Laparoscopic liver resection for hepatocellular carcinoma complicated with significant portal hypertension:A propensity score-matched survival analysis

Background: Significant portal hypertension(SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma(HCC). However, increasing evidence indicates that liver resection is feasible for HCC patients with SPH. Methods: HCC patients with cirrhosis who underwent laparoscopic liver resection(LLR) in two centers from January 2013 to April 2018 were included. Surgical and survival outcomes were analyzed to explore potential prognostic factors. Propensity score matching(PSM) analysis was performed to minimize bias. Results: A total of 165 patients were divided into two groups based on the presence(SPH, n = 76) or absence(non-SPH, n = 89) of SPH. Patients in the SPH group had longer operative time, more blood loss, and more advanced TNM stage than patients in the non-SPH group( P < 0.05). However, there were no significant differences in the postoperative 90-day mortality rate( n = 0), overall postoperative complications(47.4% vs. 41.6%, P = 0.455), Clavien-Dindo classification( P = 0.347), conversion to open surgery(9.2% vs. 6.7%, P = 0.557), or length of hospitalization(16 vs. 15 days, P = 0.203) between the SPH and non-SPH groups before PSM. Similar results were obtained after PSM. The 1-, 3-, and 5-year overall survival(OS) and recurrence-free survival rates in the SPH group were not significantly different from those in the non-SPH group both before and after PSM(log-rank P > 0.05). After PSM, alpha-fetoprotein(AFP) ≥ 400 μg/L [hazard ratio(HR) = 4.71, 95% confidence interval(CI): 2.69-8.25], ascites(HR = 2.18, 95% CI: 1.30-3.66), American Society of Anesthesiologists(ASA) classification(Ⅲ vs. Ⅱ)(HR = 2.13, 95% CI: 1.11-4.07) and tumor diameter > 5 cm(HR = 3.91, 95% CI: 2.02-7.56) independently predicted worse OS. Conclusions: LLR for patients with HCC complicated with SPH appears feasible at the price of increasing operative time and blood loss. AFP, ascites, ASA classification and tumor diameter may predict the prognosis of HCC complicated with SPH after LLR.

Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China:A large,multicenter,retrospective cohort study using a propensity score matching analysis

Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.

Optimal Matching Analysis of Net Buoyancy and Pitching Angle for Underwater Gliders

Control parameter optimization is an efficient way to improve the endurance of underwater gliders(UGs),which influences their gliding efficiency and energy consumption.This paper analyzes the optimal matching between the net buoyancy and the pitching angle and proposes a segmented control strategy of Petrel-L.The optimization of this strategy is established based on the gliding range model of UG,which is solved based on the approximate model,and the variations of the optimal control parameters with the hotel load are obtained.The optimization results indicate that the segmented control strategy can significantly increase the gliding range when the optimal matching between the net buoyancy and the pitching angle is reached,and the increase rate is influenced by the hotel load.The gliding range of the underwater glider can be increased by 10.47%at a hotel load of 0.5 W.The optimal matching analysis adopted in this study can be applied to other UGs to realize endurance improvement.

Single access laparoscopic total colectomy for severe refractory ulcerative colitis

BACKGROUND Single port laparoscopic surgery allows total colectomy and end ileostomy for medically uncontrolled ulcerative colitis solely via the stoma site incision.While intuitively appealing,there is sparse evidence for its use beyond feasibility.AIM To examine the usefulness of single access laparoscopy(SAL)in a general series experience of patients sick with ulcerative colitis.METHODS All patients presenting electively,urgently or emergently over a three-year period under a colorectal specialist team were studied.SAL was performed via the stoma site on a near-consecutive basis by one surgical team using a“surgical glove port”allowing group-comparative and case-control analysis with a contemporary cohort undergoing conventional multiport surgery.Standard,straight rigid laparoscopic instrumentation were used without additional resource.RESULTS Of 46 consecutive patients requiring surgery,39(85%)had their procedure begun laparoscopically.27(69%)of these were commenced by single port access with an 89%completion rate thereafter(three were concluded by multi-trocar laparoscopy).SAL proved effective in comparison to multiport access regardless of disease severity providing significantly reduced operative access costs(>100€case)and postoperative hospital stay(median 5 d vs 7.5 d,P=0.045)without increasing operative time.It proved especially efficient in those with preoperative albumin>30 g/dL(n=20).Its comparative advantages were further confirmed in ten pairs case-matched for gender,body mass index and preoperative albumin.SAL outcomes proved durable in the intermediate term(median follow-up=20 mo).CONCLUSION Single port total colectomy proved useful in planned and acute settings for patients with medically refractory colitis.Assumptions regarding duration and cost should not be barriers to its implementation.

Data Comparison between Elite and Amateur Soccer Players by 20 Hz GPS Data Collection

The athletic component in football is nowadays one of the most important factor to determinate the performance. This consideration is part of our study, which aims to evaluate and quantify the difference between the workload of an amateur footballer and an elite one. All this is allowed by match analysis made by GPS evaluation method for amateur and video tracking for elite. The examined teams were playing in 7th Italian league, and we used 10 GPS to track 6 games, 5 for each team. For every team and every game were analysed a forward, a central midfielder, a wide midfielder, a central defender and a full back （Age 25.3 ＋ 4.2, Weight 74.5 Kg a： 5.3, Height 1.76 cm ＋ 5.2）. In our study, we used a 20 Hz GPS （thanks to Advanced Research Group in Sport, School of Health and Sport Science with K-Sport Universal, Italy） to detect performance data, and then we compared the outcome with matches performance data from elite players gather from scientific literature. Data analysis shows that elite players reach higher values in almost all parameters taken into account. In particular, they obtained higher value in meters per minutes, High Speed Distance （〉 16 Km/h）, High Metabolic Power Distance （〉 20 W/Kg） and in high and very high and acceleration （2 m/s, 3 m/s, 〉 3 m/s） and deceleration （-2 m/s, -3 m/s, 〉 -3 m/s）. This study can be useful to select and catalogue player performance model, in order to better understand the real value of a player, and to help coaches and teams to identify talent, at least in physical values.

Sensitivity-based upscaling for history matching of reservoir models

Simulation of reservoir flow processes at the finest scale is computationally expensive and in some cases impractical.Consequently,upscaling of several fine-scale grid blocks into fewer coarse-scale grids has become an integral part of reservoir simulation for most reservoirs.This is because as the number of grid blocks increases,the number of flow equations increases and this increases,in large proportion,the time required for solving flow problems.Although we can adopt parallel computation to share the load,a large number of grid blocks still pose significant computational challenges.Thus,upscaling acts as a bridge between the reservoir scale and the simulation scale.However as the upscaling ratio is increased,the accuracy of the numerical simulation is reduced;hence,there is a need to keep a balance between the two.In this work,we present a sensitivity-based upscaling technique that is applicable during history matching.This method involves partial homogenization of the reservoir model based on the model reduction pattern obtained from analysis of the sensitivity matrix.The technique is based on wavelet transformation and reduction of the data and model spaces as presented in the 2Dwp-wk approach.In the 2Dwp-wk approach,a set of wavelets of measured data is first selected and then a reduced model space composed of important wavelets is gradually built during the first few iterations of nonlinear regression.The building of the reduced model space is done by thresholding the full wavelet sensitivity matrix.The pattern of permeability distribution in the reservoir resulting from the thresholding of the full wavelet sensitivity matrix is used to determine the neighboring grids that are upscaled.In essence,neighboring grid blocks having the same permeability values due to model space reduction are combined into a single grid block in the simulation model,thus integrating upscaling with wavelet multiscale inverse modeling.We apply the method to estimate the parameters of two synthetic reservoirs.The history matching results obtained using this sensitivity-based upscaling are in very close agreement with the match provided by fine-scale inverse analysis.The reliability of the technique is evaluated using various scenarios and almost all the cases considered have shown very good results.The technique speeds up the history matching process without seriously compromising the accuracy of the estimates.

THE EXACT SOLUTIONS OF ELASTIC－PLASTIC CRACK LINE FIELD FOR MODE Ⅱ PLANE STRESS CRACK

The near crack line field analysis method has been used io investigate into theexact elastic-plastic solutions of a mode II crack under plane stress condilion in anelastic-perfectly plastic solid. The assumptions of the usual small scale yielding theory.hare been completely. dbandoned and the correct formulations of matching conditionsat the elaslic-plastic boundary. have been given. By, matching the general solution ofthe plastic slress field (bul not the special solution used to be adopted) with the exactelastic stress field (but not the crack tip K-dominant field) at the elastic-plasticboundary, near the crack line, the plastic stresses. the length of the plastic =one and theunit normal vector of the elastic-plastic boundary.which are sufficiently precise near the crack line region ,have been given.

THE EXACT SOLUTIONS OF ELASTIC－PLASTIC CRACK LINE FIELD FOR MODE Ⅱ PLANE STRESS CRACK

The near crack line field analysis method has been used to investigate into the exact elastic-plastic solutions of a mode Ⅱ crack under plane stress condition in anelastic-perfectly plastic solid. The assumptions of the usual small scale yielding theoryhave been completely. dbandoned and the correct .formulations of matching conditionsat the elastic-plastic boundary have been given. By matching the general solution of the plastic stress field (but not the special solution used to be adopted) will the exactelastic stress field (but not the crack tip K-dominant field) at the elastic-plasticboundary. near the crack line, the plastic .stresses, the length of the plastic zone and theunit normal vector of the elaslic-plastic boundary. which sufficiently precise nearthe crack line region, hare been given.

New insights into component matching mechanism in the compression system of double bypass engine

Variable cycle engine(VCE)is one of the most promising technologies for the next-generation aircraft,the matching of different components in the compression system is a key difficulty VCE faced.To investigate the component matching mechanisms in the VCE compression system,an advanced throughflow program is employed to calculate the characteristic lines of each component,and a zero-dimensional method is developed to cap-ture the component performance deviation during the coupling working process.By setting the compressor stall and choke conditions as the boundary,the operation range of the compression system isfirst clarified,and the aerodynamic performance in the operation zone is discussed,thus providing a theoretical basis for optimization of the engine operating con-trol scheme.Results show that the efficiency of the coreflow is optimum at the left-bottom corner of the operation region,while the total pressure ratio peaks at the right-top area,hence a balance is needed when deciding the matching point.Regulations of component control pa-rameters will change the position of the operation zone,as well as the corresponding aerody-namic performance.Decreasing the core driven fan stage rotating speed can improve the total bypass ratio,yet the total pressure ratio of the coreflow will be decreased.Closing the core driven fan stage inlet guide vane can increase the total bypass ratio without changing the core flow aerodynamic performance significantly.The bypass ratio of the compression system can also be increased by increasing the fan stall margin or decreasing its rotating speed,both ways will decrease the total pressure ratio of the core flow.Results of the study will benefit the variable cycle engine design process in operation point evaluation and thermodynamic cycle optimization.