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Background: The objective of this study was to investigate the association between pre-operative body mass index (BMI) and surgical infection in perihilar cholangiocarcinoma (pCCA) patients treated with curative resection. Methods: Consecutive pCCA patients were enrolled from four tertiary hospitals between 2008 and 2022. According to pre-operative BMI, the patients were divided into three groups: low BMI (≤18.4 kg/m2), normal BMI (18.5-24.9 kg/m2), and high BMI (≥25.0 kg/m2). The incidence of surgical infection among the three groups was compared. Multivariable logistic regression models were used to determine the independent risk factors associated with surgical infection. Results: A total of 371 patients were enrolled, including 283 patients (76.3%) in the normal BMI group, 30 patients (8.1%) in the low BMI group, and 58 patients (15.6%) in the high BMI group. The incidence of surgical infection was significantly higher in the patients in the low BMI and high BMI groups than in the normal BMI group. The multivariable logistic regression model showed that low BMI and high BMI were independently associated with the occurrence of surgical infection. Conclusions: The pCCA patients with a normal BMI treated with curative resection could have a lower risk of surgical infection than pCCA patients with an abnormal BMI.
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Índice de Masa Corporal , Tumor de Klatskin , Infección de la Herida Quirúrgica , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Infección de la Herida Quirúrgica/epidemiología , Factores de Riesgo , Tumor de Klatskin/cirugía , Tumor de Klatskin/complicaciones , Incidencia , Neoplasias de los Conductos Biliares/cirugía , Neoplasias de los Conductos Biliares/complicaciones , Neoplasias de los Conductos Biliares/epidemiología , Estudios Retrospectivos , Adulto , Periodo PreoperatorioRESUMEN
The amount of genetic data generated by Next Generation Sequencing (NGS) technologies grows faster than Moore's law. This necessitates the development of efficient NGS data processing and analysis algorithms. A filter before the computationally-costly analysis step can significantly reduce the run time of the NGS data analysis. As GPUs are orders of magnitude more powerful than CPUs, this paper proposes a GPU-friendly pre-align filtering algorithm named SeedHit for the fast processing of NGS data. Inspired by BLAST, SeedHit counts seed hits between two sequences to determine their similarity. In SeedHit, a nucleic acid in a gene sequence is presented in binary format. By packaging data and generating a lookup table that fits into the L1 cache, SeedHit is GPU-friendly and high- throughput. Using three 16 s rRNA datasets from Greengenes as input SeedHit can reject 84%-89% dissimilar sequence pairs on average when the similarity is 0.9-0.99. The throughput of SeedHit achieved 1 T/s (Tera base per second) on 3080 Ti. Compared with the other two GPU-based filtering algorithms, GateKeeper and SneakySnake, SeedHit has the highest rejection rate and throughput. By incorporating SeedHit into our in-house clustering algorithm nGIA, the modified nGIA achieved a 1.6-2.1 times speedup compared to the original version.
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BACKGROUND: The prognostic value of carbohydrate antigen 19-9 (CA19-9) is known to be affected by elevated bilirubin levels in patients with gallbladder carcinoma (GBC). The clinical significance of changes in the ratio of CA19-9 levels to total bilirubin (TB) levels in patients with GBC after curative-intent resection remains unknown. The aim of this study was to determine the prognostic value of changes in preoperative and postoperative CA19-9/TB ratio in these patients. METHODS: Prospectively collected data on consecutive patients who underwent curative-intent resection for GBC between January 2015 and December 2020 stored in a multicenter database from 10 hospitals were analyzed in this retrospective cohort study. Based on the adjusted CA19-9 defined as the ratio of CA19-9 to TB, and using 2×10 3 U/µmol as the upper normal value, patients were divided into a normal group (with normal preoperative and postoperative adjusted CA19-9), a normalization group (with abnormal preoperative but normal postoperative adjusted CA19-9), and a non-normalization group (with abnormal postoperative adjusted CA19-9). The primary outcomes were overall survival (OS) and recurrence-free survival (RFS). The log-rank test was used to compare OS and RFS among the groups. The Cox regression model was used to determine factors independently associated with OS and RFS. RESULTS: The normal group ( n =179 patients) and the normalization group ( n =73 patients) had better OS and RFS than the non-normalization group ( n =65 patients) (the 3-year OS rates 72.0%, 58.4% and 24.2%, respectively; the RFS rates 54.5%, 25.5% and 11.8%, respectively; both P <0.001). There were no significant differences between the normal and the normalization groups in OS and RFS (OS, P =0.255; RFS, P =0.130). Cox regression analysis confirmed that the non-normalization group was independently associated with worse OS and RFS. Subgroup analysis revealed that the non-normalization group of patients who received adjuvant therapy had significantly improved OS and RFS as compared to those who did not receive adjuvant therapy (OS, P =0.025; RFS, P =0.003). CONCLUSIONS: Patients with GBC who underwent curative-intent surgical resection with postoperative abnormal levels of adjusted CA19-9 (the CA19-9/TB ratio) were associated with poorer long-term survival outcomes. Adjuvant therapy after surgery improved the long-term outcomes of these patients.
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Bilirrubina , Antígeno CA-19-9 , Neoplasias de la Vesícula Biliar , Humanos , Neoplasias de la Vesícula Biliar/cirugía , Neoplasias de la Vesícula Biliar/sangre , Neoplasias de la Vesícula Biliar/mortalidad , Neoplasias de la Vesícula Biliar/patología , Estudios Retrospectivos , Bilirrubina/sangre , Femenino , Masculino , Antígeno CA-19-9/sangre , Persona de Mediana Edad , Anciano , Pronóstico , AdultoRESUMEN
Developing a self-elastic sponge integrating active and passive hemostatic mechanisms for the effective management of uncontrolled coagulopathic hemorrhage remains a challenge. We here developed a chitosan-based sponge by integrating freeze-drying, chemical decoration of alkyl chains and phosphate groups, and physical loading of thrombin. The sponge exhibited high mechanical strength, self-elasticity, and rapid shape recovery. The sponge facilitated blood cell adhesion, aggregation, and activation through hydrophobic and electrostatic interactions, as well as accelerated blood clotting. The sponge exhibited higher efficacy than commercial gauze and gelatin sponge in managing uncontrolled hemorrhage from heparinized rat tail amputation, liver superficial injury, and liver perforating wound models. In addition, the sponge exhibited favorable biodegradability and biocompatibility. These findings revealed that the developed sponge holds great potential as a novel hemostat for effectively managing uncontrolled coagulopathic hemorrhage from superficial and perforating wounds.
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OBJECTIVE: To investigate changes in the upper maxillary palates of children with obstructive sleep apnoea (OSA) and mandibular retraction who were treated using modified twin-block appliances (MTBAs). METHODS: Thirty-five OSA children (age: 6-12 years) with mandibular retraction were included as the experimental group and 35 children who were Angle's class I but without mandibular retraction were included as the control group. The experimental group was treated with MTBA. Plaster models were made before the treatment and at the end of the 6-month treatment period. Plaster models of the control group were made at inclusion and after 6 months. Some plaster models were excluded because of damage or their failure to exhibit sufficiently clear marks, which left 26 pairs each for the experimental and control groups. The gender and age of the experimental group were matched with those of the control group at the end of the treatment. Three-dimensional (3D) digital model information was gathered using the external oral scanning model, and the data were extracted and analysed statistically to clarify the morphologic improvement in the maxillopalatine in OSA children treated using MTBAs. RESULTS: After the OSA children with mandibular retraction were treated with MTBAs, the maxillary intercusp width, intermolar width, anterior palate width, posterior palate width, and surface area and volume of the maxillary palate significantly increased (*P < .05). By contrast, the anterior palatal height-apex level (H3) significantly decreased (*P < .05). CONCLUSIONS: Compared with the control group, the narrow maxillary arch and basal bone were significantly enlarged after the OSA children with mandibular retraction were treated using MTBAs. The palatal surface area and volume increased, thereby allowing more space for accommodating the tongue and relieving transverse dissonance of the dentition.
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Primary gastrointestinal follicular lymphoma (PGI-FL) is a rare extra-nodal lymphoma. Its epidemiology and prognosis remain unclear. We performed a retrospective analysis of eligible patients with 1648 PGI-FL and 34 892 nodal FL (N-FL) in the Surveillance, Epidemiology and End Results (SEER) database. The age-adjusted average annual incidence of PGI-FL was 0.111/100000. The median overall survival (OS) for PGI-FL and N-FL patients was 207 and 165 months respectively. The 5-year diffuse large B-cell lymphoma (DLBCL) transformation rates were 2.1% and 2.6% respectively. Age, sex, grade, Ann Arbor stage, primary site and radiation were independent prognostic factors (p < 0.05). Nomograms were constructed to predict 1-, 5- and 10-year OS and disease-specific survival (DSS). The receiver operating characteristic curves and calibration plots showed the established nomograms had robust and accurate performance. Patients were classified into three risk groups according to nomogram score. In conclusion, the incidence of PGI-FL has increased over the past 40 years, and PGI-FL has a better prognosis and a lower DLBCL transformation rate than N-FL. The nomograms were developed and validated as an individualized tool to predict survival. Patients were divided into three risk groups to assist clinicians in identifying high-risk patients and choosing the optimal individualized treatments.
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Neoplasias Gastrointestinales , Linfoma Folicular , Programa de VERF , Humanos , Linfoma Folicular/mortalidad , Linfoma Folicular/epidemiología , Linfoma Folicular/terapia , Linfoma Folicular/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Anciano , Neoplasias Gastrointestinales/epidemiología , Neoplasias Gastrointestinales/mortalidad , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/terapia , Adulto , Estudios Retrospectivos , Pronóstico , Anciano de 80 o más Años , Nomogramas , Incidencia , Linfoma de Células B Grandes Difuso/epidemiología , Linfoma de Células B Grandes Difuso/mortalidad , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/terapia , Adolescente , Adulto JovenRESUMEN
In this study, the traditional mini split Hopkinson tension bar (SHTB) was enhanced for the dynamic mechanical performance testing of single fiber/resin interface of composites. Single Aramid III fibers were modified using a polyamine modification treatment. Quasi-static and dynamic tensile tests of modified single Aramid III fibers were conducted using an electronic tensile testing machine and mini SHTB. The test results indicated that the surface modification employing the Catechol-Tetraethylenepentamine (Cat-TEPA) approach had a negligible effect on the tensile mechanical properties of single Aramid III fibers. The microdroplet method was introduced to measure the dynamic interfacial shear strength (IFSS) of Aramid III fiber/waterborne polyurethane resin using a mini SHTB. The dynamic shear test results revealed an increase in the dynamic shear strength of the modified Aramid III fiber/resin interface from 36.16 MPa to 41.51 MPa. Furthermore, the Scanning Electron Microscope (SEM) photography of the modified single Aramid III fiber after debonding exhibited regular grid structures on the debonding area, which can prevent debonding between the single fiber and the microdroplet, thereby enhancing interfacial shear performance.
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Objective: To investigate the diagnostic utility of multimodal ultrasound for fetal bowel dilatation (FBD) in different parts of the bowel and to examine its prognostic potential in FBD. Methods: This retrospective study analyzed 86 fetuses with a dilated bowel identified via ultrasound in a 10-month postnatal follow-up. Both two- and three dimensional (2D and 3D, respectively) ultrasound volume imaging were used to characterize dilation across different bowel sections. The optimal intestinal diameter cut-off values for pathological bowel dilatation were determined and a predictive model for neonatal surgery was developed. Results: The 86 cases of dilatation were distributed as follows: duodenal (n = 36); jejunum/ileum (n = 35); and colonic (n = 15). Duodenal dilatations presented the earliest during pregnancy compared to the other 2 groups (24.4 versus [vs.] 29 vs. 33.7 weeks respectively; p < 0.05). Cases with small intestinal dilatation were delivered earlier than those with colonic dilatation (p < 0.05). Infants with duodenal dilatation had the lowest birth weight and the highest rate of multi-system abnormalities (30.6% vs. 5.7% vs. 20%; p < 0.001). More than one-half of the multi-system abnormalities had chromosomal abnormalities (multiple, 54% vs. single, 12.5%; p = 0.015). There were 2 stillbirths, 24 induced labors, 44 postnatal surgeries, and 18 normal cases after birth. In predicting adverse neonatal outcomes of jejunum/ileum dilatation using a cut-off value of 15.5 mm small intestine diameter, sensitivity was 81.5%, specificity was 62.5%, and the area under the receiver operating characteristic curve (AUC) was 0.762 (p < 0.05). For colonic dilatation, using a cut-off value of 21.5 mm colon diameter: sensitivity was 83.3%, specificity was 77.8%, and AUC was 0.861 (p < 0.05). In detecting jejunum/ileum and colonic obstruction, 3D ultrasound demonstrated significantly better diagnostic efficiency than 2D ultrasound (p < 0.05). Using the backward stepwise selection method, a predictive model for neonatal surgery in patients with jejunum/ileum and colonic dilatation was established: logit (P) = -1.58 + (2.32 × polyhydramnios) +(2.0 × ascites) +(1.14 × hyperechogenic bowel). The AUC for the prediction model was 0.874 (p < 0.05), with 76% sensitivity and 94.1% specificity. Conclusions: Duodenal dilatation occurred earlier, with a higher incidence of chromosomal abnormalities and multi-system abnormalities than dilatation of other parts of the bowel. 3D ultrasound played an important role in the detection of jejunum/ileum and colon obstructions. Clinical signs, including polyhydramnios, ascites, and strong echoes in the intestine, can be used to predict neonatal surgery.
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OBJECTIVE: To analyze the clinical characteristics of laryngomalacia in Chinese children and explore the surgical efficacy and factors influencing severe laryngomalacia. METHODS: Children (0-18 years) diagnosed with laryngomalacia in our hospital from January 2016 to January 2022 were enrolled in this study. Clinical data of patients, including general conditions, clinical symptoms, grading and classification, medical comorbidities, surgical efficacy, and the risk factors influencing severe laryngomalacia were retrospectively analyzed. RESULTS: A total of 1810 children were enrolled (male:female; 2.02:1), among which most were infants under 1 year (77.18%). Inspiratory laryngeal stridor (69.56%) was the most common symptom. Most patients had mild laryngomalacia (79.28%), with type IV laryngomalacia being the most common classification (52.27%). Congenital heart disease (37.85%) was the most common medical comorbidity. A total of 168 severe laryngomalacia cases were treated via supraglottoplasty with an effective rate of 83.93%. Notably, preterm birth (OR = 3.868, 95% CI 1.340 ~ 11.168), low birth weight (OR = 4.517, 95% CI 1.477 ~ 13.819) and medical comorbidities (OR = 7.219, 95% CI 2.534 ~ 20.564) were independent risk factors for poor prognosis (P < 0.05). CONCLUSION: Laryngomalacia is common among infants under the age of one, and it is mostly characterized by inspiratory laryngeal stridor with various medical comorbidity. Supraglottoplasty is the first treatment choice for severe laryngomalacia cases with high success rates. However, premature delivery, low birth weight, and medical comorbidities significantly affect the efficacy of surgery.
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Laringomalacia , Laringe , Nacimiento Prematuro , Lactante , Niño , Humanos , Recién Nacido , Masculino , Femenino , Laringomalacia/complicaciones , Laringomalacia/diagnóstico , Laringomalacia/cirugía , Estudios Retrospectivos , Ruidos Respiratorios/etiología , Resultado del Tratamiento , Glotis/cirugíaRESUMEN
Spiking neural network (SNN) simulators play an important role in neural system modeling and brain function research. They can help scientists reproduce and explore neuronal activities in brain regions, neuroscience, brain-like computing, and other fields and can also be applied to artificial intelligence, machine learning, and other fields. At present, many simulators using central processing unit (CPU) or graphics processing unit (GPU) have been developed. However, due to the randomness of connections between neurons and spiking events in SNN simulation, this causes a lot of memory access time. To alleviate this problem, we developed an SNN simulator SWsnn based on the new Sunway SW26010pro processor. The SW26010pro processor consists of six core groups, each with 16 MB of local data memory (LDM). LDM has the characteristics of high-speed read and write, which is suitable for performing simulation tasks similar to SNNs. Experimental results show that SWsnn runs faster than other mainstream GPU-based simulators when simulating a certain scale of neural network, showing a strong performance advantage. To conduct larger scale simulations, SWsnn designed a simulation computation based on a large shared model of Sunway processor and developed a multiprocessor version of SWsnn based on this mode, achieving larger scale SNN simulations.
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Inteligencia Artificial , Redes Neurales de la Computación , Simulación por Computador , Neuronas/fisiología , EncéfaloRESUMEN
BACKGROUND: Cholecystectomy, hepatectomy, and lymphadenectomy are recommended as the curative treatment for resectable gallbladder cancer (GBC). Textbook outcomes in liver surgery (TOLS) is a novel composite measure that has been defined by expert consensus to represent the optimal postoperative course after hepatectomy. This study aimed to determine the incidence of TOLS and the independent predictors associated with TOLS after curative-intent resection in GBC patients. METHODS: All consecutive GBC patients who underwent curative-intent resection between 2014 and 2020 were enrolled from a multicenter database from 11 hospitals as the training and the internal testing cohorts, and Southwest Hospital as the external testing cohort. TOLS was defined as no intraoperative grade greater than or equal to 2 incidents, no grade B/C postoperative bile leaks, no postoperative grade B/C liver failure, no 90-day postoperative major morbidity, no 90-day readmission, no 90-day mortality after hospital discharge, and R0 resection. Independent predictors of TOLS were identified using logistic regression and were used to construct the nomogram. The predictive performance was assessed using the area under the curve and calibration curves. RESULTS: TOLS was achieved in 168 patients (54.4%) and 74 patients (57.8%) from the training and internal testing cohorts, and the external testing cohort, respectively. On multivariate analyses, age less than or equal to 70 years, absence of preoperative jaundice (total bilirubin≤3 mg/dl), T1 stage, N0 stage, wedge hepatectomy, and no neoadjuvant therapy were independently associated with TOLS. The nomogram that incorporated these predictors demonstrated excellent calibration and good performance in both the training and external testing cohorts (area under the curve: 0.741 and 0.726). CONCLUSIONS: TOLS was only achieved in approximately half of GBC patients treated with curative-intent resection, and the constructed nomogram predicted TOLS accurately.
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Carcinoma in Situ , Neoplasias de la Vesícula Biliar , Humanos , Neoplasias de la Vesícula Biliar/cirugía , Hígado , Colecistectomía/efectos adversos , Hepatectomía/efectos adversos , Nomogramas , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios RetrospectivosRESUMEN
Hepatitis B virus (HBV) chronically infects approximately 300 million people worldwide, and permanently repressing transcription of covalently closed circular DNA (cccDNA), the episomal viral DNA reservoir, is an attractive approach toward curing HBV. However, the mechanism underlying cccDNA transcription is only partially understood. In this study, by illuminating cccDNA of wild-type HBV (HBV-WT) and transcriptionally inactive HBV that bears a deficient HBV X gene (HBV-ΔX), we found that the HBV-ΔX cccDNA more frequently colocalizes with promyelocytic leukemia (PML) bodies than that of HBV-WT cccDNA. A small interfering RNA (siRNA) screen targeting 91 PML body-related proteins identified SMC5-SMC6 localization factor 2 (SLF2) as a host restriction factor of cccDNA transcription, and subsequent studies showed that SLF2 mediates HBV cccDNA entrapment in PML bodies by interacting with the SMC5/6 complex. We further showed that the region of SLF2 comprising residues 590 to 710 interacts with and recruits the SMC5/6 complex to PML bodies, and the C-terminal domain of SLF2 containing this region is necessary for repression of cccDNA transcription. Our findings shed new light on cellular mechanisms that inhibit HBV infection and lend further support for targeting the HBx pathway to repress HBV activity. IMPORTANCE Chronic HBV infection remains a major public health problem worldwide. Current antiviral treatments rarely cure the infection, as they cannot clear the viral reservoir, cccDNA, in the nucleus. Therefore, permanently silencing HBV cccDNA transcription represents a promising approach for a cure of HBV infection. Our study provides new insights into the cellular mechanisms that restrict HBV infection, revealing the role of SLF2 in directing HBV cccDNA to PML bodies for transcriptional repression. These findings have important implications for the development of antiviral therapies against HBV.
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Hepatitis B , Leucemia , Humanos , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/metabolismo , ADN Circular/genética , ADN Circular/metabolismo , Antivirales/farmacología , ADN Viral/genética , ADN Viral/metabolismo , Proteína de la Leucemia Promielocítica/genética , Proteína de la Leucemia Promielocítica/metabolismo , Replicación Viral/genética , Proteínas Cromosómicas no Histona/metabolismo , Proteínas de Ciclo Celular/metabolismoRESUMEN
Though common, the extraction of rectal foreign bodies is still a great challenge for surgeons. The foreign body's position can usually be verified by plain abdominal radiography. Given the potential of sexually transmitted disease, screening for HIV, hepatitis, and syphilis is warranted prior to intervention. The utilization and selection of surgical instruments need to be flexible, ingenious, and innovative.