Background:Refined models of kidney disease are critical to better understand disease processes and study novel treatments while minimizing discomfort in research animals.The objective of this study was to report a te...Background:Refined models of kidney disease are critical to better understand disease processes and study novel treatments while minimizing discomfort in research animals.The objective of this study was to report a technique for minimally invasive partial kidney embolism in cats and describe outcomes following transcatheter administration of embolic microspheres with subsequent contralateral nephrectomy.Methods:Eleven,apparently healthy,male,purpose-bred cats underwent unilateral kidney embolism with 0.25 or 0.5 mL of embolic microparticle(40-120μm)suspension(0.2 mL microspheres/mL)delivered into the right renal artery under fluoroscopic guidance,followed 5 months later by contralateral nephrectomy.One month after nephrectomy,blood and urinary markers of kidney function were evaluated,and embolized kidneys were harvested for histopathology evaluation.Results:Renal artery embolization was possible in all cats.Two cats did not complete the study,one after experiencing congestive heart failure(n=1)and the other following evidence of complete kidney embolism precluding nephrectomy(n=1)postembolization.At study end,compared to baseline,cats had significant increases in median(range)serum creatinine(159.1μmol/L[141.4-530.4]versus 128.2μmol/L[92.8-150.3];p=0.0004),urea nitrogen(15.71 mmol/L[9.29-47.85]versus 7.50 mmol/L[6.07-8.57];p<0.0001),and symmetric dimethylarginine(0.74μmol/L[0.59-3.12]versus 0.67μmol/L[0.54-0.72];p=0.0288)concentrations.No differences in markers of kidney function were documented between dose groups.Conclusions:M inimally invasive kidney embolism is a promising technique for modeling kidney disease in cats.Understanding optimal dose,timing of nephrectomy,and longer-term consequences requires additional work.展开更多
Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these p...Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these patients.Of late,various recurrence patterns have been observed;the most common of them being distant metastasis followed by the pancreatic bed and lymph node recurrence.Recurrence in the remnant pancreas is on the rise due to improved survival in patients who previously underwent surgery for pancreatic cancer.Total remnant pancreatectomy is an appealing option in resectable remnant pancreatic carcinoma without distant metastasis.It is an entity showing an increasing incidence and demanding further in-depth studies to elucidate the exact pathological mechanism and to establish appropriate management protocols.展开更多
We use the Fe Kα emission in X-rays from non-equilibrium ionizing plasmas as a probe to explore the dust in supernova remnants(SNRs). We applied our model to Cassiopeia A(Cas A), a well-studied SNR with plenty of obs...We use the Fe Kα emission in X-rays from non-equilibrium ionizing plasmas as a probe to explore the dust in supernova remnants(SNRs). We applied our model to Cassiopeia A(Cas A), a well-studied SNR with plenty of observational data as a test. We use Chandra Advanced CCD Imaging Spectrometer 980 ks data of Cas A, and AtomDB v3.0.9, an atomic database for X-ray plasma spectral modeling, to fit 248 spectra. A two-temperature model is adopted to describe the physical conditions of shocked ejecta and iron-rich plasma. We measure the Fe Kα flux ratio and the centroid difference of the dust and gas contributions. We find strong 6.4 keV line emission components, which indicates that iron-rich dust can survive within Cas A's shocked ejecta. We also find that the Fe Kα complex demonstrates an apparent double-hump structure in some Fe–K rich regions, which may be caused by both dust and multi-ejecta structure in Cas A. The results of Fe Kα structures are consistent with our model for a dust cloud embedded in multi-phase ejecta and suggest the presence of both dust sputtering and drag effects in those regions. It is currently still limited by the low spatial and spectrum resolution for the current X-ray detectors, but should be more useful when the new generation, high-resolution X-ray telescopes come into service.展开更多
We identify a point-symmetric morphology of three pairs of ears/clumps in the core-collapse supernova remnant(CCSNR)Puppis A,supporting the jittering jets explosion mechanism(JJEM).In the JJEM,the three pairs of jets ...We identify a point-symmetric morphology of three pairs of ears/clumps in the core-collapse supernova remnant(CCSNR)Puppis A,supporting the jittering jets explosion mechanism(JJEM).In the JJEM,the three pairs of jets that shaped the three pairs of ears/clumps in Puppis A are part of a large set,about 10–30 pairs of jets,that exploded Puppis A.Some similarities in morphological features between CCSNR Puppis A and three multipolar planetary nebulae considered to have been shaped by jets solidify the claim for shaping by jets.Puppis A has a prominent dipole structure,where one side is bright with a well-defined boundary,while the other is faint and defused.The neutron star(NS)has a natal kick velocity in the opposite direction to the denser part of the dipole structure.We propose a new mechanism in the frame of the JJEM that imparts a natal kick to the NS,the kick-byearly asymmetrical pair(kick-BEAP)mechanism.At the early phase of the explosion process,the NS launches a pair of jets where one jet is much more energetic than the counter jet.The more energetic jet compresses a dense side to the CCSNR,and,by momentum conservation,the NS recoils in the opposite direction.Our study supports the JJEM as the primary explosion mechanism of core-collapse supernovae and enriches this explosion mechanism by introducing the novel kick-BEAP mechanism.展开更多
I examine the morphology of the core-collapse supernova(CCSN)remnant(SNR)G0.9+0.1 and reveal a pointsymmetrical morphology that implies shaping by three or more pairs of jets,as expected in the jittering jets explosio...I examine the morphology of the core-collapse supernova(CCSN)remnant(SNR)G0.9+0.1 and reveal a pointsymmetrical morphology that implies shaping by three or more pairs of jets,as expected in the jittering jets explosion mechanism(JJEM).The large northwest protrusion,the ear(or lobe),has two bright rims.I compare this ear with its rims to an ear with three rims of a jet-shaped planetary nebula and jets from an active galactic nucleus that shaped several rims on one side.Based on this similarity,I argue that two jets or more shaped the northwest ear of SNR G0.9+0.1 and its two rims.I identified the bright region south of the main shell of SNR G0.9+0.1 as a jet-shaped blowout formed by a jet that broke out from the main SNR shell.I base this on the similarity of the blowout of SNR G0.9+0.1 with that of SNR G309.2-00.6,argued in the past to be shaped by jets.I identify four symmetry axes along different directions that compose the point-symmetric morphology of SNR G0.9+0.1.I show that the morphological features of holes,granular texture,and random filaments exist in CCSNe and planetary nebulae and are unlikely to result from some unique processes in CCSNe.These structures result from similar instabilities in the JJEM and the neutrino-driven explosion mechanism and,unlike a point-symmetric morphology,cannot determine the explosion mechanism.Identifying SNR G0.9+0.1 as a new point-symmetric CCSN strengthens the JJEM as the primary explosion mechanism of CCSNe.展开更多
BACKGROUND Remnant gastric cancer(RGC)is a carcinoma arising in the stomach remnant after previous gastric resection.It is frequently reported as a tumor with a poor prognosis and distinct biological features from pri...BACKGROUND Remnant gastric cancer(RGC)is a carcinoma arising in the stomach remnant after previous gastric resection.It is frequently reported as a tumor with a poor prognosis and distinct biological features from primary gastric cancer(PGC).However,as it is less frequent,its profile regarding the current molecular classifications of gastric cancer has not been evaluated.AIM To evaluate a cohort of RGC according to molecular subtypes of GC using a panel of immunohistochemistry and in situ hybridization to determine whether the expression profile is different between PGC and RGC.METHODS Consecutive RGC patients who underwent gastrectomy between 2009 and 2019 were assessed using seven GC panels:Epstein-Barr virus in situ hybridization,immunohistochemistry for mismatch repair proteins(MutL homolog 1,MutS homolog 2,MutS homolog 6,and PMS1 homolog 2),p53 protein,and E-cadherin expression.Clinicopathological characteristics and survival of these patients were compared to 284 PGC patients.RESULTS A total of 40 RGC patients were enrolled in this study.Compared to PGC,older age(P<0.001),male(P<0.001),lower body mass index(P=0.010),and lower hemoglobin level(P<0.001)were associated with RGC patients.No difference was observed regarding Lauren’s type and pathologic Tumor Node Metastasis stage between the groups.Regarding the profiles evaluated,EBV-positive tumors were higher in RGC compared to PGC(P=0.039).The frequency of microsatellite instability,aberrant p53 immunostaining,and loss of E-cadherin expression were similar between RGC and PGC.Higher rates of simultaneous alterations in two or more profiles were observed in RGC compared to PGC(P<0.001).According to the molecular classification,the subtypes were defined as EBV in nine(22.5%)cases,microsatellite instability in nine(22.5%)cases,genomically stable in one(2.5%)case,and chromosomal instability in 21(52.5%)cases.There was no significant difference in survival between molecular subtypes in RGC patients.CONCLUSION RGC was associated with EBV positivity and higher rates of co-altered expression profiles compared to PGC.According to the molecular classification,there was no significant difference in survival between the subtypes of RGC.展开更多
BACKGROUND Three-dimensional(3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach(CRS), but its clinical efficacy remains controversial.AIM To compare the short-te...BACKGROUND Three-dimensional(3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach(CRS), but its clinical efficacy remains controversial.AIM To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy(3DLAG) with open gastrectomy(OG) for CRS.METHODS The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up,we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival(OS) rates were compared between the two groups.RESULTS Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score,initial disease state(benign or malignant), primary surgical anastomosis method,interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss(188.33 ± 191.35 mL vs 305.83 ± 303.66 mL;P =0.045) and smaller incision(10.86 ± 3.18 cm vs 20.06 ± 5.17 cm;P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG(14.0 ± 7.17 vs 10.73 ± 6.82;P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups(1.56 ± 2.84 vs 2.35 ± 5.28;P = 0.413). The complication rate(8.3% vs 20.8%;P = 0.207) and intensive care unit admission rate(5.6% vs 14.5%;P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval(CI): 72.4%-95.6%] and 73.3%(95%CI: 60.0%-89.5%)respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3%(95%CI: 76.4%-99.8%) and 75.6%(95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups(P = 0.68).CONCLUSION Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.展开更多
BACKGROUND Remnant gastric cancer(RGC)is defined as a tumor that develops in the stomach after a previous gastrectomy and is generally associated with a worse prognosis.However,there little information available regar...BACKGROUND Remnant gastric cancer(RGC)is defined as a tumor that develops in the stomach after a previous gastrectomy and is generally associated with a worse prognosis.However,there little information available regarding RGCs and their prognostic factors and survival.AIM To evaluate the clinicopathological characteristics and prognosis of RGC after previous gastrectomy for benign disease.METHODS Patients who underwent curative resection for primary gastric cancer(GC)at our institute between 2009 and 2019 were retrospectively evaluated.All RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in this study.Primary proximal GC(PGC)who underwent total gastrectomy was selected as the comparison group.Clinical and pathological data were collected from a prospective medical database.RESULTS A total of 41 patients with RGC and 120 PGC were included.Older age(P=0.001),lower body mass index(P=0.006),hemoglobin level(P<0.001),and number of resected lymph nodes resected(LN)(P<0.001)were associated with the RGC group.Lauren type,pathological tumor-node-metastasis,and perioperative morbimortality were similar between RGC and PGC.There was no difference in disease-free survival(P=0.592)and overall survival(P=0.930)between groups.LN status was the only independent factor related to survival.CONCLUSION RGC had similar clinicopathological characteristics to PGC.Despite the lower number of resected LN,RGC had a similar prognosis.展开更多
Remnant gastric cancer(RGC) and gastric stump cancer after distal gastrectomy(DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are present...Remnant gastric cancer(RGC) and gastric stump cancer after distal gastrectomy(DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori(H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.展开更多
The Nadingcuo high-K calc-alkaline rocks mainly composed of trachyte and trachyandesite are the largest outcrop area of volcanic rocks in southern Qiangtang terrane in the Tibetan plateau. However,their exact source a...The Nadingcuo high-K calc-alkaline rocks mainly composed of trachyte and trachyandesite are the largest outcrop area of volcanic rocks in southern Qiangtang terrane in the Tibetan plateau. However,their exact source and peterogenesis are still debated.^（40）Ar-^（39）Ar and LAM-ICPMS zircon U-Pb isotopic dating confirm that these rocks erupted in Eocene.In addition,the Nadingcuo volcanic rocks are characterized by high Sr/Y content ratios,similar with the adakite derived from partial melting of oceanic crust.They can be further classified as high Mg~#（Mg~#=48-57） and low Mg~# （Mg~#=33-42） subtypes.The Nadingcuo adakitic rocks have relatively low（^（87）Sr/^（86）Sr）_i and highε_（Nd）（t）, showing a trend of similarity to the Dongcuo ophiolite present in the Bangong-Nujiang oceanic crust. Simple modeling indicates that the Nadingcuo adakitic rocks are a mix resulting from the basalt of Bangong-Nujiang Ocean with 10%-20%crustal material of Lhasa terrane.On these bases we suggest that the low Mg~# Nadingcuo adakitic rocks are the product of partial melting of remnant oceanic crust with small sediment,and the high Mg~# rocks are the result of reaction between rising melt of remnant oceanic crust with subducted sediment and mantle wedge.Therefore,the origin of Nadingcuo adakitic rocks may be related to intracontinental subduction triggered by collision of India-Asia during Cenozoic.展开更多
Gastric stump carcinoma was initially reported by Balfore in 1922,and many reports of this disease have since been published. We herein review previous reports of gastric stump carcinoma with respect to epidemiology,c...Gastric stump carcinoma was initially reported by Balfore in 1922,and many reports of this disease have since been published. We herein review previous reports of gastric stump carcinoma with respect to epidemiology,carcinogenesis,Helicobacter pylori(H. pylori) infection,Epstein-Barr virus infection,clinicopathologic characteristics and endoscopic treatment. In particular,it is noteworthy that no prognostic differences are observed between gastric stump carcinoma and primary upper third gastric cancer. In addition,endoscopic submucosal dissection has recently been used to treat gastric stump carcinoma in the early stage. In contrast,many issues concerning gastric stump carcinoma remain to be clarified,including molecular biological characteristics and the carcinogenesis of H.pylori infection.We herein review the previous pertinent literature and summarize the characteristics of gastric stump carcinoma reported to date.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is the world’s sixth most common malignant tumor and the third cause of cancer death.Although great progress has been made in hepatectomy,it is still associated with a certain ...BACKGROUND Hepatocellular carcinoma(HCC)is the world’s sixth most common malignant tumor and the third cause of cancer death.Although great progress has been made in hepatectomy,it is still associated with a certain degree of risk of posthepatectomy liver failure(PHLF),which extends the length of hospital stay and remains the leading cause of postoperative death.Studies have shown that assessment of hepatic functional reserve before hepatectomy is beneficial for reducing the incidence of PHLF.AIM To assess the value of model for end-stage liver disease(MELD)score combined with standardized future liver remnant(sFLR)volume in predicting PHLF in patients undergoing hepatectomy for HCC.METHODS This study was attended by 238 patients with HCC who underwent hepatectomy between January 2015 and January 2018.Discrimination of sFLR volume,MELD score,and sFLR/MELD ratio to predict PHLF was evaluated according to the area under the receiver operating characteristic curve.RESULTS The patients were divided into two groups according to whether PHLF occurred after hepatectomy.The incidence of PHLF was 8.4%in our research.The incidence of PHLF increased with the decrease in sFLR volume and the increase in MELD score.Both sFLR volume and MELD score were considered independent predictive factors for PHLF.Moreover,the cut-off value of the sFLR/MELD score to predict PHLF was 0.078(P<0.001).This suggests that an sFLR/MELD≥0.078 indicates a higher incidence of PHLF than an sFLR/MELD<0.078.CONCLUSION MELD combined with sFLR is a reliable and effective PHLF predictor,which is superior to MELD score or sFLR volume alone.展开更多
AIM： TO re-evaluate the recent clinicopathological fea- tures of remnant gastric cancer （RGC） and to develop desirable surveillance programs.METHODS： Between 1997 and 2008, 1149 patients underwent gastrectomy for ...AIM： TO re-evaluate the recent clinicopathological fea- tures of remnant gastric cancer （RGC） and to develop desirable surveillance programs.METHODS： Between 1997 and 2008, 1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural Uni- versity of Medicine, Japan. Of these, 33 patients un- derwent gastrectomy with lymphadenectomy for RGC. Regarding the initial gastric disease, there were 19 patients with benign disease and 14 patients with gas- tric cancer. The hospital records of these patients were reviewed retrospectively. RESULTS： Concerning the initial gastric disease, the RGC group following gastric cancer had a shorter in- terval [P 〈 0.05; gastric cancer vs benign disease： 12 （2-22） vs 30 （4-51） years] and were more frequently reconstructed by Billroth- I procedure than those fol- lowing benign lesions （P 〈 0.001）. Regarding recon- struction, RGC following Billroth-]_l reconstruction showed a longer interval between surgical procedures [P 〈 0.001; Billroth-11 vs Billroth- I ： 32 （5-51） vs 12 （2-36） years] and tumors were more frequently associated with benign disease （P 〈 0.001） than those following Billroth- I reconstruction. In tumor location of RGC, after Billroth- I reconstruction, RGC occurred more fre- quently near the suture line and remnant gastric wall. After Billroth- 1I reconstruction, RGC occurred more fre- quently at the anastomotic site. The duration of follow- up was significantly associated with the stage of RGC （P 〈 0.05）. Patients diagnosed with early stage RGC such as stage Ⅰ-Ⅱ tended to have been followed up almost every second year. CONCLUSION： Meticulous follow-up examination and early detection of RGC might lead to a better prognosis. Based on the initial gastric disease and the procedure of reconstruction, an appropriate follow-up interval and programs might enable early detection of RGC.展开更多
BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical techniq...BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical technique for pancreaticoenteric anastomosis has been established.This study aimed to compare the postoperative morbidity and mortality of pancreaticogastrostomy and pancreaticojejunostomy for 'soft' pancreatic tissue remnants using modified mattress sutures.METHODS:Seventy-five patients who had undergone pancreaticogastrostomy and 75 who had undergone pancreaticojejunostomy after pancreaticoduodenectomy between 2002 and 2008 were retrospectively compared using matched-pair analysis.A modified mattress suture technique was used for the pancreaticoenteric anastomosis.Patients with an underlying 'hard' pancreatic tissue remnant,as in chronic pancreatitis,were excluded.Both groups were homogeneous for age,gender,and underlying disease.Postoperative morbidity,mortality,and preoperative and operative data were analyzed.RESULTS:There were no significant differences between the groups for the incidence of postoperative pancreatic fistula (10.7% in both).Postoperative morbidity and mortality,median operation time,median length of hospital stay,intraoperative blood loss,and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ between the groups.Patient age >65 years (P=0.017),operation time >350minutes (P=0.001),and intraoperative transfusion of erythrocyte concentrates (P=0.038) were identified as risk factors for postoperative morbidity.CONCLUSIONS:Our results showed no significant differences between the groups in the pancreaticogastrostomy and pancreaticojejunostomy anastomosis techniques using mattress sutures for 'soft' pancreatic tissue remnants.In our experience,the mattress sutures are safe and simple to use,and pancreaticogastrostomy in particular is feasible and easy to learn,with good endoscopic accessibility to the anastomosis region.However,the location of the anastomosis and the surgical technique need to be individually evaluated to further reduce the incidence of postoperative pancreatic fistula.展开更多
AIM: To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD) for the treatment of patients with gastric remnant cancer. METHODS: Thirty-two patients with ...AIM: To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD) for the treatment of patients with gastric remnant cancer. METHODS: Thirty-two patients with early gastric cancer in the remnant stomach, who underwent distal gastrectomy due to gastric carcinoma, were treated with endoscopic mucosal resection (EMR) or ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 10-year period from January 1998 to December 2007, including 17 patients treated with IT-ESD. Retrospectively, patient backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, and perforation rate were compared between patients treated with conventional EMR and those treated with IT-ESD. RESULTS: The CR rate (40% in the EMR group vs 82% in the IT-ESD group) was significantly higher in the IT-ESD group than in the EMR group; however, the operation time was significantly longer for the IT- ESD group (57.6 ± 31.9 min vs 21.1 ± 12.2 min). No significant differences were found in the rate of underlying cardiopulmonary disease (IT-ESD group, 12% vs EMR group, 13%), one-piece resection rate (100% vs 73%), bleeding rate (18% vs 6.7%), and perforation rate (0% vs 0%) between the two groups. CONCLUSION: IT-ESD appears to be an effective treatment for gastric remnant cancer post distal gastrectomy because of its high CR rate. It is useful for histological confirmation of successful treatment. Thelong-term outcome needs to be evaluated in the future.展开更多
The existence of remnant particles, which significantly reduce the reliability of relays, is a serious problem for aerospace relays. The traditional method for detecting remnant particles-particle impact noise detecti...The existence of remnant particles, which significantly reduce the reliability of relays, is a serious problem for aerospace relays. The traditional method for detecting remnant particles-particle impact noise detection （PIND）-can be used merely to detect the existence of the particle; it is not able to provide any information about the particles＇ material. However, information on the material of the particles is very helpful for analyzing the causes of remnants. By analyzing the output acoustic signals from a PIND tester, this paper proposes three feature extraction methods： unit energy average pulse durative time, shape parameter of signal power spectral density （PSD）, and pulse linear predictive coding coefficient sequence. These methods allow identified remnants to be classified into four categories based on their material. Furthermore, we prove the validity of this new method by processing P1ND signals from actual tests.展开更多
Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conserva...Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal gastrografin study on postoperative days 1 and 2 revealed collection of contrast in the fundic area of stomach with poor flow distally, and she vomited gastrograffin immediately post procedure. With the suspicion of a stricture in the mid stomach as the cause, the patient was taken back for a exploratory laparoscopy and intra-operative endoscopy. We found a twist in the gastric tube which was too tight for the endoscope to pass through. This was managed conservatively with a long stent to keep the gastric tube straight and patent. The stent was discontinued in 7 d and the patient did well. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports. If the staples fired are not aligned appropriately, it can predispose this stomach tube to undergo torsion along its long axis. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum and new stomach tube. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement.展开更多
With the depletion of easily minable coal seams,less favorable reserves under adverse conditions have to be mined out to meet the market demand.Due to some historical reasons,large amount of remnant coal was left unre...With the depletion of easily minable coal seams,less favorable reserves under adverse conditions have to be mined out to meet the market demand.Due to some historical reasons,large amount of remnant coal was left unrecovered.One such case history occurred with the remnant rectangular stripe coal pillars using partial extraction method at Guandi Mine,Shanxi Province,China.The challenge that the coal mine was facing was that there is an ultra-close coal seam right under it with an only 0.8–1.5 m sandstone dirt band in between.The simulation study was carried out to investigate the simultaneous recovery of upper remnant coal pillars while mining the ultra-close lower panel using longwall top coal caving(LTCC).The remnant coal pillar was induced to cave in as top coal in LTCC system.Physical modelling shows that the coal pillars are the abutments of the stress arch structure formed within the overburden strata.The stability of overhanging roof strata highly depends on the stability of the remnant coal pillars.And the gob development(roof strata cave-in)is intermittent with the cave-in of these coal pillars and the sandstone dirt band.FLAC3D numerical modelling shows that the multi-seam interaction has a significant influence on mining-induced stress environment for mining of lower panels.The pattern of the stress evolution on the coal pillars with the advance of the lower working face was found.It is demonstrated that the stress relief of a remnant coal pillar enhances the caveability of the pillars and sandstone dirt band below.展开更多
We report a 55-year-old male who developed advanced hepatic metastasis and peritoneal carcinomatosis after resection of remnant gastric cancer resection 3 mo ago. The patient only received epidermal growth factor (EGF...We report a 55-year-old male who developed advanced hepatic metastasis and peritoneal carcinomatosis after resection of remnant gastric cancer resection 3 mo ago. The patient only received epidermal growth factor (EGF) receptor antibody (Cetuximab) plus recombinant human endostatin (Endostar). Anti-tumor activity was assessed by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computer tomography (PET/CT) at baseline and then every 4 wk. The case illustrates that 18FDG-PET/CT could make an early prediction of the response to Cetuximab plus Endostar in such clinical situations. 18FDG-PET/CT is a useful molecular imaging modality to evaluate the biological response advanced hepatic metastasis and peritoneal carcinomatosis to Cetuximab plus Endostar in patients after remnant gastric cancer resection.展开更多
文摘Background:Refined models of kidney disease are critical to better understand disease processes and study novel treatments while minimizing discomfort in research animals.The objective of this study was to report a technique for minimally invasive partial kidney embolism in cats and describe outcomes following transcatheter administration of embolic microspheres with subsequent contralateral nephrectomy.Methods:Eleven,apparently healthy,male,purpose-bred cats underwent unilateral kidney embolism with 0.25 or 0.5 mL of embolic microparticle(40-120μm)suspension(0.2 mL microspheres/mL)delivered into the right renal artery under fluoroscopic guidance,followed 5 months later by contralateral nephrectomy.One month after nephrectomy,blood and urinary markers of kidney function were evaluated,and embolized kidneys were harvested for histopathology evaluation.Results:Renal artery embolization was possible in all cats.Two cats did not complete the study,one after experiencing congestive heart failure(n=1)and the other following evidence of complete kidney embolism precluding nephrectomy(n=1)postembolization.At study end,compared to baseline,cats had significant increases in median(range)serum creatinine(159.1μmol/L[141.4-530.4]versus 128.2μmol/L[92.8-150.3];p=0.0004),urea nitrogen(15.71 mmol/L[9.29-47.85]versus 7.50 mmol/L[6.07-8.57];p<0.0001),and symmetric dimethylarginine(0.74μmol/L[0.59-3.12]versus 0.67μmol/L[0.54-0.72];p=0.0288)concentrations.No differences in markers of kidney function were documented between dose groups.Conclusions:M inimally invasive kidney embolism is a promising technique for modeling kidney disease in cats.Understanding optimal dose,timing of nephrectomy,and longer-term consequences requires additional work.
文摘Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these patients.Of late,various recurrence patterns have been observed;the most common of them being distant metastasis followed by the pancreatic bed and lymph node recurrence.Recurrence in the remnant pancreas is on the rise due to improved survival in patients who previously underwent surgery for pancreatic cancer.Total remnant pancreatectomy is an appealing option in resectable remnant pancreatic carcinoma without distant metastasis.It is an entity showing an increasing incidence and demanding further in-depth studies to elucidate the exact pathological mechanism and to establish appropriate management protocols.
基金supported by a GRF grant of the Hong Kong Government under HKU 17304524.
文摘We use the Fe Kα emission in X-rays from non-equilibrium ionizing plasmas as a probe to explore the dust in supernova remnants(SNRs). We applied our model to Cassiopeia A(Cas A), a well-studied SNR with plenty of observational data as a test. We use Chandra Advanced CCD Imaging Spectrometer 980 ks data of Cas A, and AtomDB v3.0.9, an atomic database for X-ray plasma spectral modeling, to fit 248 spectra. A two-temperature model is adopted to describe the physical conditions of shocked ejecta and iron-rich plasma. We measure the Fe Kα flux ratio and the centroid difference of the dust and gas contributions. We find strong 6.4 keV line emission components, which indicates that iron-rich dust can survive within Cas A's shocked ejecta. We also find that the Fe Kα complex demonstrates an apparent double-hump structure in some Fe–K rich regions, which may be caused by both dust and multi-ejecta structure in Cas A. The results of Fe Kα structures are consistent with our model for a dust cloud embedded in multi-phase ejecta and suggest the presence of both dust sputtering and drag effects in those regions. It is currently still limited by the low spatial and spectrum resolution for the current X-ray detectors, but should be more useful when the new generation, high-resolution X-ray telescopes come into service.
基金A grant from the Pazy Foundation supported this research。
文摘We identify a point-symmetric morphology of three pairs of ears/clumps in the core-collapse supernova remnant(CCSNR)Puppis A,supporting the jittering jets explosion mechanism(JJEM).In the JJEM,the three pairs of jets that shaped the three pairs of ears/clumps in Puppis A are part of a large set,about 10–30 pairs of jets,that exploded Puppis A.Some similarities in morphological features between CCSNR Puppis A and three multipolar planetary nebulae considered to have been shaped by jets solidify the claim for shaping by jets.Puppis A has a prominent dipole structure,where one side is bright with a well-defined boundary,while the other is faint and defused.The neutron star(NS)has a natal kick velocity in the opposite direction to the denser part of the dipole structure.We propose a new mechanism in the frame of the JJEM that imparts a natal kick to the NS,the kick-byearly asymmetrical pair(kick-BEAP)mechanism.At the early phase of the explosion process,the NS launches a pair of jets where one jet is much more energetic than the counter jet.The more energetic jet compresses a dense side to the CCSNR,and,by momentum conservation,the NS recoils in the opposite direction.Our study supports the JJEM as the primary explosion mechanism of core-collapse supernovae and enriches this explosion mechanism by introducing the novel kick-BEAP mechanism.
文摘I examine the morphology of the core-collapse supernova(CCSN)remnant(SNR)G0.9+0.1 and reveal a pointsymmetrical morphology that implies shaping by three or more pairs of jets,as expected in the jittering jets explosion mechanism(JJEM).The large northwest protrusion,the ear(or lobe),has two bright rims.I compare this ear with its rims to an ear with three rims of a jet-shaped planetary nebula and jets from an active galactic nucleus that shaped several rims on one side.Based on this similarity,I argue that two jets or more shaped the northwest ear of SNR G0.9+0.1 and its two rims.I identified the bright region south of the main shell of SNR G0.9+0.1 as a jet-shaped blowout formed by a jet that broke out from the main SNR shell.I base this on the similarity of the blowout of SNR G0.9+0.1 with that of SNR G309.2-00.6,argued in the past to be shaped by jets.I identify four symmetry axes along different directions that compose the point-symmetric morphology of SNR G0.9+0.1.I show that the morphological features of holes,granular texture,and random filaments exist in CCSNe and planetary nebulae and are unlikely to result from some unique processes in CCSNe.These structures result from similar instabilities in the JJEM and the neutrino-driven explosion mechanism and,unlike a point-symmetric morphology,cannot determine the explosion mechanism.Identifying SNR G0.9+0.1 as a new point-symmetric CCSN strengthens the JJEM as the primary explosion mechanism of CCSNe.
基金Supported by Fundação de AmparoàPesquisa do Estado de São Paulo,No.2016/25524-0.
文摘BACKGROUND Remnant gastric cancer(RGC)is a carcinoma arising in the stomach remnant after previous gastric resection.It is frequently reported as a tumor with a poor prognosis and distinct biological features from primary gastric cancer(PGC).However,as it is less frequent,its profile regarding the current molecular classifications of gastric cancer has not been evaluated.AIM To evaluate a cohort of RGC according to molecular subtypes of GC using a panel of immunohistochemistry and in situ hybridization to determine whether the expression profile is different between PGC and RGC.METHODS Consecutive RGC patients who underwent gastrectomy between 2009 and 2019 were assessed using seven GC panels:Epstein-Barr virus in situ hybridization,immunohistochemistry for mismatch repair proteins(MutL homolog 1,MutS homolog 2,MutS homolog 6,and PMS1 homolog 2),p53 protein,and E-cadherin expression.Clinicopathological characteristics and survival of these patients were compared to 284 PGC patients.RESULTS A total of 40 RGC patients were enrolled in this study.Compared to PGC,older age(P<0.001),male(P<0.001),lower body mass index(P=0.010),and lower hemoglobin level(P<0.001)were associated with RGC patients.No difference was observed regarding Lauren’s type and pathologic Tumor Node Metastasis stage between the groups.Regarding the profiles evaluated,EBV-positive tumors were higher in RGC compared to PGC(P=0.039).The frequency of microsatellite instability,aberrant p53 immunostaining,and loss of E-cadherin expression were similar between RGC and PGC.Higher rates of simultaneous alterations in two or more profiles were observed in RGC compared to PGC(P<0.001).According to the molecular classification,the subtypes were defined as EBV in nine(22.5%)cases,microsatellite instability in nine(22.5%)cases,genomically stable in one(2.5%)case,and chromosomal instability in 21(52.5%)cases.There was no significant difference in survival between molecular subtypes in RGC patients.CONCLUSION RGC was associated with EBV positivity and higher rates of co-altered expression profiles compared to PGC.According to the molecular classification,there was no significant difference in survival between the subtypes of RGC.
文摘BACKGROUND Three-dimensional(3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach(CRS), but its clinical efficacy remains controversial.AIM To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy(3DLAG) with open gastrectomy(OG) for CRS.METHODS The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up,we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival(OS) rates were compared between the two groups.RESULTS Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score,initial disease state(benign or malignant), primary surgical anastomosis method,interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss(188.33 ± 191.35 mL vs 305.83 ± 303.66 mL;P =0.045) and smaller incision(10.86 ± 3.18 cm vs 20.06 ± 5.17 cm;P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG(14.0 ± 7.17 vs 10.73 ± 6.82;P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups(1.56 ± 2.84 vs 2.35 ± 5.28;P = 0.413). The complication rate(8.3% vs 20.8%;P = 0.207) and intensive care unit admission rate(5.6% vs 14.5%;P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval(CI): 72.4%-95.6%] and 73.3%(95%CI: 60.0%-89.5%)respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3%(95%CI: 76.4%-99.8%) and 75.6%(95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups(P = 0.68).CONCLUSION Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.
文摘BACKGROUND Remnant gastric cancer(RGC)is defined as a tumor that develops in the stomach after a previous gastrectomy and is generally associated with a worse prognosis.However,there little information available regarding RGCs and their prognostic factors and survival.AIM To evaluate the clinicopathological characteristics and prognosis of RGC after previous gastrectomy for benign disease.METHODS Patients who underwent curative resection for primary gastric cancer(GC)at our institute between 2009 and 2019 were retrospectively evaluated.All RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in this study.Primary proximal GC(PGC)who underwent total gastrectomy was selected as the comparison group.Clinical and pathological data were collected from a prospective medical database.RESULTS A total of 41 patients with RGC and 120 PGC were included.Older age(P=0.001),lower body mass index(P=0.006),hemoglobin level(P<0.001),and number of resected lymph nodes resected(LN)(P<0.001)were associated with the RGC group.Lauren type,pathological tumor-node-metastasis,and perioperative morbimortality were similar between RGC and PGC.There was no difference in disease-free survival(P=0.592)and overall survival(P=0.930)between groups.LN status was the only independent factor related to survival.CONCLUSION RGC had similar clinicopathological characteristics to PGC.Despite the lower number of resected LN,RGC had a similar prognosis.
文摘Remnant gastric cancer(RGC) and gastric stump cancer after distal gastrectomy(DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori(H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.
基金supported by the following projects:National Basic Research Program of China (2009CB421004,2009CB421003)Natural Science Foundation of China(41073033,40872055,and 40930316)+1 种基金Chinese Academy of Sciences(KZCX2-YW-Q04)China Geological Survey(1212010818098)
文摘The Nadingcuo high-K calc-alkaline rocks mainly composed of trachyte and trachyandesite are the largest outcrop area of volcanic rocks in southern Qiangtang terrane in the Tibetan plateau. However,their exact source and peterogenesis are still debated.^（40）Ar-^（39）Ar and LAM-ICPMS zircon U-Pb isotopic dating confirm that these rocks erupted in Eocene.In addition,the Nadingcuo volcanic rocks are characterized by high Sr/Y content ratios,similar with the adakite derived from partial melting of oceanic crust.They can be further classified as high Mg~#（Mg~#=48-57） and low Mg~# （Mg~#=33-42） subtypes.The Nadingcuo adakitic rocks have relatively low（^（87）Sr/^（86）Sr）_i and highε_（Nd）（t）, showing a trend of similarity to the Dongcuo ophiolite present in the Bangong-Nujiang oceanic crust. Simple modeling indicates that the Nadingcuo adakitic rocks are a mix resulting from the basalt of Bangong-Nujiang Ocean with 10%-20%crustal material of Lhasa terrane.On these bases we suggest that the low Mg~# Nadingcuo adakitic rocks are the product of partial melting of remnant oceanic crust with small sediment,and the high Mg~# rocks are the result of reaction between rising melt of remnant oceanic crust with subducted sediment and mantle wedge.Therefore,the origin of Nadingcuo adakitic rocks may be related to intracontinental subduction triggered by collision of India-Asia during Cenozoic.
文摘Gastric stump carcinoma was initially reported by Balfore in 1922,and many reports of this disease have since been published. We herein review previous reports of gastric stump carcinoma with respect to epidemiology,carcinogenesis,Helicobacter pylori(H. pylori) infection,Epstein-Barr virus infection,clinicopathologic characteristics and endoscopic treatment. In particular,it is noteworthy that no prognostic differences are observed between gastric stump carcinoma and primary upper third gastric cancer. In addition,endoscopic submucosal dissection has recently been used to treat gastric stump carcinoma in the early stage. In contrast,many issues concerning gastric stump carcinoma remain to be clarified,including molecular biological characteristics and the carcinogenesis of H.pylori infection.We herein review the previous pertinent literature and summarize the characteristics of gastric stump carcinoma reported to date.
基金Supported by the National Natural Science Foundation of China,No.81970569,No.81773293,and No.31660266Natural Science Foundation of Hunan Province,No.2015JJ4083,No.2019JJ50874,and No.2018JJ3758
文摘BACKGROUND Hepatocellular carcinoma(HCC)is the world’s sixth most common malignant tumor and the third cause of cancer death.Although great progress has been made in hepatectomy,it is still associated with a certain degree of risk of posthepatectomy liver failure(PHLF),which extends the length of hospital stay and remains the leading cause of postoperative death.Studies have shown that assessment of hepatic functional reserve before hepatectomy is beneficial for reducing the incidence of PHLF.AIM To assess the value of model for end-stage liver disease(MELD)score combined with standardized future liver remnant(sFLR)volume in predicting PHLF in patients undergoing hepatectomy for HCC.METHODS This study was attended by 238 patients with HCC who underwent hepatectomy between January 2015 and January 2018.Discrimination of sFLR volume,MELD score,and sFLR/MELD ratio to predict PHLF was evaluated according to the area under the receiver operating characteristic curve.RESULTS The patients were divided into two groups according to whether PHLF occurred after hepatectomy.The incidence of PHLF was 8.4%in our research.The incidence of PHLF increased with the decrease in sFLR volume and the increase in MELD score.Both sFLR volume and MELD score were considered independent predictive factors for PHLF.Moreover,the cut-off value of the sFLR/MELD score to predict PHLF was 0.078(P<0.001).This suggests that an sFLR/MELD≥0.078 indicates a higher incidence of PHLF than an sFLR/MELD<0.078.CONCLUSION MELD combined with sFLR is a reliable and effective PHLF predictor,which is superior to MELD score or sFLR volume alone.
文摘AIM： TO re-evaluate the recent clinicopathological fea- tures of remnant gastric cancer （RGC） and to develop desirable surveillance programs.METHODS： Between 1997 and 2008, 1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural Uni- versity of Medicine, Japan. Of these, 33 patients un- derwent gastrectomy with lymphadenectomy for RGC. Regarding the initial gastric disease, there were 19 patients with benign disease and 14 patients with gas- tric cancer. The hospital records of these patients were reviewed retrospectively. RESULTS： Concerning the initial gastric disease, the RGC group following gastric cancer had a shorter in- terval [P 〈 0.05; gastric cancer vs benign disease： 12 （2-22） vs 30 （4-51） years] and were more frequently reconstructed by Billroth- I procedure than those fol- lowing benign lesions （P 〈 0.001）. Regarding recon- struction, RGC following Billroth-]_l reconstruction showed a longer interval between surgical procedures [P 〈 0.001; Billroth-11 vs Billroth- I ： 32 （5-51） vs 12 （2-36） years] and tumors were more frequently associated with benign disease （P 〈 0.001） than those following Billroth- I reconstruction. In tumor location of RGC, after Billroth- I reconstruction, RGC occurred more fre- quently near the suture line and remnant gastric wall. After Billroth- 1I reconstruction, RGC occurred more fre- quently at the anastomotic site. The duration of follow- up was significantly associated with the stage of RGC （P 〈 0.05）. Patients diagnosed with early stage RGC such as stage Ⅰ-Ⅱ tended to have been followed up almost every second year. CONCLUSION： Meticulous follow-up examination and early detection of RGC might lead to a better prognosis. Based on the initial gastric disease and the procedure of reconstruction, an appropriate follow-up interval and programs might enable early detection of RGC.
文摘BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical technique for pancreaticoenteric anastomosis has been established.This study aimed to compare the postoperative morbidity and mortality of pancreaticogastrostomy and pancreaticojejunostomy for 'soft' pancreatic tissue remnants using modified mattress sutures.METHODS:Seventy-five patients who had undergone pancreaticogastrostomy and 75 who had undergone pancreaticojejunostomy after pancreaticoduodenectomy between 2002 and 2008 were retrospectively compared using matched-pair analysis.A modified mattress suture technique was used for the pancreaticoenteric anastomosis.Patients with an underlying 'hard' pancreatic tissue remnant,as in chronic pancreatitis,were excluded.Both groups were homogeneous for age,gender,and underlying disease.Postoperative morbidity,mortality,and preoperative and operative data were analyzed.RESULTS:There were no significant differences between the groups for the incidence of postoperative pancreatic fistula (10.7% in both).Postoperative morbidity and mortality,median operation time,median length of hospital stay,intraoperative blood loss,and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ between the groups.Patient age >65 years (P=0.017),operation time >350minutes (P=0.001),and intraoperative transfusion of erythrocyte concentrates (P=0.038) were identified as risk factors for postoperative morbidity.CONCLUSIONS:Our results showed no significant differences between the groups in the pancreaticogastrostomy and pancreaticojejunostomy anastomosis techniques using mattress sutures for 'soft' pancreatic tissue remnants.In our experience,the mattress sutures are safe and simple to use,and pancreaticogastrostomy in particular is feasible and easy to learn,with good endoscopic accessibility to the anastomosis region.However,the location of the anastomosis and the surgical technique need to be individually evaluated to further reduce the incidence of postoperative pancreatic fistula.
文摘AIM: To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD) for the treatment of patients with gastric remnant cancer. METHODS: Thirty-two patients with early gastric cancer in the remnant stomach, who underwent distal gastrectomy due to gastric carcinoma, were treated with endoscopic mucosal resection (EMR) or ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 10-year period from January 1998 to December 2007, including 17 patients treated with IT-ESD. Retrospectively, patient backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, and perforation rate were compared between patients treated with conventional EMR and those treated with IT-ESD. RESULTS: The CR rate (40% in the EMR group vs 82% in the IT-ESD group) was significantly higher in the IT-ESD group than in the EMR group; however, the operation time was significantly longer for the IT- ESD group (57.6 ± 31.9 min vs 21.1 ± 12.2 min). No significant differences were found in the rate of underlying cardiopulmonary disease (IT-ESD group, 12% vs EMR group, 13%), one-piece resection rate (100% vs 73%), bleeding rate (18% vs 6.7%), and perforation rate (0% vs 0%) between the two groups. CONCLUSION: IT-ESD appears to be an effective treatment for gastric remnant cancer post distal gastrectomy because of its high CR rate. It is useful for histological confirmation of successful treatment. Thelong-term outcome needs to be evaluated in the future.
基金China Science Technology and Industry Foundation for National Defense (FEBG 27100001)
文摘The existence of remnant particles, which significantly reduce the reliability of relays, is a serious problem for aerospace relays. The traditional method for detecting remnant particles-particle impact noise detection （PIND）-can be used merely to detect the existence of the particle; it is not able to provide any information about the particles＇ material. However, information on the material of the particles is very helpful for analyzing the causes of remnants. By analyzing the output acoustic signals from a PIND tester, this paper proposes three feature extraction methods： unit energy average pulse durative time, shape parameter of signal power spectral density （PSD）, and pulse linear predictive coding coefficient sequence. These methods allow identified remnants to be classified into four categories based on their material. Furthermore, we prove the validity of this new method by processing P1ND signals from actual tests.
文摘Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal gastrografin study on postoperative days 1 and 2 revealed collection of contrast in the fundic area of stomach with poor flow distally, and she vomited gastrograffin immediately post procedure. With the suspicion of a stricture in the mid stomach as the cause, the patient was taken back for a exploratory laparoscopy and intra-operative endoscopy. We found a twist in the gastric tube which was too tight for the endoscope to pass through. This was managed conservatively with a long stent to keep the gastric tube straight and patent. The stent was discontinued in 7 d and the patient did well. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports. If the staples fired are not aligned appropriately, it can predispose this stomach tube to undergo torsion along its long axis. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum and new stomach tube. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement.
基金This study was funded by the National Natural Science Foundation for Young Scientists of China(No.51804209)National Natural Science Foundation of China-Shanxi Joint Fund for Coal-Based Low-Carbon Technology(No.U1710258)Applied Basic Research Programs,Science and Technology Foundation for Youths of Shanxi Province,China(No.201801D221363).
文摘With the depletion of easily minable coal seams,less favorable reserves under adverse conditions have to be mined out to meet the market demand.Due to some historical reasons,large amount of remnant coal was left unrecovered.One such case history occurred with the remnant rectangular stripe coal pillars using partial extraction method at Guandi Mine,Shanxi Province,China.The challenge that the coal mine was facing was that there is an ultra-close coal seam right under it with an only 0.8–1.5 m sandstone dirt band in between.The simulation study was carried out to investigate the simultaneous recovery of upper remnant coal pillars while mining the ultra-close lower panel using longwall top coal caving(LTCC).The remnant coal pillar was induced to cave in as top coal in LTCC system.Physical modelling shows that the coal pillars are the abutments of the stress arch structure formed within the overburden strata.The stability of overhanging roof strata highly depends on the stability of the remnant coal pillars.And the gob development(roof strata cave-in)is intermittent with the cave-in of these coal pillars and the sandstone dirt band.FLAC3D numerical modelling shows that the multi-seam interaction has a significant influence on mining-induced stress environment for mining of lower panels.The pattern of the stress evolution on the coal pillars with the advance of the lower working face was found.It is demonstrated that the stress relief of a remnant coal pillar enhances the caveability of the pillars and sandstone dirt band below.
文摘We report a 55-year-old male who developed advanced hepatic metastasis and peritoneal carcinomatosis after resection of remnant gastric cancer resection 3 mo ago. The patient only received epidermal growth factor (EGF) receptor antibody (Cetuximab) plus recombinant human endostatin (Endostar). Anti-tumor activity was assessed by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computer tomography (PET/CT) at baseline and then every 4 wk. The case illustrates that 18FDG-PET/CT could make an early prediction of the response to Cetuximab plus Endostar in such clinical situations. 18FDG-PET/CT is a useful molecular imaging modality to evaluate the biological response advanced hepatic metastasis and peritoneal carcinomatosis to Cetuximab plus Endostar in patients after remnant gastric cancer resection.
