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Robotic pancreaticoduodenectomy (RPD) has been reported to be safe and feasible for patients with pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head. This study aimed to analyze the surgical outcomes and risk factors for poor long-term prognosis of these patients.Data from patients who underwent RPD for PDAC of pancreatic head were retrospectively analyzed. Multivariate Cox regression analysis was used to seek the independent prognostic factors for overall survival (OS), and an online nomogram calculator was developed based on the independent prognostic factors.Of the 273 patients who met the inclusion criteria, the median operative time was 280.0 minutes, the estimated blood loss was 100.0 mL, the median OS was 23.6 months, and the median recurrence-free survival (RFS) was 14.4 months. Multivariate analysis showed that preoperative carbohydrate antigen 19-9 (CA19-9) [hazard ratio (HR) = 2.607, 95% confidence interval (CI): 1.560-4.354, P 0.001], lymph node metastasis (HR = 1.429, 95% CI: 1.005-2.034, P = 0.047), tumor moderately (HR = 3.190, 95% CI: 1.813-5.614, P 0.001) or poorly differentiated (HR = 5.114, 95% CI: 2.839-9.212, P 0.001), and Clavien-Dindo grade ≥ III (HR = 1.657, 95% CI: 1.079-2.546, P == 0.021) were independent prognostic factors for OS. The concordance index (C-index) of the nomogram constructed based on the above four independent prognostic factors was 0.685 (95% CI: 0.640-0.729), which was significantly higher than that of the AJCC staging (8th edition): 0.541 (95% CI: 0.493-0.589) (P 0.001).This large-scale study indicated that RPD was feasible for PDAC of pancreatic head. Preoperative CA19-9, lymph node metastasis, tumor poorly differentiated, and Clavien-Dindo grade ≥ III were independent prognostic factors for OS. The online nomogram calculator could predict the OS of these patients in a simple and convenient manner.

The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) remains poor even after radical pancreaticoduodenectomy (PD). The study aimed to develop and validate a novel preoperative prognostic model to accurately predict the long-term survival of patients with PDAC.Patients with PDAC of pancreatic head from Chinese PLA General Hospital were included. The preoperative PDAC model with contour plots was developed using a non-linear model in the training cohort and then tested in the validation cohort.Of 421 patients who met the inclusion criteria, 280 were in the training cohort and 141 in the validation cohort. Contour plots for preoperative PDAC model were established to visually predict the survival probabilities of these patients, based on preoperative carbohydrate antigen 19-9, preoperative fibrinogen to albumin ratio and pain symptoms. This model stratified patients into low- and high-risk groups with distinctly different long-term survival in the training cohort [median overall survival (OS) 32.1 vs. 17.5 months; median recurrence-free survival (RFS) 19.3 vs. 10.0 months, both P0.001] and the validation cohort (median OS 28.3 vs. 19.0 months; median RFS 17.5 vs. 11.2 months, both P0.001). Time-dependent receiver operating characteristic and decision curve analyses revealed that the model provided higher diagnostic accuracy and superior net benefit compared to other staging systems.This study constructed and validated a novel preoperative prognostic model that can accurately and conveniently predict the long-term survival of patients with resectable PDAC of pancreatic head. Besides, the model can screen high-risk patients with poor prognosis, which may provide references for personal treatment strategies in the future.

The intensively concerned hafnia-based ferroelectric (FE) material has been controversial over whether the origin of its observed ferroelectricity being structural or electrochemical. We revisit the rigorous application of modern theory of polarization on displacive FE-HfO2, and make clear the microscopic mechanism of ionic conductance intertwined with continuous nucleation-and-growth FE switching in HfO2 from first principles. Independent from the involvement of vacancies, active oxygen ions in FE-HfO2 can be collectively conducted along continuous FE uniaxial-connected-paths (UCPs) in a typical nucleation-and-growth manner. The ionic conductance should have a nonlinear electric-field dependence from the Merz’s law, which is consistent with the strongly correlated ionic conductance. Based on our established physical picture, some abnormal experimental observations of HfO2 may be explained beyond the pristine understanding of FE switching within double-well potentials.

Pancreatic ductal adenocarcinoma (PDAC) is prone to relapse even after radical pancreaticoduodenectomy (PD) (including robotic, laparoscopic and open approach). This study aimed to develop an online nomogram calculator to predict early recurrence (ER) (within one year after surgery) and long-term survival in patients with PDAC.Patients with PDAC after radical PD were included. Univariate and multivariate logistic regression analysis was used to identify independent risk factors. An online nomogram calculator was developed based on independent risk factors in the training cohort and then tested in the internal and external validation cohorts.Of the 569 patients who met the inclusion criteria, 310, 155, and 104 patients were in the training, internal and external validation cohorts, respectively. Multivariate analysis revealed that preoperative carbohydrate antigen19-9 (CA19-9) [Odds Ratio (OR) 1.002; 95% confidence interval (CI) 1.001-1.003; P = 0.001], fibrinogen/albumin (FAR) (OR 1.132; 95% CI 1.012-1.266; P = 0.029), N stage (OR 2.291; 95% CI 1.283-4.092; P = 0.005), and tumor differentiation (OR 3.321; 95% CI 1.278-8.631; P = 0.014) were independent risk factors for ER. Nomogram based on the above four factors achieved good C-statistics of 0.772, 0.767 and 0.765 in predicting ER in the training, internal and external validation cohorts, respectively. Time-dependent ROC analysis (timeROC) and decision curve analysis (DCA) revealed that the nomogram provided superior diagnostic capacity and net benefit compared with other staging systems.This multi-center study developed and validated an online nomogram calculator that can predict ER and long-term survival in patients with PDAC with high degrees of stability and accuracy.

Background: Previous studies from high altitudes have reported significantly higher prevalence of congenital heart disease (CHD), consisting almost solely of simple CHD. Little is known about the occurrence of complex CHD. Neonates with complex CHD are likely admitted to NICU. We examined the prevalence and spectrum of complex CHD in NICU in order to depict a truer picture of CHD at high altitude.Methods: We reviewed charts of 4,214 neonates admitted to NICU in Qinghai province (average altitude 3,000m). Echocardiography was performed in 1,943 babies when CHD was suspected based on clinical examinations.Results: CHD was diagnosed in 1,093(56.3% of echoed babies). Mild CHD in 96.8%(1058 babies). Moderate CHD in 0.8%(9) included 1(0.1%) large secundum atrial septal defect, 3(0.3%) moderate pulmonary stenosis, 2(0.2%) aortic stenosis and 3(0.3%) partial anomalous pulmonary venous connection. Severe CHD in 2.4%(26) included 6(0.5%) complete atrioventricular septal defect, 5(0.5%) complete transposition of the great arteries, 5(0.5%) hypoplastic right heart, 3(0.3%) hypoplastic left heart, 3(0.3%) double outlet right ventricle, 3(0.3%) tetralogy of Fallot, 2(0.2%) truncus arteriosus, 2(0.2%) total anomalous pulmonary venous connection, 2(0.2%) severe aortic stenosis, 2(0.2%) Interrupted aortic arch and 2(0.2%) severe pulmonary stenosis and 1(0.1%) single-ventricle abnormality. At two-years follow-up in 737(67.4%) patients, 18(90%) with severe CHD and 38(5.3%) with mild and moderate CHD died, and 15 underwent cardiac surgery with 1 early death.Conclusions: At high altitude, a wide spectrum of CHD exists, with many heretofore unreported complex CHD. There is urgent need for routine echocardiography and early interventions in newborns particularly in NICU.

Hafnium dioxide (HfO2) is a promising ferroelectric (FE) material for achieving high-density nonvolatile memory and neuromorphic computing, due to its compatibility with the mainstream integrated circuit technology and the surprisingly enhanced ferroelectricity by reduced thickness. The FE switching dynamics is essential to the device performance, but the complexity of HfO2 atomic structure causes unknown of various FE switching paths and domain wall configurations. Here, we demonstrate that its low-barrier paths and domain walls can be comprehensively found and understood from a perspective of topological symmetry. By discussing pseudo-chirality and equivalent transformation relations in crystal with first principles and lattice modes, we classify and analyze 4 low-barrier FE switching paths and 93 irreducible topology domain wall configurations in HfO2. Anisotropic switching mechanism is found based on the mobility investigation for 12 types of 180{\deg} side domain walls. This methodology is expected to be generally applicable to displacive ferroelectrics with low unit cell point group symmetries, and lay a foundation for mechanism study of the switching dynamics.

Describe and predict the malignant tumor deaths in Xi'an so as to provide evidence for the government to formulate the prevention and treatment plans.Overall malignant tumor death in Xi'an in the past 16 years was described. The multi-decrease life table was used to calculate cumulative mortality risk by cause and life expectancy reduction years by cause of malignant tumors in 2020. The join point regression models were used to analyze the change trend of standard mortality of malignant tumors in Xi'an from 2005 to 2020. The appropriate gray models were selected to predict the death of malignant tumors in Xi'an in the next decade.The mortality of total malignant tumors in Xi'an showed that men are higher than women and the elderly are higher than other groups. As for 2020, lung cancer had the highest risk of death for both men and women, while leukemia had the highest life expectancy reduction years by cause. From 2005 to 2020, standardized mortality of majority malignant tumors showed downward trends, which were particularly obvious in recent years. The prediction results of several major malignant tumors showed that in the next decade, the mortality of most malignant tumors had downward trends, but combined with the increase of population in the future, the number of malignant tumor deaths in Xi'an will continue to increase.Malignant tumors in Xi'an have decreasing mortality trends in recent years, and effective measures to prevent and treat tumors should be strengthened in the future.

ObjectiveThis study aimed to explore the molecular mechanism of cytoplasmic vacuolation caused by BK polyomavirus (BKPyV) and thus search for potential target for drug repurposing.MethodsMorphological features of BK polyomavirus-associated nephropathy (BKPyVAN) were studied under light and electron microscopes. Microarray datasets GSE75693, GSE47199, and GSE72925 were integrated by ComBat, and differentially expressed genes (DEGs) were analyzed using limma. Furthermore, the endoplasmic reticulum (ER)-related genes obtained from GenCLiP 2.0 were intersected with DEGs. GO and KEGG enrichment pathways were performed with intersection genes by R package clusterProfiler. The single-cell RNA sequencing (scRNA-seq) from a BKPyVAN recipient was analyzed with a dataset (GSE140989) downloaded from Gene Expression Omnibus (GEO) as control for gene set variation analysis (GSVA). Immunohistochemistry and electron microscopy of kidney sections from drug-induced ERS mouse models were performed to explore the association of ERS and renal tubular vacuolation. Protein–protein interaction (PPI) network of the intersection genes was constructed to identify hub target. AutoDock was used to screen Food and Drug Administration (FDA)-approved drugs that potentially targeted hub gene.ResultsLight and electron microscopes exhibited obvious intranuclear inclusions, vacuoles, and virus particles in BKPyV-infected renal tubular cells. Transcriptome analysis revealed 629 DEGs between samples of BKPyVAN and stable transplanted kidneys, of which 16 were ER-associated genes. GO analysis with the intersection genes illustrated that ERS-related pathways were significantly involved, and KEGG analysis showed a prominent enrichment of MAPK, Toll-like receptor, and chemokine signaling pathways. GSVA analysis of the proximal tubule revealed similar pathways enrichment. An electron microscope image of the kidney from ERS mouse models showed an obvious renal tubular vacuolation with prominent activation of ERS markers verified by immunohistochemistry. Furthermore, DDIT3 was identified as the hub gene based on PPI analysis, and ZINCOOOOO1531009 (Risedronate) was indicated to be a potential drug for DDIT3.ConclusionERS was involved in renal tubular cytoplasmic vacuolation in BKPyVAN recipients. Risedronate was screened as a potential drug for BKPyVAN by targeting DDIT3.

BK polyomavirus (BKPyV) infection is the main factor affecting the prognosis of kidney transplant recipients, as no antiviral agent is yet available. A better understanding of the renal-cell-type tropism of BKPyV can serve to develop new treatment strategies. In this study, the single-cell transcriptomic analysis demonstrated that the ranking of BKPyV tropism for the kidney was proximal tubule cells (PT), collecting duct cells (CD), and glomerular endothelial cells (GEC) according to the signature of renal cell type and immune microenvironment. In normal kidneys, we found that BKPyV infection-related transcription factors P65 and CEBPB were PT-specific transcription factors, and PT showed higher glycolysis/gluconeogenesis activities than CD and GEC. Furthermore, in the BKPyV-infected kidneys, the percentage of late viral transcripts in PT was significantly higher than in CD and GEC. In addition, PT had the smallest cell–cell interactions with immune cells compared to CD and GEC in both normal and BKPyV-infected kidneys. Subsequently, we indirectly demonstrated the ranking of BKPyV tropism via the clinical observation of sequential biopsies. Together, our results provided in-depth insights into the renal cell-type tropism of BKPyV in vivo at single-cell resolution and proposed a novel antiviral target.

BackgroundThis study was designed to investigate the association between donor-derived cell-free DNA (dd-cfDNA) and renal allograft injuries.MethodsThis single-center study enrolled 113 adult kidney transplant recipients with kidney biopsies. Plasma and urine dd-cfDNA was detected by target region capture sequencing.ResultsPlasma dd-cfDNA fraction was increased in multiple types of injuries, but most significantly in antibody-mediated rejection. Plasma dd-cfDNA fraction in isolated antibody-mediated rejection (1.94%, IQR: 1.15%, 2.33%) was higher than in T cell-mediated rejection (0.55%, IQR: 0.50%, 0.73%, P = 0.002) and negative biopsies (0.58%, IQR: 0.42%, 0.78%, P ConclusionsBoth plasma and urine dd-cfDNA are sensitive markers for renal allograft injuries. The interpretation of a specific disease by dd-cfDNA should be combined with other clinical indicators.

OBJECTIVES This study aimed to perform a multicenter comparison between robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD). BACKGROUND Previous comparisons of RPD versus OPD have only been carried out in small, single-center studies of variable quality. METHODS Consecutive patients who underwent RPD (n = 1032) or OPD (n = 1154) at 7 centers in China between July 2012 and July 2020 were included. A 1:1 propensity score matching (PSM) was performed. RESULTS After PSM, 982 patients in each group were enrolled. The RPD group had significantly lower estimated blood loss (EBL) (190.0 vs 260.0 mL; P < 0.001), and a shorter postoperative 1length of hospital stay (LOS) (12.0 (9.0-16.0) days vs 14.5 (11.0-19.0) days; P < 0.001) than the OPD group. There were no significant differences in operative time, major morbidity including clinically relevant postoperative pancreatic fistula (CR-POPF), bile leakage, delayed gastric emptying, postoperative pancreatectomy hemorrhage (PPH), reoperation, readmission or 90-day mortality rates. Multivariable analysis showed R0 resection, CR-POPF, PPH and reoperation to be independent risk factors for 90-day mortality. Subgroup analysis on patients with pancreatic ductal adenocarcinoma (PDAC) (n = 326 in each subgroup) showed RPD had advantages over OPD in EBL and postoperative LOS. There were no significant differences in median disease-free survival (15.2 vs 14.3 months, P = 0.94) or median overall survival (24.2 vs 24.1 months, P = 0.88) between the 2 subgroups. CONCLUSIONS RPD was comparable to OPD in feasibility and safety. For patients with PDAC, RPD resulted in similar oncologic and survival outcomes as OPD.

Surgery is one of the main effective strategies for the treatment of solid tumors, but high postoperative recurrence is also the main cause of death in current cancer therapy. The prevention of postoperative hepatocellular carcinoma (HCC) recurrence is a clinical problem that needs to be solved urgently. At present, there are still some problems to be solved, such as, how to achieve free drugs to target the site of surgical resection; develop a strategy for the simultaneous administration of multiple drugs to inhibit postoperative recurrence; and provide the appropriate animal model that mimics the process of postoperative HCC recurrence. In this study, we used a facile and reproducible method to successfully prepare amphiphilic Janus nanoparticles (JNPs). In order to improve targeting of the JNPs to residual HCC cells after surgery, we modified the side of gold nanorods (GNRs) with lactobionic acid (LA), thus creating LA-JNPs. This provided an active and targeted co-delivery system for hydrophilic and hydrophobic drugs in separate rooms, thus avoiding mutual effects. Next, we established two models to simulate postoperative HCC recurrence: a subcutaneous postoperative recurrence model based on patient-derived tumor xenograft (PDX) tissues and a postoperative recurrence model of orthotopic HCC. By applying these models, the enhanced permeability and retention effect (EPR) based tumor targeting and LA based active targeting can jointly promote the enrichment and uptake of JNPs at tumor site. LA-JNPs represented an efficient targeting system for the co-delivery of Sorafenib/Doxorubicin with an optimized anti-recurrence effect and significantly improved the survival of mice during treatment for postoperative recurrence.

Background The surgical management of Mayo III/IV tumor thrombi is difficult and risky, and robotic surgery is even more difficult. The purpose of this study was to introduce the step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus, which was the core technique of robot operation for Mayo III/IV tumor thrombus. Method A total of 18 patients were included in this study. The average tumor thrombus height was 2.4 cm above the level of the second porta hepatis (SPH), and 9 patients were prepared for cardiopulmonary bypass (CPB) before surgery. During the operation, the height of the tumor thrombus was lowered orderly for 2-3 times, and the blood flow blocking method was changed sequentially. The CPB was required when tumor thrombus in the atrium; After the height of the thrombus was lowered to the atrium entrance, CPB was stopped and the blood flow was blocked in the upper- and retro-hepatic inferior vena cava (IVC); After the tumor thrombus continued to descend to the lower part of the SPH, liver blood flow could be restored, and then, the blood flow was simply blocked in the retro-hepatic IVC to complete the removal of the thrombus and the repair or resection of the IVC. Finally, the diseased kidney and renal vein were removed. Results All operations were successfully completed, and 2 cases were transferred to laparotomy. Seven cases received CPB, while the other 11 did not. 15 patients underwent two times of the lowering of the tumor thrombus, 2 patients underwent one time and 1 patient underwent three times. The mean liver/IVC dissociation and vascular suspension time was 22.0 min. All patients had less than Clavien-Dindo grade III complications, no serious complications occurred during operation, and no patient died within 90 days. Conclusions The step-by-step and orderly decline of tumor thrombus height is the key to the success of robot Mayo III / IV tumor thrombus surgery. This method can shorten FPH and CPB time and improve the success rate of surgery.

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy with aggressive biological behaviour. Its rapid proliferation and tumour growth require reprogramming of glucose metabolism or the Warburg effect. However, the association between glycolysis‐related genes with clinical features and prognosis of PDAC is still unknown. Here, we used the meta‐analysis to correlate the hazard ratios (HR) of 106 glycolysis genes from MSigDB by the cox proportional hazards regression analysis in 6 clinical data sets of PDAC patients to form a training cohort, and a single group of PDAC patients from the TCGA, ICGC, Arrayexpress and GEO databases to form the validation cohort. Then, a glycolysis‐related prognosis (GRP) score based on 29 glycolysis prognostic genes was established in 757 PDAC patients from the training composite cohort and validated in 267 ICGC‐CA validation cohort (all P

The requirement of continuous and stringent growth on filtration performance, including longer life span, higher overall efficiency, lower initial pressure drop and more cost effective, has still drove filter media manufactures to research and develop. One of the possible way to achieve these challenges, was to utilize a dual-channel head-box with two sets of pulp conveying system, which can produce filter media with bulky and gradient properties. In this study, three kinds of commercial cellulose were chosen to make two layers filtration media, analyzed the effect of fiber blend on physical properties and filtration performance. By fine-tune the slurry ratio of top layer, we made one single layer and two layers composition filter media, the thickness and air permeability of composition media were higher than single layer media. According to ISO 5011, filtration performance test has been done to compare single layer media with composition media, this composition gradient profiles that provided the life span 37.0% improvement to the terminal pressure drop during dust injecting, and the dust hold capacity improved 34.7%, the main contributor of dust hold capacity was decided by top layer, however, the overall efficiency was depended on wire side layer.

Air filter paper with a high filtration efficiency that can remove small-size pollutant particles and toxic gases is vital for human health and the environment. We report a nanofiltration paper that is based on wood fiber filter paper with good mechanical properties and a three-dimensional network structure. The filter paper was prepared by impregnation with multi-walled carbon nanotubes (MWCNTs) and phenol-formaldehyde (PF). The results showed that MWCNTs were present on the surfaces of the fibers and between the pores, which increased the specific surface area of the fibers and enhanced the effective interception of the particles. The optimum impregnation concentration of the MWCNT was 0.1%. Compared with the cellulose fibers (CFs), the average pore diameter of the 0.1% MWCNT–CF filter paper was reduced by 8.05%, the filtration efficiency was increased by 0.64%, and the physical properties were slightly enhanced. After impregnation with PF, the mechanical properties of the air filter paper were significantly enhanced. The PF on the fiber surfaces and at the junction of the fibers covered the MWCNTs. Based on the change in the filter paper properties after impregnation, the optimal filter paper strength index and filtration performance were observed at a solid PF content of 8.4%.

Orthodenticle homolog 1 (OTX1) has previously been revealed to be tightly associated with the development and progression of several human tumors. However, the functional roles and underlying molecular mechanisms of OTX1 in gastric cancer (GC) remain poorly understood. In the present study, we observed that OTX1 was highly expressed in GC tissues compared with adjacent non‑tumor tissues based on a large cohort of samples from The Cancer Genome Atlas (TCGA) database. An immunohistochemical analysis indicated that OTX1 levels were increased in tumors that became metastatic compared with those in tumors that did not. This finding was significantly associated with patients who had shorter overall survival times. The knockdown of OTX1 significantly inhibited the proliferation, migration and invasion of SGC‑7901 and MGC‑803 cells. Furthermore, the knockdown of OTX1 induced cell cycle arrest in the G0/G1 phase and reduced the expression of cyclin D1. In addition, the inhibition of OTX1 led to increased GC cell apoptosis by upregulating cleaved PARP, cleaved caspase‑3 and Bax. In conclusion, our data indicated that OTX1 functions as a key regulator in tumor growth and metastasis of GC cells. Thus, OTX1 may be a promising novel target for molecular therapy directed toward GC.

Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide and has a very poor prognosis. Its occurrence has been on the increase in recent years. Surgical resection and liver transplantation are the primary methods of treatment for HCC patients, but can only be applied to 15% of patients. The median survival time of unresectable or metastasizing HCC patients is only a few months. Existing systemic treatment methods are not effective for advanced HCC patients and a new method of treatment is needed for these patients. It has been established that the HCC occurs in multiple stages, however, the pathogenesis at a molecular level is not clear and many key factors are yet to be determined. In the past 30 years, it has become evident that the Ras/Raf/MEK/extracellular signal-regulated kinase (ERK) signaling pathway plays a significant role in the occurrence and development of HCC. This review focused on the association between the Ras/Raf/MEK/ERK signaling pathway and HCC.

The Glutathione S-transferases (GSTs) are a large family of multifunctional enzymes, many of which play an important role in the detoxification of endogenous and exogenous toxic substances. In this research, firstly, we measured the rutin-induced transcriptional level of BmGSTd1 gene by using real-time quantitative RT-PCR method and dual spike-in strategy. The activities of the BmGSTd1 promoter in various tissues of silkworm were measured by firefly luciferase activity and normalized by the Renilla luciferase activity. Results showed that the activity of the BmGSTd1 promoter were highest in Malpighian tubule, followed by fat body, silk gland, hemocyte, epidermis, and midgut. The essential region for basal and rutin-induced transcriptional activity was − 1573 to − 931 bp in Malpighian tubule and fat body of silkworm. Promoter truncation analysis using a dual-luciferase reporter assay in BmN cells showed that the region − 1288 to − 1202 bp for BmGSTd1 gene was essential for basal and rutin-induced transcriptional activity. Sequence analysis of this region revealed several potential transcriptional regulatory elements such as Bcd and Kr. The mutation of core base of Kr site demonstrated that Kr functioned positively in rutin-mediated BmGSTd1 transcription.

An optimized space vector pulse width modulation (SVPWM) method with common mode voltage elimination and neutral point potential balancing is proposed for an open-end winding induction motor. The motor is fed from both of the ends with two neutral point clamped (NPC) three-level inverters. In order to eliminate the common mode voltage of the motor ends and balance the neutral point potential of the DC link, only zero common mode voltage vectors are used and a balancing control factor is gained from calculation in the strategy. In order to improve the harmonic characteristics of the output voltages and currents, the balancing control factor is regulated properly and the theoretical analysis is provided. Simulation and experimental results show that by adopting the proposed method, the common mode voltage can be completely eliminated, the neutral point potential can be accurately balanced and the harmonic performance for the output voltages and currents can be effectively improved.

In this paper, we investigate the problem of global stabilization for a general class of high-order and non-smoothly stabilizable nonlinear systems with both lower-order and higher-order growth conditions. The designed continuous state feedback controller is recursively constructed to guarantee the global strong stabilization of the closed-loop system.

BACKGROUND The best technique for pancreatic anastomosis after pancreaticoduodenectomy (PD) remains controversial, and the procedure for robotic PD (RPD) has not been previously reported. This study aimed to evaluate the safety and feasibility of a novel technique of pancreaticojejunostomy (PJ) for RPD. METHODS The demographics and perioperative outcomes of a consecutive series of RPD patients who underwent single-layer continuous suture (SCS) for PJ between September 2018 and November 2018 were analyzed. RESULTS Thirty patients were included in the study. Twenty patients had a soft pancreas, and 15 patients had a small main pancreatic duct (MPD) (

Ovarian cancer is one of the most common causes of mortality among all cancers in females and is the primary cause of mortality from gynecological malignancies. The objective of the current research work was to evaluate a naturally occurring sesquiterpene-δ-Cadinene for its antiproliferative and apoptotic effects on human ovary cancer (OVCAR-3) cells. We also demonstrated the effect of δ-Cadinene on cell cycle phase distribution, intracellular damage and caspase activation. Sulforhodamine B (SRB) assay was used to evaluate the antiproliferative effect of δ-cadinene on OVCAR-3 cells. Cellular morphology after δ-cadinene treatment was demonstrated by inverted phase contrast microscopy, fluorescence microscopy and transmission electron microscopy. Flow cytometry was used to analyze the effect of δ-cadinene on cell cycle phase distribution and apoptosis using propidium iodide and Annexin V-fluorescein isothiocyanate (FITC)/PI kit. The results revealed that δ-cadinene induced dose-dependent as well as time-dependent growth inhibitory effects on OVACR-3 cell line. δ-cadinene also induced cell shrinkage, chromatin condensation and nuclear membrane rupture which are characteristic of apoptosis. Treatment with different doses of δ-cadinene also led to cell cycle arrest in sub-G1 phase which showed dose-dependence. Western blotting assay revealed that δ-cadinene led to activation of caspases in OVCAR-3 cancer cells. PARP cleavage was noticed at 50 µM dose of δ-cadinene with the advent of the cleaved 85-kDa fragment after exposure to δ-cadinene. At 100 µM, only the cleaved form of PARP was detectable. Pro-caspase-8 expression remained unaltered until 10 µM dose of δ-cadinene. However, at 50 and 100 µM dose, pro-caspase-8 expression was no longer detectable. There was a significant increase in the caspase-9 expression levels after 50 and 100 µM δ-cadinene treatments.

Background Screening newborn children for congenital heart disease (CHD) mostly focus on critical CHD using pulse oximetry. But this approach is not applicable to residents at high altitude because of variations in decreased arterial saturations. Altitude hypoxia induces pulmonary hypertension that is the main morbidity in simple left to right shunt forms of CHD. We aimed to screen newborn children at high altitude for all forms of CHD using echocardiography. Methods We included asymptomatic newborn children born in Xining, Qinghai (2260 m) between March 1, 2015, and Aug 31, 2016. Echocardiography was done on days 3–5 after birth, and follow-up echocardiography was done at 3 months, 6 months, and 12–18 months. Informed consent was obtained from the parents of each neonate. As part of a quality initiative, the study did not require approval from the Institutional Ethics Board. Consent was obtained from the parent or parents of each neonate by verbal explanations. Findings Echocardiography was performed in consecutive asymptomatic 1002 newborn children (459 girls, 543 boys; 219 Han, 673 Hui, 110 Tibetan; altitude 1800–4223 m, median 2450 m). CHD was detected in 278 (28%) children (139 girls, 139 boys; 67 Han, 181 Hui, and 30 Tibetan). Among the children with CHD, 176 children (63%) had secundumatrial septal defect, 61 children (22%) had patent ductus arteriosus, seven children (3%) had ventricular septal defect, and 34 children (12%) had multiple defects. 91 (33%) of the 278 children with CHD had a follow-up at 3 months: in eight (12%) of 69 children, the atrial septal defect had closed, and in 26 (87%) of 30 children the patent ductus arteriosus had closed. A 6 month follow-up was completed in 65 (26%) of 255 children; the atrial septal defect had closed in 28 (19%) of 57 children, the patent ductus arteriosus had closed in 11 (79%) of 14 children, and the ventricular septal defect had closed in two (67%) of three children. A 12–18 month follow up was completed in 59 (27%) of 223 children. Atrial septal defects, patent ductus arteriosus, and ventricular septal defects had closed in 23 (50%) of 46 children, 17 (85%) of 20 children, and three (75%) of four children, respectively. During the follow-up period, two babies with multiple defects died of pneumonia at 4 months and 6 months. Another two babies with atrial septal defect and one baby with patent ductus arteriosus had pulmonary arterial hypertension (systolic pressure 54 mm Hg and 50 mm Hg) at 12 months. In total, among the 166 (60%) children with CHD who attended follow-ups, defects remained unclosed in 99 (60%) children. The incidence of CHD and spontaneous closure were not correlated with altitudes and ethnic group (p>0·1 for all). Interpretation The incidence of CHD is many fold higher than that at low altitude, consisting solely of simple left to right shunt forms. By 18 months of age, about 60% of CHD remain unclosed. Follow-up remains challenging because of poor socioeconomic conditions but must be reinforced to provide early repair and prevent pulmonary arterial hypertension and death. Funding Start-up fund provided by the Capital Institute of Pediatrics.