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BackgroundAlthough there were a variety of strategies for the alimentary tract reconstruction of patients with gastric cancer who underwent laparoscopic radical distal gastrectomy, it remains controversial regarding which procedure is optimal. We developed a simple technique for Roux-en-Y reconstruction during laparoscopic surgery and evaluated its technical feasibility and safety.MethodsSeventy-one cases of modified Roux-en-Y reconstructions after laparoscopic radical distal gastrectomy were consecutively performed in our hospital, from November 2020 to March 2022. A retrospective review of medical data was conducted. Intraoperative and postoperative outcomes, including operation time and incidence of postoperative complications, were collected and analyzed.ResultsAll procedures of laparoscopic distal gastrectomy with D2 lymph node dissection were successfully completed without any intraoperative complication. The mean number of retrieved lymph node was 38.8 ± 10.6. Mean operative time was 223.5 ± 42.4 min, whereas intraoperative blood loss was 102.2 ± 96.3 ml. No postoperative mortality was recorded. Six patients (8.5%) experienced postoperative complications and were managed conservatively. In addition, only two patients (2.8%) required rehospitalization during a median short-term follow-up period of 6 months.ConclusionsThe modified method is a simple and safe approach for laparoscopic radical distal gastrectomy.

To automatically measure the surface profile of a cylindrical workpiece, a high-precision multi-beam optical method is proposed in this paper. First, some successive images for the cylindrical workpiece’s surface are acquired by a multi-beam angle sensor under different light directions. Then, the light directions are estimated based on the feature regions in the images to calculate surface normal vectors. Finally, according to the relationship of the surface normal vector and the vertical section of the workpiece’s surface, a depth map is reconstructed to achieve the curvature surface, which can be employed to measure the curvature radius of the cylindrical workpiece’s surface. Experimental results indicate that the proposed measurement method can achieve good measurement precision with a mean error of the curvature radius of a workpiece’s surface of 0.89% at a reasonable speed of 10.226 s, which is superior to some existing methods.

Objective To observe the effects of occipitoaxial angle (O‐C2 angle, OC2A) and posterior occipitocervical angle (POCA) selection on postoperative clinical efficacy and lower cervical curvature in patients with acute acquired atlantoaxial dislocation after occipitocervical fusion (OCF). Methods A total of 150 healthy subjects without cervical disease (healthy group) were randomly selected based on gender and age. Three spine surgeons measured the OC2A and POCA of the healthy group and averaged the values. A total of 30 patients with an average age of 51.0 years (range, 18–70 years; 16 male and 14 female) with trauma or rheumatoid arthritis (disease group) who underwent occipitocervical fusion (OCF) for atlantoaxial dislocation between January 2012 and June 2016 were reviewed. OC2A, POCA, and cervical spinal angle (CSA) were measured postoperative/soon after surgery and ambulation, and at the final follow‐up visit. The preoperative and final follow‐up visual analog scale (VAS), Japanese orthopedics association score (JOA), neck disability index (NDI), and dCSA (change of CSA from postoperative/soon after surgery and ambulation to final follow‐up) were recorded. Results The values of OC2A and POCA in 150 healthy subjects were 14.5° ± 3.7° and 108.2° ± 8.1°, respectively, and the 95% confidence interval (CI) were 7.2°–21.8° and 92.3°–124.0°, respectively. There was a negative correlation between OC2A and POCA (r = −0.386, P

BackgroundThe mortality rate of post-hepatectomy liver failure (PHLF) remains very high, and liver transplantation is the only effective treatment regimen for PHLF. Cell transplantation is a potential treatment for liver diseases. Previous studies have proved that mesenchymal stem cells (MSCs) have immunomodulatory functions. In the present study, we found that MSCs promoted glycogen synthesis and liver regeneration in the treatment of PHLF. MSC transplantation also improved the survival rate of rats after 90% partial hepatectomy (PH). In our current study, we aimed to determine the efficacy and mechanism of MSC transplantation in the treatment of PHLF.MethodsMesenchymal stem cells were isolated from Sprague-Dawley rats and cultured using a standardized protocol. The MSCs were transplanted to treat acute liver failure induced by 90% PH. The therapeutic efficacy of MSCs on PHLF was verified through measuring alanine transaminase (ALT), aspartate aminotransferase (AST), international normalized ratio (INR), serum ammonia, liver weight to body weight ratio, blood glucose, and histology. To further study the mechanism of MSC transplantation in treatment for PHLF, we assessed the changes in the AKT/glycogen synthase kinase-3β (GSK-3β)/β-catenin pathway. A-674563 (AKT inhibitor) and SB216763 (GSK-3β inhibitor) were employed to validate our findings. SPSS version 19.0 was used for statistical analysis, and the independent-samples t-test was carried out to analyze the collected data.ResultsMesenchymal stem cell transplantation attenuated the liver injury in acute liver failure induced by 90% PH. MSC transplantation improved the glucose metabolism and survival rate in the PHLF model. The effect of MSC transplantation on hepatocyte proliferation might be related to AKT/GSK-3β/β-catenin pathway.ConclusionMesenchymal stem cell transplantation could be use as a potential treatment for PHLF.

The potential function of distal cerebrospinal fluid-contacting nucleus (dCSF-CNs) in chronic kidney disease (CKD) development is poorly understood. We hypothesized that dCSF-CNs might affect the renin-angiotensin system (RAS) in kidney injury progression, with dCSF-CNs ablation potentially alleviating local RAS and renal fibrosis in rats after five-sixths nephrectomy (5/6Nx). Part of rats were randomly administered artificial cerebrospinal fluid (aCSF) intracerebroventricularly (icv), followed by 5/6Nx or sham operation; and other part of rats were administered Cholera toxin B subunit conjugated with saporin (CB-SAP) for dCSF-CNs lesion before 5/6Nx. The effect of CB-SAP on dCSF-CNs ablation was confirmed by double immunofluorescence staining. RAS component, NOX2 and c-fos levels in the subfornical organ (SFO), hypothalamic paraventricular nucleus (PVN) and hippocampus, as well as tyrosine hydroxylase (TH) and c-fos positive cells in rostral ventrolateral medulla (RVLM) were assessed. Next, the levels of RAS components (angiotensinogen [AGT], angiotensin-converting enzyme [ACE], Ang II type 1 receptor [AT1R], angiotensin-converting enzyme 2 [ACE2], and Mas receptor), NADPH oxidases (NOX2 and catalase), inflammatory cytokines (monocyte chemotactic protein 1 [MCP-1] and IL-6), and fibrotic factors (fibronectin and collagen I) were assessed. Less CB-labeled neurons were found in dCSF-CNs of CB-SAP-treated rats compared with 5/6Nx animals. Meanwhile, CB-SAP downregulated AGT, Ang II, AT1R, NOX2, catalase, MCP-1, IL-6, fibronectin, and collagen I, and upregulated ACE2 and Mas receptor, compared with CKD rats. More TH and c-fos positive cells were found in RVLM of 5/6Nx rats but the number decreased after dCSF-CNs ablation. Targeted dCSF-CNs ablation could alleviate renal inflammation and fibrosis in chronic kidney injury by inhibiting cerebral and renal RAS/NADPH oxidase.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has now been established as an important community-acquired pathogen. Although necrotizing pneumonia caused by community-acquired MRSA (CA-MRSA) strains producing Panton–Valentine leukocidin (PVL) has been reported with increasing frequency in many countries, it has been reported in only a few children younger than 1 year of age in Mainland China. Methods: We describe a case of life-threatening necrotizing pneumonia due to PVL-positive CA-MRSA in a 15-year-old previously healthy female who presented with high fever, shivering, a dry cough, and dyspnea. Details of the clinical outcomes, microbiological data, and therapies for this patient were collected and compared with those of cases reported in the literature on CA-MRSA. Results: Computed tomography (CT) findings showed cavitary consolidations in both lungs and bilateral pleural effusion. MRSA strains isolated from the patient's sputum and pleural fluid were susceptible to most non-β-lactam antimicrobial agents except for clindamycin and erythromycin. Both of these isolates tested positive for the mecA gene as well as PVL genes, and were identified as ST59-MRSA-SCCmec type IV-spa type t437. The patient was treated successfully with linezolid, fosfomycin, and teicoplanin. Conclusions: To our knowledge, this is the first report from Mainland China of necrotizing pneumonia due to PVL-positive CA-MRSA among those aged older than 1 year. CA-MRSA necrotizing pneumonia should be considered in the differential diagnosis of severe community-acquired pneumonia, particularly in previously healthy individuals.

The magmatic source of the Late Triassic granites in the East Kunlun Orogenic Belt (EKOB) is controversial, which restricts our understanding of crustal evolution and geodynamic evolution in the EKOB. Therefore, this study conducts zircon U-Pb isotope dating, major and trace geochemical analysis, electron microprobe analysis of feldspar and amphibole, and in situ zircon Hf isotope analysisof Xiangride host granites and their mafic microgranular enclaves (MMEs) in the EKOB to reveal their magmatic source and geodynamic implications. Zircon U-Pb dating shows that the Xiangride host granites and the MMEs crystallized simultaneously at ca. 228-223 Ma. The MMEs show an igneous texture, finer grain size, higher crystallization temperature and water content, and lower oxygen fugacity than those of the host granite, suggesting that they were probably derived from two distinct primitive magmas. Therefore, the MMEs are considered the products of magma mixing between granitic and mafic magmas. The Xiangride host granites show high Sr/Y [(42.0-73.1) and (La/Yb).sub.N] (12.7-30.7) ratios, showing afnity with adakites derived from a thickened lower crust. Combined with the indistinguishable [[epsilon].sub.Hf](t) values (-3.47 to +0.08) from the coeval mafic rocks, it is concluded that they are derived from partial melting of juvenile thickened lower crust. The adakitic features of the Xiangride host granites and widespread coeval granites indicate the existence of a thickened lower crust before 228 Ma and delamination of the lower lithosphere is likely the geodynamic process resulting in the postcollisional extension regime. Key words: geochemistry, East Kunlun Orogenic Belt, MMEs, postcollision, 1. Introduction The East Kunlun Orogenic Belt (EKOB) is located in the Qinghai-Tibet Plateau, northwestern China (Fig. 1a), East Paleo-Tethys tectonic domain. Since the Neoproterozoic, the EKOB has experienced at [...]

Pedestrian collision avoidance is one of the most fundamental problems in autonomous driving. Reinforcement learning (RL) provides a promising solution to solve this problem by learning to adapt to pedestrian behaviors. However, it is difficult to directly apply traditional RL methods due to the weak safety in training and deployment. To address this issue, we propose three safe RL methods: 1) RL with safe reward, 2) RL with constraints, 3) RL with limited exploration. Our results show that the proposed three safe RL methods make a better trade-off between the driving efficiency and the unsafety caused by unexpected pedestrian behaviors. These three safe RL methods are applicable of avoiding pedestrian collision in different environments. If the safe reward can be well designed, standard RL method can have good performance. If the safety reward is not well designed, RL with constraints should be the optimal choice. If the safety guarantee is strictly required for the RL training process, RL with limited exploration should be considered. In addition, we present several useful observations about parameter settings in safe RL methods. [ABSTRACT FROM AUTHOR]

Vehicular ad hoc networks (VANETs) have attracted great interest from both academia and industry. Information dissemination among vehicles is an important application in VANETs with edge intelligence. Defining "appropriate vehicle" and protecting vehicle privacy in information dissemination is challenging. In this paper, we present an efficient and secure information dissemination framework built on a new ciphertext-policy attribute-based encryption (CP-ABE) scheme. The distinct features of this novel framework are as follows. First, the number of pairing operations used by the decryption algorithm in our framework is independent of the number of input attributes. Therefore, our framework can greatly reduce the computational burden. Second, the group used in our paper is generated based on a novel curve, which can bring higher security to VANETs. Third, we use a short-signature technology to reduce the computation overhead of the key generation process in the vehicle rental scenario. Performance evaluation shows the effectiveness of the proposed framework. [ABSTRACT FROM AUTHOR]