Effect of surgical timing on postoperative outcomes in patients with acute cholecystitis after delayed percutaneous transhepatic gallbladder drainage

BACKGROUND To date,the optimal timing for percutaneous transhepatic gallbladder drainage(PTGBD),particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy(LC)(within 72 hours of symptom onset)has not been determined.AIM To study the effects of LC timing on outcomes of grade II/III acute cholecystitis(AC)in patients with delayed PTGBD.METHODS Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied.According to the interval between gallbladder drainage and cholecystectomy,the patients were divided into early and delayed LC groups.Outcomes including surgery time,postoperative complications and hospital stay,and patient satisfaction were analyzed and compared between the two groups using t-andχ^(2) tests.RESULTS There were no significant differences between the two groups in intraoperative blood loss,postoperative abdominal drainage tube placement time,pain index,or total disease duration(all P>0.05).Compared with those of the early LC group,the delayed group showed significant decreases in the length of procedure(surgery time),conversion rate to open surgery,degree of adhesions,surgical complications,postoperative hospital stay,and total treatment costs,and increased patient satisfaction despite a longer interval before PTGBD(all P<0.05).CONCLUSION For patients with grade II/III AC with delayed PTGBD,LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.

Airborne electromagnetic data denoising based on dictionary learning

Time-domain airborne electromagnetic(AEM)data are frequently subject to interference from various types of noise,which can reduce the data quality and affect data inversion and interpretation.Traditional denoising methods primarily deal with data directly,without analyzing the data in detail;thus,the results are not always satisfactory.In this paper,we propose a method based on dictionary learning for EM data denoising.This method uses dictionary learning to perform feature analysis and to extract and reconstruct the true signal.In the process of dictionary learning,the random noise is fi ltered out as residuals.To verify the eff ectiveness of this dictionary learning approach for denoising,we use a fi xed overcomplete discrete cosine transform(ODCT)dictionary algorithm,the method-of-optimal-directions(MOD)dictionary learning algorithm,and the K-singular value decomposition(K-SVD)dictionary learning algorithm to denoise decay curves at single points and to denoise profi le data for diff erent time channels in time-domain AEM.The results show obvious diff erences among the three dictionaries for denoising AEM data,with the K-SVD dictionary achieving the best performance.

Zircon U-Pb ages and provenance characteristics of the Zhiluo Formation sandstones and the formation background of the uranium deposit in Huangling area,Ordos Basin,China

The newly discovered medium-scale Huangling uranium deposit is located in the Shuanlong area of the southeast Ordos Basin.This paper presents the systematic geochemical and zircon U-Pb studies on the Zhiluo Formation sandstones in the Huanling area.The data obtained play an important role in deducing the provenance and tectonic setting of the source rocks.The results show that the lower part of the Zhiluo Formation is mainly composed of felsic sedimentary rocks.The source rocks originated from a continental island arc environment in terms of tectonic setting.U-Pb ages of detrital zircons obtained can be roughly divided into three groups:170‒500 Ma,1600‒2050 Ma,and 2100‒2650 Ma.Based on the characteristics of trace elements and rare earth elements(REE)and the zircon U-Pb dating results,it is considered that the Cryptozoic Edo provenance of the Zhiluo Formation mainly includes magmatic rocks(such as granodioritic intrusions)and metamorphic rocks(such as gneiss and granulite)in the orogenic belts on the northern margin of the North China Plate and in the Alxa Block.Based on sedimentological and petrological results,it can be concluded that the provenance of clastic sediments in the Zhiluo Formation was in north-south direction.The preconcentration of uranium is relatively low in the Lower Zhiluo Formation in the Huangling area.Meanwhile,the paleocurrent system in the sedimentary period is inconsistent with the ore-bearing flow field in the mineralization period,which restricts the formation of large-scale and super-large-scale uranium deposits and ore zones in the southeast Ordos Basin.The understanding of provenance directions will provide crucial references for the Jurassic prototype recovery and paleo-geomorphology of the Ordos Basin and the prediction of potential uranium reservoirs of the basin.

Clostridium perfringens gas gangrene caused by closed abdominal injury: A case report and review of the literature

BACKGROUND Abdominal Clostridium perfringens(C. perfringens) gas gangrene is a rare infection that has been described in the literature as most frequently occurring in postoperative patients with open trauma. Intra-abdominal gas gangrene caused by C.perfringens infection after closed abdominal injury is extremely rare, difficult to diagnose, and progresses rapidly with high mortality risk. Here, we report a case of C. perfringens infection caused by closed abdominal injury.CASE SUMMARY A 54-year-old male suffered multiple intestinal tears and necrosis after sustaining an injury caused by falling from a high height. These injuries and the subsequent necrosis resulted in intra-abdominal C. perfringens infection. In the first operation,we removed the necrotic intestinal segment, kept the abdomen open and covered the intestine with a Bogota bag. A vacuum sealing drainage system was used to cover the outer layer of the Bogota bag, and the drainage was flushed under negative pressure. The patient was transferred to the intensive care unit for supportive care and empirical antibiotic treatment. The antibiotics were not changed until the results of bacterial culture and drug susceptibility testing were obtained.Two consecutive operations were then performed due to secondary intestinal necrosis. After three definitive operations, the patient successfully survived the perioperative period. Unfortunately, he died of complications related to GuillainBarre syndrome 75 d after the first surgery. This paper presents this case of intraabdominal gas gangrene infection and analyzes the diagnosis and treatment based on a review of current literature.CONCLUSION When the intestines rupture leading to contamination of the abdominal cavity by intestinal contents, C. perfringens bacteria normally present in the intestinal tract may proliferate in large numbers and lead to intra-abdominal infection. Prompt surgical intervention, adequate drainage,appropriate antibiotic therapy, and intensive supportive care comprise the most effective treatment strategy. If the abdominal cavity is heavily contaminated, an open abdominal approach may be a beneficial treatment.

Research on the gully forming in the gully region of Yanhe River Basin and process of geological disasters

In recent years, the frequency of geological disasters gradually increases in the gully region of the Loess Plateaus centred with Yanhe River Basin. The research on the forming of the geological disasters in gully region and the disaster process will help us further understand the development of geological disasters and the disaster process. According to the detailed survey of geological disasters in Yan’an City, the river and gully erosion is the main natural predisposing factor that caused the geological disasters in the river gully region. In the forming of ditches and gullies, the surface water system changes the stress form of the original slope and reduces the strength combination of the slope in ways of water erosion and gravity erosion. Gully’s forming stage and stratigraphic contact form have some influence on the geological disasters and disaster process.

Effect of ultrasound-guided pleural paravertebral block combined with general anesthesia on serum monocyte chemokinin-1, interleukin-6 and interleukin-10 levels in patients with early breast cancer after modified radical mastectomy

Objective: To investigate the effect of ultrasound-guided pleural paravertebral block combined with general anesthesia on serum monocyte chemokinin-1 (McP-1), interleukin-6 (il-1) and il-10 levels in patients with early breast cancer after modified radical mastectomy. Methods: A total of 76 patients with early breast cancer from October 2015 to July 2018 were selected from our hospital and divided into study group (n=38) and control group (n=38). The control group received general anesthesia, and the study group received ultrasound-guided paravertebral block combined with general anesthesia. Data of two groups of perioperative situation (PCIA press the number, volume of intraoperative sufentanil and PACU time), preoperative and postoperative 12 h, 24 h serum factor (MCP-1, IL-6, IL-10) level, after 2 h, 4 h, 8 h, 12 h, 24 h when pain (VAS) score, preoperative (T1), 15 min after the anesthesia (T2), 5 min after surgery (T3) hemodynamic state [heart rate (HR), mean arterial pressure (MAP)], the incidence of adverse reactions were counted. Results: (1) Perioperative status: PCIA presses, intraoperative dose of sufentanil and PACU duration in the study group were less than those in the control group. (2) Serum factors: there was no significant difference in serum McP-1, il-6 and il-10 levels between the two groups before operation. The serum levels of McP-1, il-6 and il-10 in the two groups 12 h after operation were higher than those before operation. The serum levels of McP-1, il-6 and il-10 in the two groups at 24 h after surgery were significantly lower than those at 12 h after surgery, and the serum levels of McP-1, il-6 and il-10 in the group at 12 h and 24 h after surgery were lower than those of the control group. (3) Pain degree: the VAS score of the study group at 2 h, 4 h, 8 h, 12 h and 24 h after surgery was lower than that of the control group. (4) Hemodynamics: there was no significant difference in HR and MAP between the two groups during T1, HR and MAP in T2 were lower than those in T1, but the level of each indicator in the study group was higher than that in the control group. (5) Adverse Reactions: the incidence of adverse reactions was lower in the study group (10.53%) than in the control group (28.95%). Conclusion: The application of ultrasound guided early breast cancer modified radical block complex general anesthesia thoracic vertebra, can reduce the dosage of anesthetic drugs, shorten the PACU, residence time, reduce postoperative pain, maintain stable hemodynamic state, inhibiting inflammatory reaction caused by surgical trauma degree, and can reduce the incidence of adverse reactions, and has safety.

Geochemical characteristics and provenance analysis of Lower Jurassic Badaowan Formation in Changji area of Xinjiang,China

Based on the field survey of Lower Jurassic Badaowan Formation(Fm.)in Changji area of Xinjiang,China,the authors studied the sedimentary environment and provenance characteristics using the analyses of stratigraphic profiles,sedimentary structures,petrography,zircon U-Pb chronology and geochemistry.The results show that Badaowan Fm.deposited in fluvial to swamp shallow-deeplacustrine sedimentary facies deposition.Contents of Sr and ratios of Sr/Cu,Sr/Ba,Th/U,SiO_(2)/Al_(2)O_(3),V/(V+Ni),V/Cr,and Cu/Zn together indicate that Badaowan Fm.was deposited in an oxygen-poor transitional freshwater environment,under humid climatic conditions.Geochemical characteristics and Q–F–L,Qm–E–Lt,Th–Co–Zr/10,La–Th–Sc,and Th–Sc–Zr/10 discrimination diagrams indicate that the tectonic setting of the source area was a continental island arc environment.Lithological composition,Th/U ratios,and Co/Th–La/Sc,La/Th–Hf,and La/Yb–REE discrimination diagrams show that the source rocks of Badaowan Fm.were upper-crust felsic volcanic rocks.U-Pb dating of detrital zircons yields ages of 1542.3±15.0 to 232.9±3.3 Ma and mostly in the ranges of 470–410 and 370–280 Ma.A comparison of these ages with the age data from different blocks of crystalline rock in Tianshan Mountains area reveals that the sedimentary rocks in the Badaowan Fm.were sourced predominantly from the central and subordinately from the southern Tianshan Mountains during Early Jurassic.

Effect of adjuvant reduced glutathione therapy on vasoactive molecules and oxidative stress in patients with cirrhosis-induced upper gastrointestinal hemorrhage

Objective: To study the effect of adjuvant reduced glutathione therapy on vasoactive molecules and oxidative stress in patients with cirrhosis-induced upper gastrointestinal hemorrhage. Methods: Patients diagnosed with cirrhosis-induced upper gastrointestinal hemorrhage in No. 215 Hospital of Shaanxi Nuclear Industry between June 2015 and March 2017 were selected as the research subjects, and random number table was used to divide them into the GSH group who accepted reduced glutathione combined with conventional therapy and the control group who accepted conventional therapy. Serum levels of liver function indexes, vasoactive molecules and oxidative stress reaction molecules in two groups of patients were detected before treatment and 3 d after treatment. Results: 3 d after treatment, serum ALT, AST, γ-GT, TBIL, PRA, AT-Ⅱ, ALD, MDA, ox-LDL, AOPP and 8-OHdG levels of both groups of patients were significantly lower than those before treatment while SOD, GSH-Px and CAT levels were significantly high than those before treatment, and serum ALT, AST, γ-GT, TBIL, PRA, AT-II, ALD, MDA, ox-LDL, AOPP and 8-OHdG levels of GSH group were significantly lower than those of control group while SOD, GSH-Px and CAT levels were significantly higher than those of control group. Conclusion: The adjuvant reduced glutathione therapy for cirrhosis-induced upper gastrointestinal hemorrhage can improve the liver function, regulate the secretion of vasoactive molecules and reduce the oxidative stress response.

Identifying key genes associated with Hirschsprung's disease based on bioinformatics analysis of RNA-sequencing data

Background:Hirschsprung's disease (HSCR) is a type of megacolon induced by deficiency or dysfunction of ganglion cells in the distal intestine and is associated with developmental disorders of the enteric nervous system.To explore the mechanisms of HSCR,we analyzed the RNA-sequencing data of the expansion and the narrow segments of colon tissues separated from children with HSCR.Methods:RNA-sequencing of the expansion segments and the narrow segments of colon tissues isolated from children with HSCR was performed.After differentially expressed genes (DEGs) were identified using the edgeR package in R,functional and pathway enrichment analyses of DEGs were carried out using DAVID software.To further screen the key genes,protein-protein interaction (PPI) network and module analyses were conducted separately using Cytoscape software.Results:A total of 117 DEGs were identified in the expansion segment samples,including 47 up-regulated and 70 down-regulated genes.Functional enrichment analysis suggested that FOS and DUSP1 were implicated in response to endogenous stimulus.In the PPI network analysis,FOS (degree=20),EGR1 (degree=16),ATF3 (degree=9),NOS1 (degree=8),CCL5 (degree=8),DUSP1 (degree=7),CXCL3 (degree=6),VIP (degree=6),FOSB (degree=5),and NOS2 (degree=4) had higher degrees,which could interact with other genes.In addition,two significant modules (module 1 and module 2) were identified from the PPI network.Conclusion:Several genes (including FOS,EGR1,ATF3,NOS1,CCL5,DUSP1,CXCL3,VIP,FOSB,and NOS2) might be involved in the development of HSCR through their effect on the nervous system.

Multiple-Stage Mineralization in the Huayangchuan U-REE-Mo-Cu-Fe Ore Belt of the Qinling Orogen,Central China:Geological and Re-Os Geochronological Constraints

The Huayangchuan ore belt is located in the western segment of Xiaoqinling Orogen in the southern margin of the North China Craton(NCC),and hosts voluminous magmatism and significant U-REE-Mo-Cu-Fe polymetallic mineralization.However,geochronological framework of the various mineralization phases in this region is poorly understood.Here,we present new Re-Os isochron ages on magnetite from the Caotan Fe deposit(2 675 ± 410 Ma,MSWD = 0.55),and on pyrite from the Jialu REE deposit(2 127 ± 280 Ma,MSWD = 1.9) and Yuejiawa Cu deposit(418 ± 23 Ma,MSWD =11.5),and Re-Os weighted average model age on pyrite from the Taoyuan Mo-U deposit(235 ± 14 Ma,MSWD = 0.17).These ages,combined with regional geology and mineralization ages from other deposits,suggest that mineralization in the Huayangchuan ore belt lasted from the Neoarchean to the Late Mesozoic.The mineralization corresponds to regional tectono-magmatic events,including the Neoarchean alkali magmatism(REE mineralization),Paleoproterozoic plagioclase-amphibolite emplacement(Fe mineralization),Paleoproterozoic pegmatite magmatism(U mineralization),Paleozoic Shangdan oceanic slab subduction-related arc magmatism(Cu mineralization),Early Mesozoic Paleo-Tethys Ocean subduction-related arc magmatism(Mo-U mineralization),and Late Mesozoic Paleo-Pacific oceanic plate subduction direction change-related Mo(-Pb) mineralization.We proposed that the Huayangchuan ore belt has undergone prolonged metallogenic evolution,and the magmatism and associated mineralization were controlled by regional geodynamic events.

Dating of monazite-apatite-allanite-epidote corona from the Bayan Obo Group in the northern margin of the North China Craton:implications for the time of regional Au and REE mineralization

The Mesoproterozoic Bayan Obo Group located along the northern margin of the North China Craton(NMNCC)hosts a world’s largest known rare-earth element(REE)deposit(Bayan Obo Fe-REE-Nb deposit)[1,2]and a number of large gold deposits(eg.,Haoyaoerhugong and Zhulazhaga gold deposits;Fig.1a)[3],and has a long and protracted thermal history spanning from1.3 Ga to 250 Ma[1].The tectonic history was associated with Proterozoic rifting with carbonatite magmatism at1.3 Ga[4]and subsequent subduction-accretion processes of the Paleo-Asian Ocean[5,6].The Paleo-Asian oceanic subduction beneath the North China Craton(NCC)initiated in the Middle Silurian[7,8]and the ocean was closed in the Permian to induce the accretion of arcs and terranes with the NCC[2].This long and protracted tectonic history increases the difficulties both in dating and understanding the genesis of the Bayan Obo REE deposit and black shale-hosted gold deposits(e.g.,Haoyaoerhudong deposit).Thus,it is important to understand the thermal history of the hosting strata in order to constrain the tectonic drive and timing of polymetallic mineraliza-tion.There have been few attempts to date the multistage thermal events which the Bayan Obo Group has witnessed,predominantly because of greenschist facies overprint of the host rocks and lack of reliable geochronometers[9,10].

Clinical epidemiological survey of gallbladder carcinoma in northwestern China, 2009-2013: 2379 cases in 17 centers

Objective: To analyze the clinical epidemiological characteristics of patients with gallbladder carcinoma recruited from 17 hospitals in five northwestern provinces of China (Shaanxi Province, Gansu Province, Qinghai Province, Ningxia Hui Autonomous Region, and Xinjiang Uygur Autonomous Region) from 2009 to 2013, and to summarize the clinical diagnosis and treatment data of gallbladder carcinoma. Methods: Clinical information of 2379 patients with gallbladder carcinoma from 17 hospitals in five northwestern provinces of China was retrospectively collected and analyzed using the 'Questionnaire for Gallbladder Carcinoma Patients in Northwestern Area of China.' All information was verified with EpiData software and analyzed with SPSS 13.0 software. Results: (1) Gallbladder carcinoma accounted for 2.7% (2379/86,609) of all biliary tract diseases during the study period, which was significantly higher than that from 1986 to 1998 (P < 0.001). (2) Gallbladder carcinoma was more prone to occur in elderly women. The male:female incidence ratio was 1.0:2.1, the average age of onset of disease was 63.7 ± 11.3 years, and the incidence was higher in farmers than in other occupational groups. (3) A total of 57.2% (1360/2379) of patients with gallbladder carcinoma also had gallstones. (4) Abdominal pain (1796/2379, 75.5%) and jaundice (727/2379, 30.6%) were the most common clinical manifestations, 81.2% (1527/1881) were positive in those receiving B ultrasound examinations and 90.7% (1567/1727) were positive in those undergoing computed tomography, and 64.5% (1124/1742) of patients with gallbladder carcinoma were positive for carbohydrate antigen (CA) 19-9. (5) The pathological type of gallbladder carcinoma was mainly moderately and poorly differentiated adenocarcinoma with a high degree of malignancy. At admission, 55.1% (1091/1981) of patients had stage Ⅳ cancer among patients with TNM staging information; 55.9% (1331/2379) had lymphatic metastasis, 29.7% (706/2379) had bile duct metastasis, and 53.1% (1263/2379) had liver metastasis. (6) A total of 283 patients (283/2379, 11.9%) had incidentally detected gallbladder carcinoma. (7) The rate of radical surgical resection was 30.4% (723/2379). Conclusion: The proportion of gallbladder carcinoma in biliary tract diseases in the northwestern area of China was significantly higher from 2009 to 2013 than from 1986 to 1998. Gallbladder carcinoma was common in older women and mainly diagnosed at an advanced stage. Compared with other surveys in different regions, the rate of metastasis in this survey was high, leading to a low resection rate. Populations at high risk should undergo B-ultrasound examinations at regular follow-up intervals to increase the rate of early diagnosis of gallbladder carcinoma.

Efficacy and safety of high-dose esomeprazole–amoxicillin dual therapy for Helicobacter pylori rescue treatment:a multicenter,prospective,randomized,controlled trial

Background:High-dose dual therapy(HDDT)with proton pump inhibitors(PPIs)and amoxicillin has attracted widespread attention due to its favorable efficacy in eradicating Helicobacter pylori(H.pylori).This study aimed to compare the efficacy and safety of high-dose PPI-amoxicillin dual therapy and bismuth-containing quadruple therapy for H.pylori rescue treatment.Methods:This was a prospective,randomized,multicenter,non-inferiority trial.Patients recruited from eight centers who had failed previous treatment were randomly(1:1)allocated to two eradication groups:HDDT(esomeprazole 40 mg and amoxicillin 1000 mg three times daily;theHDDTgroup)and bismuth-containing quadruple therapy(esomeprazole 40 mg,bismuth potassium citrate 220 mg,and furazolidone 100 mg twice daily,combined with tetracycline 500 mg three times daily;the tetracycline,furazolidone,esomeprazole,and bismuth[TFEB]group)for 14 days.The primary endpoint was the H.pylori eradication rate.The secondary endpoints were adverse effects,symptom improvement rates,and patient compliance.Results:A total of 658 patients who met the criteria were enrolled in this study.The HDDT group achieved eradication rates of 75.4%(248/329),81.0%(248/306),and 81.3%(248/305)asdetermined by the intention-to-treat(ITT),modified intention-totreat(MITT),and per-protocol(PP)analyses,respectively.The eradication rates were similar to those in the TFEB group:78.1%(257/329),84.2%(257/305),and 85.1%(257/302).The lower 95%confidence interval boundary(9.19%in the ITT analysis,9.21%in the MITT analysis,and9.73%in the PP analysis)was greater than the predefined non-inferiority margin of10%,establishing a non-inferiority of the HDDT group vs.the TFEB group.The incidence of adverse events in the HDDT group was significantly lower than that in the TFEB group(11.1%vs.26.8%,P<0.001).Symptom improvement rates and patients’compliance were similar between the two groups.Conclusions:Fourteen-day HDDT is non-inferior to bismuth-containing quadruple therapy,with fewer adverse effects and good treatment compliance,suggesting HDDT as an alternative for H.pylori rescue treatment in the local region.Trial registration:Clinicaltrials.gov,NCT04678492.