Learning to read is a vital,complex task which can be made easier if we expand the conventional conceptualizations of reading.Many have wisely advised educators about expanding beyond understanding reading primarily a...Learning to read is a vital,complex task which can be made easier if we expand the conventional conceptualizations of reading.Many have wisely advised educators about expanding beyond understanding reading primarily as an act of decoding visual,printed symbols into words,phrases。展开更多
What are the origins,historical development,and lineages of the reincarnation system of Living Buddhas in Tibetan Buddhism?What kind of academic framework is"Han-Tibetan Buddhist Studies"?In an interview wit...What are the origins,historical development,and lineages of the reincarnation system of Living Buddhas in Tibetan Buddhism?What kind of academic framework is"Han-Tibetan Buddhist Studies"?In an interview with this journal,Professor Shen Weirong ofTsinghua University discusses these issues on the basis of his research.展开更多
By leveraging the unique qualities of microorganisms,engineered living materials(ELMs)offer functional and economic advantages in everyday applications along with notable ecological benefits.This study contributes to ...By leveraging the unique qualities of microorganisms,engineered living materials(ELMs)offer functional and economic advantages in everyday applications along with notable ecological benefits.This study contributes to the growing field of biodesign by examining the potential of Flavobacteria for thermochromic ELMs.Many Flavobacteria,commonly found in marine environments,produce iridescent structural colorations as their colonies expand on semi-solid surfaces through gliding motility.In this study,we analyzed the effects of temperature variations on flavobacterium Cellulophaga lytica PLY A 2,characterizing distinct changes in colony growth and iridescent colorations at a macroscopic and microscopic scale.Using scanning electron microscopy,we investigated the relationship between iridescent color and the underlying cell-based optical structures.By providing insights into the temperature-responsive behavior of Flavobacteria,our findings highlight their potential for future thermochromic ELMs-with applications ranging from sustainable food packaging to smart textiles-while encouraging further characterization studies within biodesign research.展开更多
Over the past few years,video live streaming has gained immense popularity as a leading internet application.In current solutions offered by cloud service providers,the Group of Pictures(GOP)length of the video source...Over the past few years,video live streaming has gained immense popularity as a leading internet application.In current solutions offered by cloud service providers,the Group of Pictures(GOP)length of the video source often significantly impacts end-to-end(E2E)latency.However,designing an optimized GOP structure to reduce this effect remains a significant challenge.This paper presents two key contributions.First,it explores how the GOP length at the video source influences E2E latency in mainstream cloud streaming services.Experimental results reveal that the mean E2E latency increases linearly with longer GOP lengths.Second,this paper proposes EGOP(an Enhanced GOP structure)that can be implemented in streaming media servers.Experiments demonstrate that EGOP maintains a consistent E2E latency,unaffected by the GOP length of the video source.Specifically,even with a GOP length of 10 s,the E2E latency remains at 1.35 s,achieving a reduction of 6.98 s compared to Volcano-Engine(the live streaming service provider for TikTok).This makes EGOP a promising solution for low-latency live streaming.展开更多
Three-dimensional supramolecular organic frameworks with precisely tunable pore sizes are highly demanded for a wide range of applications,e.g.,encapsulating enzymes to enhance their stability,activity,and reusability...Three-dimensional supramolecular organic frameworks with precisely tunable pore sizes are highly demanded for a wide range of applications,e.g.,encapsulating enzymes to enhance their stability,activity,and reusability.However,precise control and tune the pore size of such frameworks still remains a significant challenge to date.In this study,we constructed supramolecular polymer frameworks using rigid tetrahedral star polyisocyanides with tunable length and sufficiently narrow distribution as building block.First,a series of tetrahedral four-arm star polyisocyanides with controlled chain lengths and narrow molecular weight distributions was prepared via the Pd(Ⅱ)-catalyzed living isocyanide polymerization.Then 2-ureido-4[1H]-pyrimidinone(Upy) unit was installed onto each chain-end of polyisocyanide arms via post-polymerization functionalization.Leveraging the supramolecular hydrogen bonding interactions between the terminal Upy units,well-ordered supramolecular polymer frameworks were readily obtained.Notably,the pore size was dependent on the chain length of the polyisocyanide arms.Precisely control the chain length of polyisocyanide arms,supramolecular polymer frameworks with pore sizes ranging from 5.06 nm to 9.72 nm were achieved.These frameworks,with tunable and large pore apertures,demonstrated exceptional capabilities in encapsulating enzymes of different sizes,such as lipase(TL),horseradish peroxidase(HRP),and glucose oxidase(GOx).The encapsulated enzymes exhibited significantly enhanced catalytic activity and durability.Moreover,the frameworks' tunable and large pore apertures facilitated the co-encapsulation of multiple enzymes,enabling efficient dual-enzyme cascade reactions.展开更多
Objective:Heart failure(HF)is a complex clinical syndrome that affects nearly 64 million individuals globally.Frequent hospital readmissions lead to poor health outcomes,impact quality of life(QoL),and are associated ...Objective:Heart failure(HF)is a complex clinical syndrome that affects nearly 64 million individuals globally.Frequent hospital readmissions lead to poor health outcomes,impact quality of life(QoL),and are associated with high mortality rates.This study assessed readmissions,mortality,and QoL outcomes in patients with HF in a tertiary care hospital setting.Methods:Patients aged≥18 years with HF,who visited the tertiary care hospital in Karad,India were included in the study(November2019 to October 2021).Demographics,disease characteristics,and condition at discharge were recorded using the medical records of patients.The quantitative data included readmission rates and mortality rates.The qualitative aspects describing patients'QoL were assessed using a patient-reported 21-question QoL questionnaire.Results:A total of 98 patients,predominantly male(63.3%),with a mean age of 62.9 years were included.The majority of the patients(80.6%)required<15 days of hospitalization.The 2-year readmission rate was 24.4%,while the mortality rate was 43.9%.Self-care pattern showed that patients seemed to be taking mild to average care while taking good care was rare.The QoL data showed that 22.4% were living a good quality life,44.9% average,while 32.7% were living a low-quality life.Better education and better self-care were associated with a low rate of readmission.Conclusions:We were able to assess the incidence of readmission,mortality,and QoL in patients with HF in a tertiary care hospital setting.The study showed that HF impacts patients'physical,emotional,and psychological wellbeing.展开更多
Understanding the impacts of human activities on the plateau’s living environment is essential for advancing modernization pathways that promote harmony between humanity and nature.However,studies on the dynamic inte...Understanding the impacts of human activities on the plateau’s living environment is essential for advancing modernization pathways that promote harmony between humanity and nature.However,studies on the dynamic interactions between human activities and the living environment on the Qinghai-Xizang Plateau(QXP)remain limited,with a paucity of quantitative relationship analyses.This study established an assessment framework to evaluate human influences on the living environment in QXP,using data on typical human activities,ecological conditions,and human settlements.Within this framework,the spatial analysis methods and the coupling coordination model were used to examine the spatio-temporal characteristics and relationship of human activities and living environment on the QXP from 2000 to 2020.The geographical detector model was then applied to identify the key factors influencing the plateau’s human living environment.Subsequently,the four-quadrant analysis model was adopted to assess human influences on the living environment.The results indicate that the human activity intensity(HAI)on the QXP remained relatively low yet increased by 15.41%from 2000 to 2020.Spatially,the human living environment quality(LEQ)improved from northwest to southeast,with 61.14%of the areas remaining stable and 18.47%experiencing slight improvement.The analysis of coupling coordination revealed a continuous improvement between the HAI and LEQ,with the areas of high and relatively high coordinated types increasing by more than 9%.Precipitation and urban-rural construction were identified as the primary factors influencing changes in the LEQ.The interaction between the HAI and LEQ was strengthening,with 40.44%classified as coordinated development type and 38.35%as development-environment conflict type.These findings provide valuable insights for enhancing the resilience of human settlements and promoting green development across the plateau.展开更多
BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical perf...BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.展开更多
Editor's Note:As a unique system of succession in Tibetan Buddhism,the reincarnation of Living Buddhas is governed by standardized religious rituals,historical conventions,and established principles.Since the Karm...Editor's Note:As a unique system of succession in Tibetan Buddhism,the reincarnation of Living Buddhas is governed by standardized religious rituals,historical conventions,and established principles.Since the Karma Kagyu sect pioneered the reincarnation system of Living Buddhas in the 13th century,this tradition has continued for more than 700 years.Since the Gelug sect adopted the reincarnation practice in the 16th century,resulting in major lineages such as the Dalai Lama and Panchen Erdeni reincarnations,the system has now held a history of over 400 years.Since the Yuan Dynasty(1271-1368),successive central governments of China have,without exception,strengthened administration over reincarnation matters.In the 57th year of the reign of Emperor Qianlong(1792)of the Qing Dynasty,the Golden Urn Lot-Drawing System was formally established.This system has remained in place up to the present day.Demonstrating national sovereignty,governmental authority,as well as the sacredness and impartiality of Buddhism,it has effectively prevented corruption and malpractice during the reincarnation process.展开更多
Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living...Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants,even in cases of grafts with anatomical variants.We report our recent experience in using RALDN for open kidney transplantation(OKT).Methods:Between August 2021 and July 2025,122 kidney transplant recipients underwent OKT using RALDN grafts obtained at the Miami Transplant Institute.Clinical outcomes,during the first12 months post-transplant,including the incidence of delayed graft function(DGF),surgical complications,estimated glomerular filtrationrate(eGFR),and graft loss,were evaluated.Results:Sixteen pediatric and 106 adult recipients were included.The median recipient and donor ages were 42.2 yr and 39.5 yr,respectively.Male recipients comprised 63.1%(77/122);female donors comprised 56.6%(69/122).Among the donors,no conversion to open surgery was needed,and no postoperative complications attributed to the RALDN procedure were observed.Thirty-one kidney grafts required back table reconstruction.The median cold and warm ischemia times were 55.5 min and 27.0 min,respectively.One case(0.8%)of DGF was observed.One recipient(0.8%)developed a postoperative vascular complication;five(4.1%)developed a urologic complication.The median eGFRs at 1 mo,3 mo,6 mo,and 12 mo post-transplant were 71.9,77.1,75.1,and 72.1 mL/min/1.73 m2,respectively.No cases of graft failure during the first12 months post-transplant were observed,and one patient died with a functioning graft.Conclusion:RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients.This minimally invasive approach should be offered as a safe alternative to living donor patients.展开更多
BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such a...BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such as factor V Leiden(FVL)mutation.CASE SUMMARY A kidney transplant recipient with FVL mutation developed an acute transplant renal artery thrombosis.The immediate post-operative Doppler ultrasonography revealed thrombosis of the main and inferior polar renal arteries.Emergent thrombectomy and separate arterial re-anastomoses were performed after cold perfusion with heparinized saline and vasodilator solution.Reperfusion was successful with immediate urine output and gradual improvement in renal function.The patient was discharged on direct oral anticoagulation therapy.CONCLUSION Early detection and surgical intervention can preserve graft function in posttransplant renal artery thrombosis even in patients at high risk.展开更多
Hebei Province has incorporated targeted assistance services for people with disabilities into livelihood projects,upgrading the quality and efficiency of support services for disadvantaged groups.THE living and nursi...Hebei Province has incorporated targeted assistance services for people with disabilities into livelihood projects,upgrading the quality and efficiency of support services for disadvantaged groups.THE living and nursing allowances provided by the Chinese government for people with disabilities who are unable to work are not only important components of China’s social security system which provide for the needs of its disabled,but also show China’s ability to guarantee the basic living standard and social fairness and justice for this group of people.展开更多
Healthy life expectancy is a pivotal measure of population health by integrating both life expectancy and the quality of years lived.A significant increase in life expectancy was evident in most populations during the...Healthy life expectancy is a pivotal measure of population health by integrating both life expectancy and the quality of years lived.A significant increase in life expectancy was evident in most populations during the past decades worldwide[1],but the growth in healthy life expectancy has generally lagged behind[2].China has made substantial strides in enhancing both life expectancy and healthy life expectancy.展开更多
BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparosc...BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.展开更多
BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular ana...BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.展开更多
April 14-16,Manchester,United KingdomThe Global Age Assurance Standards Summit2026 brings together the international age assurance community for three days of practical insight,shared learning and real-world experienc...April 14-16,Manchester,United KingdomThe Global Age Assurance Standards Summit2026 brings together the international age assurance community for three days of practical insight,shared learning and real-world experience focused on implementing age assurance systems in live environments.展开更多
文摘Learning to read is a vital,complex task which can be made easier if we expand the conventional conceptualizations of reading.Many have wisely advised educators about expanding beyond understanding reading primarily as an act of decoding visual,printed symbols into words,phrases。
文摘What are the origins,historical development,and lineages of the reincarnation system of Living Buddhas in Tibetan Buddhism?What kind of academic framework is"Han-Tibetan Buddhist Studies"?In an interview with this journal,Professor Shen Weirong ofTsinghua University discusses these issues on the basis of his research.
基金partial support from the Living Circular Labels project,funded by the Taskforce for Applied Research SIA’s KIEM programme(No.CIE.06.007)in the Netherlands。
文摘By leveraging the unique qualities of microorganisms,engineered living materials(ELMs)offer functional and economic advantages in everyday applications along with notable ecological benefits.This study contributes to the growing field of biodesign by examining the potential of Flavobacteria for thermochromic ELMs.Many Flavobacteria,commonly found in marine environments,produce iridescent structural colorations as their colonies expand on semi-solid surfaces through gliding motility.In this study,we analyzed the effects of temperature variations on flavobacterium Cellulophaga lytica PLY A 2,characterizing distinct changes in colony growth and iridescent colorations at a macroscopic and microscopic scale.Using scanning electron microscopy,we investigated the relationship between iridescent color and the underlying cell-based optical structures.By providing insights into the temperature-responsive behavior of Flavobacteria,our findings highlight their potential for future thermochromic ELMs-with applications ranging from sustainable food packaging to smart textiles-while encouraging further characterization studies within biodesign research.
基金supported by Henan Province Major Science and Technology Project(241100210100).
文摘Over the past few years,video live streaming has gained immense popularity as a leading internet application.In current solutions offered by cloud service providers,the Group of Pictures(GOP)length of the video source often significantly impacts end-to-end(E2E)latency.However,designing an optimized GOP structure to reduce this effect remains a significant challenge.This paper presents two key contributions.First,it explores how the GOP length at the video source influences E2E latency in mainstream cloud streaming services.Experimental results reveal that the mean E2E latency increases linearly with longer GOP lengths.Second,this paper proposes EGOP(an Enhanced GOP structure)that can be implemented in streaming media servers.Experiments demonstrate that EGOP maintains a consistent E2E latency,unaffected by the GOP length of the video source.Specifically,even with a GOP length of 10 s,the E2E latency remains at 1.35 s,achieving a reduction of 6.98 s compared to Volcano-Engine(the live streaming service provider for TikTok).This makes EGOP a promising solution for low-latency live streaming.
基金The National Natural Science Foundation of China (NSFC,Nos.92256201,52273006,22071041,92356302,and 21971052)Natural Science Foundation of Jilin Province (No.20240101181JC) are gratefully appreciated for financial the supportssupported by the User Experiment Assist System of Shanghai Synchrotron Radiation Facility (SSRF)。
文摘Three-dimensional supramolecular organic frameworks with precisely tunable pore sizes are highly demanded for a wide range of applications,e.g.,encapsulating enzymes to enhance their stability,activity,and reusability.However,precise control and tune the pore size of such frameworks still remains a significant challenge to date.In this study,we constructed supramolecular polymer frameworks using rigid tetrahedral star polyisocyanides with tunable length and sufficiently narrow distribution as building block.First,a series of tetrahedral four-arm star polyisocyanides with controlled chain lengths and narrow molecular weight distributions was prepared via the Pd(Ⅱ)-catalyzed living isocyanide polymerization.Then 2-ureido-4[1H]-pyrimidinone(Upy) unit was installed onto each chain-end of polyisocyanide arms via post-polymerization functionalization.Leveraging the supramolecular hydrogen bonding interactions between the terminal Upy units,well-ordered supramolecular polymer frameworks were readily obtained.Notably,the pore size was dependent on the chain length of the polyisocyanide arms.Precisely control the chain length of polyisocyanide arms,supramolecular polymer frameworks with pore sizes ranging from 5.06 nm to 9.72 nm were achieved.These frameworks,with tunable and large pore apertures,demonstrated exceptional capabilities in encapsulating enzymes of different sizes,such as lipase(TL),horseradish peroxidase(HRP),and glucose oxidase(GOx).The encapsulated enzymes exhibited significantly enhanced catalytic activity and durability.Moreover,the frameworks' tunable and large pore apertures facilitated the co-encapsulation of multiple enzymes,enabling efficient dual-enzyme cascade reactions.
文摘Objective:Heart failure(HF)is a complex clinical syndrome that affects nearly 64 million individuals globally.Frequent hospital readmissions lead to poor health outcomes,impact quality of life(QoL),and are associated with high mortality rates.This study assessed readmissions,mortality,and QoL outcomes in patients with HF in a tertiary care hospital setting.Methods:Patients aged≥18 years with HF,who visited the tertiary care hospital in Karad,India were included in the study(November2019 to October 2021).Demographics,disease characteristics,and condition at discharge were recorded using the medical records of patients.The quantitative data included readmission rates and mortality rates.The qualitative aspects describing patients'QoL were assessed using a patient-reported 21-question QoL questionnaire.Results:A total of 98 patients,predominantly male(63.3%),with a mean age of 62.9 years were included.The majority of the patients(80.6%)required<15 days of hospitalization.The 2-year readmission rate was 24.4%,while the mortality rate was 43.9%.Self-care pattern showed that patients seemed to be taking mild to average care while taking good care was rare.The QoL data showed that 22.4% were living a good quality life,44.9% average,while 32.7% were living a low-quality life.Better education and better self-care were associated with a low rate of readmission.Conclusions:We were able to assess the incidence of readmission,mortality,and QoL in patients with HF in a tertiary care hospital setting.The study showed that HF impacts patients'physical,emotional,and psychological wellbeing.
基金The Second Tibetan Plateau Scientific Expedition and Research Program,No.2019QZKK0608。
文摘Understanding the impacts of human activities on the plateau’s living environment is essential for advancing modernization pathways that promote harmony between humanity and nature.However,studies on the dynamic interactions between human activities and the living environment on the Qinghai-Xizang Plateau(QXP)remain limited,with a paucity of quantitative relationship analyses.This study established an assessment framework to evaluate human influences on the living environment in QXP,using data on typical human activities,ecological conditions,and human settlements.Within this framework,the spatial analysis methods and the coupling coordination model were used to examine the spatio-temporal characteristics and relationship of human activities and living environment on the QXP from 2000 to 2020.The geographical detector model was then applied to identify the key factors influencing the plateau’s human living environment.Subsequently,the four-quadrant analysis model was adopted to assess human influences on the living environment.The results indicate that the human activity intensity(HAI)on the QXP remained relatively low yet increased by 15.41%from 2000 to 2020.Spatially,the human living environment quality(LEQ)improved from northwest to southeast,with 61.14%of the areas remaining stable and 18.47%experiencing slight improvement.The analysis of coupling coordination revealed a continuous improvement between the HAI and LEQ,with the areas of high and relatively high coordinated types increasing by more than 9%.Precipitation and urban-rural construction were identified as the primary factors influencing changes in the LEQ.The interaction between the HAI and LEQ was strengthening,with 40.44%classified as coordinated development type and 38.35%as development-environment conflict type.These findings provide valuable insights for enhancing the resilience of human settlements and promoting green development across the plateau.
文摘BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.
文摘Editor's Note:As a unique system of succession in Tibetan Buddhism,the reincarnation of Living Buddhas is governed by standardized religious rituals,historical conventions,and established principles.Since the Karma Kagyu sect pioneered the reincarnation system of Living Buddhas in the 13th century,this tradition has continued for more than 700 years.Since the Gelug sect adopted the reincarnation practice in the 16th century,resulting in major lineages such as the Dalai Lama and Panchen Erdeni reincarnations,the system has now held a history of over 400 years.Since the Yuan Dynasty(1271-1368),successive central governments of China have,without exception,strengthened administration over reincarnation matters.In the 57th year of the reign of Emperor Qianlong(1792)of the Qing Dynasty,the Golden Urn Lot-Drawing System was formally established.This system has remained in place up to the present day.Demonstrating national sovereignty,governmental authority,as well as the sacredness and impartiality of Buddhism,it has effectively prevented corruption and malpractice during the reincarnation process.
文摘Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants,even in cases of grafts with anatomical variants.We report our recent experience in using RALDN for open kidney transplantation(OKT).Methods:Between August 2021 and July 2025,122 kidney transplant recipients underwent OKT using RALDN grafts obtained at the Miami Transplant Institute.Clinical outcomes,during the first12 months post-transplant,including the incidence of delayed graft function(DGF),surgical complications,estimated glomerular filtrationrate(eGFR),and graft loss,were evaluated.Results:Sixteen pediatric and 106 adult recipients were included.The median recipient and donor ages were 42.2 yr and 39.5 yr,respectively.Male recipients comprised 63.1%(77/122);female donors comprised 56.6%(69/122).Among the donors,no conversion to open surgery was needed,and no postoperative complications attributed to the RALDN procedure were observed.Thirty-one kidney grafts required back table reconstruction.The median cold and warm ischemia times were 55.5 min and 27.0 min,respectively.One case(0.8%)of DGF was observed.One recipient(0.8%)developed a postoperative vascular complication;five(4.1%)developed a urologic complication.The median eGFRs at 1 mo,3 mo,6 mo,and 12 mo post-transplant were 71.9,77.1,75.1,and 72.1 mL/min/1.73 m2,respectively.No cases of graft failure during the first12 months post-transplant were observed,and one patient died with a functioning graft.Conclusion:RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients.This minimally invasive approach should be offered as a safe alternative to living donor patients.
文摘BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such as factor V Leiden(FVL)mutation.CASE SUMMARY A kidney transplant recipient with FVL mutation developed an acute transplant renal artery thrombosis.The immediate post-operative Doppler ultrasonography revealed thrombosis of the main and inferior polar renal arteries.Emergent thrombectomy and separate arterial re-anastomoses were performed after cold perfusion with heparinized saline and vasodilator solution.Reperfusion was successful with immediate urine output and gradual improvement in renal function.The patient was discharged on direct oral anticoagulation therapy.CONCLUSION Early detection and surgical intervention can preserve graft function in posttransplant renal artery thrombosis even in patients at high risk.
文摘Hebei Province has incorporated targeted assistance services for people with disabilities into livelihood projects,upgrading the quality and efficiency of support services for disadvantaged groups.THE living and nursing allowances provided by the Chinese government for people with disabilities who are unable to work are not only important components of China’s social security system which provide for the needs of its disabled,but also show China’s ability to guarantee the basic living standard and social fairness and justice for this group of people.
文摘Healthy life expectancy is a pivotal measure of population health by integrating both life expectancy and the quality of years lived.A significant increase in life expectancy was evident in most populations during the past decades worldwide[1],but the growth in healthy life expectancy has generally lagged behind[2].China has made substantial strides in enhancing both life expectancy and healthy life expectancy.
文摘BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
文摘BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.
文摘April 14-16,Manchester,United KingdomThe Global Age Assurance Standards Summit2026 brings together the international age assurance community for three days of practical insight,shared learning and real-world experience focused on implementing age assurance systems in live environments.
