Comparing short-term outcomes of robot-assisted and conventional laparoscopic total mesorectal excision surgery for rectal cancer in elderly patients

BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.AIM To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.METHODS A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023.The patients were divided into a robotassisted group(the R-TME group)and a laparoscopic group(the L-TME group),and the short-term efficacy of the two groups was compared.RESULTS There were 45 elderly patients(≥60 years)in the R-TME group and 50 elderly patients(≥60 years)in the L-TME group.There were no differences in demographics,conversion rates,or postoperative complication rates.The L-TME group had a longer surgical time than the R-TME group[145(125,187.5)vs 180(148.75,206.25)min,P=0.005),and the first postoperative meal time in the L-TME group was longer than that in the R-TME(4 vs 3 d,P=0.048).Among the sex and body mass index(BMI)subgroups,the R-TME group had better out-comes than did the L-TME group in terms of operation time(P=0.042)and intraoperative assessment of bleeding(P=0.042).In the high BMI group,catheter removal occurred earlier in the R-TME group than in the L-TME group(3 vs 4 d,P=0.001),and autonomous voiding function was restored.CONCLUSION The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery;however,robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis.Optimizing the learning curve can shorten the operation time,reduce the recovery time of gastrointestinal function,and improve the prognosis.

Effect of the traditional Chinese medicine fumigation combined with the meibomian gland squeezer for treatment of dry eye associated with meibomian gland dysfunction

Background:To observe the effect of traditional Chinese medicine fumigation combined with the meibomian gland squeezer for the treatment of dry eye associated with meibomian gland dysfunction(MGD).Methods:This is a randomized,controlled,non-masked,single-center study.Seventy-four cases(74 eyes)of dry eye associated with MGD were randomly divided into two groups.Thirty-seven patients were chosen as the treatment group was treated by the traditional Chinese medicine fumigation 3 times a week combined with the meibomian gland squeezer once a week for one month.The other 37 cases were sorted as the control group and only treated with the meibomian gland squeezer once a week for one month.Both groups received the primary treatment for 1 month,including Tobradex eye ointment once a day and 0.1%sodium hyaluronate eye drops 4-6 times daily.Patients were evaluated at baseline and 2-week and 1-month visits for the ocular symptom scores,international ocular surface disease index(OSDI),fluorescein tear break-up time(TBUT),corneal fluorescein staining test(CFS),Schirmer I test,meibum quality and meibum expressibility.Results:Sixty-seven patients were followed in the study,and the mean age was 57(±12.6)years.Thirty-three patients(11 males)in the treatment group and 34 patients(8 males)in the control group were followed in the study,and the mean age of the two groups was 45.36±15.02 years and 43.68±13.43 years,respectively.Before treatment,there was no significant difference between the two groups in gender,age,ocular symptom scores,OSDI,TBUT,CFS,Schirmer I test,meibum quality,and meibum expressibility(P>0.05).Compared with baseline,the 2 groups had different degrees of improvement in the ocular symptom scores,OSDI,TBUT,CFS,meibum quality,and meibum expressibility at the 2-week and 1-month visits(P<0.05),and the treatment group showed a more significant improvement in the ocular symptom scores,OSDI,TBUT,CFS,meibum quality and meibum expressibility compared with the control group(P<0.05).In addition,no serious adverse events were observed in each group.Conclusions:The traditional Chinese medicine fumigation combined with the meibomian gland squeezer may be safe,effective,and helpful for the treatment of dry eye associated with MGD.

改良式引流阀植入联合康柏西普治疗新生血管性青光眼

目的:探讨改良式青光眼Ahmed引流阀植入联合康柏西普玻璃体腔注射治疗新生血管性青光眼(NVG)的效果观察。方法:前瞻性研究。将我院眼科2015-05/2018-05间临床诊断为NVG的患者59例60眼纳入研究,按照随机数字抽签法分为试验组和对照组,试验组20例21眼采取改良式青光眼Ahmed引流阀植入联合康柏西普玻璃体腔注射治疗;对照组39例39眼采用单纯睫状体光凝治疗;两组患者均术后随访观察3mo,比较两组患者术后眼压情况。结果:两组患者术前资料对比无差异,在随诊观察3mo中均较术前眼压降低(P<0.05),两组患者眼压在术后1wk,1、3mo有差异(均P<0.05),术后1mo两组患者新生血管变化有差异(Z=2.74,P<0.05)。结论:改良式青光眼Ahmed引流阀植入联合康柏西普玻璃体腔注射较单纯睫状体光凝在NVG中的应用价值高,降压效果持久。

双通道视觉质量分析系统评价黄斑水肿患者视觉质量

目的:利用双通道视觉质量分析系统对黄斑水肿(ME)患者的光学质量和眼内散射进行评估,探讨视网膜病变对光学质量的影响。方法:前瞻性病例对照研究。选取2019-08/2020-01在我院眼科检查确诊的ME患者49例58眼为ME组,对照组选择性别年龄范围匹配的眼健康志愿者30例30眼纳入研究。记录两组患者的临床资料,在相同的测试条件下,由同一测试者采用OQASTMⅡ受试者对进行视觉质量的检查,包括调制传递函数截止空间频率(MTF cutoff)、斯特列尔比值(SR)、对比度为100%、20%、9%时的OV值(OV100%、OV20%、OV9%)以及客观散射指数(OSI)等。分析比较两组之间的差异性以及ME患者黄斑中心凹厚度及容积与视觉质量的相关性。结果:ME组患者平均最佳矫正视力显著低于对照组,黄斑中心凹厚度及容积显著高于对照组(P<0.001)。与对照组相比,ME组患者OSI显著增高,MTF cutoff、SR、OV100%、OV20%、OV9%显著降低(P<0.001)。ME组患者黄斑中心凹厚度与OSI呈正相关(r=0.566,P<0.001);与MTF cutoff(r=-0.336,P=0.010)、OV100%(r=-0.326,P=0.013)、OV20%(r=-0.349,P=0.007)和OV9%(r=-0.321,P=0.014)呈负相关,与SR无相关性。ME组患者黄斑中心凹容积与OSI呈正相关(r=0.574,P<0.001);与MTF cutoff(r=-0.367,P=0.005)、SR(r=-0.265,P=0.045)、OV100%(r=-0.351,P=0.007)、OV20%(r=-0.385,P=0.003)和OV9%(r=-0.375,P=0.004)呈负相关。结论:ME患者的视觉质量低于正常人群,黄斑部视网膜形态和厚度的变化可影响光学质量和眼内散射。OQASTMⅡ所测得的光学质量参数可能为黄斑功能的评估提供新的临床参考数据。

IPL治疗中重度MGD相关性干眼的短期疗效及对患者心理状况的影响

目的:评估强脉冲激光(IPL)治疗中重度睑板腺功能障碍(MGD)相关性干眼患者的短期疗效及对心理状况的影响。方法:自身前后对照。收集2018-10/2019-10就诊于武汉大学人民医院眼科门诊的中重度MGD患者25例50眼,给予IPL联合睑板腺按摩治疗。于治疗前和治疗一个疗程后1mo评估患者症状、体征及心理状态的变化,采用眼表疾病指数(OSDI)问卷评分标准评估患者症状,泪液分泌试验(SⅠt)、泪河高度、平均泪膜破裂时间(Mean BUT)、睑板腺缺失程度以及欧卡斯双通道系统测量平均散射指数(Mean OSI)来评估患者的体征,使用焦虑自评量表(SAS)和流调用抑郁自评量表(CES-D)来评估患者的心理状态。结果:患者治疗前后OSDI评分(58.36±10.34 vs 49.12±8.05分)、SⅠt(5.64±1.6 vs 8.24±1.71mm/5min)、泪河高度(0.19±0.04 vs 0.23±0.04mm)、Mean BUT(5.65±1.72 vs 7.06±1.84s)、Mean OSI(0.89±0.24 vs 0.75±0.23)、睑板腺缺失程度评分(2.56±0.58 vs 1.84±0.85分)、SAS评分(46.92±8.49 vs 40.2±8.01分),CES-D评分(21.04±6.11 vs 16.92±4.24分),所有指标治疗前后差异均有统计学意义(P<0.01)。OSDI评分与Mean BUT呈负相关(rs=-0.511,P<0.01),与Mean OSI呈正相关(rs=0.479,P<0.05),OSDI评分与SAS评分及CES-D评分均呈正相关(rs=0.775,0.856,均P<0.01),SAS评分与SⅠt和Mean BUT呈负相关(rs=-0.653,-0.713,均P<0.01),SAS与CES-D评分呈正相关(rs=0.730,P<0.01)。结论:短期观察IPL治疗中重度MGD相关性干眼安全、有效,治疗后患者干眼症状、体征及心理状态得到不同程度的缓解,患者的抑郁和焦虑与眼表症状相关。

Prognosis after resection for hepatitis B virus-associated intrahepatic cholangiocarcinoma

AIM:To investigate the prognostic factors after resection for hepatitis B virus(HBV)-associated intrahepatic cholangiocarcinoma(ICC) and to assess the impact of different extents of lymphadenectomy on patient survival.METHODS:A total of 85 patients with HBV-associated ICC who underwent curative resection from January 2005 to December 2006 were analyzed.The patients were classified into groups according to the extent of lymphadenectomy(no lymph node dissection,sampling lymph node dissection and regional lymph node dissection).Clinicopathological characteristics and survival were reviewed retrospectively.RESULTS:The cumulative 1-,3-,and 5-year survival rates were found to be 60 %,18 %,and 13 %,respectively.Multivariate analysis revealed that liver cirrhosis(HR = 1.875,95%CI:1.197-3.278,P = 0.008) and multiple tumors(HR = 2.653,95%CI:1.562-4.508,P < 0.001) were independent prognostic factors for survival.Recurrence occurred in 70 patients.The 1-,3-,and 5-year disease-free survival rates were 36%,3% and 0%,respectively.Liver cirrhosis(HR = 1.919,P = 0.012),advanced TNM stage(stage Ⅲ/Ⅳ)(HR = 2.027,P < 0.001),and vascular invasion(HR = 3.779,P = 0.02) were independent prognostic factors for disease-free survival.Patients with regional lymph node dissection demonstrated a similar survival rate to patients with sampling lymph node dissection.Lymphadenectomy did not significantly improve the survival rate of patients with negative lymph node status.CONCLUSION:The extent of lymphadenectomy does not seem to have influence on the survival of patients with HBV-associated ICC,and routine lymph nodedissection is not recommended,particularly for those without lymph node metastasis.

Insulin-like growth factor receptor-1 overexpression is associated with poor response of rectal cancers to radiotherapy

AIM: To explore the potential correlation between insulin-like growth factor receptor-1 (IGF-1R) expression and rectal cancer radiosensitivity.

软性接触镜和rb-bFGF滴眼液对角膜深层异物剔除术后促修复的疗效比较

目的:分析软性接触镜(SCL)和rb-bFGF滴眼液在角膜深层异物剔除术后促修复能力的情况。方法:将我院2017-01-01/2019-04-30角膜深层异物患者72例72眼随机分为三组,除每例术后均予左氧氟沙星滴眼液和氧氟沙星眼膏预防感染治疗外,A组术后配戴SCL,简称戴镜组;B组术后局部使用rb-bFGF滴眼液,简称rb-bFGF组;C组为空白组。比较三组患者术后1、3、5d的疼痛不适感,1wk后角膜缺损修复度,以及1mo后自觉视觉质量受影响的相关因素。结果:三组患者术后疼痛感比较,术后1、3、5d戴镜组疼痛感均明显低于rb-bFGF组和空白组;术后3、5d时rb-bFGF组的疼痛感低于空白组。术后1wk,戴镜组和rb-bFGF组角膜修复度均较空白组高,但戴镜组和rb-bFGF组间角膜修复度无差异(P>0.05)。术后1mo,视觉质量是否受影响与异物位置相关,越靠近瞳孔区,影响越大(rs=0.635,P<0.001)。结论:SCL可在早期有效缓解角膜深层异物剔除术后疼痛感,rb-bFGF滴眼液和SCL均可加速角膜的修复生长,而视觉质量是否受影响与角膜深层异物位置有关。

T1 rectal mucinous adenocarcinoma with bilateral enlarged lateral lymph nodes and unilateral metastasis:A case report

BACKGROUND There are a few cases of lateral lymph node(LLN)metastasis(LLNM)of T1 rectal cancer.Moreover,LLNM is easily missed,especially in patients with early-stage rectal cancer.To our knowledge,the possibility of bilateral LLNM before surgery has not been reported in previous studies.CASE SUMMARY A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal polyp.The pathology report showed a diagnosis of T1 rectal mucinous adenocarcinoma.She was considered to have bilateral LLNM after the examination at our hospital.Laparoscopic total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral LLNM.The patient received longcourse adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up period.CONCLUSION T1 rectal cancer could lead to LLNM and possibly,bilateral LLNM.Therefore,adequate clinical evaluation is essential for these patients.

Rogue waves of a(3+1)-dimensional BKP equation

We investigate certain rogue waves of a(3+1)-dimensional BKP equation via the Kadomtsev-Petviashili hierarchy reduction method.We obtain semi-rational solutions in the determinant form,which contain two special interactions:(i)one lump develops from a kink soliton and then fuses into the other kink one;(ii)a line rogue wave arises from the segment between two kink solitons and then disappears quickly.We find that such a lump or line rogue wave only survives in a short time and localizes in both space and time,which performs like a rogue wave.Furthermore,the higher-order semi-rational solutions describing the interaction between two lumps(one line rogue wave)and three kink solitons are presented.

Studies on the testicular toxicity of 2-bromopropane,an environmental endocrine disrupter

Aim: 2-bromopropane (2-BP) is known as an environmentalendocrine disrupter. Recently its reproductive and hematopoitic tox-icity has aroused the attention of the toxicologists. The presentstudy was designed to study its testicular toxicity in male rats.Methods; Forty male SD rats were divided into four groups of10 rats each. 2-BP was administered intraperitoneally at doses of1800 mg, 600 mg or 200 mg per kg body weight per day for 5days. The control rats were given a similar volume of the vehicle.The animals were sacrificed two days after the last dose. Results: With increasing doses, the seminiferous tubular damage wasgradually increased and the percentage of spermatogonia in the totalgerm cells gradually decreased ( P < 0. 05). The seminiferoustubular area of rats taking 1800 mg/kg was also reduced significant-ly . The body weight, testicular weight and relative testicular weightof rats taking the highest dose level were all significantly decreasedas compared with the controls. (Reprod Contracep 2001; 21; 157-60)

From seawater to hydrogen via direct photocatalytic vapor splitting: A review on device design and system integration

Solar-driven hydrogen production from seawater attracts great interest for its emerging role in decarbonizing global energy consumption. Given the complexity of natural seawater content, photocatalytic vapor splitting offers a low-cost and safe solution, but with a very low solar-to-hydrogen conversion efficiency. With a focus on cutting-edge photothermal–photocatalytic device design and system integration, the recent research advances on vapor splitting from seawater, as well as industrial implementations in the past decades were reviewed. In addition, the design strategies of the key processes were reviewed, including vapor temperature and pressure control during solar thermal vapor generation from seawater, capillary-fed vaporization with salt repellent, and direct photocatalytic vapor splitting for hydrogen production. Moreover, the existing laboratory-scale and industrial-scale systems, and the integration principles and remaining challenges in the future seawater-to-hydrogen technology were discussed.

A Bregman-Style Improved ADMM and its Linearized Version in the Nonconvex Setting:Convergence and Rate Analyses

This work explores a family of two-block nonconvex optimization problems subject to linear constraints.We first introduce a simple but universal Bregman-style improved alternating direction method of multipliers(ADMM)based on the iteration framework of ADMM and the Bregman distance.Then,we utilize the smooth performance of one of the components to develop a linearized version of it.Compared to the traditional ADMM,both proposed methods integrate a convex combination strategy into the multiplier update step.For each proposed method,we demonstrate the convergence of the entire iteration sequence to a unique critical point of the augmented Lagrangian function utilizing the powerful Kurdyka–Łojasiewicz property,and we also derive convergence rates for both the sequence of merit function values and the iteration sequence.Finally,some numerical results show that the proposed methods are effective and encouraging for the Lasso model.

Effect of light quality on total gypenosides accumulation and related key enzyme gene expression in Gynostemma pentaphyllum

Objective： Light quality has effect on the accumulation of gypenosides in the medicinal plant Gynosternma pentaphyllum in the family Cucurbitaceae, while the squalene synthase （SS） and squalene epoxidase （SE） are the key enzymes for gypenoside biosynthesis, The objective of this study was to elucidate the rela- tionship between light quality and biosynthesis key enzyme involving the regulation of gypenoside accu- mulation. Methods： The content of total gypenosides was measured by colorimetric method and the expression of SS and SE gene was determined by quantitative Real-time PCR in the seedlings of G. pentaphyllum which were grown with different light quality. Results： Light quality showed remarkable impacts on the accumulation of total gypenosides. The highest content of total gypenosides in the plant under red light condition was determined, followed by blue light and white light, while the lowest content was recorded under dark condition, qRT-PCR analysis proved that the expression levels of SS and SE genes were also affected by light quality. The high-level gene expressions of SS and SE were found in the plant under red light condition, followed by blue light, with the least content in darkness. The statistical analysis revealed that the total gypenosides were significantly different in different light treatment and the content of total gypenosides was positively related to the expression of SS and SE genes. Conclusions： Light quality regulates gypenoside accumulation via altering the expression of SS and SE in G. pentaphyllum.

Production of L-glutamate family amino acids in Corynebacterium glutamicum:Physiological mechanism,genetic modulation,and prospects

L-glutamate family amino acids(GFAAs),consisting of L-glutamate,L-arginine,L-citrulline,L-ornithine,L-proline,L-hydroxyproline,γ-aminobutyric acid,and 5-aminolevulinic acid,are widely applied in the food,pharmaceutical,cosmetic,and animal feed industries,accounting for billions of dollars of market activity.These GFAAs have many functions,including being protein constituents,maintaining the urea cycle,and providing precursors for the biosynthesis of pharmaceuticals.Currently,the production of GFAAs mainly depends on microbial fermentation using Corynebacterium glutamicum(including its related subspecies Corynebacterium crenatum),which is substantially engineered through multistep metabolic engineering strategies.This review systematically summarizes recent advances in the metabolic pathways,regulatory mechanisms,and metabolic engineering strategies for GFAA accumulation in C.glutamicum and C.crenatum,which provides insights into the recent progress in L-glutamate-derived chemical production.

Rogue Waves for a (2+1)-Dimensional Coupled Nonlinear Schr?dinger System with Variable Coefficients in a Graded-Index Waveguide

Studied in this paper is a(2+1)-dimensional coupled nonlinear Schr?dinger system with variable coefficients,which describes the propagation of an optical beam inside the two-dimensional graded-index waveguide amplifier with the polarization effects. According to the similarity transformation, we derive the type-Ⅰ and type-Ⅱ rogue-wave solutions. We graphically present two types of the rouge wave and discuss the influence of the diffraction parameter on the rogue waves.When the diffraction parameters are exponentially-growing-periodic, exponential, linear and quadratic parameters, we obtain the periodic rogue wave and composite rogue waves respectively.

Targeting central nervous system extracellular vesicles enhanced triiodothyronine remyelination effect on experimental autoimmune encephalomyelitis

The lack of targeted and high-efficiency drug delivery to the central nervous system(CNS)nidus is the main problem in the treatment of demyelinating disease.Extracellular vesicles(EVs)possess great promise as a drug delivery vector given their advanced features.However,clinical applications are limited because of their inadequate targeting ability and the“dilution effects”after systemic administration.Neural stem cells(NSCs)supply a plentiful source of EVs on account of their extraordinary capacity for self-renewal.Here,we have developed a novel therapeutic system using EVs from modified NSCs with high expressed ligand PDGF-A(EVPs)and achieve local delivery.It has been demonstrated that EVPs greatly enhance the target capability on oligodendrocyte lineage.Moreover,EVPs are used for embedding triiodothyronine(T3),a thyroid hormone that is critical for oligodendrocyte development but has serious side effects when systemically administered.Our results demonstrated that systemic injection of EVPs+T3,versus EVPs or T3 administration individually,markedly alleviated disease development,enhanced oligodendrocyte survival,inhibited myelin damage,and promoted myelin regeneration in the lesions of experimental autoimmune encephalomyelitis mice.Taken together,our findings showed that engineered EVPs possess a remarkable CNS lesion targeting potential that offers a potent therapeutic strategy for CNS demyelinating diseases as well as neuroinflammation.

Novel ACADVL variants resulting in mitochondrial defects in long-chain acyl-CoA dehydrogenase deficiency

The pathogenesis of very-long-chain acyl-CoA dehydrogenase(VLCAD)deficiency is highly heterogeneous and still unclear.Additional novel variants have been recently detected in the population.The molecular and cellular effects of these previously unreported variants are still poorly understood and require further characterization.To address this problem,we have evaluated the various functions and biochemical consequences of six novel missense variants that lead to mild VLCAD deficiency.Marked deficiencies in fatty acid oxidation(FAO)and other mitochondrial defects were observed in cells carrying one of these six variants(c.541 C>T,c.863 T>G,c.895 A>G,c.1238 T>C,c.1276 G>A,and c.1505 T>A),including reductions in mitochondrial respiratory-chain function and adenosine teriphosphate(ATP)production,and increased levels of mitochondrial reactive oxygen species(ROS).Intriguingly,higher apoptosis levels were found in cells carrying the mutant VLCAD under glucose-limited stress.Moreover,the stability of the mutant homodimer was disturbed,and major conformational changes in each mutant VLCAD structure were predicted by molecular dynamics(MD)simulation.The data presented here may provide valuable information for improving management of diagnosis and treatment of VLCAD deficiency and for a better understanding of the general molecular bases of disease variability.

Graphene quantum dots modulated solution-derived InGaO thin-film transistors and stress stability exploration

Graphene quantum dots(GQDs)doped InGaO(IGO)thin film transistors(TFTs)have been fabricated based on solution-driven ZrO_(x) as gate dielectrics.Compare to pure IGO TFTs,superior electrical performance of the GQDs-IGO TFTs can be achieved by adjusting the doping concentration.It has been demonstrated that GQDs-modified IGO TFTs devices with GQDs doping content of0.3 mg·ml^(-1)have the optimized performances,including field-effect mobility(μ_(FE))of 22.02 cm^(2)·V^(-1)·s^(-1),on/off current ratio(I_(on)/I_(off))of 7.06×10^(7),subthreshold swing(SS)of 0.09 V·dec^(-1),hysteresis of 0.04 V and interfacial trap states(D_(it))of 1.03×10^(12)cm^(-2).In addition,bias stress and illumination stress tests have been performed and excellent stability has been achieved for optimized GQDs-IGO-TFTs.The GQDs-IGO TFTs device showed smaller threshold voltage shift of 0.12 and 0.04 V under positive bias stress(PBS)test and negative bias stress(NBS)test for 3600 s,respectively.And it showed smaller threshold voltage shift of 0.27 and 0.34 V for red light under the PBS and NBS test for 3600 s,respectively.Meanwhile,it showed smaller threshold voltage shift of0.20 and 0.22 V for green light under PBS and NBS test for3600 s,respectively.It also showed smaller threshold voltage shift of 0.17 and 0.12 V for blue under the positive bias illumination stress(PBIS)test and negative bias illumination stress(NBIS)test for 3600 s,respectively.Lowfrequency noise(LFN)characteristics of GQDs-IGO/ZrO_(x)TFTs indicated that the noise source came from the fluctuations in mobility.Finally,a low voltage resistor-loaded unipolar inverter has been built based on GQDs-IGO/ZrO_(x)TFT,demonstrating good dynamic response behavior and a maximum gain of 7.4.These experimental results have suggested that solution-processed GQDs-IGO/ZrO_(x)TFT may envision potential applications in low-cost and large-area electronics.