Safety and feasibility of laparoscopic radical resection for bismuth types III and IV hilar cholangiocarcinoma: a single-center experience from China

BackgroundSurgery represents the only cure for hilar cholangiocarcinoma (HC). However, laparoscopic radical resection remains technically challenging owing to the complex anatomy and reconstruction required during surgery. Therefore, reports on laparoscopic surgery (LS) for HC, especially for types III and IV, are limited. This study aimed to evaluate the safety and feasibility of laparoscopic radical surgery for Bismuth types III and IV HC.MethodsThe data of 16 patients who underwent LS and 9 who underwent open surgery (OS) for Bismuth types III and IV HC at Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, between December 2017 and January 2022 were analyzed. Basic patient information, Bismuth–Corlette type, AJCC staging, postoperative complications, pathological findings, and follow-up results were evaluated.ResultsSixteen patients underwent LS and 9 underwent OS for HC. According to the preoperative imaging data, there were four cases of Bismuth type IIIa, eight of type IIIb, and four of type IV in the LS group and two of type IIIa, four of type IIIb, and three of type IV in the OS group (P>0.05). There were no significant differences in age, sex, ASA score, comorbidity, preoperative percutaneous transhepatic biliary drainage rate, history of abdominal surgery, or preoperative laboratory tests between the two groups (P>0.05). Although the mean operative time and mean intraoperative blood loss were higher in the LS group than in OS group, the differences were not statistically significant (P=0.121 and P=0.115, respectively). Four patients (25%) in the LS group and two (22.2%) in the OS group experienced postoperative complications (P>0.05). No significant differences were observed in other surgical outcomes and pathologic findings between the two groups. Regarding the tumor recurrence rate, there was no difference between the groups (P>0.05) during the follow-up period (23.9 ± 13.3 months vs. 17.8 ± 12.3 months, P=0.240).ConclusionLaparoscopic radical resection of Bismuth types III and IV HC remains challenging, and extremely delicate surgical skills are required when performing extended hemihepatectomy followed by complex bilioenteric reconstructions. However, this procedure is generally safe and feasible for hepatobiliary surgeons with extensive laparoscopy experience

Molecular Epidemiology of Rabies in Southern People’s Republic of China

Migration and transport of dogs may have caused recent epidemics of human rabies

Research progress in CT and MR for quantitative diagnosis of liver fibrosis

Liver fibrosis is a repair response to liver damage caused by various factors, as well as an intermediate stage between chronic liver diseases and liver cirrhosis. The development of liver fibrosis is a latent, gradual, and reversible process. Timely, accurate diagnosis of liver fibrosis is of great significance for the treatment outcome and prognosis of patients. With the development of imaging techniques, noninvasive quantitative diagnosis of liver fibrosis has attracted more and more attention. Various techniques of CT and MR for diagnosis of liver fibrosis are summarized, and the advantages and disadvantages are compared between these techniques. Our results show that CT and MR can be used for quantitative assessment of liver fibrosis and that MR is very likely to be used instead of invasive biopsy in the future due to its advantages of no radiation, high resolution, and good repeatability

Portable Bulk-Water Disinfection by Live Capture of Bacteria with Divergently Branched Porous Graphite in Electric Fields

An easy access to clean water pivots function and development of a modern society. However, it remains arduous to develop energy-efficient, facile, and portable water treatment systems for point-of-use (POU) applications, which is particularly imperative for the safety and resilience of a society during extreme weathers and critical events. Here, we report an innovative working scheme and device prototype for water disinfection via directly capturing and removing pathogen cells from bulk water using strategically designed three-dimensional (3D) porous dendritic graphite foams (PDGF) in an AC field. The prototype, integrated in a 3D-printed portable water-purification module, can reproducibly remove 99.997 % E-coli bacteria in bulk water at only a few voltages with among the lowest energy consumption of 435.5 J·L-1. The unique PDGF foams, costing at only $1.42 per piece, can robustly operate for at least 20 times without functional degradation. Furthermore, we successfully unveil the unique disinfection mechanism with one-dimensional Brownian dynamics simulation. Finally, the system is applied and practically brings natural water in the Waller Creek at UT Austin to the safe drinking level. This research, including the innovative working mechanism based on dendritically porous graphite and the design scheme, could inspire a new device paradigm for POU water treatment

The Impact of Load Style Variation on Gait Recognition Based on sEMG Images Using a Convolutional Neural Network

Surface electromyogram (sEMG) signals are widely employed as a neural control source for lower-limb exoskeletons, in which gait recognition based on sEMG is particularly important. Many scholars have taken measures to improve the accuracy of gait recognition, but several real-time limitations affect its applicability, of which variation in the load styles is obvious. The purposes of this study are to (1) investigate the impact of different load styles on gait recognition; (2) study whether good gait recognition performance can be obtained when a convolutional neural network (CNN) is used to deal with the sEMG image from sparse multichannel sEMG (SMC-sEMG); and (3) explore whether the control system of the lower-limb exoskeleton trained by sEMG from part of the load styles still works efficiently in a real-time environment where multiload styles are required. In addition, we discuss an effective method to improve gait recognition at the levels of the load styles. In our experiment, fifteen able-bodied male graduate students with load (20% of body weight) and using three load styles (SBP = backpack, SCS = cross shoulder, SSS = straight shoulder) were asked to walk uniformly on a treadmill. Each subject performed 50 continuous gait cycles under three speeds (V3 = 3 km/h, V5 = 5 km/h, and V7 = 7 km/h). A CNN was employed to deal with sEMG images from sEMG signals for gait recognition, and back propagation neural networks (BPNNs) and support vector machines (SVMs) were used for comparison by dealing with the same sEMG signal. The results indicated that (1) different load styles had remarkable impact on the gait recognition at three speeds under three load styles (p p = 0.002), from which it can be concluded that the control system of a lower-limb exoskeleton trained by sEMG using only some load styles is not sufficient in a real-time environment

TiO2 modified FeS Nanostructures with Enhanced Electrochemical Performance for Lithium-Ion Batteries

Anatase TiO(2) modified FeS nanowires assembled by numerous nanosheets were synthesized by using a typical hydrothermal method. The carbon-free nanocoated composite electrodes exhibit improved reversible capacity of 510 mAh g(−1) after 100 discharge/charge cycles at 200 mA g(−1), much higher than that of the pristine FeS nanostructures, and long-term cycling stability with little performance degradation even after 500 discharge/charge cycles at current density of 400 mA g(−1). Full batteries fabricated using the FeS@TiO(2) nanostructures anode and the LiMn(2)O(4) nanowires cathode with excellent stability, and good rate capacities could also be achieved. The enhanced electrochemical performance of the composite electrodes can be attributed to the improved conductively of the integrated electrodes and the enhanced kinetics of lithium insertion/extraction at the electrode/electrolyte interface because of the incorporation of anatase TiO(2) phase

Pleural Effusions on MRI in Autosomal Dominant Polycystic Kidney Disease

Autosomal dominant polycystic kidney disease (ADPKD) has cystic fluid accumulations in the kidneys, liver, pancreas, arachnoid spaces as well as non-cystic fluid accumulations including pericardial effusions, dural ectasia and free fluid in the male pelvis. Here, we investigate the possible association of ADPKD with pleural effusion. ADPKD subjects (n = 268) and age-gender matched controls without ADPKD (n = 268) undergoing body magnetic resonance imaging from mid-thorax down into the pelvis were independently evaluated for pleural effusion by 3 blinded expert observers. Subjects with conditions associated with pleural effusion were excluded from both populations. Clinical and laboratory data as well as kidney, liver and spleen volume, pleural fluid volume, free pelvic fluid and polycystic kidney disease genotype were evaluated. Pleural effusions were observed in 56 of 268 (21%) ADPKD subjects compared with 21 of 268 (8%) in controls (p p p = 0.02) and in males were weakly correlated with the presence of free pelvic fluid (r = 0.24, p = 0.02). ADPKD subjects with pleural effusions were younger (48 ± 14 years old vs. 43 ± 14 years old) and weighed less (77 vs. 70 kg; p ≤ 0.02) than those without pleural effusions. For ADPKD subjects with pleural effusions, the mean volume of fluid layering dependently in the posterior–inferior thorax was 19 mL and was not considered to be clinically significant. Pleural effusion is associated with ADPKD, but its role in the pathogenesis of ADPKD requires further evaluation

Evaluating the efficacy and timing of blood purification modalities in early-stage hyperlipidemic acute pancreatitis treatment

Abstract Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is characterized by a violent cytokine storm-driven inflammation and is associated with a predisposition to severe disease. The treatment strategy for HTG-AP consists mainly of conventional symptomatic and lipid-lowering treatments. For early-stage HTG-AP, blood purification (BP) can rapidly and effectively reduce serum triglyceride and inflammatory cytokine levels, block the development of systemic inflammatory response syndrome, and improve patient outcomes. Currently, the primary modalities for BP in patients with HTG-AP include plasma exchange, hemoperfusion, and hemofiltration. When using BP to treat patients with HTG-AP, a comprehensive analysis incorporating the elevated lipid levels and severity of the patient’s condition contributes to the selection of different treatment modes. Moreover, the timing of the treatment is also imperative. Early intervention is associated with a better prognosis for patients with HTG-AP requiring lipid-lowering treatment