经ERCP胆道金属支架植入治疗不可切除肝外胆道恶性梗阻的安全性及疗效评价

目的探讨经内镜逆行胰胆管造影(ERCP)胆道金属支架置入对于肝外胆道恶性梗阻的临床疗效及安全性。方法根据患者手术方法不同将40例恶性胆道梗阻患者分为经皮经肝胆管穿刺引流术(PTCD)组和ERCP组。PTCD组患者接受PTCD治疗,ERCP组患者接受ERCP置入金属支架治疗。结果两组生存时间差异有统计学意义(P<0.05)。ERCP组术后胆道通畅时间明显长于PTCD组,差异有统计学意义(P<0.05)。ERCP组住院时间明显少于PTCD组(P<0.05)。术后1周ERCP组肝功能检测指标明显优于PTCD组(P<0.05)。此外,PTCD组和ERCP组的并发症发生率分别30.0%与10.0%。ERCP组的并发症发生率明显低于PTCD组(P<0.05)。结论 ERCP支架置入与PTCD解除胆道恶性梗阻疗效相似。但是,ERCP术后胆道通畅时间长,并发症少,患者肝功能指标恢复快。因此,对于肝外胆道恶性梗阻的患者,采用ERCP临床疗效更好,安全性更高。

COVID-19 or treatment associated immunosuppression may trigger hepatitis B virus reactivation: A case report

BACKGROUND Since the initial recognition of coronavirus disease 2019(COVID-19)in Wuhan,this infectious disease has spread to most areas of the world.The pathogenesis of COVID-19 is yet unclear.Hepatitis B virus(HBV)reactivation occurring in COVID-19 patients has not yet been reported.CASE SUMMARY A 45-year-old hepatitis B man with long-term use of adefovir dipivoxil and entecavir for antiviral therapy had HBV reactivation after being treated with methylprednisolone for COVID-19 for 6 d.CONCLUSION COVID-19 or treatment associated immunosuppression may trigger HBV reactivation.

Hybrid coronary revascularization vs. percutaneous coronary interventions for multivessel coronary artery disease

OBJECTIVE Hybrid coronary revascularization(HCR)combines a minimally invasive surgical approach to the left anterior descending(LAD)artery with percutaneous coronary intervention(PCI)for non-LAD diseased coronary arteries.It is associated with shorter hospital lengths of stay and recovery times than conventional coronary artery bypass surgery,but there is little information comparing it to isolated PCI for multivessel disease.Our objective is to compare long-term outcomes of HCR and PCI for patients with multivessel disease.METHODS This cohort study used data from New York’s cardiac surgery and PCI registries in 2010−2016 to examine mortality and repeat revascularization rates for patients with multivessel coronary artery disease who underwent HCR and PCI.Cox proportional hazards methods were used to reduce selection bias.Patients were followed for a median of four years.RESULTS There was a total of 335 HCR patients(1.2%)and 25,557 PCI patients(98.8%)after exclusions.There was no difference in 6-year risk adjusted survival between HCR and PCI patients 83.17%vs.81.65%,adjusted hazard ratio(aHR)=0.90(95%CI:0.67−1.20).However,HCR patients were more likely to be free from repeat revascularization in the LAD artery(91.13%vs.83.59%,aHR=0.51(95%CI:0.34−0.77)).CONCLUSIONS For patients with multi-vessel coronary artery disease,HCR is rarely performed.There are no differences in mortality rates after four years,but HCR is associated with lower repeat revascularization rates in the LAD artery,presumably due to better longevity in left arterial mammary grafts.

Sarcomatoid intrahepatic cholangiocarcinoma with good patient prognosis after treatment with Huaier granules following hepatectomy:A case report

BACKGROUND Sarcomatoid intrahepatic cholangiocarcinoma(SICC)is an extremely rare and highly invasive malignant tumor of the liver.The precise pathologic mechanism of SICC has not been clearly identified,and the prognosis is very poor.The effectiveness of the treatment strategy of radical hepatectomy combined with Huaier granules has not yet been reported.CASE SUMMARY The patient was a 69-year-old male who presented with intermittent right upper abdominal pain for one month and 4-pound weight loss before admission.Abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography showed multiple stones in the bile ducts accompanied by dilatation of the intrahepatic and extrahepatic bile ducts.The preoperative diagnoses were right intrahepatic bile duct stones and extrahepatic bile duct stones;thus,surgical resection was performed.Choledochoscopy showed that the bile duct wall of the right anterior lobe was thickened,and a mass was visible in the duct.Then,a biopsy was performed,and rapid frozen-section biopsy analysis indicated that the tumor was malignant.The final diagnosis was SICC(T1a N0M0).Huaier granules were taken by the patient as anticancer therapy after surgery.The patient attended follow-up for 72 mo with no tumor recurrence or metastasis.CONCLUSION Sarcomatous intrahepatic cholangiocarcinoma is an extremely rare,aggressive malignancy,and the diagnostic gold standard is pathological diagnosis.We reported the first case of successful treatment with Huaier granules as anticancer therapy after surgery,which indicated that Huaier granules are safe and effective.Further studies are needed to study the anticancer molecular mechanisms of Huaier granules in sarcomatous intrahepatic cholangiocarcinoma.

一种可滑移式铅芯橡胶支座的显式数值模拟与试验验证(英文)

目的:随着隔震技术在工程结构中的逐步推广应用,橡胶隔震支座的试验与数值模拟都得到国内外工程研究人员的重视。其中后者因支座大变形时计算较难收敛、铅芯与周边橡胶以及钢板的复杂接触关系较难模拟、采用隐式积分算法时计算规模较难控制等问题,目前仍是这一方向的研究热点。本文旨在探讨基于显式积分算法对一种新型可滑移式铅芯橡胶支座进行准确可行的数值模拟的方法。创新点:1.探究基于显式积分算法的隔震支座数值模拟方法;2.采取多种方法有效地控制了数值模拟计算规模,同时实现了较高的数值模拟精度;3.采用程序中提供的3种接触方式较好地模拟了支座中存在的复杂接触关系。方法:本文主要采用4种方法减小数值模拟计算规模:1.激活程序内置的质量缩放功能;2.合理增大支座中对支座竖向刚度与水平剪切性能影响较小的非关键部件——叠层钢板的厚度;3.合理减小叠层钢板的弹性模量;4.考虑到支座中所有材料均未考虑材料的率变效应,即加载速率对支座的力学性能没有影响,本文数值模拟中所用加载频率为实际加载频率的10倍。此外,本文采用了一般接触、绑定接触与单边接触模拟支座中不同的接触关系。结论:1.显式积分的计算时间步长由2.4×10-7 s增大到3.5×10-6 s;2.与试验结果对比验证了本文提出的基于显式积分算法对该新型可滑移式铅芯橡胶支座进行数值模拟的方法的准确实用性;3.该支座在纯压作用下,部分铅芯发生塑性变形,而在最大剪切位移时,铅芯发生了很大的塑性流动变形;4.与采用隐式算法对该支座进行数值模拟研究所用时间相比,显式算法所用时间少很多。