Characteristics of gastric cancer recurrence five or more years after curative gastrectomy

Objective： To investigate the characteristics of recurrences that occurred 5 or more years after curative resection for gastric cancer.Methods： We analyzed recurrences among 1,299 patients with gastric cancer who underwent curative operations at the Department of Surgery, Inje University Seoul Paik Hospital between September 1998 and December 2002. Recurrences were classified as within 2 years （early）, 2-5 years （intermediate）, and more than 5 years （late） after gastrectomy. The clinicopathologic findings of the patients with late recurrence were compared with those of patients in the other two recurrence groups, with special reference to the patterns of recurrence. Both univariate and multivariate analyses were performed, incorporating factors such as operation type, T-stage, N-stage, stage, lymphatic invasion, neural invasion, histology, tumor size, and recurrence site.Results： At the time of last follow-up, recurrence occurred in 266 （20.5%） patients. Recurrence times were classified as 〈2 years （182 patients）, 2-5 years （61 patients）, or 〉5 years （23 patients）. The late recurrence rate was 8.6%. The occurrence of recurrence 〉5 years after gastrectomy was significantly correlated with age, operation type, T-stage, N-stage, stage, lymphatic invasion, neural invasion, histology, tumor size, location and recurrence site （P〈0.05）. The main recurrence patterns in the 23 patients with late recurrence were locoregional metastasis （10 patients, 43.5%）, peritoneal seeding （8 patients, 34.8%）, hematogenous metastasis （2 patients, 8.7%）, and multiple metastasis （3 patients, 13.0%）. A multivariate analysis showed that larger tumor size and younger age were independent prognostic factors for late recurrence. Additionally, locoregional and peritoneal recurrences were significantly more common than hematogenous recurrences. Conclusions： Although late recurrence was uncommon, younger age and larger tumor size were associated with high risk. Follow-up surveillance is recommended for locoregional and peritoneal metastasis.

Addition of hepatectomy decreases liver recurrence and leads to long survival in hilar cholangiocarcinoma

AIM： To evaluate hepatic recurrence and prognostic factors for survival in patients with surgically resected hilar cholangiocarcinoma in a single institution over the last 13 years. METHODS： From 1994 to 2007, all patients with hilar cholangiocarcinoma referred to a surgical clinic were evaluated. Demographic data, tumor characteristics, and outcome were analyzed retrospectively. Outcome was compared in patients who underwent additional liver resection with resection of the tumor. RESULTS： Of the 69 patients submitted to laparotomy for tumor resection, curative resection （Ro resection） was performed in 40 patients, and palliative resection in 29. Thirty-one patients had only duct resection, and 38 patients had combined duct resection with liver resection including 34 total or part caudate lobes. Curative rates with the combined hepatectomy were significantly improved compared with those without additional hepatectomy （27/38 vs 13/31; X^2 = 5.94, P 〈 0.05）. Concomitant liver resection was associated with a decreased incidence of initial recurrence in liver one year after surgery （11/38 vs 23/31; X^2 = 13.98, P 〈 0.01）. The 3-year survival rate after Ro resection was 30.7% and was 10.5% for palliative resection. R0 resection improved the 3-year survival rate （30.7% vs 10.5%; X^2 = 12.47, P 〈 0.01）.CONCLUSION： Hepatectomy, especially including the caudate lobe combined with bile duct resection should be considered standard treatment to cure hilar cholangiocarcinoma.

基本线性计算模型的CUR分析与并行程序有效速度的实用测定方法

具有巨量数据的科学计算程序在并行计算机上的有效速度往往是很低的,因此需要尽可能地借助算法来改善这种状况。基于高性能科学计算中对某些基本线性计算模型的处理要耗费大部分CPU时间以及cache具有较高速度这一事实,文章着重对这些计算模型的cache利用率CUR(CacheUsingRatio)进行了分析与实验比较,同时也对用户如何获取程序的浮点运算速度的方法进行了讨论。

基于CUR矩阵分解的多核学习正则化路径近似算法

多核学习在解决不规则、大规模数据问题时表现出良好的优越性。正则化路径是一种多次求解多核学习,选择最优模型的措施。针对多核学习正则化路径算法处理大规模数据时,核矩阵规模较大,计算代价高,影响优化模型效率的问题,提出一种基于CUR矩阵分解的多核学习正则化路径近似算法(Multiple kernel learning regularization path approximation algorithm with CUR,MKLRPCUR)。该算法首先采用CUR算法获得核矩阵的低秩近似矩阵的多个分解矩阵,然后在求解过程中利用低维的分解矩阵相乘替代核矩阵,调整相关矩阵计算的顺序,从而简化算法中核矩阵和拉格朗日乘子向量乘积的计算。MKLRPCUR算法降低了矩阵的计算规模,优化了矩阵计算,提高了精确算法的计算效率。从理论上分析低秩近似矩阵的相对误差和算法的时间复杂度,验证了近似算法的合理性。同时,在UCI数据集、ORL和COIL图像数据库上的实验结果表明,本文提出的近似算法不仅保证了学习的准确率,并且降低了算法的运行时间,提高了模型的效率。

mPGES-1 expression in non-cancerous liver tissue impacts on postoperative recurrence of HCC

AIM:To investigate whether microsomal prostaglandin E synthase-1 (mPGES-1) expression in hepatocellular carcinoma (HCC) and in non-cancerous liver affects HCC prognosis after hepatectomy. METHODS: The relationship between patient clinical prof iles, tumor factors, surgical determinants, and mPGES-1 expression and the recurrence-free survival rate were examined in 64 patients who underwent curative hepatectomy between March 2003 and December 2006. RESULTS: The scores for mPGES-1 expression were higher in well differentiated and moderately differentiated HCC tissues than in poorly differentiated HCC tissues (well differentiated, 5.1 ± 2.7; moderately differentiated, 5.1 ± 1.7; poorly differentiated, 3.0 ± 1.8). In noncancerous liver tissues, the mPGES-1 levels were higher in injured liver tissues than in normal tissues. Cirrhotic livers had higher mPGES-1 levels than livers with chronic hepatitis (normal livers, 3.3 ± 0.7; chronic hepatitic livers, 5.4 ± 1.9; cirrhotic livers, 6.4 ± 1.6). A univariate analysis revealed that the recurrence-free survival rate was signif icantly lower in patients with vascular invasion,a higher mPGES-1 level in non-cancerous liver tissue,a larger tumor diameter (≥5 cm), and a lower serum albumin level (≤3.7 g/dL). The mPGES-1 expression in HCC tissues did not correlate well with postoperative recurrence. A multivariate analysis demonstrated that the presence of vascular invasion and higher mPGES-1 levels were statistically significant independent predictors for early postoperative recurrence of HCC.CONCLUSION: Increased mPGES-1 expression in noncancerous liver tissues is closely associated with the early recurrence of HCC after curative resection.

System security of hybrid AC-HVDC-systems challenges and new approaches for combined security assessment,preventive optimization and curative actions

The intense application of Voltage Source Converter based HVDC interconnections and grids will result in a hybrid AC-HVDC-system. The operation of such a system becomes complex regarding system security and system operation. This paper describes major challenges and proposes potential solutions, including a combined security assessment, preventive optimization and curative actions. A coordination of both systems enables an efficient application of existing transport capacity.

Bone metastasis from early gastric cancer following non-curative endoscopic submucosal dissection

A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in 2001.The lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,with an ulcer finding.Although the tumor was confined to the mucosa with no evidence of lymphovascular involvement,the ESD was regarded as a noncurative resection due to the histological type,tumor size,and existence of an ulcer finding(as indicated by the 2010 Japanese gastric cancer treatment guidelines,ver.3).Despite strong recommendation for subsequent gastrectomy,the patient refused surgery.An alternative follow-up routine was designed,which included five years of biannual clinical examinations to detect and measure serum tumor markers and perform visual assessment of recurrence by endoscopy and computed tomography scan after which the examinations were performed annually.The patient's condition remained stable for eight years,until a complaint of back pain in 2010 prompted further clinical investigation.Bone scintigraphy indicated increased uptake.Histological examination of biopsy specimens taken from the lumbar spine revealed adenocarcinoma resembling the carcinoma cells from the EGC that had been treated previously by ESD,and which was consistent with immunohistochemical findings of gastrointestinal tract cancer.Thus,the diagnosis of bone metastasis from EGC was made.The reported rates of EGC recurrence in surgically resected cases range 1.4%-3.4%,but among these bone metastasis is very rare.To our knowledge,this is the first reported case of bone metastasis from EGC following a non-curative ESD and occurring after an eight-year disease-free interval.

基于CUR矩阵分解的网络异常大数据检测算法

大数据通过网络储存与使用信息,若没有相应的安全防护手段,其信息网络内会出现部分异常数据,使用户隐私安全受到威胁,对此提出一种基于CUR矩阵分解的网络异常大数据检测算法,通过二进尺度参数分析数据信号特性,依靠小波模极大值去除数据内干扰噪声,拟定正常区间与观测区间描述数据特征,构建异常大数据检测指标,将大数据转变成二进制表示形式组建邻接矩阵,重构数据获得残差矩阵,以上述两种矩阵和对应参数当作输入,交替更新矩阵,得到数据内残差数值,结合检测指标实现对网络异常大数据的检测。实验证明,所提方法的检测精准度高,在存在白噪声的状况下依然能够成功检测出网络大数据内存在的异常数据,抗干扰性强。

OBSERVATION OF CURATIVE EFFECT ON EOSINOPHILIC GASTROENTERITIS BY TREATMENT WITH METHOD OF REINFORCEMENT OF ESSENCE OF THE KIDNEY

12 patients with eosinophilic gastroenteritis were treated with prescriptions and drugs based mainly on the method of reinforcement of essence of the kidney. Remarkable curative effect was achieved in 9 cases and eutherapeutk effect in 3, Le, the cure rate was 100%. The efficacy began to appear hi a minimum of 7 days and a maximum of 12 days. There was no recurrence over 1 to 3 years’ follow-up observation.

基于2-RCU/CUR并联机构的运动学分析

目的随着产品的种类的丰富,出现了各类产品喷码方式不同的问题。为使得喷码机适用于不同产品,文中提出一种转动幅度较大的2-RCU/CUR机构,用于多种类产品喷码。方法应用螺旋理论对2-RCU/CUR机构进行自由度分析,并用改进的G-K公式进行验证,用闭环矢量法对机构的位置分析进行反解,在SolidWorks软件中绘制出机构模型,最后用Matlab软件对机构工作空间编程求解并绘制出工作空间。结果 2-RCU/CUR并联机构具有3个自由度,分别为2个转动自由度和1个移动自由度,在机构的工作空间内,动平台绕y轴的转动可达90°,且在工作空间内没有奇异位型。结论 2-RCU/CUR并联机构结构简单且稳定,工作精度高,工作空间较大,可以适用于多种产品喷码流程,可以提高经济效益。

Network meta-analysis of the prognosis of curative treatment strategies for recurrent hepatocellular carcinoma after hepatectomy

BACKGROUND Recurrent hepatocellular carcinoma(rHCC)is a common outcome after curative treatment.Retreatment for rHCC is recommended,but no guidelines exist.AIM To compare curative treatments such as repeated hepatectomy(RH),radiofrequency ablation(RFA),transarterial chemoembolization(TACE)and liver transplantation(LT)for patients with rHCC after primary hepatectomy by conducting a network meta-analysis(NMA).METHODS From 2011 to 2021,30 articles involving patients with rHCC after primary liver resection were retrieved for this NMA.The Q test was used to assess heterogeneity among studies,and Egger’s test was used to assess publication bias.The efficacy of rHCC treatment was assessed using disease-free survival(DFS)and overall survival(OS).RESULTS From 30 articles,a total of 17,11,8,and 12 arms of RH,RFA,TACE,and LT subgroups were collected for analysis.Forest plot analysis revealed that the LT subgroup had a better cumulative DFS and 1-year OS than the RH subgroup,with an odds ratio(OR)of 0.96(95%CI:0.31-2.96).However,the RH subgroup had a better 3-year and 5-year OS compared to the LT,RFA,and TACE subgroups.Hierarchic step diagram of different subgroups measured by the Wald test yielded the same results as the forest plot analysis.LT had a better 1-year OS(OR:1.04,95%CI:0.34-03.20),and LT was inferior to RH in 3-year OS(OR:10.61,95%CI:0.21-1.73)and 5-year OS(OR:0.95,95%CI:0.39-2.34).According to the predictive P score evaluation,the LT subgroup had a better DFS,and RH had the best OS.However,meta-regression analysis revealed that LT had a better DFS(P<0.001)as well as 3-year OS(P=0.881)and 5-year OS(P=0.188).The differences in superiority between DFS and OS were due to the different testing methods used.CONCLUSION According to this NMA,RH and LT had better DFS and OS for rHCC than RFA and TACE.However,treatment strategies should be determined by the recurrent tumor characteristics,the patient’s general health status,and the care program at each institution.

高维数据降维中SVD与CUR分解对比分析

在大数据分析和处理中有许多常用的降维方法,在线性降维中典型的方法有SVD分解和CUR分解,但是对这两种方法的使用条件和实际效果研究甚少。基于此,通过对SVD与CUR分解原理和实验结果的探讨,分析了这两种降维方法的使用条件和实际效果。

Promote the Compression Efficiency of Digital Images by Using Improved CUR Matrix Decomposition Algorithm

In order to overcome the problem that the CUR matrix decomposition algorithm loses a large amount of information when compressing images, the quality of reconstructed images is not high, we propose a CUR matrix decomposition algorithm based on standard deviation sampling. Because of retaining more image information, the reconstructed image quality is higher under the same compression ratio. At the same time, in order to further reduce the amount of image information lost during the sampling process of the CUR matrix decomposition algorithm, we propose the SVD-CUR algorithm. The experimental results verify that our algorithm can achieve high image compression efficiency, and also demonstrate the high precision and robustness of CUR matrix decomposition algorithm in dealing with low rank sparse matrix data.

3-CUR并联分拣机器人的运动学分析与仿真

目的我国传统的食品生产行业,以人工分拣为主,自动化程度低,需耗费大量的劳动力,设计一种3-CUR并联机器人,用于食品生产的快速分拣。方法运用螺旋理论分析了该机构的自由度数目和类型,并且用修正的Grubler-Kutzbach公式对该机构的自由度进行了验证。接着使用D-H运动链参数表示法和欧拉角表示法,求解该机构的位置反解,采用三维动态法和Matlab软件对该并联分拣机器人的工作空间进行了分析与仿真,最后利用ADAMS软件对该机器人的运动性能进行了仿真分析。结果该机构可以实现一平(沿z轴的平动)两转(绕x轴y轴的转动)的运动,工作空间大,可达范围广,没有出现奇异点,末端执行器各参数的运动曲线呈有规律的周期性变化,可满足分拣机器人所需的运动和工作范围。结论该机构运动性能优越,稳定性好,具有良好的工作空间,可实现食品生产过程中的高速自动扫描和分拣,在包装自动化领域具有潜在的应用价值。

Current opinion on lymphadenectomy in pancreatic cancer surgery

BACKGROUND:Adenocarcinoma of the pancreas exhibits aggressive behavior in growth,inducing an extremely poor prognosis with an overall median 5-year survival rate of only 1%-4%.Curative resection is the only potential therapeutic opportunity. DATA SOURCES:A PubMed search of relevant articles published up to 2009 was performed to identify information about the value of lymphadenectomy and its extent in curative resection of pancreatic adenocarcinoma. RESULTS:Despite recent advances in chemotherapy,radio-therapy or even immunotherapy,surgery still remains the major factor that affects the outcome.The initial promising performance in Japan gave conflicting results in Western countries for the extended and more radical pancreatectomy; it has failed to prove beneficial.Four prospective,randomized trials on extended versus standard lymphadenectomy during pancreatic cancer surgery have shown no improvement in long-term survival by the extended resection.The exact lymph node status,including malignant spread and the total number retrieved as well as the lymph node ratio,is the most important prognostic factor.Positive lymph nodes after pancreatectomy are present in 70%.Paraaortic lymph node spread indicates poor prognosis. CONCLUSIONS:Undoubtedly,a standard lymphadenectomy including>15 lymph nodes must be no longer preferred in patients with the usual head location.The extended lymphadenectomy does not have any place,unless in randomized trials.In cases with body or tail location,the radical antegrade modular pancreatosplenectomy gives promising results.Nevertheless,accurate localization and detailed examination of the resected specimen are required for better staging.

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.

Perceptual learning for treating amblyopia in children based on activation of visual signal pathway Relationship of curative effects and time

BACKGROUND： Conventional methods （such as occlusion therapy, fine manipulation, complementary, and alternative medicine） take effects slowly, are time and labor consuming, and have uncertain curative effects in the treatment of amblyopia. Perceptual learning, a new method for treating amblyopia, improves the ability to process signals from the cerebral optic nerve system by specific visual stimulation and visual learning, as well as activation of the visual signal pathway utilizing brain nervous system plasticity. OBJECTIVE： This study investigated and evaluated the curative effects of perceptual learning, which can directionally increase brain plasticity, on the treatment of amblyopia in children. The relationship between curative effect and time was also analyzed. DESIGN： A self-control experiment. SETTING： Visual Science and Optometry Center, People＇s Hospital of Guangxi Zhuang Autonomous Region. PARTICIPANTS： A total of 125 amblyopic children （250 amblyopic eyes）, 73 males, 52 females, averaging （6±2） years of age, received treatment at the Visual Science and Optometry Center, People＇s Hospital of Guangxi Zhuang Autonomous Region between September 2006 and February 2007 and were recruited for this study. All children presented with no structural disease of the eyeballs. Written informed consent for therapeutic regiments was obtained from each child＇s parent. The protocol received approval from the Hospital＇s Ethics Committee. METHODS： Visual function was tested with a perceptual learning system （Research Center for Human Health and Development of Sun Yat-sen University, National Engineering Technique Research Center for Medical Care Implement） for visual noise, position noise, contour discrimination, contrast sensitivity, grating stereogram, and random-dot fusion. These tests helped to evaluate the efficiency of visual information processing of these children, and to determine the degree of defects of the optic nerve cells and the connections of visual cortical neurons. According to results of visual function tests, individualized treatment was adopted for each amblyopia patient using perceptual learning system. One course of treatment lasted one month, and treatment was performed twice every day with two training procedures （each training procedure lasted for ten minutes）. There was a ten-minute time interval between the two training procedures. The training treatment was performed in a quiet and dark environment. Visual acuity and recovery of visual function were tested every month. Original training procedure was continued or adjusted according to the results of visual function. MAIN OUTCOME MEASURES： Visual function change; relationship of curative effects and curative time. RESULTS： A total of 125 amblyopia children were included in the final analysis. The total efficiency of perceptual learning for treating amblyopia in children was 75.2%. Visual acuity began to greatly increase 3 months after treatment （P 〈 0.05）. Visual acuity was best corrected from 0.60 ± 0.23 before treatment to 0.86 ± 0.26 after treatment （P 〈 0.05）. The mean time to reach improved levels with curative effects was （2.82 ± 1.30） months, and to reach a basically cured level was （2.87 ±1.40） months. Percentage of improved visual acuity was the highest [98% （39/40）] in children that received 3 months of treatment and the lowest [55% （31/56）] in children that received 1 month of treatment （P 〈 0.05）. The percentage of basically cured levels with curative effects increased with length of learning time and was the greatest in children that received 4 months of treatment [67% （31/46）, P 〈 0.05]. CONCLUSION： Perceptual learning rapidly and remarkably improves visual function of amblyopia children; however, the curative effects are first apparent two and three months after intervention.

Curative observation and the influence on the mental status of the patients with acne scars treated with pixe12940 laser

目的：了解痤疮凹陷性瘢痕患者的心理健康状况，观察Pixel 2940激光治疗痤疮凹陷性瘢痕的疗效及对患者心理健康的影响。方法：2010年10月～2012年8月，笔者科室采用Pixel 2940激光治疗痤疮瘢痕患者39例，并在治疗前和治疗结束后1月用Cardiff痤疮心理评估量表评估患者心理状况。结果：Pixel 2940激光治疗痤疮凹陷性瘢痕有效率达94．9％，副反应少而轻；痤疮影响了患者的心理健康，患者常常感到焦虑、愤怒和自信心下降等，但治疗后心理明显好转。结论：用Pixel 2940激光治疗痤疮凹陷性瘢痕疗效稳定、副反应少，可改善患者心理健康状况。

Outcome of curative resection for perihilar cholangiocarcinoma in Northeast Thailand

AIM: To examine survival outcomes of perihilar cholangiocarcinoma(PCCA) resection including mortality, morbidity and prognostic factors. METHODS: Multivariate analyses were carried out based on the survival data of all patients with histologically confirmed PCCA who underwent curative resection at Srinagarind Hospital from January 2006 to December 2011. RESULTS: There were 29(19%) cases of intrahepatic CCA that involved hilar and 124(81%) with hilar bileduct cancer. R0 resection was carried out on 66(43.1%) patients of whom 50(32.7%) also had lymph node metastasis. The other patients underwent R1 resection. The overall 5-year survival rate was 20.6%(95%CI: 13.8-28.4) and median survival time was 19.9 mo. Postoperative mortality was 2%, and 30% of patients had complications. Patients without lymph node metastasis were 60% less likely to die than those with metastasis. Achieving R0 led to a 58% reduction in the chance of mortality as compared to R1. CONCLUSION: To achieve a better survival outcome, focus should center on performing radical surgery and detection of patients with early stage cancer.

Current status and progress in laparoscopic surgery for gallbladder carcinoma

Gallbladder carcinoma(GBC)is the most common biliary tract malignancy associated with a concealed onset,high invasiveness and poor prognosis.Radical surgery remains the only curative treatment for GBC,and the optimal extent of surgery depends on the tumor stage.Radical resection can be achieved by simple cholecystectomy for Tis and T1a GBC.However,whether simple cholecystectomy or extended cholecystectomy,including regional lymph node dissection and hepatectomy,is the standard surgical extent for T1b GBC remains controversial.Extended cholecystectomy should be performed for T2 and some T3 GBC without distant metastasis.Secondary radical surgery is essential for incidental gallbladder cancer diagnosed after cholecystectomy.For locally advanced GBC,hepatopancreatoduodenectomy may achieve R0 resection and improve long-term survival outcomes,but the extremely high risk of the surgery limits its implementation.Laparoscopic surgery has been widely used in the treatment of gastrointestinal malignancies.GBC was once regarded as a contraindication of laparoscopic surgery.However,with improvements in surgical instruments and skills,studies have shown that laparoscopic surgery will not result in a poorer prognosis for selected patients with GBC compared with open surgery.Moreover,laparoscopic surgery is associated with enhanced recovery after surgery since it is minimally invasive.