Risk factors for recurrence of common bile duct stones after surgical treatment and effect of ursodeoxycholic acid intervention

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an accurate diagnostic method for choledocholithiasis and treatment option for stone removal.Additionally,ursodeoxycholic acid(UDCA)can dissolve cholesterol stones and prevent their development and reappearance by lowering the cholesterol concen-tration in bile.Despite these treatment options,there are still patients who experience stone recurrence.The clinical data of 100 patients with choledochal stones who were hospitalized at the Yixing People’s Hospital and underwent ERCP for successful stone extraction between June 2020 and December 2022 were retrospectively collected.According to the post-ERCP treatment plan,100 patients were classified into UDCA(n=47)and control(n=53)groups.We aimed to assess the clinical efficacy and rate of relapse in the two patient populations.We then collected information(basic demographic data,clinical characteristics,and serum biochemical indicators)and determined the factors contributing to relapse using logistic regression analysis.Our secondary goal was to determine the effects of UDCA on liver function after ERCP.Compared to the control group,the UDCA group demonstrated a higher clinical effectiveness rate of 92.45%vs 78.72%(P<0.05).No significant differences were observed in liver function indices,including total bilirubin,direct bilirubin,gamma-glutamyl transpeptidase,alanine aminotransferase,alkaline phosphatase,and aspartate aminotransferase,between the two groups before treatment.After treatment,all liver function indices were significantly reduced.Comparing the control vs UDCA groups,the UDCA group exhibited significantly lower levels of all indices(55.39±6.53 vs 77.31±8.52,32.10±4.62 vs 45.39±5.69,142.32±14.21 vs 189.63±16.87,112.52±14.25 vs 149.36±15.36,122.61±16.00 vs 171.33±22.09,96.98±10.44 vs 121.35±11.57,respectively,all P<0.05).The stone recurrence rate was lower in the UDCA group(13.21%)in contrast with the control group(44.68%).Periampullary diverticula(OR:6.00,95%CI:1.69-21.30),maximum stone diameter(OR:1.69,95%CI:1.01-2.85),stone quantity>3(OR:4.23,95%CI:1.17-15.26),and positive bile culture(OR:7.61,95%CI:2.07-27.91)were independent factors that influenced the relapse of common bile duct stones after ERCP(P<0.05).Furthermore,postoperative UDCA was identified as a preventive factor(OR:0.07;95%CI:0.08-0.09).CONCLUSION The intervention effect of UDCA after ERCP for common bile duct stones is adequate,providing new research directions and references for the prevention and treatment of stone recurrence.

Study on models for control of interest rate risks

Analyses different interest rate risks, presents a new model for assessment of interest rates and thereby establishes the framework for control of interest

Organ at Risk Doses during High Dose Rate Intracavitary Brachytherapy for Cervical Cancer: A Dosimetric Study

Background: Treatment of Cervical cancer includes a combination of external beam radiotherapy (EBRT) with intracavitary brachytherapy (ICBT). ICBT helps to boost radiation dose to primary disease. Organs like rectum, bladder, sigmoid and small bowel lie close to the cervix region and these organs receive dose from EBRT as well as ICBT and we want to know the dose to these organ at risk (OAR). Materials & Methods: Dosimetric details of 174 ICBT applications done in 58 patients were retrospectively analysed. All patients received EBRT dose of 50.4 Gy in 28 fractions. All patients had ICBT, three sessions with 7 Gy prescribed to point A. Dosimetric data including dose to right and left point A and dose to OARs were recorded from Oncentra Planning System. Results: Mean dose to point A on right side was 6.89 Gy and left side was 6.91 Gy. Mean D2cc dose to rectum, bladder, sigmoid and small bowel was 3.5 Gy, 5.25 Gy, 4.75 Gy and 4.2 Gy respectively. Mean EQD2 dose combining EBRT and ICBT in point A was 78.7 Gy on right side and 79 Gy on left side. Mean EQD2 doses to D2cc of rectum, bladder, sigmoid and small bowel was 62 Gy, 74.4 Gy, 70.5 Gy and 66.5 Gy respectively. Conclusion: From the results of this dosimetric study it is evident that OARs like rectum, sigmoid, bladder & bowel are receiving only acceptable doses of radiation using point A prescribed CT based ICBT planning. Hence with regards to OAR doses, CT based ICBT planning with dose prescribed to point A is a feasible option.

On the Distribution of Duration of First Negative Surplus for a Discrete Time Risk Model with Random Interest Rate

In this paper, we examine further annuity-due risk model presented by Cai （Probability in the Engineering and Informational Sciences, 16（2002）, 309-324）. We consider the computation for the distribution of duration of first negative surplus and the algorithm is shown for calculating probability that ruin occurs and the duration of first negative surplus takes any nonnegative integers values. Numerical illustration for the main result is given.

Exchange Rate Risk of China's Foreign Exchange Reserve Assets--An Empirical Study Based on GARCH-VaR Model

As the core economic variable in the process of the integration of world economy,the change of the exchange rate has an important impact on the import and export,foreign exchange reserves,interest rates,capital flows and other macro and microeconomic factors.This paper first analyzes the status quo of RMB exchange rate risk and the advanced experience of exchange rate management of other countries.Then,the empirical method is used to analyze the characteristics of RMB exchange rate fluctuation based on the day-frequency data of USD/RMB,GBP/RMB,EUR/RMB and JPY/RMB from December 2011 to December 2016.This paper also respectively uses the GARCH,TARCH,EGARCH and PARCH model to fit four representative foreign currencies against RMB,and selects the optimal model to calculate VaR value.Finally,validity of the data is verified through the Chi-square distribution test.The empirical results show that the four sequences are non-normal and first-order monotonic sequences.Besides,there is a significantly high-order ARCH effect,and the GARCH family model has a better fitting effect.JPY/RMB is with lower exchange rate risk,while the fluctuation of EUR/RMB is significantly greater than other currencies.According to the international situation of financial market,the status quo of RMB exchange rate and the conclusion of empirical research,this paper puts forward that the marketization and internationalization of RMB exchange rate should be based on improving the financial system and environment.It is also suggested that the government should properly intervene in the foreign exchange market and make good use of the risk measurement model and commercial banks should further develop the financial derivatives to hedge the foreign exchange risk.

Risk factors for anastomotic fistula development after radical colon cancer surgery and their impact on prognosis

BACKGROUND Colon cancer is a common malignant tumor in the gastrointestinal tract that is typically treated surgically.However,postradical surgery is prone to complic-ations such as anastomotic fistulas.AIM To investigate the risk factors for postoperative anastomotic fistulas and their impact on the prognosis of patients with colon cancer.METHODS We conducted a retrospective analysis of 488 patients with colon cancer who underwent radical surgery.This study was performed between April 2016 and April 2019 at a tertiary hospital in Wuxi,Jiangsu Province,China.A t-test was used to compare laboratory indicators between patients with and those without postoperative anastomotic fistulas.Multiple logistic regression analysis was performed to identify independent risk factors for postoperative anastomotic fistulas.The Functional Assessment of Cancer Therapy-Colorectal Cancer was also used to assess postoperative recovery.RESULTS Binary logistic regression analysis revealed that age[odds ratio(OR)=1.043,P=0.015],tumor,node,metastasis stage(OR=2.337,P=0.041),and surgical procedure were independent risk factors for postoperative anastomotic fistulas.Multiple linear regression analysis showed that the development of postoperative anastomotic fistula(P=0.000),advanced age(P=0.003),and the presence of diabetes mellitus(P=0.015),among other factors,independently affected CONCLUSION Postoperative anastomotic fistulas significantly affect prognosis and survival rates.Therefore,focusing on the clinical characteristics and risk factors and immediately implementing individualized preventive measures are important to minimize their occurrence.

Risk factors and strategy for surgical incision infection in department of abdominal surgery

Objective To study the risk factors of surgical wound infection among the patients in department of abodominal surgery. Methods The factors on surgical wound infection were investigated by retrospective study. The diagnosis standard was based on Diagnosis Standard of Hospital Infection published by Ministry of Health.

企业资源配置战略与债券信用评级

企业战略作为企业全局性、长期性资源配置的重要规划,对企业经营活动具有重要影响,也必然会影响企业的融资行为。本文从企业战略视角出发,以2008—2020年中国A股上市公司为研究对象,运用固定效应模型探究了企业资源配置战略对债券信用评级的影响。研究发现:相对于经营主导型企业,投资主导型企业的债券信用评级更低,并且该结论在处理内生性问题和进行一系列稳健性检验后依然成立。异质性分析发现,企业资源配置战略对债券信用评级的影响在非国有企业和分析师跟踪人数多的企业中更明显。中介效应检验结果表明,企业资源配置战略通过作用于企业违约风险而影响债券信用评级。本文的研究结论对发债企业、信用评级机构和债券市场投资者具有重要启示意义。

高管团队稳定性与企业ESG评级

ESG评级是推动企业可持续发展的重要动力,是企业长期生存的内在要求,而高管团队在企业长期发展中起着至关重要的作用。基于2010—2019年中国沪深A股上市公司数据,研究了高管团队稳定性对企业ESG评级的影响及其作用机制。研究发现,高管团队稳定性越高,企业ESG评级越高。机制检验显示,高管团队稳定性通过降低企业战略差异度和经营风险提高企业ESG评级。异质性检验结果表明,在内控质量较低、审计质量较低的企业中,高管团队稳定性对企业ESG评级影响效应显著;媒体关注度较低的企业中高管团队稳定性对企业ESG评级的影响更显著。因此,企业要重视高管团队稳定性,采取有效措施降低经营风险,注重ESG信息披露,提升ESG评级,以推动企业可持续发展。

老年维持性血液透析病人慢性便秘患病率和危险因素研究

目的探讨老年维持性血液透析(maintenance hemodialysis,MHD)病人慢性便秘的患病率及其危险因素。方法选取2023年1—6月东南大学附属中大医院血液净化中心定期随访的116例老年MHD病人为研究对象,收集病人的临床相关指标,采用便秘评分量表(constipation assessment scale,CAS)评估老年MHD病人的便秘水平。采用Pearson相关性分析探讨慢性便秘和临床指标的相关性;使用Logistic回归分析探讨老年MHD病人慢性便秘的危险因素。结果58例(50%)老年MHD病人患有慢性便秘,便秘评分与BMI、TC、TG水平以及总水量(total body water,TBW)、脂肪含量(body fat mass,BFM)和肥胖程度均呈正相关(P<0.05)。二元Logistic回归分析显示,TC、TG、TBW、BFM和肥胖程度是老年MHD病人便秘的危险因素(P<0.05)。结论老年MHD病人便秘的患病率较高,TC、TG、TBW、BFM和肥胖程度对老年MHD病人发生慢性便秘存在显著影响。

新疆及邻区现今GNSS变形特征与地震关系研究

基于GNSS观测数据,采用球面最小二乘配置方法计算了新疆及邻区的应变率张量特征,在统计分析研究区域应变率分布以及1900—2022年M≥6.0地震分布之间的关系的基础上,研究了GNSS应变率特征对强震地点的指示意义。通过构建三维弹性块体模型反演得到的区内主要断裂的运动变形特征,结合震源机制解结果,对比分析了断裂运动变形特征与不同区域强震类型之间的关系。结果表明:天山西段—帕米尔地区、阿尔金断裂带邻近地区呈现第二应变率高值特征,其中帕米尔构造结附近高值特性最明显;最大剪应变率方向在南天山西段—帕米尔地区主要为NE-NEE向,反映了该区以倾滑变形为主的特征。研究区域的M≥6.0地震主要分布在应变率高值区及其边缘,特别是帕米尔构造结东部地区的强震集中非常明显。区内断裂运动性质具有明显的分类特征,除整体以挤压运动为主外,NE走向断裂带以左旋走滑运动为主,NW走向的断裂以右旋走滑运动为主。NE走向的柯坪、迈丹和那拉提断裂带与NW走向的克孜勒陶、塔拉斯—费尔干纳断裂带汇集的南天山西段和帕米尔西构造结东部地区强震密集分布,强震的震源机制类型与断层运动方式较为一致。

成都地区汉族男性腹主动脉瘤的筛查及高危因素分析

目的探讨成都地区汉族男性腹主动脉瘤(AAA)患病率并分析危险因素。方法2014—2022年对成都市双流区24个敬老院和四川大学华西医院体检中心≥65岁的男性居民进行普查。筛查项目包括一般情况、合并症、生活习惯和超声指标。计算患病率。通过单因素及logistic逐步回归分析探索AAA发病的危险因素。结果共7132人纳入筛查,体检中心应答率为2518/3638(69.2%);敬老院应答率为3092/3494(88.5%)。参加筛查的人群均为男性,汉族,患病率为5.17%(290/5610)。290人患AAA为患病组,未患病者为未患病组。患病组腹痛、高血压、心血管疾病、脑血管疾病、吸烟,及饮酒高于未患病组(P<0.05)。高血压、脑血管疾病、心血管疾病、吸烟是AAA的影响因素(P<0.05)。结论超声在AAA筛查中可行;高血压、心脑血管疾病、吸烟是成都地区65岁以上男性人群AAA患病的危险因素。

关注尾部风险:贸易政策不确定性、预期与人民币汇率变动

贸易是决定汇率的首要因素,而贸易政策变动带来的不确定性如何影响人民币汇率双向变动?本研究基于无抛补利率平价思想,引入贸易政策不确定性的尾部风险对汇率预期的影响,建立中美贸易政策不确定性与人民币汇率关系的理论模型,进而基于交叉分位数回归模型探究中美贸易政策不确定性对人民币在岸与离岸市场的短期影响.实证结果表明中国和美国贸易政策不确定性对人民币在岸与离岸汇率冲击具有非对称性和尾部特征,且中国贸易政策不确定性对人民币汇率的影响占主导地位.最后,贸易政策不确定性通过改变外汇市场投资者的预期进一步作用于人民币汇率变动.因此,央行要加强针对尾部风险的主动应对措施,投资者需关注贸易政策改变带来的不确定性而调整套期保值策略。

桂皮、八角和花椒中重金属的溶出及健康风险评估

为研究八角、桂皮和花椒中的重金属摄入风险,从主产区采集15份桂皮(广西藤县)、15份八角(广西浦北县)和15份花椒(贵州德江县)样品,采用电感耦合等离子体串联质谱仪测定8种重金属(砷、钡、镉、铬、铜、锰、镍和铅)的含量,结合日常食用习惯,分析了这3种香辛料中的重金属在不同煮沸时间下的溶出情况,采用溶出结果计算其靶标危害指数(THQ)和非致癌风险指数(HI)。结果表明,这3个地区采集的八角、桂皮和花椒样品均未超过GB 2762—2022《食品安全国家标准食品中污染物限量》要求,桂皮中Mn含量要显著高于其他香调料的含量。桂皮和八角中的As,八角中的Ba、Cd、Mn和Ni溶出率超过50%,Mn和Ni在16 h后溶出率超过了95%(分别为95%和96%)。桂皮和花椒的HI值在不同时间的煮沸浸提时间段没有显著性差异(P≥0.05),八角的HI值要显著高于桂皮和花椒(P≤0.05);通过计算发现:无论是单种香辛料摄入单个重金属的THQ值,还是单种香辛料摄入8种重金属的HI值或3种香辛料叠加摄入的HI值,正常摄入来自这些地区的八角、桂皮和花椒不会引起非致癌的健康风险。

AA抑制率和ADP抑制率对脑出血后再出血及预后的预测价值分析

目的 本研究的目的是评估血栓弹力图(thrombelasto graphy,TEG)测试中AA抑制率和ADP抑制率在预测脑出血(ICH)后再出血和不良功能预后方面的有效性。方法 选取苏州市立医院2019年4月至2022年6月之间114例出现症状6 h内接受CT检查的原发性脑出血患者作为研究对象,评估两组患者入院后TEG指标中花生四烯酸(AA)抑制率、二磷酸腺苷(ADP)抑制率等与脑出血后再出血及病残率、病死率等结局的关系,以及与格拉斯哥昏迷量表评分的相关性。结果 未再出血组AA抑制率和ADP抑制率均明显低于再出血组(P<0.05);再出血组中死亡患者AA抑制率和ADP抑制率均明显高于康复组及病残组(P<0.05);AA抑制率和ADP抑制率与GCS评分呈负相关(r=-0.702,P=0.008)。结论在脑出血后再出血及预后的评估中,AA抑制率和ADP抑制率具有较好的预测价值,值得临床推广。

运动后心率恢复与心源性猝死风险的相关性:一项队列研究的Meta分析

目的通过Meta分析,综合分析运动后心率恢复(HRR)与心源性猝死(SCD)之间的关系。方法基于PubMed、Embase和Web of Science数据库,进行截至2024年1月2日的文献检索。队列研究关注于HRR和SCD间的风险关系,通过风险比(HR)及95%可信区间(CI)进行评估。统计学分析采用Stata 12.0软件。结果纳入6项研究。固定效应模型(I^(2)=41.8%,P=0.112)的汇总结果显示:与心率恢复慢相比,心率恢复快人群发生SCD风险更低(HR=0.74,95%CI:0.64~0.86,P<0.001)。大多数亚组分析中都观察到了持续结果。排除一项研究并不影响总体结果[HR(95%CI):0.66(0.55,0.79)~0.76(0.65,0.88)]。Egger检验未发现明显的发表偏倚(P=0.059)。结论心率恢复较慢会增加普通人群发生SCD的风险。因此,HRR可能是临床实践中预防SCD的一个潜在靶点。