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A single-atomic sulfur anode, constructed by ∼32 wt% single-atomic sulfur uniformly incorporated into the carbon lattice of hollow carbon nanospheres, demonstrates an outstanding combination of capacity, cyclability, and rate for potassium storage.

In the field of chronic pain research, kinesiophobia is defined as avoidance behavior due to fear of pain, but this perspective seems to be neglected in the field of coronary artery disease (CAD).To investigate the status quo of angina pectoris (AP) and kinesiophobia and factors associated with kinesiophobia in patients with AP of CAD.This was a cross-sectional study. Participants were recruited by convenience sampling, and patients with AP of CAD in four wards of the Cardiology Department of a hospital were enrolled in this study. Participants completed questionnaires and scales face-to-face with researchers.Most patients with AP of CAD suffered from at least moderate pain episodes (60.2%) of at least 5 minutes per episode (53.8%), but less than 1/3 of patients reached 5 instances of pain per week (29.1%). The total score of kinesiophobia in patients was 40.80±6.65, and the vast majority of patients had moderate to high levels of kinesiophobia (75.7%). The results of multiple linear stepwise regression analysis showed that personal monthly income, New York Heart Function Assessment (NYHA) classification, pain intensity, and pain resilience were independent factors associated with kinesiophobia, and these factors explained 30.2% of the variation in total scores of kinesiophobia.The symptoms of AP were prominent in terms of pain intensity and duration of pain. The level of kinesiophobia was moderate, and this was affected by multiple factors. Health care providers and researchers seldom pay attention to the kinesiophobia of patients with AP of CAD. This study refocused on the effect of "fear of pain" in kinesiophobia in patients with CAD. It opens up new horizons for the application of fear-avoidance models in CAD patients and helps to raise awareness of kinesiophobia in AP patients with CAD and provides guidance for reducing the level of kinesiophobia in the future.

Plastic debris, including macroplastics (5 mm) and microplastics (0.1-5 mm), has proven to be an emerging contaminant. Anaerobic digestion, coupled with energy recovery, can be an effective valorization technology for biogenic waste. But the use of the resulting digestate as a soil conditioner is a source for plastic debris release into the environment. The preprocess and postprocess used could influence the quantity of plastic debris found in the digestate, but the specifics of these effects are relatively unknown. Therefore, we measured the quantity of plastic debris in raw digestate under a variety of preprocessing scenarios. We also investigated the occurrence of plastic debris in solid and liquid digestates resulting from the dewatering of raw digestate. The quantity of plastic debris ranged from 41 to 3298 particles/kg (WW) for raw digestate, 319-3604 particles/kg (WW) for solid digestate and 7-38 particles/kg (WW) for liquid digestate. We observed that depackaging at source by citizens themselves (removing the package of biogenic waste when dropping it into bins), significantly reduced the quantities of plastic debris in raw digestate by an order of magnitude. Furthermore, the number of polymer types in raw digestate, where depackaging occurred at source, were lower than that where this rule was not in place. The average size of plastic debris in solid digestate was significantly smaller than that in raw digestate, which indicated that the process of mechanical dewatering could generate MPs. It is recommended to depackage for biogenic waste at source to reduce the quantities of MPs in digestate.

Endoscopy artifacts are widespread in real capsule endoscopy (CE) images but not in high-quality standard datasets.To improve the segmentation performance of polyps from CE images with artifacts based on ensemble learning.We collected 277 polyp images with CE artifacts from 5760 h of videos from 480 patients at Guangzhou First People's Hospital from January 2016 to December 2019. Two public high-quality standard external datasets were retrieved and used for the comparison experiments. For each dataset, we randomly segmented the data into training, validation, and testing sets for model training, selection, and testing. We compared the performance of the base models and the ensemble model in segmenting polyps from images with artifacts.The performance of the semantic segmentation model was affected by artifacts in the sample images, which also affected the results of polyp detection by CE using a single model. The evaluation based on real datasets with artifacts and standard datasets showed that the ensemble model of all state-of-the-art models performed better than the best corresponding base learner on the real dataset with artifacts. Compared with the corresponding optimal base learners, the intersection over union (IoU) and dice of the ensemble learning model increased to different degrees, ranging from 0.08% to 7.01% and 0.61% to 4.93%, respectively. Moreover, in the standard datasets without artifacts, most of the ensemble models were slightly better than the base learner, as demonstrated by the IoU and dice increases ranging from -0.28% to 1.20% and -0.61% to 0.76%, respectively.Ensemble learning can improve the segmentation accuracy of polyps from CE images with artifacts. Our results demonstrated an improvement in the detection rate of polyps with interference from artifacts.

Polymer anodes have inspired considerable research interest for Na-ion batteries (NIBs) owing to their high structural flexibility and resource sustainability but are limited by the sluggish electrode kinetics, insufficient cyclability, and inferior electronic conductivity which usually made a large fraction (20-50 wt %) of conductive carbon additive necessitated. Herein, using a polymeric carbon nitride (PCN) anode as an example, we demonstrated that a moderate pyrolysis of the polymer anode could not only reduce its optical bandgap to enhance its electronic conductivity but also tune its microstructures to facilitate Na

A series of Bi2WO6/TiO2-nanotube (Bi2WO6/TiO2-NT) heterostructured composites were prepared by utilizing natural cellulose (e.g., laboratory filter paper) as the structural template. The obtained nanoarchitectonics, namely Bi2WO6/TiO2-NT nanocomposites, displayed three-dimensionally interwoven structures which replicated the initial cellulose template. The composite Bi2WO6/TiO2-NT nanotubes were formed by TiO2 nanotubes that uniformly anchored with Bi2WO6 nanoparticles of various densities on the surface. The composites exhibited improved photocatalytic activities toward the reduction of Cr(VI) and degradation of rhodamine B under visible light (λ > 420 nm), which were attributed to the uniform anchoring of Bi2WO6 nanoparticles on TiO2 nanotubes, as well as strong mutual effects and well-proportioned formation of heterostructures in between the Bi2WO6 and TiO2 phases. These improvements arose from the cellulose-derived unique structures, leading to an enhanced absorption of visible light together with an accelerated separation and transfer of the photogenerated electron–hole pairs of the nanocomposites, which resulted in increased effective amounts of photogenerated carriers for the photocatalytic reactions. It was demonstrated that the photoinduced electrons dominated the photocatalytic reduction of Cr(VI), while hydroxyl radicals and reactive holes contributed to the photocatalytic degradation of rhodamine B.

Developing highly efficient red/near-infrared thermally activated delayed fluorescence (TADF) materials is of great importance for organic light-emitting diodes (OLEDs). Here, we reported an asymmetric TADF emitter (TCPQ), which exhibits a high reverse intersystem crossing rate as well as a low non-radiative rate due to molecular symmetry breaking through multiple donor substitution. The coexistence of multiple donors endows TCPQ with not only near-infrared emission but also excellent device performances. As for the TCPQ-based OLEDs, the 10 and 20 wt % doped devices exhibit outstanding external quantum efficiencies (EQEs) of 21.9 and 19.2% with red emission peaks at 612 and 642 nm, respectively. Meanwhile, the non-doped device achieves an EQE of 5.4% with an emission peak at 718 nm, showing near-infrared emission. These device efficiencies are among the best performances of red/near-infrared TADF-OLEDs, demonstrating that the asymmetry design is a potential strategy for constructing long wavelength TADF materials with high efficiency.

Introduction Hypoxia-inducible factor (HIF)1α has been shown to be activated and induces a glycolytic shift under hypoxic condition, however, little attention was paid to the role of HIF1α-actuated fructolysis in hypoxia-induced heart injury. Objectives In this study, we aim to explore the molecular mechanisms of miR-155-mediated fructose metabolism in hypoxic cardiac fibroblasts (CFs). Methods Immunostaining, western blot and quantitative real-time reverse transcription PCR (qRT-PCR) were performed to detect the expression of glucose transporter 5 (GLUT5), ketohexokinase (KHK)-A and KHK-C in miR-155−/− and miR-155wt CFs under normoxia or hypoxia. A microarray analysis of circRNAs was performed to identify circHIF1α. Then CoIP, RIP and mass spectrometry analysis were performed and identified SKIV2L2 (MTR4) and transformer 2 alpha (TRA2A), a member of the transformer 2 homolog family. pAd-SKIV2L2 was administrated after coronary artery ligation to investigate whether SKIV2L2 can provide a protective effect on the infarcted heart. Results When both miR-155−/− and miR-155wt CFs were exposed to hypoxia for 24 h, these two cells exhibited an increased glycolysis and decreased glycogen synthesis, and the expression of KHK-A and KHK-C, the central fructose-metabolizing enzyme, was upregulated. Mechanistically, miR-155 deletion in CFs enhanced SKIV2L2 expression and its interaction with TRA2A, which suppresses the alternative splicing of HIF1α pre-mRNA to form circHIF1α, and then decreased circHIF1α contributed to the activation of fructose metabolism through increasing the production of the KHK-C isoform. Finally, exogenous delivery of SKIV2L2 reduced myocardial damage in the infarcted heart. Conclusion In this study, we demonstrated that miR-155 deletion facilitates the activation of fructose metabolism in hypoxic CFs through regulating alternative splicing of HIF1α pre-mRNA and thus circHIF1ɑ formation.

Background: The c-ETS-1 (ETS1) expression is high in clear cell renal cell carcinoma (ccRCC) tissues; however, how it impacts ccRCC is currently unknown. Method: The online STRING web source was used to construct a protein network interacting with ETS1. The Cell Counting Kit-8 was used to detect the cell viability. A clonogenic assay, a wound-healing assay, and a Transwell assay were used to detect cell proliferation, invasion and migration abilities. Western blot was used to detect the expression of proteins. Result: The data showed the expression of ETS1 in ccRCC tissues to be significantly increased compared to adjacent tissues (p Conclusion: A high expression of ETS1 is associated with the progression of ccRCC. This study suggests that ETS1 promotes proliferation by increasing MMP2 expression in ccRCC, and combined knockdown of ETS1 and inhibition of ERK can significantly inhibit the proliferation, migration and invasion of ccRCC. ETS1 may be a therapeutic and prognostic target for renal cell carcinoma.

In this study, we found that a monoclonal anti-Toll-like receptor 4 antibody can alleviate APAP-induced acute liver injury through changes in the gut microbiota, metabolic pathways, and gut barrier function. This work suggested that the gut microbiota can be a therapeutic target of APAP-induced acute liver injury, and we performed foundation for further research.

Increased activity of the PI3K/AKT/mTOR pathway has been observed in chronic myeloid leukemia (CML). Morin, a kind of flavonoid, exhibits a significant anticancer activity by suppressing the PI3K/AKT signaling pathway. However, the effect of morin on CML and its underlying mechanisms is poorly understood. Here, we found that morin dose dependently inhibited the proliferation of CML cell lines K562 and KCL22 and induced their apoptosis, with a significant increase in cell apoptosis upon exposure of cells to 50 μmol/L morin. Moreover, morin significantly reduced CML xenograft growth in nude mice. Mechanically, morin attenuated phosphorylated AKT level by upregulating PTEN expression, thus leading to the inhibition of AKT signaling. Knockdown of PTEN by its siRNA completely abrogated morin-induced cell apoptosis, indicating that PTEN mediates the inductive effect of morin on CML cell apoptosis. More importantly, we found that miR-188-5p was significantly upregulated in CML patients and CML cell lines. Treating CML cells with morin markedly downregulated the miR-188-5p expression level. Further, we demonstrated that miR-188-5p repressed PTEN expression by directly targeting its 3′-UTR. miR-188-5p downregulation induced by morin enhanced CML cell apoptosis by relieving miR-188-5p repression of PTEN expression. In summary, morin exerts significant anticancer efficacy in CML by regulating the miR-188-5p/PTEN axis and thus repressing the PI3K/AKT signaling.

Luminescent hydrogen-bonded organic frameworks (HOFs) have attracted increasing attention due to their corresponding luminescence that enables readily visualization of structural dynamics. HOFs wit...

A20 is an anti-inflammatory molecule in nucleus pulposus (NP) cells. The anti-inflammatory properties of A20 are mainly attributed to its ability to suppress the NF-κB pathway. However, A20 can protect cells from death independently of NF-κB regulation. This study aimed to investigate the effects of A20 on pyroptosis and apoptosis of NP cells induced by lipopolysaccharide (LPS).NP cells induced by LPS were used as an in vitro model of the inflammatory environment of the intervertebral disc. Pyroptosis, apoptosis, and mitophagy marker proteins were detected. Then, NP cells were transfected with A20 overexpressed lentivirus or A20-siRNA. Annexin V FITC/PI, Western blotting, and immunofluorescence assays were used to detect the apoptosis, pyroptosis, and mitophagy of NP cells. Furthermore, the expressions of A20, related proteins, and related inflammatory cytokines were detected by western blotting, and ELISA.Apoptosis and pyroptosis of NP cells increased gradually treated with LPS for 12 h, 24 h, and 48 h. Differently, the level of mitophagy increased first and then decreased, and was the highest at LPS treatment for 12 h. Overexpression or knockdown of A20 in NP cells revealed that A20 attenuated the pyroptosis, apoptosis, and production of inflammatory cytokines of NP cells induced by LPS, while A20 sponsored mitophagy, reduced ROS production and collapse of mitochondrial membrane potential (ΔΨm). Moreover, A20 also promoted mitochondrial dynamic homeostasis and attenuated LPS-induced excessive mitochondrial fission. Excitingly, inhibition of mitophagy attenuated the effect of A20 on the negative regulation of pyroptosis of NP cells induced by LPS. Pyroptosis was accompanied by a large release of inflammatory cytokines. Inhibition of pyroptosis also significantly reduced apoptosis of NP cells. Finally, The mitochondria-targeted active peptide SS-31 inhibited LPS-induced pyroptosis and ROS production in NP cells.To sum up, A20 attenuates pyroptosis and apoptosis of NP cells via promoting mitophagy and stabilizing mitochondrial dynamics. Besides, A20 reduces LPS-induced NP cell apoptosis by inhibiting NLRP3 inflammasome-mediated pyroptosis. It provides theoretical support for the reduction of functional NP cell loss in the intervertebral disc through the gene-targeted intervention of A20.

Hybridized local and charge-transfer (HLCT) excited-state fluorophores, which enable full exciton utilization through a reverse intersystem crossing from high-lying triplet states to singlet state,...

Sertoli cell -only syndrome (SCOS) is a type of testicular pathological failure that causes male infertility and no effective treatment strategy, is available for this condition. Moreover, the molecular mechanism underlying its development remains unknown. We identified DExD/H-Box helicase 58 (DDX58) as a key gene in SCOS based on four datasets of testicular tissue samples obtained from the Gene Expression Synthesis database. DDX58 was significantly upregulated in SCOS testicular Sertoli cells. Moreover, high expression of DDX58 was positively correlated with the expression of several testicular inflammatory factors, such as IL -1β, IL-18, and IL-6. Interestingly, DDX58 could be induced in the D-galactose (D-gal)-stimulated TM4 cell injury model. Whereas silencing of DDX58 inhibited D-gal -mediated p65 expression, inflammatory cytokine release, and growth arrest. Mechanistically, we found that DDX58 acts as an RNA-binding protein, which enhances p65 expression by promoting mRNA stability. Furthermore, p65 gene silencing decreased the expression of inflammatory cytokines and inhibition of cell growth in D-gal-induced cells. In conclusion, our findings demonstrate that DDX58 promotes inflammatory responses and growth arrest in SCOS Sertoli cells by stabilizing p65 mRNA. Accordingly, the DDX58/p65 regulatory axis might be a therapeutic target for SCOS.

Polycomb group RING finger protein 6 (PCGF6) plays an important role as a regulator of transcription in a variety of cellular processes, including tumorigenesis. However, the function and expression of PCGF6 in papillary RCC (pRCC) remain unclear. In the present study, we found that PCGF6 expression was significantly elevated in pRCC tissues, and high expression of PCGF6 was associated with poor survival of patients with pRCC. The overexpression of PCGF6 promoted while depletion of PCGF6 depressed the proliferation of pRCC cells in vitro. Interestingly, myc-related zinc finger protein (MAZ), a downstream molecular of PCGF6, was upregulated in pRCC with hypomethylation promoter. Mechanically, PCGF6 promoted MAZ expression by interacting with MAX and KDM5D to form a complex, and MAX recruited PCGF6 and KDM5D to the CpG island of the MAZ promoter and facilitated H3K4 histone demethylation. Furthermore, CDK4 was a downstream molecule of MAZ that participated in PCGF6/MAZ-regulated progression of pRCC. These results indicated that the upregulation of PCGF6 facilitated MAZ/CDK4 axis expression and pRCC progression by hypomethylation of the MAZ promoter. The PCGF6/MAZ/CDK4 regulatory axis may be a potential target for the treatment of ccRCC.

Background Cuproptosis is a newly discovered programmed cell death dependent on mitochondrial respiratory disorder induced by copper overload. PDHB is one of the genes responsible for cuproptosis and is a nuclear encoded pyruvate dehydrogenase, an enzyme that catalyzes the conversion of pyruvate to acetyl coenzyme A. However, the mechanism of PDHB in renal clear cell carcinoma remains unclear. Methods We used data from TCGA and GEO to assess the expression of PDHB in normal and tumor tissues. We analysed the relationship between PDHB and somatic mutations and immune infiltration. Finally, we explored the impact of overexpressed PDHB on renal clear cell carcinoma. Results PDHB is lowly expressed in tumor tissue and reduced in high-grade tumors. Highly expressed PDHB has a better prognosis in ccRCC. In ccRCC, low PDHB expression may be associated with higher VHL, PBRM1 and KDM5C mutations. Addition of copper chloride to the 786-O cell line resulted in inhibition of cell growth and increased expression of the cuproptosis genes DLAT, PDHB and FDX1. Finally, the experiments verified that overexpression of PDHB inhibited the proliferation and migration of ccRCC cells. Conclusion Our results demonstrate that elevated PDHB expression inhibits the proliferation, migration and invasion of renal clear cell carcinoma cells, improves the prognosis of renal cancer patients and may provide a new therapeutic strategy for patients with advanced renal cancer.

Splicing factor 3B subunit 4 (SF3B4) plays important functional roles not only in pre-mRNA splicing, but also in the regulation of transcription, translation, and cell signaling, and its dysregulation contributes to various diseases including Nager syndrome and tumorigenesis. However, the role of SF3B4 and underlying mechanisms in clear cell renal cell carcinoma (ccRCC) remain obscure. In the present study, we found that the expression of SF3B4 was significantly elevated in ccRCC tissues and negatively correlated with the overall survival of ccRCC patients. Upregulation of SF3B4 promotes migration and invasion of ccRCC cells in vitro and in vivo. The promoting effect of SF3B4 on cell migration and invasion is mediated by Twist1, a key transcription factor to mediate EMT. Interestingly, SF3B4, a component of the pre-mRNA spliceosome, is able to promote KLF16 expression by facilitating the transport of KLF16 mRNA into the cytoplasm. Mechanistically, SF3B4 promotes the export of KLF16 mRNA from the nucleus to the cytoplasm and thus enhances KLF16 expression, and in turn elevated KLF16 directly binds to the Twist1 promoter to activate its transcription, leading to EMT and ccRCC progression. Our findings provide evidence that the SF3B4-KLF16-Twist1 axis plays important functional roles in the development and progression of ccRCC, and manipulating this pathway may be a novel therapeutic target for the treatment of ccRCC.

Supplemental material, sj-docx-1-tct-10.1177_15330338231157156 for MicroRNA-592 Inhibits the Growth of Ovarian Cancer Cells by Targeting ERBB3 by Qiong Jin, Ning Zhang, Yang Zhan, Xiaohong Xu, Chao Han, Hui Zhao and Xiaodi Hu, Hongbo Tang, Yumei Wu in Technology in Cancer Research & Treatment

Supplemental material, sj-docx-1-tct-10.1177_15330338231157156 for MicroRNA-592 Inhibits the Growth of Ovarian Cancer Cells by Targeting ERBB3 by Qiong Jin, Ning Zhang, Yang Zhan, Xiaohong Xu, Chao Han, Hui Zhao and Xiaodi Hu, Hongbo Tang, Yumei Wu in Technology in Cancer Research & Treatment

Chronic angiotensin II (Ang II) stimulation induces vascular smooth muscle cell (VSMC) senescence, and circRNAs and members of the ILF3 family are implicated in cellular senescence, but the mechanism underlying regulation of circRNAs and ILF3 by Ang II in VSMCs remains poorly understood. Here, a model of Ang II-induced VSMC senescence and the renal artery of hypertensive patients were used to investigate the roles and mechanisms of circACTA2 and ILF3 in VSMC senescence. We show that circACTA2 expression was elevated in Ang II-stimulated VSMCs and in the vascular walls of hypertensive patients. circACTA2 knockdown largely abrogated Ang II-induced VSMC senescence as shown by decreased p21 expression and increased CDK4 expression as well as by decreased SA β-gal-positive cells. Oligo pull-down and RIP assays revealed that both circACTA2 and CDK4 mRNA could bind with ILF3, and Ang II facilitated circACTA2 association with ILF3 and attenuated ILF3 interaction with CDK4 mRNA. Mechanistically, increased circACTA2 by Ang II reduced ILF3 association with CDK4 mRNA by competing with CDK4 mRNA to bind to ILF3, which decreases CDK4 mRNA stability and protein expression, thus leading to Ang II-induced VSMC senescence. Targeting the circACTA2-ILF3-CDK4 axis may provide a novel therapeutic strategy for VSMC senescence-associated cardiovascular diseases.

Cellular senescence severely limits the research and the application of dental pulp stem cells (DPSCs). A previous study conducted by our research group revealed a close implication of ROR2 in DPSC senescence, although the mechanism underlying the regulation of ROR2 in DPSCs remains poorly understood so far. In the present study, it was revealed that the expression of the ROR2-interacting transcription factor MSX2 was increased in aging DPSCs. It was demonstrated that the depletion of MSX2 inhibits the senescence of DPSCs and restores their self-renewal capacity, and the simultaneous overexpression of ROR2 enhanced this effect. Moreover, MSX2 knockdown suppressed the transcription of NOP2/Sun domain family member 2 (NSUN2), which regulates the expression of p21 by binding to and causing the 5-methylcytidine methylation of the 3ʹ- untranslated region of p21 mRNA. Interestingly, ROR2 downregulation elevated the levels of MSX2 protein, and not the MSX2 mRNA expression, by reducing the phosphorylation level of MSX2 and inhibiting the RNF34-mediated MSX2 ubiquitination degradation. The results of the present study demonstrated the vital role of the ROR2/MSX2/NSUN2 axis in the regulation of DPSC senescence, thereby revealing a potential target for antagonizing DPSC aging.

The application of robotic adrenalectomy (RA) has been increasing. However, there is still controversy about whether RA is more feasible than laparoscopic adrenalectomy (LA) for pheochromocytoma (PHEO).To evaluate the efficacy and safety of RA vs. LA for PHEO.A literature search of the PubMed, Ovid, and Scopus databases was performed to identify eligible studies up to April 2021. All studies comparing RA versus LA for PHEO were included. Data were analysed using the Cochrane Collaboration's Review Manager (RevMan) 5.4 software.Overall, 4 studies including 386 patients (RA 155; LA 231) were included. RA might have larger tumour size (WMD = 0.72 cm, 95% CI: 0.31 to 1.13; p0.001). There were no statistically significant differences in operative time (WMD = -12.49 min, 95% CI: -29.50 to 4.52; p = 0.15), estimated blood loss (EBL) (WMD = -28.48 ml, 95% CI: -58.92, 1.95; p = 0.07), transfusion rate (OR = 0.70, 95% CI: 0.07 to 7.07; p = 0.77), or conversion rate (OR = 0.44, 95% CI: 0.07 to 2.88; p = 0.39). There were no significant differences between the 2 groups in terms of postoperative complications (OR = 1.06, 95% CI: 0.62 to 1.82; p = 0.84) and Clavien Dindo score ≥ 3 complications (OR = 1.15, 95% CI: 0.39 to 3.41; p = 0.80). Patients from the RA group could benefit from shorter length of hospital stay (WMD = -0.51 days, 95% CI -0.91 to -0.12; p = 0.01).RA is a feasible, safe, and comparable treatment option for PHEO.

Due to more complex anatomical features, right laparoscopic adrenalectomy (RLA) could be more challenging than left laparoscopic adrenalectomy (LLA). However, this opinion remains elusive.To evaluate the perioperative and postoperative outcomes of RLA versus LLA.A systematic literature research of the PubMed, Ovid, Scopus databases (up to March 2021) and citation lists were performed to identify eligible studies. All studies comparing RLA versus LLA were included. Data were analysed using RevMan 5.4 software.Overall, 5 studies including 780 patients (RLA 361; LLA 419) were included. The operative time was similar in both groups (WMD -9.38 min, 95% CI: -21.04 to 2.28; p = 0.11). Compared with LLA, RLA showed greater volume of estimated blood loss (EBL) (WMD 13.82 ml, 95% CI: 3.77, 23.88; p = 0.007) and higher conversion rate (OR = 3.45, 95% CI: 1.12 to 10.57; p = 0.03). RLA had comparable complications (OR = 0.88, 95% CI: 0.44 to 1.76; p = 0.71), Clavien Dindo score ≥ 3 complications (OR = 0.38, 95% CI: 0.09 to 1.65; p = 0.20), and length of hospital stay (WMD -0.07 days, 95% CI: -0.35 to 0.21; p = 0.61). The transperitoneal approach analysis showed consistent results.RLA is associated with a higher risk of bleeding and higher conversion rate.

Laparoendoscopic single-site adrenalectomy (LESSA) has the advantages of early recovery and better cosmetic appearance. However, there are still debates on the efficacy and safety of LESSA and conventional laparoscopic adrenalectomy (CLA).To reevaluate the efficacy and safety of LESSA vs CLA for adrenal lesions.A systematic literature research of PubMed, Ovid, Scopus (up to February 2021), and citation lists was performed to identify eligible studies. All studies comparing LESSA versus CLA were included. Data were analyzed using the RevMan 5.4 software.Overall, eighteen studies including 1307 patients (LESSA 520; CLA 787) were included. LESSA was associated with smaller mean tumor size (weighted mean difference (WMD) = 0.53 cm, 95% CI: -0.81 to -0.24; p0.001). The operative time for LESSA was longer than CLA (WMD = 13.86 min, 95% CI: 4.43 to 23.30; p = 0.004). LESSA had a better visual analog scale (VAS) score (WMD = -0.56, 95% CI: -1.01 to -0.11; p = 0.02), shorter return to diet time (WMD = -0.27 days, 95% CI: -0.52 to -0.03; p = 0.03), shorter length of hospital stay (WMD = -0.56 days, 95% CI: -1.01 to -0.11; p = 0.01), and comparable postoperative complications (OR = 0.98, 95% CI: 0.56 to 1.70; p = 0.93). The wound size of LESSA was definitely smaller (WMD = -2.72 cm, 95% CI: -3.50 to -1.94; p0.001). The subgroup analysis of studies via the transperitoneal approach showed reasonable results.LESSA is significantly better in terms of postoperative pain, time to diet, length of hospital stay and wound size, but the operative time is significantly longer.

This paper presents a novel piezoelectric-actuated microgripper that mainly consists of a three-stage flexure-based amplification mechanism to achieve a large magnification ratio, a high structural stiffness and a great force output capacity for micromanipulation and assembly. The first two stages are configured as two bridge-type parallelogram amplification mechanisms connected in serial to provide advantages in terms of high structural stiffness and compactness. This configuration is capable of generating large forces to maintain the following connection leverage mechanism and ensure a large displacement output, and also produces a stable amplification ratio insensitive to the input change. The finite element method (FEM)-based simulation has been performed to investigate both static and dynamic characteristics of the designed microgripper. Simulation-enabled structural optimization design has been implemented to further aid and improve the proposed design. The simulation results indicate that the amplification ratio reaches 30.66 with a maximum clamping force of up to 2.32N. The gripper prototype has been fabricated based on the wire electro discharge machining technique, and its performances have been validated through pack-and-place of microbeads experiments. The experimental results have demonstrated its excellent linear amplification performance and they match well with the outcomes from both simulation and theoretical calculation in terms of motion range and amplification ratio.