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Incidental double duct sign: Should we be worried? Results from a long-term follow-up study
Lu Yao,Hoda Amar,Somaiah Aroori 한국간담췌외과학회 2024 Annals of hepato-biliary-pancreatic surgery Vol.28 No.1
Backgrounds/Aims: Double duct sign (DDS) (dilated common bile and pancreatic duct) is synonymous with pancreatic head/ peri-ampullary tumor (PHPAT). There is limited evidence on whether incidental DDS (I-DDS) is associated with an increased risk of malignancy. This study aimed to evaluate 5-year outcomes of I-DDS. Methods: Patients were categorized according to their risk of malignancy. ‘Low-risk’ patients, including those with I-DDS between 2010 and 2015, were analyzed in this study. The primary outcome was incidence of PHPAT within five years of identification of DDS. Histology results from endoscopic ultrasound-guided biopsy were considered diagnostic. Secondary outcomes were incidence of benign causes, extent of follow-up investigations, and clinical indicators of malignancy in patients with DDS. Results: Among 103 patients with DDS, 20 had I-DDS. Subsequent follow-up of these 20 patients found no patient with PHPAT, two (10%) patients with chronic pancreatitis, and 18 (90%) patients with no cause found. The median follow-up duration for ‘low-risk’ patients was 7.3 years (range, 6–11 years). The mean number of follow-up investigations per patient was two (range, 0–9). Investigations included computed tomography (n = 27), magnetic resonance cholangiopancreatography (n = 23), endoscopy (n = 16), and ultrasound (n = 14). Patients with jaundice were more likely to have malignancy (p < 0.01). Those with abdominal pain were more likely to have a benign cause (p < 0.01). Hyperbilirubinemia and/or deranged liver enzymes and raised CA19-9 were more likely to be associated with PHPAT (p < 0.01). Conclusions: Patients with I-DDS have a low risk of developing PHPAT within five years.
Lu Yao,Shaofeng Zhang,Hang Yu,Jiajing Xu,Xiaojian Cao,Yan Ma 대한토목학회 2022 KSCE JOURNAL OF CIVIL ENGINEERING Vol.26 No.11
This paper mainly numerically investigates the ultimate compression strength of un-strengthened and CFRP-strengthened steel tubes with random pitting corrosion damage. First, a developed numerical method for steel tubes with random corroded pits is introduced in detail. The accuracy of a similar numerical method is verified through the corresponding experimental measurement and numerical prediction. Then, the ultimate axial compression behavior of steel tubes with random elliptical corroded pits is numerically investigated. Several influencing factors on the ultimate strength of corroded steel tubes under axial compression load are simulated and compared, including different random distributions, region size of corroded pits, number of pits, and depth of pits. Subsequently, the method for strengthening steel tubes by using CFRPs is studied and conducted on the corroded regions of steel tubes. The reliability of steel tubes strengthened by FRP is validated through experimental and numerical results. Finally, the residual compression performance and progressive damage mechanisms of CFRP-strengthened steel tubes are researched. The different parametric influences on the strengthened performance of FRPs are simulated, including layer direction, number of composite layers, and composite materials. The results demonstrate that FRP can improve the axial compression resistance of corroded steel tubes.
Lu Yao,Niroshini Rajaretnam,Natalie Smith,Lisa Massey,Somaiah Aroori Korean Association of Hepato-Biliary-Pancreatic Su 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.3
Backgrounds/Aims: Thoracic epidural analgesia (TEA) is an established analgesic method in open Kausch-Whipple pancreaticoduodenectomy (KWPD). Although, it can cause hemodynamic instability and neurological complications. Inter pleural analgesia (IPA) is an alternative option. We aim to evaluate the effectiveness of IPA versus TEA after KWPD. Methods: We retrospectively studied the efficacy of IPA against TEA in patients, operated by a single surgeon. The primary outcome was the analgesic efficacy and secondary outcomes were analgesia-related complications, inotrope use, and duration. Results: Forty patients (TEA, 22; IPA, 18) were included. Both groups were well matched for patient characteristics, type, and duration of surgery. TEA was associated with higher analgesia-related complications (n = 8, 36.4% vs. n = 1, 5.6%; p = 0.027). TEA complications included analgesia not working (n = 4), leakage (n = 2), refractory hemodynamic instability (n = 1), and lower limb anaesthesia (n = 1). One patient in the IPA group encountered leakage. TEA was associated with longer inotrope requirement (35 vs. 18 hours; p = 0.047). There was no significant difference in intensive care unit (ITU) admission rate (81.8% vs. 77.8%; p > 0.999), median ITU stay (3 vs. 2 days, p = 0.385), or hospital stay (11 days in both groups). Conclusions: In open KWPD, IPA is not inferior to TEA in its efficacy of pain control. IPA was associated with less analgesia-related complications and shorter inotrope requirements. However, this was a small retrospective study. Larger randomized controlled trials are needed to study the effectiveness of IPA.
Imbalance of Innate and Adaptive Immunity in Esophageal Achalasia
Lu Yao,Zuqiang Liu,Weifeng Chen,Jiaqi Xu,Xiaoyue Xu,Jiaxin Xu,Liyun Ma,Xiaoqing Li,Quanlin Li,Pinghong Zhou 대한소화기 기능성질환∙운동학회 2023 Journal of Neurogastroenterology and Motility (JNM Vol.29 No.4
Background/AimsPrevious studies reveal that immune-mediated neuroinflammation plays a key role in the etiology of esophageal achalasia. However, the understanding of leucocyte phenotype and proportion is limited. This study aim to evaluate the phenotypes of leukocytes and peripheral blood mononuclear cells transcriptomes in esophageal achalasia. MethodsWe performed high-dimensional flow cytometry to identified subsets of peripheral leukocytes, and further validated in lower esophageal sphincter histologically. RNA sequencing was applied to investigate the transcriptional changes in peripheral blood mononuclear cells of patients with achalasia. Cell-type Identification by Estimating Relative Subsets of RNA Transcripts (CIBERSORT) was used for estimating the immune cell types. A differential gene expression analysis was performed and the differential expressed genes were subjected to gene ontology, Kyoto Encyclopedia of Genes and Genomes network, protein-protein interaction network construction. ResultsAn imbalance between innate and adaptive immune cells occurred in achalasia. Specifically, neutrophils and CD8+ T cells increased both in peripheral blood and lower esophageal sphincter in achalasia. Eosinophils decreased in peripheral blood but massively infiltrated in lower esophageal sphincter. CIBERSORT analysis of peripheral blood mononuclear cells RNA sequencing displayed an increased prevalence of CD8+ T cells. 170 dysregulated genes were identified in achalasia, which were enriched in immune cells migration, immune response, etc. Proton pump inhibitor analysis revealed the intersections and gained 7 hub genes in achalasia, which were IL-6, Toll-like receptor 2, IL-1β, tumor necrosis factor, complement C3, and complement C1q A chain. ConclusionPatients with achalasia exhibited an imbalance of systematic innate and adaptive immunity, which may play an important role in the development of achalasia.
Luyao Wang,Ning Wang,Dandan Mi,Yuming Luo,Jianhua Guo 한국미생물학회 2017 The journal of microbiology Vol.55 No.7
In this study, we investigate the relationship between γ-PGA productivity and biocontrol capacity of Bacillus subtilis BsE1; one bacterial isolate displayed 62.14% biocontrol efficacy against Fusarium root rot. The γ-PGA yield assay, motility assay, wheat root colonization assay, and biological control assay were analysed in different γ-PGA yield mutants of BsE1. The pgsB (PGA-synthase-CapB gene) deleted mutant of BsE1 reduced γ-PGA yield and exhibited apparent decline of in vitro motile ability. Deletion of pgsB impaired colonizing capacity of BsE1 on wheat root in 30 days, also lowered biocontrol efficacies from 62.08% (wild type BsE1) to 14.22% in greenhouse experiment against Fusarium root rot. The knockout of pgdS and ggt (genes relate to two γ-PGA degrading enzymes) on BsE1, leads to a considerable improvement in polymer yield and biocontrol efficacy, which attains higher level compared with wild type BsE1. Compared with ΔpgsB mutant, defense genes related to reactive oxygen species (ROS) and phytoalexin expressed changes by notable levels on wheat roots treated with BsE1, demonstrating the functional role γ-PGA plays in biocontrol against Fusarium root rot. γ-PGA is not only important to the motile and plant root colonization ability of BsE1, but also essential to the biological control performed by BsE1 against Fusarium root rot. Our goal in this study is to reveals a new perspective of BCAs screening on bacterial isolates, without good performance during pre-assays of antagonism ability.
Luyao Wang,Guolin Liu,Qiuxiang Tao,Ke Wang 대한토목학회 2019 KSCE Journal of Civil Engineering Vol.23 No.12
For the linear and nonlinear parameters that can be separated in the spatial Cartesian coordinate transformation model, we use the variable projection algorithm in this paper to represent the linear parameters with nonlinear parameters, which are transformed into least squares problems with only nonlinear parameters. We simplify the matrix of the nonlinear function by the Gram-Schmidt orthogonalization method, and combine the nonlinear least squares iterative method with the Levenberg-Marquardt (LM) algorithm to solve for the coordinate transformation parameters. Experiments are carried out by solving for the coordinate transformation parameters of the independent spatial Cartesian coordinate system and the CGCS2000 coordinate system. We compare the solution results of the four methods (parameter non-separation method, traditional variable projection method, variable projection method based on QR decomposition, and variable projection method based on Gram-Schmidt orthogonal decomposition) with respect to the calculated results, the number of iterations and the computation time. The experimental results show that the proposed method in this paper requires a lower computation time and achieves higher computational efficiency when obtaining the same solution results and with the same number of iterations.