Where is the optimal plane to mobilize the anterior rectal wall in female patients undergoing total mesorectal excision?

BACKGROUND Since Heald proposed the total mesorectal excision(TME)procedure,the prognosis of patients with rectal cancer has been significantly improved.But Heald did not specifically describe the anterior surgical plane in female patients.And the surgical plane for mobilizing the anterior rectal wall during TME surgery in female patients remains controversial.AIM To investigate the anatomy of the female pelvis and identify the optimal plane for mobilizing the anterior rectal wall.METHODS We retrospectively collected surgical procedure videos and clinical data of female patients diagnosed with middle or low rectal cancer who underwent the TME procedure between January 2020 and October 2022 across six hospitals.The patients were divided into two groups based on the surgical approach used to mobilize the anterior rectal wall:The experimental group was to open the peritoneum at the lowest point of the peritonea reflection and enter the plane for mobilizing,while the control group was cut at 0.5-1 cm above the peritoneal reflection and enter another plan.Then,we compared the preoperative and postoperative information between the two groups.We also dissected and observed ten adult female pelvises to analyze the anatomic structure and compare the entry plane between the two approaches.Finally,we researched the pathological structure between the rectum and the vagina.RESULTS Finally,77 cases that met the criteria were included in our study.Our observations revealed that the experimental group underwent a smooth procedure,entering the plane amidst the mesorectal fascia and adventitia of the vagina,whereas the control group entered the plane between the vaginal adventitia and muscle layers.Compared to the control group,the experimental group showed a significant decrease in intraoperative bleeding[22.5(19.5-50)mL vs 17(5-20)mL,P=0.01],as well as a shorter duration of hospitalization[9(7-11.25)d vs 7(6-10)d,P=0.03].Through the examination of surgical videos and cadaveric studies,we discovered that Denonvilliers'fascia is absent in females.Additionally,pathological sections further revealed the absence of Denonvilliers'fascia in females,with only loose connective tissue present between the mesorectal fascia and adventitia of the vagina.CONCLUSION The plane amidst the mesorectal fascia and vaginal adventitia is the optimal surgical plane to mobilize the anterior rectal wall for female patients undergoing the TME procedure.

Nomogram based on multimodal magnetic resonance combined with B7-H3mRNA for preoperative lymph node prediction in esophagus cancer

Accurate preoperative prediction of lymph node metastasis(LNM)in esophageal cancer(EC)patients is of crucial clinical significance for treatment planning and prognosis.AIM To develop a clinical radiomics nomogram that can predict the preoperative lymph node(LN)status in EC patients.METHODS A total of 32 EC patients confirmed by clinical pathology(who underwent surgical treatment)were included.Real-time fluorescent quantitative reverse transcription-polymerase chain reaction was used to detect the expression of B7-H3 mRNA in EC tissue obtained during preoperative gastroscopy,and its correlation with LNM was analyzed.Radiomics features were extracted from multi-modal magnetic resonance imaging of EC using Pyradiomics in Python.Feature extraction,data dimensionality reduction,and feature selection were performed using XGBoost model and leave-one-out cross-validation.Multivariable logistic regression analysis was used to establish the prediction model,which included radiomics features,LN status from computed tomography(CT)reports,and B7-H3 mRNA expression,represented by a radiomics nomogram.Receiver operating characteristic area under the curve(AUC)and decision curve analysis(DCA)were used to evaluate the predictive performance and clinical application value of the model.RESULTS The relative expression of B7-H3 mRNA in EC patients with LNM was higher than in those without metastasis,and the difference was statistically significant(P<0.05).The AUC value in the receiver operating characteristic(ROC)curve was 0.718(95%CI:0.528-0.907),with a sensitivity of 0.733 and specificity of 0.706,indicating good diagnostic performance.The individualized clinical prediction nomogram included radiomics features,LN status from CT reports,and B7-H3 mRNA expression.The ROC curve demonstrated good diagnostic value,with an AUC value of 0.765(95%CI:0.598-0.931),sensitivity of 0.800,and specificity of 0.706.DCA indicated the practical value of the radiomics nomogram in clinical practice.CONCLUSION This study developed a radiomics nomogram that includes radiomics features,LN status from CT reports,and B7-H3 mRNA expression,enabling convenient preoperative individualized prediction of LNM in EC patients.

LC-MS-based lipidomic analysis in distinguishing patients with nonalcoholic steatohepatitis from nonalcoholic fatty liver

Background: Nonalcoholic fatty liver disease(NAFLD) is one of the main liver diseases, and its pathologic profile includes nonalcoholic fatty liver(NAFL) and nonalcoholic steatohepatitis(NASH). However, there is no reliable non-invasive parameter in distinguishing NASH from NAFL in clinical practice. The present study was to find a non-invasive way to differentiate these two categories of NAFLD via lipidomic analysis. Methods: Lipidomic analysis was used to determine the changes of lipid moieties in blood from 20 NAFL and 10 NASH patients with liver biopsy. Liver histology was evaluated after hematoxylin and eosin staining and Masson’s trichrome staining. The profile of lipid metabolites in correlation with steatosis, inflammation, hepatocellular necroptosis, fibrosis, and NAFLD activity score(NAS) was analyzed. Results: Compared with NAFL patients, NASH patients had higher degree of steatosis, ballooning degeneration, lobular inflammation. A total of 434 different lipid molecules were identified, which were mainly composed of various phospholipids and triacylglycerols. Many lipids, such as phosphatidylcholine(PC)(P-22:0/18:1), sphingomyelin(SM)(d14:0/18:0), SM(d14:0/24:0), SM(d14:0/22:0), phosphatidylethanolamine(PE)(18:0/22:5), PC(O-22:2/12:0), and PC(26:1/11:0) were elevated in the NASH group compared to those in the NAFL group. Specific analysis revealed an overall lipidomic profile shift from NAFL to NASH, and identified valuable lipid moieties, such as PCs [PC(14:0/18:2), PE(18:0/22:5) and PC(26:1/11:0)] or plasmalogens [PC(O-22:0/0:0), PC(O-18:0/0:0), PC(O-16:0/0:0)], which were significantly altered in NASH patients. In addition, PC(14:0/18:2), phosphatidic acid(18:2/24:4) were positively correlated with NAS;whereas PC(18:0/0:0) was correlated positively with fibrosis score. Conclusions: The present study revealed overall lipidomic profile shift from NAFL to NASH, identified valuable lipid moieties which may be non-invasive biomarkers in the categorization of NAFLD. The correlations between lipid moieties and NAS and fibrosis scores indicate that these lipid biomarkers may be used to predict the severity of the disease.

Laparoscopic treatment of inflammatory myofibroblastic tumor in liver: A case report

BACKGROUND Inflammatory myofibroblastic tumor in the liver(IMTL) is a rare borderline mesenchymal tumor.Neither clinical symptoms nor laboratory tests have absolute specificity for the diagnosis of IMTL,and imaging also lacks obvious specificity.Although there are sporadic reports of recurrence after surgical treatment,surgical resection is the mainstay of treatment.CASE SUMMARY A 29-year-old man complained of general weakness,slight discomfort in the upper abdomen,with a history of upper respiratory tract infection for 1 wk before admission.Plain and enhanced upper abdominal magnetic resonance imaging showed a mass in liver segments Ⅱ and Ⅲ(48 mm × 53 mm).He was treated by laparoscopic left lateral segmentectomy.Postoperative pathological examination with hematoxylin and eosin staining suggested that the mass in liver segments Ⅱ and Ⅲ was IMTL.During 21 mo postoperative follow-up,no obvious residual or recurrent lesions were observed.CONCLUSION There is a risk of malignant degeneration in IMTL.The principal choice of treatment is laparoscopic left lateral segmentectomy.

Progress of magnetic resonance imaging radiomics in preoperative lymph node diagnosis of esophageal cancer

Esophageal cancer,also referred to as esophagus cancer,is a prevalent disease in the cardiothoracic field and is a leading cause of cancer-related mortality in China.Accurately determining the status of lymph nodes is crucial for developing treatment plans,defining the scope of intraoperative lymph node dissection,and ascertaining the prognosis of patients with esophageal cancer.Recent advances in diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging(MRI)have improved the effectiveness of MRI for assessing lymph node involvement,making it a beneficial tool for guiding personalized treatment plans for patients with esophageal cancer in a clinical setting.Radiomics is a recently developed imaging technique that transforms radiological image data from regions of interest into high-dimensional feature data that can be analyzed.The features,such as shape,texture,and waveform,are associated with the cancer phenotype and tumor microenvironment.When these features correlate with the clinical disease outcomes,they form the basis for specific and reliable clinical evidence.This study aimed to review the potential clinical applications of MRIbased radiomics in studying the lymph nodes affected by esophageal cancer.The combination of MRI and radiomics is a powerful tool for diagnosing and treating esophageal cancer,enabling a more personalized and effectual approach.

以急性消化道大出血为表现的青年小肠多发间质瘤1例并文献复习

背景临床诊疗中急性小肠出血无特异性,且因小肠活动度大,迂回曲折,内镜检查不易操作,故对小肠出血的诊断仍是临床上的一大挑战.病例概述本案例为一例青年患者发生小肠多发间质瘤合并急性消化道大出血,在积极纠正休克后,以腹部电子计算机断层扫描(computed tomography,CT)为导向,完善急诊小肠镜检查,而后经过多学科综合会诊讨论迅速制定合理规范治疗方案及后续治疗计划,挽救患者生命,使患者获得最大受益.结论小肠间质瘤起病隐匿,缺乏特异性临床表现,可结合特点联合应用B超,CT、磁共振成像及相关血管造影,胃肠镜,胶囊内镜等检查明确术前诊断、精确临床分期,经多学科讨论制定规范的治疗方案,改善患者预后.

A meshfree-based local Galerkin method with condensation of degree of freedom for elastic dynamic analysis

Condensation technique of degree of freedom is first proposed to improve the computational efficiency of meshfree method with Galerkin weak form for elastic dy- namic analysis. In the present method, scattered nodes with- out connectivity are divided into several subsets by cells with arbitrary shape. Local discrete equation is established over each cell by using moving Kriging interpolation, in which the nodes that located in the cell are used for approxima- tion. Then local discrete equations can be simplified by con- densation of degree of freedom, which transfers equations of inner nodes to equations of boundary nodes based on cells. The global dynamic system equations are obtained by as- sembling all local discrete equations and are solved by using the standard implicit Newmark＇s time integration scheme. In the scheme of present method, the calculation of each cell is carried out by meshfree method, and local search is imple- mented in interpolation. Numerical examples show that the present method has high computational efficiency and good accuracy in solving elastic dynamic problems.

Unexpected expression of heat-activated transient receptor potential(TRP)channels in winter torpid bats and cold-activated TRP channels in summer active bats

The ability to sense temperature changes is crucial for mammalian survival.Mammalian thermal sensing is primarily carried out by thermosensitive transient receptor potential channels(Thermo-TRPs).Some mammals hibernate to survive cold winter conditions,during which time their body temperature fluctuates dramatically.However,the underlying mechanisms by which these mammals regulate thermal responses remain unclear.Using quantitative real-time polymerase chain reaction(qRT-PCR)and the Western blotting,we found that Myotis ricketti bats had high levels of heat-activated TRPs(e.g.,TRPV1 and TRPV4)during torpor in winter and cold-activated TRPs(e.g.,TRPM8 and TRPC5)during active states in summer.We also found that laboratory mice had high mRNA levels of cold-activated TRPs(e.g.,Trpm8 and Trpc5)under relatively hot conditions(i.e.,40°C).These data suggest that small mammals up-regulate the expression of cold-activated TRPs even under warm or hot conditions.Binding site analysis showed that some homeobox(HOX)transcription factors(TFs)regulate the expression of hot-and cold-activated TRP genes and that some TFs of the Pit-Oct-Unc(POU)family regulate warm-sensitive and cold-activated TRP genes.The dual-luciferase reporter assay results demonstrated that TFs HOXA9,POU3F1,and POU5F1 regulate TRPC5 expression,suggesting that Thermo-TRP genes are regulated by multiple TFs of the HOX and POU families at different levels.This study provides insights into the adaptive mechanisms underlying thermal sensing used by bats to survive hibernation.

Chinese Sunspot Drawings and Their Digitization—(Ⅶ) Sunspot Penumbra to Umbra Area Ratio Using the Hand-Drawing Records from Yunnan Observatories

The ratio of penumbral to umbra area of sunspots plays a crucial role in the solar physics fields, especially for understanding the origin and evolution of the solar activity cycle. By analyzing the recently digitized sunspot drawings observed from Yunnan Observatories(1957–2021), we investigate the long-term variation of the penumbral to umbra area ratio of sunspots. An automatic extraction method, based on the maximum between-class variance and the morphological discrimination, is used to accurately extract penumbra and umbra and to calculate the ratio over six solar cycles(cycle 19–24). The expected value of the ratio of penumbra to umbra area is found to be 6.63 ± 0.98, and it does not exhibit any systematic variation with sunspot latitudes and phases. The average ratio fluctuates from 5 to 7.5 per year and the overall trend has decreased after 1999 compared to the previous one.The ratio of sunspot penumbra to umbra area satisfies the log-normal distribution, implying that its variation is related to the evolution of the photospheric magnetic field. Our results are consistent with previous works.

KCNQ Channels in the Mesolimbic Reward Circuit Regulate Nociception in Chronic Pain in Mice

Mesocorticolimbic dopaminergic(DA) neurons have been implicated in regulating nociception in chronic pain, yet the mechanisms are barely understood. Here, we found that chronic constructive injury(CCI) in mice increased the firing activity and decreased the KCNQ channel-mediated M-currents in ventral tegmental area(VTA) DA neurons projecting to the nucleus accumbens(NAc). Chemogenetic inhibition of the VTA-to-NAc DA neurons alleviated CCI-induced thermal nociception.Opposite changes in the firing activity and M-currents were recorded in VTA DA neurons projecting to the medial prefrontal cortex(mPFC) but did not affect nociception. In addition, intra-VTA injection of retigabine, a KCNQ opener, while reversing the changes of the VTA-to-NAc DA neurons, alleviated CCI-induced nociception, and this was abolished by injecting exogenous BDNF into the NAc.Taken together, these findings highlight a vital role of KCNQ channel-mediated modulation of mesolimbic DA activity in regulating thermal nociception in the chronic pain state.

Gesture Recognition Based on BP Neural Network Improved by Chaotic Genetic Algorithm

Aim at the defects of easy to fall into the local minimum point and the low convergence speed of back propagation（BP）neural network in the gesture recognition, a new method that combines the chaos algorithm with the genetic algorithm（CGA） is proposed. According to the ergodicity of chaos algorithm and global convergence of genetic algorithm, the basic idea of this paper is to encode the weights and thresholds of BP neural network and obtain a general optimal solution with genetic algorithm, and then the general optimal solution is optimized to the accurate optimal solution by adding chaotic disturbance. The optimal results of the chaotic genetic algorithm are used as the initial weights and thresholds of the BP neural network to recognize the gesture. Simulation and experimental results show that the real-time performance and accuracy of the gesture recognition are greatly improved with CGA.

A Survey of Text Summarization Approaches Based on Deep Learning

Automatic text summarization(ATS)has achieved impressive performance thanks to recent advances in deep learning(DL)and the availability of large-scale corpora.The key points in ATS are to estimate the salience of information and to generate coherent results.Recently,a variety of DL-based approaches have been developed for better considering these two aspects.However,there is still a lack of comprehensive literature review for DL-based ATS approaches.The aim of this paper is to comprehensively review significant DL-based approaches that have been proposed in the literature with respect to the notion of generic ATS tasks and provide a walk-through of their evolution.We first give an overview of ATS and DL.The comparisons of the datasets are also given,which are commonly used for model training,validation,and evaluation.Then we summarize single-document summarization approaches.After that,an overview of multi-document summarization approaches is given.We further analyze the performance of the popular ATS models on common datasets.Various popular approaches can be employed for different ATS tasks.Finally,we propose potential research directions in this fast-growing field.We hope this exploration can provide new insights into future research of DL-based ATS.

Glycemic control predicts the risk of hepatic fibrosis in biopsy-proven NAFLD:a possible mediating role for leukemia inhibitory factor?

Background:Despite the clear link between nonalcoholic fatty liver disease(NAFLD)and type 2 diabetes mellitus,little is understood about how glycemic control impacts histological severity.We aimed to investigate the deeper association between hemoglobin A1c(HbA1c)and the histologic severity of liver fibrosis.Methods:A total of 568 adults with biopsy-proven NAFLD from the PERSONS cohort in Wenzhou were enrolled.The association between mean HbA1c and hepatic histological features was investigated with ordinal logistic regression.Generalized additive models were used to identify the non-linear relationship between HbA1c and increased fibrosis stage(stage F
3).Causal mediation analysis was performed to calculate the indirect effect of the relationship between HbA1c and hepatic fibrosis mediated by cytokines.Results:Every 1%increase in mean HbA1c was associated with 16%higher odds of increased fibrosis stage(odds ratio 1.16,95%CI 1.04–1.30),even after adjustment for confounding factors.There was a non-linear association between HbA1c and increased fibrosis stage(stage F
3),and the HbA1c inflection point was 9.2%.In particular,the ORs on the left and right sides of this inflection point were 2.1(95%CI 1.4–3.3)and 0.1(95%CI 0–4.8),respectively.7%of the association(OR 1.07,95%CI 1.01–1.12)between HbA1c and liver fibrosis was mediated by leukemia inhibitory factor.Conclusions:Glycemic control predicts severity of hepatic fibrosis and leukemia inhibitory factor plays an intermediary role between them,and thus optimizing glycemic control may be a means of modifying the risk of fibrosis progression in NAFLD.