Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence

BACKGROUND Current surgical procedures for anorectal abscesses,including incision and drainage alone or combined concurrent fistulotomy,remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula.AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures.METHODS In this retrospective study,525 patients with anorectal abscesses treated by incision and drainage alone,at a tertiary general hospital from August 2012 to July 2022,were included.A new classification for anorectal abscesses based on their propensity to develop into fistulas,considering 18 other potential risk factors,was established.These factors,from electronic medical records,were screened for significance using theχ^(2)test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses.RESULTSOne year post-follow-up,the overall recurrence rate was 39%:81.0%and 23.5%for fistula-prone and non-fistulaproneabscesses,respectively.Univariateχ^(2)analysis showed significant differences in recurrence rates based onanatomical classifications and pus culture results(P<0.05).Fistula-prone abscess,≥7 days between symptomonset and surgery,chronic diarrhea,preoperative antibiotic use,and local anesthesia were risk factors for recurrence,while diabetes mellitus was protective(P<0.05).Moreover,fistula-prone abscess[odds ratio(OR)=7.651,95%CI:4.049–14.458,P<0.001],≥7 days from symptom onset to surgery(OR=2.137,95%CI:1.090–4.190,P=0.027),chronic diarrhea(OR=2.508,95%CI:1.216–5.173,P=0.013),and local anesthesia(OR=2.308,95%CI:1.313–4.059,P=0.004)were independent risk factors for postoperative anorectal abscess recurrence using multivariatelogistic regression.Body mass index≥28(OR=2.935,95%CI:1.203–7.165,P=0.018)was an independentrisk factor for postoperative recurrence of non-fistula-prone abscess.CONCLUSIONThe choice of surgical procedure for treating anorectal abscesses should follow this new classification.Prompt andthorough incision and drainage can significantly reduce postoperative recurrence.

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.

SLIP RATE AND RECURRENCE INTERVAL OF STRONG EARTHQUAKE OF QIANNING—KANGDING SEGMENT ON XIANSHUIHE FAULT

Located on the western of Sichuan, the east border of Tibet plateau, Xianshuihe fault is a significant strong earthquake zone. From Huiyuansi pull\|apart basin in Qianning, Xianshuihe fault can be divided two segments\|NW section and SE section: the construction of the former is single and a main fault; the construction of the latter is complex and composed by three parallel faults, its main fault is named as Selaha—Kangding fault, which distributes along Jinlongsi, Sehala, Mugecuo and Kangding. Yalahe fault, located at the NE direction of the main fault, and Zeduotang fault, located at the SW direction of the main fault, are all secondary faults, which are 9～13km away from the main fault. At the south of Kangding, the segment of Xianshuihe fault is a single main section, called as Moxi fault. On the basis of recent researching results, this paper mainly discusses the slip rate and recurrence interval of strong earthquake of the SE segment (Qianning—Kangding) on Xianshuihe.

Network meta-analysis of the prognosis of curative treatment strategies for recurrent hepatocellular carcinoma after hepatectomy

BACKGROUND Recurrent hepatocellular carcinoma(rHCC)is a common outcome after curative treatment.Retreatment for rHCC is recommended,but no guidelines exist.AIM To compare curative treatments such as repeated hepatectomy(RH),radiofrequency ablation(RFA),transarterial chemoembolization(TACE)and liver transplantation(LT)for patients with rHCC after primary hepatectomy by conducting a network meta-analysis(NMA).METHODS From 2011 to 2021,30 articles involving patients with rHCC after primary liver resection were retrieved for this NMA.The Q test was used to assess heterogeneity among studies,and Egger’s test was used to assess publication bias.The efficacy of rHCC treatment was assessed using disease-free survival(DFS)and overall survival(OS).RESULTS From 30 articles,a total of 17,11,8,and 12 arms of RH,RFA,TACE,and LT subgroups were collected for analysis.Forest plot analysis revealed that the LT subgroup had a better cumulative DFS and 1-year OS than the RH subgroup,with an odds ratio(OR)of 0.96(95%CI:0.31-2.96).However,the RH subgroup had a better 3-year and 5-year OS compared to the LT,RFA,and TACE subgroups.Hierarchic step diagram of different subgroups measured by the Wald test yielded the same results as the forest plot analysis.LT had a better 1-year OS(OR:1.04,95%CI:0.34-03.20),and LT was inferior to RH in 3-year OS(OR:10.61,95%CI:0.21-1.73)and 5-year OS(OR:0.95,95%CI:0.39-2.34).According to the predictive P score evaluation,the LT subgroup had a better DFS,and RH had the best OS.However,meta-regression analysis revealed that LT had a better DFS(P<0.001)as well as 3-year OS(P=0.881)and 5-year OS(P=0.188).The differences in superiority between DFS and OS were due to the different testing methods used.CONCLUSION According to this NMA,RH and LT had better DFS and OS for rHCC than RFA and TACE.However,treatment strategies should be determined by the recurrent tumor characteristics,the patient’s general health status,and the care program at each institution.

The slip rate and strong earthquake recurrence interval on the Qianning-Kangding segment of the Xianshuihe fault zone

The geometry of the Qianning-Kangding segment of the Xianshuihe fault zone is quite complex, and it is composed of four secondary-faults, i.e., the Yalahe fault, Selaha-Kangding fault, Zeduotang fault and Moxi fault. On this segment, three strong earthquakes with M(7.0 occurred in 1725, 1786 and 1955, respectively. Based on a study of fault landform and geochronology (14C and Thermoluminesense), this paper documents the average horizontal slip rates during the late-Quaternary on all the secondary-faults of the Qianning-Kangding segment as follows: Yalahe fault: (2.0(0.2) mm/a; Selaha-Kangding fault: (5.5(0.6) mm/a; Zeduotang fault: (3.6(0.3) mm/a; Moxi fault: (9.9(0.6) mm/a. The results from the investigation of surface ruptures of historical earthquakes, coseismic-slip and paleo-earthquakes show that the strong-earthquake recurrence intervals are thousands of years on the Yalahe fault, and 230 to 350 years on the Selaha-Kangding and Zeduotang faults. In the next one hundred years, the recurrence of a strong-earthquake on these faults appears impossible. However, the strong-earthquake recurrence interval on the Moxi fault is about 300 years. Up to now, it has been 214 years since the last earthquake (magnitude 7) occurred in 1786, therefore, this fault is now approaching the condition favorable for the next strong earthquake recurrence.

Radiofrequency ablation combined with transcatheter arterial chemoembolization for recurrent liver cancer

BACKGROUND The recurrence rate of liver cancer after surgery is high.Radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)is an effective treatment for liver cancer;however,its efficacy in recurrent liver cancer remains unclear.AIM To investigate the clinical effect of TACE combined with RFA in the treatment of recurrent liver cancer.METHODS Ninety patients with recurrent liver cancer were divided into 2 groups according to treatment plan:Control(RFA alone);and experimental[TACE combined with RFA(TACE+RFA)].The incidence of increased alanine aminotransferase levels,complications,and other indices were compared between the two groups before and after the procedures.RESULTS One month after the procedures,the short-term efficacy rate and Karnofsky Performance Status scores of the experimental group were significantly higher than those of the control group(P<0.05).Alpha-fetoprotein(AFP)and total bilirubin levels were lower than those in the control group(P<0.05);The overall response rate was 82.22%and 66.67%in the experimental and control groups,respectively;The disease control rate was 93.33%and 82.22%in the experimental and control groups,respectively,the differences are statistically significant(P<0.05).And there were no statistical differences in complications between the two groups(P>0.05).CONCLUSION TACE+RFA was effective for the treatment of recurrent liver cancer and significantly reduced AFP levels and improved various indices of liver function.

Effects of data smoothing and recurrent neural network(RNN)algorithms for real-time forecasting of tunnel boring machine(TBM)performance

Tunnel boring machines(TBMs)have been widely utilised in tunnel construction due to their high efficiency and reliability.Accurately predicting TBM performance can improve project time management,cost control,and risk management.This study aims to use deep learning to develop real-time models for predicting the penetration rate(PR).The models are built using data from the Changsha metro project,and their performances are evaluated using unseen data from the Zhengzhou Metro project.In one-step forecast,the predicted penetration rate follows the trend of the measured penetration rate in both training and testing.The autoregressive integrated moving average(ARIMA)model is compared with the recurrent neural network(RNN)model.The results show that univariate models,which only consider historical penetration rate itself,perform better than multivariate models that take into account multiple geological and operational parameters(GEO and OP).Next,an RNN variant combining time series of penetration rate with the last-step geological and operational parameters is developed,and it performs better than other models.A sensitivity analysis shows that the penetration rate is the most important parameter,while other parameters have a smaller impact on time series forecasting.It is also found that smoothed data are easier to predict with high accuracy.Nevertheless,over-simplified data can lose real characteristics in time series.In conclusion,the RNN variant can accurately predict the next-step penetration rate,and data smoothing is crucial in time series forecasting.This study provides practical guidance for TBM performance forecasting in practical engineering.

The Recurrence Rate of Pars Tensa Retraction Cholesteatoma and a New Staging System

Objective: To investigate the cumulative recurrence rate of pars tensa retraction cholesteatoma on the new staging system established by Japan Otological Society (JOS). Materials and Methods: It is a retrospective study and performed in a tertiary and academic center. The series comprised 71 patients with pars tensa retraction cholesteatoma who underwent surgical treatment by a single surgeon between 1994 and 2007. Results: The 10-year cumulative recurrence rate of pars tensa retraction cholesteatoma was 12.1% overall, 20.0% in Stage I, 14.4% in Stage II and 6.2% in Stage III. Conclusions: The JOS staging system for pars tensa retraction cholesteatoma did not reflect the prognosis. The development of a common international staging system for cholesteatoma in the future is desirable.

A Comparative Study of the Recurrence Rate in Hypofractionated versus Conventional Postmastectomy Radiation in Breast Cancer

Background: Treatment options available for breast cancer are Surgery [Breast conservation surgery (BCS) or Modified radical mastectomy (MRM)];Radiation treatment [Conventional radiation treatment or CRT and Hypofractionated radiation treatment or HRT] and Chemotherapy. In the postmastectomy or post lumpectomy setting, radiotherapy (RT) improves loco-regional control. CRT for breast includes 50 Gy in 25 fractions (2 Gy per fraction) and HRT includes 42.5 Gy in 16 fractions (2.7 Gy per fraction) or extreme hypofractionation like 26 Gy in 5 fractions. Alpha/beta value for breast is less, so HRT is ideal for breast. So, there will be good loco-regional control, without increased normal tissue damage. This study aims to identify recurrence rate and toxicity in breast cancer patients treated using conventional and hypofractionated postmastectomy radiotherapy among Indian population. Primary objective: To assess recurrence rate of disease in breast cancer patients treated using hypofractionated postmastectomy radiation and to compare it with breast cancer patients treated using conventional postmastectomy radiation. Secondary objective: To assess the toxicity in hypofractionation and conventional fractionation arm. Methods: This is a prospective observational study conducted in Department of Radiation Oncology from December 2017 to June 2019. Radically treated breast cancer patients who received radiation treatment either conventional or hypofractionated as one of the treatment modalities were included in the study. Data were collected using a structured proforma, history and physical examination, master file of the patients, lab results and the imaging reports, written informed consent form, ECOG performance status scale (Eastern Cooperative Oncology Group), RTOG (Radiation Therapy Oncology Group) Acute Radiation Morbidity Scoring Schema. Patients were monitored for 18 months to identify recurrence rate and toxicity in each arm. Results and discussion: A total of 241 patients were enrolled into this study, among them 175 patients (73%) were given hypofractionation radiotherapy and 66 patients (27%) were given conventional radiotherapy. In hypofractionation arm, recurrence was found in 14 patients (8%), of which, 3 were local recurrences [chest wall] and 11 were systemic recurrences, while in conventional arm, recurrence was found in 4 patients (6%) and all of them were systemic recurrences. Recurrence rate in hypofractionation arm was 8% and in conventional arm was 6.10%. The Kaplan Meier curve shows no significant difference between the two arms with p value = 0.76. Acute toxicities assessed were dermatitis, esophagitis and pneumonitis. Among acute dermatitis, 4 patients had grade 3 and 2 patients had grade 4 in hypofractionation arm, while in conventional arm, 7 patients had grade 3 and 1 patient had grade 4. Grade 1 and 2 together versus grade 3 and 4 acute dermatitis showed a statistically significant difference between the two arms, with more acute toxicity in the conventional arm. Among acute esophagitis, 1 patient had grade 3 and no patients had grade 4 in hypofractionation arm;while in conventional arm, no grade 3 and grade 4 acute esophagitis were found. Among acute pneumonitis, 2 patients had grade 3 and 1 patient had grade 4 in hypofractionation arm, while in conventional arm, 1 patient had grade 3 and no patients with grade 4 were found. Grade 2 and grade 3 acute lung toxicities were found in patients with central lung distance more than 1.5 cm. Conclusion: It was found that the recurrence rate of hypofractionation radiotherapy was comparable to conventional fractionation radiotherapy. With respect to acute dermatitis, grade 1 and grade 2 were significantly more in conventional than hypofractionation arm. Hypofractionated radiotherapy is an equally effective option to conventional radiotherapy and should be encouraged, especially for developing countries like India where the resource is limited, and the incidence of tumour is high.

Exploration of Therapeutic Measures and Clinical Efficacy for Recurrent Respiratory Infections in Children

Objective:To explore the treatment strategies and clinical effects for recurrent respiratory infections in children.Methods:From May 2022 to May 2024,100 pediatric patients with recurrent respiratory infections were selected in this study and evenly divided into two groups.The control group(50 patients)was treated with conventional therapy supplemented with budesonide,while the observation group(50 patients)received pidotimod treatment in addition to the control group’s treatment.Subsequently,the duration of clinical symptom improvement,respiratory function enhancement,serological index changes,reinfection status,and parental satisfaction were compared between the two groups.Results:In terms of clinical symptoms,the observation group showed significantly shorter durations of fever reduction,cough relief,tonsil swelling reduction,and disappearance of fine wet rales compared to the control group(average reduction times were 1.6 days,2.3 days,2.1 days,and 1.9 days,respectively,P<0.05).Regarding respiratory function,the observation group experienced a 12%increase in peak expiratory flow rate variability,a 0.6-liter increase in lung capacity,a 0.7-liter increase in forced lung capacity,and a 0.5-liter increase in forced expiratory volume in the first second after treatment,all significantly higher than the control group(P<0.05).Serological testing revealed that interferon-γand interleukin-2 levels increased by 15%and 18%,respectively,while interferon-α,interleukin-5,and interleukin-4 levels decreased by 10%,12%,and 9%,respectively,in the observation group,showing significant differences compared to the control group(P<0.05).Additionally,the reinfection rate in the observation group(10%)was significantly lower than that in the control group(30%),with an average reduction of two reinfections within one year and a 3.2-day shorter infection control time(P<0.05).In terms of parental satisfaction,the observation group achieved 95%,significantly higher than the 70%in the control group(P<0.05).Conclusion:The addition of pidotimod to conventional therapy for pediatric patients with recurrent respiratory infections can significantly alleviate clinical symptoms,promote the recovery of respiratory function,regulate serological indicators,effectively reduce the risk of reinfection,and improve parental satisfaction.This method deserves widespread clinical application.

Average recurrence intervals of strong earthquakes and potential risky segments along the Taiyuan-Linfen portion of the Shanxi graben system

Since the great 1303 Hongtong, Shanxi, earthquake of magnitude 8, 700 years have elapsed. To analyze the long-term seismic potential, this paper divides the Taiyuan-Linfen portion of the Shanxi graben system into 5 seismogenic segments. Based on data of historical earthquakes and GPS observation, the authors estimate mean seismic-moment rates and average recurrence intervals of strong earthquakes for the individual segments, and fur-ther analyze relative levels of current stress cumulation on the segments based on mapping b-values along the gra-ben system by using the network seismic data for the recent over 30 years. The main result shows that the Linfen basin segment has an estimated mean seismic-moment rate of 2.211016 Nm/a to 3.031016 Nm/a, and its average recurrence interval for M=7.5 earthquake is estimated to be between 1 560 and 2 140 years. For the Ling-shi-Hongtong segment, the estimated average recurrence interval for M=8 earthquakes is between 4 300 and 5 100 years, equivalent to having a mean moment-rate of 2.581016 Nm/a to 3.101016 Nm/a. The contour map of b-values shows that the two segments of Lingshi-Hongtong and Linfen basin have been being at low or relatively low stress levels, reflecting that since the 1303 M=8 and the 1695 M=7.5 earthquake ruptures, the fault-planes strengths of the both segments have not been resumed yet. And the other two segments, the Houma and the Jiexiu-Fenyang, have relatively high stress levels, and have been already identified as potential risky segments for the coming earthquakes from the analysis combining with the estimated average recurrence intervals of earth-quakes on the both segments.

Endoscopic mucosal resection of colorectal adenomas > 20 mm: Risk factors for recurrence

AIM: To evaluate risk factors for local recurrence after endoscopic mucosal resection of colorectal adenomas > 20 mm.METHODS: Retrospective data analysis of 216 endoscopic mucosal resections for colorectal adenomas > 20 mm in 179 patients(40.3% female; median age 68 years; range 35-91 years). All patients had at least 1 follow-up endoscopy with a minimum control interval of 2 mo(mean follow-up 6 mo/2.0-43.4 mo). Possible factors associated with local recurrence were analyzed by univariate and multivariate analysis. RESULTS: Median size of the lesions was 30 mm(20-70 mm),69.0% were localized in the right-sided(cecum,ascending and transverse) colon. Most of the lesions(85.6%) showed a non-pedunculated morphology and the majority of resections was in piecemeal technique(78.7%). Histology showed carcinoma or high-grade intraepithelial neoplasia in 51/216(23.6%) lesions including 4 low risk carcinomas(pT1 a,L0,V0,R0- G1/G2). Histologically proven recurrence was observed in 33/216 patients(15.3%). Patient age>65 years,polyp size>30 mm,non-pedunculated morphology,localization in the right-sided colon,piecemeal resection and tubular-villous histology were found as associated factors in univariate analysis. On multivariate analysis,only localization in the rightsided colon(HR = 6.842/95%CI:1.540-30.394; P=0.011),tubular-villous histology(HR = 3.713/95%CI: 1.617-8.528;P=0.002) and polyp size>30 mm(HR=2.563/95%CI:1.179-5.570; P=0.017) were significantly associated risk factors for adenoma recurrence. CONCLUSION: Meticulous endoscopic follow-up is warranted after endoscopic mucosal resection of adenomas localized in the right-sided colon larger than > 30 mm,with tubular-villous histology.

Surgical outcomes in inferior recurrences of rhegmatogenous retinal detachment

AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 females with a mean age of 54.8±14.1y)who demonstrated at least one inferior recurrence of RRD were included in this retrospective study.All patients were categorized as having received either circular scleral buckling(SB),pars plana vitrectomy(PPV),a combination of SB and PPV(SB+PPV),PPV with retinotomy(PPV+RT),or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade(PPV+RT+pPFCL).All cases were followed up until successful retinal reattachment or third recurrence.The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and bestcorrected visual acuity(BCVA).RESULTS:After the treatment of the first recurrence,the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV(P=0.0012),PPV+RT(P=0.028),or PPV+RT+pPFCL(P=0.047)group.There was no statistically significant difference between PPV+SB,PPV+RT,and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence(42 eyes).However,there was a statistically significant(P=0.016)trend towards a decrease of recurrence rate after PPV+RT+pPFCL.There was no statistically significant improvement of BCVA in either study group(P>0.05)after both first and second recurrence surgery.The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence.CONCLUSION:Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV.RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes,however,without functional improvement.

Influence of hyperbaric oxygenation treatment (HBOT) on clinical outcomes (recurrent myocardial infarction and survival rate) during five-year monitoring period after acute myocardial infarction

Surgical treatments of acute myocardial infarction (MI) possess a high clinical effectiveness, but there are fixed limitations, related to the patient’s state, which are limited by medical resources and organizational problems. The development of new medical technologies provides a better and effective non-surgical treatment of acute MI and increases long-term prognosis in this category of patients. The study aims to investigate the influence of hyperbaric oxygenation treatment on clinical outcomes (survival rate and recurrent myocardial infarction (rMI)) during the five-year period of monitoring. The study involved 697 patients who suffered from acute MI, having undergone the standard treatment. The patients were randomly divided into two groups: Group 1 (reference, n = 363);Group 2 (test, n = 334). Patients of Group 2 were given the traditional treatment, accompanied with HBOT (isopression for forty minutes at a working pressure of 0.03 MPa). HBOT was applied first through the fifth day following MI. The treatment course included six cycles, once per day. The clinical assessment was focused on clinical outcome: rMI and mortality related to cardiovascular events. HBOT application that accompanied the acute MI with traditional pharmacotherapy has been proved to reduce rMI within five years following inpatient discharge (rMI rate was 14% in the reference group and 5.4% in the test group, χ2 = 13.3, р < 0.05). The combination of HBOT with traditional methods in treating acute MI makes it possible to raise the five-year survival rate from 84.4% up to 95.9%.

Liver transplantation for hepatocellular carcinoma： is zero recurrence theoretically possible？

BACKGROUND： Hepatocellular carcinoma（HCC） recurrence remains a key issue after liver transplantation. This study aimed to determine a subgroup of HCC patients within the Milan criteria who could achieve a theoretical goal of zero recurrence rates after liver transplantation.METHODS： Between 1999 and 2009, 179 patients who received liver transplantation for HCC within the Milan criteria were retrospectively included. Analysis of the factors associated with HCC recurrence was performed to determine the subgroup of patients at the lowest risk of recurrence.RESULTS： Seventy-two percent of the patients received a bridging therapy, including 54 liver resections. Eleven（6.1%） patients recurred within a delay of 19±22 months and ultimately died. Factors associated with recurrence were serum alpha-fetoprotein level 〉400 ng/m L, satellite nodules, poor differentiation, microvascular invasion and cholangiocarcinoma component. Recurrence rates decreased from 6.1% to 3.1% in patients without any of these factors.CONCLUSIONS： Among HCC patients within the Milan criteria, selecting patients with factors based on histology would allow tending towards zero recurrence, and prior histological assessment by liver biopsy or resection may be essential to rule out poorly differentiated tumors, microvascular invasion,and cholangiocarcinoma component.

Impact of Survival Rate and Safety Analysis of Concurrent Chemoradiotherapy in Patients with Recurrent Cervical Cancer

Objective:To investigate the effect of concurrent chemoradiotherapy on the survival rate and safety of patients with recurrent cervical cancer.Methods:A total of 107 patients with recurrent cervical cancer who were treated in our hospital from March 2016 to January 2019 were retrospectively analyzed and randomly divided into the control group(n=53)and the observation group(n=54)and treated conventionally.On this basis,the control group was treated with radiotherapy,and the observation group was treated with concurrent radiotherapy and chemotherapy.The clinical efficacy,cellular immune index,survival rate and rate of adverse reactions were compared between the two groups.Results:Compared with the total effective rate of 79.25%in the control group,the observation group was 94.44%,and the difference was statistically significant(P<0.05).After treatment,the levels of NK,CD3+,and CD4+in the two groups were higher than before the treatment,and the observation group was higher than the control group.The difference was statistically significant(P<0.05).Compared with the adverse reaction rate of 18.87%in the control group,the observation group was 11.11%,but the difference was not statistically significant(P>0.05).Conclusion:Concurrent chemoradiotherapy for patients with recurrent cervical cancer has a significant effect,which not only can effectively improve the cellular immune index and the survival rate of patients,but also have high safety.

Surgical Outcomes and Local Recurrence Following Total or Subtotal Gastrectomy for Early Adenocarcinoma of Antrum

Objective： The choice between total gastrectomy （TG） and subtotal gastrectomy （STG） for early adenocarcinoma of the lower third of the stomach is still a matter of debate and controversy amongst surgeons. The aim of this study was to compare the surgical outcomes, quality of life （QoL）, and local recurrence rates as well as other results of curative resection of early distal adenocarcinoma of the stomach using TG or STG performed in Iran. Methods： Hospital records of 66 patients with early distal adenocarcinoma of stomach that underwent even total or subtotal gastrectomy with perigastric （D2） lymphadenectomy between October 2001 and February 2006 in Taleghani Hospital, Iran were reviewed retrospectively. Demographic data as well as clinicopathological factors including number of involved lymph nodes, tumor grading, depth of invation, tumor size, and tumor type were recorded. Post-operative outcomes including mortality and morbidity, tumor recurrence and quality of life were assessed. Univariate analyses using Fisher＇s exact test, the Student t-test, and the Pearson χ^2 test were used. Results： Local recurrence of tumor was found in 8 （23%） TG group patients and in 19 （61%） patients of STG group, the Pearson χ^2 test showed a significant higher recurrence rate in STG （P value=0.002, Relative Risk=2.68, Confidence Interval： 1.37-5.24）.The mean time interval between gastrectomy and tumor recurrence was not different between TG and STG. （19.75±5.1 vs. 18.0±7.8 respectively; P value=0.507） Tumor size 〉5 cm （P value=0.004）, diffuse type （P value=0.034）, poor differentiation （P value=0.000） and serosal invasion （P value=0.012） were found to be significantly related to tumor recurrence in patients undergone gastrectomy. In none of the QoL measures a significant difference was found between TG and STG Conclusion： Our results show that subtotal and total gastrectomy methods with perigastric lymphadenectomy have a similar postoperative complication rate and surgical outcomes as well as patient＇s QoL but STG was associated to a more than twofold increase in local recurrence risk.

A Markov regenerative process with recurrence time and its application

This study proposes a non-homogeneous continuous-time Markov regenerative process with recurrence times,in particular,forward and backward recurrence processes.We obtain the transient solution of the process in the form of a generalized Markov renewal equation.A distinguishing feature is that Markov and semi-Markov processes result as special cases of the proposed model.To model the credit rating dynamics to demonstrate its applicability,we apply the proposed stochastic process to Standard and Poor’s rating agency’s data.Further,statistical tests confirm that the proposed model captures the rating dynamics better than the existing models,and the inclusion of recurrence times significantly impacts the transition probabilities.

Late Quaternary Activity and Strong Earthquake Recurrence Interval along the North Segment of the Longling-Ruili Fault

According to field investigation and interpretation of remote sensing images,the north segment of the Longling-Ruili fault is a Holocene dextral strike-slip fault with a small amount of normal faulting.Based on large-scale geological mapping at some typical locations and quantitative geomorphologic deformation measurement and dating analysis,this fault is a Holocene active fault.The strike-slip rate of the Longling-Ruili fault is 2.2 ~2.5mm / a and vertical slip rate is 0.6mm /a since the late Pleistocene epoch.The strike-slip rate of the Longling-Ruili fault is 1.8~3.0mm /a and vertical slip rate is 0.5mm /a since the Holocene epoch.Based on the Poisson model,lognormal model and BPT model,the occurrence probability of strong earthquakes in 50 years is estimated to be 6.32%,0.08%and 0.05%,respectively.Then,a 1.82% probability of occurrence of characteristic earthquake for the north segment of the Longling-Ruili fault is obtained by setting a weight of 0.28,0.36 and 0.36 to the Poisson model,lognormal model and BPT model,respectively.

Long-term efficacy of microvascular decompression on trigeminal neuralgia and multi-factor research of recurrence

Objective To research the factors that affects the efficacy of 2 826 cases of of trigeminal neuralgia after microvascular decompression during follow-up more than 1 year. Methods The patients with trigeminal meuralgia were followed-up for 1-25 years ( mean 9. 8 years) after microvascular decompression from January 1984 to