Diagnostic performance of the current risk-stratified approach with computed tomography for suspected choledocholithiasis and its options when negative finding

Background:Several studies evaluated the current guideline of the American Society for Gastrointestinal Endoscopy(ASGE)and reported only suboptimal accuracy.This study evaluated the diagnostic performance of the ASGE guideline based on computed tomography(CT)and role of endoscopic ultrasonography(EUS)and magnetic resonance cholangiopancreatography(MRCP)in patients with suspected choledocholithiasis but negative CT finding.Methods:Patients with suspected choledocholithiasis undergoing ERCP between January 2016 and January 2017 were retrospectively analyzed.All patients underwent CT to detect choledocholithiasis.EUS or MRCP was performed when the CT scan showed negative findings.Patients were classified into the high and intermediate-risk groups,based on predictors from the ASGE criteria.Results:Of 583 patients with suspected choledocholithiasis,340(58.3%)had stones on ERCP(65.9%in the high-risk group and 40.6%in the intermediate-risk group).The accuracy of ASGE guideline for CT was 63.98%(79.12%sensitivity,42.80%specificity)and 36.02%(20.88%sensitivity,57.20%specificity)in the high-risk and intermediate-risk groups,respectively.In 103 patients in the high-risk group underwent both CT and US,the accuracy of CT was higher than that of US for detecting choledocholithiasis(78.64%vs.53.40%),with a significant difference in area under the curve(AUC)(0.78 vs.0.59,P<0.001).Of 339 with negative CT finding,the accuracy of EUS was higher than that of MRCP(90.91%vs.82.76%),but with no significant difference in AUC(0.91 vs.0.83,P=0.347).Conclusions:CT-based ASGE guideline showed superior diagnostic performance than US for predicting choledocholithiasis.The diagnostic options,EUS or MRCP,with negative CT finding showed comparable performance.Therefore,the diagnostic modality should be selected based on availability,experience,cost,and contraindications.

Etching characteristics of thin SiON films using a liquefied perfluorocarbon precursor of C_6F_(12)O with a low global warming potential

Perfluorocarbon gas is widely used in the semiconductor industry.However,perfluorocarbon has a negative effect on the global environment owing to its high global warming potential(GWP) value.An alternative solution is essential.Therefore,we evaluated the possibility of replacing conventional perfluorocarbon etching gases such as CHF_3 with C_6F_(12)O,which has a low GWP and is in a liquid state at room temperature.In this study,silicon oxynitride(SiON) films were plasma-etched using inductively coupled CF4+C_6F_(12)O+O_2 mixed plasmas.Subsequently,the etching characteristics of the film,such as etching rate,etching profile,selectivity over Si,and photoresist,were investigated.A double Langmuir probe was used and optical emission spectroscopy was performed for plasma diagnostics.In addition,a contact angle goniometer and x-ray photoelectron spectroscope were used to confirm the change in the surface properties of the etched SiON film surface.Consequently,the etching characteristics of the C_6F_(12)O mixed plasma exhibited a lower etching rate,higher SiON/Si selectivity,lower plasma damage,and more vertical etched profiles than the conventional CHF_3 mixed plasma.In addition,the C_6F_(12)O gas can be recovered in the liquid state,thereby decreasing global warming.These results confirmed that the C_6F_(12)O precursor can sufficiently replace the conventional etching gas.

减量FOLFIRINOX方案挽救性治疗吉西他滨抵抗的晚期胰腺癌:一项Ⅱ期研究

背景与目的奥沙利铂、伊立替康、氟尿嘧啶和亚叶酸的联合化疗方案(FOLFIRINOX)极大提高了晚期胰腺癌患者的生存期。然而,FOLFIRINOX方案作为吉西他滨失败后二线治疗的疗效尚未进行前瞻性的检测。我们研究了减量FOLFIRINOX方案治疗吉西他滨抵抗的晚期胰腺癌患者的可行性和安全性。方法在14家医院进行了这一多中心II期前瞻、开放标签的单臂研究。经组织学确诊为胰腺浸润性导管腺癌、有可测量或可评价的病灶、东部肿瘤协作组体能状况评分0或1分、器官功能良好、年龄19岁或以上的患者符合入组条件。减量FOLFIRINOX方案的组成:奥沙利铂65 mg/m2、伊立替康135 mg/m2和亚叶酸400 mg/m2,第1天静脉注射;5?氟尿嘧啶2000 mg/m2,第1–2天持续静脉输注46 h;每2周重复。主要终点为FOLIFLIOX治疗起始后的无进展生存期。次要终点为客观缓解率、疾病控制率、总生存期、安全性和耐受性。采用Kaplan?Meier法评估了总生存期和无进展生存期。结果我们招募了来自14个中心的39例患者。客观缓解率为10.3%,疾病控制率为64.1%。6个月和1年总生存率分别为59.0%和15.4%。中位无进展生存期和总生存期分别为3.8个月[95%置信区间(confidence interval,CI)=1.5–6.0个月]和8.5个月(95%CI=5.6–11.4个月)。3或4级不良事件为中性粒细胞减少(41%)、恶心(10.3%)、食欲减退(10.3%)、贫血(7.7%)、黏膜炎(7.7%)、肺炎/胸膜融合(5.1%)和乏力(5.1%)。发生1例由感染性休克引起的治疗相关死亡。结论减量FOLFIRINOX方案有望作为二线方案治疗吉西他滨抵抗的胰腺癌。

Probability Control for Verification of an Event Report Using Fuzzy System

Sensor networks include numerous sensor nodes that are vulnerable to physical attacks from the outside because they operate in open environments. The sensor nodes are compromised by an attacker. The compromised nodes generate false reports and inject the reports into sensor networks. The false report injection attacks deplete energy of the sensor nodes. Ye et al. proposed Statistical En-Route Filtering (SEF) to defend sensor nodes against the false report injection attacks. In SEF, sensor nodes verify the event reports based on a fixed probability. Thus, the verification energy of a node is the same whether the report is false or valid. But when there are few false reports, energy for verifying legitimate reports may be wasted. In this paper, we propose a method in which each node controls a probability of attempts at verification of an event report to reduce the wasted energy. The probability is determined through consideration of the number of neighboring nodes, the number of hops from the node to the sink node, and the rate of false reports among the 10 most recent event reports forwarded to a node. We simulated our proposed method to prove its energy efficiency. After the simulation, we confirmed that the proposed method is more efficient than SEF for saving sensor node’s energy.

An Effective Control Report Based Security Countermeasure against the Joint Attacks of False Report Injection Attack and Selective Forwarding Attack

Sensor networks are vulnerable to many attacks because the sensor networks operate in open environments. It is easy to incur one or more attacks such as a selective forwarding attack, a false report injection attack. It is hard to defend the sensor network from the multiple attacks through existing security methods. Thus, we suggest an energy-efficient security method in order to detect the multiple attacks. This paper presents a security method to detect the false report injection attack and the selective forwarding attack in the sensor network using a new message type. The message type is a filtering message. The filtering message prevents from generating and forwarding false alert messages. We evaluated performance of our proposed method through a simulation in comparison with an application of SEF (statistical enroute filtering scheme) and CHEMAS (Check point-based Multi-hop Acknowledgement Scheme). The simulation results represent that the proposed method is 10% more energy-efficient than the application when the number of false reports is great while retaining the detection performance.

Two distinct subpopulations of marginal zone B cells exhibit differential antibody-producing capacities and radioresistance

Marginal zone(MZ)B cells,which are splenic innate-like B cells that rapidly secrete antibodies(Abs)against blood-borne pathogens,are composed of heterogeneous subpopulations.Here,we showed that MZ B cells can be divided into two distinct subpopulations according to their CD80 expression levels.CD80^(high)MZ B cells exhibited greater Ab-producing,proliferative,and IL-10-secreting capacities than did CD80^(low)MZ B cells.Notably,CD80^(high)MZ B cells survived 2-Gy whole-body irradiation,whereas CD80^(low)MZ B cells were depleted by irradiation and then repleted with one month after irradiation.Depletion of CD80^(low)MZ B cells led to accelerated development of type II collagen(CII)-induced arthritis upon immunization with bovine CII.CD80^(high)MZ B cells exhibited higher expression of genes involved in proliferation,plasma cell differentiation,and the antioxidant response.CD80^(high)MZ B cells expressed more autoreactive B cell receptors(BCRs)that recognized double-stranded DNA or CII,expressed more immunoglobulin heavy chain sequences with shorter complementarity-determining region 3 sequences,and included more clonotypes with no N-nucleotides or with B-1a BCR sequences than CD80^(low)MZ B cells.Adoptive transfer experiments showed that CD21^(+)CD23^(+)transitional 2 MZ precursors preferentially generated CD80^(low)MZ B cells and that a proportion of CD80^(low)MZ B cells were converted into CD80^(high)MZ B cells;in contrast,CD80^(high)MZ B cells stably remained CD80^(high)MZ B cells.In summary,MZ B cells can be divided into two subpopulations according to their CD80 expression levels,Ab-producing capacity,radioresistance,and autoreactivity,and these findings may suggest a hierarchical composition of MZ B cells with differential stability and BCR specificity.

Attenuated FOLFIRINOX in the salvage treatment of gemcitabine-refractory advanced pancreatic cancer: a phase II study

Background:Combination therapy with oxaliplatin,irinotecan,fluorouracil,and leucovorin(FOLFIRINOX)chemotherapy drastically improves survival of advanced pancreatic cancer patients.However,the efficacy of FOLFIRINOX as a second-line treatment after gemcitabine failure has not been tested prospectively.We investigated the feasibility and safety of attenuated FOLFIRINOX in patients with gemcitabine-refractory advanced pancreatic cancer.Methods:A multicenter phase II prospective open-label,single-arm study was conducted at 14 hospitals.Patients with histologically proven invasive ductal pancreatic adenocarcinoma,a measurable or evaluable lesion,Eastern Cooperative Oncology Group performance status 0 or 1,adequate organ function,and aged 19 years or older were eligible.Attenuated FOLFIRINOX consisted of oxaliplatin 65 mg/m2,irinotecan 135 mg/m2,and leucovorin 400 mg/m2 injected intravenously on day 1 and 5-fluorouracil 2000 mg/m2 continuously infused intravenously over 46 h on days 1-2,repeated every 2 weeks.The primary endpoint was progression-free survival from the initiation of FOLFIRINOX.Secondary endpoints were the objective response rate,disease control rate,overall survival,safety,and tolerability.We estimated overall survival and progression-free survival using the Kaplan-Meier methods.Results:We enrolled 39 patients from 14 institutions.The objective response rate was 10.3%,while the disease control rate was 64.1%.The 6-month and 1-year overall survival rates were 59.0%and 15.4%,respectively.Median progression-free survival and overall survival were 3.8 months(95%confidence interval[CI]1.5-6.0 months)and 8.5 months(95%CI 5.6-11.4 months),respectively.Grade 3 or 4 adverse events were neutropenia(41.0%),nausea(10.3%),anorexia(10.3%),anemia(7.7%),mucositis(7.7%),pneumonia/pleural effusion(5.1%),and fatigue(5.1%).One treatment-related death attributable to septic shock occurred.Conclusion:Attenuated FOLFIRINOX may be promising as a second-line therapy for gemcitabine-refractory pancre-atic cancer.

Improving construction work zone safety using technology:A systematic review of applicable technologies

Once considered conventional,the construction industry is gradually increasing its reliance on innovations such as the application of technologies in safety management.Given the growing literature on technology applications in safety management and the varying opinions on the utility of applied technologies,a systematic review that streamlines findings from past studies is indispensable to construction stakeholders.Although a number of review studies are available in the building construction sector,the level of fragmentation and uniqueness within the construction industry necessitates a review study specifically targeting the heavy civil sector.In response,the present study applies a three-step approach to identify and review articles pertinent to the safety of highway construction work zones.The factors considered include the number of publications per year,publication locations,and technology types.In addition,the present study proposes to broadly group work zone safety technologies(WZSTs)into three categories based on their primary purpose:speed reduction systems,intrusion prevention and warning systems,and human-machine-interaction detection systems.Key findings include WZST research trends,application of smart work zone systems,and the potential relationship between WZSTs and fatalities.The paper ends with the identification of six additional research areas aimed at deepening the understanding of technology’s role in highway safety management.The trend analysis and an in-depth discussion of each technology category alongside the identified research gaps will provide a substantial informative body of knowledge that both benefits current practitioners and directs researchers towards potential future studies.