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Subacute liver and respiratory failure after segmental hepatectomy for complicated hepatolithiasis with secondary biliary cirrhosis: A case report

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World Journal of Gastrointestinal Surgery 2022年第4期14卷 341-351页

作者： wen-juan fan Xiao-Jing Zou Department of Gastroenterology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina Emergency Department/Intensive Care Unit Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

BACKGROUND Despite being a benign disease, hepatolithiasis has a poor prognosis because of its intractable nature and frequent recurrence. Nonsurgical treatment is associated with high incidences of residual and recurrent stones. Consequently, surgery via hepatic lobectomy or segmental hepatectomy has become the main treatment modality. Clinical management and resolution of complicated hepatolithiasis with bilateral or diffuse intrahepatic stones remain very difficult and challenging. Repeated cholangitis and calculous obstruction may result in secondary biliary cirrhosis, a limiting factor in the treatment of *** SUMMARY A 53-year-old woman with a 5-year history of intermittent abdominal pain and fever was admitted to the hepatopancreatobiliary surgery department following worsening symptoms over a 3-d period. Blood tests revealed elevated transaminases, alkaline phosphatase, γ-glutamyl transpeptidase, and total bilirubin, as well as anemia. Magnetic resonance cholangiopancreatography showed dilatation of the intrahepatic, left and right hepatic, common hepatic, and common bile ducts, and multiple short T2 signals in the intrahepatic and common bile ducts. Abdominal computed tomography showed splenomegaly and splenic varices. The diagnosis was bilateral hepatolithiasis and choledocholithiasis with cholangitis. Surgical treatment included hepatectomy of segments Ⅱ and Ⅲ, cholangioplasty, left hepaticolithotomy, second biliary duct exploration, choledocholithotomy, T-tube drainage, and accretion lysis. Surgical and pathological findings confirmed secondary biliary cirrhosis. Liver-protective therapy and anti-infectives were administered. The patient developed liver and respiratory failure, severe abdominal infection, and septicemia. Eventually, her family elected to discontinue *** Liver transplantation, rather than hepatectomy, might be a treatment option for complicated bilateral hepatolithiasis with secondary liver cirrhosis.

关键词： Hepatolithiasis Hepatectomy Liver failure Biliary cirrhosis Septicemia Case report

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Surgical treatments of recurrent small intestine metastatic melanoma manifesting with gastrointestinal hemorrhage and intussusception:A case report

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World Journal of Gastrointestinal Oncology 2023年第1期15卷 205-214页

作者： wen-juan fan Heng-Hui Cheng Wang Wei Department of Gastroenterology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases Wuhan 430030Hubei ProvinceChina Institution of Pathology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

BACKGROUND Melanoma is the most aggressive form of skin cancer,with a tendency to metastasize to any *** melanoma is the most frequent cause of skin cancer-related deaths *** intestine cancers especially small intestine metastases are relatively *** intestine metastases are seldom described and likely *** is most common in pediatric age,and in adults are almost 5%of all *** SUMMARY A 75-year-old man with a history of acral malignant melanoma was admitted to the Gastroenterology Department of our hospital,complaining of intermittent melena for 1 *** resonance enterography showed partial thickening of the jejunal wall and formation of a soft tissue mass,indicating a neoplastic lesion with jejunojejunal *** patient underwent partial small bowel *** findings and immunohistochemical staining indicated small intestine metastatic *** patient refused further anti-tumor treatment after the *** months after the first surgery,the patient presented with melena *** tomography enterography showed the anastomotic stoma was normal without thickening of the intestinal wall,and routine conservative treatment was *** months later,the patient developed melena *** patient underwent a second surgery,and multiple metastatic melanoma lesions were *** patient refused adjuvant anti-tumor treatment and was alive at the latest *** Small intestine metastatic melanoma should be suspected in any patient with a history of malignant melanoma and gastrointestinal symptoms.

关键词： Melanoma Metastasis Gastrointestinal hemorrhage Intussusception Small bowel resection Case report

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Secondary aortoesophageal fistula initially presented with empyema after thoracic aortic stent grafting:A case report

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World Journal of Clinical Cases 2021年第29期9卷 8938-8945页

作者： De-Qiong Wang Mei Liu wen-juan fan Department of Gastroenterology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

BACKGROUND Massive upper gastrointestinal(GI)bleeding is usually urgent and severe,and is mostly caused by GI *** fistula(AEF)after thoracic aortic stent grafting is a rare cause of this condition,and has a poor prognosis with a high mortality *** clinical symptoms of AEF are usually nonspecific,and the diagnosis is often difficult,especially when upper GI bleeding is *** identification,early diagnosis,and early treatment are very important for improving *** SUMMARY A 74-year-old man was admitted to the infectious disease department with>10-d fever and 10-mo prior history of thoracic aortic stent grafting for thoracic aortic penetrating *** tests revealed elevated inflammatory indicators and *** computed tomography(CT)showed postoperative changes of the aorta after endovascular stent graft implantation,pulmonary infection and pleural *** effusion tests showed *** 1 wk of anti-infective treatment,temperature returned to normal and chest CT indicated improvement in pulmonary infection and reduction of pleural *** endoscopy was performed because of epigastric discomfort,and showed a large ulcer with blood clot in the middle ***,on day 11,hematemesis and melena developed *** stopped temporarily after hemostatic treatment and bedside endoscopic *** and abdominal aortic CT angiography confirmed *** that day,he suffered massive hemorrhage and hemorrhagic ***,his family elected to discontinue *** AEF should be strongly considered in patients with a history of aortic intervention who present with fever,especially with empyema.

关键词： Gastrointestinal hemorrhage Esophageal fistula Esophageal perforation Thoracic aorta Empyema Case report

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A Multi-dimensional Trust-aware Cloud Service Selection Mechanism Based on Evidential Reasoning Approach

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International Journal of Automation and computing 2015年第2期12卷 208-219页

作者： wen-juan fan Shan-Lin Yang Harry Perros Jun Pei School of Management Hefei University of Technology Department of Computer Science North Carolina State University The Ministry of Education Key Laboratory of Process Optimization and Intelligent Decision Making Department of Industry and System Engineering University of Florida

In the last few years, cloud computing as a new computing paradigm has gone through significant development, but it is also facing many problems. One of them is the cloud service selection problem. As increasingly boosting cloud services are offered through the internet and some of them may be not reliable or even malicious, how to select trustworthy cloud services for cloud users is a big challenge. In this paper, we propose a multi-dimensional trust-aware cloud service selection mechanism based on evidential reasoning(ER) approach that integrates both perception-based trust value and reputation based trust value, which are derived from direct and indirect trust evidence respectively, to identify trustworthy services. Here, multi-dimensional trust evidence, which reflects the trustworthiness of cloud services from different aspects, is elicited in the form of historical users feedback ratings. Then, the ER approach is applied to aggregate the multi-dimensional trust ratings to obtain the real-time trust value and select the most trustworthy cloud service of certain type for the active users. Finally, the fresh feedback from the active users will update the trust evidence for other service users in the future.

关键词： Cloud service selection multi-dimensional trust evidence trust and reputation evaluation evidential reasoning(ER) clond service

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Endoscopic and surgical treatment of jejunal gallstone ileus caused by cholecystoduodenal fistula:A case report

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World Journal of Clinical Cases 2023年第17期11卷 4159-4167页

作者： wen-juan fan Mei Liu Xin-Xia Feng Department of Gastroenterology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

BACKGROUND Gallstone ileus is a rare complication of gallstone disease in which a stone enters the enteric lumen and causes mechanical obstruction usually by bilioenteric *** ileus accounts for 25%of all bowel obstructions among the population>65 years of *** medical advances over the last decades,gallstone ileus is still associated with high rates of morbidity and *** SUMMARY An 89-year-old man with a history of gallstones was admitted to the Gastroenterology Department of our hospital,complaining of vomiting and cessation of bowel movements and *** computed tomography showed cholecystoduodenal fistula and upper jejunum obstruction due to gallstones,pneumatosis in the gallbladder,and pneumobilia indicating Rigler’s *** the high risk of surgical management,we performed propulsive enteroscopy and laser lithotripsy twice to relieve the bowel ***,the intestinal obstruction was not relieved by the less invasive ***,the patient was transferred to the Department of Biliary-pancreatic *** patient underwent the one-stage procedure including laparoscopic duodenoplasty(fistula closure),cholecystectomy,enterolithotomy,and *** surgery,the patient presented with complications of acute renal failure,postoperative leak,acute diffuse peritonitis,septicopyemia,septic shock,and multiple organ failure,and finally *** Early surgical intervention is the mainstay of treatment for gallstone *** elderly patients with significant comorbidities,enterolithotomy alone is advised.

关键词： Gallstone ileus Cholecystoduodenal fistula Pneumobilia Small bowel

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Duodenojejunostomy treatment of groove pancreatitis-induced stenosis and obstruction of the horizontal duodenum:A case report

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2945-2953页

作者： Yu Zhang Heng-Hui Cheng wen-juan fan Department of Gastroenterology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina Institution of Pathology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

BACKGROUND Groove pancreatitis(GP)is a rare condition affecting the pancreatic groove region within the dorsal-cranial part of the pancreatic head,duodenum,and common bile *** a rare form of chronic pancreatitis,GP poses a diagnostic and therapeutic challenge for *** is frequently misdiagnosed or not considered;thus,the diagnosis is often delayed by weeks or *** treatment of GP is complicated and often requires surgical intervention,especially *** SUMMARY A 66-year-old man with a history of long-term drinking was admitted to the gastroenterology department of our hospital,complaining of vomiting and acid *** gastrointestinal endoscopy showed luminal stenosis in the descending part of the *** computed tomography showed slight exudation in the descending and horizontal parts of the duodenum with broadening of the groove region,indicating local *** symptoms of intestinal obstruction were not relieved with conservative therapy,and insertion of an enteral feeding tube was not *** laparoscopy was performed and revealed a hard mass with scarring in the horizontal part of the duodenum and *** frozen section analysis showed no evidence of malignancy,and side-to-side duodenojejunostomy was *** pathologic examination showed massive proliferation of fibrous tissue,hyaline change,and the proliferation of spindle *** on the radiologic and pathologic characteristics,a diagnosis of GP was *** patient presented with anastomotic obstruction postoperatively and took a long time to recover,requiring supportive *** GP often involves the descending and horizontal parts of the duodenum and causes duodenal stenosis,impaired duodenal motility,and gastric emptying due to fibrosis.

关键词： Groove pancreatitis Duodenal stenosis Duodenal obstruction Duodenojejunostomy Case report

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Synaptic aging disrupts synaptic morphology and function in cerebellar Purkinje cells

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Neural Regeneration Research 2018年第6期13卷 1019-1025页

作者： wen-juan fan Ming-Chao Yan Lai Wang Yi-Zheng Sun Jin-Bo Deng Jie-Xin Deng Institute of Neurobiology School of Life Science Henan University

Synapses are key structures in neural networks,and are involved in learning and memory in the central nervous *** synaptogenesis and synaptic aging is important in understanding neural development and neural degeneration in diseases such as Alzheimer disease and Parkinson’s *** previous study found that synaptogenesis and synaptic maturation were harmonized with brain development and ***,synaptic damage and loss in the aging cerebellum are not well *** study was designed to investigate the occurrence of synaptic aging in the cerebellum by observing the ultrastructural changes of dendritic spines and synapses in cerebellar Purkinje cells of aging ***,Di I diolistic assays,and transmission electron microscopy were used to visualize the morphological characteristics of synaptic buttons,dendritic spines and synapses of Purkinje cells in mice at various *** synaptic aging in the cerebellum,dendritic spines and synaptic buttons were lost,and the synaptic ultrastructure was altered,including a reduction in the number of synaptic vesicles and mitochondria in presynaptic termini and smaller thin specialized zones in pre-and post-synaptic *** findings confirm that synaptic morphology and function is disrupted in aging synapses,which may be an important pathological cause of neurodegenerative diseases.

关键词： nerve regeneration aging cerebellum degenerative disease dendritic spine nerve regeneration mice neurodegenerative diseases Purkinje cells synapse synaptogenesis synaptic ultrastructure neural regeneration

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Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain?

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World Journal of Gastroenterology 2022年第33期28卷 4861-4874页

作者： Xiu-Cai fang wen-juan fan Douglas D Drossman Shao-Mei Han Mei-Yun Ke Department of Gastroenterology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Gastroenterology Tongji HospitalTongji Medical CollegeHuazhong University of Science&TechnologyWuhan 430030Hubei ProvinceChina Center of Functional GI and Motility Disorders University of North CarolinaChapel HillNC 27517United States Center for Education and Practice of Biopsychosocial Care Drossman GastroenterologyDurhamNC 27713United States Rome Foundation Rome FoundationRaleighNC 27614United States Department of Epidemiology and Statistics Institute of Basic Medical SciencesChinese Academy of Medical Sciences&School of Basic MedicinePeking Union Medical CollegeBeijing 100005China

BACKGROUND The Rome IV criteria eliminated abdominal discomfort for irritable bowel syndrome(IBS), which was previously included in Rome III. There are questions as to whether IBS patients with abdominal discomfort(seen in Rome III but not Rome IV) are different from those with abdominal pain(Rome IV).AIM To compare bowel symptoms and psychosocial features in IBS patients diagnosed with Rome III criteria with abdominal discomfort, abdominal pain, and pain &*** We studied IBS patients meeting Rome III criteria. We administered the IBS symptom questionnaire, psychological status, and IBS quality of life. Patients were classified according to the predominant abdominal symptom associated with defecation into an only pain group, only discomfort group, and pain & discomfort group. We compared bowel symptoms, extraintestinal symptoms, IBS quality of life, psychological status and healthcare-seeking behaviors, and efficacy among the three groups. Finally, we tested risk factors for symptom reporting in IBS *** Of the 367 Rome III IBS patients enrolled, 33.8%(124 cases) failed to meet Rome IV criteria for an IBS diagnosis. There were no meaningful differences between the pain group(n = 233) and the discomfort group(n = 83) for the following:(1) Frequency of defecatory abdominal pain or discomfort;(2) Bowel habits;(3) Coexisting extragastrointestinal pain;(4) Comorbid anxiety and depression;and(5) IBS quality of life scores except more patients in the discomfort group reported mild symptom than the pain group(22.9% vs 9.0%). There is a significant tendency for patients to report their defecatory and non-defecatory abdominal symptom as pain alone, or discomfort alone, or pain & discomfort(all P < 0.001).CONCLUSION IBS patients with abdominal discomfort have similar bowel symptoms and psychosocial features to those with abdominal pain. IBS symptoms manifesting abdominal pain or discomfort may primarily be due to different sensation and reporting expe

关键词： Irritable bowel syndrome Abdominal pain Abdominal discomfort Diagnosis Psychosocial distress Quality of life

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Neural differentiation and synaptogenesis in retinal development

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Neural Regeneration Research 2016年第2期11卷 312-318页

作者： wen-juan fan Xue Li Huan-ling Yao Jie-xin Deng Hong-liang Liu Zhan-jun Cui Qiang Wang Ping Wu Jin-bo Deng Institute of Neurobiology School of Life Science Henan University

To investigate the pattern of neural differentiation and synaptogenesis in the mouse retina, immunolabeling, Brd U assay and transmission electron microscopy were used. We show that the neuroblastic cell layer is the germinal zone for neural differentiation and retinal lamination. Ganglion cells differentiated initially at embryonic day 13（E13）, and at E18 horizontal cells appeared in the neuroblastic cell layer. Neural stem cells in the outer neuroblastic cell layer differentiated into photoreceptor cells as early as postnatal day 0（P0）, and neural stem cells in the inner neuroblastic cell layer differentiated into bipolar cells at P7. Synapses in the retina were mainly located in the outer and inner plexiform layers. At P7, synaptophysin immunostaining appeared in presynaptic terminals in the outer and inner plexiform layers with button-like structures. After P14, presynaptic buttons were concentrated in outer and inner plexiform layers with strong staining. These data indicate that neural differentiation and synaptogenesis in the retina play important roles in the formation of retinal neural circuitry. Our study showed that the period before P14, especially between P0 and P14, represents a critical period during retinal development. Mouse eye opening occurs during that period, suggesting that cell differentiation and synaptic formation lead to the attainment of visual function.

关键词： nerve regeneration neural stem cells neural differentiation retinal development synaptogenesis neural regeneration

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Experimental Study on Geometry Characteristics of Turbulent Premixed Flames for Natural Gas/Air Mixtures

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Journal of Thermal Science 2025年第1期34卷 268-282页

作者： ZHENG Weilin WANG Qijiao XIAO Huahua CHEN Xiaoxiao XIE fan ZENG wen Liaoning Key Lab of Advanced Test Technology for Aerospace Propulsion System Shenyang Aerospace University State Key Laboratory of Fire Science University of science and Technology of China AVIC Shenyang Aircraft Design and Research Institute

In this study,focusing on the geometry characteristics of spherical expanding flame,the turbulent premixed flames of natural gas/air mixtures were investigated in a fan-stirred turbulent *** effects of initial temperature（T=300-400 K）,initial pressure（P=0.1-0.3 MPa）,turbulence intensity（u'=1.0-2.7 m/s）,oxygen volumetric percentage(φ（O2）=15%-21%) and carbon dioxide volumetric percentage(φ（CO2）=0-20%)were delved *** flame profile under the Cartesian coordinate system was derived from the schlieren images taken by the high-speed ***,from both macroscopic and microscopic perspectives,the influence of experimental conditions on the flame geometry characteristics was explored through flame front extraction,wavelet decomposition and network *** results demonstrate that for significant flame wrinkling,changes in species concentrations and turbulence intensity have more pronounced effects on the flame wrinkling *** wrinkling of the flame front maintains a certain degree of similarity,as evidenced by the locally concentrated distribution of the angles of the maximum fluctuation *** disturbance energy under large-scale（D6-D8） disturbances exhibits relatively high values with a similar trend,exerting a significant impact on the geometry characteristics of the flame *** peaks of correlation degree are scattered either with the decomposition scale or the development of flame radius,indicating no linear correlation between different detail ***,the probability distribution of node degrees in key wrinkled regions exhibits different trends with that of large-scale wrinkling and disturbance energy,especially with changes in initial *** occurs because the number of key wrinkles varies based on the perturbation's strength or the region's ***,an increase in the fluctuation frequency of the flame's local radius may not necessarily lead to an increase in the number of key folded regions.

关键词： fan-stirred turbulent combustor geometry characteristics large-scale wrinkling network topology wavelet decomposition

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