Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients: Meta-analysis.

BACKGROUND: Acute cholecystitis (AC) is a common disease in general surgery. Laparoscopic cholecystectomy (LC) is widely recognized as the "gold standard" surgical procedure for treating AC. For low-risk patients without complications, LC is the recommended treatment plan, but there is still controversy regarding the treatment strategy for moderate AC patients, which relies more on the surgeon's experience and the medical platform of the visiting unit. Percutaneous transhepatic gallbladder puncture drainage (PTGBD) can effectively alleviate gallbladder inflammation, reduce gallbladder wall edema and adhesion around the gallbladder, and create a "time window" for elective surgery. AIM: To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients, providing a theoretical basis for choosing reasonable surgical methods for AC patients. METHODS: In this study, we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC. We performed searches in the following databases: PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database. The search encompassed literature published from the inception of these databases to the present. Subsequently, relevant data were extracted, and a meta-analysis was conducted using RevMan 5.3 software. RESULTS: A comprehensive analysis was conducted, encompassing 24 studies involving a total of 2564 patients. These patients were categorized into two groups: 1371 in the LC group and 1193 in the PTGBD + LC group. The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD + LC group and the LC group in multiple dimensions: (1) Operative time: Mean difference (MD) = 17.51, 95%CI: 9.53-25.49, P < 0.01; (2) Conversion to open surgery rate: Odds ratio (OR) = 2.95, 95%CI: 1.90-4.58, P < 0.01; (3) Intraoperative bleeding loss: MD = 32.27, 95%CI: 23.03-41.50, P < 0.01; (4) Postoperative hospital stay: MD = 1.44, 95%CI: 0.14-2.73, P = 0.03; (5) Overall postoperative complication rate: OR = 1.88, 95%CI: 1.45-2.43, P < 0.01; (6) Bile duct injury: OR = 2.17, 95%CI: 1.30-3.64, P = 0.003; (7) Intra-abdominal hemorrhage: OR = 2.45, 95%CI: 1.06-5.64, P = 0.004; and (8) Wound infection: OR = 0. These findings consistently favored the PTGBD + LC group over the LC group. There were no significant differences in the total duration of hospitalization [MD = -1.85, 95%CI: -4.86-1.16, P = 0.23] or bile leakage [OR = 1.33, 95%CI: 0.81-2.18, P = 0.26] between the two groups. CONCLUSION: The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety, suggesting its broader application value in clinical practice.

Empirical study on clique-degree distribution of networks.

The community structure and motif-modular-network hierarchy are of great importance for understanding the relationship between structures and functions. We investigate the distribution of clique degrees, which are an extension of degree and can be used to measure the density of cliques in networks. Empirical studies indicate the extensive existence of power-law clique-degree distributions in various real networks, and the power-law exponent decreases with an increase of clique size.

Geographical networks evolving with an optimal policy.

In this article we propose a growing network model based on an optimal policy involving both topological and geographical measures. In this model, at each time step, a node, having randomly assigned coordinates in a 1x1 square, is added and connected to a previously existing node i, which minimizes the quantity ri2/kialpha, where ri is the geographical distance, ki the degree, and alpha a free parameter. The degree distribution obeys a power-law form when alpha=1, and an exponential form when alpha=0. When alpha is in the interval (0, 1), the network exhibits a stretched exponential distribution. We prove that the average topological distance increases in a logarithmic scale of the network size, indicating the existence of the small-world property. Furthermore, we obtain the geographical edge length distribution, the total geographical length of all edges, and the average geographical distance of the whole network. Interestingly, we found that the total edge length will sharply increase when alpha exceeds the critical value alphac=1, and the average geographical distance has an upper bound independent of the network size. All the results are obtained analytically with some reasonable approximations, which are well verified by simulations.