AIM: To assess the benefi ts and limits of surgery for primary hepatic lymphoma (PHL), and probability of survival after postoperative chemotherapy. METHODS: A retrospective analysis was undertaken to determine the re...AIM: To assess the benefi ts and limits of surgery for primary hepatic lymphoma (PHL), and probability of survival after postoperative chemotherapy. METHODS: A retrospective analysis was undertaken to determine the results of surgical treatment of PHL over the past 8 years. Only nine patients underwent such treatment. The detailed data of diagnosis, treatment, and prognosis were carefully studied. RESULTS: All patients were mistaken as having α-fetoprotein-negative hepatic cancer before pathological diagnosis. The mean delay time between initial symptoms and final diagnosis was 26.8 d (range:14-47 d). Hepatitis B virus infection was noted in 33.3% of these patients. Most of the lesions were found to be restricted to a solitary hepatic mass. The surgical procedure performed was left hepatectomy in five cases, including left lateral segmentectomy in three. Right hepatectomy was performed in three cases and combined procedures in one. One patient died on the eighth day after surgery,secondary to hepatic insufficiency. The cumulative 6-mo, 1-year, and 2-year survival rates after hepatic surgery were, respectively, 85.7%,71.4%, and 47.6%. One patient survived for>5 years after surgery without any signs of recurrence until latest follow-up, who received routine postoperative chemotherapy every month for 2 years and then regular follow-up. By univariate analysis, postoperative chemotherapy was a significant prognostic factor that influenced survival (P=0.006). CONCLUSION: PHL is a rare entity that is often misdiagnosed, and has a potential association with chronic hepatitis B infection. The prognosis is variable, with good response to early surgery combined with postoperative chemotherapy in strictly selected patients.展开更多
Background Intrathoracic impedance monitoring has emerged as a promising new technique for the detection of impending heart failure (HF). Although false positive episodes have been reported in case reports and clinica...Background Intrathoracic impedance monitoring has emerged as a promising new technique for the detection of impending heart failure (HF). Although false positive episodes have been reported in case reports and clinical trials, the efficacy and false positive rate in real-world practice remain unclear. Objective The aim of this study is to investigate the utility and reliability of the OptiVol alert feature in clinical practice. Methods We continuously recruited patients who underwent implantable cardioverter-defibrillator (ICD) or cardiac re-synchronization therapy with defibrillator (CRT-D) implantation with feature of intrathoracic impedance monitoring system in our center from Sep. 2010 to Oct. 2012. Regular in-office follow-up were required of all patients and the following information was collected at each visit: medical history, device interrogation, N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement and an echocardiogram. Worsening HF was defined as hospitalization or the presentation of signs or symptoms of HF. Results Forty three patients (male:76.7%, mean age:57 ± 15 years, left ventricular ejection fraction (LVEF):33%± 14%) were included in this observational study. Fifty four alert events and 14 adjudicated worsening HF were detected within 288 ±163 days follow-up. Eleven (20.4%) alert episodes were associated with acute cardiac decompensation in 9 patients with a positive predictive value of 78.6%. Forty three audible alerts showed no connection to worsening HF. The unexplained alerts rate was 79.6%and 1.27 per person-year. Thirty seven alarm alerts were detected in patients with EF<45%, among which 9 accompanied with HF, 17 alerts detected in patients with LVEF≥45%and 2 associated with HF. There was no sig-nificant difference between the two groups (9/37 vs. 2/17;P=0.47). Conclusions Patients with normal or nearly normal left ventricular systolic function also exhibited considerable alert events. The OptiVol fluid index predicted worsening cardiac events with a high unex-plained detection rate, and any alert must therefore be analyzed with great caution. Efforts to improve the specificity of this monitoring sys-tem represent a significant aspect of future studies.展开更多
Background： In patients with nonvalvular atrial fibrillation （NVAF）, embolic stroke is thought to be associated with left atrial appendage （LAA） thrombi. The WATCHMAN LAA Occlusion Device has been shown to be non...Background： In patients with nonvalvular atrial fibrillation （NVAF）, embolic stroke is thought to be associated with left atrial appendage （LAA） thrombi. The WATCHMAN LAA Occlusion Device has been shown to be noninferior to conventional oral anticoagulation with warfarin for stroke prevention in patients with NVAF. This study aimed to evaluate the procedural feasibility, safety and 12-month outcomes of the WATCHMAN LAA Occlusion Device in NVAF patients with high risk for stroke in China. Methods： The clinical data of 106 NVAF patients, who were consecutively underwent LAA closure with the WATCHMAN Device between April 2014 and May 2015, were collected. Patients were followed up at 1,3, 6, and 12 months after discharge. A transesophageal echocardiograph was performed at 45 days after implantation and repeated in case of an unexpected event during the follow-up period. Results： This study included 106 NVAF patients with a mean age of 64.2 ± 8.6 years （ranging from 50 to 88 years）, and the mean CHA,DS,-VASc score of all patients was 3.6 ± 1.6 （ranging from 2 to 9）. Among those 106 NVAF patients, 100 （94.3%） patients were implanted with the device successfully. The procedural success rate was 94.3% （100/106）, and the occlusion rate was 100.0% （100/100）. There were one tamponade, one ischemic stroke, and eight minor pericardial effusions during hospitalization. During 12-month follow-up period, two patients developed a tbrombus layer on the device that resolved with additional anticoagulation： one with visible device-thrombus experienced transient ischemic stroke, and one had a hemorrhagic stroke. There were no deaths in this study. The overall survival rate was 100.0%, and nonmajor adverse event rate was 95.0% （95/100）. In this study, the expected annual rate ofischemic stroke risk in these patients according to the CHA2DS2-VASc score was 4.0%, while the observed ischemic stroke rate was 2.0% per year. Conclusions： LAA closure with the WATCHMAN Device was feasible, efficient, and safe for NVAF to prevent the accidence of stroke in Chinese patients. During the 12-month follow-up period, the observed ischemic stroke rate （2.0% per year） in our study was lower than the predicted annual stroke risk （4.0%） using the CHA2DS：-VASc score.展开更多
To the Editor： Gallbladder cancer （GBC）, a rare entity with poor prognosis, is often discovered incidentally during or after cholecystectomy.It tends to disseminate early through lymphatic, peritoneal, endobiliary,...To the Editor： Gallbladder cancer （GBC）, a rare entity with poor prognosis, is often discovered incidentally during or after cholecystectomy.It tends to disseminate early through lymphatic, peritoneal, endobiliary, and hematogenous pathways. Patients usually present with metastatic diseases. If GBC is suspected during cholecystectomy, conversion to open surgery to perform radical resection after confirmation of cancer by intraoperative frozen biopsy is considered. When GBC is diagnosed after cholecystectomy, reoperation for radical resection according to depth of invasion of cancer （T stage） is inevitable. However, reoperation with radical surgery is not performed in all patients for several reasons including refusal to undergo radical surgery, poor medical condition, or cancer progression suggesting unresectability.展开更多
The addition of hexagonal-close-packed(hcp)non-rare-earth elements Zr,Ti and Co,to the 10-component hep rare-earth-based high-entropy alloys(HEAs)with a composition of ScYLaNdGdTbDyHoErLuX(X=Zr,Co and Ti)was investiga...The addition of hexagonal-close-packed(hcp)non-rare-earth elements Zr,Ti and Co,to the 10-component hep rare-earth-based high-entropy alloys(HEAs)with a composition of ScYLaNdGdTbDyHoErLuX(X=Zr,Co and Ti)was investigated.The enthalpy of mixing between elements was found to have a significant effect on the formation of phases.The addition of Co combines with elements that had a strong chemical affinity to form intermetallic compounds by the effect of enthalpy.Ti was added with all elements with poor chemical affinity and exhibited rejection to form a phase alone.These were the two terminal manifestations of the role of enthalpy over entropy.Part of Zr was soluble in the matrix under the action of entropy,while the other part had a greater affinity for Sc than the other elements to form a precipitate under the action of enthalpy.This was the result of the local balance between the effect of enthalpy and entropy.The solid solution of the elements had different degrees of strengthening effect,among which Zr had the most excellent strengthening effect from 185 to 355 MPa,so the solid solution strengthening model and precipitation strengthening model were proposed to predict the strength of the alloy with the addition of Zr effectively.展开更多
文摘AIM: To assess the benefi ts and limits of surgery for primary hepatic lymphoma (PHL), and probability of survival after postoperative chemotherapy. METHODS: A retrospective analysis was undertaken to determine the results of surgical treatment of PHL over the past 8 years. Only nine patients underwent such treatment. The detailed data of diagnosis, treatment, and prognosis were carefully studied. RESULTS: All patients were mistaken as having α-fetoprotein-negative hepatic cancer before pathological diagnosis. The mean delay time between initial symptoms and final diagnosis was 26.8 d (range:14-47 d). Hepatitis B virus infection was noted in 33.3% of these patients. Most of the lesions were found to be restricted to a solitary hepatic mass. The surgical procedure performed was left hepatectomy in five cases, including left lateral segmentectomy in three. Right hepatectomy was performed in three cases and combined procedures in one. One patient died on the eighth day after surgery,secondary to hepatic insufficiency. The cumulative 6-mo, 1-year, and 2-year survival rates after hepatic surgery were, respectively, 85.7%,71.4%, and 47.6%. One patient survived for>5 years after surgery without any signs of recurrence until latest follow-up, who received routine postoperative chemotherapy every month for 2 years and then regular follow-up. By univariate analysis, postoperative chemotherapy was a significant prognostic factor that influenced survival (P=0.006). CONCLUSION: PHL is a rare entity that is often misdiagnosed, and has a potential association with chronic hepatitis B infection. The prognosis is variable, with good response to early surgery combined with postoperative chemotherapy in strictly selected patients.
文摘Background Intrathoracic impedance monitoring has emerged as a promising new technique for the detection of impending heart failure (HF). Although false positive episodes have been reported in case reports and clinical trials, the efficacy and false positive rate in real-world practice remain unclear. Objective The aim of this study is to investigate the utility and reliability of the OptiVol alert feature in clinical practice. Methods We continuously recruited patients who underwent implantable cardioverter-defibrillator (ICD) or cardiac re-synchronization therapy with defibrillator (CRT-D) implantation with feature of intrathoracic impedance monitoring system in our center from Sep. 2010 to Oct. 2012. Regular in-office follow-up were required of all patients and the following information was collected at each visit: medical history, device interrogation, N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement and an echocardiogram. Worsening HF was defined as hospitalization or the presentation of signs or symptoms of HF. Results Forty three patients (male:76.7%, mean age:57 ± 15 years, left ventricular ejection fraction (LVEF):33%± 14%) were included in this observational study. Fifty four alert events and 14 adjudicated worsening HF were detected within 288 ±163 days follow-up. Eleven (20.4%) alert episodes were associated with acute cardiac decompensation in 9 patients with a positive predictive value of 78.6%. Forty three audible alerts showed no connection to worsening HF. The unexplained alerts rate was 79.6%and 1.27 per person-year. Thirty seven alarm alerts were detected in patients with EF<45%, among which 9 accompanied with HF, 17 alerts detected in patients with LVEF≥45%and 2 associated with HF. There was no sig-nificant difference between the two groups (9/37 vs. 2/17;P=0.47). Conclusions Patients with normal or nearly normal left ventricular systolic function also exhibited considerable alert events. The OptiVol fluid index predicted worsening cardiac events with a high unex-plained detection rate, and any alert must therefore be analyzed with great caution. Efforts to improve the specificity of this monitoring sys-tem represent a significant aspect of future studies.
文摘Background： In patients with nonvalvular atrial fibrillation （NVAF）, embolic stroke is thought to be associated with left atrial appendage （LAA） thrombi. The WATCHMAN LAA Occlusion Device has been shown to be noninferior to conventional oral anticoagulation with warfarin for stroke prevention in patients with NVAF. This study aimed to evaluate the procedural feasibility, safety and 12-month outcomes of the WATCHMAN LAA Occlusion Device in NVAF patients with high risk for stroke in China. Methods： The clinical data of 106 NVAF patients, who were consecutively underwent LAA closure with the WATCHMAN Device between April 2014 and May 2015, were collected. Patients were followed up at 1,3, 6, and 12 months after discharge. A transesophageal echocardiograph was performed at 45 days after implantation and repeated in case of an unexpected event during the follow-up period. Results： This study included 106 NVAF patients with a mean age of 64.2 ± 8.6 years （ranging from 50 to 88 years）, and the mean CHA,DS,-VASc score of all patients was 3.6 ± 1.6 （ranging from 2 to 9）. Among those 106 NVAF patients, 100 （94.3%） patients were implanted with the device successfully. The procedural success rate was 94.3% （100/106）, and the occlusion rate was 100.0% （100/100）. There were one tamponade, one ischemic stroke, and eight minor pericardial effusions during hospitalization. During 12-month follow-up period, two patients developed a tbrombus layer on the device that resolved with additional anticoagulation： one with visible device-thrombus experienced transient ischemic stroke, and one had a hemorrhagic stroke. There were no deaths in this study. The overall survival rate was 100.0%, and nonmajor adverse event rate was 95.0% （95/100）. In this study, the expected annual rate ofischemic stroke risk in these patients according to the CHA2DS2-VASc score was 4.0%, while the observed ischemic stroke rate was 2.0% per year. Conclusions： LAA closure with the WATCHMAN Device was feasible, efficient, and safe for NVAF to prevent the accidence of stroke in Chinese patients. During the 12-month follow-up period, the observed ischemic stroke rate （2.0% per year） in our study was lower than the predicted annual stroke risk （4.0%） using the CHA2DS：-VASc score.
基金This research was funded by grants from National Natural Science Foundation of China （Nos. 71774167, 71233008, 91224005, and 71603271）, Special Innovation Project of National Defence Science and Technology （No. 003004）, Military Medical Innovation Project of the 13th Five-Year Plan of the People＇s Liberation Army （No. 17CXZ001）, Major Project of the 12th Five-Year Plan of the People＇s Liberation Army （No. AWS12J002）, Joint Research Project in Major Disease at Shanghai Health Service （No. 2013ZYJB0006）, Shanghai Health Bureau （Nos. 20124Y154 and 20164Y0109）, and Special Medical Foundation from Second Military Medical University （Nos. 2016QN21 and 2017JS21）.
文摘To the Editor： Gallbladder cancer （GBC）, a rare entity with poor prognosis, is often discovered incidentally during or after cholecystectomy.It tends to disseminate early through lymphatic, peritoneal, endobiliary, and hematogenous pathways. Patients usually present with metastatic diseases. If GBC is suspected during cholecystectomy, conversion to open surgery to perform radical resection after confirmation of cancer by intraoperative frozen biopsy is considered. When GBC is diagnosed after cholecystectomy, reoperation for radical resection according to depth of invasion of cancer （T stage） is inevitable. However, reoperation with radical surgery is not performed in all patients for several reasons including refusal to undergo radical surgery, poor medical condition, or cancer progression suggesting unresectability.
基金financially supported by the Natural Science Foundation of Shanxi Province,China (Nos. 201901D111105 and 201901D111114)the Key Research and Development Program of Shanxi Province (No.202102050201008)+1 种基金the National Science Foundation,United States (Nos.DMR-1611180 and 1809640)the U.S.Army Research Office (Nos.W911NF-131-0438 and W911NF-19-2-0049)
文摘The addition of hexagonal-close-packed(hcp)non-rare-earth elements Zr,Ti and Co,to the 10-component hep rare-earth-based high-entropy alloys(HEAs)with a composition of ScYLaNdGdTbDyHoErLuX(X=Zr,Co and Ti)was investigated.The enthalpy of mixing between elements was found to have a significant effect on the formation of phases.The addition of Co combines with elements that had a strong chemical affinity to form intermetallic compounds by the effect of enthalpy.Ti was added with all elements with poor chemical affinity and exhibited rejection to form a phase alone.These were the two terminal manifestations of the role of enthalpy over entropy.Part of Zr was soluble in the matrix under the action of entropy,while the other part had a greater affinity for Sc than the other elements to form a precipitate under the action of enthalpy.This was the result of the local balance between the effect of enthalpy and entropy.The solid solution of the elements had different degrees of strengthening effect,among which Zr had the most excellent strengthening effect from 185 to 355 MPa,so the solid solution strengthening model and precipitation strengthening model were proposed to predict the strength of the alloy with the addition of Zr effectively.
