Laparoscopic versus open pancreaticoduodenectomy for pancreatic and periampullary tumor: A meta-analysis of randomized controlled trials and non-randomized comparative studies

ObjectiveThis meta-analysis compares the perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) to those of open pancreaticoduodenectomy (OPD) for pancreatic and periampullary tumors.BackgroundLPD has been increasingly applied in the treatment of pancreatic and periampullary tumors. However, the perioperative outcomes of LPD versus OPD are still controversial.MethodsPubMed, Web of Science, EMBASE, and the Cochrane Library were searched to identify randomized controlled trials (RCTs) and non-randomized comparative trials (NRCTs) comparing LPD versus OPD for pancreatic and periampullary tumors. The main outcomes were mortality, morbidity, serious complications, and hospital stay. The secondary outcomes were operative time, blood loss, transfusion, postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), bile leak (BL), delayed gastric emptying (DGE), lymph nodes harvested, R0 resection, reoperation, and readmission. RCTs were evaluated by the Cochrane risk-of-bias tool. NRCTs were assessed using a modified tool from the Methodological Index for Non-randomized Studies. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD42022338832).ResultsFour RCTs and 35 NRCTs concerning a total of 40,230 patients (4,262 LPD and 35,968 OPD) were included. Meta-analyses showed no significant differences in mortality (OR 0.91, p = 0.35), serious complications (OR 0.97, p = 0.74), POPF (OR 0.93, p = 0.29), PPH (OR 1.10, p = 0.42), BL (OR 1.28, p = 0.22), harvested lymph nodes (MD 0.66, p = 0.09), reoperation (OR 1.10, p = 0.41), and readmission (OR 0.95, p = 0.46) between LPD and OPD. Operative time was significantly longer for LPD (MD 85.59 min, p < 0.00001), whereas overall morbidity (OR 0.80, p < 0.00001), hospital stay (MD −2.32 days, p < 0.00001), blood loss (MD −173.84 ml, p < 0.00001), transfusion (OR 0.62, p = 0.0002), and DGE (OR 0.78, p = 0.002) were reduced for LPD. The R0 rate was higher for LPD (OR 1.25, p = 0.001).ConclusionsLPD is associated with non-inferior short-term surgical outcomes and oncologic adequacy compared to OPD when performed by experienced surgeons at large centers. LPD may result in reduced overall morbidity, blood loss, transfusion, and DGE, but longer operative time. Further RCTs should address the potential advantages of LPD over OPD.Systematic review registrationPROSPERO, identifier CRD42022338832

Utility of Tokyo Guidelines 2018 in early laparoscopic cholecystectomy for mild and moderate acute calculus cholecystitis: A retrospective cohort study

BackgroundTokyo Guidelines 2018 (TG18) proposed laparoscopic cholecystectomy (LC) for acute calculus cholecystitis (ACC) irrespective of the duration of symptoms. This retrospective study assessed the impact of utility of TG18 in early LC for ACC.MethodsFrom 2018 to 2020, 66 patients with mild (grade I) and moderate (grade II) ACC who underwent early surgery were studied. Subgroup analyses were based on timing of surgery and operation time.ResultsA total of 32 and 34 patients were operated within and beyond 7 days since ACC onset. More patients with grade II ACC were in the beyond 7 days group (P < 0.05). More patients with enlarged gallbladder were in the within 7 days group (P < 0.05). The duration of symptoms to admission, symptoms to LC, and operation time were longer in the beyond 7 days group (P < 0.05). There were no significant differences regarding intraoperative blood loss, conversion to bail-out procedures, complication rate, hospital stay, and cost between the two groups (P > 0.05). Longer operation time was significantly associated with duration of symptoms to admission, symptoms to LC, and conversion to laparoscopic subtotal cholecystectomy (LSC) (P < 0.05).ConclusionIn a subset of carefully selected patients, applying TG18 in early LC for mild and moderate ACC results in acceptable clinical outcomes. Standardized safe steps and conversion to LSC in difficult cases are important

A nomogram for predicting severe myelosuppression in small cell lung cancer patients following the first-line chemotherapy

Abstract This study aimed at establishing and validating a nomogram to predict the probability of severe myelosuppression in small cell lung cancer (SCLC) patients following the first-line chemotherapy. A total of 179 SCLC cases were screened as the training group and another 124 patients were used for the validation group. Predictors were determined by the smallest Akaike’s information criterion (AIC) in multivariate logistic regression analysis, leading to a new nomogram. The nomogram was validated in both training and validation groups and the predicting value was evaluated by area under the receiver operating characteristics (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA). Age and tumor staging were extracted as predictors to establish a nomogram, which displayed the AUC values as 0.725 and 0.727 in the training and validation groups, respectively. This nomogram exhibited acceptable calibration curves in the two groups and its prediction added more net benefits than the treat-all scheme and treat-none scheme if the range of threshold probability in the DCA was between 15 and 60% in the training and validation groups. Therefore, the nomogram objectively and accurately predict the occurrence of severe myelosuppression in SCLC patients following the first-line chemotherapy

A Physical Mechanism-Based Model of CoCrFeMnNi High Entropy Alloy Considering Adiabatic Heat Effect for Hot Bulk Forming Processes

Fabrication of a newly developed high entropy alloy is an essential step to enable it to be used as an industrial structure for its potential applications, such as billets, frames and tubes. Bulk forming processes at high temperatures are preferably used requiring the hot flow behavior of the HEA, which needs to be thoroughly investigated for accurate construction of a robust constitutive model and, hence, reliable process simulation and optimizations. In this study, to compensate for the lack of modelling microstructure using conventional phenomenological models, a novel physical mechanism-based model of CoCrFeMnNi high-entropy alloy was established. Particularly, the adiabatic heat effect was taken into account for modelling the HEA for the first time. The hot flow behavior, as well as grain evolution of this alloy under different forming conditions, are well modelled. The modelling predictions obtain great agreement with the experimental results, the calculated R-value (all higher than 0.95) and AARE (all smaller than 0.05) because the different conditions provide validity to the accuracy of the model prediction. In addition, the temperature increase due to deformation heat was well predicted to further evident to the accuracy of model. Furthermore, the hardening behavior during hot deformation was also compared, enabling the provision of useful guides for process designers of hot bulk forming HEAs

A squared <i>M</i>_split similarity transformation method for stable points selection of deformation monitoring network

In order to improve the correctness and robustness of existing stable points selection methods of reference network when there are many unstable points, a robust stable points selection method using squared Msplit similarity transformation is proposed. This method still works when the number of unstable points is close to or even more than the number of stable points. Firstly, the reference points are divided into two groups with square Msplit estimation in the process of calculating the similar transformation parameters of two measurement epochs. Then, by taking the group with more points as stable one, the stable points group is divided into two groups continually until the similarity transformation parameters of the two groups have little difference. Finally, deformation analysis is conducted with the similarity transformation parameters which are calculated with the final stable points group. Experiments are carried out to compare the effect of traditional S transformation, robust S transformation and the proposed method under the condition that there exists some points with large deformation in reference network or the number of unstable points is close to or even more than the number of stable points. And the experimental results show that the proposed method has the highest correctness rate of stable points determination, gets the smallest difference between the calculated deformation and the simulated deformation, and gains the smallest root mean square of coordinates difference of the stable points group between two measurement epochs, which means that the result of the proposed method can correctly reveal the deformation of control points

A precise calibration method for phase center of uplink antenna array considering its actual pointing

With regard to the inferior techniques and poor accuracy of phase center calibration of antenna array, by the power of precise engineering surveying technique, a new calibration method is proposed considering the actual antenna pointing. First of all, an industrial photogrammetric system is utilized to get the coordinates of points on antenna panels in different postures, and the actual pointing of mechanical axis is obtained by least square fitting. On this basis, the coordinates of antenna rotation center are obtained by seeking the intersection of mechanical axes with the matrix method. Finally, the mechanical axis in arbitrary postures is estimated based on inverse-angle weighting interpolation method, and the reliable phase center is obtained by moving a fixed length from the projective center alone the mechanical axis. An uplink antenna array consists of three φ3 m antennas is taken as experimental object, all photogrammetric coordinate systems are unified by the engineering control network, each antenna phase center is precisely calibrated with this proposed method. The effect of electrical signal synthesis shows that this method can effectively compensate the influence of gravity deformation and machining, and enhance the synthetic signal amplitude of uplink antenna array

A systematic review and meta-analysis on the use of traditional Chinese medicine compound kushen injection for bone cancer pain

Abstract Purpose Bone cancer pain presents a clinical challenge with limitations of current treatments. Compound kushen injection (CKI) is a well-known traditional Chinese medicine (TCM) formulation in treatment of patients with bone cancer pain. The objective of this study is to assess the efficacy and safety of CKI for bone cancer pain. Methods A systematic literature search was conducted in nine databases until December 2012 to identify randomized controlled trials (RCTs) of CKI versus current western therapies for bone cancer pain. The primary outcome was total pain relief rate. The secondary outcomes were the quality of life and adverse events at the end of treatment course. The methodological quality of RCTs was assessed independently using six-item criteria according to the Cochrane Collaboration, and the level of evidence was assessed by the GRADE approach. All data were analyzed using Review Manager 5.1.0. Results Seven RCTs with 521 patients from 2010 to 2012 were identified. Compared with radiotherapy or bisphosphonates, seven RCTs showed significant effects of CKI for improving pain relief in patients with bone cancer pain (n =521, risk ratio (RR)=1.25, 95 % CI (95 % confidence intervals (CI)), 1.13 to 1.38, p &lt;0.0001)), three RCTs for improving Karnofsky scoring (KPS) increase rate (n =305, RR=1.62, 95 % CI, 1.32 to 1.99, p &lt;0.00001), 1 RCT for increasing KPS scores (n =78, mean difference (MD) = 10.43, 95 % CI 4.76 to 16.10, p =0.0003). 4 RCTs reported adverse effects in both the treatment and control groups. The patients treated with CKI achieved statistically significant reductions of incidences of leukopenia (n =276, RR=0.32, 95 % CI, 0.21 to 0.47, p &lt;0.00001) and nausea (n =78, RR=0.15, 95 % CI, 0.06 to 0.34, p &lt;0.00001). No severe adverse events were found and no treatment was stopped because of adverse events of CKI in the treatment groups. However, the studies were deemed to have a high risk of bias. Conclusion This systematic review showed positive but weak evidence of CKI for bone cancer pain because of the poor methodological quality and the small quantity of the included trials. Future rigorously designed RCTs are required

Isolation and Characterization of New <i>p</i>‑Terphenyls with Antifungal, Antibacterial, and Antioxidant Activities from Halophilic Actinomycete <i>Nocardiopsis gilva</i> YIM 90087

A new <i>p</i>-terphenyl <b>1</b> and a novel <i>p</i>-terphenyl derivative <b>3</b> bearing a benzothiazole moiety were isolated from halophilic actinomycete <i>Nocardiopsis gilva</i> YIM 90087, along with known <i>p</i>-terphenyl <b>2</b>, antibiotic novobiocin <b>4</b>, cyclodipeptides <b>5–13</b>, and aromatic acids <b>14</b> and <b>15</b>. Their structures were elucidated on the basis of the interpretation of spectral data and by comparison of the corresponding data with those reported previously. The <i>p</i>-terphenyl <b>1</b> showed antifungal activity against the three pathogenic fungi, including <i>Fusarium avenaceum</i>, <i>Fusarium graminearum</i>, and <i>Fusarium culmorum</i>, that caused Fusarium head blight with minimal inhibitory concentrations (MICs) of 8, 16, and 128 μg/mL, respectively. Compound <b>1</b> showed antifungal activity against <i>Candida albicans</i> with a MIC of 32 μg/mL and antibacterial activity against <i>Bacillus subtilis</i> with a MIC of 64 μg/mL. Novobiocin <b>4</b> showed antifungal activity against <i>Pyricularia oryzae</i> with a MIC of 16 μg/mL and antibacterial activity against <i>B. subtilis</i> with a MIC of 16 μg/mL and <i>Staphylococcus aureus</i> with a MIC of 64 μg/mL. The 1,1-diphenyl-2-picryl-hydrazyl assay suggested that <b>1</b>, <b>3</b>, and <b>4</b> exhibited 54.9% (2 mg/mL), 14.3% (4 mg/mL), and 47.7% (2 mg/mL) free radical scavenging activity, respectively. The positively charged 2,2′-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid radical (ABTS^+•) scavenging assay indicated that <b>1</b>, <b>3</b>, <b>4</b>, and <b>8</b> exhibited 68.6% (1 mg/mL), 28.4% (2 mg/mL), 78.2% (0.5 mg/mL), and 54.6% (2 mg/mL) ABTS^+• scavenging capacity, respectively. The superoxide anion radical scavenging assay suggested that <b>4</b> exhibited 77.9% superoxide anion radical scavenging capacity at 2 mg/mL. <i>N. gilva</i> YIM 90087 is a new resource for novobiocin <b>4</b>