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ObjectiveTo compare the perioperative effect of whether the liver is lifted out of the abdominal cavity during Kasai surgery in patients with biliary atresia type III.MethodsWe retrospectively analyzed 29 males and 33 females aged 2.2 ± 0.6 months who underwent kasai surgery from June 2019 to December 2022 at Fujian Provincial Children's Hospital. Among the 62 children with the liver not lifted out of the abdominal cavity into the experimental group (n = 31), and those with the liver lifted out of the abdominal cavity into the control group (n = 31). We compared the operation time, surgical incision length, intraoperative blood pressure and body temperature fluctuations, average daily peritoneal drainage, postoperative length of hospital stay, postoperative complications, postoperative total bilirubin level, and autologous liver survival rate between the two groups.ResultsThe length of the surgical incision in the control group (7.5 ± 1.2 cm) was longer than that in the experimental group (6.7 ± 1.1 cm), and the difference was statistically significant (t = 2.88, P = 0.005). The fluctuations in blood pressure in the control group (before and after the liver was lifted out of the abdominal cavity) (24.3 ± 7.7 mmHg) were greater than that in the experimental group (before and after hooking to expose the hilar area) (20.2 ± 6.0 mmHg), which was a statistically significant difference (t = 2.32, P = 0.023). The temperature fluctuations in the control group (before and after the liver was lifted out of the abdominal cavity) (0.3 ± 0.1°C) was greater than that in the experimental group (before and after the liver was lifted out of the abdominal cavity) (0.1 ± 0.1°C), showing a statistically significant difference (t = 8.19, P = 0.000). The average daily abdominal drainage in the control group was 71.3 ± 33.5 ml, which was greater than that in the experimental group (49.2 ± 49.6 ml), and the difference was statistically significant (t = 2.06, P = 0.044). The number of days of postoperative hospital stay in the control group (18.2 ± 4.8 days) was significantly more than that in the experimental group (15.8 ± 3.8 days), with a statistically significant difference (t = 2.18, P = 0.033).ConclusionIn children with biliary atresia type III, the liver is not lifted out of the abdominal cavity during Kasai surgery increases the safety of surgery and reduces the length of hospital stay.

To realize the automatic orientation and decapitation of shrimp, an integrated device for shrimp orientation and decapitation was designed based on the shape and size characteristics of shrimp, which was mainly composed of oriented rollers, shrimp pushing boards, adaptive clamping claw and knife for the decapitation of shrimp. Three kinds of shrimp of small, medium, and large size were selected. Taking the speed of the shrimp pushing boards, the horizontal speed of the adaptive clamping claw, the rotational speed of oriented rollers and the radius of the oriented rollers as the test factors, and the success rate of the shrimp decapitation as the index, the single factor test and the orthogonal test were carried out to study the effect of each factor on the shrimp decapitation, and then the main parameters of the device were optimized. The results showed that the optimal parameter combinations of the three sizes of shrimp were the speed of shrimp pushing plates of 60mm/s, the horizontal speed of adaptive clamping claw of 70mm/s, the rotational speed of oriented rollers of 60r/min, and the radius of oriented rollers of 20mm. Under the optimal combination of parameters, the device has the highest decapitation success rate and the success rate of shrimp decapitation was 91.5% for small shrimp, 94.6% for medium shrimp, and 92.8% for large shrimp, the decapitation speed was 36pcs/min for small shrimp, 38 pcs/min for medium shrimp, and 37 pcs/min for large shrimp. Therefore, the feasibility of the device design is verified.

Abstract Objectives To evaluate the usefulness of porta hepatis lymph nodes (PHLNs) on ultrasonography (US) scans in diagnosing biliary atresia (BA) and predicting the outcomes after Kasai portoenterostomy (KPE) surgery. Methods A total of 668 patients from one hospital were enrolled in the study (542 non-BA and 126 BA). The independent and combined diagnostic efficacy of PHLNs, triangular cord (TC) thickness, and gallbladder morphology were assessed by drawing the receiver operating characteristic (ROC) curves and counting the area under the ROC curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The US features, histopathological findings of PHLNs, and serum total bilirubin (TBIL) levels 3 months post-KPE were correlated. Results The AUC, sensitivity, specificity, PPV, and NPV of PHLNs with hyperechogenicity and a maximum length larger than 8.4 mm were 0.898, 81.8%, 97.8%, 89.6%, and 95.8%, respectively. The combination of PHLNs, TC thickness, and gallbladder morphology achieved the best overall diagnostic efficacy among all indicators with an AUC of 0.927 and a sensitivity of 99.2%. The germinal center number and bile particle number of PHLNs were positively correlated with pathological size and US echogenicity intensity of PHLNs, respectively (r = 0.591, 0.377, p = 0.001, 0.004). The pathological size of PHLNs in BA patients was negatively correlated with jaundice clearance status 3 months after KPE surgery (r = −0.385, p = 0.047). Conclusion PHLNs with hyperechogenicity and a maximum length > 8.4 mm are useful US indicators for BA diagnosis. Additionally, the enlargement of PHLNs might play a role in predicting outcomes of KPE surgery. Critical relevance statement The article proposed for the first time that PHLNs with hyperechogenicity and a maximum length > 8.4 mm are a useful US indicator for diagnosing BA. Key Points PHLNs may be helpful in diagnosing BA and predicting outcomes after surgery. Enlarged hyperechoic PHLNs are a useful diagnostic indicator for BA, and play a role in predicting surgical outcomes. These findings can assist clinicians in more accurately diagnosing BA, enabling more timely treatments. Graphical Abstract

Abstract Background Sphingolipids not only serve as structural components for maintaining cell membrane fluidity but also function as bioactive molecules involved in cell signaling and the regulation of various biological processes. Their pivotal role in cancer cell development, encompassing cancer cell proliferation, migration, angiogenesis, and metastasis, has been a focal point for decades. However, the contribution of sphingolipids to the complexity of tumor microenvironment promoting cancer progression has been rarely investigated. Methods Through the integration of publicly available bulk RNA‐seq and single‐cell RNA‐seq data, we conducted a comprehensive analysis to compare the transcriptomic features between tumors and adjacent normal tissues, thus elucidating the intricacies of the tumor microenvironment (TME). Results Disparities in sphingolipid metabolism (SLM)‐associated genes were observed between normal and cancerous tissues, with the TME characterized by the enrichment of sphingolipid signaling in macrophages. Cellular interaction analysis revealed robust communication between macrophages and cancer cells exhibiting low SLM, identifying the crucial ligand‐receptor pair, macrophage inhibitory factor (MIF)‐CD74. Pseudo‐time analysis unveiled the involvement of SLM in modulating macrophage polarization towards either M1 or M2 phenotypes. Categorizing macrophages into six subclusters based on gene expression patterns and function, the SPP1+ cluster, RGS1+ cluster, and CXCL10+ cluster were likely implicated in sphingolipid‐induced M2 macrophage polarization. Additionally, the CXCL10+, AGER+, and FABP4+ clusters were likely to be involved in angiogenesis through their interaction with endothelial cells. Conclusion Based on multiple scRNA‐seq datasets, we propose that a MIF‐targeted strategy could potentially impede the polarization from M1 to M2 and impair tumor angiogenesis in low‐SLM non‐small cell lung cancer (NSCLC), demonstrating its potent antitumor efficacy.

The increasing demand for rehabilitation and walking assistive devices driven by aging populations has promoted the development of a novel hip joint structure. This design aims to enhance the functionality of lower limb exoskeletons by eliminating the kinematic mismatch with the human’s biological hip. The design utilizes three 1-DOF (Degree of Freedom) rotational joints to replicate natural hip movement. By integrating IMU data, motor compensation is dynamically made to facilitate a more natural gait. Experimental results indicate improved hip joint angles and enhanced user comfort, presenting a promising solution for better walking assistance for elderly individuals.

Abstract Background Research on human pluripotent stem cells (hPSCs) has shown tremendous progress in cell-based regenerative medicine. Corneal endothelial dysfunction is associated with the loss and degeneration of corneal endothelial cells (CECs), rendering cell replacement a promising therapeutic strategy. However, comprehensive preclinical assessments of hPSC-derived CECs for this cell therapy remain a challenge. Results Here we defined an adapted differentiation protocol to generate induced corneal endothelial cells (iCECs) consistently and efficiently from clinical-grade human embryonic stem cells (hESCs) with xeno-free medium and manufactured cryopreserved iCECs. Cells express high levels of typical CECs markers and exhibit transendothelial potential properties in vitro typical of iCECs. After rigorous quality control measures, cells meeting all release criteria were available for in vivo studies. We found that there was no overgrowth or tumorigenicity of grafts in immunodeficient mice. After grafting into rabbit models, the surviving iCECs ameliorated edema and recovered corneal opacity. Conclusions Our work provides an efficient approach for generating iCECs and demonstrates the safety and efficacy of iCECs in disease modeling. Therefore, clinical-grade iCECs are a reliable source for future clinical treatment of corneal endothelial dysfunction.

Rural areas around developed metropolitan areas continue to attract capital inflows, promoting rural spatial commodification. Taking Shanghai as a case study, this paper analyzes the characteristics of the spatial distribution pattern and the influencing factors of rural spatial commodification (RSC) through kernel density analysis, multiple regression models, and spatial autocorrelation analysis. This study explores four types of RSC at the township scale outside the center of Shanghai: agricultural product-oriented commodification, farm housing commodification, tourism-oriented commodification, and construction land commodification. The results show the following: (1) The four types of RSC show positive spatial correlation, a clear pattern of agglomeration, and an obvious core–edge pattern, with high-density areas distributed in rural areas with specific advantages around metropolitan areas. The distribution of RSC also demonstrates an obvious polarization, forming an uneven distribution pattern. (2) Socio-economic factors, agriculture, transportation location, urbanization, and industrialization are key factors driving RSC. (3) Different types of RSC should be effectively guided at the policy and planning levels according to regional conditions and development stages to enhance the spatial organization of rural regions and achieve the effective revitalization of the countryside surrounding the metropolis.

The key issues that have always affected the production yield of the construction industry are delays and cost overruns, especially when dealing with large-scale projects and super-high buildings in which multiple tower cranes with overlapping areas are often deployed because of urgent due date and limited space. The service scheduling of tower cranes, which act as the crucial site equipment for lifting and transporting materials, is one of the main problems not only related to the construction progress and project cost but also affecting equipment health, and it may bring security risks. The current work presents a multi-objective optimization model for a multiple tower cranes service scheduling problem (MCSSP) with overlapping areas while achieving maximum interval time of cross-tasks and minimum makespan. For the solving procedure, NSGA-Ⅱ is employed with double-layer chromosome coding and simultaneous coevolutionary strategy design, which can obtain a satisfactory solution through effectively allocating tasks within overlapping areas to each crane and then prioritizing all the assigned tasks. The makespan was minimized, and stable operation of tower cranes without collision was achieved by maximizing the cross-tasks interval time. A case study of the megaproject Daxing International Airport in China has been conducted to evaluate the proposed model and algorithm. The computational results illustrated the Pareto front and its non-dominant relationship. The Pareto optimal solution outperforms the results of the single objective classical genetic algorithm in terms of overall performance of makespan and interval time of cross-tasks. It also can be seen that significant improvement in the time interval of cross-tasks can be achieved at the cost of a tiny increase in makespan, which means effective avoidance of the tower cranes entering the overlapping area at the same time. This can help eliminate collision, interference and frequent start-up and braking of tower cranes, leading to safe, stable and efficient operation on the construction site.

Abstract Background To design and develop a surgical robot capable of assisting subretinal injection. Methods A remote center of motion (RCM) mechanical design and a master-slave teleoperation were used to develop and manufacture the assisted subretinal surgery robot (RASR). Ten fresh isolated porcine eyes were divided into the Robot Manipulation (RM) group and Manual Manipulation (MM) group (5 eyes for each group), and subretinal injections were performed by the robot and manual manipulation methods, respectively. A preliminary verification of the robot was performed by comparing the advantages and disadvantages of the robot manipulation and manual manipulation by using optical coherent tomography (OCT), fundus photography, and video motion capture analysis after the surgery. Results Both the robot and the manual manipulation were able to perform subretinal injections with a 100% success rate. The OCT results showed that the average subretinal area was 1.548 mm2 and 1.461 mm2 in the RM and MM groups, respectively (P > 0.05). Meanwhile the volume of subretinal fluid obtained using the retinal map mode built in OCT was not statistically different between the RM and MM groups (P > 0.05). By analyzing the surgical video using Kinovea, a motion capture and analysis software, the results suggest that the mean tremor amplitude of the RM group was 0.3681 pixels (x direction), which was significantly reduced compared to 18.8779 pixels (x direction) in the MM group (P

Abstract Background Immaturity of ganglia (IG) is an extremely rare disease and always requires surgical intervention in the neonatal period, but without guidelines to choose the ideal enterostomy procedure, the timing of stoma closure remains controversial. The aim of this study was to report our experience using Santulli enterostomy for the treatment of nine infants diagnosed with IG. Methods Patients who underwent Santulli enterostomy and were diagnosed with IG in our center between 2016 and 2021 were retrospectively studied. Temporary stoma occlusion and a 24-h delayed film of barium enema (BE) were performed to evaluate intestinal peristalsis function to determine the timing of stoma closure. The demographic data, clinical and radiological findings, stoma occlusion and stoma closure results were explored. Results A total of 9 infants underwent Santulli enterostomy and were diagnosed with IG postoperatively. Their median gestational age at birth was 36 weeks (range 31–42), and their median birth weight was 2765 g (range 1300–3400). All patients had symptom onset in the neonatal period, including abdominal distension and biliary vomiting. Eight patients showed obvious small bowel dilatation in the plain films, except for one patient’s films that suggested gastrointestinal perforation with free gas downstream of the diaphragm. BE was performed in 6 patients, all of which had microcolons. The median age at operation was 3 days (range 1–23). Seven patients had an obvious transitional zone (TZ) during laparotomy, and the position of the TZ was 25–100 cm proximal above the ileocecal (IC) valve. Immature ganglion cells were present in the colon in 7 patients and the terminal ileum in 6 patients. The median age of successful stoma occlusion was 5 M (range 2–17) and 8 M (range 4–22) at ostomy closure. There was little or no barium residue in the 24-h delayed film of BE before stoma closure, and all patients were free of constipation symptoms during the follow-up. Conclusion Santulli enterostomy appears to be a suitable and efficient procedure for IG, combined with temporary stoma occlusion and 24-h delayed film of BE to evaluate the recovery of intestinal peristalsis function.

ObjectiveThe objective of this study was to investigate the feasibility and effectiveness of laparoscopic-assisted radical resection of type I choledochal cyst (CC) guided by the principles of enhanced recovery after surgery (ERAS).MethodsA retrospective cohort study of type I CC admitted to our hospital between May 2020 and December 2021 were analyzed, a total of 41 patients with choledochal cyst underwent surgery during this period and 30 cases were selected based on inclusion and exclusion criteria. Patients (n = 15) who received the traditional treatment from May 2020 to March 2021 were included in the traditional group. Patients (n = 15) who received ERAS from April 2021 to December 2021 were included in the ERAS group. Both groups underwent surgery performed by the same surgical team. Preoperative data of the two groups were recorded, and relevant data were statistically analyzed and compared.ResultsThere was a statistically significant difference in the dose of opioids. Significant differences were observed between the ERAS and traditional groups in the results of the FLACC pain assessment scale on the 1st and 2nd day after surgery, time of gastric tube, urinary catheter and abdominal drainage tube removal, time of first defecation after operation, time of first eating after operation, time to reach full food intake, results of CRP, ALB, and ALT on the 3rd and 7th postoperative day, postoperative hospital stay, and total treatment cost. No significant differences were observed between the two groups in terms of gender, age, body weight, cyst size, preoperative CRP, ALB, ALT, intraoperative blood loss, operation time, and the number of cases converted to laparotomy. Neither the FLACC pain assessment scale on the 3rd day after surgery, the incidence of postoperative complications, nor the rate of readmission within 30 days showed significant differences.ConclusionsLaparoscopic-assisted radical resection of type I CC guided by the principles of ERAS is safe and effective for children. The ERAS concept demonstrated advantages over traditional laparoscopic surgery, including reduced opioid use, shorter time to first postoperative defecation, earlier resumption of postoperative feeding, shorter time to reach full feeding, shorter postoperative hospital stay, and lower total treatment cost.

Anorectal malformation (ARM) and Hirschsprungs disease (HSCR) are frequently associated with other congenital malformations, but rarely with one another. We describe the case of a child with intermediate anorectal malformation who underwent ARM correction. This child experienced recurrent postoperative symptoms, including intestinal obstruction, nutrition intolerance, and weight loss. The child was diagnosed with Hirschsprung's disease by colon barium contrast and pathological findings from a rectal biopsy, and subsequently underwent pull -through procedure after conservative treatment failed. After six months of postoperative follow-up, the patient still experiences occasional episodes of enteritis, but the symptoms are substantially less severe than they were before surgery, and the patient's weight is slowly increasing. We described a case of a child who had ARM combined with HSCR. Although the association between ARM and HSCR is uncommon, severe constipation or enteritis following complete correction of ARM in the absence of anal stricture should prompt consideration for HSCR. Before the second stage of ARM surgery, pay close attention to the barium enema examination, as an abnormal shape may indicate the presence of HSCR.

BackgroundThe term “neuroblastoma (NB)” refers to a type of solid pediatric tumor that develops from undivided neuronal cells. According to the American Cancer Society report, between 700 and 800 children under the age of 14 are diagnosed with NB every year in the United States (U.S.). About 6% of all cases of pediatric cancer in the U.S. are caused by NB. NB is the most frequent malignancy in children younger than 1 year; however, it is rarely found in those over the age of 10 and above.ObjectiveTo accurately predict cancer-specific survival (CSS) in children with NB, this research developed and validated an all-encompassing prediction model.MethodsThe present retrospective study used the Surveillance, Epidemiology, and End Results (SEER) database to collect information on 1,448 individuals diagnosed with NB between 1998 and 2019. The pool of potentially eligible patients was randomly split into two groups, a training cohort (N = 1,013) and a validation cohort (N = 435). Using multivariate Cox stepwise regression, we were able to identify the components that independently predicted outcomes. The accuracy of this nomogram was measured employing the consistency index (C-index), area under the time-dependent receiver operating characteristic curve (AUC), calibration curve, and decision-curve analysis (DCA).ResultsIn this study, we found that age, primary location, tumor size, summary stage, chemotherapy, and surgery were all significant predictors of CSS outcomes and integrated them into our model accordingly. The C-index for the validation cohort was 0.812 (95% CI: 0.773–0.851), while for the training cohort it was 0.795 (95% CI: 0.767–0.823). The C-indexes and AUC values show that the nomogram is able to discriminate well enough. The calibration curves suggest that the nomogram is quite accurate. Also, the DCA curves demonstrated the prediction model's value.ConclusionA novel nomogram was developed and validated in this work to assess personalized CSS in NB patients, and it has been indicated that this model could be a useful tool for calculating NB patients’ survival on an individual basis and enhancing therapeutic decision-making.

Background/purposeRhubarb peony decoction (RPD) is a formula of traditional Chinese medicine that has been widely used to treat intra-abdominal inflammatory diseases. To investigate the therapeutic efficacy of RPD in pediatric periappendiceal abscess, patients who received intravenous antibiotics alone were compared with those treated with intravenous antibiotics combined with RPD.MethodsA retrospective review of children with periappendiceal abscess who received conservative treatment in our hospital between January 2013 and April 2022 was performed. The patients were divided into an intravenous antibiotic group (the control group) and an intravenous antibiotic combined with RPD group (the intervention group). Interval appendectomy (IA) was generally performed 10–12 weeks after conservative treatment. The primary outcome was the cure rate of conservative treatment, while the secondary outcomes included the recurrence rate, days of total intravenous antibiotic use, length of hospital stay (LOS), postoperative complications, and liver injury caused by RPD.ResultsA total of 142 patients (77 girls and 65 boys) were included, 52 in the control group and 90 in the intervention group. The two groups were similar in demographic data and clinical characteristics (P > 0.05). The mean total course of RPD in the intervention group was 11.82 days. The intervention group had a significantly higher cure rate than the control group (93.33% vs. 80.77%, P = 0.029), and the length of total intravenous antibiotic use (P = 0.150), LOS (P = 0.077), recurrence rate (9.52% vs. 4.76%, P = 0.439), as well as the operation time (P = 0.101), LOS (P = 0.572), and postoperative complications (P = 0.549) were not significantly different between the two groups when the patients received IA. No patient had a liver injury caused by RPD during the treatment.ConclusionIntravenous antibiotics combined with RPD demonstrated high effectiveness and safety for treating pediatric periappendiceal abscess.

Abstract 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.

ObjectiveExplore the feasibility and safety of thoracoscopy in the treatment of esophageal atresia under high-frequency oscillatory ventilation (HFOV) mode.MethodsThis was a single-center retrospective analysis. A total of 24 children were divided into the HFOV and the No-HFOV group. The demographic information, surgical results and relevant experience were analyzed.ResultsAll patients in the HFOV group underwent thoracoscopic esophageal atreplasty with a mean operation duration of 165.8 ± 33.9 min. Two patients had postoperative anastomotic leakage, which was cured after conservative treatment. One child had a recurrent tracheoesophageal fistula, which was closed after endoscopic cauterization. The mean postoperative mechanical ventilation time was 8.83 ± 8.02 days. There was no return of anastomotic leakage or r-TEF after oral feeding. Furthermore, there was no significant difference between the NO-HFOV and the HFOV groups except for the operation time where the HFOV group was shorter than that of the NO-HFOV group.ConclusionThoracoscopic esophageal atresia anastomosis under HFOV ventilation is feasible for patients with severe pulmonary infection, heart malformation, such as patent ductus arteriosus, ventricular septal defect, and poor anesthesia tolerance, but the long-term prognosis still needs further study in a large sample size.

ObjectiveTo establish a nomogram to predict the outcome of biliary atresia (BA) infants 3-months post- Kasai portoenterostomy (KPE).MethodsBA Infants who underwent KPE from two hospitals were included in the training (n = 161) and validation cohorts (n = 64). A logistic regression equation (Equation A) for predicting the serum total bilirubin (TBIL) level 3-month post-KPE was established in the training cohort. Then, a nomogram was developed based on Equation A in the training cohort and validated in the validation cohort. Moreover, a new equation (Equation B) was generated based on the nomogram and the size of the enlarged hilar lymph nodes (LNs) in the validation cohort. The predictive performance of the nomogram was evaluated by the receiver operating characteristic (ROC) curve and by calculating the area under the ROC curve (AUC), sensitivity, specificity, and positive (PPV) and negative (NPV) prediction values.ResultsA nomogram based on gallbladder morphology and serum levels of TBIL and total protein (TP) was established with AUC (95%CI) of 0.673 (0.595, 0.745) and 0.647 (0.518, 0.763), sensitivity (95%CI) of 71.4% (62.1%,79.6%) and 81.8% (59.7%,94.8%), specificity (95%CI) of 63.3% (48.3%,76.6%) and 47.6% (32.0%,63.6%), PPV (95%CI) of 81.6% (72.5%,88.9%) and 45.0% (29.3%,61.5%), and NPV (95%CI) 49.2% (36.4%,62.1%) and 83.3% (62.6%,95.3%), respectively, in the training and validation cohorts. Furthermore, in the validation cohort, the AUC (95%CI) of Equation B was 0.798 (95%CI: 0.679, 0.888), which was significantly higher than that of the nomogram (P = 0.042).ConclusionA nomogram based on the pre-KPE gallbladder morphology, TBIL, and TP to predict the outcome of BA 3-months post-KPE is established. Moreover, the addition of the size of the enlarged hilar LNs into the nomogram further improves its predictive value.

Abstract Background Caudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. However, few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA + CA) in laparoscopic-assisted Soave pull-through of HD. Methods A retrospective review was performed in children with HD operated in our hospital between 2017 and 2020. Patients were divided into the GA and GA + CA group. The primary outcome was the duration of operation, and secondary outcomes included intraoperative hemodynamic changes, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, dose of anesthetics, and incidence of side effects. Results A total of 47 children with HD were included in the study, including 20 in the GA group and 27 in the GA + CA Group. The two groups were similar in age, gender, weight and type of HD (P > 0.05). The GA + CA group had significantly shorter duration of operation (especially the transanal operation time) (median 1.20 h vs. 0.83 h, P

Promoting sustainable production and consumption practices in the construction machinery industry is crucial for achieving energy savings and reducing carbon emissions. However, there is a lack of targeted studies addressing the challenge of scaling up leasing and recycling while maximizing economic benefits for enterprises. To fill this gap, this paper presents a lease-oriented closed-loop supply chain model that incorporates a carbon tax policy to investigate the impact of the carbon tax rate and consumer preferences for remanufactured products on the supply chain and introduces a leasing compensation–cost apportioning combined contract to achieve supply chain coordination in the construction machinery sector. The model considers differential selling and leasing prices for new and remanufactured products, as well as the recovery rate, under both centralized and decentralized decision-making approaches. The study explores the interrelationships between various parameters through sensitivity analysis and numerical simulation. The results demonstrate that within a certain range of the cost apportioning proportional coefficient and leasing compensation proportional coefficient, the combined contract can lead the supply chain to achieve Pareto optimality. As the carbon tax rate increases, it was observed that the profits for all parties in the supply chain tend to decrease. However, due to the increased demand for remanufactured products, the product recovery rate improves, resulting in a reduction in total carbon emissions in the closed-loop supply chain of construction machinery. Moreover, the profits of all parties and the total supply chain profits initially decrease and then increase with an increasing preference coefficient for remanufactured products among consumers. By leveraging these factors and adopting effective strategies, such as enhancing consumer recognition of remanufactured products and optimizing pricing and cost allocation, it is indeed possible for the profits of all parties and the total profits in the supply chain to surpass the initial values, even in the face of increasing carbon tax rates. This demonstrates the potential for aligning sustainability objectives with economic benefits in the construction machinery industry.

Sorafenib, a molecular targeted multi-kinase inhibitor, has received considerable interests in recent years due to its significant profiles of efficacy in cancer therapy. However, poor pharmacokinetic properties such as limited water solubility, rapid elimination and metabolism lead to low bioavailability, restricting its further clinical application. Over the past decade, with substantial progress achieved in the development of nanotechnology, various types of smart sorafenib nanoformulations have been developed to improve the targetability as well as the bioavailability of sorafenib. In this review, we summarize various aspects from the preparation and characterization to the evaluation of antitumor efficacy of numerous stimuli-responsive sorafenib nanodelivery systems, particularly with emphasis on their mechanism of drug release and tumor microenvironment response. In addition, this review makes great effort to summarize the nanosystem-based combination therapy of sorafenib with other antitumor agents, which can provide detailed information for further synergistic cancer therapy. In the final section of this review, we also provide a detailed discussion of future challenges and prospects of designing and developing ideal sorafenib nanoformulations for clinical cancer therapy.

BackgroundCholedochal cysts (CC) are rare disorders characterized by congenital biliary dilatation of the intrahepatic or extrahepatic bile ducts and always relate to pancreaticobiliary maljunction. Robot-assisted surgery has been able to complete almost all pediatric endoscopic surgery nowadays. But evidence of the post-operative outcomes of robotic-assisted operation is limited, comparing with the laparoscopic operation and traditional open operation. The aim of this meta-analysis was to identify the advantages and deficiencies about robotic-assisted operation for CC.MethodsA meta-analysis of retrospective studies published in PUBMED, MEDLINE, Web of Science and China National Knowledge Infrastructure (CNKI). No date limit was used, with the last search on April 30, 2022. No publication restrictions or study design filters were applied.ResultsNine retrospective cohort studies with 1,395 patients [366 in the robotic-assisted operation group (RG), 532 in the laparoscopic operation group (LG) and 497 in the open operation group (OG)] were enrolled in our study. Subgroup analysis demonstrated the RG had significant longer operative time [standardized mean difference (SMD) = 1.59, 95% CI = (0.02, 3.16), P < 0.05], less blood loss [SMD = −1.52, 95% CI = (−2.71, −0.32), P < 0.05], shorter enteral feeding time [SMD = −0.83, 95% CI = (−1.22, −0.44), P < 0.001], shorter time to stay in the hospital [SMD = −0.81, 95% CI = (−1.23, −0.38), P < 0.001], fewer post-operative complications [Relative risk (RR) =1.09, 95% CI = (1.04, 1.13), P < 0.001] but higher expenses [SMD = 8.58, 95% CI = (5.27, 11.89), P < 0.001] than LG. While a significant older age [SMD = 0.46, 95% CI = (0.26, 0.66), P < 0.001], longer operative time [SMD = 3.96, 95% CI = (2.38, 5.55), P < 0.001] and shorter time to stay in the hospital [SMD = −0.93, 95% CI = (−1.62, −0.25), P < 0.05] than OG.ConclusionsLaparoscopic and robotic-assisted procedure are both safe and minimal invasive operational strategies. Robotic-assisted procedure may slowly surpass and has a trend to replace laparoscopy for its advantages. More experiences in robotic-assisted operation should be accumulated for the unexpected complexities, so as to be more stable in the younger age of children.

Ursolic acid (UA), a natural pentacyclic triterpenoid, possesses widespread biological and pharmacological activities. However, drawbacks such as low bioavailability, poor targeting and rapid metabolism greatly hinder its further clinical application. Recently, with the development of nanotechnology, various UA nanosystems have emerged as promising strategies for effective cancer therapy. This article reviews various types of UA-based nano-delivery systems, primarily with emphasis placed on novel UA-based carrier-free nano-drugs, which are considered to be innovative methods for cancer therapy. Moreover, this review presents carrier-free nano-drugs that co-assembled of UA and photosensitizers that displayed synergistic antitumor performance. Finally, the article also describes the development and challenges of UA nanosystems for future research in this field. Overall, the information presented in this review will provide new insight into the rational utilization of nano-drugs in cancer therapy.

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.

Leasing and recycling are important methods for developing the low-carbon sustainability of the construction machinery industry. However, there are some dilemmas caused by the extreme limitations of product service life. There has been little research on construction machinery leasing thus far and a lack of description of its unique characteristics in previous models. Focusing on the problem of pricing and coordination, a two-stage model of a leasing closed-loop supply chain based on the practical application of an Industrial Internet platform was proposed. Under centralized and decentralized decision-making scenarios, the prices of leasing and selling, maintenance effort, and recovery rate were calculated, respectively. By using the Shapley value method to optimize the selling price, and the two-part pricing contract to calculate the compensation fee, global profits can be reasonably distributed, while the supply chain can be improved. The effects of different contracts on the improvement of supply chain profit were investigated. Additionally, the correlation among parameters was explored via sensitivity analysis and numerical simulation. The findings show that the maintenance and recycling of construction machinery can be improved by using an Industrial Internet platform while achieving supply chain coordination via contracts. The enhancement of maintenance effort can decrease remanufacturing costs, which are positively correlated with the selling price and leasing price of products, further promoting the recovery rate of used products. The findings of this paper show that manufacturers can take advantage of the Industrial Internet platform to improve recycling efficiency as well as to decrease product prices and remanufacturing costs by promoting remanufacturing technologies. On the other hand, leasers need to enhance the maintenance of construction machinery. Strengthening cooperation via contracts can jointly promote leasing and recycling in the construction machinery industry and help achieve low-carbon sustainable development.

The continuously adaptive mean shift algorithm suffers from the tracking offset phenomenon while tracking targets with colors similar to that of the background. In this paper, to improve the performance of this algorithm, the depth information is combined with the back-projection color image and the information from the moving prediction algorithm. The target search window is predicted based on switching filtering algorithm with the Extended Kalman Filter (EKF) method. The moving tracking synthesis algorithm which used 3D sensors and combines color, depth and prediction information is used to solve the problems that the continuously adaptive mean shift algorithm encounters, namely disturbance and the tendency to enlarge the tracking window. The experimental results show that the proposed algorithm can accurately track a moving target in the presence of a complex background, and greatly improves the interference resistance and robustness of the system.

Abstract Background CircMYO10 is a circular RNA generated by back-splicing of gene MYO10 and is upregulated in osteosarcoma cell lines, but its functional role in osteosarcoma is still unknown. This study aimed to clarify the mechanism of circMYO10 in osteosarcoma. Methods CircMYO10 expression in 10 paired osteosarcoma and chondroma tissues was assessed by quantitative reverse transcription polymerase chain reaction (PCR). The function of circMYO10/miR-370-3p/RUVBL1 axis was assessed regarding two key characteristics: proliferation and endothelial–mesenchymal transition (EMT). Bioinformatics analysis, western blotting, real-time PCR, fluorescence in situ hybridization, immunoprecipitation, RNA pull-down assays, luciferase reporter assays, chromatin immunoprecipitation, and rescue experiments were used to evaluate the mechanism. Stably transfected MG63 cells were injected via tail vein or subcutaneously into nude mice to assess the role of circMYO10 in vivo. Results CircMYO10 was significantly upregulated, while miR-370-3p was downregulated, in osteosarcoma cell lines and human osteosarcoma samples. Silencing circMYO10 inhibited cell proliferation and EMT in vivo and in vitro. Mechanistic investigations revealed that miR-370-3p targets RUVBL1 directly, and inhibits the interaction between RUVBL1 and β-catenin/LEF1 complex while circMYO10 showed a contrary effect via the inhibition of miR-370-3p. RUVBL1 was found to be complexed with chromatin remodeling and histone-modifying factor TIP60, and lymphoid enhancer factor-1 (LEF1) to promote histone H4K16 acetylation (H4K16Ac) in the vicinity of the promoter region of gene C-myc. Chromatin immunoprecipitation methods showed that miR-370-3p sponge promotes H4K16Ac in the indicated region, which is partially abrogated by RUVBL1 small hairpin RNA (shRNA) while circMYO10 showed a contrary result via the inhibition of miR-370-3p. Either miR-370-3p sponge or ShRUVBL1 attenuated circMYO10-induced phenotypes in osteosarcoma cell lines. MiR-370-3p inhibition abrogated the inhibition of proliferation, EMT of osteosarcoma cells in vitro and in vivo seen upon circMYO10 suppression via Wnt/β-catenin signaling. Conclusions CircMYO10 promotes osteosarcoma progression by regulating miR-370-3p/RUVBL1 axis to promote chromatin remodeling and thus enhances the transcriptional activity of β-catenin/LEF1 complex, which indicates that circMYO10 may be a potential therapeutic target for osteosarcoma treatment.

Load decomposition technology is an important aspect of power intelligence. At present, there are mainly machine learning methods based on artificial features and deep learning methods for load decomposition. The method based on artificial features has a difficult time obtaining effective load features, leading to low accuracy. The method based on deep learning can automatically extract load characteristics, which improves the accuracy of load decomposition. However, with the deepening of the model structure, the number of parameters becomes too large, the training speed is slow, and the computing cost is high, which leads to the reduction of redundant features and the learning ability in some shallow networks, and the traditional deep learning model has a difficult time obtaining effective features on the time scale. To address these problems, a feature reused long short-term memory multiple output network (M-LSTM) is proposed and used for non-invasive load decomposition tasks. The network proposes an improved multiscale fusion residual module to extract basic load features and proposes the use of LSTM cyclic units to extract time series information. Feature reuse is achieved by combining it with the reorganization of the input data into multiple branches. The proposed structure reduces the difficulty of network optimization, and multi-scale fusion can obtain features on multiple time scales, which improves the ability of model feature extraction. Compared with common network models that tend to train network models for a single target load, the structure can simultaneously decompose the target load power while ensuring the accuracy of load decomposition, thus reducing computational costs, avoiding repetitive model training, and improving training efficiency.

The gesture recognition technology based on computer vision can provide a more natural way of human–computer interaction, and become a research hotspot in the field of gesture recognition. This study proposes an improved Sobel operator which is used for static hand contour extraction. The method is based on the noise existing in the picture, and a bilateral filtering algorithm is employed to denoise and preserve the edges to a large extent. Based on the colour space, the elliptical skin colour model is used to extract the skin colour domain, and the hand is separated according to the block domain feature. Finally, in order to solve the oblique indirection problem of the traditional Sobel operator, two oblique direction templates are added and the weights are reassigned. Then the improved Sobel operator is used to extract the gesture edges, and compared with the classical extraction edge operator Laplace and Canny extraction effects. The experimental results show that the proposed algorithm has high efficiency and accuracy in static gesture segmentation in a simple environment.

Following the publication of the original paper [1], one corresponding author was inadvertently missed.