Preoperative Quantitative Flow Ratio, Intraoperative Transit Time Flow Measurement Parameters, and Their Predictive Value for Short-Term Graft Failure After Coronary Artery Bypass Grafting.

BACKGROUND: Studies on the relationship between the preoperative quantitative flow ratio (QFR) and parameters of intraoperative transit time flow measurement (TTFM) are extremely rare. In addition, the predictive value of QFR and TTFM parameters for early internal mammary artery (IMA) failure after coronary artery bypass grafting still needs to be validated. METHODS AND RESULTS: We retrospectively collected data from 510 patients who underwent in situ IMA grafting to the left anterior descending (LAD) artery at Fuwai Hospital. Spearman correlation coefficients between preoperative QFR of the LAD artery and intraoperative TTFM parameters of the IMA were -0.13 (P=0.004) for mean graft flow (Qm) and 0.14 (P=0.002) for the pulsatility index (PI). QFR and TTFM exhibited similar and good predictive value for early IMA failure (5.7% at 1 year), and they were better than percentage diameter stenosis (area under the curve 0.749 for QFR, 0.733 for Qm, 0.688 for PI, and 0.524 for percentage diameter stenosis). The optimal cut-off value of QFR was 0.765. Both univariate and multivariable regression analyses revealed that QFR >0.765, Qm ≤15 mL/min, and PI >3.0 independently contributed to early IMA failure. CONCLUSIONS: There were statistically significant correlations between preoperative QFR of the LAD artery and intraoperative TTFM parameters (Qm, PI) of the IMA. Preoperative QFR and intraoperative Qm and PI exhibited excellent predictive value for early IMA failure.

Modeling the effects of land use/land cover changes on river runoff using SWAT models: A case study of the Danjiang River source area, China.

Land use/land cover (LULC) is a crucial factor that directly influences the hydrology and water resources of a watershed. In order to assess the impacts of LULC changes on river runoff in the Danjiang River source area, we analyzed the characteristics of LULC data for three time periods (2000, 2010, and 2020). The LULC changes during these periods were quantified, and three Soil and Water Assessment Tool (SWAT) models were established and combined with eight LULC scenarios to quantitatively analyze the effects of LULC changes on river runoff. The results revealed a decrease in the cropland area and an increase in the forest, grassland, and urban land areas from 2000 to 2020. Grassland, forest, and cropland collectively accounted for over 94% of the total area, and conversions among these land types were frequent. The SWAT models constructed based on the LULC data demonstrated good calibration and validation results. Based on the LULC data in three periods, the area of each LULC type changed slightly, so the simulation results were not significantly different. In the subsequent LULC scenarios, we found that the expansion of cropland, grassland, and urban areas was associated with increased river runoff, while an increase in forest area led to a decrease in river runoff. Among the various LULC types, urban land exerted the greatest influence on changes in river runoff. This study establishes three SWAT models and combines multiple LULC scenarios, which is novel and innovative. It can provide scientific basis for the rational allocation of water resources and the optimization of LULC structure in the Danjiang River source area.

Seasonal nitrate variations, risks, and sources in groundwater under different land use types in a thousand-year-cultivated region, northwestern China.

The global public health concern of nitrate (NO3-) contamination in groundwater is particularly pronounced in irrigated agricultural regions. This paper aims to analyze the spatial distribution of groundwater NO3-, assess potential health risks for local residents, and quantitatively identify nitrate sources during different seasons and land use types in the Jinghuiqu Irrigation District, a region in northwestern China with a longstanding agricultural history. The investigation utilizes hydrochemical parameters, dual isotopic data, and the Bayesian stable isotope mixing model (MixSIAR). The findings underscore significant seasonal variations in the average concentrations of NO3-, with values of 87.72 mg/L and 101.87 mg/L during the wet and dry seasons, respectively. Furthermore, distinct fluctuations in nitrate concentration were observed across different land use types, whereby vegetable lands manifested the maximum concentration. Prolonged exposure to elevated nitrate concentrations may pose potential health risks to residents, especially in the dry season when the non-carcinogenic groundwater nitrate risk surges past its wet season counterpart. The MixSIAR analysis revealed that chemical fertilizers accounted for the majority of nitrate pollution in vegetable lands, both during the dry season (49.6%) and wet season (41.2%). In contrast, manure and sewage contributed significantly to NO3-concentrations in residential land during the wet (74.9%) and dry seasons (67.6%). For croplands, soil nitrogen emerged as a dominant source during the wet season (42.2%), while chemical fertilizers prevailed in the dry season (38.7%). In addition to source variations, the nitrate concentration of groundwater is further affected by hydrogeological conditions, with more permeable aquifers tending to display higher nitrate concentrations. Thus, targeted measures were proposed to modify or impede the nitrogen migration pathway, taking into consideration hydrogeological conditions and incorporating domestic sewage, organic fertilizer, and agricultural management practices.

Del Nido cardioplegia for myocardial protection in adult cardiac surgery: a systematic review and update meta-analysis.

OBJECTIVE: Although the application of del Nido cardioplegia solution (DNC) in adult cardiac surgery is accumulating, the feasibility and safety of this myocardial protection strategy in adults remains controversial. We aimed to update our previous meta-analysis to determine the myocardial protective effect of DNC versus conventional cardioplegia (CC) in adult cardiac surgery. METHODS: A comprehensive literature search was performed using PubMed, EMBASE, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2020. RESULTS: Thirty-seven observational studies and four randomized controlled trials (RCTs) including 21,779 patients were identified. The DNC group was associated with decreased postoperative cardiac enzymes [troponin T (cTnT) and creatine kinase-MB (CK-MB)] [standardized mean differences (SMD): -0.59, 95% confidence interval (CI): -0.99 to -0.19, p = 0.004], cardiopulmonary bypass (CPB) time (MD: -9.31, 95% CI: -13.10 to -5.51, p < 0.00001), aortic cross-clamp (ACC) time (MD: -7.20, 95% CI: -10.31 to -4.09, p < 0.00001), and cardioplegia volume (SMD: -1.95, 95% CI: -2.46 to -1.44, p < 0.00001). Intraoperative defibrillation requirement was less in the DNC group [relative risk (RR): 0.50, 95% CI: 0.33 to 0.75, p = 0.0007]. The pooled analysis revealed no significant difference in operative mortality among the patients assigned to DNC and those undergoing CC. CONCLUSION: In adult cardiac surgery, compared to CC, myocardial protection used with DNC yield similar or better short-term clinical outcomes. More high-quality trials and RCTs reflecting long-term follow-up morbidity and mortality are required in the future to confirm these findings.

Venovenous extracorporeal membrane oxygenation for coronavirus disease 2019 patients: A systematic review and meta-analysis.

OBJECTIVE: Although the application of venovenous extracorporeal membrane oxygenation (VV-ECMO) in coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome (ARDS) is accumulating, the feasibility and safety of this therapy remain controversial. We aimed to evaluate the effect of VV-ECMO in the treatment of these patients. METHODS: A comprehensive literature search was performed using PubMed, Embase, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2021. According to the inclusion and exclusion criteria, the included studies were screened, and meta-analysis was performed by R software (version 4.0.2). RESULTS: Forty-two studies including 2037 COVID-19 patients supported with VV-ECMO due to ARDS were identified. The pooled analysis revealed that 30-, 60-, and 90-day mortality among patients were respectively 46% (95% CI 37%-57%, I2 = 66%), 46% (95% CI 30%-70%, I2 = 93%), and 49% (95% CI 43%-58%, I2 = 52%), and the pooled incidence rate of in-hospital mortality, major bleeding, hemorrhagic stroke, thrombosis, pulmonary embolism, deep venous thrombosis, and renal replacement therapy were respectively 35%, 39%, 11%, 40%, 15%, 21%, and 44%. CONCLUSION: Although COVID-19 patients may have a higher risk of bleeding, hemorrhagic stroke, and acute kidney injury during ECMO therapy, the survival rate was more than half of the cases. Our data may support the application of VV-ECMO in COVID-19 patients.

Establishment of a venovenous extracorporeal membrane oxygenation in a rat model of acute respiratory distress syndrome.

INTRODUCTION: Venovenous extracorporeal membrane oxygenation (VV ECMO) is now considered a reasonable option to salvage acute respiratory distress syndrome (ARDS). However, we lack a rodent model for experimental studies. This study was undertaken to establish an animal model of VV ECMO in ARDS rats. METHODS: A total of 18 Sprague-Dawley (SD) rats (350 ± 50 g) were used in this study. Using a rat model of oleic acid (OA)-induced ARDS, VV ECMO was established through cavoatrial cannulation of the right jugular vein for venous drainage and venous reinfusion with a specially designed three-cavity catheter. Continuous arterial pressure monitoring was implemented by using a catheter through cannulation of the right femoral artery. The central temperature was monitored with a rectal probe. Arterial blood gas monitoring was implemented by a blood gas analyzer at three-time points: at baseline, 1-hour (after OA modeling), and 3.5-hour (after VV ECMO support). Lung tissue and bronchoalveolar lavage fluid were harvested respectively for protein concentration and pulmonary histologic evaluation to confirm the alleviation of lung injury during VV ECMO. RESULTS: Following ARDS induced by OA, ten rats were successfully established on VV ECMO without failure and survived the ECMO procedure. VV ECMO alleviated lung injury and restored adequate circulation for the return of lung function and oxygenation. VV ECMO was associated with decreased lung injury score, wet/dry weight ratio, and fluid leakage into airspaces. CONCLUSION: We have established a reliable, economical, and functioning ARDS rat model of VV ECMO.

Decomposition-Coordination of Double-Layer MPC for Constrained Systems.

Large-scale industrial processes usually adopt centralized control and optimization methods. However, with the growth of the scale of industrial processes leading to increasing computational complexity, the online optimization capability of the double-layer model predictive control algorithm is challenged, exacerbating the difficulty of the widespread implementation of this algorithm in the industry. This paper proposes a distributed double-layer model predictive control algorithm based on dual decomposition for multivariate constrained systems to reduce the computational complexity of process control. Firstly, to solve the problem that the original dual decomposition method does not apply to constrained systems, two improved dual decomposition model prediction control methods are proposed: the dual decomposition method based on the quadratic programming in the subsystem and the dual decomposition method based on constraint zones, respectively. It is proved that the latter will certainly converge to the constraint boundaries with appropriate convergence factors for the controlled variables. The online optimization ability of the proposed two methods is compared in discussion and simulation, concluding that the dual decomposition method based on the constraint zones exhibits superior online optimization ability. Further, a distributed double-layer model predictive control algorithm with dual decomposition based on constraint zones is proposed. Different from the objective function of the original dual decomposition model predictive control, the proposed algorithm's dynamic control-layer objective function simultaneously tracks the steady-state optimization values of the controlled and manipulated variables, giving the optimal solution formulation of the optimization problem consisting of this objective function and the constraints. The algorithm proposed in this paper achieves the control goals while significantly reducing the computational complexity and has research significance for promoting the industrial implementation of double-layer model predictive control.

Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis.

BACKGROUND: Redo coronary artery bypass grafting (redo CABG) is associated with increased mortality and morbidity. The aim of this study was to systematically evaluate the evidence comparing the outcomes of off-pump with on-pump redo CABG. METHODS: Studies were systematically searched and identified using PubMed, EMBASE, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) by two researchers independently. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality, post-operative complications, completeness of revascularization, blood transfusion rate, duration of mechanical ventilation, intensive care unit and hospital stays. RESULTS: The 21 studies including 4,889 patients were enrolled in our meta-analysis. Compared with on-pump, the off-pump technique was associated with significantly reduced 30-day mortality (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001). Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI = 0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p < 0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI = 0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR = 0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration of mechanical ventilation, intensive care unit and hospital stays (mean difference [MD] = -8.21 h, 95% CI = -11.74 to -4.68, p < 0.00001; MD = -0.77 d, 95% CI = -0.81 to -0.73, p < 0.00001; MD = -2.24 d, 95% CI = -3.17 to -1.32, p < 0.00001) could be observed when comparing the outcomes of off-pump with on-pump redo CABG. There was nonsignificant difference between off-pump and on-pump redo CABG in completeness of revascularization. CONCLUSION: In patients undergoing redo CABG surgery, the off-pump technique was associated with decreased mortality, less post-operative complications when compared to on-pump.

Urban Land Use and Land Cover Classification Using Novel Deep Learning Models Based on High Spatial Resolution Satellite Imagery.

Urban land cover and land use mapping plays an important role in urban planning and management. In this paper, novel multi-scale deep learning models, namely ASPP-Unet and ResASPP-Unet are proposed for urban land cover classification based on very high resolution (VHR) satellite imagery. The proposed ASPP-Unet model consists of a contracting path which extracts the high-level features, and an expansive path, which up-samples the features to create a high-resolution output. The atrous spatial pyramid pooling (ASPP) technique is utilized in the bottom layer in order to incorporate multi-scale deep features into a discriminative feature. The ResASPP-Unet model further improves the architecture by replacing each layer with residual unit. The models were trained and tested based on WorldView-2 (WV2) and WorldView-3 (WV3) imageries over the city of Beijing. Model parameters including layer depth and the number of initial feature maps (IFMs) as well as the input image bands were evaluated in terms of their impact on the model performances. It is shown that the ResASPP-Unet model with 11 layers and 64 IFMs based on 8-band WV2 imagery produced the highest classification accuracy (87.1% for WV2 imagery and 84.0% for WV3 imagery). The ASPP-Unet model with the same parameter setting produced slightly lower accuracy, with overall accuracy of 85.2% for WV2 imagery and 83.2% for WV3 imagery. Overall, the proposed models outperformed the state-of-the-art models, e.g., U-Net, convolutional neural network (CNN) and Support Vector Machine (SVM) model over both WV2 and WV3 images, and yielded robust and efficient urban land cover classification results.

A distal ileum malignant peripheral nerve sheath tumor causing intussusception in a patient in China: a case report.

BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) arise from a peripheral nerve or display nerve sheath differentiation. Most MPNSTs typically originate on the trunk, extremities, head, neck, and paravertebral regions. Gastrointestinal MPNSTs are rare entities with only 10 cases reported worldwide in the literatures. CASE PRESENTATION: Here, we report the first Chinese case of a malignant peripheral nerve sheath tumor of the distal ileum presenting as intussusception. A 53-year-old female patient without pathological antecedent for neurofibromatosis was admitted with pain in the right lower abdomen and multiple episodes of vomiting for 1 week. Preoperative diagnosis was intussusception with a contrast-enhanced computed tomography scan (CECT) of the abdomen showing characteristic target sign. Due to difficulty reducing the ileum-colon intussusception, right hemicolectomy with ileocolostomy was performed. Histopathology was suggestive of low-grade MPNST. The patient received postoperative care and was followed up for 9 months. There is no sign of tumor recurrence and metastatic disease. CONCLUSIONS: This case is unique in terms of a rare tumor presenting with unusual complication.

RNF43 Suppressed Triple-Negative Breast Cancer Progression by Inhibiting Wnt/beta-Catenin Pathway.

OBJECTIVE: Triple-negative breast cancer (TNBC) is a subtype with high invasiveness. Due to lacking specific and effective therapies, it is necessary to explore the mechanism of TNBC progression and search for new therapeutic targets. METHODS: Data from the GEPIA2 database was analyzed to explore RNF43 expression in each subtype of breast cancer. RNF43 expression in TNBC tissue and cell lines was determined by RT-qPCR. In vitro biological function analyses including MTT assay, colony formation assay, wound-healing assay and Transwell assay were conducted to explore the role of RNF43 in TNBC. In addition, the markers of epithelial-mesenchymal transition (EMT) were detected by western blot. The expression of ß-Catenin and its downstream effectors were also detected. RESULTS: Data from the GEPIA2 database indicated that RNF43 expression was lower in tumor tissue compared to paired adjacent tissue in TNBC. In addition, RNF43 expression in TNBC was lower than in other subtypes of breast cancer. Consistently, down-regulation of RNF43 expression in TNBC tissue and cell lines was observed. Overexpressing RNF43 attenuated the proliferation and migration of TNBC cells. Depletion of RNF43 showed the opposite effect, confirming that RNF43 played an anti-oncogenic role in TNBC. In addition, RNF43 suppressed several markers of EMT. Furthermore, RNF43 restrained the expression of ß-Catenin and its downstream effectors, implying RNF43 exerted the suppressive role in TNBC by inhibiting the ß-Catenin pathway. CONCLUSIONS: This study demonstrated that the RNF43-ß-Catenin axis attenuated TNBC progression, which might provide novel therapeutic targets for TNBC.

N7-Methylguanosine Regulatory Genes Profoundly Affect the Prognosis, Progression, and Antitumor Immune Response of Hepatocellular Carcinoma.

Background: Hepatocellular carcinoma (HCC) is a common abdominal cancer with poor survival outcomes. Although there is growing evidence that N7-methylguanosine (m7G) is closely associated with tumor prognosis, development, and immune response, few studies focus on this topic. Methods: The novel m7G risk signature was constructed through the Lasso regression analysis. Its prognostic value was evaluated through a series of survival analyses and was tested in ICGC-LIRI, GSE14520, and GSE116174 cohorts. CIBERSORT, ssGSEA, and ESTIMATE methods were applied to explore the effects of the m7G risk score on tumor immune microenvironment (TIM). The GSEA method was used to evaluate the impacts of the m7G risk score on glycolysis, ferroptosis, and pyroptosis. The human protein atlas (HPA) database was used to clarify the histological expression levels of five m7G signature genes. The biofunctions of NCBP2 in hepatocellular cancer (HC) cells were confirmed through qPCR, CCK8, and transwell assays. Results: Five m7G regulatory genes comprised the novel risk signature. The m7G risk score was identified as an independent prognostic factor of HCC and could increase the decision-making benefit of traditional prognostic models. Besides, we established a nomogram containing the clinical stage and m7G risk score to predict the survival rates of HCC patients. The prognostic value of the m7G model was successfully validated in ICGC and GSE116174 cohorts. Moreover, high m7G risk led to a decreased infiltration level of CD8+ T cells, whereas it increased the infiltration levels of Tregs and macrophages. The glycolysis and pyroptosis processes were found to be enriched in the HCC patients with high m7G risk. Finally, overexpression of NCBP2 could promote the proliferation, migration, and invasion of HC cells. Conclusions: The m7G risk score was closely related to the prognosis, antitumor immune process, glycolysis, and malignant progression of HCC. NCBP2 has pro-oncogenic abilities, showing promise as a novel treatment target.

Transcatheter versus surgical aortic valve replacement in aortic stenosis patients with advanced chronic kidney disease: a systematic review and meta-analysis.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been increasingly used in all levels of risk patients, which is less invasive and has fewer complications. However, the benefits of transcatheter and surgical methods of aortic valve replacement remain controversial for aortic stenosis (AS) patients with advanced chronic kidney disease (stage 3-5). METHODS: We comprehensively searched PubMed, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) from January 2000 to October 2020 and performed a systematic review to evaluate the two techniques. Two investigators independently conducted the literature searches, study eligibility assessment, and data extraction in duplicate. RESULTS: Compared to surgical aortic valve replacement (SAVR), TAVR had lower risk of in-hospital mortality [odds ratio (OR): 0.53; 95% confidence interval (CI): 0.36-0.78; P=0.001], lower stroke rate (OR: 0.68; 95% CI: 0.47-0.96; P=0.03), lower risk of acute kidney injury (AKI) (OR: 0.42; 95% CI: 0.34-0.52; P<0.00001) and AKI requiring dialysis (OR: 0.65; 95% CI: 0.58-0.73; P<0.00001), lower rate of bleeding (OR: 0.35; 95% CI: 0.31-0.38; P<0.00001) and blood transfusion (OR: 0.41; 95% CI: 0.32-0.52; P<0.00001), lower infection rate (OR: 0.23; 95% CI: 0.13-0.38; P<0.00001), lower risk of atrial fibrillation (AF) (OR: 0.37; 95% CI: 0.17-0.79; P=0.01) and cardiac tamponade (OR: 0.53; 95% CI: 0.37-0.75; P=0.0003), shorter ICU stay [weighted mean difference (WMD): -2.55; 95% CI: -4.13 to -0.98; P=0.002] and hospital stay (WMD: -7.06; 95% CI: -8.41 to -5.71; P<0.00001). DISCUSSION: TAVR is a safe, efficient, and feasible technique for AS patients with advanced CKD and probably a better solution for its advantage in reducing in-hospital mortality, postoperative complications, ICU, and hospital stay.

Efficacy of left ventricular unloading strategies during venoarterial extracorporeal membrane oxygenation in patients with cardiogenic shock: a protocol for a systematic review and Bayesian network meta-analysis.

INTRODUCTION: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been widely used for patients with refractory cardiogenic shock. A common side effect of this technic is the resultant increase in left ventricular (LV) afterload which could potentially aggravate myocardial ischaemia, delay ventricular recovery and increase the risk of pulmonary congestion. Several LV unloading strategies have been proposed and implemented to mitigate these complications. However, it is still indistinct that which one is the best choice for clinical application. This Bayesian network meta-analysis (NMA) aims to compare the efficacy of different LV unloading strategies during VA-ECMO. METHODS AND ANALYSIS: PubMed, Embase, the Cochrane Library and the International Clinical Trials Registry Platform will be explored from their inception to 31 December 2020. Random controlled trials and cohort studies that compared different LV unloading strategies during VA-ECMO will be included in this study. The primary outcome will be in-hospital mortality. The secondary outcomes will include neurological complications, haemolysis, bleeding, limb ischaemia, renal failure, gastrointestinal complications, sepsis, duration of mechanical ventilation, length of intensive care unit and hospital stays. Pairwise and NMA will respectively be conducted using Stata (V.16, StataCorp) and Aggregate Data Drug Information System (V.1.16.5), and the cumulative probability will be used to rank the included LV unloading strategies. The risk of bias will be conducted using the Cochrane Collaboration's tool or Newcastle-Ottawa Quality Assessment Scale according to their study design. Subgroup analysis, sensitivity analysis and publication bias assessment will be performed. The Grading of Recommendations Assessment, Development and Evaluation will be conducted to explore the quality of evidence. ETHICS AND DISSEMINATION: Either ethics approval or patient consent is not necessary, because this study will be based on literature. The results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42020165093.

Endoscopic resection of small gastrointestinal stromal tumors.

BACKGROUND: The common treatment principle of gastrointestinal stromal tumors (GISTs) is complete resection of the tumor. The rapid development of endoscopic skill makes it possible to resect GISTs en-bloc through the endoscopic approach. AIMS: The aim of this study is to evaluate the feasibility of endoscopic resection for small-size (<30 mm) gastric GISTs. METHODS: A total of 25 patients with gastric GISTs underwent endoscopic resection assisted with needle knife, loop, and snare. Clinical data, perioperative outcomes, tumor size and microscopic characteristics, immunohistochemical staining results, and follow-up outcomes were recorded. RESULTS: Endoscopic resection was successfully accomplished in 25 patients at age of 56.72 +/- 11.42 years. The average operation time was 58.52 +/- 21.84 min. Perforation for 2-6 mm occurred in seven patients (28%) and was closed well with clips, with no conversions to open surgery. No mortalities occurred. All tumors were located in the stomach, and had an average size of (11.64 +/- 6.12) mm (5-30 mm). The average length of hospitalization was 4.28 +/- 0.84 days. Out of the total of 25 patients, 21 (84%) were at very low risk and only one (4%) was at intermediate risk. Positive rate of CD117 and CD34 was 92 and 84%, respectively. A follow-up for 11.44 +/- 5.79 months (2-23 months) showed no recurrence or metastasis. CONCLUSIONS: Endoscopic resection is feasible, safe, and effective for small-size gastric GISTs (<30 mm). Short-term follow-up evaluation merits favorable clinical results.

Diffuse biliary peritonitis secondary to rupture of metastatic liver adenocarcinomas after drug-eluting bead transcatheter arterial chemoembolization: a case report.

Transcatheter arterial chemoembolization (TACE) has become one of the first-line standard treatments for intermediate-advanced hepatocellular carcinoma, as well as an effective treatment for metastatic hepatic carcinoma. The majority of TACE-related complications are mild and acceptable to patients. Compared with conventional (C)-TACE, drug-eluting bead (DEB)-TACE allows permanent embolization of blood vessels, a slow continuous release of anti-tumour drugs in a locally targeted manner, and reduction of the systemic release of anti-tumour drugs, so that their adverse effects are significantly reduced. The general consensus is that DEB-TACE is safer and better tolerated by patients than C-TACE because serious complications after DEB-TACE are rarely reported. This current case report describes a rare case of diffuse biliary peritonitis secondary to rupture of a hepatic tumour after DEB-TACE. After the procedure, the patient presented with progressively worsening upper abdominal pain. As conventional management methods for the suspected tumour rupture failed, an emergency laparotomy was performed to remove the metastatic mass of differentiated hepatic adenocarcinoma. The patient remains under surveillance with no further complications. In our opinion, although DEB-TACE is safe and rarely has serious complications, caution should be exercised when this method is used to treat tumours that are located close to the liver surface.

Treatment of an incarcerated inguinal hernia associated with abdominal tuberculosis in an adult patient.

The incidence of tuberculosis is increasing worldwide, especially in developing countries. The prevalence of abdominal tuberculosis has been found to be as high as 12% in people with extrapulmonary tuberculosis. Peritoneal thickening and intestinal adhesions can occur in patients with abdominal tuberculosis. Inguinal hernias are extremely rare in people with abdominal tuberculosis; only 11 cases have been reported in the English-language literature, half of which involved pediatric patients. No definitive guideline on the management of such cases is available. In this report, we describe the unusual finding of an incarcerated inguinal hernia in an adult with abdominal tuberculosis and propose a therapy to treat this complicated disease based on our successful experience.

Clinical value of Helicobacter pylori stool antigen test, ImmunoCard STAT HpSA, for detecting H pylori infection.

AIM: To evaluate the reliability of the Helicobacter pylori stool antigen test, ImmunoCard STAT HpSA, for detecting H pylori infection. METHODS: Stool specimens were collected from 53 patients who received upper endoscopy examination due to gastrointestinal symptoms. ImmunoCard STAT HpSA was used to detect H pylori stool antigens. H pylori infection was detected based on three different tests: the urease test, Warthin-Starry staining and culture. H pylori status was defined as positive when both the urease test and histology or culture alone was positive. RESULTS: Sensitivity, specificity, positive predictive and negative predictive values and the total accuracy of ImmunoCard STAT HpSA for the diagnosis of H pylori infection were 92.6% (25/27), 88.5% (23/26), 89.3% (25/28), 92% (23/25) and 90.6% (48/53), respectively. CONCLUSION: The stool antigen test, ImmunoCard STAT HpSA, is a simple noninvasive and accurate test for the diagnosis of H pylori infection.