Performing robot-assisted pylorus and vagus nerve-preserving gastrectomy for early gastric cancer:A case series of initial experience

BACKGROUND Pylorus and vagus nerve-preserving gastrectomy(PPG)is a function-preserving surgery for early gastric cancer(GC)that has gained considerable interest in the recent years.The operative technique performed using the Da Vinci Xi robot system is considered ideal for open and laparoscopic surgery.AIM To introduce Da Vinci Xi robot-assisted PPG(RAPPG)-based operative procedure and technical points as well as report the initial experience based on the clinical pathology data of eight cases of early GC.METHODS Da Vinci Xi robot-assisted pylorus and vagus nerve-preserving gastrectomy(RAPPG)was performed for 11 consecutive patients with middle GC from December 2020 to July 2021.Outcome measures were postoperative morbidity,operative time,blood loss,number of lymph nodes harvested,postoperative hospital stay,time to first flatus,time to diet,and resection margins.RESULTS Eight of the 11 patients who were pathologically diagnosed with early GC were enrolled in a retrospective study to assess the feasibility and safety of RAPPG.The mean operative time,mean blood loss,mean number of lymph nodes harvested,length of preserved pylorus canal,distal margin,and proximal margin were 330.63±47.24 min,57.50±37.70 mL,18.63±10.57,3.63±0.88 cm,3.50±1.31 cm,and 3.63±1.19 cm,respectively.None of the cases required conversion to laparotomy.Postoperative complications occurred in two(25.0%)patients.Postoperative complications were hyperamylasemia and gastric stasis in one case and incision infection in the other.Time to first flatus was 3.75±2.49 d after the operation,andpostoperative hospital stay was 10.13±4.55 d.CONCLUSIONThe core technique in the Da Vinci Xi RAPPG is lymph node dissection and the anatomic methodof the nerve.Robotic surgical procedures are feasible and safe.With the progress of surgicaltechnology,optimization of medical insurance structure,and emergence of evidence-basedmedicine,automated surgery systems will have a broad application in clinical treatment.

Vagus nerve stimulation in cerebral stroke:biological mechanisms,therapeutic modalities,clinical applications,and future directions

Stroke is a major disorder of the central nervous system that poses a serious threat to human life and quality of life.Many stro ke victims are left with long-term neurological dysfunction,which adversely affects the well-being of the individual and the broader socioeconomic impact.Currently,poststroke brain dysfunction is a major and difficult area of treatment.Vagus nerve stimulation is a Food and Drug Administration-approved exploratory treatment option for autis m,refractory depression,epilepsy,and Alzheimer’s disease.It is expected to be a novel therapeutic technique for the treatment of stroke owing to its association with multiple mechanisms such as alte ring neurotransmitters and the plasticity of central neuro ns.In animal models of acute ischemic stroke,vagus nerve stimulation has been shown to reduce infarct size,reduce post-stroke neurological damage,and improve learning and memory capacity in rats with stroke by reducing the inflammatory response,regulating bloodbrain barrier permeability,and promoting angiogenesis and neurogenesis.At present,vagus nerve stimulation includes both invasive and non-invasive vagus nerve stimulation.Clinical studies have found that invasive vagus nerve stimulation combined with rehabilitation therapy is effective in im proving upper limb motor and cognitive abilities in stroke patients.Further clinical studies have shown that non-invasive vagus nerve stimulation,including ear/ce rvical vagus nerve stimulation,can stimulate vagal projections to the central nervous system similarly to invasive vagus nerve stimulation and can have the same effect.In this paper,we first describe the multiple effects of vagus nerve stimulation in stroke,and then discuss in depth its neuroprotective mechanisms in ischemic stroke.We go on to outline the res ults of the current major clinical applications of invasive and non-invasive vagus nerve stimulation.Finally,we provide a more comprehensive evaluation of the advantages and disadvantages of different types of vagus nerve stimulation in the treatment of cerebral ischemia and provide an outlook on the developmental trends.We believe that vagus nerve stimulation,as an effective treatment for stroke,will be widely used in clinical practice to promote the recovery of stroke patients and reduce the incidence of disability.

Pylorus- and vagus-nerve-preserving partial gastrectomy (D2 dissection)

Pylorus- and vagus nerve-preserving partial gastrectomy is important in improving the prognosis of early gastric cancer surgery, reducing surgical complications and improving the quality of life for such patients. In the present case, pylorus- and vagus nerve-preserving partial gastrectomy was performed using the bipolar electrocautery dissection technique combined with D2 dissection along the lesser sac.

基于Vague集和响应面模型的注塑工艺多目标优化

针对注塑工艺多目标优化问题,以塑件的翘曲变形量、顶出时体积收缩率和缩痕深度作为优化目标,选取熔体温度、模具温度、注射时间、保压压力、保压时间等工艺参数为试验因素,采用中心复合试验设计结合模流分析建立试验样本,利用Vague集方法计算各优化目标相似度,通过指标相关性的指标权重确定(CRITIC)法确定各优化目标影响权重,得到综合相似度;建立综合相似度与各工艺参数之间的响应面模型,运用灰狼算法进行工艺参数寻优,得到最优工艺参数组合。结果表明,将Vague集和响应面模型相结合的优化结果显著,为实际生产过程提供了有益参考。

基于Vague集犹豫量化的机舱团队协作式评估方法

针对现有机舱团队协作评估方法不统一且主观随意性太强的缺陷,提出一种基于Vague集犹豫量化的新型评估方法。从机舱团队协作的角度对影响评估的各因素进行提取,采用集合相似系数对重要协作指标量化,并采用C-OWA算子赋权法和变异系数法确定主客观权重,利用最小鉴别信息原理求得组合权重,结合Vague集的犹豫量化特点,通过机舱团队实际操作数据与Vague集评估标准得到各指标的定性评估Vague集,并利用集合相似度分析实现机舱团队协作的综合评估。实例计算结果表明:相对于传统的评估方法,在个体完成度的基础上加入具有犹豫团队协作因素的方法,能对评估结果的犹豫度进行较好地刻画,也能很好地实现定量与定性之间的转化,是一种有效且优越的机舱团队协作式评估方法。

Gut-microbiome-brain axis:the crosstalk between the vagus nerve,alpha-synuclein and the brain in Parkinson's disease

This critical review of the literature shows that there is a close link between the microbiome,the gut,and the brain in Parkinson's disease.The vagus nerve,the main component of the parasympathetic nervous system,is involved in the regulation of immune response,digestion,heart rate,and control of mood.It can detect microbiota metabolites through its afferents,transferring this gut information to the central nervous system.Preclinical and clinical studies have shown the important role played by the gut microbiome and gut-related factors in disease development and progression,as well as treatment responses.These findings suggest that the gut microbiome may be a valuable target for new therapeutic strategies for Parkinson's disease.More studies are needed to better understand the underlying biology and how this axis can be modulated for the patient's benefit.

双论域区间值直觉模糊vague粗糙集及其应用

区间值直觉模糊集可诱导出vague集和粗糙集,而后两者的结合具有不确定性深入分析的优势.立足双论域区间值直觉模糊粗糙集,引入vague集进行融合扩张,研究双论域区间值直觉模糊vague粗糙集.首先,定义区间值直觉模糊vague相容类,构建双论域区间值直觉模糊vague粗糙集模型,提出关于双逼近近似和三支决策区域的计算算法,并确立该模型的精确度、粗糙度、依赖度.然后,研究该模型的近似算子与不确定性度量的性质.最后,采用医疗例子进行模型计算、度量测量、性质验证,并得到关于患者临床诊断的患病分析与治疗决策.

Advances of Research on Auricular Vagus Nerve Stimulation for Treatment of Nervous System Diseases

As a new type of nerve regulation technology, Vagus Nerve Stimulation is currently used in the treatment of nervous system diseases. Auricular Vagus Nerve Stimulation has become one of the research hotspots in this field, because there is no implantation risk. However, there is no unified standard for the treatment parameters of aVNS for nervous system diseases. In this paper, the research progress of the anatomical structure and parameters of the vagus nerve and its role in nervous system diseases are reviewed to provide basis for further research.

Modulatory effects of transcutaneous auricular vagus nerve stimulation (taVNS) on attentional processes

Background The modulatory effect of transcutaneous auricular vagus nerve stimulation(taVNS)on attention has varied in previous studies.This inconsistency might be attributed to the combined influence of the modulation effect on the different attentional functions,including alerting,orienting and executive control.Aims We aimed to preliminarily examine the modulatory effectsoftaVNS on differentattentionalfunctions.Methods Fifty-nine healthy participants were recruited and were randomly assigned to taVNS(receiving taVNS for 20 minutes)or control(receiving taVNS for 30 seconds)groups.All participants underwent a dot-probe task before and after the taVNS/control intervention.Their behavioural performance and electroencephalographic signals during pre-and post-tests were recorded,and different observed variables were extracted and analysed to characterise different attentional systems.Results We observed that active taVNS applied at the left ear significantly improved the overall behavioural performance,that is,shorter reaction time(RT)and lower intra-individual reaction time variability(lIRTV)for right-hand responses when compared with the control condition.In addition,active taVNS resulted in larger P3 and movement-related cortical potential(MRCP)amplitudes associated with right-hand reactions than the control condition.Active taVNS also decreased the difference between the pre-and post-tests in the power spectral density of spontaneous high-αband oscillations at C4 electrode.Importantly,parallel mediation models for right-hand responses showed that the change of P3 amplitude mediated the effects of taVNS on RT and lIRTV.In contrast,the change of MRCP amplitude suppressed the effect of taVNS on the lIRTV.Conclusions Our results provided behavioural and brain evidence supporting the effects of taVNS on different attentional systems,and their interaction further shaped behavioural performance,suggesting a promising role of taVNS in cognitive enhancement.

GTCS-Vagus Nerve Stimulator Automation Using Private IoT-Blockchain Smartcontract

Generalized Tonic Clonic Seizure(GTCS)is a form of epileptic seizure in which a patient loses control over their entire body,ultimately leading to loss of consciousness.The Vagus Nerve Stimulator(VNS)is a tool/method for treating epileptic episodes that sends counter-electrical stimulations to the Vagus Nerve in order to mitigate epileptic signals from the brain.The machine is a stand-alone device that depends on human decision-making.The proposed framework uses an IoT and Blockchain oversight mechanism to augment the device's transparency.The system counteracts against false-activation by monitoring the patient's vitals through a smart watch and allows only legitimate use.The nominal operating threshold is determined by preprocessing inferences that include an 18-year-old GTCS epileptic patient and a data set of 281 non-GTCS epileptic patients.The proposed system functions as a dual control lock where the IoT system and the manually activation system work in tandem to activate the device.Based on the values sensed by the IoT device,the deployed system is able to make deci-sions and regulate the use of the VNS.The IoT-Blockchain framework is able to fully eradicate false activation by increasing accuracy and transparency,ensur-ing the device is used correctly and safely.

Vagus nerve stimulation protects against cerebral injury after cardiopulmonary resuscitation by inhibiting inflammation through the TLR4/NF-κB and α7nAChR/JAK2 signaling pathways

BACKGROUND: Our previous research proved that vagus nerve stimulation(VNS) improved the neurological outcome after cardiopulmonary resuscitation(CPR) by activating α7 nicotinic acetylcholine receptor(α7nAChR) in a rat model, but the underlying mechanism of VNS in neuroprotection after CPR remains unclear.METHODS: In vivo, we established a mouse model of cardiac arrest(CA)/CPR to observe the survival rate, and the changes in inflammatory factors and brain tissue after VNS treatment. In vitro, we examined the effects of α7nAChR agonist on ischemia/reperfusion(I/R)-induced inflammation in BV2 cells under oxygen-glucose deprivation/reoxygenation(OGD/R) conditions. We observed the changes in cell survival rate, the levels of inflammatory factors, and the expressions of α7nAChR/Janus kinase 2(JAK2) and toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB).RESULTS: In vivo, VNS preconditioning enhanced functional recovery, improved the survival rate, and reduced hippocampal CA1 cell damage, and the levels of inflammatory mediators after CA/CPR. The application of α7nAChR agonists provided similar effects against cerebral injury after the return of spontaneous circulation(ROSC), while α7nAChR antagonists reversed these neuroprotective impacts. The in vitro results mostly matched the findings in vivo. OGD/R increased the expression of tumor necrosis factor-alpha(TNF-α), TLR4 and NF-κB p65. When nicotine was added to the OGD/R model, the expression of TLR4, NF-κB p65, and TNF-α decreased, while the phosphorylation of JAK2 increased, which was prevented by preconditioning with α7nAChR or JAK2 antagonists.CONCLUSION: The neuroprotective effect of VNS correlated with the activation of α7nAChR. VNS may alleviate cerebral IR injury by inhibiting TLR4/NF-κB and activating the α7nAChR/JAK2 signaling pathway.

Vagus nerve stimulation is a potential treatment for ischemic stroke

Microglia are the brain’s primary innate immune cells,and they are activated and affect pro-inflammatory phenotype or regulatory phenotype after ischemic stroke.Vagus nerve stimulation was shown to activate microglial phenotypic changes and exhibit neuroprotective effects in ischemia/reperfusion injury.In this study,we established rat models of ischemic stroke by occlusion of the middle cerebral artery and performed vagus nerve stimulation 30 minutes after modeling.We found that vagus nerve stimulation caused a shift from a pro-inflammatory phenotype to a regulatory phenotype in microglia in the ischemic penumbra.Vagus nerve stimulation decreased the levels of pro-inflammatory phenotype markers inducible nitric oxide synthase and tumor necrosis factorαand increased the expression of regulatory phenotype markers arginase 1 and transforming growth factorβthrough activatingα7 nicotinic acetylcholine receptor expression.Additionally,α7 nicotinic acetylcholine receptor blockade reduced the inhibition of Toll-like receptor 4/nuclear factor kappa-B pathwayassociated proteins,including Toll-like receptor 4,myeloid differentiation factor 88,I kappa B alpha,and phosphorylated-I kappa B alpha,and also weakened the neuroprotective effects of vagus nerve stimulation in ischemic stroke.Vagus nerve stimulation inhibited Toll-like receptor 4/nuclear factor kappa-B expression through activatingα7 nicotinic acetylcholine receptor and regulated microglial polarization after ischemic stroke,thereby playing a role in the treatment of ischemic stroke.Findings from this study confirm the mechanism underlying vagus nerve stimulation against ischemic stroke.

Novelty of Different Distance Approach for Multi-Criteria Decision-Making Challenges Using q-Rung Vague Sets

In this article,multiple attribute decision-making problems are solved using the vague normal set(VNS).It is possible to generalize the vague set(VS)and q-rung fuzzy set(FS)into the q-rung vague set(VS).A log q-rung normal vague weighted averaging(log q-rung NVWA),a log q-rung normal vague weighted geometric(log q-rung NVWG),a log generalized q-rung normal vague weighted averaging(log Gq-rung NVWA),and a log generalized q-rungnormal vagueweightedgeometric(logGq-rungNVWG)operator are discussed in this article.Adescription is provided of the scoring function,accuracy function and operational laws of the log q-rung VS.The algorithms underlying these functions are also described.A numerical example is provided to extend the Euclidean distance and the Humming distance.Additionally,idempotency,boundedness,commutativity,and monotonicity of the log q-rung VS are examined as they facilitate recognizing the optimal alternative more quickly and help clarify conceptualization.We chose five anemia patients with four types of symptoms including seizures,emotional shock or hysteria,brain cause,and high fever,who had either retrograde amnesia,anterograde amnesia,transient global amnesia,post-traumatic amnesia,or infantile amnesia.Natural numbers q are used to express the results of the models.To demonstrate the effectiveness and accuracy of the models we are investigating,we compare several existing models with those that have been developed.

一种基于包含关系的Vague集新相似度量方法

针对已有相似度量方法考虑因素不全面的情况,本文从二次投票出发同时考虑了二次投票中支持度、反对度和未知度的包含关系,合理设置系数,提出一种新的基于包含关系的Vague集相似度量方法,理论证明新相似度量方法满足相似度量的基本准则。分别选取小样本和大样本与已有相似度量方法进行比较,提出了一种新的相似度区分能力的定义。实验结果表明:对于小样本数据,本文提出的相似度量方法区分能力最大为0.14;对于大样本数据,本文提出的相似度量方法区分能力最大为119.8。将新相似度量方法分别应用于故障诊断、模式识别和多准则决策中,结果表明新的相似度量方法能够有效和合理地区分数据。

融合云概念的粗糙Vague集的三支决策模型

Vague集是模糊集的扩展模型,从正反两方面来描述事物的不确定性,粗糙Vague集比粗糙模糊集更具有普遍性。目前,三支决策的阈值主要是由单个专家给出,不能反映认知过程中复杂的不确定性形式。针对这一问题,提出了一种融合云概念的粗糙Vague集的三支决策模型。使用基于密度中心的云概念群决策方法求解损失函数,不仅保证综合评价的精度,还为损失函数提供了新的语义解释。构建了粗糙Vague集的三支决策模型并揭示了其误分类代价随着粒度细化而单调递减的规律。通过实验验证了该方法的可行性,克服了现有模糊集在三支决策中对事物不确定性表达不够清楚的缺点。

基于Vague集-可拓模型的断层富水区桥梁运营安全评估

为了探究断层富水区复杂地质环境对桥梁运营安全状况的影响并科学合理做出评估,从富水性特征、地质构造、桥梁结构参数、运营监测和安全管理5方面出发构建断层富水区桥梁多层次评估指标体系,将含有语言变量的Vague集设计主观权重与简洁高效的EW法设计客观权重相结合,并通过距离函数优化分配系数优化组合赋权,基于物元可拓理论建立断层富水区桥梁运营安全状态综合评估模型并应用于甘肃省某座桥梁实例中,引入安全性级别变量特征值确定评估桥梁的安全等级。研究结果表明:待评桥梁安全等级为Ⅱ级,运营状态比较安全,评估结果与现场情况基本相符,验证其评估模型的客观性与适用性。研究结果可为此类区域桥梁的加固养护提供决策依据。

Vagus efect on pylorus-preserving gastrectomy

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Electrical stimulation of the vagus nerve protects against cerebral ischemic injury through an anti-inflammatory mechanism

Vagus nerve stimulation exerts protective effects against ischemic brain injury; however, the underlying mechanisms remain unclear. In this study, a rat model of focal cerebral ischemia was established using the occlusion method, and the right vagus nerve was given electrical stimula-tion （constant current of 0.5 mA; pulse width, 0.5 ms; frequency, 20 Hz; duration, 30 seconds; every 5 minutes for a total of 60 minutes） 30 minutes, 12 hours, and 1, 2, 3, 7 and 14 days after surgery. Electrical stimulation of the vagus nerve substantially reduced infarct volume, improved neurological function, and decreased the expression levels of tumor necrosis factor-α and in-terleukin-6 in rats with focal cerebral ischemia. The experimental findings indicate that the neuroprotective effect of vagus nerve stimulation following cerebral ischemia may be associated with the inhibition of tumor necrosis factor-α and interleukin-6 expression.

TRH microinjection into DVC enhances motility of rabbits gallbladder via vagus nerve

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Electroacupuncture modulates the activity of the hippocampus-nucleus tractus solitarius-vagus nerve pathway to reduce myocardial ischemic injury

The hippocampus is involved in the regulation of the autonomic nervous system,together with the hypothalamus and brainstem nuclei,such as the paraventricular nucleus and nucleus tractus solitarius.The vagus nerve-nucleus tractus solitarius pathway has an important role in cardiovascular reflex regulation.Myocardial ischemia has been shown to cause changes in the autonomic nervous system,affecting the dynamic equilibrium of the sympathetic and vagal nerves.However,it remains poorly understood how the hippocampus communicates with brainstem nuclei to regulate the autonomic nervous system and alleviate myocardial ischemic tissue damage.A rat model of acute myocardial ischemia（AMI） was made by ligating the left anterior descending branch of the coronary artery.Three days before ischemia,the hippocampal CA1 region was damaged.Then,3 days after ischemia,electroacupuncture（EA） at Shenmen（HT7）-Tongli（HT5） was performed（continuous wave,1 m A,2 Hz,duration of 30 minutes）.Cluster analysis of firing patterns showed that one type of neuron was found in rats in the sham and AMI groups.Three types of neurons were observed in the AMI ＋ EA group.Six types of neurons were found in the AMI ＋ EA ＋ Lesion group.Correlation analysis showed that the frequency of vagus nerve discharge in each group was negatively correlated with heart rate（HR）（P 〈 0.05,r =-0.424）,and positively correlated with mean arterial pressure（MAP）（P 〈 0.05,r = 0.40987） and the rate-pressure product（RPP）（P 〈 0.05,r = 0.4252）.The total frequency of the nucleus tractus solitarius discharge in each group was positively correlated with vagus nerve discharge（P 〈 0.01,r = 0.7021）,but not with hemodynamic index（HR： P 〉 0.05,r =-0.03263; MAP： P 〉 0.05,r =-0.08993; RPP： P 〉 0.05,r =-0.03263）.Some neurons（Neuron C） were negatively correlated with vagus nerve discharge,HR,MAP and RPP in the AMI ＋ EA group（vagus nerve discharge： P 〈 0.05,r =-0.87749; HR： P 〈 0.01,r =-0.91902; MAP： P 〈 0.05,r =-0.85691; RPP： P 〈 0.01,r =-0.91902）.Some neurons（Neurons C,D and E） were positively correlated with vagus nerve discharge,HR,MAP and RPP in the AMI ＋ EA ＋ Lesion group（vagus nerve discharge： P 〈 0.01,r = 0.8905,P 〈 0.01,r = 0.9725,P 〈 0.01,r = 0.9054; HR： P 〈 0.01,r = 0.9347,P 〈 0.01,r = 0.9089,P 〈 0.05,r = 0.8247; MAP： P 〈 0.05,r = 0.8474,P 〈 0.01,r = 0.9691,P 〈 0.01,r = 0.9027; RPP： P 〈 0.05,r = 0.8637,P 〈 0.01,r = 0.9407,P 〈 0.01,r = 0.9027）.These findings show that the hippocampus-nucleus tractus solitarius-vagus nerve pathway is involved in the cardioprotective effect of EA at the heart meridian.Some interneurons in the nucleus tractus solitarius may play a particularly important role in the cardiomodulatory process.