TRIANGLE operation,combined with adequate adjuvant chemotherapy,can improve the prognosis of pancreatic head cancer:A retrospective study

BACKGROUND The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein,celiac axis-common hepatic artery,and superior mesenteric artery to improve patient prognosis.Although previously promising in patients with locally advanced pancreatic ductal adenocarcinoma(PDAC),data are limited regarding the long-term oncological outcomes of the TRIANGLE operation among resectable PDAC patients undergoing pancreaticoduodenectomy(PD).AIM To evaluate the safety of the TRIANGLE operation during PD and the prognosis in patients with resectable PDAC.METHODS This retrospective cohort study included patients who underwent PD for pancreatic head cancer between January 2017 and April 2023,with or without the TRIANGLE operation.Patients were divided into the PD_(TRIANGLE)and PD_(non-TRIANGLE)groups.Surgical and survival outcomes were compared between the two groups.Adequate adjuvant chemotherapy was defined as adjuvant chemotherapy≥6 months.RESULTS The PD_(TRIANGLE)and PD_(non-TRIANGLE) groups included 52 and 55 patients,respectively.There were no significant differences in the baseline characteristics or perioperative indexes between the two groups.Furthermore,the recurrence rate was lower in the PD_(TRIANGLE) group than in the PD_(non-TRIANGLE) group(48.1%vs 81.8%,P<0.001),and the local recurrence rate of PDAC decreased from 37.8%to 16.0%.Multivariate Cox regression analysis revealed that PD_(TRIANGLE)(HR=0.424;95%CI:0.256-0.702;P=0.001),adequate adjuvant chemotherapy≥6 months(HR=0.370;95%CI:0.222-0.618;P<0.001)and margin status(HR=2.255;95%CI:1.252-4.064;P=0.007)were found to be independent factors for the recurrence rate.CONCLUSION The TRIANGLE operation is safe for PDAC patients undergoing PD.Moreover,it reduces the local recurrence rate of PDAC and may improve survival in patients who receive adequate adjuvant chemotherapy.

RPL Based on Triangle Module Operator for AMI Networks

the routing protocol for low-power and lossy networks(RPL) has been used in advanced metering infrastructure(AMI)which could provide two-way communication between smart meters and city utilities.To improve the network performance of AMI networks, this paper proposed an improved algorithm of RPL based on triangle module operator(IAR-TMO). IAR-TMO proposes membership functions of the following five typical routing metrics: end-to-end delay, number of hops, expected transmission count(ETX),node remaining energy, and child node count.Moreover, IAR-TMO uses triangle module operator to fuse membership functions of these routing metrics. Then, IAR-TMO selects preferred parents(the next hop) based on the triangle module operator. Theoretical analysis and simulation results show that IAR-TMO has a great improvement when compared with two recent representative algorithms: ETXOF(ETX Objective Function) and OF-FL(Objective Function based on Fuzzy Logic), in terms of network lifetime, average end-to-end delay,etc. Consequently, the network performances of AMI networks can be improved effectively.

A novel context-aware RPL algorithm based on a triangle module operator

For the use in low-power and lossy networks(LLNs)under complex and harsh communication conditions,the routing protocol for LLNs(RPL)standardized by the Internet Engineering Task Force is specially designed.To improve the performance of LLNs,we propose a novel context-aware RPL algorithm based on a triangle module operator(CAR-TMO).A novel composite context-aware routing metric(CA-RM)is designed,which synchronously evaluates the residual energy index,buffer occupancy ratio of a node,expected transmission count(ETX),delay,and hop count from a candidate parent to the root.CA-RM considers the residual energy index and buffer occupancy ratio of the candidate parent and its preferred parent in a recursive manner to reduce the effect of upstream parents,since farther paths are considered.CA-RM comprehensively uses the sum,mean,and standard deviation values of ETX and delay of links in a path to ensure a better performance.Moreover,in CAR-TMO,the membership function of each routing metric is designed.Then,a comprehensive membership function is constructed based on a triangle module operator,the membership function of each routing metric,and a comprehensive context-aware objective function.A novel mechanism for calculating the node rank and the mechanisms for preferred parent selection are proposed.Finally,theoretical analysis and simulation results show that CAR-TMO outperforms several state-of-the-art RPL algorithms in terms of the packet delivery ratio and energy efficiency.