National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the experts.The Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this meeting.This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients.This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation.The diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreato-graphy.Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis.However,histopathologic confirmation is not always required before resection.Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging.The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification.Selected patients with unresectable hCCA can be considered for liver transplantation.Adjuvant chemotherapy should be offered to patients with a high risk of recurrence.The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions.Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage.Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Synthesis strategies of hard carbon anodes for sodium-ion batteries

Sodium-ion battery(SIB)is an ideal candidate for large-scale energy storage due to high abundant sodium sources,relatively high energy density,and potentially low costs.Hard carbons,as one of the most promising anodes,could deliver high plateau capacities at low potentials,which boosts the energy densities of SIBs.Their slope capacities have been demonstrated from the defect adsorption of sodium ions,while the plateau capacity depends highly on intercalation and pore filling.Nevertheless,the specific structures of sodium ions stored in hard carbons have not been clarified,namely active sites of adsorption,intercalation,and pore-filling mechanisms.Therefore,delicate synthesis methods are required to prepare hard carbons with controllable specific structures,along with elucidating the precise active sites for enhancing the Na-ion storage performance.To offer databases for future designs,we summarized the synthesis strategies of hard carbon anodes for constructing active sites of plateau capacities.Synthesis methods were highlighted with corresponding influences on the meticulous structures of hard carbons and Na-ion storage behaviors.Last but not least,perspectives were proposed for developing hard carbon anodes from the points of research and practical applications.

The potential of gene therapies for spinal cord injury repair:a systematic review and meta-analysis of pre-clinical studies

Currently,there is no cure for traumatic spinal co rd injury but one therapeutic approach showing promise is gene therapy.In this systematic review and meta-analysis,we aim to assess the efficacy of gene therapies in pre-clinical models of spinal cord injury and the risk of bias.In this metaanalysis,registe red at PROSPERO(Registration ID:CRD42020185008),we identified relevant controlled in vivo studies published in English by searching the PubMed,Web of Science,and Embase databases.No restrictions of the year of publication were applied and the last literature search was conducted on August 3,2020.We then conducted a random-effects meta-analysis using the restricted maximum likelihood estimator.A total of 71 studies met our inclusion crite ria and were included in the systematic review.Our results showed that overall,gene therapies were associated with improvements in locomotor score(standardized mean difference[SMD]:2.07,95%confidence interval[CI]:1.68-2.47,Tau^(2)=2.13,I^(2)=83.6%)and axonal regrowth(SMD:2.78,95%CI:1.92-3.65,Tau^(2)=4.13,I^(2)=85.5%).There was significant asymmetry in the funnel plots of both outcome measures indicating the presence of publication bias.We used a modified CAMARADES(Collaborative Approach to M eta-Analysis and Review of Animal Data in Experimental Studies)checklist to assess the risk of bias,finding that the median score was 4(IQR:3-5).In particula r,reports of allocation concealment and sample size calculations were lacking.In conclusion,gene therapies are showing promise as therapies for spinal co rd injury repair,but there is no consensus on which gene or genes should be targeted.

Effects of Root Growth of Deep and Shallow Rooting Rice Cultivars in Compacted Paddy Soils on Subsequent Rice Growth

Rice is often grown as multiple seasons in one year,alternating between flooded and upland systems.A major constraint,introduced from the flooded system,is a plough pan that may decrease rooting depth and productivity of follow-on upland rice.Roots penetrating the plough pan under flooded rice system can leave a legacy of weaker root growth pathways.Deeper rooting rice cultivars could have a bigger impact,but no direct evidence is available.To explore whether a deep rather than a shallow rooting rice cultivar grown in a flooded cropping cycle benefited deeper root growth of follow-on rice in an upland,reduced tillage cropping cycle,a simulated flooded paddy in greenhouse was planted with deep(Black Gora) and shallow(IR64) rooting cultivars and a plant-free control.Artificial plough pans were made in between the topsoil and subsoil to form different treatments with no plough pan(0.35 MPa),soft plough pan(1.03 MPa) and hard plough pan(1.70 MPa).After harvest of this ‘first season’ rice,the soil was drained and undisturbed to simulate zero-tillage upland and planted rice cultivar BRRI Dhan 28.The overall root length density(RLD),root surface area,the numbers of root tips and branching of BRRI Dhan 28 did not vary between plough pan and no plough pan treatments.Compared with the shallow rooting rice genotype,the deep rooting rice genotype as ‘first season’ crop produced 19% greater RLD,34% greater surface area and 29% more branching of BRRI Dhan 28 in the subsoil.In the topsoil,however,BRRI Dhan 28 had 28% greater RLD,35% greater surface area and 43% more branching for the shallow rather than deep rooting genotype planted in the ‘first season’.The results suggested that rice cultivar selection for a paddy cycle affects root growth of a follow-on rice crop grown under no-till,with benefits to subsoil access from deep rooting cultivars and topsoil proliferation for shallow rooting cultivars.

Mixing of miscible shear-thinning fluids in a lid-driven cavity

The concentration and velocity fields of two refractive index matched miscible shear-thinning fluids in a lid-driven cavity were investigated by using planar laser-induced fluorescence and particle image velocimetry,as well by computational fluid dynamics.Quantitative analyses show that the results obtained by flow simulations with the species transport model are in good agreement with the experimental results.The effects of different parameters were studied by using the intensity of segregation.For two fluids with the same rheological parameters,the relative amounts of liquids H_(1)/H and the power-law index n dominate the mixing process while the Reynolds number Re plays a marginal role.As for two fluids with density difference,buoyancy has significant influence on the mixing process.The dimensionless group Ar/Re(redefined such as to include shear thinning behavior)is proposed for assessing the effect of buoyancy and rheological properties on the mixing of miscible shear-thinning fluids.

Reliability Analysis of Correlated Competitive and Dependent Components Considering Random Isolation Times

In the Internet of Things(IoT)system,relay communication is widely used to solve the problem of energy loss in long-distance transmission and improve transmission efficiency.In Body Sensor Network(BSN)systems,biosensors communicate with receiving devices through relay nodes to improve their limited energy efficiency.When the relay node fails,the biosensor can communicate directly with the receiving device by releasing more transmitting power.However,if the remaining battery power of the biosensor is insufficient to enable it to communicate directly with the receiving device,the biosensor will be isolated by the system.Therefore,a new combinatorial analysis method is proposed to analyze the influence of random isolation time(RIT)on system reliability,and the competition relationship between biosensor isolation and propagation failure is considered.This approach inherits the advantages of common combinatorial algorithms and provides a new approach to effectively address the impact of RIT on system reliability in IoT systems,which are affected by competing failures.Finally,the method is applied to the BSN system,and the effect of RIT on the system reliability is analyzed in detail.

A Cross-Domain Trust Model of Smart City IoT Based on Self-Certification

Smart city refers to the information system with Intemet of things and cloud computing as the core tec hnology and government management and industrial development as the core content,forming a large scale,heterogeneous and dynamic distributed Internet of things environment between different Internet of things.There is a wide demand for cooperation between equipment and management institutions in the smart city.Therefore,it is necessary to establish a trust mechanism to promote cooperation,and based on this,prevent data disorder caused by the interaction between honest terminals and malicious temminals.However,most of the existing research on trust mechanism is divorced from the Internet of things environment,and does not consider the characteristics of limited computing and storage capacity and large differences of Internet of hings devices,resuling in the fact that the research on abstract trust trust mechanism cannot be directly applied to the Internet of things;On the other hand,various threats to the Internet of things caused by security vulnerabilities such as collision attacks are not considered.Aiming at the security problems of cross domain trusted authentication of Intelligent City Internet of things terminals,a cross domain trust model(CDTM)based on self-authentication is proposed.Unlike most trust models,this model uses self-certified trust.The cross-domain process of internet of things(IoT)terminal can quickly establish a trust relationship with the current domain by providing its trust certificate stored in the previous domain interaction.At the same time,in order to alleviate the collision attack and improve the accuracy of trust evaluation,the overall trust value is calculated by comprehensively considering the quantity weight,time attenuation weight and similarity weight.Finally,the simulation results show that CDTM has good anti collusion attack ability.The success rate of malicious interaction will not increase significantly.Compared with other models,the resource consumption of our proposed model is significantly reduced.

Early Diagnosis of Lung Tumors for Extending Patients’ Life Using Deep Neural Networks

The medical community has more concern on lung cancer analysis.Medical experts’physical segmentation of lung cancers is time-consuming and needs to be automated.The research study’s objective is to diagnose lung tumors at an early stage to extend the life of humans using deep learning techniques.Computer-Aided Diagnostic(CAD)system aids in the diagnosis and shortens the time necessary to detect the tumor detected.The application of Deep Neural Networks(DNN)has also been exhibited as an excellent and effective method in classification and segmentation tasks.This research aims to separate lung cancers from images of Magnetic Resonance Imaging(MRI)with threshold segmentation.The Honey hook process categorizes lung cancer based on characteristics retrieved using several classifiers.Considering this principle,the work presents a solution for image compression utilizing a Deep Wave Auto-Encoder(DWAE).The combination of the two approaches significantly reduces the overall size of the feature set required for any future classification process performed using DNN.The proposed DWAE-DNN image classifier is applied to a lung imaging dataset with Radial Basis Function(RBF)classifier.The study reported promising results with an accuracy of 97.34%,whereas using the Decision Tree(DT)classifier has an accuracy of 94.24%.The proposed approach(DWAE-DNN)is found to classify the images with an accuracy of 98.67%,either as malignant or normal patients.In contrast to the accuracy requirements,the work also uses the benchmark standards like specificity,sensitivity,and precision to evaluate the efficiency of the network.It is found from an investigation that the DT classifier provides the maximum performance in the DWAE-DNN depending on the network’s performance on image testing,as shown by the data acquired by the categorizers themselves.

SHT-based public auditing protocol with error tolerance in FDL-empowered IoVs

With the intelligentization of the Internet of Vehicles(lovs),Artificial Intelligence(Al)technology is becoming more and more essential,especially deep learning.Federated Deep Learning(FDL)is a novel distributed machine learning technology and is able to address the challenges like data security,privacy risks,and huge communication overheads from big raw data sets.However,FDL can only guarantee data security and privacy among multiple clients during data training.If the data sets stored locally in clients are corrupted,including being tampered with and lost,the training results of the FDL in intelligent IoVs must be negatively affected.In this paper,we are the first to design a secure data auditing protocol to guarantee the integrity and availability of data sets in FDL-empowered IoVs.Specifically,the cuckoo filter and Reed-Solomon codes are utilized to guarantee error tolerance,including efficient corrupted data locating and recovery.In addition,a novel data structure,Skip Hash Table(SHT)is designed to optimize data dynamics.Finally,we illustrate the security of the scheme with the Computational Diffie-Hellman(CDH)assumption on bilinear groups.Sufficient theoretical analyses and performance evaluations demonstrate the security and efficiency of our scheme for data sets in FDL-empowered IoVs.

Part-Whole Relational Few-Shot 3D Point Cloud Semantic Segmentation

This paper focuses on the task of few-shot 3D point cloud semantic segmentation.Despite some progress,this task still encounters many issues due to the insufficient samples given,e.g.,incomplete object segmentation and inaccurate semantic discrimination.To tackle these issues,we first leverage part-whole relationships into the task of 3D point cloud semantic segmentation to capture semantic integrity,which is empowered by the dynamic capsule routing with the module of 3D Capsule Networks(CapsNets)in the embedding network.Concretely,the dynamic routing amalgamates geometric information of the 3D point cloud data to construct higher-level feature representations,which capture the relationships between object parts and their wholes.Secondly,we designed a multi-prototype enhancement module to enhance the prototype discriminability.Specifically,the single-prototype enhancement mechanism is expanded to the multi-prototype enhancement version for capturing rich semantics.Besides,the shot-correlation within the category is calculated via the interaction of different samples to enhance the intra-category similarity.Ablation studies prove that the involved part-whole relations and proposed multi-prototype enhancement module help to achieve complete object segmentation and improve semantic discrimination.Moreover,under the integration of these two modules,quantitative and qualitative experiments on two public benchmarks,including S3DIS and ScanNet,indicate the superior performance of the proposed framework on the task of 3D point cloud semantic segmentation,compared to some state-of-the-art methods.

Evolutionary Multi/Many-Objective Optimisation via Bilevel Decomposition

Decomposition of a complex multi-objective optimisation problem(MOP)to multiple simple subMOPs,known as M2M for short,is an effective approach to multi-objective optimisation.However,M2M facilitates little communication/collaboration between subMOPs,which limits its use in complex optimisation scenarios.This paper extends the M2M framework to develop a unified algorithm for both multi-objective and manyobjective optimisation.Through bilevel decomposition,an MOP is divided into multiple subMOPs at upper level,each of which is further divided into a number of single-objective subproblems at lower level.Neighbouring subMOPs are allowed to share some subproblems so that the knowledge gained from solving one subMOP can be transferred to another,and eventually to all the subMOPs.The bilevel decomposition is readily combined with some new mating selection and population update strategies,leading to a high-performance algorithm that competes effectively against a number of state-of-the-arts studied in this paper for both multiand many-objective optimisation.Parameter analysis and component analysis have been also carried out to further justify the proposed algorithm.

Lateral femoral tunnel preparation and graft fixation for anterior cruciate ligament reconstruction–A discussion

This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction(ACLR),with a focus on the aspects of lateral femoral tunnel preparation and graft fixation techniques.The paper explores and comments on a recently published review by Dai et al,titled"Research progress on preparation of lateral femoral tunnel and graft fixation in ACLR",while providing insight into its relevance within the field of ACLR,and recommendations for future research.

Glacier area change (1993-2019) and its relationship to debris cover, proglacial lakes, and morphological parameters in the Chandra-Bhaga Basin, Western Himalaya, India

Glacier inventories serve as critical baseline data for understanding the impacts of climate change on glaciers.The present study maps the outlines of glaciers in the Chandra-Bhaga Basin(western Himalaya)for the years 1993,2000,2010,and 2019 using Landsat Thematic Mapper(TM),Enhanced Thematic Mapper(ETM),and Operational Land Imager(OLI)datasets.A total of 251 glaciers,each having an area above 0.5 km^(2),were identified,which include 216 clean-ice and 35 debris-covered glaciers.Area changes are estimated for three periods:1993-2000,2000-2010,and 2010-2019.The total glacierized area was 996±62 km^(2) in 1993,which decreased to 973±70 km^(2) in 2019.The mean rate of glacier area loss was higher in the recent decade(2010-2019),at 0.036 km^(2),compared to previous decades(0.029 km^(2) in 2000-2010 and 0.025 km^(2) in 1993-2000).Supraglacial debris cover changes are also mapped over the period of 1993 and 2019.It is found that the supraglacial debris cover increased by 14.12±2.54 km^(2)(15.2%)during 1993-2019.Extensive field surveys on Chhota Shigri,Panchi II,Patsio,Hamtah,Mulkila,and Yoche Lungpa glaciers were carried out to validate the glacier outlines and supraglacial debris cover estimated using satellite datasets.Controls of various morphological parameters on retreat were also analyzed.It is observed that small,clean ice,south oriented glaciers,and glaciers with proglacial lakes are losing area at faster rates than other glaciers in the basin.

Privacy Enhanced Mobile User Authentication Method Using Motion Sensors

With the development of hardware devices and the upgrading of smartphones,a large number of users save privacy-related information in mobile devices,mainly smartphones,which puts forward higher demands on the protection of mobile users’privacy information.At present,mobile user authenticationmethods based on humancomputer interaction have been extensively studied due to their advantages of high precision and non-perception,but there are still shortcomings such as low data collection efficiency,untrustworthy participating nodes,and lack of practicability.To this end,this paper proposes a privacy-enhanced mobile user authentication method with motion sensors,which mainly includes:(1)Construct a smart contract-based private chain and federated learning to improve the data collection efficiency of mobile user authentication,reduce the probability of the model being bypassed by attackers,and reduce the overhead of data centralized processing and the risk of privacy leakage;(2)Use certificateless encryption to realize the authentication of the device to ensure the credibility of the client nodes participating in the calculation;(3)Combine Variational Mode Decomposition(VMD)and Long Short-TermMemory(LSTM)to analyze and model the motion sensor data of mobile devices to improve the accuracy of model certification.The experimental results on the real environment dataset of 1513 people show that themethod proposed in this paper can effectively resist poisoning attacks while ensuring the accuracy and efficiency of mobile user authentication.

Upcycling municipal solid waste to sustainable hydrogen via two-stage gasification-reforming

As global municipal solid waste(MSW)quantities continue to escalate,serious socio-environmental challenges arise,necessitating innovative solutions.Waste-to-hydrogen(WTH)via two-stage gasification-reforming(TSGR)presents an emergent technology for MSW upcycling,offering to ease waste management burdens and bolster the burgeoning hydrogen economy.Despite early initiatives to advance TSGR technology,a cohesive and critical analysis of cutting-edge knowledge and strategies to enhance hydrogen production remains lacking.This review aggregates literature on MSW upcycling to hydrogen via TSGR,with a focus on optimizing process control and catalytic efficiency.It underscores technological avenues to augment hydrogen output,curtail catalyst costs,and refine system performance.Particularly,the review illuminates the potential for integrating chemical and calcium looping into TSGR processes,identifying opportunities,and pinpointing challenges.The review concludes with a summary of the current state of techno-economic analysis for this technology,presenting outstanding challenges and future research directions,with the ultimate goal of transitioning WTH from theoretical to practical application.

Role of the gut microbiota in inflammatory bowel disease pathogenesis: What have we learnt in the past 10 years?

Our understanding of the microbial involvement in inflammatory bowel disease (IBD) pathogenesis has increased exponentially over the past decade. The development of newer molecular tools for the global assessment of the gut microbiome and the identification of nucleotide-binding oligomerization domain-containing protein 2 in 2001 and other susceptibility genes for Crohn’s disease in particular has led to better understanding of the aetiopathogenesis of IBD. The microbial studies have elaborated the normal composition of the gut microbiome and its perturbations in the setting of IBD. This altered microbiome or “dysbiosis” is a key player in the protracted course of inflammation in IBD. Numerous genome-wide association studies have identified further genes involved in gastrointestinal innate immunity (including polymorphisms in genes involved in autophagy: ATG16L1 and IGRM), which have helped elucidate the relationship of the local innate immunity with the adjacent luminal bacteria. These developments have also spurred the search for specific pathogens which may have a role in the metamorphosis of the gut microbiome from a symbiotic entity to a putative pathogenic one. Here we review advances in our understanding of microbial involvement in IBD pathogenesis over the past 10 years and offer insight into how this will shape our therapeutic management of the disease in the coming years.

A review of fluid displacement mechanisms in surfactant-based chemical enhanced oil recovery processes:Analyses of key influencing factors

Surfactant-based oil recovery processes are employed to lower the interfacial tension in immiscible displacement processes,change the wettability of rock to a more water-wet system and emulsify the oil to displace it in subsurface porous media.Furthermore,these phenomena can reduce the capillary pressure and enhance spontaneous imbibition.The key factors affecting such immiscible displacement process are temperature,salinity and p H of the fluids,surfactant concentration and adsorption.Therefore,before any surfactant flooding process is applied,extensive studies of fluid-fluid and rock-fluid interactions are needed.The use of other chemicals along with surfactants in chemical enhanced oil recovery(c EOR)processes have been widely considered to exploit the synergy of individual chemicals and complement the weakness arises from each of them during immiscible displacement of fluids in porous media.Therefore,such combinations of chemicals lead to alkaline-surfactant(AS),surfactantpolymer(SP),alkaline-surfactant-polymer(ASP),and nanoparticle-surfactant(NS)flooding processes,among others.In this review study,we categorised the role and displacement mechanisms of surfactants and discussed the key factors to be considered for analysing the fluid displacement in porous media.

Bifurcation and dynamic response analysis of rotating blade excited by upstream vortices

A reduced model is proposed and analyzed for the simulation of vortexinduced vibrations （VIVs） for turbine blades. A rotating blade is modelled as a uniform cantilever beam, while a van der Pol oscillator is used to represent the time-varying characteristics of the vortex shedding, which interacts with the equations of motion for the blade to simulate the fluid-structure interaction. The action for the structural motion on the fluid is considered as a linear inertia coupling. The nonlinear characteristics for the dynamic responses are investigated with the multiple scale method, and the modulation equations are derived. The transition set consisting of the bifurcation set and the hystere- sis set is constructed by the singularity theory and the effects of the system parameters, such as the van der Pol damping. The coupling parameter on the equilibrium solutions is analyzed. The frequency-response curves are obtained, and the stabilities are determined by the Routh-Hurwitz criterion. The phenomena including the saddle-node and Hopf bifurcations are found to occur under certain parameter values. A direct numerical method is used to analyze the dynamic characteristics for the original system and verify the va- lidity of the multiple scale method. The results indicate that the new coupled model is useful in explaining the rich dynamic response characteristics such as possible bifurcation phenomena in the VIVs.

Soil Temperature Dependent Growth of Cotton Seedlings Before Emergence

Soil temperature is an important variable governing plant growth and development. Studies were conducted under laboratory conditions to determine the effect of soil temperature on root and shoot growth of cotton during emergence. Cotton seedlings were grown for 192 h at 20, 32 and 38℃ in soil packed in 300 mm long and 50 mm diameter cylinders. The data indicated that the longest roots （173 ram） as well as shoots （152 mm） were recorded at 32℃ followed by 20 （130 mm root and 82 mm shoot） and 38℃ （86 mm root and 50 mm shoot）. Roots grown at 20 and 38 ℃ were 20% and 50% shorter, respectively, than those grown at 32℃ after 192 h. Roots and shoots exhibited the lowest length and dry biomass at 38 ℃. Shoot lengths grown at 20 （74 mm） and 38℃（51 mm） were 44% and 61% shorter than those grown at 32℃（131 mm） after 180 h growth period, respectively. Growth at all three temperatures followed a similar pattern. Initially there was a linear growth phase followed by the reduction or cessation of growth. Time to cessation of growth varied with temperature and decreased faster at higher temperatures. Sowing of cotton should be accomplished before seedbed reaches a soil temperature （≥ 38 ℃） detrimental for emergence. Further, the seedbeds should be capable of providing sufficient moisture and essential nutrients for emerging seedling before its seed reserves are exhausted to enhance seedling establishment in soil.

Current practice of anticoagulant in the treatment of splanchnic vein thrombosis secondary to acute pancreatitis

Background:Severe acute pancreatitis is a common diagnosis in emergency general surgery and can be a cause of significant morbidity and mortality.A consequence of severe acute pancreatitis is thrombus in the splanchnic veins.These thrombi can potentially lead to bowel ischemia or hepatic failure.However,another complication of severe acute pancreatitis is retroperitoneal bleeding.At this time,it is unclear if treating patients for splanchnic vein thrombosis in the context of severe acute pancreatitis is associated with any outcome benefit.A systematic review might clarify this question.Data sources:A two-fold search strategy(one broad and one precise)looked at all published literature.The review was registered on PROSPERO(ID:CRD42018102705).MEDLINE,EMBASE,PubMed,Cochrane and Web of Science databases were searched and potentially relevant papers were reviewed indepen-dently by two researchers.Any disagreement was reviewed by a third independent researcher.Primary outcome was reestablishment of flow in the thrombosed vein versus bleeding complications.Results:Of 1462 papers assessed,a total of 16 papers were eligible for inclusion.There were no ran-domized controlled trials,2 were case series,5 retrospective single-center studies and 9 case reports.There were a total of 198 patients in these studies of whom 92(46.5%)received anticoagulation therapy.The rates of recanalization of veins in the treated and non-treated groups was 14%and 11%and bleeding complications were 16%and 5%,respectively.However,the included studies were too heterogeneous to undertake a meta-analysis.Conclusions:The systematic review highlights the lack evidence addressing this clinical question.There-fore a randomized controlled trial would be appropriate to undertake.