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Background:Acute appendicitis (AA) is one of the most common abdominal emergencies in children. There has been an increasing interest in endoscopic retrograde appendicitis treatment (ERAT) in the past twenty years. We performed a meta-analysis of ERAT for AA in children through a survey and an extensive literature search that summarized the clinical features and therapeutic efficacy of ERAT. Methods: A systematic review and meta-analysis of retrospective studies published in PUBMED, MEDLINE, Cochrane, China National Knowledge Infrastructure (CNKI), WanFang and VIP Database. The search has a limit on date from Jan 1, 2012 to Jun 31, 2022, with the last search done on Oct 31, 2022. No publication restrictions or study design filters were applied. The registration number in PROSPERO was CRD42022377739. Results: Seven retrospective cohort studies with 423 patients were enrolled in our study. In our study, almost 57.6% (95% confidence interval (CI) 52.8%-62.4%) of children who underwent ERAT were male, the pooled rate of successful intubation was 99.5%(95%CI 98.2%-100.0%), the average time of an ERAT is approximately 49 minutes(95% CI 48.179,49.833), and efficiency of ERAT for acute appendicitis was 99.0% (95% CI 96.5%-100.0%), while, the pooled rate of recurrence was 4.2% (95% CI 2.2%-6.7%), the mean time of hospital stays was 4.319 (95% CI 4.254-4.385) days probably, and occurrence of postoperative complication was about 3.9% (95% CI 2.0%-6.2%). Conclusions: Our results testify the relevant morbidity, clinical characteristics and prognosis in the ERAT, in spite of an enormous heterogeneity among few primary studies. ERAT has high efficiency and low recurrence rate in children with acute uncomplicated appendicitis, and preserves the physiological function of the appendix and avoids sizeabledamage, so it can be a safe and effective treatment for appendicitis in children.

Purpose: This study intended to assess the postoperative growth and development of infants with congenital intestinal atresia (IA) and to explore growth-associated factors. Methods: The data of 131 infants with congenital IA who were cured, discharged, and followed up in the outpatient clinic from May 2011 to August 2021 in the Fujian Maternity and Child Health Hospital were acquired. The data included prenatal color Doppler results, gestational week, gender, birth weight, IA type, atresia distal/proximal intestine diameter ratio, IA location, with or without ileocecal junction resection, remaining small intestine length, with or without meconium peritonitis, etc. According to the World Health Organization Child Growth Standards (2006), the growth and development of IA infants were assessed using age-specific height and weight. Stunting was defined as age-specific height and (or) weight 2 standard deviations (SD) below the median of the standard, and the cases were divided into normal and growth-retarded groups for comparison and analysis. Statistical analysis was performed using SPSS 21.0. Results: There were 83 males and 48 females in the 131 IA infants. 4 cases had age-specific weight and height 30 cm beyond the ligament of Treitz (P < 0.016667). No significant difference was observed in other factors between the two groups. Conclusion: Some infants were stunted after IA surgery, and birth weight and atresia location were the two factors affecting their growth and development. Moreover, long-term follow-up and prompt nutritional instructions are required for those infants.

To analyze the characteristics of ovarian necrosis in the neonatal ovarian tumor, and review treatments for ovarian torsion in neonates. Neonates with ovarian tumors undergoing surgery in Fujian Maternal and Child Health Hospital (Fujian Children's Hospital) from February 2016 to August 2021 were analyzed retrospectively. Patients were divided into the ovarian necrosis group and control group (without necrosis). Demographic characteristics, prenatal and postnatal examination, operation, and pathological findings were compared and the relevant factors of ovarian necrosis were discussed. 26 neonates were included, 12 in necrosis group and 14 in control group. The maximum diameter of the tumor in necrosis group was smaller than that in control group (P 0.01). The preoperative CRP in necrosis group was significantly higher than that in control group (P 0.05). There were no significant differences between two groups in the timeliness of surgery, pathological types, and length of postoperative hospital stay. About 26% of neonatal ovarian torsion could be rescued. Neonatal ovarian necrosis is characterized by a smaller tumor size and a higher preoperative CRP level. Timely surgery after birth might not change the ovarian outcome, but ovarian detorsion could be attempted in neonates to save residual ovarian function.

Aims To determine whether the occurrence of diabetic retinopathy (DR) and its related factors are affected by diabetes type (latent autoimmune diabetes in adults [LADA], type 1 diabetes mellitus [T1DM], type 2 diabetes mellitus [T2DM]). Methods LADA patients were matched for age (± 2 years) and sex to T1DM (1:1) and T2DM (1:2) patients. Retrieved variables included demographic characteristics, diabetes history, laboratory test findings, and history of DR screening, etc. Multiple logistic regression analysis was applied to identify influencing factors of DR. A decision tree was used to explore interactions between diabetes type and other influencing factors of DR. Results We included 110 LADA, 101 T1DM, and 220 T2DM patients. DR prevalence was 26.4% in LADA patients, lower than that in T1DM (50.5%) and T2DM (47.7%) patients (P P P P = 0.003) was an independent protective factor. Decision tree analysis showed that in patients without DN with a diabetes duration of at least 10.5 years, T1DM and LADA patients had a higher incidence of DR than T2DM patients (72.7% vs. 55.1%). Conclusions The prevalence of DR in diabetes patients was affected by diabetes duration, DN occurrence, and regular DR screening. Diabetes type indirectly affects DR occurrence through its interaction with diabetes duration and DN. Correct LADA diagnosis is necessary, and DR screening needs to be well-implemented.

CTP synthase (CTPS) can form filamentous structures termed cytoophidia in cells from all three domains of life. In order to study the mesoscale structure of cytoophidia, we perform fluorescence recovery after photobleaching (FRAP) and stimulated emission depletion (STED) microscopy in human cells. By using EGFP dimeric tag, as a tool to explore the physical properties of cytoophidia, we find that cytoophidia are dynamic and reticular. The reticular structure of CTPS cytoophidia may provide space for other components such as IMPDH. In addition, we observe CTPS granules with tentacles.

To investigate the effect of modified transanal Soave assisted by laparoscopy in children with Hirschsprung's disease (HD).The clinical data of 120 children with Hirschsprung's disease admitted to Fujian Children's Hospital from January 2018 to November 2021 were retrospectively analyzed. Based on the surgical methods, 58 children treated with modified transanal Soave were regarded as the modified group and 62 children treated with modified transanal Soave assisted by laparoscopy were divided into the laparoscopic group. The operative indexes, anal function, quality of life and perianal pressure 6 months after surgery, complications within 1 month after surgery, and recovery within 6 months after surgery of the two groups were compared. The risk factors influencing the postoperative recovery of hirschsprung's disease in children were analyzed by univariate and logistic regression analysis.The operation time, intraoperative blood loss, length of hospital stay and gastrointestinal recovery time in the laparoscopic group were lower than those in modified group (Modified transanal Soave assisted by laparoscopy can improve anal function and quality of life, relieve anal pressure, and have a low complication rate. Enteritis, abdominal distension, and anastomotic stenosis are the factors affecting the recovery of Hirschsprung's disease in children.

This paper studies the fault detection problem for a class of hypersonic vehicle with actuator faults, disturbances and random noises. To handle the unknown disturbances, an unknown input Kalman filter (UIKF) is presented to estimate the unknown system states and disturbances, simultaneously. Considering that the closed-loop structure brings the robustness to the hypersonic vehicle, which could cover some faults, the Total Measurable Fault Information Residual (ToMFIR) is employed as the fault detection residual. Moreover, to deal with the random noises, the hypothesis testing method is utilized to obtain the thresholds under some fault detection performances (false alarm rate and missing alarm rate). The fault detectability condition is also derived. Finally, the simulations verify the effectiveness of the proposed fault detection method.

BACKGROUND: Corneal transplantation is the most effective clinical treatment for irreversible corneal endothelial decompensation. However, while visual rehabilitation can be achieved by corneal transplantation, transplant rejection, poor postoperative visual acuity, and lack of suitable donor tissue are currently the greatest obstacles to corneal transplantation. As a result, endothelial cell-based therapy has emerged as an alternative to corneal transplantation treatment. Human induced pluripotent stem cells (hiPSCs) were induced to differentiate into human corneal endothelial cell (hCEC)-like cells in our study, which aimed to provide an experimental basis for studying the clinical translation and application of induced PSC (iPSC) to corneal endothelial cell (CEC) differentiation. METHODS: A two-step method to convert hiPSCs into hCEC-like cells was applied in the study. First, the transforming growth factor beta (TGF-β) and Wnt signaling pathways were regulated by adding SB4315542 and CHIR99021, and hiPSCs were induced to differentiate into neural crest cells (NCCs) by a chemically defined and serum-free in vitro induction method. Subsequently, NCCs were induced to differentiate into hCEC-like cells by adding B27, platelet-derived growth factor (PDGF)-BB, and XAV939 (Wnt pathway inhibitor) to CEC culture medium. RESULTS: IPSCs were directionally differentiated into NCCs. During the process of differentiation, iPSCs gradually lost the monoclonal morphology of PSCs. Moreover, β-catenin and SRY-related HMG-box gene 10 (SOX10) proteins were immunohistochemically expressed on the 7th day of differentiation. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) results demonstrated that the cells expressed SOX9, SOX10, nerve growth factor receptor (NGFR), human natural killer-1 (HNK-1), and β-catenin, indicating that they were successfully directionally differentiated from iPSCs to NCCs. After 5–7 days of differentiation, the cells demonstrated a hexagonal morphology of monolayer tight junctions. Immunofluorescence results demonstrated that the cells expressed CEC indicator zonula occludens-1 (ZO-1) protein. QRT-PCR results demonstrated that the cells expressed collagen type IV alpha 1 (COL4A1), COL8A2, COL8A1, and ZO-1, which indicated that they were successfully directionally differentiated from NCC to CEC. CONCLUSIONS: Our study successfully provided a simple and efficient method with clear chemical composition and serum-free media to directionally differentiate hiPSCs into hCEC-like cells, thereby advancing the results of previous studies on directional transformation into epithelial cells.

Superhydrophobic surfaces have great potential for self-cleaning, anti-icing, and drag-reducing because of their water repellency property. However, their super-hydrophobicity is destroyed under mechanical abrasion due to the vulnerability of the delicate surface textures. Here, we demonstrate a strategy to create a robust superhydrophobic surface using MXene and fluoridated silica as functional fillers in epoxy resin. The fluoridated silica produces low surface energy, MXene serves as a wear-resistant phase and epoxy resin is the binding matrix. The composite coating demonstrates a self-cleaning effect to remove particles from the superhydrophobic surface by rolling water droplets. Moreover, the coating exhibits excellent mechanical durability by standing abrasion to maintain super-hydrophobicity. The superhydrophobic composite coating has the advantages of low cost and feasibility and has the potential for expandable industrial promotion.

Building energy performance evaluation, as an important process in a sustainable building design, has important consequences for global energy conservation and environmental protection. The traditional methods to perform this evaluation are usually time-consuming and computationally complex, and have high requirements for designers’ professional knowledge on architectural physics and software operation skills. To solve these problems and provide rapid, user-friendly, and more accurate prediction results, this study presents an efficient building energy performance evaluation method which integrates building information modeling , energy simulation, and energy consumption prediction together. This method follows a three-stage research framework: Stage 1 proposes a rapid 3D building energy modeling process according to the parameterized setting, Stage 2 generates numerous simulation results automatically by EnergyPlus , and Stage 3 develops the user-friendly building energy consumption prediction model with the help of the Genetic Algorithm-Neural Network (GA-NN) and provides the energy performance level of the building design after the prediction. A case study is carried out to present the overall process and verify the accuracy of the proposed three-stage building energy performance evaluation method. This study contributes to the improvement of both the extensive dataset establishment and the operational efficiency of building energy consumption prediction. It can provide designers with a real-time, user-friendly, and reliable building energy consumption prediction tool and an energy performance assessment basis in the design phase of construction projects.

Pine wilt disease (PWD) is a great danger, due to two aspects: no effective cure and fast dissemination. One key to the prevention and treatment of pine wilt disease is the early detection of infected wood. Subsequently, appropriate treatment can be applied to limit the further spread of pine wilt disease. In this work, a UAV (Unmanned Aerial Vehicle) with a RGB (Red, Green, Blue) camera was employed as it provided high-quality images of pine trees in a timely manner. Seven flights were performed above seven sample plots in northwestern Beijing, China. Then, raw images captured by the UAV were further pre-processed, classified, annotated, and formed the research datasets. In the formal analysis, improved YOLOv5 frameworks that integrated four attention mechanism modules, i.e., SE (Squeeze-and-Excitation), CA (Coordinate Attention), ECA (Efficient Channel Attention), and CBAM (Convolutional Block Attention Module), were developed. Each of them had been shown to improve the overall identification rate of infected trees at different ranges. The CA module was found to have the best performance, with an accuracy of 92.6%, a 3.3% improvement over the original YOLOv5s model. Meanwhile, the recognition speed was improved by 20 frames/second compared to the original YOLOv5s model. The comprehensive performance could well support the need for rapid detection of pine wilt disease. The overall framework proposed by this work shows a fast response to the spread of PWD. In addition, it requires a small amount of financial resources, which determines the duplication of this method for forestry operators.

The tumor microenvironment (TME) influences disease initiation and progression. Cross-talks of cells within TME can affect the efficacy of immunotherapies. However, a precise, concise, and comprehensive TME landscape in neuroblastoma (NB) has not been established. Here, we profiled the TME landscape of 498 NB-related patients on a self-curated gene list and identified three prognostic TMEsubgroups. The differentially expressed genes in these three TMEsubgroups were used to construct a genetic signature of the TME landscape and characterize three GeneSubgroups. The subgroup with the worst overall survival prognosis, the TMEsubgroup/GeneSubgroup3, lacked immune cell infiltration and received the highest scores of MYCN- and ALK-related signatures and lowest scores of immune pathways. Additionally, we found that the GeneSubgroup3 might be benefited from anti-GD2 instead of anti-PD-1 therapy. We further created a 48-gene signature, the TMEscore, to infer prognosis and validated it in three independent NB cohorts and a pan-cancer cohort of 9,460 patients. We did RNA-seq on 16 samples and verified that TMEscore was higher in patients with stage 3/4 than stage 1/2 diseases. The TMEscore could also predict responses for several immunotherapies. After adding clinical features, we found that the nomogram-based score system, the TMEIndex, surpassed the current risk system at predicting survivals. Our analysis explained TME at the transcriptome level and paved the way for immunotherapies in NB.

To research the impact of autophagy on alveolar epithelial cell inflammation and its possible mechanism in the early stages of hypoxia, we established a cell hypoxia-reoxygenation model and orthotopic left lung ischemia-reperfusion model. Rat alveolar epithelial cells stably expressing GFP-LC3 were treated with an autophagy inhibitor (3-MA) or an autophagy promoter (rapamycin), followed by hypoxia-reoxygenation treatment for 2, 4, and 6 hr in vitro. In vivo, 20 male Sprague Dawley rats were randomly divided into four groups (model group: No blocking of the hilum in the left lung; control group: Blocking of the hilum in the left lung for 1 hr with dimethyl sulfoxide lavage; 3-MA group: Blocking of the hilum in the left lung for 1 hr with 100 ml/kg of 3-MA (5 μmol/L) solution lavage; and rapamycin group: Blocking of the hilum in the left lung for 1 hr with 100 ml/kg of rapamycin (250 nmol/L) solution lavage) to establish an orthotopic left lung ischemia model. This study demonstrated that rapamycin significantly suppressed the nuclear factor kappa B signaling pathway and limited the expression of proinflammatory factors. A contrary result was found after the 3-MA pretreatment. These findings indicate that autophagy reduces ischemia-reperfusion injury by repressing inflammatory signaling pathways in the early stages of hypoxia in vitro and in vivo. Autophagy could be a new protective method for application in lung ischemia-reperfusion injury.

Aim: We aimed to investigate the proteomics of primary chondrocyte exosomes and the effect of exosomes in osteoarthritis (OA) treatment. Materials & methods: We isolated exosomes from primary chondrocytes cultured in normal (D0) and inflammatory environments induced by IL-1β and determined the proteomics of these exosomes. Next, we investigated what effect and mechanism D0 chondrocytes exosomes have in OA treatment. Results: There were more proteins that belonged to mitochondrion and were involved in immune system processes in D0 exosomes. Notably, intra-articular administration of D0 exosomes successfully prevented the development of OA. D0 chondrocyte exosomes could restore mitochondrial dysfunction and polarize macrophage response toward an M2 phenotype. Conclusion: Our findings demonstrated that primary chondrocyte exosomes are efficient in OA treatment.

To prospectively assess whether the detection of hepatic hilar lymph nodes (LNs) contributes to the diagnosis of biliary atresia (BA). A total of 80 jaundiced infants were enrolled in this study and had abdominal ultrasound (US). The hepatic hilar LNs, the gallbladder classification, and the triangular cord (TC) thickness of all infants were evaluated. The area under the receiver operating characteristic curve (AUROC) analysis, t tests, and chi-squared tests were used to compare US signs between infants with BA and those without BA. BA was found in 45 patients and excluded in 35 patients. The length of the hepatic hilar LNs in infants with BA (median with interquartile range, 11 mm (8, 13.5)) was significantly greater than that in infants without BA (0 mm (0, 0)) (p

A 20-year-resolution speleothem δ18O record from southern China reveals a detailed Asian summer monsoon (ASM) history between 73.6 and 62.3 ka. ASM changes during Interstadial 19 and late MIS 4 matched Greenland temperature variations but were antiphased with Antarctic temperatures. However, long-term strengthening of the ASM in early MIS 4 agrees well with the gradual Antarctic warming, when Greenland remained in a stable cold state. More specifically, the ASM was less variable during peak interstadials in contrast to striking instabilities during stadials. These observations suggest that the factors dominating ASM variability change through time. During early MIS 4, negligible freshwater perturbations occurred in the North Atlantic, and sea-surface temperatures in the low- to midlatitude Pacific Ocean reached the modern level. Thus, an expansion of the Intertropical Convergence Zone (ITCZ) was likely important for the long-term ASM rise. In late MIS 4, the antiphase correlation between ASM and Antarctic temperature could be attributed to freshwater inputs into the North Atlantic and a southerly positioned ITCZ. Consequently, meridional ITCZ shifts, although within a limited latitudinal band, would result in an antiphase relationship between interhemispheric climate changes. Otherwise, an in-phase correlation could be expected if the centroid of ITCZ is stable along the equator.

Purpose To investigate the causes and treatments of early complications involving laparoscopic radical resection of choledochal cyst and summarize the experience. Methods Children with choledochal cyst treated by laparoscopy in the Department of Pediatric Surgery, Fujian Provincial Maternity and Children’s Hospital, and Guangzhou Women and Children’s Medical Centre, from March 2016 to May 2018, were retrospectively analysed. Demographics, causes and treatments of early complications, liver function analysis and ultrasonography were collected. Results In total, 231 cases were included; 204 were Type I (156 Type Ia and 46 Type Ic) and 27 were Type IV. No mortality was observed, and 224 cases were successfully laparoscopically operated, while 7 cases were converted to open surgery. Fifteen cases of postoperative developed biliary fistula. There were jejunal Roux loop obstruction in 2 cases and multiple intussusception, anastomotic stenosis after hepaticojejunostomy, residual of choledochal cyst and pancreatic fistula in one each. Patients were followed up ranging from 4 months to 48 months (12.6 ± 0.3 months on average). Postoperative ALT, AST, GGT, TBIL and DBIL all returned to normal during this time. Ultrasonography indicated 5 cases of widened Glisson’s sheath and 1 case of intrahepatic hyperdense shadow. Conclusion Early complications of laparoscopic radical resection of choledochal cyst can be minimized by properly managing preoperative indications and contraindications, carefully interpreting the magnetic resonance cholangiopancreatography results and accumulating experience by the surgeons.

Background/Purpose To investigate the clinical manifestations, treatments of retrograde intussusception and summarize the experience. Methods Children with retrograde intussusception treated in our hospital from January 2011 to January 2021 were retrospectively analysed. Demographics, clinical manifestations, preoperative colour Doppler ultrasound (CDU) findings, findings during surgery and follow-up results were collected. Results A total of 4719 cases of intussusception were treated in our department, including 12 cases of retrograde intussusception (0.25%). There were 8 males and 4 females.The age ranged from 4.1 to 14.3 months, with an average of (8.3 ± 2.8) months.; The weight ranged from 5.5 to 12.6 kg, with an average of (9.4 ± 2.3) kg; The onset time ranged from 6 to 15 h, with an average of (10.0 ± 2.4) h. All the children received CDU examination before surgery, and in one case, the possibility of 2 intussusception masses was considered. Emergency surgical exploration was performed after the failure of air enema reduction. During the operation, multiple types of intussusception were found (coincidence of anterograde and retrograde intussusception). The pattern of anterograde intussusception was all ileo-ileo-colic variety and the retrograde intussusception was proximal sigmoid colon into descending colon. All the children were successfully reduced by manual reduction without intestinal necrosis or intestinal malformation. All children were discharged 6–7 days after surgery, and had no recurrence after 3–6 months of follow-up. Conclusions Retrograde intussusception is easily misdiagnosed before surgery. During air enema, if the intussusception mass was fixed and did not move with increasing pressure, we should be aware of the possibility of retrograde intussusception, and the enema pressure should not be too large to avoid intestinal perforation. If the intraoperative position of the intussusception mass was not consistent with that of the preoperative enema, it was recommended to use bimanual examination to explore whether there was still a mass in the abdominal cavity to avoid misdiagnosis.

Biointegration of a keratoprosthesis (KPro) is critical for the device stability and long-term retention. Biointegration of the KPro device and host tissue takes place between the surrounding corneal graft and the central optic (made by poly (methyl methacrylate)). Our previous clinical results showed that auricular cartilage reinforcement is able to enhance the KPro biointegration. However, the auricular cartilage is non-renewable and difficult to acquire. In this study, we developed a novel type of biomaterial using a three-dimensional porous polyethylene glycol acrylate scaffold (3D biological P-scaffold) carrier with chondrocytes differentiated from induced human umbilical cord mesenchymal stem cells (hUC-MSCs) and tested in rabbit corneas. The results showed hUC-MSCs bear stem cell properties and coule be induced into chondrocytes, P-scaffold is beneficial to the growth and differentiation of hUC-MSCs both in vivo and in vitro. Besides, after implanting the P-scaffold into the corneal stroma, no serious immune rejection response, such as corneal ulcer or perforation were seen, suggested a good biocompatibility of P-scaffold with the corneal tissue. Moreover, after implanting P-scaffold in together with the differentiated chondrocytes into the rabbit corneal stroma, they significantly increased corneal thickness and strengthened the host cornea, and chondrocytes could stably persist inside the cornea. In summary, the 3D biological P-scaffold carrying differentiated hUC-MSCs could be the preferable material for KPro reinforcement.

Purpose: To evaluate the short-term safety and long-term efficacy of thoracoscopic surgery for esophageal atresia(EA) in low birth weight infants. Methods: From January 2011 to December 2019,a retrospective analysis on clinical data of 48 cases of low birth weight infants of EA. The clinical data were divided according to surgical methods: Thoracoscopy group A and thoracotomy group B. Variables of intra-operation, postoperative complications and mid-term postoperative complications were compared between the two groups.Results: 3 were discharged due to treatment abandoning. there were 17 cases in thoracoscopy group A and 28 cases in thoracotomy group B. The operation time of group A(172.41±20.00min)was longer than B(149.82±13.91min),the difference was statistically significant (PConclusion: Compared with thoracotomy, thoracoscopy in low weight infants with EA has the advantages of smaller incision, fewer intraoperative bleeding, and less incidence of thoracic deformities. Thoracoscopy might be a feasible surgical option for low weight infants when performed by a surgeon who has rich experience. The major mid-term complications after surgery are esophageal stenosis, gastroesophageal reflux and tracheomalacia.

Background. Wilms tumor is the most common renal malignancy of children. Identifying factors that could predict the prognosis of patients with Wilms tumor is clinically meaningful. Many studies found tumors with elevated cholesterol synthesis that are featured with dismal prognosis. Even in some clinical trials, people with excessive dietary cholesterol intake and high plasma low-density lipoprotein levels are observed to have increased risk for cancer. However, the role of cholesterol biosynthesis in Wilms tumor has not yet been well clarified. Methods. RNA sequencing transcriptome data and all corresponding clinicopathological information used in our study were downloaded from the TARGET database. High-throughput sequencing (Fragments Per Kilobase of transcript per Million fragments mapped) data sets of 130 tumor samples and 6 normal samples were obtained for further analysis. Results. Wilms tumor samples with higher activity of cholesterol synthesis are characterized with worse overall survival ( P < 0.05 ). In addition, Wilms tumor samples with mitigated activity of cholesterol synthesis are featured with better dendritic cell (DC) function and cytolytic activity ( P < 0.05 ). Furthermore, we constructed a prognosis model based on differential expressed cholesterol synthesis-related genes (DECSG), which could predict the OS of patients with Wilms tumor accurately. KEGG and GO analysis of differential expressed genes between tumor samples with high and low cholesterol synthesis indicated that DECSGs are highly enriched in “mitosis nuclear division,” “nuclear division,” “chromosome segregation,” “cell cycle,” “Spliceosome,” and “RNA transport.” Conclusions. In conclusion, our study reported increased cholesterol synthesis in Wilms tumor predicts a worse prognosis and mitigated cytolytic activity, DC function, and MHC I signature in the tumor microenvironment. We also constructed a prognosis model for predicting the OS of patients with good accuracy, which is promising in clinical translation. Future studies should focus on the detailed mechanism that caused increasing cholesterol which promotes tumor progression and undermines patients’ survival.

To develop and validate a biliary atresia (BA) diagnostic score based on serum gamma-glutamyl transferase (GGT) levels and conventional ultrasound features for discriminating BA in patients with jaundice from two centers.A total of 958 patients from one hospital were classified as the derivation cohort, and 725 patients from another hospital were classified as the validation cohort. The optimal GGT cutoff value for diagnosing BA was calculated in the derivation cohort and subsequently verified in the validation cohort. Gallbladder abnormalities and the triangular cord (TC) sign were evaluated in all patients. A BA diagnostic score was developed for diagnosing BA using the GGT levels, gallbladder abnormalities and the TC sign based on the data from the derivation cohort followed by external validation.Based on the optimal cutoff value 350.0 U/L, GGT yielded a sensitivity of 59.3% and specificity of 85.4% in diagnosing BA. The area under the receiver operating characteristic curve (AUC 0.724) was inferior to that of the gallbladder (AUC 0.911, P .001) and comparable to that of the TC sign (AUC 0.771, P = .128). The combination of GGT and ultrasound diagnosis could help to reduce the misdiagnosis of 9 infants with BA. The BA diagnostic score yielded a sensitivity of 93.3% and specificity of 95.0% with the highest AUC in this study (0.941).GGT can add diagnostic value to ultrasound examination when diagnosing BA. The BA diagnostic score based on GGT, gallbladder abnormalities and the TC sign shows satisfactory discrimination abilities in BA.

Purpose: The purpose of this study was to summarize the clinical experience of the laparoscopic-assisted Soave operation for the treatment of Hirschsprung disease in children. Methods: In total, 186 children with Hirschsprung disease participated in this study from January 2014 to January 2019. The Soave operation was used to treat Hirschsprung disease with laparoscopic assistance. Symptoms and signs were followed up at one week, one month, three months, six months, one year and every 1-2 years after the first year. Results: All 186 children underwent laparoscopic surgery successfully, and none progressed to open surgery. During hospitalization and follow-up, there were 49 patients with complications, including 1 patient with an anastomotic leakage, 1 with an anal stricture, 5 with constipation recurrence, 5 with dirty defecation, 22 with enterocolitis, and 15 with perianal erosion. There were no complications such as abdominal bleeding, abdominal infection, ureter injury, adhesive intestinal obstruction, anastomotic stricture, incontinence. Conclusion: The laparoscopic-assisted Soave operation is a safe and feasible method for the treatment of Hirschsprung disease in children. This method has the advantages of less trauma and good cosmetic effects.

General anesthetics (GA) has been discovered for centuries and was often used in surgeries. However, many patients are dying from the usage of GA for different reasons. Although scientists are working on to solve the problems, the mechanism of GA is still a mystery. Recently, scientists from Duke University found neurons that are active during sleep can be activated in anesthesia. These neurons are called Anesthetic Activated Neurons (AANs). This is a massive step for us to break the mystery. In this paper, we designed an experiment that aims to reveal one mechanism of GA: the relationship between sleep-related neurons and sensation of pain under the use of GA. The designed experiment involves several control groups that consist of mice with different treatments on their genes and different GA.

Aim This study explored the clinical effects of WeChat-based peri-operative care on parents of children with congenital megacolon. Methods Participants were randomly divided into WeChat group and telephone group. This study explored parents' knowledge of the care of children with megacolon, the follow-up rate of children, post-operative defaecation function and complications. Results WeChat group scored better in nursing knowledge than telephone group, and the difference was statistically significant. The lost follow-up rate in WeChat group was lower than that in telephone group, and the difference was statistically significant. Post-operative defaecation was also better in the WeChat group than in the phone group. Most complications in the phone group were significantly higher than those in the WeChat group. Conclusion Peri-operative care for parents of children with megacolon through WeChat can effectively enhance the level of parental care knowledge, improve defaecation, reduce the occurrence of certain complications and reduce lost follow-up.

The aggregation behavior of collagen-based materials plays an important role in their processing because it could affect their physicochemical properties. Based on the intrinsic fluorescence characteristic of tyrosine, fluorescence spectrum technology was used to investigate the aggregation state of the acylated collagen molecules in aqueous solution. The results showed that the aggregate degree of the acylated collagen was higher than that of the native collagen due to the hydrophobic interaction. With the increase of concentrations of the acylated collagen or at NaCl higher than 40 mmol/L, the aggregate degree of the acylated collagen molecules increased. When the pH was close to the isoelectric point of the acylated collagen, the hydrophobic interaction and the hydrogen bond helped to increase the aggregation degree. However, with the increase of temperature (10–70 ℃), the aggregation state of the acylated collagen decreased gradually due to the quenching, the molecular collision, and the broken of hydrogen bonds. Furthermore, two-dimensional correlation spectroscopy (2D-COS) showed that the response order was 360 > 305 nm at various acylated collagen and NaCl (>40 mmol/L) concentrations, while the response order was 305 > 360 nm when the pH value was increased from 5.0 to 9.0. Temperature-dependent 2D-COS showed there were four bands that occurred and the response order was listed as follows: 293 > 305 > 360 > 420 nm. In brief, the results might provide an important guide for molding processes of the acylated collagen.

The dynamical adjustment process (DAP) is a requisite for climate system to arrange for a new equilibrium state. To evaluate the detailed structure of DAP during Heinrich Stadial (HS), high-resolution speleothem-based Asian summer monsoon (ASM) variability was reconstructed, separately covering HSs 5 to 1. In these calcite δ18O records, a gradual increase of ASM intensity is evident in each mid-HS, followed by a centennial-scale ASM stability lasting on average 590 years during late HS. At this time, δ18O values decrease by 1%, about 50% of the total HS, compared with maximum values in early HS. This structure of monsoonal HS in speleothem records is not reflected in temperature variations at the Greenland, but is well mirrored in middle- to low latitudes within the northern hemisphere, and even southern oceanic records. It suggests that southern and low-latitude climate conditions are likely important for the termination of HS. Thus, a DAP of about 400–600 years is a precondition for the ASM sub-system to prepare for a new equilibrium.

Introduction Hirschsprung's disease (HD) is one of the most common and severe diseases treated in pediatric surgery. Since the introduction of the laparoscopic technique into pediatric surgery, laparoscopic-assisted radical surgery for HD has demonstrated unique advantages. Long-segment and total-colon HD are the best indications for laparoscopic-assisted surgery. Aim To summarize clinical experience of the laparoscopic Soave procedure for long-segment HD in a single center. Material and methods The data of children with long-segment HD who underwent the laparoscopic Soave procedure in our department from January 2013 to May 2018 were reviewed. The clinical features, surgical procedures and follow-up results were summarized and analyzed. Results Thirty-one children underwent the laparoscopic Soave procedure; none of them were converted to open surgery. The average hospitalization time was 8.7 days after the operation, and no immediate postoperative complications occurred. There was no recurrence of constipation. Six (19.3%) cases were complicated with HD associated enterocolitis in the first 3 months postoperatively; 5 (16.1%) cases had soiling in the first year. There were 0 cases of adhesive bowel obstruction, 0 cases of anastomotic stenosis, and 0 cases of constipation. Conclusions A small volume centre may achieve satisfactory results for long-segment HD. The laparoscopic Soave procedure is a minimally invasive, safe and effective treatment.

To research the impact of autophagy on alveolar epithelial cell inflammation and its possible mechanism in early stages of hypoxia, we established a cell hypoxia-reoxygenation model and orthotopic left lung ischemia-reperfusion model. Rat alveolar epithelial cells stably expressing GFP-LC3 were treated with an autophagy inhibitor (3-methyladenine, 3-MA) or autophagy promoter (rapamycin), followed by hypoxia-reoxygenation treatment at 2, 4 and 6h in vitro. In vivo, twenty-four male Sprague-Dawley rats were randomly divided into four groups (model group: no blocking of hilum in the left lung; control group: blocking of hilum in the left lung for 1h with DMSO lavage; 3-MA group: blocking of hilum in the left lung for 1h with 100ml/kg of 3-MA (5μmol/L) solution lavage; rapamycin group: blocking of hilum in the left lung for 1h with 100ml/kg of rapamycin (250nmol/L) solution lavage) to establish an orthotopic left lung ischemia model. This study demonstrated that rapamycin significantly suppressed the NF-κB signaling pathway, restrained the expression of pro-inflammatory factors. A contrary result was confirmed by 3-MA pretreatment. These findings indicate that autophagy reduces ischemia-reperfusion injury by repressing inflammatory signaling pathways in the early stage of hypoxia in vitro and in vivo. This could be a new protective method for lung ischemia-reperfusion injury.

The correlation of East Asian summer and winter monsoons (EASM and EAWM) is believed to be variable at various timescales and under different climate backgrounds. In order to address this issue, high-resolution δ18O (depleted values indicating a strong EASM) and δ13C records (depleted values representing a weak EAWM) from three stalagmites, covering Marine Isotope Stages (MIS) 4 and 3, are reconstructed from an alpine cave in central China. During MIS 4, millennial-scale changes are clear in δ18O and δ13C records, while the δ13C is only characterized by centennial-scale variability across MIS 3. Changes in these speleothem δ13C records are supported by pollen records from the same area, which suggested millennial-scale alternations between conifer and deciduous broadleaf forests during MIS 4 and a stable C3-type vegetation in MIS 3. After detrended, δ18O changes are positively correlated with the δ13C record at a centennial scale, indicating an anti-phase of EASM and EAWM. In early MIS 4, however, an in-phase relationship of EASM and EAWM can be observed at a millennial scale. Thus, an anti-phased EASM/EAWM can be expected at a centennial scale, while a complicated correlation is seen at a millennial scale. These results imply a variable EASM/EAWM phase relationship under varying climatic conditions through the geological records and at different timescales.

the classical method for detecting and distinguishing gross errors considers redundant observation components, and inner and external reliabilities are the important robustness indicators of an adjustment. It employs data snooping successively to detect gross errors and find dubitable observations, and correlation coefficients to distinguish two gross errors. Based on the method, we systematically and completely investigate the effects of common point distributions and adjustment models on the redundant observation component, interior and exterior reliabilities, and gross error distinguish ability, and find some reliable and directive results.