Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: A propensity scorematched analysis

BACKGROUND During emergency endoscopic retrograde cholangiopancreatography(ERCP),the safety and feasibility of performing one-stage endoscopic treatment for patients with acute cholangitis(AC)due to choledocholithiasis are unclear.AIM To investigate the safety and feasibility of one-stage endoscopic treatment for moderate to severe AC.METHODS We enrolled all patients diagnosed with moderate to severe cholangitis due to common bile duct stones from January 2019 to July 2023.The outcomes were compared in this study between patients who underwent ERCP within 24 h and those who underwent ERCP 24 h later,employing a propensity score(PS)frame-work.Our primary outcomes were intensive care unit(ICU)admission rates,ICU length of stay,and duration of antibiotic use.RESULTS In total,we included 254 patients and categorized them into two groups based on the time elapsed between admission and intervention:The urgent group(≤24 h,n=102)and the elective group(>24 h,n=152).Ninety-three pairs of patients with similar characteristics were selected by PS matching.The urgent ERCP group had more ICU admissions(34.4%vs 21.5%,P=0.05),shorter ICU stays(3 d vs 9 d,P<0.001),fewer antibiotic use(6 d vs 9 d,P<0.001),and shorter hospital stays(9 d vs 18.5 d,P<0.001).There were no significant differences observed in adverse events,in-hospital mortality,recurrent cholangitis occurrence,30-d readmission rate or 30-d mortality.CONCLUSION Urgent one-stage ERCP provides the advantages of a shorter ICU stay,a shorter duration of antibiotic use,and a shorter hospital stay.

Security Assurance for One-stage Resection of Left Colon Cancer with Acute Obstruction—Thorough and Prompt Enteral Decompression without Contamination

Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.

One-stage revision arthroplasty in a patient with ochronotic arthropathy accompanied by joint infection:A case report

BACKGROUND Ochronotic arthropathy(OcA)is a rare disease,which is caused by the accumulation of homogentisic acid in the joint.Patients with OcA have obvious joint pain and the disease progresses rapidly,eventually resulting in disability.Arthroplasty is an efficacious treatment in patients with OcA.However,when OcA patients have joint infection,is joint replacement an option?In the present report,we performed total knee arthroplasty in a patient with OcA and knee infection under the guidance of one-stage revision theory.CASE SUMMARY A 64-year-old male was referred to our hospital due to severe left knee pain with limited mobility for 2 years.On physical examination,the patient was found to have dark brown pigmentation of the sclera and auricle.Laboratory test results showed elevations in C-reactive protein level(65.79 mg/L)and erythrocyte sedimentation rate(90.00 mm/h).The patient underwent debridement of the left knee joint,during which the cartilage surface of the knee joint was found to be black-brown in color.Bacterial culture of synovial fluid revealed Achromobacter xylosoxidans.We then carried out arthroplasty under the guidance of the theory of one-stage revision.After surgery,the patient’s left knee joint pain disappeared and function recovered without joint infection.CONCLUSION OcA accompanied by joint infection is rare.One-stage revision arthroplasty may be a treatment option for this disease.

A Rare Long Term Survival Case of Complete Pentalogy of Cantrell in Adult after One-Staged Surgery

Pentalogy of Cantrell is a rare congenital abnormality.Even with high-quality medical care and staged corrective surgeries in professional hospitals,the mortality rate is still very high and long-term prognosis is poor.Survival is largely determined by the complexity and severity of cardiac abnormalities,the efficiency of abdominal wall closure and postoperative complications.A 24-year-old male patient with complete pentalogy of Cantrell was diagnosed.One-stage surgical repair of all abnormalities were completed.The patient recovered well and had been follow-up for 7 years.He has a good cosmetic outcome,with no signs of cardiac dysfunction.No complications were noted.

Should we use similar perioperative protocols in patients undergoing unilateral and bilateral one-stage total knee arthroplasty?

BACKGROUND Bilateral one-stage total knee arthroplasty(BTKA)is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy.However,postoperative pain and disablement during convalescence from BTKA,and procedure-related complications have been concerning issues for patients and surgeons.Although some studies reported that BTKA in selected patients is as safe as the staged procedure,well-defined guidelines for patient screening,and perioperative care and monitoring to avoid procedure-related complications are still controversial.AIM To compare the perioperative outcomes including perioperative blood loss(PBL),cardiac biomarkers,pain intensity,functional recovery,and complications between unilateral total knee arthroplasty(UTKA)and BTKA performed with a similar perioperative protocol.METHODS We conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols.The exclusion criteria of this study included patients with an American Society of Anesthesiologists score>3,and known cardiopulmonary comorbidity or high-sensitivity Troponin-T(hs-TnT)>14 ng/L.Outcome measures included visual analogue scale(VAS)score of postoperative pain,morphine consumption,range of knee motion,straight leg raise(SLR),length of stay(LOS),and serum hemoglobin(Hb)and hs-TnT monitored during hospitalization.RESULTS Of 210 UTKA and 137 BTKA patients,those in the BTKA group were younger and more predominately female.The PBL of the UTKA vs BTKA group was 646.45±272.26 mL vs 1012.40±391.95 mL(P<0.01),and blood transfusion rates were 10.48%and 40.88%(P<0.01),respectively.Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA,whereas preoperative Hb was only a determinant in UTKA patients.The BTKA group had significantly higher VAS scores than the UTKA group at 48,72,and 96 h after surgery,and also had a significantly lower degree of SLR at 72 h.The BTKA group also had a significantly longer LOS than the UTKA group.Of the patients who had undergone the procedure,5.71%of the UTKA patients and 12.41%of the BTKA patients(P=0.04)had hs-TnT>14 ng/L during the first 72 h postoperatively.However,there was no difference in other outcome measures and complications.CONCLUSION Following similar perioperative management,the blood transfusion rate in BTKA is 4-fold that required in UTKA.Also,BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA.Hence,BTKA patients may require more extensive perioperative management for blood loss and pain,even if having no higher risk of complications than UTKA.

One-Stage Bilateral Total Hip Arthroplasty for Hemophilic Spontaneous Ankylotic Hip: A Case Report

Total hip arthroplastys (THAs) for hemophilic spontaneous ankylotic hips are rare. We performed one-stage bilateral THA for hemophilic patient and I would like to report the results of the case. A 61-year-old male had been diagnosed with mild hemophilia A as a neonate. He had severe pain in both hips and moderate pain in both knees. His hips were ankylotic and had no mobility. Uncemented simultaneous bilateral THAs were performed under general anesthesia. This case suggests that one-stage THA can be a good option for hemophilic hips, provided that sufficient substitution therapy is used.

One-stage urethroplasty with circumferential vascular pedicle preputial island flap for perineal hypospadias

Objective To report the treatment of perineal hypospadias with one - stage urethroplaty with circumferential vascular pedicle preputial island flap. Methods A circumferential incision was made proximal to the cprona and the urethral plate to correct chordee. A U - shaped skin incision was then made surrounding the meatus。

基于机器学习One-stage目标检测算法的塑料自动识别系统

针对当前日益严重的塑料污染问题,对于塑料垃圾的检测识别,开发了基于机器学习One-stage目标检测领域中YOLOv2算法的塑料自动识别系统。系统构建了目标检测的神经网络,结合塑料垃圾公开数据集进行训练,从而实现实时塑料垃圾检测网络系统。同时,采用塑料垃圾数据进行系统测试,设置分样本准确率、召回率、综合平均精确率等评估参数进一步实现对系统的评估。结果表明:基于机器学习One-stage目标检测算法的塑料自动识别系统能够有效完成识别任务,综合平均精确率在87.3%左右,可以快速准确地将环境中的塑料从较为复杂的自然环境中检测出来,对解决塑料污染有较好的实际意义。

One-stage mastopexy and augmentation mammoplasty in layers: outcome analysis of first 50 consecutive cases

Aim: The single-stage procedure is a challenging procedure for Plastic Surgeons. The single-stage layered mastopexy with augmentation is a new technique that is aiming to add safety, preserving breast function and to restore normal parameters of breast. Methods: A retrospective chart review of 50 consecutive cases of layered mastopexy with augmentation mammoplasties was performed. All patients had their implants placed in muscle splitting pocket. Incisions for mastopexy were selected on the basis of nipple areolar complex to inframammary crease. Mastopexy is performed using a medially based pedicle, leaving a sufficient tissue covering the implant. Patients were divided into three groups. Group 'A' who had periareolar mastopexy, Group 'B' had vertical scar mastopexy and Group 'C' patients had mastopexy with Wise pattern markings. Results: Group A comprised 11 patients. The mean age was 28.82± 7.01 years, mean preoperative and postoperative nipple areolar complex (NAC) to IMC measurement was recorded in 10 patients with the mean of 7.15± 1.98 cm and 8.35± 1.18 cm respectively. Mean size of the implant used was 379.55± 77.18 cm3. Group B comprised 29 patients. Mean age was 35.17± 12.37 years and the mean preoperative and postoperative NAC to IMC crease was 8.53± 1.48 cm and 9.72± 1.51 cm respectively. The mean implant size used was 289.48± 109 cm3. Group C had 10 patients. Mean age was 39.60± 12.15 years and the mean preoperative and postoperative NAC to IMC crease of 10.11± 1.24 cm and 8.75± 0.98 cm respectively. The mean implant size used was 287.00± 55.08 cm3. Conclusion: The procedure allows better arterial supply, wider area for venous and lymphatic drainage, better sensory innervation to NAC and maximises lactation potential of the breast.

Simultaneous type III congenital esophageal atresia and patent ductus arteriosus in a low-weight patient: A case report

BACKGROUND We report a low-birth-weight child(1.8 kg)with neonatal type III congenital esophageal atresia(CEA)combined with symptomatic patent ductus arteriosus(PDA).After comprehensive evaluation,esophageal anastomosis was performed on postnatal day 11 after excluding surgical contraindications,and arterial catheter ligation was performed at the same time.Concurrent surgery for CEA combined with PDA has not been clearly reported in the literature.CASE SUMMARY We report a 6-day-old female child with type III CEA and PDA.The patient presented with foam at the mouth after birth,cough and shortness of breath after feeding.At another hospital,she was considered to have neonatal pneumonia,neonatal jaundice and congenital heart disease and transferred to our hospital.After iodine oil radiography of the esophagus and echocardiography we con-firmed diagnosis of CEA and PDA.The diameter of the PDA was 8 mm,with obvious left to right shunting.We performed right rear extrapleural orificium fistula ligation and esophageal anastomosis,and ligation of PDA via left axilla straight incision after 5 d of hospitalization.The operations were successful,and the incision healed after 12 d,and the patient was discharged.We re-examined the patient 1 mo after surgery.She did not vomit when she ate rice flour.Esophageal angiography showed no stricture of the anastomotic stoma.The patient weighed 3.2 kg.CONCLUSION For CEA patients with multiple risk factors,comprehensive,timely and accurate diagnosis and evaluation,and early treatment may improve prognosis.

Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening

AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.

不同种植扭力对一段式种植体骨结合影响的动物实验研究

实验目的:本研究的目的是通过动物实验观察用不同扭矩植入的一段式种植体与骨结合的情况。实验方法:选取4只成年雄性杂种狗,体重10-15Kg,分别拔除每只狗的双侧第一第二前磨牙,待3个月后分别以20Ncm、30Ncm、40Ncm的力矩旋入BLB种植体各一枚,即刻安装上部基台结构并调整咬合,每只狗在植入种植体术后一个月和三个月时拍片观察其影像学改变,于种植术后一个月和三个月时分别处死两只狗取标本,观察其组织学的改变。实验结果:12枚种植体中以30Ncm、40Ncm植入的8枚种植体获得了良好的骨结合,种植体周围包饶着致密的骨组织,未观察到任何间隙和结缔组织长入,另外以20Ncm植入的4枚种植体中3枚脱落,1枚松动。实验结论:在30Ncm及40Ncm扭转力矩下旋入的一段式种植体可获得良好的骨结合。

Clinical observation of laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography or common bile duct lithotripsy

BACKGROUND The incidence of common bile duct(CBD) stones accounts for approximately 10%–15% of all CBD diseases.Approximately 8%–20% of these patients also have gallstones with heterogenous signs and symptoms.AIM To investigate the clinical effects of laparoscopic cholecystectomy(LC) combined with endoscopic retrograde cholangiopancreatography(ERCP) and LC with CBD excision and stone extraction in one-stage suture(LBEPS) for the treatment of gallbladder and CBD stones.METHODS Ninety-four patients with gallbladder and CBD stones were selected from our hospital from January 2018 to June 2021.They were randomly divided into study and control groups with 47 patients each.The study group underwent LC with ERCP,and the control group underwent LC with LBEPS.Surgery,recovery time of gastrointestinal function,complication rates,liver function indexes,and stress response indexes were measured pre-and postoperatively in both the groups.RESULTS The durations of treatment and hospital stay were shorter in the study group than in the control group.There was no significant difference between the one-time stone removal rate between the study and control groups.The time to anal evacuation,resumption of oral feeding,time to bowel sound recovery,and time to defecation were shorter in the study group than in the control group.The preoperative serum direct bilirubin(DBIL),total bilirubin(TBIL),and alanine aminotransferase(ALT) levels were insignificantly higher in the study group than that in the control group.A day after surgery,the postoperative serum DBIL,TBIL,and ALT levels were lower than their preoperative levels in both groups,and of the two groups,the levels were lower in the study group.Although the preoperative serum adrenocorticotrophic(ACTH),cortisol(COR),epinephrine(A),and norepinephrine(NE) levels were higher in the study group than that in the control group,these differences were not significant(P > 0.05).The serum ACTH,COR,A,and NE levels in both groups decreased one day after surgery compared to the preoperative levels,but the inter-group difference was statistically insignificant.Similarly,(91.79 ±10.44) ng/mL,A,and NE levels were lower in the study group than in the control group.The incidence of complications was lower in the study group than in the control group.CONCLUSION LC combined with ERCP induces only a mild stress response;this procedure can decrease the risk of complications,improve liver function,and achieve and promote a faster recovery of gastrointestinal functions.

Gallstone ileus:Report of two cases and review of the literature

Gallstone ileus is a rare disease and accounts for 1%-4% of all cases of mechanical intestinal obstruction. It usually occurs in the elderly with a female predominance and may result in a high mortality rate. Its diagnosis is difficult and early diagnosis could reduce the mortality. Surgery remains the mainstay of treatment. We report two cases of gallstone ileus. The first was a 78-year old woman who had a 2-d history of vomiting and epigastralgia. Plain abdominal film suggested small bowel obstruction clinically attributed to adhesions. Later on, gallstone ileus was diagnosed by abdominal computed tomography (CT) based on the presence of pneumobilia, bowel obstruction, and an ectopic stone within the jejunum. She underwent emergent laparotomy with a one-stage procedure of enterolithotomy, cholecystectomy and fistula repair. The second case was a 76-year old man with a 1-wk history of epigastralgia. Plain abdominal film showed two round calcified stones in the right upper quadrant. Fistulography confirmed the presence of a cholecystoduodenal fistula and gallstone ileus was also diagnosed by abdominal CT. We attempted to remove the stones endoscopically, but failed leading to an emergent laparotomy and the same one-stage procedure as for the first case. The postoperative courses of the two cases were uneventful. Inspired by these 2 cases we reviewed the literature on the cause, diagnosis and treatment of gallstone ileus.

Resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy

BACKGROUND Neurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart.AIM To evaluate surgical resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy.METHODS This retrospective case series included patients with drug-refractory bilateral occipital lobe epilepsy treated surgically between March 2006 and November 2015.RESULTS Preoperative evaluation included scalp video-electroencephalography(EEG),magnetic resonance imaging,and PET-CT.During surgery(bilateral occipital craniotomy),epileptic foci and important functional areas were identified by EEG(intracranial cortical electrodes)and cortical functional mapping,respectively.Patients were followed up for at least 5 years to evaluate treatment outcome(Engel grade)and visual function.The 20 patients(12 males)were aged 4-30 years(median age,12 years).Time since onset was 3-20 years(median,8 years),and episode frequency was 4-270/mo(median,15/mo).Common manifestations were elementary visual hallucinations(65.0%),flashing lights(30.0%),blurred vision(20.0%)and visual field defects(20.0%).Most patients were free of disabling seizures(Engel grade I)postoperatively(18/20,90.0%)and at 1 year(18/20,90.0%),3 years(17/20,85.0%)and≥5 years(17/20,85.0%).No patients were classified Engel grade IV(no worthwhile improvement).After surgery,there was no change in visual function in 13/20(65.0%),development of a new visual field defect in 3/20(15.0%),and worsening of a preexisting defect in 4/20(20.0%).CONCLUSION Resection of bilateral occipital lobe lesions during a single operation may be applicable in bilateral occipital lobe epilepsy.

Calibration of a Confidence Interval for a Classification Accuracy

Coverage of nominal 95% confidence intervals of a proportion estimated from a sample obtained under a complex survey design, or a proportion estimated from a ratio of two random variables, can depart significantly from its target. Effective calibration methods exist for intervals for a proportion derived from a single binary study variable, but not for estimates of thematic classification accuracy. To promote a calibration of confidence intervals within the context of land-cover mapping, this study first illustrates a common problem of under and over-coverage with standard confidence intervals, and then proposes a simple and fast calibration that more often than not will improve coverage. The demonstration is with simulated sampling from a classified map with four classes, and a reference class known for every unit in a population of 160,000 units arranged in a square array. The simulations include four common probability sampling designs for accuracy assessment, and three sample sizes. Statistically significant over- and under-coverage was present in estimates of user’s (UA) and producer’s accuracy (PA) as well as in estimates of class area proportion. A calibration with Bayes intervals for UA and PA was most efficient with smaller sample sizes and two cluster sampling designs.

FastFace:实时鲁棒的人脸检测算法

目的尽管基于深度神经网络的人脸检测器在检测精度上有了极大的提升,但其代价是必须依赖强大的计算资源。如何在CPU上取得较高的检测精度的同时达到实时的检测速度是一个巨大的挑战。针对非约束性条件下的快速鲁棒的人脸检测问题,提出一种基于轻量级神经网络的检测方法。方法受轻量级网络MobileNet的启发,本文算法采用通道分离的卷积方式进行特征提取,并结合Inception和残差连接的思想,构建若干特征提取模块,最终训练出一个简单高效的特征提取网络;在检测时,采用One-Stage的检测策略,在骨干网络的若干不同层级上使用卷积的同时进行目标区域的分类和定位;在进行目标区域精调时,需要先在对应的特征层上预设先验框,然后再使用边界框回归算法调整先验框的位置和大小,使之接近真实框的位置。为了减少先验框的数量以节省模型参数,本算法针对人脸目标框的特点设置先验框。结果基于TensorFlow深度学习库构建和训练本文的检测模型,在FDDB数据集上对其进行测试,并与若干经典算法对比了检测速度和精度。相较于多任务级联卷积网络(MTCNN)等典型的深度学习方法,本文算法在CPU上将检测速度提升到25帧/s,同时平均精度(mAP)保持在0.892,高于大多数传统算法。实验结果表明本文方法能实现在CPU上的实时、高精度检测。结论提出了一种基于轻量级网络模型的人脸检测方法,以简单高效的卷积模块为基础构建骨干网络,并在检测时针对人脸比例特征设置合理的先验框。在非约束性条件以及有限计算资源条件下,该方法不仅在精度上表现良好,而且具有较快的检测速度,是一种鲁棒的检测方法。

高效检测复杂场景的快速金字塔网络SPNet

目的 针对现今主流one-stage网络框架在检测高帧率视频中的复杂目标场景时,无法兼顾检测精度和检测效率的问题,本文改进one-stage网络架构,并使用光流跟踪特征图,提出一种高效检测复杂场景的快速金字塔网络(snap pyramid network,SPNet).方法 调查特征提取网络以及金字塔网络内部,实现特征矩阵及卷积结构完全可视化,找到one-stage网络模型有效提升检测小目标以及密集目标的关键因素;构建复杂场景检测网络SPNet,由骨干网络(MainNet)内置子网络跟踪器(TrackNet).在MainNet部分,设计特征权重控制(feature weight control,FWC)模块,改进基本单元(basic block),并设计MainNet的核心网络(BackBone)与特征金字塔网络(feature pyramidnetwork,FPN)架构结合的多尺度金字塔结构,有效提升视频关键帧中存在的小而密集目标的检测精度和鲁棒性;在TrackNet部分,内置光流跟踪器到BackBone,使用高精度的光流矢量映射BackBone卷积出的特征图,代替传统的特征全卷积网络架构,有效提升检测效率.结果 SPNet能够兼顾小目标、密集目标的检测性能,在目标检测数据集MS COCO(Microsoft common objects in context)和PASCAL VOC上的平均精度为52.8%和75.96%,在MSCOCO上的小目标平均精度为13.9%;在目标跟踪数据集VOT(visual object tracking)上的平均精度为42.1%,检测速度提高到50~70帧/s.结论 本文快速金字塔结构目标检测框架,重构了one-stage检测网络的结构,利用光流充分复用卷积特征信息,侧重于复杂场景的检测能力与视频流的检测效率,实现了精度与速度的良好平衡.

One-versus two-stage partial hepatectomy for large resectable solitary hepatocellular carcinomas determined preoperatively to have a narrow resection margin:a propensity score matching analysis

Background:For patients with a large but resectable solitary hepatocellular carcinoma(HCC)of>5 cm in diameter,it is often difficult to achieve a sufficient resection margin.There is still no study on whether a two-stage hepatectomy to increase a narrow resection margin would be beneficial.Methods:From August 2014 to February 2017,patients with a large but resectable solitary HCC of>5 cm and a preoperative estimated resection margin of<1.0 cm were retrospectively studied.They were divided into one-and two-stage resection groups.A retrospective analysis was performed,followed by propensity score matching(PSM)analysis.Disease recurrence,survival,intraoperative and postoperative data were compared.Results:Before PSM,the 1-,2-,3-and 4-year recurrence-free survival rates for the one-and two-stage groups were 44.3%,31.7%,24.3%,19.2%versus 60.6%,45.4%,43.5%,32.3%,respectively(P=0.007).The corresponding OS rates were 61.0%,45.2%,43.8%,38.4%versus 69.6%,62.5%,60.7%,57.3%,respectively(P=0.029).After PSM,the 1-,2-,3-and 4-year recurrence-free survival rates for the one-and two-stage groups were 44.0%,31.5%,27.3%,21.0%versus 60.6%,45.4%,43.5%,32.3%,respectively(P=0.013).The corresponding OS rates were 62.5%,41.1%,41.1%,37.5%versus 69.6%,62.5%,60.7%,57.3%,respectively(P=0.038).Differences in the resection margins between the one-and two-stage groups before[0.3(0-0.5)versus 1.2(0.8-2.2)cm]and after[0.2(0-0.5)versus 1.2(0.8-2.2)cm]PSM were also significant.Conclusions:Two-stage hepatectomy allowed a wider resection margin for patients with a resectable but solitary HCC of>5 cm,and resulted in significantly better long-term survival outcomes after partial hepatectomy.

The diagnosis and treatment strategy of occipital skull mass in hemophilic patients: a rare case report and literature review

Cranial hemophilic pseudotumor (cHPT) is a very rare disease, which is easy to misdiagnose. It is also difficult to manage such patients. We reported the first case of occipital cHPT. Case presentation: Here, we presented a rare case of an occipital bone mass in a 3-year-old boy who was diagnosed with hemophilia A. The mass was misdiagnosed as an aneurysmal bone cyst by pathological examination. After resection, the patient underwent one-stage cranioplasty. However, the patient was admitted again for hematoma caused by an invasive procedure. A second surgery and one-stage cranioplasty were performed at the same time. A follow-up 3 months after discharging showed the patient was uneventful, and the titanium mesh was well fixed. Conclusion: The diagnosis of cHPT requires the combining of history, radiological examination, and pathological examination. Resection is the best choice for symptomatic cHPT. Replacement treatment and less invasive treatment can make perioperative management safer. One-stage cranioplasty for resection of an occipital cHPT can improve the quality of life.