BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly dev...BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.展开更多
The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc...The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.展开更多
BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid er...BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid era,but direct head-to-head cost comparisons between the two modalities are not available in literature.AIM To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.METHODS A prospective observational single-center case control study including adult patients with ARF(PaO2/FiO2 ratio<300)admitted from January 1,2024 to December 31,2024 in medical intensive care unit(ICU)of a tertiary care hospital requiring either NIV or invasive ventilation.NIV and IMV groups were compared based on average length of ICU and hospital stay,mortality,net cost of ICU treatment,need for intubation and tracheostomy.RESULTS A total of 319 patients were included in the study(197 in NIV,122 in IMV group).Statistically significant difference in length of ICU stay(NIV group:5±3.25 days,IMV group:9±2.6 days;P<0.05)and mortality rate was seen(11%NIV vs 34%IMV;P<0.01).On multivariate analyses,mortality showed a stronger association with IMV[odds ratio(OR)=7.73;95%CI:3.12-19.18]as compared to ICU stay(OR=2.73;95%CI:2.15-3.48).A total of 33 patients(17%)in NIV group required intubation of which 3 were tracheostomized,while 14 patients(11%)in IMV group needed tracheostomy.The net average cost of ICU stay was₹83902 in NIV group while in IMV group,the net ICU cost was₹476216.The average cost of ICU stay was five times higher with IMV.CONCLUSION NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.展开更多
BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery ...BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.展开更多
Invasive alien plant species(IAPS)pose severe threats to global biodiversity conservation.Effective management of IAPS requires mapping their distribution and identifying the environmental factors that drive their spr...Invasive alien plant species(IAPS)pose severe threats to global biodiversity conservation.Effective management of IAPS requires mapping their distribution and identifying the environmental factors that drive their spread.The Gaoligong Mountains,a renowned biodiversity hotspot in southwestern China,currently face the dual challenges of IAPS invasion and climate change.However,we know little about the distribution patterns,key environmental drivers,and sensitivity of IAPS to future climate change in this region.In this study,we mapped IAPS richness distribution and identified invasion hotspots throughout the Gaoligong Mountains.In addition,we assessed the relative importance of environmental variables in shaping the spatial distribution of IAPS richness and projected potential shifts in IAPS richness under various climate change scenarios.We identified 161 IAPS,primarily concentrated in the low-elevation tropical and subtropical regions along river valleys,forming belt-like invasion hotspots.The key factors shaping IAPS richness included disturbance complexity,elevation,seasonal precipitation,and vegetation types.Notably,IAPS richness significantly declined with increasing elevation and latitude but increased with higher disturbance complexity.Moreover,IAPS were more prevalent in grasslands and shrublands than in forested areas.Ensemble modeling of future climate scenarios predicted that the distribution of IAPS richness would shift to progressively higher elevations.These findings provide valuable insights for managing IAPS in mountainous regions that play a crucial role in global biodiversity conservation.展开更多
Biological invasions are a major driver of global biodiversity loss,impacting endemic species,ecosystems,and economies.Although the influence of life history traits on invasive success is well-established,the role of ...Biological invasions are a major driver of global biodiversity loss,impacting endemic species,ecosystems,and economies.Although the influence of life history traits on invasive success is well-established,the role of behavior in the invasive potential of animals is less studied.The common coqui frog,Eleutherodactylus coqui,is a highly successful invader in Hawai'i.We build on previous research characterizing changes in physiology and morphology to explore behavioral variation across the invasive range of coqui in Hawai'i.Coqui have expanded both outward and upward from their initial introduction site,andby comparing frogs from different densities and elevations-we specifically asked how the physiological challenges of high-elevation living interact with the competitive challenge of high-densities at population centers.To investigate whether differences in the field represent local adaptation or behavioral plasticity,we additionally evaluated behavior following acclimation to a shared laboratory environment.Although we identified only subtle behavioral variation among populations in the field,we found that individuals from all populations became less bold,active,and exploratory in the laboratory,converging on a similar behavioral phenotype.Alongside previous work,our results suggest that coqui adjust their behavior to local environmental conditions across their invasive range and that behavioral flexibility may contribute to invasive success.展开更多
Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularl...Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.展开更多
BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the ...BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the minimally invasive(MIS)approach and its effect on these outcomes.AIM To investigate RTW and ROD's timelines and influencing factors following anterior MIS-THA.METHODS A retrospective analysis was conducted on 124 patients who underwent anterior MIS-THA.Data on the demographics,occupational physical demands,and RTW/ROD timelines were also collected.Clinical outcomes were measured using standardised scoring systems.Statistical analyses were performed to evaluate the differences between the groups based on employment status and physical workload.RESULTS Among employed patients,the RTW rate was 94.7%,with an average return time of five weeks.The average ROD time was 3.5 weeks across all patients.Despite similar postoperative clinical scores,RTW time was significantly influenced by occupations'physical workload,with heavier physical demands associated with delayed RTW.CONCLUSION Anterior MIS-THA facilitates early RTW and ROD,particularly in occupations with lower physical demands.These findings highlight the importance of considering occupational and physical workload in postoperative care planning to optimize recovery outcomes.展开更多
Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30...Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30%-40%.The common complications following esophagectomy are pulmonary infections,cardiac events,anastomotic leakage,bleeding,chylous leak,and recurrent laryngeal nerve palsy which in turn lead to longer hospital stay,increased treatment cost and poor quality of life.A nomographic model comprising preoperative(patient,disease and treatment related)and intraoperative factors in combination with Artificial Intelligence may accurately identify the patients at higher risk of morbidity.This will aid in optimizing the modifiable risk factors preoperatively,and closely monitor these patients post operatively for early identification of complications and to initiate early corrective measures to improve the surgical outcome.展开更多
With the development of international trade and frequent personnel exchanges,biological invasion is showing a rapidly growing trend worldwide.Insects are ectothermic animals,so their geographical distribution is due l...With the development of international trade and frequent personnel exchanges,biological invasion is showing a rapidly growing trend worldwide.Insects are ectothermic animals,so their geographical distribution is due largely to their high and low temperature tolerances.To study the temperature response mechanisms of Bemisia tabaci Mediterranean cryptic species(MED),miRNA-seq technology was used to unravel the miRNA library of B.tabaci MED in three field populations(TP,HB,and HK)from cities with different environmental temperatures.We identified 12 differentially expressed miRNAs in response to temperature stress,and Bta-miR-998 and Bta-miR-129 were shown to be associated with temperature tolerance.In addition,we predicted and verified the target genes associated with the temperature tolerance imparted by Bta-miR-998 and Bta-miR-129.The results showed that the down-regulated target gene of Bta-miR-129,BtMGAT3,significantly reduced the heat tolerance and another downregulated target gene,BtRGS7,affected the cold tolerance of B.tabaci MED.These results indicate that gene expression regulated by miRNAs is an important temperature response mechanism in B.tabaci MED.This study reveals the important regulatory role of miRNA in insect temperature adaptation and provides a new avenue for studying the regulation of insect gene expression by miRNA.展开更多
Biological invasions have become recognized as one of the greatest threats to ecosystems.Codium,a genus of invasive green algae,has frequent global outbreaks and damages local marine ecosystems.It is now generally acc...Biological invasions have become recognized as one of the greatest threats to ecosystems.Codium,a genus of invasive green algae,has frequent global outbreaks and damages local marine ecosystems.It is now generally accepted that light is one of the main factors affecting the luxuriant growth of macroalgae such as Codium.In this study,to investigate the invasive photo-adaptation strategy of Codium fragile,the photo-adaptation characteristics of C.fragile and Codium.cylindricum from the Nan’ao Island of China were compared and explored.The effect of light intensity on the photosynthetic properties of the two species was investigated:the maximum quantum yield of photosystemⅡ(Fv/Fm)of C.fragile was significantly higher at low light intensity.At a light intensity of 90μmol/(m^(2)·s),maximum relative electron transport rate(rETR_(max))of the thalli was maximum,and the minimum saturating irradiance(Ek)was significantly increased.The photosynthetic rate(αvalue)of thalli was highest at a light intensity of 30μmol/(m^(2)·s).The photochemical quenching(qP)was enhanced but non-photochemical quenching(NPQ)was reduced at high light intensities.As for C.cylindricum,the optimal photochemical efficiency of the thalli at low light intensity was higher.High light intensity significantly reduced the rETR of the thalli.At low light intensity,αwas significantly higher,Ek was significantly lower,and NPQ was also significantly decreased.The response relationship between light acclimation and antioxidant capacity of the thalli of two species of Codium was investigated:there was no significant effect of light intensity variation on the total antioxidant capacity of C.fragile.In the case of C.cylindricum,the degree of membrane lipid peroxidation was significantly increased at low light intensity,and its antioxidant capacity was significantly reduced when the light intensity was too high or too low.It can be hypothesized that the self-protection ability of C.fragile may be stronger than that of C.cylindricum under low and high light intensities,which is closely related to the strong invasiveness of C.fragile.展开更多
Invasive alien species(IAS)significantly threaten global biodiversity and ecosystem stability.Despite increasing management efforts,a critical knowledge gap existed in understanding commonalities and disparities among...Invasive alien species(IAS)significantly threaten global biodiversity and ecosystem stability.Despite increasing management efforts,a critical knowledge gap existed in understanding commonalities and disparities among national strategies.We analyzed several IAS management lists from 23 countries and the European Union,focusing specifically on vascular plant species within these lists.List composition,characteristics,and associated management measures were analyzed.Key patterns in species prioritization across national lists and intercontinental exchange of invasive alien plants(IAPs)were identified.Pistia stratiotes,Pontederia crassipes,Salvinia molesta,Cabomba caroliniana,Ulex europaeus were identified as globally recognized threats,being listed by at least 33.3%of analyzed countries and invading five or more continents.Aquatic plants were found to be more frequently included in management lists.A significant directional invasion pattern between the Eastern and Western Hemispheres was identified.Species native to Asia were observed to dominate as significant donors of IAPs across continents.The analysis of list management strategies highlighted substantial gaps in achieving Target 6 of the Kunming-Montreal Global Biodiversity Framework,particularly in species prioritization and inclusion of potential IAPs.In response to these challenges,a tiered classification system for invasive alien species list was proposed,encompassing High-Priority,Watchlist,Potential,and Priority Site categories,which aimed at enhancing management effectiveness by tailoring strategies to different invasion stages and ecological contexts.This study could contribute to understanding global IAPs management strategies and serve as a reference for policymakers and conservation managers to identify priority IAPs and refine management approaches.展开更多
Chemical exposure during prenatal development has significant implications for both maternal and child health.Compared to blood,saliva is a non-invasive and less resource-intensive,alternative.Given the temporal varia...Chemical exposure during prenatal development has significant implications for both maternal and child health.Compared to blood,saliva is a non-invasive and less resource-intensive,alternative.Given the temporal variability of xenobiotic metabolites(XM),repeated sampling is essential.Therefore,saliva offers a valuable tool for the longitudinal assessment of prenatal exposomes.Despite its potential,no studies have explored saliva for XM measurement.This study pioneered using saliva to assess XM detectability and investigate the associations between prenatal XM and endogenous metabolomes in pregnant women.Saliva samples were analysed using mass spectrometry from 80 pregnant women at 24–34 weeks gestation.Metabolomes and exposomes were annotated using the Human Metabolome and U.S.Environmental Protection Agency databases.Metabolome-XM associations were clustered using Glay community clustering.Linear regression models,adjusted for age,estimated associations between catecholamines and XMs.XM levels were validated in a cohort of women(n=14)with and without preeclampsia.Our study identified 582 metabolomes and 125 XM in saliva,demonstrating its potential as a matrix for exposure measurement.After false discovery rate correction,18109 significant metabolome-XM associations were identified.Community clustering revealed 37 connected clusters,with the largest cluster(238 nodes)enriched in tyrosine and catecholamine metabolism.Food-contactchemicals and food-additives were significantly associated with higher catecholamine and their metabolite levels.Subgroup analyses revealed higher concentrations of these chemicals in women with preeclampsia compared to healthy controls.This study demonstrates that saliva contains valuable molecular data for measuring exposomes.Food-related chemicals were associated with higher catecholamine levels,which may be relevant to the prevalence of hypertensive crises in pregnancy.展开更多
Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating se...Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.展开更多
BACKGROUND Minimally invasive pancreaticoduodenectomy(MIPD)is considered one of the most complex procedures in general surgery.The number of articles on MIPD has been increasing annually.However,published reports ofte...BACKGROUND Minimally invasive pancreaticoduodenectomy(MIPD)is considered one of the most complex procedures in general surgery.The number of articles on MIPD has been increasing annually.However,published reports often have complex research directions,and the focal points frequently change.Therefore,a comprehensive review and organization of the literature in this field is necessary.AIM To summarize current research,predict future hotspots and trends,and provide insights for MIPD development.METHODS To conduct the study,the Web of Science Core Collection was searched for relevant articles.The analysis focused on the top 100 articles in the field.Two widely used bibliometric tools,CiteSpace and VOSviewer,were used to examine various aspects,including research directions,authors,countries,institutions,journals,and keywords.RESULTS The top 100 articles were published between 2005 and 2022,with the majority originating from the United States(n=51).Among the contributing institutions,Pancreas Center of the University of Chicago and the Health System of the University of Chicago had the highest number of publications(n=17).In terms of individual authors,“Zeh HJ”and“Zureikat AH”led with 13 articles each.The high-frequency keywords in the literature encompassed three main areas:Surgical modality,perioperative outcomes,and the learning curve.These keywords were further categorized into seven primary clusters,with the largest being“laparoscopic pancreaticoduodenectomy”.CONCLUSION The most influential studies predominantly originate from the United States,and there is growing interest in robotic surgery.Despite MIPD’s potential benefits,further research is required to address technical challenges and improve outcomes.展开更多
Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surger...Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surgery,studies have demonstrated that minimally invasive surgery(MIS)can provide benefits in CRC emergencies,such as reduced morbidity and a shorter length of hospitalization.However,the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology,resource constraints,and the need for technical expertise.As an alternative to emergency MIS,endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery.This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies,whilst highlighting the challenges to implementation and the strategies to overcome them.展开更多
Colorectal cancer(CRC)is one of the most prevalent malignancies in Western countries and is among the leading causes of cancer-related mortality.Despite advancements in primary tumor resection and systemic therapies,a...Colorectal cancer(CRC)is one of the most prevalent malignancies in Western countries and is among the leading causes of cancer-related mortality.Despite advancements in primary tumor resection and systemic therapies,a significantproportion of patients develop metastatic disease,with the lungs being a frequent site of dissemination.1 Approximately 10%–25%of CRC patients experience pulmonary metastases,a condition that poses substantial challenges in oncological management.展开更多
Plant invasion poses a serious environmental challenge to freshwater ecosystems. Heavy metal pollution and nutrient enrichment, particularly nitrogen (N) and phosphorus (P), are two additional critical environmental i...Plant invasion poses a serious environmental challenge to freshwater ecosystems. Heavy metal pollution and nutrient enrichment, particularly nitrogen (N) and phosphorus (P), are two additional critical environmental issues known to influence the growth of invasive plants. Notably, the N/P ratio in the environments is often inconstant;however, whether these variations can cause differential responses in invasive plants remains underexplored, despite its crucial importance for understanding plant invasiveness. In this study, we examined the effects of different N/P ratios (4:1, 16:1, 32:1, 64:1) on the growth of a widespread invasive plant Alternanthera philoxeroides in cadmium (Cd) polluted water, while maintaining either a constant N concentration (2 mmol L^(−1)) or a constant P concentration (0.5 mmol L^(−1)). Two control treatments were also included: one without Cd, N, or P, and another with Cd but without N or P. The addition of N and P did not mitigate the inhibitory effects of Cd on A. philoxeroides growth nor did it enhance its tolerance. However, under conditions of constant N concentration, the N/P ratio of 4:1 significantly increased both the main stem length and the number of nodes in A. philoxeroides under Cd stress, potentially enhancing its expansion and clonal growth. Our results suggest that A. philoxeroides exhibits greater sensitivity to variations in the N/P ratio when N concentration is held constant, compared to when P concentration is constant in Cd polluted water. This study investigated the effects of varying N/P ratios on invasive plants under Cd pollution, which has been underexplored in previous research. The findings provide an experimental basis for controlling and preventing the spread of invasive plants in freshwater systems polluted with Cd and experiencing eutrophication.展开更多
BACKGROUND Breast hamartomas are rare benign breast tumors,with an incidence rate of 0.8%-4.8%.Further,the coexistence of hamartomas and carcinoma is also uncommon.Our case report presents a unique instance where inva...BACKGROUND Breast hamartomas are rare benign breast tumors,with an incidence rate of 0.8%-4.8%.Further,the coexistence of hamartomas and carcinoma is also uncommon.Our case report presents a unique instance where invasive ductal carcinoma(IDC)and ductal carcinoma in situ were found both inside and outside a breast hamartoma.This is the second case reported in the literature.CASE SUMMARY A 51-year-old woman presented with a 6.0 cm breast tumor on mammography and ultrasound,with suspicious areas indicative of malignant transformation.Biopsy of the suspicious area confirmed IDC with intraductal carcinoma.Breast magnetic resonance imaging showed typical hamartoma changes with irregular areas of abnormal enhancement both inside and outside.A breast-conserving surgery was performed,and postoperative pathology confirmed mammary hamartoma,concurrent with IDC and intraductal carcinoma occurring both inside and outside the hamartoma.Subsequently,appropriate adjuvant therapy was initiated.Currently,the patient is in good condition.Breast cancer may be located both inside and outside the ipsilateral mammary hamartoma,which is difficult to detect preoperatively,especially when there is a focus of intraductal carcinoma,requiring accurate assessment of the tumor extent by modern imaging techniques.Early detection of the coexistence of cancer is clinically important as it can alter patient management.CONCLUSION This case emphasizes the importance of modern imaging techniques in accurately evaluating mammary hamartomas associated with malignancies prior to surgery.展开更多
文摘BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.
文摘The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.
文摘BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid era,but direct head-to-head cost comparisons between the two modalities are not available in literature.AIM To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.METHODS A prospective observational single-center case control study including adult patients with ARF(PaO2/FiO2 ratio<300)admitted from January 1,2024 to December 31,2024 in medical intensive care unit(ICU)of a tertiary care hospital requiring either NIV or invasive ventilation.NIV and IMV groups were compared based on average length of ICU and hospital stay,mortality,net cost of ICU treatment,need for intubation and tracheostomy.RESULTS A total of 319 patients were included in the study(197 in NIV,122 in IMV group).Statistically significant difference in length of ICU stay(NIV group:5±3.25 days,IMV group:9±2.6 days;P<0.05)and mortality rate was seen(11%NIV vs 34%IMV;P<0.01).On multivariate analyses,mortality showed a stronger association with IMV[odds ratio(OR)=7.73;95%CI:3.12-19.18]as compared to ICU stay(OR=2.73;95%CI:2.15-3.48).A total of 33 patients(17%)in NIV group required intubation of which 3 were tracheostomized,while 14 patients(11%)in IMV group needed tracheostomy.The net average cost of ICU stay was₹83902 in NIV group while in IMV group,the net ICU cost was₹476216.The average cost of ICU stay was five times higher with IMV.CONCLUSION NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.
文摘BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
基金Supported by Joint Funds for the Innovation of Science and Technology,Fujian Province,No.2023Y9187 and No.2021Y9057.
文摘BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.
基金supported by the Second Tibetan Plateau Scientific Expedition and Research(STEP)Program(Grant No.2019QZKK0502)National Natural Science Foundation of China(Grant No.U23A20160)Shanghai Science and Technology Innovation Action Plan(Grant No.23015810100).
文摘Invasive alien plant species(IAPS)pose severe threats to global biodiversity conservation.Effective management of IAPS requires mapping their distribution and identifying the environmental factors that drive their spread.The Gaoligong Mountains,a renowned biodiversity hotspot in southwestern China,currently face the dual challenges of IAPS invasion and climate change.However,we know little about the distribution patterns,key environmental drivers,and sensitivity of IAPS to future climate change in this region.In this study,we mapped IAPS richness distribution and identified invasion hotspots throughout the Gaoligong Mountains.In addition,we assessed the relative importance of environmental variables in shaping the spatial distribution of IAPS richness and projected potential shifts in IAPS richness under various climate change scenarios.We identified 161 IAPS,primarily concentrated in the low-elevation tropical and subtropical regions along river valleys,forming belt-like invasion hotspots.The key factors shaping IAPS richness included disturbance complexity,elevation,seasonal precipitation,and vegetation types.Notably,IAPS richness significantly declined with increasing elevation and latitude but increased with higher disturbance complexity.Moreover,IAPS were more prevalent in grasslands and shrublands than in forested areas.Ensemble modeling of future climate scenarios predicted that the distribution of IAPS richness would shift to progressively higher elevations.These findings provide valuable insights for managing IAPS in mountainous regions that play a crucial role in global biodiversity conservation.
基金supported by the United States Department of Agriculture National Institute of Food and Agriculture Hatch project 1026333(ILLU-875-984 to K.M.S)a University of Ilinois Graduate College Master's Fellowship(to K.M.S)+2 种基金a University of Illinois Graduate College Travel Award(to K.M.S)Ilinois State Toll Highway Authority funding(to D.E and A.L.C)University of Illinois Laboratory Start-up funds(to E.K.F).
文摘Biological invasions are a major driver of global biodiversity loss,impacting endemic species,ecosystems,and economies.Although the influence of life history traits on invasive success is well-established,the role of behavior in the invasive potential of animals is less studied.The common coqui frog,Eleutherodactylus coqui,is a highly successful invader in Hawai'i.We build on previous research characterizing changes in physiology and morphology to explore behavioral variation across the invasive range of coqui in Hawai'i.Coqui have expanded both outward and upward from their initial introduction site,andby comparing frogs from different densities and elevations-we specifically asked how the physiological challenges of high-elevation living interact with the competitive challenge of high-densities at population centers.To investigate whether differences in the field represent local adaptation or behavioral plasticity,we additionally evaluated behavior following acclimation to a shared laboratory environment.Although we identified only subtle behavioral variation among populations in the field,we found that individuals from all populations became less bold,active,and exploratory in the laboratory,converging on a similar behavioral phenotype.Alongside previous work,our results suggest that coqui adjust their behavior to local environmental conditions across their invasive range and that behavioral flexibility may contribute to invasive success.
文摘Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.
基金approved by the Institutional Ethics Committee of Shizuoka Red Cross Hospital(No.2023-36,approval date:January 12,2024).
文摘BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the minimally invasive(MIS)approach and its effect on these outcomes.AIM To investigate RTW and ROD's timelines and influencing factors following anterior MIS-THA.METHODS A retrospective analysis was conducted on 124 patients who underwent anterior MIS-THA.Data on the demographics,occupational physical demands,and RTW/ROD timelines were also collected.Clinical outcomes were measured using standardised scoring systems.Statistical analyses were performed to evaluate the differences between the groups based on employment status and physical workload.RESULTS Among employed patients,the RTW rate was 94.7%,with an average return time of five weeks.The average ROD time was 3.5 weeks across all patients.Despite similar postoperative clinical scores,RTW time was significantly influenced by occupations'physical workload,with heavier physical demands associated with delayed RTW.CONCLUSION Anterior MIS-THA facilitates early RTW and ROD,particularly in occupations with lower physical demands.These findings highlight the importance of considering occupational and physical workload in postoperative care planning to optimize recovery outcomes.
文摘Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30%-40%.The common complications following esophagectomy are pulmonary infections,cardiac events,anastomotic leakage,bleeding,chylous leak,and recurrent laryngeal nerve palsy which in turn lead to longer hospital stay,increased treatment cost and poor quality of life.A nomographic model comprising preoperative(patient,disease and treatment related)and intraoperative factors in combination with Artificial Intelligence may accurately identify the patients at higher risk of morbidity.This will aid in optimizing the modifiable risk factors preoperatively,and closely monitor these patients post operatively for early identification of complications and to initiate early corrective measures to improve the surgical outcome.
基金funded by the National Natural Science Foundation of China(32072494)the Fundamental Research Program of Shanxi Province,China(202203021212165)the Shanxi Province Higher Education Technology Innovation Project,China(2022L363)。
文摘With the development of international trade and frequent personnel exchanges,biological invasion is showing a rapidly growing trend worldwide.Insects are ectothermic animals,so their geographical distribution is due largely to their high and low temperature tolerances.To study the temperature response mechanisms of Bemisia tabaci Mediterranean cryptic species(MED),miRNA-seq technology was used to unravel the miRNA library of B.tabaci MED in three field populations(TP,HB,and HK)from cities with different environmental temperatures.We identified 12 differentially expressed miRNAs in response to temperature stress,and Bta-miR-998 and Bta-miR-129 were shown to be associated with temperature tolerance.In addition,we predicted and verified the target genes associated with the temperature tolerance imparted by Bta-miR-998 and Bta-miR-129.The results showed that the down-regulated target gene of Bta-miR-129,BtMGAT3,significantly reduced the heat tolerance and another downregulated target gene,BtRGS7,affected the cold tolerance of B.tabaci MED.These results indicate that gene expression regulated by miRNAs is an important temperature response mechanism in B.tabaci MED.This study reveals the important regulatory role of miRNA in insect temperature adaptation and provides a new avenue for studying the regulation of insect gene expression by miRNA.
基金The National Natural Science Foundation of China under contract Nos 32270219 and 31970216.
文摘Biological invasions have become recognized as one of the greatest threats to ecosystems.Codium,a genus of invasive green algae,has frequent global outbreaks and damages local marine ecosystems.It is now generally accepted that light is one of the main factors affecting the luxuriant growth of macroalgae such as Codium.In this study,to investigate the invasive photo-adaptation strategy of Codium fragile,the photo-adaptation characteristics of C.fragile and Codium.cylindricum from the Nan’ao Island of China were compared and explored.The effect of light intensity on the photosynthetic properties of the two species was investigated:the maximum quantum yield of photosystemⅡ(Fv/Fm)of C.fragile was significantly higher at low light intensity.At a light intensity of 90μmol/(m^(2)·s),maximum relative electron transport rate(rETR_(max))of the thalli was maximum,and the minimum saturating irradiance(Ek)was significantly increased.The photosynthetic rate(αvalue)of thalli was highest at a light intensity of 30μmol/(m^(2)·s).The photochemical quenching(qP)was enhanced but non-photochemical quenching(NPQ)was reduced at high light intensities.As for C.cylindricum,the optimal photochemical efficiency of the thalli at low light intensity was higher.High light intensity significantly reduced the rETR of the thalli.At low light intensity,αwas significantly higher,Ek was significantly lower,and NPQ was also significantly decreased.The response relationship between light acclimation and antioxidant capacity of the thalli of two species of Codium was investigated:there was no significant effect of light intensity variation on the total antioxidant capacity of C.fragile.In the case of C.cylindricum,the degree of membrane lipid peroxidation was significantly increased at low light intensity,and its antioxidant capacity was significantly reduced when the light intensity was too high or too low.It can be hypothesized that the self-protection ability of C.fragile may be stronger than that of C.cylindricum under low and high light intensities,which is closely related to the strong invasiveness of C.fragile.
基金the Fundamental Research Funds of CAF(CAFYBB2022SY020)the National Natural Science Foundation of China(31872645).
文摘Invasive alien species(IAS)significantly threaten global biodiversity and ecosystem stability.Despite increasing management efforts,a critical knowledge gap existed in understanding commonalities and disparities among national strategies.We analyzed several IAS management lists from 23 countries and the European Union,focusing specifically on vascular plant species within these lists.List composition,characteristics,and associated management measures were analyzed.Key patterns in species prioritization across national lists and intercontinental exchange of invasive alien plants(IAPs)were identified.Pistia stratiotes,Pontederia crassipes,Salvinia molesta,Cabomba caroliniana,Ulex europaeus were identified as globally recognized threats,being listed by at least 33.3%of analyzed countries and invading five or more continents.Aquatic plants were found to be more frequently included in management lists.A significant directional invasion pattern between the Eastern and Western Hemispheres was identified.Species native to Asia were observed to dominate as significant donors of IAPs across continents.The analysis of list management strategies highlighted substantial gaps in achieving Target 6 of the Kunming-Montreal Global Biodiversity Framework,particularly in species prioritization and inclusion of potential IAPs.In response to these challenges,a tiered classification system for invasive alien species list was proposed,encompassing High-Priority,Watchlist,Potential,and Priority Site categories,which aimed at enhancing management effectiveness by tailoring strategies to different invasion stages and ecological contexts.This study could contribute to understanding global IAPs management strategies and serve as a reference for policymakers and conservation managers to identify priority IAPs and refine management approaches.
基金supported by grants from Singhealth Duke-NUS Academic Medicine Research grant(AM/SU035/2020)NMRC Clinician-Scientist Individual Research Grant New Investigator Grant(CNIG20nov-0003).
文摘Chemical exposure during prenatal development has significant implications for both maternal and child health.Compared to blood,saliva is a non-invasive and less resource-intensive,alternative.Given the temporal variability of xenobiotic metabolites(XM),repeated sampling is essential.Therefore,saliva offers a valuable tool for the longitudinal assessment of prenatal exposomes.Despite its potential,no studies have explored saliva for XM measurement.This study pioneered using saliva to assess XM detectability and investigate the associations between prenatal XM and endogenous metabolomes in pregnant women.Saliva samples were analysed using mass spectrometry from 80 pregnant women at 24–34 weeks gestation.Metabolomes and exposomes were annotated using the Human Metabolome and U.S.Environmental Protection Agency databases.Metabolome-XM associations were clustered using Glay community clustering.Linear regression models,adjusted for age,estimated associations between catecholamines and XMs.XM levels were validated in a cohort of women(n=14)with and without preeclampsia.Our study identified 582 metabolomes and 125 XM in saliva,demonstrating its potential as a matrix for exposure measurement.After false discovery rate correction,18109 significant metabolome-XM associations were identified.Community clustering revealed 37 connected clusters,with the largest cluster(238 nodes)enriched in tyrosine and catecholamine metabolism.Food-contactchemicals and food-additives were significantly associated with higher catecholamine and their metabolite levels.Subgroup analyses revealed higher concentrations of these chemicals in women with preeclampsia compared to healthy controls.This study demonstrates that saliva contains valuable molecular data for measuring exposomes.Food-related chemicals were associated with higher catecholamine levels,which may be relevant to the prevalence of hypertensive crises in pregnancy.
文摘Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.
基金Supported by the Project of the Hospital Management of the General Hospital of Western Theater Command,No.2024-YGLC-A01.
文摘BACKGROUND Minimally invasive pancreaticoduodenectomy(MIPD)is considered one of the most complex procedures in general surgery.The number of articles on MIPD has been increasing annually.However,published reports often have complex research directions,and the focal points frequently change.Therefore,a comprehensive review and organization of the literature in this field is necessary.AIM To summarize current research,predict future hotspots and trends,and provide insights for MIPD development.METHODS To conduct the study,the Web of Science Core Collection was searched for relevant articles.The analysis focused on the top 100 articles in the field.Two widely used bibliometric tools,CiteSpace and VOSviewer,were used to examine various aspects,including research directions,authors,countries,institutions,journals,and keywords.RESULTS The top 100 articles were published between 2005 and 2022,with the majority originating from the United States(n=51).Among the contributing institutions,Pancreas Center of the University of Chicago and the Health System of the University of Chicago had the highest number of publications(n=17).In terms of individual authors,“Zeh HJ”and“Zureikat AH”led with 13 articles each.The high-frequency keywords in the literature encompassed three main areas:Surgical modality,perioperative outcomes,and the learning curve.These keywords were further categorized into seven primary clusters,with the largest being“laparoscopic pancreaticoduodenectomy”.CONCLUSION The most influential studies predominantly originate from the United States,and there is growing interest in robotic surgery.Despite MIPD’s potential benefits,further research is required to address technical challenges and improve outcomes.
文摘Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surgery,studies have demonstrated that minimally invasive surgery(MIS)can provide benefits in CRC emergencies,such as reduced morbidity and a shorter length of hospitalization.However,the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology,resource constraints,and the need for technical expertise.As an alternative to emergency MIS,endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery.This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies,whilst highlighting the challenges to implementation and the strategies to overcome them.
文摘Colorectal cancer(CRC)is one of the most prevalent malignancies in Western countries and is among the leading causes of cancer-related mortality.Despite advancements in primary tumor resection and systemic therapies,a significantproportion of patients develop metastatic disease,with the lungs being a frequent site of dissemination.1 Approximately 10%–25%of CRC patients experience pulmonary metastases,a condition that poses substantial challenges in oncological management.
基金supported by the National Natural Science Foundation of China(Grant No.32101264)the Science and Technology Research and Development Project of Handan(Grant 23422304086)the National College Student Innovation Training Project of China(Grant No.202410103013).
文摘Plant invasion poses a serious environmental challenge to freshwater ecosystems. Heavy metal pollution and nutrient enrichment, particularly nitrogen (N) and phosphorus (P), are two additional critical environmental issues known to influence the growth of invasive plants. Notably, the N/P ratio in the environments is often inconstant;however, whether these variations can cause differential responses in invasive plants remains underexplored, despite its crucial importance for understanding plant invasiveness. In this study, we examined the effects of different N/P ratios (4:1, 16:1, 32:1, 64:1) on the growth of a widespread invasive plant Alternanthera philoxeroides in cadmium (Cd) polluted water, while maintaining either a constant N concentration (2 mmol L^(−1)) or a constant P concentration (0.5 mmol L^(−1)). Two control treatments were also included: one without Cd, N, or P, and another with Cd but without N or P. The addition of N and P did not mitigate the inhibitory effects of Cd on A. philoxeroides growth nor did it enhance its tolerance. However, under conditions of constant N concentration, the N/P ratio of 4:1 significantly increased both the main stem length and the number of nodes in A. philoxeroides under Cd stress, potentially enhancing its expansion and clonal growth. Our results suggest that A. philoxeroides exhibits greater sensitivity to variations in the N/P ratio when N concentration is held constant, compared to when P concentration is constant in Cd polluted water. This study investigated the effects of varying N/P ratios on invasive plants under Cd pollution, which has been underexplored in previous research. The findings provide an experimental basis for controlling and preventing the spread of invasive plants in freshwater systems polluted with Cd and experiencing eutrophication.
基金Supported by Jilin City Science and Technology Innovation Development Plan Project,China,No.20230406201Jilin Province Traditional Chinese Medicine Technology Project,China,No.2024159.
文摘BACKGROUND Breast hamartomas are rare benign breast tumors,with an incidence rate of 0.8%-4.8%.Further,the coexistence of hamartomas and carcinoma is also uncommon.Our case report presents a unique instance where invasive ductal carcinoma(IDC)and ductal carcinoma in situ were found both inside and outside a breast hamartoma.This is the second case reported in the literature.CASE SUMMARY A 51-year-old woman presented with a 6.0 cm breast tumor on mammography and ultrasound,with suspicious areas indicative of malignant transformation.Biopsy of the suspicious area confirmed IDC with intraductal carcinoma.Breast magnetic resonance imaging showed typical hamartoma changes with irregular areas of abnormal enhancement both inside and outside.A breast-conserving surgery was performed,and postoperative pathology confirmed mammary hamartoma,concurrent with IDC and intraductal carcinoma occurring both inside and outside the hamartoma.Subsequently,appropriate adjuvant therapy was initiated.Currently,the patient is in good condition.Breast cancer may be located both inside and outside the ipsilateral mammary hamartoma,which is difficult to detect preoperatively,especially when there is a focus of intraductal carcinoma,requiring accurate assessment of the tumor extent by modern imaging techniques.Early detection of the coexistence of cancer is clinically important as it can alter patient management.CONCLUSION This case emphasizes the importance of modern imaging techniques in accurately evaluating mammary hamartomas associated with malignancies prior to surgery.
