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ObjectiveTo assess the potential role of disulfidptosis-related genes (DRGs) in pan-cancer on prognosis and immunity on the basis of bioinformatics approaches. MethodsPan-cancer RNA-seq data, mutation profiles, clinical information, TMB, MSI, stemness scores, and tumor and immune microenvironment data contained in TCGA and various open-source online databases, and multi-group R-language algorithms were used for comprehensive analysis. The expression levels of DRGs at the cellular level were experimentally validated using qPCR. ResultsLRPPRC, NCKAP1, NDUFS1, and NUBPL had a better prognosis in renal clear cell carcinoma (P

Cavitation is a complex hydrodynamic phenomenon that occurs when the local pressure in a liquid drops below the saturation vapor pressure, resulting in the phase transition of the liquid into vapor. This process was characterized by intricate three-dimensional flow structures and highly unsteady, violent dynamics. For applications such as hydraulic machinery, ship propulsion, and hydraulic engineering, cavitation often induces detrimental effects, and has significant impact on performance and reliability in engineering systems. In order to investigate the structure of non-constant cavitation flow field, this paper adopted the experimental method of image particle velocimetry PIV-LIF, which used a high-speed camera to photograph the cavitation flow from the side of the experimental section and followed the liquid flow by fluorescent tracer particles, so as to measure the cavitation velocity field. Using the high-resolution velocity field and grayscale snapshot data, the dynamic mode decomposition (DMD) was carried out to analyze the structure of the non-constant cavitation flow field. The DMD method can effectively decompose the flow field into several modes and identify the dominant mode for analysis. Based on the DMD method, the decomposition of the cavitated flow field has the characteristics of a single mode frequency and growth rate, which is more advantageous in the analysis of cavitated periodic flow. By analyzing the main modes that account for higher energy and performing modal reconstruction, it is found that all these modes contain certain characteristics of vacuole motion, which are related to the structure of the re-entrant jet and the accompanying vortex in the flow field, and the main evolution frequency of the vacuole is consistent with the vortex shedding frequency. The results of the flow field characteristics of each mode show that the first-order mode of the cavitation flow corresponds to a frequency of 0, which represents the average flow field; the second-order mode corresponds to a frequency of about the vacuole shedding frequency, which reveals that the vacuole grows and sheds periodically at the leading edge of the occurrence; the third-order mode corresponds to a frequency about twice that of the second-order mode, which reveals the fusion behavior of two large-scale vortices behind the hydrofoil; the fourth-order mode corresponds to a frequency about three times higher than the second-order mode, which characterizes the fusion behavior of some small-scale vortices in the flow field. Finally, the modal decomposition analysis of the cavitation flow field with different cavitation numbers was carried out, and it is found that the vortex structure of the shedding vacuole increases with decreasing cavitation number, and the second-order mode frequency decreases with decreasing cavitation number.

Abstract Background The spatiotemporal epidemiological evidence supporting joint endoscopic screening for esophageal cancer (EC) and gastric cancer (GC) remains limited. This study aims to identify combined high-risk regions for EC and GC and determine optimal areas for joint and separate endoscopic screening. Methods We analyzed the association of incidence trends between EC and GC in cancer registry areas across China from 2006 to 2016 using spatiotemporal statistical methods. Based on these analyses, we divided different combined risk regions for EC and GC to implement joint endoscopic screening. Results From 2006 to 2016, national incidence trends for both EC and GC showed a decline, with an average annual percentage change of -3.15 (95% confidence interval [CI]: -5.33 to -0.92) for EC and -3.78 (95% CI: -4.98 to -2.56) for GC. A grey comprehensive correlation analysis revealed a strong temporal association between the incidence trends of EC and GC, with correlations of 79.00% (95% CI: 77.85 to 80.14) in males and 77.62% (95% CI: 76.50 to 78.73) in females. Geographic patterns of EC and GC varied, demonstrating both homogeneity and heterogeneity across different regions. The cancer registry areas were classified into seven distinct combined risk regions, with 33 areas identified as high-risk for both EC and GC, highlighting these regions as priorities for joint endoscopic screening. Conclusion This study demonstrates a significant spatiotemporal association between EC and GC. The identified combined risk regions provide a valuable basis for optimizing joint endoscopic screening strategies for these cancers.

Abstract Background In the tumor microenvironment (TME), a bidirectional relationship exists between hypoxia and lactate metabolism, with each component exerting a reciprocal influence on the other, forming an inextricable link. The aim of the present investigation was to develop a prognostic model by amalgamating genes associated with hypoxia and lactate metabolism. This model is intended to serve as a tool for predicting patient outcomes, including survival rates, the status of the immune microenvironment, and responsiveness to therapy in patients with lung adenocarcinoma (LUAD). Methods Transcriptomic sequencing data and patient clinical information specific to LUAD were obtained from comprehensive repositories of The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO). A compendium of genes implicated in hypoxia and lactate metabolism was assembled from an array of accessible datasets. Univariate and multivariate Cox regression analyses were employed. Additional investigative procedures, including tumor mutational load (TMB), microsatellite instability (MSI), functional enrichment assessments and the ESTIMATE, CIBERSORT, and TIDE algorithms, were used to evaluate drug sensitivity and predict the efficacy of immune-based therapies. Results A novel prognostic signature comprising five lactate and hypoxia-related genes (LHRGs), PKFP, SLC2A1, BCAN, CDKN3, and ANLN, was established. This model demonstrated that LUAD patients with elevated LHRG-related risk scores exhibited significantly reduced survival rates. Both univariate and multivariate Cox analyses confirmed that the risk score was a robust prognostic indicator of overall survival. Immunophenotyping revealed increased infiltration of memory CD4 + T cells, dendritic cells and NK cells in patients classified within the high-risk category compared to their low-risk counterparts. Higher probability of mutations in lung adenocarcinoma driver genes in high-risk groups, and the MSI was associated with the risk-score. Functional enrichment analyses indicated a predominance of cell cycle-related pathways in the high-risk group, whereas metabolic pathways were more prevalent in the low-risk group. Moreover, drug sensitivity analyses revealed increased sensitivity to a variety of drugs in the high-risk group, especially inhibitors of the PI3K-AKT, EGFR, and ELK pathways. Conclusions This prognostic model integrates lactate metabolism and hypoxia parameters, offering predictive insights regarding survival, immune cell infiltration and functionality, as well as therapeutic responsiveness in LUAD patients. This model may facilitate personalized treatment strategies, tailoring interventions to the unique molecular profile of each patient’s disease.

Hydrodynamic Cavitation (HC) is a highly turbulent, unsteady, multi-phase flow that has been useful in many processing applications like wastewater treatment and process intensification and hence needs to be studied in detail. The aim of this study is to investigate the mechanisms driving HC inside a Venturi tube using numerical simulations. The numerical simulations are conducted in the form of both two-dimensional (2D) and three-dimensional (3D) simulations using the Detached Eddy Simulation (DES) model database to simulate the cavitation–turbulence interplay, and the results are validated against high-fidelity experimental data. Initial 2D calculation results show that though URANS models are able to show unsteady cavitation, they are unable to reproduce the correct cavity morphology while the DES models reproduce the cavity morphology accurately. After extending to 3D simulations and the resulting vorticity budget analysis highlight the cavitation–vortex interactions and show the domination of velocity gradients and the growth and shrinking of the fluid element terms over the baroclinic torque for vortex production. Finally, localized scale comparisons are conducted to evaluate the model’s ability to simulate the cavitation–turbulence interaction. It is observed that the 3D DES simulations are able to predict accurately the cavitation–turbulence interaction on a localized scale for turbulence properties like Reynolds shear stress and Turbulent Kinetic Energy (TKE), emphasizing the 3D effects of turbulence and their influence on the cavitating flow. However, significant discrepancies continue to exist between the numerical simulations and experiments, near the throat where the numerical simulations predict a thinner cavity. Therefore, this study offers new insights on simulating HC and highlights the bottleneck between turbulence model development and accurate simulations of HC to provide a reference for improving modeling accuracy.

Flow visualization has long been a critical tool for understanding complex fluid dynamics in both natural and engineered systems [...]

Abstract Primary subarachnoid hemorrhage (SAH) is a type of acute stroke, accounting for approximately 10% of cases, with high disability and mortality rate. Early brain injury (EBI) is a critical factor in determining SAH mortality; however, there are no effective treatment interventions for EBI. Based on our results, the transmission of cyclic GMP-AMP (cGAMP) from neurons to microglia is a key molecular event that triggers type I interferon response, amplifies neuroinflammation, and leads to neuronal apoptosis. Abnormal intracytoplasmic mitochondrial DNA (mtDNA) is the initiating factor of the cGAS-cGAMP-STING signaling axis. Overall, the cGAS-cGAMP-STING signaling axis is closely associated with neuroinflammation after subarachnoid hemorrhage. Targeting cGAS triggered by cytoplasmic mtDNA may be useful for comprehensive clinical treatment of patients after SAH. Further studies targeting cGAS-specific antagonists for treating SAH are warranted. Video Abstract

Abstract Pulmonary polymorphic carcinoma (PPC) is a rare and poorly differentiated form of non‐small cell lung cancer (NSCLC), accounting for just approximately 0.1% to 0.4% of all NSCLC cases. Historically, the conventional treatments for PPC have been linked to a grim prognosis. However, with the advent of immune checkpoint inhibitors (ICIs), including PD‐1 inhibitors, for the management of NSCLC, our center has witnessed encouraging outcomes in two PPC patients who underwent PD‐1 inhibitor therapy. The first patient was a 70‐year‐old male who initially came to our attention after the discovery of a lung mass during a routine physical examination. A lung biopsy confirmed the diagnosis of PPC, and further complications included brain metastasis. Surgical intervention was conducted for the brain metastases, while PD‐1 inhibitor therapy was employed for the lung tumors. The second patient was a 60‐year‐old male who was admitted with a history of persistent coughing and hemoptysis, which led to the diagnosis of a left lung tumor. Subsequent postoperative pathology revealed pulmonary adenocarcinoma coexisting with PPC. However, 2 months later, distant metastases were detected during a follow‐up examination. The patient encountered difficulty in tolerating the adverse effects of chemotherapy, prompting the initiation of PD‐1 inhibitor treatment. Notably, both patients underwent one cycle of PD‐1 inhibitor therapy without encountering significant adverse reactions, and their responses proved to be promising during re‐examinations. These findings suggest that surgery combined with immunotherapy PD‐1 inhibitor therapy may represent an effective approach for the treatment of PPC.

Abstract Background The aim of the study was to investigate differences in HLA‐I alleles between lung adenocarcinoma patients and healthy controls and determine their association with PD‐L1 expression and tumor mutational burden (TMB) to understand the mechanism underlying lung adenocarcinoma susceptibility. Methods Differences in HLA allele frequencies between the two groups were analyzed in a case–control study. PD‐L1 expression and TMB in lung adenocarcinoma patients were determined and their relationships with HLA‐I were analyzed. Results The lung adenocarcinoma group showed significantly higher HLA‐A*30:01 (p = 0.0067, odds ratio [OR], 1.834; 95% confidence interval [CI]: 1.176–2.860), B*13:02 (p = 0.0050, OR, 1.855; 95% CI: 1.217–2.829), and C*06:02 (p = 0.0260, OR, 1.478; 95% CI: 1.060–2.060) and significantly lower B*51:01 (p = 0.0290, OR, 0.6019; 95% CI: 0.3827–0.9467), and C*14:02 (p = 0.0255, OR, 0.5089; 95% CI: 0.2781–0.9312) than the control group. Haplotype analysis results showed that HLA‐A*30:01–B*13:02 (p = 0.0100, OR, 1.909; 95% CI: 1.182–3.085), A*11:01–C*01:02 (p = 0.0056, OR, 1.909; 95% CI: 1.182–3.085), A*30:01–C*06:02 (p = 0.0111, OR, 1.846; 95% CI: 1.147–2.969), and B*13:02–C*06:02 (p = 0.0067, OR, 1.846; 95% CI: 1.147–2.969) frequencies significantly increased and B*51:01–C*14:02 (p = 0.0219, OR, 0.490; 95% CI: 0.263–0.914) frequency significantly decreased in lung adenocarcinoma patients. Three‐locus haplotype analysis showed that HLA‐A*30:01‐B*13:02‐C*06:02 frequency (p = 0.0100, OR, 1.909; 95% CI: 1.182–3.085) significantly increased in patients. Conclusion HLA‐A*30:01, B*13:02, and C*06:02 may be the susceptibility genes and HLA‐B*51:01 and C*14:01 act as the resistance genes of lung adenocarcinoma. The changes in HLA‐I allele frequencies had no association with PD‐L1 expression and TMB among these patients.

Abstract Objective To investigate the potential causal link between genetic variants associated with gut microbiome and risk of intracranial aneurysm (IA) using two-sample mendelian randomization (MR). Methods We performed two sets of MR analyses. At first, we selected the genome-wide statistical significant(P

Abstract Human respiration reflects abundant physiological information and could enable non‐invasive monitoring, providing information about various biological parameters such as respiration rate and depth. The rapidly growing field of humidity sensors bring forward the requirement for good performance. In this work, by virtue of good hydrophilicity and conductivity, a MXene/thermoplastic polyurethane (TPU) composite film is prepared by coating MXene nanosheets on chitosan‐modified TPU electrospun nanofibers via electrostatic interactions, for fabricating a humidity sensor. Based on the principle that the tunnel resistance changing with water molecules influences the distance of MXene nanosheets, the MXene/TPU humidity sensor exhibits fast response (12 s), wide humidity response range (11–94% RH), low hysteresis (

IntroductionTo evaluate treatment strategies and clinical outcomes following endovascular embolization of tentorial dural arteriovenous fistulas.MethodsWe retrospectively analyzed 19 patients with tentorial dural arteriovenous fistulas admitted to the Department of Neurosurgery at Jiangsu Provincial People’s Hospital between October 2015 and May 2022, all treated with endovascular therapy. To collect and analyze patients’ clinical presentation, imaging data, postoperative complications, and prognosis and to analyze the safety and clinical outcomes of endovascular treatment of tentorial dural arteriovenous fistulas.ResultsImaging cure was achieved in 18 patients, with the arterial route chosen for embolization in 17 patients and the venous route in one patient; one patient received partial embolization. Staged embolization was performed in four patients. At postoperative follow-up of 9–83 months (37.8 ± 21.2), all 19 patients had recovered well (mRS score ≤ 2). Three patients experienced perioperative complications: intraoperative Onyx reflux into the middle cerebral artery in one patient; postoperative permanent limited left visual field loss and deafness in the left ear in one patient; and transient diplopia, vertigo, and decreased pain and temperature sensation of the left limb in one patient, with no abnormalities on post-procedure magnetic resonance examinations. A total of 17 patients completed a postoperative digital subtraction angiography review during follow-up, and one patient had a recurrence of an arteriovenous fistula.ConclusionEndovascular treatment of tentorial dural arteriovenous fistulas is safe and effective. Reduction of the Borden or Cognard classification via eliminating cortical venous reflux through multi-staged embolization or combined open surgery is a reasonable goal of treatment where complete obliteration of the fistula is not achievable.

Disulfidptosis, a newly revealed form of cell death, regulated by numerous genes that has been recently identified. The exact role of disulfidptosis in lung adenocarcinoma (LUAD) still uncertain. Objective of this study was to explore potential prognostic markers among disulfidptosis genes in LUAD. By combining transcriptomic information from Gene Expression Omnibus databases and The Cancer Genome Atlas, we identified differentially expressed and prognostic disulfidptosis genes. By conducting least absolute shrinkage and selection operator with multivariate Cox regression, four disulfidptosis genes were selected to create the prognostic signature. The implementation of the signature separated the training and validation cohorts into groups with high- and low-risk. Subsequently, the model was verified by conducting an independent analysis of receiver operating characteristic (ROC) curves. Further comparisons were made between the two risk-divided groups with regards the tumor microenvironment, immune cell infiltration, immunotherapy response, and drug sensitivity. The signature was constructed using four disulfidptosis-related genes: SLC7A11, SLC3A2, NCKAP1, and GYS1. According to ROC curves, the signature was effective for predicting LUAD prognosis. In addition, the prognostic signature correlated with sensitivity to chemotherapeutic agents and the efficacy of immunotherapy in LUAD. Finally, through external validation, we showed that NCKAP1 are correlated with tumor migration, proliferation, and invasion of LUAD cells. GYS1 affects immune cell, especially M2 macrophage infiltration in the tumor microenvironment. The disulfidptosis four-gene model can reliably predict the prognosis of patients diagnosed with LUAD, thereby providing valuable information for clinical applications and immunotherapy.

Abstract Background Intercostal nerve block (ICNB) is a very effective analgesic method. We aimed to explore the effect of preemptive analgesia with ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery. Methods 126 patients, aged 18–70 years, with American Society of Anesthesiologists (ASA) physical status I-II and scheduled for thoracoscopic pulmonary resection were enrolled in this study. 119 patients were left for final analysis. Patients were randomly allocated to group ICNB and group CONTROL. Patients in CONTROL group were administered sufentanil with patient-controlled analgesia device after operation In group ICNB, patients received ropivacaine ICNB prior to surgery and patient-controlled analgesia device after operation. The primary outcome is visual analog scale pain score (VAS) at rest at 0,4, 8,16,24,48,72 and 168 h postoperatively and they were compared. Surgical outcomes and rescue analgesia requirement were also recorded. Results VAS scores were statistically significantly lower for ICNB group compared to control group at 0, 4, 8, 16, 24 and 48 h postoperatively. The duration of insertion of chest tube in ICBN group was shorter than that in control group, and the difference was statistically significant (4.69 ± 2.14 vs. 5.67 ± 2.86, P = 0.036). The postoperative hospital stay, incidence of nausea and vomiting and postoperative pulmonary infection rate in ICBN group were all lower than those in the control group, but there were no statistical differences. The frequency of rescue analgesia during 48 postoperative hours was different between the two groups (ICNB vs. Control; 9.83% vs. 31.03%, P = 0.004). Conclusions For patients undergoing thoracoscopic surgery, ultrasound-guided ICNB is simple, safe, and effective for providing acute postoperative pain management during the early postoperative stage. Trial registration Chinese clinical trials: chictr.org.cn, ChiCTR1900021017. Registred on 25/01/2019.

The non-cavitating and cavitating wake flow of a circular cylinder, which contains multiscale vortices, is numerically investigated by Large Eddy Simulation combined with the Schnerr–Sauer cavitation model in this paper. In order to investigate the spatiotemporal evolution of cavitation vortex structures, the Proper Orthogonal Decomposition (POD) method is employed to perform spatiotemporal decomposition on the cylinder wake flow field obtained by numerical simulation. The results reveal that the low-order Proper Orthogonal Decomposition modes correspond to large-scale flow structures with relatively high energy and predominantly single frequencies in both non-cavitating and cavitating conditions. The presence of cavitation bubbles in the flow field leads to a more pronounced deformation of the vortex structures in the low-order modes compared to the non-cavitating case. The dissipation of pressure energy in the cylinder non-cavitating wake occurs faster than the kinetic energy. While in the cavitating wake, the kinetic energy dissipates more rapidly than the pressure energy.

The wake flow of a circular cylinder is numerically investigated by Large Eddy Simulation (LES) combined with the Schnerr–Sauer cavitation model. By comparing entropy production in the presence or absence of cavitation, the energy loss distribution in the wake flow field of a cylinder is explored, shedding light on the interactions between multiscale vortex systems and cavitation. The comparative results reveal that, under non-cavitating conditions, the energy loss region in the near-wake area is more concentrated and relatively larger. Energy dissipation in the wake flow field occurs in regions characterized by very high velocity gradients, primarily near the upper and lower surfaces of the cylinder near the leading edge. The influence of cavitation bubbles on entropy production is predominantly observed in the trailing-edge region (W1) and the near-wake region (W2). The distribution trends of wall entropy production on the cylinder’s surface are generally consistent in both conditions, with wall entropy production primarily concentrated in regions exhibiting high velocity gradients.

BackgroundEsophageal cancer (EC) is the sixth leading cause of cancer-related burden with distinct regional variations globally. Although the burden of EC has decreased, the specific reasons for this decline are still unclear. ObjectiveThis study aims to uncover the spatiotemporal patterns of EC risk–attributable burden in 204 countries and territories from 1990 to 2019 so that prevention and control strategies of EC can be prioritized worldwide. MethodsWe extracted EC risk–attributable deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) from the global burden of disease (GBD) study from 1990 to 2019, in terms of behavioral, metabolic, and dietary factors by age, sex, and geographical location. Average annual percentage change (AAPC) was used to assess the long-term trends in the ASMRs and ASDRs of EC due to specific risk factors. ResultsBetween 1990 and 2019, the greatest decrease in EC burden was attributed to low intake of fruits and vegetables. An AAPC of –2.96 (95% CI –3.28 to –2.63) and –3.12 (95% CI –3.44 to –2.79) in ASMR and ASDR was attributable to a low-fruit diet, while an AAPC of –3.60 (95% CI –3.84 to –3.36) and –3.64 (95% CI –3.92 to –3.35) in ASMR and ASDR was attributed to a low-vegetable diet. However, the trends in ASMRs and ASDRs due to high BMI showed significant increases with an AAPC of 0.52 (95% CI 0.29-0.75) in ASMR and 0.42 (95% CI 0.18-0.66) in ASDR from 1990 to 2019 compared to significant decreases in other attributable risks with AAPC

Abstract Background Surgical resection is the most effective curative management of benign rib tumors and carries an excellent prognosis. Due to complex anatomy and narrow field, higher rib resection is technically demanding and requires extensive dissection. Case presentation We report a case of second rib tumor resection performed transthoracic under Da Vinci robot assistance. A 32-year-old male complained about increasing pain in the left anterior chest wall. After 3D reconstruction of CT, it showed a well-circumscribed fusiform lesion with a multi-component structure. Measured 17 × 6 × 4 cm and extended into the chest cavity to the depth below the pectoralis minor muscle. The patient underwent robotic-assisted trans-thoracic second rib resection. At four weeks of outpatient follow-up, the patient reported no pain and uncomplicated wound healing. Conclusion This minimally invasive approach offers optimal visualization and tissue manipulation while dramatically decreasing the possibility of collateral damage, hence ensuring fast function recovery. To the best of our knowledge, these kinds of procedures are rarely reported in detail.

Abstract Background Thoracoscopic segmentectomy is a common surgical procedure in thoracic surgery today. However, identifying the intersegmental plane is difficult in the surgical process. Therefore, we evaluated the feasibility of the arterial ligation method for determining the intersegmental plane and compared the demarcation status with the intravenous indocyanine green (ICG). Methods We retrospectively reviewed the records of 35 patients with peripheral small lung nodules who underwent thoracoscopic segmentectomy between May and December 2020. First, the preoperative three-dimensional reconstruction was performed to distinguish the location of lung nodules and the anatomical structures of targeted segmental arteries, veins, and bronchi. Second, the targeted segmental arteries were ligated, and the intersegmental plane was determined by the inflation-deflation technique. The waiting time for the appearance of the inflation-deflation line was recorded. Thirdly, the intersegmental plane was identified again using the ICG fluorescence method. Finally, the consistency of the two intersegmental planes was evaluated. Results The intersegmental planes were successfully observed in all patients using the arterial ligation method. Thirty-four patients underwent segmentectomy as planned, and one patient finally underwent lobectomy due to insufficient surgical margin. The waiting time for the appearance of the intersegmental plane by arterial ligation method was 13.7 ± 3.2 min (6–19 min). The intersegmental planes determined by the arterial ligation method and the ICG fluorescence method were comparable, with a maximum distance of no more than 5 mm between the two planes. The mean operative duration was 119.1 ± 34.9 min, and the mean blood loss was 76.9 ± 70.3 ml. No evident air leakage was found during the operation. Only one patient experienced a prolonged air leak (≥ 5 days) during the postoperative recovery. No atelectasis occurred in all cases. The chest tube duration was 3.1 ± 0.9 days. Conclusion The arterial ligation method can efficiently and accurately identify the intersegmental plane, comparable to the ICG fluorescence method.

Summary: Background: Mediastinal neoplasms are typical thoracic diseases with increasing incidence in the general global population and can lead to poor prognosis. In clinical practice, the mediastinum's complex anatomic structures and intertype confusion among different mediastinal neoplasm pathologies severely hinder accurate diagnosis. To solve these difficulties, we organised a multicentre national collaboration on the basis of privacy-secured federated learning and developed CAIMEN, an efficient chest CT-based artificial intelligence (AI) mediastinal neoplasm diagnosis system. Methods: In this multicentre cohort study, 7825 mediastinal neoplasm cases and 796 normal controls were collected from 24 centres in China to develop CAIMEN. We further enhanced CAIMEN with several novel algorithms in a multiview, knowledge-transferred, multilevel decision-making pattern. CAIMEN was tested by internal (929 cases at 15 centres), external (1216 cases at five centres and a real-world cohort of 11 162 cases), and human–AI (60 positive cases from four centres and radiologists from 15 institutions) test sets to evaluate its detection, segmentation, and classification performance. Findings: In the external test experiments, the area under the receiver operating characteristic curve for detecting mediastinal neoplasms of CAIMEN was 0·973 (95% CI 0·969–0·977). In the real-world cohort, CAIMEN detected 13 false-negative cases confirmed by radiologists. The dice score for segmenting mediastinal neoplasms of CAIMEN was 0·765 (0·738–0·792). The mediastinal neoplasm classification top-1 and top-3 accuracy of CAIMEN were 0·523 (0·497–0·554) and 0·799 (0·778–0·822), respectively. In the human–AI test experiments, CAIMEN outperformed clinicians with top-1 and top-3 accuracy of 0·500 (0·383–0·633) and 0·800 (0·700–0·900), respectively. Meanwhile, with assistance from the computer aided diagnosis software based on CAIMEN, the 46 clinicians improved their average top-1 accuracy by 19·1% (0·345–0·411) and top-3 accuracy by 13·0% (0·545–0·616). Interpretation: For mediastinal neoplasms, CAIMEN can produce high diagnostic accuracy and assist the diagnosis of human experts, showing its potential for clinical practice. Funding: National Key R&D Program of China, National Natural Science Foundation of China, and Beijing Natural Science Foundation.

BackgroundIn recent years, radiomics has been increasingly utilized for the differential diagnosis of Parkinson’s disease (PD). However, the application of radiomics in PD diagnosis still lacks sufficient evidence-based support. To address this gap, we carried out a systematic review and meta-analysis to evaluate the diagnostic value of radiomics-based machine learning (ML) for PD.MethodsWe systematically searched Embase, Cochrane, PubMed, and Web of Science databases as of November 14, 2022. The radiomics quality assessment scale (RQS) was used to evaluate the quality of the included studies. The outcome measures were the c-index, which reflects the overall accuracy of the model, as well as sensitivity and specificity. During this meta-analysis, we discussed the differential diagnostic value of radiomics-based ML for Parkinson’s disease and various atypical parkinsonism syndromes (APS).ResultsTwenty-eight articles with a total of 6,057 participants were included. The mean RQS score for all included articles was 10.64, with a relative score of 29.56%. The pooled c-index, sensitivity, and specificity of radiomics for predicting PD were 0.862 (95% CI: 0.833–0.891), 0.91 (95% CI: 0.86–0.94), and 0.93 (95% CI: 0.87–0.96) in the training set, and 0.871 (95% CI: 0.853–0.890), 0.86 (95% CI: 0.81–0.89), and 0.87 (95% CI: 0.83–0.91) in the validation set, respectively. Additionally, the pooled c-index, sensitivity, and specificity of radiomics for differentiating PD from APS were 0.866 (95% CI: 0.843–0.889), 0.86 (95% CI: 0.84–0.88), and 0.80 (95% CI: 0.75–0.84) in the training set, and 0.879 (95% CI: 0.854–0.903), 0.87 (95% CI: 0.85–0.89), and 0.82 (95% CI: 0.77–0.86) in the validation set, respectively.ConclusionRadiomics-based ML can serve as a potential tool for PD diagnosis. Moreover, it has an excellent performance in distinguishing Parkinson’s disease from APS. The support vector machine (SVM) model exhibits excellent robustness when the number of samples is relatively abundant. However, due to the diverse implementation process of radiomics, it is expected that more large-scale, multi-class image data can be included to develop radiomics intelligent tools with broader applicability, promoting the application and development of radiomics in the diagnosis and prediction of Parkinson’s disease and related fields.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=383197, identifier ID: CRD42022383197.

Abstract Background The lobar and segmental anatomy are the basis for anatomical pulmonary segmentectomy. Methods From October 2017 to June 2021, 136 patients with small pulmonary nodules scheduled for anatomical pulmonary segmentectomy at our institution underwent three‐dimensional (3D) lung reconstruction. The anatomy of the left upper lobe (LUL) was statistically analyzed and graphically mapped using the reconstructed models, and the role of this reconstruction method in performing pulmonary segmentectomy was explored. Results Through the analysis of the reconstructed models, the upper stem (S1 + 2 + 3) bronchus was classified as having two (94/136 cases) or three branches (42/136 cases). The upper stem artery had two branches in 24/136 patients, three in 60/136 cases, four in 44/136 cases, and five in 8/136 cases. A total of 103/136 upper stem veins had two branches, 26/136 had three branches, and 7/136 had four branches. The lingual stem (S4 + 5) bronchus was two‐branched in 116/136 cases and three‐branched in 20/136 cases, while the lingual artery was single‐branched in 61/136 cases, two‐branched in 70/136 cases, and three‐branched in rare cases (5/136 cases). The lingual stem vein was unbranched in 119/136 cases and two‐branched in 17/136 cases. Additionally, six unusual variants (

ObjectiveThis study aimed to compare the safety and efficacy of single- and multiple-stage endovascular treatment in aneurysmal subarachnoid hemorrhage (SAH) patients with multiple intracranial aneurysms.MethodsWe retrospectively analyzed the clinical and imaging data of 61 patients who harbored multiple aneurysms and presented to our institution with aneurysmal subarachnoid hemorrhage. Patients were grouped according to endovascular treatment strategy: one-stage or multiple-stage.ResultThe 61 study patients harbored 136 aneurysms. One aneurysm in each patient had ruptured. In the one-stage treatment group, all 66 aneurysms in 31 patients were treated in one session. The mean follow-up was 25.8 months (range, 12–47). At the last follow-up, the modified Rankin scale was ≤2 in 27 patients. In total, 10 complications occurred (cerebral vasospasm, six patients; cerebral hemorrhage, two patients; and thromboembolism, two patients). In the multiple-stage treatment group, only the ruptured aneurysm (30 in total) was treated at the time of presentation, and the remaining aneurysms (40 in total) were treated later. The mean follow-up was 26.3 months (range, 7–49). At the last follow-up, the modified Rankin scale score was ≤2 in 28 patients. In total, five complications occurred (cerebral vasospasm, four patients; and subarachnoid hemorrhage, one patient). During the follow-up period, there was one recurrence of aneurysm with subarachnoid hemorrhage in the single-stage treatment group and four recurrences in the multiple-stage treatment group.ConclusionBoth single- and multiple-stage endovascular treatment is safe and effective in aneurysmal subarachnoid hemorrhage patients who harbor multiple aneurysms. However, multiple-stage treatment is associated with a lower rate of hemorrhagic and ischemic complications.

Introduction Segmentectomy and lobectomy are the main surgical procedures for early-stage lung cancer. However, few studies have analysed patient-reported outcomes after segmentectomy versus lobectomy. This study aims to compare patient-reported outcomes—such as symptoms, daily functioning and quality of life—between thoracoscopic segmentectomy and lobectomy for early-stage lung cancer during the 1 year after surgery.Methods and analysis Overall, 788 newly diagnosed patients with early-stage lung cancer (tumour size ≤2 cm), who are scheduled to undergo thoracoscopic segmentectomy or lobectomy, will be recruited in this multicentre, prospective cohort study. The patients will receive standardised care after surgery. The Perioperative Symptom Assessment for Lung Surgery—a validated lung cancer surgery-specific scale—will be used to assess the symptoms and functions at baseline, at discharge and monthly after discharge for 1 year. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Lung Cancer module 29 will be used to assess the patients’ quality of life at the same time points. The primary outcome will be the shortness of breath scores during the first year after thoracoscopic segmentectomy and lobectomy and will be compared using mixed-effects models. The secondary outcomes will include other symptoms, indicators of daily functioning, quality of life scores and traditional clinical outcomes. These will be compared using mixed-effects models and the Student’s t-test, non-parametric test or Χ2 test. Propensity score matching will be used to ensure an even distribution of known confounders between the groups.Ethics and dissemination The Ethics Committee for Medical Research and New Medical Technology of Sichuan Cancer Hospital approved this study (approval number: SCCHEC-02-2022-002). All participants will be instructed to provide informed consent. The manuscript is based on protocol version 3.0. The study results will be presented at medical conferences and published in peer-reviewed journals.Trial registration number ChiCTR2200060753.

Abstract Background The incidence of congenital bronchoesophageal fistulas in adults is rare. Most fistulas discovered in adulthood are often small and can be repaired with a simple one-step method. Case presentation A 46-year-old female patient complained of a 2-month history of chocking, coughing, and a 12 kg drop in weight. The bronchofiberscopy and gastroscopy showed a large fistula, which extended from the esophagus to the main bronchus on both sides, thus forming a special three-way channel which has never been reported. This case was challenging both to the anesthetists and surgeons. The patient was intubated with a sengstaken-blakemore tube, and then received segmental esophageal resection, anastomotic reconstruction, and double-flap repair with esophagus segment in situ. Conclusion When the fistula in BEF is large or complicated, appropriate surgical methods should be meticulously designed according to the condition of the patient. The problem of anesthesia intubation should be solved first, to allow a smooth operation. Secondly, a double-layer repair of the airway fistula by using esophageal wall tissues as patch materials is proposed.

Background and objective Lung cancer has the highest mortality in China. Different treatments are of great significance to the prognosis of patients. By comparing stage Ia non-small cell lung cancer (NSCLC) patients’ survival rates for ablation and for sub-lobectomy, we studied the difference in the effects of the two treatments on patient prognosis. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, we screened eligible patients with stage Ia NSCLC from January 2004 to December 2015. Then, 228 patients treated with ablation and 228 patients treated with sub-lobotomy were then selected based on propensity score matching. After stratification, matching, and adjustment the Kaplan-Meier analysis was performed to compare the overall survival rates of patients treated with the two procedures. Results The Kaplan-Meier survival analysis showed that there is a significant difference between the ablation group and the sub-lobectomy group (P

Abstract Background Long non-coding RNA (lncRNA) was a vital factor in the progression and initiation of human cancers. This study found a new lncRNA, FGD5-AS1, which can inhibit EMT process, proliferation, and metastasis in vitro and in vivo. Methods qRT-PCR was employed to test the expression of lncFGD5-AS1 in 30 gastric cancer patients’ cancer tissue and para-cancer tissue. Overexpressed lncFGD5-AS1 cells shown sharply decrease of proliferation, migration, and epithelial-mesenchymal transition (EMT). miR-196a-5p/SMAD6 was confirmed as downstream molecular mechanism of lncFGD5-AS1 by expression correlation analysis and mechanism experiments. In vivo study illustrated overexpression of lncFGD5-AS1 suppression tumor growth. Results LncFGD5-AS1 served as a ceRNA of miR-196a-5p to release its inhibition on SMAD6, a conventional inhibitor on the BMP pathway. Comparing with normal gastric cancer cells, FGD5-AS1 overexpressed group had fewer migration cells, lower cell viability, and lower EMT transformation rate. Meanwhile, xenografts nude mice injecting with overexpressed-FGD5-AS1 cells also shown smaller tumor weight and volume. Conclusion In conclusion, this research supported the first evidence that FGD5-AS1 suppressed proliferation and metastasis in gastric cancer by regulating miR-196a-5p/SMAD6/BMP axis and suggested a potential therapeutic candidate for gastric cancer.

ObjectiveTo investigate the link between genetic variants associated with plasma homocysteine levels and risk of intracranial aneurysm (IA) using two-sample Mendelian randomization.MethodsWe used single-nucleotide polymorphisms associated with human plasma homocysteine levels as instrumental variables for the primary analysis in a genome-wide association study of 44,147 subjects of European ancestry. Summary-level statistics were obtained for 79,429 individuals, including 7,495 IA cases and 71,934 controls. To enhance validity, five different Mendelian randomization methods (MR-Egger, weighted median, inverse variance weighted, simple mode, and weighted mode) were used for the analyses.ResultsThe inverse variance weighted analysis method produced P-values of 0.398 for aneurysmal subarachnoid hemorrhage [odds ratio (OR): 1.104; 95% confidence interval (CI): 0.878–1.387], 0.246 for IA (OR: 1.124; 95% CI: 0.923–1.368), and 0.644 for unruptured IA (OR: 1.126; 95% CI: 0.682–1.858). The MR-Egger analysis showed no association between IAs and homocysteine, with all P > 0.05.ConclusionUsing gene-related instrumental variables, the Mendelian randomization analyses demonstrated a lack of an association between plasma homocysteine levels and IAs or aneurysmal subarachnoid hemorrhage.

Background Matrix metalloproteinase‐14 (MMP‐14) is known to be a key regulator of oncogenesis and tumor progression. The present study was designed to assess the relationship between the downregulation of MMP‐14 and the in vitro proliferative, migratory, and invasive activity of esophageal squamous cell carcinoma (ESCC) cells. Methods MMP‐14 expression in human ESCC and paracancerous normal esophageal tissue samples was evaluated via immunohistochemistry, and correlations between MMP‐14 staining and patient clinicopathological features were examined. In addition, siRNA was used to knockdown MMP‐14 in ESCC cells, and the proliferation and invasive activity of these cells were then evaluated via MTT and Transwell assays, respectively. Flow cytometry was additionally used to assess cell cycle progression, while Western blotting was employed to measure protein levels within these cells. Results ESCC samples were found to exhibit MMP‐14 overexpression relative to paracancerous tissue samples, and this overexpression was positively correlated with tumor T classification (T1‐2 vs. T3; P

Background Recent studies have indicated that the incidence of esophageal cancer has declined in the past decade in the U.S. However, trends in the incidence and survival have not been thoroughly examined. Methods Data from 46 063 patients with esophageal cancer between 1973 and 2015 were collected from the Surveillance, Epidemiology, and End Results database. The trends in the age‐adjusted incidence and survival were analyzed using joinpoint regression models. Results The age‐adjusted incidence of esophageal cancer increased from 5.55 to 7.44 per 100 000 person‐years between 1973 and 2004. Later, it decreased at an annual percentage change of 1.23%. In the last 40 years, the strong male predominance increased slightly. Importantly, the percentage of patients with localized stage of squamous cell cancer decreased. It was observed that the incidence of esophageal squamous cell carcinoma declined since 1986, while the incidence of esophageal adenocarcinoma sharply increased since 1973 and surpassed the rate of squamous cell cancer, mainly due to the increase in the incidence among men. Consistently, the estimated 40‐year limited‐duration prevalence of esophageal adenocarcinoma was higher than that of esophageal squamous cell carcinoma. Additionally, we observed a modest but significant improvement in survival during the study period. Conclusion The incidence of esophageal squamous cell carcinoma has decreased significantly over the past four decades in the U.S., while the incidence of adenocarcinoma has increased, particularly among men. Overall, the long‐term survival of patients with esophageal cancer is poor but it has improved over the past decades, especially for the localized disease. Key points Significant findings of the study The incidence of esophageal cancer has decreased at an annual percentage change of 1.23% since 2004. The incidence of esophageal adenocarcinoma has sharply increased since 1973 and surpassed the rate of squamous cell cancer, mainly due to the increase in the incidence among men. What this study adds There has been a shift in the prevalence of esophageal cancer histological subtypes over the past decades in the U.S. We found that the incidence of esophageal squamous cell carcinoma has continued to decrease, while the esophageal adenocarcinoma rate has continued to increase.

Hydrodynamic cavitation is an emerging intensification technology in water treatment or chemical processing, and Venturi-type cavitation reactors exhibit advantages for industrial-scale production. The effects of temperature on hydrodynamic cavitating flows are investigated to find the optimum reaction conditions enhancing cavitating treatment intensity. Results show that the cavitation performance, including the cavitation intensity and cavitation unsteady behavior, is influenced by (1) cavitation number σ (the pressure difference affecting the vaporization process), (2) Reynolds number Re (the inertial/viscous ratio affecting the bubble size and liquid–vapor interface area), and (3) thermodynamic parameter Σ (the thermal effect affecting the temperature drop). With increasing temperature, the cavitation length first increases and then decreases, with a cavitation intensity peak at the transition temperature of 58 °C. With the growth of cavitation extent, the cavity-shedding regimes tend to transition from the attached sheet cavity to the periodic cloud cavity, and the vapor volume fluctuating frequency decreases accordingly. A combined suppression parameter (CSP) is provided to predict that, with increasing CSP value, the cavitation intensity can be decreased. Recommendations are given that working under the low-CSP range (55–60 °C) could enhance the intensification of the cavitation process.

k nearest neighbours (kNN) queries are fundamental in many applications, ranging from data mining, recommendation system and Internet of Things, to Industry 4.0 framework applications. In mining, specifically, it can be used for the classification of human activities, iterative closest point registration and pattern recognition and has also been helpful for intrusion detection systems and fault detection. Due to the importance of kNN queries, many algorithms have been proposed in the literature, for both static and dynamic data. In this paper, we focus on exact kNN queries and present a comprehensive survey of exact kNN queries. In particular, we study two fundamental types of exact kNN queries: the kNN Search queries and the kNN Join queries. Our survey focuses on exact approaches over high-dimensional data space, which covers 20 kNN Search methods and 9 kNN Join methods. To the best of our knowledge, this is the first work of a comprehensive survey of exact kNN queries over high-dimensional datasets. We specifically categorise the algorithms based on indexing strategies, data and space partitioning strategies, clustering techniques and the computing paradigm. We provide useful insights for the evolution of approaches based on the various categorisation factors, as well as the possibility of further expansion. Lastly, we discuss some open challenges and future research directions.

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease with unknown etiology and unfavorable prognosis. Ferroptosis is a form of regulated cell death with an iron-dependent way that is involved in the development of various diseases. Whereas the prognostic value of ferroptosis-related genes (FRGs) in IPF remains uncertain and needs to be further elucidated.Methods: The FerrDb database and the previous studies were screened to explore the FRGs. The data of patients with IPF were obtained from the GSE70866 dataset. Wilcoxon's test and univariate Cox regression analysis were applied to identify the FRGs that are differentially expressed between normal and patients with IPF and associated with prognosis. Next, a multigene signature was constructed by the least absolute shrinkage and selection operator (LASSO)-penalized Cox model in the training cohort and evaluated by using calibration and receiver operating characteristic (ROC) curves. Then, 30% of the dataset samples were randomly selected for internal validation. Finally, the potential function and pathways that might be affected by the risk score-related differently expressed genes (DEGs) were further explored.Results: A total of 183 FRGs were identified by the FerrDb database and the previous studies, and 19 of them were differentially expressed in bronchoalveolar lavage fluid (BALF) between IPF and healthy controls and associated with prognosis (p < 0.05). There were five FRGs (aconitase 1 [ACO1], neuroblastoma RAS viral (v-ras) oncogene homolog [NRAS], Ectonucleotide pyrophosphatase/phosphodiesterase 2 [ENPP2], Mucin 1 [MUC1], and ZFP36 ring finger protein [ZFP36]) identified as risk signatures and stratified patients with IPF into the two risk groups. The overall survival rate in patients with high risk was significantly lower than that in patients with low risk (p < 0.001). The calibration and ROC curve analysis confirmed the predictive capacity of this signature, and the results were further verified in the validation group. Risk score-related DEGs were found enriched in ECM-receptor interaction and focal adhesion pathways.Conclusion: The five FRGs in BALF can be used for prognostic prediction in IPF, which may contribute to improving the management strategies of IPF.

Objectives: Cerebral ischemic/reperfusion injury (CI/RI) is the clinical manifestation of cerebral ischemic stroke, which severely affects the health and life of the patients. We aimed to investigate the regulatory mechanism of long non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) on CI/RI in this study.Methods: The expression of lncRNA MALAT1 and miR-375 was detected by qRT-PCR. MTT was utilized to measure the viability of PC-12 cells. The levels of lactate dehydrogenase (LDH), superoxide dismutase (SOD), and reactive oxygen species (ROS) were detected by LDH assay, SOD assay, and ROS assay, respectively. The apoptosis rate of PC-12 cells was measured by flow cytometry analysis. Through enzyme-linked immunosorbent assay, the levels of NF-α, IL-1β, and IL-6 were determined. The interactions between miR-375 and MALAT1/PDE4D were predicted by Starbase/Targetscan software and verified by the dual-luciferase reporter assay. Western blot assay was performed to determine the protein expression of Bcl-2, Caspase-3, and PDE4D.Results: LncRNA MALAT1 expression was highly upregulated in the middle cerebral artery occlusion (MCAO)/reperfusion (R) model of rats. Both MALAT1 downregulation and miR-375 upregulation reversed the inhibitory effect of oxygen and glucose deprivation (OGD)/R on cell viability and the promoting effects on LDH level, cell apoptosis, and inflammatory factors levels. MALAT1 targeted miR-375, whereas miR-375 targeted PDE4D. Overexpression of miR-375 attenuated OGD/R-induced injury in PC-12 cells by targeting PDE4D. Both the low expression of miR-375 and high expression of PDE4D reversed the promoting effect of MALAT1 knockdown on SOD level and the inhibitory effects on ROS level, inflammatory factor levels, and cell apoptosis.Conclusion: Suppression of MALAT1 alleviates CI/RI of rats through regulating the miR-375/PDE4D axis. This study provides a possible therapeutic strategy for human CI/RI in clinic.

Introduction: The mechanistic basis for the development of esophageal squamous cell carcinoma (ESCC) remains poorly understood. The goal of the present study was thus to characterize mRNA and long noncoding RNA (lncRNA) expression profiles associated with ESCC in order to identify key hub genes associated with the pathogenesis of this cancer. Materials and Methods: The GSE26866 and GSE45670 datasets from the Gene Expression Omnibus (GEO) database were used to conduct a weighted gene co-expression network analysis (WGCNA), after which Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted. Cytoscape was additionally used to construct lncRNA-mRNA networks, after which hub genes were identified and validated through the assessment of TCGA datasets and clinical samples. Results: Two gene modules were found to be closely linked to ESCC tumorigenesis. These genes were enriched in cell cycle, MAPK signaling, JAK-STAT signaling, pyrimidine metabolism, arachidonic acid metabolism, and P53 signaling pathway activity, all of which are directly linked with the development of cancer. In total, we identified and validated 9 hub genes associated with ESCC (DDX18, DNMT1, NCAPG, WDHD1, PRR11, VOPP1, ZKSCAN5, LC35C2, and PHACTR2). Conclusion: In summary, we identified key gene modules and hub genes associated with ESCC development, and we constructed a lncRNA-mRNA network pertaining to this cancer type. These results provide a foundation for future research regarding the mechanistic basis of ESCC.

The intermediate-risk category of papillary thyroid cancer (PTC) comprises heterogeneous patients within a wide range of stages and varied care management. Understanding the risk features of recurrence observed after the initial therapy should be emphasized. We aimed to evaluate the prognostic significance of radioactive iodine-avid lymph nodes observed during the initial treatment of patients with PTC that were considered to be at intermediate risk. Data on patients with intermediate-risk PTC treated from 2012 to 2018 were retrospectively reviewed. Post-therapeutic SPECT/CT (Rx SPECT/CT) was evaluated in the enrolled patients. The clinical, pathologic, and incidence of radioiodine-avid (RAI-avid) lymph node metastasis (mLN) on Rx SPECT/CT were reviewed, and risk factors related to recurrent disease were analyzed. After a median follow-up of 37.26 (30.90, 46.33) months, structural persistent/recurrent disease was detected in 9.81% (36/367) of patients with intermediate-risk tumors. The incidence of recurrence was higher in patients who demonstrated RAI-avid mLN after the initial therapy than in those who did not (p < 0.001). In a multivariate Cox proportional hazard regression analysis, RAI-avid mLN appeared to be a robust risk factor for recurrent disease after the initial therapy (HR: 8.967, 95% CI: 3.433–23.421, p = 0.000). RAI-avid mLN is a significant risk factor for recurrent intermediate-risk PTC after the initial treatment.

Abstract Background Minimally invasive esophagectomy (MIE) was shown to be effective in reducing the morbidity and was adopted increasingly. The robot-assisted minimally invasive esophagectomy (RAMIE) remains in the initial stage of application. This study evaluated its safety and feasibility by comparing short-term outcomes of RAMIE and video-assisted minimally invasive esophagectomy (VAMIE). Methods Between March 2016 and December 2017, 115 consecutive patients underwent RAMIE or VAMIE at our institute. The baseline characteristics, pathological data and short-term outcomes of these two group patients were collected and compared. RAMIE patients were propensity score matched with VAMIE patients for a more accurate comparison. Results Matching based on propensity scores produced 27 patients in each group. After propensity score matching (PSM), the baseline characteristics between the two groups were comparable. The operation time in RAMIE group was significantly longer than that in VAMIE group (349 and 294 min, respectively; P

Abstract Electroacupuncture (EA) is a therapeutic modality in which the electrical stimulation is integrated with concepts of acupuncture to treat diseases. This study was designed to evaluate the connection between the electro-acupuncture induced increase in Na99mTcO4 uptake in the stomach wall, and the ionic molecule levels in the extracellular fluid in the acupoints. Wistar rats were treated by 2 or 100 Hz EA at Zusanli (ST 36) and Xiajuxu (ST 39) bilaterally for 60 minutes. The accumulation of Na99mTcO4 in the gastric wall and the free ions, including Ca2+, K+, Na+, and Cl−, in the acupoints were measured every 60 minutes. The radioactivity uptake in the stomach was significantly increased during EA, reaching peak at 180 minutes after the EA. The concentration of extracellular ions was also significantly increased during EA. The Ca2+ level continued to rise until 60 minutes after EA, then started to decrease at 120 minutes post-EA. The results suggest this up-regulatory effect of EA on gastric activity might be triggered by the increase of the extracellular ion levels, this effect lasts longer than stimulating the release of transmembrane Ca2+ flow alone. This might aid in providing a better understanding of the long-lasting effect claimed in acupuncture treatment.

Abstract Background As 3D printing technology emerge, there is increasing demand for a more customizable implant in the repair of chest-wall bony defects. This article aims to present a custom design and fabrication method for repairing bony defects of the chest wall following tumour resection, which utilizes three-dimensional (3D) printing and rapid-prototyping technology. Methods A 3D model of the bony defect was generated after acquiring helical CT data. A customized prosthesis was then designed using computer-aided design (CAD) and mirroring technology, and fabricated using titanium-alloy powder. The mechanical properties of the printed prosthesis were investigated using ANSYS software. Results The yield strength of the titanium-alloy prosthesis was 950 ± 14 MPa (mean ± SD), and its ultimate strength was 1005 ± 26 MPa. The 3D finite element analyses revealed that the equivalent stress distribution of each prosthesis was unifrom. The symmetry and reconstruction quality contour of the repaired chest wall was satisfactory. No rejection or infection occurred during the 6-month follow-up period. Conclusion Chest-wall reconstruction with a customized titanium-alloy prosthesis is a reliable technique for repairing bony defects.

The purpose of this paper is to investigate experimentally the influence of the cavitation extent on the pressure and velocity fluctuations in a small convergent–divergent channel. The mean cavity length is determined from high-speed photography images. The mean pressure and the intensity of the pressure fluctuations are obtained from the transient pressure signals recorded by two pressure transducers at the inlet and outlet of the test section. The statistical turbulence quantities are derived from the instantaneous velocity fields measured by the laser-induced fluorescent particle image velocimetry (PIV-LIF) technique. The experimental results show that the decrease of the cavitation number (the increase in the extent of cavitation) leads to a rise in the turbulent fluctuations in the wake region due to the impact of vapour clouds collapsing, while the presence of a vapour phase is found to reduce the streamwise and cross-stream velocity fluctuations in the attached cavity. It might be attributed to two mechanisms: the presence of a vapour phase modifies the vortex-stretching process, and the cavitation compressibility damps out the turbulent fluctuations. Similar effects of cavitation are also observed in the pressure fluctuations.

Background: The current management of papillary thyroid micro carcinoma (PTMC) has become more conservative. However, high-risk characteristics that can only be revealed post-surgically exist. Patients and clinicians need to estimate the risks and understand the prognostic meaning of these factors.Methods: We retrospectively analyzed 246 consecutive patients with PTMC who underwent surgery at our institution between 2015 and 2017. Clinical and histopathological parameters that may indicate recurrent disease were investigated. The responses to therapy in cases with different risks of recurrence were analyzed.Results: A total of 79.26% (195/246) of patients received total thyroidectomy (TT), of whom 177 (90.77%) also received central lymph node dissection. Radioiodine ablation (RAI) was applied in 64.23% (158/246) of patients. Intermediate-high risk features were identified in 27.64% (68/246) after primary treatment. After a median follow-up of 18 months (range, 6–39 months), 121 of 158 (76.58%) patients who received TT+RAI were evaluated as an excellent response. An incomplete response (IR) was observed in 14.56% (23/158) of this group of PTMC. Multivariate analysis identified extra thyroid extension (P = 0.001) and intermediate-high risk stratification (P = 0.014) as significant and independent risk factors for an IR.Conclusions: A total of 27.64% of PTMC cases evaluated as a low risk of recurrence pre-surgery showed intermediate to high risk disease post-surgery, and this leads to a higher rate of IR.

Introduction: This study aims to identify the prognostic factors that influence therapeutic modalities for thyroid carcinoma showing thymus-like elements (CASTLE).Materials and Methods: Reported studies with CASTLE patients published between 2004 and 2018 were retrieved from a cross-database literature search. Three patients treated in our institute were also included as one case series. Standardized data collection was performed; data pertaining to clinical stages, treatment regimens, and survival time were collected and statistically analyzed.Results: Up to 26 case series of CASTLE were selected, including 51 males and 38 females with a median age of 48 years. Follow-up time ranged from 2 to 362 months and the median survival time was 158.03 months. Lymph node metastasis and tumor invasion of adjacent tissue both showed a significant negative effect on survival (p = 0.001 and 0.013, respectively). Radiotherapy significantly improved survival (p = 0.034), while neck dissection significantly prolonged survival only in patients with extrathyroidal extension (p = 0.043).Conclusions: Extrathyroidal infiltration and nodal metastasis are important factors in cancer outcomes. Radiation therapy appears to be important for better outcomes in CASTLE patients, and neck dissection is recommended for patients with extrathyroidal extension.

The circumplex model posits a circular representation of affect and some personality traits. There is an increasing need to examine the viability of the circumplex model with multivariate time series data collected on the same individuals due to the development of new data collection methods such as smartphone applications and wearable sensors. Estimating the circumplex model with time series data is more complex than with cross-sectional data because scores at nearby time points tend to be correlated. We adapt Browne's circumplex model to accommodate time series data. We illustrate the proposed method with an empirical data set of daily affect ratings of an individual over 70 days. We conducted a simulation study to explore the statistical properties of the proposed method. The results show that the method provides more satisfactory confidence intervals and test statistics than a method that treats time series data as if they were cross-sectional data.

Objective To explore the application of cortical sensory evoked potential (Co ⁃SEP), motor evoked potential (Co⁃MEP) and electrocorticogram (ECoG) for locating functional area to enhance the effectiveness and safety of glioma resection. Methods Eighteen cases of glioma located in or adjacent to the gyri centrales were screened by iconography. fMRI and magnetoencephalography (MEG) were used to locate functional area. During operation, the Co⁃SEP and Co⁃MEP were performed to further define the functional area, and ECoG was performed to detect the epileptogenic focus. The glioma was removed as much as possible, avoiding the invasion of brain functional area. 125I and 5⁃FU were embeded in the tumor bed during operation. Results In 18 cases, one case was total resected; 13 cases were subtotal resected; 4 cases were partial resected. The curative effect was evaluated at 6 months, 12 months, and 24 months after operation. Progression⁃free survival (PFS) was 11 months on the average. Objective effective rate was 13/18, 9/18 and 6/18, respectively. Disease control rate (DCR) was 15/18, 13/18 and 10/18, respectively. Karnofsky Performance Scale Score at preoperation and 6 months, 12 months and 24 months after operation was (84.13 ± 12.88), (78.20 ± 15.13), (62.35 ± 13.21) and (46.57 ± 16.93) respectively, and the differences were all significant (P < 0.01). Incidence rate for post ⁃ operative complication was 6/18 (2 cases with hypomyodynamia, 3 case with hypoesthesia, and one case with both). Conclusion Neuro ⁃ electrophysiologic monitoring guided surgery of glioma located in or adjacent to the gyri centrales is effective for the resection of glioma as much as possible, avoiding the invasion of important functional area, and can improve patient's quality of life. After gloma resection, application of interstitial radiotherapy combined with chemotherapy may extend patient's life span, and decrease the recurrence of glioma. DOI：10.3969/j.issn.1672-6731.2011.06.007

Cerebrospinal fluid (CSF) biomarkers, such as α-synuclein (α-syn), amyloid beta peptide 1-42 (Aβ1-42), phosphorylated tau (181P) (p-tau), and total tau (t-tau), have long been associated with the development of Parkinson disease (PD) and other neurodegenerative diseases. In this investigation, we reported the assessment of CSF biomarkers and their correlations with vesicular monoamine transporter 2 (VMAT2) bindings measured with 18F-9-fluoropropyl-(+)-dihydrotetrabenazine (18F-AV133) that is being developed as a biomarker for PD. We test the hypothesis that monoaminergic degeneration was correlated with CSF biomarker levels in untreated PD patients.The available online data from the Parkinson's Progression Markers Initiative study (PPMI) project were collected and analyzed, which include demographic information, clinical evaluations, CSF biomarkers (α-syn, Aβ1-42, p-tau, and t-tau), 18F-AV133 brain PET, and T1 weighted MRIs. Region of interest (ROI) and voxel-wise Pearson correlation between standardized uptake value ratio (SUVR) and CSF biomarkers were calculated.Our major findings are: 1) Compared with controls, CSF α-syn and tau levels decreased significantly in PD; 2) α-syn was closely correlated with Aβ1-42 and tau in PD, especially in early-onset patients; and 3) hypothesis-driven ROI analysis found a significant negative correlation between CSF Aβ1-42 levels and VMAT2 densities in post cingulate, left caudate, left anterior putamen, and left ventral striatum in PDs. CSF t-tau and p-tau levels were significantly negatively related to VMAT2 SUVRs in substantia nigra and left ventral striatum, respectively. Voxel-wise analysis showed that left caudate, parahippocampal gyrus, insula and temporal lobe were negatively correlated with Aβ1-42. In addition, superior frontal gyrus and transverse temporal gyrus were negatively correlated with CSF p-tau levels.These results suggest that monoaminergic degeneration in PD is correlated with CSF biomarkers associated with cognitive impairment in neurodegenerative diseases including Alzheimer's disease. The association between loss of dopamine synaptic function and pathologic protein accumulations in PD indicates an important role of CSF biomarkers in PD development.

In the working process of Double-Fed Wind Turbines (DFWT), it is very important to monitor and predict the temperature of the high-speed output shaft of the gearbox timely and effectively. Support vector machine has more advantages in the temperature prediction of wind turbines. Least squares support vector machine is suitable for online prediction due to reducing the computational complexity of support vector machine. In order to solve the sparsity of least squares support vector machine, an improved least squares support vector machine based on pruning algorithm is proposed in this paper to predict the temperature of the high-speed output shaft of gearbox using the practical data of Double-Fed Wind Turbines. At the same time, in order to improve the prediction accuracy and to solve the problem of few links between different feature parameters in common normalization method, the paper uses the method of joint normalization to preprocess the data. The principal component analysis is used to reduce the dimension of the data. Particle swarm optimization algorithm is used to optimize the parameters of the pruning least squares support vector machine. The proposed model that is established in this paper is a new model to forecast the temperature of the high-speed output shaft. The results show that its prediction accuracy is higher than that of other algorithms.

Misalignment is an important cause for the early failure of large doubly-fed wind turbines (DFWT). For the non-stationary characteristics of the signals in the transmission system of DFWT and the reality that it is difficult to obtain a large number of fault samples, Solidworks and Adams are used to simulate the different operating conditions of the transmission system of the DFWT to obtain the corresponding characteristic signals. Improved empirical mode decomposition (IEMD), which improves the end effects of empirical mode decomposition (EMD) is used to decompose the signals to get intrinsic mode function (IMF), and the IEMD energy entropy reflecting the working state are extracted as the inputs of the support vector machine (SVM). Particle swarm optimization (PSO) is used to optimize the parameters of SVM to improve the classification performance. The results show that the proposed method can effectively and accurately identify the types of misalignment of the DFWT.