AIM To compare intravoxel incoherent motion(IVIM)-derived parameters with conventional diffusion-weighted imaging(DWI) parameters in predicting the histological grade of hepatocellular carcinoma(h CC) and to evaluate ...AIM To compare intravoxel incoherent motion(IVIM)-derived parameters with conventional diffusion-weighted imaging(DWI) parameters in predicting the histological grade of hepatocellular carcinoma(h CC) and to evaluate the correlation between the parameters and the histological grades.METHODS A retrospective study was performed. Sixty-two patients with surgically confirmed h CCs underwent diffusion-weighted magnetic resonance imaging with twelve b values(10-1200 s/mm^2). The apparent diffusion coefficient(ADC), pure diffusion coefficient(D), pseudo-diffusion coefficient(D*), and perfusion fraction(f) were calculated by two radiologists. The IVIM and conventional DWI parameters were compared among the different grades by using analysis of variance(ANOVA) and the Kruskal-Wallis test. Receiver operating characteristic(ROC) analysis was performed to evaluate the diagnostic efficiency of distinguishing between low-grade(grade 1, G1) and high-grade(grades 2 and 3, G2 and G3) hC C. The correlation between the parameters and the histological grades was assessed by using the Spearman correlation test. Bland-Altman analysis was used to evaluate the reproducibility of the two radiologists' measurements.RESULTS The differences in the ADC and D values among the groups with G1, G2, and G3 histological grades of HCCs were statistically significant(P < 0.001). The D* and f values had no significant differences among the different histological grades of h CC(P > 0.05). The ROC analyses demonstrated that the D and ADC values had better diagnostic performance in differentiating the low-grade h CC from the high-grade h CC, with areas under the curve(AUCs) of 0.909 and 0.843, respectively, measured by radiologist 1 and of 0.911 and 0.852, respectively, measured by radiologist 2. The following significant correlations were obtained between the ADC, D, and D~* values and the histological grades: r =-0.619(P < 0.001), r =-0.628(P < 0.001), and r =-0.299(P = 0.018), respectively, as measured by radiologist 1; r =-0.622(P < 0.001), r =-0.63展开更多
In this paper, a new adaptive fuzzy backstepping control approach is developed for a class of nonlinear systems with unknown time-delay and unmeasured states. Using fuzzy logic systems to approximate the unknown nonli...In this paper, a new adaptive fuzzy backstepping control approach is developed for a class of nonlinear systems with unknown time-delay and unmeasured states. Using fuzzy logic systems to approximate the unknown nonlinear functions, a fuzzy state observer is designed for estimating the unmeasured states. On the basis of the state observer and applying the backstepping technique, an adaptive fuzzy observer control approach is developed. The main features of the proposed adaptive fuzzy control approach not only guarantees that all the signals of the closed-loop system are semiglobally uniformly ultimately bounded, but also contain less adaptation parameters to be updated on-line. Finally, simulation results are provided to show the effectiveness of the proposed approach.展开更多
By means of matrix decomposition method a criterion is presented for the admissibility of T-S fuzzy descriptor system. Then, the problem of passivity control is studied for a kind of T-S fuzzy descriptor system with u...By means of matrix decomposition method a criterion is presented for the admissibility of T-S fuzzy descriptor system. Then, the problem of passivity control is studied for a kind of T-S fuzzy descriptor system with uncertain parameters, and sufficient conditions which make the closed-loop system admissible and strictly passive are obtained based on linear matrix inequality (LMI). The nonstrict LMIs restricted conditions which characterize the descriptor system are transformed into strict ones, so testing admissibility and passivity of the system can be finished simultaneously. The design scheme of state feedback controller is also obtained. Finally, a numerical example is given to show the validity and feasibility of the proposed approach.展开更多
Ice-water-structure interaction (IWSI) is a novel extension of the fluid-structure interaction (FSI), which is significant fordesign and operating of polar ship and offshore structures. It involves multi-media and mul...Ice-water-structure interaction (IWSI) is a novel extension of the fluid-structure interaction (FSI), which is significant fordesign and operating of polar ship and offshore structures. It involves multi-media and multi-interfaces and thus is quite complicated tosolve, no matter from mathematical or mechanical perspectives. Although IWSI is complex and still very new, researchers try todevelop various methods to deal with it and relevant literature starts to bloom. This paper aims to provide concise descriptions oftypical analytical numerical and experimental methods to solve IWSI, together with a review of their major applications to date. Lastly,we succinctly highlight some development tendencies and some pieces of work to be investigated for each method.展开更多
Background Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now. Methods We retrospectively analyzed...Background Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now. Methods We retrospectively analyzed the clinical data of 34 cases of total laparoscopic choledochal cyst excision between January 2007 and August 2011. All patients underwent in vitro Roux-en-Y hepatoenterostomy. Results All 34 patients underwent successful total laparoscopic choledochal cyst excision. The operation time was 200-360 minutes. The duration of hospital stay was 3-7 days. Follow-up observations lasted 1-56 months. One patient developed an anastomotic stoma stricture, but no other cases had postoperative complications. No patients died. Conclusion Total laparoscopic choledochal cyst excision is safe and feasible.展开更多
BACKGROUND The relationship between preoperative inflammation status and tumorigenesis as well as tumor progression is widely acknowledged.AIM To assess the prognostic significance of preoperative inflammatory biomark...BACKGROUND The relationship between preoperative inflammation status and tumorigenesis as well as tumor progression is widely acknowledged.AIM To assess the prognostic significance of preoperative inflammatory biomarkers in patients with distal cholangiocarcinoma(dCCA)who underwent pancreat-oduodenectomy(PD).METHODS This single-center study included 216 patients with dCCA after PD between January 1,2011,and December 31,2022.The individuals were categorized into two sets based on their systemic inflammatory response index(SIRI)levels:A low SIRI group(SIRI<1.5,n=123)and a high SIRI group(SIRI≥1.5,n=93).Inflam-matory biomarkers were evaluated for predictive accuracy using receiver operating characteristic curves.Both univariate and multivariate Cox proportional hazards analyses were performed to estimate SIRI for overall survival(OS)and recurrence-free survival(RFS).RESULTS The study included a total of 216 patients,with 58.3%being male and a mean age of 65.6±9.6 years.123 patients were in the low SIRI group and 93 were in the high SIRI group after PD for dCCA.SIRI had an area under the curve value of 0.674 for diagnosing dCCA,showing better performance than other inflammatory biomarkers.Multivariate analysis indicated that having a SIRI greater than 1.5 independently increased the risk of dCCA following PD,leading to lower OS[hazard ratios(HR)=1.868,P=0.006]and RFS(HR=0.949,P<0.001).Additionally,survival analysis indicated a significantly better prognosis for patients in the low SIRI group(P<0.001).CONCLUSION It is determined that a high SIRI before surgery is a significant risk factor for dCCA after PD.展开更多
Introduction The immune system is the cornerstone of human health,with most diseases and health conditions closely related to immune status.Therefore,immune status management is a core health issue.In recent years,sig...Introduction The immune system is the cornerstone of human health,with most diseases and health conditions closely related to immune status.Therefore,immune status management is a core health issue.In recent years,significant research breakthroughs in immunosuppressants,immune cell therapy,and immune checkpoint inhibitors have enabled clinical experts and researchers to effectively modulate immune status and regulate immunity more efficient.Key questions in the field of immunology include:How can immune function be visually assessed?What constitutes normal immune cell function status?How can immune cell function status be quantitatively evaluated?How can a standardized system for assessing immune cell function status be established?Currently,there is no consensus on these issues worldwide.On August 28,2023,the National Natural Science Foundation of China announced the National Major Research Plan:Immune Power Digital Decoding Research.Traditional research models have failed to systematically reveal the generation and evolution of immune power.展开更多
BACKGROUND Distal cholangiocarcinoma(DCC)presents as one of the relatively rare malignant tumors in the digestive system and has a poor long-term prognosis.Curative resection is currently the most appropriate therapy ...BACKGROUND Distal cholangiocarcinoma(DCC)presents as one of the relatively rare malignant tumors in the digestive system and has a poor long-term prognosis.Curative resection is currently the most appropriate therapy for patients with DCC because of the lack of effective adjuvant therapies.Therefore,it is important to accurately predict the prognosis for formulating a reasonable treatment plan and avoiding unnecessary surgical trauma.AIM To minimize the interference of obstructive jaundice on carbohydrate antigen 19-9(CA19-9)level by adapting CA19-9 toγ-glutamyltransferase(GGT)as an indicator,to determine the strong associations between CA19-9/GGT and postoperative neoplasm recurrence and long-term outcome of DCC.METHODS We enrolled 186 patients who were diagnosed with DCC between January 2010 and December 2019 and performed radical excision with strict criteria as follows in our hospital.Receiver operating characteristic curves were drawn according to preoperative CA19-9/GGT and 1-year survival.Based on this,patients were divided into two groups(group 1,low-ratio,n=81;group 2,high-ratio,n=105).Afterwards,by the way of univariate and multivariate analysis,the risk factors influencing postoperative tumor recrudesce and long-term prognosis of patients with DCC were screened out.RESULTS Optimum cut-off value of CA19-9/GGT was 0.12.Patients in group 2 represented higher CA19-9 and lymphatic metastasis rate accompanied by lower GGT,when compared with group 1(P<0.05).The 1-,3-and 5-year overall survival rates of patients in groups 1 and 2 were 88.3%,59.2%and 48.1%,and 61.0%,13.6%and 13.6%,respectively(P=0.000).Multivariate analysis indicated that CA19-9/GGT,lymphatic metastasis and tumor differentiation were independent risk factors for tumor recurrence and long-term prognosis of DCC.CONCLUSION Elevation of CA19-9/GGT performed better as a biomarker of aggressive carcinoma and predictor of poor clinical outcomes by reducing the effect of obstruction of biliary tract on CA19-9 concentration in patients with DCC.展开更多
Background Liver transplantation is the most effective treatment for end-stage liver diseases; however, infections after transplantation can seriously affect the patient＇s health. The aim of this research was to inve...Background Liver transplantation is the most effective treatment for end-stage liver diseases; however, infections after transplantation can seriously affect the patient＇s health. The aim of this research was to investigate the diagnosis and treatment of fungal infection following liver transplantation.展开更多
Cholangiocarcinoma is a malignancy derived from biliary epithelial cells,a relatively rare but highly malignant type of malignancy.Cholangiocarcinoma located below the convergence of gallbladder duct and common hepati...Cholangiocarcinoma is a malignancy derived from biliary epithelial cells,a relatively rare but highly malignant type of malignancy.Cholangiocarcinoma located below the convergence of gallbladder duct and common hepatic duct is defined as distal cholangiocarcinoma(dCCA),accounting for 20-30%of total cholangiocarcinoma.In spite of the highly developed adjuvant therapy,surgical treatment remains the core in dCCA treatment,and radical pancreaticoduodenectomy is still the only potential cure for dCCA.However,the overall prognosis of dCCA after radical surgery is still unsatisfying,with a post-operative 5-year survival rate less than 40%.展开更多
In this paper, a new fuzzy-neural adaptive control approach is developed for a class of single-input and single-output （SISO） nonlinear systems with unmeasured states. Using fuzzy neural networks to approximate the ...In this paper, a new fuzzy-neural adaptive control approach is developed for a class of single-input and single-output （SISO） nonlinear systems with unmeasured states. Using fuzzy neural networks to approximate the unknown nonlinear functions, a fuzzy- neural adaptive observer is introduced for state estimation as well as system identification. Under the framework of the backstepping design, fuzzy-neural adaptive output feedback control is constructed recursively. It is proven that the proposed fuzzy adaptive control approach guarantees the global boundedness property for all the signals, driving the tracking error to a small neighbordhood of the origin. Simulation example is included to illustrate the effectiveness of the proposed approach.展开更多
Background：Surgical resection is generally considered the main curative treatment for intrahepatic biliary cystadenocarcinoma （IBCA） or suspected IBCAs,but controversy exists regarding the prognosis for IBCAs.This ...Background：Surgical resection is generally considered the main curative treatment for intrahepatic biliary cystadenocarcinoma （IBCA） or suspected IBCAs,but controversy exists regarding the prognosis for IBCAs.This study aimed to describe the clinicopathological characteristics of IBCA and identify prognostic factors that may influence the survival of patients treated with surgical procedures.Methods：Thirty-four patients with histologically confirmed IBCA treated between January 2000 and June 2014 were included.The clinical characteristics of patients with IBCA were compared with those of 41 patients with intrahepatic biliary cystadenoma （IBC）;factors that significant difference were analyzed for prognosis analysis of IBCA using multivariate/univariate Cox proportional hazards regression models.Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank test.Results：IBCAs had a strong female predominance,and the most common presenting symptoms were abdominal pain or discomfort.Compared with IBCs,IBCAs occurred in older patients,in more male patients,and were associated statistically significant abnormal increase in alanine aminotransferase （P =0.01） and total bilirubin （P =0.04）.Mural nodules were more frequently seen with IBCAs and may associate with malignancy.It was difficult to differentiate between IBC and IBCA based on laboratory examination and imaging findings.Although complete resection is recommended,enucleation with negative margins also achieved good outcomes.Median overall patient survival was 76.2 months;survival at 1,3,and 5 years was 88.0％,68.7％,and 45.8％,respectively.Radical resection and noninvasive tumor type were independent prognostic factors for overall survival.Conclusions：It remains difficult to distinguish between cystadenomas and cystadenocarcinomas based on laboratory examination and image findings.Complete resection is recommended for curative treatment,and patients should be closely followed postoperatively,particularly t展开更多
In this paper, an adaptive fuzzy robust feedback control approach is proposed for a class of single-input and singleoutput （SISO） strict-feedback nonlinear systems with unknown nonlinear functions, time delays, unkn...In this paper, an adaptive fuzzy robust feedback control approach is proposed for a class of single-input and singleoutput （SISO） strict-feedback nonlinear systems with unknown nonlinear functions, time delays, unknown high-frequency gain sign, and without the measurements of the states. In the backstepping recursive design, fuzzy logic systems are employed to approximate the unknown smooth nonlinear functions, K-filters is designed to estimate the unmeasured states, and Nussbaum gain functions are introduced to solve the problem of unknown sign of high-frequency gain. By combining adaptive fuzzy control theory and adaptive backstepping design, a stable adaptive fuzzy output feedback control scheme is developed. It has been proven that the proposed adaptive fuzzy robust control approach can guarantee that all the signals of the closed-loop system are uniformly ultimately bounded and the tracking error can converge to a small neighborhood of the origin by appropriately choosing design parameters. Simulation results have shown the effectiveness of the proposed method.展开更多
BACKGROUND Biliary adenofibromas(BAFs)are rare primary hepatic neoplasms,some of which can potentially undergo malignant transformation.Here,we describe a rare case of malignant transformation of BAF.CASE SUMMARY A 51...BACKGROUND Biliary adenofibromas(BAFs)are rare primary hepatic neoplasms,some of which can potentially undergo malignant transformation.Here,we describe a rare case of malignant transformation of BAF.CASE SUMMARY A 51-year-old female was referred to our hospital with epigastric pain.Computed tomography showed a solitary liver mass combined with the enlargement of multiple mediastinal and cervical lymph nodes,clinically mimicking a liver carcinoma with extensive lymph node metastasis.However,core needle biopsy suggested BAF with malignant transformation.Finally,the patient underwent curative resection of the neoplasm and was recurrence-free for 12 mo.CONCLUSION Our case serves as an example of a rare manifestation of BAF.Our report and the previously published experience,reinforce that curative resection should be considered the primary treatment for BAFs with malignant transformation,leading to a favorable prognosis.展开更多
Objective:With the increasing application of vascular reconstruction in surgical procedures,allogeneic vessels are becoming more popular in clinical practice due to their abundant sources,precise diameter matching,imp...Objective:With the increasing application of vascular reconstruction in surgical procedures,allogeneic vessels are becoming more popular in clinical practice due to their abundant sources,precise diameter matching,improved histocompatibility,and higher long-term patency rate.This study aimed to investigate the protective effect of various preservation solutions on the function and structure of the isolated rat abdominal aorta preserved under hypothermal conditions.Methods:The study utilized a total of 150 Sprague-Dawley(SD)rats,with 144 rats allocated to the experimental groups and 6 rats allocated to the control groups.The abdominal aorta of the rats was chosen as the subject of our research.The aorta in the experimental groups were randomly assigned to 4 groups:University of Wisconsin(UW)solution group,histidine-tryptophan-ketoglutarate(HTK)solution group,normal saline(NS)group,and sodium lactate Ringer's solution(RS)group.Samples were subjected to examination after preservation periods of 1 day,3 days,5 days,7 days,14 days,30 days,and 90 days.Evaluation of vascular physiological function involved detecting and assessing vasoconstriction ability and measuring cell viability through the MTT test.Evaluation of the vascular wall structure involved tension tolerance tests and pathological staining.Results:The pathogen-positive rate in the HTK group and NS group at 1 month was 16.7%.Regarding the vascular skeleton structure,both the UW group and HTK group exhibited intact structures after 2 weeks of preservation,with slightly edematous collagen and elastic fibers,which was significantly better than that of the NS group and RS group.In terms of cell activity and contractile function,all preservation groups showed similar effects within 2 weeks.However,after 2 weeks,the UW group showed the most favorable preservation effect(P<0.05).In terms of vascular tension,different groups exhibited similar effects within 1 week.However,after 2 weeks,the UW group showed the best preservation effect(P<0.05).Conclusion:All 4 types o展开更多
Many industrial processes such as heating furnaces have over damping dynamic characteristics. Based on an innovative impulse response model, a method of identification and control for the over damping plant is introdu...Many industrial processes such as heating furnaces have over damping dynamic characteristics. Based on an innovative impulse response model, a method of identification and control for the over damping plant is introduced in the paper. The number of parameters of the model is much less than conventional impulse response model. The model based on tuning procedure of numerical optimum PID controller parameters is presented. For an actual instance, a large scale airflow circulatory resistance furnace control system with cascades of time delays is developed. In the system, the optimum PID control is used in the inner loop. A nonlinear PI compensation control is applied in the outer loop. The coordinating control among each output is realized by a fuzzy control strategy. A process surveillance organization monitors running situation of system and tunes controller parameters.展开更多
Objective Patients undergoing liver transplantation for hepatocellular carcinoma(HCC)within the Milan criteria have an excellent outcome.We developed a program to analyze and prove that the Milan criteria can be expan...Objective Patients undergoing liver transplantation for hepatocellular carcinoma(HCC)within the Milan criteria have an excellent outcome.We developed a program to analyze and prove that the Milan criteria can be expanded safely and effectively.Methods We retrospectively reviewed 117 HCC patients treated with liver transplantation between January 2013 and December 2017.Patients were grouped according to the Milan criteria,the University of California,San Francisco(UCSF)criteria,Up-to-seven criteria and Hangzhou criteria.Tumor-free and overall survival rates were investigated with a Kaplan-Meier analysis.Multivariable regression Cox models produced survival estimates for the patients that exceeded the Milan criteria.Results The 1-year,3-year and 5-year overall survival rates of patients fulfilling the Milan criteria(n=44)were 100%,87.5%and 78.9%,respectively.Compared with the Milan criteria,the UCSF criteria(n=50),Up-to-seven criteria(n=51)and Hangzhou criteria(n=86)provided an expansion of 13.6%,15.9%and 95.9%,respectively.The 1-year,3-year and 5-year overall survival rates of patients fulfilling UCSF criteria,Up-to-seven criteria and Hangzhou criteria were 96.0%,84.9%,76.9%;96.1%,85.2%,77.6%and 97.7%,83.9%,66.7%,respectively(P>0.05).Multifactor Cox regression showed that tumor diameter and microvascular invasion were independent risk factors for survival in patients that exceeded the Milan criteria.Conclusion Compared with the Milan criteria,the Hangzhou criteria can safely expand the scope of liver transplantation for HCC to a certain extent.By contrast,the UCSF criteria and Up-to-seven criteria result in a limited number of patients which need further expansion.Tumor diameter and microvascular invasion were the independent risk factors for survival in patients that exceeded the Milan criteria.展开更多
Objective： To discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose a classification protocol for ischemic contracture in the lower limb based on its severity and progn...Objective： To discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose a classification protocol for ischemic contracture in the lower limb based on its severity and prognosis. Methods： Atotal of 42 patients with ischemic contracture in the lower limb were included in this study. According to different types of disturbance and degrees of severity, surgical reconstructions consisting of nerve decompression, tendon lengthening or transfer, intrinsic foot muscle release and sural-tibial nerve anastomosis were performed in every patient. Results： Postoperatively, all patients were able to walk on flat ground. Drop foot was corrected in 10 patients, and 5 patients still felt some difficulty during stair activity. Split Achilles tendon transfer to flexor hallucis longus tendon was performed in 12 patients, and their walking stability was improved. Seven patients accepted ipsilateral suraltibial nerve anastomosis, and sensitivity recovery reached to S2 in 2 patients and S3 in 5 patients. Conclusions： Iscbemic contracture in the lower limb is a devastating complication after lower limb trauma. The prevention of contracture is much more important than the treatment of an established contracture. Split Achilles tendon transfer to flexor hallucis longus tendon and sural-tibial nerve anastomosis, which was initially implemented by us, could improve the functional recovery of ischemic contracture in lower limbs, and thus provides a new alternative for functional reconstruction of ischemic contracture in the lower limb.展开更多
BACKGROUND As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas(PHCs)of different T stages,selective extended lymphadenectomy(ELD)performance may improve the prognosis of patients with PHC...BACKGROUND As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas(PHCs)of different T stages,selective extended lymphadenectomy(ELD)performance may improve the prognosis of patients with PHC.AIM To investigate the effect of ELD on the long-term prognosis of patients with PHC of different T stages.METHODS We analyzed data from 216 patients with PHC who underwent surgery at our hospital between January 2011 and December 2021.The patients were divided into extended and standard lymphadenectomy(SLD)groups according to extent of lymphadenectomy and into T1,T2,and T3 groups according to the 8 th edition of the American Joint Committee on Cancer’s staging system.Perioperative data and prognoses were compared among groups.Risk factors associated with prognoses were identified through univariate and multivariate analyses.RESULTS The 1-,2-and 3-year overall survival(OS)rates in the extended and SLD groups were 69.0%,39.5%,and 26.8%and 55.1%,32.6%,and 22.1%,respectively(P=0.073).The 1-,2-and 3-year disease-free survival rates in the extended and SLD groups of patients with stage-T3 PHC were 50.3%,25.1%,and 15.1%and 22.1%,1.7%,and 0%,respectively(P=0.025);the corresponding OS rates were 65.3%,38.1%,and 21.8%and 36.1%,7.5%,and 0%,respectively(P=0.073).Multivariate analysis indicated that portal vein invasion and lymphadenectomy extent were risk factors for prognosis in patients with stage-T3 PHC.CONCLUSION ELD may improve the prognosis of patients with stage-T3 PHC and may be of benefit if performed selectively.展开更多
文摘AIM To compare intravoxel incoherent motion(IVIM)-derived parameters with conventional diffusion-weighted imaging(DWI) parameters in predicting the histological grade of hepatocellular carcinoma(h CC) and to evaluate the correlation between the parameters and the histological grades.METHODS A retrospective study was performed. Sixty-two patients with surgically confirmed h CCs underwent diffusion-weighted magnetic resonance imaging with twelve b values(10-1200 s/mm^2). The apparent diffusion coefficient(ADC), pure diffusion coefficient(D), pseudo-diffusion coefficient(D*), and perfusion fraction(f) were calculated by two radiologists. The IVIM and conventional DWI parameters were compared among the different grades by using analysis of variance(ANOVA) and the Kruskal-Wallis test. Receiver operating characteristic(ROC) analysis was performed to evaluate the diagnostic efficiency of distinguishing between low-grade(grade 1, G1) and high-grade(grades 2 and 3, G2 and G3) hC C. The correlation between the parameters and the histological grades was assessed by using the Spearman correlation test. Bland-Altman analysis was used to evaluate the reproducibility of the two radiologists' measurements.RESULTS The differences in the ADC and D values among the groups with G1, G2, and G3 histological grades of HCCs were statistically significant(P < 0.001). The D* and f values had no significant differences among the different histological grades of h CC(P > 0.05). The ROC analyses demonstrated that the D and ADC values had better diagnostic performance in differentiating the low-grade h CC from the high-grade h CC, with areas under the curve(AUCs) of 0.909 and 0.843, respectively, measured by radiologist 1 and of 0.911 and 0.852, respectively, measured by radiologist 2. The following significant correlations were obtained between the ADC, D, and D~* values and the histological grades: r =-0.619(P < 0.001), r =-0.628(P < 0.001), and r =-0.299(P = 0.018), respectively, as measured by radiologist 1; r =-0.622(P < 0.001), r =-0.63
基金supported by National Natural Science Foundation of China (No.60674056)Outstanding Youth Funds of Liaoning Province (No.2005219001)Educational Department of Liaoning Province (No.2006R29,No.2007T80)
文摘In this paper, a new adaptive fuzzy backstepping control approach is developed for a class of nonlinear systems with unknown time-delay and unmeasured states. Using fuzzy logic systems to approximate the unknown nonlinear functions, a fuzzy state observer is designed for estimating the unmeasured states. On the basis of the state observer and applying the backstepping technique, an adaptive fuzzy observer control approach is developed. The main features of the proposed adaptive fuzzy control approach not only guarantees that all the signals of the closed-loop system are semiglobally uniformly ultimately bounded, but also contain less adaptation parameters to be updated on-line. Finally, simulation results are provided to show the effectiveness of the proposed approach.
基金Supported by National Natural Science Foundation of P. R, China (60574011)the Distinguished Teacher Funds of Liaoning Universities (124210)the Key Laboratory Funds of Liaoning Universities of Intelligent Control Theory and Applications
文摘By means of matrix decomposition method a criterion is presented for the admissibility of T-S fuzzy descriptor system. Then, the problem of passivity control is studied for a kind of T-S fuzzy descriptor system with uncertain parameters, and sufficient conditions which make the closed-loop system admissible and strictly passive are obtained based on linear matrix inequality (LMI). The nonstrict LMIs restricted conditions which characterize the descriptor system are transformed into strict ones, so testing admissibility and passivity of the system can be finished simultaneously. The design scheme of state feedback controller is also obtained. Finally, a numerical example is given to show the validity and feasibility of the proposed approach.
基金Supported by the National Key Research and Development Program of China(Grant No.2017YFE0111400)the National Natural Science Foundation of China(Grant Nos.51979051,51979056 and 51639004).
文摘Ice-water-structure interaction (IWSI) is a novel extension of the fluid-structure interaction (FSI), which is significant fordesign and operating of polar ship and offshore structures. It involves multi-media and multi-interfaces and thus is quite complicated tosolve, no matter from mathematical or mechanical perspectives. Although IWSI is complex and still very new, researchers try todevelop various methods to deal with it and relevant literature starts to bloom. This paper aims to provide concise descriptions oftypical analytical numerical and experimental methods to solve IWSI, together with a review of their major applications to date. Lastly,we succinctly highlight some development tendencies and some pieces of work to be investigated for each method.
文摘Background Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now. Methods We retrospectively analyzed the clinical data of 34 cases of total laparoscopic choledochal cyst excision between January 2007 and August 2011. All patients underwent in vitro Roux-en-Y hepatoenterostomy. Results All 34 patients underwent successful total laparoscopic choledochal cyst excision. The operation time was 200-360 minutes. The duration of hospital stay was 3-7 days. Follow-up observations lasted 1-56 months. One patient developed an anastomotic stoma stricture, but no other cases had postoperative complications. No patients died. Conclusion Total laparoscopic choledochal cyst excision is safe and feasible.
文摘BACKGROUND The relationship between preoperative inflammation status and tumorigenesis as well as tumor progression is widely acknowledged.AIM To assess the prognostic significance of preoperative inflammatory biomarkers in patients with distal cholangiocarcinoma(dCCA)who underwent pancreat-oduodenectomy(PD).METHODS This single-center study included 216 patients with dCCA after PD between January 1,2011,and December 31,2022.The individuals were categorized into two sets based on their systemic inflammatory response index(SIRI)levels:A low SIRI group(SIRI<1.5,n=123)and a high SIRI group(SIRI≥1.5,n=93).Inflam-matory biomarkers were evaluated for predictive accuracy using receiver operating characteristic curves.Both univariate and multivariate Cox proportional hazards analyses were performed to estimate SIRI for overall survival(OS)and recurrence-free survival(RFS).RESULTS The study included a total of 216 patients,with 58.3%being male and a mean age of 65.6±9.6 years.123 patients were in the low SIRI group and 93 were in the high SIRI group after PD for dCCA.SIRI had an area under the curve value of 0.674 for diagnosing dCCA,showing better performance than other inflammatory biomarkers.Multivariate analysis indicated that having a SIRI greater than 1.5 independently increased the risk of dCCA following PD,leading to lower OS[hazard ratios(HR)=1.868,P=0.006]and RFS(HR=0.949,P<0.001).Additionally,survival analysis indicated a significantly better prognosis for patients in the low SIRI group(P<0.001).CONCLUSION It is determined that a high SIRI before surgery is a significant risk factor for dCCA after PD.
基金supported by grants from the National Natural Science Foundation of China(82370665,81471590 and 81571554)Beijing Natural Science Foundation(7212042,7222303 and 7232068)+1 种基金Beijing Chaoyang Hospital Golden Seeds Foundation(CYJZ202204)Science and Technology Innovation Fund of Beijing Chaoyang Hospital Affiliated to Capital Medical University in 2021(21kcjj-4).
文摘Introduction The immune system is the cornerstone of human health,with most diseases and health conditions closely related to immune status.Therefore,immune status management is a core health issue.In recent years,significant research breakthroughs in immunosuppressants,immune cell therapy,and immune checkpoint inhibitors have enabled clinical experts and researchers to effectively modulate immune status and regulate immunity more efficient.Key questions in the field of immunology include:How can immune function be visually assessed?What constitutes normal immune cell function status?How can immune cell function status be quantitatively evaluated?How can a standardized system for assessing immune cell function status be established?Currently,there is no consensus on these issues worldwide.On August 28,2023,the National Natural Science Foundation of China announced the National Major Research Plan:Immune Power Digital Decoding Research.Traditional research models have failed to systematically reveal the generation and evolution of immune power.
基金Supported by the Beijing Municipal Science&Technology Commission,No.Z181100001718164and Capital’s Funds for Health Improvement and Research,No.CFH 2020-2-2036.
文摘BACKGROUND Distal cholangiocarcinoma(DCC)presents as one of the relatively rare malignant tumors in the digestive system and has a poor long-term prognosis.Curative resection is currently the most appropriate therapy for patients with DCC because of the lack of effective adjuvant therapies.Therefore,it is important to accurately predict the prognosis for formulating a reasonable treatment plan and avoiding unnecessary surgical trauma.AIM To minimize the interference of obstructive jaundice on carbohydrate antigen 19-9(CA19-9)level by adapting CA19-9 toγ-glutamyltransferase(GGT)as an indicator,to determine the strong associations between CA19-9/GGT and postoperative neoplasm recurrence and long-term outcome of DCC.METHODS We enrolled 186 patients who were diagnosed with DCC between January 2010 and December 2019 and performed radical excision with strict criteria as follows in our hospital.Receiver operating characteristic curves were drawn according to preoperative CA19-9/GGT and 1-year survival.Based on this,patients were divided into two groups(group 1,low-ratio,n=81;group 2,high-ratio,n=105).Afterwards,by the way of univariate and multivariate analysis,the risk factors influencing postoperative tumor recrudesce and long-term prognosis of patients with DCC were screened out.RESULTS Optimum cut-off value of CA19-9/GGT was 0.12.Patients in group 2 represented higher CA19-9 and lymphatic metastasis rate accompanied by lower GGT,when compared with group 1(P<0.05).The 1-,3-and 5-year overall survival rates of patients in groups 1 and 2 were 88.3%,59.2%and 48.1%,and 61.0%,13.6%and 13.6%,respectively(P=0.000).Multivariate analysis indicated that CA19-9/GGT,lymphatic metastasis and tumor differentiation were independent risk factors for tumor recurrence and long-term prognosis of DCC.CONCLUSION Elevation of CA19-9/GGT performed better as a biomarker of aggressive carcinoma and predictor of poor clinical outcomes by reducing the effect of obstruction of biliary tract on CA19-9 concentration in patients with DCC.
文摘Background Liver transplantation is the most effective treatment for end-stage liver diseases; however, infections after transplantation can seriously affect the patient＇s health. The aim of this research was to investigate the diagnosis and treatment of fungal infection following liver transplantation.
文摘Cholangiocarcinoma is a malignancy derived from biliary epithelial cells,a relatively rare but highly malignant type of malignancy.Cholangiocarcinoma located below the convergence of gallbladder duct and common hepatic duct is defined as distal cholangiocarcinoma(dCCA),accounting for 20-30%of total cholangiocarcinoma.In spite of the highly developed adjuvant therapy,surgical treatment remains the core in dCCA treatment,and radical pancreaticoduodenectomy is still the only potential cure for dCCA.However,the overall prognosis of dCCA after radical surgery is still unsatisfying,with a post-operative 5-year survival rate less than 40%.
基金supported by National Natural Science Foundationof China (No. 60674056)National Key Basic Research and Devel-opment Program of China (No. 2002CB312200)+1 种基金Outstanding YouthFunds of Liaoning Province (No. 2005219001)Educational De-partment of Liaoning Province (No. 2006R29 and No. 2007T80)
文摘In this paper, a new fuzzy-neural adaptive control approach is developed for a class of single-input and single-output （SISO） nonlinear systems with unmeasured states. Using fuzzy neural networks to approximate the unknown nonlinear functions, a fuzzy- neural adaptive observer is introduced for state estimation as well as system identification. Under the framework of the backstepping design, fuzzy-neural adaptive output feedback control is constructed recursively. It is proven that the proposed fuzzy adaptive control approach guarantees the global boundedness property for all the signals, driving the tracking error to a small neighbordhood of the origin. Simulation example is included to illustrate the effectiveness of the proposed approach.
文摘Background：Surgical resection is generally considered the main curative treatment for intrahepatic biliary cystadenocarcinoma （IBCA） or suspected IBCAs,but controversy exists regarding the prognosis for IBCAs.This study aimed to describe the clinicopathological characteristics of IBCA and identify prognostic factors that may influence the survival of patients treated with surgical procedures.Methods：Thirty-four patients with histologically confirmed IBCA treated between January 2000 and June 2014 were included.The clinical characteristics of patients with IBCA were compared with those of 41 patients with intrahepatic biliary cystadenoma （IBC）;factors that significant difference were analyzed for prognosis analysis of IBCA using multivariate/univariate Cox proportional hazards regression models.Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank test.Results：IBCAs had a strong female predominance,and the most common presenting symptoms were abdominal pain or discomfort.Compared with IBCs,IBCAs occurred in older patients,in more male patients,and were associated statistically significant abnormal increase in alanine aminotransferase （P =0.01） and total bilirubin （P =0.04）.Mural nodules were more frequently seen with IBCAs and may associate with malignancy.It was difficult to differentiate between IBC and IBCA based on laboratory examination and imaging findings.Although complete resection is recommended,enucleation with negative margins also achieved good outcomes.Median overall patient survival was 76.2 months;survival at 1,3,and 5 years was 88.0％,68.7％,and 45.8％,respectively.Radical resection and noninvasive tumor type were independent prognostic factors for overall survival.Conclusions：It remains difficult to distinguish between cystadenomas and cystadenocarcinomas based on laboratory examination and image findings.Complete resection is recommended for curative treatment,and patients should be closely followed postoperatively,particularly t
基金supported by National Natural Science Foundation of China (No. 61074014)the Outstanding Youth Funds of Liaoning Province (No. 2005219001)Educational Department of Liaoning Province (No. 2006R29, No. 2007T80)
文摘In this paper, an adaptive fuzzy robust feedback control approach is proposed for a class of single-input and singleoutput （SISO） strict-feedback nonlinear systems with unknown nonlinear functions, time delays, unknown high-frequency gain sign, and without the measurements of the states. In the backstepping recursive design, fuzzy logic systems are employed to approximate the unknown smooth nonlinear functions, K-filters is designed to estimate the unmeasured states, and Nussbaum gain functions are introduced to solve the problem of unknown sign of high-frequency gain. By combining adaptive fuzzy control theory and adaptive backstepping design, a stable adaptive fuzzy output feedback control scheme is developed. It has been proven that the proposed adaptive fuzzy robust control approach can guarantee that all the signals of the closed-loop system are uniformly ultimately bounded and the tracking error can converge to a small neighborhood of the origin by appropriately choosing design parameters. Simulation results have shown the effectiveness of the proposed method.
基金Supported by Innovative Project of Medical and Health Science,Zhejiang Province,No.2021RC002。
文摘BACKGROUND Biliary adenofibromas(BAFs)are rare primary hepatic neoplasms,some of which can potentially undergo malignant transformation.Here,we describe a rare case of malignant transformation of BAF.CASE SUMMARY A 51-year-old female was referred to our hospital with epigastric pain.Computed tomography showed a solitary liver mass combined with the enlargement of multiple mediastinal and cervical lymph nodes,clinically mimicking a liver carcinoma with extensive lymph node metastasis.However,core needle biopsy suggested BAF with malignant transformation.Finally,the patient underwent curative resection of the neoplasm and was recurrence-free for 12 mo.CONCLUSION Our case serves as an example of a rare manifestation of BAF.Our report and the previously published experience,reinforce that curative resection should be considered the primary treatment for BAFs with malignant transformation,leading to a favorable prognosis.
文摘Objective:With the increasing application of vascular reconstruction in surgical procedures,allogeneic vessels are becoming more popular in clinical practice due to their abundant sources,precise diameter matching,improved histocompatibility,and higher long-term patency rate.This study aimed to investigate the protective effect of various preservation solutions on the function and structure of the isolated rat abdominal aorta preserved under hypothermal conditions.Methods:The study utilized a total of 150 Sprague-Dawley(SD)rats,with 144 rats allocated to the experimental groups and 6 rats allocated to the control groups.The abdominal aorta of the rats was chosen as the subject of our research.The aorta in the experimental groups were randomly assigned to 4 groups:University of Wisconsin(UW)solution group,histidine-tryptophan-ketoglutarate(HTK)solution group,normal saline(NS)group,and sodium lactate Ringer's solution(RS)group.Samples were subjected to examination after preservation periods of 1 day,3 days,5 days,7 days,14 days,30 days,and 90 days.Evaluation of vascular physiological function involved detecting and assessing vasoconstriction ability and measuring cell viability through the MTT test.Evaluation of the vascular wall structure involved tension tolerance tests and pathological staining.Results:The pathogen-positive rate in the HTK group and NS group at 1 month was 16.7%.Regarding the vascular skeleton structure,both the UW group and HTK group exhibited intact structures after 2 weeks of preservation,with slightly edematous collagen and elastic fibers,which was significantly better than that of the NS group and RS group.In terms of cell activity and contractile function,all preservation groups showed similar effects within 2 weeks.However,after 2 weeks,the UW group showed the most favorable preservation effect(P<0.05).In terms of vascular tension,different groups exhibited similar effects within 1 week.However,after 2 weeks,the UW group showed the best preservation effect(P<0.05).Conclusion:All 4 types o
文摘Many industrial processes such as heating furnaces have over damping dynamic characteristics. Based on an innovative impulse response model, a method of identification and control for the over damping plant is introduced in the paper. The number of parameters of the model is much less than conventional impulse response model. The model based on tuning procedure of numerical optimum PID controller parameters is presented. For an actual instance, a large scale airflow circulatory resistance furnace control system with cascades of time delays is developed. In the system, the optimum PID control is used in the inner loop. A nonlinear PI compensation control is applied in the outer loop. The coordinating control among each output is realized by a fuzzy control strategy. A process surveillance organization monitors running situation of system and tunes controller parameters.
文摘Objective Patients undergoing liver transplantation for hepatocellular carcinoma(HCC)within the Milan criteria have an excellent outcome.We developed a program to analyze and prove that the Milan criteria can be expanded safely and effectively.Methods We retrospectively reviewed 117 HCC patients treated with liver transplantation between January 2013 and December 2017.Patients were grouped according to the Milan criteria,the University of California,San Francisco(UCSF)criteria,Up-to-seven criteria and Hangzhou criteria.Tumor-free and overall survival rates were investigated with a Kaplan-Meier analysis.Multivariable regression Cox models produced survival estimates for the patients that exceeded the Milan criteria.Results The 1-year,3-year and 5-year overall survival rates of patients fulfilling the Milan criteria(n=44)were 100%,87.5%and 78.9%,respectively.Compared with the Milan criteria,the UCSF criteria(n=50),Up-to-seven criteria(n=51)and Hangzhou criteria(n=86)provided an expansion of 13.6%,15.9%and 95.9%,respectively.The 1-year,3-year and 5-year overall survival rates of patients fulfilling UCSF criteria,Up-to-seven criteria and Hangzhou criteria were 96.0%,84.9%,76.9%;96.1%,85.2%,77.6%and 97.7%,83.9%,66.7%,respectively(P>0.05).Multifactor Cox regression showed that tumor diameter and microvascular invasion were independent risk factors for survival in patients that exceeded the Milan criteria.Conclusion Compared with the Milan criteria,the Hangzhou criteria can safely expand the scope of liver transplantation for HCC to a certain extent.By contrast,the UCSF criteria and Up-to-seven criteria result in a limited number of patients which need further expansion.Tumor diameter and microvascular invasion were the independent risk factors for survival in patients that exceeded the Milan criteria.
文摘Objective： To discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose a classification protocol for ischemic contracture in the lower limb based on its severity and prognosis. Methods： Atotal of 42 patients with ischemic contracture in the lower limb were included in this study. According to different types of disturbance and degrees of severity, surgical reconstructions consisting of nerve decompression, tendon lengthening or transfer, intrinsic foot muscle release and sural-tibial nerve anastomosis were performed in every patient. Results： Postoperatively, all patients were able to walk on flat ground. Drop foot was corrected in 10 patients, and 5 patients still felt some difficulty during stair activity. Split Achilles tendon transfer to flexor hallucis longus tendon was performed in 12 patients, and their walking stability was improved. Seven patients accepted ipsilateral suraltibial nerve anastomosis, and sensitivity recovery reached to S2 in 2 patients and S3 in 5 patients. Conclusions： Iscbemic contracture in the lower limb is a devastating complication after lower limb trauma. The prevention of contracture is much more important than the treatment of an established contracture. Split Achilles tendon transfer to flexor hallucis longus tendon and sural-tibial nerve anastomosis, which was initially implemented by us, could improve the functional recovery of ischemic contracture in lower limbs, and thus provides a new alternative for functional reconstruction of ischemic contracture in the lower limb.
文摘BACKGROUND As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas(PHCs)of different T stages,selective extended lymphadenectomy(ELD)performance may improve the prognosis of patients with PHC.AIM To investigate the effect of ELD on the long-term prognosis of patients with PHC of different T stages.METHODS We analyzed data from 216 patients with PHC who underwent surgery at our hospital between January 2011 and December 2021.The patients were divided into extended and standard lymphadenectomy(SLD)groups according to extent of lymphadenectomy and into T1,T2,and T3 groups according to the 8 th edition of the American Joint Committee on Cancer’s staging system.Perioperative data and prognoses were compared among groups.Risk factors associated with prognoses were identified through univariate and multivariate analyses.RESULTS The 1-,2-and 3-year overall survival(OS)rates in the extended and SLD groups were 69.0%,39.5%,and 26.8%and 55.1%,32.6%,and 22.1%,respectively(P=0.073).The 1-,2-and 3-year disease-free survival rates in the extended and SLD groups of patients with stage-T3 PHC were 50.3%,25.1%,and 15.1%and 22.1%,1.7%,and 0%,respectively(P=0.025);the corresponding OS rates were 65.3%,38.1%,and 21.8%and 36.1%,7.5%,and 0%,respectively(P=0.073).Multivariate analysis indicated that portal vein invasion and lymphadenectomy extent were risk factors for prognosis in patients with stage-T3 PHC.CONCLUSION ELD may improve the prognosis of patients with stage-T3 PHC and may be of benefit if performed selectively.
