Genetic mechanisms and control on hydrocarbon accumulation in transtensional structures: A case study of Gaoqing area, northern Dongying Sag, China

Broom-shaped structures are widely seen in transtensional basins, including those discovered in many sags of the Bohai Bay Basin. Broom-shaped transtensional structural zones are generally petroliferous and thus important targets for hydrocarbon exploration. This study analyzed the evolution and genetic mechanisms of the broom-shaped transtensional structures in the Gaoqing area of the Dongying Sag using the 3D seismic flattening technique and a physical simulation experiment. Furthermore, the control effects of the broom-shaped transtensional structures on hydrocarbon accumulation and distribution were discussed. The research results are as follows. The Gaoqing area is of a broom-shaped transtensional structure in planar view, composed of several arc-shaped secondary faults intersecting with high-level main fault in the same direction. On the seismic section, it appears as a typical semi-flower-like structure. In the early stage (that is, during the deposition of the Kongdian Formation to the lower submember of the 4th member of the Shahejie Formation, Es4(L)), single-fault pattern consisting of single or multiple faults in alignment was developed under extensional stress. While with the change of structural stress (that is, during the deposition of the Es4(U) to the Es2(L)), more secondary faults were formed, and came in a pattern of broom-shaped structure together with the major fault. In the late stage (that is, during the deposition of the Es1 to the Guantao Formation), the en echelon fault pattern was formed, as the major fault broke into multiple secondary faults. The divergent end of the broom-shaped transtensional structure has many secondary faults developed, the fault planes are gentle, and small-scale fan deltas are the predominant type of deposits. The hydrocarbon tends to laterally migrate far away and accumulate mianly in structural and lithologic-structural traps. On the other hand, in the convergent end, the fault planes are relatively steep, resulting in small-scale subaqueous fans or large-scale deltas deposited along the major fault, with hydrocarbon accumulating minaly in structural-lithologic traps proximal to the provenances.

Cerebral syphilitic gumma misdiagnosed as brain abscess: A case report

BACKGROUND Cerebral syphilitic gumma is a relatively rare clinical disease.Its clinical manifest-ations are non-specific,and the imaging manifestations are similar to other in-tracranial occupying lesions,often misdiagnosed as tumors or abscesses.There are few reports on this disease in the relevant literature.To our knowledge,we have reported the first case of cerebral syphilitic gumma misdiagnosed as a brain abscess.We report this case and provide useful information for clinical doctors on neurosyphilis diseases.CASE SUMMARY We report the case to explore the diagnostic essentials of cerebral syphilitic gumma and attempt to mitigate the rates of misdiagnosis and missed diagnosis by equipping physicians with knowledge of neurosyphilis characteristics.The cli-nical diagnosis and treatment of a patient with cerebral syphilitic gumma were reported.Clinical manifestations,classifications,and diagnostic points were retro-spectively analyzed.The patient was admitted to the hospital with fever and limb weakness.Brain magnetic resonance imaging showed multiple space-occupying lesions and a positive serum Treponema pallidum gelatin agglutination test.The patient was misdiagnosed as having a brain abscess and underwent a craniotomy.A postoperative pathological diagnosis of syphilis gumma was made.The patient improved and was discharged after penicillin anti-syphilis treatment.Follow-up recovery was satisfactory.CONCLUSION Cerebral syphilitic gumma is rare in clinical practice,and it is often misdiagnosed and missed.Clinical diagnosis should be considered in combination with multiple examinations.

Regulating the non-effective carriers transport for high-performance lithium metal batteries

The absence of control over carriers transport during electrochemical cycling,accompanied by the deterioration of the solid electrolyte interphase(SEI)and the growth of lithium dendrites,has hindered the development of lithium metal batteries.Herein,a separator complexion consisting of polyacrylonitrile(PAN)nanofiber and MIL-101(Cr)particles prepared by electrospinning is proposed to bind the anions from the electrolyte utilizing abundant effective open metal sites in the MIL-101(Cr)particles to modulate the transport of non-effective carriers.The binding effect of the PANM separator promotes uniform lithium metal deposition and enhances the stability of the SEI layer and long cycling stability of ultra-high nickel layered oxide cathodes.Taking PANM as the Li||NCM96 separator enables high-voltage cycling stability,maintaining 72%capacity retention after 800 cycles at a charging and discharging rate of 0.2 C at a cut-off voltage of 4.5 V and 0°C.Meanwhile,the excellent high-rate performance delivers a specific capacity of 156.3 mA h g^(-1) at 10 C.In addition,outstanding cycling performance is realized from−20 to 60°C.The separator engineering facilitates the electrochemical performance of lithium metal batteries and enlightens a facile and promising strategy to develop fast charge/discharge over a wide range of temperatures.

Evaluating serum CXCL12,sCD22,Lp-PLA2 levels and ratios as biomarkers for diagnosis of Alzheimer's disease

BACKGROUND Grasping the underlying mechanisms of Alzheimer's disease(AD)is still a work in progress,and existing diagnostic techniques encounter various obstacles.Therefore,the discovery of dependable biomarkers is essential for early detection,tracking the disease's advancement,and steering treatment strategies.AIM To explore the diagnostic potential of serum CXCL12,sCD22,Lp-PLA2,and their ratios in AD,aiming to enhance early detection and inform targeted treatment strategies.METHODS The study was conducted in Dongying people's Hospital from January 2021 to December 2022.Participants included 60 AD patients(AD group)and 60 healthy people(control group).Using a prospective case-control design,the levels of CXCL12,sCD22 and Lp-PLA2 and their ratios were detected by enzyme-linked immunosorbent assay kit in the diagnosis of AD.The differences between the two groups were analyzed by statistical methods,and the corresponding ratio was constructed to improve the specificity and sensitivity of diagnosis.RESULTS Serum CXCL12 levels were higher in the AD group(47.2±8.5 ng/mL)than the control group(32.8±5.7 ng/mL,P<0.001),while sCD22 levels were lower(14.3±2.1 ng/mL vs 18.9±3.4 ng/mL,P<0.01).Lp-PLA2 levels were also higher in the AD group(112.5±20.6 ng/mL vs 89.7±15.2 ng/mL,P<0.05).Significant differences were noted in CXCL12/sCD22(3.3 vs 1.7,P<0.001)and Lp-PLA-2/sCD22 ratios(8.0 vs 5.2,P<0.05)between the groups.Receiver operating characteristic analysis confirmed high sensitivity and specificity of these markers and their ratios in distinguishing AD,with area under the curves ranging from CONCLUSION Serum CXCL12 and Lp-PLA2 levels were significantly increased,while sCD22 were significantly decreased,as well as increases in the ratios of CXCL12/sCD22 and Lp-PLA2/sCD22,are closely related to the onset of AD.These biomarkers and their ratios can be used as potential diagnostic indicators for AD,providing an important clinical reference for early intervention and treatment.

Geochronology and Geochemistry of the Xingxingxia Triassic A-type Granites in Central Tianshan,NW China:Petrogenesis and Tectonic Implications

The Triassic granitoids in Central Tianshan play a key role in determining the petrogenesis and tectonic evolution on the southern margin of the Central Asian orogenic belt.In this study,we present SHRIMP zircon U-Pb ages,Hf isotopic and geochemical data on the Xingxingxia biotite granite,amazonite granite and granitic pegmatite in Central Tianshan,NW China.Zircon U-Pb dating yielded formation ages of 242 Ma for the biotite granite and 240 Ma for the amazonite granite.These granitoid rocks have high K_(2)O with low MgO and CaO contents.They are enriched in Nb,Ta,Hf and Y,while being depleted in Ba and Sr,showing flat HREE patterns and negative Eu anomalies.They have typical A-type granite geochemical signatures with high Ga/A_(1)(8–13)and TFeO/(TFeO+MgO)ratios,showing an A_(2) affinity for biotite granite and an A_(1) affinity for amazonite granite and granitic pegmatite.Zircon ε_(Hf)(t)values of the granitoids are 0.45–2.66,with Hf model ages of 0.99–1.17 Ga.This suggests that these A-type granites originated from partial melting of the lower crust.We propose that Xingxingxia Triassic A-type granites formed under lithospheric extension from post-orogenic to anorogenic intraplate settings and NE-trending regional strike-slip fault-controlled magma emplacement in the upper crust.

Unveiling the secrets of gastrointestinal mucous adenocarcinoma survival after surgery with artificial intelligence:A population-based study

BACKGROUND Research on gastrointestinal mucosal adenocarcinoma(GMA)is limited and controversial,and there is no reference tool for predicting postoperative survival.AIM To investigate the prognosis of GMA and develop predictive model.METHODS From the Surveillance,Epidemiology,and End Results database,we collected clinical information on patients with GMA.After random sampling,the patients were divided into the discovery(70%of the total,for model training),validation(20%,for model evaluation),and completely blind test cohorts(10%,for further model evaluation).The main assessment metric was the area under the receiver operating characteristic curve(AUC).All collected clinical features were used for Cox proportional hazard regression analysis to determine factors influencing GMA’s prognosis.RESULTS This model had an AUC of 0.7433[95% confidence intervals(95%CI):0.7424-0.7442]in the discovery cohort,0.7244(GMA:0.7234-0.7254)in the validation cohort,and 0.7388(95%CI:0.7378-0.7398)in the test cohort.We packaged it into Windows software for doctors’use and uploaded it.Mucinous gastric adenocarcinoma had the worst prognosis,and these were protective factors of GMA:Regional nodes examined[hazard ratio(HR):0.98,95%CI:0.97-0.98,P<0.001]and chemotherapy(HR:0.62,95%CI:0.58-0.66,P<0.001).CONCLUSION The deep learning-based tool developed can accurately predict the overall survival of patients with GMA postoperatively.Combining surgery,chemotherapy,and adequate lymph node dissection during surgery can improve patient outcomes.

Interaction between source rock and evaporite:A case study of natural gas generation in the northern Dongying Depression

It is well known that oil generated from source rocks of saline-lake facies is characteristic of low Pr/Ph ratio and high contents of gammacerane.The authors found that gas generated from the same source rocks was high in benzene and cyclohexane contents and had light carbon isotope compositions.In this study,a series of thermal simulations of gas generations on source rock with/without evaporites(such as carbonate,gypsum,and sodium chlorite,respectively),were conducted.It was found that the gypsum played an important role on the catalyzsis of gas generation in the thermal simulations.Compositions of the gaseous hydrocarbons generated from source rocks with evaporites are very similar to those of natural gases discovered from northern Dongying Depression.Meanwhile,in the thermal simulations,it was found that the carbon isotopic compositions of gaseous hydrocarbons generated from source rocks with evaporites are lighter than those of the gases from source rocks without evaporites.Therefore,it is concluded that natural gases discovered from northern Dongying Depression are the product of interaction between source rocks and evaporites(especially gypsum) of the saline facies.

Geochemistry and origin of deep-seated cracked gas on the northern slope of the Dongying Sag, Shandong Province

Deep-seated cracked gas exploration was achieved great breakthrough in Es4L of the Minfeng area on the northern slope of the Dongying Sag. Carbon isotopic and molecular compositions studies revealed the characteristics of wet gas and a normal trend of carbon isotopic composition. Empirical cutoff points of δ13C2 and δ13C3 and light hydrocarbon compositions distinguished the cracking gas as sapropelic gas. Variations in i/nC5, i/nC4 and δ13C2 fur-ther confirmed that the gas was cracked from residual kerogen. Source characteristics indicated that the gas was de-rived from mature-highly mature source rocks of Es4 with kerogen type II being dominant mixed with some oil-cracking gas. Burial history modeling indicated that there were two hydrocarbon charging periods in Es4L reser-voirs. The first period refers to the Guantao-Minghuazhen stage dominated by oil charging, while the second period refers to the Minghuazhen stage and has been dominated by cracked gas charging till now.

A novel redox indicator based on relative abundances of C_(31) and C_(32) homohopanes in the Eocene lacustrine Dongying Depression, East China

A suite of oils and bitumens from the Eocene Shahejie Formation(Es) in Dongying Depression was geochemically characterized to illustrate impact of source input and redox conditions on distributions of pentacyclic terpanes. The Es_(4) developed under highly reducing, sulfidic hypersaline conditions, while Es_(3) formed under dysoxic, brackish to freshwater conditions. Oils derived from Es_(4) are enriched in C_(32) homohopanes(C_(32) H), while those from Es_(3) are prominently enriched in C_(31) homohopanes(C_(31) H). The C_(32) H/C_(31) H ratio shows positive correlation with homohopane index(HHI), gammacerane index, and negative correlation with pristane/phytane ratio, and can be used to evaluate oxic/anoxic conditions during deposition. High C32 H/C_(31) H ratio(> 0.8) is an important characteristic of oils derived from anoxic environments, while low values(< 0.8) indicate dysoxic conditions and extremely low values(< 0.4)indicate strong oxic conditions. The C_(32) H/C_(31) H ratio can be applied for deposition condition diagnosis because carboxyl group of C_(32) hopanoic acids might be reduced to C_(32) homohopanes under anoxic conditions, and oxidized to C_(31) homohopane under oxic conditions. Advantages to use C_(32) H/C_(31) H ratio as redox condition proxy compared to the HHI and gammacerane indexes are wider valid maturity range,less sensitive to biodegradation influence and better differentiating reducing from oxic environments.

Analysis of nutrient content and assessment of economic value for major salt-tolerant plants in coastal areas:a case study of Dongying City, Shandong Province

Salinization of soil is a worldwide problem concerning resources and ecology,especially serious in coastal areas.Testing of 26 sorts of data or parameters are carried out on leaves of 22 plant species(in 24 plant variety) of existing main salt-tolerant plant of the Yellow River Delta region.Data or parameters include the following ele-ments:contents of K+,Na+,Ca2+,Mg2+ and Cl-,contents of protein,fat,total energy,ash and contents of 17 amino acids.The results show that these tested plants have economic values.For example,according to their uses,they can be divided into edible plants,forage plants,medicine or health plants,and some of them can be used for multipurposes.These plants have played important roles in the sustainable utilization of plant resources in coastal areas.This paper has taken evaluations on the economic uses of salt-tolerant plants and given suggestions for saline soil improvement and resource utilization in coastal areas.Based on the results of investigation and experiments,we suppose that the salt-tolerant plants in coastal areas can be grouped into 9 main groups according to their economic value:pioneer plants for saline land improvement,medicine,edible and forage plants,industry material,forestation,breeding material,energy plants and eco-tourism resources.

Binary molten salt in situ synthesis of sandwich-structure hybrids of hollowβ-Mo2C nanotubes and N-doped carbon nanosheets for hydrogen evolution reaction

Focused exploration of earth-abundant and cost-efficient non-noble metal electrocatalysts with superior hydrogen evolution reaction(HER)performance is very important for large-scale and efficient electrolysis of water.Herein,a sandwich composite structure(designed as MS-Mo2C@NCNS)ofβ-Mo2C hollow nanotubes(HNT)and N-doped carbon nanosheets(NCNS)is designed and prepared using a binary NaCl–KCl molten salt(MS)strategy for HER.The temperature-dominant Kirkendall formation mechanism is tentatively proposed for such a three-dimensional hierarchical framework.Due to its attractive structure and componential synergism,MS-Mo2C@NCNS exposes more effective active sites,confers robust structural stability,and shows significant electrocatalytic activity/stability in HER,with a current density of 10 mA cm-2 and an overpotential of only 98 mV in 1 M KOH.Density functional theory calculations point to the synergistic effect of Mo2C HNT and NCNS,leading to enhanced electronic transport and suitable adsorption free energies of H*(ΔGH*)on the surface of electroactive Mo2C.More significantly,the MS-assisted synthetic methodology here provides an enormous perspective for the commercial development of highly active non-noble metal electrocatalysts toward efficient hydrogen evolution.

Early Cretaceous Thrust and Nappe Tectonics in North Qilian Shan,Northern Tibetan Plateau:Evidence from Field Mapping,Geochronology,and Deep Structural Analysis

The North Qilian Shan fold and thrust belt,located at the northern Tibetan Plateau and southern margin of the Hexi Corridor,is a key tectonic unit to decode the formation and expansion of the plateau.Previous studies emphasize the Cenozoic deformation due to the far-field response to the Indo-Asian collision,but the Mesozoic deformations are poorly constrained in this area.We conducted detailed field mapping,structural analysis,geochronology,and structural interpretation of deep seismic reflectional profiling and magnetotelluric(MT)sounding,to address the superposed results of the Mesozoic and Cenozoic deformation.The results recognized the North Qilian thrust and nappe system(NQTS),the root and the frontal belt are the North Qilian thrust(NQT),and the Yumu Shan klippe(YK),respectively.The middle belt is located between the NQT and the YK.Monzonitic granite zircon U-Pb dating from the middle belt yields an age of ca.415 Ma,which is similar to south NQT.The thrusting displacement is estimated at ca.48 km by structural interpretation of deep profiles.The timing is constrained in the early stage of the Early Cretaceous by the formation of simultaneous growth strata.We suggest that the NQTS has resulted from the far-field effect of the Lhasa-Qiangtang collision,and the Yumu Shan is uplifted by the superposed Cenozoic deformation.

Design and Fluid-Dynamic Analysis of a Flushing Nozzle for Drilling Applications

The actuator is a key component of the creaming tool in drilling applications.Its jet performances determine the effective reaming efficiency.In this work,a new selective reaming tool is proposed and the RNG k-εturbulence model is used to calculate its internal and externalflowfields.In particular,special attention is paid to the design of theflushing nozzle.The results show that the jet originating from theflushing nozzle has a significant influence on rock cutting and blade cooling effects.In turn,the jet performances depend on geometric structure of the creaming actuator.In this framework,a conical-cylindrical nozzle with a diameter of 7 mm is initially considered as a basis to implement a strategy to optimize the structural parameters of the reaming actuator,and improve the related side tracking reconstruction technology.

Comparison of ethanol-soaked gelatin sponge and microspheres for hepatic arterioportal fistulas embolization in hepatic cellular carcinoma

Hepatic arterioportal fistulas(APFs)are common in hepatocellular carcinoma(HCC).Moreover,correlated with poor prognosis,APFs often complicate antitumor treatments,including transarterial chemoembolization(TACE).AIM To compare the efficacy of ethanol-soaked gelatin sponges(ESG)and microspheres in the management of APFs and their impact on the prognosis of HCC.METHODS Data from patients diagnosed with HCC or hepatic APFs between June 2016 and December 2019 were retrospectively analyzed.Furthermore,APFs were embolized with ESG(group E)or microspheres(group M)during TACE.The primary outcomes were disease control rate(DCR)and objective response rate(ORR).The secondary outcomes included immediate and first follow-up APF improvement,overall survival(OS),and progression-free survival(PFS).RESULTS Altogether,91 participants were enrolled in the study,comprising 46 in group E and 45 in group M.The DCR was 93.5%and 91.1%in groups E and M,respectively(P=0.714).The ORRs were 91.3%and 66.7%in groups E and M,respectively(P=0.004).The APFs improved immediately after the procedure in 43(93.5%)patients in group E and 40(88.9%)patients in group M(P=0.485).After 2 mo,APF improvement was achieved in 37(80.4%)and 33(73.3%)participants in groups E and M,respectively(P=0.421).The OS was 26.2±1.4 and 20.6±1.1 mo in groups E and M,respectively(P=0.004),whereas the PFS was 16.6±1.0 and 13.8±0.7 mo in groups E and M,respectively(P=0.012).CONCLUSION Compared with microspheres,ESG embolization demonstrated a higher ORR and longer OS and PFS in patients of HCC with hepatic APFs.

Non-symmetric distributions of solids deposition for solid-water stratified flow in deviated tubing strings

Dynamic performance on solids flow with water in deviated tubing is essential for the reliability of pump and normal operation of horizontal and directional wells.Compared with coal-water flow in vertical tubing and sand-oil flow with high production in deviated tubing,solids deposition with water shows obvious non-symmetric distributions in deviated tubing from simulations and experiments.The mathematical model of two phase flow was developed under coupling conditions of deviated tubing,low flow rate and viscosity based on the kinetic theory of granular flow and first-order discrete scheme.The results show that solid-water stratified flow in deviated tubing can be divided into two zones of suspension bed and the moving bed throughout the flow field.The solid flowing velocity with water is negative and particles slide down at the bottom of moving bed zone.The process of solids flow with water in deviated tubing will produce pressure loss and consume the kinetic energy.The thickness of deposited layer and the flowing velocity of solids flow downward with water at the moving bed zone enhance with the decreased inlet flow rate and the increased particle size,tubing inside diameter(ID)and inclination angle.Solids are easier into suspension from the upper part of moving bed zone to suspension bed zone and more solid particles flow with water towards the tubing outlet with the increase of inlet flowing velocity.The decision is made to reduce the screen width,tubing ID and inclination angle to maintain to be greater than critical deposition velocity in order to prevent solids settling.And it provides the theoretical basis and technical reserves for solid control and offers an effective approach to enhance tubing cleaning in deviated strings.

Experimental Analysis of the Flow Characteristics of an Adjustable Critical-Flow Venturi Nozzle

The response of an adjustable critical-flow Venturi nozzle is investigated through a set indoor experiments aimed to determine the related critical flow rate,critical pressure ratio,and discharge coefficient.The effect of a variation in the cone displacement and liquid content on the critical flow characteristics is examined in detail and it is shown that the former can be used to effectively adjust the critical flow rate.The critical pressure ratio of the considered nozzle is above 0.85,and the critical flow control deviation of the gas flow is within±3%.Liquid flow can reduce the gas critical mass flow rate accordingly,especially for the cases with larger liquid volume and lower inlet pressure.The set of results and conclusions provided are intended to support the optimization of steam injection techniques in the context of heavy oil recovery processes.

Multidiscipline Applications of Triboelectric Nanogenerators for the Intelligent Era of Internet of Things

In the era of 5G and the Internet of things(IoTs),vari-ous human-computer interaction systems based on the integration of triboelectric nanogenerators(TENGs)and IoTs technologies dem-onstrate the feasibility of sustainable and self-powered functional systems.The rapid development of intelligent applications of IoTs based on TENGs mainly relies on supplying the harvested mechanical energy from surroundings and implementing active sensing,which have greatly changed the way of human production and daily life.This review mainly introduced the TENG applications in multidisci-pline scenarios of IoTs,including smart agriculture,smart industry,smart city,emergency monitoring,and machine learning-assisted artificial intelligence applications.The challenges and future research directions of TENG toward IoTs have also been proposed.The exten-sive developments and applications of TENG will push forward the IoTs into an energy autonomy fashion.

Pollution characteristics and risk assessment of organophosphate esters in aquaculture farms and natural water bodies adjacent to the Huanghe River delta

To date,little attention has been paid to the effects of organophosphate esters(OPEs)pollution on aquacultural environment and aquatic product safety.Huanghe(Yellow)River delta area is one of the largest aquaculture centers in China,where ecological security protection is crucial in the national strategy of China.To explore the pollution characteristics,bioaccumulation,and health risks of OPEs in aquaculture farms in the Huanghe River delta and natural water bodies in the adjacent seas,five species of organisms from different farm types nearby the Huanghe River delta,and the corresponding culture water and sediments were sampled in this study.The total concentrations of Σ_(13)OPEs in water,sediments,and organisms were 51.53-272.18 ng/L,52.63-63.17 ng/g dry weight(dw),and 46.82-108.90 ng/g dw,respectively.Among the five types of culture ponds,the water samples from the swimming crab and hairy crab culture ponds exhibited higher OPEs,the concentration of OPEs in the sediments from the few ponds was relatively balanced,and the OPEs in the organism from the holothurian ponds was higher.Tris(1,3-dichloro-2-isopropyl pho sphate)(TDCP)was the main contaminant in water samples and tripropyl phosphate(TPrP)in sediments and organisms.However,trisphenyl phosphate(TPhP)showed the strongest bioaccumulation ability,followed by 2-ethylhexyl diphenyl phosphate(EHDPP)and TPrP.The bioaccumulation capacities of the five species were as follows:prawn>holothurian>hairy crab>swimming crab>carp.These five types of organisms,as main seafood in human consumption,were at low risk of negative impacts of pollution.However,the risk from the mixture of organophosphate flame retardants(OPFRs)still requires more attention due to the increasing consumption and production in the world.

Short- and long-term results of open vs laparoscopic multisegmental resection and anastomosis for synchronous colorectal cancer located in separate segments

BACKGROUND It remains unclear whether laparoscopic multisegmental resection and ana-stomosis(LMRA)is safe and advantageous over traditional open multisegmental resection and anastomosis(OMRA)for treating synchronous colorectal cancer(SCRC)located in separate segments.AIM To compare the short-term efficacy and long-term prognosis of OMRA as well as LMRA for SCRC located in separate segments.METHODS Patients with SCRC who underwent surgery between January 2010 and December 2021 at the Cancer Hospital,Chinese Academy of Medical Sciences and the Peking University First Hospital were retrospectively recruited.In accordance with the RESULTS LMRA patients showed markedly less intraoperative blood loss than OMRA patients(100 vs 200 mL,P=0.006).Compared to OMRA patients,LMRA patients exhibited markedly shorter postoperative first exhaust time(2 vs 3 d,P=0.001),postoperative first fluid intake time(3 vs 4 d,P=0.012),and postoperative hospital stay(9 vs 12 d,P=0.002).The incidence of total postoperative complications(Clavien-Dindo grade:≥II)was 2.9%and 17.1%(P=0.025)in the LMRA and OMRA groups,respectively,while the incidence of anastomotic leakage was 2.9%and 7.3%(P=0.558)in the LMRA and OMRA groups,respectively.Furthermore,the LMRA group had a higher mean number of lymph nodes dissected than the OMRA group(45.2 vs 37.3,P=0.020).The 5-year overall survival(OS)and disease-free survival(DFS)rates in OMRA patients were 82.9%and 78.3%,respectively,while these rates in LMRA patients were 78.2%and 72.8%,respectively.Multivariate prognostic analysis revealed that N stage[OS:HR hazard ratio(HR)=10.161,P=0.026;DFS:HR=13.017,P=0.013],but not the surgical method(LMRA/OMRA)(OS:HR=0.834,P=0.749;DFS:HR=0.812,P=0.712),was the independent influencing factor in the OS and DFS of patients with SCRC.CONCLUSION LMRA is safe and feasible for patients with SCRC located in separate segments.Compared to OMRA,the LMRA approach has more advantages related to short-term efficacy.

Bipolar hip arthroplasty using conjoined tendon preserving posterior lateral approach in treatment of displaced femoral neck fractures

BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.