BACKGROUND Cholecystectomy is a common surgical procedure routinely performed for patients with benign gallbladder disease.The most common indications for cholecystectomy are acute or chronic cholecystitis with or wit...BACKGROUND Cholecystectomy is a common surgical procedure routinely performed for patients with benign gallbladder disease.The most common indications for cholecystectomy are acute or chronic cholecystitis with or without cholelithiasis.However,in rare instances,incidental findings ranging from benign to malignant conditions are encountered,of which gallbladder adenocarcinoma is an aggre-ssive and fatal disease.AIM To determine the prevalence of all incidental diagnoses in routinely performed cholecystectomy specimens,with a particular emphasis on adenocarcinoma,and to characterize the clinicopathological characteristics of malignant postoperative specimens.METHODS The electronic medical record and institutional pathology database were searched for analyses done on gallbladder specimens from patients who had a routine cholecystectomy for benign gallbladder disease during the study period(February 2000 to February 2023).A total of 30678 cholecystectomies performed across the study period were included for analysis.Patients who had preoperative findings or radiological results concerning malignancy were excluded.The demographic and clinical data including patient age and gender,preoperative diagnosis,ra-diographic results at time of diagnosis,gross and morphologic features of gallbladder specimens,and pathologic staging parameters according to the American Joint Committee on Cancer were recorded.RESULTS Of the 30678 cholecystectomy specimens received by the Department of Pathology from patients with who had cholecystectomy for putative benign gallbladder disease during the study period,42(0.14%)were determined to be incidental gallbladder adenocarcinoma and 1 was adenocarcinoma in situ.There were 2 benign incidental dia-gnoses,including 9 patients(0.02%)with accessory/ectopic liver lobe,and 3 with paraganglioma.CONCLUSION Thorough histopathological examination of routine gallbladder specimens is important to provide an early diagnosis of unexpected gallbladder cancer to ensure that patients receive timely care when the disease is treatable.展开更多
BACKGROUND Bile spillage occurs more frequently in patients with incidental gallbladder carcinoma(iGBC)and may be associated with poor survival due to presumed high risk of peritoneal seeding.AIM To investigate the im...BACKGROUND Bile spillage occurs more frequently in patients with incidental gallbladder carcinoma(iGBC)and may be associated with poor survival due to presumed high risk of peritoneal seeding.AIM To investigate the impact of bile spillage during primary surgery on the survival of patients with iGBC.METHODS Medical records of patients with iGBC diagnosed between 2000 and 2019 in 27 Dutch secondary centers and 5 tertiary centers were retrospectively reviewed.Patient medical records were assessed.Predictors for overall survival(OS)were determined using multivariable Cox regression.RESULTS Of the 346 included patients with iGBC,138(39.9%)had bile spillage,which was associated with higher American Society of Anesthesiologists classification(P=0.020),cholecystitis(P<0.001),higher tumor stage(P=0.005),and non-radical resection(P<0.001).Bile spillage was associated with poor OS[hazard ratio=1.97,95%confidence interval(CI):1.48-2.63,P<0.001]with a median OS of 12 months(95%CI:7-18 months)vs 34 months(95%CI:14-55 months,P<0.001).In multivariable analysis,spillage was not an independent prognostic factor for survival(hazard ratio=1.21,95%CI:0.84-1.74,P=0.313).CONCLUSION Although bile spillage correlates with prognostic factors,it lacks independent prognostic significance for survival.Patients with an indication for additional treatment should be promptly referred to a specialized hepatopancreatobiliary center,irrespective of whether bile spillage has occurred.展开更多
BACKGROUND Papillary fibroelastomas are rare,benign cardiac tumors typically found on the heart valves.This case series presents three patients with aortic valve fibroe-lastoma incidentally detected during endoscopic ...BACKGROUND Papillary fibroelastomas are rare,benign cardiac tumors typically found on the heart valves.This case series presents three patients with aortic valve fibroe-lastoma incidentally detected during endoscopic ultrasound(EUS)for pancreatic and biliary pathologies.These cases highly get the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation,raise important que-stions about the true prevalence of these lesions,and highlight the need for es-tablished guidelines for their management and surveillance.The detection of fib-roelastomas during routine EUS procedures emphasizes the importance of tho-rough assessment and multidisciplinary approaches in managing unexpected dis-coveries.This also highlights the potential thromboembolic risks associated with fibroelastomas and challenges in determining appropriate management strategies for patients who are asymptomatic.CASE SUMMARY The patients aged 72 years,51 years,and 42 years underwent EUS for various indications when aortic valve lesions consistent with fibroelastomas were discovered.These findings were subsequently confirmed by transesophageal echocardiography in two cases,with the third patient awaiting assessment.The lesions ranged in size from 0.61 cm to 1.6 cm in diameter and exhibited characteristic sonographic features of fibroelastomas,including hyperechoic appearance and attachment to the aortic valve leaflets.These cases highlight the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation,raising questions about the true prevalence of fib-roelastomas and the need for establishing management guidelines.CONCLUSION This case series raises important questions regarding the prevalence of aortic valve fibroelastoma lesions in the general population.This highlights the urgent need for comprehensive evidence-based guidelines to standardize the management and long-term surveillance of affected patients.展开更多
In order to avoid the noise and over fitting and further improve the limited classification performance of the real decision tree, a traffic incident detection method based on the random forest algorithm is presented....In order to avoid the noise and over fitting and further improve the limited classification performance of the real decision tree, a traffic incident detection method based on the random forest algorithm is presented. From the perspective of classification strength and correlation, three experiments are performed to investigate the potential application of random forest to traffic incident detection： comparison with a different number of decision trees; comparison with different decision trees; comparison with the neural network. The real traffic data of the 1-880 database is used in the experiments. The detection performance is evaluated by the common criteria including the detection rate, the false alarm rate, the mean time to detection, the classification rate and the area under the curve of the receiver operating characteristic （ROC）. The experimental results indicate that the model based on random forest can improve the decision rate, reduce the testing time, and obtain a higher classification rate. Meanwhile, it is competitive compared with multi-layer feed forward neural networks （MLF）.展开更多
An optimal resource dispatching method is proposed to solve the multiple-response problem under the conditions of potential incidents on freeway networks.Travel time of the response vehicle is selected instead of rout...An optimal resource dispatching method is proposed to solve the multiple-response problem under the conditions of potential incidents on freeway networks.Travel time of the response vehicle is selected instead of route distance as the weight to reflect the impact of traffic conditions on the decisions of rescue resources.According to the characteristics of different types of rescue vehicles the dispatching decision-making time is revised to show the heterogeneity among different rescue vehicle dispatching modes. The genetic algorithm is used to obtain the solutions to the rescue resources dispatching model. A case study shows that the proposed method can accurately reveal the impact of potential incidents on the costs of rescues according to the variations in the types and quantities of rescue resources and the optimal dispatching plan with respect to potential incidents can be obtained.The proposed method is applicable in real world scenarios.展开更多
The artificial intelligence technique is used to generate a freeway incident response plan. The incident response framework based on rule-based reasoning, case-based reasoning and Bayesian networks reasoning is presen...The artificial intelligence technique is used to generate a freeway incident response plan. The incident response framework based on rule-based reasoning, case-based reasoning and Bayesian networks reasoning is presented. First, a freeway incident management system （RK-IMS） based on rule-based reasoning is developed and applied for incident management in the northern section of the Nanjing-Lianyunguang Freeway. Then, field data from the two-year long operations of the RK-IMS are analyzed. Representations of incident case structures and Bayesian networks（BNs） structures related to incident responses are deduced. Finally, the k-nearest neighbor （k-NN） algorithm is applied to calculate the similarities of the cases. The preplan generation and the control strategy by integrating the k-NN algorithm are also developed. The model is validated by using incident data of the year 2006 from the RK-IMS. The comparison results indicate that the proposed algorithm is accurate and reliable.展开更多
Objective： In this paper, we review the previous classic research paradigms of a mass casualty incident （MCI） systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus tire, in ord...Objective： In this paper, we review the previous classic research paradigms of a mass casualty incident （MCI） systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus tire, in order to outline and develop an improved research paradigm for MCI management. Methods： We searched PubMed, EMBASE China Wanfang, and China Biology Medicine （CBM） databases for relevant studies. The following key words and medical subject headings were used： ＇mass casualty incident＇, ＇MCI＇, ＇research method＇, ＇Wenchuan＇, ＇earthquake＇, ＇research paradigm＇, ＇science of surge＇, ＇surge＇, ＇surge capacity＇, and ＇vulnerability＇. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. Results： The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods （medical severity index （MSI）, potential injury creating event （PICE） classification, and disaster severity scale （DSS））, which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored--vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. Conclusions： This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research.展开更多
BACKGROUND Incidental gallbladder cancer(IGBC)represents 50%-60%of gallbladder cancer cases.Data are conflicting on the role of IGBC diagnosis in oncological outcomes.Some studies suggest that IGBC diagnosis does not ...BACKGROUND Incidental gallbladder cancer(IGBC)represents 50%-60%of gallbladder cancer cases.Data are conflicting on the role of IGBC diagnosis in oncological outcomes.Some studies suggest that IGBC diagnosis does not affect outcomes,while others that overall survival(OS)is longer in these cases compared to non-incidental diagnosis(NIGBC).Furthermore,some studies reported early tumour stages and histopathologic characteristics as possible confounders,while others not.AIM To investigate the role of IGBC diagnosis on patients’overall survival,especially after surgical treatment with curative intent.METHODS Retrospective analysis of all patient referrals with gallbladder cancer between 2008 and 2020 in a tertiary hepatobiliary centre.Statistical comparison of patient and tumour characteristics between IGBC and NIGBC subgroups was performed.Survival analysis for the whole cohort,surgical and non-surgical subgroups was done with the Kaplan-Meier method and the use of log rank test.Risk analysis was performed with univariable and multivariable Cox regression analysis.RESULTS The cohort included 261 patients with gallbladder cancer.65%of cases had NIGBC and 35%had IGBC.A total of 90 patients received surgical treatment(66%of IGBC cases and 19%of NIGBC cases).NIGBC patients had more advanced T stage and required more extensive resections than IGBC ones.OS was longer in patients with IGBC in the whole cohort(29 vs 4 mo,P<0.001),as well as in the non-surgical(14 vs 2 mo,P<0.001)and surgical subgroups(29 vs 16.5 mo,P=0.001).Disease free survival(DFS)after surgery was longer in patients with IGBC(21.5 mo vs 8.5 mo,P=0.007).N stage and resection margin status were identified as independent predictors of OS and DFS.NIGBC diagnosis was identified as an independent predictor of OS.CONCLUSION IGBC diagnosis may confer a survival advantage independently of the pathological stage and tumour characteristics.Prospective studies are required to further investigate this,including detailed pathological analysis and molecular gene expression.展开更多
Congestion on the freeway is more frequent due to several traffic incidents, namely traffic accidents, debris on the road, vehicle breakdown, and collision with guardrails than any other incidents. These, in turn, aff...Congestion on the freeway is more frequent due to several traffic incidents, namely traffic accidents, debris on the road, vehicle breakdown, and collision with guardrails than any other incidents. These, in turn, affect the operational performance of the freeway by increasing queue length, volume, and density. Consequently, effective freeway management strategies can help to minimize these impacts. The study investigates and summarizes existing studies to identify the reasons for and effects of the traffic incidents. Attention is given to the available solutions of the freeway traffic incidents management. The ultimate goal of this study is to identify the gaps which are not yet addressed to improve the operational effectiveness of the freeway. This study was conducted through a comprehensive literature review of existing refereed publications, established standards, and formal guidelines. Literature was sought through the Transport Research International Documentation (TRID) database, IEEE Transactions database, and google scholar search engine. Research focusing on freeway traffic incidents is a growing concern in transportation operations, as transportation network performance depends on it. Due to the advancement of technology, emerging vehicle technologies like connected vehicles have the potential to address these problems affecting the US transportation system and revolutionize mobility in the future. The study can serve as a reference for the researchers that are involved in freeway traffic operations.展开更多
The stress intensity factors and stress conditions of machining cracks are analyzed by fracture mechanics on the basis of honing characteristics and of brittle ceramic mechanical behavior.Because the honing incidental...The stress intensity factors and stress conditions of machining cracks are analyzed by fracture mechanics on the basis of honing characteristics and of brittle ceramic mechanical behavior.Because the honing incidental tensile stresses effectively decrease the critical grinding stresses and increase the stress intensity factors of machining cracks,the honing process can be carried out easily.The results show that honing can be an efficient machining method for brittle materials.展开更多
In real-life freeway transportation system, a few number of incident observation （very rare event） is available while there are large numbers of normal condition dataset. Most of researches on freeway incident detec...In real-life freeway transportation system, a few number of incident observation （very rare event） is available while there are large numbers of normal condition dataset. Most of researches on freeway incident detection have considered the incident detection problem as classification one. However, because of insufficiency of incident events, most of previous researches have utilized simulated incident events to develop freeway incident detection models. In order to overcome this drawback, this paper proposes a wavelet-based Hotelling 7a control chart for freeway incident detection, which integrates a wavelet transform into an abnormal detection method. Firstly, wavelet transform extracts useful features from noisy original traffic observations, leading to reduce the dimensionality of input vectors. Then, a Hotelling T2 control chart describes a decision boundary with only normal traffic observations with the selected features in the wavelet domain. Unlike the existing incident detection algorithms, which require lots of incident observations to construct incident detection models, the proposed approach can decide a decision boundary given only normal training observations. The proposed method is evaluated in comparison with California algorithm, Minnesota algorithm and conventional neural networks. The experimental results present that the proposed algorithm in this paper is a promising alternative for freeway automatic incident detections.展开更多
In order to evaluate the general situation and find special problems of the freeway incident management system, an evaluation model is proposed. First, the expert appraisal approach is used to select the primary evalu...In order to evaluate the general situation and find special problems of the freeway incident management system, an evaluation model is proposed. First, the expert appraisal approach is used to select the primary evaluation index. As a result, 81 indices and the hierarchical structures of the index such as the object layer, the sub-object layer, the criterion layer and the index layer are determined. Then, based on the fuzzy characteristics of each index layer, the analytical hierarchy process（AHP）and the fuzzy comprehensive evaluation are applied to generate the weight and the satisfaction of the index and the criterion layers. When analyzing the relationship between the sub-object layer and the object layer, it is easy to find that the number of sub-objects is too large and sub-objects are significantly redundant. The partial least square （PLS） is proposed to solve the problems. Finally, an application example, whose result has already been accepted and employed as the indication of a new project in improving incident management, is introduced and the result verifies the feasibility and efficiency of the model.展开更多
Ultrasonic cement bond logging is a widely used method for evaluating cementing quality. Conventional ultrasonic cement bond logging uses vertical incidence and cannot accurately evaluate lightweight cement bonding. O...Ultrasonic cement bond logging is a widely used method for evaluating cementing quality. Conventional ultrasonic cement bond logging uses vertical incidence and cannot accurately evaluate lightweight cement bonding. Oblique incidence is a new technology for evaluating cement quality with improved accuracy for lightweight cements. In this study, we simulated models of acoustic impedance of cement and cementing quality using ultrasonic oblique incidence, and we obtained the relation between cementing quality, acoustic impedance of cement, and the acoustic attenuation coeffi cient of the A0-mode and S0-mode Lamb waves. Then, we simulated models of different cement thickness and we obtained the relation between cement thickness and the time difference of the arrival between the A0 and A0′ modes.展开更多
The purpose of this study is to investigate the frequency of prostate cancer （Pca） discovered incidentally in radical cystoprostatectomy specimens in Asia and to determine the feasibility of prostate-sparing cystect...The purpose of this study is to investigate the frequency of prostate cancer （Pca） discovered incidentally in radical cystoprostatectomy specimens in Asia and to determine the feasibility of prostate-sparing cystectomy （PSC） for Asian patients. Ninety-two male bladder cancer patients who underwent radical cystoprostatectomy at our center between January 2003 and January 2008 were included in this study. The mean age of patients was 67.1 years （range： 32-75 years）. Prostate-specific antigen （PSA） levels and digital rectal examination （DRE） results before surgery were obtained retrospectively. Prostates of all patients were embedded and sectioned at 5-mm intervals. The same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens. Finally, a structured literature review was performed using MEDLINE and PUBMED to estimate the occurrence of incidental Pca in Asia. Of the 92 patients, 3 （3.3%） were found to have Pca; in one out of three （33.3%） patients the disease was clinically significant due to a Gleason grade 4 carcinoma. Eight articles were included in our review. The overall incidence of Pca discovered incidentally in radical cystoprostatectomy specimens in Asia was 9.9% （64/642）. When age was restricted to 〈 60 years, only 7 out of 222 （3.2%） patients were found to have synchronous Pca, and none of the cases was clinically significant. The occurrence of Pca in radical cystoprostatectorny specimens in Asia is much lower than that in Western countries. PSC might be feasible for Asian patients under a strict preoperative selection.展开更多
The reflection of oblique incident waves from breakwaters with a partially-perforated front wall is investigated. The fluid domain is divided into two sub-domains and the eigenfunction expansion method is applied to e...The reflection of oblique incident waves from breakwaters with a partially-perforated front wall is investigated. The fluid domain is divided into two sub-domains and the eigenfunction expansion method is applied to expand velocity potentials in each domain. In the eigen-expansion of the velocity potential, evanescent waves are included. Numerical results of the present model are compared with experimental data. The effect of porosity, the relative chamber width, the relative water depth in the wave absorbing chamber and the water depth in front of the structure are discussed.展开更多
AIM: To seek and analyze features suggestive of gallbladder cancer(GBC) on preoperative imaging and intraoperative findings in patients diagnosed as having incidental GBC(IGBC). METHODS: The study was conducted on 79 ...AIM: To seek and analyze features suggestive of gallbladder cancer(GBC) on preoperative imaging and intraoperative findings in patients diagnosed as having incidental GBC(IGBC). METHODS: The study was conducted on 79 patients of IGBC managed in our department over a 10-year period(2003-2012). Review of preoperative imaging and operative notes was done to ascertain any suspicion of malignancy-in-retrospect.RESULTS: Of the 79 patients, Ultrasound abdomen showed diffuse thickening, not suspicious of malignancy in 5 patients, and diffuse suspicious thickening was seen in 4 patients. Focal thickening suspicious of malignancy was present in 24 patients. Preoperative computed tomography/magnetic resonance imaging was done in 9 patients for suspicion of malignancy. In 5 patients, dif-ficult Cholecystectomy was encountered due to dense/inflammatory adhesions. Intraoperative findings showed focal thickening of the gallbladder and a gallbladder mass in 9 and 17 patients respectively. On overall analysis, 37 patients had preoperative imaging or intraoperative findings suggestive of malignancy, which was either a missed GBC or an unsuspected/unexpected GBC. In 42(53.2%) patients, there was no evidence suggestive of malignancy and was an unanticipated diagnosis.CONCLUSION: Our study highlights a potential and not-so-rare pitfall of Laparoscopic Cholecystectomy. A greater awareness of this clinical entity along with a high index of suspicion and a low threshold for conversion to open procedure, especially in endemic areas may avert avoidable patient morbidity and mortality.展开更多
Anti-jamming solutions based on antenna arrays enhance the anti-jamming ability and the robustness of global navigation satellite system(GNSS)receiver remarkably.However,the performance of the receiver will deteriorat...Anti-jamming solutions based on antenna arrays enhance the anti-jamming ability and the robustness of global navigation satellite system(GNSS)receiver remarkably.However,the performance of the receiver will deteriorate significantly in the overloaded interferences scenario.We define the overloaded interferences scenario as where the number of interferences is more than or equal to the number of antenna arrays elements.In this paper,the effect mechanism of interferences with different incident directions is found by studying the anti-jamming performance of the adaptive space filter.The theoretical analysis and conclusions,which are first validated through numerical examples,reveal the relationships between the optimal weight vector and the eigenvectors of the input signal autocorrelation matrix,the relationships between the interference cancellation ratio(ICR),the signal to interference and noise power ratio(SINR)of the adaptive space filter output and the number of interferences,the eigenvalues of the input signal autocorrelation matrix.In addition,two simulation experiments are utilized to further corroborate the theoretical findings through soft anti-jamming receiver.The simulation results match well with the theoretical analysis results,thus validating the effect mechanism of overloaded interferences.The simulation results show that,for a four elements circular array,the performance difference is up to 19 dB with different incident directions of interferences.Anti-jamming performance evaluation and jamming deployment optimization can obtain more accurate and efficient results by using the conclusions.展开更多
Wave forces induced by the interaction between the oblique incident wave and the breakwater with a partially perforated front wall is investigated. The fluid domain is divided into two sub-domains and the eigen-functi...Wave forces induced by the interaction between the oblique incident wave and the breakwater with a partially perforated front wall is investigated. The fluid domain is divided into two sub-domains and the eigen-function expansion method is applied to expanding velocity potentials in each domain. In the eigen-expansion of the velocity potential, evanescent waves are included. Numerical results of the present model are compared with other theories and a good agreement can be found between them. Experimental data have been compared with the present theoretical results. The effect of the traverse wall on wave forces has been discussed in detail. On the basis of the linear wave theory, it is shown that in the range Of engineering practice, the incident angle of wave has small influence on wave forces on the unit length of perforated caisson.展开更多
AIM To evaluate the diagnostic value and safety mainly regarding incidents of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) for pancreatic cystic lesions(PCLs).METHODS A total of 150 consecutive patient...AIM To evaluate the diagnostic value and safety mainly regarding incidents of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) for pancreatic cystic lesions(PCLs).METHODS A total of 150 consecutive patients with suspected PCLs were prospectively enrolled from April 2015 to November 2016. We finally enrolled 140 patients undergoing EUS-FNA. We compared the diagnostic accuracy of EUS-FNA and pathological diagnosis, which is regarded as the gold standard, for PCLs. Patients undergoing EUS-FNA at least 1 wk preoperatively were monitored for incidents and adverse events to evaluate its safety.RESULTS There were 88(62.9%) women and 52(37.1%) men among 140 patients, with a mean age of 50.1(± 15.4) years. There were 67 cysts located in the head/uncinate of the pancreas and 67 in the body/tail, and 6 patients had at least 1 cyst in the pancreas. There were 75 patients undergoing surgery and 55 undergoing EUS-FNA with interval at least 1 wk before other operations, with 3 patients undergoing the procedure twice. The accuracy of EUS-FNA in differentiating benign and malignant lesions was 97.3%(73/75), while the accuracy of characterizing PCL subtype was 84.0%(63/75). The incident rate was 37.9%(22/58), whereas only 1 AE was observed in 58 cases.CONCLUSION EUS-FNA is effective and safe for diagnosis of PCLs, however procedure-related incidents are common. Caution should be taken in patients undergoing EUSFNA.展开更多
AIM To analyse the range of histopathology detected in the largest published United Kingdom series of cholecystectomy specimens and to evaluate the rational for selective histopathological analysis.METHODS Incidental ...AIM To analyse the range of histopathology detected in the largest published United Kingdom series of cholecystectomy specimens and to evaluate the rational for selective histopathological analysis.METHODS Incidental gallbladder malignancy is rare in the United Kingdom with recent literature supporting selective histological assessment of gallbladders after routine cholecystectomy.All cholecystectomy gallbladder specimens examined by the histopathology department at our hospital during a five year period between March 2008 and March 2013 were retrospectively analysed.Further data was collected on all specimens demonstrating carcinoma,dysplasia and polypoid growths.RESULTS The study included 4027 patients.The majority(97%) of specimens exhibited gallstone or cholecystitis related disease.Polyps were demonstrated in 44(1.09%),the majority of which were cholesterol based(41/44).Dysplasia,ranging from low to multifocal high-grade was demonstrated in 55(1.37%).Incidental primary gallbladder adenocarcinoma was detected in 6 specimens(0.15%,5 female and 1 male),and a single gallbladder revealed carcinoma in situ(0.02%).This large single centre study demonstrated a full range of gallbladder disease from cholecystectomy specimens,including more than 1% neoplastic histology and two cases of macroscopically occult gallbladder malignancies.CONCLUSION Routine histological evaluation of all elective and emergency cholecystectomies is justified in a United Kingdom population as selective analysis has potential to miss potentially curable life threatening pathology.展开更多
文摘BACKGROUND Cholecystectomy is a common surgical procedure routinely performed for patients with benign gallbladder disease.The most common indications for cholecystectomy are acute or chronic cholecystitis with or without cholelithiasis.However,in rare instances,incidental findings ranging from benign to malignant conditions are encountered,of which gallbladder adenocarcinoma is an aggre-ssive and fatal disease.AIM To determine the prevalence of all incidental diagnoses in routinely performed cholecystectomy specimens,with a particular emphasis on adenocarcinoma,and to characterize the clinicopathological characteristics of malignant postoperative specimens.METHODS The electronic medical record and institutional pathology database were searched for analyses done on gallbladder specimens from patients who had a routine cholecystectomy for benign gallbladder disease during the study period(February 2000 to February 2023).A total of 30678 cholecystectomies performed across the study period were included for analysis.Patients who had preoperative findings or radiological results concerning malignancy were excluded.The demographic and clinical data including patient age and gender,preoperative diagnosis,ra-diographic results at time of diagnosis,gross and morphologic features of gallbladder specimens,and pathologic staging parameters according to the American Joint Committee on Cancer were recorded.RESULTS Of the 30678 cholecystectomy specimens received by the Department of Pathology from patients with who had cholecystectomy for putative benign gallbladder disease during the study period,42(0.14%)were determined to be incidental gallbladder adenocarcinoma and 1 was adenocarcinoma in situ.There were 2 benign incidental dia-gnoses,including 9 patients(0.02%)with accessory/ectopic liver lobe,and 3 with paraganglioma.CONCLUSION Thorough histopathological examination of routine gallbladder specimens is important to provide an early diagnosis of unexpected gallbladder cancer to ensure that patients receive timely care when the disease is treatable.
文摘BACKGROUND Bile spillage occurs more frequently in patients with incidental gallbladder carcinoma(iGBC)and may be associated with poor survival due to presumed high risk of peritoneal seeding.AIM To investigate the impact of bile spillage during primary surgery on the survival of patients with iGBC.METHODS Medical records of patients with iGBC diagnosed between 2000 and 2019 in 27 Dutch secondary centers and 5 tertiary centers were retrospectively reviewed.Patient medical records were assessed.Predictors for overall survival(OS)were determined using multivariable Cox regression.RESULTS Of the 346 included patients with iGBC,138(39.9%)had bile spillage,which was associated with higher American Society of Anesthesiologists classification(P=0.020),cholecystitis(P<0.001),higher tumor stage(P=0.005),and non-radical resection(P<0.001).Bile spillage was associated with poor OS[hazard ratio=1.97,95%confidence interval(CI):1.48-2.63,P<0.001]with a median OS of 12 months(95%CI:7-18 months)vs 34 months(95%CI:14-55 months,P<0.001).In multivariable analysis,spillage was not an independent prognostic factor for survival(hazard ratio=1.21,95%CI:0.84-1.74,P=0.313).CONCLUSION Although bile spillage correlates with prognostic factors,it lacks independent prognostic significance for survival.Patients with an indication for additional treatment should be promptly referred to a specialized hepatopancreatobiliary center,irrespective of whether bile spillage has occurred.
文摘BACKGROUND Papillary fibroelastomas are rare,benign cardiac tumors typically found on the heart valves.This case series presents three patients with aortic valve fibroe-lastoma incidentally detected during endoscopic ultrasound(EUS)for pancreatic and biliary pathologies.These cases highly get the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation,raise important que-stions about the true prevalence of these lesions,and highlight the need for es-tablished guidelines for their management and surveillance.The detection of fib-roelastomas during routine EUS procedures emphasizes the importance of tho-rough assessment and multidisciplinary approaches in managing unexpected dis-coveries.This also highlights the potential thromboembolic risks associated with fibroelastomas and challenges in determining appropriate management strategies for patients who are asymptomatic.CASE SUMMARY The patients aged 72 years,51 years,and 42 years underwent EUS for various indications when aortic valve lesions consistent with fibroelastomas were discovered.These findings were subsequently confirmed by transesophageal echocardiography in two cases,with the third patient awaiting assessment.The lesions ranged in size from 0.61 cm to 1.6 cm in diameter and exhibited characteristic sonographic features of fibroelastomas,including hyperechoic appearance and attachment to the aortic valve leaflets.These cases highlight the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation,raising questions about the true prevalence of fib-roelastomas and the need for establishing management guidelines.CONCLUSION This case series raises important questions regarding the prevalence of aortic valve fibroelastoma lesions in the general population.This highlights the urgent need for comprehensive evidence-based guidelines to standardize the management and long-term surveillance of affected patients.
基金The National High Technology Research and Development Program of China(863 Program)(No.2012AA112304)the Scientific Innovation Research of College Graduates in Jiangsu Province(No.CXZZ13-0119)
文摘In order to avoid the noise and over fitting and further improve the limited classification performance of the real decision tree, a traffic incident detection method based on the random forest algorithm is presented. From the perspective of classification strength and correlation, three experiments are performed to investigate the potential application of random forest to traffic incident detection： comparison with a different number of decision trees; comparison with different decision trees; comparison with the neural network. The real traffic data of the 1-880 database is used in the experiments. The detection performance is evaluated by the common criteria including the detection rate, the false alarm rate, the mean time to detection, the classification rate and the area under the curve of the receiver operating characteristic （ROC）. The experimental results indicate that the model based on random forest can improve the decision rate, reduce the testing time, and obtain a higher classification rate. Meanwhile, it is competitive compared with multi-layer feed forward neural networks （MLF）.
基金The National Natural Science Foundation of China(No.71101025)the Science and Technology Key Plan Project of Changzhou(No.CE20125001)
文摘An optimal resource dispatching method is proposed to solve the multiple-response problem under the conditions of potential incidents on freeway networks.Travel time of the response vehicle is selected instead of route distance as the weight to reflect the impact of traffic conditions on the decisions of rescue resources.According to the characteristics of different types of rescue vehicles the dispatching decision-making time is revised to show the heterogeneity among different rescue vehicle dispatching modes. The genetic algorithm is used to obtain the solutions to the rescue resources dispatching model. A case study shows that the proposed method can accurately reveal the impact of potential incidents on the costs of rescues according to the variations in the types and quantities of rescue resources and the optimal dispatching plan with respect to potential incidents can be obtained.The proposed method is applicable in real world scenarios.
基金The Natural Science Foundation of Jiangsu Province(NoBK2008308)
文摘The artificial intelligence technique is used to generate a freeway incident response plan. The incident response framework based on rule-based reasoning, case-based reasoning and Bayesian networks reasoning is presented. First, a freeway incident management system （RK-IMS） based on rule-based reasoning is developed and applied for incident management in the northern section of the Nanjing-Lianyunguang Freeway. Then, field data from the two-year long operations of the RK-IMS are analyzed. Representations of incident case structures and Bayesian networks（BNs） structures related to incident responses are deduced. Finally, the k-nearest neighbor （k-NN） algorithm is applied to calculate the similarities of the cases. The preplan generation and the control strategy by integrating the k-NN algorithm are also developed. The model is validated by using incident data of the year 2006 from the RK-IMS. The comparison results indicate that the proposed algorithm is accurate and reliable.
基金Project supported by the Research Fund of Ministry of Health of China(No.N20080022)the Major Science and Technology Project of Zhejiang Province(No.2009C03010-3)+1 种基金the Medical Scientific Research Foundation of Zhejiang Province(No.200921012)the Educational Commission of Zhejiang Province(No.Y200908921),China
文摘Objective： In this paper, we review the previous classic research paradigms of a mass casualty incident （MCI） systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus tire, in order to outline and develop an improved research paradigm for MCI management. Methods： We searched PubMed, EMBASE China Wanfang, and China Biology Medicine （CBM） databases for relevant studies. The following key words and medical subject headings were used： ＇mass casualty incident＇, ＇MCI＇, ＇research method＇, ＇Wenchuan＇, ＇earthquake＇, ＇research paradigm＇, ＇science of surge＇, ＇surge＇, ＇surge capacity＇, and ＇vulnerability＇. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. Results： The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods （medical severity index （MSI）, potential injury creating event （PICE） classification, and disaster severity scale （DSS））, which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored--vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. Conclusions： This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research.
文摘BACKGROUND Incidental gallbladder cancer(IGBC)represents 50%-60%of gallbladder cancer cases.Data are conflicting on the role of IGBC diagnosis in oncological outcomes.Some studies suggest that IGBC diagnosis does not affect outcomes,while others that overall survival(OS)is longer in these cases compared to non-incidental diagnosis(NIGBC).Furthermore,some studies reported early tumour stages and histopathologic characteristics as possible confounders,while others not.AIM To investigate the role of IGBC diagnosis on patients’overall survival,especially after surgical treatment with curative intent.METHODS Retrospective analysis of all patient referrals with gallbladder cancer between 2008 and 2020 in a tertiary hepatobiliary centre.Statistical comparison of patient and tumour characteristics between IGBC and NIGBC subgroups was performed.Survival analysis for the whole cohort,surgical and non-surgical subgroups was done with the Kaplan-Meier method and the use of log rank test.Risk analysis was performed with univariable and multivariable Cox regression analysis.RESULTS The cohort included 261 patients with gallbladder cancer.65%of cases had NIGBC and 35%had IGBC.A total of 90 patients received surgical treatment(66%of IGBC cases and 19%of NIGBC cases).NIGBC patients had more advanced T stage and required more extensive resections than IGBC ones.OS was longer in patients with IGBC in the whole cohort(29 vs 4 mo,P<0.001),as well as in the non-surgical(14 vs 2 mo,P<0.001)and surgical subgroups(29 vs 16.5 mo,P=0.001).Disease free survival(DFS)after surgery was longer in patients with IGBC(21.5 mo vs 8.5 mo,P=0.007).N stage and resection margin status were identified as independent predictors of OS and DFS.NIGBC diagnosis was identified as an independent predictor of OS.CONCLUSION IGBC diagnosis may confer a survival advantage independently of the pathological stage and tumour characteristics.Prospective studies are required to further investigate this,including detailed pathological analysis and molecular gene expression.
文摘Congestion on the freeway is more frequent due to several traffic incidents, namely traffic accidents, debris on the road, vehicle breakdown, and collision with guardrails than any other incidents. These, in turn, affect the operational performance of the freeway by increasing queue length, volume, and density. Consequently, effective freeway management strategies can help to minimize these impacts. The study investigates and summarizes existing studies to identify the reasons for and effects of the traffic incidents. Attention is given to the available solutions of the freeway traffic incidents management. The ultimate goal of this study is to identify the gaps which are not yet addressed to improve the operational effectiveness of the freeway. This study was conducted through a comprehensive literature review of existing refereed publications, established standards, and formal guidelines. Literature was sought through the Transport Research International Documentation (TRID) database, IEEE Transactions database, and google scholar search engine. Research focusing on freeway traffic incidents is a growing concern in transportation operations, as transportation network performance depends on it. Due to the advancement of technology, emerging vehicle technologies like connected vehicles have the potential to address these problems affecting the US transportation system and revolutionize mobility in the future. The study can serve as a reference for the researchers that are involved in freeway traffic operations.
文摘The stress intensity factors and stress conditions of machining cracks are analyzed by fracture mechanics on the basis of honing characteristics and of brittle ceramic mechanical behavior.Because the honing incidental tensile stresses effectively decrease the critical grinding stresses and increase the stress intensity factors of machining cracks,the honing process can be carried out easily.The results show that honing can be an efficient machining method for brittle materials.
文摘In real-life freeway transportation system, a few number of incident observation （very rare event） is available while there are large numbers of normal condition dataset. Most of researches on freeway incident detection have considered the incident detection problem as classification one. However, because of insufficiency of incident events, most of previous researches have utilized simulated incident events to develop freeway incident detection models. In order to overcome this drawback, this paper proposes a wavelet-based Hotelling 7a control chart for freeway incident detection, which integrates a wavelet transform into an abnormal detection method. Firstly, wavelet transform extracts useful features from noisy original traffic observations, leading to reduce the dimensionality of input vectors. Then, a Hotelling T2 control chart describes a decision boundary with only normal traffic observations with the selected features in the wavelet domain. Unlike the existing incident detection algorithms, which require lots of incident observations to construct incident detection models, the proposed approach can decide a decision boundary given only normal training observations. The proposed method is evaluated in comparison with California algorithm, Minnesota algorithm and conventional neural networks. The experimental results present that the proposed algorithm in this paper is a promising alternative for freeway automatic incident detections.
文摘In order to evaluate the general situation and find special problems of the freeway incident management system, an evaluation model is proposed. First, the expert appraisal approach is used to select the primary evaluation index. As a result, 81 indices and the hierarchical structures of the index such as the object layer, the sub-object layer, the criterion layer and the index layer are determined. Then, based on the fuzzy characteristics of each index layer, the analytical hierarchy process（AHP）and the fuzzy comprehensive evaluation are applied to generate the weight and the satisfaction of the index and the criterion layers. When analyzing the relationship between the sub-object layer and the object layer, it is easy to find that the number of sub-objects is too large and sub-objects are significantly redundant. The partial least square （PLS） is proposed to solve the problems. Finally, an application example, whose result has already been accepted and employed as the indication of a new project in improving incident management, is introduced and the result verifies the feasibility and efficiency of the model.
基金partially supported by the National Natural Science Foundation of China(Nos.11204380,11374371,61102102,and 11134011)National Science and Technology Major Project(No.2011ZX05020-009)+1 种基金Petro China Innovation Foundation(No.2013D-5006-0304)Chinese Petroleum Corporation Project(Nos.2011A-3903 and 2011B-4001)
文摘Ultrasonic cement bond logging is a widely used method for evaluating cementing quality. Conventional ultrasonic cement bond logging uses vertical incidence and cannot accurately evaluate lightweight cement bonding. Oblique incidence is a new technology for evaluating cement quality with improved accuracy for lightweight cements. In this study, we simulated models of acoustic impedance of cement and cementing quality using ultrasonic oblique incidence, and we obtained the relation between cementing quality, acoustic impedance of cement, and the acoustic attenuation coeffi cient of the A0-mode and S0-mode Lamb waves. Then, we simulated models of different cement thickness and we obtained the relation between cement thickness and the time difference of the arrival between the A0 and A0′ modes.
基金Our study was supported by the National Nature Science Foundation of China （NSFC, No. 30772162）.
文摘The purpose of this study is to investigate the frequency of prostate cancer （Pca） discovered incidentally in radical cystoprostatectomy specimens in Asia and to determine the feasibility of prostate-sparing cystectomy （PSC） for Asian patients. Ninety-two male bladder cancer patients who underwent radical cystoprostatectomy at our center between January 2003 and January 2008 were included in this study. The mean age of patients was 67.1 years （range： 32-75 years）. Prostate-specific antigen （PSA） levels and digital rectal examination （DRE） results before surgery were obtained retrospectively. Prostates of all patients were embedded and sectioned at 5-mm intervals. The same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens. Finally, a structured literature review was performed using MEDLINE and PUBMED to estimate the occurrence of incidental Pca in Asia. Of the 92 patients, 3 （3.3%） were found to have Pca; in one out of three （33.3%） patients the disease was clinically significant due to a Gleason grade 4 carcinoma. Eight articles were included in our review. The overall incidence of Pca discovered incidentally in radical cystoprostatectomy specimens in Asia was 9.9% （64/642）. When age was restricted to 〈 60 years, only 7 out of 222 （3.2%） patients were found to have synchronous Pca, and none of the cases was clinically significant. The occurrence of Pca in radical cystoprostatectorny specimens in Asia is much lower than that in Western countries. PSC might be feasible for Asian patients under a strict preoperative selection.
基金by Joint Fund of the National Natural Science Foundation of China the Hong Kong Science Research Bureau (49910161985)+1 种基金the National Natural Science Foundation of China (50025924,50179004)the Research Fund for the Development of harbor engineeri
文摘The reflection of oblique incident waves from breakwaters with a partially-perforated front wall is investigated. The fluid domain is divided into two sub-domains and the eigenfunction expansion method is applied to expand velocity potentials in each domain. In the eigen-expansion of the velocity potential, evanescent waves are included. Numerical results of the present model are compared with experimental data. The effect of porosity, the relative chamber width, the relative water depth in the wave absorbing chamber and the water depth in front of the structure are discussed.
文摘AIM: To seek and analyze features suggestive of gallbladder cancer(GBC) on preoperative imaging and intraoperative findings in patients diagnosed as having incidental GBC(IGBC). METHODS: The study was conducted on 79 patients of IGBC managed in our department over a 10-year period(2003-2012). Review of preoperative imaging and operative notes was done to ascertain any suspicion of malignancy-in-retrospect.RESULTS: Of the 79 patients, Ultrasound abdomen showed diffuse thickening, not suspicious of malignancy in 5 patients, and diffuse suspicious thickening was seen in 4 patients. Focal thickening suspicious of malignancy was present in 24 patients. Preoperative computed tomography/magnetic resonance imaging was done in 9 patients for suspicion of malignancy. In 5 patients, dif-ficult Cholecystectomy was encountered due to dense/inflammatory adhesions. Intraoperative findings showed focal thickening of the gallbladder and a gallbladder mass in 9 and 17 patients respectively. On overall analysis, 37 patients had preoperative imaging or intraoperative findings suggestive of malignancy, which was either a missed GBC or an unsuspected/unexpected GBC. In 42(53.2%) patients, there was no evidence suggestive of malignancy and was an unanticipated diagnosis.CONCLUSION: Our study highlights a potential and not-so-rare pitfall of Laparoscopic Cholecystectomy. A greater awareness of this clinical entity along with a high index of suspicion and a low threshold for conversion to open procedure, especially in endemic areas may avert avoidable patient morbidity and mortality.
基金supported by the National Natural Science Foundation of China(62003354).
文摘Anti-jamming solutions based on antenna arrays enhance the anti-jamming ability and the robustness of global navigation satellite system(GNSS)receiver remarkably.However,the performance of the receiver will deteriorate significantly in the overloaded interferences scenario.We define the overloaded interferences scenario as where the number of interferences is more than or equal to the number of antenna arrays elements.In this paper,the effect mechanism of interferences with different incident directions is found by studying the anti-jamming performance of the adaptive space filter.The theoretical analysis and conclusions,which are first validated through numerical examples,reveal the relationships between the optimal weight vector and the eigenvectors of the input signal autocorrelation matrix,the relationships between the interference cancellation ratio(ICR),the signal to interference and noise power ratio(SINR)of the adaptive space filter output and the number of interferences,the eigenvalues of the input signal autocorrelation matrix.In addition,two simulation experiments are utilized to further corroborate the theoretical findings through soft anti-jamming receiver.The simulation results match well with the theoretical analysis results,thus validating the effect mechanism of overloaded interferences.The simulation results show that,for a four elements circular array,the performance difference is up to 19 dB with different incident directions of interferences.Anti-jamming performance evaluation and jamming deployment optimization can obtain more accurate and efficient results by using the conclusions.
基金This project was supported by the Research Fund for the Development of Harbor Engineering Design Specification,the Ministry of Communications of Chinathe Program for Changjiang Scholars and Innovation Research Team in University of China under contract No.IRT0420the Fok Ying Tung Education Foundation of China under contract No.81068.
文摘Wave forces induced by the interaction between the oblique incident wave and the breakwater with a partially perforated front wall is investigated. The fluid domain is divided into two sub-domains and the eigen-function expansion method is applied to expanding velocity potentials in each domain. In the eigen-expansion of the velocity potential, evanescent waves are included. Numerical results of the present model are compared with other theories and a good agreement can be found between them. Experimental data have been compared with the present theoretical results. The effect of the traverse wall on wave forces has been discussed in detail. On the basis of the linear wave theory, it is shown that in the range Of engineering practice, the incident angle of wave has small influence on wave forces on the unit length of perforated caisson.
文摘AIM To evaluate the diagnostic value and safety mainly regarding incidents of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) for pancreatic cystic lesions(PCLs).METHODS A total of 150 consecutive patients with suspected PCLs were prospectively enrolled from April 2015 to November 2016. We finally enrolled 140 patients undergoing EUS-FNA. We compared the diagnostic accuracy of EUS-FNA and pathological diagnosis, which is regarded as the gold standard, for PCLs. Patients undergoing EUS-FNA at least 1 wk preoperatively were monitored for incidents and adverse events to evaluate its safety.RESULTS There were 88(62.9%) women and 52(37.1%) men among 140 patients, with a mean age of 50.1(± 15.4) years. There were 67 cysts located in the head/uncinate of the pancreas and 67 in the body/tail, and 6 patients had at least 1 cyst in the pancreas. There were 75 patients undergoing surgery and 55 undergoing EUS-FNA with interval at least 1 wk before other operations, with 3 patients undergoing the procedure twice. The accuracy of EUS-FNA in differentiating benign and malignant lesions was 97.3%(73/75), while the accuracy of characterizing PCL subtype was 84.0%(63/75). The incident rate was 37.9%(22/58), whereas only 1 AE was observed in 58 cases.CONCLUSION EUS-FNA is effective and safe for diagnosis of PCLs, however procedure-related incidents are common. Caution should be taken in patients undergoing EUSFNA.
文摘AIM To analyse the range of histopathology detected in the largest published United Kingdom series of cholecystectomy specimens and to evaluate the rational for selective histopathological analysis.METHODS Incidental gallbladder malignancy is rare in the United Kingdom with recent literature supporting selective histological assessment of gallbladders after routine cholecystectomy.All cholecystectomy gallbladder specimens examined by the histopathology department at our hospital during a five year period between March 2008 and March 2013 were retrospectively analysed.Further data was collected on all specimens demonstrating carcinoma,dysplasia and polypoid growths.RESULTS The study included 4027 patients.The majority(97%) of specimens exhibited gallstone or cholecystitis related disease.Polyps were demonstrated in 44(1.09%),the majority of which were cholesterol based(41/44).Dysplasia,ranging from low to multifocal high-grade was demonstrated in 55(1.37%).Incidental primary gallbladder adenocarcinoma was detected in 6 specimens(0.15%,5 female and 1 male),and a single gallbladder revealed carcinoma in situ(0.02%).This large single centre study demonstrated a full range of gallbladder disease from cholecystectomy specimens,including more than 1% neoplastic histology and two cases of macroscopically occult gallbladder malignancies.CONCLUSION Routine histological evaluation of all elective and emergency cholecystectomies is justified in a United Kingdom population as selective analysis has potential to miss potentially curable life threatening pathology.
