Rapid colonization by invasive plants threatened local biodiversity worldwide;however,their distributional hotspots and future habitat shifts remain poorly understood in developing nations such as Nigeria.Using MaxEnt...Rapid colonization by invasive plants threatened local biodiversity worldwide;however,their distributional hotspots and future habitat shifts remain poorly understood in developing nations such as Nigeria.Using MaxEnt model,we investigated present and future habitat suitability for two aggressive invaders,C.odorata and T.diversifolia,across Nigeria's urban landscapes.We used a dataset consisting of 327 and 108 occurrence points for C.odorata and T.diversifolia,respectively,along with twenty-three(23)environmental variables to identify occurrence and areas of concern under current climatic fluctuations.The results revealed that the model performed strongly(AUC>0.85)and identified precipitation seasonality as the dominant predictor for both species.The finding indicates that precipitation seasonality of≤59 CV,isothermality of≥57%and precipitation of wettest month of≥170 mm enhance niche occupancy of C.odorata,while precipitation seasonality of 62-70 CV,precipitation of wettest quarter and maximum temperature of warmest month of≥450 mm and 35℃,respectively enhance that of T.differsifolia.Current predictions place C.odorata primarily along the southern coast,while T.diversifolia is most suitable in the southwest and extends into the northcentral.Future suitable area for C.odorata will slightly expand by 2050 and 2070,encroaching into southeastern and some central states.In contrast,T.diversifolia contracts under CNRM-CM5 but shows a modest expansion under GFDL-CM3.These projections indicate that climate change may reinforce the dominance of C.odorata in southern Nigeria,whereas T.differsifolia may exhibit divergent trajectories from southern to certain northern states in the future.展开更多
Microrobotic systems are emerging as transformative technology for minimally invasive medicine,driven by innovations in actuation mechanisms,advanced fabrication paradigms,and multifunctional system integration.This c...Microrobotic systems are emerging as transformative technology for minimally invasive medicine,driven by innovations in actuation mechanisms,advanced fabrication paradigms,and multifunctional system integration.This comprehensive review analyzes the evolution of microrobotic technologies through three critical dimensions:(1)actuation modalities,including magnetic,optical,acoustic,chemical,and biological actuation,with a focus on the synergistic advantages of hybrid actuation strategies in complex internal physiological environments;(2)Fabrication methods cover technolo-gies such as photolithography,microinjection molding,self-assembly,and 3D printing,emphasizing innovative strategies involving multi-technology integration and collaborative manufacturing of bio/non-bio hybrid materials;(3)Internal phys-iological applications involve disease diagnosis,targeted drug delivery,minimally invasive surgery,tissue engineering,and cell manipulation,highlighting the broad prospects of microrobots in precision medicine.Despite remarkable progress,critical challenges remain,including low actuation efficiency,as seen in acoustic systems,limited biocompatibility,exem-plified by the toxicity of hydrogen peroxide in chemical actuation,delayed clinical translation,and other related challenges that must be addressed to advance the field.展开更多
While oceanic and coastal acidification has gained increased attention,long-term pH trends and their drivers in large freshwater systems remain poorly understood.The Laurentian Great Lakes are the world’s largest fre...While oceanic and coastal acidification has gained increased attention,long-term pH trends and their drivers in large freshwater systems remain poorly understood.The Laurentian Great Lakes are the world’s largest freshwater system,and in many ways resemble marine ecosystems.However,unlike the open ocean and coastal waters where pH has declined due to rising atmospheric CO_(2),no significant pH trends have been observed in the Laurentian Great Lakes,despite significant ecosystem changes driven partly by the invasion of dreissenid mussels.This study examined 41 years of field observations from Lake Michigan to investigate the long-term carbonate chemistry dynamics.Observational results revealed substantial declines in both total alkalinity(TA)and dissolved inorganic carbon(DIC)over the four decades.Mussel shell calcification emerged as the primary mechanism behind these declines,accounting for 97%and 47%of the observed changes in TA and DIC,respectively,lowering water column pH by 0.24 units.Elevated carbon accumulation in soft mussel tissues,coupled with long-term changes in the air-water pCO_(2)gradient during summer,significantly contributed to long-term DIC variations,explaining 18%and 28%of the lake-wide DIC loss.These two mechanisms also resulted in an overall pH increase of 0.09 and 0.12 units,largely offsetting the calcification-driven pH decrease.These findings bridge a gap in acidification research for large freshwater systems and provide valuable insights for comprehensive lake-wide management strategies.展开更多
Background and AimsInfections are frequent and lethal complications of acute-on-chronic liver failure(ACLF).Reliable biomarkers to distinguish fungal from bacterial infections remain limited.Given the central role of ...Background and AimsInfections are frequent and lethal complications of acute-on-chronic liver failure(ACLF).Reliable biomarkers to distinguish fungal from bacterial infections remain limited.Given the central role of immune dysfunction in ACLF,we aimed to evaluate the diagnostic value of serum cytokines in differentiating invasive pulmonary aspergillosis(IPA)from bacterial pneumonia(BP)in HBV-associated ACLF.MethodsThis retrospective case-control study enrolled ACLF patients admitted to the Tongji Hospital,between 2018 and 2022.Patients were categorized into IPA,BP,and non-infection groups.The BP and non-infection groups were propensity score-matched to the IPA cases.Serum cytokines levels(IL-1β,sIL-2R,IL-6,IL-8,IL-10,TNF-α)and clinical data were collected,with the diagnostic performance of these cytokines as biomarkers assessed via ROC curves.ResultsA total of 32 IPA,96 BP,and 96 non-infection patients were enrolled,with balanced baseline characteristics.Compared with the non-infection group,the IPA group had higher sIL-2R(1,606.00 vs.1,211.50 U/mL,P=0.019)and IL-6(69.03 vs.15.98 pg/mL,P<0.001)levels,but lower IL-8 levels(62.20 vs.132.00 pg/mL,P=0.025).The BP group showed elevated sIL-2R(1,792.00 U/mL),IL-6(49.42 pg/mL),IL-10(13.40 pg/mL)levels compared to the non-infection group(all P<0.001).Also,IL-8 was lower in the IPA group than in the BP group(62.20 vs.176.00 pg/mL,P<0.001)and its assessment could best distinguish IPA from BP(AUC=0.743,cut-off=76.60 pg/mL;sensitivity=66.7%,specificity=82.1%).ConclusionsSerum IL-8 exhibited superior diagnostic value for IPA in patients with HBV-ACLF and could effectively discriminate Aspergillus infections from bacterial infections.展开更多
Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endo...Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endorsement due to insufficient data.This study aimed to compare the perioperative and long-term outcomes of open distal pancreatectomy(ODP)and MIDP for PDAC.Methods:We retrospectively analyzed patients with resectable pancreatic body and tail cancer treated with ODP or MIDP(laparoscopic or robotic)between January 2007 and July 2022.The surgical procedures(ODP and MIDP)were compared and the patient characteristics,perioperative outcomes,and long-term outcomes were analyzed.We also compared the outcomes of patients with neoadjuvant chemotherapy(NAC)and without NAC.Results:A total of 72 distal pancreatectomies were performed(37 ODPs and 35 MIDPs).In the upfront group,MIDP resulted in significantly less blood loss than ODP(P<0.01),despite similar operative time.There was no statistically significant difference in the 2-year recurrence-free survival(RFS)rates between ODP and MIDP(39.7%vs.57.8%,P=0.60)or in the overall survival(OS)rates(66.7%vs.74.1%,P=0.43).Similarly,in the NAC group,MIDP resulted in significantly less blood loss than ODP(P=0.01);ODP and MIDP had similar 2-year RFS rates(41.7%and 60.0%,P=0.75)and OS rates(50.0%and 70.0%,P=0.36).The interval from surgery to adjuvant chemotherapy initiation did not significantly differ between the ODP and MIDP subgroups in both the upfront group(P=0.13)and the NAC group(P=0.14).The incidence of recurrence was 64.8%for ODP and 42.8%for MIDP(P=0.06).Both procedures showed similar distributions of local and distant recurrence.Conclusions:MIDP caused less blood loss and had similar oncologic safety compared with ODP.MIDP could become a feasible,minimally invasive option with sufficient oncologic safety for pancreatic body and tail cancers.展开更多
AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:Thi...AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:This retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress doubleneedle suture technique with intralamellar knot burial via Hoffman pockets.Clinical outcomes assessed included pre-and postoperative best-corrected visual acuity(BCVA),intraocular pressure(IOP),spherical equivalent(SE),suture duration,IOL centration,and perioperative complications.RESULTS:A total of 10 eyes from 10 patients(6 males)were included.The mean age at the time of IOL refixation was 53.10±13.07y(range:28-68y).The mean interval between initial IOL implantation and dislocation was 8.44±3.54y.The mean postoperative follow-up duration was 11.45±10.30mo.Surgical time averaged 15.3±1.77min,with no intraoperative complications.The mean axial length was 27.16±4.35 mm,with high myopia(HM)as the leading comorbidity(4/10 eyes).Postoperative BCVA significantly improved compared to preoperative values(P=0.025).Postoperative SE was significantly improved compared with preoperative(P=0.01).All IOLs remained centered throughout follow-up.CONCLUSION:This minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs.The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration,avoids conjunctival dissection,and could be adopted into routine surgical practice.展开更多
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
Objectives:Cholecystokinin A receptor(CCKAR)has been linked to poor prognosis in colon cancer patients,but the role of CCKAR in colon cancer cell invasiveness and the underlying mechanisms remain elusive.This study ai...Objectives:Cholecystokinin A receptor(CCKAR)has been linked to poor prognosis in colon cancer patients,but the role of CCKAR in colon cancer cell invasiveness and the underlying mechanisms remain elusive.This study aimed to explore the effect of CCKAR on the invasive potential of colon cancer cells.Methods:Different human colon cancer cell lines were used.Gene expression was evaluated by reverse transcription polymerase chain reaction(RT-PCR)and quantitative real-time RT-PCR(qPCR),while protein expression and phosphorylation were assessed by Western blotting.Cell motility and invasiveness were examined through wound healing and invasion assays,respectively.Results:Our results showed that CCKAR expression levels varied across colon cancer cell lines,with DLD-1 and LoVo cells showing high expression.Knockdown of CCKAR significantly impaired the cell motility and invasiveness of DLD-1 and LoVo cells,downregulated integrinβ3 expression,and diminished the phosphorylation levels of focal adhesion kinase(FAK),Src,and paxillin.In addition,CCKAR knockdown modulated epithelialmesenchymal transition(EMT)markers ZO-1,E-cadherin,and vimentin and reduced urokinase-type plasminogen activator(uPA),uPA receptor(uPAR),Rho GTPase cell division control protein 42(CDC42)and RhoA,and matrix metalloproteinase-2(MMP-2).Conclusions:These findings indicate that CCKAR knockdown impairs the invasiveness of colon cancer cells,which may be attributed to modulating integrin/FAK/Rho GTPases,EMT markers,and the uPA/uPAR axis.It suggests that targeting CCKAR may represent a potential therapeutic strategy for colon cancer treatment.展开更多
Alien species from the Asteraceae family frequently invade native plant communities.This study aims to determine how the number of Asteraceae species(i.e.,Erigeron canadensis,E.annuus,and Solidago canadensis)in a co-i...Alien species from the Asteraceae family frequently invade native plant communities.This study aims to determine how the number of Asteraceae species(i.e.,Erigeron canadensis,E.annuus,and Solidago canadensis)in a co-invasion affects plant taxonomic diversity and invasibility in plant communities in China.We found that co-invasions by one or two Asteraceae species decreased plant diversity and increased community invasibility.However,co-invasion by three Asteraceae species increased plant diversity and community invasibility.We also found that plant taxonomic diversity was negatively correlated with total coverage of invasive Asteraceae species.Conversely,community invasibility was positively correlated with total coverage of invasive Asteraceae species.These findings indicate that the number of Asteraceae invasive species positively correlates with total coverage,diversity,dominance,evenness,and invasibility.Our study shows that co-invasion by three IAS may increase plant taxonomic diversity but also community invasibility,which may further facilitate subsequent invasion.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
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
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
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
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
文摘Rapid colonization by invasive plants threatened local biodiversity worldwide;however,their distributional hotspots and future habitat shifts remain poorly understood in developing nations such as Nigeria.Using MaxEnt model,we investigated present and future habitat suitability for two aggressive invaders,C.odorata and T.diversifolia,across Nigeria's urban landscapes.We used a dataset consisting of 327 and 108 occurrence points for C.odorata and T.diversifolia,respectively,along with twenty-three(23)environmental variables to identify occurrence and areas of concern under current climatic fluctuations.The results revealed that the model performed strongly(AUC>0.85)and identified precipitation seasonality as the dominant predictor for both species.The finding indicates that precipitation seasonality of≤59 CV,isothermality of≥57%and precipitation of wettest month of≥170 mm enhance niche occupancy of C.odorata,while precipitation seasonality of 62-70 CV,precipitation of wettest quarter and maximum temperature of warmest month of≥450 mm and 35℃,respectively enhance that of T.differsifolia.Current predictions place C.odorata primarily along the southern coast,while T.diversifolia is most suitable in the southwest and extends into the northcentral.Future suitable area for C.odorata will slightly expand by 2050 and 2070,encroaching into southeastern and some central states.In contrast,T.diversifolia contracts under CNRM-CM5 but shows a modest expansion under GFDL-CM3.These projections indicate that climate change may reinforce the dominance of C.odorata in southern Nigeria,whereas T.differsifolia may exhibit divergent trajectories from southern to certain northern states in the future.
基金National Natural Science Foundation of China(Grant No.61903157)the Foundation of State Key Laboratory of Robotics(Grand No.2024-O08).
文摘Microrobotic systems are emerging as transformative technology for minimally invasive medicine,driven by innovations in actuation mechanisms,advanced fabrication paradigms,and multifunctional system integration.This comprehensive review analyzes the evolution of microrobotic technologies through three critical dimensions:(1)actuation modalities,including magnetic,optical,acoustic,chemical,and biological actuation,with a focus on the synergistic advantages of hybrid actuation strategies in complex internal physiological environments;(2)Fabrication methods cover technolo-gies such as photolithography,microinjection molding,self-assembly,and 3D printing,emphasizing innovative strategies involving multi-technology integration and collaborative manufacturing of bio/non-bio hybrid materials;(3)Internal phys-iological applications involve disease diagnosis,targeted drug delivery,minimally invasive surgery,tissue engineering,and cell manipulation,highlighting the broad prospects of microrobots in precision medicine.Despite remarkable progress,critical challenges remain,including low actuation efficiency,as seen in acoustic systems,limited biocompatibility,exem-plified by the toxicity of hydrogen peroxide in chemical actuation,delayed clinical translation,and other related challenges that must be addressed to advance the field.
基金Supported by the National Natural Science Foundation of China(No.43277051)the Key Laboratory of Integrated Regulation and Resources Development of Shallow Lakes of Ministry of Education(No.B230203006).
文摘While oceanic and coastal acidification has gained increased attention,long-term pH trends and their drivers in large freshwater systems remain poorly understood.The Laurentian Great Lakes are the world’s largest freshwater system,and in many ways resemble marine ecosystems.However,unlike the open ocean and coastal waters where pH has declined due to rising atmospheric CO_(2),no significant pH trends have been observed in the Laurentian Great Lakes,despite significant ecosystem changes driven partly by the invasion of dreissenid mussels.This study examined 41 years of field observations from Lake Michigan to investigate the long-term carbonate chemistry dynamics.Observational results revealed substantial declines in both total alkalinity(TA)and dissolved inorganic carbon(DIC)over the four decades.Mussel shell calcification emerged as the primary mechanism behind these declines,accounting for 97%and 47%of the observed changes in TA and DIC,respectively,lowering water column pH by 0.24 units.Elevated carbon accumulation in soft mussel tissues,coupled with long-term changes in the air-water pCO_(2)gradient during summer,significantly contributed to long-term DIC variations,explaining 18%and 28%of the lake-wide DIC loss.These two mechanisms also resulted in an overall pH increase of 0.09 and 0.12 units,largely offsetting the calcification-driven pH decrease.These findings bridge a gap in acidification research for large freshwater systems and provide valuable insights for comprehensive lake-wide management strategies.
基金supported by the National Key Research and Development Program of China(grant number 2023YFC2308405).
文摘Background and AimsInfections are frequent and lethal complications of acute-on-chronic liver failure(ACLF).Reliable biomarkers to distinguish fungal from bacterial infections remain limited.Given the central role of immune dysfunction in ACLF,we aimed to evaluate the diagnostic value of serum cytokines in differentiating invasive pulmonary aspergillosis(IPA)from bacterial pneumonia(BP)in HBV-associated ACLF.MethodsThis retrospective case-control study enrolled ACLF patients admitted to the Tongji Hospital,between 2018 and 2022.Patients were categorized into IPA,BP,and non-infection groups.The BP and non-infection groups were propensity score-matched to the IPA cases.Serum cytokines levels(IL-1β,sIL-2R,IL-6,IL-8,IL-10,TNF-α)and clinical data were collected,with the diagnostic performance of these cytokines as biomarkers assessed via ROC curves.ResultsA total of 32 IPA,96 BP,and 96 non-infection patients were enrolled,with balanced baseline characteristics.Compared with the non-infection group,the IPA group had higher sIL-2R(1,606.00 vs.1,211.50 U/mL,P=0.019)and IL-6(69.03 vs.15.98 pg/mL,P<0.001)levels,but lower IL-8 levels(62.20 vs.132.00 pg/mL,P=0.025).The BP group showed elevated sIL-2R(1,792.00 U/mL),IL-6(49.42 pg/mL),IL-10(13.40 pg/mL)levels compared to the non-infection group(all P<0.001).Also,IL-8 was lower in the IPA group than in the BP group(62.20 vs.176.00 pg/mL,P<0.001)and its assessment could best distinguish IPA from BP(AUC=0.743,cut-off=76.60 pg/mL;sensitivity=66.7%,specificity=82.1%).ConclusionsSerum IL-8 exhibited superior diagnostic value for IPA in patients with HBV-ACLF and could effectively discriminate Aspergillus infections from bacterial infections.
文摘Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endorsement due to insufficient data.This study aimed to compare the perioperative and long-term outcomes of open distal pancreatectomy(ODP)and MIDP for PDAC.Methods:We retrospectively analyzed patients with resectable pancreatic body and tail cancer treated with ODP or MIDP(laparoscopic or robotic)between January 2007 and July 2022.The surgical procedures(ODP and MIDP)were compared and the patient characteristics,perioperative outcomes,and long-term outcomes were analyzed.We also compared the outcomes of patients with neoadjuvant chemotherapy(NAC)and without NAC.Results:A total of 72 distal pancreatectomies were performed(37 ODPs and 35 MIDPs).In the upfront group,MIDP resulted in significantly less blood loss than ODP(P<0.01),despite similar operative time.There was no statistically significant difference in the 2-year recurrence-free survival(RFS)rates between ODP and MIDP(39.7%vs.57.8%,P=0.60)or in the overall survival(OS)rates(66.7%vs.74.1%,P=0.43).Similarly,in the NAC group,MIDP resulted in significantly less blood loss than ODP(P=0.01);ODP and MIDP had similar 2-year RFS rates(41.7%and 60.0%,P=0.75)and OS rates(50.0%and 70.0%,P=0.36).The interval from surgery to adjuvant chemotherapy initiation did not significantly differ between the ODP and MIDP subgroups in both the upfront group(P=0.13)and the NAC group(P=0.14).The incidence of recurrence was 64.8%for ODP and 42.8%for MIDP(P=0.06).Both procedures showed similar distributions of local and distant recurrence.Conclusions:MIDP caused less blood loss and had similar oncologic safety compared with ODP.MIDP could become a feasible,minimally invasive option with sufficient oncologic safety for pancreatic body and tail cancers.
文摘AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:This retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress doubleneedle suture technique with intralamellar knot burial via Hoffman pockets.Clinical outcomes assessed included pre-and postoperative best-corrected visual acuity(BCVA),intraocular pressure(IOP),spherical equivalent(SE),suture duration,IOL centration,and perioperative complications.RESULTS:A total of 10 eyes from 10 patients(6 males)were included.The mean age at the time of IOL refixation was 53.10±13.07y(range:28-68y).The mean interval between initial IOL implantation and dislocation was 8.44±3.54y.The mean postoperative follow-up duration was 11.45±10.30mo.Surgical time averaged 15.3±1.77min,with no intraoperative complications.The mean axial length was 27.16±4.35 mm,with high myopia(HM)as the leading comorbidity(4/10 eyes).Postoperative BCVA significantly improved compared to preoperative values(P=0.025).Postoperative SE was significantly improved compared with preoperative(P=0.01).All IOLs remained centered throughout follow-up.CONCLUSION:This minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs.The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration,avoids conjunctival dissection,and could be adopted into routine surgical practice.
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.
基金funded by Chung Shan Medical University Hospital(grant number CSH 2023-C-010)Buddhist Tzu Chi Medical Foundation,Dalin Tzu Chi Hospital(grant number DTCRD112(2)-I-24).
文摘Objectives:Cholecystokinin A receptor(CCKAR)has been linked to poor prognosis in colon cancer patients,but the role of CCKAR in colon cancer cell invasiveness and the underlying mechanisms remain elusive.This study aimed to explore the effect of CCKAR on the invasive potential of colon cancer cells.Methods:Different human colon cancer cell lines were used.Gene expression was evaluated by reverse transcription polymerase chain reaction(RT-PCR)and quantitative real-time RT-PCR(qPCR),while protein expression and phosphorylation were assessed by Western blotting.Cell motility and invasiveness were examined through wound healing and invasion assays,respectively.Results:Our results showed that CCKAR expression levels varied across colon cancer cell lines,with DLD-1 and LoVo cells showing high expression.Knockdown of CCKAR significantly impaired the cell motility and invasiveness of DLD-1 and LoVo cells,downregulated integrinβ3 expression,and diminished the phosphorylation levels of focal adhesion kinase(FAK),Src,and paxillin.In addition,CCKAR knockdown modulated epithelialmesenchymal transition(EMT)markers ZO-1,E-cadherin,and vimentin and reduced urokinase-type plasminogen activator(uPA),uPA receptor(uPAR),Rho GTPase cell division control protein 42(CDC42)and RhoA,and matrix metalloproteinase-2(MMP-2).Conclusions:These findings indicate that CCKAR knockdown impairs the invasiveness of colon cancer cells,which may be attributed to modulating integrin/FAK/Rho GTPases,EMT markers,and the uPA/uPAR axis.It suggests that targeting CCKAR may represent a potential therapeutic strategy for colon cancer treatment.
基金funded by the following sources:State Key Research Development Program of China(2024YFF1307500)Open Science Research Fund of Key Laboratory of Ocean Space Resource Management Technology,Marine Academy of Zhejiang Province,China(KF-2024-112)+2 种基金Special Research Project of School of Emergency Management,Jiangsu University(KY-C-01)Jiangsu Collaborative Innovation Center of Technology and Material of Water Treatment(no grant number)Research project on the application of invasive plants in soil ecological restoration in Jiangsu(20240110).
文摘Alien species from the Asteraceae family frequently invade native plant communities.This study aims to determine how the number of Asteraceae species(i.e.,Erigeron canadensis,E.annuus,and Solidago canadensis)in a co-invasion affects plant taxonomic diversity and invasibility in plant communities in China.We found that co-invasions by one or two Asteraceae species decreased plant diversity and increased community invasibility.However,co-invasion by three Asteraceae species increased plant diversity and community invasibility.We also found that plant taxonomic diversity was negatively correlated with total coverage of invasive Asteraceae species.Conversely,community invasibility was positively correlated with total coverage of invasive Asteraceae species.These findings indicate that the number of Asteraceae invasive species positively correlates with total coverage,diversity,dominance,evenness,and invasibility.Our study shows that co-invasion by three IAS may increase plant taxonomic diversity but also community invasibility,which may further facilitate subsequent invasion.
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.
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.
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 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.
