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Upper gastrointestinal bleeding (UGIB) is a lethal complication of biliary-pancreatic surgery (BPS). The role of endoscopic intervention has not been fully defined in such a critical condition. The aim of this study was to assess the efficacy and safety of endoscopic hemostasis in a retrospective cohort.Consecutive patients with acute UGIB after BPS who received interventional endoscopy between January 2007 and August 2020 were included in this study. The clinical characteristics were collected and analyzed to screen for predictive factors significantly associated with successful hemostasis.Among 37,772 patients who underwent BPS, 26 patients (0.069%) developed acute UGIB. The sites and causes of hemorrhage were as follows: gastroenteric anastomoe (n=17), gastric stump (n=2), jejunal anastomose (n=1), duodenal bulb ulcer (n=2), pancreatojejunal anastomosis hemorrhage (n=1), cholangiojejunal anastomose (n=1), gastroenteric anastomose and gastric stump hemorrhage (n=1), and Dieulafoy lesion (n=1). Successful endoscopic hemostasis was achieved in 19 (73.1%) of the 26 UGIB patients. In the 7 patients who failed endotherapy, 1 patient received a successful radiologic intervention, 6 patients underwent reoperation and achieved hemostasis in 4, and the other 2 patients died after reoperation. Logistic regression analysis showed that presentation-to-endoscopy time (≤12 h) was the only independent predictive factor associated with successful endoscopic hemostasis.Endoscopic hemostasis is relatively safe and effective in controlling UIGB after BPS. Prompt intervention (≤12 h) could improve the success rate of endoscopic hemostasis.

Hepatocellular carcinoma (HCC) is one of the fastest-rising causes of cancer-related death worldwide, but its deficiency of specific biomarkers and therapeutic targets in the early stages lead to severe inadequacy in the early diagnosis and treatment of HCC. Covalently closed circular RNA (circRNA), which was once considered an aberrant splicing by-product, is now drawing new interest in cancer research because of its remarkable functionality. Beneath the surface of the dominant functional proteins events, a hidden circRNA-centric noncoding regulatory RNAs network active in the very early stage of HCC is here revealed by a genome-wide analysis of mRNA, circRNA, and microRNA (miRNA) expression profiles. Circ-CDYL (chromodomain Y like) is specifically up-regulated in the early stages of HCC and therefore contributes to the properties of epithelial cell adhesion molecule (EPCAM)-positive liver tumor-initiating cells. Circ-CDYL interacts with mRNAs encoding hepatoma-derived growth factor (HDGF) and hypoxia-inducible factor asparagine hydroxylase (HIF1AN) by acting as the sponge of miR-892a and miR-328-3p, respectively. Subsequently, activation of the phosphoinositide 3-kinase (PI3K)-AKT serine/threonine kinase-mechanistic target of rapamycin kinase complex 1/β-catenin and NOTCH2 pathways, which promote the expression of the effect proteins, baculoviral IAP repeat containing 5 (BIRC5 or SURVIVIN) and MYC proto-oncogene, is influenced by circ-CDYL. A treatment incorporating circ-CDYL interference and traditional enzyme inhibitors targeting PI3K and HIF1AN demonstrated highly effective inhibition of stem-like characteristics and tumor growth in HCC. Finally, we demonstrated that circ-CDYL expression or which combined with HDGF and HIF1AN are both independent markers for discrimination of early stages of HCC with the odds ratios of 1.09 (95% confidence interval [CI], 1.02-1.17) and 124.58 (95% CI, 13.26-1170.56), respectively. Conclusion: These findings uncover a circRNA-centric noncoding regulatory RNAs network in the early stages of HCC and thus provide a possibility for surveillance and early treatment of HCC.

Pressure vessel is widely used in the industrial engineering. Many materials in pressure vessel are inflammable and explosive dangerous goods. If the accident happens, great harm will be done to the lives and properties of people. Some common methods for studying pressure vessel have obvious drawbacks. 3D laser scanning method uses non-contact measuring method and can directly obtain the point cloud data of the mass surface which can be used to reconstruct any convex surface. According to the advantages of 3D laser scanning method, in this paper, it is introduced to measure the dimensions of flanges in pressure vessel. The experimental results obtained have little errors, which certify that 3D laser scanning method can be used to measure the dimensions of flanges and further study the characteristics of pressure vessel.

Diamond/boron/MoS2/diamond composite film electroluminescence (EL) devices with different MoS2 thickness were fabricated on p-type heavy doped silicon substrates. Its composition, microstructure and EL characteristics were tested and discussed. The experimental results show that the EL spectrum of the device has two luminous peaks in the visible region, which is located in the green region and the red region respectively. As the thickness of MoS2 increased from 10 nm to 80 nm, the peak of red luminescence shifted from 676 nm to 704 nm, and the breakdown voltage of an EL device gradually decreased from 420 V to 140 V, meanwhile the EL intensity first increases and then decreases. When thickness of MoS2 is 30 nm, the brightness of the EL device reaches the maximum.

A diamond/HoF3/diamond composite film (DHDCF) electroluminescent device was prepared on a highly doped n-type silicon substrate by plasma chemical vapor deposition system and electron beam vacuum evaporation system. The films were characterized by field emission scanning electron microscopy (FE-SEM), energy spec-troscopy (EDS), X-ray diffraction (XRD) and EL spectrum. Luminescence characteristics of the DHDCF devices were tested, and the results show that three peaks appear at 420 nm, 604 nm and 708 nm. The luminescence of the device is white when observed with the naked eye. The luminescence originates from the discrete lumi-nescence center of Ho3+ ion. The diamond film can effectively stimulate Ho3+ ions and promote the luminescence of Ho3+ ions.

By using vacuum electron beam vapor deposition (EBVD) technology, perovskite-type SrTiO3 was deposited on indium tin oxide (ITO) conductive glass. The SrTiO3 orientation and its film thickness were well-controlled by appropriately modifying the growth conditions and deposition time. The elemental composition, microstructure, surface morphology and field emission character of SrTiO3 film were characterized by energy dispersive spectrum (EDS), X-ray diffraction (XRD) spectrum, field emission scanning electron microscope (FE-SEM) and field emission (FE) detecting system. The FE test results showed that the SrTiO3 film showed good field emission characteristics. The maximum field emission current density reach 88.96 μA/cm2 at 10.45V/μm applied electric field. And the experimental results show that the SrTiO3 film has certain potential in FE field.

A series of two-dimensional MoS2 nano-sheet (MSNS) films were deposited on different metal coated substrate (Al or Mo-coated alumina ceramic substrate and Al or Mo-coated glass substrate) by using the vacuum electron beam vapor deposition (EBVD) technique. The film thickness of MSNS and metal coating was well-controlled by appropriately modifying the growth conditions and deposition time. The microstructure and surface morphology of MoS2 films were characterized by scanning electron microscope (SEM) and x-ray diffraction (XRD). The field emission (FE) test results indicated that the FE properties of the glass-Al/MSNS sample are superior to the glass-Mo/MSNS sample. And in the case that the device is working properly, the FE current density of ceramic-Al/MSNS sample is always higher than that of ceramic-Mo/MSNS sample when the external electric field is the same. All the experimental results are explained reasonably.

The supporting structure in foundation pit is very important in civil engineering and is used to support the whole foundation pit. Its diaplacement is directly related to the safety of buildings. White light digital image analysis in frequency domain has the advantages of whole-field, non-contact measurement and the simple measuring system and can obtain displacements by frequency domination correlation arithmetic. In this paper, the method was introduced to measure the displacements of supporting structure. The experimental results show the usability of the method for supporting structure in foundation pit.

Objective To evaluate the clinical efficacy of aligned acupuncture at the muscle regions plus cutaneous needle for post-stroke upper limb spasticity.

The surface displacement of soil mass is an important standard for safety in civil engineering. In this paper, white light digital image analysis in frequency domain is introduced tomeasure surface displacement of soil mass. This method has the characteristics of whole-field, non-contact measurement and the simple measuring system and can obtain displacements by frequency domination correlation arithmetic. Surface displacements of soil mass are obtained by white light digital image analysis in frequency domain. Comparing the experimental results and the theoretical values, the little error exists and the usefulness of this method is certified.

We studied chaotic threshold of a nonlinear dynamical system of beam bridge. The amplification and minification of integral inequality are proposed, which lead to the criteria for chaotic motion directly for the nonlinear system with a half sine pulse excitation avoiding the conventional approximation methods to retain the nature characteristics of the system. The efficiency of the criteria for chaotic motion obtained by use of the Melnikov's method is verified via the bifurcation diagrams, Lyapunov exponents and numerical simulations.

We presented a novel model which comprises an axial loaded beam bridge subjected to an infinite series of regularly spaced concentrated moving loads. The axial force coupled with the moving loads can lead the vibration of the beam bridge to chaos that drive the system of a given basin and jump to another one, causing damage due to the resulting amplitude jumps. An infinite sequence of moving loads leads to a barrier for conventional nonlinear techniques. The amplification and minification of integral inequality are proposed, which lead to the criteria for chaotic motion directly for the nonlinear system with a half sine pulse excitation avoiding the conventional approximation methods to retain the nature characteristics of the system. The results show the chaotic motion takes place in the system.

Signal regulatory protein (SIRP) α, a transmembrane protein belonging to the immunoglobulin superfamily, is a receptor for CD47. The interaction between SIRPα and CD47 plays an important role in regulating the phagocytosis of leukemia cells and leukemia stem cells (LSCs) by macrophages. Blocking antibodies against CD47 have been shown to promote phagocytosis of LSCs by macrophages. Here, we consider an alternative way to interrupt the interaction between CD47 and SIRPα. We expressed the extracellular domains of the human SIRPα (hSIRP(ext)) and the human CD47 (hCD47(ext)) in Escherichia coli as Trx fusion proteins, and purified them by using affinity chromatography. We show that the purified fusion protein Trx-SIRP(ext) could interact in vitro with Trx-hCD47(ext). Moreover, Trx-SIRP(ext) could effectively bind to Jurkat T-ALL cells, which expressed CD47 at a high level. CD47(ext), on the other hand, bound to human macrophages. In vitro phagocytosis assay showed that these fusion proteins could enhance the phagocytosis of Jurkat cells by macrophage, with Trx-hSIRP(ext) showed a higher efficiency than Trx-CD47(ext). These results indicated that the soluble Trx-hSIRP(ext) and Trx-CD47(ext) polypeptides could be alternative molecules to interrupt CD47-SIRPα interaction between leukemia cells and macrophages, and might be potentially useful for the targeted therapy of leukemia.

Previous studies have shown that miR-203 acts as a tumor-suppressive microRNA in various cancers, but its roles in laryngeal carcinoma are still contradicted. Here, we found that miR-203 inhibited the growth of laryngeal cancer cells and survivin was a direct target of miR-203. Moreover, silencing of survivin recapitulated the effect of miR-203 on cell cycle progression, whereas overexpression of survivin reversed this effect. Additionally, qRT-PCR showed the reciprocal relationship between miR-203 and survivin in laryngeal cancer tissues. These findings indicate that miR-203 inhibits the proliferation of laryngeal carcinoma cells by directly targeting survivin, suggesting its application in anti-cancer therapeutics.

The smooth-and-discontinue(SD) oscillator with time-dependent stiffness was put forward and founded to study dynamic characteristics of beam bridge under moving load. Mid-span deflection of beam bridge under moving load was described as vibration trace. Proper stiffness model function was elected and study nonlinear dynamic behaviors of mid-span deflection when several vehicles pass through bridge successively. The software MATLAB was used to simulate the model and obtain the bifurcation diagrams with parameter of vehicle speed and Poincare sections of the vehicle-bridge coupled system. The result shows the complicated nonlinear dynamics with periodic motion, quasi-periodic motion phenomena and chaos, the occurrence alternatively among these motions.

The system model of flexible suspension bridge under several moving loads was founded according to SD oscillator with time –dependent stiffness. The model was simulated by the software MATLAB and the nonlinear dynamic behaviors of the system with different velocities were analyzed. Bifurcation diagram of the system is obtained with the changing of vehicle speed; meanwhile the phase trajectories and the Poincaré sections are also presented. The result shows the complicated nonlinear dynamics with periodic motion, quasi-periodic phenomena and chaos, the occurrence alternatively among these quasi-period and chaos, which reveals the reason that causes the S-shape deformation of flexible suspension bridge under moving load easily.

White light digital image analysis in frequency domain has the characteristics of whole-field, non-contact measurement. The measuring system of this method is very simple and the coherent light is not demanded. Gray images before and after deformation which are recorded using CCD camera, digitalized and then analyzed by frequency domain correlation arithmetic can be used to obtain the displacement information. This method is used to study the fracture characteristics of concrete and measure the stress intensity factor of I type crack tip. Comparing the experimental results and theoretical values of the stress intensity factor of I type crack tip, the applicability of this method was certified, which shows that this method is very proper to study the deformation and fracture characteristics of concrete.

White light digital image analysis in frequency domain is introduced to study concrete deformation. This method has the characteristics of whole-field, non-contact measurement and the simple measuring system and can obtain displacements by frequency domination correlation arithmetic. Displacements of concrete specimen under axial tension are obtained by white light digital image analysis in frequency domain and then strains and Poisson ratio are calculated. Comparing the experimental results and the theoretical values, the error was little and the effectiveness of this method is certified. The applications of different surface features of concrete are studied.

1. Heart rate (HR) turbulence describes short-term sinus rhythmic fluctuation after a single premature ventricular beat. Turbulence onset (TO) and turbulence slope (TS) are two essential parameters in HR turbulence. Turbulence onset and TS have been used to evaluate cardiac autonomic nerve function. 2. In the present study, we measured the HR turbulence in dilated cardiomyopathy (DCM) and determined the possible role of benazepril, an angiotensin-converting enzyme inhibitor (ACEI), on these parameters. There were three groups: control, DCM and DCM treated with benazepril. The control group consisted of normal subjects with PVB, but no structural heart disease. Ambulatory electrocardiogram, blood pressure and echocardiography were analysed. 3. There was an increase in TO and a decrease in TS in DCM patients. Benazepril treatment (10 mg/day, p.o.) reduced those changes. There were no significant differences in blood pressure and left ventricular ejection fraction (LVEF) between DCM patients and DCM patients treated with benazepril. 4. Linear regression analysis showed that TO was negatively correlated with LVEF, whereas TS was positively correlated with LVEF, in the DCM group. After benazepril treatment, the correlations between TO and TS and LVEF disappeared. 5. It is concluded that the TO and TS of HR turbulence are altered in patients with DCM. These alterations indicate a dysfunction of the autonomic control of cardiac electrophysiology in DCM patients. Although TO and TS are correlated with LVEF in DCM patients, the effect of benazepril in improving HR turbulence parameters is not a result of its action on heart function, which suggests a new beneficial effect of ACEI in the treatment of DCM patients.

OBJECTIVE To investigate the possible stimulating mechanism of Huoxue Bushen Mixture (HXBSM), a traditional Chinese compound medicine, on hair growth of mice via measuring the variance of skin blood vessel neogenesis and vascular endothelial growth factor (VEGF) expression in the hair follicle. METHODS Hot rosin and paraffin mixture depilation were used to induce C57BL/6 mice hair follicle to enter from telogen into anagen. Ninety C57BL/6 mice were divided into 3 groups randomly: HXBSM group, Yangxue Shengfa Capsule (YXSFC, another traditional Chinese compound medicine) group and untreated group. The mice were fed with corresponding drugs after modeling. The hair growth of the mice was observed every day. Every ten mice out of each group were executed respectively at day 4, 11 and day 17. Skin blood vessel neogenesis was counted through pathological section and VEGF expression in the hair follicle was measured via immunohistochemical method. RESULTS The number of local blood vessel neogenisis in the HXBSM group observed was larger than that in the untreated group at day 4 (P

This paper aims to improve the quality of images in low light conditions. After nonlinear intensity stretching, the enlarged mixed noise is reduced using a newly proposed low rank denoising algorithm. By similar patch stacking, the established noisy matrices are assumed to be composed of low-rank noise free image, sparse random impulse noise and zero-mean Gaussian noise. Minimizing the rank of the matrices, the mixed noise can be reduced efficiently. Comparative experiments on synthetic and real data are used to verify the algorithm's performance.

This paper proposes a novel image inpainting algorithm which adopts a new way of determining patch priorities and a new strategy to search the matching patches. More importantly, the proposed algorithm takes full advantage of the similar structure of the matching patches and introduces the low-rank matrix completion effectively to repair the damaged region. The experimental results show that the proposed algorithm can set reasonable patch priority, reduce the probability of mismatching, and maintain the completeness of structure. The repaired images have more natural appearance than the results of some other mainstream image inpainting approaches.

Background Preoperative jaundice is frequent in gallbladder cancer (GBC) and indicates advanced disease. Resection is rarely recommended to treat advanced GBC. An aggressive surgical approach for advanced GBC remains lacking because of the association of this disease with serious postoperative complications and poor prognosis. This study aims to re-assess the prognostic value of jaundice for the morbidity, mortality, and survival of GBC patients who underwent surgical resection with curative intent. Methods GBC patients who underwent surgical resection with curative intent at a single institution between January 2003 and December 2012 were identified from a prospectively maintained database. Results A total of 192 patients underwent surgical resection with curative intent, of whom 47 had preoperative jaundice and 145 had none. Compared with the non-jaundiced patients, the jaundiced patients had significantly longer operative time (p

Background The data on the prognostic values of high sensitivity C-reactive protein (hsCRP) levels in patients with advanced symptomatic heart failure (HF) receiving cardiac resynchronization therapy (CRT) are scarce. The aim of present study was to investigate the association of serum hsCRP levels with left ventricle reverse remodeling after six months of CRT as well as long-term outcome. Methods A total of 232 CRT patients were included. The assessment of hsCRP values, clinical status and echocardiographic data were performed at baseline and after six months of CRT. Long-term follow-up included all-cause mortality and hospitalizations for HF. Results During the mean follow-up periods of 31.3 ± 31.5 months, elevated hsCRP (> 3 mg/L) prior to CRT was associated with a significant 2.39-fold increase (P = 0.006) in the risk of death or HF hospitalizations. At 6-month follow-up, patients who responded to CRT showed significant reductions or maintained low in hsCRP levels (–0.5 ± 4.1 mg/L reduction) compared with non-responders (1.7 ± 6.1 mg/L increase, P = 0.018). Compared with patients in whom 6-month hsCRP levels were reduced or remained low, patients in whom 6-month hsCRP levels were increased or maintained high experienced a significantly higher risk of subsequent death or HF hospitalizations (Log-rank P < 0.001). The echocardiographic improvement was also better among patients in whom 6-month hsCRP levels were reduced or remained low compared to those in whom 6-month hsCRP levels were raised or maintained high. Conclusions Our findings demonstrated that measurement of baseline and follow-up hsCRP levels may be useful as prognostic markers for timely potential risk stratification and subsequent appropriate treatment strategies in patients with advanced HF undergoing CRT.

BACKGROUND: Fragmented QRS (fQRS) marks inhomogeneous activation and asynchronous cardiac contraction. It has been proved that cardiac resynchronization therapy (CRT) could reverse geometrical remodeling as well as correct electrical dyssynchrony. We aimed to investigate whether fQRS changed corresponding to the therapeutic response to CRT. METHODS: Patients who underwent de novo CRT implantation previously and had ≥1 follow‐up between August 2012 and September 2013 in our hospital were investigated. Intrinsic electrocardiogram was recorded and fQRS in any lead was calculated. Response to CRT was defined as absolute improvement in left ventricular ejection fraction by ≥10% or by improvement >1 New York Heart Association class and without heart failure hospitalization. RESULTS: A total of 75 patients (48 male, mean ages, 61 ± 9 years) were included in this study. At a median follow‐up of 13 months, 57 patients had response to CRT. Responders had narrowed QRS (from 167 ± 23 ms to 158 ± 19 ms, P = 0.003) and reduced fQRS post‐CRT. Nonresponders had QRS prolonging (from 151 ± 26 ms to 168 ± 16 ms, P = 0.033) and increase in fQRS. Eleven of 12 patients with reduced fQRS were responders and 8 of 12 with increased fQRS were nonresponders. Both changes in QRS and fQRS correlated strongly with CRT response (r = 0.389, P = 0.001 and r = 0.403, P = 0.000, respectively). Reduction of fQRS in ≥1 leads had high specificity (95%) in association to responders, though in low sensitivity (19%). CONCLUSIONS: The changes in fQRS associated with therapeutic response to CRT. Regression of fQRS could be a maker of electrical reverse remodeling following CRT.

The aryl hydrocarbon receptor (AhR) is a ligand activated transcription factor implicated in multiple cellular processes and its expression has been shown to play a critical role in tumorigenesis. However, the role of AhR in tumorigenesis of breast cancer remains unclear. In the current study, we investigated the expression levels of AhR in breast lesions and assessing the correlation between AhR expression and clinicopathological variables using breast cancer tissue microarray. Meanwhile, 10 paired of fresh breast cancer and corresponding non-cancer samples were detected for AhR and p53 expression by Western blot, respectively. Results showed that AhR expression levels in breast cancer tissues were significantly higher than that in the non-cancer tissues. AhR expression was associated with the pathological type and P53 status, but not patients age, tumor grade and TNM, as well as ER, PR, C-erbB2, Ki-67, AR, EGFR status. Moreover, Western blot data suggested a negative correlation between p53 protein and AhR protein expression levels. The results suggest that high levels of AhR were expressed in the majority of breast cancer tissues and closely associated with P53 status and histological types of breast cancer. AHR and its abnormal expression may play an important role in multiple stages of breast cancer progression.

Nonlinear dynamical systems with irrational and fractional nonlinear restoring forces often occur in both science and engineering, and always lead to a barrier for conventional nonlinear techniques. In this paper, we have investigated the global bifurcations and the chaos directly for a nonlinear system with irrational and fractional nonlinear restoring forces avoiding the conventional Taylor's expansion to retain the natural characteristics of the system. By introducing a particular dimensionless representation and a series of transformations, the two-degree-of-freedom system can be transformed into a perturbed Hamiltonian system. The extended Melnikov method is directly used to detect the chaotic threshold of the perturbed system theoretically, which overcomes the barrier caused by solving theoretical solution for the homoclinic orbit of the unperturbed system. The numerical simulations are carried out to demonstrate the complicated dynamics of the nonlinear spring-pendulum system, which show the efficiency of the criteria for chaotic motion in the system.

Reflux cholangitis has been the most common complication after Roux-en-Y choledochojejunostomy. In this study we intended to evaluate the perioperative and long-term efficacy of a new anastomosis method for choledochojejunostomy.Clinical data of 143 eligible patients who underwent choledochojejunostomy in the Eastern Hepatobiliary Surgery Hospital affiliated to the Second Military Medical University, China between January 2007 and December 2010 were retrospectively analyzed. Among the patients, 38 consecutive cases underwent this new anastomosis method for choledochojejunostomy (improved group, IG) and 105 underwent standard Roux-en-Y choledochojejunostomy (control group, CG). Changes in the incidence of cholangitis, the time of beginning to eat liquid meals, post-operative delayed gastric emptying and liver function between the two groups were compared.There was no statistical difference in the levels of alanine transaminase, alkaline phosphomonoesterase and gamma-glutamy transferase between the two groups. The time of beginning to eat liquid meals was significantly shorter in IG than CG (P0.05). The incidence of delayed gastric emptying was lower in IG than CG, with statistical tendency between the two groups (P = 0.052). Among nine patients with different degrees of acute cholangitis in the two groups, one patient (2.6%) in IG and eight (7.6%) in CG suffered from acute cholangitis within six months of follow-up after discharge, but with no statistical difference between the two groups (P0.05). Of the nine patients with acute cholangitis, none in IG and four in CG were hospitalized for further treatment (P0.05).Patients in IG had satisfactory perioperative and long-term prognosis with shorter time of beginning to eat liquid meals and lower incidence of delayed gastric emptying. This new procedure of choledochojejunostomy by the way behind antrue pyloricum was easy and safe to perform with no mortality and low complication rates.

The smooth-and-discontinuous oscillator under constant excitations (CSD) is an unsymmetrical system with an irrational restoring force, which leads to a barrier to detect the chaotic threshold using conventional nonlinear techniques. The goal of the present work is to overcome the trouble raised by constant excitations and irrational nonlinearity to investigate the necessary and insufficient condition for chaos. A smooth approximate system, whose behaviors are topologically equivalent to the ones of the original system, is proposed to investigate the chaotic boundary. The Hamiltonian system of the approximate system is analyzed and the homoclinic orbits in analytical form are obtained. The Melnikov method is employed to determine the distance between the stable and unstable manifolds under the perturbation of damping and external forcing. Bifurcation diagrams and numerical simulations are used to reveal the motion of chaos and the period for approximate system which is in good agreement with the original system. It is worth recalling that the approach for constructing the approximate function of smoothness is presented, which puts forward a step toward the solution of the irrational nonlinearity system.

Background Intrathoracic impedance monitoring has emerged as a promising new technique for the detection of impending heart failure (HF). Although false positive episodes have been reported in case reports and clinical trials, the efficacy and false positive rate in real-world practice remain unclear. Objective The aim of this study is to investigate the utility and reliability of the OptiVol alert feature in clinical practice. Methods We continuously recruited patients who underwent implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with defibrillator (CRT-D) implantation with feature of intrathoracic impedance monitoring system in our center from Sep. 2010 to Oct. 2012. Regular in-office follow-up were required of all patients and the following information was collected at each visit: medical history, device interrogation, N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement and an echocardiogram. Worsening HF was defined as hospitalization or the presentation of signs or symptoms of HF. Results Forty three patients (male: 76.7%, mean age: 57 ± 15 years, left ventricular ejection fraction (LVEF): 33% ± 14%) were included in this observational study. Fifty four alert events and 14 adjudicated worsening HF were detected within 288 ±163 days follow-up. Eleven (20.4%) alert episodes were associated with acute cardiac decompensation in 9 patients with a positive predictive value of 78.6%. Forty three audible alerts showed no connection to worsening HF. The unexplained alerts rate was 79.6% and 1.27 per person-year. Thirty seven alarm alerts were detected in patients with EF < 45%, among which 9 accompanied with HF, 17 alerts detected in patients with LVEF ≥ 45% and 2 associated with HF. There was no significant difference between the two groups (9/37 vs. 2/17; P = 0.47). Conclusions Patients with normal or nearly normal left ventricular systolic function also exhibited considerable alert events. The OptiVol fluid index predicted worsening cardiac events with a high unexplained detection rate, and any alert must therefore be analyzed with great caution. Efforts to improve the specificity of this monitoring system represent a significant aspect of future studies.

Many studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastric cancer. However, indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined. This study was performed to assess the benefits and limits of simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases, as well as to identify prognostic factors affecting the survival.Between January 2005 and June 2008, 13 patients with synchronous hepatic metastases underwent simultaneous combined resection. The clinicopathologic features and the surgical results of the 13 patients were retrospectively analyzed. Patient, tumor (primary and metastatic carcinoma), and operative parameters were analyzed for their influence on survival.No patient died and two patients (15.4%) developed complications during peri-operative course. The actuarial 6-month, 1-year, and 2-year survival rates after hepatic resection were 76.9%, 38.5%, and 30.8%, respectively, and two patients survived for more than 2 years after surgery without any signs of recurrences until latest follow-up. In univariate analysis, hepatic tumor distribution (P=0.01) and number of hepatic metastases (P=0.003) were significant prognostic factors that influenced survival. Factors associated with the primary lesion were not significant prognostic factors.Satisfactory survival may be achieved by simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases in strictly selected patients. The number of hepatic metastases and hepatic tumor distribution are significant prognostic determinants of survival.

BACKGROUND/AIMS To summarize the experience of diagnosis and surgical treatment of mucin-producing bile duct tumors (MPBTs). METHODOLOGY A retrospective analysis was undertaken to determine the radiography characteristics and results of surgical treatment of MPBTs over the past 9 years. Only eight patients underwent such treatment. The detailed data of diagnosis, treatment and prognosis were carefully studied. RESULTS Intermittent jaundice was the most frequently clinical manifestation of MPBTs, with unique characteristics on magnetic resonance cholangiopancreatography (MPCP) when compared with gallbladder carcino-ma, hilar cholangiocarcinoma and distal bile duct can-cer. All the 8 patients with MPBTs received appropriate surgical procedure and were cured. CONCLUSIONS Appropriate diagnosis and curative hepatectomy for MPBTs made it possible to achieve long-term survival.