Morphology Study for GeV Emission of Nearby Supernova Remnant G332.5-5.6

A spatial template is important to study nearby supernova remnants(SNRs).For SNR G332.5-5.6,we report a Gaussian disk with a radius of about 1°.06 to be a potential good spatial model in the γ-ray band.Employing this new Gaussian disk,its GeV lightcurve shows a significant variability of about seven sigma.The γ-ray observations of this SNR could be explained well either by a leptonic model or a hadronic model,in which a flat spectrum for the ejected electrons/protons is required.

Unveiling the adaptation strategies of woody plants in remnant forest patches to spatiotemporal urban expansion through leaf trait networks

Background:With the expansion of urban areas,the remnants of forested areas play a crucial role in preserving biodiversity in urban environments.This study aimed to explore the impact of spatiotemporal urban expansion on the networks of leaf traits in woody plants within remnant forest patches,thereby enhancing our understanding of plant adaptive strategies and contributing to the conservation of urban biodiversity.Methods:Our study examined woody plants within 120 sample plots across 15 remnant forest patches in Guiyang,China.We constructed leaf trait networks (LTNs) based on 26 anatomical,structural,and compositional leaf traits and assessed the effects of the spatiotemporal dynamics of urban expansion on these LTNs.Results and conclusions:Our results indicate that shrubs within these patches have greater average path lengths and diameters than trees.With increasing urban expansion intensity,we observed a rise in the edge density of the LTN-shrubs.Additionally,modularity within the networks of shrubs decreased as road density and urban expansion intensity increased,and increases in the average path length and average clustering coefficient for shrubs were observed with a rise in the composite terrain complexity index.Notably,patches subjected to‘leapfrog’expansion exhibited greater average patch length and diameter than those experiencing edge growth.Stomatal traits were found to have high degree centrality within these networks,signifying their substantial contribution to multiple functions.In urban remnant forests,shrubs bolster their resilience to variable environmental pressures by augmenting the complexity of their leaf trait networks.

Feedback of Efficient Shock Acceleration on Magnetic-field Structure Inside Young Type Ia Supernova Remnants

Using an effective adiabatic index γ_(eff) to mimic the feedback of efficient shock acceleration,we simulate the temporal evolution of a young type Ia supernova remnant (SNR) with two different background magnetic field(BMF) topologies:a uniform and a turbulent BMF.The density distribution and magnetic-field characteristics of our benchmark SNR are studied with two-dimensional cylindrical magnetohydrodynamic simulations.When γ_(eff)is considered,we find that:(1) the two-shock structure shrinks and the downstream magnetic-field orientation is dominated by the Rayleigh–Taylor instability structures;(2) there exists more quasi-radial magnetic fields inside the shocked region;and (3) inside the intershock region,both the quasi-radial magnetic energy density and the total magnetic energy density are enhanced:in the radial direction,with γ_(eff)=1.1,they are amplified about 10–26 times more than those with γ_(eff)=5/3.While in the angular direction,the total magnetic energy densities could be amplified about 350 times more than those with γ_(eff)=5/3,and there are more grid cells within the intershock region where the magnetic energy density is amplified by a factor greater than 100.

Predictive value of positive lymph node ratio in patients with locally advanced gastric remnant cancer

BACKGROUND Traditional lymph node stage(N stage)has limitations in advanced gastric remnant cancer(GRC)patients;therefore,establishing a new predictive stage is necessary.AIM To explore the predictive value of positive lymph node ratio(LNR)according to clinicopathological characteristics and prognosis of locally advanced GRC.METHODS Seventy-four patients who underwent radical gastrectomy and lymphadenectomy for locally advanced GRC were retrospectively reviewed.The relationship between LNR and clinicopathological characteristics was analyzed.The survival analysis was performed using Kaplan-Meier survival curves and Cox regression model.RESULTS Number of metastatic LNs,tumor diameter,depth of tumor invasion,Borrmann type,serum tumor biomarkers,and tumor-node-metastasis(TNM)stage were correlated with LNR stage and N stage.Univariate analysis revealed that the factors affecting survival included tumor diameter,anemia,serum tumor biomarkers,vascular or neural invasion,combined resection,LNR stage,N stage,and TNM stage(all P<0.05).The median survival time for those with LNR0,LNR1,LNR2 and LNR3 stage were 61,31,23 and 17 mo,respectively,and the differences were significant(P=0.000).Anemia,tumor biomarkers and LNR stage were independent prognostic factors for survival in multivariable analysis(all P<0.05).CONCLUSION The new LNR stage is uniquely based on number of metastatic LNs,with significant prognostic value for locally advanced GRC,and could better differentiate overall survival,compared with N stage.

Laparoscopic management of remnant gall bladder with stones: Lessons from a tertiary care centre's experience

Objective:Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease.Despite its success,approximately 10%of patients may experience persistent biliary symptoms,leading to the post-cholecystectomy syndrome.A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome.The objective of this study was to shed light on the clinical manifestations,evaluation,therapeutic strategies,and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.Methods:This was a retrospective study,conducted over a five-year period(January 2017 to December 2022)at Apollo Hospitals in South India.All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included.The following data were collected:patient demographics,symptoms,preoperative investigations,intraoperative details and post operative outcomes.Results:In total,36 patients were included and analysed.The majority of patients were male(25,69.4%),with a mean age of 50.7±12.1 years.The most common presentation was pain in the upper abdomen or right upper quadrant region(24,66.7%).The laparoscopic approach was attempted in all patients,with a success rate of 94.4%.Two patients required conversion to open surgery.Cholecystoenteric fistula to the colon was observed in one patient.Choledocholithiasis was observed in 7 patients(19.4%),and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.Conclusion:Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection.Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy,a complex procedure associated with certain risks.This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.

Associations between remnant cholesterol levels and mortality in patients with diabetes

BACKGROUND Dyslipidemia is frequently present in patients with diabetes.The associations of remnant cholesterol and mortality remains unclear in patients with diabetes.AIM To explore the associations of remnant cholesterol with all-cause and cardiovas-cular mortality in patients with diabetes.METHODS This prospective cohort study included 4740 patients with diabetes who par-ticipated in the National Health and Nutrition Examination Survey from 1999 through 2018.Remnant cholesterol was used as the exposure variable,and all-cause and cardiovascular mortality were considered outcome events.Outcome data were obtained from the National Death Index,and all participants were followed from the interview date until death or December 31,2019.Multivariate proportional Cox regression models were used to explore the associations between exposure and outcomes,in which remnant cholesterol was modeled as both a categorical and a continuous variable.Restricted cubic splines(RCSs)were calculated to assess the nonlinearity of associations.Subgroup(stratified by sex,age,body mass index,and duration of diabetes)and a series of sensitivity analyses were performed to evaluate the robustness of the associations.RESULTS During a median follow-up duration of 83 months,1370 all-cause deaths and 389 cardiovascular deaths were documented.Patients with remnant cholesterol levels in the third quartile had a reduced risk of all-cause mortality[hazard ratio(HR)95%confidence interval(CI):0.66(0.52-0.85)];however,when remnant cholesterol was modeled as a continuous variable,it was associated with increased risks of all-cause[HR(95%CI):1.12(1.02-1.21)per SD]and cardiovascular[HR(95%CI):1.16(1.01-1.32),per SD]mortality.The RCS demonstrated nonlinear associations of remnant cholesterol with all-cause and cardiovascular mortality.Subgroup and sensitivity analyses did not reveal significant differences from the above results.CONCLUSION In patients with diabetes,higher remnant cholesterol was associated with increased risks of all-cause and cardiovascular mortality,and diabetes patients with slightly higher remnant cholesterol(0.68-1.04 mmol/L)had a lower risk of all-cause mortality.

Simultaneous portal and hepatic vein embolization is better than portal embolization or ALPPS for hypertrophy of future liver remnant before major hepatectomy: A systematic review and network meta-analysis

Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver metastases.The most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is portal vein embolization(PVE),which does not always lead to successful hypertrophy.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been proposed to overcome the limitations of PVE.Liver venous deprivation(LVD),a technique that includes simultaneous portal and hepatic vein embolization,has also been proposed as an alternative to ALPPS.The present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy,effectiveness,and safety of the three regenerative techniques.Data sources:A systematic search for literature was conducted using the electronic databases Embase,PubMed(MEDLINE),Google Scholar and Cochrane.Results:The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days,respectively.Intraoperative parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD cohorts.There was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort,but non-significant differences were observed when compared to the LVD cohort.Notably,the LVD cohort demonstrated a significantly better FLR/body weight(BW)ratio compared to both the ALPPS and PVE cohorts.Both the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS cohort.The LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS cohorts.Conclusions:LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major hepatectomy.Present evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE cohorts.

Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery

BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer(RGC)patients are crucial.A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.AIM To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.METHODS The clinical data of 54 patients with RGC were collected and analyzed retrospectively.Prognostic nutritional index(PNI),controlled nutritional status(CONUT),and Naples prognostic score(NPS)were calculated by preoperative blood indicators,including absolute lymphocyte count,lymphocyte to monocyte ratio,neutrophil to lymphocyte ratio,serum albumin,and serum total cholesterol.Patients with RGC were divided into groups according to the immune-nutritional risk.The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed.Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival(OS)rate between various immune-nutritional score groups.RESULTS The median age of this cohort was 70.5 years(ranging from 39 to 87 years).No significant correlation was found between most pathological features and immune-nutritional status(P>0.05).Patients with a PNI score<45,CONUT score or NPS score≥3 were considered to be at high immune-nutritional risk.The areas under the receiver operating characteristic curves of PNI,CONUT,and NPS systems for predicting postoperative survival were 0.611[95%confidence interval(CI):0.460–0.763;P=0.161],0.635(95%CI:0.485–0.784;P=0.090),and 0.707(95%CI:0.566–0.848;P=0.009),respectively.Cox regression analysis showed that the three immunenutritional scoring systems were significantly correlated with OS(PNI:P=0.002;CONUT:P=0.039;NPS:P<0.001).Survival analysis revealed a significant difference in OS between different immune-nutritional groups(PNI:75 mo vs 42 mo,P=0.001;CONUT:69 mo vs 48 mo,P=0.033;NPS:77 mo vs 40 mo,P<0.001).CONCLUSION These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC,in which the NPS system has relatively effective predictive performance.

CD4^(+)CD25^(+) regulatory T cells decreased future liver remnant after associating liver partition and portal vein ligation for staged hepatectomy

BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is an innovative surgical approach for the treatment of massive hepatocellular carcinoma(HCC),the key to successful planned stage 2 ALPPS is future liver remnant(FLR)volume growth,but the exact mechanism has not been elucidated.The correlation between regulatory T cells(Tregs)and postoperative FLR regeneration has not been reported.AIM To investigate the effect of CD4^(+)CD25^(+)Tregs on FLR regeneration after ALPPS.METHODS Clinical data and specimens were collected from 37 patients who developed massive HCC treated with ALPPS.Flow cytometry was performed to detect changes in the proportion of CD4^(+)CD25^(+)Tregs to CD4^(+)T cells in peripheral blood before and after ALPPS.To analyze the relationship between peripheral blood CD4^(+)CD25^(+)Treg proportion and clinicopathological information and liver volume.RESULTS The postoperative CD4^(+)CD25^(+)Treg proportion in stage 1 ALPPS was negatively correlated with the amount of proliferation volume,proliferation rate,and kinetic growth rate(KGR)of the FLR after stage 1 ALPPS.Patients with low Treg proportion had significantly higher KGR than those with high Treg proportion(P=0.006);patients with high Treg proportion had more severe postoperative pathological liver fibrosis than those with low Treg proportion(P=0.043).The area under the receiver operating characteristic curve between the percentage of Tregs and proliferation volume,proliferation rate,and KGR were all greater than 0.70.CONCLUSION CD4^(+)CD25^(+)Tregs in the peripheral blood of patients with massive HCC at stage 1 ALPPS were negatively correlated with indicators of FLR regeneration after stage 1 ALPPS and may influence the degree of fibrosis in patients’livers.Treg percentage was highly accurate in predicting the FLR regeneration after stage 1 ALPPS.

Classifying Core Collapse Supernova Remnants by Their Morphology as Shaped by the Last Exploding Jets

Under the assumption that jets explode all core collapse supernovae(CCSNe),I classify 14 CCSN remnants(CCSNRs)into five groups according to their morphology as shaped by jets,and attribute the classes to the specific angular momentum of the pre-collapse core.Point-symmetry(one CCSNR):According to the jittering jets explosion mechanism(JJEM)when the pre-collapse core rotates very slowly,the newly born neutron star(NS)launches tens of jet-pairs in all directions.The last several jet-pairs might leave an imprint of several pairs of“ears,”i.e.,a point-symmetric morphology.One pair of ears(eight CCSNRs):More rapidly rotating cores might force the last pair of jets to be long-lived and shape one pair of jet-inflated ears that dominates the morphology.S-shaped(one CCSNR):The accretion disk might precess,leading to an S-shaped morphology.Barrel-shaped(three CCSNRs):Even more rapidly rotating pre-collapse cores might result in a final energetic pair of jets that clear the region along the axis of the pre-collapse core rotation and form a barrel-shaped morphology.Elongated(one CCSNR):A very rapidly rotating pre-collapse core forces all jets to be along the same axis such that the jets are inefficient in expelling mass from the equatorial plane and the long-lasting accretion process turns the NS into a black hole.The two new results of this study are the classification of CCSNRs into five classes based on jet-shaped morphological features,and the attribution of the morphological classes mainly to the pre-collapse core rotation in the frame of the JJEM.

A Rare Case of a Left Ovarian Remnant Syndrome Associated with a Symptomatic Right Ovarian Cyst

Ovarian Remnant syndrome (ORS) is the presence of residual ovarian tissue after an oophorectomy was performed whether associated with a hysterectomy or not. We report the case of a 39-year-old woman with a past surgical history of total abdominal hysterectomy and left salpingo-oophorectomy with an indication of placenta accreta incidentally discovered during a caesarian section. The patient presented with pelvic pain and was diagnosed with ORS. She was successfully managed by laparoscopy with removal of the cyst and the surrounding ovarian tissue, confirmed by histopathological analysis. The post operative period was uneventful, and the patient was discharged after 2 days of good evolution. In our context, surgery remains the main treatment option, however, other treatment options including radiotherapy or medical management need to be considered as either adjunct or main therapy.

Expression profiles of gastric cancer molecular subtypes in remnant tumors

BACKGROUND Remnant gastric cancer(RGC)is a carcinoma arising in the stomach remnant after previous gastric resection.It is frequently reported as a tumor with a poor prognosis and distinct biological features from primary gastric cancer(PGC).However,as it is less frequent,its profile regarding the current molecular classifications of gastric cancer has not been evaluated.AIM To evaluate a cohort of RGC according to molecular subtypes of GC using a panel of immunohistochemistry and in situ hybridization to determine whether the expression profile is different between PGC and RGC.METHODS Consecutive RGC patients who underwent gastrectomy between 2009 and 2019 were assessed using seven GC panels:Epstein-Barr virus in situ hybridization,immunohistochemistry for mismatch repair proteins(MutL homolog 1,MutS homolog 2,MutS homolog 6,and PMS1 homolog 2),p53 protein,and E-cadherin expression.Clinicopathological characteristics and survival of these patients were compared to 284 PGC patients.RESULTS A total of 40 RGC patients were enrolled in this study.Compared to PGC,older age(P<0.001),male(P<0.001),lower body mass index(P=0.010),and lower hemoglobin level(P<0.001)were associated with RGC patients.No difference was observed regarding Lauren’s type and pathologic Tumor Node Metastasis stage between the groups.Regarding the profiles evaluated,EBV-positive tumors were higher in RGC compared to PGC(P=0.039).The frequency of microsatellite instability,aberrant p53 immunostaining,and loss of E-cadherin expression were similar between RGC and PGC.Higher rates of simultaneous alterations in two or more profiles were observed in RGC compared to PGC(P<0.001).According to the molecular classification,the subtypes were defined as EBV in nine(22.5%)cases,microsatellite instability in nine(22.5%)cases,genomically stable in one(2.5%)case,and chromosomal instability in 21(52.5%)cases.There was no significant difference in survival between molecular subtypes in RGC patients.CONCLUSION RGC was associated with EBV positivity and higher rates of co-altered expression profiles compared to PGC.According to the molecular classification,there was no significant difference in survival between the subtypes of RGC.

Remnant gastric cancer:An ordinary primary adenocarcinoma or a tumor with its own pattern?

BACKGROUND Remnant gastric cancer(RGC)is defined as a tumor that develops in the stomach after a previous gastrectomy and is generally associated with a worse prognosis.However,there little information available regarding RGCs and their prognostic factors and survival.AIM To evaluate the clinicopathological characteristics and prognosis of RGC after previous gastrectomy for benign disease.METHODS Patients who underwent curative resection for primary gastric cancer(GC)at our institute between 2009 and 2019 were retrospectively evaluated.All RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in this study.Primary proximal GC(PGC)who underwent total gastrectomy was selected as the comparison group.Clinical and pathological data were collected from a prospective medical database.RESULTS A total of 41 patients with RGC and 120 PGC were included.Older age(P=0.001),lower body mass index(P=0.006),hemoglobin level(P<0.001),and number of resected lymph nodes resected(LN)(P<0.001)were associated with the RGC group.Lauren type,pathological tumor-node-metastasis,and perioperative morbimortality were similar between RGC and PGC.There was no difference in disease-free survival(P=0.592)and overall survival(P=0.930)between groups.LN status was the only independent factor related to survival.CONCLUSION RGC had similar clinicopathological characteristics to PGC.Despite the lower number of resected LN,RGC had a similar prognosis.

3D laparoscopic-assisted vs open gastrectomy for carcinoma in the remnant stomach: A retrospective cohort study

BACKGROUND Three-dimensional(3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach(CRS), but its clinical efficacy remains controversial.AIM To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy(3DLAG) with open gastrectomy(OG) for CRS.METHODS The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up,we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival(OS) rates were compared between the two groups.RESULTS Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score,initial disease state(benign or malignant), primary surgical anastomosis method,interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss(188.33 ± 191.35 mL vs 305.83 ± 303.66 mL;P =0.045) and smaller incision(10.86 ± 3.18 cm vs 20.06 ± 5.17 cm;P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG(14.0 ± 7.17 vs 10.73 ± 6.82;P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups(1.56 ± 2.84 vs 2.35 ± 5.28;P = 0.413). The complication rate(8.3% vs 20.8%;P = 0.207) and intensive care unit admission rate(5.6% vs 14.5%;P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval(CI): 72.4%-95.6%] and 73.3%(95%CI: 60.0%-89.5%)respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3%(95%CI: 76.4%-99.8%) and 75.6%(95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups(P = 0.68).CONCLUSION Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.

肥胖儿童non-HDL-C、remnant cholesterol与亚临床动脉粥样硬化的关系

目的:了解non-HDL-C和remnant cholesterol与肥胖儿童亚临床动脉粥样硬化(AS)的关系。方法:根据甘油三酯(TG)水平将65例肥胖儿童(肥胖组)分为I组(TG≥2.3 mmol/L)32例,II组(TG<2.3 mmol/L)33例,与肥胖组儿童性别年龄相匹配的正常体质量儿童30例为III组(对照组)。比较3组儿童血脂指标,对肥胖组各项血脂指标与血浆致动脉粥样硬化指数(AIP)进行相关性分析,肥胖患儿体质指数、血脂指标与颈动脉内径、内膜-中层厚度(c-IMT)、血流参数进行相关性分析。结果:I组、II组的TG、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、non-HDL-C、remnant cholesterol、AIP均较对照组升高,高密度脂蛋白胆固醇(HDL-C)较对照组降低,且I组的remnant cholesterol、AIP均较II组升高。肥胖组儿童AIP与TG、non-HDL-C、remnant cholesterol呈正相关,与HDL-C呈负相关。37例行颈动脉超声检查的肥胖儿童的c-IMT较正常儿童的增厚。结论:non-HDL-C、remnant cholesterol在肥胖儿童亚临床AS中有重要作用,在肥胖儿童血脂异常的治疗中应关注non-HDL-C、remnant cholesterol的变化。

Current status in remnant gastric cancer after distal gastrectomy

Remnant gastric cancer(RGC) and gastric stump cancer after distal gastrectomy(DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori(H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.

Gastric cancer arising from the remnant stomach after distal gastrectomy:A review

Gastric stump carcinoma was initially reported by Balfore in 1922,and many reports of this disease have since been published. We herein review previous reports of gastric stump carcinoma with respect to epidemiology,carcinogenesis,Helicobacter pylori(H. pylori) infection,Epstein-Barr virus infection,clinicopathologic characteristics and endoscopic treatment. In particular,it is noteworthy that no prognostic differences are observed between gastric stump carcinoma and primary upper third gastric cancer. In addition,endoscopic submucosal dissection has recently been used to treat gastric stump carcinoma in the early stage. In contrast,many issues concerning gastric stump carcinoma remain to be clarified,including molecular biological characteristics and the carcinogenesis of H.pylori infection.We herein review the previous pertinent literature and summarize the characteristics of gastric stump carcinoma reported to date.

Chronology and Geochemistry of the Nadingcuo Volcanic Rocks in the Southern Qiangtang Region of the Tibetan Plateau:Partial Melting of Remnant Ocean Crust along the Bangong-Nujiang Suture

The Nadingcuo high-K calc-alkaline rocks mainly composed of trachyte and trachyandesite are the largest outcrop area of volcanic rocks in southern Qiangtang terrane in the Tibetan plateau. However,their exact source and peterogenesis are still debated.^（40）Ar-^（39）Ar and LAM-ICPMS zircon U-Pb isotopic dating confirm that these rocks erupted in Eocene.In addition,the Nadingcuo volcanic rocks are characterized by high Sr/Y content ratios,similar with the adakite derived from partial melting of oceanic crust.They can be further classified as high Mg~#（Mg~#=48-57） and low Mg~# （Mg~#=33-42） subtypes.The Nadingcuo adakitic rocks have relatively low（^（87）Sr/^（86）Sr）_i and highε_（Nd）（t）, showing a trend of similarity to the Dongcuo ophiolite present in the Bangong-Nujiang oceanic crust. Simple modeling indicates that the Nadingcuo adakitic rocks are a mix resulting from the basalt of Bangong-Nujiang Ocean with 10%-20%crustal material of Lhasa terrane.On these bases we suggest that the low Mg~# Nadingcuo adakitic rocks are the product of partial melting of remnant oceanic crust with small sediment,and the high Mg~# rocks are the result of reaction between rising melt of remnant oceanic crust with subducted sediment and mantle wedge.Therefore,the origin of Nadingcuo adakitic rocks may be related to intracontinental subduction triggered by collision of India-Asia during Cenozoic.

End-stage liver disease score and future liver remnant volume predict post-hepatectomy liver failure in hepatocellular carcinoma

BACKGROUND Hepatocellular carcinoma(HCC)is the world’s sixth most common malignant tumor and the third cause of cancer death.Although great progress has been made in hepatectomy,it is still associated with a certain degree of risk of posthepatectomy liver failure(PHLF),which extends the length of hospital stay and remains the leading cause of postoperative death.Studies have shown that assessment of hepatic functional reserve before hepatectomy is beneficial for reducing the incidence of PHLF.AIM To assess the value of model for end-stage liver disease(MELD)score combined with standardized future liver remnant(sFLR)volume in predicting PHLF in patients undergoing hepatectomy for HCC.METHODS This study was attended by 238 patients with HCC who underwent hepatectomy between January 2015 and January 2018.Discrimination of sFLR volume,MELD score,and sFLR/MELD ratio to predict PHLF was evaluated according to the area under the receiver operating characteristic curve.RESULTS The patients were divided into two groups according to whether PHLF occurred after hepatectomy.The incidence of PHLF was 8.4%in our research.The incidence of PHLF increased with the decrease in sFLR volume and the increase in MELD score.Both sFLR volume and MELD score were considered independent predictive factors for PHLF.Moreover,the cut-off value of the sFLR/MELD score to predict PHLF was 0.078(P<0.001).This suggests that an sFLR/MELD≥0.078 indicates a higher incidence of PHLF than an sFLR/MELD<0.078.CONCLUSION MELD combined with sFLR is a reliable and effective PHLF predictor,which is superior to MELD score or sFLR volume alone.

Matched-pair analysis of postoperative morbidity and mortality for pancreaticogastrostomy and pancreaticojejunostomy using mattress sutures in soft pancreatic tissue remnants

BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical technique for pancreaticoenteric anastomosis has been established.This study aimed to compare the postoperative morbidity and mortality of pancreaticogastrostomy and pancreaticojejunostomy for 'soft' pancreatic tissue remnants using modified mattress sutures.METHODS:Seventy-five patients who had undergone pancreaticogastrostomy and 75 who had undergone pancreaticojejunostomy after pancreaticoduodenectomy between 2002 and 2008 were retrospectively compared using matched-pair analysis.A modified mattress suture technique was used for the pancreaticoenteric anastomosis.Patients with an underlying 'hard' pancreatic tissue remnant,as in chronic pancreatitis,were excluded.Both groups were homogeneous for age,gender,and underlying disease.Postoperative morbidity,mortality,and preoperative and operative data were analyzed.RESULTS:There were no significant differences between the groups for the incidence of postoperative pancreatic fistula (10.7% in both).Postoperative morbidity and mortality,median operation time,median length of hospital stay,intraoperative blood loss,and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ between the groups.Patient age >65 years (P=0.017),operation time >350minutes (P=0.001),and intraoperative transfusion of erythrocyte concentrates (P=0.038) were identified as risk factors for postoperative morbidity.CONCLUSIONS:Our results showed no significant differences between the groups in the pancreaticogastrostomy and pancreaticojejunostomy anastomosis techniques using mattress sutures for 'soft' pancreatic tissue remnants.In our experience,the mattress sutures are safe and simple to use,and pancreaticogastrostomy in particular is feasible and easy to learn,with good endoscopic accessibility to the anastomosis region.However,the location of the anastomosis and the surgical technique need to be individually evaluated to further reduce the incidence of postoperative pancreatic fistula.