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Background: The dorsal midbrain, an anatomically intricate region, presents significant challenges for traditional surgical interventions due to the heightened risk of vascular and neurological injury, and the necessity of brain tissue retraction., Methods: This study retrospectively reviewed the case of a 29-year-old male diagnosed with a cavernous malformation located in the dorsal aspect of the left midbrain. The patient underwent resection via the endoscopic occipital transtentorial approach (EOTA) in July 2024. Comprehensive records were analyzed, including preoperative magnetic resonance imaging and computed tomography imaging, detailed surgical notes, and postoperative outcomes., Results: The patient initially presented with headaches and diplopia. Imaging revealed a 17 × 13 mm tumor in the dorsal aspect of the left midbrain, associated with obstructive hydrocephalus. The 2.5-hour EOTA surgery resulted in complete resection of the tumor, with the resolution of headache symptoms and improvement of diplopia. No new complications were reported postoperatively. The patient was discharged 7 days postsurgery without the need for intensive care unit admission. Pathological examination confirmed the diagnosis of a cavernous malformation. Additionally, the EOTA facilitated a concurrent endoscopic third ventriculostomy, and no evidence of hydrocephalus was observed during the 3-month follow-up period., Conclusions: The EOTA constitutes a significant advancement in neurosurgical techniques for the resection of dorsal midbrain tumors, enhancing surgical precision and safety. This approach contributes to improved patient outcomes and a reduction in complication rates. Further studies are warranted to validate these findings and to establish standardized protocols for the application of EOTA in midbrain tumor resection., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.) more...

Background: Superficial circumflex iliac vein (SCIV) and venae comitantes were qualified for traditional superficial circumflex iliac artery perforator (SCIAP) flaps. Optimal approaches for multipaddle and chimeric SCIAP flaps remain elusive. The purpose of this study is to investigate validities of SCIV-only and VCs-only conduits for such extended SCIAP flaps., Methods: A retrospective study was conducted from August 2015 to July 2023 at the author's institution. All patients who underwent multipaddle and chimeric SCIAP flaps with complete follow-up information were involved. The multipaddle SCIAP flaps included 2, 3, and 4-paddle variations, while the chimeric series involved cutaneous-iliac and cutaneous-sartorius SCIAP flaps. A comparison was made between the primary outcomes of the SCIV-only group and the VCs-only group in terms of the proportion of these variations and complications, as well as operation duration, and wound healing time., Results: Of 195 patients, the VCs-only conduit accounts for 85.6% (n = 167) and the SCIV-only approach accounts for 14.4% (n = 28). In the SCIV-only group, 89.3% were performed for 2-paddle flaps. In the VCs-only group, 167 flaps were drained by this approach, including 43 (25.8%) cases of 2-paddle flaps, 38 (22.8%) cases of 3-paddle flaps, 22 (13.2%) cases of 4-paddle flaps, 36 (21.6%) cases of cutaneous-iliac flaps, and 28 (16.8%) cases of cutaneous-sartorius flaps. The utilization rate of the VCs-only conduit was 63.2% in 2-paddle flaps, 92.7% in 3-paddle flaps, and 100% in 4-paddle and chimeric SCIAP flaps., Conclusion: This study stands in support of VCs-only drainage for multipaddle and chimeric SCIAP flaps due to its effective drainage capacity of suprafascial and subfascial tissues., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.) more...

Radiation therapy is a primary and effective treatment strategy for NasoPharyngeal Carcinoma (NPC). The precise delineation of Gross Tumor Volumes (GTVs) and Organs-At-Risk (OARs) is crucial in radiation treatment, directly impacting patient prognosis. Despite that deep learning has achieved remarkable performance on various medical image segmentation tasks, its performance on OARs and GTVs of NPC is still limited, and high-quality benchmark datasets on this task are highly desirable for model development and evaluation. To alleviate this problem, the SegRap2023 challenge was organized in conjunction with MICCAI2023 and presented a large-scale benchmark for OAR and GTV segmentation with 400 Computed Tomography (CT) scans from 200 NPC patients, each with a pair of pre-aligned non-contrast and contrast-enhanced CT scans. The challenge aimed to segment 45 OARs and 2 GTVs from the paired CT scans per patient, and received 10 and 11 complete submissions for the two tasks, respectively. In this paper, we detail the challenge and analyze the solutions of all participants. The average Dice similarity coefficient scores for all submissions ranged from 76.68% to 86.70%, and 70.42% to 73.44% for OARs and GTVs, respectively. We conclude that the segmentation of relatively large OARs is well-addressed, and more efforts are needed for GTVs and small or thin OARs. The benchmark remains available at: https://segrap2023.grand-challenge.org., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier B.V. All rights reserved.) more...

Skin wound healing is a multifaceted biological process that encompasses a variety of cell types and intricate signaling pathways. Recent research has uncovered that exosomes derived from adipose stem cells, commonly referred to as ADSC exosomes, play a crucial role in facilitating the healing process. Moreover, it has been demonstrated that an anoxic, or low-oxygen, environment significantly enhances the effectiveness of these exosomes in promoting skin repair. The primary objective of this study was to investigate the underlying mechanisms through which ADSC exosomes contribute to Skin wound healing, particularly by regulating the long non-coding RNA known as NORAD under hypoxic conditions. A significant focus of our research was to examine the interplay between the microRNA miR-524-5p and the Pumilio protein, as we aimed to understand how these molecular interactions might influence the overall healing process. In this study, ADSC exosomes were extracted by simulating hypoxia in vitro and their effects on the proliferation and migration of skin fibroblasts (FB) were evaluated. The expression levels of NORAD, miR-524-5p and Pumilio were analyzed by fluorescence quantitative PCR. Pumilio protein was silenced by siRNA technique to evaluate its role in ADSC exosome-mediated wound healing. The experimental results showed that under hypoxia conditions, NORAD levels in ADSC exosomes increased significantly and could effectively regulate the expression of miR-524-5p. After Pumilio protein silencing, the proliferation and migration ability of fibroblasts were significantly reduced, indicating that Pumilio protein played a role in the process of wound healing. By inhibiting miR-524-5p, the expression of Pumilio protein was restored, further confirming its regulatory mechanism., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.) more...

Background: The efficient resurfacing of multiple adjacent defects (MADs) requires precise reconstructive strategy. Various approaches (e.g., several flap transferring or prelamination of the recipient site) have been reported, but recipient-site impairments, pain, long hospitalization, and low cost-benefit results fatefully considered them as compromise approaches. This study aims to evaluate the feasibility of MADs reconstruction with free multipaddle superficial circumflex iliac artery perforator (SCIAP) flaps., Methods: From Dec 2015 to Dec 2020, we enrolled patients with upper and lower extremity defects treated with various multipaddle SCIAP flaps (2-paddle, 3-paddle, and 4-paddle). Patient demographics and outcomes of each group were collected., Results: Thirty-two, 21, and 6 patients underwent 2-paddle, 3-paddle, and 4-paddle SCIAP flaps transfers, respectively. All multipaddle SCIAP flaps survived without vascular problems, and the donor sites were closed directly. Except for 3 cases of 2-paddle SCIAP flaps drained by superficial circumflex iliac vein venous return, most cases (n = 56) were drained by venae comitans. Minor complications, including partial flap necrosis (4 cases) and lateral femoral cutaneous nerve palsies (11 cases), were treated conservatively. All patients were satisfied with the reconstructive outcome., Conclusion: Multiple adjacent defects reconstruction is still a Gordian knot and lacks a golden standard. The free multipaddle SCIAP flap was demonstrated as a promising alternative, not only enriching its versatility but also initially highlighting the "replace need with need" reconstructive demand., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.) more...

As an invasive alien animal, Pomacea canaliculata poses a great danger to the ecology and human beings. Recently, there has been a gradual shift towards bio-friendly control. Based on the development of RNA interference and CRISPR technology as molecular regulatory techniques for pest control, it was determined if the knockout of genes related to sex differentiation in P. canaliculata could induce sterility, thereby helping in population control. However, the knowledge of sex differentiation- and development-related genes in P. canaliculata is currently lacking. Here, transcriptomic approaches were used to study the genes expressed in the two genders of P. canaliculata at various developmental stages. Gonad transcriptomes of immature or mature males and females were compared, revealing 12,063 genes with sex-specific expression, of which 6066 were male- and 5997 were female-specific. Among the latter, 581 and 235 genes were up-regulated in immature and mature females, respectively. The sex-specific expressed genes identified included GnRHR2 and TSSK3 in males and ZAR1 and WNT4 in females. Of the genes, six were involved in reproduction: CCNBLIP1, MND1, DMC1, DLC1, MRE11, and E(sev)2B. Compared to immature snail gonads, the expression of HSP90 and CDK1 was markedly reduced in gonadal. It was hypothesized that the two were associated with the development of females. These findings provided new insights into crucial genetic information on sex differentiation and development in P. canaliculata. Additionally, some candidate genes were explored, which can contribute to future studies on controlling P. canaliculata using molecular regulatory techniques., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.) more...

Based on morphology and ITS sequence data, we identify and supplementally describe Gyrodactylus pseudorasborae Ondračková, Seifertová & Tkachenko, 2023 on the fins of topmouth gudgeon (Pseudoraspora parva) from freshwaters of southern China. The highest similarity (99.57% and 99.47%) to G. pseudorasborae suggested they were the same species. Prevalence and mean intensity were 45% and 2.3, respectively. The gyrodactylid species morphologically resembled G. pseudorasborae recorded from the same host species P. parva in Czech Republic, Ukraine, and Central China. But there were slight morphological differences in the shape and size of the marginal hook. Comparisons of marginal hook sickles of various Gyrodactylus species suggested that G. pseudorasborae and G. parvae were members of the G. wageneri-group. A molecular phylogeny of G. pseudorasborae with related species is presented and discussed within the context of the mechanism of local evolution of these sister species., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2023 Elsevier B.V. All rights reserved.) more...

Objective: Evaluate the efficacy, safety, and patient satisfaction of transradial access (TRA) compared with conventional transfemoral access (TFA) for diagnostic cerebral angiography in elderly patients (≥65 years of age)., Methods: We performed a retrospective review of patients receiving cerebral angiography via TRA or TFA between October 2020 and December 2021 at 3 institutions. Basic patient characteristics, angiographic data, postoperative complications, and patient satisfaction were collected for analysis., Results: Of the 357 enrolled elderly patients, 175 were performed through TRA and 182 were performed through TFA. There was no significant difference in mean fluoroscopy time (8.6 ± 3.8 minutes vs. 9.1 ± 3.1 minutes; P = 0.103) and radiation exposure (47.7 ± 10.8 Gy-cm 2 vs. 49.8 ± 11.3 Gy-cm 2 ; P = 0.068) between the TRA and TFA groups. However, the TRA group had a shorter procedural time (54.7 ± 6.2 minutes vs. 61.1 ± 5.6 minutes; P < 0.001) and less contrast agent (83.2 ± 28.1 mL vs. 100.1 ± 26.2 mL; P < 0.001) than the TFA group. In terms of safety, the incidence of minor vascular access complications in the TRA group was lower than that in the TFA group (1.7% vs. 8.8%; P = 0.003). The incidence of serious complications and neurologic complications in the TRA group was also lower, although the difference was not statistically significant. Overall patient satisfaction was higher in the TRA group than that in the TFA group., Conclusions: TRA was an efficient and safe alternative to conventional TFA in elderly patients who underwent diagnostic cerebral angiography and who underwent TRA were more satisfied. Findings supported the radial-first strategy for cerebral angiography in elderly populations., (Copyright © 2023 Elsevier Inc. All rights reserved.) more...

Objective: Dural arteriovenous fistulas (DAVFs) in the falx cerebri are rare. This study presents a case of DAVF in the frontal falx cerebri that was successfully resected using a purely endoscopic keyhole microsurgical technique., Methods: A 69-year-old male patient presented to the emergency department with an acute onset seizure. His condition was diagnosed as a DAVF in the frontal falx cerebri with multiple fistula points. A purely endoscopic resection was performed under neuronavigation. Postoperative angiography and clinical follow-up were performed after 10 days and 3 months, respectively., Results: The DAVF was satisfactorily observed and resected using a purely endoscopic keyhole microsurgical technique, with no deterioration of neural functions or major vessel ruptures. Postoperative angiogram revealed complete obliteration of the DAVF and no recurrent epilepsy during the clinical follow-up., Conclusions: Supported by sufficient preoperative evaluation and meticulous manipulation,a purely endoscopic minimally invasive resection is feasible and safe for DAVF, with the advantages of close observation and panoramic view., (Copyright © 2022 Elsevier Inc. All rights reserved.) more...

Background & Aims: Although the treatment of hepatocellular carcinoma (HCC) has been revolutionized by the advent of effective systemic therapies, the prognosis of patients with HCC remains dismal. Herein, we examined the pathophysiological role of PARG and assessed the utility of targeting dePARylation for HCC therapy., Methods: The oncogenic function of PARG was evaluated in 2 orthotopic xenograft models and a Parg flox/flox mice model. The therapeutic efficacy of PARG inhibitors in combination with an anti-PD-1 antibody were assessed in murine orthotopic models. Microarray analysis was used to evaluate the pathological relevance of the PARG/DDB1/c-Myc/MMR axis., Results: High PARG expression was strongly associated with poor HCC prognosis. Hepatocyte-specific PARG deletion significantly impaired liver tumorigenesis. PARG promoted HCC growth and metastasis through DDB1-dependent modulation of c-Myc. Specifically, PARG dePARylated DDB1 and consequently promoted DDB1 autoubiquitination, thus stabilizing the c-Myc protein in HCC cells. PARG downregulation attenuated c-Myc-induced MMR expression and PARG deficiency was correlated with a favorable prognosis in patients with HCC treated with anti-PD-1-based immunotherapy. In addition, PARG inhibitors could act in synergy with anti-PD-1 antibodies in orthotopic mouse models., Conclusions: PARG can act as an oncogene in HCC by modulating PARG/DDB1/c-Myc signaling and could be used as a biomarker to identify patients with HCC who may benefit from anti-PD-1 treatment. Our findings suggest that co-inhibition of PARG and PD-1 is an effective novel combination strategy for patients with HCC., Lay Summary: The increase in deaths due to hepatocellular carcinoma (HCC) is a growing concern, with the mechanisms responsible for HCC development still incompletely understood. Herein, we identify a novel mechanism by which the protein PARG contributes to HCC development. Inhibition of PARG increased the efficacy of anti-PD-1 therapy (a type of immunotherapy) in HCC. These findings support the future clinical development of PARG inhibitors, potentially in combination with anti-PD-1 inhibitors., Competing Interests: Conflict of interest The author declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2022 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.) more...

Urbanization is one of the pivotal aspects of socioeconomic advancement which is critically vulnerable to climatic extremes. Extreme precipitation and urbanization are largely interlinked. Estimating the extreme precipitation-induced urban area exposure is the fundamental aspect of urban risk assessment for precipitation-related floods. In this study, future urban area exposure to extreme precipitation and associated influential factors are investigated over South Asia under 1.5 °C, 2.0 °C, 3.0 °C, and 4.0 °C global warming thresholds. In this regard, we used newly released 20 up-to-date climate models outputs, and five Integrated Assessment Models (IAMs) based urban land-use products under four combined scenarios of the Shared Socioeconomic Pathways and Representative Concentration Pathways (SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5) from the sixth phase of Coupled Model Intercomparison Project (CMIP6). Extreme precipitation is characterized by adopting 20-, 50-, and 100-year return periods of annual maximum daily precipitation. Results reveal a massive urban area expansion over South Asia which is the utmost by 186.4% under SSP3-7.0 than the reference period (1995-2014). The variations in projected urban areas mainly occur in Indo-Gangetic Plain (IGP) region among scenarios. In relative terms, extreme precipitation frequency and associated urban area exposure are prospective to increase with continued global warming. The exposed urban area varies 4.5- to 7.4-fold higher under different warming thresholds than the reference period. The leading increase is estimated (7.4-fold) under 4.0 °C. Notably, for global warming targets set out by the Paris Agreement (1.5 °C, and 2.0 °C), exposed urban area is intended to be 10.2% higher under 2.0 °C than 1.5 °C. Spatially, the exposed urban area will be dominant in the southeast region relative to the reference period. Importantly, the interaction effect (simultaneous change in climate-urban land) is the principal contributor to the changes in urban area exposure to extreme precipitation over South Asia. However, this study's findings strongly support the accomplishment of the Paris Agreement target and provide a scientific basis for formulating urban land-use policy interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.) more...

The projections of mean temperature, precipitation (P), and potential evapotranspiration (PET) reflect the probabilities of long-term changes of hydrologic processes and induced extreme events. In this paper, we investigated the future changes in some pivotal climatic variables (mean temperature, precipitation, and potential evapotranspiration) under 1.5 °C, 2.0 °C, and 3.0 °C specific warming levels (SWLs) across the Indus River Basin of South Asia. The seven global climate models output under seven different emission scenarios (SSP1-1.9, SSP1-2.6, SSP2-4.5, SSP3-7.0, SSP4-3.4, SSP4-6.0, and SSP5-8.5) from the latest Sixth phase of Coupled Model Intercomparison Project (CMIP6) are used for this purpose. The Penman-Monteith approach is applied to estimate PET, and the water balance equation is for reflecting water surplus/deficit. Results indicate that except for precipitation, the greater increases in temperature and PET are inclined to happen with continued global warming. The highest increase in temperature is accounted for 14.6% (2.4 °C), and the enhanced PET is estimated at 5.2% higher than the reference period (1995-2014) under 3.0 °C SWL. While the precipitation is projected to increase by the highest 4.8% for 2.0 °C warming level. The differences in regional climate for an additional 0.5 °C (2.0-1.5 °C) and 1.0 °C (3.0-2.0 °C) of warming, the temperature is projected to increase by 0.4 °C and 0.9 °C in the entire IRB respectively. The highest increase in mean temperature (5.1%) and PET (2.4%) in the IRB are predicted to intensify for an additional 1.0 °C than that of 0.5 °C of warming, but precipitation is intended to decrease by 0.4%. Spatially, the increase in temperature, precipitation, and PET are dominated towards high elevation in the upper basin (north) under all the SWLs. The increased variability in climatological parameters across IRB depicts an evident occurrence of both wet events (upper basin) as well as dry events (lower basin) with the increase in global average temperature rise. However, these findings provide an insightful basis for water resource management as well as initiating mitigation and adaptation measures in the IRB related to water surplus (floods) and water deficit (droughts)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.) more...

Drought has a substantial socioeconomic impact under the changing climate. The estimation of population exposure to drought could be the pivotal signal to predict future water scarcity in the climate hotspot of South Asia. This study examines the changing population exposure to drought across South Asia using 20 climate model ensembles from the latest CMIP6 and demographic data under shared socioeconomic pathways (SSPs). Underpinning the latest version of the IPCC 6th Assessment Report (AR6), this paper focuses on the 2021-2040 (near-term), 2041-2060 (mid-term), and 2081-2100 (long-term) periods to project population exposure changes relative to the reference period (1995-2014) under four SSP-RCP scenarios. Drought events are detected by adopting the standardized precipitation evapotranspiration index (SPEI) and run theory method. Model validation suggests that CMIP6-GCM performs well in projecting climate variables and capturing drought events. The results show that the projected increases in frequent drought events and affected areal coverage are stronger during the early part of the century and weaker at the end under all scenario combinations. In relative terms, the projected increase in the number of people exposed to drought is dominant (>1.5-fold) in the near-term and mid-term periods but decreases in the long-term period. Compared to the reference period, the leading increase in population exposure (2.3-fold) is projected under the newly designed gap scenario (SSP3-7.0) in the mid-term period. A surprising decline in the number of exposed populations was estimated to be 18.8% under SSP5-8.5 by the end of the century. The mitigating effect of the predicted heavy precipitation will decrease droughts in the late future. Spatially, increasing exposure will become more pronounced across India and Afghanistan. Furthermore, the population change effect is mainly responsible for the exposure changes in South Asia. However, this study strongly recommends future 'plausible world' regional rivalry pathways (SSP3) scenario-combinations into consideration for policymaking in regard to water management as well as migration planning over South Asia., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.) more...

The meta-analysis was conducted to investigate the impact of gamma-glutamyl carboxylase (GGCX) on maintenance warfarin dose. 8 studies were included, focusing on the impact of GGCX single nucleotide polymorphisms (SNPs) on mean daily warfarin dose (MDWD). GGCX (rs699664; AA versus GG, GA versus GG, A versus GG) and GGCX (rs12714145; GA versus GG, AA versus GG, A versus GG) showed no significant differences on mean daily warfarin dose (MDWD). This meta-analysis was the first to report the relationship between GGCX SNPs and MDWD in Chinese populations. No evidence could be found in the relationship between SNPs of GGCX (rs699664 and rs12714145) and maintenance warfarin dose. more...

A new colorimetric and near-infrared (NIR) fluorescent chemosensor (1) for Cu(2+) based on BODIPY has been synthesized and investigated in this work. 1 Displays a high selectivity for Cu(2+) with about 250-fold enhancement in fluorescence emission intensity and micromolar sensitivity (K(d)=2.8±0.3 μM) in comparison with alkali and alkaline earth metal ions (Na(+), K(+), Mg(2+), Ca(2+)) and other metal ions (Ba(2+), Zn(2+), Cd(2+), Fe(2+), Pb(2+), Ni(2+), Co(2+), Ag(+)) upon excitation at 635 nm in CH(3)CN. Meanwhile, the distinct color changes and rapid switch-on fluorescence also provide 1 as colorimetric senor for Cu(2+)., (Copyright © 2012 Elsevier B.V. All rights reserved.) more...

Excision of a congenital giant nevus is advised due to the possibility of it degenerating into a malignant melanoma or for aesthetic concerns. Tissue expansion has emerged as the primary treatment of giant congenital nevi because it enables the body to produce extra skin with excellent texture, better colour match, less severe donor-site deformity and repeated usage of an expanding donor-site. We present a multi-staged expansion/local flap technique to treat a case of a circumferential nevus from the acromioclavicular joint and axillary area throughout the upper extremity excluding the hand. The affected skin was approximately 10% of the total body surface area. The patient underwent eight operations and a total of 11 rounds of tissue expansions (500 cc × 9 rounds, 600 cc × 1 round, 300 cc × 1 round) were completed over a 2-year period prior to the removal of the nevus. A good aesthetic and functional outcome in the left upper extremity was gained. It is recommended that the treatment of giant nevi is best if completed at preschool age after taking several factors into consideration., (Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.) more...