Early-stage gastric cancer;Extent of lymph node dissection;D1 dissection;D2 dissection;Recurrence rate;Survival rateObjective:To investigate the impact of different lymph node dissection scopes on postoperative recurr...Early-stage gastric cancer;Extent of lymph node dissection;D1 dissection;D2 dissection;Recurrence rate;Survival rateObjective:To investigate the impact of different lymph node dissection scopes on postoperative recurrence and survival rates in patients with early gastric cancer,providing evidence-based support for optimizing clinical surgical plans.Methods:A retrospective analysis was conducted on the clinical data of 100 patients with early gastric cancer who underwent surgical treatment at our hospital from October 2021 to October 2023.Patients were divided into Group D1(n=50)and Group D2(n=50)based on the extent of lymph node dissection.Group D1 underwent limited lymph node dissection(dissection of the first station of lymph nodes around the stomach),while Group D2 underwent standard lymph node dissection(dissection of the first and second stations of lymph nodes around the stomach).Surgical-related indicators,the incidence of postoperative complications,the 2-year recurrence rate,and the 2-year survival rate were compared between the two groups of patients.Results:The operative time,intraoperative blood loss,postoperative hospital stay,and the number of lymph nodes dissected were significantly higher in the D2 group than in the D1 group(all P<0.001).The overall incidence of postoperative complications was higher in the D1 group than in the D2 group,but the difference was not statistically significant(χ^(2)=0.884,P=0.766).After a 2-year follow-up,the recurrence rate was significantly higher in the D1 group than in the D2 group(χ^(2)=4.000,P=0.046).The 2-year survival rate was significantly lower in the D1 group than in the D2 group(χ^(2)=5.005,P=0.025).A total of 100 patients with early-stage gastric cancer were grouped according to the depth of invasion,degree of differentiation,and lymph node metastasis status,and the recurrence rates of different subgroups were compared.The results showed that the recurrence rate was higher in patients with T1b stage than in those with T1a stage(χ^(2)=5.005,P=0.025),higher in poorly differentiated patients than in moderately and well-differentiated patients(χ^(2)=4.155,P=0.042),and higher in patients with lymph node metastasis than in those without lymph node metastasis(χ^(2)=4.512,P=0.034).Conclusion:Compared with D1 limited lymph node dissection,D2 standard lymph node dissection can significantly reduce the postoperative recurrence rate and improve the 2-year survival rate in patients with early-stage gastric cancer without significantly increasing the risk of postoperative complications.Although the surgical trauma is slightly greater,the overall prognosis is better,making it a preferred surgical treatment option for patients with early-stage gastric cancer.展开更多
The Litang fault is a left-lateral secondary shear zone in the Sichuan-Yunnan active block that accommodates the tectonic deformation associated with the eastward extrusion of the upper crust of the Tibetan Plateau. B...The Litang fault is a left-lateral secondary shear zone in the Sichuan-Yunnan active block that accommodates the tectonic deformation associated with the eastward extrusion of the upper crust of the Tibetan Plateau. Based on 1 : 50 000 geological mapping of active faults, the Litang fault consists of three geometric segments, the Cuopuhu, Damaoyaba, and Litang segments, in the west of Litang, which are divided by the of Haizi Mountain uplift and the wide-angle bending and branching of the fault near Jinchanggou. This study also identifies the surface rupture of the A.D. 1890 earthquake, which is distributed intermittently along the ~28 km long Damaoyaba segments and ~25 km long Litang segments. The maximum horizontal displacement is 4.1 m along Damaoyaba segments, and 4 m along Litang segments. The rupture involves typical left-lateral shear movement. The two ruptures are divided by discontinuous segments or gaps that are ~18 km long;thus, the total surface rupture is approximately 71 km long. The estimated moment magnitude was M_(w)7.3±0.1. A comprehensive analysis of data obtained from 5 trenches excavated along the Damaoyaba and Litang segments and the trench data by Xu et al.(2005) identifies age constraints of the 4 most recent paleoseimic events occurred B.C. 1468±54–1340±25, B.C. 52±25–A.D. 76±47, A.D. 1115±90, and A.D. 1890, respectively. The recurrence intervals are 1 415±80, 1 104±104, and 775±90 a, which are consistent with quasi-periodic earthquake recurrence behavior. The average recurrence interval is 1 098±112 a.展开更多
Since the great 1303 Hongtong, Shanxi, earthquake of magnitude 8, 700 years have elapsed. To analyze the long-term seismic potential, this paper divides the Taiyuan-Linfen portion of the Shanxi graben system into 5 se...Since the great 1303 Hongtong, Shanxi, earthquake of magnitude 8, 700 years have elapsed. To analyze the long-term seismic potential, this paper divides the Taiyuan-Linfen portion of the Shanxi graben system into 5 seismogenic segments. Based on data of historical earthquakes and GPS observation, the authors estimate mean seismic-moment rates and average recurrence intervals of strong earthquakes for the individual segments, and fur-ther analyze relative levels of current stress cumulation on the segments based on mapping b-values along the gra-ben system by using the network seismic data for the recent over 30 years. The main result shows that the Linfen basin segment has an estimated mean seismic-moment rate of 2.211016 Nm/a to 3.031016 Nm/a, and its average recurrence interval for M=7.5 earthquake is estimated to be between 1 560 and 2 140 years. For the Ling-shi-Hongtong segment, the estimated average recurrence interval for M=8 earthquakes is between 4 300 and 5 100 years, equivalent to having a mean moment-rate of 2.581016 Nm/a to 3.101016 Nm/a. The contour map of b-values shows that the two segments of Lingshi-Hongtong and Linfen basin have been being at low or relatively low stress levels, reflecting that since the 1303 M=8 and the 1695 M=7.5 earthquake ruptures, the fault-planes strengths of the both segments have not been resumed yet. And the other two segments, the Houma and the Jiexiu-Fenyang, have relatively high stress levels, and have been already identified as potential risky segments for the coming earthquakes from the analysis combining with the estimated average recurrence intervals of earth-quakes on the both segments.展开更多
For the two main recurrence behaviors of segment-rupturing earthquakes on active faults of the Chinese mainland,this paper establishes corresponding empirical distributions forearthquake recurrence interval. The resul...For the two main recurrence behaviors of segment-rupturing earthquakes on active faults of the Chinese mainland,this paper establishes corresponding empirical distributions forearthquake recurrence interval. The results show that, for the time-predictable recurrence, the normalized recurrence interval, T/Tt, obeys very well the lognormal distributions: LN (μ1=0.00, σ21 =0. 152), where, T is an observed recurrence interval, and Tt is the average recurrence interval that is correlative with the size of the preceding event. For the quasi-periodic recurrence, the normalized recurrence interval, T/T, follows the lognormal distribution : LN(μq=0.00, σ2q=0.242), where, T is the median of recurrence intervals for various cycles. A statistical test suggests that, there is no significant difference between the latter distribution, built by this paper, and the recurrence interval distribution for the characteristic earthquakes of the Circum-Pacific Plate boundaries (NB model). Accordingly, this paper combines these two distributions into one and obtains a more stable lognormal distribution :LN (μ = 0.00, σ2 = 0.222), for the quasi-periodic recurrence interval.展开更多
BACKGROUND Risk factors for local recurrence after polypectomy, endoscopic mucosal resection(EMR), and endoscopic submucosal dissection(ESD) have not been identified.Additionally, the appropriate interval for endoscop...BACKGROUND Risk factors for local recurrence after polypectomy, endoscopic mucosal resection(EMR), and endoscopic submucosal dissection(ESD) have not been identified.Additionally, the appropriate interval for endoscopic surveillance of colorectal tumors at high-risk of local recurrence has not been established.AIM To clarify the clinicopathological characteristics of recurrent lesions after endoscopic colorectal tumor resection and determine the appropriate interval.METHODS Three hundred and sixty patients(1412 colorectal tumors) who underwent polypectomy, EMR, or ESD and received endoscopic surveillance subsequently for more than one year to detect local recurrence were enrolled in this study. The clinicopathological factors associated with local recurrence were determined via univariate and multivariate analyses.RESULTS Local recurrence was observed in 31 of 360(8.6%) patients [31 of 1412(2.2%)lesions] after colorectal tumor resection. Piecemeal resection, tumor size of more than 2 cm, and the presence of villous components were associated with colorectal tumor recurrence after endoscopic resection. Of these three factors, the piecemeal resection procedure was identified as an independent risk factor for recurrence. Colorectal tumors resected into more than five pieces were associated with a high risk of recurrence since the average period from resection torecurrence in these cases was approximately 3 mo. The period to recurrence in cases resected into more than 5 pieces was much shorter than that in those resected into less than 4 pieces(3.8 ± 1.9 mo vs 7.9 ± 5.0 mo, P < 0.05).CONCLUSION Local recurrence of endoscopically treated colorectal tumors depends upon the outcome of first endoscopic procedure. Piecemeal resection was the only significant risk factor associated with local recurrence after endoscopic resection.展开更多
Located on the western of Sichuan, the east border of Tibet plateau, Xianshuihe fault is a significant strong earthquake zone. From Huiyuansi pull\|apart basin in Qianning, Xianshuihe fault can be divided two segments...Located on the western of Sichuan, the east border of Tibet plateau, Xianshuihe fault is a significant strong earthquake zone. From Huiyuansi pull\|apart basin in Qianning, Xianshuihe fault can be divided two segments\|NW section and SE section: the construction of the former is single and a main fault; the construction of the latter is complex and composed by three parallel faults, its main fault is named as Selaha—Kangding fault, which distributes along Jinlongsi, Sehala, Mugecuo and Kangding. Yalahe fault, located at the NE direction of the main fault, and Zeduotang fault, located at the SW direction of the main fault, are all secondary faults, which are 9～13km away from the main fault. At the south of Kangding, the segment of Xianshuihe fault is a single main section, called as Moxi fault. On the basis of recent researching results, this paper mainly discusses the slip rate and recurrence interval of strong earthquake of the SE segment (Qianning—Kangding) on Xianshuihe.展开更多
The geometry of the Qianning-Kangding segment of the Xianshuihe fault zone is quite complex, and it is composed of four secondary-faults, i.e., the Yalahe fault, Selaha-Kangding fault, Zeduotang fault and Moxi fault. ...The geometry of the Qianning-Kangding segment of the Xianshuihe fault zone is quite complex, and it is composed of four secondary-faults, i.e., the Yalahe fault, Selaha-Kangding fault, Zeduotang fault and Moxi fault. On this segment, three strong earthquakes with M(7.0 occurred in 1725, 1786 and 1955, respectively. Based on a study of fault landform and geochronology (14C and Thermoluminesense), this paper documents the average horizontal slip rates during the late-Quaternary on all the secondary-faults of the Qianning-Kangding segment as follows: Yalahe fault: (2.0(0.2) mm/a; Selaha-Kangding fault: (5.5(0.6) mm/a; Zeduotang fault: (3.6(0.3) mm/a; Moxi fault: (9.9(0.6) mm/a. The results from the investigation of surface ruptures of historical earthquakes, coseismic-slip and paleo-earthquakes show that the strong-earthquake recurrence intervals are thousands of years on the Yalahe fault, and 230 to 350 years on the Selaha-Kangding and Zeduotang faults. In the next one hundred years, the recurrence of a strong-earthquake on these faults appears impossible. However, the strong-earthquake recurrence interval on the Moxi fault is about 300 years. Up to now, it has been 214 years since the last earthquake (magnitude 7) occurred in 1786, therefore, this fault is now approaching the condition favorable for the next strong earthquake recurrence.展开更多
According to field investigation and interpretation of remote sensing images,the north segment of the Longling-Ruili fault is a Holocene dextral strike-slip fault with a small amount of normal faulting.Based on large-...According to field investigation and interpretation of remote sensing images,the north segment of the Longling-Ruili fault is a Holocene dextral strike-slip fault with a small amount of normal faulting.Based on large-scale geological mapping at some typical locations and quantitative geomorphologic deformation measurement and dating analysis,this fault is a Holocene active fault.The strike-slip rate of the Longling-Ruili fault is 2.2 ~2.5mm / a and vertical slip rate is 0.6mm /a since the late Pleistocene epoch.The strike-slip rate of the Longling-Ruili fault is 1.8~3.0mm /a and vertical slip rate is 0.5mm /a since the Holocene epoch.Based on the Poisson model,lognormal model and BPT model,the occurrence probability of strong earthquakes in 50 years is estimated to be 6.32%,0.08%and 0.05%,respectively.Then,a 1.82% probability of occurrence of characteristic earthquake for the north segment of the Longling-Ruili fault is obtained by setting a weight of 0.28,0.36 and 0.36 to the Poisson model,lognormal model and BPT model,respectively.展开更多
The study shows that earthquake-affected time-space domain (ETSD), i.e. a time-space range in which strong earthquakes are unable to occur owing to the influence of a prior earthquake occurring, shows a hyperbolic mar...The study shows that earthquake-affected time-space domain (ETSD), i.e. a time-space range in which strong earthquakes are unable to occur owing to the influence of a prior earthquake occurring, shows a hyperbolic margin curve in the t(time)-r(distance) coordinate plane, which has a maximum affected radius r 0 at t=0 and a maximum influence time t 0 (i.e. the in-situ recurrence interval of earthquakes) at r=0. Based on the time-distance distributions of posterior earthquakes relative to prior ones in the regions of North China, Northwest China, Qinghai-Xizang (Tibet) plateau and Southwest China, the optimized and 90%-confidence margin curves are estimated using optimization and statistical analysis methods. This indicates that the concept and method of ETSD with 3-dimension (time-distance-magnitudes) instead of those of “recurrence interval" with 1-dimension (time) or 2-dimension (time-magnitude) provides a new approach to understanding the fluctuation of seismic activities, estimating the effective earthquake-preparation time of potential hypocenters, and therefore improving the medium- and long-term prediction of strong earthquakes.展开更多
Paleoearthquakes in the Yanqing-Huailai basin and on the Haiyuan fault are studied in detail.The result indicates that the recurrence behavior of large earthquakes is of a wide variety.Characteristic earthquakes show ...Paleoearthquakes in the Yanqing-Huailai basin and on the Haiyuan fault are studied in detail.The result indicates that the recurrence behavior of large earthquakes is of a wide variety.Characteristic earthquakes show the behavior characteristics of the activity of most faults,butthey are of different grades,the recurrence interval of large earthquakes is of staged nature,and the interaction between faults has effects on the recurrence sequence of large earthquakes.Thus,when the recurrence behavior of large earthquakes is staged in time or when thegradation of characteristic earthquakes has led to a sharp difference in recurrence intervalbetween paleoearthquakes of different intensities,for estimating the large earthquake risk bythe deterministic method and time-dependent probabilistic method,it is necessary to calculatethe recurrence interval value separately for each specific stage or grade in order that theaverage recurrence interval values of different stages can be determined.展开更多
Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarte...Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarterial chemoembolization(TACE)as an adjuvant therapy in HCC patients with high risk of recurrence.Methods:Patients were enrolled from eight hepatobiliary centers in China.The primary endpoint was disease-free survival(DFS).The secondary endpoints were overall survival(OS)and safety.Additionally,propensity score matching(PSM)and other three propensity score analyses were performed to balance the potential baseline bias to validate the conclusion.The adverse events(AEs)were recorded throughout the study.The study was registered at Clinical Trials.gov(NCT03838796).Results:A total of 297 patients were enrolled,with 147 in the LEN+TACE group and 150 in the TACE group.Before PSM,the LEN+TACE group achieved significantly better DFS than the TACE group(19.0 vs.10.0 months,P=0.011).PSM analysis identified 111 matched pairs.After PSM,the LEN+TACE group also showed better DFS(19.0 vs.9.0 months,P=0.018).Other three propensity score analyses yielded similar DFS benefit tendency.Furthermore,favorable OS was also obtained in the LEN+TACE group before PSM.Lenvatinib related AEs of grade 3 or 4 occurred in 28.6%of the patients in the LEN+TACE group.Conclusions:Adjuvant lenvatinib plus TACE might be a promising adjuvant approach for HCC patients with high risk of recurrence,which could significantly prolong DFS and potentially OS with a manageable safety profile.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases pos...BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for HCC.The rate of HCC recurrence is generally reported as 8%-20%in the literature.Many predictors of HCC have already been researched,however,to our knowledge there are no published studies on this topic using Australian data.AIM To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT cohort.METHODS We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and 2021.Data was collected from various health record databases and included recipient demographics,serum biochemistry,radiology,operation notes,explant histopathology and details of recurrence.Overall survival of HCC patients post-LT,stratified for recurrence,was calculated by Kaplan Meier analysis.Univariate and multivariate Cox regression was used to determine predictors of HCC recurrence post-LT.RESULTS Between 1/1/2006 and 12/31/2021,119 patients were transplanted with HCC.8.4%of subjects developed recurrent HCC after LT with median follow-up time of 5.4 years.The median time to recurrence was 2.9 years±0.75 years.When comparing baseline characteristics,a greater proportion of subjects with recurrence had common characteristics on explant histopathology,including>3 viable nodules(P=0.001),vascular invasion(P=0.003)and poorly differentiated HCC(P=0.03).Unadjusted survival curves showed lower 1-year,3-year,5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence(90%vs 92%,70%vs 88%,42%vs 80%,14%vs 76%,respectively;log rank P<0.001).CONCLUSION HCC recurrence was low at 8.4%in this contemporary Australian cohort,however it significantly impacted post-LT survival.Further studies are required to confirm predictors of recurrence and improve recipient outcomes.展开更多
Paleoearthquake research represents an essential method for determining recurrence intervals oflarge earthquakes.Reasonable determination of the average recurrence interval and coefficient of variationprovides a cruci...Paleoearthquake research represents an essential method for determining recurrence intervals oflarge earthquakes.Reasonable determination of the average recurrence interval and coefficient of variationprovides a crucial basis for the analysis of the recurrence characteristics of strong earthquakes on intraplatefaults in Chinese mainland.Paleoearthquake data from 145 fault segments of 93 well-studied faults in MainlandChina were collected,organized,and analyzed to discuss the rational estimation of the average recurrenceinterval and coefficient of variation of a strong earthquake occurrence probability model.First,differencesin structural environments were used as a basis to investigate the spatial distribution characteristics of theaverage recurrence intervals of strong earthquakes.The results indicate significant variations in the recurrenceperiods of strong earthquakes in the Sichuan–Yunnan,Xinjiang,North China,and northeastern Qinghai-Tibet Plateau structure zones.The Sichuan–Yunnan structure zone exhibited the shortest average recurrence intervalfor strong earthquakes,which was mainly distributed between 100 and 2000 years,and a relatively high sliprate.The Xinjiang structure zone attained a relatively balanced recurrence interval frequency distribution of1000–4500 years and a moderate slip rate.The North China structure zone showed the lowest slip rate,withthe strong earthquake recurrence interval mainly concentrated between 1000 and 4000 years.The northeastern Qinghai-Tibet Plateau structure zone presented two main frequency peaks in the strong earthquake recurrenceintervals between 1000–3000 years and 3000–5000 years and a relatively high slip rate.The slip rate is a keyfactor influencing the recurrence interval of strong earthquakes,and active faults with high slip rates showshort recurrence intervals.Furthermore,the relationship between fault slip rate,fault type,and the averagerecurrence interval of strong earthquakes was examined.The results indicate a good logarithmic linearrelationship between the fault slip rate and the average recurrence interval of large earthquakes—the higherthe slip rate,the shorter the recurrence interval of strong earthquakes.Fault type also showed a relation to theaverage recurrence interval,with the intervals for various types of active faults gradually increasing in theorder of strike-slip,normal,reverse strike-slip,reverse,and normal strike-slip faults.Second,we calculated theproportions of active faults and various fault types in each structure zone that had a coefficient of variation inrecurrence intervals less than 0.4.The findings reveal that the occurrence of strong earthquakes on most activefaults in Chinese mainland satisfies a quasiperiodic model.The general coefficient of variation across differentstructure zones and fault types ranges between 0.36 and 0.44,which indicates the nonsignificant difference inthe degree of variability in the periodicity of strong earthquake occurrence across various structural zones andfault types.展开更多
BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicat...BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicated by diabetes is highly pre-valent in clinical settings.AIM To analyze the results of nasal secretion cultures in diabetic patients with CRS and identify the factors influencing postoperative recurrence.METHODS A retrospective analysis was conducted on the clinical data of 203 diabetic pa-tients with CRS with nasal polyps who underwent the Messerklinger technique at Qingdao Hiser Hospital Affiliated of Qingdao University between January 2021 and January 2023.Preoperative nasal secretions were cultured to determine the types and distribution of pathogenic bacteria and assess antimicrobial suscept-ibility.Based on a one-year follow-up,patients were categorized into recurrence and nonrecurrence groups to analyze differences in their clinical data.Univariate and multivariate analyses were used to identify factors influencing postoperative recurrence.RESULTS Pathogens were detected in 153 of the 203 nasal secretion specimens collected from diabetic patients with CRS.A total of 134 pathogenic bacteria strains were isolated and identified,including 81 strains(60.4%)of gram-positive bacteria and 53 strains(39.6%)of gram-negative bacteria.Gram-positive bacteria exhibited relatively high resistance to penicillin G and erythromycin,while remaining highly sensitive to vancomycin,gentamicin,and rifampicin.Gram-negative bacteria demonstrated relatively high resistance to cefazolin and gentamicin,but showed high sensitivity to imipenem,meropenem,cefepime,and ceftazidime.Univariate analysis revealed statistically significant differences between the recurrence and nonrecurrence groups in fasting blood glucose levels,smoking history,Lund-Mackay scores,visual analog scale(VAS)scores,nasal septum deviation,allergic rhinitis,bronchial asthma,postoperative infection,long-term use of nasal decongestants,and adherence to medical prescriptions.Multivariate regression analysis identified fasting blood glucose levels and VAS-measured nasal symptom severity scores as independent factors influencing postoperative recurrence.CONCLUSION In CRS patients with nasal polyps(CRSwNP),the detection rate of nasal pathogens is relatively high,and most of the isolated bacteria exhibit antimicrobial resistance.Additionally,the blood glucose level of patients with CRS combined with CRSwNP is a risk factor for postoperative recurrence.展开更多
Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and p...Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.Ablation therapy is one of the first-line treatments for early HCC.Accurately predicting early recurrence(ER)is crucial for making pr...BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.Ablation therapy is one of the first-line treatments for early HCC.Accurately predicting early recurrence(ER)is crucial for making precise treatment plans and improving patient prognosis.AIM To establish an intratumoral and peritumoral model for predicting ER in HCC patients following curative ablation.METHODS This study included a total of 288 patients from three Centers.The patients were divided into a primary cohort(n=222)and an external cohort(n=66).Radiomics and deep learning methods were combined for feature extraction,and models were constructed following a three-step feature selection process.Model performance was evaluated using the area under the receiver operating characteristic curve(AUC),while calibration curves and decision curve analysis(DCA)were used to assess calibration and clinical utility.Finally,Kaplan-Meier(K-M)analysis was used to stratify patients according to progression-free survival(PFS)and overall survival(OS).RESULTS The combined model,which utilizes the light gradient boosting machine learning algorithm and incorporates both intratumoral and peritumoral regions(5 mm and 10 mm),demonstrated the best predictive performance for ER following HCC ablation,achieving AUCs of 0.924 in the training set,0.899 in the internal validation set,and 0.839 in the external validation set.Calibration and DCA curves confirmed strong calibration and clinical utility,whereas K-M curves provided risk stratification for PFS and OS in HCC patients.CONCLUSION The most efficient model integrated the tumor region with the peritumoral 5 mm and 10 mm regions.This model provides a noninvasive,effective,and reliable method for predicting ER after curative ablation of HCC.展开更多
BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the cor...BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.展开更多
With the increasing integration of large-scale distributed energy resources into the grid,traditional distribution network optimization and dispatch methods struggle to address the challenges posed by both generation ...With the increasing integration of large-scale distributed energy resources into the grid,traditional distribution network optimization and dispatch methods struggle to address the challenges posed by both generation and load.Accounting for these issues,this paper proposes a multi-timescale coordinated optimization dispatch method for distribution networks.First,the probability box theory was employed to determine the uncertainty intervals of generation and load forecasts,based on which,the requirements for flexibility dispatch and capacity constraints of the grid were calculated and analyzed.Subsequently,a multi-timescale optimization framework was constructed,incorporating the generation and load forecast uncertainties.This framework included optimization models for dayahead scheduling,intra-day optimization,and real-time adjustments,aiming to meet flexibility needs across different timescales and improve the economic efficiency of the grid.Furthermore,an improved soft actor-critic algorithm was introduced to enhance the uncertainty exploration capability.Utilizing a centralized training and decentralized execution framework,a multi-agent SAC network model was developed to improve the decision-making efficiency of the agents.Finally,the effectiveness and superiority of the proposed method were validated using a modified IEEE-33 bus test system.展开更多
Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamm...Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamma-carboxy prothrombin(DCP),lack specificity,limiting their utility in risk strati-fication.YKL-40,a glycoprotein involved in extracellular matrix remodeling,hepatic stellate cell activation,and immune modulation,has emerged as a promising biomarker for post-LT surveillance.Elevated serum levels of YKL-40 are associated with advanced liver disease,tumor progression,and poorer post-LT outcomes,highlighting its potential to address gaps in early detection and personalized management of HCC recurrence.This manuscript synthesizes clinical and mechanistic evidence to evaluate YKL-40’s predictive utility in post-LT care.While preliminary findings demonstrate its specificity for liver-related pathologies,challenges remain,including assay standardization,lack of pro-spective validation,and the need to distinguish between malignant and non-malignant causes of elevated levels.Integrating YKL-40 into multi-biomarker panels with AFP and DCP could enhance predictive accuracy and enable tailored therapeutic strategies.Future research should focus on multicenter studies to validate YKL-40’s clinical utility,address confounding factors like graft rejection and systemic inflammation,and explore its role in predictive models driven by emerging technologies such as artificial intelligence.YKL-40 holds transformative potential in reshaping post-LT care through precision medicine,providing a pathway for better outcomes and improved management of high-risk LT recipients.展开更多
Background: Pancreatic cancer is one of the most lethal malignancies, with postoperative recurrence severely affecting patient survival and prognosis. This study aims to develop and validate a clinical prediction mode...Background: Pancreatic cancer is one of the most lethal malignancies, with postoperative recurrence severely affecting patient survival and prognosis. This study aims to develop and validate a clinical prediction model for postoperative recurrence in pancreatic cancer patients, incorporating multiple preoperative, intraoperative, and postoperative factors to assist clinical decision-making. Methods: A retrospective study was conducted on 216 patients who underwent surgical treatment for pancreatic malignancy at the First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2023. An independent external validation cohort of 76 patients from the Second Affiliated Hospital of Chongqing Medical University was used to validate the model. Seven independent risk factors for postoperative recurrence were identified through univariate and multivariate Cox regression analyses. The model’s performance was evaluated using the concordance index (C-index) and ROC curves, and its accuracy and clinical value were assessed using calibration curves and decision curve analysis (DCA). Results: The predictive model demonstrated good discriminatory power, with a C-index of 0.72 in the training cohort and 0.66 in the validation cohort. The ROC curves for predicting recurrence at 3, 6, and 12 months postoperatively showed AUC values ranging from 0.72 to 0.83, indicating strong predictive value. Calibration curves and DCA confirmed the model’s accuracy and clinical utility. Conclusion: This study successfully developed and validated a clinical prediction model that incorporates seven independent risk factors for postoperative recurrence in pancreatic cancer. The model provides a useful tool for predicting recurrence risk, aiding in the identification of high-risk patients, and informing clinical decision-making.展开更多
基金Shaanxi Provincial People’s Hospital Science and Technology Development Incubation Fund,“Research on the Role and Mechanism of PIGU in Regulating MUC-1 in Gastric Cancer Immune Escape”(Project No.:2023YJY-29)Shaanxi Provincial Natural Science Basic Research Program,“Research on the Mechanism and Clinical Significance of miR-140-5p Related to Gastric Cancer Recurrence and Metastasis”(Project No.:2023-JC-YB-639)。
文摘Early-stage gastric cancer;Extent of lymph node dissection;D1 dissection;D2 dissection;Recurrence rate;Survival rateObjective:To investigate the impact of different lymph node dissection scopes on postoperative recurrence and survival rates in patients with early gastric cancer,providing evidence-based support for optimizing clinical surgical plans.Methods:A retrospective analysis was conducted on the clinical data of 100 patients with early gastric cancer who underwent surgical treatment at our hospital from October 2021 to October 2023.Patients were divided into Group D1(n=50)and Group D2(n=50)based on the extent of lymph node dissection.Group D1 underwent limited lymph node dissection(dissection of the first station of lymph nodes around the stomach),while Group D2 underwent standard lymph node dissection(dissection of the first and second stations of lymph nodes around the stomach).Surgical-related indicators,the incidence of postoperative complications,the 2-year recurrence rate,and the 2-year survival rate were compared between the two groups of patients.Results:The operative time,intraoperative blood loss,postoperative hospital stay,and the number of lymph nodes dissected were significantly higher in the D2 group than in the D1 group(all P<0.001).The overall incidence of postoperative complications was higher in the D1 group than in the D2 group,but the difference was not statistically significant(χ^(2)=0.884,P=0.766).After a 2-year follow-up,the recurrence rate was significantly higher in the D1 group than in the D2 group(χ^(2)=4.000,P=0.046).The 2-year survival rate was significantly lower in the D1 group than in the D2 group(χ^(2)=5.005,P=0.025).A total of 100 patients with early-stage gastric cancer were grouped according to the depth of invasion,degree of differentiation,and lymph node metastasis status,and the recurrence rates of different subgroups were compared.The results showed that the recurrence rate was higher in patients with T1b stage than in those with T1a stage(χ^(2)=5.005,P=0.025),higher in poorly differentiated patients than in moderately and well-differentiated patients(χ^(2)=4.155,P=0.042),and higher in patients with lymph node metastasis than in those without lymph node metastasis(χ^(2)=4.512,P=0.034).Conclusion:Compared with D1 limited lymph node dissection,D2 standard lymph node dissection can significantly reduce the postoperative recurrence rate and improve the 2-year survival rate in patients with early-stage gastric cancer without significantly increasing the risk of postoperative complications.Although the surgical trauma is slightly greater,the overall prognosis is better,making it a preferred surgical treatment option for patients with early-stage gastric cancer.
基金This research was supported by the“China Seismic Active Fault Exploration,Central-South Segment Project of the NorthSouth Seismic Belt”of the China Earthquake Administrationthe National Science Foundation of China(No.41372114)。
文摘The Litang fault is a left-lateral secondary shear zone in the Sichuan-Yunnan active block that accommodates the tectonic deformation associated with the eastward extrusion of the upper crust of the Tibetan Plateau. Based on 1 : 50 000 geological mapping of active faults, the Litang fault consists of three geometric segments, the Cuopuhu, Damaoyaba, and Litang segments, in the west of Litang, which are divided by the of Haizi Mountain uplift and the wide-angle bending and branching of the fault near Jinchanggou. This study also identifies the surface rupture of the A.D. 1890 earthquake, which is distributed intermittently along the ~28 km long Damaoyaba segments and ~25 km long Litang segments. The maximum horizontal displacement is 4.1 m along Damaoyaba segments, and 4 m along Litang segments. The rupture involves typical left-lateral shear movement. The two ruptures are divided by discontinuous segments or gaps that are ~18 km long;thus, the total surface rupture is approximately 71 km long. The estimated moment magnitude was M_(w)7.3±0.1. A comprehensive analysis of data obtained from 5 trenches excavated along the Damaoyaba and Litang segments and the trench data by Xu et al.(2005) identifies age constraints of the 4 most recent paleoseimic events occurred B.C. 1468±54–1340±25, B.C. 52±25–A.D. 76±47, A.D. 1115±90, and A.D. 1890, respectively. The recurrence intervals are 1 415±80, 1 104±104, and 775±90 a, which are consistent with quasi-periodic earthquake recurrence behavior. The average recurrence interval is 1 098±112 a.
文摘Since the great 1303 Hongtong, Shanxi, earthquake of magnitude 8, 700 years have elapsed. To analyze the long-term seismic potential, this paper divides the Taiyuan-Linfen portion of the Shanxi graben system into 5 seismogenic segments. Based on data of historical earthquakes and GPS observation, the authors estimate mean seismic-moment rates and average recurrence intervals of strong earthquakes for the individual segments, and fur-ther analyze relative levels of current stress cumulation on the segments based on mapping b-values along the gra-ben system by using the network seismic data for the recent over 30 years. The main result shows that the Linfen basin segment has an estimated mean seismic-moment rate of 2.211016 Nm/a to 3.031016 Nm/a, and its average recurrence interval for M=7.5 earthquake is estimated to be between 1 560 and 2 140 years. For the Ling-shi-Hongtong segment, the estimated average recurrence interval for M=8 earthquakes is between 4 300 and 5 100 years, equivalent to having a mean moment-rate of 2.581016 Nm/a to 3.101016 Nm/a. The contour map of b-values shows that the two segments of Lingshi-Hongtong and Linfen basin have been being at low or relatively low stress levels, reflecting that since the 1303 M=8 and the 1695 M=7.5 earthquake ruptures, the fault-planes strengths of the both segments have not been resumed yet. And the other two segments, the Houma and the Jiexiu-Fenyang, have relatively high stress levels, and have been already identified as potential risky segments for the coming earthquakes from the analysis combining with the estimated average recurrence intervals of earth-quakes on the both segments.
文摘For the two main recurrence behaviors of segment-rupturing earthquakes on active faults of the Chinese mainland,this paper establishes corresponding empirical distributions forearthquake recurrence interval. The results show that, for the time-predictable recurrence, the normalized recurrence interval, T/Tt, obeys very well the lognormal distributions: LN (μ1=0.00, σ21 =0. 152), where, T is an observed recurrence interval, and Tt is the average recurrence interval that is correlative with the size of the preceding event. For the quasi-periodic recurrence, the normalized recurrence interval, T/T, follows the lognormal distribution : LN(μq=0.00, σ2q=0.242), where, T is the median of recurrence intervals for various cycles. A statistical test suggests that, there is no significant difference between the latter distribution, built by this paper, and the recurrence interval distribution for the characteristic earthquakes of the Circum-Pacific Plate boundaries (NB model). Accordingly, this paper combines these two distributions into one and obtains a more stable lognormal distribution :LN (μ = 0.00, σ2 = 0.222), for the quasi-periodic recurrence interval.
文摘BACKGROUND Risk factors for local recurrence after polypectomy, endoscopic mucosal resection(EMR), and endoscopic submucosal dissection(ESD) have not been identified.Additionally, the appropriate interval for endoscopic surveillance of colorectal tumors at high-risk of local recurrence has not been established.AIM To clarify the clinicopathological characteristics of recurrent lesions after endoscopic colorectal tumor resection and determine the appropriate interval.METHODS Three hundred and sixty patients(1412 colorectal tumors) who underwent polypectomy, EMR, or ESD and received endoscopic surveillance subsequently for more than one year to detect local recurrence were enrolled in this study. The clinicopathological factors associated with local recurrence were determined via univariate and multivariate analyses.RESULTS Local recurrence was observed in 31 of 360(8.6%) patients [31 of 1412(2.2%)lesions] after colorectal tumor resection. Piecemeal resection, tumor size of more than 2 cm, and the presence of villous components were associated with colorectal tumor recurrence after endoscopic resection. Of these three factors, the piecemeal resection procedure was identified as an independent risk factor for recurrence. Colorectal tumors resected into more than five pieces were associated with a high risk of recurrence since the average period from resection torecurrence in these cases was approximately 3 mo. The period to recurrence in cases resected into more than 5 pieces was much shorter than that in those resected into less than 4 pieces(3.8 ± 1.9 mo vs 7.9 ± 5.0 mo, P < 0.05).CONCLUSION Local recurrence of endoscopically treated colorectal tumors depends upon the outcome of first endoscopic procedure. Piecemeal resection was the only significant risk factor associated with local recurrence after endoscopic resection.
文摘Located on the western of Sichuan, the east border of Tibet plateau, Xianshuihe fault is a significant strong earthquake zone. From Huiyuansi pull\|apart basin in Qianning, Xianshuihe fault can be divided two segments\|NW section and SE section: the construction of the former is single and a main fault; the construction of the latter is complex and composed by three parallel faults, its main fault is named as Selaha—Kangding fault, which distributes along Jinlongsi, Sehala, Mugecuo and Kangding. Yalahe fault, located at the NE direction of the main fault, and Zeduotang fault, located at the SW direction of the main fault, are all secondary faults, which are 9～13km away from the main fault. At the south of Kangding, the segment of Xianshuihe fault is a single main section, called as Moxi fault. On the basis of recent researching results, this paper mainly discusses the slip rate and recurrence interval of strong earthquake of the SE segment (Qianning—Kangding) on Xianshuihe.
基金Chinese Joint Seismological Science Foundation (95-07-0425).
文摘The geometry of the Qianning-Kangding segment of the Xianshuihe fault zone is quite complex, and it is composed of four secondary-faults, i.e., the Yalahe fault, Selaha-Kangding fault, Zeduotang fault and Moxi fault. On this segment, three strong earthquakes with M(7.0 occurred in 1725, 1786 and 1955, respectively. Based on a study of fault landform and geochronology (14C and Thermoluminesense), this paper documents the average horizontal slip rates during the late-Quaternary on all the secondary-faults of the Qianning-Kangding segment as follows: Yalahe fault: (2.0(0.2) mm/a; Selaha-Kangding fault: (5.5(0.6) mm/a; Zeduotang fault: (3.6(0.3) mm/a; Moxi fault: (9.9(0.6) mm/a. The results from the investigation of surface ruptures of historical earthquakes, coseismic-slip and paleo-earthquakes show that the strong-earthquake recurrence intervals are thousands of years on the Yalahe fault, and 230 to 350 years on the Selaha-Kangding and Zeduotang faults. In the next one hundred years, the recurrence of a strong-earthquake on these faults appears impossible. However, the strong-earthquake recurrence interval on the Moxi fault is about 300 years. Up to now, it has been 214 years since the last earthquake (magnitude 7) occurred in 1786, therefore, this fault is now approaching the condition favorable for the next strong earthquake recurrence.
基金sponsored by the Science and Technology Development Program of Ministry of Railways,PRC(2008G027-B)Special Program of Deep Exploration Techniques and Experimental Studies of Ministry of Land and Resources,PRC(Sinoprobe-06-04)
文摘According to field investigation and interpretation of remote sensing images,the north segment of the Longling-Ruili fault is a Holocene dextral strike-slip fault with a small amount of normal faulting.Based on large-scale geological mapping at some typical locations and quantitative geomorphologic deformation measurement and dating analysis,this fault is a Holocene active fault.The strike-slip rate of the Longling-Ruili fault is 2.2 ~2.5mm / a and vertical slip rate is 0.6mm /a since the late Pleistocene epoch.The strike-slip rate of the Longling-Ruili fault is 1.8~3.0mm /a and vertical slip rate is 0.5mm /a since the Holocene epoch.Based on the Poisson model,lognormal model and BPT model,the occurrence probability of strong earthquakes in 50 years is estimated to be 6.32%,0.08%and 0.05%,respectively.Then,a 1.82% probability of occurrence of characteristic earthquake for the north segment of the Longling-Ruili fault is obtained by setting a weight of 0.28,0.36 and 0.36 to the Poisson model,lognormal model and BPT model,respectively.
文摘The study shows that earthquake-affected time-space domain (ETSD), i.e. a time-space range in which strong earthquakes are unable to occur owing to the influence of a prior earthquake occurring, shows a hyperbolic margin curve in the t(time)-r(distance) coordinate plane, which has a maximum affected radius r 0 at t=0 and a maximum influence time t 0 (i.e. the in-situ recurrence interval of earthquakes) at r=0. Based on the time-distance distributions of posterior earthquakes relative to prior ones in the regions of North China, Northwest China, Qinghai-Xizang (Tibet) plateau and Southwest China, the optimized and 90%-confidence margin curves are estimated using optimization and statistical analysis methods. This indicates that the concept and method of ETSD with 3-dimension (time-distance-magnitudes) instead of those of “recurrence interval" with 1-dimension (time) or 2-dimension (time-magnitude) provides a new approach to understanding the fluctuation of seismic activities, estimating the effective earthquake-preparation time of potential hypocenters, and therefore improving the medium- and long-term prediction of strong earthquakes.
基金The research is a key project of the 9th Five-year Plan of China Seismological Bureau (95040803) was supported by the Joint Earthquake Science Foundation (95101).Contribution No 99B0051,Institute of Geology,CSB
文摘Paleoearthquakes in the Yanqing-Huailai basin and on the Haiyuan fault are studied in detail.The result indicates that the recurrence behavior of large earthquakes is of a wide variety.Characteristic earthquakes show the behavior characteristics of the activity of most faults,butthey are of different grades,the recurrence interval of large earthquakes is of staged nature,and the interaction between faults has effects on the recurrence sequence of large earthquakes.Thus,when the recurrence behavior of large earthquakes is staged in time or when thegradation of characteristic earthquakes has led to a sharp difference in recurrence intervalbetween paleoearthquakes of different intensities,for estimating the large earthquake risk bythe deterministic method and time-dependent probabilistic method,it is necessary to calculatethe recurrence interval value separately for each specific stage or grade in order that theaverage recurrence interval values of different stages can be determined.
基金supported by grants from the National Natural Science Foundation of China(91959203,82272836 and 82373017)。
文摘Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarterial chemoembolization(TACE)as an adjuvant therapy in HCC patients with high risk of recurrence.Methods:Patients were enrolled from eight hepatobiliary centers in China.The primary endpoint was disease-free survival(DFS).The secondary endpoints were overall survival(OS)and safety.Additionally,propensity score matching(PSM)and other three propensity score analyses were performed to balance the potential baseline bias to validate the conclusion.The adverse events(AEs)were recorded throughout the study.The study was registered at Clinical Trials.gov(NCT03838796).Results:A total of 297 patients were enrolled,with 147 in the LEN+TACE group and 150 in the TACE group.Before PSM,the LEN+TACE group achieved significantly better DFS than the TACE group(19.0 vs.10.0 months,P=0.011).PSM analysis identified 111 matched pairs.After PSM,the LEN+TACE group also showed better DFS(19.0 vs.9.0 months,P=0.018).Other three propensity score analyses yielded similar DFS benefit tendency.Furthermore,favorable OS was also obtained in the LEN+TACE group before PSM.Lenvatinib related AEs of grade 3 or 4 occurred in 28.6%of the patients in the LEN+TACE group.Conclusions:Adjuvant lenvatinib plus TACE might be a promising adjuvant approach for HCC patients with high risk of recurrence,which could significantly prolong DFS and potentially OS with a manageable safety profile.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for HCC.The rate of HCC recurrence is generally reported as 8%-20%in the literature.Many predictors of HCC have already been researched,however,to our knowledge there are no published studies on this topic using Australian data.AIM To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT cohort.METHODS We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and 2021.Data was collected from various health record databases and included recipient demographics,serum biochemistry,radiology,operation notes,explant histopathology and details of recurrence.Overall survival of HCC patients post-LT,stratified for recurrence,was calculated by Kaplan Meier analysis.Univariate and multivariate Cox regression was used to determine predictors of HCC recurrence post-LT.RESULTS Between 1/1/2006 and 12/31/2021,119 patients were transplanted with HCC.8.4%of subjects developed recurrent HCC after LT with median follow-up time of 5.4 years.The median time to recurrence was 2.9 years±0.75 years.When comparing baseline characteristics,a greater proportion of subjects with recurrence had common characteristics on explant histopathology,including>3 viable nodules(P=0.001),vascular invasion(P=0.003)and poorly differentiated HCC(P=0.03).Unadjusted survival curves showed lower 1-year,3-year,5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence(90%vs 92%,70%vs 88%,42%vs 80%,14%vs 76%,respectively;log rank P<0.001).CONCLUSION HCC recurrence was low at 8.4%in this contemporary Australian cohort,however it significantly impacted post-LT survival.Further studies are required to confirm predictors of recurrence and improve recipient outcomes.
基金Funded by the National Key Research and Development Program(2022YFC3003502).
文摘Paleoearthquake research represents an essential method for determining recurrence intervals oflarge earthquakes.Reasonable determination of the average recurrence interval and coefficient of variationprovides a crucial basis for the analysis of the recurrence characteristics of strong earthquakes on intraplatefaults in Chinese mainland.Paleoearthquake data from 145 fault segments of 93 well-studied faults in MainlandChina were collected,organized,and analyzed to discuss the rational estimation of the average recurrenceinterval and coefficient of variation of a strong earthquake occurrence probability model.First,differencesin structural environments were used as a basis to investigate the spatial distribution characteristics of theaverage recurrence intervals of strong earthquakes.The results indicate significant variations in the recurrenceperiods of strong earthquakes in the Sichuan–Yunnan,Xinjiang,North China,and northeastern Qinghai-Tibet Plateau structure zones.The Sichuan–Yunnan structure zone exhibited the shortest average recurrence intervalfor strong earthquakes,which was mainly distributed between 100 and 2000 years,and a relatively high sliprate.The Xinjiang structure zone attained a relatively balanced recurrence interval frequency distribution of1000–4500 years and a moderate slip rate.The North China structure zone showed the lowest slip rate,withthe strong earthquake recurrence interval mainly concentrated between 1000 and 4000 years.The northeastern Qinghai-Tibet Plateau structure zone presented two main frequency peaks in the strong earthquake recurrenceintervals between 1000–3000 years and 3000–5000 years and a relatively high slip rate.The slip rate is a keyfactor influencing the recurrence interval of strong earthquakes,and active faults with high slip rates showshort recurrence intervals.Furthermore,the relationship between fault slip rate,fault type,and the averagerecurrence interval of strong earthquakes was examined.The results indicate a good logarithmic linearrelationship between the fault slip rate and the average recurrence interval of large earthquakes—the higherthe slip rate,the shorter the recurrence interval of strong earthquakes.Fault type also showed a relation to theaverage recurrence interval,with the intervals for various types of active faults gradually increasing in theorder of strike-slip,normal,reverse strike-slip,reverse,and normal strike-slip faults.Second,we calculated theproportions of active faults and various fault types in each structure zone that had a coefficient of variation inrecurrence intervals less than 0.4.The findings reveal that the occurrence of strong earthquakes on most activefaults in Chinese mainland satisfies a quasiperiodic model.The general coefficient of variation across differentstructure zones and fault types ranges between 0.36 and 0.44,which indicates the nonsignificant difference inthe degree of variability in the periodicity of strong earthquake occurrence across various structural zones andfault types.
文摘BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicated by diabetes is highly pre-valent in clinical settings.AIM To analyze the results of nasal secretion cultures in diabetic patients with CRS and identify the factors influencing postoperative recurrence.METHODS A retrospective analysis was conducted on the clinical data of 203 diabetic pa-tients with CRS with nasal polyps who underwent the Messerklinger technique at Qingdao Hiser Hospital Affiliated of Qingdao University between January 2021 and January 2023.Preoperative nasal secretions were cultured to determine the types and distribution of pathogenic bacteria and assess antimicrobial suscept-ibility.Based on a one-year follow-up,patients were categorized into recurrence and nonrecurrence groups to analyze differences in their clinical data.Univariate and multivariate analyses were used to identify factors influencing postoperative recurrence.RESULTS Pathogens were detected in 153 of the 203 nasal secretion specimens collected from diabetic patients with CRS.A total of 134 pathogenic bacteria strains were isolated and identified,including 81 strains(60.4%)of gram-positive bacteria and 53 strains(39.6%)of gram-negative bacteria.Gram-positive bacteria exhibited relatively high resistance to penicillin G and erythromycin,while remaining highly sensitive to vancomycin,gentamicin,and rifampicin.Gram-negative bacteria demonstrated relatively high resistance to cefazolin and gentamicin,but showed high sensitivity to imipenem,meropenem,cefepime,and ceftazidime.Univariate analysis revealed statistically significant differences between the recurrence and nonrecurrence groups in fasting blood glucose levels,smoking history,Lund-Mackay scores,visual analog scale(VAS)scores,nasal septum deviation,allergic rhinitis,bronchial asthma,postoperative infection,long-term use of nasal decongestants,and adherence to medical prescriptions.Multivariate regression analysis identified fasting blood glucose levels and VAS-measured nasal symptom severity scores as independent factors influencing postoperative recurrence.CONCLUSION In CRS patients with nasal polyps(CRSwNP),the detection rate of nasal pathogens is relatively high,and most of the isolated bacteria exhibit antimicrobial resistance.Additionally,the blood glucose level of patients with CRS combined with CRSwNP is a risk factor for postoperative recurrence.
基金Supported by the Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.
基金Supported by Anhui Provincial Key Research and Development Plan,No.202104j07020048.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.Ablation therapy is one of the first-line treatments for early HCC.Accurately predicting early recurrence(ER)is crucial for making precise treatment plans and improving patient prognosis.AIM To establish an intratumoral and peritumoral model for predicting ER in HCC patients following curative ablation.METHODS This study included a total of 288 patients from three Centers.The patients were divided into a primary cohort(n=222)and an external cohort(n=66).Radiomics and deep learning methods were combined for feature extraction,and models were constructed following a three-step feature selection process.Model performance was evaluated using the area under the receiver operating characteristic curve(AUC),while calibration curves and decision curve analysis(DCA)were used to assess calibration and clinical utility.Finally,Kaplan-Meier(K-M)analysis was used to stratify patients according to progression-free survival(PFS)and overall survival(OS).RESULTS The combined model,which utilizes the light gradient boosting machine learning algorithm and incorporates both intratumoral and peritumoral regions(5 mm and 10 mm),demonstrated the best predictive performance for ER following HCC ablation,achieving AUCs of 0.924 in the training set,0.899 in the internal validation set,and 0.839 in the external validation set.Calibration and DCA curves confirmed strong calibration and clinical utility,whereas K-M curves provided risk stratification for PFS and OS in HCC patients.CONCLUSION The most efficient model integrated the tumor region with the peritumoral 5 mm and 10 mm regions.This model provides a noninvasive,effective,and reliable method for predicting ER after curative ablation of HCC.
文摘BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.
基金funded by Jilin Province Science and Technology Development Plan Project,grant number 20220203163SF.
文摘With the increasing integration of large-scale distributed energy resources into the grid,traditional distribution network optimization and dispatch methods struggle to address the challenges posed by both generation and load.Accounting for these issues,this paper proposes a multi-timescale coordinated optimization dispatch method for distribution networks.First,the probability box theory was employed to determine the uncertainty intervals of generation and load forecasts,based on which,the requirements for flexibility dispatch and capacity constraints of the grid were calculated and analyzed.Subsequently,a multi-timescale optimization framework was constructed,incorporating the generation and load forecast uncertainties.This framework included optimization models for dayahead scheduling,intra-day optimization,and real-time adjustments,aiming to meet flexibility needs across different timescales and improve the economic efficiency of the grid.Furthermore,an improved soft actor-critic algorithm was introduced to enhance the uncertainty exploration capability.Utilizing a centralized training and decentralized execution framework,a multi-agent SAC network model was developed to improve the decision-making efficiency of the agents.Finally,the effectiveness and superiority of the proposed method were validated using a modified IEEE-33 bus test system.
文摘Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamma-carboxy prothrombin(DCP),lack specificity,limiting their utility in risk strati-fication.YKL-40,a glycoprotein involved in extracellular matrix remodeling,hepatic stellate cell activation,and immune modulation,has emerged as a promising biomarker for post-LT surveillance.Elevated serum levels of YKL-40 are associated with advanced liver disease,tumor progression,and poorer post-LT outcomes,highlighting its potential to address gaps in early detection and personalized management of HCC recurrence.This manuscript synthesizes clinical and mechanistic evidence to evaluate YKL-40’s predictive utility in post-LT care.While preliminary findings demonstrate its specificity for liver-related pathologies,challenges remain,including assay standardization,lack of pro-spective validation,and the need to distinguish between malignant and non-malignant causes of elevated levels.Integrating YKL-40 into multi-biomarker panels with AFP and DCP could enhance predictive accuracy and enable tailored therapeutic strategies.Future research should focus on multicenter studies to validate YKL-40’s clinical utility,address confounding factors like graft rejection and systemic inflammation,and explore its role in predictive models driven by emerging technologies such as artificial intelligence.YKL-40 holds transformative potential in reshaping post-LT care through precision medicine,providing a pathway for better outcomes and improved management of high-risk LT recipients.
文摘Background: Pancreatic cancer is one of the most lethal malignancies, with postoperative recurrence severely affecting patient survival and prognosis. This study aims to develop and validate a clinical prediction model for postoperative recurrence in pancreatic cancer patients, incorporating multiple preoperative, intraoperative, and postoperative factors to assist clinical decision-making. Methods: A retrospective study was conducted on 216 patients who underwent surgical treatment for pancreatic malignancy at the First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2023. An independent external validation cohort of 76 patients from the Second Affiliated Hospital of Chongqing Medical University was used to validate the model. Seven independent risk factors for postoperative recurrence were identified through univariate and multivariate Cox regression analyses. The model’s performance was evaluated using the concordance index (C-index) and ROC curves, and its accuracy and clinical value were assessed using calibration curves and decision curve analysis (DCA). Results: The predictive model demonstrated good discriminatory power, with a C-index of 0.72 in the training cohort and 0.66 in the validation cohort. The ROC curves for predicting recurrence at 3, 6, and 12 months postoperatively showed AUC values ranging from 0.72 to 0.83, indicating strong predictive value. Calibration curves and DCA confirmed the model’s accuracy and clinical utility. Conclusion: This study successfully developed and validated a clinical prediction model that incorporates seven independent risk factors for postoperative recurrence in pancreatic cancer. The model provides a useful tool for predicting recurrence risk, aiding in the identification of high-risk patients, and informing clinical decision-making.
