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To present a case series of the exstrophy-epispadias complex (EEC) with isolated ectopic bowel segment (IEBS) with the literature review, highlighting the clinical findings and treatments.We present 3 cases of bladder exstrophy (BE) with IEBS in our institute and reviewed the literature in PubMed with the terms "("bladder exstrophy" OR "epispadias") AND ("visceral sequestration" OR "sequestered" OR "ectopic bowel")."There were 2 males and 1 female. The IEBS was detected by physical examination in 2 cases and by ultrasonography in another one. All cases were BE accompanying with lower abdominal mass which adhered to the bladder wall but was separated from the digestive system. All cases underwent the IEBS excision and BE repair simultaneously. Pathological result of IEBS suggested the histological structures of colon. There were totally 13 cases of EEC with IEBS reported in the literature, including 2 (15%) epispadias, 9 (69%) covered BE, 1 (8%) duplicate BE and 1 (8%) classic bladder exstrophy. Although their clinical manifestations were various, IEBS excision were safely conducted in all cases.EEC with IEBS is an extremely rare congenital malformation. Physical and imaging examinations are important for diagnoses. Surgical excision is safe and effective for managing IEBS.

To quantitatively measure the anatomical variations of the pelvic floor in children with exstrophy-epispadias complex using magnetic resonance imaging.Six cases of classic bladder exstrophy (CBE), 5 cases of penile epispadias (PE) and 11 cases of penopubic epispadias (PPE) were included. Another 8 cases with the testicular tumor were taken as the controls. A series of measurements obtained from the pelvic floor magnetic resonance imaging were analyzed, and the measurements with significant differences were obtained by ANOVA.The pelvic floor of the CBE was significantly different from that of controls in measurements including wider pubic diastasis (P.001), greater posterior anal distance (P = .019), greater posterior bladder neck distance (P = .004), larger iliac wing angle (P.001), diminutive ischial angle (P.001), bigger puborectalis angle (P.001), larger ileococcygeous angle (P = .002) and shortened anterior corporal length (P.001). For the PE, the posterior bladder neck distance (P = .038) was greater than that of controls. In the PPE, the posterior bladder neck distance (P = .001) and puborectalis angle (P = .026) was greater than that of controls, respectively.CBE shows severe anatomical variations of the pelvic floor. The bladder neck moves more anteriorly both in PE and PPE than the control. The enlarged puborectalis angle resulting from wider pubic diastasis and more anterior position of the anorectal canal is also noticed in PPE.

Purpose Preoperative fasting is a necessary experience for pediatric patients undergoing elective surgery. The American Society of Anesthesiologist guideline shows that preoperative fasting times were reduced and safe (no solid food up to 8 hours, no fluid or formula up to 6 hours, no breast milk up to 4 hours, and no clear fluids up to 2 hours before surgery). However, preoperative fasting is usually more prolonged than the suggested time. This study aimed to investigate the duration of preoperative fasting for elective surgery at a pediatric hospital in Shanghai, China, and compare it with the evidence from guidelines. Design The study used a descriptive cross-sectional design. Methods A total of 211 children under anesthesia in a Shanghai's pediatric hospital were included in the study. The preoperative fasting status was assessed using a self-administered record card of preoperative fasting developed by Chinese researchers. Findings The results indicated that the length of time fasted preoperatively was longer for all participants than that recommended by the American Society of Anesthesiologists. With the long length of fasting time, it is evident that the majority of children experienced hunger (17.5%), thirst (19.4%), and anxiety (16.1%) as indicated with 8 points of the Likert 10-point scale. The degrees of these experiences were relevant to the length of preoperative fasting time. Conclusions A big gap was revealed between the recommendation and actual practice, and children underwent an uncomfortable experience before the surgery. These results suggest that evidence-based clinical improvement is required, and the recommended preoperative fasting instruction transform into clinical practice should be promoted.

Cloud storage services allow a data owner to share her/his outsourced data with other users, and enable the users to search target data by keywords. To ensure the data confidentiality, data owner always encrypt data using traditional encryption schemes before outsourcing. Whereas, it makes efficiently searching impossible. Symmetric searchable encryption (SSE) is a cryptographic primitive that resolves this tension. However, most existing SSE schemes do not consider the individual characteristics of users during the search, such that they cannot support personalized search services over encrypted data. Meanwhile, security and efficiency issues in the cloud service model have also severely affected the user’s search experience, and the introduction of mobile edge servers can solve these problems to some extent. In this paper, we propose a personalized searchable encryption scheme (PSED) for mobile edge-assisted cloud storage. Our contribution consists of three aspects. First, we incorporate the user’s preference factors into the user’s query which enable users to get accurate personalized search results. Second, the computational overhead of the cloud server is reduced by calculating the relevance scores of the subqueries and subindexes on mobile edge servers. Third, by cutting the index and the query matrix, the encryption efficiency of the index and the query matrix is improved. Security analysis shows that PSED can guarantee the privacy of the data and the user. Experimental results demonstrate that the proposed schemes are highly efficient and accurate.

Mobile crowdsourcing enables mobile requesters to publish tasks, which can be accomplished by workers with awards. However, existing task allocation schemes face tradeoff between effectiveness and privacy preservation, and most of them lack consideration of win-win incentives for both requesters and workers participation. In this paper, we propose a privacy-preserving task recommendation scheme with win-win incentives in crowdsourcing through developing advanced attribute-based encryption with preparation/online encryption and outsourced decryption technologies. Specifically, we design bipartite matching between published tasks and participant workers, to recommend tasks for eligible workers with interests and provide valuable task accomplishment for requesters in a win-win manner. Furthermore, our scheme reduces encryption cost for requesters by splitting encryption into preparation and online phases, as well as shifts most of the decryption overhead from the worker side to the service platform. Privacy analysis demonstrates requester and worker privacy preservation under chosen-keyword attack and chosen-plaintext attack. Performance evaluation shows cost-efficient computation overhead for requesters and workers.

Summary Background The management of latent Mycobacterium tuberculosis infection is a new priority action for the WHO End Tuberculosis (TB) Strategy. However, national guidelines on latent tuberculosis infection testing and treatment have not yet been developed in China. Here, we present the results from the 2-year follow-up of a study that aimed to track the development of active disease in individuals with latent tuberculosis infection, identify priority populations for latent infection management, and explore the most suitable latent infection diagnostic approach. Methods A population-based multicentre prospective study was done in four sites in rural China, between 2013 and 2015. The baseline survey in 2013 measured the prevalence of latent tuberculosis infection using QuantiFERON-TB Gold In-Tube (QFT) and tuberculin skin test (TST) in eligible participants. During the follow-up phase between 2014–15, we assessed individuals who had tuberculosis infection at baseline (QFT-positivity or TST tuberculin reaction size [induration] of ≥10 mm) for the development of active disease through active case finding. Eligible participants included in follow-up survey had a birth date before June 1, 2008 (5 years or older in 2013), and continuous residence at the study site for 6 months or longer in the past year. Participants with current active tuberculosis at baseline survey were excluded. Findings Between Sept 1, 2013, and Aug 31, 2015, 7505 eligible participants (aged 5 years or older) were included in tuberculosis infection test positive cohorts (4455 were QFT positive, 6404 had TST induration ≥10 mm, and 3354 were positive for both tests) after baseline examination. During the 2-year follow-up period, 84 incident cases of active tuberculosis were diagnosed. Of participants who developed active tuberculosis, 75 were diagnosed with latent infection by QFT, 62 were diagnosed by TST, and 53 were diagnosed by both tests. An incidence rate of 0·87 (95% CI 0·68–1·07) per 100 person-years was observed for individuals who tested positive with QFT, 0·50 (0·38–0·63) per 100 person-years for those who tested positive with TST (p Interpretation Our results suggest that high-risk populations in communities in rural China, such as individuals at a high risk of disease reactivation from previous tuberculosis, should be targeted for latent infection screening and treatment with an interferon-γ releasing assay rather than a TST. Funding National Science and Technology Major Project of China, Program for Changjiang Scholars and Innovative Research Team in University of China, CAMS Innovation Fund for Medical Sciences, and Sanming Project of Medicine in Shenzhen.

Summary Intestinal epithelial stem cells (IESCs) control the intestinal homeostatic response to inflammation and regeneration. The underlying mechanisms are unclear. Cytokine-STAT5 signaling regulates intestinal epithelial homeostasis and responses to injury. We link STAT5 signaling to IESC replenishment upon injury by depletion or activation of Stat5 transcription factor. We found that depletion of Stat5 led to deregulation of IESC marker expression and decreased LGR5+ IESC proliferation. STAT5-deficient mice exhibited worse intestinal histology and impaired crypt regeneration after γ-irradiation. We generated a transgenic mouse model with inducible expression of constitutively active Stat5. In contrast to Stat5 depletion, activation of STAT5 increased IESC proliferation, accelerated crypt regeneration, and conferred resistance to intestinal injury. Furthermore, ectopic activation of STAT5 in mouse or human stem cells promoted LGR5+ IESC self-renewal. Accordingly, STAT5 promotes IESC proliferation and regeneration to mitigate intestinal inflammation. STAT5 is a functional therapeutic target to improve the IESC regenerative response to gut injury., Graphical Abstract, Highlights • Loss of STAT5 impairs intestinal stem cell proliferation • Activated STAT5 increases intestinal stem cell regeneration • Activation of cytokine-STAT5 signaling mitigates intestinal inflammation, In this article, Han and colleagues link STAT5 signaling to intestinal stem cell replenishment upon injury. They find that depletion of Stat5 leads to decreased stem cell proliferation, sensitizing mice to irradiation. In contrast, activation of STAT5 accelerates crypt regeneration, conferring resistance to gut injury. Therefore, activation of cytokine-induced STAT5 signaling promotes the regenerative capacity of intestinal stem cells to repair gut injury.

The sorption data of an anionic dye on cellulose fiber are often correlated with a log-linear model to determine the internal accessible volume of the fiber to the anionic dye ( V , L/kg) and as such the standard affinity of the anionic dye to the fiber (−Δ μ °, J/mol), but without taking into account the influence of ionized carboxyl groups due to cellulose oxidation ([COO − ] f , mol/kg). In this study, a nonlinear isotherm model was derived by incorporating [COO − ] f , V and −Δ μ ° as three model parameters. A set of classical sorption data of C. I. Direct Blue 1 on bleached cotton was correlated with the nonlinear isotherm model. The nonlinear curve fitting analysis showed that the nonlinear isotherm model was in excellent agreement with the sorption data and robust to determine the values of [COO − ] f , V and −Δ μ ° for describing the sorption behaviors of anionic dyes on cellulose fibers.

Background: To date no discrete genetic signature has been defined for isolated Dclk1+ tuft cells within the small intestine. Furthermore, recent reports on the functional significance of Dclk1+ cells in the small intestine have been inconsistent. These cells have been proposed to be fully differentiated cells, reserve stem cells, and tumor stem cells. Here we present a discrete "candidate" gene signature of Dclk1+ cells obtained from Dclk1-CreER;Rosa26-YFP mice, which will be a valuable animal model for future work seeking to uncover the latent abilities and functional role of Dclk1 expressing tuft cells and their subsets. Methods: The Dclk1-CreER;Rosa26-YFP compound mice were injected with tamoxifen to induce the expression of YFP driven by Dclk1 promoter. We FACS-sorted Dclk1+ cells from the small intestinal epithelium of Dclk1-CreER;Rosa26-YFP mice. We determined the mRNA expression levels of Dclk1 and other stem cell associated markers (Bmi1 and Lgr5), and pluripotency factors in the isolated Dclk1+ and Dclk1cells. To analyze the expression of key markers of quiescence survival and longevity, mRNA expression of cell cycle regulators and survival factors were analyzed. To explore the clonogenic capacity of the otherwise quiescent cells, we investigated self-renewal capacity in the Dclk1+ and Dclk1population. Results: Following tamoxifen administration, intestines were collected for YFP and Dclk1 staining, and we found that YFP co-localized with Dclk1 expression. Analysis of sorted YFP+ cells demonstrated marked enrichment (~6000 fold) for Dclk1 mRNA compared with YFPcells, confirming successful isolation of Dclk1+ cells. The Dclk1+ population was enriched (~6 fold) for the quiescent putative stem cell marker Bmi1, whereas the Dclk1fraction was enriched ~174 fold for Lgr5. We observed a relatively higher expression of pluripotency genes (~5-80 fold) as well as a significant increase in pro-survival genes (~4-9 fold) and quiescence regulatory markers (~8-24 fold) in the Dclk1+ cells compared to Dclk1cells. A 14-fold increase in self-renewal capability was observed in in vitro isolated Dclk1+ cells by clonogenic assay. The unique genetic profile presented in this study suggests that Dclk1+ cells may be relatively quiescent under normal homeostatic conditions but maintain their pluripotency and metabolic machinery required for survival/longevity through the expression of Cdkn1A, Cdkn1B, Oct4, Sox2, Nanog, and Klf4, Wif1, RelA, Akt and AMPK, and vital regulation of Raptor, Rictor, p53 and Survivin. Conclusion: Taken as a whole, these results provide additional support for the hypothesis that while the majority of Dclk1+ cells are committed tuft cells, they also maintain the molecular capability for stemness in reserve, and could play a role in the maintenance of the stem cell niche in an injury repair environment.