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Abstract Background The learning curve of single-port thoracoscopic lobectomy (SPTL) in lung cancer has been widely studied. However, the efficiency of different experience levels of thoracic surgeons in mastering the learning curve is unknown. Hence, we discuss this issue in depth by using several perioperative parameters and oncological outcomes. Methods A total of 120 consecutive cases of SPTL performed by a senior (STS group) and junior (JTS group) thoracic surgeons were retrospectively analyzed. Operation time, estimated blood loss, and duration of postoperative hospital stay were recorded for cumulative summation (CUSUM) learning curve analysis, while the 5-year survival rate was used for oncological evaluation. Results The CUSUM learning curve of the STS group was y = 0.000106x3 − 0.019x2 + 0.852x − 0.036, with a high R-value of 0.9517. When the number of cases exceeded 33, the slope changed from positive to negative. The CUSUM learning curve of the JTS group was y = 0.000266x3 − 0.04x2 + 1.429 × –0.335, with a high R-value of 0.9644. When the number of cases exceeded 25, the slope changed from positive to negative. The learning curve was divided into two phases (phases 1 and 2). The slope of the JTS group in phase 1 was greater than that of the STS group in phase 1 (p 0.05). In addition, the 5-year survival rate was not significantly different between the two groups (p = 0.72). Conclusion This is the first study to analyze the learning curve of thoracic surgeons with different experience levels in mastering SPTL. Moreover, it is also the first study to include multiple perioperative parameters and overall survival to study how quickly surgeons master the SPTL technique. The junior thoracic surgeon was found to have a shorter learning curve for SPTL.

Abstract Periprosthetic joint infection (PJI) is the most devastating complication following total joint arthroplasty (TJA) and is posing a global healthcare challenge as the demand for TJA mounts. Two-stage exchange arthroplasty with the placement of antibiotic-loaded spacers has been shown to be efficacious against chronic PJI. This study aimed to review the key concepts, types, and outcome evaluations of articulating spacers in the two-stage exchange for PJI. Previous studies indicated that articulating spacers have been widely used due to better functional improvement and a comparable infection control rate relative to static spacers. Several types of articulating spacers are reportedly available, including hand-made spacers, spacers fashioned from molds, commercially preformed spacers, spacers with additional metal or polyethylene elements, new or autoclaved prosthesis, custom-made articulating spacers, and 3D printing-assisted spacers. However, limited evidence suggested no significant difference in clinical outcomes among the different subtypes of articulating spacers. Surgeons should be familiar with different treatment strategies when using various spacers to know which is the most appropriate.

Abstract Background The risk of death in sepsis patients with acute respiratory distress syndrome (ARDS) was as high as 20–50%. Few studies focused on the risk identification of ARDS among sepsis patients. This study aimed to develop and validate a nomogram to predict the ARDS risk in sepsis patients based on the Medical Information Mart for Intensive Care IV database. Methods A total of 16,523 sepsis patients were included and randomly divided into the training and testing sets with a ratio of 7:3 in this retrospective cohort study. The outcomes were defined as the occurrence of ARDS for ICU patients with sepsis. Univariate and multivariate logistic regression analyses were used in the training set to identify the factors that were associated with ARDS risk, which were adopted to establish the nomogram. The receiver operating characteristic and calibration curves were used to assess the predictive performance of nomogram. Results Totally 2422 (20.66%) sepsis patients occurred ARDS, with the median follow-up time of 8.47 (5.20, 16.20) days. The results found that body mass index, respiratory rate, urine output, partial pressure of carbon dioxide, blood urea nitrogen, vasopressin, continuous renal replacement therapy, ventilation status, chronic pulmonary disease, malignant cancer, liver disease, septic shock and pancreatitis might be predictors. The area under the curve of developed model were 0.811 (95% CI 0.802–0.820) in the training set and 0.812 (95% CI 0.798–0.826) in the testing set. The calibration curve showed a good concordance between the predicted and observed ARDS among sepsis patients. Conclusion We developed a model incorporating thirteen clinical features to predict the ARDS risk in patients with sepsis. The model showed a good predictive ability by internal validation.

Abstract Background Low back pain (LBP) from hip and spinal disorders has been one of the main reasons for visiting physicians in patients with developmental dysplasia of the hip (DDH). It is essential to identify the LBP improvement among all grades of DDH patients treated with total hip arthroplasty (THA) at 5-year follow-up. Methods The study included 407 hips of 306 patients (38 males, 268 females) who underwent THA between July 2007 and December 2016. There were 65 hips in Crowe I, 61 hips in Crowe II, 69 hips in Crowe III, and 212 hips in Crowe IV. One hundred and fourteen hips received subtrochanteric shortening. Patients included 101 bilateral THA (BTHA) and 205 unilateral THA (UTHA). The evaluation was performed through Back Pain Function Scale (BPFS), Harris hip score, Visual Analogue Scale (VAS), operative data and radiographic examinations. Results The BPFS in patients of unilateral Crowe III and IV relieved significantly more (p

Abstract Cardiac aging is evident by a reduction in function which subsequently contributes to heart failure. The metabolic microenvironment has been identified as a hallmark of malignancy, but recent studies have shed light on its role in cardiovascular diseases (CVDs). Various metabolic pathways in cardiomyocytes and noncardiomyocytes determine cellular senescence in the aging heart. Metabolic alteration is a common process throughout cardiac degeneration. Importantly, the involvement of cellular senescence in cardiac injuries, including heart failure and myocardial ischemia and infarction, has been reported. However, metabolic complexity among human aging hearts hinders the development of strategies that targets metabolic susceptibility. Advances over the past decade have linked cellular senescence and function with their metabolic reprogramming pathway in cardiac aging, including autophagy, oxidative stress, epigenetic modifications, chronic inflammation, and myocyte systolic phenotype regulation. In addition, metabolic status is involved in crucial aspects of myocardial biology, from fibrosis to hypertrophy and chronic inflammation. However, further elucidation of the metabolism involvement in cardiac degeneration is still needed. Thus, deciphering the mechanisms underlying how metabolic reprogramming impacts cardiac aging is thought to contribute to the novel interventions to protect or even restore cardiac function in aging hearts. Here, we summarize emerging concepts about metabolic landscapes of cardiac aging, with specific focuses on why metabolic profile alters during cardiac degeneration and how we could utilize the current knowledge to improve the management of cardiac aging.

The ecological conservation red line (ECRL) framework plays an increasingly important role in biodiversity conservation practices in China. Following the implementation of ECRL, it is essential to systematically assess the effectiveness of this national policy in mitigating the negative impacts of human disturbances on habitat quality at the landscape and regional levels. Combined with remote sensing and ground survey data, the Integrated Valuation of Ecosystem Services and Trade-off (InVEST) habitat quality model was used to evaluate the impact of six major anthropogenic activities, including built-up land, roads, mining land, crop land, water pollution, and grazing, on habitat degradation in two grassland river corridors (Kherlen River corridor and Wuerxun River corridor) in Northeastern China. Then, the effectiveness of different management scenarios was assessed based on the ECRL framework. The results indicated that over 80% of the habitat degradation was attributed to grazing activities, followed by water pollution. Built-up land, roads, mining land, and crop land played minor roles in causing habitat degradation. Comparing the implementation of ECRL management scenario with no ECRL management scenario, habitat degradation in the Kherlen River corridor reduced by 17.86%, and habitat quality improved by 11.11%. Similarly, in the Wuerxun River corridor, compared with the priority ECRL management scenario, habitat degradation reduced by 69.23%, and habitat quality improved by 2.38% in the implementation of ECRL management scenario. Moreover, an optimized ECRL management scenario, including grazing prohibition, grassland enclosure, and ecological restoration of river habitats, further improved the habitat quality of both river corridors, resulting in a 12.70% improvement for the Kherlen River corridor and a 3.57% improvement for the Wuerxun River corridor. Our work provides a quantitative framework for optimizing conservation and restoration measures for river corridors based on the ECRL.

BackgroundTwo-stage exchange with placement of antibiotic cement spacer (ACS) is the gold standard for the treatment of chronic periprosthetic joint infection (PJI), but it could cause a high prevalence of acute kidney injury (AKI). However, the results of the current evidence on this topic are too mixed to effectively guide clinical practice.MethodsWe retrospectively identified 340 chronic PJI patients who underwent the first-stage exchange with placement of ACS. The Kidney Disease Improving Global Outcomes guideline was used to define postoperative AKI. Multivariate logistic analysis was performed to determine the potential factors associated with AKI. Furthermore, a systematic review and meta-analysis on this topic were conducted to summarize the knowledge in the current literature further.ResultsIn our cohort, the incidence of AKI following first-stage exchange was 12.1%. Older age (per 10 years, OR= 1.509) and preoperative hypoalbuminemia (OR= 3.593) were independent predictors for postoperative AKI. Eight AKI patients progressed to chronic kidney disease after 90 days. A meta-analysis including a total of 2525 PJI patients showed the incidence of AKI was 16.6%, and AKI requiring acute dialysis was 1.4%. Besides, host characteristics, poor baseline liver function, factors contributing to acute renal blood flow injury, and the use of nephrotoxic drugs may be associated with the development of AKI. However, only a few studies supported an association between antibiotic dose and AKI.ConclusionAKI occurs in approximately one out of every six PJI patients undergoing first-stage exchange. The pathogenesis of AKI is multifactorial, with hypoalbuminemia could be an overlooked associated factor. Although the need for acute dialysis is uncommon, the fact that some AKI patients will develop CKD still needs to be taken into consideration.

Abstract In the dual inverter topology of open‐winding permanent magnet synchronous motor system, due to the symmetry of the topology, switch devices have high similarity in working characteristics, which undoubtedly increases the difficulty in locating faulty devices. In this paper, by analysing the difference of inverter output characteristics before and after switch devices open‐circuit fault, the relationship between the inverter output voltage error and fault location is found, and a fault diagnosis strategy is proposed. In this strategy, a construction method of fault phase characteristic current and the estimation equation of inverter output‐voltage error are designed. Then, the real‐time diagnosis of single device fault and two devices with the same characteristics fault at the same time is realized. Since the strategy proposed in this paper does not need additional voltage sensors, it has the same applicability as the traditional current method. In addition, the diagnosis method based on voltage information reduces the diagnosis time. Besides, this method is independent of the PWM strategy and is not sensitive to the phenomena of dead time and delayed insulated gate bipolar transistors switching. Finally, experimental results demonstrate the effectiveness of the proposed fault diagnosis strategy.

Abstract Background Tuberculosis infection is a major complication of silicosis, but there is no study on whether silicosis can affect the sensitivity of QuantiFERON-TB Gold In-Tube (QFT-GIT) assays. This study will analyze the relationship between silicosis and QFT-GIT, determine the main factor of the QFT-GIT sensitivity decrease in silicosis and explore the methods to increase the sensitivity. Methods Silicosis patients with positive tubercle bacillus cultures were collected. The QFT-GIT, flow cytometry and blocking antibodies were used. Results The sensitivity of QFT-GIT in silicosis patients (58.46%) was significantly decreased and the expression of PD-1 on T cells and CD56+NK cells in pulmonary tuberculosis combined with silicosis were higher than normal tuberculosis patients and silicosis only patients. Further analysis found that the ratio of PD-1+CD4+T and IFN-γwere negatively correlated and blockaded the PD-1 pathway with antibodies can restore the sensitivity of QFT-GIT in silicosis. Conclusions This is the first study to analyze the relationship between immune exhaustion and QFT-GIT in silicosis and found that the sensitivity of QFT-GIT was decreased by the expression of PD-1 on lymphocytes. Antibody blocking experiments increased the expression of IFN-γ and provided a new method to improve the sensitivity of QFT in silicosis. The study also found that silicosis can increase PD-1 expression. As PD-1 functions in infectious diseases, it will promote immune exhaustion in silicosis and lead to tuberculosis from latent to active infection. The study provided theoretical evidence for the diagnosis and immunotherapy of silicosis complications, and it has great value in clinical diagnostics and treatment.

Abstract Background Maternal mortality has always been a major medical concern. Recently, the successful application of extracorporeal membrane oxygenation (ECMO) technology in the rescue of near-death patients has been reported. Case presentation This study retrospectively analyzed 5 cases of critically ill pregnant women/parturients treated with ECMO for respiratory and circulatory failure in the Wuxi People’s Hospital from 2018 to 2020. The mean age of the 5 cases was 30.2 years. Among them, Cases 1 and 5 were treated with Venoarterial (VA) ECMO. Case 1 was diagnosed with congenital heart disease, atrial septal defect, and severe pulmonary hypertension. VA ECMO was applied before cesarean section and was successfully removed after double lung transplantation, but the patient died 10 months after delivery from lung infection. While Case 5 was diagnosed with systemic lupus erythematosus, lupus nephritis, thrombotic vascular disease, HELLP syndrome, and cerebral hemorrhage. VA ECMO was applied 39 days after cesarean section, and the patient died 40 days after delivery due to multiple organ failure. Cases 3 and 4 were treated with Venovenous (VV) ECMO. Case 3 was diagnosed with refractory postpartum hemorrhage, and Case 4 was diagnosed with postpartum hypoglycemic coma, aspiration pneumonia, and shock. They were treated with VV ECMO after delivery, and all survived after successful evacuation. Another Case (Case 2) was diagnosed with postpartum pelvic infection, sepsis and septic shock, and was treated with VA ECMO at 15 days after delivery. The patient changed to VV ECMO at 30 days after delivery due to significant improvement in heart function and poor lung function, but eventually died of multiple organ failure. For the 5 cases, the mean duration of ECMO was 8.7 days, the mean duration of intensive care was 22.0 days, and the mean length of hospital stay was 57.6 days. As a result, 3 patients gradually returned to normal with significant improvement in ventilation and oxygenation after ECMO treatment. Conclusions ECMO technology can be used to treat some of the critical obstetric patients with respiratory and circulatory failure that is ineffective to conventional treatment, but it has no therapeutic effect on the primary disease.

A bias current in the power system will cause saturation of the measuring current transformer (CT), leading to an increase in measurement error. Therefore, in this paper, we first conducted measurements of the direct current component in a 10 kV distribution system. Subsequently, a reverse extraction method for the CT distorted current under direct current bias conditions based on Random Forest Classification (RFC) and Long Short-Term Memory (LSTM) was proposed. This method involves two stages for the reverse extraction of CT distorted currents under direct current bias conditions. In the offline stage, data samples were generated by changing the operating environment of the CT. The RFC classification algorithm was used to divide the saturation levels of the CT, and for each sub-class, Particle Swarm Optimization–Long Short-Term Memory Network (PSO-LSTM) models were trained to establish the mapping relationship between the secondary distorted current and the primary current fundamental component. In the online stage, the saturated data segments were extracted from the secondary current waveform using wavelet transform, and these segments were input into the offline model for current reverse extraction. The simulation results show that the proposed method exhibited strong robustness under various CT conditions, and achieved high reconstruction accuracy for the primary current.

Real-time performance and reliability are two critical indicators in cyber–physical production systems (CPPS). To meet strict requirements in terms of these indicators, it is necessary to solve complex job-shop scheduling problems (JSPs) and reserve considerable redundant resources for unexpected jobs before production. However, traditional job-shop methods are difficult to apply under dynamic conditions due to the uncertain time cost of transmission and computation. Edge computing offers an efficient solution to this issue. By deploying edge servers around the equipment, smart factories can achieve localized decisions based on computational intelligence (CI) methods offloaded from the cloud. Most works on edge computing have studied task offloading and dispatching scheduling based on CI. However, few of the existing methods can be used for behavior-level control due to the corresponding requirements for ultralow latency (10 ms) and ultrahigh reliability (99.9999% in wireless transmission), especially when unexpected computing jobs arise. Therefore, this paper proposes a dynamic resource prediction scheduling (DRPS) method based on CI to achieve real-time localized behavior-level control. The proposed DRPS method primarily focuses on the schedulability of unexpected computing jobs, and its core ideas are (1) to predict job arrival times based on a backpropagation neural network and (2) to perform real-time migration in the form of human–computer interaction based on the results of resource analysis. An experimental comparison with existing schemes shows that our DRPS method improves the acceptance ratio by 25.9% compared to the earliest deadline first scheme.

Shrubs, encompassing important ecosystem engineers in dryland environments, have experienced mass mortality due to long-term droughts across the northwestern Israeli Negev. This massive die-back, which has particularly affected the predominant shrub species Noaea mucronata, predominates edaphically homogeneous (low geodiversity) hillslopes, and is minor in edaphically heterogeneous (high geodiversity) hillslopes. While the homogeneous hillslopes encompass a thick and non-stony soil layer, the heterogeneous hillslopes are composed of a thin, stony layer that overlies weathered, chalky bedrock. The objective of this geophysical study was to assess the subsurface and bedrock characteristics, and its effect on shrub durability vs mass mortality in a dryland ecosystem. A combination of 2D and 3D Ground Penetrating Radar (GPR) imaging and Frequency Domain Electromagnetics (FDEM) was applied. For the GPR procedure, the 2D and 3D reflection imaging was dominated by different dielectric permittivities (dielectric constants) of layers and changes in soil-rock-water content. For the FDEM procedure, the soil-rock electrical properties, alongside the concentration of dissolved salts, determined the measured electrical conductivity (EC). The results show substantial differences in EC values between the homogeneous and heterogeneous hillslopes, which are attributed to differences in the soil-rock interface, soil-water content, and salts concentration. Overall, the much greater EC values of the soil-rock interface in the heterogeneous hillslopes are expected to adversely affect shrub vitality. However, the greater shrub vitality in these hillslopes is likely attributed to the fractured and weathered chalky underground, which retains moisture in pockets or micro-aquicludes that increase water availability for the shrubs. Under these better habitat conditions of the heterogeneous hillslopes, the high EC values do not limit shrub survival or growth. At the same time, the absence of such water pockets in the thick soil layer of the homogeneous hillslopes imposes severe stress under long-term drought conditions, resulting in shrub die-off. This study illustrates the vital role of subsurface geodiversity in determining the resilience of dryland ecosystems to droughts and climatic change.

Hp0521 is the number of cag pathogenicity island (cagPAI) family in Helicobacter pylori (H. pylori, Hp), which encoded Cag2 protein. The aim of this study was to investigate the role of hp0521 on the H. pylori 26,695 strain. We constructed the recombinant prokaryotic expression plasmid pET-32a-hp0521 and pET-32a-hpc0521. Then, we co-cultured the H. pylori wild strain 26,695 and Δhp0521 strain with GES-1 cells to detect CagA protein transport and IL-8 secretion. We found that Δhp0521 mutation increased the expression of cagA, rpoB and promoted the transportation of CagA protein in GES-1 cells. In addition, we also observed that Δhp0521 mutation had no effect on other cagPAI protein stability and the expression of IL-8. Our findings suggested that hp0521 may down-regulated the expression of cagA, rpoB and inhibited the transportation of CagA protein in GES-1 cells and had no effect on growth.

Background Artificial intelligence (AI) has promising applications in arthroplasty. In response to the knowledge explosion resulting from the rapid growth of publications, we applied bibliometric analysis to explore the research profile and topical trends in this field. Methods The articles and reviews related to AI in arthroplasty were retrieved from 2000 to 2021. The Java-based Citespace, VOSviewer, R software-based Bibiometrix, and an online platform systematically evaluated publications by countries, institutions, authors, journals, references, and keywords. Results A total of 867 publications were included. Over the past 22 years, the number of AI-related publications in the field of arthroplasty has grown exponentially. The United States was the most productive and academically influential country. The Cleveland Clinic was the most prolific institution. Most publications were published in high academic impact journals. However, collaborative networks revealed a lack and imbalance of inter-regional, inter-institutional, and inter-author cooperation. Two emerging research areas represented the development trends: major AI subfields such as machine learning and deep learning, and the other is research related to clinical outcomes. Conclusion AI in arthroplasty is evolving rapidly. Collaboration between different regions and institutions should be strengthened to deepen our understanding further and exert critical implications for decision-making. Predicting clinical outcomes of arthroplasty using novel AI strategies may be a promising application in this field.

Mesoscale eddy dipoles are oceanographic structures that can transport ocean water parcels horizontally and vertically in ways that differ from individual mesoscale eddies. The most conspicuous additional feature that presents in dipoles is the cold filament (CF) that can be spontaneously generated between a dipole’s anticyclonic eddy (AE) and cyclonic eddy (CE). A case study in this paper shows that the interaction between the CF and the CE component of the dipole is associated with the structural evolution of the dipole. This interaction is verified in synthesis and normalization studies of the CF dipoles. The CF-dipole interaction entrains CF water into the center of the dipole’ CE and leads to a cold and high chlorophyll center in the upper layer of the CE. The formation of this cold center changes the dipole’s structure by eliminating the phase difference between the thermal and dynamic centers of the dipole. The entrainment also provides a new mechanism for the development of high chlorophyll levels in the CE. In the analysis of the HYCOM (Hybrid Coordinate Ocean Model) simulation of a synthetic CF dipole, the AE has a three-zone structure while the CE only has two. The convergence of the CE’s outermost zone results in a biased interaction.

Due to the expression of “reduced activation”, the severe radioactivity of tantalum (Ta) after neutron irradiation in early decay years is easily neglected. In the presented study, after an irradiation of only 0.3 dpa by fission neutron and followed by a cooling stage of 305 days, the RAFM steel specimen with a weight of 0.8 g possessed drastic radioactivity of 4 mSv/hour at a measuring distance of 20 cm. It was ascertained that the high radioactivity was generated by 182Ta. The severe radioactivity seriously increased the danger of material experiments, even though the original Ta addition of the steel was only 0.13 wt%. Similar deteriorative radioactivity of Ta can be generated in both fission and fusion neutron irradiations. We appeal to seriously deliberate the radioactivity of Ta and control the Ta content in the RAFM steel.

Background The treatment adherence is closely related to the effect of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) , which is also strongly influenced by patients' psychosocial characteristics. However, the influence of depression symptoms on the adherence to CPAP needs to be further explored. Objective To evaluate the relationship of depression symptoms with adherence to CPAP, and the pathwaybetween the associated factors in OSA patients. Methods A total of 177 patients who were diagnosed with OSA and treated with CPAP in the Respiratory and Sleep Medicine Center, Peking University People's Hospital from May 2019 to July 2021 were selected. The general information, disease severity and adherence to CPAP were evaluated. The prevalence of depression symptoms was measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) . The severity of insomnia was assessed by the Insomnia Severity Index (ISI) . The influence of daytime sleepiness on activities of daily living was measured by the 10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10) . The 12-item Short Form Health Survey (SF-12) was used to evaluate the quality of life. The relationships among variables were determined by path analysis. Results The prevalence of depressive symptoms in OSA patients was relatively high (19.7%, 35/177) in our study. Depression symptoms were associated with increased insomnia prevalence (r=0.65, P0.05) , but could increase the adherence to CPAP by decreasing the activities of daily living (β=0.078, P

Abstract Objective Minimal invasive approach has been increasingly used in total knee arthroplasty (TKA) and more is expected of early rehabilitation in terms of pain release and recovery of knee function. The approach type is one of the major factors that determines the early rehabilitation after TKA. The purpose of this study is to determine whether mini‐subvastus approach (MSVA) is superior to the traditional medial parapatellar approach (MPA) in TKA. Methods From 2018 to 2019, a randomized double‐blinded prospective study was conducted on 58 patients who underwent simultaneous bilateral TKA. The subjects included eight men and 50 women, with an average age of 65 years. One side was randomized using MSVA and the other side using MPA. Visual analog scale (VAS), operative duration, recovery time to straight leg raising (SLR), range of motion (ROM), HSS score, release rate of lateral retinaculum, satisfaction rate were recorded and compared. Paired‐samples T test were used for quantitative data and chi‐square test for qualitative data. Results There was no statistical difference in the ratio of left and right sides, preoperative ROM, VAS, HSS score, muscular strength of lower limbs, KL grade, operative order, and operative duration between the two groups. The average ROM (118.91 ± 8.21 vs. 107.60 ± 7.99, t = 14.320, p = 0.0000) and HSS score (72.03 ± 4.55 vs. 61.22 ± 4.36, t = 13.095, p = 0.0000) on POD 3, VAS in rest and motion on POD 1 and 3, the recovery time to SLR (1.17 ± 0.38 vs. 3.09 ± 0.76, t = 19.902, p = 0.0000), and the satisfaction rate on POD 1 (96.55% vs. 74.14%, χ2 = 9.9251, p = 0.0016) were superior in the MSVA group over MPA group. ROM in rest and motion and HSS score on POD 30 had no difference. The release rate of lateral retinaculum was less in the MSVA group than in the MPA group. The mean value of HKA, FFC, and FTC and the proportion of outliers did not differ significantly between the two groups. Conclusions Compared with MPA, MSVA can make ROM of knee and SLR recover earlier, reduce postoperative pain after TKA, improve the early postoperative satisfaction and reduce the lateral release rate. MSVA can be used as a favorable measure in the concept of enhanced recovery after surgery (ERAS).

Objective Robot‐assisted surgery has been promoted worldwide in recent years. The development of a domestic orthopaedic robot and its clinical application are therefore of great significance. This study aimed to compare the early clinical and radiographic outcomes of domestic robot‐assisted total knee arthroplasty (RA‐TKA) with conventional manual total knee arthroplasty (CM‐TKA). Methods A total of 77 patients who underwent primary single‐sided TKA from June to December 2020 were prospectively enrolled; resulting in the inclusion of 72 patients. The patients were randomly divided into the RA‐TKA group (37 cases, with TKA being assisted by the Yuanhua Orthopaedic Robotic System) and the CM‐TKA group (35 cases, with TKA being performed using conventional tools). Knee function was evaluated by the knee range of motion (ROM), the American Knee Society Score (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Postoperative radiographic results were evaluated by full‐length weight‐bearing X‐rays of the lower limb and anteroposterior and lateral X‐rays of the knee were obtained preoperatively and at 90 days postoperative. The operative duration, blood loss, postoperative knee function, radiographic outcomes, and incidence of complications were compared by Student's t‐test, Mann–Whitney U test, or chi‐square test. Serum levels of inflammatory markers before the operation and 1, 3, and 30 days after the operation were recorded and compared between the two groups. Results The operation was significantly longer in the RA‐TKA group than in the CM‐TKA group (154.3 vs 115.2 min, p 0.05). The incidence of postoperative deep vein thrombosis was not statistically different between the two groups. In the radiographic findings at 90 days postoperatively we found the frequency of lateral tibial component (LTC) angle outliers was significantly lower in the RA‐TKA group (3.0% vs 29.4%, p = 0.003). The neutrophil‐to‐lymphocyte ratio (NLR) was significantly lower in the RA‐TKA group than in the CM‐TKA group on day 1 after surgery (9.9 vs 12.7, p = 0.024). Conclusions RA‐TKA requires more time than CM‐TKA, which may be related to the learning curve and intraoperative registration. The short‐term postoperative knee functional outcomes had no differences between the two groups, and RA‐TKA improved the accuracy of tibial component alignment. Further follow‐up studies are required to investigate the long‐term outcomes.

Abstract The increasingly accurate sublobar anatomical resection is constantly being explored and practiced. Surgeons try to preserve as much viable lung tissue as possible. Sublobar resection of the target tissue is similar with a cone‐shaped structure which penetrates deeply into the pulmonary parenchyma and runs through the lobe at both ends. This has not previously been described. The remaining lung tissue resembles the Triumphal Arch in Paris, France. Here, we describe triumphal arch‐like sublobectomy in detail, aiming to provide clinicians with an idea to explore this novel sublobectomy under similar conditions.

Abstract Purpose In this article, we aimed to reconstruct the cervical–thoracic junction plane (CTJP) using a three‐dimensional (3D) reconstruction system. Thus, the CTJP can be judged during surgery to better distinguish cervical–thoracic lymph nodes. Methods We included patients in Fujian Medical University Union Hospital from December 2019 to March 2020. All patients underwent a thin‐slice and enhanced computed tomography scan of the chest with 3D reconstruction using the IQQA system (EDDA technology) to reconstruct the CTJP, brachiocephalic trunk, right common carotid artery, and right subclavian artery. The distance from the intersection of the right subclavian artery and the CTJP to the origin of the right subclavian artery (ORSA) was measured, and the relationship between this distance and the patient's sex, BMI and height was analyzed. Results Seventy‐three patients were enrolled, of whom 12 had ORSA above the CTJP, while 61 had ORSA below the plane. There was a significant difference in age between the two groups (p = 0.04), compared with height, weight and BMI (p > 0.05). In 61 patients with the ORSA below the CTJP, the average distance was 24.7 ± 7.6 mm. The difference between the distance and BMI (p = 0.02) was statistically significant, and it was increased with increasing BMI. Conclusions The relationship between the ORSA and CTJP can be clarified through 3D reconstruction. The cervical‐thoracic recurrent laryngeal nerve lymph nodes can be distinguished clearly in minimally invasive esophagectomy, contributing to the accurate N staging of middle‐thoracic esophageal cancer.

Abstract Numerous long noncoding RNAs (lncRNAs) are abnormally expressed in breast cancer (BC), but the underlying mechanisms remain large unknown. Here, we aimed to investigate the functions and mechanisms of lncRNA cancer susceptibility candidate 9 (CASC9) in BC. Western blotting and quantitative real‐time PCR (qRT‐PCR) were performed to assess gene and protein expression, respectively. The proliferative and metastatic abilities of BC cells were tested by cell counting kit‐8 and transwell assays, respectively. The formation of lymphatic vessels was detected by tube formation assay. Chromatin immunoprecipitation (ChIP) and dual luciferase reporter assays were performed to verify molecular interactions. CASC9 was found to be highly expressed in BC tissues and cell lines, and ectopic overexpression was positively associated with tumor volume, TNM stage, and lymph node metastasis. In addition, CASC9 silencing significantly inhibited the proliferation and invasion of BC cells, as well as BC‐associated invasion and formation of lymphatic vessels of human dermal lymphatic endothelial cells. Mechanical studies demonstrated that CASC9 could be transcriptionally activated by STAT3 and elevate SOX4 expression by enhancing the acetylation of its promoter region. Our results illustrated that STAT3‐activated CASC9 served as a tumor‐promoting gene involved in promoting BC invasion and BC‐associated formation of lymphatic vessels by upregulating SOX4 through altering H3K27ac level. This finding elucidated a new underlying network of CASC9 in the metastasis of BC.

The plasmon-exciton interaction between gap-mode nanocavities and A excitons of MoS2 is investigated, and the longitudinal distribution of the plasmon-exciton interactions is obtained at ~1 nm spatial resolution.

Abstract Background Regulatory T cells (Treg cells) in the peripheral blood of patients with pulmonary tuberculosis (PTB) may be closely related to the progression of PTB. In this study, the distribution characteristics and clinical importance of CD8+CD28− Treg cells in patients with tuberculosis were systematically analyzed, and the role and importance of CD8+CD28− Treg cells in influencing the immune response and progression of tuberculosis were discussed, which will provide immunological indices and reference values for the clinical diagnosis of tuberculosis. Methods Flow cytometry, sputum smears and computed tomography imaging were used to analyze the distribution characteristics of CD8+CD28− Treg cells in the peripheral blood of patients with PTB and the correlation between CD8+CD28−Treg cells and clinical and immune indices. Results The percentages of CD4+CD25high and CD8+CD28− Treg cells in the peripheral blood of patients with PTB were significantly higher than those in the healthy control (HC) group. Further analysis showed that the percentage of CD4+CD25highTreg cells in the Stage II group was significantly higher than that in the HC group. The percentages of CD4+CD25high and CD8+CD28− Treg cells increased significantly in patients in the Stage II group. The proportion of CD8+CD28− Treg cells was directly proportional to the degree of positivity in sputum smears, while CD4+CD25highTreg cells did not exhibit this trend. The correlations between the percentage of CD4+CD25high and CD8+CD28− Treg cells and the percentage of lymphocyte subsets were examined. The percentage of CD8+CD28− Treg cells was negatively correlated with the percentage of CD4+T cells and positively correlated with the CD8+T cell percentage in the HC and PTB groups. The percentage of CD4 + CD25highTreg cells was positively correlated with the percentage of CD4+T cells only in the PTB group. Conclusions This study was the first to show that the proportion of CD8+CD28− Treg cells in the peripheral blood of patients with PTB was significantly increased, and the increase in CD8+CD28− Treg cells was related to the progression of PTB, which may affect the proportion of immune cell subsets by inhibiting the immune response, resulting in the progression of PTB.

By trapping hydrogen, nanoprecipitates can mitigate the hydrogen embrittlement of high strength steels. Here, the authors report direct evidences on the structural and chemical features underlying distinct hydrogen-trapping behaviors at the incoherent interfaces of precipitates and steel matrix.