Overlap吻合与π吻合在全腹腔镜全胃切除术中的应用

目的:比较Overlap吻合与π吻合在全腹腔镜全胃切除术(TLTG)中的应用效果。方法:选择2019年2月至2022年2月在成都市第五人民医院行TLTG的胃癌患者98例,根据食管空肠吻合方式分为Overlap吻合组(n=56)和π吻合组(n=42)。比较两组围手术期指标(手术时间、吻合时间、术中出血量、淋巴结清扫数目、术后肛门排气时间、术后拔除引流管时间、术后住院时间、肿瘤上缘至食管切缘距离),吻合口相关并发症(吻合口出血、吻合口狭窄、吻合口漏)与随访并发症(吻合口溃疡、倾倒综合征、反流性食管炎、营养不良)发生情况,以及术前与术后3个月整体营养状况主观评估量表(PG-SGA)评分与营养状况客观指标(血红蛋白、白蛋白、总蛋白)水平的变化。结果:Overlap吻合组手术时间[(230.36±25.12)min vs(205.58±20.43)min]、吻合时间[(43.22±6.15)min vs(27.45±5.36)min]均长于π吻合组(P<0.05);两组吻合口相关并发症、随访并发症发生率及术前、术后3个月PG-SGA量表评分与营养状况客观指标水平的变化差异均无统计学意义(P>0.05)。结论:Overlap吻合和π吻合在TLTG术中各有优势,π吻合可缩短手术时间和吻合时间。

右半结肠癌根治术中全腹腔镜下Overlap吻合的短期疗效及并发症分析

目的:通过对比全腹腔镜下顺蠕动侧侧吻合(Overlap吻合)与腹腔外吻合相关临床资料及短期疗效,探究腹腔内吻合在右半结肠癌根治术中的临床疗效及价值。方法:回顾性选择2021年01月至2023年12月我院胃肠与疝外科收治的腹腔镜右半结肠癌根治术患者临床资料,共计92例纳入临床研究。其中采用腹腔内Overlap吻合的患者为ICA组;采用腹腔外端侧吻合为ECA组。收集并分析两组患者临床资料,讨论全腹腔镜下Overlap吻合安全性及短期临床疗效差异。结果:纳入患者一般资料差异无统计学意义(P值>0.05)。手术资料方面,ICA组手术时间[(185.83±27.55)min;P=0.026]与吻合时间[(33.86±4.05)min;P<0.001]均显著长于ECA组,切口长度方面[(4.86±0.84)cm;P<0.001]ICA组显著短于ECA组。而术中出血、清扫淋巴结总数两组差异无统计学意义。术后康复方面,ICA组首次排气时间[(2.55±0.55)天;P=0.001]、首次进流质时间[(3.38±0.62)天;P<0.001]、下床时间[(2.71±0.55)天;P=0.006]、术后住院时间[(7.67±1.26)天;P=0.019]均优于ECA组,且ICA组术后引流量[(277.74±147.68)mL;P=0.017]显著少于ECA组。在术后第3天,ICA组疼痛VAS评分(3.19±0.77;P=0.04)低于ECA组。术后炎症指标方面,两组术后C反应蛋白、中性粒细胞-淋巴细胞比值(NLR)均无统计学差异(P值>0.05)。在手术后并发症方面,总并发症发生率、吻合口瘘、腹腔感染、腹腔出血、吻合口出血、切口感染、肺部感染、术后肠梗阻、术后胃瘫两组并无统计学差异(P值>0.05)。结论:全腹腔镜下Overlap吻合安全可行,具有术后肠道功能恢复更快、创伤更小等优势,手术疗效与传统腔镜辅助手术效果相当,且不会增加短期并发症发生率。

Overlapping approach Proton Pump Inhibitors/Nux vomica-Heel as new intervention for gastro-esophageal reflux management:Delphi consensus study

BACKGROUND Gastro-esophageal reflux disease(GERD)may affect the upper digestive tract;up to 20%of population in Western nations are affected by GERD.Antacids,histamine H2-receptor antagonists,and Proton Pump Inhibitors(PPIs)are considered the referring medications for GERD.Nevertheless,PPIs must be managed carefully because their use,especially chronic,could be linked with some adverse effects.An effective and safe alternative pharmacological tool for GERD is needed.After the identification of potentially new medications to flank PPIs,it is mandatory to revise and improve good clinical practices even through a consensus process.AIM To optimize diagnosis and treatment guidelines for GERD through a consensus based on Delphi method.METHODS The availability of clinical studies describing the action of the multicomponent/multitarget medication Nux vomica-Heel,subject of the consensus,is the basic prerequisite for the consensus itself.A modified Delphi process was used to reach a consensus among a panel of Italian GERD specialists on the overlapping approach PPIs/Nux vomica-Heel as a new intervention model for the management of GERD.The Voting Consensus group was composed of 49 Italian Medical Doctors with different specializations:Gastroenterology,otolaryngology,geriatrics,and general medicine.A scientific committee analyzed the literature,determined areas that required investigation(in agreement with the multiple-choice questionnaire results),and identified two topics of interest:(1)GERD disease;and(2)GERD treatment.Statements for each of these topics were then formulated and validated.The Delphi process involved two rounds of questioning submitted to the panel experts using an online platform.RESULTS According to their routinary GERD practice and current clinical evidence,the panel members provided feedback to each questionnaire statement.The experts evaluated 15 statements and reached consensus on all 15.The statements regarding the GERD disease showed high levels of agreement,with consensus ranging from 70%to 92%.The statements regarding the GERD treatment also showed very high levels of agreement,with consensus ranging from 90%to 100%.This Delphi process was able to reach consensus among physicians in relevant aspects of GERD management,such as the adoption of a new approach to treat patients with GERD based on the overlapping between PPIs and Nux vomica-Heel.The consensus was unanimous among the physicians with different specializations,underlying the uniqueness of the agreement reached to identify in the overlapping approach between PPIs and Nux vomica-Heel a new intervention model for GERD management.The results support that an effective approach to deprescribe PPIs through a progressive decalage timetable(reducing PPIs administration to as-needed use),should be considered.CONCLUSION Nux vomica-Heel appears to be a valid opportunity for GERD treatment to favor the deprescription of PPIs and to maintain low disease activity together with the symptomatology remission.

Large-Scale Multi-Objective Optimization Algorithm Based on Weighted Overlapping Grouping of Decision Variables

The large-scale multi-objective optimization algorithm(LSMOA),based on the grouping of decision variables,is an advanced method for handling high-dimensional decision variables.However,in practical problems,the interaction among decision variables is intricate,leading to large group sizes and suboptimal optimization effects;hence a large-scale multi-objective optimization algorithm based on weighted overlapping grouping of decision variables(MOEAWOD)is proposed in this paper.Initially,the decision variables are perturbed and categorized into convergence and diversity variables;subsequently,the convergence variables are subdivided into groups based on the interactions among different decision variables.If the size of a group surpasses the set threshold,that group undergoes a process of weighting and overlapping grouping.Specifically,the interaction strength is evaluated based on the interaction frequency and number of objectives among various decision variables.The decision variable with the highest interaction in the group is identified and disregarded,and the remaining variables are then reclassified into subgroups.Finally,the decision variable with the strongest interaction is added to each subgroup.MOEAWOD minimizes the interactivity between different groups and maximizes the interactivity of decision variables within groups,which contributed to the optimized direction of convergence and diversity exploration with different groups.MOEAWOD was subjected to testing on 18 benchmark large-scale optimization problems,and the experimental results demonstrate the effectiveness of our methods.Compared with the other algorithms,our method is still at an advantage.

Autoimmune hepatitis-primary biliary cholangitis overlap syndrome complicated by various autoimmune diseases:A case report

BACKGROUND Autoimmune hepatitis(AIH)and primary biliary cholangitis(PBC)are two common clinical autoimmune liver diseases,and some patients have both diseases;this feature is called AIH-PBC overlap syndrome.Autoimmune thyroid disease(AITD)is the most frequently overlapping extrahepatic autoimmune disease.Immunoglobulin(IgG)4-related disease is an autoimmune disease recognized in recent years,characterized by elevated serum IgG4 levels and infiltration of IgG4-positive plasma cells in tissues.CASE SUMMARY A 68-year-old female patient was admitted with a history of right upper quadrant pain,anorexia,and jaundice on physical examination.Laboratory examination revealed elevated liver enzymes,multiple positive autoantibodies associated with liver and thyroid disease,and imaging and biopsy suggestive of pancreatitis,hepatitis,and PBC.A diagnosis was made of a rare and complex overlap syndrome of AIH,PBC,AITD,and IgG4-related disease.Laboratory features improved on treatment with ursodeoxycholic acid,methylprednisolone,and azathioprine.CONCLUSION This case highlights the importance of screening patients with autoimmune diseases for related conditions.

Overlapping infections of Mycobacterium canariasense and Nocardia farcinica in an immunocompetent patient:A case report

BACKGROUND Infections by non-tuberculous mycobacteria(NTM)have become more common in recent years.Mycobacterium canariasense(M.canariasense)was first reported as an opportunistic pathogen in 2004,but there have been very few case reports since then.Nocardia is a genus of aerobic and Gram-positive bacilli,and these species are also opportunistic pathogens and in the Mycobacteriales order.Conventional methods for diagnosis of NTM are inefficient.Metagenomic next-generation sequencing(mNGS)can rapidly detect many pathogenic microorganisms,even rare species.Most NTM and Nocardia infections occur in immunocompromised patients with atypical clinical symptoms.There are no previous reports of infection by M.canariasense and Nocardia farcinica(N.farcinica),especially in immunocompetent patients.This case report describes an immunocompetent 52-year-old woman who had overlapping infections of M.canariasense,N.farcinica,and Candida parapsilosis(C.parapsilosis)based on mNGS.CASE SUMMARY A 52-year-old woman presented with a productive cough and chest pain for 2 wk,and recurrent episodes of moderate-grade fever for 1 wk.She received antibiotics for 1 wk at a local hospital,and experienced defervescence,but the productive cough and chest pain persisted.We collected samples of a lung lesion and alveolar lavage fluid for mNGS.The lung tissue was positive for M.canariasense,N.farcinica,and C.parapsilosis,and the alveolar lavage fluid was positive for M.canariasense.The diagnosis was pneumonia,and application of appropriate antibiotic therapy cured the patient.CONCLUSION Etiological diagnosis is critical for patients with infectious diseases.mNGS can identify rare and novel pathogens,and does not require a priori knowledge.

Novel method for extraction of ship target with overlaps in SAR image via EM algorithm

The quality of synthetic aperture radar(SAR)image degrades in the case of multiple imaging projection planes(IPPs)and multiple overlapping ship targets,and then the performance of target classification and recognition can be influenced.For addressing this issue,a method for extracting ship targets with overlaps via the expectation maximization(EM)algorithm is pro-posed.First,the scatterers of ship targets are obtained via the target detection technique.Then,the EM algorithm is applied to extract the scatterers of a single ship target with a single IPP.Afterwards,a novel image amplitude estimation approach is pro-posed,with which the radar image of a single target with a sin-gle IPP can be generated.The proposed method can accom-plish IPP selection and targets separation in the image domain,which can improve the image quality and reserve the target information most possibly.Results of simulated and real mea-sured data demonstrate the effectiveness of the proposed method.

空肠后离断Overlap吻合法在腹腔镜根治性全胃切除术中的应用

目的探讨空肠后离断Overlap吻合法相比传统Overlap吻合法在腹腔镜根治性全胃切除术中的优势及安全性。方法回顾分析2018年3月至2023年6月在昆山市第一人民医院行腹腔镜根治性全胃切除术的胃癌病人资料共43例,根据食管空肠吻合方式的不同进行分组。研究组25例,采用空肠后离断Overlap吻合法进行食管空肠重建;对照组18例,采用传统Overlap吻合法。比较两组病人在围手术期及术后近期指标等方面有无差异。结果两组病人的一般资料比较,差异均无统计学意义(均P>0.05)。两组病人均顺利完成手术,无中转开腹病例。在饮食随访中,研究组病人术后1个月均已恢复半流质饮食或普食,术后3个月均能进食普食。两组病人的术中出血量、术后住院时间以及吻合口漏、吻合口狭窄、吻合口出血等吻合口并发症的发生率相比较,差异均无统计学意义(均P>0.05)。同对照组相比较,研究组的食管空肠吻合时间[(25.4±4.3)min比(39.8±4.5)min,t=–10.549,P<0.001]和手术时间[237 min(230~250 min)比258.6 min(250~285 min),Z=–5.517,P<0.001]均缩短,差异具有统计学意义(均P<0.001)。结论在腹腔镜根治性全胃切除的病人中,改良后的空肠后离断Overlap吻合较传统Overlap吻合更加简便,是一种较好的、安全可行的吻合方式。

Predictors of survival in autoimmune liver disease overlap syndromes

BACKGROUND Survival in patients with autoimmune liver disease overlap syndromes(AILDOS)compared to those with single autoimmune liver disease is unclear.AIM To investigate the survival of patients with AILDOS and assess the accuracy of non-invasive serum models for predicting liver-related death.METHODS Patients with AILDOS were defined as either autoimmune hepatitis and primary biliary cholangitis overlap(AIH-PBC)or autoimmune hepatitis and primary sclerosing cholangitis overlap(AIH-PSC)and were identified from three tertiary centres for this cohort study.Liver-related death or transplantation(liver-related mortality)was determined using a population-based data linkage system.Prognostic scores for liver-related death were compared for accuracy[including liver outcome score(LOS),Hepascore,Mayo Score,model for end-stage liver disease(MELD)score and MELD incorporated with serum sodium(MELD-Na)score].RESULTS Twenty-two AILDOS patients were followed for a median of 3.1 years(range,0.35-7.7).Fourteen were female,the median age was 46.7 years(range,17.8 to 82.1)and median Hepascore was 1(range,0.07-1).At five years post enrolment,57%of patients remained free from liver-related mortality(74%AIH-PBC,27%AIH-PSC).There was no significant difference in survival between AIH-PBC and AIH-PSC.LOS was a significant predictor of liver-related mortality(P<0.05)in patients with AIH-PBC(n=14)but not AIH-PSC(n=8).A LOS cut-point of 6 discriminated liver-related mortality in AIH-PBC patients(P=0.012,log-rank test,100%sensitivity,77.8%specificity)(Harrell's C-statistic 0.867).The MELD score,MELD-Na score and Mayo Score were not predictive of liver-related mortality in any group.CONCLUSION Survival in the rare,AILDOS is unclear.The current study supports the LOS as a predictor of liver-related mortality in AIH-PBC patients.Further trials investigating predictors of survival in AILDOS are required.

The Practical Path of Labor Curriculum in Compulsory Education in China from the Perspective of Overlapping Influence Domain Theory

Since the new curriculum reform,labor education has gradually shed its marginalized position in the“five educations,”and the labor curriculum has become an independent course officially separated from comprehensive practical activity courses.Exploring the practical path of labor curriculum in compulsory education in China has become the primary task of labor education in China.Based on the practical situation of labor curriculum in compulsory education in China,drawing on the theory of overlapping influence domains,and from the perspective of collaborative education among family,school,and community,this paper proposes a curriculum practical path of“school-led”family-school-community collaboration and a curriculum practical path guided by“student-centered”sentiment,in order to provide references for the practice of labor curriculum in compulsory education in China.

Pseudo-Semi-Overlap Functions-Based Fuzzy Rough Sets Applied to Image Edge Extraction

As an extension of overlap functions, pseudo-semi-overlap functions are a crucial class of aggregation functions. Therefore, (I, PSO)-fuzzy rough sets are introduced, utilizing pseudo-semi-overlap functions, and further extended for applications in image edge extraction. Firstly, a new clustering function, the pseudo-semi-overlap function, is introduced by eliminating the symmetry and right continuity present in the overlap function. The relaxed nature of this function enhances its applicability in image edge extraction. Secondly, the definitions of (I, PSO)-fuzzy rough sets are provided, using (I, PSO)-fuzzy rough sets, a pair of new fuzzy mathematical morphological operators (IPSOFMM operators) is proposed. Finally, by combining the fuzzy C-means algorithm and IPSOFMM operators, a novel image edge extraction algorithm (FCM-IPSO algorithm) is proposed and implemented. Compared to existing algorithms, the FCM-IPSO algorithm exhibits more image edges and a 73.81% decrease in the noise introduction rate. The outstanding performance of (I, PSO)-fuzzy rough sets in image edge extraction demonstrates their practical application value.

Overlap吻合术式在腹腔镜结直肠手术重建中的临床研究

目的研究腹腔镜结直肠手术重建中运用侧侧吻合(Overlap)术式的临床价值。方法选择2022年1月至2023年2月期间龙游县人民医院收治的102例结直肠癌患者为研究对象,均行腹腔镜结直肠癌根治术,以吻合术式不同将其分为两组,其中行功能性端端吻合为对照组(n=51),采用Overlap吻合术式则为观察组(n=51),比较两组患者的围术期指标、炎症指标以及术后并发症发生情况,术后随访12个月,评价两组患者生活质量。结果观察组患者的术后住院、进食、手术以及排气时间均短于对照组,差异均有统计学意义(t分别=5.26、3.49、3.43、3.55,P均<0.05);观察组术后3 d的C反应蛋白(CRP)、白细胞介素-6(IL-6)以及肿瘤坏死因子-α(TNF-α)水平均低于对照组,差异均有统计学意义(t分别=13.14、15.79、12.49,P均<0.05);观察组患者的并发症发生率明显低于对照组,差异有统计学意义(χ^(2)=15.86,P<0.05);两组3、6、9、12个月的生活质量评分比较,差异均无统计学意义(t分别=0.19、0.50、0.60、0.62,P均>0.05)。结论在腹腔镜结直肠癌根治术中,通过采用Overlap吻合术式,不仅可以缩短手术时间,恢复胃肠道功能,还可以减少术后并发症,并且对患者生活质量无明显影响,可以作为有效且安全的一种吻合方式。

Overlap吻合术对腹腔镜胃癌消化道重建和并发症及患者生活质量的影响

目的:研究完全腹腔镜胃癌根治术联合overlap吻合术对消化道重建、并发症及患者生活质量的影响。方法:选取2019年6月至2021年12月于蚌埠医学院第一附属医院接受诊治的110例胃癌患者为研究对象。根据不同手术方式分为对照组(传统腹腔镜胃癌根治术,n=60)与观察组(完全腹腔镜胃癌根治术联合overlap吻合术,n=50),比较2组手术疗效及并发症,并采用胃肠道生活质量表(Gastrointestinal Quality of Life,GIQLI)评估生活质量。结果:观察组手术全程用时、消化道重建用时、总失血量均少于对照组(均P<0.05);2组肿瘤大小、淋巴结清扫数比较差异均无统计学意义(均P>0.05)。观察组术后排气时间、流食进食时间、下地时间均少于对照组(均P<0.05);2组住院时间差异无统计学意义(P>0.05)。观察组术后并发症总发生率低于对照组(P<0.05)。随访6个月,2组GIQLI各维度得分及总分均高于出院当天(均P<0.05),观察组GIQLI各维度得分及总分均高于对照组(均P<0.05)。结论:完全腹腔镜胃癌根治术联合overlap吻合术能有效重建消化道,减少并发症,改善生活质量。

改良Overlap吻合术在SiewertⅡ、Ⅲ型食管胃结合部腺癌全腹腔镜消化道重建中的临床应用价值

目的探讨改良Overlap吻合术与传统管型吻合术在腹腔镜下SiewertⅡ、Ⅲ型食管胃结合部腺癌全胃切除术后消化道重建中的临床应用价值。方法回顾性分析2018年1月—2021年10月兰州大学第二医院普外科收治的125例SiewertⅡ、Ⅲ型食管胃结合部腺癌患者的临床资料,患者均完成腹腔镜下全胃切除术+D2淋巴结清扫,其中50例患者消化道重建采用改良Overlap吻合术进行食管空肠吻合,75例患者行管型吻合器吻合。比较两种吻合术手术相关及临床效果指标的差异。结果改良Overlap吻合组与管型吻合器吻合组在术后通气时间、术后首次进食时间、淋巴结清扫数及术中出血量等差异无统计学意义(P>0.05);两组患者手术总时间、消化道重建时间、术后并发症总发生率(吻合口出血)等方面差异具有统计学意义(P<0.05)。结论改良Overlap吻合术可以在全腹腔镜下完成,操作视野良好,步骤简便可行,术后并发症少,具有较高的安全性,具有临床应用推广价值。

全腹腔镜全胃切除术食管空肠π形吻合与overlap吻合临床效果比较

目的探讨食管空肠π形吻合与overlap吻合行全腹腔镜全胃切除术后消化道重建的临床效果。方法选取2018年6月至2021年6月在我院行全腹腔镜全胃切除术的102例胃癌患者行回顾性分析,按消化道重建吻合方式分为π形吻合组及overlap吻合组,各51例。比较两组患者围术期相关指标、术后营养状况、生活质量、并发症及预后。结果两组手术时间、术中出血量、切口长度、术后首次排气及恢复进食时间、住院时间比较均无统计学差异(P>0.05),而π形吻合组吻合时间短于overlap吻合组(P<0.05)。两组患者术后3个月Alb、Hb、PAB、TP、RBC、球蛋白及铁蛋白等营养指标及QLQ-C30评分均明显改善(P<0.05),但两组间各营养指标及QLQ-C30评分比较均无统计学差异(P>0.05)。π形吻合组及overlap吻合组术后早、晚期并发症发生率分别为15.69%和21.57%、9.80%和7.84%,组间比较均无统计学差异(P>0.05)。术后均随访6~36个月,π形吻合组和overlap吻合组死亡率分别为27.45%和31.37%,两组患者平均生存时间无统计学差异(χ^(2)=0.367,P=0.545)。结论全腹腔镜全胃切除术中采用食管空肠π形吻合与overlap吻合技术行Roux-en-Y吻合均可有效改善患者的营养状况及生存质量,安全性较高,可作为消化道重建的选择方式之一。

Irritable bowel syndrome:Epidemiology,overlap disorders,pathophysiology and treatment

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disease with a significant impact on patients’ quality of life and a high socioeconomic burden. And the understanding of IBS has changed since the release of the Rome Ⅳ diagnosis in 2016. With the upcoming Rome Ⅴ revision, it is necessary to review the results of IBS research in recent years. In this review of IBS, we can highlight future concerns by reviewing the results of IBS research on epidemiology, overlap disorders, pathophysiology, and treatment over the past decade and summarizing the latest research.

全腹腔镜全胃切除术中食管空肠overlap吻合术安全性和有效性的Meta分析

目的:系统评价和比较全腹腔镜全胃切除术中overlap食管空肠吻合术和传统食管空肠吻合术治疗胃癌的安全性和有效性,为临床实践提供循证医学证据。方法:通过计算机检索国内外数据库PubMed、Embase、Cochrane Library、Web of Science、知网、万方、维普,检索时限为各大数据库建库至2022年1月。获得相关文献,逐步筛选,纳入符合条件的研究,采用Cochrane ROB偏倚风险评估工具和NOS量表对文章进行质量评价,提取高质量文献中所需数据,最后通过Review Manager 5.3软件进行Meta分析。结果:最终纳入11项研究,包括1 398例患者,其中有566例接受overlap吻合术的患者和832例接受传统吻合术的患者。结果表明,overlap吻合术和传统吻合术在手术时间(MD=0.63,95%CI=7.22,8.48,P=0.88)、术后首次排气时间(MD=-0.13,95%CI=0.43,0.18,P=0.42)、术后首次进食时间(MD=0.02,95%CI=0.33,0.37,P=0.91)、吻合口漏(OR=1.38,95%CI=0.73,2.63,P=0.32)、术后住院时间(MD=-0.16,95%CI=0.82,0.51,P=0.64)方面无显著差异(均P>0.05)。与传统吻合术相比,overlap吻合术吻合时间较长(MD=5.60,95%CI=0.59,10.62,P=0.03)、吻合口出血发生率较高(OR=2.48,95%CI=1.08,5.69,P=0.03)、术中出血量较少(MD=-6.42,95%CI=10.28,-2.56,P=0.001)、吻合口狭窄发生率较低(OR=0.17,95%CI=0.06,0.46,P=0.000 6)。结论:overlap食管空肠吻合术是一种安全、有效、预后佳的手术方式,有望成为全腹腔镜全胃切除术中食管空肠吻合标准术式。

Overlap吻合法在完全腹腔镜根治性右半结肠切除术中的应用

目的探讨完全腹腔镜根治性右半结肠切除术中采用Overlap吻合法行回结肠吻合的可行性。方法回顾性分析2020年6月至2022年12月于桐乡市第一人民医院胃肠外科接受完全腹腔镜根治性右半结肠切除+Overlap法行回结肠侧侧吻合术的32例右半结肠癌患者及接受腹腔镜辅助根治性右半结肠切除+体外吻合法行回结肠端侧吻合术的30例右半结肠癌患者的临床资料,分别记录患者的手术时间、回结肠吻合时间、术中出血量、淋巴结清扫数目、切口长度、术后24 h疼痛评分、术后肛门排气时间、术后并发症和住院天数等围手术期资料。结果全部患者成功实施腹腔镜根治性右半结肠切除术。两组患者的性别、年龄、BMI指数、肿瘤部位、cTNM分期等差异无统计学意义(P>0.05)。与体外吻合组相比,Overlap吻合组的平均回结肠吻合时间稍长,但差异无统计学意义(P>0.05);两组手术时间、术中出血量、淋巴结清扫数目、术后住院天数相比差异均无统计学意义(均P>0.05);切口长度、术后24 h疼痛评分、术后肛门排气时间相比差异有统计学意义(均P<0.05)。Overlap吻合组1例患者术后出现淋巴漏,经禁食、营养等对症治疗后治愈;体外吻合组1例患者术后出现切口感染,经换药、引流后切口愈合。Overlap吻合组1例患者、体外吻合组2例患者出现术后肠梗阻,经禁食、胃肠减压、营养等对症支持治疗后治愈。两组各有1例患者术后出现肺部感染,经抗感染、化痰、雾化等治疗后好转。结论完全腹腔镜根治性右半结肠切除术中采用Overlap吻合法行回结肠吻合安全可行,切口小、疼痛轻、术后肠道功能恢复快,具有良好的临床应用前景。

International Standardization of Blockchain and Distributed Ledger Technology:Overlaps,Gaps and Challenges

As one of the most concerned digital technologies in recent years,blockchain and distributed ledger technology are an important driving force for a new round of technological development.It is currently in the process of accelerating its evolution and maturity,and has gradually integrated with other digital technologies.It has been applied in many industries,providing decentralized solutions for various industries,realizing innovative storage models,and building a new trust system.As blockchain technology is officially incorporated into China’s new information infrastructure category,the application fields of blockchain have expanded rapidly,gradually extending from the financial field and government affairs to other fields in the real economy.At the same time,with the continuous development of the globalized economy,blockchain technology will also have a profound impact on international technological and economic development.Therefore,for the healthy and orderly development and real implementation of the blockchain industry,standardize the application of blockchain,effectively break through the cognitive and technical barriers between different countries,industries and systems on a global scale,prevent application risks,the development of the global blockchain industry needs standardization basis,which is particularly important and urgent.A sound standard system is an important key to the successful development of technology,and formulating the right standard at the right time for technology development helps ensure the ease of use and interoperability of the technology.From the perspective of international standardization,this article first introduces the general situation of ISO,ITU-T,IEEE,W3C and other international standardization organizations,and sorts out the status quo of the blockchain standardization working groups of mainstream international standardization organizations.All blockchain-related standards under development have been analyzed for the characteristics of international blockchain technology standards and industry application standards.Through data analysis,the overlaps,differences and conflicts in the field of international blockchain standard formulation are sorted out,and suggestions for blockchain standardization work in the application and development of blockchain technology standardization by international organizations and industries are put forward.The plans and layouts of future international standards are summarized to help the development of the international standardization of blockchain.

Set pair three-way overlapping community discovery algorithm for weighted social internet of things

There are many problems in Social Internet of Things(IoTs),such as complex topology information,different degree of association between nodes and overlapping communities.The idea of set pair information grain computing and clustering is introduced to solve the above problems so as to accurately describe the similarity between nodes and fully explore the multi-community structure.A Set Pair Three-Way Overlapping Community Discovery Algorithm for Weighted Social Internet of Things(WSIoT-SPTOCD)is proposed.In the local network structure,which fully considers the topological information between nodes,the set pair connection degree is used to analyze the identity,difference and reverse of neighbor nodes.The similarity degree of different neighbor nodes is defined from network edge weight and node degree,and the similarity measurement method of set pair between nodes based on the local information structure is proposed.According to the number of nodes'neighbors and the connection degree of adjacent edges,the clustering intensity of nodes is defined,and an improved algorithm for initial value selection of k-means is proposed.The nodes are allocated according to the set pair similarity between nodes and different communities.Three-way community structures composed of a positive domain,boundary domain and negative domain are generated iteratively.Next,the overlapping node set is generated according to the calculation results of community node membership.Finally,experiments are carried out on artificial networks and real networks.The results show that WSIoT-SPTOCD performs well in terms of standardized mutual information,overlapping community modularity and F1.