A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting w...A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting with right-sided abdominal pain, and the other two patients presented with bilateral lumbar masses. The previous bilateral lumbar hernia reported in the literature was repaired by open surgery. The laparoscopic approach via the transabdominal preperitoneal(TAPP) procedure with the self-gripping Parietex ProG rip? mesh was performed at our center. The laparoscopic repair was conducted by a skilled hernia surgeon, and was successfully performed in the three patients. The patients resumed a semiliquid diet and had no activity restriction after six hours following the operation. No antibiotics were used after the surgery. The operative times of the three patients were 120 min, 85 min, and 130 min. The blood loss volumes of the three patients were 20 mL, 5 mL, and 5 mL. The visual analogue scale pain scores of the three patients were 1, 2, and 2 on postoperative day 1, and were 1, 2, and 1 on postoperative day 3. No perioperative complications, such as bulge, wound infection and hematoma, occurred after the surgery. All of the patients were discharged on the third day after the operation. There was no chronic pain and no hernia recurrence during the follow-up. This study showed that the laparoscopic TAPP approach with the self-gripping mesh is safe and feasible, and can be considered an alternative method for the treatment of bilateral lumbar hernias.展开更多
Originally proposed by John McCarthy in 1955,artificial intelligence(AI)has achieved a breakthrough and revolutionized the processing methods of clinical medicine with the increasing workloads of medical records and d...Originally proposed by John McCarthy in 1955,artificial intelligence(AI)has achieved a breakthrough and revolutionized the processing methods of clinical medicine with the increasing workloads of medical records and digital images.Doctors are paying attention to AI technologies for various diseases in the fields of gastroenterology and hepatology.This review will illustrate AI technology procedures for medical image analysis,including data processing,model establishment,and model validation.Furthermore,we will summarize AI applications in endoscopy,radiology,and pathology,such as detecting and evaluating lesions,facilitating treatment,and predicting treatment response and prognosis with excellent model performance.The current challenges for AI in clinical application include potential inherent bias in retrospective studies that requires larger samples for validation,ethics and legal concerns,and the incomprehensibility of the output results.Therefore,doctors and researchers should cooperate to address the current challenges and carry out further investigations to develop more accurate AI tools for improved clinical applications.展开更多
BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors rem...BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors remain unclear.AIM To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC.METHODS Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS.In order to assess the predictive factors of PA-TACE benefit,the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model.RESULTS A total of 378 patients (PA-TACE vs surgery alone,189:189) from three centerswere included after a propensity-score 1:1 matching analysis.Compared to the group receiving surgery alone,PA-TACE prolonged the OS rate in patients with resected HCC (P <0.001).The Barcelona Clinic Liver Cancer system and ferritinto-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups.Age (P=0.023) and microscopic vascular invasion (MVI)(P=0.002) were also identified in the PA-TACE group,while gender (P=0.027),hepatitis B virus(P=0.034) and albumin-bilirubin grade (P=0.027) were also selected in the surgery alone group.In addition,PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone)<1].Notably,a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P=0.038) and without MVI (P=0.048).CONCLUSION FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS.Moreover,high FHR and the absence of MVI were important predictive factors,which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.展开更多
BACKGROUND Despite significant advances in multimodality treatments,hepatocellular carcinoma(HCC)remains one of the most common malignant tumors.Identification of novel prognostic biomarkers and molecular targets is u...BACKGROUND Despite significant advances in multimodality treatments,hepatocellular carcinoma(HCC)remains one of the most common malignant tumors.Identification of novel prognostic biomarkers and molecular targets is urgently needed.AIM To identify potential key genes associated with tumor microenvironments and the prognosis of HCC.METHODS The infiltration levels of immune cells and stromal cells were calculated and quantified based on the ESTIMATE algorithm.Differentially expressed genes(DEGs)between high and low groups according to immune or stromal scores were screened using the gene expression profile of HCC patients in The Cancer Genome Atlas and were further linked to the prognosis of HCC.These genes were validated in four independent HCC cohorts.Survival-related key genes were identified by a LASSO Cox regression model.RESULTS HCC patients with a high immune/stromal score had better survival benefits than patients with a low score.A total of 899 DEGs were identified and found to be involved in immune responses and extracellular matrices,147 of which were associated with overall survival.Subsequently,52 of 147 survival-related DEGs were validated in additional cohorts.Finally,ten key genes(STSL2,TMC5,DOK5,RASGRP2,NLRC3,KLRB1,CD5L,CFHR3,ADH1C,and UGT2B15)were selected and used to construct a prognostic gene signature,which presented a good performance in predicting overall survival.CONCLUSION This study extracted a list of genes associated with tumor microenvironments and the prognosis of HCC,thereby providing several valuable directions for the prognostic prediction and molecular targeted therapy of HCC in the future.展开更多
BACKGROUND There is a controversy as to whether laparoscopic surgery leads to a poor prognosis compared to the open approach for early gallbladder carcinoma (GBC)We hypothesized that the laparoscopic approach is an al...BACKGROUND There is a controversy as to whether laparoscopic surgery leads to a poor prognosis compared to the open approach for early gallbladder carcinoma (GBC)We hypothesized that the laparoscopic approach is an alternative for early GBC.AIM To identify and evaluate the safety and feasibility of laparoscopic surgery in the treatment of early GBC.METHODS A comprehensive search of online databases,including MEDLINE (PubMed),Cochrane libraries,and Web of Science,was performed to identify noncomparative studies reporting the outcomes of laparoscopic surgery and comparative studies involving laparoscopic surgery and open surgery in early GBC from January 2009 to October 2019.A fixed-effects meta-analysis was performed for 1-and 5-year overall survival and postoperative complications,while 3-year overall survival,operation time,blood loss,the number of lymph node dissected,and postoperative hospital stay were analyzed by random-effects models.RESULTS The review identified 7 comparative studies and 8 non-comparative studies.1068 patients (laparoscopic surgery:613;open surgery:455) were included in the meta-analysis of 1-,3-,and 5-year overall survival with no significant differences observed [(HR=0.54;95%CI:0.29-1.00;12=0.0%;P=0.051),(HR=0.75;95%CI:0.34-1.65;I^2=60.7%;P=0.474),(HR=0.71;95%CI:0.47-1.08;I^2=49.6%;P=0.107),respectively].There were no significant differences in operation time[weighted mean difference (WMD)=18.69;95%CI:-19.98-57.36;I^2=81.4%;P=0.343],intraoperative blood loss (WMD=-169.14;95%CI:-377.86-39.57;I2=89.5%;P=0.112),the number of lymph nodes resected (WMD=0.12;95%CI:-2.95-3.18;I^2=73.4%;P=0.940),and the complication rate (OR=0.69;95%CI:0.30-1.58;I2=0.0%;P=0.377) between the two groups,while patients who underwent laparoscopic surgery had a reduced length of hospital stay (WMD=-5.09;95%CI:-8.74--1.45;I2=91.0%;P=0.006).CONCLUSION This systematic review and meta-analysis confirms that laparoscopic surgery is a safe and feasible alternative to open surgery with comparable survival and operation-related outcomes for early GBC.展开更多
Background Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging.Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies,makin...Background Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging.Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies,making tissue bridging challenging.Methods This study proposes a tissue adhesive in the form of adhesive cryogel particles(ACPs) made from chitosan,acrylic acid,1-ethyl-3-(3-dimethylaminopropyl) carbodiimide(EDC) and N-hydroxysuccinimide(NHS).The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart,intestine,liver,muscle,and stomach.Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells(LO2)and human intestinal epithelial cells(Caco-2).The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models.The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart,liver,and kidney as the ex vivo models.Furthermore,a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness,biocompatibility,and applicability in clinical surgery.Results ACPs are applicable to confined and irregular tissue defects,such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs.ACPs formed tough adhesion between tissues[(670.9±50.1) J/m^(2) for the heart,(607.6±30.0) J/m^(2) for the intestine,(473.7±37.0) J/m^(2) for the liver,(186.1±13.3) J/m^(2) for the muscle,and(579.3±32.3) J/m^(2) for the stomach].ACPs showed considerable cytocompatibility in vitro study,with a high level of cell viability for 3 d[(98.8±1.2)%for LO2 and(98.3±1.6)%for Caco-2].It has comparable inflammation repair in a ruptured rat liver(P=0.58 compared with suture closure),the same with intestinal anastomosis in rabbits(P=0.40 compared with suture anastomosis).Additionally,ACP-based intestinal anastomosis(less than 30 s) was remarkably faster than the conventional suturing process(more than 10 min).When ACPs degrade after surgery,the tissues heal across the adhesion interface.Conclusions ACPs are promising as the adhesive for clinical operations and battlefield rescue,with the capability to bridge irregular tissue defects rapidly.展开更多
Background:Cachexia is a global burden that is caused by chronic diseases such as cancer.It is characterized by inflammation and progressive loss of muscle and adipose tissue,aggravating the patient’s health.Glycemic...Background:Cachexia is a global burden that is caused by chronic diseases such as cancer.It is characterized by inflammation and progressive loss of muscle and adipose tissue,aggravating the patient’s health.Glycemic metabolism disorders exacerbate cachexia and mutually reinforce each other.Thus far,no research has established a connection between the two.Therefore,we aim to explore the influence of glucose metabolism on cachexia using Mendelian randomization(MR)and provide a theoretical basis for the early prediction of cachexia.Methods:We used glycemic traits(type 2 diabetes(T2D),fasting glucose(FG),fasting insulin(FI),hemoglobin A1c(HbA1c),and 2-hour postprandial glucose(2hPG))as exposures;and cachexia traits(hand grip strength(HGS),appendicular lean mass(ALM),and walking pace(WP))as outcomes.22 mediators were included for mediating effects.Multivariable and mediation MR were used to assess the impact of glycemic metabolism on cachexia.Results:In univariate MR,higher FI increased HGS(β=0.113,95%confidence interval(CI):0.060-0.166)and WP(β=0.066,95%CI:0.021-0.112).Higher HbA1c was associated with higher ALM(β=0.067,95%CI:0.017-0.117).Higher 2hPG was associated with weaker HGS(β=−0.037,95%CI:−0.054 to−0.021).In multivariable MR,only FI maintained a relationship with HGS after adjustments for T2D(β=0.103,95%CI:0.026-0.181),FG(β=0.101,95%CI:0.034-0.169),HbA1c(β=0.115,95%CI:0.055-0.176),and 2hPG(β=0.101,95%CI:0.033-0.169).In mediation MR,three mediators were found to be significant between FI and HGS:waist circumference(WC)(48.1%),lumbar spine bone mineral density(LSBMD)(21.3%)and insulin-like growth factor 1(IGF-1)(6.7%).Conclusions:Using multivariable and mediation MR,our finding suggests that higher FI increases HGS with an independent effect.WC,LSBMD,and IGF-1 mediate between FI and HGS.This study offers a theoretical framework for the early prediction and assessment of the prognosis of cachexia in cancer patients with glycemic metabolism disorders.展开更多
Internet of Things(IoT)applications have massive client connections to cloud servers,and the number of networked IoT devices is remarkably increasing.IoT services require both low-tail latency and high concurrency in ...Internet of Things(IoT)applications have massive client connections to cloud servers,and the number of networked IoT devices is remarkably increasing.IoT services require both low-tail latency and high concurrency in datacenters.This study aims to determine whether an order of magnitude improvement is possible in tail latency and concurrency in mainstream systems by proposing a hardware-software codesigned labeled network stack(LNS)for future datacenters.The key innovation is a cross-layered payload labeling mechanism that distinguishes different requests by payload across the full network stack,including application,TCP/IP,and Ethernet layers.This type of design enables prioritized data packet processing and forwarding along the full datapath,such that latency-insensitive requests cannot significantly interfere with high-priority requests.We build a prototype datacenter server to evaluate the LNS design against a commercial X86 server and the mTCP research,using a cloud-supported IoT application scenario.Experimental results show that the LNS design can provide an order of magnitude improvement in tail latency and concurrency.A single datacenter server node can support over 2 million concurrent long-living connections for IoT devices as a 99-percentile tail latency of 50 ms is maintained.In addition,the hardware-software codesign approach remarkably reduces the labeling and prioritization overhead and constrains the interference of high-priority requests to low-priority requests.展开更多
In recent years many security attacks occur when malicious codes abuse in-process memory resources.Due to the increasing complexity,an application program may call third-party code which cannot be controlled by progra...In recent years many security attacks occur when malicious codes abuse in-process memory resources.Due to the increasing complexity,an application program may call third-party code which cannot be controlled by programmers but may contain security vulnerabilities.As a result,the users have the risk of suffering information leakage and control flow hijacking.However,current solutions like Intel memory protection extensions(MPX)severely degrade performance,while other approaches like Intel memory protection keys(MPK)lack flexibility in dividing security domains.In this paper,we propose IMPULP,an effective and efficient hardware approach for in-process memory protection.The rationale of IMPULP is user-level partitioning that user code segments are divided into different security domains according to their instruction addresses,and accessible memory spaces are specified dynamically for each domain via a set of boundary registers.Each instruction related to memory access will be checked according to its security domain and the corresponding boundaries,and illegal in-process memory access of untrusted code segments will be prevented.IMPULP can be leveraged to prevent a wide range of in-process memory abuse attacks,such as buffer overflows and memory leakages.For verification,an FPGA prototype based on RISC-V instruction set architecture has been developed.We present eight tests to verify the effectiveness of IMPULP,including five memory protection function tests,a test to defense typical buffer overflow,a test to defense famous memory leakage attack named Heartbleed,and a test for security benchmark.We execute the SPEC CPU2006 benchmark programs to evaluate the efficiency of IMPULP.The performance overhead of IMPULP is less than 0.2%runtime on average,which is negligible.Moreover,the resource overhead is less than 5.5%for hardware modification of IMPULP.展开更多
文摘A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting with right-sided abdominal pain, and the other two patients presented with bilateral lumbar masses. The previous bilateral lumbar hernia reported in the literature was repaired by open surgery. The laparoscopic approach via the transabdominal preperitoneal(TAPP) procedure with the self-gripping Parietex ProG rip? mesh was performed at our center. The laparoscopic repair was conducted by a skilled hernia surgeon, and was successfully performed in the three patients. The patients resumed a semiliquid diet and had no activity restriction after six hours following the operation. No antibiotics were used after the surgery. The operative times of the three patients were 120 min, 85 min, and 130 min. The blood loss volumes of the three patients were 20 mL, 5 mL, and 5 mL. The visual analogue scale pain scores of the three patients were 1, 2, and 2 on postoperative day 1, and were 1, 2, and 1 on postoperative day 3. No perioperative complications, such as bulge, wound infection and hematoma, occurred after the surgery. All of the patients were discharged on the third day after the operation. There was no chronic pain and no hernia recurrence during the follow-up. This study showed that the laparoscopic TAPP approach with the self-gripping mesh is safe and feasible, and can be considered an alternative method for the treatment of bilateral lumbar hernias.
基金Zhejiang Medical and Health Science and Technology Project,No.2019321842National Natural Science Foundation of China,No.81827804Zhejiang Clinical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases,No.2018E50003.
文摘Originally proposed by John McCarthy in 1955,artificial intelligence(AI)has achieved a breakthrough and revolutionized the processing methods of clinical medicine with the increasing workloads of medical records and digital images.Doctors are paying attention to AI technologies for various diseases in the fields of gastroenterology and hepatology.This review will illustrate AI technology procedures for medical image analysis,including data processing,model establishment,and model validation.Furthermore,we will summarize AI applications in endoscopy,radiology,and pathology,such as detecting and evaluating lesions,facilitating treatment,and predicting treatment response and prognosis with excellent model performance.The current challenges for AI in clinical application include potential inherent bias in retrospective studies that requires larger samples for validation,ethics and legal concerns,and the incomprehensibility of the output results.Therefore,doctors and researchers should cooperate to address the current challenges and carry out further investigations to develop more accurate AI tools for improved clinical applications.
基金Supported by Opening Fund of Engineering Research Center of Cognitive Healthcare of Zhejiang Province,No.2018KFJJ09National Natural Science Foundation of China,No.81827804
文摘BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors remain unclear.AIM To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC.METHODS Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS.In order to assess the predictive factors of PA-TACE benefit,the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model.RESULTS A total of 378 patients (PA-TACE vs surgery alone,189:189) from three centerswere included after a propensity-score 1:1 matching analysis.Compared to the group receiving surgery alone,PA-TACE prolonged the OS rate in patients with resected HCC (P <0.001).The Barcelona Clinic Liver Cancer system and ferritinto-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups.Age (P=0.023) and microscopic vascular invasion (MVI)(P=0.002) were also identified in the PA-TACE group,while gender (P=0.027),hepatitis B virus(P=0.034) and albumin-bilirubin grade (P=0.027) were also selected in the surgery alone group.In addition,PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone)<1].Notably,a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P=0.038) and without MVI (P=0.048).CONCLUSION FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS.Moreover,high FHR and the absence of MVI were important predictive factors,which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.
文摘BACKGROUND Despite significant advances in multimodality treatments,hepatocellular carcinoma(HCC)remains one of the most common malignant tumors.Identification of novel prognostic biomarkers and molecular targets is urgently needed.AIM To identify potential key genes associated with tumor microenvironments and the prognosis of HCC.METHODS The infiltration levels of immune cells and stromal cells were calculated and quantified based on the ESTIMATE algorithm.Differentially expressed genes(DEGs)between high and low groups according to immune or stromal scores were screened using the gene expression profile of HCC patients in The Cancer Genome Atlas and were further linked to the prognosis of HCC.These genes were validated in four independent HCC cohorts.Survival-related key genes were identified by a LASSO Cox regression model.RESULTS HCC patients with a high immune/stromal score had better survival benefits than patients with a low score.A total of 899 DEGs were identified and found to be involved in immune responses and extracellular matrices,147 of which were associated with overall survival.Subsequently,52 of 147 survival-related DEGs were validated in additional cohorts.Finally,ten key genes(STSL2,TMC5,DOK5,RASGRP2,NLRC3,KLRB1,CD5L,CFHR3,ADH1C,and UGT2B15)were selected and used to construct a prognostic gene signature,which presented a good performance in predicting overall survival.CONCLUSION This study extracted a list of genes associated with tumor microenvironments and the prognosis of HCC,thereby providing several valuable directions for the prognostic prediction and molecular targeted therapy of HCC in the future.
基金the Zhejiang Medical Health Science and Technology Project,No.2016133597 and No.2019321842Natural Science Foundation of Zhejiang Province,No.LQ18H160003.
文摘BACKGROUND There is a controversy as to whether laparoscopic surgery leads to a poor prognosis compared to the open approach for early gallbladder carcinoma (GBC)We hypothesized that the laparoscopic approach is an alternative for early GBC.AIM To identify and evaluate the safety and feasibility of laparoscopic surgery in the treatment of early GBC.METHODS A comprehensive search of online databases,including MEDLINE (PubMed),Cochrane libraries,and Web of Science,was performed to identify noncomparative studies reporting the outcomes of laparoscopic surgery and comparative studies involving laparoscopic surgery and open surgery in early GBC from January 2009 to October 2019.A fixed-effects meta-analysis was performed for 1-and 5-year overall survival and postoperative complications,while 3-year overall survival,operation time,blood loss,the number of lymph node dissected,and postoperative hospital stay were analyzed by random-effects models.RESULTS The review identified 7 comparative studies and 8 non-comparative studies.1068 patients (laparoscopic surgery:613;open surgery:455) were included in the meta-analysis of 1-,3-,and 5-year overall survival with no significant differences observed [(HR=0.54;95%CI:0.29-1.00;12=0.0%;P=0.051),(HR=0.75;95%CI:0.34-1.65;I^2=60.7%;P=0.474),(HR=0.71;95%CI:0.47-1.08;I^2=49.6%;P=0.107),respectively].There were no significant differences in operation time[weighted mean difference (WMD)=18.69;95%CI:-19.98-57.36;I^2=81.4%;P=0.343],intraoperative blood loss (WMD=-169.14;95%CI:-377.86-39.57;I2=89.5%;P=0.112),the number of lymph nodes resected (WMD=0.12;95%CI:-2.95-3.18;I^2=73.4%;P=0.940),and the complication rate (OR=0.69;95%CI:0.30-1.58;I2=0.0%;P=0.377) between the two groups,while patients who underwent laparoscopic surgery had a reduced length of hospital stay (WMD=-5.09;95%CI:-8.74--1.45;I2=91.0%;P=0.006).CONCLUSION This systematic review and meta-analysis confirms that laparoscopic surgery is a safe and feasible alternative to open surgery with comparable survival and operation-related outcomes for early GBC.
基金supported by the National Natural Science Foundation of China (12102388, T2125009, 92048302)the National Key Research and Development Program of China 2017 (YFA0701100)the Fundamental Research Funds for the Central Universities (226-2022-00141, 2022QZJH52)。
文摘Background Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging.Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies,making tissue bridging challenging.Methods This study proposes a tissue adhesive in the form of adhesive cryogel particles(ACPs) made from chitosan,acrylic acid,1-ethyl-3-(3-dimethylaminopropyl) carbodiimide(EDC) and N-hydroxysuccinimide(NHS).The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart,intestine,liver,muscle,and stomach.Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells(LO2)and human intestinal epithelial cells(Caco-2).The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models.The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart,liver,and kidney as the ex vivo models.Furthermore,a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness,biocompatibility,and applicability in clinical surgery.Results ACPs are applicable to confined and irregular tissue defects,such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs.ACPs formed tough adhesion between tissues[(670.9±50.1) J/m^(2) for the heart,(607.6±30.0) J/m^(2) for the intestine,(473.7±37.0) J/m^(2) for the liver,(186.1±13.3) J/m^(2) for the muscle,and(579.3±32.3) J/m^(2) for the stomach].ACPs showed considerable cytocompatibility in vitro study,with a high level of cell viability for 3 d[(98.8±1.2)%for LO2 and(98.3±1.6)%for Caco-2].It has comparable inflammation repair in a ruptured rat liver(P=0.58 compared with suture closure),the same with intestinal anastomosis in rabbits(P=0.40 compared with suture anastomosis).Additionally,ACP-based intestinal anastomosis(less than 30 s) was remarkably faster than the conventional suturing process(more than 10 min).When ACPs degrade after surgery,the tissues heal across the adhesion interface.Conclusions ACPs are promising as the adhesive for clinical operations and battlefield rescue,with the capability to bridge irregular tissue defects rapidly.
基金supported by the National Natural Science Foundation of China(82202873)the State Key Laboratory of Advanced Drug Delivery and Release Systems(DSQZ-QN-202303).
文摘Background:Cachexia is a global burden that is caused by chronic diseases such as cancer.It is characterized by inflammation and progressive loss of muscle and adipose tissue,aggravating the patient’s health.Glycemic metabolism disorders exacerbate cachexia and mutually reinforce each other.Thus far,no research has established a connection between the two.Therefore,we aim to explore the influence of glucose metabolism on cachexia using Mendelian randomization(MR)and provide a theoretical basis for the early prediction of cachexia.Methods:We used glycemic traits(type 2 diabetes(T2D),fasting glucose(FG),fasting insulin(FI),hemoglobin A1c(HbA1c),and 2-hour postprandial glucose(2hPG))as exposures;and cachexia traits(hand grip strength(HGS),appendicular lean mass(ALM),and walking pace(WP))as outcomes.22 mediators were included for mediating effects.Multivariable and mediation MR were used to assess the impact of glycemic metabolism on cachexia.Results:In univariate MR,higher FI increased HGS(β=0.113,95%confidence interval(CI):0.060-0.166)and WP(β=0.066,95%CI:0.021-0.112).Higher HbA1c was associated with higher ALM(β=0.067,95%CI:0.017-0.117).Higher 2hPG was associated with weaker HGS(β=−0.037,95%CI:−0.054 to−0.021).In multivariable MR,only FI maintained a relationship with HGS after adjustments for T2D(β=0.103,95%CI:0.026-0.181),FG(β=0.101,95%CI:0.034-0.169),HbA1c(β=0.115,95%CI:0.055-0.176),and 2hPG(β=0.101,95%CI:0.033-0.169).In mediation MR,three mediators were found to be significant between FI and HGS:waist circumference(WC)(48.1%),lumbar spine bone mineral density(LSBMD)(21.3%)and insulin-like growth factor 1(IGF-1)(6.7%).Conclusions:Using multivariable and mediation MR,our finding suggests that higher FI increases HGS with an independent effect.WC,LSBMD,and IGF-1 mediate between FI and HGS.This study offers a theoretical framework for the early prediction and assessment of the prognosis of cachexia in cancer patients with glycemic metabolism disorders.
基金The work was supported by the National Key Research and Development Plan of China under Grant No.2016YFB1000203.
文摘Internet of Things(IoT)applications have massive client connections to cloud servers,and the number of networked IoT devices is remarkably increasing.IoT services require both low-tail latency and high concurrency in datacenters.This study aims to determine whether an order of magnitude improvement is possible in tail latency and concurrency in mainstream systems by proposing a hardware-software codesigned labeled network stack(LNS)for future datacenters.The key innovation is a cross-layered payload labeling mechanism that distinguishes different requests by payload across the full network stack,including application,TCP/IP,and Ethernet layers.This type of design enables prioritized data packet processing and forwarding along the full datapath,such that latency-insensitive requests cannot significantly interfere with high-priority requests.We build a prototype datacenter server to evaluate the LNS design against a commercial X86 server and the mTCP research,using a cloud-supported IoT application scenario.Experimental results show that the LNS design can provide an order of magnitude improvement in tail latency and concurrency.A single datacenter server node can support over 2 million concurrent long-living connections for IoT devices as a 99-percentile tail latency of 50 ms is maintained.In addition,the hardware-software codesign approach remarkably reduces the labeling and prioritization overhead and constrains the interference of high-priority requests to low-priority requests.
基金This work was supported by the National Key Research and Development Plan of China under Grant No.2016YFB1000200the National Natural Science Foundation of China under Grant No.61772497the State Key Laboratory of Computer Architecture Foundation under Grant Nos.CARCH4405 and CARCH2601.
文摘In recent years many security attacks occur when malicious codes abuse in-process memory resources.Due to the increasing complexity,an application program may call third-party code which cannot be controlled by programmers but may contain security vulnerabilities.As a result,the users have the risk of suffering information leakage and control flow hijacking.However,current solutions like Intel memory protection extensions(MPX)severely degrade performance,while other approaches like Intel memory protection keys(MPK)lack flexibility in dividing security domains.In this paper,we propose IMPULP,an effective and efficient hardware approach for in-process memory protection.The rationale of IMPULP is user-level partitioning that user code segments are divided into different security domains according to their instruction addresses,and accessible memory spaces are specified dynamically for each domain via a set of boundary registers.Each instruction related to memory access will be checked according to its security domain and the corresponding boundaries,and illegal in-process memory access of untrusted code segments will be prevented.IMPULP can be leveraged to prevent a wide range of in-process memory abuse attacks,such as buffer overflows and memory leakages.For verification,an FPGA prototype based on RISC-V instruction set architecture has been developed.We present eight tests to verify the effectiveness of IMPULP,including five memory protection function tests,a test to defense typical buffer overflow,a test to defense famous memory leakage attack named Heartbleed,and a test for security benchmark.We execute the SPEC CPU2006 benchmark programs to evaluate the efficiency of IMPULP.The performance overhead of IMPULP is less than 0.2%runtime on average,which is negligible.Moreover,the resource overhead is less than 5.5%for hardware modification of IMPULP.
