Safety and efficacy of Kaffes intraductal self-expanding metal stents in the management of post-liver transplant anastomotic strictures

BACKGROUND Endoscopic management is the first-line therapy for post-liver-transplant anas-tomotic strictures.Although the optimal duration of treatment with plastic stents has been reported to be 8-12 months,data on safety and duration for metal stents in this setting is scarce.Due to limited access to endoscopic retrograde cholan-giopancreatography(ERCP)during the coronavirus disease 2019 pandemic in our centre,there was a change in practice towards increased usage and length-of-stay of the Kaffes biliary intraductal self-expanding stent in patients with suitable anatomy.This was mainly due to the theoretical benefit of Kaffes stents allowing for longer indwelling periods compared to the traditional plastic stents.METHODS Adult liver transplant recipients aged 18 years and above who underwent ERCP were retrospectively identified during a 10-year period through a database query.Unplanned admissions post-Kaffes stent insertion were identified manually through electronic and scanned medical records.The main outcome was the incidence of complications when stents were left indwelling for 3 months vs 6 months.Stent efficacy was calculated via rates of stricture recurrence between patients that had stenting courses for≤120 d or>120 d.RESULTS During the study period,a total of 66 ERCPs with Kaffes insertion were performed in 54 patients throughout their stenting course.In 33 ERCPs,the stent was removed or exchanged on a 3-month interval.No pancreatitis,perfor-ations or deaths occurred.Minor post-ERCP complications were similar between the 3-month(abdominal pain and intraductal migration)and 6-month(abdominal pain,septic shower and embedded stent)groups-6.1%vs 9.1%respectively,P=0.40.All strictures resolved at the end of the stenting course,but the stenting course was variable from 3 to 22 months.The recurrence rate for stenting courses lasting for up to 120 d was 71.4%and 21.4%for stenting courses of 121 d or over(P=0.03).There were 28 patients that were treated with a single ERCP with Kaffes,21 with removal after 120 d and 7 within 120 d.There was a significant improvement in stricture recurrence when the Kaffes was removed after 120 d when a single ERCP was used for the entire stenting course(71.0%vs 10.0%,P=0.01).CONCLUSION Utilising a single Kaffes intraductal fully-covered metal stent for at least 4 months is safe and efficacious for the management of post-transplant anastomotic strictures.

The expanding amyloid family:Structure,stability,function,and pathogenesis

The hidden world of amyloid biology has suddenly snapped into atomic-level focus,revealing over 80 amyloid protein fibrils,both pathogenic and functional.Unlike globular proteins,amyloid proteins flatten and stack into unbranched fibrils.Stranger still,a single protein sequence can adopt wildly different two-dimensional conformations,yielding distinct fibril polymorphs.

Efficacy and safety of standard and anti-reflux self-expanding metal stent: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND Self-expanding metal stents are the main palliative treatment modality for unresectable esophageal cancer. Gastroesophageal reflux is a common adverse outcome after placement of esophageal stent for cancer involving the gastroesophageal junction and the gastric cardia. Anti-reflux stents with valve have been designed to prevent the acid reflux. The superiority of anti-reflux stent over standard stent in preventing gastroesophageal reflux has not been established well. This study compares the anti-reflux stent and the standard stent in terms of their efficacy to prevent acid reflux.AIM To compare the standard and the anti-reflux stents in terms of their efficacy,safety, and complications.METHODS The meta-analysis included 8 randomized clinical trials(RCTs) to compare pooled outcomes of total 395 patients. Primary outcomes include improvement in reflux symptoms and dysphagia score. Secondary outcomes include complications of stent migration, occlusion, and bleeding.RESULTS A total of eight RCTs were included in the meta-analysis. Compared to the standard stent, the anti-reflux stent showed a trend towards reduction in the dysphagia score without reaching a statistical significance [Standardized mean difference(SMD):-0.33(-0.71, 0.05); P = 0.09, I2: 37%]. There was no statistical difference in the gastrointestinal reflux(GER) scores between the two types of stents [SMD:-0.17(-0.78, 0.45); P = 0.008, I2: 74%]. Compared to standard stent,anti-reflux stent showed no difference in the risk of stent migration [OR: 1.37(0.66, 2.83); P = 0.40, I2: 0 %], bleeding [OR: 1.43(0.40, 5.13); P = 0.59, I2: 0 %], and obstruction [OR: 1.66(0.60, 4.60); P = 0.33, I2: 0 %].CONCLUSION Traditional self-expanding standard esophageal stent and anti-reflux stent with valve are similar in terms of outcomes and complications.

A subspace expanding technique for global zero finding of multi-degree-of-freedom nonlinear systems

A subspace expanding technique(SET) is proposed to efficiently discover and find all zeros of nonlinear functions in multi-degree-of-freedom(MDOF) engineering systems by discretizing the space into smaller subdomains, which are called cells. The covering set of the cells is identified by parallel calculations with the root bracketing method. The covering set can be found first in a low-dimensional subspace, and then gradually extended to higher dimensional spaces with the introduction of more equations and variables into the calculations. The results show that the proposed SET is highlyefficient for finding zeros in high-dimensional spaces. The subdivision technique of the cell mapping method is further used to refine the covering set, and the obtained numerical results of zeros are accurate. Three examples are further carried out to verify the applicability of the proposed method, and very good results are achieved. It is believed that the proposed method will significantly enhance the ability to study the stability, bifurcation,and optimization problems in complex MDOF nonlinear dynamic systems.

Current approach for Boerhaaves syndrome:A systematic review of case reports

There is no consensus on the appropriate therapeutic strategy for Boerhaave syndrome due to its rarity and changing therapeutic approaches.We conducted a systematic review of case reports documenting Boerhaave syndrome.AIM To assess the therapeutic methods and clinical outcomes and discuss the current trends in the management of Boerhaave syndrome.METHODS We searched PubMed,Google scholar,MEDLINE,and The Cochrane Library for studies concerning Boerhaave syndrome published between 2017 and 2022.RESULTS Of the included studies,49 were case reports,including a total of 56 cases.The mean age was 55.8±16 years old.Initial conservative treatment was performed in 25 cases,while operation was performed in 31 cases.The rate of conservative treatment was significantly higher than that of operation in cases of shock vital on admission(9.7%vs 44.0%;P=0.005).Seventeen out of 25 conservative cases(68.0%)were initially treated endoscopic esophageal stenting;2 of those 17 cases subsequently underwent operation due to poor infection control.Twelve cases developed postoperative leakage(38.7%),and 4 of those 12 cases underwent endoscopic esophageal stenting to stop the leakage.The length of the hospital stay was not significantly different between the conservative treatment and operation cases(operation vs conservation:33.52±22.69 vs 38.81±35.28 days;P=0.553).CONCLUSION In the treatment of Boerhaave syndrome,it is most important to diagnose the issue immediately.Primary repair with reinforcement is the gold-standard procedure.The indication of endoscopic esophageal stenting or endoluminal vacuum-assisted therapy should always be considered for patients in a poor general condition and who continue to have leakage after repair.

Optimizing Grids Demand Reduction through Enhanced Heat Transfer in Low-Temperature Waste Heat Driven ORC Systems

With increasing awareness of energy conservation and environmental protection, the Organic Rankine Cycle (ORC) system has gained significant attention. This technology enables the recovery of industrial waste heat, waste incineration heat, and renewable energy sources such as geothermal heat, biomass energy, and solar energy at lower temperatures. However, the low-grade heat source utilized in ORC systems faces a challenge to achieving high power generation efficiency and output power. Therefore, enhancing the power generation capacity of ORC systems is a key research focus in this field. An entranced heat exchanger ORC system with the screw expander driven by the low-temperature heat source is established to investigate the relevant performance. Hot water temperature from 77°C to 132°C is adopted for performance analysis, while the environmental temperature is approximately 25°C. Refrigerant R245fa is selected as the working fluid, and the screw expander is employed for power generation. It is worth noting that the entranced heat exchanger ORC system has significant potential for low-temperature heat recovery. Experimental results indicate that the maximum power output is 12.83 kW, which is obtained at around 105°C hot water inlet temperature. Correspondingly, the average power output remains 11.75 kW, revealing the system’s high stability for power generation. The implementation of a plate heat exchanger for enhanced heat transfer has enabled a 50% reduction in system size compared to traditional shell-tube type ORC systems. Besides, economic calculations demonstrate substantial benefits associated with the ORC system. The calculations indicate an internal benefit of 560,000 RMB/year, accompanied by notable external benefits such as an energy saving and emission reduction potential of up to 784 t CO2 per year. Moreover, the payback period is 2.23 years. It shows a remarkable improvement in terms of performance and excellent economic benefits. As a result, the novel ORC presents a promising alternative for low-grade heat utilization as compared to conventional small-scale ORC systems.

Even Closer China-Philippines Relations China and the Philippines have shown commitment to managing differences and expanding cooperation,which fosters more confidence in the ongoing stability of bilateral relations over the next six years

On January 3,2023,China welcomed the first visit in the new year by a foreign head of state,Philippine President Ferdinand Marcos Jr.The visit was also the president’s first official state visit to a country outside ASEAN since he took office in June 2022,which demonstrated the great importance the two countries attach to their bilateral relations.The three-day visit was fruitful despite a tight schedule.

Expanding Food Security

China and FAO assist Uganda to become self-sufficent in food production, and serve as the food basket of the region Eighty percent of Uganda’s economy depends on agriculture, according to the Uganda Bureau of Statistics. For this reason, Frank Tumwebaze, Uganda’s minister of agriculture, animal industry and fisheries, said in an interview recently that since the majority of the country’s population is involved in agriculture.

Lateral earth pressure of granular backfills on retaining walls with expanded polystyrene geofoam inclusions under limited surcharge loading

Existing studies have focused on the behavior of the retaining wall equipped with expanded polystyrene(EPS)geofoam inclusions under semi-infinite surcharge loading rather than limited surcharge loading.In this paper,the failure mode and the earth pressure acting on the rigid retaining wall with EPS geofoam inclusions and granular backfills(henceforth referred to as EPS-wall),under limited surcharge loading are investigated through two-and three-dimensional model tests.The testing results show that different from the sliding of almost all the backfill in the EPS-wall under semi-infinite surcharge loading,only an approximately triangular backfill slides in the wall under limited surcharge loading.The distribution of the lateral earth pressure on the EPS-wall under limited surcharge loading is non-linear,and the distribution changes from the increase of the wall depth to the decrease with the increase of the limited surcharge loading.An approach based on the force equilibrium of a differential element is developed to predict the lateral earth pressure behind the EPS-wall subjected to limited surcharge loading,and its performance was fully validated by the three-dimensional model tests.

Three-Soliton Interactions and the Implementation of Their All-Optical Switching Function

As a key component in all-optical networks,all-optical switches play a role in constructing all-optical switching.Due to the absence of photoelectric conversion,all-optical networks can overcome the constraints of electronic bottlenecks,thereby improving communication speed and expanding their communication bandwidth.We study all-optical switches based on the interactions among three optical solitons.By analytically solving the coupled nonlinear Schr¨odinger equation,we obtain the three-soliton solution to the equation.We discuss the nonlinear dynamic characteristics of various optical solitons under different initial conditions.Meanwhile,we analyze the influence of relevant physical parameters on the realization of all-optical switching function during the process of three-soliton interactions.The relevant conclusions will be beneficial for expanding network bandwidth and reducing power consumption to meet the growing demand for bandwidth and traffic.

Controllable fabrication of FeCoS_(4) nanoparticles/S-doped bowl-shaped hollow carbon as efficient lithium storage anode

To address the low conductivity and easy agglomeration of transition metal sulfide nanoparticles,FeCoS_(4) nanoparticles embedded in S-doped hollow carbon(FeCoS_(4)@S-HC)composites were successfully fabricated through a combination of hydrothermal processes and sulfidation treatment.The unique bowlshaped FeCoS_(4)/S-HC composites exhibit excellent structural stability with a high specific surface area of 303.7 m^(2)·g^(-1) and a pore volume of 0.93 cm^(3)·g^(-1).When applied as anode material for lithium-ion batteries,the FeCoS_(4)@S-HC anode exhibits efficient lithium storage with high reversible specific capacity(970.2 mA·h·g^(-1) at 100 mA·g^(-1))and enhanced cycling stability(574 mA·h·g^(-1) at 0.2 A·g^(-1) after 350 cycles,a capacity retention of 84%).The excellent lithium storage is attributed to the fact that the bimetallic FeCoS_(4) nanoparticles with abundant active sites can accelerate the electrochemical reaction kinetics,and the bowl-shaped S-HC structure can provide a stable mechanical structure to suppress volume expansion.

Compression properties of cost-efficient porous expanded clay reinforced AA7075 syntactic foams fabricated by industrial-oriented die casting technology

In today’s manufacturing industries,hard competition between rival firms makes it compulsory for researchers to design lighter and cheaper machine components due to the megatrends of cost-effectiveness and anti-pollution.At this point,aluminum syntactic foams(ASFs)are new-generation engineering composites and come into the upfront as a problem-solver.Owing to their features like low density,sufficient elongation,and perfect energy absorption ability,these advanced foams have been considerably seductive for many industrial sectors nowadays.In this study,an industrial-oriented automatic die casting technology was used for the first time to manufacture the combination of AA7075/porous expanded clay(PEC).Micro evaluations(optical and FESEM)reveal that there is a homogenous particle distribution in the foam samples,and inspections are compatible with the other ASF studies.Additionally,T6 aging heat treatment was operated on one half of the produced foams to explore the probable impact of aging on the compressive responses.Attained results show that PEC particles can be an alternative to expensive hollow spheres used in the previous works.Besides,a favorable relationship is ascertained between the aging treatment and mechanical properties such as compression strength and plateau strength.

Predictors of permanent pacemaker implantation following transcatheter aortic valve replacement-the search is still on!

Several anatomical,demographic,clinical,electrocardiographic,procedural,and valve-related variables can be used to predict the probability of developing con-duction abnormalities after transcatheter aortic valve replacement(TAVR)that necessitate permanent pacemaker(PPM)implantation.These variables include calcifications around the device landing zone and in the mitral annulus;pre-existing electrocardiographic abnormalities such as left and right bundle branch blocks(BBB),first-and second-degree atrioventricular blocks,as well as bifas-cicular and trifascicular blocks;male sex;diabetes mellitus(DM);hypertension;history of atrial fibrillation;renal failure;dementia;and use of self-expanding valves.The current study supports existing literature by demonstrating that type 2 DM and baseline right BBB are significant predictors of PPM implantation post-TAVR.Regardless of the side of the BBB,this study demonstrated,for the first time,a linear association between the incidence of PPM implantation post-TAVR and every 20 ms increase in baseline QRS duration(above 100 ms).After a 1-year follow-up,patients who received PPM post-TAVR had a higher rate of hospital-ization for heart failure and nonfatal myocardial infarction.

Expandable endoprostheses in skeletally immature patients:Where we are

Approximately 45 percent of malignant bone tumors are seen under the age of 16 and one of the important results of growth plate sacrification in patients with immature skeletons is limb inequality.Until the early 1990s,the treatment options for these patients were rotationplasty or amputation.Multimodal approaches that combine imaging,chemotherapy,and surgical techniques have enabled the development of limb-preserving methods with satisfactory results.In order to overcome inequality problems,expandable prostheses have been developed in the 1980s.Extendable endoprosthesis replacements have been improved over the years and are now an established and safe alternative.Noninvasive prostheses appear to be advantageous compared to minimally invasive expandable prostheses that require multiple surgical procedures,but the complication rate remains high.Therefore,although expandable prostheses are not the definitive answer to the treatment of bone sarcomas in skeletally immature children,they are still a suitable interim choice until full adulthood is achieved.Due to reported high complication rates,the procedures require significant experience and are recommended for use only in specialized cancer centers.

Nursing Care and Causative Analysis of Grade IV Capsular Contracture Following Breast Cancer Expander Implantation

Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reasons for the formation of capsular contracture after Stage I expander implantation and prevent its recurrence following Stage II reconstruction. Methods: In May 2020, the patient noticed an increase in the size of a breast mass. In August, she underwent AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving nipple-areolar subglandular excision + right axillary lymph node dissection + expander implantation” surgery in November 2020. Radiation therapy began in January 2021. During radiation therapy, the patient experienced severe breast hardening, distortion, tenderness, and was diagnosed with Grade IV capsular contracture. To relieve the capsular contracture, the patient underwent a “contracted capsule incision and release procedure + removal of the right breast expander + right breast implantation” surgery in July 2021. Postoperatively, measures were taken to prevent incision infection, emphasizing aseptic techniques, ensuring smooth negative pressure drainage, reducing skin flap tension, monitoring skin flap blood supply, actively preventing subcutaneous effusion and hematoma, and applying appropriate compression dressings. Results: The patient was discharged after the removal of the drainage tube. During the postoperative follow-up at 3 and 6 months, there was no recurrence of capsular contracture, and the breast appeared full, upright, and relatively soft. There were no complications such as hematoma, infection, breast implant rupture, breast sagging, or displacement. The patient had a good outcome without additional financial or surgical burdens. Conclusion: The occurrence of Grade IV capsular contracture in the patient is generally related to infection after Stage I expander implantation, improper compression dressing, excessive saline injection causing content infiltration, and radiation therapy. Therefore, it is recommended to enhance the intraoperative and postoperative prophylactic use of antibiotics after Stage I expander implantation. Intermittent saline injection after surgery, with the amount of saline gradually increasing rather than filling all at once, is advisable. This helps the breast tissue gradually adapt to expansion, reducing the risk of capsular contracture. Postoperatively, patients should be instructed to wear pressure garments and breast elastic bandages while intensifying breast monitoring during radiation therapy and increasing postoperative follow-up.

Liver transplantation for hepatocellular carcinoma in India: Are we ready for 2040?

BACKGROUND Liver transplantation(LT)for hepatocellular carcinoma(HCC)has been widely researched and is well established worldwide.The cornerstone of this treatment lies in the various criteria formulated by expert consensus and experience.The variations among the criteria are staggering,and the short-and long-term outcomes are controversial.AIM To study the differences in the current practices of LT for HCC at different centers in India and discuss their clinical implications in the future.METHODS We conducted a survey of major centers in India that performed LT in December 2022.A total of 23 responses were received.The centers were classified as high-and low-volume,and the current trend of care for patients undergoing LT for HCC was noted.RESULTS Of the 23 centers,35%were high volume center(>500 Liver transplants)while 52%were high-volume centers that performed more than 50 transplants/year.Approximately 39%of centers had performed>50 LT for HCC while the percent distribution for HCC in LT patients was 5%–15%in approximately 73%of the patients.Barring a few,most centers were divided equally between University of California,San Francisco(UCSF)and center-specific criteria when choosing patients with HCC for LT,and most(65%)did not have separate transplant criteria for deceased donor LT and living donor LT(LDLT).Most centers(56%)preferred surgical resection over LT for a Child A cirrhosis patient with a resectable 4 cm HCC lesion.Positron-emission tomography-computed tomography(CT)was the modality of choice for metastatic workup in the majority of centers(74%).Downstaging was the preferred option for over 90%of the centers and included transarterial chemoembolization,transarterial radioembolization,stereotactic body radiotherapy and atezolizumab/bevacizumab with varied indications.The alphafetoprotein(AFP)cut-off was used by 74%of centers to decide on transplantation as well as to downstage tumors,even if they met the criteria.The criteria for successful downstaging varied,but most centers conformed to the UCSF or their center-specific criteria for LT,along with the AFP cutoff values.The wait time for LT from downstaging was at least 4–6 wk in all centers.Contrast-enhanced CT was the preferred imaging modality for post-LT surveillance in 52%of the centers.Approximately 65%of the centers preferred to start everolimus between 1 and 3 months post-LT.CONCLUSION The current predicted 5-year survival rate of HCC patients in India is less than 15%.The aim of transplantation is to achieve at least a 60%5-year disease free survival rate,which will provide relief to the prediction of an HCC surge over the next 20 years.The current worldwide criteria(Milan/UCSF)may have a higher 5-year survival(>70%);however,the majority of patients still do not fit these criteria and are dependent on other suboptimal modes of treatment,with much lower survival rates.To make predictions for 2040,we must prepare to arm ourselves with less stringent selection criteria to widen the pool of patients who may undergo transplantation and have a chance of a better outcome.With more advanced technology and better donor outcomes,LDLT will provide a cutting edge in the fight against liver cancer over the next two decades.

ON CHINESE MEDIA

Since 2012,China has made historic achievements in pursuing high-quality economic development.It has accelerated industrial transformation and upgrading by advancing the integrated development of industrialization and informatization,and of manufacturing and service industries,so as to gather strength through new drivers.It has adhered to the innovation-driven development in strategic emerging industries,while also cultivating future industries,and expanding new fields and tracks for further development.

Earth: Review Article

Every year on 22 April, we have celebrated Earth Day and the beautiful planet we call home. Earth Day, established in 1970, has been used to highlight our planet’s environmental challenges and raise awareness of the importance of protecting our world for future generations [1]. To provide the protection of our planet, we should explain Earth’s environmental challenges to the best of our knowledge in frames of contemporary Geophysics. This paper gives a short overview of the developed Hypersphere World-Universe Model (WUM) and pay particular attention to the principal role of Dark Matter (DM) in the Earth’s life. In this manuscript, we discuss different aspects of the Earth: a condition of Young Earth before the Beginning of life on It;Internal Structure;“The 660-km Boundary” that we named Geomagma;Random Variations of Earth’s Rotational Speed on a daily basis;Origin of Moon;Expanding Earth;Internal Heating;Faint Young Sun paradox;Geocorona and Planetary Coronas;High-Energy Atmospheric Physics. WUM proposed principally different ways to solve the problems of Internal Heating, Origin of the Moon, and Faint Young Sun paradox based on DM core of the Earth. The Model revealed the fact that the Sun Activity causes the Geomagma Activity and, as a consequence, Random Variations of Earth’s Rotational Speed by the varying Sun’s magnetic field.

《中国标准化发展年度报告(2023年)》发布

In March,Standardization Administration of China(SAC)published the Annual Report on Standardization Development of China(2023),which gives an overview of China’s standardization work last year including the analysis of key data and how standards advance technologies and promote social and economic development.It also clarifies the role of standards in promoting equipment renewal,expanding high-level opening up,and stabilizing the industrial chain in the near future.

FIGURES

5.3%China's GDP expanded by5.3%in the first quacrter from the same period of 2023, compared with the 5.2%overall growth registered last year and above the annual growth target of around5%set for this year,National Bureau of Statistics(NBS) data showed.