,the broad ligament,the adnexa of the testes,and the spermatic cord;however,they ra...Ectopic adrenal cortical neoplasms are extremely rare. Ectopic adrenocortical tissue can be found in locations such as the celiac axis,the broad ligament,the adnexa of the testes,and the spermatic cord;however,they rarely involve the stomach.We report an unusual case of a patient with an ectopic adrenal cortical adenoma in the gastric wall.The patient was a 72-year old female admitted to our hospital with upper abdominal discomfort.Physical examination revealed tenderness below the xiphoid process.Both computed tomography and fibergastroscopy revealed a mass on the lesser curvature side of the gastric antrum;it was initially diagnosed as a gastric stromal tumor.After adequate preparation,the patient underwent surgery.During the procedure,we found a 30 mm×30 mm mass with medium density in the lesser curvature near the gastric antrum within the serosa.Following immunohistochemistry examination, we corrected the diagnosis to an ectopic adrenal cortical adenoma;the tumor was nonfunctional.展开更多
On September 8, 2018, an M_S 5.9 earthquake struck Mojiang, a county in Yunnan Province, China. We collect near-field seismic recordings(epicentral distances less than 200 km) to relocate the mainshock and the aftersh...On September 8, 2018, an M_S 5.9 earthquake struck Mojiang, a county in Yunnan Province, China. We collect near-field seismic recordings(epicentral distances less than 200 km) to relocate the mainshock and the aftershocks within the first 60 hours to determine the focal mechanism solutions of the mainshock and some of the aftershocks and to invert for the finite-fault model of the mainshock.The focal mechanism solution of the mainshock and the relocation results of the aftershocks constrain the mainshock on a nearly vertical fault plane striking northeast and dipping to the southeast. The inversion of the finite-fault model reveals only a single slip asperity on the fault plane. The major slip is distributed above the initiation point, ～14 km wide along the down-dip direction and ～14 km long along the strike direction, with a maximal slip of ～22 cm at a depth of ～6 km. The focal mechanism solutions of the aftershocks show that most of the aftershocks are of the strike-slip type, a number of them are of the normal-slip type, and only a few of them are of the thrust-slip type.On average, strike-slip is dominant on the fault plane of the mainshock, as the focal mechanism solution of the mainshock suggests, but when examined in detail, slight thrust-slip appears on the southwest of the fault plane while an obvious part of normal-slip appears on the northeast, which is consistent with what the focal mechanism solutions of the aftershocks display. The multiple types of aftershock focal mechanism solutions and the slip details of the mainshock both suggest a complex tectonic setting, stress setting, or both. The intensity contours predicted exhibit a longer axis trending from northeast to southwest and a maximal intensity of Ⅷ around the epicenter and in the northwest.展开更多
To the Editor:Primary hepatic squamous cell carcinoma(PHSCC)is a rare and easily misdiagnosed disease.We reported a PHSCC case with abdominal incision metastasis after hepatectomy,and reviewed the clinical course,imag...To the Editor:Primary hepatic squamous cell carcinoma(PHSCC)is a rare and easily misdiagnosed disease.We reported a PHSCC case with abdominal incision metastasis after hepatectomy,and reviewed the clinical course,imaging,pathology and immunohistochemical findings.Our case may provide a better understanding of PHSCC.展开更多
BACKGROUND Groove pancreatitis(GP)is a type of chronic pancreatitis occurring in an anatomic area between the duodenum,head of the pancreas,and common bile duct.Duodenal obstruction is always caused by malignant pancr...BACKGROUND Groove pancreatitis(GP)is a type of chronic pancreatitis occurring in an anatomic area between the duodenum,head of the pancreas,and common bile duct.Duodenal obstruction is always caused by malignant pancreatic diseases,such as pancreatic head carcinoma,while is rarely induced by benign pancreatic diseases,such as pancreatitis.CASE SUMMARY A 39-year-old man presented with a 1-mo history of upper abdominal discomfort.His concomitant symptoms were abdominal distension,postprandial nausea,and vomiting.Contrast-enhanced computed tomography of the abdomen showed thickening of the intestinal wall with enhancement of the descending segment of the duodenum,which could not be clearly differentiated from the head of the pancreas.Upper gastrointestinal radiographs and gastrointestinal endoscopy showed a complete obstruction of the descending duodenum.An operation found that a 3-cm mass was located in the“groove part”of the pancreas and oppressing the descending duodenum.Pancreaticoduodenectomy was performed to relieve the obstruction and thoroughly remove the pancreatic lesions.The pathologic diagnosis was pancreatitis.The patient had an uneventful recovery with no complications.CONCLUSION Because of the special location and the contracture induced by long-term chronic inflammation,our case reminds surgeons that some benign pancreatic diseases,such as GP,can also present with symptoms similar to those of pancreatic cancer.This knowledge can help to avoid an unnecessary radical operation.展开更多
BACKGROUND Acute kidney injury(AKI)after surgery appears to increase the risk of death in patients with liver cancer.In recent years,machine learning algorithms have been shown to offer higher discriminative efficienc...BACKGROUND Acute kidney injury(AKI)after surgery appears to increase the risk of death in patients with liver cancer.In recent years,machine learning algorithms have been shown to offer higher discriminative efficiency than classical statistical analysis.AIM To develop prediction models for AKI after liver cancer resection using machine learning techniques.METHODS We screened a total of 2450 patients who had undergone primary hepatocellular carcinoma resection at Changzheng Hospital,Shanghai City,China,from January 1,2015 to August 31,2020.The AKI definition used was consistent with the Kidney Disease:Improving Global Outcomes.We included in our analysis preoperative data such as demographic characteristics,laboratory findings,comorbidities,and medication,as well as perioperative data such as duration of surgery.Computerized algorithms used for model development included logistic regression(LR),support vector machine(SVM),random forest(RF),extreme gradient boosting(XGboost),and decision tree(DT).Feature importance was also ranked according to its contribution to model development.RESULTS AKI events occurred in 296 patients(12.1%)within 7 d after surgery.Among the original models based on machine learning techniques,the RF algorithm had optimal discrimination with an area under the curve value of 0.92,compared to 0.87 for XGBoost,0.90 for DT,0.90 for SVM,and 0.85 for LR.The RF algorithm also had the highest concordance-index(0.86)and the lowest Brier score(0.076).The variable that contributed the most in the RF algorithm was age,followed by cholesterol,and surgery time.CONCLUSION Machine learning algorithms are highly effective in discriminating patients at high risk of developing AKI.The successful application of machine learning models may help guide clinical decisions and help improve the long-term prognosis of patients.展开更多
With the development of color Doppler and laparoscopic ultrasound, now intraoperative ultrasound(IOUS) plays an important role in liver surgery. Compared to percutaneous ultrasound(US), IOUS is conducted directly on t...With the development of color Doppler and laparoscopic ultrasound, now intraoperative ultrasound(IOUS) plays an important role in liver surgery. Compared to percutaneous ultrasound(US), IOUS is conducted directly on the liver surface, with no blind spots or dead ends, thus improves the detection, localization and characterization of lesions without influencing factors, such as obesity.展开更多
Achieving flexible electronics with comfort and durability comparable to traditional textiles is one of the ultimate pursuits of smart wearables.Ink printing is desirable for e-textile development using a simple and i...Achieving flexible electronics with comfort and durability comparable to traditional textiles is one of the ultimate pursuits of smart wearables.Ink printing is desirable for e-textile development using a simple and inexpensive process.However,fabricating high-performance atop textiles with good dispersity,stability,biocompatibility,and wearability for high-resolution,large-scale manufacturing,and practical applications has remained challenging.Here,waterbased multi-walled carbon nanotubes(MWCNTs)-decorated liquid metal(LM)inks are proposed with carbonaceous gallium–indium micro-nanostructure.With the assistance of biopolymers,the sodium alginate-encapsulated LM droplets contain high carboxyl groups which non-covalently crosslink with silk sericin-mediated MWCNTs.E-textile can be prepared subsequently via printing technique and natural waterproof triboelectric coating,enabling good flexibility,hydrophilicity,breathability,wearability,biocompatibility,conductivity,stability,and excellent versatility,without any artificial chemicals.The obtained e-textile can be used in various applications with designable patterns and circuits.Multi-sensing applications of recognizing complex human motions,breathing,phonation,and pressure distribution are demonstrated with repeatable and reliable signals.Self-powered and energy-harvesting capabilities are also presented by driving electronic devices and lighting LEDs.As proof of concept,this work provides new opportunities in a scalable and sustainable way to develop novel wearable electronics and smart clothing for future commercial applications.展开更多
In recent years,breakthrough has been made in the field of artificial intelligence(AI),which has also revolutionized the industry of robotics.Soft robots featured with high-level safety,less weight,lower power consump...In recent years,breakthrough has been made in the field of artificial intelligence(AI),which has also revolutionized the industry of robotics.Soft robots featured with high-level safety,less weight,lower power consumption have always been one of the research hotspots.Recently,multifunctional sensors for perception of soft robotics have been rapidly developed,while more algorithms and models of machine learning with high accuracy have been optimized and proposed.Designs of soft robots with AI have also been advanced ranging from multimodal sensing,human-machine interaction to effective actuation in robotic systems.Nonethe-less,comprehensive reviews concerning the new developments and strategies for the ingenious design of the soft robotic systems equipped with AI are rare.Here,the new development is systematically reviewed in the field of soft robots with AI.First,background and mechanisms of soft robotic systems are briefed,after which development focused on how to endow the soft robots with AI,including the aspects of feeling,thought and reaction,is illustrated.Next,applications of soft robots with AI are systematically summarized and discussed together with advanced strategies proposed for performance enhancement.Design thoughts for future intelligent soft robotics are pointed out.Finally,some perspectives are put forward.展开更多
基金supported by the Hong Kong Polytechnic University(1-WZ1Y,1-W34U,4-YWER).
文摘Recent years have witnessed transformative changes brought about by artificial intelligence(AI)techniques with billions of parameters for the realization of high accuracy,proposing high demand for the advanced and AI chip to solve these AI tasks efficiently and powerfully.Rapid progress has been made in the field of advanced chips recently,such as the development of photonic computing,the advancement of the quantum processors,the boost of the biomimetic chips,and so on.Designs tactics of the advanced chips can be conducted with elaborated consideration of materials,algorithms,models,architectures,and so on.Though a few reviews present the development of the chips from their unique aspects,reviews in the view of the latest design for advanced and AI chips are few.Here,the newest development is systematically reviewed in the field of advanced chips.First,background and mechanisms are summarized,and subsequently most important considerations for co-design of the software and hardware are illustrated.Next,strategies are summed up to obtain advanced and AI chips with high excellent performance by taking the important information processing steps into consideration,after which the design thought for the advanced chips in the future is proposed.Finally,some perspectives are put forward.
基金the National Natural Science Foundation of China(U22B6005,52174043,52474035)the Beijing Natural Science Foundation(3242019)the China National Petroleum Corporation(CNPC)Innovation Foundation(2022DQ02-0208 and 2024DQ02-0114).
文摘High-water-cut mature reservoirs typically serve as the“ballast”for ensuring China’s annual crude oil production of 200 million tons.Despite the use of water flooding and chemical methods,over 40%of crude oil remains unexploited.It is critical to develop efficient revolutionary technologies to further enhance oil recovery(EOR)by a large percentage in high-water-cut mature reservoirs.To address this issue,the potential of vertical remaining oil in Daqing Oilfield is first analyzed from massive monitoring data.Using molecular dynamics simulation to design optimal synthetic routine,a copolymer without flu-orine or silicon is synthesized by modifying vinyl acetate(VAc)with maleic anhydride(MA)and styrene(St),and treated as a supercritical CO_(2)(scCO_(2))thickener.The underlying EOR mechanism of the scCO_(2) thickener is thereafter clarified by high-temperature,high-pressure oil displacement experiments.The EOR effect by thickened scCO_(2) flooding in a typical high-water-cut mature reservoir is predicted,and future technological advancements of the technique are ultimately discussed.Results show that the ver-tical remaining oil enriched in weakly swept zones is a primary target for further EOR in high-water-cut mature reservoirs.The copolymer typically exhibits good solubility,strong dispersion stability,and high thickening effect in scCO_(2).Under an ambient pressure of 10 MPa and a temperature of 50℃,the disso-lution of copolymer at a mass concentration of 0.2%can effectively increase the viscosity of scCO_(2) by 39.4 times.Due to the synergistic effect between expanding vertical swept volume and inhibiting gas channel-ing,crude oil recovery can be further enhanced by 23.1%for a typical high-water-cut mature reservoir when the scCO_(2) viscosity is increased by 50 times.Our understandings demonstrate that the thickened scCO_(2) flooding technology has significant technical advantages in high-water-cut mature reservoirs,with challenges and future development directions in field-scale applications also highlighted.
文摘BACKGROUND Intrahepatic and extrahepatic bile duct stones(BDSs)have a high rate of residual stones,a high risk of recurrence,and a high rate of reoperation.It is very important to take timely and effective surgical intervention for patients.AIM To analyze the efficacy,postoperative rehabilitation,and quality of life(QoL)of patients with intra-and extrahepatic BDSs treated with endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic papillary balloon dilation(EPBD)+laparoscopic hepatectomy(LH).METHODS This study selected 114 cases of intra-and extrahepatic BDSs from April 2021 to April 2024,consisting of 55 cases in the control group receiving laparoscopic common bile duct exploration and LH and 59 cases in the observation group treated with ERCP+EPBD+LH.Efficacy,surgical indicators[operation time(OT)and intraoperative blood loss(IBL)],postoperative rehabilitation(time for body temperature to return to normal,time for pain relief,and time for drainage to reduce jaundice),hospital stay,medical expenses,and QoL[Gastrointestinal Quality of Life Index(GIQLI)]were comparatively analyzed.Further,Logistic regression analysis was conducted to analyze factors influencing the QoL of patients with intra-and extrahepatic BDSs.RESULTS The data demonstrated a higher overall effective rate in the observation group compared to the control group(P=0.011),together with notably reduced OT,less IBL,shorter body temperature recovery time,pain relief time,time for drainage to reduce jaundice,and hospital stay(all P<0.05).The postoperative GIQLI of the observation group was more significantly increased compared to the control group(P<0.05).The two groups demonstrated no marked difference in medical expenses(P>0.05).CONCLUSION The above indicates that ERCP+EPBD+LH is effective in treating patients with intra-and extrahepatic BDSs,which is conducive to postoperative rehabilitation and QoL improvement,with promising prospects for clinical promotion.
文摘AIM： To determine the prognostic value of lymphatic and/or blood vessel invasion （LBVI） in patients with stage 11 gastric cancer. METHODS： From January 2001 to December 2006, 487 patients with histologically confirmed primary gas- tric adenocarcinoma were diagnosed with stage 11 gas- tric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery, Fudan University Shanghai Cancer Center. All patients underwent curative gastrectomy with standard lymph node （LN） dissection. Fifty-one patients who died in the postoperative period, due to various complications or other conditions, were excluded. Clinicopathologicalfindings and clinical outcomes were analyzed. Patients were subdivided into four groups according to the status of LBVI and LN metastases. These four patient groups were characterized with regard to age, sex, tumor site, pT category, tumor grading and surgical procedure （subtotal resection vs total resection）, and compared for 5-year overall survival by univariate and multivariate analysis. RESULTS： The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years （range： 23-88 years）. The 5-year overall survival rates were 50.7% and the median survival time was 62 too. Stage Ⅱ a cancer was observed in 334 patients, including 268 T3N0, 63 T2N1, and three TIN2, and stage Ⅱb was observed in 102 patients, including 49 patients T3N1, 51 T2N2, one TIN3, and one T4aN0. The incidence of LBVI was 28.0% in stage II gastric cancer with 19.0% （51/269） and 42.5% （71/167） in LN-negative and LN- positive patients, respectively. In 218 patients （50.0%）, there was neither a histopathologically detectable LBVI nor LN metastases （LBVI-/LN-, group I）; in 51 patients （11.7%）, LBVI with no evidence of LN me- tastases was detected （LBVILN-, group 11）. In 167 patients （38.3%）, LN metastases were found. Among those patients, LBVI was not determined in 96 patients （22.0%） （LBVI-γLN, group Ⅲ）, and was determined in 71 patients （16.3%） （LBVI＋LN＋, group Ⅳ）. Correla- tion analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI （P 〈 0.001）. The overall 5-year sur- vival was significantly longer in LN-negative patients compared with LN-positive patients （56.1% vs 42.3%, P = 0.015）. There was a significant difference in the overall 5-year survival between LBVI-positive and LBVI- negative tumors （39.6% vs 54.8%, P = 0.006）. Overall 5-year survival rates in each group were 58.8% （ Ⅰ）, 45.8% （Ⅱ）, 45.7% （Ⅲ） and 36.9% （Ⅳ）, and there was a significant difference in overall survival between the four groups （P=-0.009）. Multivariate analysis in stage 11 gastric cancer patients revealed that LBVI in- dependently affected patient prognosis in LN-negativepatients （P = 0.018） but not in LN-positive patients （P = 0.508）. CONCLUSION： In LN-negative stage 11 gastric cancer patients, LBVI is an additional independent prognostic markeF, and may provide useful information to identify patients with poorer prognosis.
基金National Natural Science Foundation of China,No.81702923 and No.81871262.
文摘Liver transplantation(LT)has emerged as a curative strategy for hepatocellular carcinoma(HCC),but contributes to a higher predisposition to HCC recurrence in the immunosuppression context,especially for tumors beyond the Milan criteria.Although immunotherapy has dramatically improved survival for immunocompetent patients and has become the standard of care for a variety of tumors,including HCC,it is mainly used outside the scope of organ transplantation owing to potentially fatal allograft rejection.Nevertheless,accumulative evidence has expanded the therapeutic paradigms of immunotherapy for HCC,from downstaging or bridging management in the pretransplant setting to the salvage or adjuvant strategy in the posttransplant setting.Generally,immunotherapy mainly includes immune checkpoint inhibitors(ICIs),adoptive cell transfer(ACT)and vaccine therapy.ICIs,followed by ACT,have been most investigated in LT,with some promising results.Because of the complex tumor microenvironment and immunoreactivity when immunosuppressants are combined with immunotherapy,it is difficult to reach formulations for immunosuppressant adjustment and the optimal selection of immunotherapy as well as patients.In addition,the absence of effective biomarkers for identifying rejection and tumor response is still an unresolved barrier to successful clinical immunotherapy applications for LT.In this review,we comprehensively summarize the available evidence of immunotherapy used in LT that is specific to HCC.Moreover,we discuss clinically concerning issues regarding the concurrent goals of graft protection and antitumor response.
基金Supported by the National Science Foundation of China under Grant numbers,No.81702923Outstanding Postgraduate Seedling Cultivation Fund of Naval Medical University
文摘BACKGROUND Hepatic epithelioid angiomyolipoma(HEAML) is a rare liver disease and is easily misdiagnosed. Enhanced recognition of HEAML is beneficial to the differential diagnosis of rare liver diseases.CASE SUMMARY We presented two cases of HEAML in Changzheng Hospital, Naval Medical University, and then collected and analyzed all reports about HEAML recorded in PubMed, MEDLINE, China Science Periodical Database, and VIP database from January 2000 to March 2018. A total of 409 cases of HEAML in 97 reports were collected, with a ratio of men to women of 1:4.84 and an age range from 12 years to 80 years(median 44 years). Among the patients with clinical symptoms mentioned, 61.93%(205/331) were asymptomatic, 34.74%(115/331) showed upper or right upper quadrant abdomen discomfort, while a few of them showed abdominal mass, gastrointestinal symptoms, low fever, or weight loss. The misdiagnosis rate of HEAML was as high as 40.34%(165/409) due to its nonspecific imaging findings. Most of the tumors were solitary and round in morphology, with clear boundaries. Ultrasound scan indicated low echo with internal nonuniformity and rich blood supply in most cases. Computer tomography/magnetic resonance imaging enhanced scan showed varied characteristics. The ratio of fast wash-in and fast wash-out, fast wash-in and slow wash-out, and delayed enhancement was roughly 4:5:1. A definite diagnosis of HEAML depended on the pathological findings of the epithelioid cells in lesions and the expression of human melanoma black 45, smooth muscle actin,melanoma antigen, and actin by immunohistochemical staining. HEAML had a relatively low malignant rate of 3.91%. However, surgical resection was the main treatment for HEAML, due to the difficulty diagnosing before operation.CONCLUSION HEAML is a rare and easily misdiagnosed disease, and it should be diagnosed carefully, taking into account clinical course, imaging, pathological,and immunohistochemical findings.
文摘Ectopic adrenal cortical neoplasms are extremely rare. Ectopic adrenocortical tissue can be found in locations such as the celiac axis,the broad ligament,the adnexa of the testes,and the spermatic cord;however,they rarely involve the stomach.We report an unusual case of a patient with an ectopic adrenal cortical adenoma in the gastric wall.The patient was a 72-year old female admitted to our hospital with upper abdominal discomfort.Physical examination revealed tenderness below the xiphoid process.Both computed tomography and fibergastroscopy revealed a mass on the lesser curvature side of the gastric antrum;it was initially diagnosed as a gastric stromal tumor.After adequate preparation,the patient underwent surgery.During the procedure,we found a 30 mm×30 mm mass with medium density in the lesser curvature near the gastric antrum within the serosa.Following immunohistochemistry examination, we corrected the diagnosis to an ectopic adrenal cortical adenoma;the tumor was nonfunctional.
基金supported by the National Natural Science Foundation of China(project 41804088)the Special Fund of the Institute of Geophysics,China Earthquake Administration(project DQJB19B08)
文摘On September 8, 2018, an M_S 5.9 earthquake struck Mojiang, a county in Yunnan Province, China. We collect near-field seismic recordings(epicentral distances less than 200 km) to relocate the mainshock and the aftershocks within the first 60 hours to determine the focal mechanism solutions of the mainshock and some of the aftershocks and to invert for the finite-fault model of the mainshock.The focal mechanism solution of the mainshock and the relocation results of the aftershocks constrain the mainshock on a nearly vertical fault plane striking northeast and dipping to the southeast. The inversion of the finite-fault model reveals only a single slip asperity on the fault plane. The major slip is distributed above the initiation point, ～14 km wide along the down-dip direction and ～14 km long along the strike direction, with a maximal slip of ～22 cm at a depth of ～6 km. The focal mechanism solutions of the aftershocks show that most of the aftershocks are of the strike-slip type, a number of them are of the normal-slip type, and only a few of them are of the thrust-slip type.On average, strike-slip is dominant on the fault plane of the mainshock, as the focal mechanism solution of the mainshock suggests, but when examined in detail, slight thrust-slip appears on the southwest of the fault plane while an obvious part of normal-slip appears on the northeast, which is consistent with what the focal mechanism solutions of the aftershocks display. The multiple types of aftershock focal mechanism solutions and the slip details of the mainshock both suggest a complex tectonic setting, stress setting, or both. The intensity contours predicted exhibit a longer axis trending from northeast to southwest and a maximal intensity of Ⅷ around the epicenter and in the northwest.
基金supported by the grant from the National Natu-ral Science Foundation of China(81702923)
文摘To the Editor:Primary hepatic squamous cell carcinoma(PHSCC)is a rare and easily misdiagnosed disease.We reported a PHSCC case with abdominal incision metastasis after hepatectomy,and reviewed the clinical course,imaging,pathology and immunohistochemical findings.Our case may provide a better understanding of PHSCC.
基金National Natural Science Foundation of China,No.81602044Zhejiang Provincial Natural Science Foundation of China,No.LY19H160016 and No.LY17H030001+1 种基金Zhejiang Provincial Public Welfare Technology Application Research Projects,No.2015C33293Research Foundation of Health Bureau of Zhejiang Province,No.2014RCA031,No.2018RC077,No.2015KYA218,and No.2016KYB300
文摘BACKGROUND Groove pancreatitis(GP)is a type of chronic pancreatitis occurring in an anatomic area between the duodenum,head of the pancreas,and common bile duct.Duodenal obstruction is always caused by malignant pancreatic diseases,such as pancreatic head carcinoma,while is rarely induced by benign pancreatic diseases,such as pancreatitis.CASE SUMMARY A 39-year-old man presented with a 1-mo history of upper abdominal discomfort.His concomitant symptoms were abdominal distension,postprandial nausea,and vomiting.Contrast-enhanced computed tomography of the abdomen showed thickening of the intestinal wall with enhancement of the descending segment of the duodenum,which could not be clearly differentiated from the head of the pancreas.Upper gastrointestinal radiographs and gastrointestinal endoscopy showed a complete obstruction of the descending duodenum.An operation found that a 3-cm mass was located in the“groove part”of the pancreas and oppressing the descending duodenum.Pancreaticoduodenectomy was performed to relieve the obstruction and thoroughly remove the pancreatic lesions.The pathologic diagnosis was pancreatitis.The patient had an uneventful recovery with no complications.CONCLUSION Because of the special location and the contracture induced by long-term chronic inflammation,our case reminds surgeons that some benign pancreatic diseases,such as GP,can also present with symptoms similar to those of pancreatic cancer.This knowledge can help to avoid an unnecessary radical operation.
文摘BACKGROUND Acute kidney injury(AKI)after surgery appears to increase the risk of death in patients with liver cancer.In recent years,machine learning algorithms have been shown to offer higher discriminative efficiency than classical statistical analysis.AIM To develop prediction models for AKI after liver cancer resection using machine learning techniques.METHODS We screened a total of 2450 patients who had undergone primary hepatocellular carcinoma resection at Changzheng Hospital,Shanghai City,China,from January 1,2015 to August 31,2020.The AKI definition used was consistent with the Kidney Disease:Improving Global Outcomes.We included in our analysis preoperative data such as demographic characteristics,laboratory findings,comorbidities,and medication,as well as perioperative data such as duration of surgery.Computerized algorithms used for model development included logistic regression(LR),support vector machine(SVM),random forest(RF),extreme gradient boosting(XGboost),and decision tree(DT).Feature importance was also ranked according to its contribution to model development.RESULTS AKI events occurred in 296 patients(12.1%)within 7 d after surgery.Among the original models based on machine learning techniques,the RF algorithm had optimal discrimination with an area under the curve value of 0.92,compared to 0.87 for XGBoost,0.90 for DT,0.90 for SVM,and 0.85 for LR.The RF algorithm also had the highest concordance-index(0.86)and the lowest Brier score(0.076).The variable that contributed the most in the RF algorithm was age,followed by cholesterol,and surgery time.CONCLUSION Machine learning algorithms are highly effective in discriminating patients at high risk of developing AKI.The successful application of machine learning models may help guide clinical decisions and help improve the long-term prognosis of patients.
文摘With the development of color Doppler and laparoscopic ultrasound, now intraoperative ultrasound(IOUS) plays an important role in liver surgery. Compared to percutaneous ultrasound(US), IOUS is conducted directly on the liver surface, with no blind spots or dead ends, thus improves the detection, localization and characterization of lesions without influencing factors, such as obesity.
基金funded by The Hong Kong Polytechnic University(Project No.1-WZ1Y,1-YXAK,1-W21C).
文摘Achieving flexible electronics with comfort and durability comparable to traditional textiles is one of the ultimate pursuits of smart wearables.Ink printing is desirable for e-textile development using a simple and inexpensive process.However,fabricating high-performance atop textiles with good dispersity,stability,biocompatibility,and wearability for high-resolution,large-scale manufacturing,and practical applications has remained challenging.Here,waterbased multi-walled carbon nanotubes(MWCNTs)-decorated liquid metal(LM)inks are proposed with carbonaceous gallium–indium micro-nanostructure.With the assistance of biopolymers,the sodium alginate-encapsulated LM droplets contain high carboxyl groups which non-covalently crosslink with silk sericin-mediated MWCNTs.E-textile can be prepared subsequently via printing technique and natural waterproof triboelectric coating,enabling good flexibility,hydrophilicity,breathability,wearability,biocompatibility,conductivity,stability,and excellent versatility,without any artificial chemicals.The obtained e-textile can be used in various applications with designable patterns and circuits.Multi-sensing applications of recognizing complex human motions,breathing,phonation,and pressure distribution are demonstrated with repeatable and reliable signals.Self-powered and energy-harvesting capabilities are also presented by driving electronic devices and lighting LEDs.As proof of concept,this work provides new opportunities in a scalable and sustainable way to develop novel wearable electronics and smart clothing for future commercial applications.
基金supported by the Hong Kong Polytechnic University(Project No.1-WZ1Y).
文摘In recent years,breakthrough has been made in the field of artificial intelligence(AI),which has also revolutionized the industry of robotics.Soft robots featured with high-level safety,less weight,lower power consumption have always been one of the research hotspots.Recently,multifunctional sensors for perception of soft robotics have been rapidly developed,while more algorithms and models of machine learning with high accuracy have been optimized and proposed.Designs of soft robots with AI have also been advanced ranging from multimodal sensing,human-machine interaction to effective actuation in robotic systems.Nonethe-less,comprehensive reviews concerning the new developments and strategies for the ingenious design of the soft robotic systems equipped with AI are rare.Here,the new development is systematically reviewed in the field of soft robots with AI.First,background and mechanisms of soft robotic systems are briefed,after which development focused on how to endow the soft robots with AI,including the aspects of feeling,thought and reaction,is illustrated.Next,applications of soft robots with AI are systematically summarized and discussed together with advanced strategies proposed for performance enhancement.Design thoughts for future intelligent soft robotics are pointed out.Finally,some perspectives are put forward.
