BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gas...BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gastrectomy(PG)or total gastrectomy(TG)should be used for advanced proximal GC,and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIM To compare the short-term efficacy,long-term survival,and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y re-construction in patients with proximal GC following neoadjuvant chemotherapy(NACT)in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODS A multicenter retrospective cohort study was conducted at two Chinese medical centers between December,2012 and December,2022.Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included.Propensity score matching(PSM)was performed to balance baseline characteristics,and the primary endpoint was 5-year overall survival(OS).Se-condary endpoints included recurrence-free survival(RFS),postoperative complications,and reflux severity.RESULTS After PSM,244 patients(122 PG,122 TG)were finally included and all baseline characteristics were comparable between groups.The PG group had a significantly shorter operation time compared to the TG group(189.50 vs 215.00 minutes,P<0.001),with no differences in intraoperative blood loss or postoperative complications(19.68%vs 14.75%,P=0.792).The 5-year OS rates were 52.7%vs 45.5%(P=0.330),and 5-year RFS rates were 54.3%vs 47.6%(P=0.356)for the PG and TG groups,respectively.Reflux symptoms(18.0%vs 31.1%,P=0.017)and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores≥8(7.4%vs 21.3%,P<0.001)were significantly less frequent in the PG group.Multivariate analysis identified histological differentiation(HR=2.98,95%CI:2.03-4.36,P<0.001)and tumor size(HR=0.26,95%CI:0.17-0.41 for tumors≤4 cm,P<0.001)as independent prognostic factors.CONCLUSION PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT.Additionally,PG has the advantages of shorter operation time and lower rates of postoperative reflux,suggesting potential benefits for patient quality of life.Notably,the analysis of postoperative prognostic factors,including histological differentiation and tumor size,further informs clinical decision-making and highlights the importance of individualized treatment strategies.展开更多
BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anast...BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anastomosis are two relatively mature anti-reflux procedures.A comparison of these two surgical procedures,tubular gastroesophageal anastomosis and double-channel anastomosis,has rarely been reported.Therefore,this study aimed to investigate the effects of these two reconstruction methods on the quality of life of patients with proximal gastric cancer after proximal gastrectomy.AIM To compare short-term clinical results of laparoscopic proximal gastrectomy with double-channel anastomosis vs tubular gastric anastomosis.METHODS Patients who underwent proximal gastrectomy at our hospital between January 2020 and January 2023 were enrolled in this retrospective cohort study.The patients were divided into an experimental group(double-channel anastomosis,33 cases)and a control group(tubular gastric anastomosis,30 cases).Baseline characteristics,surgical data,postoperative morbidities,and postoperative nutrition were recorded.RESULTS The differences in baseline data,surgical data,and postoperative complications(20.0%vs 21.2%)were not statistically significant between the two groups.There were no statistically significant differences in the levels of postoperative nutrition indicators between the two groups of patients during the preoperative period and at 3 months postoperatively.In addition,the levels of postoperative nutrition indicators in patients in the experimental group declined significantly less at 6 months and 12 months postoperatively compared with those of the control group(P<0.05).At 12 months postoperatively,the difference in anastomotic reflux esophagitis between the two groups was statistically significant(P<0.05)with the experimental group showing less reflux esophagitis.CONCLUSION Both double-channel anastomosis and tubular gastric anastomosis after proximal gastrectomy are safe and feasible.Double-channel anastomosis has a better anti-reflux effect and is more beneficial in improving the postoperative nutritional status.展开更多
BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their gly...BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.展开更多
BACKGROUND Although surgery remains the primary treatment for proximal gastric cancer(PGC),ongoing refinements in surgical strategies are essential to improving clinical outcomes.AIM To investigate the effect of doubl...BACKGROUND Although surgery remains the primary treatment for proximal gastric cancer(PGC),ongoing refinements in surgical strategies are essential to improving clinical outcomes.AIM To investigate the effect of double-tract reconstruction(DTR)on immune function and stress response in patients undergoing laparoscopic proximal gastrectomy(LPG).METHODS In total,78 patients with PGC admitted between August 2020 and August 2024 were enrolled.The research group consisted of 39 patients who underwent DTR+LPG,whereas the control group comprised 39 patients who underwent laparoscopic total gastrectomy with Roux-en-Y esophagojejunostomy.Perioperative indices(intraoperative blood loss,digestive tract anastomosis time,and time to first postoperative flatus),postoperative complications(intestinal obstruction,anastomotic ulcer,diarrhea,dumping syndrome,and gastroesophageal reflux),nutritional parameters(serum albumin,hemoglobin,and body mass index),immune function immunoglobulin(IgG,IgA,and IgM),and stress response indicators(C-reactive protein,interleukin-6,and tumor necrosis factor-α)were collected and analyzed for both groups.RESULTS The intraoperative blood loss was lower(P<0.05),and the time to first postoperative flatus time was shorter(P<0.001)in the research group than in the control group.The two groups had comparable digestive tract anastomosis time(P>0.05).The overall complication rate was significantly lower in the research group than in the control group(P=0.042).Compared with the control group,the research group exhibited notably higher albumin,hemoglobin,and body mass index levels at 2 and 3 months postoperatively,as well as considerably high immunoglobulin(Ig)G,IgA,and IgM levels on postoperative day 1(P<0.05).The postoperative levels of C-reactive protein,interleukin-6,and tumor necrosis factor-αwere also lower in the research group than in the control group(P<0.001).CONCLUSION The combination of DTR and LPG in the treatment of patients with PGC is more effective in enhancing immune function and suppressing stress responses,showing more advantages over laparoscopic total gastrectomy.展开更多
BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in p...BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in patients undergoing this procedure.AIM To identify the most effective method for reducing reflux symptoms while preserving gastrointestinal integrity and nutritional status.METHODS A retrospective evaluation was conducted on 60 patients who underwent proximal gastrectomy between December 2020 and December 2023,divided equally into two groups based on the anastomosis technique used(forearm or posterior wall).GER symptoms were assessed using the GER disease ques-tionnaire(GerdQ)preoperatively and on the first postoperative day.Biochemical markers[diamine oxidase(DAO),D-lactic acid,and endotoxin(ETX)]and nutritional indicators[serum ferritin(SF),prealbumin(PA),and albumin(ALB)]were measured to evaluate gastrointestinal barrier function and nutritional status.RESULTS Both groups showed significant improvements in GerdQ scores and reflux symptom scores post-treatment,with the observation group exhibiting greater reductions.Biochemical markers indicated enhanced gastrointestinal barrier function post-treatment in both groups,with notable increases in DAO,D-lactic,and ETX levels.Nutritional status indicators also demonstrated significant changes,with reductions in SF,PA,and ALB levels,suggesting an impact of treatment on inflammatory and nutritional status.CONCLUSION The forearm anastomosis technique appears to be more effective in reducing GER symptoms and preserving gastrointestinal health in patients undergoing proximal gastrectomy for gastric cancer compared to the posterior wall anastomosis technique.These preliminary findings advocate for further research to confirm the benefits and potentially standardize Forearm Anastomosis in surgical practice for gastric cancer.展开更多
BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical...BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.展开更多
Background:This study aimed to evaluate the prognostic value of the lymphocyte-to-monocyte ratio(LMR)and cancer antigen 724(CA724)in patients with proximal gastric cancer residing in cold climate regions.Methods:A ret...Background:This study aimed to evaluate the prognostic value of the lymphocyte-to-monocyte ratio(LMR)and cancer antigen 724(CA724)in patients with proximal gastric cancer residing in cold climate regions.Methods:A retrospective analysis was conducted on 313 patients diagnosed with proximal gastric cancer in cold climate regions between 2014 and 2017.Preoperative hematological markers,including LMR and CA724,were assessed.Receiver operating characteristic(ROC)curves were used to determine optimal cutoff values,which were then combined to form the LMR+CA724 score.Statistical analyses included Kaplan-Meier survival curves,log-rank tests,and Cox proportional hazards regression.Results:A high preoperative LMR+CA724 score was significantly associated with older age,advanced pTNM stage,vascular invasion,and elevated levels of NMPVR,NMR,and AAR.The LMR+CA724 score demonstrated a higher area under the curve(AUC)compared to LMR or CA724 alone.Multivariate analysis identified pTNM stage,Borrmann type,histological type,and the LMR+CA724 score as independent prognostic factors for overall survival(OS).A nomogram incorporating these four variables achieved an AUC of 0.817,indicating strong predictive performance.Conclusion:The LMR+CA724 score is a reliable and independent prognostic indicator for patients with proximal gastric cancer in cold climate regions.Its integration into clinical practice may support treatment planning and long-term management by enhancing personalized care.Further prospective studies are warranted to validate these findings in broader and more diverse patient populations.展开更多
BACKGROUND Proximal gastrectomy(PG)for gastric cancer requires a delicate balance between oncological radicality and postoperative quality of life to mitigate reflux complications.Although the Kamikawa anastomosis has...BACKGROUND Proximal gastrectomy(PG)for gastric cancer requires a delicate balance between oncological radicality and postoperative quality of life to mitigate reflux complications.Although the Kamikawa anastomosis has gained attention for its theoretical anti-reflux advantages,robust clinical evidence remains limited.AIM To comprehensively evaluate the efficacy,safety,and nutritional outcomes of the Kamikawa anastomosis in PG,thereby addressing a critical gap in surgical decision-making.METHODS Following PRISMA guidelines,we systematically searched PubMed,Embase,and the Cochrane Library for studies on Kamikawa anastomosis after PG.Data were pooled using fixed-or random-effects models based on heterogeneity levels(I2 statistics).The risk of bias was evaluated using Risk of Bias in Non-randomized Studies of Interventions.The protocol was prospectively registered in PROSPERO.RESULTS Of 106 screened studies,20 involving 2291 patients were included.Most studies(85%)originated from Japan,with a mean patient age of 54-73 years and a male predominance(68.1%).Overall pooled incidence of 30-day postoperative complications was 9.9%[95%confidence interval(95%CI):6.8-12.9],with major complications(Clavien-Dindo grade≥III)occurring in 6.1%(95%CI:4.6-7.7).Anastomosis-related complications were observed in 7.2%of cases,comprising leakage 1.8%(95%CI:1.1-2.4),stenosis in 7.2%(95%CI:5.8-8.5),and bleeding in 0.7%(95%CI:0.1-1.2).Pooled incidence of reflux esophagitis was 4%(95%CI:2.7-5.3)for all LA grades at 12-month follow-up,with 28.3%(95%CI:14.7-41.9)of patients requiring regular proton pump inhibitor use.Operative outcomes demonstrated a pooled mean operative time of 349.5 minutes(95%CI:331-380),estimated blood loss of 351.5 mL(95%CI:264-495),and postoperative hospital stay of 12.3 days(95%CI:11.5-13.1).Nutritional outcomes revealed 11.4%(95%CI:10.6-12.2)body weight loss at one year.Comparative analyses showed equivalent safety profiles between the Kamikawa anastomosis and double-tract reconstruction but longer operative times(P<0.001)compared with total gastrectomy.CONCLUSION These findings underscore the clinical viability of the Kamikawa anastomosis following PG,demonstrating favorable anti-reflux efficacy,acceptable incidence of anastomotic strictures,and preservation of nutritional status.展开更多
In this study,we explore some of the best proximity point results for generalized proximal contractions in the setting of double-controlled metric-type spaces.A non-trivial example is given to elucidate our analysis,a...In this study,we explore some of the best proximity point results for generalized proximal contractions in the setting of double-controlled metric-type spaces.A non-trivial example is given to elucidate our analysis,and some novel results are derived.The discovered results generalize previously known results in the context of a double controlled metric type space environment.This article’s proximity point results are the first of their kind in the realm of controlled metric spaces.To build on the results achieved in this article,we present an application demonstrating the usability of the given results.展开更多
This paper employs the PPO(Proximal Policy Optimization) algorithm to study the risk hedging problem of the Shanghai Stock Exchange(SSE) 50ETF options. First, the action and state spaces were designed based on the cha...This paper employs the PPO(Proximal Policy Optimization) algorithm to study the risk hedging problem of the Shanghai Stock Exchange(SSE) 50ETF options. First, the action and state spaces were designed based on the characteristics of the hedging task, and a reward function was developed according to the cost function of the options. Second, combining the concept of curriculum learning, the agent was guided to adopt a simulated-to-real learning approach for dynamic hedging tasks, reducing the learning difficulty and addressing the issue of insufficient option data. A dynamic hedging strategy for 50ETF options was constructed. Finally, numerical experiments demonstrate the superiority of the designed algorithm over traditional hedging strategies in terms of hedging effectiveness.展开更多
BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid tre...BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid treatment options to reduce morbidity and mortality.AIM To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.METHODS A comprehensive search was conducted to identify relevant studies discussing the outcomes of using both CBH and PFNA in treatment of unstable intertrochanteric fractures.Studies published up to January 1,2025 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included three studies,all of which were retrospective,involving a total of 240 patients.The follow-up period for participants was at least 12 months.CBHA was associated with significantly higher blood loss compared to PFNA[mean differences(MD):129.14,95%CI(52.51,205.77),P=0.001],though heterogeneity was high(I²=97%).Operative time showed no significant difference initially[MD:6.10,95%CI(-13.34,25.54),P=0.54],but after excluding one study,BHA had longer operative times[MD:21.51,95%CI(18.60,24.41),P<0.00001].Hospital stay and Harris scores showed no significant differences between groups.CBHA facilitated faster progression to weight-bearing[MD:-11.92,95%CI(-22.46,-1.39),P=0.03]and a lower incidence of prosthetic loosening[risk ratio:0.21,95%CI(0.05,0.92),P=0.04].Refracture and thrombus formation rates were comparable between the two groups.CONCLUSION CBHA offers shorter weight-bearing duration and reduced prosthetic loosening but incurs greater blood loss and longer operative times compared to PFNA.Both techniques show comparable functional recovery,hospital stay,refracture,and thrombus risks.Clinical choice should prioritize early mobilization or surgical minimalism,guided by patient needs.Further prospective studies are warranted.展开更多
BACKGROUND Endoscopic healing(EH)is a key therapeutic target in Crohn’s disease(CD).Proximal small bowel(SB)lesions in patients with CD are associated with a significant risk of strictures and bowel resection.Assessi...BACKGROUND Endoscopic healing(EH)is a key therapeutic target in Crohn’s disease(CD).Proximal small bowel(SB)lesions in patients with CD are associated with a significant risk of strictures and bowel resection.Assessing SB in patients with CD is necessary because of its significant therapeutic implications.The advent of biologic therapies,including infliximab,ustekinumab,and vedolizumab,has significantly altered CD treatment.However,data on the efficacy of biologics in achieving EH,specifically in the proximal SB of patients with CD,remain limited.AIM To assess the effectiveness of biologics for EH in patients with jejunal and/or proximal ileal CD.METHODS Between 2017 and 2023,we retrospectively included 110 consecutive patients with isolated proximal SB CD,identified through baseline balloon-assisted enteroscopy.These patients completed 1-year of treatment with infliximab,ustekinumab,or vedolizumab,and underwent a second balloon-assisted enteroscopy at 1 year.Complete EH was defined as a modified Simple Endoscopic Score for CD(SES-CD)of<3,while EH of the jejunum and proximal ileum was defined as a segmental modified SES-CD of 0.RESULTS In total,64 patients were treated with infliximab,28 with ustekinumab,and 18 with vedolizumab.The complete EH rate at 1 year was 20.9%(23/110),with 29.6%(19/64)for infliximab,10.7%(3/28)for ustekinumab,and 5.5%(1/18)for vedolizumab.The median modified SES-CD significantly decreased compared to baseline[5(2-8)vs 8(6-9),P<0.001].The jejunal and proximal ileal EH rates at 1 year were 30.8%(12/39)and 15.5%(16/103),respectively.Multiple logistic regression analysis showed that stricturing or penetrating disease[odds ratio(OR)=0.261,95%CI:0.087-0.778,P=0.016],prior exposure to biologics(OR=0.080,95%CI:0.010-0.674,P=0.020),and moderate-tosevere endoscopic disease(OR=0.277,95%CI:0.093-0.829,P=0.022)were associated with a lower likelihood of achieving EH at 1 year.CONCLUSION Only 20.9%of patients with isolated proximal SB CD achieved complete EH after 1 year of biologic therapy.展开更多
In this paper,we develop an inexact symmetric proximal alternating direction method of multipliers(ISPADMM)with two convex combinations(ISPADMM-tcc)for solving two-block separable convex optimization problems with lin...In this paper,we develop an inexact symmetric proximal alternating direction method of multipliers(ISPADMM)with two convex combinations(ISPADMM-tcc)for solving two-block separable convex optimization problems with linear equality constraints.Specifically,the convex combination technique is incorporated into the proximal centers of both subproblems.We then approximately solve these two subproblems based on relative error criteria.The global convergence,and O(1/N)ergodic sublinear convergence rate measured by the function value residual and constraint violation are established under some mild conditions,where N denotes the number of iterations.Finally,numerical experiments on solving the l1-regularized analysis sparse recovery and the elastic net regularization regression problems illustrate the feasibility and effectiveness of the proposed method.展开更多
BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the man...BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the management of proximal humeral shaft fractures.AIM To evaluate parallax-free panoramic X-ray images during surgery.METHODS A retrospective series of 17 proximal humeral shaft fractures were treated using combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with MIPO.The operating time and radiation exposure time were recorded,and early postoperative physical therapy and partial weight bearing were encouraged.Patients were followed at regular intervals and evaluated radiographically and clinically.RESULTS The mean operating time and radiation time were 73(range,49-95)minutes and 57(range:36-98)seconds,respectively.No complications occurred during the operation.All fractures healed at an average of 16.9(range:15-23)weeks.The average Constant-Murley score for all the patients was 89.5(range:75-100)points.None of the patients showed symptoms of vascular or nerve damage or wound infection.Three months after the operation,none of the patients developed subacromial impingement syndrome.No loosening or fracture of the implants occurred.The frontal and lateral radiographs showed good alignment.CONCLUSION We consider that MIPO with combined parallax-free panoramic X-ray imaging during surgery is an efficient method for treating proximal humeral shaft fractures,and could significantly reduce operative morbidity as well as lower the rate of intra-and postoperative complications.展开更多
The exponential growth in the scale of power systems has led to a significant increase in the complexity of dispatch problem resolution,particularly within multi-area interconnected power grids.This complexity necessi...The exponential growth in the scale of power systems has led to a significant increase in the complexity of dispatch problem resolution,particularly within multi-area interconnected power grids.This complexity necessitates the employment of distributed solution methodologies,which are not only essential but also highly desirable.In the realm of computational modelling,the multi-area economic dispatch problem(MAED)can be formulated as a linearly constrained separable convex optimization problem.The proximal point algorithm(PPA)is particularly adept at addressing such mathematical constructs effectively.This study introduces parallel(PPPA)and serial(SPPA)variants of the PPA as distributed algorithms,specifically designed for the computational modelling of the MAED.The PPA introduces a quadratic term into the objective function,which,while potentially complicating the iterative updates of the algorithm,serves to dampen oscillations near the optimal solution,thereby enhancing the convergence characteristics.Furthermore,the convergence efficiency of the PPA is significantly influenced by the parameter c.To address this parameter sensitivity,this research draws on trend theory from stock market analysis to propose trend theory-driven distributed PPPA and SPPA,thereby enhancing the robustness of the computational models.The computational models proposed in this study are anticipated to exhibit superior performance in terms of convergence behaviour,stability,and robustness with respect to parameter selection,potentially outperforming existing methods such as the alternating direction method of multipliers(ADMM)and Auxiliary Problem Principle(APP)in the computational simulation of power system dispatch problems.The simulation results demonstrate that the trend theory-based PPPA,SPPA,ADMM and APP exhibit significant robustness to the initial value of parameter c,and show superior convergence characteristics compared to the residual balancing ADMM.展开更多
BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment ...BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment efficacy of dynamic condylar screws(DCS)and proximal femoral nails(PFN)for unstable intertrochanteric fractures.METHODS To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures,a thorough search was carried out.For research studies published between January 1996 and April 2024,PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar were all searched.The complete texts of the papers were retrieved,vetted,and independently examined by two investigators.Disputes were settled by consensus,and any disagreements that persisted were arbitrated by a third author.RESULTS This study included six articles,comprising a total of 173 patients.Compared to the DCS,the PFN had a shorter operation time[mean difference(MD):-41.7 min,95%confidence interval(95%CI):-63.04 to-20.35,P=0.0001],higher success rates with closed reduction techniques[risk ratio(RR):34.05,95%CI:11.12-104.31,P<0.00001],and required less intraoperative blood transfusion(MD:-1.4 units,95%CI:-1.80 to-1.00,P<0.00001).Additionally,the PFN showed shorter fracture union time(MD:-6.92 wk,95%CI:-10.27 to-3.57,P<0.0001)and a lower incidence of reoperation(RR:0.37,95%CI:0.17-0.82,P=0.01).However,there was no discernible variation regarding hospital stay,implant-related complications,and infections.CONCLUSION Compared to DCS,PFN offers shorter operative times,reduces the blood transfusions requirements,achieves higher closed reduction success,enables faster fracture healing,and lowers reoperation incidence.展开更多
BACKGROUND With the increasing incidence of proximal gastric cancer,laparoscopic proximal gastrectomy has been applied.However,reflux esophagitis often occurs after traditional esophagogastric anastomosis.In order to ...BACKGROUND With the increasing incidence of proximal gastric cancer,laparoscopic proximal gastrectomy has been applied.However,reflux esophagitis often occurs after traditional esophagogastric anastomosis.In order to solve this problem,several methods of digestive tract reconstruction have emerged,but the most satisfying method remains to be discussed.Therefore,we modified traditional Kamikawa anastomosis to investigate the appropriate digestive tract reconstruction in laparo-scopic proximal gastrectomy.All the patients were successfully operated on without conversion to laparotomy.The duration of operation and digestive tract reconstruction were 203.500(150-224)min and 87.500(73-111)min,respectively.The intraoperative amount of bleeding was 20.500 mL±0.696 mL.The time of postoperative first flatus,the first postoperative fluid intake,and the postoperative length of stay were 2(1-3)d,4(3-5)d,and 9(8-10)d,respectively.All the patients were followed up for 12-23 months.The body mass index at 6 and 12 months after surgery were 22.577 kg/m2±3.098 kg/m2 and 22.594 kg/m2±3.207 kg/m2,respectively.The nutrition risk screening 2002 score,the patient-generated subjective global assessment score,and the gastroesophageal reflux disease scale score were good at 6 and 12 months after surgery.Reflux esophagitis and anastomotic stenosis were not observed in any of the patients during their 12-month postoperative gastroscopy or upper gastrointestinal tract visits.All the patients exhibited no tumor recurrence or metastasis.CONCLUSION The modified Kamikawa anastomosis is safe and feasible for laparoscopic proximal gastrectomy and has good antireflux effects and nutritional status.展开更多
BACKGROUND In laparoscopic proximal gastrectomy(LPG),the prolapse of the hepatic left lateral lobe near the lesser curvature and esophageal hiatus can obstruct the field of vision and operation.Therefore,it is necessa...BACKGROUND In laparoscopic proximal gastrectomy(LPG),the prolapse of the hepatic left lateral lobe near the lesser curvature and esophageal hiatus can obstruct the field of vision and operation.Therefore,it is necessary to retract or obstruct the hepatic left lateral lobe to ensure a clear field of vision.AIM To investigate the safety and clinical efficacy of the modified hepatic left lateral lobe inversion technique for LPG.METHODS A retrospective analysis was conducted on the clinical data of 13 consecutive patients with early-stage upper gastric adenocarcinoma or adenocarcinoma of the esophagogastric junction treated with LPG from January to December 2023 at the Department of Gastrointestinal Surgery,Second Affiliated Hospital of Fujian Medical University.The modified hepatic left lateral lobe inversion technique was used to expose the surgical field in all patients,and short-term outcomes were observed.RESULTS In all 13 patients,the modified hepatic left lateral lobe inversion technique was successful during surgery without the need for re-retraction or alteration of the liver traction method.There were no instances of esophageal hiatus occlusion,eliminating the need for forceps to assist in exposure.There was no occurrence of intraoperative hepatic hemorrhage,hepatic vein injury,or hepatic congestion.No postoperative digestive complications of Clavien-Dindo grade≥II occurred wi-thin 30 days after surgery,except for a single case of pulmonary infection.Some patients experienced increases in alanine aminotransferase and aspartate aminotransferase levels on the first day after surgery,which significantly decreased by the third day and returned to normal by the seventh day after surgery.CONCLUSION The modified hepatic left lateral lobe inversion technique has demonstrated satisfactory results,offering ad-vantages in terms of facilitating surgical procedures,reducing surgical trauma,and protecting the liver.展开更多
With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fi...With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.展开更多
Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data o...Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.展开更多
基金Supported by Special Fund for the Beijing Hope Marathon of the China Cancer Foundation,No.LC2019 L05and the Capital Health Development Research Special Fund Project,No.2024-2-4026.
文摘BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gastrectomy(PG)or total gastrectomy(TG)should be used for advanced proximal GC,and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIM To compare the short-term efficacy,long-term survival,and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y re-construction in patients with proximal GC following neoadjuvant chemotherapy(NACT)in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODS A multicenter retrospective cohort study was conducted at two Chinese medical centers between December,2012 and December,2022.Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included.Propensity score matching(PSM)was performed to balance baseline characteristics,and the primary endpoint was 5-year overall survival(OS).Se-condary endpoints included recurrence-free survival(RFS),postoperative complications,and reflux severity.RESULTS After PSM,244 patients(122 PG,122 TG)were finally included and all baseline characteristics were comparable between groups.The PG group had a significantly shorter operation time compared to the TG group(189.50 vs 215.00 minutes,P<0.001),with no differences in intraoperative blood loss or postoperative complications(19.68%vs 14.75%,P=0.792).The 5-year OS rates were 52.7%vs 45.5%(P=0.330),and 5-year RFS rates were 54.3%vs 47.6%(P=0.356)for the PG and TG groups,respectively.Reflux symptoms(18.0%vs 31.1%,P=0.017)and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores≥8(7.4%vs 21.3%,P<0.001)were significantly less frequent in the PG group.Multivariate analysis identified histological differentiation(HR=2.98,95%CI:2.03-4.36,P<0.001)and tumor size(HR=0.26,95%CI:0.17-0.41 for tumors≤4 cm,P<0.001)as independent prognostic factors.CONCLUSION PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT.Additionally,PG has the advantages of shorter operation time and lower rates of postoperative reflux,suggesting potential benefits for patient quality of life.Notably,the analysis of postoperative prognostic factors,including histological differentiation and tumor size,further informs clinical decision-making and highlights the importance of individualized treatment strategies.
基金Supported by the“521 Project”Funding Project Day of Lianyungang。
文摘BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anastomosis are two relatively mature anti-reflux procedures.A comparison of these two surgical procedures,tubular gastroesophageal anastomosis and double-channel anastomosis,has rarely been reported.Therefore,this study aimed to investigate the effects of these two reconstruction methods on the quality of life of patients with proximal gastric cancer after proximal gastrectomy.AIM To compare short-term clinical results of laparoscopic proximal gastrectomy with double-channel anastomosis vs tubular gastric anastomosis.METHODS Patients who underwent proximal gastrectomy at our hospital between January 2020 and January 2023 were enrolled in this retrospective cohort study.The patients were divided into an experimental group(double-channel anastomosis,33 cases)and a control group(tubular gastric anastomosis,30 cases).Baseline characteristics,surgical data,postoperative morbidities,and postoperative nutrition were recorded.RESULTS The differences in baseline data,surgical data,and postoperative complications(20.0%vs 21.2%)were not statistically significant between the two groups.There were no statistically significant differences in the levels of postoperative nutrition indicators between the two groups of patients during the preoperative period and at 3 months postoperatively.In addition,the levels of postoperative nutrition indicators in patients in the experimental group declined significantly less at 6 months and 12 months postoperatively compared with those of the control group(P<0.05).At 12 months postoperatively,the difference in anastomotic reflux esophagitis between the two groups was statistically significant(P<0.05)with the experimental group showing less reflux esophagitis.CONCLUSION Both double-channel anastomosis and tubular gastric anastomosis after proximal gastrectomy are safe and feasible.Double-channel anastomosis has a better anti-reflux effect and is more beneficial in improving the postoperative nutritional status.
基金Supported by National Natural Science Foundation of China,No.82360168 and No.81960154Natural Science Foundation of Jiangxi Province,No.20212BAB206020the Foundation of Health Commission of Jiangxi Province,No.SKJP220225830.
文摘BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.
文摘BACKGROUND Although surgery remains the primary treatment for proximal gastric cancer(PGC),ongoing refinements in surgical strategies are essential to improving clinical outcomes.AIM To investigate the effect of double-tract reconstruction(DTR)on immune function and stress response in patients undergoing laparoscopic proximal gastrectomy(LPG).METHODS In total,78 patients with PGC admitted between August 2020 and August 2024 were enrolled.The research group consisted of 39 patients who underwent DTR+LPG,whereas the control group comprised 39 patients who underwent laparoscopic total gastrectomy with Roux-en-Y esophagojejunostomy.Perioperative indices(intraoperative blood loss,digestive tract anastomosis time,and time to first postoperative flatus),postoperative complications(intestinal obstruction,anastomotic ulcer,diarrhea,dumping syndrome,and gastroesophageal reflux),nutritional parameters(serum albumin,hemoglobin,and body mass index),immune function immunoglobulin(IgG,IgA,and IgM),and stress response indicators(C-reactive protein,interleukin-6,and tumor necrosis factor-α)were collected and analyzed for both groups.RESULTS The intraoperative blood loss was lower(P<0.05),and the time to first postoperative flatus time was shorter(P<0.001)in the research group than in the control group.The two groups had comparable digestive tract anastomosis time(P>0.05).The overall complication rate was significantly lower in the research group than in the control group(P=0.042).Compared with the control group,the research group exhibited notably higher albumin,hemoglobin,and body mass index levels at 2 and 3 months postoperatively,as well as considerably high immunoglobulin(Ig)G,IgA,and IgM levels on postoperative day 1(P<0.05).The postoperative levels of C-reactive protein,interleukin-6,and tumor necrosis factor-αwere also lower in the research group than in the control group(P<0.001).CONCLUSION The combination of DTR and LPG in the treatment of patients with PGC is more effective in enhancing immune function and suppressing stress responses,showing more advantages over laparoscopic total gastrectomy.
文摘BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in patients undergoing this procedure.AIM To identify the most effective method for reducing reflux symptoms while preserving gastrointestinal integrity and nutritional status.METHODS A retrospective evaluation was conducted on 60 patients who underwent proximal gastrectomy between December 2020 and December 2023,divided equally into two groups based on the anastomosis technique used(forearm or posterior wall).GER symptoms were assessed using the GER disease ques-tionnaire(GerdQ)preoperatively and on the first postoperative day.Biochemical markers[diamine oxidase(DAO),D-lactic acid,and endotoxin(ETX)]and nutritional indicators[serum ferritin(SF),prealbumin(PA),and albumin(ALB)]were measured to evaluate gastrointestinal barrier function and nutritional status.RESULTS Both groups showed significant improvements in GerdQ scores and reflux symptom scores post-treatment,with the observation group exhibiting greater reductions.Biochemical markers indicated enhanced gastrointestinal barrier function post-treatment in both groups,with notable increases in DAO,D-lactic,and ETX levels.Nutritional status indicators also demonstrated significant changes,with reductions in SF,PA,and ALB levels,suggesting an impact of treatment on inflammatory and nutritional status.CONCLUSION The forearm anastomosis technique appears to be more effective in reducing GER symptoms and preserving gastrointestinal health in patients undergoing proximal gastrectomy for gastric cancer compared to the posterior wall anastomosis technique.These preliminary findings advocate for further research to confirm the benefits and potentially standardize Forearm Anastomosis in surgical practice for gastric cancer.
文摘BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.
基金supported by the Postdoctoral Scientific Research Development Fund of Heilongjiang Province,2020(Grant No.LBH-Q20157).
文摘Background:This study aimed to evaluate the prognostic value of the lymphocyte-to-monocyte ratio(LMR)and cancer antigen 724(CA724)in patients with proximal gastric cancer residing in cold climate regions.Methods:A retrospective analysis was conducted on 313 patients diagnosed with proximal gastric cancer in cold climate regions between 2014 and 2017.Preoperative hematological markers,including LMR and CA724,were assessed.Receiver operating characteristic(ROC)curves were used to determine optimal cutoff values,which were then combined to form the LMR+CA724 score.Statistical analyses included Kaplan-Meier survival curves,log-rank tests,and Cox proportional hazards regression.Results:A high preoperative LMR+CA724 score was significantly associated with older age,advanced pTNM stage,vascular invasion,and elevated levels of NMPVR,NMR,and AAR.The LMR+CA724 score demonstrated a higher area under the curve(AUC)compared to LMR or CA724 alone.Multivariate analysis identified pTNM stage,Borrmann type,histological type,and the LMR+CA724 score as independent prognostic factors for overall survival(OS).A nomogram incorporating these four variables achieved an AUC of 0.817,indicating strong predictive performance.Conclusion:The LMR+CA724 score is a reliable and independent prognostic indicator for patients with proximal gastric cancer in cold climate regions.Its integration into clinical practice may support treatment planning and long-term management by enhancing personalized care.Further prospective studies are warranted to validate these findings in broader and more diverse patient populations.
文摘BACKGROUND Proximal gastrectomy(PG)for gastric cancer requires a delicate balance between oncological radicality and postoperative quality of life to mitigate reflux complications.Although the Kamikawa anastomosis has gained attention for its theoretical anti-reflux advantages,robust clinical evidence remains limited.AIM To comprehensively evaluate the efficacy,safety,and nutritional outcomes of the Kamikawa anastomosis in PG,thereby addressing a critical gap in surgical decision-making.METHODS Following PRISMA guidelines,we systematically searched PubMed,Embase,and the Cochrane Library for studies on Kamikawa anastomosis after PG.Data were pooled using fixed-or random-effects models based on heterogeneity levels(I2 statistics).The risk of bias was evaluated using Risk of Bias in Non-randomized Studies of Interventions.The protocol was prospectively registered in PROSPERO.RESULTS Of 106 screened studies,20 involving 2291 patients were included.Most studies(85%)originated from Japan,with a mean patient age of 54-73 years and a male predominance(68.1%).Overall pooled incidence of 30-day postoperative complications was 9.9%[95%confidence interval(95%CI):6.8-12.9],with major complications(Clavien-Dindo grade≥III)occurring in 6.1%(95%CI:4.6-7.7).Anastomosis-related complications were observed in 7.2%of cases,comprising leakage 1.8%(95%CI:1.1-2.4),stenosis in 7.2%(95%CI:5.8-8.5),and bleeding in 0.7%(95%CI:0.1-1.2).Pooled incidence of reflux esophagitis was 4%(95%CI:2.7-5.3)for all LA grades at 12-month follow-up,with 28.3%(95%CI:14.7-41.9)of patients requiring regular proton pump inhibitor use.Operative outcomes demonstrated a pooled mean operative time of 349.5 minutes(95%CI:331-380),estimated blood loss of 351.5 mL(95%CI:264-495),and postoperative hospital stay of 12.3 days(95%CI:11.5-13.1).Nutritional outcomes revealed 11.4%(95%CI:10.6-12.2)body weight loss at one year.Comparative analyses showed equivalent safety profiles between the Kamikawa anastomosis and double-tract reconstruction but longer operative times(P<0.001)compared with total gastrectomy.CONCLUSION These findings underscore the clinical viability of the Kamikawa anastomosis following PG,demonstrating favorable anti-reflux efficacy,acceptable incidence of anastomotic strictures,and preservation of nutritional status.
文摘In this study,we explore some of the best proximity point results for generalized proximal contractions in the setting of double-controlled metric-type spaces.A non-trivial example is given to elucidate our analysis,and some novel results are derived.The discovered results generalize previously known results in the context of a double controlled metric type space environment.This article’s proximity point results are the first of their kind in the realm of controlled metric spaces.To build on the results achieved in this article,we present an application demonstrating the usability of the given results.
基金supported by the Foundation of Key Laboratory of System Control and Information Processing,Ministry of Education,China,Scip20240111Aeronautical Science Foundation of China,Grant 2024Z071108001the Foundation of Key Laboratory of Traffic Information and Safety of Anhui Higher Education Institutes,Anhui Sanlian University,KLAHEI18018.
文摘This paper employs the PPO(Proximal Policy Optimization) algorithm to study the risk hedging problem of the Shanghai Stock Exchange(SSE) 50ETF options. First, the action and state spaces were designed based on the characteristics of the hedging task, and a reward function was developed according to the cost function of the options. Second, combining the concept of curriculum learning, the agent was guided to adopt a simulated-to-real learning approach for dynamic hedging tasks, reducing the learning difficulty and addressing the issue of insufficient option data. A dynamic hedging strategy for 50ETF options was constructed. Finally, numerical experiments demonstrate the superiority of the designed algorithm over traditional hedging strategies in terms of hedging effectiveness.
文摘BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid treatment options to reduce morbidity and mortality.AIM To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.METHODS A comprehensive search was conducted to identify relevant studies discussing the outcomes of using both CBH and PFNA in treatment of unstable intertrochanteric fractures.Studies published up to January 1,2025 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included three studies,all of which were retrospective,involving a total of 240 patients.The follow-up period for participants was at least 12 months.CBHA was associated with significantly higher blood loss compared to PFNA[mean differences(MD):129.14,95%CI(52.51,205.77),P=0.001],though heterogeneity was high(I²=97%).Operative time showed no significant difference initially[MD:6.10,95%CI(-13.34,25.54),P=0.54],but after excluding one study,BHA had longer operative times[MD:21.51,95%CI(18.60,24.41),P<0.00001].Hospital stay and Harris scores showed no significant differences between groups.CBHA facilitated faster progression to weight-bearing[MD:-11.92,95%CI(-22.46,-1.39),P=0.03]and a lower incidence of prosthetic loosening[risk ratio:0.21,95%CI(0.05,0.92),P=0.04].Refracture and thrombus formation rates were comparable between the two groups.CONCLUSION CBHA offers shorter weight-bearing duration and reduced prosthetic loosening but incurs greater blood loss and longer operative times compared to PFNA.Both techniques show comparable functional recovery,hospital stay,refracture,and thrombus risks.Clinical choice should prioritize early mobilization or surgical minimalism,guided by patient needs.Further prospective studies are warranted.
基金Supported by the Program of Guangdong Provincial Clinical Research Center for Digestive Diseases,No.2020B1111170004.
文摘BACKGROUND Endoscopic healing(EH)is a key therapeutic target in Crohn’s disease(CD).Proximal small bowel(SB)lesions in patients with CD are associated with a significant risk of strictures and bowel resection.Assessing SB in patients with CD is necessary because of its significant therapeutic implications.The advent of biologic therapies,including infliximab,ustekinumab,and vedolizumab,has significantly altered CD treatment.However,data on the efficacy of biologics in achieving EH,specifically in the proximal SB of patients with CD,remain limited.AIM To assess the effectiveness of biologics for EH in patients with jejunal and/or proximal ileal CD.METHODS Between 2017 and 2023,we retrospectively included 110 consecutive patients with isolated proximal SB CD,identified through baseline balloon-assisted enteroscopy.These patients completed 1-year of treatment with infliximab,ustekinumab,or vedolizumab,and underwent a second balloon-assisted enteroscopy at 1 year.Complete EH was defined as a modified Simple Endoscopic Score for CD(SES-CD)of<3,while EH of the jejunum and proximal ileum was defined as a segmental modified SES-CD of 0.RESULTS In total,64 patients were treated with infliximab,28 with ustekinumab,and 18 with vedolizumab.The complete EH rate at 1 year was 20.9%(23/110),with 29.6%(19/64)for infliximab,10.7%(3/28)for ustekinumab,and 5.5%(1/18)for vedolizumab.The median modified SES-CD significantly decreased compared to baseline[5(2-8)vs 8(6-9),P<0.001].The jejunal and proximal ileal EH rates at 1 year were 30.8%(12/39)and 15.5%(16/103),respectively.Multiple logistic regression analysis showed that stricturing or penetrating disease[odds ratio(OR)=0.261,95%CI:0.087-0.778,P=0.016],prior exposure to biologics(OR=0.080,95%CI:0.010-0.674,P=0.020),and moderate-tosevere endoscopic disease(OR=0.277,95%CI:0.093-0.829,P=0.022)were associated with a lower likelihood of achieving EH at 1 year.CONCLUSION Only 20.9%of patients with isolated proximal SB CD achieved complete EH after 1 year of biologic therapy.
基金supported by the National Natural Science Foundation of China(12171106)the Guangxi Science and Technology Program(AD23023001)+4 种基金the Natural Science Foundation of Guangxi Province(2023GXNSFBA026029)the National Natural Science Foundation of China(12401403,12361063)the Research Project of Guangxi Minzu University(2022KJQD03)the Middle-aged and Young Teachers’Basic Ability Promotion Project of Guangxi Province(2023KY0168)the Xiangsihu Young Scholars Innovative Research Team of Guangxi Minzu University(2022GXUNXSHQN04).
文摘In this paper,we develop an inexact symmetric proximal alternating direction method of multipliers(ISPADMM)with two convex combinations(ISPADMM-tcc)for solving two-block separable convex optimization problems with linear equality constraints.Specifically,the convex combination technique is incorporated into the proximal centers of both subproblems.We then approximately solve these two subproblems based on relative error criteria.The global convergence,and O(1/N)ergodic sublinear convergence rate measured by the function value residual and constraint violation are established under some mild conditions,where N denotes the number of iterations.Finally,numerical experiments on solving the l1-regularized analysis sparse recovery and the elastic net regularization regression problems illustrate the feasibility and effectiveness of the proposed method.
基金Supported by Wuhu Municipal Science and Technology Bureau of Anhui Province,No.2022cg43.
文摘BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the management of proximal humeral shaft fractures.AIM To evaluate parallax-free panoramic X-ray images during surgery.METHODS A retrospective series of 17 proximal humeral shaft fractures were treated using combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with MIPO.The operating time and radiation exposure time were recorded,and early postoperative physical therapy and partial weight bearing were encouraged.Patients were followed at regular intervals and evaluated radiographically and clinically.RESULTS The mean operating time and radiation time were 73(range,49-95)minutes and 57(range:36-98)seconds,respectively.No complications occurred during the operation.All fractures healed at an average of 16.9(range:15-23)weeks.The average Constant-Murley score for all the patients was 89.5(range:75-100)points.None of the patients showed symptoms of vascular or nerve damage or wound infection.Three months after the operation,none of the patients developed subacromial impingement syndrome.No loosening or fracture of the implants occurred.The frontal and lateral radiographs showed good alignment.CONCLUSION We consider that MIPO with combined parallax-free panoramic X-ray imaging during surgery is an efficient method for treating proximal humeral shaft fractures,and could significantly reduce operative morbidity as well as lower the rate of intra-and postoperative complications.
基金funded by Guangxi Science and Technology Base and Talent Special Project,grant number GuiKeAD20159077Foundation of Guilin University of Technology,grant number GLUTQD2018001.
文摘The exponential growth in the scale of power systems has led to a significant increase in the complexity of dispatch problem resolution,particularly within multi-area interconnected power grids.This complexity necessitates the employment of distributed solution methodologies,which are not only essential but also highly desirable.In the realm of computational modelling,the multi-area economic dispatch problem(MAED)can be formulated as a linearly constrained separable convex optimization problem.The proximal point algorithm(PPA)is particularly adept at addressing such mathematical constructs effectively.This study introduces parallel(PPPA)and serial(SPPA)variants of the PPA as distributed algorithms,specifically designed for the computational modelling of the MAED.The PPA introduces a quadratic term into the objective function,which,while potentially complicating the iterative updates of the algorithm,serves to dampen oscillations near the optimal solution,thereby enhancing the convergence characteristics.Furthermore,the convergence efficiency of the PPA is significantly influenced by the parameter c.To address this parameter sensitivity,this research draws on trend theory from stock market analysis to propose trend theory-driven distributed PPPA and SPPA,thereby enhancing the robustness of the computational models.The computational models proposed in this study are anticipated to exhibit superior performance in terms of convergence behaviour,stability,and robustness with respect to parameter selection,potentially outperforming existing methods such as the alternating direction method of multipliers(ADMM)and Auxiliary Problem Principle(APP)in the computational simulation of power system dispatch problems.The simulation results demonstrate that the trend theory-based PPPA,SPPA,ADMM and APP exhibit significant robustness to the initial value of parameter c,and show superior convergence characteristics compared to the residual balancing ADMM.
文摘BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment efficacy of dynamic condylar screws(DCS)and proximal femoral nails(PFN)for unstable intertrochanteric fractures.METHODS To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures,a thorough search was carried out.For research studies published between January 1996 and April 2024,PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar were all searched.The complete texts of the papers were retrieved,vetted,and independently examined by two investigators.Disputes were settled by consensus,and any disagreements that persisted were arbitrated by a third author.RESULTS This study included six articles,comprising a total of 173 patients.Compared to the DCS,the PFN had a shorter operation time[mean difference(MD):-41.7 min,95%confidence interval(95%CI):-63.04 to-20.35,P=0.0001],higher success rates with closed reduction techniques[risk ratio(RR):34.05,95%CI:11.12-104.31,P<0.00001],and required less intraoperative blood transfusion(MD:-1.4 units,95%CI:-1.80 to-1.00,P<0.00001).Additionally,the PFN showed shorter fracture union time(MD:-6.92 wk,95%CI:-10.27 to-3.57,P<0.0001)and a lower incidence of reoperation(RR:0.37,95%CI:0.17-0.82,P=0.01).However,there was no discernible variation regarding hospital stay,implant-related complications,and infections.CONCLUSION Compared to DCS,PFN offers shorter operative times,reduces the blood transfusions requirements,achieves higher closed reduction success,enables faster fracture healing,and lowers reoperation incidence.
基金Supported by the Fujian Medical University Sailing Fund General Project,No.2022QH1117Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘BACKGROUND With the increasing incidence of proximal gastric cancer,laparoscopic proximal gastrectomy has been applied.However,reflux esophagitis often occurs after traditional esophagogastric anastomosis.In order to solve this problem,several methods of digestive tract reconstruction have emerged,but the most satisfying method remains to be discussed.Therefore,we modified traditional Kamikawa anastomosis to investigate the appropriate digestive tract reconstruction in laparo-scopic proximal gastrectomy.All the patients were successfully operated on without conversion to laparotomy.The duration of operation and digestive tract reconstruction were 203.500(150-224)min and 87.500(73-111)min,respectively.The intraoperative amount of bleeding was 20.500 mL±0.696 mL.The time of postoperative first flatus,the first postoperative fluid intake,and the postoperative length of stay were 2(1-3)d,4(3-5)d,and 9(8-10)d,respectively.All the patients were followed up for 12-23 months.The body mass index at 6 and 12 months after surgery were 22.577 kg/m2±3.098 kg/m2 and 22.594 kg/m2±3.207 kg/m2,respectively.The nutrition risk screening 2002 score,the patient-generated subjective global assessment score,and the gastroesophageal reflux disease scale score were good at 6 and 12 months after surgery.Reflux esophagitis and anastomotic stenosis were not observed in any of the patients during their 12-month postoperative gastroscopy or upper gastrointestinal tract visits.All the patients exhibited no tumor recurrence or metastasis.CONCLUSION The modified Kamikawa anastomosis is safe and feasible for laparoscopic proximal gastrectomy and has good antireflux effects and nutritional status.
基金Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘BACKGROUND In laparoscopic proximal gastrectomy(LPG),the prolapse of the hepatic left lateral lobe near the lesser curvature and esophageal hiatus can obstruct the field of vision and operation.Therefore,it is necessary to retract or obstruct the hepatic left lateral lobe to ensure a clear field of vision.AIM To investigate the safety and clinical efficacy of the modified hepatic left lateral lobe inversion technique for LPG.METHODS A retrospective analysis was conducted on the clinical data of 13 consecutive patients with early-stage upper gastric adenocarcinoma or adenocarcinoma of the esophagogastric junction treated with LPG from January to December 2023 at the Department of Gastrointestinal Surgery,Second Affiliated Hospital of Fujian Medical University.The modified hepatic left lateral lobe inversion technique was used to expose the surgical field in all patients,and short-term outcomes were observed.RESULTS In all 13 patients,the modified hepatic left lateral lobe inversion technique was successful during surgery without the need for re-retraction or alteration of the liver traction method.There were no instances of esophageal hiatus occlusion,eliminating the need for forceps to assist in exposure.There was no occurrence of intraoperative hepatic hemorrhage,hepatic vein injury,or hepatic congestion.No postoperative digestive complications of Clavien-Dindo grade≥II occurred wi-thin 30 days after surgery,except for a single case of pulmonary infection.Some patients experienced increases in alanine aminotransferase and aspartate aminotransferase levels on the first day after surgery,which significantly decreased by the third day and returned to normal by the seventh day after surgery.CONCLUSION The modified hepatic left lateral lobe inversion technique has demonstrated satisfactory results,offering ad-vantages in terms of facilitating surgical procedures,reducing surgical trauma,and protecting the liver.
基金supported by the National Natural Science Foundation of China(32130052,82072447,and 82272578)the Fundamental Research Funds for the Central Universities,Nankai University(730-C02922112 and 730-DK2300010314).
文摘With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.
文摘Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.
