Minor hepatectomy combined with cholangioplasty and cholangiojejunostomy for Bismuth II hilar cholangiocarcinoma: A propensity score matching analysis.

BACKGROUND: The optimal surgical approach for Bismuth II hilar cholangiocarcinoma (HCCA) remains controversial. This study compared perioperative and oncological outcomes between minor and major hepatectomy. MATERIALS AND METHODS: One hundred and seventeen patients with Bismuth II HCCA who underwent hepatectomy and cholangiojejunostomy between January 2018 and December 2022 were retrospectively investigated. Propensity score matching created a cohort of 62 patients who underwent minor (n = 31) or major (n = 31) hepatectomy. Perioperative outcomes, complications, quality of life, and survival outcomes were compared between the groups. Continuous data are expressed as the mean ± standard deviation, categorical variables are presented as n (%). RESULTS: Minor hepatectomy had a significantly shorter operation time (245.42 ± 54.31 vs. 282.16 ± 66.65 min; P = 0.023), less intraoperative blood loss (194.19 ± 149.17 vs. 315.81 ± 256.80 mL; P = 0.022), a lower transfusion rate (4 vs. 11 patients; P = 0.038), more rapid bowel recovery (17.77 ± 10.00 vs. 24.94 ± 9.82 h; P = 0.005), and a lower incidence of liver failure (1 vs. 6 patients; P = 0.045). There were no significant between-group differences in wound infection, bile leak, bleeding, pulmonary infection, intra-abdominal fluid collection, and complication rates. Postoperative laboratory values, length of hospital stay, quality of life scores, 3-year overall survival (25.8 % vs. 22.6 %; P = 0.648), and 3-year disease-free survival (12.9 % vs. 16.1 %; P = 0.989) were comparable between the groups. CONCLUSION: In this propensity score-matched analysis, overall survival and disease-free survival were comparable between minor and major hepatectomy in selected patients with Bismuth II HCCA. Minor hepatectomy was associated with a shorter operation time, less intraoperative blood loss, less need for transfusion, more rapid bowel recovery, and a lower incidence of liver failure. Besides, this findings need confirmation in a large-scale, multicenter, prospective randomized controlled trial with longer-term follow-up.

Robotic versus open extended cholecystectomy for T1a-T3 gallbladder cancer: A matched comparison.

Background: The feasibility and safety of robotic extended cholecystectomy (REC) are still uncertain. This study was performed to compare the short- and long-term outcomes of REC with those of open extended cholecystectomy (OEC) for T1a-T3 gallbladder cancer. Methods: From January 2015 to April 2022, 28 patients underwent REC in our center. To minimize any confounding factors, a 1:2 propensity score-matching analysis was conducted based on the patients' demographics, liver function indicators, T stage, and symptoms. The data regarding demographics, perioperative outcomes, and long-term oncologic outcomes were reviewed. Results: The visual analogue scale score was significantly lower in the REC than OEC group immediately postoperatively (3.68 ± 2.09 vs. 4.73 ± 1.85, P = 0.008), on postoperative day 1 (2.96 ± 1.75 vs. 3.69 ± 1.41, P = 0.023), and on postoperative day 2 (2.36 ± 1.55 vs. 2.92 ± 1.21, P = 0.031). In addition, the REC group exhibited a shorter time to first ambulation (P = 0.043), a shorter time to drainage tube removal (P = 0.038), and a shorter postoperative stay (P = 0.037), but hospital costs were significantly higher in the REC group (P < 0.001). However, no statistically significant difference was found in the operation time (P = 0.134), intraoperative blood loss (P = 0.467), or incidence of postoperative morbidity (P = 0.227) or mortality (P = 0.289) between the REC and OEC groups. In regard to long-term outcomes, the 3-year disease-free survival rate was comparable between the OEC and REC groups (43.1% vs. 57.2%, P = 0.684), as was the 3-year overall survival rate (62.8% vs. 75.0%, P = 0.619). Conclusion: REC can be an effective and safe alternative to OEC for selected patients with T1a-T3 gallbladder cancer with respect to short- and long-term outcomes.

Moderation effect of urban density on changes in physical activity during the coronavirus disease 2019 pandemic.

Various social distancing measures were carried out in many cities worldwide during the coronavirus disease 2019 pandemic (COVID-19). These measures have led to decreased physical activity levels and higher health risks among urban populations. Strong evidence has been established that built environment characteristics can stimulate physical activity and thus improve public health during non-pandemic periods. Urban density was arguably one of the most important built environment characteristics. However, little is known about whether high urban density amplifies or attenuates the decline in physical activity during the pandemic. Based on two-wave physical activity data collected before and during the pandemic (in January and May 2020, respectively), we used moderation analysis to compare the changes in physical activity levels between people living in low- and high-density neighborhoods. Our results showed that people living in low-density areas have a smaller decrease in physical activity conducted in neighborhood, compared to those living in high-density areas. Our findings suggest that a flexible and porous urban development strategy could enhance the resilience of a city during the coronavirus pandemic and beyond.

Research on the Impact of the Built Environment on the Characteristics of Metropolis Rail Transit School Commuting-Take Wuhan as an Example.

The long-distance commute to school caused by urban sprawl and the car-oriented urban construction model are key factors leading to primary/middle school students being picked up by their parents in cars. Encouraging those students to take rail transit can reduce their dependence on cars. This paper uses a stepwise regression based on rail-transit swipe data to explore the influence of the built environment on rail-transit commuting characteristics in Wuhan, and uses a geographically weighted regression (GWR) model to analyze the spatial heterogeneity of significant influencing variables. The study found that: (1) 60% of students are one-way commuters; (2) 88.6% of students travel less than 10 km; (3) the floor area ratio, bus station density and whether the station is a transfer station have an obvious positive effect on the flow of commuters; (4) whether the station is a departure station has a positive effect on the commuting distance, but the mixed degree of land use and road density have a negative effect on the commuting distance. This research can assist cities in formulating built environment optimization measures and related policies to improve school-age children's use of rail transit. This is important in the development of child-friendly cities.

[Analysis of professor WU Lianzhong's experience of neck acupoints application].

OBJECTIVE: Professor WU Lianzhong's experience of neck acupoints application is introduced. The characteristics,locations, acupuncture manipulations ,efficiency and main functions of neck acupoints including Tiandixue (Extra), Jingbixue (Extra), and cervical Jiaji (EX-B 2) are stated. According to the TCM thought of treatment based on syndrome differentiation,WU Lianzhong's special theory of neck acupoints application is explained so as to provide experience for improving acupuncture effects.

[Brief analysis on professor WU Lian-Zhong's academic thought].

Professor WU Lian-zhong's academic thought and relevant theories of WU's mind regulation needling technique, the needling technique of ascending the clear and descending the turbid, clinical evidence-based needling technique at special acupoints, as well as the operation methods are introduced in this paper. In application of The mind regulation needling technique and the needling technique of ascending the clear and descending the turbid, He emphasizes the and highlights the importance of the people and the interaction between physician and patient. The needling techniques lay the stresses on motivating meridian qi, adjusting the antipathogenic qi in the core of resuscitation and mind regulation. These needling techniques bring the obvious efficacy on difficultly-treated diseases, such as stroke, dementia and tumor, etc.