Objective:To observe the clinicopathological characteristics of gastric stump cancer(GSC)and evaluate the benefitsof radical surgery of GSC.Methods:The clinicopathological characteristics and postoperative survival ti...Objective:To observe the clinicopathological characteristics of gastric stump cancer(GSC)and evaluate the benefitsof radical surgery of GSC.Methods:The clinicopathological characteristics and postoperative survival time of 37 GSC patientswho underwent surgery were investigated retrospectively.The survival time was compared according to the type of surgicaloperation(radical resection vs palliative operation).Twenty-one cases that received radical resection were analyzed based on thepTMN stage.Survival curves were traced by using Kaplan-Meier methods.Results:Most GSC(32/37)was detected in patientswho had received Billroth Ⅱ reconstruction after partial gastrectomy for benign gastric disease.The lesser curvature side and thesuture line of anastomosis were the most frequent sites where GSC occurred(27/37).Differentiated adenocarcinoma was thedominant histopathological type(24/37).The postoperative 5-year survival rate of early stage GSC patients(n=9)was significantlyhigher than advanced stage GSC(n=12)(55.6% vs 16.5%,x_L^2=11.48,P<0.01).Five-year survival rate of 21 GSC patients withradical resection were 75%(3/4)for stage Ⅰ,60%(3/5)for stage Ⅱ,14.2%(1/7)for stage Ⅲ,and 0%(0/5)for stage Ⅳ respectively.The median survival time of 21 GSC patients who underwent radical resection was longer than those undergoing palliative op-eration(43.0 m vs 13.0 m,X_L^2=36.31,P<0.01),the median survival time of stage Ⅳ patients with radical resection was 23.8months.Conclusions:Without remote metastasis,radical resection for GSC is possible,and is an effective way to improve theprognosis of GSC.Even in stage Ⅳ GSC,radical resection can still prolong the survival time.It is necessary for the patients withbenign gastric diseases who received partial gastrectomy to carry out the endoscopy follow-up,especially in patients with BillrothⅡ reconstruction procedure at 15-20 years.展开更多
Surgeons may be severely criticized from the perspective of evidence-based medicine because the majority of surgical publications appear not to be convincing. In the top nine surgical journals in 1996, half of the 175...Surgeons may be severely criticized from the perspective of evidence-based medicine because the majority of surgical publications appear not to be convincing. In the top nine surgical journals in 1996, half of the 175 publications refer to pilot studies lacking a control group, 18% to animal experiments, and only 5% to randomized controlled trials (RCT). There are five levels of clinical evidence:level 1 (randomized controlled trial), level 2 (prospective concurrent cohort study), level 3 (retrospective historical cohort study), level 4 (pre-post study), and level 5 (case report). Recently, a Japanese evidence-based guideline for the surgical treatment of hepatocellular carcinoma (HCC) was made by a committee (Chairman, Professor Makuuchi and five members). We searched the literature using the Medline Dialog System with four Keywords:HCC, surgery, English papers, in the last 20 years. A total of 915 publications were identified systematically reviewed. At the first selection (in which surgery-dominant papers were selected), 478 papers survived. In the second selection (clearly concluded papers), 181 papers survived. In the final selection (clinically significant papers), 100 papers survived. The evidence level of the 100 surviving papers is shown here:level-1 papers (13%), level-2 papers (11%), level-3 papers (52%), and level-4 papers (24%);therefore, there were 24% prospective papers and 76% retrospective papers. Here, we present a part of the guideline on the five main surgical issues:indication to operation, operative procedure, peri-operative care, prognostic factor, and post-operative adjuvant therapy.展开更多
A system for prognosis of tank failures was set up based on the results of analysis on fault phenomena. An algorithm incorporating fuzzy mathematics with the BP neural network was used to solve this prognosis model, a...A system for prognosis of tank failures was set up based on the results of analysis on fault phenomena. An algorithm incorporating fuzzy mathematics with the BP neural network was used to solve this prognosis model, and the availability of this model was also analyzed. This neural network-based fuzzy system for prognosis of tank failures has been put into operation at Huangdao oil terminal. The application results have shown that this system is effective for real-time prognosis of various potential tank failures and timely adoption of mitigative measures to avoid major tank accidents, which would have great significance for safeguarding the safe operation of the oil terminal.展开更多
Objective: To investigate if electroacupuncture(EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety am...Objective: To investigate if electroacupuncture(EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety among elderly.Methods: Totally 60 participants met the inclusion criteria were enrolled in a randomized controlled trial a ratio of 1:1, with 30 cases allocated to the treatment group and 30 cases allocated to the control group, respectively. The participants in the treatment group were provided with real-EA therapy whereas participants in control group were provided with placebo-EA therapy(Streitberger Placebo-needle). In both groups, Tou sanshen(头三神)acupoints, including Sìshéncōng(四神聪EX-HN1), Sh6 ntíng(神庭 GV24),and bilateral Běnsh6 n(本神GB13) were adopted as the main acupoints, while Bǎihui(百会GV20), bilateral Hégǔ(合谷Ll4), and bilateral Tàich6 ng(太冲LR3) were adopted as matching acupoints. Interventions were offered 5 days prior to the surgery, once daily, and continued for total 5 days. The global scores of MiniMental State Examination(MMSE), and levels of serum inflammatory cytokines including interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α), and S100-β protein were observed at 24 h prior to the surgery, and postoperative 24 and 72 h respectively for assessing the incidence of POCD and the severity of cognitive impairments among patients. Meanwhile, adverse effects were monitored and recorded.Results:(1) Compared with baseline, MMSE global scores in both treatment and control groups markedly decreased at postoperative 24 h. MMSE global scores in treatment group decreased from 29.43 ±0.97 to27.10 ±1.95 while that in control group decreased from 29.27 ± 1.01 to 26.83 ± 2.25(all ?P< 0.05), and this trend continued until postoperative 72 h(at postoperative 72 h, MMSE global scores in treatment group was 26.53 ±2.26 versus 24.79 ±3.03 in control group). Moreover, decline in control group was more significant than that in treatment group at postoperative 72 h(P<0.05).(2) Compared with baseline, levels of serum IL-1β, TNF-α and S100-β in both groups increased markedly at postoperative 24 and 72 h. IL-1β in treatment group increased from 43.13 ±5.51 to 73.13 ±2.32 at postoperative 24 h and reached 83.17 士 5.95 at postoperative 72 h, while IL-1β in control group increased from 44.87 土 5.83 to91.10 ±3.55 at postoperative 24 h and reached 111.93 ±9.18 at postoperative 72 h;TNF-α in treatment group increased from 51.27 士 6.48 to 88.80 ± 3.55 at postoperative 24 h and reached 94.37 ± 5.22 at postoperative 72 h, while TNF-α in control group increased from 52.07 ±7.48 to 116.37 ±3.14 at postoperative24 h and reached 121.40 ±3.68 at postoperative 72 h(both ?P< 0.05), furthermore, increases of IL-1β and TNF-α levels in control group were more significant(P<0.05). Statistical difference in level of S100-β was not observed(P>0.05).(3) There was no statistical difference in POCD incidence at postoperative 24 h and postoperative 72 h between two groups(P> 0.05), though the incidence of POCD in patients receiving real-EA therapy was indeed much lower than that in patients receiving placebo-EA therapy, particularly at postoperative 72 h(POCD incidence rate at postoperative 24 h in treatment group was 26.67%, 30.00%in control group;POCD incidence rate at postoperative 72 h in treatment group was 30.00%, 46.67% in control group).(4) No serious adverse events were reported in this trial. No one dropped out from this trial.Conclusion: EA preconditioning can mitigate cognitive impairments at post-knee replacement surgery 24 and 72 h in elderly through inhibiting expression of inflammation. However, there is insufficient evidence to support that EA pretreatment can reduce the incidence of POCD.展开更多
文摘Objective:To observe the clinicopathological characteristics of gastric stump cancer(GSC)and evaluate the benefitsof radical surgery of GSC.Methods:The clinicopathological characteristics and postoperative survival time of 37 GSC patientswho underwent surgery were investigated retrospectively.The survival time was compared according to the type of surgicaloperation(radical resection vs palliative operation).Twenty-one cases that received radical resection were analyzed based on thepTMN stage.Survival curves were traced by using Kaplan-Meier methods.Results:Most GSC(32/37)was detected in patientswho had received Billroth Ⅱ reconstruction after partial gastrectomy for benign gastric disease.The lesser curvature side and thesuture line of anastomosis were the most frequent sites where GSC occurred(27/37).Differentiated adenocarcinoma was thedominant histopathological type(24/37).The postoperative 5-year survival rate of early stage GSC patients(n=9)was significantlyhigher than advanced stage GSC(n=12)(55.6% vs 16.5%,x_L^2=11.48,P<0.01).Five-year survival rate of 21 GSC patients withradical resection were 75%(3/4)for stage Ⅰ,60%(3/5)for stage Ⅱ,14.2%(1/7)for stage Ⅲ,and 0%(0/5)for stage Ⅳ respectively.The median survival time of 21 GSC patients who underwent radical resection was longer than those undergoing palliative op-eration(43.0 m vs 13.0 m,X_L^2=36.31,P<0.01),the median survival time of stage Ⅳ patients with radical resection was 23.8months.Conclusions:Without remote metastasis,radical resection for GSC is possible,and is an effective way to improve theprognosis of GSC.Even in stage Ⅳ GSC,radical resection can still prolong the survival time.It is necessary for the patients withbenign gastric diseases who received partial gastrectomy to carry out the endoscopy follow-up,especially in patients with BillrothⅡ reconstruction procedure at 15-20 years.
基金a Grant-in-Aid for Scientific Research from the Ministry of Education Science and Culture, No. 13307037, No. 16209038
文摘Surgeons may be severely criticized from the perspective of evidence-based medicine because the majority of surgical publications appear not to be convincing. In the top nine surgical journals in 1996, half of the 175 publications refer to pilot studies lacking a control group, 18% to animal experiments, and only 5% to randomized controlled trials (RCT). There are five levels of clinical evidence:level 1 (randomized controlled trial), level 2 (prospective concurrent cohort study), level 3 (retrospective historical cohort study), level 4 (pre-post study), and level 5 (case report). Recently, a Japanese evidence-based guideline for the surgical treatment of hepatocellular carcinoma (HCC) was made by a committee (Chairman, Professor Makuuchi and five members). We searched the literature using the Medline Dialog System with four Keywords:HCC, surgery, English papers, in the last 20 years. A total of 915 publications were identified systematically reviewed. At the first selection (in which surgery-dominant papers were selected), 478 papers survived. In the second selection (clearly concluded papers), 181 papers survived. In the final selection (clinically significant papers), 100 papers survived. The evidence level of the 100 surviving papers is shown here:level-1 papers (13%), level-2 papers (11%), level-3 papers (52%), and level-4 papers (24%);therefore, there were 24% prospective papers and 76% retrospective papers. Here, we present a part of the guideline on the five main surgical issues:indication to operation, operative procedure, peri-operative care, prognostic factor, and post-operative adjuvant therapy.
文摘A system for prognosis of tank failures was set up based on the results of analysis on fault phenomena. An algorithm incorporating fuzzy mathematics with the BP neural network was used to solve this prognosis model, and the availability of this model was also analyzed. This neural network-based fuzzy system for prognosis of tank failures has been put into operation at Huangdao oil terminal. The application results have shown that this system is effective for real-time prognosis of various potential tank failures and timely adoption of mitigative measures to avoid major tank accidents, which would have great significance for safeguarding the safe operation of the oil terminal.
基金Supported by Key and Weak Discipline Construction Project(Gerontology of TCM),Shanghai Municipal Commission of Health and Family Planning(2015ZB050)Project of Science and Technology Commission of Shanghai Municipality(16401902600)~~
文摘Objective: To investigate if electroacupuncture(EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety among elderly.Methods: Totally 60 participants met the inclusion criteria were enrolled in a randomized controlled trial a ratio of 1:1, with 30 cases allocated to the treatment group and 30 cases allocated to the control group, respectively. The participants in the treatment group were provided with real-EA therapy whereas participants in control group were provided with placebo-EA therapy(Streitberger Placebo-needle). In both groups, Tou sanshen(头三神)acupoints, including Sìshéncōng(四神聪EX-HN1), Sh6 ntíng(神庭 GV24),and bilateral Běnsh6 n(本神GB13) were adopted as the main acupoints, while Bǎihui(百会GV20), bilateral Hégǔ(合谷Ll4), and bilateral Tàich6 ng(太冲LR3) were adopted as matching acupoints. Interventions were offered 5 days prior to the surgery, once daily, and continued for total 5 days. The global scores of MiniMental State Examination(MMSE), and levels of serum inflammatory cytokines including interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α), and S100-β protein were observed at 24 h prior to the surgery, and postoperative 24 and 72 h respectively for assessing the incidence of POCD and the severity of cognitive impairments among patients. Meanwhile, adverse effects were monitored and recorded.Results:(1) Compared with baseline, MMSE global scores in both treatment and control groups markedly decreased at postoperative 24 h. MMSE global scores in treatment group decreased from 29.43 ±0.97 to27.10 ±1.95 while that in control group decreased from 29.27 ± 1.01 to 26.83 ± 2.25(all ?P< 0.05), and this trend continued until postoperative 72 h(at postoperative 72 h, MMSE global scores in treatment group was 26.53 ±2.26 versus 24.79 ±3.03 in control group). Moreover, decline in control group was more significant than that in treatment group at postoperative 72 h(P<0.05).(2) Compared with baseline, levels of serum IL-1β, TNF-α and S100-β in both groups increased markedly at postoperative 24 and 72 h. IL-1β in treatment group increased from 43.13 ±5.51 to 73.13 ±2.32 at postoperative 24 h and reached 83.17 士 5.95 at postoperative 72 h, while IL-1β in control group increased from 44.87 土 5.83 to91.10 ±3.55 at postoperative 24 h and reached 111.93 ±9.18 at postoperative 72 h;TNF-α in treatment group increased from 51.27 士 6.48 to 88.80 ± 3.55 at postoperative 24 h and reached 94.37 ± 5.22 at postoperative 72 h, while TNF-α in control group increased from 52.07 ±7.48 to 116.37 ±3.14 at postoperative24 h and reached 121.40 ±3.68 at postoperative 72 h(both ?P< 0.05), furthermore, increases of IL-1β and TNF-α levels in control group were more significant(P<0.05). Statistical difference in level of S100-β was not observed(P>0.05).(3) There was no statistical difference in POCD incidence at postoperative 24 h and postoperative 72 h between two groups(P> 0.05), though the incidence of POCD in patients receiving real-EA therapy was indeed much lower than that in patients receiving placebo-EA therapy, particularly at postoperative 72 h(POCD incidence rate at postoperative 24 h in treatment group was 26.67%, 30.00%in control group;POCD incidence rate at postoperative 72 h in treatment group was 30.00%, 46.67% in control group).(4) No serious adverse events were reported in this trial. No one dropped out from this trial.Conclusion: EA preconditioning can mitigate cognitive impairments at post-knee replacement surgery 24 and 72 h in elderly through inhibiting expression of inflammation. However, there is insufficient evidence to support that EA pretreatment can reduce the incidence of POCD.
