Construction and validation of a risk-prediction model for anastomotic leakage after radical gastrectomy: A cohort study in China

Objectives:Anastomotic leakage(AL)stands out as a prevalent and severe complication following gastric cancer surgery.It frequently precipitates additional serious complications,significantly influencing the overall survival time of patients.This study aims to enhance the risk-assessment strategy for AL following gastrectomy for gastric cancer.Methods:This study included a derivation cohort and validation cohort.The derivation cohort included patients who underwent radical gastrectomy at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,from January 1,2015 to December 31,2020.An evidence-based predictor questionnaire was crafted through extensive literature review and panel discussions.Based on the questionnaire,inpatient data were collected to form a model-derivation cohort.This cohort underwent both univariate and multivariate analyses to identify factors associated with AL events,and a logistic regression model with stepwise regression was developed.A 5-fold cross-validation ensured model reliability.The validation cohort included patients from August 1,2021 to December 31,2021 at the same hospital.Using the same imputation method,we organized the validation-queue data.We then employed the risk-prediction model constructed in the earlier phase of the study to predict the risk of AL in the subjects included in the validation queue.We compared the predictions with the actual occurrence,and evaluated the external validation performance of the model using model-evaluation indicators such as the area under the receiver operating characteristic curve(AUROC),Brier score,and calibration curve.Results:The derivation cohort included 1377 patients,and the validation cohort included 131 patients.The independent predictors of AL after radical gastrectomy included age65 y,preoperative albumin<35 g/L,resection extent,operative time240 min,and intraoperative blood loss90 mL.The predictive model exhibited a solid AUROC of 0.750(95%CI:0.694e0.806;p<0.001)with a Brier score of 0.049.The 5-fold cross-validation confirmed these findings with a calibrated C-index of 0.749 and an average Brier score of 0.052.External validation showed an AUROC of 0.723(95%CI:0.564e0.882;p?0.006)and a Brier score of 0.055,confirming reliability in different clinical settings.Conclusions:We successfully developed a risk-prediction model for AL following radical gastrectomy.This tool will aid healthcare professionals in anticipating AL,potentially reducing unnecessary interventions.

Preoperative neutrophil-to-lymphocyte ratio predicts symptomatic anastomotic leakage in elderly colon cancer patients: Multicenter propensity score-matched analysis

BACKGROUND The neutrophil-to-lymphocyte ratio(NLR),a composite inflammatory biomarker,is associated with the prognosis in patients with colorectal tumors.However,whether the NLR can be used as a predictor of symptomatic postoperative ana-stomotic leakage(AL)in elderly patients with colon cancer is unclear.AIM To assess the role of the NLR in predicting the occurrence of symptomatic AL after surgery in elderly patients with colon cancer.METHODS Data from elderly colon cancer patients who underwent elective radical colectomy with anastomosis at three centers between 2018 and 2022 were retrospectively analyzed.Receiver operating characteristic curve analysis was performed to determine the best predictive cutoff value for the NLR.Twenty-two covariates were matched using a 1:1 propensity score matching method,and univariate and multivariate logistic regression analyses were used to determine risk factors for the development of postoperative AL.RESULTS Of the 577 patients included,36(6.2%)had symptomatic AL.The optimal cutoff value of the NLR for predicting AL was 2.66.After propensity score matching,the incidence of AL was significantly greater in the≥2.66 NLR subgroup than in the<2.66 NLR subgroup(11.5%vs 2.5%;P=0.012).Univariate logistic regression analysis revealed statistically significant correlations between blood transfusion intraoperatively and within 2 d postoper-atively,preoperative albumin concentration,preoperative prognostic nutritional index,and preoperative NLR and AL occurrence(P<0.05);multivariate logistic regression analysis revealed that an NLR≥2.66[odds ratio(OR)=5.51;95%confidence interval(CI):1.50-20.26;P=0.010]and blood transfusion intraoperatively and within 2 d postoperatively(OR=2.52;95%CI:0.88-7.25;P=0.049)were risk factors for the occurrence of symptomatic AL.CONCLUSION A preoperative NLR≥2.66 and blood transfusion intraoperatively and within 2 d postoperatively are associated with a higher incidence of postoperative symptomatic AL in elderly patients with colon cancer.The preoperative NLR has predictive value for postoperative symptomatic AL after elective surgery in elderly patients with colon cancer.

Impact of open hepatectomy on postoperative bile leakage in patients with biliary tract cancer

BACKGROUND Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer.AIM To evaluate the incidence,risk factors,and management of bile leakage after open hepatectomy in patients with biliary tract cancer.METHODS We retrospectively analyzed 120 patients who underwent open hepatectomy for biliary tract cancer from February 2018 to February 2023.Bile leak was defined as bile drainage from the surgical site or drain or the presence of a biloma on imaging.The incidence,severity,timing,location,and treatment of the bile leaks were recorded.The risk factors for bile leakage were analyzed using univariate and multivariate logistic regression analyses.RESULTS The incidence of bile leak was 16.7%(20/120),and most cases were grade A(75%,15/20)according to the International Study Group of Liver Surgery classification.The median time of onset was 5 d(range,1-14 d),and the median duration was 7 d(range,2-28 d).The most common location of bile leakage was the cut surface of the liver(70%,14/20),followed by the anastomosis site(25%,5/20)and the cystic duct stump(5%,1/20).Most bile leaks were treated conservatively with drainage,antibiotics,and nutritional support(85%,17/20),whereas some required endoscopic retrograde cholangiopancreatography with stenting(10%,2/20)or percutaneous transhepatic cholangiography with drainage(5%,1/20).Risk factors for bile leakage include male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion.CONCLUSION Bile leakage is a frequent complication of open hepatectomy for biliary tract cancer.However,most cases are mild and can be conservatively managed.Male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion were associated with an increased risk of bile leak.

Endoscopic ultrasound-guided tissue sampling induced pancreatic duct leak resolved by the placement of a pancreatic stent:A case report

BACKGROUND Pancreatic ductal leaks complicated by endoscopic ultrasonography-guided tissue sampling(EUS-TS)can manifest as acute pancreatitis.CASE SUMMARY A 63-year-old man presented with persistent abdominal pain and weight loss.Diagnosis:Laboratory findings revealed elevated carbohydrate antigen 19-9(5920 U/mL)and carcinoembryonic antigen(23.7 ng/mL)levels.Magnetic resonance imaging of the pancreas revealed an approximately 3 cm ill-defined space-occupying lesion in the inferior aspect of the head,with severe encasement of the superior mesenteric artery.Pancreatic ductal adenocarcinoma was confirmed after pathological examination of specimens obtained by EUS-TS using the fanning method.Interventions and outcomes:The following day,the patient experienced severe abdominal pain with high amylase(265 U/L)and lipase(1173 U/L)levels.Computed tomography of the abdomen revealed edematous wall thickening of the second portion of the duodenum with adjacent fluid collections and a suspicious leak from either the distal common bile duct or the main pancreatic duct in the head.Endoscopic retrograde cholangiopancreatography revealed dye leakage in the head of the main pancreatic duct.Therefore,a 5F 7 cm linear plastic stent was deployed into the pancreatic duct to divert the pancreatic juice.The patient’s abdominal pain improved immediately after pancreatic stent insertion,and amylase and lipase levels normalized within a week.Neoadjuvant chemotherapy was then initiated.CONCLUSION Using the fanning method in EUS-TS can inadvertently cause damage to the pancreatic duct and may lead to clinically significant pancreatitis.Placing a pancreatic stent may immediately resolve acute pancreatitis and shorten the waiting time for curative therapy.When using the fanning method during EUSTS,ductal structures should be excluded to prevent pancreatic ductal leakage.

Research on Leak Location Method of Water Supply Pipeline Based on MVMD

At present,the leakage rate of the water distribution network in China is still high,and the waste of water resources caused by water distribution network leakage is quite serious every year.Therefore,the location of pipeline leakage is of great significance for saving water resources and reducing economic losses.Acoustic emission technology is the most widely used pipeline leak location technology.The traditional non-stationary random signal de-noising method mainly relies on the estimation of noise parameters,ignoring periodic noise and components unrelated to pipeline leakage.Aiming at the above problems,this paper proposes a leak location method for water supply pipelines based on a multivariate variational mode decomposition algorithm.This method combines the two parameters of the energy loss coefficient and the correlation coefficient between adjacent modes,and adaptively determines the decomposition mode number K according to the characteristics of the signal itself.According to the correlation coefficient,the effective component is selected to reconstruct the signal and the cross-correlation time delay is estimated to determine the location of the pipeline leakage point.The experimental results show that this method has higher accuracy than the cross-correlation method based on VMD and the cross-correlation method based on EMD,and the average relative positioning error is less than 2.2%.

Surgical treatment of mixed cervical spondylosis with spontaneous cerebrospinal fluid leakage: A case report

BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.Here,we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur.CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction,presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton.The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago.Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae,and computed tomography showed a“sickleshaped”disc prolapse with calcification in C4/5.We chose to perform an anterior cervical discectomy.When the prolapsed C4/5 disc was scraped,clear fluid leakage was observed,and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater,which was compressed continuously with cotton patties,with no significant cerebrospinal fluid leakage after 1 h.CONCLUSION Three months after surgery,the patient was asymptomatic and follow-up imaging demonstrated complete resolution.

Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas:Basic principles and recommendations

Post-surgical leaks and fistulas are the most feared complication of bariatric surgery.They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat.These two related conditions must be distinguished and characterized to guide the appropriate treatment.Leak is defined as a transmural defect with communication between the intra and extraluminal compartments,while fistula is defined as an abnormal communication between two epithelialized surfaces.Traditionally,surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates.However,with the development of novel devices and techniques,endoscopic therapy plays an increasingly essential role in managing these conditions.Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas.Several endoscopic techniques are available with different mechanisms of action,including direct closure,covering/diverting or draining.The treatment should be individualized by considering the characteristics of both the patient and the defect.Although there is a lack of high-quality studies to provide standardized treatment algorithms,this narrative review aims to provide a summary of the current scientific evidence and,based on this data and our extensive experience,make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.

A sutureless technique for securing leaking sclerotomies with viscoelastic substances in 23-gauge microincision vitrectomy surgery

AIM:To introduce and evaluate the clinical efficacy of a new technique,the use of viscoelastic substances(VS)to close leaking sclerotomy in 23G microincision vitrectomy,and to observe its effect on the visual acuity and intraocular pressure(IOP)of patients.METHODS:Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique(June 2019 to September 2020)and after the use of VS technique(October 2020 to December 2021)were selected as the subjects of this study.The above cases underwent operation by the same surgeon and were retrospectively analyzed.VS technique was used as the alternative to suturing,in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure.RESULTS:A total of 174 eyes were covered in the study,including 84 eyes in the control group(before the use of VS technique)and 90 eyes in the VS technique group.The number of eyes that needed to be sutured decreased considerably from 42.9%in the control group to 3.3%in the VS technique group,and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7%in the control group to 2.2%in the VS technique group.No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group.No major complications associated with VS technique were identified during the study.CONCLUSION:In 23G microincision vitrectomy,VS technique is a safe,simple,and effective method to close leaking sclerotomy.

Negligible Warming Caused by Nord Stream Methane Leaks

Unanticipated sabotage of two underwater pipelines in the Baltic Sea(Nord Stream 1 and 2)happened on 26September 2022.Massive quantities of natural gas,primarily methane,were released into the atmosphere,which lasted for about one week.As a more powerful greenhouse gas than CO_(2),the potential climatic impact of methane is a global concern.Using multiple methods and datasets,a recent study reported a relatively accurate magnitude of the leaked methane at 0.22±0.03 million tons(Mt),which was lower than the initial estimate in the immediate aftermath of the event.Under an energy conservation framework used in IPCC AR6,we derived a negligible increase in global surface air temperature of 1.8×10^(-5)℃ in a 20-year time horizon caused by the methane leaks with an upper limit of 0.25 Mt.Although the resultant warming from this methane leak incident was minor,future carbon release from additional Earth system feedbacks,such as thawing permafrost,and its impact on the methane mitigation pathways of the Paris Agreement,warrants investigation.

A reliability-oriented genetic algorithm-levenberg marquardt model for leak risk assessment based on time-frequency features

Since leaks in high-pressure pipelines transporting crude oil can cause severe economic losses,a reliable leak risk assessment can assist in developing an effective pipeline maintenance plan and avoiding unexpected incidents.The fast and accurate leak detection methods are essential for maintaining pipeline safety in pipeline reliability engineering.Current oil pipeline leakage signals are insufficient for feature extraction,while the training time for traditional leakage prediction models is too long.A new leak detection method is proposed based on time-frequency features and the Genetic Algorithm-Levenberg Marquardt(GA-LM)classification model for predicting the leakage status of oil pipelines.The signal that has been processed is transformed to the time and frequency domain,allowing full expression of the original signal.The traditional Back Propagation(BP)neural network is optimized by the Genetic Algorithm(GA)and Levenberg Marquardt(LM)algorithms.The results show that the recognition effect of a combined feature parameter is superior to that of a single feature parameter.The Accuracy,Precision,Recall,and F1score of the GA-LM model is 95%,93.5%,96.7%,and 95.1%,respectively,which proves that the GA-LM model has a good predictive effect and excellent stability for positive and negative samples.The proposed GA-LM model can obviously reduce training time and improve recognition efficiency.In addition,considering that a large number of samples are required for model training,a wavelet threshold method is proposed to generate sample data with higher reliability.The research results can provide an effective theoretical and technical reference for the leakage risk assessment of the actual oil pipelines.

Progress in the study and treatment of peri-device leak after left atrial appendage closure

For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.

碎软低渗煤储层强化与煤层气地面开发技术进展

我国碎软低渗煤储层分布广泛,然而由于其煤体松软、破碎、渗透性差,常规的直井/水平井煤储层直接压裂技术应用于碎软低渗煤储层强化及其煤层气地面开发的效果并不理想,碎软低渗煤储层煤层气的高效开发是制约我国煤层气产业大规模发展以及煤矿瓦斯高效治理的重要技术瓶颈。在系统分析我国碎软低渗煤储层特征及煤层气地面开发中存在的问题基础上,以水平井为基础井型,围绕间接压裂、应力释放和先固结后压裂3种不同的技术方向,梳理了目前碎软低渗煤储层强化与煤层气地面开发技术进展。归纳评述了以顶板间接压裂、夹矸层间接压裂以及硬煤分层间接压裂为内涵的间接压裂煤层气开发技术,以水力喷射造穴、气体动力造穴、扩孔+水力喷射+流体加卸载诱导失稳造穴、水力割缝为不同应力释放方式的应力释放煤层气开发技术,以及先微生物诱导碳酸钙固结碎软煤储层再进行水力压裂的先固结后压裂煤层气开发技术。间接压裂技术的工程实践探索已有较多积累,在地质条件适宜地区对碎软低渗煤储层强化取得了较好效果,而以应力释放为代表的碎软低渗煤储层强化新技术探索已取得重大进展,并进入工程试验和验证阶段。水平井应力释放技术针对碎软低渗煤储层特性和新的开发原理,其对储层改造潜力更大、煤层气开发效果会更好。基于水平井应力释放技术,围绕扩大应力释放范围、提高煤层气开发效果以及实现煤与煤层气共采3个方面,对碎软低渗煤储层强化及煤层气地面开发技术的发展趋势进行了展望,以期为改善我国碎软低渗煤储层增产改造效果以及提高煤层气单井产量提供参考。

煤层瓦斯含量测定技术及装备研究进展

瓦斯含量是煤与瓦斯突出危险预测、煤层瓦斯资源量估算、矿井瓦斯治理工程设计的重要参数。围绕如何在大区域准确快速测定煤层瓦斯含量,依托国家科技重大专项、国家自然科学基金和煤炭企业联合基金等项目科技攻关,在取样、测试方面取得了一定进展。主要表现在如下4个方面:①煤层瓦斯含量测定取样经历了孔口接样、岩心管定点取样、压力引射定点取样和密闭取样4个阶段,密闭取样装备保压能力达到11.5 MPa,煤心直径达到38 mm;②针对不同煤层地质条件,发展形成了顺煤层定向长钻孔密闭取样、底板穿层钻孔密闭取样和顶(底)板梳状定向长钻孔密闭取样3种取样技术;③在河南焦作和山西晋城矿区硬煤层中,顺层定向长钻孔取样深度达到516 m,密闭取样法测得煤层瓦斯含量较常规取样法分别平均提高了0.44倍和1.04倍。在安徽淮南矿区碎软煤层中,穿层钻孔密闭取样深度达到209 m,测得煤层瓦斯含量较常规取样法平均提高了0.26倍;在安徽淮北矿区碎软煤层中,顶(底)板梳状钻孔密闭取样深度达到484 m,测得煤层瓦斯含量较常规取样法平均提高了0.19倍,密闭取样法在煤层瓦斯含量测定精度、探测范围上优于常规取样法;④在瓦斯含量测试方面,除了传统解吸法测试,发展了系列煤矿井下瓦斯含量快速测试装备,可实现最快30 min内测得煤层瓦斯含量,一般用于百米孔内的瓦斯含量测试。提出了煤层瓦斯含量测定密闭取样装备需向小型化、轻量化的方向发展,并能实现随钻密闭取样。在测试上,应根据实际情况确定合理的解吸终止限,并将测试装备和密闭取样装备进一步结合,以实现深孔瓦斯含量快速准确测定。密闭取样技术已成为煤层瓦斯含量大区域精准勘查、预测的主要手段,是煤炭安全高效开采的重要技术保障。

供电电压闪变对异步电动机转子故障在线检测的影响及应对

供电电压闪变可能对异步电动机转子故障在线检测产生不利影响,导致基于定子电流信号分析(motor current signature analysis,MCSA)的转子故障在线检测方法失效。通过理论分析,揭示供电电压闪变恶化转子故障在线检测性能的机制。提出免于供电电压闪变影响的异步电动机转子故障在线检测方法,首先,根据转子故障主特征频率分量预判转子健康或故障;继而,根据转子故障独有的辅助特征频率分量进一步确认转子健康或故障。仿真与实验结果证明了该方法的有效性。

超声协同大豆分离蛋白对米粉和米面包品质的影响及机制研究

目的探究超声协同大豆分离蛋白(soybean isolate protein,SPI)对米粉以及米面包品质的影响。方法以碎米为主要原料,5个梯度(0%、3%、6%、9%、12%,以碎米粉质量计)的大豆分离蛋白(soybean isolate protein,SPI)为辅料,比较超声协同5个梯度SPI对混合粉热机械学特性、糊化特性、流变特性以及米面包比容、损耗率、感官评价的影响。结果与未进行超声处理的样品相比,超声协同SPI处理的米粉的吸水率从64.90±0.00增加至94.80±0.00,其混合粉的峰值黏度从2704.00±47.76降低至1567.00±116.73,表明超声使淀粉部分支链断裂,生成大量短直链淀粉,导致分子量下降,相互作用减弱;超声处理后的样品储能模量(G')曲线随着SPI含量的增加呈现出先降低后增加再降低的趋势,损耗模量(G")曲线呈现出逐渐降低的趋势。当SPI添加量为9%时,米面包的比容达到最大值,为(0.86±0.08)mL/g,感官评分从50.05±3.75增加至86.27±2.28;当SPI添加量达到12%时,米面包的损耗率达到最低。结论综上所述,采用9%SPI的方法制备米面包,可以有效地改善米面包品质,本研究为米面包在食品领域的应用提供了理论基础。

从管段走向管网:管道泄漏诊断技术研究进展

管道泄漏诊断技术在保障管道系统安全运行中起着至关重要的作用。首先,介绍了管道泄漏诊断系统的结构,并指出由单一管段向复杂管网泄漏诊断的发展趋势。进一步从基于数据驱动的传统泄漏检测方法、管道泄漏信号源定位技术和基于深度学习的复杂管网泄漏检测方法3个方面进行综述,分析了不同方法的优势、局限性和适用范围。最后指出,随着管网系统的复杂度增加,传统方法的局限性逐渐显现,基于深度学习技术的复杂管网微弱泄漏诊断、多源信号融合和管网智能化的研究将成为未来的研究趋势。

酸溶开孔筛管支撑完井工艺研究及应用

为应对顺北断控油气藏支撑完井管柱无法穿越破碎带难题,研发了以高抗扭油管、酸溶开孔筛管和高抗扭液压丢手为关键技术的“酸溶开孔筛管”支撑完井工艺。设计的高抗扭油管和丢手器,满足下入期间旋转、钻磨对管柱抗扭能力的要求;设计的酸溶开孔筛管,初始状态管体完全密封,完井液可循环至底端钻头,满足钻磨时冲洗钻头的要求,而注酸溶解可溶塞后管体变成带孔的筛管,又可满足储层改造和生产时大排量通道要求。通过开展一系列承压、耐盐、耐碱和酸溶等试验验证了工艺的可靠性。现场应用表明,酸溶开孔筛管支撑完井工艺有效解决了破碎带难以穿越的问题,已在现场应用6井次,支撑管柱到位率100%。该工艺简单可靠、便于现场操作,且与传统工艺相比,单井提高时效53.6%,节约费用90.0%。该成果可为其他类似井选择完井工艺提供参考。

黄铁矿晶体断裂机制与表面反应性研究

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