BACKGROUND Laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct(CBD)exploration(LCBDE)is one of the main treatments for choledocholithiasis with CBD diameter of larger than 10 mm.However,for pat...BACKGROUND Laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct(CBD)exploration(LCBDE)is one of the main treatments for choledocholithiasis with CBD diameter of larger than 10 mm.However,for patients with small CBD(CBD diameter≤8 mm),endoscopic sphincterotomy remains the preferred treatment at present,but it also has some drawbacks associated with a series of complications,such as pancreatitis,hemorrhage,cholangitis,and duodenal perforation.To date,few studies have been reported that support the feasibility and safety of LCBDE for choledocholithiasis with small CBD.AIM To investigate the feasibility and safety of LCBDE for choledocholithiasis with small CBD.METHODS A total of 257 patients without acute cholangitis who underwent LC+LCBDE for cholecystolithiasis from January 2013 to December 2018 in one institution were reviewed.The clinical data were retrospectively collected and analyzed.According to whether the diameter of CBD was larger than 8 mm,257 patients were divided into large CBD group(n=146)and small CBD group(n=111).Propensity score matching(1:1)was performed to adjust for clinical differences.The demographics,intraoperative data,short-term outcomes,and long-term follow-up outcomes for the patients were recorded and compared.RESULTS In total,257 patients who underwent successful LC+LCBDE were enrolled in the study,146 had large CBD and 111 had small CBD.The median follow-up period was 39(14-86)mo.For small CBD patients,the median CBD diameter was 0.6 cm(0.2-2.0 cm),the mean operating time was 107.2±28.3 min,and the postoperative bile leak rate,rate of residual CBD stones(CBDS),CBDS recurrence rate,and CBD stenosis rate were 5.41%(6/111),3.60%(4/111),1.80%(2/111),and 0%(0/111),respectively;the mean postoperative hospital stay was 7.4±3.6 d.For large CBD patients,the median common bile duct diameter was 1.0 cm(0.3-3.0 cm),the mean operating time was 115.7±32.0 min,and the postoperative bile leak rate,rate of residual CBDS,CBDS recurrence rate,and CBD stenosis rate were 5.41%(9/146),1.37%(2/146),6.85%(10/146),and 0%(0/146),respectively;the mean postoperative hospital stay was 7.7±2.7 d.After propensity score matching,184 patients remained,and all preoperative covariates except diameter of CBD stones were balanced.Postoperative bile leak occurred in 11 patients overall(5.98%),and no difference was found between the small CBD group(4.35%,4/92)and the large CBD group(7.61%,7/92).The incidence of CBDS recurrence did not differ significantly between the small CBD group(2.17%,2/92)and the large CBD group(6.52%,6/92).CONCLUSION LC+LCBDE is safe and feasible for choledocholithiasis patients with small CBD and did not increase the postoperative bile leak rate compared with choledocholithiasis patients with large CBD.展开更多
The prognosis of T-cell lymphoma (TCL) has been shown to be associated with the clinical characteristics of patients. However, there is little knowledge of whether genetic variations also affect the prognosis of TCL. ...The prognosis of T-cell lymphoma (TCL) has been shown to be associated with the clinical characteristics of patients. However, there is little knowledge of whether genetic variations also affect the prognosis of TCL. This study investigated the associations between single nucleotide polymorphisms(SNPs) in tumor necrosis factor receptor superfamily(TNFRSF) genes and the survival of patients with TCL. A total of 38 tag SNPs in 18 TNFRSF genes were genotyped using Sequenom platform in 150 patients with TCL. Kaplan-Meier survival estimates were plotted and significance was assessed using log-rank tests. Cox proportional hazard models were used to analyze each of these 38 SNPs with adjustment for covariates that might influence patient survival, including sex and international prognostic Index score. Hazard ratios (HRs) and their 95% confidence intervals(CIs) were calculated. Among the 38 SNPs tested, 3 were significantly associated with the survival of patients with TCL. These SNPs were located at LTβR (rs3759333C>T) and TNFRSF17(rs2017662C>T and rs2071336C>T). The 5-year survival rates were significantly different among patients carrying different genotypes and the HRs for death between the different genotypes ranged from 0.45 to 2.46. These findings suggest that the SNPs in TNFRSF genes might be important determinants for the survival of TCL patients.展开更多
BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the ...BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the success rates,insertion time and complications associated with different techniques of NGT insertion in anesthetized and intubated patients.METHODS An electronic search of the PubMed,Scopus,CENTRAL(Cochrane Central Register of Controlled Trials),and Google Scholar databases were performed up to October 31,2019.We included 17 randomized controlled trials with 2500 participants in the meta-analysis.RESULTS As compared to the conventional method,successful insertion of the NGT on first attempt was higher with modified techniques such as the reverse Sellick’s maneuver[relative risk(RR)1.94;95%confidence interval(CI):1.62-2.31],use of a frozen NGT(RR 1.55;95%CI:1.13-2.13),inserting the NGT with neck flexion and lateral neck pressure(RR 1.64;95%CI:1.10-2.45),endotracheal tube-assisted(RR 1.88;95%CI:1.52-2.32)and video-assisted placements(RR 1.60;95%CI:1.31-1.95).All the modified techniques also led to comparatively higher insertion success rates than the conventional technique.CONCLUSION The use of modified techniques of NGT insertion such as the reverse Sellick’s maneuver,neck flexion with lateral neck pressure,frozen NGT,endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique.All modified techniques also significantly improve the overall chance of successful NGT placement as compared to the conventional method.展开更多
The direct comparison of the microstructure and tensile properties of Inconel 718 fabricated by selective laser melting (SLM) or laser metal deposition (LMD) has been carried out. In the as-built state, LMD-fabricated...The direct comparison of the microstructure and tensile properties of Inconel 718 fabricated by selective laser melting (SLM) or laser metal deposition (LMD) has been carried out. In the as-built state, LMD-fabricated specimens show lower tensile yield strength and fracture elongation than SLM-fabricated specimens due to the coarser solidification microstructure, including grains, cellular dendrites and Laves phases. This is mainly because the cooling rate of the LMD process is 2 to 3 orders lower than that of the SLM process. Upon the same heat treatment, both yield strengths of SLMand LMD-fabricated specimens are enhanced significantly. Notably, LMD-fabricated specimens exhibit simultaneous improvement in the strength and ductility, which is mainly attributed to the presence of small granular Laves phases and uniformly distributed nanoscale c00 strengthening phases. The results could serve as a guidance for selecting suitable postheat treatment routes for specific additive manufacturing process to attain excellent strength-ductility synergy.展开更多
Introduction Vulvar melanoma is the second most common vulvar malignancy and a significant health issue in women.Despite its low incidence,vulvar melanoma has a poor prognosis with a high tendency to metastasize due t...Introduction Vulvar melanoma is the second most common vulvar malignancy and a significant health issue in women.Despite its low incidence,vulvar melanoma has a poor prognosis with a high tendency to metastasize due to delayed diagnosis.Most women are postmenopausal and aged 50 to 70 years at the time of diagnosis[1].The occurrence of vulvar malignant melanoma (MM) at <30 years of age is extremely rare.We herein describe a case of primary vulvar MM in a 27-year-old woman during her first pregnancy.展开更多
文摘BACKGROUND Laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct(CBD)exploration(LCBDE)is one of the main treatments for choledocholithiasis with CBD diameter of larger than 10 mm.However,for patients with small CBD(CBD diameter≤8 mm),endoscopic sphincterotomy remains the preferred treatment at present,but it also has some drawbacks associated with a series of complications,such as pancreatitis,hemorrhage,cholangitis,and duodenal perforation.To date,few studies have been reported that support the feasibility and safety of LCBDE for choledocholithiasis with small CBD.AIM To investigate the feasibility and safety of LCBDE for choledocholithiasis with small CBD.METHODS A total of 257 patients without acute cholangitis who underwent LC+LCBDE for cholecystolithiasis from January 2013 to December 2018 in one institution were reviewed.The clinical data were retrospectively collected and analyzed.According to whether the diameter of CBD was larger than 8 mm,257 patients were divided into large CBD group(n=146)and small CBD group(n=111).Propensity score matching(1:1)was performed to adjust for clinical differences.The demographics,intraoperative data,short-term outcomes,and long-term follow-up outcomes for the patients were recorded and compared.RESULTS In total,257 patients who underwent successful LC+LCBDE were enrolled in the study,146 had large CBD and 111 had small CBD.The median follow-up period was 39(14-86)mo.For small CBD patients,the median CBD diameter was 0.6 cm(0.2-2.0 cm),the mean operating time was 107.2±28.3 min,and the postoperative bile leak rate,rate of residual CBD stones(CBDS),CBDS recurrence rate,and CBD stenosis rate were 5.41%(6/111),3.60%(4/111),1.80%(2/111),and 0%(0/111),respectively;the mean postoperative hospital stay was 7.4±3.6 d.For large CBD patients,the median common bile duct diameter was 1.0 cm(0.3-3.0 cm),the mean operating time was 115.7±32.0 min,and the postoperative bile leak rate,rate of residual CBDS,CBDS recurrence rate,and CBD stenosis rate were 5.41%(9/146),1.37%(2/146),6.85%(10/146),and 0%(0/146),respectively;the mean postoperative hospital stay was 7.7±2.7 d.After propensity score matching,184 patients remained,and all preoperative covariates except diameter of CBD stones were balanced.Postoperative bile leak occurred in 11 patients overall(5.98%),and no difference was found between the small CBD group(4.35%,4/92)and the large CBD group(7.61%,7/92).The incidence of CBDS recurrence did not differ significantly between the small CBD group(2.17%,2/92)and the large CBD group(6.52%,6/92).CONCLUSION LC+LCBDE is safe and feasible for choledocholithiasis patients with small CBD and did not increase the postoperative bile leak rate compared with choledocholithiasis patients with large CBD.
文摘The prognosis of T-cell lymphoma (TCL) has been shown to be associated with the clinical characteristics of patients. However, there is little knowledge of whether genetic variations also affect the prognosis of TCL. This study investigated the associations between single nucleotide polymorphisms(SNPs) in tumor necrosis factor receptor superfamily(TNFRSF) genes and the survival of patients with TCL. A total of 38 tag SNPs in 18 TNFRSF genes were genotyped using Sequenom platform in 150 patients with TCL. Kaplan-Meier survival estimates were plotted and significance was assessed using log-rank tests. Cox proportional hazard models were used to analyze each of these 38 SNPs with adjustment for covariates that might influence patient survival, including sex and international prognostic Index score. Hazard ratios (HRs) and their 95% confidence intervals(CIs) were calculated. Among the 38 SNPs tested, 3 were significantly associated with the survival of patients with TCL. These SNPs were located at LTβR (rs3759333C>T) and TNFRSF17(rs2017662C>T and rs2071336C>T). The 5-year survival rates were significantly different among patients carrying different genotypes and the HRs for death between the different genotypes ranged from 0.45 to 2.46. These findings suggest that the SNPs in TNFRSF genes might be important determinants for the survival of TCL patients.
文摘BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the success rates,insertion time and complications associated with different techniques of NGT insertion in anesthetized and intubated patients.METHODS An electronic search of the PubMed,Scopus,CENTRAL(Cochrane Central Register of Controlled Trials),and Google Scholar databases were performed up to October 31,2019.We included 17 randomized controlled trials with 2500 participants in the meta-analysis.RESULTS As compared to the conventional method,successful insertion of the NGT on first attempt was higher with modified techniques such as the reverse Sellick’s maneuver[relative risk(RR)1.94;95%confidence interval(CI):1.62-2.31],use of a frozen NGT(RR 1.55;95%CI:1.13-2.13),inserting the NGT with neck flexion and lateral neck pressure(RR 1.64;95%CI:1.10-2.45),endotracheal tube-assisted(RR 1.88;95%CI:1.52-2.32)and video-assisted placements(RR 1.60;95%CI:1.31-1.95).All the modified techniques also led to comparatively higher insertion success rates than the conventional technique.CONCLUSION The use of modified techniques of NGT insertion such as the reverse Sellick’s maneuver,neck flexion with lateral neck pressure,frozen NGT,endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique.All modified techniques also significantly improve the overall chance of successful NGT placement as compared to the conventional method.
基金support by the National Natural Science Foundation of China(U1830i21 and 11988102)National Science and Technology Major Project(2017-VI-0003-0073).
文摘The direct comparison of the microstructure and tensile properties of Inconel 718 fabricated by selective laser melting (SLM) or laser metal deposition (LMD) has been carried out. In the as-built state, LMD-fabricated specimens show lower tensile yield strength and fracture elongation than SLM-fabricated specimens due to the coarser solidification microstructure, including grains, cellular dendrites and Laves phases. This is mainly because the cooling rate of the LMD process is 2 to 3 orders lower than that of the SLM process. Upon the same heat treatment, both yield strengths of SLMand LMD-fabricated specimens are enhanced significantly. Notably, LMD-fabricated specimens exhibit simultaneous improvement in the strength and ductility, which is mainly attributed to the presence of small granular Laves phases and uniformly distributed nanoscale c00 strengthening phases. The results could serve as a guidance for selecting suitable postheat treatment routes for specific additive manufacturing process to attain excellent strength-ductility synergy.
文摘Introduction Vulvar melanoma is the second most common vulvar malignancy and a significant health issue in women.Despite its low incidence,vulvar melanoma has a poor prognosis with a high tendency to metastasize due to delayed diagnosis.Most women are postmenopausal and aged 50 to 70 years at the time of diagnosis[1].The occurrence of vulvar malignant melanoma (MM) at <30 years of age is extremely rare.We herein describe a case of primary vulvar MM in a 27-year-old woman during her first pregnancy.
