目的 分析幽門螺桿菌(Helicobacter pylori, HP)根除治療失敗相關因素，為有效根除Hp提供建議和決策。 方法 對2005年5月-2008年12月經胃鏡檢查確診的慢性胃炎或消化性潰瘍，且Hp檢測陽性并行含質子泵抑制劑三聯或四聯治療的患者103例進行研究。治療結束至少4周后，用14C呼氣試驗評估Hp是否成功根除，根據測試結果分為治療失敗組33例及治療成功組70例。運用統一標準的調查表對每位患者進行相關因素調查，就調查表所涉及的因素在根除失敗組與成功組間采用單因素及多因素Logistic回歸進行分析。 結果 通過單因素分析依從性和飲酒在兩組之間有統計學意義(P＜0.05)。Logistic多因素分析發現，依從性差是根除失敗的獨立危險因素。 結論 依從性差是治療失敗十分重要的影響因素。
Alzheimer’s disease (AD) is an irreversible neurodegenerative disorder that damages patients’ memory and cognitive abilities. Therefore, the diagnosis of AD holds significant importance. The interactions between regions of interest (ROIs) in the brain often involve multiple areas collaborating in a nonlinear manner. Leveraging these nonlinear higher-order interaction features to their fullest potential contributes to enhancing the accuracy of AD diagnosis. To address this, a framework combining nonlinear higher-order feature extraction and three-dimensional (3D) hypergraph neural networks is proposed for computer-assisted diagnosis of AD. First, a support vector machine regression model based on the radial basis function kernel was trained on ROI data to obtain a base estimator. Then, a recursive feature elimination algorithm based on the base estimator was applied to extract nonlinear higher-order features from functional magnetic resonance imaging (fMRI) data. These features were subsequently constructed into a hypergraph, leveraging the complex interactions captured in the data. Finally, a four-dimensional (4D) spatiotemporal hypergraph convolutional neural network model was constructed based on the fMRI data for classification. Experimental results on the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database demonstrated that the proposed framework outperformed the Hyper Graph Convolutional Network (HyperGCN) framework by 8% and traditional two-dimensional (2D) linear feature extraction methods by 12% in the AD/normal control (NC) classification task. In conclusion, this framework demonstrates an improvement in AD classification compared to mainstream deep learning methods, providing valuable evidence for computer-assisted diagnosis of AD.
Objective To summarize preliminary experience of laparoscopic pancreaticoduodenectomy for periampullary carcinoma. Method The clinical data of patients with periampullary carcinoma underwent laparoscopic pancreaticoduodenectomy from July 2016 to September 2016 in the Shengjing Hospital of China Medical University were analyzed retrospectively. Results Two patients underwent complete laparoscopic pancreaticoduodenectomy, 2 patients underwent laparoscopic resection and anastomosis assisted with small incision open. The R0 resection and duct to mucosa pancreaticojejunal anastomosis were performed in all the patients. The operative time was 510–600 min, intraoperative blood loss was 400–600 mL, postoperative hospitalization time was 15–21d, postoperative ambulation time was 6–7 d. Three cases of pancreatic fistula were grade A and all were cured by conservation. No postoperative bleeding, delayed gastric emptying, intra-abdominal infection, and bile leakage occurred. The postoperative pathological results showed that there was 1 case of pancreatic head ductal adenocarcinoma, 1 case of cyst adenocarcinoma of pancreas uncinate process, 1 case of papillary carcinoma of duodenum, and 1 case of terminal bile duct carcinoma. Conclusion The preliminary results of limited cases in this study show that laparoscopic pancreaticoduodenectomy has been proven to be a safe procedure, it could reduce perioperative cardiopulmonary complications, its exhaust time, feeding time, and postoperative ambulation time are shorter, but its operative complications could not be reduced.
Objective This study was conducted to evaluate and analyze the clinical effect between subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and pylorus-preserving pancreaticoduodenectomy (PPPD), especially compare the incidences of delayed gastric emptying (DGE) between them. Methods The documents about SSPPD and PPPD were searched in Cochrane Library, PubMed database, Embase database, Web of Science, Chinese biomedicine database, CNKI database, VIP database, and WanFang database. The quality of included studies was assessed according to the Cochrane systematic review methods, and statistical analysis of data was performed by using RevMan 5.3 software. Firstly, comparison of incidence of DGE and other effective indexes between SSPPD group and PPPD group was performed by enrolling all included studies, whether met the DGE standards of International Study Group of Pancreatic Surgery (ISGPS) or not, and then comparison of incidence of DGE and clinical DGE was performed by enrolling included studies that met the DGE standards of ISGPS. Results Ten studies were included, with a total of 804 patients, in which, 433 cases underwent SSPPD and 371 cases underwent PPPD. The results of meta-analysis indicated that, in all the included studies, the total incidence of DGE〔OR = 0.33, 95%CI is (0.17, 0.63),P = 0.000 9〕, and the time of nasogastric tube〔MD = –2.65，95%CI is (–4.49, –0.80),P = 0.005〕, and time of stared liquid diet〔MD = –4.13, 95%CI is (–7.35, –0.91),P = 0.01〕 showed significant differences. The total incidence of DGE, the time of nasogastric tube, and time of stared liquid diet were less in SSPPD group. But there was no significant difference between the SSPPD group and PPPD group in operating time, intraoperative blood loss, time of started solid diet, hospital stay, and incidences of reinsertion of nasogastric tube, pancreatic fistula, intra-abdominal abscess, reoperation, wound infection, postoperative hemorrhage, and mortality (P>0.05). In the 8 studies adopted DGE standard of ISGPS, the total incidence of DGE〔OR = 0.31, 95%CI is (0.15, 0.65)，P = 0.002〕 and incidence of clinical DGE 〔OR = 0.13，95%CI is (0.05, 0.40),P = 0.000 3〕showed significant differences. The total incidence of DGE and incidence of clinical DGE were both lower in SSPPD group. Conclusions Compared with PPPD group, SSPPD group was associated with significantly less incidence of DGE. Meanwhile, the time of the nasogastric tube and started liquid diet are shorter than those of SSPPD. And there is no significant difference in the other aspects.