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Background The application and feasibility of minimally invasive liver resection (MILR) for huge liver tumours (≥10 cm) has not been well documented. Methods Retrospective analysis of data on 6,617 patients who had MILR for liver tumours were gathered from 21 international centers between 2009-2019. Huge tumors and large tumors were defined as tumors with a size ≥10.0 cm and 3.0-9.9 cm based on histology, respectively. 1:1 coarsened exact-matching (CEM) and 1:2 Mahalanobis distance-matching (MDM) was performed according to clinically-selected variables. Regression discontinuity analyses were performed as an additional line of sensitivity analysis to estimate local treatment effects at the 10-cm tumor size cutoff. Results Of 2,890 patients with tumours ≥3 cm, there were 205 huge tumors. After 1:1 CEM, 174 huge tumors were matched to 174 large tumors; and after 1:2 MDM, 190 huge tumours were matched to 380 large tumours. There was significantly and consistently increased intraoperative blood loss, frequency in the application of Pringle maneuver, major morbidity and postoperative stay in the huge tumour group compared to the large tumour group after both 1:1 CEM and 1:2 MDM. These findings were reinforced in RD analyses. Intraoperative blood transfusion rate and open conversion rate were significantly higher in the huge tumor group after only 1:2 MDM but not 1:1 CEM. Conclusions MILR for huge tumours can be safely performed in expert centers It is an operation with substantial complexity and high technical requirement, with worse perioperative outcomes compared to MILR for large tumors, therefore judicious patient selection is pivotal.

Rechargeable lithium-ion batteries (LIBs), regarded as a promising power sources, have been widely applied in both electric vehicle and large stationary power supplies. As the most appealing potent...

Background Minimally invasive pancreaticoduodenectomy (MIPD) has recently been safely performed by experts, and various methods for resection have been reported. This review summarizes the literature describing surgical approaches for MIPD. Methods A systematic literature search of PubMed (MEDLINE) was conducted for studies reporting robotic and laparoscopic pancreaticoduodenectomy; the reference lists of review articles were searched. Of 444 articles yielded, 23 manuscripts describing the surgical approach to dissect around the superior mesenteric artery (SMA), including hand-searched articles, were assessed. Results Various approaches to dissect around the SMA have been reported. These approaches were categorized according to the direction toward the SMA when initiating dissection around the SMA: anterior approach (two articles), posterior approach (four articles), right approach (16 articles), and left approach (three articles). Thus, many reports used the right approach. Most articles provided a technical description. Some articles showed the advantage of their method in a comparison study. However, these were single-center retrospective studies with a small sample size. Conclusions Various approaches for MIPD have been reported; however, few authors have reported the advantage of their methods compared to other methods. Further discussion is needed to clarify the appropriate surgical approach to the SMA during MIPD.

It is highly challenging to construct a durable superhydrophobic coating for practical applications since the coating is easily destroyed by mechano-chemical attack. To address this issue, a “PDMS-in-water” emulsion approach is for the first time adopted to design a mechanochemically robust superhydrophobic cotton fabric with intelligent self-healing nature, without using any fluorine-containing components. With this approach, PDMS molecules firstly penetrate into the cotton fiber, and then graft onto the surface of the cotton fabric with a strong binding force, creating hierarchical rough structures and lowering the surface energy simultaneously. Benefitting from this design, the PDMS@cotton fabric exhibits high superhydrophobicity with a water contact angle over 155°, surpassing all the PDMS-in-organic solvent based approaches. Impressively, the surface repairs its superhydrophobicity throughout the whole lifetime though damaged by machine washing or abrasion (>100 cycles), due to the self-diffusion process of PDMS molecules from the inner part to the outer surface of the cotton fibers to minimize surface free energy. Besides, the superhydrophobic coatings display superior chemical stability in strongly acidic and alkaline solution, and maintain similar textile physical properties of the cotton fabric, such as elongation at break, tensile strength, etc. Our environment-friendly “PDMS-in-water” approach can be easily integrated into industrial textile finishing treatment and is promising to apply to various substrates with robust superhydrophobic surfaces.

Two methods for improving the detection performance of neural networks are introduced in this paper, multi-feature map detection and multi-branch convolution structure. The former is to analyze the features of each convolution layer in the network separately, because these features have different resolutions and correspond to objects of different sizes. Finally, the comprehensive judgment of the analysis results can give better consideration to the overall situation and improve the accuracy of detection. The multi-branch convolution structure uses convolutions of different sizes on multiple branches to process input in parallel, and these branches are independent of each other. Finally, the feature maps corresponding to different receptive fields from each branch are combined and analyzed comprehensively. In this paper, the application process of the above two methods is described in combination with classical neural networks, such as the single shot multibox detector (SSD) and receptive field block (RFB) net.

MnO2-based composite has attracted wide attention because of its high power density, and long cycle life as electrodes for energy storage devices. However, its instability at lower electrochemical potential limits its operating potential window (OPW) and impedes its further development as a promising electrode material for symmetrical supercapacitors. Herein, flexible MnO2@carbonized cotton textile electrodes (MCCT) is designed and demonstrated via a facile in-situ low-temperature chemical reaction method. Remarkably, an excellent electrochemical stability under negative polarization is obtained, delivering a large OPW of 1.6 V. In addition, the flexible MCCT exhibits a high areal capacitance of 526.25 mF cm−2 (751.78 F g−1) at 1 mA cm−2 coupled with good rate performance (237.6 mF cm−2 at 50 mA cm−2), as well as high cycle retention (99.7% after 10000 cycles). The operation voltage of symmetrical supercapacitors is expanded to 1.6 V, revealing a maximum energy density of 5.71 mWh cm−3 (0.057 mWh cm−2) and a high power density of 3.97 W cm−3 (39.71 mW cm−2). As a representative of high operation voltage MnO2 composite electrode, the flexible MCCT has potential for state-of-the-art energy storage devices.

To evaluate the effectiveness of pelvic floor muscle training (PFMT) on perimenopausal women with pelvic floor dysfunction (PFD). A two-group longitudinal experimental design with multiple comparisons. The intervention group (n = 37) received a 3-month intervention combining Kegel and yoga exercise. The control group (n = 37) received Kegel exercise. The combined training alleviated PFD symptoms, improved life quality and increased pelvic floor muscle strength of perimenopausal women. Women with PDF symptoms can integrate PFMT and yoga exercise to promote rehabilitation and improved outcomes. Combined exercise should be taught and practiced under supervision by qualified health professionals.

BACKGROUND The main aim of this survey was to analyze how liver surgeons perform liver resections and to define their conception of anatomic procedures within the incorporation of minimally invasive liver surgery (MILS). METHODS The survey was distributed among liver surgeons. It mainly focused on personal experience on open and MILS, methods and landmarks, and experience on anatomic resections and Glissonean approach. RESULTS A total of 445 valid answers from 54 countries was obtained. Surgeons performing MILS mainly have below 10 years of experience (81.8% of responders) and one third has never done complex MILS. New techniques, including indocyanine green demarcation are marginally used (

The main purpose of the integration of network media and middle school ideological and political course is to better realize the moral education function of middle school ideological and political development. The use of resource integration technology to manage distributed teaching resources is conducive to improving the level of information construction in colleges and universities, and so on. This paper puts forward the integration system of ideological and political multimedia network teaching resources based on wireless network. Firstly, it presents an overview of the Radio Resource Management (RRM) problem and projected strategies within wireless network framework, where several Radio Access Technologies (RATs) are collectively controlled and identify the different activities relating to the CRRM issues. Secondly, this paper targets providing a summary of the RRM problem and projected solutions within wireless network. Thirdly, the theoretical elements of the design and the teaching resource management assessment process are clarified by using XML as the data exchange carrier to realize the automatic integration of teaching resources. Fourthly, we have used dSPACE platform, by calling its API function, which then call the subscribe function of dSPACE framework and store the subscription information in the database. Whenever new teaching resources enter the subscribed field, the dSPACE framework will automatically send e-mail to the subscribers. Finally, during the operation of the system, all functions operate normally and have strong security, so as to avoid the illegal theft or leakage of the data about the education system.

Background: Biomarkers that would help prognosticate outcomes and guide treatment of patients with severe coronavirus disease 2019 (COVID-19) are currently required. We aimed to investigate whether the dynamic variation of cytokines was associated with the survival of patients admitted to an intensive care unit (ICU).Methods: A retrospective study was performed on 40 patients with COVID-19 admitted to an ICU in Wuhan, China. Demographic, clinical, and laboratory variables were collected, and serum cytokines were kinetically assessed. A multivariable- adjusted generalized linear regression model was used to evaluate the differences in serum cytokine levels between survivor and non-survivors.Results: Among the 40 patients included, a significant positive correlation was found between multiple cytokines. Serum levels of IL-6, IL-10, and tumor necrosis factor alpha in non-survivors were consistently elevated compared to that of the survivors. Kinetic variations of IL-6, IL-8, and IL-10 were associated with a fatal outcome in severe patients with COVID-19, independent of sex, age, absolute lymphocyte count, direct bilirubin, hypertension, chronic obstructive pulmonary disease, and cancer.Conclusion: Dynamic changes in serum IL-6, IL-8, and IL-10 levels were associated with survival in ICU and could serve as a predictive biomarker in patients with severe COVID-19 to determine therapeutic options.

Acrylamide has been studied for its carcinogenicity in experimental animals, causing tumors at several organ sites, and has been considered probably carcinogenic to humans as well. Given the small number of epidemiological studies that have been conducted, it is still uncertain whether the consumption of acrylamide is associated with liver cancer. Therefore, we investigated a study to determine the possible relationship between acrylamide intake and the risk of developing liver cancer in the Japanese population. A total of 85,305 participants, from the Japan Public Health Center-based Prospective Study, who provided a validated food-frequency questionnaire were enrolled between 1995 and 1998. During a median of 16.0 years follow-up, 744 new liver cancer cases were identified. Compared to the lowest tertile of acrylamide consumption (&lt, 4.8 µg/day), the multivariate hazard ratio (HR) for the highest tertile (≥7.6 µg/day) was 0.79 (95% confidence interval [CI] = 0.65–0.95) for liver cancer using multivariable model 1, adjusted for smoking status, body mass index (BMI), physical activity, medical history, and alcohol consumption, whereas the inverse relationship disappeared after additionally adjusting for coffee consumption in multivariable model 2 with HR of 1.08 (95% CI = 0.87–1.34) for the highest tertile. The effect of dietary acrylamide intake on the risk of liver cancer was not observed in the Japanese population.

For most autonomous landing based on ground cooperation markers, the design of ground cooperation markers is too simple. These markers can provide position-related information when UAV is in a high position, but when UAV is in a low position, it can easily cause the UAV to lose its target and result in landing failure due to the small size of the ground marker and the narrowness of camera's field of view. To solve the above problems, this article focuses on the precise landing of UAV. An improved ground cooperation marker which can be detected in different heights is designed, a relative position coordinate system is established for pose estimation, and a height-adaptive autonomous UAV landing strategy is proposed. Simulation done in the Gazebo environment verifies that the proposed ground marker and control strategy can improve the accuracy of the vision-based autonomous landing of the UAV.

Backgroud and purpose Almost every woman experiences discomforts during pregnancy. This study aimed to evaluate the efficacy of yoga on physiological and psychological discomforts and delivery outcomes in Chinese primiparas. Materials and methods A randomized controlled trial was conducted. Participants in the control group (n = 32) received routine prenatal care, whereas participants in the intervention group (n = 32) received routine prenatal care and yoga exercise three times a week for 12 weeks. Outcomes evaluated included physiological discomforts, prenatal depression, anxiety, childbirth self-efficacy and delivery outcomes. Intention-to-treat analysis was conducted. Results Yoga decreased the symptoms of physiological discomforts during pregnancy (F = 6.966, p = 0.010), promoted childbirth self-efficacy (F = 11.900, p = 0.001), increased the rate of vaginal delivery (χ2 = 4.267, p = 0.039), and shortened the length of the first (t = −2.612, p = 0.012), second (z = −3.313, p = 0.001) and third stages of labor (z = −3.137, p = 0.002). Conclusion Yoga offers beneficial effects on physiological discomforts, childbirth self-efficacy and delivery outcomes in Chinese primiparas.

A transient model coupled heat, air and moisture is developed and validated to investigate the heat and moisture transfer characteristics of the exterior walls. Relative humidity and temperature are chosen as the driving potentials. The temperature, relative humidity and heat flux of the internal surfaces of the Expanded Polystyrene( EPS) external insulation wall and concrete wall are analyzed. The results show that, when considering moisture transfer, the temperature fluctuations of internal surface is reduced. The thermal insulation wall has the lower internal surface temperature and is beneficial to improve the indoor thermal environment. The relative humidity of the inner surface of the insulation wall is higher. Moisture migration in the wall can cause moisture accumulation and the added latent heat caused by moisture transfer can’t be ignored. Heat flow through the inner surface of the insulation wall is smaller, therefore the insulation wall is helpful to reduce air conditioning load.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome classified into primary HLH and secondary HLH. Secondary HLH is always caused by autoimmune disease, infections, or cancer. The first-line therapy for secondary HLH is the HLH 2004 protocol, including dexamethasone, etoposide, and supportive therapy. However, up to 30% of patients, especially pediatric patients, remain unresponsive to first-line treatment, and the mortality rate reaches 50% in children with HLH. Furthermore, some children who have special conditions, such as an active virus infection, are not suitable for immunosuppressants treatment. Recently, several HLH-promoting cytokines have been identified, including interferon-γ, interleukin-2, and interleukin-6. Janus kinase 1 and 2 control the signaling of many cytokines, notably interferon-γ, interleukin-2, and interleukin-6. Janus kinase 1 and 2 inhibitors, such as ruxolitinib, have been successfully used to treat HLH in mice. Here, we report that a boy, diagnosed with HLH and high titer of hepatitis B virus–DNA copies, improved quickly, and the cytokine storm of HLH was alleviated after receiving ruxolitinib. Five days after ruxolitinib treatment, entecavir was introduced and serum titer results of hepatitis B virus–DNA returned negative. With 3 months of ruxolitinib treatment and following-up 1 year, the boy’s situation maintained sustained remission. In this study, it is suggested that ruxolitinib might be a first-line drug, which could alleviate the cytokine storm of HLH. This treatment may be ushering in the age of glucocorticosteroid-free HLH treatment, which is particularly meaningful for children because it avoids the side effects of glucocorticosteroid.

This paper describes a 2D odometry method fusing LiDAR and IMU data to estimate ground vehicle motion and performing better in long corridor scenarios and moving objecting scenarios. The method builds on range flow constraint for every scanned point and rejects moving objects by fusing IMU data. Besides, our method applies the graphical model to solve the optimization problem that adds IMU constraint to the odometry system. Experiment results demonstrate that our approach is able to perform as well as other state-of-art approaches and better than these approaches in long corridor scenarios and moving objecting scenarios. Besides we test our approach on an embedded system which makes it suitable for those low-cost robotic applications that require planar odometry.

With the explosive expansion of data center sizes, a large number of the same or similar contents are requested repeatedly by the users on network edge, which causes a serious waste of network bandwidth, and further makes the network energy consumption increase remarkably. The current researches achieve energy saving by increasing network link capacity as well as eliminating the data redundancy in routers. But the existing redundancy elimination may cause the increase of router's energy consumption. To solve this problem, we propose a flow preemption routing scheme with redundancy elimination (RE-FPR). The RE-FPR scheme uses software defined networking (SDN) technology to select different routing paths for the traffic flow and control RE function on the corresponding router under two modes, i.e., traffic peak and traffic valley. Specifically, the RE-FPR scheme also employs the SDN controller to update flow states and link states of the network. We then formulate the RE-FPR problem as a power consumption minimization problem subject to flow conservation constraint and link capacity constraint. Furthermore, we solve the optimization problem by using the maximum entropy principle and propose the RE-FPR algorithm. The simulation results show that the RE-FPR algorithm outperforms the traditional flow scheduling algorithms in term of flow completion time and the number of active RE-routers/links.

The geometry of the composite sandwich plate with bi-directional trapezoidal cores (BTCs) is characterized by its novel cores with trapezoidal convex and concave corrugations in two in-plane directions. To solve the related difficulties in mechanical problems, a reduced plate model is established and written as a variational formulation based on the variational asymptotic method (VAM). That is, the original 3D plate problem was reduced to unit cell analysis (providing effective plate properties, such as the A , B , and D matrices) and two-dimensional (2D) reference plane analysis. To validate the accuracy and effectiveness of the reduced plate model, we analyze the static displacement, global buckling, and free vibrations of the composite sandwich plate with BTCs under different boundary and load conditions. Finally, we investigate the influence of the layup configurations of the face sheet and geometric parameters of the BTCs on the effective plate properties, buckling loads, and natural frequencies of the plate, which can provide useful reference for the structure optimization of composite sandwich plate with BTCs.

Cervical transarticular fixation is a technically demanding procedure. This study aimed to develop a safer and more accurate method for C1/2 pedicle screw placement using a three-dimensional printed drilling guide. A total of 20 patients with C1/2 fractures and dislocations were recruited, and their computed tomography scans were evaluated. Under the assistance of the three-dimensional printed drilling guide, bilateral C1/2 pedicle screws were successfully placed in the three-dimensional C1/2 models. Then, sagittal and axial computed tomography scans were obtained, and the accuracy and safety of screw placement were evaluated based on X-Y-Z axis setup. The average depths for C1 and C2 pedicle screws were 30.1 ± 1.12 and 31.81 ± 0.85 mm on the left side and 29.54 ± 1.01 and 31.35 ± 0.27 mm on the right side, respectively. The average dimensional parameters for C1/C2 pedicle screw of both sides were measured and analyzed, which showed no statistically significant differences in the ideal and the actual entry points, inclined angles, and tailed angles. The method of developing a three-dimensional printed drilling guide is an easy and safe technique. This novel technique is applicable for C1/2 pedicle screw fixation; the potential use of the three-dimensional printed guide to place C1/2 pedicle screw is promising.

Background The efficacy of yoga on delivery outcomes remaining controversy. Objectives To evaluate the effects of prenatal yoga on delivery outcomes. Methods The Cochrane Library, PubMed, Embase, Web of Science, CINAHL and Elsevier databases were searched from inception to January 22, 2020, and randomized, quasi-randomized and non-randomized controlled trials evaluating the effect of yoga on the delivery outcomes in pregnant women were included. The methodological quality was assessed by the Cochrane Collaboration's tool. Meta-analysis was performed using Revman 5.3. Results This meta-analysis identified that yoga improved vaginal delivery, decreased premature delivery and birth weight of newborns, shorten the labor duration. Conclusion Prenatal yoga is an effective complementary medicine to improve delivery outcomes and not to increase the risk of fetus, which is worth recommending to pregnant women. But studies involved in this meta-analysis were not all of high quality. The Registration Number in PROSPERO is CRD42019132490.

In this paper, non-sub-sampled shearlet transform (NSST) multi-scale analysis is combined with phase stretch transform (PST) to nonlinearly enhance images. The components of different scales after NSST multi-scale decomposition are processed by nonlinear models with different thresholds, and the noise is well suppressed while enhancing the detail features. The thresholds of the enhanced model are determined by the local standard deviation of PST feature map. Experiments on Matlab platform show that the proposed algorithm has improved image distortion, cleared details, and enhanced image contrast.

Concerning the strategy of keeping multi-UAVs flight formation based on distribution method, first, large-scale multi-UAVs formation is divided into numerous two-UAV sub-formations in the way of “hierarchy”. Then, lead and wing aircraft control approach is adopted in sub-formations, i.e., UAVs in the formation are classified into lead and wing aircrafts, which are complementary to each other. In this way, formation control is thus realized by controlling wing aircrafts that track the lead aircraft. The close connection of sub-formations also constitutes a tracking chain–UAV i tracks UAV i-1. Finally, multi-UAVs formation flight is realized.

The study of energy storage characteristics of heat-supply net in distributed energy system is essential to develop the control strategy of energy efficient utilization. Studying the energy storage characteristics of the heating network in the distributed energy system is the key to formulating energy-saving utilization control strategies. In this paper, the quantitative calculation model of heat transfer and energy storage (HTES) is established through the research on the energy storage characteristics of heat-supply net in distributed energy system, and the duration of thermal storage energy (TSED) of the energy storage characteristics in heat-supply net is also described. In the HTES model, the influence factor is introduced to make the temperature of the heat transfer section in the initial model more realistic, which also improves the accuracy of the model. Based on the HTES model and experimental data, the lag time of the three heat exchange stations was calculated and compared to verify the correctness of the HTES model. Through the calculation of practical cases, the TSED is obtained and analyzed, and for a best flow rate is found for the working medium. In addition, the quality and quantity regulation of central heating network under the conditions of unit shutdown and time-divided heating is calculated to achieve the purpose of guiding the actual water supply temperature and flow.

Computed tomography (CT) is an effective tool for three-dimensional (3D) imaging by using optical detectors to capture the two-dimensional (2D) projections of tested parameters from multiple views and realizing 3D reconstruction through various algorithms. However, for practical applications, typically only a few detectors can be applied due to their high expense and the limited optical access of the test environment. The realization of high precision reconstruction with a few projections is of great significance for promoting the development and application of CT technology. The spatial arrangement of the detectors determines the amount of useful information collected by the system, which greatly affects the quality of CT reconstruction. Therefore, in this work we study the optimization method of projection arrangement based on the 3D Mojette transform theory.Mojette transform is a special discrete form of Radon transform, which can realize projection sampling with minimum redundancy and accurate tomographic reconstruction from less projection angles. It provides a new way to realize the CT technology with fewer projections. However, the existing researches mainly focus on the reconstruction theories of 2D Mojette transform, which is used for realizing the 2D slice tomography. In order to realize the real 3D tomographic reconstruction, in this work we establish a mathematical model of 3D Mojette transform, and study its accurate reconstruction condition. The results show that the 3D Mojette transform is a combination of twice 2D Mojette transform in two directions. The accurate reconstruction condition of 3D Mojette transform is that the sum of the absolute values of projection vectors’ components in x, y, and z directions is greater than the number of discrete grids in each direction. The correctness of the mathematical model and the accurate reconstruction condition are verified by numerical simulations.Considering the limitation of the pixels in the practical detectors, the method to determine the optimal arrangement of projection angles is proposed. The results indicate that the optimal arrangement is that all detectors are located in the same horizontal plane around the tested object, where the projection model is reduced to 2D Mojette transform. In this case, the minimum projection angles and pixels are required and the projection angles can be positioned in a smaller spatial range. If the condition cannot be satisfied in practice, projection vectors with smaller |pi| and |qi| should be chosen. This research provides the theoretical basis for establishing the actual CT system.

Document binarization plays a significant role in the document analysis to extract foreground text from the background. Traditional Convolutional Neural Networks (CNNs) focus only on local textual features and ignore global context, which are both important for pixel classification in segmentation based document binarization. In this paper, we propose a local-global combined approach for document binarization. This model is composed of a global branch and a local branch, taking the global patches from downsampled image and cropped local patches from source image as respective inputs. The final binary prediction is achieved via combining the results of this two branches. The experimental results on several DIBCO datasets present that our method outperforms many traditional and state-of-the-art document binarization algorithms.

The steel stiffened segment in a steel–concrete connection joint is critical to the load capability of the cable-stayed bridge with hybrid girders. The research focused on the improvement o...

Background Robotic distal pancreatectomy exhibits short-term benefits over laparoscopic distal pancreatectomy. The use of minimal invasive techniques to carry out distal pancreatosplenectomy (DPS) for pancreatic ductal adenocarcinoma (PDAC) remains controversial and has not gained popular acceptance. A comparative study was designed to analyze the short- and mid-term outcomes of robotic DPS (RDPS) versus laparoscopic DPS (LDPS) on patients with PDAC. Methods The baseline characteristics, perioperative outcomes and survival data among patients who underwent RDPS (n = 35) versus LDPS (n = 35) for PDAC between December 2011 and December 2015 were compared after a 1:1 propensity score matching. Results There were no significant differences in the operative time, blood loss, blood transfusion rate, and morbidity and pancreatic fistula rates between the RDPS and LDPS groups. RDPS significantly reduced the rate of conversion to laparotomy (5.7% vs. 22.9% when compared with LDPS, p = 0.04). There were no significant differences in R0 resection rates, number of harvested lymph nodes, positive to harvested lymph node ratios, and disease-free survival and overall survival rates between the two groups. A Cox proportional hazards analysis showed N1 stage to be significantly associated with worse survival and suggested that chemotherapy might prolong overall survival in these PDAC patients. Conclusions This single-center study demonstrated that RDPS was safe and efficacious in treatment of PDAC. When compared with LDPS, RDPS was associated with a reduced rate of conversion to open surgery. There were no significantly differences in oncological outcomes and mid-term survival rates between the groups of patients who underwent RDPS or LDPS.

The International Summit on Laparoscopic Pancreatic Resection (ISLPR) was held in Coimbatore, India, on 7th and 8th of October 2016 and thirty international experts who regularly perform laparoscopic pancreatic resections participated in ISPLR from four continents, i.e., South and North America, Europe and Asia. Prior to ISLPR, the first conversation among the experts was made online on August 26th, 2016 and the structures of ISPLR were developed. The aims of ISPLR were; i) to identify indications and optimal case selection criteria for minimally invasive pancreatic resection (MIPR) in the setting of both benign and malignant diseases; ii) standardization of techniques to increase the safety of MIPR; iii) identification of common problems faced during MIPR and developing associated management strategies; iv) development of clinical protocols to allow early identification of complications and develop the accompanying management plan to minimize morbidity and mortality. As a process for interactive discussion, the experts were requested to complete an online questionnaire consisting of 65 questions about the various technical aspects of laparoscopic pancreatic resections. Two further web-based meetings were conducted prior to ISPLR. Through further discussion during ISPLR, we have created productive statements regarding the topics of Disease, Implementation, Patients, Techniques, and Instrumentations (DIPTI) and hereby publish them as “Coimbatore Summit Statements”.

Volume reconstruction plays an important role in improving image quality for freehand three-dimensional (3D) ultrasound imaging. The kernel regression provides an effective method for volume reconstruction in 3D ultrasound imaging, but it requires heavily computational time-cost. In this paper, a programmable graphic-processor-unit-(GPU) based fast kernel regression method is proposed for freehand 3D ultrasound volume reconstruction. The most significant aspect of our method is the adopting of powerful data-parallel computing capability of GPU to improve the overall efficiency. To produce higher image quality, the results of the kernel regression with various parameter settings is deeply investigated under the help of the fast implementation of the algorithm. Experimental results demonstrate that the computational performance of the proposed GPU-based method can be over 200 times faster than that on CPU. Better image quality for speckle reduction and details preservation can be obtained with the parameter setting of kernel window size of 5×5×5 and kernel bandwidth of 1.0.

A body of experimental evidence suggests that the female sex is associated with a lower risk of mortality after trauma-hemorrhage. However, controversy remains regarding the mechanism responsible for these differences and if basic science findings correspond to clinical differences. Racial disparities in trauma outcomes have also been increasingly described. Until now, research on the association between sex and trauma patient outcomes mainly focused on patients in Europe and the United States. Our research attempted to determine whether the female sex is associated with a survival advantage among severely injured Chinese trauma patients. A retrospective analysis of data derived from the Emergency Intensive Care Unit of the Shanghai Sixth People';s Hospital Acute Trauma Center during 2010 to 2013 was performed to characterize differences in sex-based outcomes after severe blunt trauma. The patient study cohort (858 Asian subjects) was then stratified by age and injury severity (using the Injury Severity Score [ISS]). Crude and adjusted odds ratios (ORs) were calculated to evaluate the association between sex and nosocomial infection rate and hospitalized mortality, both overall and by age and ISS category subgroups. Among all trauma patients, females had a significantly lower risk of in-hospital mortality compared with males (OR, 0.41; 95% confidence interval [95% CI], 0.20 - 0.85). This difference was most apparent for patients younger than 50 years (OR, 0.31; 95% CI, 0.12 - 0.82) and the group with ISS scores of 25 or higher (OR, 0.39; 95% CI, 0.17 - 0.91). No differences in the development of nosocomial infections between sexes were seen among the overall patient group and subgroups. This study revealed a statistically significant association between sex and mortality among severe blunt trauma patients, particularly those patients younger than 50 years and with ISSs of 25 or higher. Women had significantly lower mortality than men after severe blunt trauma. These results highlight the important role of sex hormones and sex-based outcome differences after severe traumatic injury in the Chinese population.

Through the definition and analysis of the team's interactive memory system, the factors influencing the interactive memory system are analyzed from the perspective of team work and team members, such as member heterogeneity, team task responsibility, communication between members and trust among members, the corresponding scale. On the basis of pre adjustment, the scale was revised. Through questionnaire investigation and empirical analysis, the author proved the influencing factors of team interactive memory system. The research obtained four management inspirations: team structure and task responsibility rationalization, the establishment of knowledge base, free exchange platform and a harmonious team atmosphere.

Objective: To discuss the application of the Standardized Management System in Intensive Care Units (ICU) for specialist nursing and the effectiveness of this system in improving working performance within the unit. Methods: Specialty nurses were trained by the Standardized Management System that is a series of goal, position, and responsibilities setting. In addition to this development, a standardized method for evaluation is implemented. The affection was evaluated through the Quality Inspection Approach, Teaching Research, Clinical Data, and Job Satisfaction Questionnaire. Results: In terms of Quality of Care and Teaching Satisfaction, we have the best scores within the hospital. Specialty ICU nurses carried out seventeen new technological and research techniques with great success and did much the practice of detailed care within the clinic. In addition, due to the attention and care provided by the ICU Nurses, these nurses received a higher satisfaction score than any other department. (4.331±0.669 vs. 3.607±0.402，P=0.001). Conclusion: The specialty nurses with the Standardized Management System were showed improved ICU quality care and teaching level. In addition, the application of the Standardized Management System instilled a greater level for the development of ICU nursing Furth more, the specialty nurses was well satisfied with their jobs.

Objective This study aims to investigate the clinical performance of three-dimensional (3D) fast-recovery fast spin-echo (FRFSE) magnetic resonance dacryocystography (MRD) with topical administration of sterile saline solution for the assessment of the lacrimal drainage system (LDS). Methods A total of 13 healthy volunteers underwent both 3D-FRFSE MRD and two-dimensional (2D)-impulse recovery (IR)-single-shot fast spin-echo (SSFSE) MRD after topical administration of sterile saline solution, and 31 patients affected by primary LDS outflow impairment or postsurgical recurrent epiphora underwent 3D-FRFSE MRD and conventional T1- and T2-weighted sequences. All patients underwent lacrimal endoscopy or surgery, which served as a standard of reference for confirming the MRD findings. Results 3D-FRFSE MRD detected more visualized superior and inferior canaliculi and nasolacrimal duct than 2D-IR-SSFSE MRD. Compared with 2D-IR-SSFSE MRD, 3D-FRFSE MRD showed more visualized segments per LDS, although the difference was not statistically significant. Significant improvements in the inferior canaliculus and nasolacrimal duct visibility grades were achieved using 3D-FRFSE MRD. 3D-FRFSE MRD had 100% sensitivity and 63.6% specificity for detecting LDS obstruction. In 51 out of the 62 LDSs that were assessed, a 90% agreement was noted between the findings of 3D-FRFSE MRD and lacrimal endoscopy in detecting the obstruction level. Conclusion 3D-FRFSE MRD combined with topical administration of sterile saline solution is a simple and noninvasive method of obtaining detailed morphological and functional information on the LDS. Overall, 3D-FRFSE MRD could be used as a reliable diagnostic method in many patients with epiphora prior to surgery.