Early complications after interventions in patients with acute pancreatitis

AIM: To identify the possible predictors of early complications after the initial intervention in acute necrotizing pancreatitis.METHODS: We collected the medical records of 334 patients with acute necrotizing pancreatitis who received initial intervention in our center. Complications associated with predictors were analyzed.RESULTS: The postoperative mortality rate was 16% (53/334). Up to 31% of patients were successfully treated with percutaneous catheter drainage alone. The rates of intra-abdominal bleeding, colonic fistula, and progressive infection were 15% (50/334), 20% (68/334), and 26% (87/334), respectively. Multivariate analysis indicated that Marshall score upon admission, multiple organ failure, preoperative respiratory infection, and sepsis were the predictors of postoperative progressive infection (P < 0.05). Single organ failure, systemic inflammatory response syndrome upon admission, and C-reactive protein level upon admission were the risk factors of postoperative colonic fistula (P < 0.05). Moreover, preoperative Marshall score, organ failure, sepsis, and preoperative systemic inflammatory response syndrome were the risk factors of postoperative intra-abdominal bleeding (P < 0.05).CONCLUSION: Marshall score, organ failures, preoperative respiratory infection, sepsis, preoperative systemic inflammatory response syndrome, and C-reactive protein level upon admission are associated with postoperative complications.

Consecutive laparoscopic gallbladder and spleen resections in cirrhotic patients

AIM:To evaluate the feasibility,safety,and effectiveness of consecutive laparoscopic cholecystectomy(LC)plus splenectomy(LS)in liver cirrhosis patients.METHODS:From 2003 to 2013,17(group 1)patients with liver cirrhosis complicated by hypersplenism and symptomatic gallstones were treated with combined LC and LS,while 58(group 2)patients with liver cirrhosis and hypersplenism received LS alone.An additional 14(group 3)patients who received traditional open procedures during the same period were included as controls.Data were retrospectively collected and reviewed in regard to demographic characteristics and preoperative,intraoperative and postoperative features.Differences between the three groups were assessed by statistical analysis.RESULTS:The three groups showed no significant differences in the demographic characteristics or preoperative status.However,the patients treated with LC and LS required significantly longer operative time,shorter postoperative stay as well as shorter time of return to the first oral intake,and suffered less intraoperative blood loss as well as fewer postoperative surgical infections than the patients treated with traditional open procedures(group 1 vs group 3,P<0.05 for all).The patients treated with LC and LS showed no significant differences in the intraoperative and postoperative variables from those treated with LS alone(group 1 vs group 2).All patients showed significant improvements in the haematological responses(preoperative period vs postoperative period,P<0.05 for all).None of the patients treated with LC and LS presented with any gallstone-associated symptoms following discharge,while the patients treated with the traditional open procedures expressed complaints of discomfort related to their surgical incisions.CONCLUSION:Consecutive LC and LS is an appropriate treatment option for liver cirrhosis patients with gallstones and hypersplenism,especially for those with Child-Pugh A and B.

Effects of prostaglandin E combined with continuous renal replacement therapy on septic acute kidney injury

BACKGROUND The effects of prostaglandin E(PGE)combined with continuous renal replacement therapy(CRRT)on renal function and inflammatory responses in patients with septic acute kidney injury(SAKI)remain unclear.AIM To investigate the effects of PGE combined with CRRT on urinary augmenter of liver regeneration(ALR),urinary Na+/H+exchanger 3(NHE3),and serum inflammatory cytokines in patients with SAKI.METHODS The clinical data of 114 patients with SAKI admitted to Yichang Second People's Hospital from May 2017 to January 2019 were collected.Fifty-three cases treated by CRRT alone were included in a control group,while the other 61 cases treated with PGE combined with CRRT were included in an experimental group.Their urinary ALR,urinary NHE3,serum inflammatory cytokines,renal function indices,and immune function indices were detected.Changes in disease recovery and the incidence of adverse reactions were observed.The 28-d survival curve was plotted.RESULTS Before treatment,urinary ALR,urinary NHE3,blood urea nitrogen(BUN),serum creatinine(SCr),CD3+T lymphocytes,CD4+T lymphocytes,and CD4+/CD8+T lymphocyte ratio in the control and experimental groups were approximately the same.After treatment,urinary ALR and NHE3 decreased,while BUN,SCr,CD3+T lymphocytes,CD4+T lymphocytes,and CD4+/CD8+T lymphocyte ratio increased in all subjects.Urinary ALR,urinary NHE3,BUN,and SCr in the experimental group were significantly lower than those in the control group,while CD3+T lymphocytes,CD4+T lymphocytes,and CD4+/CD8+T lymphocyte ratio were significantly higher than those in the control group(P<0.05).After treatment,the levels of tumor necrosis factor-α,interleukin-18,and high sensitivity C-reactive protein in the experimental group were significantly lower than those in the control group(P<0.05).The time for urine volume recovery and intensive care unit treatment in the experimental group was significantly shorter than that in the control group(P<0.05),although there was no statistically significant difference in hospital stays between the two groups.The total incidence of adverse reactions did not differ statistically between the two groups.The 28-d survival rate in the experimental group(80.33%)was significantly higher than that in the control group(66.04%).CONCLUSION PGE combined with CRRT is clinically effective for treating SAKI,and the combination therapy can significantly improve renal function and reduce inflammatory responses.

Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl_4-induced liver fibrosis

AIM To investigate the diagnostic performance of liver stiffness measurement(LSM) by elastography point quantification(Elast PQ) in animal models and determine the longitudinal changes in liver stiffness by Elast PQ after splenectomy at different stages of fibrosis.METHODS Liver stiffness was measured in sixty-eight rabbits with CCl4-induced liver fibrosis at different stages and eight healthy control rabbits by Elast PQ. Liver biopsies and blood samples were obtained at scheduled time points to assess liver function and degree of fibrosis. Thirty-one rabbits with complete data that underwent splenectomy at different stages of liver fibrosis were then included for dynamic monitoring of changes in liver stiffness by Elast PQ and liver function according to blood tests.RESULTS LSM by Elast PQ was significantly correlated with histologic fibrosis stage(r = 0.85, P < 0.001). The optimal cutoff values by Elast PQ were 11.27, 14.89, and 18.21 k Pa for predicting minimal fibrosis, moderate fibrosis, and cirrhosis, respectively. Longitudinalmonitoring of the changes in liver stiffness by Elast PQ showed that early splenectomy(especially F1) may delay liver fibrosis progression.CONCLUSION Elast PQ is an available, convenient, objective and non-invasive technique for assessing liver stiffness in rabbits with CCl4-induced liver fibrosis. In addition, liver stiffness measurements using Elast PQ can dynamically monitor the changes in liver stiffness in rabbit models, and in patients, after splenectomy.

Internal and near-surface fields for a chiral sphere under arbitrary laser beam illumination

A general scheme for the investigation of scattering by a chiral sphere under arbitrary monochromatic laser beam illumination is presented. The scattered and internal fields are expanded by using appropriate spherical vector wave functions, and their expansion coefficients are determined by the boundary conditions and the projection method. Targeting multiple incidence forms such as Gaussian beam, Hermite–Gaussian beam, doughnut mode beam and zero-order Bessel beam, the influence and propagation of near-surface intensity field for a chiral sphere are analyzed. These properties are very important for studying the properties of chiral media, and for manipulating the optical tweezers and super-resolution imaging of particles.

Propagation of shaped beam through uniaxially anisotropic chiral slab

A general solution is obtained to a canonical problem of the reflection and refraction of an arbitrary shaped beam by using a uniaxially anisotropic chiral slab.The reflected,internal as well as refracted shaped beams are expanded in terms of cylindrical vector wave functions,and the expansion coefficients are determined by using the boundary conditions and method of moments procedure.As two typical examples,the normalized field intensity distributions are evaluated for a fundamental Gaussian beam and Hermite-Gaussian beam,and some propagation properties,especially the negative refraction phenomenon,are discussed briefly.

Strong chirality in twisted bilayerα-MoO_(3)

Chiral structures are promising in many applications,such as biological sensing and analytical chemistry,and have been extensively explored.In this paper,we theoretically investigate the chiral response of twisted bilayerα-MoO_(3).Firstly,the analytical formula for the transmissivity is derived when the structure is illuminated with circularly polarized plane waves.Furthermore,the results demonstrate that the twisted bilayerα-MoO_(3)can excite the strong chirality with the maximum circular dichroism(CD)of 0.89.In this case,the chirality is due to the simultaneous breaking the rotational symmetry and mirror symmetry,which originates from the relative rotation of twoα-MoO_(3)layers.To better understand the physical mechanism,the polarization conversion between the left-hand circular polarization(LCP)and right-hand circular polarization(RCP)waves is discussed as well.Moreover,it is found that the structure can maintain the strong chirality(CD>0.8)when the twisted angle varies from 69°to 80°,which effectively reduces the strictness in the requirement for rotation angle.In addition,the CD can be larger than 0.85 when the incidence angle of circularly polarized plane wave is less than 40°,implying that the chirality is robust against the angle of incidence.Our work not only provides an insight into chirality induced by the twisted bilayerα-MoO_(3),but also looks forward to applications in biolo gical sensing.

The property of rayleigh scattering for an anisotropic dielectric ellipsoid

The distribution of electric field of an anisotropic dielectric elliptic sphere is presented by reforming both the electromagnetic parameter and shape parameter of this ellipsoid based on the scales transformation of electromagnetic theory. The obtained results are tested. The RCS of the anisotropic target is developed. Simulations show that the direction of incident electric field and the dielectric constant tensor influences RCS remarkably but the target’ size doesn’t have a great effect on it. The obtained results have some significance in the research of electromagnetic scattering by a complicated anisotropic target.

Hidden feature extraction for unstructured agricultural environment based on supervised kernel locally linear embedding modeling

An online hidden feature extraction algorithm is proposed for unknown and unstructured agricultural environments based on a supervised kernel locally linear embedding (SKLLE) algorithm. Firstly, an online obtaining method for scene training samples is given to obtain original feature data. Secondly, Bayesian estimation of the a posteriori probability of a cluster center is performed. Thirdly, nonlinear kernel mapping function construction is employed to map the original feature data to hyper-high dimensional kernel space. Fourthly, the automatic deter mination of hidden feature dimensions is performed using a local manifold learning algorithm. Then, a low-level manifold computation in hidden space is completed. Finally, long-range scene perception is realized using a 1-NN classifier. Experiments are conducted to show the effectiveness and the influence of parameter selection for the proposed algorithm. The kernel principal component analysis (KPCA), locally linear embedding (LLE), and supervised locally linear embedding (SLLE) methods are compared under the same experimental unstructured agricultural environment scene. Test results show that the proposed algorithm is more suitable for unstructured agricultural environments than other existing methods, and that the computational load is significantly reduced.