In the last decade,intraductal papillary mucinous neoplasms(IPMNs) have become commonly diagnosed.From a morphological standpoint,they are classified in main-duct IPMNs(MD-IPMNs) and branch-duct IPMNs(BD-IPMNs),depend...In the last decade,intraductal papillary mucinous neoplasms(IPMNs) have become commonly diagnosed.From a morphological standpoint,they are classified in main-duct IPMNs(MD-IPMNs) and branch-duct IPMNs(BD-IPMNs),depending on the type of involvement of the pancreatic ductal system by the neoplasm.Despite the fact that our understanding of their natural history is still incomplete,recent data indicate that MD-IPMNs and BD-IPMNs show significant differences in terms of biological behaviour with MD-IPMNs at higher risk of malignant degeneration.In the present paper,clinical and epidemiological characteristics,rates of malignancy and the natural history of MD-IPMNs and BD-IPMNs are analyzed.The profile of IPMNs involving both the main pancreatic duct and its side branches(combined-IPMNs) are also discussed.Finally,general recommendations for management based on these differences are given.展开更多
Intraductal papillary mucinous neoplasms(IPMN) of the pancreas include a spectrum of dysplasia ranging from minimal mucinous hyperplasia to invasive carcinoma and are extensive tumors that often spread along the ducta...Intraductal papillary mucinous neoplasms(IPMN) of the pancreas include a spectrum of dysplasia ranging from minimal mucinous hyperplasia to invasive carcinoma and are extensive tumors that often spread along the ductal tree.Several studies have demonstrated that preoperative imaging is not accurate enough to adapt the extent of pancreatectomy and have suggested routinely using frozen sectioning(FS) to evaluate the completeness of resection and also to check if ductal dilatation is active or passive,in order to avoid an excessive pancreatic resection.Separate main duct and branch duct analysis is needed due to the difference in the natural history of the disease.FS accuracy averages 95%.Eroded epithelium on the main duct,severe ductal inflammation mimicking dysplasia and reactive epithelial changes secondary to obstruction can lead to inappropriate FS results.FS results change the planned extent of resection in up to 30% of cases.The optimal cut-off leading to extend pancreatectomy is not consensual and our standard option is to extend pancreatec-tomy if FS reveals:(1) at least IPMN adenoma on the main duct;or(2) at least borderline IPMN on branch ducts;or(3) invasive carcinoma.However,the decision to extend resection must be taken after a multidisciplinary discussion since it does not exclusively depend on the FS result but also on age,general condition and expected prognosis after resection.The main limitation of using FS is the existence of discontinuous("skip") lesions which account for approximately 10% of IPMN in surgical series and can lead to reoperation in up to 8% of cases.展开更多
Intraductal papillary mucinous neoplasm(IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucinproducing cells arising in the main duct(MD) and/or branch ducts(BD) of the pancreas.Involved ducts are dilate...Intraductal papillary mucinous neoplasm(IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucinproducing cells arising in the main duct(MD) and/or branch ducts(BD) of the pancreas.Involved ducts are dilated and filled with neoplastic papillae and mucus in variable intensity.IPMN lacks ovarian-type stroma,unlike mucinous cystic neoplasm,and is defined as a grossly visible entity(≥ 5 mm),unlike pancreatic intraepithelial neoplasm.With the use of high-resolution imaging techniques,very small IPMNs are increasingly being identified.Most IPMNs are solitary and located in the pancreatic head,although 20%-40% are multifocal.Macroscopic classification in MD type,BD type and mixed or combined type reflects biological differences with important prognostic and preoperative clinical management implications.Based on cytoarchitectural atypia,IPMN is classified into low-grade,intermediategrade and high-grade dysplasia.Based on histological features and mucin(MUC) immunophenotype,IPMNs are classified into gastric,intestinal,pancreatobiliary and oncocytic types.These different phenotypes can be observed together,with the IPMN classified according to the predominant type.Two pathways have been suggested:gastric phenotype corresponds to less aggressive uncommitted cells(MUC1-,MUC2-,MUC5 AC +,MUC6 +) with the capacity to evolve to intestinal phenotype(intestinal pathway)(MUC1-,MUC2 +,MUC5 AC +,MUC6- or weak +) or pancreatobiliary /oncocytic phenotypes(pyloropancreatic pathway)(MUC1 +,MUC 2-,MUC5 AC +,MUC 6 +) becoming more aggressive.Prognosis of IPMN is excellent but critically worsens when invasive carcinoma arises(about 40% of IPMNs),except in some cases of minimal invasion.The clinical challenge is to establish which IPMNs should be removed because of their higher risk of developing invasive cancer.Once resected,they must be extensively sampled or,much better,submitted in its entirety for microscopic study to completely rule out associated invasive carcinoma.展开更多
The aim of this work is mathematical education through the knowledge system and mathematical modeling. A net model of formation of mathematical knowledge as a deductive theory is suggested here. Within this model the ...The aim of this work is mathematical education through the knowledge system and mathematical modeling. A net model of formation of mathematical knowledge as a deductive theory is suggested here. Within this model the formation of deductive theory is represented as the development of a certain informational space, the elements of which are structured in the form of the orientated semantic net. This net is properly metrized and characterized by a certain system of coverings. It allows injecting net optimization parameters, regulating qualitative aspects of knowledge system under consideration. To regulate the creative processes of the formation and realization of mathematical know- edge, stochastic model of formation deductive theory is suggested here in the form of branching Markovian process, which is realized in the corresponding informational space as a semantic net. According to this stochastic model we can get correct foundation of criterion of optimization creative processes that leads to “great main points” strategy (GMP-strategy) in the process of realization of the effective control in the research work in the sphere of mathematics and its applications.展开更多
The optimal solution of the multi-constrained QoS multicast routing problem is a tree-like hierarchical structure in the topology graph. This multicast route contains a feasible path from the source node to each of th...The optimal solution of the multi-constrained QoS multicast routing problem is a tree-like hierarchical structure in the topology graph. This multicast route contains a feasible path from the source node to each of the destinations with respect to a set of QoS constraints while minimizing a cost function. Often, it is a tree. In other cases, the hierarchies can return several times to nodes and links of the topology graph. Similarly to Steiner problem, finding such a structure is an NP-hard problem. The usual tree and topology enumeration algorithms applied for the Steiner problem cannot be used to solve the addressed problem. In this paper, we propose an exact algorithm based on the Branch and Bound principle and improved by the Lookahead technique. We show relevant properties of the optimum hierarchy permitting efficient pruning of the search space. To our knowledge, our paper is the first to propose an exact algorithm for this non-trivial multi-constrained optimal multicast route computation. Simulations illustrate the efficiency of the proposed pruning operations. The analysis of the execution time shows that in simple topologies and with tight QoS constraints the exact algorithm requires relatively little execution time. With loose constraints the computation time cannot be tolerated even for off-line route computation. In these cases, the solution is close to a Steiner tree and heuristics can be applied. These results can serve as basis for the design of efficient, polynomial-time routing algorithms.展开更多
Objective To detect the impact of side branch(SB)lesion length on acute SB occlusion after main vessel(MV)stenting.Methods A total of 516 consecutive patients with 524 bifurcation lesions undergoing one-stent techniqu...Objective To detect the impact of side branch(SB)lesion length on acute SB occlusion after main vessel(MV)stenting.Methods A total of 516 consecutive patients with 524 bifurcation lesions undergoing one-stent techniques were studied.Multivariate logistic regression analysis was performed to identify independent predictors of acute SB occlusion.The lesions were also further divided into two groups according to the median of SB lesion length.The incidence of SB occlusion and lesion characteristics in the two subgroups were compared.展开更多
文摘In the last decade,intraductal papillary mucinous neoplasms(IPMNs) have become commonly diagnosed.From a morphological standpoint,they are classified in main-duct IPMNs(MD-IPMNs) and branch-duct IPMNs(BD-IPMNs),depending on the type of involvement of the pancreatic ductal system by the neoplasm.Despite the fact that our understanding of their natural history is still incomplete,recent data indicate that MD-IPMNs and BD-IPMNs show significant differences in terms of biological behaviour with MD-IPMNs at higher risk of malignant degeneration.In the present paper,clinical and epidemiological characteristics,rates of malignancy and the natural history of MD-IPMNs and BD-IPMNs are analyzed.The profile of IPMNs involving both the main pancreatic duct and its side branches(combined-IPMNs) are also discussed.Finally,general recommendations for management based on these differences are given.
文摘Intraductal papillary mucinous neoplasms(IPMN) of the pancreas include a spectrum of dysplasia ranging from minimal mucinous hyperplasia to invasive carcinoma and are extensive tumors that often spread along the ductal tree.Several studies have demonstrated that preoperative imaging is not accurate enough to adapt the extent of pancreatectomy and have suggested routinely using frozen sectioning(FS) to evaluate the completeness of resection and also to check if ductal dilatation is active or passive,in order to avoid an excessive pancreatic resection.Separate main duct and branch duct analysis is needed due to the difference in the natural history of the disease.FS accuracy averages 95%.Eroded epithelium on the main duct,severe ductal inflammation mimicking dysplasia and reactive epithelial changes secondary to obstruction can lead to inappropriate FS results.FS results change the planned extent of resection in up to 30% of cases.The optimal cut-off leading to extend pancreatectomy is not consensual and our standard option is to extend pancreatec-tomy if FS reveals:(1) at least IPMN adenoma on the main duct;or(2) at least borderline IPMN on branch ducts;or(3) invasive carcinoma.However,the decision to extend resection must be taken after a multidisciplinary discussion since it does not exclusively depend on the FS result but also on age,general condition and expected prognosis after resection.The main limitation of using FS is the existence of discontinuous("skip") lesions which account for approximately 10% of IPMN in surgical series and can lead to reoperation in up to 8% of cases.
文摘Intraductal papillary mucinous neoplasm(IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucinproducing cells arising in the main duct(MD) and/or branch ducts(BD) of the pancreas.Involved ducts are dilated and filled with neoplastic papillae and mucus in variable intensity.IPMN lacks ovarian-type stroma,unlike mucinous cystic neoplasm,and is defined as a grossly visible entity(≥ 5 mm),unlike pancreatic intraepithelial neoplasm.With the use of high-resolution imaging techniques,very small IPMNs are increasingly being identified.Most IPMNs are solitary and located in the pancreatic head,although 20%-40% are multifocal.Macroscopic classification in MD type,BD type and mixed or combined type reflects biological differences with important prognostic and preoperative clinical management implications.Based on cytoarchitectural atypia,IPMN is classified into low-grade,intermediategrade and high-grade dysplasia.Based on histological features and mucin(MUC) immunophenotype,IPMNs are classified into gastric,intestinal,pancreatobiliary and oncocytic types.These different phenotypes can be observed together,with the IPMN classified according to the predominant type.Two pathways have been suggested:gastric phenotype corresponds to less aggressive uncommitted cells(MUC1-,MUC2-,MUC5 AC +,MUC6 +) with the capacity to evolve to intestinal phenotype(intestinal pathway)(MUC1-,MUC2 +,MUC5 AC +,MUC6- or weak +) or pancreatobiliary /oncocytic phenotypes(pyloropancreatic pathway)(MUC1 +,MUC 2-,MUC5 AC +,MUC 6 +) becoming more aggressive.Prognosis of IPMN is excellent but critically worsens when invasive carcinoma arises(about 40% of IPMNs),except in some cases of minimal invasion.The clinical challenge is to establish which IPMNs should be removed because of their higher risk of developing invasive cancer.Once resected,they must be extensively sampled or,much better,submitted in its entirety for microscopic study to completely rule out associated invasive carcinoma.
文摘The aim of this work is mathematical education through the knowledge system and mathematical modeling. A net model of formation of mathematical knowledge as a deductive theory is suggested here. Within this model the formation of deductive theory is represented as the development of a certain informational space, the elements of which are structured in the form of the orientated semantic net. This net is properly metrized and characterized by a certain system of coverings. It allows injecting net optimization parameters, regulating qualitative aspects of knowledge system under consideration. To regulate the creative processes of the formation and realization of mathematical know- edge, stochastic model of formation deductive theory is suggested here in the form of branching Markovian process, which is realized in the corresponding informational space as a semantic net. According to this stochastic model we can get correct foundation of criterion of optimization creative processes that leads to “great main points” strategy (GMP-strategy) in the process of realization of the effective control in the research work in the sphere of mathematics and its applications.
文摘The optimal solution of the multi-constrained QoS multicast routing problem is a tree-like hierarchical structure in the topology graph. This multicast route contains a feasible path from the source node to each of the destinations with respect to a set of QoS constraints while minimizing a cost function. Often, it is a tree. In other cases, the hierarchies can return several times to nodes and links of the topology graph. Similarly to Steiner problem, finding such a structure is an NP-hard problem. The usual tree and topology enumeration algorithms applied for the Steiner problem cannot be used to solve the addressed problem. In this paper, we propose an exact algorithm based on the Branch and Bound principle and improved by the Lookahead technique. We show relevant properties of the optimum hierarchy permitting efficient pruning of the search space. To our knowledge, our paper is the first to propose an exact algorithm for this non-trivial multi-constrained optimal multicast route computation. Simulations illustrate the efficiency of the proposed pruning operations. The analysis of the execution time shows that in simple topologies and with tight QoS constraints the exact algorithm requires relatively little execution time. With loose constraints the computation time cannot be tolerated even for off-line route computation. In these cases, the solution is close to a Steiner tree and heuristics can be applied. These results can serve as basis for the design of efficient, polynomial-time routing algorithms.
文摘Objective To detect the impact of side branch(SB)lesion length on acute SB occlusion after main vessel(MV)stenting.Methods A total of 516 consecutive patients with 524 bifurcation lesions undergoing one-stent techniques were studied.Multivariate logistic regression analysis was performed to identify independent predictors of acute SB occlusion.The lesions were also further divided into two groups according to the median of SB lesion length.The incidence of SB occlusion and lesion characteristics in the two subgroups were compared.
