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Abstract Moiré systems featuring flat electronic bands exhibit a vast landscape of emergent exotic quantum states, making them one of the resourceful platforms in condensed matter physics. Tuning these systems via twist angle and the electric field greatly enhances our comprehension of their strongly correlated ground states. Here, we report a technique to investigate the nuanced intricacies of band structures in dual-gated multilayer graphene systems. We utilize the Landau levels of a decoupled monolayer graphene to extract the electric field-dependent bilayer graphene charge neutrality point gap. Then, we extend this method to analyze the evolution of the band gap and the flat bandwidth in twisted mono-bilayer graphene. The band gap maximizes at the same displacement field where the flat bandwidth minimizes, concomitant with the emergence of a strongly correlated phase. Moreover, we extract integer and fractional quantum Hall gaps to further demonstrate the strength of this method. Our technique paves the way for improving the understanding of electronic band structures in versatile flat band systems.

Thoracic surgery encompasses the diagnosis and treatment of various chest diseases such as lung cancer, esophageal cancer, and mediastinal tumors. The treatment plans for these diseases are complex and often involve a combination of surgery, chemotherapy, and radiotherapy, each with different impacts on the patient's quality of life. Patient-reported outcomes (PRO) and shared decision-making (SDM) are becoming increasingly important in this field. PRO allows patients to directly report their health status and the effects of treatment, aiding doctors in adjusting treatment plans. SDM ensures that treatment plans align with the patient's personal values and preferences through information sharing and joint decision-making. The comprehensive application of PRO and SDM can enhance patient satisfaction and treatment outcomes, though it also faces challenges such as data collection and time management. Future research should focus on developing more efficient PRO tools and SDM processes to improve patient-centered healthcare quality.

Porphyromonas gingivalis is a key pathogenic microorganism that triggers periodontitis. It is closely associated with oral diseases such as chronic periodontitis and recently found to have a significant correlation with the occurrence, progression, and prognosis of cancer. As the leading malignant tumor in terms of both incidence and mortality worldwide, lung cancer has always been a focus and hotspot of research. The causes of lung cancer are complex and involve multiple factors, including smoking, occupational factors, air pollution, ionizing radiation, diet and nutrition, genetic factors, etc. Researchers have also begun to pay attention to the relationship between oral microbiota and overall health, especially the link with lung cancer. The article summarizes the latest advancements in research on Porphyromonas gingivalis in lung cancer, primarily encompassing etiology and pathogenic mechanisms, and explores its potential as a therapeutic target for lung cancer, aiming to provide new insights and directions for lung cancer prevention and treatment strategies.

A new Gekko (subgenus Japonigekko) species, Gekko alpinus sp. nov., is described from the Jinsha River Basin in southwestern China, between the border of Mangkang County, Xizang Autonomous Region and Batang County, Sichuan Province, according to the integrative taxonomic results combining molecular data and morphological characters obtained from the type series comprising 11 specimens. Our molecular phylogeny inferred from the mitochondrial 16S and ND2 gene fragments indicated that this new species is most closely related to Gekko jinjiangensis, but a considerable amount of genetic divergence exists between them (p-distance: 3.6%-4.1% (16S) and 7.1%–9.1% (ND2)). The new species can be distinguished from its congeners via a combination of series morphological characters. The discovery of this new species marks the highest altitudinal range (2400 to 2542 m a.s.l.) recorded for the subgenus Japonigekko and also represents a new provincial record for the genus in Xizang Autonomous Region.

In response to the unclear understanding of fracture propagation and intersection interference in zipper fracturing under the factory development model of deep shale gas wells, a coupled hydro-mechanical model for zipper fracturing considering the influence of natural fracture zones was established based on the finite element – discrete element method. The reliability of the model was verified using experimental data and field monitoring pressure increase data. Taking the deep shale gas reservoir in southern Sichuan as an example, the propagation and interference laws of fracturing fractures under the influence of natural fracture zones with different characteristics were studied. The results show that the large approaching angle fracture zone has a blocking effect on the forward propagation of fracturing fractures and the intersection of inter well fractures. During pump shutdown, hydraulic fractures exhibit continued expansion behavior under net pressure driving. Under high stress difference, as the approaching angle of the fracture zone increases, the response well pressure increase and the total length of the fractured fracture show a trend of first decreasing and then increasing, and first increasing and then decreasing, respectively. Compared to small approach angle fracture zones, natural fracture zones with large approach angles require longer time and have greater difficulty to intersect. The width of fractures and the length of natural fractures are negatively and positively correlated with the response well pressure increase, respectively, and positively and negatively correlated with the time required for intersection, the total length of hydraulic fractures, and fracturing efficiency, respectively. As the displacement distance of the well increases, the probability of fracture intersection decreases, but the regularity between displacement distance and the response well pressure increase and the total length of fractures is not obvious.

Abstract Background Weaning causes redox dyshomeostasis in piglets, which leads to hepatic oxidative damage. Microbe-derived antioxidants (MA) have great potential for anti-oxidation. This study aimed to investigate changes in hepatic redox system, mitochondrial function and apoptosis after weaning, and effects of MA on growth performance and liver health in weaning piglets. Methods This study consisted of 2 experiments. In the both experiments, piglets were weaned at 21 days of age. In Exp. 1, at 21 (W0), 22 (W1), 25 (W4), 28 (W7), and 35 (W14) days of age, 6 piglets were slaughtered at each timepoint. In Exp. 2, piglets were divided into 2 groups: one received MA gavage (MA) and the other received saline gavage (CON). At 25 days of age, 6 piglets from each group were sacrificed. Results In Exp. 1, weaning caused growth inhibition and liver developmental retardation from W0 to W4. The mRNA sequencing between W0 and W4 revealed that pathways related to “regulation of apoptotic process” and “reactive oxygen species metabolic process” were enriched. Further study showed that weaning led to higher hepatic content of reactive oxygen species (ROS), H2O2 and O2 −. Weaning enhanced mitochondrial fission and suppressed their fusion, activated mitophagy, thus triggering cell apoptosis. In Exp. 2, MA improved growth performance of piglets with higher average daily gain (ADG) and average daily feed intake (ADFI). The hepatic ROS, as well as products of oxidative damage malonaldehyde (MDA) and 8-hydroxy-2′-deoxyguanosine (8-OHdG) in the MA group decreased significantly than that of the CON group. The MA elevated mitochondrial membrane potential, increased activity of mitochondrial respiratory chain complexes (MRC) I and IV, enhanced mitochondrial fusion and reduced mitophagy, thus decreasing cell apoptosis. Conclusions The present study showed that MA improved the growth performance of weaning piglets and reversed weaning-induced oxidative damage, mitochondrial dysfunction, and apoptosis. Our results suggested that MA had promising prospects for maintaining liver health in weaning piglets and provided a reference for studies of liver diseases in humans. Graphical Abstract

Abstract Purpose One of the most frequent side effects of radical prostatectomy (RP) is urinary incontinence. The primary cause of urine incontinence is usually thought to be impaired urethral sphincter function; nevertheless, the pathophysiology and recovery process of urine incontinence remains unclear. This study aimed to identify potential risk variables, build a risk prediction tool that considers preoperative urodynamic findings, and direct doctors to take necessary action to reduce the likelihood of developing early urinary incontinence. Methods We retrospectively screened patients who underwent radical prostatectomy between January 1, 2020 and December 31, 2023 at the First People ‘s Hospital of Nantong, China. According to nomogram results, patients who developed incontinence within three months were classified as having early incontinence. The training group’s general characteristics were first screened using univariate logistic analysis, and the LASSO method was applied for the best prediction. Multivariate logistic regression analysis was carried out to determine independent risk factors for early postoperative urine incontinence in the training group and to create nomograms that predict the likelihood of developing early urinary incontinence. The model was internally validated by computing the performance of the validation cohort. The nomogram discrimination, correction, and clinical usefulness were assessed using the c-index, receiver operating characteristic curve, correction plot, and clinical decision curve. Results The study involved 142 patients in all. Multivariate logistic regression analysis following RP found seven independent risk variables for early urinary incontinence. A nomogram was constructed based on these independent risk factors. The training and validation groups’ c-indices showed that the model had high accuracy and stability. The calibration curve demonstrates that the corrective effect of the training and verification groups is perfect, and the area under the receiver operating characteristic curve indicates great identification capacity. Using a nomogram, the clinical net benefit was maximised within a probability threshold of 0.01–1, according to decision curve analysis (DCA). Conclusion The nomogram model created in this study can offer a clear, personalised analysis of the risk of early urine incontinence following RP. It is highly discriminatory and accurate, and it can help create efficient preventative measures and identify high-risk populations.

Abstract The southern Himalayas, characterized by its dense population and hot, humid summers, are confronted with some of the world’s most severe heat stress risks. This study uses the hourly ERA5 dataset (1979–2022) and CMIP6 projections (2005–2100) to evaluate past and future heat stress based on the Wet Bulb Globe Temperature (WBGT). This has significant implications for the management of occupational workloads in the southern Himalayas. Heat stress levels are classified into 6 categories (0 to 5) using WBGT threshold intervals of 23 °C, 25 °C, 28 °C, 30 °C, and 33 °C. With heat stress surpassing level 3 for almost half of the time, people are constrained to engage in less than moderate workloads to ensure their health remains uncompromised. Flow-analogous algorithm is employed to contextualize the unprecedented heat stress case in the summer of 2020 and the associated atmospheric circulation patterns from historical and future perspectives. The results show that over 80% of the time in 2020, heat stress levels were at 3 and 4. The identified circulation pattern explains 27.6% of the extreme intensity, and such an extreme would have been nearly impossible in pre-21st-century climate conditions under the identified pattern. Future projections under SSP2-4.5 and SSP5-8.5 scenarios indicate that heat stress similar to what was experienced in 2020 will likely become a common occurrence across the southern Himalayas. Under a similar circulation pattern, the heat stress levels by the end of the 21st century would be elevated by at least one category compared to the climatic baseline in over 70% of the region, leading to an additional 120.5 (420.1) million daily population exposed to the highest heat stress level under the SSP2-4.5 (SSP5-8.5) scenario.

In the context of the Anthropocene, the unparalleled degradation of ecosystem services (ES) has been driven by the intricate nature of ecosystems and their responsive interplay with human actions. This underscores the paramount importance of forecasting and managing these services for regional sustainability. However, a comprehensive understanding of the correlated impacts and driving factors of the spatial patterns of ES remains elusive. In this study, we utilize the dynamic Bayesian belief network (DBN) to infer the probabilistic changes in ecosystem services (biodiversity conservation, carbon storage, soil retention, water regulation, net primary productivity, and crop production) under the influence of climate change and human activities in the Yangtze River Delta urban agglomeration. Through this investigation, we discern conspicuous discrepancies in the impacts of climate and human activities on various ecosystem services and their spatial differentiations in the Yangtze River Delta urban agglomeration. The dynamic Bayesian belief network model reveals that geographical factors and land use play pivotal roles in shaping the spatial patterns of ecosystem services. Concerning spatial differentiation, Water yield (WY) and Biodiversity maintenance (BM) exhibit heightened sensitivity to changes in precipitation, while Net primary productivity (NPP) is significantly influenced by variations in vegetation cover and temperature. Moreover, land use and land cover, as reflections of human activities, greatly affect Carbon storage (CF) through the expansion of construction land and the loss of forested areas. Soil retention (SR), on the other hand, is predominantly influenced by rainfall. Spatial variations in Crop production (CP) are found to be contingent on the extent of vegetation cover. In summary, our findings unveil the non-linear relationships among ecosystem services and their direct and indirect responses to climate change and human activities. These insights hold crucial implications for supporting land-use planning based on ecosystem services.

Surface sediment samples were collected from the surrounding waters of the two largest tourist islands in Sanya, China, to compare and evaluate the sources, distribution, and ecological risks of 21 organochlorine pesticides (OCPs). The total concentration of OCPs ranged from 1.35 to 5.0 ng/g. Among the OCPs, ΣDDTs accounted for the largest proportion, followed by ΣHCHs. The concentrations of HCHs and DDTs from the west side of West Island were significantly higher than those from the east side, and fine-grained sediments exhibited a stronger adsorption effect on OCPs. Source analysis indicated that the area experienced new inputs of HCH pollutants, while historical residues of HCHs remained high. Residual OCPs are still widely present in the environment, transported mainly by river runoff, with a smaller portion originating from atmospheric deposition and ship paints. Ecological risk assessment results showed that factors occasionally causing adverse biological effects include Heptachlor epoxide, 4,4'-DDE, ΣDDT, Dieldrin, Endrin, and γ-HCH, while other factors rarely caused negative biological effects. Potential ecological effect evaluations indicated that stations SY03, SY04, SY06, and SY09 were classified as having moderate ecological effect levels, while other stations were classified as having no ecological effects. Strengthened investigation, monitoring, and control of pollutant sources in ecologically impacted areas are necessary. This study fills a data gap for the region and provides an academic foundation for environmental protection and the sustainable development of tourism resources.

Abstract Computational imaging methods empower modern microscopes to produce high-resolution, large field-of-view, aberration-free images. Fourier ptychographic microscopy can increase the space-bandwidth product of conventional microscopy, but its iterative reconstruction methods are prone to parameter selection and tend to fail under excessive aberrations. Spatial Kramers–Kronig methods can analytically reconstruct complex fields, but is limited by aberration or providing extended resolution enhancement. Here, we present APIC, a closed-form method that weds the strengths of both methods while using only NA-matching and darkfield measurements. We establish an analytical phase retrieval framework which demonstrates the feasibility of analytically reconstructing the complex field associated with darkfield measurements. APIC can retrieve complex aberrations of an imaging system with no additional hardware and avoids iterative algorithms, requiring no human-designed convergence metrics while always obtaining a closed-form complex field solution. We experimentally demonstrate that APIC gives correct reconstruction results where Fourier ptychographic microscopy fails when constrained to the same number of measurements. APIC achieves 2.8 times faster computation using image tile size of 256 (length-wise), is robust against aberrations compared to Fourier ptychographic microscopy, and capable of addressing aberrations whose maximal phase difference exceeds 3.8π when using a NA 0.25 objective in experiment.

Flexible strain sensors based on textiles have attracted extensive attention owing to their light weight, flexibility, and comfort when wearing. However, challenges in integrating textile strain sensors into wearable sensing devices include the need for outstanding sensing performance, long‐term monitoring stability, and fast, convenient integration processes to achieve comprehensive monitoring. The scalable fabrication technique presented here addresses these challenges by incorporating customizable graphene‐based sensing networks into knitted structures, thus creating sensing sleeves for precise motion detection and differentiation. The performance and real‐world application potential of the sensing sleeve are evaluated by its precision in angle estimation and complex joint motion recognition during intra‐ and intersubject studies. For intra‐subject analysis, the sensing sleeve only exhibits a 2.34° angle error in five different knee activities among 20 participants, and the sensing sleeves show up to 94.1% and 96.1% accuracy in the gesture classification of knee and elbow, respectively. For inter‐subject analysis, the sensing sleeve demonstrates a 4.21° angle error, and it shows up to 79.9% and 85.5% accuracy in the gesture classification of knee and elbow, respectively. An activity‐guided user interface compatible with the sensing sleeves for human motion monitoring in home healthcare applications is presented to illustrate the potential applications.

Objectives Identifying high-risk paediatric patients with a poor prognosis and providing timely and adequate treatment are critical. This study aimed to evaluate the effects of different types of cardiac enzyme spectrum within 24 hours of admission on the short-term prognosis of patients in paediatric intensive care units.Design A retrospective study.Setting A single-centre, tertiary care hospital in China, with patient data from 2010 to 2018.Participants A total of 4343 critically ill children were enrolled.Intervention None.Primary and secondary outcome measures The main outcome measure was in-hospital mortality, which was defined as death from any cause during hospitalisation. The secondary outcome was 30-day mortality, intensive care unit (ICU) length of stay (LOS) and total LOS.Results Using the local polynomial regression fitting method, an approximately linear increase in in-hospital mortality was detected for creatine kinase (CK), creatine kinase MB (CK-MB), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH). Among the different types of cardiac enzyme spectrum, LDH had the highest area under the curve value (0.729), followed by AST (0.701), CK-MB (0.613) and CK (0.557). The Kaplan‒Meier analysis showed that the patients in the high LDH group had higher 30-day mortality. The multivariate logistic regression revealed that high LDH was independently associated with in-hospital mortality (OR 2.45, 95% CI 1.84 to 3.24). After propensity score matching (PSM) and sensitivity analysis, the results remained consistent.Conclusions LDH is a reliable outcome predictor in critically ill children, including those with various comorbidities.

Abstract Thymoma is a rare malignancy with usual location in the antero-superior mediastinum. Ectopic cervical thymoma (ECT) is an extremely rare tumor that originates from ectopic tissue, and is caused by the aberrant migration of the embryonic thymus. Our patient was a 56-year-old man who had a nodular lesion in the neck for several years. Computed tomography and Enhanced magnetic resonance imaging were performed. He underwent surgery, and a histological examination resulted in a diagnosis of type AB thymoma.

Abstract Segmentectomy is widely used to treat pulmonary nodules and more functional lungs can be preserved in patients. For pulmonary nodules deep near the intersegmental border, only one single segmentectomy may not achieve adequate surgical margins, and combined subsegmental resection becomes the most suitable treatment option. Thoracoscopic combined anatomical resections involving both of right S9 and S10b are one of the most challenging cases, especially in the right chest. We previously reported a case of combined subsegmental resection of the left complex basal segment (LS9b + 10b). To our knowledge, there has been no report of combined subsegmental resection of the right S9 and S10b. Here, we aim to introduce a different technique named as “open-gate”, which means that the intersegmental border between S7 and S10 was cut open along the intersegmental septa, to deal with complex combined basal subsegmental resections.

Single-sided formwork supporting systems (SFSSs) play a crucial role in the urban construction of retaining walls using cast-in-place concrete. By supporting the formwork from one side, an SFSS can minimize its spatial footprint, enabling its closer placement to boundary lines without compromising structural integrity. However, existing SFSS designs struggle to achieve a balance between mechanical performance and lightweight construction. To address these limitations, an innovative instrumented SFSS was proposed. It is composed of a panel structure made of a panel, vertical braces, and cross braces and a supporting structure comprising an L-shaped frame, steel tubes, and anchor bolts. These components are conducive to modular manufacturing, lightweight installation, and convenient connections. To facilitate the optimal design of this instrumented SFSS, a physics-constrained generative adversarial network (PC-GAN) approach was proposed. This approach incorporates three objective functions: minimizing material usage, adhering to deformation criteria, and ensuring structural safety. An example application is presented to demonstrate the superiority of the instrumented SFSS and validate the proposed PC-GAN approach. The instrumented SFSS enables individual components to be easily and rapidly prefabricated, assembled, and disassembled, requiring only two workers for installation or removal without the need for additional hoisting equipment. The optimized instrumented SFSS, designed using the PC-GAN approach, achieves comparable deformation performance (from 2.49 mm to 2.48 mm in maxima) and slightly improved component stress levels (from 97 MPa to 115 MPa in maxima) while reducing the total weight by 20.85%, through optimizing panel thickness, the dimensions and spacings of vertical and lateral braces, and the spacings of steel tubes. This optimized design of the instrumented SFSS using PC-GAN shows better performance than the current scheme, combining significant weight reduction with enhanced mechanical efficiency.

Abstract Offshore wind farms, a rapidly expanding sector within wind energy, are playing a significant role in achieving global carbon neutrality, and this trend is to continue. Here, we utilize ERA5 reanalysis to correct offshore wind speed trends predicted by CMIP6 models. This approach led to enhanced projections for changes in offshore Wind Power Density (WPD) under four Shared Socioeconomic Pathways (SSPs) scenarios. Throughout the 21st century, global offshore WPD is projected to follow an upward trend across all SSP scenarios. Notably, Europe stands out with the most substantial increase in offshore WPD among regions with higher current installations, projected to reach up to 26% under 4°C global warming. Our study uncovers a notable increase of global offshore WPD in a warmer climate, which offers valuable insights for the strategic planning of future global wind energy.

ABSTRACT During the harvesting of waste straw in the field, a self-propelled baler undergoes significant oscillations in the longitudinal direction around its centre of gravity, which greatly affect the stability of operation and the comfort of the driver. In order to analyse the vibration characteristics of the main frame under multi-source excitation, the complete frame is divided into a chassis frame and a baling frame. A nine-degree-of-freedom vibration system model of the whole machine is established based on the relationship between the internal motion devices, and simulations are carried out using MATLAB/Simulink. In addition, a multi-body dynamics simulation of the compression device is carried out, and the law governing the variation in force at different unit points of the mechanism is analysed. Finally, the vibration response of the main frame under different working conditions is explored. The results show that the main frequency component of the frame in the no-load state is 80 Hz, and the main response frequency of the frame is about 1.6 Hz, a finding that is consistent with the operating frequency of the compression mechanism. In particular, the displacement amplitude of the simulated signal at the centroid position is consistent with that measured in experiments, which verifies the validity of the dynamic model. Our results can provide guidance for future work aiming to further reduce the body vibration amplitude and optimise the design of the frame.

BackgroundThe clinical value of preoperative immunochemotherapy and simple chemotherapy induction regimen in the conversion therapy of locally advanced unresectable esophageal squamous cell carcinoma (ESCC) is still unclear.MethodRetrospective analysis was conducted on patients with unresectable cT4b stage ESCC who underwent conversion surgery in our hospital from January 2020 to December 2022. According to the preoperative induction treatment plan, they were divided into induction immunochemotherapy group (iICT group) and induction chemotherapy group (iCT group). The conversion surgery rate, R0 resection rate, radiological and pathological tumor responses, safety, and short-term survival outcomes were analyzed.ResultsThe results showed that a total of 199 patients with cT4b locally advanced unresectable ESCC who underwent preoperative induction therapy were included in this study. Among them, there were 64 cases (32.2%) in the iICT group, 135 cases (67.8%) in the iCT group. There was a statistically significant difference in objective response rate (73.5% vs 48.9%) and conversion surgery rate (81.3% vs 66.7%), between the iICT and iCT groups (P=0.001 and P=0.019). Among the two groups of patients who underwent surgery, there were statistically significant differences in R0 resection rate (94.2% vs 82.2%) and pathological complete remission rate (23.1% vs 6.7%) between the iICT and iCT groups (P=0.043 and P=0.004). And there was no statistically significant difference in the incidence of grade 3 and above between two groups (P=0.928). The 2-year EFS of the iICT group and iCT group were 76.4% and 42.4%, respectively, with statistically significant differences (P=0.006).ConclusionsCompared with simple chemotherapy, the combination of PD-1 inhibitors and chemotherapy can achieve better conversion surgery rate, tumor response and event-free survival in the conversion therapy of locally advanced unresectable ESCC.

Summary: Comprehending the determinants of host-associated microbiota is pivotal in microbial ecology. Yet, the links between climatic factors and variations in host-associated microbiota necessitate further clarification. Mountain-dwelling amphibians, with limited dispersal abilities, serve as valuable models for addressing these questions. Our study, using 126 amphibian-associated microbial samples (64 gut and 62 skin) and 101 environmental microbial samples (51 soil and 50 water) from the eastern Tibetan Plateau, revealed host factors as primary drivers of the variations in host-associated microbiota. However, climatic factors contributed to additional variations in gut microbial beta-diversity and skin microbial function. Water microbiota were identified as a significant contributor to the amphibian-associated microbiomes, with their climate-driven variations mediating an indirect association between the variations in climatic factors and host-associated microbiota. These findings extend our understanding of the assembly of host-associated microbiota in amphibians, emphasizing the significance of microbiota in evaluating the impact of climate change on animals.

As a new diagnosis and treatment decision-making model, shared decision making (SDM) can effectively solve the problem of patient compliance in the diagnosis and treatment of thoracic tumors, balance the status of both doctors and patients, and gradually get attention and application in the clinical practice of thoracic surgery. The application of SDM in the diagnosis and treatment of thoracic tumors is conducive to improve doctors' diagnosis and treatment level and alleviating the pressure of responsibility, reduce patients' psychological pressure and improve patients' compliance and also improve medical trust and reduce doctor-patient conflict. Due to the limited medical literacy and autonomy of patients, the time for diagnosis and treatment is short due to the imbalance of doctor-patient ratio. Meanwhile, due to the limited sample size of existing studies, SDM model cannot be proved to have a clear gain for the treatment of thoracic tumors, and the implementation of SDM model still faces resistance. In the future, the development of auxiliary decision-making system and the improvement of doctors' humanistic care ability will be conducive to promote the practical application of SDM model in thoracic surgery.

The existing surface electromyography-based pattern recognition system (sEMG-PRS) exhibits limited generalizability in practical applications. In this paper, we propose a stacked weighted random forest (SWRF) algorithm to enhance the long-term usability and user adaptability of sEMG-PRS. First, the weighted random forest (WRF) is proposed to address the issue of imbalanced performance in standard random forests (RF) caused by randomness in sampling and feature selection. Then, the stacking is employed to further enhance the generalizability of WRF. Specifically, RF is utilized as the base learner, while WRF serves as the meta-leaning layer algorithm. The SWRF is evaluated against classical classification algorithms in both online experiments and offline datasets. The offline experiments indicate that the SWRF achieves an average classification accuracy of 89.06%, outperforming RF, WRF, long short-term memory (LSTM), and support vector machine (SVM). The online experiments indicate that SWRF outperforms the aforementioned algorithms regarding long-term usability and user adaptability. We believe that our method has significant potential for practical application in sEMG-PRS.

Abstract Background Dysbacteriosis of intestinal tract may cause systemic inflammation, making distant anatomical locations more susceptible to illness. Recent research has demonstrated that the microbiome can affect both prostatitis and the inflammation of the prostate that is linked to prostate cancer. It is still unclear, though, whether this relationship indicates causation. We conducted a Mendelian randomization investigation on two samples to fully uncover gut microbiota’s potential genetic causal role in prostatitis. Method Prostatitis (1859 prostatitis cases and 72,799 controls) was utilized as the outcome, while SNPs highly linked with 196 microbial taxa (18 340 people) were chosen as instrumental factors. Random effects, inverse variance weighting, weighted medians, and MR-Egger were used to analyze causal effects. The Cochran’s Q test, funnel plot, leave-one-out analysis, and MR-Egger intercept test were all used in the sensitivity analysis. Results A causal effect in lowering the incidence of prostatitis is anticipated for five gut microorganisms (Methanobacteria, Methanobacteriaceae, Erysipelatoclostridium, Parasutterella, and Slackia; P

Abstract. Background:. The KangDuo-Surgical Robot-01 (KD-SR-01) system is a new surgical robot recently developed in China. The aim of this study was to present our single-center experience and mid-term outcomes of urological procedures using the KD-SR-01 system. Methods:. From August 2020 to April 2023, consecutive urologic procedures were performed at Peking University First Hospital using the KD-SR-01 system. The clinical features, perioperative data, and follow-up outcomes were prospectively collected and analyzed. Results:. A total of 110 consecutive patients were recruited. Among these patients, 28 underwent partial nephrectomy (PN), 41 underwent urinary tract reconstruction (26 underwent pyeloplasty, 3 underwent ureteral reconstruction and 12 underwent ureterovesical reimplantation [UR]), and 41 underwent radical prostatectomy (RP). The median operative time for PN was 112.5 min, 157.0 min for pyeloplasty, 151.0 min for ureteral reconstruction, 142.5 min for UR, and 138.0 min for RP. The median intraoperative blood loss was 10 mL for PN, 10 mL for pyeloplasty, 30 mL for ureteral reconstruction, 20 mL for UR, and 50 mL for RP. All procedures were successfully completed without conversion, and there were no major complications in any patient. The median warm ischemia time of PN was 17.3 min, and positive surgical margin was not noted in any patient. The overall positive surgical margin rate of RP was 39% (16/41), and no biochemical recurrence was observed in any RP patient during the median follow-up of 11.0 months. The surgical success rates of pyeloplasty and UR were 96% (25/26) and 92% (11/12) during the median follow-up of 29.5 months and 11.5 months, respectively. Conclusion:. The KD-SR-01 system appears feasible, safe, and effective for most urological procedures, based on our single-center experience.

Abstract Background The successful implementation of the Enhanced recovery after surgery (ERAS) concept in thoracic surgery has made it possible to complete the surgery in the day surgery unit. However, it is still unclear whether day surgery for lung cancer patients can achieve the same or even better results. Methods A systematic literature search was completed in common databases for studies published before May 2022 and the data analyzed using the Review Manager 5.3 software. Results We ultimately included 7 retrospective articles that met our criteria for the study. The results of age, smoking status, comorbidity and pulmonary function tests in day surgery group were better than in inpatient surgery group. Minimally invasive surgical method with segmentectomy was more used in day surgery group than in normal surgery group. The 30-day mortality was also lower in Day surgery group and it displayed that early discharged patients had fewer overall complications than the inpatient surgery group. Conclusions We demonstrate that younger patients, patients receiving segmental resections by VATS, and those with better pulmonary function tests or without comorbidity can be discharged early with low rates of complications and 30-day mortality, especial with ERAS program.

Objective: To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy (rRAPN) with a new robotic platform called KangDuo Surgical Robot-01 (KD-SR-01) system (Suzhou KangDuo Robot Co., Ltd., Suzhou, China) and discuss its surgical technique. Methods: A 44-year-old male patient was admitted with a 2.5 cm tumor on dorsolateral upper pole of the left kidney. The R.E.N.A.L. nephrometry score of this patient was 4x. This patient underwent rRAPN with KD-SR-01. The perinephric fat between the tumor and Gerota's fascia was preserved, which was used for internal suspension traction during tumor resection. Postoperative follow-up data were collected. Results: The surgery was successfully carried out with a duration of 127 min, in which the docking time was 6 min 25 s and console time was 60 min. The warm ischemia time was 19 min 53 s, and the estimated blood loss was 0 mL. The pathological histology showed a pathological tumor stage 1a clear cell renal cell carcinoma, with a negative surgical margin. The World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade of this patient was Grade 2. No recurrence was observed during the 6-month follow-up. Conclusion: Internal suspension in rRAPN is feasible and effective with use of the new robotic system KD-SR-01.

Abstract P2X receptors are ATP-activated cation channels, and the P2X4 subtype plays important roles in the immune system and the central nervous system, particularly in neuropathic pain. Therefore, P2X4 receptors are of increasing interest as potential drug targets. Here, we report the cryo-EM structures of the zebrafish P2X4 receptor in complex with two P2X4 subtype-specific antagonists, BX430 and BAY-1797. Both antagonists bind to the same allosteric site located at the subunit interface at the top of the extracellular domain. Structure-based mutational analysis by electrophysiology identified the important residues for the allosteric inhibition of both zebrafish and human P2X4 receptors. Structural comparison revealed the ligand-dependent structural rearrangement of the binding pocket to stabilize the binding of allosteric modulators, which in turn would prevent the structural changes of the extracellular domain associated with channel activation. Furthermore, comparison with the previously reported P2X structures of other subtypes provided mechanistic insights into subtype-specific allosteric inhibition.

Background: Cases of simultaneous TA-TAVR and Mckeown dual minimally invasive surgery are very rare. A retrospective analysis of the clinical features, perioperative surgical cooperation and care of an elderly patient with esophageal cancer combined with moderate-to-severe aortic regurgitation. Methods: An elderly patient with esophageal cancer combined with moderate to severe aortic valve regurgitation was admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University in September 2022. Through preoperative MDT discussion, two minimally invasive surgical options were identified and analyzed to develop personalized and standardized perioperative operating room care and surgical coordination. Informed written consent and institutional review board approval were both obtained (No. 2021-879; July 25, 2022) for the surgery and the publication of the study data. Results: After a thorough preoperative MDT discussion and the development of a personalized and standardized operating room care plan, the two surgeries lasted a total of 5h 35mins with a total bleeding volume of 150 ml. The surgeries went smoothly, and the patients were sent to the ICU and transferred back to the general ward on the second day after surgery without complications. Conclusion: The simultaneous performance of dual minimally invasive level IV surgery is indeed a high-risk procedure, which is a new challenge for both patients and health care workers. Standardized OR care planning and surgical coordination are also important aspects of MDT, reflecting that OR care is an indispensable role in the surgical team as well.

Abstract Near‐surface wind speed (NSWS) over China shows multiple time‐scale changes at a centennial scale, but the contributions of internal variability (IV), anthropogenic forcing (ANT), and natural forcing (NAT) to those changes remain unknown. This study investigated the contributions of IV, ANT, and NAT to NSWS changes at a centennial scale. Results show that the NSWS changes were attributed mainly to IV. IV not only modulated the interannual changes in NSWS but also determined the interdecadal transition in NSWS. The relative contributions of IV to the interannual and decadal NSWS exceeded 75.0%. ANT contributed particularly to the long‐term reduction in NSWS; especially, it has contributed 55.0% of the reduction in NSWS since 1957, serving as the major contributor to the reduction in NSWS. NAT had a small‐to‐negligible effect on China's NSWS throughout the study period. This study enhances our understanding of NSWS changes at different time scales.

Abstract：: Background: One of the most fatal forms of cancer of the urinary system, renal cell carcinoma (RCC), significantly negatively impacts human health. Recent research reveals that abnormal glycosylation contributes to the growth and spread of tumors. However, there is no information on the function of genes related to glycosylation in RCC. Methods: In this study, we created a technique that can be used to guide the choice of immunotherapy and chemotherapy regimens for RCC patients while predicting their survival prognosis. The Cancer Genome Atlas (TCGA) provided us with patient information, while the GeneCards database allowed us to collect genes involved in glycosylation. GSE29609 was used as external validation to assess the accuracy of prognostic models. The “ConsensusClusterPlus” program created molecular subtypes based on genes relevant to glycosylation discovered using differential expression analysis and univariate Cox analysis. We examined immune cell infiltration as measured by estimate, CIBERSORT, TIMER, and ssGSEA algorithms, Tumor Immune Dysfunction and Exclusion (TIDE) and exclusion of tumour stemness indices (TSIs) based on glycosylation-related molecular subtypes and risk profiles. Stratification, somatic mutation, nomogram creation, and chemotherapy response prediction were carried out based on risk factors. Results: We built and verified 16 gene signatures associated with the prognosis of ccRCC patients, which are independent prognostic variables, and identified glycosylation-related genes by bioinformatics research. Cluster 2 is associated with lower human leukocyte antigen expression, worse overall survival, higher immunological checkpoints, and higher immune escape scores. In addition, cluster 2 had significantly better angiogenic activity, mesenchymal EMT, and stem ability scores. Higher immune checkpoint genes and human leukocyte antigens are associated with lower overall survival and a higher risk score. Higher estimated and immune scores, lesser tumor purity, lower mesenchymal EMT, and higher stem scores were all characteristics of the high-risk group. High amounts of tumor-infiltrating lymphocytes, a high mutation load, and a high copy number alteration frequency were present in the high-risk group.Discussion.According to our research, the 16-gene prognostic signature may be helpful in predicting prognosis and developing individualized treatments for patients with renal clear cell carcinoma, which may result in new personalized management options for these patients.

Abstract Epithelioid emangioendothelioma (EHE) is a rare tumor originating from vascular endothelial cells, which belongs to malignant vascular tumors with low to moderate differentiation and potential metastatic ability and its incidence rate is less than one in a million. We herein report a rare case of EHE of pulmonary origin and a review of the literature concerning the clinical and pathological features of this disease. The patient underwent left upper lobectomy to completely extirpate the lesion by video‐assisted thoracic surgery. Our findings suggest the difficulty of making a diagnosis before surgery and that more cases need to be reported in order to facilitate the preoperative diagnosis of such a rare tumor.

Shale gas reservoirs, as representative reservoirs in the Sichuan Basin, have attracted widespread attention regarding development. Using gas reservoir numerical simulation to assist development has greatly improved the work efficiency of workers. However, traditional gas reservoir numerical simulation is widely criticized for its inability to effectively integrate with geological and engineering factors. In this study, we proposed a geological engineering integration method that considers pre-fracturing parameters. We further applied it to a typical well (N03) in a certain block of the Sichuan Basin. The reliability of the method was determined through historical fitting. Based on the N03 geological model, the optimization range of fracturing construction parameters in adjacent areas was determined with the goal of maximizing EUR. Recommended values for widely distributed construction parameter combinations of Class II reservoirs were provided through orthogonal analysis. The influence order of fracturing construction parameters is (1) sand addition strength, (2) cluster spacing, (3) construction displacement, (4) fracture fluid strength, and (5) horizontal segment length. Finally, we compared the simulated data with the actual case. The results showed that an integrated numerical simulation method including geological and engineering factors can comprehensively and accurately assist in reservoir development.

Abstract Concurrent heat extremes (CHEs) are becoming increasingly common in the mid‐high latitudes across the Northern Hemisphere (NH), underscoring the need to comprehend their spatiotemporal characteristics and underlying causes. Here we reveal a phase‐locking behavior in Wave‐4 pattern, particularly after mid‐1990s, giving rise to a prominent CHE mode akin to heat extreme pattern observed in 2022, which swept most NH regions. Wave‐4 pattern significantly amplifies the likelihood of CHEs in Eastern Europe (∼30%), Northeast Asia (∼25%), and northwestern coast of North America (∼15%), while reducing the likelihood in central North America and northern Central Asia. During 1979–2022, the identified pattern accounted for over 69.7% of the trends in heat extremes over the mid‐high latitudes of the NH, directly exposing approximately 333.5 million people to heat extremes. Observations and simulations indicate that radiation anomalies over Eastern European Plain and West Siberian Plain play pivotal roles as primary forcing sources for Wave‐4 pattern.

It has become a consensus that large-scale hydraulic fracturing is adopted to achieve the stimulation of unconventional oil and gas reservoir. The complex fracture network formed by fracturing is closely related to the effect of reservoir stimulation, which has extremely complicated evolution process. Therefore, it is necessary to study the evolution law of fracture network in large-scale hydraulic fracturing of unconventional reservoirs. In this article, the geological engineering parameters of horizontal well H in shale gas reservoir in southern Sichuan are taken as an example, a three-dimensional fracture network expansion model is established based on the boundary element method and finite volume method, and the simulation of the complex fracture network in a whole well section is carried out to analyze the evolution law of reservoir fracture network under different geological and engineering parameters. The results show that the horizontal stress field distribution has a significant effect on fracture geometric form. Hydraulic fractures in reservoirs with larger horizontal stress difference have stronger directivity, while the horizontal wellbore tends to obtain better reservoir stimulation results when it is parallel to the minimum horizontal principal stress setting. The conjugated natural fracture developed in the reservoir inhibits the hydraulic expansion fractures in both directions. Although it increases the complexity of the fractures, it is not necessarily conducive to improving the reservoir stimulation effectiveness. The lower the strength of natural fracture is, the more complex the fracture geometric form becomes, and the smaller the stimulated reservoir volume is. Correspondingly, the higher the strength of natural fracture is, the simpler the fracture geometric form becomes, and the larger the stimulated reservoir volume is. Suitable fracturing construction displacement can not only contribute to form a more complex fracture distribution, but also help to obtain a larger stimulated reservoir volume. The optimal construction displacement ranges from 10 to 14 m3/min. Low viscosity fracturing fluids are suitable for the formation of long-narrow fractures and able to connect with the remote reservoir and form complex fracture networks. Lower viscosity fluids can be used to achieve better reservoir stimulation effectiveness when sand-carrying capacity is met.

Casing deformation seriously affects the fracturing progress and stimulation effect of shale gas reservoirs. Considering casing deformations in fractured deep shale gas wells in the Luzhou block of southern Sichuan Basin, the influences of micro-structure, natural fractures, frequent layer penetration during drilling, cementing quality, borehole enlargement and fracturing operation on casing deformation were systematically analyzed. The results show that the occurrence rate of casing deformation is 51 % and 66.3 % respectively in areas with micro-structure and frequent layer penetration, the overlap rate of casing deformation points and natural fracture points is only 22 %, the proportion corresponding to good cementing quality is only 36.5 %, borehole enlargement/shrinking universally exists, and the fracturing intensity and scale are generally large before casing deformation. It is concluded that casing deformation is closely related to micro-structure, layer penetration and lithologic mutation surface, and controlled by well diameter, frequent layer penetration, cementing quality, micro-structure and natural fractures in a descending order of influence degree. Accordingly, a multi-factor weighting evaluation method and the vertical well trajectory, well quality and well stimulation classification criteria were built to realize the prediction, prevention and control of casing deformation in deep shale gas wells in the Luzhou block, demonstrating effectively improvement in stimulation effect.

Abstract Global warming is expected to have far‐reaching impacts on the frequency and intensity of extreme events, but the effects of anthropogenic warming on the emergence seasons of year‐maximum near‐surface wind speed (NSWS) remain poorly understood. We provide a comprehensive map of the changing emergence seasons of year‐maximum NSWS using Coupled Model Intercomparison Project Phase 6 projections. Our analysis reveals a rapid response of synoptic‐scale extreme NSWS to global warming, with consistent spatial patterns observed across various periods and warming scenarios. The most significant increase (∼16%) in the emergence season is projected to occur in December‐January‐February (DJF) over Mid‐high‐latitude Asia by the end of the 21st century. The study also anticipates changes in the emergence seasons of year‐maximum NSWS at a regional scale. These results deepen our understanding of the complex and interconnected nature of global climate change and underscore the need for concerted efforts in addressing this pressing challenge.

The fluid–solid coupling effect is an important factor which cannot be ignored to study the surface subsidence of deep coal seam mining in the area with abundant underground water. To study the influence of boundary permeability characteristics on surface subsidence in deep near-horizontal coal seam mining under the effect of fluid–solid coupling, the pore water pressure field, vertical stress field, surface subsidence, and vertical displacement of a rock seam during deep mining under different permeability boundary conditions were analyzed based on fluid–solid coupling theory, taking the 3−1501 working face of Erdos Hongqinghe coal mine as an example. The results revealed that the permeability characteristics of different hydraulic boundaries affected the pore water pressure, vertical stress in the rock layer, and surface subsidence during deep mining. Moreover, the trends of pore water pressure, vertical stress, and surface subsidence of a fixed-head permeability boundary were largely the same as those under impermeable boundary conditions, but the calculated results of the fixed-head permeability boundary were lower than those for the impermeable boundary at the same depth. The maximum surface subsidence for the fixed-head permeable boundary condition and the impermeable boundary condition was 879 and 925 mm, respectively, which were 239 and 285 mm higher than those obtained when the fluid–solid coupling effect was neglected (an increase of 37.3% and 44.5%, respectively). The field monitoring trend for the subsidence basin aligns closely with the subsidence basin trend under the influence of fluid–solid coupling. Considering the constant head permeable boundary conditions in the context of fluid–solid coupling yields accurate surface subsidence results. The results have provided a theoretical basis for the analysis and prediction of coal mining surface subsidence considering the fluid–solid coupling effect.

To better carry out maintenance management for medium and small span highway concrete beam bridges, this bridge is taken as the research object. Building information modeling technology is applied to its maintenance management. The corresponding management system is constructed. Through this system, the distribution of diseases and other information can be viewed. Long short-term memory neural network is used to build the corresponding prediction model to predict the technical condition score of bridge components. The results show that the prediction error is small. The minimum error rate in component technical condition scoring prediction is 0.00 %. In the full bridge technology scoring prediction, the minimum scoring error is 2.8 points, and the maximum scoring error is 6 points. The minimum average error rate of this model in predicting component technical condition scores is 0.15 %. Except for individual components, the average error rate of all other components is less than 5 %. The accuracy of the prediction model is 95 %. The performance is superior to linear regression models. The average error rate in the abutment is 7.45 % lower than the linear regression model. This method can effectively predict the degradation of small and medium-sized span highway concrete beam bridges and achieve three-dimensional visualization of diseases.

Abstract Colon cancer (CC) has a poor 5-year survival rate though the treatment techniques and strategies have been improved. Succinylation and long noncoding RNAs (lncRNAs) have prognostic value for CC patients. We analyzed and obtained succinylation-related lncRNA by co-expression in CC. A novel succinylation-related lncRNA model was developed by univariate and Least absolute shrinkage and selection operator (Lasso) regression analysis and we used principal component analysis (PCA), functional enrichment annotation, tumor immune environment, drug sensitivity and nomogram to verify the model, respectively. Six succinylation-related lncRNAs in our model were finally confirmed to distinguish the survival status of CC and showed statistically significant differences in training set, testing set, and entire set. The prognosis of with this model was associated with age, gender, M0 stage, N2 stage, T3 + T4 stage and Stage III + IV. The high-risk group showed a higher mutation rate than the low-risk group. We constructed a model to predict overall survival for 1-, 3-, and 5-year with AUCs of 0.694, 0.729, and 0.802, respectively. The high-risk group was sensitive to Cisplatin and Temozolomide compounds. Our study provided novel insights into the value of the succinylation-related lncRNA signature as a predictor of prognosis, which had high clinical application value in the future.

Abstract Background Atherosclerosis is the main pathological change in atherosclerotic cardiovascular disease, and its underlying mechanisms are not well understood. The aim of this study was to explore the hub genes involved in atherosclerosis and their potential mechanisms through bioinformatics analysis. Methods Three microarray datasets from Gene Expression Omnibus (GEO) identified robust differentially expressed genes (DEGs) by robust rank aggregation (RRA). We performed connectivity map (CMap) analysis and functional enrichment analysis on robust DEGs and constructed a protein‒protein interaction (PPI) network using the STRING database to identify the hub gene using 12 algorithms of cytoHubba in Cytoscape. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic potency of the hub genes.The CIBERSORT algorithm was used to perform immunocyte infiltration analysis and explore the association between the identified biomarkers and infiltrating immunocytes using Spearman’s rank correlation analysis in R software. Finally, we evaluated the expression of the hub gene in foam cells. Results A total of 155 robust DEGs were screened by RRA and were revealed to be mainly associated with cytokines and chemokines by functional enrichment analysis. CD52 and IL1RN were identified as hub genes and were validated in the GSE40231 dataset. Immunocyte infiltration analysis showed that CD52 was positively correlated with gamma delta T cells, M1 macrophages and CD4 memory resting T cells, while IL1RN was positively correlated with monocytes and activated mast cells. RT-qPCR results indicate that CD52 and IL1RN were highly expressed in foam cells, in agreement with bioinformatics analysis. Conclusions ​This study has established that CD52 and IL1RN may play a key role in the occurrence and development of atherosclerosis, which opens new lines of thought for further research on the pathogenesis of atherosclerosis.

Abstract Research and development of ramie harvesting equipment is a key link to revitalize ramie industry, problems such as the tendency of stalks to tangle and clog the machine are very problematic, seriously affect the quality and fluency of the harvester. The structure of ramie stalk is complex, and the mechanical properties of each component vary greatly, collision between stalk and machine creates complex stress relationship. By building a finite element model, it is possible to analyze the stress state of the stalk during bending from a microscopic perspective, and to analyze the complex stress–strain situation within the stalk. The purpose of this paper is to establish a standard ramie stalk bending finite element model to provide a theoretical basis for the subsequent kinematics and dynamics. Firstly, material experiments were carried out on ramie straw. The structural and mechanical parameters of the straw components were obtained through measurement and calculation tests, and the force–deformation curves for straw bending were obtained. Bending finite element simulations were carried out on the basis of mechanical tests, and the parameters such as dynamic friction coefficient, wood Poisson's ratio and bast Poisson's ratio were determined by the central combination design. Then established an accurate bending finite element simulation model of ramie stalk, the accuracy of the model was verified at the end. In this paper, the key parameters of the ramie stalk model were calibrated through a combination of material tests and simulations. All parameters of the ramie stalk model were finally obtained, and the bending mechanical properties of the ramie stalk were analysed by applying finite element analysis. This bending mechanics simulation model can be used for kinematic and dynamics simulation analysis of conveying and baling to provide a theoretical basis for the structural design of the harvester. The methods explored here can be applied to other slender straw crops.

Abstract Circulating tumor cells (CTCs) and cancer-associated fibroblasts (CAFs) from whole blood are emerging as important biomarkers that potentially aid in cancer diagnosis and prognosis. The microfilter technology provides an efficient capture platform for them but is confounded by two challenges. First, uneven microfilter surfaces makes it hard for commercial scanners to obtain images with all cells in-focus. Second, current analysis is labor-intensive with long turnaround time and user-to-user variability. Here we addressed the first challenge through developing a customized imaging system and data pre-processing algorithms. Utilizing cultured cancer and CAF cells captured by microfilters, we showed that images from our custom system are 99.3% in-focus compared to 89.9% from a top-of-the-line commercial scanner. Then we developed a deep-learning-based method to automatically identify tumor cells serving to mimic CTC (mCTC) and CAFs. Our deep learning method achieved precision and recall of 94% (± 0.2%) and 96% (± 0.2%) for mCTC detection, and 93% (± 1.7%) and 84% (± 3.1%) for CAF detection, significantly better than a conventional computer vision method, whose numbers are 92% (± 0.2%) and 78% (± 0.3%) for mCTC and 58% (± 3.9%) and 56% (± 3.5%) for CAF. Our custom imaging system combined with deep learning cell identification method represents an important advance on CTC and CAF analysis.

Abstract Clear cell renal cell carcinoma (ccRCC) is a main subtype of renal cancer, and advanced ccRCC frequently has poor prognosis. Many studies have found that lipid metabolism influences tumor development and treatment. This study was to examine the prognostic and functional significance of genes associated with lipid metabolism in individuals with ccRCC. Using the database TCGA, differentially expressed genes (DEGs) associated with fatty acid metabolism (FAM) were identified. Prognostic risk score models for genes related to FAM were created using univariate and least absolute shrinkage and selection operator (LASSO) Cox regression analyses. Our findings demonstrate that the prognosis of patients with ccRCC correlate highly with the profiles of FAM-related lncRNAs (AC009166.1, LINC00605, LINC01615, HOXA-AS2, AC103706.1, AC009686.2, AL590094.1, AC093278.2). The prognostic signature can serve as an independent predictive predictor for patients with ccRCC. The predictive signature's diagnostic effectiveness was superior to individual clinicopathological factors. Between the low- and high-risk groups, immunity research revealed a startling difference in terms of cells, function, and checkpoint scores. Chemotherapeutic medications such lapatinib, AZD8055, and WIKI4 had better outcomes for patients in the high-risk group. Overall, the predictive signature can help with clinical selection of immunotherapeutic regimens and chemotherapeutic drugs, improving prognosis prediction for ccRCC patients.

The coronavirus disease 2019 pandemic has drawn attention to telesurgery. Important advances in fifth-generation (5G) mobile telecommunication technology have facilitated the rapid evolution of telesurgery. Previously, only a single console was used in telesurgery; thus, there was the possibility of open or laparoscopic conversion. Furthermore, the 5G network has not been available for regional hospitals in China. From October 2021 to April 2022, dual-console telesurgeries with the KangDuo Surgical Robot-01 (KD-SR-01) system were performed using 5G and wired networks in an animal experiment and clinical study. A partial nephrectomy in a porcine model was performed successfully using a wired network. The console time, warm ischemia time, and control swap time were 69 min, 27 min, and 3 s, respectively. The mean latency time was 130 (range, 60–200) ms. A 32-yr-old male patient successfully underwent a remote pyeloplasty using a series connection of 5G wireless and wired networks. The console time and control swap time were 98 min and 3 s, respectively. The mean latency time was 271 (range, 206–307) ms. In the two studies, data pocket loss was

Objectives To evaluate the safety and efficacy of high-dose amoxicillin-proton pump inhibitor dual therapy, and to provide a new eradication regimen as a first-line option for patients with H. pylori infection. Methods A total of 971 H. pylori positive patients who received initial treatment were recruited from March to August 2020, and randomly divided into treatment group and control group. The treatment group received of 20 mg esomeprazole four times daily and 750 mg amoxicillin four times daily for 14 days. Control group received of 220 mg bismuth potassium citrate twice daily, 20 mg esomeprazole twice daily, 1000 mg amoxicillin twice daily and 250 mg clarithromycin capsule twice daily for 14 days. Four weeks after the end of treatment, the urea breath test was reviewed to detect whether H. pylori was eradicated. Results There were no statistical differences in age, gender, the total clinical symptom scores before and after initial treatment, the compliance, and the degree of remission of symptoms before and after initial treatment between the two groups. The eradication rates of H. pylori between dual therapy and quadruple therapy were 88.31% and 85.26% (p=.158) by intention-to-treat (ITT) analysis, 88.66% and 85.44% (p=.186) by modified intention-to-treat (mITT) analysis, and 91.63% and 90.60% (p=.116) by PP analysis, respectively. Adverse events in dual therapy group were significantly lower than quadruple therapy group (13.3% vs. 28.2% (p

Abstract Background In this study, we aimed to summarize the extremely important lesson and experience in the whole process of surgical treatments of lung tumors for the benefit of steps taken to prevent against unplanned reoperation. Methods Demographical and clinical information of 7732 patients were retrospectively retrieved and reviewed, who were diagnosed with pulmonary tumor and underwent surgical treatments from January 2016 to March 2021. Those patients who underwent unplanned reoperation for the treatment of severe complications were focused carefully and analyzed meticulously. Results A total of forty-one patients (41/7732) received 44 unplanned reoperations. Among them, eight and thirty-three patients were diagnosed with benign and malignant tumor, respectively. The incidence of unplanned reoperations seemed to be similar on both sides (Left vs. Right: 12/3231 vs. 29/4501, p = 0.103). Lobectomy plus segmentectomy is prone to reoperation (2/16, 12.5%) as compared to the other types of surgery. The complications leading to reoperation was hemothorax, including active hemorrhage (23/44, 52.3%) and clotted hemothorax (6/44, 13.6%), chylothorax (8/44, 18.2%), and the others (7/44, 15.9%) including bronchopleural fistula, torsion, or injury of right middle bronchus and pulmonary bulla rupture. The morbidity and mortality after unplanned reoperation were 17.1% (7/41) and 12.2% (5/41), respectively. Conclusions Bronchi or vessel stumps, the surgical edges of the lung parenchyma, and pleural adhesions should be checked to avoid postoperative bleeding. Prophylactic ligation of the thoracic duct should be recommended in case of the suspected oily-like exudation in the lymph node bed. Smooth expansion of the middle lobe is important to avoid narrowing and torsion before transection of the bronchus.

Non-small cell lung cancer (NSCLC) young patients (≤45 years old), despite their low prevalence, have unique clinical and pathological features. Its morbidity has been on the rise in recent years. With the concept of individualized lung cancer treatment, related researches are gradually gaining attention. In addition, the treatment response and prognosis in NSCLC young patients are different from older patients, so the study of NSCLC young patients is of great clinical significance. This article reviews the clinical manifestations, treatment and prognosis of NSCLC young patients.