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BACKGROUND Several techniques of nasogastric tube (NGT) insertion have been described in the literature with different success rates. AIM To systematically search the literature and conduct a meta-analysis comparing the success rates, insertion time and complications associated with different techniques of NGT insertion in anesthetized and intubated patients. METHODS An electronic search of the PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases were performed up to October 31, 2019. We included 17 randomized controlled trials with 2500 participants in the meta-analysis. RESULTS As compared to the conventional method, successful insertion of the NGT on first attempt was higher with modified techniques such as the reverse Sellick’s maneuver [relative risk (RR) 1.94; 95% confidence interval (CI): 1.62-2.31], use of a frozen NGT (RR 1.55; 95%CI: 1.13-2.13), inserting the NGT with neck flexion and lateral neck pressure (RR 1.64; 95%CI: 1.10-2.45), endotracheal tube-assisted (RR 1.88; 95%CI: 1.52-2.32) and video-assisted placements (RR 1.60; 95%CI: 1.31-1.95). All the modified techniques also led to comparatively higher insertion success rates than the conventional technique. CONCLUSION The use of modified techniques of NGT insertion such as the reverse Sellick’s maneuver, neck flexion with lateral neck pressure, frozen NGT, endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique. All modified techniques also significantly improve the overall chance of successful NGT placement as compared to the conventional method.

ObjectivesThere are still challenging problems in diagnosis of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) before operation. This study aimed to analyze the imaging features of HCC with B1–B3 BDTT.Materials and MethodsThe clinicopathological data and imaging findings of 30 HCC patients with B1–B3 BDTT from three high-volume institutions were retrospectively reviewed. A total of 631 patients without BDTT who were randomly collected from each of the enrolled centers were recorded as the control group to analyze the differences in clinicopathological characteristics and imaging features between the two groups. A total of 453 HCC patients who underwent surgical treatment in the three institutions from January 2020 to December 2020 were collected for a blinded reading test as the validation group.ResultsHCC patients with B1–B3 BDTT had more advanced tumor stages and adverse clinicopathological features. HCC lesions were detected in all patients, and intrahepatic bile duct dilation was observed in 28 (93.3%) patients with B1–B3 BDTT and 9 (1.43%) patients in HCC without BDTT. The intrahepatic bile duct dilation showed no enhancement at hepatic arterial phase (HAP) and no progressively delayed enhancement at portal venous phase (PVP), but it was more obvious at PVP on CT. In the reports of the 30 HCC patients with B1–B3 BDTT generated for the image when the scan was done, BDTT was observed in all 13 B3 patients and 3 of 12 B2 patients, but none of the 5 B1 patients. Fourteen patients were misdiagnosed before surgery. However, when using intrahepatic bile duct dilation in HCC patients as a potential biomarker for BDTT diagnosis, the sensitivity and specificity for BDTT diagnosis were 93.33% and 98.57%, respectively. The blinded reading test showed that intrahepatic bile duct dilation in CT and MRI scans could be for separating HCC patients with B1–B3 BDTT from HCC patients without BDTT.ConclusionsThe HCC lesions and intrahepatic bile duct dilation on CT or MRI scans are imaging features of HCC with BDTT, which might facilitate the early diagnosis of B1–B3 BDTT.

BACKGROUND Laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct (CBD) exploration (LCBDE) is one of the main treatments for choledocholithiasis with CBD diameter of larger than 10 mm. However, for patients with small CBD (CBD diameter ≤ 8 mm), endoscopic sphincterotomy remains the preferred treatment at present, but it also has some drawbacks associated with a series of complications, such as pancreatitis, hemorrhage, cholangitis, and duodenal perforation. To date, few studies have been reported that support the feasibility and safety of LCBDE for choledocholithiasis with small CBD. AIM To investigate the feasibility and safety of LCBDE for choledocholithiasis with small CBD. METHODS A total of 257 patients without acute cholangitis who underwent LC + LCBDE for cholecystolithiasis from January 2013 to December 2018 in one institution were reviewed. The clinical data were retrospectively collected and analyzed. According to whether the diameter of CBD was larger than 8 mm, 257 patients were divided into large CBD group (n = 146) and small CBD group (n = 111). Propensity score matching (1:1) was performed to adjust for clinical differences. The demographics, intraoperative data, short-term outcomes, and long-term follow-up outcomes for the patients were recorded and compared. RESULTS In total, 257 patients who underwent successful LC + LCBDE were enrolled in the study, 146 had large CBD and 111 had small CBD. The median follow-up period was 39 (14-86) mo. For small CBD patients, the median CBD diameter was 0.6 cm (0.2-2.0 cm), the mean operating time was 107.2 ± 28.3 min, and the postoperative bile leak rate, rate of residual CBD stones (CBDS), CBDS recurrence rate, and CBD stenosis rate were 5.41% (6/111), 3.60% (4/111), 1.80% (2/111), and 0% (0/111), respectively; the mean postoperative hospital stay was 7.4 ± 3.6 d. For large CBD patients, the median common bile duct diameter was 1.0 cm (0.3-3.0 cm), the mean operating time was 115.7 ± 32.0 min, and the postoperative bile leak rate, rate of residual CBDS, CBDS recurrence rate, and CBD stenosis rate were 5.41% (9/146), 1.37% (2/146), 6.85% (10/146), and 0% (0/146), respectively; the mean postoperative hospital stay was 7.7 ± 2.7 d. After propensity score matching, 184 patients remained, and all preoperative covariates except diameter of CBD stones were balanced. Postoperative bile leak occurred in 11 patients overall (5.98%), and no difference was found between the small CBD group (4.35%, 4/92) and the large CBD group (7.61%, 7/92). The incidence of CBDS recurrence did not differ significantly between the small CBD group (2.17%, 2/92) and the large CBD group (6.52%, 6/92). CONCLUSION LC + LCBDE is safe and feasible for choledocholithiasis patients with small CBD and did not increase the postoperative bile leak rate compared with chole-docholithiasis patients with large CBD.

To examine the association between serum uric acid (UA) levels and cardiovascular risk factors in subjects without diabetes or hyperuricemia.6172 women and 2662 men aged 50+ years without diabetes from Phase 1 of the Guangzhou Biobank Cohort Study were included. Data on personal history, physical examination and biochemical parameters were collected. Subjects were categorized by serum UA concentration, and the association between UA levels and cardiovascular risk factors was examined using generalized linear models.In both men and women with normouricemia (UA420 μmol/l in men and360 μmol/l in women), tertiles of UA levels were adversely associated with body mass index, waist circumference, waist-to-hip ratio, total- and HDL-cholesterol, apolipoprotein A1, systolic and diastolic blood pressures, pulse pressure, fasting plasma glucose and white blood cell count (P value for trend ranged from 0.04 to0.001), and also consistently associated with metabolic disorders including obesity, hypertension, hypertension treatment, dyslipidemia, waist circumference increased since the age of 18 years and the metabolic syndrome (P value for trend ranged from 0.02 to0.001).Increasing UA levels, even in subjects with normouricemia and without diabetes, were associated with increasing prevalence of cardiovascular risk factors, suggesting that clinically dichotomous definition of hyperuricemia may be inadequate and high-normal value of UA may warn of metabolic disorders.

This paper studied the impact of differential settlement of foundation on the inner force of architectural structure by applying back-analysis method. By taking the three-dimensional coactions system of upper structure-piled raft foundation-foundation with different pile length and different raft thickness as the research object, its differential settlement law of foundation under the effect of load was studied, which was combined with the practical measured data to fit the quadratic settlement surface equation of the foundation. The analysis demonstrated that the differential settlement of foundation will change the inner force of upper structure significantly, thus enabling most of construction components to produce great additional axial force, additional shearing force and additional bending moment, especially changing the additional inner force of corner post more evidently.

This paper introduces ultrasonic ranging system which can be applied to avoid obstacle and navigate for mobile robot .This system is composed of AT89S51 single chip microcomputer ,ultrasonic transmitting circuit, ultrasonic receiving circuit, amplifying and filtering circuit , peak value time detecting circuit, environment temperature compensation circuit. The method of echo peak time detection point is used to eliminate the error. It is proved that The maximum range of the system is 10 meter and maximum measurement error can be controlled to± 2 cm or so. This system has such merits as rapid corresponding, high precision, high performance price rate.

Magnetic fluids viscous damper is a new type of dampers, whose structure including magnetic fluids, permanent magnet and a non-magnetic container. Inside the non-magnetic container, magnetic fluids supports the permanent magnet to suspense in it and moves as a working element. Under the influence of external oscillatory inertia forces, the movement of the permanent magnet leads the damper to a viscous dissipation of the oscillating system energy. This kind of viscous damper is very suitable for spacecraft under low frequency oscillation. In our experiments, model of magnetic fluids viscous damper and its test circuit were designed. The result of tests indicates that the damper based on magnetic fluids can suppress the low frequency oscillation.

This article presents a method for segmentation of multiple human objects in a video stream. Given the base frame of a video stream, a fuzzy self-clustering technique is used to group similar pixels of the frame into a set of segments. Combinations of segments are checked if candidate face regions can be formed using chrominance values and the face shape feature. The existence of a face within each candidate face region is investigated by searching for possible constellations of eyes-mouth triangles and verifying each eyes-mouth combination based on the predefined template and a set of criteria. By referring to the position and orientation of a face, the corresponding body is found. Then rough foreground and background are formed. Finally, human objects in the base frame and the remaining frames of the video stream are located by a fuzzy neural network, which is trained by a SVD-based hybrid learning algorithm. From experimental results, we have found that our system can locate human objects more accurately and efficiently than other systems.

Increased incidence of pertussis has been noted among infants too young to be immunized. We studied the disease burden of pertussis in pediatric intensive care units and the source of infection in several Asian, European and Latin American countries.The study was conducted in 7 countries from September 2001 to January 2004. Children1 year of age were enrolled from pediatric intensive care units (PICU) and pediatric wards if they presented with respiratory failure, apnea, bradycardia, or cough accompanied by paroxysms, vomiting, whoop or cyanosis. Household members of pertussis-positive index cases were asked to answer a questionnaire and provide diagnostic specimens.Pertussis was confirmed in 99 infants (12%) of 823 infants included in the analysis: 10 of 90 (11%) in Brazil, 9 of 88 (10%) in Costa Rica, 11 of 145 (8%) in Germany, 13 of 147 (9%) in Singapore, 29 of 67 (43%) in Spain, 2 of 86 (2%) in Taiwan and 25 of 200 (13%) in Uruguay. However, sensitivity analysis indicated that these figures were conservative. The mean (+/- SD) average age of infection was 2.6 +/- 2.2 months. Pertussis was found among 96 of 269 (36%) of household contacts investigated. At least one household contact was identified as the source of infection in 24 of 88 (27%) of the PICU cases and mothers were identified as being the most frequent source of infection.Although regional differences exist, severe pertussis represents a considerable global disease burden. Since most infants are infected before vaccination and concomitant protection is completed, household contacts should be targeted for booster vaccination to reduce the pertussis reservoir.

Poly(o-methoxyaniline) (POMA) and poly(2,5-dimethoxyaniline) (PDMA) were used for fabricating Schottky diode devices with sandwich structure, as Al/POMA/indium tin oxide (ITO) coated glass and ITO/PDMA/Al. These devices exhibit rectifying behavior with differences in performance parameters like turn on voltage of the device, barrier height and saturation current density. A close comparison of the current (I)–voltage (V) characteristics reveals such differences. Cyclicvoltammetry and UV-Vis spectroscopy of POMA and PDMA films were used to obtain electrochemical and optical properties of the polymers and discussed in support of the observed differences in the electronic properties of the devices fabricated with POMA/PDMA.

Congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) syndrome is a rare X-linked dominant disease characterized by peculiar cutaneous presentations and skeletal abnormalities. Verruciform xanthoma (VX)-like histologic changes occasionally occur in CHILD syndrome, but typical VX-like lesions coexisting with CHILD syndrome are rare. In this study we report a rare case of multiple, coexisting VXs on the vulva and left lower limb of an 11-year-old Chinese girl who also exhibited the typical clinical presentations and limb defects of CHILD syndrome. Histologic and immunohistochemical analyses showed that the lesions were typical VXs.

Evolution of serological markers of hepatitis B virus (HBV) carriage or infection has rarely been investigated among human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART).During the period 1997-2002, a total of 633 HIV-infected patients were tested for HBV serological markers at baseline, including hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs ), antibody to hepatitis B core antigen (anti-HBc), hepatitis C virus (HCV) antibody (anti-HCV) antibody, HCV RNA level, and HBV DNA level, all of which were retested at least 1 year apart. Medical records were reviewed to identify clinical characteristics associated with evolution of these serological markers.After a median duration of follow-up for 4.96 years, 161 patients (25.4%) had changes in HBV serological markers. Of 119 patients (18.8%) who tested positive for HBsAg at baseline, 6 (5.0%) developed anti-HBs, and 9 (7.6%) developed isolated anti-HBc. Of 270 patients (42.7%) who tested positive for anti-HBs, 18 (6.7%) lost anti-HBs. Of 179 patients (28.3%) in whom isolated anti-HBc had been detected, 73 (40.8%) developed anti-HBs, 18 (10.1%) lost all HBV markers, and 7 (3.9%) developed HBsAg. Of 65 patients (10.2%) who tested negative for all HBV markers, 13 (20%) developed anti-HBs, 13 (20%) developed isolated anti-HBc, and 4 (6.2%) developed HBsAg, indicating a high risk of HBV exposure. Patients in whom anti-HBc was detected at baseline were more likely to have acquired immunodeficiency syndrome (P=.008). Multivariate analysis revealed that an increase in the CD4 cell count after the commencement of HAART was significantly associated with persistence or subsequent development of anti-HBs in patients with anti-HBs or anti-HBc at baseline, respectively.Periodic measurements of HBV serological markers in HIV-infected patients are recommended, because new HBV infections and changes of HBV serological markers are not uncommon in patients with improved immunity after commencement of HAART.

Liquid phase deposition (LPD) method to grow the silicon dioxide interlayer on the PES plastic substrates with the O2/Ar plasma pre-treatment is investigated. After which, the interlayer on the plastic substrates is grown and the films' quality on the substrates with or without the plasma pre-treatment is examined by using scanning electron microscopy, etching rate of the oxide layer by the diluted HF solution and surface leakage current measurement. The pentacene-based organic thin film transistors on the dielectric layers suitable for flexible electronics applications are demonstrated

We propose a neuro-fuzzy approach for segmentation of human objects. A fuzzy self-clustering technique is used to divide the video frame into a set of segments. The existence of a face within a candidate face region is ensured by searching for possible constellations of eye-mouth triangles and verifying each eye-mouth combination with the predefined template. Then rough foreground and background are formed based on a combination of multiple criteria. Finally, human objects in the base frame and the remaining frames of the video stream are precisely located by a fuzzy neural network which is trained by a SVD-based hybrid learning algorithm. Through experiments, we compare our system with two other approaches, and the results have shown that our system can detect face locations and extract human objects more accurately.

Pentacene-based highly transparent thin-film transistors which are fabricated by inserting a thin insulating lithium fluoride layer between pentacene and transparent source/drain electrodes are presented. Through this method, device performance can be enhanced dramatically with an average transmittance of as high as 69.72% in the visible region, indicating that the LiF layer is not responsible for optical transmission. For example, there is a significant improvement of a few times with the introduction of the 1-nm-thick LiF layer, the maximum saturation drain current and the field-effect mobility. These improvements are attributed to the energy band realignment and the tunneling process.