Machine learning model for prediction of low anterior resection syndrome following laparoscopic anterior resection of rectal cancer:A multicenter study

BACKGROUND Low anterior resection syndrome(LARS)severely impairs patient postoperative quality of life,especially major LARS.However,there are few tools that can accurately predict major LARS in clinical practice.AIM To develop a machine learning model using preoperative and intraoperative factors for predicting major LARS following laparoscopic surgery of rectal cancer in Chinese populations.METHODS Clinical data and follow-up information of patients who received laparoscopic anterior resection for rectal cancer from two medical centers(one discovery cohort and one external validation cohort)were included in this retrospective study.For the discovery cohort,the machine learning prediction algorithms were developed and internally validated.In the external validation cohort,we evaluated the trained model using various performance metrics.Further,the clinical utility of the model was tested by decision curve analysis.RESULTS Overall,1651 patients were included in the present study.Anastomotic height,neoadjuvant therapy,diverting stoma,body mass index,clinical stage,specimen length,tumor size,and age were the risk factors associated with major LARS.They were used to construct the machine learning model to predict major LARS.The trained random forest(RF)model performed with an area under the curve of 0.852 and a sensitivity of 0.795(95%CI:0.681-0.877),a specificity of 0.758(95%CI:0.671-0.828),and Brier score of 0.166 in the external validation set.Compared to the previous preoperative LARS score model,the current model exhibited superior predictive performance in predicting major LARS in our cohort(accuracy of 0.772 for the RF model vs 0.355 for the preoperative LARS score model).CONCLUSION We developed and validated a robust tool for predicting major LARS.This model could potentially be used in the clinic to identify patients with a high risk of developing major LARS and then improve the quality of life.

Time and Dose-related Effects of the Pyrethroid Fluvalinate on Haemolymph Carbohydrates and Gut Lipids of Honeybees,Following in vivo Injection of very Low Doses

The injection to emerging adult workerbees with fluvalinate doses ranging from 1 femtomol to 1 nanomol per individual resulted in a reduction of haemolymph carbohydrate concentrations, particularly at the lowest dose 1 hour after injections. At the same time, a large increase was observed for triacylglycerols and to a much lesser extent for steroids and phospholipids with 0.1 picomol per bee. By contrast, fatty acids, steroids and triacylglycerols exhibited a depress at the higher dose. Most responses were thus biphasic, showing that much attention should be paid to the effects of very low doses of pesticide.

Changes in Lymphocyte Reactivity to ModulatoryFactors Following Low DoseIonizing Radiation

Catecholamines (CA) and corticosterone (CS) exerted modulatory effect on the proliferative activity of splenic and thymic lymphocytes in response to mitogenic stimulation in vilro. Epinephrine (E) and norepinephrine (NE) potentiated proliferation in concentrations above 1 and 10 nmol/L, respectively, while CS showed a biphasic effect, stimulating proliferation at concentrations below 0.1 nmol/L and suppressing proliferation at concentrations above 10 nmol/L. Combination of CS with E, NE or both in an ineffective concentration of each (0.1 nmol/L ) showed stimulatory effect on the proliferative response of both splenic and thymic lympliocytes to Con A. Whole-body irradiation (WBI) of mice with 75 mGy incIeased the reactivity of splenic and thymic lymphocytes to Con A. It is reported for the first time in the present paper that the proliferative reactivity of splenic and thymic lymphocytes from low dose irradiated mice could be further increased in the presence of suboptimal concentrations of CS and E as well as suboptimal concentrations of phorbol myristate acetate (PMA ) and A23187. These findings may have significance in the mechanism of immunologic stimulation after low dose WBI

The Problems and Solutions of Rural Labor Flowing in low Marketization Level

Rural labor flowing in low marketization level restricts rural production elements of effective allocation, and restricts the development of rural economy, causes the gap between urban and rural areas to continue expanding. This article has analyzed the reasons of phenomenon, and raised some solutions from abolishing the barrier of the household register, improved rural labor＇ s cultural and skills quality, and built a social security system in rural areas improve the marketization level of rural labor flow.

Effect of long-term low dose of aspirin on severity of disease following onset of acute cerebral infarction

BACKGROUND： Aspirin can decrease the incidence risk of high-risk crowdgroup of cerebral infarction, but there are still controversy if it might decrease the degree of disease in degree of patients with acute cerebral infarction. OBJECTIVE： To observe the effect of lower dose of aspirin during taking for a long time on disease degree of disease following onset of acute cerebral infarction. DESIGN： Grouping according to the admission time and 1：1 paired observation.SETTING ： Department of Neurology, Qilu Hospital of Shandong University.PARTICIPANTS ： The participants in present study were 321 patients with acute cerebral infarction who received treatments in the Department of Neurology, Qilu Hospital of Shandong University from January 1999 to June 2000. There were 190 male and 131 female ,with mean （65±11 ）years of age. Inclusive criteria： ① A focal neurological disturbance occurred suddenly and had lasted for more than 24 hours, patients were admitted within 3 days after onset of disease; ② A computed tomography of the brain was performed and excluded hemorrhage in all patients; ③ The patients were proved internal carotid occlusions by clinical features and image findings; ④ The functions of limbs were normal （before the first stroke） or almost normal （before the second stroke）. Exclusive criteria：①The patients who had have cardiogenic cerebral embolism; ②The patients who had taken warfarin orally and other platelet agglutination drugs. METHODS ：①All the patients were divided into 2 groups according to whether they had taken aspirin before： aspirin-treated group （n=110） and blank control group （n=211）. there were 70 male and 40 female in aspirin-treated group, with average（65±10） years of age.All patients had taken 50-100 mg/d aspirin for 6 months to 10 years before onset. There were 120 male and 91 female in blank control group, with average （65±13） years of age. Patients received a clinical scoring within 3 days and similar therapeutic measures （such as anti-platelet agglutination, improving cerebral circulation and metabolism-promoting reagent）. Two groups of patients had the same basic conditions except for taking aspirin or not before. ②The matched pairs were made between 50 cases selected from aspirin-treated group and 50 cases from non-aspirin-treated groups according to age, gender, and other stroke risk factors. ③ Evaluation： Degree of disease after onset was evaluated by means of Acute Cerebral Infarction Clinical Neurologic Impairment Degree Scoring Standard of Carotid Artery System. MAIN OUTCOME MEASURES： Acute Cerebral Infarction Clinical Neurologic Impairment Degree Scoring Standard of Carotid Artery System. RESULTS ： All 321 patients entered the stage of analysis with no loss in the midway. ① The symptom following onset of acute cerebral infarction was evaluated with clinical neurologic impairment scoring criteria, there were no significant differences between aspirin group and blank control group [（17.39±9.90） vs （16.22 ± 9.98） （t=1.025, P〉 0.05）]. ② No significant differences were found in 1：1 matched pairs of 100 cases from aspirin group and blank control group （t=1.74, P 〉 0.05）. CONCLUSION ： Taking a lower dose of aspirin during long time may not decrease the degree of disease following onset of acute cerebral infarction.

Efficacy and Safety of Low Molecular Weight Heparin Prophylaxis for Venous Thromboembolism Following Lumbar Decompression Surgery

Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.

Interannual Relationship between the Winter Aleutian Low and Rainfall in the Following Summer in South China

Using observations and reanalysis data, this study investigates the interannual relationship between the winter Aleutian Low(AL) and the rainfall anomalies in the following summer in South China(SC). Results show that the winter AL is significantly positively(negatively) correlated with the SC rainfall anomalies in the following July(August). Specifically, SC rainfall anomalies have a tendency to be positive(negative) in July(August) when the preceding winter AL is stronger than normal. The winter AL-related atmospheric circulation anomalies in the following summer are also examined. When the winter AL is stronger, there is a significant anticyclonic(cyclonic) circulation anomaly over the subtropical western North Pacific in the following July(August). Southerly(northerly) wind anomalies to the west of this anomalous anticyclonic(cyclonic) circulation increase(decrease) the northward moisture transportation and contribute to the positive(negative) rainfall anomalies over SC in July(August). This study indicates that the AL in the preceding winter can be used as a potential predictor of the rainfall anomalies in the following July and August over SC.

Astrocytic effect of low molecular weight heparin-superoxide dismutase conjugate in interleukin-6 overexpressing mice following local cerebral ischemia

BACKGROUND： Studies have shown that low molecular weight heparin-superoxide dismutase conjugate exhibits a remarkable neuroprotective effect. OBJECTIVE： To investigate the effect of low molecular weight heparin-superoxide dismutase conjugate on astrocytes in an interleukin-6 （IL-6） overexpressing mice following local cerebral ischemia. DESIGN, TIME AND SETTING： Randomized, cytological, controlled, animal study was performed in the Department of Physiology and Neuroscience, Neurology and Biochemistry and Molecular Biology, Medical University of South Carolina from January 2005 to March 2005. MATERIALS： Nine IL-6 transgenic mice, irrespective of gender, were randomly divided into three groups： sham-operated, model, and treatment, with three mice in each group. With exception of the sham-operated group, right middle cerebral artery occlusion was induced in the mice. Expression of glial fibrillary acidic protein, an astrocyte marker, was determined by immunohistochemistry. Low molecular weight heparin-superoxide dismutase conjugate was purchased from Biochemistry and Biotechnique Institute, Shandong University. METHODS： Two minutes prior to ischemia induction, 0.5 mL/kg saline or 20 000 U/kg low molecular weight heparin-superoxide dismutase conjugate were administrated via the femoral artery in the model group and treatment group, respectively. The sham-operated group underwent the same protocols, with the exception of occlusion and treatment. MAIN OUTCOME MEASURES： The number of glial fibrillary acidic protein-positive cells was quantified under light microscopy （x200）. RESULTS： In the sham-operated group, there were a large number of astrocytes in the IL-6 transgenic mice. However, the cell bodies were small, and the branches were few and thin. The number of astrocytes in the model group was remarkably less than the sham-operated group. Compared to the model and sham-operated groups, the number of astrocytes significantly increased, and the cell body became larger, following treatment with low molecular weight heparin-superoxide dismutase conjugate. Astrocytes exhibited hypertrophy and hyperplasia, and the processes became longer and thicker. CONCLUSION： The low molecular weight heparin-superoxide dismutase conjugate may provide neuroprotection through astrocytic activation at the super-early stage of cerebral ischemia and reperfusion.

Improvement in Radicular Symptoms but Continued Facet Arthropathy and Axial Back Pain Following Rupture of a Facet Joint Synovial Cyst

Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.

Compensatory Growth of Juvenile Brown Flounder Paralichthys olivaceus Following Low Temperature Treatment for Different Periods

We investigated the effects of low temperature(8.5℃) on the growth and feeding rates and feed conversion efficiency of juvenile P.olivaceus with an average initial weight of 3.87 ± 0.06 g(mean ± SE).Fish were exposed to 8.5℃ for 0(control),1,2,3 and 4 weeks,and then to 20℃ for 10,9,8,7 and 6 weeks,respectively.Low temperature clearly led to growth depression.The weight of fish exposed to low temperature for 1 week was restored to that of control,while that of fish exposed to low temperature longer was significantly decreased(P < 0.05).During the entire low-temperature period,specific growth rate,feeding rate and feed conversion efficiency of the fish were significantly lower(P < 0.05) than those of control,while in the whole recovery period,specific growth and average feeding rate were markedly higher(P < 0.05) than those of control.At the end of experiment,only the feeding rate of the fish exposed to low temperature for 1 week was not significantly different from that of control(P > 0.05).Feeding rate and feed conversion efficiency were reduced at low temperature in juvenile P.olivaceus.The compensatory growth of juvenile P.olivaceus may therefore be attributed to the improvement of feeding rate.Our results suggested that growth depression occurs when juvenile P.olivaceus are exposed to low temperature for more than one week.

Post traumatic dural sinus thrombosis following epidural hematoma: Literature review and case report

Dural sinus thrombosis following a head trauma is a rare condition,described in literature along with the lack of consensus regarding diagnosis and management.We present a case of a fifty-year-old man with a head injury and combined supratentorial-subtentorial epidural hematoma who was treated conservatively through the administration of low molecular weight heparin.The diagnosis and management of this condition are discussed based on a literature review.The early diagnosis may prevent potentially treatable poor outcomes.

Finding the Needle in the Haystack—An Unusual Case of Astasia-Abasia Following Sacro-Iliac Joint Injection for Chronic Low Back Pain

We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.

Transanal minimally invasive surgery to rescue anastomosis following leak after low anterior resection: A case report

Restorative low anterior resection(LAR)for rectal cancer carries a significant risk of anastomotic leak:One of the most feared complications in colorectal surgery.Operative management may include takedown of the anastomosis and end colostomy which,in some cases,is permanent.Other contemporary operative measures include over the scope clips and Endosponge.Recently,there have been case reports and a Society of American Endoscopic and Gastrointestinal Surgeons video on the novel use of transanal minimally invasive surgery(TAMIS)in the management of anastomotic leak.We present a 59-year-old female who underwent LAR after declining radiotherapy for a bulky 9 cm rectal tumour 9-10 cm from the anal verge.Following clinical deterioration,computed tomography demonstrated an anastomotic leak communicating with a 5-cm pelvic collection containing gas.At laparoscopy,pus and faeculent material were washed from the pelvic cavity and drains were placed.Intra-operative endoscopy demonstrated a 7-8 mm dehiscence at the anastomosis.The defect(approximately 7 cm from the anal verge)was successfully closed using TAMIS and a running V-lock suture.The patient recovered well and was discharged home on post-operative day 20.In this case,a low colorectal anastomotic leak was successfully rescued with TAMIS.This novel technique may be useful in the armamentarium of colorectal surgeons experienced in TAMIS.

低温等离子治疗儿童鼻咽部第二鳃裂囊肿分析

目的探讨儿童鼻咽部第二鳃裂囊肿的临床特征和治疗方式,提高诊治能力。方法回顾性分析河北省儿童医院收治的4例儿童鼻咽部第二鳃裂囊肿的临床资料,包括年龄、性别、症状、影像学资料和治疗过程。总结分析病变部位特点,B超、CT或MRI特征,术后病理结果及治疗方式。结果4例鼻咽部第二鳃裂囊肿患儿均表现为鼻咽侧壁咽鼓管咽口与腭咽弓后上方连线上的囊性肿物,囊壁较厚,影像学检查结果均为囊性病变。4例患儿选择内镜下低温等离子病变切除术,其中2例为内侧囊壁大部分切除术,将囊腔充分敞开,2例为囊肿全部切除术。术后病理提示衬覆纤毛柱状上皮或复层上皮,周围淋巴组织增生。术后随访1.5~3年无复发。结论儿童鼻咽部第二鳃裂囊肿临床罕见,诊断主要依靠病变部位及术后病理结果,内镜下低温等离子切除病变组织是微创、安全、有效的治疗方式。

Alkyl dimethyl betaine activates the low-temperature collection capacity of sodium oleate for scheelite

The impact of alkyl dimethyl betaine (ADB) on the collection capacity of sodium oleate (NaOl) at low temperatures was evaluated using flotation tests at various scales. The low-temperature synergistic mechanism of ADB and NaOl was explored by infrared spectroscopy, X-ray photoelectron spectroscopy, surface tension measurement, foam performance test, and flotation reagent size measurement.The flotation tests revealed that the collector mixed with octadecyl dimethyl betaine (ODB) and NaOl in a mass ratio of 4:96 exhibited the highest collection capacity. The combined collector could increase the scheelite recovery by 3.48% at low temperatures of 8–12℃. This is particularly relevant in the Luanchuan area, which has the largest scheelite concentrate output in China. The results confirmed that ODB enhanced the collection capability of NaOl by improving the dispersion and foaming performance. Betaine can be introduced as an additive to NaOl to improve the recovery of scheelite at low temperatures.

An ionic liquid-assisted strategy for enhanced anticorrosion of low-energy PEO coatings on magnesium–lithium alloy

A low-energy plasma electrolytic oxidation(LePEO)technique is developed to simultaneously improve energy efficiency and anti-corrosion.Ionic liquids(1-butyl-3-methylimidazole tetrafluoroborate(BmimBF_(4)))as sustainable corrosion inhibitors are chosen to investigate the corrosion inhibition behavior of ionic liquid(ILs)during the LePEO process for LA91 magnesium-lithium(Mg-Li)alloy.Results show that the ionic liquid BmimBF_(4)participates in the LePEO coating formation process,causing an increment in coating thickness and surface roughness.The low conductivity of the ionic liquid is responsible for the voltage and breakdown voltage increases during the LePEO with IL process(LePEO-IL).After adding BmimBF_(4),corrosion current density decreases from 1.159×10^(−4)A·cm^(−2)to 8.143×10^(−6)A·cm^(−2).The impedance modulus increases to 1.048×10^(4)Ω·cm^(−2)and neutral salt spray remains intact for 24 h.The superior corrosion resistance of the LePEO coating assisted by ionic liquid could be mainly attributed to its compact and thick barrier layer and physical absorption of ionic liquid.The ionic liquid-assisted LePEO technique provides a promising approach to reducing energy consumption and improving film performance.

Application of artificial hibernation technology in acute brain injury

Controlling intracranial pressure,nerve cell regeneration,and microenvironment regulation are the key issues in reducing mortality and disability in acute brain injury.There is currently a lack of effective treatment methods.Hibernation has the characteristics of low temperature,low metabolism,and hibernation rhythm,as well as protective effects on the nervous,cardiovascular,and motor systems.Artificial hibernation technology is a new technology that can effectively treat acute brain injury by altering the body’s metabolism,lowering the body’s core temperature,and allowing the body to enter a state similar to hibernation.This review introduces artificial hibernation technology,including mild hypothermia treatment technology,central nervous system regulation technology,and artificial hibernation-inducer technology.Upon summarizing the relevant research on artificial hibernation technology in acute brain injury,the research results show that artificial hibernation technology has neuroprotective,anti-inflammatory,and oxidative stress-resistance effects,indicating that it has therapeutic significance in acute brain injury.Furthermore,artificial hibernation technology can alleviate the damage of ischemic stroke,traumatic brain injury,cerebral hemorrhage,cerebral infarction,and other diseases,providing new strategies for treating acute brain injury.However,artificial hibernation technology is currently in its infancy and has some complications,such as electrolyte imbalance and coagulation disorders,which limit its use.Further research is needed for its clinical application.

Electrolyte Design for Low‑Temperature Li‑Metal Batteries:Challenges and Prospects

Electrolyte design holds the greatest opportunity for the development of batteries that are capable of sub-zero temperature operation.To get the most energy storage out of the battery at low temperatures,improvements in electrolyte chemistry need to be coupled with optimized electrode materials and tailored electrolyte/electrode interphases.Herein,this review critically outlines electrolytes’limiting factors,including reduced ionic conductivity,large de-solvation energy,sluggish charge transfer,and slow Li-ion transportation across the electrolyte/electrode interphases,which affect the low-temperature performance of Li-metal batteries.Detailed theoretical derivations that explain the explicit influence of temperature on battery performance are presented to deepen understanding.Emerging improvement strategies from the aspects of electrolyte design and electrolyte/electrode interphase engineering are summarized and rigorously compared.Perspectives on future research are proposed to guide the ongoing exploration for better low-temperature Li-metal batteries.

Revealing the key role of non-solvating diluents for fast-charging and low temperature Li-ion batteries

Fast-charging and low temperature operation are of vital importance for the further development of lithium-ion batteries(LIBs),which is hindered by the utilization of conventional carbonate-based electrolytes due to their slow kinetics,narrow operating temperature and voltage range.Herein,an acetonitrile(AN)-based localized high-concentration electrolyte(LHCE)is proposed to retain liquid state and high ionic conductivity at ultra-low temperatures while possessing high oxidation stability.We originally reveal the excellent thermal shielding effect of non-solvating diluent to prevent the aggregation of Li^(+) solvates as temperature drops,maintaining the merits of fast Li transport and facile desolvation as at room temperature,which bestows the graphite electrode with remarkable low temperature performance(264 mA h g^(-1) at-20 C).Remarkably,an extremely high capacity retention of 97%is achieved for high-voltage high-energy graphite||NCM batteries after 250 cycles at-20 C,and a high capacity of 110 mA h g^(-1)(71%of its room-temperature capacity)is retained at-30°C.The study unveils the key role of the non-solvating diluents and provides instructive guidance in designing electrolytes towards fast-charging and low temperature LIBs.

Synergistic anionic/zwitterionic mixed surfactant system with high emulsification efficiency for enhanced oil recovery in low permeability reservoirs

Emulsification is one of the important mechanisms of surfactant flooding. To improve oil recovery for low permeability reservoirs, a highly efficient emulsification oil flooding system consisting of anionic surfactant sodium alkyl glucosyl hydroxypropyl sulfonate(APGSHS) and zwitterionic surfactant octadecyl betaine(BS-18) is proposed. The performance of APGSHS/BS-18 mixed surfactant system was evaluated in terms of interfacial tension, emulsification capability, emulsion size and distribution, wettability alteration, temperature-resistance and salt-resistance. The emulsification speed was used to evaluate the emulsification ability of surfactant systems, and the results show that mixed surfactant systems can completely emulsify the crude oil into emulsions droplets even under low energy conditions. Meanwhile,the system exhibits good temperature and salt resistance. Finally, the best oil recovery of 25.45% is achieved for low permeability core by the mixed surfactant system with a total concentration of 0.3 wt%while the molar ratio of APGSHS:BS-18 is 4:6. The current study indicates that the anionic/zwitterionic mixed surfactant system can improve the oil flooding efficiency and is potential candidate for application in low permeability reservoirs.