Comparative efficacy and safety between endoscopic submucosal dissection,surgery and definitive chemoradiotherapy in patients with cT1N0M0 esophageal cancer

BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.

Survival outcomes of patients with cervical esophageal cancer who received definitive radiotherapy:a retrospective study conducted in a single institution

Objective Cervical esophageal cancer(CEC)is a relatively rare condition,with limited treatment options.The current study aimed to assess the survival outcomes of patients with CEC who received definitive radiotherapy.Methods In total,63 consecutive patients with CEC who received definitive radiotherapy between 2010 and 2018 were included in this study.The survival outcomes were analyzed based on statistics.Results The median progression-free survival(PFS)and overall survival(OS)of the patients were 12 and 19 months,respectively.There were no significant differences in terms of survival outcomes between the groups who received radiation doses≥60 and<60 Gy.Interestingly,in the proximal CEC subgroup,the PFS(P=0.039),OS(P=0.031),and loco-regional failure-free survival(LRFFS)(P=0.005)improved significantly in patients who received a radiation dose≥60 Gy compared with those who received a radiation dose<60 Gy.However,in the distal CEC subgroup,the PFS,OS,and LRFFS did not significantly improve between patients who received radiation doses≥60 and<60 Gy.Definitive radiotherapy was well tolerated,and no significant differences were observed in terms of treatment-related toxicities between the groups who received radiation doses≥60 and<60 Gy.Conclusion The survival outcomes of patients with CEC should be improved.In proximal CEC,a radiation dose≥60 Gy is significantly correlated with better PFS,OS,and LRFFS.However,further research must be performed to validate this finding.

Combined Single Step Definitive Treatment in Acute Pilonidal Sinus Abscess Running Head: Single Step Treatment of Pilonidal Abscess

Backgrounds: The treatment of choice has been drainage and definitive surgical treatment after an interval for acute pilonidal sinus abscess till now. Because of the high incidence of chronic pilonidal sinus disease following drainage and aiming the cure in one step, synchronous treatment choices to drainage have been attempted recently. We analyzed retrospectively 20 patients with pilonidal sinus abscess on whom we carried out drainage+ marsupialization as singlestep treatment. Methods: Drainage+ synchronous marsupialization results of 20 patients (17 male, 3 female) between 20 to 37 years of age (mean 28) were analyzed retrospectively on the parameters of operation time, recovery period, time to workreturn and recurrence ratios. Results Operation times were between 15 to 25 minutes. Mean recovery period was 45 days (3050 days), the mean period from operation to workreturn was 24 (2230) days. There were full recovery in 18 patients (90%) and recurrence in 2 patients (10%). Silver nitrate ablation treatment achieved cure in recurrences. Conclusion: Drainage+ Marsupialization is an applicable and successful combined choice in the treatment of Pilonidal sinus abscess.

Cardiac Tamponade Associated with Blunt Cardiac Injury: Its Definitive Management in the Emergency Department

Cardiac tamponade secondary to blunt cardiac injury is an extremely serious and life-threatening condition that the emergency physician is required to make definitive and appropriate management and resuscitation. Although blunt cardiac injury includes a wide spectrum of pathological conditions, cardiac tamponade due to blunt trauma is rarely seen because most of the patients with cardiac rupture die at the scene or before arrival at the hospital. Definitive surgical repair is commonly necessary following pericardial decompression if the patient is too unstable with impending cardiac arrest. Bringing the patient to definitive surgery as soon as possible is crucial for the chance of survival to the emergency physician. We describe two cases of cardiac tamponade resulting from blunt chest trauma successfully treated with a definitive management and surgical repair.

Building a Beautiful China:A Definitive Exploration on Sustainable Economy

FINALLY,the world is witnessing what may well turn out to be the definitive how-to guide on building a sustainable economy that works in complete harmony with the environment:China’s transformation under the banner of an"ecological civilization."It’s been a long time coming.For well over a century,

Numerical study of the mechanical process of long-distance replacement of the definitive lining in severely damaged highway tunnels

Mountain road tunnels are prone to water leakage and lining corrosion under the complex geological conditions and corrosive envi-ronments,which will reduce the strength of the lining structure until it loses its load-bearing capacity;eventually,the definitive lining will need to be replaced.In this paper,a highway tunnel in a mountainous area in Southwest China is taken as an example.Field investi-gation found that the tunnel was seriously corroded by sulfate,the strength of the definitive lining decreased,and large-scale cracks and spalling appeared on the surface,so the operator decided to replace the definitive lining by the method of interval replacement.Based on the data obtained from drilling and coring,a numerical model of long-distance replacement of the definitive lining of the damaged tunnel is established.First,the back analysis of the calculation parameters is carried out,and the modified calculation results are com-pared with the field monitoring results for verification.Then,the deformation trend of the tunnel and the development of the plastic zone during the process of long-distance replacement of the definitive lining are studied.Finally,the construction scheme is optimized.Numer-ical analysis results show that the replacement of the definitive lining of the tunnel mainly leads to the settlement of the arch crown and the uplift of the inverted arch.The deformation of the tunnel shows two rapid growth stages and two stable stages during the replace-ment process;after replacement,the deformation of the arch crown and the inverted arch is divided into two buffer zones and one stable zone.In the progress of the replacement of the definitive lining,the plastic zone does not change.Regarding the reinforcement measures,with the increase in the grouting range,the grouting efficiency decreases,and the effect of the temporary steel arch on controlling the overall deformation is not obvious.The length of the replacement of the single section should be determined according to the geological conditions of the replacement section and the monitoring data during construction.The research results can provide a reference for sim-ilar projects for the replacement of the definitive lining.

Small-scale spatial analysis of intermediate and definitive hosts of Angiostrongylus cantonensis

Background:Angiostrongyliasis is a food-borne parasitic zoonosis.Human infection is caused by infection with the third-stage larvae of Angiostrongylus cantonensis.The life cycle of A.cantonensis involves rodents as definitive hosts and molluscs as intermediate hosts.This study aims to investigate on the infection status and characteristics of spatial distribution of these hosts,which are key components in the strategy for the prevention and control of angiostrongyliasis.Methods:Three villages from Nanao Island,Guangdong Province,China,were chosen as study area by stratified random sampling.The density and natural infection of Pomacea canaliculata and various rat species were surveyed every three months from December 2015 to September 2016,with spatial correlations of the positive P.canaliculata and the infection rates analysed by ArcGIS,scan statistics,ordinary least squares(OLS)and geographically weighted regression(GWR)models.Results:A total of 2192 P.canaliculata specimens were collected from the field,of which 1190 were randomly chosen to be examined for third-stage larvae of A.cantonensis.Seventy-two Angiostrongylus-infected snails were found,which represents a larval infection rate of 6.1%(72/1190).In total,110 rats including 85 Rattus norvegicus,10 R.flavipectus,one R.losea and 14 Suncus murinus were captured,and 32 individuals were positive(for adult worms),representing an infection rate of 29.1%of the definitive hosts(32/110).Worms were only found in R.norvegicus and R.flavipectus,representing a prevalence of 36.5%(31/85)and 10%(1/10),respectively in these species,but none in R.losea and S.murinus,despite testing as many as 32 of the latter species.Statistically,spatial correlation and spatial clusters in the spatial distribution of positive P.canaliculata and positive rats existed.Most of the spatial variability of the host infection rates came from spatial autocorrelation.Nine spatial clusters with respect to positive P.canaliculata were identified,but only two correlated to infection rates.The results show that corrected Akaike information criterion,R2,R2 adjusted andσ2 in the GWR model were superior to those in the OLS model.Conclusions:P.canaliculata and rats were widely distributed in Nanao Island and positive infection has also been found in the hosts,demonstrating that there was a risk of angiostrongyliasis in this region of China.The distribution of positive P.canaliculata and rats exhibited spatial correlation,and the GWR model had advantage over the OLS model in the spatial analysis of hosts of A.cantonensis.

Survival differences between definitive radiotherapy and surgery followed by adjuvant radiotherapy in supraglottic and hypopharyngeal carcinoma

Background:Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcin improve the quality of life(QOL).Definitive radiotherapy(DRT)with or without systematic treatment,such as chemotherapy,is always the first choice to achieve improved QOL.This retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy(S+RT)in supraglottic and hypopharyngeal carcinoma.Methods:This study included adult patients with supraglottic or hypopharyngeal carcinoma undergoing single-modality treatment with either DRT or S+RT between January 2012 and August 2016.A total of 59 patients were identified,of whom 31 were treated with DRT,and 28 were treated with S+RT.In the 31 cases of DRT,23 cases were treated with concurrent chemoradiotherapy(CRT),one case was treated with DRT plus cetuximab,and seven cases were treated with DRT alone.Of the other 28 cases of S+RT,15 cases were treated with adjuvant concurrent CRT.Survival analysis was used to compare the overall survival(OS),local recurrence-free survival(LRFS)and distant metastasis-free survival(DMFS)between DRT and S+RT groups.Results:The median follow-up was 20 months(range,4-67 months).The patients of the two groups were similar with respect to mean age,original sites,and tumor stages.The 1-,2-,and 5-year OS rates were 80.6%,53.4%,and 24.7% for the DRT group and 85.7%,67.1%,and 24.7%for the S+RT group,respectively.There was no significant difference between the two groups(x^2=3.183,P=0.074).The 1-,2-,and 5-year LRFS and DMFS were 90.4%,61.7%,and 18.0%and 87.4%,49.2%,and 9.9%,respectively,and no statistical difference was observed between the two groups(LRFS:x^2=0.028,P=0.868;DMFS:x^2=3.347,P=0.067).No significant difference was found between the two groups in acute radiotoxicity.Conclusions:Without loss of laryngeal function,the survival of DRT is comparable to that of S+RT in supraglottic and hypopharyngeal carcinoma.

Long-term follow-up of volumetric modulated arc therapy in definitive radiotherapy for cervical cancer: A single-center retrospective experience

Objective:To evaluate the treatment outcomes and toxicity of volumetric modulated arc therapy(VMAT)in definitive radiotherapy for patients with cervical cancer.Methods:Medical records of 440 patients with cervical cancer treated with VMAT in definitive radiotherapy with or without concurrent chemotherapy between January 2010 and June 2015 in our institution were retrospectively reviewed.A dose of 45 Gy was prescribed to the planning target volume with VMAT in 25 fractions,followed by high-dose rate intracavitary brachytherapy with 28–36 Gy in 4–6 fractions.Survival time was estimated using Kaplan-Meier method.Risk factors for treatment failure were identified using Cox proportional hazards regression model.Results:The median follow-up periods were 58.3 months(range:2.7–112.9 months).The 3-and 5-year survival rates were overall survival(OS)79.4%and 74.4%,cancer-specific survival(CSS)81.4%and 77.1%,progressionfree survival(PFS)73.3%and 71.1%,locoregional control(LC)83.3%and 82%and distant metastasis-free survival(DMFS)80.8%and 77.7%,respectively.The 5-year OS for patients with different stages was IB191.6%,IB2100%,IIA 82.5%,IIB 74.4%,IIIA 57.1%,IIIB 61.7%and IVB 17.6%,respectively.Of the 124 patients with recurrence,93 patients(75.0%)experienced distant failure.Multivariate analysis showed that non-squamous cell carcinoma of the cervix(P<0.001),more advanced stage(P=0.004),pelvic lymph node metastasis(P<0.001)and para-aortic lymph node metastasis(P=0.019)were all independent risk factors of PFS.The incidence of grades 3–4 late bowel toxicities was 2.7%.No grades 3–4 bladder toxicity was observed.Conclusion:This study demonstrated that the use of VMAT in definitive radiotherapy resulted in satisfactory outcomes with acceptable toxicities for patients with cervical cancer.Distant metastasis predominated as the pattern of disease relapse.Further studies are needed to investigate the intensified systemic therapies.

意想不到的震撼能量 Definitive Technology|7.1.2声音系统

临近新年,不知为何杂志社的多声道系统器材来得特别集中,以至于容下所有设备的视听室仿佛活脱脱一个音响大卖场,其中来自Definitive Technology的这套7.1.2系统因为独特外观设计特别引人注意,尤以主箱BP9080x最为突出,它全身被网罩裹得严严实实,而且不可卸下,实不知里头的结构究竟,看过去好比烟雨气息中一个头戴斗笠、身穿蓑衣的寒江隐士,隐隐约约,又朦朦胧胧。整套系统由落地箱BP9080x、中置音箱CS9060、环绕音箱SR9080、SR9040以及超低音音箱SC8000组成。

ZJ116A卷接机单支重量加工精度的优化研究

作为单支重量加工精度的重要指标,烟支的重量标准偏差反映了烟支内在品质的稳定性。前期研究找到了影响卷烟重量标准偏差的6项关键因子。该文的DOE试验选用确定性筛选设计(Definitive Screening Design,DSD)方法,通过合理安排试验的运行顺序和条件,找到了关键因子间的关系和最佳搭配。一次试验实现了筛选重要因子、描述基本特性以及找到最优方案等目标。经过ZJ116A试生产验证,重量标准偏差均值为18.86mg,重量标准偏差合格率为95%,取得了满意效果。

Delayed versus immediate intervention of ruptured brain arteriovenous malformations:A case report

BACKGROUND Brain arteriovenous malformations(bAVMs)remains one of the most prevalent causes of intracranial hemorrhage and stroke-like syndromes in the young adult population.Although it has been agreed upon that definitive treatment using either single or multi-modal approach is warranted for successful bAVM management,much debate still revolves regarding the optimal timing of definitive treatment.CASE SUMMARY In this report,we present a case of delayed,definitive endovascular treatment for ruptured bAVM in a 21-year-old female,3 mo post-ictus.The bAVM,with a left pericallosal feeding artery and cortical draining veins,was successfully obliterated through embolization using the Onyx 18.On follow-up the patient has recommenced her daily activities and experiences only mild occasional headaches with mild motor deficits.The report leads to our review on an important issue regarding the optimal timing of ruptured bAVM definitive management and bring forward the current evidence available on delayed vs immediate definitive bAVM intervention.We also highlight current issues that need to be addressed for clearer guidelines on definitive therapy initiation.CONCLUSION Current treatment paradigms of ruptured bAVM remains elusive,with substantial heterogeneity in the current literature.A consensus on the definition of“acute”vs“delayed”,management goal,follow-up length and outcome parameters are required to support formation of a clear paradigm.

一种基于MBD的三维尺寸完备性审查方法

为减轻人工审查MBD(model based definition)模型尺寸标注的劳动强度,对三维尺寸完备性的自动化审查进行了研究。将尺寸完备性问题归结为对相关几何要素是否定形定位的判断问题,建立了对应约束模型记录约束状态;建立了解析尺寸约束和拓扑约束的约束传播规则,并总结了几何约束的解析算法;针对尺寸缺失造成的约束不足,采用打分策略,并以指定基准或指出尺寸缺失的方式主动添加约束;提出了三维尺寸完备性检查的总体算法。通过对3DDFM原型系统的继续开发,并用三维模型实例验证了方法的有效性。

Siemens Definition AS128 CT维修5例

介绍了Siemens Definition AS128 CT的硬件构成,分析并总结了该设备在日常使用中出现的检查床水平移动后机架掉电、图像重建系统(image reconstruction system,IRS)计算机硬盘故障、开机时F1开关脱开、“Exam”按钮灰化等故障产生的原因及维修思路,为临床工程技术人员排除相似故障提供了参考。

奇异鞍点问题中广义位移分裂迭代方法的半收敛性分析

Recently,some authors(Shen and Shi,2016)studied the generalized shiftsplitting(GSS)iteration method for singular saddle point problem with nonsymmetric positive definite(1,1)-block and symmetric positive semidefinite(2,2)-block.In this paper,we further apply the GSS iteration method to solve singular saddle point problem with nonsymmetric positive semidefinite(1,1)-block and symmetric positive semidefinite(2,2)-block,prove the semi-convergence of the GSS iteration method and analyze the spectral properties of the corresponding preconditioned matrix.Numerical experiment is given to indicate that the GSS iteration method with appropriate iteration parameters is effective and competitive for practical use.

Hermite Positive Definite Solution of the Quaternion Matrix Equation Xm + B*XB = C

This paper discusses the necessary and sufficient conditions for the existence of Hermite positive definite solutions of the quaternion matrix equation Xm+ B*XB = C (m > 0) and its iterative solution method. According to the characteristics of the coefficient matrix, a corresponding algebraic equation system is ingeniously constructed, and by discussing the equation system’s solvability, the matrix equation’s existence interval is obtained. Based on the characteristics of the coefficient matrix, some necessary and sufficient conditions for the existence of Hermitian positive definite solutions of the matrix equation are derived. Then, the upper and lower bounds of the positive actual solutions are estimated by using matrix inequalities. Four iteration formats are constructed according to the given conditions and existence intervals, and their convergence is proven. The selection method for the initial matrix is also provided. Finally, using the complexification operator of quaternion matrices, an equivalent iteration on the complex field is established to solve the equation in the Matlab environment. Two numerical examples are used to test the effectiveness and feasibility of the given method. .

Monkeypox in humans:Transmission,pathophysiology,diagnosis,treatment,prevention,and all recent updates

The Centers for Disease Control and Prevention(CDC)is monitoring an epidemic of monkeypox infection in the United States.The outbreak is now global and more than 6900 cases have already been reported.There are 83 confirmed cases among children and adolescents,as shown in the report published on November 3,2022,in the USA.However,monkeypox in pediatric patients is still infrequent(<0.3%of total cases).Among cases in the United States,16 cases were in children<5 years,12 in the age group 5-12 years,and 55 cases in adolescents 13-17 years old.In the adolescent age group,89%were male.For children<12 years of age,close physical contact with an adult household with monkeypox was the primary exposure,but for adolescents,male-to-male sexual contact was found more frequently.The CDC advised United States healthcare providers to remain vigilant for patients with a rash resembling monkeypox,even if there is no history of travel to a country with high risk.This article summarizes the history and epidemiology of monkeypox with a specific emphasis on clinical features and management in pediatric patients.