Gallbladder cancer with tumor thrombus in the portal vein: A case report.

RATIONALE: Gallbladder cancer (GBC) is a highly fatal malignancy. Due to its invasiveness and delayed diagnosis, many GBC patients are diagnosed with synchronous liver and hepatoduodenal ligament involvement. In our case, we report a gallbladder cancer with portal vein thrombus. PATIENT CONCERNS: A 60-year-old woman presented with persistent upper abdominal dull pain for 2 months. DIAGNOSES: Ultrasound examination showed gallbladder carcinoma invading liver segment IV, and a tumor thrombus in the left and right main portal trunk. Ultrasonography and contrast-enhanced magnetic resonance imaging (MRI) showed gallbladder carcinoma with invasion of adjacent liver, and tumor thrombus in the right branch of the portal vein and intrahepatic bile duct. Abdominal computed tomography angiography (CTA) revealed no hepatic artery invasion. INTERVENTIONS: We made a decision to perform extended right lobectomy. Twenty-six days later, the patient underwent intravenous infusion port implantation for S-1 plus oxaliplatin (SOX) therapy. OUTCOMES: After treatment, the patient has been doing very well and no recurrence has been found for 5 months. LESSONS: The patient with gallbladder cancer and tumor thrombus in the portal vein described in this report provides a reminder for surgeons of the importance of early diagnosis, and adequate surgical and adjuvant treatment. Multi-disciplinary treatment is significantly beneficial for the overall survival of patients with advanced GBC.

A comparative assessment of economic-incentive and command-and-control instruments for air pollution and CO2 control in China's iron and steel sector.

China's iron and steel sector is faced with increasing pressure to control both local air pollutants and CO2 simultaneously. Additional policy instruments are needed to co-control these emissions in this sector. This study quantitatively evaluates and compares two categories of emission reduction instruments, namely the economic-incentive (EI) instrument of a carbon tax, and the command-and-control (CAC) instrument of mandatory application of end-of-pipe emission control measures for CO2, SO2 and NOx. The comparative evaluation tool is an integrated assessment model, which combines a top-down computable general equilibrium sub-model and a bottom-up technology-based sub-model through a soft-linkage. The simulation results indicate that the carbon tax can co-control multiple pollutants, but the emission reduction rates are limited under the tax rates examined in this study. In comparison, the CAC instruments are found to have excellent effects on controlling different pollutants separately, but not jointly. Such results indicate that no single EI or CAC instrument is overwhelmingly superior. The environmental and economic effectiveness of an instrument highly depends on its specific attributes, and cannot be predicted by the general policy category. These findings highlight the necessity of clearer identification of policy target priorities, and detail-oriented and integrated policy-making among different governmental departments.

Guaranteed cost synchronization of chaotic cellular neural networks with time-varying delay.

Synchronization of cellular neural networks with time-varying delay is discussed in this letter. Based on Razumikhin theorem, a guaranteed cost synchronous controller is given. Unlike Lyapunov-Krasovskii analysis process, there is no constraint on the change rate of time delay. The saturated terms emerging in the Razumikhin analysis are amplified by zoned discussion and maximax synthesis rather than by Lipschitz condition and vector inequality, which will bring more conservatism. Then the controller criterion is transformed from quadratic matrix inequality form into linear matrix inequality form, with the help of a sufficient and necessary transformation condition. The minimization of the guaranteed cost is studied, and a further criterion for getting the controller is presented. Finally, the guaranteed cost synchronous control and its corresponding minimization problem are illustrated with examples of chaotic time-varying delay cellular neural networks.