BACKGROUND： Major complications after pancreaticoduo- denectomy are usually caused by a leaking pancreaticojejunal anastomosis. Omental flaps around various anastomoses were used to prevent the formation of fistula.
BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to...BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduo-denectomy (PD) from an individual unit during transit from low to a high volume center. METHODS: A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received convention-al surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postopera-tive recovery, length of hospital stay and patient readmission requirement. RESULTS: The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally (7.8 vs 12.1 days). The intraoperative events like operative blood loss (417.9±83.8 vs 997.4 ±151.8 mL, P<0.001), blood transfused (a median of 0 vs 1 unit,P<0.001) and operative time taken (125 vs 245 minutes,P<0.001) were signiifcantly lower in the fast track group. The frequency of pancreatic ifstula (4.9% vs 13.0%) and delayed gastric empty-ing (7.0% vs 17.4%) was also signiifcantly reduced with fast track treatment. Nevertheless, the readmission rate (11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol. CONCLUSIONS: This preliminary analysis suggests that the fast track approach might be beneifcial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and signiifcantly shortens their length of hospital stay.展开更多
BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary...BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.展开更多
AIM To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy(PD) on surgical outcome.METHODS A retrospective collection of data was done for patients who under...AIM To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy(PD) on surgical outcome.METHODS A retrospective collection of data was done for patients who underwent PD.According to the number of PDs undertaken per year,we categorized the volume into low volume(< 10 PDs/year),medium volume(10-24 PDs/year) and high volume(> 25 PDs/year) groups.RESULTS From 2002 to 2013,200 patients underwent PD.The annual number of PD increased from 4 in 2002 to 34 in 2013.The mean operative time,operative blood loss and need for intraoperative blood transfusion decreased considerably over the volume categories(P < 0.001,P < 0.001 and P < 0.001,respectively).Increased procedural volume was associated with a lower morbidity(P = 0.021) and shorter length of hospital stay(P < 0.001).Similarly the rate of mortality dropped from 10% for the low volume group to 2.2% for the medium volume group and 0.0% for the high volume group(P = 0.007).CONCLUSION The transformation from a low volume to a high volume provider of PD resulted in most favourable outcomes favouring the continued centralization of this high risk procedure.展开更多
The advent of mass vaccination has saved millions of human lives and revolutionized the quality of life. Vaccination is currently one of the most cost effective ways of managing healthcare costs in both emerging and d...The advent of mass vaccination has saved millions of human lives and revolutionized the quality of life. Vaccination is currently one of the most cost effective ways of managing healthcare costs in both emerging and developed countries. Despite the long vaccine history and success, design and development of efficacious and safe vaccines has been tradi-tionally semi-empirical. This is mainly due to our limited understanding of vaccination mechanism and its influencing factors. The most important factor is arguably the type and concentration of vaccine adjuvants. Until recently, however, only one type of adjuvant – aluminum salts, had been widely used within licensed human vaccines in the US, even though a variety of novel adjuvants have been evaluated in the past few decades. This review summarizes the key adju-vants that have been evaluated in recent years with an intention to facilitate more efficient development of vaccine products to combat human diseases.展开更多
Radioactivity of the nuclides 238U, 226Ra, 232Th and 40K was measured in soil by γ-ray spectrometry using HPGe detector. A criterion was set in order to analyse soil samples from plain, semi-hilly and hilly areas in ...Radioactivity of the nuclides 238U, 226Ra, 232Th and 40K was measured in soil by γ-ray spectrometry using HPGe detector. A criterion was set in order to analyse soil samples from plain, semi-hilly and hilly areas in northern India. More than three γ-ray energy peaks were used for the determination of 226Ra and 232Th activity concentrations to obtain more accurate results. Some of these peaks have interfering energies, which was caused by the limited resolution of the detector, but they were resolved theoretically and used in the analysis because of their significance in reducing the random error to its minimum level. Relationships between the measured radionuclides have been discussed elaborately. Radionuclides 238U and 226Ra were found in disequilibrium with ratio of specific activities 238U/, 226Ra) less than unity for most of the samples. In some cases this disequilibrium may be significant enough to modify the γ-ray dose factors.展开更多
2008年全球金融危机后,国际社会愈发重视金融担保品在维护金融稳定中发挥的重要作用,新兴市场证券逐步走入国际视野。在此背景下,2021年,国际货币基金组织(IMF)发表了工作论文《新兴市场证券加入全球金融管网》(Emerging Market Securit...2008年全球金融危机后,国际社会愈发重视金融担保品在维护金融稳定中发挥的重要作用,新兴市场证券逐步走入国际视野。在此背景下,2021年,国际货币基金组织(IMF)发表了工作论文《新兴市场证券加入全球金融管网》(Emerging Market Securities Access to Global Plumbing),从金融担保品跨境转移的经济学视角,提出了对促进新兴市场证券加入全球金融管网的思考和建议。中央结算公司征得IMF授权,翻译该论文,希望为人民币债券担保品加入全球金融管网带来启发。展开更多
Optical coherence tomography(OCT)is a widely used non-invasive biomedical imaging modality that can rapidly provide volumetric images of samples.Here,we present a deep learning-based image reconstruction framework tha...Optical coherence tomography(OCT)is a widely used non-invasive biomedical imaging modality that can rapidly provide volumetric images of samples.Here,we present a deep learning-based image reconstruction framework that can generate swept-source OCT(SS-OCT)images using undersampled spectral data,without any spatial aliasing artifacts.This neural network-based image reconstruction does not require any hardware changes to the optical setup and can be easily integrated with existing swept-source or spectral-domain OCT systems to reduce the amount of raw spectral data to be acquired.To show the efficacy of this framework,we trained and blindly tested a deep neural network using mouse embryo samples imaged by an SS-OCT system.Using 2-fold undersampled spectral data(i.e.,640 spectral points per A-line),the trained neural network can blindly reconstruct 512 A-lines in 0.59 ms using multiple graphics-processing units(GPUs),removing spatial aliasing artifacts due to spectral undersampling,also presenting a very good match to the images of the same samples,reconstructed using the full spectral OCT data(i.e.,1280 spectral points per A-line).We also successfully demonstrate that this framework can be further extended to process 3×undersampled spectral data per A-line,with some performance degradation in the reconstructed image quality compared to 2×spectral undersampling.Furthermore,an A-line-optimized undersampling method is presented by jointly optimizing the spectral sampling locations and the corresponding image reconstruction network,which improved the overall imaging performance using less spectral data points per A-line compared to 2×or 3×spectral undersampling results.This deep learning-enabled image reconstruction approach can be broadly used in various forms of spectral-domain OCT systems,helping to increase their imaging speed without sacrificing image resolution and signal-to-noise ratio.展开更多
文摘BACKGROUND： Major complications after pancreaticoduo- denectomy are usually caused by a leaking pancreaticojejunal anastomosis. Omental flaps around various anastomoses were used to prevent the formation of fistula.
文摘BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduo-denectomy (PD) from an individual unit during transit from low to a high volume center. METHODS: A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received convention-al surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postopera-tive recovery, length of hospital stay and patient readmission requirement. RESULTS: The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally (7.8 vs 12.1 days). The intraoperative events like operative blood loss (417.9±83.8 vs 997.4 ±151.8 mL, P<0.001), blood transfused (a median of 0 vs 1 unit,P<0.001) and operative time taken (125 vs 245 minutes,P<0.001) were signiifcantly lower in the fast track group. The frequency of pancreatic ifstula (4.9% vs 13.0%) and delayed gastric empty-ing (7.0% vs 17.4%) was also signiifcantly reduced with fast track treatment. Nevertheless, the readmission rate (11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol. CONCLUSIONS: This preliminary analysis suggests that the fast track approach might be beneifcial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and signiifcantly shortens their length of hospital stay.
文摘BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.
文摘AIM To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy(PD) on surgical outcome.METHODS A retrospective collection of data was done for patients who underwent PD.According to the number of PDs undertaken per year,we categorized the volume into low volume(< 10 PDs/year),medium volume(10-24 PDs/year) and high volume(> 25 PDs/year) groups.RESULTS From 2002 to 2013,200 patients underwent PD.The annual number of PD increased from 4 in 2002 to 34 in 2013.The mean operative time,operative blood loss and need for intraoperative blood transfusion decreased considerably over the volume categories(P < 0.001,P < 0.001 and P < 0.001,respectively).Increased procedural volume was associated with a lower morbidity(P = 0.021) and shorter length of hospital stay(P < 0.001).Similarly the rate of mortality dropped from 10% for the low volume group to 2.2% for the medium volume group and 0.0% for the high volume group(P = 0.007).CONCLUSION The transformation from a low volume to a high volume provider of PD resulted in most favourable outcomes favouring the continued centralization of this high risk procedure.
文摘The advent of mass vaccination has saved millions of human lives and revolutionized the quality of life. Vaccination is currently one of the most cost effective ways of managing healthcare costs in both emerging and developed countries. Despite the long vaccine history and success, design and development of efficacious and safe vaccines has been tradi-tionally semi-empirical. This is mainly due to our limited understanding of vaccination mechanism and its influencing factors. The most important factor is arguably the type and concentration of vaccine adjuvants. Until recently, however, only one type of adjuvant – aluminum salts, had been widely used within licensed human vaccines in the US, even though a variety of novel adjuvants have been evaluated in the past few decades. This review summarizes the key adju-vants that have been evaluated in recent years with an intention to facilitate more efficient development of vaccine products to combat human diseases.
文摘Radioactivity of the nuclides 238U, 226Ra, 232Th and 40K was measured in soil by γ-ray spectrometry using HPGe detector. A criterion was set in order to analyse soil samples from plain, semi-hilly and hilly areas in northern India. More than three γ-ray energy peaks were used for the determination of 226Ra and 232Th activity concentrations to obtain more accurate results. Some of these peaks have interfering energies, which was caused by the limited resolution of the detector, but they were resolved theoretically and used in the analysis because of their significance in reducing the random error to its minimum level. Relationships between the measured radionuclides have been discussed elaborately. Radionuclides 238U and 226Ra were found in disequilibrium with ratio of specific activities 238U/, 226Ra) less than unity for most of the samples. In some cases this disequilibrium may be significant enough to modify the γ-ray dose factors.
文摘2008年全球金融危机后,国际社会愈发重视金融担保品在维护金融稳定中发挥的重要作用,新兴市场证券逐步走入国际视野。在此背景下,2021年,国际货币基金组织(IMF)发表了工作论文《新兴市场证券加入全球金融管网》(Emerging Market Securities Access to Global Plumbing),从金融担保品跨境转移的经济学视角,提出了对促进新兴市场证券加入全球金融管网的思考和建议。中央结算公司征得IMF授权,翻译该论文,希望为人民币债券担保品加入全球金融管网带来启发。
基金The Ozcan Lab at UCLA acknowledges the support of NSF and HHMI.The Larin Lab at UH acknowledges the support of NIH(R01AA028406,R01HD096335,R01EB027099,and R01HL146745).
文摘Optical coherence tomography(OCT)is a widely used non-invasive biomedical imaging modality that can rapidly provide volumetric images of samples.Here,we present a deep learning-based image reconstruction framework that can generate swept-source OCT(SS-OCT)images using undersampled spectral data,without any spatial aliasing artifacts.This neural network-based image reconstruction does not require any hardware changes to the optical setup and can be easily integrated with existing swept-source or spectral-domain OCT systems to reduce the amount of raw spectral data to be acquired.To show the efficacy of this framework,we trained and blindly tested a deep neural network using mouse embryo samples imaged by an SS-OCT system.Using 2-fold undersampled spectral data(i.e.,640 spectral points per A-line),the trained neural network can blindly reconstruct 512 A-lines in 0.59 ms using multiple graphics-processing units(GPUs),removing spatial aliasing artifacts due to spectral undersampling,also presenting a very good match to the images of the same samples,reconstructed using the full spectral OCT data(i.e.,1280 spectral points per A-line).We also successfully demonstrate that this framework can be further extended to process 3×undersampled spectral data per A-line,with some performance degradation in the reconstructed image quality compared to 2×spectral undersampling.Furthermore,an A-line-optimized undersampling method is presented by jointly optimizing the spectral sampling locations and the corresponding image reconstruction network,which improved the overall imaging performance using less spectral data points per A-line compared to 2×or 3×spectral undersampling results.This deep learning-enabled image reconstruction approach can be broadly used in various forms of spectral-domain OCT systems,helping to increase their imaging speed without sacrificing image resolution and signal-to-noise ratio.
