BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated ...BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated using clips.However,postoperative migration of clips to the common bile duct(CBD)or Ttube sinus tract is an overlooked complication of laparoscopic biliary surgery.Previously,most reported cases of postoperative clip migration involved metal clips,with only a few cases involving Hem-o-lok clips and review of the literature.CASE SUMMARY This report describes two cases in which Hem-o-lok clips migrated into the CBD and the T-tube sinus tract following laparoscopic surgery.Case 1 is a 68-year-old female admitted due to abdominal discomfort,and two Hem-o-lok clips were found to have migrated into the CBD 17 months after LC and LCBDE with T-tube drainage,and were removed using a stone extraction balloon.The patient was discharged smoothly after recovery.Case 2 is a 74-year-old male who underwent LC and LCBDE with T-tube drainage and laparoscopic biliary tract basket stone extraction.Nine weeks postoperatively,following T-tube removal,a Hem-o-lok clip was found in the sinus tract,and was extracted from the T-tube sinus tract.The patient recovered smoothly postoperatively.This study also reviews the literature from 2013 to July 2024 on using Hem-o-lok clips in LC and/or LCBDE treatment of gallbladder and biliary diseases and the postoperative migration of these clips into the CBD,T-tube sinus tract,or duodenum.CONCLUSION In patients with a history of LC and/or LCBDE,clip migration should be considered as a differential diagnosis.展开更多
BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic c...BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic chemotherapy,targeted therapies,and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.CASE SUMMARY A 39-year-old male presented with unresectable stage IIIB ICC(cT3N1M0),abdominal pain,and elevated carbohydrate antigen(CA)19-9 levels.He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy(GEMOX-HAIC),lenvatinib(8 mg daily),and toripalimab(160 mg every three weeks).After five cycles,significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy.Complications,including biliary stenosis and liver abscesses,were managed with biliary stenting and percutaneous drainage,which allowed for the continuation of chemotherapy.Postoperative pathological examination confirmed a pathological complete response.At the last follow-up,the patient had maintained 29 months of diseasefree survival post-resection and was continuing postoperative therapy.CONCLUSION This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC,lenvatinib,and toripalimab to convert unresectable ICC to a resectable status,thereby potentially improving patient survival by surgical resection.Further clinical trials investigating this regimen are warranted.展开更多
The Yamansu belt,an important tectonic component of Eastern Tianshan Mountains,of the Central Asian Orogenic Belt,NW China hosts many Fe-(Cu)deposit.In this study,we present new zircon U-Pb geochronology and geochemic...The Yamansu belt,an important tectonic component of Eastern Tianshan Mountains,of the Central Asian Orogenic Belt,NW China hosts many Fe-(Cu)deposit.In this study,we present new zircon U-Pb geochronology and geochemical data of the volcanic rocks of Shaquanzi Formation and diorite intrusions in the Yamansu belt.The Shaquanzi Formation comprises mainly basalt,andesite/andesitic tuff,rhyolite and sub-volcanic diabase with local diorite intrusions.The volcanic rocks and diorites contain ca.315-305 Ma and ca.298 Ma zircons respectively.These rocks show calc-alkaline affinity with enrichment in large-ion lithophile elements(LILEs),light rare-earth elements(LREEs),and depletion in high field strength elements(HFSEs)in primitive mantle normalized multi-element diagrams,which resemble typical back-arc basin rocks.They show depleted mantle signature with ε_(Nd)(t)ranging from+3.1 to +5.6 for basalt;+2.1 to+4.7 for andesite;-0.2 to+1.5 for rhyolite and the ε_(Hf)(t)ranges from-0.1 to +13.0 for andesites;+5.8 to +10.7 for andesitic tuffs.We suggest that the Shaquanzi Formation basalt might have originated from a depleted,metasomatized lithospheric mantle source mixed with minor(3-5%)subduction-derived materials,whereas the andesite and rhyolite could be fractional crystallization products of the basaltic magma.The Shaquanzi Formation volcanic rocks could have formed in an intracontinental back-arc basin setting,probably via the southward subduction of the Kangguer Ocean beneath the Middle Tianshan Massif.The Yamansu mineralization belt might have undergone a continental arc to back-arc basin transition during the Late Carboniferous and the intra-continental back-arc basin might have closed in the Early Permian,marked by the emplacement of dioritic magma in the Shaquanzi belt.展开更多
AIM:To investigate whether a virus constitutively expressing active Akt is useful to prevent cirrhosis induced by carbon tetrachloride(CCl4).METHODS:Using cre-loxp technique,we created an Ad-myr-HA-Akt virus,in which ...AIM:To investigate whether a virus constitutively expressing active Akt is useful to prevent cirrhosis induced by carbon tetrachloride(CCl4).METHODS:Using cre-loxp technique,we created an Ad-myr-HA-Akt virus,in which Akt is labeled by a HA tag and its expression is driven by myr promoter.Further,through measuring enzyme levels and histological structure,we determined the efficacy of this Ad-myrHA-Akt virus in inhibiting the development of cirrhosis induced by CCl4in rats.Lastly,using western blotting,we examined the expression levels and/or phosphorylation status of Akt,apoptotic mediators,endothelial nitric oxide synthase(eNOS),and markers for hepatic stellate cells activation to understand the underlying mechanisms of protective role of this virus.RESULTS:The Ad-myr-HA-Akt virus was confirmed using polymerase chain reaction amplification of inserted Akt gene and sequencing for full length of inserted fragment,which was consistent with the sequence reported in the GenBank.The concentrations of Admyr-HA-Akt and adenoviral enhanced green fluorescent protein(Ad-EGFP)virus used in the current study were5.5×1011vp/mL.The portal vein diameter,peak velocity of blood flow,portal blood flow and congestion index were significantly increased in untreated,saline and Ad-EGFP cirrhosis groups when compared to normal control after the virus was introduced to animal through tail veil injection.In contrast,these parameters in the Akt cirrhosis group were comparable to normal control group.Compared to the normal control,the liver function(Alanine aminotransferase,Aspartate aminotransferase and Albumin)was significantly impaired in the untreated,saline and Ad-EGFP cirrhosis groups.The Akt cirrhosis group showed significant improvement of liver function when compared to the untreated,saline and Ad-EGFP cirrhosis groups.The Hyp level and portal vein pressure in Akt cirrhosis groups were also significantly lower than other cirrhosis groups.The results of HE and Van Gieson staining indicated that Akt group has better preservation of histological structure and less fibrosis than other cirrhosis groups.The percentage of apoptotic cell was greatly less in Akt cirrhosis group than in other cirrhosis groups.Akt group showed positive HA tag and an increased level of phosphorylated Akt as well as decreased levels of Fas.In contrast,Caspase-3 and Caspase-9 levels in Akt group were significantly lower than other cirrhosis groups.Noticeable decrease of DR5 andα-SMA and increase of phosphorylated eNOS were observed in the Akt group when compared to other cirrhosis groups.The NO level in liver was significantly higher in Akt group than other cirrhosis groups,which was consistent with the level of phosphorylated eNOS in these groups.CONCLUSION:This study suggest that Ad-myr-HA-Akt virus is a useful tool to prevent CCl4-induced cirrhosis in rat model and Akt pathway may be a therapeutic target for human cirrhosis.展开更多
BACKGROUND Juxtaglomerular cell tumor(JGCT)of the kidney,also known as reninoma,is a rare renal tumor that typically clinically manifests as hypertension,hypokalemia,high renin,and high aldosterone.It is a cause of se...BACKGROUND Juxtaglomerular cell tumor(JGCT)of the kidney,also known as reninoma,is a rare renal tumor that typically clinically manifests as hypertension,hypokalemia,high renin,and high aldosterone.It is a cause of secondary hypertension.Pregnancy with JGCT is rarer and easily misdiagnosed as pregnancy-induced hypertension,thus affecting treatment.CASE SUMMARY A 28-year-old woman presented in early pregnancy with hypertension(blood pressure of 229/159 mmHg),nausea,and occasional dizziness and headache.The patient was diagnosed with pregnancy-induced hypertension,and no relief was found after symptomatic treatment;hence,the pregnancy was terminated by artificial abortion.Her blood pressure remained high following termination of pregnancy.Blood tests suggested hypokalemia(2.997 mmol/L),blood aldo-sterone measured 613 ng/L,and computed tomography urography showed a tumor in the right kidney.Therefore,laparoscopic partial nephrectomy was performed.After surgery,the patient’s blood pressure returned to normal,and blood potassium,aldosterone,and renin normalized.Postoperative pathological examination revealed JGCT.After long-term follow-up,the patient became pregnant again 6 mo after surgery.No hypertension occurred during pregnancy,and the patient delivered a healthy female neonate.CONCLUSION Patients with pregnancy complicated by JGCT are difficult to diagnose.Herein,we advise surgeons on proper handling of such situations.展开更多
Neuromyelitis optica spectrum disorder(NMOSD)is an autoimmune inflammatory demyelinating disease of the central nervous system(CNS)accompanied by blood-brain barrier(BBB)disruption.Dysfunction in microglial lipid meta...Neuromyelitis optica spectrum disorder(NMOSD)is an autoimmune inflammatory demyelinating disease of the central nervous system(CNS)accompanied by blood-brain barrier(BBB)disruption.Dysfunction in microglial lipid metabolism is believed to be closely associated with the neuropathology of NMOSD.However,there is limited evidence on the functional relevance of circulating lipids in CNS demyelination,cellular metabolism,and microglial function.Here,we found that serum low-density lipoprotein(LDL)was positively correlated with markers of neurological damage in NMOSD patients.In addition,we demonstrated in a mouse model of NMOSD that LDL penetrates the CNS through the leaky BBB,directly activating microglia.This activation leads to excessive phagocytosis of myelin debris,inhibition of lipid metabolism,and increased glycolysis,ultimately exacerbating myelin damage.We also found that therapeutic interventions aimed at reducing circulating LDL effectively reversed the lipid metabolic dysfunction in microglia and mitigated the demyelinating injury in NMOSD.These findings shed light on the molecular and cellular mechanisms underlying the positive correlation between serum LDL and neurological damage,highlighting the potential therapeutic target for lowering circulating lipids to alleviate the acute demyelinating injury in NMOSD.展开更多
Precluding the excessive lipoproteins from plasma rapidly and effectively is highly needed for biomedical detection and reducing plasma product scrap in blood donation stations.The current centrifugation procedure is ...Precluding the excessive lipoproteins from plasma rapidly and effectively is highly needed for biomedical detection and reducing plasma product scrap in blood donation stations.The current centrifugation procedure is high-cost and time-consuming.Herein,we fabricated an anionic microfiltration polyethersulfone(PES)membrane modified by interface swelling and implanting of acrylic acid(AA)for screening out large particle lipoprotein chylomicron(CM)and adsorbing cationic very low-density lipoproteins(VLDL).To improve the separation efficiency,a two-stage filtration through carboxylated polyethersulfone microfiltration membranes with the mean pore size of 0.45 and 0.22μm respectively were conducted.Attenuated total reflection Fourier transform infrared technique(ATR-FTIR),water contact angle(WCA),Zeta potential and scanning electron microscope(SEM)were employed to characterize the modified membrane.To test the effectiveness of this membrane,plasma flux and concentration variation of plasma components were examined to study the purification effectiveness.Furthermore,the hemocompatibility of modified membranes was tested to confirm its practicability on bloodcontacting materials.The carboxylated polyethersulfone microfiltration membrane shows its promising potential application to purify chylous plasma.展开更多
The factors influencing the permeability coefficient of gravelly soils used for the development of embankment dams(core wall)are analyzed.Such factors include(but are not limited to)soil size,anisotropy,density and bo...The factors influencing the permeability coefficient of gravelly soils used for the development of embankment dams(core wall)are analyzed.Such factors include(but are not limited to)soil size,anisotropy,density and boundary effects.A review of the literature is conducted and new directions of research are proposed.In such a framework,it is shown that gravelly soil with controlled density and vertical stress should be used to optimize the measurement of the vertical and horizontal permeability coefficients,respectively.展开更多
Dear Editor,Enterovirus 71(EV71)belongs to the genus Enterovirus,family Picornaviridae(Oberste et al.,1999).It was first isolated from patients with central nervous system diseases in California between 1969 and1974(S...Dear Editor,Enterovirus 71(EV71)belongs to the genus Enterovirus,family Picornaviridae(Oberste et al.,1999).It was first isolated from patients with central nervous system diseases in California between 1969 and1974(Schmidt et al.,1974)and has spread worldwide(Solomon et al.,2010).EV71 infection usually causes mild,self-limiting hand,foot,and mouth disease in children.Acute EV71 infection may also cause severe polio-like neurological diseases and significant mortality.展开更多
Cerebral or intracranial aneurysm is a leading cause of subarachnoid hemorrhage. It was initially treated with open surgical clipping but as rapid development of technology a less invasive endovascular coiling techniq...Cerebral or intracranial aneurysm is a leading cause of subarachnoid hemorrhage. It was initially treated with open surgical clipping but as rapid development of technology a less invasive endovascular coiling technique of aneurysm revolutionized the treatment. Due to tortuous anatomy of parent artery and complicated morphology and location of aneurysm there is ongoing challenge in the complete obliteration of aneurysms. To aid in the advances of treating aneurysm stent assisted endovascular coiling was introduced to give more scaffold support to parent artery and decrease events of coil protrusion from aneurysms. Many types and generation of stents were developed. One of the most recently introduced stent is low profile visualized intraluminal support (LVIS) stent. Due to its low profile nature it can be used in 0.017-inch inner diameter microcatheter and reach small and complex vessels providing high aneurysmal neck coverage which was not possible through other traditional stent. In addition, its braided design with tantalum strands and radiopaque markers make it more visible during stent placement and post procedure stent evaluation. Despite of many advantages of LVIS stent it is related to high rate of thromboembolic complications and technical complications. Aim of this review paper was to evaluate therapeutic safety, effectiveness and feasibility of LVIS stent in endovascular coil embolization of intracranial aneurysms.展开更多
Vegetative insecticidal proteins(VIPs),produced during the vegetative stage of their growth in Bacillus thuringiensis,are a group of insecticidal proteins and represent the second generation of insecticidal trans-gene...Vegetative insecticidal proteins(VIPs),produced during the vegetative stage of their growth in Bacillus thuringiensis,are a group of insecticidal proteins and represent the second generation of insecticidal trans-genes that will complement the novelδendotoxins in future.Fewer structural and functional relationships of Vip proteins are known in comparison with those ofδ-endotoxins.In this study,both the maximum-likelihood methods and the maximum parsimony based sliding window analysis were used to evaluate the molecular evolution of Vip proteins.As a result,strong evidence was found that Vip proteins are subject to the high rates of positive selection,and 16 sites are identified to be under positive selection using the Bayes Empirical Bayesian method.Interestingly,all these positively selected sites are located from site-705 to site-809 in the C-terminus of the Vip proteins.Most of these sites are exposed and clustered in the loop regions when mapped onto its computational predicted secondary tertiary and a part of the tertiary structure.It has been postulated that the high divergence in the C-terminal of Vip proteins may not result from the lack of functional constraints,but rather from the rapid mutation to adapt their targeted insects,driven by positive selection.The potential positive selection pressures may be an attempt to adapt for the"arm race"between Vip proteins and the targeted insects,or to enlarge their target's host range.Sites identified to be under positive selection may be related to the insect host range,which may shed a light on the investigation of the Vip proteins'structural and functional relationships.展开更多
[Objectives]The research aimed to study the chemical constituents of ethanol extract from Yao medicine Cissampelopsis spelaeicola.[Methods]The petroleum ether,ethyl acetate and n-butanol fractions from 75%ethanol extr...[Objectives]The research aimed to study the chemical constituents of ethanol extract from Yao medicine Cissampelopsis spelaeicola.[Methods]The petroleum ether,ethyl acetate and n-butanol fractions from 75%ethanol extract of C.spelaeicola were isolated and purified by silica gel,SephadexLH-20 gel column and AB-8 macroporous resin column,etc.The structures of the compounds were analyzed and identified by physicochemical properties and spectral data(mass spectrometry,hydrogen spectrum and carbon spectrum).[Results]Twelve compounds were isolated and identified from 75%ethanol extract of C.spelaeicola.β-sitostero(I)and stigmasterol(II)were isolated from petroleum ether fraction;p-hydroxybenzoic acid(III),β-daucossterol(IV),protocatechuic acid(V),6β-hydroxyeremophi-7(11)-en-12,8β-olide(VI),10β-hydroxyeremophil-7(11)-en-8,12-olide(VII),10β-hydroxyeremophi-7(11),8(9)-dien-8,12-olide(VIII),quercetin(IX),hyperin(X)and 4α-hydroxy-eudesman-11-ene(XI)were isolated from ethyl acetate fraction;quercetin-3-O-robinobioside(XII)was isolated from n-butanol fraction.Compounds I-XII were isolated from C.spelaeicola for the first time.[Conclusions]The study can lay material foundation for activity study of C.spelaeicola.展开更多
Phenolics are vital for the adaptation of plants to terrestrial habitats and for species diversity.Phenoloxidases(catechol oxidases,COs,and laccases,LACs)are responsible for the oxidation and polymerization of phenoli...Phenolics are vital for the adaptation of plants to terrestrial habitats and for species diversity.Phenoloxidases(catechol oxidases,COs,and laccases,LACs)are responsible for the oxidation and polymerization of phenolics.However,their origin,evolution,and differential roles during plant development and land colonization are unclear.We performed the phylogeny,domain,amino acids,compositional biases,and intron analyses to clarify the origin and evolution of COs and LACs,and analysed the structure,selective pressure,and chloroplast targeting to understand the species-dependent distribution of COs.We found that Streptophyta COs were not homologous to the Chlorophyta tyrosinases(TYRs),and might have been acquired by horizontal gene transfer from bacteria.COs expanded in bryophytes.Structural-functionality and selective pressure were partially responsible for the species-dependent retention of COs in embryophytes.LACs emerged in Zygnemaphyceae,having evolved from ascorbate oxidases(AAOs),and prevailed in the vascular plants and strongly expanded in seed plants.COs and LACs coevolved with the phenolic metabolism pathway genes.These results suggested that TYRs and AAOs were the first-stage phenoloxidases in Chlorophyta.COs might be the second key for the early land colonization.LACs were the third one(dominating in the vascular plants)and might be advantageous for diversified phenol substrates and the erect growth of plants.This work provided new insights into how phenoloxidases evolved and were devoted to plant evolution.展开更多
To the Editor:Depression is a common psychiatric disorder,affecting over 260 million people of all ages globally.[1]Prior studies investigating the association between antidepressant use and stroke risk have yielded i...To the Editor:Depression is a common psychiatric disorder,affecting over 260 million people of all ages globally.[1]Prior studies investigating the association between antidepressant use and stroke risk have yielded inconsistent results.[2,3]Consequently,it remains unclear which of the various antidepressant categories may affect stroke.Thus,the rational use of antidepressants is important for reducing stroke risk and recurrence,while offering candidate therapeutic targets.Drug-target Mendelian randomization(MR)analysis,which uses genetic variants located in or near the region of drug target genes as proxies for drug effects,is a promising tool for identifying causal links between drug targets and diseases.展开更多
Moving beyond the static“enabling-rebound”framework,this paper introduces Socio-Technical Transition(STT)theory and its Multi-Level Perspective(MLP)to conceptualize green digital trade as a dynamic system linking da...Moving beyond the static“enabling-rebound”framework,this paper introduces Socio-Technical Transition(STT)theory and its Multi-Level Perspective(MLP)to conceptualize green digital trade as a dynamic system linking data governance and the trade regime.We identify the European Union’s Carbon Border Adjustment Mechanism(CBAM)as a“landscape shock”that destabilizes the incumbent,carbon-intensive trade“regime”by pricing embedded carbon at the border.In response,we propose“Digital Carbon Competitiveness”(DCC)—a firm’s dynamic capability to measure,manage,verify,and valorize carbon emissions using digital tools—as the critical“niche lever”for scaling innovation.Based on this,we outline a multi-level governance design(micro-niche incubation,meso-regime reformation,macro-rule shaping)and derive a set of testable propositions on how the interaction between CBAM and DCC affects emissions and competitiveness.The pa-per’s contributions are threefold:(1)extending MLP theory to the under-researched domain of international trade;(2)conceptualizing and operationalizing DCC;and(3)proposing an integrated governance pathway for shaping the“twin transition.”展开更多
This paper discusses the adaptive strategies and practical effectiveness of SMEs in Shandong Province during the process of digital transformation.It analyzes the key positive factors within the internal and external ...This paper discusses the adaptive strategies and practical effectiveness of SMEs in Shandong Province during the process of digital transformation.It analyzes the key positive factors within the internal and external environments of enterprises,as well as the mutual support between traditional and emerging digital industries,by constructing a comprehensive influencing model of the“double support”framework.The study adopts a combination of quantitative and qualitative methods,collecting data through questionnaires,the Delphi method,and case studies,and applying the DEMATEL model to reveal the interactions and interdependencies between internal and external factors.The findings show that internal management optimization,technological innovation,market positioning,and supply chain management are the core internal drivers of digital transformation,while government policy,market demand,and industry chain synergy are the key external drivers.Through the application of the DEMATEL model,this study further clarifies the interactions and impacts between these factors,providing both a theoretical foundation and practical guidance for enterprises to formulate targeted digital transformation strategies.In addition,the study proposes differentiated transformation paths according to the different development stages of enterprises,in order to help them achieve smooth and effective digital transformation and enhance their competitiveness and market position.The results not only enrich the micro-level theory of digital transformation in SMEs but also provide concrete guidance for practice,offering important theoretical and practical significance.展开更多
This paper introduces the Quantum-Agential framework to address the"foundational gap"in Al-mediated education,where classical dualisms fail to capture the entangled realities of human machine learning.Draw-i...This paper introduces the Quantum-Agential framework to address the"foundational gap"in Al-mediated education,where classical dualisms fail to capture the entangled realities of human machine learning.Draw-ing on Karen Barad's Agential Realism and quantum-like models of cognition,the framework reconceptualizes cognition,agency,and ethics as emergent properties of material-discursive apparatuses rather than attributes ofisolated individuals or tools.By dissolving binaries such as human/machine and subject/object,it provides a re-lational ontology and a formal language for modeling uncertainty,contextuality,and entanglement in learning processes.Case studies of co-writing with generative Al and adaptive tutoring systems illustrate how this ap-proach reframes cognitive load,distributed agency,and systemic ethics.The framework advances post-humanist pedagogy,emphasizes educator roles as architects of learning apparatuses,and proposes diffractive methodolo-gies for research.It offers a principled path toward ethically responsible,cognitively aware,and human-centered futures for Al in education.展开更多
This article investigates how the twin transitions of digitalisation and decarbonisation jointly reshape the logic of global trade by creating new confgurations of“green risk”in digital trade.It argues that digital ...This article investigates how the twin transitions of digitalisation and decarbonisation jointly reshape the logic of global trade by creating new confgurations of“green risk”in digital trade.It argues that digital trade is environmentally ambivalent:if guided only by efciency and speed,energy-intensive data infrastructures,fragmented cross-border logistics and proliferating e-waste can lock in high-carbon development paths.Drawing on Environmental Kuznets Curve reasoning,new institutional economics and the technology–organisation–environment framework,the study develops a system-oriented“Digital Trade–Environment–Regulation”(DTER)model that captures feedback loops between trade expansion,carbon emissions and regulatory responses.On this basis,it constructs a three-pillar regulatory architecture centred on cost internalisation,information transparency and algorithmic steering,and embeds it in a system dynamics simulation framework.Scenario analysis of EU-type,China-type and US-type regimes illustrates how different combinations of carbon pricing,infrastructure policy and platform governance shift the timing and height of the emissions peak while reconfguring trade costs and market access conditions.The article concludes that well-designed green regulation can turn environmental compliance from a latent trade barrier into a driver of long-term competitiveness,provided that standards are interoperable,data governance is trusted and facilitation benefts are explicitly linked to credible low-carbon performance.展开更多
基金Supported by Shenzhen Science and Technology Program Project,No.JCYJ20220530145006013.
文摘BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated using clips.However,postoperative migration of clips to the common bile duct(CBD)or Ttube sinus tract is an overlooked complication of laparoscopic biliary surgery.Previously,most reported cases of postoperative clip migration involved metal clips,with only a few cases involving Hem-o-lok clips and review of the literature.CASE SUMMARY This report describes two cases in which Hem-o-lok clips migrated into the CBD and the T-tube sinus tract following laparoscopic surgery.Case 1 is a 68-year-old female admitted due to abdominal discomfort,and two Hem-o-lok clips were found to have migrated into the CBD 17 months after LC and LCBDE with T-tube drainage,and were removed using a stone extraction balloon.The patient was discharged smoothly after recovery.Case 2 is a 74-year-old male who underwent LC and LCBDE with T-tube drainage and laparoscopic biliary tract basket stone extraction.Nine weeks postoperatively,following T-tube removal,a Hem-o-lok clip was found in the sinus tract,and was extracted from the T-tube sinus tract.The patient recovered smoothly postoperatively.This study also reviews the literature from 2013 to July 2024 on using Hem-o-lok clips in LC and/or LCBDE treatment of gallbladder and biliary diseases and the postoperative migration of these clips into the CBD,T-tube sinus tract,or duodenum.CONCLUSION In patients with a history of LC and/or LCBDE,clip migration should be considered as a differential diagnosis.
基金Supported by Shenzhen Clinical Research Center for Gastroenterology(Gastrointestinal Surgery),No.LCYSSQ20220823091203008.
文摘BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic chemotherapy,targeted therapies,and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.CASE SUMMARY A 39-year-old male presented with unresectable stage IIIB ICC(cT3N1M0),abdominal pain,and elevated carbohydrate antigen(CA)19-9 levels.He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy(GEMOX-HAIC),lenvatinib(8 mg daily),and toripalimab(160 mg every three weeks).After five cycles,significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy.Complications,including biliary stenosis and liver abscesses,were managed with biliary stenting and percutaneous drainage,which allowed for the continuation of chemotherapy.Postoperative pathological examination confirmed a pathological complete response.At the last follow-up,the patient had maintained 29 months of diseasefree survival post-resection and was continuing postoperative therapy.CONCLUSION This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC,lenvatinib,and toripalimab to convert unresectable ICC to a resectable status,thereby potentially improving patient survival by surgical resection.Further clinical trials investigating this regimen are warranted.
基金financially supported by the Chinese National Basic Research 973-Program(No.2014CB440802)Project No.IS-2353 of GIGCAS
文摘The Yamansu belt,an important tectonic component of Eastern Tianshan Mountains,of the Central Asian Orogenic Belt,NW China hosts many Fe-(Cu)deposit.In this study,we present new zircon U-Pb geochronology and geochemical data of the volcanic rocks of Shaquanzi Formation and diorite intrusions in the Yamansu belt.The Shaquanzi Formation comprises mainly basalt,andesite/andesitic tuff,rhyolite and sub-volcanic diabase with local diorite intrusions.The volcanic rocks and diorites contain ca.315-305 Ma and ca.298 Ma zircons respectively.These rocks show calc-alkaline affinity with enrichment in large-ion lithophile elements(LILEs),light rare-earth elements(LREEs),and depletion in high field strength elements(HFSEs)in primitive mantle normalized multi-element diagrams,which resemble typical back-arc basin rocks.They show depleted mantle signature with ε_(Nd)(t)ranging from+3.1 to +5.6 for basalt;+2.1 to+4.7 for andesite;-0.2 to+1.5 for rhyolite and the ε_(Hf)(t)ranges from-0.1 to +13.0 for andesites;+5.8 to +10.7 for andesitic tuffs.We suggest that the Shaquanzi Formation basalt might have originated from a depleted,metasomatized lithospheric mantle source mixed with minor(3-5%)subduction-derived materials,whereas the andesite and rhyolite could be fractional crystallization products of the basaltic magma.The Shaquanzi Formation volcanic rocks could have formed in an intracontinental back-arc basin setting,probably via the southward subduction of the Kangguer Ocean beneath the Middle Tianshan Massif.The Yamansu mineralization belt might have undergone a continental arc to back-arc basin transition during the Late Carboniferous and the intra-continental back-arc basin might have closed in the Early Permian,marked by the emplacement of dioritic magma in the Shaquanzi belt.
文摘AIM:To investigate whether a virus constitutively expressing active Akt is useful to prevent cirrhosis induced by carbon tetrachloride(CCl4).METHODS:Using cre-loxp technique,we created an Ad-myr-HA-Akt virus,in which Akt is labeled by a HA tag and its expression is driven by myr promoter.Further,through measuring enzyme levels and histological structure,we determined the efficacy of this Ad-myrHA-Akt virus in inhibiting the development of cirrhosis induced by CCl4in rats.Lastly,using western blotting,we examined the expression levels and/or phosphorylation status of Akt,apoptotic mediators,endothelial nitric oxide synthase(eNOS),and markers for hepatic stellate cells activation to understand the underlying mechanisms of protective role of this virus.RESULTS:The Ad-myr-HA-Akt virus was confirmed using polymerase chain reaction amplification of inserted Akt gene and sequencing for full length of inserted fragment,which was consistent with the sequence reported in the GenBank.The concentrations of Admyr-HA-Akt and adenoviral enhanced green fluorescent protein(Ad-EGFP)virus used in the current study were5.5×1011vp/mL.The portal vein diameter,peak velocity of blood flow,portal blood flow and congestion index were significantly increased in untreated,saline and Ad-EGFP cirrhosis groups when compared to normal control after the virus was introduced to animal through tail veil injection.In contrast,these parameters in the Akt cirrhosis group were comparable to normal control group.Compared to the normal control,the liver function(Alanine aminotransferase,Aspartate aminotransferase and Albumin)was significantly impaired in the untreated,saline and Ad-EGFP cirrhosis groups.The Akt cirrhosis group showed significant improvement of liver function when compared to the untreated,saline and Ad-EGFP cirrhosis groups.The Hyp level and portal vein pressure in Akt cirrhosis groups were also significantly lower than other cirrhosis groups.The results of HE and Van Gieson staining indicated that Akt group has better preservation of histological structure and less fibrosis than other cirrhosis groups.The percentage of apoptotic cell was greatly less in Akt cirrhosis group than in other cirrhosis groups.Akt group showed positive HA tag and an increased level of phosphorylated Akt as well as decreased levels of Fas.In contrast,Caspase-3 and Caspase-9 levels in Akt group were significantly lower than other cirrhosis groups.Noticeable decrease of DR5 andα-SMA and increase of phosphorylated eNOS were observed in the Akt group when compared to other cirrhosis groups.The NO level in liver was significantly higher in Akt group than other cirrhosis groups,which was consistent with the level of phosphorylated eNOS in these groups.CONCLUSION:This study suggest that Ad-myr-HA-Akt virus is a useful tool to prevent CCl4-induced cirrhosis in rat model and Akt pathway may be a therapeutic target for human cirrhosis.
基金Supported by Medical and Health Technology Project of Hangzhou,No.A20220540.
文摘BACKGROUND Juxtaglomerular cell tumor(JGCT)of the kidney,also known as reninoma,is a rare renal tumor that typically clinically manifests as hypertension,hypokalemia,high renin,and high aldosterone.It is a cause of secondary hypertension.Pregnancy with JGCT is rarer and easily misdiagnosed as pregnancy-induced hypertension,thus affecting treatment.CASE SUMMARY A 28-year-old woman presented in early pregnancy with hypertension(blood pressure of 229/159 mmHg),nausea,and occasional dizziness and headache.The patient was diagnosed with pregnancy-induced hypertension,and no relief was found after symptomatic treatment;hence,the pregnancy was terminated by artificial abortion.Her blood pressure remained high following termination of pregnancy.Blood tests suggested hypokalemia(2.997 mmol/L),blood aldo-sterone measured 613 ng/L,and computed tomography urography showed a tumor in the right kidney.Therefore,laparoscopic partial nephrectomy was performed.After surgery,the patient’s blood pressure returned to normal,and blood potassium,aldosterone,and renin normalized.Postoperative pathological examination revealed JGCT.After long-term follow-up,the patient became pregnant again 6 mo after surgery.No hypertension occurred during pregnancy,and the patient delivered a healthy female neonate.CONCLUSION Patients with pregnancy complicated by JGCT are difficult to diagnose.Herein,we advise surgeons on proper handling of such situations.
基金supported by the National Natural Science Foundation of China(82371404,82271341,82071380,and 81873743)the Knowledge Innovation Program of Wuhan Shuguang Project(2022020801020454)the Tongji Hospital Foundation for Excellent Young Scientists(2020YQ06).
文摘Neuromyelitis optica spectrum disorder(NMOSD)is an autoimmune inflammatory demyelinating disease of the central nervous system(CNS)accompanied by blood-brain barrier(BBB)disruption.Dysfunction in microglial lipid metabolism is believed to be closely associated with the neuropathology of NMOSD.However,there is limited evidence on the functional relevance of circulating lipids in CNS demyelination,cellular metabolism,and microglial function.Here,we found that serum low-density lipoprotein(LDL)was positively correlated with markers of neurological damage in NMOSD patients.In addition,we demonstrated in a mouse model of NMOSD that LDL penetrates the CNS through the leaky BBB,directly activating microglia.This activation leads to excessive phagocytosis of myelin debris,inhibition of lipid metabolism,and increased glycolysis,ultimately exacerbating myelin damage.We also found that therapeutic interventions aimed at reducing circulating LDL effectively reversed the lipid metabolic dysfunction in microglia and mitigated the demyelinating injury in NMOSD.These findings shed light on the molecular and cellular mechanisms underlying the positive correlation between serum LDL and neurological damage,highlighting the potential therapeutic target for lowering circulating lipids to alleviate the acute demyelinating injury in NMOSD.
基金financially supported by Natural Science Foundation of Ningbo City(2018A610026)Zhejiang Provincial Natural Science Foundation of China for Distinguished Young Scholars(LR20E030002)+1 种基金Ten thousand plan-high level talents special support plan of Zhejiang province,China(ZJWR0108020)Youth Innovation Promotion Association of Chinese Academy of Science(2014258)。
文摘Precluding the excessive lipoproteins from plasma rapidly and effectively is highly needed for biomedical detection and reducing plasma product scrap in blood donation stations.The current centrifugation procedure is high-cost and time-consuming.Herein,we fabricated an anionic microfiltration polyethersulfone(PES)membrane modified by interface swelling and implanting of acrylic acid(AA)for screening out large particle lipoprotein chylomicron(CM)and adsorbing cationic very low-density lipoproteins(VLDL).To improve the separation efficiency,a two-stage filtration through carboxylated polyethersulfone microfiltration membranes with the mean pore size of 0.45 and 0.22μm respectively were conducted.Attenuated total reflection Fourier transform infrared technique(ATR-FTIR),water contact angle(WCA),Zeta potential and scanning electron microscope(SEM)were employed to characterize the modified membrane.To test the effectiveness of this membrane,plasma flux and concentration variation of plasma components were examined to study the purification effectiveness.Furthermore,the hemocompatibility of modified membranes was tested to confirm its practicability on bloodcontacting materials.The carboxylated polyethersulfone microfiltration membrane shows its promising potential application to purify chylous plasma.
基金The work is supported by National Key Research and Development Program of China(No.2017YFC0404803)Guizhou High-Level Innovative Talents Project[2018](No.5630)+2 种基金Guizhou Science and Support[2019](No.2869)State Key Laboratory of Simulation and Regulation of Water Cycle in River Basin(No.SKL2020ZY09)Science and Technology Project of Huaneng Group Headquarters(HNKJ17-H18).
文摘The factors influencing the permeability coefficient of gravelly soils used for the development of embankment dams(core wall)are analyzed.Such factors include(but are not limited to)soil size,anisotropy,density and boundary effects.A review of the literature is conducted and new directions of research are proposed.In such a framework,it is shown that gravelly soil with controlled density and vertical stress should be used to optimize the measurement of the vertical and horizontal permeability coefficients,respectively.
基金supported by the National Natural Science Foundation of China grants(No.31870827 to X Zhao,No.31970169 to X Zhou)the National Key Research and Development Program of China grant(No.2019YFA0802701 to X Zhao)+1 种基金the Zhejiang Sci-Tech University Research Startup grants(No.19042401-Y to M Miao)the Zhejiang Sci-Tech University Youth Innovation grants(No.20042140-Y to M Miao)。
文摘Dear Editor,Enterovirus 71(EV71)belongs to the genus Enterovirus,family Picornaviridae(Oberste et al.,1999).It was first isolated from patients with central nervous system diseases in California between 1969 and1974(Schmidt et al.,1974)and has spread worldwide(Solomon et al.,2010).EV71 infection usually causes mild,self-limiting hand,foot,and mouth disease in children.Acute EV71 infection may also cause severe polio-like neurological diseases and significant mortality.
文摘Cerebral or intracranial aneurysm is a leading cause of subarachnoid hemorrhage. It was initially treated with open surgical clipping but as rapid development of technology a less invasive endovascular coiling technique of aneurysm revolutionized the treatment. Due to tortuous anatomy of parent artery and complicated morphology and location of aneurysm there is ongoing challenge in the complete obliteration of aneurysms. To aid in the advances of treating aneurysm stent assisted endovascular coiling was introduced to give more scaffold support to parent artery and decrease events of coil protrusion from aneurysms. Many types and generation of stents were developed. One of the most recently introduced stent is low profile visualized intraluminal support (LVIS) stent. Due to its low profile nature it can be used in 0.017-inch inner diameter microcatheter and reach small and complex vessels providing high aneurysmal neck coverage which was not possible through other traditional stent. In addition, its braided design with tantalum strands and radiopaque markers make it more visible during stent placement and post procedure stent evaluation. Despite of many advantages of LVIS stent it is related to high rate of thromboembolic complications and technical complications. Aim of this review paper was to evaluate therapeutic safety, effectiveness and feasibility of LVIS stent in endovascular coil embolization of intracranial aneurysms.
基金National Natural Science Foundation of China(No.30571009).
文摘Vegetative insecticidal proteins(VIPs),produced during the vegetative stage of their growth in Bacillus thuringiensis,are a group of insecticidal proteins and represent the second generation of insecticidal trans-genes that will complement the novelδendotoxins in future.Fewer structural and functional relationships of Vip proteins are known in comparison with those ofδ-endotoxins.In this study,both the maximum-likelihood methods and the maximum parsimony based sliding window analysis were used to evaluate the molecular evolution of Vip proteins.As a result,strong evidence was found that Vip proteins are subject to the high rates of positive selection,and 16 sites are identified to be under positive selection using the Bayes Empirical Bayesian method.Interestingly,all these positively selected sites are located from site-705 to site-809 in the C-terminus of the Vip proteins.Most of these sites are exposed and clustered in the loop regions when mapped onto its computational predicted secondary tertiary and a part of the tertiary structure.It has been postulated that the high divergence in the C-terminal of Vip proteins may not result from the lack of functional constraints,but rather from the rapid mutation to adapt their targeted insects,driven by positive selection.The potential positive selection pressures may be an attempt to adapt for the"arm race"between Vip proteins and the targeted insects,or to enlarge their target's host range.Sites identified to be under positive selection may be related to the insect host range,which may shed a light on the investigation of the Vip proteins'structural and functional relationships.
基金Guangxi Natural Science Foundation(2016GXNS-FAA380066)Key Laboratory Project of Science and Technology Department of Guangxi Zhuang Autonomous Region(Guikejizi[2014]32)+2 种基金Construction Project of Guangxi Collaborative Innovation Center(Guijiaokeyan[2014]13)the Scientific Research Project from the Key Laboratory of the Foundation and Application of Zhuang Medicine in Guangxi Colleges and Universities(Guijiaokeyan[2016]6 zyfy201605)Quality Evaluation and Standard Research Project of the Quality Standards of Yao Medicinal Materials in Guangxi Zhuang Autonomous Region(Volume II)by Food and Drug Administration of Guangxi Zhuang Autonomous Region.
文摘[Objectives]The research aimed to study the chemical constituents of ethanol extract from Yao medicine Cissampelopsis spelaeicola.[Methods]The petroleum ether,ethyl acetate and n-butanol fractions from 75%ethanol extract of C.spelaeicola were isolated and purified by silica gel,SephadexLH-20 gel column and AB-8 macroporous resin column,etc.The structures of the compounds were analyzed and identified by physicochemical properties and spectral data(mass spectrometry,hydrogen spectrum and carbon spectrum).[Results]Twelve compounds were isolated and identified from 75%ethanol extract of C.spelaeicola.β-sitostero(I)and stigmasterol(II)were isolated from petroleum ether fraction;p-hydroxybenzoic acid(III),β-daucossterol(IV),protocatechuic acid(V),6β-hydroxyeremophi-7(11)-en-12,8β-olide(VI),10β-hydroxyeremophil-7(11)-en-8,12-olide(VII),10β-hydroxyeremophi-7(11),8(9)-dien-8,12-olide(VIII),quercetin(IX),hyperin(X)and 4α-hydroxy-eudesman-11-ene(XI)were isolated from ethyl acetate fraction;quercetin-3-O-robinobioside(XII)was isolated from n-butanol fraction.Compounds I-XII were isolated from C.spelaeicola for the first time.[Conclusions]The study can lay material foundation for activity study of C.spelaeicola.
基金This work received financial support from the National Natural Science Foundation in China(Grant No.32060175 and 32060043)Fundamental Research Projects of Yunnan Province(2022530401740002).
文摘Phenolics are vital for the adaptation of plants to terrestrial habitats and for species diversity.Phenoloxidases(catechol oxidases,COs,and laccases,LACs)are responsible for the oxidation and polymerization of phenolics.However,their origin,evolution,and differential roles during plant development and land colonization are unclear.We performed the phylogeny,domain,amino acids,compositional biases,and intron analyses to clarify the origin and evolution of COs and LACs,and analysed the structure,selective pressure,and chloroplast targeting to understand the species-dependent distribution of COs.We found that Streptophyta COs were not homologous to the Chlorophyta tyrosinases(TYRs),and might have been acquired by horizontal gene transfer from bacteria.COs expanded in bryophytes.Structural-functionality and selective pressure were partially responsible for the species-dependent retention of COs in embryophytes.LACs emerged in Zygnemaphyceae,having evolved from ascorbate oxidases(AAOs),and prevailed in the vascular plants and strongly expanded in seed plants.COs and LACs coevolved with the phenolic metabolism pathway genes.These results suggested that TYRs and AAOs were the first-stage phenoloxidases in Chlorophyta.COs might be the second key for the early land colonization.LACs were the third one(dominating in the vascular plants)and might be advantageous for diversified phenol substrates and the erect growth of plants.This work provided new insights into how phenoloxidases evolved and were devoted to plant evolution.
文摘To the Editor:Depression is a common psychiatric disorder,affecting over 260 million people of all ages globally.[1]Prior studies investigating the association between antidepressant use and stroke risk have yielded inconsistent results.[2,3]Consequently,it remains unclear which of the various antidepressant categories may affect stroke.Thus,the rational use of antidepressants is important for reducing stroke risk and recurrence,while offering candidate therapeutic targets.Drug-target Mendelian randomization(MR)analysis,which uses genetic variants located in or near the region of drug target genes as proxies for drug effects,is a promising tool for identifying causal links between drug targets and diseases.
文摘Moving beyond the static“enabling-rebound”framework,this paper introduces Socio-Technical Transition(STT)theory and its Multi-Level Perspective(MLP)to conceptualize green digital trade as a dynamic system linking data governance and the trade regime.We identify the European Union’s Carbon Border Adjustment Mechanism(CBAM)as a“landscape shock”that destabilizes the incumbent,carbon-intensive trade“regime”by pricing embedded carbon at the border.In response,we propose“Digital Carbon Competitiveness”(DCC)—a firm’s dynamic capability to measure,manage,verify,and valorize carbon emissions using digital tools—as the critical“niche lever”for scaling innovation.Based on this,we outline a multi-level governance design(micro-niche incubation,meso-regime reformation,macro-rule shaping)and derive a set of testable propositions on how the interaction between CBAM and DCC affects emissions and competitiveness.The pa-per’s contributions are threefold:(1)extending MLP theory to the under-researched domain of international trade;(2)conceptualizing and operationalizing DCC;and(3)proposing an integrated governance pathway for shaping the“twin transition.”
文摘This paper discusses the adaptive strategies and practical effectiveness of SMEs in Shandong Province during the process of digital transformation.It analyzes the key positive factors within the internal and external environments of enterprises,as well as the mutual support between traditional and emerging digital industries,by constructing a comprehensive influencing model of the“double support”framework.The study adopts a combination of quantitative and qualitative methods,collecting data through questionnaires,the Delphi method,and case studies,and applying the DEMATEL model to reveal the interactions and interdependencies between internal and external factors.The findings show that internal management optimization,technological innovation,market positioning,and supply chain management are the core internal drivers of digital transformation,while government policy,market demand,and industry chain synergy are the key external drivers.Through the application of the DEMATEL model,this study further clarifies the interactions and impacts between these factors,providing both a theoretical foundation and practical guidance for enterprises to formulate targeted digital transformation strategies.In addition,the study proposes differentiated transformation paths according to the different development stages of enterprises,in order to help them achieve smooth and effective digital transformation and enhance their competitiveness and market position.The results not only enrich the micro-level theory of digital transformation in SMEs but also provide concrete guidance for practice,offering important theoretical and practical significance.
文摘This paper introduces the Quantum-Agential framework to address the"foundational gap"in Al-mediated education,where classical dualisms fail to capture the entangled realities of human machine learning.Draw-ing on Karen Barad's Agential Realism and quantum-like models of cognition,the framework reconceptualizes cognition,agency,and ethics as emergent properties of material-discursive apparatuses rather than attributes ofisolated individuals or tools.By dissolving binaries such as human/machine and subject/object,it provides a re-lational ontology and a formal language for modeling uncertainty,contextuality,and entanglement in learning processes.Case studies of co-writing with generative Al and adaptive tutoring systems illustrate how this ap-proach reframes cognitive load,distributed agency,and systemic ethics.The framework advances post-humanist pedagogy,emphasizes educator roles as architects of learning apparatuses,and proposes diffractive methodolo-gies for research.It offers a principled path toward ethically responsible,cognitively aware,and human-centered futures for Al in education.
文摘This article investigates how the twin transitions of digitalisation and decarbonisation jointly reshape the logic of global trade by creating new confgurations of“green risk”in digital trade.It argues that digital trade is environmentally ambivalent:if guided only by efciency and speed,energy-intensive data infrastructures,fragmented cross-border logistics and proliferating e-waste can lock in high-carbon development paths.Drawing on Environmental Kuznets Curve reasoning,new institutional economics and the technology–organisation–environment framework,the study develops a system-oriented“Digital Trade–Environment–Regulation”(DTER)model that captures feedback loops between trade expansion,carbon emissions and regulatory responses.On this basis,it constructs a three-pillar regulatory architecture centred on cost internalisation,information transparency and algorithmic steering,and embeds it in a system dynamics simulation framework.Scenario analysis of EU-type,China-type and US-type regimes illustrates how different combinations of carbon pricing,infrastructure policy and platform governance shift the timing and height of the emissions peak while reconfguring trade costs and market access conditions.The article concludes that well-designed green regulation can turn environmental compliance from a latent trade barrier into a driver of long-term competitiveness,provided that standards are interoperable,data governance is trusted and facilitation benefts are explicitly linked to credible low-carbon performance.
