Risk factors of poor prognosis and portal vein tumor thrombosis after curative resection of solitary hepatocellular carcinoma

BACKGROUND:Predictors of poor prognosis of solitary hepatocellular carcinoma(SHCC),a subgroup encompassing most patients with the malignancy,are still controversial.Hence,risk factors for portal vein tumor thrombosis(PVTT) in SHCC are obscure.The present study was designed to address this issue.METHOD:Clinicopathological and follow-up data for 156 consecutive patients with SHCC following curative hepatic resection were analyzed using uni-and multi-variate analyses.RESULTS:Univariate analysis showed that PVTT,tumornode-metastasis(TNM) stage,Edmondson-Steiner grade and preoperative serum alpha-fetoprotein(AFP) level were associated with the overall and disease-free survival,whereas tumor size only influenced the overall survival.In multivariate Cox regression tests,Edmondson-Steiner grade and TNM stage were independent prognostic markers for both overall and diseasefree survival.In addition,the Chi-square test showed that AFP level and Edmondson-Steiner grade were correlated with PVTT.Among them,only Edmondson-Steiner grade was shown to be of independent significance for PVTT in multi-variate logistic regression analysis.Additionally,AFP,the sole preoperative factor for PVTT,was not adequately sensitive and specific.CONCLUSIONS:Factors relating to post-surgical prognosis and PVTT in SHCC are all tumor-related.Of these,EdmondsonSteiner grade and TNM stage might be of particular importance in survival analysis.In addition,accurate prediction of PVTT by clinicopathological parameters before surgery remains difficult.

Choledochoduodenal fistula caused by migration of endoclip after laparoscopic cholecystectomy

The wide use of surgical endoclips in laparoscopic surgery has led to a variety of complications.Postcholecystectomy endoclips migrating into the common bile duct after laparoscopic cholecystectomy is rare.A migrated endoclip can cause obstruction,serve as a nidus for stone formation,and cause cholangitis.While the exact pathogenesis is still unknown,it is probably related to improper clip application,subclinical bile leak,inflammation,and subsequent necrosis,allowing the clips to erode directly into the common bile duct.We present a case of endoclip migrating into the common bile duct and duodenum,resulting in choledochoduodenal fistula after laparoscopic cholecystectomy and a successful reconstruction of the biliary tract by a hepaticojejunostomy with a Roux-en-Y procedure.This case shows that surgical endoclips can penetrate into the intact bile duct wall through serial maceration,and it is believed that careful application of clips may be the only way to prevent their migration after laparoscopic cholecystectomy.

Capability-based IoT access control using blockchain

Internet of Things(IoT)devices facilitate intelligent service delivery in a broad range of settings,such as smart offices,homes and cities.However,the existing IoT access control solutions are mainly based on conventional identity management schemes and use centralized architectures.There are knowm security and privacy limitations with such schemes and architectures,such as the single-point failure or surveillance(e.g.,device tracking).Hence,in this paper,we present an architecture for capability-based IoT access control utilizing the blockchain and decentralized identifiers to manage the identity and access control for IoT devices.Then,we propose a protocol to provide a systematic view of system interactions,to improve security.We also implement a proof-of-concept prototype of the proposed approach and evaluate the prototype using a real-world use case.Our evaluation results show that the proposed solution is feasible,secure,and scalable.

Huge brown tumor of the rib in an unlocatable hyperparathyroidism patient with “self-recovered” serum calcium and parathyroid hormone: A case report

BACKGROUND The brown tumor is a kind of complication of hyperparathyroidism(HPT). The ultimate therapy usually is the resolution of HPT. We herein report an unlocatable HPT patient who received resection of a huge brown tumor of the rib, and experienced "self-recovery" of serum calcium and parathyroid hormone.CASE SUMMARY A 34-year-old female patient who suffered from a gradually increasing mass of the left chest wall since 2007 came to our hospital for treatment. The patient had a history of serum Ca and parathyroid hormone(PTH) increasing since June 2015 and received zoledronic acid treatment for 17 mo. When she came to our hospital in November 2017 after discontinuing medical treatment for 3 mo, the serum Ca and PTH levels were within normal ranges. The patient had no imaging abnormalities of parathyroid ultrasound or 99 m Tc-methoxyisobutyl isonitrile.Enhanced computed tomography revealed a local soft tissue mass of 96 mm × 113 mm with bone erosion of the left 8 th rib, and the mass presented irregular enhancement with an unclear boundary between the mass and spleen. The mass was thought to likely be caused by HPT, but a malignancy could not be ruled out.Resection of the mass was performed, and the pathology proved that the mass was a brown tumor. A diagnosis of unlocatable HPT was considered. Since the serum Ca and PTH levels were both normal pre-and post-operation, the patient did not receive exploratory surgery for HPT, and received regular follow-up.CONCLUSION The huge brown tumor of the rib and "self-recovered" serum PTH and Ca levels are relatively rare in HPT patients. An exploratory operation may be deferred for these patients, and long-term follow-up should be performed.

Surgical procedure determination based on tumor-node-metastasis staging of gallbladder cancer

AIM: To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis(TNM) staging system.METHODS: A retrospective study was performed by reviewing 152 patients with primary gallbladder carcinoma treated at Peking Union Medical College Hospital from January 2003 to June 2013. Postsurgical follow-up was performed by telephone and outpatient visits. Clinical records were reviewed and patients were grouped based on the new edition of TNM staging system(AJCC, seventh edition, 2010). Prognoses were analyzed and compared based on surgical operations including simple cholecystectomy, radical cholecystectomy(or extended radical cholecystectomy), and palliative surgery. Simple cholecystectomy is, by definition, resection of the gallbladder fossa. Radical cholecystectomy involves a wedge resection of the gallbladder fossa with 2 cm nonneoplastic liver tissue; resection of a suprapancreatic segment of the extrahepatic bile duct and extended portal lymph node dissection may also be considered based on the patient's circumstance. Palliative surgery refers to cholecystectomy with biliary drainage. Data analysis was performed with SPSS 19.0 software. KaplanMeier survival analysis and Logrank test were used for survival rate comparison. P < 0.05 was consideredstatistically significant.RESULTS: Patients were grouped based on the new 7th edition of TNM staging system, including 8 cases of stage 0, 10 cases of stage Ⅰ, 25 cases of stage Ⅱ, 21 cases of stage ⅢA, 21 cases of stage ⅢB, 24 cases of stage ⅣA, 43 cases of stage ⅣB. Simple cholecystectomy was performed on 28 cases, radical cholecystectomy or expanded gallbladder radical resection on 57 cases, and palliative resection on 28 cases. Thirty-nine cases were not operated. Patients with stages 0 and Ⅰ disease demonstrated no statistical significant difference in survival time between those receiving radical cholecystectomy and simple cholecystectomy(P = 0.826). The prognosis of stage Ⅱ patients with radical cholecystectomy was better than that of simple cholecystectomy. For stage Ⅲ patients, radical cholecystectomy was significantly superior to other surgical options(P < 0.05). For stage ⅣA patients, radical cholecystectomy was not better than palliative resection and non-surgical treatment. For stage ⅣB, patients who underwent palliative resection significantly outlived those with non-surgical treatment(P < 0.01)CONCLUSION: For stages 0 and Ⅰ patients, simple cholecystectomy is the optimal surgical procedure, while radical cholecystectomy should be actively operated for stages Ⅱ and Ⅲ patients.

Both the 5th and 6th Editions of TNM Staging System Fail to Independently Predict Long-term Prognosis after Radical Hepatectomy in Hepatocellular Carcinoma Sized > or = 5cm

Objective To validate the predictive power of the 5th and 6th editions of TNM staging system(TNM-5,TNM-6) in a Chinese patient cohort with hepatocellular carcinoma(HCC) sized > or = 5 cm after radical hepatectomy.Methods Consecutive 121 patients with HCC sized > or = 5 cm undergoing radical hepatectomy between January 1995 and December 2002 were included.The impact of clinicopathological variables on prognosis was determined by univariate and multivariate analyses,after excluding 2 perioperative deaths.Results In univariate analysis,TNM-5 stage did not show prognostic significance for overall or disease-free survival,as opposed to TNM-6 stage,Edmondson-Steiner grade,portal vein tumor thrombosis(PVTT),vascular invasion,satellite nodule,Child-Pugh grade,and hepatitis B surface antigen(HBsAg) positivity.When these significant variables were entered in multivariate analysis,Edmondson-Steiner grade was the sole independent prognosticator for both overall and disease-free survival,whereas Child-Pugh grade independently influenced disease-free survival.However,TNM-6 stage lost its predictive potential in multivariate analysis.Conclusions Neither TNM-5 nor TNM-6 staging system is revealed to be independently prognostic in patients with HCC sized > or = 5 cm after radical hepatectomy.Therefore,TNM-6 calls for more support in many subsets of HCC patients.

Preparation of panda-shaped photonic crystal fibers with and without silver wire

A method of preparing panda-shaped photonic crystal fibers(PCFs)based on secondary drawing technology is proposed in this paper.The secondary drawing can not only reduce fiber diameter but also reduce core size by adding a glass sleeve.Silver-filled and non-silver-filled panda PCFs are prepared.The two ends of silver-filled panda PCF are connected with a broadband light source and a spectrometer,respectively,and the surface plasmon resonance phenomenon is detected.The secondary drawing technology provides a meaningful reference for the preparation of PCF in the future,and the prepared silver-filled panda PCF can be prepared into an optical fiber filter.

Introducing on-chain graph data to consortium blockchain for commercial transactions

1 Introduction A blockchain can be referred to as a distributed ledger[1].Nowadays,according to our previous work[2],the graphrelated blockchain grows efficiently in both academic studies and commercial scenarios.Graph data,algorithms and applications can be applied in blockchain now,such as[3].

超声速流边界层中的壁面正、负压力脉动

本文对来流马赫数2.25、基于动量厚度的雷诺数4000的平板湍流边界层开展了直接数值模拟,通过聚类连通法和条件相关研究了壁面正、负压力脉动.负脉动比正脉动的特征长度小,但是二者特征时间接近.正脉动的对流速度略大.壁面压力脉动结构的空间距离是自相似的,即空间距离与特征长度成正比.同类壁面压力结构在展向成串出现,正、负壁面压力脉动在流向成对。流向壁面剪切脉动大致在壁面压力脉动的下游,而展向壁面剪切脉动则与壁面压力脉动成对角线方式分布,二者的相关函数成“四极子”形式,其中壁面压力脉动与其上游的展向壁面剪切相关系数大于下游.

Gaucher Disease with Mesenteric Lymphadenopathy： A Case with 13-year Follow-up

Mesenteric lymphadenopathy is a rare manifestation of Gaucher disease （GD） with only 26 cases reported worldwide and its outcome remains largely unknown.In this manuscript,we described a 17-year-old girl with GD who has been treated with standard enzyme replacement therapy （ERT） for 16 years.The follow-up of her mesenteric lymphadenopathy began 13 years ago,which is one of the longest follow-up for this condition worldwide.

Blockchain technology forecasting by patent analytics and text mining

Information technologies(ITs)have been playing an important role in improving our society,and the fast evolution of ITs creates a competitive environment not only for companies but also for regions.Hence,recognizing the future trend of technologies can be effective in decision-making with regard to technology selection and investment.Blockchain technology with its vast and impressive applications has received considerable attention from researchers,investors,and public agencies.The purpose of this research is to investigate blockchain technology to explore its trends according to their classification by use of the World Intellectual Property Organization(WIPO)database.Furthermore,we particularly evaluate the registered patents in the world's most well-known patent databases such as the USA patent database.We drew the current technology trends in blockchain patents by applying the text mining and clustering approach.The results represent that the registered patents in the USA patent database have been achieved in the growth phase.That means,attention to the blockchain is rising nowadays and most patents focused the cryptocurrencies and their applications in finance.However,blockchain technology is in the emergence phase and is evolving by researchers and inventors.

Matching user identities across social networks with limited profile data

Privacy preservation is a primary concern in social networks which employ a variety of privacy preservations mechanisms to preserve and protect sensitive user information including age,location,education,interests,and others.The task of matching user identities across different social networks is considered a challenging task.In this work,we propose an algorithm to reveal user identities as a set of linked accounts from different social networks using limited user profile data,i.e,user-name and friendship.Thus,we propose a framework,ExpandUIL,that includes three standalone al-gorithms based on(i)the percolation graph matching in Ex-pand FullName algorithm,(i)a supervised machine learning algorithm that works with the graph embedding,and(ii)a combination of the two,ExpandUserLinkage algorithm.The proposed framework as a set of algorithms is significant as,(i)it is based on the network topology and requires only name feature of the nodes,(i)it requires a considerably low initial seed,as low as one initial seed suffices,(ii)it is iterative and scalable with applicability to online incoming stream graphs,and(iv)it has an experimental proof of stability over a real ground-truth dataset.Experiments on real datasets,Instagram and VK social networks,show upto 75%recall for linked ac-counts with 96%accuracy using only one given seed pair.

Normal-Weight Abdominal Obesity: A Risk Factor for Hypertension and Cardiometabolic Dysregulation

Objective:This study aimed to examine the associations of waist circumference with hypertension and cardiometabolic dysregulation among normal-weight adults.Methods:This cross-sectional study included 8795 normal-weight participants aged 20 to 79 years from the 2009–2018 US National Health and Nutrition Examination Survey.The demographic characteristics and cardiometabolic risk factors across waist circumference quartiles were summarized.We used adjusted multivariate logistic regression models,subgroup analysis,and restricted cubic spline to analyze the association between waist circumference and the prevalence of hypertension.Thereafter,we used the random forest supervised machine learning method,together with least absolute shrinkage and selection operator regression,to select hypertension-related features and created a predictive model based on regression analysis to identify hypertension in normal-weight individuals.Results:Waist circumference was positively correlated with hypertension in the non-adjusted,minimally adjusted,and fully adjusted models,with odds ratios(95%confidence interval)of 2.28(2.14–2.44),1.27(1.12–1.44),and 1.27(1.12–1.44),respectively.In the fully adjusted model,participants in the highest waist circumference quartile had a higher risk of hypertension relative to those in the lowest quartile,with an odds ratio(95%confidence interval)of 3.87(1.59–10.34).Sensitivity analysis demonstrated the robustness of the association.In the testing set,the predictive model exhibited good performance,with an area under the curve of 0.803,sensitivity of 0.72,specificity of 0.76,and negative predictive value of 0.84.Conclusions:Measuring waist circumference may improve the evaluation of the risk of hypertension and help to manage cardiometabolic risk in normal-weight individuals.