Maintaining the structural integrity of parallel natural gas pipelines during leakage-induced jet fires remains a critical engineering challenge.Existing methods often fail to account for the complex interactions amon...Maintaining the structural integrity of parallel natural gas pipelines during leakage-induced jet fires remains a critical engineering challenge.Existing methods often fail to account for the complex interactions among heat transfer,material behavior,and pipeline geometry,which can lead to overly simplified and potentially unsafe assessments.To address these limitations,this study develops a multiphysics approach that integrates small-orifice leakage theory with detailed thermo-fluid-structural simulations.The proposed framework contributes to a more accurate failure analysis through three main components:(1)coupled modeling that tracks transient heat flow and stress development as fire conditions evolve;(2)risk assessment incorporating spatial layout,material property changes with temperature,and operational limits;and(3)sensitivity analysis to identify key design factors that influence structural performance under high thermal loads.Simulation results demonstrate that thermal radiation from neighboring jet fires significantly accelerates material degradation,with inter-pipeline spacing emerging as a critical determinant of structural response.Notably,increasing the spacing between pipelines reduces thermal interaction and mechanical stress transfer.As a result,systems with optimized spacing exhibit markedly lower deformation than conventional configurations.These findings provide a foundation for re-evaluating pipeline layout strategies and strengthening safety protocols,particularly in high-risk environments where fire exposure can severely compromise structural reliability.The proposed approach offers actionable guidance for engineers and policymakers seeking to enhance the resilience of pipeline infrastructure under extreme thermal conditions.展开更多
Liquid leakage of pipeline networks not only results in considerableresource wastage but also leads to environmental pollution and ecological imbalance.In response to this global issue, a bioinspired superhydrophobic ...Liquid leakage of pipeline networks not only results in considerableresource wastage but also leads to environmental pollution and ecological imbalance.In response to this global issue, a bioinspired superhydrophobic thermoplastic polyurethane/carbon nanotubes/graphene nanosheets flexible strain sensor (TCGS) hasbeen developed using a combination of micro-extrusion compression molding andsurface modification for real-time wireless detection of liquid leakage. The TCGSutilizes the synergistic effects of Archimedean spiral crack arrays and micropores,which are inspired by the remarkable sensory capabilities of scorpions. This designachieves a sensitivity of 218.13 at a strain of 2%, which is an increase of 4300%. Additionally, it demonstrates exceptional durability bywithstanding over 5000 usage cycles. The robust superhydrophobicity of the TCGS significantly enhances sensitivity and stability indetecting small-scale liquid leakage, enabling precise monitoring of liquid leakage across a wide range of sizes, velocities, and compositionswhile issuing prompt alerts. This provides critical early warnings for both industrial pipelines and potential liquid leakage scenariosin everyday life. The development and utilization of bioinspired ultrasensitive flexible strain sensors offer an innovative and effectivesolution for the early wireless detection of liquid leakage.展开更多
BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic...BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.展开更多
Bile leakage is one of the common complications after hepatectomy.Recalcitrant bile leakage not only seriously affects the quality of life of patients,but also prolongs the hospitalization time,increases hospitalizati...Bile leakage is one of the common complications after hepatectomy.Recalcitrant bile leakage not only seriously affects the quality of life of patients,but also prolongs the hospitalization time,increases hospitalization costs,and puts psychological,mental,and financial pressure on patients.The most commonly used methods for the surgical detection of bile leakage include the White test,developer injection through the gallbladder tube/gallbladder,and photodynamic imaging.A new method,Peng’s leakage test,was developed by the authors to detect bile duct leakage and was shown to be the bestmethod available to prevent postoperative bile leakage in patients.展开更多
This work proposes and fabricates the 4H-SiC power MOSFET with top oxide and double P-well(TODP-MOSFET)to enhance the single-event radiation tolerance of the gate oxide.Simulation results suggest that the proposed TOD...This work proposes and fabricates the 4H-SiC power MOSFET with top oxide and double P-well(TODP-MOSFET)to enhance the single-event radiation tolerance of the gate oxide.Simulation results suggest that the proposed TODP structure reduces the peak electric field within the oxide and minimizes the sensitive region by more than 70%compared to C-MOSFETs.Experimental results show that the gate degradation voltage of the TODP-MOSFET is higher than that of the C-MOSFET,and the gate leakage current is reduced by 95%compared to the C-MOSFET under heavy-ion irradiation with a linear energy transfer(LET)value exceeding 75 MeV·cm^(2)/mg.展开更多
Owing to their rolling friction,two-dimensional piston pumps are highly suitable as power components for electro-hydrostatic actuators(EHAs).These pumps are particularly advantageous for applications requiring high ef...Owing to their rolling friction,two-dimensional piston pumps are highly suitable as power components for electro-hydrostatic actuators(EHAs).These pumps are particularly advantageous for applications requiring high efficiency and reliability.However,the ambiguity surrounding the output flow characteristics of individual two-dimensional pumps poses a significant challenge in achieving precise closed-loop control of the EHA positions.To address this issue,this study established a comprehensive numerical model that included gap leakage to analyze the impact of leakage on the output flow characteristics of a two-dimensional piston pump.The validity of the numerical analysis was indirectly confirmed through meticulous measurements of the leakage and volumetric efficiency,ensuring robust results.The research findings indicated that,at lower pump speeds,leakage significantly affected the output flow rate,leading to potential inefficiencies in the system.Conversely,at higher rotational speeds,the impact of leakage was less pronounced,implying that the influence of leakage on the pump outlet flow must be carefully considered and managed for EHAs to perform position servo control.Additionally,the research demonstrates that two-dimensional motion does not have a unique or additional effect on pump leakage,thus simplifying the design considerations.Finally,the study concluded that maintaining an oil-filled leakage environment is beneficial because it helps reduce the impact of leakage and enhances the overall volumetric efficiency of the pump system.展开更多
BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate...BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate of AL,their preventive effects are controversial.AIM To determine the efficacy of reinforcing sutures in preventing AL in rectal cancer.METHODS A systematic search of major medical databases was conducted to identify studies up to June 2024.Intraoperative and postoperative outcomes were assessed;the primary outcome assessed was the incidence of AL.Pooled odds ratios(ORs)and mean differences(MDs)with a 95%confidence interval(CI)were calculated using fixed-effect or random-effect models under heterogeneity.RESULTS This meta-analysis incorporated 20 studies involving 3726 patients.Pooled results demonstrated a statistically significant reduction AL incidence in the reinforced suture group(OR:0.26,95%CI:0.19-0.35,P<0.001)than the unreinforced suture group.The reinforced suture group also exhibited a shorter hospital stay(MD:-1.17,95%CI:-1.78 to-0.57,P<0.001),earlier anal exhaust(MD:-0.13,95%CI:-0.22 to-0.05,P=0.002),longer operative time(MD:15.25,95%CI:10.71-19.80,P<0.001),lower infection rate(OR:0.54,95%CI:0.29-1.00,P=0.05)and lower reoperation rate(OR:0.19,95%CI:0.08-0.45,P<0.001).CONCLUSION The results substantiate the clinical value of anastomotic reinforcement sutures in reducing AL incidence postrectal cancer surgery.Nevertheless,these conclusions warrant verification through additional high-quality randomized controlled trials.展开更多
BACKGROUND Despite the promising prospects of utilizing artificial intelligence and machine learning(ML)for comprehensive disease analysis,few models constructed have been applied in clinical practice due to their com...BACKGROUND Despite the promising prospects of utilizing artificial intelligence and machine learning(ML)for comprehensive disease analysis,few models constructed have been applied in clinical practice due to their complexity and the lack of reasonable explanations.In contrast to previous studies with small sample sizes and limited model interpretability,we developed a transparent eXtreme Gradient Boosting(XGBoost)-based model supported by multi-center data,using patients'basic information and clinical indicators to forecast the occurrence of anastomotic leakage(AL)after rectal cancer resection surgery.The model demonstrated robust predictive performance and identified clinically relevant thresholds,which may assist physicians in optimizing perioperative management.AIM To develop an interpretable ML model for accurately predicting the occurrence probability of AL after rectal cancer resection and define our clinical alert values for serum calcium ions.METHODS Patients who underwent anterior resection of the rectum for rectal carcinoma at the Department of Digestive Surgery,Xijing Hospital of Digestive Diseases,Air Force Medical University,and Shaanxi Provincial People's Hospital,were retrospectively collected from January 2011 to December 2021.Ten ML models were integrated to analyze the data and develop the predictive models.Receiver operating characteristic(ROC)curves,calibration curve,decision curve analysis,accuracy,sensitivity,specificity,positive predictive value,negative predictive value,and F1 score were used to evaluate model performance.We employed the SHapley Additive exPlanations(SHAP)algorithm to explain the feature importance of the optimal model.RESULTS A total of ten features were integrated to construct the predictive model and identify the optimal model.XGBoost was considered the best-performing model with an area under the ROC curve(AUC)of 0.984(95%confidence interval:0.972-0.996)in the test set(accuracy:0.925;sensitivity:0.92;specificity:0.927).Furthermore,the model achieved an AUC of 0.703 in external validation.The interpretable SHAP algorithm revealed that the serum calcium ion level was the crucial factor influencing the predictions of the model.CONCLUSION A superior predictive model,leveraging clinical data,has been crafted by employing the most effective XGBoost from a selection of ten algorithms.This model,by predicting the occurrence of AL in patients after rectal cancer resection,has identified the significant role of serum calcium ion levels,providing guidance for clinical practice.The integration of SHAP provides a clear interpretation of the model's predictions.展开更多
Kang et al published a study recently in the World Journal of Gastroenterology introducing an interpretable machine learning model to predict anastomotic leakage after rectal cancer surgery,highlighting postoperative ...Kang et al published a study recently in the World Journal of Gastroenterology introducing an interpretable machine learning model to predict anastomotic leakage after rectal cancer surgery,highlighting postoperative serum calcium as a key predictive feature.While this represents a significant advancement,we argue that reliance on a static calcium threshold may limit clinical applicability.We advocate for a dynamic,trajectory-based assessment of serum calcium levels across perioperative time points,using modeling approaches such as time-series regression or mixed-effects models.Furthermore,the model’s robustness could be improved by incorporating systemic inflammation and nutritional indices such as C-reactive protein,procalcitonin,the neutrophil-to-lymphocyte ratio,and the systemic immune-inflammation index,supported by recent prospective studies.Finally,generalizability remains a concern,warranting broader validation and clearer clinical deployment strategies.By addressing these aspects,the model’s clinical translation and decision-making impact could be substantially enhanced.展开更多
Salt cavern hydrogen storage(SCHS)is an important component of large-scale underground hydrogen storage,with advantages such as large hydrogen storage capacity and economic feasibility.However,the uniqueness of the sa...Salt cavern hydrogen storage(SCHS)is an important component of large-scale underground hydrogen storage,with advantages such as large hydrogen storage capacity and economic feasibility.However,the uniqueness of the salt cavern structure and the inherent high risk of hydrogen storage pose a potential leakage risk.This study aims to assess the leakage risk of salt cavern hydrogen storage through a comprehensive assessment.First,the three major influencing factors of leakage risk are summarized,taking into account the unique engineering,geological conditions,and operating conditions of salt cavern storage.Subsequently,the salt cavern hydrogen storage leakage risk evaluation index system was established,and the weights of the evaluation indexes were assigned using the combination assignment method.On the basis of the two-dimensional cloud model,a new leakage risk assessment method was proposed.In addition,the risk level assessment of the salt cavern hydrogen storage facility proposed to be constructed in Pingdingshan City,Henan Province,was carried out.Finally,corresponding risk control and preventive measures are proposed.The results of the study are useful and instructive for the safe construction of deep salt cavern hydrogen storage.展开更多
Source term estimation(STE)of hazardous gas leakages in chemical industrial parks(CIPs)is important for addressing environmental pollution and improving safety and reliability in engineering practice.To achieve real-t...Source term estimation(STE)of hazardous gas leakages in chemical industrial parks(CIPs)is important for addressing environmental pollution and improving safety and reliability in engineering practice.To achieve real-time STE,least squares-based STE methods have recently been developed.However,these methods require the number and locations of potential hazardous gas leakage sources are known as a priori,which is difficult in many practical scenarios.To address this limitation,we propose a new datadriven STE approach,which enables the STE to be implemented in real time and applicable to complicated turbulent dispersion scenarios.The linear independent analysis in data science is applied to historically collected concentration data of a hazardous gas of concern from a network of sensors to extract the sensor data which represent independent hazardous gas leakage scenarios(IHGLSs).An appropriate Gaussian model approximation to a high-fidelity computational fluid dynamics(CFD)model that must be used to represent the hazardous gas leakage scenarios of concern is built,and the off-line STE of IHGLSs using the approximating Gaussian model is then performed to build the datadriven STE model.The performance of the proposed approach is evaluated by using data that are generated by simulating ethane leakage scenarios in a CIP using a CFD model.Results indicate that the leakage localization accuracy is 100%and the mean relative estimation error for the leakage strength is6.76%.Moreover,the proposed approach is validated with real data in Prairie Grass field dispersion experiments,demonstrating the practical applicability of the proposed approach.展开更多
This study investigates the gate leakage mechanisms of AlN/GaN metal–insulator–semiconductor high-electronmobility transistors(MIS-HEMTs)fabricated on silicon substrate with Al_(2)O_(3)/SiN as stacked gate dielectri...This study investigates the gate leakage mechanisms of AlN/GaN metal–insulator–semiconductor high-electronmobility transistors(MIS-HEMTs)fabricated on silicon substrate with Al_(2)O_(3)/SiN as stacked gate dielectrics,analyzing behaviors across high and low temperature conditions.In the high-temperature reverse bias region(T>275 K,V_(G)<0 V),Poole–Frenkel emission(PFE)dominates at low electric fields,while trap-assisted tunneling(TAT)is the primary mechanism at medium to high electric fields.The shift from PFE to TAT as the dominant conduction mechanism is due to the increased tunneling effect of electrons as the electric field strength rises.Additionally,TAT is found to be the main gate leakage mechanism under low-temperature reverse bias(T<275 K,V_(G)<0 V).At lower temperatures,the reduction in electron energy causes the emission process to rely more on electric field forces.Furthermore,under forward bias conditions at both high and low temperatures(225 K<T<375 K,V_(G)>0 V),conduction is primarily dominated by defect-assisted tunneling(DAT).展开更多
Bile leakage remains a formidable challenge in post-liver transplantation management,posing significant risks to patient outcomes and graft survival.This editorial provides a critical appraisal of the recent clinical ...Bile leakage remains a formidable challenge in post-liver transplantation management,posing significant risks to patient outcomes and graft survival.This editorial provides a critical appraisal of the recent clinical study by Gu et al,which compared the efficacy of stent placement vs endoscopic nasobiliary drainage(ENBD)for treating post-transplant bile leaks.By retrospectively analyzing data from their institutional cohort of liver transplant recipients with bile leaks,the authors evaluated the therapeutic success rates and clinical outcomes between the stent and ENBD groups,with a focused discussion on the relative advantages of each approach.Gu et al demonstrated that both stent placement and ENBD were effective in managing post-transplant bile leaks,with comparable therapeutic outcomes.However,the study also recognized its limitations,such as the lack of an assessment of the impact of bile leak severity on outcome and the absence of long-term follow-up data.The editorial further highlights the pressing need for advancing research on long-term complications post-liver transplantation and underscores the pivotal role of clinical stratification and physician expertise in guiding therapeutic decisions.In summary,Gu et al’s study enhances our understanding of mitigating post-transplant complications like bile leaks and offers evidence-based insights to refine clinical protocols.This commentary aims to contextualize current research trends and future directions in the field,advocating for sustained innovation and evidence-driven practice.展开更多
Leakage from buried drainage pipes can cause underground road damage and eventually lead to the formation of cavities.Additionally,rainfall increases the probability of collapse disasters.However,the processes by whic...Leakage from buried drainage pipes can cause underground road damage and eventually lead to the formation of cavities.Additionally,rainfall increases the probability of collapse disasters.However,the processes by which rainfall and pipeline leakage lead to water infiltration and subsequent migration of underground soil-thereby forming cavities-are not well understood.To address this challenge,we developed a physical model to simulate the soil erosion and migration process.This model,which incorporated both model testing and theoretical analysis,simultaneously simulated the effects of rainfall and pipeline leakage on soil erosion and migration.In addition,particle-level optical tracing microscopy was used to investigate the mechanisms of rainfall-and leakage-induced debonding and migration of soil particles and to analyze the characteristics of soil migration and critical gushing.Results revealed that pipeline-leakage-induced soil erosion weakened the bonds between soil particles surrounding the pipes and caused the initial opening of cracks between particles,the fluid began to diffuse from these initial openings,forming ice-flower-like patterns around the point.Under leakage conditions,the microchannels of runoff were interconnected,and the migration of eroded soil exhibited a gridded distribution of soil agglomerates.Moreover,a critical velocity of erosion migration occurred,once this threshold was exceeded,the dispersal of water and soil medium led to the instability of the soil structure.Rainfall and leakage intensified the formation of runoff channels and expanded the cross-sectional areas of these channels.The merging of infiltrated rainwater and leakage flow initiated the gushing of pipe-flow soil.The critical time of gushing in the test environment was approximately 46%earlier than that in the same period of the only-leakage condition.The average area of pits formed by soil collapse was also increased by approximately 105%.Furthermore,the soil erosion and migration process comprised three stages:debonding,migration,and gushing.Rainfall infiltration and leakage-induced erosion synergistically formed soil cavities,intensifying underground soil loss.The soil cavities expanded upward,causing the ground surface to collapse.An"e"-shaped vortex halo formed around the pit created by the collapse of the ground surface,leading to secondary collapses.The findings of this study provide a scientific foundation for the prevention and control of road collapse.展开更多
BACKGROUND Both stent placement and endoscopic nasobiliary drainage(ENBD)are commonly used for treating bile leakage following liver transplantation.However,little research has compared the advantages of both methods....BACKGROUND Both stent placement and endoscopic nasobiliary drainage(ENBD)are commonly used for treating bile leakage following liver transplantation.However,little research has compared the advantages of both methods.AIM To compare the prognosis of stent placement and ENBD in treating bile leakage following liver transplantation.METHODS We retrospectively collected data for patients with bile leakage after liver tran-splantation in our center.The efficiency and prognosis were compared between the stent placement and ENBD groups.RESULTS We retrospectively collected data from 50 patients diagnosed with bile leakage within 1 month after liver transplantation.Forty patients underwent ENBD and nine received stent placement.Baseline patient characteristics,except white blood cell count,total bilirubin and direct bilirubin levels,were comparable between the two groups.Additionally,there was no significant difference in the rates of re-conveyance or postoperative biliary stricture.CONCLUSION Stent placement and ENBD are recommended for treating bile leakage after liver transplantation,with similar efficacy and prognosis.展开更多
BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS ...BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS A retrospective analysis was conducted on 68 patients with mid-low rectal cancer who underwent laparoscopic low anterior resection(LAR)and developed ALs.Leakage were identified using imaging studies and digital rectal examinations when local abscesses or systemic infections were present.In each patient,the leakage site was determined using the index finger and a drainage tube was inserted transanally to drain the abscesses and exudates outside the anus.The clinical outcomes of the patients following transanal drainage were analyzed.RESULTS A total of 43 patients received TDT treatment,while 25 patients did not receive TDT treatment.Among the patients in the TDT group,9 required reoperation compared to 12 in the non-TDT group.In the TDT group,76.74%of the patients were able to restore intestinal continuity,whereas only 40%of the patients in the non-TDT group achieved restored intestinal continuity.In the TDT group,48.48%of patients developed LAR syndrome(LARS),whereas in the non-TDT group,90%of patients developed LARS.The median drainage time was 7 days,the median postoperative hospital stay was 21 days,the median fasting time was 6.5 days,and the median hospitalization cost was 109205.93 RMB.CONCLUSION TDT use lowered reoperation rate but did not increase hospitalization expenses.After≥1 year of follow-up,its use improved intestinal patency rate and reduced the incidence of LARS.展开更多
BACKGROUND Colonic anastomotic leakage(AL)remains a feared complication of colorectal surgery.Usually,a defunctioning stoma or a proximal colostomy is performed to reduce the AL rate but cannot completely prevent AL.M...BACKGROUND Colonic anastomotic leakage(AL)remains a feared complication of colorectal surgery.Usually,a defunctioning stoma or a proximal colostomy is performed to reduce the AL rate but cannot completely prevent AL.Moreover,defunctioning colostomy is associated with high morbidity.This study assessed the feasibility of completely preventing colonic AL using total enteric flow diversion without a defunctioning stoma in a pig model of colonic AL.AIM To determine the feasibility of preventing colonic AL via total enteric flow diversion in pigs.METHODS A total of 14 pigs underwent surgery to create colon anaesthesia with severe defects for establishing the AL model.The pigs were then randomized into the control group(n=7),which received no further therapy,and a diversion group(n=7),which underwent placement of a modified ileostomy tube to divert the enteric contents from the colon externally.The general condition,serum Creactive protein level,white blood cell count,5-day incidence of colon AL,and development of abdominal abscesses were evaluated.RESULTS A modified ileostomy tube with a balloon was placed and pressurized to 20 kPa at a distance of 10-20 cm proximal to the ileocecal valve,effectively obstructing the intestine without causing injury and efficiently diverting the enteric contents.In the diversion group,no cases of peritonitis or abscess were observed.In contrast,all pigs in the control group developed either abdominal abscesses or peritonitis.CONCLUSION Instead of ileostomy or colostomy,the total enteric flow diversion technique with the placement of a modified ileostomy tube and balloon in the ileum can effectively or completely prevent colon AL.展开更多
Biliary leakage is a potentially life-threatening complication following liver transplantation and is associated with significant postoperative morbidity,prolonged hospitalization,and potential graft failure.Its incid...Biliary leakage is a potentially life-threatening complication following liver transplantation and is associated with significant postoperative morbidity,prolonged hospitalization,and potential graft failure.Its incidence underscores the need for timely diagnosis and effective intervention.Diagnostic modalities such as magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography offer both anatomical and functional insights.Endoscopic management with endoscopic retrograde cholangiopancreatography remains the mainstay of treatment,while percutaneous transhepatic cholangiography offers an alternative in patients with altered anatomy or failed endoscopic access.Surgical revision is considered a last resort after other methods have failed.Preventive strategies,including machine perfusion and meticulous surgical techniques,are essential in reducing incidence and improving outcomes.This editorial provides a comprehensive overview of clinical management and therapeutic strategies for biliary leakage after liver transplantation.展开更多
BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is cruc...BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.AIM To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC,with a focus on strict adherence to indications.METHODS Clinical data of 106 cases undergoing LCBDE+PDC in the Hepatobiliary and Pancreatic Surgery Department(Division 1)of Chuzhou First People’s Hospital from April 2019 to March 2024 were collected.Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage.The change in surgical time was analyzed using the cumulative summation(CUSUM)method,and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.RESULTS Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage(P<0.05).The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage(P<0.05),with statistical significance.The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve(P=0.023).CONCLUSION With a good assessment of duodenal papilla sphincter function,unobstructed bile-pancreatic duct convergence,exact stone clearance,and sufficient surgical experience to complete the learning curve,PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.展开更多
文摘Maintaining the structural integrity of parallel natural gas pipelines during leakage-induced jet fires remains a critical engineering challenge.Existing methods often fail to account for the complex interactions among heat transfer,material behavior,and pipeline geometry,which can lead to overly simplified and potentially unsafe assessments.To address these limitations,this study develops a multiphysics approach that integrates small-orifice leakage theory with detailed thermo-fluid-structural simulations.The proposed framework contributes to a more accurate failure analysis through three main components:(1)coupled modeling that tracks transient heat flow and stress development as fire conditions evolve;(2)risk assessment incorporating spatial layout,material property changes with temperature,and operational limits;and(3)sensitivity analysis to identify key design factors that influence structural performance under high thermal loads.Simulation results demonstrate that thermal radiation from neighboring jet fires significantly accelerates material degradation,with inter-pipeline spacing emerging as a critical determinant of structural response.Notably,increasing the spacing between pipelines reduces thermal interaction and mechanical stress transfer.As a result,systems with optimized spacing exhibit markedly lower deformation than conventional configurations.These findings provide a foundation for re-evaluating pipeline layout strategies and strengthening safety protocols,particularly in high-risk environments where fire exposure can severely compromise structural reliability.The proposed approach offers actionable guidance for engineers and policymakers seeking to enhance the resilience of pipeline infrastructure under extreme thermal conditions.
基金the National Natural Science Foundation of China(Grant No.52203037,52103031,and 52073107)the Natural Science Foundation of Hubei Province of China(Grant No.2022CFB649)the National Key Research and Development Program of China(Grant No.2022YFC3901902).
文摘Liquid leakage of pipeline networks not only results in considerableresource wastage but also leads to environmental pollution and ecological imbalance.In response to this global issue, a bioinspired superhydrophobic thermoplastic polyurethane/carbon nanotubes/graphene nanosheets flexible strain sensor (TCGS) hasbeen developed using a combination of micro-extrusion compression molding andsurface modification for real-time wireless detection of liquid leakage. The TCGSutilizes the synergistic effects of Archimedean spiral crack arrays and micropores,which are inspired by the remarkable sensory capabilities of scorpions. This designachieves a sensitivity of 218.13 at a strain of 2%, which is an increase of 4300%. Additionally, it demonstrates exceptional durability bywithstanding over 5000 usage cycles. The robust superhydrophobicity of the TCGS significantly enhances sensitivity and stability indetecting small-scale liquid leakage, enabling precise monitoring of liquid leakage across a wide range of sizes, velocities, and compositionswhile issuing prompt alerts. This provides critical early warnings for both industrial pipelines and potential liquid leakage scenariosin everyday life. The development and utilization of bioinspired ultrasensitive flexible strain sensors offer an innovative and effectivesolution for the early wireless detection of liquid leakage.
基金Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2022D01C297.
文摘BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.
基金supported in part by the National Natural Science Foundation of China(No.82260548)Medical Excellence Award Funded by the Creative Research Development Grant from the First Affiliated Hospital of Guangxi Medical University(No.2021006)+1 种基金the Natural Science Foundation of the Guangxi Province of China(No.2018 GXNSFBA138013)the Guangxi Key R&D Program(No.GKEAB18221019).
文摘Bile leakage is one of the common complications after hepatectomy.Recalcitrant bile leakage not only seriously affects the quality of life of patients,but also prolongs the hospitalization time,increases hospitalization costs,and puts psychological,mental,and financial pressure on patients.The most commonly used methods for the surgical detection of bile leakage include the White test,developer injection through the gallbladder tube/gallbladder,and photodynamic imaging.A new method,Peng’s leakage test,was developed by the authors to detect bile duct leakage and was shown to be the bestmethod available to prevent postoperative bile leakage in patients.
基金supported by the Joint Funds of the National Natural Science Foundation of China(Grant No.U2341220)the Hefei Comprehensive National Science Center。
文摘This work proposes and fabricates the 4H-SiC power MOSFET with top oxide and double P-well(TODP-MOSFET)to enhance the single-event radiation tolerance of the gate oxide.Simulation results suggest that the proposed TODP structure reduces the peak electric field within the oxide and minimizes the sensitive region by more than 70%compared to C-MOSFETs.Experimental results show that the gate degradation voltage of the TODP-MOSFET is higher than that of the C-MOSFET,and the gate leakage current is reduced by 95%compared to the C-MOSFET under heavy-ion irradiation with a linear energy transfer(LET)value exceeding 75 MeV·cm^(2)/mg.
基金Supported by National Natural Science Foundation of China(Grant No.52205072).
文摘Owing to their rolling friction,two-dimensional piston pumps are highly suitable as power components for electro-hydrostatic actuators(EHAs).These pumps are particularly advantageous for applications requiring high efficiency and reliability.However,the ambiguity surrounding the output flow characteristics of individual two-dimensional pumps poses a significant challenge in achieving precise closed-loop control of the EHA positions.To address this issue,this study established a comprehensive numerical model that included gap leakage to analyze the impact of leakage on the output flow characteristics of a two-dimensional piston pump.The validity of the numerical analysis was indirectly confirmed through meticulous measurements of the leakage and volumetric efficiency,ensuring robust results.The research findings indicated that,at lower pump speeds,leakage significantly affected the output flow rate,leading to potential inefficiencies in the system.Conversely,at higher rotational speeds,the impact of leakage was less pronounced,implying that the influence of leakage on the pump outlet flow must be carefully considered and managed for EHAs to perform position servo control.Additionally,the research demonstrates that two-dimensional motion does not have a unique or additional effect on pump leakage,thus simplifying the design considerations.Finally,the study concluded that maintaining an oil-filled leakage environment is beneficial because it helps reduce the impact of leakage and enhances the overall volumetric efficiency of the pump system.
文摘BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate of AL,their preventive effects are controversial.AIM To determine the efficacy of reinforcing sutures in preventing AL in rectal cancer.METHODS A systematic search of major medical databases was conducted to identify studies up to June 2024.Intraoperative and postoperative outcomes were assessed;the primary outcome assessed was the incidence of AL.Pooled odds ratios(ORs)and mean differences(MDs)with a 95%confidence interval(CI)were calculated using fixed-effect or random-effect models under heterogeneity.RESULTS This meta-analysis incorporated 20 studies involving 3726 patients.Pooled results demonstrated a statistically significant reduction AL incidence in the reinforced suture group(OR:0.26,95%CI:0.19-0.35,P<0.001)than the unreinforced suture group.The reinforced suture group also exhibited a shorter hospital stay(MD:-1.17,95%CI:-1.78 to-0.57,P<0.001),earlier anal exhaust(MD:-0.13,95%CI:-0.22 to-0.05,P=0.002),longer operative time(MD:15.25,95%CI:10.71-19.80,P<0.001),lower infection rate(OR:0.54,95%CI:0.29-1.00,P=0.05)and lower reoperation rate(OR:0.19,95%CI:0.08-0.45,P<0.001).CONCLUSION The results substantiate the clinical value of anastomotic reinforcement sutures in reducing AL incidence postrectal cancer surgery.Nevertheless,these conclusions warrant verification through additional high-quality randomized controlled trials.
基金Supported by National Natural Science Foundation of China,No.82172781Shaanxi Health Scientific Research Innovation Team Project,No.2024TD-06.
文摘BACKGROUND Despite the promising prospects of utilizing artificial intelligence and machine learning(ML)for comprehensive disease analysis,few models constructed have been applied in clinical practice due to their complexity and the lack of reasonable explanations.In contrast to previous studies with small sample sizes and limited model interpretability,we developed a transparent eXtreme Gradient Boosting(XGBoost)-based model supported by multi-center data,using patients'basic information and clinical indicators to forecast the occurrence of anastomotic leakage(AL)after rectal cancer resection surgery.The model demonstrated robust predictive performance and identified clinically relevant thresholds,which may assist physicians in optimizing perioperative management.AIM To develop an interpretable ML model for accurately predicting the occurrence probability of AL after rectal cancer resection and define our clinical alert values for serum calcium ions.METHODS Patients who underwent anterior resection of the rectum for rectal carcinoma at the Department of Digestive Surgery,Xijing Hospital of Digestive Diseases,Air Force Medical University,and Shaanxi Provincial People's Hospital,were retrospectively collected from January 2011 to December 2021.Ten ML models were integrated to analyze the data and develop the predictive models.Receiver operating characteristic(ROC)curves,calibration curve,decision curve analysis,accuracy,sensitivity,specificity,positive predictive value,negative predictive value,and F1 score were used to evaluate model performance.We employed the SHapley Additive exPlanations(SHAP)algorithm to explain the feature importance of the optimal model.RESULTS A total of ten features were integrated to construct the predictive model and identify the optimal model.XGBoost was considered the best-performing model with an area under the ROC curve(AUC)of 0.984(95%confidence interval:0.972-0.996)in the test set(accuracy:0.925;sensitivity:0.92;specificity:0.927).Furthermore,the model achieved an AUC of 0.703 in external validation.The interpretable SHAP algorithm revealed that the serum calcium ion level was the crucial factor influencing the predictions of the model.CONCLUSION A superior predictive model,leveraging clinical data,has been crafted by employing the most effective XGBoost from a selection of ten algorithms.This model,by predicting the occurrence of AL in patients after rectal cancer resection,has identified the significant role of serum calcium ion levels,providing guidance for clinical practice.The integration of SHAP provides a clear interpretation of the model's predictions.
基金Supported by Clinical Translational Medicine Project of the Department of Science and Technology of Anhui Province,No.202427b10020138.
文摘Kang et al published a study recently in the World Journal of Gastroenterology introducing an interpretable machine learning model to predict anastomotic leakage after rectal cancer surgery,highlighting postoperative serum calcium as a key predictive feature.While this represents a significant advancement,we argue that reliance on a static calcium threshold may limit clinical applicability.We advocate for a dynamic,trajectory-based assessment of serum calcium levels across perioperative time points,using modeling approaches such as time-series regression or mixed-effects models.Furthermore,the model’s robustness could be improved by incorporating systemic inflammation and nutritional indices such as C-reactive protein,procalcitonin,the neutrophil-to-lymphocyte ratio,and the systemic immune-inflammation index,supported by recent prospective studies.Finally,generalizability remains a concern,warranting broader validation and clearer clinical deployment strategies.By addressing these aspects,the model’s clinical translation and decision-making impact could be substantially enhanced.
基金Youth Innovation Promotion Association of the Chinese Academy of Sciences,Grant/Award Number:No.Y2023089Excellent Young Scientists Fund,Grant/Award Number:No.52122403National Natural Science Foundation of China,Grant/Award Number:No.52374069。
文摘Salt cavern hydrogen storage(SCHS)is an important component of large-scale underground hydrogen storage,with advantages such as large hydrogen storage capacity and economic feasibility.However,the uniqueness of the salt cavern structure and the inherent high risk of hydrogen storage pose a potential leakage risk.This study aims to assess the leakage risk of salt cavern hydrogen storage through a comprehensive assessment.First,the three major influencing factors of leakage risk are summarized,taking into account the unique engineering,geological conditions,and operating conditions of salt cavern storage.Subsequently,the salt cavern hydrogen storage leakage risk evaluation index system was established,and the weights of the evaluation indexes were assigned using the combination assignment method.On the basis of the two-dimensional cloud model,a new leakage risk assessment method was proposed.In addition,the risk level assessment of the salt cavern hydrogen storage facility proposed to be constructed in Pingdingshan City,Henan Province,was carried out.Finally,corresponding risk control and preventive measures are proposed.The results of the study are useful and instructive for the safe construction of deep salt cavern hydrogen storage.
基金supported by the National Natural Science Foundation of China(Basic Science Center Program 61988101,62303186,62203173)。
文摘Source term estimation(STE)of hazardous gas leakages in chemical industrial parks(CIPs)is important for addressing environmental pollution and improving safety and reliability in engineering practice.To achieve real-time STE,least squares-based STE methods have recently been developed.However,these methods require the number and locations of potential hazardous gas leakage sources are known as a priori,which is difficult in many practical scenarios.To address this limitation,we propose a new datadriven STE approach,which enables the STE to be implemented in real time and applicable to complicated turbulent dispersion scenarios.The linear independent analysis in data science is applied to historically collected concentration data of a hazardous gas of concern from a network of sensors to extract the sensor data which represent independent hazardous gas leakage scenarios(IHGLSs).An appropriate Gaussian model approximation to a high-fidelity computational fluid dynamics(CFD)model that must be used to represent the hazardous gas leakage scenarios of concern is built,and the off-line STE of IHGLSs using the approximating Gaussian model is then performed to build the datadriven STE model.The performance of the proposed approach is evaluated by using data that are generated by simulating ethane leakage scenarios in a CIP using a CFD model.Results indicate that the leakage localization accuracy is 100%and the mean relative estimation error for the leakage strength is6.76%.Moreover,the proposed approach is validated with real data in Prairie Grass field dispersion experiments,demonstrating the practical applicability of the proposed approach.
基金Project supported by the National Natural Science Foundation of China(Grant Nos.62188102,62174125,and 62131014).
文摘This study investigates the gate leakage mechanisms of AlN/GaN metal–insulator–semiconductor high-electronmobility transistors(MIS-HEMTs)fabricated on silicon substrate with Al_(2)O_(3)/SiN as stacked gate dielectrics,analyzing behaviors across high and low temperature conditions.In the high-temperature reverse bias region(T>275 K,V_(G)<0 V),Poole–Frenkel emission(PFE)dominates at low electric fields,while trap-assisted tunneling(TAT)is the primary mechanism at medium to high electric fields.The shift from PFE to TAT as the dominant conduction mechanism is due to the increased tunneling effect of electrons as the electric field strength rises.Additionally,TAT is found to be the main gate leakage mechanism under low-temperature reverse bias(T<275 K,V_(G)<0 V).At lower temperatures,the reduction in electron energy causes the emission process to rely more on electric field forces.Furthermore,under forward bias conditions at both high and low temperatures(225 K<T<375 K,V_(G)>0 V),conduction is primarily dominated by defect-assisted tunneling(DAT).
文摘Bile leakage remains a formidable challenge in post-liver transplantation management,posing significant risks to patient outcomes and graft survival.This editorial provides a critical appraisal of the recent clinical study by Gu et al,which compared the efficacy of stent placement vs endoscopic nasobiliary drainage(ENBD)for treating post-transplant bile leaks.By retrospectively analyzing data from their institutional cohort of liver transplant recipients with bile leaks,the authors evaluated the therapeutic success rates and clinical outcomes between the stent and ENBD groups,with a focused discussion on the relative advantages of each approach.Gu et al demonstrated that both stent placement and ENBD were effective in managing post-transplant bile leaks,with comparable therapeutic outcomes.However,the study also recognized its limitations,such as the lack of an assessment of the impact of bile leak severity on outcome and the absence of long-term follow-up data.The editorial further highlights the pressing need for advancing research on long-term complications post-liver transplantation and underscores the pivotal role of clinical stratification and physician expertise in guiding therapeutic decisions.In summary,Gu et al’s study enhances our understanding of mitigating post-transplant complications like bile leaks and offers evidence-based insights to refine clinical protocols.This commentary aims to contextualize current research trends and future directions in the field,advocating for sustained innovation and evidence-driven practice.
基金supported by the Beijing Natural Science Foundation(JQ21028)the National Natural Science Foundation of China(52278326)the National High-Level Talent Program(SQ2022QB03353).
文摘Leakage from buried drainage pipes can cause underground road damage and eventually lead to the formation of cavities.Additionally,rainfall increases the probability of collapse disasters.However,the processes by which rainfall and pipeline leakage lead to water infiltration and subsequent migration of underground soil-thereby forming cavities-are not well understood.To address this challenge,we developed a physical model to simulate the soil erosion and migration process.This model,which incorporated both model testing and theoretical analysis,simultaneously simulated the effects of rainfall and pipeline leakage on soil erosion and migration.In addition,particle-level optical tracing microscopy was used to investigate the mechanisms of rainfall-and leakage-induced debonding and migration of soil particles and to analyze the characteristics of soil migration and critical gushing.Results revealed that pipeline-leakage-induced soil erosion weakened the bonds between soil particles surrounding the pipes and caused the initial opening of cracks between particles,the fluid began to diffuse from these initial openings,forming ice-flower-like patterns around the point.Under leakage conditions,the microchannels of runoff were interconnected,and the migration of eroded soil exhibited a gridded distribution of soil agglomerates.Moreover,a critical velocity of erosion migration occurred,once this threshold was exceeded,the dispersal of water and soil medium led to the instability of the soil structure.Rainfall and leakage intensified the formation of runoff channels and expanded the cross-sectional areas of these channels.The merging of infiltrated rainwater and leakage flow initiated the gushing of pipe-flow soil.The critical time of gushing in the test environment was approximately 46%earlier than that in the same period of the only-leakage condition.The average area of pits formed by soil collapse was also increased by approximately 105%.Furthermore,the soil erosion and migration process comprised three stages:debonding,migration,and gushing.Rainfall infiltration and leakage-induced erosion synergistically formed soil cavities,intensifying underground soil loss.The soil cavities expanded upward,causing the ground surface to collapse.An"e"-shaped vortex halo formed around the pit created by the collapse of the ground surface,leading to secondary collapses.The findings of this study provide a scientific foundation for the prevention and control of road collapse.
文摘BACKGROUND Both stent placement and endoscopic nasobiliary drainage(ENBD)are commonly used for treating bile leakage following liver transplantation.However,little research has compared the advantages of both methods.AIM To compare the prognosis of stent placement and ENBD in treating bile leakage following liver transplantation.METHODS We retrospectively collected data for patients with bile leakage after liver tran-splantation in our center.The efficiency and prognosis were compared between the stent placement and ENBD groups.RESULTS We retrospectively collected data from 50 patients diagnosed with bile leakage within 1 month after liver transplantation.Forty patients underwent ENBD and nine received stent placement.Baseline patient characteristics,except white blood cell count,total bilirubin and direct bilirubin levels,were comparable between the two groups.Additionally,there was no significant difference in the rates of re-conveyance or postoperative biliary stricture.CONCLUSION Stent placement and ENBD are recommended for treating bile leakage after liver transplantation,with similar efficacy and prognosis.
文摘BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS A retrospective analysis was conducted on 68 patients with mid-low rectal cancer who underwent laparoscopic low anterior resection(LAR)and developed ALs.Leakage were identified using imaging studies and digital rectal examinations when local abscesses or systemic infections were present.In each patient,the leakage site was determined using the index finger and a drainage tube was inserted transanally to drain the abscesses and exudates outside the anus.The clinical outcomes of the patients following transanal drainage were analyzed.RESULTS A total of 43 patients received TDT treatment,while 25 patients did not receive TDT treatment.Among the patients in the TDT group,9 required reoperation compared to 12 in the non-TDT group.In the TDT group,76.74%of the patients were able to restore intestinal continuity,whereas only 40%of the patients in the non-TDT group achieved restored intestinal continuity.In the TDT group,48.48%of patients developed LAR syndrome(LARS),whereas in the non-TDT group,90%of patients developed LARS.The median drainage time was 7 days,the median postoperative hospital stay was 21 days,the median fasting time was 6.5 days,and the median hospitalization cost was 109205.93 RMB.CONCLUSION TDT use lowered reoperation rate but did not increase hospitalization expenses.After≥1 year of follow-up,its use improved intestinal patency rate and reduced the incidence of LARS.
基金Supported by the Fundamental Research Funds for the Central Universities of Central South University,No.2024XQLH027.
文摘BACKGROUND Colonic anastomotic leakage(AL)remains a feared complication of colorectal surgery.Usually,a defunctioning stoma or a proximal colostomy is performed to reduce the AL rate but cannot completely prevent AL.Moreover,defunctioning colostomy is associated with high morbidity.This study assessed the feasibility of completely preventing colonic AL using total enteric flow diversion without a defunctioning stoma in a pig model of colonic AL.AIM To determine the feasibility of preventing colonic AL via total enteric flow diversion in pigs.METHODS A total of 14 pigs underwent surgery to create colon anaesthesia with severe defects for establishing the AL model.The pigs were then randomized into the control group(n=7),which received no further therapy,and a diversion group(n=7),which underwent placement of a modified ileostomy tube to divert the enteric contents from the colon externally.The general condition,serum Creactive protein level,white blood cell count,5-day incidence of colon AL,and development of abdominal abscesses were evaluated.RESULTS A modified ileostomy tube with a balloon was placed and pressurized to 20 kPa at a distance of 10-20 cm proximal to the ileocecal valve,effectively obstructing the intestine without causing injury and efficiently diverting the enteric contents.In the diversion group,no cases of peritonitis or abscess were observed.In contrast,all pigs in the control group developed either abdominal abscesses or peritonitis.CONCLUSION Instead of ileostomy or colostomy,the total enteric flow diversion technique with the placement of a modified ileostomy tube and balloon in the ileum can effectively or completely prevent colon AL.
文摘Biliary leakage is a potentially life-threatening complication following liver transplantation and is associated with significant postoperative morbidity,prolonged hospitalization,and potential graft failure.Its incidence underscores the need for timely diagnosis and effective intervention.Diagnostic modalities such as magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography offer both anatomical and functional insights.Endoscopic management with endoscopic retrograde cholangiopancreatography remains the mainstay of treatment,while percutaneous transhepatic cholangiography offers an alternative in patients with altered anatomy or failed endoscopic access.Surgical revision is considered a last resort after other methods have failed.Preventive strategies,including machine perfusion and meticulous surgical techniques,are essential in reducing incidence and improving outcomes.This editorial provides a comprehensive overview of clinical management and therapeutic strategies for biliary leakage after liver transplantation.
基金Supported by the Wannan Medical College Teaching Hospital Special Application for Scientific Research,No.WK2023JXYY036the Anhui Provincial Translational Clinical Medical Research Special Application,No.202204295107020062.
文摘BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.AIM To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC,with a focus on strict adherence to indications.METHODS Clinical data of 106 cases undergoing LCBDE+PDC in the Hepatobiliary and Pancreatic Surgery Department(Division 1)of Chuzhou First People’s Hospital from April 2019 to March 2024 were collected.Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage.The change in surgical time was analyzed using the cumulative summation(CUSUM)method,and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.RESULTS Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage(P<0.05).The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage(P<0.05),with statistical significance.The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve(P=0.023).CONCLUSION With a good assessment of duodenal papilla sphincter function,unobstructed bile-pancreatic duct convergence,exact stone clearance,and sufficient surgical experience to complete the learning curve,PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.
